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

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

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

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

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

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

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

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

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

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

Pain as baby comes off, caused by:

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

OK at first, painful as feed progresses.

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

Stabbing pains in the breast throughout feed and afterwards.

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

When baby is around 3 months or older.

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

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

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

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

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

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

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

Nipple not so prominent-baby having difficulty latching on.

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

Nipple turns white, possibly bluish, then red.

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

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

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

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

Crack that weeps or crusts.

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

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

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

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

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

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

Written by Karen Butler and Sue Upstone and mothers of LLLGB

Further Reading

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

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

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

Copyright LLLGB 2016

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

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this leaflet provides mothers and health professionals with key information about breastfeeding

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Breastfeeding-leaflet  Off to the Best Start

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

1. Support your breast with one hand - thumb on one side, fingers on the other.

2. Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

1. Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

2. Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

3. Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

4. Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

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

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow. It is also important to maintain a mother's milk supply during separation and make milk available for someone else to feed the baby. This video shows how to hand express breastmilk.

Join the Conversation

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How to Express Breastmilk - Video - Global Health Media Project

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Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow. It is also important to maintain a mother's

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This leaflet offers advice and information for parents on getting to know their baby and setting up the foundations for a close and loving relationship.

We now know that building a strong relationship between parents and their new baby will give them the best possible start in life and will help them to grow up happy and confident. This leaflet is free to download and helps parents to develop that strong relationship, starting in pregnancy and continuing into the early days, weeks and months of a baby's life.

Health professionals may want to use this leaflet in conjunction with the Baby Friendly guide to antenatal and postnatal conversations and accompanying signature sheets.

Printed copies cost £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.
Please note: Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning please use our digital resources order form. Our myth buster posters show the key Happy Baby messages in bright and colourful poster form - find out more.

Building a Happy Baby: A Guide for Parents

Baby Friendly standards

Support to build a close and loving relationship is a key element of the Baby Friendly standards. Find out more about embedding our standards in your service.

Find more relationship building resources

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Building a happy baby: A Guide for Parents Leaflet - Baby Friendly Initiative

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This leaflet helps parents to get to know their baby and to set up the foundations for a close and loving relationship.

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Understanding baby sleep | Australian Breastfeeding Association

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Why do babies wake? And all the other sleep questions you desperately want answers to.

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Sleepy baby at the breast and slow weight gain

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Sleepy baby at the breast and slow weight gain

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Sleepy Baby – Why And What To Do - La Leche League GB

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Nobody likes to disturb a sleeping baby, but sometimes a baby can be too sleepy for their own good. At times like this they may need you to take action. Your newborn baby needs to nurse actively for one or both breast at each feed. Offer the second breast after they seem to have finished […]

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Expressing milk means squeezing milk out of your breast so you can store it and feed it to your baby later.

You might want to express milk if:

How to express breast milk

You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you're doing it.

Sometimes it takes a little while for your milk to start flowing. Try to choose a time when you feel relaxed. Having your baby (or a photo of them) nearby may help your milk to flow.

You may find it easier to express if you cover your breasts with a warm towel first, or after you have a shower or bath.

Expressing breast milk by hand

Some find it easier to express milk by hand, especially in the first few days or weeks. It also means you can express without needing a pump, or an electricity supply.

Hand expressing allows you to encourage milk to flow from a particular part of the breast. This may be useful, for example, if one of the milk ducts in your breast becomes blocked.

Hold a sterilised feeding bottle or container below your breast to catch the milk as it flows.

These tips may help:

Before you start, wash your hands with soap and warm water.

Have something clean ready to collect the milk in.

Some find gently massaging their breasts before expressing helps their milk to let down.

Cup your breast with one hand then, with your other hand, form a "C" shape with your forefinger and thumb.

Squeeze gently, keeping your finger and thumb a few centimetres away from your nipple, just outside the darker area around it (areola). Do not squeeze the nipple itself as you could make it sore. This should not hurt.

Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.

Drops should start to appear, and then your milk usually starts to flow.

If no drops appear, try moving your finger and thumb slightly, but still avoid squeezing the darker area near your nipple.

When the flow slows down, move your fingers round to a different section of your breast, and repeat.

When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.

Watch a video about expressing milk by hand on the UNICEF website

Expressing milk with a breast pump

There are 2 different types of breast pump: manual (hand-operated) and electric.

Manual pumps are cheaper but may not be as quick as an electric pump.

You may be able to hire an electric pump. Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you.

The suction strength can be altered on some electric pumps. Build up slowly. Setting the strength to high straight away may be painful or damage your nipple.

You may also be able to get different funnel (the part that goes over your nipple) sizes to fit your nipples. The pump should never cause bruising or catch your nipple as it's sucked into the funnel.

Always make sure that the pump and container are clean and sterilised before you use them.

Find out how to sterilise baby bottles

Storing breast milk

You can store breast milk in a sterilised container or in special breast milk storage bags:

in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) - if you're not sure of the temperature of your fridge, or it is higher than 4C, use it within 3 days

for 2 weeks in the ice compartment of a fridge

for up to 6 months in a freezer, if it's -18C or lower

Breast milk that's been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Storing breast milk in small quantities will help avoid waste. If you're freezing it, make sure you label and date it first.

Defrosting frozen breast milk

It's best to defrost frozen breast milk slowly in the fridge before giving it to your baby. If you need to use it straight away, you can defrost it by putting it in a jug of warm water or holding it under running warm water.

Once it's defrosted, give it a gentle shake if it has separated. Use it straight away. Do not re-freeze milk that's been defrosted.

Once your baby has drunk from a bottle of breast milk it should be used within 1 hour and anything left over should be thrown away.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water or holding it under running warm water.

Do not use a microwave to heat up or defrost breast milk. This can cause hot spots, which can burn your baby's mouth.

Storing breast milk if your baby is in hospital

If you're expressing breast milk because your baby is premature or sick, ask the hospital staff caring for your baby for advice on how to store it.

Read more about breastfeeding a premature or sick baby

If you're having difficulty expressing breast milk

If you're finding it difficult or uncomfortable to express your breast milk:

Ask your midwife, health visitor or breastfeeding supporter for help. They can also tell you about other breastfeeding support available near you.

Search online for breastfeeding support in your area.

Call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm daily).

The Bliss website also has advice about expressing milk for a premature or sick baby

Community content from HealthUnlocked

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Everything you need to know about expressing and storing your breast milk, including tips on hand expressing and electric breast pumps, and how to freeze, defrost and warm breast milk.

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this resource works best as a printed leaflet

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Communicating with your baby in the womb

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Communicating with your baby in the womb

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Communicating with your baby before they are born/how babies start processing sounds in the womb

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Mum

I usually play Punjabi music - baby starts rolling, kicking, taking different positions. My bump is going that way.

Dad

You actually see the bump move.

Trish - Health Visitor

At this stage in your pregnancy, the baby can hear your voices.That helps them feel calmer as well because it's voices that they're used to.

Cristina - SLT

Your baby really is listening, they're getting ready to be a language learner even before they're born. What your baby's tuning into first is something called prosody. This is the rhythm and pitch patterns of your speech, a bit like the tune of your voice. For example, English has a different tune to Japanese and your baby is already beginning to learn this.

Mum

We speak two languages which is Punjabi and English. I usually say "Is my baby hungry? Let's go into the kitchen and see what we can make today."

Cristina - SLT

By eighteen weeks your baby's ears are beginning to send signals to the brain about the sounds that they can hear. There's one sound above all else that they're learning about and that's the sound of their mum.

Mum

I usually spend most of the time at home so I just talk with baby bump.

Cristina - SLT

By 23 weeks they can hear the muffled sounds of their mum's voice and by 24 weeks they respond to that voice. Their mum's voice can calm them down and they can become more still as they listen to it.

Dad

Usually, whenever I come home from work before we eat,I usually sit and talk to the baby and just say, rub the baby and just go 'Hi baby, how's your day' things like that, just until the baby gets used to my voice.

Trish - Health Visitor

Yes absolutely.

Cristina - SLT

When it comes to recognising and processing speech it's the left temporal lobe of your baby's brain that is the most active part. When your baby hears their favourite people talking brain starts to develop important speech processing skills which set them up to be future word learners.

Dad

Haway pet, how you doing?

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When can baby hear your voice in the womb?

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By 24 weeks babies in the womb can respond to voices. Their mum's voice can calm them down and they can become more still as they listen to it.

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4 day old feeding with breast compressions

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4 day old feeding with breast compressions

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compare with the 'printed leaflet' version above

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Expressing and storing breastmilk - The Breastfeeding Network

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

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key information about breastfeeding - for parents and health care professionals

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key information about breastfeeding - for parents and health care professionals

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Published by Better Health Start for Life and the Baby Friendly Initiative and updated in 2022, this leaflet provides mothers and health professionals with key information about breastfeeding.

The leaflet is a teaching aid for health professionals when discussing the benefits and management of breastfeeding with pregnant women, and when teaching new mothers how to breastfeed. Health professionals may also find our breastfeeding assessment tools and practical skills review forms useful when talking to new mothers.
To enquire about printed copies of this leaflet, please visit the Department of Health & Social Care campaign resource centre. The UNICEF UK Baby Friendly Initiative is unable to assist with printed leaflets for this resource.

Off to the Best Start leaflet - A guide to help you start breastfeeding

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Off to the best start leaflet - Baby Friendly Initiative

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This leaflet from the Department of Health and the Baby Friendly Initiative provides key information about breastfeeding.

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

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

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

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biological nursing/laid back feeding is 2:50 - 3:50 min into the video

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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Positions for Breastfeeding - Video - Global Health Media Project

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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A mother's experience of biological nursing

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A mother's experience of biological nursing

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Biological Nurturing or Laid Back Breastfeeding – La Leche League International

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Originally published December 2015A mother’s tale of Biological Nurturing or Laid Back Breastfeeding, a non-prescriptive approach that encourages breastfeeding in a semi-reclined or laid back position.

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Building a happy baby

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Learning What Your Newborn Baby is Saying To You

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How your baby communicates leaflet in several languages

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How your baby communicates leaflet in several languages

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‘how your baby communicates leaflet’ - An introduction to your baby's behaviour, states and cues from birth to 3 months - in several other languages including  Arabic, Chinese, Danish, French, Japanese, Polish, Portuguese, Spanish, Ukrainian, Welsh, Zulu

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Supporting Dads in Greater Manchester to have the best possible relationships with their families

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We aim to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues.

We hope to get dads engaged with services that have traditionally been targeted at mums, and to train & support volunteer dads to work with us.

We work directly with services that support Dads, families and especially babies to increase engagement and knowledge across the sector.

We want to make sure dads know how important they are, how to access support when they need it and why it's essential for baby's development.

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VOLUNTEER WITH US EVENTS REGISTRATION FIND SUPPORT IN YOUR AREA DONATE HERE We aim to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues. We hope to get dads engaged with services that have traditionally been targeted at mums,

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Why breastfeed and practical tips to support mothers/ parents who do.

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference.

Did you know that a new parent is more likely to choose to breastfeed if they're sure their partner is positive about it? And if they do decide to breastfeed, they're much more likely to have a good experience and manage any difficulties if their partner supports their decision (Tohotoa, 2009; Rempel, 2011). A partner's emotional support is so important for helping breastfeeding for longer too (Tohatoa et al, 2009; Su, 2016).

Why is breastfeeding important?

If your partner is breastfeeding your baby - or planning to - that's fantastic because breastmilk has so many benefits for babies. For instance, breastmilk can help to reduce the risk of your baby getting infections and diseases (NHS, 2017). It also contains hormones that help your baby's development (Victora et al, 2016).

