• What you should know about breastfeeding
• Breastfeeding guide
• Breastfeeding positions & skills
• Natural pattern of breastfeeding
• Monitoring baby’s progress
• Common difficulties with breastfeeding
• Expressing & storing breast milk

• Sterilisation
• Nutrition & looking after yourself
• Dad’s help
• Comforters
• Weaning
• Allergies & intolerances

• Breast milk is free, sterile and always at the right temperature.
• It’s easy for your baby to digest.
• It actually improves brain development & visual acuity.
• It’s packed with antibodies to protect against infection.
• It helps against developing allergies e.g. asthma, eczema
• Baby isn’t the only one to benefit.
• Breastfeeding helps your uterus return to its normal size more quickly.
• There is a reduced risk of haemorrhaging.
• Prolonged period of infertility thereby child spacing.
• There is some protection against osteoporosis, ovarian & breast cancer.
• It uses up about 800 calories/day thereby helping with weight loss.

Yet, for many mums, it isn’t as easy as nature intended. When you’re worried your baby’s not feeding properly, your nipples maybe sore and your breasts are swollen and uncomfortable you can find yourself wondering whether it’s worth carrying on. In short, the answer is yes. Mums have been getting to grips with breastfeeding for thousands of years before handy guides like this came along – and most of them started out feeling just as nervous and inexperienced as you! Stick with it and in no time you’ll be enjoying one of the best kinds of job satisfaction there is.

We also recommend that you consult either a midwife, lactation consultant or other mums to get the best possible advice available to you.

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Babies are usually very alert just after birth. This is an excellent time for both of you to practise.

• Get comfortable as best as you can. Remember you are both on your “L” plates (most of us don’t progress to “P”s for 6 – 8 weeks) so don’t be too hard on yourself
• Relax and place baby close to you, watch what they do. Let them lick and nuzzle until they are ready to open their mouth, that’s when you can help if needed.
• Just like you babies have to master the skill of feeding, newborn babies may need more assistance to attach to the breast than older babies. Their oral reflexes may need to be stimulated and encouraged to help with attaching to the breast. There are, of course, those babies that seem to have been here before and just jump on the breast without any help from anyone.

We will go through the basics from the newborn stage. Anyone having problems with attachment, sore nipples, poor feeding etc. can go back to the basics and check the attachment of your baby onto the breast.

• Find a comfortable position for both of you – with the phone and remote near your free hand and a drink handy.
• Sit upright and comfortably so that your breasts fall forward. Look at the fall of your breast. Gravity may play a part in this.
• Your back and feet need to be supported, and your baby unwrapped.
• Have your baby facing you.
• You need to be holding your baby in one arm close to your body whichever arm is the most comfortable for you. That way one hand is always free to help. See pictures of the different positions – the cradle or madonna hold, transitional, underarm or football and side-lying.

You can also download the Tommee Tippee Breastfeeding Guide (200KB PDF file) which contains explanatory photographs for each of the positions described below.

Cradle position

• Hold baby in the same arm as the breast you are going to feed from.
• Your hand will be down baby’s back with their head resting on your forearm (not quite on their bottom).
• To aid attachment, using the opposite hand place 2 fingers on the edge & either side of the areola and pinch the skin together.
• The purpose being to reduce the size of the breast. Much like when you squash a hamburger to fit into your mouth.
• Looking down, your finger tips will be placed at 2 & 8 o’clock on your breast with the other fingers curled into the palm of your hand and wrist bent.
• Your fingers should be parallel to baby’s lips, like posting a letter.
• Make sure your fingers are not placed on the areola.
• Try not to put your fingers too far along, passed your nipple, as baby needs room for their chin and tongue to grab underneath the breast.
• Hold the pinch until baby starts to rhythmical suck. This allows baby to take the breast from you.

Transitional position

• Hold your baby with the opposite arm to the breast you are going to feed from.
• Your hand will be on baby’s shoulders with fingers cupping the head.
• You can use your other hand to pinch the skin of the breast to aid attachment.
• Looking down your thumb & fore-finger will be placed at 2 & 8 o’clock with your hand cupping the breast.
• Your fingers should be parallel to baby’s lips, like posting a letter.
• Make sure your fingers are not placed on the areola.
• Try not to put your fingers too far along, passed your nipple, as baby needs room for their chin and tongue to grab underneath the breast.
• Hold the pinch until baby starts to rhythmical suck. This allows baby to take the breast from you.

