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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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infant feeding support groups poster jpeg

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It's a way of holding and carrying your baby that more and more parents are using. It's you keep your child close more easily, whilst freeing you to do the other important things in parent's life!

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Meet like-minded parents and get the support you need Salisbury Sling Library is your local, not-for-profit community service offering a huge range of slings and carriers for you to hire, as well as free support and advice at our weekly drop-in meets. find out more COVID-19 UPDATE 14.10.20 - New "Covid safe" Sling Library meets ...

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Free antenatal online course

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This information was updated in December 2022. A PDF version is available here.

"I was surprised by how suddenly I felt ill. We went to a wedding and I only missed one feed.
Within a couple of hours I felt fluey and achey. My GP was reluctant to prescribe antibiotics,
saying they were often not needed if I kept feeding. I also took ibuprofen tablets which helped
me cope. I was surprised how well the self-help worked and that I never needed a prescription.
I felt very miserable and depressed when I had the symptoms, wondering whether
breastfeeding was worth all this - but once I felt better I remembered how good it feels."

Mastitis means inflammation of the breast.

The first sign of mastitis is a swollen usually painful area on the breast. On darker skin tones
there might be a darkening of the skin and on lighter skin tones this might be visible as a red
area on the breast. However, it is important to note that there could be no visible change in
skin colour at all. The inflammation and swelling is not always a sign of infection (WHO, 2000).
Harmful bacteria are not always present: antibiotics may not be needed if self-help measures
are started promptly. Very rarely mastitis can develop into a more serious condition which
needs urgent hospital admission and IV antibiotics (RCOG, 2012).

You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts
in the same way as it does to an infection - by increasing blood supply. This produces the
inflammation.
NB You may not have all of the above signs during mastitis.
Prevention of Mastitis

A localised area in the breast which is painful to the touch, often in the outer upper
area. Some mums might notice a change of colour or a red area on their breast.

A lumpy breast which feels hot to touch.

The whole breast aches and may appear swollen and skin may be reddened or darker,
depending on skin tone.

Flu like symptoms - aching, increased temperature, shivering, feeling tearful and tired
(Jahanfar et al., 2013). This feeling can sometimes start very suddenly and get worse very quickly.

Signs that the Baby is Well Attached

Try to avoid suddenly going longer between feeds. If you are intending to reduce breastfeeding, cutting down gradually reduces the risk of mastitis.

Make sure your breasts don't become overfull

Avoid pressure on your breast from clothing and fingers

Start self-help measures at the first sign of any lumpy or swollen areas on your breast

Factors which make mastitis more likely:

Difficulty with attaching your baby to the breast - this may mean that the milk is not

being removed effectively and milk may leak into the breast tissue

Pressure from tight fitting clothing, particularly your bra, or a finger pressing into the

breast during feeds

Engorgement or a blocked duct

Sudden changes in how often the baby is feeding, leaving the breasts feeling full

Injuries, such as bumps or knocks from toddlers

Self-Help Measures
Mastitis starts with poor milk drainage. If your baby is not effectively attached to your breast,
or has difficulty feeding, it may be hard for the baby to remove the milk and some parts of
your breast may not be drained during a feed. Improving the way your baby is attached at
the breast will reduce the chance of you getting mastitis again. If in doubt, contact your
midwife, health visitor or breastfeeding peer supporter for help with attaching your baby for
feeding. You can also contact the National Breastfeeding Helpline.

Your baby's chin is firmly touching your breast.

Your baby's mouth is wide open

Your baby has a large mouthful of breast.

If you can see the darker skin around your nipple, you should see more dark skin above your baby's top lip than below your baby's bottom lip.

It doesn't hurt you when your baby feeds (although the first few sucks may feel strong).

No change in shape or colour of the nipple after feeds e.g. it should not be lipstick shaped or have a pressure line across the nipple

Your baby's cheeks stay rounded during sucking.

Your baby rhythmically takes sucks and swallows (it is normal for your baby to pause from time to time).

Your baby finishes the feed and comes off the breast on his or her own.

Your baby produces 6 or more heavy wet nappies every 24 hours (from 7 days old)

Your baby produces at least two yellow poos at least the size of a £2 coin every 24 hours (from 7-28 days old). See UNICEF's breastfeeding checklist for more details.

If your mastitis comes back after you have taken a full course of antibiotics, or is unusually severe, it is good practice to send a sample of milk for bacteria tests. This will help the GP chose the correct antibiotic for your symptoms (Jahanfar et al., 2013). For public health reasons doctors try to avoid antibiotics that are not essential or are unlikely to be effective. It is important that you finish the whole course of antibiotics to make sure that you recover fully and to help prevent the mastitis coming back with resistant bacteria (NICE NG15).
When should I contact my GP or health visitor? If you do not begin to feel better after 24 hours despite using self-help measures, or especially if you start to feel worse, you should speak to your GP or health visitor. You may need to take antibiotics.
These will also help to clear blocked ducts and engorgement. Most cases of mastitis can be improved or resolved with self-help measures.
When should I seek help urgently?

Keep on breastfeeding - you may feel ill, in pain, tearful or discouraged but continuing to breastfeed will help you to get better, and your breastmilk is still the best food for your baby

Feed your baby frequently and responsively (whenever your baby seems like they want to feed), and/or pump to your normal routine (Mitchell et al., 2022; Douglas 2022)

Don't attempt to "empty the breast" by prolonging feeds or expressing extra milk between feeds. You may see this suggested in some places, but the current research suggests you should aim to meet your baby's needs, but avoid increasing your supply beyond that as it could make the inflammation worse. (Mitchell et al., 2022; Douglas 2022)

Try to rest as much as you can, as this will help you recover

Check that your baby is effectively positioned and attached to your breast - if in doubt seek help from your midwife, health visitor or breastfeeding supporter, as even a minor tweak can make a difference.

Try feeding with your baby in different positions.

If necessary, soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.

Some mothers find warm compresses are soothing, and warmth on the nipple can aid let-down. However, take care using these as compresses that are too hot or used frequently could increase swelling and inflammation. Cool compresses may ease symptoms in between feeds. (Mitchell et al., 2022; Douglas 2022)

Avoid any firm pressure or massage to the breast, or use of items such as an electric toothbrush to massage lumps or sore areas. This could cause tissue damage and increase inflammation (Mitchell et al., 2022; Douglas 2022). Any pressure you apply to your breast should be no firmer than stroking a cat.

Check for clothing or anything else which is pressing into your breast. This includes a bra - some women find it helpful to go without.

Medical Treatment for Mastitis
If you feel these symptoms beginning again, start self-help measures right away.

You should contact your GP if the area becomes round and swollen or, if you can see redness or a change of colour on your skin and the pattern of the colour change/redness changes. Redness may be less visible on darker skin tones. Mastitis can develop into an abscess (a painful collection of pus). There is more information about this here: https://www.nhs.uk/conditions/breast-abscess/.
The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250-500 milligrams four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic. Other options have been suggested by Jahanfar et al., (2013).
If you feel seriously unwell, dizzy, confused, develop nausea, vomiting or diarrhoea or slurred speech along with the symptoms of mastitis you need to seek urgent medical attention. These can be signs that mastitis is developing into sepsis. If severe, this is a medical emergency which needs urgent hospital admission and IV antibiotics. (NHS Choices: Sepsis, RCOG, 2012:6.1)

This information comes from the Drugs in Breastmilk Service.
References

Ibuprofen reduces the inflammation, relieves pain and reduces temperature. Take 400mg three times a day after food. Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin. The levels of ibuprofen which pass to the baby are small. Ibuprofen is safe to take whilst breastfeeding. See https://www.breastfeedingnetwork.org.uk/analgesics/ for more information.

Paracetamol relieves pain and reduces temperature but has no anti-inflammatory action. Take two 500mg tablets four times a day.

Aspirin should not be taken by breastfeeding mothers.

Antibiotics may be needed if no improvement is seen with self-help measures. Mostantibiotics can be safely taken whilst breastfeeding.

It is essential that breastfeeding is not interrupted during mastitis.

