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How to enable comfortable breastfeeding from birth

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Importance of Zero separation for at least the first 20 hours

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Whatever is needed for the medical, emotional, psychological and physical well being of mother and baby is provided to them, without separating them. This might mean adding ultramodern equipment if available, or purely intense psychological support in contexts with no resources. It can even mean going home very early.

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Whatever is needed for the medical, emotional, psychological and physical well being of mother and baby is provided to them, without separating them. This might mean adding ultramodern equipment if available, or purely intense psychological support in contexts with no resources. It can even mean going home very early.

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Co-sleeping is a term that refers to a mother and/or her partner (or any other person) being asleep on the same sleep surface as a baby.

If your baby ends up in your bed during the night, you're not alone. Many parents find that bringing their baby into their bed is easier. It helps them to care for their baby at night and everyone gets more sleep. Australian research has found that around 75% of babies spend at least some time co-sleeping in the first 3 to 6 months of life.

It is recommended that babies sleep in their own safe sleeping space next to the parent's bed for the first 6 to 12 months of life. However, many parents choose to, or have no option but to, share a sleep surface with their baby.

It's not bed-sharing alone that is dangerous, but other factors which may interact in bed-sharing and shared sleep environments to increase the risk of a sudden unexpected death in infancy (SUDI).

Breastfeeding has a protective effect against SIDS

There are several theories as to why breastfeeding protects against sudden unexpected deaths in infancy:

Breastfed babies are more easily woken up than formula-fed babies at 2 to 3 months of age, which is within the 2-to-4-month age when SIDS occurs most.

Breastfeeding provides babies with important immune factors (e.g. antibodies and white blood cells) which may help to protect babies from SIDS.

Some babies whose deaths are sudden and unexpected have had a minor infection in the days before that wasn't considered sufficient alone to have caused death. Breastfed babies suffer fewer infections than formula-fed babies.

Breastfeeding and co-sleeping

Babies need to be fed during the night and many new mums fall asleep while feeding their baby. Co-sleeping helps to minimise disruption to sleep for both mum and baby.

Breastfeeding and co-sleeping mutually support each other. Co-sleeping is convenient for night feeding so that's why parents choose to do it. Mums who bed-share with their baby tend to breastfeed longer and keep exclusively breastfeeding for longer than those who do not co-sleep.

You may be concerned about co-sleeping with your baby. However, it has been found that when a breastfeeding mum co-sleeps, she usually lies in a position that helps her keep close physical contact and care of her baby.

She usually forms a protective "C'' shape around her baby. She keeps her baby at the level of her breast with an arm between her baby's head and the pillow.

She instinctively bends her legs making the protective space around the baby. It's impossible for another person to roll onto the baby without first touching her legs.

A breastfeeding mum who co-sleeps with her baby also tends to be highly responsive to her baby's needs. As long as she hasn't drunk alcohol, taken illegal or sleep-inducing drugs and isn't extremely tired.

Mums and babies who co-sleep tend to wake more during the night and this may protect against sudden unexpected infant deaths. The mum checks her baby and breastfeeds them more frequently when co-sleeping than when room-sharing.

Risk factors for SUDI when co-sleeping

Under certain circumstances, some studies have reported an increased risk of SUDI in co-sleeping babies. The following risk factors have been identified:

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Is it safe to sleep with baby? Find out more about bed sharing and co-sleeping.

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To reduce the risk of sudden infant death syndrome (SIDS) the safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. However, we know that many parents find themselves co-sleeping whether they mean to or not. Wherever you're planning for your baby to sleep we recommend making your bed a safer place for baby. Our advice on co-sleeping with your baby will tell you how.

When not to co-sleep

Whether you choose to co-sleep or it is unplanned, there are some key risks you should avoid.
Co-sleeping with your baby is very dangerous if:
In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or Moses basket. Keeping the cot or Moses basket next to your bed might make this easier.
Never fall asleep on a sofa or armchair with your baby. The risk of SIDS is 50 times higher for babies when they sleep on a sofa or armchair with an adult. They are also at risk of accidental death as they can easily slip into a position where they are trapped and can't breathe.
Co-sleeping more safely

Keep pillows and adult bedding away from your baby or any other items that could cover their head or cause them to overheat. A high proportion of babies who die as a result of SIDS are found with their head covered by loose bedding.

Follow all The Lullaby Trust's other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back

To reduce the risk of accidents, do not bring other children or pets into bed with you.

Try to make sure or check that baby cannot be trapped, wedged or fall out of bed or get trapped between the mattress and the wall

Never leave your baby unattended in an adult bed

For more info on co-sleeping and safer sleep read our guide for parents
If you are bedsharing with your baby you should consider any risks before every sleep. It is easy for your situation to change if you are unwell or have drunk any alcohol, which means your baby will be safest in a separate sleep space such as a cot or Moses basket on that occasion.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep while I breastfeed my baby at night, is this ok?

Click here to open this question

Breastfeeding reduces the chance of SIDS. If you feel you might fall asleep we would recommend you prepare the bed as described above so it is safer for baby if this happens.

Make sure you know the advice on when never to co-sleep so you know when to take particular care. It is really important that you do not accidentally fall asleep with your baby on a sofa or armchair. If you think you might fall asleep on a sofa or armchair, put the baby down in a safe place to sleep.

Should I co-sleep with my baby?

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The safest place for a baby is their own separate sleep space, such as a cot or Moses basket. We would just advise you to read all the information on co-sleeping and how to reduce the risks, so you can make an informed decision for you and your baby.

However, there are some circumstances where we would strongly recommend against co-sleeping such as on a sofa or armchair, if anyone in the bed smokes or has drunk alcohol or your baby was premature or a low birth weight.

Can I co-sleep with twins or multiples?

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If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

Is it safer to co-sleep using a nest or pod than with a baby just lying on the adult bed?

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No. We do not recommend that babies sleep on soft surfaces such as pods or nests. If you choose to co-sleep with your baby the safest place is a clear space on a firm flat mattress the same as we would advise with a cot.

Why do you advise against co-sleeping in certain scenarios?

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It is estimated that around half of SIDS deaths occur whilst co-sleeping, and that most of these are in high risk situations. We do not know the cause of SIDS and why these deaths happen but we do know what some of the risk factors are and that removing those risks greatly lowers the chance of SIDS occurring.

For that reason we strongly advise against co-sleeping when there are risk factors such as a baby being premature or a parent having drunk alcohol.

What bedding should I use for my baby when we co-sleep?
The Lullaby Trust has worked with Public Heath England, Unicef UK Baby Friendly and Basis on two publications to support families with safer sleep advice and advice on co-sleeping more safely. We have also collaborated on a guide for health professionals to have more open and productive discussions with families about safer sleep and co-sleeping. These can be downloaded below.

Click here to open this question

Adult bedding should be kept well away from your baby along with any belts or cords from clothing. Keep adult bedding at your waist height and add an extra layer of clothing if you are cold

A baby sleeping bag is a good way of giving your baby their own bedding when bedsharing.

Baby sleeping bags should be well fitted, so the baby can't wriggle down inside. Most sleeping bags are fitted according to a baby's weight, rather than age.

You might also be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

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Some parents choose to share a bed (known as co-sleeping) with their babies. Read our advice on how to co-sleep more safely.

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Helping to transition a baby to the breast

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Everything you need to know about breastfeeding

This book covers every possible situation you could come across when feeding your baby from feeding a premature baby to twins and triplets to feeding in an emergency situation.

I do wish it had come out before I had my baby as I would have had more information to overcome some of the difficulties I faced in the early days of feeding my son. However it has helped me understand a lot about my experience including why I had a massive improvement in my...more

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Everything you need to know about breastfeeding This book covers every possible situation you could come across when feeding your baby from feeding a premature baby to twins and triplets to feeding in an emergency situation.

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Information from the GP Infant Feeding Network

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by Dr Louise Santhanam, General Practitioner The UK Department of Health and the World Health Organisation (WHO) recommend breastfeeding exclusively for six months, with continued breastfeeding the…

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Watch our video for information about formula milk.

What is infant formula?

Infant formula is a breastmilk substitute that is given to babies who are either not breast fed or are combination fed (fed both breastmilk and formula milk). Formula milk provides babies with the nutrients they need to grow and develop. But it does not have the same benefits as breastmilk for you and your baby. For example, it cannot protect your baby from infections (NHS, 2019a).

Is powdered or ready-made formula better?

Infant formula normally comes in two different forms: a dry powder that you mix with water, or a ready-to-feed liquid formula. You might hear that one is better than the other, but any difference between the two comes down to production methods and there is no evidence that any differences have any effect on your baby (First Steps Nutrition Trust, 2021).

Ready-made milks are more expensive and use more packaging. The source of ingredients used varies between manufacturers, and there might also be differences from batch to batch (First Steps Nutrition Trust, 2021).

Ready-made products are less likely to be halal-approved and this can also vary between product sizes. So always check each product label (First Steps Nutrition Trust, 2021).

What ingredients are in infant formula?

The majority of infant formula milks start with a base of cows' milk protein, although a few contain goats' milk protein. Lactose and other carbohydrates, vegetable, fish and other oils, vitamins and minerals are all added to the milk base (First Steps Nutrition Trust, no date).

The basic components of any infant milk, regardless of whether they're powdered or ready-made, are proteins, fats, carbohydrates, vitamins and minerals. The major infant formula producers develop their own brands with a combination of each of these components. You can see a full list of constituents on the packaging of infant formula milk for babies.

Which formula milk nutrients are best?

If a substance has proven benefits for your baby and can be added to infant formula, the law requires it to be added to all formula. So buying a more expensive brand of formula does not mean that your baby will grow or develop better than if you were buying a cheaper one. The basic nutritional profile of the majority of infant milks is actually very similar (First Steps Nutrition Trust, 2020; 2021).

In the UK, the ingredients in infant formula are strictly regulated and each manufacturer must follow strict national and EU guidelines on composition (Department of Health, 2013). Formula producers have to add formula milk components in accordance with the regulatory framework of the Infant Formula and Follow-on Formula Regulations 2007. They also have to comply with any relevant changes to those regulations and to regulations around foods for special medical purposes (First Steps Nutrition Trust, 2020).

Which formula milk is best?

The answer to this question is that there is no 'best' type of formula. For a healthy, full-term baby, it really doesn't matter which brand or type you choose. While manufacturers make different claims about their products, regardless of their cost, all brands have to meet the same nutritional and safety standards and have a relatively similar composition (First Steps Nutrition Trust, 2021).

First Steps Nutrition Trust is an independent organisation, which has more information here on the different brands of formula milk available in the UK and their ingredients. First Steps Nutrition Trust also has information on the claims about formula milks that manufacturers make.

Can I change the formula my baby has?

Traditionally, parents were advised to stick to one brand, but there's no good evidence that changing does any harm or good (NHS, 2019a). You can try different formulas to see which your baby might prefer in case the small variations in ingredients have an effect.

As manufacturers sometimes change ingredients slightly from batch to batch, it may be that one brand no longer agrees with your baby (NHS, 2019a).

A few babies may do better with a special formula instead of the regular kind. If you're worried your baby might be reacting to the formula you're using, your GP or health visitor should be able to advise you (NHS, 2021).

Is formula vegetarian or vegan?

Most formula, and all formula for babies under six months old, is made from animal milk protein. Information on suitable formulas is available here from First Steps Nutrition Trust.

Soya-based formulas are suitable for vegetarians, but are not recommended for babies under six months old except under medical supervision (NHS, 2019a). There are currently no infant milks suitable for vegans in the UK because even those without animal proteins contain vitamin D from sheep's wool (First Steps Nutrition Trust, 2021).

It is recommended that those who follow a vegan diet breastfeed throughout their baby's first year of life. They can move their children onto a non-animal milk at one year of age. Parents who want to bring up their children as vegans should seek medical advice to ensure their nutritional needs are being met (First Steps Nutrition Trust, 2021).

How does formula milk compare to breastmilk for my baby's health?

When formula is prepared safely, it provides babies with the nutrients they need to grow and develop (Martin et al, 2016). Yet formula milk cannot offer many of the same health benefits as breastfeeding, such as protection from infections and other illnesses. This is because breastmilk contains living cells, hormones and friendly bacteria, which change continuously to meet the baby's needs. And this cannot be replicated by a man-made process (First Steps Nutrition Trust, 2020).

Can I use formula and continue to breastfeed?

If you continue to breastfeed as well as feed formula, your breastmilk will continue to provide nutrition and protection to your baby (NHS, 2019c). Yet because milk supply is driven by frequent, effective breastfeeding, giving your baby formula can mean they breastfeed less often, so you make less milk. Read our article about mixed feeding to find out more.

You may find it useful to talk through your options with your midwife, health visitor or breastfeeding counsellor. You can contact one of our friendly and knowledgeable breastfeeding counsellors by calling our Infant Feeding Support Line on 0300 330 0700. They're open between 8am and midnight every day.

How do I make up powdered formula?

As powdered formula is not sterile, it is important that it's made up correctly each time, using boiled water that has cooled for no more than 30 minutes. To kill any bacteria within the powder, it is important that the water is at least 70⁰C (NHS, 2019a).

Safe preparation is key - all formula has to be made using the right amount of powder as diluting or using too much powder could make your baby unwell (NHS, 2019b). See our step-by-step guide to preparing baby formula and how to make up a bottle if you're out for more details.
This page was last reviewed in February 2022.
Further information

We support all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline 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. You can also find more useful articles here.

For more detailed information on the different formula milks that are available, visit First Steps Nutrition Trust.

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What's the best kind of formula milk? | Baby & toddler, Feeding articles & support | NCT

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With so many different formula milk brands on the market, how do you know which one to choose for your baby? Are the more expensive ones better? Find out everything you need to know here.

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Sling information

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Wear My Baby is the UK's baby carrier shop and advice service. We sell only the best ergonomic baby carriers, selected by our expert team.
If you're looking for a baby carrier for newborns. a front-facing baby carrier, backpack carrier for hiking or toddler carrier, you'll find the very best baby carriers here.

The UK's Leading Baby Carrier Online Store: We ship worldwide, with FREE UK delivery over £50

Baby Carrier Shop: Visit our London store in SW17 to shop for baby carriers, baby essentials and baby gifts

Baby Carrier Advice: FREE 15 minute video fit check with every purchase

Baby Carrier Consultations: Get 1:1 support for your family, in person or via video

Baby Carrier Hire: Try before you buy with our sling library service, across the UK

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Wear My Baby - Your Specialist Baby Carrier Shop & Advice Service

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Wear My Baby is the UK's baby carrier shop and advice service. We sell only the best ergonomic baby carriers, selected by our expert team. If you're looking for a baby carrier for newborns. a front-facing baby carrier, backpack carrier for hiking or toddler carrier, you'll find the very best baby carriers here.

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Unicef

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This leaflet offers advice and information for parents on getting to know their baby and setting up the foundations for a close and loving relationship.

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

Health professionals may want to use this leaflet in conjunction with the Baby Friendly guide to antenatal and postnatal conversations and accompanying signature sheets.

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

Building a Happy Baby: A Guide for Parents

Baby Friendly standards

Support to build a close and loving relationship is a key element of the Baby Friendly standards. Find out more about embedding our standards in your service.

Find more relationship building resources

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

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This leaflet helps parents to get to know their baby and to set up the foundations for a close and loving relationship.

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Understanding breastfed babies' needs

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you've got it in you: a positive guide to breast feeding

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You've Got it in You: A Positive Guide to Breast Feeding

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Buy You've Got it in You: A Positive Guide to Breast Feeding by Emma Pickett (ISBN: 9781784624910) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

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Breastfeeding and sleeping

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Is it fine for your baby to breastfeed him while you are taking medication for epilepsy?

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Information for women with epilepsy about breastfeeding including concerns about passing medication to the baby.

The Department of Health recommends that every woman is encouraged to breastfeed her baby if at all possible. Breastmilk usually provides all the nutrients a baby needs for the first six months of their life.

AEDs and breastfeeding

If you take anti-epileptic drugs (AEDs), your baby will have become used to the drugs while in your womb. If you decide to breastfeed, then a small amount will be passed to your baby in your breastmilk. Breastfeeding can be a useful way of weaning your baby off the medication that they have become used to.

Some drugs, such as phenobarbital and primidone, can pass more easily into breastmilk and can make a baby sleepy, so it may be a good idea to alternate between formula milk and breastfeeds.

The patient information leaflet that comes with your AED often includes information about breastfeeding and that particular drug. You can also talk to your neurologist, midwife, or health visitor about any concerns you may have.

The Breastfeeding Network has a helpline run by pharmacists on a voluntary basis. You may have to leave a message so that they can call you back.

Sharing feeds

If you are more likely to have seizures when you are overtired, sharing night time feeds with a partner might help to increase the chance of a good night's sleep.

