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All types of birth can have an impact on our babies, and they can even hold some tension in their bodies just from being tucked up inside the uterus.

Tensions are common in the first few days of life, and should settle by around 1 week. You may see things like a preference to feed or look to one particular side, or less range of motion in the neck.

To help support your baby we suggest lots of skin to skin in an upright position - so baby can stretch their neck out and "bob" to help release it.

Gently encourage your baby to centralise their head, or look the other way if they have a preference.

Ensure you are breastfeeding on both sides - you may need to use alternative positions per side if baby has a preference.

If you are bottle feeding ensure you swap arms so babies can feed on both sides.

If you are concerned about birth tensions or feel they are persisting beyond 1 week, or you are having further feeding issues. Please contact our team on 07771 150396 or ask your community team to refer you.

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You can also find up to date information by visiting Beside You Kent at #BesideYou | Breastfeeding support in Kent and Medway

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The why, when and how of pumping breast milk

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The why, when and how of pumping breast milk

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Why Express Milk?

Expressing Milk

Storing Milk

Why express milk?

There are several reasons why you might need or want to express milk for your baby. These include:

when a baby can't breastfeed

to make more milk

a return to paid work

separation

choice

When a baby can't breastfeed

Babies and parents have many instincts for breastfeeding, but it is still a learned skill that can take time and practice. When babies won't breastfeed, it is usually because they can't. This could be for many reasons, for example:

they are preterm

they are unwell

they have a tongue tie

they are sleepy as a result of birth medications

they had a difficult birth

it is taking time to learn how to breastfeed

Expressing milk when your baby cannot nurse - or nurse effectively - protects your milk supply and provides milk to feed them. Breastmilk is especially important for babies who are unwell and/or preterm as it helps protect against illness and infections, and is ideal for a baby's sensitive and immature digestive system.

Expressing milk is often a short-term solution. However, some mothers may find themselves exclusively expressing breast milk (' exclusively pumping ') long-term when their baby is ill or has medical difficulties.

A return to paid work

There are many ways to combine working and breastfeeding. It is not always necessary to express milk when returning to work. It may depend on:

the age of your baby

the length of time you are apart

your willingness - and ability - to express; pumping is not effective for everyone, although there are ways to improve this.

your baby's willingness to take your milk when you aren't there

Many mothers express initially for reassurance and comfort, and to avoid blocked ducts and mastitis. However, you may find that your body quickly adjusts to a new breastfeeding pattern and you no longer need or want to express.

You and your baby may need to be apart. This may be for illness or health reasons, an appointment or event, or a night away.

Your baby has an intense need for your presence as well as your milk, and separation can be hard for both of you. It may be possible to take your baby with you - young babies are very portable and often enjoy being out and about.

Some mothers choose to express milk some or all of the time. You might want - or feel pressured - to let a partner or other family member feed your baby. Some parents choose to exclusively pump because they don't enjoy breastfeeding, but want their baby to have the benefits of their milk.

Expressing Milk

What kind of pump do I need?

Pumps are available to hire and to buy. The pump you use depends on your reason(s) for expressing and your personal preference. We all respond differently to pumps and have different needs.

Single electric pumps and manual pumps are best suited to occasional expressing, for example, short term separation or a return to work. They can also be used to express 'to comfort' any time your breast feels very full and your baby doesn't want to feed.

Double electric pumps express milk from both breasts at once, which often saves time. It is also said that they tend to stimulate more milk production. They are available as personal use pumps and 'hospital grade' pumps.

Hospital grade pumps are very powerful and are intended to be used by more than one person multiple times a day. They are usually hired. Hospital grade pumps are recommended when you are exclusively expressing, expressing very frequently, or trying to increase your supply. Parents might start with a hospital grade and then switch to a personal use pump once their supply is established and if they need to keep expressing.

Silicone pumps tend to be best suited to occasional use. Some mothers have found them helpful to relieve blocked ducts. (Note: When attached to the breast, a silicone pump is not just a device for collecting dripping milk - it creates a vacuum stimulating a 'letdown'. If this is not your planned use, it can create supply issues.)

Hands-free pumps come as single or double electric pumps. They can be handy for mums who want to pump on the go, or pump and multitask. Hands-free pumps have small motors and are possibly best suited to occasional pumping. You can buy or make a hands-free bra for a pump to fit in to.
Types of Pump (image above)
A. Manual breast pump
B. Single electric pump
C. Double electric pump

It is also possible to express without any equipment. Hand expressing is a great skill to learn for all ages and stages! It can take a little practice, but it can quickly become second nature:

It is free and can be done any time, anywhere!

It is the perfect choice for the early days when you are producing colostrum (you can collect - or 'harvest' - colostrum before your baby is born).

You can practise antenatally and become familiar with your breasts before your baby arrives.

Getting 'hands-on' during a pumping session can increase milk output. See Expressing Tips.

What else do I need to know about pumps?

Pumps are often sold in a standard size, however pump parts come in different sizes. The funnel-shaped piece that touches your breast is usually called a flange . The tubed-shaped bit that the nipple goes into is sometimes called the nipple tunnel

If pumping is comfortable with good milk flow, you probably have a good fit. However, if pumping is painful or causing swelling and/or rubbing, you may need a bigger or smaller flange. Sometimes a different flange size is needed for each breast. A poor fit can also reduce milk flow. ¹

The nipple should have enough room to slide in and out during pumping, without rubbing. The areola (darker area around the nipples) may move slightly with it, but it shouldn't be drawn into the nipple tunnel. After pumping, the nipple will almost certainly be bigger, but shouldn't seem darker or swollen. ²
Pump Flange Sizes (image above)
A. Milk expression
B. Flange is too big
C. Flange fits
D. Flange is too small
Suction strength and cycle speed
Electric pumps often come with a range of settings. There will be settings for suction strength and settings for cycle speed.

A pump is trying to mimic a breastfeeding baby. When a baby nurses, they do a fast, light suck to trigger a letdown. Once the milk lets down, the sucking slows and they swallow more.

You might begin by using a low suction, high speed setting and once your milk starts flowing, switching to a higher suction, lower speed setting.

Exactly how high or low depends on how it feels and if it is removing milk well. Expressing should be comfortable, and a pump provides most milk when it is set at the upper end of fully comfortable. ³

Painful pumping may impact milk flow, damage your nipples, and is unlikely to make you feel like doing it!

How often and when should I express?

If your baby can't breastfeed yet, aim to express 8-10 times in a 24-hour period, including at least once at night. These do not need to be at regular time intervals, but avoid stretches longer than 5 or 6 hours. Once your supply is well established, you may find that you can get by with fewer sessions.⁴

If you are trying to make more milk, express after or between feeds. How often depends on how much more milk your baby needs and how feeding at the breast is going.

If you are returning to paid work, how often you express will depend on a number of things. Some parents look at how often they feed on average in a 24-hour period and work out how many feeds they will typically have when they are with their child, so express the same number of times when separated to maintain this daily average.

If you are stockpiling milk for short-term separation or in the run up to a return to work, express once or twice a day after or between feeds. If your baby typically feeds from one breast, you could express from the other side while they feed. The amounts may seem small, but they quickly build up!

Some mothers try 'power pumping' as a short-term strategy to increase their milk supply, or when they are struggling to fit pumping into their daytime routine. This approach involves expressing very frequently for short periods, stopping and starting as many times as possible - it is said to mimic cluster feeding.

How long should I express for?

Just like breastfeeding, expressing milk is not a 'one-size-fits-all'. Observe your milk flow, notice how your breasts feel and find what works for you.

If you are using a single pump, this usually takes about 20-30 minutes for both breasts. You might try switching sides when the milk flow slows, usually every 5-7 minutes.⁵

Double pumps save time. A double-pumping session that replaces what would have been nursing will probably last no more than 15 minutes. However, it is more important to pay attention to your breasts than the clock.⁶

How much milk will I express?

How much we can express at any one time depends on lots of different things. If you've never used a pump before, it might be helpful to think of the first pumping sessions as practice. ⁷

Expect small amounts in the early days. This will be drops for some and as much as a teaspoon for others. Many parents think of it as 'putting in their order' for more milk later.⁸

If you are breastfeeding full-time, expect to express around 15-60ml (0.5-2 fl oz) in total from both breasts per pumping session.⁹

If you are exclusively pumping, consider the overall volume in 24 hours. Full milk production is about 750-900 ml (25-30 fl oz) per baby. Milk production reaches its peak at about five weeks and stays relatively stable until around six months.¹⁰

Once milk production peaks, a typical feed is about 60-120ml (2-4 fl oz).¹¹

We all respond differently to pumps. How much you can express is not always a reliable or accurate sign of how much milk is there. It's important to remember that a baby who is nursing effectively will get more milk than a pump.

Expressing tips

Before expressing:

Wash your hands and get comfortable

Put something warm on your breasts, such as a warm flannel

Gently massage your breasts

Use any objects or techniques that help you to feel calm and relaxed. This might be a photo of your baby, an item of their clothing, a favourite warm drink or snack, music or visualisations.

While expressing:

Try 'hands-on pumping'. This is said to produce better results than relying on a pump alone¹²

Use breast compression to increase milk flow

Take a break midway and gently massage the breasts to help increase the amount of milk.¹³

Hand express from both breasts after you have finished pumping.

Try nursing your baby on one side and expressing on the other, or expressing from both sides at the same time, to encourage more letdowns

After expressing:

Hand-express for a minute or two to help increase output and supply.

Cleaning pump parts

There is not complete agreement about cleaning pumping equipment. Some public/advisory bodies (including NHS England) recommend sterilising equipment after every feed.

Others recommend washing pump parts thoroughly after every feed and sterilising once a day.

Some advisory bodies and breastfeeding organisations state that pump parts do not need to be sterilised, and that washing in hot soapy water is enough if your baby is healthy and full term.

Day-to-day milk handling

There is very little research on the day-to-day problems of milk handling, so guidelines often err on the side of caution.

Fresh human milk kills almost all bacteria, viruses and fungi that it comes in contact with.¹⁴

Mothers who are exclusively expressing, or expressing frequently, sometimes put the whole pumping kit (flanges attached) in a clean container in the fridge until the next expressing session and clean everything at the end of the day.

Breastmilk can be safely stored at room temperature for up to 4 hours (see below). Some parents apply the same timeframe to their pump and pump parts, and express multiple times within a 4 hour period before cleaning everything.

One quick method of sterilising is to use a sterilising fluid that you change every 24 hours. Submerge pump parts in the solution after washing them each time.¹⁵

Washing and drying

Ensure hands and pump area are clean.

