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Support with feeding your baby- Ealing, Hounslow and Richmond

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Support with feeding your baby- Ealing, Hounslow and Richmond

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updated Jan 2026

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Support with Feeding – Ealing, Hounslow and Richmond

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Tuesdays SW6

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Tuesdays SW6

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Thursdays W14

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Thursdays W14

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Universal Baby Cues (English) – Responsive Care Series

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Video helping you understand your sleepy baby

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Video helping you understand your sleepy baby

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Breastfeeding sleepy and reluctant babies

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Wandsworth and Richmond antenatal Workshop

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Wandsworth and Richmond antenatal Workshop

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Peer to Peer support is invaluable. Book onto the Workshops so you can feel better prepared as well as meet other expectant parents. 

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Have you booked on to the Early Days Workshop?

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Have you booked on to the Early Days Workshop?

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Antenatal workshops — Chelsea and Westminster Hospital NHS Foundation Trust

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WFN - Dads Matter

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West Middlesex Hospital - LIITLE BABY BIG NEEDS. Antenatal education 

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West Middlesex Hospital - LIITLE BABY BIG NEEDS. Antenatal education 

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W12 Breastfeeding Support Drop-in

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EASY READ- Off to the best start leaflet 2025 

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EASY READ- Off to the best start leaflet 2025 

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This easy read leaflet, available to support health and care practitioners in conversations with mums, parents and carers, provides information and useful tips on breastfeeding. The resource contains information on:

Why is breastfeeding good?

How long can I breastfeed?

How do I breastfeed my baby?

How do I know if breastfeeding is going well?

Is my baby is getting enough breast milk?

When to get help

When should I breastfeed my baby?

Vitamin D

For use with audiences with low literacy levels or where English is not a first language.

This resource is available to order or download.
This resource was created in collaboration with the UNICEF UK Baby Friendly Initiative.
If partners need to order more booklets, please get in touch at partnerships@dhsc.gov.uk

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Easy Read - Off to the best start breastfeeding leaflet

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We’ve put some small files called cookies on your device to make our site work.

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Chelsea and Westminster FACE TO FACE Early Days Workshops

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Chelsea and Westminster FACE TO FACE Early Days Workshops

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These workshops focus on all the practicalities of having a new baby including meeting your baby and caring for them in hospital, normal newborn behaviour, feeding, nappies, bathing and skin care, sleep, car safety and more.

We run quarterly face-to-face early days workshops at Chelsea and Westminster hospital. Numbers are limited, so please book early by email chelwest.birth.preparation@nhs.net

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Chelsea and Westminster: Parents as Partners in care

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Chelsea and Westminster: Parents as Partners in care

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It is recommended you attend these as often as you can.

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It is important you always follow safe preparation guidelines as powdered formula is not a sterile product.

If you are using another product to make formula you must ensure you monitor it is performing safely. First Steps Nutrition Trust can help guide you if you are looking at alternative products.

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How do I prepare a bottle of formula milk for my baby?

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Chelsea and Westminster Postnatal Online Support Group 

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Chelsea and Westminster Postnatal Online Support Group 

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Online Postnatal Feeding Support Group Tickets| Eventbrite

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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Supporting Gut health in formula fed babies

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Supporting Gut health in formula fed babies

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The term postbiotics refers to soluble products or metabolic by-products secreted by live bacteria (probiotics), or released after bacterial break down, such as enzymes, peptides, oligosaccharides, polysaccharides, cell surface proteins, and organic acids. It is being suggested that postbiotics may have anti-inflammatory, immunomodulatory, antiobesogenic, antihypertensive, hypocholesterolemic, anti-proliferative, and antioxidant activities (Aguilar-Toalâ et al, 2018). These suggested properties could mean that postbiotics might contribute to the improvement of host health by improving specific physiological functions. Currently mechanisms of action for postbiotics have not been entirely elucidated.

The presence of postbiotics in infant milks is not a new development as 'acidified' infant milks produced by fermentation with lactic acid producing bacteria have been available in other European countries such as France and in African countries for many years. They contain postbiotics and have been described as:

"Infant and follow-on formulae that have been fermented with lactic acid-producing bacteria during the production process, but do not contain live bacteria in the final product due to inactivation of the fermenting bacteria by heat treatment or other means". (ESPGHAN, 2007).

They have typically been marketed as being useful in preventing a range of gastrointestinal symptoms and, in particular, in preventing diarrhoeal disease. Despite widespread use globally, there is little published data available to support their use.

There are a small number of studies that have investigated the effects of fermented infant milks on diarrhoeal disease amongst infants who are receiving complementary foods. Brunser et al,1989 showed a reduction in the incidence of diarrhoea as well as a lower proportion of days with diarrhoea and shorter duration of episodes in Chilean children fed acidified Nestlé Pelargon formula, compared to those receiving the same formula but non acidified. In a more recent controlled clinical trial that examined the effect of a fermented formula on the incidence of acute diarrhoea in healthy 4-6-months-old infants, reductions in the severity, but not in the incidence of diarrhoea were reported. The outcomes of this trial were based on parental report and 4 visits with a paediatrician. The trial was sponsored by Blédina (Nutricia). There was no breastfed reference group and the milk did not contain prebiotics. Neither the composition of the milk, nor the proportion of fermented milk used were disclosed (Thibault et al, 2004).

Recent additions to the formula milk market in the UK have included infant milks containing approximately a quarter of their whey component from milk fermented with the lactic acid producing bacteria Bifidobacterium breve and Streptococcus thermophiles. These milks therefore contain metabolites from the fermentation process but do not contain live bacteria. Despite this, the milks are not marketed as acidified or fermented milks but as containing postbiotics, a new ingredient. Infant milks that contain a proportion of fermented milk claim to also contain 3'-galactosyllactose, this HMO is produced as a result of the fermentation of the cows' milk used in the product mix.

A number of claims have been made about the use of postbiotics in combination with a prebiotic GOS:FOS mix including:

'Gut and immune markers closer to breastfed infants' and 'This combination of prebiotics and postbiotics have been shown to support a healthy gut in infants, important for immune system development and functioning.'

In 2007 The ESPGHAN Committee on Nutrition carried out a systematic review of the literature to assess knowledge on the effects of fermented infant formula without live bacteria. They concluded that "the published data on the effects of fermented infant formulae without live bacteria are limited and do not allow firm conclusions" and that "the effects of fermented infant formulae on infectious diarrhea and other relevant outcomes should be assessed in further randomized controlled trials" (Agostoni et al, 2007)

References

Agostoni C, Goulet O, Kolacek S, et al (2007). Fermented Infant Formulae Without Live Bacteria: Medical position paper by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 44, 392-397.

Aguilar-Toala JE, Garcia-Varela R, Garcia HS, Mata-Haro V et al (2018) Postbiotics: An evolving term within the functional foods field. Trends in Food Sci and Chem, 75, 105-114

Brunser O, Araya M, Espinoza J et al (1989). Effect of an acidified milk on diarrhoea and the carrier state in infants of low socio-economic stratum. Acta Paediatrica Scandanavia, 78, 259-264

Thibault H, Aubert-Jacquin C, Goulet O (2004). Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants. Journal of Pediatric Gastroenterology and Nutrition, 39, 147-152.

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Acidified infant milk and postbiotics - First Steps Nutrition Trust

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A great video to learn about how babies breast/chest feed. Get a cuppa, sit down and relax with this 40 minute video with your key support people.

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Natural Breastfeeding - Love to Love Breastfeeding

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Which formula milk to choose?                                                                       If you choose to use formula we advise first stage formula for the first 12 months of your baby's life.  Go the First Steps Nutrition Trust Website for more information      

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Which formula milk to choose?                                                                       If you choose to use formula we advise first stage formula for the first 12 months of your baby's life.  Go the First Steps Nutrition Trust Website for more information      

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INFANT MILK INFORMATION | Types of infant milks on the UK market

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we provide information about the types of infant milks on the UK market and for infant formula, follow-on formula and infant milks marketed

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Congratulations on your new family journey!

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Congratulations on your new family journey!

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We embrace the beauty and joy of a growing family unit and we appreciate that everyone's journeys are unique.

If you feel you would like to explore all your feeding options and would like a one-to-one focused discussion, please refer to section 2 for our contact details.

We look forward to meeting you

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If your baby is admitted to Special Care or another unit,we will do all we can to support you.

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If your baby is admitted to Special Care or another unit,we will do all we can to support you.

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The following are some tips on what you can do..

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Information on feeding and nurturing your baby in alternative languages.

Please click on link below:

Infant Feeding Multi lingual (padlet.com)

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Videos

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If you need to purchase any equipment or need advice on Infant Formulas, please refer to this site to enable you to make informed choices

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If you need to purchase any equipment or need advice on Infant Formulas, please refer to this site to enable you to make informed choices

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

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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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Further Advice

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Research Projects

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Research and evidence on 'How breastfeeding works'

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A guide to what you can find..

Infant Feeding Teams Contact Details

Antenatal Breastfeeding and Early Days Workshop

16 Week Antenatal Appointment

28 Week Antenatal Appointment

34 Week Antenatal Appointment

Antenatal Expressing (Expressing colostrum while pregnant)

Happy Birth Day!

Feeding Your Baby Soon After Birth

How Do You Know If Breastfeeding Is Going Well?

Infant Feeding Support Offered in the Local Communities

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Research on Safer Sleep guidelines

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Research on Close Loving Relationship building and brain development

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Medela

Symphony double breastpump

Symphony rental | Double electric breast pump| Medela

ARDO

Carum double breastpump

Rent a Breast Pump | Ardo Breastpumps

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Your postnatal discharge support will be provided by your local hospital. You will be advised of who that is on discharge but below is a list of individual area support you can access.

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In the Early Days as you're getting to know your baby, feeding cues are your baby's only form of communication to say "I need something", respond to the cues as early as you can. However, your baby may want to come to your chest for many other reasons such as comfort and stimulation.

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Babies typically start to make eye contact from around 6 weeks of age, though all babies develop at different rates.

How far can babies see?

Babies can only focus on things a short distance away at newborn stage - typically only about 20-30 centimetres. For this reason, it's important that adults get up close and face to face when talking to babies, so they can see your face and follow your expressions.

The benefits of getting face to face with baby

If you get up close to your baby as you're talking to them, they can watch the movements you make with your face as you speak and they listen to the sounds that you are making. This is the first step toward them learning about making speech sounds for themselves.

If you couple being face to face with sing-song baby talk, they'll find it easier to pick out the sounds that you're making in words and how you're making them.

Face to face time with baby

There are lots of great opportunities for you to get down to babies' level. You could try chatting to baby through nappy changes, getting up close during singing to baby during a feed or talking through bath time.

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Tools for Talking 0-3 months: Why getting face to face with your baby is brilliant

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Do you know babies learn so much from your face? The best thing you can do when talking to a newborn baby is to get up close and make eye contact with them. Watch the video on our page to find out why.

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As well as having lots of health benefits to both baby and the birthing parent, skin-to-skin helps boost Oxytocin for you and your baby- this helps get feeding off to a good start- this applies to all feeding methods. These positive brain connections continue building your baby's brain.

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Congratulations on the birth of your baby/babies!!

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Congratulations on the birth of your baby/babies!!

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Today you get to meet and welcome them to the world!

You get to hug them, smell them, gaze into their eyes and kiss them.

Building on your close and loving relationship.

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Expressing and storing breastmilk - The Breastfeeding Network

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

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

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

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

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Expressing breast milk by hand - Start for Life

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

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You may be advised by your Midwife to start antenatally collecting your breastmilk

You may choose to start practicing the technique from 38weeks of pregnancy (speak with your midwife prior to starting)

If you are able to collect, it will be small amounts. Don't panic if you don't see any droplets. The practice is the key to helping you get feeding off to a good start.

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Have you booked onto our Antenatal Feeding Class?

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Have you booked onto our Antenatal Feeding Class?

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Check the links on section 3 of this padlet to book

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Now is the time to start exploring your local area and finding your Peer Support and Baby groups.

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What are your thoughts, feelings or expectations about feeding your baby?

