Our health visitor answers your breastfeeding problems...
Posted: 1 September 2011
by Practical Parenting’s Annette Maloney
1) Should I be looking for a let-down?
Q. I’ve been told by my friends that I should feel a let-down reflex when I’m breastfeeding. What is this?
A. Every time your baby suckles, a hormone called oxytocin is released, which stimulates muscle cells in the breast to squeeze out milk. That’s when the let-down reflex occurs.
It’s basically the milk moving towards the nipple. Some mums feel a tingle, or a slight pressure, maybe even discomfort in the breast. You may notice the feeling of relaxation that oxytocin gives or notice milk dripping from either breast. After a while, some mums get a reflex response when their, or another, baby cries – even just thinking about your little one can cause your milk to flow, so it’s worthwhile keeping a few breast pads handy just in case. Eventually you’ll get used to the feelings and probably not notice anything at all.
2) How important are night feeds?
Q. I’m breastfeeding my 6 week old and seem to be constantly on duty, especially at night. Is it possible to reduce some of the night feeds as I’m worn out!
A. All parents with a newborn baby will empathise with you and the exhaustion that caring for young babies brings. The truth is, this tiredness will happen whenever your baby feeds.
When you breastfeed at night the hormone prolactin (important in milk production) is produced at higher levels. So a breastfeed at night is important in helping your milk production. The good news is that prolactin, along with oxytocin, which is also released when you feed, help you to relax and even feel sleepy. So a night feed may improve the quality of sleep at least! Try and find ways to rest in the day instead, so you’re ready for the night shift.
3) Moving from breastfeeding to bottle
Q. I want to stop breastfeeding my 7-month-old baby, but so far he’s refusing to take a bottle. Any advice?
A. When moving from breast to bottle it’s often worth enrolling the help of someone else to offer feeds to your baby. At the moment he expects to be breastfed when he sees you. So ask his dad or a friend to try. Leave the room completely – it will be easier for everyone if you’re not hovering. Some babies will skip out bottles completely and go straight to soft-top feeder beakers, so this may be worth trying, particularly as he’s over 6 months. Introduce a non-breast feed at a regular time of day, when he’s not too hungry or tired. If you haven’t already done so, start offering water from a feeder cup. Some mums reduce breastfeeding gradually over a month or so and others will aim to stop in a few days. Do what suits you, but be consistent and avoid any other big changes until your baby has settled into the new routine.
4) Milk at work
Q. I’m breastfeeding my 7 month old and want to express milk when I return to work. Any advice on getting organised?
A. Start by having a chat with your employer. While it’s not a legal requirement, the Health and Safety Executive recommends your work provide “a private, healthy and safe environment for nursing mothers to express and store milk”. Ideally that’s a room with a lockable door, washing facilities for equipment and hands, and suitable access to a fridge to store milk. And it’s not OK to make do with the loo.
It’s worth having a trial run to identify any issues that need to be sorted out. You might also like to pop an extra T-shirt or cardigan in your bag, in case of leakages.
5) My baby isn’t gaining enough weight
Q. I’m breastfeeding my newborn but he’s gaining weight more slowly than expected. Should I offer formula as well? I don’t want to give up breastfeeding.
A. Before offering formula feeds to your baby, spend time focusing on improving how he attaches at the breast. Visit a breastfeeding counsellor or local group. Your health visitor will have details. Breastfeeding takes time for both you and your baby to master – up to four weeks is not unusual. During this time weight gain is one indicator of how your baby is doing, but not the only one. Introducing formula will not encourage your milk production at this early stage. Sticking with getting attachment right, feeding on demand for as long as your baby needs and keeping him close with lots of skin-to-skin contact should, with good support and advice, help your baby thrive.
6) How do you hand express breast milk?
Q. I’d like to hand express some of my breast milk rather than use a pump, but am not sure how to go about it. Do you have any tips?
A. First, you’ll need a container with a wide lip – jugs are ideal. Sterilise or rinse it with scalding water. Relax and make a ‘C’ shape by placing your thumb above and your fingers below your breast, near the areola (dark area), but away from the nipple ‘teat’. Gently press and release with rhythmic movements until milk flows, moving clockwise round the breast, until all areas have been massaged. Attempt to express all areas of the breast, alternating from side to side as you would a feed. Remember, babies take more milk feeding directly, so don’t worry too much about the volume you produce.
7) Learning about latching on
Q. I’m about to start breastfeeding and have heard about ‘latching on’, but am not sure what it means.
A. Latching on describes how your baby gets into position for feeding and actually takes the breast into his mouth. It’s important to get it right, so that he can feed properly and drain your breast, too. Follow these tips, be patient, and you should get the hang of it:
- Hold your baby close to you, his nose level to your nipple.
- Wait until he opens his mouth very wide with his tongue down.
- Quickly move him closer. He’ll tilt his head back, and come to the breast chin first.
- He’ll take a large mouthful of breast. Your nipple will go towards the roof of his mouth. He is now latched on.
8) Hungry or something else?
Q. I’m breastfeeding my new baby, but am still unsure how to tell if his cry is hunger or something else.
A. Breastfed newborn babies may feed 12 times (sometimes even more) during a 24-hour period, so for the main part when he is awake, a feed is never far away. Some obvious signs to look for are crying, rooting around for your breast, sucking his fingers or making sucking noises, and oddly rapid eye movements.
It takes a little time to learn to identify and pick up cues for all your baby’s needs. Keeping your little one close to you will speed up this process. Spend as much time as is reasonable having skin-to-skin contact with your new baby. This helps soothe both of you and also gives you a little time to get to know each other. Be patient, you’ll soon learn the right signs.
9) Should his feeds change?
Q. Should I stop breastfeeding my 6 week old on demand? He feeds every two hours.
A. Your baby’s tummy is still very small and can’t hold much at once. So he needs to get food continuously, which makes such regular feeds perfectly normal. As he grows, his tummy will start to hold more, his suck will develop and the frequency of his feeds will change too. So yes, continue to feed on demand at this age.
With any breastfeeding query, always check your attachment is OK. Empty one breast (so he gets the hind milk, which has the highest fat content and comes through after a few minutes) before you offer the other. Also, keeping up night feeds, when prolactin levels (breastfeeding hormone) are high, means you’ll continue to breastfeed successfully.
10) Breast to bottle
Q. I’m going back to work soon, so I want to cut down on my 8-month-old’s breastfeeds by using a bottle. Any tips?
A. We all know breast is best for your baby, but if you want to change your baby’s diet before you head back to work, it’s a good idea to do it gradually to give you and your baby time to adapt. Try offering a formula feed when your baby isn’t too hungry and is fairly relaxed – mornings are a good time.
Introducing formula will affect the amount of breast milk you produce, so you’ll need to keep your supply up if you still want to breastfeed. To help with this, lots of mums breastfeed before and after work and use formula milk during the day.
Some babies take a little time to get used to new feeding routines, so you’ll need to be calm and persistent. Talk it through with your childminder or nursery, who can work with you to establish a new feeding pattern for your little one.