Underarm position

• Hold your baby with the same arm as you are feeding from but baby’s body will be under your arm.
• Your hand will be on baby’s shoulders with fingers cupping the head.
• You can use your other hand to pinch the skin of the breast to aid attachment.
• Looking down your thumb & fore-finger will be placed at 2 & 8 o’clock with your hand cupping the breast.
  Your fingers should be parallel to baby’s lips, like posting a letter.
• Make sure your fingers are not placed on the areola.
• Try not to put your fingers too far along passed your nipple as baby needs room for their chin and tongue to grab underneath the breast.
• Hold the pinch until baby starts to rhythmical suck. This allows baby to take the breast from you.

Side-lying position

• Lying on your side with baby facing you.
• This position can be difficult to get good vision of your nipple thus attachment.
• Have the arm under you in a comfortable position usually curled under your head.
• Your top arm guides the baby’s shoulders towards you or if needed this hand can pinch the skin at the edge of the areola to mould the breast.
• Looking down, your finger tips will be placed at 2 & 8 o’clock on your breast with the other fingers curled into the palm of your hand.
• Your fingers should be parallel to baby’s lips, like posting a letter.
• Make sure your fingers are not placed on the areola.
• Try not to put your fingers too far along passed your nipple as baby needs room for their chin and tongue to grab underneath the breast.
• Hold the pinch until baby starts to rhythmical suck. This allows baby to take the breast from you.

If you are feeding twins all the sitting positions are possible – babies on either side of your body.

Good positioning will always be the key to smooth attachment of baby onto the breast, between your legs or under your arms.

In all positions there are common points to help achieve good attachment:

• Good vision of the nipple and baby’s mouth is important.
• Line baby’s nose up with your nipple - as baby will lift their head up and back when they open their mouth just like you do when you drink.
• You can encourage baby to open their mouth by stroking baby’s top lip with your nipple. Do this a couple of times – baby will open their mouth wider each time you do this and the tongue will come forward. You are eliciting the gape & extrusion reflexes.
• Once you are happy baby’s mouth is wide open bring baby to the breast quickly by guiding the shoulders forward, not the head, that way they will take a good mouthful of breast tissue and not just the nipple.
• The nipple will be pointing up towards the roof of baby’s mouth.
• Baby’s chin should touch the breast first, their neck will be straight and the nose will be just touching or away from the breast.
• A good mouthful of breast will mean baby can suck properly, get your milk flowing and be pain free.
• Baby will start sucking with quick jaw movements, then the rhythm will slow with deep jaw movements and you will hear swallowing. Baby will take short breaks, this is polite eating, like you putting your knife & fork down for a rest then the sucking and swallowing will start again.
• If the cheeks are sucked in or you hear a clicking, then attachment is poor - reattach.
• Once baby gains mastery of their feeding skills and neck control they can attach without help.
• Babies will stop feeding when they want to. Give them a rest as this is usually first course.
• If your breast feels like there is more milk, offer the same breast again. This way you are letting baby get to the dessert portion of the meal – hindmilk. Also this cares for your milk supply and breast comfort.
• Good breast drainage helps with milk supply and preventing mastitis. Baby can have the other breast if still hungry.

Babies that have good attachment and drain the breast well usually sleep, gain weight and are contented. Also this helps in preventing nipple pain, engorgement, mastitis and milk supply issues.

• The baby must be allowed to feed without any restriction to the length or frequency of the feeds.
• The baby will detach when ready and should always be offered at least another go at the breast. They may not take any more or go to the other breast.
• The time taken to feed your baby can vary feed to feed depending on your milk flow and their effectiveness at the breast.
• The intervals between feeds may vary; some babies require feeding every 2 hours when having a growth spurt while others can last 4-6 hours.
• The composition of breast milk changes throughout the feed. The fat content of the milk rises as the rate of milk flow decreases. To ensure expressed milk is high in fat, continue to express on one side until the flow is diminished before swapping sides and come back to the first side again. Do both breasts twice.
• As a result it is important to allow the baby to drain the breast effectively by ensuring he ends the feed.
  

