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If a breastfed baby is gaining very little weight, not gaining, or losing weight due to not getting enough milk, the first priority is to make sure the baby gets more milk. There are several ways to increase a mother's breast milk supply, however, these can take time and the baby may need more milk straight away. Sometimes parents are reluctant to supplement large quantities of donor milk or formula in case this undermines breastfeeding but medically indicated additional calories do not have to mean the end of breastfeeding.

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This article discusses a general care plan for supplementing an underweight baby while protecting breastfeeding-with the end goal of returning to full breastfeeding where possible. It is a companion article to read alongside Baby Not Gaining Weight and Understanding Your Baby's Weight Chart. This general plan should never be considered a replacement for medical advice or a tailored care plan from your baby's physician and your own IBCLC lactation consultant as it cannot take into account yours or your baby's medical details. Please discuss the information in this article with the health professional caring for your baby.

Breaking the low weight cycle

When a baby is very underweight he can become too weak to breastfeed. This will mean he cannot "drive" or stimulate his mother's milk supply properly. Milk production slows to meet the weak demand which causes even lower weight gain and so on in a cycle of low weight/low energy/low milk. Breaking this cycle involves checking baby's health, restoring baby's nutritional status and maximising the mother's breast milk supply:

Medical checks. Rule out any underlying health issues for baby with your doctor or paediatrician to establish whether low milk intake is the only cause of poor weight gain. Stay in close contact with your baby's doctor so they can monitor your baby's recovery.

More milk. If a baby is substantially underweight they will need extra calories right away to protect their health, gain weight, and have more energy for breastfeeding. Doctor Marianne Neifert explains:

Excerpt from

Providing appropriate supplemental milk to an underweight infant is necessary to prevent malnutrition, dehydration, electrolyte imbalance, cerebral infarcts, and other complications of inadequate breastfeeding.

Maximise breast milk supply. Although supplements may be needed short term, breastfeeding can be protected by increasing breast milk volume as soon as possible. With a more abundant milk supply a baby will be encouraged to breastfeed more readily (Neifert, 2001).

Supplementing an underweight baby

- A three step plan

The following care plan for rebuilding a baby's weight while protecting breastfeeding is based on lactation consultant Pamela Morrison's five step feeding plan and Marianne Neifert's triple feeding plan :

#1 Breastfeed

Breastfeed often, at least every two to three hours in the day and every four hours at night. Wake a sleepy baby to feed if needed-upright positions can help a baby stay awake to feed.

Latch and position. Check baby's latch (the way they attach to the breast) and positioning with a breastfeeding professional, a good latch is important to drive a milk supply.

Offer both breasts per feed and use breast compressions. Rather than allowing baby to finish each side at their own pace, watch for active sucking and swallowing and help milk flow with breast compressions; a technique made popular by Canadian paediatrician Jack Newman. When active sucking stops despite compressions, switch breasts and repeat.

Limit the feed. Breastfeed for around 10-15 minutes each breast or 20-30 minutes total. A time limit prevents very long ineffective feeds. Long feeds where baby is flutter sucking or sleeping-but not drinking-do not stimulate a milk supply and perpetuate the low gain cycle. Long sessions of poor quality feeding also contribute to baby burning precious calories.

#2 Supplement

When baby isn't swallowing at the breast any more, or after 20-30 minutes, stop breastfeeding. Top your baby up in the easiest way for you and your baby (see below). Use expressed milk first and then donor milk or formula as needed, use enough supplement so that your baby stops drinking of his own accord (see below for a guide to volumes). Settle your baby so that you can pump.

#3 Pump

Pump both breasts as soon as possible after you have breastfed, topped-up and settled your baby. Aim to pump at least six times per day if you can. Using "hands-on-pumping" (gentle light touch breast massage and breast compression while you pump) can stimulate more milk. Pump until the milk stops flowing and only produces drops of milk (around 10-15 minutes). Pumping both breasts at the same time (double pumping) can save time or some mothers may prefer to pump and massage each breast separately. Hand expressing after pumping can really help milk supply. Save any collected milk towards your baby's next top-up, with the end goal of gradually pumping the entire supplement volume. See How Long Does Breast Milk Last? for storage information and How to Increase Milk Supply When Pumping for more pumping tips.

An hour goal

It is helpful to try to keep breastfeeding, topping up and pumping all within a reasonable time interval otherwise it can feel too difficult and time consuming for the mother. Aim to breastfeed for around 20-30 minutes, top baby up to satiety (10-20 minutes), then pump (10-15 minutes) all within an hour. Marianne Neifert recommends:

The mother should pump for 10 to 15 minutes using a dual collection system to drain both breasts simultaneously. The high-fat, calorie-dense hindmilk obtained with the breast pump may be used to supplement the infant, with additional formula as required. This triple-feeding regimen-breastfeeding for approximately 10 minutes per breast, supplementing the infant to satiety, and pumping for approximately 10 minutes-should not exceed 1 hour.

Frequently asked questions

Is my baby really hungry or just small?

The characteristics of a hungry baby can sometimes be mistaken for being either very fussy, very "good" or just small/petite. See Baby Not Gaining Weight for a summary of behaviours you might notice in a hungry baby and check Understanding Your Baby's Weight Chart. Your health professional and/or IBCLC lactation consultant can help to interpret your baby's weight.

Why can't I just breastfeed more?

If breastfeeding has led to your baby not gaining weight, simply doing more of the same, in the same way, is unlikely to help until your baby has more stamina and the reasons for low gain/low milk have been found and addressed. Supplements may be needed to provide enough food, and pumping will help to jump-start your milk supply. There are a couple of situations to be aware of:

If a baby is only slightly underweight but otherwise healthy or for whom growth faltering is a very recent event, appropriate breastfeeding management measures may be sufficient to increase a mother's breast milk supply. Always be guided by and stay in close contact with your baby's doctor or health visitor. If there is no extra weight gain after two to four days, supplements will be needed (Morrison, 2011).

The newborn baby who has lost more than 10% of their bodyweight after birth, is at risk of dehydration or breastfeeding-associated hypernatremia (high sodium levels in the blood). This is a serious condition and babies will need to be assessed by a doctor so that their electrolytes (e.g. sodium levels) can be checked and carefully corrected and supplements provided under medical guidance.

How can I make more breast milk?

The more often milk is removed from the breast and the more thoroughly, the more milk will be made. An underweight baby is not very good at this, help him stimulate your milk supply by:

Review reasons for low supply

In some cases there may be medical reasons for low milk supply, review possible causes for low milk/low weight gain with a breastfeeding expert.

For more information see How to Make More Breast Milk or follow the advice tailored for you by your IBCLC lactation consultant.

Do I have to pump? I can't pump much

Once a baby catches up and is back to the healthy weight-for-age they should be, a baby is often better able to drive his mother's milk supply. Until this time, pumping with an efficient pump can really help to stimulate your milk. Try not to be disheartened if you only get 10-20ml from each breast or less when you first start pumping, you can build on this. The process of pumping an empty breast is putting in the order for more milk tomorrow.

Keeping a record

It can be helpful to keep a record of volumes of breast milk expressed each day and volumes of formula given so you can gauge progress (over time breast milk will go up, formula will go down). Charting the number of wet and dirty nappies can also help gauge whether your baby is getting enough milk, alongside weighing your baby regularly.

What supplement should I give?

The first choice for a supplement is always mothers' own expressed breast milk. However, if a mother is unable to pump enough expressed milk to satisfy her baby, she will need to choose between donor milk where available or using baby formula. Always feed any expressed breast milk first, then donor milk, and finally formula. It is thought that mixing human milk and formula into the same container should be avoided as there are concerns that direct mixing could interfere with the antibacterial benefits of breast milk and mixing could lead to wasted breast milk if baby doesn't finish the bottle. See Supplementing With Formula for more information.

How much supplement should I give?

A general guide used for overall milk intake normally is 150-200ml/Kg/day. How much supplement an individual baby needs will vary with their age, weight, frequency of feeds and depending how much breast milk they get. Krugman and Dubowitz say that infants recovering from faltering growth (failure to thrive) need 150% of the intake for their expected, not actual, weight for catch-up growth. This means the amount of top-up needed may be much higher than expected for a while. A top-up at each feed might be anything from 30ml to 120ml or even more.

Pamela Morrison explains that while 180ml/kg/day above 10 days of age is a normal intake for a healthy baby, some babies will start taking surprisingly large volumes while they catch up. Be guided by a baby's appetite by offering enough supplement until they stop drinking because they are full. She explains:

In consultation with the baby's paediatrician it may be appropriate to feed the baby up to 280-300 ml/kg/day while s/he achieves a "catch-up gain"

If your baby doesn't seem hungry

A very underweight baby may find it hard to drink much at first as they may have become used to very small meals and they might bring back some of the top-up as spit up. If so, try offering smaller volumes more frequently and then follow baby's appetite as it picks up. If your baby is not showing hunger cues Wambach and Spencer suggest aiming for a minimum supplement of 100ml/kg/day divided into eight to twelve feeds. After one to two days increase the supplement gradually until the baby starts to demand his feeds.

My doctor says to give two bottles of formula per day

Your experienced health professional may prefer to prescribe set volumes of top-up to be certain your baby is getting what he needs-particularly if your baby is not showing good hunger cues. If your health professional recommends, let's say, two 150ml (5oz) top-up bottles per day or 300ml/10oz per day this is the same as topping up 50ml after six day time breastfeeds (50 x 6 = 300ml per day). Topping up smaller amounts to make up the same total can be more protective of breastfeeding because:

Baby is not overloaded in one meal which may cause him to sleep for a long time missing potential breastfeeds

Baby is able to satisfy their appetite throughout the day not just twice a day

Too much milk in one go could be brought back as spit up.

In practice, find the pattern that works for you and keeps your baby well fed-monitor baby's weight gain closely. If a breastfeed is missed out, remember to pump during the interval.

How should I give the supplement?

