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How to find a position that works with your baby's natural instincts

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Positions that help you work with your baby's innate feeding instincts

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Cordelia's article on common breastfeeding myths

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Cordelia's article on common breastfeeding myths

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It's UK national breastfeeding week, an important time to speak not only about breastfeeding but how new mums can best be supported to establish successful breastfeeding. Biamother expert Cordelia Uys is here to tell us more.

This is an important conversation. The UK's breastfeeding rates are shockingly low compared to other countries.

A 2010 UK-wide Infant Feeding Survey found:

At 6 months - percentage of babies getting any breastmilk:

The UK: 34%

The United States: 49%

Norway: 71%

At 12 months - percentage of babies getting any breastmilk:

The UK: 0.5%

The United States: 27%

Germany: 23%

Brazil: 56%

Senegal: 99%

There are a variety of reasons for this low number, but the biggest factor is that we live in a culture where bottle feeding is the norm. Could this be due to the many myths surrounding breastfeeding? Cordelia Uys is an NCT breastfeeding counsellor who has been facilitating breastfeeding for 11 years. With a team of colleagues, she runs classes on introducing solids, parenting, and facilitating breastfeeding. Cordelia is Biamother's breastfeeding expert and is here to debunk some of the myths surrounding breastfeeding.

Establishing breastfeeding is easy:

Breastfeeding might be natural, but for most new mothers it doesn't come naturally; it's a physical skill they need to master, like learning to dance. It takes some time and practice before muscle memory sets in, and then it does become easy.

Breastfeeding makes your breasts sag:

It's pregnancy and in particular, the hormone relaxin which loosens the ligaments in a woman's pelvis in preparation for birth that causes some women's breasts to sag. A study in 2008 concluded that breastfeeding does not have an adverse effect on breast appearance.

Breastfeeding mothers need to eat healthily:

New mothers, just like the rest of us, benefit from having a balanced diet, and eating plenty of fresh, home-cooked foods, but the quality and volume of milk they produce will be just the same whether they eat well or exist on junk food. You may be interested to know that seven mothers whose babies were born in Auschwitz shortly before liberation, all managed to successfully breastfeed their babies despite being severely malnourished.

Breastfeeding mothers need to drink milk

Have you ever seen an adult cow drinking milk?! There is absolutely no need to drink milk in order to make milk.

Breastfeeding mothers need to avoid spicy foods

Breastmilk is made from a mother's blood, so all the food a mother eats is digested, metabolised and filtered. Only a trace of whatever she has eaten will be in her milk. In fact, these tiny traces are a good thing as they mean that unlike formula, the taste of breastmilk is constantly changing. It's believed this is why breastfed babies tend to be more adventurous in their food preferences once they start solids.

Breastfeeding mothers need to avoid citrus fruit and wind-inducing vegetables, or their baby will have wind/tummy ache:

Please see above: the foods a mother eats are far too filtered to give a baby wind. In every culture, there are foods mothers are told to avoid, and in every culture, these foods are different.

Breastfeeding mothers can't drink alcohol:

According to the Breastfeeding Network (BfN): "Alcohol passes freely into breastmilk reaching approximately maternal levels BUT maternal blood levels have to reach 300mg/100ml before mild sedation is reached in the baby. This compares with a level of 80mg/100ml needed to fail the police breath test in England. To reduce exposure of the baby to alcohol, avoid breastfeeding for 2-3 hours after drinking." In short, if you can legally drive, you can safely breastfeed.

All medications need to be avoided when breastfeeding:

According to Dr Thomas Hale, author of Medications and Mothers' Milk: "All medications transfer into human milk to some degree, although it is almost always quite low...Most drugs don't enter milk in levels that are hazardous to a breastfed infant." It is of course vital that breastfeeding mothers check on the safety of any medication before taking it. The Breastfeeding Network (BfN) has drugs sheets available online covering every topic from antidepressants to X-rays. They also offer an individual information service.

Breastfeeding mothers can't do vigorous exercise:

A randomised trial from 2019 showed that moderate to high-intensity physical activity has no impact on the volume or the macronutrient (meaning the fat, carbohydrate and protein) content of human milk. In a good illustration of what's possible, in 2019, the runner Sophie Power stopped briefly during a 106-mile ultra-marathon to breastfeed her 3-month old son.
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Pain is normal and inevitable when you breastfeed:

In everyday life, pain means something is wrong, and this is also the case for breastfeeding. If a mother is experiencing pain when feeding, she needs to seek out support from a Breastfeeding Counsellor or Lactation Consultant ASAP. If a baby is well positioned and deeply latched, breastfeeding will almost always be pain-free. Often a small adjustment is all it takes to make feeding significantly more comfortable.

Nipples need toughening up during pregnancy:

It was common in the past for pregnant women to be told to rub their nipples with a rough towel, and sometimes even with methylated spirits, to prepare them for breastfeeding! Unfortunately, this advice is sometimes still given. A woman's nipples don't need any kind of external preparation, the hormones of pregnancy prepare breasts for feeding.

Nipple creams prevent pain and damage:

A mother's areola have little glands on them called Montgomery's Tubercles that produce sweet-smelling, antibacterial oils which lubricate the nipple and protect against infection. If mothers put cream or ointment on their nipples, it will mask these oils, and will sometimes make it harder for a baby to latch. What prevents a mother from experiencing pain and damage is having her baby well-positioned and deeply latched.

(If damage does occur, a mother can apply some breastmilk, which has healing properties, to her nipples. It can also be helpful to apply a pea-sized amount of Vaseline or ultrapure modified lanolin to her nipples, as this encourages moist-wound healing. If there is substantial damage, Jelonet gauze dressing helps nipples to heal.)

Breasts need to be washed before breastfeeding:

This isn't recommended as it can dry out the areola and nipples and wash away the lipid-rich oils produced by the Montgomery's Tubercles (see above).

Mothers need to time breastfeeds:

Mothers are often told their baby needs to spend X amount of minutes on the breast to get everything they need. Sometimes they're told it's 15 minutes, sometimes 20 and sometimes 30. Anyone who knows anything about how breastfeeding works knows this advice is ludicrous. Imagine telling someone that they need to spend 20 minutes eating breakfast, or they won't have eaten enough. Some babies who are well-latched and whose mothers have a generous milk supply can get all the milk they need in 5 minutes, and some babies can spend an hour on the breast with a poor latch and transfer virtually no milk at all.

According to Wikipedia, clocks have existed for circa 700 years. Since the human race has existed for circa 200,000 years and up until around 150 years ago a baby would only have survived if they were breastfed, it seems fairly obvious that if were necessary to time breastfeeds, the human race would have died out a long ago.

Many women struggle to produce enough milk for their baby:

Over 95% of mothers can make all the milk their baby, or babies, need. Contrary to popular belief, the size of a woman's breasts does not impact on the volumes of milk she can produce. Milk production depends entirely on supply and demand: in the early months, milk needs to be removed effectively from both her breasts at least 8 times in 24 hours for a mother's supply to be established and maintained. By far the most common reason for low milk supply is under-stimulation of a mother's breasts, either because her baby isn't feeding frequently enough or isn't removing milk effectively.

You need to empty the breast:

It's impossible to empty a breast: the more milk is removed, the more milk will be made. Breasts are like rivers, not lakes. If a baby is fed whenever they show feeding cues, offered both breasts at each feed, and allowed to decide for themselves how long to spend on each breast, a mother will make exactly the right amount of milk for her baby, and the baby will get exactly the amount of milk they need.

Women with fair skin have more sensitive nipples:

This is very commonly told to mothers and is not only patently ridiculous but also borders on being racist. Fair skin might burn more easily in the sun, but it's no more sensitive to being hurt than very dark skin.

Biamother is the world's first app that cares for new mums. We are a team of maternal health experts, all women, mostly mothers, offering guidance and recommendations to help you eat, move and sleep better, as well as personalized workouts you can do at home that adapt to suit your changing needs, body type and concerns. Vogue Magazine, June 2020 issue calls Biamother "a life coach in your pocket."
Article by Biamother expert Cordelia Uys, NCT Breastfeeding Expert
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It's UK national breastfeeding week, an important time to speak not only about breastfeeding but how new mums can best be supported to establish successful breastfeeding. Biamother expert Cordelia Uys is here to tell us more. This is an important conversation. The UK's breastfeeding rates are shockingly low compared to other countries.

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A brilliant explanation of breast storage capacity: 

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A brilliant explanation of breast storage capacity: 

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Cordelia's article on establishing breastfeeding

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Cordelia's article on establishing breastfeeding

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Cordelia Uys

Steps to take before you give birth

Spend time with a friend who is having a positive experience of breastfeeding

Lots of people think because breastfeeding is natural, that it will come naturally to mothers, but in fact, for all female apes, breastfeeding is a learned behaviour. This can be seen from the experience of the juvenile female gorilla in Ohio zoo who, having been separated from her mother and their troop at a young age, had no idea how to feed her first baby. During her second pregnancy, zoo keepers had the inspired idea of asking some human mothers to come and regularly breastfeed their babies in front of her. When her second baby was born, she immediately put her baby to the breast.

In the past, human mothers would have learned how to breastfeed by watching relatives and friends. For this reason, I strongly encourage pregnant women who want to breastfeed to go and spend some time with a friend who is successfully nursing her little one, and to befriend other breastfeeding mothers. In the case of breastfeeding, seeing really is believing. When new mothers have spent time with other breastfeeding mothers, they're more likely to persevere if they encounter any initial challenges.

Find out antenatally which of your friends and family had a positive experience of breastfeeding, so you can turn to them for support when your baby arrives.

Inform yourself about breastfeeding antenatally

Read a good quality book on breastfeeding. Prof Amy Brown's The Positive Breastfeeding Book is clear, comprehensive and evidence-based.

Attend an antenatal breastfeeding workshop facilitated by an accredited Breastfeeding Counsellor or an IBCLC Lactation Consultant. The NCT includes a dedicated breastfeeding workshop alongside their antenatal birth classes. Most IBCLC Lactation Consultants offer private antenatal breastfeeding sessions.

Find out about local breastfeeding drop-ins

Search out a good drop-in in your area, run by a Breastfeeding Counsellor accredited by one of the 4 breastfeeding charities (NCT, ABM, BfN or LLL) or by an IBCLC Lactation Consultant. You want to be sure the person providing you with support and information has in-depth training.

Find an IBCLC Lactation Consultant or Breastfeeding Counsellor who can visit you in the first week after your baby is born.

Join an online breastfeeding support group (please see list below)

When women join an online support group antenatally, breastfeeding tends to go more smoothly as they get a better idea of what to expect, and what to do if they experience difficulties.

Explore the website Basisonline so you can inform yourself about normal infant sleep.

Frequent night waking is normal, breastfeeding lowers the chances of SIDS, and in the early months, night feeds are crucial for maintaining a mother's milk supply because prolactin levels (the hormone that makes milk) are highest at night.

Make sure you have comfortable furniture and props

A comfortable L shaped sofa where you can put your feet up and have head support is ideal. Alternatively, a nice big foot rest, or poof, to support your feet when you're breastfeeding on your sofa or comfortable armchair is great. Ensure you have lots of cotton cushions (velvet or satin are too slippery) and pillows. A special breastfeeding pillow isn't usually helpful, unless you have very large breasts.

It's essential that you are completely comfy, with all of your body well-supported, because in the early months you are going to be spending hours and hours breastfeeding.

Consider doing some antenatal hand expressing from 36 weeks

If you are having a low risk pregnancy, there is evidence that doing some antenatal expressing of colostrum (your first milk) from 36 weeks of pregnancy is safe and can be helpful in building your confidence in your body's ability to feed your baby. Having some syringes of colostrum to take into hospital can act as a safety net and help you feel more relaxed.

Consider hiring a doula to provide you with practical and emotional support in the postnatal period.

Unlike maternity nurses who take care of the baby, doulas focus on taking care of the mother, and empowering her to become confident in her mothering skills.

Steps to maximise your chances of successful breastfeeding once baby arrives

Uninterrupted skin to skin with your baby for the first two hours immediately following birth helps enormously with bonding. When babies breastfeed at this time, they are likely to 'remember' how to breastfeed later on.

Spending the majority of the time in skin to skin with your baby in the early hours and days will help bring your mature milk in sooner. (See The Importance of Skin to Skin).

Keeping your baby close and feeding him or her as soon as they show any feeding cues will help you establish and maintain a good milk supply. When babies are in a cot or Moses basket, it's easy to miss feeding cues.

Until your baby has overtaken their birth weight, make sure they don't go longer than circa 3 hours without breastfeeding. A baby who isn't getting enough milk might not have the energy to wake and ask to be fed.

Always offer both breasts at each feed. Once your baby has come off the first breast of their own accord, offer them the second breast. If they've fallen asleep, wake them up; nappy changing normally does the trick. However long they spend on the second breast, make sure to start the next feed on that second breast. Only offering one breast per feed can lead to slow weight gain for the baby and lower milk supply for the mum.

