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Find an antenatal breastfeeding workshop

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What’s on for expectant parents – Bolton Council

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Antenatal appointments, birth registration, support for mums and dads to be

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Breastfeeding Videos - Global Health Media Project

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Search your language - breastfeeding videos

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Search your language - breastfeeding videos

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Click on All Languages to find videos with breastfeeding information in your preferred language.

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Breastfeeding Videos - Global Health Media Project

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© 2023 Global Health Media Project | a 501(c)(3) nonprofit

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Building a strong
relationship with your unborn baby helps their brain development - here's why and how you can do this

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The early relationship you, your partner and family have with your baby's really important. How you meet their needs and care for them, shapes how their brain develops. This is as true before they're born as when they arrive.

Attachment

The way your baby builds these close relationships is called attachment. It lays the foundations for them to feel safe and secure.

Babies are totally dependent on those who care for them to keep them safe.

When you give your baby responsive care and lots of attention, it will help them manage their feelings and have safe and healthy relationships in the future.

Babies need their carers close at all times. Staying close to your baby will help you notice when they're trying to communicate with you.

Your baby's needs are met by forming a close relationship with you. It's usual for babies to form attachment with any adult in the family group who provides consistent care.

Bonding before birth

Your baby can hear you from at least 16 weeks, and perhaps earlier.

Babies hear their mother's voices most clearly, but anyone can talk and sing to them - your baby will love to hear from anyone.

This helps your baby:

to get to know voices, which will help them feel safe and secure

tune up their hearing and get ready for when they will eventually talk

Talking and singing to your baby is also good for their development.

Talk or sing to your baby

Find a quiet time when you and your baby can focus on each other and use a tuneful, sing-song voice.

It doesn't matter what music or song - if you like it, so will your baby. Never put headphones on mum's tummy though, as it's too loud for your baby.

If you feel a bit silly talking to the bump, don't worry - lots of people do. If you can't think of anything to say, just chat about the day or share a story.
For tips about reading and singing to your baby before birth, visit the Scottish Book Trust Read more about building a relationship with your baby after they're born
Bonding takes time

Parents don't always feel a great rush of love and bonding straight away. It comes in time.

Many parents have other feelings such as fear along with love, especially if it's a first baby. It's what you do that counts.

Attachment and love aren't the same thing. Some parents love their children but can't keep them consistently cared for and safe and if that happens it can cause attachment issues. If you're worried about your safety or your baby's, tell someone you trust and ask for help.

Further information and other languages and formats

Translations and alternative formats of this information are available from Public Health Scotland.

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How your baby's development is helped by building a relationship with them early in your pregnancy

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"Is this normal?" The first week with a breastfeeding newborn

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Normal Newborn Behaviours - What to Expect in the First Week

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Normal Newborn Behaviours - What to Expect in the First Week

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An explanation of what to expect in the early days, and normal behaviour for a newborn baby

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

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

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

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

Two things that are normal:

1.Babies want to be close to you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Breastfeeding can sometimes be challenging - here's what to do in some common situations. Always speak to your midwife, health visitor or a member of the feeding team with any concerns

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Get help with common problems like sore nipples and breast pain.

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Where to find support if you live in Bolton

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Skin-to-skin contact - Baby Friendly Initiative

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Holding your baby in skin to skin - benefits and safety

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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This leaflet explains the benefits of skin to skin and how to do this safely

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Skin to skin leaflet online version English

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Skin-to-skin contact - Baby Friendly Initiative

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Holding your baby in skin to skin - benefits and safety

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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Drugs Factsheets - The Breastfeeding Network

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Useful information about medications and safety with breastfeeding. You can also contact the Infant Feeding Team with any queries.

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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This video shows how a baby attaches to the breast, and why good attachment is important

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding

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Where to find support for breastfeeding if you live in Salford and Bury

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Previous Next Supporting mums on their breastfeeding journey in Salford and Bury We empower women to be open about their breastfeeding experiences and inspire others to breastfeed for longer. We have been supporting mums on their breastfeeding journeys since 2014 and we believe that every mum should have the chance to have a happy, safe ...

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Supporting your baby during skin to skin

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Out & About With Your Breastfed Baby - La Leche League GB

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Preparing to go out with your breastfeeding baby

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Early days

After giving birth to your baby, you may prefer to be close to home. Taking things easy and lots of breastfeeding will help you regain your strength and build up a good milk supply while getting to know your baby. When you feel ready to go out, a short walk or drive to your local shops or to visit a friend or relative may be enough. Remember to listen to your body and pace your activity to your energy level. Going out can prevent you from feeling isolated and give structure to your day. Breastfed babies are very portable-with your baby in a sling or carrier, you may only need a nappy or two and away you go. Babies will often sleep contentedly when carried close to their mothers, so you may even get there and back while your baby is asleep.

Public places

Mothers often worry about breastfeeding in public spaces such as shops and cafés. But the law protects you when you breastfeed in a public place and on premises. It is against the law to discriminate against a breastfeeding mother. A crying baby will guarantee an audience so watch for early feeding cues so you have time to find a suitable place. Other people probably won't notice you're breastfeeding if you're relaxed and confident-especially if you continue chatting or reading the menu and avoid eye contact with passers-by. If you prefer to keep covered then lifting your top from the waist means your baby hides your tummy and you remain covered on top. A layered look can help-depending on the weather try an open blouse, shirt or cardigan over a t-shirt. A breastfeeding vest can cover your tummy. Some baby slings and carriers can also hide a feeding baby. Or dress your baby in a sun hat. If you feel self-conscious, try practising in front of your partner, a friend or a mirror.

Planning ahead

Handling leaks

Breast pads inside your bra will provide some protection from leaks if you experience them. Some breast pads even prevent leaking. Avoid plastic backed pads, which can trap wetness next to the skin and cause soreness. If you feel the tingling of your milk beginning to flow, pressing hard on your nipples for several seconds can prevent leaking. You can do this by crossing your arms tightly across your chest and pressing firmly on your nipples with the palms of your hands. Hold for a few seconds before releasing and all should be well. If it doesn't work first time, try again for a little longer. If your breasts feel full, this is a sign to take the time to nurse your baby. Patterned fabrics, layered clothing and scarves can all hide evidence of leaks.

Where to breastfeed

If you prefer privacy, many public places have mother and baby rooms where you can sit to nurse and change your baby's nappy. Some clothes shops will make a changing room available to a nursing mother at quiet times. Mothers breastfeed in many public places with seating areas: shopping, leisure and visitor centres, libraries, museums and more. Look out for quiet spots with fewer distractions as some babies insist on looking around instead of feeding when there's a lot of hustle and bustle! A town garden or park may be an option when the weather is good. Or visit a café or the family room of a pub and quench your thirst at the same time. You can also breastfeed while walking with your baby in a sling.

A flexible approach

Some babies find it difficult to cope when travelling, on holiday, visiting family etc if they have a strict routine which can't be followed because of travel arrangements and lack of access to a separate room for sleep. When you follow your baby's natural feeding and sleeping rhythms such problems are less likely and you may feel more relaxed about visiting relatives or taking a family holiday.

Time for social activity

Many new mothers find it helpful to meet up with other breastfeeding mums. Local LLL groups are a good starting point-offering mother-to-mother support and the chance to socialise. You'll also be able to see how other mothers handle breastfeeding in a public place, and gather ideas. You may well develop good friendships to support you in your new mothering role.

Travelling with your baby

Public transport When hopping on and off buses and trains a carrier or sling is a real boon, with or without a pushchair. If you take a pushchair, modern train doors are usually wide enough and many buses have low floors for easy access. A backpack can be a useful handbag, leaving your hands free for your baby.

In the car Plan to stop frequently and give your baby breaks from his car seat. It can help to time long journeys for when he usually sleeps. Avoid rush hour if you can. Place your car seat where you can safely see your baby as you drive. An extra mirror can be useful if your baby travels in the back. Bear in mind that if your baby gets upset this can distract you while driving. Letting someone else drive when possible leaves you free to calm your baby. Babies are usually happier in the car if they can see mum or another adult. You could talk or sing to your baby to reassure him you are there. If your ba by doesn't like the car it may be easier to take public transport so you can hold and nurse him as you travel.

Flying A sling or soft carrier can be really convenient at the airport. It can also give you privacy as you nurse duringthe flight. It can be useful to request a bulkhead seat to give you more space. Alternatively having an aisle seat allows you to get up easily if your baby is restless without disturbing other passengers.

Take a few of your baby's favourite toys and, if possible, familiar snacks if he has started eating solid food. Breastfeeding during take off and landing can help equalize the pressure in your baby's ears, keeping him comfortable. However, to comply with seat belt regulations you may need to nurse in an unusual position. If seat belts make breastfeeding too awkward, offering your baby a finger or suitable toy to suck on may do the trick. When the seat belt light goes out, you can nurse him as normal.

Special Occasions

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

Further Reading
Supporting Women's Right to Breastfeed
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010.
Breastfeeding in Public Spaces

You can buy this information in printed form from the LLLGB Shop

Copyright LLLGB 2016

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Out & About With Your Breastfed Baby - La Leche League GB

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Early days After giving birth to your baby, you may prefer to be close to home. Taking things easy and lots of breastfeeding will help you regain your strength and build up a good milk supply while getting to know your baby.

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Read about how to position your baby comfortably for feeding

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Getting your baby positioned and attached comfortably at the breast is an art-mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they've breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed.
But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too.
Many babies can find their way to the breast by themselves, especially if they haven't been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader.

When all is going well, specific holds and positions don't really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.

Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.

There's no 'right' or 'wrong'. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules-but there are a few principles that can help you work out what to do if things aren't going well: see Latching on - getting a good attachment.

Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant. Attachment describes the way he latches onto the breast.

Tips for getting started
The laid-back approach
Latching on - getting a good attachment
Different breastfeeding positions
As time goes by

Tips for getting started

If it hurts then make changes

If it doesn't feel right to you, then it isn't fine, whatever anyone says. Pain is your body's way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed.

Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural.

Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don't be afraid to use what feels right for you and discard the rest.

Your baby needs to be calm

You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn't obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include suckingtheir hand, smacking their lips, turning their head towards you, or fussing. They won't latch well if they are distressed. If your baby is upset take time to soothe them. Hold them upright against you, stroke them and talk to them. A little expressed colostrum or breastmilk given on a spoon can help to calm them if they are desperately hungry.

Your baby needs full body contact

When your baby is held in full body contact against you, they will feel stable and be better able to coordinate their movements. Laid back positions ensure full body contact. If you're sitting up, you'll need to hug your baby in as tightly as if you were standing up holding them against you. Babies who don't feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren't always necessary. So wait until after your baby's latched on, and then tuck them in only if you need them for support.

Some babies need time

Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using laid-back breastfeeding positions with skin-to-skin contact can maximise your baby's natural instinct to breastfeed. If your baby isn't latching or feeding well seek help from an LLL Leader and read our page My Baby Won't Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.

Laid-back breastfeeding

Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid-back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby's birth. There is more and more evidence that laid-back breastfeeding positions (also called Biological Nurturing) help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks.

Laid back breastfeeding is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don't have to be in bed; the sofa or a reclining chair is a comfortable alternative.

You can also use laid-back breastfeeding principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of their weight to be supported by your body and less by your arms. It isn't safe to sleep with your baby on a chair or sofa.

Sleepy babies

If your baby is sleepy, perhaps because of birth interventions, then using laid-back positions with skin-to-skin contact can encourage your baby's interest in feeding. In laid-back positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage them to latch.

How laid back breastfeeding works

You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.

Your baby lies against you, their whole front against your body, vertically or at any comfortable angle.

Your baby feels stable and secure and their instinctive feeding reflexes are triggered, prompting them to bob their head and seek out the breast.

Gravity helps them latch deeply and stay latched, rather than hindering the process.

Your hands are free to support and caress your baby and help them attach.

Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.

There are no rules-you and your baby are free to work it out between yourselves.

Latching on - getting a good attachment

Your baby needs to tip their head back and reach forward with their lower jaw. As your baby tips their head back their jaw drops and their mouth opens wide, so they can anchor their chin and lower lip firmly against your breast. If they have to tuck their chin in to reach the nipple they won't be able to open their mouth so wide. Tipping their head back also makes a deep latch possible, swallowing easier, and frees up their nose for comfortable breathing. In laid-back positions lay your baby with their head between your breasts. If you are sitting up, keep your supporting hand away from the back of their head. Babies tend to creep forward, so try shifting them so that their eyes and nose are opposite the nipple to encourage them to reach forward and anchor their chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as they latch brings their chest in closer and helps their head tip back.

Their lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich-the principle is the same. Your baby's lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where their chin and lower jaw need to be so their lower lip and chin can sink into your breast. Your baby's chin needs to stay firmly in contact with your breast.

Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.

The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with their nose. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. Avoid pressing your nipple into their mouth. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. You can then slip your finger out.

Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:

Let your breast rest at its natural level. It can be tempting to lift your breast and move it towards your baby's mouth. If you do this, your baby probably won't get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of their mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking them in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after they are well attached.

Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With their body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you'll feel a lot more comfortable too.

It's easier to latch onto a softer breast. It's much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk too if needed.

Your baby needs to choose his own timing. Your baby will probably do best if they pick the moment to latch on. You can help by supporting them in a position that lets them do this when they are ready. To encourage your baby to gape hold them close against you, close enough to the breast so they know the nipple is there, but where they can't quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before they are ready to open wide.

The natural or laid-back breastfeeding positions shown in the following videos can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with their whole front against you and their body completely supported by yours.

Best Beginnings' video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.

This video demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:

This video shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:
http://m.raisingchildren.net.au/articles/breastfeeding_attachment_video.html

Using different breastfeeding positions

The cradle hold

Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby's body firmly against you to give them stability because their weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby's head and to keep them high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against your body. It may not be the best choice at first if you're experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you're more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.

Your baby's whole front is against your tummy, their hip resting on or near your thigh, tucked around you like a comma. Their chest will be snuggled into the breast and your nipple near their nose.

Their head is resting on your forearm and/ or wrist (not the crook of the elbow).

As your baby opens their mouth to take the breast, pull their body in firmly against you.

Once your baby is attached, settle back a little for your own comfort and so that more of their weight is taken by your body.

Laid back breastfeeding

Remember that Biological Nurturing™ positions aren't just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.

The cross-cradle hold

The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby's head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.

Cross cradle

Tuck their whole front against your tummy, their hip near or resting on your thigh.

Your hand supports their neck (not the back of the head) with your palm between their shoulder blades.

Your other hand is free to shape or stabilise your breast if needed.

Make sure your baby isn't too far round the front-line them up so their eyes and nose are near the nipple.

As your baby opens their mouth, give a little push with the palm of your hand to bring their chest in close against you.

This will help their head tip back and let them plant their chin deeply against your breast.

Once your baby is attached you can bring your other arm round to support your baby's body and settle back a little for your own comfort and so that more of his weight is taken by your body. Hold your baby with the arm opposite to the breast he's going to latch onto.

The underarm (clutch or rugby) hold

The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby's head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby's length.

Your baby's front is close against your side, with your hand under their shoulders and neck.

Your elbow keeps them tucked closely against your body.

Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.

Make sure your baby isn't too far round the front. You may need a cushion between your back and the chair back to allow room for your baby's length and prevent them pushing themselves forward with his feet.

Side lying

This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it's well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.

* Lie on your side, with your knees bent up and a pillow under your head.
* Place your baby on their side facing you so that their body and your body form a V-shape, meeting at your hips, with your nipple level with their nose or eyes.
* You can put your arm under your baby's head as shown, or up by the pillow with your baby lying on the bed.
* As your baby latches, give a little push between their shoulder blades to bring their chest in closer and help their head to tip back and their mouth to
open wide.
* You may find it helpful to tuck a small pillow or rolled blanket behind the small of your back and/or between your knees.

Standing up

At some feeds babies just do better if you stand up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let them lead the way. Try angling their legs down instead of holding them horizontal, and see what happens. Or try starting with them against your shoulder, supporting them as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.

As time goes by

Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

Mastitis
Beginning Breastfeeding
Breastfeeding Your Baby - easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding - easy read
Skin-to-Skin
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Inverted Nipples
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nipple Shields
Nursing Supplementers
Safe Sleep & the Breastfed Baby
Sleepy Baby - Why & What To Do
Tongue Tie
Too Much Milk & Oversupply

LLLI Resources
Position to breastfeed

Other resources
How to do Biological Nurturing: www.biologicalnurturing.com/video/bn3clip.html
Best Beginnings videos to watch online: www.bestbeginnings.org.uk/watch-fbtb

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.

This information is available to buy in printed form form the LLLGB Shop.
It is also available in kindle edition.

Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively.

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Parenting when your partner breastfeeds - La Leche League GB

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There are lots of ways that you can bond with and take care of your baby when you are not feeding.

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All parents have a unique relationship with their baby, which grows and develops as their baby does. A breastfeeding mother builds a special relationship with her baby through the act of breastfeeding. But children build important relationships with other adults in their lives, beginning with those they see most often. This may be the baby's biological father, but it can be anyone else who lives with mother and baby and who is a constant presence in their lives. LLL recognises that families come in many different shapes and sizes. In most relationships there will be a non-breastfeeding partner although sometimes both partners may breastfeed. An LLL Leader can give you more information about this option.

A different person

You are different from your breastfeeding partner, with a different feel, a different sound and a different smell. At the end of a long day a new and different person with a fresh pair of arms may be just what is needed to settle your tired and fractious baby.

Carrying and comforting

The love hormone oxytocin, released when a mother breastfeeds, promotes a feeling of closeness and connection with her baby. But oxytocin isn't limited to just nursing mothers. It works in a similar way when you hold, cuddle and care for your baby. A great way to experience continuous close contact with your baby is to use a carrier or sling. Babies usually love them and it's a handy way to settle a baby. At times when your baby is fussy or uncomfortable and nothing else works, you might also try the colic hold (see picture overleaf).

Breastfeeding-the obvious choice

Breastfeeding is the normal way to feed and comfort a baby. It is protective against asthma, coeliac disease, cot death, diabetes, diarrhoea and tummy upsets, ear infections and heart disease, to name but a few. What is more, the practical everyday benefits include:

No getting up to prepare bottles during the night.

Sweet smelling nappies.

No feeding equipment and expensive formula to buy for your baby.

Less to take with you when you go out as a family.

Early Days

In the early days, your baby will probably want to breastfeed a lot of the time he's awake. At this stage, your partner may only be managing to eat, sleep and nurse the baby. This is normal. At first his mum and nursing will be the centre of your baby's world. A baby's bond with his mother is the basis for all other relationships. Encouraging that bond will strengthen his love for you later.

As life settles down

You and your partner will probably both need time to adjust to your new roles. Many couples say they didn't feel prepared for the emotional upheaval they experienced on becoming parents. A breastfeeding mother usually feels an intense connection with her baby, both emotionally and physically, due to breastfeeding hormones and the practical need to stay close to feed the baby. It can be easy to feel a bit left out of this. Getting involved in practical ways such as nappy changes, baths, walks and playtimes will help you bond with your baby. Caring for your baby teaches him that love comes from interacting with people as well as from food. Your partner will love you for it and so will your baby.

Maintaining your closeness as a couple

Almost every sexual relationship changes with the birth of a baby. Daily life can be exhausting and your partner may need time to recover physically. Resuming your sex life together may take time, but simple gestures like kissing, holding hands and sitting alongside her as she nurses your baby can keep you connected and remind you of your love for one another.

Support for you

Sometimes there is so much focus on the health and well-being of mum and baby that partners may be overlooked. Post-natal depression can affect either person in a couple, especially after a difficult birth. Tell your partner and seek help from your GP if you are in this situation

What partners can do
Your partner needs practical help and emotional support while recovering from the birth. Mum and baby need to establish a strong bond, plentiful milk production and an enjoyable breastfeeding relationship. You can help this happen with your attitude, actions and words:

Support mother-baby bonding. The most important thing you can do for your baby's future health and well-being is to be a breastfeeding advocate.

Make the most of your parental leave. Take as long as you can manage. Take it when the new mum and baby would otherwise be at home alone. Concentrate just on the needs of your partner, baby and any other children. Let everything else wait.

Fix it so the household 'ticks over'. Take charge and welcome help from others. You could also buy in help: a cleaner, supermarket delivery, mother's help.

Guard against too many visitors. Let others know when your new little family needs to be alone. Protect mum and baby from over-enthusiastic visitors and callers, and try to ensure you all have some peaceful uninterrupted time together. Turn off the phone and put a 'do not disturb' sign on the front door.

Look after your other children. Provide fun activities and opportunity for exercise. Try to meet their needs for attention, sleep and healthy food.

Protect your partner from well meaning but unhelpful advice that undermines breastfeeding-even if it comes from your own mum!

Seek skilled help if any breastfeeding problems crop up. Problems are more easily solved if you call for help straight away. Problems with soreness or not enough milk can usually be fixed easily if you track down the right help early on. So keep looking until you find that help. New mums are often given a contact number for a breastfeeding counsellor or peer supporter. Encourage your partner to give her a call.

Respect your partner's instincts. Nature isn't daft and maternal instincts have ensured the survival of our species for millions of years. A new mum's hormones motivate her to mother her baby through breastfeeding.

Fight off any pressure to separate mum and baby. Help mum and baby spend lots of time snuggling together in the hours and days after birth.

Search for details of local mums' breastfeeding groups. Encourage your partner to attend before and after birth so she gets this vital mother-to mother contact. She will get ongoing support to carry on breastfeeding as long as she and baby want. It can make all the difference.

Admire and praise your baby's mother. Your love and encouragement will work wonders.

Firmly resist pressures to feed baby anything other than mum's own milk before he is six months old. Your baby doesn't need other foods until he can sit up and begin to feed himself. Even then, breastmilk carries on being an important food for older babies and toddlers.

Meet your baby's need for you. Spend time with your baby and enjoy building your own unique relationship.

Getting help

LLL Leaders are skilled at helping new mothers. You or your partner can call our helpline. for information and support. Local LLL groups are a source of support and encouragement that can make all the difference. Some groups also run meetings for couples. Visit here for further information.

Further Reading

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

WHY PERINATAL DEPRESSION MATTERS, Scotland, M. London: Pinter & Martin, 2016.
LLL Information Sheets and Leaflets Amazing Milk Birth and Breastfeeding Breastfeeding Basics Dummies & Breastfeeding Is My Baby Getting Enough Milk Out and About With Your Breastfed Baby Rhythms & Routines Safe Sleep and the Breastfed Baby Smoking & Breastfeeding Supporting a Breastfeeding Mother
This leaflet and those above are available from La Leche League GB SHOP,

This information sheet is dedicated to the partners and families of LLL Leaders. Their support and encouragement enables Leaders to volunteer their time to give breastfeeding help to many other families.
If you wish to fund an LLLGB leaflet dedicated to a loved one, please contact us at the address below. Written by Sue Upstone, Deborah Robertson & mothers of La Leche League Great Britain.
La Leche League Great Britain 2018

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Parenting when your partner breastfeeds - La Leche League GB

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All parents have a unique relationship with their baby, which grows and develops as their baby does. A breastfeeding mother builds a special relationship with her baby through the act of breastfeeding. But children build important relationships with other adults in their lives, beginning with those they see most often.

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Where to find support for breastfeeding if you live in Wigan

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What To Do About Nipple Pain  - Global Health Media Project

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Breastfeeding should not be painful - if you are in pain ask for help - see the 'Where to find support' section.

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Nipple pain in a breastfeeding mother is common but not normal. It often happens when mothers first start breastfeeding and is usually due to a baby not attaching deeply. This video shows how nipple pain happens and what a mother can do to help herself.

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What To Do About Nipple Pain - Video - Global Health Media Project

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Nipple pain in a breastfeeding mother is common but not normal. It often happens when mothers first start breastfeeding and is usually due to a baby not attaching deeply. This video shows how nipple pain happens and what a mother can do to help herself.

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Blocked ducts can usually be resolved with some simple measures

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If you're breastfeeding and you feel a small, tender lump in your breast, you might have an inflammation in your milk duct, sometimes referred to as a blocked duct. But what is it and what causes it?

What causes inflammation of a milk duct?

The glands that make milk in your breasts are divided into segments. A bit like an orange, in fact. Your milk ducts are the narrow tubes that carry milk to your nipple from each segment (NHS, 2022).

It used to be thought that there was a plug of milk blocking the tube, causing a lump in the breast tissue, but recent evidence shows it is the tissue swelling up which causes the narrowing of the ducts (Mitchell et al, 2022).

You can get an inflamed milk duct when there is an excess of milk in your breasts. The excess of milk can irritate the ducts and cause the inflammation. You may have an abundant supply of milk, especially in the first few weeks, or feeding and expressing between feeds can cause an excess of milk (Mitchell et al, 2022).

Your baby missing feeds, or if you are delaying feeds, or weaning from the breast by reducing breastfeeds, can all lead to an excess of breastmilk for a short period of time (Mitchell et al, 2022).

Sometimes a blocked milk duct can happen if your breast tissue is irritated for other reasons. This might be something putting pressure on the breast or that has bruised it; for example, a tight bra or tight clothing, bag strap, seat belt, baby carrier; rigorous massage of the breast or an awkward sleeping position where you're putting weight onto your breast (NHS, 2022).

Symptoms of an inflamed milk duct

An inflamed and narrowing milk duct will cause the area of the breast to feel hard and painful. Depending on your skin tone, it might also be red or darker, warm to the touch and slightly tender (NHS, 2022). When your baby feeds on the side of the narrowed duct, they might fuss because they're getting your milk more slowly than usual. There may be some temporary relief after the baby has fed and the pressure has been reduced on the duct.

Reducing the inflammation of the duct prevents it from developing into a more widespread inflammation of the breast tissue which is known as mastitis (NHS, 2022).

Treatment for an inflamed milk duct

Previous advice suggested massage, increasing the number of times a baby feeds or expressing on top of feeding would help clear what was believed to be a blockage from the milk. However, recent research shows that increasing the amount of milk taken from the breast will increase the mother's breastmilk supply and may cause an increase in the inflammation (Mitchell et al, 2022).

Current evidence suggests the following is more effective:

Carry on breastfeeding/expressing in response to your baby's needs.

Reduce any extra expressing that you are doing until the inflammation subsides.

Rest as much as possible and stay hydrated.

You can take paracetamol or ibuprofen while breastfeeding. If you're taking other medicines, do check with a pharmacist. Aspirin should not be taken by women who are breastfeeding. Apply a cold cloth or cool gel pack after feeds to reduce the inflammation.

If you were thinking of stopping breastfeeding, you might decide to wait until the inflammation reduces and then drop feeds gradually after that.

Avoid nipple shields unless essential for feeding your baby. If using nipple shields seek support from a breastfeeding counsellor to use them without causing further issues.

You may wish to explore how your baby is feeding with a Breastfeeding Counsellor to identify ways to eliminate risk factors. (NHS, 2022; Mitchell et al, 2022).

Contact your nearest breastfeeding support group, or our Infant Feeding support line on 0300 330 0700. It's open between 8am and midnight.
In general:
If the inflammation has not cleared after 12-24 hours or symptoms worsen (e.g. a fever and flu-like symptoms), you could go and see your GP (NHS, 2022).

Milk blisters or blebs

Sometimes, a blocked duct is associated with a bleb or blister on the end of the nipple. Milk blisters or blebs look like a flat patch of white on the nipple and some women find them very painful (Mohrbacher, 2020).

Previously it has been recommended that milk blisters be removed by gently rubbing them or by removing a thin layer of skin blocking one of the nipple openings. However, current evidence suggests this could exacerbate the inflammation of the breast tissue (Mitchell et al, 2022).

The current recommendation is sunflower or soya lecithin capsules, 5-10g daily, and applying hydrocortisone 1% cream to reduce inflammation. This is safe with breastfeeding and can be wiped off with a tissue or towel before feeding your baby (Mitchell et al, 2022). You can buy both of these over the counter from your pharmacy or health food shop.

Mastitis symptoms

If a blocked milk duct is not cleared, it can lead to mastitis (NHS, 2022). Mastitis is a common condition that causes inflammation and pain in the breast. It's most common in the first three months after birth but it can happen anytime (NHS, Start for Life, no date).

Symptoms of mastitis may include:

A swollen, red or darker area (depending on skin colour), usually on one breast, that can feel hot and painful when you touch it.

A breast lump or a hard area.

Flu-like symptoms, such as aches, a fever, chills or tiredness.

A burning or radiating pain in your breast.

Nipple discharge, either white or with streaks of blood.

