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The information and links on this page do NOT replace professional medical support. 

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The information and links on this page do NOT replace professional medical support. 

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Always speak to your Midwife, GP or Health visitor if you feel unwell or have any concerns about your baby

For further information and support, please come and join me, like and share my Facebook page! https://www.facebook.com/AnitaIbclcIndependentBreastfeedingSupport/

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19.

You're at higher risk of getting seriously ill from COVID-19 if you're pregnant. If you get COVID-19 late in your pregnancy, your baby could also be at risk.

Evidence shows that most pregnant women with COVID-19 who need hospital treatment or intensive care in the UK have not been vaccinated.

If you're pregnant and have not had your first 2 doses and booster dose yet, it's important to get your vaccinations as soon as possible.

If you're pregnant and have been vaccinated, you should have a seasonal booster dose this autumn.

It's safe to have the vaccine during any stage of pregnancy, from the first few weeks up to your expected due date. You do not need to delay vaccination until after you have given birth.

Getting vaccinated against COVID-19 reduces the risk of having a stillbirth.

There's no evidence COVID-19 vaccination increases the risk of having a miscarriage, pre-term birth or other complications in your pregnancy.

The COVID-19 vaccines do not contain any live viruses and cannot give you or your baby COVID-19.

They have been widely used during pregnancy in other countries and there have been no safety concerns. In the UK, over 100,000 pregnant women have been vaccinated.
Find out how to get a COVID-19 vaccine

You'll be able to discuss having a COVID-19 vaccine during pregnancy at your vaccination appointment.

You can also speak to a GP or your maternity team for advice.

You may find the COVID-19 vaccination in pregnancy decision aid from the Royal College of Obstetricians and Gynaecologists (PDF, 405KB) helpful.

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19. You're at higher risk of getting seriously ill from COVID-19 if you're pregnant.

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https://www.nationalbreastfeedinghelpline.org.uk/

https://www.nct.org.uk/baby-toddler/feeding/early-days/support-breastfeeding-or-bottle-feeding-our-infant-feeding-line

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Support with breastfeeding your premature baby

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Find more information about breastfeeding your premature or sick baby here, including how to get started and how to find support.

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Scroll right to access all topics listed

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It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

The bacterial contamination of powdered infant formula

This report summarises evidence about the known risks associated with potential bacterial contamination of powdered infant formula (PIF). We believe that maintaining the minimum 70 ⁰ C water temperature for making up PIF is essential but also recommend a review of water cooling times and alternative preparation methods. In addition, we recommend an urgent independent review by the Food Standards Agency of risks and/or benefits of the use of probiotics in infant milk products bearing in mind the known risks associated with potential pathogen presence in PIF.

Information and our concerns about formula preparation machines (including the Tommee Tippee Perfect Prep machine) can be found on pages 37-40 of this report.

Latest evidence on formula preparation devices

In October 2023 a paper was published which confirms that, despite their marketing claims, formula preparation devices often do not deliver water hot enough (i.e. at least 70˚C) to kill any bacteria that may be in the powdered infant formula.

The FSA are advising parents/carers to check that the temperature of the water used to prepare infant formula is at least 70˚C "regardless of the method used", and that if that is not the case for those using an infant formula preparation machine, that they should contact the manufacturer and their local Trading Standards Department or Citizens Advice.

The UK's product safety regulator, the Office for Product Safety and Standards has purchased examples of the infant formula preparation machines to assess compliance and have said that, if necessary, UK consumers will be informed of any actions they might need to take.

The safest way to prepare infant formula is using a kettle, following NHS guidance

If you use a formula preparation machine, we suggest: Check the temperature of the water dispensed using a food thermometer. Always do this separately to making a bottle as the thermometer can contaminate the water. If the temperature if below 70 degrees: - Use a kettle instead to make up bottles following NHS guidance - Report to your manufacturer. Scan QR code for NHS advice: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula

Guide to bottle feeding:
How to prepare infant formula and sterilise bottles

Guide to Bottle Feeding by UNICEF Baby Friendly, Better Health Start for Life and the NHS provides information on safe preparation and storage of infant milks.

It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

Making up bottles of infant formula from hot taps and baby kettles

More kitchens are now fitted with hot water taps dispensing boiling water directly. This statement provides some information to support families making up formula this way to do so safely.

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Making infant milk safely - First Steps Nutrition Trust

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It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

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From LLL

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SAFE SLEEP FOR BREASTFEEDING BABIES

Mothers and babies sleeping together is a normal, healthy, shared instinct as old as humankind. But certain situations can make this normal behavior unsafe. Let's see what it takes to avoid those situations so you can enjoy being with your baby awake or asleep.

The two big safety concerns with shared sleep are suffocation and Sudden Infant Death Syndrome (also called SIDS, Crib Death, or Cot Death). They are not the same thing, their causes are different, and that's important to know when you're setting up a sensible sleeping arrangement. SIDS is an unexpected infant death under a year of age that can't be explained any other way. The biggest risk factors can be avoided. Suffocation is death from a lack of oxygen, from a blocked nose and mouth or becoming tightly wedged, or choking. Protecting your baby from suffocation just means preventing problem situations - usually simple and straightforward to accomplish.

THE SAFE SLEEP 7

The authors of LLLI's book, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, have boiled safe infant sleep down to these 7 items.

If you are

1. a non-smoking mother who is

2. not taking drugs or medications that interfere with normal awareness, and is

3. breastfeeding - that is, your breast is your baby's food and comfort spot, day and night -

And if your baby is

1. healthy - full term with no major health issues,

2. on his or her back when not nursing,

3. not swaddled or overheated,

And if you are both

on a safe surface

then you have eliminated all the major SIDS risks, and have hugely reduced or eliminated suffocation risks.

Here's a closer look at the Safe Sleep 7:

1) Exposure to smoking is by far the biggest risk factor for SIDS. Smoking during pregnancy means a baby's SIDS risk is higher right from birth. Exposure to smoke after birth - even if the smoker doesn't smoke in the house and sleeps away from the baby - is also a big risk. The greater the exposure, the greater the risk, but even being in a smoky room raises an infant's risk of SIDS.

2) Being out of the care of a responsible adult is another major risk factor for SIDS. Having your baby sleep in a separate room - even a lovingly prepared nursery, even with a monitor - increases the risks of SIDS and suffocation. Alcohol, sleep aids, and any other drugs or medicines that make you less alert, increase your baby's risk. To be truly safe, a baby needs to be within sight and touch of a responsible adult.

3) Formula-feeding doubles the risk of SIDS. It's thought that the less the formula, the lower the risk. Bottle-feeding itself is a risk factor for suffocation. The mother who feeds her baby at breast automatically puts her baby near her breast for sleep and curls her body around the baby in what's sometimes called a "cuddle curl". Her arm above the baby's head keeps the baby from scooching up into the pillows. Her thigh below the baby's feet keeps the baby from scooching down. And the baby has a strong urge to stay near her breast - the ultimate source of food and comfort. It's not possible for the mother or anyone else to roll onto a baby in that protected cove. But it doesn't work the same for bottle-feeding mothers and babies. If a baby doesn't seek the mother's breast, or if a mother puts her baby near her face instead of in that protected space, the baby is at risk for moving away from the mother and pushing into soft pillows and bedding.

4) Premature babies, seriously ill babies, and babies with chronic health issues have a higher risk of SIDS and possibly of suffocation. They may be challenged by the same conditions that are desirable for full-term, healthy babies.

5) A major risk for SIDS is leaving a baby alone on his or her tummy for sleep. Breastfeeding mothers and babies have that one covered. Mothers and babies typically lie on their sides to nurse in bed. When they finish nursing they typically roll onto their backs (the mother returns to her cuddle curl position when she shifts onto her side again). So no need to worry about your baby's position if you fall asleep nursing.

6) Overheating is a risk factor for SIDS. No need to dress your baby any more heavily than you dress yourself. And swaddling isn't safe bedsharing; babies need their arms and legs free, to bat the covers away, nurse, and shift into better positions.

7) Making a safe surface is mostly just common sense. Make sure your mattress is firm enough that your baby doesn't roll into the trough your body makes and get stuck there. If your bed is close to a wall, you can move the bed farther away or put yourself between the baby and the gap so your baby can't become wedged. Is there a gap between mattress and rail? You can stuff this space tightly with a rolled towel or small rolled blanket. Make sure there are no cords or sharp corners. Your own light bedding and pillow are fine; avoid heavy quilts and comforters. Stuffed animals, bolsters, infant "sleep positioners", and extra pillows should be removed. Some mothers make a soft "landing pad" next to the bed in case of falls. Some just put their mattress directly on the floor for a while, or make up a blanket-bed on the floor while they think about a more permanent arrangement. If you have a bed partner, sleep between the baby and your partner for now, until you're sure of everyone's nighttime behaviors.

Couches and recliners have too many cracks, corners, crevices, and cushions to be safe places for sharing sleep, or even for really drowsy nursing. That's why planning ahead for a safe place to sleep with your baby is important, even if you don't plan to use it.

A sidecar or bedside bassinet/cot can be a good compromise because you can scoot your baby in and out of your bed. But make your bed safe anyway, for those times when you fall asleep before moving the baby. Think of it as your very first form of child-proofing.

WHAT DOES YOUR BABY GAIN FROM BEDSHARING?

Longer breastfeeding. Research and major health organizations recommend at least a year of breastfeeding, preferably two or more. Babies who sleep alone are more likely to wean before their mothers wanted them to.

More food, at healthy intervals. Babies who sleep alone tend to nurse less often and take in less food. Despite what some books still say, babies are built for frequent snacks, not widely-spaced feasts.

Normal infant sleep patterns. Long, deep sleep isn't healthy for young babies. A breastfeeding, bedsharing mother rouses slightly many times in the night without realizing it, to kiss or stroke her baby or to adjust the baby's position or covers. All those little stimulations are important for normal, healthy infant sleep.

Gentle and automatic guidance into more mature sleep patterns. No need to fight with each other over it.

WHAT DO YOU GAIN FROM BEDSHARING?

More sleep! Research shows that bedsharing, breastfeeding mothers get the most sleep of all new mothers. Mothers who sleep away from their babies rouse less often but more completely and actually get less sleep overall.

Less stress. Your baby's rhythms and your own rhythms actually synchronize, so that your baby tends to waken gently when you do, and you tend to waken gently when your baby does. No wailing from another room that jolts you awake unexpectedly. As one mother said before she started bedsharing, "At night I felt like he was the enemy."

