Читать книгу Happy Baby, Happy Family: Learning to trust yourself and enjoy your baby - Sarah Beeson, Sarah Beeson - Страница 8
ОглавлениеEvery Day You Breastfeed Is a Huge Achievement
If you choose to breastfeed it will have lots of benefits for both you and your baby. Give it a go if you can and want to, would be my advice, but don’t be pressured in any way. This is your baby and your decision; no one should make you feel guilty about your choice to breastfeed or not. Take it one day at a time – understanding breastfeeding and having realistic expectations of yourself and your baby will make it more likely you’ll be relaxed and have a positive experience.
Breastfeeding is a wonderful thing; there are huge health benefits for mother and child, and it helps to develop attachment – but it’s not always easy. Please don’t think you are doing something wrong if you find it challenging, because it can be. You wouldn’t expect to get into a car for the first time and just drive it; it takes practice and then one day you find yourself driving along without really even having to think about it.
Nearly all babies have some frustration when learning how to feed; you’re both doing something new for the first time, and practice makes perfect when it comes to breastfeeding.
The first time you breastfeed
If possible, put your baby to the breast as soon as possible after delivery so they benefit from the colostrum (the milk you produce from birth) – it’s full of antibodies and nutrients that are perfect for your baby.
Making Milk for Your Baby
The milk you produce after giving birth is called colostrum – it is designed by nature especially for your baby to help them fight infection and get off to a flying start. It is thick, yellow and chock-full of protective antibodies.
There are three stages of milk production during the first week:
1st Stage Colostrum produced from birth to 3–4 days
2nd Stage Transitional milk from 3–4 days to 7+ days
3rd Stage Mature milk from 7+ days
Skin to skin
Put your naked baby (with or without nappy) against your bare chest or tummy and hold them close. Relax and enjoy your baby – you’ve been waiting for this moment. Skin-to-skin contact as soon as possible after birth is beneficial for babies, mums and dads – it is a very special feeling.
Skin to skin helps to stimulate your body’s production of breast milk and allows both parents to bond with their baby. Most hospitals encourage skin to skin and will help you do it for the first time as soon as your baby is born. It will help your Little One (I’ll refer to your baby as ‘LO’ throughout this book!) to feel comforted and secure.
Visualising holding your baby for the first time is a positive image many women use during labour to help them focus on the end result. You can go back to skin to skin over the weeks and months to come when your baby needs comforting – babies just adore it.
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Dads Can Do Skin to Skin Too
Skin to skin with Mum or Dad is great. Your LO will be comforted by familiar sounds from the womb like your heartbeat and breathing, and just love the warmth and the closeness.
Breastfeeding if your baby is in a special care baby unit
Some babies, due to complications or premature birth, need extra care in a neonatal unit from dedicated hospital staff. I know how this feels: my own baby, Amy, was seven weeks premature and weighed only 2 lb 11 oz and was in the incubator for five weeks. You may feel a mixture of anxiety, hope, love, fear and anger that this is happening to you and your baby. Many women find the separation from their baby overwhelming, and naturally so. Like any new mum, taking care of yourself will help you to give your child the love and care they need. In the days, weeks and months to come, it may be you can easily put it behind you, but some mums do find the experience can be difficult to shake off. (If you find you are still feeling anxious or low about the experience you had giving birth, have a look at Chapter 4, Being a New Mum Is Life Changing).
If your baby is in an incubator or needs special care, it is still possible to breastfeed. All babies benefit from breast milk, but poorly or premature babies really do – your milk will help give your Little One the nourishment they need. It might be that you need to express your breast milk rather than feed directly from the breast (have a look at the section on expressing breast milk later in this chapter). You may only be able to express a little milk during the first few days, but that precious colostrum is going to make a big difference to your baby and it is full of antibodies. Both you and the nursing and midwifery team may feed your baby through a tube until the baby is ready to feed independently at the breast.
As soon as a newborn baby shows they are ready to suckle and are more alert you should be able to start breastfeeding your baby whilst you’re in hospital. If you’re on a separate ward or have been discharged you can leave expressed breast milk for the times you won’t be there.
It is the skin-to-skin contact that will help stimulate the milk supply and give you the opportunity to have some one-to-one time with your Little One. Enjoy those cuddles and remember, the more contact you have, the better. It’ll help you relax and become more familiar with each other, and will get your baby demanding and you supplying breast milk.
It’s likely you will be offered professional help to get you started with breastfeeding, but this is no reflection on you – breastfeeding in these circumstances is challenging. Getting the right support, whether that’s from the nursing and midwifery team, family or friends, will make a big difference – you are not alone, take it one step at a time.
How breastfeeding supports attachment between mother and baby
The touch of your skin your baby experiences during breastfeeding, the sound of your breath and heartbeat all contribute towards the development of a very strong bond between mother and child. Breastfeeding mums have to put their baby at the centre of their lives. You cannot leave your baby for long peri-ods of time if you are breastfeeding, so, without giving it much conscious thought, you will naturally be tuning in to the rhythm of your baby, instinctively putting their needs first and doing all the elementary things that help to build strong attachment. You’ll be enjoying the looks, smiles and little touches your baby only gives you whilst you’re nursing. You’ll hear their first coos and gurgles and have plenty of opportunity to talk, sing to and cuddle your baby. All of this will help your Little One to feel loved and secure, because the foundation of attachment is laid down from the earliest days of your baby’s life.
