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Supporting Your Feeding Journey: The Breastfeeding Network Birmingham

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What is a nursing strike?

If a baby who has been quite happily breastfeeding suddenly starts to refuse the breast it could be a "nursing strike". Sometimes this can be mistaken for the baby wanting to stop breastfeeding, but a baby who is ready to wean usually does so over a period of time. In nursing strikes the baby seems unwilling to feed even though he appears really unhappy about it.

Something happens which makes your baby not want to feed and it can take time and patience to help them return to the breast. Nursing strikes are nearly always a temporary reaction to something which has happened and the cause may never be discovered. ¹

What might cause a nursing strike?

The term nursing strike relates to an older baby who suddenly refuses to feed. If you have a newborn baby who is not feeding, please refer to our article about When my baby won't breastfeed for more information.
Sometimes the cause is physical:

The baby might have a stuffy nose or earache which is making feeding uncomfortable.

They might have a sore throat or mouth. Some mothers have found a little injury such as a cut in their baby's mouth or an ulcer which hadn't been noticed.

Hand, foot and mouth disease or chickenpox can cause a nursing strike as it is so uncomfortable to feed.

They could have sore gums from teething, a thrush infection or even a urinary tract infection.

They may be uncomfortable from a vaccination.

They might be frustrated at a low milk supply or a change in milk taste due to something the mother has ingested. An oversupply of milk could also sometimes scare a baby who finds the flow overwhelming.

Sometimes the cause is emotional:

A common cause of a sudden nursing strike is the baby being startled in some way while nursing, perhaps by a loud noise or by a mother involuntarily exclaiming when the baby bites.

A mother may have been feeling stressed because of moving house, having visitors, travelling or dealing with a family crisis and put off nursing and the baby senses her distraction.

A mother has changed her deodorant, soap, body lotion or perfume and so smells "different" to her baby.

A new job may have meant a change in nursing habits or the baby being left with another carer for longer periods of time. Attempts to regulate nursing or offering too many bottles or dummies could also contribute to a baby refusing to breastfeed.

What can help end a nursing strike?

If illness or injury might be the cause, then consulting a doctor about medication could be useful.

Some babies will nurse, sometimes reluctantly, at night. Trying to nurse the baby in their sleep or when they are sleepy can work: it keeps them fed and helps with your milk supply.

Trying to force your baby to feed won't work and a baby will often get upset if a mother tries. Although it's hard, being relaxed and offering cuddles and skin-to-skin contact helps keep you feeling close.

Sing or rock the baby with your shirt open so perhaps they will relax and instinctively latch on.

Sitting in a quiet room with dimmed lights and no distractions may help.

Try taking a bath together.

If you can get help around the house and with other children it means you can spend more time just relaxing with the baby.

Try nursing somewhere different, while walking around, using a baby sling, sitting in the car, outside or at a friend's house. You can also try a completely different position such as facing you or vertical. Some mothers have tried facing away from a room so that the baby can see what is happening while nursing.

Rocking, dancing or doing the "baby bounce" (starting small but getting bouncier and bouncier) while holding him in a nursing position might help. Some babies love this, others don't.

Stimulate your let-down and get your milk flowing before offering the breast so the baby gets an immediate reward. You can also offer the baby something else to suck before offering to nurse so he is in "sucking" mode!

If the baby continues to get upset when offered the breast it is sometimes necessary to stop offering for a day or two and let things settle down. You can then make it clear that your breast is available without forcing the issue. See the section below on milk supply for suggestions on preventing a drop in your milk production.

If a baby has a sore mouth, some mothers have found offering breastmilk ice lollies before a feed can help to numb the mouth and make nursing more comfortable. Expressed breastmilk can also be frozen in cubes and offered in a clean cloth/muslin to suck on. This can be useful for a teething baby. Other mothers have offered a child analgesic as appropriate before trying to nurse.

Sometimes these ideas will need to be repeated for a few days before things get back to normal.

Here are a couple of unusual ideas to try

One solution that has worked for some mothers is to sit on an office chair, holding the baby in your lap but not at your breast. Ask someone to spin the chair around; not too fast but until you feel a little dizzy, and then offer the breast. It seems that being a little disorientated stimulates a natural instinct to go to the breast.

Something which has also worked is for the mother to pretend to nurse a doll or cuddly toy, causing the baby to want his comfort back from the intruder!

What about my milk supply during a strike?

It's natural to want to give the baby lots of other food and drink while they aren't nursing. As as long as they are healthy, continue to offer their usual food and water but don't rush to replace all their nursing needs with extra food immediately. Pumping or hand expressing will maintain your milk supply and help prevent you from getting uncomfortably full, which might lead to plugged ducts or mastitis.

If the nursing strike continues for more than a day you can offer expressed milk in a cup, eye-dropper, feeding syringe or spoon. It is best to avoid bottles as they can cause nipple confusion.

Nursing strikes are distressing for mother and baby

It can be really upsetting and frightening to have a baby who has suddenly lost their main food source, their biggest comfort and a lovely way to fall asleep. You want to comfort your baby but they turn away. It can help to remember that your baby isn't rejecting you. They don't understand why breastfeeding is uncomfortable, they just think it is causing discomfort and they are scared to try it again, even if the original problem is sorted out.

Almost all nursing strikes are temporary and end happily, although not necessarily quickly. Some mothers have reported nursing strikes that lasted almost three weeks, but more often the baby goes back to breastfeeding in a few days.

Even if your baby doesn't immediately return to the breast you can continue to offer for as long as you want to. If it really does turn out to be the end of breastfeeding, allow yourself to be sad and grieve for its sudden ending. Breastfeeding ideally continues until both the mother and baby are ready to stop, but sometimes the baby makes the decision for you both in spite of a mother's efforts. (For more on how it feels after your baby weans, you may find this article helpful: After weaning - what next?)

Note: If you have a newborn baby who is refusing to feed this is not a nursing strike.
See these posts for help or get support from an LLL Leader:

My Baby Won't Breastfeed
Sleepy Baby: Why and What To Do
Jaundice
Beginning Breastfeeding
Is My Baby Getting Enough Milk?

Written by Anna Burbidge for LLLGB, 2017

1 The Womanly Art of Breastfeeding 8 th Edition, pages 407-409.

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What is a nursing strike? If a baby who has been quite happily breastfeeding suddenly starts to refuse the breast it could be a "nursing strike". Sometimes this can be mistaken for the baby wanting to stop breastfeeding, but a baby who is ready to wean usually does so over a period of time.

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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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Feed Your Way - Making Nottingham a breastfeeding-friendly city

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Feed Your Way Birmingham Whether you’re beginning your journey, expressing, combination feeding, or working through challenges, Feed Your Way Birmingham connects you with local advice, services, and community support - helping you feel confident at every step. About us Feed Your Way Birmingham is a city-wide initiative created alongside local families to support parents in every part

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Infant Feeding support for Solihull Parents

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Infant Feeding support for Solihull Parents

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Solihull.IFT | Instagram, Facebook | Linktree

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An NHS team offering feeding support and online classes to families in Solihull.

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The Breastfeeding Network Birmingham service overview (video)

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Nishkam Start of Life Care FREE Antenatal Classes

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Funded by Birmingham and Solihull ICS, we provide an antenatal course consisting of 10 free expert-led antenatal classes, in a safe, culturally appropriate setting, to support women through pregnancy, with a focus on self-care, emotional wellbeing, peer support, and preparation for pregnancy, birth and afterwards.

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Nishkam Start of Life Care Antenatal Course | Nishkam Centre

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Join our FREE Antenatal Classes taking place in Birmingham to empower mothers through pregnancy, birth and beyond.

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It's up to you and your baby to decide when you want to finish breastfeeding.

How long to breastfeed

It's recommended that you breastfeed your baby exclusively (give them breast milk only) for the first 6 months of their life.

Breastfeeding still has lots of benefits for you and your baby after 6 months. It protects them from infections and there's some evidence that it helps with the digestion of your baby's first solid foods. It also continues to provide the balance of nutrients your baby needs.

The World Health Organization recommends that all babies are exclusively breastfed for the first 6 months of their life, and from 6 months babies should start eating solid foods as well as being breastfed for up to 2 years or longer.

If you're not sure whether to continue with breastfeeding, contact the National Breastfeeding Helpline on 0300 100 0212 (available every day, 9.30am to 9.30pm).

Read more about the benefits of breastfeeding

Stopping breastfeeding gradually

There's no right or wrong way to stop breastfeeding. For lots of mothers and babies, stopping breastfeeding happens gradually as the child grows and eats more solid foods.

It's important that solid food should not simply replace breast milk. There's evidence that breast milk may play a part in helping a baby's digestive system to deal with their first solids.

Once they're eating solids, your baby will still need to have breast milk or formula as their main drink up to at least their 1st birthday.

Cows' milk is not suitable as a main drink for babies under 1 year old, although it can be added to foods, such as mashed potatoes.

Carrying on breastfeeding while giving your baby some formula can work very well.

Babies breastfeed for comfort as well as food. Phasing out breastfeeding gently will give you both time to get used to the idea. Stopping gradually will also help prevent problems like overfull, hard (engorged) breasts and mastitis.

You'll probably find it easiest to drop 1 feed at a time. It does not matter which feed you drop first, so it will usually be a case of how it fits in with your life. For example, some mothers may prefer to continue night feeds so their baby can still have the comfort at night.

If your baby is younger than 1 year, you'll need to replace the dropped breastfeed with a formula feed from a bottle or (if they're over 6 months) a cup or beaker, instead.

If your child is over 1 year and having a variety of foods and drinks, they will not need a replacement feed.

Once you and your baby are settled into a pattern of having 1 less breastfeed, you can then think about dropping another feed. Completely stopping breastfeeding can take anything from a few weeks to several months.

If you're trying to stop breastfeeding and having problems, you can get help and ideas from a health visitor or a breastfeeding specialist.

Read more about drinks and cups for babies

Combining breast milk and formula

Some women decide to combine breastfeeding and bottle feeding with formula milk rather than stopping breastfeeding completely.

If you want to do this, it's best to wait until your milk supply is fully established. This can take around 6 to 8 weeks.

You can start by replacing 1 of your baby's regular daily breastfeeds with a bottle (or, if your baby is over 6 months, a cup or beaker) of formula, instead.

Common reasons for stopping breastfeeding

Sore or painful breasts

Some women find breastfeeding uncomfortable, especially in the early days and weeks. Common problems include sore or cracked nipples and painful breasts.

These problems can often happen when your baby is not positioned or attached well at the breast. A midwife, health visitor or a breastfeeding specialist can help you with positioning your baby and getting them properly attached.

Not enough breast milk

Lots of women worry that their baby is not getting enough milk when in fact they have plenty to meet their baby's needs.

A midwife, health visitor or breastfeeding specialist can suggest ways to increase your milk supply if necessary. This could just mean making sure your baby is well attached to the breast and that you're feeding often enough.

Going back to work

Some women worry about breastfeeding and returning to work. Going back to work does not necessarily mean you have to stop breastfeeding.

If your breast milk supply is well established, going back to work does not have to affect your milk supply for your baby. You can either express at work, give your breast milk to your child's carer, or provide formula milk while you're away.

If your employer is not familiar with the rules around breastfeeding and expressing in the workplace, it's worth sharing the ACAS guidance on pregnancy and maternity with them, or contacting your union if you have one.

Going on holiday

As with work, going on holiday does not mean that you have to give up breastfeeding. In fact, breastfeeding can be more convenient while you're away.

If you breastfeed, you do not need to worry about boiling water and sterilising feeding equipment. Plus, if you're flying, there's no need to worry about restrictions on carrying bottles or cups of formula through airport security checks.

Breastfeeding also helps to equalise the pressure in your baby's ears on take-off or landing.

Getting pregnant again

If you get pregnant again while you're breastfeeding, it should not affect your baby or the pregnancy. However, you may feel tired, and changes in your appetite and emotions can make breastfeeding more challenging.

Do not be put off feeding an older baby and a newborn (tandem nursing). The more milk your babies take, the more your breasts produce, so it's possible to feed more than 1 baby.

Taking some medicines

Most medicines can be taken while you're breastfeeding without harming your baby.

But it's always best to tell a doctor, dentist or pharmacist if you're breastfeeding.

Read more about breastfeeding and medicines

Restarting breastfeeding after stopping

Stopping breastfeeding does not always have to be permanent, but starting again may take a lot of time and not everyone will produce enough to meet their baby's needs. It partly depends on how well-established your milk supply was already.

Stimulating your breasts by expressing breast milk and offering the breast to your baby regularly can encourage your body to start making milk again.