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What are your thoughts, feelings or expectations about feeding your baby?

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Speak with your midwife in your appointment about any concerns you have, you may both decide you would benefit from a one-to-one session with a member of our Infant Feeding Team

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The value of Breast/Chestfeeding and Human milk

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The value of Breast/Chestfeeding and Human milk

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Check out some ideas for talking and bonding with your baby during pregnancy as well as reasons why you should talk to your bump and things to do to help you prepare for baby's arrival.

Why bond with your bump?

Ways to bond with your bump

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Baby bump bonding - BBC Tiny Happy People

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A collection of films and articles with ideas for talking and bonding with your baby during pregnancy, before they're even born.

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Responding to your baby's needs for physical and emotional comfort, as well as feeding, helps your baby's brain to grow and your baby to feel safe and secure

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Responding to your baby's needs for physical and emotional comfort, as well as feeding, helps your baby's brain to grow and your baby to feel safe and secure

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COOKIE SETTINGS

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Accept All Cookies

MANAGE COOKIE PREFERENCE

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COOKIE SETTINGS We use cookies that help the website to function and also to track how you interact with it. We will only use the cookies if you consent to it by clicking on. You can also manage individual cookie preferences.

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Understanding the importance of building a close loving relationship

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Understanding the importance of building a close loving relationship

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Taking time to think about your growing baby and responding to their movements helps you bond with your unborn baby and promote positive brain development.

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Infant feeding support offered in Lambeth and Southwark.

Please note: these details may change. Please contact the numbers on the flyer to confirm if the session is running.

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Infant Feeding Multi lingual (padlet.com)

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Mastitis - quick reference guide for self-help measures

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Mastitis - quick reference guide for self-help measures

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Please reach out to your Community Midwives or Health Visiting Team if you experience signs of mastitis.

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Is your baby getting enough milk? (Video) 

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Is your baby getting enough milk? (Video) 

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Video detailing suck:swallow pattern, nappy output, activity levels (level of alertness when awake).

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Is Your Baby Getting Enough Milk - Video - Global Health Media Project

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A common concern of a new mother is whether her baby is getting enough milk. This video shows signs to tell whether the baby is feeding well.

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Lullaby Trust: video on safer co-sleeping

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Lullaby Trust: video on safer co-sleeping

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ABM (Association of Breastfeeding Mothers) Helpline

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ABM (Association of Breastfeeding Mothers) Helpline

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The ABM Breastfeeding Helpline number is 0300 330 5453 (9.30am -10.30pm).
ABM volunteers are happy to talk to mums, partners, families – anyone who has a question or concern about breastfeeding.

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Speak directly to an accredited LLL Leader (breastfeeding counsellor) by calling the Le Leche League Helpline on 0345 120 2918. This line is open from 8am to 11pm, 365 days a year.

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Chelsea and Westminster Hospital FACE-TO-FACE Antenatal Breastfeeding Workshops

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Chelsea and Westminster Hospital FACE-TO-FACE Antenatal Breastfeeding Workshops

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This is an interactive workshop run by the Chelsea and Westminster Infant Feeding Team.

The aim of this workshop is to help you make informed decisions on how to feed and nurture your baby and build close loving relationships, by exploring the health benefits of human milk, breast/chest feeding and responsive care.

The workshop also includes teaching practical skills using props.

This is a great time to ask any questions you have and to meet and chat with other expectant parents.

Due to limited spaces, we ask that only parents who are booked to have their baby at Chelsea & Westminster Hospital book onto the workshop.

NOTE: When booking on Eventbrite, 'Follow' the event to ensure you receive the pre-emails. You will receive information of the location 24hrs prior, or you can get this information at the main hospital entrance when you attend.

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chelsea and westminster face-to-face antenatal breastfeeding workshops

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chelsea and westminster face-to-face antenatal breastfeeding workshops tickets

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chelsea and westminster face-to-face antenatal breastfeeding workshops london

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chelsea and westminster face-to-face antenatal breastfeeding workshops london tickets

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Chelsea and Westminster face-to-face Antenatal Breastfeeding Workshops

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Eventbrite - Chelsea and Westminster Hospital presents Chelsea and Westminster face-to-face Antenatal Breastfeeding Workshops - Saturday, 25 February 2023 | Monday, 27 March 2023 at Chelsea and Westminster Hospital, London, England. Find event and ticket information.

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Antenatal expression: bring expressed colostrum to the hospital

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Antenatal expression: bring expressed colostrum to the hospital

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Please ensure that any expressed colostrum/breastmilk is handed to your midwives on arrival to the hospital.

Frozen colostrum/breastmilk needs to be put into the hospital freezer to remain frozen (once thawed, any expressed milk needs to be used within 24 hours).

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Local infant feeding support in Westminster, Chelsea, Kensington, Hammersmith and Fulham 

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Local infant feeding support in Westminster, Chelsea, Kensington, Hammersmith and Fulham 

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Local breastfeeding and infant feeding support sessions available Mon-Fri.

Please note: these details may change. Please contact the numbers on the flyer to confirm if the session is running.

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https://www.instagram.com/chelwestinfantfeeding?ish+d21nNXhmcDd4YmM5

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West Middlesex Hospital FACE TO FACE Preparing for Early Days workshops

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West Middlesex Hospital FACE TO FACE Preparing for Early Days workshops

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This session focuses on all the practicalities of having a new baby; we encourage both mother and support person to attend (if possible). You are welcome to attend at any stage of your pregnancy to help you prepare for your baby’s arrival. At the start of the session please let us know if there is a particular topic you would like information or guidance on. These are the usual topics of discussion:

Meeting your baby and caring for them in hospital

Normal newborn behaviour (if you are concerned- who to contact)

Nappies

Sleep (Baby’s, yours and safety)

Car seats

Bathing and skin care

Visitors- Friends and Family support

Due to limited spaces, we ask that only those who are booked to have their baby at West Middlesex University Hospital or Chelsea & Westminster Hospital attend these sessions. If you are unable to make your session, please reschedule as soon as you can. If you are bringing a partner, mother or friend that is going to be supporting you after the birth, please ensure you have booked a place for them too. You will need to bring your notes in order to attend the session.

Bookings via Eventbrite
West Middlesex Hospital Early Days Workshops | Eventbrite

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West Middlesex Hospital Early Days Workshops

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Book onto a FACE-TO-FACE Early Days session on a day, location and time that suits you to learn about the practicalities of caring for your newborn baby.

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West Middlesex Hospital - FACE TO FACE Breastfeeding Workshops

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West Middlesex Hospital - FACE TO FACE Breastfeeding Workshops

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These workshops will be run by one of the members of our Infant Feeding Team. They will talk you through the benefits of breastfeeding and the practicalities of breastfeeding your new baby. The aim of this workshop is to help you feel more confident about breastfeeding and understand how to prevent and solve common breastfeeding difficulties, how to tell if your baby is getting enough milk and where to get help if you need it.

The session is fully interactive and you will be able to ask questions and have an opportunity to chat with other expectant parents.

Due to limited spaces, we ask that only those who are booked to have their baby at West Middlesex University Hospital or Chelsea & Westminster Hospital attend these sessions. We do encourage fathers, partners and any other family members to book on too – whoever may be supporting you when your baby is born.

Bookings via Eventbrite
West Middlesex Hospital Breastfeeding Workshops | Eventbrite

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West Middlesex Hospital Breastfeeding Workshops

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Book onto a FACE-TO-FACE Breastfeeding session on a day, location and time that suits you to learn about feeding your baby

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Postnatal Infant Feeding Support Groups run by the Infant Feeding team of West Middlesex Hospital

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Postnatal Infant Feeding Support Groups run by the Infant Feeding team of West Middlesex Hospital

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First Steps Nutrition Trust hosts information about infant formula milks (for 0-12 month olds).
This simple guide to infant formula, follow-on formula and other infant milks provides information about these breastmilk substitutes to ensure simple, clear, evidence-based information.

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Selection of videos on feeding and nurturing small/premature babies.
Available in various languages.
Breastfeeding Videos - Global Health Media Project

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Breastfeeding in the early days. Resources in English, Dari, Pashto, Russian and Ukrainian 

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Breastfeeding in the early days. Resources in English, Dari, Pashto, Russian and Ukrainian 

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Maternity information translations - Welcome (southeastclinicalnetworks.nhs.uk)

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Multiple national recommendations state that it is not necessary to interrupt breastfeeding following the use of a gadolinium contrast during an MRI scan because of the low bio availability of the injected medium Breastfeeding can continue as normal. Use of mannitol and hyoscine is also compatible with breastfeeding after a single dose.

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Where possible X rays are avoided during pregnancy but there is no reason to avoid them during breastfeeding.  Diagnostic X-rays have no known effect on the milk in the breast at the time of imaging, nor on milk production.

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Resources for parents with babies in the neonatal units (both C&W and West Middlesex hospitals). Please click link:
Parent Information (padlet.com)

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Infant feeding support in Wandsworth, Richmond, Merton

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Infant feeding support in Wandsworth, Richmond, Merton

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Private, closed Facebook group for trans and non-binary birthing and/or lactating parents.

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Birthing and Breast or Chestfeeding Trans People and Allies

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We have a high volume of requests and limited time. Check your "Filtered" folder by clicking the Messages icon, "See all," "More" to open a drop-down, and then "Filtered." If you have been...

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An article about Trevor MacDonald's experiences of feeding his children.

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It was in an idyllic Canadian mountain town, surrounded by jagged, imposing peaks, that the conflicting facets of Trevor MacDonald's identity came crashing together.

MacDonald, soft-spoken and sporting a wispy goatee, was breastfeeding his first child at the time. He and his partner had splashed on a lavish dinner, baby in tow. When his son began fussing, MacDonald eyed the waitstaff and patrons wandering about in formal attire and thought it best to head to the restroom.

It was there, holding his fussing son, that he was struck by the incongruity of nursing a child in a men's bathroom. "It was this weird scenario," says MacDonald, who was born female and began transitioning some eight years ago. "I've felt pressured to nurse in bathrooms because of the supposed lewdness of feeding a baby from my body. I'm also told that my body and gender don't fit into the neatly divided men's and women's restrooms of western society. People like me are told to keep out."

Carrying a baby never felt gendered to MacDonald. Photograph: Trevor MacDonald

While south of the border the controversial "bathroom bill" stirs up a political firestorm, in Canada MacDonald is seeking to broaden the conversation, sharing his own experience as a transgender man who carried two babies to term and breastfed both of them. His recently published memoir, Where's the Mother: Stories of a Transgender Dad, aims to shed light on gender diversity in parents through his story of being both male and pregnant.

MacDonald points to the often trotted out narrative of a transgender person as someone who was born in the wrong body. "Our stories are so much more diverse than that one phrase," the 31-year-old says over coffee during a recent trip to Toronto for book readings. "When someone who has only seen that narrative hears about a trans person becoming pregnant, they think, well that doesn't make any sense. If it's the wrong body, why are you doing this with your body? But it's so much more nuanced than that."

MacDonald, who lives in rural Manitoba, began transitioning in his early 20s, legally changing his name and taking testosterone. About a year later, he had chest surgery.

As his body fell in line with his gender identity, the stress that had dogged him for much of his life melted away. His relationship with his partner blossomed and a happier, more confident MacDonald began contemplating starting a family for the first time ever.

The pair briefly considered adoption, but worried that the odds would be stacked against them as a transgender man and a gay man. They soon realised that there was a simpler path: as MacDonald had never felt the need to have a hysterectomy, the pair had the anatomy needed to make a baby.

'Throughout the pregnancy, I was able to continue presenting as male.' Photograph: Trevor MacDonald

MacDonald stopped taking testosterone in order to begin trying to conceive. After he became pregnant, the effects of the hormone endured, leaving him with facial hair and a low voice. "Throughout the pregnancy, I was able to continue presenting as male," he says.

The couple had - to the best of their abilities - timed the pregnancy so it would coincide with the Canadian winter, leaving MacDonald wrapped in figure-concealing coats and sweaters just as his pregnancy was beginning to show. Many who spotted his changing figure simply assumed he had gained weight, he says with a smile. "Our next door neighbours did not know that that there had been a pregnancy until we came by with the baby."

