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Breastfeeding - a good start

Breastfeeding is a skill that you and your baby learn

Newborn babies have instincts that help them to breastfeed and mothers have instincts too – but many of us have seen more bottle-feeding than breastfeeding and feel uncertain what to do. ‘I thought I’d be able to do it – no problem – but it was hard at the beginning. I’m glad I kept on because it got a lot easier and there’s nothing like feeding a hungry baby yourself and watching her grow bigger. It’s just so satisfying.’

Contents

Why your choice to breastfeed matters

...for babies

  • Breastmilk is a living fluid and every mother’s milk is tailor-made for her own baby. It contains many ingredients which help a baby stay healthy, such as antibodies to fight germs, hormones and factors that help your baby’s development.
  • Compared to breastfed babies, babies who are given formula milk are much more likely to have ear or urine infections or to get a stomach bug or chest infection that may mean going to hospital.
  • Babies who are breastfed are less likely to become overweight children.
  • If your family has allergies, your baby is more likely to get eczema or a wheezy chest if you formula feed.
  • Fewer babies who are breastfed get diabetes in childhood.
  • Premature babies who receive breastmilk have a lower risk of necrotizing enterocolitis (a potentially fatal bowel disorder).

...for mothers

  • Breastfeeding helps reduce the risk of developing certain types of ovarian and breast cancer.
  • In old age, mothers who have breastfed have a lower risk of hip fractures and diabetes.
  • Breastfeeding helps your uterus return to its normal size after birth.

...for everyone

  • Breastfeeding does not have an impact on the environment.

How breastfeeding works

One of the first signs of pregnancy is heavier, more sensitive breasts and, as your baby grows in the womb, your breasts begin preparing for the birth. Colostrum, the special early milk, is there from about halfway through the pregnancy and for the first few days after your baby’s birth.

Soon after your baby is born, pregnancy hormones fall and levels of the milk-producing hormone, prolactin, rise in your body. Your milk ‘comes in’ after the first few days when the colostrum changes to form milk.

The let-down reflex – making milk available

When your baby starts sucking, the hormone oxytocin is released, causing the muscle cells around your milk glands to contract and squeeze out breastmilk. This ‘squeezing’ is known as the let-down reflex.

Milk changes as the feed progresses

Even before this reflex occurs, some milk is waiting for your baby. This is called foremilk and is thirst-quenching.

The milk that comes with the let-down reflex is called hindmilk and has more fat, and therefore more calories, satisfying your baby’s hunger.

Your let-down reflex must be stimulated for the milk supply to build up, but don’t worry if you don’t notice it happening. After a while, baby and breast are working in harmony, with your milk supply matching his needs.

It’s that simple!

What’s in breastmilk?

Colostrum

An amazingly rich mixture of proteins, vitamins and anti-infective agents that helps a newborn through the first few days of life. It’s small in quantity, but very high in quality – just what your baby needs.

Mature milk

A few days after your baby’s birth, the colostrum becomes mature milk with its perfect balance of proteins, carbohydrates, fats, vitamins and minerals.

Both colostrum and breastmilk contain many special factors to help:

  • absorb nutrients
  • prevent infections
  • your baby’s gut to develop and
  • her immune system to mature.

Let your baby stay on one breast, until she lets you know by coming off, or stopping sucking, that she’s finished.

Then you can offer her your other breast, unless you’re sure she’s already full.

What you will need

  • At least 2-3 nursing bras – even if you don’t usually wear a bra, you’ll probably feel more comfortable wearing one while breastfeeding. Wait until you are about 36 weeks pregnant before getting yourself measured. The NCT has bra agents who can measure you and help you choose the most suitable bra. You can contact an agent by phoning the NCT on 0300 33 00 770.
  • The NCT Sales catalogue has a range of bras worth trying. You can get a free catalogue by phoning 0845 8100 100 or order from the website at www.nctshop.co.uk.
  • A pack of six washable breast pads – not essential, but if you find you leak at first (and some women do) breast pads absorb the milk. You can use cotton handkerchiefs instead, folded up.
  • Plenty of loose tops to wear – this makes feeding easier, as you can lift up your top and feed your baby without anything much showing.

Straight after birth

Your baby’s instincts to breastfeed are particularly strong after the birth. Cuddling your baby on your chest in unhurried skin-to-skin contact can help you both to start breastfeeding.