Skin-to-skin contact with your baby can promote lactation (milk production) too.

You can ask a midwife, health visitor or a breastfeeding specialist for help if you would like to restart breastfeeding.

Breastfeeding older children

There's no reason why you should not continue breastfeeding your child into their 2nd year and beyond. You and your toddler can continue to enjoy the benefits of breastfeeding for as long as you want to.

Your toddler may also find breastfeeding comforting when they're ill or upset.

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Thinking of stopping breastfeeding? Find out how to wean your baby off the breast once you're both ready to stop.

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Ending your breastfeeding journey: some approaches to parent-led weaning

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Ending your breastfeeding journey: some approaches to parent-led weaning

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Making the decision to end breastfeeding
Breastfeeding support is all about helping you to breastfeed for as long as you want to. We want families to reach their breastfeeding goals, and that means Breastfeeding Supporters are here for parents at the end of their breastfeeding experience, as well as at the start. Some families want to breastfeed for years. Some want to for months or weeks. If you are able to make the decision with the right information and feeling supported, we have done our job.

We want to make sure that you make the decision to end breastfeeding in a way that you will have peace with in the future. If you are struggling with breastfeeding, it may be that the right support can resolve issues and you can continue breastfeeding happily. We would want all avenues to be explored if the idea of ending breastfeeding is an unhappy one.

Are you hoping that ending breastfeeding might improve your child's sleep? It's important that parents understand what's normal when it comes to how babies sleep: "No difference in night wakings or night feeds was found between mothers who were currently breastfeeding or formula feeding ... Breastfeeding has no impact on infant sleep in the second 6 months postpartum." (Brown and Harries 2015)

You might have been told you have to end breastfeeding to take a medication and the Drugs in Breastmilk Information Service can provide evidence-based information on the compatibility of breastfeeding and medications. Sadly, parents are often misinformed.

It can be valuable for you to talk through your decision to end breastfeeding before starting the process. A breastfeeding supporter can help you reflect on your decision, as well as help you take some practical steps to get the process started. Every family's journey will be different because every child and parent's relationship to the breast is different. There is no 'one size fits all' approach to ending breastfeeding. In some families, the breast is at the heart of parenting. A mother might breastfeed throughout the night and day to meet her child's emotional needs in a host of different ways. In other families, a child might be feeding a couple of times a day, and even then, only when offered. You can see those families will have very different experiences around the weaning process. However, there are some general guidelines about starting the transition to ending breastfeeding.
Weaning under 12 months
If your baby under 12 months is ending breastfeeding, their nutritional requirements will obviously need to be the highest priority. A baby of around 7-9 months who is taking solid food reliably will still need around 600 ml (20 oz) of formula in 24 hours (NHS Better Health Start for Life 2023). From around 10-12 months, if we can assume that solids have become more established, we're expecting still around 400 ml (13 oz) of formula in 24 hours. If a young baby is feeding roughly eight times in 24 hours (it could easily be more), then we would start by looking at the formula total needed over 24 hours and dividing by eight. If day one means one bottle of 30 ml of formula at some point in the day (perhaps before a breastfeed), when everyone is in a good mood, that is a good place to start. If that volume increases gradually until one feed is entirely with the bottle, we might then pause for a couple of days to let breasts adjust and to consider next steps. Dropping one breastfeed no faster than every three days feels sensible to reduce the risk of breast health problems.

What kind of bottle is best? Parents often get pulled down a rabbit hole when it comes to this question. If a family is ending breastfeeding, we have less need to consider which bottle is protective of breastfeeding. There is not one 'best' bottle. We are looking for the bottle which is affordable, easy to buy where a family lives and with replaceable teats that are also easy to find.

What about choosing the type of formula? Any 'First' formula is appropriate and babies do not need 'follow-on' formula.

"All infant formula have to be of a similar composition to comply with UK compositional requirements and all brands are nutritionally adequate for infants. If a substance was found that was definitely beneficial for infant health that could be added to infant formula, it would be in all infant formula by law." (First Steps Nutrition Trust 2021)

After 12 months, full fat cow's milk can be given as a main drink. With a younger baby, giving milk in a bottle is likely to be a first choice. We want all bottle feeding parents to be confident with a technique known as responsive bottle feeding (sometimes referred to as paced bottle feeding) which can help the feed to be a time for connection and communication and reduce the risk of over-eating. However, the NHS recommend that families move away from bottles from around 12 months, and that means some older babies will be moving from a breast directly to a cup. We want families who use powdered formula to understand that the powder may contain bacteria and other pathogens and there are careful recommendations about how to make up a bottle safely. ( https://www.nhs.uk/start4life/baby/feeding-your-baby/bottle-feeding/how-to-make-up-a-feed/making-up-a-feed/)

When we talk about a baby under twelve months transitioning from breastfeeding, it is easy to get wrapped up on dropping breastfeeds and discussions of milk volume, but we must never lose sight of the fact that breastfeeding was about connection and an exchange of love and physical affection too. It was about oxytocin. We still want that oxytocin creation to happen. We are not just changing how a baby is fed but adding in a new method of feeding AND lots of opportunities for physical affection. Bottle feeding can happen skin-to-skin and there's lots of time for snuggles and connection.

Whatever age a baby is when breastfeeding ends, we need parents to be prepared for some possible impacts on them. Ideally, the transition from breastfeeding to exclusive bottle feeding happens gradually. If you have been producing a full milk supply, it is going to take time for your body to get the message that the order has changed. If that isn't handled carefully, at the very least we could be looking at engorgement and blocked ducts. In more serious cases, we could be increasing the risk of mastitis and abscesses. A gradual weaning process means it's more likely that the body will adapt. The grape-like lobules in the milk storage areas can feel lumpy under the skin and this can be frightening if you have spent months, or even years, associating lumpiness with blocked ducts. Milk storage areas that remain full are doing some important jobs. Fullness is part of the natural process which slows milk production. However, this is a balance, and we want the reduction to be as comfortable as possible. Breasts need to be well supported (but not squashed). Pain relief may be helpful. Cool compresses, and even cabbage leaves, may also provide relief. There are physical adaptations that are needed, but also emotional ones. You might experience 'weaning blues' even if you very much wanted to end breastfeeding. Your body is adapting to a change in hormones. Previously, with every breastfeed, there was a release of oxytocin. Your body may miss that, and you may have some other complicated feelings alongside the end of breastfeeding. It's important for you to be gentle with yourself and reach out for support if you need to.
Weaning an older toddler
Let's imagine we are talking about ending breastfeeding an older child. We start with doing some thinking about this child's relationship to the breast. Are they more likely to ask at a particular time of day? Or when you are engaged in a certain activity? Are they hungry for food or hungry for connection? Once we understand when requests for a breastfeed are more likely, we can reflect on what a child will need to replace breastfeeding. The act of weaning is not simply the act of removing breastfeeding. Many new things often need to be added in. We can think of breastfeeding as being like the 'Swiss army pen knife' of parenting. It contained so many different tools and met so many different needs. Now you are taking it out of your tool belt, and you're going to need to replace it with some new things. Some parents will learn to parent in different ways. Your child may need new ways to ask for help in emotional co-regulation. They may need a new language that helps them feel empowered and in control of their world. They may need a new language of sleep and getting to sleep. They may need help to find ways to say, "I'm feeling a bit vulnerable, and I need to check in with you."

It may be that breastfeeding is the tool a child uses to physically calm themselves. It is how they wind down when they are buzzing. It is also often used as a tool for sleep. It makes biological sense when you think that breastmilk contains hormones that aid sleep for any age - for both the nursling and the parent. Nurslings of any age can enjoy breastfeeding as a way to transition to sleep, whether it is for a nap, at bedtime or after waking in the middle of the night. Breastfeeding might also be their decompressing tool when they feel overwhelmed at other times. They may be experiencing physical pain or feeling unwell. They may feel afraid.

Weaning is not a battle of parent versus nursling. It is trying to find a new world together, with compassion, that meets the needs of everyone. A lot is going to depend on the age of the child, but if your child is verbal and is able to understand what you are saying, they can be a partner in your process. You might start with conversations in daily life that explain milkies don't last forever for everyone. These conversations can happen long before they are personalised to say, 'One day, YOU will not have mummy milk.' We want your child to understand that one day breastfeeding ends and that can be hard, but it ends for everyone eventually. In the park, you might point out an older child on a skateboard, 'I wonder how old he is. I think he's about ten. I wonder how old he was when he stopped having mummy milk and how he felt about that?' A parent might talk about people in the supermarket, characters in the background of picture books or television friends. Does Peppa Pig still have mummy milk? It is never discussed so we assume not. I wonder how old she was when she stopped? How does she get to sleep now? What does she do when she wants to feel close to mummy pig?

Reading picture books about weaning can also be an extension of this conversation. For many young children, reading a book is a time where they are most likely to focus, and the repetition is ideal to embed new concepts. You may like to go one step further and make your own weaning book. Using online photo companies, it's possible to create individualised books using family photos with familiar phrases, that give everyone a sense of ownership of the process. Young children often like to see photos of themselves, and you can include photos of their sleeping space, special toys and their favourite foods and activities.

Alongside reading picture books, eventually the time comes to put the theory into practice. You will need to explain to your child that one day milk will go away FOR THEM. You might share pictures of early breastfeeding and share memories. You might talk about how you have loved breastfeeding and how special it is and how you will find it hard to say goodbye too. This conversation doesn't just happen once but is sprinkled throughout some days at different times. It might happen at the park or during dinner. Ideally it happens at times when emotions are steady to start with, and there is time to explore feelings that arise. A child as young as 18 months or two years old may not be able to articulate, or even fully comprehend what is being said, but repetition may help and it makes sense to try and offer some explanation, rather than underestimate their level of understanding. It is important that you reflect on how you will explain to their child WHY breastfeeding is going away. Some parents struggle with doing this authentically. You will see stories online of parents rubbing their nipples in unpleasant tasting foods or even chilli oil (ouch). Breastfeeding has been such an honest and beautiful connection. If a parent has breastfed their child for several years, it seems a shame to end it with something inauthentic, and something they may later look back on with suspicion. Are we really protecting them?

Many parents fear speaking honestly. They want to say things like, 'milk is going away because you are getting older' or 'I think we will both sleep better if we don't have milk at night.' Neither of those concepts really make sense to a child. Why is milk going away? Being 'older' or 'a big boy' doesn't mean they don't need you! They may feel they sleep better at night because they have milk. They don't want a parent to do this for them! If a parent can find a starting place that is truthful, they will be able to continue with that honest communication. You might say something like, 'My body is going to stop making milkies' or 'my boobies are tired, and my body is tired and I'm going to help you say goodbye to milkies. I know it will be hard and sometimes you might feel angry and sad that boobies are going away, but mummy cuddles will always be here.'

A nursling who is weaning reluctantly has every right to be angry. Just as you have a right to wean, your nursling has the right to be angry and disappointed. It is important that they understand the feelings they express are to be validated. There is a misunderstanding by some that validation is a tool we use to calm children down. When we say, 'I understand', that we are actually hoping it is enough to stop them being upset, but in fact things might be more painful initially. A child who knows that their feelings are being listened to and recognised, is eventually going to be in a better place.

It is sometimes said that distraction is a valuable weaning tool. I have said it myself in the past. For much younger children, it can be useful as you seek to meet their needs in other ways as quickly and as effectively as possible. It is natural to not want to imagine that a child is experiencing pain. If there is a way to avoid seeing distress or anger, that sounds like an ideal scenario. However, distraction shouldn't be about pretending weaning isn't happening. We are not aiming to wean and hope they don't notice.

The psychotherapist Philippa Perry describes how distraction 'can be an insult to a child's intelligence': "What message does distraction convey? Imagine you fall over and badly graze your knee how would you feel if your partner, instead of being concerned or interested in the pain or the blood or the embarrassment, pointed out a squirrel or promised that you could play your favourite video game?" (Perry 2019)

Distraction is attractive in the short term. It might feel like a handy short cut, but this may not be the best time for short cuts. Of course, it does depend on what a child's motivations for wanting the breast are. Ideally, if distraction does happen, it should be on-topic and meeting the underlying need. If your child is requesting connection and time with you, then offering a different loving focused activity isn't distraction so much as offering a new way to meet the same need. However, a child who is asking for connection, and is instead offered a screen and a snack, is not having that need met respectfully.

If we see weaning from breastfeeding as a time to add in new parenting tools and new languages, what can that look like in practice? A new language around thirst and nutrition is about providing opportunities. Does the child have a cup they can use independently that is within easy reach? Do they have a way to request snacks or to explain when they feel hungry? All they may be skilled to do in that situation is to ask for a breastfeed.