Overall, breastfeeding will have a positive impact on your baby's health. What's more, it can influence their health as an adult too (Victora et al, 2016).

Is breastfeeding hard or will my partner just know what to do?

Many parents see breastfeeding as a natural process but it can take time to learn this new skill together. It might take around six weeks to get the hang of it fully (NHS, 2016).

The good news is that with the right support, your partner can overcome any challenges and continue breastfeeding if they want to. If you think your partner needs more information, support or just someone to talk to, why not give one of our trained breastfeeding counsellors a call on our support line: 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

You might find it helpful to read up about breastfeeding and attend a breastfeeding session before your baby is born. This can help you know what to expect and perhaps give you a little more confidence. It can also help you both talk about feeding your baby and raise any questions or worries you might have.

What do I need to know about breastfeeding?

You might find it helpful to know how breastfeeding works and what normal behaviour is for breastfed babies. Here are a few quick and handy facts:

Babies are happier if they're fed as soon as they show signs of being hungry.

Babies usually feed frequently (anything from eight to 12 times or more in 24 hours) in the early weeks, especially during the evenings.

Some babies are slow feeders at first, but they get quicker as they get older.

The more a baby feeds, the more milk the parent makes because it's the removal of milk that drives the production of it.

The Department of Health recommends exclusive breastfeeding for at least your baby's first six months. Breastfeeding is also beneficial for toddlers because it gives them a health boost every time they feed. So your partner can breastfeed your baby for as long as they both want to.

Nipple soreness or pain during feeding might be a sign that a baby needs some adjustment to their attachment at the breast. If there is soreness or pain when breastfeeding, talking to a healthcare professional or breastfeeding counsellor can help.

Women and parents enjoy feeding more when they are comfortable and relaxed.

(Department of Health, 2011; La Leche League, 2016; NHS, 2016)

What can I do to help support my partner with breastfeeding?

There are lots of things you can do to support and encourage breastfeeding.

Here are 10 tips:

1. Boost your partner's confidence by being positive and encouraging progress. As with learning any new skill, reassurance and praise are a massive help.

2. Listen and talk honestly about how you each feel about finding your way with your new baby.

3. Be involved with your baby in other ways so that the caring is shared (see below).

4. Help to reduce the household chores so your partner can feed your baby for as long and as often as they need.

5. Try to help your partner to relax by giving them a massage.

6. There's no need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

7. Help them get specialist support if they're struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

8. Help out by bottle feeding your baby expressed milk once your partner and baby have got the hang of breastfeeding (see below).

9. Accept your partner's decision on when to stop breastfeeding.

10. Try to remember that with your support, breastfeeding can quickly become just another part of your family life.

(Rempel et al, 2010)

What practical support can I give to my baby if my partner is breastfeeding?

You might expect to feel like a bit of a spare part with feeding but it's good to remember that each parent plays a different and vital role. The decision on how you feed your baby is certainly a joint one (deMontigny et al, 2018). It might take a while to get used to the different parts you play though.

Whatever you decide to do, you might actually find feeding is less important to you than you expected anyway. Especially if you're hands-on with your baby in different and rewarding ways.

Tips for being a hands-on partner with your baby

Changing nappies and generally caring for your baby - it's great if you can spend time with your baby and interact (see below) with them while you're looking after them.

Bathing your baby - you could bath your baby or even have a bath with your baby. You'll both enjoy the bonding benefits of skin-to-skin contact and one-to-one time together (NHS, 2018).

Talking and playing - babies enjoy hearing gentle sounds. They even recognise the muffled tones of people talking from their time in the womb and they'll be aware of familiar voices like yours (Lee and Kisilevsky, 2013). So a chat with your baby might be a little one-sided but rest assured, they know it's you. Socially interacting with your baby through their senses helps to stimulate their brain development; for example, you could pull some different expressions (Boucenna et al, 2010).

Baby carrying - this means taking your baby out and about in a sling. It can be a rewarding and comforting experience for both you and your baby (Miller, 2019).

For more ideas on being a hands-on parent, see our article about bonding with and getting to know your baby.

How can I share feeding our baby?

If you're keen to feed your baby, you could give them expressed breastmilk from a spoon, syringe, cup or a bottle. But only introduce your baby to a bottle once breastfeeding is going well. For more on expressing, see our 10 bottle feeding tips for breastfed babies article.

And once your baby's moved on to solid food, there are so many ways you can get involved with that...chopping, mashing, cleaning up all the food that ends up on the floor...

I want to support breastfeeding but will it affect our sex life?

Possibly, but tiredness - and your partner's birth experience and recovery - is more likely to affect their sex drive rather than breastfeeding (Rowland et al, 2005). See our article about breastfeeding and sex for more details.

What if I feel uncomfortable about my partner breastfeeding in public?

If you're feeling uncomfortable or nervous about your partner breastfeeding in public, talk it through. Maybe you're worried about your partner showing their breasts in public? Yet in reality, very little breast actually shows when a baby is feeding. You might have even seen someone breastfeeding before without realising it.

It might also help to talk to other families who are breastfeeding and find out about both partners' experiences of it. The chances are, you'll change your mind as you get used to seeing breastfeeding.

It's good to know that breastfeeding in public is protected by the law under the Equality Act 2010. That means providers of any services or facilities open for the public are not allowed to discriminate against breastfeeding (Maternity Action, 2019).

Many places now welcome breastfeeding and have special facilities for feeding in private.

Some people might feel uncertain themselves about feeding in public at first and may appreciate the reassurance of having their partner with them.

At the end of the day...

Don't underestimate the huge difference you can make if your partner is breastfeeding. With you both on board, breastfeeding can quickly become an everyday part of your lives (Rempel, 2011).
This page was last reviewed in October 2017.
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.

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

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

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Health Talk has some interesting videos about different people's experiences of breastfeeding, click here to view them.

Boucenna S, Gaussier P, Andry P, Hafemeister L. (2010) Imitation as a communication tool for online facial expression learning and recognition. 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems, Taipei: 5323-5328. Available at: https://ieeexplore.ieee.org/abstract/document/5650357 (Accessed 1st July 2018)

deMontigny F, Gervais C, Larivière-Bastien D, St-Arneault K. (2018) The role of fathers during breastfeeding. Midwifery. 58:6-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29272696 (Accessed 1st July 2018)

Department of Health. (2011) Breastfeeding. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publichealth/Nutrition/Nutritionpregnancyearlyyears/DH_127625 (Accessed 1st July 2018)

La Leche League. (2016) Still nursing? Available at: https://www.laleche.org.uk/still-nursing/ (Accessed 1st July 2018)

Lee GY, Kisilevsky BS. (2013) Fetuses respond to father's voice but prefer mother's voice after birth. Dev Psychobiol. 2014 Jan;56(1):1-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23817883 (Accessed 1st July 2018)

Miller R. (2019). Babywearing education in the neonatal intensive care unit. The International journal of childbirth education: the official publication of the International Childbirth Education Association. 34. 43-47. Available at: https://www.researchgate.net/publication/334151320_Babywearing_Education_in_the_Neonatal_Intensive_Care_Unit (Accessed 1st July 2018)

NHS. (2016) How to combine breast and bottle feeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Accessed 1st July 2018)

NHS. (2017) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx (Accessed 1st July 2018)

NHS. (2018) Washing and bathing your baby. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/washing-your-baby/ (Accessed 1st July 2018)

Rempel LA, Rempel JK. (2010) The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. (2):115-21. Available at: http://journals.sagepub.com/doi/abs/10.1177/0890334410390045 (Accessed 1st July 2018)

Rowland M, Foxcroft L, Hopman WM, Patel R. (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Oct;51:1366-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479788/ (Accessed 1st July 2018)

Su M, Ouyang YQ. (2016) Father's role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeed Med. 11:144-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26836960 (Accessed 1st July 2018)

Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 4:15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788531/ (Accessed 1st July 2018)

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 387(10017):475-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26869575 (Accessed 1st July 2018)

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How can partners support breastfeeding? | NCT

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This article looks at how partners can help support breastfeeding in the early days.

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The essential guide for new dads, developed with the NHS. This resource will support you and your partner to give your baby the best possible start in life.

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I was a bit scared when we found out we were having a baby, obviously happy, but a bit scared and in the beginning I was a bit clueless. The child development part is my favourite bit, but there's things in there, like things about mental health, that I didn't know about and that I didn't know you needed to know about.

Ross, 22

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DadPad | The Essential Guide for New Dads | Support Guide for New Dads

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Developed with the NHS, DadPad gives new dads and dads-to-be the knowledge and skills needed to gain confidence and give their baby the best start in life.

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Baby behaviour, how to deal with fussy evenings. Including concept of the 4th trimester

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

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

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

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

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

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

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

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

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

your baby seems to be in pain;

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

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

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

breastfeeding is painful for you and not getting any better;

your baby is often unhappy or frustrated at the breast;

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

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

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

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

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

Why babies need so much help in the evening

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

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

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

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

Breastfeeding - more than just milk

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

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

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

The "fourth trimester"

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

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

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

A typical evening with a newborn

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

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

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

What can you do about it?

Here are some ideas you might like to try:

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

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

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

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

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

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

Try going outside - babies are often happier outdoors.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Blog: the first week breastfeeding a newborn

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Blog: the first week breastfeeding a newborn

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A blog exploring what’s “normal” in the first few days, encouraging mums to trust their baby and their own instincts of love, affection and responsive feeding.

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

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

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

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

Two things that are normal:

1.Babies want to be close to you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Signs of hunger
Mothers can follow their baby's lead in how often to breastfeed.
Rather than watching the clock, watch for cues that your baby is hungry such as the rooting reflex, chewing/sucking on hands or fingers.
Early feeding cues (signs) are the best time to feed!
Early cues: "I'm hungry" (stirring, mouth opening, turning head and seeking/rooting).

Mid-cues: "I'm really hungry" (stretching, increasing physical movement, hand to mouth).

Late cues: "Calm me, then feed me" (crying, agitated body movements, colour turning red).

In this guide:

1. Breastfeeding 101

2. In pregnancy - planning for breastfeeding

3. Breastfeeding - the first few days

4. Signs of hunger

5. Breastfeeding - the early weeks

6. Positioning and attachment

7. Signs of an effective attachment

8. Breastfeeding positions

9. Common breastfeeding questions and concerns

10. Common breastfeeding issues

11. Breastfeeding in the first year

12. Important points about breastfeeding

Print entire guide

Previous ( https://www.qld.gov.au/health/children/pregnancy/antenatal-information/breastfeeding-101/breastfeeding-the-first-few-days )

Next ( https://www.qld.gov.au/health/children/pregnancy/antenatal-information/breastfeeding-101/breastfeeding-the-early-weeks )

Acknowledgments

Queensland Health acknowledges the Metro North Hospital and Health Services, Royal Brisbane and Women's Hospital, for permission to use the content of their GLOW antenatal education resource.

COVID-19 and breastfeeding

Coronavirus (COVID-19) is a new virus and we are still learning how it may affect you and your baby. See COVID-19 information for pregnant and breastfeeding women for the latest information and call your doctor or 13 HEALTH (13 43 25 84) Should you have any questions.

The COVID-19 virus has not been found in breastmilk. However, COVID-19 is easily passed from person to person through close contact. It is important that you do your best to protect your baby from the virus by following the steps outlined in our COVID-19 and breastfeeding fact sheet (PDF).

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Mothers can follow their baby's lead in how often to breastfeed. Rather than watching the clock, watch for cues that your baby is hungry such as the rooting reflex, chewing/sucking on hands or fingers. Early feeding cues (signs) are the best time to feed! Early cues: "I'm hungry" (stirring, mouth opening, turning head and seeking/rooting).

