Author Name:
Sharon Trotter, Midwife

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.

Antenatal Period

What are the benefits to my baby if I breastfeed?
Answer:

• Breastmilk is tailor-made with your very own baby in mind. It provides exactly the correct nutrients in an easy to digest package at exactly the right temperature, whenever your baby wants it!
• Colostrum or first milk is produced during pregnancy and in the first two to four days of life prior to the milk ‘coming in’. This is rich in antibodies to help protect your new baby from infections and build resistance. Colostrum is also high in protein, so a little goes a long way. Even if you do not want to breastfeed your baby on a regular basis, it is very important to give your baby the benefit of this excellent first food. It is also known to aid the smooth passage of meconium through the bowels. This is the sticky dark stool that has been in the bowels of your baby during pregnancy.
• Breastfed babies suffer less infections in their first year. This is not only better for the baby, but also for the NHS, as the breastfed baby is less likely to need expensive treatment in hospital. Their need for antibiotics is also reduced, which avoids any side-effects to their immature immmune system. Infections include those to the eyes, ears, chest, urinary system, skin and gastrointestinal system [tummy bugs]
• Sticky eyes are very common in the newborn and cause much worry and struggling with fiddly eyedrops. I did not realise, until I was informed by a friend, that expressing a few drops of breastmilk straight into the affected eye would treat it. I tried it and miraculously my son’s sticky eye cleared up within hours! This treatment is used by mothers in the developing World all the time.
• Obesity is uncommon with breastfed babies as they seem to only take what their body needs to grow. This will lessen risks of developing complications in later life. These include heart disease , strokes, high blood pressure, diabetes and many more.
• Necrotizing enterocolitis is a bowel infection seen mostly in premature infants. This is known to be up to ten times more common in formula fed babies than breastfed babies.
• Immunisation. With all the recent talk about the dangers of immunisation, especially the MMR (measles, mumps and rubella) you will be encouraged to hear that breastfed babies appear to have a better tolerance to immunisations than formula fed babies. Breastmilk contains high levels of antibodies that pass from mother to infant. This natural immunity continues until you wean. In addition, his immune system appears to mature at a faster rate, so he is better equipped to fight infections .
• Allergies were an important issue to me, as I suffer from hayfever and am allergic to penicilin, cats and dogs. I was keen to try and avoid my children suffering, as I had. Also, in a world where there are so many new chemicals and man-made products, which are known to harm young immune systems, it is vital to give them the best protection possible. Breastfeeding has been seen to reduce the incidence of allergic reactions, which go on to cause: asthma, eczema, hayfever and, more commonly now, nut allergies. It is important to remember that you should try to avoid allergy-triggers, which may go on to sensitize an infant’s immune system (Northstone 2002). Current advice recommends giving gluten-free products for the first six months and to avoid cows-milk as a drink until a year. Nuts and eggs are also thought to trigger allergies, if introduced too early. Recent research also suggests, that it is important to avoid baby bath products, baby wipes and antiseptic powders in the first few weeks of life. The skin needs time to mature and could become sensitized to these products, if used too early.
• Less dental problems and better jaw development
• Better brain and nerve development leading to higher IQ levels!
• Sudden Infant Death Syndrome (SIDS) is a complex subject and there are many causes. Breastfeeding alone will not give your baby total protection from this tragedy, but it will lessen the risks. Our first son died at three weeks of age due to cotdeath. I mention this because he was breastfed, so why did this not protect him? He had been born with hydrocephalus (fluid on the brain), he had undergone surgery at a few days old, been given lots of drugs, all of which would have been risk factors. He also slept on his tummy (which is not recommended today). I may never know the real reason why he died but I do know, that by breastfeeding him, I gave him the best chance I could. The best advice for any new mother is still to breastfeed, if possible and NOT TO smoke near your baby. Always lay your baby on their back, towards the bottom of the cot, so they cannot wriggle down under the covers. The use of duvets and cot bumpers are not recommended until a year old as they could cause overheating, which is, in itself, another risk factor.
  ©Sharon Trotter@ www.tipslimited.com
  
