How to maximise your chances of successfully establishing breastfeeding

by Cordelia Uys, Breastfeeding Counsellor,

December 2021

Over 80% of mothers in the UK want to breastfeed, the majority of women can produce all the milk their baby needs, and the walls of antenatal clinics are covered in posters extolling the health protections breastfeeding confers to mothers and babies, yet the UK has some of the lowest breastfeeding rates in the world. I explore the reasons for this in my article Why does the UK have such low breastfeeding rates and how to buck the trend? In this article, let’s look at what you can do to maximise your chances of successfully establishing breastfeeding.

Here’s what you can do before your baby is born:

Spend time with a friend who is having a positive experience of breastfeeding

Lots of people think because breastfeeding is natural, that it will come naturally to mothers, but in fact, for all female apes, breastfeeding is a learned behaviour. This can be seen from the experience of the juvenile female gorilla in Ohio zoo who, having been separated from her mother and their troop at a young age, had no idea how to feed her first baby. During her second pregnancy, zoo keepers had the inspired idea of asking some human mothers to come and regularly breastfeed their babies in front of her. When her second baby was born, she immediately put her baby to the breast. (This story is recounted in the book Breastfeeding Made Simple – Seven Laws for Nursing Mothers by Nancy Mohrbacher and Kathleen A. Kendall-Tackett).

In the past, human mothers would have learned how to breastfeed by watching relatives and friends. For this reason, I strongly encourage pregnant women who want to breastfeed, to go and spend some time with a friend who is successfully nursing her little one, and to befriend other breastfeeding mothers. In the case of breastfeeding, seeing really is believing. When new mothers have spent time with other breastfeeding mothers, they’re more likely to persevere if they encounter any initial challenges.

Find out antenatally which of your friends and family had a positive experience of breastfeeding, so you can turn to them for support when your baby arrives.

Inform yourself about breastfeeding antenatally

a) Read a good quality book on breastfeeding. Prof Amy Brown’s The Positive Breastfeeding Book is clear, comprehensive and evidence-based.

b) Attend an antenatal breastfeeding workshop facilitated by an accredited Breastfeeding Counsellor or an IBCLC Lactation Consultant. The NCT includes a dedicated breastfeeding workshop alongside their antenatal birth classes. Most IBCLC Lactation Consultants offer private antenatal breastfeeding sessions.

Find out about local breastfeeding drop-ins

Search out a good drop-in in your area, run by a Breastfeeding Counsellor accredited by one of the 4 breastfeeding charities (NCT, ABM, BfN or LLL) or by an IBCLC Lactation Consultant. You want to be sure the person providing you with support and information has in-depth training. When it comes to breastfeeding, the knowledge and training of midwives, health visitors and GPs can be variable. Please see Who’s Who in Breastfeeding Support and Lactation in the UK below.

Find an IBCLC Lactation Consultant or Breastfeeding Counsellor who can visit you in the first week after your baby is born.

Join an online breastfeeding support group (please see list below)

When women join an online support group antenatally, breastfeeding tends to go more smoothly, as they get a better idea of what to expect, and what to do if they experience difficulties.

Explore the website Basisonline https://www.basisonline.org.uk/ so you can inform yourself about normal infant sleep.

Frequent night waking is normal, breastfeeding lowers the chances of SIDS, and in the early months, night feeds are crucial for maintaining a mother’s milk supply because prolactin (the hormone that makes milk) levels are highest at night.

Make sure you have comfortable furniture and props

If you can afford it, buy a comfortable L shaped sofa, and place it up against a wall, so you can put your feet up and have head support. Alternatively, get a nice big foot rest, or poof, to support your feet when you’re breastfeeding on your sofa or a comfortable armchair. Ensure you have lots of cotton cushions (velvet or satin are too slippery) and pillows. A special breastfeeding pillow isn’t usually helpful, unless you have very large breasts.

It’s essential that you are completely comfy, with all of your body well-supported, because in the early months, you are going to be spending hours and hours breastfeeding.

Consider doing some antenatal hand expressing from 36 weeks

If you are having a low risk pregnancy, there is evidence that doing some antenatal expressing of colostrum (your first milk) from 36 weeks of pregnancy is safe and can be helpful in building your confidence in your body’s ability to feed your baby. Having some syringes of colostrum to take into hospital can act as a safety net and help you feel more relaxed. See my article https://www.cordeliauys.co.uk/antenatal-harvesting-of-colostrum .

Consider hiring a doula to provide you with practical and emotional support in the postnatal period.

Unlike maternity nurses who take care of the baby, doulas focus on taking care of the mother, and empowering her to become confident in her mothering skills.

Here’s what you can do once your baby is born:

Uninterrupted skin to skin with your baby for the first two hours immediately following birth helps enormously with bonding. When babies breastfeed at this time, they are likely to ‘remember’ how to breastfeed later on.

Spending the majority of the time in skin to skin with your baby in the early hours and days will help bring your mature milk in sooner.
See my article: https://www.cordeliauys.co.uk/the-importance-of-skin-to-skin

Keeping your baby close and feeding him or her as soon as they show any feeding cues will help you establish and maintain a good milk supply. When babies are in a cot or Moses basket, it’s easy to miss feeding cues.

Until your baby has overtaken their birth weight, make sure they don’t go longer than circa 3 hours without breastfeeding. A baby who isn’t getting enough milk might not have the energy to wake and ask to be fed.

Always offer both breasts at each feed. Once your baby has come off the first breast of their own accord, offer them the second breast. If they’ve fallen asleep, wake them up; nappy changing normally does the trick. However long they spend on the second breast, make sure to start the next feed on that second breast. Only offering one breast per feed can lead to slow weight gain for the baby and lower milk supply for the mum.

