Preparing to Breastfeed

My tips and top links for breastfeeding parents to be!

Having a baby comes with a lot of questions for parents to be. Which pushchair is best? What should my baby sleep in? What clothes do they need? How can I prepare for birth?

If you are anything like me, reading this while pregnant with your first child, the last one might feel a bit all-consuming. When I ‘prepared for my baby’ I read everything possible about birth options. I read next to nothing decent about breastfeeding.

When the midwife asked me how I planned to feed my baby, there was no question in my mind I would breastfeed. It didn’t occur to me I knew nothing about breastfeeding. I thought I had boobs and I would have a baby, and I had booked antenatal classes, so surely that would be enough. I thought my determination would fill in any gaps.

Really, what would have been helpful, was to have done less research into what Moses basket we needed for our baby (spoiler alert: actually a completely useless item) and a more research into breastfeeding. To have had a breastfeeding plan to sit alongside that birth plan. Why is this? For the simple reason, that while breastfeeding is a natural skill, it is a learned skill like walking, not an innate skill like breathing. Much like walking, while you learn to breastfeed you might land on your arse. You might need a bit of support. This is entirely normal in a culture where we do not learn to breastfeed the way we are supposed to. We are meant to learn by watching other people breastfeed, but very few of us see breastfeeding in our everyday lives. Bottle feeding culture prevails in the UK. Quite often, the first breastfeeding baby we might see is our own.

With that in mind, here are a few tips from me, to you, with the benefit of hindsight and a bit of training in breastfeeding support
💚 .

Book an antenatal breastfeeding workshop

In some areas, your local breastfeeding support groups may hold specific antenatal breastfeeding workshops. While lots of us will do an antenatal class, these breastfeeding specific workshops will be far more in-depth. Your midwives or health visitors would hopefully know if these run in your area. If not, it could be worth getting in touch with local support yourself to check if they have any upcoming sessions.

Sometimes lactation consultants will run antenatal breastfeeding preparation. Depending on the consultant there may be a charge for this.

Getting in touch with support options in advance to do this nicely leads me on to the next tip…

Visit a breastfeeding cafe

breastfeedinggroup

Visiting a breastfeeding group antenatally can be well worth doing. It might only take an hour out of your day and there are several benefits; you make contact with the support before you need it, so you know exactly where to go when baby arrives, you get to observe and take in what breastfeeding looks like (so important!) and breastfeeding parents will be able to talk to you about their experiences and what to expect. Breastfeeding groups are often totally free and informal. So you’ve really got nothing to lose💚.

Find your local breastfeeding support groups here and here!

Read a good book about breastfeeding

recommendedbreastfeedingbooks
Top left: The Food of Love by Kate Evans
Top right: The Womanly Art of Breastfeeding by La Leche League International
Bottom left: The Positive Breastfeeding Book by Amy Brown
Bottom right: You’ve Got it in You by Emma Pickett IBCLC

Reading a good book about breastfeeding can be really helpful. It’s also handy to have on hand for those early days when you might feel overwhelmed. It’s easy to forget what was said in the workshop or the hospital especially when you have a small baby. Popping this book in your breastfeeding box (more on this later!) can be super useful.

Like most things in life the quality of breastfeeding advice in print can massively vary so look out for the ones in the picture there. These are my favourite breastfeeding books for parents. All of them are evidence-based and written by people who know their stuff.

Think about safe sleep

baby-sleep-safe-sleep-image-thanks-to-basis

Image Credit: https://www.basisonline.org.uk/co-sleeping-image-archive/

Pre-baby it can be really easy to think you’ve got where the baby will sleep sussed. Chances are you’ve bought a Moses basket, a crib or maybe you’ve invested one of those co-sleeper cots that attach to your bed. However, it can be worth thinking about what you will do if your baby prefers to sleep closer to you.

Almost 50% of babies will have slept in an adult bed with one or both parents by three months, whether intended or not. Breastfeeding also releases oxytocin, which is a hormone which can make you sleepy (this is one reason breastfeeding parents are thought to get better quality sleep). There is a significant association between longer duration of breastfeeding and bedsharing. It’s important to be aware of safe bedsharing guidelines. You might not need to use them but it is far better to plan and be safe than it is to not plan and end up in a riskier situation, such as exhausted on the sofa.

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/07/Co-sleeping-and-SIDS-A-Guide-for-Health-Professionals.pdf

I’ve written more about sleep here, click the link to find out more.

Prepare your breastfeeding box!

In the first few weeks of breastfeeding, expect to be breastfeeding a lot. This is normal and it is a good thing because it also encourages new mothers to rest and recover. A breastfeeding box can be helpful, it should be something you can easily move about the house with you. Things you might like to pop into it are:

  • Spare breast pads.
  • A large water bottle.
  • A leak-proof, insulated mug.
  • A muslin to catch spit ups.
  • The TV remotes.
  • Phone chargers.
  • Magazine or book, ebook reader or tablet (basically- entertainment)!
  • Your breastfeeding book (see above)!
  • Details of local breastfeeding support services.
  • Tasty snacks.
  • Tissues
  • A small pot of vaseline- either for your lips, or if you are unfortunate enough to suffer a cracked nipple, to help with healing.

You might also want to throw in a stretchy wrap for those early days. Find a sling library near you for lessons in how to babywear, you will be so glad you did!

If you have an older child, you might want to set up a breastfeeding box for them too. This can include crafts, colouring, puzzles, books, special toys or a special film to watch. Whatever you think will keep the older sibling engaged and happy. Consider things you can help with one-handed if needs be!

Finally, it won’t go in the box, but a Netflix subscription would be a much handier present than flowers… I am looking at you, visitors and wannabe baby cuddlers! #justsaying

Antenatal expression (optional extra!)