  Are there any benefits to the mother if she chooses to breastfeed?
  Answer:
  A lot is said about the benefits to the baby , but what about the mother? You may be surprised to hear that there are just as many advantages for her including:
• Reduced susceptability to breast cancer
• Reduced susceptability to ovarian cancer
• Reduced susceptability to uterine cancer
• Less chance of developing postnatal depression. This is due to hormone levels staying much more stable during breastfeeding. Added to this, during each feed, the brain releases endorphins into the bloodstream. This creates a feeling of wellbeing and relaxation – well it worked for me!
• Protection against osteoporosis. This is due to the delay in the return of your periods – when they do return they usually continue until later in life. This means that the high levels of progesterone and oestrogen also continue, delaying the menopause and its associated risks to your bone density, which can lead to osteoporosis.
• Closer relationship with your baby leading to contentment for mother and child.
• Added contraceptive protection. Although this cannot be guaranteed, breastfeeding delays the return of menstruation and hence fertility. This provides a natural gap between babies, which is safer for mother and child. My periods did not return for nine to 13 months following the birth of my children.
• You will get your figure back! Now this really is one to shout about!
• It is cheaper! There is no need to buy expensive sterilising equipment and bottles, and with the cost of formula milk on the increase, breastfeeding saves .
• It is environmentally friendly – if it benefits the world we live in, then it will benefit the mother and her baby in the long term.
• A guaranteed natural high! Every time you feed your baby you get a rush of endorphins ( feel good hormones) that will relax and de-stress you within five minutes. Definitely not to be missed .
• Sex. Breastfeeding is an extremely sensual experience. In the early months, when you are overwhelmed by hormones and tiredness, sex is probably the last thing on your mind! However, once you become established with feeding, you will realise how relaxing it can be. The endorphin boost you get during a feed could put you in the mood! So, once your baby is safely tucked-up in his cot, you can turn your attentions to your partner! A definite benefit – I think you will agree!
  These are all great reasons to breastfeed, but for me it is the overwhelming pleasure and satisfaction I feel that is beneficial in itself. To see your thriving baby and know that you have played a part in this, not only gives you a great feeling of achievement, but also gives your baby a first-class start in life, which is priceless! It is hard work and exhausting at times, but so is bottlefeeding! Breastfeeding is much more a two-way street, where you both get to benefit from the whole process together.
  ©Sharon Trotter @ www.tipslimited.com
  
  What can I do during my pregnancy to prepare myself for successful breastfeeding?
  Answer:
• Start to think about how you want to feed your baby as soon as possible
• Get information from your midwife at the antenatal clinic
• Read as much as you can on the subject, while you still have the time!
• Ask friends and family for advice if they breastfed
• If you have inverted or flat nipples, it may be worth having a chat with your midwife or lactation consultant. It is perfectly possible to breastfeed with little or no help, but sometimes treatment is required. (see FAQ about this subject)
• There are many old wives tales on how to toughen up your nipples, all of which are pointless. The best way to prepare is by gentle nipple stimulation with your partner on a regular basis, which is much more fun!
• You will produce colostrum while you are pregnant and this will naturally moisturise and protect your nipples. So as not to wash this away do not use soaps, creams or lotions. Use only plain water.
• Talk it over with your partner and get his support and understanding. Explain to him the reasons why you want to breastfeed and the advantages to you and your baby. Studies show that a partners support is one of the most important factors to eventual success. Include him every step of the way and reassure him that he will not have to do any night feeds – this usually works a treat! In return, he can agree to help out more in the daytime.
• Stock up on basics in your storecupboard and fill the freezer with ready-made meals. This will avoid any unnecessary shopping trips in the early days. Have a kitty put aside for takeaways when you cannot be bothered to cook! Shop online if you have a computer – this is such a great idea!
• Go to a breastfeeding workshop . This is a great way of learning about breastfeeding from midwives, counsellors and feeding mothers. Your local antenatal clinic should offer you a place on one. If not, ask the National Childbirth Trust (NCT) or your local breastfeeding counsellor/lactation consultant.
• Before your baby is due, organise an evening out with your partner and enjoy your last night of freedom for a while!
• Get to know your midwife and explain your wishes for birth and breastfeeding. Do not be embarrassed to ask any questions. You can be sure she will have heard them all before , however strange!
• Take some disposable breastpads with you into the hospital, as you may need them in the first few days. 100% cotton are the best.
  ©Sharon Trotter@ www.tipslimited.com
  
