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How do my breasts produce milk?

As soon as you're pregnant, your body starts to change to support milk-making. You may notice some of these changes in your breasts, like a slight tenderness and maybe a darkening of your nipples and areola. These changes are among the early signs of pregnancy (NHS Choices, 2016b).

Mammary glands

These glands are in your breasts and produce breastmilk. Each mammary gland contains the following parts that help you to make breastmilk (MIDIRS, 2011).

Alveoli

These are small clusters of sacs that develop when you are pregnant and produce your breastmilk (Sternlicht et al, 2006). Muscles that squeeze the milk into ductules surround these sacs.

Ductules

These are small channels carrying milk from the alveoli to the milk ducts.

Milk ducts

These are the network of channels delivering milk from the alveoli and ductules to your baby. When you're pregnant, these ducts grow larger and there will be more of them. The average breast has about nine milk ducts ready for breastfeeding (Geddes, 2007).

When will I start making milk?

During pregnancy your breasts increase in size as the mammary glands grow to support milk production. Sometime during the second trimester your body is ready to produce milk. You might notice a little milk leaking from your breasts in the final weeks of pregnancy (WHO, 2009).

Once your baby is born and you pass the placenta, your body releases the hormone prolactin. This tells your body to produce milk (WHO, 2009).

"You can start to feed your baby immediately after birth as soon as you're both ready."

Skin-to-skin contac t can help to stimulate your milk flow and your baby's natural feeding responses (NHS Choices, 2016b).

What is colostrum?

Colostrum is the first milk your breasts produce in the few days following birth. It is thick and golden yellow in colour (NHS Choices, 2016b). Colostrum is very concentrated and full of vitamins and antibodies. All of this helps your baby grow and fight off infections (NHS Choices, 2016b). It also helps expel meconium - the black, sticky poo babies are born with (NHS Choices, 2016b).

Your baby will only need about a teaspoonful at each feed because colostrum is so concentrated. To begin with your baby may want to feed often, perhaps every hour. They'll begin to have fewer, longer feeds after a few days. The more you breastfeed, the more your baby's sucking will stimulate your supply and the more milk you'll make.

After a few days the colostrum will be replaced by more mature milk, which is more liquid and greater in volume (WHO, 2009). Approximately two to four days after birth you may notice your breasts are warmer and fuller feeling; this is known as your milk coming in (NHS Choices, 2016b).

The let-down reflex

When your baby starts sucking at your breast, this releases the hormone oxytocin, causing the tiny muscle cells around the alveoli to contract and squeeze out breastmilk. This squeezing is known as the let-down reflex (WHO, 2009; NHS Choices, 2016b). Some women get a tingling feeling, which can be quite strong, while others don't feel anything. Both are normal.

You may notice your baby respond when your milk 'lets down'. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks, while they wait for more milk to arrive (NHS Choices, 2016b). There may be a number of let downs every time you breastfeed, which you may or may not be aware of.

You may also feel some contractions in your belly during the first few days of breastfeeding your baby. These are known as afterpains and feel like mild labour contractions. They are caused by oxytocin shrinking your uterus (womb) back to its pre-pregnancy size (WHO, 2009; NHS Choices, 2016b).

Breastfeeding frequency

Mums start producing mature milk as soon as their baby is born. This happens whether their baby is ever placed at their breast or not. You may notice this surge in production as your milk coming in around two to four days after the birth. Your breasts may look and feel fuller than before (NHS Choices, 2016b).

After this, you continue to make milk as a result of milk being removed from your breasts. This happens either as your baby drinks the milk or by you expressing it with your hands or a breast pump (WHO, 2009).

When breastfeeding is going well, this is what drives the milk supply. As milk is removed, your body gets the signal to make more. Your baby will never fully empty your breasts. If your baby feeds a lot, your body increases the milk supply in response (NHS Choices, 2016b).

Young babies typically feed frequently, at least eight times in 24 hours (or more), often in clusters of feeds with small gaps in between. Counting the feeds is not realistic, as you might not know whether your baby is starting a new feed or ending a previous one (NHS Choices, 2016c).

Changes in your breast milk

The fat content of your milk gradually increases as the milk is removed. So when breasts are less full, the fat content is proportionately higher (Martin et al, 2016). Healthy, effectively feeding babies usually get the right milk intake and type of milk for them (Martin et al, 2016).

When your baby seems to have had sufficient on one breast, you can switch sides and offer the other breast. Your baby may show they've had enough of one breast by coming off it or slowing right down. Not all babies take both sides each time. Some are happy with one, while other babies show they want three, four or more sides at a session (NHS Choices, 2016c; NHS Choices, 2017).

"Breastmilk constantly changes to meet your baby's needs. It is responsive to changes in the mother's diet, bacteria and viruses in the environment and the baby's feeding behaviours."

Breastmilk content also varies according to the time of day. Evening milk contains more components that relax and aid babies sleep, while daytime milk contains different elements that stimulate activity (Sanchez et al, 2009).

Breastmilk can also change in response to the baby or mother's illness, with an increase immune cell levels to aid recovery (Riskin et al, 2012). After your child's first year in the world, the fat and energy content of breastmilk increases to meet their growing needs (Mandel et al, 2005).

Support to help you breastfeed

It can take time for you and your baby to get the hang of breastfeeding. Plenty of help and support is available to help you overcome any challenges. Getting breastfeeding support makes a huge, positive difference.

Contact your local NCT branch or call our Infant Feeding Line on 0300 330 0700 to find out what breastfeeding support is available locally. We have local NCT Breastfeeding Counsellors who can offer a call, virtual visit, or home visit, depending on their availability. You may also have a local drop-in NCT breastfeeding support group. Our breastfeeding support groups are a great place to meet other mums with babies of a similar age. Peer support is really beneficial to new mums.

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.

You might find attending one of our groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Geddes DT. (2007) Inside the lactating breast: the latest anatomy research. J Mid Women's Health 52(6):556-63. Available From: http://breastnbabylactation.com/pdf/11_inside_lactating_breast.pdf [Accessed January 2018].

Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. (2005) Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 116(3):e432-e435. Available From: http://pediatrics.aappublications.org/content/116/3/e432 [Accessed 1st January 2018].

Martin CR, Ling PR, Blackburn GL. (2016) Review of Infant Feeding: Key features of breast milk and infant formula. Nutrients. 8(5): 279. Available From: http://doi.org/10.3390/nu8050279. [Accessed 1st January 2018].

NHS Choices. (2016) Signs and Symptoms of Pregnancy. Available from: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/signs-and-symptoms-pregnancy.aspx [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding the first few days. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/breastfeeding-first-days.aspx?tabname=Your%20newborn [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding: is my baby getting enough milk? Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 1st January 2018].

NHS Choices. (2017) Your breastfeeding questions answered. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 1st January 2018].

Riskin A, Almog M, Peri R, Halasz K, Srugo I, Kessel A. (2012) Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant. Pediatr Res. 71(2): 220-225. DOI: 10.1038. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22258136 [Accessed 1st January 2018].

Sánchez CL, Cubero J, Sánchez J, Chanclón B, Rivero M, Rodríguez AB, Barriga C. (2009) The possible role of human milk nucleotides as sleep inducers. Nutritional Neuroscience. 12 (1):2 DOI: 10.1179/147683009X388922. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19178785 [Accessed 1st January 2018].

Sternlicht MD, Kouros-Mehr H, Lu P, Werb Z. (2006). Hormonal and local control of mammary branching morphogenesis. Differentiation 74(7):365-381. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580831/ [Accessed 1st January 2018].

WHO. (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 1st January 2018].

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As soon as you're pregnant, your body starts to change to support milk-making. You may notice some of these changes in your breasts, like a slight tenderness and maybe a darkening of your nipples and areola. These changes are among the early signs of pregnancy (NHS Choices, 2016b).

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How to store breast milk

Store breast milk in a sterilised container, or special breast milk storage bags - remember to label and date it. Your milk can then be kept in the:

fridge, at the back and not the door, for up to 5 days (at 4°C or lower)

ice compartment of the fridge for up to 2 weeks

freezer for up to 6 months

Tip: Store your milk in small quantities to avoid waste.

The best way to defrost frozen breast milk is by leaving it in the fridge to thaw out completely. But if you need it straightaway, you can defrost it by placing the bag or container in a jug of warm water, or by holding it under running warm water. Whichever way you defrost the milk, it must be used immediately (never re-freeze it).

Warming breast milk

Your baby may be perfectly happy to drink the milk cold, but if not, you can warm it (up to body temperature) under warm running water, or by sitting it in a jug of warm water. Make sure to use the milk within an hour, anything left over should be discarded.

