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Find out about colic, including what the symptoms are, what you can do to help soothe your baby, and when to get medical help.

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Best Start - Specialist Nurses who work with families that require comprehensive support.

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Best Start - Specialist Nurses who work with families that require comprehensive support.

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Email the Best Start team at: BestStartReferrals@nottshc.nhs.uk

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Nottinghamshire Healthcare NHS Foundation Trust

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Nottinghamshire Healthcare NHS Foundation Trust

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Where more support is required there will be further reviews at 3-4 months and 3-3½ years.

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Breast/chestfeeding info - additional languages 

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Breast/chestfeeding info - additional languages 

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Supporting breastfeeding in Lincolnshire

It's natural to have questions and concerns about feeding but there is plenty of support and advice available to you. There is lots of work going on to promote and support successful breastfeeding across Lincolnshire. Families, friends, nurseries, schools, workplaces, businesses - everyone has a part to play in making a Breastfeeding Friendly Lincolnshire! ​ ​

​ ​ ​ ​

Information in additional languages

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Read about our Latch on Lincolnshire campaign and find out where you can get support breastfeeding in Lincolnshire.

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For refugee women and parents or those seeking asylum

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For refugee women and parents or those seeking asylum

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Free support for Black women and birthing people

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Free support for Black women and birthing people

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WE NEED YOUR HELP

Our team is working tirelessly to increase awareness of the disparities in maternal mortality rates for black women in the U.K.

With your support Five X More has an ambitious and exciting plan to play a leading role in eradicating the statistics for good.

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Our team is working tirelessly to increase awareness of the disparities in maternal mortality rates for black women in the U.K. With your support Five X More has an ambitious and exciting plan to play a leading role in eradicating the statistics for good.

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Free app for South Asian women and birthing people 

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Free app for South Asian women and birthing people 

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Info for traveller women and birthing people

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Info for traveller women and birthing people

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Advice | Travellers-advice-team-tat | Travellers Times

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We are an independent, local charity and brand partner of Age UK, working in the two counties and striving to make Herefordshire and Worcestershire a great place to grow older.

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Translated info on breastfeeding and chestfeeding

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Translated info on breastfeeding and chestfeeding

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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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Polish Village - Support Me Maternal Project

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What is the purpose of the Polish Village? The Village of support for Polish Families in the UK. We specialise in pregnancy and up to the first years of life. The Polish Village promotes conscious motherhood and attachment parenting, breastfeeding and upbringing in bilingualism. We embrace our Polish heritage, offering a range of free […]

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Muslim Village - Support Me Maternal Project

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We started our Muslim Village project to provide culturally-aligned support to Muslim families from pregnancy to the first years of life. Muslim Village promotes conscious motherhood and attachment parenting, breastfeeding and embracing one’s culture whilst offering a range of free services. We are made up of Muslim mothers and volunteers in the UK, who have […]

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Notts group for Arab women and birthing people

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Notts group for Arab women and birthing people

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Our aim is to empower women in Nottingham, improve integrity and build a stronger community.

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Notts Trans Hub offers peer support, group, and community events for transgender people in Nottingham. It’s the perfect place to make friends and find a community.

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Birthing and Breast or Chestfeeding Trans People and Allies

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Birthing and Breast or Chestfeeding Trans People and Allies

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https://www.facebook.com/groups/TransReproductiveSupport

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Inducing Lactation - Surrogacy, Co-Nursing, Adoptive or Chest feeding

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Inducing Lactation - Surrogacy, Co-Nursing, Adoptive or Chest feeding

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Support group - Breaking Breastfeeding barriers - Black and brown women and parents

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Support group - Breaking Breastfeeding barriers - Black and brown women and parents

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Image library - breast/chestfeeding conditions (e.g. mastitis, nipple eczema, abscess) in people with Black and Brown skin

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Image library - breast/chestfeeding conditions (e.g. mastitis, nipple eczema, abscess) in people with Black and Brown skin

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Our goal is to develop and maintain an open access image bank of normality, pathology and anatomical variations in the lactating breast/chest across a range of skin colours. We are particularly focusing on people with black and brown skin as they are under-represented in Western medical and lactation educational resources.

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Free local antenatal classes - days and evening

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Free local antenatal classes - days and evening

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free translation at sherwood forest hospitals 2026

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Urgent concerns - call 999

Sherwood Birthing Unit (24/7) 01623 672244.

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Breast and chest feeding - Sherwood Forest Hospitals

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The Lime Green Team host free monthly sessions for women and birthing parents. To request listings for upcoming classes email sfh-tr.infantfeeding@nhs.net

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How to tell if breast/chestfeeding is going well 

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How to tell if breast/chestfeeding is going well 

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National Breastfeeding Helpline - Helpline

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This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website.

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Notts - Feeding support options from SFH,  Healthy Family Team  Health Visiting and GP

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Notts - Feeding support options from SFH,  Healthy Family Team  Health Visiting and GP

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Breastfed/chestfed babies from birth to one year of age should be given a daily supplement - and the woman/birthing person should also take daily Vitamin D

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Breastfed/chestfed babies from birth to one year of age should be given a daily supplement - and the woman/birthing person should also take daily Vitamin D

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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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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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When your baby won’t sleep, you may worry that something is wrong. Here’s what to expect, and how to still practice safer sleep even when…

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Feeding baby for your needs and when they show feeding cues

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Feeding baby for your needs and when they show feeding cues

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Nottingham & Nottinghamshire - free breast/chestfeeding peer support 

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Nottingham & Nottinghamshire - free breast/chestfeeding peer support 

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Nottinghamshire Healthcare NHS Foundation Trust

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Nottinghamshire Healthcare NHS Foundation Trust

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Information on breastfeeding support from professional advice to loved
one’s support.

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Positions for feeding after caesarean section

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Positions for feeding after caesarean section

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Breastfeeding after a c-section (caesarean)

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Your midwife will help you start breastfeeding after your caesarean section (c-section). Once you’re home, you can get support from your community midwife.