Easier nursing. Once they get the hang of it, most bedsharing mothers just roll onto their side to nurse. How often does their baby nurse at night? Their answer might be, "I'm not sure."

Not everyone's situation matches the Safe Sleep 7. What if your baby is wholly or partly formula-fed? Or your partner smokes? Or you feel your bed is too soft? Or your baby is ill? Parenting is never one-size-fits-all, and that's where responsible, informed decision-making comes in. You'll find more information in the resources at the bottom, to help you find an arrangement that you're comfortable with.

MOST IMPORTANT OF ALL

No matter what your situation is, or what nighttime arrangements you plan, be sure to set up a place where you can fall asleep together as safely as possible. Even if you have no plans to bedshare, on a night when you just can't stay awake, you won't fall asleep with your baby on the sofa. You'll have a much, much safer place to go.

FOR MORE INFORMATION

La Leche League International's Sweet Sleep, Nighttime and Naptime Strategies for the Breastfeeding Family covers everything from infant sleep study results to how to wriggle away from the toddler you just nursed to sleep. And there are pages that you can tear out to share with healthcare and daycare providers.

In addition to Sweet Sleep and the Safe Sleep 7, there are some excellent online resources.

The Academy of Breastfeeding Medicine's protocol on bedsharing https://www.bfmed.org/assets/Protocol%20Number%206%202019%20Revision.pdf is an excellent resource for your baby's healthcare provider, and reassuring reading for you. There are also visuals from several of the Academy's bedsharing conference presentations https://www.bfmed.org/bedsharing-and-breastfeeding-resources.

BASIS (Baby Sleep Information Source) https://www.basisonline.org.uk/ has great research-based information on the biology of normal infant sleep, with practical information to help you make decisions that fit your family.

Dr James McKenna's Mother-Baby Behavioral Sleep Lab https://cosleeping.nd.edu/ website presents the Lab's research on how mothers and babies normally interact at night, with guidelines for families and information for healthcare providers.

Each resource has its own style and purpose, and all of them have years of solid research behind them. Find the parts that work for you... and sleep sweet!

Image by Rob Mank, courtesy of Baby Sleep Information Source, with thanks

Sweet Sleep
Safe Sleep and Breastfeeding Babies
Sleep Training... or not
Sleep: Talking With Your Doctor About Bedsharing Suggestions
Sleep: Safe Surface Checklist
ORDER YOUR COPY OF SWEET SLEEP TODAY, NORTH AMERICAN EDITION ORDER YOUR COPY OF SWEET SLEEP TODAY, BRITISH EDITION ORDER YOUR COPY TODAY, ITALIAN EDITION PUOI ORDINARE LA TUA COPIA DELLA EDIZIONE ITALIANA QUI

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Sleep: Bedshare | La Leche League International

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SAFE SLEEP FOR BREASTFEEDING BABIES Mothers and babies sleeping together is a normal, healthy, shared instinct as old as humankind. But certain situations can make this normal behavior unsafe. Let's see what it takes to avoid those situations so you can enjoy being with your baby awake or asleep.

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Lots of information to help you on your parenting journey

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Lots of information to help you on your parenting journey

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https://what0-18.nhs.uk/

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Feeling your baby moves means they are well.  A great website with useful information.

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Your Baby's Movements Matter. Kicks Count is the UK's leading baby movement campaign, keeping mums and babies safe.

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Kicks Count is the UK's leading baby movement resource and awareness campaign. By empowering pregnant women with knowledge and confidence, babies' lives can be saved.

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Meeting baby for the first time video - Baby Friendly Initiative

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Baby Friendly’s video on skin-to-skin contact and how it can help mothers and babies get their relationship off to the best start.

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immediately after your baby is born

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Healthy Children Project
159 Long Pond Drive
Harwich, MA 02645
Ph: 508.888.8044
Fax: 508.888.8050

The First Hour After Birth: A Baby's 9 Instinctive Stages

The first hours after birth are a developmentally distinct time for a baby and there are well documented short and long term physical and psychological advantages when a baby is held skin to skin during this time.

When a baby is in skin to skin contact after birth there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of these stages, there are a variety of actions the baby may demonstrate.

Stage 1: The Birth Cry
The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby's lungs expand.

Stage 2: Relaxation
The second stage is the relaxation stage. During the relaxation stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped. The baby is skin to skin with the mother and covered with a warm, dry towel or blanket.
Stage 3: Awakening The third stage is the awakening stage. During this stage the newborn exhibits small thrusts of movement in the head and shoulders. This stage usually begins about 3 minutes after birth. The newborn in the awakening stage may exhibit head movements, open his eyes, show some mouth activity and might move his shoulders.

Stage 4: Activity
The fourth stage is the activity stage. During this stage, the newborn begins to make increased mouthing and sucking movements as the rooting reflex becomes more obvious. This stage usually begins about 8 minutes after birth.

Stage 5: Rest
At any point, the baby may rest. The baby may have periods of resting between periods of activity throughout the first hour or so after birth.

Stage 6: Crawling
The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 minutes after birth.

Stage 7: Familiarization
The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the mother by licking the nipple and touching and massaging her breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more.

Stage 8: Suckling
The eighth stage is suckling. During this stage, the newborn takes the nipple, self attaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. If the mother has had analgesia/anesthesia during labor, it may take more time with skin to skin for the baby to complete the stages and begin suckling.

Stage 9: Sleep
The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1½ to 2 hours after birth.

Benefits for Babies:
Regardless of how you are feeding your baby, your baby can benefit from skin to skin contact.

Babies are warmer.

Babies are calmer.

Babies can hear their mother's heartbeat.

Heart and breathing rates are normalized.

Milk supply may be improved.

Other family members can hold and bond with babies through skin to skin holding too!

What To Do in the First Hour with Mother

You and your baby are covered with a blanket. The baby's head stays out. The baby is naked and not wrapped. You and your baby will rest skin to skin for an hour or two after birth. This is a special time for you and your baby. Necessary procedures and checks are done with the mother and baby skin to skin.

If there are medical reasons that keep you and your baby from skin to skin holding right after birth, start as soon as possible.

If you are on medications or anything that might impair your strength or ability to stay awake when holding the baby, be sure someone else can help you care for the baby and hold the baby skin to skin.

Kajsa Brimdyr, PhD, CLC
Healthy Children Project
159 Long Pond Drive
Harwich, MA 02645, (508) 888 8044

© Health Education Associates, Inc. Based on the research of Widström, et al.

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When a baby is in skin to skin contact after birth there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of these stages, there are a variety of actions the baby may demonstrate.

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Courtesy of the Hillingdon Hospital NHS Foundation Trust

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In this section you can find out about the experience of breastfeeding by seeing and hearing people share their personal stories on film. travelled all around the UK to talk to 56 women and 2 men in their own homes. Seven new interviews were added in 2015. Find out what people said about issues such as sore nipples, feeding patterns, dealing with difficult times and introducing solid foods. We hope you find the information helpful and reassuring.

You may also be interested in our other pregnancy sections.

Centre for Qualitative Research, Bournemouth University

Institute of Health & Community Studies, Bournemouth UniversityPublication date: May 2007
WOMen, Babies & their families (WOMB) Programmatic Research Group

Last updated: November 2018.
Review date: November 2020.

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In this section you can find out about the experience of breastfeeding by seeing and hearing people share their personal stories on film. travelled all around the UK to talk to 56 women and 2 men in their own homes. Seven new interviews were added in 2015.

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Why you might want to put the baby books down!

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Why you might want to put the baby books down!

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College of Human and Health Sciences, Swansea University

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Why you might want to put the baby books down...

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http://www.nationalbreastfeedinghelpline.org.uk/

https://abm.me.uk/

National Childbirth Trust Feeding Helpline: 0300 330 0700
Option 1 then Option 1: Every day, 8am to Midnight, including bank holidays

https://www.laleche.org.uk/get-support/

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From UNICEF BFI

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Taking a while to get breastfeeding going? If you need to or want to cup feed your baby, please ensure a trained healthcare professional or Lactation Consultant shows you how to do this safely.

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TAMBA Twins and Multiple Babies Association

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TAMBA Twins and Multiple Babies Association

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Feeding mulitples

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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NHS Dorset Antenatal infant Online Feeding Course

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NHS Dorset Antenatal infant Online Feeding Course

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www.dorsethealthcare.nhs.uk/breastfeedingcourse

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For information and guidance across Dorset during pregnancy and beyond.

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If you've recently found out you're pregnant, let us know - we want to make sure you're getting the right care EARLY PREGNANCY 0-12 weeks TELL ME MORE MID PREGNANCY 13-27 weeks TELL ME MORE LATE PREGNANCY 28 weeks onward

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College of Human and Health Sciences, Swansea University

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Information on medication in breastmilk:
https://www.breastfeedingnetwork.org.uk/drugs-factsheets/
or
https://www.facebook.com/BfNDrugsinBreastmilkinformation/

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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Safety information from The Lullaby Trust

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The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families

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This information can also be viewed as a PDF by clicking here.
Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in the sofa/chair. If you do binge drink, your baby should be cared for by an adult who has not had any alcohol. It is not necessary to express breastmilk to clear it of alcohol.

Never share a bed or sofa with your baby if you have drunk any alcohol. Doing this has an increased association with sudden infant death syndrome (SIDS).

Alcohol passes freely into breastmilk reaching approximately maternal levels BUT maternal blood levels have to reach 300mg/100ml before mild sedation is reached in the baby (this compares with a level of 80mg/100ml needed to fail the police breath test in England, Wales and N. Ireland; 50mg/100ml Scotland.

To reduce exposure of the baby to alcohol, avoid breastfeeding for 2-3 hours after drinking.

Peak levels in the milk appear after 30-90 minutes but this does not mean that social drinking of small amounts of alcohol mean that you cannot breastfeed.

Excess levels of alcohol in milk may lead to drowsiness, deep sleep, weakness and decreased growth in the infant. Reduction of let-down is reported when the mother drinks heavily. Alcohol may reduce the baby's sucking time at the breast but not the volume of milk consumed.

It is not necessary to express breastmilk to clear it of alcohol; as the mother's blood levels fall, the level of alcohol in the breastmilk will decrease.

Binge drinking (more than 6 units of alcohol in one period), may make you less aware of your baby's needs. If you have drunk enough alcohol to make you feel disorientated or cause vomiting you should not be caring for your baby without supervision from a sober adult. You should ideally express for comfort and to maintain your supply - although this may be the last thing on your mind!