  • If you give birth in an upright position – standing, kneeling or crouching – you can reach down and gather your baby in your arms. A baby born naturally can then find and attach herself to your breast within the first hour or she can be guided. See "Positions for labour and birth" for more information.
  • You may have given birth lying down or lying on your side. The midwife will normally pass your baby to you after the birth. There is no need for babies to be washed straightaway if there are no problems. Your baby can be weighed (preferably on her front) straight after the birth or after the first feed to avoid interrupting skin contact.

You may both want to watch and wait for a while, cuddling skin-to-skin, but after a while your baby may make hand movements and then start ‘rooting’ (turning toward your nipple and opening her mouth). You may like to help her find your nipple.

  • After a caesarean, your midwife can still help you have skin-to-skin contact and then a breastfeed.

Many babies are ready to feed in the first hour but not all are. If you had painkillers, such as pethidine or an epidural, during labour your baby may be more sleepy and unsure of what to do.

If you cuddle your baby or keep her close to you, you will know when she seems interested in feeding. In the first day or two, some babies only feed occasionally while others want to feed frequently. A good feed at this time may only be equal to a couple of teaspoonfuls of colostrum.

Breastfeeding helps your uterus to return quickly to its pre-pregnancy size. You may feel this as ‘afterpains’ for a while during feeds. Trying to relax can help.

Starting a feed

  • It may be helpful to gather useful items together before you start a feed, such as a drink for you, tissues or muslin squares, breastfeeding leaflet....
  • Being comfortable helps. If you prefer to sit up straight, you might like to use some firm pillows behind your back for support, under your arms to take the weight of your baby, or across your lap to lift the baby to breast height. (You won’t always need them but they may help in the early days.)
  • Some mothers prefer a reclining position with the baby supported by the mother’s body and often a baby will then attach herself.
  • You can lie down if you prefer or have the baby under your arm.
  • Your baby will feed better if she is calm. Holding her against you, talking to her or perhaps wrapping her securely in a towel or shawl may help if she needs to be calmed. Later she may want to have her hands free to touch and stroke your breast.
  • It helps to hold your baby really close, her whole body towards you, her back and head in a straight line. If you line up her nose so that it’s level with your nipple, she will have to tilt her head back slightly when she latches on so as to get a good mouthful.
  • Your baby prefers to be able to move her head freely. She also needs to open her mouth really wide to attach well.

Attaching (latching on)
 
 
 

  • If you wish, support your breast gently from below, using the flat of your hand. It is important not to press or squeeze the delicate breast tissue as this could cause bruising or a blocked milk duct.
  • If your baby is not already rooting for your breast, you can touch her lips with your nipple. Wait for her to open her mouth as wide as a yawn. Her mouth needs to be open wide enough to take in both your nipple and plenty of breast.
  • As soon as your baby’s jaw drops and her mouth is opening really wide, draw her whole body closer so that she gets a good mouthful of breast. Your nipple will enter the top of your baby’s mouth, not the middle. That way, she will be able to feed effectively.
  • It may take several attempts to get the attachment good enough. Your nipple needs to be at the back of her mouth so that it is not squashed.

Good attachment

What you should see:

  • baby tucked in as close to you as possible
  • chin against your breast, rather than tucked down
  • wide open mouth
  • nose not pressed into your breast
  • deep jaw movements
  • if some of the areola (the coloured part around your nipple) is showing, there will be more above the top lip than below the bottom lip

What you shouldn’t see:

  • cheeks sucked in
  • lips looking like sucking on a straw

What you should hear:

  • soft sounds of milk being swallowed

What you shouldn’t hear:

  • clicking noises
  • lip smacking

What you may feel:

  • a feeling of being ‘firmly gripped’
  • the let-down reflex – a tingling, ‘drawing’ feeling in your breasts
  • a fleeting pain at the start of the feed in the first few days or weeks. (Imagining a relaxing scene, or getting someone to massage your shoulders, may help in these situations.)

What you shouldn’t feel:

  •  pain while your baby is actually feeding, or persisting after the feed.

If you see, hear or feel anything that doesn’t seem right, you can gently insert your little finger into your baby’s mouth to break the suction and let her come off, then let her latch on again.

How much? How often?

If you let your baby set the pace for feeding in the early weeks, she’ll be happier because she won’t be kept waiting when she’s hungry. Crying increases the level of stress hormones in her body. Also, by responding to her hunger signals your breasts will produce the correct amount for her. If you try to cut down the feeds, you may not make enough milk.

