The vital first few days of breastfeeding and the importance of the Mama and her support network in the success of it.
How to start a successful breastfeeding journey
First off, let me say, that how you choose to feed your baby is up to you. Yes, research shows that it is most beneficial for a human infant to be fed with human milk whether it be their mothers or another mother’s (donor milk) and there are future health impacts on the infant if they are formula fed, BUT there are some physiological and mental health reasons that a woman may not be able to breastfeed. We need to support mothers in their well informed choices. We also need to support a woman to be successful in her breastfeeding journey if this is how she chooses to feed her baby.
This includes normalising breastfeeding – breastfeeding in public, letting children grow up seeing breastfeeding - friends, cousins, siblings, endeavouring to change societal perceptions of breastfeeding, and letting go of the construct that it’s ‘Breast is best’ versus ‘Fed is best’. There are many arguments for and against both of these – as I said there are medical and emotional reasons a woman cannot or chooses not to breastfeed, what if it was normalised that she consider donor milk instead of formula so that her baby is fed with the same mammal’s milk. What if donor milk was as easily accessible as formula. Let’s not let the reasons a woman makes the choice not to breastfeed be surmountable with the right investigation and solution-oriented woman-centred approach. Reasons like excruciating pain, recurrent mastitis, undiagnosed tongue and or lip ties, poor postnatal care/support or family/societal pressure.
Picture this: A woman has just birthed her first baby hours prior and has been transferred to the postnatal ward. She is exhausted from being in labour all night. She ended up with an episiotomy and a ventouse delivery. Her partner has had to leave as it’s not OK he stays the night. Every muscle in her body is aching, her bottom is raw and swollen. Her heart is full of a newfound love, she is more tired than she has ever been in her whole life, her mind is a whirlwind of thoughts, good and bad, her baby is screaming and the care provider on duty has just come in and said ‘Your baby is starving, I will need to express some milk off for him, has anyone shown you how to hand express? Here, it will just be quicker if I do it, is that OK?’.
The woman had not done hand expressing before and as can be normal for the first few times, no colostrum is able to be expressed. The care provider then tells the woman she does not have enough milk and suggests because the baby is so unsettled that it would be best if the baby had some formula. This does a few things – firstly, it leads the mother to believe that she can’t and or won’t make enough milk for her baby; secondly, it takes away the mother’s autonomy around feeding and nurturing her baby.
Antenatal Milk Expression (AME)
This is the practice of hand expressing, collecting and freezing colostrum in the antenatal period for use in the first few days post birth (and if you have some leftover leave it frozen as it is amazing to give your kids to help recover from sickness!). Research shows that women between 36-39 weeks that antenatally express no more than twice a day for no longer than 10 minutes at a time were at no higher risk of pre-term birth and their babies, if they had hypoglycaemia, were less likely to receive formula supplementation. Given research that giving a baby formula puts it at risk of developing diabetes, metabolic and immune disorders in the future, it may be important to endeavour not to give babies formula unless absolutely necessary.
Empowering yourself with the knowledge of how to hand express can give you confidence of how your breasts work, give you colostrum to be able to give your baby in the first few days (if needed) while your milk supply is establishing, and can mean you keep the power in terms of body autonomy and dignity.
If you or your care provider is unable to hand express colostrum from your breasts, that does not mean you do not have any colostrum or that the baby is not getting any colostrum when they are suckling themselves.
An unsettled baby does not equal a 'hungry baby' (please see below ‘Reasons a baby cries in the first few hours/days/weeks of life’).
Babies (healthy & term) do not need to feed 3-4 hourly in the first 24 hours - that normal input as little as 4ml of colostrum in the first 24 hours is normal.
If babies are unsettled, mothers need to be helped with settling their babies into tubigrips or skin to skin shirts if they are not feeding.
Normal newborn behaviour such as not wanting to be put down and crying need to be reassured as such.
I believe it would be very helpful to have a supply of hydrogel breast discs to be able to give mothers a pair in the first 24 hours to allow them time to get their own and also to decrease occurrence of nipple damage.