Chronic consumption of alcohol is more likely to cause harm than occasional social drinking.

NB It is vital that mothers who have been drinking alcohol should never let themselves be in a situation where they might fall asleep with the baby; on a bed, chair or settee (this would also apply to other carers who have been drinking alcohol). The place of sleep is a bigger risk than the fact that the mother has been drinking unless her consumption has been very high.

Drinking alcohol reduces the ability of the mother to be aware of her baby's needs, whether she is breastfeeding or not. It is safest to ask someone else to care for the baby.

Other websites

NHS Breastfeeding and drinking alcohol. - Your pregnancy and baby guide www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-alcohol/

Guidelines from the NHS

Anything you eat or drink while you're breastfeeding can find its way into your breast milk, and that includes alcohol.

If you regularly drink as much as 14 units per week, it's best to spread your drinking evenly over 3 or more days.

If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

Fourteen units is equivalent to: 6 pints of average-strength beer, 10 small glasses of low-strength wine

Use Alcohol Change's alcohol calculator to check your units: https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network March 2021

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Alcohol and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in [...]

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Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

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How to know feeding is going well

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The first week with a newborn can be a wonderful and exciting time, but adjusting to a new life can also be overwhelming, especially when parents aren't sure what to expect. In this guest blog, lactation consultant Emma Pickett explores what's "normal" in the first few days, and encourages mums to trust their baby and their own instincts of love, affection and responsive feeding.
I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused. The first voice we hear might sometimes be the partner's and a mum is too upset to even come to the phone.

Hundreds of these calls end with a contented calm voice saying, "Thank you. It's such a relief to know that's normal. I feel so much better now". As it happened, breastfeeding was actually going OK; what was interpreted as a breastfeeding 'problem' was actually a new baby's normal and natural response to their new environment. The family just didn't know how babies were 'supposed to behave'.

If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film - but instead of the ability to pilot helicopters or practise high level martial arts, you'd know about cluster feeding and a newborn's desire for closeness, nappies and normal fussiness. The National Breastfeeding Helpline would be quieter overnight but we'd all feel a lot more relaxed and able to enjoy these teeny new people in our lives.

But actually ... you've already had that download. You just may not have realised it. It's deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day three, or how to correct a baby's latch without help, but there's so much you do know. You may not have grown up surrounded by breastfeeding, and for some aspects you will need support and information, but there's a ton you do know about your baby: things that just feel right and things that don't. And your baby had the download too. Sometimes it gets fuzzied with a birth that didn't go to plan but their instincts are in there too.

Two things that are normal:

1.Babies want to be close to you.

Imagine a news story about a baby gorilla just born in London zoo: "ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health" but days later it's reported that staff are concerned. Fumbi's mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She's losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn't feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin- (the hormone that promotes feelings of love) induced bonding that helps the formation of their early relationship. Fumbi is at risk.

Oh dear. Something seems to have happened to Fumbi's mother. We'd be worried.

However, this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We're designed to be close to our babies. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains, and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us 'carry mammals'.

But instead we get the message that babies can be 'spoilt'. We are supposed to encourage them to be independent and sleep apart from us. If we can't put them down, if they want to sleep touching us, if we hold them when they sleep - we've apparently failed some test. Though it's not quite clear who the examiner is.

There are popular books that even use terms like 'accidental parenting' just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of 'advice' has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby's sleep by the clock and leave a baby only a few weeks old to cry if necessary.
What does your baby want?
They don't want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don't want to waste energy keeping warm and crying when they don't need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.

"My baby won't go down in its Moses basket". Yes, it's frustrating when you thought that was what they were 'supposed to do'. But would it feel easier if you knew that wasn't likely to be their first choice and there are good biological and evolutionary reasons for that?

"But I'm not going to get any sleep". According to the Baby Sleep Information Source, "70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart." Research shows that these mums breastfeeding through the night (and mostly bed sharing) will also be getting better quality sleep and be more rested than other parents. Good sleep is possible if we stop battling nature.

The book "Sweet Sleep: night time and naptime strategies for the breastfeeding family" is a great place to start. It talks to you about creating a safe space where everyone gets a better night's sleep.

A lot of your baby's urges are eminently sensible. If they don't want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.

Don't expect to be up and making a moussaka on day five. The feeling that you 'shouldn't' be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren't supposed to change. Our commitment to work isn't supposed to change. Our ability to engage with political life and housework and social media isn't supposed to change. Actually, throughout much of human history, mum isn't going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn't have to be moussaka), sleeping and being with our new baby.

2.They come to the breast for lots of different reasons and they usually have a good reason for doing so.

Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'. I have written elsewhere on the dangerous obsession of the infant feeding interval. It's dangerous for both babies and mothers. But we need to remember breastfeeding isn't just about feeding and it never has been.

Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin (which is the key hormone in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing levels of the stress hormone, cortisol. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotionally secure, growing brain connections and trying to get to sleep (which is one of the purposes of breastfeeding.)

To think breastfeeding is just about food and calories (and "quick, measure the gap between breastfeeds!") is to do nature a huge disservice. Measuring all the different reasons a baby comes to the breast is like trying to measure fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack or has a meal? You wouldn't find an app for that.

Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby's needs in the way they are asking you to. Don't try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are a routine person and you are struggling with a feeling of 'losing control', give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you'll have some options. Try and 'control' too early and you'll find things go out of your influence in ways you can't come back from easily.

Get help if things feel wrong - if breastfeeding hurts, if you're not sure about weight gain or nappies, if you can't work out how to meet your own needs for food and sleep. There are lots of people who will help out and we're at the end of a phone or a Twitter account or Facebook page. But don't confuse your baby behaving unexpectedly for something going 'wrong'. Maybe no one told you what normal would be.
If we let normal happen it will make all of our lives easier in the long term. You're creating a little person who enters this world with their needs being met.
This blog was originally featured on the Growing Families conference website.

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Guest blog: "Is this normal?" The first week with a breastfeeding newborn - Baby Friendly Initiative

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In this guest blog, lactation consultant Emma Pickett explores what's "normal" in the first week with a newborn, and encourages mums to trust their baby and their own instincts.

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Evidence Based information on how infants sleep and why

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Evidence Based information on how infants sleep and why

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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Yes, there is another trimester! 😊

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"He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on her play mat" "He hates going in his pram, he cries the second we put him in it".
If I had a pound every time I heard these from a new parent I'd be a very rich lady by now! What amazes me though is that society in general doesn't get it, they don't get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! We spend more than time though, the 'putting babies down' industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on..................having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn't enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn't consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak.
"Empathy: the intellectual identification with thoughts, or attitudes of another." or vicarious experiencing of the feelings, "Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to "behave." If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he's labeled an "easy baby"; if he does not adapt readily, he is labeled "difficult."" - Dr. William Sears.
To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world - but which world? The world they have spent most of their life in, their 'womb world' or the world they are in now - our world. To fully understand we must appreciate the enormous transition they have made - a concept known to many as 'The Fourth Trimester' -some make the womb to world transition easily, others less so and it is this latter group in particular "the clingy babies" we can learn so much from through this concept.

So lets quickly compare the two different 'worlds' your baby has lived in:

Pretty different huh? On top of this the big thing to understand is that in utero the baby's world was constant, each day was the same, the stimulation didn't change, but now they are born each day is different - ever changing, ever stimulating!

The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help - but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally.
Movement
Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don't already know, you will soon learn what your baby likes best and that's what matters, that it is unique to *your* baby. Prescriptive 'do this/don't do this' baby calming lists don't help anybody - because they forget they are dealing with individuals - both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won't work, some you won't like - and that's OK! because really it isn't about these tips it's about you and your baby getting to know each other!
Skin to Skin Contact
The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride.
Bed-Sharing
Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin - the love and bonding hormone - in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you.

Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it's a subject that makes society very uncomfortable, but...it is an *amazing* baby calmer! It's really important that you think about how bedsharing will work and follow some important safety guidelines HERE.
Swaddling
For more on bedsharing and other ways to improve your newborn's sleep, watch my free webinar here:

Imagine how snug your baby was at the very end of your pregnancy inside of you - now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don't want to or indeed can't then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby's hunger cues if you are feeding on demand:
** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Babywearing

Never swaddle over your baby's head or near his face

Never swaddle your baby if he is ill or has a fever

Make sure your baby does not overheat and only swaddle with a breathable/thin fabric

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

Do not swaddle tightly around your baby's hips and legs, his legs should be free to "froggy up" into a typical newborn position.

Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before.

Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of "quiet alertness" - a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us - yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands!

Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby's spine whilst not placing any pressure on your baby's growing hips - newborns should always be carried facing inwards with a "frog leg" pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an 'in arms' position - i.e: how your baby would be held if you were holding them!

Babywearing is a great way for dads to bond with babies!
Position
It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling - it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up:

The "tiger in the tree" position below, taken from baby yoga, is often magical, stopping a crying baby in an instant!
Feed
Noise
Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A special white noise recording, such as , can be played on loop whilst your baby sleeps to help keep them calm.
Deep Bathing
If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine - whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby's skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier.
Outside
The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby's tears in seconds - even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer.
What have you found calms your newborn? The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.
If all else fails many babies stop crying the minute they hit the open air - I'm not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air - but it works!

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"My baby is only happy in my arms, the minute I put her down she cries" "He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on ...

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How to breastfeed

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College of Human and Health Sciences, Swansea University

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https://what0-18.nhs.uk/

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Find one that works for you and your baby

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The way you hold your baby or position them will affect how easy it is for them to breastfeed effectively. You can breastfeed your baby in many different positions, so it's good to try different ones. This helps you find what's most comfortable for you and allows your baby to get just the right mouthful of breast to feed effectively and easily.

Breastfeeding positions for newborns

When you first start breastfeeding, you and your baby may take a while to master this new skill. Patience and trying different positions will help you find a position that works for you both.
Our video has some great tips on different ways to hold your baby.
If you're having problems breastfeeding, or with latching or attachment, do call our infant feeding support line on 0300 330 0700 to talk to a breastfeeding counsellor. Your midwife or health visitor may know about local breastfeeding support groups.

Getting some support with breastfeeding can help you to get comfortable in one or more of the breastfeeding positions that we describe in this article.

Here's how to get started...

Preparing to feed

Your baby will be happier and will latch more easily if you can identify and respond to their early feeding cues. If they are crying or upset, they need to be calmed before they are ready to feed.

Holding them against you, talking to them, walking around or gently rocking might help if they need to be calmed. Most babies like to have their hands free to touch and stroke your breast; this helps to reassure them that they are in the right place.

