National Childbirth Trust guide to breastfeeding

Breastfeeding advice for mums and mums-to-be from the NCT, from feeding straight after birth, to changes in breast milk and how often your baby needs to be fed

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We asked the UK’s biggest parenting charity the National Childbirth Trust – often just referred to as the NCT – to share its approach to breastfeeding.

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Heather Welford, NCT breastfeeding counsellor and author of Successful Infant Feeding (Carroll & Brown, £12.99), explains, “The NCT support all mothers regardless of their method of feeding. However, we recognise that mothers who want to breastfeed may need to be enabled to do so in a way that they don’t need to be for formula feeding, because formula feeding has become the social and cultural norm. Even if a woman wants to breastfeed, they may end up using formula because of difficulties and expectations that they haven’t been able to overcome.”

Heather underlines that the NCT’s breastfeeding counsellors offer less an advice service, more a support service. “We don’t give advice as such – rather we support breastfeeding mothers and give them information. So if someone rings up with a difficulty, we may have suggestions on how to overcome that difficulty.” You can call the NCT’s National Breastfeeding Helpline on 0300 330 0771. It’s available seven days a week, from 8am-10pm.

The NCT approach to breastfeeding is about offering help and encouragement, rather than preaching. “Anybody who has any experience supporting women with breastfeeding will know that to just say ‘persevere, carry on, you’ll get there in the end’ is useless and can even be unkind,” explains Heather.

“Pain is a very real factor for some mothers, and can be very off-putting. Sometimes women who are in pain are told to persevere, and we would never do that – instead, we would help them work out what the cause of the pain might be. We would also never use words like ‘right’ or ‘wrong’ – if a woman hears she is doing something ‘wrong’ she may think, ‘I am wrong’. They may feel puzzled or judged or incompetent, which we would never want,” says Heather.

How do you start breastfeeding straight after labour?

Start thinking about breastfeeding before the birth, if you can

It’s a good idea to think about your first feed before you go into labour, so you can plan ahead. Your baby’s instincts to breastfeed are often strong straight after the birth, though this will depend on your individual birth experience.

Aim for skin-to-skin contact straight away

Skin-to-skin contact immediately after delivery is a great way to encourage breastfeeding. This means holding your baby so his bare skin is touching yours, without any clothing or blankets in the way. Ask your midwife to help you.

Heather says, “A newborn baby needs and expects to be held closely skin-to-skin with his mother, unless there is some medical reason why he should be separated. If your baby is born by caesarean section, you can still hold him in the same way. He is likely to be just as keen on getting up close and snuggly as a baby born vaginally.”

Feed early on

Ideally your baby’s first breastfeed should be as soon as possible after the birth. Feeding at the breast early on can encourage your milk to come in. “Even if you have had painkillers, such as pethidine, during the birth and your baby is sleepy as a result, it may be possible – it just possibly affects the experience,” says Heather.

Watch for ‘rooting’ movements and feeding cues

While you cuddle your baby skin-to-skin, watch out for ‘rooting’ movements, such as your baby turning towards your nipple and opening his mouth. You can gently guide him towards finding your nipple, or ask your midwife to help you.

As Heather explains, not all babies will feed straight away. “Skin-to-skin contact is as much about the experience of being close and the taste and smell of his mother, and hearing the sound of her and his father’s voices,” she says. “It also means a mother observes what her baby is doing. She can spot early feeding cues, such as the baby being alert, looking around and making mouth movements. If it’s been a difficult birth, or a baby’s mother has had a lot of pain relief, a baby’s feeding instinct’s may be repressed, but skin-to-skin contact still encourages breastfeeding.”

What is colostrum?

Colostrum is the special, rich milk that your breasts produce in the first few days after birth. It is packed full of vitamins, proteins, enzymes and anti-bacterial agents to help keep your newborn healthy. A good first breastfeed may only be equal to a few millilitres of colostrum as your baby’s stomach is still tiny.

Soon after your baby is born, your pregnancy hormones decrease and the milk-producing hormone, prolactin, is produced. Your milk ‘comes in’ after the first few days, when colostrum is gradually replaced with milk. By around days 10 to 14, your milk will be ‘mature’. 

What is the letdown reflex?

When your baby begins to suck at your breast, the hormone oxytocin is released. This causes the muscle cells around your milk glands to contract and squeeze out breast milk. This ‘squeezing’ is known as the letdown reflex. Some women experience the letdown reflex as a tingling sensation in the breast, but not everyone does.

Oxytocin also helps to shrink your uterus after birth. During your first breastfeed after birth you may feel ‘afterpains’ –  like mild contractions – as your uterus contracts to its pre-pregnancy size.