  Why is the support of my partner and family so important to the success of breastfeeding?
  Answer:
  Breastfeeding is a learned skill and the best way to achieve success is by watching others. If you have been lucky enough to have grown-up in a family where breastfeeding was the norm, it will seem quite natural to you to continue this tradition. However, if you have never seen anyone breastfeeding, this does not mean you will not succeed. What is important, though, is the support you receive from your partner, along with your family, midwife and other health professionals. Peer support is also important and many peer support groups are cropping up all over the country with excellent support and advice from fellow breastfeeders. Your partner can help in many practical ways, like doing chores,cooking meals,keeping visitors to a minimum( in the early days) and letting you rest. Even more importantly, By learning about the benefits to both mother and baby, they can also feel happy in the knowledge that you, as a couple, are giving your baby the best possible start in life. As far as other siblings are concerned, this is the best way to educate a child in the natural art of breastfeeding. They will grow up with the understanding that breastfeeding is the norm. When they become parents, they too will be much more likely to give it a go and in this way, attitudes will gradually change in favour of breastfeeding. Once you become more confident as a breastfeeder, you will feel happy to feed while out and about with your baby. This, in itself, will promote breastfeeding to the wider community and so continue the ‘drip-drip’ effect of education by example. It may take another generation for this message to get through, but hopefully the results will be longterm.
  ©Sharon Trotter@ www.tipslimited.com
  
  What should I look for in a breastfeeding bra?
  Answer:
  There are many things to look for when buying a breastfeeding bra. Certain features will be more important to some mothers than to others. In my opinion these are the main features to look for in a good feeding bra:
  
• Attractive to look at: although this is important, it is only one consideration.
• Supportive: needs will vary but there is little use in a bra looking lovely if it does not give you the support you desire.
• Size: does it come in a wide enough range of sizes to fulfill your needs? During pregnancy it is recommended that you do not wear under wired bras, as they could restrict the breast tissue. A good supporting bra in the correct size is vital. If possible get measured properly for your feeding bra a few weeks before your baby is due.
• Availability: is it easy to get hold of? Is it sold in a high street store, mail order catalogue or over the Internet?
• Comfortable: this is most definitely a must. It is important to try on the bra because you cannot tell how it is going to fit from a picture. This is where high street brands are helpful because you can try before you buy. If you do buy mail order or over the Internet, make sure the company has a good returns policy. The National Childbirth Trust gives great advice online.
• Free from restrictive straps etc: in the early days of breastfeeding, your breasts can be swollen and tender. It is very important not to wear a restrictive bra at these times. Straps that are too tight or that cut in at awkward places could cause a blocked duct, which is not pleasant. Avoid bras that are closed-in (i.e. the breast is surrounded by an inner layer of fabric) as these can cause the problems mentioned above. The best bras are completely open once the clip or popper system is undone. This allows the breasts to be free from obstruction during feeding. Play around with the different features so that you are familiar with how they will perform when you are feeding. This may sound odd but will pay dividends when you find the right bra for you!
• Easy to use: it doesn’t matter if it feels great, looks great, but you cant manage to easily use the bra opening device for feeding. Once again, it is important to try it out before you buy it. A one handed device is the easiest so that you can be as discreet as possible.
• Fabric: is the fabric too thick or too thin? Will it be hot or will the straps dig in? The sports type bras often have an elastic under-bust band. This should not be too tight and should be tried on and tested for comfort?
• Easy to put on: this may seem obvious but needs a mention. If you have tender breasts, it is not easy to struggle putting on a bra over your head. It is much more comfortable to have a front or back opening bra.
• Washing instructions: you will need to wash and dry your breastfeeding bras on an almost daily basis, so it is better if they are machine washable and even better if they go in the tumble dryer. Check the labels if you don’t want to be hand washing
• Information: you don’t need a book, but some accurate information on the bra and about breastfeeding would be helpful. Check to see if there are leaflets in store to go with the bras. These can be very informative and are usually free!
• Matching underwear: just because you are breastfeeding doesn’t mean that you need to feel frumpy and unsexy. There are lots of maternity bras that have lovely pants to match and that come in a variety of colours.
• Price: you will need at least four or more bras if you are going to breastfeed. With this in mind you must choose the bra that best suits your budget.
• Remember that you may need to fit breast pads inside the bra, so allow for this when trying out the bra. The best breast pads are those that do not have any plastic backing as they become hot and sticky. 100% cotton is the best and most absorbent material.
  And you thought it was just a matter of buying the first maternity bra that you came across!!
  ©Sharon Trotter@ www.tipslimited.com
  