Read more about getting started with breastfeeding in our article here.

Laid-back position

Sitting upright

Lying down

Underarm or rugby ball

Holding your baby under your arm may be suggested to women who have given birth by caesarean, to avoid pressure on the wound. This position might also be suggested to mothers of twins. However, it can be difficult to maintain this position as the baby's weight is being taken by the mother's hand. Babies soon outgrow this position, and it doesn't allow them to use their instincts and reflexes to attach on to the breast (NHS, 2020; La Leche League, 2022).

Breastfeeding positions for a fast milk flow

If you have a fast milk flow, this could be due to a large supply of breast milk. A fast milk flow can make your baby cough, splutter and come off the breast, which is sometimes similar to reflux symptoms. If they're having problems, it could be that the baby needs more control when they're feeding. If this is the case, laid-back feeding, where the baby is more in control, could be useful as it helps your baby to attach better and pull back if they need to take a break.

Breastfeeding your baby as they grow

As your baby grows, they become more active in getting themselves into position, and they're longer and heavier. So you might need to adjust you and your baby's position to continue to feed comfortably and effectively.

A laid-back breastfeeding position could be useful with larger or older babies as you do not have to use your arms to hold their weight. You can always ask a breastfeeding counsellor for support with finding positions that suit you and your baby.

Breastfeeding position tips

Whichever breastfeeding position you choose, remember...

Get comfortable before you start.

Tuck your baby in closely to you.

Bring your baby to your breast or let them attach themselves rather than leaning towards them.

Avoid putting the breast in your baby's mouth; let them take it in themselves.

Check that their ear, shoulder and hip are all in a line - not twisted round.

If you are bringing your baby to your breast, make sure they are turned towards your breast, with your nipple level with baby's nose - they shouldn't have to turn their head.

Cushions, special breastfeeding pillows and other supports can prevent your baby's body from getting close enough to your body or may raise your baby's body too high for effective attachment. It's best to get your baby attached to the breast, then if support is needed tuck a pillow in under your arm at the point where you are feeling strain from the weight of the baby.

(UNICEF and NHS, 2022)

Many women and babies take a while to get used to breastfeeding and it can take a while to find the position(s) that work best for you. Experimenting with different positions can help you find the ones that work best for you and your baby.
Page last reviewed December 2022.
Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 021.

For further information on how to breastfeed, including positioning and breastfeeding attachment, and a section on expressing your breastmilk by hand, visit Unicef's Baby Friendly Initiative support area for parents.

Bump to Breastfeeding DVD: available from your midwife or library - see more at www.bestbeginnings.org.uk

Coulson S. (2012) Biological nurturing: the laid-back breastfeeding revolution Midwifery today. 101. Available at: https://midwiferytoday.com/mt-articles/biological-nurturing/ [Accessed 7th November 2022]

La Leche League. (2022) Positioning. Available at: https://www.llli.org/breastfeeding-info/positioning [Accessed 7th November 2022]

Milinco M, Travan L, Cattaneo A, Knowles A, Sola MV, Causin E, et al. (2020) Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 15(1):21. Available at: https://doi.org/10.1186/s13006-020-00261-4

NHS. (2020) How to breastfeed. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-... [Accessed 7th November 2022]

UNICEF; NHS. (2022) Off to the best start. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfe... [Accessed 25th November 2022]

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Breastfeeding positions: which are best for you? | Baby & toddler, Feeding articles & support | NCT

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Here we provide tips on breastfeeding positions, including laid-back, lying down, sitting upright and underarm positions.

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What do dirty nappies really look like?

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic.

You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis. Expressing small amounts of colostrum before your baby is born can help give your baby extra milk in the first few days.

Please also refer to our downloadable leaflet on Expressing and Storing Breastmilk.

If you will be exclusively expressing (feeding only expressed breastmilk), whether for just a few days or longer, you might like to read our blog post on this.

Note: If your baby has been ill or was born prematurely please discuss this information with your health professional to check that the storage times apply. This is especially important if you are bringing your colostrum or milk into hospital for your baby.

Your breastmilk

Can be expressed by hand, by hand pump or by electric pump. Once you know how, hand expressing is easy and needs little equipment.

Contains anti-infective ingredients that limit the growth of unwanted bacteria.

Should still be handled and stored carefully to stop unwanted bacteria from getting into your milk and growing.

Stays at the highest quality when stored in a fridge, particularly when running at 4°C or below. Note: some fridges run higher at 5-10°C - if you don't know the temperature of your fridge assume it is running at this higher temperature.

Can be frozen, which affects some (but by no means all) of the nutrients and anti-infective ingredients of breastmilk.

Expressing breastmilk

When you first start to express it is common to get only a few drops of milk. As with breastfeeding, the more you practice, the easier it gets. Expressing at a different time of day may work better for you.

When might I need to express?

Before your baby is born - you may be advised that your baby might need extra milk when they are born. You can express and store your first milk (colostrum) from 36 to 37 weeks gestation. You can read more about this here.

In the first few days - if your baby is sleepy, or to help them attach and feed.

For both these stages your midwife will give you small oral syringes to collect your milk. These are usually 1ml to begin with.

Use the ideas in this leaflet to discover what works for you. Colostrum usually starts in tiny droplets and is often sticky - having help to collect these drops in the syringe can be useful.

Aim to express twice a day from 36-37 weeks for no more than 10 minutes, freezing the same day.

Once your baby is born, express as needed aiming to stimulate your breasts at least 8 times a day including once overnight through direct breastfeeding or expressing as this will increase your milk supply to meet your baby's needs and can help you feel more comfortable.

Hand Expressing

Once your milk is flowing, you will need a wide mouthed container like a sterile plastic pot or container that is well-cleaned and scalded with boiling water - a jug is ideal - so get this ready before you start.

Remember to wash your hands first.

Find somewhere comfortable to relax, then to help your milk to flow (let down) you might:

Relax with a warm drink, music or TV.

Have your baby close, or look at a photograph, clothing or toy to remind you of your baby.

Warm your breasts in a bath, shower or using warm flannels and practice expressing.

Try some ways to gently massage your whole breast, working from the outside toward your nipple.

Take care not to drag your skin:

Stroke with your fingertips

Roll using your knuckles.

Try using circular movements.

Make a 'C' shape by placing your thumb above and your fingers below your breast 2-3 centimetres back from your nipple

Gently press your thumb and fingers together, release your fingers and repeat in a rhythmic movement.

Sometimes pressing inwards back towards your chest wall as you squeeze helps. You may need to experiment with how far back from your nipple to squeeze - everyone is slightly different.

When the milk flow slows, re-position your fingers and thumb (as if moving them around a clock face), then express another area of your breast.

Try to express all areas of your breast and alternate between breasts.

See this video on hand expressing from UNICEF for more ideas.

Good hygiene is very important:

Always wash your hands before expressing and handling breastmilk and ask others giving expressed milk to do the same.

Always use a sterile container with a lid, not the collection jug, to store your breastmilk. You can buy disposable containers. Take care with plastic bags that can puncture easily.

Try to use a different storage container each time you collect milk. If necessary, newly collected milk may be cooled and added to previously stored milk on the same day only.

Label the storage containers or syringes with your name, breastmilk, time and date and put inside a clean sealed bag or box before storing. Name and date the bag too.

Store your breastmilk in the fridge or freezer as soon as possible.

Store away from meat products, eggs or any uncooked foods. Store at the back of the fridge and not in the door.

Storing expressed breastmilk

How long can I keep my breastmilk at room temperature if a fridge is not available?

If your breastmilk is freshly expressed it will keep for 6 hours without refrigeration, either at home or away from home. See 'travelling with breastmilk' section below for more details.
If your baby has been ill or was born prematurely please discuss this with your health professional to check that the same storage times apply.
How long can I store breastmilk in the fridge?

You can store your breastmilk for up to 3 days where you don't know the temperature, or it runs between 5-10°C.

Breastmilk can be stored for 5 days in a fridge running at 4°C or lower.*
*One study has shown fresh breastmilk can be used for up to 8 days when the fridge temperature is kept stable at 4°C or below.

If the fridge temperature goes above 4°C during this time, use your milk within 6 hours or throw away.

If you can't use a fridge at 4°C, try using a cool bag or box with deep frozen ice packs (changed every 24 hours). Protect your milk from direct contact with the ice packs or it may freeze - try wrapping the ice packs in kitchen towel. The bag can also be used to carry milk.

The lower the storage temperature, the longer expressed breastmilk can be stored. The storage temperatures given here include a degree of caution so that your milk remains safe for your baby.

If you wish to store your breastmilk for longer than 5 days, freeze as soon as you can after expressing.
If taking colostrum or milk into hospital follow their storage and transport times. REMEMBER: The more often the fridge door is opened, the more likely the temperature will rise. Try to check the temperature of every fridge (or cool bag) used for storing your milk each time you use it. If the fridge has no built in thermometer, use a fridge thermometer which can be bought cheaply from kitchenware stores.
How long can I store breastmilk in the freezer?

Breastmilk can be stored in a freezer at -18°C for up to six months.

You can store breastmilk in the ice compartment of a fridge for two weeks.

Safe Storage of breastmilk in the home

This table aims to provide a guide to how long you can store breastmilk for a full term baby with no additional health concerns.

Why are there variations in recommendations for storing expressed breastmilk?

More information about this can be found at the bottom of this page.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

Feeding baby expressed breastmilk

What happens if my baby doesn't take all of one bottle? Can I put it back in the fridge or on the side use it again?

Once the baby has drunk from a bottle of expressed milk it should be used up within an hour or thrown away. To avoid wasting your expressed breastmilk it is best to offer the baby only a little (e.g. 30ml) at a time until you know your baby's pattern. You can do this by keeping most of it in one container, in the fridge, and using it to top up the baby's bottle a little at a time.

Defrosting frozen breastmilk

How do I defrost my milk?

Ideally, defrost frozen breastmilk in the fridge. This milk should be used once fully defrosted which usually takes about 12 hours. If your breastmilk is still frozen after this time or you need to use it quickly, try defrosting under cool, then warm, running water. Dry the outside of the container with kitchen paper before use and use immediately. If you frequently find your milk is frozen after 12 hours in the fridge, try to freeze in smaller quantities.

How long can I keep defrosted breastmilk?

Defrosted breastmilk should be used straight away once it has fully defrosted. Throw away any unused milk.

Why can't I defrost breastmilk in a microwave?

