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TRANSCRIPT
Off to a good startALL YOU NEED TO KNOW ABOUT BREASTFEEDING YOUR BABY
01/19
View the online version here:
Acknowledgements
This booklet has been adapted from Health Scotland’s Off to a Good Start: all you need to know about breastfeeding, 2016. It reflects the views, comments and opinions of health professionals, breastfeeding counsellors, professional and voluntary organisations, and mothers, all of whose suggestions were receivedwith thanks.
Particular thanks to everyone who agreed to bephotographed and gave permission for theirphotographs to be used in this booklet.
© this version, Public Health Agency, 2018.Reproduced with kind permission from Off to a Good Start: all you need to know about breastfeeding © 2016.
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Contents
2 Introduction howthisbookletcanhelpyou
4 Thinking about breastfeeding whybreastfeedingisgoodforyouand yourbaby
12 How breastfeeding works onceyouknow,it’seasier!
15 Getting started atbirth positioningandattachment
21 How do you know breastfeeding is going well? buildingyourconfidence
24 How breastfeeding changes afterthefirstdaysandweeks
30 Expressing your milk ausefulskill
35 Breastfeeding and your baby in special care challengesandovercomingthem
38 Getting it right problemsandhowtoresolvethem
50 Breastfeeding and your life fittingitin,makingiteasy
“I love it when he falls asleep at my breast – it’s a lovely feeling of closeness.”Anne-Marie
56 Going back to work? youandyouroptions
59 Your questions about breastfeeding herearetheanswers!
63 Further information, support and sources of help
67 Glossary
69 Appendix checklist:howcanItellthat breastfeedingisgoingwell?
Inthisbooklet,babiesarereferredtoas‘he’.
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Introductionhow this booklet can help you
Anybreastfeeding,evenforashorttime,isbeneficialforyouandyourbaby.MoremothersinNorthernIrelandarechoosingtobreastfeed,andmoreofthemarecontinuingtodosoafterthefirstweeksandmonthsfollowingbirth.Havinggoodinformationabouthowbreastfeedingworkshelpsyougetofftoagoodstart,andtherightsortofsupporthelpsyoutokeepgoing.
Thisbookletwillhelpyouifyouhaven’tdecidedhowtofeedyourbabyandneedmoreinformation,or:
• ifyouhaveconcernsaboutbreastfeeding–maybeapreviousexperience withitwasdifficult,orperhapsyouknowsomeonewhohadproblems
• becauseknowingwhatliesaheadhelpsyoubeprepared
• ifyouthinkyoumightstartbreastfeeding,butyouaren’tsurehowlong you’lldoitfor.
Theinformationinthisbookletwillhelpyoutounderstandhowtobreastfeedsuccessfullyandhowyouandyourbabywillbenefitfromtheexperience.Youwilllearnhowyoucanincorporatebreastfeedingintoallaspectsofyourandyourfamily’slifeandhowtodealwithproblemsshouldtheyarise.Youwillalsodiscoverwheretofindadviceandsupportwheneveryouneedit.Sometermsinthisbookmaybenewtoyou,butyouwillfindmanyofthemexplainedintheglossaryonpage67.
Howyoufeedyourbabyisadecisiononlyyoucanmake.Ifyoudecidenottobreastfeed,oryoudecidetochangetoformulafeeding,youshouldcontinuetogetgoodsupportfromthehealthprofessionalswhoarecaringforyouandyourbaby.
“I had gone to a breastfeeding workshop in the
hospital when I was pregnant, and the advice was useful
when I was trying to position Mhari and get her latched on.”
Jackie
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You can find out more on the Baby Friendly Initiativewebsitewww.unicef.org.uk/babyfriendly
Supporting your choice to breastfeed
TheUNICEFUKBabyFriendlyInitiativehasdevelopedasetofstandardsformaternity,neonatal,healthvisitingandSureStartservicestoensureevidence-basedpracticetopromoteandsupportbreastfeeding,andtostrengthenmother-babyandfamilyrelationships.MaternityunitsandhealthcarefacilitiesinvolvedareassessedbyUNICEFandaredesignated‘Babyfriendly’oncetheyachieveandmaintainthesestandards.
AllmaternityunitsinNorthernIrelandhavebeendesignatedasBabyFriendly.Thismeansthatstaffwillexplaintoyouhowyoucanbreastfeedsuccessfully.Theywilldiscussthiswithyouwhenyouarestillpregnant,andalsowhileyouareinhospital.
YouwillalsofindinformationoninfantfeedingandyourdevelopingrelationshipwithyourbabyinthePregnancy Book.Ifyouhaven’treceivedaPregnancy Bookyetaskyourmidwifeforacopy.
YoucanalsoviewanddownloadthePregnancy Bookatwww.publichealth.hscni.net/publications/pregnancy-book-0
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Thinking about breastfeedingwhy breastfeeding is good for you and your baby
You’ll be given the chance to talk about feedingwhile you’re still pregnant, usually with a midwife,
health visitor or GP. If you’re unsure about breastfeeding, or if you have questions about how to make it a
happy experience for you and your baby, during pregnancy is a good time to ask.
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Thinking about breastfeedingwhy breastfeeding is good for you and your baby
You’ll be given the chance to talk about feedingwhile you’re still pregnant, usually with a midwife,
health visitor or GP. If you’re unsure about breastfeeding, or if you have questions about how to make it a
happy experience for you and your baby, during pregnancy is a good time to ask.
“I am so glad I did it. It is a great bond.”Lesley
Quitesimply,mother’smilkisthehealthierchoiceforyouandyourbaby.
Sowhenyoudecidetobreastfeed,you’regivingyourbabyawonderfulstartinlife.Studieshavecomparedthehealthofbreastfedbabieswiththatofbabiesfedonformulamilk.There’snowalargeamountofresearchthatshowsbeyonddoubtthatbreastfeedingbenefitsyourbabyinmanyways,andthebenefitslastintochildhoodandbeyond.Thegreatestbenefitsaretobegainedbyfeedingyourbabybreastmilkandnothingelseforthefirstsixmonthsoflife,andthencontinuingtobreastfeedafteryourbabystartstakingsolidfood.Butanyperiodofbreastfeedingatall,howevershort,willbenefityouandyourbaby.
Pages8and9showjusthowimportantyourbreastmilkisforyourbaby.It’susefultosharethisinformationwithothersinyourfamily,especiallyiftheideaofbreastfeedingisnewtothem,oriftheyfedtheirownchildrenwithformulamilk.
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Talking about breastfeeding
Inpregnancy,amidwifeormidwiveswilltalktoyouaboutbreastfeeding.They’llansweryourquestionsandexplainwhattoexpect.They’llalsodiscussthesepoints:
• the importance of skin-to-skin contact(seepage 16)afteryourbabyisborn.Thisisalovelywayfor youtogreetandgettoknowyourbabyandit:
– keepsyourbabycalm,warmandcomforted
– steadiesyourbaby’sheartbeatandbreathing
– releasesmotheringhormones
– helpsgetfeedingunderway.
• keeping your baby with you,whileyouarein thematernityunitand,later,whenyou’reat home.Thisisknownas‘roomingin’andit:
– helpsyouseewhenyourbabyisshowing yousignsheisreadytofeed
– buildsupyourconfidenceincaringforhim
– meetstheLullabyTrust’srecommendation thatyourbabyshouldshareyourroomfor atleastthefirstsixmonths(seepage54).
• responsive feedingisaboutrespondingto yourbaby’sfeedingcues(suchasrestlessness, stickingtongueout,suckingfingersand hands)andfeedingasoftenandaslongas babywants.Itmeansofferingyourbreastfor bothfoodandcomfortandit:
– makessureyourmilksupplyisgood
– allowsforfrequentfeeds,whicharenormal, andmeansyourbreastsarelesslikelyto getengorged.
• making sure your baby is correctly positioned and attached at the breast.Thismeans:
– you’relesslikelytogetsore
– yourbabygetsenoughmilk.
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• why it’s important to avoid the use of teats and dummies while you and your baby are learning to breastfeed, because:
– yourbabyneedstolearnhowtobreastfeed;using adummyorteatbeforefeedingisestablished mayconfusehimbecausethesucking actionisdifferent
– heneedstobreastfeedasoften ashewants,inordertoestablishthe milksupply.Usingadummymay reducethefrequencyofbreastfeeds anddecreasesthemilksupply.
• feeding breastmilk and nothing else for around six months,which:
– helpsyourbabygetthemaximum healthbenefitsfrombreastfeeding
– helpsprotectagainstinfections, allergiesanddiabetes.
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Breastmilk and formula: the difference
Breastmilkisverydifferentfromformula.Themaindifferencesareshownhere:
Formula
• Manufacturedfromcow’smilkandprocessedsothatitmeetsthebasicnutritionalneedsofadevelopingbaby.
• Doesnotcontaintheantibodies,livingcells,enzymesorhormones
foundinbreastmilk.• Doesnotcontaintheprotectivefactorsthatpromote
yourbaby’shealth.
• Yourbabywilltakemoreformulaashegrows,butitscompositionwon’tchangedaily,weeklyandmonthlytomeethisindividualneedsasbreastmilkdoes.
Breastmilk ingredients
Formula ingredients
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Breastmilkcontainsatleast34ingredientsnotfoundininfantformula.
Breastmilk
• Naturalandprovidesallthenourishmentyourbabyneeds.
• Whenyourbabyisborn,hisimmunesystemisnotfully developed.Breastmilkhelpsyourbabyfightinfections,such asearandchestinfectionsandtummyupsets.Weknowthat babieswhoarebreastfedarelesslikelytoneedtoseea doctorwiththeseillnesses.
• Provideslong-termhealthbenefitsforyourbaby,suchas alowerriskofdiabetesandobesity.
• Breastmilkisuniqueandproducedbyyoutomeetthe particularneedsofyourbaby;yourmilkchangesashegrows.
Help with growth and development
Help protect against infection
Promote immunity
Help ensure nutrients are absorbed
Help control how cells and organs do their work
Aid digestion and destroy bacteria
Promote a healthy gut
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SIDS
LowerriskofSuddenInfant
DeathSyndrome(cotdeath)
Great reasons to breastfeed
Thesenexttwopagesshowwhatweknowaboutbreastfeeding.Youcantakeitonedayatatimebutthelongeryoubreastfeedandthemorebreastmilkyourbabyreceives,thegreaterthebenefit.Tofindoutmoreabouthowspecialyourbreastmilkis,visitwww.breastfedbabies.organdwatchthevideoonthehomepage.
Good for you Breastfeedingisgoodforyourhealthaswellasyourbaby’s.Mumswhobreastfeedhavealowerriskofdevelopingbreastandovariancancer,andthelongerandmoreexclusivelyyoubreastfeedthebetteryourprotection.Breastfeedingmumsalsousemorecalories(around335perday)andthiscanhelpyouloseanyextraweightyouputonwhileyouwerepregnant.
Good for baby
Immunesystem
Protectsagainstinfectionandinflammation
Reducesthe risk of diabetes
Cancer
Reducesriskofchildhood
leukaemia
Healthy weight
Helpsababymaintainahealthyweightas
theygrowolder
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Ears
Fewerearinfections
Teeth
Lesslikelytoneedtreatmentfordentalproblems
Tummy
Helpsprotectagainstseriousinfectioninprematurebabies
Protectsagainsttummybugsandinfections
Lesslikelytobeadmittedtohospitalwithgastro-enteritis
Intelligence
Improvedintelligence–anaverageextra3IQpoints
Lungs
Lesslikelytobehospitalisedwithalowerrespiratoryinfectionwhentheyareolder
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How breastfeeding worksonce you know, it’s easier!
Your body assumes you’re going to breastfeed,so prepares for it, right from the start of
pregnancy. You are able to make all the milkyour baby needs – even if you have twins, or more.