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Breastfeeding is normal and natural but it may take you and your baby time to learn. Milk production speeds up (your body makes more milk faster) if you nurse or pump more frequently. The emptier the breast, the faster your body works to replace the milk that was taken out. Milk is being produced at all times, and breasts are only ever about 75% empty, even after a very long feeding. For more information on how your breasts make milk see: How milk production works.

Breastfeed early
Breastfeed often
Colostrum
Learn to breastfeed comfortably
Allow him to take full feeds
Watch for signs he is hungry
After your milk comes in
Give only your milk
Night feeds are important
Get to know and enjoy your baby
Coping with engorgement
Help for sore nipples

Breastfeed early

Your breasts will already be making colostrum (first milk).

Lay your baby against you skin-to-skin as soon as you can, to make the most of his inborn instinct to breastfeed. Ideally do this within the first hour after birth before any interruptions such as washing and weighing.

It's never too late to start Biological Nurturing, even if your baby is sleepy due to drugs you had in labour-spending lots of time skin-to-skin helps babies breastfeed well.

Breastfeed often

Babies have tiny tummies so they can't wait long for food.

Encourage your newborn to breastfeed at least 8 to 12 times in 24 hours.

Your colostrum (first milk) is made in just the right amounts for your baby's tiny tummy.

Small, frequent feeds ensure that your baby takes in all the milk he needs-the more you nurse, the more milk you will make.

Colostrum

This concentrated milk produced in the first few days clears meconium (first poo), reduces jaundice and is rich in antibodies to protect your baby against infection.

Getting your baby latched on well to the breast is the key.

Get yourself comfortable and well supported.

Keep your breast at its natural level.

Hold your baby so his whole front is close against yours, wrapped around or along your body.

Align him 'nose to nipple' to encourage him to extend his neck. That will help him open his mouth wide and get a deep, comfortable latch.

Seek skilled help early on if you are finding breastfeeding difficult or uncomfortable.

Allow him to take a full feed

There is no need to time each breastfeed-he will let you know he has had enough by letting go or falling asleep.

Offer the other breast if he wants it. That way he'll get what he needs and your breasts will be encouraged to make plenty of milk.

Watch for signs he is hungry

Wriggling or fidgeting, rooting (head turning) and fist sucking are all early signs of hunger.

Offer a breastfeed while he is still calm-crying is a late sign of hunger.

Just like you, he will be hungrier and thirstier at some times of the day than at others. Many babies 'cluster nurse' and space feeds closer together at certain times of the day, especially during the evening.

Some babies sleep a lot at first because of the effects of anaesthetics during birth or because they're jaundiced. This can mean they're not able to feed as much as they need. More information about sleepy babies.

Watch for signs he is getting enough milk

After your milk comes in

Listen for swallowing during feeds.

At least three yellow 50p coin sized poos in each 24 hours are a sign he's getting enough milk.

Seek skilled help if your baby seems constantly unsettled, even after a long breastfeed.

Encourage a sleepy baby to feed actively 10 to 12 times in 24 hours. Hold him more and encourage latching on when awake and during periods of light sleep.

Is My Baby Getting Enough milk?

Give only your milk

Your healthy full-term baby doesn't need any other fluids or solids until around six months.

Giving formula milk or other liquids reduces your milk production and may trigger allergies.

As well as affecting your milk production, bottles or dummies can confuse your baby's sucking technique and make him reluctant to breastfeed. See Dummies & Breastfeeding for more about this.

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

Night feeds are important

Your baby will need to breastfeed during the night to ensure he takes in enough milk.

Night feeds will help you to establish and maintain your milk supply and avoid engorgement, blocked ducts and mastitis.

You can make night feeds easier by keeping your baby close by.

For more information see our page on Safe Sleep & the Breastfed Baby.

Get to know and enjoy your baby

You will soon learn what he needs and enjoys. The easiest way to care for a newborn baby is to accept and meet his need for closeness. Dads and partners can enjoy closeness too -by cuddling, changing, bathing or carrying baby in a sling.

Settle into your own rhythms

The responsibility of looking after a baby 24 hours a day can be quite overwhelming at first. Try to relax-soon you will find gentle patterns emerging. You can then build on these patterns, creating a daily rhythm to suit you both. Read more about Rhythms and Routines.

Get out and about

Going out can prevent you feeling isolated and give structure to your day. It's possible to breastfeed a baby discreetly so that other people may not even notice. It helps to practise at home in front of a mirror. Offer a feed before your baby gets frantic-after all, a crying baby will guarantee an audience!

As time goes by

Your healthy baby needs only your milk until about the middle of the first year, when he starts to show signs of readiness for solids. If you are returning to work, you can express your milk and continue to breastfeed when you are together.

Growth spurts

Babies have frequent growth spurts starting in the first few weeks. During a growth spurt your baby will be extra hungry-nurse as often as you can to increase your milk production. Your breasts will also feel softer and more comfortable as your milk production is established. This can coincide with a growth spurt. Don't panic, you are still producing plenty of milk and feeding will settle down again soon. Have a look at the ways you can tell if your Baby Getting Enough Milk?

Coping with engorgement

Breastfeed as often as you can.
Reverse pressure softening moves fluids away from the nipple area so your baby can latch on well:

Press all five fingertips of one hand around the base of the nipple.

Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers.

Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be. Gently hand express a little milk if needed.

Warm moist heat just before feeding helps milk flow. Cold compresses between feeds help reduce swelling and pain.

Help for sore nipples

Remember-getting your baby latched on comfortably is important for preventing sore nipples. Pain is a sign that something needs changing-seek skilled help. Nurse your baby before he is really hungry. Offer the least sore breast first and try different nursing positions. Insert your finger between your baby's gums if you need to remove him from the breast. If you experience itchy or burning nipples or shooting pains during or between feeds consult an LLL Leader to help identify the cause.

Help for sore breasts

Redness, a tender spot or a sore lump may be a blocked duct. Avoid mastitis by nursing frequently to keep milk flowing. Use different nursing positions and check your baby's attachment at the breast. Rest and treat as for engorgement. Avoid bras and clothing that cause pressure on the breast. Seek medical help if things don't improve.

Seek support

It is OK to ask for help-it can take a while for breastfeeding to become easy, or for your baby to learn to breastfeed effectively. It will get easier as time goes on. You can easily get skilled help from an LLL Leader by calling our Helpline. You may also find support and encouragement from breastfeeding mothers in your local LLL Group.

Written by Karen Butler based on original text by Sue Upstone, Ginny Eaton and mothers of La Leche League Great Britain.

Further reading

The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Adjusting to Motherhood
How does milk production work?
Engorged Breasts -Avoiding & Treating
Hand Expression of Breastmilk
Nipple pain - why and what to do
Positioning & attachment
Comfortable Breastfeeding
Is my baby getting enough milk?
Rhythms and routines
Supporting a Breastfeeding Mother
Dummies and Breastfeeding
Safe sleep and the breastfed baby

Other websites
LLLI Frequency of Feeding FAQs

Milk production speeds up (your body makes more milk faster) if you nurse or pump more frequently.

How Does Milk Production Work?
Frequently Asked Questions about Milk Production

This information is available in printed form from the LLLGB Shop.

Copright LLLGB 2016

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Beginning Breastfeeding - La Leche League GB

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Milk production speeds up (your body makes more milk faster) if you nurse or pump more frequently. The emptier the breast, the faster your body works to replace the milk that was taken out. Milk is being produced at all times, and breasts are only every about 75% empty, even after a very long feeding.

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Laid-back breastfeeding: benefits and uses | NCT

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Many mums and babies use laid-back breastfeeding straight after birth but it has many benefits even after that first snuggle. Here’s how…

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

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

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

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

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

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

Tips for getting started

If it hurts then make changes

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

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

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

Your baby needs to be calm

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

Your baby needs full body contact

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

Some babies need time

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

Laid-back breastfeeding

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

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

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

Sleepy babies

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

How laid back breastfeeding works

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

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

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

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

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

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

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

Latching on - getting a good attachment

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

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

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

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

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

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

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

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

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

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

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

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

This video from Raising Children.net.au shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:

Using different breastfeeding positions

The cradle hold

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

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

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

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

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

Laid back breastfeeding

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

The cross-cradle hold

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

Cross cradle

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

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

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

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

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

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

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

The underarm (clutch or rugby) hold

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

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

Your elbow keeps them tucked closely against your body.

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

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

Side lying

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

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

Standing up

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

As time goes by

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

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

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

LLLI Resources
Position to breastfeed

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

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

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

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

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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

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The reality of feeding -10 things you need to know

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The reality of feeding -10 things you need to know

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The reality of feeding: 10 things you need to know | NCT

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We look at 10 things that are useful for every parent to know when it comes to feeding their baby.

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Learn to feed responsively when using a bottle

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Learn to feed responsively when using a bottle

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Preparing infant formula and sterilizing bottles

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Preparing infant formula and sterilizing bottles

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Guide to bottle feeding

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But your decision to breastfeed doesn't have to change.

Breastmilk is especially important for multiples, who are often small at birth and need all the health benefits it provides. Breastfeeding also helps you create a special bond with each of your babies. Many mothers have nursed their multiples; you can enjoy nurturing your babies this way, too.

Planning ahead

Attend La Leche League meetings or our Antenatal Breastfeeding classes in pregnancy to learn about breastfeeding and meet breastfeeding mothers. Do read The Womanly Art of Breastfeeding, Mothering Multiples by Karen Gromada and our page on Birth and Breastfeeding.

A healthy diet with plenty of protein, complex carbohydrates and good fats will get you all off to a good start. Gaining healthy amounts of weight during pregnancy is good for your babies' birth weights and may also help prevent premature birth.

Even with good care, you might experience complications during pregnancy so it helps to be prepared. Ask your midwife for information on warning signs for premature labour. Seek medical attention quickly if any occur, or you have any of these symptoms: a severe headache or stomach ache, see spots in front of your eyes, or feel extremely irritable or tense.

Limit visitors

Limit visitors while in hospital and in the early days to those you feel comfortable breastfeeding in front of. When nursing two babies at once, you may feel exposed, at least until you can manage both babies and keeping your breasts covered (if you feel you want to). Tell friends and family you need time to recover and suggest they visit later, or drop round a meal!

Separation

Any separation after birth may make breastfeeding harder, but it's still possible. Hold, or at least touch, your babies immediately after the birth or as soon as you can. You can still touch and stroke a baby in special care and may be able to hold him against you in 'kangaroo mother care'. If he can't breastfeed, express your milk for him. This is the most important thing you can do whilst you are waiting to start breastfeeding. When you are back together, spend as much time as possible snuggling together skin-to-skin or lightly dressed to establish breastfeeding.

If you need to express your milk because one or both babies can't nurse, hand expression is useful in the first few days. Plan to express from both breasts at least eight times in 24 hours, about every two to three hours during the day and at least once during the night. As your milk increases, you can switch to a hospital grade automatic electric pump.

Once breastfeeding is established, mothers of multiples often find nursing two at once is easiest and it saves time to co-ordinate feeds. Biological Nurturing ™ positions can leave your hands free.

Breastfeeding at night lying down gives you more rest. It gets easier as your babies grow. In the meantime, use enough pillows to recline in bed and feed two babies at once. Keep a drink and snack handy plus books or music to pass the time. See Safer Sleep and the Breastfed Baby.

Making enough milk

The more milk your babies take, the more your breasts will make. This is especially important in the first few weeks. Since mothers of multiples usually experience more breast development during pregnancy, mothers of twins can almost always produce enough milk for both babies, and triplets can also be totally breastfed.

See Is My Baby Getting Enough Milk?

