How to breastfeed successfully

Breastfeeding has many benefits for both mum and baby.

Breastfeeding

Hi, I’m Charlotte. I’m one of the specialist midwives at North and Hartlepool NHS Foundation Trust, and I’m here to talk to you about how to know when your baby’s getting enough milk.

So, we would expect your baby to feed 8 to 12 times in a 24-hour period. When baby does feed, we ideally want to see plenty of sucking and swallowing in a rhythmic pattern, and we’d expect babies to be settled and content after their feeds.
For mums, we should make sure that feeds are always comfortable.

You may hear us say something like, “If it’s going in, it’ll be coming out.” So the number of wet and dirty nappies that you may expect in the early days will continue to grow, particularly as we notice change in stools from meconium through to a change in colour to bright yellow.

Ideally by day six, we would expect to see six wet nappies and at least two poos the size of a two pound coin. If you feel that your baby isn’t having this level of output, you should contact your midwife for further advice.

It’s not uncommon for some babies to lose weight after they’re born. For weight losses of greater than 8%, you may see your midwife put into place a proactive feeding plan to make sure you have the help that you need.

Sometimes babies will also gain their birth weight back quite slowly, and that might involve additional support as well. By the age of 2 weeks, they should be back to their birth weight and gaining weight steadily. A good indicator of this can be a change in the fit of your baby’s clothes and nappies.

Crying is normal, but is usually a late sign for hunger. So try to focus on early feeding cues including rooting, lip smacking, finding their hands so that you can offer feeds responsively.

Another good time when you might offer a feed is for your own personal comfort responding to your own needs. That might be if you need a cuddle with baby, if your breasts are feeling full, or if it’s just a convenient time to be together.

If you’re ever unsure, please reach out to your midwife or health visitor for support. You’re doing an amazing job.

So hand expression can be a really useful skill to learn, especially in the antenatal period. You can collect colostrum from 37 weeks of pregnancy.

Another time that might be helpful is if you were needing some milk and you hadn’t been able to offer your baby a feed at the breast.

So it’s really important when preparing to hand express that you find a sterile clean container and you also wash your hands before getting started. If you can find a nice relaxing setting in which to do it, that helps a lot more in terms of the release of your hormone oxytocin, which is really important for milk production.

So, I’m sat down in a nice comfortable place and then what I’m going to do is some soft touch and massage and that can be really helpful to stimulate the hormone prolactin, which is really touch sensitive.

Following that, once I’ve done that massage, what I’m going to do is take my hand in a C-shape and then I’m going to place it two to three centimetres from the base of the nipple, like so. You can see that C-shape there.

Then what I’m going to do is very firmly compress and release and compress and release, and if you’re going to see any milk, it’ll be in small beads around about here. If it isn’t working in this position, you can come half a centimetre back or half a centimetre forward dependent on how those breasts feel for you, and then continue to do so until you see a reduction in flow. As that starts to slow down, what you might want to do is rotate round because there are milk ducts all the way around the breast, a bit like segments of an orange. So, as you move your placement of your C-shape round, you’ll be stimulating different ducts to help with that flow of milk. Once you’ve done one breast, you can move over to the other one as well.

Positioning

Effective positioning is essential to enable your baby to take as much milk from the breast as needed. This is often evidenced by feeding being comfortable for you both or signs that baby is swallowing milk well.

If you are experiencing any pain or discomfort during a feed, or are concerned that baby may not be swallowing much milk, please contact your midwife or health visitor who will be able to support you.

There are many different positions for breastfeeding but all you need to remember is the acronym CHINS*.

CHINS

Close – baby needs to be close to mum so that he can scoop enough breast into his mouth.
Head free – baby needs to be able to tilt his head back when attaching to the breast. This is to allow his chin to lead as he comes on to the breast.
In-line – Baby’s head and body need to be in a straight line so that he doesn’t have to twist his neck. This makes swallowing easier.
Nose to nipple – Mum’s nipple should be just below babies nose so that as he roots and tilts his head backwards the nipple will slip under his top lip upwards and backwards to rest on the baby’s palate.
Sustainable – The position should be comfortable for both mum and baby for the duration of the feed.

*CHINS was developed in 2010 by Dr Lynette Shotton at Northumbria University.