Developing your latching technique
During the first week, when the milk comes in, sometimes women experience a toe-curling sensation for the first few seconds as the baby latches on (but this won’t last much beyond the first week). This sensation varies from woman to woman – for some it’s a small sharp shock, for others it’s akin to plucking your eyebrows, and then there are those fortunate mums who don’t feel a thing.
As long as your baby is properly attached, any discomfort should last for only a few moments. If pain persists during the feed, I’d suggest talking to a health professional about latching on and positions, to find a solution that’s going to be right for you.
Start by supporting your baby’s head, shoulders, neck and back. Tilt your baby’s head back safely to bring them up towards the breast. Your baby needs to have a big open mouth and be brought up towards the nipple from underneath the breast to enable them to latch on.
You need to get the whole areola (the dark circle surrounding the nipple) or nearly all of it into the baby’s mouth to ensure good attachment. Your baby’s nose should be in line with your nipple, with their chin touching your breast, keeping the baby’s nose clear so as not to obstruct breathing.
For most women breastfeeding is a big challenge, though a very rewarding one. It is demanding both in the time it takes and in the levels of energy it uses. There will be the occasional woman who never has a day’s difficulty, but most women have issues at some point – but all problems have solutions and you’ll be so pleased you kept on going.
I always say that every day you breastfeed is a massive achievement, so just take it one day at a time. Using a relaxation technique that might have helped you in labour could help you get through those first few uncomfortable seconds. Just do what feels right for you.
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Getting Your LO to Open Wide
Brush your baby’s top lip and/or cheek with your nipple. This makes them open nice and wide for the whole areola.
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Keeping the Nose Free
Help to keep the nose clear from the breast by drawing your baby’s hips and bottom towards you at a slightly tilted angle. LO’s body will be in a straight line but the head is tilted up towards you so you can look into their eyes.
The Latching Technique
1 Get the baby’s body in a straight line and lift the baby up to the breast from below.
2 Line up your baby’s nose to the nipple.
3 Get as much of the dark nipple area as possible into the baby’s mouth, still keeping the nose clear.
Top three secrets of breastfeeding
The secrets of getting breastfeeding off to a flying start – remember the three Ps: Position, Patience and Perseverance.
1. Get in a comfortable position
Many babies thrash about, moving from side to side, missing the nipple completely and getting very annoyed. This is perfectly normal and no failing on your part; just be patient and keep on trying. If you watch any baby animal feeding for the first time on nature programmes, they always do this, pummelling and bumping into their mum. This is nature’s way of helping the milk let down so you produce more milk. It is supply and demand – and it can be difficult to believe just how much milk a newborn baby demands. The more the baby suckles, the more milk you will produce, and you’ll notice they often place a little hand on your breast or tap it; they are instinctively doing this to let the milk down.
Mastering the technique of breastfeeding is simply getting into the right position so your baby can swallow easily. That’s why having the baby in a straight line enables them to do this. Two positions most mothers use are the cradle and cross-cradle (using either one or two arms for support) and the side-lying position (really useful for those night-time feeds).
Positioning is really important, as if the baby sucks on the end of the nipple it becomes sore very quickly. That’s no fun for baby or mum, as they won’t get the feed they need and you will be in pain and find your levels of tiredness and frustration escalate very quickly. (If this does happen, all is not lost; later on in this chapter we’ll look at coping strategies if you experience problems, allowing you time to heal, give the baby their feed, and get things back on track. You can also look up problems quickly in the A–Z section.)
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Get Comfy
Feeding takes time, so make the most of it. Get yourself set up with a drink, a snack, the remote control, and your phone or an eBook all within reach. Place one comfy cushion behind your back, and a cushion to support the baby as well if you want to, and put your feet up – when else will you get the chance!
Happy Baby Breastfeeding Positions
Cradle or cross-cradle Place the baby’s head in the crook of the supporting arm and hold the baby across your body with either the same arm or both arms.
Side-lying Support the baby’s head in the crook of the arm on your side, resting the baby’s body against your upper body.
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Avoid Sore Nipples
It can feel like a bit of an extra faff, but using a nipple gel helps to keep your in-demand nipples supple and stops soreness – prevention is better than cure!
2. Be patient; it takes time
Nearly all babies (and many mums) have some frustration when starting to feed. Women are often disappointed or reproach themselves if they don’t take to breastfeeding instantly, and think they are doing something wrong. I’ve heard many a woman say, ‘They never said it was going to be difficult in the antenatal classes. What am I doing wrong?’ You are doing nothing wrong, you are giving your all, and the fact you are breastfeeding is amazing. Focus on getting yourself something to eat, a wash and your head down for a nap when you can, because there won’t be time for anything else in the early days. If you’d never used a computer or played an instrument, no one would expect you to do it perfectly on the first day, not even in the first week.
Also let’s not forget your body has just done some-thing miraculous – you’ve given birth! You’re tired and life is never going to be the same again – emotions run high – one minute you’ll feel on top of the world and the next you can feel like you want to run in the bathroom and lock the door for 5 minutes’ peace. Staying calm, taking a deep breath and taking your time to get into the right position are what’s needed.
You both need support and the opportunity to get used to feeding, and in the early days it takes a lot of concentration and energy. I’ve known women who’ve needed complete silence and have banned the television being on whilst learning to breastfeed, or others who have needed the TV or radio on to distract them and help pass the time. Some women find at first they can only feed in bed and don’t want lots of clothes getting in the way; others like to rest the baby on a pillow in their laps; some want to be lying down – just do whatever feels right for you.
Be patient with yourself and your baby, and be flexible, as your baby’s needs and your ability to interpret those needs will change and develop with each feed. Each day you feed, you’ll grow in confidence, improve your technique and find a range of different positions and methods that work for you. Soon you will be able to pop them on whenever and wherever you need to with ease. Even when you’re proficient at breastfeeding, everyone has the odd difficult day; when that happens put it behind you and remind yourself how much you’ve achieved and take it one feed at a time.
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Breathe ...
Just before you put your baby on the breast, take a deep breath in and breathe out slowly and evenly. Count to ten, drop your shoulders away from your ears and relax.
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One Day at a Time
Say to yourself, ‘Each day I breastfeed is a great achievement and I’m doing something very special for my baby.’ Keep on adding an extra day and before you know it you’ll have been breastfeeding for weeks and then months.
3. Persevere: take it a one feed at a time
Babies can be very demanding and all-consuming. In the early days when you’ve had hardly any sleep, you’ve got sore nipples and you can’t remember the last time you washed your hair, it does require great determination and perseverance to keep on going with breastfeeding – but it does get better, and you’ll feel such a strong bond with your baby for doing it.
The support network you have can really make all the difference in helping you to keep on breastfeeding for as long as you want to. It may only be you that can feed the baby, but your partner and family have a big supportive role to play here, too.
It’s important to ask for help and support; if you are talking to a health professional never feel that a question is silly or insignificant – it’s not. In some areas other mothers who are breastfeeding or have recently breastfed their babies offer mum-to-mum support. This gives you the opportunity to get help, tips and encouragement from other mums who’ve had similar experiences. It can be really good to find out about nice cafés and places to go where women enjoy breastfeeding their babies, because you won’t want to stay at home forever, and it’s important you find places where you feel comfortable. Breastfeeding in public can be a very liberating experience – it is what breasts are for, after all!
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It’s Good to Talk
A problem shared really can be a problem halved. Whether it’s with a professional, your mum, your sister, your partner or a friend who is going through the same thing ... breastfeeding is not without its drama days, and it’s nice to know you’re not the only one.
I remember when ... I first worked in rural Kent getting a desperate call from a mum late one Christmas Eve. She was near to giving up breastfeeding her newborn baby, and there was no way I was going to make her wait for help until after Boxing Day. It was getting dark and I made my way through the snow down the country lanes in my trusty Mini to see her. When I got there I saw straight away that she had a very long baby who was also a very cross baby who needed more breast milk to satisfy his mighty appetite. When I looked in his nappy he had a light green poo that only stained his terry towelling nappy. We both knew he needed more milk. I sat down with his mum and together we calmly revisited latching on and how to calm him; we talked about and tried to find a good feeding position for her, and I told her about the ways you can tell if your baby is getting enough milk. This lovely mum also needed a little TLC herself; she was rushed off her feet and needed to take a little time to eat and drink while I had a cuddle with the baby. I was with them for a couple of hours, and when I got back to my Mini I realised I’d left the headlights on and the battery was flat. Now, the snow was falling heavily and I was miles from home. I walked to the telephone box to call out the local mechanic, trying to work out how I was going to pay the bill. He came out on Christmas Eve and got my little Mini going, and when I asked him how much, he said, ‘No charge, Nurse.’ I learned that day that patience and perseverance are just what mums and newly qualified health visitors need to get them through. I’ll never forget the kindness of that mechanic; he had the true spirit of Christmas.
Is my baby getting enough milk?
I don’t think I have ever met a breastfeeding mother who didn’t have some anxiety about whether her baby was getting enough milk, even when it feels like you are feeding non-stop. I have found there are three signs that tell you if a baby is getting enough milk, which I will talk you through in a moment.
I know it can be hard to believe that all your baby’s food and drink needs can be satisfied by breast milk – but for the first few months they really are. It is supply and demand; the more the baby suckles, the more milk is produced, and this is why your Little One needs to feed so frequently. You’ll notice your appetite increases, too, and you need to eat well and drink lots of extra fluids to make that milk.
The three signs your baby is getting enough breast milk
1st sign: the sound your baby makes when feeding
When a baby is getting mouthfuls of feed and swallowing it sounds like gulping, there will be a glug, glug, glug noise as the milk goes down into their stomach, often with a siss, siss, siss sound as well.
When the baby latches on they will feed for a few minutes and then have a little rest and a breather whilst more milk travels down. After a couple of minutes’ rest, if you gently move your baby they will start up again and have some more. They may do this several times before they have finished on that breast. It’s like they are saying to you, ‘Not finished yet, Mum. A little more, please.’ They will do this four or five times before they allow you to finish on that side, and they will look sleepy – milk drunk, in fact.
If you think about the way you eat, generally we don’t take everything on our plate in one go. Sometimes you feel like a light lunch and other times you fancy a really big dinner, but you like to have a little pause in between your starter and your main course. You’ll find your baby will have different requirements with each feed; just tune in to them and they’ll soon show you the way.
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Test to See If the Breast Is Empty
Gently use your thumb and forefinger in a pressing-down motion on the nipple to see if there is any milk left.
Feeding from both sides
You’ll want your baby to empty the breast and get the lovely rich hind milk that comes down towards the end of the feed. Babies often know they have had the lot before you do, and start crying for more and getting very cross with the empty breast. You’ll soon learn when the breast is empty, although you may not feel any sensation as strong as you do when the breast feels full. It can be frustrating for your baby if they are sucking on an empty breast. Giving them the other side as well will keep your Little One topped up and give you a little more time in-between feeds, as the baby will be fuller for longer.