As well as trying the above suggestions, your GP might prescribe antibiotics (Mitchell et al, 2022). For more information on continuing to breastfeed with, and treating, mastitis, take a look at this article.
This page was last reviewed in July 2023
Further information

For support with feeding your baby, call the NCT support line. It's open 8am to midnight, every day of the year: 0300 330 0700

You could read Sarah Oakley's parent-friendly explanation of 'The Mastitis Spectrum'

We support 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 support 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. You can also find more useful articles here.

You might find attending one of our NCT New Baby courses 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.

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

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Inflammation of the milk ducts (also known as blocked ducts) | Baby & toddler, Feeding articles & support | NCT

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What does an inflamed milk duct feel and look like? And what's the best way to treat it? Find out everything you need to know here.

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If you think you may have mastitis contact your midwife, health visitor or GP as soon as possible

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This information was updated in December 2022. A PDF version is available here.

"I was surprised by how suddenly I felt ill. We went to a wedding and I only missed one feed.
Within a couple of hours I felt fluey and achey. My GP was reluctant to prescribe antibiotics,
saying they were often not needed if I kept feeding. I also took ibuprofen tablets which helped
me cope. I was surprised how well the self-help worked and that I never needed a prescription.
I felt very miserable and depressed when I had the symptoms, wondering whether
breastfeeding was worth all this - but once I felt better I remembered how good it feels."

Mastitis means inflammation of the breast.

The first sign of mastitis is a swollen usually painful area on the breast. On darker skin tones
there might be a darkening of the skin and on lighter skin tones this might be visible as a red
area on the breast. However, it is important to note that there could be no visible change in
skin colour at all. The inflammation and swelling is not always a sign of infection (WHO, 2000).
Harmful bacteria are not always present: antibiotics may not be needed if self-help measures
are started promptly. Very rarely mastitis can develop into a more serious condition which
needs urgent hospital admission and IV antibiotics (RCOG, 2012).

You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts
in the same way as it does to an infection - by increasing blood supply. This produces the
inflammation.
NB You may not have all of the above signs during mastitis.
Prevention of Mastitis

A localised area in the breast which is painful to the touch, often in the outer upper
area. Some mums might notice a change of colour or a red area on their breast.

A lumpy breast which feels hot to touch.

The whole breast aches and may appear swollen and skin may be reddened or darker,
depending on skin tone.

Flu like symptoms - aching, increased temperature, shivering, feeling tearful and tired
(Jahanfar et al., 2013). This feeling can sometimes start very suddenly and get worse very quickly.

Signs that the Baby is Well Attached

Try to avoid suddenly going longer between feeds. If you are intending to reduce breastfeeding, cutting down gradually reduces the risk of mastitis.

Make sure your breasts don't become overfull

Avoid pressure on your breast from clothing and fingers

Start self-help measures at the first sign of any lumpy or swollen areas on your breast

Factors which make mastitis more likely:

Difficulty with attaching your baby to the breast - this may mean that the milk is not

being removed effectively and milk may leak into the breast tissue

Pressure from tight fitting clothing, particularly your bra, or a finger pressing into the

breast during feeds

Engorgement or a blocked duct

Sudden changes in how often the baby is feeding, leaving the breasts feeling full

Injuries, such as bumps or knocks from toddlers

Self-Help Measures
Mastitis starts with poor milk drainage. If your baby is not effectively attached to your breast,
or has difficulty feeding, it may be hard for the baby to remove the milk and some parts of
your breast may not be drained during a feed. Improving the way your baby is attached at
the breast will reduce the chance of you getting mastitis again. If in doubt, contact your
midwife, health visitor or breastfeeding peer supporter for help with attaching your baby for
feeding. You can also contact the National Breastfeeding Helpline.

Your baby's chin is firmly touching your breast.

Your baby's mouth is wide open

Your baby has a large mouthful of breast.

If you can see the darker skin around your nipple, you should see more dark skin above your baby's top lip than below your baby's bottom lip.

It doesn't hurt you when your baby feeds (although the first few sucks may feel strong).

No change in shape or colour of the nipple after feeds e.g. it should not be lipstick shaped or have a pressure line across the nipple

Your baby's cheeks stay rounded during sucking.

Your baby rhythmically takes sucks and swallows (it is normal for your baby to pause from time to time).

Your baby finishes the feed and comes off the breast on his or her own.

Your baby produces 6 or more heavy wet nappies every 24 hours (from 7 days old)

Your baby produces at least two yellow poos at least the size of a £2 coin every 24 hours (from 7-28 days old). See UNICEF's breastfeeding checklist for more details.

If your mastitis comes back after you have taken a full course of antibiotics, or is unusually severe, it is good practice to send a sample of milk for bacteria tests. This will help the GP chose the correct antibiotic for your symptoms (Jahanfar et al., 2013). For public health reasons doctors try to avoid antibiotics that are not essential or are unlikely to be effective. It is important that you finish the whole course of antibiotics to make sure that you recover fully and to help prevent the mastitis coming back with resistant bacteria (NICE NG15).
When should I contact my GP or health visitor? If you do not begin to feel better after 24 hours despite using self-help measures, or especially if you start to feel worse, you should speak to your GP or health visitor. You may need to take antibiotics.
These will also help to clear blocked ducts and engorgement. Most cases of mastitis can be improved or resolved with self-help measures.
When should I seek help urgently?

Keep on breastfeeding - you may feel ill, in pain, tearful or discouraged but continuing to breastfeed will help you to get better, and your breastmilk is still the best food for your baby

Feed your baby frequently and responsively (whenever your baby seems like they want to feed), and/or pump to your normal routine (Mitchell et al., 2022; Douglas 2022)

Don't attempt to "empty the breast" by prolonging feeds or expressing extra milk between feeds. You may see this suggested in some places, but the current research suggests you should aim to meet your baby's needs, but avoid increasing your supply beyond that as it could make the inflammation worse. (Mitchell et al., 2022; Douglas 2022)

Try to rest as much as you can, as this will help you recover

Check that your baby is effectively positioned and attached to your breast - if in doubt seek help from your midwife, health visitor or breastfeeding supporter, as even a minor tweak can make a difference.

Try feeding with your baby in different positions.

If necessary, soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.

Some mothers find warm compresses are soothing, and warmth on the nipple can aid let-down. However, take care using these as compresses that are too hot or used frequently could increase swelling and inflammation. Cool compresses may ease symptoms in between feeds. (Mitchell et al., 2022; Douglas 2022)

Avoid any firm pressure or massage to the breast, or use of items such as an electric toothbrush to massage lumps or sore areas. This could cause tissue damage and increase inflammation (Mitchell et al., 2022; Douglas 2022). Any pressure you apply to your breast should be no firmer than stroking a cat.

Check for clothing or anything else which is pressing into your breast. This includes a bra - some women find it helpful to go without.

Medical Treatment for Mastitis
If you feel these symptoms beginning again, start self-help measures right away.

You should contact your GP if the area becomes round and swollen or, if you can see redness or a change of colour on your skin and the pattern of the colour change/redness changes. Redness may be less visible on darker skin tones. Mastitis can develop into an abscess (a painful collection of pus). There is more information about this here: https://www.nhs.uk/conditions/breast-abscess/.
The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250-500 milligrams four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic. Other options have been suggested by Jahanfar et al., (2013).
If you feel seriously unwell, dizzy, confused, develop nausea, vomiting or diarrhoea or slurred speech along with the symptoms of mastitis you need to seek urgent medical attention. These can be signs that mastitis is developing into sepsis. If severe, this is a medical emergency which needs urgent hospital admission and IV antibiotics. (NHS Choices: Sepsis, RCOG, 2012:6.1)

This information comes from the Drugs in Breastmilk Service.
References

Ibuprofen reduces the inflammation, relieves pain and reduces temperature. Take 400mg three times a day after food. Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin. The levels of ibuprofen which pass to the baby are small. Ibuprofen is safe to take whilst breastfeeding. See https://www.breastfeedingnetwork.org.uk/analgesics/ for more information.

Paracetamol relieves pain and reduces temperature but has no anti-inflammatory action. Take two 500mg tablets four times a day.

Aspirin should not be taken by breastfeeding mothers.

Antibiotics may be needed if no improvement is seen with self-help measures. Mostantibiotics can be safely taken whilst breastfeeding.

It is essential that breastfeeding is not interrupted during mastitis.

Note: Antibiotics can make the baby produce loose, runny motions and become irritable, colicky and restless. This lasts for a short time and will get better when you finish the antibiotics.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD005458. DOI:10.1002/14651858.CD005458.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005458.pub3/abstract (accessed 19 November 2020)

Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007239. DOI:10.1002/14651858.CD007239.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007239.pub3/full (December 2022)

Hale T., Medications and Mothers' Milk 2014 (16th Ed),

NICE guideline [NG194] Published: 20 April 2021 https://www.nice.org.uk/guidance/ng194/chapter/Recommendations (accessed December 2022)

World Health Organization. 2000, Mastitis: causes and management, WHO: Geneva http://apps.who.int/iris/bitstream/10665/66230/1/WHO_FCH_CAH_00.13_eng.pdf?ua=1.(accessed December 2022)

NICE guidelines [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use www.nice.org.uk/guidance/ng15 (accessed December 2022)

NHS Choices: Sepsis www.nhs.uk/conditions/Bloodpoisoning/Pages/Introduction.aspx (accessed December 2022)

Royal College of Obstetricians and Gynaecologists (RCOG) (2012) Green-top Guideline No. 64b. Bacterial Sepsis following Pregnancy: 6.1. www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf (accessed December 2022)

Unicef: https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf (Accessed December 2022)

Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B., & Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 Breastfeeding medicine : the official journal of the Academy of Breastfeeding
Medicine, 17(5), 360-376. https://doi.org/10.1089/bfm.2022.29207.kbm
Please note this information is not yet available in print. The previous print version has now been withdrawn and should no longer be used. A new print version is planned for 2023.
Douglas P. (2022). Re-thinking benign inflammation of the lactating breast: Classification,
prevention, and management. Women's health (London, England), 18, 17455057221091349.
https://doi.org/10.1177/17455057221091349

Original leaflet compiled by Wendy Jones MBE Pharmacist and Phyll Buchanan
Breastfeeding Network Supporter and Tutor, in 2015. With thanks to Magda Sachs who
developed earlier versions

This version revised 22 December 2022.

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Information on mastitis and breastfeeding, updated December 2022 and provided by the Breastfeeding Network

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Colic is a common set of symptoms in young babies but can be challenging to cope with

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There are other reasons why your baby may be crying, it's a good idea to check if they:

are hungry

have a dirty or wet nappy

have wind

are too hot or too cold

are bored or overstimulated

If your baby tends to cry during or after feeds, it's worth checking whether this could be reflux. Our guide to reflux in breastfed babies has information on the signs and symptoms.

What causes colic?

There are no known reasons why some babies get colic &ndash some doctors think it's a type of stomach cramp. But it may happen because babies find it harder to digest food when they are really young.

Constant crying could also be due to food allergies, such as cow's milk allergy. If you think this is the case, talk to your GP before making any changes to your baby's diet.

Colic remedies for breastfed babies

Sadly, there is no actual cure for baby colic, only methods to provide relief and soothe them. These are some of the tried and tested techniques that other parents use to relieve colic symptoms in breastfed babies:

Burping

Burp (or wind) your baby during and after every feed - have a look at burping your baby for techniques.

Sit your baby up

When breast or bottle feeding, sit your baby up as straight as possible. This will help minimise the amount of air they swallow. If you are bottle feeding, try to make sure the milk fills the teat and there are no air pockets - you could try using an anti-colic bottle to see if that helps.

Attachment

Check that your baby is attached (latching on) properly as this may help reduce colic symptoms. If you are unsure that your baby is attaching properly while breastfeeding, have a look at our guide to latching on.

Diet

There is no evidence that changing your diet will help &ndash however some people say that cutting down on spicy foods, caffeine and acohol has made a difference for them.

If you are mixed feeding (combining breast and bottle feeding), have a look at our guide to colic when bottle feeding.

Other ways to soothe your baby

Hold them

During bouts of crying, hold your baby to your chest so they can feel and hear your heartbeat.

Rock your baby

Sometimes the swaying motion of rocking your baby in your arms can help.

Warm bath and a massage

A warm bath can be soothing, followed by a gentle tummy massage (with gentle, circular strokes on the tummy).

Create a calming atmosphere

Babies can become overstimulated with lots of noise and activity around them. Try to quieten your surroundings, switch the TV off, dim the lights, and try to take some deep breaths yourself.

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There are other reasons why your baby may be crying, it's a good idea to check if they: are hungry have a dirty or wet nappy have wind are too hot or too cold are bored or overstimulated If your baby tends to cry during or after feeds, it's worth checking whether this could be reflux.

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If you suspect you have thrush it's important to speak to someone who can help with feeding and advice about treatment if needed.

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as a cause of pain. Even if there is another medical basis for the pain, getting positioning and attachment as comfortable as possible will still help.

When you first start breastfeeding, it is common to experience a strong and sometimes uncomfortable sensation for the first few seconds of your baby latching on. However, this should pass quickly, and feeding should become comfortable. If this is not the case, trying some small changes to your positioning and attachment could help make feeding more comfortable for you.

Signs that attachment is not as effective as it could be include:

If the pain is worst at the start of a feed, and continues for more than a few seconds.

If your nipple changes shape after breastfeeding - either lipstick shaped or flattened

If your baby slurps onto nipple rather than attaching with open gape

If your nipple changes colour after the breastfeed - classically a white tip to the nipple, although this may not be visible on all skin tones

If your nipple is damaged, with cracks or bleeding

If the pain is not improved after trying some of the ideas in our guide on positioning and attachment, please seek support from a breastfeeding supporter. They can observe and assess a full feed. You can also find a local support group here or contact the National Breastfeeding Helpline.

If your nipple is damaged, use moist wound healing within the wound (avoid applying cream to whole nipple) to stop a scab forming, which will deepen the wound. You can continue to breastfeed on a damaged nipple as it will still be able to heal, but it is very important to get support with positioning and attachment to prevent further damage occurring.

If a breastfeeding practitioner has helped you adjust your positioning and attachment and you still have pain or nipple damage, your baby may need to be assessed for a tongue tie or other issues that might be making breastfeeding harder.

Other causes of pain in breastfeeding:

Allergy

If your nipples are itchy (which may be triggered by warmth) or changed in colour (which may show as redness on lighter skin tones) but you do not see any change in the shape of your nipples and are not experiencing pain, the problem may be an allergy to something in contact with your nipples, such as nipple cream or breast pads. Try eliminating these to identify the cause. If disposable breast pads are causing irritation, you could try washable ones instead.

The symptoms may be relieved by a non-sedating antihistamine and hydrocortisone 1% cream applied sparingly. See our factsheet on antihistamines for more information on taking these whilst breastfeeding.

Vasospasm

If your nipple turns white at tip after breastfeeds and pain or itchiness, and redness on some skin tones, occurs immediately at end of feed when blood returns, vasospasm could be the cause.

This is due to restricted circulation from compression of the nipple by the baby squashing it between their tongue and the roof of their mouth during a feed. It can be relieved by help with attachment from a specialist breastfeeding practitioner. Vasospasm can occur in one or both breasts. It does not respond to medication which is unnecessary, but can be improved by adjusting positioning and attachment.

Raynaud's Phenomenon

If the pain is worst at the end of or after a feed and your nipples change colour rapidly after breastfeeds from white to purple then red (this might not be visible on all skin tones), you may be experiencing Raynaud's Phenomenon.

If you have a history of circulation problems or migraine and pain is triggered or made worse by cold, Raynaud's Phenomenon is more likely. Pain can be immediately after a feed but may also be delayed or can be triggered by cold even when not feeding.

You may be able to improve your symptoms by avoiding breastfeeding in cold places, covering your nipple as soon as a feed is finished and applying warmth after feeds. If this is not effective, consider asking GP to prescribe nifedipine 10mg three times a day or nifedipine LA 30mg daily. Treatment for two weeks may be sufficient or may be needed long term. You can find more detail in our Raynaud's phenomenon factsheet.

A white spot, bleb or blocked nipple pore.

If pain is worst at the end of or after a feed and you can point to a discrete spot (which may be white, yellow or pale pink) on your nipple as the origin of the pain, this is likely to be due to a white spot, also called a bleb, blocked nipple pore or milk blister. Symptoms may return periodically.

A white spot is thought to be caused by a thin bit of skin growing over a milk duct opening, and milk backing up behind it.

You can continue to feed with a white spot, and feeding may cause it to clear spontaneously. If it does not clear, the skin overgrowth can sometimes be removed by soaking the nipple in warm water and rubbing gently with a clean, moist washcloth. You can also try softening the skin with an oil such as olive oil. If this doesn't work, the skin may require removal by a healthcare professional using a sterile needle. Antibiotic cream may be required if a significant wound results. If you squeeze just behind the blister some toothpaste-like thickened milk may come out through the now opened blister.

Expressing milk

If your nipple is sore or damaged and you are using a breast pump rather than feeding directly, you may need to reduce the strength of the suction on your pump or you may be using a flange that is the wrong size. Speak to your health visitor, midwife or peer supporter to get support with expressing your milk if needed.

Strong let-down

If the pain is strongest at start of feed or just before a feed and there is a sharp intense pain in your breast(s), often described as squeezing pain, this can be due to the let down or milk ejection reflex. Pain can be worse on fuller breast.

If it is associated with leaking milk, you can reduce this by applying firm hand pressure to your breast at the time of leaking.

If your baby also makes a clicking noise during feeds or pulls away choking once the feed has started, the fast flow of milk may mean your baby is struggling to attach well. Further support from a skilled breastfeeding practitioner to improve attachment may be useful.

You may find it helpful to express a small amount of milk just before a feed if your breasts are full, to get past the powerful let-down before starting the feed, or to use a laid-back breastfeeding position, so that the milk flow is less overwhelming for your baby.

Engorgement

If your breasts are painfully hard and full, and feeding or expressing milk relieves this sensation, your breasts may be engorged. This may be worst first thing in the morning, especially if you have not fed frequently through the night. You can avoid engorgement by feeding frequently and responsively, including at night time. Consider offering your baby a feed whenever your breasts start to feel full or uncomfortable. If you are unable to feed at that time, or if your baby refuses a feed, you can express just enough milk to relieve the discomfort. Avoid expressing more milk than necessary, as this could trigger an increase in your milk supply and make the engorgement worse. Allowing your breasts to remain engorged could lead to your breasts becoming inflamed (mastitis), or a reduction in your milk supply, so it is best to avoid this whenever possible.

If you find it hard to latch your baby on when your breasts become very full, you may like to try reverse pressure softening. Reverse pressure softening is a way to soften your areola. It can help make latching and removing milk easier when your areola is very swollen and engorged by temporarily relieving firmness and swelling.

It can be particularly helpful if you have some oedema or swelling due to IV fluids or drugs given during labour and birth, especially if you had a caesarean section. Breast engorgement in the early days can be caused by your milk coming in or by a combination of fluid held in the breast tissue around the milk ducts as well as by milk within the breast.

Reverse pressure softening briefly moves mild or firmer swelling away from under your areola, slightly backward into your breast for a short period of 5-10 minutes. This allows your areola to change shape and makes latching easier as your baby is able to get more of your areola and breast tissue into their mouth.

Reverse pressure softening also causes a 'let-down' reflex, making it easier for your baby to get milk or for you to remove milk by hand expressing or expressing with a breast pump.

Reverse pressure softening should not be used if you have mastitis, plugged ducts or a breast abscess.
How to do reverse pressure softening:
The key is to make your areola very soft right around the base of the nipple. This can make it easier for your baby to get a better latch.

Press gently on the edge of your areola, inward towards your chest wall, counting slowly to 50

Once the areola has softened, you can start to feed your baby or express (by hand or using a breast pump on low to medium pressure)

If you have very swollen breasts, doing reverse pressure softening lying on your back (taking advantage of gravity) will give more relief

Soften your areola right before each feeding (or expressing) until the swelling goes away. This takes two to four days or more

Blocked ducts and Mastitis

If there is a sore, lumpy area on your breast that may also feel hot and can appear red on lighter skin tones, you may have a blocked duct or mastitis. Mastitis is an inflammation of the breast. It may be accompanied by flu-like symptoms. Continue to feed responsively and seek support from a specialist breastfeeding practitioner as soon as possible. Blocked ducts or mastitis may be triggered by feeding infrequently, allowing your breasts to become overfull or other situations that increase pressure on your breast, for example, wearing a bra that is too tight or wearing your baby in a sling for longer than usual. Adjusting the way you hold your baby and bring them to your breast when feeding ( positioning and attachment) may also help.

You can take ibuprofen 400mg as anti-inflammatory if appropriate (i.e. if you have no contra-indications such as asthma or stomach ulcer), and also paracetamol for pain or fever. Antibiotics are not usually required if self-help measures are started quickly, but you should see a doctor if your symptoms persist. You can read our factsheets on pain relief medicines and breastfeeding and our mastitis page for more detailed information.

Abscess

An abscess is a rare complication of mastitis. You might want to consider whether you have an abscess if mastitis has not resolved following frequent, effective feeding and a course of antibiotics and if the skin on your breast looks like orange peel. A milk sample should be taken to ascertain the micro-organism involved in the infection to help decide which antibiotic might be most appropriate. An ultra sound investigation may be required to diagnose an abscess. Drainage of pus by needle aspiration or surgical drainage together with appropriate antibiotic might be offered. Abscess formation is a rare complication of infectious mastitis and may involve MRSA. You may benefit from emotional support from a breastfeeding supporter alongside specialist support from medical staff.

Thrush

Signs of thrush in you

Thrush (Candida albicans) infection can affect your breast while you are breastfeeding. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

You have pain in only one breast/nipple (thrush spreads quickly from one breast to the other)

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

Thrush in the first few weeks of feeding is rare unless the mother had vaginal thrush at delivery or had deep breast thrush at the end of a previous lactation. Less than perfect positioning and attachment with consequent damage are more likely to cause the pain at this stage.

Signs of thrush in your baby

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

If you think you have thrush:

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection.

Breastfeeding should be pain free from the point of attachment (the moment the baby goes to the breast) onwards. Pain from thrush begins after a feed. There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain. Be aware of the other causes of nipple and breast pain described on this page, and exclude them first.

Self-help measures

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally, some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally, some mothers find reducing the level of sugar and yeast in their diet helps

If a thrush infection is confirmed, to make sure that you get rid of it, both you and your baby need treatment, prescribed by a doctor. Usually, once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.

If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.

Treatment

Ongoing attention to positioning and attachment is important because even the best latch can slip a little sometimes.

Miconazole cream applied to your nipples after every feed - sparingly and without washing off before the next feed

Miconazole oral gel applied gently to your baby's mouth 4 times a day a small amount at a time

If symptoms persist you may need fluconazole 150-400mg as a loading dose followed by 100-200mg daily for at least ten days. This is rarely necessary if your baby is less than 6 weeks old and could cause vomiting and stomach pains.

For more information, see our detailed factsheet on thrush and our factsheet on miconazole oral gel and the breastfed baby with oral thrush.

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Pain: if breastfeeding hurts - The Breastfeeding Network

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as [...]

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Hand expression video - Baby Friendly Initiative

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Hand expressing is a useful skill to learn - it doesn't require special equipment and can be used to help with many situations

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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Useful information for you if you are exclusively expressing milk for your baby

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping. While this is often a temporary solution to protect milk supply until the baby is able to nurse directly at the breast, some mothers may find themselves exclusively pumping long term. Some mothers may also actively choose to exclusively pump and some mothers may be unable to feed their baby directly at the breast because their baby is poorly or has medical difficulties.

The decision to exclusively express breastmilk usually stems from an awareness of the irreplaceable qualities of breastmilk. Mothers also find that providing their babies with breastmilk can help with the grief from not being able to nurse directly at the breast. If their baby has medical difficulties, many mothers feel strongly that providing human milk will give their child the best possible start, particularly if their baby is in hospital. Yet, exclusive pumping is a significant undertaking which requires dedication, information and support.

You might find the decision to exclusively express feels difficult, and that you don't feel you fit with breastfeeding mothers or with those using formula. Please be sure that you will receive a warm welcome and support at LLL meetings and from your local Leader, and that we understand the lengths you're going to, to make sure your baby has your milk.

This page concentrates on the practicalities of how and when to express your milk and feed it to your baby, to establish exclusive expressing as your feeding method. Sometimes it can help to focus on all these practicalities and, once you have a workable plan, to give yourself time too to process how you're feeling about it, as you settle into life with your new baby. If you have a partner or supporter at home with you, all the things that are useful in supporting a breastfeeding mother will apply to you too!

Getting Started

If you have recently given birth and your mature milk has not yet come in, hand expressing is the most effective way of collecting colostrum to feed to your baby. It is important to start expressing colostrum within six hours (ideally after one hour, if possible) of giving birth, though if this doesn't happen for you, it is still possible to get started.

A newborn would expect to feed 8-12 times in 24 hours, and the feeds might not be evenly spread over that time, though they do need to include some feeds in the night; it is important to try to express breastmilk just as frequently in order to lay the groundwork for a robust milk supply later on. If you can have skin to skin contact with your baby while you're expressing, it can really help, and a photo or something that smells of your baby can be a substitute. You can collect your colostrum in a syringe, a small clean cup or a spoon. See our article on Hand Expression of Breastmilk for more information on hand expressing, and you might also find this video on hands-on pumping helpful. This technique can be tricky to get the hang of, so please do ask your midwife or other breastfeeding supporter to help. It's very common to need an extra pair of hands to collect the drops of colostrum.

Equipment

As your milk starts to transition, you will probably notice it start to change colour and spray out as you are expressing; this is a good time to introduce a breast pump. Although some women respond better to hand expressing, using a hospital grade double electric pump is the most effective way of removing breastmilk when a baby isn't latching or is not nursing adequately. If you are planning on exclusively expressing for your baby long term, then it will be worth investing in a hospital grade double pump. If you would like to try one before deciding whether or not to buy it, your hospital or midwife may be able to provide you with one on a short-term loan. Alternatively, you can hire a pump, although it may turn out to be rather expensive if you are exclusively expressing long term.

A breast pump usually comes with a collection set and the part that sits over your nipple/areola, which is called a flange. As women's nipples and skin elasticity differ, flanges are available in different sizes. It's important to ensure you have the right size for your nipples, as flanges that are too large or too small may cause pain or nipple damage and reduce the amount of milk you are able to express. Finding the right flange size may be a bit of a trial and error process; you may want to start by trying the standard size that comes with the pump (which varies for different pump brands) and see how you respond. If the standard flange sucks in too much areola, or if your nipple is at the back of the pump, you may need to go down a size. If, instead, you are left with a white ring around your nipple, you may need to go up a size.

Many mums find being able to express handsfree invaluable in terms of allowing them to fit regular pumping sessions into their day. There are a small variety of pumps that provide milk collection cups that sit inside your bra, freeing you up to cuddle your baby without fear of spilling your milk. However, they tend to have a limited range of flange sizes. Alternatively, you can buy special bras designed to hold your pump flanges against your breasts, or you can even DIY your own by cutting holes in a stretchy bra that line up with your nipples.

There are several other things to consider when choosing which hospital grade double pump to purchase or hire:

- How often will you use it? If you are planning to exclusively pump long term, you may need to consider motor life, to make sure the pump you purchase will live up to its use.

- How portable is it? If it uses a battery, then it can be carried around the house or out and about with you. Some pumps have built-in rechargeable batteries, while others offer the option to purchase a power pack or a car charger. Some pumps use removable batteries which are easy to replace if you unexpectedly run out of charge while away from a plug socket. However, using removable batteries may end up being rather expensive long term. You might find you end up using two different pumps - an efficient hospital grade one when you're at home and a hand pump or battery pump when you're out and about.

- Can you purchase spare collection sets? Having a spare collection set or two can come in handy, as most mothers find that it is easier to stick to their pumping schedule if their pump is set up and ready to go at a moment's notice, especially at nighttime.

Setting your schedule

For the first three-four months, you will need to express regularly to build a robust milk supply, ideally 8-12 times in 24 hours. Although you do not always need to pump at regular intervals, it is best not to go more than two to three hours between pumping sessions, with one longer stretch of four-five hours at night if you can take this break without damaging your milk supply. You will need to have at least one pumping session overnight, ideally between 2am and 5am when prolactin levels are highest. If you are able to pump when your baby wakes up for a feed, you may find it easier to do so than setting an alarm. If you need to set an alarm, but are having difficulty waking up, it may be worth experimenting with setting it for different times to try and coincide with the periods in your sleep cycle where you are in a lighter sleep. Many mothers find that they are able to express the most milk first thing in the morning, and less as the day goes on. You will notice your own patterns. It's also common for one breast to produce more milk or have a faster flow than the other side.