Giving a child a new language to ask for connection and affection is often at the heart of weaning from breastfeeding. When a child continues breastfeeding beyond infancy, the dialogue of requesting a breastfeed and having that need met can feel powerful and wonderful. The most important person in their lives is pausing and meeting their request. When they have that urge for parental love and a sign of affection, they have the tools to do that. If that tool is taken away and no alternative is given, the risk is that the child feels not only rejected but also disempowered and destabilised. That was the only way that they knew how to ask for a physical sign of love. It was the only way they knew how to say, 'Hey I need you for a moment!' Can your child ask for a cuddle? Do you ask them for a cuddle? What other kinds of physical affection do you model in your home and have words for? You may want to add in more times for attachment play and power reversal play, where your child feels in control and taking the lead. Attachment play may only last for 10-15 minutes but it's a time when you give your child your focus and your energy.

A feed that is sometimes difficult to drop is the reconnection feed that happens when a child is reunited with their parent after a day of nursery and work. That feed is a powerful moment of a child decompressing at the end of a long day and celebrating seeing the parent again. Some children will arrive home full of energy, and high energy connective play and physical games may meet a need. Some are tired and are looking for a moment of peace. Activities like a hand massage or head and shoulder massage can be special, and the nursling might take the role of the facilitator and the expert. Dens are a great tool to give little people a sense of fun and excitement. You can create a cuddle nook which may be a tent or a home-made den, with cushions, bean bags and fairy lights. This isn't a place where breastfeeding happens but where reading and cuddling and other kinds of physical connection occur. It would be sensible to discuss in the morning what will happen at the reunion. Another caregiver could mention it and remind the child during the day. The parent might even be able to speak to them on the way home via a video call to prepare them for what is going to happen.

Alongside introducing a new language around connection and physical affection, other boundaries around breastfeeding are progressively being put in place. Breastfeeding might still happen in the day, but only in certain places. Perhaps no longer on a particular chair or restricted to a less interesting and stimulating room. You might agree to do a feed for a short period of time and then offer a different activity that may be more appealing. If you are saying, 'not right now', you can give them a choice about what might happen instead to help them feel they have some control over the process.

What about night weaning? What can be helpful is the concept of habit-stacking (a term used by Lyndsey Hookway). We want the child to have more than one association with safe and soothing bedtime and the process of falling asleep. Then as the breastfeeding is removed, they are left with something familiar that already helps their brain to think, 'Ahh, yes, sleep time now.' After all, being a creature of habit is a normal human state of affairs. Adults would also not be thrilled if our familiar routine was yanked out from under us overnight. Parents can introduce one or two additional habits alongside breastfeeding. It is something that involves the parent, so they are still offering co-regulation once the breastfeeding goes. It will differ for every child. Some would be irritated by stroking or patting and may prefer something auditory. A parent might choose a gentle phrase that can be repeated. They might tell a narrative along the lines of, 'You are sleeping now. Mummy is sleeping now. Granny is sleeping now. Cats are sleeping now. The birds in the trees are sleeping now.' When it later comes time for night weaning, the parent can add in, 'Boobies are sleeping now.' Some families might choose gentle singing or a white noise machine with ocean sounds.

For older nurslings, a guided meditation can also be a valuable tool at bedtime and the peaceful language repeated during the night in smaller chunks. An older child may also be able to express an opinion on what they would like to use as their additional sleep habit. At the same time, it can be useful to have conversation in the day about the process of falling asleep, to help reinforce that this is a process that involves an element of choice. How does Daddy fall asleep at night? How does a friend? What do they do when they can't fall asleep easily? A parent might role play falling asleep with cuddly toys during playtime. What is teddy going to choose? And teddy might be angry with Mummy because booby isn't happening throughout the night. A parent might 'play bedtimes', where they are the child, and the nursling becomes the parent. Or original roles might be maintained, and the parent offers alternatives to the breast. Role play can be a useful way to work through emotions.

Breastfeeding toddlers often haven't attached to a cuddly toy at bedtime. Why would they? The parent is their cuddly toy. However, it might be useful to introduce a transitional object for the first time, to provide one further means of support if night weaning is going to happen. Again, with an older nursling, this is something they may to like have agency over. A parent might explain that one day boobies will go away, and they can choose a new friend to be with them at night to help them.

In the nights prior to the onset of night weaning, daytime conversation is valuable. This is not something that comes out of the blue. However, weeks of preparation are unlikely to be helpful. Being gentle is not always the same thing as being very slow. A young child is unlikely to have a sophisticated sense of time and concepts like 'next month' or even 'next week' are fairly meaningless. Something like 'in a few days' might be more useful. You might discuss it on the bus, walking back from the park, at dinner time. You could eventually remind their child that, 'tonight is the last night that booby happens all night. Then tomorrow booby is sleeping at night.' Or you might say, 'tonight is the last night booby happens all night. Tomorrow, we can only do two boobies at night.' You remind them that it will be hard, and you will be there to help them. Then the during the day, prior to the big night, there are lots of reminders.

What is important is to emphasise that you will be there to support your child, whatever they are feeling. We are not implying that we are asking them to be a 'good boy' or to 'try hard'. Equally, the next morning, we are not praising them for not being upset. All feelings are welcome because the child is loved unconditionally. If you have a partner, they can provide important support for both of you, but it is not ideal if your approach to weaning involves you stepping away entirely and leaving your partner to take over (or for you to leave the home entirely). Your child is scared and experiencing their first major loss in their life. They need to know they are not losing you entirely. You are there to support them through this loss. And you'll also need to practise your new skills of providing comfort and co-regulation. Sometimes when parents do attempt to use separation as a weaning technique, it can leave a child feeling more vulnerable and even more desperate for breastfeeding to continue. Sometimes there is no alternative other than to face difficult feelings and to be there for your child during their time of loss.

Ending breastfeeding is hard. Even the most careful and loving parent who approaches the weaning process sensitively and gently may find it upsetting and difficult. Just as we make space for little people to feel sad, we may need to allow ourselves to have mixed feelings too. As AA Milne says (as quoted in the weaning book, 'Booby Moon' by Yvette Reid): "How lucky am I to have something that makes saying goodbye so hard." Then, when you are done, take a moment to look back and celebrate your breastfeeding achievement. Remember those early days and weeks. Remember the special times. IBCLC Glenni Lorick says that parenting is a 'series of weanings'. This has probably been your first. Well done for getting through it.
Emma's book: SUPPORTING THE TRANSITION FROM BREASTFEEDING: A GUIDE TO WEANING FOR PROFESSIONALS, SUPPORTERS AND PARENTS will be published by Jessica Kingsley Publishers soon.
References:

1. Brown, A. and Harries, V. (2015) 'Infant sleep and night feeding patterns during later infancy: association with breastfeeding frequency, daytime complementary food intake, and infant weight.' Breastfeeding medicine 10, 5, 246-252. doi: org/10.1089/bfm.2014.0153

2. Drugs in Breastmilk information service: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

3. NHS Better Health Start for Life (2023) What to Feed Your Baby. UK: NHS Public Health England. https:/www.nhs.uk/start4life/weaning/what-to-feed-your-baby/7-9-months/

4. First Steps Nutrition Trust (2021b) Infant milks: A simple guide to infant formula, follow-on formula and other infant milks. London: First Steps Nutrition Trust. https://www.firststepsnutrition.org/parents-carers

5. Perry, P. (2019) The Book You Wish Your Parents Had Read (and Your Children Will Be Glad That You Did). London: Penguin. P.79

6. Hookway, L. (2021) Still Awake: responsive sleep tools for toddlers to tweens. London: Pinter & Martin.

7. Reid, Y. (2021) Booby Moon: a weaning book for toddlers. New Zealand: Yvette Reid.

8. Lorick, G. (2009) 'Life is full of weanings', Conservative Granola Mommies, 2 March. https://conservativegranolamommies.blogspot.com/2009/03/life-is-full-of-weanings.html.

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Ending your breastfeeding journey: some approaches to parent-led weaning - The Breastfeeding Network

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Emma Pickett IBCLC Making the decision to end breastfeeding Breastfeeding support is all about helping you to breastfeed for as long as you want to. We want families to reach their breastfeeding goals, and that means Breastfeeding Supporters are here for parents at the end of their breastfeeding experience, as well as at the start.

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

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

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

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

Getting Started

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

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

Equipment

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

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

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

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

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

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

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

Setting your schedule

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

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

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

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

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

How long is an expressing session?

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

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

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

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

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

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

The importance of Oxytocin

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

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

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

How to pump

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

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

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

How much milk to pump

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

Feeding your breastmilk

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

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

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

Storing your breastmilk

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

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

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

Stopping exclusively pumping

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

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

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

Further reading

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

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

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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

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Birmingham Women's Hospital Antenatal Workshops

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Birmingham Women's Hospital Antenatal Workshops

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Birmingham Women’s Hospital Infant Feeding Team

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Birmingham Women’s Hospital Infant Feeding Team

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Birmingham Women's Hospital Infant Feeding Team

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Birmingham Women's Hospital Infant Feeding Team

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Infant feeding Team

In the Infant Feeding Team we support all mothers, babies and their families who use the services of Birmingham Women's and Children's Trust in their infant feeding choices.

We look to achieve the best possible outcomes for overall health and wellbeing of your baby by building close and loving relationships and helping you achieve optimal responsive baby feeding.
The Infant Feeding Team aim to:

Help parents and carers with making informed decisions on feeding their babies, supporting them to achieve their feeding goals.

Provide care which is mother/carer and family centred, non-judgemental and supports and respects individuals decisions.

Be committed to providing clear and impartial information which adheres to the WHO Code of Marketing Breast Milk Substitutes (WHO 1991).

Contact us

Birmingham Women's Hospital
bwc.infant-feeding@nhs.net
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Responsive bottle feeding/ a.k.a. paced feeding

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These factsheets are maintained 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 (including age […]

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The image above lists the key ways in which the constituents of breastmilk or human milk work to protect infant health.
Key points

Even the basic nutritional constituents vary greatly between human milk and infant formula. Breastmilk contains many more live constituents that promote health.

Water: We are very lucky to have access to clean water in UK, but occasionally climate issues like floods, accidental over use of cleansing products, or fluorine can sometimes contain contaminants. Breastmilk water is filtered at source.

Protein: Protein in breastmilk is more whey based (60-80%) and easier to digest and the main protein, alpha lactalbumin, which makes up 20% of the total protein, has been associated with the destruction of over 40 types of cancer cells including bladder and brain. Protein in formula (cows' milk protein) has been associated with an increased risk of a baby developing juvenile onset diabetes.

Carbohydrates: Lactose is the primary carbohydrate in breastmilk and provides around 40% of the total calories. Lactose is also more prevalent in UK formula but you may also see sucrose, fructose and glucose in some soya or lactose free formula.

Fats are essential for brain development and absorption of fat soluble vitamins, and are a major calorie source. The long chain polyunsaturated fatty acids (LCPs) which naturally occur in breastmilk support the development of the entire nervous system including retinol development (improved eyesight) and there is some evidence of a link to improved IQ. Fats in formula tend to change depending on the market - currently they are mainly vegetable such as rapeseed oil, sunflower oil, coconut oil and algal oil, but some contain egg (egg phospholipid anhydrous milk fat) or fish oil.

Vitamins and minerals are essential for the health of our bodies from healing wounds and supporting bone growth to bolstering the immune system. In formula milk extra vitamins and minerals are added to the powder to ensure they are sustained for the entire shelf life (six months to a year), so amounts will vary accordingly.

Growth factors: Epidermal, insulin and transforming factors which promote gut growth. The epidermal growth factor is higher in the milk of mothers who have preterm babies, and it is linked to a reduction in Necrotising Enterocolitis (NEC) and other inflammatory responses. There is some evidence that growth factors also play a role in early life programming and so may be associated with a reduced risk of obesity and cancer in later life.

Transfer factors enable effective absorption of nutrients in the milk e.g. lactoferrin, which assists with the absorption of iron, and in so doing reduces the amount of free iron which attracts bacteria. Lactoferrin is also bactericidal e.g. it kills E.coli bacteria. There are also transfer factors that help with the absorption of fats and vitamins.

Stem cells: an internal repair system - these cells have the ability to develop into many different cell types. There is some evidence that these cells remain in the system long after breastfeeding has stopped. Scientists are looking at their potential for treating conditions such as leukaemia, diabetes, spinal injuries and Parkinson's.