It is important to find an easy way for the low weight baby to take his supplement. Options include

Cup feeding-baby must be awake and alert which can be problematic with a very weak and sleepy underweight baby

Supplemental tube-either at breast or by finger-feeding. This may work for some babies but may be too difficult or slow and consume too much energy for others who are very weak

A bottle can be the most efficient and least stressful feeding method for an underweight, sleepy baby until they have gained their expected catch-up weight (Neifert, 2001). There are several ways to make a bottle feed more like a breastfeed and reduce nipple confusion but avoid overly pacing a feed for an underweight baby, their appetite needs encouraging!

My lactation consultant says supplement first, then breastfeed?

The three step plan above discusses breastfeeding first and then supplementing your baby. Alternatively some lactation consultants favour giving a limited amount of supplement before breastfeeding. The rationale being that the baby receives some calories to give them energy to breastfeed well and then baby associates the breast with feeling full as they fall asleep. This may work well for some babies. It can be difficult to gauge the top up volume before a breastfeed so that a baby is well fed yet not too full or sleepy to breastfeed efficiently. Another variation is to start and finish at the breast with the top up in the middle. As long as an underweight baby is getting the additional calories they need, is still getting plenty of chances to breastfeed, and mother has time to pump, parents can find what works best for them.

When can I get back to exclusive breastfeeding?

The time taken to get back to exclusive breastfeeding will vary depending on a number of factors including how well your milk supply rebounds, the age of your baby and how underweight they were. Some mothers will find supplements are only needed for a few weeks or months while others may still need to top up until solid foods become a regular part of baby's diet. If supplements are stopped too soon, a baby's weight can falter again. As a mother's breast milk supply increases and baby has more stamina to take more direct at breast, baby will gradually take less and less supplement after they have breastfed until it isn't needed. Marianne Neifert suggests continuing to pump after breastfeeds until the baby is gaining weight well with exclusive breastfeeding, and then gradually reduce pumping sessions.

How quickly will my baby gain weight?

Although this will vary between babies, once they are getting more milk it is common for an underweight baby to have a few days of weight gains up to 120g a day while they replenish body fluids (Smillie, 2016). They will usually continue to steadily gain weight and gradually move up one or more centile lines on their weight chart until they reach a healthier weight for their age. The baby's initial ravenous appetite will settle down again into the normal pattern of weight gain for their age once they have caught up. See Understanding Your Baby's Weight Chart and Baby Not Gaining Weight to know what to expect as time goes on and keep a close eye on your baby's weight gain as they recover from faltering growth.

Summary

When a baby has growth faltering due to not getting enough breast milk, a plan of care that includes breastfeeding, supplementing and pumping ensures baby is well fed while protecting the breastfeeding relationship. Such a plan should always be under the guidance of your baby's medical team who will monitor your baby's recovery and weight gain. By finding the reasons for low milk intake and starting measures to maximise a milk supply, supplements do not have to mean the end of breastfeeding. Supplementation should not be withdrawn too soon or baby might start to lose weight again. Once a baby is back to the weight he should have been, and the original causes for low milk supply addressed, exclusive breastfeeding can often continue. Occasionally a mother may not be able to provide a full milk supply for her baby.

Thank you
Special thanks to Pamela Morrison IBCLC who first introduced me to this plan and shared her extensive experience with low weight gain babies making this article possible.

Footnotes & References

1. Breastfeeding and Human Lactation, Wambach and Spencer, 2021, p 342

2. Breastfeeding and Human Lactation, Wambach and Spencer, 2021, p 342

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If a breastfed baby is gaining very little weight, not gaining, or losing weight due to not getting enough milk,

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

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

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

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

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

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

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

If your nipple is damaged, with cracks or bleeding

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

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

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

Other causes of pain in breastfeeding:

Allergy

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

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

Vasospasm

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

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

Raynaud's Phenomenon

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

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

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

A white spot, bleb or blocked nipple pore.

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

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

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

Expressing milk

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

Strong let-down

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

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

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

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

Engorgement

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

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

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

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

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

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

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

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

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

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

Blocked ducts and Mastitis

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

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

Abscess

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

Thrush

Signs of thrush in you

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

Thrush should not be diagnosed if:

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

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

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

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

Signs of thrush in your baby

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

Baby's tongue/lips may have a white gloss

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

If you think you have thrush:

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

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

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

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

Self-help measures

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

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

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

Use a separate towel for each person in the family

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

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

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

Treatment

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

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

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

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

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

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Pain: if breastfeeding hurts - The Breastfeeding Network

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

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https://abm.me.uk/breastfeeding-information/antenatal-expression-colostrum/

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Colostrum harvesting is collecting colostrum from the breast. Colostrum is the first secretion from the mammary glands, rich in antibodies. It is a sticky liquid from the nipples which is made before the milk has 'come in' (before breast milk is produced). It is produced from around the 20th week of pregnancy, up until the first few days after the baby has been born.

Colostrum is easily digested and is packed with proteins, vitamins, minerals and salt which helps prevent dehydration and help boost the baby's immune system. Colostrum helps the passing of meconium (the baby's first bowel movement) which also assists in preventing jaundice.

Antenatal colostrum harvesting is when the mother collects or expresses the colostrum from the breast during pregnancy before the baby is born and freezes it for use after birth.

The frozen colostrum is taken to the hospital and stored until it is required, where it can be defrosted and fed to the baby.

The link between diabetes and colostrum harvesting

Many babies born to diabetic mothers can have low blood sugar levels after birth putting them at risk of neonatal hypoglycaemia and jaundice.

Neonatal hypoglycaemia (low blood sugar levels) is the biggest post-birth complication we see in our support group, even when the mother's blood sugar levels have been well controlled.

To raise blood sugar levels the baby needs to feed as much as possible. Even though many mothers manage to successfully breastfeed, some babies still require further top-up feeds and some have difficulties feeding and therefore require bottle or cup feeds. In more concerning situations, babies born to gestational diabetes mothers may need an NG tube or a glucose/dextrose infusion.

The best thing to raise blood sugar levels in the baby is colostrum. If you choose not to breastfeed or cannot for any reason, the formula can be used to raise blood sugar levels instead.

Increased risk of neonatal hypoglycaemia

Babies born to diabetic mothers have very likely been subject to high blood glucose levels whilst growing in the uterus at some point. In response to processing these high blood glucose levels from the mother during the pregnancy, the baby overproduces its own insulin to compensate.

Once born, the baby may still overproduce insulin amounts in their body, struggling to regulate their own insulin production and causing low blood glucose levels.

The baby may struggle to raise their blood sugar levels without additional help and so this is where additional colostrum top-up feeds can really help.

Things that can be done to help control babies born to diabetic mothers' blood glucose levels after birth

1. It is really important to try to gain control and keep blood glucose levels stable throughout pregnancy, especially towards the end and during labour. Avoiding any high readings becomes extremely important right at the end, so don't be tempted to give in to temptations in those last few days, thinking "oh it won't make much difference now I'm so close to the end!". Despite what you may be told, avoid energy drinks or high sugar foods which may be suggested such as flapjack during labour. Keeping your blood sugar levels stabilised gives the baby the best chance to normalise their own insulin production and blood glucose levels before they are born

2. Harvesting colostrum so that you have some readily available should baby require top-up feeds

3. Have skin to skin and try to initiate breastfeeding as soon as possible, ideally straight away

4. Feed baby as regularly as possible, ideally every 3 hours. If you have a sleepy baby then you may need to strip the baby down, change their nappy etc. to help rouse them and encourage them to feed. If you have any difficulties breastfeeding then don't be afraid to ask for help and support from the midwives and nurses. Some hospitals have breastfeeding consultants, support workers and specialist breastfeeding midwives.

Experienced breastfeeding mothers benefit too

Many ladies who are experienced breastfeeding mothers do not understand the need for expressing colostrum before birth. Firstly, each and every baby can be very different, along with different complications such as issues with latching and/or tongue tie, preventing them from breastfeeding. GD babies can be very sleepy and may also struggle to latch, wake for feeds or feed effectively. Some babies may feed well from the breast but still require additional feeds on top of regular breastfeeds to keep blood sugar levels stable.

Colostrum v's formula

Formula will raise blood sugar levels, however, research suggests that breastfeeding colostrum has a better effect on raising blood sugar levels than formula:

RESULTS: Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L(-1), P = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L(-1), P = 0.002).

CONCLUSIONS: Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.

Can't I just breastfeed or express when the baby is born?

Yes, of course, you can breastfeed when the baby is born and we actively encourage this. However each baby is different, some babies may have difficulty feeding for many reasons and some may need additional top-up feeds on top of breastfeeding. Expressing can be difficult and having a supply harvested ready for use can be helpful and reassuring should your baby need it.

Lactation aiding foods/drinks and sweet things to increase sugar amounts in colostrum are not necessary

Colostrum itself is extremely potent and sweet (we call it 'liquid gold'). Your normal GD-friendly diet is best and you don't want to cause any unnecessary high blood sugar levels for yourself and your growing baby. Stay well hydrated by drinking plenty of fluids.

Please note that whilst lactation cookies, teas, oats, fenugreek etc. may be advocated to assist milk production, there is no evidence to support these things increasing colostrum production during pregnancy.

You will still have gestational diabetes at this time and so it is important to not risk eating or drinking things that could cause high blood sugar levels, in fact, this could have a detrimental effect on your baby's blood sugar levels after birth and so should be avoided.

When to start colostrum harvesting

After 36 weeks is the usual time for mothers with gestational diabetes, based on induction or planned delivery of around 38 weeks+. But giving yourself 2 weeks before the baby is due or planned is a good idea. It is advisable to speak with your diabetic team regarding when would be the best time for you.

It is not advised to express in order to collect colostrum before this time as expressing may induce contractions early.

However, if you are leaking colostrum then do not waste it! All colostrum is full of goodness and so this can be sucked from the nipple with a sterile syringe and frozen. If you start to get strong Braxton Hicks or contractions then stop expressing. If you are leaking lots through the day, then you may want to purchase some milk collection shells so that every little drop of colostrum can be saved, rather than letting it soak into breast pads and be wasted.