Some 12 weeks into the pregnancy, he shared the news with his co-workers. "There were people who immediately began calling me 'mom' and 'she,'" says MacDonald. One person told him simply: "If you're giving birth, you're a mother."

MacDonald disagrees. While many wouldn't hesitate to describe childbearing as a female experience, carrying a baby never felt gendered to him.

I was worried that breastfeeding might feel gendered to me - I thought, am I going to be able to do this?

Trevor MacDonald

To his delight, neither did breastfeeding. Despite his chest surgery, he was able to breastfeed - or chestfeed - both of his children, now aged five and 18 months, using a combination of his own milk and donated milk from a community that ranged from a military family to Mormons. "I was worried that breastfeeding might feel gendered to me - I thought, am I going to be able to do that, or am I going to experience a lot of gender dysphoria?"

MacDonald became an ardent fan of breastfeeding, leaving him with mixed emotions about his chest surgery. While the surgery had helped propel him to a place where he felt comfortable in his own skin, it now hindered his ability to feed his children.

He turned to a blog to document his travails of breastfeeding as a trans male. As he penned posts that ranged from achingly vulnerable to deeply thought-provoking, MacDonald became the public voice of a conversation long hidden in the shadows.

He soon found himself inundated with questions from around the world; from transgender people eager to start their own family to healthcare workers keen on providing better care for transgender people. Wary of generalising too much from his own experience, MacDonald began working with a research team to design and produce a series of research papers, funded by the Canadian Institutes of Health Research, that aim to draw parallels among the experiences of pregnancy, birth and infant feeding of 22 transgender men from around the world.

The groundbreaking research has already revealed some interesting findings, he says. Of the nine men in the study who had had chest surgery prior to becoming pregnant, not one had raised the possibility of breastfeeding with their surgeons beforehand. "There is this assumption that goes along with the 'born in the wrong body' narrative, that if you are a trans guy you would want a hysterectomy and never use your body to carry a pregnancy," says MacDonald.

One participant in the study said he had actively withheld his desire to have children from his surgeon, worried that any questions about breastfeeding would hamper his chances of obtaining the surgery.

While the diapers, bottles and sleepless nights of parenthood are universal - "a baby doesn't know what your pronouns are," he says - the study also seeks to highlight the additional barriers transgender parents often face in navigating healthcare systems unfamiliar with their needs.

MacDonald points to one night during his second pregnancy as an example. After consulting with his midwife about some worrying symptoms, he was instructed to head to the obstetrics unit at the nearest hospital.

When he arrived at the downtown hospital, the front doors were already locked for the night. The security guards eyed MacDonald's beard warily, demanding to know why a man needed immediate access to the obstetrics unit. "I had to come out to them as transgender and explain a lot of my backstory in the middle of a hallway alongside other people who were also trying to get past the security desk," he says. "That didn't feel particularly safe."

It's those kind of stories he hopes to bring into focus by sharing his own experiences and with his research project. As the push for transgender rights in the US stagnates in the grasp of a polarising debate on bathrooms - "it's so sad; this is a population that is already incredibly vulnerable to suicide," he says - he believes the the need to widen the parameters of the discussion elsewhere is vital.

He points to Thomas Beatie, a transgender dad who made headlines in 2008. "People wrote about it as the world's first pregnant man. And people in the trans community said, no, no he's really not. He was the first really publicised person."

MacDonald was transitioning just as Beatie's story was making headlines. "I specifically remember thinking I am not going to do anything like that," he says with a laugh. "I just wanted to be a nice, normal trans person - an acceptable trans person."

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Breastfeeding as a trans dad: 'A baby doesn't know what your pronouns are'

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Giving birth to two children as a transgender man gave Trevor MacDonald rare insight into the manifold struggles of trans individuals

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A paper exploring the experiences of co-nursing families with a gestational parent (GP) and a non-gestational parent (NGP).

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Introduction

"I felt that because I did breastfeed my non-biological child...she has a deeper bond with me. I feel that others saw me breastfeed and it solidified my place as an active mom. Strangers didn't question if I was the bio mom because they saw me feed her." --Julie1

What makes a parent a parent? The parent-child relationship is integral to our society and to our self-identity, so it makes sense we care so much about how to define it. Despite the increasing variety in how families are structured, the hetero-paired nuclear family is often still seen as the standard upon which others are based, and from which they deviate. It makes sense: one mom and one dad, with children biologically descended from both, makes for easily defined familial relationships. For parents who are genetically unrelated to the child, these relationships are no longer seen as absolute, and cannot be taken for granted. We have to discuss them, worry about them, and go to great lengths to protect them. Lacking genetics, we rely on our actions to define us as parents. It is true that some actions are interpreted more unquestioningly as those of a legitimate parent than others, including genetic contribution and legal guardianship, factors over which we may have no control. These actions are not more important to parenting, but because they confer such widely-accepted markers of legitimacy, they function as shortcuts to determining parenthood. I would like to add nursing (also called chestfeeding or breastfeeding, not to be confused with the career of being a nurse) to that list. By sharing the joys and responsibilities of nursing, non-gestational parents can strengthen their familial relationships and declare their legitimacy as parents, to themselves, within the family, and to the world.

Location and Terminology

Because we all write from within our own perspective, it is imperative for authors to discuss their location in relation to the text. My viewpoint is that of an early-30's queer. I was assigned female at birth, though I do not exactly identify as either female or male today; my partner at the time of initial writing identifies as lesbian. I am not yet a parent, so have no first-hand experience co-nursing or nursing in general. (Edit: I became a single parent in 2013 and nursed for two years with the use of at-nipple donor milk supplementation.) I was raised working class on the west coast of the US and am college educated. My studies and career path focus on midwifery and holistic reproductive health. I support nursing and also support parents' innate right to choose what is best for themselves and their families.

Though I am aware that preferred terminology varies widely even within communities, and I am unlikely to find a term that makes everyone happy, I intend to use the umbrella term queer for the families kind enough to share their experiences with me. Queer in this sense encompasses partnerships between cis or trans women (who may or may not identify as lesbian, bisexual, pansexual, etc), partnerships between cis or trans men (who may identify as gay, bisexual, pansexual, etc), and/or any relationship in which one or both partners are transgender or genderqueer. I recognize that this working definition must allow room for flexibility, and is not meant to be final. Because family structures can vary immensely, some of the points I discuss may be relevant for your family and others may not. Conversely, I will use the terms straight or hetero-partnered to refer to couples consisting of a cisgender woman and a cisgender man. (I recognize that these folks may also be queer.)

I would also like to emphasize that, though I have not limited my participants to those in dyad relationships, at this point I have not spoken with any three-or-more parent families in which two or more partners have shared nursing. The outcomes of my research should be applicable to polyamorous families, although variables are present and future research should include poly parents when discussing queer families.

In general, I believe that parenthood is not a gendered act, and I will attempt to refer to parents collectively as parents, although some discussion points refer to the sociolinguistic implications unique to mother, and I use the gendered term at that time.

Review of the Literature

Families headed by queer couples are sometimes said to be on the frontier of parenting. Studies have repeatedly found these couples to be more egalitarian when it comes to division of labor, as well as in their roles and responsibilities as parents, compared with their straight counterparts. 2,3 Reports of labor ratios across all types of tasks are closer to equal for queer couples than for hetero-partnered couples. Also, whereas straight men believe themselves to be contributing more than their partners report, members of queer couples are more likely to agree about who actually does what work. This indicates that queer couples may be more aware of labor division and be more likely to discuss the division together.

Early parenting, however, tends to push even the most egalitarian families toward specialized roles: while queer couples still divide housework relatively equally, birthing parents contribute disproportionately more to childcare, and their partners work more outside the home. 4 The largest factor in this division of labor is certainly the nursing relationship: because pregnancy and birth naturally lead to lactation, the parent who gave birth--the gestational parent (GP)--is far more likely to have a nursing relationship with their new baby while the non-gestational parent (NGP) bonds with the baby through other means while providing a larger share of the financial support.

This disparity can lead to complicated emotions for both partners. The GP can become exhausted and overwhelmed, and may be struggling to balance parenting and nursing. On the other hand, the NGP can have mixed emotions about watching their partner breastfeed: they may cherish the closeness shared by two of their favorite people, and at the same time mourn the lack of their own special connection to the baby. 5,6(p484) When Goldberg and Perry-Jenkins talked to lesbian couples during pregnancy and then again three months postpartum, the NGPs they interviewed "felt envious of their partner's capacity to nurse, and excluded from the neonatal dyad." 4(p310)

This specialization of roles is certainly not unique to queer families. In her blog, Freja writes about her experience being a nursing parent in an otherwise egalitarian relationship:

We were emphatically committed to sharing the duties of parenting. But this [nursing] is something that we cannot share. It does not matter how much of a feminist you are, how committed you are to equal parenting, how dismissive you are of gender roles: if one of you is breastfeeding, [it] will result in you being utterly tied to that child in a way that no one else can share.7

Freja's observation reaches across family structures to a problem familiar to many parents, queer and straight alike.

The majority of hetero-paired couples, however, despite any difference in parental roles, have an equality in relationship to the baby that is unattainable for many queer families. When pregnancy occurs "the old fashioned way," both parents will be genetically related to the baby, and even couples using fertility assistance are generally granted automatic legal guardianship. Babies in queer families, on the other hand, are more likely formed with gametes from one of the intended parents and those of a donor, which results in "genetic asymmetry" 8(p173) within the family. Although the GP is indisputably the baby's parent, the NGP's status as a true parent is less obvious. In most cases, the legal system considers one the biological parent, and the other, a biological--and thus, legal--stranger to the baby. In about half of the US states, guardianship is granted only after a home visit and expensive second-parent adoption process similar to that of step-parent adoption, despite intending parenthood since prior to conception. 9 In other states, same-sex second-parent adoption isn't allowed at all, and parents are stuck in the perilous situation of choosing which parent gets legal protection and the ability to make choices on behalf of their child. This legal situation, and the socio-political climate that reciprocally reinforces it, makes the NGP's role as a parent much more tenuous than the GP or either parent in a heterosexual couple.

Queer parents experience this phenomenon, which I refer to here as gestational privilege, in many ways: NGPs may be barred access to their child in the hospital. Strangers may direct questions about the baby to the GP as if the NGP does not know the answer. And in the unfortunate event of a break-up, NGPs may not be granted custody or visitation rights.

The interplay between a queer couple's inclination toward egalitarian parenting and the stressors of genetic asymmetry influence the question of how to become parents in the first place. Goldberg reports that some lesbian couples are specifically choosing adoption because it offers "a unique advantage over insemination, in that it will eliminate the asymmetry of their roles and allow both partners to start out on 'equal footing.'" 10(p942) Both parents are symmetrically non-related to the baby, and an equal division of childcare is easy, as parents can share bottle-feeding duties.

Another option for AFAB/AFAB (assigned female at birth) couples is for both to be biological parents to the baby: one as the genetic parent, and the other as the gestational/ birthing parent. This can be accomplished by extracting one partner's eggs, fertilizing them with donor sperm, and implanting them in the other's uterus. The process, which has been called "reciprocal IVF" or "ROPA" (Reception of Oocytes from PArtner), is the same as that used by folks conceiving with the help of an egg donor or gestational surrogate. One article on the ethical implications of ROPA stresses the importance of "contribution of both partners in the creation of the child, the confirmation this entails for their relationship, and the foundation of a shared responsibility for the well-being of the child." 11(p814) Essentially, ROPA allows non-gestational parents access to some additional markers of parental legitimacy, and the fact that some families choose to undergo this expensive and medically intensive procedure is evidence of the importance of these markers. The fact that queer families are willing to put in the extra time, effort, and money for adoption or ROPA exemplifies their dedication to strategies supportive of egalitarian dynamics and parental legitimacy.