Immunoglobulins: IgA, IgG, IgM and IgD, the most important is IgA, which provides a protective coating to the baby's gut; it covers the mucosal gut surface to prevent entry of pathogenic bacteria and enteroviruses (E Coli, Salmonella, Streptococci, Staph, pneumococci, rotavirus etc.), protecting against gastroenteritis, respiratory infections etc. Please see slide 11 for an explanation of how a mother provides up to date antibodies to her baby.

Leukocytes destroy harmful bacteria. One type, called macrophages, also produce lysozyme, an enzyme which destroys bacteria by disrupting the cell wall.

Oligosaccharides: More than 200 types of simple carbohydrates are found in breastmilk. These influence the development of the microflora by increasing the number of beneficial bacteria found in the baby's gut and in so doing they protect the baby against infections e.g. otitis media, respiratory, urine and gastrointestinal.

Milk lipids damage the outer surface of certain virus types, reducing infection rate in the baby.

Enzymes aid digestion and absorption and some destroy bacteria.

IL-7 is linked to the size of the thymus which is a central organ in the immune system. Breastfed babies have a much larger thymus than formula fed babies, which demonstrates a stronger immune system. IL-7 also has a role in stimulating antibody producing cells. It is also considered to play a part in reducing the risk of childhood leukaemia.

Cytokines: Another important constituent for boosting immune system.

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Baby Milk Constituents - Milton Keynes University Hospital

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The image above lists the key ways in which the constituents of breastmilk or human milk work to protect infant health. Key points Even the basic nutritional constituents vary greatly

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Unicef UK Baby Friendly Initiative | Breastfeeding and Relationship Building

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Unicef UK Baby Friendly Initiative | Meeting baby for the first time

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What Cluster Feeding Really Looks Like (and Why It’s Normal) — La Leche League of Western Pennsylvania (LLL of WPA)

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Low milk supply and helping your baby gain weight 

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Low milk supply and helping your baby gain weight 

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You can tell if your baby is getting enough milk by looking at how much they are weeing and pooing, and whether they are gaining weight. If they are producing the expected amount of wee and poo, and their weight is increasing and approximately following their centile line on their growth chart, then they are getting enough milk. You cannot tell how much milk you are producing from how full/empty your breasts feel, or how long your baby feeds for.

Sometimes breastfeeding mothers worry that they are not producing enough milk for their baby. However, most mothers ARE able to produce enough milk, and if your milk supply does drop, you can usually increase it again with some simple measures, including adjusting your positioning and attachment and feeding your baby frequently and responsively.

If you are concerned that your baby is not getting enough milk, speak to your breastfeeding supporter, midwife, health visitor or GP.  This article on low milk supply (and why many mothers may worry that their supply is low when it actually isn't) may also be helpful: Low milk supply 101 - Association of Breastfeeding Mothers

Some suggestions to increase the amount of milk your baby is getting:

In the first weeks we now think that babies become sleepy when the flow of milk slows, not because they are full.

The following points should help you baby get more milk at each feed:

Aim for the best attachment possible. Even good attachment can be better. You can read more on our "how to breastfeed" page.

Learn how to see milk being transferred: open mouth wide->pause->close mouth: the longer the pause the greater the amount of milk your baby is drinking

Offer both breasts at each feed. Your baby may need a pause between breasts

Ask your health visitor, midwife or a breastfeeding supporter (at a group or on the National Breastfeeding Helpline) about how to recognise early feeding cues. It is easier to attach a baby before they are really hungry. You can read more about early cues and responsive breastfeeding here.

Feeding in response to early cues may mean it is possible to fit in an extra feed within 24 hours

Ask a health professional or a breastfeeding supporter to show you how breast compression works. It can be a good way to give your baby some extra milk at a feed.

Breast compressions

Breast compression is a simple method to try and get your baby to take more milk during a feed. It is done whilst the baby is attached to the breast. You can gently squeeze the breast using a c shaped hand held away from the nipple. You should gently compress the breast and then hold, until you see your baby start to suck and swallow more rapidly and then slow again. Once the swallowing slows you can release the breast and then do another compression, maybe in a slightly different position on your breast. You can keep doing this as long as it seems to have an impact on how much milk your baby is taking (e.g. sucking/swallowing increases).

Take a look here for video explanation of breast compression.

If breast compression helps, the amount of wee or poo your baby is doing may increase. If there is no change, ask for a breastfeeding supporter or health professional to check for other factors which might make feeding more difficult.

Very occasionally, medications such as decongestants or contraceptives may affect your milk supply. You can read our factsheets to find out more or contact our Drugs in Breastmilk service to discuss this.

For more information on how to tell if feeding is going well, you can have a look at Off to the Best Start.

Common causes of low milk supply/your baby not getting enough milk:

Positioning and Attachment: How your baby attaches to your breast, including how you hold them, is often called 'positioning and attachment'. If your baby is not effectively attached at your breast, it will be harder for them to remove milk efficiently. This may mean that they are getting less milk than they need. If this continues, your milk supply may drop as milk production works on a supply and demand basis. Working on your positioning and attachment will mean your baby is able to drink more milk more efficiently, and as they take more milk from your breasts, your body will respond to the increased demand by increasing your supply.  Even if some of the other causes here are relevant for you and your baby, improving how your baby comes to the breast will improve milk transfer. Read more on our page on how to breastfeed.

Spacing out feeds or feeding to a schedule: If you attempt to space feeds out, wait for your breasts to "fill up" or to feed to a schedule, rather than feeding responsively, your breasts may become over-full in between feeds. When your breasts become full, a hormone called feedback inhibitor of lactation (FIL) tells your body to stop making milk. This in turn can cause your milk supply to drop. Breastfeeding responsively, including putting your baby to your breast any time your breasts start to feel full, is the best way to establish and maintain your milk supply, and to ensure your baby gets enough milk. Your breasts are never completely drained, they are always making more milk, so you can offer them for a feed even if they feel empty. This will help increase your milk supply.

Using a dummy or pacifier: A dummy or pacifier can mask early feeding cues, meaning you don't feed your baby as soon as they start to feel hungry, and feeds may become more spaced out. This could lead to your baby taking less milk overall, and your breasts becoming over-full in between feeds, causing your milk supply to drop. Breastfeeding parents who wish to use a dummy could consider waiting until breastfeeding is well established before introducing it.

You can find more information on using a dummy from NHS start4life and The Lullaby Trust.

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Low milk supply and helping your baby gain weight - The Breastfeeding Network

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You can tell if your baby is getting enough milk by looking at how much they are weeing and pooing, and whether they are gaining weight. If they are producing the expected amount of wee and poo, and their weight is increasing and approximately following their centile line on their growth chart, then they are [...]

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

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

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

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

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

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

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

(Stevens et al, 2019)

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

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

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

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

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

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

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

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

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

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

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

Breastfeeding positions

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

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

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

Here are some positions you could try...

Lying down on your side

Laid-back breastfeeding

Rugby-ball or underarm position

Why a caesarean birth might make breastfeeding more difficult

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Unicef UK Baby Friendly Initiative | Positioning and attachment

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How to breastfeed - The Breastfeeding Network

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Getting Started Breastfeeding should be COMFORTABLE How you sit (or lie down) and how close you hold your baby as you feed can make a difference to how well things go. Sometimes a little difference in how your baby is feeding can make a big difference to how comfortable it is for you and how [...]

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1. Cradle hold

This is the probably the most popular breastfeeding position.

However, if you've had a caesarean, it may be uncomfortable because your baby lies across your tummy near the scar (try lying on your side or the rugby hold instead).

For the cradle hold, sit in a comfy chair with arm rests, or a bed with cushions or pillows around you.

1. Lie your baby across your lap, facing you.

2. Place your baby's head on your forearm - nose towards your nipple. Your hand should support the length of their body.

3. Place your baby's lower arm under yours.

4. Check to make sure your baby's ear, shoulder and hip are in a straight line.

Cradle hold tip

If you're sitting on a chair, rest your feet on a stool or small table - this will stop you from leaning forward which can make your back ache.

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Breastfeeding positions - Start for Life

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Find out about the different ways you can breastfeed with our step-by-step guide to breastfeeding positions.

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How do I know I’m holding my baby in the right position to breastfeed?

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While babies are born with the reflex to look for their mother's breast, many mothers need support with positioning their baby for breastfeeding and making sure their baby is correctly attached. Breastfeeding takes time and practice for both mothers and babies!

To help you both make the most of breastfeeding, here are some (of many!) positions to try. Remember, the most important thing is for your baby to be able to feed well. It may take a few tries before you find what works best for both of you.
If you ever have any questions or concerns about breastfeeding, be sure to speak to your midwife, lactation specialist or other health care provider.
Breastfeeding tips

Signs of a good latch

A comfortable experience with no pain.

More areola is visible above your baby's mouth than below.

Your baby's mouth is wide open.

Their lower lip is turned out.

Their chin is touching - or nearly touching - your breast.

Signs of good positioning

Your baby's head and body are in line. A baby cannot suckle or swallow easily if their head is twisted or bent.

Your baby is held close to your body. A baby cannot attach well to the breast if they are far away from it.

Your baby's whole body is supported with your arm along their back. This is particularly important for newborns and young babies. For older babies, support of the upper part of the body is usually enough.

Your baby approaches breast nose to nipple, so that they come to your breast from underneath the nipple.

Signs of effective suckling

Your baby takes slow deep suckles, sometimes pausing.

You may be able to see or hear your baby swallowing after one or two suckles.

Suckling is comfortable and pain free for you.

Your baby finishes the feed, releases the breast and looks contented and relaxed.

Your breast is softer after the feed.

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4 ways to make feeding comfortable for you and your baby.

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Breastfeeding at night is one of the most discussed topics at La Leche League meetings, both in person and online. This is often because breastfeeding at night, especially in the early days, can be so important to establishing a successful breastfeeding relationship. It is also because of its inextricable link with the topic of sleep, which can be one of the biggest changes many mothers and families experience when they have a new child.

There is no doubt that caring for a new baby can be exhausting, especially if you feel you are not getting enough sleep. Understanding why breastfeeding at night is so important can help. There is a huge amount of both reliable and rather less reliable information on the internet and in countless parenting books about what infant sleep 'ought' to be like, and therefore what infant night-time feeding 'ought' to be like. This article is designed to give mothers and parents the information and reassurance they need to inform their own night-time breastfeeding approach, including some helpful tips on how to get more rest when you can.

Breastfeeding at night in the early weeks and months is normal and important

Babies wake to feed at night in the early weeks and months (and often beyond) for a number of important reasons. Breastfeeding at night is a vital part of establishing and maintaining a good milk supply and ensuring that newborn babies get all the milk they need to grow and thrive. Breastmilk works on a supply and demand basis: the more milk that is removed, the more milk your breasts make. For the majority of mothers, this means milk needs to be removed roughly every 2-3 hours in the early weeks. Although some babies may sleep for slightly longer periods overnight, perhaps 3-4 hour stretches, newborn babies will typically wake several times a night to feed. This also helps to ensure that you don't get engorged breasts, which may lead to blocked ducts or mastitis.

Newborn babies often wake to feed because their bodies have signalled that they are hungry. However, newborns (and babies and children of all ages) also wake at night for many other reasons, including being scared or uncomfortable, being hot or cold, feeling the need for comfort and connection, and so on. As adults, we have developed ways of meeting these needs ourselves - adjusting a pillow, having a sip of water, cuddling our partner. As babies have no way of independently meeting these needs, they rely on their mother or parent to meet them. Breastfeeding at night offers mothers a way of easily and conveniently meeting the vast majority of these needs in one go.

Lots of research shows that night waking is the biological norm for babies. You can read more about it here as well as in Sweet Sleep, La Leche League International's exhaustive publication on nights and naps for breastfeeding families. Research also shows that, overall, breastfeeding mothers get more sleep than mixed- and formula-feeding mothers. This is for a number of reasons, including the impact of natural hormones and chemicals released for baby and mother when breastfeeding at night. There is also a perception that babies who have formula milk sleep longer than breastfed babies. Evidence shows this is not the case. "Despite the common perception that supplementing an infant's diet with formula milk or solid food will promote sleep, a recent study found that there was no difference in the frequency of night waking between breastfeeding and formula feeding infants aged 6-12 months old. Infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake."

Breastmilk at night

Research shows that breastmilk changes all the time, in response to all sorts of things, like the needs and health of your baby, temperature, and the time of day. For most mothers, breastmilk will gradually increase in fat content throughout the day. During the evening, young babies often cluster feed, taking in frequent feeds of this fattier milk, which tends to satisfy them enough to have their longest stretch of sleep. This cluster feeding in the early months may go on late into the evening when you were hoping you would be asleep, which can naturally feel exhausting.