A baby who is well attached will stop feeding when she has had enough. She may not always need both sides but you can offer the second side, perhaps after a cuddle or nappy change, to be sure.

It’s normal for young babies to need frequent feeds. Sometimes a baby will have several short feeds clustered together. Feeds will tend to get quicker and more spaced as your baby grows.

But breastfeeding is much more than transferring milk from mother to baby. It is a social activity that is an important part of the mother-baby relationship, enjoyable and comforting when it goes well.

She’s feeding all the time!

This could be because:

  • She’s not attached properly so not receiving enough of the creamier milk that comes with the let-down reflex (your nipples may also be very sore).
  • She’s trying to build up your milk supply – and babies sometimes have increases in appetite, which leads to more milk being made.
  • She needs the comfort and closeness that being at the breast gives her.

She’s not feeding enough!

  • There’s no need to wait for your newborn or young baby to cry before you offer her a feed. Signs that she may be waking and ready to feed include flickering eyelids, little noises, mouth movements and searching for a breast (rooting).
  • Hold her close to your breast and touch her lips with your nipple. Some mothers like to squeeze out a few drops of milk to tempt the baby.
  • You might like to have a bath with your baby to encourage her to latch on and feed. It works best if you lie back in warm water with your baby on your chest, her lower body in the water. You need someone else there who can keep your baby warm by gently pouring water over her.

How to make more milk

  • Feeding your baby frequently helps. Also check she is feeding effectively – you may need to ask for help from a health professional or breastfeeding counsellor. The best helpers will enable you to learn to do this for yourself.
  • If you give formula milk instead of breastfeeding, or as a ‘top-up’, your body will produce less milk – so it’s better to breastfeed more often. You can offer 3 or 4 ‘sides’ at a feed if your baby is still hungry after two breasts.
  • Your own diet, fluid intake and amount of rest have very little to do with your ability to make milk. But eating regularly and drinking to thirst will help you to feel more able to cope with caring for a baby.

Feeding positions

Traditional position
 
Traditional position
 
Underarm
 
Lying down
 
Choosing a comfortable position for yourself.

Sitting in a chair.

  • Let her lie across your lap, with her head supported on your forearm, her nose towards your nipple.
  • Make sure her ear, shoulder and hip are in a line, not twisted round.

Or you could...

  • Lay her across your lap, with your opposite hand and wrist supporting her upper back and neck.

Underarm

By placing cushions at your side, your baby can rest on them, with her legs pointing behind you. You will probably need cushions behind you to leave enough room for her legs to go past your back.

  • She will be tucked under your arm for support.
  • You can rest her head in your right hand when she’s at your right breast; and vice versa, or support her with pillows.
  • Starting nose to nipple may help her attach well.

Lying down

If you lie on your side and rest your head on a pillow, your baby can tuck in close to your body. You can guide her to your breast and support her with your free hand.

  • A pillow behind you will support your back.
  • A thin pillow or folded towel under your rib cage will lift your body slightly – helpful if you have large breasts.

Encouraging your baby’s instincts

Choose a comfortable position for yourself, such as lying back (reclining), cuddling and holding your baby whichever way feels comfortable to you, for as long as you wish. Your baby’s body is completely supported by your body, facing and closely touching it. New research suggests that this encourages your baby’s instincts, such as rooting, and is often more comfortable, so helps breasrfeeding.

(Visit www.biologicalnurturing.com for more information)

Whatever position you choose, remember:

  • bring your baby to your breast or let her attach herself rather than leaning towards her
  • tuck her in closely to you
  • check that her ear, shoulder and hip are all in a line – not twisted round
  • make sure she’s facing your nipple – she shouldn’t have to turn her head.

Possible problems

Do ask your midwife, health visitor, or an NCT breastfeeding counsellor for support if you have questions about breastfeeding. You can contact a counsellor by phoning 0300 330 0771.

Sore nipples

  • These are caused by your baby sucking on your nipple and rubbing it, rather than suckling – squeezing the milk out with her tongue.
  • If feeding is uncomfortable, you can break the suction by putting your little finger in your baby’s mouth. Encourage her to open her mouth really wide when you help her latch on again. Changing the feeding position may help. You’ll probably prefer to start with the less sore side.
  • Expressing a little hindmilk after a feed and spreading it gently over the nipple can help sore nipples to heal. Although there is little research, using ultra-pure lanolin seems to help if nipples become cracked.