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How breastfeeding worksonce you know, it’s easier!
Your body assumes you’re going to breastfeed,so prepares for it, right from the start of
pregnancy. You are able to make all the milkyour baby needs – even if you have twins, or more.
In pregnancy
Assoonasyoubecomepregnantyourmilk-producingcellsandmilk-collectingductsgetreadytoproducemilk.Thereisanincreaseinthebloodsupplytoyourbreastsaswell.This‘activity’insidesometimesmakesthebreastfeeltense,extrasensitiveandpossiblyslightlylargerinsize.Youmayneedalargerbra–it’sagoodideatogetproperlymeasuredtobesureofacomfortablefit.
• Fromaboutthesixthorseventhweekof pregnancyyoumaynoticesmallraised ‘spots’oneachareola(thedarkareasurroundingthe nipple).TheyarecalledMontgomery’stubercules,and theysecreteanoilysubstancethatkeepsyournipples andareolaesuppleandsoft.
• Fromthemiddleofyourpregnancyonwards,your breastsmakeconcentratedmilk(colostrum),whichis ahighlyvaluable,antibody-richfluid.Itisdesignedto meetyourbaby’snutritionalneedsforthefirstfew daysafterthebirthuntilthematuremilkisproduced.
Somewomenleakalittlebitofcolostruminpregnancy–ifthishappenstoyou,justwashoffanydriedcolostrumonyournippleswithplainwater.
ReproducedbykindpermissionoftheUNICEFUKBabyFriendlyInitiative.
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How you continue to make milk
Youcontinueproducingmilkonlyifitistakenfromthebreast.Normallythishappensasaresultofthebabyfeedingatthebreast,sowhenyourbabyisfeedingeffectivelyyoumakemilkinresponse,intheamountyourbabyneedsinordertothrive.
Youcanalsoencouragemilkproductionbyexpressingyourmilk(seepages31-34).Youmayneedtodothisifyourbabyisverysleepyandreluctanttofeedintheearlydays,orifheisunabletobreastfeeddirectlyfromyou,perhapsbecauseheispretermorill.
Ifyoudon’tbreastfeed,orexpress,yourmilkproductiongraduallystops.Itispossibletoproducemilkevenifyouhavebottle-fedforthefirstfewdaysorevenweeksafterbirth.Togetyourmilksupplygoing,youcanexpressorkeepputtingyourbabytothebreastfrequently.
After the birth
Everywomanmakesbreastmilkatfirst,whetherornotherbabyevercomestothebreast.
Thedeliveryoftheplacenta(afterbirth)setsupahormonalresponseinyourbody,andprolactin,thehormonewhichstimulatesmilkproduction,startsactingonthebreasts,‘telling’themtomakemilk.
Atsometimebetweendaytwoanddayfiveafterthebirth,yourbabyisreadyformoremilkandyourbreastsstartproducingmorebreastmilkinresponse.Youmayfeelyourbreastsarefullerandheavierthanusual.It’snotjustthemilkthatmakesthemfeellikethis;thereisagreatincreaseintheamountofbloodandfluidgoingtoyourbreastsatthistime.Youmaybeuncomfortableasaresultbutthisusuallypassesinadayorso(readmoreonpage40). Getting started
at birth
Positioning and attachment
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Getting startedat birth
Positioning and attachment
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Skin-to-skin contact at birth
Thefirsthourorsoafteryourbabyisbornisaveryspecialtime.Itisachanceforyoutosayhellotoyourbabyandtostarttobuildaclose,lovingrelationship.Evenifyouhaveacaesareansectionorareunabletohaveskin-to-skincontactimmediatelyafter,youcanstillhaveskin-to-skincontactwithyourbabyassoonasyouareable.
Holdingyourbabyskin-to-skinhelpstoregulatehistemperatureandbreathing.Itwillalsoreleasecalminghormones.Afteraperiodoftimethebabywillbegintoshowsignsofbeingreadytofeed(feedingcues)andthemidwifewilloffertohelpyoutoattachthebabyatthebreastforthefirstfeed.Usuallythebabywilltakelongerthan30minutestobereadytofeedbutthisvariesfrombabytobaby.Somewillbereadyearlierandsomewilltakemuchlonger,particularlyifyouhavehadpethidineordiamorphineinlabour.
Itisessentialthatskincontactstartsassoonaspossibleandisunhurriedandnotinterrupted,unlessyouoryourbabyrequiremedicalattention.
Skin-to-skin later
Ifyourbabyishavingdifficultyattachingtothebreastorissleepyandnotfeeding,skin-to-skincontactcanhelpgethiminterestedinfeeding.Ifheiscrying,skincontactcanhelpsootheadistressedbaby.
Skin-to-skin at birth-placebabyonyourtummy
withhisheadnexttoyourbreast
-gentlytouchandsoothehim
-leavehimthereuntilhehashisfirstfeed
-ifyoucan,letyourbabystayinskincontactforaslongaspossibleandideallyforthefirstsixhoursorsoafterthebirth.
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Positioning and attachment
Breastfeedingseemsnatural,butisactuallyalearnedskill.Manymothersandbabiesenjoytheexperience,butthatdoesn’tmeanit’salwayseasyforeveryone.Breastfeedinghastobelearnt,andyouandyourbabymayneedsomepracticetogetitright.
Thewayyourbabyispositionedandattachedtoyourbreastcanmakethedifferencebetweenahappy,comfortableandsuccessfulfeedandonewhichispainfulforyouandfrustratingforyourbaby.
Helping baby feed
RememberC-H-I-N(Close,Headfree,Inline,Nosetonipple)*:
• Bringyourbabyinclose to your bodysothathedoesn’thave tostretchtoreachyourbreast.
• Supporthisneck,shouldersandback(seephoto1).Make surehishead is freetobeabletotiltback.
• Checkhisheadandbodyare in a straight linefacingthe samewayashewillbeuncomfortableifheistwistedwhen feeding.
• Moveyourbabysothathestartsthefeedwithhisnose pointing to your nipple(seephoto2).Starting‘noseto nipple’likethisallowshimtoreachupandgetamouthfulof breastfromunderneathyournipple(seephoto3).
1
2
3
*CHINacronymdevelopedbyLynetteHarland,UniversityofTeeside.
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What you’ll see and feel: when your baby is feeding and how to know he is correctly attached
•Yourbabyhasalargemouthfulofbreast.
•Yourbaby’schinistouchingyourbreast.
•Feedingiscomfortableanddoesn’thurtyou(thefirst fewsucksmayfeelstrong).
•Ifyoucanseethedarkskinaroundyournipple,therewill bemoredarkskinaboveyourbaby’stoplipthanbelow yourbaby’sbottomlip.
•Yourbaby’scheeksarefullandroundwhilesucking.
•Yourbabytakeslongrhythmicsucksandswallows withpauses.
•Yourbabyfinishesthefeedandcomesoffhimself.
Feeding positions Thepreviouspicturesshowonecommonpositionforbreastfeedingbutthereareothers.Youcanfeedlyingdownwiththebaby’sbodyparallelto
yoursortuckthebaby’sbodyunderyourarm(the‘rugbyhold’).Trydifferentoptionstoseewhichyoufindmostcomfortable.Theprocessforattachingisalwaysthesamethough.
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Remember:
• yourbabyshouldn’thavetotwist,turnorflexhis head
• supportyourbreastfromunderneathwithyour handifyouneedto,butbecarefulnottoputyour fingerstoonearthenippleorareola–youcould preventyourbabyattachingwell
• it’s‘babytobreast’not‘breasttobaby’–trynot toholdyourbreastupand‘post’yournippleinto yourbaby’smouthasitcanbedifficulttomaintain thatposition
• trynottopushyourbaby’sheadontoyourbreast –thiscanfrightensomebabiesandputthemoff thewholeidea.
Atfirstyoumayfindbreastfeedinguncomfortablewhenyourbabylatchesonandbeginstofeed.Thisdiscomfortshouldn’tlastthroughthewholefeed.Afterthefirstfewdays,breastfeedingshouldn’thurt–thisincludespaininyournipples,backorshoulders.Ifyoudofeelpain,youmayneedhelptogetintoamorenaturalpositionforfeeding.
Usingapillowtosupportyourbabycanhelpwiththeveryearlyfeeds,butyouhavetofindoutwhatworksforyou.Ifyouwanttouseapillow,checkthatitdoesn’traiseyourbabyuptoohigh,makingitharderforhimtolatchon.
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Let-down reflex
Thereflexisstimulatedbythebabyfeedingatthebreast.Thehormoneoxytocinisreleasedintothebloodstreamcausingthetinymusclessurroundingthemilk-producingcellstocontract,pushingthemilkdownintothemilk-collectingducts(seediagramonpage13).
Thereflexensuresthatasatisfyingfeedisavailabletoyourbaby.Somemothersareawareofthereflexasa‘drawing’feelingwithinthebreast;othermothersarebarelyawareofit.Somemothersmayonlynoticemorerapiddrippingofmilkfromtheoppositebreastoncethebabybeginstofeed.
Theamountofmilkyoumakedependsonhowoftenandhowwellyoufeedyourbabyorexpressmilkoff.Theamountofmilkyoumakewillbelessif:
• yourbabydoesn’tfeedeffectively (perhapsbecauseheisn’twell-attachedor well-positionedatthebreast)
• youtrytobreastfeedlessoftenandmakefeeds shorter,mostbabiesneedtofeedatleast8-12 timesadayandsomefeedscanbeshort(about 5minutesorso)andotherswillbelonger(40 minutesorso)
• yourbabygetsabottleofformulamilkwhich fillshistummyupandthenhemaynotbe interestedinabreastfeed,inwhichcaseyour bodygetsthemessagethatlessmilkisneeded andproducesless
• youareseparatedfromyourbabyanddon’t startexpressingbreastmilk.
Intime,ifyoudon’tbreastfeedorexpressmilkfrequently,themilksupplydwindlesaway.Youcanseethis‘inaction’whenamotherchoosesnottobreastfeed.Hermilkwill‘comein’betweendaystwoandfive,andthenoveraperiodofdays(andsometimesafewweeks)itwillgo,andherbreastswillstopmakingmilk.
Youdon’tneedtoemptythebreastsateachfeed–that’salmostimpossibleanyway.Justensuringthatyourbreastmilkisremovedfrequentlybyfeedingorexpressinghelpsyourbodytocontinuemakingmilk.
Making enough milk How do you knowbreastfeeding is going well?
building your confidence
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How do you knowbreastfeeding is going well?
building your confidence
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You and your baby are doing fine if:
1 yourbabyappearscontentandsatisfiedaftermostfeeds
2 yourbabymanagestoattachtothebreastwithoutafussat mostfeeds
3 yourbabyishealthy,andgainingweightsatisfactorily
4 youfeelconfident,andyourbreastsandnipplesaren’tsore
5ondays one and twoyourbabywillhavetwoormorewet nappiesandoneormoredirtynappiesofmeconium(thefirst darkblackpoo).Manybabiespass‘urates’,adarkpink/red substance,inthefirstcoupleofdays.Thisisnotaproblemat thisstagebutifyourbabycontinuestopassuratesbeyond thefirstcoupleofdaysyoushouldtellyourmidwifeasthis maybeasignthatyourbabyisnotgettingenoughmilk.
Withthelatestdisposablenappiesitmaybehardtotellif theyarewet,sotogetanideaifthereisenoughurine,takea freshnappyandaddtwotofourtablespoonsofwater.This willgiveyouanideaofhowheavyanappyshouldbe.
6 ondays three and fourexpectthreeormorewetnappiesand twoormoredirtygreennappies
7 afterday fiveyourbabyshouldhaveatleastsixheavywet nappies.Bydays five and sixyouwillseeasoftyellowstoolat leastonetothreeormoretimeseveryday(seethepicture foracolourguide).