Breastmilk should not be defrosted in the microwave because it heats unevenly, destroying antibodies and nutrients. There is also a risk of scalds and the milk would need to be left at room temperature before use.

Travelling with expressed breastmilk

How do I bring my milk home, which I have expressed at work or elsewhere?

Try to use a cool bag for transportation and put the milk in the fridge once you are home.

Fresh breastmilk can be transported within 24 hours provided storage temperatures are maintained using an insulated box or bag and deep frozen ice-packs, and total storage and transportation times do not exceed the recommended storage times.

Previously refrigerated breastmilk can be kept cool (10°C or below) for up to 24 hours when in a well-insulated bag with deep-frozen ice-packs. Take care not to freeze your milk by wrapping the ice-packs in kitchen paper first. Ensure this milk is used within the recommended refrigeration storage times as mentioned above.

Re-heating expressed breastmilk

How do I re-heat expressed breastmilk?

Expressed breastmilk can be used straight from the fridge. It does not need to be warmed. If you would like it warmed place the container (such as a bottle or sealed cup) in warm water to take the chill off. Take care not to over warm.

If the milk smells sour DO NOT USE.

When stored, the cream and milk may separate out. This is normal. Shake gently to mix before use.

Some babies are reluctant to take milk from a bottle, particularly at first. Try offering milk from a cup or spoon. They may be less reluctant when someone else gives it. If expressed milk is refused try not to worry - your baby will make up any missed feeds by breastfeeding more often or for longer on your return. See also info on this page about introducing a bottle.

Finding a breast pump

The two UK breast pump hire companies are:
Ardo breast pumps Medela breast pumps
Your midwife, health visitor or a local breastfeeding supporter may also be able to give you details of pump hire services near you.

Useful links
Human Milk Foundation
UKAMB (UK Milk Banks - find out about donating or receiving milk)
Milk Bank Scotland
Antenatal Expressing - more detailed information about this

References

(links checked May 2023)

Cook, P. Food Standards Agency. MCN10. 2006 Handling and storage of expressed breastmilk pp1-12 https://www.nice.org.uk/guidance/ph11/documents/mcn-consultation-expert-report-handling-and-storage-of-expressed-breast-milk2

Eglash, A, Simon, L, and The Academy of Breastfeeding Medicine, ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, BREASTFEEDING MEDICINE Volume 12, Number 7, 2017 (c) Mary Ann Liebert, Inc. pp390-395 https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/8-human-milk-storage-protocol-english.pdf See correction to freezer temp here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065517/

Forster, Della A et al. (2017) Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet, Volume 389, Issue 10085, 2204 - 2213 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31373-9/ppt

Hands A. (2003) Safe storage of expressed breastmilk in the home. MIDIRS Midwifery Digest, vol 13, no 3.

Royle, J. Weaver, G. (2016) Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Special Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings. 2nd Ed. Section 6, p18-32
BDA Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Specialist Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings
IMPORTANT: If you have any further questions on expressing or breastfeeding, do contact your midwife, health visitor or breastfeeding supporter for help and support. You can also call the National Breastfeeding Helpline on 0300 100 0212, open 9.30am-9.30pm every day of the year.

Page reviewed and updated November 2019

Variations in Recommendations for Storing Expressed Breast Milk

Written by Anabel Hands

In 2003, aware of the confusion for mothers resulting from the significant variations in recommendations for storing expressed breast milk, the BfN decided to collate all available information from primary research papers, and national and local guidance documents. These findings were published in the MIDIRS Midwifery Digest 1. The study found that storage temperature clearly determines storage time. Recommended storage times given in our Expressing and Storing Breast Milk leaflet were based on the primary research papers discussed in the study. You can find the link to this leaflet below for more information 2.

Our publication was sent to other breastfeeding organisations, including the Department of Health (DH), to facilitate agreement on storage recommendations using the results of primary research. The DH asked the National Institute of Clinical Excellence (NICE) to review breast milk storage guidelines, and official storage recommendations were changed from 24 hours in the fridge to up to 5 days at 4°C or lower, two weeks in the ice compartment of a fridge and up to six months in a freezer (March 2008) 3.NICE also recognised that refrigeration preserves the unique properties of breast milk more effectively than freezing. The National Health Service (NHS) adopted these guidelines, which appear in their leaflet Off to the best start (updated November 2009) which you can find a link to below 4.

Although a little different to BfN guidelines, the NICE and NHS recommendations took into account that fridge temperatures can vary and that a 5-day storage time covered most situations, including the need for milk expressed at the end of one working week to be used at the beginning of the following week. Some busy hospital neonatal units restrict the time milk is refrigerated as an added precaution; this is because their fridges are opened very frequently, which may affect the storage temperatures 5.

Other breastfeeding organisations, such as La Leche League, updated their published recommendations to distinguish between acceptable storage (8 days in the fridge) from ideal storage (72 hours in the fridge), and also recognised that refrigerated expressed breast milk was preferable to frozen breast milk (March 2012) see link below for more information. These recommendations are in line with the BfN leaflet 6.

It is important for mothers and breastfeeding supporters to note that leaflets and recommendations inconsistent with the published research are still in circulation, particularly on the Internet, and that countries outside of the UK may recommend different guidelines.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

References

1. HANDS A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest, vol 13, no 3, Sep 2003, pp 378 & 385.

2. BfN (Breastfeeding Network) leaflet. Expressing and storing breast milk. September 2004.

3. National Institute for Health and Clinical Excellence (NICE) Public health guidance 11: Maternal and child nutrition. March 2008.

4. Department of Health. Off to the best start. Crown Copyright 2007 278957 5p 200k Nov 09 (BEL) 299223.

5. MCN consultation: Expert report & Handling and storage of expressed breast milk. 05 April 2007.

6. La Leche League International. "The Breastfeeding Answer Book" Updated March 2012.

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Expressing and storing breastmilk - The Breastfeeding Network

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic. You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis.

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Combining breast and bottle - any amount of breast milk is good for your baby

https://www.nct.org.uk/parenting/mixed-feeding-combining-breast-and-bottle-feeding

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How you can help support a Mum who is breastfeeding

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How you can help support a Mum who is breastfeeding

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College of Human and Health Sciences, Swansea University

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How you can Help Support a Breastfeeding Mum...

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Excellent Evidence based website.  Link for "fussy babies"

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By Kelly Bonyata, BS, IBCLC
It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months.
My daughter had a fussy time every evening for a couple of months (yes, it does go away!). I spent weeks camped out on the end of the sofa with a constantly nursing and/or fussy baby every evening from about 6 to 10 PM. With my son, we didn't have the luxury of being able to sit down. Alex was unhappy and crying unless he was upright and being walked around at this time of day (and sometimes this only helped him to be less unhappy). He would occasionally have a very fussy time during the day, too. Nursing rarely helped to calm his fussiness (unlike with my daughter), so I usually didn't have that tool to work with (though I always tried). His fussiness was such that I looked into other causes (such as food sensitivity), but we never determined any reason for it and he was all smiles the rest of the time. The fussiness gradually went away between 3 and 4 months, as is the norm, but the first few months were hard. Nowadays, the typical comment that I hear about him is "Is he always this happy?" So remember: this, too, will pass...

Cluster feeding, also called bunch feeding, is when babies space feeding closer together at certain times of the day and go longer between feedings at other times. This is very common, and often occurs in the evenings. It's often -but not always- followed by a longer sleep period than usual: baby may be "tanking up" before a long sleep. For example, your baby may nurse every hour (or even constantly) between 6 and 10 PM, then have a longish stretch of sleep at night - baby may even sleep all night.

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Cluster feeding often coincides with your baby's . Baby will nurse a few minutes, pull off, fuss/cry, nurse a few minutes, pull off, fuss/cry... on and on... for hours. This can be VERY frustrating, and mom starts wondering if baby is getting enough milk, if something she is eating is bothering baby, if EVERYTHING she is doing is bothering baby... It can really ruin your confidence, particularly if there is someone else around asking the same questions (your mother, your husband, your mother-in-law).

This behavior is NORMAL! It has nothing to do with your breastmilk or your mothering. If baby is happy the rest of the day, and baby doesn't seem to be in pain (as with colic) during the fussy time - just keep trying to soothe your baby and don't beat yourself up about the cause. Let baby nurse as long and as often as he will. Recruit dad (or another helper) to bring you food/drink and fetch things (book/remote/phone/etc.) while you are nursing and holding baby.

Does this mean that baby needs more milk than I can provide?

No. Don't give baby a bottle - supplementation will only tell your body that you need LESS milk at this time, and that will not help matters. Also, keep in mind that formula fed babies experience fussy periods in the evening, too - fussy evenings are common for all young babies, no matter how they are fed. The Academy of Breastfeeding Medicine spells this out in their supplementary feeding guidelines:

There are common clinical situations where evaluation and breastfeeding management may be necessary, but supplementation is NOT INDICATED including... The infant who is fussy at night or constantly feeding for several hours.

Why do babies fuss in the evening?

One frequently-heard explanation for baby's fussiness in the evenings is that milk volume tends to be lower in the evening due to the natural cycling of hormones throughout the day. However, Dr. Peter Hartmann, a breastfeeding researcher, has said that in the women he has studied, milk volume is not low at this time of day. Even if milk volume is lower in the evening, fat content is typically higher in the evening (particularly if baby is allowed to control this via cue feeding), so the amount of calories that baby is getting should not be significantly different. Milk flow can be slower in the evening, which may be frustrating for some babies.

Doctors often attribute evening fussiness to baby's immature nervous system (and the fussiness does end as baby gets older, usually by 3-4 months). However, Dr. Katherine Dettwyler (who does research on breastfeeding in traditional societies) states that babies in Mali, West Africa and other traditional societies don't have colic or late afternoon/evening fussiness. These babies are carried all day and usually nurse several times each hour.

So perhaps none of these explanations is a complete answer to baby's evening fussiness. For many babies, the fussy time seems to be characterized by a need to have small quantities of milk at frequent intervals, combined with lots of holding, cuddling and movement. Babies who are offered as much expressed milk or formula as they will take by bottle [note: this practice will decrease your milk supply!] often behave in exactly the same way in the evenings. Baby takes a small amount and dozes (and fusses), then a little more, and so on. Perhaps babies "remember" mom being very active during her pregnancy at these times, and want to be held, rocked, and nurtured constantly again.
Perhaps babies simply need to nurse more often at this time - rather than consume more milk.
Soothing techniques for the fussy times

Wear baby in a sling or baby carrier. This will free one or both hands for other tasks (fixing dinner, caring for other children) while you hold, soothe and nurse your baby.

