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or laid back breastfeeding. More than just a different breastfeeding position, BN is about a way of comforting and nurturing a baby that uses a mother's and baby's instinctive behaviours.

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In this laid back feeding position the baby finds the breast for herself. This video shows typical patterns of feeding behaviour. Baby is gradually learning the geography of her mum - where the breast is. Once on, she feeds well and comes pff looking satisfied.

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Can I see Natural Breastfeeding positions in action?

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Lots of information and tips on how babies sleep and on safe sleep

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A straightforward summary of safe sleep bedsharing guidance

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Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman

Photo: Weaver by Lisa on Location Photography
Excerpted fromSweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, Chapter 2: The Safe Sleep Seven, by Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman, a La Leche League International book, Ballantine Books, 2014.
Wah! Wah! Wah! Drag yourself out of your nice cozy bed, pick up your screaming baby, sit down to nurse, try to stay awake, put him back in the crib, stagger back to bed, and hope, hope, hope he stays asleep for at least two hours. I had no idea I could feel that exhausted. I could not understand how other mothers survived this, because I didn't think I was going to.
My friend who's a La Leche League Leader came over and saw how worn down and bleary-eyed my husband and I looked. She asked if we'd thought about bedsharing to get more sleep. No. Not for us. Never. But she laid out seven things that make it safer. That night, out of pure desperation and sleep deprivation, I brought my son into my bed for part of the night . . . and I started the next day a bit brighter. He spent more and more time in my bed at night, and lo and behold, we both got more and more sleep. -Monica

Today's culture says you should keep the baby in your room... but not in your bed. Feed him in bed and get really drowsy...but then get out of bed again. Two trips out of bed for every feeding. By about six weeks, something has to give. (1) Weaning? Leads to short-term and long-term problems. (2) Night weaning? Not healthy for you, your baby, or your milk supply at this age. (3) Supplementing? Ditto. (4) Break out the sleep-training book from the baby shower? Not as harmless as it seems (see Chapter 18).

A mother's first step is usually to find a place where she can relax for night feedings. The American Academy of Pediatrics (AAP) says, "Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep." (5) Easy to say. When most of us are "ready to return to sleep," steeped in hormones that make us sleepy, the last thing we want is to get up again. If a mother's afraid to nurse in her own bed, her most likely options are a sofa, recliner, or upholstered chair-all riskier places to sleep with a baby. One study found that 44 percent of mothers who nurse in those places at night fell asleep there at least once. (6) Eventually, many mothers find that bedsharing is a low-risk, long-term solution for sleep deprivation and an unhappy baby. (7) But they often go through several high-risk arrangements along the way.

The Safe Sleep Seven Bedsharing Song

(to the tune of "Row, Row, Row Your Boat")
No smoke, sober mom
Baby at your breast
Healthy baby on his back
Keep him lightly dressed.
Not too soft a bed
Watch the cords and gaps
Keep the covers off his head
For your nights and naps.

Even though most new breastfeeding mothers today don't plan to bedshare, studies show that eventually 60 to 75 percent of them will, at least some of the time. (8) Why? Probably because most breastfeeding mothers get more sleep when they bedshare. (9) In fact, a lot of mothers who say they don't bedshare actually do. If the baby starts the night in the crib, if the baby started the night in the crib last night, if the baby usually comes into his mother's bed at the first waking, even if a family simply owns a crib . . . any of those can lead a mother to say-and believe-that she doesn't bedshare when she actually does. (10)

One of the big reasons that bedsharing is safer when you're breastfeeding is the way you position your body next to your baby. During sleep, you'll automatically go into the same position as breastfeeding mothers all over the world and throughout time. It's called a cuddle curl, and it's nature's way of protecting a baby during sleep. Your knees come up and your arm tucks under your head or pillow, or curls around your baby, creating a protected space. There's no way for you to roll toward your baby because your bent legs won't let you. And no one else can roll into the space because your knees and elbows are in the way. (11) Very cool! (If you're worried about your partner, just sleep between your partner and the baby.)

Even during sleep a breastfed baby will instinctively stay with his face near the breast, because that's the center of his universe (and his kitchen). (12) If your baby homes in on your breast, he's not going to wander up into the pillows or down under the covers (and your arm and legs won't let him).

There's another layer of protection too: normally, we're aware of the edges of our bed and the bodies of our pets, even when we're sound asleep. We don't roll over on a baby any more than we roll off the side of the bed or roll over on the cat. And of course both the cat and the baby would react if you tried.

A mother who has never breastfed loses some of these protections. She tends to move her baby closer to her own face, where those puffy, smothery pillows are. (13) And a baby who doesn't breastfeed is more likely to wander up there himself, even if the bottles are filled with his mother's milk.

What if you're still working out the kinks, maybe pumping for a baby who isn't nursing yet? A newborn will automatically seek his mother's breast. If you've been focused on helping him breastfeed, you'll probably find yourself doing a cuddle curl, at least at first.

If you breastfeed most of the time but give occasional bottles of pumped milk, you'll probably still sleep in a breastfeeding cuddle curl, and your baby will most likely stay at chest level. (14) But if either of you sees a bottle as the more important food source, you and your baby may not automatically "think breast," and your bedsharing risk may increase. (15) If you're just not sure, think carefully about how you cradle your baby when you lie down, and maybe have your partner watch how you interact before you decide for or against bedsharing.

What if your baby gets formula sometimes? Exclusive formula-feeding increases the risk of SIDS (see Chapter 19); partial formula-feeding is a smaller SIDS risk.

By about four months, any responsible adult can bedshare as safely as a responsible breastfeeding mother. (16)

For those who say they don't need to prepare their bed for bedsharing because they'll never, ever do it, think about car accidents. No one ever expects them to happen either. But they do. That's why we wear seat belts. It's not that we're planning to have an accident; it's that accidents are never planned. So we plan ahead, and we don't give it another thought. Simple and safe-or as safe as being in a car can get.

A planned-ahead bed is just a seat belt. Then at 3:00 a.m. when your baby just can't sleep alone even though you've tried everything up, down, and sideways, you can collapse in bed with your baby and stay there snugly until morning. Tomorrow morning you can decide what you want to do tomorrow night. Life is risky, no matter how you live it. A safe bed, like a seat belt, can greatly reduce that risk.

The Key Points for Safe Sleep for All Babies
Stay smoke-free. Stay sober. Stay off sofas, upholstered chairs, and recliners for sleep. Keep your healthy baby lightly dressed, on his back, and near you for sleep. And, of course, keep breastfeeding.

But what about all the warnings against bedsharing? If you meet the criteria outlined in the Safe Sleep Seven, then you're not the mother the warnings are for! Only a small subset of babies with certain preexisting vulnerabilities is at risk for SIDS. The risk for SIDS or suffocation is far, far, far greater in a household where the mother smokes, where alcohol or drugs are involved, where the baby is formula-fed, or in truly chaotic settings where the baby sleeps who knows where or with who knows whom (see Chapter 19). In an attempt to reach certain mothers and protect certain babies, the warnings have be en made very clear, very strong, and very simple. The answers for you are just as simple.

The Key Points for Applying the Key Points
Every situation is different. Life is never 100 percent safe. And everyone balances risk and benefits differently. Take the information we present and use your mother-wisdom to decide what's best for you, your baby, and your family.

All those scary warnings are about only the first four months. Beyond that? Even the researchers behind the bedsharing cautions agree that by about four months bedsharing by any responsible, nonsmoking adult is as safe as having your baby sleep separately in a bassinet or crib. (11)

If you and your baby fit the Safe Sleep Seven criteria, your baby's risk of SIDS is what one sleep researcher calls vanishingly small. And you'll virtually eliminate overlying and other suffocation risks.

If you are:
1. A nonsmoker
2. Sober and unimpaired
3. A breastfeeding mother and your baby is:
4. Healthy and full-term
5. On his back
6. Lightly dressed
and you both are:
7. On a safe surface

Then your baby in bed with you is at no greater risk for SIDS than if he's nearby in a crib. The Safe Surface checklist explains number 7 and practically eliminates breathing risks no matter where he sleeps. Rolling over on your baby is virtually impossible because you have the cuddle curl (see above) and responsiveness of a breastfeeding mother. By the time the baby is about four months old, research indicates that bedsharing with a healthy baby by any responsible nonsmoking adult on a safe surface is as safe as any other sleep arrangement.

The Safe Surface Checklist

Avoid these possible smothering risks:

Sofas and recliners

Softness or sagging that rolls your baby against you or keeps him from lifting his head free

Spaces between mattress and headboard, side rails, or wall where a baby could get stuck

Pets that could interfere

Clear your bed of:

Unused pillows

Stuffed toys

Heavy covers and comforters

Anything nearby that dangles or tangles (such as cords, strings, scarves, ribbons, elastics)

Check your bed for possible hazards:

Distance to floor

Landing surface

Sharp, poking, or pinching place

The remainder of Chapter 2 explores the details of each Safe Sleep Seven criteria, including the research and common sense behind them.

Something to Sleep On

Research on infant sleep risks, which we go over in depth in Chapter 19, shows again and again that the big risks of shared sleep are a mix of SIDS risks that affect vulnerable babies and breathing hazards that affect all babies: smoking, alcohol or drugs, risky surfaces like sofas, baby on his front (unless he's on an adult's chest), and formula-feeding. Combine two or more of those, and the risk can skyrocket.

If you and your baby meet the requirements in the Safe Sleep Seven checklist, you've already eliminated all the biggest SIDS risks. And if you prepare your bed, then your baby's overall nighttime risk becomes vanishingly small. It's like putting your seat belt on and then driving slowly on a deserted (and lovely!) country road. Enjoy having your baby beside you for the journey.

Sleep: Bedshare
Sleep: Safe Sleep
Sleep: Safe Surface
Sleep: Talking With Your Doctor About Bedsharing
Infant Sleep
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References

1 Ball, H. L. Breastfeeding, bed-sharing, and infant sleep. Birth 30, no. 3 (2003): 181-188. Ball, H. L., Hooker, E., Kelly, P. J. Where will the baby sleep? Attitudes and practices of new and experienced parents regarding cosleeping with their newborn infants. American Anthropologist 101, no. 1 (1999): 143-151.

2 U.S. Department of Health and Human Services. Executive summary: the surgeon general's call
to action to support breastfeeding. Breastfeeding Medicine 6, no. 1 (2011): 3-5.

3 Imong, S. M., Jackson, D. A., Wongsawasdii, L., et al. Predictors of breast milk intake in rural northern Thailand. Journal of Pediatric Gastroenterology and Nutrition 8, no. 3 (1989): 359-370. Kent, J. C. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics 117, no. 3 (2006): e387-e395.

4 Howel, D., Ball, H. Association between length of exclusive breastfeeding and subsequent breastfeeding continuation. Journal of Human Lactation 29, no. 4 (2013): 579-585.

5 Moon, R. Y., et al. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 128, no. 5 (2011): e1341-e1367.

6 Kendall-Tackett, K., Cong, Z., Hale, T. W. Mother- infant sleep locations and nighttime feeding behavior. Clinical Lactation 1, no. 1 (2010): 27-30.

7 Colson, E. R., Willinger, M., Rybin, D., et al. Trends and factors associated with infant bed sharing, 1993-2010. The National Infant Sleep Position Study. JAMA Pediatrics 167, no. 11 (2013): 1032-1037.

8 Ball, H. L. Breastfeeding, bed-sharing, and infant sleep. Birth 30, no. 3 (2003): 181-188. Ball,
H. L. Bed-sharing practices of initially breastfed infants in the first 6 months of life. Infant and Child Development 16, no. 4 (2007): 387-401.

Ball, H. L. Reasons to bed-share: why parents sleep with their infants. Journal of Reproductive and Infant Psychology 20, no. 4 (2002): 207-221.

Kendall-Tackett, K., Cong, Z., Hale, T. W. Mother- infant sleep locations and nighttime feeding behavior. Clinical Lactation 1, no. 1 (2010): 27-30.

Lahr, M. B., Rosenberg, K. D., Lapidus, J. A. Maternal-infant bedsharing: risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Maternal and Child Health Journal 11, no. 3 (2007): 277-286.

Blair, P. S. The prevalence and characteristics associated with parent-infant bed-sharing in England. Archives of Disease in Childhood 89, no. 12 (2004): 1106-1110.

9 Quillin, S. I. M. Interaction between feeding method and co-sleeping on maternal-newborn sleep. Journal of Obstetric, Gynecologic, and Neonatal Nursing 33, no. 5 (2004): 580-588.

10 Ball, H. L., Hooker, E., Kelly, P. J. Where will the baby sleep? Attitudes and practices of new and experienced parents regarding cosleeping with their newborn infants. American Anthropologist 101, no. 1 (1999): 143-151.

11 Ball, H. Parent-infant bed-sharing behavior. Human Nature 17, no. 3 (2006): 301-318.

Ball, H. L., Klingaman, K. Breastfeeding and mother- infant sleep proximity. In Trevathan, W. R., Smith, E. O., McKenna, J. J. (eds.), Evolutionary Medicine. New York: Oxford University Press, 1999.

12 Richard, C., Mosko, S., McKenna, J., et al. Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep 19, no. 9 (1996): 685-690.

Baddock, S. A., Galland, B. C., Bolton, D. P. G., et al. Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics 117, no. 5 (2006): 1599-1607.

13 Ball, H. Parent-infant bed-sharing behavior. Human Nature 17, no. 3 (2006): 301-318. Ball, H. L., Klingaman, K. Breastfeeding and mother-infant sleep proximity. In Trevathan, W., Smith, E. O., McKenna, J. J. (eds.), Evolutionary Medicine and Health: New Perspectives. Oxford: Oxford University Press, 2008.

14 Ball, H. Parent-infant bed-sharing behavior. Human Nature 17, no. 3 (2006): 301-318. McKenna, J. J., Ball, H. L., Gettler, L. T. Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. American Journal of Physical Anthropology 134, suppl. 45 (2007): 133-161.

15 Volpe, L. E., Ball, H. L., McKenna, J. J. Nighttime parenting strategies and sleep-related risks to infants. Social Science and Medicine no. 79 (2013): 92-100.

16 Blair, P. S., Fleming, P. J., Smith, I. J., et al. Babies sleeping with parents: case-control study
of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI Research Group.
BMJ 319, no. 7223 (1999): 1457-1461. Carpenter, R. G., Irgens, L. M., Blair, P. S., et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 363, no. 9404 (2004): 185-191. Tappin, D., Ecob, R., Brooke, H. Bedsharing, roomsharing, and sudden infant
death syndrome in Scotland: a case-control study. Journal of Pediatrics 147, no. 1 (2005): 32-37. Vennemann, M. M., Bajanowski, T., Brinkmann, B., et al. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics123, no. 4 (2009): 1162-1170. Ruys, J. H., De Jonge, G. A., Brand, R., et al. Bed sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatrica 96, no. 10 (2007): 1399-1403. Moon, R. Y., et al. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 128, no. 5 (2011): e1341-e1367.

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The Safe Sleep Seven - La Leche League International

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Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman Photo: Weaver by Lisa on Location Photography Excerpted from Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, Chapter 2: The Safe Sleep Seven, by Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman, a La Leche League International book, Ballantine Books, 2014.

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You might like to try this method of lowering baby sideways - it avoids triggering the startle reflex

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Transferring your sleeping baby into their crib

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Little adjustments can make a big difference.

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What adjustments make early breastfeeding easier?

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If your breasts are very engorged, it can be hard for your baby to latch on. This technique, called reverse pressure softening, can be helpful to soften the area around the nipple, making latching easier.

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How To Relieve Engorgement - RPS By Mother

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How you can help when it’s not going as expected

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How you can help when it’s not going as expected

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I work with some amazingly determined, inspiring women. As a breastfeeding counsellor, I am often supporting women who are struggling with breastfeeding. And I am constantly in awe of the resolution and persistence many mothers have to overcome challenges to meet their babies' needs.

Some of those mothers, with a little support, guidance and practice, quickly move to a place of comfort and enjoyment and they don't look back. But some of them just don't. Some of them need incredible determination to overcome problems and difficulties. Some go far beyond what even they thought they would do. And some reach a point where they run out of energy and emotion to keep going.

What do these mothers need from those around them?

How can partners, family, friends or health professionals support them in a way that helps those mothers who are discovering that breastfeeding isn't going as well as they expected? Here are five areas for supporters to consider:

1. Help her find the right support

Unicef has shown that eight out of 10 women stop breastfeeding before they want to. And that " For breastfeeding to work, you need someone to turn to who believes it's important and believes you can do it." 1 And that means helping her find a qualified, informed breastfeeding supporter; often a breastfeeding counsellor ² or IBCLC (International Board Certified Lactation Consultant).

The first step is always to explore what's happening with breastfeeding - not suggest alternatives. The cliché ' Breastfeeding problems have breastfeeding solutions' has great value. It's saying that even if additional solutions are needed to overcome problems and meet the baby's needs, the first step is to look at what's going on with breastfeeding. Finding someone for her who can offer breastfeeding expertise and knowledge, and who will look at the mother and baby as a unit, might be the biggest act of support you can give her and the baby.

For example, If I told you that I really wanted to get fit but after the first few days of going running, I was sore and aching, what would you do to encourage me? Would you spur me on, or would you say, don't worry about it - it's not important, and offer to give me a lift in your car instead? When we don't help mothers find the right support, that's what we are doing: we are offering her solutions that don't match the problems.

Care and concern come from a good place. Of course no-one wants to see someone they love or care about struggling or distressed. And no-one, least of all the baby's mother, wants to see a baby do anything but thrive. The first rule is always feed the baby. But helping her to find the right support to do that is the best help - to help her achieve her breastfeeding goals or make the decision to change those goals.

2. Listen to her

Mothers are already facing a society and culture where bottle-feeding is seen as the norm. By the time her baby arrives, she will have already been bombarded with adverts and images of the best bottles and formulas. Mothers talk about pressure to breastfeed - but also pressure NOT to breastfeed. It can already feel like swimming against the tide for a mother who WANTS to breastfeed, even with a supportive partner.

And so supporters have a huge role in helping mothers to focus on what she wants to do. I've heard many mothers say she can't talk to her family about her difficulties anymore because they just say, out of care for her, "you've done so well, you could stop now". And mothers say they are told by health professionals that "You know you don't have to breastfeed". Of course she knows that. But what if she wants to?

Instead, supporters can ask her what she wants to happen? Where would she like to get to with her baby? What are her goals and ideals for feeding her baby? Without knowing the answer to what she wants, those around might offer the mother solutions that don't help her and in fact make her feel more isolated. Just like those around her, her priority will be to make sure her baby's needs are met - she's not breatfeeding 'just for herself'. How can she tell you she's finding it hard if when she is upset or in pain, what she hears is "well there is an easier way" or "you could give him a bottle".

Sometimes her reasons for struggling aren't obvious but are deep-rooted, perhaps she is finding it hard because of hidden issues or historical experiences around her body and breasts and how she feels about herself or her body. Breastfeeding can unearth hidden hurts, complexities and sensitivities about how mothers view their bodies, their breasts and themselves. None of which may be visible or apparent to someone supporting them and yet can make them feel all the more scared and isolated if they are struggling with breastfeeding.

3. Unde rstand she is driven to breastfeed beyond what she expected

For many mothers the instinct to breastfeed is powerful. And that drive can be really hard for supporters to understand. I hear mothers often say that they didn't realise it would matter so much to them. Just as sometimes a woman has an inexplicable desire and urge to have a baby, the drive to breastfeed can often come as a surprise to the woman herself. The fundamental biological instinct to feed her baby is so ingrained in what it means to be a mother, that it is beyond words. Mothers talk about "just knowing they wanted to breastfeed". Mothers are biologically hardwired to breastfeed their babies.

Petra Hoehfurtner in her excellent article Breastfeeding - A Woman's Right ³ talks about the biological drive to breastfeed and she says:

"But at the end of the day - when it comes to breastfeeding - our bodies and min ds are run by our instincts. Therefore, if a woman, for whatever reason doesn't succeed in breastfeeding her baby, the sense of loss and failure goes much deeper than intellect or emotions; it connects on an instinct level... This woman has 'failed' the human race as she hasn't been able to do the most basic thing: to feed her baby. This sense of failure goes much deeper than any other failure someone experiences in their life."

Mothers are driven by the biological need to make sure their baby thrives. When it doesn't go smoothly or there are challenges, many mothers have a single-minded commitment to making it work. Not out of any external pressure to breastfeed (though others might think that), but because they want to, because it's what their body and mind expect to happen. And they are often surprised by the shift from "I'll try to breastfeed if I can, but I won't worry about it" when pregnant, to "I am determined to do this, I NEED to do this" when their baby is in their arms.

I frequently hear mothers saying that they didn't expect to feel so strongly that they wanted to make it work, and that they are finding depths of determination they didn't know they had. And this is in the context of a culture which already makes breastfeeding complicated in so many ways.

One determined mother told me:

"Breastfeeding was something I knew I wanted to do but it was only when I found I had supply issues I discovered that I was willing to walk to the end of the Earth to try to make it work. Rationally I knew she would be fine with formula supplements, but something altogether deeper took over and I found I was willing to do practically anything to return her to being exclusively breastfed as soon as possible."

For some mothers that will mean days or weeks of struggling and then they get to a place where breastfeeding is what they had hoped for, and they are so relieved that they didn't stop. And they are rightly proud of what they have achieved.

And for others, they get to the point, where they make the decision to stop or her goals evolve so that she gets to a place where she is satisfied: even if it is different from what she first hoped for. But only she can make that decision if she is to gain any sense of peace with it. She has to know it's her choice. And it might be that her goals may change.

4. Tell her it's okay to be angry

As a supporter, giving mothers space to be angry can be liberating for them. A mother might feel angry that system has let her down. Most of the mothers who I see struggling with breastfeeding have been failed at some point. Either by not getting the skilled support and information they needed in the early days. Or worse, that their breastfeeding relationship has been sabotaged by ill-informed support or care in the early days or weeks.

So often mothers are told "that latch looks fine" but are still in pain or the baby is hardly swallowing, or "only feed your baby from one breast to get the really good milk" or "only feed every three hours to make sure you baby is really hungry": all common advice which is likely to undo the breastfeeding relationship. Or when their baby fails to gain weight, mothers are referred to a paediatrician to find out what's wrong with the baby, rather than anyone looking at what's happening with breastfeeding and why isn't the baby getting all he needs at the breast.

And so then not only are mothers coping with overcoming their difficulties, but they are also dealing with a sense of betrayal, isolation and lack of trust in those around who they thought were helping them in a professional capacity. It can feel isolating to think "but I thought they were helping me" and let down by the people they put their trust in.

5. And if she stops breastfeeding, let her grieve

For some mothers, the hurdles and challenges are more than they can overcome, and they reach a point where they decide that they will stop breastfeeding. But we need to watch our language: she hasn't 'given up'; she hasn't failed. It is never h er fault for strug gling or stopping.

When mothers themselves talk about 'giving up', or when we use that language around her we enhance her sense of failure. Instead, she can own the decision. Just like in birth: when mothers feel in control they have a more positive birth experience whatever it might look like. She needs to be in control of the decision of when she will stop breastfeeding.

And at the point of deciding to stop, especially if it has been an intense, stressful, scary, painful time mothers may feel relief. One mother said:

"I was relieved and I knew it was the rig ht decision. It was the right decision at that time - d oesn't mean it couldn't have been different, but I'm at peace I made the right decision then. Yes, I regret it wasn't different. But my memory of stopping is overwhelmingly one of relief."

But that's the point. Each mother will feel differently, so it's important that supporters don't assume, or don't placate. We just need to listen to what she wants to say about it. One mother who stopped breastfeeding, told me about her family:

"They won't let me say I'm sad about it - every time I say something like that, they shut m e down by telling me 'I did well', 'she'll be fine'. I know all that. But I want them to just let me be sad about it."

And then we often hear about GUILT: that the mother feels guilty for stopping. Or she feels guilty and wonders if maybe she didn't try hard enough or guilty that maybe, just maybe she wonders if just doing this for herself. But guilt is so hard to deal with because no-one can fix it. But if we turn it around: and perhaps help the mother to see she is describing GRIEF, then perhaps she can start processing it. It's a grief that breastfeeding isn't as she has hoped for. A grief that her id eal of how she thought it would be for her and her baby isn't the reality. It's the grief that Petra Hoehfurtner explains as "the sense of loss and failure that goes much deeper than intellect or emotions."

But just as with any grief - mothers need to go through the process of dealing with that grief. One model proposes five stages: denial, anger, bargaining, depression and acceptance as part of the framework of moving on. And that can take time. But often the instinct of those around is to want to stop her grieving, and to get her to a place of contentment with her decision. But no-one can do that for someone else - it's grief and that's a personal process that has its own timing.

A last word to the mother who knows the struggle

In the last few months I have met a number of mothers who have gone to amazing lengths to make it work. Some are still breastfeeding, some are combination-feeding and some are no longer breastfeeding. Many have had brilliant supporters, partners, fathers by their sides: after all it takes a team to parent a baby ⁴.

But whatever the outcome, each of them has shown an incredible determination and strength to meet their babies' needs. And to them, I want to say, I am in awe of you and you inspire me. It's not your fault. Be proud of your successes.

And for those mothers who are in the middle of a struggle to make breastfeeding work right now: you are doing an amazing job. Keep asking for support from those who can help you. Celebrate your successes. Hang on in there. I hope you reach your goals - whatever they might be - and that you find a pride and peace in your achievements.