There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation Prof Della A Forster et al. 2017

Will my diabetic team or midwife discuss colostrum harvesting with me?

Some diabetic teams will advocate colostrum harvesting, giving out supplies or packs for colostrum harvesting, along with guidance and support on how to express. Other teams may look at you like you've grown another head when you mention it! Just like with everything else related to gestational diabetes, advice, support and information can vary dramatically from one hospital to another.

In a survey Gestational Diabetes UK ran in 2016, from 1,308 answers 77% (1,005 ladies) were not happy with the information and support giving around colostrum harvesting at their hospital

If you wish to harvest colostrum ready for birth, then speak with your diabetes team and breastfeeding specialists and if they are unaware, then explain the benefits and reasons why. As long as they have space in a freezer for your colostrum to be stored during your labour, then there should be no reason why you can't harvest.

Some may suggest that they would prefer to use formula instead of colostrum if the baby requires top-up feeds. This is your decision and if you wish to use colostrum instead, as long as it has been stored correctly, there is no reason for the formula to be used instead.

Harvesting colostrum

Some Mums may find they leak colostrum, others will need to express to extract colostrum from the breast.
Please do not panic or worry that you are not leaking colostrum or do not notice any difference in your breasts. This does not mean you will not be able to harvest colostrum.
Equipment needed

Sterile syringes should be used to collect the colostrum and is what are recommended for use in the UK.

1ml sterile syringes are best for collecting colostrum which can be bought in pharmacies or online. We find 1ml the best as each syringe can be defrosted and used without any wastage.

Capped syringes (syringes with caps or lids) are not necessary but may be preferred to eliminate contamination risks. However, these can be hard to get hold of and quite expensive.

Ask for some syringes

In the first instance ask your diabetic team or midwife if you could have some syringes. Sterile syringes without caps will serve the same purpose as long as the filled syringe is placed inside the wrapper or a clean plastic bag (like a sandwich/freezer bag) and chilled or frozen straight away. Or you could ask your hospital for some syringe caps.

Your diabetic team/midwife may be able to supply syringes for free so it is worth asking! Some teams even offer colostrum harvesting packs such as these

ask your diabetic team if they provide colostrum harvesting packs or syringes for free

If your hospital cannot provide you with syringes for colostrum harvesting and you need to purchase some syringes, then head over to Drops of Gold where you can purchase everything from just syringes to whole colostrum harvesting kits!

How to harvest colostrum - antenatal expressing of colostrum

Step 1. Always wash your hands before you start expressing.

Expressing after a shower or bath can be extremely beneficial to colostrum harvesting. Some ladies also find a warm compress such as a hot flannel or holding a hot water bottle to the breasts aids colostrum harvesting.

Make sure you have your colostrum harvesting equipment ready to hand such as your sterile syringes, sterile spoon or pot.

Step 2. Sit in a comfortable position. You need time, space and to be able to relax. Some mothers find it helps to sit in the baby's nursery or to look at scan pictures of their baby.

Step 3. Gently massage your breast, massaging from the back of your breast towards the nipple. Use kneading, circular and stroking movements to massage. You should be gentle when massaging, you can use one or both hands and it should not cause any discomfort. Some mothers find it works well to massage whilst in the shower or bath.

Step 4. Find the correct place to press using your thumb and index finger.

This is usually a few centimetres back from the base of the nipple, or move up slightly until you find where the breast feels firmer and a change in the texture of the breast tissue is felt.

Cup the breast using the 'C shape' position with the thumb and finger.

Step 5. Using the pads of your fingers rather than the fingertips, press back into the breast, squeezing gently for a few seconds and then releasing.

Your fingers should not touch the nipple, they should work on the outside of the areola but should not tug, squeeze, pinch or drag your nipple.

Squeeze and release, squeeze and release. Continue to repeat this motion to mimic the action of a baby sucking.

(This picture shows beads of colostrum forming on the nipple, but it may take many, many attempts before any colostrum is seen - do not let this put you off! This is completely normal)

Step 6. If any beads of colostrum form they can be collected in 3 different ways depending on how much colostrum is produced.

6a) Beads of colostrum on the nipple: The easiest way to collect colostrum which is forming beads on the nipple is to suck it directly from the nipple into a sterile syringe. This can be fairly tricky and you may need a little help in sucking up the colostrum.

Have a sterile syringe ready to use. DO NOT pull the plunger out. To use the syringe it must have the plunger pushed fully into the syringe.

Place the tip of the syringe over the bead of colostrum and with your other hand, gently pull up the plunger slightly (but only enough to suck up the bead of colostrum).

If the colostrum is pulled too far down the syringe, flick the syringe to remove any air bubbles and very gently push up the plunger. This will push the colostrum back nearer the top BUT do this carefully! Many ladies have done this, pressed too hard and lost all the colostrum out the end of the syringe.

Continue expressing and keep adding to the syringe each time a bead forms.

6b) Slightly more flow can be expressed onto a sterile spoon

If you are getting more flow than just beads forming, you may want to try expressing directly onto a sterile spoon which involves catching the droplets with the spoon.

Once you have some on the spoon, you can then use your syringe to suck up the colostrum.

Use the same technique mentioned above to suck up the colostrum and move the colostrum up the syringe to the top.

6c) Heavier flow can be expressed into a sterile pot

If you're lucky enough to get larger volumes of colostrum then you may find it easier to express straight into a sterile container. This involves holding your breast over the container and allowing the colostrum to flow or drop into it.

Once you have finished expressing, the colostrum can then be sucked straight into a sterile syringe.

Step 7. After expressing in this position for a while, move your hand around to hold the breast in the 'C position' from another angle and repeat the squeeze and release motions again.

Step 8. Repeat the whole process on the other breast.

Step 9. When you have finished expressing, replace the syringes into their wrappers or place a cap on them.

Step 10. Label your syringes with your name, hospital number and most importantly the date.

Many ladies have forgotten to do this in the past which has resulted in wasted colostrum.

You can continue adding to the same syringe for 48 hours (as long as it is kept refrigerated) but the date you first expressed is the date that should be written on the syringe.

Step 11. Refrigerate or freeze your colostrum. Use a Tupperware box or a suitable freezer bag to store your colostrum.

Don't let your hard work and efforts go to waste! Make sure your colostrum is stored correctly until you need it.

For further details on storing colostrum, please read below.

*Please note: The mother in the video above is expressing breast milk and so please do not expect this amount of milk to flow. Colostrum can be very thick and sticky and may form in very small droplets, rather than 'squirting' out when expressing. This is completely normal! We recommend collecting colostrum in small syringes (1-2ml) so that small top-up feeds can be defrosted as and when needed to avoid any wastage of defrosted colostrum

Further guidance on hand expressing

Hand expressing is advised for antenatal colostrum harvesting. Hand expressing is when you use your hand to massage and squeeze the breast to extract colostrum as the guide above explains.

Further guidance on hand expression can be found through the many links below.

Please remember, you will not be expressing milk as breast milk will not 'come in' until after the baby is born. Also don't expect great amounts of colostrum unless you're really lucky! You may only manage a bead or two, but don't give in...the more you express, the more you collect!.. Every drop of liquid gold counts!

Colostrum will not 'run out' or be used up by the time your baby is born, you will continue to produce colostrum until your milk comes in, so please do not worry that your supply will disappear by expressing.

Here is a video to demonstrate how to hand express, but please note that the recommendations around freezing are different in the UK. Sterile syringes are the preferred way to store harvested colostrum - this can easily be given straight into the baby's mouth when required. These should then be clearly marked with your name and date

Here is another video showing expressing, this shows a lady actually expressing from the breast, but please bear in mind that colostrum is much thicker and stickier than breast milk and so it doesn't tend to flow from the breast like this and another video here from UNICEF.

Can I use a breast pump?

If you are getting a heavier flow of colostrum then breast pumps can cause a lot of wastage as colostrum is so sticky and can get stuck in the breast pump tubes.

If you are really struggling to get any droplets to form then you may find using a breast pump is enough to encourage your colostrum to bead or form droplets. Personally, I could only harvest colostrum by using an electric breast pump. It was just enough to get beads of colostrum to form for me to suck up.

Breast pumps should be used with caution antenatally due to the expression being stronger than with hand expressing. If you decide to use a breast pump then use it sensibly and stop expressing if you notice any tightenings or contractions.

Storing colostrum

You should only store colostrum in a sterilised container, ideally a sterile syringe. Ensure the syringes you use are sterile before using. Coldwater sterilisation is the best method for non-sterile syringes.

Label every syringe with your name and the date it was collected, hospital stickers from your handheld notes are great for this if you have spares!

How long to store colostrum for

in the fridge for up to 48 hours at 4ºc or lower (store in the main part of the fridge, not the door). You can add to the same syringe for a couple of days before freezing but you should date it as the first date collected

for two weeks in the ice or freezer compartment of a fridge

for up to six months in a freezer

Colours and consistency of colostrum

Colostrum can vary dramatically in colour, from dark orange/brown, and yellow/cream to pale/clear.

Please do not panic if yours does not look the same colour as the examples are shown here, or if yours changes colour and consistency over a few expressing sessions, this is normal.

Consistency can be very thick and sticky, or more watery and thinner.

All colostrum is packed with the goodness your baby needs, so please do not worry. If you express and get pink colostrum then this may mean that some blood may be present. Small amounts of blood are not harmful to the baby and so they should not be discarded. If you have any concerns then please speak to a medical professional.

Frequency of colostrum harvesting and the amount required

Collect as much as you would like and are able to. Bear in mind that a newborn baby's tummy is the size of cherry on Day 1, the size of a walnut by Day 3 and the size of an apricot by 1 Week. You don't need huge amounts, but any harvested colostrum will not go to waste.