You may like to use a separate basin and separate utensils for cleaning pump parts and equipment rather than the sink.

Clean with hot soapy water and rinse separately with clean water.

Some pump equipment is also dishwasher-safe.

Air dry or dry with paper towels.

Clean pump dials and switches with a disinfectant spray or wipe.

Store dry pump equipment in a clean container.

If you are expressing milk for a sick or premature baby, good hygiene is vital and sterilising is essential.

Storing Milk

How long can I store milk for?

There isn't complete agreement about milk storage.

Wherever you are storing milk, the fresher it is, the better.

Good hygiene is important - clean hands, clean pump parts, clean storage.

For healthy, full term babies ¹⁶:
Room temperature

Ideally, use within 4 hours.

Depending on room temperature and how clean storage conditions are, up to 6-8 hours may be safe.

Frozen milk that has thawed and kept at room temperature should be used within 4 hours.

Fridge

Ideally, use within 4 days.

When conditions are very clean, 5-8 days may be acceptable.

Store milk in the back of the fridge rather than in the door.

Frozen milk that has thawed in the fridge should be used within 24 hours.

Freezer

Ideally, use within 6 months.

Can be stored for up to 12 months.

Store at the back of the freezer, away from the door where temperatures may fluctuate.

Insulated bag
Milk left over after a feed should be used within 1-2 hours as it mixes with a baby's saliva, although it may be safe to put it in a fridge for up to 4 hours. ¹⁷

For premature or sick babies, consult with hospital staff and follow hospital guidelines.

Combining expressed milk

When combining milk expressed at different times, mix cold with cold:

Chill newly expressed milk before adding it to an existing container.

You can add refrigerated milk to frozen as long as there is less refrigerated milk than frozen.

Use within the time limit of the oldest expressed milk.

What can I store milk in?

You can store milk in any clean container, such as a hard (BPA-free) plastic or glass container with a tight-fitting lid, or a disposable milk storage bag.

Milk expands in the freezer, so leave space in the bag or bottle if you plan to freeze it.

Put the date on the container.

How much milk should I store?

Store milk in small quantities to avoid waste. Small amounts also defrost more quickly.

For babies older than one month, a feed is approximately 60-120ml. You could also store some smaller amounts in case you need to offer more.

How do I prepare stored milk?

You don't have to warm milk - some babies like it cold!

If you do warm milk, run the container under a warm tap or place it in a pan of warm water.

Never use a microwave or heat milk directly.

Swirl milk to combine rather than shaking it.

If defrosting milk, thaw it overnight in a fridge or hold it under warm running water.

Thawed milk should not be kept at room temperature. It should either be fed immediately or put in the fridge.

Smelly milk

Sometimes milk smells or tastes soapy after a short time in the fridge or freezer. This is because of an enzyme (lipase) that breaks down fats in milk. The milk is completely safe and most babies will drink it. However, if they refuse to, heat freshly-expressed milk to scalding (bubbling around the edges, but not boiling) and then quickly cool and freeze it. Scalding reduces some of the immune factors, but may be the only option for some families. You can also experiment with the length of storage time needed for the milk to acquire the smell.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Further Reading

Bottles and other tools
Comfortable Breastfeeding
How to increase your milk supply
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
Sleepy Baby - Why and What to Do When Mum Can't Be There
Working and Breastfeeding

Online Information

Hand expressing:

Maximizing milk production when expressing:

Books

La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010.
Marasco, L & West, DMaking More Milk, McGraw Hill, New York: 2019.
Mohrbacher, N.,Breastfeeding Answers, Nancy Mohrbacher Solutions, Illinois: 2020.
Ruddle, L.,Relactation: A Guide to Rebuilding Your Milk Supply, Praeclarus Press, Texas: 2020.

References

1. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 298.

2. As above, p304.

3. As above, p489.

4. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 300.

5. As above, p500.

6. Bonyata, K. I'm not pumping enough milk. What can I do? Accessed: 28 March 2023.

7. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 307.

8. As above, p301.

9. As above, p300.

10. As above, p309.

11. As above, p515.

Copyright LLLGB 2023

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Expressing & Storing Milk - La Leche League GB

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Why Express Milk? When a baby can't breastfeed Making more milk A return to paid work Separation Choice Expressing Milk What kind of pump do I need? What else do I need to know about pumps? How often and when should I express? How long should I express for?

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Getting the right FIT with your breastpump

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Getting the right FIT with your breastpump

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Preventing Neonatal Herpes - why we don't encourage kissing newborns

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Preventing Neonatal Herpes - why we don't encourage kissing newborns

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Neonatal herpes is a herpes infection in a young baby. The younger the baby, the more vulnerable they are to the harmful effects of infection. Herpes can be very serious for a young baby, whose immune system will not have fully developed to fight off the virus.
Neonatal herpes, which is rare in the UK, is caused by the herpes simplex virus. This virus is very common and causes cold sores and genital ulcers in adults.

Neonatal herpes can be prevented by following some simple advice.

How does a newborn baby catch herpes?

During pregnancy and labour

If you had genital herpes for the first time within the last 6 weeks of your pregnancy, your newborn baby is at risk of catching herpes.

There's a risk you will have passed the infection on to your baby if you had a vaginal delivery.

This risk is much lower if you have had genital herpes before.

After birth

The herpes simplex virus can be passed to a baby through a cold sore if a person has a cold sore and kisses the baby.

The herpes virus can also be spread to your baby if you have a blister caused by herpes on your breast and you feed your baby with the affected breast or expressed breast milk from the affected breast.

A baby is most at risk of getting a herpes infection in the first 4 weeks after birth.

You should not kiss a baby if you have a cold sore to reduce the risk of spreading infection.

Cold sores and other blisters caused by the herpes virus are at their most contagious when they burst. They remain contagious until completely healed.

What are the warning signs in babies?

Because newborn babies have underdeveloped immune systems, they can quickly become seriously ill after catching the virus.

Call a GP or contact 111 straight away if your baby:

These are early warning signs that your baby may be unwell.

Call 999 immediately if your baby:

is lacking in energy (listless)

is becoming floppy and unresponsive

is difficult to wake up from sleep

has breathing difficulties or starts grunting

breathes rapidly

has a blue tongue and skin (cyanosis) - if they have brown or black skin this may be easier to see on their lips, tongue and gums, under their nails and around their eyes

Very often the baby will not have any specific herpes symptoms, such as a rash.

But they can become unwell very quickly, so you need to act fast.

How is neonatal herpes treated?

Neonatal herpes is usually treated with antiviral medicines given directly into the baby's vein (intravenously).

This treatment may be needed for several weeks.

Any related complications, such as fits (seizures), will also need to be treated.

You can breastfeed your baby while they're receiving treatment, unless you have herpes sores around your nipples.

If you are taking antiviral treatment too, this can be excreted in your breast milk, but is not thought to cause any harm to your baby.

How serious is herpes for a baby?

Sometimes neonatal herpes will only affect the baby's eyes, mouth or skin.

In these cases, most babies will make a complete recovery with antiviral treatment.

But the condition is much more serious if it has spread to the baby's organs.

Many infants with this type of neonatal herpes will die, even after they have been treated.

If widespread herpes is not treated immediately, there's a high chance the baby will die.

How can neonatal herpes be prevented?

If you're pregnant and have a history of genital herpes, tell your doctor or midwife.

You may need to take medicine during the last month of pregnancy to prevent an outbreak of vaginal sores during labour.

Delivery by caesarean section is recommended if the genital herpes has occurred for the first time in the last 6 weeks of your pregnancy.

If you develop a cold sore or have any signs of a herpes infection, take these precautions:

do not kiss any babies

wash your hands before contact with a baby

wash your hands before breastfeeding

cover up any cold sores, lesions or signs of a herpes infection anywhere on your body to avoid passing on the virus

Support and advice if you have been affected

You may find these resources helpful:

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Information on neonatal herpes (herpes in newborn babies), with links to other useful resources.

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Your baby's theory test to learn how to feed!

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This resource, which also has an accompanying app, supports you to understand how babys sleep, how to keep them safe and what to expect in the early days.

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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Within this padlet by Chelsea and Westminster they have compiled as much feeding information as possible in an incredible number of languages

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Colostrum Harvesting Drop-in Updated Poster

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Breast engorgement is a really common breastfeeding issue.

It often happens within the first week postpartum as your milk "comes in" and transitions from colostrum to mature milk. Engorgement may also happen as fluid shifts in your body after labor and delivery or if you go too long between feedings.

Engorgement is NOT fun - it feels like your breasts have filled up like balloons! Your breasts feel full, firm, and tender to touch.

Because of all the excess fluid around the nipple, being engorged makes it more difficult for your baby to latch and for you to pump.
An easy technique called Reverse Pressure Softening (RPS) helps by removing the fluid around the nipple area so your baby can latch better.

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Reverse Pressure Softening - A Step-by-Step Tutorial - Milkology®

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Breast engorgement is a really common breastfeeding issue. It often happens within the first week postpartum as your milk "comes in" and transitions from colostrum to mature milk. Engorgement may also happen as fluid shifts in your body after labor and delivery or if you go too long betwe

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There are times when mothers are separated from their child for work or for school. It is important to know that you can still provide milk for your child when you are away and you can maintain your breastfeeding relationship.

How often will I have to pump when I go back to work or school (college)?

How long you are apart from you baby influences this decision. Ideally, you would pump as often as your baby would nurse. This may not be possible with your work/ school schedule. Most mothers find that pumping every 2-3 hours maintains their milk supply and does not cause them to become uncomfortably full.

For example, if a mother worked an 8 hour work day, she would nurse her child before coming to work, then pump mid-morning, at lunchtime and then mid-afternoon. She would nurse her baby when she returned home.

Should I single or double pump?

Using a pump that can express milk from both breasts at the same time will save the most time. It may take about 15 minutes to pump both breasts instead of 30 minutes or more to pump each breast separately. Double pumping also provides very strong stimulation to keep a good milk supply. Prolactin, which is an important hormone for making milk, becomes very elevated when mothers double pump.

Is there any way to decrease the number of times I have to pump at work?

If it is possible for you to go home at lunch, or have someone meet you on your break with your baby, you can breastfeed instead of pump. Some employers have onsite child care and this could allow you to take your breaks with your baby.

Some babies develop a pattern known as "reverse cycle breastfeeding." (Gale Pryor / Nursing Mother, Working Mother). This means that your baby will sleep more while you away and breastfeed more when you are together. If this happens, you may find you need to pump less when you are away from your baby. Keep your baby near you at night, so that you may nurse easily and get as much sleep as possible.

