Breastfeeding: the early days

Whatever shape or size your breasts are - large, small, pert, droopy or lopsided - they are all able to produce milk when the time comes, and their appearance is not a factor governing your ability to breastfeed. In fact the breasts only store a small amount of milk in the ducts; it’s the milk-producing cells that determine milk production.

Breastfeeding works by supply and demand; as long as your baby suckles frequently the milk will be there for him as he needs it. The keys to success in the early days are frequent feeding and correct positioning.

During pregnancy, you might discover that you are starting to produce a little breast milk which may leak out from time to time. This is quite normal, but it is equally normal not to produce any. You may find that if you gently squeeze your nipple, some drops of milk will appear towards the end of your pregnancy.

There is no need to make any physical preparations for breastfeeding. Ignore any old wives’ tales that you hear about toughening up your nipples. However, finding out about breastfeeding from someone who has breastfed their children, and having the phone number of a breastfeeding counsellor, will mean that you are as well prepared as you can be.

Many first-time mothers find getting breastfeeding established difficult and combined with the baby blues it can be a very emotional time. Problems will not go away on their own so ask for help and support immediately, or you may be put off breastfeeding altogether.

• First feeds
• First milk
• Mature milk
• Making plenty of milk
• Positions
• Latching on
• Let down
• Initial soreness
• Taking your baby off
• Baby-led feeding

First feeds

After your baby is born, you should offer him a feed as soon he is interested. Many mothers feed immediately after delivery, and there is evidence that the sooner breastfeeding begins, the more likely you are to be successful. But don’t worry if you don’t get off to a text-book start. A strong desire to breastfeed will make up for any delay. If you are keen to breastfeed, you should write this down in your birth plan, so the hospital staff can help you.

Your baby will follow his own pattern of feeding, but it is not unusual for the first 24 hours to be fairly quiet, as he rests after the birth. After that, you may find that he is feeding erratically; maybe every hour for five hours, and then a four-hour sleep. But there is no pattern, no rights and wrongs, apart from letting your baby feed when he wants to. Don’t expect any routine to be emerging at this stage, and just rest when you can.

A good feeding position is vital during these first days. While a certain amount of discomfort at the beginning of a feed is not unusual, severe pain throughout the feed is sending you a message that something is wrong. Very often, the pain is caused by the baby being poorly positioned at the breast, which can be quickly remedied.

First milk

For the first few days your breasts contain colostrum, a highly concentrated creamy milk which is brimming with antibodies, proteins, vitamins and anti-infective agents.

At this stage your breasts won’t look any different, and because the amount of colostrum your baby needs is small, you may think that you’re not producing anything. But you are, and you should let the baby suckle whenever he wants to. His suckling will stimulate your system into producing mature milk, and frequent suckling in these first few days will help prevent engorgement when the milk does come in.

Mature milk

After two or three days mature milk will appear. You will notice your breasts getting bigger and heavier as the volume of milk being produced increases, and that the milk becomes thinner and whiter.

At every feed your milk will include foremilk and hindmilk. The foremilk is a thirst-quenching drink, high in lactose (milk sugar) but low in fat, while the hindmilk that follows on is higher in fat and very important for your baby’s growth.

Restricting the time your baby is at the breast can mean he gets too much foremilk and not enough hindmilk. This means he will become hungry again quite quickly, and may make him colicky. Let him feed for as long as he wants at one breast, to ensure he gets sufficient hindmilk.

Making plenty of milk

The more you feed your baby, the more milk you will make. Suckling acts as a trigger for producing more of it. Therefore, so long as your baby is well positioned on the breast and feeding regularly, he will be getting plenty of food.

If your baby isn’t properly latched on, not only will you find it very painful, but also he won’t be able to take the milk he is ordering. You will make more and more milk, but he won’t be removing it, which may lead to you becoming engorged, or developing mastitis.

If you are uncertain about the positioning, ask your midwife.

Some mothers worry about the amount of milk their baby is getting because it’s impossible to see how much the baby takes. There are other ways of identifying whether your baby is feeding well and has plenty of breast milk. If he’s producing plenty of wet nappies, is bright and alert and gaining weight steadily, then you can be reassured that he is getting all the milk he needs. If you feel concerned, ask your midwife or health visitor for advice.

Here’s how to maximise the amount of milk you make for your baby:

• Get the positioning checked by your breastfeeding counsellor or midwife
• Put the baby to the breast frequently
• Rest more. Have a ‘babymoon’; go back to bed with your baby for 24 hours and just rest and feed together
• If your baby is very sleepy, ill or premature, express milk after a feed to keep your supply up
• If your problems have lasted some time, start all over again. Imagine that your baby is newborn, help him to latch on correctly and offer him lots of feeds

Positions

Finding a feeding position that is comfortable is very important. There will be times when you are feeding for some time, and if you don’t feel relaxed and comfortable, you will want to end the feed as soon as possible, rather than when your baby has finished.