DCF 1.0

Baby being syringe fed colostrum. With thanks to https://www.flickr.com/people/crimfants/

For some parents, antenatal hand expression can be great preparation for breastfeeding. This might be for many different reasons. Perhaps you are expecting an early delivery, or you have gestational diabetes, your baby might have been diagnosed with a congenital difference or you might have had a difficult journey the first time around. You might just want an extra bit of reassurance. Antenatal expression of colostrum is just that, an insurance policy. It should never replace at breast feedings unless it is necessary. The ideal situation is that you don’t use it. However, it can come in handy if something unexpected happens which means boobing isn’t going to plan or you are separated from your baby.

One advantage to hand expressing colostrum antenatally is that it gets you familiar with your boobs and how things all work. Studies have found hand expressing in pregnancy helps parents to feel more confident about breastfeeding, and that parents who do this breastfeed for longer.

Antenatal expression of colostrum is thought to be safe from around the 37-week mark. If you want to start earlier check with your midwife or consultant first. You can find out more about the antenatal expression of colostrum here.

You’ve done the prep…so now what’s your breastfeeding plan?

So hopefully after thinking about a few bits, you will have a better idea of what to put on your breastfeeding plan and what is important in order to get breastfeeding off to a good start!

The Australian Breastfeeding Association have some brilliant example plans which you can use or adapt here to suit: https://www.breastfeeding.asn.au/bf-info/your-baby-arrives/my-breastfeeding-plan

Want to read more about early days breastfeeding?

Some brilliant extra reading to prepare you for your breastfeeding journey:

General questions about breastfeeding answered by the Association of Breastfeeding Mothers

Breastfeeding a newborn, what to expect by Kellymom

The First Time You Breastfeed, by Emma Pickett

A brilliant video about attaching your baby at the breast, by Global Health Media

Newborn nappy output- what to expect by the NCT

Identifying good transfer of milk, by Global Health Media

Normal newborn behaviour in the first months, by Sarah Ockwell-Smith

Cluster feeding and fussy evenings, by Kellymom

Emma Pickett reassures parents about normal feeding intervals

Find an International Board Certified Lactation Consultant

Prepare for the birth, but make sure you also prepare for what comes after!

Like this? Watch this space, and subscribe or like me on FacebookInstagram or Twitter for news of upcoming blogs .

Breastfeeding is not just for my toddler, it’s for me too

So today, while my daughter entertained herself by running wild in a soft play, I took some time to have a hot drink and play around on Facebook. I saw a cartoon which made me smile at first.

The cartoon showed three mums breastfeeding toddlers and the toddlers were doing various gym-nurstics and other cheeky toddler nursing antics. Probably the sort of stuff anyone breastfeeding beyond babyhood can relate to. Sat next to them, a lady who doesn’t have a child says “My mom always said anyone breastfeeding a toddler does it for their own pleasure, I can see now that’s not true!”.

After the initial smile, I paused. And I thought. And the more I thought about this cartoon the more annoyed it made me. I got very annoyed, not with the cartoon as such, but with our society and our wider culture which says “Okay, if we have to accept you might want to breastfeed an older baby or child, you absolutely can’t, absolutely shan’t, enjoy any minute of it.”

I know this cartoon wasn’t badly meant. It was meant to be funny. A bit of solidarity for parents breastfeeding older children in a world where there is little of it. I can applaud it for that. Maybe I just take things a bit too seriously. Maybe sitting in a Wacky Warehouse for three hours just makes me angry. If you don’t agree, I’m happy for you to scroll on by, no hard feelings. However, I need to speak my truth. I want to speak it for all those people out there feeding older children. The ones who also don’t feel they can say it.

I still breastfeed my preschooler. She’s pushing four. So obviously, I’ve been breastfeeding a while. We nurse maybe two or three times a day. As she gets older it happens less, becomes a brief sweet interlude in our busy days. I love my daughter and she loves her “baboo time”, and of course, I often do it for her. Sometimes I might not feel like it, I might feel a bit touched out, I might put her off because I’m not wearing the right bra or I’m in a nice dress with no boob access. I get to have a say too. And because I have a say, I will say: Sometimes when we breastfeed, I also do it for me.

It’s kind of taboo, especially with an older boobling, to say that.

I nurse my daughter for many reasons and some of those reasons are selfless. Some of them are not.

I wouldn’t breastfeed A if I didn’t like to breastfeed her. And no, I don’t mean I like it in that creepy way some people think of when somebody talks about nursing older children (if this is you, seek help m’kay?). Sometimes, just taking a moment in the day to reconnect, in a way that is special to us, is pretty wonderful. The oxytocin starts flowing and we are having a cuddle and I remember how much I love being her mum and just enjoy the closeness we have.

I also nurse her at bedtime because thank goodness for boob, it makes bedtime in this house so frickin easy. Ten minutes and zzzz, she is OUT. No bedtime battles here. I am happily smug, with a glass of wine by 7pm in our house. It’s not the bedtime magic bullet for everyone, but I am so glad it is for me!

I breastfeed my daughter because she rarely gets sick. I’ve had to take less than a handful of days leave from work despite her being at childcare four days out of seven. Hurrah for that milky, immune system supporting magic!

I nurse her back to sleep at 5.30am, because quite frankly, I am not ready to get up and it means I am not cursing CBeebies because it doesn’t start until 6am like some of my parent friends are. Seriously though BBC, sort that s*** out.

I nurse her because it cures any tantrum and upset without me having to negotiate a screaming, writhing, octopus child. This is great for me, I am not so great at negotiating with a screaming kid. My husband is awesome at it. Me? I’m glad I have a boob to use.