Remember that it's normal for newborn babies to want to feed A LOT! UNICEF talk about an average of 10 to 12 feeds in 24 hours, and many babies will feed more often than that. Their tummies are small, and breastmilk is easily digested. On top of that, newborn babies not only want to breastfeed for hunger and thirst, but also whenever they're tired, sad, lonely, bored, in pain, feeling ill, wanting comfort or having a growth spurt. All this stimulation is excellent for your milk supply, and once your baby is 2 to 3 months old, you will start to reap the rewards, as your supply will be perfectly in tune with your baby's needs, and they'll have become a super-efficient feeder.

Be prepared for periods of cluster feeding in the first couple of months. Cluster feeding (a period of 5 or more hours when your baby wants to feed almost incessantly) usually starts on the 2nd night of your baby's life. Over the first week or so, cluster feeding gradually moves from the middle of the night to the slightly more civilised times of around 5 or 6pm to midnight. Having a stretch of several hours when a baby feeds very frequently is probably nature's way of ensuring an excellent milk supply: the more often a baby feeds, and the emptier a mother's breasts, the more milk she will make.

Be prepared for the fact that it's normal for your baby to want to spend the majority of their time in your arms and to refuse to sleep unless they are in physical contact with you or your partner; this contact is deeply comforting and physiologically regulating for a baby. We now know that responding lovingly to a baby's need for food, closeness and comfort allows optimal brain development.

Know the signs that your baby is getting enough milk. In the early weeks, your baby's nappy output and weight gain will give you all the information you need.

Learn how to breastfeed your baby safely in the side-lying position as soon as you can. This position is technically the recovery position and will prevent you from rolling on to your baby even if you fall asleep while breastfeeding. Please read the Lullaby Trust leaflet Safer sleep for babies a guide for parents tounderstand how to bed share as safely as possible. At night it's not safe to breastfeed sitting on a soft chair or sofa because if you fall asleep, your baby could end up in a dangerous position.

Consider spending the first couple of weeks (or more) having as few visitors as possible. Being able to spend the majority of your time in your pyjamas makes life with a newborn less stressful.

Arrange a visit from an IBCLC Lactation Consultant or Breastfeeding Counsellor in the first few days after your baby's birth, to help optimise their latch and positioning at the breast, and to double check you're on the right track. It's impossible to exaggerate how much difference good attachment and positioning make to a mother's comfort and to her milk supply. Often tiny adjustments can be transformational.

If things don't feel right, seek out expert help ASAP. Pain means something is wrong - don't put up with it!

Be patient with yourself: breastfeeding is a physical skill that you learn, like dancing. It may take time and practice to get good at it, but after a while, it becomes muscle memory.

Believe that all your hard work in the early weeks will pay off. As a client once said to me: "I wish I'd known that I would end up actually enjoying breastfeeding, not just out of pride, but simply for the act itself and for the moments of calm with my son."

Breastfeeding resources for additional information and support:

Books on baby brain development:

Breastfeeding lines:

National Breastfeeding Helpline: 0300 100 0212 (9.30am to 9.30pm every day of the year).

NCT feeding line: 0300 330 0700 (option 1). The line is open from 8am to midnight, including bank holidays.

Association of Breastfeeding Mothers: 0300 330 5453 (9.30am -10.30pm).

La Leche League: 0345 120 2918 (8am to 11pm, seven days a week).

Facebook groups for nursing mothers:

Further articles to help support you with breastfeeding, healthy meal and snack ideas, pregnancy and postnatal workouts and more can all be found on the Biamother app. Designed by a team of maternal health experts, all women, mostly mothers, Biamother offers guidance and recommendations to help you eat, move and feel better, as well as personalised workouts you can do at home that adapt to suit your changing needs, body type and concerns. Biamother believes a healthy baby begins with a healthy mother and are currently offering Biamother free to download on the app store until June 30th 2020.

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Maximise Your Chances of Succesful Breastfeeding

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Maximise Your Chances of Succesful Breastfeeding Steps to take before you give birth Spend time with a friend who is having a positive experience of breastfeeding Lots of people think because breastfeeding is natural, that it will come naturally to mothers, but in fact, for all female apes, breastfeeding is a learned behaviour.

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This week (7- 12 June) is Infant Mental Health Awareness Week and the theme is '20:20 vision: Seeing the world through babies' eyes'. The Week is led by the Parent-Infant Foundation (PIF) and the First 1001 Days Movement, a collaboration of relevant organisations with the PIF as secretariat, which is being launched during the week.

What is infant mental health? It is the emotional wellbeing of babies. The Movement's vision is that 'every baby has loving and nurturing relationships in a society that values emotional wellbeing and development in the first 1001 days, from pregnancy, as the critical foundation for a healthy and fulfilling life.'

What babies want is what they need and these needs are basic. As obstetrician Grantly Dick-Read wrote in the mid 20 th century:

"The newborn has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three."

They do also need to receive attention from other humans. If their needs are usually met, babies can form secure relationships (attachment) with their caregivers. Usually, there is one primary caregiver, most commonly the mother. Attachment theory was developed by the psychoanalyst John Bowlby in the 1950s. An attachment figure who cares responsively for the infant provides a secure base. It is believed that behaviours by the infant to stay close when separated, like screaming and clinging, have been reinforced by natural selection (see What is attachment theory).

Babies are vulnerable - as Donald Winnicott, paediatrician and psychoanalyst, among his other insightful quotes, stated:

'There is no such thing as a baby, there is a baby and someone'.

However, infants are not passive as they communicate by giving cues to their needs, such as the rooting reflex when hungry. If their needs are not responded to quickly, they become upset. Dr. Edward Tronick's 'still face' experiments in the 1970s showed the importance of human connection for an infant. If the parent's face is still and unresponsive to her baby, the baby looks confused and then becomes distressed. The experiments also showed that ruptures in a relationship like this are easily repaired. Parents do not need to respond perfectly.

However, when there is repeatedly no response to a baby's distress, as in sleep training where the baby is left alone and expected to adapt, it was found that the babies' behaviour changed so that by the third night they were no longer crying but their cortisol (stress hormone) levels were still high so there was a mismatch between behaviour and physiology; instead of learning to self-soothe it seems as though they were giving up so in despair.

The significance of the care babies receive is that their experiences, starting before birth, influence the neural connections that are formed in the developing brain - the 'wiring'. A parent who is emotionally not really available to the baby (so not attuned to their needs) will find it difficult either to respond or to respond appropriately, providing an unintentional 'still face' or angry face. The parents could be ill, depressed, addicted, suffering domestic abuse, desperately worried about their financial situation, overloaded with responsibilities.........It is therefore crucial for a society to care for parents so that they can be emotionally available to their children.

Feeding is a crucial part of nurturing care and breastfeeding facilitates the process.There is considerable evidence that not being breastfed is linked to poorer physical health in infants (Lancet, 2016). Breastfeeding provides personalised nutrition. Antibodies and other components in breastmilk reduce the chance and severity of infections. Oligosaccharides in breastmilk feed and thus favour beneficial bacteria in the infant's gut and this helps the development of a healthy immune system. It is difficult to allow for confounding factors in studies on breastfeeding but reviews show it is linked with better cognitive performance, which is likely to be due to the fatty acids in breastmilk. But what about any impact on emotional development? There are studies which suggest that being breastfed is associated with paying more attention to positive emotions in others. Breastmilk contains the calming hormone oxytocin, which stimulates social interactions, and which is further released through touch and suckling, so the moods of both mother and baby benefit. Several studies indicate that mothers who are breastfeeding tend to touch their babies more, are more responsive and tend to gaze at them more, all of which will help the infant's emotional wellbeing. The Unicef UK Baby Friendly Initiative leaflet, Building a Happy Baby, provides practical suggestions for parents to support their baby's brain development and addresses myths and realities.

Jones found that breastfeeding helps to protect infants from the harmful effects of maternal depression.

Mothers who stop breastfeeding before they want to are at greater risk of postnatal depression ( Borra et al 2014) so mothers need easy access to breastfeeding support to help them continue, thereby benefitting their babies physically and emotionally. Sadly, there are barriers to breastfeeding throughout society, as outlined in the WBTi UK report.

Parents and carers urgently need more support, especially during the stresses and isolation of lockdown and the COVID19 pandemic. We call on government to make infants and their families a high priority during the pandemic and in our plans to rebuild a stronger society.
Photo used with permission

Patricia Wise is an NCT breastfeeding Counsellor and a member of the WBTi UK Steering Group

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This week (7- 12 June) is Infant Mental Health Awareness Week and the theme is '20:20 vision: Seeing the world through babies' eyes'. The Week is led by the Parent-Infant Foundation (PIF) and the First 1001 Days Movement, a collaboration of relevant organisations with the PIF as secretariat, which is being launched during the week....

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown. For those families who do continue to breastfeed, it has a significant value that goes beyond nutritional or health benefits. Children allowed to continue breastfeeding will typically self-wean between the ages of 2 and 7 (natural term). A breastfed child eats normal solid foods alongside breastmilk, and they do not require any other mammalian milk (e.g. cow's milk). There is no evidence of harm to children or mothers who breastfeed to natural term. Breastfeeding beyond infancy is biologically normal: it should be celebrated and encouraged in mothers who wish to do so. It has health, economic and environmental benefits for the individuals involved as well as wider society; yet British culture is not generally supportive of natural term breastfeeding. Few GPs receive high quality lactation education, and thus may be inadequately informed to support families achieve longer term breastfeeding. This guide summarises the evidence available and how GPs can help. Effects on maternal and child health
Most GPs are aware of the vast array of benefits of breastfeeding babies (1), but may mistakenly believe that these benefits are time-limited. Breastmilk remains rich in vitamins, minerals and fats through toddlerhood and beyond (2,3), and immune components unique to human milk actually increase as the child ages (4). Children who are breastfed beyond 1 year have a reduced risk of acute otitis media (5), type 2 diabetes (6) and obesity (7). Breastfeeding beyond infancy may have psychological benefits for the child (8) and is an important source of comfort for young children. Many mothers find breastfeeding an invaluable parenting tool, by soothing a tired, injured or frustrated toddler and helping to promote sleep. Continued breastfeeding can prevent dehydration and malnourishment in unwell or hospitalised children, and is an ideal source of nutrition for 'fussy eaters'; parental attempts to increase solid foods in these situations can lead to displacement of nutrient-rich breastmilk (9). Breastmilk is particularly important for children with cow's milk protein allergy, as ready-made soya, oat, coconut or other milk substitutes are unsuitable under 2 years of age (10). There are also numerous benefits for mothers, but it should be noted that few (if any) mothers continue to breastfeed beyond 12 months solely for their own benefit. Benefits include a reduction in the risk of breast cancer (11), endometrial cancer (12) ovarian cancer (13), cardiovascular disease (14) and type 2 diabetes (15). Indeed, the UK government estimates savings of over £31 million for each annual cohort of new mothers through reduction of maternal breast cancer, if more women breastfed and did so for longer (16). There is no evidence in the literature of harm to either mother or child from natural term breastfeeding, including tooth decay (17). Production of toddler 'follow-on milks', which in ordinary circumstances are not proven to be necessary (18), undermine the International Code of Marketing of Breast-milk Substitutes and contribute to environmental impact (19).
Considerations for GPs

Mothers who breastfeed any age of child(ren) do not require any specific dietary adjustment or supplement apart from 10mcg Vitamin D daily (20).

It is very rarely necessary for a mother to stop breastfeeding in order to take medication (21). Many mothers will opt to delay treatment if a breastfeeding compatible medication is not prioritised. The BNF alone is an inadequate reference for safety in lactation, and GPs should check additional sources for more comprehensive information (22): we recommend UK Drugs In Lactation Advisory Service (NHS service) or The Breastfeeding Network.

Lactational Amenorrhoea Method of contraception is only suitable for use if the baby is under 6 months and has several strict criteria, as detailed by FSRH (23). Beyond 6 weeks of age, all hormonal forms of contraception (including COCP) are categorised as UKMEC 1 or 2 (24), however this is a complex area. Breastfeeding professionals frequently see mothers reporting a decrease in milk supply with all types of hormonal contraception, and GPs should be prepared to counsel women fully, including a discussion of the risks (25).

Women breastfeeding a baby or child of any age may develop sore nipples, engorgement, blocked ducts, mastitis or thrush and should be supported appropriately - see GP Infant Feeding Network for detailed information (26).

Supporting Breastfeeding
Breastfeeding is not always easy, and families who have reached 12 months may have overcome many challenges (27). Whilst many mothers report they receive good breastfeeding support in the early months, this reduces as their baby gets older (28). Lactation-specific education is scarce in UK medical schools and postgraduate training programmes, leaving many GPs ill-prepared to support natural term breastfeeding. Unsolicited advice to wean, unsupportive personal opinions or inaccurate information are all unhelpful to families who trust their GP, and may damage the doctor-patient relationship (29). US research has shown that even a very brief educational programme can improve doctors' attitude and knowledge towards breastfeeding beyond infancy (30). A doctor's personal experience of breastfeeding can affect their breastfeeding advocacy (31). Therefore, GPs who have had a negative personal experience of breastfeeding should ensure that any advice they give is evidence-based rather than anecdotal. Mothers who fear ridicule may choose to hide the fact that they breastfeed (32). But breastfeeding in public in the UK is protected by law, and there is no upper age limit to this (33). Mothers returning to work can successfully continue breastfeeding with appropriate support, and there is no need to wean unless she or the child wish to (34).