Some babies may have both sides at most of their feeds, others only when they are extra hungry like after a long sleep. Sometimes it seems like they can hardly wait five seconds while you switch them over from one breast to the other. If you’ve got a baby that usually just wants to feed, feed, feed with virtually no stopping, change their nappy at the start of the feed; if they are on the sleepy side, changing their nappy at ‘half time’ will wake them up a bit and stimulate their appetite for the other side, ensuring they get plenty of milk and a nice full tummy. Always start the next feed on the side they didn’t have or that you finished on.
2nd sign: understanding how your baby gains weight
A baby’s weight is individual to that baby, and comparing it to another child is not an indicator of how well they are doing – you wouldn’t expect all adults to be the same height and weight. Understanding the weight gain that is right for and unique to your baby can be really helpful and put your mind at rest.
The weight your baby puts on will help you to tell if your baby is getting enough milk. If you’re in the UK, the midwife and then your health visitor will weigh the baby to monitor their growth, and chart it on what is called a percentile chart (usually referred to as ‘centiles’). These graphs are next to the weight pages in your Parent Held Record (The Red Book) and show how your baby is progressing along their own line.
It can be difficult to get your head round what the centiles mean. If you think about 100 babies born on the same day as your baby, they will be charted somewhere on the graph. Let’s say your Little One is on the ninth centile, which means 91 babies would weigh more and eight babies less than your baby. If your baby was born on the 50th centile, half of the 100 will weigh more and half less. It doesn’t matter where on the chart your baby starts; it’s the progress they make along their own line that matters, not what anyone else’s baby weighs. What you want to see is your baby progressing along their line or moving above it. If your baby started to drop significantly below their own centile line, you would want to get them checked and discuss why that may be happening.
Babies seem to have an inner clock that regulates how much they need to feed. Sometimes they feed very frequently and other times they can go longer and seem to be less frantic. It is amazing, but more often than not a baby follows their centile line perfectly (though if they are poorly they might deviate from their usual rate of growth until they get better). It is always good to see their progress and to act on anything that is not expected.
Your health visitor should monitor their progress with you, so keep an eye on it but don’t worry about small fluctuations. If you do have any concerns about weight gain, seek help from your health visitor or doctor. Get your baby’s weight checked at clinic every two weeks until you are happy with their weight gain, and then go every three to four weeks just to get it checked if you want to.
The minimum weight you would expect a breastfed baby to gain in a week would be 3–4 oz/90–120 g. Your baby may gain a lot more than this, and some babies put on 8 oz/250 g in just over a week. This is just a very rough guide, and if your baby is feeding well and having lots of wet and dirty nappies, and is content as well as looking well and active, they will be putting on the weight they need in nearly all cases.
So many women have told me they feel under pressure when their baby is losing weight in the first week. This is often due to the passing of meconium stools (the blackish first stools the baby passes after birth) and because your baby has not started to gain weight yet. If your Little One is on the large side you may find it will take them longer to regain their birth weight.
Most babies will lose some weight because they suddenly have to work very hard to get their grub; when they were a foetus, life was so easy and comfortable. Now they’ve got feeding, pooing and producing lots of wind to do, all of which requires a lot of effort on their part – it’s no wonder they get grumpy.
How much your baby weighs can be a great source of anxiety for some mothers; it seems to be the one question people keep asking, often followed by, ‘That’s not much,’ or ‘What a whopper. What are you feeding them?’ The pressure for babies to gain weight from family and friends can seem to dominate those early visits, but it is only one indicator of how well a baby is feeding. For instance, long babies or very active babies might put less weight on. Both small and big babies get a lot of weight-related comments, and mums sometimes feel that their Little One doesn’t weigh enough or needs to lose weight.
If your baby is still having lots of wet and dirty nappies and is feeding well and is content, it is fine to let them go at their own pace – they’ll gain in the time that is right for them, and sometimes it is unreasonable to expect them to do this in the immediate postnatal period. Some babies take up to two weeks to regain their birth weight, but if your baby is not keen to suckle and not feeding well, then get them checked at the doctor’s in case jaundice is making your baby sleepy and is affecting their intake of milk.
Mostly, with perseverance and patience they will start to put weight on – then keeping pace with their appetite will be your next challenge! Don’t forget: if they are weighed with a full tummy, having just fed and not having pooed yet, they will weigh a little more than a baby who has filled their nappy and is waiting for a feed.
3rd sign: lots of dirty nappies
Well-fed babies produce lots of dirty nappies. Monitor the frequency, quantity and colour of nappies – if lots of brimming mustard-coloured nappies are coming your way, you can be confident that your baby is getting enough to eat.
The first poos a baby does are the meconium stools which usually last for about three days or so. Usually on the third or fourth day this poo will change to a lighter colour with a more greenish look. Babies also get lots of wind passing through them at both ends. When your baby is past the fourth or fifth day they will do about two or more poos every day, usually just small amounts to start.
Your baby will wet and fill most nappies in the early weeks, and the stools are often very soft liquid and bright yellow like the colour of mustard. They can be frothy as well and shoot out onto the changing mat, all of which is normal (watch out for those exploding nappies!). Yellow poos tell us the baby is getting all the milk they need including the rich hind milk, which is responsible for that golden colour, and it is reassuring to know your baby is emptying the breast to get it. So, changing lots of nappies is a good thing – I promise.