8 bydays10-14yourbabyshouldpassfrequentsoftrunny yellowstoolseverydaywithtwostoolsaweekbeingthe minimumyouwouldexpect.
DAY 2-3
DAY 1 DAY 4COLOUR CHART
Guideforababy’sstoolsforthefirstfewdays.
Use as a guide only
Longfeedsintheeveningareverycommon–manybabiesneedextracomfortingandattentionintheevenings,butthatgoesforformula-fedbabiesaswell.
Ifyouaretakingyourbabyoffyourbreast,insertyourfingerintothecornerofhismouthtobreakthesuctionfirst.
One side or both?
Followwhatyourbabywantswhenitcomestoofferingoneorbothbreasts.Therearenorules.Somebabieswantbothbreastsateachfeed,andyoucanofferthesecondwhenyourbabyseemstotakeanaturalbreakafterthefirst.Ifhedoesn’twantit,that’sfine;justofferthe‘unused’breastatthenextfeed.Somebabiesliketochangefromsidetosideduringbreastfeeding.Yourbreastmilkchangesduringthecourseofafeed,butaslongasyoualwaysletthebabydecidewhenhe’shadenough,hewillgetwhatheneeds.Afterawhileyouwillbecomeveryskilledatknowingwhatyourbabyis‘telling’you.
How do I know how long my babyneeds at any single feed?
Itreallydoesn’tmatterthatyoucan’tseeexactlyhowmuchyourbabyhashadatanyonefeed.Infactsomeresearchsuggeststhatthisisagoodthingasitallowsthebabytotakejustwhathewantsorneeds,helpinghimtoestablishhisownappetitecontrol.Thiscouldbeimportantinavoidingobesitylateron.
Sometimes,it’seasytotellyourbabyhashadenough.Hestopssucking,comesoffthebreastbyhimself,andliesinyourarmsinadeep,contentedsleep.Atothertimes,youmaynotgetsuchclearsigns.Somebabiesappeartohavefinished,andthentheyshowsignsofwantingmore.Othersstayatthebreast,happilysucking,offandonforalongtime.Intime,youlearnwhenyoucantakeyourbabyoffwithouthimobjecting.
Youwillgraduallygetbetteratknowingwhatyourbabywants.Somebabies,especiallyolderones,takewhattheyneedatsomefeedsinjustafewminutes. 23
9 After4-6weekswhenbreastfeedingismore establishedthismaychangewithsomebabies goingafewdaysormorewithoutstooling. Breastfedonlybabiesdon’tusuallybecome constipatedandwhentheydopassastoolitwill stillbesoft,yellowandabundant.
See also page 70 for a checklist of how to tell if breastfeeding is going well.
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How breastfeeding changesafter the first days and weeks
The early weeks often mean frequent feeds, with no set
pattern, but this is normal and it’s the way
breastfeeding becomes established.
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How breastfeeding changesafter the first days and weeks
The early weeks often mean frequent feeds, with no set
pattern, but this is normal and it’s the way
breastfeeding becomes established.
What you might expect – day by day
Ifthisisyourfirstbabyoryouhaven’tbreastfedbefore,youmightnotknowwhattoexpectinthefirstdaysandweeks.Theinformationonthefollowingfewpagescomesfromrealmums’experiencesandwillgiveyousomepointersthatmighthelp.
Remember,though,thatallmumsandbabiesaredifferent.Someofthethingsmentionedmayhappenonadifferentdayormaynothappenatall!
Day 1
Immediatelyafterbirth,yourbabyhasaprettygoodideaofwhattodo.Makethemostofitandletyourbabyattachtoyourbreastandfeedwhenheneedsto,orifhewantsacuddle–inskin-to-skincontactifyoulike.
Hewillbegettingusedtohisnewworld,withdifferentnoisesandsmells,andbeingheldclosewillhelphimtofeelsafeandsecure.Hemaybequitesleepy,butlotsofskin-to-skincontactandclosenesswillbesoothingforhimandwillgivehimtheopportunitytofeed.
Keepingyourbabyclose:babiesareoftensleepyandfeedfrequentlyintheearlydays.Athome,itisrecommendedthatyourbabysleepsinacotinyourroomuntilheisatleastsixmonthsold.Itisalsonowadvisedthatyourbabyshouldbeinthesameroomasyouwhentheysleepduringthedaytimetoo.
Night-time feeds
Mostbabies,whethertheyarebreastorbottle-fed,willneedtofeedatleastonceduringthenightforthefirstsixmonthsormore.Itcanbealovelyquiettime,awayfromthehustleandbustleoftheday.Keepingyourbabyinthesameroomwillhelpyouknowwhenheishungry–youmightbewokenupwithsomemurmuringnoisesandmovements.Keepthingsascalmaspossible.Trylowlighting,asoftvoiceanddon’tchangehisnappyifyoudon’tneedto.
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Day 2
Todayyoumaybereadytofeedwhenyourbabyisstillsleepingandwhenyouareabouttofallasleephewantstobefed!Yourbabywillalsobestartingtogetusedtohisnewsurroundings.Rememberthatbreastfeedingcanbeusedtocomforthimaswellasprovidingfood.Insteadofyourbabybeingfedinyourwombwithoutanyeffort,henowhastoworkforhisfoodandhemightneedalittlepractice.Remember,newbornbabiescomewitha‘packedlunch’savedfromyourwombandtheywon’tcometoanyharm.Colostrumisjustrightandallthat’sneededtoday.
Day 3
Todayyourbabymaybemoreawakeandbeginningtogetusedtohisnewworld.Thiscouldbethedaythatheisreadytofeedandyourbodyhasmadesureyourbreastsarefullofmilk–perfecttiming!Theymayfeelmoresolid.(Thismayhappenanytimebetweentodayandday5.)It’snotjustmilkbutalsoextrafluidinyourbreasttissue.Youmightthink‘Wheredidallthismilkcomefrom?’.It’squitenormalanditwon’tlastforever.Agoodsupportingbracanhelpyoufeelcomfortable.Makingsureyourbabyiswellattached(seepages17-18)andallowinghimtofeedasoftenashewantsisthebestthingtodo.Ifyourbreastsfeeluncomfortablyfull,youshouldfeedfrequently.Ifnecessary,youcanexpresssomemilkbyhandtoallowyourbabytoattachproperly.
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Day 4
Forsomemumsandbabies,everythingisgoingwell.Forothersitmightnotbe!Remember–youmayhavebeenfeelinglikethisyesterday,andtodaymightbeabreeze.Youmightfeelthatit’salltoomuch–sorenipples,fullbreastsandfrequentfeedingandcrying.Ontopofeverything,youmaybefeelingabitweepytoo,asyourhormonessettledown.However,feedingandcomfortingyourbabywhenheneedsitmeansthathewillcryless,andfeelsafeandsecure.Thiswillallmakelifeeasierforyou.
Ifyouhavehadabadday,trytothinkofthereasonsyouwanttobreastfeed.Whateveryoudo,don’tgiveuptoday.Persevereandworkwithyourbaby’sbehaviour,skincontactandresponsivefeeding.Supportandhelpwithfeedingwillalsogetthingsbackontrack.Seepages64-65forthedifferentsortsofhelpavailable.
Todayyoushouldnoticethatthecontentofyourbaby’snappieswillgraduallybechangingfromsomethinglikeblacktartoagreenish-yellowymess(hooray!).Whenthisbeginstohappen,youknowyouareontherighttrack.It’sasignthatyourbabyisgettingenoughmilk.Ifyouarefindingithardgoing,it’sgoodtoknowthatfromnowonthingswillgraduallygetbetterandeverydaywillbedifferent.
Day 5
Thingsaregettingbettertoday.
Youmayfeelasthoughyouhavebeenupallnightfeedingandchanging.Itseemsamazingthatsuchasmallbabycanfeedsooftenandproducesomanywetanddirtynappies.(Mostbabiesshouldproduceatleastsixheavywetnappiesandatleasttwoyellowpoostoday.)
Isitbecauseyou’veeatensomethingyoushouldn’thave?Probablynot!Todayit’smorelikelythatyourbaby’ssystemisjustsettlingdown.Keepgoingwithlotsoffeeds.It’sbesttofeedwhenyourbabywantstobefed.
Youwillsoonlearntorecognisewhenyourbabywantstobefed,ifheneedshisnappychangingorhewantsacuddle.
Shannon, 19
I’vebeenbreastfeedingmybabyfor20monthsnow.Iknowit’sgoodforme,it’sgoodforMarlyn,itkeepsusclose.
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Day 6
Hopefullytodaythingsmightbelookingabitmorereasonable.Yourmilkisstillthere,andlotsofit,butsomeofthediscomfortisprobablygoingaway.Yourbabymaybecalmingdown.
Thedirtynappiesarebecomingtheyellowcolourtheywillnowremain.
Atthemomentyourbabymayonlymanageonebreastatatime,ormaydropofftosleepafterstartingthesecondbreast.That’sfine.Justmakesureyoustartwiththesecondbreastatthenextfeed,andthenbacktothefirst,andsoon.
Respondtothesignsthatyourbabyisgettinghungry.Afterawhile,youmightseeapattern.Atthisstage,though,it’sstillimportanttofeedyourbabywhenheishungryratherthantryingtodeveloparegularroutine.
Vitamin D
NewevidencesuggeststhatbabiesandadultsneedadailysupplementofvitaminD.Thisisbecauseourbodiesdon’tmakeenoughvitaminDfromsunlightduringthe‘winter’months.
Breastfedbabiesshouldbegivenasupplementstartingsoonafterbirth.Youcangetsuitablevitamindropsfromyourpharmacist.Formoreinformation,seewww.pha.site/vitamin-d
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Day 7
Youwillbestartingtorecognisewhenyourbabywantstobefedorwantsacuddle.Remember,youcanbreastfeedyourbabytocomforthimtoo!Ofcoursetheremaystillbeafewtoughdaysbutyouandyourbabyarelearningtodealwiththemtogether.Remember,it’sstillOKtoaskforhelpifyouneedit.Youarebothbeginningtoenjoythewarmthandclosenessthatcomeswithbreastfeeding.
Youwillnoticethatyourmilkischanging.Itwillstarttolookmorewatery.Thisislessconcentratedmaturemilkandjustwhatthebabyneeds.Yourbreastswillstarttofeellessfull(butmaystillfeelfullattimesforthenextfewweeks).Don’tbefooledintothinkingthatyounolongerhaveenough.Youandyourbabyarestartingtoworkoutbetweenyouexactlyhowmuchheneeds.(Itmaytakeafewweekstosettlecompletely.)
Myth
‘Mencan’tgetalook-inifthebabyisbreastfed.’
Fact
Wrong.Menaregreatatcalmingacryingorunsettledbaby.Bathtimeisfantasticforplayingandbondingwithyourbaby.
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Expressing your milka useful skill
If you go somewhere without your baby, and he is likely towant to feed while you are away, you can express your
breastmilk. Hand expressing can be useful in the early days,especially if your baby is ill or reluctant to feed. Once
breastfeeding is established, you can use a breast pump toexpress milk.
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Expressing your milka useful skill
If you go somewhere without your baby, and he is likely towant to feed while you are away, you can express your
breastmilk. Hand expressing can be useful in the early days,especially if your baby is ill or reluctant to feed. Once
breastfeeding is established, you can use a breast pump toexpress milk.
How do I express by hand?
Step 1 Startoffbyencouragingyourmilktoflow–beingnearyourbabywillhelp.Toexpressbyhand,startbygentlymassagingyourbreastandnippletostimulatethehormonesneededtoreleasemilk.
Step 2Positionyourthumbandfingersina‘C’shape,2to3cmbackfromthebaseofyournipple.