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Breastfeeding works best when you feed your baby responsively. There are no limits to how often you can offer your baby your breast. In the early weeks especially, you can breastfeed your baby every time he or she wants it. A new baby is not used to feelings of hunger and will feel upset and alone if their needs are not met. They have a small tummy and can digest breastmilk quickly, so they need to feed frequently. You can breastfeed your baby to comfort them as well or help them drop off to sleep.

You can also feed your baby whenever you feel you want to, for example if you feel your breasts are becoming over full, or if you are about to do something like attend an appointment, eat a meal or have a bath and want to be sure they won't be hungry whilst you are occupied.

Responsive breastfeeding is the best way to ensure you establish and maintain a good milk supply and will also help your breasts feel comfortable and avoid engorgement. Trying to feed to a schedule or space feeds out could result in your milk supply dropping.

Early signs of hunger include:

rooting

moving their eyes or head from side to side

wriggling

waving or sucking fists

making murmuring noises

Crying and distress are late signs of hunger, and it is harder to breastfeed a distressed baby, so responding to early cues will help make breastfeeding easier and calmer.

As a guide, you should expect to feed your baby at least 8 times every 24 hours, including during the night, but the pattern may be very variable, and it is common to feed more frequently.

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Responsive breastfeeding - The Breastfeeding Network

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Breastfeeding works best when you feed your baby responsively. There are no limits to how often you can offer your baby your breast. In the early weeks especially, you can breastfeed your baby every time he or she wants it. A new baby is not used to feelings of hunger and will feel upset and [...]

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Research shows correctly measured and fitted flanges on pumps increase yield of breastmilk, reduce parent’s discomfort, and can reduce the incidence of developing mastitis.

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Safer sleep for babies: Sleep Position, Sleep Environment and Bedding

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Reduced stools? Call your Midwife asap - at least x2 per day until 6 weeks of age if breast/chestfeeding.

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Reduced stools? Call your Midwife asap - at least x2 per day until 6 weeks of age if breast/chestfeeding.

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The witching 'hour' - coping with an unsettled baby

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The witching 'hour' - coping with an unsettled baby

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My baby feeds all evening, and my breasts feel empty - have I run out of milk?

Every time I try to put my baby down to sleep, they cry! What am I doing wrong?

Why does my baby cry at the breast sometimes, even though they still seem hungry?

If you've ever asked questions like this during the rollercoaster weeks of new parenthood, you're in good company! Most new parents, unless they have been around newborn babies a lot before, are surprised and sometimes confused by how intensely their baby needs to be held and comforted. At times, it can feel like very hard work, or even as if, whatever you try, nothing quite works. Babies on the TV might sleep quietly in their beds between feeds, but real babies often don't!

Here is some information that may help you make sense of your baby's behaviour and work out whether there is a problem that needs fixing, or whether your baby is just doing what normal babies do. If you haven't had your baby yet, reading ahead can help prepare you for what to expect, so that you take this stage in your stride!
This article about normal newborn behaviour assumes that your baby is full-term, healthy, feeding well and growing normally. If your baby was born early, is unwell, or if you are not sure whether your baby is feeding or growing well, please check with your midwife, health visitor, doctor or breastfeeding supporter. Here is a (non-exhaustive) list of signs that more could be going on than just normal newborn behaviour:

your baby's poo output is less than expected (What's in a nappy);

your baby loses more than 7% of birthweight by day 5 or keeps losing weight after day 5;

your baby grows at an average of less than 20-30g per day after day 5;

your baby doesn't wake at least 8-12 times in 24 hours to feed;

your baby seems to be in pain;

your baby cries inconsolably for hours, even in your arms;

your baby develops patches of dry skin/eczema or a wheeze;

your baby has green/mucousy stools or blood in their stool;

breastfeeding is painful for you and not getting any better;

your baby is often unhappy or frustrated at the breast;

your baby often feeds for more than 40 minutes per breast or doesn't stop breastfeeding until you take them off the breast.

If any of these apply to you, please seek further help from your healthcare provider or a breastfeeding supporter.
"Fussy periods"

When they aren't feeding, many babies sleep most of the time during the first few days after birth. This may be nature's way of letting both mother and baby recover from their birth experience.

Around 10-14 days old, though, your baby may "wake up", sometimes quite suddenly, and you may be shocked by the change! From now on, your baby will spend increasing amounts of time awake. At times, it can feel like hard work to make sense of what they need and to help them get back to sleep when they have had enough of being awake.

Many young babies have a "fussy period" of a few hours each day, when they especially need lots of calming and soothing. This is most commonly, though not always, in the evening and first part of the night, and tends to build in intensity over the next few weeks. The peak age for crying is around 6-8 weeks.

Why babies need so much help in the evening

Many pregnant women notice that their unborn baby seems most active when they lie down at bedtime. This could be because they have stopped walking around and lulling their baby back to sleep!

It is common for newborn babies to continue this pattern of evening wakefulness during the first few weeks after birth. By about 6 weeks, most babies are learning that the night is for sleeping, and (though they may still need to feed at night for many months) will begin to settle to sleep more quickly after a feed. You can gently help your baby learn the difference between night and day by taking them out in the daylight, especially in the morning, and keeping the lights low at night.

Another reason for babies to be unsettled by the end of the day is that their brains feel like they are on fire! Babies' brains are growing amazingly fast - they double in size in the first year. Every day, they take on lots of new information and experiences, and by the evening they are so excited by the day's learning that it takes them a long time to wind down towards sleep.

In busy households, with other adults and children coming back at the end of the day, some babies may find all the extra activity overwhelming, too. And if it's been just you and the baby all day, by the evening you may be feeling frazzled yourself, and in need of nurture and care, just like your baby! Unlike adults, babies can't just "switch off" and relax; they need lots of help from calm, loving adults.

