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Back to my breastfeeding Information Homepage

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Bitesize videos full of helpful supports on lots of aspects of prematurity

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

Introduction

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

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

First hours

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

Expressing breast milk

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

Holding your baby

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

Your time in hospital

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

Feeding independently

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

Preparing for home

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

First months at home

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

Twins and triplets

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

Bereavement

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

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

Latest

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

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

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Breastfeeding Babies born around 36 weeks

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Breastfeeding Babies born around 36 weeks

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One of the best (and most up-to-date) articles I've read describing the unique issues with babies born at 'late pre-term'.

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A baby born between 34+0 weeks and 36+6 weeks gestation is defined as a late preterm baby. A baby born between 37+0 weeks and 38+6 weeks is defined as an early term baby. The average length of a twin pregnancy is 36+4 weeks. Many twin babies are born between 36 and 38 weeks gestation due to the NICE guidelines.

For babies who are born at this time, establishing breastfeeding can be quite difficult. They are often well enough to remain on the postnatal ward with their mothers , which is great as they do not have to go to special care. But as such they often get treated the same as a full term baby and are left to "demand feed".

The problem is that these babies often do not "demand" enough and prefer to sleep, although I prefer the term "cue-based feeding" or "baby-led feeding". They are often too sleepy for the mother to be able to follow their lead completely. And if they do not feed enough, they get even sleepier and harder to rouse to feed. Also a lot of slightly early babies are not physically strong enough or coordinated enough to fully breastfeed, often until around due date or even a bit after. They have a few sucks, take on a little milk, and then fall asleep before they have had their fill.

This can lead to real problems! Babies can lose weight, or jaundice can set in. Mum's milk supply may not be stimulated enough, or she may lose her hard-earned milk supply if she was pumping in NICU. After a week or two it is decided the babies need supplementing, but the lack of breast milk may mean they need to use formula.

These problems are also experienced by parents of more premature babies as they are often discharged around what would have been 36-37 weeks gestation with minimal breastfeeding support. They are often given the chance to "room in" for a couple of days to practise feeding and looking after their baby or babies full time, and this is often the first time the breastfeeding mother is allowed to follow her babies' lead.

These families need lots of support. They need good quality face-to-face breastfeeding support after discharge. They need to be shown the subtle cues their baby makes to show that they need a feed; stirring, mouth opening, turning head from side to side, and the later cues including stretching, moving arms and legs, trying to bring hand to mouth. Crying and agitation are late cues. (Maria Biancuzzo, Dec2018) They should be encouraged to feed their babies frequently. Dr Tena Fry said in her interview with Maria Biancuzzo: "If a baby's eyes are open they should be offered food". Parents also ned to be supported to understand when their baby is not cueing frequently enough. We would suggest not to let a baby of this gestation go longer than 3 hours from the start of each feed to ensure they have a minimum of 8 feeds in 24 hours.

Parents should also be shown how to ensure the babies are latching on well to feed. And tandem feeding positions can be discussed to help with the intensity of breastfeeding new baby twins. Also breast compressions are a very useful tool to help transfer a bit more milk to the babies during the feed, and to remind them to keep feeding when they get a bit sleepy towards the end of the feed. Sometimes a baby of this gestation may have trouble latching directly on to the breast. Babies who are a little early sometimes latch better and feed more efficiently when using nipple shields. Close attention should be paid to milk weight gain and nappy output if shields are used as they can inhibit milk transfer.

Parents may need support with continuing to pump for top ups if the babies are not ready to fully breastfeed. And they need to be shown how to tell that their baby is developmentally ready and feeding efficiently enough to move away from 3 hourly feeds and on to baby-led, cue-based feeding. The problem is each baby is different. Some will be ready to fully breastfeed at 36 weeks, others at 42 weeks, and everything in between. But mums often continue to supplement and schedule far longer than they need to. We would normally look for each baby to be putting on weight as expected, generally waking themselves for feeds before the 3 hour schedule, and having a good proportion of "active feeding" during a breastfeed. Then if mum is pumping for top ups this can be gradually phased out. They will be safe to move on to baby-led feeding. If parents are using formula to top up this can be gradually phased out. See our guide here

Ideally each family would be guided by somebody highly qualified such as an IBCLC or experienced breastfeeding counsellor. This is a scenario that deserves specialist breastfeeding support in the home on discharge from hospital , to ensure they can maximise the breast milk intake of their babies.

Kathryn Stagg IBCLC 2019

Cue-Based Feeding for Late Preterm Infants: 5 Facts You May Not Know

The Baby Friendly Initiative

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Breastfeeding babies of 36 or 37 weeks gestation

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A baby born between 34+0 weeks and 36+6 weeks gestation is defined as a late preterm baby. A baby born between 37+0 weeks and 38+6 weeks is defined as an early term baby. The average length of a twin pregnancy is 36+4 weeks. Many twin babies are born between 36 and 38 weeks gestation due...