• Your baby will be alert and responding to you when awake.
• They have bright eyes and the skin is firm.
• They will produce very wet nappies at least equal to the number of feeds you give them. If you are feeding 6 times a day, average, then they will have 6 wet nappies. 8 – 10 feeds/day = 8 – 10 wet nappies.
• The bowel motions are soft or runny depending on breastfeeding.
• After leaving hospital the weight will be steadily increasing. Don’t worry about the small ups and downs in weight as this could simply be the time when you weigh or if they have had a recent feed, wet or dirty nappy. As a rough guide:

If the weight remains the same or drops then speak to your Early Childhood Nurse or G.P.

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• Your nipples are highly sensitive in the first few days after birth. Pain is not normal.
• Sensitivity should improve when the milk begins to flow.
• If there is pain, then the positioning and attachment of the baby at the breast is incorrect and needs to be checked.
• This can lead to nipple grazes and cracks.
• Poor positioning and attachment can lead to inadequate breast drainage resulting in engorgement, block ducts and mastitis.
• Baby may also have an incorrect sucking action which causes pain.
• Thrush infection of the nipples can also cause pain without obvious signs of trauma.
• Eczema or dermatitis that affects the nipples and breasts.

• Avoid using shampoos and soap on the nipples
• Rub a little of the milk into the nipple at the end of each feed. The milk at the end of the feed is high in fat and contains antibacterial agents making it the perfect emollient for nipples.
• Allow the nipples to air-dry before closing bra.
• If using nursing pads, replace frequently.
• Creams are not used routinely on nipples however purified lanolin cream in certain situations may be useful.
• Correct positioning and attachment are important.
• If the cause has been identified then treat. Eg thrush – antifungal agent.
• Get help so breastfeeding can continue. If necessary rest your nipples and express the milk.

Nipple shields are a tool for breastfeeding and can be used appropriately or abused. If used incorrectly their use can be associated with reduced milk supply, poor breast drainage and nipple damage.

• Flip the outside rim of the shield back so you can centre your nipple in the middle of the teat.
• Express a little milk into the teat and fold back the rim onto the breast.
• You may need to place your fingers on the rim to hold in place. You do not want any movement of the shield when baby is attaching.
• Line baby up as normal – nose to nipple.
• Bring baby to the breast.
• There should be no pain.
• Baby should get into a suck swallow rhythm and you will hear the swallowing of milk.
• Always feel your breast to make sure that it is emptying well.
• Check with your health professional on a regular basis to avoid any problems.

• Usually occurs in the first few days of your milk coming in or if breastmilk is not removed effectively.
• Your breasts become uncomfortable and distended.
• Frequent feeding with good positioning and attachment will help.
• Expressing to soften the areola will help baby’s attachment.
• If you have a lot of milk then expressing before baby sucks will allow baby to finish the breast and give good breast drainage.
• You may need to feed on only 1 side for a short time, letting the other side leak as you are feeding. Alternating with each feed.
• If it is not resolving then expressing both breast to completely drain them will help.
• Seek advice if you are concerned or your breasts are not responding to your efforts.

• A blocked milk duct is the correct term for a ‘bank up’ of milk, which cannot flow.
• Results in a hard tender painful reddened area on the breast.
• Needs to be cleared quickly to prevent you getting sick.
• Usually caused by incorrect positioning of baby or baby not sucking effectively, causing inadequate breast drainage.
• Other causes include possibly missing a feed, pressure from a tight bra, tight clothing, consistently lying on the same side in bed or pressing too hard on your breast during a feed.
• Blockages can keep on happening and need to be dealt with quickly.
• Check baby’s positioning and attachment.
• Vary the feeding positions.
• Offer the sore breast first and point the chin towards the sore part.
• Feed frequently if baby will help out. Express if necessary.
• Apply a heat pack and massage during the feed, massaging towards the nipple.
• Apply a cold pack after a feed for comfort.

