Help & advice with breastfeeding Here writer and breastfeeding counsellor Heather Welford has compiled some up-to-date information to help you with any breastfeeding questions you may have Why breastfeed? Human babies thrive best on human milk. Current guidance from the UK, the World Health Organisation and in many countries of the world, is to recommend exclusive breastfeeding - that's breastfeeding without any other foods or drinks - for the first six months, and thereafter alongside other foods and drinks for as long as you and your baby want. Babies who aren't breastfed are at a higher risk of contracting infections and developing allergies. There is also a higher risk of some serious conditions such as diabetes and some childhood cancers. Mothers who don't breastfeed have a higher risk of breast or ovarian cancer and they're more likely to have fractures associated with osteoporosis in later life, too. When it's going well breastfeeding is enjoyable and convenient; it needs no preparation and, unlike formula milk, breastmilk is free. Who can breastfeed? There's no firm evidence to give a definite answer to this question, but the experience of experts all over the world, including countries where just about every mother chooses to breastfeed, strongly suggests that only a very tiny number of women aren't able to fully nourish their babies at the breast. Breastfeeding is a skill, and mother and baby learn it together. In countries like the UK, this skill is more of a challenge, as we don't see breastfeeding very often, and the knowledge of how to help it effectively has been lost. Good information, encouragement and support can help you breastfeed happily - and it can help you 'fix' things if they're not going well. How long should I breastfeed for? The World Health Organisation states that breastfeeding is beneficial for two years or more, and there's no real upper limit. Worldwide, and in history, it's not uncommon for children to breastfeed for what we might consider to be a long time, if all we are used to is babies who breastfeed for a few months only. Older children may not breastfeed very often, and weaning from the breast may take a long time. It's your choice, and your child's choice, how long to breastfeed. However, any breastfeeding has measurable health benefits - even a day's worth. If you breastfeed for only a short time, for whatever reason, you can feel proud that you have given your baby a better start. What's in breastmilk? Breastmilk contains more than 200 essential substances which help your baby's growth and development, and which provide him with resistance to infection. During pregnancy, and during the first few days of the baby's life, you produce colostrum - a highly concentrated source of nutrients with a high level of antibodies to protect your baby. After 3 to 5 days there is a gradual transition to mature breastmilk. Milk is made in direct response to the needs of the baby. The more often your baby feeds, the more quickly you make the milk. Your breasts are never totally empty, but they do get fuller, as the milk your baby removed at the previous feed is replaced. Long gaps between feeds mean you make less milk. A substance called the feedback inhibitor of lactation (FIL) in the milk 'tells' the body to stop making milk, and the fuller the breasts, the more FIL. This is how the body regulates the amount of milk so it matches the needs of your baby. The constituents of milk change according to the amount of milk in the breast. As milk is removed by the baby, the amount of fat (cream) in the breasts increases - that's simply because the fattier components of the milk stick to the producing and storage cells, and become available to the baby only after he removes the more watery parts of the milk. It makes no sense to time this process - so don't believe you have to feed your baby for a certain amount of time. The timing depends on the baby, on the responsiveness of your body, and the storage capacity of your breasts. All those aspects are unique to you and your baby. Following your baby's needs means you'll make enough milk; following the clock means you may not. How do I get started? If your baby's healthy, start by holding him skin to skin with you, next to your breast, straight away after birth. Weighing and bathing don't have to happen immediately - you and your baby can start getting to know each other, and your baby might well show you signs of being interested in feeding in these precious early moments. Afterwards, hold your baby close as often as you can, and learn to spot the 'feeding cues' that show you your baby will respond to the breast. This might mean very frequent, short feeds, with your baby 'catnapping' at the breast, enjoying the feeling of closeness and familiarity of your voice, your taste, your smell and your touch. What if I hit problems? Seek help from your midwife, health visitor or a breastfeeding counsellor. In many cases, small changes can make a world of difference. What do I need to do to make sure breastfeeding goes well? Getting your baby well-positioned and attached helps avoid a lot of problems. There are a number of helpful websites that can show you with graphics how the baby takes the breast: www.kellymom.com www.breastfeeding.com and seeing what to do can be a lot easier than reading about it. Getting the position and attachment of your baby right allows him to have an effective feed, removing the milk efficiently, and stimulating your milk production to make more. So: the nipple goes into the top of the mouth, over the tongue, and not centrally - it's called the 'asymmetrical latch' which allows the baby to draw your nipple right to the back of the mouth so it doesn't get compressed between tongue and hard