Neighbourhood Midwives


Breastfeeding brings many health benefits for you and your baby and in the long run breastfeeding is the easy option involving less work.

Like every new skill it takes a while to get it right for both you and your baby but it is worth it.

There are so many health benefits for you and your baby and in the long run breastfeeding is the easy option involving less work. Like every new skill it takes a while to get it right for both you and your baby but it is worth it.
Breast milk comes ready prepared with the perfect composition and nutrients for your baby and the smart thing is that your body will make the appropriate milk for your baby’s growing needs. No other food or drink is needed and it will adapt to the climate and baby’s changing needs. It has antibodies from the mum to help to build baby’s immune system and protect baby from infection and allergies. It reduces the risk of diabetes and childhood cancer. It provides comfort, pain relief and the natural nurturing babies need to develop their brains. The World Health Organisation recommend that baby’s are breastfed for at least first six months.
Remember it is free, fast, convenient, always available. Fresh and clean, correct temperature, you don’t need to sterilize, refrigerate or worry about taking bottles with you.

Breastfeeding reduces the risk of breast and ovarian cancer in women. It helps the uterus to return to it’s pre pregnancy size and uses up the excess fat from pregnancy. It can be relaxing and enjoyable once established.

It may be surprising to learn that many mothers and babies start their breastfeeding journey with ease, however even those mums will report that support from their partner and family made the journey easier. In the first few days after birth, you and your baby will be learning each other’s language. It won’t be very long before you and your baby start speaking the same language which helps you to recognise when it’s time to feed baby. As soon as your baby is born, putting her to the breast and doing skin to skin within an hour after birth helps your body to recognise that it’s time to feed your baby.

Whether you have a straightforward vaginal birth or a more complicated or caesarean birth, cuddling skin to skin with your baby helps to regulate your baby’s hormones, helps them to feel calm and increases your chances of successfully breastfeeding. Even slightly premature babies do better tucked in with their mum skin to skin. Some babies are tired after their birth journey so may not feed straight away, which shouldn’t create a problem if you are using skin to skin for as long and as much as you can. However, it is important to encourage and help your baby to feed as soon as possible after birth as a baby’s suckling instinct is strongest in the first hour after birth.

There are many ways that you can hold your baby to breastfeed. However, in the early days, many mums find it useful to stick to what works as there is lots of time after you feel confident to try position acrobatics.

One of the keys to successful breastfeeding is to ensure that baby attaches to the breast correctly. This is known as the latch. There are a few things you can do to help your baby to latch.

  • Always hold your baby so he is facing your breast and lying in a straight line not having to twist or turn his body. The nipple should be lined up with the baby’s nose, not his mouth. This means that as he opens wide the nipple is positioned to enter up under the roof of the mouth and not just inside the lips.
  • Bring him to the breast with his chin touching the breast first, then his bottom lip and tongue near the outer edge of the areola, and bringing his top lip to latch over the nipple as far as possible on to the other side of the areola. Make sure he takes a good mouthful of the areola (the dark area surrounding the nipple) and not just the nipple itself. He should have more areola in his mouth in the area of his bottom lip rather than his top lip.
  • Before you bring baby to your breast it’s important that you see a wide open mouth then bring him onto the breast. Babies breastfeed — they don’t nipple feed. Allowing your baby to suck on just the nipples will make them extremely sore, and can lead to cracking and bleeding. Remember to always bring your baby to your breast rather than trying to move your breast to your baby.

REMEMBER: Tummy to Mummy, Nose to Nipple, and Baby to Breast.

When your baby starts to suckle, they will initially do rapid sucks and you should notice them sucking and swallowing and see their jaw moving. Their chin should be in close and after a few minutes you may notice your “let down” which is the hormone oxytocin pushing the milk through your breast, enabling it to flow which helps the transfer of milk from breast to baby. Your baby should be tucked in nice and close and their body should be turned towards you. Generally, it shouldn’t hurt and the baby should stay latched for the feed.
In the early days many mums find trying laid back breastfeeding positions more comfortable. Laid back breastfeeding positions can be very comfortable for your new born baby as they help to calm your baby’s natural reflexes which helps them to feel more grounded and settled.