Breastfeeding - more than just milk

Breastfeeding provides babies with much more than just milk. A frazzled baby seeks the breast because the rhythm of sucking, the closeness and security of being held, and the feel and smell of their mother's body help them to feel safe and calm.

Most babies like to feed more often in the evening. Milk flow might be a bit slower than it is first thing in the morning, but this isn't a problem; it means that babies can do lots of calming, soothing sucking at the breast without getting uncomfortably full. If your baby cries when you offer the breast yet again, it won't be because the breast suddenly doesn't work! It's much more likely that they've just had enough for the moment. The signals for "I'm hungry" are very similar to "I'm bored/tired/sad/uncomfortable/need a cuddle". Your baby still needs help, they just don't want the breast again right now.

You can find some ideas below of other ways to soothe a frazzled baby. If you're not sure what your baby wants, try offering the breast first, but if it seems to make things worse, try something else, and offer again when they are calmer.

The "fourth trimester"

Some experts talk about the "fourth trimester" of pregnancy; the first few months after birth, when babies' brains are still in an "unfinished" state. Human babies have to be born while their brains are still relatively immature, in order to fit through their mother's upright, restricted pelvis.

Your baby will learn to calm down and manage their own emotions when they are ready, but a young baby can't do this yet. You don't need to be worried that, by giving them the help they need now, they will be "clingy", "spoiled" or more dependent later. In fact, the opposite is true. Psychologists know that babies whose needs are met promptly early on are more likely to develop into trusting, confident children, because they find the world to be a safe place and know that they can always find help if they need it.

In the early months, if you are managing to keep your baby safe, fed, comfortable and reasonably happy, you are doing a great job.

A typical evening with a newborn

You feed your baby until they look fast asleep. You carefully put them down in their bed. Either immediately or soon afterwards they wake up and cry. You think they must be hungry... maybe breastfeeding isn't working? You feed them again until you think they can't possibly fit in any more milk, and put them down.... and so on, until the early hours of the morning.

Although (especially if you haven't breastfed before) you may worry that your baby cries at the breast because there's a problem with feeding, as long as the signs of milk intake (weight, wet & dirty nappies) are OK ( What's in a nappy and My Baby needs more milk) , and your baby is happier the rest of the time, it's probably nothing to do with hunger, or a breastfeeding malfunction! Your baby is most likely to have woken up because they were put down.

The conditions that adults might prefer for sleep - quiet, dark, being left alone - are scary for babies, who fear being abandoned more than anything. For our ancestors, a baby who was left alone was a baby who probably wouldn't survive. Your baby has an "alarm", carefully developed over thousands of years of human evolution, that is programmed to go off if they sense that they have been left alone.

What can you do about it?

Here are some ideas you might like to try:

Babies, like other small primates, feel safest held closely against an adult body, especially an adult who is moving around. Try swaying or gently dancing with your baby.

If you want to put your baby down, try to help them feel they are still with you: warm their bed, put something in it that smells of you, rock the crib, leave your hand resting on them while they fall asleep, etc.

Wait about 20 minutes until they are in deep sleep before putting them down. If you put them down too soon, they are more likely to wake up, perhaps quite upset, because they wanted to be asleep.

Carrying your baby in your arms or a sling meets most of the same needs as breastfeeding, and can be done by another adult. Dads or other close care-taking adults are often brilliant at this. A baby who is not hungry will still head towards a milky breast if they smell it close by. If they really don't want to nurse again, they might protest when they get there, which can be confusing for everyone!

You don't need to put your baby down if you don't want to.

If you do want to, enlist the support of other people who can get to know and love your baby. If you don't have another adult living with you, could a family member or friend come and stay for a while? Do you have an older neighbour who misses their grandchildren? A teenager who is brilliant with babies? Even very young babies can have close relationships with several adults (and older children) at once, and another pair of arms can be helpful to both you and your baby at the end of a long day.

Try going outside - babies are often happier outdoors.

Babies often seem more relaxed when you are surrounded by other adults; they know the sabre-toothed tiger can't get them! Visiting a pub garden can work really well on summer evenings. If you are at home and don't have company, try the radio or TV on a channel with people talking.

Experiment with singing, dancing, music, massage, bathing, rocking, walking.

Try turning the lights and the noise down. Some babies are more sensitive to lights and noise than others.

If you can do so safely, (Safe sleep and the breastfed baby) you might want to experiment with sharing a bed with your baby. Learning to feed lying down in a safely prepared bed means that you won't have to move your baby once they are asleep, and you can get some rest while you feed. If you are worried about whether your baby will be safe in bed with you, you might want to try it in the daytime first, with another adult keeping an eye on both of you.

Make sure you get something to eat (prepare a meal/snack in advance) and get a nap or at least a rest earlier in the day if you can, to prepare for the time of day when your baby needs you the most.

Sometimes nothing works; you can still let your baby know you are there with them in their distress.

If your baby is crying as if they are in pain, check with your doctor. There is more information here about possible reasons for crying. (Unhappy baby)

If you feel overwhelmed by your baby's needs, get help & support. Looking after a crying baby is really hard, but much harder if you feel unsupported. Your midwife, health visitor, GP or a parent support group can all help.

Although attending a La Leche League meeting will not guarantee you more sleep, knowing that this phase is normal and will pass can really help. Other mothers who have experienced the intensity of the early weeks with a baby will welcome and encourage you. Many LLL groups offer support on Facebook too. (Find a group)

You are working enormously hard to understand and meet your baby's needs. Every baby is different, and you are becoming an expert on your baby. There is no "right" or "wrong" way to be with your baby (any more than there is a right or wrong way to be with a partner or friend); there is only what works for you both, today.

This can feel scary at first (if only babies came with an instruction manual!), but as time goes on, you will feel able to try different ideas for calming your baby, and come up with some new ones. As the weeks go by, you will learn more about what helps your baby (and what doesn't!) and become more confident about knowing when they are OK, and when to get help. As your baby gets older and more experienced, they will find the world, and their own bodily sensations, less alarming.