What's next?

See parenting and epilepsy for ideas about keeping you and baby safe if you have seizures.

Taken from our Pregnancy and parenting leaflet. Order this leaflet from our online shop as part of our 'first five free' offer, or download the pdf using the link below.

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Information for women with epilepsy about breastfeeding including concerns about passing medication to the baby. The Department of Health recommends that every woman is encouraged to breastfeed her baby if at all possible. Breastmilk usually provides all the nutrients a baby needs for the first six months of their life.

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Stop watching the clock!

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This guest blog from breastfeeding counsellor Emma Pickett discusses the dangers of promoting a strict feeding schedule at the expense of responsive, flexible infant feeding.
Add your voice to Unicef UK's Change the Conversation campaign, calling on UK governments to take urgent action to protect, promote and support breastfeeding.
Somehow, somewhere, 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 seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1 hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, "Only 30 minutes till my next sip of water or mint! Not long now". But yet we expect teeny growing babies to be governed by this artificial notion of time.

Basic misconceptions

I spoke to a new mother last week who was perfectly happy with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

Searching for "normal"

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Breastfeeding Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But not all will.

One of the most popular babycare books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Responsive feeding: So much more than milk

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record book records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK.

It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.
Sources

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

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Guest blog: Breastfeeding: The dangerous obsession with the infant feeding interval - Baby Friendly Initiative

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Advice that babies must follow a strict three-hourly breastfeeding routine is causing mothers distress and guilt,and reducing breastfeeding rates.

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First Steps Nutrition

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This new report looks at commercially produced baby foods marketed for infants under 12 months of age in the UK by the four largest manufacturers. It considers how well these support our guidance on introduction of solids and looks at composition, cost, texture and ingredients.

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What might help?

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Eczema, psoriasis, and dermatitis are skin conditions that can develop on the breast, areola, and nipple. They can show up as dry, red, raised rashes or flaky, scaly patches on the skin that may itch, burn, crack, bleed or ooze. These skin conditions can make it painful to nurse your child, but you do not have to stop breastfeeding if they develop.

Tips For Dealing With Skin Conditions of the Breast:

See your doctor or a dermatologist for a true diagnosis, treatment instructions, and pain relief.

A common cause of breast irritation that can lead to outbreaks of these types of skin conditions is an incorrect latch. By correcting a poor latch, you can help to prevent further damage to your skin. If you need help with your baby's position and latch, contact your doctor, a lactation consultant or your local La Leche group for assistance.

Dermatitis and eczema are sometimes caused by an allergy or irritation. If you can determine the cause, try to eliminate it. Once you remove the irritant, your skin can begin to heal more quickly.

Do not wear tight-fitting bras or clothing that can put pressure on your breasts and irritate your skin.

Use breast pads without plastic linings and change your breast pads when they get wet.

Wearing breast shells inside your bra may be helpful. Breast shells can prevent your clothing from rubbing against your skin.

Warm water compresses or hydrogel breast pads may be useful to soothe irritated breasts.

You can try rubbing some freshly expressed breast milk onto the area. Breast milk can help to moisturize your skin and promote healing.

UVB light treatments may be helpful, and they are considered safe for breastfeeding women.

Many treatment plans for skin conditions include the use of topical steroid ointments or creams that you need to apply directly to the affected area. Use these medications immediately after nursing and gently wash your breasts well before nursing again.

If it is too painful to breastfeed from one of your breasts, continue to nurse from the other side. Pump or hand express your milk from the painful side while it's healing.

If both breasts need time to heal you may need to temporarily wean your child. If you are not putting your baby to the breast, use a breast pump frequently to maintain your milk supply and prevent some of the common problems of breastfeeding. You can also use an alternative feeding method to feed your child until you can return to breastfeeding.

Certain options for the treatment of psoriasis including methotrexate, cyclosporine, PUVA and biologic medications are not safe to use while breastfeeding. Make sure your doctor knows that you are breastfeeding before he prescribes any treatments.

Call you doctor if your condition does not improve with treatment. Thrush or other forms of dermatitis may look similar to eczema or psoriasis. And, although uncommon, a kind of cancer called Paget's disease of the breast can be misdiagnosed as eczema or dermatitis.

American Academy of Pediatrics. New Mother's Guide To Breastfeeding. Bantam Books. New York. 2011. Barankin B, Gross MS. Nipple and Areolar Eczema in the Breastfeeding Woman. Journal of Cutaneous Medicine and Surgery: Incorporating Medical and Surgical Dermatology. 2004; 8 (2): 126-130. Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Sixth Edition. Mosby. Philadelphia. 2005. Newman, Jack, MD, Pitman, Theresa. The Ultimate Breastfeeding Book of Answers. Three Rivers Press. New York. 2006. Weatherhead S, Robson SC, Reynolds NJ. Management of Psoriasis in Pregnancy. British Medical Journal. 2007; 334 (7605): 1218-1220.

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Breastfeeding with Eczema, Psoriasis & Dermatitis of the Breast

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Eczema, psoriasis, and dermatitis are skin conditions that can develop on the breast, areola, and nipple. They can show up as dry, red, raised rashes or flaky, scaly patches on the skin that may itch, burn, crack, bleed or ooze.

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How to prevent an excess of lipase making your stored milk go sour

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Lipase is an enzyme that is naturally present in human milk. It has several very beneficial dietary functions such as:

- Aids in keeping the milk fat emulsified (or mixed well) with the protein portion of the milk known as the "whey".

-Keeps the fat globules tiny so that the body can easily digest them

-Helps to break down the milk fat enabling the fat soluble nutrients such as certain vitamins (A&D) and free fatty acids (responsible for protecting the baby's immunity) become more easily absorbed by the body.

Some mothers may notice their expressed milk will have a "soapy" appearance and taste that becomes rancid rather quickly after being stored. This is a rare condition resulting from an excess of the enzyme lipase in their milk. Lipase is responsible for breaking down the fat in the milk. If there is an excess of this enzyme then the fat gets broken down to quickly after being expressed thus resulting in the change. The milk is not harmful, and most babies are not bothered by the mild change. However, the longer the milk sits the more apparent the taste/smell becomes which then will result in the baby most likely having an aversion to it.

Once the milk has soured or become "soapy" there unfortunately is nothing you can do to reverse the state the milk is in. However, there is something you can do to help prevent the bothersome change with future expressed milk. If you are certain that your milk storing issues are related to an excess of lipase, you can try scalding the milk prior to storing it in the freezer or fridge. Scalding the milk soon after it is expressed with stop the breakdown process of the fat properties resulting from the access enzymes. To scald, heat the milk in a pan on the stove to around 180 degrees F, or until you begin to see bubbles forming around the edge of the pan. DO NOT bring the milk to a rolling boil. Once the proper temperature has been reached, immediately cool the milk down and store in an air tight container.

It is true that scalding the milk at such a high temperature will result in killing some of the antibodies and pro-biotic features of breast milk, however there are still many valuable components to breast milk that will still provide better nutrients to your baby then store bought formula. As long as your baby is receiving breast milk directly from the source a couple times a day, and yes momma that means you, loosing the additional antibodies from the heat treated milk shouldn't be a problem.

For further information consult with a Licensed Dietitian or Lactation Consultant.

REFERENCES:

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 156-158, 203-205, 771, 781.

Source: kellymom.com

Copyright© 2011 Danielle Gauss/ JustBreastFeeding.com. All Rights Reserved

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Lipase is an enzyme that is naturally present in human milk. It has several very beneficial dietary functions such as: - Aids in keeping the milk fat emulsified (or mixed well) with the protein portion of the milk known as the "whey".

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How to tell if it's safe to give baby

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know when expressed breast milk is spoiled

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How to Know when Expressed Breast Milk Is Spoiled

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Some moms like or need to express breast milk so that their baby can be fed when they're not around. It is important for your baby's health that this milk does not go rancid. There are a variety of ways to ensure that it keeps. Luckily,...

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Try a silicone pump for lazy expressing!

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Hand expressing antenatally

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy.

It is advised for mothers to wait until around 37 weeks before starting antenatal expression. Mothers who are having multiple births may sometimes start sooner as giving birth earlier is more likely.

For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

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

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

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

These include babies

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

with a cleft lip or palate identified during pregnancy.

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

diagnosed with intrauterine growth restriction.

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

who are twins or triplets.

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

There are also reasons why women may need to consider supplementing their baby's feeds. These include women

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

A mother should discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies.

It is preferable to express antenatally by hand rather than use an electric or manual breast pump. This is because colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth.
How to hand express
Always wash your hands before expressing.

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

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

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

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

Move your thumb and fingers a few centimetres back from the nipple

Press in towards your chest, press your fingers together and draw them forwards.

Repeat this process, building up a rhythm. It may be useful to look online for videos of hand expression techniques.

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

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe).

If nothing happens, adjust your finger position slightly to find the spot that works for you. You should not be pinching the nipple or sliding the fingers uncomfortably over the skin.

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

Express each breast twice during each session. The oxytocin hormone released stimulates the uterus. If you experience any cramping in your uterus, you should stop and discuss your choice with your healthcare provider.

Colostrum can vary in appearance.

Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

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

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.

You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

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

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

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

If harvested colostrum ends up being 'wasted' because early exclusive breastfeeding was possible and successful, this is a cause for celebration rather than commiseration!

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

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02 Expressing your milk before your baby arrives

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy. It is advised for mothers to wait until around 37 weeks before starting antenatal expression. Mothers who are having multiple births may sometimes start sooner as giving birth earlier is more likely.

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How to eliminate bilirubin

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Treatment will depend on:

Your baby's bilirubin level, which naturally rises during the first week of life

How fast the bilirubin level has been going up

Whether your baby was born early

How your baby has been feeding

How old your baby is now

Often, the bilirubin level is normal for the baby's age. Newborns normally have higher levels than older children and adults. In this case, no treatment is needed, other than close follow-up.

You can prevent the kind of jaundice that is caused by too little breastfeeding by making sure your baby is getting enough milk.

Feed about 10 to 12 times each day, starting on the first day. Feed whenever baby is alert, sucking on the hands, and smacking the lips. This is how babies let you know they are hungry.

If you wait until your baby cries, feeding will not go as well.

Give babies unlimited time at each breast, as long as they are sucking and swallowing steadily. Full babies will relax, unclench their hands, and drift off to sleep.

If breastfeeding is not going well, get help from a lactation consultant or your doctor as soon as possible. Babies born before 37 or 38 weeks most often need extra help. Their moms often need to express or pump to make enough milk while they are learning to breastfeed.

Nursing or pumping more often (up to 12 times a day) will increase the amount of milk the baby gets. They can cause the bilirubin level to drop.

Ask your doctor before deciding to give your newborn formula.

It is best to keep breastfeeding. Babies need their mothers' milk. Although a baby full of formula can be less demanding, formula feeding may cause you to make less milk.

If the milk supply is low because baby's demand has been low (for example, if baby was born early), you may have to use formula for a brief time. You should also use a pump to help make more breast milk until baby is better able to nurse.

Spending "skin to skin" time can also help babies feed better and help moms make more milk.

In some cases, if babies aren't able to feed well, fluids are given through a vein to help increase their fluid levels and lower bilirubin levels.

To help break down the bilirubin if it is too high, your baby may be placed under special blue lights (phototherapy). You may be able to do phototherapy at home.

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Jaundice and breastfeeding: MedlinePlus Medical Encyclopedia

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Treatment will depend on: Your baby's bilirubin level, which naturally rises during the first week of life How fast the bilirubin level has been going up Whether your baby was born early How your baby has been feeding How old your baby is now Often, the bilirubin level is normal for the baby's age.

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Every mother has the right to make informed choice to bottle feed her baby. Then why, when a mother makes an informed choice to breastfeed her baby, does she not have the same right?

Surely, I jest? Mothers can breastfeed if they want, who is to stop them? Often, in fact, mothers do not seem to have the right to breastfeed and are forced, by health professionals, judges and child protective agencies to bottle feed. There are mothers who want to breastfeed and trust the health care system to help them continue when in fact, they are frequently left feeling guilty for not breastfeeding, feeling that they "failed" or feeling that they "couldn't" breastfeed for medical reasons. A lot of formula feeding by mothers who had originally intended to breastfeed is unnecessary and not medically indicated. Mother's fear of the baby starving or his health being compromised are used as scare tactics to get mothers to consent to formula feeding and to shake her resolve to breastfeed.

If the slightest problem arises with regard to the mother or baby and their breastfeeding relationship, the first thing many mothers will hear from doctors is "give the baby formula" or even "stop breastfeeding altogether." And mothers are often forced, not infrequently in cases of slow weight gain, with a threat of the child protection services taking away the baby if they don't comply with "doctor's orders". From our experience with many thousands of mothers having come to our breastfeeding clinic during the past 32 years, I can say that in many such cases, with a little good help, the mother could carry on breastfeeding exclusively. Unfortunately, in only a small minority of cases do the mothers actually get the help they need. Sometimes the solution is easy, not complicated at all. Sometimes it's not so easy, but it can be done. Most of the time, however, mothers are left feeling frustrated and devastated because they desired to breastfeed and due to the lack of qualified help or incorrect medical advice they begin to see breastfeeding as "unreliable," "painful" and "potentially dangerous" and ultimately its importance as "exaggerated." When women are prevented from breastfeeding when they wanted to breastfeed they become angry and traumatized, unable to see and experience the joy of breastfeeding and they resort to all sorts of coping mechanisms which resurface in discussions of infant feeding.

Below are just a few examples of how we don't allow mothers to breastfeed their babies. They are examples of how formula feeding is considered the standard way of feeding and breastfeeding is seen as a dispensable, nice but not necessary.

1. Mothers of babies born prematurely are almost universally told (at least in North America) that they cannot put the baby to breast until the baby is 34 weeks gestation (still 6 weeks premature). This undermines breastfeeding because the doctors and nurses insist the "babies must to learn to bottle feed before they can breastfeed." Really? Where does that come from? Not from any scientific studies. But we do know from work in Scandinavia that premature babies will often latch on to the breast at 28 weeks and sometimes even earlier than that. Not all, but at least some. And it is not rare that premature babies can be exclusively and completely breastfed (at the breast) by 32 to 33 weeks gestation, 1 to 2 weeks before we even allow the babies to try to breastfeed in North America. (It is necessary to add "at the breast" because so many in Western societies believe that giving breast milk in the bottle is breastfeeding - no, it's not at all the same).

2. Mothers of premature babies are told that they must supplement with a bottle because breastfeeding is more tiring than bottle feeding (this is said about babies of any age actually). It is complete rubbish to say that breastfeeding is tiring for a baby, but it is widely believed because most health professionals learn almost nothing about breastfeeding in their training and nothing after they finish their training. Babies respond to milk flow and if the flow is slow, the baby tends to fall asleep at the breast, especially in the first few weeks of life. And this occurs simply because most mothers are not taught the basics of breastfeeding, (including how to get a good latch, and how to know a baby is getting milk from the breast). Watch this video showing a premature baby responding to flow from the breast. It is worth reading the text that accompanies the video. Furthermore, premature babies have to compete with the flow the baby was getting from the bottle and the fact that the mother's milk supply is dwindling because they were pumping instead of being skin to skin with their babies and breastfeeding.

3. Mothers of premature babies are told they must "fortify" their milk with cow milk based "fortifier". It may be true that the tiniest of premature babies need fortification (but fortifiers can be made from human milk, and the need for fortifiers even by these very tiny babies is starting to be questioned). But what about a 33 week gestation baby? With good help, most babies of 33 or even younger do not need fortifiers. They need to breastfeed. Not even at 31 weeks do they necessarily need "fortified" breast milk. But again with tiresome regularity, the bottle is introduced, and breastfeeding undermined.

4. Mothers of babies born at risk for low blood sugar are often forced to give or allow the baby to be given formula (by bottle of course). But it is known that breast milk, especially the very early milk called colostrum, is better for preventing and treating low blood sugar than formula. Most often, if the mother gets good help with breastfeeding, the baby is protected by breastfeeding (at the breast, because skin to skin contact also helps prevent low blood sugar).

5. Mothers whose baby has jaundice in the first few days are often forced to supplement their babies with formula, or even take the baby off the breast because the health professionals "helping her", think that breast milk causes jaundice. It doesn't. What causes higher than average levels of bilirubin in the majority of babies of that age is that the baby is not getting enough breast milk. And the answer is not formula, but rather helping the mother breastfeed better and get more milk to her baby. In the first few days, it can be so easy to turn inadequate breastfeeding around and make it work well and even prevent problems in the first place. Unfortunately, too many mothers and babies are not getting that help. And the worst of it all is that because the baby's jaundice decreases rapidly once the baby is being formula fed, this proves to the health providers that they were right, that the breast milk caused the jaundice, when in fact, the reason the jaundice decreases is that the baby now gets more milk. Could this decrease have been accomplished by helping the mother breastfeed more effectively? Yes, but it happens only rarely that mothers get this help and the default treatment is formula feeding by bottle.