For more information, see "Breastfeeding and your nipples".

Pink and shiny painful nipples

  • There may also be cracks and/or white spots. These are signs of thrush (a fungal infection) on the nipples. However, it is important to check with a health professional or breastfeeding counsellor that your baby is well attached so not causing any nipple damage. If you do have thrush, your doctor (or possibly a health visitor) will probably prescribe drops for your baby and a cream for you.
  • If you have razor-like or shooting pains in your breasts, especially after feeds, you may have thrush in the ducts and then you are likely to need tablets on prescription to get rid of it.
  • Whether the thrush is on your nipples or in your breasts, both you and your baby need treatment.

For more information, see "Breastfeeding and your nipples".

Also, see http://www.breastfeedingnetwork.org.uk/thrush-and-breastfeeding.html for further information.

Baby feeds very frequently

  • This could be due to a delay in your milk building up, or to positioning or attachment that need improving. It is helpful to check this first. If frequent feeding is a new pattern, she may be building up your supply of milk and should settle again in a day or so. Or she may simply be the kind of baby who draws enormous comfort from being at the breast. Relax and enjoy it if you can. When you look back, this time will seem very short indeed.

Over-full, hard breasts

  • Known as ‘engorged’ and most likely when the milk is coming in. Putting warm flannels on your breasts helps the milk to flow, or you might prefer to have a bath or shower before you feed. If you express a little milk before a feed, it’s easier for your baby to latch on. Frequent feeding helps to prevent engorgement. Once your milk supply has settled down, you may become engorged again if you miss a feed or use formula milk.

Small, tender lump in the breast

  • This could be a blocked duct. Massage and warmth will help the milk to flow and unblock the duct. Your baby is more likely to help the lump to clear if she feeds from the sore breast first and is positioned so that her lower jaw is nearer the lump. You can massage your breast and express milk after a feed if it still feels sore and lumpy.

Red, inflamed areas on breast and a flu-like feeling

  • These are signs of mastitis. Mastitis is an inflammation of the breast. It happens when breastmilk leaks into breast tissue. Resting in bed helps if you feel unwell.

Feeding frequently, offering the sore side first, can help to drain milk from the inflamed area. Your midwife can recommend a painkiller and cold compresses help to reduce the swelling. If you don’t feel better in 12-24 hours, you will need to see your GP. The doctor may want to discuss prescribing anti-inflammatory drugs or antibiotics (only needed if there is an infection). He or she will make sure they are safe to take when breastfeeding.

For more information, see "Breastfeeding and your nipples".

Baby won’t take the breast

  • If your baby won’t take the breast from the beginning, keep trying gently. Express a few drops of breastmilk and let your baby taste it on your nipple; open your own mouth wide as she watches you, to show her how. Don’t leave it too long before asking for help from your midwife or NCT breastfeeding counsellor – call our telephone line 0870 444 8708.
  • If your baby refuses the breast later on, after feeding well for weeks, this could be caused by a recent change.
  • You can try distraction techniques, like feeding your baby when you’re standing up or in the bath, when she’s half-asleep, or when the lights are dim.
  • If your baby still doesn’t want to breastfeed you may need to express milk to keep up your milk supply.

How long should I breastfeed?

You can breastfeed for as long as you and your baby choose to. The World Health Organization and UK Departments of Health recommend breastfeeding without any formula milk or solid food for the first six months, then continuing to breastfeed while introducing other foods. Babies have the best chance of good health if breastfeeding then continues along with solids until they are at least two years old.

Feeding, however it’s done, is always far more than just a way of getting milk into your baby. It’s part of your relationship with her. There are many factors – practical, physical, emotional – involved in your decision to carry on breastfeeding, wind down, or stop. Talking it through with a breastfeeding counsellor can help.

Starting solids

By the age of 6 months, a baby’s body can cope with solids. She can also sit, grasp objects and move them to her mouth. Baby-led weaning is a natural approach where the baby is offered a selection of nutritious finger foods, suitable for her age, and progresses at her own pace.

For more information see "When do I introduce solids to my baby?" and "Breastfeeding – how long?"

Click here to buy copies of the NCT Booklet "Breastfeeding - a good start".

Page lasted updated 2009.