Q: My first labour was long and I had a Caesarean. After several days with a sleepy baby who was refusing to suck, I was unable to produce milk, and my midwife advised me to consider bottle-feeding. My second baby is due in August. Should I accept that I am one of the few women who will never produce enough milk?
A: Long labour and a Caesarean can leave you feeling tired and the baby sleepy, but it doesn’t mean that your next labour will follow this pattern. Discuss your previous experience with your midwife and see if there is anything you can do to have a shorter birth. Do not be put off by your previous experience of breastfeeding; it is unlikely that you will not be able to produce enough milk. Being tired and anxious can affect the milk supply, and putting the baby on the breast and letting him feed as he wants to is the best stimulus for milk production. If you do feel tired or have a Caesarean, accept offers of help so that you can recover and spend time establishing breastfeeding. Most women feel more confident in their second pregnancy, and this can help you to feel less anxious when breastfeeding.
Q: My partner and I have decided that he’ll help with night feeds, but I’m worried that suddenly being faced with a bottle of expressed milk might confuse my breastfed baby. How can I introduce this alongside breastfeeding?
A: Breastfeeding offers the best start for your baby, although it is worth remembering that it can take some time for feeding to be established and for you and baby to feel at ease with it.
In the first few days, your baby receives colostrum ( a thick milk like substance) and by around day 3 the milk starts to come in. You may want to wait until you are confident with breastfeeding before you start to express. Babies use a different sucking action when feeding at the breast compared with a bottle that is why it is best to wait until feeding at the breast is well established before introducing a bottle.
It’s great that your partner is willing to help out with the care, and there is a lot he can do to support you at night. Whilst feeding is being established he could help with the general care of your baby. You also need to make the most of any opportunity to rest during the day when your baby is asleep so that you feel a little more prepared for disturbed nights.
When you start to express milk, you need to ensure that you keep all equipment clean to minimise the risk of infection. You should ask your midwife about how to express milk, either by hand or with a pump, so that you avoid damaging the delicate breast tissue. The UNICEF Baby Friendly Initiative website has some useful leaflets to download (www.babyfriendly.org.uk/home.asp ).
Q: My 4-month-old is terrified of our cat. He screams whenever he sees her and takes ages to calm down again. As far as I know (and I’ve been careful not to let the cat into his room) she has never scratched him or anything. Why does he have this reaction and how can I stop it?
A: It is unlikely that he is afraid of the cat but he might be anxious in response to your concerns about the cat being in the room. You are wary of the cat frightening your son and you may pass this worry on to him. Get him used to the cat gradually: try cuddling him while showing him the cat and introduce pictures of a cat in a storybook.
Talk to your son and make eye contact with him when he becomes anxious. This will help to reassure him. As he gets more confident he will probably enjoy playing with the cat, although you may want to keep and eye on them.
Q: My baby takes a long time to settle and cries if I leave the room before he falls asleep. I can’t bear to leave him to cry himself to sleep, but I feel he needs to get used to being alone at some point.
A: You don’t mention how old your baby is, but newborns will take some time to settle into a routine – after all, they’re in a strange new environment. If you are happy that your baby is well, not hungry, and clean and dry, leave him for a few minutes to settle, but don’t leave him crying so long that he becomes too distressed. If you do go back to him, don’t pick him up immediately: try talking to him or stroking his skin to comfort him. Don’t bring him into the busy areas of the house, where activity will wake him further.
Think about yourself too – if you are tired and anxious he might pick up on it.
Q: My baby’s due in a few weeks and I’m worried about how to look after the umbilical cord stump properly after the birth. How do I bathe my baby without hurting him and is there anything I must do to avoid infection?
A: The umbilical cord has nourished and supported your baby through pregnancy. After birth it withers and falls off. There are no nerves in the cord so the baby does not feel any discomfort through the process.
It is fine to bath your baby and it doesn’t matter if the cord stump gets wet as long as you allow it to dry. Plastic nappies and pants over the cord tend to make it moist, as the baby gets hot and occasionally, especially with boys, urine may seep through the nappy.
The cord doesn’t need any special soap or powders, and if it appears clean and dry it is best not to do anything to it. If the cord stump does become moist or contaminated with urine or faeces it should be cleaned with plain water and cotton wool and then dried. If the cord becomes moist it may start to smell slightly. If this happens, just ensure that you clean it and then keep it dry.
The cord usually falls off within about 7 to 10 days and it may be necessary to continue to bathe the umbilicus for a few days after this. If there is any redness around the umbilicus and the baby seems unwell, ask your midwife or doctor for advice.