Microwaves are not suitable for warming or defrosting milk, they can cause hot spots which can burn your baby's mouth.

Feeding your baby expressed milk

You can feed your baby with your expressed milk in a bottle, syringe, spoon, or special feeding cup. If you are feeding your newborn in hospital, your midwife will be able to give you some help and guidance. And if you're at home, your health visitor will be able to help.

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Start4Life - Expressing Breast Milk | Breastfeeding | Start4Life

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Store breast milk in a sterilised container, or special breast milk storage bags - remember to label and date it. Your milk can then be kept in the: fridge, at the back and not the door, for up to 5 days (at 4°C or lower) ice compartment of the fridge for up to 2 weeks freezer for up to 6 months Tip: Store your milk in small quantities to avoid waste.

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

The Association of Tongue-tie Practitioners (ATP) was set up in 2012 by a group of tongue-tie practitioners from the NHS and independent sectors with the aims of:

Increasing awareness about the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

Supporting parents of tongue-tied babies to access safe and effective care.

Assisting tongue-tie practitioners to provide safe and effective care through training and sharing knowledge and experience.

Providing resources and education for healthcare providers who refer babies for tongue-tie division.

The Association of Tongue-tie Practitioners (ATP) is also actively working to redress inaccuracies in the reporting and documenting of the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

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Association of Tongue-tie Practitioners | For parents & health care providers, all of the information you need about tongue-tie and the support available.

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

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Reprinted from Mother-2-Mother.com (2000-2006), with permission from the author, Paula Y.

A note about exclusive pumping:

There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula. There is another option however, and one that doesn't seem to get the support or acknowledgment it deserves - exclusively pumping, also known as " EPing ".

In most cases, a mother who has made the decision to exclusively pump has not done so "lightly". She is aware of the irreplaceable benefits of her milk, and she wants her baby to have the best, so the most logical conclusion for her is to pump and provide her milk to baby by bottle.

Sadly, many (including health care providers) will tell mom that this is crazy idea, and "it'll never work"; "you'll run out of milk"; or will say "you simply will not be able to keep up". Without the support and information she needs, a mom may simply give up.

Those who don't give up often are faced with other issues to overcome. They often feel like they are in a class by themselves, excluded from the usual groups of moms who typically form into "support groups" either for breastfeeding mothers, or for formula feeding mothers.

They may feel they must explain "why" they are "bottle feeding" breastmilk - even to their health care providers who often ask.. "breast or bottle" assuming "bottle" is formula.

While everyone does agree that there are irreplaceable benefits to nursing baby directly from breast, everyone also must agree that breastmilk itself is irreplaceable. When faced with providing breastmilk, or not, then whenever possible it should be breastmilk regardless of the method of delivery.

There is no room or need for guilt here - the mother who has done all she can to bf "normally" isn't a failure - she is just doing the best she can in the situation she is in. Mothers who choose to exclusively pump are very dedicated mothers - determined to do the best they can for their precious babies, and they deserve respect and support.

Here are some tips and information regarding exclusive pumping:

All About Exclusive Pumping and Tips for EPing Moms by EPing Moms:
The Best... Expressed!
(italicized info shared by Shanna)
HOW OFTEN TO PUMP & WHEN?:

First and foremost - one should have a good quality, double electric pump. Some mothers rent them, others buy pumps such as the Hygeia EnJoye. The quality of the pump can make all the difference in the world!

A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this.

"It's insanely hard in the beginning but you need to pump every 2 to 3 hours around the clock. Prolactin levels (the hormone that tells your body to make milk) are highest in the early morning hours so mom would want to make sure she is pumping then as well. This is like the 1am to 5am stretch of time. If mom can at least get one pump in during this time, it will really help. The main concern is to get enough pumps in per day - a minimum of 7 pumps per day. I will say from experience that when I pushed myself to get in 8 pumps per day, my supply REALLY increased. Most of the time, I just couldn't push myself and ended up with 7 times. And to create a little bit of sanity, it is the number of pumps per day that you get in and not necessarily the amount of time you wait in between pumps that counts. So, if I needed to run an errand or just wanted to get out of the house without dragging my pump along, I would pump every 2 hours in the morning and then have a window of about 4 or 5 hours in the afternoon to do everything and would then pump again every 2 hours in the evening to get my total of 7 pumps in for the day. That being said, I did NOT get up to pump in the middle of the night if my baby wasn't awake. I thought that was cruel and couldn't do it! Ha! The sleep was more important to me (especially after the c-section). A lot of pumping is trial and error and this is why keeping info in a spreadsheet (or journal) is helpful. If you start sleeping through the night or going longer stretches and see a huge decline in your volume, you can always set you alarm to add another pump back in. I never had to but this can vary from mom to mom. I did the early morning pump as long as I was up feeding the baby, but if she slept 5 hours through the night, so did I! "

PUMPING - HOW LONG?

Most experts agree that whatever the reason for pumping, moms should pump for about 20 minutes. Most agree its best to pump at least 15 minutes, and to avoid going much longer than 20 minutes. Experts also encourage pumping about five minutes past when the milk stops flowing, often by doing so mom will elicit another letdown, and at the very least will maintain production as well as encouraging increase in supply if needed.

"The standard advice is to pump for 15-20 minutes. Even if you don't have milk flowing that entire time, you need to pump that long to get enough nipple stimulation. Also pumping at least 5 minutes after your milk stops flowing will tell your body that you need more milk; thus increasing your supply. 15 minutes should absolutely be the minimum pumping time. I've talked to women who only pumped for 10 minutes and eventually started losing their supply. They had to work really hard to rebuild it."

Pump Settings

"More is not better" when it comes to the suction settings on the breast pump. Most experienced moms do not set the pump speed on high, but rather keep it on lower setting for comfort.
"This one was a BIGGIE for me and I want to definitely pass this one on! There should be a suction setting on your pump and a speed dial. This is very important, the higher the suction does NOT mean the more milk you make. Your pump will probably have a suction setting of minimum, medium, and maximum. I had mine set on medium when I developed a blister. Once it healed, I turned it down to minimum and have never had another blister or pain again. I keep the speed at 3 but if you feel like too much areola is being sucked into the horn, then turning down the speed will remedy that. If you are in a lot of pain and turn down the settings, you might actually get more milk because you are more relaxed!"

HOW MUCH MILK PER BOTTLE?

Moms may find it surprising that the breastfed baby often takes less milk in the bottle than formula babies take in. This is because breastmilk is so well utilized by the baby's body that less is needed. Since breastmilk is so easily and completely digested, the breastfed baby needs to eat more often, but they don't need as much per bottle.

When a baby is nursed from the breast, research shows us that baby will vary their intake of milk from feeding to feeding, and the length of time at the breast doesn't always correlate with the amount of milk taken from the breast. Overall, the average bf baby takes in between 19 and 30 oz (or 570 - 900 mL) per day (24 hrs), but the amount taken per bottle may vary somewhat from feeding to feeding, just as it does at the breast, depending on baby's need at the time.

" According to the most current breastfeeding research, exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. This may vary a little from baby to baby, but the average range of milk intake is 19-30 oz per day (570-900 mL per day).
To estimate the average amount of milk baby will need at a feeding:

Estimate the number of times that baby nurses per day (24 hours).

Then divide 25 oz by the number of nursings.

This gives you a "ballpark" figure for the amount of expressed milk your exclusively breastfed baby will need at one feeding.

Example: If baby usually nurses around 8 times per day, you can guess that baby might need around 3 ounces per feeding every 3 hours when mom is away. (25/8=3.1).

NOTE: Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months."

You can find a quick and easy expressed breastmilk calculator here.

HOW TO BOTTLEFEED

It is important to remember that it is very easy to overfeed a baby using bottles. This is because the way a baby drinks from a bottle is very different than how a baby would nurse from the breast. A baby cannot control the flow of milk from a bottle thus experts recommend using slow flow or "newborn" type nipples, to reduce the risk of overfeeding.

The breastmilk should never be warmed in the microwave, since doing so not only creates hot spots that cannot fully be distributed evenly even when the milk is mixed (the heat adheres to the fats which "glob" together, and can result in scalding of a baby's mouth and throat), but it actually alters the composition of the breastmilk, damaging some of the nutrients. Shaking breastmilk is also not recommended (gently swirl to mix, instead).

Ideally bottlefeeding the baby should mimic how a mother breastfeeds her baby. The baby should be fed on cue, or demand, and not according to a rigid schedule. Breastmilk digests in about 90 minutes, so one would expect the feedings to be anywhere from 1.5 hrs to 3 hours apart. (younger babies often need to eat more frequently than older babies).