These early weeks, which can feel like "forever", will pass. Before you know it, you will be able to support a newer parent who is wondering how on earth they will get through it, because you did!

Written by Jayne Joyce, on behalf of LLLGB, January 2019

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"Fussy evenings" with a newborn - La Leche League GB

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My baby feeds all evening, and my breasts feel empty - have I run out of milk? Every time I try to put my baby down to sleep, they cry! What am I doing wrong? Why does my baby cry at the breast sometimes, even though they still seem hungry?

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Positioning and attachment - always keep baby's nose 'free' so they can breathe, and feed comfortably

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Positioning and attachment - always keep baby's nose 'free' so they can breathe, and feed comfortably

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Breast/Chest Feeding - Positioning and Attachment

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If baby isn't latching - their chin needs to be connected to your breast/chest

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If baby isn't latching - their chin needs to be connected to your breast/chest

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11K views · 124 reactions | Newborn near the nipple but desperately rooting around seeming like they don’t have a clue? | Lucy Webber Feeding Support - IBCLC

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Newborn near the nipple but desperately rooting around seeming like they don’t have a clue?

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Autistic birth and beyond - positioning and attachment

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Autistic birth and beyond - positioning and attachment

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Positioning your baby for breast-feeding: a how to guide | Lydia Murtagh

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How to get a deeper latch by moving baby's position 

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How to get a deeper latch by moving baby's position 

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42K views · 192 reactions | One simple change that can really help latching | Lucy Webber Feeding Support - IBCLC

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One simple change that can really help latching

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Effective milk transfer  - 2:1 or 1:1 suck/swallow ratio (from around day 3 when milk 'comes in')

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Effective milk transfer  - 2:1 or 1:1 suck/swallow ratio (from around day 3 when milk 'comes in')

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Active Milk Transfer - Deep Jaw Movements - Good Swallowing by breastfeeding baby

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How to recognise effective milk transfer #2

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How to recognise effective milk transfer #2

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What typical breastfeeding sounds and looks like

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31 reactions · 24 shares | The key to the laidback position is your baby attaching themselves. To help them along you should be slightly more reclined. It will take the weight off your shoulders and feel more relaxed!

Have you tried breastfeeding in this way and how did you find it? Let us know 👇

🤱 For more breastfeeding advice and support visit https://bit.ly/3jCrLfV | Every Child Wales

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The key to the laidback position is your baby attaching themselves. To help them along you should be slightly more reclined. It will take the weight off your shoulders and feel more relaxed!

Have...

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How a deep latch looks inside baby's mouth

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How a deep latch looks inside baby's mouth

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Breastfeeding in public - The Breastfeeding Network

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Every day hundreds of babies are being breastfed outside the home – it is a bit like being pregnant, you don’t notice that anyone else is until it happens to you and then suddenly it seems like everyone is expecting a baby! So even though babies are feeding when out and about, most of the time we […]

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

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

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

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

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

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

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

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

The let-down reflex

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

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

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

How do I start to breastfeed my baby?

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

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

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

What breastfeeding positions should I try?

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

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

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

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

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

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

Where can I get help and support with breastfeeding?

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

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

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

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

There are also helplines and organisations that can help:

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

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Practical support for families staying on NICU

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Practical support for families staying on NICU

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One of the main requests by the nurses was a few essentials to be given to parents upon their baby’s arrival on the unit. The packs include a pack of nappies; a pack of bibs in pink/blue; a fleece blanket in pink/blue; some cotton wool balls, a scented heart and a diary for parents to complete.

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Do you often find yourself wondering how long your baby should sleep? We explain baby sleep patterns, baby sleep cycles and what to expect…

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If you plan to formula feed - bringing milk into hospital

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If you plan to formula feed - bringing milk into hospital

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https://www.sfh-tr.nhs.uk/services/maternity/infant-feeding/bottle-feeding/

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Foreign language resources - bottle feeding - 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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Getting to know your baby and setting up the foundations for a close and loving relationship.

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Getting to know your baby and setting up the foundations for a close and loving relationship.

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Your feedback | Sherwood Forest Hospitals

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Your voice is really important to us and we are grateful to everyone who takes the time to share feedback.

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Doncaster and Bassetlaw support for breastfeeding and chestfeeding

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Doncaster and Bassetlaw support for breastfeeding and chestfeeding

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Doncaster and Bassetlaw Teaching Hospitals

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Doncaster and Bassetlaw Teaching Hospitals

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Breastfeeding support contacts - Doncaster and Bassetlaw Teaching Hospitals

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This patient information has been provided by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust to help you understand your care and treatment.

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Derbyshire - Free breast/chestfeeding peer support

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Derbyshire - Free breast/chestfeeding peer support

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For more information or to find a group near you visit our linktree, here.
Since May 2018, Derbyshire County Council and Derbyshire Community Health Services have been working with The Breastfeeding Network to give mums the best possible chance of reaching their own breastfeeding goals.

In Derbyshire, over 70 Breastfeeding Network volunteers provide peer support to families and all of our support is completely free to access.

Our well trained peer supporters provide emotional support to mothers and families, support mothers with positioning and attachment, and signpost parents to up-to-date information. Our volunteers, who have all breastfed their own babies, play an important role in empowering new mothers and helping them to gain the confidence they need to breastfeed for as long as they wish.

Type of services available

Indoor support groups

121 support on zoom (contact your local peer support team to organise)

Group "chat" closed groups on Facebook

Antenatal zoom groups

Parent in the park walks

Contact details

For updates on opening times please contact your local peer support team (which you can
find here: https://linktr.ee/derbyshire_bfn) or email derbyshire@breastfeedingnetwork.org.uk

Social media and other links

Facebook bfnderbyshire
Instagram bfn_derbyshire

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For more information or to find a group near you visit our linktree, here. Since May 2018, Derbyshire County Council and Derbyshire Community Health Services have been working with The Breastfeeding Network to give mums the best possible chance of reaching their own breastfeeding goals.

