Much of my work as a professional lactation consultant includes visiting parents in the early days and weeks of breastfeeding when they have hit a bump in the road. With nearly every family I meet, I wish I could go back in time to share certain information during pregnancy.
Here’s why: I can almost always find a moment in their history where something happened which derailed their breastfeeding experience, often because they didn't have certain support or information.
The World Health Organisation recommends exclusive breastfeeding for six months and then breastfeeding with complimentary foods for “two years and beyond”. UNICEF statistics show us that parents in England want to breastfeed; however, in the first few weeks the figures nosedive from 81% initiating breastfeeding to just 24% exclusively breastfeeding by 6 weeks old. The percentages for 6 months exclusive breastfeeding is just 1%, and these figures are from 2010 because data collection has dried up.
A 2015 study published in BMC Pregnancy and Childbirth by three NCT researchers found “80% of these women stopped breastfeeding sooner than they intended, with women citing feeding difficulties and lack of adequate support”.
I truly believe many more families could meet their breastfeeding goals if they had certain resources & information available in the early days.
This is why I offer breastfeeding antenatal sessions - find more information here.
Here are a few of those tips and resources:
1. Breastfeeding is enough, even if it doesn’t feel that way*
This one definitely fits into the category of uncomfortable truths, to the extent that I often don't share this information with families. Typically by the time I have met them, they have already given their baby one or two tiny portions of formula on the postnatal ward.
The simple fact is that before around six months your baby’s gut is not sealed. Particles from formula and other products can pass easily from the baby’s gut into the body where they can affect short and long term health.
A valuable International Board of Lactation Consultant Examiners paper here explains further:
“While it may sound harmless and helpful, bottles of infant formula given to newborn breastfeeding infants have been shown to interfere with the successful establishment of breastfeeding, reduce both the exclusivity and duration of breastfeeding, and permanently alter the infant gut microbiome. One bottle of formula per day for the first week of life is enough to shift the gut microbiome toward….a condition where gut inflammation becomes the precursor to both acute and chronic diseases and conditions such as autoimmune diseases and obesity”.
An important note from this paper is that partly the damage of early formula supplementation is because it plants doubt in the families mind that breastfeeding is not adequate or not enough, or that babies need formula. So even if your baby has had some formula in the early days, (and you want to exclusively breastfeed) then hopefully just knowing that exclusive breastfeeding is the “gold standard” recommendation is helpful.
[*See Editor's note]
2. Colostrum can be expressed and stored from 36 weeks**
I sell colostrum harvesting kits on my website, and give them away to all my antenatal clients. These come with a link to a private page full of films and resources about how, why and when to express colostrum. More info here.
Maybe your breastfeeding journey has a challenging start - your baby has low blood sugar or jaundice in the first days, is reluctant to feed or you might be temporarily separated after birth. When these things happen having either some harvested colostrum or having the skill to extract colostrum can avoid early formula supplementation.
During the pandemic, I was volunteering on the postnatal ward of a central London hospital where I often supported mothers who were trying for the first time colostrum harvesting. Trying to learn a brand-new skill when you have just given birth (and potentially been awake for 48+hrs) can be really tough, and unfortunately the postnatal ward staff rarely have time to spend helping you. They are more likely to give you some syringes and a leaflet or YouTube link then leave you to get on with it as they are so overstretched.
[**Do chat with your midwife about whether this is right for you]
3. ‘Second Night Syndrome’
Many babies will feed in the first hour or so after birth, often quite well. It's then very common that they become sleepy for the next 24/48 hours and may not want to feed.
In this situation, it's very important to remember that we say babies arrive "packing a picnic”. They have brown fat stores and extra red blood cells which are metabolised. It's normal and natural for babies to lose weight after birth and then start gaining later.
After this period of sleepy behaviour many babies appear to suddenly wake up and become very restless and fussy. This is sometimes called Second Night Syndrome and it can be a stressful experience which causes many parents (and health professionals too) to reach for the “emergency formula” they brought in the hospital bag.
Jan Barger (R.N., M.A., IBCLC, FILCA) wrote an excellent brief on this, paraphrasing:
A lot of moms think their baby is fussy because he/she/they is not getting enough milk and is hungry. However, that is not the reason. Instead, the baby is suddenly aware that the most comforting place to be is at your breast.
Here are some additional reassuring suggestions from the same brief:
- Keep your baby in skin to skin contact - don’t worry about trying to put them down
- Feed them whenever they seem to signal for a feed
- Don’t be concerned with trying to burp your baby after a feed
Personally, I always find that it's helpful for parents to know what to expect. Sometimes just realising that ‘Second Night Syndrome’ is normal enables parents to get through it more easily.
4. Forget about foremilk and hindmilk!
In my private work as a home visiting lactation consultant, I feel like I come up against this on nearly every visit. It is so common for midwives and health visitors to tell parents that their baby needs to stay on one breast for a certain period of time in order to “reach the fattier milk”, sometimes this is as long as 20, 30 or 40 minutes. This information is about 10 years out of date and can be very damaging to the breastfeeding relationship.
In fact, anybody who gives you a binary figure about something you should do without a thorough consultation and history arguably isn’t providing you with tailored support; everyone is different as are the needs of each baby. Please just follow your baby’s lead. Put them to one breast until your breast has softened and they are not actively feeding any longer. Then, feel free to offer the second breast or swap back again between the third and fourth “course” as frequently as feels right. (Source)
5. The Three 'Keeps'
If your breastfeeding journey starts with some challenges, the Laleche league book, The Womanly Art of Breastfeeding, says don't be disheartened - just remember the three keeps:
Keep your baby close: try to maintain an oxytocin rich environment with lots of skin to skin which UNICEF says:
- Calms and relaxes both mother and baby
- Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
- Stimulates digestion and an interest in feeding
- Regulates temperature
- Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection
- Stimulates the release of hormones to support breastfeeding and mothering.
Keep your baby fed by whatever method necessary - you might need to use some finger feeding or syringe feeding for a while, maybe bottles of expressed milk or formula as a bridge just until your baby is able to feed effectively at the breast.
Keep your milk flowing which means that you might need to gently hand express or massage your breasts or use an electric pump to maintain and build your supply until it’s where you need it to be.
You've got time on your side, with the right support (ideally from a lactation consultant) maintaining the three keeps will give you time to reach your breastfeeding goals.
Sally Rickard is an IBCLC Lactation Consultant offering antenatal workshops online and in person in South East and Central London
The views expressed here are that of Sally Rickard in her capacity as an accredited lactation consultant. Cleannest as a company does not have the expertise to make such recommendations.
Editorial Note from BabyThrive and Cleannest: We acknowledge that breastfeeding is not an option or goal for everyone. Our aim with this piece is to provide access to helpful, accurate information for those who aspire to breastfeed. We strive to share only the facts and insights gained from years of expert experience. We hope to help all families thrive so if there is a topic you would like us to cover, please reach out to firstname.lastname@example.org.
Recommended additional reading from Sally: