Breastfeeding Tips for New Mothers

Breastfeeding offers many benefits to your baby as breast milk contains the right nutrients that are required by your baby for proper growth and development. Breast milk also protects the baby from common childhood infections and illnesses. WHO recommends exclusive breastfeeding up to six months of age with continued breastfeeding along with other food for up to two years.

Breast milk protects your baby against infection and provides all of your baby’s nutrition. Breastfeeding promotes mother and baby bonding. Breastfeeding benefits the mother’s health.

START BREASTFEEDING EARLY

Try breastfeeding soon after your baby is born.
Let your baby know who you are with skin-to-skin contact. Babies have a keen sense of smell.
Breastfeeding eight to twelve times a day is normal in the first few days.
Keep your baby with you day and night. You will soon know what your baby needs and when to feed.
Ask your midwife/nurse to watch you breastfeeding and see if the baby is well attached and positioned at the breast.

SIGNS THAT YOUR BABY IS READY TO FEED

Stirring from sleep with yawning and stretching
Mouthing and licking lips
Bringing hands to mouth
Crying will occur if response to other signals is slow.

HOW TO FEED

Change your baby’s nappy if dirty.
Wash your hands.
Have a glass of water handy.
Alternate the breast you start each feed.
Allow your baby to suck until he/she stop or naturally comes off the breast – watch your baby, not the clock.
Offer both breasts – your baby may take one or both.

POSITIONING

It is important you are comfortable.
Support your back.
Position yourself first then bring your baby to you.
Unwrap your baby for closer contact.
Turn your baby on their side to face you – chest to chest, chin to breast.
Hold your baby firmly by the shoulders, not the head.

ATTACHMENT

Wait for your baby to open her mouth very wide. You may need to stroke her lips with your nipple.
Direct your nipple to the roof of your baby’s mouth to be sure they take in plenty of breast tissue and not just the nipple.
The first sucking is rapid, followed by a slower suck/swallow pattern with regular pauses.
Nipple shape should not be distorted when your baby comes off – if it is, there may be an attachment problem.
Nipple tenderness can be normal in the first few days, but continuous nipple pain, cracks and bleeding are not – ask for help.

COLOSTRUM

Produced for the first few days – can be clear to yellow or orange in colour before changing to mature breastmilk
Highly nutritious, it protects against infections and allergies
Satisfies a baby’s hunger and thirst, it can be a few drops or as much as 5–15 mL
Is a natural laxative to help a baby pass meconium and reduce the possibility of developing jaundice

MATURE BREASTMILK

Milk starts to ‘come in’ from three to five days, and matures over two to four weeks.
Milk at the start of the feed can look a watery, whitish blue colour – it satisfies a baby’s thirst.
Towards the end of the feed, it looks creamy as the fat concentration increases. These extra calories will satisfy a baby’s hunger.
Breasts can become very firm and even lumpy for a few days. Feed regularly and change your baby’s position at the breast. Use cold compresses, gentle massage and pain relief if uncomfortable.

NIGHT FEEDING

Many babies feed more often in the evening.
Feeding at night increases milk production.
Failure to breastfeed overnight can result in engorged breasts and a reduced milk supply.

WHY NO BOTTLE?

Supplementary feeds of formula are not routine and will only be given if medically indicated.
Using a bottle and teat can confuse a breastfeeding baby because the sucking action is different. Cup feeding may be an alternative.
For the same reasons, we do not recommend using dummies/pacifiers while trying to establish breastfeeding.

STORING YOUR BREASTMILK

Breastmilk is best used when fresh, but can be refrigerated or stored frozen in a clean, covered plastic or glass container. Label it with your name, date and time of expression.
Warm the breastmilk in hot (not boiling) water for a few minutes. Shake gently to mix.
Breastmilk should NOT be thawed or warmed in a microwave, as it heats unevenly and may change or destroy some of the special properties of the milk.
Thawed milk must be used within 24 hours.
Chill fresh milk before adding to previously expressed chilled or frozen milk. Always label with date of oldest milk.
To transport milk, place it in an insulated container with ice.
Freezing milk in small quantities reduces waste.
Express at least six times in 24 hours and at least once overnight if your baby is unable to feed at the breast.

WEANING OR SUPRESSING LACTATION

Colostrum (first milk) may be produced as early as 16 weeks into the pregnancy. A woman’s body is designed to produce milk after the birth, regardless of whether she decides to breastfeed or not. Mothers who choose not to, or who are unable to breastfeed after birth usually choose immediate suppression.

There are many reasons why women decide to wean. The timing of this decision is individual to each mother and baby. Weaning can trigger a number of different feelings and emotions.

WHAT IS WEANING?

Weaning is a process where mothers gradually introduce their babies to foods while continuing to breastfeed.

It is also the term commonly given to stopping, or reducing breastfeeding and the introduction of formula or cow’s milk to babies/children.

WHEN TO WEAN?

