Most women, when given accurate information and adequate support and encouragement, can successfully breastfeed.
The midwives caring for you will provide you with education and support to help you establish and maintain breastfeeding. Please do not hesitate to ask your midwife for advice, at any
Small, preterm or sick babies may have additional special needs for their feeding.
How you feed your baby is one of the most important decisions you will make.
The risks of not breastfeeding
We respect your choice on how to feed your baby. According to the World Health Organization (WHO) and current research, there are risks associated with not breastfeeding your infant and it is important that you are aware of this information.
- For infants, not being breastfed is associated with an increased incidence of infections, such as ear infections, gastroenteritis, and pneumonia. There is also an elevated risk of childhood obesity, type 1 and type 2 diabetes, leukaemia, and sudden infant death syndrome (SIDS).
- For premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC), a condition where the intestines become infected and can begin to die. This usually requires surgery.
- For mothers, not breastfeeding is associated with an increased incidence of pre-menopausal breast cancer, ovarian cancer, type 2 diabetes and retained pregnancy weight gain.
For more detailed information about these risks, please see Mater’s Breastfeeding—a decision aid brochure.
These differences in health outcomes can be explained by the specific and innate immune factors present in human milk. In other words, every mother makes milk specifically for her own baby’s needs with immune protection designed just for them. Therefore, the National Health and Medical Research Council (NHMRC) and the Australian National Breastfeeding Strategy 2010–15 recommend that all infants be exclusively breastfeed for six months and continue at least until the infant’s first birthday. Mother and baby can then continue to breastfeed for as long as they both wish to do so. The World Health Organization recommends at least two years of breastfeeding for all infants.
Mater Mothers’ Hospital’s staff will provide you with support and guidance, with feeding your baby, whatever your decision.
How breastfeeding works
Breastfeeding works on supply and demand. Every time your baby feeds, your body starts to make the next feed. The more your baby feeds, the more milk you make. You do not have to wait a specific amount of time for your breasts to fill up before feeding your baby again.
Mater Mothers’ Hospitals practices rooming-in, allowing you and your baby to remain together 24-hours a day. This means you are able to respond to your baby when feeding cues are displayed, helping you establish a good milk flow by promoting milk let-down. Rooming-in also helps you to bond with your baby and gain confidence caring for them. Additionally, current research indicates that mothers and babies who room-in together actually sleep more effectively.
Feeding cues—how to know when your baby is ready to feed
Look for, and respond to, early feeding cues that your baby displays to indicate
they are ready to feed. These feeding cues include:
- rapid eye movement
- clicking or tongue sucking
- rooting—opening their mouth and searching to suck on contact
- hand movements to their mouth and sucking on hands
- moving other extremities
- general increased alertness or activity.
Crying is a late sign of hunger. Avoid waiting for this sign as a crying baby can be more difficult to attach.
The first breastfeed
The first step towards successful breastfeeding is early skin-to-skin contact—if possible, allow uninterrupted skin-to-skin contact with your baby following their birth (skin-to-skin contact is beneficial at any time). This encourages licking, nuzzling, touching, sniffing and eventual feeding when your baby is ready, which is normally within the first after hour birth. Bathing and weighing should wait until after the first breastfeed.
Correct attachment and positioning of your baby to your breast is also important. Please ask your midwife to provide guidance when attaching your baby, until you feel confident managing this independently.
Positions for feeding
Before you start breastfeeding make yourself comfortable. Have a glass of water close by—many mothers find they become thirsty during a feed.
Baby led attachment
Babies have natural instincts which enable them to find their mother’s breast, from birth, with little, or no, help from anyone. These behaviours are seen as early as one to two hours after birth and continue for at least three months.
- poking their tongue out
- turning their head from side to side (rooting)
- finding and grasping the nipple
- attaching onto the breast
The following information will guide you to help your baby to attach to your breast:
- Get to know your baby’s hunger cues.
- A calm baby—your baby will be able to follow through with their instincts if they are calm rather than upset.