Nursing aversion (intense unpleasant emotions experienced whilst breastfeeding) may affect mothers, particularly of older children (35). Some mothers persevere for the benefit of their child; others may wish to wean. In either case, mothers benefit from their GP asking them about their wishes and then providing appropriate signposting to achieve this. Weaning from the breast may be mother-led or child-led (or a combination): natural child-led weaning is a gradual and gentle process and all children will eventually wean (36). Families should avoid abrupt weaning due to the risk of breast engorgement, mastitis and emotional distress for both mother and child. Some mothers fall pregnant whilst breastfeeding, and may continue to breastfeed their older child throughout their pregnancy and once their baby is born (tandem nursing). There is no evidence that breastfeeding during a normal pregnancy causes miscarriage or premature labour (37).

Mothers seeking breastfeeding support can contact the National Breastfeeding Helpline on 0300 100 0212, or can seek face to face support from Peer/Mother Supporters, Breastfeeding Counsellors or International Board Certified Lactation Consultants. IBCLCs are recognised as the gold standard in breastfeeding support and are available throughout the UK (38). GPs who wish to learn more about breastfeeding can do so via Unicef's e-learning package (39) or RCGP's e-learning course (40), which is free to College members. The ABM also offers their Breastfeeding Support Training Foundation Module (41), an online course suitable for healthcare professionals. Finally an online book for doctors has recently been published and is free to access (42).
Conclusions
In summary, GPs have an important role to play in helping to normalise and support breastfeeding beyond infancy. Breastfeeding mothers have a right to ongoing high standards of evidence-based healthcare for as long as they choose to continue. Breastfeeding beyond infancy benefits mothers, children and the NHS and thus should be actively supported by all GPs.
Dr Naomi Dow (GP) naomi.dow@nhs.scot Emma Pickett (International Board Certified Lactation Consultant, Chair of Association of Breastfeeding Mothers) Dr Vicky Thomas (Consultant Paediatrician with special interest in growth and nutrition)
Whilst we have used the terms 'mother', 'woman' and 'breastfeeding', we recognise that not all families use this terminology. We encourage GPs to use the terminology preferred by each parent or family.

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Breastfeeding Beyond Infancy a GP Guide - ABM

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown.

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Article by Prof Amy Brown

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A full night's sleep will be near the top of many parents' wish lists. Sleep deprivation is no fun and many parents find themselves turning to baby care books that promise to train their child to sleep through the night.

These books promote a range of ideas. At the more extreme end, extinction - often known as " cry it out" - involves putting the baby to bed and ignoring their cries (sometimes checking periodically to make sure they are not unwell or in danger). A modified version of this, often known as "controlled crying", suggests parents should ignore cries for a set amount of time, before responding briefly to reassure their baby, gradually increasing the amount of time between checks. The idea is that babies will eventually realise no one is going to come - and sleep instead.

But there are two main issues with both variations of this sleep training. Babies can become distressed during longer periods of crying, with raised levels of stress hormones. In addition, not responding to a baby's cries goes against everything we know about building positive attachment relationships. Babies who learn that someone will respond to their needs, in a loving and appropriate way, typically go on to have better social, emotional and educational outcomes.

Shutterstock/MonkeyBusinessImages

The research explained

Research into these methods has shown mixed results, mainly because many parents find leaving their baby to cry too distressing. This is unsurprising. Parents are hardwired to want to respond to their baby's cries. Other research suggests that such techniques may only work temporarily or only work for some babies.

In one study that examined whether mothers implemented sleep training advice in books, the advice only worked for around 20% of babies. Most struggled to follow the guidance or it had no impact, leaving them feeling frustrated and even like a failure.

One reason why sleep training might not work is because waking at night is developmentally normal for most babies throughout their first year. Even adults sometimes have difficulties sleeping through the night and insomnia is a common complaint. But, unlike babies, adults are able to meet their own needs. If we do wake, we can get ourselves a drink, pull the covers back or rationalise our thoughts.

In addition, some parents may be getting confusing advice, as research headlines don't always give the full picture. One trial randomised mothers who felt their baby had a sleep problem to either behavioural sleep training techniques or "usual care". Those in the sleep training group reported better mental health and fewer sleep problems at one year. But those mothers were also taught about normal infant sleep and given an opportunity to chat to a nurse about their worries and ideas for self-care.

At the end of the trial, mothers rated "having someone to talk to" as the most useful thing. Is this evidence that rather than trying to teach babies to sleep, there should be more support for new families instead?

So what does work?

If you are reading this as a sleep-deprived parent, do not despair. There are gentler ways to help your baby sleep better that do not involve listening to your baby cry. And the good news is that responsive sleep support can be just as effective and less stressful for everyone.

First, understanding the sleep needs and circadian rhythms of the baby can go a long way towards optimising sleep. There are two sleep regulating mechanisms in the human body. The first is the Circadian rhythm, or body clock. This is regulated by exposure to light, noise, activity and social cues at the right time of day. Getting outside in the daytime and having a predictable darkening of the room one to two hours before bedtime can really help. Some parents find a predictable routine that signals bedtime helps (having a bath, getting changed and maybe a soothing story or song).

The second regulating mechanism is something known as " homeostatic sleep pressure ". The drive to sleep (when your eyes start drooping) builds during wakeful hours. The younger we are, the less time we can manage awake. So, understanding how to support babies to take regular naps to prevent them from becoming overtired makes a big difference.

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This is easier to achieve when you learn to recognise your baby's sleep, feeding and other cues. Understanding these cues helps parents to spot when their baby is ready for sleep, before they become overly tired and frustrated. It also helps deepen the bond between parent and child. Being able to accurately interpret a baby's need for more action, quiet time, food, cuddles or sleep will mean that parents are more in tune with them. No book can tell a parent what their baby needs right now. This can only be learned through observation and trial and error.

Read more: Babies don't need sleep coaches - but sometimes their parents do

Finally, decreasing parental stress can make a huge difference to sleep. The more we worry about sleep, the worse it gets. Little things like accepting what's normal, taking time for self-care and accepting offers of help, not only make it easier to feel more rested and able to cope, but can also rub off on the baby. Babies are masters at responding to emotional states, so parents will probably find that their baby is easier to settle and sleeps better when they take care of their own emotional well-being.

And if you are one such sleep-deprived parent, please remember: your baby will not be like this forever - they will sleep one day.

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Sleep-training and babies: why 'crying it out' is best avoided

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A full night's sleep will be near the top of many parents' wish lists. Sleep deprivation is no fun and many parents find themselves turning to baby care books that promise to train their child to sleep through the night. These books promote a range of ideas.

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Why you might want to put the baby books down:

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Why you might want to put the baby books down:

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College of Human and Health Sciences, Swansea University

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Why you might want to put the baby books down...

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It's normal for newborn babies to want to feed very frequently:

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It's normal for newborn babies to want to feed very frequently:

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School of Health & Social Care, Swansea University

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Breastfeeding Beyond Infancy is the Norm...in Much of the World - Mothering

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According to a UNICEF data, most women around the world breastfeed children past the 12-month mark. In fact, it's considered the norm.

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It's common for babies to become distracted and to want to spend much less time on the breast:

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Running two support groups every week, I get all sorts of questions from moms with concerns about their breastfeeding babies. One of the questions/concerns I hear the most often is this: "My baby is suddenly not feeding for nearly as long as they used to and they aren't interested in feeding as often. They get fussy easily at the breast and pull off after just a few minutes. I'm concerned that they aren't getting enough milk from me!" I can almost always predict the age of these babies - somewhere around 12-16 weeks. And here's why.

Many moms know that babies feed frequently in the early weeks. They expect feedings around the clock that can last quite a while. What many moms don't realize is that this *can* change dramatically around the 3-4 month mark. Babies who used to feed every 1 to 3 hours, for 30 minutes or more, babies who were always happy to breastfeed when offered - suddenly start refusing the breast at times, and when they do accept, may only feed for a few minutes before pulling off. This can be a frustrating time for moms as they are often concerned that the baby may not be getting enough and are worried about this significant change in baby's feeding patterns. In this article, we'll discuss why this happens, how to know if there is reason for concern, as well as how to manage this new behavior.

Why is this happening?

While it's great to know that this behavior is normal, many moms want to know why their baby's breastfeeding behavior has changed so much. Much of it has to do with developmental changes that occur as baby grows and matures. One reason the length of a baby's feeding may shorten significantly is simply that baby is becoming more efficient at the breast - meaning she/he can get more milk out in less time. This can be hard for moms to believe, so visiting a support group where you can do a weighted feed to see how much baby is taking is a great way to confirm this! I can't tell you how many moms come to my groups and are amazed at how much their baby can take in only 5-10 minutes. Another factor is baby is experiencing a huge developmental leap at this time... awareness of his/her surroundings is exploding. Suddenly, your baby will notice the plant in the corner, the dog chasing it's tail, the freckles on mom's nose! Everything is so new and exciting, babies are often too distracted to breastfeed. They may go hours between feedings, and when they do go to breast, they will often pop off frequently to look around and interact with their surroundings.

Should you be concerned?

If your baby has breastfed well up to this new stage, if weight gain has been within normal limits (4-7oz per week), and they are having the appropriate amount of wet and dirty diapers, you can rest assured that this is all normal behavior and your baby will not go hungry. It is very uncommon for a baby who has gained weight well to suddenly start to have difficulties. Yes, your baby may take in less during the day if they're distracted by all that goes on around them, but they will make up for it in other ways. Baby may start to wake more at night, asking to feed, to make up for the milk he/she missed during the day. This is one of the reasons that we don't recommend night weaning at this time - your baby might need those middle of the night feedings! But don't worry, tired mama, this won't go on forever.

While you may not know what your baby's weight gain looks like in between doctors' appts, you can visit a weekly breastfeeding support group to monitor baby's weight on a weekly or monthly basis and be sure that he/she is gaining appropriately.

What can you do?

Offer your baby the breast when he/she shows signs of wanting it, but don't worry too much if he/she don't take it, or doesn't feed for as long as she/he used to.

A couple of times a day, try to feed your baby in a dark, quiet place with fewer distractions.

Consider purchasing a nursing necklace so that your baby has something to play with while breastfeeding. It will help keep your baby's attention on you rather than the ceiling fan above your head.

Try nursing in a carrier, which provides a nice, quiet, distraction-less space on the go.

When your baby wakes at night, respond to him/her and breastfeed, as he/she may need these feedings now more than ever.

But mostly, relax! Enjoy the shorter feeding periods and longer stretches between them. Have fun with your baby as he/she explores his/her surroundings and learn about the world. Trust that your baby will let you know when he/she is really hungry and follow his/her lead!

Here are a few more resources about breastfeeding a 3-4 month old:
Help a Mama Out: Tips for Breastfeeding the Distracted Baby I've Had My Baby - Now What? Breastfeeding During Months 2-6 The Boob Group: New Mom Breastfeeding Manual 2-6 Months

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Breastfeeding at 3-4 Months - It Can Look Very Different! - SDBFC

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Written by Ashley Treadwell, IBCLC Running two support groups every week, I get all sorts of questions from moms with concerns about their breastfeeding babies. One of the questions/concerns I hear the most often is this: "My baby is suddenly not feeding for nearly as long as they used t

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Sometimes a baby can get all the milk he or she needs in 5 minutes or less.

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A new mum is asking for help. Her 8-week-old baby is refusing the breast and every feed is turning into a battle. She can get him to feed 'a little' and nappies seem OK for the moment but she's worried that her supply will soon decrease and he's going to have weight gain problems. Breast refusal can be scary and we start with lots of gentle questions.

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Good drinking in the baby led (laid back) position:

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Good drinking in the baby led (laid back) position:

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Good drinking in the cross cradle position: 

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Good drinking in the cross cradle position: 

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How to get a breastfed baby to take a bottle:

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How to get a breastfed baby to take a bottle:

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Help! My Breastfed Baby Won't Take a Bottle!

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First off, your baby is not being stubborn or "refusing" to take a bottle - they simply don't connect it with food and so whenever you offer it and they're hun

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Average weight gain for breastfed babies

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Average weight gain for breastfed babies

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Average Weight Gain for Breastfed Babies

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What members of NWL Breastfeeding say they wish they'd know about breastfeeding before having their baby: 

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What members of NWL Breastfeeding say they wish they'd know about breastfeeding before having their baby: 

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What I wish Id known about  breastfeeding before my baby came along (002)

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Breastfeeding for Doctors 101: https://www.paediatricfoam.com/2018/09/breastfeeding-for-doctors-101-part-1/

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Here's important recent research recommending that babies born via a c-section should have their weight at 24 hours used to calculate weight loss, rather than their birth weight:

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Using 24-Hour Weight as Reference for Weight Loss Calculation Reduces Supplementation and Promotes Exclusive Breastfeeding in Infants Born by Cesar... - PubMed - NCBI

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Average weight gain for breastfed babies:

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Average weight gain for breastfed babies:

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0-4 months

5.5 - 8.5 ounces per week

4-6 months

3.25 - 4.5 ounces per week

6-12 months

1.75 - 2.75 ounces per week ‡

[click here to see tables in Metric Units]† It is acceptable for some babies to gain 4-5 ounces per week.‡ The average breastfed baby doubles birth weight by 3-4 months. By one year, the typical breastfed baby will weigh about 2 1/2 - 3 times birth weight.

