2. Breastfeeding 24pp 13/2/06 11:01 am Page 2
feeding
YOUR NEW BABY
contents
2
YOUR CHOICE Your Guide To Our Local
Breastfeeding Policy
This booklet has been designed to
give you all the information you
Breastfeeding: Some of the 3
will need about feeding your
baby. We do not expect you to Health Benefits
absorb it all at once but gradually
during your pregnancy. During Your Pregnancy 4
These guidelines apply only to
Positioning - Holding your Baby 5
healthy full term babies. Your
midwife will advise you if your
Attachment - Giving Your Baby 7
baby is small, premature or ill.
a Little Help
We hope that you find this guide useful,
however, it should not replace the professional Exaggerated Attachment 9
support you can obtain from your midwife,
health visitor and GP.
Early Days 10
* For ease of understanding, the baby will be called he Questions About Breastfeeding 12
Weaning 17
Returning To Work Plan 18
Eating and Drinking Whilst 21
Breastfeeding
Breastfeeding Problems 21
Derby Hospitals NHS Foundation Trust
Breastfeeding Problem Solving 22
Charts
National Contact Numbers for 24
Local Breastfeeding Support
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Your guide
Breastfeeding is the healthiest way you can feed your baby.
We recognise important health benefits exist for both you
and your baby and we want to do all we can to support
you in your decision to breastfeed.
TO OUR LOCAL BREASTFEEDING POLICY
Ways in which we will help you
All staff supporting breastfeeding mothers
1
are fully trained to help with
breastfeeding. Please ask them about
breastfeeding queries, or if you feel you
need specialised advice, they will be able to
give you contact details.
2 During your pregnancy you will have an
individual discussion about feeding and
caring for your new baby. This usually
happens by 32 weeks of pregnancy.
3 You will be encouraged to hold your baby
Brian Moody
in skin to skin contact as soon as possible
after the birth, for as long as you like
(ideally more than 45 minutes).
4 Maintaining skin contact with your baby 8 We will encourage baby led feeding,
often leads to the first breastfeed. Most where babies are allowed to choose when
babies are naturally ready to feed within and for how long they feed. This way you
the first hour if left undisturbed. can be sure your baby is getting enough
milk.
5 Staff will be available to explain how you
can put your baby to the breast correctly 9 We recommend that you avoid using
and to help with feeds in the early days. bottles, dummies or nipple shields while
your baby is learning to breastfeed. This is
You will be shown how to hand express
because they can make it more difficult for
your milk.
your baby to learn to breastfeed
6 Most babies do not need to be given successfully and for you to establish a good
anything other than breast milk until they milk supply.
are around 6 months old. If for some
reason your baby needs some other food
10 We will help you to recognise when your
baby is ready for other foods (normally
or drink before this, the reason will be fully
around 6 months) and explain how these
explained to you and your agreement
can be introduced.
obtained.
7 We recommend that you keep your baby 11 We welcome breastfeeding in all areas of
our premises. If you would prefer
near you whenever you can so that you can
somewhere private please ask a member of
get to know each other. We will give you
staff.
information and advice about bed sharing
and infant safety. If any medical procedures 12 We will give you a list of people who can
are necessary in hospital, you will always be help if you need extra support with
invited to accompany your baby. breastfeeding.
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breastfeeding
SOME OF THE HEALTH BENEFITS FOR YOU AND YOUR BABY
FOR BABY
Protection against ear infections
Protection against chest infections and
wheezing
Lower risk of diabetes
Less allergic disease (eczema, asthma, wheezy)
Protection against diarrhoea, gastro-enteritis
and tummy upsets
Better mental development
Better mouth formation and straighter teeth
Less obesity
FOR MOTHER
Lower risk of ovarian cancer
Lower risk of pre-menopausal breast cancer
Stronger bones in later life
“I breastfed my baby because I knew he would
get less infections and tummy bugs giving him
the best start in life, and that there is goodness
you don’t get in bottled milk”.
Bravada Bras
Did you know?
Bras don’t need to be boring!
Your milk provides all the nourishment your
baby needs until he is around 6 months old. system more acidic, this prevents harmful
Your milk is made just right for your baby bacteria (bugs) from growing which leads to
and it constantly changes to meet your baby’s tummy upsets (sickness and diarrhoea).
needs, as he grows unlike artificial milk. It Babies who receive artificial milk are more
provides special factors that promote growth, likely to develop diabetes, eczema and
which cannot be found in any other milk. asthma than babies who receive mother’s
Your milk contains antibodies, which provide milk.
protection for your baby from infection.
Breastfeeding your baby reduces the risk of
Chest, tummy, ear and urine infections are
accidental scalds or burns which can occur
more likely in babies who receive artificial
when heating up milk.
milk, because it does not contain properties
which help prevent or fight infection. Breastfeeding should continue for as long as
Your milk also makes your baby’s digestive possible. Ideally for a year and beyond.
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during your pregnancy,
IT WILL HELP IF….