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B.E.A.R.S Breastfeeding Support across Amber Valley | Belper

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B.E.A.R.S Breastfeeding Support across Amber Valley, Belper. 2,080 likes · 10 talking about this · 2 were here. We are part of and all peer supporters have continual training by The Breastfeeding…

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Most babies go through several growth spurts (also called frequency days) during the first 12 months.

What is a growth spurt?

During a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual.

The increase in baby's milk intake during growth spurts is temporary. In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months. As solids are gradually introduced after six months, baby's milk intake will gradually decrease.

Physical growth is not the only reason that babies may have a temporary need for increased nursing. Babies often exhibit the same type of behavior (increased nursing with or without increased fussiness) when they are working on developmental advances such as rolling over, crawling, walking or talking. Mom's milk is for growing the brain as well as the body!

When do babies have growth spurts?

Common times for growth spurts are during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). Babies don't read calendars, however, so your baby may do things differently.

Growth spurts don't stop after the first year - most moms notice growth spurts every few months during the toddler years and periodically thereafter on through the teenage years.

How long do growth spurts last?

Growth spurts usually last 2-3 days, but sometimes last a week or so.

What is the best way to handle a growth spurt?

Follow your child's lead. Baby will automatically get more milk by nursing more frequently, and your milk supply will increase due to the increased nursing. It is not necessary (or advised) to supplement your baby with formula or expressed milk during a growth spurt. Supplementing (and/or scheduling feeds) interferes with the natural supply and demand of milk production and will prevent your body from getting the message to make more milk during the growth spurt.

Some nursing moms feel more hungry or thirsty when baby is going through a growth spurt. Listen to your body - you may need to eat or drink more during the time that baby is nursing more often.

See My baby is fussy! Is something wrong? for tips on comforting a fussy baby.

Additional Resources @ KellyMom

Additional Resources at other websites

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Most babies go through several growth spurts (also called frequency days) during the first 12 months. During a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual. The increase in baby's milk intake during growth spurts is temporary.

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Pelvic Health Physiotherapy | Sherwood Forest Hospitals

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Information about Pelvic Health Physiotherapy

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Local Maternity and Neonatal Voices Partnership

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Local Maternity and Neonatal Voices Partnership

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Maternity and Neonatal Voices Partnership - NHS Nottingham and Nottinghamshire ICB

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What is an MNVP? An MNVP listens to the experiences of women and families, and brings together service users, staff and other stakeholders to plan, review […]

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Local parents - experiences of feeding their baby

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Local parents - experiences of feeding their baby

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Feed Your Way - Making Nottingham a breastfeeding-friendly city

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Breastfeeding looks different for every family. We spoke to nine Nottinghamshire-based families about their breastfeeding experiences. They told us about some of the challenges they faced, and the special moments they shared. They also had advice - from things they wished they knew, to information they found along the way. Find out how Becca, Eleanor,

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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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Blood loss and after pains when breast/chestfeeding

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Blood loss and after pains when breast/chestfeeding

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What amount of bleeding should be expected?

Everyone who has given birth will experience vaginal bleeding. This is called lochia (LOCK-ee-ur). The same amount of bleeding can be expected after a caesarean birth as after a vaginal birth.

Some of this blood comes from the place where the placenta was attached to the uterus. There might also be bleeding from a graze, tear or cut during the birth (RCOG, 2016).

The rest of the blood comes from the lining of the womb shedding, in the same way as a period.

Very absorbent pads should be used and changed regularly (NHS, 2024). The pads can also help the midwife know how much bleeding has happened by how many have been used.

What might be a cause for concern?

If the woman or birthing parent is losing clots larger than a 50p piece, they should tell their midwife (NHS, 2024).

Get medical help straight away if they:

suddenly lose a lot of blood from the vagina

feel faint

have a rapid heartbeat

This could be a sign of a postpartum haemorrhage (NHS, 2024).

Also get immediate medical help if they have:

a high temperature

a sore and tender tummy

This could be a sign of sepsis (NHS, 2024).

Does breastfeeding make a difference to the bleeding?

Bleeding is redder and heavier just after breastfeeding or expressing milk, as breastfeeding makes the womb contract (NHS, 2024). However, the overall amount of blood will be the same if breastfeeding or not.

Stronger 'afterpains' cramps might also be felt while breastfeeding. Read our article about vagina and pelvic floor after birth.

Support from a breastfeeding counsellor can also be really beneficial. You can call our NCT breastfeeding counsellors on 0300 330 0700, every day from 8am to midnight.

How long will bleeding last?

The bleeding will be heaviest immediately after birth and lessen after a few hours. The first week might be like the heaviest days of a period and the blood will be bright red.

Over the following weeks it reduces and turns brown. It should have stopped by the time the baby is 12 weeks old (RCOG, 2016). Talk to the midwife if it isn't reducing or stopping.

When will periods return?

Periods could come back 5-6 weeks after birth when formula feeding or mixed feeding. If exclusively breastfeeding and/or expressing, including at night, periods might not return until breastfeeding is reduced (NHS, 2024).

Is it safe to use tampons after giving birth?

Tampons or menstrual cups shouldn't be used before the 6-8 week postnatal check. This is because of the risk of infection. Pads should be used instead (NHS, 2024).

Is sex possible while bleeding?

The woman or birthing parent can have sex if it feels comfortable, and they want to. Read more in our article about sex after birth.

Postpartum haemorrhage (PPH)

A postpartum haemorrhage (HEM-mor-ridge) is very heavy bleeding after birth. It can be Primary PPH or a Secondary PPH (RCOG, 2016).

Primary PPH

This is when a woman or birthing parent loses more than 500ml of blood in the first 24 hours after the baby is born. Losing more than 1000ml of blood is a major PPH.

