Used with permission from Mama Aroha

Used with permission from Mama Aroha

Breastfeeding support 

 

Before your baby arrives

Why is breastfeeding important? 

Breastfeeding is important

For you
It helps you relax and encourages a close bond between you and your baby
It helps your uterus (womb) contract after birth, so there’s less blood loss
It can help you return to your pre-baby weight sooner
It usually delays periods for a while. This may help prevent you from becoming pregnant again. Check out the Lactation Amenorrhoea Method.
Less Postnatal Depression
Less risk of cervical, ovarian and breast cancer
Less risk of high blood pressure and heart disease
Less risk of brittle bones later in life

For your baby
It is the best food (super kai!) for a baby for the first six months
It is always ready and at the right temperature. No waiting required
Babies love being held close while breastfeeding
Less tummy bugs, chest infections, ear infections, urinary tract infections and less likelihood of sepsis and meningitis
Less risk of SUDI (Sudden Unexpected Death in Infancy)
Less risk of allergies, eczema, asthma, and reflux
Less risk of some childhood cancers, celiac disease, and Crohn’s disease
Breastfeeding helps your baby’s brain develop
Breastfeeding helps with good development of the jaw, teeth and speech
Less risk of heart disease, obesity and diabetes in later life

For your family
Saves time and money - no transport, shopping, prep or cleaning up required. No need to buy formula, bottles, teats and sterilising equipment
Go anywhere and feed anytime
No waste - which is good for the environment
Breastfeeding is normal for human babies

Facts about breastfeeding 

If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year

Ten Facts About Breastfeeding

The World health Organisation (WHO) and United Nations Children’s Fund (UNICEF) recommend feeding babies only breastmilk (exclusive breastfeeding) up until 6 months of age and to continue breastfeeding for up to two years with complementary food and fluids.

Black RE, Victora CG, Walker SP, and the Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; published online

Some useful sources of Breastfeeding Information  What are my rights around maternity leave?  What are my rights around breastfeeding?  How can I prepare for breastfeeding? 

Breastfeeding is instinctive for babies, but a learnt skill for mothers

  • Do all you can to learn about breastfeeding before your baby arrives.
  • Ask the women in your family/whanau about breastfeeding. There is often a wealth of experience and knowledge within families.
  • Going to the Birthing Centre Coffee Meetings, or a La Leche League meeting can be very helpful. Being around other women breastfeeding their babies is a very natural way to learn. It also helps establish supportive connections for later.
  • You can learn a lot about breastfeeding by going to antenatal classes.
  • Talk to your midwife during your antenatal visits, and discuss what will happen in the early days after the birth. If you have any worries (like inverted nipples), make sure your midwife knows and you have the opportunity to talk this through. You can ask her for your free copy of the ministry of health DVD – “Breastfeeding Naturally”.
  • Wearing maternity bras during your pregnancy will get them softened and comfortable for the early days of breastfeeding when breasts and nipples can be tender. Your glandular (milk making) breast tissue grows in pregnancy. About a bra cup size increase tells you that you have a normal amount of milk making tissue. This also tells you that you can make a normal amount of milk J Your breasts will get bigger too, after your baby is born. Tight bra’s are not helpful so make sure yours have some room.
  • There is no need to toughen up nipples for breastfeeding, but elasticity helps. A few drops of Extra Virgin Olive Oil applied regularly reduces cracking.
  • You can massage your breasts and express out a little bit of colostrum in the last weeks of pregnancy. This gets you used to handling your breasts and nipples and stimulates colostrum production. See How do I hand express my breastmilk? or see Antenatal Hand Expression 
    A good colostrum production will make life easier for both of you in the first days.
    You can also collect and freeze colostrum for when your baby comes. Storing Breastmilk
    You can discuss this with your midwife.
  • Talk to you partner and family about your goals and the importance of their support around breastfeeding. Partner support is the most significant factor for breastfeeding success.
  • Plan your maternity leave (as needed)
  • See a lactation Consultant for particular concerns
Do labour medications, or the type of birth, affect breastfeeding?  

Many of the medications used in hospitals, and a difficult birth, can result in a baby finding it difficult to feed well in the first few days. The milk may also be a delayed in coming in.

A natural, drug free birth, is the best start to breastfeeding. Planning for a natural birth and using drug free ways to cope with labour can be discussed with your LMC during your pregnancy.

Sometimes birth interventions are beyond our control. If this happens, lots of ‘skin to skin’ in the early days and hand expressing of colostrum to feed your baby is a the best way to help.

How can I get breastfeeding off to the best start? 
  • A natural un-medicated birth followed by uninterrupted skin to skin contact with your baby is the best start for breastfeeding
  • The early days are a unique, and occasionally challenging, time. 
  • Getting informed before your baby comes, about what to expect
  • The practical support of your partner is a great help.
  • During your stay at HBC the nurses, midwives and Lactation Consultants (as needed) will provide information and support.
  • see How can I prepare for breastfeeding?

Best Start For Your Baby.pdf

What are the challenges to getting breastfeeding of the the best start? 

Challenges to Breastfeeding

There are a number of things that can pose challenges to breastfeeding, many are outside our control. They include… no breast changes during pregnancy, inverted nipples, hormonal or metabolic conditions eg, Poly Cystic Ovarian syndrome, Insulin Dependent Diabetes, severe eating disorders, a high BMI, use of illegal or abuse of prescription drugs, previous breast surgery, being an older first time mum eg 35+ yrs. Also birth interventions. These include the use of syntocinon (This is usually given during inductions or to help strengthen contractions, and again after the birth to help the placenta come out, or because of bleeding) Also Intravenous fluids, Pethidine, an Epidural, or a forceps, ventouse or caesarean birth. A difficult birth, separation of a mum and baby, an unwell mum or baby, a baby smaller than 2500 gms, or born before 38 weeks, or a baby that is tongue tied can all be challenges for breastfeeding. Whew.

…however, there is good news… 

Every breastfeeding pair is unique and not everyone is affected by the same issues in the same way

If you and your baby have some of the ‘risk factors’ listed above there are many simple steps you can take to help, including… 

Before baby is born:
       Breast massage and Hand Expression of colostrum in the weeks before the baby is born,
       Collection and storage of colostrum, for use during the first days
       Applying Virgin Coconut Oil and Olive Oil to nipples
       Gaining extra length to nipples (if flat or inverted)
       A natural birth if possible

After the birth:
      Lots of Skin-To-Skin with baby. You could use a wrap and do continuous Skin-to-skin ‘kangaroo care style. This video shows how to do it safely https://tinyurl.com/ycrctub6
 Encouraging baby’s instincts and reflexes to feed through the Biological Position
        Early and frequent breastfeeds while using Breast Compressions
        Hand expression of colostrum after feeds or feed attempts
        Use of a breast pump for extra stimulation after feeds or feed attempts
        Giving supplements only if medically indicated
        Getting help from your midwife and/or a Lactation Consultant, for more ways to help

Even if breastfeeding has a challenging start, with time and support, for most people breastfeeding can become easy and enjoyable.

BFHI and making the most of things

Building a happy baby   I don't think I'll be able to breastfeed 

What if I have inverted nipples, have no breast growth in pregnancy and problems with my health or other issues?
It is likely you can still successfully breastfeed. Seeing a Lactation Consultant and learning all you can about breastfeeding before your baby is born is a good idea. See also 'Challenges to Breastfeeding'

Depending on your issues, you may want to find ways to encourage more length to your nipples, or stimulate your colostrum production and save it. Some mothers get a little frozen milk from another mum, in case they need a bit extra while getting their own milk production going well. (The World Health Organisation advises that donated breastmilk from a healthy woman is preferable to formula)

Having a plan for the first few days will help get breastfeeding off to the very best start.

Lots of skin-to-skin contact from the start, and extra, frequent breast stimulation by hand expression and/or pumping can give your milk production that extra ‘kick start’ it needs.

But even after a slow start, milk production can usually be built up to a good supply. Bodies are amazing, and often surprise us with what they are capable of.

Even when there are major challenges, if you have some glandular breast tissue you can make some milk for you baby. Even just a little bit will be really good for your baby.

The baby friendly initiative and making the most of things 

What's the problem with Infant Formula? 

Infant Formula is made from dried cow’s milk with additives. It is very different from human milk. It is not a living substance like breastmilk and does not provide the ongoing protection against germs.formula tin.jpg

Infant formula results in a different pH (acid balance) in a baby’s gut. This results in different types of bacteria living in the gut. Science is discovering that the type of bacteria living in and on us has a big part to play in our health, and even in how our genes work.

The Invisible Universe Of The Human Microbiome

Feeding Infant Formula results in less breastmilk fed to the baby, and a greater chance of…

  • A weaker immune system resulting in more allergies, eczema & asthma, diarrhoea & serious stomach problems, meningitis, ear, chest & bladder infections & some childhood cancers like leukaemia.
  • Crooked teeth
  • Worse eyesight
  • Not being as smart
  • More risk of Sudden Unexplained Death in Infancy (SUDI)
  • More Doctors appointments and more likely to be admitted to hospital 
  • And later in life have an increased risk of: obesity, heart disease, multiple sclerosis, diabetes and liver disease

And for Mum…

  • more bleeding after the baby
  • a slower return to pre pregnancy weight
  • less bonding with the baby
  • a greater risk of:
  • postnatal depression
  • breast, cervical & ovarian cancer
  • osteoporosis & hip fractures
  • high blood pressure & heart disease
  • less convenience
  • less money in your pocket

There are also risks to using formula.

  • Babies can react or become allergic to all types of infant formula
  • The powder or the water can be contaminated
  • Formula can be mixed up too strong or too dilute by not understanding or following the directions correctly. 
  • The markings on bottles are not always accurate.
  • It can be mixed up un-hygienically or become unhygienic if not used correctly

It is not recommended to give your baby extra fluid (either formula or water) as this can affect your supply, expose your baby to a foreign protein, and may make your baby less willing to take the breast.     

Occasionally it is medically indicated to give a baby a supplementary feed. If this is necessary, it will be discussed with you by the health professionals caring for you.

There are a few reasons why some women cannot breastfeed, or choose not to breastfeed.
Your LMC and Helensville Birthing Centre staff will support your choice of feeding and help you with what you need to know.

Effects of Just One Bottle.pdf

www.tensteps.org/pdf/21dangers-jun2012.pdf
www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/
www.infactcanada.ca/pdf/14-Risks-Small.pdf
www.health.govt.nz/your-health/pregnancy-and-kids/first-year/helpful-advice-during-first-year/formula-feeding/risks-formula-feeding
www.lactationtraining.com/resources/handouts-parents?task=document.viewdoc&id=164

What's the problem with dummies and teats? 

Teats and dummies interfere with breastfeeding. Babies suck differently on bottle teats and dummies because they are so different than breasts. Babies develop a different technique and strengthen different muscles. This different technique can cause sore nipples, and frustration for the baby trying to get milk when at the breast.