6. Mothers are told that if their babies have a cleft palate then they cannot breastfeed and should not even bother trying. True many can't latch on to the breast, but some can. But one thing is certain; if one doesn't try, breastfeeding can't happen.

7. Mothers are told that if their baby loses more than 10% of their birth weight the baby must have formula by bottle. But the notion of 10% weight loss is based on nothing scientific at all and results in many babies being unnecessarily supplemented and much too often ending up only bottle feeding. Again, the mother and baby getting good hands on help can change the situation dramatically for the better. . People sometimes act as if getting the baby fed and the baby being breastfed were mutually exclusive things. The goal of helping mothers should be to get the baby fed by improving breastfeeding. Health professionals need to start looking at the long term effects of their interventions, not just grabbing at the quick fix which formula feeding seemingly offers.

8. Mothers are told that if they have had breast reduction surgery, they won't be able to breastfeed. Maybe most won't be able to breastfeed exclusively, but they can still breastfeed with additional donated breast milk or formula as supplements. And the baby can be at the breast, without bottles, the supplement given with a lactation aid at the breast. Supplementing while the baby is still on the breast is important because, aside from the baby getting more milk even as the baby is being supplemented, but very importantly, breastfeeding is so much more than breast milk. It is a close, intimate relationship between two people who are usually very much in love with each other. The value of that relationship is not measured by how much breast milk the mother can produce and it is important that people start seeing breastfeeding in its different forms.

9. Too many mothers are told they must interrupt or stop breastfeeding for medications they are taking. This is not true except with a very few, usually infrequently used, drugs, many of which can be substituted by other equally effective drugs. The vast majority of drugs don't get into the milk in quantities that are harmful to the baby, the amounts being vanishingly small. There are some drugs that don't get into the milk at all and yet mothers are told they will harm their babies if they continue breastfeeding. In any case, the real question is this: Which is safer for the baby, breastfeeding with tiny amounts of drug in the milk (and the amounts are almost always tiny) or formula? Given the risks of not breastfeeding, in the vast majority of cases, breastfeeding is safer.

10. Judges dealing with access and custody cases, do not include the needs of the breastfed baby in their decisions. Both father and mother could be accommodated in terms of spending time with the baby if the judge realized that breastfed babies are different from bottle fed babies. And breastfed toddlers are even more different. Whether one agrees or not, the breastfed baby and toddler derives security from the breast. As mentioned previously breastfeeding is not just about nutrition, a notion that seems foreign to so many people, including judges.

11. In many areas the child protective services are a huge problem. Instead of mothers getting help to continue breastfeeding, what the mothers usually get is "Stop breastfeeding, give formula, or we will apprehend your child".

These 11 problems are just a few of dozens of situations when mothers are unnecessarily told to stop breastfeeding, must stop breastfeeding, or else. Most of the time, the problems could have been prevented in the first place or treated without using formula or stopping breastfeeding. But most of the time, the mothers do not get the help they need.

I am not saying that breastfeeding will always work, even with the best of help, but a lot more mothers and babies could be doing a lot better.

If I went through all the situations I hear about on a daily basis, situations where mothers do not have the right to breastfeed even though they made an informed decision to do so, I would be writing something longer than War and Peace. Even if I just went into details regarding the 11 problems, it would take a book.

Dr Jack Newman's Guide to Breastfeeding covers the above points and more in more detail. It has chapters on Why Breastfeeding is Important, Jaundice, Hypoglycemia, Premature Babies, Dealing with Breastfeeding Issues and How to Get the Help you Need to Breastfeeding and provides practical solutions to the questions breastfeeding mothers face, including many photos. Several videos which are extremely helpful for mothers and health professionals, with explanatory texts in 22 different languages are available on our website www.nbci.ca

Related...

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Do Mothers Really Have The Choice To Breastfeed?

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Every mother has the right to make informed choice to bottle feed her baby. Then why, when a mother makes an informed choice to breastfeed her baby, does she not have the same right? Surely, I jest? Mothers can breastfeed if they want, who is to stop them?

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Can my baby breastfeed?

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With the birth of a child who has a cleft lip, palate, or both a cleft lip and palate, comes many uncertainties regarding the cause, effect and repair of the cleft. The mother may also be concerned about her ability to care for and feed her baby. These uncertainties can affect the early bonding phases of parenting.

Breastfeeding a child born with a cleft lip or palate assures that mother and baby spend lots of cuddling time together. If breastfeeding is initiated right after birth, closeness between mother and baby will be enhanced. Mothers and babies find the skin to skin contact during breastfeeding calming and comforting.

The soft breast is ideal for the baby's mouth. The flexibility of the breast allows it to be molded to compensate for abnormalities of the baby's lip or mouth. The baby has more control over the flow of milk and the position of the breast in his/her mouth. Early practice helps baby imprint on the breast.

Although choking due to milk leakage into the nose is a common problem when there is an opening in the soft or hard palate, human milk is a natural bodily fluid that is not irritating to the mucous membranes. Therefore, breastmilk is the optimal choice for feeding a cleft lip or palate baby.

A baby needs to suck for comfort as well as nourishment. Breastfeeding allows a baby to spend time at the breast sucking for comfort as well as for feeding. At The Children's Hospital of The King's Daughters, we encourage breastfeeding after surgical repair.

Prior to the repair and possibly immediately after surgery, mother may find that they need to stimulate their milk supply with an electric breast pump. Pumped milk can be fed to the baby by bottle, finger feeding, cup feeding or supplementary feeding at the breast to assist in maintaining the baby's nutritional needs.

The Children's Hospital of The King's Daughter's has Lactation Consultants (Breastfeeding Specialists) available to mothers and families throughout the breastfeeding experience. The consultants are available to provide support and to answer questions.

Breastfeeding early after surgical repair is encouraged at the Children's Hospital. As members of the craniofacial team, the lactation consultants, work collaboratively with the other team to help our mothers achieve breastfeeding success. The goal of the entire team is to make the surgical repair a positive experience by encouraging bonding, good nutrition and optimal growth for the child.

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SMILES - Breastfeeding a Cleft Lip and/or Cleft Palate Baby

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With the birth of a child who has a cleft lip, palate, or both a cleft lip and palate, comes many uncertainties regarding the cause, effect and repair of the cleft. The mother may also be concerned about her ability to care for and feed her baby.

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By Kelly Bonyata, BS, IBCLC

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush. If the normal color returns after your baby has finished a feeding and there is no pain, then the blanching is not a problem.

Blanching due to compression

The most common reason for nipple blanching is that that baby is compressing the nipple while nursing. This can be due to:

When blanching is due to baby's compression of the nipple, the nipple is white and often misformed (flattened, creased, pointed, etc.) immediately upon coming out of baby's mouth. There may be a white stripe across the nipple directly after nursing. Pain may not start until a few seconds to a few minutes after nursing, as the circulation returns to the nipple. If you are experiencing pain with the blanching, then finding and remedying the underlying cause will also eliminate the blanching.

Blanching due to vasospasm

Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings. Vasospasm can have various causes:

Vasospasm can be a secondary response to pain or nipple trauma (damaged nipples or thrush). In this case, the nipple(s) turns white shortly after nursing (rather than coming out of baby's mouth white and misformed). Mom might notice a white circle on the face of the nipple a few seconds to a few minutes after breastfeeding. Cold often triggers the vasospasm and/or makes it worse. Unlike blanching due to compression, latch and positioning may be fine if the source of any nipple damage has already been fixed. Healing the nipple trauma or other source of pain should eliminate the vasospasms, although they may persist for a short time after the nipple has healed (previously damaged tissue can remain sensitive for a time).

Raynaud's of the nipple

Vasospasm can also be caused by Raynaud's Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud's Phenomenon (Raynaud's of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change - from white to blue to red - as blood flow returns. The color change may also be biphasic - from white to blue.

Vasospasm due to Raynaud's is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud's phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.

Per Anderson et al, "Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud's phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents."

Keep in mind that Raynaud's is not caused by breastfeeding (anyone might have it) - it simply has the potential to affect breastfeeding. For example, any person might have inverted nipples, which might or might not affect a mother's breastfeeding relationship (as this can make latching or sore nipples more of a challenge in the beginning). Raynaud's works the same way - anyone might have it coming into breastfeeding, and it might (or might not) affect the breastfeeding relationship if the vasospasms are triggered by bad latch, a sudden temperature change as baby unlatches, etc.

Some maternal medications have been associated with vasospasm, including oral contraceptives containing estrogen. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud's phenomenon. Some sources indicate that the antifungal medication fluconazole may be associated with vasospasm, although the manufacturer does not report this as a known complication of fluconazole use. Other sources feel that vasospasms experienced by mothers taking fluconazole are a result of nipple pain/trauma due to thrush (and not due to the medication used to treat the thrush).

Treatment options for vasospasm

Avoid cold. Apply dry heat to the breast when needed (this relaxes the "cramping" blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.)

Cover the nipple as soon as possible after baby comes off the breast. Some moms say that it is helpful use a wool breast pad or a soft cloth diaper.

Apply dry heat immediately after breastfeeding. A rice sock can be useful as a source of dry heat: Fill a sock or a cloth bag with uncooked rice and microwave 45 seconds (or until desired warmth is achieved); hold the rice sock against the nipple (over the cloth or mom's shirt) until blood flow resumes.

Massage the nipple with olive oil when mom is feeling pain from the vasospasm.

Avoid caffeine, nicotine/smoking, diet pills, cold medications containing pseudoephedrine or phenylephrine, beta blockers, and other vasoconstrictive drugs, as they can precipitate symptoms. Oral contraceptives containing estrogen have also been associated with vasospasm.

Medications and dietary supplements may also be helpful:

Ibuprofen.

Dietary supplementation with calcium/magnesium.

Dietary supplementation with a vitamin B complex that includes B6 and niacin.

Dietary supplementation with fish oil supplements.

Low dose oral nifedipine.

See links below for additional details.
Additional information and references

Nipple pain - links @

Vasospasm and Raynaud's Phenomenon by Jack Newman, MD

Nipple Vasospasm and Breastfeeding by Philippa Pearson-Glaze IBCLC

Patient information: Raynaud phenomenon (Beyond the Basics) by Fredrick M Wigley, MD

Clampdown Bite Reflex by Mary Jozwiak, from Leaven, Vol. 30 No. 4, July-August 1994, pp. 53-4.

References

Anderson JE, Held N, Wright K. Raynaud's Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. Pediatrics. 2004 Apr;113(4):e360-4.

Garrison CP. Nipple vasospasms, Raynaud's syndrome, and nifedipine (case report). J Hum Lact. 2002 Nov;18(4):382-5.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett 1999, p. 492-493.

Lawlor-Smith L, Lawlor-Smith C. Raynaud's phenomenon of the nipple: a preventable cause of breastfeeding failure? Med J Aust. 1997 Apr 21;166(8):448.

Lawlor-Smith L, Lawlor-Smith C. Vasospasm of the nipple - a manifestation of Raynaud's phenomenon: case reports. BMJ. 1997 Mar 1;314(7081):644-5.

Snyder JB. [letter]. J Hum Lact. 1994 Sept;10(3):153.

Escott R. Vasospasm of the nipple: another case [letter]. J Hum Lact. 1994 Mar;10(1):6.

Coates MM. Nipple pain related to vasospasm in the nipple? J Hum Lact. 1992 Sep;8(3):153.

An Overview of Solutions to Breastfeeding and Sucking Problems by Susan Meintz Maher, IBCLC, La Leche League 1988, p 14.

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Nipple blanching and vasospasm * KellyMom.com

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Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush.

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One of the most common health concerns for women of childbearing age is an autoimmune disorder. According to the American Autoimmune Related Disorders Association 1, authorities estimate that around one in five people-two thirds of them women-are living with an autoimmune disorder in the United States. Unfortunately, autoimmune disorders are not as rare today as in previous generations 1. The reason for the increase in frequency of autoimmune disorders is unknown. Mothers with autoimmune disorders face unique challenges with regard to pregnancy and breastfeeding. This subset of mothers is often overlooked in standard parenting literature. This is a brief introduction to autoimmune disorders to give a better understanding of the issues surrounding the intersection of autoimmune disorders and motherhood.
What is an autoimmune disorder?
The immune system is responsible for fighting off infections as well as identifying and destroying abnormal cells, like cancer cells 2. The ability to correctly identify normal "self" cells and invading microorganisms or abnormal cells as "non-self" cells is crucial to normal, correct functioning of the immune system. In an autoimmune disorder, the immune system gets 'confused' and is not able to tell the difference between normal and abnormal "self" cells 2. This confusion means that the body begins to attack itself, causing an astonishing array of symptoms and diseases, ranging from relatively mild to life-threatening. In fact, autoimmune diseases are counted in the top ten causes of death for women under 65 1. No one knows what causes this confusion, except that these disorders are caused by a combination of genetic influence and environmental, not any one trigger 2.
What are some examples of an autoimmune disorder?
There are over 100 different kinds of autoimmune disease 1. Here are some examples:

Type 1 diabetes: the immune system attacks the pancreas or insulin receptors (sometimes both), resulting in the inability to make and use insulin3.

Hashimoto's thyroiditis and Graves' disease: conditions in which the immune system attacks the thyroid gland, resulting in under or overproduction of thyroid hormone2. Thyroid hormone is responsible for a whole host of functions, including metabolism and neurological development in the fetus and newborn.

Ulcerative colitis and Crohn's disease: collectively referred to as "inflammatory bowel disease". The immune system mistakenly attacks the digestive system, causing painful abdominal cramps, digestive problems, and sometimes nutritional deficiencies4.

Multiple sclerosis: the target is the nervous system. Interruptions in nerve transmissions result in a variety of symptoms, including numbness, pain and paralysis1. It is usually intermittent at first and often progresses to permanent disability5.

Rheumatoid arthritis: generally results in the body attacking the joints, causing joint deformation, debilitating pain, and stiffness,2.

Systemic lupus erythematosus (lupus): any system of the body may be attacked, from the heart and lungs to kidneys, skin, digestive or nervous system, causing damage and malfunction to that system2.

How does life change with an immune disorder?
Life with an autoimmune disorder varies with the disorder. Usually, a woman who looks perfectly healthy will start having vague symptoms that come and go and are hard to describe 1. Often, she will have an idea that something is wrong, but because it is hard to describe the symptoms, she will put off talking to her doctor about it until they start to affect her everyday living. Thus begins the diagnostic odyssey.

Diagnosis with an autoimmune disease can be a long, difficult process. While some are able to get a diagnosis within weeks of the onset of symptoms, for others the process takes years of frustrating visits to numerous doctors. It isn't uncommon for sufferers of some diseases to be incorrectly labeled as drug seekers, chronic complainers, or worse, told that the disease is "all in the head" 1. Treating the disease is not always easy, either. Some diseases simply require replacement of hormones that aren't being produced, like autoimmune hypothyroidism. Others, like lupus, may require life-long suppression of the immune system, along with management of the many symptoms that result from organ damage 2. Finding the right medications to manage symptoms is an adventure in and of itself, with scary-sounding side effects like the possibility of cancer or heart problems. It is not uncommon for people with autoimmune disorders to go months or years at a time with minimal or no symptoms, followed by what's called a "flare up," an exacerbation of the disorder when the symptoms get very difficult to deal with and may keep a person bed or house-bound until it recedes. Others may not get a break, causing them to be unable to keep a job or manage around the house without help.

My own journey with autoimmune disease began as a postnasal drip and headaches when my first daughter was around a year old. Then a few months later, a vague, aching pain began, deep in my leg muscles at night. Sometimes I would get tingling nerve pain and my arms or legs would "fall asleep." At first, the symptoms weren't too bad, and I passed it off as aches from exercising, bad posture, and allergies. By the time she was two, I realized that not only were the symptoms getting worse, keeping me from being able to sleep at night, but the symptoms didn't correlate with exercise or anything else. They were also starting to affect my day-to-day living, interfering with my ability to attend school, go to social engagements, and even interact with my family. Over the counter medications didn't help, so I sought treatment, but was unable to find a doctor who would help. After many doctors visits, trials with different drugs and nasal sprays were ineffective. I just learned to cope. Eventually, when my daughter was four, I found a rheumatologist who diagnosed me with "undifferentiated connective tissue disorder" because although my lab results indicated something autoimmune, my symptoms didn't fit anything on his list. My symptoms finally became manageable with the drugs he prescribed. Because my disease wasn't "bad enough" to affect anything vital, however, getting a precise diagnosis was not a priority.