The number of dirty nappies is important because if your baby weren’t getting enough milk you’d notice a light green stool that would only stain the nappy, as there wouldn’t be enough poo to fill it up. To get a baby back on track, more frequent feeds are needed – and if they were only taking one side, now is the time to ensure your baby feeds from both breasts at most feeds.
Darker grey/green with yellow poos do sometimes occur when the baby is a bit older – this is not a problem. The poo looks a bit mixed, somewhere between green and yellow, and can resemble little grains like rice. Some mums say this looks like tiny leaves. This poo is not a hunger stool and is fine.
Change Bag Essentials
Nipple gel
Breastfeeding pads
Shawl
Bottle of water for you
Travel pillow
Muslin
Nappies
Wipes
Nappy bags
Spare set of baby clothes
Older babies often poo less
In the early days there is an endless stream of dirty nappies, but as your baby gets older you may notice they don’t do as many poos in a day, and then just poo every other day. It can often be they do three to five dirty nappies a day for a few weeks, then it goes down to two or three a day, and by 12–14 weeks some babies only do one dirty nappy a day, or even go several days without one (though some babies will always do several poos a day – just to keep you on your toes).
At this stage if there are still lots of wet nappies to change, you’ll know everything is normal and your baby is being very efficient with the digestion of the milk and making fewer waste products. It may seem alarming that a baby does this, but it is normal in a fully breastfed baby before they are weaned onto solid foods.
This often happens from 10–12 weeks and in other babies at 16–20 weeks. Just be prepared that when they don’t go for a little while, when they go, they really go! If you are out and about, have plenty of spare nappies, wipes and a clean set of clothes – nearly all mums experience their baby’s poo explosion just at the most inconvenient moment. Every baby should produce lots of wet nappies a day – if your Little One does not have several wet nappies, or if the wee looks dark, do go and see your doctor or a health professional to see if there is a problem.
How often should I feed my baby?
This is another question new mums have a lot of anxiety over, and understandably so. The health and well-being of your baby is a big responsibility, and you want to feel confident about the choices you make about how best to care for your baby. Getting the feeding right is where it all starts, so it’s good you are asking yourself this question – now here’s the information you need to put your mind at rest that you are doing a great job.
It is normal for a newborn baby to feed every two to three hours (timing it from when you started the feed, not when you finished it). Your new baby’s little stomach is the same size as their clenched fist, so they can only comfortably hold a small amount of milk in their tummy and then they will be ready for more – they really do need to feed that often.
Your baby is driven by an inner clock that demands food and cannot wait – they will scream, suck their fingers and work themselves up into a frenzy when they get hungry. All the while you have to get yourself a drink, go to the loo and get ready to feed again. Understandably it can be difficult to feel relaxed, but do take those few minutes you need to get ready before you start the feed, and then you’ll be in a better position to feed your baby for as long as they want and as often as they want. If your baby is crying while you are getting ready to feed, ask your partner, a relative or a friend to help calm the baby using the Up-Down Technique (see Chapter 3, Sleep, Calming and Creating Your Own Routine). The calmer the baby is, the more likely they are to latch on with ease.
The gap between feeds will get longer as the weeks and months go by, and your baby will become more efficient at getting the milk they need. It can be helpful for you and your family to acknowledge to yourselves that your baby cannot practise patience but you all can. When your baby gets upset it is not that they don’t like you or you are not doing a good job – just that your Little One can only focus on getting their own needs met and isn’t aware that you need to eat, drink, wash and sleep as well.
This demanding time is temporary, and in retrospect you’ll feel like it went by in a flash, though at the time when you are sleep-deprived and exhausted it may not feel that way. That’s why reminding yourself regularly of all you’ve achieved – bringing your baby into the world and sustaining them completely by the milk you give them is simply amazing. Recognising the wonderful, positive things you are doing for your child and family will increase your ability to cope and increase your own sense of well-being. It’ll be even better if your partner, family and friends tell you what a great mum you are, too (hint, hint).
As time goes by your confidence in your ability to interpret your baby’s needs will grow. As you get more practice at caring for your baby it will become a little easier day by day, and you’ll feel less anxious about getting things right and be more able to go with the flow. I believe knowing what to expect and shaping your day around the needs of your baby is a really good thing. You may hear people talk a lot about routines – though in my experience tiny babies do not have a strict routine, they don’t follow a timetable. After all, each child is unique – and though there are definitely general practices we can follow, they have to be shaped around that child and their family.
You will probably start to notice patterns developing and have a mini-routine going for about a week, and then things will change again (have a look at the adaptable mini-routines in Chapter 3). Many mothers find that a baby does not behave exactly the same two days in a row, so I think the secret to success is anticipating your baby’s needs but having enough flexibility to enjoy each day with your baby. Having too strict a structure can make mothers feel trapped, and that’s not good for them or their Little One.
Nap times and feed times will vary, but you can exercise influence over your day. You and your baby will develop a rhythm that helps you read them more easily so you can pick up on the cues that tell you they’re getting tired or hungry, and act on them before things escalate and tears appear. This is your baby and your life, so do what works for you. As long as your baby’s needs are met, all will be well.
Is it normal for me to be this hungry?
If you are breastfeeding, yes it is! You are very likely to have a much bigger appetite than usual when you start breastfeeding – you do need to eat (you can’t breastfeed a baby successfully on a salad and a crispbread). Many women crave carbohydrates, chocolate and sweet things because you need a good intake of carbohydrates to make that milk. You’ll want to balance this out with a good helping of protein-rich foods and adequate fats, plus plenty of fruits and vegetables each day.