Step 3 Gentlypressandrelease,pressandrelease,andkeeprepeatinguntilyourmilkstartstoflow.Thismaytakeafewminutes.
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Tip:Expressingmilkbyhandorbyusingapumpwillonlybesuccessfulifyoucangetyourletdownreflextowork.Todothisjusttakeyourtime,trytorelaxandvisualizefeedingyourbaby.Itusuallyhelpstogentlymassageyourbreastsbeforeyoustart.
Iftheflowstopswhileexpressing,changebackandforthfromonebreasttotheother.
Step 4
Whentheflowslowsdown,moveyourfingersroundtoadifferentpartofyourbreastandstartagain.
Ifyourbabyonlyfeedsfromonebreast,youcouldexpressfromtheother.
Donating breastmilk
Breastmilkisparticularlyimportantforprematureandillbabiesbutsometimesmumsarenotabletoprovidebreastmilk.Donatedbreastmilkisoftengiventosuchbabiesuntilthemumcanproducemilkofherown.TheHumanMilkBankarealwayslookingfordonorstodonatetheirbreastmilktoneonatalunits(seepage65fordetails).
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Duringthefirstfewdays,yourcolostrumcomesoutindrips.That’snormal–colostrumisproducedinsmallamounts,asthat’sallyourbabyneeds.Whenyourmilkhas‘comein’,itdripsatfirstandthenmaycomeoutinstreamsorspurts–thisiswhatyouwant.Continuetodothisuntiltheflowofmilkeitherstopsorslowsdowntodripsagain,thenmoveyourfingerandthumbroundyourbreasttothenextsetofmilk-collectingductsandstartagain.
Somewomenfindthattheygetplentyofmilkbyfollowingtheabovemethods.However,otherwomenfindthattheirbreastsneedmorestimulationtogetthestreamsorspurtsofmilkflowing.Massagingyourbreastswillgivethisextrastimulation.
Othersuggestionsforhelpingthemilktoflowinclude:
• heat–tryawarmflannelonyourbreastorhaveashoweror bathbeforehand
• sitsomewherewarmandcomfortable
• trytorelax–perhapsdoingsomedeepbreathing, watchingTVorlisteningtosomemusicyoulike
• trythinkingaboutyourbaby–aphotoorpieceofhis clothingmayhelp,orevenatapeofhissounds.
Manywomenfinditmosteffectivetocombinepumpandhandexpressingiftheyareseparatedfromtheirbaby.
With a pump:mosthospitalmaternityunitshaveelectricpumpsforuseontheunit,oryoucanhireorborrowsimilarmodelsforuseathome.Youcanalsobuysmallerelectricpumpswhichrunonbatteriesorfromthemains.Ifyourbabyisillorpremature,apumpisavailableonloanfromTinyLife–call02890815050.
Handpumpscomeindifferentversions.Youcanbuythemfrompharmaciesorbabystoresandonline.
How much to express?
Asaroughguide,ababyunderthreemonthswilltake100-120ml(3-4fluidounces)ofexpressedbreastmilkperfeed,andababyoverthreemonthswilltake150-200ml(5-7fluidounces)perfeed.Butthisisverygeneral–afteryouhavedoneitafewtimes,you’llsoonbecomegoodatknowingwhatyourbabyislikelytoneed.
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Whattypeofpumpyouneeddependsonhowoftenyou’regoingtouseit.Askothermothersandhealthprofessionalsforadviceonwhichoneislikelytoworkbestforyou.
Keeping your expressed breastmilk
Youwillfinddifferentbooksgivedifferentguidelinesaboutthelengthoftimeforwhichyoucansafelystoreexpressedbreastmilk.However,themostup-to-dateadviceisthatmilkcanbekeptinthefridgeforthreetofivedays.Themilkmayseparate,butit’sstillperfectlysafe–justgiveitashakebeforeyouuseit.Expressedbreastmilkcanalsobefrozenforuptothreemonths.Yourfridgeandfreezerneedtobecleanandthetemperaturereliable.Youcanalsostoreandtransportexpressedbreastmilkinacoolbaguntilyougethome–that’susefulifyouareexpressingatworkanddon’thaveafridgeyoucanusethere.
Therecommendedstoragetimesforillorpretermbabiesmaybe24-48hours.Checkwiththestaffinthespecialcarebabyunitifthisappliestoyou.
When expressing and storing:
• alwaysuseasterilisedcontainerforthemilk
• freezeinsmallquantitiesusingsmall breastmilkstoragebottlesorbreastmilk storagebags.Thisway,it’seasierto defrostthemilkandalsolesswastefulif yourbabyonlyneedsasmallamount
• labelanddateyourmilk
• thawbyleavingitinthefridgeovernight,or bystandingthecontainerinajugofwarm water.Keepthejugawayfromyourbaby, forsafetyreasons.Donotuseamicrowave; itmayheatthemilkunevenlyandscald yourbaby.Thereisalsoevidencethat microwavingbreastmilkdestroyssomeof thebeneficialanti-immunefactors.
Feeding your baby expressed milk
Ifyou’reexpressingbreastmilkintheearlydaysforababywhoisillorreluctanttofeed,it’sbesttouseasyringeoranewbornfeedingcup.Thehospitalstafforyourmidwifewilldothisorshowyouhowtodoit.
Onceyouareconfidentaboutbreastfeeding,yourmilksupplyisestablishedandyourbabyisattachingeasily,thenyourbabycanbefedyourexpressedmilkfromabottleandteat.
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Breastfeeding and yourbaby in special care
challenges and overcoming them
If you’d never thought about breastfeeding before,
having a small or ill baby may change your mind.
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Breastmilkisevenmoreimportanttothehealthofasick,smallorpretermbaby.Babiesbornearlyarevulnerabletosomepotentiallyverydangerousproblems(suchasneonatalnecrotisingenterocolitis,whichisaveryseriousboweldisorder)andbreastmilkprotectsagainstthis.Breastmilkalsoensuresbettereyesightandbraindevelopmentinpretermbabies.Forthesereasonsyoumaybeencouragedtogiveyourbabyexpressedbreastmilkwhileheisvulnerable,butthisdoesnotmeanthatyouhavetobreastfeedlaterifyoudonotwantto.
“The twins were born five weeks early andwere taken straight to the special care unit...
the hospital had a good breast pump and Iexpressed milk every three hours which the
staff then gave to the girls through theirfeeding tube.”
Sarah
Staffinthespecialcarebabyunitwillencourageyoutoexpressyourmilkifyourbabyisunabletocometothebreastatfirst,orifyoureallydon’twanttoputyourbabytothebreast.
Expressedbreastmilkcanbegiventoyourbabybytube(whichgoesinhisnoseormouthandintohistummy),syringeorcup,and,later,ifyoudon’twanttobreastfeed,bybottle.
Verypretermbabiesmaynotbeabletobreastfeedintheearlyweeks,astheirreflexesdon’tstarttomatureuntilabout32weeks’gestation.Fromabout36weeks,mostbabiescanmanagetoco-ordinatetheirsuckingandswallowing,thoughyouandyourbabymaystillneedhelpandsupporttogetitright.Yourbaby’smedicalcondition,weightandmaturityallplayapartinhissuckingability.
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Here’s how to get going with breastfeeding smallor ill babies:
• expressearly–assoonasyoucan,andpreferablywithinthe firsttwohoursofyourbaby’sbirth.Handexpressingisusually betteratthisstage(seepage31)
• expressasoftenasyoucanmanage–eighttotentimes in24hoursisideal,includingatleastonceinthenight
• atfirstyouwillexpresssmallamounts–everydropisvaluable– andthentheamountwillincreaseafterabouttwotofivedays
• talktothestaffaboutcontinuinghandexpressing,or whetherchangingtoabreastpumpwouldmakethings easierforyou.Doublepumping–expressingbothbreasts together–cansavetimeandincreasetheamountproduced.
Helping your baby to feed
Eventheverytiniestbabiesbenefitfromskin-to-skincontact,andbeingheldclosetoyourbreast(seepage16).Yourbabywillbeawareofyoursmell,tasteandtouch,andithelpshimpractiserootingforthebreast,andgetpositioningandattachmentright.Itmaytakemanyattemptsoverseveraldaysorweeksuntilheisreadytofeed–everyoneneedstobepatientduringthistime,andtorememberthathe’lldoitwhenheisready.
Cup feeding
Prematurebabiesandbabieswhoareillcanoftencupfeedbeforetheycanbreastfeed;cupfeedingcanbepartofthepathwaytowardsbreastfeeding,andstaffinmostspecialcarebabyunitswilldoitorteachyouhowtodoit.Itgivesyourbabyapositivefeedingexperience,andreducestheneedfortubefeeding.
AskthestaffintheneonatalunitforyourcopyoftheSmallWondersDVDproducedbyBestBeginnings.Itwillhelpsupportyouonyourjourneywithyourprematureorsick
babyandcoversexpressingyourmilkandholdingyourbabyandwillgiveyouconfidenceingettinginvolvedinthecareofyourbaby.
Youcanalsoseethevideoatwww.bestbeginnings.org.uk/small-wonders
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Getting it rightproblems and how to resolve them
Breastfeeding seems natural, but is actually a learned skill.Many mothers and babies enjoy the experience,
but that doesn’t mean it’s always easy for everyone.Breastfeeding has to be learnt, and you and your baby
may need quite a lot of practice to get it right.If you have good information, support and the confidence
you need, you are likely to be able to overcome anydifficulties. Ask your health visitor or midwife for help and
advice if you are having any problems.
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Getting it rightproblems and how to resolve them
Breastfeeding seems natural, but is actually a learned skill.Many mothers and babies enjoy the experience,
but that doesn’t mean it’s always easy for everyone.Breastfeeding has to be learnt, and you and your baby
may need quite a lot of practice to get it right.If you have good information, support and the confidence
you need, you are likely to be able to overcome anydifficulties. Ask your health visitor or midwife for help and
advice if you are having any problems.
Manymumsandbabiesenjoytheexperienceofbreastfeedingbutthisdoesnotmeanitiseasyforeveryoneallthetime.Aboutoneinthreemumswillneedextrasupportatsomepoint.Somecommonproblemsarelistedbelowandoverleaf,andthenextsectiongivesinformationonwhereyoucangethelpifyouneedit.
Manydifficultiesthatyoumightencounterarebecauseyourbaby’spositionisnotquiterightorheisn’tattachedtoyourbreastcorrectly.Often,onlysmallchangesareneededtohelpthingsgosmoothlyagain.Listedbelowaresomeofthemorecommonproblemsandsometriedandtestedsolutions.
Remember, don’t be afraid to ask for help.
Troubleshooting guide
The issue Why it is happening What you can do
I have sore, Yournippleskiniseasily Makesurethatyouandyourbabyareinagoodpositionandhe cracked grazedorcrackedasa isattachedproperly–seepages17–18. nipples. resultofyourbaby’sgum pinchingit,orthetipof Askyourmidwifeorhealthvisitor/familynurseassoonasyou yournipplebecomessore cantohelpyou.Youcouldalsogoalongtoalocalbreastfeeding becauseithasn’tbeenfar grouporringtheNationalBreastfeedingHelplineon enoughbackinyour 03001000212–seepages64and65forcontactnumbers. baby’smouth,andhas rubbedagainsttheroof ofhismouth.
My baby is Thisismorecommonin Lotsofskin-to-skincontactandclosenesswillbesoothingfor very thefirstdaysafterbirth. himandwillgivehimtheopportunitytofeed.Trymassaging sleepy. Somebabiesaretiredand hisskin,changinghisnappy,expressingalittlemilkforhim mayneedtobewokenfor totaste,andothergentleeffortstowakenandinteresthimin feedstomakesurethey feeding.Seepage46forhowtotellyourbabyisgettingenough getenoughmilkbutthis milk.Yourmidwifewillcheckonyoubothtomakesureyour isonlytemporary. babyiswell.Inthemeantime,starthandexpressingyourmilk andgivingittohimwithaspoon,dropperorcup–your midwifewillshowyouhow.