Encourage each baby to feed at least 8-10 times in 24 hours. If one of your babies is too sleepy or groggy to rouse himself every few hours, you will need to wake him to feed to ensure he gets enough milk. See our page Sleepy Baby-why and what to do.

At first you may feel you are doing nothing but feeding, but things will settle down as your babies grow and your milk production adjusts. Practical help with everything else will allow you to sit or lie down and concentrate on the important job of establishing breastfeeding.

Looking after yourself

You'll be busy looking after your babies but don't forget to look after yourself too. Try to eat a balanced diet and drink enough. Get as much rest as possible, and sleep whenever your babies sleep.

Looking after your babies will be a full-time job for quite a while so expect to do only the absolute minimum of housework.

Others will offer help with housework or entertaining older children-do accept if you feel you want to and make an effort to ask for help when you need it. Have a list of simple tasks ready to make it easier when people do offer help and you could share information from our pageSupporting a Breastfeeding Mother.

Your partner or support person will have a crucial role both practically and emotionally. Because they are needed so much, non-gestational parents of multiples have the opportunity to quickly develop close relationships with their babies. Other family members may also enjoy the chance to be practically involved. Take moments to appreciate this special time and be proud that you can nourish and nurture two or more little human beings at once!

Other sources of practical help

Midwives, health visitors, clinics and surgeries.

Homestart - a charity which offers support and friendship to families who are struggling to cope for a variety of reasons.

Local college students studying child development or members of local community groups.

Mixed feelings

Parents of twins or more often have mixed emotions about their multiple babies. It's normal to feel overwhelmed by the prospect of caring for two or more babies at once.

It can really help to talk to another family in the same situation. Your local LLL Leader can put you in touch with other mothers who have breastfed multiples, some LLL groups have Facebook support groups specifically for mothers of multiples. There may also be a local twins support group near you (see Further Information section). Adjusting to Motherhood has practical tips on dealing with feelings too.

Practicalities of getting out

It's daunting leaving the house with more than one baby. Start by going out briefly with someone else to help.

Keep a changing bag packed and ready. A backpack leaves your hands free.

Keep valuables and keys safe to hand in a waist pack or small bag across your chest.

Consider using a sling or carrier for one baby even when out with a pushchair. A double pushchair can be useful for carrying shopping too.

Alternate which baby gets carried: it's easy to overlook a quieter baby's need for closeness if one fusses more when out and about.

Think about suitable places for feeding ahead of time. Look out for your babies' early feeding cues so you can offer a feed before they start to fuss and attract attention from others.

Get to know your babies: with time, you will come to know your babies as individuals. Take opportunities to give them a little undivided attention: feeding, nappy changes etc. A few minutes here and there all add up. Their personalities will soon show through.

Finding support

It's OK to ask for help-it can take a while for breastfeeding to become easy, or for your babies to learn to breastfeed effectively. It will get easier as time goes on. You can get skilled help from an LLL Leader by calling our Helpline. Seek support and encouragement from the mothers in your local LLL group.

Written by Sue Upstone and mothers of LLLGB, photos courtesy of Sarah W.

Further Reading

Adjusting to Motherhood
Antenatal Expression of Colostrum
Birth and Breastfeeding
Caesarean Birth and Breastfeeding
Hand Expression of Breastmilk
My Baby Needs More Milk
Sleepy Baby - Why and What to Do
Supporting A Breastfeeding Mother
Mothering through special care

LLLI Resources
Breastfeeding Premature Babies

Other websites
Information on nursing multiples by the author of Mothering Multiples.
Website and blog of Krista Gray, IBCLC and mother of twins.
Breastfeeding Twins and Triplets by Kathryn Stagg, IBCLC

Books

The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010.
Hold your Prem. Jill Bergman and Dr Nils Bergman. Cape Town: New Voices Publishing, 2010.
Mothering Multiples. Karen Kerkhoff Gromada. Schaumburg, IL: LLLI, 2007.
Breastfeeding Your Premature Baby. Gwen Gotsch. LLLI, 2002.

Further Information

Twins Trust provides information and support networks for families of twins or more. Tel: 0800 138 0509 (10 am-1 pm and 7pm-10pm, daily).

Breastfeeding Twins and Triplets UK is a charity providing breastfeeding information and support run by breastfeeding counsellors

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

Copyright LLLGB 2016

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But your decision to breastfeed doesn't have to change. Breastmilk is especially important for multiples, who are often small at birth and need all the health benefits it provides. Breastfeeding also helps you create a special bond with each of your [...]

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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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For parents who wish to make informed
choices about infant sleep and night-time care

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

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Useful guide to expressing, when to express, why its useful, and how to do it! Details of hand expressing and pump, and how to use Expressed breast milk.

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video shows improving baby's latch throughout. breast compressions discussed and shown from 2 min into video. from 3 min onwards more strategies to increase supply are discussed.

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Increasing Your Milk Supply – Breastfeeding Series

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Mastitis (breast inflammation), includes a wide range of symptoms, from a small, tender area (often called a blocked duct), through to severe infection.

If your breasts are inflamed or swollen, it's important to act quickly to relieve discomfort and stop it getting worse. You may also need to deal with any underlying causes.

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

How can I prevent mastitis in the future?

Mastitis just means 'breast inflammation'. Recent research is changing how mastitis is viewed and treated. It's now understood as a wide spectrum, from a small, tender area - often called a blocked duct - to a severe infection.

Milk blisters/blebs look like tiny white or yellow dots on the tip of the nipple. They can cause no trouble, or they might be very painful (often described as 'stinging' pain). Sometimes they form in one or more 'milk pores', blocking milk from coming out of part of the breast. They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help. Milk blisters that don't block milk coming out, and don't hurt, can be safely left alone. They eventually disappear.

Engorgement is when the whole breast becomes swollen with extra fluid. It's common 2-5 days after birth, when milk production is increasing very fast. The mastitis self-treatment measures described below are helpful for engorged breasts, too. Treat engorgement promptly to avoid developing mastitis.

A breast abscess is a collection of pus (infection) within the breast. It is usually a complication of mastitis that was not adequately treated. An abscess needs urgent medical treatment: drainage and antibiotics.

One or more areas that are tender (sometimes called a blocked duct).

Your breast might feel warmer, harder, or lumpier than usual.

There may be a patch of skin on your breast that has changed colour (dark skin might look darker than usual, on light skin you might see a red patch).

You might have a fever and feel like you have the flu. Your body may respond to inflammation with an increase in temperature - it doesn't necessarily mean you have an infection. See below, "Do I need medical help?"

Could it be a breast abscess?

Most (though not all) people with an abscess feel very ill. If you have one or more lumps in your breast that don't get smaller as milk is removed, and don't respond to the treatments for mastitis suggested in this article, contact your GP or NHS 111. An abscess needs urgent medical treatment. It's usually possible - and may be preferable - to continue breastfeeding while an abscess is treated, if you want to. LLL Leaders can support you through it.

When breasts are too full of milk, or the breast is injured, your body may react with inflammation - a response to a threat. Blood flow to the area increases, and fluids and immune cells rush in to repair damage and fight off bacteria. As pressure within the breast increases, it feels tender or painful, and it may become difficult for the milk to flow easily.

Common causes of mastitis

Issues with positioning and attachment: Your baby is not removing milk efficiently.

Scheduling or limiting feeds: If breasts aren't relieved as often as they need to be, this can result in mastitis (and decreased milk production). The amount of milk breasts can hold - and how long they can comfortably hold it for - varies hugely between individuals, and changes over time.

Oversupply: Having a lot more milk than you need. Sometimes it's caused by 'overpumping'. Sometimes it just happens - this is more likely with second or subsequent babies. Your baby may get upset, gag, and splutter when your milk releases. They are probably growing very fast. Your breast/s may feel uncomfortably full a lot of the time. If you're struggling with oversupply, LLL Leaders can help.

Suddenly removing less milk than usual: For example, because your baby is ill, sleeping longer, or you are away from your baby.

Weaning: If you reduce the amount you breastfeed faster than your breasts can manage.

Breast injury, e.g. from a too-tight bra, bag or sling strap, breast pump, or seatbelt. Or even sleeping on your stomach.

Bacterial infection in the breast, possibly through an open nipple wound.

Less common causes of mastitis

Previous breast surgery, such as implants

Being under a lot more stress than usual, or extremely exhausted

Being anaemic or having other health conditions that make your immune system work less well

Gut health. Some experts think that imbalances in the 'microbiome' (the bacteria that live in your body) may make some people more likely to get mastitis. The breast has its own microbiome which is affected by many factors, including your diet, antibiotic use, and whether your baby feeds direct at the breast. It's a developing field of research.

Factors that may make mastitis more likely:

Causes of engorgement

your baby is unwell and feeding less than usual, or less than your breasts need

your baby starts sleeping for a longer stretch at night

you are away from your baby and don't express as often as your breasts need.

In the first few days after birth, you may have more engorgement if you were given extra fluids during labour and birth. But engorgement can happen at any stage of breastfeeding if there's more milk than your breast/s can comfortably hold. For example, if:

Take standard doses of an over-the-counter non-steroidal anti-inflammatory medication such as ibuprofen, if you can usually take it. Paracetamol may also be helpful if you're in pain, but ibuprofen is more useful for mastitis, because it also reduces inflammation. Both are safe to take while breastfeeding.

Experiment with cold or cool compresses on the affected area/s between feeds, to see what helps you feel most comfortable. Some cultures and communities advise new mothers to avoid cold in the early week after birth, and to use heat instead - if this is the case for you, see "things to avoid", below.

Remove milk as often as you need to, to keep the breast as comfortable as you can. Feed your baby whenever they want to be fed or continue expressing whenever you would usually express. Offer a feed or express some milk if your breast feels very full and uncomfortable.

Rest as much as you can. Inflammation is tiring for your whole body. Those who have had mastitis often say that they got it when they were under extra stress, or busier than usual - it may be a sign that you need to slow down. Rest is an important part of healing. Taking time off work, or having a partner or support person help you care for your baby can be useful for a few days.

Experiment with different feeding positions. This may help you be more comfortable and help to drain different areas of the breast.

Some experts recommend taking probiotics, or the food supplement lecithin. Check with your healthcare provider, a breastfeeding supporter, or LLL websites for current information.

Contact an LLL Leader or your local LLL group for more information and support.

Start treatment at the first signs of breast swelling or inflammation. It's often possible to deal with it at home without medical help.

Things to avoid

Rough massage of your breasts. This can increase inflammation - and really hurts! If you want to massage while feeding or expressing, use gentle touch, as if you were stroking a cat.

Applying a lot of heat, e.g. hot showers or compresses. Heat can increase inflammation. If a little warmth helps the milk to flow when you're feeding or expressing, or helps you feel more comfortable between feeds, use it for as short a time as possible. Don't direct a hot shower straight at your breast.

Trying to force milk out of the breast won't fix the inflammation and may make it worse.Electric toothbrushes, combs or other devices.

Trying to remove a lot more milk than usual. This can increase the amount of milk you're producing, increasing pressure in the breast. If you need to express more milk than your baby wants, aim to express just enough to be comfortable - not every available drop.

Some of the treatments that used to be recommended for mastitis don't help, and may even make things worse:

My breasts feel full but I can't get milk out - help!

Babies sometimes refuse to feed on a breast that has mastitis. The milk is safe for your baby but may taste different from usual. Your baby may also be objecting to a slower flow of milk - some people notice a temporary supply dip during mastitis. It usually goes back to normal when the breast has recovered. You will need to express milk from the affected breast until your baby is willing to feed on it again.

See Nursing Strikes for ideas to encourage your baby to feed.

