Breastfeeding newborns – the simple yet essential questions

Breastfeeding is supposed be a very natural thing. You would think that some sort of instinct would kick in, and that it really would be something everyone would be able to do. For whatever reason, this is not always the case and it definitely was not something that I found particularly easy. Perhaps because our lives have changed so much, it is not something we are exposed to or really have much knowledge about until you are expected to feed a crying infant. Despite the fact that there has been such a big push to promote breastfeeding, babies are hidden away under muslins and feeding bibs because that is just what is socially acceptable. So, how can we ask the questions we need to? That’s why this blog is intended as a tool for newcomers that have the simply yet important questions.

Q: How do I prepare?

It is definitely a good idea to try to talk about breastfeeding and look at pictures or videos, before baby arrives. This can be at an antenatal class, at an NCT meeting or simply with friends or family. Don’t be afraid to ask, most people are happy to share their tips and distastes stories. Despite being prepared, don’t worry if it takes a little time to get the hang of it. The midwives are great at explaining and showing you what to do and if you can get access to a specific breastfeeding consultant, this goes a long way to helping you get things going. If things are going a little slowly or you need to express, this does not mean that you will not be able to breastfeed. Simply go with what baby needs at the time and don’t give up.

The first fluid that you will produce following the birth is colostrum, which does not look like milk at all, but is usually a yellow coloured fluid. Colostrum has more protein and less fat and carbohydrates than mature breast milk. It is rich in secretory immunoglobulin A, which helps to protect baby from infections and also helps to establish a normal gut microbiome. As it is low volume and highly nutritious, it helps your newborn as they learn to regulate the suck, swallow, and breathe cycle during feeds. I remember having to hand express tiny quantities of colostrum and painstakingly collect tiny drops in a syringe, which did seem a bit ridiculous but given the benefits, felt worth all the effort. The main thing to remember is that you just do the best that you can and try to get some of the benefits of this precious fluid.

Q: How long will I have to do this?

Initially baby may want to feed very often, so it is not unusual to have to feed every hour. Then once your breasts produce more milk and baby gets better at feeding you will notice baby feeding for longer. The more you feed the more this will stimulate your milk production. The other thing that you will notice is that the sucking will release your milk – otherwise know as the let-down reflex. Some women will feel this as a tingling or burning sensation, which can be quite strange. Baby will initially do quick sucks at the start of the feed, then sometimes pause waiting for the release of milk and change to a deep rhythmic suck when the flow begins. It can be quite fast and may cause your baby to cough or splutter when the milk does start to flow. This is not usually a persistent problem as baby will adapt to this, but you may need to change your position.

Q: How do I know how long baby needs to feed for?

The general rule about how much to breastfeed a baby is – on demand, which means as often as they want and for as long as they want. This will change over the days and weeks to settle into a more reasonable pattern. A rough guide is at least 8 times in 24 hours in the first few weeks. It is not possible to overfeed a breastfed baby – you will hear this many times. It is worth trying to look out for the hunger cues and start feeding then, because once they are really crying it is difficult to calm them down and just makes everything more stressful for you. If you notice baby sucking their fist, getting restless or rooting (turning their head an opening their mouth), try to get yourself in a place and position to be feeding.

I felt that the most important thing, was being taught about how to get baby to latch. It is a bit counter intuitive and there are a couple of tips that may help, although it really is something that is easier to demonstrate and get somebody to help you with. The first thing is to ensure you are comfortable and relaxed, make sure your arms are relaxed and not straining, you may be there a while! Your baby’s head and body should be in a straight line and baby’s face should be close to your breast. Support their neck, shoulders and back, but don’t hold the back of their head. They will tilt their head back a bit which allows them to swallow more easily. Bring your baby towards your breast, with their nose at the level of your nipple. Wait for them to open their mouth wide and allow them to get a big mouthful of breast, with their chin coming into contact with your breast first.

Q: Should I express?

This is a personal choice and everyone will find their own happy balance. It is very useful to have some milk stored and to be able to get baby to take a bottle, to give you some rest. I would recommend that everyone has a pump though. Even if you are not planning to express for feeds, you may need to use the pump to help prevent or ease the symptoms of mastitis. This is something that breastfeeding mothers fear as it makes you feel so awful. Usually you will be feverish, and there will be an area on the breast that will be red, hot, firm and very tender. If this is the case seek medical attention immediately as you may need a course of antibiotics. This can come on when there is a mismatch in your supply and how much baby is feeding. If you feel that after a feed instead of being soft and pain free, they are still firm and sore it can be useful to express until the pain eases and are less firm. Don’t be tempted to express too much as this can increase your supply. Baby will usually then catch up or your body will regulate your milk supply.

Q: How can I tell if I have thrush?

You may notice burning or stinging around the nipple or areola. The nipple may look different – going white during feeds and bright red after feeds or cracks that don’t seem to heal. You may also notice severe pain on latching, which worsens with re-latching or a deep pain in the breast. Baby can also get thrush, which can be white patches or a coating on the tongue or appearing uncomfortable during feeds. If you notice any of these symptoms please seek medical attention for you and baby to be checked over and to get appropriate treatment.

Q: How long should I breastfeed for?

This is also a very personal thing, every mother and baby is different. Do not feel bad if you have to or want to top up with formula. You may be advised to do this if baby is not gaining weight, and the main thing is having a healthy, happy baby (and Mummy). The World Health Organisation (WHO) recommend breastfeeding for at least 6 months, at which point most babies start weaning. There are so many factors that determine how long women breastfeed for and it is different with each child. Ironically, after having struggled through and becoming successful breastfeeders, some mothers find the next battle is how to stop. The WHO also recommend that breastfeeding should continue for up to 2 years or beyond. It really it something that you will decide for yourself and when the time is right, you will find the strength to overcome this hurdle. I wish you all the very best of luck!

Some additional great resources for further information on these topics can be found online at Mom Loves Best, a fantastic place for all your questions.

Dr Kat Kunert
GP, Coyne Medical