Remember that it’s normal for newborn babies to want to feed A LOT! UNICEF talk about an average of 10 to 12 feeds in 24 hours, and many babies will feed more often than that. Their tummies are small, and breastmilk is easily digested. On top of that, newborn babies not only want to breastfeed for hunger and thirst, but also whenever they’re tired, sad, lonely, bored, in pain, feeling ill, wanting comfort, having a growth spurt…. All this stimulation is excellent for your milk supply, and once your baby is 2 to 3 months old, you will start to reap the rewards, as your supply will be perfectly in tune with your baby’s needs, and they’ll have become a super-efficient feeder.

Be prepared for periods of cluster feeding in the first couple of months. Cluster feeding (a period of 5 or more hours when your baby wants to feed almost incessantly) usually starts on the 2nd night of your baby’s life. Over the first week or so, cluster feeding gradually moves from the middle of the night to the slightly more civilised times of around 5 or 6pm to midnight. Having a stretch of several hours when a baby feeds very frequently is probably nature’s way of ensuring an excellent milk supply: the more often a baby feeds, and the emptier a mother’s breasts, the more milk she will make.

Be prepared for the fact that it’s normal for your baby to want to spend the majority of their time in your arms and to refuse to sleep unless they are in physical contact with you or your partner; this contact is deeply comforting and physiologically regulating for a baby. We now know that responding lovingly to a baby’s need for food, closeness and comfort allows optimal brain development.

Know the signs that your baby is getting enough milk. In the early weeks, your baby’s nappy output and weight gain will give you all the information you need.
See my article: https://www.cordeliauys.co.uk/howtotellyourbreastfedbabyisgettingenoughmilk

Learn how to breastfeed your baby safely in the side-lying position as soon as you can. This position is technically the recovery position and will prevent you from rolling on to your baby even if you fall asleep while breastfeeding. Please read the Lullaby Trust leaflet Safer sleep for babies a guide for parents to understand how to bed share as safely as possible. At night it’s not safe to breastfeed sitting on a soft chair or sofa because if you fall asleep, your baby could end up in a dangerous position.

Consider spending the first couple of weeks (or more) having as few visitors as possible. Being able to spend the majority of your time in your pyjamas makes life with a newborn less stressful.

Arrange a visit from an IBCLC Lactation Consultant or Breastfeeding Counsellor in the first few days after your baby’s birth, to help optimise their latch and positioning at the breast, and to double check you’re on the right track. It’s impossible to exaggerate how much difference good attachment and positioning make to a mother’s comfort and to her milk supply. Often tiny adjustments can be transformational.

If things don’t feel right, seek out expert help ASAP. Pain means something is wrong – don’t put up with it!

Be patient with yourself: breastfeeding is a physical skill that you learn, like dancing. It may take time and practice to get good at it, but after a while, it becomes muscle memory.

Believe that all your hard work in the early weeks will pay off. As a client once said to me: “I wish I’d known that I would end up actually enjoying breastfeeding, not just out of pride, but simply for the act itself and for the moments of calm with my son.”

Books:

Breastfeeding

The story of the gorilla is recounted in the book Breastfeeding Made Simple – Seven Laws for Nursing Mother by Nancy Mohrbacher and Kathleen A. Kendall-Tackett.

The Positive Breastfeeding Book by Prof Amy Brown: https://www.pinterandmartin.com/the-positive-breastfeeding-book

Parenting:

Let’s Talk About the First Year of Parenting by Prof Amy Brown, pub by Pinter & Martin 2020

Let’s Talk About Your New Family’s Sleep by Lyndsey Hookway, pub. By Pinter & Martin 2020

Why Love Matters - how affection shapes a baby's brain by Sue Gerhardt, pub. by Brunner-Routledge. Fascinating but very scientific language.

What Every Parent Needs to Know by Margot Sunderland, pub. by Dorling Kindersley. Also about infant brain development but much more accessible to the lay person and with practical suggestions on how parents can care for their children in the light of recent discoveries in neuroscience. I highly recommend this book.

The book you wish your parents had read by Philippa Perry, pub. by Penguin

Raising Babies by Steve Biddulph, pub. by HarperCollins UK 2006

How to Talk so Kids Will Listen, and How to Listen so Kids Will Talk by Adele Faber and Elaine Mazlish, pub by Piccadilly Press

Links:

First Droplets is a website set up by the paediatrician Dr Jane Morton: ‘The cornerstone of successful breastfeeding is a plentiful milk supply. We will help mothers go into delivery understanding that milk removal in the first few hours, either by the baby, herself or her partner, is the key for future milk production. Simply put, it’s early milk out, later milk in’: https://firstdroplets.com/team/

Find an IBCLC Lactation Consultant: https://lcgb.org/find-an-ibclc/

Who’s who in the world of breastfeeding:

https://www.lcgb.org/wp-content/uploads/2018/02/Whos-Who-2017-Oct-17-1.pdf

UNICEF on the effects of skin to skin contact:

https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/

Baby feeding cues:

https://metronorth.health.qld.gov.au/rbwh/wp-content/uploads/sites/2/2017/07/feeding-cues-term.pdf

https://youtu.be/IYUPdw8qQtw

UNICEF’s leaflet on the importance of responsive feeding:

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf

NCT’s What’s in a nappy leaflet:

https://www.nct.org.uk/sites/default/files/related_documents/What%27s%20in%20a%20nappy%20%28ENGLISH%20VERSION%29%20FINAL%20WITHOUT%20BLEED.pdf