Breastfeeding is the best way to feed your baby. It creates a bond between you and your baby and provides the best nutrition for your infant. Breastfeeding also protects your baby against many illnesses.

Your breast milk is perfect for your baby and adapts to meet your baby’s changing needs. The size and shape of your breasts are not related to your ability to breastfeed.

Most babies will need no other food or drink until they are about six months old.

What are the benefits of Breastfeeding?

Practical benefits

• Low in cost to your family.
• You can feed your baby anywhere, with no preparation required. Your milk is at the right temperature and available in the right quantity.

Benefits for your baby

• Optimal nutrition for your baby.
• Breast milk is easy to digest, resulting in less risk of reflux.
• Breast milk contains antibodies to protect your baby from infection. This includes upper respiratory, ear and urine infections. Your baby will also have protection against constipation, diarrhea, and allergic reactions.
• Breastfeeding promotes healthy sucking reflexes and reduces the risk of dental caries.
• Breast milk may provide protection against certain child and adult-onset disease (Crohn’s disease and Type 1 Diabetes)
• Breastfed babies experience less atopic (Hyperallergic) disease. This includes eczema and asthma.
• Breastfed babies have a lower risk of developing childhood obesity.
• Research suggests that breastfed babies have better mental development.

Benefits for you

• You will find that breastfeeding enables you to lose weight more easily in the first 6 months following birth.
• Breastfeeding releases hormones that help your womb to contract in the first weeks after birth. This process helps keep your bleeding minimal.
• Breastfeeding reduces your risk of osteoporosis, ovarian cancer, and pre-menopausal breast cancer.

What is in breast milk?

• Breast milk changes over the days and weeks that your baby feeds to meet his/her needs.
• The first milk is called colostrum. It is produced in the first 3 days following birth. It is a light yellow color, is easily digested, encourages the passing of the first stool (meconium) and contains lower levels of fat and sugar than mature milk. It is full of antibodies which will get passed to your baby.
• Colostrum provides a protective lining to your baby’s stomach and helps the stomach to develop.
• Your breast milk will change after 3 days to what is considered a more mature milk. The color and quantity of the milk will change from the beginning of the feed to the end and from morning to evening.
• Breast milk also changes within the same feed. The first milk (foremilk) contains more water and sugar and the later milk (hindmilk) contains more fat and the enzyme for digesting it. The baby needs both foremilk and hindmilk.
• Breast milk contains sufficient amounts of water even in hot weather.
• The world health organization recommends exclusive breastfeeding up to 6 months of age. After six months, your child should receive complementary foods in addition to breast milk.
• Breast milk continues to be important, often providing one-third to one-half the calories for the child at twelve months of age, and should be continued up to 2 years of age and beyond.

How often should I breastfeed?

• It is best to begin breastfeeding as soon as possible after birth.
• Following the birth of your baby, skin-to-skin contact will be provided. The Midwife or Physician will ensure that your baby is healthy and then help you to position your baby.
• Skin-to-skin contact has been shown to encourage both you and your baby’s ability to breastfeed.
• It is important to allow your baby to feed when he/she chooses to. You should watch for early hunger cues, which would include the following:
  • Moving from a sleepy state to a quiet –alert state.
  • Making small noises and sucking movements.
  • Sucking of hands or fingers.
  • Rooting – the turning of the head in response to a finger touching the baby’s cheek.
• It is more difficult to get a very hungry baby to breastfeed, so watch out for the early signs that your baby is hungry!
• It is normal for a newborn baby to feed often and for long periods during the first couple of weeks following birth.
• Breastfeeding babies should feed for a minimum of 8 – 12 times in a 24 hour period.
• You should allow your baby to feed for as long as they choose to. This is called ‘Demand feeding’.
• Demand feeding enables your baby to establish a supply of milk that is appropriate for them. The more a baby breastfeeds, the more breast milk is produced. This is called ‘supply and demand’.
• Your baby will progress through regular growth spurts, and it is during these times particularly that they will ask to feed more.
• When your baby has had enough breast milk, they will cease suckling, fall asleep and then let go of the breast spontaneously.

How should I position myself and my baby to breastfeed?