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Babies born just before term may have their own issues.

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Breastfeeding Your Late Preterm Baby - Best Start

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Home / For Parents / Information on caring for a baby? / Breastfeeding Your Late Preterm Baby Booklet in English and 17 other languages for new parents : All they need to know to breastfeed and/or provide breast milk to their late preterm baby.

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Some good images of positioning and attachment, but speak to your health professionals about top-up info tailored to your baby's needs.

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Most small babies take many weeks to develop the skills and strength to effectively breastfeed. This video shows ways you can meet the special challenges of breastfeeding your small baby. About the...

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Good general article on this often useful way to prepare when you know things might be complicated after the birth.

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

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

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

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

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

These include babies:

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

with a cleft lip or palate identified during pregnancy.

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

diagnosed with intrauterine growth restriction.

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

who are twins or triplets.

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

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

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

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

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

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

Always wash your hands before expressing.

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

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

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

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

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

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

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

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

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

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

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

Express each breast twice during each session.

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

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

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

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

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

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

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

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

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Expressing your milk before your baby arrives - ABM

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

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Although this article focuses on antenatal expressing. The 'how-to' guide and pictures would be an excellent resource for anybody expressing colostrum after the birth.

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

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

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

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

The link between diabetes and colostrum harvesting

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

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

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

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

Increased risk of neonatal hypoglycaemia

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

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

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

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

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

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

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

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

Experienced breastfeeding mothers benefit too

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

Colostrum v's formula

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

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

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

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

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

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

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

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

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

When to start colostrum harvesting

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

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

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

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

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

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

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

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

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

Harvesting colostrum

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

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

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

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

Ask for some syringes

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

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

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

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

How to harvest colostrum - antenatal expressing of colostrum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For further details on storing colostrum, please read below.

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

Further guidance on hand expressing

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

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

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

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

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

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

Can I use a breast pump?

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

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

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

Storing colostrum

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

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

How long to store colostrum for

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

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

for up to six months in a freezer

Colours and consistency of colostrum

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

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

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

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

Frequency of colostrum harvesting and the amount required

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

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

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

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

Don't panic!

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

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

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

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

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

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

Tips:

1. Try expressing after a warm bath or shower

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

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

4. Massage your breasts before expressing

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

6. Drink plenty of fluids

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

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

Is it safe to harvest colostrum when taking Metformin?

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

More helpful links:

Research
Importance of early first feed for babies of diabetic mums

Background

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

Methods

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

Findings

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

Interpretation

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

Funding

Australian National Health and Medical Research Council

Prof Della A Forster, PhD

Lisa H Amir, PhD

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

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

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

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

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

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

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Colostrum harvesting * Gestational Diabetes UK

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

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World-class, evidence-based information about twin co-bedding, sleep patterns and parental sleep

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While a vast amount of research has been done concerning the sleep of single babies, much less has focussed on multiples. Here we summarise the research which has been done.

Whilst Sudden Infant Death Syndrome (SIDS) is extremely rare, the rate is two- to four-times higher in twins, compared to singleton babies. This is likely to be because many more twins are born premature and/or at a low birth weight; factors which are associated with increased SIDS risk in all babies.

It is important that parents are aware of how the sleep environment of twins can affect SIDS risk, as well as its effect on babies' sleep, and ease of night-time care.

Twins Trust, a charity focused on twins and multiple births, provide information for sleeping twins and multiples.

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NICE Guidelines for Multiple Pregnancies

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NICE Guidelines for Multiple Pregnancies

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The recommended pathways and options - essential reading.

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About this information | Information for the public | Multiple pregnancy: antenatal care for twin and triplet pregnancies | Guidance | NICE

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Evidence-based recommendations on antenatal care of women with multiple pregnancies (twins and triplets)

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One of the Best Beginnings videos focusing on multiples

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

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

Latest

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

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Follow three mothers as they share their tips on the joys and challenges of feeding twins. Vimeo Video http://www.vimeo.com/11739595 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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A useful browsable list of links

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"Virtually all mothers can breastfeed one or more infants, provided that they have correct information and the support of their family, the health care system, and society at large."

- Bennington, Linda K. " Breastfeeding Multiples: It Can Be Done." Newborn and Infant Nursing Reviews 11.4 (2011): 194-197.

Breastfeeding Triplets from the Milk Meg

Breastfeeding Twins from La Leche League

Karen Kerkhoff Gromada, IBCLC is the author of Mothering Multiples: Breastfeeding and Caring for Twins or More!!! In particular, check out the FAQ, articles & photos.