Working out ways to fit pumping sessions into your routine is key to long-term success. Some mothers will express while cooking, or holding a sleeping baby, or while travelling; sometimes before they feed their baby, sometimes afterwards. Experiment to find out what works best for your family and your daily rhythms.

In the early days, you may find that you are producing more milk than your baby needs; this is common and it will settle down in a few weeks. It can be useful to freeze any excess milk in small portions for later on, should your baby suddenly require more milk, such as during a growth spurt or period of illness.

Once your supply has established, usually between three and four months, you may decide to slowly reduce your number of daily pumping sessions. If you are planning to exclusively express long term, however, you may decide not to make any changes to your pumping schedule. If you start to reduce your expressing sessions, you may like to keep a record of your daily pumping outputs so that you can monitor what effect it has on your overall milk supply. You could start by increasing the intervals between your overnight pumping sessions, although it will still be important to express once at night. After doing this for about three-four weeks, you may consider dropping one daytime session. This may require you to adjust the time of all your other pumping sessions, in order to avoid leaving a big gap in between them, which could make you vulnerable to experiencing blocked ducts or mastitis.

Once your baby starts eating solids reliably, around eight-nine months, you may start to notice a change in their milk requirements and can adjust your pumping schedule and milk supply accordingly. However, many mothers find that introducing solids does not affect milk intake for a lot longer (in some cases, 18 months). When your baby is sat in a highchair, it can be a good time to express your milk without them pulling on the pump tubes.

How long is an expressing session?

The length of each expressing session will vary for each mother, based on her breast storage capacity and the type of pump she uses. If you are able to express milk from both breasts at once, then you will find it much faster.

While some experts recommend pumping for about 15-20 minutes, others believe that specifying the duration of a pumping session may not be helpful, as some mothers may take up to 45 minutes. In her book Exclusively Pumping Breastmilk, Stephanie Casemore suggests spending two hours over the course of 24 hours expressing. However, this total pumping time may need to be adjusted for mothers who need long individual expressing sessions. Also, other experts believe the total number of separate sessions to be more important than total pumping duration, with shorter, more frequent expressing sessions usually being more effective than fewer, longer sessions.

As a general rule of thumb, you can express until your milk stops spraying, and then for an additional five minutes to stimulate another let-down. If you need to increase your supply, you can pump for 10 more minutes and use hand expression right after to remove as much milk as possible. Breast compressions and massage during sessions ( hands-on pumping) also help to stimulate let-downs and maximise milk output. Some mothers find that it helps to experiment with "power pumping", where they pump frequently for short periods, to mimic cluster feeding. This might be something to use on occasion rather than as part of a daily routine as it can be quite time-intensive.

If, on the other hand, you need to decrease your supply, then slowly reduce the length of time you are expressing for. In both cases, many of the techniques discussed in our articles " My baby needs more milk" and " Too Much Milk and Oversupply " can be adapted for use with a breast pump.

If you are worried that you do not have enough time to do a full session, then it is better to pump less time and have a longer session later, than to miss one entirely.

Over time, as you reduce the number of pumping sessions, you may find that you will need to express for longer to obtain the same amount of milk. Many women find that if they cycle through their pump settings again, they can trigger a second or even a third let-down over a period of 30-45 minutes.

The importance of Oxytocin

Oxytocin is the hormone that triggers your letdown (milk ejection reflex). It is especially important to be mindful of this when expressing, as even mildly stressful situations of feeling rushed can make it difficult to trigger a letdown when using a breast pump. Many mothers find looking at their baby - or at pictures of their baby if they are separated - while expressing helpful. Gently massaging your breasts before and during your pumping session, as well as applying warm compresses or taking a warm shower before expressing can also trigger a let-down. Other ways to boost your oxytocin might include listening to music, watching a comedy on TV, reading a book, or browsing social media on your phone.

If you are able to cuddle your baby while expressing, you may see an increase in your normal milk output! It is even possible to express while carrying your baby in a sling or baby carrier. As your baby gets older and more mobile, you may find it easier to remove yourself to a different room where you can relax without worrying about them pulling on your tubes, or getting into things they shouldn't.

It can feel disheartening if you are watching your collection bottles and feel that they are not filling up quickly enough. Covering the bottles with socks, or distracting yourself so that you are not watching, can be helpful. If you are struggling to get a let-down, it is ok to put your pump away and come back to it 10-20 minutes later and try again. If it is a persistent problem at certain times of day, try to remember that the stimulation you are giving your breast still has a valuable purpose.

How to pump

In order to keep pumping comfortable and avoid nipple damage, you may want to consider using lubrication, such as lanolin or olive oil, inside the pump flange to reduce friction. The flange needs to make a comfortable seal around the breast.

Pumps have different suction and cycles settings. You may want to start with a low suction and high number of cycles to stimulate your let-down. Once your milk starts flowing, you can decrease the number of cycles and increase suction. In order to avoid getting sore, it is a good idea not to use the same suction setting for long periods of time. Switching between low and high suction also helps to trigger more let-downs.

Once you are done pumping, you can massage both breasts and hand express to make sure your breasts are completely drained.

How much milk to pump

As breastmilk is highly digestible, breastfed babies tend to feed little and often. When babies nurse directly at the breast, milk intake varies from feeding to feeding, so the amount of breastmilk taken per bottle may also vary throughout the day. On average, babies need 750-1035ml of breastmilk per day between one and six months of age. You may want to pump slightly more than this to make sure you have enough milk when your baby goes through a grow spurt.

Feeding your breastmilk

Babies drink from a bottle and nurse from the breast in a completely different way. When drinking from a bottle, babies cannot control the flow of milk, which can be uncomfortable for them and can lead to overfeeding. In order to minimise this problem, you may want to feed your baby your expressed milk in a way that is as close as possible to nursing. This is often referred to as paced bottle feeding.

Rather than feeding your baby bottles of expressed milk according to a strict schedule, you may want to feed on demand, as you would if they were nursing at the breast, being aware of early hunger cues. Holding your baby upright and keeping the bottle in a horizontal position allows the baby to suck actively, as he would at the breast, and to control the flow of milk, taking a break whenever he needs to. Offering the bottle teat gently, letting the baby draw it into their mouth, and feeding to satiation also allow the baby to be more in control of his feed. You can find more information on how to feed your baby your expressed milk in our article ' Bottles and other tools '.

It's important to remember that breastmilk should not be warmed up in a microwave or in a pan on the hob, in order to avoid damaging its nutrients. Shaking breastmilk is also not necessary.

Storing your breastmilk

Breastmilk's antibacterial properties help it stay fresh, so it can be safely stored at room temperature for four-six 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, however all human milk is beneficial for you baby.

You may well see that your expressed milk is not always the same colour, and that it separates into layers when it has been stored for a while. Neither of these is a cause for concern, and a gentle swirl of the container before you feed your milk to your baby should make the layers mix again.

If you find that you are producing more milk than your baby needs, you might like to consider donating your milk by registering as a donor for your local breastmilk bank.

Stopping exclusively pumping

When you feel ready to stop expressing milk for your baby, it's important not to rush into dropping pumping sessions, in order to avoid the risk of experiencing blocked ducts or mastitis. Your breasts need time to adjust, so it's best to adopt a gradual approach. You could try to reduce the length of your pumping sessions by a few minutes over a few weeks, or you could try slowly increasing the intervals between sessions.

Exclusive pumping, while also doing the day to day work of looking after your baby, can be exhausting, and sometimes mothers and parents wrestle with feeling guilty about having stopped "too soon". By taking on the work of exclusive pumping, though, you gave your baby a wonderful gift.

Written by Nicola Sheldon (LLL Berkshire and Oxfordshire) and Eva Williams (LLL Oxfordshire), May 2020.
Thanks to Harriet Valentino for her input and to Lois Rowlands, Rae Vacher Lowe and Laura Loasby for the photos.

Further reading

https://www.laleche.org.uk/hand-expression-of-breastmilk/
https://www.laleche.org.uk/my-baby-needs-more-milk/
https://www.laleche.org.uk/too-much-milk-and-oversupply/
https://www.laleche.org.uk/bottles-and-other-tools/
https://www.laleche.org.uk/expressing-your-milk/#Pumps
https://www.laleche.org.uk/storing-your-milk/
A mother's story from our members magazine breastfeeding matters
https://kellymom.com/category/bf/pumpingmoms/pumping/
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

i Exclusively Pumping Breastmilk. Second edition. Casemore, S. Gray Lion Publishing, 2014

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping.

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Expressing and how to store breastmilk - Breastfeeding Network

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This leaflet gives you a guide for expressing and storing your milk

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Information about the advantages and disadvantages of different equipment for expressing

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful. I did a quick google and really could not find anything useful to help a mum select an appropriate breast pump from the vast array on offer. This reaffirmed to me the difficulties mothers in this situation face. I see families daily who are using a breast pump that is not appropriate to meet their needs or who have spent hundreds of pounds on a pump that remains in its box unused.

So, as a parent how do you choose a breast pump? There are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.

In the early days after birth you may find you need to pump frequently to provide milk for your baby who, for whatever reason, is not able to latch and feed directly at the breast. Or your baby may be struggling to drain the breast effectively. Frequent expressing will be needed to stimulate milk production and manage engorgement as the milk starts to come in. Later, you may need to express because of inefficient feeding and/or slow weight gain to provide top ups and/or boost a low supply. As baby gets older you may want the flexibility of being able to leave her baby in the care of someone else so you can have a break, go to bed early or attend appointments. You may be returning to work and need to leave milk for your baby.

There may also be situations where a mother wishes to re-establish a milk supply after a break from breastfeeding (relactation). More parents are now inducing lactation in situations where they are adopting a baby, or in same sex couples where the non-birthing parent wishes to share in the breastfeeding, or where a parent is transgender. Both these situations usually necessitate frequent expressing.

Not all breast pumps are equal, and some are designed for frequent use, whereas others are more suited to occasional use.

When a baby cannot latch and suckle effectively at the breast immediately after birth due, for example to prematurity, illness in the baby or mother, other additional needs, an oral abnormality such as a cleft palate or tongue-tie or simply because of a difficult birth then it is vital that expressing starts early. This will ensure a good milk supply is established and provide colostrum for the baby. Early stimulation and drainage of the breast helps to further develop the glandular tissue (the milk factory) within the breast.

Furthermore, once the milk comes in at day 3-6 milk production begins to switch from endocrine control (driven by hormones) to autocrine control (driven by the frequent and effective removal of milk from the breast).

So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a multi user pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps.

These multi user pumps were traditionally called 'hospital grade'. Unfortunately the term 'hospital grade' is no applied to virtually every pump on the market as a marketing ploy. The only two pumps available in the UK that were designed to be used by multiple mothers are the Medela Symphony and Ardo Carum and these cost around £1000 to purchase so are usually hired. However, in terms of efficacy the Spectra S1, which can also be hired, compares favourably with the Medela Symphony but is more light weight and portable. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production ( Jones et al, 2001) .
Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
https://www.ardomedical.co.uk/shop/products/rent-a-breastpump/ https://www.medela-rental.co.uk/ https://www.anawiz.com/collections/breast-pump-rental

Some Children's Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are 'personal use' double pumps, not hospital grade. They are also often loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.

Personal use electric pumps come in double and single options. All double personal use pumps can be used as a single pump. However, most single electric pumps cannot be converted to double. Double personal use pumps are good for maintaining supply, returning to work or for boosting supply if for any reason it has dipped. Many mums will switch to a personal use pump, after the first month or so, when they have established a good supply with a hospital grade pump, if they are in a situation where ongoing frequent expressing is needed.

Sometimes, mothers experience a drop in supply after the early weeks due to illness, the use of formula, certain medications, an undiagnosed latching or sucking issue (commonly a tongue-tie), or because they have implemented scheduled feeding to get baby into a routine. Double personal use pumps can be extremely helpful in boosting supply in these situations. Generally supply recovers more quickly and efficiently than with a single electric pump. Double personal use pumps are also helpful when returning to work as pumping sessions at work will take less time.

Single electric pumps can be used for the same purposes as the double personal use pumps, but pumping will be less effective and more time consuming. They are more suited to mothers who only need to pump once or twice a day to stock the freezer or provide milk so someone else can feed the baby. Some single electric pumps, such as the Medela Swing Flex, retail for the same price as personal use double pumps, such as the Spectra S1 and S2 or the Ardo Calypso, so this is something to be aware of.

Electric pumps, whether single or double, can be helpful in effectively draining breasts affected by engorgement, blocked ducts, or mastitis when a baby is struggling to do this, or the nipples are too sore for breastfeeding.

What about hands free wearable pumps like the Elvie? These are relatively new to the market. They can be useful for mothers who need to pump on the go or discreetly and my feeling is that working mothers with established milk supplies are the ones who may benefit most from this type of pump. I have had a few mothers use the Elvie in the early days of their breastfeeding journey, but supply has been slow to pick up. This is probably because we know that double pumping is most effective at this stage. Plus, the design of hands-free pumps necessitates the use of a very small motor which is not likely to be as powerful as the much larger motors found in the hospital grade pumps. The size, shape, texture and contour of the breast will influence how well a wearable pump fits and works for individual users. For a single pump hands free designs are comparatively expensive. There are some cheaper models like the Momcozy and Fraupaw which some of my clients have reported positive experiences with.

Some mums find the hands free wearable pumps don't fit particularly well to their breasts.

There are other ways to achieve hands free pumping. The simplest way is to use a 'pumping bra' or, if you have basic sewing skills, convert a standard nursing bra or close-fitting crop top for the purpose. are cups that can be worn inside your bra and in place of the flange and collection bottle on your usual pump. They are compatible with the major brands of pumps. Some pump companies, such as Spectra, make their own hands-free pumping kits.

But what about manual pumps and the all-in-one silicone pumps? These are useful for the occasional pumping session for the occasional bottle feed or for softening up engorged breasts for making latching easier. Many mums get in to the habit of using the silicone pumps for collecting the milk that is ejected when the baby is feeding on the opposite breast, rather than allowing this milk to soak into a breast pad and be wasted. However, caution is needed when doing this. Unlike breast shells which are designed to simply collect 'drip' milk from the 'let down', the silicone pumps actually create suction at the breast and draw milk so frequent use can result in an oversupply. Over supply can be associated with engorgement, blocked ducts and mastitis for mum and latching difficulties, gulping and choking, wind and reflux for baby.

When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes.
The standard size flange supplied with many pumps is a 24mm but most women will ned a flange that is no larger than 21mm.

Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange/s supplied with your pump do not fit then you will need to buy a different sized flange or a flange insert.

Manufacturers have fitting guides on their websites and they usually suggest a flange that is about 4mm larger than the diameter of your nipple. But recent research on this suggests a snugger fit, with a flange that is no more than 2mm larger than the nipple diameter is better.

Most manufacturers of pumps do not make flanges in the smaller 13mm-19mm size range. But Maymom and other companies do make a range of smaller flanges and flange inserts compatible with most of the pumps on the market. One nipple may be larger than the other, so some mums find they need a different size flange on each breast.

I strongly recommend seeking out an IBCLC who offers a flange fitting service to avoid using the wrong size flange and spending money on flanges and inserts that may not fit. I offer this service.

The availability and cost of spare parts is also something to investigate before you buy. With cheaper pumps it is unlikely you will be able to obtain spares in a situation that a part gets lost or damaged. The cost of spare parts for some brands of pump are higher than for others.

Some electric pumps work just off the mains. But others have the option to work off a battery, making them more portable, or can be powered via the 12-volt socket in a car which means you can pump in locations away from home and mains electricity.

The quality of a pump is something to consider too. Generally speaking pumps made by companies whose core business is the manufacture of breast pumps are better in terms of reliability, efficiency and durability and they often offer better after sales service. They dedicate a lot of resources to research and development of their products. Pumps made by bottle manufacturers, such as Tommee Tippee, in my experience do not compare well. Why would they? Bottle manufacturers make their money from families who formula feed and the breast pump in their range is purely a complement to their other products, not their core business or main source of income.

Finally, a word about second-hand pumps. These may seem like a good idea as they are cheaper than a new pump and many mums are given second-hand pumps by friends and relatives. However, in my experience there can be problems with this. Some second-hand pumps have been very well used and may be third or fourth hand. Even if they have only had one previous owner, she may have used the pump for more than one baby. I have seen many situations where a mum has complained that she cannot pump much milk or her supply is not increasing and upon investigation I have found that she has been using a second-hand pump with a worn out motor or defective parts.

Parts, particularly the crucial but delicate valves, can easily get damaged during use and plastic can deteriorate with repeated cleaning and sterilising, and storage meaning that seal and therefore suction is compromised. For these reasons and for reasons of hygiene it is recommended that collection sets are replaced and not handed on. Furthermore, not all pumps are 'closed systems', notably personal use pumps in the Medela range. This means that it is possible for milk to be drawn up the tubing and into the motor housing and this poses a theoretical risk of cross infection. So, if you do opt for a second-hand pump ensure that it has not been overused, replace the collection sets and check that it is a 'closed system' pump.

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In this post, I delve into the complexities of selecting an appropriate breast pump, emphasizing that the choice should align with your specific needs and circumstances. I discuss various types of pumps, including hospital-grade, personal-use double electric, single electric, manual, and wearable models, highlighting their suitability for different situations.

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Watch the video for information about safer sleep for your baby

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This leaflet gives important information about sleep safety

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Other language resources - Baby Friendly Initiative

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Breastfeeding and Bottle Feeding Information in other languages

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Breastfeeding and Bottle Feeding Information in other languages

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Here you can find Information Sheets for breastfeeding in different languages

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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Alcohol and Breastfeeding - The Breastfeeding Network

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Important considerations for you if you drink alcohol whilst breastfeeding

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

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

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

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

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

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

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

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

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

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

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

Other websites

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

Guidelines from the NHS

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

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

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

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

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

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Alcohol and Breastfeeding - The Breastfeeding Network

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

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Using a nipple shield with a breastfed baby - ABM

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If you feel that you need to use a nipple shield when breastfeeding speak to your midwife or health visitor, or contact a member of the infant feeding team for help

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A nipple shield is a flexible silicone nipple that is worn over the mother's own nipple during breastfeeding.
When are they used?
Nipple shields can help establish breastfeeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast. However, very few benefit from using a nipple shield. Please consult a breastfeeding counsellor or health professional for one-to-one support before you use a nipple shield. A nipple shield can be a temporary solution but not a permanent fix to an underlying problem. They may affect transfer of milk to the baby which may contribute to poor weight gain and health problems for both mother and baby.
What might cause my baby to have difficulty with attachment?

Events around labour and delivery.

Use of artificial nipples.

Baby's physiology.

Other reasons a shield could be used:

Flat or inverted i.e. non protractile nipples.

Breast refusal.

Sore, cracked, bleeding nipples.

Weaning a baby from bottle to breast.

Re-lactation or induced lactation (adoptive breastfeeding).

Before using a nipple shield, consider:

Accessing skilled breastfeeding support, ideally face-to-face.

Prolonged skin contact, and 'biological nurturing' i.e. laid-back breastfeeding techniques.

Hand expressing drops of milk onto the nipple to tempt the baby to attach.

Regular (2-3 hourly) hand expressing of colostrum to protect milk supply.

Regular (2-3 hourly) feeding of expressed breast milk (EBM) via syringe/cup.

Trying different positions/techniques e.g. cross cradle hold and exaggerated attachment, lying down feeding, underarm hold.

Applying cold to a soft nipple to firm it.

Use of nipple massage, gentle use of breast pump or other suction device to draw nipple out.

If milk is in, deal with any engorgement to soften areola to facilitate attachment.

When breastfeeding is uncomfortable, using a nipple shield can feel like a quick fix, but shields are not a substitute for finding qualified breastfeeding support. If there is an underlying latching problem, adding a shield on top can risk blocked ducts and mastitis, supply reduction, and a baby not getting enough milk. Feeds can end up being long and unsettled and baby may take in more air. When the shield is removed, the underlying problems remain, and may even be worse as the baby has become accustomed to using the shield. Always try and find qualified help if breastfeeding is uncomfortable or challenging.
Care
Wash the shield with hot soapy water, rinse with clean water, dry carefully and store in a clean container.
Choosing a shield
Nipple shields are sized according to the diameter of the base of the mother's nipple. A poorly fitting shield can cause problems including reduced milk transfer and pain.

In the U.K., the standard sizes are 16mm (small), 20mm (medium) and 24mm (large). A larger 28mm size is available online but can be difficult to find.

The size of shield you use is not the same size as the pump funnel you use. Shields are a closer fit. Many shops will only sell one size and you may have to shop online to get a wider selection.

A 'contact' nipple shield has a cut away piece that allows baby's nose or chin to remain close to the breast. This is preferable to a shield where the baby's nose is pressed against plastic.
How to use a nipple shield
It's often helpful to place your baby in skin to skin contact well before you attempt a feed. This will stimulate baby's instinctive feeding behaviours and make attachment to the breast more likely to be successful.

First, try latching the baby without the shield if you feel you can. How long you spend trying to latch effectively without the shield is a very personal decision and will depend on how long ago the baby fed, the support you have, and how breastfeeding has been going in the past.

A warm wet shield sticks to the breast better - run the shield under warm water prior to use.

Roll the wet, warm shield back about halfway down the shank of the shield.

It may adhere to the breast better if you apply a little water or breastmilk around the edge.

Roll the shield back onto the breast so the nipple is drawn into the teat of the shield.

There are some videos online that show you how to apply a shield with this 'slightly inside out' method.

Attachment
Attachment technique is still important with a shield. Don't just poke the shield teat centrally into baby's mouth. Baby should be held close, mouth wide open and chin in contact with the breast. Once attached, you should notice their chin moving deeply to show active swallowing and you will often hear some swallowing at the beginning of a feed.

Towards the end of the feed (when baby's swallowing slows) it is a good idea to use breast compression while baby suckles to increase the milk and fat transfer to the baby. Offering baby both breasts at each feed will mean baby gets more milk.

The nipple shield is a projection of the nipple so, when the baby unlatches, it should look well rounded, just as though baby had a good latch directly at the breast. You should see milk in the shield when baby comes off. As using a shield is often associated with reduced milk transfer, it can be recommended to express in addition, to help protect your supply. Your breastfeeding counsellor or health professional can support you to consider how often this is needed, depending on how things are going.

It's a good idea to keep an especially close eye on baby's bowel movements and urine output while you're using a nipple shield, as these give an indication of milk intake. Baby should have about three tablespoon-sized yellow, grainy stools in 24 hours (after the fifth day) and have at least six wet nappies.

If baby is discharged from hospital using nipple shields, their progress should be closely monitored by the community midwife or health visitor.
Weaning from a shield
Be sure not to make this a battle with your baby, or they will resist more. Don't obsess with weaning off the shield to the point that you are unhappy with breastfeeding. As long as your baby is gaining weight well, there is no need to rush into trying to wean them from the shield. Don't cut down a shield to wean a baby off it - this practice is no longer recommended.

You may be able to remove the shield part way through a feed and continue without. You may only use a shield on one breast, or for the first few minutes. Some babies need only one or two sessions with the nipple shields, while others may need more.

Keep trying as often as you can and give it some time. Your baby might be more receptive to feeding without the shield when they are less hungry or sleepy. Some continue to use a shield for the duration of their breastfeeding experience, but most are able to stop using the shield after only a short time if they wish to.

Be patient while you work through this time of transition. Breastfeeding with a shield is still breastfeeding.

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Using a nipple shield with a breastfed baby - ABM

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Nipple shields can help establish breast-feeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast.

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Tummy time is useful for your baby's development - here is some information on how to do this

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Tummy time is a great way to help your baby to strengthen the muscles they need for sitting, rolling and crawling (Pin et al, 2007). Encouraging them to lie on their tummy also gives them a different view of the world.

Here's what else tummy time is about and how to do it...

What is tummy time?

Tummy time is, quite simply, all about getting your baby to spend a little bit of time on their tummy.

Why is tummy time important?

Tummy time has plenty of benefits for your baby:

It's important for their physical development, helping your baby to strengthen their back, arms and neck muscles.

Tummy time helps your baby to develop their motor skills and encourages them to roll over.

Tummy time varies the position your baby lies in, which can also help prevent head flattening (positional plagiocephaly).

(Pin et al, 2007; AAP, 2017; NHS, 2017; Worcestershire Health and Care Trust, 2017)

When do you start tummy time?

You can get your baby to try out tummy time from when they born (AAP, 2017; NHS, 2017; Worcestershire Health and Care Trust, 2017). You will need to be careful though to only give your baby tummy time when you're both totally awake and they're under your close watch (AAP, 2017; NHS, 2017).

"You could start off by giving your baby very short stretches of tummy time, maybe up to three to five minutes of tummy time two or three times a day (AAP, 2017)."

But see how they get on with this and trust your instincts, especially if your baby doesn't like it (Worcestershire Health and Care Trust, 2017). If they're happy with tummy time, you could try to build it up by a minute every few days (Worcestershire Health and Care Trust, 2017).

If your baby isn't keen on tummy time, you could just hold them upright, for example by giving them a cuddle. Babies who don't do tummy time might take a little longer to walk but they'll still take a normal amount of time to do it (Pin et al, 2007).

How do you do tummy time?

From birth, you could try a few different positions to help them play and wriggle around on their tummy. For a comfy and reassuring position with loads of eye and skin contact, you could lay your baby on your chest while you're lying on your back (Worcestershire Health and Care Trust, 2017). You could also place your baby across your lap, holding them securely so they don't squirm away (Worcestershire Health and Care Trust, 2017).

When they're ready and can lean on their arms, you could see how they are with tummy time on the floor. Try this using a rolled up towel under their chest and armpits so they can lift their head more easily (NHS, 2017; Worcestershire Health and Care Trust, 2017).

Once they're four months old and can prop themselves up fully through their arms, they might not need the towel support for tummy time on the floor. This position is great for play and reaching for toys can help your baby to get stronger (Worcestershire Health and Care Trust, 2017).

After they're six months old, you could have even more fun with them by playing 'Superman'. That's where you hold them under their arms and gently lift them up so they stretch into the flying superhero's pose (Worcestershire Health and Care Trust, 2017).

Top tips for tummy time:

Stay with your baby

You need to supervise your baby during tummy time. Only get them to try out tummy time when you're both on the ball and you're watching them closely (NHS, 2017).

Little and often

It's a good idea to start your baby's tummy time with a little and often approach (NHS, 2017).

Try very short periods of time, possibly even a minute or two at a time, to start with. Nappy changes or when they wake up could give you a good opportunity to try tummy time (AAP, 2017).

Increase stamina slowly

It will take time for your little one to develop confidence and strengthen their muscles during tummy time (Worcestershire Health and Care Trust, 2017).

Trust your instincts as some babies won't like being on their tummy at first - try holding them upright instead if so. For babies that are ok on their tummies, you could help them to play and encourage them when they're on their belly so they start enjoying it more. You can then increase their tummy time when they show they're enjoying it - see what works (AAP, 2017). They will soon get the hang of it.

Tummy to tummy

Try lying on your back, tummy to tummy with your baby, smiling, talking or singing softly to them (Worcestershire Health and Care Trust, 2017). Dads or partners can get involved with this too. Skin-to-skin tummy time can be a good bonding experience.

The eye and body contact will be comforting and reassuring for your little one. You might find they stay engaged with tummy time for a bit longer this way (Worcestershire Health and Care Trust, 2017).

Tummy time fun

Try to turn tummy time into playtime (NHS, 2017; Worcestershire Health and Care Trust, 2017). You can buy baby tummy time play mats to help make tummy time more fun for your baby.

Otherwise, lie your little one on a soft blanket and put some playthings out for them. You could put brightly coloured books, toys or a baby mirror nearby for them to look at and reach out to.
This page was last reviewed in October 2017.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days 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.

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Top tips for tummy time | Baby & toddler, Your child's development articles & support | NCT

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We look at what tummy time is, when to start and why it's important. We also give you some top tips for tummy time success.

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Building a strong relationship with your baby helps with brain development - you can start this before your baby is born

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This video shows what should happen when your baby is latching to the breast

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Information on the importance of breastfeeding for baby, mother and society.

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Some good reasons to breastfeed

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About breastmilk and breastfeeding | NCT

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Breastfeeding is the way mammals, including humans, have evolved to feed and bond with their babies. However, learning how to do it can feel tricky in the early days. Read our article on how breastfeeding works, and how to cope with common problems.

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All about breastmilk and how it benefits your baby

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Breastmilk has everything a growing baby needs in exactly the right amounts and is easy to digest. Research shows that a baby who is not breastfed is more likely to suffer from health problems, both as a child and throughout adulthood.

Can anyone breastfeed?

Breastfeeding is the normal, natural way to feed and care for a baby and babies are born expecting to breastfeed. Women all over the world, regardless of their diet, produce the right type and amount of milk to nourish their growing babies, whether it's one or more!