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The issue Why it is happening What you can do
Engorgement Thiswouldusuallybeinthe Makesureyouarefeedingyourbabyoftenenoughandyour – the stage firstfewdaysafteryourbaby babyisattachedaswellashecanbe.Itmighthelptoexpress beyond normal isbornbutcouldalsohappen somebreastmilk.Thisshouldhelptoreducethediscomfort fullness of atlaterstagestoo–when andallowyourbabytoattachmoreeasily. your breasts. feedingpatternschangeor They will be weaningfoodsareintroduced. Awell-supportingbraorvestcanhelpwiththediscomfort. swollen, Itcanalsohappenifyoumiss Youcanalsouseawarmorcoolpad,forexampleacloththat lumpy or full. afeedwhilehavingtobe hasbeeninthefreezerorasmallhotwaterbottlewrapped If it’s severe awayfromyourbaby.Ifhehas inacloth.Fullness willoftengoawaybyitselfasyourbaby they will be beendelayedinreceivinga getsinterestedinfeeding.Handexpressingmilkcanalso tender, shiny, feedorisnotattached relieveenoughtensionforyourbabytofeedmoreeasily. red and very correctlyornotfeeding swollen. enough,milkbuildsup. Blocked ducts Thiscanhappenatanytime It’sveryimportanttocarryonbreastfeedingatthistime. – these can butusuallytwotothreeweeks Makesureyourbabyisproperlyattached.Feedingoften, lead to afteryourbabyisborn.It ontheaffectedsidefirst,overthenextfewfeedswillhelp. mastitis, but meansthatmilkisunableto Alsomassagetheaffectedareaortryadifferentfeeding not always. flowanditbuildsup,resulting position. inswelling.
If you have any doubts,
speak to your midwife,
health visitor or family
nurse.
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The issue Why it is happening What you can do
Mastitis – Blockedductsand Itisimportanttokeepyourmilkflowinginyourbreastandto you will see mastitisarelinkedbut ensurethatitisdrainingwell.Massagingyourbreastand a red area on theyarenotthesame frequentfeedingcanhelpclearablockedduct.Ifyourbaby your breast, condition.Mastitisisan won’tbreastfeedontheaffectedbreast,youmayneedtohand usually with a inflammationoran expresstoremoveyourmilk.Ifyoursymptomsdon’timprove, lump. Your infectionofthebreast youmayneedmedication,particularlyifyoufeelfluey,soitis breast may be orbreasts.Thiscanbe importanttospeaktoyourmidwife,healthvisitor/familynurse painful and causedbyablocked oryourGP. hot and you ductsoitisimportant may develop toclearthisbymassage Formoreonmastitis,seepage43. flu-like orfrequentfeeding. symptoms.
Thrush – your Athrushinfectioncan Checkyourbaby’spositionandattachment,asthisisthemost nipples are happenatanytimebut commoncauseofsorenipples.Ifthisdoesn’thelp,speakto sore and may itseemstobemore yourmidwife/healthvisitorforadvice.YourGPwillbeable be ‘flaky’ in commonaftertaking togiveyouandyourbabymedicationifthrushisdiagnosed. appearance, antibioticsorafterthe look red or earlydaysof Ifyoudohavethrush,anyexpressedbreastmilkshouldnotbe pale, possibly breastfeeding. stored,asthethrushinfectionwillbepresentinthemilk.As shiny and feel youandyourbabywillbehavingtreatmentatthesametime,it itchy and Thrushcanthriveon isfinetocarryonbreastfeeding.Itisalsoagoodideatoput burning. You brokenskinandinwarm, yourbrathroughaveryhotorboilwashtohelpkillthethrush, may also have moistconditionsand andtochangeyourbreastpadsfrequentlyasthesecouldcause a sharp canbepassedbetween reinfection. shooting pain mumandbaby. during or Formoreinformationonbreastfeedingandthrushvisit after feeds www.breastfeedingnetwork.org Your baby may have a white coating in his mouth.
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The issue Why it is happening What you can do
Refusing the Babiesrefusingtosuckat Holdyourbabynexttoyou,skin-to-skin,asoftenasyoucanso breast – some somepointisquite thatyoucanrespondstraightawaywhenheshowssignsof babies get common.Therecanbe wantingtofeed.Thatwayhelearnsthatyourbreastisa cross and manyreasonsforthis.It’s comfortingandsoothingplacetobe. frustrated, and importanttotryandfind seem to fight, outwhat’scausingit,but tossing their sometimespatienceisall heads from youneed. side to side.
Slow weight Babiesareindividualsand Makesureyourbabyiswellpositionedandcorrectlyattachedand gain. gainweightatdifferent feedhimasoftenandforaslongashewants.Rememberthat rates,soslowweightgain babieshavenaturalpausesduringafeed,andyourbabymay canbenormalforsome sometimesappeartohavehadallheneedswheninrealityheis babies.However,for restingbeforewantingtofeedmore.Itisimportanttotalkto othersitcanbeasignthat yourmidwife,healthvisitor/familynurseorGPifyouhave theyarenotgetting concerns. enoughmilktogrow.
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Mastitis: inflammation of the breast
What you may see and feel
Thefirstsignofmastitisisusuallyaredareaonpartofthebreast,oftentheouter,upperarea,whichmaybepainfultotouch.Othersignsare:
• alumpybreast,whichfeelshottotouch
• thewholebreastachesandmaybecomered
• flu-likesymptoms–aching,increased temperature,shivering,feelingtearfuland tired(thiscansometimesstartverysuddenly andgetworseveryquickly)
You may not have all of the above signs during mastitis.
When it happensAtanytime,butitismorelikelytohappentwotothreeweeksafterthebirth.
Why it happensYoumaygetmastitiswhenmilkleaksintobreasttissuefromablockedduct.Thebodyreactsinthesamewayasitdoestoaninfection–byincreasingbloodsupply.Thisproducestheinflammation(swelling)andredness.Factorswhichmakemastitismorelikely:
• difficultyattachingyourbabytothebreast (seepages17and18)–thismaymeanthatthe breastisnotdrainedwell
• pressurefromtightfittingclothing, particularlyyourbra,orafingerpressinginto thebreastduringfeeds
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• engorgement
• ablockedduct
• stressandtiredness
• suddenchangesinhowoftenthebabyis feeding,leavingthebreastsfeelingfull.
Preventing mastitis
• trytoavoidsuddenlygoinglongerbetween feeds–ifpossiblecutdowngradually
• makesureyourbreastsdon’tbecomeoverfull
• avoidpressureonyourbreastfromclothingandfingers
• startself-helpmeasures(seebelow)atthefirstsignof anyredareaonyourbreast
• speaktoyourmidwife,healthvisitorordoctorifyoudo notfeelatallbetter12–24hoursafterstartingself-help measures.
Solving the problem
• keeponbreastfeeding–youmayfeelillanddiscouraged butcontinuingtobreastfeedisthequickestwaytoget better–andwon’thurtyourbaby
• feedyourbabymorefrequentlyorexpressbetween feedsifyourbreastsfeeluncomfortablyfull
• expressgentlyafterfeeds,sothatyourbreastsarekept aswelldrainedaspossible,untilyoufeelbetter
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• checkthatyourbabyiswellattachedtoyour breastwhilefeeding–ifindoubtseekhelp fromyourmidwife,healthvisitororvolunteer breastfeedingsupporter
• feedfromthesidewhichissorefirsttodrain itasthoroughlyaspossible
• tryfeedingwithyourbabyindifferentpositions
• warmthonyourbreastandgentlemassage beforeyoufeedorexpresswillhelpthemilk toflowmoreeasily
• placingacoldcleanflanneloragelcompress onyourbreastcanbesoothingbetweenfeeds
• checkforanyclothingthatmaybepressing intoyourbreast,thisincludesabra–some womenfindithelpfultogowithoutabra– bumpsorknocksfromtoddlerscanalsohave thesameeffect
• trytorestasmuchasyoucanandkeep feedingyourbaby
• itisimportantifmastitissymptomsstartto comeback,youstartself-helpmeasuresright away.
Ifyoudonotbegintofeelbetter,andespeciallyif you start to feel worse,despiteusingtheseself-helpmeasures,youshouldspeaktoyourGPorhealthvisitor.
Other treatmentYouwillneedtotakesomeparacetamoltorelievepainandreduceyourtemperature.Makesureyoudonottakemorethantherecommendeddose
(two500mgtabletsfourtimesadayandnomorethan8tabletsin24hours).Ibuprofencanalsobetakenasithelpstoreducetheinflammation.Take400mgthreetimesadayafterfood.
• Ibuprofenshouldnotbetakenbywomen whohaveasthma,stomachulcersorare allergictoaspirin.Aspirinshouldnotbetaken bybreastfeedingmothers.
• Ifyourmastitisisnotimprovingyouwillneed toseeyourGPasyoumayneedantibiotics.If so,youshouldbeprescribeda10-daycourse. Youshouldfeelsomeimprovementwithin 12–24hours. Itisveryimportanttofinishthewholecourse ofantibiotics.Ifyourmastitiscomesback afteryouhavetakenafullcourseof antibiotics,orisunusuallysevere,youmaybe askedtogiveasampleofmilk.Thiswillbe testedtohelpthedoctorchoosethecorrect antibioticforyourtreatment.
Antibiotics may make the baby produce loose, runny motions and become irritable and restless, but the baby won’t be harmed and will get better when you finish the antibiotics.
It is important not to stop breastfeeding during mastitis as this can make your mastitis much worse.
“When I had the mastitis I knew I needed to keep feeding and expressing milk, but I wasn’t getting any better so I rang the doctor and got antibiotics, which seemed to work.” Siobhan
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Concerns about milk supply
Manymothersworrythattheirbabymaynotbegettingenoughmilk.Youwillknowwhatisgoinginbywhatcomesout(seepage22).
Sometimesyoumayhaveconcernsaboutyourbaby’sweightgain.Slowweightgaincanbenormalforsomebabies,butforothersitcanbeasignthatthebabyisn’tgettingenoughmilktogrow.Thevariationinweightgainishugebutmostbreastfedbabiesshouldregaintheirbirthweightby2weeksandthenwillgain:
0-4months 125-200gperweek (5-8oz)
4-6months 50-150gperweek (2-6oz)6-12months 25-75gperweek (1-3oz)
What you may see and feel
Ifyourbabyisn’tgettingenoughmilk,hemaybeunhappyandfrustratedatthebreast.Alternatively,hemaybelistless,sleepalot,andseemuninterestedinfeedingforalongtime–itsoundscontradictory,butsometimesthequietbabymaybewronglythoughtofas‘good’becausehe’sundemanding.Buthemaynotdemandverymuchbecausehe’ssavinghisenergy.
Hemayhavefewerwetnappiesthannormal(seepage22).Hemaypassdarkordrystoolsinfrequently.Infrequentstoolscanbenormalafterthefirstmonthorso,butmostbabieshaveadirtynappyseveraltimesadayinthefirstweeksandwithinthefirstthreetofourdaysbabiesshouldhavesoft,runnystools.
Overaperiodoftime,hisgrowthmaygivecauseforconcern.Youngbabiesnormallylosesomeweightintheearlydaysastheyusetheirfluidandfuelstores,butababywhoisnotgettingenoughmilkwilllosemore,continuetoloseweight,orbeslowtoregainhisbirthweight.
‘I don’t think I have enough breastmilk’
‘I’m worried that my baby won’t put on enough weight‘
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When it happens
Sometimes,youmaybemistakeninthinkingyouhaven’tgotenoughmilk.Butthiscananddoeshappenatanytime–eitherbecausebreastfeedinghasnotgotofftoagoodstart,orbecauseproblemshaven’tbeensolved.