Your midwife talks to you about the
following topics:
I Skin to skin contact
I Offering help with first feed as soon as
possible after birth
I Baby led feeding
I Keeping your baby close to you 24
Derby Hospitals NHS Foundation Trust
hours a day (in hospital and at home)
I Importance of good positioning and
attachment for breastfeeding
I Avoiding teats and dummies
I Not giving your baby anything other than
breast milk for the first six months
Skin to skin contact When your baby sucks at your breast it
stimulates the nipple, a message is sent to a
This is when you hold your baby in skin
gland in your brain called the pituitary. One
contact as soon as possible after birth. Ideally
part of the gland sends out prolactin, this
this should last for more than 45 minutes. If
your baby is left undisturbed he will slowly goes into the blood stream to the milk
move towards your breast and self attach and producing cells. The other part of the gland
feed. sends out oxytocin, which makes the muscle
cells around the milk producing cells squeeze
All mothers, irrespective of their ultimate
the milk down the ducts. This is called the
feeding choice, will be encouraged to offer
“let down” reflex.
this first feed.
This period of alertness usually lasts for an Your breast size is unrelated to the amount
hour or so. After this it may be some time of milk they produce.
before your baby wakes again. Your milk production will be reduced if your
baby does not suckle at the breast. This is
How your body works to produce milk because there is a special substance found in
breast milk which, if not removed, will tell
The breast produces small amounts of milk
your breast to stop producing milk. This
from 16 weeks of pregnancy. Once your baby
substance allows each breast to individually
is born and the afterbirth (placenta) is
produce its own volume of milk.
expelled, your pregnancy hormone levels
(oestrogen and progesterone) start to fall. If you stop breastfeeding or choose not to
This allows another hormone, prolactin, to breastfeed your milk supply will gradually
start to produce milk. This is helped by reduce over a few days. You can get more
offering the first feed as soon as possible information from your health care worker.
after birth. (see page 24).
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Positioning
THERE ARE MANY DIFFERENT WAYS TO HOLD YOUR BABY WHILST BREASTFEEDING
Remember Cross Cradle hold
However you choose to hold your baby
make sure:
I You support his whole body
I His body is turned towards you
I His forehead, shoulders and hips should be
in a straight line.
I You hold your baby close
I His nose is opposite your nipple before he
attaches to your breast.
Here are the 4 most commonly used holds.
Cradle hold
Chesterfield Sure Start
This is a hold successfully used by many first
time breastfeeding mothers. You may find it
easier to support and guide your baby onto
your breast. Once your baby is feeding, it
will be more comfortable to bring your other
arm to rest under the arm which supports
your baby’s body.
Start off by holding your baby horizontally
with your baby’s nose opposite your nipple.
Chesterfield Sure Start
Turn your baby completely on his side. Tuck
his legs under your arm (if possible). With
your elbow, bring his bottom close to you.
Support your baby’s neck and shoulder
This is the most instinctive position that a between your spread out finger and thumb.
mother uses. Your baby is turned towards Your baby’s head should fall back gently
your body and his shoulders are supported on between the V shape your finger and thumb
your forearm to allow his head to tilt back so makes. This helps raise his chin off his chest
he can open his mouth wide and self attach. so that he can open his mouth wide.
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Underarm hold (Rugby Ball) Side lying hold
Derby Hospitals NHS Foundation Trust
This position may be useful if you have had a: This allows you to rest whilst your baby
I caesarean section, feeds, it may be useful if you have had a:
I small or premature baby I caesarean section
I find it uncomfortable to sit
or if you have:
I larger breasts or inverted nipples Start off by lying on your side, with a pillow
between your head and lower arm. Turn your
I difficulty attaching your baby using other
baby completely on his side to face you. Bring
holds.
his body close to you making sure his head is
Start off by holding your baby at your side tilting back and can then attach.
with your baby’s head at the level of the
nipple. Your baby should lie on his back. You
may need to use a pillow to support baby.
Make sure that your baby cannot push away
with his legs whilst feeding.
Support your baby’s neck and shoulder
between your spread out finger and thumb.
Your baby’s head should fall back gently
between the V shape your finger and thumb
makes. This helps raise your baby’s head off
his chest so that he can open his mouth wide
and his chin is close to the breast. Your
breast should always be supported by the
baby’s chest.
All finished!
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Attachment
GIVING YOUR BABY A LITTLE HELP
B
1
If you are going to feed from your left breast,
cup your breast underneath with your left hand.
Your fingers should be away from the areola (that is
the brown area) and nipple. Your small finger should
just be touching your ribs. Your thumb should rest
on top of your breast (usually on the edge of the
areola). Your nipple should then be lined up with
your baby’s nose. Your nipple should not be aimed
centrally into the baby’s mouth. He will smell the
1
milk and open his mouth wide.
2
His bottom lip should make contact with
the areola, well away from the base of
the nipple.
Try to imagine a piece of Velcro attached to
his bottom lip and a matching piece of Velcro
attached about 2.5cms (1 inch) from the base
of the nipple. These pieces of Velcro need to
be matched together first.
2
3 Then your thumb needs to quickly slide or
roll the nipple forward under the roof of
his mouth.
Photographs courtesy of Mother Baby picture library
3
Relax your shoulders and enjoy watching your baby feed contentedly. You should feel a drawing sensation and
after the initial attachment you should not feel any discomfort. If you feel pain, take your baby off by releasing
the suction between the baby’s gums with your finger and try again. A midwife will be available to help you.
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There are three possible ways your baby may attach to your breast.
