Author Name:
Midwife Sharon Trotter

Biography:
Sharon trained as a general nurse at the Dorset School of Nursing in 1979. She moved to London in 1983 to complete her midwifery training at Queen Charlottes Maternity Hospital and following her marriage to Aidan in 1984, they moved to Scotland. They now live on the west coast, where Sharon has worked at the local maternity unit for over 20 years, in between bringing up their four children. Sharon has recently returned to Paisley University to complete her BSc in Advanced Studies in Midwifery and is due to graduate later this year. Her first publication, Breastfeeding: the essential guide gives for parents and professionals and is the result of many years work.

I was told that it is important to feed my baby within the first hour of life. Why is this and what other factors will help us to succeed?
Answer:

• Whatever type of birth you experience, you will hopefully be encouraged to have immediate skin-to-skin contact with your baby. The benefits of early skin-to-skin contact cannot be underestimated and research shows that it greatly increases the success of breastfeeding. You should try to feed your baby, with help if needed, as soon as he looks interested. This is usually within an hour of birth, when the baby is wide awake and you will still be awake with excitement! If your baby is traumatised, as a result of the birth, breastfeeding, and skin-to-skin contact, will actually provide pain relief and stabilise his heartrate and temperature.
• Getting comfortable before feeding is THE most important piece of advice I can give you! This is no easy task in the early days, but well worth spending time getting right. If you have had a caesarean section or are feeling too sore to sit, then lie down on your side. If sitting, I found the V-shaped pillows a great help, especially as a support for your back. For perineal pain, there are now cooling gel pads (feme pads) that alleviate discomfort. Pain killers should also be offered in the maternity unit. If not, ask!
• There is much written about how to position your baby but I have found that the best way is also the most natural way. By cuddling your baby close and turning his whole body towards you, this brings his nose in line with your nipple. This allows the baby’s mouth/cheek to be in contact with the breast and increases the chances of successful breastfeeding. This is also known as biological nurturing, which describes the instinctive ways in which women and babies respond to each other whilst breastfeeding. A baby will naturally tilt his head while feeding and this is why you do not need to hold onto his head (except gentle support). His bottom lip and chin will touch your breast first and this stimulates him to open his mouth and get a good mouthful. More areola (darkened area around the nipple) will be seen above the top lip than below the chin.
• NEVER let the baby suckle on the nipple alone as this will become very painful – the baby gets milk by squeezing the ducts around the nipple and not from the nipple itself.
• You may want to bring the nipple out slightly by using your thumb and forefinger to roll it. This may express a little colostrum (first milk), which will tempt the baby to fix onto the breast.
• Alternatively, stroke the baby’s lips/cheek with your nipple and this will stimulate him to open his mouth wide enough to take a good mouthful. This is called attachment (sometimes referred to fixing or latching) and once achieved you can relax and enjoy!
• Although breastfeeding should be painfree, some women find it to be a toe-tingling experience during the first few seconds. This is perfectly normal and should subside as your nipples become used to the new sensation. A good way to check correct attachment is to look at the shape of the nipple after a feed. There should not be any sign of distortion, squashing or blistering.
• I cannot emphasise enough how important these first feeds are in establishing good positioning and attachment techniques. It will take a little while to get it right but once you have , it is like riding a bike – the rest will follow.
• Following a breastfeed, you may find you bleed more. This is because, during the feed, the uterus contracts (similar to when you were in labour – often called ‘after pains’). This is due to the release of hormones while feeding and helps your uterus go back to its pre-pregnant size quickly. It is nothing to worry about as long as it is not associated with large clots or very heavy bleeding. Should this happen, contact your midwife. The bleeding will gradually lessen and change colour from pink to brown. It should have stopped by six weeks postnatally.
  