In contrast to my years-long (and still incomplete) journey toward diagnosis, a friend of mine, Joanna, started having symptoms one November and was diagnosed by the next month with ulcerative colitis. This disease is particularly difficult to deal with when it flares. Joanna describes what it's like: "I get lots of pain, cramping and bloody stool, with times of flare ups which can keep me on the toilet for over an hour at a time and many times through the day and night. I get very tired because of dealing with the pain and being on the toilet, and I worry about taking care of my daughter and getting her to school on time and being able to pick her up. Leaving the house can be scary just for things like grocery shopping; it can take me much longer than everyone else because I may have to use the restroom 2-5 times while in the store. The pain can be very severe. There were times when I was in so much pain I was trying not to scream; it was like giving birth multiple times a day, where [her husband] was threatening to call 911 and send me to the hospital."
What do these changes mean for women of childbearing age?
The hormonal activity inherent in menstrual cycles is believed to be the reason women of childbearing age are at increased risk of autoimmune disease 7, 8, 9. Years ago, women with autoimmune conditions were simply advised not to get pregnant (5, 11). With modern medicine, doctors and researchers are finding that this advice is outdated 5-7, 10, 11. Unfortunately, many women are still incorrectly advised that their condition is a complete contraindication to pregnancy and breastfeeding.

When women with autoimmune disorders want to get pregnant, they are advised to plan pregnancies carefully. They are told to wait until they are on a pregnancy-safe medication, or to wait a certain number of months after stopping a medication that is expected to cause birth defects. They may be told to wait until their disorder has been in remission, and they can find a good team of doctors to take care of them 10.
Can a woman with an autoimmune disorder safely carry her baby to term and breastfeed?
Although many doctors mistakenly tell women that it is not safe to get pregnant or breastfeed simply because of their diagnosis, this is not evidence-based advice. Some doctors insinuate or outright tell mothers that if they breastfeed, the antibodies in their system will get into the baby and cause an autoimmune disease in the breastfed infant; this is not true 12. Other health-care workers may incorrectly tell women that they won't be able to continue taking the drugs that control their disorder if they choose to get pregnant or breastfeed. Some women with advanced disease states may be counseled against pregnancy due to symptoms such as uncontrollable high blood pressure or kidney damage. According to experts well-versed in current research, a diagnosis of an autoimmune disorder in and of itself is never a contraindication to pregnancy or breastfeeding 10. In addition, current research indicates that many drugs previously believed to be unsafe for pregnant or nursing mothers are, in fact, no more likely to cause birth defects than other drugs considered safe 5-7, 11, 13, 15. Most women with autoimmune disorders can have a baby without serious side effects, though some diseases require careful monitoring, 7-10. In fact, for some disorders, like multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease, the progression of symptoms can be slowed or stalled by pregnancy and exclusive breastfeeding 6,8,9,15,16. This is thought to be associated with the hormonal shift that accompanies lactational amenorrhea 7,8,9,15. While there are some risks to the fetus, including the risk of prematurity and low birth weight, most risks can be managed quite well 6,7,10,11,13. Risks from medication can be managed during breastfeeding, as well 5, 10, 13, 14, 15, 17. Some autoimmune diseases-those relating to hormonal function-may interfere with milk supply, however 19, 20. This occurs when a mother's disease interferes with normal levels of thyroid or insulin, for example. This should be managed by correcting the hormone to its normal levels, but many women are unaware of this possibility, especially with diabetes or pre-diabetes 20.

One often-repeated concern regarding breastfeeding has been made which deserves special attention. Early studies of the hormone prolactin on nursing mice and in women with rheumatoid arthritis indicated that prolactin, and therefore breastfeeding, increased the severity and number of flares postpartum for women with rheumatoid arthritis who were having their first child 18. This finding was often quoted by later researchers without much discussion 6, 15. Frustratingly, not a single one of these studies controlled for partial breastfeeding versus exclusive breastfeeding, although they did divide breastfeeding mothers into those breastfeeding their first child versus those breastfeeding subsequent children. There was some acknowledgement that the sensitivity to prolactin may be genetic. In patients with multiple sclerosis, partial and exclusive breastfeeding mothers had different outcomes 5, 8, 9.

Additionally, many women who chose to breastfeed in these earlier studies discontinued their medications in order to do so, making it difficult to distinguish between symptoms linked to breastfeeding and those due to the lack of medication. In studies of women with inflammatory bowel disease, breastfeeding was first believed to be associated with increased disease activity postpartum, but further analysis showed that when medication use was taken into account, the difference in disease activity was negligible 15, 16. This underscores the importance of critically examining studies relating to disease activity and breastfeeding. Unfortunately, there are very few well-done studies to date relating to disease activity and breastfeeding specifically. Research in this area is starting to increase, but may not be available for several years. The reality is that the hormonal interplay of postpartum and breastfeeding with the immune system is so complex that we are just barely beginning to scratch the surface.

During my second pregnancy, my symptoms improved so much that I was able to stop taking daily medications. In fact, thanks to the hormonal influence of breastfeeding, I have not yet needed to start taking them again, even though my daughter is now 14 months old. Breastfeeding has actually proved to be pain-relieving for me. I often come home from school fatigued and in pain, to flop into my bed with my baby girl and nurse, only to find my energy increased and my pain gone. I tried finding an explanation for this phenomenon, but research in this area is scarce, at least as far as mothers are concerned. Joanna was able to control her symptoms throughout her pregnancy with the medication she was taking, but she suffered a very bad flare immediately postpartum, necessitating some creative thinking in order to breastfeed her child. She is now on a different medication.
What are a mom's major concerns when she is dealing with an immune disorder and an infant?
Dealing with symptoms and worries about the side effects of medication are probably the top two concerns of mothers with autoimmune disorders. Getting accurate, evidence-based information is a challenge because many doctors are not well-versed in current research in these areas. Despite the ameliorating effect breastfeeding has on my pain, I don't always have time to breastfeed the pain away. As a busy mom, I still have to weigh my symptoms against taking medication occasionally. I know that at some point, the hormonal influence which keeps the majority of symptoms at bay will decline and I will need to decide whether to discontinue breastfeeding, find a breastfeeding compatible medication, or take my chances continuing to breastfeed with a poorly researched medication.

Joanna, on the other hand, had to deal with her symptoms much sooner. Immediately postpartum, she suffered such a severe flare-up that she had to get a doctor's permission to nurse her one-day-old baby on the hospital toilet. Joanna decided that it would help her mental state to give an occasional bottle of formula as she dealt with her symptoms postpartum. However, by taking medication safe to use during pregnancy and beyond, she was able to continue breastfeeding her daughter for a year. Her doctors' support was very important as they encouraged her desire to breastfeed. Her daughter is now a vibrant, healthy six year old.

Many mothers with inflammatory bowel disease are hesitant to try breastfeeding. Joanna has this to say: "Don't be afraid to breastfeed. As long as you can find a medication that is compatible with breastfeeding, the medication will keep you healthy, and then your baby will get what he or she needs and be able to thrive. But don't let yourself feel guilty if you are breastfeeding and need to supplement with an occasional bottle of formula. And if you need a stronger medication that is not compatible with breastfeeding, remember that it is better to have a healthy mother whose baby is on formula. You are doing the best that you can with the body you have been given."

How can a Breastfeeding USA Counselor be of help?

Breastfeeding USA Counselors offer encouragement and share evidence-based information. They listen to and empathize with mothers' concerns. They discuss problems that arise or might potentially arise and think of ways to mitigate them ahead of time. For example, if a mother has concerns that she might not always be available to breastfeed as needed, a Breastfeeding Counselor can provide information about pumping, both to increase and maintain the mother's milk production, and to ensure that there is extra milk in the freezer so baby can be supplemented when necessary. If a mother is in pain, a Breastfeeding Counselor can help her find alternative nursing positions so that she can comfortably breastfeed. Breastfeeding Counselors reassure mothers that even if they do need to supplement with formula, as long as they are continuing to breastfeed, their babies will be getting important immunological and nutritional support. They can also help mothers to find ways to make sure that occasional supplementation does not begin to interfere with milk production.

Breastfeeding USA Counselors are often the first line of support and are aware that some autoimmune diseases may lead to decreased milk production. They cannot diagnose an autoimmune condition or hormonal imbalance, but they are able, for example, to refer a mother to her doctor when she has unexplained low milk production to rule these out possible causes, even if she does not have a previous history of these disorders.

In addition, Breastfeeding USA Counselors help mothers find vital information about medications from sources such as Medications and Mothers' Milk, the Infant Risk Hotline, and LactMed. This information can help mothers talk to their doctors about finding the right medications to both control their symptoms and safely continue breastfeeding. There is support available for mothers with autoimmune diseases.
References
1. American Autoimmune Related Disorders Association. (2013). Autoimmune Information: Questions and answers.

2. Copstead, L. E. & Banaski, J. (2010). Pathophysiology (4th ed). St. Louis, MO: Elsevier.

3. Paddock, C. (2011). Is Type 2 diabetes an autoimmune disease?

4. Crohn's and Colitis Foundation of America. (2013). What are Crohn's and Colitis?

5. Houtchens, M. (2013). Multiple sclerosis and pregnancy. Clinical Obstetrics & Gynecology, 56(2), 342-349. doi:10.1097/GRF.0b013e31828f272b

6. Elliott, A., & Chakravarty, E. (2010). Management of rheumatic diseases during pregnancy. Postgraduate Medicine, 122(3), 213-221. doi:10.3810/pgm.2010.05.2160

7. Østensen, M., Brucato, A., Carp, H., et al. (2011). Pregnancy and reproduction in autoimmune rheumatic diseases. Rheumatology, 50(4), 657-664.

8. Langer-Gould A, Huang SM, Gupta R, et al. (2009). Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women with Multiple Sclerosis. Archives of Neurology. 66(8):958-963. doi:10.1001/archneurol.2009.132.

9. Langer-Gould, A., Gupta, R., Huang, S. et al. (2010). Interferon-gamma-producing T cells, pregnancy, and postpartum relapses of multiple sclerosis. Archives of Neurology, 67(1), 51-57. doi:10.1001/archneurol.2009.304

10. Levy, D. (2007) Clinical Feature: Autoimmune diseases complicate pregnancy.

11. Borisow, N., Döring, A., Pfueller, C., Paul, F., Dörr, J., & Hellwig, K. (2012). Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy. The EPMA Journal, 3(1), 9. doi:10.1186/1878-5085-3-9

12. Newman, J. (2009). Breastfeeding and illness.

13. Keeling, S. O., & Oswald, A. E. (2009). Pregnancy and rheumatic disease: "by the book" or "by the doc". Clinical Rheumatology, 28(1), 1-9. doi:10.1007/s10067-008-1031-9

14. Makol, A., Wright, K., & Amin, S. (2011). Rheumatoid Arthritis and Pregnancy: Safety Considerations in Pharmacological Management. Drugs, 71(15), 1973-1987.

15. Moffatt, D., Ilnyckyj, A., & Bernstein, C. (2009). A Population-Based Study of Breastfeeding in Inflammatory Bowel Disease: Initiation, Duration, and Effect on Disease in the Postpartum Period. American Journal Of Gastroenterology, 104(10), 2517-2523. doi:10.1038/ajg.2009.362

16. van der Woude, C., Kolacek, S., Dotan, I., Oresland, T., Vermeire, S., Munkholm, P., & ... Dignass, A. (2010). European evidenced-based consensus on reproduction in inflammatory bowel disease. Journal Of Crohn's & Colitis, 4(5), 493-510. doi:10.1016/j.crohns.2010.07.004

17. Wallace, D., Gudsoorkar, V., Weisman, M., & Venuturupalli, S. (2012). New insights into mechanisms of therapeutic effects of antimalarial agents in SLE. Nature Reviews. Rheumatology, 8(9), 522-533. doi:10.1038/nrrheum.2012.106

18. Brennan, P., & Silman, A. (1994). Breast-feeding and the onset of rheumatoid arthritis. Arthritis And Rheumatism, 37(6), 808-813.

19. Marasco, L. (2006). The impact of thyroid dysfunction on lactation.

20. Nordqvist, C. (2013). Insulin's role in making breast milk.

Published February 2014.

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Maternal Autoimmune Disorders and Breastfeeding

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One of the most common health concerns for women of childbearing age is an autoimmune disorder. According to the American Autoimmune Related Disorders Association (1), authorities estimate that around one in five people-two thirds of them women-are living with an autoimmune disorder in the United States.

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Does exercise affect your milk?

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No. Exercise contributes to your overall health and is beneficial and appropriate for breastfeeding moms like you. Even vigorous exercise does not significantly affect the amount or composition of milk your body produces. And despite what you may have heard, it's unlikely that your baby will reject your milk even if you breastfeed shortly after exercising.

You might have read about a widely publicized 1992 study that found mothers' milk is higher in lactic acid right after exercise and that babies find it less appealing. Researchers concluded that mothers should nurse their babies (or pump) before exercising and avoid nursing after exercise for up to 90 minutes. These findings are now considered questionable for a number of reasons. One is that the babies were fed milk with a medicine dropper. And even though the babies were not accustomed to drinking milk that way, the researchers didn't take this into consideration.

As long as your baby seems content to nurse, there's absolutely no reason not to nurse right after you work out. For your own comfort, though, you might want to pump or feed your baby before high-impact activities such as running, and wear a bra that provides plenty of support. Some women wear a sports bra over a nursing bra for extra support.

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Will exercising affect my milk or my ability to breastfeed? | BabyCenter

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No. Exercise contributes to your overall health and is beneficial and appropriate for breastfeeding moms like you. Even vigorous exercise does not significantly affect the amount or composition of milk your body produces. And despite what you may have heard, it's unlikely that your baby will reject your milk even if you breastfeed shortly after exercising.

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Does augmentation affect your ability to breastfeed?

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There's a good chance you can breastfeed after having breast implants, though you may face some challenges, such as problems with milk supply. A lactation consultant can help identify issues and show you how to address them, so you can provide your baby with as much breast milk as possible.

If you're considering, but haven't yet had, augmentation surgery and may want to breastfeed in the future, talk to a breast surgeon as well as a lactation consultant about how implants could affect your ability to breastfeed.

Will breastfeeding with implants be difficult?

Here are the problems you might face:

Low milk supply: Depending on how your augmentation surgery was done (see "Will breast implants affect my milk production?" below), you may have trouble producing enough breast milk to exclusively breastfeed. According to the Institute of Medicine, women who have had breast implants are three times as likely as other women to have a low milk supply.

Inhibited letdown: If your nipples lost sensitivity, you may have less-effective letdown and lower milk production.

Sore nipples: If your nipples are more sensitive than normal, you may develop sore nipples, which make breastfeeding painful.

Mastitis: Women with implants are at greater risk for mastitis.

Engorged breasts: Women with implants are at greater risk for exaggerated breast engorgement.

Will breast implants affect my milk production?

They can. But even if the surgery damages the milk-making parts of the breasts, most mothers are still able to produce some breastmilk - and any amount is beneficial for your baby.

The following factors can affect your milk supply if you have breast implants:

The type of incision you had. Some surgical techniques cause more damage to milk ducts, glandular tissue, and nerves than other techniques.

Incisions made around the areola (the circle of pigmented skin around your nipple) are more likely to sever milk ducts and affect the nerves that play a role in breastfeeding.

Incisions that are made under the breast (where the breast meets the chest wall) or through the armpit usually cause little damage. Damaged ducts, glands, and nerves can sometimes repair themselves, but it happens gradually with each monthly cycle. The more time that passes between getting implants and becoming pregnant, the more likely the damaged tissue is to heal and produce milk.

Numbness or pain in your nipple or breast as a result of implants makes it more likely that you have some nerve damage. (The scar tissue your body forms in response to the implant may cause pain or numbness. If this scarring extends into the milk ducts it may impair supply.)

Where the implants are placed. Implants can be placed under or over the layer of muscle in your breasts. When they're over the muscle, they're more likely to put pressure on milk ducts and glands, which could slow down milk production.

Why you had the surgery. If you had surgery because you had underdeveloped (hypoplastic) breasts, you may have trouble producing enough milk. (This would be the case whether or not you had breast augmentation.) Even though the implants increased your breast size, the functional structures required for breastfeeding are still underdeveloped.

If you had breast augmentation after a mastectomy, you will not be able to breastfeed on that side, due to the loss of breast tissue and glands that produce milk. It is possible, however, to exclusively breastfeed with one breast.

When you had the surgery. Nipple sensation can take up to two years to return after surgery. Also, the average time from placement of the implants to revisions (replacing the implants) is seven years. Revisions can further damage nerves and tissue, and increase the risk of challenges with milk production.

Could my breast implants harm my baby?

There's not much conclusive research on this. The Centers for Disease Control and Prevention states, "Research is limited; however, there have been no recent reports of clinical problems in infants of mothers with silicone breast implants."