Change of pace. Let dad have some "baby time" while mom takes a shower or simply gets some time to herself to relax and regroup after a long day.

Go outside. Relax baby (and mom too) with a walk, or just sit and enjoy the outdoors. Try this a little before baby's regular fussy time.

Soothe with sound. Sing, hum, talk, murmur shhhh, listen to music, or use 'white noise.' Try different types of sound, different styles of music and singers with different types of voices.

Soothe with rhythmic motion. Walk, sway, bounce, dance, swing, or even try a car ride.

Soothe with touch. Hold or bathe baby, try baby massage.

Reduce stimulation. Dim lights, reduce noise, swaddle baby.

Vary nursing positions. Try side lying, lying on your back to nurse with baby tummy to tummy, etc.

Nurse in motion (while rocking, swaying, walking, etc.).

Combine rhythmic motion with soothing sounds.

Avoid scheduling, even more so in the fussy evening hours.

More soothing techniques.

More resources for fussy babies

@ KellyMom

@ other websites

Helpful books

The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer
by Harvey Karp, MD

The Fussy Baby Book: Parenting Your High-Need Child From Birth to Age Five
by William Sears, MD and Martha Sears, RN, IBCLC

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Cluster Feeding and Fussy Evenings * KellyMom.com

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It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months. My daughter had a fussy time every evening for a couple of months (yes, it does go away!).

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https://www.nct.org.uk/life-parent/dads-and-partners

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https://breastfeeding.support/best-bottle-breastfed-baby/?fbclid=IwAR1UTUzYPutKqzDGfIvwrdCFT9pvkVh_-18BmjnHM4iktYZVMBFwd5LEo9I

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There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer to breastfeeding in some way, whether it is the shape or size of the teat, the rate of flow of milk, the softness of the material or something about the sucking mechanism. Unfortunately, most of these claims are poorly researched and simply a ploy to increase sales. Although there is no single "best bottle" for breastfeeding, and we can't rely on advertising claims, there are certain bottle teat characteristics that seem to help preserve a baby's breastfeeding technique.

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This article discusses pros and cons of a selection of newborn teat shapes with respect to how they might influence breastfeeding. The information should be read alongside Tips to Bottle Feed a Breastfed Baby and try to check customer reviews from other breastfeeding mothers before you buy.

The aim of the game

When choosing a bottle teat for a breastfed baby, the goal is to try to recreate the same mouth position and tongue action with the bottle that your baby uses at the breast:

A short or medium length bottle teat with a rounded tip (not flattened on one side) and a medium-wide base can allow a baby to take most of the bottle teat in his mouth close to the screw cap. This will give him a wide open mouth around the base of the bottle teat and the tip of the teat will be deep in his mouth in the same position as the nipple during breastfeeding.

Comparing bottle teats

Expensive branded teats with fancy packaging are not necessarily any better than cheaper unbranded makes. Many lactation consultants recommend starting with a cheaper teat and see how that works before spending more money on expensive brands.

#1 The wide based bottle teat

A popular choice with manufacturers is to make a bottle teat that looks like a breast i.e. a short bottle nipple protrudes from a wide base. However when the angle between the nipple and base is very steep, it makes it more difficult for a baby to make a wide mouth on the teat because they can slip off it and be forced to make a narrow mouth on the nipple tip. If the artificial teat is also made of a relatively inflexible or rigid silicone, this will be even harder for the baby to shape and hold with their tongue and will feel very different to a breast. The particular teat photographed has multiple rings of ridges on the inside surface of the nipple base which will make it more difficult to keep clean.

#2 The long narrow nipple

Some bottle teats have a very long nipple compared to the base. If the length of the nipple is too long this might be longer than a newborn baby's mouth possibly making them gag. If the nipple is too long, it will also prevent the baby opening their mouth wide on the base of the teat. Whether this style will suit your baby will depend on the gradient between nipple and base, the size of your baby's mouth, and the height of the teat. The greater the number of parts inside the teat, the more difficult it will be to keep clean.

#3 The small based teat

When the base of the teat is smaller, the contrast between the nipple and the base of the teat will be less severe. A baby is more likely to be able to get both the nipple and base in his mouth up to the screw cap to mimic a deep latch (attachment) at the breast, however, if the base is too small, this will result in a smaller gape. Also be aware with small teats that if the total height is too short it might not reach deep enough into baby's mouth to mimic the correct position for breastfeeding and may encourage a shallow latch when baby returns to the breast. Ideally the material used for the teat will not be too soft that it collapses in baby's mouth, nor too rigid.

#4 The very soft teat

Some teats are made of very soft material. The teats in the following pictures are made of latex and have a slanted nipple tip. The softness of this type of teat has proved popular with premature babies or babies with neurological issues who are having difficulties with a regular teat. However if the teat is so soft that it collapses in baby's mouth when they feed, this can create a very closed, clenched mouth position which is not desirable for breastfeeding. Slanted or "orthodontic" bottle nipples may cause a baby to retract and hump the back of his tongue during bottle feeding which if repeated at the breast will compress the mother's nipple . A mother's nipple should not be compressed or distorted during a feed-this indicates the nipple has been rubbing in baby's mouth causing pain, soreness or vasospasm.

Latex is an allergenic material and some babies could be allergic to latex .

#5 The flattened teat

If a teat is sculptured on two opposite sides it will create a slightly flattened, angular teat. Depending how deeply a baby can take the teat in their mouth the flattened shape may prove difficult for baby to get a good seal with his lips and the edges of the sculptured areas could contribute to lip blisters. However if the silicone material is soft and the sides are not too steeply graded with a medium wide base, this style may suit some babies.

#6 The medium based teat with a medium height nipple

In theory the medium based teat with a short to medium height nipple is a shape thought to work well for a breastfed baby. Success will vary depending on the softness of the material used for the teat (not too firm, not too soft), the gradient between nipple and base, and the size of your baby's mouth.

#7 The gently sloping teat

Some bottle teats do not have a clearly defined difference between the nipple and the base, they look more like a nipple shield. Depending on the slope between nipple and base and the height of the teat, this shape could allow a baby to have a wide open mouth on the teat base to recreate the deep latch position desired in breastfeeding. According to reviews, some mothers found their breastfed babies accepted these when they refused other bottle teat shapes.

What about the bottle?

The bottle shape and size are not as important to preserving breastfeeding technique as the bottle teat. However the size of the bottle is worth considering. Some bottles have a very large capacity e.g. 260ml (9oz) or 330ml (11oz) yet a newborn breastfed baby typically does not take anything like these volumes at each feed. In the first few weeks, volumes per feed might be around 60-80ml (2-3oz) and between one month and six months of age, it is estimated that breastfed babies take an average 89-148ml (3-5oz) per feed . Smaller capacity bottles (e.g. 150ml/5oz) will give a more realistic estimate of both your baby's appetite and the volume of breast milk you might expect to pump in one go. See Tips to Bottle Feed a Breastfed Baby for ideas to help control the flow of milk to your baby to resemble what happens during breastfeeding.

Cleaning bottles and teats

Bottle feeding equipment needs to be kept scrupulously clean to avoid being an infection hazard. Ridges, crevices and internal parts in teats make them much more difficult to keep clean. See Sterilising Baby Bottles (National Health Service website, 2016) for comprehensive information on how to clean your baby's feeding equipment.

Alternatives to bottle feeding?

When introducing bottles to your breastfed baby, there is a risk that your baby could start to prefer a bottle teat over the breast (sometimes called nipple confusion or bottle preference) and this could undermine breastfeeding. Particularly if the reasons they are having bottle feeds are to do with difficulties breastfeeding or low milk supply. While the choice of teat shape and our Tips to Bottle Feed a Breastfed Baby can help to minimise problems, there are other feeding methods to consider such as Cup Feeding, or Breastfeeding With a Supplemental Nursing System. An IBCLC lactation consultant can help you decide on the best choice of feeding method for your baby's situation.

Low milk supply?

If you are struggling with low milk supply, contacting an IBCLC lactation consultant or other breastfeeding specialist for help can be invaluable, and see How to Make More Breast Milk. If you're considering using industrially made milks, Supplementing With Formula includes information on preparing formula safely and answers other frequently asked questions.

Summary

There are many different bottle teat shapes made of different materials with differing flexibility and flow rates. Manufacturers' statements that their bottles are "closer to breastfeeding" are just marketing claims designed to sell their products. Expensive brands are not necessarily better than cheap ones. Certain features of a bottle teat such as the length of teat, or width of the base can help mimic breastfeeding more closely. Babies come in different shapes and sizes with different sucking skills so one teat is not going to suit all babies making it difficult to recommend specific brands. Parents may have to try a few different styles to find the best bottle teat for their baby that doesn't seem to interfere with breastfeeding, and recreates the same open mouth position needed at the breast. The ideal shape will likely be a medium wide base with a short to medium nipple. Using bottles could undermine breastfeeding for some babies and cup feeding or supplementing at the breast are other feeding options to consider. This article should be read in conjunction with Tips to Bottle Feed a Breastfed Baby.

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Best Bottle for a Breastfed Baby? - Breastfeeding Support

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There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer to breastfeeding in some way, whether it is the shape or size of the teat, the rate of flow of milk, the softness of the material or something about the sucking mechanism.

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https://abm.me.uk/breastfeeding-information/grandparents/

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Naturally, you want the very best for your new grandchild. You would like to pass on advice and the benefit of your wisdom to the new mum. Mum is going to breastfeed and perhaps you don't know an awful lot about it - when your children were small most mums bottle-fed. This leaflet will give you the latest information on breastfeeding so you can feel more confident in supporting mum in her decision to breastfeed your grandchild.

Lots of babies are bottle-fed and turn out OK. What's so good about breastfeeding?

It's true that artificial milk (formula) is adequate ― but it has lots of disadvantages compared with mum's breast milk.

Babies fed formula milk are at greater risk of developing eczema, asthma and other allergies, and are more likely to suffer with ear infections and diarrhoea.

Formula feeding increases baby's risk of more serious illnesses like diabetes and some cancers.

Formula-fed babies are more likely to be obese as they get older.

Formula-fed babies may have an increased risk of cot death.

Formula milk is harder to digest and gives baby foul smelling bowel movements. Baby is more likely to suffer constipation.

Bottle-feeding is expensive ― milk, bottles and teats, steriliser, bottle bag ― they all add up.

Breastfeeding requires no special equipment and costs nothing.