How Do I Choose a Breast Pump?

They type of breast pump you need depends very much on your situation. Your ability to pump well will depend on matching your specific needs to the best pumping system that meets those needs.

If you do need to leave your baby because you are returning to work or school, a good pump will be needed. There are many options to choose from. It is important to choose one that will meet your specific needs. Some things to consider are cost, efficiency, how easy it is to transport and how much noise it makes.

If you only need to pump occasionally, a hand operated pump may be the right one. They are small, easy to carry and use and are not very expensive (for example they may cost $20-50 in the US). One pump that is no longer recommended is the "bicycle horn" style manual pump. This pump did not work well and many mothers found it to be uncomfortable to use.

If you will only be away a few hours a day and only need to pump once or twice, a small electric pump may be appropriate. The cost of these range from about $50 to $150 in the US. Some are double pumping styles, others will pump one breast at a time. Some of them are fairly quiet, but some are rather noisy. These can be plugged into the wall or use batteries. Some have AC adapters.

If you will be away for 8 or more hours, a double electric pump is likely the best choice. These are recommended if the time you have to pump is limited and/or you will be pumping 3 or more times per day. These pumps are automatic and they have a suck release cycle that mimics the pattern of a baby nursing. They can be fairly large, and come in carrying cases that resemble a large handbag. These cases hold all of the accessories needed. They are usually quiet. They cost between $200 - 300 in the US and are classified as single user pumps by the manufacturers.

The last option is the hospital grade pump, also called the multi user pump (USFDA). This is a very strong pump and is used when mother and baby are separated, such as pumping milk for a premature baby in the hospital, or if mother needs strong stimulation to increase her milk supply. These are rarely purchased. Most mothers rent them from a hospital or from a Durable Medical Equipment Company.

Many mothers find it helpful to talk with their friends about whether or not a pump is needed, and if so, what kind worked best. Be sure to ask what features worked well and what didn't.

My friend no longer needs her pump and said I can use it. Is this okay?

It is important to know that most breast pumps are considered single user. Milk can flow backwards into the pump mechanism and cause contamination. For this reason, sharing or borrowing single user pumps is not recommended.

Pumping Tips

Pumping while away from your baby can be tricky. Finding the time and space to do it, as well as relaxing while you do it can be easier said than done.

Mothers who have successfully pumped are a great resource and can provide many suggestions to make the process easier. Here are some of those suggestions:

* Find a quiet place where you are not likely to be interrupted. You may want to look around your work area before you go out on leave to find the best place. It does not have to be fancy, but it should be private. The restroom is not an acceptable place to be asked to pump. Be aware that there are laws in place in some countries to protect you.

*Relaxing is important. Many mothers look at pictures of their babies, listen to music, drink water or have a snack. Some use their phones to watch videos of their babies or face time the baby and caregiver.

*Some mothers find that hand expressing for 1-2 minutes before using the pump gives them better results. The warmth of their hands and "Skin on skin" first provides good stimulation so that their milk is released better.

* Stay hydrated. Drink plenty of fluids so that you do not become overly thirsty. If you can snack as well as get a good meal break, this is helpful as well.

*Invest in a hands free pumping bra. There are several on the market or you can make your own. If you make your own, simply use a sports bra and cut holes where the flanges will go through. You can use duct tape to seal the edges so they don't fray.

*Invest in a good pump. It will be cheaper than formula in the long run and it will be more comfortable for you. Most manufacturer's have various sizes of flanges. Be sure your flange is not too tight, nor too loose.

The law

ACAS have produced a comprehensive guide for employers on Accommodating Breastfeeding in the Workplace.
http://www.acas.org.uk/media/pdf/2/i/Acas-guide-on-accommodating-breastfeeding-in-the-workplace.pdf
LLLGB also have useful information on pumping at work:
https://www.laleche.org.uk/working-and-breastfeeding/

USA
There are federal laws in place in the United States to protect you when pumping:
https://www.dol.gov/whd/regs/compliance/whdfs73.htm
Fact Sheet #73: Break Time for Nursing Mothers under the FLSA
This fact sheet provides general information on the break time requirement for nursing mothers in the Patient Protection and Affordable Care Act ("PPACA"), which took effect when the PPACA was signed into law on March 23, 2010 (P.L. 111-148).

Cleaning and Sanitizing Pumping Accessories
Hand Expressing
Feeding Breastmilk From a Bottle

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Pumping Milk - La Leche League International

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There are times when mothers are separated from their child for work or for school. It is important to know that you can still provide milk for your child when you are away and you can maintain your breastfeeding relationship. How often will I have to pump when I go back to work or school (college)?

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A nipple shield is a flexible silicone nipple that is worn over the mother's own nipple during breastfeeding.
When are they used?
Nipple shields can help establish breastfeeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast. However, very few benefit from using a nipple shield. Please consult a breastfeeding counsellor or health professional for one-to-one support before you use a nipple shield. A nipple shield can be a temporary solution but not a permanent fix to an underlying problem. They may affect transfer of milk to the baby which may contribute to poor weight gain and health problems for both mother and baby.
What might cause my baby to have difficulty with attachment?

Events around labour and delivery.

Use of artificial nipples.

Baby's physiology.

Other reasons a shield could be used:

Flat or inverted i.e. non protractile nipples.

Breast refusal.

Sore, cracked, bleeding nipples.

Weaning a baby from bottle to breast.

Re-lactation or induced lactation (adoptive breastfeeding).

Before using a nipple shield, consider:

Accessing skilled breastfeeding support, ideally face-to-face.

Prolonged skin contact, and 'biological nurturing' i.e. laid-back breastfeeding techniques.

Hand expressing drops of milk onto the nipple to tempt the baby to attach.

Regular (2-3 hourly) hand expressing of colostrum to protect milk supply.

Regular (2-3 hourly) feeding of expressed breast milk (EBM) via syringe/cup.

Trying different positions/techniques e.g. cross cradle hold and exaggerated attachment, lying down feeding, underarm hold.

Applying cold to a soft nipple to firm it.

Use of nipple massage, gentle use of breast pump or other suction device to draw nipple out.

If milk is in, deal with any engorgement to soften areola to facilitate attachment.

When breastfeeding is uncomfortable, using a nipple shield can feel like a quick fix, but shields are not a substitute for finding qualified breastfeeding support. If there is an underlying latching problem, adding a shield on top can risk blocked ducts and mastitis, supply reduction, and a baby not getting enough milk. Feeds can end up being long and unsettled and baby may take in more air. When the shield is removed, the underlying problems remain, and may even be worse as the baby has become accustomed to using the shield. Always try and find qualified help if breastfeeding is uncomfortable or challenging.
Care
Wash the shield with hot soapy water, rinse with clean water, dry carefully and store in a clean container.
Choosing a shield
Nipple shields are sized according to the diameter of the base of the mother's nipple. A poorly fitting shield can cause problems including reduced milk transfer and pain.

In the U.K., the standard sizes are 16mm (small), 20mm (medium) and 24mm (large). A larger 28mm size is available online but can be difficult to find.

The size of shield you use is not the same size as the pump funnel you use. Shields are a closer fit. Many shops will only sell one size and you may have to shop online to get a wider selection.

A 'contact' nipple shield has a cut away piece that allows baby's nose or chin to remain close to the breast. This is preferable to a shield where the baby's nose is pressed against plastic.
How to use a nipple shield
It's often helpful to place your baby in skin to skin contact well before you attempt a feed. This will stimulate baby's instinctive feeding behaviours and make attachment to the breast more likely to be successful.

First, try latching the baby without the shield if you feel you can. How long you spend trying to latch effectively without the shield is a very personal decision and will depend on how long ago the baby fed, the support you have, and how breastfeeding has been going in the past.

A warm wet shield sticks to the breast better - run the shield under warm water prior to use.

Roll the wet, warm shield back about halfway down the shank of the shield.

It may adhere to the breast better if you apply a little water or breastmilk around the edge.

Roll the shield back onto the breast so the nipple is drawn into the teat of the shield.

There are some videos online that show you how to apply a shield with this 'slightly inside out' method.

Attachment
Attachment technique is still important with a shield. Don't just poke the shield teat centrally into baby's mouth. Baby should be held close, mouth wide open and chin in contact with the breast. Once attached, you should notice their chin moving deeply to show active swallowing and you will often hear some swallowing at the beginning of a feed.

Towards the end of the feed (when baby's swallowing slows) it is a good idea to use breast compression while baby suckles to increase the milk and fat transfer to the baby. Offering baby both breasts at each feed will mean baby gets more milk.

The nipple shield is a projection of the nipple so, when the baby unlatches, it should look well rounded, just as though baby had a good latch directly at the breast. You should see milk in the shield when baby comes off. As using a shield is often associated with reduced milk transfer, it can be recommended to express in addition, to help protect your supply. Your breastfeeding counsellor or health professional can support you to consider how often this is needed, depending on how things are going.

It's a good idea to keep an especially close eye on baby's bowel movements and urine output while you're using a nipple shield, as these give an indication of milk intake. Baby should have about three tablespoon-sized yellow, grainy stools in 24 hours (after the fifth day) and have at least six wet nappies.

If baby is discharged from hospital using nipple shields, their progress should be closely monitored by the community midwife or health visitor.
Weaning from a shield
Be sure not to make this a battle with your baby, or they will resist more. Don't obsess with weaning off the shield to the point that you are unhappy with breastfeeding. As long as your baby is gaining weight well, there is no need to rush into trying to wean them from the shield. Don't cut down a shield to wean a baby off it - this practice is no longer recommended.

You may be able to remove the shield part way through a feed and continue without. You may only use a shield on one breast, or for the first few minutes. Some babies need only one or two sessions with the nipple shields, while others may need more.

Keep trying as often as you can and give it some time. Your baby might be more receptive to feeding without the shield when they are less hungry or sleepy. Some continue to use a shield for the duration of their breastfeeding experience, but most are able to stop using the shield after only a short time if they wish to.

Be patient while you work through this time of transition. Breastfeeding with a shield is still breastfeeding.

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Using a nipple shield with a breastfed baby - ABM

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Nipple shields can help establish breast-feeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast.