  What happens during a breastfeed?
  Answer:
• Once your baby has attached to the breast correctly, and you are comfortable, he will begin to suck. This sensation may seem strange at first, but should be completely painfree.
• You will notice his jaw moving in time with his sucking.
• This sends a message to the brain and back to the breast for the ‘let-down’ of milk to occur.
• This takes about one to two minutes and may be associated with a tingling sensation as your breasts fill with milk.
• As your baby sucks, you will hear the milk being swallowed and sometimes even gulping noises.
• The baby’s sucking now becomes deeper and slower as he takes his milk feed.
• By the end of the feed the baby will hardly suck at all, except for slight fluttery movements. These are important and will be still be stimulating your breasts. Let the baby continue until he lets go of the breast or falls asleep.
• The first part of the feed is watery and quenches your baby’s thirst. This is sometimes referred to as ‘foremilk’.
• The second part of the feed is more creamy and higher in calories. This satisfies your baby’s need for calories and is sometimes referred to as ‘hind milk’.
• Try not to get confused with colostrum, foremilk and hind milk. They all combine to form the perfect combination of breast milk which adapts to the changing needs of your baby.
• What is important though, is to complete the whole feed from each breast. If the baby gets only foremilk, it could cause him to become unsatisfied and may lead to colic.
• You will know when your breasts are empty, because they will become much softer to touch and the feeling of fullness will lessen as the feed progresses. The best way to judge is to look at the baby, who is usually flat-out when they have emptied a breast.
• Once the feed nears an end, the sucking pattern will become shallow and intermittent. When ready, the baby will let go of the breast and may fall asleep. If the baby does not let go by himself, you can put a clean finger into the side of his mouth to break the suction and release the nipple. Try not to just pull the baby from the nipple as you may become sore, especially when the teeth start to appear. I know this to be true from bitter experience!
• As a rule, there is no need to ‘wind’ a breastfed baby as he will usually bring up any wind naturally. However, if you think your baby is uncomfortable, you could sit him up and support his chin under your hand, keeping his back straight. This will allow any wind to be passed easily. Alternatively, you could put your baby over your shoulder, which will have the same effect – do not forget to protect your shoulder first.
• Breastfed babies are not often sick, but they may bring up a mouthful of milk at the end of a feed.
• If the baby is still hungry, then change over to the other breast and let him feed until he has had enough.
  ©Sharon Trotter@ www.tipslimited.com
  
  Why is it so important to not offer any formula feeds in the first few days of
  breastfeeding?
  Answer:
• It is vital to allow completely unrestricted feeding as this will stimulate your breasts to produce milk. This takes between 2-4 days depending on how frequently you put the baby to the breast. This is called: ‘the milk coming in’.
• Do not worry that your baby will starve before the milk comes in. He will be getting colostrum (first milk), which is full of antibodies and high in protein. It is also important because it helps the passage of the meconium (first stool) through the gut of your baby. This will change colour from dark brown to green to yellow and have ‘mustard seed’appearance by the third to fourth day. Breastfed babies’ stools will remain like this until mixed feeding begins and must not be confused with diarrhoea.
• Do NOT be tempted to supplement with a bottle of formula milk. Your baby does not need this and it may well confuse him. If he sees how easy it is to get milk from a teat , he may be reluctant to feed from the breast in future. Some people may try to tell you that large babies will be harder to feed and that they need extra formula. This is not the case and your breasts will provide exactly the right amount of milk, whatever the size of your baby. My children ranged in weight from 8lbs 3ozs to 12lbs 2ozs at birth and were all exclusively breastfed until four months and thereafter for one to three years.
• If you do introduce formula feeds early on, you run the risk of sensitising your baby’s system, which could lead to the early onset of allergic reactions. These include asthma, eczema, hayfever and many more. This can occur after only one bottle of formula milk.
• The use of dummies or pacifiers is not encouraged as this tends to just confuse or frustrate breastfed babies. A clean finger can always be used in an emergency.
• Keep your baby close to you and sleep when he sleeps, to try and conserve your energy. Let your partner help if you need a break. He can let the baby suck on his clean finger or pace the floors for a time, while you have a bath or go to the toilet in peace.
• Your breasts will get noticeably larger and tense when your milk ‘comes in’ (this is known as engorgement) and will probably leak on one side as you feed from the other – this is when the breastpads come in useful.
• Let the baby complete a feed from one breast until he has had enough and lets go. If you take him off half way through a feed, he will not empty the breast properly, which could cause problems later.
• Move over to the second breast , if the baby is still looking for more. If he is sound asleep, leave him to wake up naturally and give him the second breast next time.
• If your baby is very sleepy or affected by drugs from the labour, you should initially feed him three hourly until the effects wear off. You could try changing his nappy to wake him up. If you think he has still not taken a good feed, you could try changing him after each side. Alternatively you could give him some expressed milk from a spoon or cup. This phase should be short-lived.
• The baby will naturally lose about 10% of his birthweight in the first two to three days. This is perfectly normal – he has enough fat stores to deal with this loss. Once the milk ‘comes in’, he should start to regain this and by ten to 14 days will probably be back to his birthweight.
• A lot of babies become jaundiced (yellow tinged skin colour) in the first week of life. This is called physiological jaundice and should have disappeared by 14 days. This is caused by the breakdown of the red blood cells that were at a high level prior to birth (allowing for maximum oxygen levels during labour). Breastfeeding will help to flush out the by-products of this breakdown, so the condition will correct itself. Extra supplements of water or formula milk are NOT necessary. Sometimes the baby will be more sleepy as a result of jaundice. In this instance, it is advisable to wake the baby up for frequent feeds until the jaundice has passed.
• Never time your feeds – it is not necessary.
• You may find it useful to write down which side you have fed on as it is easy to forget. Alternatively you could leave a breastpad in the side you are due to feed from next.
• This can be an exhausting time, but will also be very rewarding. Try to make the most of these precious few days by getting to know your new baby.
• Get as much help as possible and get your partner to do any household chores. This is when the ready meals and takeaways come into their own. Older children can also help out and toddlers will enjoy being spoiled by grandparents or friends. Prioritise and remember that most things can wait, whereas your new baby cannot!
• When it comes to friends and family visiting, it is up to you to set the ground rules. Especially in the first few days, when you are trying to establish feeding, keep visitors to the absolute minimum. People will understand and can see you all at a later date. If you are embarassed about feeding in public, give yourself time and your confidence will grow daily. Once you have settled into breastfeeding, you will be surprised at how easy it is to feed anywhere, without having to expose yourself to anyone. This is where your partner can help, by giving you the time and space required to establish a feeding pattern.
• Gradually, by feeding on demand you will fall into some sort of routine (although it will be like no other you have experienced before). This is when you stand at your bedroom window at 3am in the morning and wonder if you are the only person awake – you are not!
  