In a different context, Zizzo also discusses the tenuous nature of the parental role, and ways in which one can acquire markers of parenthood. In her interviews with heterosexual donors and recipients at a milk bank, she found that they frequently had no issue with sharing breast milk...so long as this breast milk was not delivered through breastfeeding or the suckling of another woman's breast... [A] distance from the body that provided the breast milk was preferred, so that emotional bonds between their child and the woman who produced the milk were not formed, thereby, compromising their own maternal identity. 12(p103) Zizzo's research corroborates the idea of a strong societal association between nursing and parenthood, which is relatively recent. Whereas the wet nurse used to be commonplace and was not considered threatening to parents, today nursing a baby unambiguously declares one's parenthood.

Other research corroborates Zizzo's hypothesis that the nursing relationship is a key factor in parent-infant bonding. 5,6,13 Goldberg, Downing, and Sauck examined the parental preferences of children raised by lesbian couples, as well as the parents' perceptions about why such preferences existed. 14 Overall, participants reported that their older children tended to prefer both parents equally, or they alternate in a roughly equal way. However, parents overwhelmingly reported their babies' and younger children's preference for their gestational parent; even more interesting, the parents themselves predominantly attributed this preference to the nursing relationship. In a family in which parity is so valued and genetic asymmetry is likely, a child's strong parental preference can be an added stressor on the family: "the initial preference for the [gestational parent] was indeed a 'problem' that required collaborative work on the part of each parent to make things more equal." 14(p426)

A famous example of this stress is entertainer Rosie O'Donnell's announcement on The View that she had pressured her partner Kelli to stop nursing their baby Vivienne: "Kelli only nursed for like a month and then I was very angry. With the other babies, nobody nursed because they were adopted. But with this baby she was the only one getting to bond, so I was like, 'The nursing is over!' I cut her off." 15 O'Donnell got a lot of criticism for her comments, but unfortunately not many of the reactions acknowledged how difficult the asymmetrical relationship was for her. Perhaps her approach was severe, but O'Donnell found a way to create new models for parenting that worked for her family.

Knowing that nursing produces distinct roles and relationships, many queer couples have sought ways to apply their more egalitarian parenting style to the supposedly inherent inequity of feeding a baby. Some families create a system for the NGP to feed as well, via some combination of the GP pumping, donor milk, and formula. Then the NGP can feed the baby via a bottle or supplemental nursing system (SNS), a bottle or syringe attached to a tube placed at the nipple so a non-lactating parent can provide nutrition and reap the other benefits of nursing. 5,6 Other parents, like Rosie and Kelli O'Donnell, choose to forego nursing altogether, so they can take turns bottle feeding and thus keep parity well-defined.

Each of these strategies allow NGPs to participate in feeding their babies, and many parents who had "the complementary role of bottlefeeding...noted some relief at this arrangement." 4(p309) However, there is no tactic that works for everyone. Many parents prefer the baby to be fed human milk over use of formula, and pumping requires a lot of time and effort from the GP--some say even more so than simply nursing. 5 For many families, these strategies serve to create a more harmonious household, but a growing minority of queer parents are looking beyond these options, to something that might better fit their needs or goals for parenting.

Queer families seeking alternatives might look to the experiences of another group of parents who share the dilemmas of feeding and bonding with babies they did not birth, as well as the struggles of parental legitimacy: adoptive parents and parents whose babies are born via gestational surrogacy. Like queer parents, these parents may choose to feed their babies formula using a bottle or SNS, but some have decided that their best option is induced lactation, a process by which someone encourages milk production without pregnancy. Inducing lactation involves stimulating the nipples, lacation tissue and endocrine system, usually with a breast pump. Herbs or medications may also be used to increase levels of prolactin, the body's hormone that stimulates milk production. 16-19

The most well known protocols for inducing lactation are those created by Jack Newman. In 2000, together with lactation professional Lenore Goldfarb, he developed what became known as the Newman-Goldfarb Protocols to help Lenore nurse her own baby, who was born via gestational surrogacy. 17 Their original work has since developed into three different protocols on induced lactation; parents choose from among them depending on their situation. The three protocols vary in details, but generally use birth control pills and Domperidone, in addition to pumping, eating oatmeal, drinking lots of water, and taking the herbs fenugreek and blessed thistle.

If adoptive parents and parents of babies born via gestational surrogacy can induce lactation and nurse their babies, why not the NGP in a queer family? Zizzo proposes that queer couples can "facilitate an equal bond with their child based on the physical act of breastfeeding" 12(p104) as well as "equal recognition as dual [parents] from the very early stages of their parenting experience." 12(p96) It seems fitting that a strategy available only to queer families could be used to alleviate stressors unique to queer families. Ironically, Zizzo's work is based on interviews with straight-identified donors and recipients of banked milk: her proposal about queer families is only hypothetical.

Although Zizzo never worked with queer parents, Newman and Goldfarb have. Their protocols are easily adapted to a two-parent shared nursing situation, and in fact already have been. In 2007, Goldfarb gave a presentation on induced lactation with several case studies, including a lesbian couple in which the NGP induced lactation while her partner was pregnant, and then both nursed the baby. 18 Unfortunately, Goldfarb only mentions a few logistical facts about them on a presentation slide, so it's difficult to surmise how the process influenced their lives.

Through much research and networking, I have been able to contact other families who are willing to speak about their experiences sharing nursing. Some of these queer couples intentionally chose to induce lactation, like Goldfarb's case study parents. Other couples were both already lactating: either they were pregnant at the same time or close together, or they took turns at pregnancy and the NGP of the new baby still had a milk supply from nursing their older child. In order to investigate the nuances of two-parent co-nursing, we clearly need to talk to these families about their experiences. Never before have the co-nursing experiences of queer families been gathered together, and I am excited to have the opportunity to do so.

Research Design

My research explores the effects of co-nursing on division of childcare, familial relationships, and perceptions of parental legitimacy. The research tool consists of an online questionnaire distributed to parents in queer relationships who shared nursing of one or more children with their partners. Because this practice is relatively uncommon, parents were recruited mostly via online networking. An invitation to participate was extended to parents of every known eligible family: a total of 17 parents from nine families.

The questionnaire has a core of 30 questions for those with experience co-nursing one child, 13 of which are child-specific, and are repeated for each additional child. The questions cover the following subjects: logistics about the breastfeeding experience, division of childcare, perceptions regarding familial relationships, perceptions of parental legitimacy, and overall opinions on the co-nursing experience. Research was conducted in Portland, OR in the winter of 2012; participants were given one week to complete the questionnaires.

Parents were allowed to choose a pseudonym for themselves to provide anonymity. Throughout this paper, all references to participants and quotations will use these self-selected pseudonyms. All research findings and quotations from participants are sourced from my questionnaire, entitled Experiences Co-Nursing in Queer Families 1; full participant responses can be found in Appendix B.

Research Findings

My initial questionnaire response rate was 88%: of the 17 invitations, I received responses from 15 parents. The day after I closed my questionnaire to responses, I was contacted by another prospective volunteer who, along with her partner, wanted to participate. They both completed the questionnaire, bringing my totals to 17 parents, representing ten families, discussing their experiences co-nursing 20 separate children. The majority of parents identify as female; they describe themselves as lesbian, queer, dyke, bisexual, gay, and "currently with a woman." One participant identifies as transsexual male. Racial/ ethnic identification was predominantly white or Caucasian, with two respondents identifying as "white, Hispanic" and three as "white, Jewish"; heritage includes Australian, Cuban, German, and Chilean. Reported economic class backgrounds varied from working class to upper-middle class, with the majority lower-middle or middle class. These families have one to four children and live mostly throughout the US, with two families in Australia. They have experience co-nursing children across a range of years: some still have infants, and others have children who are now adults. The majority (15) of the children who were co-nursed are currently between one and five years old.

For some aspects of analysis, I have divided the participants' experiences into categories based on their nursing arrangement. The majority of experiences are of parents cross-feeding their children: I have received 14 accounts of cross-feeding from the NGPs' perspective and 13 accounts by GPs of their partners cross-feeding. These cross-feeding accounts represent six families. Of the four families that induced lactation, I have four accounts of NGPs who induced lactation, including two accounts by an adoptive couple in which both parents induced lactation, and two experiences of GPs whose partners induced lactation. I also have two accounts from a GP whose partner fed the babies using an SNS. One family has experiences with induced lactation as well as cross-feeding.

Account-specific questions. After the demographics questions, parents were asked about their experience co-nursing a given baby. Parents answered this set of questions once for each baby they co-nursed, so some parents provided accounts of their experiences both as a GP and as an NGP, or the experiences with cross-feeding and with induced lactation. Although I find it useful for some analyses to compare average responses by GPs with those by NGPs, I in no way mean to imply that each family has one of each. One really helpful aspect of the way the questionnaire was set up was that when members of a couple both participated, their children were discussed twice: once by each responding parent. This allowed me to compare their perspectives to get a more thorough view of the experience.

For the most part, GPs provided more of the baby's milk than NGPs: 80.0% for cross-feeding families and 87.5% for families inducing lactation. In eight of the ten participating families, the GP contributed at least 60% of the breast milk, except for one NGP who was the at-home caregiver, and contributed 60% herself. The participants who adopted and both induced lactation reported contributing equal amounts of breast milk, and the family that used an SNS reported the baby consumed 100% breast milk from the GP.

Participants recorded their own frequency of nursing as well as that of their partner. In instances in which partners also completed the questionnaire, I received two accounts of the experience, one from each of their perspective (and responses differed from partner to partner). Therefore some situations are recorded twice, one for each parent's experience.

Examining the results of the nursing frequency question,(Figure 1) which is broken into 3-month increments for the first year, I was surprised and proud to see that all 20 of these kids were nursed up to around their first birthday or beyond! This statistic in itself is noteworthy, and suggests a link between the decision to co-nurse and the familial valuing of extended nursing.

Findings showed a tendency for GPs to nurse more often than NGPs, with most GPs across the board nursing day and night for the duration of the first year. NGPs frequency of nursing varied a lot, and often varied for a given family over the course of the first year. At first glance, it seems cross-feeding NGPs nursed less often than NGPs who induced lactation. However, the participating couple in which both partners induced lactation for their baby, who was adopted, had a vastly different experience from those of other induced lactation families: they both reported nursing day and night for the entirety of the first year, and were the only induced lactation NGPs to have done so. For NGPs who induced lactation and whose partners were GP to the baby, the average frequency of nursing was 2.44. In addition, the cross-feeding group's responses were skewed by several parents who reported nursing "not at all" at first. These parents actually did not begin to co-nurse until their younger children were born, whom they birthed. These few responses shifted the mean frequency down a bit.

Only two participants elaborated on how the specific division of nursing affected them, but their experiences may offer some insight into these numbers. Chloe and Beam, co-parents in a cross-feeding family, both reported attempting a close to 50/50 split of nursing with their first pair of children, born 15 weeks apart. As Chloe described, "we initially started out, and hoped, to share nursing exactly equally. We swapped night feeding from one night to the next (which was stressful). It turned out that this was too hard, both for us and the babies." With their second pair, born 10 weeks apart, Chloe says:

I absolutely insisted that we not swap night feeding at all - my partner was reluctant (because she still believed that we should be able to feed and be attached 50/50) but I wouldn't budge! We still did a fair bit of cross-feeding during the day, more as they got older, and even more once they became mobile. So we ended up with a better outcome than we did when we tried to institute exactly 50/50 feeding!

Her partner Beam agreed that they "tried hard to do 50/50 with the first babies... It worked much better when we were more relaxed about our parenting." Chloe and Beam were the only parents to discuss trying different nursing ratios; they were also the only parents who had the opportunity to cross-feed twice. While their experience is only their own, potential co-nursing families may be relieved to hear that they found the "more relaxed" approach worked better. Perhaps less concern about doing things "exactly equally" leads to less stress over all.