Primary PPH might cause sickness or dizziness. A midwife will call for assistance straight away if the pregnant woman or person is in hospital. If they are at home or a midwife-led unit and unwell, they will be offered transfer to hospital. In most cases the bleeding will settle quickly with treatment, but it may mean a longer hospital stay (RCOG, 2016).

Primary PPH occurs in 1 in 4 births (NHS Digital, 2023a). However, it is at a different rate after different types of birth (NHS Digital, 2023b):

Spontaneous vaginal birth: 18 in 100

Planned caesarean birth: 26 in 100

Unplanned caesarean birth: 34 in 100

Vaginal birth with forceps or ventouse: 45 in 100

So as the national rate of interventions increases, so does the national rate of PPH.

Secondary PPH

This is heavy bleeding from 24 hours to 12 weeks after birth, usually after the woman or birthing parent has left hospital. It is often caused by an infection and might be linked to retained placenta (RCOG, 2016). It occurs in 2 in 100 postnatal women (Fox et al, 2023).

If someone loses a lot of blood after birth, they can become anaemic and extremely tired. It's important to get medical help straight away if the mother or birthing parent is bleeding heavily. This helps prevent life-threatening blood loss (RCOG, 2016).

Contact the midwife or GP if the bleeding is getting heavier, the blood smells bad or the woman or birthing person doesn't feel well. They might need antibiotics for the infection (RCOG, 2016).

If heavy bleeding doesn't stop, the mother or birthing person might need to go to hospital for further treatment (RCOG, 2016).

To find out more about PPH read the RCOG patient information.

Does PPH affect breastfeeding?

Significant blood loss can affect breastfeeding and milk supply. This is partly because the mother or birthing parent and baby are likely to be separated for medical procedures. The loss of blood can also affect the release of hormones to stimulate milk production.

The clinician and partner may also be anxious to prioritise rest for the woman over supporting breastfeeding or expressing (Flood et al, 2023; Henry & Britz, 2013). It is important that the mother continues to receive support with expressing or breastfeeding if that is what they want (Flood et al, 2023).

When this happens, skin-to-skin contact with the mother could be offered when the bleeding is controlled (Flood et al, 2023). Read our article on skin to skin to understand why skin-to-skin is important.

Flood, MM. et al. (2023) Primary postpartum haemorrhage adversely impacts breastfeeding initiation in Victoria, Australia. Women and Birth, 36 (6), e582 - e590. https://doi.org/10.1016/j.wombi.2023.05.001

Fox R, Aitken G, Mooney SS, (2023) Management of secondary postpartum haemorrhage: A systematic review, European Journal of Obstetrics & Gynecology and Reproductive Biology. 282, pp116-123. https://doi.org/10.1016/j.ejogrb.2023.01.023

Henry L, Britz SP (2013) Loss of Blood = Loss of Breast Milk? The Effect of Postpartum Hemorrhage on Breastfeeding Success. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42, Supplement 1, S100. https://doi.org/10.1111/1552-6909.12198

NHS (2024) Your body after the birth. https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/ [11 Nov 24]

NHS Digital (2023a) NHS Maternity statistics, England, 2022-23. Summary report tables. https://digital.nhs.uk/data-and-information/publications/statistical/nh... [11 Nov 24]

NHS Digital (2023b) NHS Maternity statistics, England, 2022-23. HES NHS maternity statistics tables. https://digital.nhs.uk/data-and-information/publications/statistical/nh... [11 Nov 24]

RCOG (2016) Heavy bleeding after birth (postpartum haemorrhage). https://www.rcog.org.uk/for-the-public/browse-our-patient-information/h... [11 Nov 24]

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Bleeding after birth and postpartum haemorrhage (PPH) | NCT

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How much bleeding is normal after birth and how long should it last? Learn about bleeding after having a baby and how to recognise if too much blood is being lost.

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Starting to make milk again after a break

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Starting to make milk again after a break

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Many individuals find they can relactate - successfully - even after having weaned for weeks or months.
Time to give it a try? Our infographic below can help you.

You might also find these articles useful:
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10 Ways to Relactate After a Period of Not Breastfeeding

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Relactation Infographic Many individuals find they can relactate - successfully - even after having weaned for weeks or months. Time to give it a try? Our Many individuals find they can relactate - successfully - even after having weaned for weeks or months.

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Introducing solids and eating well up to baby's first birthday

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Introducing solids and eating well up to baby's first birthday

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Eating well: the first year
A guide to introducing solids and eating well up to baby's first birthday

This guide provides information and practical advice on introducing solid foods to babies (also called weaning, complementary feeding), with recipes and photos to show the sorts of foods, and amounts of foods, that will give them a good start to their eating journey.

The information is in line with current policy in the UK and provides a pictorial guide which can be used to support families in the first year of their baby's lives. This guide includes information and example recipes for vegan, vegetarian, gluten-free, egg-free and dairy-free diets. Information on cultural diets and fussy eating are also included in this guide.

Downloading options for this resource
This guide is 130 pages long and in full colour. Please be aware that printing it out in full will use a lot of ink - especially yellow ink (!) and when we have done it on a home printer it has used more than one cartridge, so you might find it cheaper to buy a hard copy if you are doing this yourself.

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Eating well in the first year - First Steps Nutrition Trust

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A guide to eating well and starting solids up to baby's first birthday. This guide introduces weaning/complementary feeding and gives practical tips on introducing food to your baby.

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Large breast/chest - positioning and attachment 

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Large breast/chest - positioning and attachment 

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Positioning with a newborn when you have large breasts

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Breast/chest feeding after caesarean section 

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Breast/chest feeding after caesarean section 

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Best Beginnings - creators of Baby Buddy

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Ask the breastfeeding expert: breastfeeding after caesarean

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Massage and lymphatic drainage for engorgment and mastitis

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When milk flows too fast - overactive letdown

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When milk flows too fast - overactive letdown

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Breastfeeding When Milk Flows too Fast: Forceful or Overactive Letdown

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Tongue tie division (Frenulotomy) under 6 weeks of age at Sherwood Forest Hospitals

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

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

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

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

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

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

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

Why do babies fuss in the evening?

