Why do some mothers have problems breastfeeding?
It is very important to remember that many thousands of mothers take to breastfeeding without any problems whatsoever. For others, however, refining the skills required takes longer before the techniques start to feel more normal - as with learning any new skill, some master it quicker than others, and the more you practise, the more proficient you will become.
Most new mothers will be starting to breastfeed more confidently by the time their baby is 10 days old, but it can sometimes take up to a month to really feel ‘on top’ of the process. If after 10 days, you are still experiencing pain or difficulty by this time, or your baby is very unsettled, it is likely that your technique is not ‘quite right’ – if this is the case, a session with a breastfeeding expert to assess how you’re doing, and what little tweaks can be made to perfect your practice, may be the answer to support you to fully master the required skills.
The change to your lifestyle and the fact that your life suddenly revolves around a little person who is entirely dependent on you for all his needs can be a big shock to the system. Support can be crucial, and specifically from those around you who will reinforce your choice and provide help to keep you going when the breastfeeding process gets tough and tiring. Breastfeeding your baby, for however short a period, is the only way to ensure your baby receives the most perfect form of nutrition, with the added bonus of protection against countless infections and allergic reactions.
Avoid being influenced by those who tell you horror stories about breastfeeding. Each experience is different, and you can’t possibly know what their tolerance is to discomfort or change. Concentrate on listening to those who have had good breastfeeding experiences, and remember - giving birth simply gives you a baby; learning to breastfeed teaches you how to be a mother.
At The Latch® we will help you to understand how lactation works, and how to master breastfeeding skills, giving you all the support needed to get off to the best possible start. However, if at any time you decide that breastfeeding is not for you, we will support you to choose what is best for you and your baby, and assist you towards your preferred path.
What should I do with early colostrum?
Colostrum is packed with antibodies for all the infections you have ever been exposed to – either naturally or via immunisations. Colostrum will start to form in your breasts from about 16 weeks of pregnancy. Some breastfeeding counsellors advocate expressing and freezing colostrum from the breasts during the final month or so of pregnancy so that you have a store available, if required, when your baby is born. This could then be used if your baby is slow to start to breastfeed, or has some sort of problem that means he can’t breastfeed immediately. However, one of the amazing things about the lactation process is that the breasts produce colostrum or milk that is absolutely tailor-made to the baby for delivery at that very moment, and varies in its constituent parts according to the precise stage of the baby’s development both inside and outside the womb. Thus, if, say, you are unlucky enough to have a heavy cold or flu when you go into labour (yes, it happens!) the colostrum will contain the antibodies your body has been producing to fight that virus. These will be instantly passed to your baby as he breastfeeds after birth, and will start protecting him immediately. By breastfeeding him directly you are therefore providing him with ‘real-time’ protection against infections which will be effective for several weeks and possibly longer.
Occasionally, there may be a reason why your baby is not able to breastfeed immediately after birth, and it can then be useful to have previously expressed and frozen a store of colostrum prior to birth which can then be given to your baby instead of formula. Learning how to hand express is a useful skill, and hand-expressing colostrum before your baby is born may enable you to store up this ‘liquid gold.’ Newborns will take only about a teaspoon of colostrum at each visit to the breast, so there is no need to aim for huge quantities. If you decide to do this, wait until after 36 weeks of pregnancy, keep the content expressed at each session separate (never add warm colostrum or milk to cold or frozen), and freeze it in sterile plastic food bags as soon as possible after expressing. If there is then a need for colostrum to be given to the baby by bottle or, occasionally, through a temporary feeding tube directly into his stomach, the stored colostrum can be used, and will very likely preclude the need to give artificial formula if your baby is unable to breastfeed for whatever reason.
When will my milk start coming in?
Colostrum is produced by your breasts from around 16 weeks of pregnancy, and will be all your baby needs for his feeds during the first days of life until the colostrum naturally transitions to milk around day 2-4 after birth. This happens when your breasts respond to the changed hormones circulating in your body resulting from the delivery of your placenta and its membranes, which will follow the delivery of your baby. As long as you feed your baby according to his demand, you may well be largely unaware of the gradual change from colostrum to milk. Your breasts may feel fuller and larger, but they should not be unduly painful or uncomfortable. If you haven’t already been wearing a bra, you may find it more comfortable to do so now, and this will help the drainage of milk to and from your breasts.
Should my baby have extra water until my milk comes in?
The short answer is NO!! Colostrum is very thick, and rich, containing all the nutrients your baby needs until your breasts start to produce milk. In research conducted over the past 30 years, not a single result has shown that giving other fluids in the first days of life is of any clinical benefit to babies, regardless of the surrounding temperature, and further, is consistently declared to be ‘unhelpful’ to the establishment of the natural lactation cycle.
During the first days of life, frequent skin to skin contact between mother and baby, and uninterrupted access to the breast are now known to be of major importance in the development of the baby’s brain, the formation of the bond between mother and baby during which both learn to recognise emotions and signs of need in each other (including early signs that the baby needs to feed) and for the successful establishment of the lactation cycle. Any interruption to this by the use of extra fluids or formula milk serves to adversely affect these essential developmental steps, and unless specifically indicated for sound clinical reasons, should be avoided.
Make sure your baby goes to the breast whenever he demands it. The small amounts of colostrum taken (approx. 5 ml per visit to the breast) encourage and provide practice for the baby’s coordination of sucking, breathing and swallowing before the arrival of the larger quantities of milk. He may want to go to the breast several times an hour, or just a few times a day in the first few days of life. Do not be persuaded to give him water as a supplement, however hot it may be outside. As long has he has unlimited access to the breast, and is having at least two wet nappies in the first couple of days of life; three or more until day 5, and six or more by the end of the week, then you can be sure that your baby is receiving enough fluid. If you are at all concerned, speak to your midwife who will want to ensure that you are feeding effectively.
At The Latch® we believe that if newborn babies needed water (or anything else other than colostrum or breast milk) Mother Nature would have provided mothers with their own supply of the required alternative! If it is suggested to you by a healthcare professional that your baby requires extra or alternative fluids, it is perfectly acceptable to ask what the clinical reason for this is, and for an explanation as to why unlimited access to the breast will not meet his demands. It is rare for there to be any sound reason why giving alternatives to colostrum or breast milk are clinically indicated and it is contrary to the World Health Organisation’s (WHO) Baby Friendly Initiative (BFI) for the health of babies around the globe.
Why is it so important to avoid giving formula or water to breastfed babies?
Giving formula to babies interferes with the way that their digestive systems become naturally populated after birth with beneficial bacteria. This in turn may affect the level of protection against certain infections, and the development of other conditions, such as allergic responses to different substances. Thus, in order to ensure that your baby receives all of the advantages that breast milk affords, it is recommended that he receives nothing but the colostrum and milk that his mother produces.
Giving too much water to tiny babies can lower their sodium levels, which in turn can adversely affect brain function. Unrestricted breastfeeding will provide all the nutrition and fluid that your baby requires - trust nature to provide everything he needs as and when he requires it.
In addition to the adverse affects that extra formula or water can have on your baby’s health and development, giving him anything other than breast milk will interfere with his natural demand to go to the breast and even a single supplementary or complementary feed or drink will have the effect of reducing the amount of milk that is produced.
How long should I feed my baby for?
The World Health Organisation recommends that babies should be ‘exclusively breastfed’ (i.e absolutely no supplements other than breast milk) for a period of six months in order for the baby to benefit fully from all the advantages that breast milk provides. Thereafter, for optimum advantages to the health of both mother and baby, breastfeeding should continue for up to two years alongside a mixed diet. Remember - these are guidelines only - no mother should ever feel that if they are not able to commit to 6 months of breastfeeding, that it isn’t worth doing - that is categorically not correct.
With the increased use of MRIs and ultrasound scanning, it has now been shown that the white matter in the brain and reproductive tissue of breastfed babies differs from that of non-breastfed babies. Just because babies and small children look similar on the outside does not mean that they all carry the same risk factors for future medical conditions, such as heart disease, allergies, obesity etc. Medical research has also revealed that the ingestion of colostrum and breast milk, that is not exposed to the additional digestive processes that formula baby milk requires, creates what is described as a protective ‘immunological paint’ along the entire length of the baby’s gut. This develops over the months of exclusive breastfeeding, and has even been reported to still be evident at post mortem in elderly individuals who were exclusively breastfed for several months after birth. providing a protective element to the child in infancy (and possibly long after childhood) against infection and adverse reactions to ingested substances. This may be the reason why exclusively breastfed babies suffer significantly less incidents of diarrhoea in the first six months of life.
Without doubt, and as now scientifically proven, the longer you breastfeed your baby, the more advantages are derived to you both in terms of physical and mental health, and also to the environment. Even if you only manage a short period of breastfeeding, you will have given your baby the very best possible start in life - providing a stepping stone from the constant protection and nurturing that he received in the womb, to the onslaught of potential infection and the need to communicate his needs for nutrition and physical and emotional comfort that life outside the womb requires. You may even find - as countless others do - that the emotional reward of your baby taking himself off your breast, gazing deeply into your eyes, and giving you a broad gummy grin, aimed exclusively at you, inspires you to continue long after you intended to stop!
How often will I need to feed my baby?
Every baby is different and the duration of each feed will vary in the same baby. The bottom line is that the cycle of lactation is fundamentally dependent on the baby’s unlimited access to the breast and failure to empty the breasts regularly will result in a decrease in supply. Remember - your breasts have food, drink and comfort in them – you don’t need to worry which your baby needs, or what you are delivering – just offer your breast whenever it is demanded.
At times when the milk supply needs to increase to keep up with the growing baby’s needs, he will feed more frequently and for longer - often termed ‘cluster feeds.’ When the breasts have responded by producing more milk, the frequency of his demand will generally reduce as he is able to take more milk on board at each feed which will last him longer before he needs another refill.
It is the frequency of breastfeeding that many mothers find difficult to adapt to. Feeds over the first month of life may be demanded as often as every 1½ hours, and this can be incredibly emotionally and physically tiring and difficult to manage. However, there are little ‘tweaks’ to the mother’s routine that can be made to accommodate the baby’s unique pattern of demand, without interrupting the all-important regular emptying of the breast on which the lactation cycle is dependent.
A session with The Latch® can help new mothers to manage their routine during the period when the baby is making heavy demands on her time and energy. Modifying your own routine to accommodate breastfeeding during the first month is one of the most important ways of ensuring that breastfeeding gets off to a good start. It is important to remember that the very frequent demands for feeds will decrease over the first month or so of your baby’s life, becoming gradually more manageable as time passes.
How do I know if my baby has had enough?
The surest sign that your baby has had enough is to see him definitively remove himself from your breast. This is as opposed to falling asleep still attached to the breast, which frequently happens as a result of being full of a mixture of milk and air. By making sure that you help him to avoid or get rid of wind, you will ensure that his tummy is filled with milk, rather than air, which will distend his tummy and make him feel full, until such time as he passes the wind, upwards or downwards, and will then demand a top-up of milk! The Latch® will show you how to watch for signs that your baby needs to feed before he starts to cry, or furiously suck his fists, swallowing air in the process. Efficient techniques will be demonstrated for winding your baby and which will enable you to ensure that at the end of a feed his tummy is full of milk, and he will settle for a sound sleep before his next feed.
I’ve heard some women report that their milk ‘dried up’ after around 6 weeks of breastfeeding. Why does this happen?
The short answer is that it doesn’t!
One of the most common reasons for giving up breastfeeding is the mother’s perception that she doesn’t have enough milk to satisfy her baby. However, as mentioned above, the breasts need to be prompted by the baby’s demand to produce the amount of milk required for his needs. This demand and supply mechanism is essential for successful breastfeeding. Babies have regular growth spurts (often termed ‘cluster feeding’) during which they feed more frequently and for longer periods over several days, thereby prompting the breasts to increase their production. A growth spurt typically occurring around 6 weeks usually follows a period during which mothers have grown accustomed to a calmer period of breastfeeding after the steep learning curve that frequently accompanies the first month after birth - the sudden increased demand from their baby to visit the breast comes as a surprise and can sometimes be misinterpreted by mothers as a sign that their milk has ‘dried up’ or that they suddenly don’t produce enough milk for their baby. Their response is to start ‘topping up’ with formula feeds which has the effect of reducing the baby’s stimulation of the breast, thereby sending messages to the brain that milk is not required and thus production reduces very promptly at precisely the time that the very opposite is required. However, if the mother allows free access of her baby to the breast over the 4 to 5 day duration of the growth spurt, and gives no extra fluids or formula feeds, the breasts respond by increasing the quantity of milk produced, and the baby again receives all the fluid and nutrition he needs. And the best news, is that following the 6 week growth spurt, babies seem to suddenly realise that there’s more to life than breastfeeding – the baby is able to take more milk on board at each feed, feeds become consequently shorter, and the baby can last longer between feeds. Night waking too, becomes less frequent, and babies will often drop a night feed around this time.
It is often said that giving a ‘top up’ of formula milk to a baby is the ‘beginning of the end of breastfeeding’, and this can indeed be the case. If a mother wants to breastfeed, it is essential that she understands that at any time, she has the ability to increase her milk supply by emptying the breasts more frequently.
How do I prevent mastitis?
Mastitis is inflammation of the milk producing structures in the breast. This can be caused by a blocked milk duct or when the milk fails to flow freely through the breast as a result of an imperfect latch. A blocked duct can sometimes be caused by holding the breast too tightly during feed, or by wearing an ill-fitting bra whilst lactating. Infective mastitis may result from bacteria which can enter the breast through a cracked nipple. Mastitis and nipple damage are invariably due in some way to imperfect technique. The Latch® will ensure that your baby is attached in the optimum position to ensure free flow of milk to prevent any blockage or restriction to the flow.
How should I feed: routine or on demand?
The lactation cycle, through which your baby’s demand prompts your breasts to produce milk in the quantities and constituent parts he requires at any one time is entirely dependent on allowing him free access to the breast on demand. As soon as constraints are imposed which limit the stimulation of the breast (eg ‘top-ups’, or trying to impose an unnatural routine for feeding) the milk production will be adversely affected.
The lactation cycle is explained in detail by The Latch® during the pre-delivery preparation session, and our clients learn how to get breastfeeding established successfully and comfortably. Also discussed are ways of incorporating the breastfeeding process into busy lifestyles. It generally takes about a month for mothers to become more confident and for breastfeeding to start to feel more natural. This coincides with the growth of the baby’s stomach reaching the size of a large chicken’s egg, and with a capacity to take on up to 150 mls of milk at a time which enables him to last longer between feeds while the previous intake of milk is being digested. By this time, too, you will have become more familiar with your baby’s natural feeding pattern.
Babies typically need to feed between 6 and 18 times over a 24 hour period to take enough nutrition and fluid on board to meet their needs. Every baby is different, and it is therefore not ideal to try and enforce a one-size-fits-all routine. Any schedule which will limit the baby’s stimulation of your breasts, will inevitably have the result of reducing the amount of milk produced. The effects of this will normally be seen in fractious behaviour in babies in the evenings, or more frequent waking overnight. Do remember, that this can always be rectified by feeding and/or expressing more frequently over several days - the answer is NOT in giving extra formula or other fluids. A far more successful method of establishing some sort of routine may be achieved by trying to modify your own routine to fit around your baby’s natural feeding pattern. This is something which The Latch® can help you to manage.
Which positions are best to use for feeding?
Successful breastfeeding is dependent upon the baby latching well on the breast. To do this, the baby is best nursed with his head, neck and body in a straight line, and his head close to the mother’s breast. The Latch® shows clients how this is most effectively achieved in the early days of breastfeeding, so that the lactation cycle is established early and comfortably for both mother and baby. Ultimately mothers will find their own favourite positions for feeding. As long as an effective latch is maintained, and feeding is comfortable for both mother and baby, a variety of positions may be used.
Studies on lactation have shown that the levels of Prolactin (which prompts the production of milk) are higher when the mother is lying down than when she feeds in a sitting position. All clients of The Latch® are taught how to feed effectively and comfortably lying down, and this can be an important skill, enabling a new mother to catch up on sleep without reducing her baby’s access to the breast.
Can my baby breathe while feeding?
The baby’s correct attachment at the breast ensures that his nose is free to breathe when he is feeding. The Latch® will show you how to position your baby to achieve the all-important ‘latch’ required for efficient and comfortable breastfeeding, and which allows your baby’s nose to be free throughout the feed.
Can you do breast and formula?
The amount of breast milk that is produced is entirely dependent upon the unrestricted access of the baby to the breast. A protein in breast milk notifies the brain when the milk has not moved through the breast, indicating that production is not required, and the supply subsequently reduces. If artificial feeding is used, the baby will not want to go to the breast for the duration of the time it takes him to digest the more complex structure of formula milk. In response to the reduction of the baby’s time at the breast, again, less milk will be produced, and over time, the baby will start taking greater quantities of formula. It is therefore true to say that if formula is introduced, it is the beginning of the end of breastfeeding.
It is also worth noting that research has shown that the increased digestive processes needed to deal with formula milk are thought to destroy some of the protective properties of breast milk, along with the protective ‘paint’ layer that breast milk forms along the length of the gut. Thus, some of the most important properties of breast milk are lost, and this effectively negates the time and efforts already made by the mother to provide these. There are also various genetic conditions (eg asthma, eczema etc) which the baby may have inherited from family members and which may be avoided if exclusive breastfeeding is employed for the first few months of life. Colic, too, is more common in formula fed babies as it is thought to be due to an intolerance to one of the constituent parts of the milk.
When can I start expressing and introducing bottles for my partner to feed the baby?
Expressing breast milk, either manually or with the use of a pump provides the breasts with the stimulation necessary to continue milk production. New mothers can begin to express milk in the early days following delivery, and this can be given to the baby by bottle. Some babies may show signs of confusion between the technique of feeding through a teat, and feeding at the breast, and it is important that care is taken to ensure they fix well to the breast at all times to prevent nipple damage and interference with the lactation cycle. The Latch® provides guidance for expressing milk to give clients an occasional welcome break from feeding to catch up on sleep, and gives their partners the opportunity to give the baby a bottle.
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The Latch® acknowledges that babies may be born male or female, but as all mothers are biologically female, and purely for the purposes of clarity, we refer to the baby as ‘he’ or ‘him’ throughout our information and resources.