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Choosing a breast pump and where to hire them from.

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Choosing a breast pump and where to hire them from.

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Information to help you make an informed choice.

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

Why do you need to express?

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

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

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

Not all breast pumps are the same

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

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

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

Hospital grade pumps

So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a hospital grade pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production (Jones et al, 2001) .

Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
https://www.ardomedical.co.uk/shop/products/rent-a-breastpump/ https://www.medela-rental.co.uk/ https://www.anawiz.com/collections/breast-pump-rental
Some Children's Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are 'personal use' double pumps, not hospital grade. They are also loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.

Personal use double electric pumps

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

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

Single electric pumps

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

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

Hands free wearable pumping

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

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

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

Manual and silicone pumps

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

Flange fit

When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes. The cheaper pumps tend to come with just one flange size and if this does not fit there is no option to buy a different size. Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange supplied with your pump does not fit then you will need to buy a different size. Manufacturers have fitting guides on their websites and they usually suggest a flange that is about 4mm larger than the diameter of your nipple. But recent research and teaching on this suggests a snugger fit with a flange that is just 2mm larger than the nipple diameter is better. One nipple may be much larger than the other, so some mums find they need a different size flange on each breast.

Spare parts

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

Portability

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

Quality

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

Second hand pumps

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

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

Sarah Oakley Independent Nurse, Health Visitor and International Board Certified Lactation Consultant 25/10/20

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Choosing a breast pump - Sarah Oakley Lactation

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful.

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This video talks you through bottle feeding your breastfed baby.

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Baby Led Bottle Feeding - Wendy Lever IBCLC

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With all of their needs being met in the womb, after birth your baby has to learn how to communicate their needs.

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Womb to world: helping your newborn adapt to life outside the womb (photos)

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Find out how your baby develops in the fourth trimester and learn how you can give your newborn all the support and attention he needs to flourish in his…

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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As source of resources specifically for mothers breastfeeding twins and triplets.

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Here at Breastfeeding Twins and Triplets UK we will answer all of these questions and more. We will try to put your mind at rest whilst being honest about journey on which you are about to embark. Breastfeeding more than one baby is challenging, but it is definitely possible and a lot of mums go on to have a really enjoyable experience.

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Twins Trust offer support through email, phone or text. You can talk to trained Peer Supporters who are all mothers to twins or triplets about feeding challenges and options however you feed your babies.

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Information and pictures shared exploring tandem feeding full term twins.

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You have two babies, you have two breasts. Many twin mums like to feed their babies together to save time and to try to maximise sleep!

But should you try straight away or should you single feed first whilst you are all practising? The answer is it really depends on your babies and you. Some babies struggle to latch in the early days so trying to juggle two babies and latching both on with one hand each can be quite stressful. And they often take a few goes each to latch. So sometimes its preferable to wait until they have practised a bit feeding singly. Other babies, especially if they are full term, a good size and nice and alert, can tandem feed straight away. So you will really have to wait and see. Some mums try tandem feeding and just don't enjoy it. And that's fine too. But I think its always a good idea to be able to tandem feed if you need to, even if you don't do it all the time.

So how do you go about tandem feeding? The most popular position is the "double rugby hold", or "double football hold" if you are American. The babies lie one down each side of you. Start nose to nipple, so the babies need to be quite far back with their legs curled round your waist; you may need an extra cushion or two behind you to make room for their legs, especially as they grow longer! Support the baby with your hand behind their shoulders with thumb and fingers round the neck behind the ears. Tickle top lip with your nipple to stimulate baby to open her mouth wide, and bring on to the breast chin first with nipple going up into the roof of the mouth. A twin feeding pillow can help to support the babies in a good position. You can read my blog about different twin feeding pillows here. If you have your feeding pillow set up well you should be able to let go of the babies and feed hands free (meaning you can eat ice-cream!).

Many mums are worried about how they will be able to tandem feed without help when their partner goes back to work. The most important thing is to keep everything nearby within reach. Then get your feeding pillow ready. Pick up one baby and put on sofa or bed next to you. Ensure baby cannot roll or push themselves off. It is surprising how early babies can move themselves! Then pick up the second and place next to the first. Get settled and make sure the feeding pillow is in position. Lift one baby onto the pillow, ensure they can't roll off, you can either use your arm to support it or some prefer to roll up a muslin and just prop them up. Lift second baby onto the cushion. I usually advise mums to start with the fussier feeder as you can concentrate more on the latch and use both hands. Then once the first baby has settled into a deep feeding rhythm and the milk is flowing, latch on the second baby. Sometimes this knocks the first baby off the nipple and you have to start again! But with practice, you will get there.

But you don't have to be constrained by the double rugby hold and needing to use a pillow to tandem feed. There are several other positions you could try. And especially as the babies get older, more able to control their heads, and faster at feeding, you really can be quite creative.

Commonly called "The Stack" you can feed one baby in cradle hold and one in rugby hold. This is quite a good position for feeding out and about as you can do it either without a feeding pillow or with just a couple of cushions to support your arms. Or you can sit cross-legged on the floor and have your legs support the babies.

The "double clutch" can be another good way of tandem feeding without a pillow. It is especially useful when babies are a bit older and can feed in a more sitting up position.

You can even tandem feed in the car. Just make sure you are not actually driving at the time!

And you can feed walking around if you can master the "tandem twin sling feed". The ultimate food on the move.

And most importantly, there are ways you can tandem feed lying down, so you can lie back and relax whilst you feed. These positions can be used from birth when babies like to feed very frequently, or later on during the long, cluster feeding sessions during growth spurts.

And when the babies become toddlers, they can feed any old how.

Kathryn Stagg, IBCLC, Jan 2018

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You have two babies, you have two breasts. Many twin mums like to feed their babies together to save time and to try to maximise sleep! But should you try straight away or should you single feed first whilst you are all practising? The answer is it really depends on your babies and you.

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Shares a range of information on different aspects of feeding twins, triplets and more (some you have to be a member to see).

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

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A guide which shares information about feeding, when babies do not settle and putting your baby down to sleep.

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A video explaining why, including fullness in the early days and symptoms. Plus ways to relieve and prevention tips.

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Call me on 07840 713 294. If there is no answer then please send me a text or WhatsApp.
Alternatively you can email me at:catcoulsonnct@gmail.com
I will aim to respond to messages and emails within 24 hours.

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Surrey and Sussex Healthcare Maternity support, Burstow babies
For support with infant feeding in the first 28 days.
Available to families that have had babies at East Surrey and or live in the area.

sash.burstowbabies@nhs.net

Surrey health visiting support line
For infant feeding support.
8am-5pm Monday to Friday
01883 340 922

Breastfeeding Support Drop-ins
For a breastfeeding support group hosted by trained professionals and joined by other new mums. (See picture for further details)

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For telephone support open daily:

NCT helpline

8am-midnight

0300 330 0700

National Breastfeeding Helpline
Welsh and Polish support available

9.30am-9.30pm

0300 100 0212

Le Leche League

8am-11pm

0345 120 2918

Breastfeeding Network Supporterline
For Bengali and Sylheti support

9.30am to 9.30pm

0300 456 2421

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

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

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What they are and useful tips for breastfeeding your baby.

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The size and shape of nipples and breasts vary widely between women. These differences have little to do with the ability to breastfeed-though if one or both nipples are flat or inverted some mothers find that establishing breastfeeding takes a little extra time and patience in the early days.

Inverted nipples? Many nipples will protrude when stimulated. If you think yours may be inverted, try placing your thumb and finger on opposite sides of the areola (the darker area of skin surrounding the nipple) and squeezing gently inwards. A nipple that stands out when stimulated is not inverted. Sometimes nipples may be partly inverted, looking dimpled or folded. Severely inverted nipples usually retract deeply when compressed or stimulated.

It's common for nipples to change shape during pregnancy, gradually protruding more. After your baby is born, your nipples may appear flatter but babies often lick the nipple to stimulate it before latching on. Your nipples may also appear flatter if your breasts are very full or engorged.

Causes

Inverted nipples may be caused by:

Tiny bands of connective tissue connecting the nipple to the inner breast tissue

Short milk ducts

Less dense connective tissue beneath the nipple than in women with protruding nipples

Treatment

There is no agreement about whether it is helpful to treat inverted nipples. The Royal College of Midwives believes that a diagnosis of flat or inverted nipples serves only to damage a mother's confidence in her ability to breastfeed. While individual mothers sometimes find one of the treatments suggested overleaf for inverted nipples helpful, no controlled studies have shown any particular treatment to be effective. Whether or not you try the techniques overleaf, do learn how to hand express milk. You may also like to try expressing your colostrum in the last four weeks of pregnancy. Any colostrum you collect can be frozen and given to your baby after the birth if needed. Antenatal Expression of Colostrum provides more information.

Good attachment is the key

Whatever breastfeeding specialists think about the different treatment options, they all agree that getting a deep latch is crucial. Babies breastfeed-not nipple feed-so with effective positioning and attachment your baby can learn to nurse well even if you have flat or inverted nipples. When a baby takes in a large enough mouthful of breast he will be able to feed effectively, so the shape of your nipples may not be an issue at all. Reading La Leche League books and leaflets before your baby is born will help you learn about breastfeeding and how to avoid common difficulties. Try to attend an LLL Meeting too-pregnant women are always welcome.

Comfortable breastfeeding

Comfortable positioning and attachment are important for all mothers. You will have time to practice with your baby while your breasts are soft before your milk comes in. Whether or not you have flattish nipples, start as soon as possible by holding your baby in skin-to-skin contact right after the birth. The earlier you start, the easier it is. laid-back or 'natural' positions can be a great help in encouraging your baby to latch on well, as well as being comfortable for you.

If your baby isn't nursing well

Hand express or pump to stimulate your breasts to make milk. Aim to express as often as your baby would be feeding, about 8-12 times in 24 hours. Your expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Avoid using bottles or dummies as they may cause nipple confusion, making matters worse.

Soften your breast

Breastfeed as often as you can. When your baby bobs his head and licks the nipple, he naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk if needed.

Stimulate your nipples

If your baby's head bobbing and licking isn't enough to stimulate your nipples, try:

Rolling your nipple gently between your thumb and finger

Touching your nipple with a cold moist cloth

Try using a breast pump

With some deeply inverted nipples, when a baby tries to breastfeed, he compresses the buried nipple beneath his mother's areola. If simpler techniques of stimulating your nipples before a feed fail, an automatic electric pump may be needed to provide suction to draw the nipple out before a feed. Once may be enough, or you may need to pump before each feed for a few days or perhaps weeks.

Nipple shields

A nipple shield is a thin, silicone teat that can be placed over a mother's nipple and may help a baby who is having difficulty learning to breastfeed. Nipple shields can be used temporarily to help establish breastfeeding. They come in different sizes-a comfortable fit is very important.

It is very important to seek skilled help with positioning, attachment and any other problems if you are already using nipple shields or planning to use them. Whilst a nipple shield can be a useful tool it should be regarded as only a temporary solution-continue to offer your baby some time in skin-to-skin contact every day without a nipple shield so he has the opportunity to latch on if he is able.

