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8 steps for breastfeeding success

Most women aim to breastfeed their babies, yet over 80% of those who had stopped before their baby’s 6-8 week check-up wanted to breastfeed longer. Here’s a handy guide to the eight most common factors that help you get breastfeeding off to a great start.

1. Skin-to-skin

Hopefully your midwife will have told you the importance of the ‘golden hour’, of uninterrupted skin-to-skin time with your baby straight after the birth.This helps trigger the babies feeding reflexes, and babies can actually manoeuvre themselves over to the breast and get themselves on.It also helps the baby transition from the womb and regulates their heart rate and temperature and promotes bonding.You can even have skin-to-skin in theatre after a caesarean, and if you are not well enough for it, then your partner can do skin-to-skin.But it’s not just for the birth room.

Skin-to-skin in the days after the birth is almost a magic wand for sorting out breastfeeding problems.I helped a couple with their three-day-old baby who had not had a single feed from the breast, she was just too sleepy.It had been a difficult birth and they had been separated for the first 24 hours.The woman was expressing and they were cup feeding their daughter.We tried some skin-to-skin and immediately she started to be more interested and moved herself over to the breast – and then fell asleep again.But at least that gave them confidence that she could do it.I left them with instructions to do skin-to-skin all the time, and keep up with the expressing and cup feeding.On the third day of doing this they said it was like she woke up.She shuffled herself over to the breast and started feeding.When I last saw them their daughter was a year old and still breastfeeding.

Skin-to-skin will also boost your milk supply anytime.If you can’t go to bed and do it, then do naked baby wearing – go topless with a cloth wrap sling.It will keep your modesty, and give you a free pair of hands.(There are sling libraries all over the country and lots of YouTube videos of how to wrap.)

Last word on skin-to-skin: baby can wear a nappy!And if you are more comfortable you can wear a bra and a top – just tuck your baby inside.

2. Little and often

Babies tummies are tiny.So they want to feed often.This is normal and not a sign that you don’t have enough milk, nor that your milk isn’t good enough – it will be. They are used to being feed 24 hours a day through the umbilical cord so don’t be surprised if they seem to want to be as attached to your breast sometimes.It will pass.

It is worth understanding normal baby behaviour in the first week.If they have had a fairly straightforward birth (no caesarean, assisted birth, epidural or pethidine) then they are likely to be fairly awake for a couple of hours after birth and then have a long sleep (2-6 hours) as they get over the birth.Then they wake up super hungry and want to be fed every hour and a half/two hours.This lasts for one or two days and then they the feeds start to stretch out.But don’t get too obsessed by the feeding interval.Follow your baby’s lead. The more they feed; the more milk you’ll make. And that’s a great way to get breastfeeding going.

Did you know that babies are programmed by millions of years of evolution to feed more at the times of the day when their mothers’ bodies are producing more prolactin (the milk making hormone)?Do you want to guess when this is?If you have had a baby you will probably be able to guess – about 6pm and 5am. So don’t be surprised if your baby cluster feeds at these times.

After the first week there will still be days when they don’t want to be put down. These are often called ‘growth spurts’, though actually these periods of high demand usually come just before a ‘growth spurt’ as the baby is nudging the body to change the milk supply for the next stage of their development.

3. Good latch

Nobody wants sore nipples so it is worth getting this sorted early on.A good latch also means the baby is able to get enough milk out – and that means you’ll make more milk so it’s a win-win.Don’t leave it too long to get help because the baby gets used to doing it one way.Sometimes all it takes is a small adjustment.Take a look at my blog article Seven signs of a good latch.

One of the easiest ways to get the latch sorted is to lean back (so your baby’s weight is on your chest), place the baby between your breasts (skin-to-skin preferably but not necessarily) and let the baby get themselves over to the breast and self-latch.

4. Nothing but breastmilk

The more your baby feeds, the more milk you will make.It is that simple.So if you start giving your baby anything else (formula, boiled water) you will make less milk. Breastmilk is all your baby needs till about six months. In hot weather your milk will be more watery to quench your baby’s thirst.Your breastmilk is perfectly designed for your baby.Scientists have found that breastmilk is different for boys and girls; it is different at night (fewer calories and more brain building stuff); and it changes as your baby gets older. Amazing stuff.

In the first day your baby only needs a teaspoonful per feed (of the rich colostrum).It just comes out in drops.When your milk comes in, usually around day five, you will be making about 70ml per feed.Babies need a lot more formula to get the same amount of nutrients so don’t be put off if your friend is giving her bottle fed baby more than that.

Some women are tempted to give their babies ‘top ups’ of formula milk because they fear they don’t have enough milk, or to help their baby go longer between feeds.Top ups and going longer between feeds will cause your milk supply to drop, so if you think this is sometime you’d like to do then talk to someone about how to keep your milk supply up.It’s too easy to end up in a downhill spiral of top ups and then less milk so more top ups, and before you know it breastfeeding has stopped.