It is best to avoid teats and dummies for at least the first 4-6 weeks. If you really need to use one, find one that is big or long so your baby isn’t practicing a really shallow latch. Avoid those that look like a badly misshapen nipple (the so-called ‘orthodontic’ teats) unless you want your baby to expect and practice that!

Bottles, dummies and teats can be a source of thrush infections.

Are there foods I should avoid? What about allergies? 

    No. Your baby will have been enjoying all sorts of flavours during your pregnancy, as the fluid around your baby picks up the flavours of the food you eat. Your breastmilk will be the same. This is good for your baby’s development.
    ‘Everything in moderation’ is a good approach.

    It is a good idea to limit caffeine as this may make your baby wakeful.

Eat peanuts during pregnancy and breastfeeding to reduce peanut sensitisation in your child

 

Are there foods I should eat? 

No. Your breasts will always make good milk, just like your body always makes good blood. (breastmilk is made from your blood supply) 
Eating nutritious food makes good sense, for your own health
Making breastmilk uses up about 500 calories and 25gms of protein and tiny amounts of trace elements. 

What is The Baby Friendly Initiative? 

Helensville Birthing Centre is an accreditied Baby Friendly Birthing Centre

The Baby Friendly Intiative (A video - Canada)
Baby Friendly UK 

10 Good Things To Know About Exclusive Breastfeeding 

10whobf.jpg


Getting Started

What is so important about Skin To Skin? 

Being 'Skin to Skin' helps stabilize your baby’s breathing, heart rate and temperature. It helps with bonding, breastfeeding and protecting your baby from infections. Your baby will be calmer and less likely to cry.

It helps the placenta come out, your breastfeeding hormones increase, and helps you feel calm and bond with your baby.

When your baby is skin to skin he/she will, using all five senses; sight, sound (your voice), taste and especially smell and touch, try to find your breast and latch on. Your baby will take short rests too. Many babies will manage this, all on their own, within the first hour after birth.

This can be a wonderful time for you and your baby to recover and get to know each other. A breastfeed during this first hour is especially good for your baby and your milk supply.

Some babies can be sleepy or have difficulty due to labour medications or a difficult birth. In this case it is good to express some of your milk and give it to your baby. (see Hand Expression)  

Skin to skin is beneficial at any time – not just straight after the birth
You can discuss Skin to Skin with your support people, so they know how important it is, and can help.

Keeping your baby skin to skin
Dr Nils Bergman on Skin to Skin
The importance of Skin to Skin 
Skin to Skin – for you and your baby at Helensville Birthing Centre

What can I expect in the first few days? 

A big change for baby
Your baby will want to be held a lot, and not sleep for long (if at all) in a bassinette. This is to be expected. It is not a ‘bad habit’. Skin to skin care, and your voice, helps reassure your baby he/she is safe.
Big changes for you
    Feeding ++++ Your baby will need to feed frequently, especially at night. Newborns feed the most between 9pm and 3am. During the second night, it may seem continuous. Feeding at this time is important. Colostrum volumes are very small, but perfect for baby’s small tummy. Lots of stimulation tells your breasts to produce more colostrum.
    Tiredness You will be tired from the labour and birth and from time spent in the night caring for your baby. Visitors will need to know that it is essential for you to sleep during the day
    Breastfeeding challenges…learning how to position yourself and baby comfortably, coping with the very frequent feeding, tender nipples, and helping a baby get colostrum (and supporting milk production), when feeding is tricky, are all common things. The milk usually comes in on the third day, but is sometimes delayed. 
    Mixed emotions
You may feel elated and in love with your baby. You may also feel tired, sore, and anxious at times. Day three especially, is known for the ‘baby blues’. 

What your baby knows about breastfeeding  10 Steps to Successful Breastfeeding  How do I help my baby with breastfeeding? 

Breastfeeding is instinctive for babies. But for mums it is more of a learned art, where confidence comes with practice. In a week or two it is usually heaps easier. 

Babies are born with many reflexes to help them find the breast, latch on and feed

  • Arm and leg circling
  • Head bobbing
  • Rooting – turning head from side to side, especially if anything touches the cheek
  • Gape – your baby will open his/her mouth and tilt the head back into the drinking position when something brushes the top lip
  • Extrusion – your baby will open his/her mouth and tongue will come forward when something brushes the bottom lip.
  • Suck – your baby will begin to suck when something touches the roof of the mouth

Your baby is able to make best use of these reflexes when on his/her tummy. Understanding this and working with your baby can get breastfeeding off to a great start.

  • Use your hands or arms to help your baby feel stable and secure. 
  • Babies find the breast by smell and feel, searching for the breast with their face. If they can’t feel with their face they will use their hands. Sucking on their fists, and massaging the nipple with their fists, is all a normal part of how a baby learns to feed.

A baby will often vocalise during this time. Your voice will be reassuring and encouraging to your baby.
It’s helpful if feeds are as often and as long as your baby wants.
It’s usual for a newborn baby to feed 8 – 12 feeds (or more) in each 24hr period. Most of the feeds will be at night to begin with because…

Newborn babies feed the most between 9pm and 3am!

How do I latch my baby on? 

Latching step by step...  
 1. Have your baby ‘skin to skin’ as much as possible, and respond to early cues.
It’s best if your baby is not wrapped up in a blanket when feeding, so that your baby’s body can get in really close and snug with yours, tummy to tummy. Your baby will also want to have his/her hands free.

 2. Set yourself up so you are comfortable and supported. A near to 45 degree slope works well. Have a pillow behind your back, so that your back is straight and not curled around in a C shape. This gives your baby lots of your body to have contact with, and it makes your nipples point out at a helpful angle. If the nipples point down, it can be tricky for your baby to latch on to. A small rolled up cloth under your breasts will lift them up a bit. 

            ­        position.jpg

3. Have your baby on his/her tummy on top of you with arms and legs in a crawling position. This way your baby will feel secure and able to use those inbuilt reflexes purposefully. 

postion b.jpgBreasts are circular. Babies can feed at all sorts of angles

4. You can 'shape' your breasts a little so that the nipple feels really obvious to your baby and so that he/she gets a big mouthful when landing on it…as long as you don’t move your breasts from where they naturally sit. This 'shaping' is much the same as how we shape a burger or sandwhich so we can get our mouth around it. Don’t try and put your nipple in your baby’s mouth, but help your baby take the nipple.

Talk to your baby to help him/her stay calm. Your baby will likely latch all on his/her own. Babies often wriggle and shuffle to adjust their position and latch, and babies like to have their feet in contact with something. Babies use their hands in purposeful ways to help themselves too.

If your baby isn’t able to latch give him some expressed colostrum (maybe on a spoon). Having some ready is helpful.

5.  If your breasts are very full, expressing a small amount of milk may soften the breast enough to help baby latch.

6.  Sometimes after having a little colostrum a baby is ready to try again. You can try different positions eg the side-lying position.

7.  If after about 15 minutes of trying the baby isn’t successful it is best to hand express and give your baby what is available on a spoon. It’s not helpful for either of you to get tired and stressed out.

If latching is often difficult get help from your midwife or a lactation consultant.
There are many different reasons why a baby can have difficulty feeding in the first few days….and none of them include negative personality traits!

Introduction to Laid Back Breastfeeding - youtube
Baby led latch how awaken your babys breastfeeding instincts
Laid Back Breastfeeding LLL.pdf
what happens when mothers lie back.pdf
Improving Latch By Improving Positioning: Introduction and Laid Back Breastfeeding
www.biologicalnurturing.com/index.html

see also How can I get a good latch?


Getting help

From my whanau 

Having a supportive partner and whanau/family is important for successful breastfeeding.
Breastfeeding is a learned skill and mums and babies take time to become expert.

It is helpful if support people attend antenatal classes with you, and learn about breastfeeding.
It’s helpful for everyone to get the same up-to-date information.

Even though they may not be able to do the breastfeeding, there are many ways other people can provide help. They can give important emotional support, reassurance, praise and practical help.
For example, they can...

  • Limit visitors in the early days so you can get enough rest
  • Encourage you to eat well and drink plenty of fluids
  • Encourage both you and your partner to rest whenever baby sleeps
  • Change, wind, bath, talk to or cuddle your baby
  • Prepare meals and do household chores. 
  • Be understanding and encouraging
From my midwife  

Your midwife will help with that important firsst feed soon after the birth
Hospital of Brithing Centre staff will give you help and support during your stay, alongside the care of you midwife
Your Lead Maternity Carer or Midwife will continue to provide help and support until your baby is four to six weeks old. You will be visited at home 5-10 times during that time.
Once you LMC has stopped visiting, you will be referred to a Well Child Provider of your choice, such as Plunket or Tamariki Ora services. 

From breastfeeding mums   From a HBC Lactation Consultant 
Plunketline and Healthline 

Plunketline ph 0800 933 922
Healthline  ph 0800 611 116


Gaining knowledge and skills

How do I carry/wear my baby? How do I use a wrap? 

Lots of close contact will help your baby thrivewearing.jpg
Finding ways to carry, or ‘wear’ your baby is both beneficial and practical
Caring for your baby in this way is sometimes referred to as Kangaroo Care
These videos' explain
Continuous Skin to Skin Care 
Carrying Your Baby Skin to Skin

This video shows many easy ways to use simple wraps.
It shows how to safely care for your baby in this way, so that you can also sleep.
Wrap designs for Skin to Skin care

How do I know when my baby needs to feed? What are feeding cues / hunger cues?  What are the common breastfeeding positions? 

Certain positions have become known by various names. The best position is what works for you and your baby – what is comfortable for both of you, and lets your baby drink well. 

'Biological / Laid Back / Baby Led /Natural Breastfeeding' Position
Biological or Laid-back position 
Introduction to Laid Back Breastfeeding - youtube
Laid Back Breastfeeding LLL.pdf
what happens when mothers lie back.pdf

'Cross Cradle / Transitional / Beginners' Hold
Cross cradle, Transitional or Beginners Hold 
 
Clarifying the Confusion Over Cross Cradle Hold.pdf
How to latch your baby to your left breast in a cross-cradle hold in 33 easy to master steps

Cradle or Madonna Hold  
Football or Rugby Hold 
Koala position 
Side lying position 

How do I get my baby to open wide?   How can I get a good latch?   What is a 'let down'? 

A 'let down' is when the cells in your breast contract and push milk out towards the nipple. It usually takes a few minutes of sucking or hand expression for it to happen. The nerves around the areola send a message to the brain to produce oxytocin. The oxytocin then flows all through your body. It is a ‘feel good’ hormone and good for your health in other ways. It can feel like a tingling sensation.

Anxiety, pain or stress slows the oxytocin being released. Deep breathing, thinking about your loved ones, favourite music, back and shoulder massages, and visualising the milk flowing helps.

If you have had lots of Syntocinon (synthetic oxytocin) in labour, your own natural oxytocin production can be a little low after birh.
Breast Compressions can help your baby get milk. 

What is normal? What can I expect? 

Breastfeeding Uncovered by Dr Amy Brown of Swanwea University 

How do I know if my baby is feeding well? 