Overnight, your prolactin levels - the hormone designed to support milk production - are at their highest. So, when your baby feeds frequently at night, the message to your body to boost milk supply is even stronger. Breastmilk at night is also high in the amino acid tryptophan, which in turn helps your baby to make melatonin, which is used by the body to develop its circadian rhythm (our internal system for recognising the difference between day and night) and to sleep better. Hormones produced while breastfeeding also help you to relax and fall more quickly back to sleep, which may be why you find yourself nodding off so easily while breastfeeding.

Given the fact that the hormones in night-time breastmilk help you and your baby to get back to sleep quickly, feeding babies to sleep is completely natural. A mother and baby's bodies are designed to work in tandem this way. Breastfeeding your baby to sleep helps baby feel calm, safe and secure. Over time, babies stop falling asleep at the breast so easily, and eventually all babies or children stop needing the breast to fall asleep. Sleep is not a taught development, and all children get there in their own time. So, while breastfeeding to sleep continues to work, many mothers find it a wonderful, loving and responsive way to help their children doze off.

Breast-sleeping / Co-sleeping

Safely sharing a bed with your baby, or having your baby sleep very close to you in a sidecar cot or similar, is one way of getting more sleep and rest. The majority of other mammals sleep with their young, and our own infants are hard-wired to expect this too. For many breastfeeding mothers, learning to feed lying down and being able to fall back asleep safely with baby is when things start to feel a lot more manageable at night. Some mothers may start out nursing their babies at night sat up in bed, but many soon find that mastering breastfeeding lying on their side can really help everyone to get more sleep, especially as baby gets a bit older and can latch on by themselves. Mums can feed from both breasts when lying on one side by simply tilting their body forwards more. The same principles for getting a comfortable, deep latch apply when side-lying as when feeding upright. It may take a little practice, but overall it's easier and less disruptive for both mother and baby at night. Research shows that breastfeeding tends to be more successful overall for mothers that co-sleep than those that keep their baby separated from them at night. You can read more about how to co-sleep or breast-sleep safely with your baby here

Breastfeeding at night after the early months

Many mothers go through patches where their baby may wish to breastfeed more or less at night, especially within the first year. This will be related to a whole host of reasons, including growth spurts, teething, illness, and learning new skills such as sitting, crawling and walking. Like so much else with babies and children, the frequency of breastfeeds at night is not a linear progression. Phases of increased night feedings are usually relatively short-lived and you may find that co-sleeping is a really valuable tool for managing those phases. Increased periods of waking and breastfeeding around four-six months are very common and are not a sign that your baby is hungry and needs formula and/or solids. You can read more about this in our article 'What happens at four months'

As your baby gets older and bigger, you may find that night feeding becomes much easier. While in the early days you may feel the need to switch on a light or sit up in bed in order to latch your baby comfortably onto your breast, as your baby gets stronger and learns to self-latch, feeding at night can be a simple matter of rolling over and putting the breast near your baby, who will manage the rest. Night feeds often become quicker too. Some mothers use breast compressions as a way of speeding up feeds. Being able to help their older baby back to sleep quickly with a breastfeed helps many mothers get the most sleep.

Coping with the challenges

Knowing that waking at night to breastfeed is positive for our supply and our baby, and that it is the biological norm, can often be reassuring for mothers and parents. Nevertheless, sleep deprivation can be really challenging for many families. It can feel especially hard if your baby is waking more than your friends' babies, or if they are an older baby still waking up more than you had expected.

New parents often get asked about their babies' sleep and their approach to feeding at night. These conversations can sometimes lead to (unwanted) comments about what is normal, what you 'should' be doing, and how to 'fix' things. And if you are feeling really tired or at a low point, you may be thinking that you do need to find a 'solution' and try some of those suggestions. The many unhelpful sources out there setting unrealistic expectations may be undermining your self-confidence as a mother. Perhaps you're wondering what a loving and respectful approach that suits both you and your baby would be?

First, it's important to say that you are not alone. At any point in time there are hundreds of thousands, if not millions, of mothers up and breastfeeding their babies - of varying ages - at night. A turning point for some of them is when they are able to relax their expectations of themselves and their babies a little. Some mothers also find that being constantly reminded of when they have been woken up is actually part of the problem, and they decide to ignore the clock and not to use their phones at night.

Being responsible for all the night-feeds can feel exhausting, or even unfair. Sometimes well-intentioned comments may suggest that a partner or other care-giver could feed the baby at night with a bottle. It can be useful to remember that the hormones in night-time milk make it easier for both you and your baby to get back to sleep quickly. And since the hormones in night-time milk are made at night-time, there is some evidence that giving your baby breastmilk expressed at other times does not always have quite the same effect. It is also sometimes easy to overlook the practicalities of another care-giver taking care of night-feeds. Mothers will often wake up when their baby does anyway, and may struggle to get back to sleep if they can hear their baby being upset while waiting for a bottle to be warmed up. Most mothers will also need to pump or hand express milk during the night to protect their supply and avoid engorgement, so they are often awake anyway during the time their baby is being fed by their partner.

Even though breastfeeding at night may be the responsibility of the mother alone, there are lots of ways to get supported so that things feel easier. For example, sometimes dads and partners get up with the baby first thing in the morning to give mums some extra time in bed, which can make a big difference to how tired they feel. Good communication is really helpful - ask for help with other things where you can and be clear about the kind of support you need. It's OK not to enjoy breastfeeding every second, and it's OK to complain about being tired: that doesn't mean you don't want to do it, so you can explain that asking 'Why don't you just stop?' is not helpful and that you'd rather be asked 'How can I help you find time to rest today?'

If you are really struggling with tiredness, you may want to think of ways to adapt your own routines for a short while to help you get more rest - perhaps sleeping more during the day, or going to bed earlier when your baby has her first 'longer' stretch of sleep. It can also be a great time to join an LLL group meeting with other breastfeeding mothers, as hearing that they are experiencing the same challenges can be really reassuring. Mothers often get bombarded with unrealistic expectations of infant sleep, and it's precisely this misalignment of expectation and reality that can cause stress.

Another challenge that mothers may experience (usually once their baby is a bit older) is a feeling of nursing aversion or irritability, particularly during night-time feeds. These feelings can be very normal and are often linked to tiredness or feeling 'touched out'. You may experience them more when your baby is waking or feeding a lot more frequently, for example when teething or feeling ill. You may also experience these feelings when there is a change in your own hormones, for example, during ovulation or your period. There is some anecdotal evidence that taking magnesium supplements can be helpful. Many mothers describe these feelings as irrational and usually short-lived; they can be a sign that you need to give yourself a little 'self-care' - perhaps asking for some more help during the day so that you can rest or focus on yourself.

Nursing aversion can sometimes lead to feelings of guilt about not enjoying breastfeeding, and make you wonder whether it is a sign you need to stop. There are some helpful information groups on social media where mothers share their nursing aversion experiences, as well as tips and tricks that helped them overcome those feelings. Like anything in life, you may not enjoy breastfeeding every moment of every day; that's OK. Take things one day at a time, listen to your body and your baby.

Stopping breastfeeding at night

Breastfeeding at night meets a baby's needs in a variety of ways. For many mothers, it's the easiest way to settle their baby back to sleep when they wake at night, and they continue to use it for as long as it continues to work. It is not a bad habit and all babies eventually fall asleep and stay asleep without the breast. You may decide that you are happy with breastfeeding back to sleep, but you are feeling pressured by others' expectations about what your baby 'should' be doing.

Some books suggest that after six months babies no longer need night feeds. Not only is this an arbitrary figure, taking little account of the different circumstances of different babies and families, but it also has no evidence to back it up. Sometimes, mothers worry that breastfeeding at night is what is causing their baby to wake up several times. This is not the case. Babies wake for lots of reasons and it is better to think of breastfeeding as a tool that meets the vast majority of those needs. Some sources claim that babies after a certain age don't 'need' breastmilk at night any longer, but breastfeeding goes on meeting a baby's needs for a long time. Many babies will continue to need the calories from night-time breastmilk, as well as all the other comforts that it brings, for some time after six months, and sometimes well beyond.

Some families may feel that their baby is ready to cut some breastfeeds at night or stop breastfeeding at night altogether. Generally speaking, the evidence seems to suggest that night-weaning is best left until after around 18 months. Many mothers find that gently cutting down feeds at this point is much easier, as the baby is learning to talk and the mother can help to explain any changes. There is helpful information about approaches to cutting down night feeds here. Any changes are best approached gradually and respectfully, so that you can preserve the important close connection to the baby at night-time. As your baby gets older, you will discover ways of being responsive to their needs at night that might not include offering your breast every time. For example, you may find that you are able to try other things like rocking, patting and shushing before offering the breast. These may not work initially, but over time, as your baby develops, you may find that in some cases these soothe him back to sleep. As always, you are the expert on your baby and you'll be able to assess whether your child is ready to stop breastfeeding at night, or whether it would be easier to try night weaning later on.

Conclusion

Having a baby, and eventually a toddler, can of course be exhausting. Since responding to your baby's intense needs at night can feel overwhelming, being able to access reliable information about infant sleep and night-time feeding behaviour can help you adjust your expectations. You may be happy breastfeeding your baby back to sleep as often as needed, yet you may feel pressured by well-meaning comments from friends and family about what your baby's sleep 'should' be like. Sometimes spending time with others who understand what you're going through, and who are supportive or your choices, can help you feel confident to make the decisions that work for you. Chatting with other mothers at a La Leche League meeting, in person or online, about what they found helpful, and exchanging ideas for getting more sleep may help you decide what's right for you and your baby. Never forget that you know your baby best!

Written by Rhiannon Butterfield, LLL Cambridge. February 2021

Endnotes:

i Baby Sleep Info Source (BASIS) - Durham University

ii Brown A, Harries V. Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight. Breastfeeding Medicine. 2015;10(5):246-252.

iii https://gpifn.org.uk/sleep-and-safe-sleeping/

Further reading:
Safer Sleep and the Breastfed Baby
I need some sleep!
LLLI: Safe Sleep Seven
The reasons why nightwaking is the biological norm
Letting babies cry: the science behind the studies
Sweet Sleep available in our LLLGB Shop

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Breastfeeding at night - La Leche League GB

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Breastfeeding at night is one of the most discussed topics at La Leche League meetings, both in person and online. This is often because breastfeeding at night, especially in the early days, can be so important to establishing a successful breastfeeding relationship. It is also because of its inextricable link with the topic of sleep, [...]

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Some babies sleep much more than others. Some sleep for long periods, others in short bursts. Some soon sleep through the night, while some don't for a long time.
Your baby will have their own pattern of waking and sleeping, and it's unlikely to be the same as other babies you know.

It's also unlikely to fit in with your need for sleep. Try to sleep when your baby sleeps.

If you're breastfeeding, in the early weeks your baby is likely to doze off for short periods during a feed. Carry on feeding until you think your baby has finished or until they're fully asleep. This is a good opportunity to try to get a bit of rest yourself.

If you're not sleeping at the same time as your baby, don't worry about keeping the house silent while they sleep. It's good to get your baby used to sleeping through a certain amount of noise.

How can I get my baby used to night and day?

It's a good idea to teach your baby that night-time is different from daytime from the start. During the day, open curtains, play games and don't worry too much about everyday noises when they sleep.

At night, you might find it helpful to:

keep the lights down low

not talk much and keep your voice quiet

put your baby down as soon as they've been fed and changed

not change your baby unless they need it

not play with your baby

Your baby will gradually learn that night-time is for sleeping.

Where should my baby sleep?

For the first 6 months your baby should be in the same room as you when they're asleep, both day and night. This can reduce the risk of SIDS (sudden infant death syndrome).

Particularly in the early weeks, you may find your baby only falls asleep in your or your partner's arms, or when you're standing by the cot.

You can start getting your baby used to going to sleep without you comforting them by putting them down before they fall asleep or when they've just finished a feed. It may be easier to do this once your baby starts to stay alert more frequently or for longer.

If you use a baby sling to carry your baby, make sure you use it safely. The Lullaby Trust has information about swaddling your baby and using slings safely.

Establishing a baby bedtime routine

You may feel ready to introduce a bedtime routine when your baby is around 3 months old. Getting them into a simple, soothing bedtime routine can be a great opportunity to have 1-to-1 time with your baby.

The routine could consist of:

having a bath

changing into night clothes and a fresh nappy

putting them to bed

reading a bedtime story (see more in Baby and toddler play ideas)

dimming the lights in the room to create a calm atmosphere

giving a goodnight kiss and cuddle

singing a lullaby or having a wind-up musical mobile you can turn on when you've put your baby to bed

brushing their teeth (if they have any)

As your child gets older, it can be helpful to keep to a similar bedtime routine. Too much excitement and stimulation just before bedtime can wake your child up again. Spend some time winding down and doing some calmer activities, like reading.