I also believe there are a lot of missed tongue-ties that cause much pain and eventually for women to give up breastfeeding altogether because of the pain so having these professionally assessed if there are signs of ties - lipsticking of or ‘squashed’ nipples after a feed, feeding is excruciatingly painful even though latch looks outwardly good (differential diagnosis here is Raynaud’s Syndrome), baby is very irritable at breast and very reluctant to latch or latches on and off (differential diagnosis here is an instrumental birth and does not like head or neck touched), baby cannot poke out tongue very far, baby has a line at tip and middle of tongue or ‘heart-shaped’ tongue or a ‘double furrow’ usually best evident when crying.
Reasons a baby cries in the first few hours/days/weeks of life
Adaptation to extra-uterine life – being born is scary shit, one minute you are happily snugged up inside your cosy womb home surrounded in warm fluid and hearing Mama’s heartbeat, next minute you are thrust into the cold air, you have to breathe air, get fluid (mucus) out of your lungs, your blood and heart circulation completely changes direction and path, your immature stomach is having to digest actual food (milk), you see (bright) light, you hear noises, loud and not muffled, there are all sorts of new smells and bacteria, you are immediately laying down your immune system foundation, you are wearing clothes and a nappy, you are having to learn how to breastfeed, people expect you to sleep by yourself in a plastic bowl, you might be being touched, assessed and moved by various people, care providers or family and friends, all.for.the.first.time. In the space of a few hours. I would cry too if I had to experience all of that in such a short space of time.
Mucus – many babies are ‘mucusy’ post-birth as they are trying to get the leftover third of fluid (surfactant) off their previously entirely wet lungs - and depending on how babies are born (vaginal or cesarean), they may have more mucus to shift than others. This can last a couple of days and can mean a baby is less interested in feeding as they bring/gag the mucus up into their mouth from their lungs and either spit it out or swallow it. It is fine either way, if they swallow it, it is composed of lipids and proteins so has some caloric benefit. It can be quite a yellow colour and sometimes when they bring it up it can be mixed with colostrum or even old or fresh blood which can be a normal part of the birth process. Bringing up mucus can be upsetting to the baby as they really have to gag to bring it up and they can easily cry because sometimes it blocks their airway – if you see your baby gagging, sit them up to help them bring up the mucus. Call for your care provider if you are worried about them at all in this process.
Instrumental or fast birth – baby has a really sore head and probably neck after being pulled/zoomed out of the birth canal and in the first few days, they do not like being moved around.at.all.
Need a cuddle.
Has a sore tummy/wind.
Wants to suckle for comfort/sleep/colostrum/to bring milk in.
How to establish a good supply for your baby
Make sure you are positioning and latching the baby well (deeply) and always seek help if you need it. Watch your nipple shape after baby has fed - it should still be the same shape as when it went in the mouth, not squashed or like a lipstick. Learn different positions to feed baby and do what feel comfortable to you both. If you are experiencing nipple pain or lipsticking, sometimes laid back feeding can be helpful in achieving a deeper less painful latch and always check that babies’ lips are out and not tucked in (you can flick out the lips once latched if either is tucked in rather than having to re-latch and pain should subside if it was this causing the pain). Letdown and the initial latch and suckling can be painful for some women but if it is still painful after 30 seconds of initially latching then I recommend either re-latching or asking for help with your latch.
Breastmilk production is all about supply and demand - feed on demand and be aware of baby’s feeding cues especially when being cuddled by someone else.
Drain one breast before offering the other - a drained breast means faster milk production and a fuller one means slower milk production.
Check in with your care provider about starting on a breast-pump - introducing top-ups or replacing feeds with expressed breastmilk or formula can hinder your supply - the best possible way to make more milk is for your baby to remove it from your breast, not a pump. If however, you have delayed lactation or have a baby in NICU then pumping can be important.
Skin to skin cuddles.