Some mothers have used expressed colostrum when returning home from hospital and some even use it for the first stages of weaning at 6 months or for teething lollies! Colostrum has many uses including using it to ease sore nipples from feeding or in skin or eye infections of baby. It really is liquid gold!

You can express colostrum as often as you feel comfortable doing so. Most mothers prefer to express daily after a warm shower or bath.

ARGH...I've been trying for ages and I'm not getting any colostrum!

Don't panic!

It is not easy expressing and harvesting colostrum and many (in fact the majority) really struggle to do it.

It may take many days of trying and a lot of frustration before you even see a bead of colostrum!

If you're happy to continue then keep trying every day. If it's stressing and upsetting you then stop putting pressure on yourself. Only you can choose if you wish to continue or not. It is is not necessary to harvest colostrum and so please do not feel that you HAVE to do this.

Many mothers that have tried expressing colostrum have found that they have had better breast feeding experiences compared to previous births where they've struggled to breastfeed. This is obviously not a given, but even if you struggle to actually collect colostrum, know that the process is helping prepare your body for feeding your baby. If you collect some colostrum then it's a bonus!

Not being able to harvest colostrum has NO indication of lack of milk production or how well breast feeding will go

The amount of colostrum harvested, or lack of, prior to birth does not mean that you will not be able to breastfeed or express once your baby has been born. I repeat, it has NO impact or indication of a lack of milk production. Please do not feel that if you can't express colostrum that you will not be able to breast feed or produce milk.

Tips:

1. Try expressing after a warm bath or shower

2. Hold warm flannels or even a hot water bottle wrapped in a cover or towel on your breasts before expressing to increase circulation. You can also purchase breast warming pads which may be helpful

3. RELAX, Relax, relax - stressing will not help, if you can do it great, if you can't it is not the end of the world and it has no relation to whether you will be able to breastfeed or not OR how much milk you will have

4. Massage your breasts before expressing

5. Don't touch the nipple during expressing or try to express too close to the nipple - many ladies say that they have sore nipples following trying to express. It shouldn't hurt. Pulling fingers back to the outside of the areola then forwards really milks the ducts

6. Drink plenty of fluids

7. Looking at scan pictures, sitting in your nursery or baby's room, rocking something like a toy like you would your baby, thinking of your baby and listening to a newborn baby cry have all been great tips to help!

8. Ask for help! Speak with midwives, your health visitor, local breastfeeding peer supporters and lactation consultants in your area for tips and advice on expressing. There are lots of people out there who can help you, but you may have to go online and search for local specialists. Try The Breastfeeding network or La Leche League

Is it safe to harvest colostrum when taking Metformin?

Yes - Metformin is often used in women who have PCOS. PCOS causes insulin resistance and so many mother's with GD may have PCOS. Both PCOS and insulin resistance can be linked to low milk supply. For further information regarding metformin and PCOS please read more here

More helpful links:

Research
Importance of early first feed for babies of diabetic mums

Background

Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy.

Methods

We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909.

Findings

Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315).

Interpretation

There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation.

Funding

Australian National Health and Medical Research Council

Prof Della A Forster, PhD

Lisa H Amir, PhD

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

It has been recognised that babies of diabetic mothers are at greater risk of hypoglycaemia and as such, an early feed is recommended. This study was carried out to ascertain both the impact of an early feed and to establish what type of feeding provided the best option to reduce the risk of hypoglycaemia. The researchers found that infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period and the researchers concluded that an early breastfeed may facilitate stable blood glucose levels in the infants of mothers with gestational diabetes.

Neonatal hypoglycaemia in infants of diabetic mothers Management of Infants of Diabetic Mothers The Confidential Enquiry into Maternal and Child Health (CEMACH). Diabetes in pregnancy: caring for the baby after birth. Findings of a National enquiry: England, Wales and Northern Ireland. CEMACH London; 2007

Results: Eighteen (47%) infants developed hypoglycaemia (blood glucose level less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglycaemia (3.7 ± 1.1 vs 4.5 ± 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk of developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95%CI 1.3-40.7). Hypoglycaemic infants were of significantly higher birthweight, and were more likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the infant's haematocrit were not different between infants with or without hypoglycaemia.

Conclusions: In well-controlled diabetic mothers, the incidence of early hypoglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify the infants with hypoglycaemia.

Hypoglycemia rates in the first days of life among term infants born to diabetic mothers Colostrum Versus Formula Supplementation for Glucose Stabilization in Newborns of Diabetic Mothers Nutritional Factors That Affect the Postnatal Metabolic Adaptation of Full-Term Small- and Large-for-Gestational-Age Infants Hypoglycemia and the breastfed neonate Metformin before and during pregnancy and lactation in polycystic ovary syndrome
Hypoglycaemia of the Newborn, copy of the literature, from WHO (World Health Organization), with 10 pages of references

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Colostrum harvesting * Gestational Diabetes UK

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Colostrum harvesting is expressing and collecting colostrum whilst pregnant. Colostrum is hugely beneficial to babies born to diabetics. Learn more here...

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Breastfeeding Support Groups in Sheffield

Click here to find a list of the Breastfeeding Support Groups in Sheffield Jan-Mar 2020

There will always be a trained Infant Feeding Support Worker at these groups to offer help and advice on your breastfeeding journey. There will be other mums there too who can share their experiences with you and offer support. You are welcome to try as many of the groups as you like and in any area of Sheffield.

There is at least one Infant Feeding Peer Support Worker attached to every Family Centre (formerly known as Children's Centres) in Sheffield. They can offer breastfeeding support over the telephone or on a one to one basis, at the groups, cafes and drop-ins they hold.

The primary aim of the recently named Infant Feeding Peer Support Worker is to increase breastfeeding rates but we recognise that you may need support however you choose to feed your child.

Family Centres

Family Centres are for families with children under 5 years old. They provide a range of services, depending on what's needed locally. The services offered will not be the same everywhere, because needs and communities vary greatly. Types of services include:

information, advice and support for parents and carers

health services

family support

employment advice

family learning

parents forums

Contact your local centre to find out what's available near you.

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Breastfeeding Support Groups - Breastfeeding in Sheffield

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Breastfeeding Support Groups in Sheffield Click here to find a list of the Breastfeeding Support Groups in Sheffield Jan-Mar 2020 There will always be a trained Infant Feeding Support Worker at these groups to offer help and advice on your breastfeeding journey. There will be other mums there too who can share their experiences withRead more...

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

The bacterial contamination of powdered infant formula

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

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

Latest evidence on formula preparation devices

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

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

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

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

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

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

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

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

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

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

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Making infant milk safely - First Steps Nutrition Trust

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

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https://parenthub.nct.org.uk/

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NCT Parent Hub - Pregnancy and parenting information exclusively for NCT Antenatal course attendees.

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Email, text, PM or call me anytime 07775888249 samrobbking@gmail.com

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

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Support with breastfeeding or bottle feeding: our infant feeding line | Baby & toddler, Feeding articles & support | NCT

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Find out more here about our infant feeding support line and the help available if you have any questions or concerns about feeding your baby.

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https://lcgb.org/find-an-ibclc/

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https://breastfeeding-and-medication.co.uk/contact-me

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Details are given below for myself should you require further support and information or wish to contact me about information within the web site including presentations, lectures or E-Learning Packs.

If Emaling me directly, please use clear subject titles such as 'Medication, Website Feedback, Lectures, E-Learning.
Contact Details
Wendy@breastfeeding-and-medication.co.uk

Tel: no telephone queries being taken at present

Facebook

I have a facebook page https://www.facebook.com/breastfeedingandmedication/ through which you can PM me

and a new Facebook Page relating to Breastfeeding for Dads and Grandmas www.facebook.com/Breastfeeding4dadsandgrandmas/
Medicine Related Questions
If you do wish to contact me directly include your baby's age and the drug that you are taking.
Other contacts
You can also contact me through the BfN Link druginformation@breastfeedingnetwork.org.uk or the Facebbok page https://www.facebook.com/BfNDrugsinBreastmilkinformation/

Health professionals, please ensure that you do not provide any confidential information without obtaining the Mother's permission.

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Details are given below for myself should you require further support and information or wish to contact me about information within the web site including presentations, lectures or E-Learning Packs. If Emaling me directly, please use clear subject titles such as 'Medication, Website Feedback, Lectures, E-Learning.

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https://www.nct.org.uk/about-us/community-support-programmes/baby-cafe

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We are the charity that supports people as they become parents.

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https://www.clubfootcares.org/breastfeeding

https://lllusa.org/breastfeeding-through-clubfoot-treatment/

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https://abm.me.uk/breastfeeding-information/tips-for-supporting-lgbtq-families/

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As a gay woman, I'm painfully aware that health professionals sometimes don't have the knowledge or the sensitivity needed to work with me.
For example, when it was taking a while for me to get pregnant, the GP advised me, "Keep having sex regularly with your husband." She said this despite the fact that she'd seen me before and I had told her that I was married to a woman. Presumably this also would have been listed in my notes (not to mention that this advice is pretty unhelpful for anyone suffering from fertility issues). I pointed out that having regular sex with my wife, as fun as that might be, wasn't going to produce a baby. The GP didn't even have the good grace to apologise for her mistake and instead just said, "I haven't dealt with people like you before, though I did have a single lady once who wanted to get pregnant." My wife and I switched GP practices after this.

When it comes to matters of health, including breastfeeding, we owe it to our fellow human beings to try to understand as much about their lives and their needs as possible. So here I'd like to mention some of the issues we might want to consider when supporting queer* mums and trans dads; by these terms I mean gay/lesbian and bisexual women (and women in same-sex relationships who don't identify as gay/lesbian or bisexual), and men who were considered girls when they were born but who self-identify as male.
* I'm aware that not everyone is comfortable with the term queer, but I find it inclusive and encompassing, so I like using it, but as with all terminology issues, your mileage may vary.

"As a gay mum, I am always really grateful when people simply acknowledge our situation and attempt to understand us as a family rather than either pretending our differences don't exist or else asking a lot of inappropriate and immaterial questions."