Practicalities

First breastfeeds
Breastfeed early and often after your baby's birth to minimize engorgement. Many babies have no difficulty feeding from mothers with inverted nipples, so start off by putting him to the breast and see how he gets on. If he latches on well and you are comfortable he will get plenty of practice and will probably continue to feed well after your milk comes in and your breasts feel fuller.

If your baby won't breastfeed
Don't panic! A baby usually starts to suck spontaneously if he can snuggle up close to his mother's bare chest for periods of time. Try letting your baby lie on your body as you recline so that both his chest and tummy are against you. This kind of contact, sometimes known as Biological Nurturing™, usually stimulates a baby's instinct to attach and suckle well at the breast. In such positions babies can also latch on when sleepy or in light sleep. Watch for signs your baby is stirring and gently encourage feeding.

Practical tips
Getting a deep latch
Help your baby get a deep mouthful of breast using the following tips:

Bring baby to breast, not breast to baby. Relax comfortably with your breast in its natural position

Keep your baby's whole body close against your body

Help your baby approach the breast 'nose to nipple' with his chin on or close to the breast. Keep his body tucked in close as he attaches and feeds but make sure he can tip his head back easily to open his mouth wide

As your breast touches his tongue, it will push his lower jaw open wider. If you are sitting up, as he opens his mouth to take the breast pull his body in firmly against you and give a little push between his shoulder blades

This will help him open his mouth very wide to get his top lip over the nipple area to latch on, resulting in a bigger and better mouthful of breast

His lower jaw will be tucked into your breast well away from the base of your nipple and his nose will be free. Active sucking is triggered when your breast tissue reaches the back of his mouth

Once your baby is attached you can make small adjustments to maximise your own comfort. If you're sitting up to feed, try shifting your weight back onto your tail bone and reclining your body back a little to open up a space for your baby. This allows more of his weight to be supported by your body and less by your arms. Gravity can help him stay attached deeply.

You can als o experiment with different holds to help you find what works best for you. An LLL Leader can help you find the most effective approach. You can find more detailed information by reading our page Positioning & Attachment.

Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way.

Exaggerated latch
To help get an even deeper latch you could try placing your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with his nose. As you press, your nipple will tilt away from your baby, presenting him with your breast rather than your nipple. As he opens wide, snuggle him in close and use your thumb or finger to tuck the breast into his mouth. Your nipple will be taken in last and unroll in his mouth. You can then slip your finger out.

Seek Support

Many mothers experience challenges with breastfeeding and find attending LLL meetings supportive. They will give you the chance to see that, whatever challenges you may face, breastfeeding can become a rewarding experience. If there is no LLL group in your area, you can still contact an LLL Leader for support.

Treating inverted nipples

Various techniques can be used to draw out nipples-though research on their effectiveness is inconclusive. If using devices, it is important to follow the manufacturer's instructions.

The Hoffman Technique
This technique is used during pregnancy. With a thumb on each side of the base of the nipple, press in firmly against the breast tissue and at the same time pull your thumbs away from each other. If this feels comfortable, repeat five times each morning, moving your thumbs around the base of the nipple. If you experience pain this technique may not be appropriate for you.

The Nipplette™
The Nipplette™ is a device that uses suction to help a nipple protrude. It consists of a transparent nipple mould from which air is sucked using a small syringe. The device is placed over the nipple area for increasing time each day during the first six months of pregnancy. One device is needed for each inverted nipple. The manufacturers do not recommend use in the last three months of pregnancy. While breastfeeding, limit use to a few minutes to draw out the nipple immediately before breastfeeding.

Breast shells
Sometimes, two-piece breast shells are suggested to apply steady pressure to encourage flat or inverted nipples to protrude. Whilst individual mothers report that using breast shells is a help, research has found them to be ineffective. They can be worn during pregnancy or before breastfeeds. If you decide to try breast shells, wear them for no longer than 30 minutes before feeds to reduce the risk of nipple soreness due to lack of air circulating around the nipple and blocked ducts due to pressure. You may need a bra with a larger cup size than normal. Breast shells need to be washed daily and any milk collected should be discarded because of the risk of bacterial growth.

Other concerns
Sore nipples
You may experience some discomfort in the first couple of weeks of breastfeeding as your baby gradually draws your nipple out. This is temporary and different from nipple damage and soreness caused by a baby who isn't latching on well. Pat your nipples dry after feeds, replace breast pads frequently and change wet bras. Your aim is for comfortable, relaxed feeds for you and your baby. So seek skilled help if you do experience nipple damage.

One breast preference
Differences in your nipples can lead to your baby preferring one breast to the other. You can encourage your baby to breastfeed on the least preferred side by putting your baby to the breast when he is in light sleep, offering it first at feeds and by breastfeeding frequently. Some mothers express from the least preferred breast to maintain milk production. However, some babies are quite determined in their preferences and end up breastfeeding from only one side. If this happens, milk production from the preferred breast will increase to meet your baby's needs as the other breast produces less. Any lop-sidedness will be temporary.

When further help is needed

If you have flat or inverted nipples and then experience additional challenges such as a premature birth or a thrush infection, seek help from your midwife or LLL Leader.

Written by Karen Butler, Sue Upstone & mothers of LLLGB. Photos courtesy Lois Rowlands and Kate Riley.

Further Reading
Antenatal Expression of Colostrum Beginning Breastfeeding Comfortable Breastfeeding
Engorged breasts - avoiding and treating
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk?
My Baby Won't Breastfeed Nipple Confusion Nipple Shields Sleepy Baby - why and what to do

From LLLI
Inverted nipples don't stop breastfeeding

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

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing; Laid-back breastfeeding for mothers DVD. Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills Watson Genna,C. Burlington, MA: Jones & Bartlett, 2012.
How to do Biological Nurturing
This information is available to buy in printed form from our Shop.

Copyright LLLGB 2016

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The size and shape of nipples and breasts vary widely between women. These differences have little to do with the ability to breastfeed-though if one or both nipples are flat or inverted some mothers find that establishing breastfeeding takes a little extra time and patience in the early days. Inverted nipples?

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To access all of the information, scroll across the page and up and down the columns. If you are looking for a specific topic you can try Ctrl + F as a search function.

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Rebecca Cooney is a Les Smith Distinguished Professor of Communication at Washington State University.

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Unicef UK Baby Friendly Initiative | Hand expression

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

You might want to express milk if:

How to express breast milk

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

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

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

Expressing breast milk by hand

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

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

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

These tips may help:

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

Have something clean ready to collect the milk in.

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

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

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

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

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

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

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

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

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

Expressing milk with a breast pump

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

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

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

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

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

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

Find out how to sterilise baby bottles

Storing breast milk

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

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

for 2 weeks in the ice compartment of a fridge

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

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

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

Defrosting frozen breast milk

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

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

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

Warming breast milk

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

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

Storing breast milk if your baby is in hospital

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

Read more about breastfeeding a premature or sick baby

If you're having difficulty expressing breast milk

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

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

Search online for breastfeeding support in your area.

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

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

Community content from HealthUnlocked

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

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Be prepared: what do you need?

Whether you're bottle-feeding your baby using formula milk, expressed breastmilk, or a combination of the two, it helps to be prepared. Make sure you buy any kit you'll need like bottles and teats. There are many different types of bottles and teats for sale. It may take a while to try a couple of different ones to see what works best for you and your baby.

You can also buy additional equipment if you like. For example, some mums will express milk by hand, while others will use an electric breast pump. There is also a range of sterilisation equipment available to buy (NHS Choices 2018).

Making up infant formula

Bottles and teats need to be washed thoroughly and sterilised before each use (NHS 2016). Read about how to sterilise bottles and teats.

When making up infant formula, it is very important to ensure the water is at the correct temperature as formula powder is not sterile. Measure the correct amount of water at 70°C into the bottle, before adding the correct number of scoops of powder (directions for the volume of water and number of scoops will be found on the packaging) (NHS 2016). Different brands have different sized scoops. Care must be taken to avoid accidentally using too much or too little milk powder (UNICEF UK).

It's important to follow good hygiene practices like always washing your hands before preparing your baby's feed and following any instructions on the formula packaging. This is to help prevent your baby picking up an infection (NHS 2015).

How to spot 'early hunger cues'

Keep an eye out for any early signs your baby is getting hungry. They may start to stick their tongue out, suck on their fists or perhaps turn their head to the side. Crying is the last sign of wanting to feed, so it is better to feed your baby before they do (NHS, 2019).

If you learn how to spot these early feeding cues, you may find that your little one feeds more calmly and more easily. If your baby is already upset or crying, then try to soothe them first before offering them a milk feed. You could talk to them gently or try skin-to-skin contact which can also help to calm them (Breastmilk counts, 2019).

Bond with your baby

Feeding your baby, especially in the early days, can be a good time for closeness and bonding. So, whether it's you or your partner who would like some special time with your little one, make sure you're comfortable and create a calm environment. It's better to limit the feeding to you and your partner in the early days to build a close and loving relationship with your baby and help them feel safe and secure. Some babies respond well to background music, while others prefer it to be quiet. As they get older, most babies will enjoy looking up into your eyes (First Steps Nutrition Trust, 2018; UNICEF UK, 2016).

Responsive feeding

Responsive feeding is all about trying to respond quickly to your baby's needs, not getting distracted during feeding time and not encouraging your little one to over-eat or finish bottles of milk when they're no longer hungry (UNICEF UK, 2016).

Research into responsive feeding suggests that it can help parents from over-feeding their baby and therefore help to reduce the risk of obesity (UNICEF UK, 2016; DiSantis et al, 2011; NHS 2018).

How to hold your baby for bottle feeding

Hold your baby close to you. They should be fairly upright, with their head supported - so they can breathe and swallow comfortably. Support your baby so they're slightly raised and able to look at you. Babies shouldn't be flat on their backs or left alone with a propped-up bottle when they are being fed to avoid any risk of choking (UNICEF UK).

Try talking to your baby gently and look into their eyes to reassure them during feeds. This helps them to feel safe and loved (NHS 2015; UNICEF UK, 2019; NHS, 2012; NHS Choices, 2018).

How to feed your baby using a bottle

Rub the bottle teat against your baby's upper lip gently to encourage them to open their mouth and draw the teat in, rather than forcing it into the mouth. Tip the bottle horizontal with only a slight tilt just enough to ensure there is milk in the teat. This also prevents milk from flowing too fast. Be guided by your baby's reactions while feeding. They should be able to suck and swallow, slowly and naturally, without spluttering, and without pushing the teat out with their tongue (First Steps Nutrition Trust, 2018; NHS, 2018).

If the teat becomes flattened while feeding, pull gently on the corner of their mouth to release the vacuum (First Steps Nutrition Trust, 2018; NHS 2018, UNICEF 2018).

'Pacing' feed

Babies feed in bursts of sucking with short pauses to rest. When your baby slows their sucking and swallowing, you can help 'pace' the feed by partially moving the bottle teat out and then letting them draw it in again. This mimics the stop-start motion of breastfeeding. This can also help avoid over-feeding your baby. Interrupting the feed from time to time gives your baby a chance to register how full they are and how much more they need - helping them to control their intake (UNICEF, 2018).