Note: Antibiotics can make the baby produce loose, runny motions and become irritable, colicky and restless. This lasts for a short time and will get better when you finish the antibiotics.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD005458. DOI:10.1002/14651858.CD005458.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005458.pub3/abstract (accessed 19 November 2020)

Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007239. DOI:10.1002/14651858.CD007239.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007239.pub3/full (December 2022)

Hale T., Medications and Mothers' Milk 2014 (16th Ed),

NICE guideline [NG194] Published: 20 April 2021 https://www.nice.org.uk/guidance/ng194/chapter/Recommendations (accessed December 2022)

World Health Organization. 2000, Mastitis: causes and management, WHO: Geneva http://apps.who.int/iris/bitstream/10665/66230/1/WHO_FCH_CAH_00.13_eng.pdf?ua=1.(accessed December 2022)

NICE guidelines [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use www.nice.org.uk/guidance/ng15 (accessed December 2022)

NHS Choices: Sepsis www.nhs.uk/conditions/Bloodpoisoning/Pages/Introduction.aspx (accessed December 2022)

Royal College of Obstetricians and Gynaecologists (RCOG) (2012) Green-top Guideline No. 64b. Bacterial Sepsis following Pregnancy: 6.1. www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf (accessed December 2022)

Unicef: https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf (Accessed December 2022)

Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B., & Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 Breastfeeding medicine : the official journal of the Academy of Breastfeeding
Medicine, 17(5), 360-376. https://doi.org/10.1089/bfm.2022.29207.kbm
Please note this information is not yet available in print. The previous print version has now been withdrawn and should no longer be used. A new print version is planned for 2023.
Douglas P. (2022). Re-thinking benign inflammation of the lactating breast: Classification,
prevention, and management. Women's health (London, England), 18, 17455057221091349.
https://doi.org/10.1177/17455057221091349

Original leaflet compiled by Wendy Jones MBE Pharmacist and Phyll Buchanan
Breastfeeding Network Supporter and Tutor, in 2015. With thanks to Magda Sachs who
developed earlier versions

This version revised 22 December 2022.

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Information on mastitis and breastfeeding, updated December 2022 and provided by the Breastfeeding Network

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We hire of our hospital grade, Ardo Calypso pumps. The pumps are loaned for 14 days. We offer this hire for £10 which goes towards our hospital charity; the stars appeal. We are also starting to measure mums to make sure that the pumps flange fits your breasts.

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Information on infant milks for health professionals.

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Information on infant milks for health professionals.

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Our partner site

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market. On this website we provide information about the types of infant milks on the UK market and provide compositional information for infant formula, follow-on formula and infant milks marketed as foods for special medical purposes that are available for sale over the counter.

First Steps Nutrition Trust provides a one stop shop for information on infant milks marketed in the UK. We provide information on the composition of infant milks, the claims made and the usefulness and safety of ingredients. We gather together all the information needed to support families who use these products to feed their infants.

The International Code of marketing of breastmilk substitutes and all the subsequent World Health Assembly resolutions are global agreements designed toprotect all babies from unscrupulous marketing and claims about alternatives to breastmilk. Some but not all of the Code and resolutions are written into regulation in the UK, which means that advertising of follow on formula, and advertising to health professionals is permissible.

Everyone working in Unicef UK Baby Friendly Initiative accredited settings however pledges to work within the Code and resolutions, and we are pleased to work in partnership with them to support health professionals in this.

In this section we summarise the history of infant milks, how infant milk composition is regulated, and the current infant feeding patterns in the UK. The UK and international markets for infant milks are also summarised in this section.

It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely. Here you can link to useful information on making up milks safely, how to use vaccum flasks safely when making up milk on the move and the safety of electrical milk preparation machines (such as Tommy Tippee Perfect Prep™).

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Infant milks for health workers - First Steps Nutrition Trust

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First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market. On this website we provide information about the types of infant milks on the UK market and provide compositional information for infant formula, follow-on formula and infant milks marketed as foods for special medical purposes that are available for sale over the counter.

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Here is our referral form for our specialist clinics.

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Here is our referral form for our specialist clinics.

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Please do join our Facebook group for support

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Bottle feeding your baby. A guide to pace bottle feeding.

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Maternity information in Dari and Pashto.

This includes both breast and bottle feeding

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Maternity information in Dari and Pashto

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Community United is delighted to be able to share a newly-launched maternity resource. In collaboration with Papillon Translations and Surrey Heartlands’ Local Maternity and Neonatal System, NHS So…

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Understanding how your baby is communicating with you.

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Newborns need to feed often. At least eight times in each 24 hour period.

If you can spot the early signs, feeding will be calmer.

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

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

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

Planning ahead

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

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

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

Limit visitors

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

Separation

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

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

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

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

Making enough milk

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

See Is My Baby Getting Enough Milk?

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

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

Looking after yourself

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

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

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

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

Other sources of practical help

Midwives, health visitors, clinics and surgeries.

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

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

Mixed feelings

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

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

Practicalities of getting out

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

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

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

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

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

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

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

Finding support

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

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

Further Reading

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

LLLI Resources
Breastfeeding Premature Babies

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

Books

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

Further Information

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

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

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

Copyright LLLGB 2016

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

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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It’s never to early to start building a relationship with your baby.

When you are pregnant it’s important to talk, sing to your baby.

Some people have a name for their bump.

Getting to think what your baby may look like will help you bond with them and make your baby grow up happy and confident.

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our registered pharmacist volunteers. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

Most popular factsheets

All factsheets

Computed Tomography (CT) scans

Cows' Milk Protein Allergy (CMPA)

Cracked Nipples and Moist Wound Healing

Creams and Ointments applied to the skin

Differential Diagnosis of Breast Pain

Emergency hormonal contraception

Haemorrhoid (piles) and anal fissure treatment

Irritable Bowel Syndrome (IBS)

Miconazole Gel and oral Thrush (Candida)

Obsessive Compulsive Disorder (OCD)

Podiatry - local anaesthetics

Smoking and smoking cessation

Thrush (of the breast/nipple)

Thrush (of the breast/nipple)

Thyroid medication (under and over active)

Whooping Cough (Pertussis) vaccination

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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

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Thinking about breastfeeding, but not sure. Have a read of this simple guides that explains the benefits for you and your baby.

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Face to Face support groups

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Beyond Bottles: alternative ways to supplement a breastfed baby

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This is a great online free course offered by the ABM.

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This is a great online free course offered by the ABM.

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It doesn't just take the parent who has the breasts to make breastfeeding work, it takes a team and you can make all the difference! It's about knowing how breastfeeding happens, knowing how newborns behave, accessing qualified support when things are challenging, providing encouragement and emotional support - and practical support around the home too.

This FREE course is aimed at,

Expectant couples

grannies and grandads

sisters and the brothers

aunties and the uncles

friends and supporters

The course is broken down in to 5 sections which include articles and videos to empower you to become informed and confident.

1. The decision to breastfeed

2. How breastfeeding works

3. How newborns behave

4. What challenges can arise

5. Where to get help

At the end of each section, you'll also find a 'partner challenge' - an activity you can do with your partner. It can take a few minutes in the car on the way to the supermarket, or however long you like. You can do them at any point in the course or afterwards!

Please note this course is compatible only on Edge, Chrome and Safari Browsers.

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A free online short course to empower you to become informed and confident around the topic of breastfeeding

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Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year.

Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby. We like to offer parents a choice of where they give birth, and our priority is to provide high quality care. This can be in the Maternity Unit, our new Birth Centre or at home.

We are a team that include caring midwives and experienced specialist doctors (obstetricians), led by Joanne Hayward, Head of Maternity & Neonatal Services. We are supported by our other healthcare professionals from the Neonatal Unit and across the hospital to provide you with the most comprehensive care. We always include the parents in any decisions made, keeping you fully informed and involved in your care and supporting you to make the right decisions for you and your baby. We also encourage you to tell us about your needs and expectations.

Our Unit includes:

We invite you to register your pregnancy with us any time after the sixth week of your pregnancy.
If you are looking to book your pregnancy care with us, please click here:

Please note: For a few days (beginning 26th June) due to a technical fault, we have been unable to receive pregnancy notifications via the 'Register Your Pregnancy with Us' button above. We are pleased to announce that this issue has since been resolved.

If you have informed us of your pregnancy and have not received a call from your midwife (within 72 hours of you logging your details with us), can we ask that you kindly re-register your pregnancy, using the ' Register Your Pregnancy with Us' button or email us on sft.maternity.routine.enquiries@nhs.net. You can call our Triage Team on 01722 425185.
We are extremely sorry for the inconvenience this has caused.

Please feel free to explore all the useful information on our website, to help guide you from pre-conception, all the way through your pregnancy, labour, birth and caring for your baby.

Please note: Where the term 'women' is used on this page, this refers to all birthing people.

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Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year. Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby.

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Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year.

Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby. We like to offer parents a choice of where they give birth, and our priority is to provide high quality care. This can be in the Maternity Unit, our new Birth Centre or at home.

We are a team that include caring midwives and experienced specialist doctors (obstetricians), led by Joanne Hayward, Head of Maternity & Neonatal Services. We are supported by our other healthcare professionals from the Neonatal Unit and across the hospital to provide you with the most comprehensive care. We always include the parents in any decisions made, keeping you fully informed and involved in your care and supporting you to make the right decisions for you and your baby. We also encourage you to tell us about your needs and expectations.