Now infants can get
all their vitamin D
from their mothers' milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
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Two Pairs and a Trio: Breastfeeding Twins by Allison Berryhill, Tips For Breastfeeding Twins, from Mothering

Mothering Multiples: Breastfeeding & Caring for Twins or More by Karen Kerkhoff Gromada

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If you think you may be having a c-section, read up and get prepared with these helpful suggestions

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KellyMom.com - Breastfeeding and Parenting

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Breastfeeding after a Cesarean Birth - KellyMom.com

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Educate yourself and arrange for breastfeeding help Find a La Leche League group near you! Try to attend at least one meeting before your baby is born. Ask questions! Talk to the lactation consultant (LC)--assuming your hospital has one on staff--and ask that she meet with you as soon as you get out…

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Dealing with visitors when you have twins

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Dealing with visitors when you have twins

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This site is lousy with adverts and affiliate links but this article of quotes from other mums stands out.

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Now that my twins are no longer newborns (5 months), I'm getting a lot of requests for people wanting to visit. This is so nice that everyone wants to meet them, but taking care of 5-month-old twins is still so hard. I find that most of the visitors seem to want to sit down and just hang out and chat like a regular visit. I find myself so stressed out getting ready for people coming over (cleaning, getting snacks and drinks to offer, etc.) and then while they are here I am trying to be polite and give them attention but it's so hard to do while taking care of the babies. Then a couple hours have gone by and I have fallen behind in bottle prep or diaper changes, etc. I love the people who come to help and don't need my attention but those are few and far between. I think it's nice that people want to see the babies, but these visits loom over me. What do I do? Here's what our Twiniversity Fans had to say:
- Make it known that all who enter are put to work. Whether they're just holding a fussy baby or doing diaper duty. And don't worry about prepping for visitors, if they want to visit you and the babies they won't mind the clutter that comes with two new ones. ∼ SHM

- I would let people come over. You need some adult interaction. Most people could care less if you clean house prior to the visit. ∼ JY

- Put. Them. To. Work. No one gets a free visit. Hand them a baby, or a dirty bottle, or a diaper pail that needs changing. There's a price for being in the presence of such cuteness. ∼ DM

- I told visitors their ticket through the door was food (half jokingly). The house was as it was. The people visiting were friends and family, so they weren't exactly "guests". I don't tolerate judgement in my home, so I just didn't welcome anyone who would offer negativity. If I needed help with anything, I would simply ask. ∼ AD

- When we had visitors, they would hold the babies and help feed. While they visited, I would use that chance to wash the dishes or bottles or even go take a shower! Don't feel obligated to have to entertain your visitors or even worry about tidying up. ∼ JHPB

- Don't worry about your house or offering snacks and drinks. If guests don't come with food and expect you to serve them with twins and judge the cleanliness of your house, you probably don't need them around! ∼ LBF

- Be honest with people "I'd love to see you but while you're here I'd love a hand with some jobs too. Would that be okay?" I'm one of the last in my friendship group to have kids and it'll be twins so I understand from both side and trust me. Whenever I went to someone's place I wanted to help however I could, even just holding a baby while someone has a shower. ∼ NC

- I fell into this trap too. Memorize the words: we will let you know when we are ready for company. Or if you are bolder than I am, give them the expectation that they are coming to help.

- There are no guests, only helpers. I have 5 month old twins and if they can't help with chores or the babies, they're not welcome. Everyone's been more than thrilled to bring food, empty a dishwasher, change a diaper or feed a baby. Surround yourself with those that are useful. Everyone else can stay home. ∼ AP

- Do not have company until you are ready. Put a list of chores on the front door. Entry means picking a chore or two (bring meals, mow lawn, run dish washer, fold laundry, etc.) Everyone wants to help but they need to be told what would be helpful. Most of all, rest and heal and enjoy the babies. ∼ DB

- If people want to visit to see the babies don't entertain them with food. I'd say "Come after lunch" or "Come before dinner" and "Don't mind the fact my house looks like a bomb hit it". You have to just stop caring. ∼ PFM

- Limit the number of visitors. Choose 1 or 2 days a week where someone can come visit you, but give them a chore to do for you while they're visiting. ∼ SF

- We did a meet the baby party at my parents when we were ready. That way everyone came saw and the left. Also I have no shame in saying if you are coming over can you take trash out or vacuum or entertain kids so I can shower. In most cases they are there to see the kids so take advantage of a free babysitter and shower or whatever. But at the end of the day if it's stresses u out then it's probably isn't a good time to have visitors. When u stress the babies feel that stress. ∼ CM

- Drop your standards. I don't clean my house for guests at all anymore. Or make snacks. Or even pay attention to what people are saying to me. I just smile and nod and keep changing my diapers and chasing babies and wiping noses. Most are also moms who understand fragmented conversation. ∼ ST

- Sometimes I would offer to bring the babies to visit at their place. Getting out of the house with twin babies is no small task either but the fresh air and change of scenery is a good thing, and then the duration of the visit is kept reasonable. "We better get going, it will soon be nap time." ∼ AG
Related Articles Should I Allow Hospital Visitors After Having Twins? How To Say "Yes, Please" Accepting Help When It Is Offered 5 Tips on How to Survive The First 3 Months With Twins

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How Do I Handle Visitors When I Need to Stick to a Schedule? - Twiniversity

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Now that my twins are no longer newborns (5 months), I'm getting a lot of requests for people wanting to visit. This is so nice that everyone wants to meet them, but taking care of 5-month-old twins is still so hard.