If your baby gets upset at having the teat removed, tip the bottle downwards while it remains in their mouth, which will stop or slow down the flow. Holding the bottle horizontal to ground with only a slight tilt will also ensure that baby doesn't get milk while they're pausing for a rest (UNICEF 2018).

Winding your baby

Your little one may need short breaks during their feed and may need to be burped. Hold them upright and rock or rub and gently pat their back to help them bring up any wind. Continue feeding your baby when they are more comfortable.

Some babies will need more winding than others. If your baby cries excessively or you are concerned about their feeding, talk to your health visitor or GP (UNICEF UK).

When you have finished feeding your baby, remember to throw away any unused formula milk as it may become contaminated and give baby an upset tummy.

Hot or cold milk?

Some babies are happy with their milk cool (room temperature) while others like it warm. Always check the temperature of the milk from your baby's bottle on the inside of your wrist before you feed them to make sure it's not too hot. This is necessary in order to avoid scalding their mouth. It should be warm or cool, not too hot. You don't need to warm it up at all if you don't want to or your baby doesn't mind.

Precious moments

Sometimes in the early days, feeding your baby can seem overwhelming and time-consuming, especially if they feed little and often and you have to get up countless times in the night.

It can be helpful to remember that as your baby grows bigger, they will get more efficient at feeding and their milk feeds usually space out more as they grow. If you are concerned about your baby's feeding talk to your health visitor or GP (UNICEF UK).

Further information

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

Our support line offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

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

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

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Tips for bottle-feeding your baby | Baby & toddler, Feeding articles & support | NCT

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Introducing bottle-feeding to a breastfed baby can take a bit of getting used to, so don't be discouraged if it doesn't go smoothly the first few times. Here we've put together some useful bottle-feeding tips to help you through.

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You don't need to eat anything special while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet.
A healthy diet includes:

at least 5 portions of a variety of fruit and vegetables a day, including fresh, frozen, tinned and dried fruit and vegetables, and no more than one 150ml glass of 100% unsweetened juice

starchy foods, such as wholemeal bread, pasta, rice and potatoes

plenty of fibre from wholemeal bread and pasta, breakfast cereals, rice, pulses such as beans and lentils, and fruit and vegetables - after having a baby, some women have bowel problems and constipation, and fibre helps with both of these

protein, such as lean meat and chicken, fish, eggs, nuts, seeds, soya foods and pulses - no more than 2 portions of fish a week is recommended, including 1 portion of oily fish

dairy foods, such as milk, cheese and yoghurt - these contain calcium and are a source of protein

non-dairy sources of calcium suitable for vegans include tofu, brown bread, pulses and dried fruit

drinking plenty of fluids - have a drink beside you when you settle down to breastfeed: water and skimmed or semi-skimmed milk are all good choices

See more detailed advice about healthy eating.

Small amounts of what you're eating and drinking can pass to your baby through your breast milk.

If you think a food you're eating is affecting your baby and they're unsettled, talk to your GP or health visitor, or contact the National Breastfeeding Helpline on 0300 100 0212.

Find out more about the helpline on the National Breastfeeding Helpline website.

Vitamins and breastfeeding

Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10mcg of vitamin D.

From late March to the end of September, the majority of people aged 5 years and above will probably get enough vitamin D from sunlight when they are outdoors. So you might choose not to take a vitamin D supplement during these months

You can get all the other vitamins and minerals you need by eating a varied and balanced diet.

Ask your GP or health visitor where to get vitamin D supplements. You may be able to get free vitamin supplements without a prescription if you're eligible for the Healthy Start scheme.

Find out more about getting vitamins on the Healthy Start website.

You're entitled to free NHS prescriptions for 12 months after your baby is born. You will need to show a valid maternity exemption certificate to prove your entitlement.

If you did not apply for a maternity exemption certificate while you were pregnant, you can still apply at any time in the 12 months after your baby is born.

Healthy snack ideas for breastfeeding mums

The following snacks are quick and simple to make, and will give you energy and strength:

fresh fruit

sandwiches filled with salad, grated cheese, mashed salmon or cold meat

yoghurts and fromage frais

hummus with bread or vegetable sticks

ready-to-eat dried apricots, figs or prunes

vegetable and bean soups

fortified unsweetened breakfast cereals, muesli and other wholegrain cereals with milk

milky drinks or a 150ml glass of 100% unsweetened fruit juice

baked beans on toast or a baked potato

Healthy Start vouchers

You can get Healthy Start vouchers if you're pregnant or have a young child under 4 and are getting certain benefits or tax credits, or you're pregnant and under 18.

These can be spent on milk and fresh or frozen fruit and vegetables, or they can be put towards formula milk if you're not breastfeeding.

You can't use vouchers to buy fruit and veg with added fat, sugar and salt or flavourings, such as oven chips and seasoned stir fries. You can also get Healthy Start vouchers for free vitamin supplements.

For more information or an application leaflet, visit the Healthy Start website, or call the helpline on 0300 330 7010.

If you're already receiving Healthy Start vouchers, ask your midwife or health visitor where you can exchange the vouchers for vitamins.

Eating fish while breastfeeding

Eating fish is good for your and your baby's health, but while you are breastfeeding you should have no more than 2 portions of fish a week. A portion is around 140g.

Make 1 of them oily fish such as fresh mackerel, sardines, trout or salmon.

All adults should also eat no more than 1 portion a week of shark, swordfish or marlin.

Caffeine and breastfeeding

Caffeine can reach your baby through your breast milk. Caffeine is a stimulant, so if you have a lot, it may make your baby restless and keep them awake.

Caffeine occurs naturally in lots of foods and drinks, including coffee, tea and chocolate. It's also added to some soft drinks and energy drinks, as well as some cold and flu remedies.

There's not enough information to say how much caffeine is too much, and babies respond to caffeine differently. But it's a good idea to reduce how much caffeine you drink, especially when your baby is less than 6 months old.

If you're breastfeeding, it's recommended that you have no more than 200mg a day. This may include 1 mug, 1 can or 1 bar of:

instant coffee (100mg)

filter coffee (140mg)

tea (including green tea, which can have the same amount of caffeine as regular tea) (75mg)

cola (40mg)

energy drink (a 250ml can is 80mg)

plain dark chocolate (a 50g bar is less than 25mg)

plain milk chocolate (a 50g bar is less than 10mg)

You could also try herbal teas, 100% fruit juice (but no more than one 150ml glass per day) or mineral water.

Peanuts and breastfeeding

If you'd like to eat peanuts or foods containing peanuts, such as peanut butter, while breastfeeding, you can do so as part of a healthy, balanced diet (unless, of course, you are allergic to them).

There's no clear evidence that eating peanuts while breastfeeding affects your baby's chances of developing a peanut allergy. If you have any questions or concerns, you can talk to your GP, midwife or health visitor.

See more about food allergies.

Got a breastfeeding question?

You can message the Start4Life Breastfeeding Friend chatbot on Facebook Messenger for fast, friendly, trusted NHS advice anytime, day or night.

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Advice on eating a healthy diet while you are breastfeeding, including advice on what vitamins you need.

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Mastitis: symptoms and treatment | Baby & toddler, Feeding articles & support | NCT

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Mastitis is a painful breast condition. Here we discuss its symptoms, treatment, how to continue breastfeeding with mastitis and how to help prevent it.

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

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

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What is it and how it may effect feeding.

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Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.

Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn't happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.

Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled.

Identifying tongue tie

When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its centre down and restricting its movement. Or you may be able to see or feel firm tissue where their tongue meets the floor of his mouth. Degrees of tongue tie vary and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot.

How breastfeeding may be affected

Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with their mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.

A baby may:
* Be unable to latch on to the breast at all.
* Be unable to latch on deeply, causing nipple pain and damage.
* Have difficulties staying on the breast, making a clicking sound as he loses suction.
* Splutter and choke when coping with fast flowing milk.
* Breastfeed constantly to get enough milk.
* Have poor weight gain or need supplementation to maintain adequate weight gain.
* Develop jaundice that needs treating.
* Be fussy at the breast when the milk flow slows.
* Develop colic.

A mother may experience:
* Pain during feeds, with damaged nipples. Her nipple may be compressed or distorted into a wedge shape like that of a new lipstick immediately after feeding, often with a stripe at its tip.
* Engorgement, blocked ducts and mastitis because of ineffective milk removal.
* Low milk production because of ineffective milk removal.
* Oversupply-if her baby compensates for not being able to breastfeed well by nursing very frequently.
* Tiredness, frustration and discouragement.
* A premature end to breastfeeding.

Breastfeeding is important for every baby

Though sometimes needed as a temporary supplement if your milk production is very low, introducing infant formula is not the answer. It has short-term and long-term health risks for both your baby and you. A baby with tongue tie can also have difficulties with bottlefeeding. Milk may leak from his mouth during feeds and he may suffer from colic.

Treatment

Where a tongue tie is causing breastfeeding problems, treatment options are available and effective- especially if the treatment is prompt. Although attention to positioning and attachment can help maintain breastfeeding and improve comfort to a certain extent, there is evidence that treating tongue tie by frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the continued breastfeeding benefits, continuing to breastfeed after frenotomy maximises a baby's chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth, helping prevent tooth decay.

Keeping breastfeeding going

Mastering the art of breastfeeding can sometimes be a challenge and it takes determination to keep going if you are in pain. The information here can help you keep breastfeeding, both before and after treatment.

Soften your breast

A baby with tongue tie may find it easier to latch on if your breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, they naturally makes it easier to latch on. Or you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be. Gently hand express a little milk if needed.

Biological nurturing™
A baby often instinctively attaches more deeply and comfortably if they can snuggle up close to their mother's chest for periods of time. Try letting your baby lie on your body as you recline so both their chest and tummy are against you. This kind of 'laid-back' breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed-whatever is more comfortable and convenient for you both. Because gravity helps a baby keep their tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make. See picture above and Online Information section for details of an online video.

A deeper latch
Help your baby get as deep a latch as possible at the breast. This will maximise the amount of milk they get and minimise nipple pain.

If your baby retracts (pulls back) their tongue when they open their mouth, try sliding their chin a little further from the nipple so he can feel the 'fatter' part of the breast with his tongue. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help.

You could also try placing your thumb or finger near the base of the nipple where your baby's upper lip will be. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. If needed, you can then slip your finger out. An LLL Leader can give you further suggestions to help you improve your baby's positioning and attachment

Encourage tongue mobility

To encourage your baby to move their tongue forward, you can also try:
* Reclining with your baby on top of you. Try leaning forward and back yourself to understand how gravity affects tongue position.
* Encouraging them to lick milk from their lips or from your nipple before and after feeds.
* Sticking your tongue out at your baby to encourage them to copy you.

Maintain milk production

If your baby is sleepy or has jaundice, or if you have engorgement or inverted nipples, then a tongue tie can make things worse. If they are not able to take enough milk directly at the breast then you will need to express it and give it to your baby until they are able to breastfeed effectively. Express by hand and/or with a pump at least 8 times a day if your baby is not draining the breast well. This will maintain your milk production and ensure they get enough milk.