1. https://www.unicef.org.uk/babyfriendly/supporting-breastfeeding-make-it-happen/

2. Breastfeeding counsellors in the UK are trained and accredited with LLL (LLL Leader), ABM, BfN or NCT

3. http://petrah.co.uk/Articles

4. For a great article on how partners can support breastfeeding: https://www.laleche.org.uk/supporting-a-breastfeeding-mother/

A big thank you to Katie Dring, Helen Lloyd and Maddie McMahon for their very helpful comments and thoughts at various stages in writing this.

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Five ways to help when breastfeeding doesn't go as expected... - Justine Fieth

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I work with some amazingly determined, inspiring women. As a breastfeeding counsellor, I am often supporting women who are struggling with breastfeeding. And I am constantly in awe of the resolution and persistence many mothers have to overcome challenges to meet their babies' needs.

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A father’s account of soothing his baby daughter

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A father’s account of soothing his baby daughter

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give me some skin: a nighttime ritual to bond parent and child - cnn

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Give me some skin: A nighttime ritual to bond parent and child

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To combat my impatience as I tried to get my daughters to sleep, I started counting off 100 backrubs. And in so doing created a ritual that releases stress-relieving chemicals in the brain and is the definition of bonding.

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This is such a common concern! Here is a very helpful article explaining about wind (or gas) in babies.

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By Kelly Bonyata, BS, IBCLC

Does a mom need to watch everything she eats to avoid having a gassy baby?

The idea that certain foods in any mom's diet will cause gas in her baby is incredibly persistent but is not founded in research. If certain foods in moms' diets were an overall problem for most babies, we would expect that cultures that emphasize those foods would have more gassy and fussy babies, but this does not occur at all.

This is not to say that certain foods would not bother a particular baby - this does happen occasionally (and it's more likely with very young babies). However, there is no list of foods that every mom should avoid while breastfeeding. In fact, most babies are fine with any food that mom eats, so there is no reason to avoid a food unless you notice an obvious reaction in your baby every time you eat a particular food.

Most babies are gassy from time to time, some more than others. Gassiness is often worse at night. This is due, on the most part, to baby's immature digestive system and has nothing to do with what mom does or eats. Because so many people promote the idea that food in mom's diet causes gas, many a breastfeeding mom will immediately assume it is due to something she has eaten if her baby is gassy.

The list of foods that "might cause gas" is practically endless, and moms who try to avoid all these foods will ( needlessly) have a *very* limited diet. Formula-feeding moms blame it on a chill, a draft, the formula type, the formula being too hot or cold, baby being overdressed, underdressed, jostled too much, etc. Formula-feeding moms never think it was what the cow ate the day she was milked, months ago!

Some causes of gas in babies

Many young babies have a certain amount of gas and seem to strain as it is passed or as a bowel movement occurs simply because of the immaturity of their digestive system. This doesn't always indicate a problem. Most babies' bodies manage gas more easily with growth, maturity, and greater activity. As long as your baby is not overly bothered by the gas or has no other symptoms of food sensitivity or other problems, then "tincture of time" is likely the best solution.

Too much milk too fast, so that baby gulps and chokes and takes in too much air along with the milk. See forceful let-down.

Anything that causes baby to take in too much air may result in a gassy baby (what goes in must come out!):

Crying - Babies swallow air when they are crying, so crying is more likely to be the cause of gas, rather than the result of gas. Respond to baby's feeding cues promptly.

Bottlefeeding - Babies usually swallow more air when drinking from a bottle. When using bottles, use the slowest-flow nipples so baby doesn't get overwhelmed with the milk flow. To reduce air swallowing, keep baby at about a 45 degree angle (rather than lying down), make sure baby has a good seal on the base of the nipple, and keep the bottle tilted so the neck & nipple are filled with milk. There are also varieties of bottles that aim to reduce air swallowing. Don't let baby suck on an empty bottle. Burp baby more often if he seems to be swallowing too much air.

Overabundant milk supply. See Too Much Milk?

Thrush can cause gassiness in babies.

Babies who skip several days between stools tend to be gassier. Older breastfed babies (after the first 6-8 weeks) can go several days without a stool. Ten days or more is not uncommon! The long periods between stools in a baby who is obviously thriving is not a cause for concern if the baby's abdomen remains soft, baby is content and alert, and the stool is soft and profuse if several days have gone by.

Sensitivity to something in mother's diet, including any vitamin/iron supplements, etc. See Dairy and other Food Sensitivities in Breastfed Babies. If this is the reason, you will most likely notice other symptoms, such as excessive spitting up or vomiting, colic, diarrhea, rash, persistent congestion or runny nose.

Anything that baby is eating/drinking other than mother's milk, including vitamins, formula, teas, medications or herbs, solids, juice. Any substance (other than breastmilk) has a much greater potential to increase gassiness rather than reduce it.

Formula feeding tends to cause more gas and digestive upset for most babies because it is not specific to the human baby. Formula-fed babies overall tend to spit up more, be constipated more, have more gas, be more colicky, have more intestinal illnesses, etc. Remember, too, that supplementation most always undermines your milk supply and may result in premature weaning.

Frequently Asked Questions about breastfeeding and gassy babies

Breastmilk is made from what passes into mom's blood, not what is in her stomach or digestive track. Below are a few common questions that moms have about breastfeeding and gassy babies.

Can drinking carbonated sodas cause gas in baby? No. For something to pass into your milk, it must first pass into your bloodstream. It's the carbonation in sodas, etc. that can cause gas in mom. The bubbles in a carbonated drink cannot pass into your milk and affect baby. If this could happen, you'd have carbonated blood and carbonated milk!

If mom is gassy, can that make baby gassy? No. Gas in mom's body cannot pass into breastmilk.

See also Can a nursing mother eat this food? which includes a discussion of How will eating "gassy foods" affect baby?

Popular treatments for gas in babies
Time
For most babies, the number one most effective treatment for gas is TIME. Babies are born with an immature digestive system, and it needs time to mature. Until this happens, baby is likely to be gassy no matter what you do. Some babies "wake up" around 3-4 weeks to all the new GI sensations they are feeling and get really unhappy about it. If you cannot find an apparent cause for your baby's gassiness, he probably just needs a little more time to mature.
Gripe water, fennel tea or other herbal remedies
Herbal remedies have been used for gassy babies for a countless number of years. I prefer to avoid using herbal remedies for gas in young babies. Here are my reasons:

In a healthy baby, anything other than breastmilk is more likely to cause problems rather than solve them.

Giving baby substances other than breastmilk can alter the intestinal flora and reduce the protective qualities of exclusive breastfeeding, thus making baby more susceptable to illness and allergies. See Why Delay Solids? for more on this.

Many of these products contain mixtures of herbs or other substances, thus putting baby more at risk for adverse reactions. Some contain alcohol, so read labels very carefully.

Most of these products have not been tested in infants for safety or effectiveness.

It is more effective to look at treating the causes, rather than simply trying to treat the symptoms.

Note: Star anise has been associated with illness ranging from serious neurological effects, such as seizures, to vomiting, jitteriness and rapid eye movement.

Mint tea is sometimes used for gas and gas pains. Peppermint oil and tea can be dangerous if given directly to babies. Large amounts of peppermint or spearmint are known to decrease milk supply, and mint tea is traditionally used for decreasing milk supply - breastfeeding mothers should avoid drinking mint tea regularly or in large amounts.
Simethicone drops (Mylicon, Ovol)
This medication is considered quite safe, as it is not absorbed by the body. It breaks down bubbles of gas trapped in the stomach and the intestines. Whether this treatment is effective is a different story, however. In clinical trials, simethicone drops have been shown to be effective in reducing the total amount of gas passed. However, they have not been shown to be more effective than a placebo when the study focused on baby's total crying time and the severity of colic-like episodes.

Roberts DM, Ostapchuk M, O'Brien JG. Infantile Colic. Am Fam Physician. 2004 Aug 15;70(4):735-740.

Garrison MM, Christakis DA. A Systematic Review of Treatment for Infant Colic. Pediatrics. 2000;106(1):184-190.

Lucassen PL, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998 May 23;316(7144):1563-9.

Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics 1994 Jul;94(1):29-34.

Sferra TJ, Heitlinger LA. Gastrointestinal gas formation and infantile colic. Pediatr Clin North Am 1996 Apr;43(2):489-510.

Pharmacology information on Simethicone from FamilyPracticeNotebook.com

Colic by Prashant G Deshpande, MD

So, what does work? My baby is unhappy and I am too! We don't want to just wait it out.
Additional Information

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My baby is gassy. Is this caused by something in my diet? * KellyMom.com

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Does a mom need to watch everything she eats to avoid having a gassy baby? The idea that certain foods in any mom's diet will cause gas in her baby is incredibly persistent but is not founded in research.

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Research on babies crying and parental response 

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Research on babies crying and parental response 

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TERESA PITMAN

Originally published May 2014 and republished with the express permission of the author.
Photo: Sweetdreams Photography.

I was once in an airport, waiting for my flight, when I saw a father carrying around his baby. The baby wasn't crying hard, just fussing and being unhappy, and the dad was patting his back gently as he walked up and down between the seats filled with tired travelers. It made me smile, but I was shocked when an older woman stood up and planted herself in front of the father. In a voice loud enough for all of us to hear, she berated him for "spoiling that baby" and let him know that the infant would be "ruined for life" if he kept on carrying and soothing him.

She couldn't have been more wrong.

Responding to a crying baby, it turns out, is important for the baby's development in many ways. For one thing, it reduces the amount of crying as the baby gets older. Silvia Bell and Mary Ainsworth from John Hopkins University found that mothers who responded quickly to crying in the first few months had babies who cried less often and for shorter periods of time at one year, compared with the mothers who delayed responding or sometimes ignored the crying.

And now more recent research is showing that responding to your crying baby protects him or her against future mental health problems and negative reactions to stress. Megan Gunnar and others found that they could measure the levels of the stress hormone cortisol in a baby's system by offering the baby a soft strip of fabric with a sweet taste to suck. This allowed them to find out whether a particular situation was causing the baby stress, and how much.

In a 2009 presentation, Gunnar explained that the stress hormone system is very reactive in the first three or four months after birth. The baby is easily stressed by many things that seem minor upsets to the rest of us: being away from his or her mother, being bathed, having diapers changed and being hungry. These everyday events can send the baby's cortisol levels shooting up. But when the baby's caregiver responds to the baby's cries and other signals of being upset by comforting and soothing the baby, the levels of cortisol go back down. Gunnar adds that this sensitive, responsive care is needed throughout early childhood to maintain cortisol at healthy levels.

Why does the cortisol level matter? Because consistently elevated cortisol affects the way the baby's brain develops, the way he responds to stress in the future, his immune system, his risk of obesity and other areas of development. It's no small thing.

The good news is that you don't have to be a "perfect" mother to protect your baby from stress. I learned that first-hand. For the first couple of weeks of my eldest son's life, he was pretty easy-going. He nursed fairly often but slept most of the time in between feedings. I thought I was a brilliant mother.

At two weeks, however, that honeymoon was over. He was often fussy, cried more often than I'd expected, and wanted to breastfeed on and off all evening long. I tried everything I could think of to soothe him, and while sometimes he'd settle down, often I couldn't figure out what he wanted.

Babies' tears

I remember sitting and holding him against my shoulder, his eyes closed tightly and his little face red from the effort of crying, and saying: "I don't know what to do to help you, but I'm here." It seemed to be the best I could do. Now that I've had four children and six grandchildren, I know the truth of that comment. Sometimes a baby's crying can be comforted away and sometimes it can't, but the research says that just being there makes all the difference in the world. Crying in the arms of a loving mother is a very different experience for the baby than crying alone in a crib.

Purpose? Crying is so universal it seems that there should be some purpose to it beyond just driving parents crazy. Apparently there is-and the need to breastfeed is part of that purpose. Dr. Ron Barr, a Canadian physician who has researched colic and infant crying for many years, has looked at babies around the world, not just in North America or Europe, so he's able to talk about the aspects of crying that cross cultural lines. He finds a consistent pattern everywhere in the world: babies don't cry too much in the first week or two, then they steadily increase the amount of crying over the next few weeks. It peaks at around two months, and then gradually decreases.

Barr has also found that in all societies there are babies who cry more-sometimes much more-than average. We'd call them "colicky." There's nothing medically wrong with these babies, Barr says. They are just at the extreme end of the "crying continuum."

Barr's research, and other research he's reviewed, came up with several possible benefits of crying.

In traditional cultures, where breastfeeding is the norm, mothers usually respond to the baby's crying or fussing by offering the breast. Usually the baby will nurse briefly three or four times per hour. As Dr. Barr puts it, in those cultures, the baby controls the feeding process. In ours, parents usually control it. Frequent crying in the early weeks and months helps to make sure the baby gets plenty of milk and also establishes milk production so that there will continue to be abundant milk for many months to come.