A good feed…

  • Is comfortable for both of you.
  • Baby latches well and doesn’t slip off
  • Baby has a regular sucking pattern with swallows and pauses. When your baby swallows the chin will go down a little lower and then there will be a soft ‘ah’ sound.
  • You may feel thirsty during a feed and your uterus may contract giving you a few ‘after-pains’ – this means your breastfeeding hormones are working well.
  • Your baby becomes more relaxed as the feed continues.
  • Your nipple should not look misshapen afterwards.
  • Your breasts should feel softer after your baby has fed (except for the first few days before the milk has come in)

 

Should I feed off both sides each feed or just one? 

It depends. Sometimes a baby will have one side, sometimes two or three sides - or more, depending on what is needed.
“Finish the First Side First and always offer the second side” is the usual idea. Your baby is your guide.
So how do I know when the first side is ‘finished’?
 - Your baby may release the breast and look satisfied.
      Or
 - you may notice that despite sucking, there is not much swallowing going on.
    (this means that your baby has had most of what is available)
 - You can then use breast compressions, this helps get the remaining milk, which is nice and creamy.
 - If you sense that your baby is still hungry (eg there is still some tension in baby’s body) you may want to offer the other side.
   Slip your finger into your baby’s mouth to release the suction and take baby off.
   After a short opportunity to burp, you can then offer the other side.
 - If after the second side, your baby still seems hungry go back to the first side, because more milk will have already accumulated there.
 - Keep going in this way until baby is ‘done’. This is called ‘switch feeding’ and is a great way to increase milk production.

How long should my baby's feeds be? How often should my baby feed? 

How long? It varies. Something between 5 minutes and 30 mins is normal. 
Babies have different size feeds, just like grownups. Sometimes it is a quick drink to quench thirst or have a snack and sometimes it is a whole feast. This is normal. 

‘Watch your baby, not the clock’ The idea is to let baby feed until he/she seems done. 

How often? Babies usually need to feed at least 8 times each 24 hours

  • To begin with, babies need to feed very frequently because their tummy is so small (and colostrum and breastmilk is always digested quickly) This is also the way breasts get stimulated to make more milk.

The interval between feeding times can vary greatly – maybe from 30 minutes to 4 hours.

  • Babies also usually don’t feed at regularly spaced intervals but tend to go longer between feeds in the morning and then less time between feeds in the evening.

Having fixed ideas or trying to manipulate feeds can cause problems.
UNICEF on stretching out feed times

How often a baby needs to feed is also related to a mum’s milk storage capacity. This varies between women, and also between breasts. (You can’t tell by looking at the breasts).               

For one mum the production might slow right down (because her breasts are getting full) when there is maybe 40mls of milk stored. For another mum the production might only slow down when there is around 80mls stored.

Both these mums can make the same amount of milk over 24 hours, but the mum with the smaller storage will need to remove milk twice as often. Her baby’s feeds will probably be quicker, and even seem like ‘snack’ feeds. It doesn’t matter. In fact, the mother of this baby is likely to spend less time on winding, baby’s discomfort and mopping up sicky spills, than the mother whose baby has fewer, but huge, feeds.

Milk production slows as breasts fill, This is a necessary feedback system!

 

How do I know if my baby is getting enough?  

Newborns have tiny tummies. A one day-old baby’s tummy only holds about a teaspoon, so a few drops to a teaspoon of colostrum is ‘enough’ to start with.

Your baby’s wee and poo and weight gains can give you a good idea of how much your baby is getting. This is a chart of what you can expect.

poo chart.jpg

Mothers can experience a delay with their milk coming in. This is a temporary thing, but may cause a loss of confidence. When the milk comes in there is usually lots.

Some mothers worry that they don’t have enough milk if their baby is unsettled or feeding frequently, but this can be normal for babies.

Babies can have ‘growth spurts’ or ‘frequency days’ and need to feed more often to increase the milk production. This can happen every few weeks in the early stages of breastfeeding. Letting your baby feed often will soon increase the production.

….give me some numbers!

 …after the initial weeks, once breastmilk production has got ‘up to speed’ the average numbers for each 24 hours between 1 month old and 6 months old is about...

  • 750 mL of breastmilk (range 570-900 mL)
  • 10 feeds 
  • 75mls per feed
  • The un-stretched tummy of a 1 month old is about 40mls.
    The un-stretched tummy of a 6 month old is about 100mls
    (Tummies can stretch to hold more, but there may be discomfort and spilling)
  • 155-240 gms weight gain each week until four months old then 95-125 gms each week until six months old

- If you think you need to give your baby additional milk it’s a good idea to talk with your health professional.
- It’s best to give the smallest amount that your baby might need, while working on ways to increase your milk production.
 - Extra milk does not need to be given at each feed, or need to be the same volume each time. It can be given by spoon, cup, tube at the breast, or bottle.

If you are supplementing your baby’s feeds, or entirely bottle feeding, it is important to be guided by tummy sizes, normal breastfeeding volumes, normal length of breastfeeds (eg 15-20 mins) and your baby’s feeding and satisfaction cues. Calculations using formulas such as mls/kg/day are guides for when fluid requirements (often IV fluids) are needed and a baby’s normal feeding or satiation cues can’t be relied upon. 

Giving Infant Formula is usually not the answer.  It will decrease the time spent at the breast and interfere with supply and demand. This leads to slower milk production. The World Health Organisation says it is preferable to give breastmilk from another healthy mother, rather than Infant Formula.

 Is my baby getting enough milk? 

How do I help my baby get more milk? What are 'Breast Compression's'?  

Breast Compressions
This is using your hands to help the milk flow
It’s a ‘squeeze and hold’ technique or using the flat of your hand to create pressure to push the milk out It’s not massage or stroking It can be helpful to think of your breast as an icing bag and you are squeezing the icing out :)

icing bag.jpg

Breast Compressions are helpful when…

  • there are small colostrum or milk volumes
  • your baby is tiring
  • the milk flow slows
  • you want your baby to get the ‘last drops’ of creamy milk.

https://www.youtube.com/watch?v=25qhrc4Y0tU

this video shows compressions in action, but baby is almost hanging off the nipple to start with! Baby needs to be held closer, or mum needs to lean back
https://www.youtube.com/watch?v=wBrLYhABUlM

 

 

How do I put 'Breast Compression's', 'Switch Feeding', Supplementing and Pumping together?! 

This is not something a breastfeeding mum may need to give any thought to at all.  
But if you have good reason to believe your baby is not getting enough milk you may find reading this information helpful

Putting Switch Feeding, Breast Compressions, Supplementing and Pumping together - Step by Step

About milk production - What every breastfeeder needs to know  How do I hand express my breastmilk? 

How to Hand Express
- Wash your hands
- Gently massage your breasts and areola. Using warmth is helpful
- Put your finger and thumb on opposite sides of your breast about 2-3 cm away from the nipple
- Push back into your chest
- Roll finger and thumb together. Avoid pulling, squeezing or sliding
- Then relax your fingers and repeat

Repeat many times in a rhythmic way
It may take some time for milk to flow
In the early days there will only be drops
After a few minutes rotate the position of your fingers
Relaxing, visualising milk flowing, thinking about your baby, doing more massage and changing breasts all help the milk to flow.

Like most things, it gets easier with practice!
If you wish to collect your milk, use a clean container eg small bowl or cup 

How to hand express your breastmilk 
Storing Breastmilk

Should I use a breast pump? 

Many women successful breastfeed without ever using a breastpump. 
If you need to remove milk from your breast, using your hands to express your milk is effective and free. 
Using a breastpump can be helpful if you need to get milk out of your breasts often, it's your choice. 
You do not need to spend lots of money on an expensive machine. What is important is how frequently you remove milk, and how you use your hands. 

Using your hands when you pump
Using a Breast Pump.pdf

How do I store my breastmilk?  54 Breastfeeding Myths 

 

 

 Information - Dr Jack Newman's Breastfeeding Handouts

Some Breastfeeding Myths, and Still More Myths, and Even More and More Myths!!

1. Many women do not produce enough milk. Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurtNot true! Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads breastfeeding. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day three or four or lasts beyond five or six days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. Taking the baby off the breast for the nipples to heal should be a last resort only. (See Information Sheet Sore Nipples).

3. There is no (not enough) milk during the first three or four days after birthNot true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk that is available. When there is not a lot of milk (as there is not, normally, in the first few days), the baby must be well latched on in order to get the milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk, though good latching from the beginning, even in if the milk is abundant, prevents problems later on.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each sideNot true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed better and longer if the mother compresses the breast to keep the flow of milk going, once he no longer drinks on his own (Information Sheet Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong. To see how to know a baby is getting milk see the videos.

5. A breastfeeding baby needs extra water in hot weatherNot true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin DNot true! Everyone needs vitamin D. Formula has it added at the factory. But the baby is born with a liver full of vitamin D, and breastmilk does have some vitamin D. Outside exposure allows the baby to get the rest of his vitamin D requirements from ultraviolet light even in winter. The baby does not need a lot of outside exposure and does not need outside exposure every day. Vitamin D is a fat soluble vitamin and is stored in the body. In some circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy) it may be prudent to supplement the baby with vitamin D. Exposing the baby to sunlight through a closed window does not work to get the baby more vitamin D.

7. A mother should wash her nipples each time before feeding the babyNot true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has. Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who breastfeeds well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needsNot true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first six months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and the baby poops out most of it. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeedNot true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.

11. Breastfeeding ties the mother down. Not true! But it depends how you look at it. A baby can be breastfed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting. Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open mouth wide—pause—close mouth type of suck). Other ways also help show that the baby is getting plenty (Information Sheet Is my Baby Getting Enough Milk?). Also see the videos at nbci.ca.

13. Modern formulas are almost the same as breastmilkNot true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally, formulas are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium, lead and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby. Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than nutrients.

14. If the mother has an infection she should stop breastfeedingNot true! With very, very few exceptions, the mother's continuing to breastfeed will actually protect the baby. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

15. If the baby has diarrhea or vomiting, the mother should stop breastfeedingNot true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula manufacturers (who also make oral rehydrating solutions) to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

16. If the mother is taking medicine she should not breastfeedNot true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines that are safe. The risks of artificial feeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).


More Breastfeeding Myths

1. A breastfeeding mother has to be obsessive about what she eatsNot true! A breastfeeding mother should try to eat a balanced diet, but neither needs to eat any special foods nor avoid certain foods. A breastfeeding mother does not need to drink milk in order to make milk. A breastfeeding mother does not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding mother should eat a normal healthful diet. Although there are situations when something the mother eats may affect the baby, this is unusual. Most commonly, "colic", "gassiness" and crying can be improved by changing breastfeeding techniques, rather than changing the mother's diet. (Information Sheet Colic in the Breastfed Baby).