- Begin with skin-to-skin contact.
- Position your baby in any way that feels right, such as upright on your chest between your breasts. You may also like to semi-recline as this position makes it easier for your baby to make their own way to your breast.
- When your baby is ready to feed they will lift and ‘bob’ their head or glide towards the nipple, using their cheek and chin to manoeuvre them in that direction.
- As your baby moves closer to your breast they will nuzzle at your nipple. Do not hurry your baby; they will do this in their own time.
- When your baby finds the breast, they will bring their tongue forward and may lick at the nipple. They may press on your breast with their fist or rub your tummy with their feet. This helps to stimulate the secretion of oxytocin, which is the hormone required to release your breast milk.
- When your baby finds the nipple, they will dig their chin into the breast, reach up with an open mouth, attach to your breast and start sucking.
- Tuck your baby’s bottom in firmly against you and provide support to their neck and shoulders while avoiding putting any pressure on their head. Babies need to have their head free in order to position themselves correctly to attach to your breast.
Some small, preterm or very sleepy babies may need some hands-on assistance to attach to the breast.
Signs of correct attachment
- Comfortable for mother i.e. no pain or stinging.
- Deep slow rhythmic sucking pattern. The slower the suck, the more milk that is drawn into your baby’s mouth.
- Your baby appears relaxed.
- Your breasts soften with the feed.
Sore or damaged nipples
A certain amount of nipple sensitivity in the early days of breastfeeding is normal. However, damaged or grazed nipples are not normal and usually mean your baby has not attached properly. If you have grazed or cracked nipples, ask your midwife to guide you when you are attaching your baby to the breast.
The nipple area produces its own natural oils, and nipple creams can block openings from the ducts on your nipples, increasing the possibility of mastitis. Breast milk contains special skin healing properties so expressed breast milk is the ideal treatment for sore nipples. Gently rub expressed breast milk onto the nipple after feeds and allow the milk to dry before replacing your bra. To prevent infection always wash your hands before you handle your breasts. Once you are home, if nipple damage or soreness worsens please seek help, as soon as possible, from any of the organisations listed under Breastfeeding support after discharge from hospital.
Breastfed babies feed according to hunger. Allow your baby to stay continue feeding until they have had enough and fall asleep or come off your breast. You may notice that your baby wishes to suck more often in the early days until your milk comes in, which is usually on the second or third day following birth. This is normal infant behaviour and should be encouraged.
Feed your baby whenever they exhibit hunger cues. Sucking time may vary from feed to feed. Allow your baby to feed on the first breast until their rhythmic, or nutritive, sucking stops. They may then flutter suck at the end of the feed. This is normal and helps your baby to have the fat-rich milk which is available towards the end of the feed. Babies settle for longer periods and gain more weight when allowed to flutter suck at the end of a feed.
Babies will generally feed between eight to 12 times each day. If they have a longer break between feeds they often have several feeds close together (cluster feeding). Some babies may not display hunger cues so if you are having difficulty waking and feeding your baby please speak to your midwife.
How do I know if my baby is getting enough breast milk?
Breast milk contains all the nutrients and fluid that your baby needs in the first six months of life. No other fluids are needed. You can be confident in knowing that your baby is receiving enough breast milk if your baby:
- has five to six wet disposable nappies per day (or six to eight wet cloth nappies) and their urine is pale in colour
- has two to three loose bowel movements per day that are yellow, or mustard, in colour. After six weeks of age your baby’s bowel motions may decrease in frequency, but this is not a concern if weight gain and the number of wet nappies are adequate. Breastfed babies are rarely constipated
- settles following most feeds
- looks alert when awake
- has a moist mouth.
Mater does not routinely give infant formula or boiled water to breastfed babies unless medically indicated for the following reasons:
- Any infant formula given to your baby in the newborn period will interfere with the protection against infection that breast milk is creating in your baby’s gut.
- Both soy and cows’ milk formula can cause allergies.
- Your breasts may become overfull and painful (engorged) if the breastmilk is not removed regularly.