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KCHFT are running 2 virtual sessions per month and have face to face sessions being set up in some Districts. Please book your session using the QR code above on on the link below Getting ready to feed your baby - Kent family (kentcht.nhs.uk)

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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Breastfeeding Positions - Video - Global Health Media Project

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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Early Initiation of Breastfeeding - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother’s breast and attach on their own. This video shows early

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Infant Feeding Team Feedback - Google Forms

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…

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Laid back breastfeeding also known as Biological Nurturing

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Laid back breastfeeding also known as Biological Nurturing

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What is laid-back breastfeeding or biological nurturing?

Laid-back breastfeeding is where you to use a comfortable, reclined position to feed your baby. It's really a relaxed approach where breastfeeding is seen as a relationship between you and your baby, with no need to follow a series of instructions.

Laid-back breastfeeding is also known as biological nurturing or the natural breastfeeding position (Colson, 2003).

What are the benefits of laid-back breastfeeding?

Laid-back breastfeeding:

Helps to release your baby's many feeding reflexes.

Encourages high levels of the nurturing hormone oxytocin in both you and your baby, helping you both to learn how to breastfeed together.

Uses gravity, which helps to support your baby as they lie on your body, giving them the freedom to use their instinctive feeding behaviour. Gravity also helps your baby to latch more effectively as they're able to use their natural reflexes, so you're less likely to get sore nipples.

Uses skin-to-skin contact, although it also works well when you're wearing a thin layer of clothing or whatever you're comfortable in.

Many mums say laid-back breastfeeding helps them to bond with their baby and get to know them sooner. That's because laid-back breastfeeding encourages mums to spend lots of time with their baby in the laid-back position even when their babies are not hungry or feeding.

Can be used at any time - it's about you feeling comfortable and well-supported, and finding whatever position feels right for you and your baby.

(Colson, 2008, 2012, 2019)

Laid-back breastfeeding: how your newborn latches on

Mums and babies most commonly use laid-back breastfeeding in the hours after birth. This is when your baby may spend time lying tummy-to-tummy with you.

In this period of close contact, you might notice your baby wriggling, pushing with their feet, and moving their head from side to side on your chest. These are primitive feeding reflexes, and you are helping your baby to use these to find your breast (Vinall, 2015; UNICEF, 2019).

Laid-back breastfeeding after a caesarean

Laid-back breastfeeding is useful following a caesarean birth, or in any situation where it's difficult to sit comfortably upright. That's because it allows for you to find your own relaxed and supported position (Colson, 2019). If it's hard to move or lift your baby, ask someone to help you both to get comfortable.

Continuing with laid-back breastfeeding

As your baby learns to breastfeed, they'll probably adapt easily to different positions, making laid-back breastfeeding very flexible, whether you're at home or out of the house.

If you're finding breastfeeding difficult, uncomfortable or painful, the laid-back breastfeeding approach can often help and breastfeeding counsellors use it widely (Vinall, 2015). To find your nearest breastfeeding counsellor or support group, call our Infant Feeding Support line on 0300 3300 700.

How to do laid-back breastfeeding in public

Laid-back breastfeeding doesn't have to be a very reclined or exposing position. In fact, you can sit in any comfortable, slightly reclined position, much in the same way as you might on a sofa or a deep chair.

Many coffee shops, for example, have soft chairs and sofas that would be suitable for laid-back breastfeeding in public. You could also use a changing bag or your coat to support you when you recline if you're out and about.

Your baby can be more diagonal than if you were reclined right back. You only need to be wearing loose enough clothing to allow your baby access to your breast, to sit in comfort with your friends and enjoy being out of the house.

Tips: laid-back breastfeeding and helping your baby latch on

1. Lean back if you're sitting or recline on any supportive surface. But do not lie flat on your back. It's okay to adjust your position until it feels right.

2. Hold your baby close so they're lying on your tummy with their core fully supported. If you've had a caesarean birth, you might want to place your baby to one side - away from your scar.

3. There should be constant contact between you but you don't need to put pressure on their neck or back. As you relax into the chair or bed, your baby relaxes into your body.

4. In this position, your baby's feet and legs will brush against your body, and usually find something to push against (such as your leg/hand/the bed/your partner's hand).

5. You will notice them nuzzling their face or bobbing their head from side to side until they locate the breast, then open their mouth wide as they latch on. As his or her mouth finds the breast, his sucking reflex starts to work.

The great thing is, you can use laid-back breastfeeding whenever you like, for as long as you like. And just remember - cuddles will not spoil your baby (Unicef, 2018).
This page was last reviewed in October 2019.
Further Information

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

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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

Colson S. (2003) Cuddles, biological nurturing, exclusive breastfeeding and public health. Journal of the Royal Society for the Promotion of Health. 123(2):76-77. Available at: https://doi.org/10.1177/146642400312300206 (accessed 22nd October 2019)

Colson S. (2019) Biological Nurturing - Instinctual Breastfeeding 2nd Edition. Pinter & Martin, London.

Colson S, Meek JH, Hawdon JM. (2008) Optimal positions for the release of primitive neonatal reflexes for early breastfeeding. Early Human Development. 84:441-449

Colson S, DeRooy L, Hawdon J. (2003) Biological nurturing increases breastfeeding duration. MIDIRS Midwifery Digest.13(1):92-97.

Rosin SI. (2019) A Case Study of Biological Nurturing. Journal of Human Lactation. 35(2): 318-322. Available at: https://doi.org/10.1177/0890334419829044 (accessed 22nd October 2019)

UNICEF. (2018) The Baby Friendly Initiative building a happy baby: a guide for parents. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/04/happybaby_leaflet_web.pdf (accessed 22nd October 2019)

UNICEF. (2019) Meeting your baby for the first time. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/relationship-building-resources/meeting-baby-for-the-first-time-video/ (accessed 22nd October 2019)

Vinall R. (2015) The value of introducing laid-back breastfeeding Perspective. Dec 2015. Available at: https://www.nct.org.uk/sites/default/files/related_documents/Vinall%20The%20value%20of%20introducing%20laid-back%20breastfeeding_0.pdf (accessed 22nd October 2019)

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Laid-back breastfeeding: benefits and uses | Baby & toddler, Feeding articles & support | NCT

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Many mums and babies use laid-back breastfeeding straight after birth but it has many benefits even after that first snuggle. Here's how...

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(6) 5 tips to help support Dads through the neonatal journey - YouTube

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5 tips to help support Dads through the neonatal journey

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PIL00001865 updated NOAH leaflet Aug 2020

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The Making Miracles Pathway - UK Birth Trauma Charity Center

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Kent Community Health NHS Foundation Trust

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Welcome to Kent Baby! Here you will find films, resources and links that can help you and your child on the journey from pregnancy to starting school. Kent Baby has been developed by the Health Visiting Service, provided by Kent Community Health NHS Foundation Trust. Ready for pregnancy You and your…

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If you are based in Swale and looking for peer support to continue supporting you breastfeeding journey this is where to go!

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(10) Breast Compressions - YouTube

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply.

Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive. Oversupply can also make feeding uncomfortable and increase the risk of mastitis.

Symptoms of oversupply
How does oversupply happen?
How is your milk supply established?
A note about foremilk and hindmilk
What can I do about the symptoms of oversupply?
Reducing your milk supply
If you still have problems
Breast compression
Adjusting to the new normal

Symptoms of oversupply

The main symptoms of oversupply for a baby are:

Very fast weight gain, moving upwards through centile lines

Explosive green frothy poos

Struggling to control milk flow

Pain and excessive wind or 'gas'

You may also notice the following:

Choking, coughing, and pulling on and off the breast

Clamping down and biting to slow the flow of milk

Frequent spitting up

Always appearing hungry and unsatisfied despite large weight gain

Unwillingness to nurse to sleep

Breast refusal

Faltering weight gain due to breast refusal

Lots of wet and dirty nappies

General 'colicky' behaviour

A mother with oversupply may have the following symptoms:

Some of these symptoms may have other causes; allergies and reflux, for example, can have similar symptoms to oversupply. They may also fall within the normal range. Therefore, it is important to rule out other possibilities before taking steps to reduce your milk supply, as this can have longer term consequences.

How does oversupply happen?

Some mothers naturally produce large quantities of milk, and we tend to produce more milk with each baby. Occasionally, there are medical reasons for having much more milk than your baby needs. Oversupply can also occur as a result of breastfeeding management, for example, when a baby's feeds are scheduled, or if a mother is told to feed from each breast for a certain amount of time. It can happen if a pump is used too often, or used in a way that overstimulates the breast.

Milk production is best regulated by your baby's appetite. When you breastfeed responsively, rather than by following a schedule, your milk production adapts to their needs. Occasionally, a poor latch can contribute to oversupply as a baby might feed very frequently to get the volume they need. However, this tends to reduce milk supply over time.

How is your milk supply established?

After your baby is born, milk production is regulated on a supply and demand basis. Put simply, the more milk you remove, the more milk you are likely to make. How quickly or slowly milk is made depends on the fullness of the breast - an 'empty' breast makes milk more quickly, a full breast makes milk more slowly.

It takes a few weeks for your supply to settle down to what your baby actually needs. It is not unusual in the early weeks to feel as if you have too much milk, and to have times when the breasts feel full or even engorged. This is not the same as oversupply.

Feeding frequently and removing milk from the breasts is essential to resolving engorgement - it won't make the engorgement worse or result in too much milk.

Babies usually nurse more during developmental leaps and growth spurts, and many mothers find there are changes to their baby's nursing pattern during holidays and family get-togethers, or during periods of stress. Milk supply is very adaptable - if you follow your baby and your body, your supply will most likely regulate itself.

Read more about how milk production works.

A note about foremilk and hindmilk

One of the symptoms of oversupply in a baby is green frothy poos, gas, and pain. This is sometimes called lactose overload or a foremilk-hindmilk imbalance.

You may be given confusing information about foremilk and hindmilk, and how long a feed 'should' last. Or think that there are two different kinds of milk - lower-fat and fat-rich - and that one is better than the other.

Typically, the fat content does increase during a feed, as the fat globules tend to be drawn down towards the end of a feed. However, it is not the length of a feed that is important, but the length of time between feeds. Fat content is determined mostly by the fullness of the breast. If there is a long gap between feeds and the breast is full, the baby may get a large quantity of lower-fat milk before much of the fat starts getting pulled down. The same may be true if a mother naturally produces very large quantities of milk. In the absence of fat-rich milk, the lower-fat milk moves through the gut faster than it can be digested, causing green poos, gas, and pain.

All breastmilk is good! What matters most to weight gain is overall milk volume.

What can I do about the symptoms of oversupply?