Women who are not able to exclusively breastfeed can choose to partially breastfeed, using supplements as needed so their baby still benefits from breastmilk. For those facing breastfeeding challenges, skilled help is available from LLL Leaders.

Breastmilk contains:

Stem cells which are used by the baby. Stem cells create and repair the body, and they are a key part of treatments for many illnesses and diseases. [1]

Human milk oligosaccharides (HMOs) - sugars which are indigestible to the baby but feed friendly bacteria lactobacilli and bifidobacteria (among others). These are crucial to the development of a healthy gut microbiome, which kickstarts the immune system, promotes good digestion, and reduces the growth of unfriendly bacteria. An imbalanced microbiome could affect lifetime health and increase the risk of all non-infectious diseases. [2]

Antibodies which are specifically tailored to bacteria and viruses found in your environment. Just 20 mins after being exposed to an infectious agent a mother is producing the right antibody in her milk. [1, 3]

Immune cells, cytokines and antimicrobial factors which all help support the baby while his immune system is still developing (approx. 6 yrs). [2]

Oxytocin - a hormone which reduces stress and promotes feelings of well-being in mum and baby. [1]

Alpha-lactalbumin - a protein with pain relief properties. [1]

Extra melatonin at night which helps mum and baby go back to sleep quickly. [4]

Healthier for life

Studies show your baby will be healthier throughout their life if they are breastfed. Infant formula increases a child's risk of:

SIDS, Cancer, Obesity, Diabetes, and Allergies. [5]

In addition to an increased risk of:

Asthma, Autoimmune disorders including multiple sclerosis and coeliac disease, Cardiovascular disease, Crohn's disease and ulcerative colitis, Dental caries, Diarrhoea, Ear infections, Epilepsy, Gastroenteritis, High blood pressure and high cholesterol, Hypersensitivity and inflammation, Liver disease, Mental health issues, Necrotising enterocolitis (NEC), Respiratory infections including bronchiolitis, and Urinary tract infections. [5, 6]

Babies have tiny tummies and breastmilk is digested quickly so a newborn baby breastfeeds at least 8-12 times in a 24 hour period. The first time a newborn baby feeds he only takes about a teaspoon of milk (colostrum) but this provides his first immunity boost and lines and protects his intestines.

Infant Formula:

Is a breastmilk substitute

Infant formula is a highly processed food: a base of cow's milk, goat's milk or soy, with vegetable oils and other additives. Breastmilk is a complete and perfect food for your baby - nature has been refining your breastmilk for hundreds of millions of years. [1]

Can never accurately replicate human milk

Breastmilk is a living tissue, just like blood. It changes throughout feeds and from feed to feed to match your baby's needs. We can't accurately synthesise artificial breastmilk. Many breastmilk components have unique structures that can't be made in a factory.

Cow's milk for calves, breastmilk for human babies

Cow's milk is designed to help calves grow fast and put on lots of muscle. Human breastmilk builds intelligent human brains with gradual physical growth.

Reasons to breastfeed

Good for Mum

Breastfeeding:

Helps the uterus return to normal size after giving birth.

Is the natural way to be close to your baby and encourages a strong mother-baby bond. The mothering hormones prolactin and oxytocin help you care for your baby by lowering your blood pressure and helping you to relax physically.

Aids in natural child spacing by delaying the return of periods.

Breastfeeding reduces your risk of: [5]

Breast and ovarian cancer;

High blood pressure and diabetes;

Cardiovascular disease;

Autoimmune diseases including rheumatoid arthritis and multiple sclerosis;

Stroke;

Endometriosis and endometrial cancer;

Osteoporosis.

Nice for dads and partners

Breastfeeding is free; no need for tins of formula, bottles or sterilising equipment.

Your breastfed baby is likely to stay healthier, so fewer trips to the doctor or hospital.

Nice smells! A breastfed baby's nappy hardly smells.

No need to prepare bottles over night.

While mum is breastfeeding you can bond with your baby in other fun ways: cuddles, baths, nappy changes, walks, playtimes and carrying your baby in a sling.

Perfect for baby

Breastmilk is important for brain and nervous system development. [5]

Breastmilk kills cancer cells in the lab. [1]

Breastfeeding has been shown as effective pain relief during painful procedures. [5]

Breastfeeding is convenient

Breastmilk is always ready at the right temperature - anytime, any place, anywhere. Your baby can feed whenever he's hungry and get just what he needs. No sterilising, no making up bottles, no washing up! Keeping your baby close at night makes night-feeding easier too.

Breastfeeding is eco-friendly

Breastmilk is the most environmentally friendly baby food imaginable! Bottle feeding produces pollution and waste disposal problems due to the manufacture, packaging, transport and preparation of the formula and bottles.

Position is important

Getting a baby positioned and latched on comfortably at the breast is the key to enjoyable feeds and making enough milk. Breastfeeding is normal and natural, but it's an art that can take both mum and baby a bit of time and practice to learn. One of the best ways to find out about breastfeeding is to watch and learn from other breastfeeding mothers.

You can breastfeed anywhere

Babies often want to breastfeed when people around them are eating and drinking - and why not? Breastfeeding mothers are protected under UK equality law. Some women may feel unsure about breastfeeding in front of others initially, but soon become more confident. If you wish, it's very easy to be discreet while breastfeeding - there are lots of clothes designed especially for breastfeeding.

Breastfeeding doesn't ruin your figure

A woman's body changes naturally during pregnancy. The shape of her breasts change regardless of whether she breastfeeds or not. Breastfeeding helps mums lose weight quickly after the birth.

Breastfeeding can carry on...

Breastmilk is still a nutritious food as your baby grows into toddlerhood. Mum and baby can continue breastfeeding for as long as they want.
Revised and updated by Bronwyn Davies 2019. Adapted from an original version written by Philippa Pearson-Glaze and mothers of La Leche League.
Further Information
Positioning & attachment Comfortable Breastfeeding
Safer Sleep and The Breastfed Baby
Supporting a Breastfeeding Mother
Birth and breastfeeding
Diabetes and breastfeeding
Smoking and breastfeeding

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Mother-Baby Experiences of Nurturing, Colson, S. 2000.
References

1. https://www.human-milk.com/science.html

2. https://www.mdpi.com/2072-6643/10/8/1038/htm

3. Wendy Jones, BSc, MSc, PhD, MRPharmS, Breastfeeding Network

4. https://www.ncbi.nlm.nih.gov/books/NBK501863/

5. https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/

6. https://www.ncbi.nlm.nih.gov/pubmed/8275215

Copyright LLLGB 2019

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Breastmilk has everything a growing baby needs in exactly the right amounts and is easy to digest. Research shows that a baby who is not breastfed is more likely to suffer from health problems, both as a child and throughout adulthood. Can anyone breastfeed? Breastfeeding is the normal, natural way to feed and care [...]

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Expressing Milk before your Baby Arrives

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Expressing Milk before your Baby Arrives

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You can collect colostrum for your baby before the birth. Anyone can do this, but it's particularly helpful for babies with cleft lip/palate, or mothers with diabetes or high blood pressure. You can obtain equipment to do this from the Infant Feeding Team

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Antenatal Expressing leaflet 2024 English

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Association of Breastfeeding Mothers - antenatal-expressing

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Expressing your milk before your baby arrives

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Early Initiation of Breastfeeding - Breastfeeding Series

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Babies are amazing! This video shows how a baby in skin to skin can move to your breast, latch and feed if given time and not disturbed. Discuss skin to skin with your midwife during your pregnancy so you know what to expect.

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Early Initiation of Breastfeeding - Breastfeeding Series

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You can continue to breastfeed your older child when you are pregnant

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Pregnant and Breastfeeding - La Leche League GB

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If you’re expecting a baby and are continuing to breastfeed your older child, many questions may be going through your mind. Mothers can breastfeed while pregnant; some go on to nurse both their new baby and their older child after the birth. This is known as ‘tandem nursing’. Breastfeeding during…

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How do I know my baby is getting enough milk?

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How do I know my baby is getting enough milk?

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There are lots of reassuring signs you can look for to show that your baby is getting plenty of milk. If you have any concerns speak to your midwife or health visitor

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Breastfeeding: is my baby getting enough milk?

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How to tell if your breastfed baby is getting enough milk, signs your baby is properly attached and feeding well, plus ways to boost your breast milk supply.

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Information from experienced peer supporters about breastfeeding during fasting periods such as Ramadan

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The verse of the Qur'an which relates to this is as follows:
​
"Observe Saum (fasts)] for a fixed number of days, but if any of you is ill or on a journey, the same number (should be made up) from other days. [...] (2:184).

Scholars are of the view that pregnant and nursing mums fall in the category of people who are ill.
Islam recognises how tiring it can be for Mums who are breastfeeding, with their body working hard to meet the demands of a growing baby, and has given this exemption to ease their life. It will be beneficial for both Mum and baby to take advantage of this exemption, especially if the baby is less than one year old. With very young babies there is the possibility that the milk supply could be affected by the fasting if it is just being established.

If your baby is on solids and your milk supply is well established and you do decide to fast, there is less chance that your fasting will have an effect on your milk production. The weight gain and growth rate of breastfed older babies does not appear to be affected by their mother fasting during Ramadan. However, especially during the long summer fasts, it can still be very difficult for Mums to cope with the demands of both breastfeeding and fasting, and the exemption from fasting is there as a mercy from Allah to help mothers to fulfil the child's right to two years of breastfeeding.

In fact it is more pleasing to Allah when we take advantage of a concession that we have been given, and you do not need to feel bad for not fasting because of breastfeeding. As breastfeeding your baby during the first years is crucial and this is a time which once gone cannot be brought back, in order to avoid having regrets later, it is advisable to report the fasting for later and concentrate your efforts in ensuring the well-being of your baby.
If you choose not to fast, which is completely legitimate, there are many other ways for you to seek the rewards and spiritual boost of Ramadan, and the time you spend breastfeeding can be put to good use for example to read the Qur'an, do Dhikr and make Du'as.

Also bear in mind that breastfeeding too can be a form of worship if done with the right intention.

This can be quite tricky especially if everybody else is fasting, but your body and your baby have the same demands whether in Ramadan or outside. It is a good idea to stock up on your favourite healthy snacks, such as fresh or dried fruit, nuts, and yoghurt, and keep in mind some easy and healthy lunch recipes, especially ones that can be prepared ahead, such as sandwiches or pasta or rice salads.
​One other important point for a breastfeeding mum to remember is to take care of your own physical health, whether you are fasting or not.
Dates are also an excellent source of nutrients for breastfeeding mums.

Below are some handy tips for Mums who are breastfeeding while fasting:

Do shopping and other chores that require extra energy (such as spring-cleaning) before the start of Ramadan

Keep a food diary to keep track of what you are eating and drinking overnight, so you can make sure that you are getting a good balance of healthy, nutritious foods.

Drink plenty when you break your fast, but not so much that you have no room for food-getting enough calories is important too.

Do not skip Suhoor (the pre-dawn meal) as your body will need to store as many nutrients as it can -set an alarm clock if needs be.

As there is some evidence that fasting can affect the levels of some nutrients in breast-milk (zinc, magnesium and potassium), it is important to eat well, and perhaps take a vitamin supplement for breastfeeding mums.

Keep cool and rest as much as you can during the day. You might find it helpful to nap when your baby does.

If you begin to notice signs of dehydration (headaches, feeling thirsty, feeling dizzy or faint), break your fast with water, ideally with some sugar and salt added, to rehydrate you quickly.

Listen to your body and speak to a health professional if you feel unwell, and follow the advice that they give to you.

It is also helpful to be aware of things to look out for which show that your baby might not be getting enough milk. This depends to some extent on your intuition as a mother, as it will vary from baby to baby depending on what your baby's natural habits are. Some things to look out for might include a significant change in the number of wet and dirty nappies your child is doing in a day, your baby's temperament changing, and becoming more unsettled, and, for young babies, a drop in weight gain. In all of these cases it would be wise to take a break from fasting, and to seek further support and guidance though the Mammas helpline, or another breastfeeding support service. If you are in any doubt, it is best to speak to a trained breastfeeding supporter so they can help you work out the best course of action for you.
Some mums find that fasting one day and then having a break for a day or a number of days can work for them. However this is not the case for all mums. It is important that you do what is manageable for you and your baby. Every mum and baby is different. Allah is aware of what is manageable for each individual, and will not expect us to go beyond that, even if another mum is able to do more.

If breastfeeding problems develop while you are fasting you are always welcome to call us on our breastfeeding helpline:
Mammas breastfeeding helpline 07794667791
Gujarati/Urdu helpline 07794667901
Anita & Faranaaz
​Mammas ©

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The verse of the Qur'an which relates to this is as follows: ​ "Observe Saum (fasts)] for a fixed number of days, but if any of you is ill or on a journey, the same number (should be made up)...

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Reflux is normal and does not usually require treatment. If you are concerned contact your midwife, health visitor or GP for advice

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has vomit that's green or yellow, or has blood in it

is projectile vomiting (being sick with more force than usual)

has blood in their poo

has a swollen or tender tummy

has a very high temperature or they feel hot or shivery

keeps being sick and cannot keep fluid down

has diarrhoea that lasts for over a week or has signs of dehydration

will not stop crying and is very distressed

is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

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Find out about reflux, where a baby brings up milk during or soon after a feed.

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Find out what to expect from breastfeeding in the first few days after birth, including what colostrum is, what happens when your milk ‘comes in’ and what the let-down reflex feels like.

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Is Your Baby Getting Enough Milk – Breastfeeding Series

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How to recognise that your baby is drinking as well as sucking at the breast

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How to recognise that your baby is drinking as well as sucking at the breast

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This video will help you to recognise that your baby is drinking well and getting a good amount of milk. If you are worried that your baby is not swallowing whilst at the breast talk to your midwife.

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Is Your Baby Getting Enough Milk – Breastfeeding Series

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Useful information for co-sleeping with your baby. Many parents find themselves co-sleeping whether they mean to or not. Wherever you’re planning for your baby to sleep we recommend making your bed a safer place for baby.

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To reduce the risk of sudden infant death syndrome (SIDS) the safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. However, we know that many parents find themselves co-sleeping whether they mean to or not. Wherever you're planning for your baby to sleep we recommend making your bed a safer place for baby. Our advice on co-sleeping with your baby will tell you how.

When not to co-sleep

Whether you choose to co-sleep or it is unplanned, there are some key risks you should avoid.
Co-sleeping with your baby is very dangerous if:
In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or Moses basket. Keeping the cot or Moses basket next to your bed might make this easier.
Never fall asleep on a sofa or armchair with your baby. The risk of SIDS is 50 times higher for babies when they sleep on a sofa or armchair with an adult. They are also at risk of accidental death as they can easily slip into a position where they are trapped and can't breathe.
Co-sleeping more safely

Keep pillows and adult bedding away from your baby or any other items that could cover their head or cause them to overheat. A high proportion of babies who die as a result of SIDS are found with their head covered by loose bedding.

Follow all The Lullaby Trust's other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back

To reduce the risk of accidents, do not bring other children or pets into bed with you.

Try to make sure or check that baby cannot be trapped, wedged or fall out of bed or get trapped between the mattress and the wall

Never leave your baby unattended in an adult bed

For more info on co-sleeping and safer sleep read our guide for parents
If you are bedsharing with your baby you should consider any risks before every sleep. It is easy for your situation to change if you are unwell or have drunk any alcohol, which means your baby will be safest in a separate sleep space such as a cot or Moses basket on that occasion.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep while I breastfeed my baby at night, is this ok?

Click here to open this question

Breastfeeding reduces the chance of SIDS. If you feel you might fall asleep we would recommend you prepare the bed as described above so it is safer for baby if this happens.

Make sure you know the advice on when never to co-sleep so you know when to take particular care. It is really important that you do not accidentally fall asleep with your baby on a sofa or armchair. If you think you might fall asleep on a sofa or armchair, put the baby down in a safe place to sleep.

Should I co-sleep with my baby?

Click here to open this question

The safest place for a baby is their own separate sleep space, such as a cot or Moses basket. We would just advise you to read all the information on co-sleeping and how to reduce the risks, so you can make an informed decision for you and your baby.

However, there are some circumstances where we would strongly recommend against co-sleeping such as on a sofa or armchair, if anyone in the bed smokes or has drunk alcohol or your baby was premature or a low birth weight.

Can I co-sleep with twins or multiples?

Click here to open this question

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

Is it safer to co-sleep using a nest or pod than with a baby just lying on the adult bed?

Click here to open this question

No. We do not recommend that babies sleep on soft surfaces such as pods or nests. If you choose to co-sleep with your baby the safest place is a clear space on a firm flat mattress the same as we would advise with a cot.

Why do you advise against co-sleeping in certain scenarios?

Click here to open this question

It is estimated that around half of SIDS deaths occur whilst co-sleeping, and that most of these are in high risk situations. We do not know the cause of SIDS and why these deaths happen but we do know what some of the risk factors are and that removing those risks greatly lowers the chance of SIDS occurring.

For that reason we strongly advise against co-sleeping when there are risk factors such as a baby being premature or a parent having drunk alcohol.

What bedding should I use for my baby when we co-sleep?
The Lullaby Trust has worked with Public Heath England, Unicef UK Baby Friendly and Basis on two publications to support families with safer sleep advice and advice on co-sleeping more safely. We have also collaborated on a guide for health professionals to have more open and productive discussions with families about safer sleep and co-sleeping. These can be downloaded below.

Click here to open this question

Adult bedding should be kept well away from your baby along with any belts or cords from clothing. Keep adult bedding at your waist height and add an extra layer of clothing if you are cold

A baby sleeping bag is a good way of giving your baby their own bedding when bedsharing.

Baby sleeping bags should be well fitted, so the baby can't wriggle down inside. Most sleeping bags are fitted according to a baby's weight, rather than age.

You might also be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

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Some parents choose to share a bed (known as co-sleeping) with their babies. Read our advice on how to co-sleep more safely.

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If you have had breast surgery you may benefit from extra support from a Breastfeeding Specialist. Details for support are in the 'Where to find support' section.

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Evidence suggests that if there has been more than five years, this is a positive factor.

So whether you are pregnant or already starting to breastfeed now, and you have already had breast reduction surgery, regardless of the type of surgery that you had, there are still possibilities to increase your supply.

It is essential, therefore, to seek out skilled help from an IBCLC, a breastfeeding counselor, or your health professional who can get alongside you and give you some added information on boosting supply.

It's essential to learn about how to boost and maintain your milk production by doing regular, daily skin to skin , good positioning at the breast , extra pumping , use of galactagogues , and breast compressions . All of these strategies can help.

If your baby can latch at the breast, it is possible to be able to feed fully at the breast.

However, if your body is struggling to produce all the milk your baby needs, you may need to combine breastfeeding with formula feeding.

In that situation, you may choose to feed your baby at the breast using an at breast supplementer.

I appreciate that some mothers want to have their baby at the breast for all of the suckling needs. Some feel strongly that they don't want to offer bottles.

For some of you, however, giving bottles is the preferred option alongside feeding at the breast. This is really an individual decision.

Babies come to the breast for warmth, comfort, and relationship building .

Lots of skin to skin can be done with your baby, so even if you find that with all of your best efforts, your body is not able to make enough milk or even NO milk, you can still use a nursing supplementer to have your baby fully at the breast, as long as he can latch.

In this particular scenario, you may prefer to bring your baby to the breast just for comfort and also to offer bottles of formula to your baby. There are lots of ways to do things!

If you have had breast reduction surgery, I can appreciate that all of this can sound rather daunting, but the rewards of trying to boost your supply and maximizing your breastmilk can undoubtedly pay off.

You will know that you have given your best efforts, and your relationship with your baby at the breast, with or without a full milk supply, can still carry on regardless if desired.

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Breastfeeding After Breast Reduction - The Breastfeeding Companion

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Evidence suggests that if there has been more than five years, this is a positive factor. So whether you are pregnant or already starting to breastfeed now, and you have already had breast reduction surgery, regardless of the type of surgery that you had, there are still possibilities to increase your supply.

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Newborn baby poo in nappies: what to expect 

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Your baby's nappies can help you to be confident that feeding is going well

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Your baby’s nappy can tell you a lot - find out more here.

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Breast compressions can be useful to help your baby drink more at the breast - watch the video for when and how to do this

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Information for parents who are expecting twins or more

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Many new mums worry about whether they will have enough milk, but in fact there are very few women who don't have enough.

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Breastfeeding after a caesarean birth - NCT

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You can have skin to skin and breastfeed after a Caesarean birth. Ask the staff on the ward to help you.

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Some evidence suggests that mums who give birth by caesarean can find it more difficult to establish breastfeeding and are more likely to stop breastfeeding earlier. But other research has found that the type of birth has very little effect on the numbers of mums still breastfeeding when their babies are six months old (Prior et al, 2012; Hobbs et al, 2016).

We discuss why a caesarean birth might make breastfeeding more difficult. And here are some helpful suggestions for breastfeeding your baby after a caesarean birth, including how some positions can make it easier.

How to get breastfeeding off to a good start after a caesarean birth

Skin-to-skin contact between mum and baby are recommended immediately after birth (NICE, 2021; UNICEF, no date). This means your baby is placed naked onto your bare chest. This helps babies adjust to the world, begin bonding and start breastfeeding.

Babies in skin-to-skin contact with their mums soon after birth are more likely to have a successful first feed and are more likely to be breastfeeding at four months (Moore et al, 2016). Mums who give birth by caesarean are more likely to stop breastfeeding earlier than those who give birth vaginally (Hobbs et al, 2016). Yet there is no difference in breastfeeding rates with different types of birth in babies who have early skin-to-skin contact (Lau et al, 2018).

Skin-to-skin contact within the first hour after a caesarean birth is more challenging, but mums who request this - and who are supported by health professionals to achieve this - are more likely to have a positive outcome (Stevens et al, 2018). Guidelines on caesarean birth recommend that women who want to breastfeed should be supported to have skin-to-skin contact with their babies as soon as possible after birth (NICE, 2021).

The many benefits for you and your baby of holding them skin-to-skin include:

(Stevens et al, 2019)

If a baby can't have skin-to-skin contact with their mum, skin-to-skin with the other parent is also beneficial (UNICEF, 2019b).

Tips: how to get the breastfeeding support you need after a caesearean

After a caesarean birth, early skin-to-skin contact should be encouraged and extra support offered (Beake et al, 2017; NICE, 2021). Extra support could include the following...

You can ask your midwife to help you to find positions that are comfortable for breastfeeding (NICE, 2021).

Your midwife or someone on the infant feeding team should support you with keeping your baby as close to you as possible. They should also support you to help your baby to have as much skin-to-skin contact and access to your breasts as possible (NICE, 2021).

They can check whether your baby is latching effectively, especially if they're drowsy from medication. They'll also help to make sure your baby feeds frequently and will continue to support you with breastfeeding your newborn.

If your baby is unable to breastfeed directly, they should show you how to express your milk. This is so that your baby can have your milk and your milk supply will be maintained (UNICEF, 2014).

Women do experience pain after a caesarean birth, which can have a negative effect on establishing breastfeeding. It is usually necessary to take pain relief. It's fine to take paracetamol and ibuprofen to help with the pain but aspirin and codeine are not recommended when breastfeeding (Karlström et al, 2007; NICE, 2021).

Babies born by caesarean absorb some of the IV fluids given to the mum during surgery, increasing the baby's weight at birth. These babies urinate more in the first 24 hours, which restores their weight to normal. That means it's more accurate for babies born by caesarean to have their birth weight recorded at 24 hours and for this to be used as a baseline to compare their progress with (UNICEF, 2019).

Do give yourself and your baby time to adjust, you've just been through an amazing but huge change in your life and your baby needs time to get used to life outside the womb. Plus, it takes time for you and your baby to recover physically from the caesarean birth and from any medications you had (NICE, 2019).

Do accept all offers of help and certainly don't be afraid to ask for it - you've just had an operation and a baby after all. Help isn't just good for you, it's good for your baby too. Research says that mums who 'look after themselves' by asking for more help are more likely to breastfeed for longer (Tully and Ball, 2014).

Breastfeeding positions

It's important to find a breastfeeding position that's comfortable for both you and your baby. This helps your baby to latch well and helps you to maintain the position for as long as your baby is feeding.

Some mums like to cover their caesarean scar to protect it, others prefer positions that keep their baby away from it. Some mums find the position of the cannula in their hand or arm from the caesarean can affect how easy it is to find a comfortable breastfeeding position. So it might be worth discussing this with midwives or breastfeeding supporters.

When your baby is breastfeeding, they should come to your breast chin first, nipple pointing up the nose, body in a straight line, nipple aimed towards the roof of their mouth and their body very close to you. Read our article How to help your baby attach and breastfeed for more information.

Here are some positions you could try...

Lying down on your side

Laid-back breastfeeding

Rugby-ball or underarm position

Why a caesarean birth might make breastfeeding more difficult

Frequent, effective removal of milk from a mum's breasts ensures she produces the amount of milk her baby needs. That's because the more milk your baby takes, the higher your levels of breastfeeding hormones (prolactin and oxytocin) will be and the more milk you'll make. We also know that the earlier breastfeeding starts, the more likely it is to continue. A caesarean birth could affect this in a variety of ways...

Pain - from the scar and from the baby not latching well at the breast because the mum finds it harder to get comfortable (Tully and Bull, 2014). This could cause her not to feed as often or for as long.

Loss of mobility - can make it harder to get into a comfortable position to feed and to pick the baby up when they want feeding (Tully and Bull, 2014).

Not going through labour - if a mum has an elective caesarean birth before labour starts, she will not have produced labour hormones. This might lead to lower levels of breastfeeding hormones in the mother and babies being less prepared for feeding (Prior et al, 2012; Zanardo et al, 2013; Hobbs et al, 2016).

Long and stressful labour - an emergency caesarean birth can leave women feeling tired and anxious for themselves and their baby. This stress can lead to lower levels of breastfeeding hormones (Hobbs et al, 2016).

Exhaustion - in both mum and baby can lead to the baby feeding less often and less effectively.

Medication - can lead to a mum feeling drowsy or unwell, which can make early breastfeeding less likely. Medication can also affect the baby, making them drowsy and less able to breastfeed effectively (Brown and Jordan, 2013; UNICEF, 2019).

Separation - if mum and baby are separated, this can mean less chances for early breastfeeds.

Less opportunities for early skin-to-skin and a delayed first breastfeed - caesarean births might mean less opportunities for skin-to-skin contact. Skin-to-skin contact and the baby having their first breastfeed as soon as possible after birth help breastfeeding to become established (Moore et al, 2016).

Effects of a caesarean on the baby - babies born by caesarean are more likely to have mucous in their lungs, which can affect how interested they are in feeding (Tully and Ball, 2014). The IV fluids during labour can also boost a baby's birth weight, which can lead to worries that they've lost too much weight and to early formula supplementation and less breastfeeding (Noel-Weiss, 2011; Chantry et al, 2014).

Loss of confidence - mums might be less likely to believe their bodies can nurture and feed their baby and that breastfeeding is going well. Well-meaning family members might also be more likely to suggest a mum gives her baby formula (this makes breastfeeding more difficult) so she can rest after her caesarean. Early formula supplementation reduces a mother's milk production and confidence in her ability to feed her baby (Tully and Ball, 2014).

Night feeds - feeding at night can be particularly difficult after a caesarean birth if family members or supporters are not available to help with picking the baby up. Some mums say they feel asking midwives for help is a sign of failure.

Take a look at our articles for more about the practicalities of recovering from a caesarean birth and for tips to help you recover more quickly.
This page was last reviewed in December 2021.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days 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.