Assumptions

We should try to avoid making assumptions about people in general, of course, but there are a few things that are particularly relevant to queer families. Many heterosexual/ cisgender people assume that if two women or a trans man (or a single woman, for that matter) have a baby, the baby must have been created through IVF. In fact, IVF is only one of many ways that queer families come to be. Other methods include adoption, using a known donor (a friend or a relative), using an unknown donor and having a more "natural" insemination at a clinic (i.e. without medication), inseminating at home with frozen sperm, and having a child with a former partner. It's often not relevant to the issue of breastfeeding in any case, but sometimes people try to make conversation and it just gets awkward. We had people asking us what clinic we used, for example, though there was no reason for them to know whether we had even gone to a clinic. Similarly, it's best not to make assumptions about gender roles. Just because one person has been pregnant and given birth doesn't mean that that person is the "woman" in the relationship; the person could identify in all sorts of ways, as could their partner. My wife is not the "father" or the "man" (we're both women and mothers), and a trans man would in most cases not want to be viewed as the mother. If you're unsure, ask, but try to do so sensitively and only if it makes any difference to the topic of breastfeeding and your interactions with the person.

Pronouns and terminology

It's best not to assume what pronouns, titles, or terms people want to use. Trans men, for instance, usually would not want pronouns such as "she" and "her" employed to them and, as already noted, do not see themselves as women or mothers. Partners may want to be called wives, spouses, partners, husbands, or something else. "Breastfeeding" is itself a loaded term; trans men in particular may feel more comfortable with "chestfeeding" or "nursing", as the connotations around "breasts" are not included in those words. And some would prefer us to describe ourselves as peer supporters rather than mother supporters. Many queer people are used to confusion around terms and will tell you what they prefer; for example, a genderqueer friend of mine hands out small pieces of paper that say, "My pronouns are they/them/their, and my title is Mx." If you need to know, ask as politely as possible.

Sensitive topics

Pregnancy and nursing can bring up challenging feelings for anyone, but there are a few issues that we want to be especially aware of when it comes to queer parents. For example, trans men might have body issues, since even though they wanted to get pregnant and give birth, pregnancy and feeding a baby can remind them that they were born with female parts. Feeding can feel threatening because it is seen as a quintessentially female act. For two -mum families, the non-birth mother might feel left out or even jealous of the nursing mum-nursling dyad, even if she actually had no desire to experience pregnancy or breastfeeding herself. I lost count of the number of people who questioned me about whether our baby got confused about whether to latch on to my breasts or my wife's breasts or whether my wife was angry not to be breastfeeding. These people asked out of prurient curiosity and it was never something I actually wanted to discuss or needed support with but I know other gay women who did want help in regard to this. We should be sensitive when it comes to these subjects and we should be prepared to support parents who want to talk about upsetting feelings regarding breastfeeding (or chestfeeding).

Medication/hormones

While most of us aren't trained to give advice on medicine, we should be aware that some trans dads in particular will be taking medication or hormones and we should know where to suggest they look for information. They will hopefully have discussed their hormone regime with their GPs, but they might also like to be told about the Drugs In Breastmilk helpline** . Sometimes the non-birth mother in a two-mum family might attempt to induce lactation, often with the help of medication and will need to be directed to appropriate information.

In short, as peer supporters and counsellors, we hope to be as understanding and helpful as we can in any situation but it behoves us to keep some of these topics in mind when we work with gay, lesbian, bisexual, queer, and/or trans parents. As a gay mum, I am always really grateful when people simply acknowledge our situation and attempt to understand us as a family rather than either pretending our differences don't exist or else asking a lot of inappropriate and immaterial questions.

** Drugs In Breastmilk helpline: 0844 412 4665. https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in- breastmilk/
B.J. Epstein Woodstein is a senior lecturer in literature at the University of East Anglia in Norwich, a peer supporter and newly qualified ABM Breastfeeding Counsellor.

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Tips for supporting LGBTQ Families - ABM

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Experiences of a gay woman "...health professionals sometimes don't have the knowledge or the sensitivity needed to work with me..."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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https://www.laleche.org.uk/twins/

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But you can still plan to breastfeed. Breastmilk is a complete and perfect food for your baby. It is especially important for multiples, who are often small at birth. Breastfeeding also helps you create a spe…

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https://twinstrust.org/let-us-help/parenting/under-1s/feeding.html

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We rely on the generosity of our members and supporters to fund our work. Every penny we receive goes to wherever the need is greatest.

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http://wearefamilymagazine.co.uk/shared-breast-feeding-induced-lactation/

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

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

https://www.asklenore.info/breastfeeding/induced_lactation/gn_protocols.shtml

https://www.prideangel.com/Information-Centre/Pregnancy/Induced-Lactation.aspx

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https://youtu.be/K0zVCwdJZw0

https://www.youtube.com/watch?v=qdo7Srkoy_w

https://globalhealthmedia.org/videos/how-to-express-your-first-milk/

https://globalhealthmedia.org/portfolio-items/how-to-express-breastmilk/

https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/expressing-breast-milk/

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Most babies born too small or too young will not be able to breastfeed well enough at first. As a new mother, you will need to learn how to remove your milk and give it to your baby by spoon, cup, or feeding tube. This video shows you how to express colostrum, your first milk.

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How to Express Your First Milk - Video - Global Health Media Project

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Most babies born too small or too young will not be able to breastfeed well enough at first. As a new mother, you will need to learn how to remove your milk and give it to your baby by spoon, cup, or feeding tube. This video shows you how to express colostrum, your first milk.

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https://www.youtube.com/watch?v=yomFk1e_M0s

https://www.nct.org.uk/baby-toddler/feeding/common-concerns/what-baby-reflux-symptoms-and-support

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http://www.nancymohrbacher.com/articles/2015/8/17/the-clock-and-early-breastfeeding

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https://www.laleche.org.uk/mothers-on-nursing-with-large-breasts/
https://www.feedeatspeak.co.uk/blog/2020/12/9/breastfeeding-with-large-breasts?fbclid=IwAR1KRqQemHRHOlki-qnnI7la7eWcUd6WIqxI3m2RnY6RfjOWtItm0Rjumw8
https://breastfeeding.support/breastfeeding-with-large-breasts/

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Written by Cordelia Uys, NCT breastfeeding counsellor

It is often assumed that women with larger breasts will produce more milk and that having large breasts is therefore an advantage when you're breastfeeding. In fact, there's no correlation between the size of a woman's breasts and her milk production. Women with larger breasts have more fatty tissue, not more glandular tissue, and the latter is where milk is produced. Of course, women with large breasts can produce plenty of milk; that was certainly my experience with my three sons. I was a bra size 34 H and had a very generous milk supply.

The drawback of having bigger breasts is that it can make latching your baby significantly more challenging. For example, in the commonly used cross-cradle hold, even if tucked closely under your other breast, your newborn baby might not be able to stretch far enough across your body to reach the breast they're going to feed from. And even if they can reach, it can be difficult to get a good view of what you're doing.

The laid-back position, in which your baby lies vertically on top of you, can be tricky as they're likely to sink into the gap between your abdomen and your breast. In some cases, placing a rolled-up flannel or muslin under your breast can fill that gap and allow the baby to latch comfortably.

These are the positions that tend to work best for mums with bigger breasts, especially in the early days:

The rugby hold:

In this position, the baby is tucked under your arm, like a rugby ball, with their feet behind your body. Make sure the arm supporting your baby is well-supported by a cushion or pillow (or two). This position makes it much easier for you and your baby to be in close contact, and for you to see what you're doing when working on achieving an asymmetric latch. Before latching your baby, place a small cushion behind you, so that it comes up to the small of your back, and then place your baby's feet on top of the cushion. Once your baby has latched, drop another, bigger cushion behind you. This should allow you to lean back without squashing your baby's feet.

Side-lying:

This position is an absolute lifesaver as it allows you to breastfeed your baby and rest at the same time. Since the breast you're feeding from will be lying flat on the mattress, latching tends to be easier. Some bigger-breasted women can even lean forward a little and feed their baby from their other breast. Make sure to put a pillow between your legs, as this will prevent backache. A roll-up baby blanket placed along your baby's back (but with their head free to tilt back) will help to keep them in place.

Other helpful tips:

A breastfeeding pillow: this can be really helpfulif you're using the rugby or cross cradle hold and find that your baby struggles to stay latched because the weight of your breast pulls it out of their mouth. Do make sure that the pillow doesn't lift your baby too high, and that you can still tuck them very close to you, with their arms on either side of your breast.

The sandwich hold: shaping your breast while latching your baby can help to hold your breast in place while you achieve an asymmetric latch. Your fingers need to be well back from your areola and parallel to your baby's mouth. Let your baby do a few sucks to create a seal before removing your hand.

Blocked nose: whatever position you use, if you find your baby's nose is buried into your breast, all you need to do is pull their bum into your body, and their nose will pivot away.

Nursing bras: A comfortable, supportive and properly fitted bra, that doesn't put pressure anywhere, is essential for all breastfeeding mothers, and even more so for those with larger breasts. It's recommended to avoid using an underwired nursing bra for the first 6 weeks, as mothers are particularly vulnerable to getting blocked ducts while their milk supply is being established. Molke make soft bras for large breasted women and are highly recommended by breastfeeding mothers due to the ease of access to the breast. Underwired bras are usually fine after that, as long as they're 100% comfortable. There are lots of milk ducts on the underside of your breasts, so you don't want anything constricting that area. If you can't find a well fitting nursing bra you can convert one of your own bras using a nursing bra conversion kit.

A breast 'sling': if you have particularly large breasts, and especially if your nipples point downwards, it can be extremely difficult to see what you're doing, and to fit your baby close enough to your body, when latching them. Creating a sling out of a long cotton scarf, tying it round your neck and then under your breast, so that the breast is lifted, can be very helpful. This doesn't tend to be necessary past the newborn stage.