What’s the best position for your baby’s first breastfeeds?

For the first feeds after the birth, it is often easiest to try what’s know as the ‘biological nurturing’ position – this is where you lie semi-reclined, with your body, especially your head and neck, well supported. Your baby lies on top of your body, on his tummy, with his head near your breast.

In this position, most babies will instinctively root around for your nipple by themselves. Even newborns are able to lift up their heads and attach themselves to the breast. You can help your baby by giving his feet something to push against. This could be your leg, if you have your knees up.

If you’ve had a caesarean, he can be across you with his legs to the side.

How often do you need to breastfeed?

This is a question that many new mums understandably have. There are no hard and fast rules here, but you should feed your newborn baby whenever you think he may want it in the first days of life. Frequent feeds are normal as your baby’s stomach is so small – expect to spend a lot of your time feeding at first.

In general, in the early weeks, feed your baby when he asks for it. As NCT breastfeeding counselor Heather explains, “Research tells us that breastfeeding gets off to a good start when the baby feeds unrestrictedly. He may come to the breast many times over 24 hours – anything from about eight times to 15 times or even more – but he may only have short ‘episodes’ of feeding on some of those occasions. It’s better not to use the clock as a guide, just your baby’s behaviour.”

Seek help if your baby isn’t feeding

In the first day or two, some babies feed frequently while others feed less often. However, Heather advises, “If a baby hasn’t fed at all in the first hours after birth, then a mother needs to start hand expressing so the baby gets some colostrum and she should see her midwife for advice. Just leaving a baby to it is not safe.”

Let your baby set the pace

In general, if you let your baby set the pace, then he will be happier as he won’t be kept waiting for a feed – and as a result you’ll probably be happier too. Crying increases the level of stress hormones in your baby’s body and by responding to his hunger, your breasts will produce the right amount of milk for him. If you try to cut down on breastfeeds, you may not make enough milk.

Keep your baby close by

It helps to keep your baby close to you so you can read his signals. You baby should sleep in the same room with you at night.

How can you ensure your baby is latching on correctly?

When your baby is well attached, he is more likely to breastfeed effectively. Getting your baby to latch on correctly will also help prevent sore nipples. The good news is your baby’s instincts are primed to help attachment happen.

Try these four steps to help your baby correctly latch on:

1. Get comfortable

First of all, make sure you’re comfortable yourself. Find a position both you and your baby are comfy in, whether it’s sitting upright in a chair, reclining or lying down. Use pillows if necessary.

2. Touch your baby’s top lip to your nipple

If your baby is not already seeking out your breast, you can touch his top lip with your nipple. His ‘rooting’ instinct means he will lift his chin and open his mouth. He needs to be able to move his head back to get comfortably attached, which is why it isn’t a good idea to hold his head.

3. Make sure your baby’s mouth is wide open

Wait for him to open his mouth as wide as a yawn. His mouth needs to be open wide enough to take in both your nipple and plenty of breast. As soon as your baby’s jaw drops and his mouth is wide enough, bring your baby to your breast – draw his entire body closer so he gets a good mouthful of breast. Your nipple will enter the top of your baby’s mouth, not the middle, helping him feed effectively.

4. Keep practicing

It may take several attempts to get your baby attached correctly – and that means comfortably for both of you. Your nipple needs to be at the back of your baby’s mouth so that it isn’t squashed. If you wish, support your breast gently from below, using the flat of your hand. It is important not to press or squeeze the delicate breast tissue as this could cause bruising or a blocked milk duct.

If you’re having difficulty in one position, you can try a different one.

Signs of a good attachment:

  • Check your baby’s body is tucked in as close to yours as possible
  • Your baby’s chin should be against your breast, with his head slightly tipped  back
  • Your baby’s mouth should be wide open, but his nose should not be pressed into your breast
  • Your baby should show deep jaw movements
  • You may hear the sound of milk being swallowed
  • You may feel a tingling feeling in your breast, also known as the ‘letdown’ reflex (explained above)
  • If some of the areola (the coloured part around your nipple) is showing, there may be more above the top lip than below the bottom lip. However, on this point Heather explains, “People often talk about seeing more of the nipple above than below. But that really depends on how big a mother’s areola is. It’s not always helpful, because as the baby’s head is in the way, you can’t really see what is going on. What people really mean when they talk about seeing more of the nipple above is the idea of thinking about an asymmetric latch, where the nipple goes in the top third of the baby’s mouth.”