Gloabal Health Media: Attaching your baby at the breast

Recognising effective attachment

There are several queues to look out for that will help mum to recognise when their baby has effectively latched on to the breast:

Chin touching breast
Mouth wide open
Cheeks full and rounded
More areola visible above top lip
Rhythmic suck / swallow with pauses
Feeding is should be pain-free

Exaggerated latch

Also known as the ‘flipple’ or modified latch. This technique can be helpful to achieve a deeper more effective latch if normal positioning and attachment techniques are not working.

The Milky Life: How to latch a baby using the exaggerated latch technique

Responsive feeding

A sensitive two way relationship between a mother and her baby. A mother responds to her baby when:

Baby shows feeding cues – rooting, moving their eyes, wriggling, waving sucking fists, blanket and making murmuring noises
Baby is distressed – tired or lonely
Her breasts are full
She simply wants to sit and cuddle

Confident feeding

Your midwife will listen to any concerns you may have about feeding your baby and support you to gain confidence by:

Making sure you understand what is responsive feeding
Showing you how to hold your baby for feeding
Informing you how to access help when at home

Unicef: Breastfeeding leaflet – off to the best start

Breast compressions

Breast compressions can help increase the flow of milk whilst baby is breastfeeding. This can be useful if a baby is struggling to attach effectively or is sleepy at the breast and not feeding well.

Kathryn Stagg IBCLC: Breast compressions

Colostrum harvesting

An effective establishment of breastfeeding in the first few day’s with baby, significantly increases your chances of maintaining and continuing a good breastfeeding routine.

However, some babies may experience initial feeding difficulties, or challenges maintaining their blood sugar and for medical reasons they may require supplementation.

In these cases, some mothers may wish to make an informed choice to express colostrum before delivery to support in breastfeeding and to avoid the use of formula.

Ask your midwife about colostrum harvesting from 36-week gestation and to get a colostrum harvesting pack.

Hand expression is a useful skill to know for breastfeeding women, particularly in the following situations:

To tempt a sleepy baby to feed
To relieve engorgement, and help a baby attach
To manage blocked ducts
To feed a baby that is unwell and needs to be admitted to the neonatal unit
To express colostrum prior to baby’s arrival

Colostrum Harvesting

The below video from UNICEF also explains how you can hand express.

Expressing your milk

How to hand express

The UNICEF UK baby friendly initiative recommends that all mothers are sown how to express.

This is a useful skill that can be used in the following situations:

– Expressing small lots of colostrum to tempt the sleepy baby in the early stages of breast feeding
– When breasts are full, making it hard for babies to atta
– To help clear a blocked duct
– Or if you are separated from your baby, for example when your baby is on the neonatal unit.

So when you’re expressing start by doing anything that relaxes you. A cuddle with your little one, skin-to-skin, bit of massage, anything that helps you relax.
So sometimes it can be kneading around the breast, stroking whatever feels right. Whatever feels comfortable to you.

If expressing for a premature baby, massaging is important to ensure a good milk let down. However, if just expressing to soften your breast, just a small amount of massage with suffice.

Once you’ve done that for some time, if you make a ‘C’ shape with your hand. The thumb and finger. Gently feel back from the nipple about 2-3 centimetres. Hold that for a few seconds and then release. Compress hold and release.

Now in the early days of colostrum, this wont come straight away, it can take some time.

So just keep working that one area, it will appear as little beads, as the milk comes in you’ll see it will flow much more easily.

Sometimes you may need to move forward a little bit, then back a little bit, the main thing is working that one area until it fully subsides.

Then what you can do is rotate around the breast and work on the next area compressing, holding and releasing.

That key thing is you’re doing that key compressing right with your thumb and finger are and you’re making sure you’re not sliding, that’s really important.

When you slide along the skin it’s not as effecting and you can cause trauma to the skin. So work in the one area, keep that thumb and finger opposite each other is just perfect.

Ask your midwife or health visitor to talk you through how to hand express.
If you are expressing for a baby who is in the neonatal unit, try to express near to your baby or have a photo or piece of babies clothing to hand as this will help boost your milk making hormones.

Storing expressed breast milk

Expressed milk can be stored at room temperature for just six hours.

The department of health (DOH) advices that milk can be stored in the fridge for five days or in the freezer for:

Freezer -18° = six months
Defrosted in fridge (use within 12 hours)
Defrosted at room temp (use immediately)

Support

If you are having any difficulties with breastfeeding it is important that you seek help from your midwife, health visitor or an infant feeding specialist as soon as possible.

This can help to solve issues like sore nipples or breast engorgement quickly.

The NHS website has lots of useful information around some of the most common problems breastfeeding and tips on how to tackle them.

NHS: Breastfeeding challenges