2. A breastfeeding mother has to eat more in order to make enough milkNot true! Women on even very low calorie diets usually make enough milk, at least until the mother's calorie intake becomes critically low for a prolonged period of time. Generally, the baby will get what he needs. Some women worry that if they eat poorly for a few days this also will affect their milk. There is no need for concern. Such variations will not affect milk supply or quality. It is commonly said that women need to eat 500 extra calories a day in order to breastfeed. This is not true. Some women do eat more when they breastfeed, but others do not, and some even eat less, without any harm done to the mother or baby or the milk supply. The mother should eat a balanced diet dictated by her appetite. Rules about eating just make breastfeeding unnecessarily complicated.

3. A breastfeeding mother has to drink lots of fluidsNot true! The mother should drink according to her thirst. Some mothers feel they are thirsty all the time, but many others do not drink more than usual. The mother's body knows if she needs more fluids, and tells her by making her feel thirsty. Do not believe that you have to drink at least a certain number of glasses a day. Rules about drinking just make breastfeeding unnecessarily complicated.

4. A mother who smokes is better not to breastfeedNot true! A mother who cannot stop smoking should breastfeed. Breastfeeding has been shown to decrease the negative effects of cigarette smoke on the baby's lungs, for example. Breastfeeding confers great health benefits on both mother and baby. It would be better if the mother not smoke, but if she cannot stop or cut down, then it is better she smoke and breastfeed than smoke and formula feed.

5. A mother should not drink alcohol while breastfeedingNot true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.

6. A mother who bleeds from her nipples should not breastfeedNot true! Though blood makes the baby spit up more, and the blood may even show up in his bowel movements, this is not a reason to stop breastfeeding the baby. Nipples that are painful and bleeding are not worse than nipples that are painful and not bleeding. It is the pain the mother is having that is the problem. This nipple pain can often be helped considerably. Get help. (Information Sheet Sore Nipples and Vasospasm and Raynaud's Phenomenon). Sometimes mothers have bleeding from the nipples that is obviously coming from inside the breast and is not usually associated with pain. This often occurs in the first few days after birth and settles within a few days. The mother should not stop breastfeeding for this. If bleeding does not stop soon, the source of the problem needs to be investigated, but the mother should keep breastfeeding.

7. A woman who has had breast augmentation surgery cannot breastfeedNot true! Most do very well. There is no evidence that breastfeeding with silicone implants is harmful to the baby. Occasionally this operation is done through the areola. These women do have often have problems with milk supply, as does any woman who has an incision around the areolar line.

8. A woman who has had breast reduction surgery cannot breastfeedNot true! Breast reduction surgery does often decrease the mother's capacity to produce milk, but since many mothers produce more than enough milk, some mothers who have had breast reduction surgery sometimes can breastfeed exclusively. In such a situation, the establishment of breastfeeding should be done with special care to the principles mentioned in the Information Sheet Breastfeeding—Starting Out Right. However, if the mother seems not to produce enough, she can still breastfeed, supplementing with a lactation aid (so that artificial nipples do not interfere with breastfeeding). See Information Sheet Lactation Aid.

9. Premature babies need to learn to take bottles before they can start breastfeedingNot true! Premature babies are less stressed by breastfeeding than by bottle feeding. A baby as small as 1200 grams and even smaller can start at the breast as soon as he is stable, though he may not latch on for several weeks. Still, he is learning and he is being held which is important for his wellbeing and his mother's. Actually, weight or gestational age do not matter as much as the baby's readiness to suck, as determined by his making sucking movements. There is no more reason to give bottles to premature babies than to full term babies. When supplementation is truly required there are ways to supplement without using artificial nipples.

10. Babies with cleft lip and/or palate cannot breastfeedNot true! Some do very well. Babies with a cleft lip only usually manage fine. But many babies with cleft palate do indeed find it very difficult to latch on. There is no doubt, however, that if breastfeeding is not even tried, for sure the baby won't breastfeed. The baby's ability to breastfeed does not always seem to depend on the severity of the cleft. Breastfeeding should be started, as much as possible, using the principles of proper establishment of breastfeeding. (Information Sheet Breastfeeding—Starting Out Right). If bottles are given, they will undermine the baby's ability to breastfeed. If the baby needs to be fed, but is not latching on, a cup can and should be used in preference to a bottle. Finger feeding occasionally is successful in babies with cleft lip/palate, but not usually (See Information Sheet Finger and Cup Feeding).

11. Women with small breasts produce less milk than those with large breastsNonsense!

12. Breastfeeding does not provide any protection against becoming pregnantNot true! It is not a foolproof method, but no method is. In fact, breastfeeding is not a bad method of child spacing, and gives reliable protection especially during the first six months after birth. It is almost as good as the Pill if the baby is under six months of age, if breastfeeding is exclusive, and if the mother has not yet had a normal menstrual period after giving birth. After the first six months, the protection is less, but still present, and on average, women breastfeeding into the second year of life will have a baby every two to three years even without any artificial method of contraception.

13. Breastfeeding women cannot take the birth control pillNot true! The question is not about exposure to female hormones, to which the baby is exposed anyway through breastfeeding. The baby gets only a tiny bit more from the pill. However, some women who take the pill, even the progestin only pill, find that their milk supply decreases. Estrogen-containing pills are more likely to decrease the milk supply. Because so many women produce more than enough, this sometimes does not matter, but sometimes it does even in the presence of an abundant supply, and the baby becomes fussy and is not satisfied by breastfeeding. Babies respond to the rate of flow of milk, not what's "in the breast", so that even a very good milk supply may seem to cause the baby who is used to faster flow to be fussy. Stopping the pill often brings things back to normal. If possible, women who are breastfeeding should avoid the pill, or at least wait until the baby is taking other foods (usually around 6 months of age). Even if the baby is older, the milk supply may decrease significantly. If the pill must be used, it is preferable to use the progestin only pill (without estrogen).

14. Breastfeeding babies need other types of milk after six monthsNot true! Breastmilk gives the baby everything there is in other milks and more. Babies older than six months should be started on solids mainly so that they learn how to eat and so that they begin to get another source of iron, which by 7-9 months, is not supplied in sufficient quantities from breastmilk alone. Thus cow's milk or formula will not be necessary as long as the baby is breastfeeding. However, if the mother wishes to give milk after 6 months, there is no reason that the baby cannot get cow's or goat's milk, as long as the baby is still breastfeeding a few times a day, and is also getting a wide variety of solid foods in more than minimal amounts. Most babies older than six months who have never had formula will not accept it because of the taste.


Still More Breastfeeding Myths

1. Women with flat or inverted nipples cannot breastfeedNot true! Babies do not breastfeed on nipples, they breastfeed on the breast. Though it may be easier for a baby to latch on to a breast with a prominent nipple, it is not necessary for nipples to stick out. A proper start will usually prevent problems and mothers with any shaped nipples can breastfeed perfectly adequately. In the past, a nipple shield was frequently suggested to get the baby to take the breast. This gadget should not be used, especially in the first two weeks! Though it may seem a solution, its use can result in poor feeding and severe weight loss, and makes it even more difficult to get the baby to take the breast. (See Information Sheet Finger and Cup Feeding). If the baby does not take the breast at first, with proper help, he will often take the breast later. Breasts also change in the first few weeks, and as long as the mother maintains a good milk supply, the baby will usually latch on by 8 weeks of age no matter what, but get help and the baby may latch on before. See Information Sheet When a Baby Does not yet Latch.

2. A woman who becomes pregnant must stop breastfeedingNot true! If the mother and child desire, breastfeeding can continue. Some continue breastfeeding the older child even after delivery of the new baby. Many women do decide to stop breastfeeding when they become pregnant because their nipples are sore, or for other reasons, but there is no rush or medical necessity to do so. In fact, there are often good reasons to continue. The milk supply will likely decrease during pregnancy, but if the baby is taking other foods, this is not a usually a problem. However, some babies will stop breastfeeding if the milk supply is low.

3. A baby with diarrhea should not breastfeedNot true! The best treatment for a gut infection (gastroenteritis) is breastfeeding. Furthermore, it is very unusual for the baby to require fluids other than breastmilk. If lactose intolerance is a problem, the baby can receive lactase drops, available without prescription, just before or after the feeding, but this is rarely necessary in breastfeeding babies. Get information on its use from the clinic. In any case, lactose intolerance due to gastroenteritis will disappear with time. Lactose free formula is not better than breastfeeding. Breastfeeding is better than any formula.

4. Babies will stay on the breast for two hours because they like to suckNot true! Babies need and like to suck, but how much do they need? Most babies who stay at the breast for such a long time are probably hungry, even though they may be gaining well. Being on the breast is not the same as drinking at the breast. Latching the baby better onto the breast allows the baby to breastfeed more effectively, and thus spend more time actually drinking. You can also help the baby to drink more by expressing milk into his mouth when he no longer swallows on his own (See Information Sheet Breast Compression). Babies younger than 5-6 weeks often fall asleep at the breast because the flow of milk is slow, not necessarily because they have had enough to eat. See videos at nbci.ca.

5. Babies need to know how to take a bottle. Therefore a bottle should always be introduced before the baby refuses to take oneNot true!Though many mothers decide to introduce a bottle for various reasons, there is no reason a baby must learn how to use one. Indeed, there is no great advantage in a baby's taking a bottle. Since Canadian women are supposed to receive 52 weeks maternity leave, the baby can start eating solids around 6 months, well before the mother goes back to her outside work. The baby can even take fluids or solids that are quite liquid off a spoon. The baby can start learning how to drink from a cup right from birth or older, and though it may take several weeks for the older baby to learn to use it efficiently, he will learn. If the mother is going to introduce a bottle, it is better she wait until the baby has been breastfeeding well for 4-6 weeks, and then give it only occasionally. Sometimes, however, babies who take the bottle well at 6 weeks, refuse it at 3 or 4 months even if they have been getting bottles regularly (smart babies). Do not worry, and proceed as above with solids and spoon. Giving a bottle when breastfeeding is not going well is not a good idea and usually makes the breastfeeding even more difficult. For your sake and the baby's do not try to "starve the baby into submission". Get help.

6. If a mother has surgery, she has to wait a day before restarting breastfeedingNot true! The mother can breastfeed immediately after surgery, as soon as she is awake and up to it. Neither the medications used during anaesthesia, nor pain medications nor antibiotics used after surgery require the mother to interrupt breastfeeding, except under exceptional circumstances. Enlightened hospitals will accommodate breastfeeding mothers and babies when either the mother or the baby needs to be admitted to the hospital, so that breastfeeding can continue. Many rules that restrict breastfeeding are more for the convenience of staff than for the benefit of mothers and babies.

7. Breastfeeding twins is too difficult to manageNot true! Breastfeeding twins is easier than bottle feeding twins, if breastfeeding is going well. This is why it is so important that a special effort should be made to get breastfeeding started right when the mother has had twins (See Information Sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Some women have breastfed triplets exclusively. This obviously takes a lot of work and time, but twins and triplets take a lot of work and time no matter how the infants are fed.

8. Women whose breasts do not enlarge or enlarge only a little during pregnancy, will not produce enough milkNot true! There are a very few women who cannot produce enough milk (though they can continue to breastfeed by supplementing with a lactation aid). Some of these women say that their breasts did not enlarge during pregnancy. However, the vast majority of women whose breasts do not seem to enlarge during pregnancy produce more than enough milk.