  ©Sharon Trotter@ www.tipslimited.com
  
  My baby is jaundiced and seems to be too sleepy to feed. Why is this and how can breastfeeding help?
  Answer:
  In order to understand why your baby is sleepy, you need to know the causes and treatment of jaundice itself.
  To provide extra oxygen during the stressful period of labour and birth, a baby’s blood contains many more red blood cells than usual. In the first few days after birth, these red blood cells are broken down in the reticuloendothelial system (liver, spleen and bone marrow). The resultant waste product called bilirubin rises and is the cause of the yellow skin your baby displays. This is called jaundice and can even the white (sclera) of the eye can become discoloured. Following various chemical processes the baby combines the bilirubin with proteins so that it can be safely excreted via the liver and kidneys.
  Physiological jaundice, as it is known, is very common and affects about 30% of all babies. It occurs around the 3rd day and is usually clear by the 10th-14th day, without any long-term consequences. Jaundice is observed using simple colour charts (icterometer) and if the colour deepens a heel prick blood test will be carried out. This is called a serum bilirubin (SBR). Serum bilirubin levels are checked once or twice daily and as long as they do not rise above 250-300 mmol/litre no treatment is required. Each hospital will have in place a set of guidelines that are followed in order to highlight any potential problems.
  If levels rise above this, there can be a risk of brain damage, which is why it is so important to monitor bilirubin levels regularly. Phototherapy helps to speed the process of bilirubin breakdown, thus bringing it back to normal.
  Phototherapy consists of a set of fluorescent strip lights that provide blue light. This is either placed over the cot/incubator or as a mattress (called a bilibed) that the baby lies on top of. The baby is nursed naked and fed frequently to provide the necessary energy and protein. Extra care is needed to reassure the mother that this is a short-term process that will hopefully resolve the problem.
  If levels rise further and are not helped by phototherapy, there may be a need to investigate the cause. An exchange transfusion of blood may be required in this instance. However these complications are very rare and the most important point to remember is the commencement of early feeding.
  Breastfeeding not only provides the baby with the energy and proteins that are needed for the breakdown processes, but also aids the efficient removal of the first stools through the gut, thus allowing for the excretion of the by products of the bilirubin breakdown.
  As a consequence of all these chemical processes, it is not surprising that a jaundiced baby is sleepy, making feeding difficult. This is why it is important to feed a little and often. If the baby is reluctant to breastfeed, milk can be expressed and given to the baby using a spoon or cup. This avoids the baby using up too much of his energy on actually feeding. The breast can be offered for short periods, whilst the mother is encouraged to express in between times, until the baby is strong enough to take all the feeds himself. It is not necessary to give formula feeds, as long as enough expressed breast milk is collected.
  Extra clear fluids used to be given to ‘flush’ the kidneys. However this is now known to be unnecessary. The priority is to provide the baby with sugars for energy and proteins to bind with bilirubin. These are both available in the perfect proportions in the mother’s own breastmilk.
  In this way, the levels of bilirubin can be reduced quickly and turned into safe waste products that can then be excreted in the baby’s urine and stools. This, alongside phototherapy should be enough to treat most infants.
  If you have any worries, your midwife will be happy to advise you.
  ©Sharon Trotter@ www.tipslimited.com
  