A Your baby attaches himself naturally. When brought to the breast he spontaneously attaches and feeds
without any help. He should start rhythmically sucking and swallowing and it should not hurt. THIS IS THE IDEAL
B You may need to give him a little help
C You may need to use an exaggerated technique
4 It may be necessary sometimes to maintain a
slight pressure with your thumb above the
areola until your baby is rhythmically feeding. This
usually applies when your breast is very full i.e. when
your milk volume increases.
4
5 6 Once your baby has established a good
feeding rhythm, your hand should be
slowly released from your breast and brought to rest
under him.
Signs of good attachment
I Babies mouth is open wide.
I Cheeks are ‘full’ and rounded.
I Chin is tucked closely into the breast with
5
nose free allowing baby to breathe
I More of the lower part of the areola is in the
Photographs courtesy of Mother Baby picture library
baby’s mouth than the upper part.
I Bottom lip should be curled back (this may
be difficult to see and you do not need to
check this).
I Suckling pattern will change to long deep
sucks and swallows with pauses.
I After the initial drawing in of the
attachment, it should feel comfortable.
6 I Lots of wet dirty nappies.
Whilst your baby is feeding ask your midwife to explain and show you the difference between nutritive and non-nutritive feeding
(this means when your baby is taking milk, or not.) Once the feed has been completed apply some expressed breast milk to your nipples.
REMEMBER! Breastfeeding is natural, BUT it is not always instinctive. Some babies need to learn how and some learn
faster than others. You may need a lot of patience in the early days.
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Attachment
EXAGGERATED ATTACHMENT
C
piece of Velcro attached to your baby’s
When to use an exaggerated attachment: If bottom lip and a matching piece attached
your baby: about 2.5-5cm from the base of the nipple,
I is unable to attach and feed this length will vary depending whether your
I has a “tongue tie” and has difficulty baby is large or small. An easy way to
staying attached. measure this is to use your thumbs knuckle to
nail as a guide.
I has a cleft palate
I is premature
I weighed a lot at birth and feeding is
painful, even if he looks well attached
I your nipples are sore or cracked and
feeding is almost unbearable
Nottingham City Hospital
How to use an exaggerated attachment at
the breast.
If you are going to feed from your left breast,
cup your breast underneath with your left
hand. Keep your fingers well away from the
areola (that is the brown area). There is These imaginary pieces of Velcro need to be
always a tendency you will want to move matched together first. Then your thumb
your fingers up but if you do this it will affect needs to QUICKLY roll the nipple forward
the success of your attachment. Your thumb under the roof of your baby’s mouth
should tilt the nipple back so it looks like its
You must maintain the pressure with your
pointing away from your baby. This will have
thumb above the areola until your baby is
the effect of making the breast under the
rhythmically feeding. Before you remove
nipple bulge forwards.
your hand make sure that you are holding
your baby really snuggly into you and you
can see that his cheek is touching your breast
with his nose free to enable him to breathe
Nottingham City Hospital
Nottingham City Hospital
The baby’s bottom lip should make contact
with the breast well away from the base of
the nipple as in photo 1. Try to imagine a
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early days
Early days At home it is recommended that your baby
Healthy term babies may not feed very much in sleeps in a cot in your room until he is at
the first 48 hours; they have energy stores that least 6 months old. Research suggests that
they can use until your milk volume increases, most mothers and babies share their bed at
so try not to worry about this. However, they some time, and may unintentionally fall
may cry for cuddles if they feel insecure at this asleep together. The joint UNICEF/FSID leaflet
time. Do not be afraid to cuddle, stroke or talk
'Sharing a bed with your baby' provides
to your baby, as this will give him added
clear, comprehensive and evidence-based
security. You cannot ‘spoil’ babies with lots of
information for parents (obtained from
love and cuddles!
www.babyfriendly.org.uk or ask your
Babies systems are not designed to take large
midwife health visitor).
amounts of fluid during the early days, as their
kidneys are very immature. Your breast will Never share a bed with your baby if you or
provide the exact amount of colostrum that your partner;
your baby needs, so do not feel that there is • smoke
‘not enough there’.
• have been using alcohol
Your midwife will offer help with the second
breastfeed within six hours of birth. Pain relief • are taking medication or drugs that make
given in labour (e.g. pethidine or morphine) you drowsy
can make babies extra sleepy. If you feel that • are excessively tired
your baby needs extra encouragement to feed,
it can be helpful to offer your baby breast NEVER SLEEP WITH YOUR BABY ON A SOFA
contact at regular intervals and give him hand OR ARM CHAIR.
expressed colostrum.
After about 48 hours your baby may then come The first week
into a busy feeding period. Do not panic and do
Breastfeeding your baby can be a rewarding
not give up! Frequent feeds according to your
and satisfying experience for both you and your
baby‘s demands will lessen the chance of your
baby. However, some mothers and babies need
breasts becoming overfull, letting your body
a little more help than others. Each
know how much milk to provide for the future.
mother/baby partnership is unique and even
This is ‘programming’ time and it is very mums who have successfully breastfed before
important and it soon passes. may need a little help.