Sources:

World Health Organization Child Growth Standards, 2006. Available at: http://www.who.int/childgrowth/en/. To figure average weight gain, we used the weight-per-age percentile charts for birth - 5 years. The range is a combination of boys and girls 5% to 95%, rounded to the nearest quarter-ounce.

0-6 months

1 inch per month

1/2 inch per month

6-12 months †

1/2 inch per month

1/4 inch per month

[click here to see tables in Metric Units]† By one year, the typical breastfed baby will increase birth length by 50% and head circumference by 33%.

Source: Mohrbacher N. Breastfeeding Answers Made Simple, Amarillo Texas: Hale Publishing, L.P., 2010, p. 213.

See also the Infant growth calculators and breastfed baby growth charts @

A few things to keep in mind when evaluating weight gain

A 5-7% weight loss during the first 3-4 days after birth is normal. A 10% weight loss is sometimes considered normal, but this amount of weight loss is a sign that the breastfeeding needs to be evaluated. It's a good idea to have a routine weight check at 5 days (baby should be gaining rather than losing weight by day 5), so that any developing problems can be caught and remedied early.

Baby should regain birth weight by 10 days to 2 weeks. If your baby lost a good bit of weight in the early days, or if your baby is sick or premature, it may take longer to regain birth weight. If baby does not regain birth weight by two weeks, this is a sign that the breastfeeding needs to be evaluated.

Always figure weight gain from the lowest point rather than from baby's birth weight.

Baby needs to be weighed on the same scale with the same amount of clothing (preferably naked) each time to get an accurate picture of weight gain. Different scales can give very different readings (I've personally seen a difference of a pound in two different scales); clothing or diapers can vary in weight and throw the numbers off. The scale should be zeroed before weighing, and baby should be centered on the scale tray. It's never a bad idea to do a second measurement (it should be close to the first) and then use an average of the two measurements. If your baby is very active or distressed, don't expect to get an accurate measurement. Babies grow in spurts rather than at a steady rate - to keep from needless worrying, it's generally best to weigh baby no more often than once a week.

Additional information and references

@
@ other websites

Look at the Baby, Not the Scale by Dr. Jay Gordon and Cheryl Taylor White

How much weight should I expect my breastfeeding baby to gain? by William Sears, MD

Healthy and Petite by Joyce Schaal, from New Beginnings, Vol. 15 No. 1, January - February 1998, p. 8-10.

Articles on Weight Issues from New Beginnings

Growth Failure by Stephen Kemp, MD, PhD and Neslihan Güngör, MD, from emedicine.com

American Academy of Pediatrics Policy Statement on the Importance of Breastfeeding

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: pp. 203-213.

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Average Weight Gain for Breastfed Babies * KellyMom.com

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A few things to keep in mind when evaluating weight gain A 5-7% weight loss during the first 3-4 days after birth is normal. A 10% weight loss is sometimes considered normal, but this amount of weight loss is a sign that the breastfeeding needs to be evaluated.

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NCT leaflet on mixed or combination feeding: 

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NCT leaflet on mixed or combination feeding: 

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

What is mixed feeding?

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

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

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

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

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

Your partner might want to be involved with feeding.

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

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

How do I combine bottle feeding and breastfeeding?

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

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

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

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

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

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

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

What effect will combining breastfeeding and formula feeding have?

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

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

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

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

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

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

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

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

Tips to introduce a bottle to a breastfed baby

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

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

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

Try softening the teat with warm, boiled water.

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

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

(La Leche League, 2019)

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

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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

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The best way of knowing if your baby is getting enough milk in the early days, is by keeping close track of his or her nappies: 

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The best way of knowing if your baby is getting enough milk in the early days, is by keeping close track of his or her nappies: 

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On days 5-6

Wees: Five or more heavy nappies per day.

Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel.

False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls. It comes from the effects of your own hormones on her system, and it soon stops.

After the first week: babies continue to wee and poo several times each day for the first few weeks.

After about six weeks, some (not all) babies poo much less often. Breastfed babies may go many days without producing any poo at all after this time - that's normal, too. As long as your baby is growing well, and the poo he produces is soft, you don't need to be worried. Ask your health visitor about this, if you need to.

What's a 'heavy nappy'?

Try this test - pour three tablespoons of water (45ml) into a dry nappy, and pick it up. That's how heavy your baby's nappy will be, after the first five to six days.

How do I know if my baby is weeing often enough when disposable nappies just absorb the wee?

All babies should produce several heavy nappies every day. If you use disposable nappies, do the 'heavy nappy' test with water so you know what you are looking for. You can also place a cloth inside the nappy, which will stay wet when your baby wees. Any questions about your baby's health or feeding, just ask your midwife.

Urates, sometimes known as brick dust because that's what it looks like: tiny orange or pinkish crystals. They are harmless: they are salts in the urine, and tend to show up in the very early days. Most babies will pass them once only. They can be a sign your baby needs a little help to feed more often or more effectively. Ask you midwife.

Further information

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

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

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

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

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Wees: Five or more heavy nappies per day. Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel. False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls.

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Here’s an NHS page on breastfeeding in public:

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Here’s an NHS page on breastfeeding in public:

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Read our top tips on breastfeeding in public, including your legal rights and real mums' stories.

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Here's an article by Emma Pickett, Chair of the Association of Breastfeeding Mothers, on breastfeeding in public: 

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Here's an article by Emma Pickett, Chair of the Association of Breastfeeding Mothers, on breastfeeding in public: 

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In one of my voluntary roles, I am sometimes asked by national and local media to comment on breastfeeding issues. Today I was asked to comment on whether businesses on Kent should offer more...

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Breastfeeding in Public: The Equality Act (2010) protects breastfeeding mothers against unfair treatment (everywhere in the UK except Northern Ireland!). It states that it is sex discrimination to treat a woman less favourably because she is breastfeeding, and therefore, by implication, trying to prevent a mother from breastfeeding is against the law:

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Breastfeeding in Public: The Equality Act (2010) protects breastfeeding mothers against unfair treatment (everywhere in the UK except Northern Ireland!). It states that it is sex discrimination to treat a woman less favourably because she is breastfeeding, and therefore, by implication, trying to prevent a mother from breastfeeding is against the law:

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The Equality Act, passed by Parliament in April 2010, comes into force this month, making this protection a reality and giving mums the freedom to breastfeed when away from home.

Under the new law, mums cannot be discriminated against, asked to leave a venue or treated unfavourably because they are breastfeeding when out and about in England and Wales. Support from local services can also give mums the confidence to breastfeed wherever they are, creating an example for younger people.

Rosie Dodds, Senior Public Policy Officer, NCT, said: "This is a huge win for the charity and we are very pleased. Years of hard work and determined campaigning have paid off, and now mums who want to breastfeed in cafés, shopping centres, swimming pools or other public venues will be free to do so, without any bother or fear of harassment.

"It is important that women know they have this right, and the charity is calling on leisure centres, councils and other venues to do all they can to welcome breastfeeding mums.

"Many congratulations to all those involved in developing evidence and campaigning on behalf of mothers for this right at a local and national level over the years."

From training breastfeeding counsellors to running courses for expectant and new mums to peer support schemes across the UK, working with and for breastfeeding mothers is an important part of the charity's history.

To support mums, NCT runs local breastfeeding sessions. NCT breastfeeding counsellors are available seven days a week to answer questions and provide support. NCT Breastfeeding Line on 0300 330 0771 is open every day, 8am - 10pm.

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Historic month for NCT as women win right to breastfeed in public

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The Equality Act, passed by Parliament in April 2010, comes into force this month, making this protection a reality and giving mums the freedom to breastfeed when away from home. Under the new law, mums cannot be discriminated against, asked to leave a venue or treated unfavourably because they are breastfeeding when out and about in England and Wales.

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What to expect when your milk comes in:  

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What to expect when your milk comes in:  

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You can check the safety of any medication you need to take while breastfeeding here: 

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You can check the safety of any medication you need to take while breastfeeding here: 

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

Please use the below links for more information

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

What is the Drugs in Breastmilk Information Service?

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

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

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

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

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

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

Evaluation of the Drugs in Breastmilk Information Service

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

Become a Friend of Drugs in Breastmilk

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

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

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

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You've made it through your first 24 hours as a new mom. Maybe you have other children, but you are a new mom all over again... and now it's your baby's second night.

All of a sudden, your little one discovers that he's no longer back in the warmth and comfort - though a bit crowded - womb where he has spent the last 9 months - and it is SCARY out here! He isn't hearing your familiar heartbeat, the swooshing of the placental arteries, the soothing sound of your lungs or the comforting gurgling of your intestines. Instead, he's in a crib, swaddled, in a diaper, a tee-shirt, a hat and a blanket. All sorts of people have been handling him, and he's not yet become accustomed to the new noises, lights, sounds and smells. He has found one thing though, and that's his voice... and you find that each time you take him off the breast where he comfortably drifted off to sleep, and put him in the bassinet - he protests, loudly!

In fact, each time you put him back on the breast he nurses for a little bit and then goes to sleep. As you take him off and put him back to bed - he cries again... and starts rooting around, looking for you. This goes on - seemingly for hours. A lot of moms are convinced it is because their milk isn't "in" yet, and the baby is starving. However, it isn't that, but the baby's sudden awakening to the fact that the most comforting and comfortable place for him to be is at the breast. It's the closest to "home" he can get. It seems that this is pretty universal among babies - lactation consultants all over the world have noticed the same thing.

So, what do you do? When he drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of his mouth. Don't move him except to gently slide him into an upright neutral position with his head to the side. Don't try and burp him - just snuggle with him until he falls into a deep sleep where he won't be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every ½ hour or so. If he starts to root and act as though he wants to go back to breast, that's fine... this is his way of settling and comforting. During deep sleep, the baby's breathing is very quiet and regular, and there is no movement beneath his eyelids.

Another helpful hint... his hands were his best friends in utero... he could suck on his thumb or his fingers anytime he was the slightest bit disturbed or uncomfortable. And all of a sudden he's had them taken away from him and someone has put mittens on him! He has no way of soothing himself with those mittens on. Babies need to touch - to feel - and even his touch on your breast will increase your oxytocin levels which will help boost your milk supply! So take the mittens off and loosen his blanket so he can get to his hands. He might scratch himself, but it will heal very rapidly - after all, he had fingernails when he was inside you, and no one put mittens on him then!

By the way - this might happen every once in a while at home too, particularly if you've changed his environment such as going to the doctor's, to church, to the mall, or to the grandparents! Don't let it throw you - sometimes babies just need some extra snuggling at the breast, because for the baby, the breast is "home."

Copyright © by Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants

No portion of this text may be copied or reproduced in any manner, electronically or otherwise, without the express written permission of the author (IBCLC@aol.com).

Jan Barger is a mom of three, and proud Grammie of three and one due in 2017. She has been in private practice as a lactation consultant, worked for many years for a pediatric practice in the Chicago 'burbs as their lactation consultant, has a background in all aspects of maternal-child health nursing, and currently teaches with Lactation Education Consultants - an organization that provides education for those aspiring to become IBCLCs. Jan is a past president of ILCA, was on the IBLCE board and exam committee, and is a co-author of Clinical Experience in Lactation: A Blueprint for Internship, and Clinical Instruction in Lactation: Teaching the Next Generation. She lives in Wheaton IL with husband Bob and loves to travel and read.

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You've made it through your first 24 hours as a new mom. Maybe you have other children, but you are a new mom all over again... and now it's your baby's second night.