I don’t nurse her for this reason but it is nice to know I have significantly reduced my chances of breast and ovarian cancers, diabetes, heart disease and osteoporosis.

I nurse my daughter because it is special to me.

I nurse her because I love to see the sheer joy on her face as I say “oh okay then”, as she jumps on my lap and laughs as I cuddle her close.

I breastfeed her because I love it.

Breastfeeding is for the dyad. That means both participants. Not just the baby. When we deny this to the world and laugh and say “oh, it is all for them really” aren’t we really saying it is unacceptable for the mother to enjoy breastfeeding? Why do we have to be martyrs? Why does it feel so scandalous to say “You know what, sometimes I really enjoy breastfeeding my toddler?”

That day is coming down the road fast, so fast. Too fast. I know the day when my child will no longer need those special cuddles and breastfeeds will come and go before I know it. This won’t be forever, and when it ends, I will treasure those memories, though my arms will ache and feel empty. Snatching a brief hug here, and a brief snuggle there as my child runs away to play with her friends. This is the way that parenting goes. It moves on, it evolves and often, you don’t get a say in whether you are ready. It just happens.

Once, way back when A was a babe I was agonising over whether to start putting her into her own bedroom. I remember clearly when this lovely lady who ran the group smiled at me and said, “Our children are always moving away from us, don’t rush it if you don’t want to”. Her words were so beautiful. I think I will remember them forever.

So I’m not going to rush it or deny what I get out of breastfeeding too. While I might not savour every moment, and I won’t tell you to, because that is false, and not how life is, I will also not be ashamed to say I breastfeed for me as well as for my child.

I will speak my truth.

Remember, it’s okay to speak yours.

Like this? Watch this space, and subscribe or like me on FacebookInstagram or Twitter for news of upcoming blogs .

Busting Baby Sleep Myths

Whether or not your baby sleeps through the night, remember your success as a parent is defined by so much more.

Without a doubt, sleep deprivation is one of the biggest challenges I have faced to date while raising A. The lowest points were after her twelve week birthday. We went to bed together one evening as normal and instead of the couple of hours I had become used to, she woke up after forty-five minutes. And then forty-five minutes after that. And…well you get the picture. For a long time, she woke very frequently. She was *gasp* a couple of months shy of four before she really consistently slept for most of the night.

I cannot count the hours I spent googling baby sleep. Sleep became an all-consuming topic for me. I read everything. Worried about everything. I was determined to find out WHY my baby would not sleep. I lacked a lot of knowledge about what is normal sleep, not just in babies, but in toddlers and preschoolers. I wasted a lot of time. While we did find some triggers for her frequent waking, some of it was just personality. Miss A is now a bright, inquisitive, smart and curious pre-schooler and sleep, well sleep is boring isn’t it? Her father also gets by happily on less sleep than average. Indeed, some studies have suggested the way our children sleep, may actually be largely genetic.

I really want to say one thing I think a lot of parents need to hear, so listen up. If your baby doesn’t sleep through the night, it is unlikely to be your fault.

Here are some of the most common myths about how and where babies sleep:

Your baby should be sleeping through the night by *insert arbitrary figure here*

A lot of popular information suggests babies should be capable of sleeping through the night from an early age. In reality, instead of talking about “sleeping through the night” we should talk about babies sleeping in ‘consolidated blocks’. In many scientific studies, ‘sleeping through the night’ is defined as sleeping a 5 hour period between midnight and 5am. Not quite the picture parents have in mind! Research has shown huge variance in when babies start to sleep in consolidated blocks and whether they settle themselves, or ‘signal’ (read yell their little heads off) for assistance. We don’t know why there is such a big difference, though many feel the answers lie in the personality of the baby.

BASIS suggests it is completely normal when infants wake frequently for the first year and beyond. Indeed, they say 13% of year old babies, still do not sleep in a consolidated block of 5 hours or more regularly. Gives us a slightly new perspective on those baby sleep books!

Toddlers definitely shouldn’t be waking up at night though right?

Though there seems to be a huge divide about when babies should sleep through the night, it feels like most people are in agreement that toddlers definitely should. However, again, the research doesn’t particularly back this idea up. Studies have shown that toddlers often continue to wake up during the night and need input from their parents, well into the second year of life.

Sarah Ockwell-Smith, someone who has spent an awful lot more time talking in an evidence-based fashion about how children sleep than me, suggests sleeping through is more like a roller coaster, than a linear trajectory. Basically, children are all different, and some may sleep “well” from babyhood, others may well be into their pre-school years before they consistently start to “sleep through”. Both are normal.

Formula or solid food helps babies to sleep better at night

Yeah, I had high hopes for starting solids too. My baby was totally going to sleep through once she was on solid foods! Except she didn’t. Also, formula fed babies still wake up frequently at night, the difference is, you also have to go downstairs and make bottles when they do. When people insist babies fed formula sleep better it is frankly insulting to their hard-working parents, who are up with bottles in the middle of the night. Seriously, it’s not like safe formula prep at 2am is the easy option! I wish we would stop saying that it is. These pervasive myths are by far best addressed by this lovely video from the team at Swansea University (I apologise if the catchy tune gets stuck in your head!):

If you stop feeding your baby at night, you will get more sleep

Sometimes night weaning might be helpful, and sometimes- it might not. This is because advocates of night weaning often forget that night waking is not just about food for babies. Development spurts often play their part. It is particularly common to hear parents asking about night weaning when they are smack in the middle of a leap. This may be absolutely the worst time to attempt night weaning. Your child is waking because they need reassurance, pulling away might actually make things worse or result in a lot of distress. Successful night weaning often depends on whether the child (and the mother) is truly ready.