  Are there any books on the subject of breastfeeding that you would recommend?
  Answer:
  My Top 5 Breastfeeding books:
  
  Breastfeeding: the essential guide by Sharon Trotter.
  ISBN: 0954838106 – Trotters Independent Publishing Services. 2004.
  This is the result of over 20 years experience as a midwife and seven years total experience breastfeeding my own babies. It is a user-friendly, non-judgemental and above all realistic account of all things breastfeeding. Ideal for parents, professionals and anyone supporting the needs of breastfeeders.
  
  Breast is best by Doctors Penny and Andrew Stanway.
  ISBN: 0330347535 – Publisher: Pan books. 1996 edition has been fully revised and updated.
  I was shown the 1983 second edition and from then on it became my Bible. An excellent read if you want to know everything about the subject that is worth knowing.
  Bestfeeding – getting breastfeeding right for you: an illustrated guide. By Mary Renfrew, Chloe Fisher and Suzanne Arms.
  ISBN: 0890879559. Published by Celestial Arts. Release date 2000 -available through NCT maternity sales.
  This is another excellent book that will give you lots of help and support.
  The breastfeeding answer book by Nancy Mohrbacher IBCLA and Julie Stock BA, IBCLA.
  ISBN: 0912500948. Published by La Leche League International. Release date – 2003.
  It contains everything ,and more, that you will ever need to know about breastfeeding! This is a large format book with a ringbinder for ease of use. It is rather expensive, but if you really want to know it all, this is your book.
  How weaning happens by Diane Bengson
  ISBN: 0912500549. Published by La Leche League International. Release date: 1999.
  This book gives comprehensive advice about weaning your baby and is especially aimed at breastfeeders.
  ©Sharon Trotter@ www.tipslimited.com
  
  Do I need any special equipment for breastfeeding?
  Answer:
  The beauty of breastfeeding is that there is no need for expensive equipment and your milk is ready for your baby at the perfect temperature wherever and whenever you need it. Having said this, there are a few items that will come in handy. These include:
• Bra: This must be comfortable, supportive, breathable and above all easy to use whilst breastfeeding. There are many on the market, available through high street stores, mail order catalogues and on the Internet. They range in price but it’s worth shopping around to get the right one for you.
• Breast pads: These can be reusable or disposable. Available in all baby shops and departments. The reusable ones are made of 100% cotton and can be machine-washed. They cost about £5 for 6 pads. The disposable ones come in lots of shapes and materials but the best, by far are the 100% cotton. They cost about £4 for 50 pads. They are soft, comfortable, breathable and very absorbent. Try to avoid ones that have a plastic backing as they may cause you to become hot and sticky. They may cost a little more but you will need less of them because of the superior quality. Take it from me they work!
• Bibs and Burp-pads: In the early days you will need a drawer full of terry or muslin squares. These are great for mopping up little accidents after feeding. When you start mixed feeding terry towelling bibs are ideal. Many have a Velcro strap for ease of removal. Avoid plastic backed bibs as they will become hard and cracked after a few washes. Stick to white or light colours as they can be washed at a high temperature to remove stains. There are many fashionable designs on the market but in my experience the motifs merely reduce the absorbency of the bib, so it just runs off onto the clothes it is trying to protect!
• Nursing pillow: This is widely available and reasonably priced. You can also buy spare pillowcase covers. This is invaluable, especially in the early days when you need to protect yourself from back strain whilst feeding. I would not go anywhere without this comfort and it is all machine washable, in case of accidents!
• Breast Pump: Once you have become established with breastfeeding, you may want to express some breast milk, so that you can leave your baby in the care of a babysitter for social events. You may need to go back to work and do not want to give up breastfeeding. Whatever the reason, a good breast pump is worth its weight in gold. You could hand express if you wish, which is easy to do and does not require a breast pump. However, this does not always suit, so a breast pump that is easy to use, efficient at milking the breasts and easy to sterilise is vital. I have tried many and in my opinion the hand held models are the best. They are easy to use and new designs simulate the action of your baby sucking. This in turn leads to faster ‘let-down’ of milk. They are hand operated and above all quiet, so you can use them anywhere. These pumps are available in most baby stores and mail order, costing approx. £25. Well worth every penny
  ©Sharon Trotter@ www.tipslimited.com
  