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Is THIS normal? The first week with a breastfeeding newborn:

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Is THIS normal? The first week with a breastfeeding newborn:

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Reposted from: Imagine a news story about a baby gorilla just born in London zoo:Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'. I have written elsewhere on the dangerous obsession of the infant feeding interval [4]. It's dangerous for both babies and mothers. But we need to remember breastfeeding isn't just about feeding and it never has been. https://growingfamilies.co.uk/blog/
"ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health" but days later it's reported that staff are concerned. Fumbi's mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She's losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn't feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin induced bonding that helps the formation of their early relationship. Fumbi is at risk.
Oh dear. Something seems to have happened to Fumbi's mother. We'd be worried.
A phrase most breastfeeding supporters would like to evaporate from the planet is, 'he is using me like a dummy'. No, dummies were invented partly because we forgot what breastfeeding was about. There's not enough evidence to say for certain how dummies impact on breastfeeding [5] but those of us who work with breastfeeding families can see how the sucking action and latching can sometimes shift when babies use dummies a lot and there can be issues when mums feed less and milk supply doesn't get the messages it needs.
Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin hormone (which is the hormone key in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing cortisol stress levels. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotional secure, growing brain connections, trying to get to sleep (which YES is one of the purposes of breastfeeding.)
If you just think breastfeeding is about food and calories (and "quick, measure the gap between breastfeeds!") you are doing a nature a huge disservice.
And you want to use an app on your phone to measure all those different reasons why a baby comes to the breast? You're measuring fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack, has a meal? You wouldn't find an app for that and if you did, it would probably flag you up as someone needing some urgent assistance.
Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby's needs in the way they are asking you to. Don't try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are routine person and you are struggling with a feeling of 'losing control', give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you'll have some options. Try and 'control' too early and you'll find things go out of your influence in ways you can't come back from easily.
Get help if things feel wrong- if breastfeeding hurts, if you're not sure about weight gain or nappies, if you can't work out how to meet your own needs for food and sleep. There are lots of people who will help out and we're at the end of a phone or a Twitter account or Facebook page. But don't confuse your baby behaving unexpectedly for something going 'wrong'. Maybe no one told you what normal would be.
If we let normal happen it WILL make all of your lives easier in the long term.
You're creating a little person who enters this world with their needs being met - we call it love.
​
Emma Pickett IBCLC
ABM Breastfeeding Counsellor
The ABM is kindly sponsoring Emma's session at Growing Families - http://abm.me.uk/
References:
However this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We're not designed to dump our babies and go off hunting and foraging for nuts. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us 'carry mammals'.
But instead we got the message somewhere that babies can be 'spoilt'. We are supposed to encourage them to be independent and sleep apart from us. We're meant to be able to put them down. If we can't put them down, if they want to sleep touching us, if we hold them when they sleep - we've apparently failed some test. Though it's not quite clear who the examiner is.
There are popular books that even use terms like 'accidental parenting' just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of 'advice' has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby's sleep by the clock and leave a baby only a few weeks old to cry if necessary.
What does your baby want?
They don't want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don't want to waste energy keeping warm and crying when they don't need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.
"My baby won't go down in its Moses basket". Yes, it's frustrating when you thought that was what they were 'supposed to do'. But would it feel easier if you knew that wasn't likely to be their first choice and there are good biological and evolutionary reasons for that?
"But I'm not going to get any sleep".
From the Infant Sleep Information Source [1]:
"70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart."
Research shows that these mums breastfeeding through the night (and mostly bed sharing) will ALSO be getting better quality sleep and be more rested than other parents [2] Good sleep is possible if we stop battling nature.
The book "Sweet Sleep: night time and naptime strategies for the breastfeeding family" is a great place to start. It talks to you about creating a safe space where everyone gets a better night's sleep.
A lot of your baby's urges are eminently sensible. If they don't want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.
Don't expect to be up and making a moussaka on day 5. The feeling that you 'shouldn't' be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren't supposed to change. Our commitment to work isn't supposed to change. Our ability to engage with political life and housework and social media isn't supposed to change. Actually, throughout much of human history, mum isn't going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn't have to be moussaka), sleeping and being with our new baby.

Emma Pickett IBCLC is leading our breakout session on Breastfeeding at "Growing Families: Facts, Fiction and Other Stuff" this October. It is a one-day event for all expectant and new families - mum, dad, grandma, grandad, aunts, uncles, supporters - and the professionals who work with them. This is a not-for-profit event, created by four mothers, two of whom are also healthcare professionals. Our mission is to tackle the postnatal information that desperately needs covering for new families. To explore expectations and evidence around the early days with baby. To keep ticket prices low, with no expectation of making a profit, in order to open up the event to as many people as we can. To ensure that support for the event comes from ethical organisations and those who share our interest in evidence based information and family well-being. To give new families the confidence to face the challenges ahead.
Please click here to book your place: https://growingfamilies.co.uk/prices-booking/
​
Here Emma tells us about what is actually "normal" when breastfeeding a newborn baby.

I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused. The first voice we hear might sometimes be the partner's and a mum is too upset to even come to the phone.
Hundreds of these calls end with a contented calm voice saying, "Thank you. It's such a relief to know that's normal. I feel so much better now". As it happened, breastfeeding was actually going OK but it was her understanding of everything else that was confused. What she interpreted as a breastfeeding 'problem' was actually a new baby's normal and natural response to their new environment. She just didn't know how babies were 'supposed to behave'.
If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film - but instead of the ability to pilot helicopters or practise high level martial arts, you'd know about cluster feeding and a newborn's desire for closeness, nappies and normal fussiness.
The National Breastfeeding Helpline would be quieter overnight but we'd all feel a lot more relaxed and able to enjoy these teeny new people in our lives.
But actually... you've already had that download. You just may not have realised it. It's deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day 3 or how to correct a baby's latch without help but there's so much you do know. You probably didn't grow up surrounded by breastfeeding (as Elena Abell's recent blog highlighted) and for some aspects of breastfeeding you will need support and information, but there's a ton you do know about your baby: things that just feel right and things that don't.
And your baby had the download too. Sometimes it gets fuzzied with a birth that didn't go to plan but their instincts are in there too.
Two things that are normal:

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

1. https://www.isisonline.org.uk/where_babies_sleep/parents_bed/

2. http://www.ncbi.nlm.nih.gov/pubmed/17700096

3. http://www.llli.org/sweetsleepbook

4. http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/the-dangerous-game-of-the-feeding-interval-obsession

5. http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Miscellaneous-illnesses/Review-of-dummy-use-and-its-potential-impact-on-breastfeeding/

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Is THIS normal? The first week with a breastfeeding newborn

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Reposted from: Imagine a news story about a baby gorilla just born in London zoo:Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'.

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The importance of not trying to space breastfeeds: 

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The importance of not trying to space breastfeeds: 

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The Dangerous Game of the Feeding Interval Obsession

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day. It...

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Here’s a good summary of the findings in the Lancet Breastfeeding Series:

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Here’s a good summary of the findings in the Lancet Breastfeeding Series:

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If almost every mother breastfed her children it could prevent more than 800,000 child deaths a year, yet governments are failing to promote and support breastfeeding, with rates remaining far below international targets, new research has found.

Poor government policies, lack of community support and an aggressive formula milk industry mean breastfeeding is not as widespread as it could be, according to a two-part Lancet breastfeeding series published on Thursday.

The success or failure of breastfeeding should not be seen solely as the responsibility of the woman

Dr Nigel Rollins, WHO

Children who are breastfed for longer have higher IQs, lower death rates and less risk of infection than those who are breastfed for shorter periods or not at all, the research found. Breastfeeding may also protect against diabetes and obesity later in life, while for mothers it can help with birth spacing, protect against breast cancer and may reduce the risk of ovarian cancer and type 2 diabetes.

Despite these proven benefits, however, only 37% of children aged six months and under in lower- and middle-income countries are exclusively breastfed, with women worldwide failing to receive the support they need to start, or continue, the practice.

"The success or failure of breastfeeding should not be seen solely as the responsibility of the woman," said Dr Nigel Rollins of the World Health Organisation (WHO), who co-authored the series. "Her ability to breastfeed is very much shaped by the support and the environment in which she lives. There is a broader responsibility of governments and society to support women through policies and programmes in the community."

While global data shows that nearly 80% of newborns receive breast milk, rates of exclusive breastfeeding are far below the WHO target of half of all children under six months by 2025. Women in poorer countries tend to breastfeed for longer than those in higher-income countries. Yet as income increases, the trend is away from breastfeeding towards substitute milk instead - a change that has already taken place in wealthier countries.

"In the west, when GDP per capita doubles, breastfeeding rates in children at 12 months drop by 10 percentage points," said Rollins. "Not breastfeeding is seen as the modern and sophisticated thing to do - it seems convenient, it allows women to get back to work, it's all the things you want to 'achieve'. We've seen this trajectory with developed countries and don't want it to play out a second time in low- and middle-income countries."

Campaign groups hope that the series - the most comprehensive review of breastfeeding research ever - will lead to long-lasting policy change.

"Breastfeeding is one of the most cost effective interventions for newborn health, but the support needed is too often lacking," said Brigid McConville, director of the maternal health group White Ribbon Alliance.

"Lancet's evidence will help citizen advocates push their governments to improve policies, and above all hold governments to account for their actions, making sure the policies lead to more support for new mothers and better health for their newborns."

If breastfeeding were scaled up to near universal levels, the authors found, 823,000 deaths of children under five could be prevented every year. An additional 22,000 annual deaths from breast cancer could be prevented if breastfeeding continued up to two years of age in lower- and middle-income countries, and up to 12 months in higher-income countries.

"The benefits of breastfeeding have been widely publicised yet ... it's clear that efforts are still falling far too short and the grave reality is that this is costing children's lives," said Professor Russell Viner of the Royal College of Paediatrics and Child Health.

Not breastfeeding creates a major burden on the world economy as well, costing $302bn (£210bn) globally in lost earnings, the authors found. Children who are breastfed consistently perform better in intelligence tests - in some studies by as much as seven IQ points - with higher intelligence related to higher average earnings.

Losses in poorer countries are estimated at $71bn of gross national income - with the Middle East and north Africa losing $12bn, east Asia and the Pacific $28bn, and Latin America and the Caribbean $12bn.

Governments can promote breastfeeding by raising awareness, improving maternity laws, and establishing nursing breaks and places to breastfeed in the workplace. Women who face stigma tend to stop breastfeeding earlier.

Even in countries where governments have actively encouraged breastfeeding, aggressive marketing by the formula milk industry - projected to reach $70bn by 2019 - far surpasses what governments spend to support breastfeeding.

Advertisements presenting formula milk as just as good as, if not better than, breast milk have - along with free samples - fuelled the industry in emerging markets. In Brazil, where hospitals, communities and the government all promote breastfeeding, the formula milk market is still projected to be worth $950bn within three years. The market is set to grow 7% in the Middle East and Africa, and 11% in Asia Pacific by 2019.

Promoting breast milk not only has social, medical and economic benefits, it is also environmentally friendly, the authors argue, as more than 4,000 litres of water are needed to produce a kilo of formula powder.

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Breastfeeding could prevent 800,000 child deaths, Lancet says

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If almost every mother breastfed her children it could prevent more than 800,000 child deaths a year, yet governments are failing to promote and support breastfeeding, with rates remaining far below international targets, new research has found.

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"Human Milk, Tailor-Made For Tiny Humans" advert

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The ad campaign was created by a collective of parents with different skills, lead by artist Claire Tchaikowski. 

We all came together for the love of helping parents and babies to breastfeed. 

The campaign has been entirely funded by team and family members giving time, skills and resources for free throughout, from the beginning in September 2014, to date.

Human Milk advert team

Founder and producer: Claire Tchaikowski, Bristol
Production Company: BURST, London
Director: Eric Trometer, London
Producer - Editor: Dana Trometer, London

Science advisors:

Natalie Shenker PhD, Imperial College London

Emma Pickett IBCLC, London, Chair of The Association of Breastfeeding Mothers UK

Laurel Wilson BS, IBCLC, CCE, CLE, Board of Directors for The United States Breastfeeding Committee, Executive Director of Lactation Programs for the Childbirth and Postpartum Professional Association USA

Olivia Bibollet-Bahena PhD, Montreal

Brand and website designer: Hilda Allen, Bristol
Music composer and producer: Neil Davidge, Bristol
Music mix engineer: Flemming Bloch, Copenhagen
PR Communication: Catherine Aithal, Head of New Business and Marketing - Havas Media Group
Website technical implementation/support: Daniel Puzey, Bristol
Graphics animators: Dominik McMahon, Ray Mongey, Yusuf Hasan at GLUE VFX, Dublin

Communications Team: Catherine Aithal, Alix McKenzie-Wain, Cara Luff, Daniel Puzey, Nicola Cunnington, Kate Hewitt, Anna Brown, Arti Pitamber-Davis, Iyato Dun

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Film on breastfeeding from the charity Best Beginnings: 

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Film on breastfeeding from the charity Best Beginnings: 

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On this page you can watch the From Bump to Breastfeeding DVD videos in English. From Bump to Breastfeeding guides you through all the questions, and talks to young mums about what it's really like. The videos are also available to view in our Baby Buddy app, on our YouTube channel, and on the web version of Baby Buddy.

You can buy copies of the From Bump to Breastfeeding DVD, which comes in seven languages (English, Arabic, Urdu, Bengali, Polish, Somali, and British Sign Language) from our online shop. There is also a Welsh version available.

A short introduction to From Bump to Breastfeeding.

Meet four prospective mums, Melissa, Maria, Teresa and Angela. Melissa has never been through labour - she had a caesarian-section with her previous child. For medical reasons Maria has to have a c-section; Teresa wants to give birth at home; and Angela is expecting her third child. We follow them as they prepare for their births.

All our mums have different birth experiences. Find out why skin-to-skin contact is so important and about breastfeeding for the first time. "It's a great feeling to be able to provide for him without anything else, just me myself," Angela says. Melissa's partner Andy says breastfeeding is healthy, cheaper and much less effort than making up bottles.

How to make sure your baby is attaching well at the breast.

Angela is back home with baby Cameron and breastfeeding is going well. "It's a great feeling to be able to sit there and watch him feeding away. It's a really special bond," she says. Teresa is making sure she has plenty of contact with Rufus, ensuring her body is supplying enough milk for him. Breastfeeding can protect you against ovarian cancer and give you stronger bones in later life.

Meet four mums whose babies have been breastfeeding for a little while and hear their experiences. Linda was troubled by breastfeeding outside the home - until she tried it. "I thought, 'nobody breastfeeds in public,'" she says. "What I realised is, loads of women breastfeed in public, you just don't realise it's happening."

Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly.

Linda and Heidi have fed their babies breast milk for six months. Now their babies are ready to try their first solids.