The bottle should be offered gently, in a non-stressful manner, with the baby drawing the nipple into the mouth. The type of bottle or nipple is not as important as the manner in which the bottle is offered. A typical nursing session lasts about 15 to 20 min, and care should be taken to allow baby to take his/her time to drink the bottle, not "rushing" through a feeding as quickly as possible. Changing position mid-way through a feeding is often recommended, as is holding baby is a more upright position. Propping a bottle is also not recommended.

INCREASING YOUR SUPPLY

There are wonderful tips on increasing milk supply below - those that work for nursing mothers also work for mothers who exclusively pump, the biggest "difference" is that nursing mothers are encouraged to put baby to breast often, and pumping mothers are encouraged to pump often. Probably THE most important thing to remember is to pump often and pump long enough to soften (or "empty") the breast.
"Some little tips to help increase your supply if you really need it. It's nice to have these on hand just in case:
First drink plenty of water. I don't drink a ton but I make sure to stay hydrated. Check your pee when you go (I know, sounds funny!). If it is light yellow to clear, you are plenty hydrated.
Make sure you eat! While you are pumping, you will keep the weight off, I promise! It can make you hungry as a horse and it does that for a reason. You need the extra calories because you are burning so much off! When I didn't eat enough, I would get really light headed and feel like I was going to drop my baby...not good! Eventually, your hunger should taper off (mine has).

Eat REAL oatmeal, not the instant. You can eat the quick oats (the ones that cook in 1 minute) or the old fashioned oats (that cook in 5 minutes). You can also make cookies that have oatmeal in them and get oatmeal that way (I prefer this way! Ha!). The way they process the instant oatmeal, it doesn't give you the same results. No one is sure how the oatmeal works but it does!

Get some rest (yeah, I know easier said than done!) If you are exhausted and have the opportunity to take a nap (even if it pushes your pump back) do it! You will actually get more milk that way! Even if you're not sleeping, rest by sitting down a lot. Conserving energy is important.

Don't stress too much. This all depends on how you personally handle stress. I tend to be a thinker, so I think things out a lot. It has to be some MAJOR stressful situation for it to hurt my supply.

Some suggest drinking dark beer, with or without alcohol. Some say it's the barley in it or something, that helps to increase supply. Plus some women just swear by the relaxation it gives them! You can have 1 or 2 beers without much crossing into your milk. ( Note: Most breastfeeding experts do not routinely recommend using alcohol to boost milk supply. More on alcohol and breastfeeding here.)

There is a tea called Mothers Milk Tea and it is supposed to increase your supply if you drink it.

There are herbs like Fenugreek and also prescription medications that will increase your supply if you really need it. I would use these as a last resort but they can be effective and are available!
Most importantly, good pumping habits will keep your supply up and increase it!"

PUMPING TRICKS & More Tips For EPing Moms by EPing Moms

(aka "Tricks of the Trade" shared by Shanna)

"Go hands free! This was the best trick I learned!! I went hands free and set my pump up by my computer and read my pumping board while I pump. It keeps me from looking down into my bottles wondering how much I'm getting, being bored out of my mind, and makes time FLY by! You can use an old nursing bra and just cut slits in the flap. Then you just slide the horns through. I did this for a while but I didn't want to wear the cut up bra all day long so that meant I had to literally change bras before each pump. At 7 times a day, that was a bit much!! So, I bought a pumping bra and LOVE it! It's the Easy Expressions bustier.

The best thing about this bustier is that it can be worn over any nursing bra. So, when it's time to pump, I put the flaps down on my nursing bra, wrap the bustier around, slide the horns through the holes, position them and zip it up. That's all!"
"The refrigerator trick. This is where you rinse your horns and/or collection bottles after each pumping session. You put them in a ziplock bag (or not, this is optional), and put them in the refrigerator. The idea is that since breast milk is good in the fridge for 5-8 days, any residue left on the horns won't matter. Then you can wash the horns/bottles once at night. I throw mine into the dishwasher (all except the white membranes) and it's easy, easy, easy!""Storage bags. Many of us started out using the Gerber Seal-N-Go bag but they get very pricey quickly. They are like $5.50 for a box of 25 bags. After researching it online, I found many other women were using regular freezer bags for freezing the milk....MUCH cheaper! Everything I've read shows that they are safe to use. From what I have found, I only buy Glad and not Ziploc. Ziploc seems to have a much higher rate of leaks. I write the date and amount of ounces on the label with a sharpie and put the milk in and freeze flat. I then take several of them and put them into a gallon size freezer bag and write the dates that are enclosed on the gallon bag. This helps by double bagging and keeping them grouped. This way the corners on the bags won't get poked and possibly cause the bag to leak. Also, whenever I want to get a bag, I can just dig through gallon size bags instead of tons of little bags floating around! : I usually put one or two days worth in a gallon bag." "Lube Up! It is perfectly safe to put the lansinoh on before pumping and still use the milk. Putting it on before and after pumping really helps to keep you from getting too sore. Purelan100 is also good (and cheaper). I've used this from the beginning. You can also rub Olive Oil on the horns and inside the nipple chamber to reduce friction. Olive Oil is antibacterial so it is helpful. This is also safe to use and pump milk with. I've done both of these and hadn't had a problem. There are times when I seem to get sorer than other times with no real explanation. But, it then goes away as quickly as it came! Who knows!""Taking Care of Baby When Pumping. Once I went hands free and had to do those early morning feedings by myself, I would sit on the floor and prop my baby up in her boppy pillow on the floor. I would get hooked up to the pump and start it and pump while I fed her. About the time she was done eating, I was done pumping and I would put her back in bed and go to sleep myself. This will cut down on your time tremendously! It also helps to do this if your pumping time happens to correspond to your baby's feeding time during the day. The bouncy seat is my best friend! I would put her in the bouncy seat and bounce it with my foot while surfing the net and pumping. It made time fly by and she was content. You may find other solutions if you have older children, or extra help.""Taking Care of Older Children, and Pumping. You may not need a lot of tricks for this one depending on the age of the child, or children. They will probably understand if you just explain that while you are pumping, they can't get up and get things without help. Some tricks other moms had mentioned to keep their other child entertained and kind of reward them would be to go shopping and let your child pick out a special toy or video that she really wants. Then when ever it comes time for you to pump, she can play with it. But, she ONLY gets to play with it when you pump. This helps to make pumping time special for her as well and can help prevent any resentment she might begin to feel."Excessive caffeine may cause problems (like keeping the baby wired!). I avoid caffeine completely (except chocolate) but even if you have 1 drink a day, it won't hurt. Just don't go over board. (More on caffeine here.)

Medications that have Sudafed (pseudoephedrine HCl) in them can affect milk supply! Be careful!
Regular birth control pills will impact milk supply, and some women even have a problem with the mini pill. Breastfeeding (and yes that's what you are doing even if it's not from "the tap") is a good deterrent for ovulation but not 100% so be careful! However, you may find you get hot flashes and things like that. It is normal because your body is acting like it's going through menopause. This suppresses ovulation and allows you to make milk. I thought I was going crazy until I learned this! Ha! Sometimes if you get your period back while pumping, it can decrease your supply. This can be fixed by taking a calcium/magnesium supplement. (I don't have mine back yet and loving it!).
"WHEN DOES THIS GET EASIER?
Around 3 months your supply will probably be established. This is when you can begin to drop the number of times per day that you pump and not see too much of a decrease in total output (this is again, where the spreadsheet comes in handy). That's why if you do the hard work in the beginning, I promise it will pay off when this time comes! If you don't keep up the number of pumps per day in the beginning, you may continue to have to pump a high number of times per day just to maintain a small supply. Of course, this is all dependent on how each woman produces milk. So, you may have such a great supply and so much frozen that you can drop pumps earlier. I began dropping pumps at 10 weeks and by 3 months I was down to 4 pumps per day! I lost a little with each drop but am currently at 50 ounces per day. There's no way my baby will ever eat that much so I see no reason to pump more. You will have to decide for yourself. Once you start dropping pumps, you will need to pump longer at each session (because you've gone longer in between pumps and need longer to empty your breasts). This is also dependent on the woman. I pump about 35-40 minutes per pump now on 4 times because I get another let down at about 36 minutes into it!"

I firmly believe that pumping is 10% physical and 90% psychological. If you try to view this as positively as possible, I think you will have a better outcome. That's why going hands free and doing everything to minimize your stress about pumping is important.

A lot of people don't understand pumping. I still get stupid questions like, "Why don't you just nurse?" Well, DUH! She won't nurse! Ha! You should do whatever makes you comfortable. Sometimes strangers ask me if I'm breastfeeding and if I don't feel like dealing with anything, I just say yes. I am after all! She's just getting it "to go" instead of from "the tap"! Ha!

