Beginners breastfeeding – essential info and (not-so) essential kit

This post started life as a paragraph in the essential baby kit list that I recently posted, but it got too big so it warranted its own space. The essential things you need to start breastfeeding are not kit but rather accurate info and helpful support. All the kit you really need is a pair of breasts! There are, however, some bits of kit that you may end up finding useful or they may make life easier once you’ve got going. This post has two parts: first a list of essential info to get breastfeeding off to a good start, based on my experience of having one baby and then doing it better the second time around; and second my take on the bits of kit that you may like to get at some point.

First of all though, as I said in my kit list post, of course I don’t want to assume that everyone will breastfeed, but I would highly recommend at least trying it, based on the info that I know. You may decide for whatever reason to feed formula in bottles right from the start; i personally don’t have experience of exclusive bottle feeding, so I’m not an expert on how much kit you need for that. But I do know what it’s like to supplement with formula from a week old, which did involve bottles with Andrew, though not with Joel (at least he won’t take one at 12 weeks without a lot of persuasion – I do use them to mix up powdered formula sometimes rather than do it directly in the SNS which can be fiddly), so I have some idea of the faff in terms of kit compared to breastfeeding. I can say that if I didn’t have to, I wouldn’t go through all this faff!

Tips for getting breastfeeding off to a good start:

  • Let baby feed as soon as possible after birth: If possible, hold your baby snuggled up to your chest without your top on straight away after birth, so that yours and baby’s skin are touching and they can latch on to your breast as soon as they like. Of course if there have been complications with either of you in the delivery, such as a c-section, or baby needs urgent medical attention, you might not be able to do this. Skin to skin with Daddy is always an option if you are not well enough to do it yourself. I was blessed with two very fast and uncomplicated births, after which I was able to pick my baby up and have him on my tummy/chest immediately afterwards – they both rooted towards my breast within minutes of being born and had their first feed. The soonest possible that first suck is, the better for breastfeeding, but don’t worry if you get separated and the first possible opportunity is later than straight after birth, it’s not a disaster for breastfeeding – just take the first opportunity you have to get your baby latched on for their first feed. Some babies are less good at latching on by themselves than others, so if they don’t seem interested, get help from someone who knows what they are talking about with breastfeeding.
    A sleepy moment – he spent the night after the birth feeding and sleeping, next to me the whole time, skin to skin.
  • Let baby feed whenever they want for however long they want (aka demand feeding): If you take nothing from this post other than this bit of info I’d be a happy bunny! It may seem like baby is feeding all the time, but in the first few days that’s a good thing – baby is sucking to stimulate your milk production and help get your milk to “come in”. If you try and feed to a schedule, or think about timings like ‘he/she only fed 10 minutes ago, he/she can’t be hungry again yet”, then you risk interfering with your body’s natural mechanisms for producing enough milk, and you’ll probably stress yourself out in doing so.
  • Lots of skin to skin: Holding your baby with both of you unclothed so that your skin is touching is important not only straight after birth but also in the early days and weeks, and beyond in fact. It helps to stimulate your milk production via the hormones that drive it. A few hours after Andrew was born and he’d fallen asleep after his first feed, which was pretty long actually, the midwife dressed and swaddled him because she said he needed to keep warm as his body wasn’t good at regulating temperature yet, So I did what she said and he slept swaddled in the fish tank cot next to my bed all night whilst I lay there staring at him! Since then I learned through getting accurate info based on research from my local La Leche League (LLL) group that lying with baby skin to skin in those hours after birth is better for both of us, because my body heat helps to regulate baby’s body temperature, and it helps stimulate the start of milk production. So after Joel was born, I refused to let them swaddle him (not that they tried this time, maybe having read my birth plan requesting them not to!), and we lay skin to skin all night, during which time he fed and slept in alternation. We also spent a lot of time skin to skin at home, putting a blanket over us snuggled on the sofa. We still spend every afternoon whilst Andrew is napping together skin to skin on the sofa.
  • If baby seems very sleepy, wake them up: This seems so wrong – let sleeping babies lie, says everyone. But if baby is very sleepy in the early days, they are missing out on enough sucking to stimulate your milk to “come in”, potentially making it slower and not as plentiful. It could be that they had a difficult birth, or are jaundiced, or have some other underlying reason to be sleepy. There are some simple things you can do to encourage them to feed more often (like I did with Joel as he was jaundiced and very sleepy): remove layers of clothing; have skin to skin time with no clothes |(at the risk of me sounding like a broken record!); change the nappy if they’ve fallen asleep at the breast – if they want more it’ll soon wake them up; tickle their feet and cheeks whilst feeding; talk to them; put them down in the middle of the bed.
  • Limit cuddles with other people in the early days: You’ll probably have a queue of visitors at your door, either at home or in hospital, most of whom will no doubt want to cuddle your new little bundle of cuteness. It’s fine to let them, of course, but be careful that baby actually gets to be with you for the majority of the time and doesn’t spend the day just being passed around Uncle Tom Cobley and all. The best thing that visitors can do is help you in other ways, like bring you hot meals, fill up your drinks bottles, do the washing up, the laundry, clean the bathroom, empty the bins and so on and so on. Your parter can be a real support by kindly pointing this out to visitors for you.
  • Rest, and don’t try to do too much too soon: I think these days there’s quite a lot of pressure to appear to be super-mum and be back on your feet, out and about doing all the stuff you were doing before baby arrived. But giving birth is one massive ordeal that your body goes through in order to produce said bundle of cuteness, so you need time to recover physically as well as helping your body to get on with the next stage – producing lots of milk. Spending all day in your pyjamas and sitting on the sofa or in bed is totally fine, nothing to feel bad about. If, like me, staying inside the same four walls all day can make you feel cooped up and a bit cabin feverish, a gentle short walk or drive (as the passenger) somewhere calm can help, but don’t go anywhere that you find stressful (for example, supermarkets). The word ‘babymoon’ is worth remembering – treat the first days and even weeks if you can like a honeymoon with your baby, doing nothing but focussing on them and yourself.
  • Eat and drink enough: Make sure you drink to thirst and eat to hunger. Not drinking enough leads to dehydration, and drinking more than what you feel thirsty for can actually be detrimental to milk production too. I find sports cap bottles of water are handy – no risk of spilling and you can open them with your teeth when you hands are too full to unscrew a bottle top. Eating a good balanced diet is essential, and it’s not a time for dieting to try and shift the ‘baby weight’ – you gained that weight for a reason, and over time, maybe after several months, with breastfeeding it will come off as it is used in making milk. As I was so sick and nauseous throughout my pregnancies, my appetite was limited and I couldn’t keep much down to begin with, so I didn’t put on any weight. But whilst breastfeeding I have found myself ravenously hungry and have definitely consumed more food per day than I ever did in pregnancy and before having kids – I’m sure this is my body’s natural way of saying ‘come on, I need stores of energy to make this milk, and I didn’t get them in pregnancy’. I find that I’m particularly hungry overnight, so I have a box with snacks in next to the bed and I munch through them during night feeds. Some foods, such as oats, are supposedly good for helping milk production, so I eat a lot of porridge, muesli and flapjacks!
  • Make sure feeding feels comfortable: Breastfeeding should not feel painful. The first few days of having a baby sucking on your nipple can feel a little uncomfortable until you’re used to it, and particularly the first minute or so of a feed can feel uncomfortable to begin with, but if you experience real pain or prolonged discomfort, there’s something wrong. Often this can be fixed by adjusting the latch and baby’s positioning, and sometimes it is due to the baby’s tongue being too anchored to the jaw – this is ‘tongue-tie’ and can be fixed by a simple snip of the ‘frenulum’ holding the tongue to the bottom of the mouth – I blogged about this before. Ask someone who knows about breastfeeding to spend time watching you feed so they can check the latch, and if you suspect tongue-tie (see my previous post on it), find an expert who can assess it, which may mean contacting a private lactation consultant if your GP won’t refer you through the NHS.
  • If in any doubt, ASK FOR HELP: Don’t hesitate to get help, no matter how small or big you think your concern is – the earlier issues are picked up, the easier it is in general to sort them out, and small issues can quickly spiral into big issues if not dealt with. Although the obvious people to ask may be your midwife team or health visitor, they are often very busy with big caseloads and overcrowded clinics to spend time with you, and they don’t actually get a lot of specialist training on breastfeeding. Local drop-ins and support groups such as those run by LLL and NCT are often better places to get more personal and detailed support. It’s a good idea to look for your local support groups before baby is born, so you can build up a support network before you need it, if you end up needing it, and if you don’t then you can still go along and meet with other breastfeeding mums anyway. It’s much easier to pick up the phone to someone you’ve already met a few times to ask for help when you’re an emotional wreck than it is to phone just a name and number on a leaflet.
  • Believe in your body: I’m a rare case (always like to be different I do), and unless like me you have a specific reason to doubt your breasts, it is likely that you are physically able to produce enough milk IF ALL THE CIRCUMSTANCES IN THE EARLY DAYS ARE FAVOURABLE (that’s a big if – see all of the above!) And even if it turns out you can’t produce enough milk for whatever reason, there’s no reason you can’t continue to breastfeed just like we have using the SNS.