In general, the questionnaire results do indicate that co-nursing is somewhat less stressful than without co-nursing, a mean of 5.0 on a 7-point scale, with 1 being much more stress than without co-nursing, 4 being about the same amount of stress, and 7 being much less stress. 5 on this scale was marked "somewhat less stress." Analyzed based on nursing arrangement, accounts of GPs whose partners induced lactation found the situation the least stressful at a mean of 5.5; their counterparts, NGPs who induced lactation, found it more stressful than their partners, but still less stressful than without co-nursing, at 5.0. There was a smaller discrepancy between cross-feeding partners: NGP cross-feeders reported 5.16 and GP cross-feeders 5.09. The only group that reported co-nursing to be more stressful than without co-nursing was the SNS group, with a mean response of 3. The parent who reported these experiences attributed the added stress to the work of pumping, using an SNS, and cleaning up. Only one other participant reported co-nursing to have been more stressful: she indicated a stress level of 2 with her oldest two children (similar age, cross-fed), but she also reported it was less stressful with her younger two children (also similar age cross-fed). Overall, co-nursing appears to have a stress-reducing effect on the family.

Perhaps the most important findings in the analysis of specific co-nursing accounts are those about how parents perceive co-nursing to have affected their familial relationships. Participants were asked about their own relationship with the baby, their partner's relationship with the baby, and their relationship with their partner: they rated each relationship "within the first 6 months" as well as the "long term relationship." Responses fell on a scale of 1-100, with 1 being "Weaker/ More Distant," 100 being "Stronger/ Closer," and 50 being "Not Affected at All."

The first thing I noticed was that nearly everyone reported all relationships at 50 or greater, meaning that overall, they felt co-nursing was beneficial or neutral.(Figure 2) Of the six relationship assessments for each of 35 co-nursing experiences (210 total responses), only three fell on the "weaker/ more distant" end of the scale, at less than 50. These ratings were 46, 45, and 29, and they each related to specific difficulties the families were experiencing at the time. I found this positive response very encouraging.

After initial evaluation, I grouped responses of the NGP-baby relationship, GP-baby relationship, and the couple's relationship, and further divided responses based on whether they were cross-feeding, induced lactation, or used an SNS. I was not surprised to find that everyone found co-nursing to be more beneficial to NGP-baby relationships than to GP-baby relationships, considering the default alternative is for the GP to nurse the baby alone.

One noteworthy difference between groups is the effect of co-nursing on the GP-baby relationship. Gestational parents whose partners induced lactation reported co-nursing to have little to no effect on the GP-baby relationship (50.5 in the short term and 50.0 in the long term); the participant whose partner used an SNS also reported no effect on the GP-baby relationship. However, gestational parents whose partners cross-fed reported co-nursing to have a marked benefit for the GP-baby relationship (74.2 in the short term and 72.5 in the long term). One potential explanation for this is the added relationship with the other baby. Within induced lactation couples, both GPs and NGPs were more likely to report more benefit to their partner's relationship to the baby than their partners reported themselves.

Cross-feeding couples also reported higher benefit to their partner relationship: both NGPs and GPs average about 77 for both the short and long term. Induced lactation couples also saw a partner relationship benefit, although slightly less than the cross-feeding group, with GPs reporting higher levels of benefit (78 in the short term, 64 over time) than NGPs (69.3 in the short term, 61.3 over time).

Some participants elaborated on the benefit of strengthening relationships, especially the relationship between babies and NGPs. As Anne says, "[m]y partner had some problems bonding well with her, and I think knowing she can breastfeed her, helped her move through that." Ruth responded similarly: "while breastfeeding is not the only way to bond with a child, it is a powerful way, and it helped my wife bond with our daughter in a special way."

General opinion questions. The final set of questions was only asked once per participant, regardless of their situation. These were primarily looking at overall feelings about co-nursing, as well as a matrix about perceptions of parental legitimacy. This section also included several open-ended questions, including some that allowed participants to elaborate on other questions as they liked.

Out of the entire questionnaire, the question with the widest variance was the seven-point scale asking participants to rate whether they found co-nursing from 1, "difficult at first," to 7, "easy at first," with 4 being neutral.(Figure 3) Though the mean value was 4.5, responses were distributed across the range. Looking more closely, we see that responses aligned strongly with breastfeeding arrangement. Mean response for cross-feeders was a rather high 5.5, compared with 2.8 for the induced lactation group and 3.0 for the one parent using an SNS. This response pattern makes a lot of sense, as these arrangements do require a lot more effort than cross-feeding.

Edit: the actual value for the Induced Lactation group, for the Unpleasant--Pleasant, is 6.8. I have fixed this in the pdf but have not yet changed this .png.

In the long run, co-nursing was easier for almost everyone. The mean response value for "difficult in the long run" to "easy in the long run" was 5.7 on the same seven-point scale. Again, responses were distributed across most of the range, but clustered more toward "easy." Divided into groups based on breastfeeding arrangement, the cross-feeding group again found co-nursing to be easiest, with a mean response of 6.3. The induced lactation group's mean rating rose to 5.0, and the SNS group maintained a 3, which is consistent with the level of work involved.

The other three scales offered to participants had a much clearer response, which varied much less based on nursing arrangement. Parents rated co-nursing a 6.6 on the scale of "useless" to "useful," with 12 parents reporting a 7. The responses on the scale of "regrettable" to "worthwhile" and the scale of "unpleasant" to "pleasant" were identical, with a mean response of 6.7, and 13 parents reporting a 7 for each. No one reported less than a 5 for any of these three values. It is also of note that all 11 members of the cross-feeding group rated co-nursing a 7, the highest possible score, in terms of being useful and of being worthwhile.

To rate perceptions of parental legitimacy, participants were given another seven-point scale. They were asked to report how an NGP, an NGP's partner, extended family, and the general community would view a co-nursing NGP, both in the early months and over the long term.(Figure 4) The scale went from "much less like a 'real' parent" at 1 to "much more like 'real' parent" at 7, with 4 being "the same as without co-nursing."

An analysis of the answers to this question suggests that nursing does actually confer some parental markers for NGPs, both within the family and outside: the mean for each category falls between 4.9 and 5.4. Similarly to the relationship-strengthening effect we reviewed earlier, most participants found this effect to be strongest in the early months, and then less so over the long term. Many parents reported increased legitimacy in the early months and then perceptions returning to "the same as without co-nursing" over the long term. Triomami put this well when she says, "I think in the beginning it does make you feel like more of a 'real' parent. I think this effect lessens with time in that regardless of [nursing], you...feel like a real parent when you are in the daily grind. However I think it does mean something to extended family and the community when you are the parent provid[ing] your child (nongestational) with breast milk."

Here, also, we see the clearest correlation in the cross-feeding group. Their mean reported values ranged from 5.2 to 5.7, whereas the mean of the induced lactation group and the SNS participant had values between 4.0 and 5.0--still indicative of increased perceptions of parental legitimacy, but not as markedly as the cross-feeding group.

Many of my participants elaborated on their belief that co-nursing increases perception of an NGP being a "real" parent. As Christy put it, "I consider my kids to each have 2 parents. I have always considered their mama to be their mama...Being able to comfort her child made more people feel like she was a real parent." Particularly interesting is that the strongest legitimizing effect seems to be to the NGPs view of themselves as "real" parents. This could be related to the closer NGP-baby relationship, although whether one causes the other is not within the scope of this research.

When asked about "the strongest benefits of co-nursing," 12 participants included some variation of bonding, intimacy, or closeness to the baby. Eight participants mentioned increased parity, either in the ability to share childcare responsibilities, or babies' ability to be comforted by either parent. Nine listed various factors of convenience or logistical ease. Four parents also mentioned health benefits to the baby, including wider range of antibodies, and two parents each mentioned the fun of it and having a shared experience with their partner.

These open-ended responses help illuminate what factors are most important to families, and corroborate the statistical data from the closed-ended questions. The participants' focus on relationships and parity are especially pertinent. Clearly, participants' emphasis on bonding in the free-write benefits section parallels the closer NGP-baby relationship reported earlier by numeric values, and some of the other responses, especially parity and shared experience, may explain the closer couple relationship values as well.

When asked to discuss "the strongest drawbacks of co-nursing," the trends were less obvious. Six parents said they experienced no drawbacks at all, which in itself is noteworthy; of the 11 who did list drawbacks, four mentioned that co-nursing can be logistically challenging, including two who specifically indicated the time involved with pumping. Three parents listed concern about milk supply issues. Two parents discussed that imbalances can be emotionally difficult: one parent experienced insecurities around baby preferences, and another said "if one parent does it more 'successfully' than the other...then it's stressful." Other issues, mentioned by one participant each, were societal views and the challenge of night weaning when both parents are nursing. One respondent, Kelly, answered, "[t]he unfairness of it. I think sometimes my partner was sad that she didn't breastfeed our first child and she was a little sad that I *could* breastfeed her gestational baby, our second child." Her response indicates the complexity of emotions parents may experience, and suggests that periodic discussion around all of these potential challenges may be required.

Of the 17 parents, 14 (82%) said they would be "likely" or "very likely" to attempt co-nursing again, with 13 reporting "very likely."(Figure 5) One of the three who said they would be unlikely to co-nurse again, Tracy Linkletter, is an NGP who induced lactation. She says, "I think the experience of co-nursing was wonderful, but I wouldn't do it again because of the difficulty." The other two who would be unlikely to co-nurse again are actually partners: Layla says she "[w]ould not co-nurse again only due to logistics in making my own milk." Her partner, Triomami, adds that she "would totally induce lactation" if her partner were to birth another baby, but she herself would be the one to carry any future children, and her partner would not want to induce lactation.

When asked if they would recommend co-nursing to others, 11 of the 17 (65%) "definitely would," and four (24%) "probably would."(Figure 6) The remaining two respondents said they "don't know." No one said they would not recommend it, although some parents mentioned in the free-write section that they do not recommend 50/50 co-nursing.

My participants' answers indicate unmistakably that their overall experience with co-nursing has been positive. Both their numeric ratings and their free-write responses demonstrate the strongest benefits to be in the areas of bonding, logistical ease, and perceptions of parental legitimacy. I would like to express my appreciation for the parents who shared their life experiences for the purpose of this research.

Discussion

Though my findings have been encouraging, more research is clearly indicated. This study had a small sample size of 17 participants, which cannot produce statistically relevant results. I also only collected data from parents who chose to co-nurse. Because one cannot look at the same dyad relationship both with and without co-nursing, I opted to have the parents give their opinions about how these relationships compare to the situation if they had not co-nursed. If I were looking for objective data about relationship strength and closeness, I might have had a control-matched group of parents who did not co-nurse; however, I am actually interested in the subjective opinions of my participants. Regardless of whether the relationship is objectively stronger, I believe that the parents' perception of this strength is actually more important.

My research includes families that cross-fed and those that induced lactation, as well as one family that pumped and used an SNS: this variety is both a strength and a limitation. I am able to compare these groups, and my findings are applicable to more families. However, because I included such a variety of arrangements, the statistical significance within each sub-section is even lower, even to the point of having a sample size of only one family.

Another limitation in comparing family nursing arrangements was the difference in number of accounts. Though six families had cross-fed at least once, and four families had induced lactation at least once, the total accounts about cross-feeding (27) were far more numerous than those of inducing lactation (5). I see two factors contributing to this discrepancy. First, both parents from each cross-feeding family completed the survey, whereas three of the induced lactation families ultimately had only one parent participate. Secondly, cross-feeding by definition requires two children, and if the cross-feeding is bi-directional (as it was in every family with similarly aged babies, and some families with an age gap), twice as many experiences are collected.

In terms of my research tool, I might not create questions using sliders again. I don't think they interfered with the data, but it was more difficult to talk about participant responses than the questions that had a selection of choices. I would also have liked to conduct open interviews in addition to the specific questions included in my questionnaire. Family experiences are often so much richer than numbers and little tick boxes can capture.

Recommendations

My primary recommendation is that care providers who work with queer and trans families should be aware of specific emotional, social, and legal issues they may encounter, and keep in mind that families may choose to co-nurse. One of my participants, Beam, tells about her experience with lack of care provider awareness, and perceptions of parental legitimacy: "[d]espite cross feeding, people were still always handing the baby back to my partner. The first day she was born, several midwives were shocked to see me giving her a feed (just colostrum - I was pregnant), and I guess I felt embarrassed too. Less legitimate. Like I shouldn't be feeding her as I wasn't the 'proper' mum." As midwives, we strive to avoid contributing to parents' feeling "embarrassed" and "less legitimate": awareness about co-nursing can help us better support our clients and encourage them as parents.