Mostly though, I do all I can to educate. I know many women who didn't know this option was even possible and wished they had when breastfeeding didn't work out. Don't listen to doctors or nurses who tell you this isn't possible. There just isn't enough wide spread info out there and unfortunately most health care professionals give really bad advice (like only pump for 10 minutes). So, when they hear back from their patients on how they had supply problems or dried up, they just assume it's not possible to pump long term. On my online group, there are women who have been pumping for a year or longer! It is DEFINITELY possible!

Most importantly, if for any reason you just don't want to do it anymore, it is perfectly fine! Remember, a happy mommy = a happy baby. You have to do whatever is right for your entire family. Pumping is hard and can take its toll on you. There is no right or wrong when it comes to how you feed your baby! Remember that! We all have days when we want to wean. That's why support is SOOO important!"

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There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula.

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

When a baby can't breastfeed
Return to work or separation
Making more milk
Storing breastmilk
Pumps
Tips for expressing
Expressing when out and about
Support and Encouragement
Feeding your baby your milk

When a baby can't breastfeed

Breastmilk is especially important for babies who are unwell. And if your baby can't breastfeed because of prematurity he will benefit from every drop of breastmilk you can give him. Some babies have conditions which mean they can't feed at the breast, they can still have your milk. If your full term baby is taking a while to learn to breastfeed, expressing protects your milk production and gives you both time to practice.

The prospect of expressing might seem daunting at first but giving your milk is something you can do that will make a real difference to your baby's short and long term health.

Return to work or separation

When you can't be with your baby, expressing maintains your milk production and helps you avoid engorged breasts during the separation. It also means your baby can continue to have his familiar milk when you're away.

See Working and breastfeeding, and When mum can't be there.

Making more milk

You teach your breasts to make more milk by removing milk. Full breasts signal to your body to slow down milk production, so don't wait for your breasts to 'fill up' before expressing, as this will mean a lower milk supply over time. The more thoroughly and frequently you remove milk from your breasts, especially in the early days and weeks, the more milk you will make and the greater the benefit for your long term supply. If you're expressing to establish milk production, making extra milk in the early days can make it easier to produce more milk later on to keep up with your baby's needs. Milk can always be frozen and used later.

If you are expressing to increase milk production remember a well-attached baby is far more effective than any pump, so do seek help to improve positioning and attachment so your baby can feed more effectively when at the breast.

See How to increase your milk supply.

Storing breastmilk

Breastmilk's antibacterial properties help it stay fresh so it can be safely stored at room temperature for up to 4 hours and in the fridge for up to a week. If away from home you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections.

Pumps

You can simply use your hands to express, or you can buy or rent a pump. Your choice of pump will depend on your reasons for expressing and your circumstances.

If your baby can't yet feed directly from the breast, or if you need to greatly increase your milk production then consider a hospital-grade double electric pump. Such a pump lets you adjust the suction and pumping speed (cycling) and is designed for long-term use. Many hospitals have these pumps available for use on the ward. Some have pumps that you can hire and take home for use during the night, or you could rent from a pump manufacturer.
Even if you rent a hospital-grade pump you may also find a smaller, portable pump useful for when you are out and about.

For expressing while out at work mini electric pumps are a popular choice. These usually come in a carry case for portability.

For occasional pumping a smaller electric or hand pump may be sufficient. Or you could just hand express.

Double pump set: hire pumps and some mini electric pumps come with two pump sets. Double pumping (expressing from both breasts at once) improves milk flow and saves time.

Check fit: check that your pump flange and nipple tunnel fits you comfortably. If too much of your areola is pulled into the tunnel during pumping it can cause rubbing and soreness. If the tunnel is too tight it can inhibit milk flow. Size varies between different makes and models, with some available in a choice of sizes. You may need a different size for each breast.

Suction and cycling controls: look for a pump with separate controls for suction and cycling (speed) so you can vary these to suit yourself.
Cleaning the equipment:
Always wash your hands before expressing milk.
If you're expressing for a premature or sick baby who is still in hospital then you'll need to follow the hospital procedures for cleaning and sterilizing the pump parts.
If your baby is healthy, pump manufacturers generally recommend washing with hot soapy water. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container or bag for longer periods, giving you more time for your baby.

Tips for Expressing

Relax!
Successful expressing has a lot to do with your emotions and how you are feeling. The hormone oxytocin causes the milk in your breasts to be released (let-down). Oxytocin is released when you feel happy and relaxed. It can be difficult to relax if your baby is very ill and in hospital, or if you feel rushed or under pressure. Make a conscious effort to put your mind at ease and use your senses to help trigger milk release. Hold or sit near your baby, or look at a picture or video of him, listen to a sound recording or hold and smell an item of his clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to think about how much milk you are producing-instead, try distracting yourself by reading, listening to music or a relaxation CD, watching TV or even chatting on the phone. Some mothers who express long term build up a pre-expressing ritual that 'prompts' their breasts to release milk.

Use your hands
When hand expressing, the skin-to-skin contact helps stimulate the let-down reflex. And your hands can remove milk from parts of your breast which the pump can't. It's also perfect for the first few days after birth when the small droplets of precious colostrum you make can be collected on a clean teaspoon.

Combine hand expression with pumping
This can help you remove milk more thoroughly than with pumping alone.
Each time you express start with hand expression to stimulate a let-down. Then alternate pumping (double pumping if possible) and massage/hand expression until the flow slows. Finish by hand expressing into the pump flange, or single pumping with intensive breast compressions, switching between breasts until you feel that no more milk can be removed.

Suction and cycling speed
When using a pump, set its suction strength so it feels comfortable. Aim for the lowest suction strength which effectively produces milk for you; higher settings can hurt and won't necessarily produce more milk. Encourage multiple milk releases by mimicking a baby's natural sucking pattern. Increase the cycling speed when milk flow slows and use a slower speed as flow increases again. Aim for at least 3-5 milk releases during the session. If single pumping, switching between breasts several times can help trigger milk releases.

How often?

If you need to establish milk production without breastfeeding your newborn baby, aim to express 8-12 times per 24 hours including at least once during the night to mimic a baby's natural breastfeeding pattern. It might help to plan when to express during the day (e.g. on waking, after breakfast, mid-morning, after lunch, mid afternoon, early evening, twice during the evening and once at night).

Once your milk supply is well established, you may find that you can maintain your milk production with fewer expressing sessions.

You don't need to express at evenly spaced intervals-little and often can be more effective than long sessions.

Express until milk flow stops, then have a short break and come back to it-even a few extra drops of milk or expressing for a few minutes here and there make a difference.

Expressing several times (cluster pumping) during the evening can help you increase the number of times you remove milk per day, so increasing your milk production.

If you're expressing to increase milk production, or because your baby isn't yet feeding well at the breast, do it after or between feeds to ensure your breasts stay well drained. This will stimulate them to make milk faster.

If you are expressing at work or for a short term separation from your baby see our page Workday Practicalities for useful suggestions.

Expressing when out and about

You can breastfeed your baby very discreetly but you may feel much more exposed when expressing. In a public place you can use a lockable baby change facility or ask to use a changing room in a clothes shop. A battery or hand pump can be useful in these situations. Some mothers express in the car, creating privacy with shades on the windows and/ or with a cardigan or scarf. When visiting people you may feel more comfortable and relaxed in a separate room. At home it helps if you can get used to expressing with family around, as retreating to a separate room may reduce how often you do it. But some women just find it easier in a private place.

Support and encouragement

Expressing milk is sometimes challenging but it's always worthwhile, whether you are establishing breastfeeding, producing milk for a baby who is unable to breastfeed, increasing your milk or returning to work. Seek support from people who understand and value what you are doing and ignore comments from those who don't. Your local LLL Leader and Group will be able to give you encouragement and support. To find them take a look at our website.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Written by mothers of LLLGB. Photos courtesy of Lois Rowlands and Rae Vacher Lowe.

Further Reading

How to increase your milk supply
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
When Mum Can't Be There
Comfortable Breastfeeding
Sleepy Baby - Why and What to Do
Storing Your Milk
Bottles and other tools

Other websites
Hand expressing:

Maximizing milk production when expressing:

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Solutions. Mohrbacher, N. New Harbinger Publications, Inc. 2013.
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

References:
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy in printed form from our shop.