Small amounts of expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Bottles or dummies can confuse your baby's sucking technique so consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

An unusual palate

Restricted tongue movement caused by tongue tie may affect the shape of a baby's palate, leading to a high palate or a bubble palate with a high spot. These may be a factor in broken suction, a clicking sound and pain during breastfeeding. A baby with an unusual palate may also resist a deeper latch due to gagging.
The following may help.
* Start with a clean finger with closely trimmed nail.
* Touch your baby's lips and wait until they open their mouth.
* Gently slide in your finger, pad side up along his hard palate, stopping just before the gag reflex is triggered.

Make this a pleasant game and, over a few days, gradually move your finger back to overcome sensitivity. After a tongue tie is divided, a baby's increased tongue movement helps the palate shape become more normal

Treating Tongue Tie

What can be done?
Frenotomy-dividing the tongue tie-can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is a quick and simple procedure. No anaesthetic is needed for a baby under six months of age.

There are health professionals around the UK who have been specifically trained to divide tongue ties. For treatment on the NHS, you will need a referral from your midwife, health visitor or GP. Knowledge about tongue ties and how they affect breastfeeding varies, so it is worth persisting and seeking a second opinion. In areas where only GPs can refer, your midwife or health visitor may be able to give a recommendation to your GP or suggest seeing a particular GP. Private treatment may also be an option. See Further Reading for information on finding a practitioner trained to divide tongue ties

Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a baby over six months old is also a more complicated procedure and usually requires a general anaesthetic.

Frenotomy-what will happen?
After the health professional's initial assessment, your baby will be swaddled and held (often by an assistant) so they stay still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of round-ended sterile scissors or by cauterising it.

Does it hurt?
No anaesthetic is needed for a very young baby as having a tongue tie divided only hurts a little, if at all. Some babies protest more at being swaddled than about the treatment. Others sleep right through the procedure! You will be asked to breastfeed your baby as soon as the procedure is over, to offer comfort, clean the wound and get their tongue moving as soon as possible. The inside of a baby's mouth heals very quickly. The only treatment usually needed is to breastfeed to keep the wound clean and keep his tongue mobile. There may be a white patch under your baby's tongue, but this heals within 24 to 48 hours.

If things don't resolve
Usually a mother notices an instant improvement in her comfort during breastfeeds. Sometimes it takes a week or two for a baby to adjust to their tongue's greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally a baby's frenulum needs dividing a second time, usually because the division was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby's breastfeeding problems arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can suggest further paths to explore and provide ongoing support.

Painful nipples

Using different feeding positions can help if breastfeeding is painful. Or use the position you find most comfortable until your nipples heal. Check your baby's attachment later in the feed-if they slip down your nipple, this may cause you pain. Reclining breastfeeding positions or extra support under your arms may help.

Ask your LLL Leader about breast compression, which can help your baby get more milk quicker. An increase in milk flow may also help them breastfeed more effectively.

Hand express to stimulate milk flow before feeding. Or start on the least painful side, switching sides once your milk lets down. Pain can reduce milk flow, leading to engorgement and mastitis. Ask your doctor, midwife or health visitor about using a suitable painkiller. Applying warmth and using gentle massage and relaxation exercises just before feeds can help milk to flow.

Moist wound healing

When the underlying problem is corrected, moist wound healing can help your nipples heal without scab formation. After each feed gently pat your nipples dry to remove surface wetness. Apply a tiny smear of ultra pure modified lanolin to each nipple, dabbing it on rather than rubbing. Hydrogel pads without a cloth backing can also be used.

Blood from cracked nipples
Blood from cracked nipples is not harmful to your baby. You can continue to breastfeed whilst working to improve positioning and attachment.

If healing is slow
Once your baby starts latching on well you should feel more comfortable and notice signs of healing within a few days. If not, visit your GP-sometimes a bacterial or fungal infection can prevent healing. Continued pain may be a sign that treatment (or further treatment) of your baby's tongue tie is needed.

Seek support

This is a time when the support of other mothers in your local LLL group can be invaluable. You can find your nearest Leader or by calling our Helpline.

Further Reading

Find a tongue tie practitioner- Association of Tongue Tie Practitioners, has details of both NHS and Private Practitioners
Biological Nurturing™
Lactation Consultants of Great Britain

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010: p63-81, 428-430.
Comfortable Breastfeeding
Engorged Breasts - Avoiding & Treating
Expressing Your Milk
Hand Expression of Breastmilk
My Baby Needs More Milk
Nipple Know-How
Nipple pain
Nursing Supplementers
Sleep Baby - Why and What To Do
Storing Your Milk
LLLI Resources
Tongue Tie & the Breastfed Baby
References

Hazelbaker, AK. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press, 2010.

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

Watson Genna, C. Supporting Sucking Skills in Breastfeeding Infants. Burlington, MA. Jones & Bartlett, 2012.

Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188-94.

Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246-50.

Hong, P. et al. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Ped Otorhinolaryngology 2010; 74:1003-6.

Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010.

Miranda, BH. and Milroy, CJ. A quick snip-a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. JPRAS 2010; 63:e683-5.

NICE Guideline s

Watson Genna, C. And Coryllos, EV. Breastfeeding and tongue-tie. J Hum Lact 2009; 25(1):111-2.

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

Copyright LLLGB 2016

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Treating and coping with breastfeeding a baby with tongue tie

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If you get sore nipples when breastfeeding, it's usually because your baby's not positioned and attached properly at the breast.
It's important not to stop breastfeeding. With help, feeding should quickly become more comfortable again.

Get help early for sore nipples

If you find 1 or both nipples hurt at every feed, or your nipples start to crack or bleed, it's important to get help from your midwife, health visitor or breastfeeding supporter as soon as you can.

They can watch as you feed your baby and help you get them correctly positioned and attached to the breast.

When your baby is effectively attached, your nipple rests comfortably against the soft palate at the back of their mouth.

If your baby is poorly attached to the breast, the nipple is nearer the front of their mouth and can be pinched against the hard palate, causing pain.

Flattened, wedged or white nipples at the end of a feed are 1 sign your baby may not be properly attached. Your baby may also seem unsettled after feeds.

Having sore nipples when you're trying to breastfeed a new baby can be stressful and upsetting.

Try to carry on breastfeeding or express milk by hand if you can, and ask for help early.
Learn more about expressing milk by hand

Self-help tips for sore nipples

Bear in mind that self-help tips will not be effective if your baby is poorly attached during breastfeeds.

But you may find it helps to:

change breast pads at each feed (if you're using them) - if possible, use pads without a plastic backing

wear a cotton bra so air can circulate

keep feeding your baby for as long as they want - keeping breastfeeds short to "rest" your nipples will not ease nipple pain and could affect your milk supply

avoid using nipple shields (a thin, protective cover worn over your nipple as you breastfeed) or breast shells (a hard, protective cover worn inside your bra) - these will not improve your baby's attachment to the breast

If your nipples start to crack, try dabbing a little expressed breast milk onto them after feeds.

Important

Get help early if your nipples are cracked or bleeding, as this increases your risk of getting an infection in your nipple.

If nipple pain does not improve

If your baby is properly positioned and attached at the breast during feeds and your nipples are still sore, ask your midwife, health visitor or breastfeeding supporter for help.

There may be an underlying problem, such as thrush.

Video: How do I know if my baby is properly latched?

In this video, a midwife talks about how to check if your baby is latched on properly when breast feeding.

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Sore or cracked nipples when breastfeeding

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If you get sore nipples when breastfeeding, it's usually because your baby's not positioned and attached properly at the breast. It's important not to stop breastfeeding. With help, feeding should quickly become more comfortable again.

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Is it ok?

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Frequent feeding | Welcome to Human Milk CIC

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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Recognising that the baby is getting good amounts of milk at the breast.

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Does everyone ask how your baby sleeps?

Does everyone else's baby seem to sleep more than yours?

Do you feel like you or your baby are being judged by how 'well' he/she sleeps?

If so, you are not alone!

When we have a new baby, many of us often find that talking about sleep causes others to offer (often unwanted) suggestions for how we can (or 'should') encourage our baby to sleep more. Although we all know that the first few months with a baby will involve disrupted nights, our expectations for how long this lasts, and our understanding of how normal infant sleep develops, can be unclear or unrealistic, and comments from others can be worrying:

Am I doing it right? Is there something wrong with my baby?

As sleep deprivation continues, we may search for bright ideas for getting a 'good night's sleep', or we may be tempted to try out the suggestions of family, friends, or well-wishers. But how do we know these ideas or suggestions are safe, that they won't affect our infant's health, or have long-term consequences?

It is important to remember that babies operate according to their own internal biological rhythms and they are unaware of what their parents are reading or being told.

Babies do not have a body clock when they are born. It often takes several months for a baby's day-night pattern of wake and sleep to become established, and for night-time sleep consolidation to happen.

During this time many parents just need reassurance that their baby is normal, and that their baby's sleep patterns are developing as expected.

In cases where we are unhappy with our infant's sleep development it may not be the baby that is problematic, but our expectations regarding sleep and babies' needs.

If you are a parent who is reading this site, we assume this means you are looking for information and want to make informed decisions. This is what we aim to provide, at least for those topics where there is good research evidence about normal infant sleep.

Where little or no research exists, we'll tell you - but if you are looking for information we don't seem to provide let us know, and we'll try to address that.

In the following sections we summarise what is currently known about normal infant sleep development, why babies sleep the way they do, and what research has so far discovered about 'managing' how babies sleep.

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Does everyone ask how your baby sleeps? Does everyone else's baby seem to sleep more than yours? Do you feel like you or your baby are being judged by how 'well' he/she sleeps? If so, you are not alone!

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Something you may consider doing when you have gestational diabetes

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

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

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

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

The link between diabetes and colostrum harvesting

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

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

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

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

Increased risk of neonatal hypoglycaemia

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

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

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

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

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

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

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

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

Experienced breastfeeding mothers benefit too

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

Colostrum v's formula

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

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

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

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

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

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

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

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

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

When to start colostrum harvesting

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

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

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

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

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

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

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

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

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

Harvesting colostrum

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

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

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

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

Ask for some syringes

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

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

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

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

How to harvest colostrum - antenatal expressing of colostrum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For further details on storing colostrum, please read below.

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

Further guidance on hand expressing

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

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

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

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

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

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

Can I use a breast pump?

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

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

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

Storing colostrum

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

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

How long to store colostrum for

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

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

for up to six months in a freezer

Colours and consistency of colostrum

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

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

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

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

Frequency of colostrum harvesting and the amount required

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

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

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

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

Don't panic!

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

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

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

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

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

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

Tips:

1. Try expressing after a warm bath or shower

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

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

4. Massage your breasts before expressing

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

6. Drink plenty of fluids

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

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

Is it safe to harvest colostrum when taking Metformin?

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

More helpful links:

Research
Importance of early first feed for babies of diabetic mums

Background

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

Methods

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

Findings

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

Interpretation

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

Funding

Australian National Health and Medical Research Council

Prof Della A Forster, PhD

Lisa H Amir, PhD

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

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

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

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

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

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

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Colostrum harvesting * Gestational Diabetes UK

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

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What the first few weeks may feel like for the baby.

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What the first few weeks may feel like for the baby.

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Kathryn Kelly, NCT antenatal teacher, explains: 'The Fourth Trimester is a way of describing the period after birth when both parents and baby are adjusting to their new lives.