Your baby will stay with you all the time whilst All babies differ in their needs and therefore
you are in hospital. This will help you to get to each mother/baby experience will be different.
know each other and enable you to recognise
Knowing what is normal and why it is
your baby’s early feeding signals, before your
happening helps mothers develop their own
baby becomes too unhappy. Staying together is
coping strategies.
especially beneficial for night feeds. You can
easily lift your baby for feeding without your Your midwife/neonatal nurse will give you extra
sleep being disturbed too much. information if your baby is small, premature or ill.
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early days
EMPTY OR FULL? HOW CAN I TELL?
This is such a common question...
Here is a little tip for the early days
for the majority of babies.
Whilst feeding observe your baby.
He will be giving you clues not only
from his sucking pattern but also
from his body language.
For example, look at these photos.
This baby has just started the
feed. Note the position of his
arm. This is the ‘empty’ sign.
Now look at the position of the
arm as the baby progresses
through the feed. It gradually
moves through 180 degrees.
When the breast is almost
completed, you can see the
arm is completely relaxed and
is at rest. This is the ‘full’ sign.
This is often repeated when
the second side is offered.
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your questions
ABOUT BREASTFEEDING
One breast or two? What is a growth spurt?
Always offer both breasts at each feed, but both may Your breast fullness will gradually settle down and your
not be taken. Your baby should be allowed to finish the breasts will feel very soft most of the time. This is
first breast completely. Many babies, after completing natural. It does not mean that your milk is ‘going’ or is
the first breast, may look full and sleepy, but do not be ‘too thin’ neither does it indicate that you do not have
fooled! If you leave them to sleep, they are likely to enough milk for your baby. However, there will be times
wake soon again wanting the other breast. in the future when your baby will need to make extra
milk for his growing needs. This is often referred to as a
After the first breast, let your baby stretch out
growth spurt.
somewhere safe. You can use this break to get a drink
Your baby changes his normal feeding pattern and
and now is also an ideal time to change your baby’s
starts to feed more frequently i.e. feed, short rest, feed,
nappy. If your baby stays asleep, following the nappy
short rest, etc. This only lasts for about 24 hours, so for
change he is showing you that he is satisfied and that
this short time it is important to relax and respond to
the feed is complete. If he “roots” around then offer
your baby’s needs. Growth spurts, which soon pass, can
the second side.
occur at any stage.
Which breast do I use first at each feed?
My baby is very unsettled in the evening, is there
Start on a different breast to the one you started on last something wrong?
time.
Many mothers say their babies have very unsettled
How long and frequent should feeds be? evenings and this is quite normal. It may be referred to
Feeding should be baby led which means feeding by others as evening colic but this has not been proven.
whenever your baby wants, for as long as he wants. If It is difficult to know why babies do this but it is very
feed times appear very long ask your midwife, health common. Try and work with it. It does pass ! Here some
visitor or breastfeeding counsellor to check the way things you can try.
your baby is attached to the breast. 1. Follow your baby and let him have short feeds and
sleeps. This can help boost your milk supply.
Can I give my baby a dummy?
2. Place him in a baby sling (you or partner) and go for
If you introduce a dummy at a very early stage it may
a walk around the house.
discourage your baby from feeding. If your baby does
3. Give him a nice relaxing bath.
not breastfeed often enough you may not make
enough milk to meet his future needs. 4. You, your partner or helper can have skin to skin
contact with your baby
How do I know my baby is getting enough milk?
5. Plan what you are going to have for tea and prepare
1. Plenty of pale wet nappies, with no orange/pink
as much as possible earlier in the day. If anyone asks if
crystals staining the nappy.
they can do anything to help then say putting a meal in
2. The baby passes stools (poo) regularly and the colour
the freezer would be very useful.
has changed to a bright yellow (within the first week)
If it happens all through the day and evening, look at
3. The baby is contented after feeds.
the problem solving charts initially then seek help as
4. The baby starts to gain weight and looks well. there are other things you can do.
Does my baby need extra drinks? If I get sore could I use a nipple shield?
No - the milk that you produce at the start of a feed is Sore nipples are caused by poor attachment; seek help
more watery and very thirst quenching. During hot as soon as possible to overcome this (see problem
weather babies tend to have shorter, more frequent solving guide and telephone contact numbers). Nipple
feeds. This prevents him from becoming thirsty. shields are not recommended because they reduce the
Therefore, extra drinks are not needed and if given may quality and quantity of milk the baby receives and
affect your future milk supply. ideally should not be used in the long term.
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your questions
ABOUT BREASTFEEDING
Feeding patterns
All babies are individuals and really should not be compared to each other. Here are some of the individual
differences. All these babies are thriving, happy and contented but their feeding patterns are very different.
Lauren - She fed well for fifteen
Jessica - She fed for twenty minutes minutes and then started to fuss
from the first breast and then around. She was offered the second
dozed off. breast and fed for ten minutes and
She then had her nappy changed went to sleep totally satisfied after
and fed for fifteen minutes from her nappy change.
the second breast, and then she
went to sleep.
Marzen - He fed for five minutes on his least
favourite breast. He then lost interest. He had his
Nathanial - He fed relentlessly for nappy changed and was still rooting
thirty minutes from the first breast around. He was offered his favourite
and he came off the breast breast and fed contentedly for thirty
himself. He had a “blissful” look minutes. His mother always had to
and did not wake during his offer his least favourite breast first;
nappy change. He was left to otherwise he would refuse it if it
sleep contentedly. were offered as the second breast.