  During labour I was given an injection to help the pain. The midwife said that this could make my baby sleepy for a few hours. Will this upset my chances of breastfeeding?
  Answer:
  The simple answer is yes. However there are steps you can take to minimise any problems.
  The most common painkiller given by injection today is called Diamorphine. Some units still use Pethidine, which is also given by injection. These are strong drugs that cross the placenta and, as such, can also affect the baby. If they are given early in labour, this will not cause a problem because the effects will have worn off by the time the baby is delivered. However, if they are given towards the end of labour, the baby may indeed be quite sleepy. An antidote can be given, if necessary, but is not common practice in most cases.
  Immediately after delivery, even if affected by these drugs, you will find that most babies are wide-awake for the first hour or so. This is why it is so important to introduce the first breastfeed at this time. It will give your baby a well-earned feed after the exertion of labour and delivery, as well as reassuring you that you are capable of latching on and feeding your baby.
  Over the next few hours and days your baby may continue to be sleepy at times. This does not necessarily have to be a problem. The only difference is that demand feeding may need to be prompted slightly, should the baby remain sleepy for long periods. As the drugs wear off, you will find that your baby is more alert and looking for feeds. Once this happens you can become more baby-led.
  It is important to express some breast milk after feeds, whilst the baby is affected, so that your milk supply is not interrupted. This milk can be given to your baby on a spoon or from a small cup. This will avoid any confusion over teats, which may hinder the establishment of breastfeeding.
  The most important advice is to be patient and by following these simple guidelines, your baby will soon be waking and taking his feeds on demand.
  ©Sharon Trotter@ www.tipslimited.com
  
  How can I tell if my baby is getting enough milk?
  Answer:
  This is one of the most commonly asked questions about breastfeeding and the answer is surprisingly straightforward.
  As long as your baby is; waking and alert before a feed, takes the feed well,settles between feeds and has lots of wet and dirty nappies, he will probably be getting enough. This is a simplification and all babies stray from the rules because they don’t know what the rules are!
  Your baby may feed more frequently during the evenings, but this can also be said of formula fed babies. Weight gain will vary but, on average, it will be less than a formua fed baby. Some weeks your baby may gain a whole pound, whilst others, it could be as little as a few ounces.
  Your breast should feel soft and relaxed after a feed is complete. I say breast because you will probably only need to feed from one side at a time. It is very important to finish one breast before changing over to the second. This is because, the feed is made up of two types of milk. The first is sometimes reffered to as foremilk and is watery to quench your babies thirst. The second is sometimes referred to as hindmilk and contains the bulk of the calories to satisfy your baby. If you were to switch over to the second breast too early, your baby could drink too much foremilk ,get overful, but still seem unsatisfied. This is a common problem, which can easily be helped by following these simple guidelines.
  Let your baby feed on demand, for unrestricted periods and he will eventually settle into a pattern. Every few weeks, you may find that your baby needs more feeds than usual. This does not mean that your milk supply has run out, but your baby is probably going through a growth spurt. Feed more often, as and when the baby demands and within 24-48 hours things will have settled down and you will be producing enough milk to cope with your babies growing needs.
  It is all about supply and demand and this is how your breasts make sure that your baby is getting enough.
  
  ©Sharon Trotter@ www.tipslimited.com
  
  These frequently asked questions and their answers were written by Sharon Trotter. For more information than there is room for on this website you can buy her book Breastfeeding - The Essential Guide for £5.99.