How much sleep does your baby need?

Just as with adults, babies' and children's sleep patterns vary. From birth, some babies need more or less sleep than others. The list below shows the average amount of sleep babies and children need during a 24-hour period, including daytime naps.

Newborn sleep needs

Most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from 8 hours up to 16 or 18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep.

Sleep requirements at 3 to 6 months old

As your baby grows, they'll need fewer night feeds and will be able to sleep for longer. Some babies will sleep for 8 hours or longer at night, but not all. By 4 months, they may be spending around twice as long sleeping at night as they do during the day.

Baby sleep at 6 to 12 months

For babies aged 6 months to a year, night feeds may no longer be necessary and some babies will sleep for up to 12 hours at night. Teething discomfort or hunger may wake some babies during the night.

Sleep requirements from 12 months

Babies will sleep for around 12 to 15 hours in total after their first birthday.

2-year-old sleep needs

Most 2 year olds will sleep for 11 to 12 hours at night, with 1 or 2 naps in the daytime.

Sleep requirements for 3 to 4 year olds

Most children aged 3 or 4 will need about 12 hours sleep, but this can range from 8 hours up to 14. Some young children will still need a nap during the day.

Coping with disturbed nights

Newborn babies invariably wake up repeatedly in the night for the first few months, and disturbed nights can be very hard to cope with.

If you have a partner, ask them to help. If you're formula feeding, encourage your partner to share the feeds. If you're breastfeeding, ask your partner to take over the early morning changing and dressing so you can go back to sleep.

Once you're into a good breastfeeding routine, your partner could occasionally give a bottle of expressed breast milk during the night. If you're on your own, you could ask a friend or relative to stay for a few days so you can get some sleep.

Dealing with baby sleep pattern changes

All babies change their sleep patterns. Just when you think you have it sorted and you've all had a good night's sleep, the next night you might be up every 2 hours.

Be prepared to change routines as your baby grows and enters different stages. And remember, growth spurts, teething and illnesses can all affect how your baby sleeps.

If your baby is having problems sleeping or you need more advice about getting into a routine, speak to your health visitor.

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Read tips on how to help your baby sleep, including what to expect, establishing a routine, and safe sleeping.

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Introducing a bottle - The Breastfeeding Network

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At the beginning babies have a strong sucking reflex which means they usually suck on a teat easily. After a few weeks this reflex fades and introducing a bottle can take a while for your baby to get used to sucking on a teat, even if they have had bottles before. Sometimes just getting used […]

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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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Expressing your milk by hand is a useful skill to have. It may take a bit of time and practice, but once you've mastered it, you'll find it's very helpful.

And the great thing is you only need your hands and a container - rather than a shop-bought breast pump.

Hand expression can be useful in various situations, for example if your baby isn't feeding or latching on well, if you want to stimulate your milk production, or if your breasts become engorged (this is a good way to relieve them).

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Expressing breast milk by hand - Start for Life

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Watch our video and read our step-by-step guide to expressing breast milk by hand.

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This simple, concise guide provides parents who are bottle feeding with an overview on how to bottle feed responsively and, for parents who are formula feeding, how to choose an infant formula.

Bottle feeding as responsively as possible can help support the development of a close and loving parent-infant relationship. More tips on building a close and loving relationship with babies can be found in our Building a Happy Baby leaflet for parents.

UNICEF UK's Baby Friendly Initiative is firmly committed to the promotion, protection and support of breastfeeding. However, in the UK bottle feeding remains very common and so we also work to ensure the best outcomes possible for babies when they are not breastfed. When considering use of our materials outside of the UK, we suggest taking into account the country context and individual needs before deciding whether or not our materials are suitable for use.

Further reading

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Infant formula and responsive bottle feeding - Baby Friendly Initiative

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This guide provides an overview on how to bottle feed responsively and, for parents who are formula feeding, how to choose an infant formula.

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If you are leaving your child with a carer for an evening out, when working, or at college, or if you are separated from your baby for any other reason.

To feed a premature or hospitalized baby.

To increase or protect your supply.

If your child isn't attaching at the breast.

To donate to a milk bank (www.ukamb.org).

A breastfeeding counsellor will be able to discuss your particular situation with you.
Can I hire a pump?
Only hospital-grade electric pumps are available for hire. They can be hired from pump agents around the country or can be dispatched quickly online, often arriving the next working day. If your baby is in special care, then you may be able to obtain a pump from the hospital.
Should I sterilise the equipment?
When storing and expressing breastmilk, everything coming into contact with the milk should be sterilised before first use. If you're storing milk for your own healthy baby, you might choose to sterilise the equipment each time for extra protection, but research suggests a wash with hot soapy water is sufficient. Some pumps parts can be washed in a dishwasher.

We know breast milk can be stored at room temperature for several hours, and in the fridge for several days, so some mums who are pumping frequently do choose to reuse the pump without washing, and then wash it carefully after several sessions. This isn't an area where there is a lot of research and you can discuss your options with a breastfeeding counsellor or lactation consultant.
How should I express?
You can express by hand or use a manual or electric breast pump. There's a first time for everyone when it comes to expressing, so don't feel upset or put off if only a few drops come out at first.

Begin by washing your hands and relaxing. Relaxing will help the milk ejection reflex (also known as the 'letdown' reflex).

You may warm your breasts, wrapping a warm towel around, or express after a shower or bath.

By hand:
Massage your breast in a circular manner. You can roll the nipple to optimize oxytocin release (the hormone needed for milk flow to start). Have something clean ready to collect your milk in. Something with a wide opening, such as a bowl or jug, can make it easier to catch every drop.

Find where you need to put your fingers to express most effectively. This is usually a few centimetres back from the nipple, but everyone is different. Cup the breast and make a 'C' shape with your thumb on one side and some fingers on the other. Compress the breast tissue. It may help to think: "press back, bring together, press forward". Release and repeat. Then rotate the fingers around the areola to express a new area when the milk flow subsides. There are lots of online videos on hand expression that might help you get started. Instructions may be different if you are expressing colostrum in the very early days so speak with your midwife or breastfeeding supporter.
By pump:
Pumps create a vacuum to remove milk. Make sure the funnel isn't too small, nor too large, as this could damage the nipple and reduce your milk flow. Some manufacturers can provide alternative sizes. Pumping shouldn't be painful nor leave a mark on your breast.

lf you're expressing to increase your supply; shorter more frequent pumping sessions are more likely to increase supply than a few long sessions. 'Hands on pumping' can help to increase output by nearly 50%. You can start with breast massage, continue to massage and compress your breasts while you use the pump, and finish with some hand expression. Some people use an adapted bra or crop top to hold the pump in place.

Electric pumps can lose effectiveness over time and may need servicing after heavy use. Many personal grade pumps are not suitable to be shared with someone else as milk can enter the mechanism of the pump and not all pumps are designed to be used more than once or twice a day.
Using Expressed Breastmilk (EBM)
Depending on age and health, your baby may be fed EBM in several ways: by cup, spoon, beaker, syringe or tube.

If you are using a bottle, consider using 'paced' feeding which may reduce confusion for the baby around the different skills needed to breast and bottle feed, and help prevent overfeeding. You may also see it called 'responsive bottle feeding'. Babies can overfeed from a bottle even when only breastmilk is used.
Any other tips?

Express as often as your baby would normally feed, if possible. If your young baby is not feeding at the breast, it's usually recommended to pump at least 8 times in 24 hours.

You could try expressing from one breast when your baby is feeding from the other. This takes advantage of the natural milk ejection reflex. There are some pumps which attach to your breast with suction and catch the letdown without you needing to touch the pump further.

Try not to focus on the amount as you pump. Remember that a large volume of milk may be high in water content but not necessarily high in fat content. A smaller amount may be more valuable.

Some mums find it helpful to use breathing exercises or to focus on their baby by looking at a picture or using a piece of clothing. Others listen to music or watch TV. Find what works best for you.

Pumping can send messages to your milk supply which may not always match your baby's needs.

It's often recommended not to pump too much in the early days or earlier than you need to.

Remember, don't use your pumping output as a reliable judge for what is going on with your milk supply. Pumping is a skill and, even when mastered, it is not the same process as a baby feeding.

How can I store breast milk?
These storage guidelines are suitable for a healthy term born baby.
Different storage times may be needed for sick infants or donated milk.

Room temperature (77°F/25°C)for up to 6 hours

In main part of fridge (below 4°C)for up to 5 days (up to 8 days according to some sources)

Warmer fridge (5°C-10°C) for 3 days

Fridge thermometers can be bought from kitchen shops.

Freezer (approx. -18°C)for 6 months

Previously frozen/thawed milk12 - 24 hours in fridge

When transporting frozen EBM in a cold box, check the cool blocks are newly frozen and refrozen regularly.
Refrigerate your milk in a sealed container as soon as possible. Store in small quantities so there is less waste and it's quicker to thaw or warm. It's possible to collect together milk from a number of expressing sessions but allow each batch to cool before adding it to the sealed container.
How do I defrost breastmilk?
It is possible to defrost milk in a number of different ways, either slowly in a fridge or with the container in contact with warm water. It is not recommended to defrost breastmilk in a microwave.

Gently shake the milk before use as the fats may have separated. It is a myth that you will damage the proteins in the milk with vigorous shaking, but you may cause air bubbles to form in the milk.

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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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ABM are a group of trained volunteers dedicated to supporting breastfeeding mums and their families. We’ve been supporting mums and nurturing families for almost 40 years. We’d love you to join us. Become a member of the ABM and help us continue our work.

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LATEST NEWS AND RESOURCES

Unaffordable infant formula price rises

Recommendations for the UK Government

LEARN MORE ABOUT THE CODE

UNICEF UK's Baby Friendly Initiative has made a real difference in giving our staff the skills and confidence to change the conversation about breastfeeding and early relationship building with parents... Together we can ensure that every single mother and baby receives the very best possible care, at a point in their lives where the information and support we provide will have a profound effect on their future health and development.

Ellie Elkins, Infant Feeding Lead for West Sussex, Sussex Community NHS Foundation Trust

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The Unicef UK Baby Friendly Initiative supports breastfeeding and parent infant relationships by working with public services to improve standards of care.

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A Family Hub is somewhere families, parents, carers, and young people can get support.

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Babies cry, you can cope When babies cry it can be stressful and overwhelming. Help is out there and all you need to do is ask. Latest news Testimonials

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A mothers story:

I knew I wanted to breastfeed my baby. I knew it was natural. So I was surprised when baby James and I could not seem to get the hang of it. I phoned a Breastfeeding Supporter. She gave us some good ideas about how I was sitting and holding James. But most of all it was good to have someone to talk to."

There are many reasons to breastfeed, but the simplest and most obvious one is "because you want to!" Your breasts have evolved to produce food for your baby, and if you want to use them for that purpose, you don't need any other explanation. However, breastmilk is amazing, and some of the other great reasons for breastfeeding are described below.

Breastfeeding supports bonding, parenting and your baby's development

Breastfeeding releases lots of a hormone called oxytocin (sometimes nicknamed "the love hormone") in your baby and you. This helps you to form a loving bond, feel calm, relaxed and happy. It also helps your baby's brain to grow and develop, which happens at an incredible pace in the first months of life. It is impossible to overfeed a breastfed baby, so breastfeeding can be used to sooth your baby, help them sleep, spend time together or rest whenever you want. Breastfeeding is a two-way relationship that supports both you and your baby emotionally.

You can learn more about this on these pages:

UNICEF leaflet: Building a happy baby, a guide for parents

UNICEF video: Breastfeeding and relationships in the early days

Parent-Infant Foundation: The first 1001 days

Health

Department of Health guidance states breastfeeding is the healthiest way to feed your baby. Exclusive breastfeeding (giving your baby breast milk only) is recommended for around the first six months (26 weeks) of your baby's life. After that, giving your baby breast milk alongside other food will help them continue to grow and develop. The World Health Organisation (WHO) and UNICEF recommend breastfeeding alongside other foods to age two and beyond.

Breastmilk contains all the nutrients your baby needs for the first six months. It is much more than just food: it is also a living fluid, full of antibodies and other bioactive factors that strengthen your baby's developing immune system, providing protection against infection, and other factors which help them digest nutrients. These living components are not found in infant formula.