Extra films

Join a class with specialist midwife Bella Dale, who explains how breastfeeding works and how mums' bodies start preparing to feed their babies before birth.

Three mums tell us how they overcame hurdles with breastfeeding. Thomasina overcame sore nipples, while Lowri encountered mastitis, both of which were caused because their babies weren't attaching properly at the breast.

We meet three mothers who express their milk for different reasons and learnt how to do it in different ways. Find out techniques for expressing, different pumps and ways to store breast milk. We also discover how mothers fit breastfeeding into their return to work.

In their first few weeks, pre-term babies may be fed using a nasogastric tube. But as they progress they will begin to take milk feeds, usually through a tube into the baby's mouth or nose. Breast milk is best for many reasons. Find out why and how as we follow four mothers and their premature babies.

Follow three mothers as they share their tips on the joys and challenges of feeding twins.

Thank you for considering donating to Best Beginnings. To join our SpringBoard Programme for regular givers please select the regular donation tab below. To find out more about our SpringBoard Programme and how your donation can make a difference please watch the film above.

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On this page you can watch the From Bump to Breastfeeding DVD videos. From Bump to Breastfeeding guides you through all the questions, and talks to young mums about what it's really like. The videos follow four mums who decide to breastfeed their babies - it will tell you everything you ever wanted to know about breastfeeding and how to do it successfully.

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It’s helpful to be prepared for cluster feeding in the evenings, which almost all babies do for the first 8 weeks of their lives. The constant breastfeeding every evening that babies want to do in the first weeks of their lives can really undermine a mother’s faith in her milk supply:

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It’s helpful to be prepared for cluster feeding in the evenings, which almost all babies do for the first 8 weeks of their lives. The constant breastfeeding every evening that babies want to do in the first weeks of their lives can really undermine a mother’s faith in her milk supply:

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By Kelly Bonyata, BS, IBCLC
It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months.
My daughter had a fussy time every evening for a couple of months (yes, it does go away!). I spent weeks camped out on the end of the sofa with a constantly nursing and/or fussy baby every evening from about 6 to 10 PM. With my son, we didn't have the luxury of being able to sit down. Alex was unhappy and crying unless he was upright and being walked around at this time of day (and sometimes this only helped him to be less unhappy). He would occasionally have a very fussy time during the day, too. Nursing rarely helped to calm his fussiness (unlike with my daughter), so I usually didn't have that tool to work with (though I always tried). His fussiness was such that I looked into other causes (such as food sensitivity), but we never determined any reason for it and he was all smiles the rest of the time. The fussiness gradually went away between 3 and 4 months, as is the norm, but the first few months were hard. Nowadays, the typical comment that I hear about him is "Is he always this happy?" So remember: this, too, will pass...

Cluster feeding, also called bunch feeding, is when babies space feeding closer together at certain times of the day and go longer between feedings at other times. This is very common, and often occurs in the evenings. It's often -but not always- followed by a longer sleep period than usual: baby may be "tanking up" before a long sleep. For example, your baby may nurse every hour (or even constantly) between 6 and 10 PM, then have a longish stretch of sleep at night - baby may even sleep all night.

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Cluster feeding often coincides with your baby's . Baby will nurse a few minutes, pull off, fuss/cry, nurse a few minutes, pull off, fuss/cry... on and on... for hours. This can be VERY frustrating, and mom starts wondering if baby is getting enough milk, if something she is eating is bothering baby, if EVERYTHING she is doing is bothering baby... It can really ruin your confidence, particularly if there is someone else around asking the same questions (your mother, your husband, your mother-in-law).

This behavior is NORMAL! It has nothing to do with your breastmilk or your mothering. If baby is happy the rest of the day, and baby doesn't seem to be in pain (as with colic) during the fussy time - just keep trying to soothe your baby and don't beat yourself up about the cause. Let baby nurse as long and as often as he will. Recruit dad (or another helper) to bring you food/drink and fetch things (book/remote/phone/etc.) while you are nursing and holding baby.

Does this mean that baby needs more milk than I can provide?

No. Don't give baby a bottle - supplementation will only tell your body that you need LESS milk at this time, and that will not help matters. Also, keep in mind that formula fed babies experience fussy periods in the evening, too - fussy evenings are common for all young babies, no matter how they are fed. The Academy of Breastfeeding Medicine spells this out in their supplementary feeding guidelines:

There are common clinical situations where evaluation and breastfeeding management may be necessary, but supplementation is NOT INDICATED including... The infant who is fussy at night or constantly feeding for several hours.

Why do babies fuss in the evening?

One frequently-heard explanation for baby's fussiness in the evenings is that milk volume tends to be lower in the evening due to the natural cycling of hormones throughout the day. However, Dr. Peter Hartmann, a breastfeeding researcher, has said that in the women he has studied, milk volume is not low at this time of day. Even if milk volume is lower in the evening, fat content is typically higher in the evening (particularly if baby is allowed to control this via cue feeding), so the amount of calories that baby is getting should not be significantly different. Milk flow can be slower in the evening, which may be frustrating for some babies.

Doctors often attribute evening fussiness to baby's immature nervous system (and the fussiness does end as baby gets older, usually by 3-4 months). However, Dr. Katherine Dettwyler (who does research on breastfeeding in traditional societies) states that babies in Mali, West Africa and other traditional societies don't have colic or late afternoon/evening fussiness. These babies are carried all day and usually nurse several times each hour.

So perhaps none of these explanations is a complete answer to baby's evening fussiness. For many babies, the fussy time seems to be characterized by a need to have small quantities of milk at frequent intervals, combined with lots of holding, cuddling and movement. Babies who are offered as much expressed milk or formula as they will take by bottle [note: this practice will decrease your milk supply!] often behave in exactly the same way in the evenings. Baby takes a small amount and dozes (and fusses), then a little more, and so on. Perhaps babies "remember" mom being very active during her pregnancy at these times, and want to be held, rocked, and nurtured constantly again.
Perhaps babies simply need to nurse more often at this time - rather than consume more milk.
Soothing techniques for the fussy times

Wear baby in a sling or baby carrier. This will free one or both hands for other tasks (fixing dinner, caring for other children) while you hold, soothe and nurse your baby.

Change of pace. Let dad have some "baby time" while mom takes a shower or simply gets some time to herself to relax and regroup after a long day.

Go outside. Relax baby (and mom too) with a walk, or just sit and enjoy the outdoors. Try this a little before baby's regular fussy time.

Soothe with sound. Sing, hum, talk, murmur shhhh, listen to music, or use 'white noise.' Try different types of sound, different styles of music and singers with different types of voices.

Soothe with rhythmic motion. Walk, sway, bounce, dance, swing, or even try a car ride.

Soothe with touch. Hold or bathe baby, try baby massage.

Reduce stimulation. Dim lights, reduce noise, swaddle baby.

Vary nursing positions. Try side lying, lying on your back to nurse with baby tummy to tummy, etc.

Nurse in motion (while rocking, swaying, walking, etc.).

Combine rhythmic motion with soothing sounds.

Avoid scheduling, even more so in the fussy evening hours.

More soothing techniques.

More resources for fussy babies

@ KellyMom

@ other websites

Helpful books

The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer
by Harvey Karp, MD

The Fussy Baby Book: Parenting Your High-Need Child From Birth to Age Five
by William Sears, MD and Martha Sears, RN, IBCLC

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Cluster Feeding and Fussy Evenings * KellyMom.com

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It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months. My daughter had a fussy time every evening for a couple of months (yes, it does go away!).

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Here's an electronic version of my 'Breastfeeding Resources' sheets which I handed out, which has loads of information about drop-ins, phone-lines, websites, getting nursing bras, recommended reading, etc....

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Here's an electronic version of my 'Breastfeeding Resources' sheets which I handed out, which has loads of information about drop-ins, phone-lines, websites, getting nursing bras, recommended reading, etc....

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Here's a link to an explanation of REVERSE PRESSURE SOFTENING, a technique which can be very helpful if a woman's breasts become so engorged, when her milk comes in, that her baby can't latch:

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Here's a link to an explanation of REVERSE PRESSURE SOFTENING, a technique which can be very helpful if a woman's breasts become so engorged, when her milk comes in, that her baby can't latch:

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Check out stylish,
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and accessories from
our sponsor Sarah Wells Bags.

by K. Jean Cotterman RNC, IBCLC. Reprinted with permission from the author.

More health care providers are observing that mothers receiving multiple intrapartum IV's experience delay in expected postpartum fluid shift. Increased edema during the puerperium complicates engorgement, increases sub-areolar tissue resistance, distorts the nipple and interferes with comfortable, efficient latching. Edema may appear early, or later, within 48-96 hours, often lasting 10-14 days. (This may depend on both the quantity of IV fluid given and the time of infusion in relation to placental delivery, the stimulus for lactogenesis II.)

Reverse pressure softening (RPS) is a simple intervention that has proven very helpful in the first 14 days postpartum. RPS uses gentle positive pressure to soften a 1-2 inch area of the areola surrounding the base of the nipple, temporarily moving some swelling slightly backward and upward into the breast. RPS may be applied by the health care provider, and/or taught to the mother/significant others, if necessary, over the telephone.

Interstitial fluid volume increases 30% above normal before edema becomes visible. ( Guyton) To contain edema, areolar tissues must expand, limiting their ability to extend the nipple well into the baby's mouth. Early proactive use of RPS causes no harm and may facilitate increased milk transfer, reduce risk of nipple trauma, and help resolve engorgement.

Conversely, pumping may attract edema into the flange area, especially at maximum vacuum settings. Areolar tissue may then appear "thickened", seeming to "bury" the subareolar ducts. Then, neither infant tongue action, fingertip expression nor the pump itself removes milk very successfully.

RPS is best performed immediately before each attempt to latch, for as many feedings as needed:

The mother may prefer to apply RPS herself, or the HCP, with her permission, may apply RPS.

facing the mother, or

from slightly behind the mother, reaching over her shoulders

or place his/her fingers over those of the mother, to reinforce pressure.

The firmer or more swollen the areola, the more time is needed to achieve pliability.

RPS often forms temporary "dimples" or "pits", but edema soon re-enters the pits after pressure is released.

Positioning the mother with severe edema flat on her back during RPS delays re-entry of swelling, allowing a longer window of time for latching.

Firmly but gently, press steadily on the areola, right at the nipple base.

Pressure should not be firm enough to cause pain. Avoid discomfort with less pressure for longer intervals.

Press inward toward the chest wall for a full 60 seconds or longer (10-20 minutes or more if needed. This is a good time for instructions.)

Any finger combination may be used. (See diagrams)

Mothers may find short nails with curved fingertips of both hands the most effective method.

One-handed methods are convenient if the other hand is busy.

HCP's may find straight-fingers or two-thumb methods more convenient.

Use the flats of two thumbs or the first several fingers on each hand lengthwise above and below the nipple, creating a 1-2 inch long depression.

Continue to alternate in opposite quadrants, with repeated 2 minute periods of pressure, partially overlapping the first set of pits, to keep edema displaced from the entire area at the base of the nipple.

After RPS, additional fingertip expression to further soften the areola is much easier, more comfortable and more productive. Creating a special niche for the chin often permits deeper latching.

Two handed, one-step method
Fingernails short, fingertips curved;
each one touching the side of nipple.

Two handed, two-step method
Using 2 or 3 straight fingers on each side, first knuckles touching nipple. Move ¼ turn. Repeat above & below nipple.

Two thumbs, two-step method (Step 1). Using straight thumbs, base of
thumbnail even with side of nipple.

Two thumbs, two-step method (Step 2).Move ¼ turn. Repeat above & below nipple.

One handed "flower hold"
Fingernails short, fingertips curved,
placed where baby's tongue will go.
(To see your areola better,
try using a hand mirror.)

Soft ring method
Cut off bottom half of an artificial nipple to place on areola to press with fingers.

Benefits of RPS include:

Steady stimulation of nerves under the areola automatically triggers the milk ejection reflex, propelling milk forward in the breast, nearly always within 1-2 minutes or less.

Excess interstitial fluid is temporarily moved in the direction of natural lymphatic drainage.

Displacing milk slightly backward into deeper ducts relieves over-distention of subareolar ducts, reducing latch discomfort and facilitating milk transfer.

Areolar elasticity is freed for

extending the nipple more deeply into baby's mouth

responding to the rippling of the tongue.

Guyton, AC, Basic Human Physiology: Normal Function and Mechanisms of Disease, 2nd Ed., W. B. Saunders Co. Philadelphia, 1977, p. 321.

Permission is hereby given to reproduce and distribute this article as long as the original wording and my authorship and credit for diagrams by Kyle Cotterman are retained. You may contact me at: mellomom@juno.com

See also:

Engorgement at KellyMom

Too Swollen to Latch On? Try Reverse Pressure Softening First by K. Jean Cotterman, RNC, RLC, IBCLC, from Leaven, Vol. 39 No. 2, April-May 2003, pp. 38-40.

Cotterman KJ. Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement. J Hum Lact 2004 20: 227-237.