Advantages for baby

Breast milk has exactly the right amount of each nutrient baby needs. Research finds new nutrients in breast milk all the time, and then manufacturers try to add some of these to the artificial milks on the market.

Breast milk is produced on a demand and supply system. There is always milk ready when baby is hungry or thirsty. Breast milk, and especially the first milk, colostrum, has lots of infection-fighting agents to help baby's immune system.

Advantages for mum

Breastfeeding is free and it is convenient. No need to pack bottles or find somewhere to warm them whilst out. Breastfeeding can quickly calm a fussy or crying baby.

Breastfeeding helps mum and baby bond and is enjoyable. There is the sense of satisfaction in mum feeding baby from her own body.

Breastfeeding makes the womb return to its normal size quickly. Mum gets her figure back faster and can lose the weight she put on in pregnancy without dieting.

Breastfeeding reduces mum's risk of getting breast cancer, ovarian cancer and osteoporosis.

Breastfeeding delays the return of mum's periods. Breastfeeding is the perfect way for mum to relax. Sitting or lying down to breastfeed ensures she gets enough rest.

How long should feeds last?

Feeds don't need to be timed. Baby should be left at the breast until he comes off himself. Then he can be winded and offered the other breast (some babies want to feed on both sides at each feed, others don't).

Long feeds will not hurt mum's nipples if baby is attached properly. Baby suckles on the breast itself and breastfeeding shouldn't hurt.

Why are babies demand fed instead of being fed four-hourly?

Breast milk is easily digested so baby will need to feed quite often ― usually at least 8 to 12 times a day in the early weeks.

Less frequent feeding can decrease mum's milk supply, impact on baby's weight gain and hydration and increase mum's risk of blocked ducts and mastitis.

Baby needs to feed when he shows hunger signs (rooting, finger sucking). Crying is a last resort. The feeding action causes mum's body to make more milk. The more baby feeds, the more milk will be on tap.

Shouldn't baby be starting solids soon?

Breast milk is all the food baby needs in his first six months. Baby will be getting ready for first tastes of solid foods once he is sitting unsupported, taking food from your plate and feeding himself. This usually happens around six months or later.

Giving any solids or drinks (including formula milk) before six months is linked with later health problems. Introducing solid food early will result in breast milk being replaced by less nutritious first foods and baby gets fewer of mum's antibodies.

Can I give a bottle so mum can rest?

Baby should not be given a bottle or a dummy in the first few weeks while breastfeeding is being established. Sucking on a plastic teat is a very different action to breastfeeding. Baby could get nipple confusion and have problems breastfeeding. There are some suggestions for other ways of helping mum below.
How can I help with my grandchild?
There are lots of ways you can help with your grandchild: cuddling, winding, bathing, and taking him out for a short walk. Any offers of help with housework, making a cup of tea or a meal will probably be gratefully accepted. Perhaps ask mum what she thinks might help.

Encourage mum to be comfortable feeding her baby in your company. Don't make her sit in a bedroom or other private place for feeding ― it will make her feel left out of things. Mum will be able to breastfeed without 'exposing herself'.

One of the best ways to help is to support mum in her decision to breastfeed. If mum has a problem, help her to solve it (if necessary with help from a breastfeeding counsellor, midwife or health visitor).
Nearly all women are physically capable of breastfeeding but breastfeeding can sometimes be a struggle without accurate information and without support from close family.
Be careful not to undermine mum's decision to breastfeed by suggesting that she gives her baby a bottle. If you can support mum and help her self-confidence, she will be able to give your grandchild the love and care he needs and give him the best possible start by breastfeeding.
You might like to show your support for mum by giving her a gift subscription to the ABM. Her welcome pack will contain all our ABM breastfeeding leaflets and she'll receive our ABM magazine (published three times a year).

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Congratulations, you're going to be a grandparent - ABM

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Naturally, you want the very best for your new grandchild. You would like to pass on advice and the benefit of your wisdom to the new mum. Mum is going to breastfeed and perhaps you don't know an awful lot about it - when your children were small most mums bottle-fed.

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Evidence based information on breastfeeding and infant milks in the UK

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Evidence based information on breastfeeding and infant milks in the UK

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

To find out more about what First Steps Nutrition Trust achieved in its first 10 years and what we are seeking to do at present, you can read our summary report here.

To hear how First Steps Nutrition Trust's followers rate the relevance and accessibility of our resources and communications, you can read the results of our 2023 evaluation here.

Jamie Oliver MBE

Jamie Oliver is a chef and campaigner who has a particular interest in good food for children, and food education. He has been given awards from the Harvard School of Public Health and the RCGP for his work on tackling childhood obesity. Jamie also set up Food Revolution to make practical food education a compulsory part of every school curriculum across the world.

Patti Rundall OBE

Patti Rundall is the Policy Director at Baby Milk Action and co-chair of IBFAN's Global Council. She is an indefatigable campaigner for safe infant feeding and the protection of all infants from irresponsible marketing of breastmilk substitutes as well as a global campaigner for conflict of interest free public health policy making.

Dr Vicky Sibson

DIRECTOR

Vicky is a Public Health Nutritionist with a PhD from University College London. She started off her career in the humanitarian world and worked for several international NGOs both overseas and as a head office adviser for over a decade, during which time she gained a particular interest in infant and young child nutrition. Vicky joined First Steps Nutrition Trust shortly after having her first baby and keen to bring her international experience to bear in the UK. She is excited to take on the role of Director and passionate about protecting, promoting and supporting optimal feeding for all infants and young children.

vicky@firststepsnutrition.org

First Steps Nutrition Trust has four Trustees

Rob Percival

Rob Percival works as Head of Food Policy for the Soil Association, leading the organisation's advocacy and influencing in support of healthy and sustainable diets. For the past decade he has worked closely with the Soil Association's Food for Life programme, improving the food served in schools and hospitals, and he leads the organisation's policy and campaigns on ultra-processed foods. He is also the author of 'The Meat Paradox', a book published in 2022 which explores the complexity of the meat debate.

Dr Vicky Thomas

Dr Vicky Thomas is a consultant paediatrician at the Great North Children's Hospital in Newcastle upon Tyne. A generalist at heart, she has a portfolio of interests including childhood nutrition, infant sleep, child protection, and supporting parents with normal baby behaviour. She sits on the scientific committee of the Lullaby Trust, is a professional adviser to La Leche League and works with a number of other voluntary organisations supporting families.

Marjon Willers

Marjon Willers is the specialist dietitian for schools and early years in Islington, where she works as part of the health and wellbeing team supporting schools and early years to develop a health promoting environment and adopt healthy food provision. Marjon is also a co-director of the Health Education Trust, the charity which developed the School Nutrition Action Groups and is a national partner of Food for Life supporting the whole school approach, food policy, consultation and engagement.

Dr Marko Kerac

Dr Marko Kerac is a clinical associate professor and programme director for the 'Nutrition for Global Health' MSc at the London School of Hygiene & Tropical Medicine. Initially trained in paediatrics, he did his PhD based in Malawi before finishing specialty training in public health in London. His research focuses on severe malnutrition in infants and children. He particularly enjoys the challenges of GRIPP (Getting Research into Policy/Practice): working in multidisciplinary groups from the very start of a project to together identify high-priority problems and develop practical (and thus hopefully scalable!) solutions.

Dr Helen Crawley

Dr Helen Crawley founded First Steps Nutrition Trust in 2011 and was the charity's Director until 2021. A dietitian and public health nutritionist with over 30 years' experience in public health nutrition across government, academia, research and the charitable sector, she created First Steps with the purpose of providing clear, evidence-based and conflict of interest free information and resources on eating well in the early years.

Helen was previously the Science Director for Caroline Walker Trust, where she wrote national guidance for food in schools and early years settings. She also held an honorary research fellow post at City University London, sat on the WHO scientific and technical working group on inappropriate marketing of foods to infants and children, the CODEX e-working group on standards for follow-up formula, the NICE panel on maternal and child nutrition and the Unicef Baby Friendly UK designation committee. Helen also sat on the UK Food Poverty Alliance, the London Food Board, chaired the London Boroughs Food Group and sat on the Healthy Early Years London strategy group.

Having dedicated 10 years of her illustrious career to developing First Steps Nutrition Trust in to what it is today, Helen stepped down in 2021 to pursue other projects.

trustees

We are recruiting for two new trustees to augment our board; one to bring fundraising expertise and connections to the benefit of our small charity as we seek to diversify our income, and a second to bring fresh ideas from the perspective of a practicing health care professional familiar with current challenges facing young families trying to eat well. These are voluntary roles but will play an integral part in shaping the strategy and ongoing success of First Steps at an exciting time. For more information please click on the links below:

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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Tailor-Made for Tiny Humans

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Supporting parents and tiny humans with the science of human milk

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…

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A guide to how much your baby may need.

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Unicef UK Baby Friendly Initiative | Importance of relationship building

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From the Association of Breastfeeding Mothers #Feedon

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Demonstration using knitted breast

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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You can donate your breastmilk to help premature babies.  Find out more at: http://www.ukamb.org/

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If your baby does not latch, nipple shields *may* help. CARE should be taken to ensure your baby is getting enough milk if you decide to use nipple shields

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KellyMom.com - Breastfeeding and Parenting

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A nipple shield is a flexible silicone nipple that is worn over the mom’s nipple during a feeding. Nipple shields should in general be considered a short-term solution and should be used under the guidance of a lactation consultant.

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https://www.tongue-tie.org.uk/

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to a successful start.

Before your baby arrives
Your premature newborn
Establishing breastfeeding
Looking after your own health and wellbeing
Taking your breastfed baby home

Before your baby arrives

If you know your baby will be arriving soon, you may wish to try antenatal expression of colostrum. This is where you hand express some of the thick, creamy first milk into a sterile container such as a syringe. This can be given to your baby immediately after birth reducing the possibility of them needing to have early formula feeds. Hypoglycaemia (low blood sugar) can cause serious long term health problems if left untreated, and preterm babies are at higher risk of low blood sugar than babies born at term. Having some colostrum ready means that this is available instead of formula (or donor milk if available).

If you are at risk of early labour and taking precautions to avoid it, then consult with your healthcare professionals about your individual case before starting antenatal expression as it may be considered to increase your risk of going into labour.
You can read more about antenatal expression here.

If there is time before your baby arrives, someone from the paediatric team on the neonatal unit where your baby will be cared for should come and talk to you about how you plan to feed your baby. You can supply them with any expressed colostrum you have in a labelled container, and discuss how you wish your baby to be fed while you are establishing your milk supply.