9. A mother whose breasts do not seem full has little milk in the breastNot true! Breasts do not have to feel full to produce plenty of milk. It is normal that a breastfeeding woman's breasts feel less full as her body adjusts to her baby's milk intake. This can happen suddenly and may occur as early as two weeks after birth or even earlier. The breast is never "empty" and also produces milk as the baby breastfeeds. Is the baby getting milk from the breast? That's what's important, not how full the breast feels. Look skeptically upon anyone who squeezes your breasts to make a determination of milk sufficiency or insufficiency. See videos at nbci.ca.

10. Breastfeeding in public is not decentNot true! It is the humiliation and harassment of mothers who are breastfeeding their babies that is not decent. Women who are trying to do the best for their babies should not be forced by other people's hang-ups or lack of understanding to stay home or feed their babies in public washrooms. Those who are offended need only avert their eyes. Children will not be damaged psychologically by seeing a woman breastfeeding. On the contrary, they might learn something important, beautiful and fascinating. They might even learn that breasts are not only for selling beer. Other women who have left their babies at home to be bottle fed when they went out might be encouraged to bring the baby with them the next time.

11. Breastfeeding a child until 3 or 4 years of age is abnormal and bad for the child, causing an over-dependent relationship between mother and childNot true! Breastfeeding for 2-4 years was the rule in most cultures since the beginning of human time on this planet. Only in the last 100 years or so has breastfeeding been seen as something to be limited. Children breastfeed into the third year are not overly dependent. On the contrary, they tend to be very secure and thus more independent. They themselves will make the step to stop breastfeeding (with gentle encouragement from the mother), and thus will be secure in their accomplishment.

12. If the baby is off the breast for a few days (weeks), the mother should not restart breastfeeding because the milk soursNot true! The milk is as good as it ever was. Breastmilk in the breast is not milk or formula in a bottle.

13. After exercise a mother should not breastfeedNot true! There is absolutely no reason why a mother would not be able to breastfeed after exercising. The study that purported to show that babies were fussy feeding after mother exercising was poorly done and contradicts the everyday experience of millions of mothers.

14. A breastfeeding mother cannot get a permanent or dye her hairNot true! I have no idea where this comes from.

15. Breastfeeding is blamed for everythingTrue! Family, health professionals, neighbours, friends and taxi drivers will blame breastfeeding if the mother is tired, nervous, weepy, sick, has pain in her knees, has difficulty sleeping, is always sleepy, feels dizzy, is anemic, has a relapse of her arthritis (migraines, or any chronic problem) complains of hair loss, change of vision, ringing in the ears or itchy skin. Breastfeeding will be blamed as the cause of marriage problems and the other children acting up. Breastfeeding is to blame when the mortgage rates go up and the economy is faltering. And whenever there is something that does not fit the "picture book" life, the mother will be advised by everyone that it will be better if she stops breastfeeding.


More and More Breastfeeding Myths

1. Breastfeeding mothers cannot breastfeed if they have had X-raysNot true! Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may breastfeed without concern. Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. Furthermore, there are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram, etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should, in my opinion, continue breastfeeding. If you feel you must stop for a period of time, express milk in advance so that the baby can be fed your milk and not formula. After two half lives, 75% of the compound will be out of your body. This is surely waiting long enough (the half life of technetium, which is used in most radioactive scans is only six hours, so that 12 hours after the injection, 75% of it will be out of your body). The exception is the thyroid scan using I131. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. If the scan must be done, doing it with I123 requires the mother to stop breastfeeding for 12 to 24 hours only depending on the dose. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months. Incidentally, lung scans with radioactive contrast no longer is the best test to rule out a lung clot. CT scan is now the preferred test to prove or disprove the diagnosis. [See also Information Sheet Breastfeeding and Medications)

2. Breastfeeding mothers' milk can "dry up" just like thatNot true! Or if this can occur, it must be a rare occurrence. Aside from day-to-day and morning-to-evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:

1. An increase in the needs of the baby, the so-called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent breastfeeding will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression).

2. A change in the baby's behaviour. At about five to six weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try using breast compression to help the baby get more milk. See the website nbci.ca for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression.

3. The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (Information sheet Is My Baby Getting Enough Milk?).

4. The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods. Other drugs that can decrease milk supply are pseudoephedrine (Sudafed), some antihistamines, and perhaps diuretics.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle that may only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid that will not interfere with breastfeeding, or by cup if the baby will not take the aid. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression).

3. Physicians know a lot about breastfeedingNot true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

4. Pediatricians, at least, know a lot about breastfeedingNot true! Obviously, there are exceptions. However, in their post-medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.

5. Formula company literature and formula samples do not influence how long a mother breastfeedsReally? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Do formula companies take on the cost of the samples and booklets so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. But in competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

6. Breastmilk given with formula may cause problems for the babyNot true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

7. Babies who are breastfed on demand are likely to be "colicky"Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the breastmilk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more high fat milk, by compressing the breast once the baby sucks but does not drink. (Information Sheets Colic in the Breastfed Baby and Breast Compression). Also see videos.

8. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks)Not true! Why should they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

9. There is no such thing as nipple confusionNot true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle will figure that one out pretty quickly. A baby who has had only the breast for three or four months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Information sheet Breastfeeding Myths, Jack Newman MD, FRCPC, IBCLC, 2009©
Revised by Edith Kernerman, IBCLC, 2009©

All of our information sheets may be copied and distributed without further permission on the condition that it is not used in ANY context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions.

http://www.mamancherie.ca/en/information/40-dr-jack-newman/82-breastfeeding-myths

 


Concerns

What do I do about sore or painful nipples? 
  • Nipples are sensitive during pregnancy and in the early days of breastfeeding due to the hormones. The sensitivity usually goes by about two weeks.
  • It can be normal to have some discomfort at the beginning of feeds as a baby latches and the nipple is stretched.
  • It’s not normal to have pain through the whole feed, or for the nipple to look misshapen after the feed.
  • Sometimes a baby may not get a big mouthful of breast, but be just on the nipple. This can lead to pain and nipple damage. And there are other reasons
  • Help your baby get a big mouthful of breast, not just the nipple
  • You can shape your breast, like you might squish a burger to get your mouth around it.
  • Trying a different position, especially getting your baby more on his/her tummy may help get a bigger mouthful
  • Once your baby is latched, you can sometimes pull on the chin and get a wider open mouth
  • Check that the nipple is not getting bent during feeds. Look for a nipple pointing to the side, or a crease at the base of the nipple the moment the nipple is released. This often happens when the ‘cross cradle’ position is used and the baby’s head gets tilted, or a little ‘around to the side’, or with the nose and not the chin being closest to the breast.
  • If you are taking your baby off the breast, make sure you break the suction with your finger first
  • Breastmilk left to dry on the nipple is healing, so is olive oil and coconut oil. Soaking or swabbing with saline (salty water) is helpful. Manuka Honey Breast pads promote healing and inhibit infections if the skin is broken.
  • You can take Panadol or Ibuprofen (hardly any gets through to the baby)
  • There is no need to buy nipple creams. There is little evidence that they are any help. Lanolin and hydrogel pads have been found to be associated with infections, particularly thrush. Breastmilk, olive oil, and coconut oil, have all been found to be helpful. Washing the nipples with mild soap and applying saline (1/2 tsp salt in a cup of water) has been found to reduce infection.
  • If your nipples are damaged - Manuka Honey gel pads are proven to promote wound healing and inhibit infection. Many mothers find them soothing, especially when cooled in the fridge first. (NB – the gel pad need to be first removed from the supporting rigid plastic disk) A saline soak and wet green tea bags are also helpful
  • Nipples do best when they are not squashed, and get some light and air. Smearing with perfumed creams, wrapping firmly and being kept in the dark is good for embalming Egyptian Mummies, not for nipples. 
  • If you have lots of pain, and / or nipple damage, don’t suffer, get help from your midwife or a lactation consultant. There are many different causes of sore nipples, and many ways to help.     
    Sore nipples or breasts 
    Care of Nipples.pdf
    Are there any cures for sore nipples.pdf
    Topical treatment for nipples.pdf
    Does Lanolin Increase the Risk For Infection -.pdf
I have burning, stabbing, shooting nipple pain. Could it be thrush? 

Nipple and Breast Thrush?

Nipples are very tender to touch and even light clothing can cause pain. You may have stinging nipple pain during and after feeds. Your nipples may be bright pink and/or shiny and the areola may be reddened, dry or slightly flaky.
Your breasts may have shooting, stabbing, or deep aching pain. It might radiate into your back or down your arm. It’s often during let-down and also after feeding or expressing.
The pain may be on side or both.
Your breasts will look and feel normal (not with a hard and/or red area like with mastitis)
You probably had antibiotics recently.

If you have nipple thrush... 

- Expose nipples to air and UV light (as much as practicable J)
- Heal damaged nipples – use Manuka Honey Breast Pads, get expert help if nipple pain / damage is not improving after the initial days
- you can take Ibuprofen (or Paracetamol) for your pain
- Miconazole oral gel/cream or nystatin cream applied after each feed (or 3-4 hourly during the day). (It is not necessary to wipe the gel/cream from the nipples before the next feed)
- Gentian violet applied after breastfeeding twice a day for up to 7 days can sometimes be available
- Your doctor may prescribe fluconazole 150 mg capsules, one every second day for 3 doses, followed by course of Nystatin 2 tablets, 3 times a day. Sometimes a repeat prescription is needed, especially if the pain involves your whole breast. Ketoconazole can sometimes be used for resistant cases.
- For your baby’s mouth…Miconazole oral gel (Miconazole Oral Gel (Daktarin®) 4 times a day for 1 week, then once daily for 1 week after signs/symptoms resolve.

It's best to avoid…

Lanolin and other nipple ointments (other than as above)
nursing/breast pads
tight, synthetic bras
wearing bra at night
tight synthetic clothing
large amounts of sugars, honey, artificial sweeteners, carbohydrates, dairy products (except yogurt with live cultures) yeasts (including Brewers Yeast and Vit B supplements), alcohol, fermented foods
anti-bacterial soap (just use a regular soap, you want your normal bacteria)
dummies / pacifiers

Try to…

Improve diet and treat any deficiencies of vitamins A, B, C, and K, folic acid, Iron, Zinc
wash hands after handling the breasts or milk, changing nappies and using the toilet
Use hottest wash and exposure to UV light laundry items.
Use hottest wash for dishes.
Sterilise by boiling any toys, teats, pacifiers, teethers, pump parts.
Treat any nappy rash, vaginal thrush, tinea
Use distilled vinegar (heat treated to remove mold spores) and water solution to add to baths, final rinses of washing machines and directly on affected or at risk skin can also be effective. The resulting pH change makes it less congenial to yeast.