Our Unit includes:

We invite you to register your pregnancy with us any time after the sixth week of your pregnancy.
If you are looking to book your pregnancy care with us, please click here:

Please note: For a few days (beginning 26th June) due to a technical fault, we have been unable to receive pregnancy notifications via the 'Register Your Pregnancy with Us' button above. We are pleased to announce that this issue has since been resolved.

If you have informed us of your pregnancy and have not received a call from your midwife (within 72 hours of you logging your details with us), can we ask that you kindly re-register your pregnancy, using the ' Register Your Pregnancy with Us' button or email us on sft.maternity.routine.enquiries@nhs.net. You can call our Triage Team on 01722 425185.
We are extremely sorry for the inconvenience this has caused.

Please feel free to explore all the useful information on our website, to help guide you from pre-conception, all the way through your pregnancy, labour, birth and caring for your baby.

Please note: Where the term 'women' is used on this page, this refers to all birthing people.

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Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year. Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby.

# data[].attributes.attachment_link.readable_text
Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year.

Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby. We like to offer parents a choice of where they give birth, and our priority is to provide high quality care. This can be in the Maternity Unit, our new Birth Centre or at home.

We are a team that include caring midwives and experienced specialist doctors (obstetricians), led by Joanne Hayward, Head of Maternity & Neonatal Services. We are supported by our other healthcare professionals from the Neonatal Unit and across the hospital to provide you with the most comprehensive care. We always include the parents in any decisions made, keeping you fully informed and involved in your care and supporting you to make the right decisions for you and your baby. We also encourage you to tell us about your needs and expectations.

Our Unit includes:

We invite you to register your pregnancy with us any time after the sixth week of your pregnancy.
If you are looking to book your pregnancy care with us, please click here:

Please note: For a few days (beginning 26th June) due to a technical fault, we have been unable to receive pregnancy notifications via the 'Register Your Pregnancy with Us' button above. We are pleased to announce that this issue has since been resolved.

If you have informed us of your pregnancy and have not received a call from your midwife (within 72 hours of you logging your details with us), can we ask that you kindly re-register your pregnancy, using the ' Register Your Pregnancy with Us' button or email us on sft.maternity.routine.enquiries@nhs.net. You can call our Triage Team on 01722 425185.
We are extremely sorry for the inconvenience this has caused.

Please feel free to explore all the useful information on our website, to help guide you from pre-conception, all the way through your pregnancy, labour, birth and caring for your baby.

Please note: Where the term 'women' is used on this page, this refers to all birthing people.

# data[].attributes.attachment_link.description
Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year. Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby.

# data[].attributes.attachment_link.readable_text
Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year.

Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby. We like to offer parents a choice of where they give birth, and our priority is to provide high quality care. This can be in the Maternity Unit, our new Birth Centre or at home.

We are a team that include caring midwives and experienced specialist doctors (obstetricians), led by Joanne Hayward, Head of Maternity & Neonatal Services. We are supported by our other healthcare professionals from the Neonatal Unit and across the hospital to provide you with the most comprehensive care. We always include the parents in any decisions made, keeping you fully informed and involved in your care and supporting you to make the right decisions for you and your baby. We also encourage you to tell us about your needs and expectations.

Our Unit includes:

We invite you to register your pregnancy with us any time after the sixth week of your pregnancy.
If you are looking to book your pregnancy care with us, please click here:

Please note: For a few days (beginning 26th June) due to a technical fault, we have been unable to receive pregnancy notifications via the 'Register Your Pregnancy with Us' button above. We are pleased to announce that this issue has since been resolved.

If you have informed us of your pregnancy and have not received a call from your midwife (within 72 hours of you logging your details with us), can we ask that you kindly re-register your pregnancy, using the ' Register Your Pregnancy with Us' button or email us on sft.maternity.routine.enquiries@nhs.net. You can call our Triage Team on 01722 425185.
We are extremely sorry for the inconvenience this has caused.

Please feel free to explore all the useful information on our website, to help guide you from pre-conception, all the way through your pregnancy, labour, birth and caring for your baby.

Please note: Where the term 'women' is used on this page, this refers to all birthing people.

# data[].attributes.attachment_link.description
Whether you are expecting a baby or thinking of starting a family, we are delighted that you are considering us for your care. We are a small, professional, and friendly team supporting approximately 2,500 mothers per year. Our aim is for you to have a safe and fully informed pregnancy and birth experience, resulting in a healthy mother and baby.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual.

Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

Tongue-tie is sometimes diagnosed during a baby's newborn physical examination, but it's not always easy to spot. It may not be obvious until your baby has problems feeding.

See a health visitor, midwife or GP if you're concerned about your baby's feeding and think they may have tongue-tie.

Signs of tongue-tie

To breastfeed successfully, a baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage.

Some babies with tongue-tie are not able to open their mouths wide enough to latch on to the breast properly.

If you're breastfeeding your baby and they have tongue-tie they may:

have difficulty attaching to the breast or staying attached for a full feed

feed for a long time, have a short break, then feed again

be unsettled and seem to be hungry all the time

not gain weight as quickly as they should

make a "clicking" sound as they feed - this can also be a sign you need support with the positioning and attachment of your baby at the breast

Tongue-tie can also sometimes cause problems for a breastfeeding mother. Problems can include:

Most breastfeeding problems, however, are not caused by tongue-tie and can be overcome with the right support.

If you're finding breastfeeding difficult, ask a midwife, health visitor or a breastfeeding specialist for help.

Read more about breastfeeding problems and how to overcome them.

Other signs of tongue-tie

Other signs that may indicate your baby has tongue-tie include:

difficulty lifting their tongue up or moving it from side to side

difficulty sticking their tongue out

their tongue looks heart-shaped when they stick it out

Treating tongue-tie

Treatment is not always needed, if your baby has tongue-tie but can feed without any problems. If their feeding is affected, treatment involves a simple procedure called tongue-tie division.

Tongue-tie division

Tongue-tie division involves cutting the short, tight piece of skin connecting the underside of the tongue to the bottom of the mouth.

It's a quick, simple and almost painless procedure that usually improves feeding straight away.

The procedure

Tongue-tie division is done by doctors, nurses or midwives.

In very young babies (those who are only a few months old), it is usually done without anaesthetic (painkilling medicine), or with a local anaesthetic that numbs the tongue.

The procedure does not seem to hurt babies. This is because there are very few nerve endings in the area around the bottom of the mouth. Some babies sleep through the procedure, while others may cry a bit.

A general anaesthetic is usually needed for older babies with teeth, which means they'll be unconscious throughout the procedure.

The baby's head is held securely while sharp, sterile scissors with blunt ends are used to cut the skin.

It only takes a few seconds, and you can start feeding your baby immediately afterwards.

There should not be much bleeding. Your baby may get a white patch (ulcer) under their tongue, but this should heal in 1 to 2 days. It will not bother your baby.

Research suggests most babies who have treatment for tongue-tie find breastfeeding easier afterwards.

The Association of Tongue-tie Practitioners (ATP) can help you find a tongue-tie practitioner.

Older children and adults

Untreated tongue-tie may not cause any problems as a child gets older, and any tightness may resolve naturally as the mouth develops.

However, tongue-tie can sometimes cause problems such as speech difficulties and difficulty eating certain foods.

Speak to a GP if you think you or your child are having problems caused by tongue-tie.

Tongue-tie division can be carried out in older children and adults, although it's usually done under general anaesthetic.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual. Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

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La Leche League is an international, nonprofit, nonsectarian organisation. 1 LLLGB supports everyone who wants to breastfeed or chestfeed in reaching their goals. We do not discriminate based on sex, gender or gender identity.

Trans men, trans women and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed, as we can also see in the experiences of those nursing adopted babies.

Transgender dad Trevor MacDonald writes that, "It is equally important to note that some trans people experience severe gender dysphoria when breast or chestfeeding, and that they may decide not to nurse their babies for mental health reasons. Trans parents choosing to breast or chestfeed and those choosing to suppress lactation and bottlefeed may require the support of breastfeeding counsellors or lactation professionals." ²

Amazing milk

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

Skin-to-skin

Skin-to-skin contact is beneficial for babies and parents; it simply means holding your naked baby on your bare chest. You can drape a blanket over you both for warmth. Within minutes, you will see the benefits of skin-to-skin as you and your baby relax. Your baby's body temperature, breathing, and heart rate will stabilise. Babies often latch on and nurse more efficiently during and after skin-to-skin contact.
It is a lovely way to nurture your baby even if you are not nursing.