Beake S, Bick D, Narracott C, Chang YS. (2017) Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. Matern Child Nutr. 13:e12390. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27882659 [Accessed 30th December 2021]

Chantry C, Dewey K, Peerson J, Wagner E, Nommsen-Rivers L. (2014) In-hospital formula use increases early breastfeeding cessation among first-time mums intending to exclusively breastfeed. J Pediatr. 164:1339-1345. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120190/ [Accessed 30th December 2021]

Hobbs A, Mannion C, McDonald S, Brockway M, Tough S. (2016) The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth. 16:90. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s1288... [Accessed 30th December 2021]

Karlström A, Engström-Olofsson R, Norbergh K-G, Sjöling M, Hildingsson I. (2007) Postoperative pain after cesarean birth affects breastfeeding and infant care. JOGNN. 36: 430-440. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17880313 [Accessed 30th December 2021]

Lau Y, Tha PH, Ho-Lim SST, Wong LY, Peng IL, Nurfarah BZMC, et al. (2018) An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. Matern Child Nutr. 14(1):e12492. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866048/ [Accessed 30th December 2021]

Moore E, Bergman N, Anderson G, Medley N. (2016) Early skin-to-skin contact for mums and their healthy newborn infants'. Cochrane Database of Systematic Reviews. (11):CD003519. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/full [Accessed 30th December 2021]

NICE. (2021) NG192 Caesarean birth. Available at https://www.nice.org.uk/guidance/ng192/chapter/Recommendations#care-of-... [Accessed 30th December 2021]

Noel-Weiss J, Woodend AK, Peterson WE, Gib W, Groll DL. (2011) An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Int Breastfeed J. 6:9. Available at: http://www.internationalbreastfeedingjournal.com/content/6/1/9 [Accessed 30th December 2021]

O'Brien M, Buikstra E, Fallon T, Hegney D. (2009) Strategies for success: a toolbox of coping strategies used by breastfeeding women. J Clin Nurs. 18:1574-1582. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19220615 [Accessed 30th December 2021]

Prior E, Santhakumaran S, Gale C, Philipps L, Modi N, Hyde M. (2012) Breastfeeding after caesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 95(5):1113-1135. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22456657 [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen HG. (2018) Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section. Women Birth. 31(6):453-462. Available at: https://pubmed.ncbi.nlm.nih.gov/29496385/ [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen H. (2019) Skin-to-skin contact and what women want in the ﬁrst hours after a caesarean section. Midwifery. 74:140-146. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30954633 [Accessed 30th December 2021]

Tully K, Ball H. (2014) Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth. Midwifery. 30:712-719. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451198/ [Accessed 30th December 2021]

UNICEF. (no date) Skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implemen... [Accessed 30th December 2021]

UNICEF (2014) The Baby Friendly Initiative - The ten steps to successful breastfeeding. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2014/... [accessed 30th December 2021]

UNICEF. (2019) Research on skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/ [Accessed 30th December 2021]

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Breastfeeding after a caesarean birth | Baby & toddler, Feeding articles & support | NCT

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A caesarean birth can affect breastfeeding at first so here are some helpful tips on how to get breastfeeding off to the best start.

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A series of videos on how to reduce the risk of SIDS when caring for your baby.

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Safer Sleep for babies online presentations

To access the presentations simply click the link and enter your name and email address to register. You will then be able to view the presentation
Safer sleep for babies - Sleep position, sleep environment and bedding
Find out more about the safest way to put your baby down to sleep for both daytime naps and at night.
https://attendee.gototraining.com/r/99838260930278401 Safer sleep for babies - Overheating, temperature and overwrapping
Find out more about the safest room temperature for your baby and the risk associated with overheating and overwrapping your baby.
https://attendee.gototraining.com/r/4732765744628309762 Safer sleep for babies - Baby ill-health, Baby Check app and vaccination
Find out more information about checking for signs that your baby maybe unwell, how to use the Baby Check app and the importance of vaccinating your baby.
https://attendee.gototraining.com/r/3914196930066085890 Safer sleep for babies - Breastfeeding
Find out more about the benefits of breastfeeding.
https://attendee.gototraining.com/r/6540597056868292609 Safer sleep for babies - Smoking and e-cigarettes
Find out more about the benefits of not smoking before and after your baby is born.
https://attendee.gototraining.com/r/5716067789797323522

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To access the presentations simply click the link and enter your name and email address to register. You will then be able to view the presentation Safer sleep for babies - Sleep position, sleep environment and bedding Find out more about the safest way to put your baby down to sleep for both daytime naps and at night.

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Caring for your baby at night - A Guide for Parents

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Caring for your baby at night - A Guide for Parents

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Information about caring for your baby at night, including feeding and sleeping safely

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Tips to help you understand how your baby communicates

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Learning What Your Newborn Is Saying

My Language

Right from birth and well before your baby speaks their first words, they are communicating with you through their behaviour. This communication can be as clear as a good loud cry or as subtle as a slight movement of their eyebrow. Think of all your baby's movements, expressions and responses as phrases they use to communicate with you- the unspoken words of their first language. Watch for, observe and interpret the meaning of your baby's signals and cues and you will soon become familiar with what they are saying and get to know them very well.

Window Into My World

Your baby's cues are completely trustworthy and authentic responses giving you information about what care they need and what they like and dislike. Unlike adults, there is no discrepancy between the feeling and its expression. Your baby cannot mask their feelings so what you observe you can trust unconditionally.

My Favourite Toy

Your baby not only knows your face and voice but also loves nothing more than connecting with you when they are in a quiet and alert state. They are much more engaged with your expressions and slow directed speech than they are in a toy. Have your face at a distance of around 10-18 inches. They will enjoy following your face and finding your voice- see their inborn hunger to connect with you.

Watch and Wait

When your baby's eyes are heavy or flicker open and closed, they are in a kind of 'no man's land' between sleep and wakefulness. As much as you would love to play, your baby is asking for you to wait for them during this transitional state. You will soon see if they are going back to sleep or ready to wake up.

Do Not Disturb

At this early stage, your baby will sleep for long periods in the day as they grow and develop rapidly. Your baby has an amazing ability to selectively tune out sounds and bright lights to preserve their sleep. They also appreciate your support in minimising disturbances in the environment.

Learning Emotions

Your baby feels validated and learns to understand how different emotions feel when you reflect those for them. When they have bright smiling eyes, beam back at them. When they are upset show them you sympathise with what is bothering them are ready to help.

Clever Me

Along with support from you, your baby has amazing inbuilt abilities to help himself/herself stay calm and organised; especially if they are beginning to feel a little overwhelmed from the environment and stimulation around them. Admire how focusing in on an object or the rhythmic suck of their hand calms them.

Grow My Brain

Your baby is exquisitely sensitive to your touch, words and affirmation. Every loving response and every social experience will leave imprints on their brain, major transformations at this time of rapid brain development. When your baby is in a quiet, alert state, take every opportunity to interact. You will be deepening their sense of security and laying the foundations of a relationship that will last a lifetime.

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Learning What Your Newborn Baby Is Saying - Brazelton Centre UK

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Right from birth and well before your baby speaks their first words, they are communicating with you through their behaviour. This communication can be as clear as a good loud cry or as subtle as a slight movement of their eyebrow.

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Advice from the Lullaby Trust to help you keep your baby safe.

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It is important to make sure that your baby is a comfortable temperature - not too hot or too cold. The chance of SIDS is higher in babies who get too hot. A room temperature of 16-20°C - with light bedding or a lightweight, well-fitting baby sleep bag- is comfortable and safe for sleeping babies.

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Slings and carriers can be useful, especially for times when your baby needs to be close to you. Here's how to make sure your baby is safe while you do this

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Keep your baby close and keep your baby safe. When you're wearing a sling or carrier, don't forget the T.I.C.K.S.

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It's recommended that all pregnant women take a Vitamin D supplement, and continue this during breastfeeding. Your breastfeeding baby should also have Vitamin D drops.

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
In 2012 the Chief Medical Officer in the UK made recommendations about supplementing all pregnant and breastfeeding mothers and children with Vitamin D. There seems to remain a lot of confusion as to who should take these supplements, why this is necessary and how to obtain them. The recommendations were updated in July 2016 in line with the SACN recommendations on vitamin D and health.

Breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D as a precaution (SACN 2016)

Breastfeeding Mothers should also take a daily Vitamin D supplement of 10 µg per day

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live.

Breastmilk is perfect for babies

Vitamin D drops should be given to babies on a teaspoon as droppers are hard to sterilise

Healthy Start Vitamins remain an excellent, economic source of vitamin D and are provided free of charge in many areas. The daily dose of 5 drops contains 10µg www.healthystart.nhs.uk/for-health-professionals/vitamins/

Babies born to mothers with low vitamin D status are at risk of developing rickets. Taking into account that MOST of us are deficient between October and April at best and MANY of us will have low levels throughout the year, the recommendation that ALL pregnant women should take a supplement of 10 µg Vitamin D per day throughout pregnancy is sensible and cost effective (Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation).

Babies born to mothers who have not taken a vitamin D supplement in pregnancy are likely to be born with low vitamin D status. Levels of vitamin D in that mother are also likely to be low and even if she begins to take a supplement herself at that time, cannot redress the baby's deficiency by breastfeeding. So the recommendation is that the baby should receive its own oral vitamin D drops containing 7-8.5µg per day from 4 weeks of birth until the age of 5 years. Waiting until the baby is 6 months may be too late to prevent development of symptoms. Mothers may also develop symptoms of deficiency themselves.

Although it was thought that levels of vitamin D stores laid down in pregnancy by a mother who has taken vitamin D supplements in pregnancy would be sufficient for a few months,
new recommendations (July 2016) are that breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough ( www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-D.aspx). In addition breastfeeding mothers should take a daily Vitamin D supplement of 10 µg per day - in fact as more and more conditions are linked with lack of vitamin D most of us would benefit from taking it regularly.

In children; rickets, delayed tooth eruption, increased risk of infection, decreased bone mass, hypocalcaemic seizures, delay in walking.

In adults; osteomalacia, muscle weakness, bone pain plus possible association in many other conditions.

Mothers who are diagnosed with vitamin D deficiency may be prescribed very high dose supplements. Papers looking at these doses are scarce. Hollis and Wagner (2004) concluded that "Maternal vitamin D intakes of 4000 IU/d appear to be safe and to provide sufficient vitamin D to ensure adequate nutritional vitamin D status for both mothers and nursing infants. Hollis et al 2015 that "Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant's requirement and offers an alternate strategy to direct infant supplementation.

For information on high dose vitamin D prescribed for breastfeeding women see https://breastfeeding-and-medication.co.uk/fact-sheet/high-dose-vitamin-d-supplements-and-breastfeeding

Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna

Cod liver oil and other fish oils

Egg yolk; 0.5 micrograms (20 IU) per yolk)

Mushrooms

Supplemented breakfast cereals typically contain between 2 and 8 micrograms (80-320 IU) per 100 g

Margarine

The average dietary vitamin D intake of young women in the UK approximates 3 micrograms per day and fewer than 1% consume more than the 10 micrograms (Williams 2007). The National Diet and Nutrition Survey of British adults suggest that if such a threshold were investigated in the UK population data, some 80-90% would be deficient (Henderson 2003).

The main source is Ultraviolet B sunlight exposure; more than 90% of mankind's vitamin D supply is derived from exposure UVB in sunlight. Deficiency of vitamin D in the UK is predominantly caused by poor weather, increasing use of high factor sunscreen (more than factor 8), and latitude: those born north of approximately Birmingham (40°N) are unlikely to be able to reach sufficient exposure.

Sunlight exposure needed is 2 hours per day (if only the face exposed), 20-30 minutes a day if the face, arms and neck are exposed without sunscreen. Sun protection factor in excess of 8 prevents absorption of the UVB sufficient to make vitamin D. Need increases for those with darker skins. In all cases it is important to avoid sunburn, particularly in babies.

Those who are eligible for Healthy Start vouchers receive free vitamin tablets and drops containing the correct dose of vitamin D for mothers and children.

Those not eligible for Healthy Start may purchase vitamin supplements form pharmacies and Health Food Stores - please check that they contain 10µg for adults and at least 7-8.5µg for children (usually 10 µg).

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live. The addition of vitamin D to formula milk does not make it better than breastmilk - it does not contain all the immunological properties that make breastmilk specific to cater for each baby's needs.

Some mother and infant groups have been shown to be at increased risk, including:

Babies of mothers with darker skin types

Pregnant and breastfeeding women.

Babies born in the winter months and not exposed to the sun

Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight

Babies and mothers who spend a lot of time indoors or use sun creams, reducing exposure to sunlight

Babies of obese mothers (BMI >30)

Babies of mothers with gestational diabetes.

Ahmed SF et al. Recent trends and clinical features of childhood vitamin D deficiency presenting to a children's hospital in Glasgow. Arch Dis Child 2011;96:694-6 http://adc.bmj.com/content/96/7/694.full.pdf+html

American Academy of Paediatrics Prevention of Rickets and Vitamin D deficiency in infants, children and adolescents 2008 http://pediatrics.aappublications.org/content/122/5/1142.full.pdf+html

CMO Vitamin D supplements for at risk groups. dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132508.pdf

Department of Health. Vitamin D an essential nutrient for all, but who is at risk of vitamin D deficiency? http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_111302.pdf

Henderson L, Irving K, Gregory J, et al. The National Diet and Nutrition Survey: adults aged 19 to 64 years. Vol 3. Vitamin and mineral intake and urinary analytes . London: Stationery Office, 2003: 1-160.

Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004;80(Suppl 6):1752S-1758S

Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG,Taylor SN, Morella K, Lawrence RA,Hulsey TC, Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics 2015;136 (4):

Jones W. Breastfeeding and Medication Routledge 2018

Michie C. Managing vitamin D deficiency in children. London Journal of primary care July 2010 londonjournalofprimarycare.org.uk/articles/3186685.pdf

NHS Choices. nhs.uk/news/2012/01January/Pages/vitamin-d-medical-advice-and-supplements.aspx

Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation. infantfeedingwm.org.uk/documents/Website_VitD.pdf

SACN Update on Vitamin D 2007. sacn.gov.uk/pdfs/sacn_position_vitamin_d_2007_05_07.pdf

SACN Vitamin D and Health 2016 www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network June 2020

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Vitamin D and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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Antidepressants and Breastfeeding - The Breastfeeding Network

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Useful information if you are taking antidepressants whilst you are breastfeeding

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Sertraline has the lowest passage of SSRI drugs into breastmilk. Citalopram also passes into breastmilk in low levels. If a breastfeeding mother has found an antidepressant previously prescribed of benefit, that may influence the choice of drug prescribed

It is important that post-natal depression is recognised and treated effectively as it may impair bonding between mother and child and enjoyment of an important period in the relationship. Approximately 80% of women experience post-natal blues but some 10-15% experience more severe symptoms and need medication and or counselling and cognitive behavioural therapy. Some mothers may not immediately recognise or accept that they are depressed. Some fathers may recognise the difference in their partners. Others will deny the possibility.

The symptoms of post-natal depression may include obsessive thoughts often concerning harm to the baby, hyperactivity or lethargy, weight loss, volatility of behaviour and restlessness. Some women will express suicidal tendencies. But many symptoms are non-specific e.g. feeling of tiredness and not wanting to get up, not being able to cope as the day goes on and needing to go to bed early - could describe the natural effects of caring for a new baby 24 hours a day. Some women, particularly those who are normally natural leaders, may express concern over loss of confidence.

Most anti-depressants take three to four weeks to exert maximal efficacy and it is important that the woman is informed of this. Many patients stop taking anti-depressant medication within the first four weeks having found no benefit. Initially some medicines may also make symptoms appear worse and patients need to be aware of this to ensure concordance with the drug regime.

For information on anxiety and breastfeeding see www.breastfeedingnetwork.org.uk/anxiety/

For information on OCD and breastfeeding see www.breastfeedingnetwork.org.uk/ocd/

The treatment for depression usually involves SSRIs which act by inhibiting re-uptake of serotonin into neurones in the central nervous system. The majority of manufacturers have not conducted clinical trials on the use in lactation and in the Summary of Product characteristics recommend that they are not used by breastfeeding mothers. Their use is therefore off-licence and at the discretion and responsibility of the prescribing physician.

Side effects include nausea which may be particularly marked in the early weeks of therapy, diarrhoea, headache, insomnia and agitation. It may be difficult to differentiate the side effects of the drugs from the symptoms of depression so it may seem that the drugs are not being effective in the early weeks of therapy.

Sertraline (Lustral®) - has a shorter half-life. The long half-life metabolite is only marginally active, unlike that in fluoxetine and hence is unlikely to cause accumulation in the baby. There are published studies on more than 30 infants with no untoward effects noted. In almost all cases none of the drug has been detected in the infant plasma. Reported but anecdotal, evaluation of an infant exposed to 100milligrammes daily was that the child reached normal developmental milestones and weight at 3 months. There is one report of an infant developing benign neonatal sleep at 4 months, which resolved at 6 months, it is unclear whether this bears any relationship with the maternal use of sertraline. It is normally seen as the SSRI of choice for a breastfeeding mother if she has not had a previous antidepressant which was effective for her - this would then be the drug of choice.

Citalopram (Cipramil®) - There is one report of an infant exhibiting "uneasy" sleep patterns on a maternal dose of 40milligrammes/day. This resolved when the mother's dose was reduced. There are also two reports of excessive somnolence, decreased feeding and weight loss in breastfed infants. In studies no adverse effects on the babies were noted. If the baby shows less than expected weight gain it might be prudent to discontinue the drug and change to another SSRI. It should not be given concomitantly with erythromycin or fluconazole. However, the majority of breastfed babies tolerate it well.

The milk plasma ratio has been estimated to be 1.16-3, suggesting that the drug concentrates in milk. The metabolite enters breastmilk in low levels and at a normal daily intake would produce 14.6 microgrammes/Kg/day (0.7-5.9% of the maternal dose) a very low level.

Paroxetine (Seroxat®) - One case reports levels in breast milk below the level of detection in 16 infants exposed to levels up to 50milligrammes per day (dose normally 20-30milligrammes daily) through their mother's breastmilk. There are reports of neonatal withdrawal syndrome in newborns exposed to paroxetine in utero. Symptoms include jitteriness, vomiting, irritability and hypoglycaemia. Paroxetine may be difficult to stop due to discontinuation syndrome.

Fluoxetine (Prozac®) - has a very long half-life which may in theory, lead to accumulation and high levels in the infant. It has an active metabolite. Adverse effects including increased irritability and colic have been reported. One anecdotal report linking severe colic with the use of fluoxetine has been published. Hale reports personal communications, indicating that it can cause excessive sedation if used throughout pregnancy and then in subsequent lactation. It has been recommended in the past 10 years that if it is used in pregnancy that the mother is changed onto another SSRI in the 2 weeks before expected delivery. However, this is a time when women are very vulnerable and to suggest that they change a medication which is effective drug for them at this time may not be in their best interest. If it has been taken during pregnancy the baby may be very sleepy for several days and need help to obtain full milk volumes (syringe feeding, antenatal expression of colostrum etc). Symptoms seem to resolve within 5 days (Hale). If it has been shown to be effective for a mother in the past it would be the drug of choice for her regardless of the slightly higher passage into milk (Jones 2018). It is suggested that initiation in mothers of babies more than 4 months old would appear to be compatible with breastfeeding particularly if it has been shown to be effective for that woman in the past.

Venlafaxine (Efexor®) - The dose transferred to the infant is relatively high although no adverse reports have been reported. As the drug is associated with discontinuation syndrome it would be difficult for the mother to stop abruptly. In neonates, monitoring for excessive sedation and lower than expected weight gain is advisable.

The mean total drug dose reported in the infant is 7.6% of the maternal weight adjusted dose. Metabolites have been detected at low levels but infants have shown no adverse effects and would appear able to metabolise the drug. The action is similar to that of fluoxetine but with fewer anti-cholinergic effects.

Mirtazapine (Zispin®) - Mirtazapine maybe initiated if other antidepressants have proved ineffective or not been tolerated. It may also be invaluable when poor sleep is the major symptom of depression. Mirtazapine produces fewer symptoms of sexual dysfunction that have been reported in SSRIs. It can initially cause drowsiness and abnormal dreams. Care should be taken with co sleeping as natural reactions will be lessened. In a study of 8 babies whose mothers were taking up to 120mg at night. Levels of mirtazapine were only identified at a low level in one baby and were undetectable after 12 hours.

Tricyclic antidepressants have been around for a considerable period and much is known of their metabolism, safety and side effects. However. the latter can be intolerable for some patients, particularly nursing mothers. Side effects include sleepiness, dry mouth, urine retention and constipation. Care should be taken with co sleeping due to the possibility of drowsiness.

Amitriptyline - The levels measured in breastmilk are low because the drug is 94.8% bound to plasma proteins. There have been no reports of adverse effects on the baby and in one study where the mother took 150milligrammes there was no detectable drug in the infant's serum.

Clomipramine (Anafranil®) - is particularly useful for panic attacks and obsessive, compulsive disorders. In one study of 4 women taking 75-125milligrammes daily, plasma levels of clomipramine in the infants were below the level of detection. No untoward effects were noted in any of the infants.

Imipramine - has an active metabolite, desipramine. At therapeutic doses it is estimated that the baby would receive 20-200microgrammes / day and no adverse effects have been noted. It would be prudent to observe the baby for sedation and dry mouth.

Lofepramine (Gamanil®) - amount in breastmilk likely to be too small to present risk to breastfed baby. No precise data on transfer is available.

The use of cognitive counselling together with anti-depressant therapy has been shown to be advantageous.
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network May 2022

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Antidepressants and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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Feeling anxious is very common when you have a new baby. Always talk to a health professional if you have any concerns.

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This information is also available as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
There are many reasons that we become anxious at one point or another in our lives. Anxiety is a normal and healthy emotion which helps to tell us that something in our environment may be threatening, either physically or emotionally to either ourselves or the people we care about. Feeling anxious about these situations encourages us to act to make ourselves safe. Without it we would not be able to recognise danger or keep ourselves safe. It is only necessary to seek help if you find your feelings spiralling out of control. Tell your loved ones how you feel, a hug and an opportunity to express your frustration and worries may be all that you need.

Sometimes though we misinterpret situations and start to believe that they are threatening when they are not. This can be affected by;

the information we are given by others,

how confident we feel about coping with a situation,

our experiences from the past.

If we have been told that something will be difficult or upsetting, or have experienced struggling in a situation in the past we are more likely to be anxious about that situation again now.

It is important to know that 1 in 10 of us will experience a significant anxiety disorder at some point in our lives although this increases during pregnancy and the year after giving birth. It doesn't mean that you need medication, nor that you are a bad mother or a failure. You may benefit from access to Improved Access to Psychological Therapies (IAPT) services. You may feel better knowing that what you are feeling is perfectly normal and common in many mothers. We hope that this information gives you options to decide what is right for you.

Parenthood is a time when all experiences are new. We are given a lot of information (much of it conflicting) and advice. It feels like there is pressure to get everything 'right' every time - to keep our child healthy and to be seen as a 'good' mother. Add into the mix the fact that we are usually sleep deprived, exhausted and having difficulty concentrating, and it is very understandable that anxiety is common in mothers, especially those with young babies.

This information sheet is not designed to give a definitive answer that will immediately make the anxiety disappear - we wish it could. Anxiety is very much more complicated and the solutions will be individual to each one of us. Hopefully it will be able to provide some information on what anxiety is and how we may be able deal with this. It will also try to normalise anxiety and consider what a normal reaction to a situation is and when we may want to seek more help. It is important to recognize that anxiety may begin in pregnancy and that it can occur alongside other conditions such as depression and obsessive compulsive disorder (OCD) which can make it less readily recognized by you and your healthcare professionals.

Anxiety is a feeling of dread or fear about a real or imagined situation. It is often characterised by excessively worrying and focusing on thoughts and situations that scare or upset you and is accompanied by a range of physical sensations. We will often notice changes in three areas, our thoughts, our physical feelings and our behaviours. Below are listed some of the symptoms in these areas you may experience.

Racing heart beat

Changes in breathing (feeling breathless, holding your breath or rapid breathing)

Tightness or pain in your chest

Pins and needles or tingling in the arms and legs

Butterflies

Feeling sick (sometimes, although rarely, also being sick)

Stomach upsets and needing to go to the toilet frequently or urgently.

Wobbly legs

Feeling dizzy and light headed

Feeling as if things don't feel real/dream like (depersonalisation)

Difficulty concentrating

Head aches

Muscles tension, especially in the neck, shoulders and jaw

Irritability

Disturbed sleep, difficulty getting to sleep or waking frequently

Feeling exhausted

Worrying excessively, either about one thing or many things

Feeling that others are looking at you or judging you

Thinking that you will be unable to cope with a situation

Thinking you are not good enough in some way

Focusing on bad or upsetting experiences from your past Feeling unable to let go or stop thinking about something

Worrying that something is wrong or will go wrong in the future

Unpleasant thoughts about bad things happening that pop into our head.

Often these thoughts feel very out of control and we may find it difficult to concentrate on normal daily life because our head is so full of these thoughts. We may also find that no matter how much we think about the problems they don't get better, and often get worse. When someone asks what you are worrying about you may respond "everything and nothing". That's okay, it's how you feel that you are dealing with your thoughts that is important.

Reducing normal activities

Feeling unable to face talking to people

Avoiding crowded places

Repeatedly checking things, our children, information, locks, switches etc.

Avoiding thinking or doing things that make us anxious

Becoming withdrawn

Initially taking some time out may be helpful to give us time to rest and spend time with our baby. However in the long run by reducing enjoyable activities we have little else to distract us or balance the negative thoughts.

Anxiety is normal and a natural part of our biology which we share with all animals. It comes from our fight or flight response that is designed to keep us safe. When we were cavewomen, if we came across a sabre toothed tiger, to keep ourselves safe we would either need to fight it, or run away. In order to do this our brain reacts very quickly to give us the best chance of escaping or winning by making our bodies ready for action by releasing adrenaline. This causes several immediate changes:

Our hearts beat faster to help pump blood around the body

Our breathing rate increases to give our muscles oxygen

We get tingling in our arms, legs and stomach (butterflies) as our blood diverts away from our stomach where it's not needed and into our arms and legs instead

Our stomachs are not essential for fighting so we may feel sick or need to go to the toilet

Our muscles tense ready for actions

We feel on edge as our senses are on high alert for danger

We feel the urge to escape or leave a situation

In our modern life we rarely encounter sabre toothed tigers, but the same reaction can still be triggered if a situation or thought feels threatening to us. Our bodies are unable to differentiate whether something we just think is real or not. Even if you are just thinking about an anxiety provoking situation, what may or may not happen, or worrying that something might be wrong, this will still cause all the same physical reactions that a physical threat would.

Parents are anxious about doing their best for their child and as a result some level of anxiety is to be expected. Not only do we worry about our children, but we may also be facing massive changes to our lives; changes in our role within a family, greater responsibility, less time to ourselves, less money, less time with our partners and friends. The list is endless but below are some common worries you may experience:

Is my child eating enough?

Is my child gaining weight?

Am I feeding too frequently/frequently enough?

Is the baby's poo the right colour?

Are they safe where they are sleeping?

Will my baby nap today?

Everyone loves to give advice about how best we should care for our children, this is especially true when it comes to feeding. Over the past 100 years breastfeeding has become less common than it was and information about what is normal has been lost over time. Instead we are inundated with advice which is often unrealistic and related to old childrearing practices that we no longer regard as helpful or evidence based.

Advice may include ideas that every baby should sleep through the night from x weeks, that they should only be fed every y hours, if they cry or are fussy they are hungry, mums can't produce enough milk to feed a large baby and a million more opinions that you will be exposed to every day.

With breastfeeding it isn't as easy to see exactly how much milk a baby has consumed. We may question our ability to sufficiently feed the baby - especially if a healthcare professional questions baby's weight gain or feeding schedule. Concerns about breastfeeding or perceived lack of support may add to anxiety.

Breastmilk is completely absorbed so breastfed babies will be more likely to wake frequently throughout the night and for longer. This is not a bad thing for the babies, who are feeding effectively and naturally, however this may lead to more disrupted sleep for the parents. Feeling more tired may result in higher levels of anxiety as we struggle to think clearly when tired. Few babies sleep through the night for the first year, but the pressure that is given by society for them to do this may again lead to anxiety and self-doubt.

We may get very conflicting or incorrect advice about what is normal from a variety of sources. Our society also has limited knowledge about healthy breastfeeding practices so we may be more likely to encounter misinformed opinions from others which may make us feel uncertain about what we are doing. You may feel your wishes to breastfeed or indeed to give up, may not be listened to or respected. This may add to your feelings of loss of control.

There are several simple things we can do to balance our life and manage anxiety. The focus should be on reducing focus on the worrying thoughts and trying to refocus attention on life activities which are happening at the moment, rather than what may happen in the future.

Deal with or approach a problem if you can - if you can't do anything or it hasn't happened yet - let it go. The Exeter Worry Guide in the link below may give you some ways in which to do this. Mindfulness techniques may also be helpful with this and there are links to some helpful websites in the next section.

Talk to people - other mums in similar situations to get an idea of what is normal. This may be via baby groups, helplines, Facebook groups or online forums. However, you may find that the mood of a forum may be negative and make you feel worse. If that happens find somewhere that helps you feel positive. Keep talking to those who love you and let them know how you are feeling.

Keep doing enjoyable activities. These may need to be adapted to life with a baby but try to do something enjoyable every day e.g. baby groups, walks, playing with your baby or swimming. If you can get someone to babysit you may enjoy getting time out for half an hour to go for a run, have a bath, painting your nails, reading a book or even going to the toilet by yourself.

Get out of the house - get to the shops for some milk, walk around the block, go for a drive.