Yeast Infections and the Breastfeeding Family
Yeast Infections and the Breastfeeding Family - pdf

What to do about uncomfortably full breasts? 
  • This can begin a few days after the birth
  • It's important to relieve the fullness as best you can
  • The best way to relieve this engorgement is to feed your baby often
  • You can wake your baby for a feed or hand express to relieve the fullness
  • If your breasts are too full for your baby to latch on well, express some milk before trying again.
  • You can use your fingers on the areola area to push back and hold for a moment or two immediately before latching. This will help push some of the swelling away and make it easier to latch. (This is called Reverse Pressure Softening)
  • After feeds use something cold on your breasts. Some women find putting chilled cabbage leaves on their breasts, for up to 20 minutes, helps
  • You can take 400mg of Ibuprofen every 8 hours, or paracetamol.
  • Wearing a supportive bra may help, or you may prefer to go bra-less
  • Spending some time massaging away from the nipple and towards the armpit can relieve a lot of swelling. There can be a lot of fluid (not milk) that needs to drain away through the lymph system. You might like to massage with some oil while lying on your back. In some cultures, this breast massage is a normal part of a woman’s care at this time. 
  • More about sore nipples or breasts 
I have painful breasts. Do I have a plugged duct or mastitis? 

I have a painful area in my breast

Sometimes an area of breast doesn’t drain well. Maybe your baby’s position wasn’t the best and your nipple was a little bent. If it’s persistent it is referred to as a blocked duct. Sometimes a plug of thick milk can cause a blockage in the nipple. You can see this as a white dot. It’s called a ‘bleb’. You can usually squeeze it out. It’s important to get the milk moving asap.

I have a painful area in my breast and I feel unwell

A painful area, often reddened, with flu-like symptoms is likely to be a breast infection (Mastitis). You may have a temperature and feel “dreadful”. This sometimes happens around 2-3 months, but can happen at other times. It can be caused by poor drainage of milk due to a poor latch, missed feeds, blocked ducts or fatigue & poor health. It is often related to sore and damaged nipples.

•      It is important to continue to remove milk – by breastfeeding, hand expression or pumping
•      Help your baby to get the best position and latch.
•      Relieve a blocked duct, if that’s an issue.
•      Express your breast after feeds if necessary to drain the breast well
•      Use gentle breast compressions behind a hard area to help milk drain
•      Use heat for comfort (if needed) before feeding and expressing
•      After pumping or expressing apply something cool
•      Get lots of rest. Stay in bed and feed baby very frequently
•      Eat well and drink plenty
•      If after about 12 hours you are not feeling better, consult your midwife or doctor. You may need antibiotics.

I have sore breasts
Do I have mastitis?

Why does my baby fight the breast? Why doesn’t my baby want to breastfeed? 

My baby fights the breast

Young babies have many reflexes to help them find the breast, latch on and begin sucking. Most of these are designed to work with gravity, ie with the baby on his tummy. In this position the arm and leg circling, the head rooting from side to side and the head bobbing are all very effective.
But when babies are on their side these same reflexes can look like pushing, punching, ‘head-butting’ and turning away. It seems like your baby is not wanting to feed! When in fact it is the opposite.
If your hands are holding your baby’s head or neck it can be uncomfortable for your baby, and difficult to drink well too, so he/she may fuss.
The remedy is to lean back so your baby is more on his tummy, and able to move his/her head. See Biological Position

My baby fusses and pulls off 

Babies are all about ‘flow’. If the flow is too fast or too slow they will fuss and pull off and sometimes cry.
 - If you suspect it is because the flow is a bit slow, squeeze and hold you breast while your baby feeds. This will help your baby get the milk faster. You can also change sides often as this makes more milk available.
- If you think it is because the flow is a bit fast for your baby it is best to lean back and have your baby more on top of you. That way your baby will cope with it better and not feel like he/she is drowning in it!
If your baby has a tongue restriction, both a slow flow and a fast flow will be more difficult to manage.   

There can be other reasons for a baby fussing at the breast.
Lots of help here http://kellymom.com/ages/newborn/nb-challenges/back-to-breast/

My baby struggles at the breast

What should my baby’s weight gains be? 
Roughly...

back to birth weight by 14 days then
155-240 gms each week until four months old then
95-125 gms each week until six months old then
50-80 gms each week until 1 year old

How can I increase my baby’s weight gain?  Do I have low milk supply? How can I make more milk? 

How to increase milk production
- Remove milk more often…by breastfeeding, hand expression or pumping.
- Help your baby get a good mouthful of breast
- Help your baby be in a good drinking position…in close, tummy to tummy, chin in breast, head back
- Squeeze and compress your breasts to help your baby get the milk
- Swap sides often
- Eat well, including protein and complex carbohydrates like oats
- Drink enough fluids
- Rest, relax, sleep
- Make sure you are not doing the things that slow production
- There are also herbs and medications that help
- If you are still concerned talk to your midwife, or a lactation consultant

Increasing low milk supply 
Hidden Hinderences to a Healthy Milk Supply

More Milk Out = More Milk Made
 
Emptier breasts make milk faster
Frequent milk removal = fast milk production

Fuller breasts make milk slower
Infrequent milk removal = slow milk production

How often a baby needs to feed is also related to a mum’s milk storage capacity. This varies between women, and also between breasts. (You can’t tell by looking at the breasts).               

For one mum the production might slow right down (because her breasts are getting full) when there is maybe 40mls of milk stored. For another mum the production might only slow down when there is around 80mls stored.

Both these mums can make the same amount of milk over 24 hours, but the mum with the smaller storage will need to remove milk twice as often. Her baby’s feeds will probably be quicker, and even seem like ‘snack’ feeds. It doesn’t matter. In fact, the mother of this baby is likely to spend less time on winding, baby’s discomfort and mopping up sicky spills, than the mother whose baby has fewer, but huge, feeds.

 Milk production slows as breasts fill, This is a necessary feedback system!

Why is my baby crying?  How do I know if my baby is getting enough hind-milk? 

There is no need to worry about hind milk. The fat content evens out between feeds and it’s the overall volume of milk that baby needs for growth, not just fat. 

Breast massage and compressions will increase the fat that a baby gets. Trying to get more fat by restricting a baby to one breast only per feed, or going back to the same breast for a specified time, will slow the overall milk production...and ultimately less fat too.

Up to 6 months, breastmilk is 7.4% fat, but after 12 months it is 10.7%!

Foremilk and Hindmilk - What does that mean?
Worries about Foremilk and Hindmilk 
http://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/
http://www.llli.org/faq/foremilk.html

A Neurobehavioral Approach to Breastfeeding. Dr Nils Bergman, M.D., D.C.H., M.P.H., Ph.D.Cape Town, South Africa www.kangaroomothercare.com

Can I overfeed my breastfed baby?  I think I have too much milk 

I think I have too much milk
    Full breasts, leaking breasts, a strong let down causing your baby to cough and splutter, explosive frothy green poo, baby spilling lots, and appearing uncomfortable with gas, can all be caused by things other than having too much milk.
    Sometimes in the early weeks there can be a little ‘oversupply’ but it usually settles on its own. But if these things above are a problem, and your baby’s weight gains are massive, you may benefit from slowing the milk production.
    If you do need to reduce your production, an effective way is to feed your baby from one breast only each feed, or sometimes back to the same breast for number of hours eg. three or four. It’s best not to overdo this though, because you don’t want to reduce the milk production too much or risk mastitis. Restricting feeds in this way for a week is probably long enough.

 

How does milk production slow down? 

How milk production slows down.. 

Removing milk less often. This happens by…postponing feeds, making baby wait for feeds, feeding from one side only every feed, getting baby to suck on a dummy, baby has a long stretch of sleep (eg 5 hours) at night, trying to get into ‘a routine’ rather than responding to baby’s feeding cues, or trying ‘Sleep Training’.

Removing milk less efficiently. This happens by…limiting the feed time, baby not having a big mouthful of breast, baby not being in a comfortable position to swallow easily (chin not touching breast or maybe body is twisted), the position of the baby’s head is making the nipple is slightly bent (reducing milk flow), some tongue restriction due to a tight or short frenulum (tongue tie), or some other problem. Lots of anxiety and stress can make it difficult to ‘let down’ (because adrenalin inhibits oxytocin)

Other things that can slow milk production…
Dieting
Smoking & Alcohol
Lots of vigorous exercise
Being unwell
Hormonal contraception before milk production is really well established
Cold and flu medications designed to dry up secretions

All these things affect women and babies differently

My baby is tongue tied 

Tongue-tie or ankyloglossia is when the thin membrane under the tongue is short, thick or attached too far forward. A Lactation Consultant or Midwife can assess this. Tongue-tie can cause problems with a baby’s ability to feed, usually resulting in sore nipples and a poor milk intake.

Often a frenotomy, where that tight bit of membrane is released, is recommended. A frenotomy is done by scissors or laser and is very quick. It doesn’t seem to bother young babies very much and is thought to be best done the sooner the better.

WDHB's TT leaflet.pdf
www.unicef.org.uk - BabyFriendly - Tongue Tie

NZ tongue tie & Support - Facebook
NZ Tongue tie discussion - Facebook

 

Is Tongue Tie a fad? Where is the evidence for Frenotomy? 

Randomized controlled trials of tongue-tie or ankyloglossia

  1. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005;41:246-50.

  2. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006;41:1598-600.

  3. Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011;128:280-8. (Free full text)

  4. Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med. 2012;7:189-93.

  5. Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Arch Dis Child Fetal Neonatal Ed. 2014;99:F189-95. (Free full text.)

  6. Ovental A, Marom R, Botzer E, Batscha N, Dollberg S. Using topical benzocaine before lingual frenotomy did not reduce crying and should be discouraged. Acta Paediatr. 2014;103:780-2.

Systematic Reviews

  1. Francis DO, Chinnadurai S, Morad A, Epstein RA, Kohanim S, Krishnaswami S, Sathe NA, McPheeters ML.Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 May. (Free full text)

  2. Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics. 2015;135:e1467-74.

  3. Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015 Jun;135(6):e1458-66.

  4. Ito Y. Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia? . Pediatr Int. 2014;56:497-505.

  5. Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013 May;77(5):635-46.

  6. Suter VG, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol. 2009 Aug;80(8):1204-19.

  7. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007 Jun;53(6):1027-33. (Free Full Text)

 Follow-up studies

  1. Dollberg S, Marom R, Botzer E. Lingual frenotomy for breastfeeding difficulties: a prospective follow–upstudy. Breastfeed Med. 2014;9:286-9.

  2. Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact. 2004;20:409-14

 

Frenotomy for Speech dysfunction

  1. Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children. Pediatr Int. 2015;57:222-6.

  2. Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH Jr. Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol. 2014;78:128-31.

  3. Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013;77:635-46.

  4. Dollberg S, Manor Y, Makai E, Botzer E. Evaluation of speech intelligibility in children with tongue-tie. Acta Paediatr. 2011;100:e125-7

  5. Messner AH, Lalakea ML The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg. 2002;127:539-45.

  6. Block JR. The role of the speech clinician in determining indications for frenulotomy in cases ofankyloglossia. N Y State Dent J. 1968;34:479-81.