Treat the inflammation by taking ibuprofen and perhaps applying a cold compress about 20-30 minutes before you feed or express.

If your baby is struggling to attach because the whole breast is engorged (full and tight), try expressing a little milk before offering the breast to your baby. Or try 'reverse pressure softening': press firmly around the nipple with fingertips or finger lengths for about one minute before feeding. This moves swelling away from the nipple.

Try gentle 'lymphatic drainage' massage (towards your armpit). See Further Reading.

What if your baby will feed, or you're trying to express, but little or no milk is coming out?

Don't panic! Engorgement or mastitis can act like a traffic jam in the breast . These tips can help you get the milk moving again:

Your symptoms are the same after 24 hours, or getting worse

You start to feel ill - shivery, shaky, like you have flu

You have a fever

A patch on your breast has changed colour and is getting larger, or you see streaks on your breast

You see signs of infection, such as a wound that looks crusty or oozes yellow, or your nipple is a different shape, size, or colour from normal.

If you're feeling okay in yourself (you don't have a fever or feel ill), you can try treating yourself at home for 24 hours. If by that time your symptoms are improving, you can continue for another 24 hours.

Get breastfeeding help if you need it. A breastfeeding supporter can help you get your baby deeply and comfortably attached at the breast.

Keep your milk flowing. Avoid too much milk building up in your breasts: feed or express as much as your baby wants, and offer extra feeds or express some milk if your breasts become uncomfortable at other times. If you have a lot more milk than you need, a breastfeeding supporter can help.

Check your breast comfort. Make sure nothing is pressing on the breast (see above, "Why does it happen?")

Watch out for early signs of mastitis and start self-help measures right away.

Contact NHS 111 or your GP straight away if:

You may need antibiotics. The NHS guideline on mastitis says that you should usually be given a 10-14 day course (if you have a shorter course, the mastitis is more likely to come back). If you need antibiotics, it's important to keep up with the self-help treatments above, as well as taking the medication. Let your doctor know if you're still not feeling any better by the third day after starting antibiotics.

Mastitis can be horrible, and make you question whether you can carry on breastfeeding. It's important not to suddenly stop removing milk while you've got mastitis, as this can lead to complications. You need plenty of practical and emotional support, and good medical care if necessary, until you're feeling better.

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

My Baby Won't Breastfeed When a Mother is Unwell
Mastitis
La Leche League International article on mastitis: https://llli.org/breastfeeding-info/mastitis/

References

Baeza, C. et al. 2022. Re: "Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022" by Mitchell et al. Breastfeed Med 2022 17(11):970-971.

Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. Women's Health. 2022;18. doi:10.1177/17455065221075907

Mitchell, K.B. et al.; Academy of Breastfeeding Medicine. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 17(5):360- 376. Erratum in: Breastfeed Med 2022 17(11):977-978.
Engorgement
NICE Mastitis and Breast Abscess (Clinical Knowledge Summary)
Blebs
Last revised in December 2023 Wilson, E. et al. 2020. Incidence of and risk factors for lactational mastitis: a systematic review. 36(4):673-686.

Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD006946. DOI: 10.1002/14651858.CD006946.pub4.

Douglas P. Re-thinking lactation-related nipple pain and damage. Womens Health (Lond). 2022 Jan-Dec;18:17455057221087865.
Over-the-counter medication
Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;25(2):79-83.

O'Hara, M. A. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids: A case series. Breastfeeding Medicine. 2012

NHS Specialist Pharmacy Service - UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding , published November 2023

Using NSAIDS during breastfeeding , published February 2024

Other websites

Academy of Breastfeeding Medicine Clinical Protocol #36:The Mastitis Spectrum, 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

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

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

This information is available to buy as a printed booklet from our .

Copyright LLLGB 2024

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Mastitis, blocked ducts, and engorgement - La Leche League GB

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Avoiding and treating mastitis and breast infections

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Self-help measures and when to seek medical attention

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A great resource by the BfN and maintained by a team of pharmacists from the Drugs in Breastmilk information service

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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

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Smoking/ smoking cessation and breastfeeding

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Smoking/ smoking cessation and breastfeeding

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This information can also be viewed as a PDF by clicking here
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
Smoking whilst breastfeeding is not advised. However the benefits of breastfeeding and smoking are still greater than formula feeding. Smoking only after feeding and away from the baby is recommended to limit the baby's exposure.

Nicotine is found in breastmilk.

The flavour of breastmilk collected 30-60 minutes after smoking was identified as tasting more like cigarettes than samples taken at any other time.

The levels of cotinine (the chemical into which nicotine is changed in the body) in the urine of breastfed babies whose mothers smoked were ten times higher than those of formula fed babies of smoking mothers. It appears that this is due to passage through breastmilk and not through exposure to smoke in a room.

Babies of mothers who smoke appear to be more likely to suffer from colic.

Smoking appears to lower breastmilk production - more women who smoke believe that they have insufficient milk

Mothers who smoke are likely to breastfeed for a shorter length of time

Many women continue to smoke whilst breastfeeding perceiving that it is the only time that they have for themselves, to overcome tiredness or to reduce their appetite.

Passive smoking is related to early onset of wheezing - breastfeeding may reduce the severity of bronchial asthma.

Research shows exposure to smoke increases the risk of cot death in babies.

There have been recent reports linking smoking during breastfeeding with risk of obesity and endocrine dysfunction in the baby in later life (Lisboa 2012, 2015)

Mothers and fathers should stop smoking - or not restart after pregnancy

The use of nicotine replacement therapy exposes the baby to less nicotine than smoking does

There appears to be no current research on "e cigarettes". Although there is some vapour release the risk would probably be less than with smoking.

It is safer to use nicotine replacement therapy whilst breastfeeding than to smoke.

NRT products are not licensed to be used by breastfeeding mothers. This means that the manufacturers have not included a statement on their use when they first made the product available. It does not mean they are not safe.

Babies will be exposed to less nicotine through NRT than through smoking. Smoking produces blood levels of nicotine of 44ng/ml whilst NRT patches produce around 17 ng/ml

NRT avoids exposure to the other chemical compounds in tobacco smoke.

Mothers should not use NRT and continue to smoke

Patches applied over a 24 hour period may produce vivid dreams in the mother; it might be advisable to remove the patch overnight so that the baby is exposed to less during night time feeds.

NRT products do not cause breastmilk to smell of cigarettes.

Nicotine gum produces large variations in nicotine levels whilst patches produce a sustained but lower level. If gum is used it should be chewed immediately after feeds to reduce the baby's exposure. NRT nasal sprays similarly produce rapid high levels and may best be used after feeds.

Exposure of the baby to NRT products is safer than exposure to cigarettes and with appropriate support may help the mother (and ideally her partner) to quit smoking permanently.

NB - Research shows exposure to smoke increases the risk of cot death in babies.

Oral medication to help with smoking cessation Varenicline (Champix ®) and Bupropion (Zyban ®) should be avoided during breastfeeding.

These suggestions are based on my experience of running a smoking cessation clinic as in independent prescribing pharmacist.

Think about why you want to stop smoking - is it for you, for your baby or older children, because somebody says you OUGHT to? If the latter you are unlikely to succeed long term, you need to decide that it is what YOU want to do and have a clear reason to do so.

Set a date when you plan to stop smoking and work towards that date.

Decide on what NRT you wish to use - it is much easier than trying to go cold-turkey. Can you get support from your local community pharmacy, practice nurse or smoking cessation service? They may well prescribe for you so the NRT is free if your baby is under 12 months of age. They will also monitor your carbon monoxide level in your breath showing you how your lungs clear quickly.

Think about when you smoke - is it a routine e.g. after a meal, with a cup of coffee, when you are tired or hungry? Think about each cigarette you have over several days - what made you decide to light this cigarette? Do you really want it?

Think about where you smoke - is it always in the same place e.g. a chair you sit in, outside the kitchen door so in sight or sound of your baby but not with him/her.

Decide how you can change each time you smoke - can you distract yourself for 20 minutes? This is the time it usually takes a craving to subside. Could you wash the floor, sing a song to your baby, make everything ready for the next meal, paint your nails or something else that works for you? Can you change where you sit?

On the day you decide to stop you may want to tell everyone so that you elicit their support or you may want to keep quiet so no-one tries to tempt you because they haven't made their own decision.

Put away the cash you would have spent on the cigarettes and spend it after 6 weeks of being cigarette free on a treat for YOU - not the family, not the baby, this is YOUR celebration of overcoming the addictive habit called smoking.

If you smoke to give yourself "5 minutes peace" think about how else you could spend that time.

Have strong tasting sweets around to suck - traditionally these are mints but could be anything you like. Also have lots of healthy snacks so you don't resort to chocolate instead.

Be proud of yourself - stopping smoking is not easy! Take every day as it comes and celebrate. If you have one cigarette it doesn't mean you failed, think why it happened and plan how to avoid that situation again. Do not give up giving up!

Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. 2003 Jul; 11(2):19-29. www.ncbi.nlm.nih.gov/pubmed/14768313?dopt=Abstract

British National Formulary

Dahlström A, Ebersjö C, Lundell B Nicotine exposure in breastfed infants. Acta Paediatr. 2004 Jun;93(6):810-6 .www.ncbi.nlm.nih.gov/pubmed/15244232?dopt=Abstract

Hale T. W Medications in Mothers Milk

Ilett KF, Hale TW, Page-Sharp M, Kristensen JH, Kohan R, Hackett LP. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharmacol Ther. 2003 Dec; 74(6):516-24. www.ncbi.nlm.nih.gov/pubmed/14663454?dopt=Abstract

Jones W Breastfeeding and Medication 2018 Routledge

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Lisboa PC et al Effects of maternal nicotine exposure on thyroid hormone metabolism and function in adult rat. J Endocrinology posted online 4 February 2015 http://joe.endocrinology-journals.org/content/early/2015/02/04/JOE-14-0473.abstract?sid=6e1733c0-0501-4c8f-ad40-d4f493cfafc2

Lisboa PC, Elaine de Oliveira E, and de Moura E G Obesity and Endocrine Dysfunction Programmed by Maternal Smoking in Pregnancy and Lactation. Front Physiol. 2012; 3: 437 www.ncbi.nlm.nih.gov/pmc/articles/PMC3500832/

NICE Smoking Cessation services PH10 2008 http://publications.nice.org.uk/smoking-cessation-services-in-primary-care-pharmacies-local-authorities-and-workplaces-ph10

Reijneveld SA ,Brugman E , Hirasing RA Infantile colic: maternal smoking as potential risk Factor Arch Dis Child 2000;83:302-303

Shenassa ED, Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics. 2004 Oct; 114(4):e497-505. http://pediatrics.aappublications.org/content/114/4/e497.full

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Smoking, Smoking Cessation and Breastfeeding - The Breastfeeding Network

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

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

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

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

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

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

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

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

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

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

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

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

Other websites

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

Guidelines from the NHS

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

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

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

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

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

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Alcohol and Breastfeeding - The Breastfeeding Network

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

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Support for Transgender and Non-binary Parents  LLLGB

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Support for Transgender and Non-binary Parents  LLLGB

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Breastfeeding and coronavirus
Getting breastfeeding started

Life with a new baby

Common Concerns

Milk Supply and Combi-Feeding

Milk Expression and Storage

Family Foods

Working and separation

Breastfeeding an older baby

Can I breastfeed if...?

Other Topics

Breastfeeding Today (LLLI)
Information & stories
article index
Please note: The breastfeeding information on this website has been put together by La Leche League Leaders, who are accredited by La Leche League to provide breastfeeding information. Please note that Leaders have a wide knowledge and experience of breastfeeding but are not medically trained. If you have a medical query, or are concerned about your health or the health of your child please consult your doctor.

