Breastfeeding

Breastfeeding is the best way to feed your baby. Breastmilk provides the perfect nutrition to match your baby’s needs for growth and development. Colostrum, the breastmilk produced in the first few days after birth, is especially rich in nutrients and immune components that help protect your baby from infection.

Why breastfeeding is important#

Breastfeeding helps you bond with your baby and reduces the risk of many health problems. For your baby, it can lower the risk of:

• middle-ear, gastrointestinal, urinary and respiratory infections
• asthma, allergies and eczema
• diarrhoeal disease
• juvenile diabetes and childhood obesity
• some childhood cancers
• sudden unexpected death in infants (SUDI), which includes sudden infant death syndrome (SIDS)

Breastfeeding also benefits you. It can help your uterus return to its pre-pregnancy size more quickly and may reduce your risk of breast cancer, ovarian cancer and osteoporosis. It is also convenient and costs less than formula feeding.

Getting started#

If you plan to breastfeed, you will be encouraged to start within one hour of birth where possible. Early skin-to-skin contact between you and your baby also helps breastfeeding to get under way.

Even if you do not plan to breastfeed, skin-to-skin contact soon after birth is important for you and your baby. Some women feel disappointed or wonder what happened if they are unable to breastfeed, or stop sooner than they had hoped. Help is available if you would like to talk to someone about how you feel.

If you formula feed#

If you choose not to breastfeed, a midwife can help you feed your baby. It is important to:

• choose a formula suitable for your baby’s age – babies under 12 months need infant formula
• sterilise all equipment used to prepare feeds and to feed your baby
• make up and store the formula exactly as stated on the packaging
• learn how to prepare feeds safely and to watch for your baby’s feeding cues

Positioning and attachment#

Positioning and attachment come naturally to some babies and mothers, but many need time and practice. The following tips may help:

• Have skin-to-skin contact with your baby and feed soon after birth, ideally within the first hour. Your milk supply usually increases between 24 and 72 hours after birth – this is often called your milk “coming in”. Babies need to feed often, usually 8 to 12 times in 24 hours.
• Hold your baby fully facing you and close to your body. Touch the area between your baby’s nose and mouth with your nipple to encourage a wide-open mouth, ready to take in the nipple and surrounding breast.
• Breastfeeding can be a little uncomfortable at first. If you feel pain, break the suction by gently slipping a clean finger into the corner of your baby’s mouth, then try again. Re-attaching your baby often helps.
• If your baby has difficulty attaching, hand express your breastmilk and give it to them. For most women, learning to breastfeed takes some time, so don’t be afraid to ask for help.

How often your baby will feed#

Young babies feed more easily when you respond to their early feeding cues, so try to delay changing the nappy until after a feed. Crying is a late sign of hunger – try to respond before your baby becomes distressed. Avoid giving dummies, teats or fluids other than breastmilk unless a health professional has advised it.

Each baby is different, but a young baby usually needs to feed 8 to 12 times in 24 hours. Your milk supply adjusts to your baby’s needs, so it helps to feed whenever they are ready.

Signs that your baby is feeding well include:

• short, frequent sucks at first to stimulate the milk flow, then slower, more rhythmic sucking with rest periods between bursts; as the feed goes on, the bursts get shorter and the rests longer
• you can hear or see your baby swallowing
• 6 to 8 wet cloth nappies, or 4 to 5 heavy disposable nappies, in 24 hours
• soft bowel motions, usually at least one a day in the first 3 months
• settling after most feeds
• bright eyes and good skin tone
• weight gain appropriate for their age

How long to breastfeed#

The World Health Organization and health professionals recommend exclusive breastfeeding for about 6 months, gradually introducing suitable solids in the second 6 months, and continuing breastfeeding to 2 years or beyond. If you are thinking about stopping, talk with your maternal and child health nurse or another care provider, as there may be options such as partial breastfeeding.

Weaning#

Weaning begins once you start to supplement your baby’s diet with anything other than breastmilk – such as water, juice, solids or other milks – and is complete once your baby no longer feeds from the breast. This may be mutual, baby-led (your baby decides to stop) or mother-led (you decide it is time to stop).