Again, in those traditional cultures, the parents pick up the baby when she cries and keep her close to them-and this protects the baby from predators and other dangers. A baby not in her parent's arms or next to an adult body is at risk, so frequent crying makes sure she's safe. Our babies aren't as much at risk from wild animals or exposure to the elements, but they don't know that. As Dr. Barr notes: "Separation causes crying, and contact often stops it."

When mothers respond to the cries by breastfeeding, the baby gets benefits beyond just milk. The frequent feeding at the breast stimulates production of the milk-producing hormone prolactin, suppressing ovulation and making it less likely that the mother will get pregnant again. Prolactin is highest during night feedings, and we know that frequency of suckling at the breast seems to be more important in stopping ovulation than the duration of each feeding. In other words, it's more effective (in terms of suppressing fertility) for the baby to suckle for five short feedings in the evening than for two long ones. Frequent fussing and feeding in the evening mean two good things from a biolog- ical perspective: the current baby won't have his milk supply diminished by another pregnancy, and the mother is less likely to become anemic due to iron loss through menstruation.

When parents are not frustrated and angry, crying can create caring and nurturing emotions and strengthen the bonds between parents and baby. You know how that newborn cry tugs on your heart. These early weeks are a time for parents and baby to get to know each other, and for the parents to learn what soothes and comforts the baby. Frequent crying gives them lots of opportunities to practice and even feel successful!

Mother's response

If responding to a baby's cries is so important, you'd think it would be "built-in" to mother's brain. Actually, it is. Dr. James Swain, a Canadian professor at Yale University, has been studying brain imaging of mothers' responses to crying. "A baby crying activates the circuits in the mother's brain that are similar to those that become overactive in people with obsessive-compulsive disorder," Swain says. "It also affects the parts of the brain that motivate us, help us appraise the environment, and calm us so we don't get too angry."

This brain activity makes sense when you think about the baby's needs: when she cries, she wants someone to be motivated to respond, to be a little obsessed with making sure everything is okay, and to stay calm while soothing her.

Breastfeeding affects how your brain responds, as well. In 2011, Swain and his fellow researchers had mothers who were exclusively breastfeeding scanned with MRI machines as they heard their two to four-week-old babies crying. They compared the MRI results to those of exclusively formula-feeding mothers who listened to their babies crying. The breastfeeding mothers, on average, had higher activity in the parts of their brains linked to nurturing behaviors and showed greater sensitivity to their babies when seen again at four months postpartum.

As part of his original study, Swain also compared mothers who had given birth vaginally and those who had elective cesarean sections. When the first set of scans was done, the babies were all between two and four weeks old, and Swain found that the mothers who had delivered vaginally were significantly more sensitive to the cries of their own babies. While none of the mothers in the study had clinical depression, those who were less sensitive to their babies' crying also showed more symptoms of depression.

Swain is quick to add: "This doesn't mean that mothers who have elective cesareans are bad mothers. We repeated the brain scans when the babies were about four months old, and by then the differences were much less. All that time holding and caring for and interacting with the baby compensated for any difference due to the method of birth."

Parents

Swain's work is built on past studies of the responses of adult brains to infant crying. Seifritz, a Swiss researcher, found in 2003 that the brains of women with or without children responded more to babies' laughter and crying than men without children did, but parents of both genders showed stronger reactions to crying. That reinforces Swain's observations that the experience of caring for their babies changes how parents' brains respond to crying. If crying is supposed to help parents and babies connect, why is it also linked to abuse? It's well known that most cases of babies being hit or shaken are related to crying. What makes it such a problem for parents in our society?

For one thing, parents in our society are often warned not to do the things that traditional parents naturally do to soothe their babies when they cry. Research by Barr and others has shown that babies cry only half as much when parents carry them in close contact (skin to skin as much as possible), sleep next to them, feed them very frequently, and respond quickly if they cry or fuss. But most parents in Western societies are told that these soothing actions will "spoil" the baby or that the baby is being "manipulative," so the baby cries more and more, and the parent gets more and more frustrated.

For another, many parents don't have someone to lend a hand when the crying starts to wear them down. Your brain may be saying "Respond to that baby" but your body is saying "Sleep, need sleep!" That's when having a grandmother or partner or postpartum doula or other support person can make all the difference, giving the mother a break while still reassuring the baby that yes, someone is here to hold you and you are safe.

La Leche League has always encouraged mothers to listen to their hearts in responding to their babies, and the newest research is confirming that as the best way to protect your baby from the harmful effects of stress. Okay, the message to "pick up and cuddle your baby" is actually coming from your brain, not your heart-but we feel it in our hearts.

Resources

Gerhardt, S. Why Love Matters: How Affection Shapes a Baby's Brain.

References

Barr, R.G., Elias, M.F. Nursing interval and maternal responsivity: effect on early infant crying. Pediatrics 1988 Apr; 81(4): 529-36.
Barr, R.G., Paterson, J.A., MacMartin L.M. et al. Prolonged and unsoothable crying bouts in infants. J Dev Behav Pediatr 2005 Feb; 26(1):14-23.
Bell, S.M., Ainsworth, M.D. Infant crying and maternal responsiveness. Child Dev. 1972 Dec; 43(4):1171-90.
Gunnar, M.R., Herrera, A., Hostinar, C. Encyclopedia on Early Childhood Development ©2009 Centre of Excellence for Early Childhood Development
Hunziker, U.A., Barr R.G., Increased carrying reduces infant crying: a randomized controlled trial. Pediatrics 1986 May; 77(5):641-8.

Seifritz, E. et al. Differential sex-independent amygdala responses to infant crying in parents versus non-parents. Biol Psychiatry 2003 Dec 15; 54(12):1367-75.
Swain, J.E., Lorberbaum, J.P. Kose, S., Strathearn L. Brain basis of early parent- infant interactions. J Child Psychol Psychiatry 2007 Mar-Apr; 48(3-4):262-87.
Swain, J.E., Tasqin, E., Mayes, L.C. et al. Maternal brain responses to own baby cry is affected by cesarean section delivery. J Child Psychol Psychiatry 2008 Oct; 49(10):1042-52.

Teresa Pitman has been a La Leche League Leader for 40 years. She is one of the co-authors of the LLLI books The Womanly Art of Breastfeeding and Sweet Sleep and is the author of 16 other books with a 17th book coming out in January 2019 (on starting solids!). She is the mother of four grown children and the grandmother of ten.

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Why Babies' Tears Make Us Cry and Why They Matter | La Leche League International

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TERESA PITMAN Originally published May 2014 and republished with the express permission of the author. Photo: Sweetdreams Photography. I was once in an airport, waiting for my flight, when I saw a father carrying around his baby. The baby wasn't crying hard, just fussing and being unhappy, and the dad was patting his back gently as ...

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In fact you may well be contributing to their future well-being.

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The amount of close and comforting contact that young infants get doesn't just keep them warm, snug, and loved. A new study says it can actually affect babies at the molecular level, and the effects can last for years.

Based on the study, babies who get less physical contact and are more distressed at a young age, end up with changes in molecular processes that affect gene expression.

The team from the University of British Columbia in Canada emphasises that it's still very early days for this research, and it's not clear exactly what's causing the change.

But it could give scientists some useful insights into how touching affects the epigenome - the biochemical changes that influence gene expression in the body.

During the study, parents of 94 babies were asked to keep diaries of their touching and cuddling habits from five weeks after birth, as well as logging the behaviour of the infants - sleeping, crying, and so on.

Four-and-a-half years later, DNA swabs were taken of the kids to analyse a biochemical modification called DNA methylation. It's an epigenetic mechanism in which some parts of the chromosome are tagged with small carbon and hydrogen molecules, often changing how genes function and affecting their expression.

The researchers found DNA methylation differences between "high-contact" children and "low-contact" children at five specific DNA sites, two of which were within genes: one related to the immune system, and one to the metabolic system.

DNA methylation also acts as a marker for normal biological development and the processes that go along with it, and it can be influenced by external, environmental factors as well.

Then there was the epigenetic age, the biological ageing of blood and tissue. This marker was lower than expected in the kids who hadn't had much contact as babies, and had experienced more distress in their early years, compared with their actual age.

"In children, we think slower epigenetic ageing could reflect less favourable developmental progress," says one of the team, Michael Kobor.

In fact, similar findings were spotted in a study from 2013 looking at how much care and attention young rats were given from a very early age.

Gaps between epigenetic age and chronological age have been linked to health problems in the past, but again it's too soon to draw those kind of conclusions: the scientists readily admit they don't yet know how this will affect the kids later in life.

We are also talking about less than 100 babies in the study, but it does seem that close contact and cuddles do somehow change the body at a genetic level.

Of course it's well accepted that human touch is good for us and our development in all kinds of ways, but this is the first study to look at how it might be changing the epigenetics of human babies.

It will be the job of further studies to work out why, and to investigate whether any long-term changes in health might appear as a consequence.

"We plan to follow up on whether the 'biological immaturity' we saw in these children carries broad implications for their health, especially their psychological development," says one of the researchers, Sarah Moore.

"If further research confirms this initial finding, it will underscore the importance of providing physical contact, especially for distressed infants."

The research has been published in Development and Psychopathology.

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Babies Who Get More Cuddles Have Their Genetics Changed For Years, Study Shows

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The amount of close and comforting contact that young infants get doesn't just keep them warm, snug, and loved. A new study says it can actually affect babies at the molecular level, and the effects can last for years.

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A reminder that when women are looked after and supported. . . 

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A reminder that when women are looked after and supported. . . 

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it's much easier to cope with adapting to motherhood. In most traditional cultures it is normal to care for women for an extended period after birth

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There's no doubt about it-from maternity leave (or lack thereof) to postpartum care traditions for mother and baby, the United States is seriously lacking. Which is why we've found the book The First Forty Days: The Essential Art of Nourishing the New Mother so inspiring. Rooted in Chinese practices and giving a nod to rich postpartum rituals around the world, this thoughtful tome is filled with healing recipes and guidance on how women can take care of themselves after birth (or recruit others to take care of them). One of our favorite sections of the book is a rundown of other global postpartum care traditions that are thoroughly engrained in culture. Read some of them, excerpted from the book, below. Who knows, maybe some of these time-tested cultural traditions will inspire your own postpartum plans.

China: In its purest form, traditional Chinese zuo yuezi advises a tough-love approach of sponge baths instead of showers (to reduce the chance of catching a chill), no books in case reading strains the eyes, and no movies in case sad scenes upset you and disrupt your flow of chi-while others take over all your household duties, of course. Zuo yuezi is often referred to as "the Gateway," as it is a threshold between one way of being (your life before baby) and an entirely new existence (life with baby). The reward for spending dedicated time in this revitalizing in-between space? The mother can emerge more beautiful and rejuvenated than before. Traditional Chinese medicine (TCM) doctors say that if the woman shirks this recovery, she may experience a yin deficiency, resulting in insomnia, excessive night sweats, hair loss, anxiety, or headaches. Chinese-American families frequently do a bit of zuo yuezi without even realizing it. Many a relative has shown up to visit mom and newborn at the hospital with traditional chicken soup, appalled at the idea of her picking at a limp tuna sandwich from the canteen cooler. (A customary gift of dried longan fruit might come with the soup.) That small warming gesture in itself is tradition in action.

Zambia: In Zambia, the mom is strictly banned from any work around the house until the umbilical cord falls off. (A whopping week to ten days usually-and then it may be back to doing the dishes as normal).

Latin America: In many parts of Latin America, a forty-day period known as la cuarentena -it literally means "quarantine" yet also plays off the Spanish word for "forty," cuarenta-has female relatives take on all domestic duties to ensure the new mother rests at home, in order to safeguard against future exhaustion-related illnesses or ailments. Her midwife may visit frequently over the first two weeks to check on baby and mother's well-being, and homemade chicken soup simmers on the stove (overly spicy or heavy dishes are nixed). The new mother's abdomen is wrapped in a faja or cloth to help keep her belly warm.

Japan: Japanese mothers return to their mothers' houses for a month or two of focused care and traditional food.

Native Americans: In many Native American tribes, ceremony is key: The customary "lying in" period after birth culminates in ritualistic bathing, a baby-naming ceremony, and going to a sweat lodge to boost circulation and help mom's body eliminate any toxins. The Hopi people in the southwestern United States recall practices of twenty-day seclusion periods for mother and babe, during which the mother might be served blue corn piki bread, a ceremonial food. Prepared in an hours-long process by a wise elder woman of the community, the flaky, thin-as-air bread was served to honor rites of passage.

