Breastfeeding – The basics

Many pregnant women feel bombarded with information about breastfeeding, and this can make them anxious about it even before the baby arrives. While some women decide that it is not for them, the majority of women start breastfeeding. A high percentage stop before they wanted to because it’s not always easy at first. Getting the right information and support in the early days can make a lot of difference.

Know where to find support

In the past women grew up seeing breastfeeding as a natural part of life, but now new mothers may not be surrounded by people who can help them if difficulties arise. Finding a breastfeeding support group before the birth gives women a chance to talk to breastfeeding mothers about how they overcame any problems, and boosts confidence in their ability to nurse their babies. Help from a breastfeeding supporter can make all the difference if small, initial problems arise.

Some facts about breastmilk

Breastmilk is meant for our babies. It contains living cells, hormones, active enzymes, antibodies and compounds with unique structures that can never be replicated in formula It adapts to suit each individual, and if a baby is premature it will adjust so that it is ideal for the continued growth that baby needs.

Colostrum (the milk produced in the first few days after birth) contains especially high concentrations of antibodies to help a baby’s immune system to mature after birth. One of these antibodies called slgA (secretory immunoglobulin A) “paints” a protective coating on the inside of a baby’s intestines to prevent penetration by potential allergens. Mature milk continues to provide this protection from the inside to help the baby remain healthy and fight germs to which either the mother or baby have been exposed. Some studies have shown that breastmilk also helps a baby to get used to the sort of food its family eats before solids are started.

The composition of human milk changes to meet the changing needs of baby as he matures and even from feed to feed. Even when baby is able to take solids, human milk is the primary source of nutrition during the first year. It becomes a supplement to solids during the second year but it maintains nutritional value, as well emotional benefits.

Getting Started

Breastfeeding is a learning curve, as mother and baby get to know each other. What works for one may not be right for another, and can even vary from feed to feed. Watch for early feeding cues, sucking his hand, smacking his lips, turning his head towards you, rather than waiting until he’s crying.

When a baby is born a mother’s instinct is to help him to the breast but even if she doesn’t help his instincts and reflexes would help him crawl to the nipple and latch on. If possible a newborn should be put into his mother’s arms straight after birth. Some babies start searching for the breast almost immediately but some are still feeling a bit shocked from the birth. The baby may cry at first, she has just made an incredible journey! Dribbling, making sucking movements with her lips or bringing her fist to her mouth are all cues that she is ready to nurse. A baby may then lift her head and bob her face on and off the mother’s skin. To help her baby latch on a mother might help by moving her closer to the breast or supporting her. When the baby is ready and her face is near the nipple, she’ll lift her head, open her mouth wide, latch and begin to suck. If this feels uncomfortable a mother can make small adjustments to either the baby’s or her position.

Laid-Back Breastfeeding – leaning back and letting gravity hold the baby- has been found to be comfortable by mothers and babies throughout history. As mother and baby learn together and get used to each other it will feel more comfortable to change the position to one which seems to suit both.

When starting breastfeeding a feed may take some time so it helps to find a comfortable position where you feel well supported, and this can be sitting, reclining or lying down. If you use pillows they should be for your own comfort to support your head, shoulders, body, arms and legs rather than under your baby. Bringing the baby to you, rather than lowering yourself to the baby makes it easier to get a good position.

There are no hard and fast rules about positioning and some babies find the best position by themselves. The baby’s own mouth shape and the mother’s breast, nipple and areola shape and size means that this will be different for each individual, and even vary between siblings. It helps to breastfeed as soon as possible after birth but some babies are feeling tired and sleepy and may need some encouragement. If it takes a while for a baby to seem interested a mother can ask about expressing colostrum until he gets the hang of it to stimulate the supply.

To help find the most comfortable position a baby’s tummy should be against his mother and he needs to feel well supported. A baby needs to take a good big mouthful of breast, not just the nipple; it helps to let his chin sink into your breast so his head can tip back a bit. This way he can open his mouth wide and his lower jaw will have plenty of room to move. We cannot eat if our chin is down on our chest and it is the same for a baby. Some mothers like to support the breast with their hand when nursing, but try to keep the “lower jaw fingers” out baby’s way so it won’t impede on the sucking action.

The nipple is the last part of the breast to enter his mouth, aimed towards the back of the roof of the mouth to trigger active sucking. Once a baby is attached if it doesn’t feel quite right then you can make small adjustments to positioning maximize comfort. Gently tucking his body in closer can help with this.

How often?

A one day old baby’s stomach is about the size of a small marble. It does not stretch to hold much more than 5-7ml. Colostrum, the first milk, is just the right amount for a baby’s initial feedings. It contains high concentrations of antibodies to help a baby’s immune system mature after birth.

Although it can seem worrying if a baby to bobs at the breast and licks the nipple this, along with wanting to nurse frequently is normal behaviour. Small frequent feeds, at least 8-12 times in 24 hours, help to prevent engorgement when your milk comes in, and to make the transition from being drip-fed nonstop via the umbilical tube. The breasts are always making milk and the more a woman feeds the more milk she will make. Some recent research has shown that frequent feeding in the early days helps to “prime” the breasts for good milk production in the future.

As your milk comes in breasts swell and enlarge. This is not just milk but extra blood and fluids which causes congestion and swelling. This will decrease as a woman’s body adjusts to making milk but can make it harder for a baby to latch on. Some things which can help during this stage are expressing a small amount of milk before you feed (in the bath or shower is easiest) or feeding the baby frequently so breasts don’t get to hard. Gentle massage or applying moist warmth just before a feed can also help. You can ease swelling back with your fingertips to make it easier for your baby to latch on deeply and prevent you getting sore.

How much milk?

There is no need to time a feed. Once you feel your baby is properly and comfortably positioned and swallowing, he will let you know he has had enough by letting go or falling asleep. Offering both breasts at each feed in the early days helps to ensure a plentiful milk supply, starting with the opposite breast next time. Some mothers can feel when the milk “lets down” into the breast after the first few sucks and notice the baby’s increased swallowing.

The more you feed the more milk you produce. Babies nurse for comfort as well as food and there’s always some milk there. Night feeds help to establish and maintain your supply and avoid engorgement. Wet and dirty nappies are a good indicator of how much milk your baby is taking; measuring weight gain from the lowest weight, not birth weight. A newborn can lose up to 7% of his birth weight during the first few days.   Most babies regain birth weight by 10 to 14 days. They grow in length and head circumference too and from 0-3 months usually gain about 4-7 ounces a week. Looking at your baby can be a good guide to how he is doing, not just his weight. A baby who is feeding well will usually have a good colour, with firm skin and will seem active and alert. A baby who was premature or ill will have different weight gain patterns.

Once at home it takes time for you and your baby to get to know each other. Breastmilk is not just about getting food into a baby, it is part of the mothering package. The early days of breastfeeding can be intensive and sometimes challenging but they do pass, and as babies and mothers learn and grow together breastfeeding usually becomes a very enjoyable and important part of mothering for both.

La Leche League GB

La Leche League GB (Registered Charity No 283771) is passionate about providing mother-to-mother breastfeeding support and information which is supportive, accurate and available to all women. Leche League GB Leaders are mothers who have breastfed their own babies and have completed our international accreditation programme. The core of our work is our network of local mother-to-mother support groups. We produce leaflets on a wide range of breastfeeding topics, and have books covering various aspects of parenting. We also provide a telephone helpline, and email support. We provide a listening ear when things are not going well alongside accurate information so women can decide what feels right for them and their baby.  LLL Leaders are all volunteers. We receive no official funding and rely on memberships and donations but anyone can use our services or information without charge.