In order to make rich, plentiful breast milk, eat at least three portions of carbohydrate a day. Healthy choices are cereals, oats, bread, potatoes, rice and pasta – they are all a good source of carbohydrate as part of a balanced diet.
Never try to diet when breastfeeding, as you need your calories from a wide range of foods for nutrients (particularly no-carb or very low-carb regimes are no good for milk production). This is because breast milk has a high proportion of carbohydrate (if your milk leaks you’ll see that when it dries it starches your clothing, which shows the sugar levels in the breast milk made by a good intake of carbohydrate).
Eat the foods you want and like, and only avoid foods if you think they are upsetting you or the baby. Tastes do change during pregnancy and during breastfeeding, so it may be you can no longer stomach that old favourite but you are craving things you didn’t like before. Many women find they can’t eat certain foods whilst breastfeeding, and if you notice your baby is very grumpy and difficult to settle or satisfy all of a sudden, look back over the past 24 hours to see if you’ve eaten or drunk something that might have disagreed with them. It may be that some foods that are high in fibre like bran or new potatoes, or too many fresh berries or fruit juice may upset the breast milk. It may also change your LO’s poos, but this can be difficult to detect as normal poo is runny and explosive anyway.
I remember when ... my daughter Amy had just had her baby and I was staying with them to help out for the first couple of weeks. Baby Ava would feed all night long, and I used to bring Amy tea and toast in the middle of the night as it was feed, feed, feed and she needed to eat and drink enough to keep on going. I would often sit up and chat and laugh with her till the sun came up to help Amy make it through those long nights, and then once the baby had finally had enough (at about breakfast time) I used to make Amy some breakfast, and then look after the baby while she got a few hours’ much-needed sleep.
Solutions to common breastfeeding problems
Sore nipples
Having sore or painful nipples is probably the most frequently experienced problem women have when breastfeeding. In the first week it can be the result of your baby first learning to feed and your milk coming in, and it can be a toe-curling experience.
When your baby first starts to suck it may be painful for the first few seconds. If the pain persists, check the position of your baby – they may be sucking on the end of the nipple and not getting the big mouthful of breast they get when correctly attached (revisit the Latching Technique section at the beginning of this chapter). If this happens, slip your little finger in at the corner of their mouth and break the suction. Adjust your position and try using a pillow if you want to (even if you are out and about, there are little travel cushions you can slip into the change bag to make life easier when feeding in public). Raise the baby up and bring them up to the breast. Check they are nose to nipple and ensure they have an open mouth coming from below the breast to latch on, getting as much of the brown area of the nipple into their mouth as possible and having a good seal, not a ‘gappy’ one, and keeping the nose clear from obstruction.
When they have finished, squeeze out some hind milk and gently rub it into the nipple to help soothe and protect it. Using breastfeeding gels before and after feeding may also help make you more comfortable. Also, don’t over-wash the breasts as this may actually be a cause of soreness.
Trust Yourself
Aching Back? Maybe You Need a Bigger Bra
The size of your breasts increases as the milk comes in, and many women go up several cup sizes. Having an ill-fitting bra can cause backache. A loose-fitting bra to begin with for your hospital bag and wearing around the house is fine until you feel like a trip out to get properly fitted.
Cracked nipples
If your nipples are very sore and using expressed breast milk or gel is not sufficient, then you may need to get a prescription for cream to heal the nipples. Any cream you use will need to be washed off before feeding the baby so they are fiddly and more time-consuming than using gel or hind milk. But sometimes if you use a cream for just 24 hours and let plenty of air get to the breasts, the nipple will heal a lot faster.
If you are suffering, using a cream to heal faster is well worth the bother, and much better in the long run than feeding on a very sore breast. Apply the cream in a thick layer, then wipe off with damp cotton wool before you feed your baby. I know this can be a real pain during night feeds, but do make sure it’s all gone, as the baby should not ingest any of the cream.
While the nipple is healing you may want to breastfeed on only one side and express milk from the sore breast, just until it is comfortable to feed again.
If you are diagnosed with thrush, then not only will you need to finish any course of treatment to clear the infection but the baby will need to take oral medication as well (see also the A–Z section for more about thrush).
Blocked ducts
You may notice a small tender lump in your breast that could indicate a blocked duct. Try massaging the breast or using the warmth from a covered hot water bottle or warmed pad to help to disperse it. You may find this works best if you gently massage the breast to unblock the duct while you are in the bath or shower. This is best done after a feed; a good feed will help to empty the affected breast and clear the blockage. If a blocked duct does not clear it may lead to mastitis, so ask your health visitor or doctor for further advice at the earliest opportunity.
Mastitis
Mastitis can be a mild or severe inflammation of the breast and sometimes can cause fever and vomiting. If the breasts are painful and swollen and/or hot and red, you may have mastitis. Seek medical advice as soon as you notice the symptoms, especially if you have flu-like symptoms and are feeling hot and cold with achy joints and feeling generally unwell. Your doctor may prescribe some antibiotics if the mastitis has become infected. Only take medication as instructed by your health practitioner.
Drink lots of fluids and try using warm packs, or sometimes an ice pack can help, or even a small quantity of frozen peas in a plastic bag wrapped in a clean towel (remember not to eat the peas later on, though you could label them and refreeze for medicinal use again).
Do keep feeding the baby if you can, and check the position for breastfeeding and how the baby latches on to ensure you’re going to be as comfortable as possible. (Revisit the Latching Techniques and positioning advice earlier in this chapter to double-check.)