Copyright LLLGB 2016

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Expressing Your Milk - La Leche League GB

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

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As promised here is the Padlet containing some trustworthy websites that you may wish to visit before or after your babies arrive. The Blue posts are a quick link to local feeding drop ins and the Green links are all NCT information. Please do not hesitate to get in touch if I can be of feeding assistance.
Amy
078554784** (Tus, Thurs, Fri 10-3pm)
amylloyd79@hotmail.com (Any time)
NCT feeding Support line - 0300 3300 700 (8am - midnight, 7 days a week)

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Avoiding and treating engorgement

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to...
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like
watermelons!

Try these suggestions

Breastfeed your baby frequently from birth-at least 8-12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, hand express frequently until your milk 'comes in', then combine with using a hospital-grade electric breastpump to help establish your milk production and relieve engorgement. Your milk can be given to your baby until he is able to nurse.

Treat engorgement to...

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn't removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces. Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection. Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you're apart from your baby.

Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby's needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly
If you experience engorgement during weaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2-3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second

Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15-20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn't ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he'll take a large mouthful of br east. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on - when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

Reverse pressure softening

works by moving fluid away from the nipple area.

Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.

You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

If this isn't enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red, localised areas of your breast.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby's breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won't Breastfeed
Nipple Pain - why and what to do
Positioning and Attachment
Sleepy Baby - why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

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Engorged Breasts - avoiding and treating - La Leche League GB

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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NCT

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How to help your baby attach and breastfeed | Baby & toddler, Feeding articles & support | NCT

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Many people assume breastfeeding just comes ‘naturally’ but it’s a learning process for many mums and babies. Here are our tips on getting the hang of it…

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NHS

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How to breastfeed

Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to.

There are lots of different positions you can use to breastfeed. You can try different ones to find out what works best for you. You just need to check the following points:

Are you comfortable? It's worth getting comfortable before a feed. Use pillows or cushions if necessary. Your shoulders and arms should be relaxed.

Are your baby's head and body in a straight line? It's hard for your baby to swallow if their head and neck are twisted.

Are you holding your baby close to you, facing your breast? Supporting their neck, shoulders and back should allow them to tilt their head back and swallow easily.

Always bring your baby to the breast and let them latch themselves. Avoid leaning your breast forward into your baby's mouth, as this can lead to poor attachment.

Your baby needs to get a big mouthful of breast. Placing your baby with their nose level with your nipple will encourage them to open their mouth wide and attach to the breast well.

Try not to hold the back of your baby's head, so that they can tip their head back. This way your nipple goes past the hard roof of their mouth and ends up at the back of their mouth against the soft palate.

Read Start4Life's information on 3 common positions for breastfeeding

How to latch your baby on to your breast

Hold your baby close to you with their nose level with the nipple.

Let your baby's head tip back a little so that their top lip can brush against your nipple. This should help your baby to make a wide, open mouth.

When your baby's mouth is open wide enough their chin should be able to touch your breast first, with their head tipped back so that their tongue can reach as much of your breast as possible.

With your baby's chin firmly touching your breast and their nose clear, their mouth should be wide open. When they attach you should see much more of the darker nipple skin above your baby's top lip than below their bottom lip. Your baby's cheeks will look full and rounded as they feed.

Read Start4Life's visual guide to latching your baby on

Video: how do I know if my baby is properly latched?

In this video, a midwife talks about how to check if your baby is latched on properly when breast feeding.

Help and support with breastfeeding

If you have any questions or concerns, you can:

speak to your midwife, health visitor or breastfeeding supporter

call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm, daily)

get online advice about sore nipples and other commmon breastfeeding problems

Visit healthtalk.org to see mums talking about positioning and attaching their babies at the breast.

How to tell if your baby is getting enough milk

You baby starts feeding with a few rapid sucks followed by longer sucks.

Their cheeks stay rounded out, not sucked in, and you can hear them swallowing.

Your baby seems calm during feeding and comes off your breast themselves when they have had enough.

They appear content and satisfied after most feeds.

They should be healthy and gaining weight (although it's normal for babies to lose a little weight in the first week after birth). Talk to your midwife or health visitor if you are concerned your baby is not gaining weight and is unsettled during or after breast feeds.

After the first few days, your baby should have at least 6 wet nappies a day.

After about 5 to 6 days, your baby's poo should stop looking black and thick and they should also have at least 2 soft or runny yellow poos.

See tips on building up your milk supply.

Breastfeeding premature and ill babies

If your baby is in a neonatal or special care unit after the birth, you'll probably be encouraged to try something called kangaroo care once your baby is well enough. Kangaroo care means holding your baby close to you, usually under your clothes with your baby dressed only in a nappy.

This skin-to-skin contact helps you bond with your premature baby and increase your milk supply.

Find out more about breastfeeding a premature baby.

Got a breastfeeding question?

Use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to. There are lots of different positions you can use to breastfeed. You can try different ones to find out what works best for you. You just need to check the following points: Are you comfortable?

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Unicef

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A breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this. You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website. Video not working? Contact us

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LLL

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Breastfeeding is intended to be comfortable and enjoyable-so experiencing painful or sore nipples is a clear sign that something isn't quite right. The information should help you identify the most likely cause of your discomfort and take steps to resolve it.

Whilst there are a number of causes of nipple pain, by far the most common is poor attachment at the breast. Almost always the first step is to try to improve your baby's latch-on. Experiment with different ways of holding your baby and also try letting your baby take the lead: sitting in a semi-reclined position and placing your baby on your front triggers his instinctive feeding reflexes ( laid-back breastfeeding). If improving attachment brings no relief then you may need to consider other causes.

An LLL Leader can tell you more about specific causes and treatments, and further information can be found in our other pages linked below.

You can get skilled help from an LLL Leader online, by calling your local Leader or our national helpline, or through one of our breastfeeding support groups. Getting support and encouragement from other breastfeeding mothers in your local LLL Group may be a real help. The sooner you seek help, the easier it usually is to resolve the problem.

Pain on latch-on that improves as milk starts flowing, caused by:

Holding your breast between your index and middle fingers while latching on, too close to the nipple - Try supporting your breast between your thumb and fingers, keeping your fingers well back from the areola. Sometimes shaping your breast slightly to match the oval of your baby's mouth can help. Or try laid-back breastfeeding, which reduces the need to hold your baby, leaving you with both hands free to shape your breast and help him latch.

Slow let-down of milk - At the start of a feed use gentle massage, relaxation, hand expression and breast compression to get milk flowing before or as your baby latches on.

Pain throughout feed, stops when baby comes off, caused by:

Baby is using tongue incorrectly having become used to bottle teat or dummy -Avoid using teats or dummies. See Nipple Confusion? and Dummies and Breastfeeding

Baby is using his tongue incorrectly possibly due to a tongue-tie (ankyloglossia) - Seek skilled breastfeeding help to assess your baby for tongue-tie. Ask for a referral for assessment and treatment if necessary.

Pain as baby comes off, caused by:

Suction not broken when taking baby off - put a clean finger between your baby's gums to break the suction if you need to remove him from the breast.

OK at first, painful as feed progresses.

Attachment has slipped during feed perhaps because either your breast or your baby has dropped into a lower position - Sit or lie comfortably with your body and arms supported. Keep your baby's whole body against yours. If you recline, some or all of his weight can be supported by your body so your arms aren't holding his entire weight throughout the feed. Let your breast rest at its natural level and bring your baby to breast, not breast to baby. Experiment with different breastfeeding positions and seek further help from an LLL Leader.

Stabbing pains in the breast throughout feed and afterwards.

Raynaud's phenomenon. This is where blood vessels narrow, associated with cold - Eliminate other causes first, especially if breastfeeding has always been painful or your nipples are flattened or wedge-shaped after feeds. Seek medical assessment. Keep warm and avoid nicotine and caffeine, which can be triggers.

When baby is around 3 months or older.

Shallow latch because baby has grown and positioning has not been adjusted - Adjust how you hold your baby so he can latch more deeply onto the breast. Seek further help if needed.

- Offer your baby something cold to chew on before breastfeeds.

Baby bites to get your full attention or clamps down as he releases the breast at the end of a feed - Give your baby your full attention while nursing and have a finger ready to break suction at end of feed if needed.

Skin of nipple reacting to food particles present in baby's mouth - Rinse baby's mouth with water before nursing; avoid offering that particular food for a while.

Hormonal changes associated with pregnancy or your period can increase nipple sensitivity - Hand express to get milk flowing and vary nursing positions. A toddler may be willing to nurse for shorter times until the discomfort decreases.

Nipple shaped normally but pain experienced, commonly at the tip of the nipple.

Breastpump suction too high or pump flange poor fit - Reduce suction or vacuum to a comfortable level. Moisten the flange of the breastpump. Centre your nipple in the flange and/or try a different sized flange. Use breast massage and hand expression to encourage milk to flow. Lubricate your nipples and areolae with purified lanolin suitable for breastfeeding mothers.