Why it happens
Ifyourbabyisn’twellattachedhemaynotstimulateagoodsupply.Ifyoutimethefeeds,ortrytofitthemintoaschedule(likefeedingforacertainnumberofminutesasideeverythreeorfourhours),youmayupsettheresponsivefeedingapproachthatproducestheamountofmilkthebabyneeds.Themoreoftenmilkisremovedfromthebreast,themoremilkisproduced.Or,removingthebabyfromthebreastbeforehe’sfinishedmaymeanhedoesn’tgetenoughmilk.Givingyourbabybottlesofformulamilkorotherfluids,orintroducingsolidfoodstooearly,mayalsointerferewithagoodmilksupply.
Solving the problem
Makesureyourbabyiswell-positionedandcorrectlyattached(seepages17–18),andfeedasoftenandforaslongashewants.Offerbothsidesateveryfeed–hemayonlytakeone,butofferhimthesecondanyway.Rememberthatbabieshavenaturalpausesduringafeed,andyourbabymaysometimesappeartohavehadallheneedswhen,inreality,heisjustrestingbeforewantingtofeedsomemore.
Maximising your milk supply
Breastfeedingatnightisimportantinkeepingupagoodmilksupply.Ifyoudecidetogivesomeformula,keepittoaminimumandcarryongivingasmanybreastfeedsaspossible.Themoreformulayourbabygets,theloweryourmilksupply.
Ifyourbabylikestosleepalot,wakehimupmoreoftensothatyoucanfeedhimmore.Ifheislistlessanduninterestedinfeedinghemaybeunwell,soitisbesttocontactyourdoctor,midwifeorhealthvisitor.Sometimes,forashortperiodoftime,youmaybeadvisedtoexpressmilkinordertoincreasemilkproductionandgetthebabybackontrack.
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Mixed feeding – breast and formula feeding
What is it?
Givingyourbabyformulaaswellasbreastmilkisknownas‘mixedfeeding’.Intheearlydaysafterthebirthit’snormaltobetired–you’refeedingyourbabyoften,duringthedayandnight.Thiscanbeatimewhenyoumaythinkaboutchangingtoformula,ormixingbreastandformulafeeding.Continuingtogiveasmuchbreastmilkaspossibleisimportantforyourbaby’shealth.Givingformularegularlywillalsoreducetheamountofbreastmilkyouproduce.Thereareafewthingstothinkabouttohelpyoumakeupyourmindwhatisbestforyouandyourbaby.
What you will notice
Rememberthatafterafewweeksofbreastfeedingyourbreastswillnotfeelasfullastheydidatthebeginning.Thisdoesn’tmeanthatyouarenotproducingenoughmilk–itjustmeansthatyouandyourbabyhaveworkedoutexactlyhowmuchmilkheneeds.Ifyouareunsure,speaktoyourhealthvisitor/familynurse.
Breastfedbabiesgrowdifferentlyfrombabiesfedwithformula.Breastfedbabiesgrowataratethatisbetterfortheirfuturehealth.Theycanputonweightmoreslowlyandsomeearlyweightlossisnormal.Ifyouareconcernedaboutyourbaby’sweight,speaktoyourhealthvisitor/familynurseormidwife.
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‘Giving a bottle of formula might make my baby sleep better at
night.’
‘Giving a bottle of formula means that a member of my family can
feed my baby.’
Sometimesbabiesfinditdifficulttobreastfeedaftertheyhavebeenfedwithabottle,ortochangefromonetoanother.However,otherbabiesseemtohavenotroublewiththis.Becausewedon’tknowwhichbabiesmightfindthisdifficult,itwouldbebesttoavoidgivingbottlesandteatsintheearlydaysandweeks.
Itisusuallyagoodideatogetbreastfeedingworkingwelloverafewweeksbeforeabottleisintroduced,sothatthemilksupplyiscompletelyestablishedandthebabyknowshowtobreastfeedwell.
Ifyouchangeyourmindaboutmixedfeeding,itispossibletogobacktosolelybreastfeeding–butremember,givingformulawillreduceyourmilksupply.
Safetynote:ifyouareintroducingformula,alwaysaskyourhealthvisitor/familynurseabouthowtomakeitupsafely.
Thereisnoevidencethatthisistrue.Night-timebreastfeedsareimportanttotellyourbodytokeepmakingmilk–especiallyintheearlyweeks.Asyourbabygrows,hecantakemoremilkandsleepforlonger.Lookingathowfamilyandfriendscangivepracticalhelp,sothatyoucanhavesomerestduringtheday,maybeawayofhelpingyouthroughthosefirstweeksuntilyourbabynaturallywakeslesstofeed.Ifyoudodecidethatthebabyshouldhaveabottleofformulaatnight,trytogivethisoccasionallyratherthaneverynight.Thiswillhelpkeepyourmilksupplyup.
Whilethisisalovelyidea(andyoumayfeelunderpressuretodoso),youneedtothinkaboutwhethertheadvantagesofthisaremoreimportantthantheriskofreducingyourmilksupplyandlosingsomeofthebenefitsthatbreastfeedingbrings.Ifit’simportantforyourpartnerormaybeyourmumtobeinvolvedwithfeedingthebaby,oncebreastfeedingisworkingwell,youcouldexpressyourbreastmilkforyourbaby.Remember,therearelotsofotherwaysforyourpartnerandfamilytobondwithyourbaby.Makesureyoukeepthepeoplewhofeedhimtojustyourpartnerorsomeonewhoisclosetoyou–thiswillhelphimfeelsafeandsecure.
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Breastfeeding and your lifefitting it in, making it easy
When you’re thinking about whether to breastfeed,or whether to continue once you’ve begun, you
may find other people’s attitudes and feelings playa part in your decision. In the end, what you do isup to you and your baby – but your friends and
family, and your own personal circumstances, arelikely to influence you.
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What about:
...in the hospital?
Mostmumsneedsomepracticalhelpwithstartingbreastfeeding,notleastbecausebreastfeedingisacompletelynewskillforthemandthey’retiredafterthedelivery.Themidwifewillhelpyoupositionyourbabyproperlysothathecanattachwell.Thefirstfewattemptsmaybetricky,butitwillgeteasierasyougetmoreexperienced.
Mostwomendon’tgetthetechniquestraightaway,sowhenyouarelearningtofeedinthehospitalyoucanpullthecurtainsroundyourbedforextraprivacyifyouwantto.Youmayalsowanttoletfamilyandfriendsknowbeforethebirththatyouwillbebreastfeeding,tomakeiteasierwhentheyvisit.Itmayseemstrangeatfirst,butonceyougetthehangofbreastfeedingyouwillbeabletodoitverydiscreetly.
...breastfeeding in front of others?
Somemotherscanfeedhappilyenoughwhenfamilyorfriendsarearoundbutfeelawkwardwhentheyareinapublicplace;othersfindit’stheotherwayround.
Attitudesarechangingandsomeshopsandstoresandpublicplacesnowhavesupportivebreastfeedingpolicies.Onceyoufeelconfident,youcanbreastfeedsothatothersarenotevenawareofit.Youdon’tneedtounbuttonyourtopandexposeyourwholebreasttofeedyourbaby.Ifyouwearsomethingthatliftsupfromthewaistlikeat-shirtorajumper,ratherthanashirtorblousewithbuttons,youcanbreastfeedwithoutanybreastshowingatall.
Rememberthatyourconfidenceislikelytogrowasyouandyourbabygetmoreusedtobreastfeeding.Also,yourbaby’sfeedswillbecomelessfrequent,soyoucanplanoutingsbetweenfeeds.
Here in Northern Ireland the PHA has ascheme called Breastfeeding Welcome Here.This helps you recognise places that particularly welcome breastfeeding. Look
for the heart-shaped logo. A map showing welcome scheme members can be viewed at www.breastfedbabies.org
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...getting support from family, friends or a partner?
Yourrelativesmaybeinfavourofbottlefeeding,orperhapstheyknowverylittleaboutbreastfeedingastheyhaven’tdoneitthemselves.Itwillhelpifyoucanexplainaboutthehealthbenefitsofbreastfeeding,whichtheymaynotknowabout,andremindthemthatallhealthprofessionalsencourageit.Perhapstheywouldliketoreadthisbooklet,ortalkwiththemidwifeorhealthvisitorthemselves.
Thesupportofyourfamilyissohelpfultoyouthatit’sworthmakingsuretheyknowwhyyouhavechosentobreastfeed.
Yourpartnermaybeuncomfortableaboutyoubreastfeeding,orfeelunhappyaboutyoufeedinginfrontofotherpeople.It’sknownthatpartners’attitudestobreastfeedingarecrucialtosuccess–ifyourpartnerisnotkeen,forwhateverreason,itwillbealotmoredifficultforyoutocarryon–seetheleafletWhat Dads should knowonwww.publichealth.hscni.netItmayhelptoremindhimthattherearemanyotheraspectsofyourbaby’scarehecanbeinvolvedin–cuddling,holding,bathing,playing,massaging–andthatthetimewhenyourbabyisreceivingnothingbutyourmilkisveryshort(aroundsixmonths).
Fatherscanshowbabiesthatlovedoesn’thavetocomeasapackagewithfood–theycandeveloptheirownuniquerelationship,andthat’svaluableforyouandthebaby.Yourpartnermayworrythathecan’thelpifyouarebreastfeeding–reassurehim,andlethimknowyouandyourbabyneedhimforotheressentialthings.
...feeling ‘tied’ to the baby?Asyou’retheonlyonewhocanfeedthebaby,youmightfeelyouhavelessfreedomtogoout,tosocialiseortosharethecareofyourbaby.
Therearewaysofcopingwiththis,nevertheless.Youwillfindyourbaby’sneedsaremorepredictableashegetsolder,andhecanbeencouragedtobemoreflexibletoo,sohecanfeedatatimethatsuitsyou.Youcanalsoexpressmilkforsomeoneelsetogivetoyourbaby(seepages31–34).Or,youmaywanttogivetheoccasionalbottleofformulamilk,butbearinmindthebenefitsofexclusivebreastfeeding,andthepossibleimpactofusingteatsanddummies(seepage7).Seepages57–58forcombiningbreastfeedingandworking.
“Breastfeeding wassomething I hadn’t thoughtabout. I didn’t really knowmuch about it. My wife waskeen to give it a go althoughat times I felt it was quitehard for her. In the early daysthe baby seemed to want tofeed all evening and that wastiring for both of us! But itwas magic seeing him fallasleep, full up, content withthat wee half smile on hisface! I didn’t feel left out. Sheneeded me there and when Ilook back now it was such ashort but very special time inour lives. It’s a great start youcan both give your baby.”Andrew
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...meeting other mothers?
Manymothersfindithelpfultomeetotherswhoarealsobreastfeeding.TherearebreastfeedingsupportgroupsinallpartsofNorthernIreland,whichofferfriendshipandmutualsupport.Youcanusuallyjointhesegroupswhileyouarepregnant.Supportgroupsgiveinformationandreassurance,aswellasthechancetomakenewfriends.Yourmidwifeorhealthvisitorwillknowthegroupsmeetingnearyou,oraskyourlocalmaternityhospital.(Seepages64–65forinformationaboutsupportgroups,etc.)Youcanfindoutwhereyournearestbreastfeedingsupportgroupisbygoingtowww.breastfedbabies.organdclickingonyourlocalareaonthemap.
…caring for your baby at night and night-time feeding
Itisimportantforallbabiestobefedduringthenightbecauseintheearlyweeksandmonthsababyisgrowingfastandhehasasmallstomach,whichcanonlytakeinenoughmilktolastashorttime,andsohewillneedfedaroundtheclock.