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A straightforward cheerful article

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I'm starting out with some cheerleading because I hear so much negativity about it. Sure, it can be hard work, but it is not some impossible task only for superwomen. My twins breastfed until they were about two and half - and I'm a normal lady (honest). So, here are a few tips on breastfeeding twins. And please do ask if you have further questions 🙂

When your babies are very young, you will need to tandem feed them because they will both want to feed so much of the time. But as they get older, you can go with the flow. Feed them separately or at the same time - whatever works for you.

Starting out breastfeeding twins can be tricky because multiples are more likely to be premature or have other complications. But try not to be too discouraged by a slower start: give yourself lots of time to get the feeding established. If the start involves some bottles or feeding tubes, it does not signal the end of breastfeeding. Think marathon, not sprint.

This is related to my previous point - if you really want to nurse your twins, it is totally valid to put lots of time and effort into it. Sometimes well-meaning people can discourage you from putting in the effort (they think they are preserving your sanity). But if you want to do it, don't let the negativity put you off.

4. Latching gets easier with time

Getting two little babies to latch on properly is difficult at first. But it truly does get easier as you learn, and as your babies learn. If the latch is sore, unlatch and try again. I know, it is tempting to just push on through the pain. After all, it took you twenty minutes to arrange the cushions. But keep in mind that your baby will feed more efficiently with a good latch. And nobody wants cracked nipples. Believe me.

One of my favourite things about breastfeeding twins was knowing that each precious baby was getting lots of cuddles with mama. Having twin newborns was beyond busy, and so often I was overwhelmed and torn in different directions. Was I giving each baby what they needed? It was so reassuring to know that they were both being cuddled and fed a lot.

6. Learn to ignore the staring

Yep, people sometimes look at you as if tandem feeding is some sort of freakshow. But that's ok - you have just made their day a little more interesting. And you know it is just natural for you and your babies. Breastfeeding twins really does become the easier option as the babies continue to grow: no bottles to carry around and clean; instant comfort when they are tired or sad. And it is so cute when they feed and hold hands - sweeeet...

7. You can make enough milk!

Breastfeeding works on a supply and demand basis, so two babies produce enough milk for two babies. But it is so easy for people to knock your confidence about this. If there are issues gaining weight, this is what I suggest: check the babies are latching on as well as possible and give them lots and lots of time feeding for four days solid. But the chances are, you can make enough milk. If you need advice on breastfeeding twins, try www.kellymom.com or a trained lactation consultant. Not just your midwife, your paediatrician, your mom, your best friend, your best friend's mom.... So obviously feel free to ignore me! But I mention it because had so much bad advice from people who were not properly informed about breastfeeding (even medical professionals), and it takes a while to gain the confidence to ignore it.

So, a little bit of cheerleading for you, ladies. Breastfeeding twins can take lots of time and effort, but it is also so so precious, and so so possible.
Supporting breastfeeding mamas is a passion of mine: Are there more questions I can help you with? Do you have more questions about twins (feeding or otherwise)? Please ask! Leave me a comment below, or email me directly at [email protected] You might also like: How to potty train twins with no stress whatsoever It's twins! Do you need two of everything? or perhaps Not all nipple creams are created equal

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Breastfeeding twins - 7 helpful tips - What Mama Knows

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I'm starting out with some cheerleading because I hear so much negativity about it. Sure, it can be hard work, but it is not some impossible task only for superwomen. My twins breastfed until they were about two and half - and I'm a normal lady (honest).

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Another useful article with some positive quotes, links and suggestions

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Birth Boot Camp® Amazing Childbirth Education Classes

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Breastfeeding your baby is one of life's most precious relationships. While we place a lot of emphasis on the birth (especially since birth can impact the breastfeeding relationship), no doubt, breastfeeding is an act that will take far longer and have lasting health impact for both the mother and her baby.

Breastfeeding is particularly important for babies and women who experience cesarean birth. Breastfeeding provides closeness, bonding, infant nourishment, and a hormonal cocktail that benefits both mom and baby.

Here are some tips and information about breastfeeding after cesarean. In fact, this information is beneficial to any mom and any baby, no matter how they birth! Breastfeeding is incredible!

Advocate for Skin to Skin Contact

Skin to skin contact is known to help facilitate breastfeeding. We love the idea that being on mama's chest is the "natural habitat" for the newborn human infant. Truly, this is their happy place and where they want to be. This is true immediately after the birth and for months afterwards.