I gently night weaned my preschooler when she was three. I’ll be honest, at first it made absolutely no difference to her sleep, and in fact, she still wakes up and asks for a cuddle and a drink. So if you are considering night weaning, it might be a good idea to think carefully about how you will feel if sleep does not improve. If your child still wakes up, will night weaning still help you feel more rested? For me, it made quite a lot of difference as I struggled to sleep through night feeds, but could sleep through a cuddle. If you are a mum who finds you can sleep through the night feeds anyway, it may make less difference.

Most gentle parenting and breastfeeding advocates do not suggest night weaning babies under twelve months old. These babies may still need night feeds. Which leads us on to…

A baby no longer needs to breastfeed at night once they have reached a certain age or weight

It is common for people to suggest babies do not “need” night feeds once they are six weeks/six months/double their birth weight etc…

Firstly, can we define ‘need’? Breastfeeding is, as well as a way to satisfy hunger, a relationship. A breastfeed is a cuddle, immunity, reassurance, warmth. How many times a night might you wake and have a sip of water, adjust your blankets, reach out for a warm body to snuggle into?

Secondly, this doesn’t take into account that all babies are different, and all boobies are different! Have a read about milk storage capacity here. Some mothers may need to feed more frequently to give the baby the same amount of milk per feed as her friend. This is not a mother with a supply problem, but natural variation. In order to support a healthy milk supply, breastfeeding works best when babies are fed to cue. In the first year milk is the most crucial part of baby’s nutrition and what is important is not how much baby gets per feed, but how much they get in twenty-four hours. A set rule for everyone just goes against basic biology.

In many cases, breastfeeding is a far easier way to get baby to sleep more quickly, and get better quality sleep. Use that magic while you can!

Responding to your baby every time they cry at night, makes children dependent and clingy

This is so far from the truth it makes me laugh. There is a wealth of research which suggests responsive parenting promotes healthy, secure and confident children. See Unicef’s “building a happy baby” leaflet or look into “attachment theory”. Not responding to children has been shown to do exactly the opposite of making children independent. Sleep training is a divisive subject and a blog post of its own. I will simply say, it isn’t the magic bullet people suggest, and that more information on it can be found here.

Responding to your baby does good things for both of you!

Bed-sharing is *the* most dangerous way for your baby to sleep! Don’t do it!

So this one was a massive bug-bear of mine. We previously have not been having nuanced conversations with parents about where breastfed babies should sleep. Positively, the tide seems to be turning a little recently, with the Lullaby Trust, Unicef UK, BASIS and PHE collaborating on new safe sleep guidelines which finally discuss bed-sharing in the mix.

Why is it important to talk about this? Because otherwise parents do not talk to their health visitors about this for fear of judgement. And then, they do not get the information they need about how to bed-share safely. On any given night 22% of babies will be bedsharing with their parents. Blanket recommendations not to bedshare have been clearly shown not to work and may have even increased the risk of SIDS for our babies.

We have historically focused more on the risk of bed-sharing to breastfed babies than we do on the increased risk of SIDS from other practices which parents might turn to instead- like sofa sleeping or giving formula instead to help their baby to sleep. Why have we not talked more about the impact of alcohol, smoking and drugs on SIDS rates? Risks which are so much greater? Why are we still not getting our knickers in a knot about the relationship between poverty and SIDS rates and holding society accountable for that? Focusing our support and resources on all of these things would have so much more impact.

Unicef Co-sleeping Guidance for Health Professionals

For a long time health professionals have been in a tricky spot. Advocating 6 months exclusively breastfeeding yet having to advise against one of the tools that help many people to achieve it. Studies suggest “breast-sleeping” (i.e. bedsharing as a breastfeeding mother) supports breastfeeding, with mothers showing increased responsiveness and increased breastfeeding overnight (see below for links to a wealth of research information). Mothers who bedshare also tend to breastfeed for longer than mothers who do not.

I could go on about this forever, but I won’t. I am glad the guidance is finally start to shift in line with the reality for many families. If you are considering bedsharing with your baby, read evidence-based information and decide what is right for your baby. Safety guidelines are really important if you go ahead. You can see these in the new guidance I have already linked, as well as here, and here, and here.

If I could wave a magic wand and change one thing, what would it be? I would love to do away with this culture where parents who announce their child is sleeping well get congratulated. I slept well for years before children. I am pretty sure nobody said “well done” every time I woke up after a full 8 hours. Nobody insinuated this made me a better person, or that it was because of the big dinner I had that night. I want to stop having to reassure and comfort tired parents in breastfeeding groups who think their baby is broken. Not because it annoys me to do so, but because this crippling pressure is unfair to them. We create it with expectations which are so off-kilter from reality it is ridiculous. I would love people to start showing empathy to parents rather than judgement. Maybe help them out around the house, or make them a coffee. In the absence of a magic wand, I hope the myths busted in this blog help. Watch this space, and subscribe or like me on Facebook, Instagram or Twitter for news of upcoming blogs about how to cope with frequent night waking, and gentle night weaning.

You can find more good information about sleep here:https://www.basisonline.org.uk/

Recommending reading about infant and child sleep:

Bedsharing research:

For more papers from Prof Helen Ball

Evidence based bedsharing info from BASIS site

Prof. James Mckenna’s work here

Image Credit: https://www.basisonline.org.uk/co-sleeping-image-archive/

Updated: 27/03/19

Tips for Breastfeeding a Baby With a Tongue Tie

When my daughter was born we had issues establishing breastfeeding. Feeding her was painful, and her weight gain was slow because she was tongue-tied. My memories of the early days of motherhood are still a haze to me, but by far one of my clearest (and saddest) memories was of looking at my perfect baby girl, willing her not to wake up. I couldn’t bear to feed her again. My nipples were bruised and cracked. I was on strong painkillers, because I had an emergency C-section, yet even with those, the pain far outweighed the wound I was recovering from. For various reasons, I was feeding my daughter for seven weeks before her tie was fully released and feeding started along the slow path to improvement. I won’t dwell too much on my story, perhaps I will tell it more fully one day on another blog. The purpose of this one is to share a few things I found helped me during the long weeks, plus a few things I have learned during my training in breastfeeding support.