The Institute of Medicine reports that silicone or any harmful substance has not been found in the breast milk of women with implants. In fact, the levels of silicon in infant formula were found to be much higher than in the breast milk of women with or without implants.

Even if a little silicone did get into your milk, it's very unlikely to harm your baby. According to the U.S. Food and Drug Administration, silicone is safe for an infant to ingest.

What if I can't produce enough milk?

If your milk supply isn't quite enough to meet your baby's needs, you'll need to supplement with formula or donor milk. If you have to supplement, remember that any amount of breast milk that you're able to provide for your baby is beneficial.

What can I do to breastfeed successfully if I have breast implants?

Work with a lactation consultant. She can help you get off to a good start by making sure your baby has a good latch and is well positioned for nursing. She can also give you tips for dealing with nipple sensitivity. If you're feeling anxious or want to get some questions answered in advance, consider meeting with a lactation consultant before your baby is born.

Nurse your baby often. The more often your baby nurses, the more often your body will get the signal to produce more milk. Your lactation consultant may suggest using a breast pump between feedings, too, to strengthen the message.

Tell your baby's doctor about your surgery. She'll need to keep a close eye on your baby's weight gain to make sure he's getting enough to eat.

Will breastfeeding ruin my implants?

No, breastfeeding shouldn't affect your implants or the appearance of your augmented breasts.

I'm thinking about getting breast implants. Should I wait until after I'm finished breastfeeding?

Yes, waiting is a good idea. If you're thinking about getting breast implants and want to be able to nurse your babies, postponing surgery until after you've weaned your last child will make it easier for you to breastfeed and establish a good milk supply.

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Breastfeeding after breast augmentation (implants) | BabyCenter

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There's a good chance you can breastfeed after having breast implants, though you may face some challenges, such as problems with milk supply. A lactation consultant can help identify issues and show you how to address them, so you can provide your baby with as much breast milk as possible.

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family & relationships / parenting / general

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family & relationships / parenting / general

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Buy The Continuum Concept (Arkana) New Ed by Liedloff, Jean (ISBN: 8601200961409) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

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**Please note: ALL our Face To Face services (Drop-In Sessions, Workshops & Consultations) are currently suspended. Please consider an Online Consultation or buying a vBook instead. Postal Sling & Carrier Hire is still available. Visit our blog (via our Home Page) for details. **
We are an independent, Mum-run service providing expert sling and baby carrier advice sessions (Drop-In's, Workshops & Private Consultations) and hire from locations across South London. All of our Consultants are qualified and insured.

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A session dedicated to whatever you need. Choose up to 30 or 90 minutes, in Lewisham or Crystal Palace. Learn about your options before Baby arrives, find your first sling/carrier, learn to back carry your bigger baby, or something else - it's up to you! See Details...

Drop-In Sessions

Our Drop-In Sessions are busy group sessions where you can get help with a sling or a carrier, either from one of our Volunteers or from a Babywearing Consultant. See Details...

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Our workshops are small group sessions (max 6 adults) which are focussed on a particular theme or skill. Come & learn with others who are looking for the same sort of information as you. See Details...

What other parents say

"We went to the park after we left yours, & I carried her confidently." - Angela

"Sarah is quite brilliant. You need a bit of knowhow to use a sling and Sarah has so much knowledge - we wouldn't have been able to do it without her guidance. It is a brilliant way of being mobile with your child and makes our daughter so much happier than time spent in the stroller. I can't recommend it enough." -Andrew

"SLSL's Sarah is extremely helpful! She gives excellent expert advice. Hiring a wrap or carrier is a really nice way to get familiar with carrying your baby and trying before you buy.
Highly recommend booking a consultation, so you can use a wrap/carrier with confidence."
- Chantal

"Great service, very helpful and respond quickly. Hired a sling for our holiday which proved invaluable."
-Vicky

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Please note: ALL our Face To Face services (Drop-In Sessions, Workshops & Consultations) are currently suspended. Please consider an Online Consultation or buying a vBook instead. Postal Sling & Carrier Hire is still available. Visit our blog (via our Home Page) for details.

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Unexplained crying

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Colic is when a baby cries a lot but there's no obvious cause. It's a common problem that should get better on its own. But call NHS 111 or see a GP if you're worried.

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Finger feeding is a technique that allows you to feed the baby without giving the baby an artificial nipple. Finger feeding is also a method that helps train the baby to take the breast. If you want to breastfeed successfully, it is better to avoid the use of artificial nipples before your milk supply is well established.

Why Finger Feed

Finger feeding may be used if:

The baby refuses the breast for whatever reason, or if the baby is too sleepy at the breast to nurse well; it is also a very good way to wake up a sleepy baby.

The baby does not seem to be able to latch on to the breast properly, and thus does not get milk well. (If a lactation aid can be used at the breast, why use finger feeding?).

The baby is separated from the mother, for whatever reason. However, in such a situation, a cup is probably a better method of feeding the baby.

Breastfeeding is stopped temporarily

Your nipples are so sore that you cannot put the baby to the breast. Finger feeding for several days may allow your nipples to heal without causing more problems by getting the baby used to an artificial nipple. Cup feeding is also more appropriate in this situation and takes less time. Please keep in mind that positioning and a good latch help sore nipples far more frequently than finger feeding.

Finger feeding is much more similar to breastfeeding than bottle feeding is. In order to finger feed, the baby must keep his tongue down and forward over the gums, the mouth wide open ( the larger the finger used, the better), and the jaw forward. Furthermore, the motion of the tongue and jaw is similar to what the baby does while feeding at the breast. Finger feeding is best used to prepare the baby to take the breast. It should be used for a minute or two just before trying the baby on the breast if the baby is refusing to latch on. Cup feeding is usually easier and faster when the mother is not present to feed the baby or to finish the feeding if finger feeding is slow.

Please Note: If the baby is taking the breast, it is better by far to use the lactation aid tube at the breast if supplementation is truly necessary.

Wash your hands. It is better if the fingernail on the finger you will use has been cut short, but this is not necessary.

It is best to position yourself and the baby comfortably. The baby's head should be supported with one hand behind his shoulders and neck, the baby should be on your lap, half seated, and facing you. However, any position which is comfortable for you and the baby and which allows you to keep your finger flat in the baby's mouth will do.

You will need a lactation aid, made up of a feeding tube (#5F, 36" long), and a feeding bottle with expressed breast milk, sugar water, or, if necessary, formula, depending on the circumstances. The feeding tube is passed through the enlarged nipple hole into the fluid.

Line up the tube so that it sits on the soft part of your index (or other) finger. The end of the tube should line up no farther than the end of your finger. It is easiest to grip the tube, about where it makes a gentle curve, between your thumb and middle finger and then position your index finger under the tube. If this is done properly, there is no need to tape the tube to your finger.

Using the finger with the tube, tickle the baby's lips lightly until the baby opens up his mouth enough to allow your finger to enter. If the baby is very sleepy but needs to be fed, the finger may be gently insinuated into his mouth. Generally, the baby will begin to suckle even if asleep, and receiving liquids will then awaken him.

Insert your finger with the tube so that the soft part of your finger remains upwards. Keep your finger as flat as possible. Usually, the baby will begin sucking on the finger and allow the finger to enter quite far. The baby will not usually gag on your finger even if it is in his mouth quite far unless the baby is full or used to bottles.

Pull down the baby's chin, if his lower lip is sucked in.

The technique is working if the baby is drinking. If feeding is very slow, you may raise the bottle above the baby's head. Try to keep your finger straight, flattening the baby's tongue. Try not to point your finger up, but keep it flat, thus keeping down the baby's tongue, and working the lower jaw forward.

The use of finger feeding with a syringe to push milk into the baby's mouth is too difficult for the mother to do alone and probably less effective than simply using a bottle with the nipple hole enlarged and the tube coming from it.

How Finger Feeding Can Help With Breastfeeding

If you are having trouble getting the baby to latch on to or to suckle at the breast, remember that a ravenous baby can make the going very difficult. Take the edge off his hunger by using the finger feeding technique for a minute or so. Once the baby has settled a little and sucks well on your finger (usually only a minute or so), try offering the breast again. If you still encounter difficulty, do not be discouraged. Go back to finger feeding and try again later in the feed or next feeding. This technique usually works. Sometimes several days, or on occasion a week or more, of finger feeding are necessary, however.

If you are leaving the hospital finger feeding the baby, make an appointment with the clinic within a day or so of discharge. The earlier the better.

Once the baby is taking the breast, he may still require the lactation aid to supplement for a period of time. Although the baby may take the breast, the latch can still be less than ideal, and the suckle may still not be efficient enough to ensure adequate intake.

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Finger feeding is a technique that allows you to feed the baby without giving the baby an artificial nipple. Finger feeding is also a method that helps train the baby to take the breast. If you want to breastfeed successfully, it is better to avoid the use of artificial nipples before your milk supply is well established.

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If your baby is having a difficult time with latch on, a nipple shield may be helpful. There are many reasons why a nipple shield is beneficial, but in every case, it's important that a lactation consultant observe the latch and positioning to make sure you actually need one. When used properly, a nipple shield can help prevent nipple pain and trauma. In some cases using the shield can also help with milk removal because it allows your baby to maintain a deep latch on your breast.

The nipple shield can help in cases of nipple trauma (cuts, fissures, cracks, etc.) by decreasing the level of sensitivity while breastfeeding. However, for some moms the nipple shield might cause lower milk production because your body won't be as stimulated. In this case, your body doesn't receive the same level of signaling to keep producing milk for your baby.

A nipple shield can allow a mom to maintain a very robust milk supply. Nipple shields come in different sizes, so it's important to use the proper size to ensure nipple health and prevent nipple problems, as well as promote adequate milk removal and production.

Talk with your lactation consultant to review your needs and use of a nipple shield.
Are you concerned about baby's latch, or experiencing some kind of nipple trauma? Talk to one of our healthcare professionals to find personalized solutions today.

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If your baby is having a difficult time with latch on, a nipple shield may be helpful. There are many reasons why a nipple shield is beneficial, but in every case, it's important that a lactation consultant observe the latch and positioning to make sure you actually need one.

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Important Infant Sleep Facts

In order to better understand the how-to's of getting you and your baby to enjoy going to sleep and staying asleep, here are some important principles of sleep that every new parent needs to understand.

1. How you sleep.

After dressing or undressing for bed, most adults help themselves relax for sleep by performing various bedtime rituals: reading, listening to music, watching TV, or having sex. As you drift into sleep, your higher brain centers begin to rest; enabling you to enter the stage of deep sleep called "non-REM" (non-rapid eye movement - NREM), or deep sleep (also called quiet sleep). Your mind and body are quietest during this stage of sleep. Your body is still, your breathing is shallow and regular, your muscles are loose, and you're really "zonked." After about an hour and a half in this quiet sleep stage, your brain begins to "wake up" and start working, which brings you out of your deep sleep and into light sleep or active sleep, called rapid eye movement or "REM" sleep. During this stage of sleep your eyes actually move under your eyelids as your brain exercises. You dream and stir, turn over, and may even adjust the covers without fully awakening. It is during this sleep stage that you may fully awaken to go to the bathroom, then return to bed and fall back into a deep sleep. These alternating cycles of light and deep sleep continue every couple hours throughout the night, so that a typical adult may spend an average of six hours in quiet sleep and two hours in active sleep. Thus, you do not sleep deeply all night, even though you may feel as though you do.

2. How your infant sleeps.

You're rocking, walking, or nursing your baby and her eyelids droop as she begins to nod off in your arms. Her eyes close completely, but her eyelids continue to flutter and her breathing is still irregular. Her hands and limbs are flexed, and she may startle, twitch, and show fleeting smiles, called "sleep grins." She may even continue a flutter-like sucking. Just as you bend over to deposit your "sleeping" baby in her crib so you can creep quietly away, she awakens and cries. That's because she wasn't fully asleep. She was still in the state of light sleep when you put her down. Now try your proven bedtime ritual again, but continue this ritual longer (about twenty more minutes). You will notice that baby's grimaces and twitches stop; her breathing becomes more regular and shallow, her muscles completely relax. Her fisted hands unfold and her arms and limbs dangle weightlessly. Martha and I call this "limp-limb" sign of deep sleep. Baby is now in a deeper sleep, allowing you to put her down and sneak away, breathing a satisfying sigh of relief that your baby is finally resting comfortably.

3. Babies have shorter sleep cycles than you do.

Stand adoringly next to your sleeping baby and watch him sleep. About an hour after he goes to sleep, he begins to squirm, he tosses a bit, his eyelids flutter, his face muscles grimace, he breathes irregularly, and his muscles tighten. He is reentering the phase of light sleep. The time of moving from deep to light sleep is a vulnerable period during which many babies will awaken if any upsetting or uncomfortable stimulus, such as hunger, occurs. If the baby does not awaken, he will drift through this light sleep period over the next ten minutes, and descend back into deep sleep. Adult sleep cycles (going from light to deep sleep, and then back to light sleep) lasts an average of 90 minutes. Infant sleep cycles are shorter, lasting 50 to 60 minutes, so they experience a vulnerable period for nightwaking around every hour or even less. As your baby enters this light sleep, if you lay a comforting hand on your baby's back, sing a soothing lullaby, or just be there next to baby if he is in your bed; you can help him get through this light sleep period without waking.

4. Babies don't sleep as deeply as you do.

Not only do babies take longer to go to sleep and have more frequent vulnerable periods for nightwaking; they have twice as much active, or lighter, sleep as adults. At first glance, this hardly seems fair to parents tired from daylong baby care. Yet, if you consider the developmental principle that infants sleep the way they do - or don't - for a vital reason, it may be easier for you to understand your baby's nighttime needs and develop a nighttime parenting style that helps rather than harms the natural infant sleep rhythms. Here's where I'm at odds with modern sleep trainers who advise a variety of gadgets and techniques designed to help baby sleep more deeply through the night - for a price, and perhaps at a risk.

5. Nightwaking has survival benefits.

In the first few months, babies' needs are the highest, but their ability to communicate their needs is the lowest. Suppose a baby slept deeply most of the night. Some basic needs would go unfulfilled. Tiny babies have tiny tummies, and mother's milk is digested very rapidly. If a baby's stimulus for hunger could not easily arouse her, this would not be good for baby's survival. If baby's nose was stuffed and she could not breathe, or was cold and needed warmth, and her sleep state was so deep that she could not communicate her needs, her survival would be jeopardized.

One thing we have learned during our years in pediatrics is that babies do what they do because they're designed that way. In the case of infant sleep, research suggests that active sleep protects babies. Suppose your baby sleeps like an adult, meaning predominantly deep sleep. Sounds wonderful! For you, perhaps, but not for baby. Suppose baby had a need for warmth, food, or even unobstructed air, but because he was sleeping so deeply he couldn't arouse to recognize and act on these needs. Baby's well being could be threatened. It appears that babies come wired with infant sleep patterns that enable them to awaken in response to circumstances that threaten their well being. We believe, and research supports, that frequent stages of active (REM) sleep serve the best physiologic interest of babies during the early months, when their well being is most threatened.

6. Nightwaking has developmental benefits.

Sleep researchers believe that infant sleeping patterns is a "smarter" way to sleep than typical adult sleeping. They theorize that light sleep helps the brain develop because the brain doesn't rest during REM sleep. In fact, blood flow to the brain nearly doubles during REM sleep. (This increased blood flow is particularly evident in the area of the brain that automatically controls breathing.) During REM sleep the body increases its manufacture of certain nerve proteins, the building blocks of the brain. Learning is also thought to occur during the active stage of sleep. The brain may use this time to process information acquired while awake, storing what is beneficial to the individual and discarding what is not. Some sleep researchers believe that REM sleeps acts to auto-stimulate the developing brain, providing beneficial imagery that promotes mental development. During the light sleep stage, the higher centers of the brain keep operating, yet during deep sleep these higher brain centers shut off and the baby functions on her lower brain centers. It is possible that during this stage of rapid brain growth (babies' brains grow to nearly seventy percent of adult volume during the first two years) the brain needs to continue functioning during sleep in order to develop. It is interesting to note that premature babies spend even more of their sleep time (approximately 90 percent) in REM sleep, perhaps to accelerate their brain growth. As you can see, the period of life when humans sleep the most and the brain is developing the most rapidly is also the time when they have the most active sleep. One day as I was explaining the theory that light sleep helps babies' brains develop, a tired mother of a wakeful infant chuckled and said, "If that's true, my baby's going to be very smart."

7. As they grow, babies achieve sleep maturity.

"Okay," you say, "I understand this developmental design, but when will my baby sleep through the night?" The age at which babies settle - meaning they go to sleep easily and stay asleep varies widely among babies. For some infants sleep is easily come by, but they don't stay asleep. Others go to sleep with difficulty but will stay asleep. Other exhausting babies neither want to go to sleep nor stay asleep.