Knowledge of induced lactation protocols is obviously helpful. Some lactation consultants have acquired relevant experience working with adoptive parents or intended parents working with a gestational surrogate, and can apply that experience to their work with queer families. Midwives, on the other hand, rarely work with soon-to-be parents who are not themselves pregnant, so our lactation knowledge focuses on gestational parents nursing newborns, and occasionally working with gestational surrogates or birth mothers who choose adoption: situations that may indicate an opposite protocol, cessation of lactation in the early postpartum. For this reason, midwives, especially those working with queer clientele, should acquire a basic knowledge of the protocols for induced lactation.

It is important to remember that there are many possible arrangements for co-nursing. Let the parents tell you their goals and offer to assist in creating a strategy. If working prenatally with a couple in which the NGP is inducing lactation, discuss how the process is going at each prenatal, and provide referrals for access to pharmaceuticals if desired. When discussing the birth plan, include questions about when the NGP intends to begin nursing, and make sure the whole care team is aware and supportive of their plans.

During the postpartum period, remember to inquire about nursing issues for both parents, as well as any emotional issues that may arise, such as insecurities or mourning the loss of co-nursing previous children. Consider creating a list of lactation consultants and nursing support groups with more co-nursing experience.

Conclusion

So, what makes a parent? It's in the little daily things, like bedtime rituals and care for a skinned knee. It's the cuddles, the holidays, and the love: in short, being a parent is what makes a parent. But being a parent can also be really difficult, and we have seen that queer families have unique challenges. The parents who participated in my research reported that co-nursing strengthened familial relationships, eased logistical difficulties, and increased perceptions of parental legitimacy. Overall, they would co-nurse again, and would recommend it to other families. Co-nursing should be seen as one more possible way to bring families together.

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Two-Parent Co-Nursing in Queer Families · Growing Season

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"I felt that because I did breastfeed my non-biological child...she has a deeper bond with me. I feel that others saw me breastfeed and it solidified my place as an active mom. Strangers didn't question if I was the bio mom because they saw me feed her."

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In this article three trans women share their experiences of inducing lactation and breastfeeding.

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My body will never allow me to conceive and bear a child, and I've always wanted to at least be able to nurse one. That was the main motivation for this. The secondary motivation was that I wanted to bring my breasts to full maturity. At that time I was comfortably into stage four on the Tanner scale [a system used to medically qualify the development of secondary sex characteristics], and from my research I realized most cis women do not even make it to Tanner stage five unless they've gone through pregnancy or a lactation protocol, because it requires that extra bit of development that prepares you for breastfeeding in order to finish the development of your breasts.

I did some research about lactation and tried to dig up whatever I could on it, and came across a protocol called Newman Goldfarb.

With a fairly long session, I could produce about an ounce. It was kind of funny because my spouse has really struggled with my breasts growing and at that point she was giving me tips on how to stimulate more milk production. I think that I would have done quite a bit more, except at about that time we found out we had to move to move to another city, and then we've had to move again since. I've stayed away from the progesterone in hopes that at some point I can re-lactate and get into donation.

It was a very satisfying experience, but it was also very taxing. If you get into donating, you have to keep the kind of schedule that a new mother needs to keep. It's really, really intense.
Dr. Laura Arrowsmith D.O., 68, Tulsa, OK
When I was in my late 50s, I decided that I was going to try this to see if I could do it. I underwent a drug regimen and used a breast pump fairly regularly. And gosh, within about a month, I guess, I was producing milk!

After I got to the point where I understood that I could lactate, I didn't pursue it further - I didn't have any need to maintain lactation. It's a supply and demand sort of thing, so I stopped the medication and the pumping and of course I dried up. It was just super, super neat.

I think it strongly reinforced my sense of womanhood. I had some great inner satisfaction in knowing that I could do what a cisgender woman could. It was very important to me, and I'm proud and happy that I did that.

My main career was as a radiologist. I retired from that about a year ago; I've seen my own mammograms and there's absolutely no way that a radiologist could look at my mammogram and say "Oh, that person's trans." Breast tissue is breast tissue. Looks identically, works identically.

The lactation thing for me just affirmed my womanhood, I think that was the most important part.
Katelyn Burns is a freelance journalist and trans woman. Her other work has been featured for The Washington Post, VICE, Elle, Esquire, and Playboy, among others. She lives in Maine with her two young children.

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Yes, Trans Women Can Breastfeed - Here's How

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My body will never allow me to conceive and bear a child, and I've always wanted to at least be able to nurse one. That was the main motivation for this. The secondary motivation was that I wanted to bring my breasts to full maturity.

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For trans and non-binary parents, the act of feeding can bring about negative feelings connected to gender dysphoria. Others might feel somewhat pragmatic or positive about the experience, with their mammary glands now serving a purpose and being 'wanted' for perhaps the first time.
If you are suffering with gender dysphoria, this link contains more information on obtaining a referral to an NHS gender dysphoria clinic.

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Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria.
Your particular needs may be best addressed by transgender health services offered by NHS gender dysphoria clinics (GDCs).

All NHS GDCs are commissioned by NHS England, who set the service specifications for how they work.

A GP or another health professional can refer you directly to one of the 8 GDCs. You do not need an assessment by a mental health service first. Neither does the GP need prior approval from their Clinical Commissioning Group (CCG).

The websites of the clinics listed on this page also have useful information for you to think about before you see a GP.

Gender dysphoria clinics in London and the southeast
The Tavistock and Portman NHS Foundation Trust: Gender Dysphoria Clinic for Adults
Lief House
3 Sumpter House
Finchley Road
London
NW3 5HR

Phone: 020 8938 7590

Email: gic@nhs.net

The GDC website has an overview of information useful for anyone with gender identity needs, not just those in the area.
The Tavistock and Portman NHS Foundation Trust Gender Identity Development Service (GIDS) for children and young people
GIDS
The Tavistock Centre
120 Belsize Lane
London
NW3 5BA

Phone: 020 8938 2030

Email: gids@tavi-port.nhs.uk

GIDS also has a clinic in Leeds, which is for people from northern regions of England:

8 Park Square
Leeds
LS1 2LH

Phone: 0113 247 1955

The Gender Identity Development Service website includes information about the services they offer young people (up to the age of 18). They help those who are experiencing difficulties in the development of their gender identity, and their families.

Gender dysphoria clinics in the north
Sheffield Health and Social Care NHS Foundation Trust Gender Dysphoria Service
Porterbrook Clinic
Michael Carlisle Centre
75 Osborne Road
Sheffield
S11 9BF

Phone: 0114 271 6671

Email: porterbrook@shsc.nhs.uk

The Sheffield clinic's website includes information about referrals, clinic opening hours and links to eligibility criteria.
Leeds and York Partnership NHS Foundation Trust Gender Dysphoria Service
Management Suite
1st Floor
The Newsam Centre
Seacroft Hospital
York Road
Leeds
LS14 6WB

Phone: 0113 855 6346

Email: gid.lypft@nhs.net

The Leeds clinic's website covers referrals, commonly used medicines and information on the clinic's Gender Outreach workers.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Northern Region Gender Dysphoria Service
Benfield House
Walkergate Park
Benfield Road
Newcastle
NE6 4PF

Phone: 0191 287 6130

Email: NRGDS@cntw.nhs.uk

The Northern Region Gender Dysphoria Service website has a range of leaflets, including information about referral, hormones and support groups.

Gender dysphoria clinics in the Midlands
Northamptonshire Healthcare NHS Foundation Trust Gender Dysphoria Clinic
Danetre Hospital
H Block
London Road
Daventry
Northamptonshire
NN11 4DY

Phone: 01327 708147

Email: genderclinic@nhft.nhs.uk

Visit the Northampton clinic's website for more information about how to get a referral and the role of the GP.
Nottinghamshire Healthcare NHS Foundation Trust The Nottingham Centre for Transgender Health
12 Broad Street
Nottingham
NG1 3AL

Phone: 0115 876 0160

Email: NCTHGeneral@nottshc.nhs.uk

Visit The Nottingham Centre for Transgender Health website for more information about how to get a referral.

Gender dysphoria clinics in the southwest
Devon Partnership NHS Trust West of England Specialist Gender Dysphoria Clinic
The Laurels
11-15 Dix's Field
Exeter
EX1 1QA

Phone: 01392 677 077

Email: dpn-tr.thelaurels@nhs.net

The Laurels' website has information about the types of services on offer and the help available during transition.

New gender dysphoria services in 2020

In 2020 new NHS gender dysphoria services for adults will open in Greater Manchester, London and Merseyside.

These services will be delivered by healthcare professionals with specialist skills and based in local NHS areas, such as sexual health services. Full details will be available once each service is opened.

Initially, access to these services will be available to people who are already on a waiting list to be seen at one of the established gender dysphoria clinics.

NHS England will assess how useful these new pilot services are.

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How to find an NHS gender dysphoria clinic

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Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria. Your particular needs may be best addressed by transgender health services offered by NHS gender dysphoria clinics (GDCs).

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Chestfeeding without a full milk supply? This article explores an alternative to bottlefeeding for providing supplements.

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Sometimes a baby may need supplemental breast milk, donor milk or formula in addition to direct breastfeeding. There are many possible reasons for low milk supply and if a baby isn't gaining weight or not gaining enough weight more milk may be needed either temporarily or longer term.

Traditionally supplemental milk has been fed by spoon, syringe, cup-feeding or bottle. But there is another option; supplementing at the breast using a fine feeding tube or supply line. This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

How supplementing at the breast works

Supplementing at the breast requires a container of milk connected to a length of flexible feeding tube. The tube and container may be referred to as an at-breast supplementer, nursing supplementer, lactation aid or a supply line. The free end of the feeding tube is held or taped to run alongside mother's nipple so that the baby takes the tube and nipple together in his mouth when he latches. Alternatively the tube can be inserted in the corner of baby's mouth part way through a breastfeed after the breast has been drained. While the baby feeds at the breast, he also receives supplemental milk via the small tube. As long as baby breastfeeds with a good attachment (latch) and suction, with his lips sealed around the breast, milk will flow up the tube with much the same principle as sucking up a straw.

It is a good idea to stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast.

Types of supplemental feeding system

There are currently only a few commercial systems, each using different designs and each with their own advantages and disadvantages. It is also possible to make a homemade version, see Homemade Supplemental Nursing System or use a supply line as a finger-feeder. The commercial systems include:

The Medela Supplemental Nursing System (SNS) uses a hard sided container for the supplement which hangs from your neck. Two tubes deliver the supplement from the container one to each breast. The feeding tubes can be taped to the breast with surgical tape or a sticking plaster. Slits in the cap make it possible to pinch shut one or both tubes to prevent milk flowing.

The Lact-Aid uses a soft disposable bag to hold the supplement which also has a neck strap to hang around the neck like the SNS and a clamp to stop milk flow if needed. This system only has one feeding tube which can be moved between breasts. There are ongoing costs to buy new sterile bags to hold the supplement.

Haakaa's Supplemental Feeding Combo is a new supplementer on the market currently available in New Zealand. Squeezing the container of milk controls the flow of supplement.

Controlling the rate of flow of milk

It is important to get the flow of supplement at the right speed-too fast and your baby may get too much milk to cope with. If the flow is too slow, an underweight baby may not have the stamina to keep feeding long enough or at all. Ideally with the supplementer in place, your baby will be having one swallow of milk after every suck or after every two to three sucks for most of the feed. The rate of flow of milk from the supplementer varies with:

The diameter of the tube-the wider the tube, the faster the flow of milk. The Medela SNS provides several sizes of tube to help you find the right flow rate for your baby.

The position of the container in relation to the baby-the flow is slower if the bottle is positioned below the baby and faster if the container is positioned above baby's head.