'We think of other trimesters as being three months long, and we can think in terms of roughly another three months after the birth to make the adjustments to being a new family.'

What's the fourth trimester like for babies?

Having been in your warm womb for nine months, your baby has now got to get used to a sensory overload of sights, sounds and smells, as well as a frequently colder environment where they're not constantly supported by your protective amniotic fluid.

Kathryn says: 'Babies have been used to being fed continuously, sleeping when they want to, and being rocked in the cosy embrace of their mum's tummy. When babies are born we introduce gaps between feeds, and put them in a different place to sleep. It's no wonder that they can find this scary, and it's natural that they cry to express their fears.'

Understandably, babies are likely to cry more in this three-month period than any other time in their life. But however logical it might be, it doesn't make this period any easier for new parents. Knowing that other parents are going through the same experience, and thinking of this period as the fourth trimester, might help.

'Parents describe it as a very useful concept, which reminds them that it is OK to find the early days with a baby hard. It is a period of transition, where women become mums, men become dads, and babies adjust to life outside the womb,' Kathryn says.

What can you do to help your baby in the fourth trimester?

Fundamentally, the closer your baby feels to you, the happier they will be. According to Kathryn: 'Anything that mum, dad or other carers can do to replicate the womb-like world will help their baby feel safe. And when we feel safe, we thrive. For your baby, this means holding them close, perhaps in a sling, so they feel the warmth of your body, hear your heartbeat, and are gently rocked as you go about your day (or night).

'Feeding for babies, just like for adults, is about more than just nutrition, it's also social - a way of sharing and being with those we care for. Feeding your baby whenever they they want to will support their emotional development, as well as their physical and intellectual development.

'Your baby will sleep when they're tired, and you will both feel safer if they're close to you. Many parents tell me that in the early days their baby won't sleep in their Moses basket or crib, but only when they're held by a parent. This is perfectly normal and understandable when you think about the baby's point of view. It's important that parents find out about the safer sleep guidelines, and work out a way of sleeping that suits them as a family.'

Can you 'spoil' your baby in the fourth trimester?

No. Despite some people saying that babies need to 'learn' that you won't rush to pick them up every time they cry, in this crucial Fourth Trimester period you can't care for them too much. In fact, the more you look after them when they're upset, the more reassured and confident they'll be.

How might you be feeling?

Even if you're not an international tennis champion, parents who have gone from living busy, independent lives, can find the sudden change to around-the-clock care for a completely dependable infant hard.

Add to that the need to recover from a traumatic or difficult birth, and you can understandably feel like you're the one in need of a little TLC. Kathryn says: 'With the emotional changes in a woman's body, plus the realisation of the enormous responsibility of having a baby, new mums can feel overwhelmed and tearful at times.

'Partners can be dealing with their own response to the birth, their changing identity, and strong feelings about protecting and providing for the family. All of these feelings can also be affected by the way both mum and her partner were parented themselves.'

As with all stages of early parenthood, it's worth remembering that this stage will pass. In what seems no time at all, you might be looking back at the period with fondness at how tiny and attached to you your baby was when they were first born.

However, that is not to downplay how challenging the Fourth Trimester can be for parents. When you're in it, it's all-consuming. You can feel like you don't know what you're doing and you're constantly one step behind.

So, what should I do?

If you think in terms of the first three months of your baby's life being a Fourth Trimester, it can be easier to take the pressure off getting back to 'normal'. You wouldn't have been trying to rush around tidying the house and welcoming endless visitors when you were heavily pregnant, so don't put pressure on yourself to do it now.

'When women are discharged from healthcare some people might think that means they should be able to return to normal life, but there is a long period of adjustment and care needed at home,' says Kathryn. 'Friends and family can support new parents with food, help around the house, and reassurance that they are doing a great job of looking after their baby.'

This is especially important for mums who are raising their baby alone, in which case asking for help from friends and family in advance can help ensure you get the support you need.

Kathryn adds: 'Having very modest aims in the early days - getting outside most days (perhaps a short walk around the block), eating well, resting as much as possible - will change over time to meeting up with friends regularly, getting some exercise every day, and doing the most necessary housework.'

When will the crying settle down?

'As babies grow and change, things that seemed easy one day might feel very difficult another,' Kathryn says. 'A baby's crying tends to peak at around week six, which can mean that parents feel they must be doing something wrong, or that there is a problem with their baby. However, this is normal, and has usually reduced by three months.

'Parents report the excitement and happiness that comes when they see their baby is starting to interact with them, including smiling for the first time.'

Where can I get more help?

'Part of the challenge of this early period is the feeling that there is so much to learn, and to worry about,' explains Kathryn. 'Using safe sources when looking for information about caring for yourself or your baby will reduce anxiety.

'Reputable sources such as NCT practitioners and the website, or NHS health professionals and are a good place to start. Avoid sources of information (including people or media) who make you feel bad about your parenting, and stick with people who you trust and who support you.

'Although things can feel like they're getting harder in the early weeks, most people are feeling much better by around three months after the birth, and some will feel fine before that. If parents are still finding life a real struggle at that point they might consider talking to a health professional, or seeking more support from friends and family, to help them until they are feeling more in control.'

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.

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. To find out when an NCT nearly new sale is happening near you, search here.

You might find attending one of NCT's New Baby 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.

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What is the fourth trimester? | Baby & toddler articles & support | NCT

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Everyone knows that pregnancies last three trimesters - so what exactly is the Fourth Trimester? We explain what this crucial stage is, and what it means for you and baby

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Includes tips and explains a mother's rights when breastfeeding in public.

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Many mums wonder how others might respond to them breastfeeding in public. So it's good to know that public opinion is behind you - a survey said 72% of people support breastfeeding in public (gov.uk, 2015).

And you do of course have the right to breastfeed in public. NCT spent many years campaigning to bring about the specific protection of breastfeeding in public (NCT, 2011). Specific laws now protect breastfeeding in public in England, Wales and Scotland, and other laws protect it in Northern Ireland.

But breastfeeding in public isn't just accepted and protected, it can have a bunch of benefits. Here's how and why you could make breastfeeding in public work for you...

Why breastfeed in public?

Breastfeeding is a convenient way of feeding your baby when you're out and about as you don't need any extra equipment. In fact, with a little practice it can become virtually effortless. You'll have the great tool at your disposal of being able to feed your baby anywhere and to calm them when they're fretful at any time.

"I found breastfeeding useful when we were out for the day as the only 'kit' that was needed was me! But especially so if my baby became overstimulated with the sounds and lights of busy shops - if she started getting restless or agitated, holding her close for a feed would help to calm her down."

How do I start breastfeeding in public?

In the early days, before going out with your baby, it can help to gain confidence with different breastfeeding positions and making sure your baby's achieving an effective latch. That way you'll feel more comfortable feeding in front of others. Some mums find it useful to practice in advance - either in front of the mirror or in front of someone else, such as their partner, a close family member or a friend.

If you want to keep covered up, having easily accessible clothing can help with that. You could try wearing a loose vest underneath a t-shirt - so one layer goes down and the other goes up. You could also try wearing a loose cardigan or a scarf.

"I would wear stretchy vest tops underneath so that I kept warm still while feeding. Plus, I was more concerned about flashing my mummy tummy than anything else!"

It's possible to feed in a sling or carrier too. A sling or carrier has the added advantage of keeping your baby close and the oxytocin flowing, which aids milk production (Knowles, 2019).

How do I get more confident about breastfeeding in public?

Some new mums worry about feeling embarrassed or uncomfortable breastfeeding in front of others (Public Health England, 2017). So it can be really helpful to look for support around you and check what groups your local NCT branch run.

You could also ask your midwife, health visitor, breastfeeding counsellor or lactation consultant about local drop-in groups. At these groups, you're likely to meet other breastfeeding mums and this will help you gather some tips, ideas and general support.

Attending a local Baby Café or other breastfeeding drop-in provides an environment where you're likely to be around other parents at a similar stage of parenting and feeding. This peer support and having the support of a qualified practitioner might increase your confidence in many areas of breastfeeding, not just feeding in public (Fox et al, 2015).

It can be handy to have someone with you that first time you head out with your baby. It's also good to look ahead for information about breastfeeding friendly places to go. You can find breastfeeding friendly places on social media, websites, and local/national initiatives where breastfeeding friendly businesses can register.

Is breastfeeding in public difficult?

It's not difficult but there can be challenges. One challenge of breastfeeding in public is dealing with breastmilk leaks. Most mums find that breastpads provide sufficient protection from leaks should you experience them.

If you're out and can feel a let down of milk but you're unable to feed your baby, then applying compression to your nipples for a few seconds might help stop the leaking. You can do this by folding your arms over and using the palms of your hand to press down firmly on your nipples (La Leche League GB, 2016).

When your baby is older, feeding in public may seem more challenging as your child is mobile and vocal. So it's good to read their body language and be ready to move if they do and if you want to keep covered up. You could also consider having some snacks or toys to offer as a distraction until you are somewhere more comfortable to breastfeed (kellymom, 2018).

What exactly are my rights about breastfeeding in public?

A mum has a right to breastfeed her child across the UK, but the area of the UK you live in will govern which legislation covers this right:

England and Wales - the Equality Act 2010 (British Chambers of Commerce, 2010) states that 'a business cannot discriminate against mums who are breastfeeding a child of any age.' This means that anybody providing a service, and their employees, cannot ask a mum to stop breastfeeding or to leave their premises.

Scotland - the Breastfeeding etc. (Scotland) Act 2005 states that 'it is an offence deliberately to prevent or stop a person in charge of a child from feeding milk to that child in a public place or on licensed premises.' (The age of the child is determined as up to the age of two years and feeding is determined as breast or bottle feeding.) This means that any person feeding a child milk cannot be asked to stop or leave the area or premises.

Northern Ireland - there is no specific legislation currently in Northern Ireland covering rights to breastfeed. But there is some protection within the Sex Discrimination (Northern Ireland) Order 1976 for women who have been treated unfavourably while pregnant and for the duration of their maternity leave. In January 2017 a potential Breastfeeding Bill was announced but progress on passing this Bill was on hold at the time of writing (Department of Health, 2018).

Are there any circumstances where I can't breastfeed in public?

Across the UK, there are two main categories where it is not unlawful to prevent a mum from breastfeeding:

1. If there is a valid health and safety reason to do so. For example, the mum and/or child may be at harm if they do not leave.