• Inflammation of the breast tissue
• Can result from a blocked duct, when excess milk is forced into the surrounding breast tissue, causing local inflammation and flu-like symptoms.
• Other causes include nipple trauma, poor health, and sudden changes in feeding patterns or use of nipple creams.
• The breast will be red, hot, swollen and painful.
• Treat blocked milk ducts quickly.
• Look at your positioning and attachment to prevent nipple damage.
• Get plenty of rest and eat well.
• Be careful of sudden long periods between feeds.
• Wear loose, comfortable clothing check your bra is not too tight.
• Don’t use nipple creams or ointments unless advised too.
• Change your breast pads frequently.
• Ensure the affected breast is adequately drained by feeding frequently and expressing if necessary.
• Change feeding position – make sure the baby’s chin is pointing towards the reddened area as this will encourage drainage of the affected area.
• Feed frequently if baby will help out.
• Express before a feed to help with good attachment and if breast is not drained express after feeding.
• Apply a heat pack and massage during the feed, massaging towards the nipple.
• Apply a cold pack after a feed for comfort.
• Give appropriate antibiotics. You will need to be seen by your G.P.
• NB: This is not the time to wean if you have any of above-mentioned problems. It is essential that breastfeeding continue frequently from the affected breast in order to resolve the situation.

• In the early days/weeks of breastfeeding it is not uncommon to have more milk than your infant needs.
• It can take 4 – 6 weeks for your breasts to settle down to baby’s needs.
• If baby is not effectively draining the breast then this can be perceived as an oversupply.
• Check baby’s attachment so they can effectively milk the breast.
• Make sure baby is draining the 1st breast before offering the 2nd breast. That is 1 side per feed. Let the other breast leak.
• You may need to express prior to feeding to soften the areola and remove some milk making it easier for baby to attach and feed. This will also help with breast drainage.
• Expressing after a feed may be necessary for comfort.
• A warm shower will help to soften the breast to relieve discomfort.
• Pain relief may be required (e.g. Panadol).

• Very few mums cannot produce enough milk for their baby.
• Inadequate breast drainage can eventually lead to a drop in supply.
• Causes for this are poor positioning and attachment of baby on the breast.
• Baby is not feeding enough or for long enough on the breast.
• If a dummy is being used instead of giving baby a feed.
• Retained placenta.
• Breast surgery.
• Insufficient glandular tissue in the breast.
• Smoking and the use of some medications.
• Check your positioning and attachment of baby on the breast.
• Offer the breast more frequently. Give baby 2 goes on each breast making sure the breasts are empty.
• Express your breasts after feeding to drain and stimulate.
• Try and rest, eat a well-balanced diet and drink to your thirst.
• There are drugs which can help to increase your milk supply. Speak with a health professional.
• NB: If needing to supplement baby during this time a supply line can be used or the Tommee Tippee Closer to Nature range may be helpful.

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• your breasts are full and uncomfortable – engorged
• you are trying to increase your milk supply
• baby is sick and/or premature
• you will be temporarily separated from your baby
• you are returning to paid work

Expressing of breastmilk can be accomplished by either hand or the use of pumps (hand or electric). Before you start a few handy hints that are common to all ways of expressing;

• be in a comfortable position
• wash your hands with soap
• have a drink handy
• have a sterilised container to collect the milk or sterilised equipment ready if using a pump
  relax, maybe music or TV will help
• if away from baby maybe a photo to help your letdown
• begin by massaging your breasts gently from the top and stroke towards the nipple, don’t forget the underside, repeat all over the breast.
  

• Wash your hands thoroughly with soap & water
• Expressed breastmilk is already sterile
• Use fresh expressed milk whenever possible
• It can be stored in glass or plastic containers
• Refrigerate or freeze milk after you have expressed
• Date the container at time of expressing
• Freeze milk that will not be used within 2 days
• Expressed milk can be refrigerated and then added to frozen milk
• Use the oldest milk first

For effective sterilisation all equipment should be rinsed in cold water, washed in hot water with detergent using a bottle brush to thoroughly clean bottles and teats, rinse again before sterilising.

• Diet should be well balanced and according to appetite, however calcium needs are greater and dairy intake should increase.
• Fluids to satisfy thirst. All adults should drink 3 litres of water per day.
• You do not need to avoid certain foods in the belief they will cause colic in their babies. Everything in moderation is the way to go.
• Alcohol should be avoided, however if consumed, best to have 1 glass just after the breastfeed.
• Smoking should be avoided, however if not possible, avoid 1 hour prior and during the breastfeed. No-one should smoke in the same room as an infant.
• Other drugs, e.g. Marijuana, mood-altering drugs are to be avoided. They are excreted in the breastmilk and you could be a hazard to yourself and baby.

