Breastfeeding is the healthiest and most natural way to feed your baby, but that doesn’t mean it’s always straightforward – learning to feed your baby can take time and patience. The NHS Breastfeeding midwifery team are here to support you and give you confidence, so that breastfeeding is enjoyable for both of you.
Babies are all different: some will feed frequently and settle afterwards, some will feed most of the time, and others may be sleepy and need reminding to feed. The midwives and maternity care assistants are all trained in breastfeeding support and will give you personalised advice so that your baby starts to breastfeed at their own pace.
If this is the first time you are breastfeeding, it is important to get help and support on how to latch your baby to the breast correctly from the start. The NHS Breastfeeding team are here to help make the start of your feeding journey as smooth as possible for you and your baby.
If you have breastfed before, you will probably be confident about feeding this time around, but you should always ask the staff if you need help as babies can be very different.
Northamptonshire LMNS works closely with The Milk&You project which aims to give families access to excellent infant feeding support by working together with health and social care professionals to provide parents with a safe, supportive and equitable service.
Working as part of the Integrated Care System, Milk&You is committed to listening to women and their families and learning from our community and partner organisations to sustain a county wide peer support service that helps support the increase in breastfeeding rates across Northamptonshire.
Telephone: 01327 220 705
Email: [email protected]
If you have made an informed decision to feed your baby with formula, the maternity team will support you. Northamptonshire maternity units do not provide formula milk unless your baby requires it for medical reasons. In all other cases you will be expected to provide formula yourself. As there are no facilities to make up feeds in the maternity units, you’ll need to pack premixed liquid formula. You can buy starter packs containing single use bottles and disposable teats.
Please ensure you that you bring sufficient supplies. Your baby will feed every 2- 3 hours so a pack of 12 bottles should last you 24 hours. These starter packs are available from most supermarkets, so if you require a longer stay you should ask your partner, a friend or relative to bring more.
The team will make sure you are confident with making up formula feeds and sterilising equipment to protect your baby from infection. You’ll also be shown how to practice responsive feeding and paced feeding, allowing you to recognise when your baby is hungry and prevent them from over-feeding.
Your midwife and health visitor will support you with feeding advice as your baby grows. They’ll make sure your baby is content and feeding well, and check that their growth and weight gain is within normal range. Formula manufacturers also have guides for feeding based on weight and age printed on their packaging if you are unsure.
Formula milk is available in powder form, which must be prepared with hot water, or liquid formula that is premixed and ready to use. While premixed formula is sterile, powdered formula can contain bacteria so it must be made up with water that is over 70 degrees Celsius in order to keep your baby safe. You should never mix powdered formula with cold water as this will not kill off any bacteria in the powder. You will need to allow it cool before you feed it to your baby. To test the temperature of the milk, put a small amount on the inside of your wrist (once you know it won’t scald you). As the bottle cools down again, the bacteria can begin to grow so it is not recommended to make up feeds in advance. If you are planning to go out for the day it is best to take a flask of boiling water and use this to make up the feeds – still allowing it to cool down before feeding your baby. For specific guidance, see the NHS guidelines on making up formula feeds.
Bottle feeding can mean giving a baby expressed breast milk or formula via a bottle. If you choose to bottle feed, or need to do so for medical reasons, you will be encouraged to practice responsive feeding, which helps to increase bonding between you and your baby. Responsive feeding means recognising and responding to your baby’s feeding cues rather than waiting for your baby to cry. Each baby is different, but cues can include your baby being restless, wriggling, putting their hands or fingers near or into their mouth or rooting.
You will also be encouraged to practice paced feeding, which allows your baby to control how much milk they are taking and recognise when they are full. It’s thought that babies who pace feed are less likely to become overweight. Paced feeding involves letting your baby find the teat, using a slow flow teat, tilting the bottle enough so that the teat is just full, and taking regular breaks during the feed. This gives your baby time to recognise that they are full and prevents them from taking too much milk.
If your baby is struggling to feed from a bottle, they may have a tongue tie – ask your midwife about this, they can refer you to a tongue tie clinic for assessment and treatment. Not all tongue ties need to be treated, but if they are affecting feeding they can be snipped as an outpatient without the need for anaesthetic or stitches.
There are lots of reasons for expressing or pumping breastmilk. The most common reason is having a baby in the neonatal unit or special care baby unit who’s not yet able to cope with breast or bottle feeding, but other women choose to express to enable others to feed the baby, to top up babies who seem unsettled after feeds, or to be able to give colostrum to a sleepy baby.
The maternity team can show you how to hand express your milk. Alternatively, Start 4 Life has some detailed information.
If you want to breastfeed but your baby is in the neonatal unit and not yet able to latch, you’ll be given advice on using a breast pump. You can use a manual pump, which you squeeze by hand to express milk, or an electric pump – these can be either single pumps, or double pumps (so you can express from both breasts at the same time).
Some women respond well to pumping and expressing, but others may struggle. A pump is not as efficient at getting milk from your breasts as a baby, and this can lead to worries that your baby won’t be able to get enough milk from you when breastfeeding. It’s important to remember that the amount you can pump is not always a reflection of how much milk you can produce when breastfeeding.
If you are pumping exclusively, you should try to mimic the way your baby feeds as much as possible. You’ll be encouraged to pump 8-12 times a day for around 20 minutes to build up your supply, as this mimics a baby’s breastfeeding pattern. It’s a good idea to pump every time your baby feeds, and aim to get at least as much milk as they are taking during that feed.