• Proper positioning is essential to successful breastfeeding. Make sure you are relaxed and in a comfortable position with support for your back.
• Positioning refers to the following:
  • The way you hold and support your baby.
  • The position of your hand as you support your breast.
  • The position of your baby’s mouth, lips, and tongue as they breastfeed. This is often called the ’Latch’ of the baby.
• Once you are in a comfortable position, the baby should be moved to your breast, do not be tempted to lean over your baby. This may result in muscle strain, tiredness and sore nipples for you.
• Raise your baby’s head to face the front of your breast. The baby’s ear should be in alignment with his/her shoulder, as this helps to ensure a correct latch.
• The baby should preferably be placed ’chest to chest’, with your baby’s chest placed against your chest, and the baby’s nose opposite your nipple.
• In the beginning, it is good to breastfeed your baby with his skin pressing against your skin. There should be nothing between your baby and you. Hold your baby very close to you. You can cover him to keep him warm.
• Here are some positions in which you can hold your baby while breastfeeding. You can choose the one(s) that you and your baby feel most comfortable with.
  • Cradle Position: This is a commonly used position that is comfortable for most mothers. Hold your baby with his head on your forearm and their whole body facing yours.
  • Cross-cradle or transitional Position: This is a good position if your baby has been born prematurely, or if your baby is having trouble latching on. Hold your baby along the opposite arm from the breast you are using. Support your baby’s head with the palm of your hand.
    

• Clutch, football, or side position: Hold your baby at your side, with the baby lying on his/her back, and the baby’s head at the level of your nipple. Support your baby’s head with the palm of your hand.
  
• Side-lying position: this allows you to rest or sleep while your baby breastfeeds. This is a good position if you have had a cesarean birth. Bring your baby close and guide your baby’s mouth to your nipple.
  

How should I hold and position my breast whilst breastfeeding?

• Supporting your breast makes it easier for the baby to latch on. It keeps the weight of the breast away from the baby’s chin during feeds, so your baby is able to stay latched on well.
• You should hold your breast in either a ‘C’ or a ‘U’ hold.
• Rest your fingers on your chest wall under your breast, so that your first finger forms a support at the base of the breast.
• Use your thumb to press the top of the breast slightly. This can improve the shape of your breast so that it is easier for your baby to latch well. However, this pressure should be light, and not always in the same spot.
• Make sure that your fingers are not near your nipple so that they do not block your baby from getting a big mouthful of your breast.

How do I know if my baby has latched correctly?

• Your baby’s mouth should be very wide at the start of the latch on.
• Stimulate the rooting reflex by lightly touching your baby’s mouth with your finger.
• Be patient. You should wait for your baby to open their mouth and search for your breast.
• When your baby’s mouth is wide open, pull your baby close quickly and gently, chin first.
• You will notice a ’Tugging’ sensation, but there should be no sensation of pain.
• You should see more areola above the baby’s top lip than below.
• You will see that your baby’s mouth is widely positioned around your breast, creating a good seal.
• Your baby’s mouth will have the lower lip turned out, and his /her chin touching your breast.
• You will see slow, deep sucking and may hear gentle swallowing or gulps.
• Your baby’s cheeks should be rounded and not drawn in during the breastfeed.
• Your baby will release your breast by themselves, and will usually look content following a good feed.

How can I unlatch my baby?

• Should you experience pain once your baby has latched on, it is important to re-position and re-latch your baby.
• The suction caused while breastfeeding is very strong, so damage to your nipple may occur if the baby is latched incorrectly.
• Don’t try to pull your nipple away from your baby without breaking the suction first. Slide a finger into the corner of your baby’s mouth alongside your breast and the baby will release the breast.

How do I know if my baby is getting enough milk?

• You should feel the let-down reflex (tingling sensation in your breast, leaking breast milk, abdominal cramps, thirst, a feeling of relaxation and well being).
• The baby is sucking well and you can hear the baby swallowing.
• There are at least 3 – 5 wet diapers in 24 hours.
• There are at least 3 bowel movements in 24 hours (after 6 weeks, some breastfed babies have only 1 stool every 3-5 days and this is normal).
• There is adequate weight gain.

When your baby seems hungrier than usual, feed, feed, feed, and your milk supply will increase to meet the need.

When should I hand express?

• For breast comfort, such as to relieve engorgement when your breasts are very full of milk.
• To rub a few drops of hindmilk on the nipple area to soothe if the nipple is tender.
• To encourage a baby to breastfeed by expressing milk on to the nipple so that the baby can smell and taste it.
• To express milk directly into the baby’s mouth if the baby has a weak suck.
• To soften the areola of a full breast so that the baby can latch easier.
• To keep up the milk production when the baby is not suckling or to increase milk production.
• To obtain milk if the baby is unable to breastfeed, or if the baby is small and tires quickly.
• In the event that for a particular reason you and your baby are separated.

What are some of the benefits of expressing by hand?

• Hands are always with you, and there are no parts to lose or break.
• Hand expression has been shown to contain higher amounts of healthy fat than expressed milk obtained by using a machine.
• Hand expression can be very effective and quick when you are experienced.
• The skin-to-skin stimulation from hand expression can allow milk to flow quicker.
• Hand expression is usually gentler than a pump, particularly if your nipple is sore.
• There is less risk of cross-infection.