palate - ouch! your baby's mouth needs to be wide open, and you can bring him onto your breast at the moment it is at its widest. and when he's on, his chin will be touching your breast and his nose will be free he will suck and swallow with a deep, 'open-pause-close' movement of the mouth How do I know breastfeeding is going well? In the early days, there are some useful signs to give you confidence your baby gains weight your baby passes meconium (the first bowel motions) every day for the first 3-4 days, with the colour changing from black to brown to green your baby passes several soft yellow stools a day, after about day 4-5 your baby is eager to feed many times in 24 hours you aren't sore, and feeding is comfortable for you If any of these signs aren't there, then ask for help. By 4 - 6 weeks, many babies stop producing stools as often as before. One stool every few days can be normal. Do I feed from one breast or both? Follow your baby's lead. In the early days, it's sensible to try and ensure both breasts get equal 'time' over the course of a day, so you might alternate them. Some babies always want two breasts every time; some babies only ever want one; some babies do one thing one feed and another thing on another occasion. It's perfectly normal for babies to 'cluster feed' - be on and off the breast several times, often in the evenings, and for you to stop being aware of separate 'feeds'. When might I need to use a breastpump? A breastpump is a way of removing milk. This does two things: it makes milk available to a baby who gets it via a bottle, cup, syringe or tube it 'tells' the mother's body to make milk The main reasons you might need a pump include if your baby is in special or intensive care if you are separated from your baby for whatever reason, for example, work if your baby is unable to feed direct from you if you want to collect milk for someone else to give it to your baby, perhaps while you rest or go somewhere without your baby for comfort, if your breasts are engorged or if your nipples are sore (though bear in mind that both these problems can be resolved with skilled help, and by positioning and attaching your baby better) as a supplement to your baby's 'direct' breastfeed if there is concern about how effectively he is feeding, and to help him gain weight to increase your milk supply if you have twins or more, and find it useful to express to let someone else share the feeding Note: you can express breastmilk by hand, but many mothers find a good pump is more convenient and easier, especially if you need to express more than just occasionally. For information on cup feeding, see here. A useful website if you want to express your milk, especially if you need or want to express long-term, is Express Yourself Mums. How do I use a breastpump? See the instructions on the website for our pumps How often should I express? If you are expressing to keep up a milk supply, or to build one up because you want to start breastfeeding again after stopping for some reason, then your pump is effectively taking the place of your baby. So you need to express at least as often as your baby would feed. In practical terms, this means at least 8 times in 24 hours, including at least once at night. If you don't express as often as this, then your body starts to produce less; over time, your milk supply will dwindle. Do I need a flexishield? A flexishield can improve the fit of the pump flange against your breast. See here. How can I store my breastmilk? A useful, evidence-based overview of this from the Association of Breastfeeding Mothers on expressing and storing is here but if you are expressing for a baby in special care or intensive care, ask if there are any special precautions or procedures to follow. What happens when I go back to work? You can express for your baby to have your milk when you are away. Many mothers express at work, taking their pump and a cool bag with them, to collect milk during the working day. It's worthwhile discussing your plans with your human resources people at work, with your professional association or trades union, to see if there is a breastfeeding policy for mothers in your situation. If there isn't one, then perhaps you can start one! The law in the UK is not explicit or detailed about what employers should do to support continued breastfeeding, but under health and safety regulations, your employer should enable you to have somewhere clean, private and safe to express and store your milk, for the sake of your own well-being. I stopped breastfeeding - can I start again? Yes - this is called relactation. A call to any of the helplines will support you in this. If it's a long time since you stopped (more than a week or so) you may need to work hard at expressing often and offering the breast to your baby many times in the day and night. But the milk supply can be 'rescued' in this way ? removing the milk with a pump or by hand expressing many times (at least 8 times in 24 hours including at least once at night) gives your body the right message, and with the return of your milk, your baby may be more willing to suck. Can I donate breastmilk? Yes. There are a number of breastmilk banks linked with maternity units and special care baby units in the UK. You can find out more here [link to http://www.ukamb.org/donor.htm]. Donating breastmilk to babies who need it and whose mothers are unable to do so, or to produce enough, is a very special gift. Can mothers of adopted babies breastfeed? Yes - adoptive breastfeeding is possible, and a good pump can be useful as a way of stimulating the breasts to produce milk before your baby arrives, and for maintaining a milk supply to give by bottle or in some other way. You can find out more here.