Skin to skin advice is supported by other experts. Skin to skin helps regulate temperature, blood sugar, and of course, gives easy access to your breasts for a baby that needs to nurse frequently.

Keep Baby Close

One thing that can be a big obstacle to nursing any baby is early separation from their mother, the source of breastmilk. This separation is a problem no matter the mode of delivery, but long separation from baby, often of about four hours, is very common after a cesarean birth.

Advocating for gentle care for you and your baby and a prompt return of your baby, or even better, no separation if possible, is one of the first and most important steps for nursing after cesarean delivery. In fact, helping the mother initiate breastfeeding with 30 minutes after the birth is one of 10 steps to baby friendly care - for ANY birthing woman. There are no exceptions for babies born via cesarean section.

Cameo describes how she was able to have her baby breastfeed soon after birth, despite some common struggles specific to cesarean section birth.

"After my cesarean, I got labor shakes really bad. I wasn't comfortable even holding my baby for fear of dropping her but I wanted to breastfeed her. After about 45 minutes of my mom holding her, I asked for my baby back and a nurse helped me get my daughter in the football hold despite all my shaking. Literally the second she started nursing, all the shakes went away. It was amazing." Cameo Sherman, Birth Doula, Bowie, MD

It is not unusual for a mother to need some help from others in that initial latch, particularly if their hands are not free to hold their baby. Staff, family, or a trained doula can help in this role so that the mom who births via cesarean section can still nurse her baby soon after birth.

Preparation for Breastfeeding is Key

Preparation for breastfeeding is imperative. While it is a natural process, and your baby is born knowing how to suck, it takes work and training for both mom and baby to master the rest of the skills needed for breastfeeding. If you know you are having a cesarean, it can help to know some of the potential barriers that may arise, how your hospital handles cesarean birth and immediate postpartum care, and who can help you postpartum. A more mother-friendly or "gentle" cesarean is a great option, if possible.

Melissa's quote, below, is powerful because it shows how easy it is to be blindsided by the realities of cesarean birth and how lack of support (even when you don't know to ask for it) makes such a big difference.

"I don't think my breastfeeding struggles were directly related to having a cesarean, but more a lack of support and not knowing to ask for help. I was able to nurse as soon as I was out of surgery, but I was so out of it, drugged up, and shaky, it definitely wasn't a special moment for me, and was more awkward and forced than it should have been."

Melissa Kosloski, Childbirth Educator,

Women DO breastfeed after cesarean. It is possible. Caryn, who had three cesarean sections before her two VBAC births, tells an incredible story about how the breastfeeding relationship changed with each of these cesarean births and what she did to help make it more positive.

Caryn says,
"With my third baby, even though he was a planned cesarean, I was bound and determined to get this thing right! He was taken away from me just as the others, but I spent a little more time holding him in the recovery room before he was taken away. I kept calling them until they finally brought him to me. Since it was planned and not late at night, I was a little more awake during our first nursing session. This time it seemed so much different! I did not once give him a bottle while I was in the hospital. In fact, in the 15 months that I went on to breastfeed my third child, he only took a bottle once!"

Caryn Westdyk, Childbirth Educator in Carrollton, TX

Planning and preparation really does make a difference in breastfeeding!

Enlist Partner Support

Support is key for any successful breastfeeding relationship and can come from any direction. The support of your partner is particularly imperative. If mom's partner is offering bottles to the baby, this can be so detrimental to the breastfeeding mother. The words of family, nurses, care providers, and friends are all powerful whether negative or positive. Seek out and embrace those people who show support. This is even more important after cesarean.

Cameo's experience beautifully illustrates this point.
"After my cesarean, I needed a lot of help from others. I had my mom and sister take turns staying with me at the hospital so they could get my baby out of the bassinet and give her to me and put her back in when needed. Once home, that became my husband's job. I also discovered side-lying to be a wonderful way to nurse at night so I could get rest without her laying on my incision." Cameo Sherman, Birth Doula, Bowie, MD

Cameo got help before she even left the hospital and continued to have this support even after she returned home. Oh, how things would be different if every woman had this kind of help breastfeeding after cesarean!

Co-Sleeping Can Be Helpful

Sleeping near your baby is something that many women find helpful for breastfeeding. Having to wake frequently throughout the night, march down a hallway, and nurse your baby, wakes everybody up and often results in a baby that is upset by the time you get to them.

This is even more true in the early days of recovery after a cesarean section. Though a common way to give birth, it is a serious abdominal surgery that requires healing and rest. If being closer to your baby helps your breastfeeding relationship, consider it! Melissa says:

"I co-slept initially out of necessity. My husband deployed when our oldest was a week old. Getting up multiple times a night to get baby out of the pack n' play was really tough while trying to recover from surgery. Having him laying next to me made night nursing feasible! Bed share, get a co-sleeper, or sidecar a crib to make your life easier!"