Staring at the same four walls will not help to distract you and your thoughts will go round in circles. Getting out even just for 15 minutes a day can be helpful to clear your head and may help your baby sleep too.

Focus on positives each day - try and write one positive thing in a daily diary or try 100 days of happiness on Facebook. Maybe if someone asks how things are going, try to think of the positives first before the problems. Also make a list of all the things you are doing well rather than where you might be struggling.

Take a breath and ignore those giving advice which doesn't feel comfortable - they are giving their opinion not facts. Their baby might be very different from yours, whatever they did was their choice but you do not have to conform to everyone else's ideas.

Stop googling! There is a place for internet searches, but you can also drive yourself mad looking at conflicting, inaccurate and catastrophic advice. Go to reliable sources and once you have found an answer, stop checking further - you will just start to doubt yourself and you keep yourself focused on the worrying thoughts rather than the solutions.

As we have said, some level of anxiety is normal in parenthood, however if you find that you are anxious most of the day, several days a week for more than 2-3 weeks then this can be signs that anxiety is becoming more of a problem for you. If it is impacting on your ability to continue your normal life then you may wish to seek further help from your GP or other voluntary services. Your health visitor and GP should both be checking on your mental health at each appointment and even if you do not feel you need help yet, if you are starting to feel anxious or low you can still discuss it with them so that they know to check up on you in the future.

Your GP may suggest a period of two weeks of watchful waiting to see whether your mood improves by itself. This is normally the first plan of action if anxiety or low mood is mild. They will normally suggest some self-help guides similar to the ones at the bottom of this page and then book a review appointment in two weeks.

If you and your GP decide you need some support, they may offer you a referral to a talking therapy service or discuss whether medication would be helpful.

Talking therapy services based within mental health teams are very different to how they were 20 years ago. They are designed to support people within the community with common mental health issues such as anxiety, depression and panic attacks. You will be offered an assessment during which you can discuss what difficulties you have been facing and what your goals are. After this you may be offered some treatment, the most common of which is counselling or Cognitive Behavioural Therapy (CBT). Counselling allows you to look at issues more commonly from your past which may be affecting you now, or issues around relationships with other people. Cognitive Behavioural Therapy comes in many forms, most of which is face to face, but it can be offered over the telephone or in group settings. CBT looks at cycles of thoughts, feelings and behaviours which may be keeping you stuck. It aims to help you understand what is happening and may offer practical steps to reassessing whether these thoughts are realistic and changing unhelpful behaviours.

CBT currently has the greatest evidence base for treating anxiety and is widely available within the NHS however there are other therapy options available in some teams such as Cognitive Analytical Therapy (CAT), Interpersonal Therapy and Mindfulness.

If you and your doctor decide that prescribed medication is the best route for you, there are several options which you can take and continue breastfeeding. They include, in no particular order:

1. SSRI antidepressants e.g. sertraline, citalopram, fluoxetine, paroxetine all have anti- anxiety activity. They take 4 to 6 weeks to exert full benefit.

2. Tri-cyclic antidepressants e.g. amitriptyline, imipramine.

3. Beta blockers e.g. propranolol act to reduce heart rate and slow the body and act very quickly. They can be taken regularly or when required. They cannot be taken if you have asthma.

4. Benzodiazepines e.g. diazepam, lorazepam, alprazolam act very quickly to reduce anxiety but cannot be taken long-term because they are addictive and can also accumulate in the breastfed baby leading to drowsiness and poor feeding.

The first thing most mothers prescribed with anti-anxiety medications worry about is whether the drugs will harm the baby in the short or long term. They are also concerned that they are 'bad' mothers for needing to take medication but they don't know how to cope without. They worry about long term use, addiction, withdrawal, development of the baby, whether formula milk may be a better option than breastmilk containing even a small amount of the drug. They 'google' madly trying to find the information which supports their concerns, but often don't trust those sites which support the safety. They may ask lots of people's opinions which can be even more anxiety provoking according to that person's experience of breastfeeding and medication. Often they fear that even admitting that they are anxious may lead to their baby being taken into care and them being labelled as an unfit mother. This is not going to happen but can sadly lead to delays in seeking treatment.

Information websites:

Although rarely talked about, when people have been feeling very anxious or depressed for long periods of time, they can feel that they are unable to cope and they can experience thoughts of suicide or self- harm. The intensity of these can vary significantly, some people experience fleeting thoughts of 'I just don't want to be here', for others they can start to imagine more in depth thoughts and plans about what they could do. Most of the time having these thoughts does not mean that you intend to act on them. It can be part of our brain's way of imagining one possible escape, and often we have many protective factors that would stop us ever acting on them, such as our children, partners, family, friends, faith or hope for the future. Normally once our mood improves, thoughts of harming ourselves reduce and disappear. However they can still be very distressing to experience so it can be helpful to talk to others if you feel able to. Although they may find it upsetting to hear that you feel this low, friends and family can often support you to manage these feelings when they occur and help you not to feel so alone. You can also talk to your GP or health visitor about them and they can decide with you what support would be helpful.

If you ever feel that you may be more seriously thinking about harming yourself or unable to keep yourself safe it is important that you speak to your GP or another health professional as soon as possible. Doctors, midwives and health visitors are aware that these are symptoms of depression and anxiety. They should support you to access help and appropriate treatment.

If you need immediate help you can go to any accident and emergency department or drop in clinics to help. Suicidal or self-harm thoughts are also seen as a priority and would be counted as a reason for an emergency appointment with a GP. You can also call NHS direct on 111 or in an emergency 999.

Antenatal and postnatal mental health: clinical management and service guidance. NICE guidelines [CG192] December 2014

Bauer A, Parsonage M, Knapp M, Lemmi V,Adelaja B Costs of perinatal mental health problems. October 2014 www.centreformentalhealth.org.uk/costs-of-perinatal-mhproblems

British National Formulary

CG192 Antenatal and Postnatal mental healthcare

Hale T. W Medications in Mothers Milk

Health Outcomes Paediatrics; 131(4):2013 http://pediatrics.aappublications.org/content/early/2013/02/26/peds.20122147.full.pdf+html

Jones W Breastfeeding and Medication 2018 Routledge

Khan L Falling through the gaps. Perinatal mental health and general practice. March 2015

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Martindale, the Extra Pharmacopia 2007

Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS, Postpartum Anxiety and Maternal-Infant

Royal College of General Practitioners Practical Implications for Primary Care of the NICE guidelines

www.centreformentalhealth.org.uk/falling-through-the-gaps

This information was compiled by Beth Chapman Cognitive Behavioural Psychotherapist and Wendy Jones Pharmacist.
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Anxiety and Breastfeeding - The Breastfeeding Network

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This information is also available as a PDF by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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Bolton Infant Feeding Team run a clinic for those babies who are having feeding difficulties caused by tongue tie. Your midwife or health visitor can refer you if feeding support does not help to resolve the problem

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How milk production works - La Leche League GB

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Read about how your body produces milk for your baby, and how you can build a good milk supply

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Mothers have successfully fed their children for thousands of years of human history without understanding how it works. It's a bit like driving a car - as long as it's working well, you don't need to know what is going on under the bonnet!

If you are having breastfeeding problems, such as low milk supply or too much milk, or are wondering why your baby's feeding pattern is different from what you expected, it can help to understand more about the science of lactation (producing milk).

Most of the research that has ever been done on breastfeeding and human milk has been done in the last few years. It is a very exciting time for lactation science. Lots of things that experienced mothers have always known turn out to have a clear basis in the anatomy of the breast and the science of milk production, for example:

Each baby and mother pair is different

Healthy babies are the best judges of when and how to feed

The way to make more milk is to remove more milk

Getting ready - the developing breast

Breast development starts around the age of 10-12 years. From puberty, the breast grows a little with each menstrual cycle. Inside the breast, the branches and buds that will become milk ducts and alveoli (milk storage sacs) start to develop. Radiation or trauma to the chest at this stage can have an impact on later breast development.

Lactation begins - pregnancy

For many women, tender breasts are an early sign of pregnancy. The breast completes its development during pregnancy, and milk production begins in the middle trimester. If a pregnancy ends after 15-16 weeks, colostrum (early milk) will be present. Some women choose to express colostrum in the last few weeks of pregnancy. This is recommended for women with diabetes, whose milk may be a bit slower to increase and whose babies may have low blood sugar after birth. Colostrum expressed before birth can be stored, to be given to the baby if they need extra milk. Mothers with high-risk pregnancies, or who are concerned about having enough milk, may also choose to express colostrum in the last weeks of pregnancy. It is usually recommended not to start before 36 weeks, unless premature birth is imminent. The amount of colostrum you can express before birth does not predict your ability to make enough milk afterwards.

After birth (day 1-3)- lactation takes off!

During pregnancy, milk production is held in check by the hormone progesterone, produced by the placenta. Once the baby is born and the placenta is delivered, levels of progesterone drop rapidly; this, coupled with high levels of prolactin, allows lactation to begin fully.

Retained placental fragments can reduce or even stop milk production. If you have unexplained low milk production and are still bleeding heavily or irregularly after you would expect to have stopped, check with your midwifery team or doctor. Removal of the last fragments of placenta will usually allow milk production to resume normally.

Mothers typically start to notice the signs of " onset of copious milk production " (also known as milk "coming in") two or three days after birth. For a day or two you might experience:

The discomfort you feel is primarily due to tissue swelling, in response to the sudden increase in milk volumes. Don't panic - your breasts won't feel like this for long! As your breasts adjust to making the amount of milk your baby needs, the swelling will settle down. If feeding your baby or expressing milk doesn't quickly help you feel more comfortable, there are other steps you can take to deal with engorgement.

Onset of copious milk production can happen a bit more slowly:

For first-time mothers

After a more difficult birth

You may have read that being overweight or obese (having a higher BMI, especially over 30) can lead to breastfeeding problems. It is not clear whether having a higher BMI, by itself, is a problem for breastfeeding and many women with high BMI breastfeed easily. We do know that some conditions associated with higher BMI, such as diabetes and metabolic syndrome, may delay your milk "coming in" (increasing in volume) in the early days after birth. This can make breastfeeding more challenging.

To make milk, remove milk (day 3-4 onwards)

Until day 3-4, milk production is controlled entirely by hormones and will happen automatically, whether or not you go on to breastfeed. After day 3-4, another mechanism comes into play. Milk will only continue to be made if milk is removed from the breasts. The more milk that is removed, the more milk will be made. This enables your body to adapt to the number of babies you have. With enough milk removal, it is possible to exclusively breastfeed twins or triplets! If you do not breastfeed or express milk at all, your milk production will shut down within about two weeks after birth.

Remove milk early

The amount of milk that is removed in the period immediately after birth is important for later milk production. Research on lactation after premature birth has shown that starting to express milk within an hour of birth, compared with starting at six hours, is associated with more milk six weeks later.

If your baby has any risk factors for not being able to feed effectively at first, such as being:

then early, frequent milk expression will help to ensure plenty of milk to meet their needs, now and later. You can see a useful video about this here:

Parents who have risk factors for low milk supply can give their milk production the best possible start by removing milk early and frequently after birth.

Risk factors include:

Previous history of low milk production

Previous breast radiation or surgery

Polycystic ovary syndrome (PCOS)

Thyroid problems (hypo- or hyper-)

A history of infertility with hormonal cause

Unevenly sized, widely spaced breasts, with little or no changes during or after pregnancy

Obesity (BMI over 30)

People with these risk factors may be able to make a full or partial milk supply - you never know what you can do until you try! If you are not producing all the milk your baby needs, you can still enjoy a close, happy feeding relationship with your baby. You can read more about how to use donor breastmilk or formula milk to support breastfeeding here.

Some mothers who need to supplement their own supply with donor milk or formula milk in the early months are able to reduce or eliminate the supplementary milk after their baby starts complementary foods, at around six months, going on to happily breastfeed alongside solids.

Remove milk often

After their first feed and a few hours of sleep, full-term, healthy newborn babies feed frequently, around the clock. Most babies need to feed at least 8-12 times in 24 hours in the early weeks, suckling and swallowing actively at each feed, to get enough milk and stimulate their mother's milk production. If your baby is not feeding as often or energetically as this yet, it is important to express your milk, if your goal is a full milk supply.

As milk builds up in the breast, a protein in the milk, known as the "Feedback Inhibitor of Lactation" (FIL), begins to slow down milk production. Breasts that are full make milk slowly, and eventually not at all. Breasts that are well drained make milk quickly. This is why, if you are trying to maximise milk production, it is important not to wait until your breasts feel full before feeding or expressing. Over time, this will reduce milk production.

Different breasts, different feeding patterns

Storage capacity is quite a new concept in breastfeeding, and it explains a lot of things that mothers instinctively knew, but were not in the textbooks!

A mother's storage capacity is the amount of milk that her breasts can hold between feeds. It is not related to breast size and it is not related to the total amount of milk that a mother can make each day.

To understand storage capacity, let's assume that:
Alisha and Beth both have 3 month old babies and well established milk supplies. Alisha's breasts can hold 75ml of milk and Beth's breasts can hold 150ml of milk.
Both their babies need about 750ml of milk per day (this is an average amount. Some babies might take as much as 1200ml per day).
Alisha's baby needs to feed at least 10 times in 24 hours to get this amount of milk, while Beth's baby could get the same amount of milk in only five or six feeds. [Feeding this infrequently is not common - it is at one end of a wide spectrum of feeding patterns!]
Both babies are getting as much milk as they need and growing well, but they have very different feeding patterns. What happens if Alisha and Beth are told that their babies "should" both be feeding eight times in 24 hours?
Alisha's baby is hungry and miserable. She is no longer getting enough milk and if this continues, Alisha's milk production will slow down due to the action of FIL in the full breast. It might be hard to increase milk production again, after the early weeks, when milk supply settles at a stable level. Beth's baby is irritable because his mother keeps trying to feed him again when he doesn't want any more milk!
Both Alisha and Beth can successfully breastfeed their babies as long as their feeding pattern works for their milk storage capacity.
Beth, with her larger storage capacity, has more flexibility in her feeding patterns. Her baby is likely to have fewer feeds per day than Alisha's, is more likely only to take one breast per feed and may start sleeping for longer stretches earlier. She could choose to feed more often, if her baby wanted to. Alisha has less flexibility in her feeding patterns because if she doesn't feed often enough, her breasts fill up and she doesn't have room to make more milk. Her baby is likely to feed frequently day and night during the exclusive breastfeeding period and may need to feed on both breasts at most feeds.
Most babies need to feed at least 8-12 times in 24 hours and it is important to ensure frequent feeding during the early weeks, when milk production is becoming established. After the early weeks, most babies spend less total time feeding, as efficiency improves. Some babies will also significantly reduce the frequency of feeds.

Most mothers never need to worry or even think about their breast storage capacity, because their babies are brilliant at working it out for them! Full-term, healthy, thriving babies are able to choose their own feeding pattern that works with their mother's breasts and their own needs as they grow. . If your baby is growing well and seems contented, their feeding pattern is working well for them.

Fat in milk

This is a topic that often worries parents, because of poorly understood information circulating among families about the differences between "foremilk" and "hindmilk".

We know from research that:

The breast makes milk fat at a stable level. The types of fat in milk are somewhat related to the types of fat in the mother's diet, but the amount of fat is not related to her diet.

The milk available at the start of a feed (often referred to as foremilk) has a lower level of fat than the milk at the end of the feed (often referred to as hindmilk). As the breast is drained, fat levels in milk increase as more fat droplets are "squeezed" to the front of the breast and out through the nipple.

The level of the fat at the start of one feed depends on how long it has been since the last feed. The longer the interval between feeds, the lower the level of fat at the start of the next feed.

Parents often worry, or are told, that their baby might not get enough fat (this is often described as "getting too much foremilk")

Research shows that full-term, healthy, thriving babies are brilliant at balancing their own diets. They will stop feeding when they have had enough calories. When fat levels in milk are higher, they will take less milk. When fat levels are lower, they will take more. The varying amount of fat in milk is not a problem - all the milk is good! It enables babies to quench their thirst at the start of a feed and finish with a creamy "dessert", if they want to.

The balance of fat in milk can be a problem for a small number of babies, if:

The baby is taken off the breast before they have had as much milk as they wanted; or

There is an overwhelming amount of milk. In this case, the baby may be growing very fast (their growth curve crosses centiles upwards on the growth chart) and may struggle with the speed of milk flow, coming off the breast gagging, spluttering and upset. You can find practical tips to help your baby manage fast milk flow here.

In either of these two situations, the baby may not get enough fat to slow down the transit of milk through their gut. Milk may rush through the gut faster than the baby can digest the milk sugar (lactose). The sugar ferments in the gut, producing green, frothy, explosive poo, flatulence (farting) and severe discomfort.

A baby who does yellow poo and is comfortable does not have any problem with the balance of fat in their diet. A baby who is growing more slowly than expected needs more milk overall, not just more fat. These babies should be seen by a doctor to rule out an underlying health problem.

You can read more about fat levels in milk here.

How much milk?

In the first 24 hours after birth, volumes of colostrum are small, but enough for your baby. The average amount per feed is about 7ml (1 ½ teaspoons). This is because full-term babies are not hungry - they are born with food stores in their body. They don't need fluid - they shed extra fluid in the first few days (this is why most babies lose a little weight). Colostrum is primarily immune protection, rather than food. It coats the inside of the baby's gut to keep pathogens out, stimulates the baby's immune system, and provides the baby with a powerful, tailor-made dose of growth factors, hormones, live immune cells and other components that no manufactured milk can begin to match.

The small quantity and thick texture of colostrum give the baby a chance to practice feeding before they have to manage larger volumes. The amount of colostrum increases quickly, more or less doubling every day in the first few days. If you need to express on the first day after birth, you might use a syringe to catch drops. A syringe quickly becomes too small for the increasing volumes. By the 5 th day after birth a baby might be taking 60ml (2oz) or more per feed.

If you are expressing your milk, for example because your baby was born early, it can help to know how much to aim for:

500ml in 24 hours by the end of the first week after birth

750ml in 24 hours by the end of the second or third week after birth

Your baby might not need this much milk yet, but aiming for a full supply now means you will have enough to satisfy them for the rest of their breastfeeding time.

Milk production remains stable, within a range of about 600ml - 1200ml per 24 hours, from about one month after birth to six months. After the baby starts eating complementary foods, milk production starts to decrease, as milk is gradually replaced by other foods in the baby's diet. If you are making as much milk as your baby needs at one month, you are likely to keep on doing so, as long as your baby keeps on removing enough milk and you don't get pregnant or use one of a small number of medications that can affect milk production. Birth control methods that contain progesterone may reduce milk production in some women.

How milk changes

If you are expressing your milk, you will be able to see the change from sticky, transparent, yellow or orange colostrum to thinner, white or blue-ish "transitional milk" by about the fourth day after birth. The composition of your milk is changing to adapt to your baby's need for more energy. Your milk changes from day to day for as long as you breastfeed or express, responding to your baby's stage of development, any illnesses you or your baby are in contact with, and even the time of day or night it was made. The milk of mothers who give birth prematurely is initially different from the milk of mothers who give birth at full term, to meet the extra needs of their babies.

Getting back on track after a difficult start

Milk production peaks by about a month after birth, with most of the increase happening in the first two weeks. Many mothers find it becomes more difficult - in some cases impossible - to increase the amount of milk they are making, after the early weeks. This is why it is important to get good feeding support early, if there are any signs that there might be a problem with your baby getting enough milk, for example, if your baby:

Does not poo every day (in the first 4-6 weeks)

Has pink crystals (urates) in their nappy after the third day

Is not doing yellow poo by the end of the fourth day

Loses more than 7% of their birth weight by the fifth day

Loses weight after the fifth day

Does not regain their birth weight by 10-14 days

An LLL Leader or infant feeding specialist can help you work out whether there is likely to be a problem with milk production or whether (more commonly) your baby is not yet feeding effectively. If not enough milk is being removed, the risk is that your milk production will not increase to the level your baby needs. Expressing your milk gives you time to work on any feeding issues.

If the problem is with milk production, your breastfeeding supporter can help you make a plan to keep your baby safely fed while you work to maximise your milk supply. You will need to work closely with your baby's healthcare providers to monitor their growth and wellbeing.

Lactation beyond the early months

Parents are sometimes told that their milk has no value to their baby after 6 months, or 12 months. This is not the case. Milk is the baby's main source of protein and calories until about a year of age, and continues to contribute to the child's health and nutrition through the second year and beyond.

Your milk adapts to meet your baby's needs as they grow. For example:

From about six months, the digestive enzyme amylase starts to be present in milk, helping your baby digest starchy foods.

From about six months, levels of the antibacterial enzyme lysozyme increase in milk, protecting your baby as they put foods and other objects in their mouth.

As the total amount of milk begins to decrease gradually, from about six months, levels of key immune factors such as immunoglobulins increase, so that the child receives about the same amount per day, even though they take less milk.

Levels of fat, protein and energy in milk are higher in the second year than in the first year of lactation.

Lactation ends - involution

Milk will continue to be made in the breast for as long as milk is removed from the breast. In the early days of lactation, milk supply is relatively fragile - the mother's body quickly shuts down production if milk removal stops. In later lactation, milk production is much more robust. Mothers returning to work after six months, for example, can be confident that their milk supply will withstand variations in their schedule from day to day and week to week. In later lactation it is possible to breastfeed part-time, even if you work shifts or need to travel away overnight. Many breastfeeding toddlers and older children spend time away overnight with a non-resident parent, grandparents, etc. and continue breastfeeding when they are with their mother.

It takes at least 40 days for the breast to reach complete "involution" (a non-lactating state) after the end of breastfeeding or milk expression. Some mothers find that they leak or can express drops of milk months or even years after their last feed. If the amount of milk is large, or you start making milk again after a gap even though you are not pregnant, check with your doctor. Spontaneous milk secretion (galactorrhoea) can be a side effect of some medications, or a sign of hormonal dysfunction.

When children are able to wean from the breast at their own pace, weaning often takes place over a period of months and years. The most common time for children to choose to stop breastfeeding is between their second and third birthdays. Milk production reduces gradually and, by the time the child has their final feed, may have dwindled to almost nothing. Some of the immune components of milk become more concentrated as milk volumes decrease, so the child continues to benefit to the last drop of breastmilk.

Written by Jayne Joyce, LLL Oxfordshire and Karla Napier, LLL Edinburgh - February 2021
Endnotes:

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How milk production works - La Leche League GB

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Mothers have successfully fed their children for thousands of years of human history without understanding how it works. It's a bit like driving a car - as long as it's working well, you don't need to know what is going on under the bonnet! If you are having breastfeeding problems, such as low milk supply [...]

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Where to find support for breastfeeding if you live in Bury

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Organisations providing telephone support and advice

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Get off to a good start with this guide offering help and support for breastfeeding.

1-to-1 support for breastfeeding

Midwives, health visitors and trained local volunteers (peer supporters) are there to help you get breastfeeding off to a good start. They can give you lots of information and support when you need it.

You can contact your midwife or health visitor between your usual appointments if you need to speak to someone.

You could also go to your local drop-in baby clinic to see a health visitor face to face.

You should find contact details for your midwife or health visitor in your baby's personal child health record (PCHR), known as their "red book".

Ask them to show you the page when you first get it.

Breastfeeding drop-ins, cafes and centres

Breastfeeding drop-ins, cafes and centres are all great places to make new friends and share the ups and downs of looking after a baby.

There's no need to make an appointment - just go along when you can.

To find out what's available in your area:

talk to your midwife, health visitor or GP

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

contact your local council on GOV.UK who can put you in touch with a Sure Start Children's Centre or Family Information Service, as these often have lists of local breastfeeding groups and activities

use the NHS services search to find a breastfeeding drop-in near you

Breastfeeding helplines and websites

Helplines

National Breastfeeding Helpline: 0300 100 0212

Association of Breastfeeding Mothers: 0300 330 5453

La Leche League: 0345 120 2918

National Childbirth Trust (NCT): 0300 330 0700

The Breastfeeding Network supporter line in Bengali and Sylheti: 0300 456 2421

Websites

Got a breastfeeding question?

Chat to the Start4Life Breastfeeding Friend chatbot on Amazon Alexa, Facebook Messenger, or Google Home for fast, friendly, trusted NHS advice anytime, day or night.

How your partner can support breastfeeding

Getting support from a partner can be very helpful when you're breastfeeding.

Practical ways partners can help with breastfeeding include:

going to antenatal or breastfeeding sessions - some sessions are organised especially for partners - ask your midwife or at a local Children's Centre for details

giving emotional and practical support - praising and encouraging someone who is breastfeeding can help to build their confidence

arranging paternity leave - talk to your employer about paternity leave early on, so you can plan leave that suits your family's needs

making life easier - for example, bring your partner dinner if the baby wants to feed at the same time, or bring them a cup of tea and a magazine while they're feeding the baby, or perhaps arrange for family or friends to keep your partner company while you're at work

doing your bit around the home - so your partner can focus on caring for the baby and getting breastfeeding off to a good start

providing some stress relief - if you have young children, take the stress away from your partner by keeping them entertained when the baby is feeding

getting involved in your baby's care - bathing your baby, changing nappies and helping at bedtime are great ways to get close to your baby

giving your baby a bottle of breast milk - once your partner feels happy and confident with breastfeeding, they may choose to begin expressing breast milk - you could give your baby a bottle of breast milk

Get Start4Life pregnancy and baby emails

For information and advice you can trust, sign up for weekly Start4Life pregnancy and baby emails.

Community content from HealthUnlocked

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Find out about the breastfeeding help and support available from midwives, health visitors, peer supporters, helplines, websites and support groups.

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Unicef Baby Friendly Support for Parents

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Unicef Baby Friendly Support for Parents

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Here you will find lots of videos and sources of support

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

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

Find more useful organisations.

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

Resources to support you

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

Overcoming breastfeeding problems

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

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

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

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Support for parents - Baby Friendly Initiative

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Resources and information for parents to support with feeding and developing close and loving relationships with their baby.

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Rhythms and Routines - La Leche League GB

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Feeding Rhythms and Responding to your Baby's Needs

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Feeding Rhythms and Responding to your Baby's Needs

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Breastfeeding is nature’s way of satisfying a baby’s need for food, love, comfort and connection

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs. It's nature's way of satisfying a baby's need for food, love, comfort and connection.

It can take time to learn what a baby needs. Some childcare experts promote strict routines for babies and young children. They claim that if a mother follows their rulebook, her baby will be perfectly content. But every baby is different. While we may feel reassured if our day follows a predictable pattern, strict routines for feeding and sleeping often fail to meet the needs of individual babies.

Difficulties with routines
Full breasts slow down their rate of milk production, which may lead to:
Problems caused by expressing
Breastmilk: a balanced meal, a drink, a snack
Breastfeeding: comfort and connection too
Frequent breastfeeds: day and night
One breast or two
Breastfeeding patterns adjust
Finding your own rhythms: a sense of freedom
Think of breastfeeds as minor events
Expect the unexpected
Establishing helpful patterns
Babies are little for such a short time

Difficulties with routines

Some babies will object strongly to an imposed routine that doesn't meet their needs. Others are easy going, and give only subtle signals that a particular routine isn't right for them. Early feeding cues include hand sucking, lip smacking, turning their head towards you, or fussing. Don't wait until they are desperate-crying is a late sign of hunger. Trying to 'stretch' the gaps between feeds is hard work and stressful for you both and can reduce your baby's overall intake of milk.

A well-drained breast makes milk faster than a full one. Encourage your baby to nurse frequently enough to keep your breasts soft and comfortable.

Full breasts slow down their rate of milk production, which may lead to:

A baby gaining weight slowly or needing supplements to maintain adequate weight gain.

A sleepy baby who needs to be roused and encouraged to breastfeed actively to get the food they need.

Lengthy feeds.

A fussy baby.

Engorgement, blocked ducts or mastitis.

Expressing milk (pumping) can cause problems

Some childcare experts advise pumping to keep milk supply one step ahead of a baby's needs. However, expressing can interfere with the delicate balance that happens when your baby and body are in tune with each other. Making more milk than your baby needs increases your risk of mastitis. You may experience fast flow and/or oversupply causing your baby to gag, splutter or come on and off the breast. Your baby might also have colic or be fussy.

Breastmilk: a balanced meal, a drink, a snack

Just like adults, babies feed irregularly-none of us eats the same amount at every meal, nor do we always follow a set timetable for eating and drinking. With easy access to the breast, babies will balance their intake of fluids, calories, proteins, fats and other nutrients so they receive exactly what they need. All that is usually needed is the confidence to let your baby take the lead.