India: In India, the new mother often returns to her parents' home with her newborn for up to three months of focused care. There, many pairs of hands are on call throughout the day. The women of the family cook soft and nurturing foods, boil fresh milk three times in a row to break down its proteins, and stir in melted ghee (clarified butter) and special spices, so it becomes easy to digest and restores the mother's depleted state. These loving hands also hold the baby whenever mom needs a break. If members of the new mother's family are versed in Ayurveda-the five-thousand-year-old healing art of India-she may drink herbal tonics for energy, immunity, and lactation and receive daily, warm-oil massages from a specially trained technician to soothe her nerves by calming the excess vata or "wind" in her system after birth. She even gets taught how to gently massage her little one's body as well-a relaxing and bonding experience for both parties.

The Middle East: Forty-day rest periods for the new mother are traditional in Jordan, Lebanon, Egypt, and Palestine.

Korea: Korea's postpartum tradition of samchilil decrees a period of at least twenty-one days, and ideally thirty days, of specialized maternal care dedicated to keeping mom warm, snug, and well fed. Miyeokguk, a traditional seaweed soup with beef, chicken, or anchovies, is served several times a day, every day, to boost circulation, restore lost nutrients, and enrich breast milk. Gums are tender so icy foods are banned to avoid dental problems later. At one hundred days, the baby is introduced to the wider family for the first time with a baek-il ceremony-a kind of fourth-trimester graduation party! This also ends the close-up focus on mom care-she's ready to graduate, too.

Vietnam: Vietnamese parents don't introduce strangers to their babies for six weeks, to protect them from envy or, simply, too much attention.

Ivory Coast: Female relatives descend on the new mother's home in the Ivory Coast right after birth. The mother is bathed and massaged in shea butter by her own mother-a pampering rite that saturates skin with healing oils-while her grandmother and grandaunts gently bathe and dress the baby. Younger cousins and aunts cook a delicious meal, and after eating all together, the circle lets the new mother nap, with baby safe in their sights.

Indonesia: In Indonesia, a bright light burns in the new mother's home for forty days after birth to honor the new life that has arrived. The midwife visits daily to massage mom; bathe her in therapeutic baths; feed her jamu, a special nourishing concoction of egg yolks, palm sugar, tamarind, and healing herbs; and wrap her belly to support her uterine healing while also checking in on baby. For forty days, the placenta is preserved and kept near the mother before being ceremonially buried. It is believed that the placenta still holds protective spiritual power that can safeguard the new mother from infection or illness.

Moldova: The Eastern European country of Moldova has a special chicken soup to encourage breast milk production.

Malaysia: In Malaysia's pantang protocol, the mother secludes herself for forty-four days and receives hot stone massages, full-body exfoliation, herbal baths, and hot compresses to care for the life force that is sourced in her womb. Her mother or mother-in-law may oversee this, or an experienced live-in helper might guide her through this process. And it doesn't stop there. Ask women of different ethnicities and backgrounds about their maternal customs and the stories keep coming. What does it take to help the expanded winter melon-sized uterus return to its normal pear-like size? The dramatic changes in the body of a new mother have to be nurtured slowly back to its prenatal form. If the new mother does not take care during this time, the roots of various ailments will establish themselves and lie dormant in her body, surfacing in her middle age. Thus, a new mother should not be annoyed when her mother-in-law keeps advising her to eat more digestive food, drink more nutritional tonics and soups, and keep away from specific foods. Proper postnatal care, rest, and diet will rebuild a
more mature, yet beautiful, body for the new mother.

Shanghai & Hong Kong: At the far other end of the scale, in Shanghai and Hong Kong, high-luxury "confinement hotels" offer upwardly mobile women a red-carpet way to experience zuo yuezi-call it five-star confinement-and conveniently lets them sidestep the drama of having mother-in-law take up camp in their home for a month. Sumptuously bathrobed in her plush hotel room, the new mom is served medicinal soups from gourmet chefs and can visit an on-site spa as often as she likes, while uniformed nannies handle baby's every need, taking him out for sun baths daily and dipping him in warm pools to tone his muscles. It may be the antithesis of attachment parenting-and it certainly is a status symbol for the parents-but it hits the spot for busy women of means: Every moment of the month is devoted to optimal health for the newborn, and optimal rest and pampering for mom.

Europe and North America: In the past, special pui-yuet or confinement companions might have been hired by Chinese households to help run the month of care. Modern-day variations of this are emerging, putting traditional programs of postpartum care in reach of women wanting to experience the old ways: In Europe and North America, an emerging field of practitioners known as Ayurdoulas, postpartum doulas trained in Ayurvedic care, can be hired to visit the home over several weeks, bringing food, giving massages, and helping mom learn about baby care. In Canadian cities like Toronto and Vancouver, zuo yuezi -trained doulas do a bustling trade visiting homes in Chinese communities, and highly traditional cooking services can bring breast milk-enriching fish and papaya soup to your door. In New York and other U.S. cities, there are even humble Mandarin- or Cantonese-speaking guesthouses where first-generation immigrants who have no relatives nearby can "sit the month" in the old ways with a clutch of other mothers.

Reprinted with permission of the authors of The First Forty Days: The Essential Art of Nourishing the New Mother.
Related Article: An Arugument For Taking The First 40 Days Slow Postpartum.

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There's no doubt about it-from maternity leave (or lack thereof) to postpartum care traditions for mother and baby, the United States is seriously lacking. Which is why we've found the book The First Forty Days: The Essential Art of Nourishing the New Mother so inspiring.

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In the first few weeks nappies are a parent-friendly and accurate way of checking if your baby is getting enough milk

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Having a crying, unhappy baby is hard. Here is an evidence-based guide to help you calm your little one.

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How to keep babies calm, happy, and emotionally healthy

© 2015 Gwen Dewar, Ph.D., all rights reserved

Why stress in babies matters

Nobody wants a stressed-out baby. The stress is contagious, and chronic stress has long-term health consequences. When babies are exposed to high levels of the stress hormone, cortisol, they are more likely to develop behavior problems and stress-related diseases later in life (Asok et al 2013; Luby et al 2013). In the worst case scenario, toxic stress can alter brain growth and shorten the lifespan.

But there is good news for parents feeling the strain: We can do a lot to protect babies from the effects of toxic stress.

For example, experiments on nonhuman animals show that infants exposed to lots of nurturing touch are more likely to develop into stress-resilient adults - even if they were born with risk factors for stress-related problems (Meaney 2001). And the same seems to be true for human beings.

When Helen Sharp and her colleagues tracked the development of babies at high risk for developing stress-related problems, the researchers found evidence for the protective power of physical affection: High-risk babies developed normally if their mothers gave them many cuddles and caresses during early infancy (Sharp et al 2012; Sharp et al 2014).

Other research attests to the power of parental sensitivity and responsiveness - the ability to "read" a baby's cues and give him what he needs in a timely way.

For instance, parents who show higher levels of sensitivity tend to have babies with lower baseline cortisol levels (Blair et al 2006). And it's the infants born with "difficult," easily-distressed temperaments that seem to benefit the most. In studies tracking children over the long term, such babies have ended up with better outcomes than their more laid-back peers - if they were raised by sensitive, responsive parents (Stright et al 2008; Pluess and Belsky 2010).

So parenting makes a difference. But how does it work? And what can parents do to become more attuned, stress-savvy caregivers? Here are some evidence-based pointers.
1. Offer lots of physical affection...but pay attention to what your baby likes and dislikes.
As noted above, nurturing touch appears to protect babies from harmful stress, and researchers think they know why.

Affectionate physical contact triggers the release of several stress-busting chemicals in the brain, including oxytocin (the so-called "love hormone") and endogenous opioids (natural painkillers).

These have a calming effect, and help switch off the production of cortisol. As a result, there is less physiological wear-and-tear on the body, and the brain is more likely to develop a long-term pattern of resilience to stress.

But there is something crucial to keep in mind: Touch can also be irritating, creepy, or overwhelming.

For instance, experiments suggest that many young babies don't like the sensation of a light caress (Kida and Shinohara 2013). They might prefer a more firm sort of touch.

Babies may also find it stressful to be touched in isolation, outside the context of a friendly, multi-sensory interaction. In experiments on newborns, infants showed a drop in cortisol levels when they were stroked by a caregiver who rocked them, made eye contact, and spoke soothingly. But when they were stroked in silence --without rocking or eye contact - these babies experienced a cortisol surge (White-Traut et al 2009).

So we should adapt our approach to the preferences of the baby, and sometimes that means backing off altogether. Occasionally babies feel over-stimulated and need to withdraw, and we can cause stress if we don't respect their wishes. In one study, researchers watched mothers and infants as they played together, and noted whether or not mothers heeded their babies' signals about being touched. Babies who received unwanted stimulation had higher cortisol levels (Feldman et al 2010).

2. Think like a baby

It's hard to imagine. When is the last time you found yourself vulnerable, dependent, immobilized, and unable to communicate with language?

But the better you understand your baby's perspective, the better your chances of minimizing stress.

For example, take bath time. Do you prepare everything first, and then undress the baby just before putting him in the water? Or do you undress the baby first, and make him wait for his bath?

Amie Hane and Lauren Philbrook (2012) note what might go wrong in the latter case: The parent tries to hold the baby in one arm while she readies the bath with the other, but the baby is cold. So he cries and squirms, making it hard for his mother to hold onto him. When the water is ready, she releases the baby awkwardly, plunking him in the water more abruptly than she intended. The water feels particularly warm against the baby's skin, and he screams in outrage.

Thus, one misstep - allowing the baby to get cold- might lead to a lot of unnecessary strife for everyone. And, say Hane and Philbrook, little episodes like this might push families in the wrong direction. Because the baby seems so temperamental and intolerant of change, the parent decides to handle these situations by becoming more brusque and controlling. It's going to be miserable, so why not get it over with quickly? But forcing the matter ensures that the encounter will be stressful, and creates a vicious circle of bad feelings--one calculated to turn childcare into a series of conflicts.

Perhaps, then, we can avert a whole cascade of negative effects by figuring out what sets our babies off, and changing our tactics. If your baby's irritation has you stumped, try asking an experienced helper for advice. You might be too stressed to see things objectively.

And take heart: Making the effort to understand your baby's point of view may lead to many benefits. Studies suggest that parents who tune in end up with stronger attachment relationships -- and with babies who develop better social skills. Read more about it in my article on "mind-minded parenting."

3. Don't underestimate your baby's ability to read - and mirror - your negative emotions.
When you're distracted, upset, or depressed, you might think your baby doesn't notice. But research suggests otherwise.

Studies show that babies - even newborns -- get distressed when their caregivers become emotionally unresponsive (Yoo and Reeb-Sutherland 2013). By 6 months, many babies can distinguish between happy and angry body language (Zeiber et al 2013), and they seem to be very sensitive to "background" hostility:

Babies exposed to the sights or sounds of angry, bickering adults are more likely to develop abnormal stress response systems (Towe-Goodman et al 2012; Graham et al 2013).

Moreover, a compelling experiment hints that babies can tell when we feel stressed, even when it's about something that doesn't concern them. Researchers temporarily separated mothers from their infants and then asked the mothers to perform a public speaking task. Some mothers completed a version of the task that was particularly stressful; others were assigned an easier job.

When the mothers were reunited with the babies, the researchers measured everyone's stress responses. The results? Infants in the high-stress condition mirrored their mothers' stress reactivity, paralleling changes in heart rate and showing more anxiety towards other people (Waters et al 2014). The takeaway lesson may be this: Managing your own stress - by seeking social support or other remedies - could make an important difference to your baby's behavior and well-being.

4. Engage your baby in one-on-one communication, but don't force it.

Like physical affection, friendly talk and sympathetic body language can trigger our brains to release "feel good" chemicals, like oxytocin.

Moreover, studies reveal that babies benefit when we treat them as conversation partners--acknowledging their feelings, responding to their implied questions, and offering them support when they are distressed. Not only do these tactics teach babies cope with their negative emotions, they also help babies develop secure, healthy attachment relationships.

But once again, we need to be careful about the context. Just as babies can become stressed by physical touch, they can be overwhelmed by face-to-face communication.

If your face is too close, or your baby has simply had enough "conversation," she will let you know. She may duck or put her hands over her face. She may try to turn her head and look away (Beebe et al 2010).

It's old wisdom supported by recent science: Babies like to be carried around, and seem to find it more soothing than being held by a person who doesn't move. In a series of experiments, researchers found that infants experienced slower heart rates, reduced body movement, and reduced crying when they were held by an adult who was walking from place to place (Esposito et al 2013).

6. Make yourself emotionally available at bedtime.

For most of human history, our ancestors slept close to their babies, and an infant's survival depended on staying near. So it shouldn't surprise us that babies find it stressful to be left alone in the dark.

Indeed, there is evidence that babies experience elevated cortisol levels in this situation - even if they have been "trained" to sleep in their own rooms, and remain relatively quiet (Middlemiss et al 2011).