Itcanbechallengingcopingwithcaringforyourbabyatnight,especiallyifheiswakefulandwantstofeedfrequently.Havingyoursleepdisturbedcanbefrustratingandtakesabitofadjustingto,yourbabywillneedtoknowthatyouareclosebyandthatyouwillrespondtohisneedstobecomfortedandfed.Feedingatnightcanalsobealovelyquiettimeforbothmumandbaby.
...making night-time feeds as safe as possible
Researchshowsthatthe safest place for a baby to sleep is in a cot by the side of your bed.Youmaywanttoconsiderusingacotthatcanbeplacedrightnexttoyourbedatthelevelofthemattressasthisallowseasyaccesstothebaby.
Breastfeedinghasbeenshowntosignificantlyreducetheriskofsuddeninfantdeathandnightfeedsareimportantinkeepingupagoodmilksupply.Youmaychoosetobreastfeedwhilelyingdowninbedandinordertotrytoreducetheriskofsuddeninfantdeathyouwillneedtomakethefollowingadjustments:• makesureyourbabycannotbecometrapped betweenthemattressandwallorfalloutofbed
• keepyourbabywellawayfrompillows
• makesurethebaby’sbodyorheadisnotcovered byaduvetoranyotherbedclothes
• donotleaveyourbabyaloneinabedashemay movetoadangerousposition.
Ifyourbabywasprematureorverysmallitisnotsafetobed-shareintheearlymonths.
Donotsleepwithyourbabyifyouoryourpartner:• havebeendrinkingalcohol• havetakenanydrugs(legalorillegal)that couldcausedrowsiness
• havebeensmoking
• areholdingyourbabyonasofaoranarmchair.
Note: It is extremely dangerous to put yourself in a position where you might fall asleep with your baby on an armchair or sofa.
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...making nighttime more manageableItcanmakethingseasierandmorerestfulandhelpyourbabytounderstandthatnighttimeisdifferentifyou:• keepyourbaby’scotclosebyyourbed,the safest place for your baby to sleep is in a cot by the side of your bed for at least the first six months.Therearebedsidecotsavailablethathaveadrop downsidesothat,whenitisbesideyourhead,youcaneasily reachovertosootheyourbabywithouthavingtogetoutofbed (seephoto);
• keepthelightsdownlowandtrynottoswitchonlightsasthis isn’tusuallynecessaryforsoothingorfeedingbaby;
• ifpossible,offerafeedassoonasthebabyisshowingsignsof wantingtofeedandbeginningtowakenratherthanwaitinguntil babystartscrying;
• talktoyourbabyinaquietreassuringvoiceandonlychangethe nappyifit’sreallynecessary.
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...when your baby isn’t settling
Somebabiescanbeveryunsettledattimesandtheymayhavedifficultygoingbacktosleepafterfeeding.Ifso,trythefollowingsuggestions:
• Tryofferingthebreastagain,evenifyourbabyhasjustfedhemayneedto suckleagainandtobecomfortedbybeingbreastfed.
• Rockingyourbabyandholdinghiminskincontactcanbesoothingand willhelphimrelaxandfallasleep.
• Getyourpartnertohelpbymakingsureyouarecomfortable,passingyou thebaby,changingnappies,gettingyouadrink.
• Ifyourbabyseemstowanttofeedmoreoftenatnight,lookoutforsigns thatbabywantstofeedduringthedayandofferfeedsfrequently,rest whenyoucanwhenheissleepingduringtheday.
• Askyourfamilyandfriendstohelpoutwithhouseworkandshoppingso thatyouarelesstiredandmoreabletocopewithnight-time.
• Usingaslingorsoftbabycarriercanbehelpfultocomfortyourbaby.Forpeaceof mind,buyfromalargerscalemanufacturerwhohashadtheircarriersindependently testedtoindustryrecognisedsafetystandardsandcarefullyfollowtheinstructions. Toviewtheguidelinesforsafe‘baby-wearing’,goto www.babywearingni.co.uk/baby-wearing-safety
Ifyourbabyiscryingforlongperiodshemaybeillandsohewillneedamedicalcheck.
Youcanfindoutmoreaboutcopingwithnighttimesandreducingtheriskofsuddeninfantdeathfromwww.nidirect.gov.ukorfromthePublicHealthAgencyleafletSafer sleeping.
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Going back to work?you and your options
Any breastfeeding, even for a short time,is worthwhile, so, if you want to breastfeed,
don’t let the fact that you’re returning to workput you off. Breastfeeding can be combined
with a working life.
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TofindoutmoreaboutcombiningworkingwithbreastfeedingseethePHAleafletBreastfeeding and returning to workatwww.pha.site/breastfeeding-returning-work
Manywomenwillbereturningtoworkwhentheirbabyisaroundsixmonthsold.Atthisstage,yourbabywillbebeginningtotakesomesolidfoodandneedingfewerbreastfeeds,sothiscanmakeiteasiertocombinebreastfeedingandwork.
Continuing breastfeeding
Ifyouareluckyenoughtogetchildcareatornearyourworkplace,youmaybeabletocontinuetobreastfeedasnormal.Youcanfeedimmediatelybeforeorafterwork,atlunchtimeorduringworkbreaks.Itwillhelpifthepeopleprovidingchildcarearesupportiveofcontinuedbreastfeeding.
Youcantalktoyouremployeraboutwhatyouwillneedinordertocontinuebreastfeeding.AdviceforemployerscanbefoundintheleafletPromoting breastfeeding for mothers returning to work: a guide for employersatwww.pha.site/breastfeeding-mothers-returning-work-guide-employers
Feeding expressed breastmilk
Youcanexpressyourbreastmilksothatsomeoneelsecangiveittoyourbabywhileyouareatwork.Dependingonyourworkinghours,youmayneedtoexpressatwork,sothatyouhavemilktoleaveforyourbabyforthenextday.Expressingwillalsohelpstopyourbreastsgettingoverfullandmaintainyourmilksupply.
It’sagoodideatostartexpressingmilkandfreezingitafewweeksbeforeyoureturntowork,sothatyouhaveabackupsupplyincasethere’severatimeyoucan’texpressforsomereason.Atthesametime,youwillalsoneedtogetyourbabyusedtotakingexpressedmilk.Olderbreastfedbabiesmaybereluctanttoacceptabottleiftheyhaveneverhadonebefore,butwillhappilydrinkfromacup.Itmaybeeasierifsomeoneelsefeedsyourbabythiswayatfirst–breastfedbabiessometimesgetconfusedandcrossiftheirmotheroffersanexpressedfeed.
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Combining breastfeeding and formulafeeding
Youcouldalsobreastfeedyourbabywhenyouaretogetherandleaveformulaforwhenyouareapart.Providingbreastfeedingisalreadywellestablished,mostwomenfindthattheirbodiesquicklyadaptandthattheyhaveenoughmilktofeedintheeveningsandatweekends.
Ifyouchoosethisoption,youwillneedtostartpreparingaboutamonthbeforeyoureturntowork.Identifythebreastfeedsyouwillneedtosubstitutewithformulaandgraduallyreplacethem–onefeedeverythreedaysorso.Thiswillallowyourmilksupplytoadjustgradually–ifyoustopfeedssuddenlyyourbreastsmaybecomesoreandengorged.Aswithexpressing,youwillalsoneedtogetyourbabyusedtofeedingfromabottleorcup.
Breastfeeding and your employer
Thereislegislationinplacewhichmeansthatyouremployermustmakeitpossibleforyoutocontinuebreastfeedingwhenyougobacktowork.Youmustletthemknowinwritingthatyouintendtocontinuebreastfeeding.Fordetailsof
thespecificlegislation,seeourwebsitewww.breastfedbabies.orgordownloadtheleafletBreastfeeding and returning to workfromwww.pha.site/breastfeeding-returning-workTheHealthandSafetyExecutiveforNorthernIrelandcanalsoadviseyou.
Preparing for going back
Toqualifyforprotectionunderthecurrentlegislation,youmustinformyouremployerinwritingthatyouintendtocontinuebreastfeedingafteryoureturntowork.It’sagoodideatoletthemknowasearlyaspossible,toallowplentyoftimetomakearrangements.
Ifyouareplanningtoexpressmilkatwork,youwillneedtoarrangewithyouremployerhowyouaregoingtomanagethis.Therearehealthandsafetyguidelinescoveringbreastfeedingmothersatwork.Ideally,youshouldhaveaccessto:
• aclean,warmroomwithalow,comfortable chair.Ifthedoorcan’tbelocked,youcanputa signonittoensureprivacy.Thetoiletisnota suitableplace
• anelectricpointforanelectricpumpifnecessary
• handwashingfacilitiesnearby
• ahygienicareawhereyoucancleanyourpump andstoreyoursterilisingequipment
• afridgeforstoringmilk.Ifthisisdifficult,a well-insulatedcoolbagisanalternative.
Foradviceonhowtoexpressandstorebreastmilk,seepages31–34.You’llalsoneedtomakesurethatyourchildminderornurseryknowsthecorrectwaytostoreanduseyourbreastmilk.
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Your questionsabout breastfeeding
here are the answers!
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Here are some of the questions often asked by breastfeeding mothers.
My mother says that when she had me, she didn’t have enough milk to feed me. Will I have the same problems?
What about my diet when I’mbreastfeeding?
Thevastmajorityofwomenhaveenoughmilk,butifbreastfeedsaretimedorlimited,orifthepositioning’snotright,thenbuildingupagoodsupplymaybedifficult.Yourmothermayhavebeentoldtofeedtoaschedule(motherswere,atonetime),andthatcanbeharmfulforbreastfeeding;shemaynothavehadhelptoensureagoodposition.There’snoreasontothinkyouwillfacethesameproblems,especiallyifyougetanyhelpyouneedtogetbreastfeedingofftoagoodstart.
Youdon’tneedtoeatanythingspecialwhileyou’rebreastfeeding.Butit’sagoodideaforyou,justlikeeveryoneelse,toeatahealthydiet.Simplymakesureyoueataccordingtohunger,anddrinkaccordingtothirst.Eatavarietyoffoods,includingfiveormoreportionsoffruitandvegetables,alongwithwholemealbread,cereals,potatoes,riceandpasta,andlimityourintakeoffattyandsugaryfoods.Mostwomenfeelhungryandthirstyduringbreastfeeding.Thisprobablyreflectsthedemandsmadeonthebody.
Youdon’tneedtocontinuetoavoidthefoodsthatarenotrecommendedinpregnancysuchasliverorsoftcheese.However,theScientificAdvisoryCommitteeonNutrition(SACN)andtheCommitteeonToxicityadvisethatbreastfeedingwomen,likealladults,shouldnoteatmorethanoneportionaweekofshark,swordfishormarlin.Thisisbecausethesefishcontainmoremercurythanothertypesoffish.
It’sgoodtolookafteryourownhealthwhilebreastfeeding.Inordertogetallthenutrientsyouneed,youshouldconsidertakingsupplementscontaining10micrograms(mcg)ofvitaminDeachday.IfyouqualifyfortheHealthyStartscheme,you’reentitledtofreesupplements–askyourmidwifeorhealthvisitoraboutthis.TofindoutmoreaboutHealthyStart,visitwww.healthystart.nhs.uk
YourbabywillalsoneedasupplementofvitaminD.ThePHAleafletprovidesguidanceonwhyandhowmuchisneededforyouandyourbaby.Seewww.pha.site/vitamin-d
It’simportantnottoexcludewholefoodgroupsfromyourdietwhileyouarebreastfeedingwithoutseekingadvicefromahealthcareprofessional.
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What should I do if I smoke, and can Idrink alcohol while I’m breastfeeding?
My baby was jaundiced and very sleepy.He didn’t seem interested in feeding.He needed phototherapy (to go under avery bright light). What can I do if thishappens with my next baby?