Milk changes
High quality, low volume colostrum is present first. Which photo; A, B or C contains the most fat?
When your milk volume starts to increase this The Answer is C Despite its pale colour this milk has
combines with colostrum to give your baby ongoing the most fat.
protection. The colostrum remains there for up to 14
days. Your baby may still feed frequently as the milk The amount of fatty milk your baby receives is
has not yet matured. As your milk matures, the fat dependent on three main factors:
levels increase to meet the growing needs of your
1. A good attachment on the breast
baby. This may take a few weeks. Babies then may
establish a routine, but not necessarily. 2. Allowing the baby to finish one breast completely
Hand expressing 3. Regular use of both breasts according to what he
Hand expressing, is a useful technique to learn, needs.
especially if it has been practised antenatally.
This is because: Picture A Picture B Picture C
I It is a more effective method of removing your
colostrum in the first few days than breast pumps.
I You can tempt your baby to feed help your
milk start to flow
I It can help your baby attach if your breasts are
full, or to clear blocked ducts or to relieve mastitis.
However, when your milk increases some mothers
may prefer to use a breast pump (see next section). Colostrum Changing milk Mature milk
When hand expressing, the best method for These photographs show how your milk matures
obtaining the greatest amount of milk is to use each
breast twice.
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How to hand express
You should be shown how to hand express your milk either antenatally or soon after your baby is born.
Please ask for help.
Breast massage
Gentle breast massage can be used at any time to start or
improve the milk flow.
Find where you need to press to express your milk.
The correct place to press is a few centimetres away from the
nipple where the breast changes in texture, it may feel a little
firmer. Position the thumb and the first finger opposite each
other, so that this area lies beneath them.
Expressing (removing) the milk.
Derby Hospitals NHS Foundation Trust
Compress and release your When milk stops flowing, move
finger and thumb rhythmically your fingers and thumbs to a
to obtain milk. It may take a new position and repeat until
few minutes until the let down milk stops flowing.
reflex works. Repeat on second breast.
Expressing Your Milk What are the different types of breast pump?
Is it necessary? Advantages Disadvantages Points to consider
Hand Low cost May be time Easy when breast
It is not necessary unless you plan to be Pump consuming is full but
separated from your baby at any time before (for Quiet sometimes difficult
occasional Hand action later on when
he is having solid food, e.g. going to work. use) No need for may be tiring breast is soft
electric
When to Start supply Requires
both hands
If you wish, you can start expressing as early Mini Quick and Can be noisy Facility for double
Electric efficient pumping action
as 7 – 10 days after the birth. This is because Pumps More costly can save time
there is plenty of extra milk available at this (for Not tiring
long term If battery run Check if battery
time, as your breasts produce more than your use) Requires only, may or mains options
baby needs. This milk can then be frozen one hand need frequent are available
only battery
until it is needed. changes Good for long
term use
If you decide to express when your baby is Large Quiet Large to Good for long
older, your body’s milk supply will have Electric carry around term use
Pump Efficient
settled down to your baby’s requirements so (for More expensive Variable suction
you may find it more difficult at this time long term As above to hire over useful, if available
use) long periods
You can increase your supply of milk, this can Available than mini
in hospitals electric
take a few days so be patient.
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your questions
ABOUT BREASTFEEDING
Good Times to Express
When expressing you may find these times most
successful:
I About 30 minutes after your baby has been
fed. (Express both breasts once or twice if
required).
I In the morning after your baby’s first feed.
I If your baby only takes 1 breast at a feed
express from the unused one or both if more
milk is required.
I In between feeds or when your breasts feel
particularly full.
I When the baby is feeding from one side
express the other at the same time ( this can
be the most successful)
Single Breast Pumping How much milk should I express
1. Massage first breast and stimulate the nipple, each time?
express that breast until the milk slows to a This is going to vary quite considerably from
drip. mother to mother depending on the reasons
2 Swap over to the second breast, massage, why you are expressing. If you are expressing
stimulate and express again. because your baby is not breastfeeding you
I When the milk flow slows to a drip, return to really need to express as much as you can each
the first breast and repeat steps 1 2. time. If you are expressing for social reasons,
I Expressing is complete when your breasts are
here is a very rough guide on how much your
baby will need each feed:
soft or the required amount of milk is obtained.
Baby’s weight in kilos x 150mls = amount in 24
hours. Divide this by number of feeds in 24 hours.
Double breast pumping i.e. 5 kg baby x 150mls = 750mls divided by 8 =
Expressing both breasts together. The fat 93 mls approx.
content of your milk can be increased if double Remember, every baby is an individual so ideally
pumping is accompanied by breast massage. express more than you think he is going to take.
This is useful if you:
I intend to express for a long time (i.e. if you Storage of breast milk in your home
have a baby on the Neonatal Unit) You may read differing times but the
I have a premature baby recommendations from The Breastfeeding
I have had Twins or Triplets Network are as follows:
Fresh breastmilk
I Refrigerate as soon as possible but can be
If your baby is unable to breast feed, it is
important that you start expressing as soon as
possible after delivery, i.e. within 6 hours. If you stored at room temperature for use within 6
hours.
I Store in the Fridge
have a baby, or babies in the Neonatal Unit it is
important to express at least 6 to 8 times in 24
hours and at least once during the night. - 5 to 10°C, use within 3 days
Prolactin (the hormone that produces milk) is at - 0 to 4°C, use within 8 days
its highest between 2 am and 4 am and - Low down and towards the back
expressing at this time may ensure a good on- Try and use fresh milk wherever possible as
going supply. some qualities are lost during freezing.
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Frozen breastmilk How do I give expressed breastmilk to
I Store in Freezer -18°C or lower for 6 months
my baby?
I Use immediately if defrosted outside fridge.
In the early days small amounts of breastmilk
If you have expressed small amounts and want to can be given by using a small cup. Ask your
mix them, ideally chill to the same temperature Midwife or Health Visitor about this. Early
before mixing. introduction of a teat may confuse the baby
and may result in a poor breastfeeding
To defrost milk. technique which may reduce your milk supply.
I Thaw in the fridge and use within 12 hours. However, if you are going to be separated from
I If needed quickly stand the bottle in a jug of your baby, you may choose to give baby your
warm water, replacing the water when it milk in preparation via a teat once daily, once
becomes cold use immediately breastfeeding is established. When introducing
I Shake to mix the creamy separated particles. a teat it is important to remember that every
baby is unique. If problems have been
Microwaves should never be used to heat
encountered with breastfeeding it is important
breast milk.
to delay this for as long as possible.
Effects of offering artificial milk to a breast fed baby
Breastfeeding works on a supply demand basis. If this is interrupted with milk feed, you may
not produce enough milk.
Suckling from a teat is different to breastfeeding and may confuse the baby, making it more
difficult for your baby to attach to your breast correctly.
Breasts can become full and uncomfortable (engorged) if your baby does not feed frequently
enough. This can make it painful and more difficult to attach your baby to your breast.
Babies given large amounts of artificial milk may be less satisfied with subsequent breast feeds.
Baby’s digestive system contains a range of normal bacteria. Artificial milk destroys the
protective coating in the gut that your milk provides. This can increase the risk of your baby
getting infections.
If there is a history of diabetes, asthma, eczema allergy in the family, giving artificial milk may
increase the risk of baby developing allergies.
Breastfeeding works on a supply and demand basis. If this is interrupted with an artificial milk or
water, the breast may not produce enough milk.
Before giving your baby artificial milk, please speak to your midwife or health visitor.
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weaning
I It considerably reduces the risk of
gastroenteritis (diarrhoea and sickness)
I It protects the baby’s immune system so
there is less chance of getting infections.
I It reduces the risk of developing food
related allergies eg asthma and eczema and
intolerances because the baby’s bowel has
matured enough to prevent larger molecules
passing through the wall of the bowel,
which may trigger an allergy.
I It increases the ability of your baby to digest
solids, as younger infants do not actually
produce all the enzymes needed to digest
Chesterfield Sure Start
starchy foods and fat.
I It decreases the risk of developing obesity.
Leaving solid foods until around 6 months
means that less time is spent preparing purees,
as babies can move onto mashed/lumpier foods
Your breast milk is the perfect first food. The quicker. This makes going out with a weaning
Department of Health recommends waiting baby much easier as they can eat your food.
until your baby is around 6 months (26 weeks) There is no need to take food with you and
of age before giving any other food or drink. worry about how you are going to safely
At around 6 months most babies show signs of reheat it.
readiness for starting solids, which include:
I The ability to sit up with minimal support
I The ability to hold his head steady
I When his tongue stops pushing food out of
the mouth (fading of the tongue-thrust
reflex)
I Ability to pick up food and put it in his
mouth
I Readiness to chew.
It is also much better for your baby’s long-
term health if you wait until 6 months
because;
I Younger infants are more likely to choke on
solid foods.
I Your baby’s kidneys need to be mature
enough to cope with an increased
concentration of different nutrients. Extra
stress is put on them if they are given solid Breastfeeding should continue for as long as
foods too soon. possible, ideally for a year and beyond.
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returning to work
Make a plan as early as possible to help things I Breastfeed immediately before leaving your
go smoothly. This may depend on your personal baby, and on return, it will reduce the number
feelings, family circumstances, type of job, of times you need to express. You will need to
number of hours worked, and the facilities express regularly to prevent your breasts
available at work and also when you plan to becoming full and to maintain your milk supply.
I Ensure you are aware of correct methods of
return to work.
However soon you plan to return to work after sterilising equipment.
I If you are having problems with your milk
the birth of your baby, breastfeeding is possible
and very beneficial to you both.
supply, please seek further advice.
Exclusive breastfeeding for around 6 months
Plan 3 Using artificial milk when you are
provides the maximum health benefits to both
not there and continue breastfeeding at
you and your baby. Continuing to breastfeed
other times
for a year and beyond has added health benefits.
I If you wish to use artificial milk whilst you
You may wish to discuss your individual needs
are away at work, it is wise to replace those
with your midwife, health visitor or a
breastfeeds gradually with a whey based
breastfeeding supporter so that you can make
artificial milk.
informed decisions about the best way to return
to work. I Substituting one feed every 4 days to allow
your supply to gradually reduce.
Plan 1 To maintain breastfeeding entirely
I You will usually need to allow 2 weeks to
I Ideal if crêche facilities are provided at work
make the change. Many mothers manage to
or the baby’s caregiver is situated near the
maintain breastfeeding at other times. This
workplace. You may either go to your baby,
will provide some protection from infections.
or arrange for the caregiver to bring your
baby to the workplace for breastfeeds. Plan 4 - Changing over gradually to artificial
I To maintain your milk supply, express when milk before returning to work.
your breasts feel full. If you wish to change completely to artificial
Plan 2 To provide expressed breast milk milk before returning to work, you may need to
(EBM) whilst you are separated from allow 3 - 4 weeks. This allows your supply to
your baby gradually reduce and will prevent problems
I When expressing you need to consider the
occurring such as engorgement.
entire time you will be away from your baby It is important to choose a whey based milk, ie
and should make plans to express as per usual ‘First Stage’. Progressing to other milks is not
feeding times. necessary.
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returning to work
Plan 5 - Returning to work after 6 months baby can be a most amazing experience! The
Most babies will show signs of readiness to excitement on his face followed by the
wean around 6 months but remember contentment, as you both snuggle down
breastfeeds should still be offered on a demand together is very special.
feed basis. However you may find that his feeds
Your breastfeeding rights at work
I Tell your employer in writing you are
are much shorter than when he was younger.
In preparation for returning to work you can
breastfeeding, before returning to work.
start practising giving him a beaker of expressed
Your employer must carry out a risk
breastmilk or water. He may be reluctant at first
assessment to identify any causes of harm to
so persevere. Often they will take it better
you or your infant.
when given by a carer. If not, in reality, some
weaned babies do manage on very little fluid I Discuss further needs with your employer
when they are away from their mothers and before returning to work.
tend to make up for it on their return!
I If the nature of your job is not conducive to
Once back at work you can express your milk
breastfeeding or expressing milk, your
and use the fresh expressed breastmilk for the
employer must find a suitable alternative
next day’s drinks
with the same terms and conditions.
I Breastfeeding can then continue at all other
times when you are with your baby. This is I If your working conditions prevent you from
particularly important as when your milk continuing to breastfeed successfully, your
supply decreases, the antibody levels in your employer has a legal duty to make
milk increase, this gives your baby added reasonable adjustments to your job. Examples
protection against infection. may include breaks for expressing milk or
visiting your baby if cared nearby, offering
This is especially important if your baby goes to
hours conducive to breastfeeding or allowing
a nursery where they may be more likely to
a shorter working day.
catch an infection.
On returning home from work the I Employers are obliged to provide a suitable
breastfeeding reunion between you and your place of ‘rest’ for breastfeeding mothers.
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your personal
RETURN TO WORK PLAN
Use page 18 and 19 to help identify your best plan discuss with your midwife or health visitor.
The following checklist may help you plan your return to work.
Discuss expressing - how, when, where, best times milk storage
________________________________________________________________________________________________
Discuss equipment - Breast pumps, hand or electric (double pumping), containers.
________________________________________________________________________________________________
When will I be returning to work? _______________________________________________________________
How old will my baby be when I return to work? __________________________________________________
What type of work (shifts)? _____________________________________________________________________
No of hours/ days each week ___________________________________________________________________
Who will be looking after my baby where? ____________________________________________________
What facilities will I need at work? (Fridge, area to breastfeed or express my milk)
________________________________________________________________________________________________
Send a letter to my employer stating that I will be breastfeeding/expressing my milk when I return
to work (very important to protect your rights)
________________________________________________________________________________________________
Discussion with my employer ___________________________________________________________________
Risk assessment performed by my employer _____________________________________________________
Five good reasons why employers should recognise that breastfeeding is good for business!
1. You are less likely to feel stressed about returning to work if your employer supports you in
combining work and breastfeeding.
2. If you carry on breastfeeding your baby is less likely to become ill so you are less likely to need time
off work to look after him.
3. Employers who enable their staff to continue breastfeeding find that their staff are more
committed to the company.
4. If your employer believes in equal opportunities point out that support for breastfeeding is crucial
to enable women to combine work family.
5. It is good for public relations for your employer to be a family friendly employer.
Your employer has legal obligations to enable you to continue breastfeeding once you have returned
to work. In 2000 the European Commission issued guidelines (COM2000 466 final) which are intended
to form the basis of risk assessments for pregnant and breastfeeding workers in the UK.
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eating drinking breastfeeding
WHILST BREASTFEEDING PROBLEMS
I There is some evidence that lactation increases the Most breastfeeding problems that mothers experience
mother’s need for calories. This is why mothers can be linked to the way your baby attaches to the
often feel more hungry when breastfeeding. A breast.
varied healthy diet is as important at this time as
any other. There is no need to avoid any particular IF YOU THINK THAT ANY OF THESE APPLY TO YOU THEN
food, be guided by your own hunger and thirst. YOU MUST ASK FOR HELP. (see problem solving chart).
I Caffeine can pass into breast milk and can cause
irritability in your baby. So try to avoid large Signs of poor attachment as seen in photograph below
I Discomfort or pain
amounts of tea, coffee, chocolate and cola.