Newborn babies communicate through something called cues. Cues are the subtle way that your baby will tell you that they are hungry or even just need a cuddle. Breastfeeding involves a lot of trust as well as looking for other signs that your baby is feeding well and regularly/frequently enough. Early feeding cues include your baby making murmuring sounds, turning their heads, sucking their fingers and small movements of the mouth.

Breastfeeding should NOT be painful and most mothers will find that breastfeeding does not hurt. However, some mothers mention that in the first few days when baby initially latches that for a couple of seconds that the sensation feels strong but before the end of the first week most mums find that it no longer feels that way. If you find that breastfeeding hurts throughout the feed then it is likely that baby has not latched onto the breast properly and may be nipple feeding rather than breastfeeding, which can cause discomfort. If at any time you feel unsure, then it is important that you get the right help and support; speak to your midwife and she can have a look at how things are going and assess if baby is latching onto the breast correctly. The baby could also have a tongue tie which is a common cause of sore nipples. Here at Neighbourhood Midwives, we visit women every day for the first five days and provide plenty of positive hands on support to ensure that breastfeeding gets off to a good start and problems are eliminated quickly.

Baby led and responsive feeding involves you listening to your baby so that they can tell you when they need to eat and not watching the clock. Sometimes, they will feed every two hours and other times they will go longer. The idea is to respond to what your baby needs rather than imposing a schedule on him/her. Getting to know your baby will help you know when they have had enough. At the end of a feed, your baby should come off the breast by themselves if you lift the nipple away and he will appear calm and relaxed. Sometimes in the early days, it is clear that the baby would like a little more feeding. Put the baby back to feed from the side they were last feeding on. It’s a bit like when you allow yourself some space after having dinner when you want some desert. Each time you respond lovingly to your baby you help to teach them that you will be there when s/he needs you. This helps your baby to learn to trust that their environment is safe and that they are loved and cared for. It is important to remind yourself how tiny your baby’s stomach is and, therefore, that regular feeding is essential.

There is so much that your family can do to support you while you are breastfeeding. Firstly, they can support your choice to breastfeed by giving you encouragement and also do their own research on how breastfeeding works so that they understand. Your partner and family can help by bringing you water every time you feed baby as you can find yourself very thirsty. Having your partner or family making sure that you are eating and drinking well after birth can help. Let them know what nutritionally balanced meals they can prepare for you after birth for the first few weeks. They can wind baby after a feed and do the nappy change. Most of all, they can acknowledge what a great job you are doing and encourage you to keep going and feel positive.

In the early days, feeds might last 10 to 40 minutes or more, averaging out to around 30 minutes each feed. The key here though is that the baby should be actively feeding for most of the feed. Sometimes babies get sleepy at the breast and only suck very gently or spasmodically. If this happens take the baby off, wake him or her by sitting baby up or changing his nappy and then relatch on the same breast to finish the feed. It’s important to understand that each baby is different and not to get too caught up on the timing in the first few weeks. In the first few weeks, your baby should be feeding between 10-12 times in a 24 hour period and should have lots of wet nappies (eight or more) and at least a couple of dirty (that’s the poo ones) nappies each day. In the first two days, your baby’s poos will be dark in colour and look like marmite. On days three and four, you should notice that the poos are starting to change and will look a greeny black colour, this is known as changing stools. Once your milk is in and baby is feeding well, the poos should be yellowy in colour.

Did you know that the hormones that help your body to make breast milk are highest at night? Your baby knows this instinctively, hence being awake at night in those first few weeks. It means that your baby is doing the right thing in the early weeks by asking to be fed during the night. We know this can be challenging and many mums find that trying to have a nap during the afternoon or early evening can help them to cope. Feeding during the night is essential for your baby’s growth and development and will help your baby to grow. Some women find it quite a special time, quiet and cosy with their baby. This time won’t last forever and later on, you will look back fondly on these early days.