To start with, you might like to:

adjust your position and your baby's attachment to help them manage a fast letdown

feed responsively (as often as your baby wants) and/or offer more frequent feeds

use breast massage

avoid overpumping

Managing a Fast letdown
A fast letdown can be one symptom of oversupply. It is possible to have a fast letdown with an 'average' milk production. When your baby nurses, a hormonal reflex causes milk to release, (what is known as 'letdown'). When this happens, it is not unusual for milk to spray out quickly. Some babies like this fast flow, but others are upset by it and struggle to coordinate sucking, swallowing, and breathing. You may find it helpful to:

Ensure that your baby is deeply attached at the breast. This will make it easier for them to manage a fast flow.

Try different positions. Some parents use gravity to help them by feeding in a 'laid-back' (reclined) position. Others find it helps to feed in a more upright position such as a 'koala hold', or to feed while using a sling or baby carrier. Side-lying may also be helpful as excess milk can easily leak out.

Allow your baby to come off the breast when they need to catch their breath, and use a muslin to catch the spray.

Some mothers hand express a little to slow the flow before bringing the baby to the breast (however, if this is done frequently, it may make oversupply worse).

If your breast is very full and engorged, you might try 'reverse pressure softening' to move fluids away from the nipple area as this can help your baby to latch more deeply.

Feed frequently so that the milk spray doesn't have quite so much volume and force behind it.

Try breastfeeding before your baby is really hungry, or while they are slightly sleepy.

Responsive feeding
How do you know how often or how long to feed your baby for? Let your baby tell you! We all have different milk storage capacities and this may determine how frequently your baby feeds, and whether they feed from one side or two. Allow your baby to feed from the first breast for as long as they want to before offering the second breast - they may or may not take it.

Sometimes babies will only take one breast, and sometimes two (or three or four!). Most babies will take both breasts, at least some of the time. Babies are very good at letting us know how often they want to feed, and if in doubt, it is always fine to offer.
Breast massage
You could do what is sometimes called the 'breast milkshake'. This involves massaging each breast very gently for half a minute or so before feeding, then using a combination of massage and breast compression (see below) during a feed to help dislodge some of the fat. Any massage should use a light fingertip pressure such as you would use to apply body lotion.
Expressing
Overuse of pumps - or using a pump in a way that unintentionally stimulates milk production (such as a silicone pump to collect dripping milk) - can make oversupply worse. If you've been expressing regularly, reduce this gradually to avoid further problems.

Reducing your milk supply

If your baby is gaining more weight than average and you and your baby are happy, then you don't need to change anything. It is not possible to overfeed a breastfed baby.

If you or your baby are struggling with some of the above symptoms, you have ruled out other causes and changes to breastfeeding management do not help, then you may want to consider taking steps to gradually slow milk production.

Consult an LLL Leader before using these approaches. This is especially important if your baby is under one month old, or you are experiencing other problems such as sore nipples or mastitis.

Monitor your baby's weight gain to ensure it doesn't drop below expected levels, and keep a close eye on nappy output.

One side per feed
Limit your baby to one breast per feed. If your baby wants to have a short rest during a feed, then offer the same breast again. When a mother has a generous milk storage capacity, their baby may only need to feed on one side. This approach may help milk production to reduce in line with their baby's demand.

Block feeding
Block feeding involves feeding on the same side for a set period of time (block), e.g. for two or three hours. If your baby wants to feed again within that time block, offer the same side. As a starting point, you might like to:

Limit your baby to one breast for about two hours, allowing them to nurse as often and for as long as they like, but only on that one side.

Continue in this way, switching breasts every two hours. If your baby is asleep, switch breasts when they wake.

It is important not to have a rigid approach to block feeding: read your breasts and your baby, not just the clock. By doing this, you will find the time block that works best for both of you. If the unused breast feels uncomfortably full before the next feed then 'express to comfort' only.

It is possible to experience oversupply in just one breast, in which case you could nurse for longer periods on the unaffected side.

Full drainage and block feeding method
For more severe oversupply - for example, if you are suffering from recurrent blocked ducts or mastitis and your breasts never feel soft and comfortable even after a breastfeed - you will need to keep your breasts well drained while you take steps to reduce milk production.

You could try the following, in consultation with an infant feeding specialist, in addition to block feeding:

Express from both sides thoroughly to 'empty' your breasts as fully as possible.

After expressing, immediately offer both 'empty' breasts to your baby.

Next, limit your baby to one breast changing sides every two or three hours (see block feeding above).

Some mothers will need to use this approach only once. However, if your breasts feel uncomfortably full, you may need to repeat it, increasing the interval between each pump for your breasts to readjust.

Medications and herbs to reduce milk production
There are herbs and medications that can help dry up your milk production. Talk with your health care provider or a lactation consultant.

If you still have problems

After 4-7 days, your breasts may be more comfortable. If you and your baby still have trouble coping with the supply of milk, you can gradually increase the time block you keep your baby to one breast. Some women with extreme oversupply have gone as long as six or more hours before switching breasts to adjust milk production. A hormonal imbalance may cause overproduction of milk, but this is rare. A visit to your doctor may be helpful if the suggestions offered here aren't enough.

Block feeding should be a temporary measure. In practice, it is suggested that it is done for no more than one week, and only when babies are gaining double (or more) the average weight for their age. Once supply has settled, you can return to a more normal feeding pattern, following and trusting your baby and your body.

Breast compression

Babies used to a generous milk flow can become fussy at the breast when milk flow slows. They may have to work harder at the breast and deepen their latch to remove milk effectively. Breast compression will increase milk flow and encourage your baby to keep feeding actively:

1. Support your breast with one hand - thumb on one side, fingers on the other.

2. Wait while your baby breastfeeds actively (slow, rhythmic sucking, lots of swallowing). When their swallowing slows, compress your breast gently to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Be gentle - this shouldn't hurt.

Adjusting to the new normal

Always monitor your baby's weight gain, wet and dirty nappies, and overall well-being while following these strategies. Monitor their weight over a period of several weeks to see a trend. If your baby had been gaining weight very quickly, you may see 'catch-down' growth. Your baby will gain weight steadily, but may gradually drop against the percentile lines as your milk production adjusts. Their weight should then settle into following a new percentile line on the chart.

As your supply reduces, your breasts will feel softer and more comfortable, and leaking will be reduced. Soft comfortable breasts between feeds during the early weeks are normal and a sign that your milk production is in tune with your baby's needs.

Written by Charlotte Allam

Last updated May 2023

Kimberly Seals Allers' photos on this site are used under a creative commons license of Black Breastfeeding 360° http://mochamanual.com/bb/

Further Reading
Mastitis
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk
Comfortable Breastfeeding
Rhythms & Routines
The Unhappy Breastfed Baby
Reflux
Allergies and Intolerances
Fat Content of Breastmilk - FAQs
Positioning and Attachment

Other websites
UK-WHO Growth Charts: www.rcpch.ac.uk/growthcharts
Block Feeding Dos and Don'ts: http://www.nancymohrbacher.com/articles/2013/10/9/block-feeding-dos-donts.html?rq=oversupply

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

Copyright LLLGB 2023

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply. Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive.

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If you've decided to bottle feed, you may be worried about what formula to buy, what equipment you'll need and how to get the hang of feeding your baby when everything is so new.

We're here to provide lots of helpful information and advice on bottle feeding. If you have any worries or concerns, the best thing to do is speak to your midwife or health visitor.

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From making formula feeds to how to bottle feed your baby, we have lots of useful advice and tips.

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Breastfeeding exclusively (giving your baby no other food or drink) is recommended for around the first 6 months. After this time, breastfeeding is recommended alongside solid food.

Therefore, it's likely that you'll be breastfeeding when you return to work, training or education.

There are several options. You can:

arrange for childcare close to work or college so that you can breastfeed during breaks, or before and after work - the evening feed can be a wonderful way for you to relax with your baby

express breast milk (taking milk from the breast by hand or using a pump) so that someone else can feed your baby while you're at work

ask your employer or college for flexible working hours arranged around your breastfeeding needs

combine breastfeeding and bottle feeding to fit around your hours

Think about it early. Before you go back to work or college, tell your employer or tutor you're breastfeeding.

You may have an HR department that can help. It can make preparations, such as finding you a private room where you can breastfeed or express your milk.

Organising breastfeeding and work

Before returning to work you can:

label and date expressed breast milk before putting it in the fridge or freezer so your childminder knows which one to use first

have a trial run with childcare before returning to work

store breast milk in a sterilised container or in special breast milk storage bags in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) - if you're not sure of the temperature of your fridge, or it's higher than 4C, use it within 3 days

Information for employers about breastfeeding mothers

Employers have certain legal obligations to breastfeeding mothers. Supporting breastfeeding has business benefits too. These include:

reduced absence due to child sickness (breastfed babies are generally healthier)

increased staff morale and loyalty, and a subsequently higher rate of return to work

lower recruitment and training costs

an extra incentive to offer potential employees

How employers can help breastfeeding mothers

Employers can have a policy to support breastfeeding. This includes:

a break allowance for mothers to express milk

provision of a clean, warm, private room (not the toilet) for expressing

a secure, clean fridge to store expressed milk

flexible working hours for breastfeeding mothers

Let your employees know about your policy before they start their maternity leave.

What the law says about breastfeeding mothers at work

It's up to mothers to decide how long they want to breastfeed. Returning to work doesn't mean a mother has to stop. Before returning to work, she should give her employer written notification that she's breastfeeding. Her employer must then conduct a specific risk assessment.

Workplace regulations require employers to provide suitable facilities where pregnant and breastfeeding mothers can rest.

The Health and Safety Executive (HSE) recommends that it's good practice for employers to provide a private, healthy and safe environment for breastfeeding mothers to express and store milk. The toilets are not a suitable place to express breast milk.

The HSE has more advice about protecting new and expectant mothers at work.

Talk to other breastfeeding mums

If you know any breastfeeding mothers who have already gone back to work, ask them for advice.

You could also visit healthtalk.org to see mothers talking about breastfeeding and working.

Got a breastfeeding question?

Sign into Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Information for employees and employers on returning to work and breastfeeding, including tips on expressing and storing breast milk.

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Intuitive bottle feeding to avoid 'flow preference'

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Intuitive bottle feeding to avoid 'flow preference'

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Intuitive Bottle Feeding for Breastfed Babies

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Get help to buy food and milk (Healthy Start)

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What is Healthy Start?

If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk.

If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops. We'll add your benefit onto this card every 4 weeks.