Information, references and links on this website are taken from La Leche League resources, unless stated otherwise. Please note that La Leche League GB does not endorse information from outside sources, extra information is provided for you to consider.

Information supplied is not intended as advice. You are in the best position to make a decision as to how the information offered will affect you and your baby.

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There are a range of ways LLLGB can offer you support with breastfeeding, by telephone, in writing, or using our online information and printed materials. If the blue "chat now" button is showing, then you can also use our online chat service to have an instant conversation with one of our breastfeeding counsellors.

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Support for Transgender & Non-binary Parents  LLLI

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Support for Transgender & Non-binary Parents  LLLI

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Support for Transgender & Non-binary Parents

La Leche League is an international, nonprofit, nonsectarian organisation. ¹
LLL supports everyone who wants to breastfeed or chestfeed in reaching their goals.
We at La Leche League have all nursed our babies. If you want to do the same, whoever you are, whatever your story is, we're here to help. LLLI is committed to serving everyone inclusive of race, ethnicity, religion, sex, national origin, ancestry, age, marital status, physical or mental ability, socio-economic status, political views, gender identity, sexual orientation, family structure, or other protected status.
Trans men, trans women, and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed, as we can also see in the experiences of those nursing adopted babies.

Retired Canadian LLL Leader and transgender dad Trevor MacDonald writes that, "It is equally important to note that some trans people experience severe gender dysphoria when breast or chestfeeding, and that they may decide not to nurse their babies for mental health reasons. Trans parents choosing to breast or chestfeed and those choosing to suppress lactation and bottlefeed may require the support of breastfeeding counsellors or lactation professionals." 2 It is also the case that some parents with gender dysphoria choose to pump and bottlefeed their milk to their baby. Whether you are pregnant, nursing your baby, pumping your milk, using donor milk, mixed feeding or considering your options La Leche League is here for you.

Please note that some of the links in this post will take you to articles or websites where you may notice gendered language.

Amazing milk

One of the concepts La Leche League is founded on is that: human milk is the natural food for babies, uniquely meeting their changing needs.

Human milk is amazing. It has everything a growing baby needs in exactly the right amounts and babies can easily digest it all. Research shows that a baby who is not fed on human milk is more likely to suffer from illnesses and diseases, both as a child and later in life.
By meeting your baby's needs for warmth, food and security at your chest you give them a secure attachment so they can develop into a conﬁdent child.

Skin-to-skin

Skin-to-skin contact is beneficial for babies and parents; it simply means holding your naked baby on your bare chest. You can drape a blanket over you both for warmth. Within minutes, you will see the benefits of skin-to-skin as you and your baby relax. Your baby's body temperature, breathing, and heart rate will stabilise. Babies often latch on and nurse more efficiently during and after skin-to-skin contact.

It is a lovely way to nurture your baby even if you are not nursing.

Your milk supply

Some transgender and non-binary parents have a full milk supply.

If you have had chest (top) surgery you may be able to produce some milk. Many factors will affect the amount of milk you can make.

Two reasons that a trans man or non-binary individual might have a reduced milk supply are:

1. Milk-making tissue has been surgically removed, and/or ducts have been damaged in surgery.

2. Testosterone interferes with the hormone necessary for lactation (prolactin) and can cause a significant decrease in milk supply. However, taking testosterone would not prevent someone from using an at-chest supplementer and having a nursing relationship.

Trans women can use a protocol similar to adoptive and other non-gestational mothers and stimulate their milk supply: it is called the Newman-Goldfarb protocol. You can read more here and here. A number of different protocols are described here. Our article about Breastfeeding Without Giving Birth may also be useful. Transfeminine nursing parents may also need to take the hormone spironolactone to suppress their testosterone. Read a case report of induced lactation in a transgender woman here.

You can also give human milk or formula supplements using an at-breast supplementer. Your healthcare provider can help you look at your options, and your local LLL Leader can offer support with your breast or chestfeeding goals and journey.

You may find the following websites have useful information, you may notice gendered language in them:

Many parents worry about whether their baby is 'getting enough'. LLL meetings are a good place to get support from others.

These LLL posts are great for checking signs your baby is feeding effectively, you may notice gendered language in them:

Using a nursing supplementer

If your baby needs a supplement of expressed milk or formula you might want to consider using a nursing supplementer. Doing this can give your baby that extra milk while they are nursing.
Supplementers can help parents have an at-breast or at-chest relationship with their baby whether or not they are able to produce milk.

This post has lots of useful information about nursing supplementers.

Read about a transgender dad's experience of using a supplementer here.

Read a mother's story about the long term use of a supplementer here.

Milk sharing

Some transgender and non-binary parents use milk banks to acquire human milk for their babies. La Leche League fully supports the use of human milk for babies; we cannot facilitate or set up milk sharing networks, though your local LLL Leader can help you with contact information for non-profit human milk banks, other regulated collection centres, and formal/medically supervised or informal milk sharing networks. ³
Human milk banks provide pasteurised, screened donor milk. In some countries (for example the US) it may be pooled - this means milk from different donors is mixed. In some countries, and individual milk banks, milk pooling is not carried out.

There are documented benefits and risks to informal milk sharing. Benefits of human milk include, but are not limited to:

Optimal nutrition

Easy digestibility

Immunological protection

Risks of sharing milk can include, but are not limited to:

Transmission of certain infectious agents, like bacteria or viruses, some of which may be found in milk expressed by asymptomatic people

Medicines and other drugs

Environmental contaminants as a result of unhygienic storage and handling of unprocessed donated milk

Human Milk for Human Babies (HM4HB) is an "informed milk sharing network", and is an international organisation that many parents use to source human milk. Another organisation is Eats On Feets, it offers more information about safe milksharing practices, you can find resources here http://www.eatsonfeetsresources.org/ and a world map with milksharing chapters around the world here http://www.eatsonfeets.org/

LLL Support

All nursing parents need support and La Leche League is a great place to find it.

There are LLL groups in over 80 countries across the world, many offer meetings open to all - contact your local group to find out how they can support you.

Many groups also have private Facebook groups where you can ask questions and connect with other nursing parents.

LLL meetings are held in a wide range of venues - LLL is not affiliated to, and does not endorse or support, any business, organisation or religion whose premises we use.

Other support

Queer and genderqueer inclusive LLL Facebook group for support 'Inducing Lactation & Relactation'International Facebook group for 'Birthing and Breast or Chestfeeding Trans People and Allies'
International Facebook group for 'Trans Feminine Breastfeeding and Lactation Support'
Please ask to join the 'Trans Feminine Breastfeeding and Lactation Support' group from within the 'Birthing and Breast or Chestfeeding Parents and Allies' group.

LLL Resources

Breastfeeding Without Giving Birth
My journey: non-binary nursing, a story from LLLUSA
Sostengo per genitori transgender e non binari, LLL Italia
Información general: Transgénero/transexual/ Género fluido, La Liga de la Leche de Euskadi
Lactancia materna. Apoyando a mujeres transexuales, La Liga de la Leche de Euskadi
Lactancia. Apoyando a hombres transexuales, La Liga de la Leche de Euskadi Apoyo Para Parentalidades Transgénero Y No-Binarias, LLLI

OTHER RESOURCES

Adapted from an article first published by LLLGB - https://www.laleche.org.uk/support-transgender-non-binary-parents/
References
1 La Leche League International Bylaws, Section 1: General Purpose
2 http://kellymom.com/bf/got-milk/transgender-parents-chestbreastfeeding/?fref=gc
3 https://llli.org/breastfeeding-info/milk-donation/#Milk

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Transgender & Non-binary Parents - La Leche League International

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Support for Transgender & Non-binary Parents La Leche League is an international, nonprofit, nonsectarian organisation.1 LLL supports everyone who

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The Beginning Breastfeeding Online course is facilitated by LLL Leaders

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Making up infant milks safely - FSN Trust

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Making up infant milks safely - FSN Trust

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Great resources explaining how to make up baby formula safely, information about preparation machines, hot taps, etc

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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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Introducing solids -  A guide to introducing solids and eating well up to baby's first birthday

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Introducing solids -  A guide to introducing solids and eating well up to baby's first birthday

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A comprehensive guide to complimentary feeding -all for free!

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

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

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

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

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Eating well in the first year - First Steps Nutrition Trust

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

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Weaning your baby / starting solid foods

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Weaning means introducing your baby to solid foods alongside their usual breast milk or infant formula. We’re here to guide you through the journey.

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There are many causes of nipple and breast pain. Nipple thrush is one possible cause, although it is often wrongly or over-diagnosed before other possibilities have been investigated. A skilled breastfeeding supporter can help you rule out other possible causes before a thrush diagnosis is made.

What is thrush?

Thrush is a yeast infection, usually caused by the fungus Candida albicans . Thrush likes warm, dark and moist environments, and it might grow on your nipple.

Candida albicans is naturally present in our bodies and usually it causes us no harm; however, certain things can create an imbalance in the body and cause an overgrowth. These include:

Previous nipple damage.

If you have thrush affecting any other part of your body, or if another family member has a thrush infection.

If you or your baby have been treated with antibiotics or corticosteroids.

If you take the contraceptive pill.

Bottle or dummy use, especially in the early weeks after birth.

Anaemia or diabetes.

Exhaustion and stress.

Diagnosing thrush

Thrush is diagnosed by symptoms and/or by looking at mother and baby. Sometimes culture samples are taken. This is known as swabbing.

There are different views about swabbing. Some breastfeeding organisations recommend swabbing to confirm thrush species can be easily singled out in the laboratory when present in milk, there is a lack of consistent rules for milk sample, collection, storage and analysis globally. ¹. However, some studies say that swabbing is neither reliable nor accurate, as Candida can be part of the normal healthy skin surface. Although the ²

Swabbing is more complex than just 'taking a test'. It does not always give a clear thrush diagnosis, or confirm if the pain is due to thrush or a bacterial infection. The roles of bacteria and yeast in relation to nipple and breast pain during breastfeeding remain unclear. It is also possible to have both and on the nipples without any symptoms.

Thrush symptoms

There can be many causes of 'thrush-like' symptoms. Nipple and breast pain is likely to be caused by something OTHER THAN thrush if:

Breastfeeding has always been painful.

Your nipples are flattened, wedge-shaped or appear white after feeds.

Your baby has no symptoms.

Signs of thrush in the nursing parent may include:

A burning feeling in the nipples, especially after every feed.

Itchy nipples that may be sensitive to touch.

Flaking and/or shiny skin on the nipple or areola. Nipple skin and areola may be red on lighter skin and darker brown, purple or grey on darker skin. This can be more difficult to see on darker skin tones.

White patches/tiny blisters on the nipple or areola.

A loss of colour in the nipple or areola.

A nipple wound which is not healing despite appropriate management.

Nipple pain which:

Gets worse during feeds and may continue after a feed.

Begins suddenly after a period of pain-free breastfeeding.

Happens on both sides.

According to research, thrush is more likely to be a cause of painful nursing if the following symptoms occur together:

Shiny nipple/areola with stabbing pain

Flaky nipple/areola and mammary pain.³

Pain may be felt deep in the breast; however, deep shooting pain between feeds, previously said to be a secondary infection in the milk ducts, is more likely to have a different cause.

Signs of thrush in the baby include:

White patches on the cheeks, tongue, roof of mouth or gums. When wiped off they may look red or bleed.

Fussing during and between feeds due to pain.

A white coating on the tongue alone is not a sign of thrush as most nursing babies have a white, milky coating on their tongue (sometimes this may be as a result of poor tongue function). Nappy rash and fussiness may also have other causes.