© NCT Publishing

• In the first few days you may find it helps to sit in an upright chair and bring the baby up to the right height by lying him on one or two pillows
• You should have plenty of support for your back and neck - try leaning against a pillow or two
• You may also want to raise the level of your feet so that your lap isn’t sloping downwards. Use a low stool, some magazines or a cushion under your feet
• Mothers who have had a Caesarean section often prefer to feed lying down in order to avoid the baby pressing on the wound
• For the first few feeds you may need the help and support of your midwife to position the baby properly

By experimenting you will quickly find positions that feel comfortable for you and will be able to feed your baby either sitting up or lying down.

Your baby’s position is also important:

• Your baby’s whole body should be facing your breast, so he should be lying on his side rather than on his back whether you are feeding him sitting up or lying down
• His body should be in a straight line, so that he doesn’t have to turn his head to feed
• He should be tucked in as close to you as possible

So long as you remember these three rules, you can feed in any position you choose. As you become more confident you will be able to feed standing up, or sitting cross legged, but most mothers take a few weeks to get to that stage, so take your time finding the right way for you.

Latching on

A vital ingredient of successful breastfeeding is getting your baby properly latched on, which means attaching him to the breast with a wide open mouth.

Some babies seem to do this instinctively from the start, and others need to be encouraged. Your baby will learn the right method quickly if you always wait for his open mouth before he latches on.

© NCT Publishing	When you are ready to start a feed: Make sure your baby’s nose is opposite your nipple Move your baby close to you and stroke his mouth or cheek with your finger or nipple. He should respond by opening his mouth and turning towards the stimulus. This is the rooting reflex
Move your baby towards you so he can take the breast. He should take as much as possible, so that your nipple rests against his upper palate and his tongue is underneath. If the nipple is far enough back in his mouth, it won’t move during the feed, and shouldn’t get sore	© NCT Publishing

Look for the following evidence of a good latch:

• Open mouth, with bottom lip curled back
• Baby’s chin touching your breast
• Mouth and jaw movement
• Tops of ears wiggling slightly as he sucks
• Most of the areola (the pigmented area of skin around the nipple) in the baby’s mouth

© NCT Publishing

He isn’t well latched on if:

• You can hear a clicking noise
• You can see his cheeks are sucked in
• You feel pain throughout the feed rather than a slight initial soreness

If he isn’t latched on correctly, take him off and start again.

Let-down

There will always be some foremilk ready for your baby to drink when he latches on to the breast. When he starts to suck, the milk-producing cells then start to squeeze hindmilk forward into the ducts leading to the nipple so that it is there for him to take.

This is called the let-down reflex. A tingling sensation or pins and needles in your breast, as well as some leaking of milk in the non-feeding breast, sometimes accompany it. You may also feel a sense of calm and relaxation come over you. It isn’t always obvious, so don’t worry if you don’t feel anything. So long as your baby is thriving on your milk, it will be happening anyway.

In the first few days after the birth, you may feel stomach cramps when the let-down takes place. This is because the hormone oxytocin, which stimulates the let-down, also causes the womb to contract, helping it to return to its original shape. These contractions will only last for a day or so, if at all; many first-time mothers don’t experience them.

As your body adjusts to breastfeeding, you may find that the let-down is triggered by hearing a baby crying, or even just thinking about your baby.

Initial soreness

For the first week or so many women experience some initial soreness. This is not surprising really since your breasts and have been safely tucked away inside bras for years. Good positioning will prevent soreness developing into a problem and your breasts will become less sensitive.

You can help minimise soreness by:

• Making sure the baby is properly latched on. Get help from your midwife or breastfeeding counsellor if you are not sure
• Leaving your bra off for short periods, unless you find it uncomfortable, so your breasts get some fresh air
• Rubbing in a little expressed breast milk at the end of a feed and allowing it to dry on the skin

Some women like to use nipple creams, but these can cause problems. They may need to be washed off before a feed, which can be uncomfortable if you are sore. Any cream left on the nipple can make the breast slippery, so the baby does not latch on properly. If you do find using a cream helps, choose one that can be put on after a feed and allowed to soak in before the next feed (homeopathic creams work in this way). Use it sparingly.

Taking your baby off

One of the most frequently asked questions about breastfeeding is: how do I know when my baby has finished a feed? Very often, your baby appears to be fast asleep at the end of the feed, but as soon as you try to gently extricate yourself, he starts to suck vigorously again.

As you get to know your baby better, a pattern will begin to emerge, and you will see how long he tends to take for a feed. You are an important factor in this as well. There may be times when you are able to let him doze and suck for an extra half hour, and other times when that isn’t possible.

The baby’s grip on the breast can be very firm, so it is important to break the suction before moving him. If you try to pull your nipple out of his mouth, you may find you get very sore.

You should break the suction by putting a clean little finger in the corner of his mouth, which will release the hold and allow you to gently remove him.

Baby-led feeding

Breastfeeding is governed by the principle of supply and demand, which your baby will instinctively be able to control. The action of feeding triggers a reaction by your body to make more milk for the next feed.

This is why it works best to feed your baby on demand, when he indicates that he wants to feed, rather than by the clock. If you do this your body will be perfectly attuned to the nutritional needs of your baby and will make the correct amount of milk.

This does mean that you will be doing a lot of feeding in the first week or two, perhaps more than you anticipated. If you can, use this time to rest and relax. As your baby grows, there will be more room in his stomach to accommodate a larger feed, and he will also be able to take a feed more quickly, so this phase shouldn’t last too long.