Your milk supply

Some transgender and non-binary parents have a full milk supply. If you have had chest (top) surgery you may be able to produce some milk. Many factors will affect the amount of milk you can make.

Two reasons that a trans man might have a reduced milk supply are:
1. Milk-making tissue has been surgically removed, and/or ducts have been damaged in surgery.
2. Testosterone interferes with the hormone necessary for lactation (prolactin) and can cause a significant decrease in milk supply. However, taking testosterone would not prevent someone from using an at-chest supplementer and having a nursing relationship.

Trans women can use a protocol similar to adoptive and other non-gestational mothers and stimulate their milk supply: it is called the Newman-Goldfarb protocol. You can read more here https://www.laleche.org.uk/relactation-induced-lactation/ and here http://www.asklenore.info/breastfeeding/induced_lactation/protocols4print.shtml.

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

You may find the following websites have useful information:
Breastfeeding After Breast and Nipple Surgery http://bfar.org/index.shtml?fref=gc
Low Milk Supply http://www.lowmilksupply.org/

Many parents worry about whether their baby is 'getting enough'. LLL meetings are a good place to get support from others. These LLL posts are great for checking signs your baby is feeding effectively:
https://www.laleche.org.uk/is-my-baby-getting-enough-milk/
https://www.laleche.org.uk/signs-effective-feeding-early-days-2/

Using a nursing supplementer

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

This post has lots of useful information about nursing supplementers: https://www.laleche.org.uk/nursing-supplementers/.

Milk sharing

Some transgender and non-binary parents use milk banks to acquire human milk for their babies. La Leche League fully supports the use of human milk for babies; we cannot facilitate or set up milk sharing networks, though your local LLL Leader can help you with contact information for non-profit human milk banks, other regulated collection centres, and formal/medically supervised or informal milk sharing networks. 3 Human milk banks provide pasteurised, screened donor milk.

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

optimal nutrition

easy digestibility

immunological protection

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

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

medicines and other drugs

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

Human Milk for Human Babies (HM4HB) is an "informed milk sharing network", and is an international organisation that many parents use to source human milk: https://www.facebook.com/HM4HBUK/

LLL Support

All parents need support and La Leche League is a great place to find it. There are over 70 LLL groups across Great Britain, most offer meetings open to all - contact your local group to find out how they can support you. Many groups also have closed Facebook groups where you can ask questions and connect with other nursing parents.

LLL meetings are held in a wide range of venues - LLLGB is not affiliated to, and does not endorse or support, any business, organisation or religion whose premises we use. https://www.laleche.org.uk/find-lll-support-group/?fref=gc

LLLGB also offers these services:
National Helpline: 0345 120 2918 https://www.laleche.org.uk/telephone-helpline/
Online Helpform support: https://www.laleche.org.uk/submit-help-request/
Contact us for non judgmental information and support.

Find more LLLGB support listed here:
https://www.laleche.org.uk/get-support/?fref=gc<

Other support

International Facebook group for 'birthing and breast or chestfeeding trans people and allies': https://www.facebook.com/groups/TransReproductiveSupport/?fref=gc&hc_location=ufi

La Leche League - Inducing lactation and relactation Facebook group

Resources

Where's the Mother? Stories from a Transgender Dad. Trevor MacDonald: Trans Canada Press, 2016

LLL article: Support for Transgender and Non-binary parents

Defining Your Own Success: Breastfeeding After Breast Reduction Surgery. Diana West: LLLI, 2001:
https://www.bfar.org/book.shtml

My Journey: Non-binary Nursing - from LLLUS
https://lllusa.org/my-journey-non-binary-nursing/

Trans breastfeeding FAQ:
http://dianawest.com/trans-breastfeeding-faq/?fref=gc

US based website Kellymom's post:
http://kellymom.com/bf/got-milk/transgender-parents-chestbreastfeeding/?fref=gc

Transmasculine individuals' experiences with lactation, chestfeeding, and gender identity: a qualitative study:
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0907-y?fref=gc

Transgender/transsexual/genderfluid Tip Sheet - General Information, LLL Canada
https://www.lllc.ca/sites/default/files/REVISED-Trans-Nursing_Tip-Sheet.pdf

Breastfeeding without giving birth, LLLI article by Aylssa Schnell
https://www.llli.org/breastfeeding-without-giving-birth-2

Language

We are aware that transgender and non-binary individuals use a variety of different terms to describe their anatomy and the acts of feeding and nurturing their babies. We have used the terms "chestfeeding" and "nursing", with the second of these capturing the nurturing relationship associated with this way of feeding a baby.

Elsewhere on the site we use 'breastfeeding', 'breastmilk' and 'mother': they reflect the founding and unchanged mission of LLLI to provide mother-to-mother support for breastfeeding. They also reflect the stated identity and valued role of the majority of people whom we support and provide information to - those who identify as breastfeeding mothers.

Whatever language you use we hope that much of the information we share is still helpful and relevant.

References
1 La Leche League International Bylaws, Section 1: General Purpose
2 http://kellymom.com/bf/got-milk/transgender-parents-chestbreastfeeding/?fref=gc
3 http://leadertoday.breastfeedingtoday-llli.org/milk-donation-policy/

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Support for Transgender & Non-binary Parents - La Leche League GB

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La Leche League is an international, nonprofit, nonsectarian organisation.1 LLLGB supports everyone who wants to breastfeed or chestfeed in reaching their goals. We do not discriminate based on sex, gender or gender identity. Trans men, trans women and non-binary individuals may choose to breastfeed or chestfeed their babies.

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Baby Slings
How to swaddle a baby

Sleep baby on their back

Never put a swaddled baby to sleep on their front or side. The safest sleeping position for a baby (swaddled or not) is on their back .

Use thin swaddling materials

Use materials such as a thin muslin or thin cot sheet, and never place any additional bedding over a swaddled baby as they could cause them to overheat.

Do not use blankets to swaddle a baby.

Use minimum amount of clothing necessary

Ensure baby is not overdressed under the swaddle and has their head uncovered. Babies do not need hats indoors unless advised by a medical professional, as it can cause them to overheat.

Check your baby's temperature to ensure they don't t get too hot (the back of the neck is a good spot for this). If their skin is hot or sweaty, remove one or more layers of bedclothes.

It is also important to . keep an eye on how warm or cold the room is 16-20°C is a comfortable room temperature for sleeping babies so we would advise you to use a room thermometer in the rooms where your baby sleeps.

Swaddle securely

To reduce the risk of your baby's face getting covered by loose material, they should be swaddled securely so the swaddle can't come apart or undone. This is because loose, soft bedding can accidentally get pulled over a baby's head, causing overheating or a breathing obstruction, increasing the chance of SIDS.

However, swaddles should not be applied very tightly around the hips as this is a strongly associated with developmental dysplasia of the hip.

How to swaddle a baby: a diagram

Never swaddle a baby when:

When to stop swaddling

Once a baby shows signs of rolling, stop swaddling them with their arms wrapped inside the material. This is because your little one may roll onto their tummy and not be able to roll back again without the use of their arms.

The safest sleeping position for a baby is on their back , so we don't want to risk them getting stuck on their tummy.

Swaddling products

There are various swaddle products on the market such as swaddle blankets, swaddle sacks and swaddle bags. We can't comment on their safety but parents/carers need to ensure the product meets necessary safety standards and fits their baby well.

Always follow the individual product's guidance. (For example, some swaddle manufacturers recommend their product is based on a baby's weight rather than age.)

We do not advise on a specific tog rating for swaddle products. However, we advise parents/carers to use a lower tog rating to reduce the chance of baby overheating.

How to use a baby sling

Slings and baby-carriers

Slings and baby-carriers are useful for holding a baby hands-free, however they are not always used safely. Although there is no reliable evidence that slings are directly associated with SIDS, there have been a number of deaths worldwide where infants have suffered a fatal accident from the use of a sling. These accidents are particularly due to suffocation, and particularly in young infants.

The risk appears to be greatest when a baby's airway is obstructed either by their chin resting on their chest or their mouth and nose being covered by a parent's skin or clothing.

The safest baby carrier to use will keep the infant firmly in an upright position where a parent can always see their baby's face, and ensure their airways are free. Complete guidance is available by visiting The Royal Society for the Prevention of Accidents.

The Consortium of UK Sling Manufacturers and Retailers provides the following advice to baby sling wearers: keep your baby close and keep your baby safe. When wearing a sling or baby carrier, keep in mind the TICKS guidelines:

This is to ensure that your baby's airway is kept clear, and so you can check that they are able to breathe easily and are not overheating.

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Swaddling and slings - The Lullaby Trust

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It is very important to follow the guidelines on how to swaddle a baby or use a sling more safely. This is to reduce the risk of SIDS.