You can use your card to buy:

plain liquid cow's milk

fresh, frozen, and tinned fruit and vegetables

fresh, dried, and tinned pulses

infant formula milk based on cow's milk

You can also use your card to collect:

Healthy Start vitamins - these support you during pregnancy and breastfeeding

vitamin drops for babies and young children - these are suitable from birth to 4 years old

If you live in Scotland

You can get help from Best Start Foods (opens in a new tab) instead.

Advice on healthy eating

For more advice on healthy eating, visit:

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If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk. If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops.

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Welcome to North West Kent Sling Library (weebly.com)

Please visit the North West Kent Sling Library if you are needing any support with Baby Wearing.

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NWKslings is a local lending library and advice service for North West Kent and Medway.

NWKslings aims to provide advice and information to help you decide which style of sling is right for you and your baby's needs, and sling hire at an affordable rate.

​We hope to see you at one of our meetings soon!

We are proud member of the UK Sling Library Network. Peer supporters are insured and trained by the School of Babywearing.
​

​Follow us on Facebook, Instagram and Twitter

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Welcome to North West Kent Sling Library

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NWKslings is a local lending library and advice service for North West Kent and Medway. NWKslings aims to provide advice and information to help you decide which style of sling is right for you and your baby's needs, and sling hire at an affordable rate.

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The Padlet is our interactive whiteboard to share all of our evidence based information with you.

If you are currently pregnant, please feel free to browse the entire Padlet, but the first half of this information may be the most useful for you. Learning how to colostrum harvest, the importance of skin to skin and relationship building, are the best ways to get your feeding journey off to the best start.

If you have had your baby - congratulations! This information is also useful for you to use in the hospital, or in the first few weeks at home. You may also wish to read further into our troubleshooting sections if you are experiencing any feeding issues.

Our contact details can be found at the bottom of the welcome section if you require more specialist help.

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The exaggerated latch or Flipple technique

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The exaggerated latch or Flipple technique

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Having a good latch is key to having a successful breastfeeding relationship, but if your baby doesn't naturally latch on well, you need to figure out how to help the situation. It becomes increasingly challenging if your baby has a tongue-tie or physical issue that prevents them from latching onto enough the areola. That's when the flipple latch technique comes into play.

Good positioning and latching are essential for maintaining milk production. When your baby attaches deeply at the breast, she can remove milk effectively. That's essential for keeping your supply and also for your baby's growth and development.

If you're struggling or facing nipple pain, try the exaggerated latch. It should take your issues away!

How to Use the Flipple Latch Technique

The goal of the exaggerated latch is to get the deepest latch possible, which is perfect when you have cracked or damaged nipples. It also can work if your baby has a tongue or lip tie that makes latching difficult, along with any other medical condition that might be making latching harder. The flipple technique also is suitable for any mother and baby who needs help deepening their latch and taking more of the breast into their mouth.

Here's what you need to do to get the flipple latch down properly.

1. Get your baby into a comfortable, supported position. This technique can work no matter how you hold them, whether you have your baby in a cradled position or a laid-back position.

2. Now, you'll want to put your thumb or finger above your nipple, lining up with your baby's lip. Your finger will be above your areola, and you'll press downward, which will move your nipple upward.

3. If you press above your nipple, your breast will naturally tilt upward, which means your baby will be facing your breast, not your nipple. He won't be able to latch just yet. You don't want to press or shove your nipple into his mouth; that will cause a bad latch and damage to your nipples.

4. Your baby's instinct will cause your baby to open up his mouth wide, bring him close, and let your breast gently fall into his mouth. This technique will cause your nipple to land right at the best spot in his mouth to be pulled back towards his soft palate.

Are you still confused? You can watch an easy to understand video from The Milk Meg to help you get it correct.

Is There a Better Position for the Exaggerated Latch?

You can use this latch technique in any position; I've used it multiple times in the cradle position and the laid-back position. However, if you can pair the flipple latch technique with the koala breastfeeding position, it's even more effective to get a deep latch.

Using the koala hold is helpful because you can get your knees lower than your hips, making it easier for many mothers. You can help your baby latch on your nipple properly without struggling to line up with your baby's mouth in this position.

Final Thoughts

Getting the right latch is a vital part of breastfeeding, and if you and your baby are struggling to do so, using the flipple latch technique could be the answer for you. This technique encourages deep latching to reduce any discomfort you might experience while allowing your baby to remove milk from the breast efficiently.

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Having Latch Problems? Flipple Technique Can Be the Solution

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Having a good latch is key to having a successful breastfeeding relationship, but if your baby doesn't naturally latch on well, you need to figure out how to help the situation. It becomes increasingly challenging if your baby has a tongue-tie or physical issue that prevents them from latching onto enough the areola.

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

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

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

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

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

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

Tips for getting started

If it hurts then make changes

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

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

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

Your baby needs to be calm

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

Your baby needs full body contact

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

Some babies need time

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

Laid-back breastfeeding

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

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

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

Sleepy babies

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

How laid back breastfeeding works

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

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

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

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

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

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

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

Latching on - getting a good attachment

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

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

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

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

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

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

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

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

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

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

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

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

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

Using different breastfeeding positions

The cradle hold

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

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

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

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

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

Laid back breastfeeding

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

The cross-cradle hold

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

Cross cradle

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

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

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

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

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

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

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

The underarm (clutch or rugby) hold

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

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

Your elbow keeps them tucked closely against your body.

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

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

Side lying

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

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

Standing up

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

As time goes by

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

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

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

LLLI Resources
Position to breastfeed

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

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

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

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

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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

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When you are beginning your breastfeeding journey it can take time and a lot of patience to get a comfortable latch.  This is completely normal, it's a new skill so be kind to yourself.
Always seek support from your midwife or support workers in the early days and remember your journey will continue to change. You can ask for support from your health visitor and peer supporters as you go along your journey, no question is ever silly!

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

Get help early for sore nipples

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

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

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

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

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

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

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

Self-help tips for sore nipples

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

But you may find it helps to:

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

wear a cotton bra so air can circulate

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

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

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

Important

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

If nipple pain does not improve

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

There may be an underlying problem, such as thrush.

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

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

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Sore or cracked nipples when breastfeeding

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

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Thrush is easily treated but can cause an issue for mums and babies.  Its important that for a breastfeeding mum and baby that if either are diagnosed both are treated otherwise they will continue to keep infecting each other.

Always speak to your GP for treatment and follow the guidance above.

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

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This information can also be viewed as a PDF 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 decision…

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There are many reasons why you may experience engorgement, knowing how to manage it can ensure you are able to comfortably continue feeding and avoid further issues.

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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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Mastitis can come on very quickly and is caused by issues with the basics of breastfeeding. Diagnosis should also involve a full assessment of the breastfeeds to identify the underlying issue to prevent further issues. Always seek support from an experienced breastfeeding professional if you have or are concerned you have mastitis.

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Find out about mastitis, including what the symptoms are, how to treat it and why it happens.

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Hold me close, keep me safe

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You can access peer support at any time during your feeding journey. No question or issue is too small. Support for Mums from Mums in the community.

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Come along to learn all about responsive feeding and what this means for you and your baby.

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In this video from our 2015 Annual Conference, psychologist and parent educator Robin Grille discusses Neuro-social evolution: how connectedness was lost, how to reclaim it, and what it means for humanity's future.

In this talk, Robin joins neuropsychology, epigenetics, psycho-history and anthropology to illustrate how and why many of the world's cultures lost the capacity for healthy attachment and/or healthy individuation in childhood. Now that so much is known about the centrality of infant attachment for healthy human function, there is a social and global imperative to ease back towards a healthy attachment society.

A few questions arose from Robin's talk, which he has answered below:
What about people who argue against responding consistently to babies' needs, saying: "I'm bringing my child up in a 'competitive, violent world', which they need to be able to thrive in. Otherwise they're just going to be crushed by bullies."
'Should one really consider denying a baby healthy attachment in the hope to prepare them for what we perceive to be a hard, denying world? Please distinguish between a baby and an older child! There are plenty of demands on older children, which prepare them for a demanding world. But placing demands on a baby is misguided and potentially harmful. It is not for a baby to be trained for a "tough world". In fact, trauma research clearly shows that adults are far more resilient when they have had all their early-life dependency needs met. So, the best way to prepare a baby for a "tough world" is to always say "yes" to a baby's needs. That is what distinguishes a baby from an older child.'
Many parents, prior to having their own baby, come from a career-focused background, with no previous experience of children. It could be argued that this encourages them to gravitate towards strict routines for babies as a method of upbringing. How can I counter this with evidence to show that a more responsive style of parenting will actually be better for their children?
'There is good empirical evidence that modern sleep-training techniques unnecessarily stress babies, and we should be concerned about possible long-term effects. Babies who "fall asleep" after controlled-crying or sleep training show elevated cortisol levels. Their "sleep" is not peaceful: Bruce Perry refers to the baby's collapse as the "defeat response".

'Healthy attachment is the core foundation of neuro-psychological and immunological health for the life-span. Healthy attachment (for babies) is about responding to the baby's cues - not about systematically delaying or denying the response. Controlled-crying, controlled-comforting or similar sleep-training methods may in some cases quieten the house - at the expense of the baby. In the medium to long term, this does not help the parents.'

The Australian Association for Infant Mental Health has expressed strong concern about these practices in their Position Statement #1 on controlled-crying.'

Problems viewing this video? Please contact us.

Further references

Middlemiss W, Granger DA, Goldberg WA, Nathans L. 'Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep'. Early Human Development 2012 Apr;88(4):227-32

Lewis M and Ramsay D. 'Infant Emotional and Cortisol Responses to Goal Blockage'. Child Development (2005) Volume 76(2) PP 518-53

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Robin Grille on neuro-social evolution - Baby Friendly Initiative

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In this talk, Robin joins neuropsychology, epigenetics, psycho-history and anthropology to illustrate how and why many of the world's cultures lost the capacity for healthy attachment and/or healthy individuation in childhood. Now that so much is known about the centrality of infant attachment for healthy human function, there is a social and global imperative to ease back towards a healthy attachment society.

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You can contact Hayley and Nancy or the team, via email directly or through your community midwifery team.

Medwayft.infantfeeding@nhs.net

Infant Feeding Team: 07771 150396

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How can I tell that breastfeeding is going well?

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How can I tell that breastfeeding is going well?

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This tool is designed for parents to use when they are learning to breastfeed their baby and are unsure of how to know if things are going well or not.

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During the first few days and weeks with your baby the midwifery team are here to support you to get breastfeeding off to a good start.