2. If there is a justified reason for a single sex service where women would not ordinarily be permitted.

(Maternity Action, 2019)

If you have reason to complain about how you were treated while feeding your child, the first course of action would be to complain to the business/organisation where the mistreatment occurred, where possible (Maternity Action, 2019). Ask them for their complaints procedure, which will explain how to lodge your complaint. If you're not satisfied with the outcome, you could make a claim in a county court in England, Wales and Northern Ireland, or in a Sheriff court in Scotland.
This page was last reviewed in August 2019.
Further information

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

Breastfeeding etc. (Scotland) Act 2005. Available at: http://www.legislation.gov.uk/asp/2005/1 (Accessed 25th August 2019)

British Chambers of Commerce. (2010) Equality Act 2010: What do I need to know? Quick-start guide for businesses who sell goods and services. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/85008/business-quickstart.pdf (Accessed: 25th August 2019)

Department of Health (NI). (2018) Breastfeeding - a great start. A strategy for NI 2013-2023 Mid-term review. Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/draft-mid-term-review-breastfeeding-strategy.pdf (Accessed 25th August 2019)

Fox R, McMullen S, Newburn M. (2015) 'UK women's experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services', BMC Pregnancy and Childbirth, 15: 147. doi: 10.1186/s12884-015-0581-5

Gov.uk (2015) New mothers are anxious about breastfeeding in public. Available at:

https://www.gov.uk/government/news/new-mothers-are-anxious-about-breastfeeding-in-public (Accessed 9th December 2019)

Kellymom. (2018) Breastfeeding in public. Available at: https://kellymom.com/bf/concerns/legal/bfip/ (Accessed 26th August 2019)

Knowles R. (2019) Breast and bottle feeding safely in a sling. Available at: https://www.carryingmatters.co.uk/breast-and-bottle-feeding-safely-in-a-sling/ (Accessed 29th August 2019)

La Leche League GB. (2016) Out and about with your breastfed baby. Available at: https://www.laleche.org.uk/out-about-with-your-breastfed-baby/ (Accessed 26th August 2019)

Maternity Action. (2019) Breastfeeding while out and about. Available at: https://maternityaction.org.uk/advice/breastfeeding-in-public-places/ (Accessed 25th August 2019)

NCT. (2011) Historic month for NCT as women win right to breastfeed in public. Available at: https://www.nct.org.uk/about-us/news-and-views/news/historic-month-for-nct-women-win-right-breastfeed-public (Accessed 11th December 2019)

NHS. (2017) Breastfeeding in Public. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-in-public/ (Accessed 25th August 2019)

Sex Discrimation (Northern Ireland) Order 1976, c. 5A. Available at: http://www.legislation.gov.uk/nisi/1976/1042/article/5A (Accessed 25th August 2019)

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How to breastfeed in public | Baby & toddler, Feeding articles & support | NCT

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You're not alone if you have questions about breastfeeding in public. Here we explain how to do it comfortably and confidently and what your rights are.

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The early days.

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In the early days, dads can sometimes feel like the secondary parent. Perhaps taking a back seat and assuming that their partner has everything sussed when it comes to feeding, soothing and caring. In reality, while mums might have a head start with becoming a parent through pregnancy and giving birth, dads can - and do - play an important role (Machin, 2018).
Watch this video for some great tips from dads to dads.
You won't break them

Newborns seem so fragile at this age - with their little heads lolling all over the place. You wouldn't be the first dad to worry you might 'break' them or feel awkward picking them up. But holding them and looking after them is all part of the bondingexperience. And the more you do it, the easier it'll become (Keller et al, 1985). Really.

Gary, dad to nine-month-old twins Arriya and Nieva, says: 'Have confidence and get involved from day one. I think there's a tendency to sit back as a new dad and rely on other people. But I think the quicker you get involved, the quicker you build confidence and also bond with your baby.'

Finding out how your baby likes to be held and soothed will also help you feel close to them. Talk to your partner about your roles and your part in caring for your newborn. We've got lots of tips on ways to bond with your baby.

Family and friends

In the first week, you might be bombarded with requests from family and friends to meet your new baby. While all the attention is lovely, it can be a lot to deal with. Especially when you and your partner are likely to be feeling worn out. If that's the case, try to limit visits and enjoy this special time for your new family.

You can always spread visits over a few weeks. People will generally understand that this is a period of adjustment when you're getting used to caring for your baby. It can also be nice to spend time together as your new family unit. Your partner might find it more helpful to have visitors after you go back to work, at which point she will be on her own.

Accept all offers

This is exactly the time to accept help or ask for it. If somebody offers to do your washing or cook for you, take them up on it.

When people do visit, don't feel that the normal rules of hospitality apply. Say yes if they offer to bring a meal with them. Being able to just heat up some food someone else has prepared when you're shattered and hungry is a lifesaver.

Nobody will expect the house to be spotless, and visitors can easily find the kettle and make their own tea. In fact, they can make you both one too.

Helping your partner recover after the birth

Giving birth is physically and emotionally demanding. Regardless of the type of birth she had, you can support your partner's recovery in lots of ways.

Encourage her to rest when she can and not over-do it. Staying in bed might be the best way to do this for some women. If that's the case for you, your partner will appreciate you bringing her snacks and drinks. And just generally making sure she has what she needs.

If your partner had a caesarean birth or any major medical intervention, she'll need extra time to recover (NCCWCH, 2011). Think about the ways you can help by doing the shopping, helping her move around or driving when needed.

As well as physical support, emotional support is so important too. Tell her that you think she's doing a great job. Right now, she's probably at her most vulnerable so it's important to know that you're with her all the way.

Even if she gets moody or emotional at times, try not to let this affect you negatively. Think about your emotional needs too and seek more support if you need it. Talking through how you're feeling can help.

Likewise, if you feel that your partner's emotions or behaviour doesn't feel right, it could be a sign of postnatal depression. Read our article for more about this.

Lack of sleep

Everybody will have told you how exhausting the early days and weeks can be. Yet nothing can really prepare you for the lack of sleep after becoming a new dad (Beattie et al, 2014). It might not help much to know that sleep deprivation is common among new parents but at least you know you're not alone.

Sleep can be one of the most contentious issues after having a baby, as it can feel like neither you nor your partner are getting enough sleep. Probably neither of you are.

Have an honest conversation about sleep and sleeping arrangements. If your partner is getting up to look after the baby, maybe let her get some rest during the day. Or do your bit at the weekend and be the one to answer that 5am wakeup call from your little one... (Insana et al, 2014).

You've probably also heard the recommendation to 'sleep when the baby sleeps'. OK, so it's a bit of a cliché but it really does work, and it doesn't just apply to mums. If you've been up in the night looking after your baby or just worn out from the non-stop needs of a newborn, it's good advice for dads too.

Tom, dad to Tommy (four months) and Freddie (two years), says: 'Sleep as much as possible, even if its two o'clock in the afternoon. If you can just get your head down for a couple of hours it will help you in the long run.'

Everything seems more manageable when you're rested, so although it might feel a little strange at first, try to sleep or just lie down at every opportunity. When you're exhausted, it'll be easier than you think...

Don't let any visits from family or friends put you off. You don't have to be constantly on show and presentable for visitors. They'll understand if you just need to rest. They could push the buggy round the park while you have a lie down.

Feeding your baby

Babies like to feed frequently which is normal and healthy (NHS, 2016, 2017). This is mainly because they have such small tummies and to also help establish a good breastmilk supply (Peaker and Wilde, 1996; Neville, 2001).

Some new dads find that if their partner is breastfeeding, they're not sure what they can do to help. But you can support your partner in a number of practical ways. You could try fetching drinks (yes, that really is important) and letting her have a break and a rest when she needs to (Ueda et al, 1994; NHS, 2016; Buck et al 2018). Read more in our article ' How to support breastfeeding '.

If your partner is finding breastfeeding challenging, you could help her get support from a breastfeeding counsellor on our Infant Feeding line or in person. It can take some mums and babies about six weeks to get the hang of breastfeeding (NHS, 2017). Once breastfeeding is up and running, you can get stuck in with bottle feeding your breastfed baby expressed milk or a mixture of breast and formula milk, although using formula can reduce breastmilk supply (World Health Organization, 2009).

If you and your partner are feeding your baby formula from the start, you can help with bottle-feeding and making up bottles from the outset. For more tips and information, read our article Tips for bottle-feeding your baby.

Look after yourself

Having a baby can be all-consuming at first, but remember to put aside some time for you to do the things you used to enjoy. Alan, dad to Rocco, says: 'Don't suddenly put the rest of your life on hold. You've got to look after your new son or daughter but you've got to make sure you have a bit of me time as well. Do some of the things you enjoy, find a way to build that in.'

Read more about friendships and changing relationships as a new dad here.
This page was last reviewed in May 2019.
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 NCT's 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 are happening nearby.

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Being a new dad: the early days | Life as a parent articles & support | NCT

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Congratulations, you're a dad. Caring for both a newborn and your partner can be a huge life change. Read our tips for new dads on how to manage.

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Understanding how breasts work and make milk.

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Understanding how breasts work and make milk.

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How do my breasts produce milk?

As soon as you're pregnant, your body starts to change to support milk-making. You may notice some of these changes in your breasts, like a slight tenderness and maybe a darkening of your nipples and areola. These changes are among the early signs of pregnancy (NHS Choices, 2016b).

Mammary glands

These glands are in your breasts and produce breastmilk. Each mammary gland contains the following parts that help you to make breastmilk (MIDIRS, 2011).

Alveoli

These are small clusters of sacs that develop when you are pregnant and produce your breastmilk (Sternlicht et al, 2006). Muscles that squeeze the milk into ductules surround these sacs.

Ductules

These are small channels carrying milk from the alveoli to the milk ducts.

Milk ducts

These are the network of channels delivering milk from the alveoli and ductules to your baby. When you're pregnant, these ducts grow larger and there will be more of them. The average breast has about nine milk ducts ready for breastfeeding (Geddes, 2007).

When will I start making milk?

During pregnancy your breasts increase in size as the mammary glands grow to support milk production. Sometime during the second trimester your body is ready to produce milk. You might notice a little milk leaking from your breasts in the final weeks of pregnancy (WHO, 2009).

Once your baby is born and you pass the placenta, your body releases the hormone prolactin. This tells your body to produce milk (WHO, 2009).

"You can start to feed your baby immediately after birth as soon as you're both ready."

Skin-to-skin contac t can help to stimulate your milk flow and your baby's natural feeding responses (NHS Choices, 2016b).

What is colostrum?

Colostrum is the first milk your breasts produce in the few days following birth. It is thick and golden yellow in colour (NHS Choices, 2016b). Colostrum is very concentrated and full of vitamins and antibodies. All of this helps your baby grow and fight off infections (NHS Choices, 2016b). It also helps expel meconium - the black, sticky poo babies are born with (NHS Choices, 2016b).

Your baby will only need about a teaspoonful at each feed because colostrum is so concentrated. To begin with your baby may want to feed often, perhaps every hour. They'll begin to have fewer, longer feeds after a few days. The more you breastfeed, the more your baby's sucking will stimulate your supply and the more milk you'll make.

After a few days the colostrum will be replaced by more mature milk, which is more liquid and greater in volume (WHO, 2009). Approximately two to four days after birth you may notice your breasts are warmer and fuller feeling; this is known as your milk coming in (NHS Choices, 2016b).

The let-down reflex

When your baby starts sucking at your breast, this releases the hormone oxytocin, causing the tiny muscle cells around the alveoli to contract and squeeze out breastmilk. This squeezing is known as the let-down reflex (WHO, 2009; NHS Choices, 2016b). Some women get a tingling feeling, which can be quite strong, while others don't feel anything. Both are normal.

You may notice your baby respond when your milk 'lets down'. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks, while they wait for more milk to arrive (NHS Choices, 2016b). There may be a number of let downs every time you breastfeed, which you may or may not be aware of.