The World Health Organization (WHO) recommends that children be given only breastmilk during the first six months of life, then introduce complementary foods while still breastfeeding. WHO also recommends that breastfeeding continue for up to two years and beyond.

Immediate suppression – ways to reduce breast discomfort

As breasts become full, heavy and tender:

A comfortable, supportive bra and breast pads may be useful.
Apply cold packs such as chilled washers or a bag of frozen peas and change them often enough to keep you comfortable. Washed cabbage leaves can also be used.
Limit stimulation and handling.
Avoid heat on breasts.
Take Paracetamol as directed to relieve pain and discomfort.
Express enough milk to keep breasts comfortable and avoid mastitis. This does not increase your supply because you are not emptying the breasts.

Gradual suppression/weaning

If you have been breastfeeding and decide to wean, it is better to do it over several days or weeks rather than suddenly. It is the safest and most recommended method as it allows your baby and your breasts to adjust. It reduces the risk of engorgement, blocked ducts and mastitis.

Initially drop one feed every few days. Replace this with milk from a bottle or a cup.
Express for comfort as necessary at this time, reducing this slowly. Watch for any signs of mastitis, such as redness, pain or flu-like symptoms. If these occur, continue to express until resolved and contact a healthcare professional.
When breasts feel comfortable, drop another feed.
Continue to drop feeds in this way, usually about one feed a week.

Partial weaning

This means that some breastfeeds are substituted with formula or cow’s milk or solids and some continue. This may be useful if the mother returns to work as it allows the baby to continue receiving some nourishment from breast milk and gives mother and baby some one-on-one time after being apart.

Abrupt weaning

This is the sudden ending of all breastfeeds. It is not recommended and you should seek the advice of your doctor or nurse if you find it is necessary.

Suppressing after pumping

This is particularly important for any mother who has been expressing by pump for more than two weeks. If weaning suddenly after your milk supply is established, keep expressing enough milk to keep your breasts comfortable.

Restricting fluids to reduce milk supply is no longer recommended. Medication is rarely used, and is only prescribed by a doctor in exceptional circumstances.

Leakage may occur for some time after the discomfort has settled.

Weaning a reluctant toddler

When you decide to wean, try to stick to your decision.
Offer plenty of alternative fluids.
Wean directly to a cup.
Wear non-breastfeeding clothes.
Avoid sitting in usual breastfeeding positions.
Provide distractions and alternatives, for example, plan outings or activities.
Provide extra cuddles and smiles.

THINGS TO WATCH FOR:

Engorgement
This is when breasts become hard, red, shiny and painful. Should this happen, expressing and emptying breasts once can relieve the pain. Continue to express just enough milk for comfort over several days.
Mastitis
This is a tender, inflamed area on the breast often accompanied by fever and joint aches and pains.

PREPARATION OF FORMULA FEEDS

Formula feeds can be made up in individual bottles as needed, or for a 24-hour period. Use the feeding table on the container as a guide only, as your baby may need more or less than indicated. Your health professional can advise you.

Use the exact number of scoops of powder per mL of water as instructed on the container. Using more or less powder than indicated can lead to dehydration or deprive your baby of proper nutrition. Unboiled water, unsterilised bottles or incorrect dilution can also make a baby ill. Babies aged less than six months need a new-born formula.

Method

Wash hands with soap and water. Dry with a clean hand towel.
Fill a kettle, jug or saucepan with fresh water and bring to a boil. Then, allow the water to cool until steam stops rising.
Pour the correct amount of cooled, boiled water into sterilised bottles.
Use only the measuring scoop provided for each container and fill without packing down the powder. Level by passing the flat edge of a knife blade across the rim of the scoop or use the cutting edge of the container. Never use half scoops.
Add the correct number of scoops to the measured cooled water.
Cap the bottle and shake well to mix the formula.

Storage

Store made up formula in the centre, at the back of the fridge, where it is coldest (not in the door) and use within 24 hours.
Discard the remains of part-used bottles after one hour.
Store cans of infant formula in a cool dry place.
To ensure freshness, replace the plastic lid after opening and use contents within four weeks.

SAFE BOTTLE FEEDING TIPS

Babies generally prefer feeds warmed to room temperature.
Standing the prepared bottle in warm water is the safest way of heating.
A microwave oven should not be used to heat milk as it heats unevenly and may burn your baby’s mouth.
Thermostat-controlled bottle warmers are safe, but the bottle should not be left in the warmer for longer than 10 minutes as bacteria multiply rapidly.
Always check the temperature of the feed by shaking a few drops on the inside of your wrist.
To check the flow, invert the bottle. Milk should drip steadily from the teat.
Place the teat into the baby’s mouth slowly. The teat is then held against the roof of the mouth (hard palate) with both lips flanged around the teat.

HINT: When travelling, carry cooled, boiled water and formula powder separately. Mix only when needed.