Kit that may be useful once you’ve got going:

The one piece of kit that you do need is a good bra (or 4! – they get dirty with milk and sick pretty quickly). Although it’s not essential that you get nursing bras which open up with a clip to allow you easy access to each breast for feeding, it does make life easier in the early weeks, and you need to get new ones based on your postnatal bra size anyway. The question is when to get fitted.  Most sources I read said that you can do this in late pregnancy and just allow for a bit more room in the cup size for when your milk comes in. I did this in pregnancy with Andrew, but then my breasts didn’t actually change much at all due to the hypoplasia and lack of fullness with milk, so they ended up being a bit big. With Joel I waited until he was about a week old to get fitted more accurately. I know I’m unusual though to not have experienced a sudden increase in breast size when the milk comes in.  I found that Karen at Boobie Milk has some good tips on her website and blog (she organised the breastfeeding scavenger hunt that I took part in back in June).

I’ve heard that breast pads are often essential for breastfeeding mums particularly in the early weeks once the milk has come in, as many mums are prone to leaks, and pads can be popped in the bra to soak up any excess. Again I never experienced this, and not all mums do. I seem to remember getting some free disposable ones in the various Bounty packs that I was given in pregnancy with Andrew. If you find you get through lots, there are washable ones, and I’ve seen some lovely soft and luxurious looking ones on various cloth nappy websites such as here.

Some mums I know have recommended breastfeeding pillows for easier positioning in the early weeks. These are usually u-shaped or v-shaped, to fit around your body so that you can rest baby on them to get them at the right height and position to latch comfortably. I just used an ordinary cushion in the early days, and soon found that I could just hold my baby without the need for extra support (it did help I guess that neither Andrew nor Joel were that heavy for their age). So I don’t have any particular specialist pillows to recommend myself.

You may see breastfeeding chairs advertised, which are usually a rocking chair in style and often come with a matching footstool. I never even contemplated one of these as we don’t have room for any more furniture in our flat, and they seemed like a lot of money for what they were, though I guess it’s the kind of thing you could get secondhand if you were more inclined to hunt out a bargain one than I was. I’ve found that the sofa we have now is actually very good in terms of height and squishiness for feeding – my knees are high enough as it’s quite low to the ground, and it has a firm back but soft-ish cushions to sit on so I don’t slide down too much. When I was feeding Andrew as a young baby, we had a futon, which was great for height, but for some reason I kept slipping down it and gradually hurting my back; this got a lot better when we swapped the futon for the new sofa.