Signs an attachment may not be working:

  • Your baby’s cheeks appear ‘sucked in’ – looking almost as if he is sucking on a straw
  • A squashed nipple at the end of the feed when your baby comes off
  • Sounds such as clicking or lip smacking during a feed
  • Pain during and after the feed

What are the signs your baby’s getting enough breast milk?

As you can’t physically see how much milk your baby is getting, many mums wonder if their babies are getting enough.

  • In the first 48 hours, your baby is likely to have only two or three wet nappies. Wet nappies should then start to become more frequent, with at least six wet nappies every 24 hours from day five onwards. Urine should be pale and not dark brown. 
  • After the initial greeny-black meconium in the first couple of days, your baby should be passing loose yellow stools regularly – sometimes these may look grainy, at other times creamier. Most babies poo three or four times a day, but some breastfeed babies poo less often.
  • Most babies lose weight in the first few days, so don’t be alarmed – it’s normal. From then on, your baby should start to gain weight. Most babies regain their birth weight within the first two weeks of life. 
  • Your breasts and nipples shouldn’t be sore. If they are, speak to your NCT breastfeeding counsellor or other breastfeeding counsellor.

If you’re concerned your baby might not be getting enough milk, speak to your midwife or health visitor.

How will you know when to breastfeed your baby?

Watch out for your baby’s feeding cues. Your baby will make little signals to indicate he is hungry, such as sucking his fists, licking his lips, wriggling and tossing and turning, waving his hands around and opening and closing his mouth, searching for your breast.

Looking out for and responding to these cues is important because the sooner you respond to them, the less frustrated your baby will be between feeds.  As time goes on, you’ll become better at spotting the signs that your baby’s hungry, rather than just wanting a cuddle or simply to suck, rather than feed.

How long should a breastfeed last?

There are no hard and fast rules here. Every baby is different so feeds will vary in length and it’s best to be guided by your baby.

Remember every feed will be different as, like you, your baby’s appetite varies. Sometimes your baby may only want a quick thirst-quenching feed or ‘snack’. At other times he might want a more filling meal. The important thing is to follow your baby’s cues. Your baby will usually let you know when he has had enough.

How do you know you’re producing enough milk?

Breastfeeding works on a supply-and-demand basis. Milk production is stimulated by the removal of milk from the breast, either because your baby’s drinking the milk or because you’re expressing the breast milk. So the more you breastfeed your baby, the more milk your breasts will make. If your baby is well attached, you’re both comfortable and you’re feeding him when he asks for it, then you will hopefully make sufficient milk. 

What’s meant by ‘foremilk’ and ‘hindmilk’?

A few days after your baby’s born, the colostrum becomes mature milk, with a different mix of proteins, vitamins, carbohydrates and fats. This also contains special agents that help fight infection, and help your baby’s gut to develop healthily.

During a feed, breast milk also changes. At the start of a feed, it is more thirst quenching – the lower-fat ‘foremilk’. As the feed continues, creamier milk – the so-called ‘hindmilk’ – is produced, and become more filling and satisfying. So your baby gets its benefits, it’s important not to switch breasts too soon when you’re feeding (you can read more about when to switch breasts below).
 
The fat content of your milk increases as the milk is removed, so when breasts are relatively less full, the fat content is proportionately higher. When your breasts are relatively fuller, the fat content is proportionately lower. Healthy babies who are feeding well will get the right milk intake and type of milk for them. This also means you don’t need to worry about whether your baby is getting a certain amount of ‘foremilk’ or ‘hindmilk’.

How do you know when your baby’s had enough milk – and do you need to switch breasts?

A breastfed baby who is fed on demand can’t be overfed. Although you can’t physically measure how much milk your breastfed baby is drinking, he will come off the breast when he has had enough, and will ask for more if he wants to stimulate your supply.

A well-attached baby will stop feeding when he has had enough. He will usually push out the nipple – and may look sleepy or ‘drunk’. If he is still awake you can offer him the other breast. He may want some or none of it. Remember to offer that breast first next time you feed.

How can you get your baby to safely come off the breast?

If you’re in pain, your baby is in distress or something doesn’t seem right, you can gently insert your little finger into your baby’s mouth to break the suction and let him come off, then start again. Breastfeeding will be easier if you can stay calm and relaxed. Remember you can ask your midwife or a breastfeeding counsellor for help if you need to.

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If you’re struggling, what should you do?

Learning to feed your baby may take time and practice, so never be afraid to ask for help and trust your instincts and judgment. If breastfeeding is hurting, you’ve unanswered questions or you’re worried about anything, speak to your midwife, health visitor, local breastfeeding counsellor, or call the NCT National Breastfeeding Helpline on 0300 330 0771.

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