Educate yourself about cluster feeding - in the first 6 or so weeks, your baby will do a big cluster feed at least once a week to ‘order’ more milk for the following week or few days depending on how fast they are growing. It is also normal for a baby to have a 2 hour cluster feeding in the evening before they go down for their first night sleep - it could be 5-7pm or 9-11pm, totally depends on your baby. You can try and encourage them to do it earlier if it is too late for you. Your baby is not cluster feeding because they are hungry, they are cluster feeding to order more milk because they are growing. If you introduce a bottle or top-up during this time you will not make enough milk for the subsequent days for your baby and then it can be difficult to get your supply back on track.
Seek help early on if you have any pain with feeding after letdown as some women have a painful letdown and this is normal for them.
And make sure you eat well (use moderation as a lot of one thing will usually upset a baby’s immature digestive system) and drink at least 3 litres of water a day. A really good way to ensure this is every time you feed baby, pour yourself a drink of water before you sit down.
How to increase your supply if needed
Feed, feed, feed on demand.
Eat galactagogue foods such as dark leafy greens (like spinach, collard greens and kale), oats and other wholegrains, nuts and seeds, like almonds and cashews, garlic, ginger, spices notably fennel/cumin/anise seeds and turmeric, chickpeas, papaya (especially green).
Drink a daily smoothie with enriching and milk boosting ingredients like brewer’s yeast and moringa powder (see our Breastfeeding Recipes blog post for some suggestions).
If you don’t like smoothies you can take herbs like goat’s rue, fenugreek or a tea blend made specifically for breastfeeding Mama’s to boost supply. It is always good to talk to a qualified Herbalist when taking herbs to make sure you are taking the right herb for you and your issue.
How can you best support the breastfeeding Mama?
Tell her what a great job she is doing.
Thank her for nurturing and growing your baby/grandchild/niece/nephew.
Feed her! Make her nutritious and delicious food that sustains her because she needs nurturing too. Make her cups of herbal tea and smoothies to drink. A really good idea before baby arrives is to make up freezer packs with pre-prepared food like snaplock bags with smoothie ingredients and soups, lasagnes, stews, casseroles and breakfast muffins - things to make easy snacks, lunches and dinners.
Do the dishes.
Hang out the washing/Bring in the washing/Fold the washing.
Take the toddler out to the park.
Hold the baby so Mama can shower.
Protect her sleep space.
Learn about and consider antenatal expression of colostrum.
Ask that your baby is checked by an expert for a tongue and lip-tie in the first few days.
If breastfeeding is excruciatingly painful - thinking outside the box of a bad latch - consider Raynaud’s, nipple thrush and tongue-tie (possibly posterior/sub-mucosal which are easy to miss).
Have a lot of skin to skin cuddles with your baby in the first few days, using a Kangaroo Care shirt or pocket carrier such as Milk & Baby, NuRoo,VIJA or Nesting Days or just a tubigrip – ask your care provider to show you how to do it safely - you should have baby high enough to be able to kiss the top of their head, their head to the side and their face clear, that their feet are up under their bottom (“frog legs” or “M” position) and that the tubigrip or skin to skin shirt you are using is tight enough to prevent baby falling off you.
Empower yourself with both belief in your body and your baby to be able to breastfeed successfully; and also knowledge of normal newborn behaviour and the physiological process of lactation. Learning this antenatally as well as learning how to hand express can help in this and if you have any problems along the way then you can discuss them with your care provider and troubleshoot so you are prepared before the baby is even born. You can also discuss the shape of your nipples with your care provider or a lactation consultant as you made need different tricks if you have flat or inverted nipples. There are also breastfeeding classes or tutorials you can take or watch prior to baby being born so you are armed with the best knowledge to commence your breastfeeding relationship.
Ask to change care provider (whether it be in a facility or not) if you feel the language being used by them is not conducive to successfully establishing your breastfeeding relationship.
Ensure the team around you are 100% supportive of how you would like to feed your baby – however that may be.
Know that if the first breastfeeding relationship was unsuccessful, it does not indicate your subsequent ones will be.
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