Sometimes a baby decides not to breastfeed for a while. This may be temporary, so contact a breastfeeding counsellor for advice. If your baby is stopping permanently, you may feel a mixture of emotions, including rejection, disappointment and sadness. If you need help with these feelings, talk with a breastfeeding counsellor or your health care provider.

You may decide to stop breastfeeding for many reasons, such as returning to work (you can be supported to keep breastfeeding and leave expressed milk for your baby), wanting to become pregnant again, medical reasons, or simply feeling ready to stop.

It is ideal, for both mother and baby, to wean gradually. As you drop feeds – about one every few days – your milk supply slowly decreases, which lowers the risk of blocked ducts and gives you and your baby time to adjust. If your breasts become too full after dropping a feed, it is fine to do an extra breastfeed or to relieve the fullness.

Getting support#

Breastfeeding does not always come easily, and it is important for you, your baby and your family to seek the support you need – whether to help you get started or to deal with difficulties. Support can come from your partner and family, your maternal and child health nurse, your doctor or midwife, lactation consultants, breastfeeding counsellors and breastfeeding support organisations.

Many products claim to improve milk supply, but there is very little scientific evidence that lactation biscuits, cookies or powders increase the amount of breastmilk you make.

It can help to learn about breastfeeding and attend breastfeeding classes while you are pregnant, ideally with your partner. Classes may cover feeding techniques, common myths and feelings about breastfeeding. They are a good way to build confidence, set expectations and ask any questions before your baby is born.

How partners can help#

Partners can do a lot to support breastfeeding mothers through the difficult patches by believing in their partner’s ability to breastfeed and taking an active role in day-to-day care. Taking the baby for a walk, cuddling, changing nappies or bathing the baby helps partners get to know their baby and gives you a rest and some time for yourself.

Breastfeeding problems#

Mastitis#

Mastitis is inflammation of the breast, commonly caused by trying to slow the milk supply too quickly. Symptoms include feeling feverish and unwell (hot and cold, with aching joints), a sore, hard area of the breast and a patch of red skin.

If you notice these symptoms:

• Keep breastfeeding or expressing – it is safe and helps the affected breast drain.
• Use warm packs or a warm shower to help the milk flow.
• Gently massage any breast lumps, for example while feeding, expressing or in the shower.
• Use a cool pack after feeding to ease discomfort and reduce swelling.
• Drink water when thirsty and rest as much as you can.
• Take paracetamol (acetaminophen) or ibuprofen for pain relief.

If symptoms continue for more than a few hours, see your doctor, and mention that you think you have mastitis when you make the appointment. Mastitis is easy to treat but can become serious if left untreated. Your doctor may prescribe antibiotics that are safe to take while breastfeeding.

Other problems#

Other breastfeeding problems can include blocked milk ducts, nipple damage, poor attachment, breasts that are too full (for example, from going too long between feeds), wearing a bra that is too tight, breast and nipple thrush, nipple vasospasm (tightened blood vessels), inverted or flat nipples, low milk supply and tongue-tie.

Fertility, sex and everyday life#

For most women who breastfeed, the return of fertility is delayed, which helps with spacing pregnancies. However, some women can become pregnant while breastfeeding, so if it is important not to conceive, seek family planning advice.

Having a baby almost always changes your sex life, however your baby is fed. Recovery from childbirth takes time, and being a new mother can be exhausting. Many breastfeeding women have an enjoyable sex life, while some find their interest in sex is lower while feeding, often because of tiredness. Be patient and talk with your partner about how you feel.

Breastfed babies are very portable. You can take your baby along to many of your usual activities, or store expressed milk in the fridge or freezer for a carer to feed your baby.

Most medicines are safe to take while breastfeeding, but let your doctor or pharmacist know you are breastfeeding so they can check that anything prescribed for you is suitable. Also tell your health care provider about everything you take, including over-the-counter and herbal medicines, as well as substances such as nicotine and alcohol.

Key points#

• Discuss with your midwife and other pregnancy carers how you will feed your baby.
• It is important to learn how to safely prepare feeds and to watch your baby’s feeding cues.
• If you formula feed, choose a formula suitable for your baby’s age.
• Make up and store formula exactly as stated on the packaging.
• Weaning gradually reduces the risk of blocked ducts and gives you both time to adjust.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).