Breastfeeding in public: feeding discreetly with large breasts can be tricky. I remember feeling very envious of my smaller-busted friends who could effortlessly latch their babies without needing a hand to support their breast, especially since the baby then completely covered any bare breast.

Discovering the 'one up, one down' method was a revelation. This involves wearing a long, stretchy vest under a looser outer top. The floatier and looser the outer top, the better. You get your baby in position, unclip your bra, pull down the part of the vest covering your breast, lift the outer top and quickly latch your baby. This means all the fiddly unclipping of your bra and manoeuvring of your baby is done under the outer top, and minimal time is spent with your breast on display. The stretchy vest covers not only the breast you're not feeding from, but also your stomach, which is a part of our body most of us would rather not have exposed.

The good news: as your baby gets older and larger, breastfeeding with larger breasts tends to get much easier.
Cordelia Uys is an NCT breastfeeding counsellor. She facilitates antenatal breastfeeding classes, introducing solids workshops and parenting classes. She also runs a private breastfeeding drop in with a team of IBCLC's and two cranial osteopaths. Cordelia is also the breastfeeding expert for a new mothers' wellbeing App Biamother. She is mother to three grown up boys, all of whom were breastfed.

Written by Cordelia Uys, NCT breastfeeding counsellor

It is often assumed that women with larger breasts will produce more milk and that having large breasts is therefore an advantage when you're breastfeeding. In fact, there's no correlation between the size of a woman's breasts and her milk production. Women with larger breasts have more fatty tissue, not more glandular tissue, and the latter is where milk is produced. Of course, women with large breasts can produce plenty of milk; that was certainly my experience with my three sons. I was a bra size 34 H and had a very generous milk supply.

The drawback of having bigger breasts is that it can make latching your baby significantly more challenging. For example, in the commonly used cross-cradle hold, even if tucked closely under your other breast, your newborn baby might not be able to stretch far enough across your body to reach the breast they're going to feed from. And even if they can reach, it can be difficult to get a good view of what you're doing.

The laid-back position, in which your baby lies vertically on top of you, can be tricky as they're likely to sink into the gap between your abdomen and your breast. In some cases, placing a rolled-up flannel or muslin under your breast can fill that gap and allow the baby to latch comfortably.

These are the positions that tend to work best for mums with bigger breasts, especially in the early days:

The rugby hold:

In this position, the baby is tucked under your arm, like a rugby ball, with their feet behind your body. Make sure the arm supporting your baby is well-supported by a cushion or pillow (or two). This position makes it much easier for you and your baby to be in close contact, and for you to see what you're doing when working on achieving an asymmetric latch. Before latching your baby, place a small cushion behind you, so that it comes up to the small of your back, and then place your baby's feet on top of the cushion. Once your baby has latched, drop another, bigger cushion behind you. This should allow you to lean back without squashing your baby's feet.

Side-lying:

This position is an absolute lifesaver as it allows you to breastfeed your baby and rest at the same time. Since the breast you're feeding from will be lying flat on the mattress, latching tends to be easier. Some bigger-breasted women can even lean forward a little and feed their baby from their other breast. Make sure to put a pillow between your legs, as this will prevent backache. A roll-up baby blanket placed along your baby's back (but with their head free to tilt back) will help to keep them in place.

Other helpful tips:

A breastfeeding pillow: this can be really helpfulif you're using the rugby or cross cradle hold and find that your baby struggles to stay latched because the weight of your breast pulls it out of their mouth. Do make sure that the pillow doesn't lift your baby too high, and that you can still tuck them very close to you, with their arms on either side of your breast.

The sandwich hold: shaping your breast while latching your baby can help to hold your breast in place while you achieve an asymmetric latch. Your fingers need to be well back from your areola and parallel to your baby's mouth. Let your baby do a few sucks to create a seal before removing your hand.

Blocked nose: whatever position you use, if you find your baby's nose is buried into your breast, all you need to do is pull their bum into your body, and their nose will pivot away.

Nursing bras: A comfortable, supportive and properly fitted bra, that doesn't put pressure anywhere, is essential for all breastfeeding mothers, and even more so for those with larger breasts. It's recommended to avoid using an underwired nursing bra for the first 6 weeks, as mothers are particularly vulnerable to getting blocked ducts while their milk supply is being established. Molke make soft bras for large breasted women and are highly recommended by breastfeeding mothers due to the ease of access to the breast. Underwired bras are usually fine after that, as long as they're 100% comfortable. There are lots of milk ducts on the underside of your breasts, so you don't want anything constricting that area. If you can't find a well fitting nursing bra you can convert one of your own bras using a nursing bra conversion kit.

A breast 'sling': if you have particularly large breasts, and especially if your nipples point downwards, it can be extremely difficult to see what you're doing, and to fit your baby close enough to your body, when latching them. Creating a sling out of a long cotton scarf, tying it round your neck and then under your breast, so that the breast is lifted, can be very helpful. This doesn't tend to be necessary past the newborn stage.

Breastfeeding in public: feeding discreetly with large breasts can be tricky. I remember feeling very envious of my smaller-busted friends who could effortlessly latch their babies without needing a hand to support their breast, especially since the baby then completely covered any bare breast.

Discovering the 'one up, one down' method was a revelation. This involves wearing a long, stretchy vest under a looser outer top. The floatier and looser the outer top, the better. You get your baby in position, unclip your bra, pull down the part of the vest covering your breast, lift the outer top and quickly latch your baby. This means all the fiddly unclipping of your bra and manoeuvring of your baby is done under the outer top, and minimal time is spent with your breast on display. The stretchy vest covers not only the breast you're not feeding from, but also your stomach, which is a part of our body most of us would rather not have exposed.

The good news: as your baby gets older and larger, breastfeeding with larger breasts tends to get much easier.
Cordelia Uys is an NCT breastfeeding counsellor. She facilitates antenatal breastfeeding classes, introducing solids workshops and parenting classes. She also runs a private breastfeeding drop in with a team of IBCLC's and two cranial osteopaths. Cordelia is also the breastfeeding expert for a new mothers' wellbeing App Biamother. She is mother to three grown up boys, all of whom were breastfed.

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Breastfeeding with large breasts - Feed Eat Speak - Stacey Zimmels

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The drawback of having bigger breasts is that it can make latching your baby significantly more challenging. These are the breastfeeding positions that tend to work best for mums with bigger breasts, especially in the early days:

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Feeding should be comfortable for both you and your baby. If you experience any discomfort, or have concerns about your baby's feeding, talking to someone who can help could make all the difference.
Watch our video to find out about support for breastfeeding.
Common problems with breastfeeding include:
Sore nipples
Tongue tie
Sore breasts
Unsettled baby and frequent feeding
Baby refuses the breast

Sore nipples

An unfamiliar feeling of tingling, or pressure, without actual pain, is normal when you first start to breastfeed. But if breastfeeding hurts your nipples, then the most likely reason is that you and your baby need to change the way he latches on. Read about how to deal with sore nipples.

Tongue-tie

Some babies find a comfortable, effective latch hard to achieve because of tongue tie. Read our article on tongue-tie.

Sore breasts

When your baby is feeding, your breasts 'let down' milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax and breathe through it and ask your midwife for tips. Find out more in our article here.

Unsettled baby and frequent feeding

If your baby seems unhappy, unable to sleep, or difficult to feed, do ask for help. Many women worry a great deal when their babies seem to need to breastfeed a lot, or for prolonged periods of time, and show by their crying they don't like being placed in a crib or cot for very long. Read about how to deal with frequent feeding here.

Baby refuses the breast

If your baby is very sleepy and doesn't seem interested in feeding, then do seek help. It could be that the after-effects of the birth or pain relief used during labour are affecting his responses. Other babies fight and struggle at the breast, and seem to resist it. Find out more here.

For problems that are more likely to affect your breastfeeding, as your baby gets older click here.

Further information

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

National Breastfeeding Line (government funded) 0844 209 0920

NHS information on mastitis.

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

Healthtalkonline.org: Managing Breastfeeding - dealing with difficult times.

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Breastfeeding problems and concerns in the early days | Baby & toddler, Feeding articles & support | NCT

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Here we look at some of the problems and concerns that can make breastfeeding in the early days challenging.

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Weight loss

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Your baby will be weighed at birth and at particular stages during their first weeks and months (NHS Choices, 2017a). This is because weight gain can be an important indicator of how healthy and well they are.

Your baby will be weighed in the first two weeks to make sure they are regaining their birth weight.

After the first two weeks, your baby should be weighed:

once a month up to six months old

every two months from six to 12 months old

every three months over the age of one.

(NHS Choices, 2017a)

Your baby will usually only be weighed more often if you ask for it or if health professionals are concerned about their health or growth.

Baby weight gain

What to expect

In the first few days after birth, your baby will probably lose a little weight as they get rid of urine and meconium (NHS Choices, 2017a). Most babies have returned to their birth weight by three weeks old (NICE, 2017).

Babies shouldn't lose more than 10% of their weight from when they were born (NICE, 2017). If your baby loses more than this or has not returned to it by three weeks old, a health professional will assess them (NICE, 2017).

Assessment

An assessment will look for signs of illness, like dehydration. The health professional will ask for details about how your baby has been feeding. The health professional might also ask to look at your baby having a feed. That can help them give you some support with feeding (NICE, 2017).

You can also ask your midwife, health visitor or breastfeeding counsellor to observe you feeding your baby. They can check your positioning and whether your baby is taking in milk effectively (NHS Choices, 2017a). They can also help to see whether your baby is attached well at your breast and they can spot a tongue tie (NHS Choices, 2017a).

If health professionals are concerned about your baby's weight loss, they will continue to support you. Your baby should be reweighed at suitable intervals depending on the level of concern. Your baby might then be referred to paediatric services if they are showing signs of illness, obvious weight loss or if they're not responding to feeding support.

What can I do if my baby is not gaining weight?

If your baby hasn't regained their birth weight and you're breastfeeding, you might need to offer them more breastfeeds. It can take time to get the hang of breastfeeding but there is plenty of support available.