Breastfeeding: comfort and connection too

Breastfeeding isn't just food and drink. It also helps you and your baby maintain that connection and closeness with each other. So when your baby is tired or unhappy or upset, theyinstinctively ask to nurse because it helps them regain a sense of rightness with the world. Many breastfeeding mothers say that the ability to calm and comfort a baby just by nursing is one of the main reasons for carrying on. It makes life easier and more peaceful for everyone.

Frequent breastfeeds: day and night

Your baby needs to nurse frequently to establish and maintain your milk production, especially in the early weeks. While breastfeeds may be further apart in the morning, it's very common for babies to nurse frequently (or 'cluster feed') in the evening. Babies receive fattier milk when they nurse more often. Your baby is stocking up for the night and putting in their order for tomorrow! (See here for more on coping with Fussy evenings with a newborn.)

One breast or two

Sometimes your baby will want one breast, at other times both. Your baby knows what they need-let them nurse actively from the first breast until they come off looking satisfied or sleepy. Then offer the second breast. After the first few months babies often become really efficient feeders-so don't be surprised if they've finished in 10 minutes or so! Their nappy output and continuing weight gain will reassure you they are getting enough. ( Is my baby getting enough milk?)

Breastfeeding patterns adjust

A baby's growth rate and mother's breast storage capacity will affect their nursing pattern. Even the weather can make a difference-a thirsty baby will probably nurse more in hot weather. When babies have growth spurts and seem extra hungry, most mothers find there's no need to pump to keep up milk production-more frequent feeds will do the trick. Milk production quickly adapts to meet your baby's needs and feeding patterns settle down within a few days.

Finding your own rhythms: a sense of freedom

Combining some predictability with flexibility can give you a sense of freedom and stop you feeling tied down. At first, life with a new baby can seem quite chaotic, but if you relax and observe your baby you will find gentle patterns emerging. You can build on these patterns, creating a daily rhythm to suit you both.

Strict routines don't necessarily make life easier for you. Being tied to particular routines, nap-times and sleep places can make getting out and about, visiting friends or taking holidays more complicated.

Your needs and those of your baby will change with time and from day to day. Following your baby's rhythms will help you meet their needs when they have has growth spurts or are ill. It will also give you confidence to adapt when necessary, for example for a doctor's appointment or holiday travel arrangements. When your baby is attached to you, rather than their routine, problems are less likely and you may feel more relaxed about managing the day.

Think of breastfeeds as minor events

Just as with your own tea-breaks, try thinking of feeds as minor and flexible events that fit in with everyday life rather than major events which have to be planned for.

Expect the unexpected

Whatever your baby's usual pattern is, there will always be times when they surprise you. They might sleep at a different time, sleep longer, or not at all. They might go longer between feeds, or suddenly want to feed more frequently. But there's no need to panic-this is how babies are! We may never know the reason for such changes. Life will either settle back into the original pattern or a new one will establish itself. Your baby will continue to grow and surprise you over the coming years.

Establishing helpful patterns

Morning - Having a reasonably regular time and pattern for getting up and dressed can be a springboard for your day.
Going out - Going out can help structure your day, entertain your baby and give you a sense of purpose. You can develop a routine for getting everyone fed, ready, and out of the house. Prepare what you'll need the evening before if you need to get out early.
Afternoon - Babies are often ready to have a sleep somewhere around the middle of the day. Babies are all different and patterns change as they grow and develop. Try to tune in to your own baby's natural rhythms of feeding, alertness and sleep and adjust your activities to match them. A nap or a rest for yourself, too, can help boost your energy for the rest of the day.
Night-time - A gentle evening routine, eg bath, rocking, singing and nursing can help a tired baby wind down to sleep. Watch for fussing, yawning and rubbing of eyes and start your wind down pattern promptly. Some babies are natural 'night owls', taking a late afternoon nap and being alert during the evening.

Household tasks - Developing the ability to be 'interruptible' is a real help. Completing housework in small 'bites' while being prepared to pause and attend to children can be a successful way to meet everyone's needs. Seeing the world through your baby's eyes can help you slow down and enjoy the present rather than rushing to get things done. Mothering babies and young children is a full-time job-it's ambitious to expect to be a cleaner, cook and gardener at the same time. Concentrate on essentials. Do those things you can do with a baby around and save really tricky jobs for times when you have help. It's unlikely you'll look back in years to come and wish you had done more housework!

Babies are little for such a short time

You can't spoil a baby with love and attention. The easiest way to care for a baby is to accept and meet their need for closeness. Remember, you know your baby best; take the information, advice and the ideas that are helpful to you and ignore those suggestions that don't feel right. You can develop rhythms and routines that are in tune with your needs, and those of your baby and family.

For support in meeting your baby's needs contact an LLL Leader by calling our Helpline or visiting our website. It can be helpful to share experiences with others at your local LLL group where you can exchange practical tips.

Written by Karen Butler, Sue Upstone and mothers of LLLGB.

Pages you might also be interested in:
Is My Baby Getting Enough Milk?
Adjusting to Motherhood
Breastfeeding Basics
The Unhappy Baby
Safe Sleep and the Breastfed Baby
Fussy evenings with a newborn

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
How Mothers Love and How Relationships Are Born. Stadlen, N. London: Piatkus Books, 2011.
What Mothers Do, Especially When It Looks Like Nothing. Stadlen, N. London: Piatkus Books, 2005.
Why Love Matters: How affection shapes a baby's brain. Gerhardt, S. London: Routledge, 2004.
Kiss me! How to raise your children with love. Carlos Gonzalez. London: Pinter & March 2020

The information sheet is available to buy in printed format from our shop.
Rhythms & Routines is dedicated to all LLL Leaders who have given their time generously to support breastfeeding mothers and families over the past sixty years and continue to do so.
Copyright LLLGB 2020

Updated June 2022

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Rhythms and Routines - La Leche League GB

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs.

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Returning to work doesn't mean you have to stop breastfeeding.

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Breastfeeding exclusively (giving your baby no other food or drink) is recommended for around the first 6 months. After this time, breastfeeding is recommended alongside solid food.

Therefore, it's likely that you'll be breastfeeding when you return to work, training or education.

There are several options. You can:

arrange for childcare close to work or college so that you can breastfeed during breaks, or before and after work - the evening feed can be a wonderful way for you to relax with your baby

express breast milk (taking milk from the breast by hand or using a pump) so that someone else can feed your baby while you're at work

ask your employer or college for flexible working hours arranged around your breastfeeding needs

combine breastfeeding and bottle feeding to fit around your hours

Think about it early. Before you go back to work or college, tell your employer or tutor you're breastfeeding.

You may have an HR department that can help. It can make preparations, such as finding you a private room where you can breastfeed or express your milk.

Organising breastfeeding and work

Before returning to work you can:

label and date expressed breast milk before putting it in the fridge or freezer so your childminder knows which one to use first

have a trial run with childcare before returning to work

store breast milk in a sterilised container or in special breast milk storage bags in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) - if you're not sure of the temperature of your fridge, or it's higher than 4C, use it within 3 days

Information for employers about breastfeeding mothers

Employers have certain legal obligations to breastfeeding mothers. Supporting breastfeeding has business benefits too. These include:

reduced absence due to child sickness (breastfed babies are generally healthier)

increased staff morale and loyalty, and a subsequently higher rate of return to work

lower recruitment and training costs

an extra incentive to offer potential employees

How employers can help breastfeeding mothers

Employers can have a policy to support breastfeeding. This includes:

a break allowance for mothers to express milk

provision of a clean, warm, private room (not the toilet) for expressing

a secure, clean fridge to store expressed milk

flexible working hours for breastfeeding mothers

Let your employees know about your policy before they start their maternity leave.

What the law says about breastfeeding mothers at work

It's up to mothers to decide how long they want to breastfeed. Returning to work doesn't mean a mother has to stop. Before returning to work, she should give her employer written notification that she's breastfeeding. Her employer must then conduct a specific risk assessment.

Workplace regulations require employers to provide suitable facilities where pregnant and breastfeeding mothers can rest.

The Health and Safety Executive (HSE) recommends that it's good practice for employers to provide a private, healthy and safe environment for breastfeeding mothers to express and store milk. The toilets are not a suitable place to express breast milk.

The HSE has more advice about protecting new and expectant mothers at work.

Talk to other breastfeeding mums

If you know any breastfeeding mothers who have already gone back to work, ask them for advice.

You could also visit healthtalk.org to see mothers talking about breastfeeding and working.

Got a breastfeeding question?

Sign into Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Information for employees and employers on returning to work and breastfeeding, including tips on expressing and storing breast milk.

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Breastfeeding a baby with Down Syndrome - The Breastfeeding Network

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Breastfeeding a baby with Down syndrome is not only possible, but it also provides important benefits to both mum and baby. Specialist support is available via the Infant Feeding Team to help you manage any challenges

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Down syndrome is the most common chromosomal abnormality in babies. Normally, the nucleus of each cell of a baby's body contains 23 pairs of chromosomes, half of which are inherited from mum and half from dad. Down syndrome occurs when some or all of a person's cells have an extra full or partial copy of chromosome 21. Some babies with Down Syndrome may have poor muscle tone, so may find it hard to maintain attachment to the breast during a feed. Others, especially those with an associated cardiac issue, may tire very easily and not be able to take a full feed in one go.

Benefits of Breastfeeding

Breastfeeding a baby with Down syndrome is not only possible, but it also provides important benefits to both mum and baby.

1. Breastmilk boosts your baby's immune system and contains anti-infective factors including antibodies against germs that you and your baby are exposed to. This is especially important for babies with Down syndrome since they are prone to respiratory[i] and viral infections.

2. Babies with Down syndrome can have low muscle tone. The specific sucking action needed during breastfeeding will help strengthen your baby's lips, tongue, and face[ii]. This serves as a stepping stone for eating other foods and speech development[iii].

3. Breastmilk is both food and drink for your baby and it contains all of the nutrients, calories, and fluids your baby needs, but it is also much more than just nutrition. It provides your baby with comfort and warmth and the physical closeness when you are feeding helps create a special bond between you and your baby.

The first days and weeks of breastfeeding are a time for you and your baby to get to know each other and learn together how to breastfeed effectively. As you get to know your baby better, you might discover that there are some specific physical characteristics of babies with Down syndrome that may have an impact on your breastfeeding journey. Of course, every baby is unique so you might not encounter all of the challenges mentioned. If your baby has difficulties breastfeeding at first, then ask for support and remember that many mums and babies need extra help to breastfeed and that ongoing support and time can help you both learn how to breastfeed effectively.

If you are having difficulties to begin with, then you can choose to express and feed your baby breastmilk. This can help by giving you both more time to learn whilst also making sure your baby is still getting the benefits of breastmilk and it can also be useful if your baby needs to be apart from you in the early days or if they need feeding by a tube for any reason. To begin with you would need to express around 8-10 times in 24 hours, including at least once overnight as that helps build your milk supply. It can help to have your baby nearby when you express if possible or to have a photo or something that smells like your baby. You might want to hand express or use a pump, if you are still in the hospital you could ask about borrowing a hospital grade pump. We have lots more information on expressing and storing breastmilk here.

Hints and tips for breastfeeding a baby with Down Syndrome

Low muscle tone

Babies with Down syndrome can have low muscle tone and so may have trouble attaching effectively to the breast[iv] and staying there for a full feed. Some babies may also have difficulty coordinating their sucking, swallowing and breathing and may gulp or splutter as they feed. They might get less milk for their efforts and they often get tired quickly. This generally improves with practice and time. The act of breastfeeding will actually improve your baby's muscle strength. As baby gets stronger and learns to breastfeed more effectively, he will be able to drink more milk. As well as the breastfeeding positions that people commonly use there is also a position called Dancer Hand position that can sometimes help by providing your little one with gentle support for their head when they go to attach to your breast. For this position you need to have your baby sat upright on your lap facing you, cup your hand under your breast, then slide it forward so that three fingers support your breast. Make a U-shape with your thumb and first finger and use that U shape to support your baby's jaw. Ask your healthcare provider if you want to know more about this position.

Tongue thrust

If you find your baby has a tongue that sticks out more than usual it can sometimes make breastfeeding harder. You can help by trying to position your baby in a way that really encourages him to open his mouth really wide and to keep his tongue down and touching his bottom lip when he goes to attach onto your breast. You might be able to help with this by very gently pressing on his chin to open his mouth wider as he goes to latch on. There are also very simple tongue exercises that can sometimes help. Ask your health care provider if you think these might be useful for you.

Sleepy babies

Some babies with Down syndrome can be very sleepy or tire more quickly, especially if they have any issues with their heart. Positioning your baby in a comfortable and supportive arrangement can also help your baby get more milk for his efforts, better stimulate your milk supply and mean that he doesn't get tired so quickly. You can help by starting your milk flowing before you put your baby to the breast, so that he will not have to spend energy sucking without any milk coming out. Gentle hand expressing, rolling your nipple between your thumb and forefinger, gentle massage and perhaps a warm face cloth on the breast can help encourage your milk to let down.

Weight gain

Babies with Down syndrome can sometimes gain weight slower than other babies. There are specific weight charts available for children with Down syndrome so that this can be monitored carefully, especially if your baby also has other medical issues that mean they might gain weight slower than usual. All the same things apply in terms of knowing if your baby is getting enough milk, including looking at the number of wet and dirty nappies and how content your baby is between feeds. If you have any concerns about weight gain or whether your baby is getting enough milk please speak to your health care provider.

Resources

A Guide to Breastfeeding a Baby with Down Syndrome BfN Blog posts on Down Syndrome Positive About Down Syndrome Website Positive About Down Syndrome - Lived Experiences
The Breastfeeding Network

Sarah Edwards, Training Development Manager and Breastfeeding Supporter

[i] Pisacane, A., Toscano, E., Pirri, I., et al (2003), Down syndrome and breastfeeding. Acta Paediar 92(12),1479-1481.

[ii] Dowling, D., Danner, S., Coffey, P., Wellman, L. (2007), March of Dimes Defects Foundation. Breastfeeding the infant with special needs. New York: March of Dimes Foundation

[iii] Buckley, S. (2000), Speech and language development for individuals with Down Syndrome - an overview. Hampshire: The Down Syndrome Education Trust

[iv] Buckley, S. (2000), Speech and language development for individuals with Down Syndrome - an overview. Hampshire: The Down Syndrome Education Trust

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Breastfeeding a baby with Down Syndrome - The Breastfeeding Network

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Down syndrome is the most common chromosomal abnormality in babies. Normally, the nucleus of each cell of a baby's body contains 23 pairs of chromosomes, half of which are inherited from mum and half from dad. Down syndrome occurs when some or all of a person's cells have an extra full or partial copy of [...]

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The benefits of skin to skin and keeping your baby safe - Kurdish Sorani

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What happens on the first feed - Kurdish

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The benefits of skin to skin and keeping your baby safe - Urdu

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The benefits of skin to skin and keeping your baby safe

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What happens on the first feed - Hungarian

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The benefits of skin to skin and keeping your baby safe - Arabic

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If you are temporarily unable to put your baby to the breast staff can assist you with feeding in a way that avoids giving bottles. Feeding cups are available on the postnatal ward

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Support for Transgender and Non Binary Parents

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Support for Transgender and Non Binary Parents

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Trans men, trans women and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed. Ask the Infant Feeding Team for support.

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La Leche League is an international, nonprofit, nonsectarian organisation. 1 LLLGB supports everyone who wants to breastfeed or chestfeed in reaching their goals. We do not discriminate based on sex, gender or gender identity.

Trans men, trans women and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed, as we can also see in the experiences of those nursing adopted babies.

Transgender dad Trevor MacDonald writes that, "It is equally important to note that some trans people experience severe gender dysphoria when breast or chestfeeding, and that they may decide not to nurse their babies for mental health reasons. Trans parents choosing to breast or chestfeed and those choosing to suppress lactation and bottlefeed may require the support of breastfeeding counsellors or lactation professionals." ²

Amazing milk

One of the concepts La Leche League is founded on is that: human milk is the natural food for babies, uniquely meeting their changing needs. Human milk is amazing. It has everything a growing baby needs in exactly the right amounts and babies can easily digest it all. Research shows that a baby who is not fed on human milk is more likely to suffer from illnesses and diseases, both as a child and later in life. By meeting your baby's needs for warmth, food and security at your chest you give them a secure attachment so they can develop into a conﬁdent child.

Skin-to-skin

Skin-to-skin contact is beneficial for babies and parents; it simply means holding your naked baby on your bare chest. You can drape a blanket over you both for warmth. Within minutes, you will see the benefits of skin-to-skin as you and your baby relax. Your baby's body temperature, breathing, and heart rate will stabilise. Babies often latch on and nurse more efficiently during and after skin-to-skin contact.
It is a lovely way to nurture your baby even if you are not nursing.

Your milk supply

Some transgender and non-binary parents have a full milk supply. If you have had chest (top) surgery you may be able to produce some milk. Many factors will affect the amount of milk you can make.

Two reasons that a trans man might have a reduced milk supply are:
1. Milk-making tissue has been surgically removed, and/or ducts have been damaged in surgery.
2. Testosterone interferes with the hormone necessary for lactation (prolactin) and can cause a significant decrease in milk supply. However, taking testosterone would not prevent someone from using an at-chest supplementer and having a nursing relationship.

Trans women can use a protocol similar to adoptive and other non-gestational mothers and stimulate their milk supply: it is called the Newman-Goldfarb protocol. You can read more here https://www.laleche.org.uk/relactation-induced-lactation/ and here http://www.asklenore.info/breastfeeding/induced_lactation/protocols4print.shtml.

You can also give human milk or formula supplements using an at-breast supplementer. Your healthcare provider can help you look at your options, and your local LLL Leader can offer support with your breast or chestfeeding goals and journey.

You may find the following websites have useful information:
Breastfeeding After Breast and Nipple Surgery http://bfar.org/index.shtml?fref=gc
Low Milk Supply http://www.lowmilksupply.org/

Many parents worry about whether their baby is 'getting enough'. LLL meetings are a good place to get support from others. These LLL posts are great for checking signs your baby is feeding effectively:
https://www.laleche.org.uk/is-my-baby-getting-enough-milk/
https://www.laleche.org.uk/signs-effective-feeding-early-days-2/

Using a nursing supplementer

If your baby needs a supplement of expressed milk or formula you might want to consider using a nursing supplementer. Doing this can give your baby that extra milk while they are nursing.
Supplementers can help parents have an at-breast or at-chest relationship with their baby whether or not they are able to produce milk.

This post has lots of useful information about nursing supplementers: https://www.laleche.org.uk/nursing-supplementers/.

Milk sharing

Some transgender and non-binary parents use milk banks to acquire human milk for their babies. La Leche League fully supports the use of human milk for babies; we cannot facilitate or set up milk sharing networks, though your local LLL Leader can help you with contact information for non-profit human milk banks, other regulated collection centres, and formal/medically supervised or informal milk sharing networks. 3 Human milk banks provide pasteurised, screened donor milk.

There are documented benefits and risks to informal milk sharing. Benefits of human milk include, but are not limited to:

optimal nutrition

easy digestibility

immunological protection

Risks of sharing milk can include, but are not limited to:

transmission of certain infectious agents, like bacteria or viruses, some of which may be found in milk expressed by asymptomatic people

medicines and other drugs

environmental contaminants as a result of unhygienic storage and handling of unprocessed donated milk

Human Milk for Human Babies (HM4HB) is an "informed milk sharing network", and is an international organisation that many parents use to source human milk: https://www.facebook.com/HM4HBUK/

LLL Support

All parents need support and La Leche League is a great place to find it. There are over 70 LLL groups across Great Britain, most offer meetings open to all - contact your local group to find out how they can support you. Many groups also have closed Facebook groups where you can ask questions and connect with other nursing parents.

LLL meetings are held in a wide range of venues - LLLGB is not affiliated to, and does not endorse or support, any business, organisation or religion whose premises we use. https://www.laleche.org.uk/find-lll-support-group/?fref=gc

LLLGB also offers these services:
National Helpline: 0345 120 2918 https://www.laleche.org.uk/telephone-helpline/
Online Helpform support: https://www.laleche.org.uk/submit-help-request/
Contact us for non judgmental information and support.

Find more LLLGB support listed here:
https://www.laleche.org.uk/get-support/?fref=gc<

Other support

International Facebook group for 'birthing and breast or chestfeeding trans people and allies': https://www.facebook.com/groups/TransReproductiveSupport/?fref=gc&hc_location=ufi

La Leche League - Inducing lactation and relactation Facebook group

Resources

Where's the Mother? Stories from a Transgender Dad. Trevor MacDonald: Trans Canada Press, 2016

LLL article: Support for Transgender and Non-binary parents

Defining Your Own Success: Breastfeeding After Breast Reduction Surgery. Diana West: LLLI, 2001:
https://www.bfar.org/book.shtml

My Journey: Non-binary Nursing - from LLLUS
https://lllusa.org/my-journey-non-binary-nursing/

Trans breastfeeding FAQ:
http://dianawest.com/trans-breastfeeding-faq/?fref=gc

US based website Kellymom's post:
http://kellymom.com/bf/got-milk/transgender-parents-chestbreastfeeding/?fref=gc

Transmasculine individuals' experiences with lactation, chestfeeding, and gender identity: a qualitative study:
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0907-y?fref=gc

Transgender/transsexual/genderfluid Tip Sheet - General Information, LLL Canada
https://www.lllc.ca/sites/default/files/REVISED-Trans-Nursing_Tip-Sheet.pdf

Breastfeeding without giving birth, LLLI article by Aylssa Schnell
https://www.llli.org/breastfeeding-without-giving-birth-2

Language

We are aware that transgender and non-binary individuals use a variety of different terms to describe their anatomy and the acts of feeding and nurturing their babies. We have used the terms "chestfeeding" and "nursing", with the second of these capturing the nurturing relationship associated with this way of feeding a baby.

Elsewhere on the site we use 'breastfeeding', 'breastmilk' and 'mother': they reflect the founding and unchanged mission of LLLI to provide mother-to-mother support for breastfeeding. They also reflect the stated identity and valued role of the majority of people whom we support and provide information to - those who identify as breastfeeding mothers.

Whatever language you use we hope that much of the information we share is still helpful and relevant.

References
1 La Leche League International Bylaws, Section 1: General Purpose
2 http://kellymom.com/bf/got-milk/transgender-parents-chestbreastfeeding/?fref=gc
3 http://leadertoday.breastfeedingtoday-llli.org/milk-donation-policy/

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Support for Transgender & Non-binary Parents - La Leche League GB

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La Leche League is an international, nonprofit, nonsectarian organisation.1 LLLGB supports everyone who wants to breastfeed or chestfeed in reaching their goals. We do not discriminate based on sex, gender or gender identity. Trans men, trans women and non-binary individuals may choose to breastfeed or chestfeed their babies.

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My Baby Won't Breastfeed - La Leche League GB

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Information if you are worried that your baby isn’t breastfeeding well, or at all, in the first few hours or days.

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This page is about young babies who have never breastfed or who get very upset when offered the breast. If your baby was breastfeeding well but is now refusing, see our page on "nursing strikes". Sometimes, a new difficulty with feeding is the first sign that the baby is becoming unwell. If you are not sure that your baby is well, please contact your doctor.
When a baby doesn't breastfeed after birth, it can be upsetting, confusing and frustrating. You might wonder whether you're doing something wrong, or even whether your baby likes you. It's hard not to take it personally!

Babies are 'hardwired' to breastfeed - it is an essential survival behaviour. When a baby doesn't breastfeed, it's never because they don't want to. Something is making it hard for them. Babies are never "lazy" or "difficult" - they always do the best they can. So do their mothers!
When it's taking time for breastfeeding to get going:
If you do this, your baby is very likely to breastfeed when they are ready. Time, patience, and good feeding support are usually all you need.
This useful summary of the "3 Keeps" can be downloaded as a free A4 poster
You can read more about getting breastfeeding on track after a difficult start here.

Why isn't my baby breastfeeding?

After a straightforward birth, most well, full-term babies will start feeding within an hour or so. Not all babies have such an easy start, though. Babies can take longer to start breastfeeding if:

They had a more complicated birth. Babies born with the aid of forceps, for example, often take a few days to recover and feed well. If you had pain medication in labour, your baby may be sleepy and uncoordinated at first.

Your baby was born early, or small for their gestational age. See also breastfeeding premature babies and late preterm babies (those born between 34 and 37 weeks). Even being born one or two weeks early can mean that your baby takes longer to start breastfeeding. It might take until around your baby's due date, or a little longer, before they are ready to feed well.

You and your baby were separated after birth because one or both of you needed medical care.

Your baby is very sleepy and doesn't yet have enough energy to breastfeed. See also sleepy baby and newborn jaundice.

Your baby is unwell.

Your baby is uncomfortable, e.g., some babies have a sore head or sore shoulder after birth.

Your baby has low muscle tone (hypotonia).

Your baby has a physical challenge such as tongue-tie.

You have plenty of time

Parents sometimes worry that if their baby isn't breastfeeding well, or at all, in the first few hours, days or weeks after birth, it will never happen. While breastfeeding in the first hour after birth is ideal, the window of opportunity for babies to start breastfeeding is much longer than this. The feeding reflexes, which keep babies seeking and attaching to the breast, last for at least two to three months after birth. We have seen many babies start breastfeeding older than three months, too! There are even reports of children over a year old starting to breastfeed, when placed for adoption with a lactating mother. Where there is milk, there is always the possibility of breastfeeding.

First things first

Sorting out breastfeeding problems can feel overwhelming. There seems to be so much to do, and you might feel you have to do it all at the same time! It is helpful to know what is urgent and what can wait. This can help you to work out what to do in what order, and how best to use your time and energy. Feeding at the breast is the least urgent thing, at this stage.

If your goal is to have a full milk supply (enough milk to meet all your baby's needs) but you need to use donated breastmilk or formula at the moment, or if your baby is not growing well just on your milk, then making more milk is the top priority. This is more urgent than your baby starting to feed at the breast.

If your baby is not breastfeeding at all yet, or is not breastfeeding effectively, you can express your milk. This gives you milk to feed your baby now and encourages your breasts to make plenty of milk for the weeks and months to come.

Your breasts may temporarily become swollen and uncomfortable, starting around 2-4 days after birth. This is called "engorgement" and is a sign that your breasts are becoming more active (though not all mothers feel it). It is important to treat engorgement, to keep your breasts comfortable and your milk flowing well. Read more here: Engorged breasts - avoiding and treating.

Read here about how milk production works and how to increase your milk supply.

You can find information here on how to use bottles and other feeding tools.

Exclusive Expressing

Expressing all the milk your baby needs is known as "exclusive pumping" or "EP". You can read more here. Some mothers choose to do this; many do it because their babies are not able to breastfeed. You might find it helpful to join an online support group for "EP mums".
If you need to express your milk for a baby who is not breastfeeding yet, it is important to work with a skilled breastfeeding supporter. You might also want to connect with other mothers who have needed to express milk - they can be your best cheerleaders while you do this important job! Your local La Leche League group would love to support you.
Setting the scene for breastfeeding - happy time at (or near) the breast

Most babies need only time, patience, and gentle encouragement to help them start breastfeeding. Babies are born expecting to breastfeed, with a set of reflexes to help them do it. We need to keep them well fed (with expressed or formula milk), give them lots of relaxed time near the breast, and.... give the baby time.

Here are some ideas to try:

Hold your baby skin-to-skin. Babies use their whole bodies to feed. The more of their skin they feel against yours, the more likely they are to find the breast and start feeding. Undress your baby down to their nappy and move your clothes out of the way. If you are cold, you can put a blanket round both of you. Even if your baby doesn't breastfeed yet, it feels lovely, and helps your baby get used to being at or near the breast. Holding your baby against your skin helps you make more milk, too! If your baby can't tolerate being held in a feeding position, try holding them against your shoulder.

Avoid holding your baby in a feeding position during medical procedures, especially if your baby will be having lots. Offer the breast afterwards instead, if it calms them.

Try "laid-back" breastfeeding. Try putting your baby tummy-down, on the slope of your body as you recline comfortably (as if you are lying on a sun lounger). Placed like this, they can use their arms and legs to help themselves find the breast and attach well for feeding. This can work better than trying to "put" the baby to the breast, especially if they have already had difficult experiences of this. This video shows you how. The safest place to do this is in a bed that has been set up following safe sleep guidance. See our article on safer sleep.

Turn up the smell! Newborn babies don't recognise the breast well by sight, though they do recognise your face, and love looking at it. They find the breast mostly by feel and smell. The little bumps around your nipple (Montgomery's glands) make a scented oil which helps your baby find the breast and encourages them to feed. You can give your baby extra help by expressing a bit of milk and rubbing it on and around your nipples. This can encourage your baby to feed by increasing the smell and giving them something to lick as they approach the breast!