Ankyloglossia and airway anatomy

  1. Mukai S, Mukai C, Asaoka K Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults. Ann Otol Rhinol Laryngol. 1993;102:620-4.

 Mukai S, Mukai C, Asaoka K. Ankyloglossia with deviation of the epiglottis and larynx. Ann Otol Rhinol Laryngol Suppl. 1991 May;153:3-20

www.ncbi.nlm.nih.gov/pubmed
www.unicef.org.uk/babyfriendly/

Official Statements

Canadian Pediatric Society: Position statement: Ankyloglossia and breastfeeding
American Academy of Pediatrics: Congenital Tongue-Tie and its impact on breastfeeding
Israel Neonatal Society (Hebrew) 
Agency for Healthcare Research and Quality U.S. Department of Health and Human Services: Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie
American Academy of Pediatric Dentistry: Guideline on Management Considerations for Pediatric Oral Surgery and Oral Pathology by the AAPD
The Academy of Breastfeeding Medicine - Protocol # 11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad 

 

https://tonguetieprofessionals.org/

www.alisonhazelbaker.com/blog/2015/9/1/modern-myths-about-tongue-tie-the-unnecessary-controversy-continues

My baby prefers one side 

Many newborn babies are born a little ‘wonky’. They have been growing in a very tight space, and so are sometimes a little tighter & stronger on one side of their face and neck than the other. You might notice your baby’s head keeps turning to one side. This is often called Torticollis. Sometimes the jaw is a little crooked too. This can make feeding off one side easier than the other.

Help your baby to find a position to feed well in. Plenty of tummy time and helping your baby alternate what side the head rests on when sleeping, and in the car seat, is a good idea.

Growing with good alignment pdf

A baby will fuss at the breast if the flow is slow. If the milk production on one side has become less, so will the flow.

If there is infection on that side, the taste may be different, causing a baby to fuss.

If concerned, see your midwife or lactation consultant

My baby has wind 

Wind occurs when air is swallowed during a feed. If there is an opportunity and perhaps a little movement, any air bubble will be released as a burp. But sometimes the air bubble will travel through the gut until it’s released as a fart.

A young baby’s gut is immature. It is possible that some babies are more bothered than others by all the new and sometimes uncomfortable sensations.

Breastfed babies are much less likely to be troubled by wind than non-breastfed babies.

Air is swallowed during a feed when the flow is fast, especially when the baby is beneath the flow. Feeding in the side lying position, or when you are leaning back so baby is more on top helps with this. Babies that don’t have a good latch & seal on the breast can also swallow more air.

The bottle feeding of infant formula can cause lots wind and discomfort because the feeds are often taken too fast. There is also discomfort due to the difficulties of digesting the foreign protein.

The influence of the practice of bottle feeding babies, along with the marketing of assorted ‘wind remedies’, has unfortunately caused a lot of expectation and anxiety around ‘wind’ for new parents.

When babies are carried, and fed small amounts frequently, ‘wind’ is much less of a problem

When newborns are unsettled it is likely the baby is needing more skin to skin time, and more feeding, rather than ‘winding’

My baby throws up 

‘Spitting up’ or ‘spilling’ is very common and often happens when babies are burped. Babies aren’t usually bothered by their spitting up.

Babies ‘spit up’ when they've taken more milk than their tummy can hold.

The un-stretched tummy of a 1 week old is about 20 mls.
The un-stretched tummy of a 1 month old is about 40mls.
The un-stretched tummy of a 6 month old is about 100mls
Tummies can stretch to hold more, but some discomfort is possible.

Smaller frequent feeds may result in less milk coming back up and will also mean the tummy contents are less acid.

Vomiting is forceful. If your baby is vomiting talk to your health professional.

A Neurobehavioral Approach to Breastfeeding. Dr Nils Bergman, M.D., D.C.H., M.P.H., Ph.D.Cape Town, South Africa www.kangaroomothercare.com
When will my baby sleep? 

My baby won’t sleep in the bassinette
    This is normal behaviour for a newborn baby. All your baby has ever known is being completely surrounded by your body. Every single moment there was your warm body contact, your smell, the sounds of your body, and its movement. But now everything is different and strange. Your baby will want to be close to you all the time.
    After a few days your baby will have adjusted somewhat and will often be ‘milk drunk’ after a feed. This makes settling in the bassinette a little more successful. 

  • Babies waking at night is normal
  • Babies tummies are small and need to feed often to get what they need
  • Sucking to sleep is normal
  • Babies wake for many reasons, and need help to get back to sleep
  • A night feed is usually needed to maintain milk production
  • Exclusively breastfeeding mothers usually have more sleep, and better quality sleep, than those formula or mixed feeding
  • In time, your baby will stop waking at night even if you do nothing 

 

Babies usually get the sleep they need - it just might not be as much as the parents would like them to have :) 

 

Caring for Your Baby at Night
All about sleep 
Advice from Elizabeth Pantley
Advice from Elizabthe Pantley pdf
Simple Ways to Calm a Crying Baby pdf
Why Not Cry it Out Part 1 pdf
Why Not Cry it Out Part 2 pdf

https://www.isisonline.org.uk/how_babies_sleep/normal_sleep_development/
http://kellymom.com/parenting/nighttime/comfortnursing/
http://kellymom.com/parenting/nighttime/sleep/
http://kellymom.com/parenting/nighttime/sleepstudies/
http://www.uppitysciencechick.com/nighttime_breastfeeding.pdf

What about 'Sleep Training'? 
  • Results may not last and training is likely to need to be repeated, eg after teething or illness
  • It may have negative consequences for breastfeeding
  • It may have longer term or ’bigger picture’ type consequences
  • The ‘Sleep Consultant’ industry is unregulated 

How_babies_sleep / sleep_training / research_evidence
How_babies_sleep / sleep_training / considerations

What about co-sleeping? 

Newborns feed the most at night and most babies continue to feed at night for a long time. Many mothers and babies co-sleep.

If you choose to bed share or co-sleep you can calculate your own baby’s risk here.   http://clients.teamdf.com/curekids/site/

There are ways to make co-sleeping safer 

The Safe Sleep Seven
Bed sharing and infant sleep
kellymom.com/parenting/nighttime/cosleeping
cosleeping.nd.edu


Other concerns 

My baby is a 'lazy feeder' 

My baby sucks for a few minutes and then falls asleep but as soon as I take him off he shows cues again!

     Babies will do this when the flow is slow, and are taking a break to conserve their energy. Sometimes a baby will look like they are asleep but if you notice the fists you will see them tightly clenched. This is a baby that is tense, and taking some ‘time out’ to rest. This is not a baby that is done feeding.

  • Squeezing and compressing your breast will get a little milk to flow and this usually gets a baby feeding again. This is so much more effective (and kinder) than blowing on, tickling or using other ways of harassing a baby to feed.
  • Continuing to compress your breasts while your baby sucks, will help your baby get milk.
  • Swap sides when there is an opportunity
  • Watch for those little fingers to unfurl and then the whole arm to become floppy and relaxed

If you have lots of milk and a strong let-down causing the milk to flow really fast, it is possible for a baby to have a feed very quickly (and then fall asleep). But in this situation you would notice very active feeding with lots of rapid, obvious swallows – not just sucking, then baby would take him/her-self off the breast looking full and satisfied…with a floppy and relaxed arm.

My baby is using me 'like a dummy' 
  • For a baby the breast is not just about food, but so much more. It is a place of warmth, comfort, reassurance and connection. It’s what a baby oves, so will want to be there often.
  • You can’t spoil your baby by offering the breast whenever cues are given. Frequent sucking at the breast, especially during the first weeks, is how a good milk production is established. Not letting your baby have the breast can delay this.
  • Dummies are an attempt to provide a breast substitute, not the other way around. The baby only ever uses the breast like a breast. 
  • see 'How do I help my baby get more milk'
My baby is 'snack feeding' 

My baby wants to feed all the time

- Babies often cluster feeds together and it can seem endless, like a breastfeeding marathon.
- Between 9pm and 3am is when newborns feed the most, but in an older baby its earlier in the evening or the late afternoon. This is totally normal and helps to increase your milk production.
- Newborns then feed the least between 3am and 9am. They often have some good stretches of sleep then, and then on to lunchtime. That may be your best opportunity for catching up on the Zzzz’s.

  • Using Breast Compressions and swapping sides when there are not many swallows, will help make the most of your baby’s time at the breast.

- 8 – 12 feeds (or more), taking about 30 minutes (each 24 hours) is a normal beginning breastfeeding pattern. - By responding to cues and feeding often, the sooner your milk production will meet your baby’s needs and then the feeds may become less frequent. The feeds are also likely to become quicker.
- 'Endless feeding' can be a symptom of a tongue tie. Or there could be other issues. If you are concerned, talk to your midwife or lactation consultant. 

My baby is 'comfort sucking' 

Sucking is comforting! Perhaps what you are noticing is that your baby I’s sucking is ‘fluttery ‘in nature. This is what happens when a baby is drifting off to sleep.

Or maybe you are noticing that your baby is sucking but not swallowing. This may be because most of the milk has been removed from that breast for the time being. Maybe it is time to use Breast Compressions or swap sides

Or maybe your baby is wanting to be at the breast when you feel your baby has had a good feed, and can’t be hungry. Maybe your baby is still hungry.

Or maybe your baby does want some comfort. This is not wrong. The breast is not just about food. Providing a little comfort in this way becomes one of the most rewarding (not to mention instant and highly effective) aspects of the breastfeeding experience.

Stretching out feed times 

Stretching out feed times is not a good idea.
UNICEF on stretching out feed times

Getting into a routine 

You will find that your baby's feeds, awake times and sleep times develop into something of a pattern. But no two days will be exactly the same. Your baby will be growing, developing and changing every day. 
Trying to manipulate feeding and sleeping times may not work, and may result in unintended consequences eg, less breastmilk production. 
The Importance of Relationship Building

Stretching out feed times
New reseach finks link between some baby books and postnatal depression
Babies and Sleep. A Matter of Choice

My baby feeds sooooo often!   I think my baby is reacting to something in my milk 

Windiness, tummy aches and unsettled behaviour are all a normal part of life with a young baby. It can be made worse by swallowing air if the milk flow is fast and/or if the latch not the best.

Your baby’s tummy and gut is immature and the best remedy is time. It’s usually nothing to do with the milk itself.  

But sometimes babies can be allergic and react to something in the milk. These babies seem to vomit a lot, have lots of mucousy green explosive poo’s, have really rashy, spotty skin and are unhappy and not growing so well. Sometimes eliminating certain foods from a mums’ diet can result in a baby’s symptoms improving.

http://kellymom.com/health/baby-health/food-sensitivity/

Stopping breastfeeding is not the answer. If your baby is this allergic to tiny particles of a protein that come through your milk, it could be very difficult to find an alternative milk that is not more of a problem. 

see also What about allergies       

What about allergies? 

The latest from The Centre for Food & Allergy Research (CFAR) - The Australasian Society for Clinical Immunology and Allergy (ASCIA) Guidelines is….