In the first three months, tiny babies seldom sleep for more than four-hour stretches without needing a feeding. Tiny babies have tiny tummies. Yet, they usually sleep a total of 14-18 hours a day. From three to six months, most babies begin to settle. They are awake for longer stretches during the day and some may sleep five-hour stretches at night. Between three to six months, expect one or two nightwakings. You will also see the period of deep sleep lengthen. The vulnerable periods for nightwaking decrease and babies are able to enter deep sleep more quickly. This is called sleep maturity.

8. Babies still wake up.

When babies mature into these adult-like sleep patterns varies among babies. Yet, even though babies achieve this sleep maturity some time during the last half of the first year, many still wake up. The reason? Painful stimuli, such as colds and teething pain, become more frequent. Major developmental milestones, such as sitting, crawling, and walking, drive babies to "practice" their new developmental skills in their sleep. Then between one and two years of age, when baby begins to sleep through the above-mentioned wake-up stimuli, other causes of nightwaking occur, such as separation anxiety and nightmares.

Even though you understand why babies are prone to nightwaking, you realize it's still important for parents and babies to get a restful night's sleep, otherwise, baby, the parents, and their relationship won't thrive.

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8 Infant Sleep Facts Every Parent Should Know

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In order to better understand the how-to's of getting you and your baby to enjoy going to sleep and staying asleep, here are some important principles of sleep that every new parent needs to understand. After dressing or undressing for bed, most adults help themselves relax for sleep by performing various bedtime rituals: reading, listening to music, watching TV, or having sex.

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istock.com / Steve Debenport

What is expressing breastmilk?

Expressing is a way of taking milk from your breast without your baby needing to suckle. You can do this by using:

Once you've expressed your milk, you can store it in the fridge or freezer to feed to your baby later, if you don't need it straight away.

You can give your baby expressed breastmilk in a number of different ways:

in a bottle

in an open cup

in a syringe or a half-filled spoon (for younger babies)

in a beaker with a simple valve (for babies older than three months)
(LLLGB 2016a)

Your midwife can help you choose what works best for you and your baby, and give you advice about feeding safely.
Why express breastmilk?

There are lots of reasons why you might want to express milk. Your baby can still have the benefits of breastmilk if she's not able to breastfeed, or if you can't be with her all the time.

Expressing also means that other people can feed your baby as well as you, so you can have a break.

Expressing milk can be helpful if:

Your partner or someone else is going to feed your baby.

You want to produce more milk, as expressing can boost your supply. In fact, if you express milk to make extra in the early days, it can make it easier to produce more milk later.

You have to be apart from your baby, for example, if she's in special care or you go back to work.

Your breasts are uncomfortable and very full (engorged). If this happens, then expressing some milk can help you feel more comfortable.

If your baby can't suckle well or can't take milk straight from your breast at first. Or if you or your baby have a condition or illness that makes breastfeeding difficult for the time being.
(NHS Choices 2016, LLLGB 2016b)

How do I express milk?

Whether you are hand expressing or using a pump, always wash your hands before you start and make sure any equipment you're using has been sterilised.

It's helpful to get in the right mood too. The more relaxed you are, the easier it will be. The hormone oxytocin is released in your body when you're feeling happy and relaxed, and that's what causes your milk to be released (let down) (LLLGB 2016b). Sometimes that's hard if your baby is ill or if you're feeling rushed and stressed.

Holding your baby or sitting near her, looking at a picture of her, or holding and smelling her clothes can all help (LLLGB 2016b).

You'll need a wide-mouthed container, such as a jug, to collect your milk in. Make sure it's either well-cleaned and scalded with boiling water, or sterilised (BFN 2009). You'll also need some sterile bags, bottles or lidded containers to store your milk in (BFN 2009, Welford 2012).

Hand expressing does take a bit of getting used to, and you may need to practise for a while. These tips may help:

Gently massaging your breasts or applying a warm flannel to them before you start can help the milk to let down.

Cup your breast with one hand. With your other hand, make a "C" shape with your fingers and thumb. Squeeze the area around the nipple gently (rather than the nipple itself).

Squeeze and then release until you get into a rhythm. Your milk will start to appear as a few drops at first, increasing to a more steady flow. If it doesn't, rotate your hand round your breast and try another area.

Keep going until the flow slows down and then move to a different part of your breast. When you've done one breast, move onto the other.
(NHS Choices 2016)

Using a pump to express
Some women find it easier to use a pump. Whether you use a manual or an electric pump will depend on what you're comfortable with, how often you need to express and how much milk you need to produce. Some electric pumps allow you to express both breasts at the same time.
Most pumps work in a similar way. You put a suction cup and funnel attachment over your nipple and areola. This mimics how your baby suckles, stimulating your milk to flow. If you're using a manual pump you repeatedly squeeze a handle to create the pumping action. If you're using an electric pump, the machine does this for you.

Expressing shouldn't be painful, but if you're experiencing any pain, or you're finding it difficult, speak to your midwife.

It can take anywhere between 15 minutes and 45 minutes to pump both your breasts. Don't use time to guide you, though. Just pump for as long as your milk is flowing well. Change breasts when the flow slows down. Keep changing between breasts. Even if you're only getting a small amount out, it all adds up (LLLGB 2016b).

If you only need to express the odd feed, expressing by hand or using a cheaper manual pump may work best. If you'd like to pump regularly at home, a standard electric pump may be the best choice for you.

If you need to produce lots of milk because your baby can't feed from your breast, you may want a hospital-grade double electric pump (LLLGB 2016b). Many hospitals will have these pumps on the wards, and you can also hire them for use at home.

When using a breast pump, try these tips:

Sit comfortably, with your back straight.

Support your breast from underneath. Place your fingers flat on your ribs, with your first finger between your breast and your ribs.

Ease your nipple into the funnel, making sure that your nipple is in the centre. It's important to make sure you've got a good fit. If too much areole is pulled into the funnel it can make your nipples sore. A tight funnel can also inhibit your milk flow. Many pumps come with a selection of funnel sizes so choose one that's right for you.

Keep the funnel close enough to maintain a seal with your skin, without forcing it on to your breast.

Be patient. It often takes a minute or two for your milk to flow well.

If you're using an electric pump, you can sometimes change the force of the suction on it. If you can, start on a lower strength and build up. If you start with a high strength it can be painful and may damage your nipples.
(NHS Choices 2016, LLLG. 2016b)

How should I store breastmilk?

Store your breastmilk in sterilised containers, such as plastic feeding bottles with secure tops, or plastic bags made especially for storing milk (NHS Choices 2016). Remember to write the date on the bottle or bag before putting it in the fridge or freezer, so that you use up the oldest ones first (Welford 2012).

To keep your milk safe in the fridge, you need to know how cold your fridge is. You can buy a thermometer if your fridge doesn't have one built in.

Freshly expressed milk can be stored for:

Up to five days, in the main part of a fridge, at 4 degrees C or lower. It's best to put the milk at the back of the fridge where it's coldest.

Up to two weeks, in the freezer compartment of a fridge.

Up to six months in a freezer, at minus 18 degrees C or lower.
(NHS Choices 2016)

If you plan to store expressed breastmilk for fewer than five days, it's fine to keep it in the fridge (NHS Choices 2016). Breastmilk that's been cooled in a fridge can be stored for 24 hours in a cool bag or box with ice packs in it (NHS Choices 2016).
Freezing milk destroys some of its antibodies, which your baby needs to help fight infections (LLLG 2016c). So, it's best not to freeze any that you plan to use within five days. Frozen breastmilk is still healthier for your baby than formula milk, though (NHS Choices 2016).

You can thaw frozen milk in any of the following ways:

Place the bottle or bag in a bowl of warm water (NCT nd).

Run it under cool then warm water from the tap (NHS Choices 2016).

Defrost it in the fridge overnight (NHS Choices 2016).

Don't be tempted to speed up the thawing or warming process, even if time is limited. Using a microwave to do the job can create hot spots in the milk, which can burn your baby's mouth (Welford 2012).
Once the milk is thawed it can separate, so simply give it a shake to mix it (BFN 2009). Use it straight away, and throw away any milk that's left after the feed (BFN 2009). If the milk smells sour, don't use it (BFN 2009).

More on expressing breastmilk

Last reviewed: October 2017

References

BFN. 2009. Expressing and storing breastmilk. The Breastfeeding Network. www.breastfeedingnetwork.org.uk [pdf file, accessed September 2017]

LLLG. 2016a. When mum can't be there. La Leche League GB. [Accessed September 2017]

LLLG. 2016b.Expressing your milk. La Leche League GB. [Accessed September 2017]

LLLG. 2016c. Storing your milk. La Leche League GB. [Accessed September 2017]

NCT nd. How to store expressed breastmilk. www.nct.org.uk [Accessed September 2017]

NHS Choices. 2016. Expressing and storing breastmilk. NHS Choices, Health A-Z. www.nhs.uk [Accessed September 2017]

Welford H. 2012. Expressing and storing your milk. London: NCT www.nct.org.uk [pdf file, accessed September 2017]

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istock.com / Steve Debenport Expressing is a way of taking milk from your breast without your baby needing to suckle. You can do this by using: Once you've expressed your milk, you can store it in the fridge or freezer to feed to your baby later, if you don't need it straight away.

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Getting support when you need it is important. Feeding isn’t always straightforward and it can take time to feel confident. The great news is that NCT is here to support you. 

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Baby Cafe Penge. 633 likes · 1 talking about this. Baby Cafe Penge is a breastfeeding drop in group to support all parents and their families in and around Penge. It is open on Fridays 1-3pm, 48...

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Baby Cafe Beckenham. 915 likes · 2 talking about this. Baby Café Beckenham is a free breastfeeding support group for families in and around Beckenham.

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Can I continue breastfeeding when I return to work?

Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to.

How you do this will depend on your individual circumstances. Some mums might arrange their baby's childcare close to their work or place of study. They can then visit them to breastfeed when they can during the working day (NHS, 2018). Alternatively, your partner, childminder, friend or relative might bring your baby to your workplace so you can breastfeed them.

Some mums express milk during working hours to maintain their milk supply and so that their baby can be fed this expressed milk from a bottle while they're at work (NHS, 2018). Some parents opt for mixed feeding, also called combination feeding. This means continuing to breastfeed and offering suitable alternative milk when you're not able to breastfeed.

What are my legal rights around breastfeeding at work?

Before returning to work, it helps to let your employer know in writing that you are breastfeeding (NHS, 2018; HSE 2018). They can then complete a risk assessment and consider whether there are any specific risks to you for as long as you are breastfeeding (ACAS, 2014; HSE 2018).

There are few direct risks to breastfeeding but you should seek advice if you work with dangerous substances, such as organic mercury (HSE 2018).

Employers are legally required to provide a space for mums who are breastfeeding to lie down and rest if they need to (ACAS, 2014; NHS, 2018).

There is no legal right, however, for your employer to provide breastfeeding breaks at work. But they must meet their obligations to employees who breastfeed under health and safety law, flexible working law and discrimination law. (Maternity Action, 2017) This means your employer should make sure you don't feel unfairly treated because you are breastfeeding.

Can I express milk for my baby at work?

You should be able to express milk at your workplace if you wish. You can request that your employer provides you with a suitable private space where you can do this.

Guidelines recommend that you have access to a private, clean and comfortable room with a lockable door - not a toilet - in which to express. However, there is no legal obligation for your employer to provide this space (HSE 2018).

It's also recommended that you have use of a fridge to store your breast milk. (HSE 2018).

Can I change my hours to suit breastfeeding?

You might find that you'd like to make changes to your hours or working pattern to accommodate breastfeeding and/or expressing. Some parents share parental leave, some new mums choose to return part-time and others change their working hours. Have a think about what might suit you best and discuss different options with your employer.

One thing that could support your case is outlining the many benefits of employing and supporting mums who breastfeed, including fewer absences from the workplace and greater staff retention (Maternity Action, 2014; Steurer, 2017). There is also a long-term public health impact of continued breastfeeding and workplaces should be encouraging women to breastfeed (Rojjanasrirat, 2010). You could ask your employer to read Maternity Action's employer leaflet about this.

Your options may be partly determined by your financial situation and how flexible your workplace is. There are lots of sources of support and information to help you with this, such as Maternity Action (see Further information below).

My employer is not supportive of breastfeeding, what should I do?

Your employer must not refuse to allow you access to training or stop you returning to work because you're breastfeeding. If they refuse to act to protect your health and safety, you may have a claim under the Equality Act and you should seek advice.

If you feel like you are being discriminated against in the workplace contact Maternity Action.

This page was last reviewed in February 2019

Further information

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

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

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

Maternity Rights Advice Line: 0808 802 0029.

Maternity Action is a UK charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children - from conception through to the child's early years.

Maternity Action's employer leaflet.

Health and Safety Executive information on breastfeeding and returning to work.

ACAS. (2014) Accommodating breastfeeding in the workplace. Available from: http://www.acas.org.uk/media/pdf/b/s/Acas-guide-on-accommodating-breastfeeding-in-the-workplace.pdf [Accessed 1st Oct 2017].

Borelli JL, Nelson SK, River SL, Birken SA, Moss-Racusin C (2017) Gender differences in work-family guilt in parents of young children. Sex Roles; 76(5-6): 356-368. Available from: https://link.springer.com/article/10.1007/s11199-016-0579-0. [Accessed 1st September 2017].

Gatrell CJ (2007) Secrets and lies: Breastfeeding and professional paid work. Soc Sci Med. 2007;65(2):393-404. Available from: http://www.sciencedirect.com/science/article/pii/S0277953607001487. [Accessed 1st September 2017].

HSE. The Health and Safety Executive Expectant Mothers - FAQs. Available from: http://www.hse.gov.uk/mothers/faqs.htm [Accessed 20 February 2019]

Maternity Action. (2014) Accommodating breastfeeding on return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/11/BORTW-employer-leaflet-FINAL.pdf [Accessed 1st Oct 2017].

Maternity Action. (2017) Continuing to breastfeed when you return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/03/Continuing-to-breastfeed-when-you-return-to-work-2017.pdf [Accessed 1st Oct 2017].

NHS Choices. (2018) Breastfeeding and going back to work. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-back-to-work/ [Accessed 1st Oct 2017].

Rojjanasrirat W, Sousa VD (2010) Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010;19(13-14):2014-2022. DOI 10.1111/j.1365-2702.2009.03152.x Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03152.x/full [Accessed 1st September 2017].

Steurer LM (2017) Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding. Public Health Nurs. 34(3):286-294. DOI: 10.1111/phn.12321. Available from: http://onlinelibrary.wiley.com/doi/10.1111/phn.12321/full [Accessed 1st September 2017].
Further reading
Dettwyler KA (2017) A Time to Wean: The Hominid Blueprint For the Natural Age of Weaning in Modern Human Populations. In: Dettwyler KA, Stuart-Macadam P Breastfeeding: Biocultural Perspectives. Chapter 6. Available from: https://books.google.co.uk/books?hl=en&lr=&id=_8s3DwAAQBAJ&oi=fnd&pg=PT56&dq=+benefits+of+breastfeeding+beyond+two+years&ots=KPM3VOOAYR&sig=F0157OTEF3SC2SzIOsTKKkDfg6E (Accessed 1st October 2017).

Grether T, Wiese BS (2016) Stay at home or go back to work? Antecedents and consequences of mothers' return to work after childbirth. Research perspectives on work and the transition to motherhood Soc Sci Med. 65(2): 105-128. Available from: https://link.springer.com/chapter/10.1007/978-3-319-41121-7_6 [Accessed 1st September 2017].

La Leche League GB. (2016) Working and Breastfeeding. Available from: https://www.laleche.org.uk/working-and-breastfeeding [Accessed 1st Oct 2017].

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Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to. How you do this will depend on your individual circumstances.

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and impact on breastfeeding

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

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

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

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

Signs of tongue-tie

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

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

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

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

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

be unsettled and seem to be hungry all the time

not gain weight as quickly as they should

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

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

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

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

Read more about breastfeeding problems and how to overcome them.

Other signs of tongue-tie

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

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

difficulty sticking their tongue out

their tongue looks heart-shaped when they stick it out

Treating tongue-tie

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

Tongue-tie division

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

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

The procedure

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

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

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

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

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

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

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

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

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

Older children and adults

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

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

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

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

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

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Some women get sore, cracked or painful nipples in the early days of breastfeeding.

Sore nipples are the most common breastfeeding complication and the most common reason women give up breastfeeding (NHS, 2019a). With a little breastfeeding support this can often easily be rectified.

What causes sore nipples when breastfeeding?

Some women find their nipples get very sore a few days after they begin breastfeeding their baby.