There may be many reasons you are waiting to have a tongue tie division or indeed you may have decided the procedure isn’t the right decision for your family. Here are a few ideas and tips for you to consider.

Seek experienced feeding support whatever position you find yourself in. Find a lovely boob group too. Whatever happens on your breastfeeding journey, remember it is a journey. Sometimes a division isn’t an instant fix. Ongoing experienced support and moral support can be really helpful. Find a breastfeeding group here.

A breastfeeding counsellor or IBCLC can help you experiment with different positions. Some positions which work well for tied babies include laidback breastfeeding, the rugby hold, the straddle hold. Pay particular attention to the fundamentals of good attachment as this may be a harder to achieve with a tongue tied baby.

Get skin to skin! Skin to skin feeding can really help encourage a baby’s natural latching reflexes and has the added bonus of removing layers which separate you and the baby. It may just make that bit of difference.

Experiment with exaggerated latch techniques. These can be really helpful to encourage a deeper attachment. Options include tilting the nipple (“flipple”) or shaping the breast (“breast sandwich”).

It can be really helpful to use a couple of different positions while feeding when feeding is painful. This is because it stops the same part of the nipple being hurt and potentially damaged at every feed.

If baby struggles to transfer milk effectively while feeding

If feeds are very lengthy, painful or your breasts don’t feel relieved afterwards- there are a couple of things you can try. Breast compressions can improve milk transfer. Switch nursing can keep an ineffective feeder from falling asleep too soon at the breast and maximise milk intake. Combining both techniques can be particularly effective. Using both techniques during a feed might look like this; offer boob one, when the baby looks like their sucking is slowing (fluttering) or getting sleepy use compressions to speed up the milk flow again. You might find that sleepy baby springs awake again because babies often respond to milk flow! Once compressions become less effective, switch baby to side two and repeat. Once the same thing happens, then offer the first side again, and continue switching until baby signals they are done. You will ideally offer 4 sides minimum per feed.

Patience and support are important when feeding tied babies. Feeds may take longer than average and babies may feed more frequently to compensate. It can be helpful to reflect on your wider support network. Can someone help around the house or with other children while this is going on? Can your partner/family/friends offer any extra support?

Keep a close eye on nappy output and weight gain, and keep in contact with that experienced breastfeeding support I talked about earlier. An experienced supporter can help you to decide if your baby needs additional supplements of expressed milk and give you information about how best to do this while protecting your milk supply.

Sometimes the baby may be doing well but you may be struggling with engorged breasts, blocked ducts and even bouts of mastitis. If this is the case, firstly ouch, I am so sorry! One thing to consider may be expressing milk for a short amount of time after feeds to soften the breasts. This may also protect your long-term milk supply. If you need support with blocked ducts this factsheet might be useful.

“I can’t carry on! Feeding is too painful!”

Nipple shields are often considered by mothers in this situation. There can be some pitfalls to using shields, but if it is a choice between a shield or a bottle, a shield might be the better option. Ideally, shields need to be used with support from experienced breastfeeding support. Attention still needs paying to try to achieve a deep latch. Here is some more information to consider while using a shield.

I can empathise when mothers decide to use a bottle because they have tried so many options, and feeding is just too painful. Sometimes a mother may have nipple damage and just can’t bear feeding on demand at that time. I know how tough it is. If this is you remember to talk to your breastfeeding support person. In an ideal world you will still offer the breast for at least some feeds in a 24 hour period. As babies get bigger often latching can improve. It may also help with transition back to fully breastfeeding if this is what you want to do. Continuing to offer the breast, even if it is only a small amount to practise breastfeeding, protects your options down the line. If mixing breast with bottle, paced feeding techniques can be helpful to reduce the risks of bottle flow preferences. There are also alternatives to bottles, for example syringe or cup feeding.

If your baby is not breastfeeding much, or not at all, you may find the following information links useful:

Information on expressing: https://www.laleche.org.uk/expressing-your-milk/

Maintaining milk supply if the baby is not directly breastfeeding: https://kellymom.com/bf/got-milk/basics/maintainsupply-pump/

If using bottles or formula continuing to express when baby has a bottle can help support your milk production. Remember skin to skin is not only great for supply, but does good things for both of you, so keep baby close however you feed them. If you are using some formula it is important to prepare it safely.

Nipple damage

If you have sore nipples but no open wounds, there is no evidence a cream is more helpful than using your own milk rubbed into the nipple.

If you have bruising, the usual treatment for bruising can be helpful such as cold compresses after feeds.

If you have open wounds, moist wound healing may be helpful. This is essentially treating a cracked nipple like a cracked lip and not allowing it to dry out. Cracks in nipples that dry out may split open again at every feed, and this can be very painful. Keeping the crack soft can help healing from the inside out. There is no evidence any one cream is better than another, some mums prefer a lanolin based cream but soft white paraffin (Vaseline) can be just as effective and cheaper. Do use a new pot though and not something that’s been knocking about in the medicine cabinet for donkeys years! Both of these options are safe to breastfeed with, no need to wash off. Just wipe any excess off before feeds.

While we are on the subject of washing, if you have cracked nipples it is essential the wound is kept clean to prevent infections. Some mums use a fragrance-free soap (some babies can be bothered by strong perfumes), others prefer a salt water rinse like the one suggested here.