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Engorgement Help: Reverse Pressure Softening * KellyMom.com

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More health care providers are observing that mothers receiving multiple intrapartum IV's experience delay in expected postpartum fluid shift. Increased edema during the puerperium complicates engorgement, increases sub-areolar tissue resistance, distorts the nipple and interferes with comfortable, efficient latching. Edema may appear early, or later, within 48-96 hours, often lasting 10-14 days.

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It can be quite overwhelming when a mother’s milk comes in, which is normally somewhere between day 2 and day 4. I urge to read this link, on dealing with ENGORGED BREASTS, before your baby is born. Applying cold cabbage leaves to breasts between feeds can really help during this period, which usually only lasts 24 hours or so:

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It can be quite overwhelming when a mother’s milk comes in, which is normally somewhere between day 2 and day 4. I urge to read this link, on dealing with ENGORGED BREASTS, before your baby is born. Applying cold cabbage leaves to breasts between feeds can really help during this period, which usually only lasts 24 hours or so:

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By Kelly Bonyata, BS, IBCLC

What is Normal?

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (" comes in ") 2-5 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

How to prevent or minimize engorgement

Nurse early and often - at least 10 times per 24 hours. Don't skip feedings (even at night).

Nurse on baby's cues ("on demand"). If baby is very sleepy: wake baby to nurse every 2-3 hours, allowing one longer stretch of 4-5 hours at night.

Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don't limit baby's time at the breast.

Ensure correct latch and positioning so that baby is nursing well and sufficiently softening the breasts.

If baby is not nursing well, express your milk regularly and frequently to maintain milk supply and minimize engorgement.

Signs & Symptoms of Engorgement

When? Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

How does the breast feel? The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. Engorgement may extend up into the armpit.

How does the areola feel? The areola will typically feel hard (like the tip of your nose or your forehead) rather than soft (like your earlobe), with tight skin that may appear shiny. The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

Moms' experiences of engorgement differ. Engorgement:

May occur in the areola and/or body of the breast;

May occur in one or both breasts;

May build to a peak and then decrease, stay at the same level for a period of time (anywhere from minimal to intense), or peak several times.

Tips for treating engorgement

Before nursing

Gentle breast massage from the chest wall toward the nipple area before nursing.

Cool compresses for up to 20 minutes before nursing.

Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.

If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:

While nursing

Gentle breast compressions and massage during the nursing session can reduce engorgement.

After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.

Between feedings

If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.

Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.

Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage). A "juice-jar" pump may also be used.

Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.

It's not good to let the breasts get too full, but you also don't want to overdo the pumping, as too much pumping will encourage overproduction. If you do need to express milk for comfort, your need to express will likely decrease gradually over time; if it does not, then try gradually decreasing the amount you express.

Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.

Cabbage leaf compresses can also be helpful.

Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.

Talk to your health care provider about using a non-steroidal anti-inflammatory such as ibuprofen (approved by the American Academy of Pediatrics for use in breastfeeding mothers) to relieve pain and inflammation.

AVOID:

Excess stimulation (for example, don't direct a shower spray directly on the breasts).

Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.

Restricting fluids. This does not reduce engorgement. Drink to thirst.

Contact your lactation consultant or health care provider if:

Engorgement is not relieved by these measures.

Baby is unable to latch or is not having enough wet/dirty diapers.

You have mastitis symptoms: red/painful breast, temperature greater
than 100.6 degrees F, chills, body aches, flu-like symptoms.

You have any questions.

Other treatments for engorgement

Cabbage

Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

What are cabbage compresses used for?

Engorgement.

Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing "uphill," etc.) are not working

During weaning, to reduce mom's discomfort and decrease milk supply.

Sprains or broken bones, to reduce swelling.

To use cabbage leaves:

Green cabbage leaves may be used chilled or at room temperature.

Wash cabbage leaves and apply to breasts between feedings.

For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use as soon as engorgement/oversupply begins to subside.

During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.

For further information on how to use cabbage leaves:

"Juice Jar" breast pump

This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.

Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.

Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.

Pour all the water out of the jar.

Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).

Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.

As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort - if the jar cools too quickly it may create excessive suction which can damage breast tissue.

Repeat for the other breast.

Some moms need to repeat this, others find it works sufficiently with only one try.

Fenugreek seed poultice

This is a traditional treatment for engorgement or mastitis. Steep several ounces of fenugreek seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots. For more information, see Fenugreek.

Additional Resources

@

Reverse Pressure Softening ... aids latching when mom is engorged

@ other websites

Prevention and Treatment of Engorgement by Becky Flora, BS, IBCLC

Animation of baby nursing when mom is engorged showing how engorgement can lead to nipple trauma, from the Breastfeeding Management Series software by Sallie Page-Goertz, MN, CPNP, IBCLC and Sarah McCamman, MS, RD, LD

References:

Veldhuizen-Staas C. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007; 2: 11. doi: 10.1186/1746-4358-2-11

Cotterman KJ. Too Swollen to Latch On? Try Reverse Pressure Softening First. Leaven, April-May 2003;39(2):38-40.

Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact. 1994 Jun;10(2):79-86.

Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes. J Hum Lact. 1994 Jun;10(2):87-93.

Lawrence R and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. St. Louis: Mosby, 2005, p. 278-281.

Moon JL, Humenick SS. Breast engorgement: contributing variables and variables amenable to nursing intervention. J Obstet Gynecol Neonatal Nurs. 1989 Jul-Aug;18(4):309-15.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010, p. 679-683.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004, p. 205-207, 228.

Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995 Sep;11(3):191-4.

Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. J Hum Lact. 1995 Mar;11(1):17-20.

Smith A, Heads J. Breast Pathology. In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 175-180.

Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2001;(2):CD000046.

Walker M. Breastfeeding and Engorgement. Breastfeeding Abstracts, November 2000;20(2):11-12.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, Third Edition. Austin, Texas: LactNews Press, 2005, p. 109-111.

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It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity ("comes in") 2-6 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

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Here's some information about colostrum, the first milk which women's bodies start to produce during pregnancy and continue to produce for the first few days after a baby is born. Please remember that it’s normal for there to be very, very small amounts of colostrum. Remember, colostrum comes in tiny drops:

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Here's some information about colostrum, the first milk which women's bodies start to produce during pregnancy and continue to produce for the first few days after a baby is born. Please remember that it’s normal for there to be very, very small amounts of colostrum. Remember, colostrum comes in tiny drops:

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Page not found - La Leche League International

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And a poster illustrating breast storage capacity:

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And a poster illustrating breast storage capacity:

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Breast Storage Capacity is free and downloadable and only available in electronic version. Scroll down to see Breast Storage Capacity in Spanish, French, German, Mandarin, Polish, and Bulgarian. Many thanks to its volunteer translators!

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Breast Storage Capacity - Nancy Mohrbacher

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Breast Storage Capacity is free and downloadable and only available in electronic version. Scroll down to see Breast Storage Capacity in Spanish, French, German, Mandarin, Polish, and Bulgarian. Many thanks to its volunteer translators!

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Here’s a very good explanation of how milk production works:

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Here’s a very good explanation of how milk production works:

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By Kelly Bonyata, BS, IBCLC

To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works...

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For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.
In the Beginning...

Endocrine (Hormonal) Control of Milk Synthesis - Lactogenesis I & II

Milk production doesn't start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven - this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

During the latter part of pregnancy, the breasts are making colostrum, but high levels of progesterone inhibit milk secretion and keep the volume "turned down". At birth, the delivery of the placenta results in a sudden drop in progesterone/estrogen/HPL levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels cues Lactogenesis II (copious milk production). Other hormones (insulin, thyroxine, cortisol) are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Lactogenesis II commences approximately 30-40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk "coming in") until 50-73 hours (2-3 days) after birth.

These first two stages of lactation are hormonally driven - they occur whether or not a mother is breastfeeding her baby.

Established Lactation...

Autocrine (Local) Control of Milk Synthesis - Lactogenesis III

After Lactogenesis II, there is a switch to the autocrine (or local) control system. This maintenance stage of milk production is also called Lactogenesis III. In the maintenance stage, milk synthesis is controlled at the breast - milk removal is the primary control mechanism for supply. Milk removal is driven by baby's appetite. Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.

By understanding how local/autocrine control of milk synthesis works, we can gain an understanding of how to effectively increase (or decrease) milk supply.

What does current research tell us about milk production?

Current research suggests that there are two factors that control milk synthesis:

Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) - the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).

The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites - thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through - thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.

Both of the above factors support research findings that tell us:

FULL
Breast
=
SLOWER
Milk
Production

EMPTY
Breast
=
FASTER
Milk
Production

Research indicates that fat content of the milk is also determined by how empty the breast is (emptier breast = higher fat milk), rather than by the time of day or stage of the feed.

How does milk supply vary throughout the day?

Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses. Fat content tends to increase as the day progresses (Hurgoiu V, 1985). These observations are consistent with current research if we assume the researchers were observing babies with a fairly typical nursing pattern, where baby has a longer sleep period at night and gradually decreases the amount of time between nursing as the day progresses.

Storage capacity: Another factor that affects milk production and breastfeeding management is mom's milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby's growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby's appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

Think of storage capacity as a cup - you can easily drink a large amount of water throughout the day using any size of cup - small, medium or large - but if you use a smaller cup it will be refilled more often.

What does the research tell us about increasing milk supply?

Milk is being produced at all times, with speed of production depending upon how empty the breast is. Milk collects in mom's breasts between feedings, so the amount of milk stored in the breast between feedings is greater when more time has passed since the last feed. The more milk in the breast, the slower the speed of milk production.

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings:

EMPTY
Breast
=
FASTER
Milk
Production

In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.

To accomplish this goal and increase milk production:

1. Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)

2. Empty the breasts as thoroughly as possible at each nursing/pumping session.

To better empty the breasts:

Make sure baby is nursing efficiently.

Use breast massage and compression.

Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.

Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Are you having problems with oversupply?

Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by "block nursing" - mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby's nursing frequency is not limited.

See also:
Frequently Asked Questions about Milk Production I'm confused about foremilk and hindmilk - how does this work?
Anatomy of the human breast. Diagram by DT Ramsay, RL Hartmann, PE Hartmann

Note: the graphics above are copyrighted. Do not use without express written permission.

Many thanks to Denise Fisher of Health e-Learning for the valuable feedback!

Additional information

Anatomy of a Working Breast by Anna Edgar, from New Beginnings, Vol. 22 No. 2, March-April, pp. 44-50.

How the breasts make and deliver milk from AskDrSears.com

Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

Human Milk and Lactation by Carol L Wagner, MD

References

Cox DB, Kent JC, Casey TM, Owens RA, Hartmann PE. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationships. Exp Physiol. 1999;84(2):421-34.

Cox DB, Owens RA, Hartmann PE. Studies on Human Lactation: The Development of the Computerized Breast Measurement System. June 1998. Accessed May 28, 2004.

Cox DB, Owens RA, Hartmann PE. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996 Nov;81(6):1007-20.

Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume and duration between feeds in women breastfeeding their full-term infants over a 24 h period. Exp Physiol. 2002 Mar;87(2):207-14.

Hartmann PE, Prosser CG. Physiological basis of longitudinal changes in human milk yield and composition. Fed Proc. 1984 Jun; 43(9): 2448-53.

Hurgoiu V, Marcu A, Sopon E, Olariu M. Dynamics of the composition of lipids in human milk during lactation. [French]. Pediatrie. 1985 Apr-May;40(3):201-5.

Ingram J, Woolridge M, Greenwood R. Breastfeeding: it is worth trying with the second baby. Lancet. 2001 Sep 22;358(9286):986-7.

Marasco L, Barger J. Cue Feeding: Wisdom and Science. Breastfeeding Abstracts. 1999 May;18(4):28-29

Mohrbacher N, Stock J. The Breastfeeding Answer Book. Third Revised Edition. Schaumburg, Illinois: La Leche League International; 2003. 16-23.

Neville MC, Morton J. Physiology and endocrine changes underlying human lactogenesis II. J Nutr. 2001 Nov; 131(11): 3005S-8S.

Neville MC. Anatomy and physiology of lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 13-34.

Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 35-52.

Peaker M, Wilde CJ. Feedback control of milk secretion from milk. J Mammary Gland Biol Neoplasia. 1996 Jul;1(3):307-15.

Perez-Escamilla R, Chapman DJ. Validity and public health implications of maternal perception of the onset of lactation: an international analytical overview. J Nutr. 2001 Nov;131(11):3021S-4S.

Ramsay DT, Kent JC, Owens RA, Hartmann PE. Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics. 2004 Feb;113(2):361-7.

Walker M. Physiology of the Breast During Pregnancy and Lactation. In: Walker M, editor. Core Curriculum for Lactation Consultant Practice, Sudbury, Massachusetts: Jones and Bartlett; 2002. 27-34.

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How does milk production work? * KellyMom.com

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To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works... For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.

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Here's the sheet comparing the ingredients in breastmilk with the ingredients in formula:

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Here's the sheet comparing the ingredients in breastmilk with the ingredients in formula:

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Here’s a leaflet called “Breastfeeding Basics”, which sums up what we covered:

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Here’s a leaflet called “Breastfeeding Basics”, which sums up what we covered:

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There is no need to worry about foremilk and hindmilk: 

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There is no need to worry about foremilk and hindmilk: 

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A little knowledge can be a dangerous thing. This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning.

