Getting started with breastfeeding
Getting started with breastfeeding
What to expect when establishing breastfeeding – from your baby’s first feed after birth and finding comfortable nursing positions, to where and when to seek support with breastfeeding problems.
- The first feed
- Breastfeeding positions
- Colostrum vs mature milk
- Feeding cues
- How often will my baby breastfeed?
- When should I seek help?
- Where to find breastfeeding support
- Taking medicines while breastfeeding
- Coronavirus update
Breastfeeding may be natural, but that doesn’t mean it’s easy. If you and your baby are breastfeeding beginners, it will probably take time and a lot of practice for you both to get the hang of nursing after the birth.
Your breastfeeding journey starts with your baby’s first feed, which usually happens within an hour of the birth. The ideal way to get things started is by having your naked baby on your bare chest as soon as possible.
Skin-to-skin contact is important because it:
- stimulates your baby’s feeding instinct
- makes your baby feel calm and regulates their body temperature
- helps you produce more breastfeeding hormones, which increases your milk production.
If you have a vaginal birth, the midwife or doctor will usually place your baby straight on your chest when they’re born. Your baby may even start to feed before the umbilical cord has been clamped.
If your baby is born through a c-section you should also be able to have your baby skin-to-skin very quickly, often while you’re still in the operating theatre.
While most midwives and obstetricians will offer you skin-to-skin by default after the birth, it’s still a good idea to include it in your birth plan so everyone who looks after you knows it’s something you’re keen to do.
When your baby is lying on your bare chest after the birth, they may start rooting for your nipple and even latch on to your breast by themselves without much input from you. However, many new mums and babies do need a bit of help at first, especially if the birth was long and tiring.
Your midwife will stay in the room with you after the birth to make sure that the first feed goes well and answer any questions you have, so you won’t have to figure it all out on your own.
Talk to the midwives if you’re having trouble latching your baby – either if it’s painful, or if your baby doesn’t seem to be able to take milk or they aren’t interested in feeding. You may need some tips on positioning, or your baby could have a tongue tie that needs treatment in order for breastfeeding to work as well as possible.
There isn’t any one breastfeeding position that is ‘right’ – it all comes down to what is comfortable for you and your baby. How you position your newborn while feeding can depend on:
- the type of birth you had (for example, some positions can be painful after a c-section birth)
- the size and shape of your breasts and nipples
- whether your baby needs help to hold their head in position.
Here are a few of the most common breastfeeding positions you may like to try:
When you first start breastfeeding, you’ll make a very concentrated nutritious liquid called colostrum. It’s yellow in colour and perfect for newborn babies as their stomachs are very small, so they can only take in a small amount of milk at a time.
After a few days, usually by day five, the colostrum will change into mature milk which is white in colour and more watery. This is known as your milk ‘coming in’ and when it happens, you may find your breasts suddenly feel very full and warm, or engorged.
Try to feed your baby whenever your breasts feel full, as it can help prevent breastfeeding problems like blocked ducts and mastitis.
Most people imagine a baby will scream to let you know that they’re hungry, but babies can also show earlier and far more subtle feeding cues.
You baby may be looking for a feed if they:
- wake up and act restless
- suck their fingers or fist
- stick their tongue out
- make smacking or sucking sounds
- root for your nipple by turning their head and opening their mouth.
In the early weeks, your baby will need to feed often, both in the day and during the night. You can expect your baby to want to feed every three hours or more, so at least eight times a day.
It’s best to feed your baby any time they show that they want to, or when your breasts are full or you just feel like a snuggle. It can be good to know that it’s not possible to overfeed a breastfed baby – they’ll simply unlatch when they’ve had enough.
It takes around six weeks for breastfeeding to be established and it’s not at all unusual to experience breastfeeding problems of some sort in this time, or even later on.
Getting the right help when you’re having difficulties can often make the difference between being able to continue breastfeeding for as long as you want and having to stop breastfeeding before you’re ready.
Below are a few examples of situations where it’s a good idea to seek help, but it’s important to remember that you know your own body and your baby best – if you feel like something is wrong, it’s always worth asking for support.
Talk to your midwife, health visitor, GP or another professional if:
- Your newborn baby seems very sleepy and not interested in feeding. Alternatively, if they go a very long time between feeds in the early days. This can be a sign that your baby is not getting enough milk.
- You’re in pain when breastfeeding. Breastfeeding can feel strange and uncomfortable, but it shouldn’t be painful or make your nipples crack or bleed. If you are in pain, it can be a sign that your baby’s latch needs to be improved or that you have an infection.
- Your breast is tender, warm and red (especially if you’re feeling feverish). This can be a sign of a blocked duct or mastitis. Both are very common in the early weeks, but can quickly get better with the right treatment.
There are a number of people at your maternity unit and in the local community, as well as online and over the phone, who you can turn to for help with breastfeeding – whether that’s the day after you’ve given birth or a year down the line.
If you’re staying on a postnatal ward after the birth, there should be midwives available to help you with breastfeeding at any time of the day or night.