You may also be aware of breastfeeding covers that look a bit like a short apron, which you hang round your neck and it hangs down over baby, covering you and them whilst they are feeding. I personally think that no mum should feel forced to cover up whilst feeding her baby – would people expect me to cover my toddler and me up when I give him a sandwich when we’re out? However, I do understand that a mum may not feel confident about her own body, or may feel happier covering up rather than not for reasons other than being forced to by other people. In that case I see the benefit of a cover. I’ve never felt I needed one – a positive thing about having hardly any breast tissue (gotta look on the bright side and all that) is that it’s not hard to feed discreetly anyway, but maybe I would feel differently if I was better endowed. I’ve just always worn clothes that help in me feeling happy about myself and how much is visible to others if they are bothered by it.

Talking of clothes, there are special breastfeeding tops available to buy, but I’ve not got any, because I found that certain styles of ordinary top do perfectly well and are generally cheaper or in my wardrobe anyway. There are two basic options: pull up a top and feed from below it, or pull down or unbutton a top from the top and feed from above it. I’ve found the first option to be most successful, but I know plenty of mums who do the second option. For the pull up option, empire line tops work well, which are fitted at the top and then flow down nice and loosely, so they give you lots of fabric to pull up. If you’re particularly worried about exposing a post-natal wobbly tummy, then you can wear a vest underneath – get one with adjustable straps and set them to the longest possible (you may need a bigger size to get enough length on them) so that you can wear it below your breasts to just cover your torso so they are available for feeding without pulling the vest up. This is not so practical in summer though. For the pull down option, tops and shirts that unbutton at the top are good, or something with enough stretch to pull down and go back into shape afterwards so it doesn’t end up sagging and not covering you when not feeding. I love those big flowy cardigans that come down to your thighs and have no buttons, as you can wrap it around yourself and baby, particularly in winter if you have any bare skin exposed to the cold when you’ve pulled your top up with no vest underneath.

Andrew (4 months) and mummy enjoying a feed - this was a hot day in early summer, so I had just a vest top on, nothing special, and just pulled it up to feed him.
Joel (6 weeks) feeding whilst we had lunch out - the cardigan is very useful for wrapping around us both in winter, as it was when this was taken.

Even if you intend to give breastfeeding a go, you may be thinking about the possibility of expressing some of your milk to give in a bottle – maybe your maternity leave is quite short and you want to carry on breastfeeding when back at work, or maybe you’d like your partner or another relative to be able to feed your baby sometimes, such as overnight. I would say that it’s a good idea to wait until your milk supply has been established, so at least 6-8 weeks, before you start introducing expressing as an alternative to baby-led feeding at the breast, because it could interfere with your body’s natural ability to produce enough milk based on your baby demanding all they need by sucking at the breast. However, there may well turn out to be specific reasons why you would express before this age, such as your baby won’t latch properly or they are separated from you due to being in neonatal special care, and you need to express to build up and keep up your supply during the lack of contact with baby.

if you do decide to express for whatever reason, you’ll need the following…

  • breast pump: If it’s just a small amount of expressing, you can actually be very effective at getting milk out just with your hands, so a pump isn’t necessary. But for whole feeds worth of milk, a pump makes sense. Manual pumps require you to pull a lever by hand over and over again to pump, so again, they’re more for smaller amounts of pumping otherwise they get tiring, but they are cheaper than electric pumps, If you end up doing a fair amount of pumping, you’ll probably think that an electric pump is worth investing in. They range from small portable ones with battery or mains options, to hospital grade ones that you can hire. Some come with one pumping piece, some come with two so you can do two breasts at the same time – useful if you’re pumping with little or no time with baby at the breast. Over time, the effectiveness of the pump decreases, so it may not be worth getting a secondhand one. I was given a secondhand one that hadn’t been used much, and I compared how much I got out with what I got out using a double hospital grade pump that I hired for 2 weeks when Joel was born – there was no difference, so I carried on using the single one I’d been given before Andrew was born, but it could well have been different had the pump been used more. (I pump sometimes to try and increase supply, though I don’t have much time to do it now with a toddler as well, so I mainly do it overnight.)
  • bottles: Breast pumps come with at least one bottle, attached to the pump via a length of tubing. You’ll probably need to get more than this, because by the time you’ve filled, emptied, washed and sterilised, it’s handy to have a few. I would always buy new bottles. There are a few bottles marketed at being shaped such that they are closer to the shape of a breast and therefore make it easy for the baby to switch between bottle and breast. We have a few of these as well as a few with the more traditional teat shape, and Andrew managed to switch fine between bottle and breast with both sorts, and his latch onto each teat shape didn’t appear to differ. That said, he took a bottle as well as the breast from a week old, whereas an older baby might do one or both of two things: refuse to take a bottle in the first place because they’ve got used to the breast and prefer that (this is what I’m now finding with Joel at 12 weeks); get used to the easier flow of the bottle and start getting fussy at the breast.
  • steriliser: There are two basic ways of sterilising – steaming in the microwave and bathing in a chemical solution (Milton fluid). I only have experience of the microwave method, but find it pretty easy, and you can pick up secondhand microwave sterilisers at a good price at, for example, nearly new sales or through friends.

Phew, another post to rival my kit list in length! We were discussing amongst a few of us at our breastfeeding support group the other day how hard it is to reach mums when they really need help in the first week of baby’s life – antenatal classes are OK for theoretical info before baby arrives, and support groups are fine if mums having problems make it along, often not in the first week. So even if this post helps just one mum at the time she needs it most, I’d be very happy.

Pregnancy diary: week 35 – birth plan

As yesterday was my last day at work (I’ll come back to that in a mo….), all of a sudden giving birth seems like a much more imminent event! So I thought it was about time that I write my ‘birth plan’. I thought I’d saved a copy of my birth plan for Andrew’s birth, but I have a feeling I didn’t back it up to the server (unusual for me, Little Miss Paranoid Doer of Back-ups) and annoyingly my laptop hard-drive died a few days after Andrew was born. The birth plan must be forever lost in an irretrievable gobble-ti-gook of 1s and 0s. But nevermind. I managed to find a great resource on the NHS choices website, which runs through the various points you might like to include in a birth plan. It even lets you save an online version of a birth plan that you create by ticking various multiple choice option boxes and then printing off a PDF, but I found this a little restrictive and preferred to write my own using ideas from the website.

Not much to say this week, other than it's a bump!

I’m not a massive fan of the word ‘plan’ in this context, because I don’t think labour and delivery are really things that you can ‘plan’ in the sense that I normally plan things (like what I’m doing next Monday morning at 10am, or when we will go on holiday next year, or what we’ll eat for dinner tonight, for example). Yes I have an image of what would be an ‘ideal’ birth, and actually I came pretty close to this with Andrew (lose the vomiting after the syntocinon injection and it would have been perfect), but I’m not so naive to think that there is no possibility of complications that might cause my ‘ideal’ birth to fly out the maternity hospital window. I’m optimistic that, given previous experience, the birth will go smoothly, but realistic that I have no control over the fact that it might not.

I remember when I came to write my birth plan for having Andrew that I didn’t know where to start. Although I had some ideas about what I wanted and didn’t want, I also had no idea how I would react to and cope with the pain once I was in labour, having never experienced anything like it before. So most of my points were couched in a ‘I’d like it to be as natural as possible but if I scream for drugs then please give them to me’ kind of tone. This time, of course, I know what it’s like, so I found it easier to write down what I hope for, complications and long duration notwithstanding.

This sets the scene for my birth plan, which I’ve set out below. I will print this out and keep it with my maternity notes, so that whichever midwife gets the job of helping us through labour will see it when she looks at my notes – this worked well last time, and she was keen to read what I’d written before doing much else with me. I’ve probably forgotten some important points, so if you think of anything I might like to mention, I’m all ears. Next week I have another midwife appointment, so I might have chance to go through it with her too, particularly as she’s coming to look at the flat in case of home birth necessity!