You can read more about the many different components of breastmilk on this NHS page and also visit www.human-milk.com for lots more information.
Not breastfeeding increases various health risks for both mother and baby.
Babies who are not breastfed have an increased risk of:

infections, with more visits to hospital as a result

diarrhoea and vomiting, with more visits to hospital as a result

sudden infant death syndrome (SIDS)

obesity

cardiovascular disease in adulthood

Mothers who do not breastfeed have an increased risk of:

breast cancer

ovarian cancer

osteoporosis (weak bones)

cardiovascular disease

obesity

You can read more about how breastfeeding is linked to health on the NHS website.

Cost

You don't have to pay for breastmilk and breastfeeding does not usually need any special equipment. The cost of exclusively feeding infant formula for six months and continuing to provide it alongside other food until 12 months ranges from approximately £33 a month for the cheapest available powdered infant formula to around £80 a month for one of the most widely available brands ( First Steps Nutrition, data from November 2022. Note; all first infant formula sold in the UK is nutritionally equivalent. There is no need to purchase a more expensive brand). In addition, formula feeding requires bottles and teats which must be sterilised in between each use, and powdered infant formula must be mixed with boiled water that is at least 70 degrees C. Infant formula can also be purchased in pre-mixed cartons, which are more convenient, but these are much more expensive than powdered infant formula.

Breastfeeding mothers may choose to use a breast pump and bottles to feed expressed milk, to wear special breastfeeding clothes or to buy breastfeeding pillows or other accessories. These things can be helpful, but it is usually possible to breastfeed without them.

Convenience

Breastmilk is always available immediately, at the correct temperature, with no preparation required, at any time of day or night. It doesn't need to be mixed, heated or cooled, it doesn't go off in the breast and it won't be wasted if your baby decides they only want a small feed.  At night-time, you can breastfeed without getting out of bed!

Breastfeeding may feel challenging at first, and to begin with you may feel like you can only do it in a particular place, but once they get the hang of it, many mums find they can breastfeed almost anywhere, and whilst doing other activities.

Of course, breastfeeding means that you will be the only one who is able to breastfeed your baby, and this can sometimes feel overwhelming. However, even if you bottle-feed, UNICEF says that babies feel more secure if feeds are only given by the main caregivers, which helps them to bond. Once breastfeeding is established, some parents decide to introduce an occasional bottle, which can be expressed breastmilk, to give the mother more flexibility to be away from her baby for short periods of time. See our page on introducing a bottle for more information.

Environment

Breastmilk is the ultimate sustainable food. Breastfeeding has a very small carbon footprint compared to formula feeding. Infant formula is made from cows milk which must be processed, packaged, transported, stored and fed using bottles. Breastfeeding doesn't generate any waste. You can read more about this here.

Culture

Breastfeeding is more common in some cultures and communities than others. You may want to breastfeed because it is the norm in your community or cultural setting. By contrast, some mums may choose not to breastfeed, or may find breastfeeding challenging, because it is not so common within their community. However, there are breastfeeding support groups in most places in the UK which let you socialise in a place where breastfeeding is normal. These groups can give you practical and emotional support to help you continue breastfeeding. Check out our local groups here or contact the National Breastfeeding Helpline to find a group local to you.

Speak to a registered Breastfeeding Supporter

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Why breastfeed? - The Breastfeeding Network

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A mothers story: I knew I wanted to breastfeed my baby. I knew it was natural. So I was surprised when baby James and I could not seem to get the hang of it. I phoned a Breastfeeding Supporter. She gave us some good ideas about how I was sitting and holding James.

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It's not known why some babies die suddenly and for no apparent reason from sudden infant death syndrome (SIDS), or cot death.

Experts do know placing a baby to sleep on their back reduces the risk, and exposing a baby to cigarette smoke or allowing them to overheat increases the risk.

It's also known there's an association between sleeping with your baby on a sofa or chair and SIDS.

Follow the advice on this page to reduce the risks as much as possible.

How to reduce the risk of SIDS

To reduce the risk of SIDS:

place your baby on their back to sleep, in the same room as you, for the first 6 months

keep your baby's head uncovered - their blanket should be tucked in no higher than their shoulders

if wearing your baby in a sling or carrier, do not cover their head with the sling material or with a muslin

place your baby in the "feet to foot" position, with their feet at the end of the cot or Moses basket

do not let your baby get too hot or cold

never sleep with your baby on a sofa or armchair

do not smoke when you're pregnant or around your baby after they're born, and do not let anyone smoke in the same room as your baby

Place your baby on their back to sleep

Place your baby on their back to sleep from the very beginning for both day and night sleeps. This will reduce the risk of cot death.

Do not put your baby to sleep on their side or tummy.

Once your baby is old enough to roll over, there's no need to worry if they turn onto their tummy or side while sleeping.

Do not let your baby's head become covered

Babies whose heads are covered with bedding are at an increased risk of SIDS.

To prevent your baby wriggling down under the covers, place them in the "feet to foot" position. This means their feet are at the end of the crib, cot or Moses basket.

To put your baby in the feet to foot position:

tuck the covers in securely under your baby's arms so they cannot slip over their head - use 1 or more layers of lightweight blankets

use a baby mattress that's firm, flat, well-fitting, clean and waterproof on the outside - cover the mattress with a single sheet

do not use duvets, quilts, baby nests, wedges, bedding rolls or pillows

If you use a sling or carrier, make sure you use it safely.
The Lullaby Trust has more information and advice about swaddling your baby and using slings

Do not let your baby get too hot or too cold

Overheating can increase the risk of SIDS. Babies can overheat because of too much bedding or clothing, or because the room is too hot.

When you check your baby, make sure they're not too hot. If your baby is sweating or their tummy feels hot to the touch, take off some of the bedding. Do not worry if their hands or feet feel cool - this is normal.

It's easier to adjust for the temperature by using layers of lightweight blankets. Remember, a folded blanket counts as 2 blankets. Lightweight, well-fitting baby sleeping bags are a good choice, too.

Babies do not need hot rooms. All-night heating is rarely necessary. Keep the room at a temperature that's comfortable - about 16 to 20C is ideal.

If it's very warm, your baby may not need any bedclothes other than a sheet.

Even in winter, most babies who are unwell or feverish do not need extra clothes.

Babies should never sleep with a hot water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine.

Babies lose excess heat through their heads, so make sure their heads cannot be covered by bedclothes, slings or carriers while they're asleep.

Remove hats and extra clothing as soon as you come indoors or enter a warm car, bus or train, even if it means waking your baby.

Be safe if you share a bed with your baby

If you share a bed with your baby (co-sleeping), you should:

make sure they sleep on a firm, flat mattress lying on their back

not have any pillows or duvets near them

not have other children or pets in the bed at the same time

It's important not to share a bed with your baby if they had a low birthweight (less than 2.5kg or 5.5lb) or if you or your partner:

smoke (no matter where or when you smoke and even if you never smoke in bed)

have had 2 or more units of alcohol

have taken recreational drugs

have taken medicine that causes drowsiness

Never sleep with a baby on a sofa or armchair

It's lovely to have your baby with you for a cuddle or a feed, but sleeping with your baby on a sofa or armchair is linked to a higher risk of SIDS.

It's safest to put your baby back in their cot before you go to sleep.

Do not let anyone smoke near your baby

Babies exposed to cigarette smoke before and after birth are at an increased risk of SIDS. Do not let anyone smoke in the house, including visitors.

Ask anyone who needs to smoke to go outside. Do not take your baby into smoky places.

If you smoke, sharing a bed with your baby increases the risk of cot death.

Get help and support if you want to quit smoking

Feeding, dummies and SIDS

Breastfeeding your baby reduces the risk of SIDS.

It's possible using a dummy at the start of a sleep also reduces the risk of SIDS. But the evidence is not strong and not all experts agree that dummies should be promoted.

If you do use a dummy, do not start until breastfeeding is well established. This is usually when your baby is around 1 month old.

Stop giving them the dummy when they're between 6 and 12 months old.

Get medical help quickly if your baby is unwell

Babies often have minor illnesses that you do not need to worry about.

Give your baby plenty of fluids to drink and do not let them get too hot. If your baby sleeps a lot, wake them up regularly for a drink.

It can be difficult to judge whether an illness is more serious and needs urgent medical attention.

See spotting the signs of serious illness for guidance on when to get help.

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Reduce the risk of sudden infant death syndrome (SIDS)

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Sudden infant death syndrome (SIDS), or cot death, is rare. Find out how you can reduce the risk even further.

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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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What’s in breastmilk?

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What’s in breastmilk? The CHILD Cohort Study takes a look. © AllerGen Inc. 2020

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College of Human and Health Sciences, Swansea University

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Why you might want to put the baby books down...

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Why you might want to put the baby books down...

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School of Health & Social Care, Swansea University

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Why you might want to put the baby books down...

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How to Use Nipple Shields | Infant Feeding Team

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Birmingham Forward Steps – The best start for our children

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Pre and postnatal depression in Birmingham

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Pre and postnatal depression in Birmingham

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support services

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Acacia Family Support | Prenatal Depression and Postnatal Depression Support Services | Birmingham

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Acacia Family Support - Prenatal Depression and Postnatal Depression Support Services

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Birmingham and Solihull Maternity & Neonatal Voices Partnership

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Birmingham and Solihull Maternity & Neonatal Voices Partnership

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Birmingham and Solihull MNVP - Gateway Family Services

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We are a social enterprise dedicated to addressing the root causes of health inequalities through community-based support.

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Skip to main content Skip to accessibility tools

Helping every baby to have the best possible start to life

This is a new website, so your feedback will help us in shaping the content and layout as we develop. We'd love to hear what you like and what you think we could improve.

Our Local Maternity and Neonatal System (LMNS) works to ensure that every baby has the best possible start to life.
Our two local maternity providers, along with supporting NHS Trusts and voluntary organisations, are united as part of the Birmingham and Solihull United Maternity and Newborn Partnership (Bump) to provide high-quality services and care.

Our LMNS has a vision of ensuring that every woman is empowered to access consistent, world-class care which is right for them, their baby and their family.

Across Birmingham and Solihull, more than 18,500 babies are born every year. Our population is incredibly diverse and there are many factors which impact on the support which mums and babies require on their pregnancy journey.

Registering your pregnancy

If you live in the Birmingham and Solihull area (not including West Birmingham), and you plan to give birth here, you can register your pregnancy yourself through our self-referral portal. You can access this by clicking here.

PLEASE NOTE - SELECT THE CORRECT GP. Your pregnancy care will be provided by a team of midwives based on which GP surgery you are registered with. Your GP maybe listed on another portal, where you can complete a referral for Sandwell, Walsall, Wolverhampton, Coventry and Warwickshire areas by clicking the 'Change Location' button at the bottom of the page.

If you are unsure of your NHS number, It is important that the correct NHS number is entered to avoid delays in accessing care. you can find it by following this link here.

For more information about each of the above hospitals, please click the links. This will take you to the individual Trust websites.

Support for women and families

LMNS strategy: 2024 - 2027

Birmingham and Solihull Local Maternity and Neonatal System (LMNS) works to provide every baby with the best possible start to life, ensuring that women and birthing people receive optimum care through the antenatal, birthing and postnatal periods of their pregnancy.

Our three-year strategy, which is aligned to national plans, outlines how we will provide the very best outcomes and experience for the more than 18,000 babies who are born in our region every year. The population we serve is very diverse and we will ensure we tackle health inequalities, hear all voices and co-produce care.

To read the full strategy, click here.
To read the 'Plan on a Page' summary version of the strategy, click here.

LMNS Equity and Equality plan

Birmingham and Solihull Local Maternity and Neonatal System (LMNS) works to ensure that every baby has the best possible start to life.

This Equity and Equality Plan sets out how our system will support every woman in our area to receive the best possible care, regardless of their background, supported by a workforce which understands and is representative of the communities we serve.

Detailed in this document are the vision, values and aims of the plan, as well as the actions which are being taken to support safe and personalised care.

To read the summary document, click here.

To read the full plan, click here.

Learn more about different parts of our Local Maternity and Neonatal System

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Helping every baby to have the best possible start to life

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What is the BFS Virtual Hub?

The Birmingham Forward Steps Health Visiting Virtual Hub offers a single point of access, making it easier for you to contact us and have your questions answered. The hub provided parents and carers of pre-school children, and professionals virtual access to a Health Visitor who can offer advice and support.
What can I get help with?
The Hub is a Health Visiting Service advice line only and can provide support to parents who have queries in relation to the development of their children aged 0-5.
Who will I be speaking to?
Our dedicated admin team will answer your call, and will then ensure that you are directed to the right clinician, who will support you with your query, or signpost you to the right services for your needs
Who can access the Virtual HUB?
The virtual HUB pilot is currently only available for families living within the following districts:

Erdington and Sutton Coldfield

Ladywood

Selly Oak

Yardley

The Hub is open for calls 9am - 5pm, Monday to Friday. P lease call: 0121 683 2330
See below for a list of useful contacts, resources and apps.