How should I express and store my breast milk?

• You can express your breast milk either by hand or by the use of an expressing machine.
• Your hands should be washed before and after expressing.
• It is important to try and express your breast milk every 3 – 4 hours, to simulate a regular feeding pattern, as your baby would feed.
• Breast milk should be stored in a refrigerator/freezer. Do not leave expressed breast milk out at room temperature for longer than 6 hours.
• You can store your milk in a refrigerator for 48 hours. If you wish to store your expressed milk in the freezer, you can do so for 2 – 3 weeks at a time. Do not store your milk in the door of a refrigerator as the temperature will not be stable. Place the milk in its container towards the back of the refrigerator.
• You can store your milk in a freezer for up to 2 weeks, at -18℃ for 3 -6 months and in a deep freezer at – 20℃ for 6 – 12 months.
• If you wish to defrost your breast milk, you should place the frozen milk in its container, under warm running water, until it is warm to the touch. Defrosted milk should be used within 24 hours and any leftover milk should be discarded.
• Do not try and defrost your frozen milk by microwaving it. This creates pockets of extreme heat and could burn your baby’s mouth.
• Any equipment that you use should be thoroughly washed with warm, soapy water.
• It is easier to hand express when the breast is soft rather than full and tender.
• There are 4 steps to follow when you hand express –
  1. Encourage your milk to flow.
  2. Find your milk ducts.
  3.  Compress your breast over the ducts
  4. Repeat in all areas of your breast.

Encourage the milk to flow

• Be comfortable and relaxed.
• Think about your baby; look at your baby (or even at a photograph).
• Warm your breast, gently massage it or stroke it.
• Gently roll your nipple between your fingers and thumb.

Find the milk ducts

• Gently feel your breast near the outer edge of the areola, back from the nipple until you find a place where the breast feels different. It may feel like a knotted string or a row of peas.
• These are the ducts of milk. Depending on what part of the breast it is, you should place your first finger over the duct, and your thumb on the opposite side of the breast. You can support your breast with the other fingers of that hand, or with her other hand.

Compress the breast over the ducts

• Gently press your thumb and fingers slightly back towards your chest wall.
• Press the thumb and first finger together, compressing the milk duct between them. This helps the milk to flow towards the nipple. Release the pressure and repeat the compress and release movement until milk starts to drip out (it may take a few minutes).
• Colostrum may come out in drops as it is very thick. Later, the milk may spray out in streams.

Repeat in all parts of the breast

• When the milk flow slows, you can move your thumb and finger around the edge of your areola to another section and repeat the press and release movement.
• When milk flow stops, you can change to the other breast and repeat.
• You can pause to massage your breast again if needed. You can go back and forth between your breasts a few times if needed.

How should I care for my breasts?

• Clean your breasts with water only. Soaps, lotions, oils, and Vaseline all interfere with the natural lubrication of your skin.
• Washing your breasts once a day as part of general body hygiene is sufficient. It is not necessary to wash your breasts directly before feeds. This removes protective oils and alters the scent of your breasts. Your baby uses this scent to identify you as his/her mother.
• Brassieres are not necessary but can be used if desired. Choose a brassiere that fits well and is not too tight.
• If you are not breastfeeding, you also need to care for your breasts. Your breast milk dries up naturally if your baby does not remove it by suckling, but this can take a week or more. You can express just enough milk to keep your breasts comfortable and healthy while your milk dries up.

Dietary considerations

• Eating a healthy, varied diet in pregnancy will help you to get most of the vitamins and minerals you need.
• Vitamin D regulates the amount of calcium and phosphate in your body, these are needed to keep your bones and teeth healthy.
• You should take a supplement of vitamin D each day when you are pregnant and if you breastfeed. This is particularly important if your health care provider has already identified you as having a vitamin D deficiency.
• Vitamin D can also be found naturally in the following foods –
  • Oily fish (salmon, mackerel and sardines).
  • Eggs
  • Meat
  • Some manufacturers add it to some breakfast cereals, soy products, some dairy products, powdered milk, and fat spreads such as margarine.
• The best source of vitamin D is sunlight on your skin. The amount of time you need in the sun to make enough vitamin D is different for every person and depends on things such as your skin type, the time of day and the time of year.
• Calcium-rich foods include:
  • Sheep or cows milk and cheese.
  • Whole grains and whole-grain flour.
  • Sesame seeds, which can be eaten whole, in the form of tahini (sesame butter).
  • Green leafy vegetables.
  • Almonds or other types of nuts and dry fruit, such as walnuts and dry figs.