SIGNS THAT A BABY IS FEEDING WELL

The baby is generally content, settles after feeds and has a good colour and skin tone.
6-8 pale, wet, cloth nappies (4-5 heavy, wet disposable nappies) every 24 hours
Regular bowel motions
Weight gain is evident

CUP FEEDING

Cup feeding provides a safe alternative to bottles and teats when your baby is unable to breastfeed effectively or requires additional fluids.

It can also be used if you are temporarily unable to breastfeed your baby.

Expressed breast milk should be used. Where medically indicated or at your request, a breast milk substitute (formula) may be given.

The cup used should be small and smooth edged, the capacity should be no more than 30 mL.

HOW TO CUP FEED

Before starting, wash your hands thoroughly and place the milk into a clean and dry cup.
Ensure your baby is awake and alert prior to starting a cup feed.
Wrap your baby securely to prevent his/her hands from knocking the cup.
Place a bib under your baby’s chin; the baby may dribble some of the milk.
Hold your baby in a supported sitting position on your lap, so that you are both comfortable.
Keep your baby in an upright position throughout the feed.
The cup should be no more than half full.
Place the cup so the rim is gently resting on your baby’s lower lip.
Tilt the cup until the milk is at the rim.
Your baby will open his/her mouth and begin to sip or lap up the milk. You will hear swallowing.
Leave the cup in place while your baby is feeding actively. Your baby will regulate the pace and volume of the feed. Remove the cup when the baby stops drinking.
Return the cup when your baby is showing signs of being ready to feed again.
Repeat this process until the feed is finished, usually within 20 to 30 minutes.
Wash the cup in hot soapy water then rinse and dry. The cup can be stored in a clean container (with a lid) in the fridge for later use

SUPPLEMENTARY FEEDS FOR NEW-BORN INFANTS

The World Health Organization recommends giving infants under six months no food or drink other than breast milk, unless medically indicated. Supplements of water, glucose and water or formula are no longer routinely given. If a supplement is recommended, this will be discussed with you.

Studies have shown that breastfeeding a healthy baby according to need, without a supplement:

Encourages early milk production (within 24 to 48 hours)
Decreases the likelihood of jaundice
Supports better weight gain in infants
Is associated with a longer and more successful breastfeeding experience.

If you are concerned about your supply of breast milk, try:

Breastfeeding more often
Offering both breasts twice at each feed
Expressing and using breast milk as a supplement
Offering a feed instead of a dummy
Increasing skin to skin contact

Did you know?

There is sufficient milk in the breast 30 minutes after a feed to give a top up feed.
Any infant formula interferes with the protection against infection that colostrum and breast milk is creating in the baby’s gut.
A baby’s suck on an artificial teat is different from a baby’s suck on the breast. A breastfed baby can become confused and may then have difficulty latching onto the breast. If a baby needs a supplement, using a cup is an alternative.
Infant formula is more slowly digested than breast milk. This effects a baby’s need to breastfeed and can also reduce a mother’s milk supply.
Goat’s milk, soy milk and cow’s milk infant formula can create a potential allergic response.

If you are having problems with your supply, you will need extra support from your:

Midwife/nurse
Lactation consultant (IBCLC)

Cleaning Breast Pumps

You must clean your new kit before the first use. Babies are prone to infection, so it is essential to keep bottles, teats, caps, and dummies sterilised for the first 12 months.

To clean breast pump parts

Take the breast pump kit apart, and separate all pieces. Rinse in cold water all the parts that have been in contact with your milk.
Wash in hot, soapy water using a clean bottle brush. Use a brush kept only for this purpose.
Rinse all parts in hot water, at least twice.
Drain bottles and containers upside-down on new paper towel or clean cloth towel and cover with more paper / cloth towel while they air dry. Finish drying all containers with new paper towel before putting away. Store the dry kit in a new plastic bag, plastic wrap, more paper towel or clean, covered container until next use.
Sterilise equipment every 24 hours.

Sterilisation of Equipment

Sterilisation - boiling method

Place washed equipment in a large saucepan.
Cover with water removing air bubbles.
Boil for 5 minutes, once bubbles start rising.
To avoid scalds, allow equipment to cool in saucepan or use clean tongs.
Store sterilised equipment in a clean, sealed container in the fridge.
Wash and boil equipment every 24 hours whether used or not.

Sterilisation - chemical method

Follow the manufacturer’s instructions when using antibacterial solution or tablets to make solution correctly. Use plastic or glass as metal corrodes.

After washing, submerge all items. Remove all air bubbles and cover the container.
Soak for 15 minutes starting from when the last item was added.
A good shake will rid items of any excess solution. Do not rinse.
Store sterilised equipment in a clean, covered container in fridge.
Wash container in hot, soapy water. Make up fresh solution and re-sterilise equipment every 24 hours.

Microwave or electric steam sterilising units

These are suitable to use as long as the manufacturer’s instructions are followed. The amount of water and length of time taken will vary with each unit.