All our midwives and maternity support workers are trained to the highest standards set by the Unicef Baby Friendly Initiative (BFI).  Medway Maternity is proud to be a Unicef BFI Level 3 accredited unit.

In the postnatal period we offer both home and clinic visits for families.  This is what you can routinely expect:
Day 1 @ home
Day 2 @ home for breastfeeding families/telephone contact for artificially feeding families
Day 5 @ home for weighing baby and Newborn Blood Spot screening (NBBS).
Day 10 @ clinic for weighing baby and discharge

Your health visitor will then take over care from the midwifery team and will look after you and your baby until your baby goes to school.

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How, when and why skin to skin is so good for parents and babies

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How, when and why skin to skin is so good for parents and babies

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Skin-to-skin care (SSC) is a biologically normal practice. It consists of placing an unclothed or diaper-only newborn baby chest-to-chest with mother immediately after delivery and keeping them together for at least the first hour after birth, whether the mother has had a vaginal or cesarean birth and regardless of the feeding method planned. This practice is supported by the World Health Organization (WHO), Baby Friendly Hospital Initiative (BFHI), the Academy of Breastfeeding Medicine (ABM), and the American Academy of Pediatrics (AAP). This is an important component of family-centered care.

Immediate SSC for a minimum of one hour after birth is one of the most effective methods for promoting exclusive breastfeeding. Babies who have early SSC are more likely to be exclusively breastfed at discharge, exclusively breastfed after discharge, and breastfed for longer durations.

Reasons why SSC is important for baby and mother:

Keeps mother and baby together.

Promotes bonding between mother and baby.

Provides for earlier initiation of the first breastfeeding experience.

Reduces crying.

Helps baby maintain body temperature better than a hospital warmer, as your body will alter your own temperature to warm or cool the baby to maintain a normal temperature.

Helps regulate baby's breathing and heart rate.

Helps keep baby's blood sugar level stable.

"Normalizes" a difficult or surgical birth.

Decreases pain for baby from any procedures done while skin-to-skin.

Reduces postpartum hemorrhage in mother.

Can reduce maternal stress and postpartum depression.

Increases the probability of breastfeeding as well as the length of time you will breastfeed your baby beyond the hospital time.

Skin-to-skin right after birth:

Mother is in a slightly reclined position.

Baby is placed on mother's abdomen, dried, and covered with a blanket until the cord is clamped.

Once the cord is clamped, baby is placed chest-to-chest with mother and remains there uninterrupted for at least one hour and preferably until the first breastfeeding is completed. This provides optimal physiological stability.

Baby's face is easily visible and uncovered, neck is straight, knees are bent.

Baby may be naked or diapered.

Baby can be dried during process of placing skin-to-skin then baby and mother are covered by a warmed blanket.

Other tests like Apgar scoring can be done while baby is being held skin-to-skin.

Most other "standard procedures," like a Vitamin K shot, can be done while baby is on mother's chest.

Baby's measurements can be delayed for up to six hours - they are not going to change dramatically in that time frame.

Time in a warmer will not be needed since mother's body will keep baby warm.

Baby and mother are monitored by nursing staff during SSC.

Mother notices baby's feeding cues, like rooting or sucking on hands, and can guide baby to breast for first feeding.

SSC can continue as mother and baby are moved from the labor suite to the postpartum setting with proper observation for safety.

Continued SSC:

Regardless the birth setting - hospital, birth center or home - SSC can be part of the normal care of the newborn.

The more that mother and baby are together, the easier it is for mother to recognize baby's early feeding cues, more frequently baby will breastfeed, and a greater milk volume will be stimulated.

Mothers who "room-in" in the hospital will tend to practice SSC more frequently.

Mothers who practice SSC report greater confidence in their ability to feed and care for their baby.

Babies who "room-in" have more quiet sleep than those who are separated.

Remember that SSC can continue past the birth period and early postpartum. Many mothers have found that snuggling baby skin-to-skin can be soothing at any time and any age.

Mothers often ask:

How safe is SSC?

Very safe when mother and baby are positioned properly and observed.

There is nursing staff there to observe mother and baby to monitor temperature, heart rate, respiration, as well as assessing for any unusual health issues.

I'm expecting twins. Can I still do SSC?

Absolutely! Each one is positioned side-to-side, one over each breast.

Studies have shown that the temperature of each breast will rise or fall to warm to cool each baby independently

What if I'm not feeling well enough?

Let staff know if you are not feeling well enough to hold your baby.

Allow your support person for labor hold the baby skin-to-skin until you are ready.

How does this work if I have a cesarean?

Check your hospital's policy to be sure they are set up for this practice.

If it is a planned cesarean, you can arrange to have your support person with you to hold the baby skin-to-skin until you are ready.

Your baby will be placed on your chest, above the drape. Many hospitals are set up to have SSC begin even while your incision is being closed. Your support person can help with positioning as needed.

What if my baby comes early?

If the baby will be going to the mother-baby floor with you, you can begin SSC right after birth and any specific medical checks needed due to the early arrival.

If the baby is premature and going to a neonatal intensive care unit (NICU), you can begin SSC as soon as baby is stable enough to be held outside the isolette. (See "Skin-to-Skin Care in the NICU" create link)

How do I find out my hospital's policy for SSC?

Ask your OB or midwife about their practice with regards to skin-to-skin. They can tell you if there are any limitations at the facility you have chosen for your birth.

Attend a prepared childbirth class. The instructor will have a good sense of the practices of the hospitals in your area.

If you are preparing a birth plan, include this request in your plan.

If the hospital where you plan to deliver does not have SSC as part of their standard of care for childbirth, ask your healthcare team to advocate for you. If you chose another hospital or practice, make sure you let them know why you have made the switch.

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Skin-to-Skin Care - La Leche League International

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Skin-to-skin care (SSC) is a biologically normal practice. It consists of placing an unclothed or diaper-only newborn baby chest-to-chest with mother immediately after delivery and keeping them together for at least the first hour after birth, whether the mother has had a vaginal or cesarean birth and regardless of the feeding method planned.

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In this video, we look at the importance of developing close and loving relationships with babies in their early days and weeks.

Responding to babies' needs for comfort and food is hugely beneficial for brain development and makes for more confident toddlers. Parents should be supported in breastfeeding responsively and keeping their babies close to help them become happy, healthy and secure children and adults.

For more information:

Find more relationship building resources

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The Importance of relationship building video - Baby Friendly Initiative

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This video looks at the importance of developing close, loving relationships with babies in their early days and weeks.

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How to reduce the risk of SIDS for your baby

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How to reduce the risk of SIDS for your baby

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One gift, twice the impact

From now until midday on Tuesday 5th December, donations to The Lullaby Trust made via the Big Give will be DOUBLED at no extra cost to you. Please donate today if you can. One gift will make twice the difference to babies living in crisis situations.

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How to reduce the risk of SIDS

Our safer sleep advice gives simple steps for how you can sleep your baby to reduce the risk of sudden infant death syndrome (SIDS) which is commonly known as cot death. It can give you the peace of mind to enjoy this special time.

Our advice is based on strong scientific evidence and should be followed for all sleep periods, not just at night.

If you have any questions about SIDS or safer sleep, please call our information line on 0808 802 6869 (lines open Monday-Friday 10am-2pm).

Watch our free presentations on how to sleep your baby safely and reduce the risk of SIDS

Things you can do

Always place your baby on their back to sleep

Keep your baby smoke free during pregnancy and after birth

Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months

Breastfeed your baby

Use a firm, flat, waterproof mattress in good condition

Things to avoid

Never sleep on a sofa or in an armchair with your baby

Don't sleep in the same bed as your baby if you smoke, drink or take drugs or are extremely tired, if your baby was born prematurely or was of low birth-weight

Avoid letting your baby get too hot

Don't cover your baby's face or head while sleeping or use loose bedding

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Reduce the risk of sudden infant death syndrome (SIDS) for your baby by following our safer sleep advice. The advice is based on strong scientific evidence.

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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 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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Transcript of 'Breastfeeding: Mini Parenting Master Class' video

"Did you know that your nipples have good bacteria? So you don't need to wash them before breastfeeding.

My name is Dr. Michele Griswald, and this is my Mini Parenting Master Class on breastfeeding."

Is breastfeeding easy?

"Sometimes mothers get messages that breastfeeding is natural and it's easy. Sometimes breastfeeding can be easy with the first baby, and hard with the second baby for the same mother. So it really just depends."

Does breastfeeding hurt?

"You shouldn't stop breastfeeding if your nipples hurt. You should keep breastfeeding but you should get help to see why it's hurting."

How much should my baby eat?

"They should see signs of hunger about 8 to 12 times in 24 hours. Newborn babies need to eat a lot because they're growing rapidly. They double their birth weight in the first six months of life, or before. So you can imagine how much you would need to eat if you had to double your weight."

Should I wash my nipples before breastfeeding?

"It's not necessary to wash your nipples before you breastfeed, because the breasts and the skin around the nipple actually produces good bacteria. And it's that good bacteria that helps to prevent infections on the mother's breast."

When should I start breastfeeding?

"The first hour after birth is a very important time for the mother and the baby. Breastfeeding is a very organized, neurological behavior. And so right after birth, keeping them against the mother's skin can help them to be calm enough to start to seek the breast. And if we do just leave mothers and babies like that after birth, then they will usually start to go towards the breast on their own. Within about 30 minutes to one hour."

What should I eat while breastfeeding?

"Most mothers can eat anything they want when they breastfeed. They can follow their normal diet. And the interesting thing is whatever they eat, the babies will taste through their milk and start to get them ready for table foods when they're about 6 months old."

When should I wean my baby?

"Babies will naturally wean starting around one year of age or so because developmentally, they're changing so much. They're becoming less focused on their mother, and more focused on learning about the world around them."

Will I have to wean my baby when I got back to work?

"We would hope that mothers who return to work do not have to wean their babies. Mothers need time and they need support to continue to breastfeed their babies. They need the support of their family, they need the support of their workplace, their employers, they need the support of their entire community.

Breastfeeding not just about food. It's part a nurturing care package that helps children to grow and thrive throughout their entire life."

UNICEF Mini Parenting Master Class with Dr. Michele Griswold PhD, MPH, RN, IBCLC. Dr Griswold is a lactation consultant, registered nurse, breastfeeding researcher and advocate. She represents the International Lactation Consultant Association to the WHO/UNICEF Global Breastfeeding Collective, which calls on governments and society as a whole to provide mothers the support they need to breastfeed.