This usually happens if your baby isn't positioned or attached well at the breast. If a baby only sucks the nipple rather than taking a good mouthful of breast, then their tongue or roof of the mouth may rub on the nipple. This causes nipples to get sore quickly and might cause nipple cracking (NHS, 2019a).

What can help sore nipples?

Breastfeeding shouldn't be painful, so it's important to get breastfeeding support right from the start (NHS, 2019a). Breastfeeding support should be offered by a midwife before you leave the hospital or birth centre. They can help you to position and attach your baby to your breast, and explain the signs that your baby is feeding well (NHS, 2019a).

If your nipples are getting sore but you're already home, it's a good idea to ask for breastfeeding support from a midwife, health visitor or breastfeeding counsellor as soon as you start to notice a problem. They can watch you while you feed your baby and check your baby is positioned well and feeding effectively.

You might also be able to feel when your baby is well attached. Your nipple should rest comfortably against the soft palate at the back of their mouth. If the nipple is nearer to the front of their mouth, your baby might be poorly attached. This can cause pinching of your nipple against the hard palate, which can cause pain.

You can check with your local NCT group what local breastfeeding support might be available. You may be able to drop in to a breastfeeding group for support or you might be able to have an NCT breastfeeding counsellor visit you at home. You can call the NCT support line for practical and emotional support on 0300 330 0700.

Your midwife, health visitor or breastfeeding counsellor might be able to help identify any other underlying issues (NHS, 2019a). Read on to find out more...

What other less common causes of sore nipples are there?

Engorgement

When breasts become full of milk, they might become sore (Breastfeeding Basics, 2015). This can happen when your breastmilk first comes in.

Feed your baby as often as they would like and for as long as they like. You can also try using a warm heat pack or having a warm shower before feeding or expressing milk, or use cold packs after feeding for pain relief (NICE, 2017).

Flat or inverted nipples

Nipples come in all sorts of sizes and shapes. While most protrude, some are flat or inverted.

These differences don't usually affect your ability to breastfeed. Yet if one or both nipples are flat or inverted, you might find it takes you a bit longer to get breastfeeding established. It can help to get extra support with positioning and attachment.

Various techniques and devices have been suggested to help 'draw out' inverted nipples but it's uncertain how effective they are. Things that can help include stimulating the nipple before feeding, holding the breast while baby is latching on, or using an exaggerated latch position (La Leche League, 2016a). Here's a video showing you how to get an exaggerated latch or 'flipple'.

Tongue tie

Tongue-tie is when the skin joining the underside of the baby's tongue to the floor of their mouth (frenulum) restricts how they can move their tongue. This causes difficulty in latching, which can result in sore nipples.

Other symptoms of tongue tie include: your baby having difficulty latching or staying latched onto the breast; nipples becoming squashed in your baby's mouth; feeding very frequently or for a long time; slow weight gain; or making a clicking sound while feeding. Some parents notice that their baby has difficulty moving their tongue from side to side or sticking out their tongue.

If you're experiencing breastfeeding difficulties and you think your baby might have tongue-tie, speak to your health visitor and you could ask to be referred to a local tongue-tie practitioner. If your baby has tongue-tie, they might suggest dividing your baby's frenulum, which involves cutting the piece of skin; it's a quick, simple, painless procedure and can immediately improve feeding (NICE, 2017). You can find an independent tongue-tie practitioner here.

Thrush (candida) infection

Breast or nipple pain can sometimes be caused by a thrush infection. Candida can infect your nipples if they become cracked or damaged.

Babies who are breastfed can also develop thrush in their mouth. This is likely to be the cause if you have severe pain in both breasts for up to an hour after breastfeeding, despite weeks of pain-free breastfeeding (NHS, 2018).

Symptoms in the mum

Feeling new pain in or behind the nipples or through the breast after feeds. Pain can be described as shooting or pins-and-needles pain. Pain can last for several hours after a feed.

It's unlikely to be thrush if it's only in one breast, accompanied by fever or a red/dark patch on the breast (NHS, 2018).

Symptoms in the baby

Unsettled during feeds, white film on lips, and white spots in their mouth, which don't come off if rubbed; persistent nappy rash (NHS, 2018).

Treatment

If you think you have thrush, see your GP. They can prescribe cream to treat you and your baby. It's important that both mum and baby are treated for thrush because it is very easily transmitted from one to the other. Other members of the family might need to be treated too (NHS, 2018).

It's recommended that you wash and sterilise several times any bottle teats, dummies or anything else that has been in baby's mouth. It's also best not to use any expressed milk from when you had thrush because it might be contaminated with thrush (NHS, 2018).

Mastitis

Mastitis is an inflammation of the breast caused by uncleared blocked ducts or an infection, that often causes the breast to become darker or red (depending on skin colour) and inflamed. See our article on mastitis for more information on symptoms and treatment. Continue to feed your baby and make sure they are attached well to the breast.

Mastitis can lead to a breast abscess (collection of pus), which might need draining, so you may want to see your GP to discuss antibiotics (NHS, 2019b).

Nipple vasospasm

Sometimes painful and sore nipples can be caused by nipple vasospasm, where blood flow is restricted to the area. This can be triggered if a baby's latch is shallow and can also be connected to Raynaud's phenomenon (a condition affecting blood supply) (Breastfeeding Support, 2018).

Some mums' nipples look white (blanched) after a feed and they may experience a deep pain or burning sensation. If this is the case, avoid exposing your nipples to the cold, wear warm clothing and breastfeed in a warm environment (NICE, 2017).

Should I limit my baby's time at the breast to avoid sore nipples?

Limiting your baby's time at the breast is likely to decrease your milk supply. Continue breastfeeding if you can and get breastfeeding support to help you solve any issues like a poor latch or attachment (NICE, 2017).

What are nipple shields or breast shells and can they help?

Nipple shields are thin, protective covers worn over the nipple while breastfeeding. Breast shells are hard, protective covers worn inside the bra.

The use of nipple shields is controversial. They can reduce milk transfer but their use can help women to continue breastfeeding (McKechnie and Eglash, 2010).

For some women and babies, nipple shields can help to establish breastfeeding and make it more comfortable. They might also compensate for immature feeding behaviour in premature babies. On the other hand, they might reduce milk supply, leading to premature weaning from the breast. Babies can also become reliant on them, not wanting to feed without (Chow et al, 2015).

Nipple shields, while effective in helping some women to continue breastfeeding, do not correct the underlying problem (a poor latch). So skilled help is recommended for sore nipples and for women using nipple shields (La Leche League, 2016b).

Breastfeeding support can help you identify and solve any breastfeeding issues (NICE, 2017; NHS, 2019).

Treatment of sore nipples

Early breastfeeding support can help make sure your baby is positioned and attached well. Some women treat nipple cracks with nipple cream, but the evidence for this is inconclusive. You might wish to consider expressing breast milk if your nipples are very sore or cracked.

Getting sore nipples from breastfeeding suggests that it could be helpful to get support with the positioning and latching of your baby from an appropriately trained person (NHS, 2019a).

For more information, read our article on self-help tips for sore nipples.

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline 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. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 021.

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

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Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

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How to help your baby attach and breastfeed | Baby & toddler, Feeding articles & support | NCT

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Many people assume breastfeeding just comes ‘naturally’ but it’s a learning process for many mums and babies. Here are our tips on getting the hang of it…

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What's the best way to introduce my baby to a bottle?

Most lactation experts suggest waiting until your baby is at least a month old and breastfeeding is well established before introducing a bottle. If you're returning to work, start bottle-feeding at least two weeks before your start date so you both have time to adjust. (Find more information on such topics as sterilizing bottles and how often to bottle-feed in our article on bottle-feeding basics.)

Sucking milk from a bottle requires different mouth and tongue movements than breastfeeding, so it may take your baby a little time to get used to the change. Try these tips for a smooth transition:

Offer him a bottle in the evening after his regular feeding to get him used to the nipple. Start with a small amount of breast milk - about half an ounce.

Try paced (or responsive, or cue-based) feeding, which mimics breastfeeding. Use a slow-flow nipple, keep the bottle horizontal, pause frequently during feedings, switch sides as you would when breastfeeding, and stop feeding your baby when he shows signs of being full.

Let someone else feed him the first bottle. If you try to give your baby his first bottle, he may wonder why he's not getting your breast. He may be less confused if someone else makes the introduction. Ask your mother, your partner, a childcare provider, or a friend to help.

Try to be out of the house. A baby can smell his mother, even from a distance, so he may know that you (and your breasts) are just in the next room.

Tory Winnick introduced her son Philip to the bottle when he was 3 weeks old. "I pumped and put my breast milk in a bottle so my husband Mike could experience feeding the baby," she remembers. "We had to try a few different nipples until we found one that most closely simulated the breast. It really made Mike feel great that he could feed the baby too."

Your baby may not eat very much when you aren't home and may begin waking more frequently at night if you're apart all day. Don't be surprised if this happens, and just take advantage of these quiet and intimate times to reconnect with your baby.

What can I do if my baby resists taking a bottle?

Some babies take to the bottle without much fuss, but others struggle quite a bit with the transition. If your baby is having a hard time, try these techniques:

Use a bottle nipple similar to her pacifier. If she sucks on a latex pacifier, use a latex bottle nipple (rather than a silicone one) and vice versa. Warm the nipple with water to make it feel more appealing.

Put some breast milk on the nipple. When your baby tastes it, she may start sucking to get more. (Don't use honey, which can cause infant botulism in children younger than 12 months.)

Let your baby play with the nipple so she can familiarize herself with it. If she just chews on it, let her for now. She may actually start sucking on it soon.

Hold her in a different position: Put her in an infant or car seat so she is semi-upright, and then feed her the bottle while facing her. Or try feeding her on your lap with her back to your chest. Once she is used to taking a bottle, you can hold her as you usually would for feedings.

Try different temperatures. It could be your baby prefers her milk slightly warmer or colder than you've been giving it to her. Experiment with different temperatures to see what she prefers. You might also see if there's a difference between giving her fresh milk or milk that's been frozen.

Offer the bottle at other times of day. If your baby won't take the bottle during the day, try offering it during a nighttime feeding or vice versa.

One resourceful father put on his wife's bathrobe and tucked the bottle under his arm while holding the baby in a breastfeeding position. That won't work for you, but it might work for Dad!

I've tried everything, but my baby is only getting more frustrated and resistant.

Your baby needs time to get used to new sensations, so stick with the same nipple, bottle, and feeding technique for a while before trying something new. Constantly changing the feeding position or switching out new nipples may just end up confusing (and frustrating) him.

Make sure you have lots of time to take it slow during this process. If your baby starts crying and pushes the bottle away, back off, comfort him, and then try again. If you've tried offering the bottle and your baby has refused three times, let it go for now. (Wait at least five minutes before breastfeeding - that way he won't associate refusing the bottle with immediate gratification.)

Offer the bottle again in an hour or two, when your baby is alert and receptive but not frantically hungry.

My baby took to the bottle easily at first, but now she wants only to breastfeed.

Early success isn't necessarily an ironclad guarantee that your baby will always take a bottle. Many babies who have been getting bottles all along suddenly decide they simply prefer breastfeeding and don't want a bottle anymore. And why not? Breastfeeding is warm, cozy, and involves their favorite person - Mom.

But don't worry: For most babies, this is just a short-lived developmental step. If your baby suddenly refuses to take a bottle, talk to your child's doctor to rule out a medical reason then try reintroducing it at another time.

What if I want to skip the bottle and teach my baby to drink from a cup?

In some countries, infants who can't nurse are taught to use a cup from the get-go. There are some advantages to this method: There's no chance of nipple confusion, and you won't be tempted to prop up your baby with a bottle at nap time or bedtime (which can lead to tooth decay). You'll also never have to break a bottle habit.

Of course, helping your baby drink from a cup is time-consuming. Unless you use a sippy cup or a cup with a built-in straw, you'll have to help her drink - and be prepared for the inevitable mess. Daycare providers may not be able to accommodate this arrangement.

Many of the same principles of introducing your baby to a bottle hold true for using a cup. Have her get used to a cup at an early age (but not until breastfeeding is well established), and introduce it gradually - one feeding a day. If you're going back to work, start a few weeks before so your child has time to get used to this new feeding method.

My baby absolutely refuses to take a bottle. What should I do?

When this happens, it's not uncommon to blame yourself, saying, "If only I had given him a bottle a day from the beginning, this wouldn't be happening." But this just isn't true. Some babies never take a bottle.

Others may tell you that if you just wait him out, he'll eventually be hungry enough to take a bottle. That's not necessarily true, and making a baby go for long stretches without eating isn't a good idea. Don't make mealtime into a battleground.

If all attempts to bottle-feed him fail, go the cup route. Hold him upright in one arm and bring the cup to his mouth, tilting it gently until a bit of milk or formula drips in. He'll lap it up at first and then figure out to drink it. You can also use a hollow-handled medicine spoon to do the same thing.

What if I decide to wean my baby from the breast?

If you've decided to wean your baby, or to nurse only before and after work, you deserve congratulations and support for having given your baby weeks or months of breast milk. Just be sure that your baby gets the same one-on-one, physically nurturing and affectionate time with you during bottle-feeding that she did with breastfeeding. For more information on easing this transition, see our article on how to wean your baby.

See more on breastfeeding and the working mom.

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Introducing your breastfed baby to the bottle or cup | BabyCenter

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Most lactation experts suggest waiting until your baby is at least a month old and breastfeeding is well established before introducing a bottle. If you're returning to work, start bottle-feeding at least two weeks before your start date so you both have time to adjust.

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Nighttime Breastfeeding

One of the most difficult aspects of caring for a newborn baby is the sleep deprivation that comes with it. Each night feed just seems to roll into the next.

As you start each day feeling as though you've barely slept a wink, you might start to question the wisdom of breastfeeding. The truth is, though, no matter how your baby is fed, nighttime feeds can be exhausting.

Understanding why nighttime breastfeeding is important for your baby and your milk supply can help you cope better with the lack of sleep.

Here are 7 reasons why nighttime breastfeeding is so important.

#1: Babies Have Tiny Tummies

A newborn's tummy is tiny. At birth, it has the capacity to hold up to about 20mL of fluid, and gradually increases after that. Also, breastmilk empties from the stomach within about an hour.

For some newborns a pattern of feeding every one to two hours is common, and well within the wide range of normal. The good news is that frequent breastfeeds (and therefore milk removal) in the early days and weeks help to maximise your milk-producing capability later on.

#2: Nighttime Breastmilk Intake Makes An Important Contribution To Babies' Total Intake

Breastmilk that babies consume through the night makes up an important part of their total 24 hour intake.

Research has shown that most (64%) of breastfed babies between 1-6 months of age feed between one and three times at night (from 10pm to 4am), and that about 20% of their 24 hour intake is from these night feeds.

#3: Breastfeeding At Night Helps Babies Sleep

Circadian rhythms are our internal body clocks. They are regulated by hormones which help us wake up and feel energetic during the day, and enable us to fall asleep easily at night.

Breastmilk contains tryptophan, an amino acid used by the body to make melatonin. Melatonin is a hormone that helps induce and regulate sleep. Tryptophan levels in breastmilk rise and fall according to maternal circadian rhythms. Breastfeeding can help develop babies' circadian rhythms, and help them to settle to sleep better at night.

#4: Babies' Circadian Rhythms Are Still Developing

While breastfeeding might help establish a baby's circadian rhythm, research has shown that the rhythm isn't usually established until after 2 months of age. Therefore, it's only after this time that your baby will have any significant physiological hormonal influence helping her body to know whether it's daytime or nighttime.

So, regardless of whether babies are breastfed or formula fed, sleeping longer stretches at nighttime is a developmental milestone that all babies reach at a different rate.

#5: Nighttime Breastfeeding Is Necessary For Lactational Amenorrhea

LAM, or the Lactational Amenorrhea Method, is a form of birth control that is 98% effective if used correctly. If your baby is younger than 6 months, and is being exclusively breastfed (day and night), and if your menstrual cycle hasn't returned, you can use LAM as birth control. It's not uncommon for mothers to find their menstrual cycle returns when they cease (or significantly reduce) nighttime breastfeeding.

It's possible to fall pregnant using most forms of birth control, even if the risk is small. If you're strongly against falling pregnant too soon, you might like to consider using additional forms of birth control, for example, condoms. Here are some things to think about if you're considering using the pill.

#6: Breastfeeding Is Protective Against SIDS

Perhaps one of the most important reasons for nighttime breastfeeding might be to help reduce the risk of sudden, unexplained death in infancy (SIDS). It might be that infant arousals are an important mechanism for survival, and these arousals are more frequent for breastfeeding babies.

Since breastfeeding is the normal way to feed babies, it should be the benchmark, or the control, with which other forms of infant feeding are compared. From this point of view, while breastfeeding doesn't reduce the risk of SIDS, formula feeding increases it.