Mastitis occurs when a milk duct gets blocked. The area around the blocked duct can get swollen, red and inflamed. Mastitis also has flu like symptoms and you may notice that you have a raised temperature. To prevent a blocked duct turning into mastitis, you should feed regularly from the breast with the problem. Use hot, wet compresses or a bath or shower to soften the blockage. Hand express your milk to help stop the breast from getting engorged (too full) and also try gently massaging the area that feels uncomfortable using fingers covered with oil. Then, use cool compresses to relieve inflammation. The aim is to soften with the heat, break up with fingers and clear by feeding. This must be done frequently until the symptoms go. At the same time, rest and drink plenty of clear fluids. Mastitis can be caused by baby not latching on the breast properly, missed breastfeeds, or a poor fitting bra. It is also more common if breasts get cold or the woman is stressed and/or very busy and tired. Not all blocked ducts turned into mastitis and if you try the things suggested earlier, you can help yourself to keep mastitis at bay. However, if you begin to feel really unwell or have a high temperature, contact your midwife or GP quickly.

Tongue tie is caused by a short or tight membrane under the tongue, restricting the mobility of the tongue. It effects approximately 10% of babies, although only about half of these will have problems with feeding as a result of the tongue tie.

Anterior (or 100%) tongue ties are very easy to spot as the tongue can be heart-shaped at the tip and look ‘pulled back’ when the baby attempts to move the tongue forward. It can also be seen when the baby cries as the tight membrane, pulls the tongue towards the floor of the mouth. Posterior ties (where the membrane is attached further back on the tongue) are often harder to spot as the tongue tip may appear normal. Most posterior tongue ties tend to be diagnosed by symptoms and then a thorough examination of the mouth and tongue by a health care provider trained in tongue tie diagnosis.

Tongue tie can cause significant problems for both the Mother and baby. In the mother, she may suffer from cracked, damaged, painful or crushed/blanched nipples, despite seeming to ‘have a good latch’. Mothers often complain of feeling that their baby is ‘biting’ them to stay on the breast – this is due to the baby using their gums, rather than tongue to attach to the nipple. Mothers may also suffer from poor milk supply, mastitis, thrush (caused by nipple damage) and pain. Babies can struggle with latching onto the nipple, frequently coming on/off the nipple, having a small gape resulting in biting on the nipple, excessive early weight loss or poor weight gain, feeding very frequently, being unsettled at the breast, wind and colic. However, there may be other reasons why babies may have these symptoms, therefore your baby needs assessment from a practitioner skilled in breastfeeding and ideally trained to identify tongue tie.

Tongue tie division is a very simple procedure which involves the tight membrane being divided to give the baby increased tongue mobility. A tongue tie practitioner is often a midwife, nurse or doctor who has received specialist training to perform the procedure. The baby is wrapped in a blanket or shawl and the practitioner will then perform an assessment of the baby’s tongue mobility and the palate. The tongue tie is then divided back to the floor of the mouth with sterile scissors – blood loss and pain are usually minimal.
Research evidence shows that a significant number of babies have an improvement with breastfeeding following the procedure. There is little research around improvement with bottle feeding, although anecdotal evidence shows that this also improves following tongue tie division.
The risks are very minor and usually are around bleeding or infection. All parents who choose tongue tie division should be provided with good, research based information in order to make an informed decision prior to the procedure.

Thrush is a fungal infection that can affect your baby’s mouth and your breast which means if either you or your baby have thrush, you both need treatment. Common signs of thrush are sore nipples that appear pink, shiny and sore. Mothers may notice that the pain will increase during feeding when it was never there before. Signs that the baby has thrush are white spots or patches on the roof of their mouth or a thick white coating on their tongue. Sometimes, this is not obvious, but your baby may have a sore bottom. Also, the baby may be fretful at the breast and unsettled. Your midwife can let you know if it appears that you or your baby has thrush and the good news is, it can be easily treated. If you feel shooting pains in your breast or deep pain, you may need a more specific treatment. If you had antibiotics during labour or your baby had antibiotics after birth, taking a probiotic supplement can help to keep thrush at bay. Grapeseed extract is also found to be useful as a topical treatment.