But our nighttime sleeping arrangements don't just affect the stress babies feel at night. They also may affect how babies handle stress at other times. For instance, when researchers subjected 12-month-old babies to a social stressor - the so-called "strange situation" - they found that infants varied depending on their personal histories. Babies who had spent more weeks "rooming in" with their parents experienced less cortisol reactivity, even after controlling for other factors, like parental sensitivity and attachment security (Beijers et al 2013).

Another study reports that 5-week-old infants with a history of co-sleeping showed evidence of greater calm. While co-sleeping history had no apparent effect on the babies' responses to a painful vaccination, it was linked with less cortisol reactivity during bath time (Tollenaar et al 2012).

So being physically close at night may help babies regulate their stress responses throughout the day. But physical proximity isn't the whole story. Some researchers argue that the crucial ingredient is emotional availability at bedtime - a characteristic that depends on a variety of behaviors. Do you use quiet, soothing routines to help your baby fall asleep at night? Do you avoid initiating social interactions with your baby as she approaches sleep? Is your manner free of any hostility or irritation? Do you respond promptly (within a minute) when your baby cries out in distress?

When Lauren Philbrook and her colleagues observed the normal nighttime routines of families with young babies, they found that mothers who were rated as highly "emotionally available" were more likely to have babies with low nighttime cortisol levels. In addition, these babies were also more likely to develop normal, healthy patterns of hormonal change over the 24-hour day (Philbrook et al 2014).

More reading

For more evidence-based information about infants, see my collection of Parenting Science articles about babies.

To read more about the effects of parenting on a child's developing stress response system, see my Parenting Science article, "The health benefits of sensitive, responsive parenting" as well as my blog posts, "Positive parenting protects kids from brain-shrinking stress?" and "Can a mother's touch reverse the effects of prenatal stress?"

Looking for help with infant sleep? See these evidence-based articles on understanding and trouble-shooting baby sleep problems.

In addition, if you know a highly reactive or "difficult" baby, be sure to read my post discussing the importance of alleviating stress in babies with very sensitive temperaments.

For a discussion of cultural biases against taking babies' distress seriously, see my blog post, "Babies can't remember is bunk," and my editorial about the way people often dismiss stress in babies as fussiness.

And to access my collection of Parenting Science articles about babies, including evidence-based information about excessive infant crying,

References: Stress in babies

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Tu MT, Lupien SJ, and Walker CD. 2006. Multiparity reveals the blunting effect of breastfeeding on physiological reactivity to psychological stress. J Neuroendocrinol. 18(7):494-503.

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Waters SF, West TV, Mendes WB. 2014. Stress contagion: physiological covariation between mothers and infants. Psychol Sci. 25(4):934-42.

Weller A and Feldman R. 2003. Emotion regulation and touch in infants: the role of cholecystokinin and opioids. Peptides 24(5):779-88.

White-Traut RC, Schwertz D, McFarlin B, and Kogan J. 2009. Salivary cortisol and behavioral state responses of healthy newborn infants to tactile-only and multisensory interventions. J Obstet Gynecol Neonatal Nurs. 38(1):22-34.

Yoo K and Reeb-Sutherland BC. 2013. Effects of negative temperament on 5-month-old infants' behavior during the still-face paradigm. Infant Behav Dev. 36(3):344-8.

Zieber N, Kangas A, Hock A, and Bhatt RS. 2010. Infants' Perception of Emotion From Body Movements. Child Dev. 2013 Jun 26. doi: 10.1111/cdev.12134. [Epub ahead of print]

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Content of "Stress in Babies" last modified 5/2015

Portions of the text are derived from an earlier article by the same title.

Image of father and infant copyright Katie Tegtmeyer / flickr

Image of baby and adult hands copyright Clarence Goss / wikimedia commons

Image of baby massage copyright arekmalang / istock

Image of mother and son by Ken Hammond / USDA

Image of baby in closeup by Kenny Louie / wikimedia commons

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Stress in babies: An evidence-based guide to keeping babies calm and healthy

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© 2015 Gwen Dewar, Ph.D., all rights reserved Why stress in babies matters Nobody wants a stressed-out baby. The stress is contagious, and chronic stress has long-term health consequences. When babies are exposed to high levels of the stress hormone, cortisol, they are more likely to develop behavior problems and stress-related diseases later in life (Asok et al 2013; Luby et al 2013).

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

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

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

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

Two things that are normal:

1.Babies want to be close to you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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A useful explanation of why babies need to feed so frequently and when parents need to intervene to make sure baby gets enough feeds.

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We all love and need to eat! It makes us feel good and gives us the energy to do things in life.
Human babies are no different in this need. They want to eat when fuel is needed and then feel content. Where they do differ from adults though is in their ability to get their food.

Once out of the womb, human babies are dependent on adults to create the right conditions to enable them to feed. If this is breastfeeding, the baby needs to be in full body contact with its mother's body, on its tummy in an alert state (not too groggy after birth) so it can step, crawl, push, feel, smell and see its way to the breast. If the feeding is to be by bottle, the baby needs holding in an appropriate manner so it can drink safely from it.

We as adults all recognise that babies need feeding soon after birth. Birth, after all, means the ending of the constant food delivery system that baby's been used to for many months. The drip-feeding from mother to baby via the placenta and umbilical cord has to be replaced quickly so that blood sugar levels stay steady. This is why - in Baby Friendly hospitals in particular - there's an emphasis on getting babies to feed within the first hour.

Why then do I come across - on the national telephone helplines, in groups, in private practice - so many situations where, within the first week, the baby has either become very jaundiced and sleepy, or very unsettled and crying a lot, weight gain is stalling or even still sliding down, mother may feel her breasts have never become very full, and baby is being topped up with formula out of desperation? What happened after the laudable effort to get baby breastfeeding quickly after birth?

I feel it lies in a continuing misunderstanding of the frequency of newborn feeding. The word 'frequent' is used a lot. But how frequent is frequent? Nils Bergman says it could well be hourly in the first days. Jill Bergman reminds us that the stomach empties a milk meal in 60 minutes; that the sugar content of milk lasts just 60 minutes; that the proteins in human milk come in low concentrations which also need topping up every hour; and that the normal sleep cycle of a baby from deep to light sleep states is also approximately every 60 minutes. It's known that a full-term baby can use its brown fat stores for several hours after birth if for any reason access to the breast is limited. But by day 2 of life, the baby needs to be receiving additional fuel from the breast and from then on needs to feed a lot. Very often though, a lot of asking to be fed is interpreted as something inadequate about mother's milk quality or production; and mothers may be counselled to rest after the effort of labour. These are misguided concerns and can be very detrimental for the future of the breastfeeding journey.

The baby, nevertheless, is primed to want to ask to feed a lot. S/he's been anticipating the necessity to feed frequently and has been doing a lot of practice in the womb. At 15 weeks gestation, swallowing starts; at 21 weeks, tongue cupping (like it would be around a breast) has been observed; at 22-24 weeks the baby is doing consistent swallowing of amniotic fluid. The volumes it swallows are big compared to when it starts swallowing colostrum after birth. These volumes of colostrum are small: for some it's 2-10 mls per feed, for others it's 5-7 mls per feed on day 1. For the baby who has been accustomed to bigger swallows in the womb, it's a real incentive to keep going back to the breast to ask for more - and this is just what the breasts need for stimulating the onset of full milk production within 72 hours of birth. So even if the feed volumes seem small, if the baby goes to the breast a lot, then the small amounts add up to an appropriate amount of intake. By day 2 the intake may be 5-15 mls per feed with an average total of 150mls per day; by day 3 it's increasing to approximately 15-30mls per feed totalling an average intake of 250mls per day. As can be seen, there are some babies who will need to feed more often to get an overall adequate amount of milk.

Which babies need more attention paid to how often and how effectively they feed? The baby who arrives early, a baby who is a lighter weight, a baby who is producing high amounts of bilirubin, the baby of a mother who had gestational diabetes or who is diabetic - these babies have compromised reserves (less brown fat stores) and increased demands. Babies born earlier than 39 weeks (and especially those 34-37 weekers) have immature systems which means that they're at much greater risk of under-nutrition, hypoglycaemia and jaundice. We know in addition that these will compromise their breastfeeding skills: babies need energy in order to be able to feed robustly so as soon as they're not getting enough fuel (for any of the reasons above), they feed even less well. How often do we hear of the baby who can just about get to the breast but falls asleep almost immediately?

Unfortunately, even though early and smaller babies are most at risk, they're not the only ones. Full-term babies can quite quickly drop into this risky place of not getting enough calories. These well-known and often used phrases - "be led by your baby", "feed on demand", even "responsive feeding" - can unwittingly cause insufficient breastfeeding for a baby. Separation of mother and baby - even if it's just into a bedside cot - takes baby away from the habitat it needs to achieve breastfeeding. Jill and Nils Bergman have written extensively about the need of the human infant to be in the mother's chest zone, in order for it to signal and then follow-through its intention to breastfeed. The baby not on mother (or on some other aware adult's body) may do some wiggles or head-turning or a bit of grimacing or move its eyes under its eyelids and then drift back to sleep again - and that is a feeding opportunity missed. The full blown cry or very obvious hands in mouth aren't every baby's signal and it can be easy to miss the more subtle signals of a less alert baby, especially in cultures where a sleeping and quiet baby is preferred. As the minutes tick by and baby's energy flags a little more, the cues may become even less obvious - so it's confusing for a mother to be "led by her baby" if the baby appears to be 'saying' nothing.

I believe we need to be explicit with new parents about the importance in the earliest days of life of keeping baby adequately energised. They need to be aware of possibly quite subtle signs from their baby of wanting to feed; and that if a baby is sleeping more than expected (the birth could be having an impact here), then it's vital to get milk into baby. This is "semi-demand feeding", when parents observe their baby closely, step in and make the decision themselves to feed baby, getting those all-important calories in, using a spoon or finger-feeding tube or syringe if baby is too sleepy to actively breastfeed.

This is where breastmilk production needs to happen too. Mother needs to be expressing in order to facilitate the normal course of breastmilk production if baby is already not stimulating her breasts appropriately. Hand-expressing colostrum (which has more fat by this method) on to a spoon is ideal; and if it's done more than 5 times daily in the first 3 days of life, the rate of breastmilk production is influenced for up to 8 weeks.

In addition, unlimited skin-to-skin will help to achieve better attachment, meaning good latching and effective milk transfer. But good attachment only really works if the calories are going in to baby quickly and repeatedly in the first hours and days after birth. If there's any compromise for baby in how well it feeds - due to separation, birth interventions, size, earliness, jaundice, musculo-skeletal effects from in utero positioning or birth - then mother needs to follow the Three Keeps, neatly summarised in The Womanly Art of Breastfeeding: keep baby fed, keep baby close, keep milk flowing out of the breast.

Feeding every 60-90 minutes may seem a lot to start with - so women need support and encouragement and skilled assessement of good positioning, their breasts and the state of the baby. It can help if parents are reminded to think of the breast replacing the frequency of food passing through the umbilical cord; and if they can be reassured that as baby's energy levels are kept high through lots of milk giving, the feeding frequency will tame down somewhat - then mothers will always try to do what they know their baby needs.

Let's ditch "3 hourly" from our breastfeeding vocabulary. Let's instead encourage parents to be vigilant - to be "semi-demand feeders" if necessary - and to feed babies really little and often with the hopeful result that lactation specialists will see fewer and fewer infants who simply need more milk. Calories, breastmilk production and good attachment are what all babies need, frequently (perhaps hourly for some), effectively and comfortably at the start of life.

Sources:
Nancy Mohrbacher, 2012.
Jane Morton, GOLD 2010; GOLD 2016.
Jill Bergman, 'Hold your Prem', 2010.

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We all love and need to eat! It makes us feel good and gives us the energy to do things in life. Human babies are no different in this need. They want to eat when fuel is needed and then feel content. Where they do differ from adults though is in their ability to get their food.

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Some people say it should never hurt, others tell you to expect pain. What's normal?

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For more information on breastfeeding click here: www.themilkmeg.com

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The need to soothe your little one - and frustration if you can't - can be overwhelming. But it is important to try to look after yourself during these challenging times too. A calm baby can begin with calm parents.

Crying is normal behaviour for babies and there are lots of reasons why they might cry. Watch our video to find out more.

Try the following to keep your tension levels down and navigate through their tears (and yours).

1. Take a break

Ask for help. From your partner, your family or a close friend. A support network is vital in those early days and people will love to come over to help. They are often itching for you to reach out and invite them for baby cuddles.

If you don't have a partner or friends and family nearby, try prioritising your own needs when your baby is sleeping or settled. That way you can revive yourself too.

2. Step away from the baby

If you're unable to soothe their cries and feel yourself getting increasingly upset or agitated, take some time out. Put your baby in a safe environment, such as their crib, pram or floor mat (before they are rolling) and go and sit down, make a cup of tea, or call someone for support.