It might be helpful to start feeds on the least sore or damaged side, babies tend to suck more vigorously at the start of a feed. If you do this, listen to your body to make sure the other breast is still adequately having milk removed, via expression if necessary, to help avoid any engorgement or loss of supply.

If you are in a lot of pain feeding here is information on analgesics which you can use to help.

When you have a long wait for a tongue tie division, I know it can feel impossible. Like an eternity. Those early weeks can feel like months even when things go smoothly. I can totally empathise how overwhelming it might feel. I can’t tell you whether to stick it out, or what is best for you but I can tell you that you are stronger than you know you are.

I remember one day being asked why I had persevered with breastfeeding for so many weeks despite painful challenges. This is something I’ve considered a lot because on that day I couldn’t give an answer.  One thing I have come to understand is often it isn’t really about “the milk”, it is about an inner desire for this connection to our babies. Focusing on that can be more motivating than anything else. Try to remember why you started breastfeeding and why it is important to you. Encourage your partner to remind you of this. Hold on to any moments that are positive. Remember any breastfeeding you can do is significant. Setting small goals can be helpful- try to think about making it to the next day, or next week rather than longer term. This will all pass someday. By setting small goals one day you might suddenly realise you have stopped setting goals to get to next week and will know that the worst is behind you.

Whatever you decide to do, make sure you have support so you can talk it through and feel empowered to make decisions you feel at peace with. Finally, remember, there are lots of us out there to support you. You got this mama💚.

For more information and support:

Association of Tongue-tie Practioners for information about tongue tie

If you need support or someone to talk to fast about the issues you are having try the National Breastfeeding Helpline

Facebook tongue tie support group

Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories

Does Big Business Really Want to Help you Breastfeed?

When advice and help isn’t all that it seems

Breastfeeding Support

Boots, it seems, want to help you to breastfeed. They now produce a leaflet which you can pick up in store, and have a section on their website devoted to it. I see photos of this leaflet shared on breastfeeding groups, usually with the caption “Found this in Boots, isn’t it brilliant they have this?”

As someone who volunteers in infant feeding, this sort of thing sets off my cynicism alarm. Retailers are in business to sell you things, altruism usually isn’t high on their list of priorities.

hmmm breastfeeding

Confession time: I’m going to be picking on Boots a bit here. They are one example in truth, they certainly aren’t the only brand to do this sort of thing. Other companies also like to give out information about breastfeeding. Infant formula or bottle companies, for example, often do this too.

Let’s dissect the website information on Boots.com a little and see what we find.

The first sections: “Why is Breastfeeding Good For Me?”

Boots have chosen not to linger on the well-documented child health reasons to breastfeed, with a ‘blink and you’d miss it’ section, but they do have time to mention our appearance.

“There are lots of really good reasons to breastfeed, including benefits to mum. These include: It helps you to regain your old figure“.

Here we are, in 2018, with Boots suggesting weight loss is a top three reason to breastfeed. Talking about our body image before they mention the reduced risk of ovarian and breast cancers. I’ll leave you to think about that.

breastfeeding what

“How Do I Start Breastfeeding?”

Then we come to the next section “How do I start Breastfeeding”, where Boots have some advice from Clare Byam-Cook, a controversial figure* in breastfeeding support due to her lack of any breastfeeding specific qualification.

“Hold the baby close, facing the breast, with its shoulders and body in a straight line and it’s neck supported but the head free to extend (use a feeding pillow if more comfortable), offer your breast to the baby…”

ouch breastfeeding hurts

I am wincing reading that description. “Facing the breast” implies a “mouth to nipple” position to me, something most breastfeeding professionals will tell you is a recipe for a painful latch. This is a good demonstration as to why that is (thanks to the Empowered Birth Company for the video). It also says “head free to extend”, a clearer phrase I feel would be: “head free to tilt back”. Thirdly, “Offer your breast to baby” conjures images of a mother holding her breast and smooshing it into baby’s face, this would likely encourage an uncomfortable feed for the mother in an unsustainable position. Finally, we see them suggest “use a feeding pillow if more comfortable”, with a link taking you a range of pillows. I have nothing against pillows as long as they work for the mother, but this should be your first clue this isn’t a selfless exercise on behalf of a retailer.

“Common breastfeeding niggles solved”

The second passage is “Common breastfeeding niggles solved”. If you used the first section to give you information on how to attach your baby, you may need the information here.

My first problem with this section is it is so negative, it almost seems to scream “Breastfeeding will cause you excruciating pain!”

I am not going to sit here and tell you breastfeeding shouldn’t hurt. That would dismiss the lived experience of many mothers. Breastfeeding has a learning curve, and getting to grips with attaching a baby to the breast when hardly any of us see it on a regular basis can be hard. Sometimes, while establishing breastfeeding, mothers experience pain. What I would say is, if this is you, don’t feel like you have to wait for things to “toughen up”, or that the answer is expensive nipple creams. The research just doesn’t support that. A bit of support with attachment or a tweak may make it feel better.

I do question why, in a limited space, a large portion of this leaflet is devoted to pain? Surely some diagrams of attaching a baby instead, might help their mothers prevent some of these issues in the first place?

Well, reading further it becomes clear. They can sell you stuff to help with pain. We see links to nipple cream and a range of nipple shields. I have no doubt nipple shields are useful for some mothers, I know for some mothers, they kept them breastfeeding. However, they can be an absolute faff to use all the time, especially in public. Babies can get overly reliant on them. They also don’t solve underlying issues the mother or baby may have.

Moving on to “engorged breasts”. Here, we see suggestions that using breast-pumps and bottle feeding until the engorgement subsides is a good course of action. This is the section I find most shocking.