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

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

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

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

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

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

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

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

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

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

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

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

Combine rhythmic motion with soothing sounds.

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

More soothing techniques.

More resources for fussy babies

@ KellyMom

@ other websites

Helpful books

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

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

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Cluster Feeding and Fussy Evenings * KellyMom.com

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

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Eating Well for pregnant & breastfeeding women, babies and young children living in temporary accommodation (PDF/Digital Download Only)

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Please note: This is the digital version only. All our resources are free to download but please consider making a contribution to enable us to keep this and all our resources updated and in line with latest UK public health recommendations. This guide is for healthcare practitioners, community groups, social services, volunteers, and hotel staff working with pregnant and breastfeeding women,

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The World Health Organisation, UNICEF and the UK Department of Health recommend that ideally, babies’ only food should be breastmilk for around six months. Breastfeeding can then continue alongside suitable solid foods up to two years old or beyond.

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This guest blog from breastfeeding counsellor Emma Pickett discusses the dangers of promoting a strict feeding schedule at the expense of responsive, flexible infant feeding.
Add your voice to Unicef UK's Change the Conversation campaign, calling on UK governments to take urgent action to protect, promote and support breastfeeding.
Somehow, somewhere, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1 hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, "Only 30 minutes till my next sip of water or mint! Not long now". But yet we expect teeny growing babies to be governed by this artificial notion of time.

Basic misconceptions

I spoke to a new mother last week who was perfectly happy with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

Searching for "normal"

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Breastfeeding Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But not all will.

One of the most popular babycare books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Responsive feeding: So much more than milk

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record book records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK.

It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.
Sources

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

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Guest blog: Breastfeeding: The dangerous obsession with the infant feeding interval - Baby Friendly Initiative

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Advice that babies must follow a strict three-hourly breastfeeding routine is causing mothers distress and guilt,and reducing breastfeeding rates.

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

A note about exclusive pumping:

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

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

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

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

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

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

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

Here are some tips and information regarding exclusive pumping:

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

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

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

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

PUMPING - HOW LONG?

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

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

Pump Settings

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

HOW MUCH MILK PER BOTTLE?

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

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

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

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

Then divide 25 oz by the number of nursings.

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

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

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

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

HOW TO BOTTLEFEED

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

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

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

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

INCREASING YOUR SUPPLY

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

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

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

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

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

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

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

PUMPING TRICKS & More Tips For EPing Moms by EPing Moms

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

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

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

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

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

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

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

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

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

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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Feeding for comfort and responding to baby = brain development 

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Feeding for comfort and responding to baby = brain development 

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Unicef UK Baby Friendly Initiative | Importance of relationship building

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Pumping and reduced amount of milk being produced

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Pumping and reduced amount of milk being produced

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Why Am I Pumping and No Milk is Coming Out? Does this Mean my Baby Isn’t Getting Enough? - Carla Corral Lactation Consultant

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For many breastfeeding mothers, pumping is a key part of their routine, whether it’s to ensure there’s enough milk for their baby, for preparing for returning to work, or simply to build up a freezer stash. However, one common concern I often hear during my consultations is “Why am I pumping, and no milk is […]

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https://laleche.org.uk/five-ways-help-breastfeeding-doesnt-go-expected/

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Continuing breast/chestfeeding on return to work

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Continuing breast/chestfeeding on return to work

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Many mothers work outside the home and continue to breastfeed. LLLGB is here to help with information and support if you are going back to work.

I'm going back to work. Do I need to stop breastfeeding?
Why is breastfeeding so important?
But won't it be a hassle?
What are my options? Choose childcare carefully Consider expressing your milk Solid foods Making it work Somewhere to express Before you return to work Expressing
Working and breastfeeding Further reading

I'm going back to work. Do I need to stop breastfeeding?

There is no need to stop breastfeeding when you return to work. Returning to paid work doesn't prevent you from breastfeeding your baby. Depending on the nature of your job and the age of your baby, you'll probably need to adjust your nursing relationship. You'll also need to talk to your employer, but time away from your little one doesn't mean breastfeeding has to end. Continuing to nurse may be even more important to you both as you adjust to big changes in your lives. Mothers choose to continue breastfeeding for their babies' health and because breastfeeding is good for the whole family. It provides easy feeding on days at home and a warm way to reconnect at the end of a long day for mother and child. It's well worth planning how to balance breastfeeding with your work routine.

Why is breastfeeding so important?

Your milk alone is vital to your baby during the first six months of life, and continues to be an important part of his diet until 12 months and beyond. Formula just doesn't compare. As well as meeting nutritional needs, breastmilk is packed with antibodies-particularly important if your little one will be spending time in nursery or with a childminder. And when you are together, making time to reconnect through snuggling up and nursing will be even more meaningful. You'll miss each other when you're apart.

But won't it be a hassle?

Being a working mother will be challenging, but breastfeeding can make life easier. Ending the breastfeeding relationship may appear at first to be the simplest solution, but with the increased risk of illness, plus the effort involved in buying, preparing and storing formula, weaning may ultimately be the real hassle. Also consider that your baby will eventually outgrow the need to nurse. Most mothers reduce and stop pumping before their babies stop breastfeeding.

What are my options?

Your options depend on the age of your baby and the nature of your job. You can start planning before your baby is born. Gather ideas from any co-workers who breastfed their babies. Studies show that the longer you wait before returning to work, the easier the transition will be for both you and your baby.

Consider your employment flexibility and workday practicalities:

Can you extend your maternity leave, request part-time or flexible working hours, or an extended lunch hour?

Are you able to work from home for all or some of the time, or even bring your baby to work?

Can you break up your working week, perhaps working alternate days, so your baby is not away from you several days in a row?