You may also feel some contractions in your belly during the first few days of breastfeeding your baby. These are known as afterpains and feel like mild labour contractions. They are caused by oxytocin shrinking your uterus (womb) back to its pre-pregnancy size (WHO, 2009; NHS Choices, 2016b).

Breastfeeding frequency

Mums start producing mature milk as soon as their baby is born. This happens whether their baby is ever placed at their breast or not. You may notice this surge in production as your milk coming in around two to four days after the birth. Your breasts may look and feel fuller than before (NHS Choices, 2016b).

After this, you continue to make milk as a result of milk being removed from your breasts. This happens either as your baby drinks the milk or by you expressing it with your hands or a breast pump (WHO, 2009).

When breastfeeding is going well, this is what drives the milk supply. As milk is removed, your body gets the signal to make more. Your baby will never fully empty your breasts. If your baby feeds a lot, your body increases the milk supply in response (NHS Choices, 2016b).

Young babies typically feed frequently, at least eight times in 24 hours (or more), often in clusters of feeds with small gaps in between. Counting the feeds is not realistic, as you might not know whether your baby is starting a new feed or ending a previous one (NHS Choices, 2016c).

Changes in your breast milk

The fat content of your milk gradually increases as the milk is removed. So when breasts are less full, the fat content is proportionately higher (Martin et al, 2016). Healthy, effectively feeding babies usually get the right milk intake and type of milk for them (Martin et al, 2016).

When your baby seems to have had sufficient on one breast, you can switch sides and offer the other breast. Your baby may show they've had enough of one breast by coming off it or slowing right down. Not all babies take both sides each time. Some are happy with one, while other babies show they want three, four or more sides at a session (NHS Choices, 2016c; NHS Choices, 2017).

"Breastmilk constantly changes to meet your baby's needs. It is responsive to changes in the mother's diet, bacteria and viruses in the environment and the baby's feeding behaviours."

Breastmilk content also varies according to the time of day. Evening milk contains more components that relax and aid babies sleep, while daytime milk contains different elements that stimulate activity (Sanchez et al, 2009).

Breastmilk can also change in response to the baby or mother's illness, with an increase immune cell levels to aid recovery (Riskin et al, 2012). After your child's first year in the world, the fat and energy content of breastmilk increases to meet their growing needs (Mandel et al, 2005).

Support to help you breastfeed

It can take time for you and your baby to get the hang of breastfeeding. Plenty of help and support is available to help you overcome any challenges. Getting breastfeeding support makes a huge, positive difference.

Contact your local NCT branch or call our Infant Feeding Line on 0300 330 0700 to find out what breastfeeding support is available locally. We have local NCT Breastfeeding Counsellors who can offer a call, virtual visit, or home visit, depending on their availability. You may also have a local drop-in NCT breastfeeding support group. Our breastfeeding support groups are a great place to meet other mums with babies of a similar age. Peer support is really beneficial to new mums.

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

You might find attending one of our 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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Geddes DT. (2007) Inside the lactating breast: the latest anatomy research. J Mid Women's Health 52(6):556-63. Available From: http://breastnbabylactation.com/pdf/11_inside_lactating_breast.pdf [Accessed January 2018].

Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. (2005) Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 116(3):e432-e435. Available From: http://pediatrics.aappublications.org/content/116/3/e432 [Accessed 1st January 2018].

Martin CR, Ling PR, Blackburn GL. (2016) Review of Infant Feeding: Key features of breast milk and infant formula. Nutrients. 8(5): 279. Available From: http://doi.org/10.3390/nu8050279. [Accessed 1st January 2018].

NHS Choices. (2016) Signs and Symptoms of Pregnancy. Available from: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/signs-and-symptoms-pregnancy.aspx [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding the first few days. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/breastfeeding-first-days.aspx?tabname=Your%20newborn [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding: is my baby getting enough milk? Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 1st January 2018].

NHS Choices. (2017) Your breastfeeding questions answered. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 1st January 2018].

Riskin A, Almog M, Peri R, Halasz K, Srugo I, Kessel A. (2012) Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant. Pediatr Res. 71(2): 220-225. DOI: 10.1038. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22258136 [Accessed 1st January 2018].

Sánchez CL, Cubero J, Sánchez J, Chanclón B, Rivero M, Rodríguez AB, Barriga C. (2009) The possible role of human milk nucleotides as sleep inducers. Nutritional Neuroscience. 12 (1):2 DOI: 10.1179/147683009X388922. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19178785 [Accessed 1st January 2018].

Sternlicht MD, Kouros-Mehr H, Lu P, Werb Z. (2006). Hormonal and local control of mammary branching morphogenesis. Differentiation 74(7):365-381. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580831/ [Accessed 1st January 2018].

WHO. (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 1st January 2018].

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About breastmilk and breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Curious about what's happening to allow breastfeeding? This article explains how you'll produce breastmilk and how your breastmilk adapts and changes.

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How to get breastfeeding off to a good start.

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

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Breastfeeding in the First Hours - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

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How to encourage comfortable and effective breast feeding.

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The way a baby is held to the breast affects how easily they can breastfeed. Certain positions can make it difficult for a baby to get a deep latch i.e. a big mouthful of breast tissue as well as the nipple. If a baby is in a shallow latch with mostly just nipple in his mouth, this is likely to lead to sore nipples, a drop in milk supply, a hungry baby and possibly cause a premature end to breastfeeding altogether.

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This article shares a selection of breastfeeding videos that show helpful breastfeeding positions, the principles of a good latch, how to tell if a baby is drinking plenty of breast milk and more. Breastfeeding Videos is a companion article to Breastfeeding Positions for Newborns and Latching Tips.

Breastfeeding positions

There are many ways to hold your baby to breastfeed and these are described in Breastfeeding Positions for Newborns. The most popular positions are known as:

cradle hold

cross-cradle hold

clutch/rugby/football hold

side-lying position

breastfeeding in a reclining semi-upright position.

Global Health Media

Our first video Positions for Breastfeeding, by Global Health Media shows a variety of positions including how to position twins. Global Health Media's breastfeeding video collection is excellent and is available in English, Spanish, French, Swahili, Nepali, Lao, Malay, Khmer, Kinyarwanda and Vietnamese.

Reclining positions for breastfeeding

Reclining or natural breastfeeding positions are also sometimes called "laid-back" or biological nurturing positions. Reclining positions involve lying back slightly, preferably with baby skin-to-skin (or lightly dressed) with baby's tummy against mother's chest. In this position the mother's body supports her baby rather than taking the baby's weight with her arms. This position triggers a baby's natural feeding reflexes and helps him to take a good mouthful of breast while feeling very stable on the mother's body.

The next clip from biologicalnurturing.com demonstrates a mother holding her baby in a semi-reclining position. The clip describes how to spot early feeding cues and shows baby feeding comfortably on his tummy (in the "prone" position):

Why Skin to Skin? also has a collection of videos of babies latching just after birth with the mothers in reclining positions. And in the next short video lactation consultant and breastfeeding author Nancy Mohrbacher explains how natural, laid-back, breastfeeding positions, can really help a baby to latch deeply and comfortably without arm waving and fighting at the breast.

Find the right position for you and your baby

While some mothers find laid-back positions can fix a painful latch or stop their baby struggling at the breast, for others it does not feel right at all. Well supported cross-cradle and rugby holds may give more control for your latch. Your own body position is important too, if your arms tire during a feeding your baby may not remain level with the breast and may slip down and exert more pressure on the nipple or slide down to the nipple base causing pain or damage.

Getting a deep latch

The next video by Global Health Media explains the difference between a shallow and a deep latch. A deep latch is one where the baby takes a good mouthful of breast tissue as well as the nipple. The nipple will be deep in a baby's mouth so that the nipple isn't getting rubbed on baby's hard palate. The video shows babies latching to the breast in a variety of positions, and discusses how to recognise a good latch. See Latching Tips on this website for photographs and more videos that describe how to achieve a comfortable latch.

Breastfeeding with larger breasts or heavy breasts

A heavy breast may need to be supported during a feed as the weight of it may tend to pull from baby's mouth causing your baby to lose their grip. Biological nursing positions and rugby hold may help with this or the cross-cradle position can give good control as you have a hand free to shape and support the breast. Sometimes you may need to support the breast throughout the feed to prevent baby slipping off. See Breastfeeding With Large Breasts for much more information including images of mothers supporting their breasts during a breastfeed.

In the following video clip by Nancy Mohrbacher, a larger breasted mother shares how reclining positions work well for her and her baby. And a helper explains how stimulating pressure points on the baby's knees, feet and ribs can trigger a deeper latch.

Good milk transfer

The following clip from Canadian paediatrician and breastfeeding expert Dr Jack Newman shows an example of good latch and milk transfer. The mother is using cross-cradle hold. Dr Newman describes how to see the pause in a baby's suck as they swallow milk. For more ways to tell if a baby is getting plenty of milk see Is My Baby Getting Enough Milk?

If breastfeeding hurts

Breastfeeding is not supposed to hurt and pain indicates something is wrong. If you are finding breastfeeding painful or experiencing any problems, the best way to get your baby's latch checked is by an IBCLC lactation consultant as they will be able to check that your baby is transferring breast milk well, take a full history and talk to you about breastfeeding management for you and your baby. For further ideas see Latching Tips, Breastfeeding Tips and Why Does Breastfeeding Hurt?

Summary

The way you position your baby to breastfeed affects how well they can latch, and latch affects how well a baby can drain the breasts to drive a milk supply. A poor latch will also usually be painful for the mother. There are lots of resources available to help with positioning and good videos can be particularly helpful. If you are experiencing problems however, there is no substitute for face-to-face help from a breastfeeding specialist.

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The way a baby is held to the breast affects how easily they can breastfeed. Certain positions can make it difficult for a baby to get a deep latch i.e. a big mouthful of breast tissue as well as the nipple.

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

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

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

once a month up to six months old

every two months from six to 12 months old

every three months over the age of one.

(NHS Choices, 2017a)

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

Baby weight gain

What to expect

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

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

Assessment

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

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

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

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

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

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

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

How is my baby's weight recorded?

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

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

Causes for concern

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

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

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

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

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

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

perform a clinical, developmental and social assessment

take a detailed feeding or eating history

observe feeding or meal times

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

perform further investigations as needed based on the clinical assessment.

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

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

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

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

Try breastfeeding more often, day and night.

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

Try breast compression.

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

(NHS Choices, 2016a)

What about giving my baby expressed breastmilk?

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

What about donor milk?

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

What is a supplemental nursing system?

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

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

Does my baby need formula?

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

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

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

Should my baby have solid food?

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

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

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

Further information

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

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

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

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

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My baby is not gaining weight | Baby & toddler, Feeding articles & support | NCT

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

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Breastfeeding: how much milk does a baby need?

If you're panicking that you're not producing enough breast milk for your baby in the early days of feeding, try not to worry. It is normal for you to take a while to feel confident that your baby's getting what they need (NHS, 2016).

In the meantime, it can be reassuring to know that a breastfed baby who's fed on demand can't be overfed (NHS, 2017). And although you can't measure how much they are drinking, they will come off your breast when they've had enough, and ask for more if they want to stimulate your supply (NHS, 2017).