1. When your baby is ready, at around six months, but not before four months, start to introduce a variety of solid foods, starting with iron rich foods, while continuing breastfeeding.
2.  All babies should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This includes infants at high risk of allergy.
3.  Hydrolysed (partially or extensively) infant formula are not recommended for prevention of allergic disease.

Although your baby is likely to be taking increasing amounts of solids, breastmilk remains an important food for your baby. 

New Recomendations for infant feeding
UNICEF - Allergies
Eat peanuts during pregnancy and breastfeeding to reduce peanut sensitisation in your child
A Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in food, Consumer products and the Environmentood 
Media Release - Great result for Infant Feeding Guidelines consensus

What about ‘Follow On’ formula? 

The World Health Organization says follow-on formula is not necessary, and is unsuitable as a breast-milk replacement from six months of age onwards. It says current formulations lead to a higher protein intake and lower intake of essential fatty acids, iron, zinc and B vitamins than recommended for adequate growth and development. You can read about it here…

Information concerning the use and marketing of Follow-Up Formula

Be aware. Claims manufacturers make are for marketing purposes, and may have no scientific basis. There is a lot of money to be made from parents of babies and young children!

When your baby is one year old, he/she can have regular cow’s milk (as well as breastmilk ideally) but there is no need for infant formula of any kind.

 

When should my baby start solids? 
  • From six months of age remains the World Health Organisation’s recommendation (manufacturers of food purees are always pushing for this to be changed)
  • Starting solids earlier isn’t necessary and it doesn’t help babies sleep better at night
  • Processed baby foods are often high in sugar. This is not good for your baby.
  • Breastmilk remains the most important food until at least a one year

some links to latest research 

New Recomendations for infant feeding
Media Release - Great result for Infant Feeding Guidelines consensus
UNICEF - Allergies
A Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in food, Consumer products and the Environmentood 

How long should I breastfeed for? 

The World health Organisation (WHO) and United Nations Children’s Fund (UNICEF) recommend feeding babies only breastmilk (exclusive breastfeeding) up until 6 months of age and to continue breastfeeding for up to two years with complementary food and fluids.


Food, Drink, Drugs, Medications, Milk Sharing

Can I drink alcohol and breastfeed? 

It is recommended to not drink alcohol while you are breastfeeding, as the alcohol goes into the milk. It takes a while to move out of your body. But when you no longer feel the effects of the alcohol it won’t be in your milk either.

If you have an occasion coming up where you know you will be drinking a fair bit, you can express milk before, to have available for your baby. Be sure there is a sober adult to care for your baby. 

Can I smoke and breastfeed? 

It is best to stop smoking during pregnancy and breastfeeding. But if you can’t, try and smoke less and avoid smoking before baby needs a feed. Smoking can reduce your milk supply and increase the effects of caffeine on your baby.  But it is still better to smoke and breastfeed, than not breastfeed at all.

Can I drink coffee or other caffeinated drinks and breastfeed? 

Caffeine is in coffee, tea and also in many fizzy drinks such as Coke, ‘V’, Red Bull etc. Caffeine can make your baby jittery, irritable and not sleep. One or two cups of caffeine a day is probably OK, but let your baby be your guide. High levels of caffeine can reduce the amount of iron in your milk.

Medications and breastfeeding  

Many medications can be taken while breastfeeding, because usually only a very small amount gets into the breastmilk. Some medications are more suitable than others, so can be substituted.

You can check things out yourself with free Apps
MommyMeds for Mothers www.infantrisk.com/apps
Lactmed https://itunes.apple.com/nz/app/lactmed/id441969514?mt=8
Infant Risk Centre

Milk Sharing 

When feeding babies, the World Health Organisation’s order of preference is… 

  •  Milk from own mother, by breastfeeding
  •  Milk from own mother, expressed
  •  Milk from a healthy donor or a milk bank
  •  Breastmilk substitute (infant Formula) 

Sometimes mothers may have a delay in producing enough of their own milk or have a low supply for a while. Some mothers in this situation choose to give their baby milk from another mother rather than Infant formula.

Breastmilk can contain viruses or traces of medications which could cause illness in a baby. The mother donating the milk can have a blood test to see if this is a problem.

For more information see www.healthpoint.co.nz scroll down to find the brochure ‘Sharing Breastmilk’
Also lots of information here www.eatsonfeets.org
NZ milk sharing sites… www.mothersmilknz.org.nz/mother-to-mother-milk-sharing.html
www.facebook.com/hm4hbnz
www.facebook.com/milksharingnz
www.facebook.com/piripoho


Adjusting

Looking after yourself 

coming soon!

Getting support 

coming soon!

I feel anxious and/or depressed 

Peripartum Distress

NZ has high rates of anxiety and depression during pregnancy and when the baby has arrived, for both men and women.

Depression in New Mothers
Postnatal Depression NZMOH
www.wellwomenfranklin.org.nz   Telephone 021 1588 134  If ph is not answered directly, leave a message. 
www.uppitysciencechick.com/ppdhandouts.html Lots of information on things that help
Mental Health.org Postnatal Depression
www.mothersmatter.co.nz
www.pada.nz
www.anxiety.org.nz
https://depression.org.nz/  FREE 24/7 HELPLINE: 0800 111 757 TEXT 4202
www.mentalhealth.org.nz/get-help/in-crisis/support-groups/

Breastfeeding has been shown to reduce stress and reduce the likelihood of postnatal depression - when it’s going well. If you are having difficulties, getting help with the problems promptly can protect your mental health.

New reseach finks link between some baby books and postnatal depression

Support for fathers 


Going back to work 

What are my rights around breastfeeding and working? 

Many women breastfeed & work
The Human Rights Act says it is illegal for someone to stop you breastfeeding at work, where you are studying, on public transport, in government departments, in public places and in restaurants and shops…anywhere you are entitled to be.
Your rights as a breastfeeding mother

There are changes to maternity leave entitlement from 1/7/17 Payrollhg

By law, your employer must give you unpaid breaks to breastfeed your baby or express milk at work, and must provide you with facilities to do this. More info.. 
www.moh.govt.nz - returning-to-work-english.pdf 
Breastfeeding Friendly Workplaces
The Department of Labour 0800 209 020

Using a pump once or twice while at work is one way to keep your milk production going well and provide milk for your baby. It’s an idea to practice pumping before you return to work.

How do I keep breastfeeding while working? 

Using a pump once or twice while at work is one way to keep your milk production going well and provide milk for your baby.

How much milk will my baby need?

It depends how long you are away from your baby. And how often your baby might want to feed (which can be a little more difficult to predict)

From about 1-2 weeks onwards, the ‘average
amount breastfed babies have in total each 24 hours is 750 mL, (range 570-900 mL)
number of feeds is ten
amount each feed about 75mls
The average amount of breastmilk per 24 hours gradually increases to become about 900 mls each 24 hours

A feed (full tummy) for a week old baby could be about 45-60 ml
A feed (full tummy) for a month old baby could be about 80-150 ml

Many babies will take only small amounts of breastmilk from a bottle or cup, but once back with mum, will feed lots. It’s not likely to matter.

Some helpful info kellymom.com/bf/pumpingmoms/pumping/milkcalc

Using a bottle

If you provide bottles for cargivers to feed your baby with while you are away it is helpful if they know how to give a feed that, as much as possible, is like breastfeeding. Explaining to your baby’s caregivers about ‘Paced Bottle Feeding’ will help. How to bottle feed a baby
That should help ensure that the volumes given are manageable for you to keep up with.
It will also lessen your baby’s frustration when back feeding at the breast.

Breastfeeding and Working 

 

What are my rights as a breastfeeding mother? Can I breastfeed at work?  
How do I use a Breast Pump? How do I pump more milk? 

There are many times when using hand expression or pumping can be helpful. These may include:

  • If your baby is having difficulty latching on, or getting milk from the breast
  • to stimulate milk production
  • relieving fullness or engorgement
  • if you have a premature baby
  • if you and your baby are separated for some reason
  • if you are returning to work or need to go out without your baby

 You can get milk by hand, or use a pump…whatever works best for you.

Using a breast pump.

There are all sorts of pumps available.
Regardless of what you use, you will get more milk if you use your hands to compress and squeeze your breasts. Some mums find they don’t get much when using a pump. Don’t worry, it’s not always a good indication of the amount available. It’s helpful to respond to your pump as if it’s your baby, so the oxytocin flows J

How to pump lots of breastmilk 

How long can I store my breastmilk? 

Breastmilk can be stored for days in the fridge and months in the freezer.
It’s better to have it at the back and bottom of the fridge, rather than the door.
It’s best to store breast milk in small quantities to avoid waste.

Thaw and heat the amount of milk needed for a feed by standing the container in warm water.
Frozen breastmilk should be used within 24 hours of defrosting.
Don’t use the microwave for thawing or heating breastmilk as this can alter special properties in the milk and may heat the milk unevenly.

Storing Breastmilk pdf

www.babyfriendly.org.nz - Storage of Breastmilk Factsheet.pdf

How do I give my baby a bottle? 

If you provide bottles for cargivers to feed your baby with while you are away it is helpful if they know how to give a feed that, as much as possible, is like breastfeeding. Explaining to your baby’s caregivers about ‘Paced Bottle Feeding’ will help. How to bottle feed a baby

That should help ensure that the volumes given are manageable for you to keep up with. 
It will also lessen your baby’s frustration when back feeding at the breast.

It's not necessary to use a bottle. Milk can also be given by cup (even newborns)


Other

What are the 'Breastfeeding Definitions"? 

Breastfeeding Definitions

Exclusive Breastfeeding
(EXBF)

 “The infant has never, to the mother’s knowledge, had any water, formula or other liquid or solid food. Only breastmilk, from the breast or expressed, and prescribed* medicine have been given from birth”. *Prescribed as per the Medicines Act 1981…this includes Dextrose gel and breastmilk from another mother.

Fully
Breastfeeding
(Fully BF)

 “The infant has taken breastmilk only, no other liquids or solids except a minimal amount of water or prescribed medicines in the past 48 hrs

Partial
Breastfeeding
(Partial BF)

 “The infant has taken some breastmilk and some infant formula or other solid food in the past 48 hrs” 

Artificial Feeding
(AF)

 “The infant has had no breastmilk but has had alternative liquid, such as infant formula with or without solid food in the past 48 hrs” 

Coubrough, L. (1999). Breastfeeding Definitions For Monitoring The National Health Outcome Targets In New Zealand: Review of the Evidence and Recommendations. Wellington, New Zealand: Ministry of Health. Retrieved from http://www.moh.govt.nz/notebook/nbbooks.nsf/0/65454BE64D7D1C3ACC257A5C00089216/$file/Breastfeeding%20definitions.pdf
 
 
 

Please note: The page has been created by Debbie Tetlow RN IBCLC, for Helensville Birthing Centre. While every effort is made to provide evidence based and up-to-date information the opinions expressed, and the links, above are not necessarily those of Helensville Birthing Centre and inclusion does not necessarily indicate endorsement or recommendation.
Please emaiDebbie with any feedback. Thanks 

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