Nipple not so prominent-baby having difficulty latching on.

Nipple looks white and misshapen or wedge shaped when baby comes off; pain during and after feeds.

Nipple turns white, possibly bluish, then red.

Raynaud's phenomenon. May experience similar symptoms in fingers and toes, associated with cold - Seek medical assessment. Keep warm and avoid
nicotine and caffeine, which can be triggers.

Soreness or crack in line with the position of your baby's lower lip.

Shallow attachment and/or your baby's lower lip is sucked in - Use your fingers to ease your baby's lower lip out. Take steps to help your baby latch more deeply. Avoid pressure on the back of your baby's head.

Crack across or beside nipple that may or may not bleed.

Crack that weeps or crusts.

Possible infection -Visit your GP who may prescribe an antibiotic. Change breastpads frequently and wash affected area daily with a mild, unperfumed soap.

Nipple area red and/or itchy. Burning sensation and/or flaky skin.

Irritation due to contact with detergent or toiletries, or from clothing rubbing - Identify the cause of the irritation Wash nipples with plain water, avoiding soaps and other toiletries, including proprietary nipple sprays, creams and lotions.

Eczema, dermatitis, psoriasis or impetigo - Seek treatment from your GP.

A blister or white spot on your nipple which may/may not be painful.

Milk blister or 'bleb'. Thickened milk may block milk flow near the opening of the nipple or a thin layer of skin may block the milk duct opening - Apply moist heat using warm compresses or soak the nipple in warm water. Then compress the nipple behind the blockage to try and express the blockage. If this does not bring quick relief seek medical help.

Written by Karen Butler and Sue Upstone and mothers of LLLGB

Further Reading

Positioning & attachment
Comfortable Breastfeeding
Engorged Breasts - avoiding and treating
Hand Expression of Breastmilk
Inverted Nipples?
Nipple Confusion?
Nipple Shields?
Positioning and Attachment (link to a Kindle publication)
Too Much Milk
Tongue-tie
Treating Thrush

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

LLLI Resources
Breastfeeding with Sore Nipples
Other websites
Biological Nurturing™
This information is available to buy in a printed form from the LLLGB Shop

Copyright LLLGB 2016

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Breastfeeding is intended to be comfortable and enjoyable-so experiencing painful or sore nipples is a clear sign that something isn't quite right. The information should help you identify the most likely cause of your discomfort and take steps to resolve it. Whilst there are a number of causes of nipple pain, by far the most [...]

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Breastfeeding Concerns, Problems & Solutions

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Breastfeeding Concerns, Problems & Solutions

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Watch our video to find out the top 5 most-asked questions about feeding.

What if I don't make enough breast milk?

All mums make breastmilk, and supply continues in response to their baby's needs - frequent and effective emptying of the breast drives the supply. If there are problems with supply, then these can often resolve by feeding more often, and making sure the baby is comfortably positioned and effectively attached

Do speak to a midwife, health visitor or breastfeeding counsellor about this, and explore whether your expectations (and those around you) might be making you believe there's a problem with supply, when there isn't.

However, there are a few women whose bodies can't physically make enough breastmilk for their babies, even after problems have been addressed.

There are ways of maintaining breastfeeding, if this is what you want. You can breastfeed alongside the use of formula milk, and/or express your milk and give it to your baby if direct breastfeeding is not working well enough.

I don't know whether I will want to breastfeed

If you're not sure what you want to do when it comes to feeding your baby, you can wait until after the birth and see how you feel then. Your breasts will make colostrum - the first milk you make - which has a number of valuable health properties, and you might decide to give this to your baby even if you don't plan to breastfeed long-term.

Or you might just take it one feed at a time. Your milk will 'come in' about three days after your baby is born and breastfeeding will help you relieve any fullness you experience then.

Whatever your plans, cuddling skin-to-skin with your baby gives you the best time to get to know and bond with each other.

If you stop breastfeeding and start to give formula, it is possible to change your mind and start breastfeeding again but it can take time and patience. An NCT breastfeeding counsellor will be able to give you appropriate support, with no judgment.

I don't know if I will be able to breastfeed and continue my medication

For a very few women breastfeeding is not possible for medical reasons, but you needn't assume that any medicine you need to take rules out breastfeeding.

Check with your GP to see if your medications are safe while breastfeeding, or if not, if there is an alternative. You can also download factsheets on drugs and feeding from the Breastfeeding Network.

What if I develop breastfeeding problems?

Some new mums have a difficult time establishing breastfeeding. This might be more likely after a long or difficult birth, or because they or their baby are not well enough to breastfeed straight away.

Your midwife will be able to help you express milk or bring your baby to you for breastfeeds, if you can't be kept together.

I want to breastfeed. But what if I end up using formula? How will I feel?

If you planned to fully breastfeed, and then use formula either partially or fully, or temporarily or longer-term, then you might have mixed feelings about using formula. You may feel disappointed or angry - even guilty. You might think people are criticising you, or judging you.

We know from research that these negative feelings can be very real. Logically, of course, guilt is misplaced - guilt is what you feel when you deliberately and consciously decide to do something you know to be wrong, and this does not apply with a baby who needs to be fed! But feeding produces emotional responses. The reality of the situation is that most people don't judge or criticise you, but you might still be sensitive to their comments and maybe 'read' them in that way.

Or, you might not have planned to breastfeed at all.

"Regardless of how you feed your baby, you are entitled to support and understanding."

If you're feeling concerned about using formula, share this with someone who can help you feel more positive, and support you.

Is long-term expressing feasible?

Some mums decide for whatever reason not to breastfeed directly, but are still able to express their milk and feed it to their baby in a bottle.

Remember, you can put your baby to your breast whenever you want, even if you decide breastfeeding isn't for you, and whether or not your baby actually breastfeeds; you can give your baby the closeness of skin-to-skin contact, and give the bottle like that, too.
This page was last reviewed in August 2016.
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. Feeding 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 0212.

Cleft lip and Palate association has information on feeding babies with cleft lip or palate.

BLISS, a charity supporting families with premature and special care babies, has information on feeding.

If you are breastfeeding twins or more, The Twins and Multiples Birth Association (Tamba) has a team of 12 NCT-accredited peer supporters who have all breastfed twins and can offer mother-to-mother information and support to families on breastfeeding twins and triplets. If you would like to contact a Peer Supporter, please e-mail tambabreastfeeding@gmail.com.

The Department of Health publishes its ' Feeding your baby' guide, available in hard copy or to download.

NHS guidance is available here.

Bump to Breastfeeding DVD: your midwife should be able to provide a copy for you to borrow, or go to www.bestbeginnings.org.uk

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Breastfeeding concerns, problems and solutions

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Watch our video to find out the top 5 most-asked questions about feeding. All mums make breastmilk, and supply continues in response to their baby's needs - frequent and effective emptying of the breast drives the supply.

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Over coming common Breastfeeding challenges

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Over coming common Breastfeeding challenges

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Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

Latest

Related

Most read

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It's #VolunteersWeek and Harry, Beatrice and Francesco, our dear volunteers and interns, share their experience of volunteering for Best Beginnings. Read more

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Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly. Vimeo Video http://www.vimeo.com/11715916 The rest of the DVD can be viewed by clicking through the links below.

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line 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.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019). Mixed feeding usually means mixing breast and bottle feeding.

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Straightforward Breastfeeding

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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 your newborn, they will not be able to hold themselves in a good position. So you'll have to maintain a comfortable position for both of you for quite long periods. It takes time for your baby to develop the muscles and skills to feed effectively.
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 can also signpost you to your nearest breastfeeding support group.

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

Whichever nursing positions you use, your baby will feed better if they're calm and you're comfortable. Holding them against you, talking to them or perhaps wrapping them securely in a towel or shawl might help if they need to be calmed. Or they might want to have their hands free to touch and stroke your breast.

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

Laid-back, relaxing position

Sitting in a chair

Underarm or rugby ball

Lying down

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. Some mums who have a fast milk flow worry their baby might have reflux if they're having problems, but it could be that their baby needs more control when they're feeding. If this is the case, laid-back feeding 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 get heavier

As your baby grows, they become more active in getting themselves into position, as well as being larger and heavier. 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...

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

Tuck your baby in closely to you.

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

Make sure your baby is facing your nipple - they shouldn't have to turn their head.

Using cushions, special breastfeeding pillows and other supports might help in the early days, but you might be equally comfortable without them.

(UNICEF Baby Friendly Initiative and Public Health England, 2015)

Many women take a while to get used to holding their baby comfortably. Trying different positions can help you find the ones that work best for you and your baby.
Page last reviewed: November 2019
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

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Breastfeeding positions: which are best for you?