Alcoholdoesreachthebreastmilk,butthere’snoevidenceyettoshowthatlightsocialdrinkingdoesanyharm.Lightsocialdrinkingmeansoneortwodrinks.
Ifyouoryourpartnersmoke,breastmilkisstillthehealthieroptionforyouandyourbabyandwillgiveyourbabyprotection.However,nicotinefromcigarettesdoesreachthebreastmilkandhasbeenshowntoreducethemilksupplyandcanmakeyoumorepronetomastitis.
Ifyouwouldlikehelptostopsmoking,visitwww.want2stop.infowherethereisinformationonlocalcessationservices.Youcanusenicotinereplacementtherapy(gumorpatches)whileyou’rebreastfeeding,butyoumusttalktoyourdoctorormidwifefirstifyouwanttotrythis.
Jaundiceisverycommoninnewbornbabies,particularlysleepybabieswhoarereluctanttofeed,andsomebabiesneedphototherapy.Feedyourbabyassoonasyoucanafterbirthandasoftenashewants.
Ifheissleepyanddoesnotwanttofeed,trytowakenhimandfeedhimmoreoftenorexpressandcupfeedhimsomeextrabreastmilk.Jaundicedbabiesmayneedmorebreastmilktoreplacefluidslostwithphototherapyandevenifhedoesnotneedtreatment,extrabreastmilkwillhelptoclearthejaundice.
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How do I wean my baby from the breast? Alwaysdothisgradually,unlessyouareswitchingtothebottleinthefirstdaysoflife.Substituteonebreastfeedeveryfewdayswithabottlefeed,or,ifyourbabyisoldenough,youcanusealiddedcup.
Ifyourbabyisoverayear,youmayhavetodistracthisattentionattimeswhenhewantstobreastfeed.
Can I breastfeed twins?
Can I breastfeed if I use drugs?
Yes–eventriplets!Youwillneedmorehelpwithotherjobs,asfeedingtwinscantakemoretime.Youmaketwiceasmuchmilkfortwinsbecauseyourbreastmilksupplygetstwicethestimulation.
Prescribedandover-the-countermedicationscanaffectbreastfeeding.Makesureyoutellyourdoctoryouarebreastfeedingifhe/sheprescribesmedication,oraskthepharmacist’sadviceifyou’rebuyingover-thecountermedicationssuchaspainkillersorcoldandfluremedies.
Thequalityofyourbreastmilkshouldnotbeaffectedifyouaregivenantidepressantmedicationforpostnataldepression.
Ifyouuseillegaldrugs,youcanbereferredforspecialisthelpinpregnancyandafterwards.Ifyouarearegularuser,andyou’retoldthereisariskyourbabymightsufferwithdrawalsymptomswhenheisborn,itcansometimesbereallyhelpfultoyourbabyifyoubreastfeed.Asktospeaktohealthprofessionalswithexperienceinsupportingmumswhousedrugs,andyouwillbeabletomakeachoicebasedongoodinformation.YoucanalsocalltheNationalDrugsHelplinefreeon0800776600.
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Further information,support and sources of help
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Local breastfeeding support groups
NorthernIrelandhasalmost70breastfeedinggroupswhichoffertheopportunitytotalkaboutfeedingyourbabyandprovidefriendshipandacupofteaorcoffee.Thesegroupsarereallyhelpfulifyoudon’tknowanyotherbreastfeedingmumsorifyouhaveaconcernaboutbreastfeeding.
Askyourmidwife,healthvisitororlocalSureStartteamwhereandwhenyourlocalgroupmeetsorvisitwww.breastfedbabies.org/supportforamapofgroupsinNorthernIreland.
Breastfeeding peer support (mother-to-mother support)Peersupportvolunteersaremotherswhohavethemselvesbreastfedandhavehadtrainingsothattheyareabletoofferbreastfeedinginformationandsupporttoothermothersintheirarea.
Tofindouthowyoucanspeaktoapeersupportmotheraskyourmidwifeorhealthvisitororcalloneofthesenumbers:
Mum-to-Mum,BelfastTrust02895044246
Mid Ulster Mums02886769994andwww.midulstermums.co.uk
Mums 4 Mums,Larne02828276044www.mums4mumslarne.co.uk
Southern Trust Breastfeeding Peer Support volunteer schemeCraigavonAreaHospital07795426923(voicemail)DaisyHillHospital07823532306(voicemail)
Western Trust Breastfeeding Peer Support Londonderryandwiderarea02871345171ext3233orbleep8230
Northern Trust Breastfeeding Peer Support Thisgrouphasjustrecentlystarted.ForfurtherdetailspleasecontactPaulineMcKeown,BreastfeedingCoordinatoron07833463373.
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Telephone support from a breastfeeding counsellorIfyouareconcernedaboutbreastfeedingyoucanalsospeaktoabreastfeedingcounsellorbycallingoneofthesehelplinenumbers:
NationalBreastfeedingHelpline03001000212(9.30am-9.30pm)
LaLecheLeague08451202918(24hours)
BreastfeedingNetwork03001000210
NationalChildbirthTrust03003300771(8.00am-12.00midnight)
Other organisations and support groups
UNICEF UK Baby Friendly Initiative30aGreatSuttonStreetLondonEC1V0DU02074902388www.babyfriendly.org.uk
Visitthewebsiteforinformationonbreastfeeding,andfordetailsabouttheBabyFriendlyInitiativewhichaimstoensurethatbreastfeedingmothersinhospitalandoutsidegettherightsortofsupport.
Tiny LifeTheArchesCentre11-13BloomfieldAvenueBelfastBT55AA02890815050www.tinylife.org.ukSupportforparentsofprematurebabiesandbreastpumphire.
YoucanalsocheckoutthelocalsupportgroupsforbreastfeedingmumsonFacebookbysearchingfor‘breastfeedinginNorthernIreland’.
Wecannotguaranteethequalityorsafetyofinformationprovided
byotherorganisations,whetheronlineoratbreastfeedinggroups.
Signpostingtotheseresourcesandorganisationsdoesnot
necessarilyimplyendorsementbythePHA.
TheHumanMilkBankarealwayslookingfordonorstodonatetheirbreastmilktoneonatalunitscaringforillorprematurebabies.Ifyoufeelthatyouwouldliketocontributetothisworthwhilecauseorwouldlikemoreinformation,callthemilkbankon02868628333oremail:[email protected]
Youmaywanttolinkwithotherbreastfeedingmumsonline.TheBreastfeedinginNIFacebookpageisanonlinecommunitywithover8,000breastfeedingmotherswww.facebook.com/BreastfeedinginNI/
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Glossary
Here’s a handy glossary of termsyou’ll come across in this booklet and in other
discussions about feeding.
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Glossary
Here’s a handy glossary of termsyou’ll come across in this booklet and in other
discussions about feeding.
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Appendix
Alveoli:tinystructuresinthebreastwhichactuallymakeandstorethemilk.
Areola (plural, areolae):thecolouredskinsurroundingyournipple.Strictlyspeaking,thenippleisonlytheendbit.Differentwomenhavedifferent-sizedareolae,whichiswhyitismisleadingtosaythebaby‘shouldhave’alltheareolainhismouthwhenfeeding.
Baby Friendly Initiative:UNICEF/WHOprogrammewhichaimstoensurethathealthprofessionalsandtheplaceswheretheyworkfollowpracticeswhichsupportawoman’schoicetobreastfeed.
Blocked ducts:aductinthebreastcanbecomecloggedandpreventafreeflowofmilk(seepage40).
Colostrum:thefirstfluidproducedinthebreasts,inlaterpregnancyandforthefirstdaysafterbirth.
Engorgement:swellingofthebreast,becauseofextramilk,bloodandlymph(seepage40).
Exclusive breastfeeding:breastfeedingonlywithnootherfluidsorfoodsgiventothebaby.
Expressing:removingthebreastmilkbyhandorpump.
Inhibitory factor:asubstanceinthemilkwhichpreventsmilkbeingproduced;ifalotofmilkisleftinthebreastforalongtime,theinhibitoryfactorhasmoretimetowork,andthereforemilkproductionslowsdown.
Latched on:whenababyis‘latchedon’heiswell-positionedandattached.
Let-down reflex:underoxytocin,thelet-downreflexhappensinsidethebreast,andmakestinymusclecellssurroundingthealveolipushthemilkoutintotheducts(seepage20).
Mastitis:inflammationofthebreast(seepage43).
Mixed feeding:thisusedtomeansolidsalongsidebreastmilk/formulamilk.Nowitusuallymeansfeedingwithformulamilkandbreastmilk.
Oxytocin:thehormonewhichproducesthelet-downreflex(seeabove).
Placenta:theafterbirth.Oncetheplacentaisdelivered,thebreastsreceivethehormonaltriggertoproducebreastmilk.
Positioning and attachment:gettingthisright(seepages17–18)ensuresyoudonothaveanypainandyourbabyhasagoodfeed.
Prolactin:themilk-makinghormone,producedatthestartofbreastfeeding.Prolactinlevelsarehighatfirst,andthenfallasbreastfeedingbecomeswellestablished.
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Appendix
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Checklist: how can I tell that breastfeeding is going well?
Breastfeeding is going well when:
Yourbabyhaseightfeedsormorein24hours
Yourbabyisfeedingforbetweenfiveand30minutesateachfeed
Yourbabyhasnormalskincolour
Yourbabyisgenerallycalmandrelaxedwhistfeedingandiscontentaftermostfeeds
Yourbabyhaswetanddirtynappies(seepage22)
Breastfeedingiscomfortable
Whenyourbabyisthreetofourdaysoldandbeyondyoushouldbeabletohearyourbabyswallowingfrequentlyduringthefeed
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Talk to your midwife if:
Yourbabyissleepyandhashadlessthansixfeedsin24hours
YourbabyconsistentlyfeedsforfiveminutesorlessateachfeedYourbabyconsistentlyfeedsforlongerthan40minutesateachfeed
Yourbabyalwaysfallsasleeponthebreastand/orneverfinishesthefeedhimself
Yourbabyappearsjaundiced(yellowdiscolourationoftheskin)Mostjaundiceinbabiesisnotharmful.However,itisimportanttocheckyourbabyforanysignsofyellowcolouring,particularlyduringthefirstweekoflife.Theyellowcolourwillusuallyappeararoundthefaceandforeheadfirstandthenspreadtothebody,armsandlegs.Agoodtimetocheckiswhenyouarechanginganappyorclothes.Fromtimetotimepressyourbaby’sskingentlytoseeifyoucanseeayellowtingedeveloping.Alsocheckthewhitesofyourbaby’seyeswhentheyareopenandtheinsideofhis/hermouthwhenopentoseeifthesides,gumsorroofofthemouthlookyellow.
Yourbabycomesonandoffthebreastfrequentlyduringthefeedorrefusestobreastfeed
Yourbabyisnothavingthewetanddirtynappiesexplainedonpage22
Youarehavingpaininyourbreastsornipples,whichdoesn’tdisappearafterthebaby’sfirstfewsucks.Yournipplecomesoutofthebaby’smouthlookingpinchedorflattenedononeside
Youcannottellifyourbabyisswallowinganymilkwhenyourbabyisthreetofourdaysoldandbeyond
Youthinkyourbabyneedsadummy
Youfeelyouneedtogiveyourbabyformulamilk
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Thisbookletcannotcoverallaspectsofbreastfeeding,
soifyouneedmoreinformationyourmidwife,healthvisitor,
breastfeedingcounsellorordoctorwillbeabletoadviseyou.
However,itshouldhelptomakeyoufeelmoreconfident
aboutbreastfeedingandabletoenjoythisexperience
withyourbaby.
Off to a good startALL YOU NEED TO KNOW ABOUT BREASTFEEDING YOUR BABY
01/19
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