Expressing breast milk (EBM)
You can express breast milk either by hand or by using a hand or electric pump so that your baby can get their milk from a sterilised bottle, cup or spoon rather than at the breast for a feed.
It is usually preferable to feed your baby at the breast and not to express milk in the early days but it may be something you want to do for a short time if you are experiencing sore nipples or you are separated from your baby. You may not be able to meet all your baby’s milk needs through EBM alone but it can be a useful supplement alongside breastfeeding or for babies who are in a special care baby unit.
Breastfeeding Shopping List
Breast pads
Nipple gel or cream
Freezer bags
Steriliser
Breast pump
Bottles
Bottle brush
Nipple shields
Breastfeeding tops, dresses, cardigans
A shawl
Feeding pillow
Muslin
Breastfed babies need to get milk from both breasts as often as possible to establish and increase the supply of breast milk with frequent sucking. It is very unlikely that a mother can express the same amount of milk for her baby that feeding at the breast delivers, so unless there are special circumstances, like the baby being in a special care unit, I would advise that you feed from the breasts for the first two weeks or so to get the milk supply established.
If a baby is premature or poorly and is in a special care unit, a mum has no other choice than to use EBM if they are not allowed to put the baby to the breast. Whatever your circumstances are, expressing breast milk is hard work. It often gives you flexibility, but some women find it draining, and you will need even more sustenance to both express and also breastfeed.
EBM can be really handy to have in the fridge when your baby is demanding huge amounts of milk in the night; giving your breasts a rest, and if your partner takes over it’ll give you a rest, too. Expressing milk does mean extra washing and sterilising of bottles and equipment (this is often a good job for your partner to take on; have a look at Chapter 2 to find out how to sterilise bottles and equipment). Many mums find that expressing after a feed works best. This milk can either be chilled in the fridge for up to 48 hours or frozen for up to three months for later use.
Pumps can be bought at the pharmacy, and some breastfeeding organisations lend out pumps, usually for a small charge, as electric pumps are expensive.
There are many pumps on the market but the important thing to remember is that they must be sterilised before each use and you will need to follow the instructions for correct assembly and usage. This is a job your partner could take responsibility for, as the pump needs to be ‘built’ before each use, and it is much better to be handed the pump sterilised, assembled and ready to go. Even if you prefer to express whilst your partner is at work, they could always get it ready for you before they go in the morning.
Leaking milk
Leaking varies enormously for many women: some mums find a crying baby (not always their own) causes leaking and can’t leave the house without breast pads; other women have only a little leak now and then. Most women do need to use breast pads inserted in their bra to cope with leaking between feeds in the first months of breastfeeding, as this is when milk production is highest.
When there have been some hours between feeds, leaking is often copious and the first feed of the morning may soak your clothes whilst you are feeding from the first side, so it can be helpful to insert a muslin (soft cotton) cloth into your nightdress or top to mop up the milk if you haven’t had the chance to put on your bra and a breast pad yet.
A little consolation for all this dampness is that you are producing lots of milk for your baby. You’ll find that when weaning starts and you start to reduce the number of times you feed a day you’ll leak less and may not need to wear breast pads any more.
Colic
You will be able to see if it is colic that is making your baby cry when they draw up their knees, arch their back or try to push themselves off your lap or out of your arms with their feet. Keeping a firm hold will keep them safe and secure. To calm them you may want to try the Up-Down Technique (see Chapter 3) to get them to stop crying – dads are usually great at this.
Try soothing your Little One: babies love sympathy. If you calmly tell them Mummy or Daddy is here and you know how hard it is, it will help focus your mind and give them comfort to get over the colic spasm quickly. It is hard for your baby when they have colic, as they don’t understand what this pain is, and they don’t know it will pass soon enough.
Colic, which literally means ‘pain’, is horrid for your baby and for you. Your Little One is experiencing the discomfort of digestion for the first time. Just picture all the rumblings in their tummy and the windy feeling as a brand-new gut has to digest all the nutrients from their milk. Their bodies are learning how to do this, and your baby’s problem is gas, not you. I know it’s horrible when they get beside themselves with colic, but your baby has no idea what is causing this pain and does not know when it will end. It comes as a bit of a shock for them after all those months of a carefree existence in the womb.
You can give your Little One some relief by staying calm and giving them lots of comfort; it may be you want to try some skin-to-skin contact so they can feel your warmth and hear your heartbeat.
There are products on the market to help relieve colic, and your doctor or health visitor can write you a prescription or you can get over-the-counter remedies from the pharmacist.
There are remedies you give to your baby before the feed which work by bringing all the little bubbles of wind together to help your baby to burp them up, and they may posset and vomit up a little milk as well which is to be expected with these products.
You can also use gripe water from the ages of six to eight weeks by giving a 2.5 ml spoon in 1 fl oz of cooled boiled water in a sterilised bottle. I usually say gripe water works best when your Little One is experiencing colic as it will help to bring up any wind if you give it to them 10–15 minutes before their feed, and make it more likely they’ll have an easier job finishing their milk.
What works for your baby may not be the same as for your friends’ babies, so keep an open mind and use only one product at a time. I have known mums who have been having such a hard time and are so desperate to find a remedy they’ve given all the products together, but not only would this mean you wouldn’t know which product worked for your baby, it would be unsafe as well. (See the A–Z section for further information.)