Shorter workdays may be easier to manage, with less pumping for you and fewer missed breastfeeds for your baby.

Or you may prefer fewer but longer workdays, with more full days at home with your baby.

Choose childcare carefully

Having your baby nearby may allow you to go and nurse him during your lunch hour. Or maybe someone could bring him to you? Look for carers who are supportive of and knowledgeable about breastfeeding. It's important they respect your decision to provide only your milk for your baby.

Consider expressing your milk

You can use a good quality electric pump or learn to hand express. This is especially important if your baby is less than a year old. Expressing milk will enable you to maintain milk production as well as ensuring your baby can still receive your milk whilst you're apart. If you decide not to express your milk at work you can still continue breastfeeding when you're at home. You may need to express at first to avoid the discomfort of engorgement and the risk of mastitis.

Solid foods

Once your baby is eating more solid foods, he will need less expressed milk while you are away. But your baby will enjoy your yummy milk once you get home again!

Making it work

I don't want to wean, but I'm sure my employer will want me to!
This is one time when your employer can't tell you what to do! Daunting as it may seem, it's important to tell your employer about your need to express milk for your baby. Depending on what is available in your workplace, you may find it helpful to speak to someone from the human resources department, a health and safety representative and/or your trade union representative before speaking to your line manager. Employers are legally required to do a health and safety risk assessment for breastfeeding mothers, so you'll need to notify them in writing a few weeks before you return to work. Explain that being able to pump regularly will reduce any risk of you becoming engorged and developing mastitis.

Research shows it's a win-win situation if breastfeeding is supported and therefore continues: you'll feel positive about your company and your job satisfaction will increase-along with your willingness to work hard! Your employer will gain from your hard work and, because your baby will have breastmilk's infection protection, you're likely to take less time off.

For more information on your rights, and what employers are required to do to support you, see:
Maternity Action and their guidance on Breastfeeding at Work
ACAS: accommodating breastfeeding in the workplace
The Health & Safety Executive: Protecting pregnant workers and new mothers

Somewhere to express

You'll want to request somewhere private to express your milk, preferably with a door that can be locked. It helps to have access to electricity for your pump, a fridge and running water. A comfortable place to sit and a table for your pump and other supplies are also important. Bathrooms and toilets are not suitable. Employers are legally required to provide suitable facilities for pregnant and breastfeeding mothers to "rest". Although, they are not required by law to provide a private and safe place to express and store milk, the Health and Safety Executive recommend that they do. All employers must carry out a risk assessment so it would be very difficult for them to refuse. Be very clear about what you want to do and what you need. And do point out that expressing is something that, depending on the age of your baby, you may only need to do for a few months.

Before you return to work

Attend LLL meetings to meet other breastfeeding mothers in your area. You can offer each other vital support when breastfeeding, pumping, mothering or working becomes challenging.

Practise pumping or hand expressing to learn what works for you. You can freeze the small amounts of milk you collect to use for your first few days back at work and to give you a small back-up supply. Once you're missing feeds, the amount of milk you can pump will incre se and your baby can have fresh milk from the previous workday. Fresh milk retains more nutrients and immune factors.

Wait to introduce a bottle until just before you start back to work. Making breastfeeding a priority while you are at home will help you avoid feeding problems. An older baby may never need a bottle. Milk can be given in a cup or mixed with solid food.

Make your return to work easier by starting back on a Thursday or Friday. At the weekend, rest and prepare for any challenges you didn't anticipate. Make changes if your first strategy doesn't suit you or your baby.

Expressing

It's usually best to express milk at least every three hours while you are away from your baby. You may need to pump or express your milk more frequently at first so you don't feel uncomfortably full or start to leak. Be sure to include commuting time when deciding how often to pump. If you feel the tingling of your milk beginning to flow, pressing hard on your nipples for several seconds can prevent leaking. This can be done discreetly 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. But bear in mind that if your breasts feel full, this is a sign you need to express some milk. With time you'll have fewer problems with leaking.

Working and breastfeeding

It can be so rewarding to continue to nurse your baby after returning to work. It's a wonderful way of reconnecting after a day apart. LLL meetings can continue to be a good source of support after you return to work. If you're unable to attend every meeting, your local LLL Leader can still listen to any concerns you have and offer support.

Written by Sue Upstone & Mothers of LLLGB.

Further reading

Working and Breastfeeding
Workday practicalities
If you leave your baby
When mum can't be there
Expressing your breastmilk
Hand expression of breastmilk
My Journey Returning To Work, a mother's story
Mothers on ... breastfeeding & work

Books
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010.
Exclusively Pumping Breastmilk Stephanie Casemore. Canada: Gray Lion Publ. 2013

LLL Articles
New Guidance For Employers on Breastfeeding Breaks in the Workplace
Supporting Women's Right To Breastfeed

You may also wish to look at the following guidance:
Maternity Action and their guidance on Breastfeeding at Work
ACAS: accommodating breastfeeding in the workplace
The Health & Safety Executive: Protecting pregnant workers and new mothers

This information is available to buy in printed form from the LLLGB Shop

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Working and Breastfeeding - La Leche League GB

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There is no need to stop breastfeeding when you return to work. Many mothers work outside the home and continue to breastfeed. LLLGB is here to help with information and support if you are going back to work.

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(Many) benefits of breast/chestfeeding after age 1 and beyond 

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(Many) benefits of breast/chestfeeding after age 1 and beyond 

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KellyMom.com - Breastfeeding and Parenting

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Breastfeeding Past Infancy: Fact Sheet - KellyMom.com

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Breastfeeding children benefit NUTRITIONALLY Although there has been little research done on children who breastfeed beyond the age of two, the available information indicates that breastfeeding continues to be a valuable source of nutrition and disease protection for as long as breastfeeding continues.

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Using a nursing system to offer extra milk to baby

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Using a nursing system to offer extra milk to baby

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supplementing at the breast with an SNS/tube system and a shield