Lactation consultants Diana West and Diane Wiessinger discuss how to adjust flow rate in the Medela SNS in the following excerpt:

A baby who is seriously underweight or who has a weak suck might be fed with the larger tube, while a baby who is gaining well might use the smaller tube. Most mothers start with the medium size tubing. If milk flow is not sufficient with any one tube size, even when the bottle is as high as it can go, another option is to tape both tubes of a given size together on one breast, or to tape one tube to the side of the bottle, facing upwards and unclamp it, allowing air to enter the reservoir more quickly. Milk exits only when air enters, so the faster air flows into the reservoir, the faster milk can be removed from it.

Cleaning a supplemental nursing system

The small feeding tubes are very difficult to clean and will need replacing regularly. Follow manufacturer's cleaning recommendations very carefully for commercial feeding systems and for information about cleaning homemade versions see Homemade Supplemental Nursing System on this website.

When to use an at-breast supplementer

Supplementing at the breast can be used short term or long term and helps avoid a baby losing interest in breastfeeding prematurely in favour of a bottle. Potential uses include:

Supplementing a baby if there is a reason for low milk supply including insufficient glandular tissue.

Keeping an adopted baby fed at the breast to give mother and baby the experience of breastfeeding.

Keeping a baby interested in latching when encouraging a baby back to the breast after a period of bottle feeding or while a mother is relactating.

The tube can be used as part of a finger feeding exercise for suck training.

Pros and cons of supplementing at the breast

Advantages

Baby can get the additional milk he needs at the breast without introducing other feeding methods or techniques.

Baby gets more practice at breastfeeding well. If baby doesn't feed correctly, milk won't come up the tube.

Mother is able to enjoy the full experience of breastfeeding.

Helps avoid bottle preference or nipple confusion. There is less chance that a baby will start to prefer a bottle instead of the breast or stop breastfeeding correctly due to nipple confusion with a bottle teat.

Increases the flow of milk. Supplementing at the breast eliminates a baby's frustration with slow flow when milk supply is very low.

The breasts are stimulated to make more breast milk by additional suckling.

Baby associates feeling full with the breast and this reinforces his desire to breastfeed.

Disadvantages

It can be difficult and fiddly to use until you get the hang of it, particularly when away from home. An IBCLC lactation consultant can help you get started.

It is difficult to clean the little tubes thoroughly.

The system can leak, particularly homemade versions.

Doesn't work for all babies. Some babies can't seem to suck milk up the tube or are not able to get very much. A very underweight baby may still fall asleep at the breast without having fed well. Older babies may be aware of the tube and keep pulling it out.

Only works with good positioning. It isn't a suitable method if a baby isn't latching or is latching so badly as to make his mother's nipples painfully sore.

May affect baby's attachment at breast (latch). Some babies are aware of the tube and it can disturb their latch, tweaking it into different positions may help. Some babies try to suck on the tube like a straw rather than breastfeed correctly.

The tube could cause gagging if it reaches too far into the baby's mouth. Taping the tube to the breast with medical tape so that it aligns with the end of the nipple or behind the nipple can avoid this (see "Taping the tube" below)

Reconstituted powdered formula may clog the tubing.

What supplements can be used with a supply line?

This will depend on your individual circumstances. Supplements could be a mother's own expressed breast milk, donor milk or formula supplements if needed. Some mothers prefer to use ready made formula as powdered formula may clog the small tubes if it is not well blended. If using powdered formula, use the World Health Organization (WHO) guidelines for safe preparation or the UK's National Health Service guidelines Making up Infant Formula, NHS, 2019. And when using expressed breast milk see our storage guidelines. If your baby is underweight, your health professional or IBCLC lactation consultant can guide you with suggested volumes of milk to use in the supplementer. Generally a baby will take as much as they need at any given feeding and this could vary widely depending how much breast milk he is also getting direct from the breast. Staying in contact with your health care team for regular weights will ensure baby is getting enough and growing appropriately.

Taping the tube

The manufacturer's instructions for one of the commercial systems discuss taping the tube beyond the end of the nipple. However, this might cause a baby to gag or use the tube as a straw instead of breastfeeding correctly. The tube need not extend beyond the mother's nipple to work. Surgical sticky tape can be used horizontally across the tube or vertically along its length to prevent the tube from slipping. Some mothers use sticking plasters to guide and hold the tubes by slipping the tube under the non sticky portion of the plaster at each feed.

Video of inserting a lactation aid with Dr. Jack Newman

This clip from Dr Jack Newman's website shows a homemade supplementer being inserted during a breastfeed. Note the baby in this clip looks like he is having to turn his head slightly to reach the breast as he is on his back. Rotating a baby's body towards his mother to ensure his head and neck are all in a straight line is usually preferable to make swallowing easier for baby. See Homemade Supplemental Nursing System for further information on how to make your own at-breast supplementer.

Video using a commercial supplementation system by Natasha Batsford

Get help with breastfeeding

There are lots of ideas to increase your baby's intake of breast milk even if you can't produce a full supply. See How to Make More Breast Milk and contact your IBCLC lactation consultant for more support. Your lactation consultant can help you find the best latch and position for you and your baby, check your baby's tongue function, and help with breastfeeding management.

Summary

An at-breast supplementer or supply line allows a baby to take top ups of supplemental milk directly at the breast while breastfeeding. Supplementing this way has various pros and cons but is another option to consider alongside bottles or cup feeding. A very underweight baby who has not been gaining weight can still tend to fall asleep at the breast without having swallowed plenty of milk, even with a supplemental tube in place. It is important to monitor weight gains and dirty nappies to establish whether your baby is getting enough milk. Stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast using a lactation aid.

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This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

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La Leche League Inducing Lactation Facebook Group

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La Leche League Inducing Lactation Facebook Group

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Closed, private and inclusive support group, moderated by La Leche League.

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La Leche League - Inducing Lactation & Relactation has 7,627 members. This is an inclusive support group for those looking for information and support on how to induce lactation (bring in a milk...

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Alyssa Schnell, St. Louis, Missouri, USA
Alyssa Schnell is an International Board Certified Lactation Consultant (IBCLC) based in the United States. She speaks internationally about inducing lactation and relactation and specializes in helping parents who have not given birth (non-gestational parents) to breastfeed their babies. In this article Alyssa discusses how parents who have not given birth can breastfeed by inducing lactation and how La Leche League Leaders can support them.
Breastfeeding is a special gift a baby receives from their gestational parent. However, many non-gestational parents-adoptive parents, intended parents (through surrogacy), parents whose partner is birthing, and transwomen-are finding out that this wonderful experience is also available to them. Because parents who haven't given birth do not have the hormones of pregnancy to get their bodies started with making milk, they need more information and support to make breastfeeding a reality.

Why Would a Non-Gestational Parent Choose to Breastfeed or Chestfeed?

Attachment. Breastfeeding helps the parent and baby form a secure attachment, a particular concern when babies are separated from their gestational parent or gestational carrier (in surrogacy).

Nutrition. Human milk provides the optimal nutrition and necessary immunities for human babies.
Healing. Breastfeeding can help heal the heartache of infertility, and provides a biological connection between mother/parent and baby. Breastfeeding is much more than breast milk. Breastfeeding is a close, intimate, physical and emotional relationship between two or more people who love each other.

Sharing. When both parents are breastfeeding, they share the caregiving role.

Facts about breastfeeding without birthing

Women have breastfed babies they did not birth throughout history. With the easy availability and common use of bottles and infant formula in modern developed countries, culture has largely lost track of how breastfeeding can also be an option for non-gestational parents.

Non-gestational parents can start preparing for breastfeeding as soon as they decide to grow their family, after an adoption match has occurred or once their partner or gestational carrier is pregnant. They can even wait until the baby is in their arms.

The amount of milk produced when inducing lactation can vary widely. While some parents make no milk and others make all the milk their babies need, most will make a partial milk supply. Fortunately, breastfeeding is possible no matter how much or little milk is produced-even if it is none at all! Human milk feeding can be simulated with a nursing supplementer: a bag or bottle that holds human milk or formula carried to the nipple via a tiny feeding tube. Parents who are not making any milk may also choose to feed with a bottle while their baby comforts and connects with them by suckling at the (dry) breast.

Newborn babies are wired to initiate breastfeeding, but with gentle and patient encouragement, along with a few handy tools and techniques, even older babies can learn to breastfeed.

Some mothers will take medications or herbs to help them make more milk, but this is not essential. The only necessary component to induce lactation-the official term for making milk without pregnancy and birth-is to stimulate and drain the breasts. That stimulation or emptying can happen with baby breastfeeding, with an electric breast pump, or using a variety of manual techniques.

The composition of milk produced by inducing lactation is comparable to that produced following birth., The milk does not contain dangerous levels of artificial hormones-in fact, it very rarely contains any artificial hormones at all. In most cases, the only artificial hormones that are taken are estrogen and/or progesterone before there is milk production (Step 1 below.) Progesterone and estrogen levels are high during pregnancy and taking these hormones artificially may help to make the body think it is pregnant. Estrogen and progesterone play a role in breast development in pregnancy.

It is not necessary to be fertile-or even to have ovaries or a uterus-to breastfeed. The hormones responsible for milk production (prolactin) and milk ejection (oxytocin) are released from the pituitary gland located at the base of the brain.

Both parents, whether or not one has given birth, can share the breastfeeding role. This is called co-nursing.

Step 1: Preparing the Breasts for Lactation
How to induce lactation
Step 2: Starting to Make Milk Before Baby Arrives
As stated above, the primary way to induce lactation is through breast emptying: breastfeeding, pumping, or hand expression. The effectiveness of these physical techniques can be enhanced with the use of galactogogues: medications, herbs and homeopathic remedies that support the production of milk. These tools can be put together in a variety of ways to be effective and applicable to each individual parent. While the use of medications, herbs or homeopathic preparations is an individual choice, parents should always discuss their individual situation with their health care providers.
Step 3: Feeding Baby and Continuing to Grow Milk Production
Generic protocols are available (such as Dr Jack Newman's protocol) or an experienced International Board Certified Lactation Consultant (IBCLC) can work with parents to develop a personalized protocol customized to meet their specific health history, circumstances, and values. The process can be broken down into three steps:

This step mimics the hormonal and breast changes that occur during pregnancy. This step is not about making milk; it is about growing and developing the glandular breast tissue in preparation for making milk. Many parents will take hormone therapy for a period of time to achieve this. However, this step is optional.

Milk is often produced very, very slowly when lactation is induced compared with the sudden increase in milk supply between days 3-5 following birth. In order to have a milk supply by the time baby arrives, parents will often start the process of growing their milk production several weeks or months before. The main component of Step 2 for many parents is frequent pumping. Ideally, parents will express their milk as frequently as a baby nurses-just like for birthing parents, frequent breast drainage "places the order" for healthy milk production. Parents can store any milk they produce for use when baby arrives.

This is the big payoff! Baby is here and the parent can begin feeding baby their milk. This step generally involves putting baby to breast.

Not every parent's protocol will use all three steps. Each parent's needs and circumstances determine which steps will be appropriate for them. For most parents with adequate information and support, milk production begins within 6-8 weeks of beginning the process of inducing lactation.

What is the role of a La Leche League Leader?

Although extremely rewarding, inducing lactation can be a challenging breastfeeding situation. Mothers/parents need and deserve all of the support they can get. While working with an International Board Certified Lactation Consultant (IBCLC) is highly recommended, La Leche League Leaders can also play a very valuable role. As always, Leaders provide essential information and encouragement. More specifically, La Leche League Leaders may:
Alyssa Schnell has been helping parents and babies with breastfeeding for the past 17 years, first as a La Leche League Leader and now as an International Board Certified Lactation Consultant (IBCLC). Her private practice, Sweet Pea Breastfeeding Support, provides individual lactation consultations either in person or by phone or video-conference for parents throughout the United States and beyond. Alyssa is also the co-host of the Breastfeeding Outside the Box podcast, which is devoted to families breastfeeding or chestfeeding in extraordinary situations. Alyssa enjoys working with all parents and babies, but she has a special place in her heart for helping non-gestational parents to breastfeed/chestfeed their babies. She is the author of Breastfeeding Without Birthing: A Breastfeeding Guide for Mothers Through Adoption, Surrogacy, and Other Special Circumstances and is an international speaker on the topics of inducing lactation, relactation, and other related topics. Alyssa lives in St. Louis, Missouri, USA and is the proud mother of three breastfed children-two by birth and one by adoption.