- A baby has a completely different sucking action for breastfeeding compared to sucking on a teat. A breastfed baby can become confused between the two and may have difficulty latching correctly onto the breast.
Nipple shields are made of soft silicone and may be used to help those women who have flat or inverted nipples to breastfeed. However, it is imperative that a nipple shield not be used until your milk comes in (usually around day three), and then only with assistance from a midwife. Follow-up with a lactation consultant or child health nurse is recommended if you are discharged home using a nipple shield. You will be able to stop using the nipple shield when it feels right for both of you.
To clean your nipple shield:
- rinse in cold water
- wash in hot soapy water, ensuring all milky residue is removed
- rinse thoroughly with clean water
- air dry or pat dry with clean paper towel
- store in a clean airtight container, which should be washed daily.
The early use of pacifiers can interfere with the natural process of breastfeeding. Pacifiers can contribute to slow weight gain, early weaning and thrush infections of your baby’s mouth and your nipples. The routine use of pacifiers for breastfed babies is not recommended. If you choose to use a pacifier, they must be washed regularly in hot soapy water, rinsed thoroughly and allowed to air-dry. Clean pacifiers should be stored in a clean air-tight container.
How fathers can help
Supporting your partner’s decision to breastfeed and encouraging her throughout provides her with invaluable support. Fathers may be concerned that they will not bond as closely with their baby if their partner chooses to breastfeed. However, there are many ways in which you can support your partner and still form a close bond with your baby.
Spending time with your baby, doing other important things such as bathing, burping, changing nappies and cuddling help you to get to know your baby. For example, put your baby in a sling and go for a walk while your partner has a rest—your baby will enjoy the closeness with you and your partner will be grateful for some time to catch up on sleep.
Continuing breastfeeding following discharge from hospital
During the early stages of breastfeeding, your baby’s feeding pattern will vary significantly. Remember, the amount of breast milk you produce depends on the amount of sucking stimulation your breasts receive so continue to feed as often as your baby wishes.
It is normal for your baby to have some unsettled periods throughout the day. The most common time is in the late afternoon and early evening when your baby’s feeds may be close together, which is called cluster feeding. This is normal infant behaviour and should be encouraged.
As your baby grows there may be when they will want to feed more often. Growth spurts, or periods of increased breastfeeds, commonly occur at around three and six weeks and three months of age. More frequent feeding is your baby’s way of increasing your milk supply to meet their growing needs. Continue to feed on demand and your baby’s feeding patterns should return to normal after two to three days. This is also normal infant behaviour.
Breastfeeding and nutrition
Breastfeeding helps you lose weight after your baby is born but now is not the time to diet. You may become hungrier when you are breastfeeding and it is best to satisfy your hunger with nutritious foods. Eat a generous amount of fruits and vegetables, wholegrain breads and cereals, calcium and protein rich foods—do not skip meals.
No one food has been proven to upset babies or cause wind. The best advice is to eat all foods in moderation, unless there is a family history of food allergies or intolerance. The natural variation in your diet will change the flavour of the breast milk for your baby, which may better prepare your baby for the introduction of solid foods after six months of age.
Breastfeeding mothers need enough fluids to stay hydrated. Drink to satisfy your thirst only. Increasing the amount of fluid you drink does little to increase your milk supply.
Alcohol in your bloodstream passes into your breast milk and reaches concentrations similar to that in your blood. The level of alcohol in your breast milk will decrease as you metabolise the alcohol in your blood stream. Your baby will metabolise and excrete alcohol more slowly than you will. Even relatively low levels of alcohol intake may reduce your milk supply and possibly cause irritability, poor feeding and sleep disturbances in your baby.
The current Australian guidelines recommend that, for women who are breastfeeding, not drinking alcohol is the safest option.
You should avoid alcohol in the first month after birth until breastfeeding is well established. After that:
- your alcohol intake should be limited to no more than two standard drinks a day
- you should avoid drinking alcohol immediately before breastfeeding
- if you wish to drink alcohol you should consider expressing in advance. It is not necessary to express and discard breast milk, except for your comfort when you are not feeding for an extended time.