Mimicking the way babies feed can also help you increase your supply. Starting out with quick but gentle pumps mimics the way babies encourage milk flow at the breast. Once your milk has started flowing, you can switch to stronger and slower pumping, just as your baby would take long slow sucks at the breast. If the milk stops flowing during the pumping session, start this process again.
Some babies may need some help with feeding, particularly those who are premature or have other health issues. There are lots of other methods that can be used to feed babies besides breastfeeding and bottle feeding. For the majority of babies, these are temporary measures and the team will ensure that your baby is able to breastfeed or bottle feed before they are discharged. Babies may be fed in a combination of these ways (e.g. alternating tube feeds with breast or bottle feeds).
Although expressed milk can be given via bottle, not all babies will be strong enough to bottle feed, and in some cases the use of a teat can make it more difficult for babies to breastfeed. If you are planning to breastfeed, you should discuss this with the team caring for your baby so that they can find the best alternative.
The best methods for feeding your baby will be discussed with you. A feeding plan will be completed and reviewed regularly. You’ll be given support to get your baby breastfeeding as soon as possible and shown how to feed your baby using alternative methods.
These methods include:
Letting your baby suck colostrum from your finger in their first few days
This involves using a sterile syringe to feed small amount of colostrum to your baby. This allows you to feed the colostrum you’ve expressed and collected directly to your baby. Once you are giving more than 5ml of milk at a time, it’s best to move on to cup feeding.
Using a small plastic open cup about the size of a shot glass to feed your baby. Cup feeding encourages the baby to use their tongue and lower jaw in a similar way as they would when breastfeeding. The cup is half-filled with expressed breastmilk or formula and then held to the baby’s lips, so that they can lap at the milk with their tongue.
A fine plastic tube, called a nasogastric tube (or NG tube), is passed into your baby’s stomach via the nose, and milk is syringed into this tube. It’s very important that the end of the tube stays in your baby’s stomach so you’ll be shown how to check this yourself before giving a feed. This method allows a baby to have a full feed even if they are not strong enough to latch or suck, so it is often used for premature or unwell babies.
Supplemental Nursing System (SNS)
Fine plastic tubes are taped to the breast, allowing additional breastmilk or formula to be given while your baby is breastfeeding. This is a good way to give additional milk while establishing breastfeeding and encouraging your baby to latch.
Whether this is your first time feeding a baby or you’ve already experienced feeding singletons, feeding twins is very different and can seem overwhelming at first. The NHS has a useful guide to feeding multiples, whether you’re planning to breastfeed, pump or bottle feed.
It is possible to tandem feed your twins (e.g. breastfeed two babies at the same time) but it’s often best to feed them separately at first until you are all coping well with latching correctly. Special twin breastfeeding pillows are available to help support both babies while feeding.
TAMBA (the Twin And Multiple Birth Association) have a free peer support service for breastfeeding multiples, as well as a general helpline.
As twins are more likely to be premature, there’s a reasonable chance that you may have to use other types of feeding such as syringe, cup or tube feeding when they are born. The team will show you how to do this safely.
If you are bottle feeding, it’s important not to use bottle props as these can increase the risk of choking. When your babies are small and unable to support their head, it’s best to feed them one at a time.
The medical literature up to the 1990s makes little if any reference to tongue-tie and its impact on breastfeeding. There is now evidence that tongue-tie can cause problems with both breast and bottle-feeding. For pain-free and effective breastfeeding, free movement of the tongue is vital. The baby needs to advance the tongue beyond the lower gum and take in a portion of the mother’s breast tissue behind the nipple. This places the nipple near the back of the mouth.
In contrast, a tongue-tied infant cannot move the tongue freely. The baby may not be able to attach easily to the breast or bottle, and swallowing may also be difficult. The mother’s nipples may get damaged and blocked ducts and mastitis may result. The pain can make it very hard to continue with breastfeeding.
Do all tongue-ties need treating?
NO, not all tongue-ties are the cause of feeding problems.
If you have problems breastfeeding it is more important to get a good breastfeeding assessment done and help with potential problems relating to positioning and attachment. Talk to your midwife or maternity support worker about this. You may also benefit from the support of a breastfeeding specialist.
Not all babies with a tongue-tie need treatment in the early days. Early diagnosis and extra support from an infant feeding specialist may prevent or solve problems. Many tongue ties are asymptomatic and do not require treatment and the tie may loosen or break on its own. If problems persist, the baby should be referred for assessment as soon as possible.
Treating a tongue-tie by frenulotomy
A simple surgical technique is used to treat the baby as an outpatient. The base of the frenulum is carefully snipped with sharp blunt- ended scissors to free the tongue. No anaesthetic or stitching is needed, and there is little if any pain or bleeding. The baby can feed straight after the snip, to avoid interruption of breastfeeding.
How is the tongue-tie divided?
The extent of the tongue-tie is carefully assessed, and baby’s head and shoulders are held securely. Sharp blunt-tipped scissors are used to divide the frenulum. The snip is very quick and does not harm the tongue. Blood loss is minimal, and stops quickly. (Babies may cry, as they don’t like having their mouths held open)
The baby is immediately offered a feed. If the baby doesn’t want to feed straight away, a finger to suck can be offered instead. Feeding should improve in the next few days.
Follow up support may be needed if there is little chan
Although breastfeeding is natural, it doesn’t always come naturally to everyone – mums and babies need time to get used to feeding. When you have problems, there’s lots of information and support available to you.
Online and telephone help and support