You may have a buzzer which you can press to get assistance if you’re unable to pick up your baby or need help getting into a comfortable position for feeding, for example if you’re unable to move after a c-section.
Infant feeding coordinator
In addition to the midwives, a lot of maternity hospitals have staff members with additional training and responsibility for breastfeeding. These specialists are known as lactation consultants or ‘infant feeding coordinators’.
You can ask to speak to the infant feeding coordinator at your local hospital if you feel you don’t get the right support from the midwives on the postnatal ward, you experience complex breastfeeding problems or your baby has to spend some time in NICU.
To be sure that you’re receiving advice from someone with the necessary qualifications, you can ask if the coordinator is an International Board Certified Lactation Consultant (IBCLC). This is the highest level of breastfeeding support available.
Your community midwife
Once you’ve gone home from the labour ward or birth centre, or if you had a home birth, you should have been given contact details for midwives so you can call them if you’re having problems with breastfeeding after the initial feed.
At your postnatal appointments, your midwife will check that your baby’s having wet and dirty nappies and gaining weight (good indications that they’re getting enough milk) and that feeding isn’t painful for you.
Your health visitor
You’ll probably be advised to see your health visitor to have your baby weighed once a month, and that’s a good time to ask any breastfeeding questions you may have.
You can also contact your health visitor in between the monthly appointments if you have any queries or concerns.
You can turn to your GP if you have any medical issues that you think may be breastfeeding related, for example if you think you’re suffering from mastitis. Likewise, if your baby seems to be having problems that require medication, the GP can prescribe the necessary treatment.
NHS breastfeeding clinics
A lot of hospitals run daily or weekly breastfeeding clinics where you can take your baby to be assessed for tongue-tie, get advice on latch and positioning, or simply find someone to talk to about breastfeeding without needing to have an appointment.
You can ask your midwife or health visitor what breastfeeding clinics are available in your area.
Peer breastfeeding groups
Many organisations, for example La Leche League and NCT, arrange free meet-ups for new and expectant parents. You may find it useful to go along to their meetings, for support and reassurance from other breastfeeding mums.
This map of breastfeeding support groups can be a good starting point to find a group near you.
Breastfeeding helplines and online groups
If you don’t have any groups around you, or simply don’t feel like leaving your home (completely understandable – especially if you’ve just given birth), you may like to join some of the many breastfeeding groups and pages on Facebook and other social media channels.
Many organisations also have helplines that you can call. These are often run by breastfeeding counsellors, women who have breastfed their own babies and undergone a training programme to be able to help with breastfeeding queries.
Private breastfeeding practitioners
While many women feel they get enough free support, other new mothers may not find the help they need to continue breastfeeding for as long as they wish.
A private practitioner that you pay for may be able to spend more time helping you to breastfeed than NHS staff. And while you may have to wait weeks to have your baby’s tongue-tie corrected on the NHS in some areas, a private practitioner can often do this within days.
If you’re looking into private breastfeeding support, make sure you ask what qualifications the person advising you has. Ideally, you want to see someone who is an IBCLC so you know they’re qualified to help you.
Right after you’ve given birth, the midwives and doctors will make sure that any painkillers you’re prescribed are safe for breastfeeding. As your baby gets older, make sure you mention that you’re breastfeeding whenever you go to see your GP, so you’re given medicines that are safe for your baby.
What should I do if I’ve been told I need to take a medicine that is incompatible with breastfeeding?
Before you make any decision to stop or pause breastfeeding, it’s important that you find out:
- if the medicine you’ve been prescribed actually is incompatible with breastfeeding, and
- if there is an alternative medicine that is safe for breastfeeding that you can be prescribed instead.
To make sure that the information you’ve been given by your doctor is correct and up to date, you can check with The Breastfeeding Network. It’s run by pharmacists and has drug factsheets where you can look up the safety of the most common medicines and alternatives.
For any more specific questions on medications, you can contact The Breastfeeding Network’s volunteer team of qualified pharmacists on social media or by email for personal advice and help.
The Royal College of Obstetricians and Gynaecologists (RCOG) has said there is no evidence that the coronavirus can be carried in breastmilk. Mothers with suspected or confirmed coronavirus can continue to breastfeed.
The RCOG says that the main risk of breastfeeding is the close contact between mother and baby, which could lead to infection through airborne droplets. They recommend discussing the risks and benefits of breastfeeding with your family and maternity team.
If you choose to breastfeed your baby, the following precautions are recommended:
- Wash your hands before touching your baby, breast pump or bottles
- Try and avoid coughing or sneezing on your baby while feeding at the breast
- Consider wearing a face mask while breastfeeding, if available
- Follow recommendations for pump cleaning after each use
- Consider asking someone who is well to feed expressed breast milk to your baby
- Sterilise all feeding equipment according to NHS guidelines
- If you are expressing milk in hospital, a dedicated breast pump should be used
Content last updated 23/03/2020. Please check out Royal College of Obstetricians and Gynaecologists for any more recent updates.