Refer parents to resources on inducing lactation (see below).

Provide support for inducing lactation.

Facilitate La Leche League Group meetings where older babies who are bottle-feeding can observe breastfeeding babies, and parents can participate in a breastfeeding culture. Group meetings are also opportunities for parents to connect with other mothers who are nursing in a variety of situations.

Facilitate healthy social media information and interaction.

Share information about donor milk.

Breastfeeding without birthing may not be easy, but it is possible and it is powerful. La Leche League Leaders can be part of the team supporting these parents and their babies.

Resources for La Leche League Leaders and parents

Some notes about language: The term "gestational" is used throughout this article instead of "biological." In surrogacy, the intended mother is often the biological mother (baby is often conceived with her egg) even though she is not gestating (pregnant with) the baby. And oftentimes same-sex female couples will conceive baby via in vitro fertilization (IVF) using the egg of one parent (biological parent) implanted in the uterus of the other parent (gestational parent). This article also attempts to use gender-inclusive language such as parent versus mother and breastfeeding/chestfeeding versus breastfeeding. Some of the parents referred to in this article may be cis male, trans male, or non-binary.

Note: inducing lactation with medication should not be started unless the parent has an approximate timeline for their baby's arrival. Taking medication without a definite end could be hazardous.

Other manual approaches might include breast massage, nipple manipulation (gently pulling out and twisting of the nipple), and a partner suckling.

Kulski, J. K., Hartmann, P. E., Saint, W. J., Giles, P. F., & Gutteridge, D. H. (1981). Changes in the milk composition of nonpuerperal women. American journal of obstetrics and gynecology, 139(5), 597-604.

Perrin, M. T., Wilson, E., Chetwynd, E., & Fogleman, A. (2015). A pilot study on the protein composition of induced nonpuerperal human milk. Journal of Human Lactation, 31(1), 166-171.

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Breastfeeding Without Giving Birth - La Leche League International

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Alyssa Schnell, St. Louis, Missouri, USA Alyssa Schnell is an International Board Certified Lactation Consultant (IBCLC) based in the United States. She speaks internationally about inducing lactation and relactation and specializes in helping parents who have not given birth (non-gestational parents) to breastfeed their babies.

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Breastfeeding can be a 98% reliable form of contraception in the first six months after birth - if a mother’s periods haven’t returned yet and her baby has nothing other than breast milk to eat or drink. Find out more in the article above.

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Can You Get Pregnant While Breastfeeding?

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Exclusive breastfeeding can work as a contraceptive preventing pregnancy for many women in the early months after birth. But when

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Find out about ensuring good oral health for your child

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Find out about ensuring good oral health for your child

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Virtual Antenatal Oral Health Session

One-off antenatal session to cover oral health in babies/toddlers:

Book here:

ChelWest Maternity Oral Health Class (Patients) Tickets, Multiple Dates | Eventbrite

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Royal College of Obstetricians and Gynaecologists Q&A on COVID vaccines and pregnancy/breastfeeding

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Royal College of Obstetricians and Gynaecologists Q&A on COVID vaccines and pregnancy/breastfeeding

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More than 1.3 million women worldwide have had COVID-19 vaccines in pregnancy.

Studies following up nearly 350,000 pregnant women in the US and UK who were vaccinated in pregnancy have not raised any safety concerns. Since most of these women received mRNA vaccines, such as Comirnaty/Pfizer BioNTech and Moderna Spikevax, the JCVI advises that it is preferable for these mRNA vaccines to be offered to pregnant women in the UK, where available.

The UKHSA (formally Public Health England) and Public Health Scotland have reported that well over 150 000 pregnant women have received a COVID-19 vaccine in England and Scotland, with no serious adverse effects recorded. UKHSA data from April to June 2022 reported that 72.6% of women who gave birth had received at least one dose of COVID-19 vaccine prior to giving birth.

Current research indicates COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccines cause harm to the pregnancy or to fertility.

The COVID-19 vaccines being used in the UK are not 'live' vaccines and so cannot cause COVID-19 infection in you or your baby. Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough).

Studies have shown that protective antibodies from vaccination do cross the placenta, helping with the baby's immunity to COVID-19. We know that catching COVID-19 during pregnancy can cause severe illness in a pregnant woman, which is why COVID-19 vaccine in pregnancy is so strongly recommended.

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COVID-19 vaccines, pregnancy and breastfeeding FAQs | RCOG

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These Q&As on COVID-19 vaccines, pregnancy and breastfeeding are reviewed as new information and advice emerges.

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Medela

Symphony double breastpump

Symphony rental | Double electric breast pump| Medela

ARDO

Carum double breastpump

Rent a Breast Pump | Ardo Breastpumps

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Medela

Symphony double breastpump

Symphony rental | Double electric breast pump| Medela

ARDO

Carum double breastpump

Rent a Breast Pump | Ardo Breastpumps

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Postnatal support for families who have given birth in the Kensington Wing

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Postnatal support for families who have given birth in the Kensington Wing

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24 hours, 7 days a week.

T: 020 3315 8616
E: chelwest.kensington@nhs.net

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Bottle feeding at West Middlesex Hospital 

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Bottle feeding at West Middlesex Hospital 

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West Middlesex Hospital supplies sterile single-use bottles and teats for parents deciding to bottle feed. Please note: we do not have sterilising facilities/formula making capacity. If parents decide to use formula, please ensure premade/ready-made first stage (infant) milk is brought in.

We have a fridge and freezer for expressed breastmilk in the expressing room on the postnatal ward and a fridge for formula on the postnatal ward.

For parents using the hospital pump, a 72-hour pump set will be provided.

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Bottle feeding at Chelsea & Westminster Hospital

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Bottle feeding at Chelsea & Westminster Hospital

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Chelsea & Westminster Hospital supplies sterile single-use bottles and teats for parents deciding to bottle feed. Please note: we do not have sterilising facilities/formula making capacity. If parents decide to use formula, please ensure premade/ready-made first stage (infant) milk is brought in.

We have a milk freezer for frozen antenatal colostrum (please hand any frozen colostrum immediately to a Midwife). We have a fridge on the postnatal ward to store expressed breastmilk/formula.

For parents using the hospital pump, a 24-hour pump set will be provided.

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Protecting your baby from low blood sugar

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Protecting your baby from low blood sugar

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If you're diabetic, taking medication for high blood pressure, or know you may have a premature or small baby, read this leaflet to find out what additional support your baby needs to avoid low blood sugar.
We would encourage you to consider expressing your colostrum during pregnancy (see next leaflet down).

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. Read more on laid back positions and why they are useful in achieving a deep, effective latch.

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

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

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

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

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

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

Tips for getting started

If it hurts then make changes

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

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

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

Your baby needs to be calm

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

Your baby needs full body contact

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

Some babies need time

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

Laid-back breastfeeding

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

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

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

Sleepy babies

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

How laid back breastfeeding works

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

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

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

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

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

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

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

Latching on - getting a good attachment

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

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

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

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

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

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

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

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

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

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

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

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

This video shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:
http://m.raisingchildren.net.au/articles/breastfeeding_attachment_video.html

Using different breastfeeding positions

The cradle hold

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

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

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

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

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

Laid back breastfeeding

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

The cross-cradle hold

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

Cross cradle

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

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

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

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

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

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

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

The underarm (clutch or rugby) hold

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

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

Your elbow keeps them tucked closely against your body.

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

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

Side lying

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

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

Standing up

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

As time goes by

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

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

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

LLLI Resources
Position to breastfeed

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

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

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

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

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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

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Breastfeeding resources in other languages

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Breastfeeding resources in other languages

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Please see link for sources of resources in various languages.

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Useful websites

Listed in alphabetical order:

Find an IBCLC

Search for a breastfeeding expert near you

Australian Breastfeeding Association

The Australian Breastfeeding Association has translated the following free booklets into multiple languages:

Breastfeeding Confidence. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dari, Dinka, Farsi, Hindi, Karen, Tamil and Vietnamese.Each language can be downloaded from their website here.

Breastfeeding and Childcare. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dinka, Farsi, Hindi, Tamil and Vietnamese. Each language can be downloaded from their website here.

Breastfeeding and Ramadan. Translations available in English, Arabic and Urdu, downloaded from their website here.

Best Start Resource Centre: Ontario's Maternal Newborn and Early Child Development Resource Centre

The Best Start Resource Centre has several breastfeeding resources available in French, Arabic, Bengali, Chinese, Farsi, Gujarati, Hindi, Korean, Punjabi, Russian, Serbian, Somali, Spanish, Tagalog, Tamil, Urdu and Vietnamese, as well as English:

Breastcrawl.org

Breastcrawl.org has a number of breastfeeding resources in several languages; the website itself can be translated into over 100 languages including Hindi, Punjabi, Urdu and Gujarati, Italian, Spanish, and French. Select the language you require from the drop down menus at the top of the page. A video of a breast crawl can be viewed in English, Italian, Marathi and Spanish with sub-titles available in Bengali, English, Gujarati, Hindi, Kannada, Malayalam, Marathi, Oriya, Punjabi, Tamil, Telugu and Urdu.

European Lactation Consultants Alliance (ELACTA)

ELACTA provides basic breastfeeding tips with simple line drawings in 24 translations (Albanian, Arabic, Serbian, Croatian, Danish, Dutch, English, Farsi, Finish, French, German, Greek, Hebrew, Italian, Lithuanian, Polish, Romanian, Russian, Slovak, Slovenian, Spanish, Turkish, Ukranian and Vietnamese). These can be dowloaded as pdfs from this page.

Global Health Media

Global Health Media has many excellent breastfeeding videos available in French, Spanish, Swahili, Bamanankan, Italian, Khmer, Kinyarwanda, Lao, Malay, Nepali, Slovak, Vietnamese and English. Select the language you require from the drop down menus at the top of the page.

La Leche League Great Britain

La Leche League Great Britain (LLLGB) has translations of three information sheets in Welsh:

Visit their Support in Languages Other Than English page for more language support services.

La Leche League International

La Leche League International (LLLI) is an international breastfeeding charity. Their breastfeeding resources can be translated on the website (via google translate) into 100 languages. Visit llli.org and select your preferred language from the drop down menu at the top of each page. Alternatively their Get Help page lists where to find a breastfeeding counsellor or breastfeeding support group by country.

UNICEF (United Nations International Children's Emergency Fund)

Unicef's UK Baby Friendly Initiative has some breastfeeding and bottle-feeding resources in Arabic, Bengali, Hindu, Lithuanian, Mandarin, Polish, Romanian, Slovak, Turkish and Urdu. See Foreign Language Resources on the UNICEF website to access the translations and to see an English version for comparison.

Telephone helplines

Summary

A number of reputable websites have translations of breastfeeding information. Breastfeeding videos and telephone helplines are also available in multiple languages.

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Listed in alphabetical order: Find an IBCLC Search for a breastfeeding expert near you Australian Breastfeeding Association The Australian Breastfeeding Association has translated the following free booklets into multiple languages: Breastfeeding Confidence. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dari, Dinka, Farsi, Hindi, Karen, Tamil and Vietnamese.Each language can be downloaded from their website here.

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Research - Baby Friendly Initiative (unicef.org.uk)

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The Association of Tongue-tie Practitioners supports parents of tongue-tied babies by providing access safe and effective care, appropriately regulated, by trained healthcare professionals, who are insured and registered.
Link includes information on how to access support from a private Tongue-tie Practitioner.

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Tongue tie clinic — Chelsea and Westminster Hospital NHS Foundation Trust

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Video demonstrating how to bottle feed responsively.

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This website provides information and support to mothers who wish to breastfeed after breast or nipple surgery.

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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The BFAR website provides information and support to mothers who wish to breastfeed after breast or nipple surgery, and their friends and family. It is also an online resource for healthcare providers who help mothers breastfeed.

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Information and resources when breastfeeding multiple babies.

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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.