It is good to know that you can now go back to eating normally after you have had your baby. You no longer need to worry avoiding all the foods you had to whilst you were pregnant. However, you might find that certain foods irritate your baby although this will vary from woman to woman. Common culprits are onions, cabbage, cauliflower, and lots of tea and coffee with caffeine. Some mums report finding that starting their day with a nice warm bowl of porridge helps them with their milk supply.

Of course, many partners and family members look forward to bonding with your baby and there are lots of ways that they can do this as well as helping you. They can help you with burping baby, cuddling baby between feeds, settling and rocking, dressing and changing baby and even changing those dirty nappies (breastfed poos don’t smell bad!). When your baby is six months old, they will start weaning and it can be a very exciting time introducing new food and recipes and your partner and other family members can join in on the fun. If you are choosing to breastfeed, then you can help you and your baby to have the best start if you exclusively breastfeed for the first four weeks or so before expressing your milk for a bottle. This is because by then, your milk supply is established and it is more likely to be easier to express and your supply is less likely to be affected by the process. However, if you choose to express your milk and have family feed the baby then the best advice is to express whilst the baby has a bottle of your milk to ensure that your supply still remains the same.

Of course you will! The same rules apply - cuddling your baby skin to skin soon after birth helps to give you and baby the best start. Also, ask your midwife to help latch the baby on whilst still in theatre. Some mothers will find that they are more comfortable using the rugby breastfeeding hold when they feed their baby as their tummy is likely to be tender. You can even try the laidback breastfeeding with baby across your shoulder so that your healing tummy won’t feel so sore. Generally, you will need more help lifting and settling the baby so do remember to ask. Any pain relief you are prescribed after birth will take into account that you are breastfeeding so will be safe for you to take.

Many mothers are able to successfully feed their twins and find that if they prepare and have the right support, they are able to manage it well. There are lots of things you can do to help you cope with the challenge of breastfeeding more than one baby. Twins are more likely to be born a little earlier and the first milk your body makes, colostrum, is perfect for a baby’s immature tummy. Your body is very clever and is able to make enough milk for both of your babies. You can help your body to produce milk for your babies by feeding them regularly and eating a well-nourished diet and drinking lots of water. Your babies will give you cues to let you know when they are hungry; these include your baby sucking their finger, smacking their lips together and licking their lips. The more you feed your babies, the more your body will get the message to make milk for your baby. Some mothers choose to exclusively breastfeed their twins, other mothers will express their milk in to a bottle and breastfeed and other mothers will choose to combination feed their babies with both breast milk and formula.
Sometimes twins are a little slow to get started so you should get help to express your colostrum and use a syringe to finger feed your babies. The midwife will help with this. At Neighbourhood Midwives, we care for a lot of twin mums and spend a great deal of time on this aspect. Colostrum can even be expressed before the birth to increase production. Ask your midwife about this.
Did you know that you if you choose to you can breastfeed both of your babies at the same time? This is called tandem feeding. Some mother like to tandem feed as they feel like it takes up less time and also helps them to get their babies into a routine. Other mothers like to feed their babies individually.
The key is to try different feeding positions that make you and both of your babies feel comfortable.

Sometimes premature babies are not able to breastfeed straight away but that does not mean that your baby is not able to have your breast milk. Breast milk contains lots of antibodies that can help to protect your early baby and you can help your baby by expressing your milk. You will produce a very tiny amount at first which is just what your baby needs. This will gradually increase. Breast milk is also highly digestible and easy for your baby’s body to absorb. Special care baby and neonatal units are fully equipped to support you in expressing your milk for your baby. Some units even have breast milk donated by other mothers too which many mothers choose to use in the first few days if they need to.