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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.

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NCT Breastfeeding Support Line 0300 330 0771

(8am - midnight, 7 days a week)
Association of Breastfeeding Mothers 08444 122 949

(9.30am - 10.30pm every day)
Breastfeeding Network Supporter Line 0844 412 4664
(9.30am - 9.30pm every day)

La Leche League 0845 120 2918
National breastfeeding helpline 0300 100 0212
(9.30am - 9.30pm every day)

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Aslo known as laid back breastfeeding can be comfortable after a caesarean birth

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Many of you requested repeated access to our first webinar series. The Foundations of Biological Nurturing. We appreciate your comments. In this series, Advanced Biological Nurtuirng: Womb to World, for your convenience, if you miss the live sessions, you can view the live presentation from a secure website for as many times as you want for 2 weeks afterwards.

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Informative video explaining  milk production

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Informative video explaining  milk production

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50% amazing 50% mind blowing

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What is co-sleeping?

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Co-sleeping essentially means sleeping in close proximity to your child. It may be in the same bed or just in the same room. Some ways of co-sleeping that different families use are:

Bed-sharing/Family Bed:
Parent(s) sleep in the same bed with the child.

Sidecar arrangement:
Securely attach a crib to one side of the parents' bed, next to the mother. Three sides of the baby's crib are left intact, but the side next to the parents' bed is lowered or removed so that mother and baby have easy access to one another. Commercial cosleeper/sidecar cribs are also available.

Different beds in the same room:
This might include having baby's bassinet or crib within arm reach of the parents (easier at night) or just in the same room; or preparing a pallet or bed for an older child on the floor next to, or at the foot of, the parents' bed.

Child welcomed into parents' bed as needed:
The baby/child has her own bedroom, but is welcomed into the parents' bed at any time. In many families, children start their overnight hours in a separate bed or room, but are welcomed into the parents' bed after a night waking.

Advantages of co-sleeping

Co-sleeping is not the best fit for every family, but it can have many advantages:

Parents often get more sleep.

Babies often get more sleep. Baby stirs and almost wakes up when she needs to nurse, but since she is right beside mom, mom can breastfeed or soothe her back to sleep before she fully wakes up.

Breastfeeding during the night is easier when baby is nearby.

Breastfeeding at night helps to maintain your milk supply.

Sleeping in the same room as your baby reduces the risk of SIDS by as much as 50% [AAP].

Night nursing also tends to prolong the child-spacing effects of breastfeeding.

No nighttime separation anxiety.

Fewer bedtime hassles.

It's lovely to wake up next to a smiling baby!

Creating a safe sleep area for your baby

Any sleep surface that baby uses (including cribs, nap surfaces, or adult beds) should be made safe for baby:

Baby should be placed on his back to sleep.

The sleep surface should be firm. Do not put a baby on a waterbed mattress, pillow, beanbag, sheepskin or any other soft surface to sleep.

Bedding should be tight fitting to the mattress.

The mattress should be tight fitting to the headboard and footboard (or sides of the crib).

There should not be any loose pillows, stuffed animals, or soft blankets near the baby's face.

There should not be any space between the bed and adjoining wall where the baby could roll and become trapped.

Babies (with or without an adult) should never sleep on a sofa, couch, futon, recliner, or other surface where baby can slip into a crevice or become wedged against the back of the chair/sofa/etc.

Bed-sharing Safety

Bed-sharing is just one of the ways that a family might co-sleep, but it is frequently practiced by breastfeeding mothers. One of the biggest issues when it comes to bed-sharing is safety. Some sources publicize bed-sharing as an unsafe practice, no matter how it's done, but there are ways to sleep safely while bed-sharing if you follow guidelines for safe sleep surfaces and safe sleep sharing.

According to the Academy of Breastfeeding Medicine, in their Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding:

There is currently not enough evidence to support routine recommendations against co-sleeping. Parents should be educated about risks and benefits of co-sleeping and unsafe co-sleeping practices and should be allowed to make their own informed decision.

The ISIS Infant Sleep Information Source website notes:

The most recent studies have shown that most bed-sharing deaths happen when an adult sleeping with a baby has been smoking, drinking alcohol, or taking drugs (illegal or over-the-counter medicines) that make them sleep deeply.

Sometimes people fall asleep with their babies accidentally or without meaning to. This can be very dangerous, especially if it happens on a couch/sofa where a baby can get wedged or trapped between the adult and the cushions.

James J. McKenna, Ph.D., a world-recognized infant sleep authority, notes:

In sum, overwhelmingly, bedsharing deaths are associated with at least one independent risk factor associated with an infant dying. These include an infant being placed prone (on its stomach) and placed in an adult bed without supervision, or no breastfeeding, or other children in the bed, or infants being placed in an adult bed on top of a pillow, or who bedshare even though their mothers smoked during the pregnancy therein compromising potentially the infants ability to arouse (to terminate too little oxygen, or to terminate an apnea). Drug use and alcohol have historically been associated with poor outcomes for bedsharing babies so if drugs and/or alcohol are present, please don't bedshare.

General Safety Guidelines for Bed-sharing

If baby is sharing sleep with another person:

Very small premature or low birth-weight babies appear to be at greater risk when bed-sharing, but benefit greatly from co-sleeping nearby but on a separate surface (more).

Do not sleep with baby if you are currently a smoker or if you smoked during pregnancy - this greatly increases SIDS risk (more)

Do not sleep on the same surface as your baby if you are overly tired or have ingested alcohol/sedatives/drugs (or any substance that makes you less aware) (more).

Baby appears to be safest when sleeping beside his/her breastfeeding mother. (More info here for non-breastfeeding parents)

Older siblings or other children should not sleep with babies under a year old.

Do not swaddle your baby when bed-sharing. Baby may overheat (which is a risk factor for SIDS) and a swaddled baby is not able to effectively move covers from the face or use arms and legs to alert an adult who is too close (more).

Other potential hazards: very long hair should be tied up so that it does not become wrapped around baby's neck; a parent who is an exceptionally deep sleeper or an extremely obese parent who has a problem feeling exactly how close baby is should consider having baby sleep nearby, but on a separate sleep surface (more).

Some authorities specifically recommend co-sleeping without bed-sharing, since they feel that not bed-sharing is the easiest way to eliminate any risks of bed-sharing. For example, the American Academy of Pediatrics says, "Room-sharing without bedsharing is recommended- There is evidence that this arrangement decreases the risk of SIDS by as much as 50%."

Night nursing and ear infections?

You might hear that breastfeeding your baby in a lying down position will cause ear infections. Research indicates that this is . Also, keep in mind that with most nursing positions, baby is lying down while nursing anyway - whether mom is or not!

Can co-sleeping cause psychological problems in my child?

People who are uncomfortable with the idea of co-sleeping often suggest that co-sleeping is "less healthy" than the child sleeping alone and will cause psychological damage to the child, cause baby to become too dependent on the parents, etc. Dr. James McKenna counters these suggestions:

In part, this view represents a personal and arbitrary judgment that anyone is entitled to make as long as it is not passed on as scientific fact. Such judgments are based on Western values favoring the perception of how individualism and infant autonomy are best promoted and obtained. No study has shown, however, that the goals for separateness and independence (or happiness, for that matter) are obtained in the individual by, among other things, separate sleeping arrangements for parents and children, nor do any studies demonstrate negative consequences for children or parents who choose to cosleep for ideological or emotional purposes, except when cosleeping is part of a larger psychologically disordered set of family relationships or when cosleeping occurs under dangerous social or physical circumstances. The only studies of the psychological or social effects of cosleeping reveal not negative but positive consequences. One study among military families revealed that cosleeping children receive higher evaluations of their comportment from their teachers than do solitary sleeping children and are under-represented among psychiatric populations, when compared with children who do not cosleep [Forbes JF, Weiss DS: The cosleeping habits of military children. Mil Med 1992; 157:196-200]. Lewis and Janda found that college-age students who coslept as children were better adjusted and more satisfied with their sexual identities and behavior than college-age students who did not cosleep [Lewis RJ, Janda H: The relationship between adult sexual adjustment and childhood experience regarding exposure to nudity, sleeping in the parental bed, and parental attitudes towards sexuality. Arch Sex Behav 1988; 17:349-363] . Clearly, we need to change our conceptualization concerning what constitutes a normal or healthy childhood sleep pattern!