This post has some great tips for co-sleeping safely.

Find Your Own Success!

When you talk to hundreds of women who have breastfed their babies, you find that the definition of "successful breastfeeding" is not universal. Everyone has different experiences. For one woman successful breastfeeding may mean exclusive breastfeeding until six months and a nursing relationship that extends to two years.

We have seen women struggling with insufficient glandular tissue (IGT) who work incredibly hard to keep their babies at the breast but simply must supplement with something besides their own breastmilk in order for their baby to grow healthy and strong.

This quote from Ebon'nae Piggee after her unplanned, emergency cesarean is so beautiful and shows how successful she was and how hard she worked to breastfeed her baby.

"I had always heard the phrase "breast is best", so I KNEW I wanted to breastfeed my baby. Yet, after an induction gone wrong; I ended up being rushed into the OR for an emergency Cesarean. With it being my first pregnancy, I didn't research nor consider having a Cesarean. I had no defenses nor preparation for the pain, hormonal delays, and emotional disarray my body or my baby would be up against after the surgery. I woke up after surgery wanting to nurse my child, but having NO clue and NO support (besides an unsure nurse) through the process.

I did the best I knew how with the little info I'd read online to latch my baby on my breast, but after a day or so he seemed to reject the breast completely. Unfortunately, he'd been receiving bottles of formula in the hospital nursery. I was not prepared for the pain of a Cesarean. I couldn't stand and It hurt to laugh. I blew up like a marshmallow man, from all the fluid retention. Every time I'd put my baby to my breast he would scream and cry and so would I. I felt so guilty that I didn't have a seamless breastfeeding experience, but still I went on to pump for about six months."

Ebon'Nae Piggee, Childbirth Educator, Desoto, TX

Ebon'Nae is an example of nursing success against the odds. She was still able to give her baby the gift of breastmilk. Successful breastfeeding looks different to every woman. Set your own goals. Get the help you need. And know that your best is more than enough- it is amazing.

Breastfeeding After Cesarean is Empowering

Women experience cesarean birth for a variety of different reasons. For some it is planned and wanted. For others it is a traumatic experience that took them by surprise.

No matter your birth, breastfeeding can be incredibly empowering. It shows us the miraculous things that our bodies can do- not only can we grow a human within ourselves, we can grown them outside of us too! There is something awe inspiring about watching a baby double and triple in size while being fed only milk from mother.

Lauren, who experienced a planned home birth turned to cesarean describes this perfectly.

"I felt like everything was out of my control, ending up with a cesarean. Breastfeeding felt powerful and calm. In that moment there was still something I could do for my cesarean baby, right here, right now. Breastfeeding was something I could plan to do regardless of how the birth went. Breastfeeding returned me to my mother power in the face of sterilized and medical birth."

Lauren McClain, Childbirth Educator, Bowie, MD

Breastfeeding after cesarean is possible and often a healing experience.

Build your support network, seek for help, decide what makes the relationship successful for you, and re-discover the empowerment that is possible after birth.

You can have an amazing breastfeeding experience after cesarean!
Photo credit: remysharp / Foter / CC BY-SA, Photo credit: Marie in NC / Foter / CC BY, Photo credit: Kelly Sue / Foter / CC BY-SA

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Breastfeeding After Cesarean - Birth Boot Camp® Amazing Childbirth Education Classes

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Breastfeeding your baby is one of life's most precious relationships. While we place a lot of emphasis on the birth (especially since birth can impact the breastfeeding relationship), no doubt, breastfeeding is an act that will take far longer and have lasting health impact for both the mother and her baby.

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Breastfeeding Twins - One Mum's perspective

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Breastfeeding Twins - One Mum's perspective

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Realistic and positive

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If you're expecting twins (or more), you may be asking yourself if it's even possible to nurse two babies. Well - It is. Harder? Perhaps so. Possible? Absolutely. Breastfeeding twins is something you can do.

I breastfed my own twin boys until the age of one and here is my take on the ups and downs I experienced throughout that year, as well as how I managed to do it.

Your Pediatrician will tell you that breastfed babies experience fewer respiratory infections, ear infections and bouts of constipation. Breastfeeding is linked to higher IQ scores. It's thought to lower obesity, diabetes and certain cancers. I could probably write an entire post on all the benefits to mom and baby, but you can look that stuff up online elsewhere. You don't need to hear it from me. The bottom line is its good stuff.

The Good, The Bad & The Ugly of Breastfeeding Twins

To reiterate what I said above, it CAN be done. Of course there are certain medical reasons some women are unable to breastfeed. Those things aside, you can do it.

This small fact in itself was enough to help get me started after the birth of my twins. Unfortunately, despite knowing that it was possible, the expressions on my Nurses faces told me it wasn't necessarily the norm for twin Mama's to actually find success with breastfeeding.

But I showed them, and now I have bragging rights for life.