Posseting
Posseting is common in most babies and is an old-fashioned word that we use for babies who bring up little bits of vomit after feeding or sometimes even during a feed. It is normal for babies to posset because, as they burp, often some partly digested feed comes up. Many babies will be experiencing symptoms of colic as well as posseting from birth to six months, so it is no wonder it makes many parents feel anxious. Posseting is nothing to worry about unless you think it is affecting your baby’s weight gain and well-being.
You cannot stop your baby being sick but you can help them by feeding frequently (usually every two to three hours); raising the head end of their crib by placing a folded blanket or muslin underneath their mattress so your baby can rest in a more upright position; and giving your baby the opportunity to be on their tummy during regular supervised ‘Tummy Time’. Once they can sit up with support, being upright may help lessen their vomiting reflex. Once babies start to wean and are having solid food and spend more of their day in an upright position, most parents notice they posset less or not at all.
Reflux
A small number of babies have Gastro-Oesophageal Reflux Disease (GORD) when acid from the stomach leaks out and backs up into the oesophagus. Sometimes this is confused with posseting, which is very common in new babies who frequently posset or vomit up some of their milk feed during or after a feed. In babies, reflux occurs when the milk feed ‘flows back’ up the baby’s food pipe and is either projectile-vomited or, in the case of silent reflux, is regurgitated back up in the oesophagus and swallowed again.
Reflux requires a professional medical diagnosis and treatment as the acid reflux may cause inflammation of your baby’s food pipe and affect their weight gain. If you think your baby has reflux and are worried they are not gaining weight and are in pain and distress, ask for a referral to a paediatrician to investigate and treat if needed.
Tongue-tie
Tongue-tie is when the frenulum, a short string-like membrane under the tongue, is tightly attached to the floor of the mouth rather than loosely attached. If your baby has trouble sticking out their tongue and it doesn’t go past their gums, or pulls into a heart shape, they may be tongue-tied. If your baby latches on and feeds well, and is gaining weight, they may not need any treatment. However, if your baby finds latching difficult and is not feeding well, ask your health visitor or doctor about whether they think it would help to clip the frenulum.
Winding
Wind is a build-up of gases in the stomach. With all the feeding your baby does there is inevitably a lot of wind in their tummy which causes gripe pains. By winding and burping your baby you are helping them to bring up some of that gas so they feel more relaxed and happier. (Winding techniques are described in the A–Z section.)
Moving on from breastfeeding when the time is right for you
There is no perfect time to give up breastfeeding; it is simply when the time is right for you. Many mums will experience a moment that signifies breastfeeding is coming to an end. It may be for practical reasons like returning to work, or it may be when biting becomes a problem, or that weaning is so established your baby is not showing much interest in breast milk these days. Don’t worry about what your friends are doing; some women may only breastfeed for the first few weeks; others will go on until their child is one or over. Whatever you decide, your baby has benefited hugely from the nourishment and time you have given them.
How to manage giving up breastfeeding if your baby is 0–6 months
If in the early weeks of breastfeeding you feel you want to stop and completely switch to formula, do try and drop one feed at a time if you can, rather than suddenly stopping altogether, which makes it hard on you physically (you’ll experience engorgement) and your baby (who will need time to adjust to taking formula from a bottle).
You may want your partner or someone else to give the bottle to start with, as it can be confusing for your baby to smell the milk on you and taste the formula at the same time. Once they are used to it, most babies will happily take the bottle of formula from Mum and some won’t care who gives it to them just so long as they get their milk. Do whatever is right for you and your baby. (You’ll find some helpful advice on bottle feeding in the next chapter.)
Strategies for giving up breastfeeding if your baby is over 6 months old
For mums who want to switch to formula from six months, it is best to drop one feed at a time and replace with a bottle. Babies who are weaning still need regular milk feeds, but when you give them is trial and error. Often it is the middle feed of the day that is easiest to switch first of all from breast to bottle. Your Little One should be easily taking their bottle before you drop another breastfeed. When you are both ready, try replacing the mid-morning breastfeed with a bottle, and then the mid-afternoon or tea-time feed. Pick the feeds where it makes sense or feels right to give the bottle. I know mums who’ve dropped the tea-time feed first because that is when their partner gets home from work and they can give the bottle instead.
The last feeds to go are usually the early-morning feed and finally the last feed before bed.
How long you take to do this is up to you. It may be that for practical reasons such as returning to work it is something that has to be done over a few weeks. Alternatively, you may have the time to make a gradual change over months.
Dropping the breastfeeds one at a time sounds easy but it can be an emotional and challenging time for many women. You may have your own feeling of loss and even grief when switching to the bottle even if you have been expressing milk, or it might be a huge relief – there is no right or wrong way to feel. Giving up breastfeeding is a decision only you can make. Don’t put too much pressure on yourself and, if you can, go with the flow (no pun intended!). Look at the positives – you may find you have more energy, less of an appetite, or just a bit more time to yourself. Trust yourself; you love your baby more than anyone, so have confidence in your own skills and intuitive feelings, and you and your baby will settle into this new method and way of feeding. (For further advice on formula feeding or when to switch to cows’ milk, take a look at the next chapter.)
Trust Yourself Checklist
Here’s a few reminders for you to check off, so you can trust that you are doing everything you can to successfully breastfeed your baby.
Positioning – is the position you are using ensuring your baby is properly latched on and feeding for as long as they need?
Patience – are you setting aside time to feed where you feel comfortable and relaxed to help reduce frustration and anxiety?
Perseverance – are you taking it a day at a time, recognising the achievement of each day’s breastfeeding?
Are you aware of the three signs that your baby is getting enough milk?