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TICKS used with permission of the UK Sling Consortium, please credit when used.

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Discover the first breastfeeding support app | LatchAid

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LatchAid is the first baby breastfeeding app that provides support for mothers and mothers-to-be, teaching them vital breastfeeding skills.

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Using smart technology, we provide parents and parents-to-be with vital support on their breastfeeding and parenting journey, anytime, anywhere.

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https://padlet.com/BSWMVP/infant-feeding-padlet-bsw-mvp-t3phb5hsufeat0w3

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Engorgement means that there is an excessive build up of milk within the breast.

It is normal for the breasts to feel warm, heavy and tender when they first fill with milk around 3 days after the baby is born. However, if the breasts feel hot, painful, hard and tight this is not normal and needs to be addressed in order to prevent future problems such as mastitis and reduced milk supply. Engorgement is common in the first week after birth, but can also happen at any time if the milk is not being removed effectively from the breasts.

How can engorgement be prevented?

Engorgement is prevented by making sure that milk is removed efficiently from the breast so it is not allowed to build up excessively. This is done by:

Making sure positioning and attachment are effective - help may be needed to improve this

Feeding frequently so milk is removed

Avoiding infant formula which replaces breastfeeds and dummies which may reduce the frequency of breastfeeding

How can engorgement be treated?

It is important that engorgement is managed quickly and effectively in order to prevent complications such as a reduced milk supply, blocked ducts and mastitis. Enabling the baby to attach effectively can be difficult with an engorged breast. Gently hand expressing some milk at the start of feeds to soften the breast tissue can help to enable the baby to attach and have an effective feed. Following feeds, if the breasts remain full, further expression to soften the breast until comfortable will help avoid milk stasis which can reduce future milk production. Warmth before feeding/expressing can help milk flow more easily.

For more information please see the NHS website.

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Overcoming Breastfeeding Problems: Engorgement - Baby Friendly Initiative

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It is normal for the breasts to feel warm, heavy and tender when they first fill with milk around 3 days after the baby is born. However, if the breasts feel hot, painful, hard and tight this is not normal and needs to be addressed in order to prevent future problems such as mastitis and reduced milk supply.

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This information is also available in PDF format by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals. "I had been breastfeeding without problem for 5 months then suddenly developed terrible pains after every breastfeed. I hadn't changed anything and I was very confused. I noticed my baby's tongue was white. The doctor took swabs of my nipples and my daughter's mouth which confirmed we had thrush. It cleared up with treatment within a week" "I was told I had thrush when my baby was 4 weeks old but I could feel her clamping onto my nipple to slow my really fast flow. I went to see someone else who helped me to sort out my baby's attachment at the breast and the pain went without any medicines." "Who'd have thought such pain could stem from just an incorrect latch on. He fed for longer and it definitely didn't hurt as much afterwards. I'll keep on working to improve the attachment."
Thrush (Candida albicans) infection can affect a mother's breast while she is breastfeeding but it is being over-diagnosed at the moment. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

There is pain in only one breast/nipple

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

www.breastfeedingnetwork.org.uk/differential-diagnosis-of-breast-pain/

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

If you think you have thrush

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

If breastfeeding itself hurts check this information: www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection

BREASTFEEDING SHOULD BE PAIN-FREE from the point of attachment (the moment the baby goes to the breast) onwards. (Pain from thrush begins after a feed). There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain.

Other causes of nipple pain:

attachment of the baby to the breast may need fine-tuning

eczema including reactions to breast pads or creams

tongue-tie in the baby

Reynaud's syndrome (associated with history of poor circulation and pain made worse when cold)

white spot which produces pin-point pain

bacterial infection which appears as a yellowy, thick discharge

vasospasm which is associated with less than perfect attachment of the baby at the breast and produces white nipples (particularly at the tip) after breastfeeds

www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015
Self-help measures

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally some mothers find reducing the level of sugar and yeast in their diet helps

IMPORTANT - To make sure that you get rid of thrush infection, both you and your baby need treatment. Usually once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.
If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.
Treatment

Ongoing attention to positioning and attachment because even the best latch can slip a little sometimes.

Miconazole cream applied to your nipples after every feed - sparingly and without washing off before the next feed

Miconazole oral gel applied gently to your baby's mouth 4 times a day a small amount at a time

If symptoms persist you may need fluconazole 150-400mg as a loading dose followed by 100-200mg daily for at least ten days. This is rarely necessary if your baby is less than 6 weeks old and could cause vomiting and stomach pains.
More detailed information can be found at www.breastfeedingnetwork.org.uk/thrush-detailed.
© Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network June 2020

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Thrush (of the breast/nipple) and Breastfeeding - Information for Mothers - The Breastfeeding Network

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

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The National Breastfeeding Helpline offers friendly, non-judgemental, independent, evidence based breastfeeding support and information to anyone in the UK who needs it.

Open 365 days a year from 9.30am to 9.30pm. Support is also available in Welsh, Polish, Bengali & Sylheti and for people who have hearing or speech impairments.

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National Breastfeeding Helpline - Helpline

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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

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Trained breastfeeding counsellors are available at:National Breastfeeding Helpline, Find a local support group, Access web chat or email us.

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Find more information about breastfeeding your premature or sick baby here, including how to get started and how to find support.

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The Essential Guide to feeding and caring for your baby is a fantastic resource for new mothers and families. It is full of great tips on caring for your baby, skin to skin care, and breastfeeding positions and attachment.

All guides have been produced with the latest UNICEF Baby Friendly Initiative standards in mind, as well as incorporating feedback from families, health professionals and Children’s Centres so we can make the best, most up-to-date guide available.

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The Essential Guide to feeding and caring for your baby is a fantastic resource for new mothers and families. It is full of great tips on caring for your baby, skin to skin care, and breastfeeding positions and attachment.

All guides have been produced with the latest UNICEF Baby Friendly Initiative standards in mind, as well as incorporating feedback from families, health professionals and Children’s Centres so we can make the best, most up-to-date guide available.

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Neonatal

Introducing the DadPad Neonatal...

Being a new dad can be a difficult thing to come to terms with. However, being the parent of a child in neonatal care potentially brings even more complex emotions and problems, as well as a wealth of complex information to digest.

The idea for the DadPad Neonatal was conceived by consultant neonatologist Professor Minesh Khashu. He recognised that there was a need for better communication and support for fathers of babies on neonatal units. The product complements the existing DadPad for new dads and is thought to be the first resource of its kind.

Professor Khashu said:

"DadPad is such a good idea for new dads, bringing together a range of information in a handy and convenient pack.

"I was excited about the potential opportunities for neonatal units and keen to develop a specialised version for this purpose."

How will DadPad Neonatal help?

The pack of laminated cards contains practical information and advice on relevant matters. These include: how dads can best help themselves and their partners as they each deal with their feelings and emotions; where to go to seek further help, support and information; and practical guidance on holding, handling, bonding with and caring for their premature baby.

It is hoped that the DadPad Neonatal will significantly improve a dad's understanding of their baby's care and treatment. It will also help in conversations with healthcare professionals on a range of topics.

The resource should become a valuable tool for fathers during this sensitive time, as well as growing into a 'keepsake' book for the father, child and family, with spaces in which to record information and emotions.

The DadPad Neonatal was written by the DadPad team, in partnership with Professor Khashu. Funding from National Lottery's Awards4All allowed the concept to be developed, with the DadPad Neonatal initially launched in two units in 2018: Poole Hospital, in Dorset, and Royal Cornwall Hospital Treliske, in Cornwall.

Professor Khashu hopes that other neonatal units around the country will adopt the DadPad Neonatal and benefit from the support that it offers.

"Having a sick or preterm baby is a very stressful time for parents. It can get even more stressful for dads who may have to go back to work quite quickly and may not be able to spend as much time on the neonatal unit as they would wish to.

"I think the new pack will be a huge asset for all parents and staff, and especially for dads."

Find out more...

To find out more about the DadPad Neonatal, or if you are a healthcare professional looking for more support in your neonatal unit, please send a message to Julian or call him on 07403 274757.
...BREAKING NEWS... September 2019
We are delighted to report that the DadPad Neonatal was Highly Commended in the Innovation category in the 2019 BMA Patient Information Awards. Read all about the Award over on our News page...

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DadPad | DadPad Neonatal | Neonatal Guide for New Dads

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Being a new dad can be a difficult thing to come to terms with. However, being the parent of a child in neonatal care potentially brings even more complex emotions and problems, as well as a wealth of complex information to digest. The idea for the DadPad Neonatal was conceived by consultant neonatologist Professor Minesh Khashu.