Will I have enough milk?

If there's a demand, your body will produce it.

If you are worried about it, don't be. If you are really worried about it, pump. After you finish a nursing session, try to express some milk to build some extra stored milk. I unfortunately was not one of those women who gushes milk all over the place. I never had a freezer full of milk. I had just enough. But I did pump from time to time. I also didn't get hung up about offering a bottle or two of formula. If you are stressing about it, offer a bottle, and pump. It is better to stay relaxed than to agonize over some formula. Your milk supply will thank you. A stress free mom is a milk full mom.

If you do become engorged with milk in the beginning, get that stuff bagged up. It is your ticket to freedom. Pat yourself on the back for being a milk goddess. Not all are so lucky. I wasn't.

It sucks. Well, in the beginning at least. Think about how often a newborn eats.

1. Every Two Hours

2. Every Hour

3. Every Twenty Minutes

The answer is all of the above are possible scenarios.

A newborn baby does exactly three things. They eat, they poop, and they sleep. Breast milk is more easily digested by the body, which is why a breastfed baby is more likely to want to eat more often. Depending on the personality of your newborn, they may also want to nurse for comfort. This isn't typically a concern, except when you have another hungry baby waiting on the sidelines.

YOU WILL BE A FEEDING MACHINE

For the first two weeks it is almost essential that you have a support person with you. You are in pain from the birth, and there are two helpless babies to tend to. For me that person was my husband. During those early weeks we worked in an assembly line. A baby would wake and he would change them, and then place them on my lap to nurse. If the other woke while I was still busy with the first, he would change him and hold him until I was ready to switch.

Since I experienced latch on issues with one of the twins, I was a sweaty stressed out mess by the end of his nursing session, but would have to turn around and begin anew with his brother on the other side.

We all slept in the living room. My husband on the floor, I on the couch and the babies in a pack and play next to the sofa. In fact, I don't believe I left the living room at all during those first two weeks, or maybe it was the first two months, except to use the bathroom on occasion.

One at a Time

In the beginning when you're trying to learn how to breastfeed, it is awkward and uncomfortable, and latching one child, let alone two is a daunting task. That is why for myself, I nursed one at a time for the first 4 weeks. So the question is, where and what do you do with your second baby while you are nursing the first?

In an ideal world, one of your babies will either be asleep or have an easier disposition and will be willing to wait the fifteen or twenty minutes it takes for you to nurse their sibling. If not, bouncer seats will become your new best friend.

After my husband's leave was over and he returned to work, I would position a seat in front of me on the floor, and lightly bounce one child in it with my foot while nursing the other. I would sing, make goofy faces or just carry on a one sided conversation with the bouncing twin, until it was time to switch. Most often the nursed baby would be asleep by the end of their nursing session and could be transitioned to the crib for the duration of the second baby's turn.

Several times a day, I would attempt to latch them both on together. It took some time for the three of us to master it. There were a whole lot of frustrated tears. It wasn't easy, but I didn't give up. I knew that my key to success would be learning this skill. If I couldn't, failure would be more likely. Nursing them individually equated to being held prisoner by my couch. If I ever wanted to sleep, I needed to learn to nurse them together. About a month in, we finally managed it, and it was a glorious day.

The Logistics of Nursing Two

Just as with breastfeeding one baby, with two it is critical to find a nursing pillow that you are comfortable with. For me that was the EZ2 Nurse Twin Nursing Pillow. I also heavily utilized Boppy Pillows, but only as a positioning device, not to nurse.

Sitting on the couch I'd place a boppy pillow on either side of me, and then the Twin Nursing Pillow on my lap. I would place each baby in a boppy pillow next to me and then pick one up, latch him in place on the same side as the child still sitting in their boppy, and then pick up the other to be latched on. It is done in this way so the first baby will not unlatch when you reach over to pick up the second baby. You are also able to keep them securely in place, and prevent them from rolling away from you. Once a child finished nursing I'd slide him back over into his boppy pillow, or bouncer seat, until the other was done.

Once the babies learned to roll, I'd transition the finished baby onto a waiting bouncer seat in front of me, and bounce them with my foot if needed until their brother finished up.

Exactly That. You may want to hide all your mirrors for a while because sleep will only exist in fairy tales my friend.

Round the clock feedings that only you can provide

Sore nipples

Pumping Sessions (if you experience latch on issues with a twin as I did)

It's exhausting, difficult work. But rarely do things that are worthwhile or meaningful come easily. With that being said, I acknowledge that it isn't for everyone. Despite their best efforts, many women experience obstacles that they are unable to overcome, and no woman should ever feel guilt if in the end it doesn't end up being right for you.

Your Very Best

My goal here is to share my own experiences and help those who may not have expected breastfeeding to be a challenge. Oftentimes we are led to believe that if it doesn't come naturally, we are failing in some way. Hopefully, it will be a snap for you, in which case you are supremely fortunate, but most likely not reading this. I myself experienced struggles.