Engorgement is most common in the first days after birth. So why encourage parents to pump and bottle feed instead of using simple techniques to soothe and resolve engorgement, such as hand expressing, nipple stimulation and cool packs? Pumping is known to overstimulate supply in the early days (parents are usually advised not to pump unless necessary in the first few weeks). Using a bottle instead means possibly going longer between breastfeeds with engorged breasts! This is not a good thing for breast health or milk supply. Not everyone can effectively remove milk from their breasts with a pump, at least, not as well as their baby. No mention of how early introduction of bottles may be detrimental to breastfeeding in some cases and that the Baby-Friendly Hospital Initiative advises against bottles and teats in early breastfeeding.

Then we come on to the last “common breastfeeding niggle”, mastitis. Hardly a ‘niggle’, is it? Mum is instructed to go straight to the GP, sensible. A bizarre choice though, I feel, to spend so much time encouraging pumping and bottle feeding through engorgement, but offering no well-known self-care methods for clearing a blocked duct.

“Do I have to breastfeed all through the night?” & Other Anxieties

Not content with suggesting you use a pump once, Boots move on to trying to sell you them again (with handy links to their range of pumps). This time it is to get dad involved in night feeds while mum sleeps. Now, I know this is a strategy some parents will try, and if it worked for your family, great. However, they have omitted the facts that:

  • In the early months of breastfeeding, a mother will usually need to pump around the same time in the night, in order to avoid engorged breasts, blocked ducts, and mastitis.
  • Quite often a baby will drain the bottle, but still want boob, because breastfeeding is not all about the milk.
  • Night feedings can be important in supporting milk supply.

Then there is a section talking about new mothers breastfeeding in public. It’s OK though. Boots have a cover for that they can sell you. Oh and don’t forget about all the leaking. Boots can sell you stuff for that too.

This all seems to me, rather than helpful information, to be a fabulous example of how brands who sell you formula, pumps, bottles, and teats may complicate, or even sabotage breastfeeding, knowingly or unknowingly, in their quest to sell you ‘stuff’.

“What Can I Eat and Drink While Breastfeeding?”

So we come to the final section. The way this is written reads as if a mother needs to be hyper-aware of her diet: “good nutrition is more important than ever”. I find this paragraph pretty undermining. A good diet is important for everyone, it is not a necessity for breastfeeding. If it was I would be worried about my own child, since my early breastfeeding diet was 70% cake, 30% toast. Breast-milk is robust, and will in nearly all cases, still be the healthiest option for your child, (even on a 70/30 cake/toast diet). A mother would need to be malnourished for her breast-milk to be impacted.

“The occasional sweet treat is fine too- goodness knows you deserve a slice of cake”: Wow. Breastfeeding mothers of the world, quite frankly, if you want the whole bloody cake, eat it. Nobody needs permission from a shop to eat cake!

eating cake

Finally, the article ends with some links showing us more bottles, talking about pumps and baby food (we haven’t even managed to breastfeed yet and Boots are talking to you about baby food? Seriously?) Sadly, no links to any organisation which may help you establish breastfeeding (you can find these at the end of this blog).

Companies like Boots may want you to start breastfeeding. Shops want you to buy stuff for breastfeeding from them. Let’s face it, this is how they make money. I imagine they want to sell you some expensive pumps, nipple creams, covers, bottles, and shields. Unfortunately for some, following this sort of information may mean their breastfeeding journey is over sooner than they hoped.

Luckily, if you do have to stop breastfeeding, Boots have a large selection of infant formula they can sell you, often on code-breaking special displays.

I do wonder what is in it for companies, to suggest things like mothers need to follow a healthy diet to breastfeed? Or to give out information which might make breastfeeding painful for a mother? Or lower milk supply? Why devote so much time to suggesting that breastfeeding usually comes with pain and problems?

I can’t answer these questions for Boots or any other retailer. I don’t explicitly know their intentions. I do think we need to be careful where we choose to get our help from, and that the first question we should ask ourselves when a retailer tries to give advice is- “What’s in it for them?”

why breastfeeding

Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories

This is an opinion piece, and all opinions expressed here are my own.

*For an example of said controversy Byam-Cook’s last appearance on ITV sparked a petition for them to use qualified breastfeeding experts in future. The petition was signed by nearly 5000 people.

Print

Breastfeeding a Baby with Reflux

How to get the support you need

reflux baby help

As a breastfeeding support volunteer, I generally avoid sharing my own story as I prefer to focus on the parent in front of me but bear with me because my story is relevant to why this blog has been written and it is one of the reasons I am so passionate about infant feeding support.

My daughter was a “reflux baby” and she was treated with anti-acid medication for a long while, so when I talk to you about reflux, believe me, I know it, and I know how hard it can be.

I joke that when A was born she cried straight away and didn’t stop! My poor baby spent her first weeks wailing, coughing, writhing and red in the face, pretty much all day and most of the night. I felt trapped in the house. I remember feeling so desperate I wanted to cry when the health visitor left me in the house alone, with a baby who did nothing but scream at me. It was a pretty awful introduction to parenting. At 5 weeks old, she was diagnosed with reflux and we were prescribed infant Gaviscon by our GP. Like many parents, I took the prescription gratefully, and the numerous prescriptions that followed. It was the beginning of a journey which didn’t resolve for another twenty months.

What is problem reflux, or GORD?

Reflux simply means “a flowing back” and many babies spit up and vomit without being bothered by it at all. Problem reflux (GORD) has a variety of symptoms, which you can read more about here. Certain conditions can contribute to reflux, for example, it is more common in babies who are premature or babies who have other health conditions.