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Neonatal

Introducing the DadPad Neonatal...

Being a new dad can be a difficult thing to come to terms with. However, being the parent of a child in neonatal care potentially brings even more complex emotions and problems, as well as a wealth of complex information to digest.

The idea for the DadPad Neonatal was conceived by consultant neonatologist Professor Minesh Khashu. He recognised that there was a need for better communication and support for fathers of babies on neonatal units. The product complements the existing DadPad for new dads and is thought to be the first resource of its kind.

Professor Khashu said:

"DadPad is such a good idea for new dads, bringing together a range of information in a handy and convenient pack.

"I was excited about the potential opportunities for neonatal units and keen to develop a specialised version for this purpose."

How will DadPad Neonatal help?

The pack of laminated cards contains practical information and advice on relevant matters. These include: how dads can best help themselves and their partners as they each deal with their feelings and emotions; where to go to seek further help, support and information; and practical guidance on holding, handling, bonding with and caring for their premature baby.

It is hoped that the DadPad Neonatal will significantly improve a dad's understanding of their baby's care and treatment. It will also help in conversations with healthcare professionals on a range of topics.

The resource should become a valuable tool for fathers during this sensitive time, as well as growing into a 'keepsake' book for the father, child and family, with spaces in which to record information and emotions.

The DadPad Neonatal was written by the DadPad team, in partnership with Professor Khashu. Funding from National Lottery's Awards4All allowed the concept to be developed, with the DadPad Neonatal initially launched in two units in 2018: Poole Hospital, in Dorset, and Royal Cornwall Hospital Treliske, in Cornwall.

Professor Khashu hopes that other neonatal units around the country will adopt the DadPad Neonatal and benefit from the support that it offers.

"Having a sick or preterm baby is a very stressful time for parents. It can get even more stressful for dads who may have to go back to work quite quickly and may not be able to spend as much time on the neonatal unit as they would wish to.

"I think the new pack will be a huge asset for all parents and staff, and especially for dads."

Find out more...

To find out more about the DadPad Neonatal, or if you are a healthcare professional looking for more support in your neonatal unit, please send a message to Julian or call him on 07403 274757.
...BREAKING NEWS... September 2019
We are delighted to report that the DadPad Neonatal was Highly Commended in the Innovation category in the 2019 BMA Patient Information Awards. Read all about the Award over on our News page...

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DadPad | DadPad Neonatal | Neonatal Guide for New Dads

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Being a new dad can be a difficult thing to come to terms with. However, being the parent of a child in neonatal care potentially brings even more complex emotions and problems, as well as a wealth of complex information to digest. The idea for the DadPad Neonatal was conceived by consultant neonatologist Professor Minesh Khashu.

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Skin to Skin helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

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Skin-to-skin contact - Baby Friendly Initiative

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

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Skin to Skin helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

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Skin-to-skin contact - Baby Friendly Initiative

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

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This leaflet provides mothers with key information around breastfeeding.

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

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

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

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Off to the best start leaflet - Baby Friendly Initiative

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

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The Breastfeeding Network | Independent Breastfeeding Support

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

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Good attachment will help a baby get more milk and make breastfeeding comfortable.

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

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

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

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A short video that shows you how breast milk is made.

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Expecting a baby? - Find out how your milk making Superpower works! Check out our fab new video explaining all about how lactation works.

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

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

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

Further reading

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Infant formula and responsive bottle feeding - Baby Friendly Initiative

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

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Breastfeeding lowers the risk of Sudden Infant Death Syndrome. Find out what else you can do to reduce risk.

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

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Updated in 2022 with important new messaging on sleep safety, this leaflet offers helpful, practical advice to parents on looking after their sleeping baby both during the day and at night.

Caring for Your Baby at Night and When Sleeping covers a range of topics, including getting some rest, night feeding, safe sleeping environments and helping baby to settle. It is endorsed by the Lullaby Trust, the Baby Sleep Info Source (BASIS), the Royal College of Midwives (RCM) and the Institute of Health Visiting (iHV).

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

Caring for your Baby at Night and when Sleeping

A Guide for Parents

Download now

Caring For Your Baby at Night and When Sleeping: A guide for health professionals

Our accompanying guide supports health professionals who will be using Caring for Your Baby at Night and When Sleeping with new parents. It looks at the evidence underpinning the recommendations in the leaflet and offers guidance on discussing these issues.
An updated version of the health professional's guide will be made available soon.

Further resources

The Baby Sleep Information Source (Basis) is an informational source for parents who wish to make informed choices about their infant's sleep and night time care, and is the result of a collaboration between the Durham University Parent-Infant Sleep Lab, La Leche League, NCT, and the UNICEF UK Baby Friendly Initiative.

We have also collaborated with The Lullaby Trust, Public Health England, and Basis to create a range of resources for parents and health professionals, with accessible guidance on safer sleep practices. The following are available to download and buy on The Lullaby Trust website.

Safer Sleep for Babies: A Guide for Parents

Safer Sleep for Babies: Saving Babies' Lives - A Guide for Professionals

Safer Sleep for Babies: Quick Reference Card

Public Health Wales have produced a version of the Caring for your baby at night leaflet in Welsh, which is free to download.

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Caring for your baby at night leaflet - Baby Friendly Initiative

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This leaflet, endorsed by BASIS, the RCM and The Lullaby Trust, offers practical advice for parents on caring for their sleeping baby.

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Impartial, evidence- based information on different types of infant formula.

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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Going home from the neonatal unit leaflet

Download now
This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit.

This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

Weaning card

Download now
A double-sided A5 info card to give to parents with top tips on weaning your premature baby.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Weaning your premature baby

Download now

Our guide to help parents introduce their premature baby to solid foods.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Common infectious illnesses

Download now

Information for parents about common infectious illnesses, how you can help prevent your baby catching them, and what to do if you're worried about your baby's health.

You could also direct parents to the common infectious illnesses info on our website (or tell them to search on the Bliss site for 'common infectious illnesses').

Look at me - I'm talking to you

Download now
An A5 information guide about watching and understanding signals and cues from a premature baby.

Translated from the French publication Je vous parle, regardez-moi! Produced by SPARADRAP.

Skin to skin with your premature baby

Download now
An A5 information guide to help parents do skin-to skin with a baby in neonatal care.

You could also direct parents to the skin-to-skin information on our website (or tell them to search on the Bliss site for 'skin-to-skin').

Getting involved info card

Download now
An A5 double sided info card giving parents tips on how to get involved in their baby's care on the unit.

You could also direct parents to the looking after your baby on the neonatal unit (or tell them to search on the Bliss site for 'looking after your baby' or 'family centred care').

Mental health info card

Download now
A double sided A5 info card giving parents tips on how to look after their mental health whilst on the neonatal unit.

You could also direct parents to the information on mental health on our website (or tell them to search on the Bliss site for 'mental health').

About neonatal care leaflet

Download now
This leaflet has been written especially to answer the questions parents might have when they first arrive on the unit.

It explains how neonatal care works, who parents might see on the unit, what the equipment does, the care their baby might get, and how they can parent their baby on the unit. It also has helpful ideas for getting more support, and places to write down questions parents might have, or notes on how they're feeling.

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Download now This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit. This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

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Positioning and Attachment - Breastfeeding

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Hello! We are the infant feeding team! Jackie and Naomi share the role of Infant Feeding Leads at Salisbury Hospital. Also, in our team you may meet Sophie who works alongside us. There will also be another member of the team joining us soon.         Our office is based on the neonatal ward, but we work throughout maternity and occasionally the children's ward. We are passionate about supporting mothers and their families to reach their feeding goals and supporting the loving relationship between parents and their new baby. We work Monday – Saturday.  If you find you are struggling with any aspects of feeding, then talk to your midwife who will be your first  point of call, if they feel you require extra support a member of the Infant feeding team will pop up and see you on the postnatal ward.                                                             If you are at home, your community midwife feels that you need specialist support, then they will refer you into one of our specialist clinics.               We aim to see you within 72 hours.                              As well as giving families support on labour ward, postnatal and the neonatal ward we also run a tongue tie and specialist clinic, where we see mums for extra feeding support. Many of the issues we see include positioning and attachment, sore cracked nipples, recurrent mastitis, support with feeding plans, weight loss and tongue ties.  We can also assess your baby for tongue tie and divide it if necessary. We would only investigate and divide a tongue tie based on feeding issues that are present currently.                                              We also hire out electric pumps so please get in contact if you would like to hire one from us. We currently hire the Ardo Calypso for 14 days. We ask for £10 which goes towards our hospital charity, the stars appeal. We can also help to measure you and make sure that the pump you are using is the correct fit.                                                                            The information on this website should provide a useful introduction to your options around feeding your baby – it is never too early to think about this, so please be sure to ask your community midwives for support and information as you start (or continue!) your journey into parenthood. We are here to support you until your baby is 4 weeks old, whether that be a text, phone call or a referral into our specialist clinic. If you are already here in the hospital for an appointment and you would like to see us, in most cases where we can, we will come to you, so please do not hesitate to ask. We look forward to welcoming you and your baby!  We are always working to make the service Iwe provide better, so please do provide us with feedback!