  
  Are Inverted or flat nipples necessarily a problem?
  Answer:
  Many women manage without any help, but some may experience problems. Treatment is available in the form of a new product called the Niplette. This is a relatively cheap device invented by a plastic surgeon. It looks like a transparent nipple-shaped cup with a syringe attached. By following the instructions and using the device for two to three months, preferably before or in the first six months of pregnancy, your nipples are prepared for feeding. Clinical trials sponsored by the manufacturer have been carried out and results look promising. This said, the best advice is still to consult your midwife or lactation consultant.
  ©Sharon Trotter@ www.tipslimited.com
  
  In what circumtances may breastfeeding not be suitable for the mother?
  Answer:
  There are some occasions where breastfeeding may not be advisable - these include:
• Breast reduction surgery – many women have managed to breastfeed following surgery, although success is not guaranteed. It is important to speak to your surgeon to find out how destructive the surgery will be around the nipple area. This will determine the possibility of future breastfeeding. Breast reduction surgery almost always involves moving the nipple to a new position and if great care is taken, most of the milk producing ducts can be saved. Whatever happens, you will need support and information and should be prepared for some problems along the way. There is an excellent website which gives detailed advice on all aspects of breastfeeding after surgery. Go to: www.bfar.org
• HIV positive status – although research is ongoing. Some studies have shown that a baby, born to an HIV positive mother, who is exclusively breastfed (no introduction of formula feeds for the first six months of life), has a better chance of becoming HIV negative as his immune system matures.
• Certain drug therapies – drugs are known to cross over into the breastmilk. Most drug companies have little data concerning breastfeeding, which is why they cannot recommend the use of their products for breastfeeding mothers. However benefits must be weighed against the potential risks before deciding whether or not to prescribe a drug. This is certainly the case with ex-drug users who are now taking methadone. Breastfeeding is positively encouraged for these mothers because the benefits for the baby far outweigh the risks. Dr. Mary Hepburn is famous for her work with drug dependent mothers at the special reproductive health unit at the Princess Royal Maternity Hospital in Glasgow. Detailed information about drugs and breastfeeding is also available in the annual publication by Dr Thomas Hale and via the Breastfeeding Network (www.ibreastfeeding.com ).
  ©Sharon Trotter@ www.tipslimited.com
  
  In what circumtances may breastfeeding not be suitable for the baby?
  Answer:
• Serious metabolic disorders ie galactosaemia.
• Cleft lip or palate malformations. This does not mean that you cannot breastfeed, but it will be more challenging and expert advice should be sought. Cup feeding or using specially adapted spoons and teats have been found to be helpful in order to feed the baby expressed breast millk (EBM). Once surgery has been carried out to repair the problem, then breastfeeding can start properly and will actually aid the development of the mouth and jaw. To contact the Cleft Lip and Palate Association go to their website at: www.clapa.com or phone 020 7431 0033.
  ©Sharon Trotter@ www.tipslimited.com