Some neonatal units will have access to donor breastmilk, and will be able to tell you if your baby will be eligible to receive this - as supply is limited, this is likely to be restricted to the babies who need it the most. They will discuss and get your consent if formula may need to be given while you are building your milk supply. This may also be the time to talk about how you want supplementary feeds to be given to your baby.

Smaller or weaker babies will be given a nasogastric tube, to allow milk (your own, donor or formula) to be fed down the tube. Bigger and stronger babies may be given bottles. You may wish to discuss paced bottle feeding (the art of giving bottle feeds in a way that supports breastfeeding) or cup feeding.

If you wish to express breastmilk for your baby, then your hospital should be able to provide you with a breastpump - asking for this before your baby is born means that you have it ready as early as possible. In the early days you need to be stimulating milk production in your breasts between eight and twelve times in twenty four hours, including at least once at night - this might be by your baby feeding effectively at the breast, or pumping sessions.

To read more about successfully expressing breastmilk, click here.

Your premature newborn

When you baby arrives there is likely to be a sudden rush of activity as your baby is checked and stabilised. They may be rushed off to the neonatal unit leaving you feeling stranded in the delivery unit. Be kind to yourself. You may feel that starting to express milk is a practical way that you can be involved in their care even when you are apart from each other. There is evidence to show that if you start expressing within the first hour after birth it can have a long term positive effect on your milk supply.

Establishing breastfeeding

You may be expressing on your ward (if you are still an inpatient) or on the neonatal unit. Many mothers find that being close to their babies while they are expressing can help to increase the amount that they are able to express. If you are separated, looking at photos of your baby can help or smelling something that has been close them.

If you are expressing on the unit, you may wish to be close to your baby as you do so. Some mothers use screens for privacy. You can ask for these to be provided. You don't have to use screens if you prefer not to - using scarves or nothing at all is a completely acceptable choice. Do what you feel comfortable with and helps your milk to flow easily. Listening to music may help you to relax and increase your milk production.

You are the person most known and familiar to your baby. Being with you is the safest and most secure they can possibly feel. If your baby is very fragile they may not be able to come out of their incubator at first. Ask the staff how you can be involved in their care and to show you how to hold and comfort them through the vents in the incubator. Once your baby is able to come out of the incubator, then kangaroo care can become an important part of your time together. This is where your baby is placed skin to skin on your chest for as long as possible and a blanket put over both of you. Your baby is able to enjoy the sensations of your closeness and the deep relaxation and comfort they feel helps them to regulate their breathing, temperature and other health indicators. It also helps your breast to become a familiar environment and allows them to practise feeding directly from the breast easily.

It used to be thought that babies under a certain gestation didn't have the ability to suck and swallow, or that directly breastfeeding was tiring to them. Happily, more recent studies have disproved these concerns. Once babies are well enough to breathe unaided (off ventilation and continuous positive airway pressure - CPAP), they can be brought to the breast. Smaller and younger babies will still need to have some of their milk given to them via tube feeds, but this allows you and your baby to learn to breastfeed together without a feeling of pressure.

Smaller babies have smaller mouths and lower muscle tone. This may mean you need extra support to get breastfeeding established. Seek skilled help early and often. Keep asking until you find someone who is able to support you effectively.

Premature babies often find it easier to feed in laid back breastfeeding positions. This is where you are supported in a reclined position with your baby tummy down on top of you. This helps gravity to 'stick' your baby to you and stops them slipping off. If you need to sit in a more upright position, then supporting the whole length of your baby's body close to yours with a hand behind their shoulders means they don't have to support their weight and stops them from curling in on themselves. Read more about laid back breastfeeding here.

You may find that your baby quickly falls asleep when breastfeeding. This isn't a sign that you are exhausting them, but that they are small and being soothed. You can help them to stay awake for longer by washing their face with cool water, gently blowing on them or tickling their feet. You may find that breast compressions - gently smoothing down your breast towards the nipple - helps your baby to stay alert and interested in feeding as this makes the milk flow more quickly and easily for them.

All new babies need to feed frequently - and premature babies are no different. The volume of milk that their stomachs can take at each feed is very small, and breastmilk is easily digested. It is normal for babies to feed between 8-12 times in a 24 hour period, including at least once at night.

Neonatal unit staff need to be able to ensure that all the babies in their care are receiving the right amount of milk for them to grow. Premature or sick babies may be less able to communicate their need for milk. These two things combined mean that units often use feeding schedules, with feeds timetabled every two, three, or even four hours.

When you agree how often your baby is to be offered supplemental feeds (any milk not directly from the breast) it may be helpful to remember that four hourly is less frequently than you would expect a healthy, full term newborn to feed. You may also choose to consider these as 'backup' feeds - any time spent feeding directly from the breast doesn't reset the clock, but is bonus extra calories. Keep writing down how often you are breastfeeding in your baby's notes, as this may help you and the staff to feel confident about the transition from scheduled, measured feeds, to baby led, responsive feeding.

One of the things the unit staff will look for in a baby coming close to going home is that your baby is able to rouse themselves to feed. If your baby is waking for feeds more often than their feeding 'schedule' (and you are spotting signs of effective feeding), this may be a sign that they are becoming better able to manage their own need for milk. You will probably need to keep offering more frequently than they ask for milk - this is true for many babies. Remember, you can't feed too often, and your baby can always say no if they don't want milk right now!

Breastmilk is an incredibly responsive food, made specially for each baby. The milk that you are making for your premature baby will be even more densely nutritious than the milk of a full term mother. Every drop of milk that you can supply for your baby is like medicine - strengthening and building their immune system and providing the calories they need to grow. Some mothers feel that providing milk for their babies is a unique way that they can care for their babies. It can be an important part of bonding with a new and fragile baby. While your baby will continue to benefit from your milk for as long as you provide it, you aren't tied to expressing for longer than you want to do so. If you decide it's time to stop, then gradually reducing your pumping sessions will slow and stop your milk production without causing problems for you.

Looking after your own heath and wellbeing

You will be recovering from pregnancy and birth, and may be experiencing additional health problems. It is important to remember to look after yourself - the more smoothly your recovery goes, the more strength and energy you will have to become more and more involved in your baby's care. If you have older children at home, you may be struggling to balance meeting their needs with being present with your newborn. Many mothers have to leave hospital long before their baby is ready to come home and have to travel back and forwards to be with their baby. This is a time to say yes to as many offers of help as you possibly can. If someone can provide a lift, deliver a meal, entertain an older child or do a load of washing - or just sit with you to talk things over in the hospital cafe - these may make life a little easier for you and help you to keep going at a difficult time.

You may be taking medications yourself and be concerned about them passing through your milk. Discuss your concerns with your and your baby's medical teams. They may be able to reassure you or find suitable alternatives. For specialist information about whether a drug is compatible with breastfeeding, you can contact your local LLL Leader who has access to resources and professional support.

It may feel impossibly painful to keep leaving your baby. Remember that by looking after yourself - eating, sleeping and taking the medication you need to get well - you are making sure that you carry on being able to be there to look after your baby.

Taking your breastfed baby home

Separately to any health issues your baby may be facing, your neonatal unit will want to know that you are able to make sure your baby is getting enough milk to continue growing. Being aware of your baby's early hunger cues is important so that you can feed responsively and before baby gets too upset. You may have a very sleepy baby who still needs your help to wake themselves up to feed beyond their due date. Setting an alarm for the middle of the night can help you to make sure they don't go for longer than a four hour stretch without feeding at night.

Read more about recognising early hunger cues and about waking a sleepy baby here.

Read more about how to tell if your baby is getting enough milk here.

Many breastfeeding mothers and babies enjoy safe cosleeping. Premature babies are at greater risk of Sudden Infant Death Syndrome or Sudden Unexplained Death in Infancy (SIDS/SUDI). While they will benefit from sleeping close to their mother, premature babies should sleep on a separate, firm surface such as a sidecar cot.

It can be scary to make the transition from caring for your baby in hospital with a team of staff around you, to being at home. Your healthcare professionals are likely to make extra visits to support you and to keep an eye on your baby's weight gain. You may find that being home together, able to stay together all the time, and in a comfortable environment, you rapidly get to know and understand your baby more easily and become more confident in your mothering skills.
Photo credits: Olivia Brown and other mothers
Other resources

You can read a mother's story about mothering her premature baby through special care

This video looks at breastfeeding in the first hour after birth

The drugs in breastmilk service, while not an LLL resource, gives quick access to information from a qualified pharmacist

The Small Wonders films follow families through their experiences of having a baby on a neonatal unit

Global Health Media have a series of videos about various aspects of life with a small baby

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Successfully breastfeeding your premature baby - La Leche League GB

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to [...]

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Sleep pods and nests are not recommended.

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Sleep pods and nests are not recommended.

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Check out this safety guide

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Baby product information - The Lullaby Trust

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It can be hard to know which products are safest for your baby to sleep in. We’re here to help you find the safest baby products…

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Support for parents

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Below are a range of useful resources for parents on infant feeding and relationship building, as well as information on overcoming common breastfeeding challenges.

Overcoming breastfeeding problems

You may find whilst trying to establish breastfeeding that you run into problems. Whilst these can be debilitating and painful, thankfully the most common ones can be solved relatively quickly and easily - given the right support.

Unfortunately, support is often not available or, what is worse, mothers are told that problems such as engorgement and sore nipples are a normal part of breastfeeding. This is not true.

Below you can read about how different problems develop, how to spot them at a early stage, and how to solve them by yourself or with the support of a health professional.

There are various mother support groups which offer infant feeding support:

Find more useful organisations.

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart. Giving infant formula to a breastfed baby will reduce your milk supply. You do not need to eat any special foods while breastfeeding, but it is a good idea for you, just like everyone else, to eat a healthy diet.

Resources to support you

Below is a selection of resources to support you with feeding, caring, and building a close and loving relationship with your baby.

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Support for parents - Baby Friendly Initiative

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You may find whilst trying to establish breastfeeding that you run into problems. Whilst these can be debilitating and painful, thankfully the most common ones can be solved relatively quickly and easily - given the right support.

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Anita Burden IBCLC Dip HE Breastfeeding Counselling
I don't endorse or recommend any particular organisation, individual or product.  This information does not replace medical advice.
If you think you or your baby are unwell, please contact your GP, Midwife, Health Visitor, call 111 or in an emergency dial 999.
Anita Burden IBCLC Dip HE Breastfeeding Counsellor