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Hello! We are the infant feeding team! Jackie and Naomi share the role of Infant Feeding Leads at Salisbury Hospital. Also, in our team you may meet Sophie who works alongside us. There will also be another member of the team joining us soon.         Our office is based on the neonatal ward, but we work throughout maternity and occasionally the children's ward. We are passionate about supporting mothers and their families to reach their feeding goals and supporting the loving relationship between parents and their new baby. We work Monday – Saturday.  If you find you are struggling with any aspects of feeding, then talk to your midwife who will be your first  point of call, if they feel you require extra support a member of the Infant feeding team will pop up and see you on the postnatal ward.                                                             If you are at home, your community midwife feels that you need specialist support, then they will refer you into one of our specialist clinics.               We aim to see you within 72 hours.                              As well as giving families support on labour ward, postnatal and the neonatal ward we also run a tongue tie and specialist clinic, where we see mums for extra feeding support. Many of the issues we see include positioning and attachment, sore cracked nipples, recurrent mastitis, support with feeding plans, weight loss and tongue ties.  We can also assess your baby for tongue tie and divide it if necessary. We would only investigate and divide a tongue tie based on feeding issues that are present currently.                                              We also hire out electric pumps so please get in contact if you would like to hire one from us. We currently hire the Ardo Calypso for 14 days. We ask for £10 which goes towards our hospital charity, the stars appeal. We can also help to measure you and make sure that the pump you are using is the correct fit.                                                                            The information on this website should provide a useful introduction to your options around feeding your baby – it is never too early to think about this, so please be sure to ask your community midwives for support and information as you start (or continue!) your journey into parenthood. We are here to support you until your baby is 4 weeks old, whether that be a text, phone call or a referral into our specialist clinic. If you are already here in the hospital for an appointment and you would like to see us, in most cases where we can, we will come to you, so please do not hesitate to ask. We look forward to welcoming you and your baby!  We are always working to make the service Iwe provide better, so please do provide us with feedback!

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While birth is the end of your pregnancy journey, many medical professionals and experienced parents acknowledge that a new mom's physical and emotional experience is just beginning.

Likewise, your newborn is encountering unfamiliar territory, too. The big wide world they've unwittingly entered is nothing like the warm and cozy womb they've called home for the last few months.

The first 12 weeks of life on the other side of pregnancy will be a whirlwind, but you and your baby will navigate this uncharted territory together. Welcome to your new reality - the fourth trimester.

The fourth trimester is the idea of a transitional period between birth and 12 weeks postpartum during which your baby is adjusting to the world and you're adjusting to your baby.

While there's often much to be celebrated, it can also be a physically and mentally taxing time for parents and a period of major developmental changes for your baby.

Dr. Harvey Karp, renowned pediatrician and author of "The Happiest Baby on the Block," is credited for popularizing the concept of the fourth trimester.

According to Karp, even full-term human babies are born "too soon," and he encourages parents to think of their little ones as fetuses outside the womb for the first 3 months of their lives.

Parents also experience major transition during the first 12 weeks. The learning curve is real; it takes time to master those swaddling skills and distinguish cries of hunger from those of discomfort.

Additionally, birth parents may be contending with postpartum pain, breastfeeding challenges, and fluctuating hormones.

Throw in some sleep deprivation and it's fair to say that new parents have a whole lot on their proverbial plates.

The first 3 months of your baby's life may seem like a blur of poop and spit-up, but there is an abundance of activity occurring on a cellular level, and you get a front-row seat for all the developmental changes.

By the time a newborn hits the 3-month milestone, they've become little people with budding personalities, curious minds, and basic motor skills. In the meantime, there's a lot you'll be doing to support that development.

Why this time is important

There's a compelling reason Karp believes babies are born too soon - a newborn's nervous system and brain aren't entirely developed at birth. It takes time for a baby to create those important synapses that help them master skills like smiling.

Fortunately, you can encourage this brain-cell connectivity by interacting with your newborn - holding, rocking, and talking to them fosters activity in a baby's blossoming brain.

Additionally, while a baby is born with all five senses, some need additional time to mature. A newborn sees light and dark items within an 8- to 10-inch radius most distinctly. By the end of the fourth trimester, however, many babies are better able to focus on smaller items and to notice colors.

Of course, the fourth trimester also lays the foundation for your baby's continued physical growth and muscular development.

At birth, a newborn has an array of reflexes - they innately startle, grasp, suck, and root for food. However, throughout the first 3 months of life, a baby's responses will become less automatic and more controlled.

While a newborn tends to resemble a bobble-head doll in the first couple of weeks, early tummy time work will help them gain the ability to lift their head, push up with their arms, and stretch out those scrawny little legs. It's fascinating how quickly they can master these all-important moves and gain muscular strength.

Sometime in the fourth trimester, a baby might also learn to bring their hands together, grab a toy, and track a moving item. While all of these are important developmental advances, in the meantime you'll be doing a lot of the same things to care for your fourth trimester baby.

Lots of feeding

Newborns eat often. Whether you're breastfeeding, expressing milk, or formula feeding, you'll likely be offering the breast or bottle 8 to 12 times per day or every 2 to 3 hours.

A newborn will initially consume about an ounce per feeding, graduating to 2 to 3 ounces by 2 weeks of age and 4 to 6 ounces by 3 months.

Babies go through sudden growth spurts, so you might find your little one sometimes requires more frequent feedings and/or additional ounces. Cluster feeds can have a breastfeeding mom nursing around the clock - so trust your instinct and watch for hunger cues.

If your baby is steadily gaining weight and consistently wetting diapers, you can feel confident they're getting what they need.

Lots of soothing to sleep

On average a brand new baby will snooze for 14 to 17 hours in a 24-hour span. Unfortunately, this sleep schedule is quite erratic. New babies have shorter sleep cycles and more frequent wakings. Moreover, many babies start off with their days and nights confused, further fueling the exhaustive routine.

Fortunately, around 6 to 8 weeks, babies begin to sleep less during the day and more in the evening hours. While most infants won't sleep through the night for another few months (many stop needing nighttime feedings around the 4- to 6-month mark), it's encouraging to know that longer stretches will come as you approach the end of the fourth trimester.

Lots of interpreting crying

A newborn cries as a means of communication. It's their way of letting you know they're wet, distressed, tired, uncomfortable, or hungry.

It can be disheartening listening to a baby's incessant wails; but, rest assured, that periods of fussing are completely normal, and crying usually peaks around 6 weeks of age - so there is a light at the end of the fourth-trimester tunnel.

If a healthy baby cries for 3 or more hours a day for 3 weeks, they may be suffering from colic. While many people believe colic may be connected to tummy troubles, the underlying causes are actually unknown.

Holding and comforting your newborn is key during these ornery hours, but it might not completely quell the crying. It can be trying while it lasts, but colic is temporary and typically ends in tandem with the fourth trimester.

Babies seem to have it made, but life on the outside is harder than it looks, and your wee one may need constant comforting and care during these first weeks.

The good news: You can't spoil a newborn. Holding them for extended periods of time will not make them dependent, so feel free to snuggle to your heart's content and your baby's satisfaction. They'll thrive with your close attention and affection.

There are some additional tactics you can try:

The 5 S's

The stark and bright disruptions of a baby's new normal can be intimidating at first. Part of Karp's theory of the fourth trimester involves helping your baby to slowly adjust to the change of leaving the womb for the world. Recreate a serene gestation-like scene, and help them feel like they're back in the womb - safe, secure, and snug.

The 5 S's, as coined by Karp, will help you find what works best for your baby.

Swaddle

Bundling a baby and restricting the free movement of their arms and legs can have an instantly calming effect on a fussy newborn. It mimics the snugness they experienced in the womb and reduces the startle reflex.

Swaddling may also work well to help your baby sleep. Keep in mind that - like the fourth trimester - swaddling is temporary and should be stopped once your baby starts trying to roll over.

Side or stomach

While a baby should always be placed on their back for sleep, you can soothe a fussing newborn by holding them on their side or by placing them over your shoulder and gently putting pressure on their tummy.

Shush

The perpetual sound of blood rushing around your body helped lull your baby into a state of relaxation while in utero. White noise machines can help create comforting acoustics during naps and bedtime.