Not Thrush? Alternative causes

Other conditions that can result in 'thrush-like' symptoms may include:

Bacterial infection

Bacterial and thrush infections of the nipple can have similar symptoms, such as burning pain and soreness. Staphylococcus aureus (Staph.) is the most common bacteria associated with breast infection. With a bacterial infection of the nipple there may be:

It is possible for you to have both thrush and a bacterial infection.

Shallow latch

When the latch is shallow, the nipple is squashed, causing pain on the nipple and sometimes deeper within the breast. This may damage the nipple and increase the possibility of a bacterial infection. Even when thrush is the cause of sore nipples, a deeper latch can make it less painful.

You can read more about Positioning and Attachment here.

Skin conditions

Skin conditions, such as eczema or psoriasis, can affect the nipple area. Some people may also have sensitivities to nipple balms containing lanolin. If you have a history of skin allergies or a similar problem elsewhere on your body, discuss this with your GP. A dermatology referral is sometimes necessary.

You can read more about causes of nipple pain here.

Subacute Mastitis

Mastitis is inflammation of the breast. This may or may not be caused by a bacterial infection.

Often, the general term 'mastitis' is used to mean one type of breast inflammation. However, it may help to think of mastitis as being on a spectrum, with blocked ducts at one end and abscess at the other.

Different types of bacteria may be involved in breast inflammation. Some of these do not cause fever or flu-like symptoms, but you may still experience painful breastfeeding, needle-like burning pain and engorgement. Some researchers have suggested the term 'subacute mastitis' to describe inflammation of the breast without fever or flu-like symptoms. These researchers believe that the term 'mammary candidiasis' (thrush) should be avoided and replaced by 'subacute mastitis'.

You can read more about mastitis and treatment of mastitis here.

Vasospasm

Vasospasm is a sudden narrowing of the blood vessels. The main cause of nipple vasospasm is a shallow latch. When the nipple is squashed it may turn white or change shape. As blood flows back to the nipple, it causes pain on the nipple and deeper in the breast. Deep breast pain is sometimes called 'Mammary Constriction Syndrome'. Tension and positioning may add to deep breast or muscle pain.

Vasospasm is also connected with the circulatory condition Raynaud's Phenomenon. A history of Raynaud's may increase the likelihood of it happening during breastfeeding. Symptoms may happen in response to cold and separately from breastfeeding.

Thrush treatments

When thrush is diagnosed, it is recommended that both mother and baby are treated at the same time, even if one is symptom free, as they may pass a thrush infection back and forth between them. Breastfeeding should continue if thrush is diagnosed.

Medications for the nursing parent:

The most effective treatment for topical thrush is Miconazole (Daktarin) cream (2%), which should be applied to the nipple in small amounts after every feed. In mild cases, expect improvement within a couple of days. In more severe cases, it may take 3 to 5 days or longer. Sometimes, symptoms get worse before they get better.

If nipples are very inflamed, a mild steroid cream (hydrocortisone 1%) can be used to facilitate healing.

If symptoms do not improve, oral fluconazole may be required in addition to the above. A higher initial dose of 150-400mg is prescribed, followed by 100-200mg daily for at least 10 days. It may take a week or longer for the pain to disappear.

Mothers may also be prescribed nystatin (Nystan) cream or ointment, or clotrimazole (Canestan) cream. However, both are considered to be less effective than other options and clotrimazole is associated with allergic reactions.

Thrush can spread to other family members. Therefore, it may be necessary to treat partners and, if breastfeeding more than one child, the sibling.
Comfort options

Rinse nipples with clean water and let them air dry after each feeding.

Place something cold on your nipples before nursing. If cold or air drying increases the pain, it may be related to nipple vasospasm (see above).

Take mild over-the-counter pain medication.

In the short term, express milk and offer it to your baby by another means if feeding is too painful.

Medications for the baby:

Miconazole (Daktarin) oral gel four times a day after feeds. Manufacturers recommend that this is not used in babies under 4 months due to risk of choking. Healthcare providers must ensure that the parent/carer is aware of how to apply the gel safely if prescribed under this age.

Nystatin (Nystatin) oral suspension may be prescribed, but this is considered less effective than miconazole gel.

Neither miconazole gel or nystatin suspension should be applied to the mother's nipples.

Non-medical treatment options:

Practical, self-help measures you can take to combat thrush alongside medication include:

Frequent hand washing, particularly after nappy changes or using the toilet.

Having a separate towel for each person in the family, or at least for you and your baby.

Keeping nipples dry. Avoid breast pads, if possible, or throw away/change frequently.

Wearing 100% cotton bras and underwear.

Washing towels/clothing at 50 °C or above. A hot iron can also kill yeasts.

Washing and sterilising dummies, nipple shields, teats and toys frequently.

Replacing toothbrushes, toiletries and cosmetics.

Reducing sugar, yeast, dairy products and artificial sweeteners.

Rinsing nipples with vinegar in water or baking soda in water after every feed.

Switching to a non-antibacterial hand soap.

Taking herbal supplements and vitamins, such as grapefruit seed extract, garlic, B vitamins and zinc.

Anecdotally, some mothers find it helpful to take a probiotic, such as lactobacillus acidophilus.

If there is no improvement following prescription medications and self-care measures, then it may be worth considering if the original diagnosis of thrush is correct.
Expressing milk

Previously, parents were advised to avoid expressing and storing milk during a thrush infection to avoid possible re-infection, as freezing does not kill yeast. However, there is currently no evidence to suggest that this will happen.

If you are worried about using expressed/stored milk during a yeast infection, you can either use it while you and your baby are being treated for thrush, or you can warm the milk to 63 °C for 30 minutes to kill bacteria and yeast, before cooling and offering.

Current/ongoing research

Research has been carried out on both breastfeeding and non-breastfeeding, non-pregnant women in order to learn more about yeast infections of the nipple and reliable ways of confirming this.

There are different views about the presence of nipple thrush and how accurately it is diagnosed. One study suggests that the evidence supporting a link between nipple/breast pain and thrush is "non-scientific" and largely anecdotal, without the support of a proper microbiological analysis.

Others believe that since thrush does not grow on normal skin, damage of the nipple and areola as a result of a shallow latch is the real problem and that, unless this is dealt with, nipple thrush will remain difficult to treat.

In summary

Candida albicans is naturally present in our bodies and finding an overgrowth can be difficult. Furthermore, the relationship between and the role of fungus and bacteria in relation to nipple/breast pain is unclear.

More research is needed to understand how common nipple thrush is and to find reliable ways of confirming this.
Further LLLGB reading
Blocked Ducts & Mastitis
Comfortable Breastfeeding
Nipple Pain - Why and What to do?
Positioning & Attachment
The Unhappy Breastfed Baby
References
1. The Breastfeeding Network Drugs in Breastmilk Information. Thrush and Breastfeeding, May 2020
(accessed 18th September 2022).
2. Jiménez E, Arroyo R, Cárdenas N, et al. Mammary candidiasis: A medical condition without scientific evidence? PLoS ONE, 2017; 12(7):
e0181071.
3. Mohrbacher, N. Breastfeeding Answers Made Simple. TX: Hale Publishing, 2012; 727.
4. Ibid., 728.
5. Ibid., 724.
6. Jiménez E, Arroyo R, Cárdenas N, et al. Mammary candidiasis: A medical condition without scientific evidence? PLoS ONE, 2017; 12(7):
e0181071.
7. Mohrbacher, N. Breastfeeding Answers Made Simple. TX: Hale Publishing, 2012; 755.
8. Ibid., 730.
9. Ibid.
10. The Breastfeeding Network Drugs in Breastmilk Information. Thrush and Breastfeeding, May 2020, (accessed 18th September 2022).
11. The Breastfeeding Network Drugs in Breastmilk Information. Miconazole Gel and the Breastfed baby with Oral Thrush (Candida), May 2020, (accessed 16th August 2022).
12. Jiménez E, Arroyo R, Cárdenas N, et al. Mammary candidiasis: A medical condition without scientific evidence? PLoS ONE, 2017; 12(7):
e0181071.
13. International Breastfeeding Centre. Candida Protocol, 2021, ibconline.ca/information-sheets/candida-protocol/ (accessed 18th September
2022).

Further Reading

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2013/10/NIFN_statement_thrush_2014.pdf
https://laleche.org.uk/positioning-attachment/
https://laleche.org.uk/mastitis/
https://www.llli.org/breastfeeding-info/thrush/
https://breastfeeding.support/thrush-on-nipples/
https://breastfeeding.support/nipple-vasospasm-breastfeeding/
https://cks.nice.org.uk/topics/breastfeeding-problems/management/breastfeeding-problems-management/

Written by Charlotte Allam.

LLLGB copyright. Updated October 2022.

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Thrush and Breastfeeding - La Leche League GB

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
Raynaud's phenomenon affects up to 10% of otherwise healthy women aged 21-50 years of age. It is 9 times more common in women than men. It was first described by Maurice Raynor 1862 who referred to "local asphyxia of the extremities" and "episodic digital ischaemia provoked by cold and emotion. Originally it was described as affecting mainly fingers and toes but it can affect ear lobes, nose and lips as well as parts of the body.

The first published study of the impact of Raynaud's phenomenon on breastfeeding was published by Coates (1992)
[Printable version of this sheet includes images for descriptions at Fig.2 below - click to view] Fig. 2 Tri colour changes in the nipple affected by Reynaud's disease (reproduced from Holmen 2009)
The mother took the photographs above on a camera phone. The mother was 25 years old and described pain in both breasts lasting 5-15 minutes after feeds. Symptoms began in the second week after her child's birth. She had no medical history of poor circulation but suffered migraines. She did not smoke and had never undergone breast surgery. Nipple pain began in pregnancy but resolved immediately after delivery at 38 weeks gestation. The baby weighed 2.8kg. Breastfeeding technique was checked at 2 weeks post partum when the unbearable pain began. Prescription of Nifedipine produced resolution of the pain totally within a week but it re-occurred when the drug stopped. The mother took nifedipine 30milligrammes daily for 12 months and breastfed for a total of 18 months

Lawlor-Smith and Lawlor-Smith (1997) studied 5 patients with severe, debilitating nipple pain. Three had had symptoms during other lactations: one gave up breastfeeding at 6 weeks, another breastfed for 14 months, and the third breastfed for 7 months despite the pain. In all women the cold precipitated pain. All five exhibited blanching during, after, and between feeds. None of them smoked and 2 had history of Reynaud's, 2 others had parents with Reynaud's.

There are other case reports where women have been diagnosed with thrush and treated with oral or topical antifungal medication (Barrett). Among the 22 patients with Raynaud phenomenon of the nipple studied, 20 (91%) had previously been treated for Candida with oral or topical antifungals without effect. Of the 12 patients who tolerated a trial of nifedipine, 10 (83%) reported decreased or resolved nipple pain. All patients experienced marked improvement of symptoms with appropriate therapy involving treatment of Raynaud phenomenon. They reported that Nifedipine appeared to be an effective medication for the treatment of Raynaud phenomenon of the nipple and associated improvement of nipple pain.

One study suggested that a mother's stress increased the severity of symptoms.

Pain which worsens in the cold e.g. passing fridges in the supermarket or even exposure of the nipple to feed

Bi or tri-phasic colour changes immediately after feeds

History of circulation problems or close family history of circulation problems

Early delivery of baby or small baby - due to vasoconstriction of placental blood vessels

Optimisation of attachment should be undertaken before considering medical treatment.

stop smoking Even 2 cigarettes a day are enough to increase constriction of blood vessels by 100% and reduce blood flow by 40%.

limit caffeine intake (both nicotine and caffeine constrict blood vessels). Caffeine is not just in tea and coffee but also in soft and energy drinks as well as some painkillers

avoid getting cold, and try moderate aerobic exercise (Cardelli 1989).

rub the nipples gently with warm oil immediately after feeds or cover the breast immediately with a warm heat- retaining compress eg wheat bag.

avoid decongestants (in cold remedies), the contraceptive pill and fluconazole which can make symptoms worse

High doses of vitamin B6 (Newman 2012), magnesium (Smith 1960, Turlapaty Leppert1994), calcium (DiGiacomo 1989), fatty acids (Belch 1985) and fish oil supplementation (DiGiacomo 1989) have also been suggested but take a minimum of 6 weeks to be effective.

Ginger 2000mg-4000mg daily. Capsules usually contain 500mg. It may also be beneficial to add ginger to your diet, to drink ginger tea, or to put a spoonful of ground ginger in your bathing water (Royal Free hospital http://www.royalfree.nhs.uk/pip_admin/docs/Raynaudsnatural_186.pdf

Symptoms can be successfully managed by the use of nifedipine 30milligrammes daily (10milligrammes capsules three times a day or long acting tablet 30milligrammes daily) for two weeks. Some women need ongoing medication but many find symptoms resolve by this stage. However the drug produces flushing particularly of the face and headaches which some women find intolerable.

Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Raynaud Phenomenon of the Nipple in Breastfeeding Mothers: An Underdiagnosed Cause of Nipple Pain. Arch Dermatol. 2012 Dec 17:1-7.

Belch JJ, Shaw B, O'Dowd A, Saniabadi A, Leiberman P, Sturrock RD, Forbes CD.Evening primrose oil (Efamol) in the treatment of Raynaud's phenomenon: A double-blind study. Throm Haemost 1985; 54 (2):490-4.

Cardelli MB Raynaud's phenomenon and disease. Med Clin North Am. 1989; 73(5):1127-41

Coates M. Nipple pain related to vasospasm J.Hum.Lact 1992; 8(3):153

DiGiacomo RA. Fish oil supplementation in patients with Raynaud's's Phenomenon: a double blind, controlled, perspective study. Am J Med 1989; 86:158 ‐ 64

Holmen L and Backe B. Underdiagnosed cause of nipple pain presented on a camera phone. BMJ 2009; 339:b2553

Kernerman E and Newman J Vasospasm ( www.drjacknewman.com/help/Vasospasm%20and%20Raynaud%E2%80%99s%20Phenomenon.asp

Lawlor-Smith L and Lawlor-Smith C Vasospasm of the nipple: a manifestation of Raynaud's's Phenomenon: case reports. BMJ 1997; 324:644

Leppert J, Myrdal U, Hedner T, Edvinsson. The concentration of magnesium in erythrocytes in female patients with primary Raynaud's phenomenon; fluctuation with the time of year. Angiology 1994; 45:283-8.

Natural remedies in Raynauds Phenomenon Royal Free hospital http://www.royalfree.nhs.uk/pip_admin/docs/Raynaudsnatural_186.pdf

Smith WO, Hammarsten JF, Eliel LP. The clinical expression of magnesium deficiency. JAMA 1960; 174:77-8.

Turlapaty P, Altura BM. Magnesium deficiency produces spasms of coronary arteries; relationship to etiology of sudden death ischemic heart disease. Science 1980; 208:198-200

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Raynaud's Phenomenon in Breastfeeding Mothers - The Breastfeeding Network

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

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'I'm worried I might not be able to breastfeed'

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'I'm worried I might not be able to breastfeed'

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I’m worried I might not be able to breastfeed - The Breastfeeding Network

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The vast majority of women CAN breastfeed, as long as they get skilled support when they need it. Some mums find it helpful to visit a local breastfeeding group and chat to other breastfeeding mums or a breastfeeding supporter about any worries they have before their baby is born. You can find information on our […]

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How to latch a baby using the exaggerated latch technique.

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Breastfeeding longer term: Still nursing? LLLGB

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Breastfeeding longer term: Still nursing? LLLGB

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Not so long ago you first held your tiny newborn and started on your breastfeeding journey together. Suddenly time has passed and you find yourself still breastfeeding an older baby or toddler – something you may never have envisaged doing! At this point you may wonder whether your child will end up ‘nursing forever’. For […]

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Breastfeeding longer term: Breastfeeding Beyond Infancy - ABM

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Breastfeeding longer term: Breastfeeding Beyond Infancy - ABM

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Breastmilk continues to be a valuable source of nutrients even when your child is eating a varied diet. Find out the benefits of breastfeed an older baby.

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Breastfeeding longer term:  Breastfeeding Beyond Infancy - a GP guide - ABM

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Breastfeeding longer term:  Breastfeeding Beyond Infancy - a GP guide - ABM

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown. For those families who do continue to breastfeed, it has a significant value that goes beyond nutritional or health benefits. Children allowed to continue breastfeeding will typically self-wean between the ages of 2 and 7 (natural term). A breastfed child eats normal solid foods alongside breastmilk, and they do not require any other mammalian milk (e.g. cow's milk). There is no evidence of harm to children or mothers who breastfeed to natural term. Breastfeeding beyond infancy is biologically normal: it should be celebrated and encouraged in mothers who wish to do so. It has health, economic and environmental benefits for the individuals involved as well as wider society; yet British culture is not generally supportive of natural term breastfeeding. Few GPs receive high quality lactation education, and thus may be inadequately informed to support families achieve longer term breastfeeding. This guide summarises the evidence available and how GPs can help. Effects on maternal and child health
Most GPs are aware of the vast array of benefits of breastfeeding babies (1), but may mistakenly believe that these benefits are time-limited. Breastmilk remains rich in vitamins, minerals and fats through toddlerhood and beyond (2,3), and immune components unique to human milk actually increase as the child ages (4). Children who are breastfed beyond 1 year have a reduced risk of acute otitis media (5), type 2 diabetes (6) and obesity (7). Breastfeeding beyond infancy may have psychological benefits for the child (8) and is an important source of comfort for young children. Many mothers find breastfeeding an invaluable parenting tool, by soothing a tired, injured or frustrated toddler and helping to promote sleep. Continued breastfeeding can prevent dehydration and malnourishment in unwell or hospitalised children, and is an ideal source of nutrition for 'fussy eaters'; parental attempts to increase solid foods in these situations can lead to displacement of nutrient-rich breastmilk (9). Breastmilk is particularly important for children with cow's milk protein allergy, as ready-made soya, oat, coconut or other milk substitutes are unsuitable under 2 years of age (10). There are also numerous benefits for mothers, but it should be noted that few (if any) mothers continue to breastfeed beyond 12 months solely for their own benefit. Benefits include a reduction in the risk of breast cancer (11), endometrial cancer (12) ovarian cancer (13), cardiovascular disease (14) and type 2 diabetes (15). Indeed, the UK government estimates savings of over £31 million for each annual cohort of new mothers through reduction of maternal breast cancer, if more women breastfed and did so for longer (16). There is no evidence in the literature of harm to either mother or child from natural term breastfeeding, including tooth decay (17). Production of toddler 'follow-on milks', which in ordinary circumstances are not proven to be necessary (18), undermine the International Code of Marketing of Breast-milk Substitutes and contribute to environmental impact (19).
Considerations for GPs

Mothers who breastfeed any age of child(ren) do not require any specific dietary adjustment or supplement apart from 10mcg Vitamin D daily (20).

It is very rarely necessary for a mother to stop breastfeeding in order to take medication (21). Many mothers will opt to delay treatment if a breastfeeding compatible medication is not prioritised. The BNF alone is an inadequate reference for safety in lactation, and GPs should check additional sources for more comprehensive information (22): we recommend UK Drugs In Lactation Advisory Service (NHS service) or The Breastfeeding Network.

Lactational Amenorrhoea Method of contraception is only suitable for use if the baby is under 6 months and has several strict criteria, as detailed by FSRH (23). Beyond 6 weeks of age, all hormonal forms of contraception (including COCP) are categorised as UKMEC 1 or 2 (24), however this is a complex area. Breastfeeding professionals frequently see mothers reporting a decrease in milk supply with all types of hormonal contraception, and GPs should be prepared to counsel women fully, including a discussion of the risks (25).

Women breastfeeding a baby or child of any age may develop sore nipples, engorgement, blocked ducts, mastitis or thrush and should be supported appropriately - see GP Infant Feeding Network for detailed information (26).

Supporting Breastfeeding
Breastfeeding is not always easy, and families who have reached 12 months may have overcome many challenges (27). Whilst many mothers report they receive good breastfeeding support in the early months, this reduces as their baby gets older (28). Lactation-specific education is scarce in UK medical schools and postgraduate training programmes, leaving many GPs ill-prepared to support natural term breastfeeding. Unsolicited advice to wean, unsupportive personal opinions or inaccurate information are all unhelpful to families who trust their GP, and may damage the doctor-patient relationship (29). US research has shown that even a very brief educational programme can improve doctors' attitude and knowledge towards breastfeeding beyond infancy (30). A doctor's personal experience of breastfeeding can affect their breastfeeding advocacy (31). Therefore, GPs who have had a negative personal experience of breastfeeding should ensure that any advice they give is evidence-based rather than anecdotal. Mothers who fear ridicule may choose to hide the fact that they breastfeed (32). But breastfeeding in public in the UK is protected by law, and there is no upper age limit to this (33). Mothers returning to work can successfully continue breastfeeding with appropriate support, and there is no need to wean unless she or the child wish to (34).

Nursing aversion (intense unpleasant emotions experienced whilst breastfeeding) may affect mothers, particularly of older children (35). Some mothers persevere for the benefit of their child; others may wish to wean. In either case, mothers benefit from their GP asking them about their wishes and then providing appropriate signposting to achieve this. Weaning from the breast may be mother-led or child-led (or a combination): natural child-led weaning is a gradual and gentle process and all children will eventually wean (36). Families should avoid abrupt weaning due to the risk of breast engorgement, mastitis and emotional distress for both mother and child. Some mothers fall pregnant whilst breastfeeding, and may continue to breastfeed their older child throughout their pregnancy and once their baby is born (tandem nursing). There is no evidence that breastfeeding during a normal pregnancy causes miscarriage or premature labour (37).

Mothers seeking breastfeeding support can contact the National Breastfeeding Helpline on 0300 100 0212, or can seek face to face support from Peer/Mother Supporters, Breastfeeding Counsellors or International Board Certified Lactation Consultants. IBCLCs are recognised as the gold standard in breastfeeding support and are available throughout the UK (38). GPs who wish to learn more about breastfeeding can do so via Unicef's e-learning package (39) or RCGP's e-learning course (40), which is free to College members. The ABM also offers their Breastfeeding Support Training Foundation Module (41), an online course suitable for healthcare professionals. Finally an online book for doctors has recently been published and is free to access (42).
Conclusions
In summary, GPs have an important role to play in helping to normalise and support breastfeeding beyond infancy. Breastfeeding mothers have a right to ongoing high standards of evidence-based healthcare for as long as they choose to continue. Breastfeeding beyond infancy benefits mothers, children and the NHS and thus should be actively supported by all GPs.
Dr Naomi Dow (GP) naomi.dow@nhs.scot Emma Pickett (International Board Certified Lactation Consultant, Chair of Association of Breastfeeding Mothers) Dr Vicky Thomas (Consultant Paediatrician with special interest in growth and nutrition)
Whilst we have used the terms 'mother', 'woman' and 'breastfeeding', we recognise that not all families use this terminology. We encourage GPs to use the terminology preferred by each parent or family.

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Breastfeeding Beyond Infancy a GP Guide - ABM

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown.