In most cases breastfeeding should be started as soon as possible after birth when the baby is particularly receptive. Exceptions to this guidance include situations where the baby is unable to breastfeed immediately after birth, such as when a baby is born prematurely or needs special care or after a caesarean section.
A correct feeding position will provide the baby with a good flow of milk and also prevents the nipples from becoming sore.
Breastfeeding may feel uncomfortable at first, but this usually eases as the feed continues, and should cease altogether after the first week or two. If not, you should ask your midwife, health visitor, or breastfeeding counsellor to check whether your baby is positioned correctly.
To ensure that both breasts are used equally, most mothers either offer both breasts at each feed, or switch mid-feed. Starting each new feed on alternate breasts can be an easy way to make sure they both get used.
Newborns usually get hungry every 2-3 hours, but as babies grow and take more milk they often need less frequent feeding - the main thing is to feed them when they're hungry and offer them a feed if you think they want one. You will produce milk to satisfy your baby's demand. The more you feed your baby, the more milk you will make.
Make sure you get plenty of rest and eat well, although you do not need a special diet in order to produce enough milk.
How breast milk is produced
Following the delivery of the placenta after childbirth, levels of the hormones oestrogen and progesterone drop quickly. The body starts to release a hormone called prolactin, which stimulates the body to produce breast milk.
Special cells in the breast (acini cells) make milk, which is then stored in the breast. When the baby touches the breast a hormone called oxytocin is released, beginning a process known as milk let-down or ejection reflex. This pushes the milk to the areola (nipple and surrounding area), and releases it as the baby feeds. When you first start breastfeeding, let-down happens without you having much control over it. Later it becomes a reflex action in response to the baby's cry or just by thinking about the baby or feeding.
Milk Supply
Your baby will need to be fed as often as they are hungry to help establish your milk supply. Every time that you feed your baby, messages are sent to your brain, which then sends messages to your breast to produce more milk.
For the first few days after birth, the breasts produce a yellowish substance called colostrum. This is rich in fats and protein and easy for the baby to digest. Colostrum also contains infection-fighting antibodies (immunoglobulins), which strengthen the baby's immune system.
The baby will feed frequently on colostrum until a supply of mature breast milk is established (this can take up to ten days). Mature milk has a more watery appearance. At the beginning of a feed it is almost blue in colour and becomes white by the end of a feed as the fat content increases.
Breasts produce two kinds of milk needed by the baby, in perfect quantities:
- foremilk - is thin and watery, and quenches the baby's thirst. It is the first milk to come out at the start of a feed, and it is low in fat, but high in milk sugar (lactose).
- hindmilk - as the feed continues, the fat content increases, and the milk starts to consist of hindmilk. This is rich in fat, provides calories for energy, and promotes the growth of the baby. As the baby grows, it is important that they receive the hindmilk in order to meet their nutritional needs.
Breast size bears no relation to how much milk you can produce. A woman with small breasts can produce just as much milk as a woman with large breasts.
How long a feed takes
Feeds usually vary in length, from anything between a few minutes to up to one hour, and there is no ideal length of feed. The average length of a feed is influenced by:
- whether the baby is positioned at the breast correctly,
- the speed of milk let-down and rate of flow,
- the quantity of milk available, and
- the baby's age.
For some mothers, breastfeeding comes easily, while for others it may present more of a challenge. If you are finding breastfeeding difficult or painful ask your GP, midwife, breastfeeding counsellor, or health visitor for advice as soon as you can.
Recommendation
A balanced, varied diet and drinking plenty of fluids (at least eight glasses of water a day) is very important during breastfeeding, to ensure that mother and baby are in the best of health.
Breastfeeding requires at least an additional 500 calories per day. Much of this energy can be derived from fat stores laid down during pregnancy. However, remembering to eat when you are hungry, and drink when thirsty, is essential.
Some substances pass into breast milk from the mother's body. Although generally less than 1% of any drug will pass through, it is wise to reduce or avoid your intake of anything likely to unsettle or irritate your baby. For example, nicotine, alcohol, caffeine or illegal drugs can affect feeding, sleeping and digestion.
Mothers taking medication for an existing condition should always seek the advice of their doctor. It is essential when consulting health professionals to tell them that you are breastfeeding, so that advice and treatment is appropriate.
The frequency of feeds can increase during a baby's growth spurts, which commonly occur at around two weeks, six weeks, three months and six months, although every baby is different.
It may take 24-48 hours for the milk supply to catch up with the increase in demand, so rest where possible, eat well and drink plenty of fluids during this time.
Expressing milk
If you want to combine breastfeeding with using bottles of formula milk, it is important to get breastfeeding fully established first to ensure that your own milk supply is not affected. It is more difficult to change from bottle feeding with formula milk to breastfeeding than the other way around.
As an alternative to introducing formula (which is nutritionally different because it is made from cow's milk), many mothers use breast pumps to express milk into bottles. This supply can be kept in the fridge for a maximum of 24 hours, or stored in a freezer for up to three months for later use. It should never be re-frozen once thawed.
Working mothers can also find pumps useful for expressing milk during the day. If you spend much of the day away from your baby, your milk supply may change. Using a pump can help to keep the supply up and the expressed milk can be used for the baby's feeds while you are at work.
Breastfeeding and contraception
The production of prolactin during breastfeeding suppresses the release of eggs from the ovary in some women. However, this contraceptive effect is only true if you are fully breastfeeding a baby aged less than six months.
This means that you must:
- be breastfeeding at regular intervals, day and night (feeds no longer than six hours apart),
- be giving your baby no other food or drink, so no breastfeeds are missed, and
- have had no normal periods since the baby's birth.
Even if you fulfil these conditions, there is still a chance you could get pregnant. Most family planning clinics and GPs advise taking extra precautions, such as the use of condoms, the progestogen-only pill (POP) or IUD (the coil).
If your baby has a cold or flu...
If you baby has flu, breastfeeding should help reduce the risk of associated complications, such as pneumonia and chest infections.
Answers to some commonly asked questions are given below.
My baby has flu and seems to be feeding all the time - is my milk not enough?
Babies with colds and flu often feed frequently, both for extra fluid and for comfort. Feeds might be short as it can be harder for your baby to feed with a snuffly nose. The more frequently you feed your baby, the more milk you will make.
Why does my baby pull off and cry when he starts to feed?
Babies can get earache when they get colds and flu, which may mean they pull off when feeding and cry. You may notice this more when they have had a long sleep or at night, as the flow of milk may be faster. If you baby has a temperature or seems ill, call your GP.
My baby is now three months old and I’m thinking of stopping breastfeeding. Will the fact that I have breastfed her up until now still help protect her?
Research shows that when breastfeeding stops, the protective effects of breastfeeding start to wear off. To give your baby more protection, consider carrying on breastfeeding for at least six months.
Breestfeeding