- From: Stein MT, et al. Cosleeping (Bedsharing) Among Infants and Toddlers. Pediatrics 2001 Apr; 107(4); 873-877

Dr. McKenna also notes that

It has never been proven, nor shown, nor is it even probable, that sleeping with your baby has any kind of negative long-term effects when the relationships between those involved are healthy. Instead, experts are finding that cosleeping can help develop positive qualities, such as more comfort with physical affection, more confidence in one's own sexual gender identity, a more positive and optimistic attitude about life, or more innovativeness as a toddler and an increased ability to be alone.

See also: What are the long term effects on my baby of sharing a bed? by James McKenna, PhD.

More information

Co-sleeping safety

Where Babies Sleep from the ISIS Infant Sleep Information Source

Guidelines to Sleeping Safe with Infants by James J. McKenna, Ph.D.

Safe Sleep 7: Is it safe to bedshare? is a free handout for parents, produced by La Leche League International

Infant Health Research: Bed Sharing, Infant Sleep and SIDS from the UNICEF UK Baby Friendly Initiative
Attachment Parenting International - Infant Sleep Safety
Babies sharing their mothers' beds while in hospital: a sample policy from the UNICEF UK Baby Friendly Initiative

Guideline on Co-Sleeping and Breastfeeding, Clinical Protocol Number 6 from the Academy for Breastfeeding Medicine

AAP Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment (Oct. 17, 2011)

Logistics: Making co-sleeping work for your family

Rooming-in at the Hospital: Assessing the Practical Considerations by Martin Ward-Platt and Helen L. Ball, from Mothering, Issue 114 September/October 2002.

Excerpts from the book Good Nights - The Happy Parents' Guide to the Family Bed (and a Peaceful Night's Sleep!)

How to make sleep sharing work from BabyCenter.com, with input from James McKenna, PhD

Co-sleeping: Yes, No, Sometimes? by William Sears, MD

Collections of co-sleeping articles

Sleep & Family Bed articles from Mothering.com

Sleep & Family Bed Articles at The Natural Child Project

Making & defending the decision to co-sleep - Research and opinion articles on co-sleeping

Responding to criticism @ is written about breastfeeding, but can be applied to any other parenting choice that draws criticism from others. Some of the links included are directly geared toward co-sleeping.

Safe Sleep & the Breastfed Baby from La Leche League Great Britain

What Every Health Professional Should Know About Sleeping with Baby by James J. McKenna, Ph.D.

Does Bedsharing Increase the Risk of Death for Younger Infants? by Tracy Cassels BA, MA, PhD, at Evolutionary Parenting, discusses this article: Colvin JD, Collie-Ackers V, Schunn C, Moon RY. Sleep environment risks for younger and older infants. Pediatrics 2014; doi:10.1542/peds.2014-0401.

Interview with James J. McKenna, Ph.D. from the Huffington Post

Should the AAP Sleep Alone? by Melissa Bartick, MD, MSc, from the Academy of Breastfeeding Medicine blog, April 2014

Somebody's been sleeping in my bed! by Amy Spangler, from Amy Spangler's Feeding Times, December 2004.

Ten Reasons to Sleep Next to Your Child at Night by Jan Hunt at The Natural Child Project

Sleep With Me: A Trans-Cultural Look at the Power - and Protection - of Sharing a Bed by Meredith F. Small

Go Ahead - Sleep With Your Kids by Robert Wright

Annals of Parenthood: Sleeping with the Baby - Which Side of the Bed Are You On? The Author and His Wife Defied the Experts by John Seabrook. This article is reprinted from an article first published in the Nov. 8, 1999 issue of the New Yorker Magazine, and includes the interview with Dr. Richard Ferber where he said

"...There's plenty of examples of co-sleeping where it works out just fine. My feeling now is that children can sleep with or without their parents. What's really important is that the parents work out what they want to do."

Research and discussion of research

Mother-and-Baby Behavioural Sleep Laboratory Professor James J. McKenna's area at the University of Notre Dame website. Dr. McKenna is best known for his pioneering studies of the differences between the physiology and behavior of solitary and co-sleeping mothers an infants-and the connection these data might have in addressing SIDS risks. He is a Professor at the University of Notre Dame and runs the University of Notre Dame Mother-Baby Behavioral Sleep Laboratory.

Parent-Infant Sleep Lab, Department of Anthropology, University of Durham, UK. The Parent-Infant Sleep Lab is the home for a team of researchers led by Dr Helen L. Ball who are examining various aspects of infant sleep and night-time parenting. Their website includes research papers, project descriptions, presentations and other resources.

Why the Conflicting Results on Bedsharing Risk? by Tracy Cassels BA, MA, PhD, at Evolutionary Parenting

Thompson J, Tanabe K, et al. Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics. November 2017, volume 140 / issue 5.

Fleming P, Blair P, Mckenna J. New knowledge, new insights, and new recommendations: Scientific controversy and media hype in unexpected infant deaths. Arch Dis Child. 2006;91(10):799-801.

McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005 Jun;6(2):134-52.

Okami P, Weisner T, Olmstead R. Outcome correlates of parent-child bedsharing: an eighteen-year longitudinal study. J Dev Behav Pediatr. 2002 Aug;23(4):244-53.

Baby bedsharing fears dismissed. Discussion of the above Okami study from BBC News.

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Co-sleeping and Bed-sharing * KellyMom.com

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Check out stylish, functional breast pump bags and accessories from our sponsor Sarah Wells Bags. Co-sleeping essentially means sleeping in close proximity to your child. It may be in the same bed or just in the same room. Some ways of co-sleeping that different families use are: Bed-sharing/Family Bed : Parent(s) sleep in the same bed with the child.

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What if I need to formula feed my baby away from home? | Baby & toddler, Feeding articles & support | NCT

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Here we explain how to prepare a bottle for going out and how to make up formula safely when you are out...

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Clear guidelines on how and where to store breast milk

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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

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

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

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

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

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

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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Herts
http://www.hertsdirect.org/services/edlearn/css/childrenscentres/breasfeedingsup/

Cambs http://www.cuh.org.uk/pregnancy-labour-and-birth/going-home/caring-for-your-baby/feeding-your-baby/community-support

Bucks http://www.buckshealthcare.nhs.uk/Health-visiting/breastfeeding-your-baby.htm

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Friendly local drop ins.

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Baby Brasseries are café style breastfeeding support groups around Bedfordshire with a welcoming atmosphere where breastfeeding mums can meet and support each other, have a hot drink and also find help and support with breastfeeding issues. We welcome mums to attend with older siblings and encourage pregnant women to join us and talk about breastfeeding, meet the team and become familiar with the group. This may help new mums to feel more confident to attend once the baby has arrived.
http://eput.nhs.uk/wp-content/uploads/2015/08/BBAudio.mp3 A Mother's Voice
There will either be a member of the 0-19 Team or a Children's Centre worker, as well as our Bedfordshire Breastfeeding Buddies. Within Bedfordshire there are currently 5 Baby Brasseries in Bedford Borough and 8 in Central Bedfordshire.

How to contact service & hours of operation

Lakeview Village Hall, Wixams - Tuesday - 10.00 - 11.30
Brooklands Avenue, Wixams, Bedford MK42 6AE

Central Bedfordshire
Downside Neighbourhood Centre, Dunstable South - Monday - 12.00 - 13.30
Downside Lower School, Oakwood Avenue, Dunstable LU5 4AS
Tel: 01582 666403
Dates with effect from 07 April 2017
For help and support with breastfeeding outside of normal working hours the following contact details may be useful.

National helpline numbers which are charged at local rates
National Breastfeeding helpline number - 0300 100 0212 - 9.30-21.30
NCT Breastfeeding helpline number - 0300 330 0771 - 08.00 - 22.00
Breastfeeding Network supporter line - 0300 456 2421 - 09.30 - 21.30
(Bengali and Syleti)
La Leche League helpline number - 0345 1202918 (24hrs)

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Baby Brasseries are café style breastfeeding support groups around Bedfordshire with a welcoming atmosphere where breastfeeding mums can meet and support each other, have a hot drink and also find help and support with breastfeeding issues. We welcome mums to attend with older siblings and encourage pregnant women to join us and talk about breastfeeding,...

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Whether you're breastfeeding, formula-feeding or both, you'll find lots of useful articles about feeding here. Plus, tips on introducing solids when you're ready.

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Search Results | Hertfordshire Directory

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Getting help with breastfeeding, at the time you need it, is really important. Please don't be afraid to ask for help. BfN Registered Volunteers want to help you with breastfeeding. It is why they have done training and offer their time. Call the National Breastfeeding...

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Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you.

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# data[].attributes.attachment_link.description
Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you. Let's use the actual video below to see the differences. We have always felt that videos speak louder than words. See below. As you have seen, ViewPure removes all distracting comments and side-bar related videos.