A baby crying for just a few minutes like this isn't going to do them any harm. It can actually help you reset to be able to respond to their needs better.

3. Think back to birth breathing

Perhaps you learnt breathing techniques as part of birth preparations. These can be used once your baby is born too.

Either step away from the baby and take a few minutes to breathe deeply or employ this deep breathing while holding your baby. Think back to a pregnancy yoga class or a favourite calming song or experience, and breathe deep, rhythmical breaths. You and your baby are so closely connected that this may well calm them too.

4. Keep your emotional strength up

Lack of sleep, hunger and feeling isolated can all make it harder to cope with your baby's tears. Try to build your resilience by napping in the afternoon when possible and ensuring you eat well. Boosting your emotional wellbeing means you are better able to face your baby's cries and respond to their needs.

5. Don't hide away

Some parents are afraid to venture out if their baby cries a lot. But the fresh air and social interactions can be a fantastic respite for you and them.

Your friends, family, or other parents you meet are bound to understand - they've been there too. You'll also find numerous baby-friendly parks, cafes and play spaces where crying babies are the rule not the exception.

6. Attend to their needs, wherever you are

Don't be afraid to stop, wherever you are, and attend to your baby. Perfect strangers can often turn into best friends during your time of need and offer to help in the most wonderful of ways.

New parents up and down the country, right now, are feeding/burping/ changing their babies in car parks, car boots, side roads, restaurants and a thousand other places. More often than not, parents tell us that people are very happy for you to soothe your crying baby wherever and whenever.

7. A new normal

As time goes on, your baby will cry less as you learn to anticipate their needs. You'll also learn what's normal for them and when to be concerned. Take comfort in the fact that like every stage, this crying phase won't last forever.

8. Your network is broader than you think

New mums and dads can access a number of resources, although some are not immediately obvious. As well as friends and family, don't be afraid to call your health visitor or GP. This is especially true if you're afraid your frustration is getting too much and you're at risk of harming your baby.

Extreme cases where parents don't cope well with a crying baby and shake, throw or roughly handle them, can lead to death or long-term disability (Reijneveld et al, 2004).

Make sure you reach out before it gets too much. The NSPCC 's website is a useful resource as are the resources mentioned below.
This page was last reviewed in March 2022.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0333 252 5051.

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

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

Watch our coping with crying film.

Understanding childhood also have a range of resources available online and to download, developed by child psychotherapists, including a leaflet on crying.

There's also useful information on the NHS website.

The NSPCC helpline provides help and support to thousands of parents and families.

The Lullaby Trust has lots of useful information and support for parents about safe sleep.

Other useful websites include Cry-sis, Care for the Family and Family Lives.

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How to cope and keep calm with a crying baby | Baby & toddler articles & support | NCT

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The need to soothe your little one - and frustration if you can't - can be overwhelming. But it is important to try to look after yourself during these challenging times too. A calm baby can begin with calm parents. Crying is normal behaviour for babies and there are lots of reasons why they might cry.

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Mothers often worry about this. Here is a useful article to help you work out if your baby is getting enough milk

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Breastfeeding mothers frequently ask how to know their babies are getting enough milk. The breast is not the bottle, and it is not possible to hold the breast up to the light to see how many ounces or milliliters of milk the baby drank. And this is a good thing!! We are not supposed to know how much the baby is getting but rather is baby getting enough. Our number-obsessed society makes it difficult for some mothers to accept not seeing exactly how much milk the baby receives. However, there are ways of knowing that the baby is getting enough. In the long run, weight gain is the best indication whether the baby is getting enough, but rules about weight gain appropriate for bottle fed babies may not be appropriate for breastfed babies. In the short term, there are ways to know if baby is satisfied by looking at how well the baby feeds, and even just looking at the baby after a feeding - is the baby content, satisfied, is he rooting or sucking his hand?
Ways of Knowing

Baby's breastfeeding is characteristic. A baby who is obtaining good amounts of milk at the breast sucks in a very characteristic way. When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is making sucking movements), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide > pause > close mouth type of sucking). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This same pause that is visible at the baby's chin represents a mouthful of milk when the baby does it at the breast. The the pause, the the baby got. Once you can recognize this pause you will realize that so much of what women are told about timing the baby on the breast is meaningless. For example, it is meaningless to suggest to mothers to feed the baby twenty minutes on each side. Twenty minutes of what? Sucking without drinking? Sucking and drinking (some pausing in the movement of the chin)? All long pause-types of sucks? A baby who does this type of sucking (with the pauses) for twenty minutes straight might not even take the second side. A baby who nibbles (doesn't drink) for 20 hours will come off the breast hungry. Our website nbci.ca shows video clips of drinking at the breast. If the baby comes off the breast while doing this kind of drinking with long pauses, then baby is probably saying, I have had enough. If baby is continually just sucking without drinking (therefore little or no pausing) baby will still be hungry. Play detective, what is baby's chin doing as he seems to "finish"? If the milk is flowing well the baby can either choose to drink it or take a little break (in fact the baby does not need to suck continuously and most babies do not). If the milk is not flowing well, then baby will be 'forced' to just suck without drinking. If this is the case, use compression to help more milk to flow (see information sheet Breast Compression).

1. Baby's bowel movements(stools, poops). For the first few days after birth, the baby passes meconium, a dark green, almost black, substance which has collected in his intestines during pregnancy. It is passed during the first few days, and by the third day, the bowel movements start becoming lighter, as the baby drinks more milk. Usually by the fourth day, the bowel movements have taken on the appearance of the normal breastmilk stool. The normal breastmilk stool is pasty to watery, mustard coloured, and usually has little odour. However, bowel movements may vary considerably from this description. They may be green or orange, may contain curds or mucus, or may resemble shaving cream in consistency (full of air bubbles). The variations in colour do not mean something is wrong. A baby who is getting only breastmilk, and is starting to have bowel movements that are becoming lighter by day 3 of life, is doing well.Without becoming obsessive about it, monitoring the frequency and quantity of bowel movements is one of the best ways, next to observing the baby's drinking (see above, and videos at nbci.ca to see if the baby is getting enough milk). After the first three to four days, the baby should have increasing bowel movements so that by the end of the first week he should be passing at least two to three substantial yellow stools each day. In addition, many infants have a stained diaper with almost each feeding. A baby who is still passing meconium on the fourth or fifth day of life should be seen at the clinic the same day. A baby who is passing only brown bowel movements is probably not getting enough, but this is not a very reliable sign.Some breastfed babies, after the first three to four weeks of life, may suddenly change their stool pattern from many each day, to one every three days or even less. Some babies have gone as long as 20 days or more without a bowel movement. As long as the baby is otherwise well, and the stool is the usual pasty or soft, yellow movement, this is not constipation and is of no concern. No treatment is necessary or desirable, because no treatment is necessary or desirable for something that is normal.Any baby between five and 21 days of age who does not pass at least one substantial bowel movement within a 24 hour period should be seen at the breastfeeding clinic the same day if possible, but certainly within a couple of days. If this same baby is soaking at least 6 heavy wet diapers (see #3, Urination), then baby is most likely fine and getting enough. Generally, and only as a general rule, small, infrequent bowel movements during this time period mean insufficient intake. There are definitely some exceptions and everything may be fine, but it is better to check.

2. Urination (pees). If, after about 4 or 5 days of age, the baby is soaking sixdiapers in a 24 hour period, (the diapers should be soaking, not just damp or just wet) you can be reasonably sure that the baby is getting a lot of milk (if he is breastfeeding only). Unfortunately, the new super dry "disposable" diapers often do indeed feel dry even when full of urine, but when soaked with urine they are heavy. It should be obvious that this indication of milk intake does not apply if you are giving the baby extra water (which, in any case, is unnecessary for breastfed babies, and if given by bottle, may interfere with breastfeeding). The baby's urine should be almost colourless after the first few days, though occasional darker urine is not of concern.During the first two to three days of life, some babies pass pink or red urine. This is not a reason to panic and does not mean the baby is dehydrated. No one knows what it means, or even if it is abnormal. It is undoubtedly associated with the lesser intake of the breastfed baby compared with the bottle fed baby during this time, but the bottle feeding baby is the standard on which to judge breastfeeding. However, the appearance of this colour urine should result in attention to getting the baby well latched on and making sure the baby is drinking at the breast (see the video clips at nbci.ca to see babies breastfeeding well or not). During the first few days of life, only if the baby is well latched on can he get his mother's milk. Giving water by bottle or cup or finger feeding at this point does not fix the problem. It only gets the baby out of hospital with urine that is not red. Fixing the latch and using compression will usually fix the problem (See information sheet Protocol to Increase Breastmilk Intake). If fixing the latch and breast compression do not result in better intake, there are ways of giving extra fluid without giving a bottle directly (see the information sheetLactation Aid). Limiting the duration or frequency of feedings can also contribute to decreased intake of milk.

The following are NOT good ways of judging

1. Your breasts do not feel full. After the first few days or weeks, it is usual for most mothers not to feel full. Your body adjusts to your baby's requirements. This change may occur quite suddenly. Some mothers who are breastfeeding perfectly well never feel engorged or full.

2. The baby sleeps through the night. Not necessarily. A baby who is sleeping through the night at 10 days of age, for example, may, in fact, not be getting enough milk. A baby who is too sleepy and has to be woken for feeds or who is "too good" may not be getting enough milk. There are many exceptions, but get help quickly.

3. The baby cries after feeding. Although babies sometimes cry after feedings because of hunger, there are also other reasons for crying. See also the information sheet Colic in the Breastfeeding Baby. Do not limit feeding times. "Finish" the first side before offering the other. Remember, play detective and watch baby's chin-this will tell you if baby has been actually feeding or just going through the motions!

4. The baby feeds often and/or for a long time. For one mother feeding every three hours or so may be often; for another, three hours or so may be a long period between feeds. For one, a feeding that lasts for 30 minutes is a long feeding; for another, it is a short one. There are no rules how often or for how long a baby should breastfeed. It is not true that the baby gets 90% of the feed in the first 10 minutes. Let the baby determine when he is ready for feeding and things usually come right, if the baby is sucking and at the breast and having at least two to three substantial yellow bowel movements each day. Remember, a baby may be on the breast for two hours, but if he is actually feeding or drinking (open wide > pause > close mouth type of sucking) for only two minutes, he will likely come off the breast hungry. If the baby falls asleep quickly at the breast, you can compress the breast to continue the flow of milk(see the information sheet Breast Compression). Contact the breastfeeding clinic with any concerns, but wait to start supplementing. If supplementation is truly necessary, there are ways of supplementing which do not use an artificial nipple (see the information sheet Lactation Aid).

5. "I can express only half an ounce of milk". This means nothing and should not influence you. Therefore, you should not pump your breasts "just to know". Most mothers have plenty of milk. The problem usually is that the baby is not getting the milk that is available, and this is usually because he is latched on poorly, and/or the milk is not flowing well. Breast Compressions might need to be used (information sheet Breast Compressions). These problems can often be fixed easily.

6. The baby will take a bottle after feeding. This does not necessarily mean that the baby is still hungry, and using this 'test' is not a good idea, as bottles may interfere with breastfeeding. Babies will often take more liquid from a bottle even if they are already full.

7. The five week old is suddenly pulling away from the breast but still seems hungry. This does not mean your milk has "dried up" or decreased. During the first few weeks of life, babies often fall asleep at the breast when the flow of milk slows down even if they have not had their fill. When they are older (four to six weeks of age), they may no longer fall asleep but rather start to pull away or get upset. The milk supply has not changed; the baby has changed. Get the best latch possible and use compression to help you increase flow to the baby (see information sheets When Latchingand Breast Compression and watch the video clips at nbci.ca.

Notes on scales and weights

1. Scales are all different. We have documented significant differences from one scale to another. Weights have often been written down wrong. A soaked cloth diaper may weigh 250 grams (half a pound) or more, so babies should be weighed naked.

2. Many rules about weight gain are taken from observations of growth of formula feeding babies. They do not necessarily apply to breastfeeding babies. A slow start may be compensated for later by fixing the breastfeeding. Growth charts are guidelines only.

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, updated July 2009

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

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International BreastFeeding Centre | How to know a baby is getting enough breastmilk from the breast

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Breastfeeding mothers frequently ask how to know their babies are getting enough milk. The breast is not the bottle, and it is not possible to hold the breast up to the light to see how many ounces or milliliters of milk the baby drank. And this is a good thing!!

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How to get breastfeeding off to a good start with skin to skin and good attachment

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'Breastfeeding in the First Hours After Birth - Breastfeeding Series' on ViewPure

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By Global Health Media Project. Download link: http://globalhealthmedia.org/videos/\n\nWithin the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own.

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How much milk does a baby need in the first few days?