Australia's leading health organisation, the National Health and Medical Research Council, indicates that not breastfeeding increases the risk of SIDS by 56%. Putting this into perspective, in Australia, the risk of SIDS is currently around 1 in 3000 births. Therefore, if all babies were formula fed, the 56% increase in SIDS would then mean that the risk of SIDS would increase to around 3 in 6000 births.

#7: Breastfeeding Mothers Actually Get More Sleep

Research shows that mixed feeding or formula-feeding reduces a mother's total sleep time, and increases the time it takes to go to sleep, when compared with exclusive breastfeeding.

Other research has shown that mothers who exclusively breastfeed get 40-45 minutes more sleep than mothers whose babies are given formula. While 40-45 minutes might not seem like much, it can make a big difference to women dealing with sleep deprivation.

...

Sleeping through the night is a developmental milestone for your baby, and is unrelated to how your baby is fed. In the meantime, embrace breastfeeding your baby at nighttime, knowing there are many good reasons for doing so. Before you know it your baby will be all grown up, and you might find that you miss those cuddly, peaceful nighttime feeds.

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Nighttime Breastfeeding - 7 Reasons Why It's So Important | BellyBelly

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One of the most difficult aspects of caring for a newborn baby is the sleep deprivation that comes with it. Each night feed just seems to roll into the next. As you start each day feeling as though you've barely slept a wink, you might start to question the wisdom of breastfeeding.

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Most expectant fathers know that breastfeeding is the best way to feed a baby. Breast milk contains the perfect blend of nutrients and provides babies with a wide range of health benefits. Plus, breastfeeding is free, requires no preparation or cleanup, and is a great way for a mother to bond with her baby.

But a lot of new fathers find that their feelings about breastfeeding change after the baby comes. It's not that dads don't support breastfeeding and its benefits - it's just that the whole experience makes them feel a little left out.

Coping with feelings of inadequacy

"Breastfeeding continues the exclusive relationship the mother and infant experienced during pregnancy," says Pamela Jordan, an associate professor in the Department of Family and Child Nursing at the University of Washington. (Jordan is one of the few researchers to explore the effects of breastfeeding on men.) For dads of breastfed babies, it's common to feel some or all of the following:

Worry that you'll have a harder time bonding and developing a relationship with your baby than your partner will

A sense of inadequacy, thinking that nothing you do for your child could ever compare to your partner's contribution

Resentment of the baby who has physically "come between" you and your partner

Belief that because women breastfeed, they have knowledge and skills that automatically make them better parents

Five ways to make breastfeeding better for everyone

There's no doubt about it: Feeding is one of the most important aspects of caring for an infant. And that means that if your partner is breastfeeding, you may be at a bit of a disadvantage.

But you don't have to back off just because she's got the food supply taken care of. Studies show that the more supportive their partners are, the longer women breastfeed and the more confident they feel about their ability to do so.

So while it may sound strange, dads have a very important role to play in breastfeeding. Here are a few specific ways you can help:

Be supportive and thoughtful. Breastfeeding is hard work, so take on your partner's chores and help out whenever you can. When she's breastfeeding, bring her a pillow or a glass of water, or offer to burp your baby when he's done eating.

Make sure to get a lot of skin-to-skin contact with your baby. Cuddling, bathing, and reading in a chair while your baby naps on your chest are all great relationship builders. And they'll give you and your little one a chance to bond in similar ways to the physical closeness breastfeeding brings.

Spend plenty of time just hanging out with your baby. Take him for walks in the stroller, put him in a sling or carrier and go grocery shopping, or play on the floor together. This will give you and your baby a chance to be alone, and the more this happens, the more confident you'll feel about your own abilities as a parent.

Bottle-feed your baby with breast milk. If expressing milk manually or with a pump works for Mom, you can introduce your baby to a bottle and start taking over at feeding times. (Before you start bottle-feeding, wait until your baby is at least 4 weeks old so that breastfeeding is well established. You want to give your baby a chance to get completely comfortable with nursing on a real breast first.)

Try not to take it personally if your baby seems less than interested in taking a bottle from you at first. Plastic nipples, like real ones, come in all shapes and sizes. So you may have to do a little experimenting before you and your baby discover the kind he likes best.

Be patient if your partner seems less interested in sex. She may feel all "touched out" from nursing your baby, and because nursing women have lower amounts of estrogen, she may have less vaginal lubrication. This can cause uncomfortable or painful intercourse. So instead of assuming that your partner isn't aroused by you anymore, stock up on a good water-based lubricant for when she is in the mood.

Armin A. Brott is the father of three daughters and the author of the best-selling books The Expectant Father: Facts, Tips, and Advice for Dads-to-Be, The New Father: A Dad's Guide to the First Year, and Fathering Your Toddler: A Guide to the Second and Third Years. He also has a popular DVD, Toolbox for New Dads.

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Most expectant fathers know that breastfeeding is the best way to feed a baby. Breast milk contains the perfect blend of nutrients and provides babies with a wide range of health benefits. Plus, breastfeeding is free, requires no preparation or cleanup, and is a great way for a mother to bond with her baby.

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Having a drink while breastfeeding

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Breastfeeding mothers often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.

La Leche League's The Womanly Art Of Breastfeeding (p. 328) says:

"The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful."

If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk-ejection reflex in the mother. Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected.

Dr. Jack Newman MD, FRCPC and Thomas W. Hale, R.Ph. Ph.D, are both members of La Leche League International's Health Advisory Council. They believe that a mother can drink some alcohol and continue breastfeeding as she normally does.

Dr. Jack Newman, says this in his handout "More Breastfeeding Myths":

"Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers."

Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers' Milk (17th ed.):

"Alcohol transfers into human milk readily, with an average plasma/ milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight (1). Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2 - 3 hours after drinking alcohol. Heavy drinkers should wait longer.

In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less (2). Compensatory increases in intake were then observed during the 8 - 16 hours after exposure when mothers refrained from drinking.

Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed."

References:

Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973; 115(6):817-821.

Mennella JA. Regulation of milk intake after exposure to alcohol in mothers' milk. Alcohol Clin Exp Res 2001; 25(4):590-593.

Important Considerations

Your baby's age

A newborn has an immature liver, and will be more affected by alcohol

Up until around three months of age, infants metabolize alcohol at about half the rate of adults

An older baby can metabolize alcohol more quickly than a young infant

Your weight

A person's size has an impact on how quickly they metabolize alcohol

A heavier person can metabolize alcohol more quickly than a lighter person

Amount of alcohol

The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed

The more alcohol consumed, the longer it takes to clear the body

Will you be eating
An alcoholic drink consumed with food decreases absorption.

Can drinking an alcoholic beverage help me relax and stimulate milk production?

Alcohol consumption has not been shown to stimulate milk production. Studies have found that babies nurse more frequently, but consume less milk in the 3-4 hours after an alcoholic beverage is consumed.

Do I have to pump and dump after drinking an alcoholic beverage?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not "trapped" in breastmilk (it returns to the bloodstream as mother's blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.

What if I get drunk?

Mothers who are intoxicated should not breastfeed until they are completely sober, at which time most of the alcohol will have left the mother's blood. Drinking to the point of intoxication, or binge drinking, by breastfeeding mothers has not been adequately studied. Since all of the risks are not understood, drinking to the point of intoxication is not advised.

Can alcohol abuse affect a breastfed baby?

Yes. Alcohol abuse (excessive drinking) by the mother can result in slow weight gain or failure to thrive in her baby. The let-down of a mother who abuses alcohol may be affected by her alcohol consumption, and she may not breastfeed enough. The baby may sleep excessively, or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is drinking alcohol excessively, contact your healthcare professional.

Weighing the Risks and Benefits

Many mothers find themselves in a situation where they may want to drink. Maybe you are going to an event where wine will be served. Or perhaps you are going out with friends, or on a date. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

Plan Ahead

If you want to drink, but are concerned about the effect on your baby, you can store some expressed breastmilk for the occasion

You can choose to wait for the alcohol to clear your system before nursing

If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express

Alternatives
If you're concerned about consuming alcohol while breastfeeding you might prefer to stick to non-alcoholic drinks instead.

If you are sober enough to drive you should be sober enough to breastfeed.
LLL France Article LLL Greece Article

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Drinking Alcohol and Breastfeeding | La Leche League International

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Breastfeeding mothers often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.

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Mastitis symptoms usually develop quickly, with signs of inflammation normally appearing in one breast, often alongside feeling like you have flu. It's most common in women who are breastfeeding.

What is mastitis?

Mastitis causes a woman's breast to become swollen, painful, inflamed and it might appear red or darker, depending on skin colour. It usually occurs within the first three months after giving birth (NHS Start for Life, no date).

Mastitis symptoms

Mastitis usually occurs in one breast, but may affect both. Symptoms usually develop quickly and might include:

What causes mastitis?

Mastitis is often caused by excess milk in the breast leading to inflammation of the milk ducts and a disruption of the makeup of the breastmilk or microbiome.

You might get mastitis because:

you have an abundant supply of breastmilk

you are feeding your baby and also expressing as well

your baby is not attached well to the breast, and you need support to find a position that is comfortable for both of you

your baby is missing feeds, or you are delaying feeds, or maybe missing feeding cues (perhaps as a result of using a dummy)

you are weaning from the breast, (it's better to reduce breastfeeds gradually).

the kind of birth you have could also affect the chance of mastitis. This is because both caesarean surgery and the antibiotics received as a result of surgery disrupt the mother's microbiome.

something is putting pressure on the breast or has bruised it; for example, a tight bra or tight clothing, bag strap, seat belt, baby carrier

Using nipple shields has been associated with an increased likelihood of mastitis

In some cases, a large breastmilk supply can cause an imbalance in the breastmilk causing the growth of harmful bacteria. This is called infective mastitis and you might need antibiotics to treat it.

(La Leche League GB, 2023; NHS, 2023; Mitchell et al, 2022)

For some women mastitis recurs every couple of weeks. This could be because:

Previous issues of attachment, position, or supply were not resolved.

Previous infectious mastitis was not resolved with antibiotics.

(Mitchell et al, 2022)

Continuing to breastfeed with mastitis

If you develop mastitis, continuing to breastfeed in response to your babies needs will help improve the symptoms and won't harm your baby. It has previously been thought that extra feeding or expressing was helpful along with breast massage, however there is now evidence this will not help and may make things worse.

(La Leche League, 2023; NHS, 2023; Mitchell et al, 2022)

Mastitis treatment

Mastitis is usually easy to treat, and most women recover well and quickly. Some self-help measures can be helpful, such as:

continuing to breastfeed in response to your baby's needs

getting lots of rest and relaxation

applying cold to the affected area

staying hydrated

using paracetamol or ibuprofen for relief from pain or fever

avoiding tight or restrictive clothes or bras until symptoms improve (see our article about maternity and nursing bras for more tips).

avoid nipple shields unless essential for feeding your baby. If using nipple shields seek support from a breastfeeding counsellor to use them without causing further issues

(NHS, 2023; Mitchell et al, 2022)

Continue with self-help measures, and if the inflammation has not cleared after 12-24 hours, or symptoms worsen (eg a fever and flu-like symptoms), you could see your GP (NHS, 2022).

You might need antibiotics to treat mastitis if there is an infection, however antibiotics will not be helpful if no infection is present. If you're breastfeeding, your GP will be able to prescribe antibiotics that are safe to use while breastfeeding.

You might also need to contact your GP if you:

continue to feel feverish or if your temperature rises above 38.4°C

see pus or blood in your milk

have a cracked nipple that looks infected

(NHS, 2023; Mitchell et al, 2022)

Some women with mastitis or recurrent mastitis can develop a breast abscess - a collection of pus, which might need to be drained surgically (Mitchell et al, 2022).

Preventing mastitis

If you find you have recurring mastitis, it's a good idea to seek breastfeeding support to help make adjustments to your baby's latch and to discuss ways to manage your breastmilk supply. It might also be helpful to check that your baby doesn't have any underlying medical conditions, such as a tongue-tie. Try to take these steps to help prevent mastitis:

If expressing as well as breastfeeding, build up the frequency slowly.

If you have infective mastitis, ask your GP about a breast milk culture to ensure the right antibiotics are being used.

When weaning from the breast, reduce breastfeeds gradually.

This page was last reviewed in July 2023
Further information

We support all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our support line on 0300 330 0700 (open 8am to midnight every day of the year), 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. You can also find more useful articles here.

Best Beginnings  - Bump to Breastfeeding, Chapter 7 'Overcoming Challenges'.

Sarah Oakley's parent-friendly explanation of 'The Mastitis Spectrum'

National Breastfeeding Line (government funded): 0300 100 021.

You might find attending one of our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified Postnatal Practitioner 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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Mastitis: symptoms and treatment | Baby & toddler, Feeding articles & support | NCT

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Mastitis is a painful breast condition. Here we discuss its symptoms, treatment, how to continue breastfeeding with mastitis and how to help prevent it.

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By Kelly Bonyata, BS, IBCLC

Normally the changing fat content of milk doesn't require any thought at all. This is an explanation of how it works, and why it is recommended to allow your baby to finish the first breast before offering the second (instead of switching sides while baby is actively breastfeeding).

The breast only makes one type of milk (which has a relatively high fat content). Because of the mechanics of milk release, the amount of fat in the milk available to baby gradually changes as a feed progresses. As milk is produced in the breast, the fat globules in the milk tend to stick to each other and to the walls of the alveoli (where the milk is made). Between feedings, milk collects in the breasts and gradually moves out toward the nipple, leaving more and more of the fat "stuck" further back in the milk ducts. The more time between milk removal (feeding or expression), the lower the fat content of the milk available to baby at the beginning of the feeding.

Foremilk and hindmilk are not different types of milk-they are only terms that refer to whether we're looking at milk at the start or end of a feeding. The term foremilk refers to the milk at the beginning of a feeding; hindmilk refers to milk at the end of a feeding, which has a higher fat content than the milk at the beginning of that particular feeding. There is no sharp distinction between foremilk and hindmilk- the change is very gradual. Research from Peter Hartmann's group tells us that fat content of the milk is primarily determined by the emptiness of the breast - the less milk in the breast, the higher the fat content.

Once the let-down (or Milk Ejection Reflex/MER) is triggered (by baby's nursing, pumping, etc.), the milk is squeezed down the ducts until it becomes accessible to the baby. Milk production is not faster during letdown - the flow is simply faster. There are several let-downs per feed, although most mothers only sense the first one.

As the breast starts to empty, the fat globules begin to dislodge and move down the ducts (let-down facilitates this process). So the further into the feed, the higher the fat content of the milk, as more and more fat globules are forced out. The end result is that the milk gradually increases in fat as the feeding progresses.

Your breasts don't "flip a switch" at some arbitrary point and start producing hindmilk instead of foremilk. Instead, think of the beginning of a nursing session as being like turning on a hot water faucet.The first water you get out of the tap isn't usually hot, but cold. As the water runs, it gradually gets warmer and warmer and warmer. This is what happens with the fat content in mom's milk - moms's milk gradually increases in fat content until the end of the feeding.

Since fat content is is directly related to the degree of emptiness of the breast, it is possible, depending upon nursing pattern, for fat content to be higher at the beginning of a particular feeding than it is at the end of some other feeding.
Now think about the hot water faucet again. If there is a long period of time before the faucet is used again, then you go through the "cold to hot" process once more, but if you turn the water on fairly soon after it was used then the water is either pretty warm or still hot, depending upon how long it's been since the faucet was last on.This is how it works with mother's milk too - the longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you're starting off with a higher fat content.
As a particular feeding progresses, fat content increases, milk volume and flow decrease, and milk synthesis speeds up. Because every baby varies in the amount of time it takes him to receive his fill of the higher-fat milk at the end of the feeding, it is important not to switch breasts while baby is actively nursing.

More:

Frequently Asked Questions about Milk Production @ KellyMom

How does milk production work? @ KellyMom

Worries About Foremilk and Hindmilk by Nancy Mohrbacher, IBCLC, FILCA

Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch by Anne-Marie Ablett
Many thanks to Paula Yount of Mother-2-Mother.com for the great analogy!
Forceful Let-down (Milk Ejection Reflex) & Oversupply @ KellyMom

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Foremilk and hindmilk - what does this mean? * KellyMom.com

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The breast only makes one type of milk (which has a relatively high fat content). Because of the mechanics of milk release, the amount of fat in the milk available to baby gradually changes as a feed progresses.

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kate.cameron@btinternet.com

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020 8658 7671 at home or

07860 763635 on the mobile

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for getting breastfeeding started

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Relax with laid back feeding

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19 Nov 2015. InZwang - Bevallen presentation. More details (pdf)

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Breastfeeding information and support
07860 763635