Useful Contacts

Acacia: 0121 301 5990 Pre and postnatal support for the whole family:

Audiology: 0121 313 9364
Hearing assessment service from birth to 16 years of age.

Birmingham and Solihull Women's Aid: 0121 685 8686
Support women and children affected by domestic violence and abuse.

Breast Feeding Network Advice Line: 0300 1000 201
An independent source of support and information for breastfeeding women and others.

Cerebra: 0800 328 1159
Sleep advice and support.
Occupational Therapy advice line: Speech and Language advice line: 0121 466 6231 0121 683 2325
Central Booking: 0121 683 2320 option 3
For Children and Young People who are referred to the Community Paediatric service, Speech and Language Therapy, Paediatric Physiotherapy and Paediatric Occupational services.

Women's Aid: 0808 800 0028
Support for women and children who are victims of domestic abuse.

Useful Resources

Your local Children Centre's deliver a range of key services for 0-5's including:

Antenatal programmes

Breastfeeding support

Emotional wellbeing

Family support

Health eating

Speech and language

and more!

To find your local Children's Centre, please click here and enter your postcode.

To find your local stay and play, please click here and enter your postcode.

Useful Apps

Developed by UK charity Best Beginnings in collaboration with parents, healthcare professionals and partner charities across the country: the free Baby Buddy app is with you throughout your pregnancy and parenting journey, day by day.

The Baby Check App features 19 simple checks that parents can do if their baby is showing signs of illness. Each check tests for a different symptom and when completed, a score is calculated that tells parents or carers how ill their baby is. The app then lets parents know whether their baby needs to see a doctor or health professional.

Parenting tips and activities, personalised for you and your 0-5 year old, from our playful community of parents and experts.

Additional Needs

The ADHD Foundation is the UK's leading neurodiversity charity, offering a strength-based, lifespan service for the 1 in 5 of us who live with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, Tourette's Syndrome and more.

AWM are the leading charity in the West Midlands for people on the autism spectrum. They use expertise to enrich the lives of autistic people and those who love and care for them.

Help, advice and information about the services available for a child or young person from birth to 25 years with a Special Educational Need or Disability (SEND).

Cerebra is the national charity helping children with brain conditions and their families discover a better life together.

The umbrella body for the disabled children's sector with a membership of over 300 voluntary and community organisations and an active network of practitioners that spans education, health and social care.

KIDS supports almost 15,000 disabled children, young people and their families every year by delivering over 60 services across England.

Behaviour Management

There are lots of possible reasons for difficult behaviour in toddlers and young children. This website will give you tips and advice that can help you and your child.

This guide shares practical advice and tips for positive parenting techniques that work well for children

Cost of Living Support

There are lots of different ways you can get food for free or low cost. Visit the Birmingham food justice network map to find local options including food banks, food clubs/pantries (cheaper food) and community cafes (free/cheaper meals).

Your 2-year-old can get free childcare if you live in England and receive benefits. See if you are eligible today.

Inclusive and non-judgmental free access to heated communal spaces with the option of spaces for children and families only. Find a warm space local to you.

Dental Health

It is recommended to start cleaning a babies teeth around 6 months or when the first tooth erupts. Children under 7 should be helped or supervised by an adult to clean their teeth but this does not need to mean they cannot try cleaning their teeth themselves too. Startwell's Smiley Shen can help.

The NHS 'find your dentist' allows you to find a dentist near you, it also details if they are accepting new patients.

Feeding

Find your local breastfeeding lounge where you can access advice and support and make new friends for you and your baby.

The Breastfeeding Network (BfN) is a source of support and information for breastfeeding women and others.

Eating well in pregnancy, infants and new mums and in early years information and resources.

Healthy Start Vitamins are FREE for children under 4 years old and pregnant women from the start of their pregnancy up until their child is 12 months old. You must be with a Birmingham GP.

The Infant and Toddler Forum is dedicated to early-life nutrition from pregnancy to pre-school. Visit to see fussy eating, weaning, portion sizes.

The Startwell programme is based around 8 key characters and their messages to help early years settings, parents and health professionals create a healthier environment for our children and families.

Information on nutrition.

Sleep

A range of sleep services will help your child and everyone in your family get a good night's sleep.

The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families.

The Sleep Charity provide advice, information and support for those living with sleep issues.

Speech and Language Support

Tiny Happy People is here to help you develop your child's language skills. Explore simple activities and play ideas and find out about babies and toddlers' amazing early development.

BCHC SLT provide evidence based specialist support to children (0-19) with a range of specific speech, language and communication difficulties and those with difficulties swallowing, eating and drinking.

Tips and ideas to help with speech development.

For at least 1.7 million children in the UK, learning to talk and understand words feels like an impossible hurdle.  ICAN give children and young people the skills they need so they aren't left behind, waiting to be understood.

An independent charity working with schools and communities to give disadvantaged children the literacy skills to succeed in life.

Free resources and services can help with understanding what to look out for, how to get support and even some simple ways you can help your child at home.

Toilet Training

ERIC is the national charity dedicated to improving children's bowel and bladder health. Their mission is to reduce the impact of continence problems on children and their families.

Nursery

Find your local Nursery who provides day care for children aged from a few weeks old to those about to start primary school.

Mental Health

For Urgent Mental Health Help Call:
0121 262 3555
or
0800 915 9292
(24 hours a day, 7 days a week)

Free health and wellbeing services are provided by over 30 charities and/or non profit organisations based in the West Midlands.

Babies cry and you can cope - advice and support.

Vaccines

Vaccination for children against TB if the child has a parent or grandparent born in a country where TB is high.

Gov child immunisation information.

NHS child vaccination information, advice and when to have them.

Other Support

Acacia offer a range of free services including peer led listening and befriending support to families across Birmingham experiencing pre and postnatal depression/anxiety.

Acacia offers additional support for dads, Black, Asian and Minority Ethnic (BAME) and LGBTQ+ parents resources and support.

The Children's Advice and Support Service(CASS) provides a single point of contact for professionals and members of the public who want to access support or raise concerns about a child.

Top tips for parents on moving from pregnancy to the first few weeks, breastfeeding, mental health, health weight and nutrition and minor illness and reducing accidents.

How childhood trauma affects child brain development resources and information.

Women's Aid is a grassroots federation working together to provide life-saving services in England and build a future where domestic abuse is not tolerated.

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BFS Health Visiting HUB – Birmingham Forward Steps

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The Birmingham Forward Steps Health Visiting Virtual Hub offers a single point of access, making it easier for you to contact us and have your questions answered. The hub provided parents and carers of pre-school children, and professionals virtual access to a Health Visitor who can offer advice and support.

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Breastfeeding videos: attachment, milk making and much more

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Breastfeeding videos: attachment, milk making and much more

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Breastfeeding Attachment - 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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Resources which encourage interaction between parents and their babies.

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Resources which encourage interaction between parents and their babies.

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Look, Say, Sing, Play is a set of resources which encourage interaction between parents and their babies.

Parents and carers interact with their babies all the time without always realising how those interactions shape the way their baby's brain develops.

Improving interaction and encouraging parents to be more sensitive to their baby's cues helps parents identify and respond to their needs.

It also improves attunement and sensitivity of parents from an early stage, setting up positive behaviour as their child grows.

Improving interaction between parents and babies

These brain-building resources are based on the work of Vroom, a US public health initiative that uses the science of early learning to help parents improve back-and-forth interactions with their children.

Serve and return interactions - when a parent responds positively to their child by speaking, gesturing or touching - help shape brain architecture by building and strengthening the neural connections that babies need to develop communication and social skills.

This set of resources will help you to provide parents with brain-building tips that they can easily incorporate into their everyday routine and boost their child's development.

Evaluating Look, Say, Sing, Play

The Institute of Health Visiting and the School of Education, Communication and Language Sciences at Newcastle University are working with the NSPCC to evaluate Look, Say, Sing, Play. We hope that the evaluation will help us learn more about how to successfully implement the behaviour change campaign, the potential benefits for babies and parents and carers, and how to encourage even more positive behaviours. The evaluation is due to be published in 2022.

Download the resources

Look, Say, Sing, Play leaflet

This leaflet gives parents a handy introduction to brain-building tips for their child from birth, up until the age of 2. It helps them understand how they can bring more interaction in to their daily routine, and gives them an introduction to the science behind the campaign.
> Download the Look, Say, Sing, Play leaflet (PDF)
Look, Say, Sing, Play posters

A series of four posters to display where parents will see them. Each design give a different brain-building tip on how to interact with their baby and encourages parents to sign up for weekly tips via email.
> Download the set of four Look, Say, Sing, Play posters (PDF)
You can also download the posters individually:

Look, Say, Sing, Play activity posters

Ten activity posters outlining a range of different age-appropriate tips which parents can try with their child. These can be displayed and used around children's centres where Look, Say, Sing, Play sessions are running or by parents independently.
> Download blowfish activity poster (PDF) > Download colour hunt activity poster (PDF) > Download copy cat activity poster (PDF) > Download follow the face activity poster (PDF) > Download fun with fingers activity poster (PDF) > Download saw the sign activity poster (PDF) > Download sharing the story activity poster (PDF) > Download sing-song voice activity poster (PDF) > Download space explorer activity poster (PDF) > Download vroom, vroom activity poster (PDF)
Look, Say, Sing, Play session plans

There are three different session plans. The first is a guide to running a standalone session, the second is a guide to running a virtual session, and the third is a shorter version with ideas of how to incorporate Look, Say, Sing, Play messages into an existing group or activity.

We have also provided an information sheet for practitioners, containing key information that is helpful to know before delivering a Look, Say, Sing, Play session.
> Download the standalone Look, Say, Sing, Play session plan (PDF) > Download the virtual Look, Say, Sing, Play session plan (PDF) > Download the guide to including Look, Say, Sing, Play into an existing group (PDF) > Download the information for practitioners (PDF)
Look, Say, Sing, Play display pack

Easy-to-use display materials to share Look, Say, Sing, Play tips and activities with parents.
> Download the Look, Say, Sing, Play display pack (PDF)
Look, Say, Sing, Play activity sheets

Four activity sheets outlining a range of different age-appropriate tips which parents can try with their child. These can be used within a session which is outlined in the plans above or by parents independently.
> Download the set of four Look, Say, Sing, Play activity sheets (PDF)
Look, Say, Sing, Play flashcards

Two A4 sheets to be printed double-sided and cut into 17 flashcards. Each card gives an everyday activity parents can try with their child. The flip-side of each card explains 'the science bit' - how the activity helps their child's development.
> Download the Look, Say, Sing, Play flashcards (PDF)
Download resources in other languages

Some of our Look, Say, Sing, Play resources are also available in Welsh, Polish and Somali.
Welsh > Download the Look, Say, Sing, Play leaflet - Welsh (PDF) > Download the set of four Look, Say, Sing, Play posters - Welsh (PDF) > Download the Look, Say, Sing, Play flashcards - Welsh (PDF) > Download the plan for incorporating Look, Say, Sing, Play into a session - Welsh (PDF) > Download the Look, Say, Sing, Play standalone session plan - Welsh (PDF) > Download the Look, Say, Sing, Play activity sheets - Bilingual (PDF) Polish > Download the Look, Say, Sing, Play leaflet - Polish (PDF) > Download the set of four Look, Say, Sing, Play posters - Polish (PDF) Somali > Download the Look, Say, Sing, Play leaflet - Somali (PDF) > Download the set of four Look, Say, Sing, Play posters - Somali (PDF)
The research behind the Look Say Sing Play resources

Our briefing outlines the insights behind Look, Say, Sing, Play - giving an overview of the evidence which underpins the campaign and the research project which the NSPCC has commissioned.
> Download the Look, Say, Sing, Play briefing document (PDF)
How we're working with communities across the UK to develop the resources

We've been working with communities across the UK to develop these resources and activities for their local areas. This involves running workshops, not just for professionals, but for parents too.
> Get in touch with us about running a local campaign in your community

Talk with Me

For more free tips and expert advice on how you can help your child learn to talk, visit Talk with Me - the Welsh government's campaign on speech, language and communication for children aged 0 to 5 years.
> Visit Talk with Me

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Look, Say, Sing, Play early years resources to use and share with parents | NSPCC Learning

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A set of resources to help parents interact with their baby, boosting child development and setting up positive behaviour as their child grows.