Find out from your local NCT branch what breastfeeding support services are available in your area. An NCT breastfeeding counsellor might be available locally to visit you at home. You can ask a breastfeeding counsellor about how to increase your baby's breastmilk intake.

You might have a local drop-in breastfeeding support session too, where you can meet other mums and their babies. Peer support like this can be really beneficial.

How is my baby's weight recorded?

After your baby is two weeks old, they will have their weight recorded on a centile chart in their red book (Royal College of Paediatrics and Child Health, 2016). Centile charts track average weight and height gain for all babies whether they are fed breast or formula milk.

A baby on the 25th centile is heavier than 24% of babies the same age, and lighter than 74% of babies the same age. Most babies roughly follow the same line of growth on the chart as they get older, while others veer away from the line or find a 'new' line (NHS Choices, 2017a).

Causes for concern

There might be concern about your baby's growth if:

there is a fall across one or more weight centile spaces, if their birth weight was below the ninth centile

there is a fall across two or more weight centile spaces, if their birth weight was between the ninth and 91st centiles

there is a fall across three or more weight centile spaces, if their birth weight was above the 91st centile

their current weight is below the second centile for age, whatever their birth weight.

If there is concern about your baby's growth, a health professional might:

perform a clinical, developmental and social assessment

take a detailed feeding or eating history

observe feeding or meal times

check for urinary tract infections and coeliac disease, if the diet has included gluten-containing foods

perform further investigations as needed based on the clinical assessment.

When your baby is weighed, you'll be keen to make sure it's done accurately. Your baby should be naked each time. Check the weight reading yourself and how it's written in your records as mistakes can happen.

What if my baby's weight gain is slower than expected?

Most babies who gain weight more slowly than expected are healthy with no underlying illness or difficulty. They might just be naturally slow at gaining weight (NHS Choices, 2017a).

You and your health visitor can discuss your baby's weight. If there is concern but no urgent medical recommendations, the first step is to try to increase your baby's intake of milk. You can:

Try breastfeeding more often, day and night.

Offer at least both breasts at each feed. Try 'switch nursing', which is when you try to use each breast several times at each feed.

Try breast compression.

Keeping your baby close to you, skin-to-skin when possible as this usually helps your baby to feed more often. This might be something you can try intensively over a period of a few days, it's sometimes called a 'babymoon'.

(NHS Choices, 2016a)

What about giving my baby expressed breastmilk?

Expressing and offering expressed breastmilk in addition to direct breastfeeds is another possibility. If your baby is feeding well from the breast, extra direct breastfeeds are an easier option. The more your baby feeds at the breast, the more milk your body will produce.

What about donor milk?

Donor milk is breastmilk from other mothers. It might be available from a hospital-based milk bank. But mostly, milk banks give milk to vulnerable, pre-term or sick babies who are still under hospital care. Donor milk is also available through private milk donation schemes.

What is a supplemental nursing system?

Some women whose baby has problems breastfeeding use a supplementary nursing system (SNS). This device allows a baby to receive extra milk at the breast, rather than top-ups by bottle.

It is a container of milk connected to a feeding tube at the breast. The baby breastfeeds as well as receiving extra milk from the supplementary nursing system. You can use expressed breastmilk, donor milk or formula-milk in this system.

Does my baby need formula?

Using formula might be medically necessary to help your baby grow if their weight is still a concern. This might be the case if extra breastfeeds are not making enough difference or you can't get donor milk (NHS Choices, 2017b).

Feeding your baby with formula milk does not mean you have to stop breastfeeding if you don't want to - you can do both. It also doesn't mean the benefits of breastfeeding are wiped out (NHS Choices, 2017b).

If you still want to breastfeed, you can limit the amount of formula and you may be able to drop it once your baby's weight is ok, if that's what you prefer. Talk about this with a breastfeeding counsellor or a healthcare professional.

Should my baby have solid food?

Babies under six months don't generally benefit from food other than breastmilk or formula milk. Solids might not increase a baby's calorie intake and may even mean a baby takes less milk than before. So it may be an ineffective way to address low weight (NHS Choices, 2015).

This is something you can discuss with your health visitor or GP (NHS Choices, 2015).

Most babies who are slow to gain weight eventually catch up and most are healthy with no underlying illness or difficulties. Weight is only one aspect of your baby's health and development (NHS Choices, 2017a). Trust your instincts and contact your GP if you are concerned about your baby, especially if you think they might be dehydrated, which can be serious for young babies.

Further information

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

Read our list of breastfeeding support contacts to help you get support if you need it.

Find out from your local NCT branch what breastfeeding support services are available locally.

If you have serious concerns about your baby or are worried they are getting dehydrated contact your GP or 111.

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Your baby will be weighed at birth and at particular stages during their first weeks and months (NHS Choices, 2017a). This is because weight gain can be an important indicator of how healthy and well they are. Your baby will be weighed in the first two weeks to make sure they are regaining their birth weight.

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Sore nipples

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Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

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Overview of pumping
https://www.babycenter.com/0_pumping-breast-milk-an-overview_8791.bc

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https://www.ameda.com/milk-101-article/ameda-purely-ultra-basics-milk-production-breast-pumping-english/

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https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/

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Why Express Milk?

Expressing Milk

Storing Milk

Why express milk?

There are several reasons why you might need or want to express milk for your baby. These include:

when a baby can't breastfeed

to make more milk

a return to paid work

separation

choice

When a baby can't breastfeed

Babies and parents have many instincts for breastfeeding, but it is still a learned skill that can take time and practice. When babies won't breastfeed, it is usually because they can't. This could be for many reasons, for example:

they are preterm

they are unwell

they have a tongue tie

they are sleepy as a result of birth medications

they had a difficult birth

it is taking time to learn how to breastfeed

Expressing milk when your baby cannot nurse - or nurse effectively - protects your milk supply and provides milk to feed them. Breastmilk is especially important for babies who are unwell and/or preterm as it helps protect against illness and infections, and is ideal for a baby's sensitive and immature digestive system.

Expressing milk is often a short-term solution. However, some mothers may find themselves exclusively expressing breast milk (' exclusively pumping ') long-term when their baby is ill or has medical difficulties.

A return to paid work

There are many ways to combine working and breastfeeding. It is not always necessary to express milk when returning to work. It may depend on:

the age of your baby

the length of time you are apart

your willingness - and ability - to express; pumping is not effective for everyone, although there are ways to improve this.

your baby's willingness to take your milk when you aren't there

Many mothers express initially for reassurance and comfort, and to avoid blocked ducts and mastitis. However, you may find that your body quickly adjusts to a new breastfeeding pattern and you no longer need or want to express.

You and your baby may need to be apart. This may be for illness or health reasons, an appointment or event, or a night away.

Your baby has an intense need for your presence as well as your milk, and separation can be hard for both of you. It may be possible to take your baby with you - young babies are very portable and often enjoy being out and about.

Some mothers choose to express milk some or all of the time. You might want - or feel pressured - to let a partner or other family member feed your baby. Some parents choose to exclusively pump because they don't enjoy breastfeeding, but want their baby to have the benefits of their milk.

Expressing Milk

What kind of pump do I need?

Pumps are available to hire and to buy. The pump you use depends on your reason(s) for expressing and your personal preference. We all respond differently to pumps and have different needs.

Single electric pumps and manual pumps are best suited to occasional expressing, for example, short term separation or a return to work. They can also be used to express 'to comfort' any time your breast feels very full and your baby doesn't want to feed.

Double electric pumps express milk from both breasts at once, which often saves time. It is also said that they tend to stimulate more milk production. They are available as personal use pumps and 'hospital grade' pumps.

Hospital grade pumps are very powerful and are intended to be used by more than one person multiple times a day. They are usually hired. Hospital grade pumps are recommended when you are exclusively expressing, expressing very frequently, or trying to increase your supply. Parents might start with a hospital grade and then switch to a personal use pump once their supply is established and if they need to keep expressing.

Silicone pumps tend to be best suited to occasional use. Some mothers have found them helpful to relieve blocked ducts. (Note: When attached to the breast, a silicone pump is not just a device for collecting dripping milk - it creates a vacuum stimulating a 'letdown'. If this is not your planned use, it can create supply issues.)

Hands-free pumps come as single or double electric pumps. They can be handy for mums who want to pump on the go, or pump and multitask. Hands-free pumps have small motors and are possibly best suited to occasional pumping. You can buy or make a hands-free bra for a pump to fit in to.
Types of Pump (image above)
A. Manual breast pump
B. Single electric pump
C. Double electric pump

It is also possible to express without any equipment. Hand expressing is a great skill to learn for all ages and stages! It can take a little practice, but it can quickly become second nature:

It is free and can be done any time, anywhere!

It is the perfect choice for the early days when you are producing colostrum (you can collect - or 'harvest' - colostrum before your baby is born).

You can practise antenatally and become familiar with your breasts before your baby arrives.

Getting 'hands-on' during a pumping session can increase milk output. See Expressing Tips.

What else do I need to know about pumps?

Pumps are often sold in a standard size, however pump parts come in different sizes. The funnel-shaped piece that touches your breast is usually called a flange . The tubed-shaped bit that the nipple goes into is sometimes called the nipple tunnel

If pumping is comfortable with good milk flow, you probably have a good fit. However, if pumping is painful or causing swelling and/or rubbing, you may need a bigger or smaller flange. Sometimes a different flange size is needed for each breast. A poor fit can also reduce milk flow. ¹

The nipple should have enough room to slide in and out during pumping, without rubbing. The areola (darker area around the nipples) may move slightly with it, but it shouldn't be drawn into the nipple tunnel. After pumping, the nipple will almost certainly be bigger, but shouldn't seem darker or swollen. ²
Pump Flange Sizes (image above)
A. Milk expression
B. Flange is too big
C. Flange fits
D. Flange is too small
Suction strength and cycle speed
Electric pumps often come with a range of settings. There will be settings for suction strength and settings for cycle speed.

A pump is trying to mimic a breastfeeding baby. When a baby nurses, they do a fast, light suck to trigger a letdown. Once the milk lets down, the sucking slows and they swallow more.

You might begin by using a low suction, high speed setting and once your milk starts flowing, switching to a higher suction, lower speed setting.

Exactly how high or low depends on how it feels and if it is removing milk well. Expressing should be comfortable, and a pump provides most milk when it is set at the upper end of fully comfortable. ³

Painful pumping may impact milk flow, damage your nipples, and is unlikely to make you feel like doing it!

How often and when should I express?

If your baby can't breastfeed yet, aim to express 8-10 times in a 24-hour period, including at least once at night. These do not need to be at regular time intervals, but avoid stretches longer than 5 or 6 hours. Once your supply is well established, you may find that you can get by with fewer sessions.⁴

If you are trying to make more milk, express after or between feeds. How often depends on how much more milk your baby needs and how feeding at the breast is going.

If you are returning to paid work, how often you express will depend on a number of things. Some parents look at how often they feed on average in a 24-hour period and work out how many feeds they will typically have when they are with their child, so express the same number of times when separated to maintain this daily average.

If you are stockpiling milk for short-term separation or in the run up to a return to work, express once or twice a day after or between feeds. If your baby typically feeds from one breast, you could express from the other side while they feed. The amounts may seem small, but they quickly build up!

Some mothers try 'power pumping' as a short-term strategy to increase their milk supply, or when they are struggling to fit pumping into their daytime routine. This approach involves expressing very frequently for short periods, stopping and starting as many times as possible - it is said to mimic cluster feeding.

How long should I express for?

Just like breastfeeding, expressing milk is not a 'one-size-fits-all'. Observe your milk flow, notice how your breasts feel and find what works for you.

If you are using a single pump, this usually takes about 20-30 minutes for both breasts. You might try switching sides when the milk flow slows, usually every 5-7 minutes.⁵

Double pumps save time. A double-pumping session that replaces what would have been nursing will probably last no more than 15 minutes. However, it is more important to pay attention to your breasts than the clock.⁶

How much milk will I express?

How much we can express at any one time depends on lots of different things. If you've never used a pump before, it might be helpful to think of the first pumping sessions as practice. ⁷

Expect small amounts in the early days. This will be drops for some and as much as a teaspoon for others. Many parents think of it as 'putting in their order' for more milk later.⁸

If you are breastfeeding full-time, expect to express around 15-60ml (0.5-2 fl oz) in total from both breasts per pumping session.⁹

If you are exclusively pumping, consider the overall volume in 24 hours. Full milk production is about 750-900 ml (25-30 fl oz) per baby. Milk production reaches its peak at about five weeks and stays relatively stable until around six months.¹⁰

Once milk production peaks, a typical feed is about 60-120ml (2-4 fl oz).¹¹

We all respond differently to pumps. How much you can express is not always a reliable or accurate sign of how much milk is there. It's important to remember that a baby who is nursing effectively will get more milk than a pump.

Expressing tips

Before expressing:

Wash your hands and get comfortable

Put something warm on your breasts, such as a warm flannel

Gently massage your breasts

Use any objects or techniques that help you to feel calm and relaxed. This might be a photo of your baby, an item of their clothing, a favourite warm drink or snack, music or visualisations.

While expressing:

Try 'hands-on pumping'. This is said to produce better results than relying on a pump alone¹²

Use breast compression to increase milk flow

Take a break midway and gently massage the breasts to help increase the amount of milk.¹³

Hand express from both breasts after you have finished pumping.

Try nursing your baby on one side and expressing on the other, or expressing from both sides at the same time, to encourage more letdowns

After expressing:

Hand-express for a minute or two to help increase output and supply.

Cleaning pump parts

There is not complete agreement about cleaning pumping equipment. Some public/advisory bodies (including NHS England) recommend sterilising equipment after every feed.

Others recommend washing pump parts thoroughly after every feed and sterilising once a day.

Some advisory bodies and breastfeeding organisations state that pump parts do not need to be sterilised, and that washing in hot soapy water is enough if your baby is healthy and full term.

Day-to-day milk handling

There is very little research on the day-to-day problems of milk handling, so guidelines often err on the side of caution.

Fresh human milk kills almost all bacteria, viruses and fungi that it comes in contact with.¹⁴

Mothers who are exclusively expressing, or expressing frequently, sometimes put the whole pumping kit (flanges attached) in a clean container in the fridge until the next expressing session and clean everything at the end of the day.

Breastmilk can be safely stored at room temperature for up to 4 hours (see below). Some parents apply the same timeframe to their pump and pump parts, and express multiple times within a 4 hour period before cleaning everything.

One quick method of sterilising is to use a sterilising fluid that you change every 24 hours. Submerge pump parts in the solution after washing them each time.¹⁵

Washing and drying

Ensure hands and pump area are clean.

You may like to use a separate basin and separate utensils for cleaning pump parts and equipment rather than the sink.

Clean with hot soapy water and rinse separately with clean water.

Some pump equipment is also dishwasher-safe.

Air dry or dry with paper towels.

Clean pump dials and switches with a disinfectant spray or wipe.

Store dry pump equipment in a clean container.

If you are expressing milk for a sick or premature baby, good hygiene is vital and sterilising is essential.

Storing Milk

How long can I store milk for?

There isn't complete agreement about milk storage.

Wherever you are storing milk, the fresher it is, the better.

Good hygiene is important - clean hands, clean pump parts, clean storage.

For healthy, full term babies ¹⁶:
Room temperature

Ideally, use within 4 hours.

Depending on room temperature and how clean storage conditions are, up to 6-8 hours may be safe.

Frozen milk that has thawed and kept at room temperature should be used within 4 hours.

Fridge

Ideally, use within 4 days.

When conditions are very clean, 5-8 days may be acceptable.

Store milk in the back of the fridge rather than in the door.

Frozen milk that has thawed in the fridge should be used within 24 hours.

Freezer

Ideally, use within 6 months.

Can be stored for up to 12 months.

Store at the back of the freezer, away from the door where temperatures may fluctuate.

Insulated bag
Milk left over after a feed should be used within 1-2 hours as it mixes with a baby's saliva, although it may be safe to put it in a fridge for up to 4 hours. ¹⁷

For premature or sick babies, consult with hospital staff and follow hospital guidelines.

Combining expressed milk

When combining milk expressed at different times, mix cold with cold:

Chill newly expressed milk before adding it to an existing container.

You can add refrigerated milk to frozen as long as there is less refrigerated milk than frozen.

Use within the time limit of the oldest expressed milk.

What can I store milk in?

You can store milk in any clean container, such as a hard (BPA-free) plastic or glass container with a tight-fitting lid, or a disposable milk storage bag.

Milk expands in the freezer, so leave space in the bag or bottle if you plan to freeze it.

Put the date on the container.

How much milk should I store?

Store milk in small quantities to avoid waste. Small amounts also defrost more quickly.

For babies older than one month, a feed is approximately 60-120ml. You could also store some smaller amounts in case you need to offer more.

How do I prepare stored milk?

You don't have to warm milk - some babies like it cold!

If you do warm milk, run the container under a warm tap or place it in a pan of warm water.

Never use a microwave or heat milk directly.

Swirl milk to combine rather than shaking it.

If defrosting milk, thaw it overnight in a fridge or hold it under warm running water.

Thawed milk should not be kept at room temperature. It should either be fed immediately or put in the fridge.

Smelly milk

Sometimes milk smells or tastes soapy after a short time in the fridge or freezer. This is because of an enzyme (lipase) that breaks down fats in milk. The milk is completely safe and most babies will drink it. However, if they refuse to, heat freshly-expressed milk to scalding (bubbling around the edges, but not boiling) and then quickly cool and freeze it. Scalding reduces some of the immune factors, but may be the only option for some families. You can also experiment with the length of storage time needed for the milk to acquire the smell.

Feeding your baby your milk

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

Further Reading

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

Online Information

Hand expressing:

Maximizing milk production when expressing:

Books

La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010.
Marasco, L & West, DMaking More Milk, McGraw Hill, New York: 2019.
Mohrbacher, N.,Breastfeeding Answers, Nancy Mohrbacher Solutions, Illinois: 2020.
Ruddle, L.,Relactation: A Guide to Rebuilding Your Milk Supply, Praeclarus Press, Texas: 2020.

References

1. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 298.

2. As above, p304.

3. As above, p489.

4. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 300.

5. As above, p500.

6. Bonyata, K. I'm not pumping enough milk. What can I do? Accessed: 28 March 2023.

7. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 307.

8. As above, p301.

9. As above, p300.

10. As above, p309.

11. As above, p515.

Copyright LLLGB 2023

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Expressing & Storing Milk - La Leche League GB

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Why Express Milk? When a baby can't breastfeed Making more milk A return to paid work Separation Choice Expressing Milk What kind of pump do I need? What else do I need to know about pumps? How often and when should I express? How long should I express for?

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www.ardobreastpumps.co.uk
quote: AGENTSNCT to get a discount (£37)

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https://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/

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https://www.youtube.com/watch?v=4aXY1fy75Is

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https://www.laleche.org.uk/birth-breastfeeding/

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NCT - what's in a nappy leaflet (used in session)

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NCT - what's in a nappy leaflet (used in session)

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Jessop Wing breastfeeding is going well leaflet (used in session)

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Jessop Wing breastfeeding is going well leaflet (used in session)

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https://publicdocuments.sth.nhs.uk/PIL3992.PDF

# data[].attributes.headline
how to tell your baby is getting enough milk 

# data[].attributes.subject
how to tell your baby is getting enough milk 

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combination feeding - offering breast and formula milk

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combination feeding - offering breast and formula milk

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impact of breastfeeding on maternal and child health

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impact of breastfeeding on maternal and child health

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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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breastfeeding in public - what the law says 

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breastfeeding in public - what the law says 

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attachment at the breast (sent before session)

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attachment at the breast (sent before session)

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