Try "drip-drop feeding". Your partner or supporter uses a cup and spoon to drip milk (expressed milk or formula) onto the breast as you hold your baby. This can encourage babies to attach and feed. You can watch a video here.

Take a bath with your baby. When placed skin-to-skin with their mother in a warm bath, some babies find the breast and feed for the first time. Some mothers even describe it as "a second chance at giving birth". You could set the scene with low lighting, a candle or soft music. Whether or not your baby is ready to breastfeed yet, sharing a bath can help you and your baby relax together and enjoy each other. Have another adult with you to help you get in and out safely, put the baby on you and wrap them in a warm towel when they are ready to get out.

"Wear" your baby. Babies who are kept close in a sling or soft carrier cry less, are calmer and warmer than babies who are put down by themselves. Being carried is good for babies' physical & emotional development and helps parents and babies make strong connections. If your baby is not breastfeeding yet, carrying them close, as much as you want, is an excellent way to help them feel comfortable near the breast. Always follow the instructions for your sling or carrier and the rules for safe babywearing. You can read more about babywearing in this book.

Feed your baby at or near the breast. If your baby will go to the breast at all, consider using a nursing supplementer so your baby can have extra milk while they breastfeed. This can be helpful when milk supply is low and/or your baby is frustrated by the speed of milk flow at the breast. If your baby is fed by cup or bottle, try feeding them skin-to-skin with their cheek against your breast. Let your baby end the feed by sleeping with their cheek pillowed on the breast.

Consider sleeping with your baby. Some babies will attach and feed in their sleep if the breast is near enough to smell and feel. Always consider sleep safety before sleeping with your baby in your bed. It is never safe to sleep with a baby on a sofa. You can read more about sleep safety and normal baby sleep in LLL's book Sweet Sleep.

Babies with low muscle tone (hypotonia)

A baby who has been diagnosed with a condition that makes them hypotonic, or 'floppy', may show little interest in breastfeeding. To make feeding easier:

Support your breast. Tuck a rolled-up cloth under your breast close to your chest wall, or support your breast with your thumb on one side of the areola, fingers on the other side.

Support your baby's chin. If your thumb is parallel to your baby's upper lip, you can use your index finger to put gentle pressure just behind the bony part of the chin while your baby feeds.

Try upright positions. A hypotonic baby often feeds better held with their head higher than their bottom.

Breast compression can also be helpful, but you may also need to give some expressed milk until your baby's muscle tone improves. Breast compressions are explained in more detail in "My baby needs more milk".

If your baby suddenly becomes floppy and you don't know why, seek medical advice.

Baby steps

When you are keen to breastfeed, but your baby isn't yet ready, it can be frustrating. Don't forget to celebrate how far you have already come! Every time your baby enjoys being held close to your body, or falls asleep near your breast, they are taking another "baby step" towards breastfeeding. Your baby is doing the best they can for now, and so are you.

When breastfeeding is stressful

When breastfeeding is difficult for your baby, it may become stressful for both of you. Babies who have had unhappy experiences at the breast can develop negative associations with breastfeeding. This might happen, for example, when:

A baby is in pain or discomfort e.g. from birth injury or allergy.

A sensitive baby is handled at the breast in a way they don't like, e.g., if a helper tries hard to "put" the baby to the breast when they aren't ready.

Milk supply is low.

A baby has a physical restriction (e.g., tongue tie) that makes attaching and sucking difficult.

A baby who is finding feeding difficult may become upset:

A short time into the feed, when milk flow slows down.

At the start of the feed, when milk doesn't come straight away.

When offered the breast.

When put in a breastfeeding position.

When they see the breast.

When feeding isn't going well, babies may come to associate the breast with hunger and frustration. They may develop a preference for another feeding method, such as a bottle, if they associate it with feeling full and satisfied. You can find some ideas on how to keep your baby's relationship with the breast positive here: using donor milk & formula milk to support breastfeeding

The ideas in the previous section ("Setting the scene for breastfeeding - happy time at (or near) the breast") can help your baby learn that the breast is a lovely place to be, and to associate it with calm, relaxation, comfort, and satisfaction rather than hunger and frustration.

Take a break

If breastfeeding has become very stressful for you and your baby, you might need a "breastfeeding break". You could stop trying for a few days, whilst expressing your milk to keep your baby fed and keep your milk flowing. When you're both ready, you can try again. There is no rush! Dr Christina Smillie, an American doctor who specialises in breastfeeding medicine, calls this " rebooting the baby ".

What if my baby is still not breastfeeding?

When you are eager to breastfeed, it is hard to wait. It is not uncommon for babies to need time to begin breastfeeding well. You might be encouraged by hearing the stories of other parents whose babies took time to get going.

If your baby is still not breastfeeding even with time, patience and some of the tips in this article, there will be a reason why. A skilled breastfeeding supporter can help you find out, and work towards breastfeeding. Some babies need medical care, some benefit from feeding tools such as nipple shields and a few need treatment for tongue tie. Many just need a little more time.

A few babies never do breastfeed. Some have a medical condition that makes it impossible. Very rarely, we never find out why. You don't have to feed your baby directly from the breast to give them the many benefits of your milk or to nurture them at your breast. We can support you to have a close, happy feeding relationship with your baby, whatever form that takes.

La Leche League Leaders (breastfeeding counsellors) can help. You can find your local group, and LLL Zoom Meetings all over the country, at https://www.laleche.org.uk/find-lll-support-group/

Jayne Joyce, LLL Oxfordshire & Karla Napier, LLL Edinburgh, April 2022

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My Baby Won't Breastfeed - La Leche League GB

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Breastfeeding is normal and nature but some babies struggle to get started. This page explores ideas for helping babies won't breastfeed

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Most jaundice in babies happens as part of a normal process and resolves with good feeding. If you have any questions or concerns about jaundice contact your midwife.

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Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia.
Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.

But if there's too much bilirubin in the blood or the liver cannot get rid of it, the excess bilirubin causes jaundice.

Jaundice in babies

Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.

A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.

This means the level of bilirubin in babies is much higher than in adults.

By the time a baby is around 2 weeks old, they're producing less bilirubin and their liver is more effective at removing it from the body.

This means the jaundice often corrects itself by this point without causing any harm.

Breastfeeding

Breastfeeding your baby can increase their chances of developing jaundice.

But there's no need to stop breastfeeding your baby if they have jaundice, because the symptoms normally pass in a few weeks.

Some breastfed babies can have jaundice for as long as 12 weeks, but it's important that this is checked by a health visitor or GP so other more serious causes of jaundice can be ruled out.

The benefits of breastfeeding outweigh any potential risks associated with the condition.

If your baby needs to be treated for jaundice, they may need extra fluids and more frequent feeds during treatment.

See treating newborn jaundice for more information.

It's unclear why breastfed babies are more likely to develop jaundice, but a number of theories have been suggested.

For example, it may be that breast milk contains certain substances that reduce the ability of the liver to process bilirubin.

Newborn jaundice thought to be linked to breastfeeding is sometimes called breast milk jaundice.

Underlying health conditions

Sometimes jaundice may be caused by another health problem. This is known as pathological jaundice.

Some causes of pathological jaundice include:

an underactive thyroid gland (hypothyroidism) (where the thyroid gland does not produce enough hormones)

blood group incompatibility (when the mother and baby have different blood types, which are mixed during the pregnancy or the birth)

rhesus disease (a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood)

a urinary tract infection (UTI)

Crigler-Najjar syndrome (an inherited condition that affects the enzyme responsible for processing bilirubin)

a blockage or problem in the bile ducts and gallbladder (the gallbladder stores bile, which is transported by the bile ducts to the gut)

An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus.

It's important to let your midwife, GP or paediatrician know if you have a family history of G6PD. Your baby's jaundice symptoms will need to be closely monitored.

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Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down. The bilirubin travels in the bloodstream to the liver.

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Find out more about breastfeeding/chestfeeding/
induced lactation for transgender or non-binary parents

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Lactation in the LGBTQ+ community

The information on the whole HIFN website will be relevant to LGBTQ+ individuals. This page goes through some specific areas of lactation that healthcare professionals may not be familiar with. First we will describe the available tools and then the ways in which these may be combined in different scenarios. Finally the specific needs of transmasculine parents are discussed.

A list of specific resources is available in the resources section of the website. The Academy of Breastfeeding Medicine has a thorough protocol on the same topics described here (protocol number 33). There is some basic information on chestfeeding and testosterone in lactation from the NHS.

In general, LGBTQ+ individuals experience significant discrimination both within and outside the healthcare system and may avoid seeking medical advice because of this (see this report from the LGBT Foundation on the experiences of trans and non binary birthing parents). It is therefore particularly important for healthcare professionals to educate themselves about issues faced by the LGBTQ+ community and to understand the importance of appropriate language. Using 'additive' language in general (for example mother or parent; breastfeeding or chestfeeding) and the parent's own preferred terms in particular (pronouns and how they refer to lactation/body parts) can signal understanding and acceptance. This document from Brighton & Sussex NHS Trust describes this approach more fully.

Induced lactation

Another form of induced lactation is relactation, if the parent has lactated in the past after a previous birth. This can involve simply frequent and prolonged breast stimulation with a breast pump.

In the LGBTQ+ community, induced lactation or relactation may be used by lesbian mothers who have not given birth - for example after adoption or by the non-birthing partner. A lesbian couple may both breastfeed a baby ('co-nursing'). Attention should be paid to the birthing parent's milk supply to ensure this is well established, either through waiting for 4-6 weeks before the non-birthing parent starts to breastfeed or through regular breast expression to make up for the reduced stimulation while the baby is being fed by the non-birthing parent.

At breast/chest supplementation

Extra milk can be delivered to a baby feeding at the breast/chest with the use of a 'supplemental nursing system' (SNS), if the parent is not producing sufficient milk to fully satisfy the baby. It is simply a thin tube, similar to a nasogastric tube, which has one end in a container of milk and the other end is held next to the nipple within the baby's mouth so that as the baby sucks they will receive both milk from the parent and milk from the supplementer (see picture at the bottom of the screen of a supplementer used alongside a nipple shield). There are several commercial products available. They can be difficult to use initially and parents will benefit from experienced support in the practicalities of their use, which is generally from a lactation professional. The milk within the supplementer can be human milk (donated or parental) or infant formula.

Supplementers can be used within the LGBTQ+ community by anyone who is not producing a full milk supply, either because of limited mammary tissue, use of an induced lactation protocol or simply because of low milk supply.

Transmasculine feeding

After puberty, trans men have more extensive mammary tissue than cisgender men and at the point of having a child they may or may not have had surgery to reduce the amount and appearance of this tissue. This 'top surgery' would reduce the amount of tissue available for lactation. In some cases milk ducts may be severed and there may no longer be a connection between mammary tissue and the nipple. This may reduce the amount of milk a trans man can produce or make any lactation impossible.

Trans men report difficulties with discussing the effect of surgery on lactation with their surgeon, and given that the area is new their surgeons may not know the potential effects either. Lactation is likely to be more affected by 'double incision' surgery where nipples are repositioned than surgeries that preserve the nipple pedicle. However it appears that trans men who have had surgery of all kinds can experience changes in the mammary tissue if they become pregnant and may produce milk of various amounts.

Even when a trans man doesn't want to continue lactation they should be advised on what to look out for in their chest tissue after birth to avoid engorgement and mastitis. The shape and amount of mammary tissue after top surgery may bring difficulties with how to best position a baby at the chest to effectively latch - several techniques have been advised such as forming a 'sandwich' with the parent's hand, using a nipple shield and avoiding any laid back positions that stretch the chest tissue. An at-chest supplementer and/or the use of a galactogogue may be useful if milk supply is low.

Some transmasculine individuals and non-binary people assigned female at birth suffer gender dysphoria related to their chest appearance and therefore lactation may exacerbate this. Some may limit the length of lactation in order to go back to binding their chest, taking testosterone or having top surgery (for which it is generally advised to wait at least six months after lactation). However not everyone experiences dysphoria in this way - in fact some report that using their chest tissue for this practical purpose and to connect with their child reduces dysphoria.

It is generally advised not to bind the chest or use testosterone while chestfeeding or lactating. Low dose testosterone does not appear to enter human milk but the higher doses used for cross-sex hormone therapy are likely to enter human milk. Several case studies support the idea that testosterone levels in the child remain normal despite parental testosterone use due to first pass metabolism and no clinical effects were seen in the children in these reports. Testosterone may reduce milk supply. Some trans men have reported using gentle chest binding during lactation with careful attention to any signs of blocked ducts or mastitis.

Transfeminine lactation

Trans women may choose to use induced lactation protocols and supplemental nursing systems as discussed above. There are two others areas to discuss. Firstly a trans woman may be taking an anti-androgen medication such as spironolactone so this should be checked with a trusted source of information about medications and lactation. For example, spironolactone is not a contraindication to breastfeeding.

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Sex, gender and sexual orientation | HIFN

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What do health professionals need to know about lactation and LGBTQ families?

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Bengali - Information for partners about breastfeeding

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Polish - Information for Partners

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Punjabi - Information for partners

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Urdu - Information for Partners

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Welcome to this Padlet - it's full of information to help you when you are breastfeeding your baby.
Each section is titled so you can easily find what you're looking for.
Scroll across to see all the sections.
Once you have the section you want, scroll down to click on the link that you want to watch or read.
If you have any concerns for yourself or your baby contact your midwife - this Padlet is not intended to replace advice from a Health Professional.
Padlet is not owned by Bolton NHS Foundation Trust - access to any third party website is at your own risk. Padlet may contain terms and privacy policies that are different from the Trust's.

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A technique that helps baby bring gas up and out by tilting baby to their left on your right shoulder.

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Shel Banks IBCLC Infant Feeding Specialist

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Technique for getting gas out of the baby's stomach

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Breastfeeding is a skill that takes time to get the hang of. Lots of mums wonder if their baby's feeding well and getting enough - especially in the first few days.

But once you've mastered it, you'll probably find it's the easiest and most satisfying way to feed your baby.

We're here to provide lots of helpful information and advice on breastfeeding.

If you have any breastfeeding worries or concerns, the best thing to do is speak to your midwife or health visitor, or join a local breastfeeding support group.

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Breastfeeding can take practice - read our guides on breastfeeding to find out what works best for you

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Empowering Families With Positive Breastfeeding Support

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Breastfeeding Together's volunteers help with breastfeeding on the postnatal ward, but you can also contact them once you go home. They provide pregnancy and breastfeeding groups in Bolton.

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Empowering Families With Positive Breastfeeding Support

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Breastfeeding Together is a registered charity set up in 2015 to provide positive peer support to families from pregnancy to early years and beyond.

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How to support a partner who is breastfeeding

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How to support a partner who is breastfeeding

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Support and encouragement for your partner when breastfeeding is vital.

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By choosing to make your baby a breastfed baby, you and your partner are giving your baby the very best start. USeful information for partners.

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Food and drinks to avoid when breastfeeding - Start for Life

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Most food and drink is fine when breastfeeding but extra care is sometimes needed

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Food and drinks to avoid when breastfeeding - Start for Life

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See what food and drink you should try to avoid when breastfeeding.

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Drop ins available for support if you live in Salford

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IFS Drop-ins - Home-Start Trafford Salford and Wigan

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Useful thoughts about breastfeeding your baby outside of your home.

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People ask for a lactation consultant's help for lots of different reasons. We often see people at one of the most difficult times in their lives. They might be damaged and in pain and feeling really desperate. Positioning and attachment problems are a common issue.
Sometimes we can see immediately how things could be improved and after just a few minutes, a mum might feel more comfortable. A look of relief passes across her face. I've had mums say things like, " This is the first time it's ever felt like this." Or they don't even need to say anything as their stress just falls away.

Many many times, towards the end of one of these sessions (where I'm feeling really good about what I do and slightly smug), a mum then says, " But what would I do if I was feeding outside the house. How would this work if I wasn't sitting here? "

She's overcome an enormous obstacle and the next problem for her immediately pops into her head.

I see these comments as a positive. It suggests she feels like she's making progress and feels her major difficulties are behind her but it does reveal just how the subject of breastfeeding outside the home nibbles at the mind of many new mums.

I think most of us know that mothers and babies are not allowed to be discriminated against on the grounds of breastfeeding. Their access to businesses and services is not allowed to be restricted. You are not allowed to ask them to move on or to stop. It's not complicated. It really isn't. The Equality Act 2010 protects mums in England and Wales. In Scotland, it is a criminal act to stop anyone breastfeeding up until the age of two: http://www.legislation.gov.uk/asp/2005/1/contents
But the law doesn't automatically change how people feel.
The idea of breastfeeding in a public place feels scary when the whole breastfeeding things feels new and you are getting used to your body behaving unpredictably.

Are feelings based on reality?

A Start4Life poll showed that 72% of the UK population 'support' breastfeeding in public. But yet a third of mums still feel uncomfortable.

Media love a story of a breastfeeding mum being harassed. And there's no doubt that there ARE some poorly educated employees and members of the public sailing beyond the law and embarrassing themselves regularly. But these stories make headlines precisely because they are rare and juicy. If 72% support breastfeeding in public, a heck of a lot more really aren't that bothered. And I'll bet in the tiny group that are bothered, most will mumble an internal dialogue that the mother doesn't pick up on.
Yet it doesn't stop it feeling scary even when we know the statistics.
In my years of breastfeeding, I have fed all around the world - on planes, trains, mountain-sides, cafes, doorsteps, bus stops - and not ONCE have I ever received a negative comment or glance or been asked to stop. The response has either been warm and supportive or indifferent. I have spoken to many experienced breastfeeding mums and breastfeeding counsellors and none of them have ever received a negative comment (and actually quite a few wish they had as they would have loved to have snapped something back).
Yet it doesn't stop it feeling scary even when experienced breastfeeding mums tell you not to worry and in their experience everything is fine.
What might help?

Acknowledge what is the scary bit for YOU.

What is the thing that you are really really worried about? Deep deep down. The thing that worries you won't necessarily be the thing that worries your friend.

Are you worried about people seeing your breasts?
People seeing your new baby tummy?
People seeing milk dripping or spraying?
People seeing you in pain?
Not having your stuff with you?
Are you worried about people saying something negative?
Or about people looking?

Depending on what you worry is, you might address the problem differently.

What is the absolute worst thing that would happen in your worst nightmare? Imagine it. How is it likely to go?

For someone, it might be the middle aged bloke yelling across the room that it is disgusting that you are breastfeeding outside the home and he doesn't want to see that. I think we all know that's bloody unlikely to happen but what happens then in your nightmare? Does everyone rise out of their chairs with pitchforks and move towards you with threatening expressions on their faces?

Is that what happened in that internet story someone posted on your birth group? I bet actually someone came to the mum's defence: the bloke on the train who protected her or the employees in the bowling alley who formed a line and threw the bloke out (and several of these videos are set up by actors to test public reaction and get a nice bit of internet clickbait by the way).

The new mum would have felt scared but she probably also felt protected by those around her and angry on behalf of her baby rather than upset.

If it's more likely that you are worried about looks, don't look around the room. Why should you? I remember when my own son was less than 6 months old and I was feeding him in a café in an unfamiliar town, I scanned the room before I started. I clocked a man across the room chatting to a friend and when I was feeding, I looked over again. Why did I do that? What on earth was I doing? Almost certainly giving off a nervous vibe which is the sort of vibe an unkind person might sometimes thrive on. As it happened, the café customer I had first clocked called across, " you're alright love. Good on ya." OK, that was pretty embarrassing too as it happens but I expect he had felt obliged because he sensed I was nervous.

I once spoke to a mum who took off her glasses when she fed to stop her being tempted to look around. It's probably not going to help the breastfeeding if you're nervous so just give your focus to your baby for that moment. They will latch on more easily and oxytocin is more likely to happen.

Is the scary thing actually about being outside of the house with a new baby? I think for many people the nightmare is not the pitchforks or a weird shouting person but it's that you will have a crying screaming loud baby and you won't be able to sort it out. They might get themselves in such a frazzle that they can't even latch on. And then what would you do?

At home, you try some skin-to-skin or walk around for a bit and try another room. You are not disturbing anyone else unless you have thin walls and neighbours who are home.

But in a café there are people EVERYWHERE and VERY CLOSE. People wanting to relax and talk to others. People with their own stresses. And YOU are making so much noise.

I promise that everyone in that room is feeling sorry for you and wishing they could help. We are British and get embarrassed so our embarrassment and discomfort FOR you might look like edginess for other reasons but we really just wish we could help.

That's not about breastfeeding really, it's just about fear of loss of control.
The solution? Have a baby for longer. After a few more weeks and months, it feels easier. Babies still cry but you feel better about not being able to retain control.

Choose places to go where you know you could escape if you really needed to. Go with people who offer you emotional support.

Who you have with you when you breastfeed outside the home in the early days is really important.

Go to a café with your partner or your mum to practise. Meet your NCT group in a friendly library space and tell them if you are worried. The test of a great post-natal group is the one where you don't have to pretend you are sailing through this parenting experience and you are allowed to say when you need help. See if you can find some friends that don't always meet outside the home.

Being a new parent can feel like a constant cocktail party. Just when you feel least up to it, you are trying to develop new friendships and work out what place these new people will have in your lives. And your house is a complete heap too. Here's another test of a post-natal group: people are OK to come to each other's houses and sit on piles of washing and not care. It doesn't always have to be Starbucks.

If you are in Starbucks, it's not just who you are with, the way you breastfeed helps too.

I've met mums who say that they don't want to use a cushion at home because they won't have one when they are out and about. Sod that. If you want to use a cushion, use a cushion! Be as comfortable as you can for each breastfeed that you do. There's no point in making strict rules about these things.

Babies change shape really quickly - all over their bodies. They get heavier and their heads move differently for starters. But WE change shape too. I've supported mums who find breastfeeding is getting trickier after a couple of weeks and it turns out that they were previously resting baby on their arms and THEN their arms were resting on their baby belly. When their belly started to go, their arms were doing more work and they started to get more tired.

If you find yourself loving your cushion at home, the idea of breastfeeding without it seems terrifying. Well, if you want to put in a plastic bag under the pram and take it out with you, who cares? Do it!

But you may find that other chair is a different height anyway? Perhaps it doesn't work quite the same with your cushion? You may want to rethink. You could improvise with a rolled up jacket or even your change bag but I would try and develop a position where the baby's weight is supported by your torso and not a cushion nor just your arms.

Have a look at Nancy Mohrbacher's resources on Natural Breastfeeding. If you lean back a bit, a baby can be supported securely against your body and cushions and all the rest of it doesn't matter. You don't even need to do it in a sofa (though coffee shops are good at those). You can slouch in quite an upright chair but scooting your bottom forward and putting your leg out in front of you to support you.

Truthfully, the position you use in the corner café might not be super perfect. It might just be good enough.

It might seem tempting to take a bottle when you go out. Now that we have super dooper breast pumps and the bottles that ALL claim to be just like breastfeeding, that might seem appealing but it's not quite so straightforward.

First off, if you are getting to grips with breastfeeding, let's not give a baby a masterclass in bad latching. That bottle may claim to be like breastfeeding but which bit of breastfeeding did they pick? The tongue position? The need to elicit a letdown before milk starts to really flow? The way the milk gets gradually thicker and the letdowns come and go? The wide gape? Two of those if you are lucky. Some babies transfer between breast and bottle just fine but if you haven't yet sorted your latch, it might be wise to hold off.

The other crucial thing is that even if your baby's latch is fine and a bottle is less of a risk, even if you can easily transport breastmilk outside the home (and it is easy), what's going to happen to your breasts if you don't use them? In the early days, we're going to be more sensitive to signals that reduce our milk supply if we go for several hours without removing milk. When our breasts become full and engorged, that sends messages to reduce production. We're also vulnerable to getting blocked ducts and even developing mastitis. So realistically, you might have to pump around the same time you give your baby a bottle. I have yet to find someone who considers pumping milk in public to be easier (though plenty of exclusively pumping mums find a way to make it work).

We also need to bear in mind that for a breastfeeding baby, breastfeeding isn't just about the milk. When you are out in the big wide world and you are very small and everything else seems very loud and big (and smells of coffee) being attached to mummy also brings calm and contentment.

And all of this is about your baby. They can't stand up for themselves. They can't write a rude comment on that article when someone makes a stupid comment about public breastfeeding. They can't shout at the television when a daft celebrity makes a lazy statement. What would they say to you? What would they say when you were feeling nervous?

I doubt they would want you to feel stuck at home. They want to see the world too. They would want you to leave the house whenever you wanted to. But also not to feel that you HAD to.
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And they might thank you for helping to create a world where other women feel able to breastfeed in public. Every time you breastfeed outside the home, you make someone else feel that little bit better and normalise it for the next generation - for the little girl who may not have her own baby until 2040 and might not even remember that she saw you but it's in her subconscious somewhere. For her partner who will support her. For the woman who is now going to breastfeed outside her home next week.

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People ask for a lactation consultant's help for lots of different reasons. We often see people at one of the most difficult times in their lives. They might be damaged and in pain and feeling really desperate. Positioning and attachment problems are a common issue.

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Your baby can crawl to the breast and latch as soon as they are born

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

Join the Conversation

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Breastfeeding in the First Hours - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early

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This leaflet may help you to cope with your baby's crying and keep them safe

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You can attend a free 10 week parenting course to help you understand your baby's behaviour and development if you live in Bolton

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Empowering Families Through Peer Support

Our Parenting Groups are designed for parents who would like a better understanding of responsive and effective parenting techniques.

The Solihull Approach serves as the foundation for this program. For more information on about The Solihull Approach, please click HERE

About the groups

Each Solihull Approach Parenting Group consists of 10 sessions, and lasts for two hours.

Each week we'll cover a different topic and there will be discussion, activities and hopefully some fun as we develop our understanding of parent-infant relationships and gain new ways of thinking, strategies, and skills.

The groups are open to all families living in Bolton with children under the age of 3 years, who would like to have a better understanding of responsive and effective parenting techniques. You do not need to be experiencing difficulties or your child experiencing behavioural problems to attend. The goal of the groups is to establish a framework for understanding parent-child relationships, that can be made into a lifelong skill we can use both now and in the future!

What we'll Cover:

Introduction to Understanding your child's behaviour

How are you and your child feeling?

Tuning in to your child's development

Responding to your child's feelings

Different styles of parenting

Parent-child partnership - having fun together

The rhythm of interaction and sleep

Self regulation and anger

Communication and attunement

Reflecting on and celebrating our progress

You can book your place by clicking HERE or by calling 07514 484157

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Our Parenting Groups are designed for parents who would like a better understanding of responsive and effective parenting techniques. The Solihull Approach serves as the foundation for this program. For more information on about The Solihull Approach, please click HERE About the groups https://videopress.com/v/4HQpCMcT?resizeToParent=true&cover=true&preloadContent=metadata&useAverageColor=true Each Solihull Approach Parenting Group consists of 10 sessions, and lasts...

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Having your baby in a sling is a great way to keep them calm and close. You can get advice and help from the Sling Library.

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Here is some advice for the times when you find your baby's crying challenging

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Who we are

In 1981 a small group of parents, who were experiencing problems with their crying and sleepless babies, set up a support group. They discovered how important support is and how reassuring it can be to talk to someone. Today that support group has become Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. From modest beginnings Cry-sis has become a well-respected national charity which:

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Support For Crying And Sleepless Babies | Cry-sis

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Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. Call the helpline now...

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Some babies find it easy to burp, while others need a helping hand.

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What's the best position to burp my baby?

Support your baby's head and neck, make sure their tummy and back is nice and straight (not curled up), and rub or pat their back gently.

You don't need to spend ages burping your baby, a couple of minutes should be enough.

There are a few ways to burp your baby. Try them all out and see which works best - or use a combination.

1. Over your shoulder

With your baby's chin resting on your shoulder, support the head and shoulder area with one hand, and gently rub and pat your baby's back.

It might help to walk around as you are doing this.

2. Sitting on your lap

Sit your baby on your lap facing away from you.

Place the palm of your hand flat against their chest and support their chin and jaw (do not put any pressure on the throat area).

Lean your baby forwards slightly and with your free hand, gently rub or pat your baby's back.

3. Lying across your lap

Lie your baby across your lap face down.

Supporting their chin (do not put any pressure on the throat area), use your free hand to gently rub or pat your baby's back.

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Burping your baby will get rid of the air they have swallowed while drinking milk. See our guide for burping tips and best positions.

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Why Skin to skin is important and how to do this safely

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Skin to skin leaflet online version Arabic

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Why Skin to Skin is important and how to do this safely

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Skin to skin leaflet online version Gujurati

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Why Skin to Skin is important and how to do this safely

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Skin to skin leaflet online version Kurdish Sorani

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Why Skin to Skin is important and how to do this safely

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Skin to skin leaflet online version Polish