I Foods restricted during pregnancy can now be
I His mouth not opening very wide
enjoyed freely without any adverse effects on
your baby eg raw/undercooked egg, soft cheeses I Cheeks sucking in with each jaw movement
and liver. However, there are still the same risks to I Your baby appears not to have sufficient breast in
mothers (ie salmonella from eggs). his mouth
Alcohol and smoking I There is a space between the chin and breast
I Smoking is unhealthy for both you and your baby. I He keeps sliding off the breast
If you have been successful in giving up smoking I Rapid sucking with not many swallows
I Noisy feeding (usually clicking noises)
during pregnancy, it is important not to start
smoking again.
I Nicotine gets into breast milk. If you smoke, avoid
smoking just before breastfeeding, as this is when
nicotine will be at the highest level. If you require
help to stop smoking please phone the free
Quitline number 0800 002200.
I It is advisable not to drink alcohol as it passes into
breast milk. If you do have a drink it is
recommended that your intake should not exceed
2 units per day eg 1 unit = 1/2 pint of beer / 1
glass of wine.
Peanuts
I The Department of Health is advising, ‘that
pregnant or breastfeeding women who suffer Derby Hospitals NHS Foundation Trust
from diagnosed allergic conditions, or where the
father or any brother or sister has a clinical history
of such conditions, may wish to avoid eating
peanut products. However, many mums choose
not to eat them, to avoid sensitisation.
Vitamin D Supplementation
Mothers who choose to cover up and/ or receive little
exposure to sunlight (e.g, using sun screens) are less
likely to be effectively producing vitamin D. Because of
this, recently the number of children developing rickets
has increased. You can see the baby’s bottom lip just under the base of
the nipple.
Therefore the Department of Health recommends, that There doesn’t appear to be much breast inside the baby’s
pregnant and breastfeeding women in these groups take mouth.
a supplement of Vitamin D (10µg daily). You can discuss The chin is not close to the breast. This can result in a
this with your midwife, health visitor or GP. number of problems.
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Breastfeeding problem solving charts
This is to help you do some initial troubleshooting. It should not replace contacting any of the people
below that have been specially trained in breastfeeding.
This symbol means you should seek additional help from feeding advisor, midwife, health visitor or breastfeeding supporter.
Mother
Problem Symptom Causes Solutions
Inverted Difficulty in getting the Seek help antenatally
Nipple baby to attach on the Need a very good attachment,
breast properly avoid dummies, nipple shields
Sore Nipples Feels uncomfortable, Due to: 1. Nipple stretching 1. None - soon passes
no damage 2. Poor attachment 2. Improve attachment
Nipple damage 3. Tongue tie in baby 3. asap exaggerated attachment needed,
Nipple soreness, should express at least once daily
looks pink and shiny 4. Thrush 4. Treatment needed CONTACT GP HV ASAP
Breast Pain Shooting pains at/after 1. Thrush in milk ducts 1. Treatment needed CONTACT GP HV ASAP
feeding 2. High caffeine levels 2. Reduce caffeine - found in tea,
coffee, cola, chocolate
Milk Arrival Red, painful breasts 1. Poor attachment 1. Hot flannels aid milk flow, Remove backlog,
Engorgement express breasts after feed, use ice packs with care.
Improve attachment.
2. Restricting feeds or 2. Encourage baby to feed more frequently
baby not waking enough (and follow above)
Cessation Red, painful breasts Abruptly Not recommended to stop suddenly.
Engorgement stopped Try to gradually replace feeds with formula,
breastfeeding this will prevent mastitis / abscess
Blocked Duct Painful lump 1. Poor attachment 1. Improve attachment, massage whilst
feeding. Check for white spot on nipple
(fatty blockage)
2. Bra pressure 2. Check bra
Mastitis Red, lumpy area of breast. 1. Blocked duct untreated. 1. Submerge breast in hot bath, massage
(Non-infected) Pain and flu symptoms and express. Massage whilst feeding.
and / or high temperature. 2. Poor attachment 2. Improve attachment, feed under arm,
express after feed until resolved.
3. Bra pressure 3. Find cause please see back page for
helpline telephone numbers
Mastitis As above but will become As above but will become CONTACT GP ASAP
(infected) infective if left untreated infective if left untreated
Baby
Problem Symptom Causes Solutions
Prolonged Feeding more than 1. Poor attachment 1. Improve, even if it looks OK
feeding 30 minutes each breast 2. Not recognising when 2. Baby does not release breast spontaneously,
(after early weeks) to change breasts no swallowing heard. Move to second breast
Frequent Baby not settling 1. Poor attachment 1. Improve attachment
feeding 2. Unrealistic expectations 2. Seek reassurance
Derby Hospitals NHS Foundation Trust
3. Insufficient milk 3. Very rare, seek help
4. Not offering both breasts 4. Change nappy after first breast,
wake up and offer second breast
5. Over tired/anxious 5. Seek help
Poor weight Weight static or slow increase 1. Poor attachment 1. Improve attachment
gain - healthy 2. Too good baby 2. Encourage more feeds
baby 3. Not offering both breasts 3. See page 7: quot;One breast or two?quot;
4. Slow lactation 4. Increase stimulation by expressing,
top up with EMB - not formula unless
baby at risk. Switch feed
Colic Unsettled baby Babies normally unsettled Find coping strategy.
(Evening only) in the evening Keep to one breast during
evening only, use different breast
next evening
Colic (All day) Fretful baby, appears to have Various causes, Contact
discomfort, windy, watery stools need specialist advice
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