By sticking out the early weeks, I was rewarded with so many beautiful moments as the months went by. With their faces pressed close together in the night, my boys would both fall asleep on the nursing pillow holding hands. The closeness I experienced with my babies was something indescribable.

If you are just beginning your breastfeeding journey, keep up the good fight, because the rewards will come in time, and you will be so grateful you stuck it out. Remember, even a few days of breastfeeding is beneficial to your babies, and all each of us can do is our very best. I hope I have inspired you to reach for yours.

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An Inside Scoop on Breastfeeding Twins - Debt Free Dana

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If you're expecting twins (or more), you may be asking yourself if it's even possible to nurse two babies. Well - It is. Harder? Perhaps so. Possible? Absolutely. Breastfeeding twins is something you can do.

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Breastfeeding Twins when Mum is home alone

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Breastfeeding Twins when Mum is home alone

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How do you make it work without a helping hand?

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When I was pregnant with twins, I knew I wanted to breastfeed them but I wasn't sure how it would work logistically. Where would all those limbs go? How would I hold them? Keep them still? Burp them? What about when one needs a diaper change and the other wants to eat? I knew there would be help in the hospital, but once I took my bundles home, what would I do all alone with them? And is breastfeeding twins unassisted even possible?

If you're expecting twins or just recently brought home a pair of squirming babes, you might be feeling a tad...overwhelmed. The first thing I want to say to you is, take heart! You can do it! Breastfeeding will get easier, and you'll all learn as your little ones grow and change. Don't give up now. The second thing I want to say to you is that there is no "one-size-fits-all" approach. Just because your lactation consultant loves the football hold doesn't mean you have to. And just because your friend who has twins recommends pumping and bottle feeding doesn't mean that's what you should do. You will find the system/approach/position that works best for you and your little ones.

Immediately After Giving Birth...

I highly recommend reading breastfeeding books by La Leche League prior to giving birth. Or even better yet, join a multiples group with La Leche. This book provides descriptions and photos of different breastfeeding positions for twins. A group of other mothers of multiples will provide a wealth of encouragement and advice. Also, take advantage of the hospital's lactation consultant or your midwife's expertise soon after giving birth. Have her help you find a position or two that are comfortable for you. As your little ones grow, you may experiment with new positions.

As You Settle Into a Routine at Home...

Some mothers have the benefit of a husband or other family member who shares nighttime feeding responsibilities, but other mothers are on their own. (See more tips on breastfeeding twins.) For moms of multiples, the awkwardness of feeding two at once can become a jumble of arms, legs, wails, and squirting milk. I was advised from the start to always feed my twins together, especially at nighttime. In theory, it made sense: limit my waking time and get the two of them on the same schedule. So, I tried. But I found what sounded good in theory didn't work in practice for me. My boys' needs were so distinct from each other. One could sleep far longer and deeper than the other, so there was no sense waking him for four nighttime feedings when he could thrive with just two. One had medical complications and was hooked up to various machinery day and night for months, so maneuvering with all his cords and alarms on the rocking chair was enough for me to handle without adding another baby into the mix. And when one was finished eating, I never seemed to figure out how to lift him to my shoulder for burping without detaching the other.

Maybe you will figure out a system that works great for tandem feeding, but for me we did nighttime feedings individually. During the day, I usually fed one at a time just because I liked the one-on-one snuggle time. But at other times, we were in a hurry to get out the door, or I needed them to eat quickly in the car at a rest stop or in a dressing room at the mall. In these instances, I would feed them together in the cradle hold.

I also fed them simultaneously if they both woke in the morning at the same time. By this time my husband was gone for the day, so I wasn't worried about waking him, and we were all too tired to get up for the day yet. We would often do a side-lying position in bed and then all drift off together for an extra 45 minutes of sleep before rising for the day. Here are some examples of positions for breastfeeding twins.

Is Breastfeeding Twins Unassisted Worth It?

You might be wondering if this all sounds too complicated - if it's worth the effort. It is!!! I was so sad to finally wean my twins. We all loved breastfeeding. In the busyness of raising two at once, the special cuddle time of breastfeeding skin-to-skin can't be imitated or replaced by any other activity. Like learning to drive, what seems difficult, overwhelming, and complicated eventually becomes second nature. Find your "bread and butter" position and then experiment with new ones. Eventually you will find yourself in the position of offering advice to other twin moms and encouraging them in breastfeeding twins unassisted!

What position works best for you for breastfeeding twins unassisted?

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Breastfeeding Twins Unassisted: What to Do When You Are All Alone

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When I was pregnant with twins, I knew I wanted to breastfeed them but I wasn't sure how it would work logistically. Where would all those limbs go? How would I hold them? Keep them still? Burp them? What about when one needs a diaper change and the other wants to eat?