A baby who is spitting up a lot without distress or without other problematic symptoms it is unlikely to have reflux disease. If your baby is crying mostly during the evening hours yet content most of the day, they may be experiencing normal baby evening fussies.  So while these things can be alarming for parents (and messy!), it is important to be aware of the difference between what is normal and what is “reflux disease”.

Print


Mums who worry their baby has reflux often say to me, “I think it’s reflux because he just won’t let me put him down in the cot! I think he hates being on his back.” Here’s a secret which might help you feel better: most newborn babies hate being put down and prefer to be held. That’s normal baby behaviour.

Many medications used in the treatment of reflux disease are used “off-label”, they weren’t originally developed with infants in mind, and there are some studies which raise concerns about their use, especially over long periods of time.

If you’ve read all of the above and you are still with me at this point, I’m sorry. Dealing with reflux is a really distressing and difficult thing to cope with, and I know how it can feel relentless and never-ending. Here is some more information for you to consider.

Some common causes of reflux in breastfed babies

(This is not an exhaustive list!)

1. A shallow latch, or otherwise disorganised feeding

If your baby is not attached deeply to the breast or has a disorganised suckle they may take in more air as they feed. When air is expelled it can result in spitting up. Trapped air can also be very painful for the baby. This can result in reflux symptoms such as back arching, crying, and hiccoughs. Babies with shallow attachment may also struggle to transfer milk, leading to a fussy baby who wants to breastfeed 24/7.

This is why NICE recommends a breastfeeding assessment first as part of its quality standards: “A breastfeeding assessment should be the first step in supporting parents and carers with managing frequent regurgitation of feeds associated with marked distress. Correcting the breastfeeding technique for breastfed infants (for example, positioning and attachment) can improve or eliminate the symptoms.”

Sorting out a shallow latch can be as simple as doing a little work on positioning and attachment. Some babies with shallow attachment may have anatomical differences which hinder deeper attachment, for example, tongue tie or a high arch palate.

This is a great resource to help you with attaching your baby.

2. Breastfeeding management

In the UK we have a cultural expectation of having a few hours between feeds and this impacts on how we feed and treat our babies. Instead of smaller, frequent feeds sometimes we encourage our babies to “go longer” and take in more milk, less often. Some babies cope with this just fine but others may struggle, with large volumes of milk hitting the stomach and then coming straight back up. Some babies may protest- loudly!- about having their feeds delayed. So responsive feeding, and watching our babies instead of the clock may help. More about responsive feeding.

Our babies also spend a lot of time on their backs, which is no help for reflux. We commonly feed babies in the cradle hold, and then they are placed on their backs in Moses baskets and in prams. However, our babies evolved to be held. You cannot cuddle a baby too much. Simply carrying our infants more and experimenting with other feeding positions can go a long way towards helping babies with a tendency to reflux feeds.

3. Food intolerances and allergies

If your child has been properly diagnosed with GORD, and you’ve had a breastfeeding assessment which found no problems, it’s interesting to note research suggests a significant link between food allergy particularly CPMA. Some studies show a link of up to around 40%. CMPA is discussed in the NICE guidelines as one differential diagnosis for GORD.

Does that mean all parents with reflux babies should immediately be told to cut out dairy products? No, I don’t think so.

As you can see above, there are other things to explore before taking drastic steps, unless your child is exhibiting other clear symptoms of cows’ milk protein allergy. If you want to learn more about CMPA you can read my blog, or the BfN factsheet might be helpful.

Addressing attachment, examining the oral anatomy and considering breastfeeding management first is usually quicker and easier than making big changes to your diet. It is far more likely a more commonplace issue is the problem and it can take 4-6 weeks for both mum and baby to be totally free of dairy protein. Looking at the basics first is really important.

If you are concerned about CMPA it’s also a good idea to speak with a GP or health visitor as you may need support from a dietician.

4. More great reading on the management of reflux and other potential causes here.

You’ve had a reflux diagnosis for your breastfed baby. What now?

We’ve talked about the NICE guidelines above and so we know a breastfeeding assessment may be helpful. It’s worth making sure the person who does the assessment is skilled and experienced in doing this, so you probably want to see a breastfeeding counselor, La Leche League leader or IBCLC.

It might be a good idea to make sure you see somebody who is familiar with tongue tie, just in case this is a factor.

The great thing about doing this is that an IBCLC can help you look at the full picture and consider all the angles such as:

  • Attachment and positioning.
  • Your baby’s suck/swallow/breathe pattern.
  • If there signs of oversupply or milk transfer problems.
  • Indications or risk factors for allergies.

In some cases, after doing all of this, medications can be appropriate and necessary. A pediatrician can discuss with you the risks and benefits so you can make an informed choice about the best way forward.

Coping with a breastfed baby with reflux

I’ve made this into a meme, for easy sharing and saving. Basically, “Think Boobs!” (I know, I’m a cheeseball, but I couldn’t resist):

Print

Reflux does generally pass and get easier with time. With some help and support, it may pass more quickly. Asking the right questions is the first step to moving forward.
How did my own story end? Well, after getting some support from an IBCLC, my daughter was diagnosed with a cows’ milk protein allergy. We finally came off all our medications and beat the demon that is reflux. She still didn’t sleep in her cot, but that’s okay – I liked the cuddles ❤.

This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure any concerns about your baby are discussed with a medical professional or a health visitor.

Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories

Further reading:

GPIFN: https://gpifn.org.uk/reflux-and-gord/

Kellymom: https://kellymom.com/hot-topics/reflux/

*This blog has been substantially updated from an article I wrote for Breastfeeding Support and Information UK‘s blog “Through the Eyes of a Breastfeeding Support Group” if you like you can still read the original here *