Swing

For 9 months, you were your baby's on-the-go swing. Your perpetual movements would rock your little one to sleep inside the womb.

Whether you cradle your baby and gently sway, sit in a glider, or use a fancy swing, experiment with different motions and speed to find a rhythm that soothes your baby.

Suck

Sucking is a reflex and an innately reassuring action, and pacifiers can help a newborn self-soothe. Note that if you are breastfeeding, you might want to wait a few weeks before introducing the binky to avoid potential nipple confusion.

Other tactics

Some newborns respond well to water and are soothed by a warm bath. Others enjoy a gentle massage. Wearing a baby in a sling or carrier can also be very effective; they free your arms but give your sweetie the physical closeness they crave. Check for the correct sizing and wear of your baby carrier in order to reduce risk of injury

Remember that a newborn can easily become overstimulated, so keep things dim and quiet whenever possible.

Becoming a parent is transformative. In a split second, you become responsible for a tiny and helpless human being (no pressure).

The early days of parenthood will be rewarding and stressful - full of exciting firsts and tremendous trials. These challenging 12 weeks will test your patience and exhaust you beyond measure.

It's a push and pull; you'll want to relish every moment while eagerly awaiting a more predictable phase.

The emotional and physical toll

It's normal to feel a range of emotions as a new parent. One moment you'll be elated, the next you'll question your ability to raise a child. The fourth trimester is a bumpy ride full of highs and lows.

One of the challenges is feeling on your own. In contrast to the regular doctor visits and checkups you experienced at the end of your pregnancy, after delivery you may not see your own caregiver again for 4 to 6 weeks.

During those first few weeks, many birth parents will experience a fleeting case of the "baby blues." Postpartum depression, on the other hand, sticks around and can have a completely oppressive presence in a new parent's life.

If you are feeling helpless, hopeless, or unable to take care of yourself and your baby, seek professional help.

In the first 6 to 8 weeks, a birth parent is also recovering from the very real trauma of childbirth, be it a vaginal delivery or C-section.

Vaginal soreness from delivery can make just about any level of activity uncomfortable, and bleeding and cramping may continue for weeks. And if you had a C-section, you will need even more downtime as your body recovers from major surgery.

Most birth parents will have their first postpartum checkup 6 weeks after giving birth, but that wait can feel interminable when you are hurting physically or suffering emotionally - so never hesitate to reach out to your doctor.

No two recoveries are completely alike, and you need to listen to your body. It can be hard to strike balance between taking care of yourself and tending to your baby, but a healthy, happy parent is more equipped for the journey of parenthood, so be sure to prioritize your own needs too.

The fourth trimester is what you've been waiting for - your baby has arrived and you are officially a parent! Enjoy this fleeting time. It will be frustrating, draining, and so incredibly rewarding.

Your baby might struggle to adjust to life outside the womb in those first 12 weeks, too, but they will find comfort and contentment in your loving arms. You've got this.

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Understanding the 4th Trimester: What to Expect for Your Baby and You

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While birth is the end of your pregnancy journey, many medical professionals and experienced parents acknowledge that a new mom's physical and emotional experience is just beginning. Likewise, your newborn is encountering unfamiliar territory, too. The big wide world they've unwittingly entered is nothing like the warm and cozy womb they've called home for the last few months.

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Guide to bottle feeding including how to sterilise equipment.

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Guide to bottle feeding leaflet - Baby Friendly Initiative

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This leaflet provides families and health professionals with key information about bottle feeding and how to make up feeds safely.

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This leaflet is designed to give parents comfort and confidence in the care of their sick or premature baby.

This leaflet covers a wide range of issues and provides a useful tool to help conversations with parents on the neonatal unit.

Printed copies are available for £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.

Public Health Wales have produced a version of the You and Your Baby neonatal leaflet in Welsh, which is free to download.
Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning, please use our digital resources order form.

You and Your Baby: Supporting Love and Nurture on the Neonatal Unit leaflet

More neonatal resources to support you

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You and your baby leaflet - Baby Friendly Initiative

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This leaflet covers a wide range of issues and provides a useful tool to help conversations with parents on the neonatal unit.

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Conversations in pregnancy - Antenatal signature sheet - Baby Friendly Initiative

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Home > Baby Friendly Resources > Implementing Baby Friendly standards resources > Guidance for antenatal and postnatal conversations > Conversations in pregnancy - Antenatal signature sheet

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Expressing your colostrum (Harvesting breast milk) during your pregnancy. This leaflet will explain the benefits of doing this, when and how.
If you have any questions please contact your community midwife or the Infant Feeding Team

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts.

Mothers are normally advised to wait until around 36 weeks before starting antenatal expression. Mums who are having multiple births may sometimes start sooner as giving birth earlier is more likely.
Why do it?
For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

Colostrum contains vital immunological properties and helps to colonise the baby's gut with healthy bacteria that protect against allergy and disease.

It also contains the perfect balance of proteins, fats and micronutrients needed for human babies as well as acting as a laxative to help the passing of the first tarry meconium stools.

Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and therefore may require supplementary feeds.

These include babies:

whose mother had diabetes in pregnancy or who has a history of diabetes.

with a cleft lip or palate identified during pregnancy.

with congenital conditions e.g. Down syndrome or cardiac complications.

diagnosed with intrauterine growth restriction.

whose mother is taking beta blockers to control high blood pressure.

who are twins or triplets.

Where there is a family history of cow's milk protein sensitivity or type 1 diabetes, families may be particularly keen to avoid the use of early formula supplementation.

Some women may need to consider supplementing feeds from an early stage if there are concerns over their ability to make and/or secrete milk.

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

It is important for a mother to discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies, or have a surgical stitch, for example.

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect. A pump at this stage is likely to be more uncomfortable than gentle hands. Try hand expressing for a few minutes, 2 or 3 times a day.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth. Your health care provider may be able to supply you with sterile syringes.
How to hand express:

Always wash your hands before expressing.

Applying a warm compress to your breast or expressing after a warm bath or shower can help the flow of colostrum.

Get yourself comfortable. Perhaps seated and leaning slightly forward but find what works best for you.

Start with a gentle breast massage, stroking from the back of your breast towards the nipple to encourage the let-down reflex.

Put your thumb above the nipple and your first few fingers below the nipple. You will be cupping the breast in a 'C' shape.

With your thumb and fingers, feel a few centimetres back from the nipple.

Press back towards your chest, then compress (press your fingers together), and release.

Repeat this process, building up a rhythm. Press, compress, release.

It may be useful to look online for videos of hand expression techniques.

Colostrum should start to arrive drop by drop. Initially it may just be a glisten on the end of your nipple, and it may take a few days of practice before drops appear.

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe). If nothing happens, adjust your finger position slightly to find the spot that works for you. Try not to pinch your nipple or slide your fingers uncomfortably over the skin.

Rotate the position of your fingers and thumb around the areola (imagine a clock face) and repeat the expressing process to stimulate and remove colostrum from different parts of your breast.

Express each breast twice during each session.

Colostrum can vary in appearance. Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner. Expressing colostrum antenatally will not decrease or increase your milk supply after baby is born.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

At the end of the collecting day, the colostrum can be frozen - place the syringe into a zip-lock bag before putting into the freezer. Label the syringe and bag (separately) with the date and time of when you expressed.

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.
Is it safe?
The oxytocin hormone released when expressing, stimulates the uterus. Opinions differ on whether expressing colostrum antenatally is likely to induce labour. Those who advocate it do not believe that expressing would constitute sufficient stimulation to start labour. Sex while pregnant and breastfeeding through pregnancy both release oxytocin and both are generally considered safe while pregnant. If you experience any cramping in your uterus however, you should stop expressing and discuss your choice with your healthcare provider.
Transporting your frozen colostrum
You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

It's a good idea to mention your colostrum stores on your birth plan and make sure staff are aware in advance of your wishes in certain situations. The hospital may have access to a freezer for storage once you arrive.

After the birth, breastfeeding should usually be unrestricted. Ideally, a baby should feed successfully at the breast and the antenatally expressed colostrum would remain unused.

If your baby is experiencing difficulties with breastfeeding at this time, you may be encouraged to express some fresh colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you in preference to using any formula.

If harvested colostrum ends up being 'wasted' because you are able to establish early exclusive breastfeeding, this is a cause for celebration rather than commiseration!

The process of antenatal expressing however, gives you a back-up if things don't go to plan which many families find reassuring. You'll also start your breastfeeding with a good sense of how to hand express and confidence about how your breasts work.

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Expressing your milk before your baby arrives - ABM

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy. Find out if it could be a useful tool for you.