It takes approximately two hours for the average woman to completely eliminate one standard alcoholic drink, four hours for two drinks, six hours for three drinks, and so on.
The younger your baby is the longer it will take any caffeine to be metabolised by their body. Excessive caffeine intake may make your baby wakeful and fussy. Remember, caffeine can be found in tea, coffee, soft drinks, energy drinks, some medications, herbal preparations, as well as foods containing coffee or chocolate.
Trouble shooting breastfeeding problems
Full, painful, hard or shiny breasts, commonly referred to as engorgement, will rarely occur if your baby is able to breastfeed at any time of the day or night. Correct positioning and attachment will also help to prevent engorgement.
If your breasts do become overfull and uncomfortable:
- continue to feed your baby when they’re hungry
- remove your bra when your baby is feeding
- hand express a little milk before a feed, softening the areola to assist your baby to latch well
- continue allowing your baby to soften one breast first before offering the second breast. Express the second breast for comfort only
- wear a supportive bra between feeds but make sure that it is not too tight
- apply covered cold packs for 10–15 minutes after feeds for comfort (only while your breasts are engorged).
It is a good idea to check your breasts regularly, and
note any lumps and flushed or tender areas as quick treatment of a blocked duct
can actually prevent mastitis.
Mastitis is a hot, red, painful inflammation of the breast tissue, usually caused by
a blocked duct in the breast. Factors which can lead to mastitis include:
- sudden, strict timing of breastfeeds
- sudden changes in feeding patterns
- nipple damage including cracks or grazes
- poor attachment resulting in the breast not draining well
- untreated engorgement
- being overtired, skipping meals and not looking after yourself.
To treat blocked ducts and mastitis it is extremely important to empty the sore, tender breast as much as possible and feeding your baby is the best way to do this—now is not the time to wean. Apply moist heat, such as a warm face washer, to the affected area before you feed. When attaching your baby to the breast, point their chin towards the flushed area for better drainage.
Start feeding on the affected side for two feeds and do not limit the sucking time on this breast. Gently massage the affected area with the pads of your fingers while feeding or expressing. You may need to express the other breast for comfort. If you cannot feed your baby, express your breast milk.
You also need to get plenty of rest and maintain a healthy diet.
You should seek medical advice if symptoms continue for 12 to 24 hours; you have a temperature above 37.5 degrees Celsius or feel unwell. Your doctor will prescribe antibiotics which treats mastitis and will not harm your baby. Ensure you take the entire course of the antibiotic tablets (you may need two courses of antibiotics) to prevent mastitis returning.
Returning to work and breastfeeding
Breastfeed when you are not at work. Express after breastfeeds when you are at home if you require more expressed milk for when you are at work. While you are at work express milk for each feed you will miss. If extra milk is required express when your supply is greatest; this is usually first thing in the morning, so express after feeding your baby and prior to leaving for work. When you are on days off breastfeed your baby and express only if you require a stock of breast milk for work days.
Breastfeeding support after discharge from hospital
Support, advice, and assistance on breastfeeding following discharge from hospital are available from a variety of sources:
- Mater Mothers’ Breastfeeding Support Service, level 7, Mater Mothers’ Hospitals. Please telephone 07 3163 8847 to arrange an appointment.
- The Australian Breastfeeding Association 1800 686 2 686 or www.breastfeeding.asn.au
- Child health help line 13 43 25 84
- Private lactation consultants—to locate an International Board Certified Lactation Consultant near you visit www.ilca.org and look under ‘find a consultant’.
Baby Friendly Health Initiative
Mater is currently working towards Baby Friendly Health Initiative (BFHI) accreditation. BFHI is a global initiative introduced by the World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) to implement practices that protect, promote and support breastfeeding.
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Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: HOSP-013-00886, HOSP-006-00635
Last modified 21/4/2016.