As a parent looking after yourself is paramount. The job of raising children is a time of many adjustments and demands. No rule book and the desire to be perfect in the job you are doing. It affects your confidence, relationships, sleep patterns and way of life. So:

• Take a break every so often to help renew your strength
• Eat well, exercise and sleep where possible making healthy lifestyle choices
• Remember when having a bad day tomorrow will be better
• Recognise your limits and when to call for help, friends, family or health professionals
• Call your doctor when concerned about baby’s abnormal behaviour
• Communicate with your partner, problems can be solved – 2 heads being better than 1 at times
• Keep your expectations realistic about yourself and your baby – there is no perfect parent or baby

Although Dad can’t breastfeed your baby, they can play a key role in the success of breastfeeding.

• Support and encourage by bringing drinks and making sure you are comfortable. Feed the mum = feed the baby.
• When baby wakes, he can change baby’s nappy before handing him to you.
• He can sit with you and share in the process.
• He can have skin-to-skin contact with baby. Once the feed is finished place your baby, dressed in a nappy, next to his skin. He will experience the closeness as you do when breastfeeding.

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• Hospitals do not recommend using Comforters because the focus is helping mothers establish breastfeeding.
• Think of comforters as a tool to be used wisely when baby has had a good breastfeed, but may still need to suck or comfort themselves.
• Comforters if used instead of feeding can reduce the sucking time at the breast and can eventually reduce the milk supply.
• In reality however many women find comforters very useful for settling their babies.
• Most babies have a very strong and natural urge to suck.
• For hygiene and safety reasons, you should change a comforter around every 4 weeks.
• Always inspect a comforter before you give it to a baby, replace it if it is worn or torn.
• Always keep comforters clean.
• Types: latex rubber, soft and gentle but need replacing often.
• Types: silicone is slightly firmer and last longer.
• Both come in either cherry or orthodontic shape.
• When breastfeeding it is suggested that a large cherry-shaped dummy is more appropriate as it takes up more room in baby’s mouth, more like the breast.
• It has been suggested (British Dental Assoc.) that comforters are better than a baby sucking on a thumb.

• Should be gradual to avoid breast engorgement.
• Drop one feed, then wait a few days to allow the breasts to adjust, then drop another feed. Continue slowly spacing breastfeeds evenly over the day.
• Be aware of how your breasts feel and where necessary feed or express if problems.
• Combining breastfeeding and formula is certainly an option. Some mothers returning to work prefer to provide formula during the day and breastfeed when they are with their babies in the morning and at night.
• It’s best to wait until breastfeeding is well established, which can take 6 weeks to 3 months.
• Remember babies under one year require breast milk or formula.
• Full strength cow’s milk can be given as a drink from 12 months onwards.
• In addition to their milk feeds babies should be offered water in a cup from 6 months of age.
• Fruit juice is not necessary at any age.

Breastfed babies have some protection against allergies. If your family history is highly allergic then breastfeeding exclusively for the first 6 months is recommended.
The immaturity of baby’s digestive and immune systems is the reason for the reaction. Breast milk speeds up the maturation of the immune system. It can protect against allergic rhinitis, wheezing, asthma and conditions that are caused by hereditary reactions to certain allergens.
To minimise the risks of allergy;

• Provide a smoke-free environment
• Exclusively breastfeed for 6 months
• Discuss with a health professional the use of a hydrolysed protein formula if you cease breastfeeding
• Introduce solids after 6 months
• Start with rice cereal, then vegetables, fruits, meats
• Start with 1 food at a time and wait several days before adding another food
• If there is a strong family history of allergies delay introducing the highly allergenic foods during the first year:
  > cows milk & dairy products
  > soy products
  > eggs
  > nuts & peanuts
  > fish & shellfish

Discuss with a health professional if you should avoid these foods when you are breastfeeding. If you exclude any foods from your diet you need to be careful that your nutritional requirements are adequate.

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