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Breastfeeding: Mini Parenting Master Class

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"Did you know that your nipples have good bacteria? So you don't need to wash them before breastfeeding. My name is Dr. Michele Griswald, and this is my Mini Parenting Master Class on breastfeeding." "Sometimes mothers get messages that breastfeeding is natural and it's easy.

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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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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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Friendly breastfeeding support from pregnancy onward.

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National Breastfeeding Helpline - Helpline

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Covid 19 Vaccination information for women who might get pregnant, who are pregnant or are breastfeeding their baby

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Covid 19 Vaccination information for women who might get pregnant, who are pregnant or are breastfeeding their baby

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Covid 19 Vaccines, pregnancy and breastfeeding

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Covid 19 Vaccines, pregnancy and breastfeeding

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COVID-19 vaccines, pregnancy and breastfeeding FAQs | RCOG

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COVID-19 vaccines are strongly recommended in pregnancy.

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The first 1,000 days of your baby’s life (the time between when you get pregnant and your baby’s second birthday) are really important for the human brain.

Your baby’s brain is developing really quickly, the quickest that it will grow during their life time.

Advances in science mean that we know a baby’s brain develops better if they feel safe and secure. This is true when a baby is still inside their mother’s tummy and once they are born.

Simple actions like singing to your baby, stroking or talking to your bump, helps your little one to feel loved and safe.

Scientific research has revealed that when unborn babies and young children feel stressed they release a hormone called cortisol, which prevents healthy brain development.

UNICEF have reported that the right side of a baby’s brain develops best when they enjoy a strong bond with their parents or carers. This brain development is really important as it’s the right side of the brain that is responsible for our emotions and how well we communicate.

So the development of your baby’s brain can affect what sort of adult they will grow up to be, from how well they are able to manage their feelings to whether they can form positive relationships.

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The story behind grow my brain

The idea for grow my brain came to midwife Jo Maynard one night when she was lying in bed and couldn't get to sleep.

Jo started thinking about how best she could support the families that she meets every day as part of her job as Lead Midwife for Infant Feeding at Medway Maritime Hospital.

She shared her idea with another midwife called Trude, who in her spare time is a very talented illustrator. Together they created the beautiful illustrations and words that are at the heart of the grow my brain campaign.

Grow my brain is supported by the Medway NHS Foundation Trust, Medway Community Healthcare and the council. It was launched on Valentine's Day 2019.

The science behind grow my brain

The first 1,000 days of your baby's life (the time between when you get pregnant and your baby's second birthday) are really important for the human brain.

Your baby's brain is developing really quickly, the quickest that it will grow during their lifetime.

Advances in science mean that we know a baby's brain develops better if they feel safe and secure. This is true when a baby is still inside their mother's tummy and once they are born.

Simple actions like singing to your baby, stroking or talking to your bump, helps your little one to feel loved and safe.

Scientific research has revealed that when unborn babies and young children feel stressed they release a hormone called cortisol, which prevents healthy brain development.

UNICEF have reported that the right side of a baby's brain develops best when they enjoy a strong bond with their parents or carers. This brain development is really important as it's the right side of the brain that is responsible for our emotions and how well we communicate.

So the development of your baby's brain can affect what sort of adult they will grow up to be, from how well they are able to manage their feelings to whether they can form positive relationships.

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Find out how to help your baby's brain development with our short videos as part of our Grow My Brain campaign.

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Beside you offers evidence based information and support on your breastfeeding journey from pregnancy onwards.

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Beside You breastfeeding support in Medway. Antenatal information to prepare you in pregnancy. Breastfeeding information and support

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Nancy qualified as a midwife in 2016 having undertaken her training in Essex, where she continued to work for the first 3 years of her career. The majority of this time she worked in an incredible standalone birthing centre, which reinforced her love of continuity of care and low risk labour. She then returned to Kent where she worked as a full time Community Midwife. Nancy's passions include being a Mum to Indiana, aromatherapy, breastfeeding and her French Bulldog Sassy.

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This tool is designed to be used by you and your midwife to ensure you feel happy and empowered to know when feeding is going well and also when you need further support.

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The first milk that your body produces for your baby is called Colostrum. It is designed especially for your new baby on the day they are born whether they are born around their due date or early! Meaning it contains all the protective and nutritional components unique to your baby.

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Supporting love and nurture on the neonatal unit

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Supporting love and nurture on the neonatal unit

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Research on the links between breastfeeding and cognitive development
Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour
This narrative review presents a complex picture of the current state of knowledge on the role of human milk and its components in the development of neurological processes and cognitive performance in infants. It offers practical and theoretical recommendations to advance research in this field, including innovative directions for future studies on cost implications and current support structures with the aim of inspiring social and political support for improvements in breastfeeding opportunities.
Weerth, C. et al. (2022). Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour. https://doi.org/10.1080/10408398.2022.2053058. To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study
This study evaluates whether the association between breastfeeding duration and improved childhood cognitive development can be explained by socioeconomic position (SEP) and maternal cognitive ability. The study uses multivariable linear mixed-effects models to compare verbal and spatial cognitive scores at ages 5, 7, 11, and 14 with reported breastfeeding durations. At all ages, longer breastfeeding durations were associated with higher cognitive scores after accounting for the child's own characteristics, however the effect was modest. Adjustment for SEP approximately halved the effect sizes.
Pereyra-Elias, R., Quigley, M., Carson, C. (2022). To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study. https://doi.org/10.1371/journal.pone.0267326 Preterm nutrition and neurodevelopmental outcomes
Whilst survival of preterm infants has been steadily improving due to advances in perinatal and neonatal medicine, it does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is also often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. This review focuses on the role of nutrition in preterm neurodevelopment, including the primordial importance of human milk and oligosaccharides and how these help to prevent neonatal complications and contribute to increased preterm survival.

Preterm infants are at increased risk of alterations in brain structure and connectivity and subsequent neurocognitive impairment. This study explores the extent to which breastmilk exposure is associated with improved markers of brain development and connectivity in preterm infants at term equivalent age. Findings from an analysis of data on 47 preterm infants' neonatal breastmilk exposure and brain MRI suggests that breastmilk feeding in the weeks after preterm birth is associated with improved structural connectivity of developing networks and greater fractional anisotropy in major white matter fasciculi.
Blesa M, Sullivan G, Anblagan D, Telford EJ, Quigley AJ, Sparrow SA, Serag A, Semple SI, Bastin ME, Boardman JP. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage. 2019 Jan 1;184:431-439. doi: 10.1016/j.neuroimage.2018.09.045. Epub 2018 Sep 18. PMID: 30240903.

Impact of breastfeeding on intelligence, educational attainment and income at 30 years of age in Brazil
Victora et al (2015). Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health, 3: e199-205 Horta, B. L. et al (2015). Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 14-19.

Impact of Baby Friendly accreditation on breastfeeding rates, cognitive outcomes and maternal mental health
Del Bono E, Rabe B. Breastfeeding and child cognitive outcomes: Evidence from a hospital-based breastfeeding support policy. ISER Working Paper Series: 2012-29

Breastfeeding and child development outcomes
Huang, J., Vaughn, M.G. & Kremer, K.P. (2015). Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis. Maternal and Child Nutrition, DOI: 10.1111/mcn.12200

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Research on Brain and Cognitive Development - Baby Friendly Initiative

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The latest infant health studies that we have found to be most pertinent about brain and cognitive development.

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It's never too early to start thinking about how you're going to feed your baby. But you do not have to make up your mind until your baby is born.
Some of the benefits of breastfeeding are:

your breast milk meets all of your baby's nutritional needs

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

breast milk is available for your baby whenever your baby needs it

breastfeeding can build a strong emotional bond between you and your baby

Formula milk does not provide the same protection from illness and does not give you any health benefits.

Health benefits of breastfeeding for your baby

Breastfeeding has long-term benefits for your baby, lasting right into adulthood.

Any amount of breast milk has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits.

Breastfeeding can help to reduce your baby's risk of:

Giving nothing but breast milk is recommended for about the first 6 months (26 weeks) of your baby's life.

After that, giving your baby breast milk alongside solid foods for as long as you and your baby want will help them grow and develop healthily.

Breast milk adapts as your baby grows to meet your baby's changing needs.

Health benefits of breastfeeding for you

Breastfeeding and making breast milk also has health benefits for you. The more you breastfeed, the greater the benefits.

Breastfeeding lowers your risk of:

Got a breastfeeding question?

Sign in to Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Breastfeeding has lots of health benefits for your new baby, including fewer infections and a lower risk of obesity, as well as protecting you from some cancers and other health problems, too.

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Human milk is full of components that helps to protect your baby from infections and reduce the risks of diseases, such as diabetes, heart disease and cancer. It has everything your baby needs to grow and reach their full potential in physical health and brain development.

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Recent News: Dutch researchers find Covid-19 antibodies in human milk

'We think when drinking the milk, the antibodies attach themselves to the surface of our mucous membranes,' Hans van Goudoever, head of the Emma children's hospital at the UMC, said. 'Then they attack the virus particles before they force their way into the body.' The UMC has now started a campaign to find 1,000 women who are willing to donate 100ml of breast milk for the research project. 'Women who may have had coronavirus without noticing it may also have made antibodies which can be found in milk,'

Here you'll find references and research supporting the information in the advert.

"Nature has been researching your milk for hundreds of millions of years"

"Your milk contains ingredients that kill cancerous cells"

"Your milk contains stem cells. These are cells that create and repair the body, and are being researched worldwide to cure conditions like Alzheimers and diabetes."

"Your body identifies bacteria and viruses found in your baby's body and environment. You then produce antibodies specifically tailored for those infections, and deliver them to your baby through your milk. The more milk she drinks, the more antibodies she receives."

"Your milk appears to switch on a gene in your baby's body, which produces a hormone called Leptin. This hormone tells your baby when his tummy is full, protecting him against over eating."

"Your milk contains Oxytocin, a hormone that induces relaxation, and feelings of well-being in your child and in you."

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The science of human milk and breastfeeding

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Infant Feeding Specialist Midwife - Hayley

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Infant Feeding Specialist Midwife - Hayley

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Hello and welcome to the Infant Feeding information pages.

My name is Hayley Clinton, I am the specialist Infant Feeding Midwife for Medway Maritime Hospital, I am also a Lactation Consultant (IBCLC).  I have worked at Medway Maritime since September 2016.  Starting as a rotational hospital midwife before heading out to join the community teams, delivering wrap around care from booking pregnancy to home birth and then finally discharging a newly made family.

I have been involved in the world of infant feeding since 2010 when I trained as a Peer supporter with Medway Community Healthcare, peer support network.