A small study done at Bedford Hospital showed that babies who had top ups of formula milk in the first week were more likely to stop breastfeeding.Some women give their baby top ups because that’s what they’ve been advised.It is better for your milk supply to give the top up all in one feed, and express then, rather than a bit at a time, which may mean your baby goes longer between feeds – and fewer feeds mean less milk is made.If you are in this situation it is worth asking too see the infant feeding midwife, as paediatricians are not experts in breastfeeding (believe it or not).

Having said all this it is possible to combine breast and bottle feeding – it is not an either/or.If at any time you feel your milk supply going down then encourage your baby to feed frequently for a day – you’ll notice the different 24-36 hours later.

5. No teats or dummies

It is a different action for the baby to drink from a bottle then to take milk from a breast.Some babies cope fine with both, but for others it’s enough to stop them feeding well at the breast, either because they don’t latch on well, or because they prefer the quick flow of the bottle.You can avoid this ‘nipple confusion’ by doing ‘paced bottle feeding’ which encourages the baby to take the bottle more like the breast.

If you need to give your baby top ups or expressed milk in the first few days and weeks you can do this without using a bottle.In the first couple of days you can use an oral syringe, and then move on to a cup.You can even use a supplemental nursing system, which is basically a bottle or pouch with the milk in, and a thin tube which goes into your baby’s mouth while they are at the breast. This encourages your baby to attach at the breast and also stimulates your breasts to make more milk.

It’s also good to avoid a dummy – at least in the first few weeks while breastfeeding is getting established.A dummy can hide your baby’s hunger cues, and because sucking on a dummy may encourage your baby to go longer between feeds – which isn’t actually a good thing for your milk supply.

6. Straightforward birth

With a straightforward birth you are more likely to get skin-to-skin, your hormones and the baby’s will be high with oxytocin which helps with breastfeeding.Having a caesarean, assisted birth, epidural and/or pethidine can make your baby more sleepy and less willing to feed. Knowing this is useful because then you can give yourself and your baby a bit longer to get breastfeeding going. Research shows, for example, that having a caesarean means it takes longer to get breastfeeding going – but you are just as likely to be feeding at 6 weeks as someone who didn’t. Keep going; do lots of skin-to-skin; express to keep your milk supply up; and get help. As with the example earlier you can express and syringe or cup feed.Although it is very distressing when your baby won’t feed remember babies have stories of fat to help them in the first few days of life.And there are lots of people to help you – see below.

7. Support at home

This means practical and moral support.You can take a ‘baby moon’ and stay in bed for the first week with your baby.This helps you recover from the birth and gives you the space and time to get breastfeeding sorted, because in those first few days it is often easiest just to have everything out so you can see what you are doing.You can do lots of skin-to-skin, and get to know your baby and their cues.Midwives and health visitors are always very happy to see a mum and baby in bed (they’d be more worried if you were up and dressed and the house was spotless). If you have guests you feel you should get up for then they are not the guests you should have in the first week. If you have an older one this is a great chance for them to spend extra time with daddy and nanny/aunt. They’ve had you to themselves for the last x years, your new baby only gets this one week.If you concentrate on them early on it will be easier later when you are juggling two.

Even after the first week breastfeeding can seem like you are tied to the bed or the sofa, but that’s not necessarily a bad thing.And it will pass.So it can really help to have help to do the housework and the cooking.It will become quicker and easier and come three months when you can just pop them on for 10 mins and they’re done, and you’re not washing and sterilising bottles, you will be pleased you persevered.

You also need moral support too.Sometimes the most well-meaning people can be really undermining.A relative said to me after I’d had my third that if I was giving bottles then they could help with feeding. But breastfeeding was the only time I got to sit down so I wasn’t going to stop that.You particularly need moral support for breastfeeding in public. This is a big fear for many women, but in actuality over 99% of times women are breastfeeding in public nobody says a single thing.In fact, it is so rare that when it does happen it is national news.Take a deep breath. You’ve got this.

8. Knowing where to get help

Maybe you need help with one of the things above, or maybe there is something else at play, such as tongue tie, thrush or mastitis.There is lots of great support out there.

All over the country there are breastfeeding drop ins with highly trained, friendly, understanding staff – like me - waiting for you to turn up. Use them. Your midwife should have given you a list. Or call your local surgery or children’s centre.

Call your midwife or your health visitor and ask them to visit. You are not putting them out. They will be very pleased.It is their job. And they have targets to achieve around the numbers of babies being breastfeed. They want to help. However, not all are as experienced as others, and some still give bad advice, so if they weren’t helpful or you would like further advice, go to a drop in or use one of the helplines below. A little tip: GPs aren’t breastfeeding experts, and can be behind the times.

Here are some helplines, and some organisations have trained breastfeeding counsellors who can visit, or who run drop ins.

You can also contact a private lactation consultant.

I hope you found this helpful. There is always so much more to say. Take it one day at a time. Please let me know what helped you. What advice would you give to new mums?

I trained as a breastfeeding supporter with the NHS, and ran the breastfeeding drop in at the Sure Start children's centre where I worked, where I helped hundreds of women, both at the drop in and at home visits. I now work as a doula (birth and postnatal) and provide breastfeeding support through this. I run antenatal breastfeeding masterclasses.

Please check out my website for details of this and my other services.

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