The 2003 edition of The Breastfeeding Answer Book defines these terms this way:

"The milk the baby receives when he begins breastfeeding is called the 'foremilk,' which is high in volume but low in fat. As the feeding progresses, the fat content of the milk rises steadily as the volume decreases. The milk near the end of the feeding is low in volume but high in fat and is called the 'hindmilk'" (Mohrbacher and Stock, p. 34).

It goes on to explain that by simply letting the baby "finish the first breast first"-switching breasts when the baby comes off the breast on his own rather than after a set time-the mother can be sure her baby receives the "proper balance of fluid and fat." Since this book was published, research has expanded our understanding of foremilk and hindmilk and answered many of the common questions mothers have about these concepts.

What worries? Confusion about foremilk and hindmilk has led to all sorts of uncertainty. Are there two distinctly different types of milk? Does the baby need to breastfeed for a specific number of minutes before foremilk suddenly turns to hindmilk? Can a baby miss out on hindmilk altogether if he breastfeeds for too short a time? If this happens often, will his weight gain suffer? Sometimes healthcare providers get into the act, telling breastfeeding mothers they should watch the clock to make sure their baby breastfeeds "long enough to get the hindmilk," with the number of minutes recommended varying by adviserWhat do we really need to know about foremilk and hindmilk? And is there any reason to worry?

The truth about foremilk and hindmilk. Research has found this concept is not as simple as it sounds. It is true that fat sticks to the milk ducts in the breast and the percentage of fat in the milk increases during a breastfeeding as the fat is released from the ducts during milk ejections. But the reality of this seemingly simple dynamic is not always as it seems.

There are not "two kinds of milk."Despite this common belief, there is no "magic moment" when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.

The total milk consumed daily-not the hindmilk-determines baby's weight gain. Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary.

Foremilk is not always low-fat. The reason for this is that at the fat content of the foremilk varies greatly, depending on the daily breastfeeding pattern. If the baby breastfeeds again soon after the last feeding, the foremilk at that feeding may be higher in fat than the hindmilk consumed at other feedings.

How does this work? Interestingly, foremilk and hindmilk are concepts that really only make sense when longer intervals such as two to three hours or more occur between feedings. The longer the time gap between feedings and the fuller a mother's breasts become, the greater the difference in fat content between her foremilk and hindmilk. These differences in fat content can vary greatly over the course of a day even among individual mothers. For example, when a long breastfeeding gap occurs during the night, at the next feeding a mother's foremilk will be lower in fat than during the evening when her baby breastfeeds more often.

What really matters. Research indicates that there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. As long as a baby is breastfeeding effectively and the mother does not cut feedings short, baby will receive about the same amount of milk fat over the course of a day no matter what the breastfeeding pattern (Kent, 2007). This is because the baby who breastfeeds more often consumes foremilk higher in fat than the baby who breastfeeds less often. So in the end it all evens out.

What's most important to a baby's weight gain and growth is the total volume of milk consumed every 24 hours. On average, babies consume about 750 mL of milk per day (Kent et al., 2006). As far as growth is concerned, it doesn't matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010). In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat. Let's simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our "worry lists."
References
Hartmann, P.E. (2007). Mammary gland: Past, present, and future. in eds. Hale, T.W. & Hartmann, P.E. Hale & Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.

Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd edition. Schaumburg, IL: La Leche League International, 2003.

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Worries About Foremilk and Hindmilk - Nancy Mohrbacher

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A little knowledge can be a dangerous thing. This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and prem

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THE RECOMMENDATION IS TO OFFER A BABY BOTH BREASTS AT EACH FEED: once the baby has come off the 1st breast of their own accord, offer them the 2nd breast. If they have fallen asleep, which is very common, then you can wake them up either by changing their nappy, or just taking off some of their clothes. Whether they take a little, a lot, or none of the 2nd breast, GO BACK TO THAT 2nd BREAST FOR THE NEXT FEED. If a mother only offers one breast per feed in the early weeks, it could hinder her ability to establish a good milk supply.

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THE RECOMMENDATION IS TO OFFER A BABY BOTH BREASTS AT EACH FEED: once the baby has come off the 1st breast of their own accord, offer them the 2nd breast. If they have fallen asleep, which is very common, then you can wake them up either by changing their nappy, or just taking off some of their clothes. Whether they take a little, a lot, or none of the 2nd breast, GO BACK TO THAT 2nd BREAST FOR THE NEXT FEED. If a mother only offers one breast per feed in the early weeks, it could hinder her ability to establish a good milk supply.

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Should a baby have one breast per feed or both sides? This article looks at how breastfeeding works to help understand whether a baby needs one breast or two per feed, how often a baby might want to breastfeed and what to do if a baby needs more milk.

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Breasts make different amounts of milk

How much breast milk a breast can store varies from mother to mother and even from breast to breast within the same mother. How much breast milk a breast can store is known as the storage capacity. A mother with a small storage capacity can make just as much milk in 24 hours as one with a large storage capacity but she will need to feed her baby much more often.

Size doesn't matter

It's not possible to tell how much breast milk a mother's breasts can store by looking at purely the size of the breasts because the amount of fatty tissue will control the cup size. It is the amount of glandular tissue (milk making tissue) within the breast that controls the amount of milk stored between feeds. So how can a mother know what her storage capacity is and whether her baby needs one breast or two per feed?

One breast or two per feed?

Let your baby decide! The only person who can tell you how often he needs to feed is your baby. Only your baby knows when one breast is empty and whether he needs the milk from another breast straight away to fill him up or in half an hour or two hours. Put another way, if a mother can store 50ml in each breast her baby might want both breasts per feed. Whereas the baby of a mother who stores 120ml in each breast may only want one breast per feed. You don't need to know how much milk is stored so long as a baby is:

fed on demand

allowed to finish the first breast of his own accord before offering the second side (or third or fourth)

has plenty of dirty nappies and is gaining weight appropriately and thriving

All breast milk is good

You may come across the idea that there are two kinds of milk in a breast; low fat foremilk at the start of a feed and high fat hindmilk that arrives towards the end of a feed. Taken a step further you may have heard that the foremilk is like a drink or a soup starter but the hindmilk is the more important "meal" and "pudding". It can be confusing and unhelpful to think of breast milk in terms of two kinds of milk because all breast milk is good. See Forget About Foremilk and Hindmilk to explain why you don't need to worry about this. Confusion about foremilk and hindmilk can lead to harmful advice such as in the following example.

My health visitor told me to keep to one breast per feed to reach the hindmilk

Keeping to one breast "to reach the hindmilk" is a very common myth but is poor general advice because:

Staying on one breast can reduce a milk supply

Keeping a baby on one breast per feed-or for a specified block of time-is generally a way to decrease a breast milk supply. Offering the other breast after your baby has finished the first side, or switching between breasts (see box) is generally a way to increase a milk supply.

If you have a low storage capacity then keeping to one breast is potentially denying your baby half his milk or more. Your baby may need the "hindmilk" from both breasts.

If you have a high storage capacity and an abundance of milk, keeping to one breast per feed, or for a block of time, may work well.

If you are not sure whether you have a low or high storage capacity, check with an IBCLC lactation consultant who will take a full history and check on your baby's weight gain and dirty nappies.

Switch nursing involves switching (changing) breasts a couple of times during a breastfeed to keep a sleepy baby feeding and can help to increase milk supply. Start by letting your baby feed on the first breast until their sucking slows right down or stops and then move him across to the other breast. The faster flow of another let down on the second side will keep him interested in feeding, then, once sucking slows on this breast, swap back to the first breast and so on. Switch nursing can be combined with breast compression; once sucking slows on each side try breast compression to keep your baby feeding actively before offering the next breast.

An underweight baby needs more milk

When weight gain is an issue, the answer is almost always that the baby needs more breast milk rather than a few more drops of higher fat milk from one breast:

When a baby isn't gaining weight they most likely need more milk, not more time on an already empty breast which will further reduce a mother's supply. An extra 7-8 ml of high fat milk from the same breast is no substitute for the extra 70-80 ml of fore-hind-and-in-the-middle-milk they might need from the other breast.

Making more milk

Breasts make milk on demand; so that the faster your baby drinks the available milk, the faster your breasts will make more milk to replace it, indefinitely. Breasts gauge demand by their degree of fullness:

Whenever a breast is full, milk production slows down

Whenever a breast is emptied regularly, milk production increases

More frequent feeds, breast compressions, and using both breasts per feed are all strategies to make more milk and see How to Make More Milk on this website.

Sometimes one breast, sometimes two

Let your baby decide whether he wants one breast or two per feed and whether he wants to feed again in 30 minutes or two hours. Start each new feed with the breast that baby finished on last. Breastfeeding authors Mohrbacher and Kendall-Tackett explain:

Once your milk increases on the third or fourth day, most babies take one breast at some feedings and both breasts at others. This strategy relies on your baby's ability to tell you what he needs. As with us adults, some babies are fast eaters and some are slow eaters. So a clock will never tell you when your baby is done. (How would you feel if, in the middle of your meal, someone pulled your plate away?) Only your baby knows for sure when the flow on one breast has slowed down to the point where he is ready for the other side. Only he knows when he has had the right amount of milk for that feeding.

Lopsided?

It's very common for one breast to have more milk than another or for a baby to have a favourite side-perhaps they prefer one nipple over another or the flow of milk on one side feels just right. Over time the favourite side will usually compensate and produce more milk while the least favourite side will slow down production. This can cause breasts to be lopsided for a while but after breastfeeding ends they will even out again. If a mother is concerned about the size difference

Try to recreate the same position from the favourite side on the other breast. For example if baby prefers the cross cradle hold on the left side, try rugby hold on the right so that baby's body position on that side mimics their position on the favoured side.

Pumping with a good breast pump can help to increase the milk supply on the least favourite side-when there is more milk it is likely to be more desirable again to your baby.

What if my baby falls asleep at the breast? Is this a bad habit?

It is quite normal for a baby to enjoy sleeping in his mother's arms with the breast in his mouth, sometimes this is called comfort nursing. Breastfeeding your baby to sleep need not be a problem when coupled with good weight gain. However, watch for the baby who "hangs out at the bar without buying any drinks" i.e. he is latched on but actually he is barely swallowing anything before getting tired and falling asleep half way through the first side. Consult with your IBCLC if this is the case to get breastfeeding back on track with a care plan tailored for you and your baby and check out Breastfeeding a Sleepy Baby, Is My Baby Getting Enough Milk? or Baby Not Gaining Weight. For more information about comfort nursing see Flutter Sucking and Comfort Nursing.

I'm still not sure when to feed him!

When your baby shows early feeding cues such as sucking his fist or fingers, or moving his head side to side with an open mouth; offer him the breast. If you miss the early cues he may have to cry to get your attention, but you don't have to wait for crying; babies latch best when they are calm and before they get ravenous.

Breast milk is easily and quickly digested-even as quickly as one hour-and babies have tiny tummies so they need to feed little and often. It is usually recommended that a baby has at least 8-12 feeds in 24 hours i.e. that they breastfeed every two to three hours from the start of one feed to the start of the next and this ties in with a newborn's sleep patterns. Some babies may feed more frequently e.g. every hour at first. Frequent breastfeeds will provide plenty of breastfeeding practice, provide baby with a steady supply of food and stimulate the breasts to make more milk.

How can I tell my baby has finished feeding?

Check that your baby is feeding well by watching his jaw move and listening for swallows, there is more information in Is My Baby Getting Enough Milk? As the feed progresses his rhythmic sucking will slow down to flutter sucks with less frequent swallows; he may fall asleep and/or let go of the breast to signal he is finished. If you feel he hasn't drained the breast properly or has fallen asleep before he finished, you can try some breast compressions to get him sucking again, when he stops sucking with the compressions, offer the second side. Sometimes he may want the second side and sometimes he might not.

Offer the breast frequently

There is a lovely passage in the Womanly Art of Breastfeeding that helps explain how often to feed a baby by comparing the breast to a snack tray:

When you're at a party, the hostess doesn't usually ask if you're hungry before she passes the snack tray. She offers frequently, and you decide whether to eat or pass it on. You're the one with the breast "snack tray", why not be a good hostess and offer whenever your baby seems unsettled? No need to force the issue if you've guessed wrong. But your baby can't nurse if the offer isn't made.

Isn't he just using me as a pacifier?

Not at all! Nursing feeds him, pacifies him, puts him to sleep, comforts, reassures and relaxes him. If you offer your breast only as food and not as a "pacifier", you'll cut out all the calories he gets along with those other reasons, you're more likely to end up with supply problems, and you'll lose the pleasure of-literally-going with the flow. The phrase "he's just using you as a pacifier" works against confident, smooth-running breastfeeding. Nursing is how a baby grows; why hold back?

Summary

Breasts vary in their breast milk storage capacities. Where one mother's baby might only want one breast per feed and not be hungry for two hours, another may need both breasts per feed and be hungry again in an hour. Let your baby decide how many breasts he wants at a particular feed by looking for his feeding cues and offering him plenty of opportunities to breastfeed.

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Should a baby have one breast per feed or both sides? This article looks at how breastfeeding works to help understand whether a baby needs one breast or two per feed, how often a baby might want to breastfeed and what to do if a baby needs more milk.