Watch our video about how to know if you're feeding your baby in the right way.

You'll also be able tell if they're feeding well by checking the following...

Their poo

Meconium is the type of poo your baby will do on days one to two, it's sticky and green/black. After that, newborns should do at least two soft, yellow, £2 coin-sized poos every day for the first few weeks of their lives (UNICEF and Start4Life, 2010). Babies who are formula feeding might have more solid poo than those who breastfeed (NHS, 2015).

Their wet nappies

In their first 48 hours, your baby will probably only have two or three wet nappies. But from day five, you should get at least five or six heavy, wet nappies every 24 hours. Their wee should be pale and not dark brown (UNICEF and Start4Life, 2010; UNICEF UK Baby Friendly Initiative, 2010; NHS, 2016).

Their behaviour

If your baby has a full tummy, they should seem healthy and alert when they're awake. They will also seem calm and relaxed while they're breastfeeding (UNICEF UK Baby Friendly Initiative, 2010; NHS, 2016).

Weight gain

It's normal for babies to lose some of their birth weight in the first two weeks (NHS, 2016). Losing up to 5% to 7% of their body weight in the first two weeks is considered normal but it can be more or less than that (Noel-Weiss et al, 2008; Thulier, 2016). After that, they should be growing and putting on weight steadily (NHS, 2016).

Formula feeding or expressed milk: how much milk does a baby need?

If you're offering your baby milk from a bottle, whether formula or expressed milk, try and respond to your baby's signals about when they're hungry/thirsty and when they've had enough milk, unless there is a concern and your midwife or doctor has suggested otherwise (UNICEF, 2019).

Formula packaging suggests how much milk to offer and you can use this as a rough guide while you're getting to know your baby.

Research into responsive or 'paced' bottle feeding suggests it can help reduce the risk of obesity. When your baby has had all the milk they want, remember to throw away any milk left in the bottle. See more suggestions about how to bottle-feed responsively. (UNICEF, 2019).

How can I tell if breastfeeding is going well?

The following are seen as signs that breastfeeding is going well:

Your baby's well-attached if:

they have a wide mouth

they have a big mouthful of breast

their chin is touching your breast

their lower lip is rolled down (although you might not see this)

their nose is not squashed against your breast

your breasts or nipples are not painful when your baby's feeding, although their first few sucks might feel strong

more of the dark skin around your nipple (areola) is visible above your baby's lips than below them.

(UNICEF UK Baby Friendly Initiative, 2010; NICE, 2015; NHS, 2016 )

Your baby's getting enough milk if:

their feeding starts with a few quick sucks and after that their sucks and swallows are longer and rhythmical, with a few pauses

you see them swallow and you can hear them swallowing by around day three to four

their cheeks are rounded when they suck, rather than hollow

they're calm and relaxed when they're feeding

they come off the breast on their own when they've finished a feed

they've got a moist mouth after they've fed

they look content and satisfied after most feeds

your breasts become softer after feeds

your nipple looks about the same after your baby's feeds, rather than white, flattened or pinched

you feel relaxed and sleepy after you've breastfed.

(NICE, 2015; NHS, 2016)

How do I know that my baby is thriving?

How a baby looks and their behaviour are useful guides to whether they are 'thriving'. A thriving baby:

has a good skin colour

is alert when they're awake

asks for feeds

is usually satisfied after feeds.

(UNICEF UK Baby Friendly Initiative, 2010)

What should I do if I don't think I have enough milk?

If you're worried your baby isn't getting enough, speak to your health visitor, midwife or a breastfeeding counsellor. They can rule out any problems like a tongue tie, and look at attachment, positioning and your baby's health (NICE, 2015).

Breastfeeding specialists are likely to come and see you, or you can visit a breastfeeding support group. You could take a look at our article about breastfeeding support page to find out more.

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk.

Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

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Is my baby getting enough milk from breastfeeding or formula?

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If you're panicking that you're not producing enough breast milk for your baby in the early days of feeding, try not to worry. It is normal for you to take a while to feel confident that your baby's getting what they need (NHS, 2016).

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How to tell that feeding is going well from your babys nappies.

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

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

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

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

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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How partners can support with breastfeeding.

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How partners can support with breastfeeding.

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

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

Why is breastfeeding important?

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

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

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

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

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

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

What do I need to know about breastfeeding?

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

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

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

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

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

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

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

Women enjoy feeding more when they are comfortable and relaxed.

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

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

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

Here are 10 tips:

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

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

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

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

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

6. Women don't need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

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

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

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

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

(Rempel et al, 2010)

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

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

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

Tips for being a hands-on partner with your baby

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

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

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

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

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

How can I share feeding our baby?

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

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

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

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

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

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

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

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

Many places now welcome breastfeeding and have special facilities for mums if they'd prefer to feed in private.

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

At the end of the day...

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

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

You might find attending one of our 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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How can dads and partners support breastfeeding? | Baby & toddler, Feeding articles & support | NCT

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This article looks at how dads and partners can help support a new mum who is breastfeeding in the early days.

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Understanding Sleep and how to cope with sleepless nights.

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Sleep | Information and support on babies & toddlers | NCT

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Skin-to-skin contact - Baby Friendly Initiative

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

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Feeding cues and how to begin recognising them.

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Feeding cues and how to begin recognising them.

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The reality of feeding: 10 things you need to know | Baby & toddler, Feeding articles & support | NCT

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

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding

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What a deep attachment looks like at the breast.

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What a deep attachment looks like at the breast.

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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A collection of information including videos, information sheets and articles focusing on feeding your baby.

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

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Laid back or Biological Nurturing postition. 

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Laid back or Biological Nurturing postition. 

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What is laid-back breastfeeding or biological nurturing?

Laid-back breastfeeding is where you to use a comfortable, reclined position to feed your baby. It's really a relaxed approach where breastfeeding is seen as a relationship between you and your baby, with no need to follow a series of instructions.

Laid-back breastfeeding is also known as biological nurturing or the natural breastfeeding position (Colson, 2003).

What are the benefits of laid-back breastfeeding?

Laid-back breastfeeding:

Helps to release your baby's many feeding reflexes.

Encourages high levels of the nurturing hormone oxytocin in both you and your baby, helping you both to learn how to breastfeed together.

Uses gravity, which helps to support your baby as they lie on your body, giving them the freedom to use their instinctive feeding behaviour. Gravity also helps your baby to latch more effectively as they're able to use their natural reflexes, so you're less likely to get sore nipples.

Uses skin-to-skin contact, although it also works well when you're wearing a thin layer of clothing or whatever you're comfortable in.

Many mums say laid-back breastfeeding helps them to bond with their baby and get to know them sooner. That's because laid-back breastfeeding encourages mums to spend lots of time with their baby in the laid-back position even when their babies are not hungry or feeding.

Can be used at any time - it's about you feeling comfortable and well-supported, and finding whatever position feels right for you and your baby.

(Colson, 2008, 2012, 2019)

Laid-back breastfeeding: how your newborn latches on

Mums and babies most commonly use laid-back breastfeeding in the hours after birth. This is when your baby may spend time lying tummy-to-tummy with you.

In this period of close contact, you might notice your baby wriggling, pushing with their feet, and moving their head from side to side on your chest. These are primitive feeding reflexes, and you are helping your baby to use these to find your breast (Vinall, 2015; UNICEF, 2019).

Laid-back breastfeeding after a caesarean

Laid-back breastfeeding is useful following a caesarean birth, or in any situation where it's difficult to sit comfortably upright. That's because it allows for you to find your own relaxed and supported position (Colson, 2019). If it's hard to move or lift your baby, ask someone to help you both to get comfortable.

Continuing with laid-back breastfeeding

As your baby learns to breastfeed, they'll probably adapt easily to different positions, making laid-back breastfeeding very flexible, whether you're at home or out of the house.

If you're finding breastfeeding difficult, uncomfortable or painful, the laid-back breastfeeding approach can often help and breastfeeding counsellors use it widely (Vinall, 2015). To find your nearest breastfeeding counsellor or support group, call our Infant Feeding Support line on 0300 3300 700.

How to do laid-back breastfeeding in public

Laid-back breastfeeding doesn't have to be a very reclined or exposing position. In fact, you can sit in any comfortable, slightly reclined position, much in the same way as you might on a sofa or a deep chair.

Many coffee shops, for example, have soft chairs and sofas that would be suitable for laid-back breastfeeding in public. You could also use a changing bag or your coat to support you when you recline if you're out and about.

Your baby can be more diagonal than if you were reclined right back. You only need to be wearing loose enough clothing to allow your baby access to your breast, to sit in comfort with your friends and enjoy being out of the house.

Tips: laid-back breastfeeding and helping your baby latch on

1. Lean back if you're sitting or recline on any supportive surface. But do not lie flat on your back. It's okay to adjust your position until it feels right.

2. Hold your baby close so they're lying on your tummy with their core fully supported. If you've had a caesarean birth, you might want to place your baby to one side - away from your scar.

3. There should be constant contact between you but you don't need to put pressure on their neck or back. As you relax into the chair or bed, your baby relaxes into your body.

4. In this position, your baby's feet and legs will brush against your body, and usually find something to push against (such as your leg/hand/the bed/your partner's hand).

5. You will notice them nuzzling their face or bobbing their head from side to side until they locate the breast, then open their mouth wide as they latch on. As his or her mouth finds the breast, his sucking reflex starts to work.

The great thing is, you can use laid-back breastfeeding whenever you like, for as long as you like. And just remember - cuddles will not spoil your baby (Unicef, 2018).
This page was last reviewed in October 2019.
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.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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.

Colson S. (2003) Cuddles, biological nurturing, exclusive breastfeeding and public health. Journal of the Royal Society for the Promotion of Health. 123(2):76-77. Available at: https://doi.org/10.1177/146642400312300206 (accessed 22nd October 2019)

Colson S. (2019) Biological Nurturing - Instinctual Breastfeeding 2nd Edition. Pinter & Martin, London.

Colson S, Meek JH, Hawdon JM. (2008) Optimal positions for the release of primitive neonatal reflexes for early breastfeeding. Early Human Development. 84:441-449

Colson S, DeRooy L, Hawdon J. (2003) Biological nurturing increases breastfeeding duration. MIDIRS Midwifery Digest.13(1):92-97.

Rosin SI. (2019) A Case Study of Biological Nurturing. Journal of Human Lactation. 35(2): 318-322. Available at: https://doi.org/10.1177/0890334419829044 (accessed 22nd October 2019)

UNICEF. (2018) The Baby Friendly Initiative building a happy baby: a guide for parents. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/04/happybaby_leaflet_web.pdf (accessed 22nd October 2019)

UNICEF. (2019) Meeting your baby for the first time. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/relationship-building-resources/meeting-baby-for-the-first-time-video/ (accessed 22nd October 2019)

Vinall R. (2015) The value of introducing laid-back breastfeeding Perspective. Dec 2015. Available at: https://www.nct.org.uk/sites/default/files/related_documents/Vinall%20The%20value%20of%20introducing%20laid-back%20breastfeeding_0.pdf (accessed 22nd October 2019)

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Laid-back breastfeeding: benefits and uses | Baby & toddler, Feeding articles & support | NCT

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