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How much milk does a baby need in the first few days?

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Very helpful visual guide.

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Why responding to your baby's need for comfort and nurture is important.

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

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

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We focus so much on planning for the birth; what you really need is a plan for after - here's why

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I've just finished looking after a new mum as a postnatal doula.

As I supported the new mother, once again I was reminded of the fact that our culture's focus, when it comes to postnatal recovery, is completely wrong.

Our culture got it wrong because it focuses entirely on the new baby, when it should be focusing on the new mother.

I have touched on this before when talking about postnatal recovery, but I need to dedicate a whole post about this topic.

What it boils down to is in fact very simple.

A new baby's needs, too, are very simple: food, warmth and shelter.

But those needs are also incredibly intense and time consuming, because babies need a lot of cuddles, and feeding little and often.

Traditional wisdom around the world understands this well, and new mothers are nurtured, and are not expected to cook, do chores and or look after other children etc for at least a month after the birth of a baby.

The support often comes in the form of extended family and local community, or an older woman or young girl is hired to help.

This happens because these cultures understand how important it is for a mother to recover physically and emotionally after growing and birthing a baby- and also how important it is for her to have time to get to know her new baby.

The nurturing takes place in the form of special nourishing dishes, as well as physical practises such as massage and/or binding of the abdomen or hips with a cloth (again many cultures are very specific about this, understanding how vulnerable the new mother is).

Since I started teaching the closing the bones postnatal massage 4 years ago, and started learning about the importance of this practise to help a new mother regain her strength and energy, I have taken it upon myself to ask every foreigner I meet what the traditional postpartum practises of his or her culture entails, and I have found that some form of nurturing practise of this kind (usually involving massage and/or binding of the abdomen hips )is ubiquitous around the world.

An Indian mum told me how her mother hired an old lady from the village who came and gave her a full body massage EVERY DAY for a month after the birth of her twins. A Kenyan mum told me how people would fight over whose turn it was to cook her food, and how she was so well looked after, she didn't even wash herself.

What do we get, In the Western world today, on the other hand? Two weeks paternity leave and "sleep when the baby sleeps". We get presents that are entirely focused on the baby (bar the odd bouquet of flowers maybe-but you can't eat those sadly), which again is very telling about what our culture considers important.

New mums aren't nurtured, quite the opposite, in fact, their needs are ignored, nobody is admiring and respecting them for the amazing feat they just accomplished (growing and birthing a whole new person!), and they are even encouraged to "get back to normal" as soon as possible and admired if they do so.

This is SO wrong.

It also means that women feel guilty for seeking support for themselves, because of this bullshit, superwoman, "I can do it all by myself" crap that is peddled by our culture.

As I mentioned above, a new baby's needs are simple, but they are also intense, and so what the baby really needs is for his mum to feel strong and nurtured enough to be able to meet those needs.

The needs of a new mother too, are incredible simple when it comes to it.
She needs good food, and she needs rest. She needs not to worry about meeting anybody else's needs for a while, but her own (and her baby's).
But those simple needs, in our nuclear family culture, can be incredibly hard to meet.

So as I mentioned in my post " why you need to write a postnatal recovery plan " before, I would like to encourage expectant parents to plan a few weeks of support after the birth of their baby, thinking about how they are going to eat, rest and look after their house/family for the first 4-6 weeks after the birth.

You could call upon your family for support if this is a good option for you. When my children were born, my parents came from France for 2 weeks under the agreement that they would take care of all the shopping, all the cooking and cleaning etc and that my husband and I wouldn't lift a finger. I get on very well with them so for me, this was heaven. I know, however, that many new parents do not have any family nearby, or that the family's company may not necessarily be the kind that brings, calm peace and rest, and it will only work if that is the case.

You could plan ahead and batch cook and freeze food, or order some in.

If you can afford it, getting some support in the form of a postnatal doula, a cleaner (even if only for a short while), a mother's help, or any other extra pair of adult hands which can take the weight of for a bit is completely priceless.

I just supported a new mum, and during the first 2 weeks postpartum, I gave her the closing the bones massage 4 times. It felt great to be able to nurture her this way, and it also felt very much needed. But I am also aware that, whilst I offered this to her as part of my postnatal doula package, not many mums who haven't got a doula skilled in doing this would feel they can justify the expense, because of the misplaced cultural focus I mentioned above.

So if you are reading this and you're an expectant mother, I urge you to write a postnatal recovery plan, and demand presents that support you and your growing family rather than your baby.

If you are reading this and you know a new mum who could do with some support, either give her that support directly if you can, in the form of some nourishing home cooked food delivered to her house with no expectation of entertainment in return, in the offer to play with her kids or hold her baby whilst she naps (tidy her house up, fold some laundry and empty her dishwasher whilst you're at it), or if alternatively, buy her some help-a few hours of support from a postnatal doula, a delivery of frozen dishes that she can just pop in the oven (my client used this company ), or a closing the bones massage or 3!

Together, we can slowly help change our culture's focus to one that honours and support new families.

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What new mothers really need | Sophie Messager

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I've just finished looking after a new mum as a postnatal doula. As I supported the new mother, once again I was reminded of the fact that our culture's focus, when it comes to postnatal recovery, is completely wrong. Our culture got it wrong because it focuses entirely on the new baby, when it should be focusing on the new mother.

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If you have diabetes or gestational diabetes. . .

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If you have diabetes or gestational diabetes. . .

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You may want to consider colostrum harvesting

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

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

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

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

The link between diabetes and colostrum harvesting

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

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

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

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

Increased risk of neonatal hypoglycaemia

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

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

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

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

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

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

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

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

Experienced breastfeeding mothers benefit too

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

Colostrum v's formula

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

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

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

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

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

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

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

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

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

When to start colostrum harvesting

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

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

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

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

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

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

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

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

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

Harvesting colostrum

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

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

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

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

Ask for some syringes

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

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

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

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

How to harvest colostrum - antenatal expressing of colostrum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For further details on storing colostrum, please read below.

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

Further guidance on hand expressing

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

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

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

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

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

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

Can I use a breast pump?

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

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

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

Storing colostrum

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

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

How long to store colostrum for

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

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

for up to six months in a freezer

Colours and consistency of colostrum

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

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

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

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

Frequency of colostrum harvesting and the amount required

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

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

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

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

Don't panic!

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

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

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

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

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

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

Tips:

1. Try expressing after a warm bath or shower

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

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

4. Massage your breasts before expressing

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

6. Drink plenty of fluids

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

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

Is it safe to harvest colostrum when taking Metformin?

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

More helpful links:

Research
Importance of early first feed for babies of diabetic mums

Background

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

Methods

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

Findings

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

Interpretation

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

Funding

Australian National Health and Medical Research Council

Prof Della A Forster, PhD

Lisa H Amir, PhD

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

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

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

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

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

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

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Colostrum harvesting * Gestational Diabetes UK

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Colostrum harvesting is collecting colostrum from the breast. Colostrum is the first secretion from the mammary glands, rich in antibodies. It is a sticky liquid from the nipples which is made before the milk has 'come in' (before breast milk is produced).

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It can be a shock if your baby is born early. Here is a video all about the experience. It includes practical information and the experiences of other parents

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

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The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Thinking about Infacol? This is interesting.

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According to their webpage Infacol is:

"Clinically proven to significantly reduce the frequency and severity of crying attacks associated with colic."

Music to the ears of any new parent with a distressed bundle right? It seems so as their site claims they are "Britain's number 1 infant colic remedy"!
I'm guessing that's pretty profitable, heck they even provide a phone app to help you identify if your baby has "colic".

Now perhaps I'm naive, but as colic is only defined as frequent persistent periods of unexplained crying (often in the evening), I'm pretty sure that parents know whether this is happening without an app to tell them?

It seems others agree as two reviewers wrote:

"Easy to use, navigate and understand but felt too engineered to get you to the end and say 'Use Infacol!'"

"It basically tells you what you already know and then says buy infacol."

Shock horror.

For those who aren't familiar the active ingredient in Infacol is Simethicone; and it's not just colic Infacol claims to work for:

"Unfortunately, wind can sometimes get trapped which can cause your baby discomfort. Infacol can gently help to bring up wind as its active ingredient- simeticone- helps the little trapped gas bubbles join into bigger bubbles which your baby can easily bring up as wind. - helping to relieve the pain. Infacol can be used from birth onwards, unlike gripe waters, which can only be given to babies 1 month old and over"

Wow wind and colic right, and suitable from birth.

Perhaps this is why so many doctors, midwives and health visitors prescribe or recommend parents try it? And given how many do, it must be pretty solid "clinically proven" evidence right?

Er no.

A BMJ paper published in 2007 reviewing treatment of colic examined the evidence :

"One poor-quality randomised controlled trial (RCT) found limited evidence that simethicone reduced the number of crying attacks on days 4-7 of treatment compared with placebo."

By poor quality the BMJ clarify that there were only 26 infants aged 1-12 weeks in the study and no reported details on how cases of colic were defined.

Oh that's disappointing. But surely GP's and all these other health professionals aren't suggesting or prescribing infacol on the basis of a "poor quality" small study of 26 babies? A study that doesn't define nor claim to ease colic, but refers to "crying attacks" which could potentially have any cause or be of any frequency?

The BMJ discuss two other trials that do define colic, perhaps these are more compelling.

First is a double-blind, crossover of 83 infants aged 2-8 weeks, comparing 0.3 mL of simethicone versus placebo for a week before feeds.

"It found no significant difference in colic (using the standard colic definition), when rated by carers, between simethicone and placebo (28% improved with simethicone v 37% with placebo v 20% with simethicone plus placebo.)"

So a study three times the size of the first, found Infacol was actually 9% LESS effective than a placebo at helping colic?

Let's try again.

The second study (double-blind, crossover trial, 27 infants aged 2-8 weeks) found no significant difference between simethicone and placebo (10 drops before meals, duration of treatment 24 hours) in improvement as rated by parental interview, 24-hour diary, or behavioural observation.

In fact the BMJ conclude:

"Further trials are not considered to be of clinical importance and are unlikely to be undertaken. According to the available evidence, there is no reason to use simethicone in the treatment of infantile colic."

"This medicine helps relieve griping pains and colic in babies and infants which may be caused by swallowing air."

Does it NHS? Says who? Infacol themselves with their "clinically proven" claims? The BMJ disagrees!

What about reasons not to?

Let's look at the other ingredients in Infacol besides Simethicone.

Purified Water

Hypromellose

Orange Flavour

Saccharin Sodium

Methyl Hydroxybenzoate (E218)

Propyl Hydroxybenzoate (E216)

Obviously these ingredients have been approved for use in this product, but when weighing up whether to use or take a medicine, we typically consider the benefits that can be obtained, versus any risks or downsides.
The literature surrounding infacol states that Simethicone is not absorbed into the body and thus is unlikely to cause harm (although some parents do report perceived side effects and some more here), but some do warn that Methyl and propyl hydroxybenzoates (E218, E216) may cause allergic reactions (possibly delayed)

Furthermore E216 and E218 are parabens considered controversial by some and even taking this out of the equation, has anyone considered the potential the impact to the baby's gut flora of putting a product containing fungicide, combined with artificial sweetener and a dollop of orange flavour in his digestive system several times per day for weeks at a time?

All for something that evidence suggests doesn't work?

What's also interesting is that there is a mounting body of evidence that probiotics may be an effective tool in reducing infant crying, including a trial that directly compared them to Simethicone:

"Eighty-three infants completed the trial: 41 in the probiotic group and 42 in the simethicone group. The infants were similar regarding gestational age, birth weight, gender, and crying time at baseline.
On day 28, 39 patients (95%) were responders in the probiotic group and 3 patients (7%) were responders in the simethicone group.

And it's not an isolated study, a second study highlights effectiveness of probiotics for colic here and a third here.

So why then aren't GP's, health visitors and midwives prescribing and recommending them instead of something seemingly no more effective than a placebo?

Like Calpol, it seems to me Infacol has just via clever marketing become recognised as a default turn to product for many parents. But as the antibiotic popping for every ailment generation age, more parents are becoming aware of the implications of what we put into our bodies, more cynical about marketing and more holistic (and thus less keen to simply medicate symptoms without looking for a cause). Perhaps gradually we will see a change.

1. Effectiveness of treatments for infantile colic: systematic review, BMJ 1998;316:1563

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Before You Try Infacol, Try This Blog...

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According to their webpage Infacol is: "Clinically proven to significantly reduce the frequency and severity of crying attacks associated with colic." Music to the ears of any new parent with a distressed bundle right? It seems so as their site claims they are "Britain's number 1 infant colic remedy"!

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If baby has a big mouthful of breast, generally feeding will not hurt and the baby will feed well.

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Watch safe YouTube videos without comments, related videos, or any other distractions. It’s great for teachers, parents, and organizations alike - or really, anybody.