Ruth Cumming’s birth plan

This is not so much of a ‘plan’, because I’m not sure you can really ‘plan’ labour and birth, but rather it’s a list of things that I would like and not like to happen, if at all possible.

Location

My preferred place of birth is in the Rosie Birth Centre, because I had my son at the former MLBU, and I liked the relaxed atmosphere and received excellent care from the midwives, who helped me but did not take over.

However, if baby comes even faster than my son did (which was pretty fast), I may decide that I’d rather stay at home, because I’d rather not risk being in advanced labour in the car – I’d rather have a ‘home birth’ than a ‘car birth’!

Of course if there are complications, I understand that going up to the delivery unit in the main Rosie hospital would be necessary.

My birth partner is Tom, my husband, and I would like him with me at all times during labour, no matter what happens.

Labour and delivery

I would like to be in a birth pool during active labour (another reason for choosing the Birth Centre); this helped me a lot for my first labour.

If possible I would like to deliver the baby in the water. Last time the midwife could tell that being in the water was relaxing me too much and she was concerned that I wasn’t pushing as hard as I could during the final stage in there, so she suggested I got out for delivery. She was right, because I gave birth within minutes of getting out, as I pushed much harder ‘on land’. If this happens again, I’m not against getting out of the water if necessary, but would rather have a water birth if possible.

Last time I used a birthing stool for the final pushes – this worked well and I would like it again if ‘on land’.

I am happy for baby’s heartbeat to be monitored like it was last time – with a detached probe device every now and then, i.e. I’m not constantly hooked up to a machine so I can move around freely.

I will move around during labour before the pool is ready, and get into positions that I find most comfortable at each point. This could include getting on all fours (possibly on the bed) and walking around. But I hope to spend most of the time in the pool.

I hope to deliver in the water, squatting or upright in some other way, or if I’m on land, squatting on a birthing stool worked well last time. I do not want to be on my back, lying down or completely horizontal in any way.

If I am in the water for delivery, I would like to pick baby up myself from the water, and sit there skin to skin for a while until I feel I’d like to get out.

If I am on land for delivery, baby should be delivered straight onto my tummy, without being cleaned, so that we can have skin to skin time. This worked well for my son, and he latched on for a breastfeed almost straight away. I would like this to happen again if possible.

I would like the midwife to cut the cord (Tom is not particularly keen to do this).

I do not mind if there are trainee midwives in the room.

Possible drugs/interventions

For pain relief, I would like to try and use just natural methodsbreathing, movements, and the water of the pool. This worked for my first labour and I didn’t need any drugs.

However, if labour goes on for a lot longer than my first labour, I may decide on other pain relief methods. Gas and air would be my first choice. I didn’t find a TENS machine helpful last time, so I won’t try it again.

I would prefer not to have an epidural, but I can see that if I’ve been in pain for several hours and I’m exhausted, that this would be something I would consider and would want to be given if I decided on having it.

I had a 2nd degree tear with my son, so I’m prepared that this might happen again. I’d rather not have an episiotomy if at all possible, but would consider it if the midwife thinks it is necessary if baby was in trouble.

I would rather not have an assisted delivery with forceps or ventuose. But if baby was in trouble and therefore it was advisable to have these interventions, I would consider them.

After my son was born I opted to have the syntocinon injection, but in a reaction to this drug I vomited several times and felt nauseous for about 6 hours after the birth. I would rather not have the syntocinon injection this time, but if the midwife thinks it is necessary because I am bleeding a lot (and I know I’ve had a slightly low platelet count that might not help the situation), I am prepared to have the injection. I would like Tom to be able to stay for as long as possible after the birth this time if I am feeling sick.

I would like my baby to have the vitamin K injection or oral drops.

Breastfeeding

I am going to breastfeed and this is extremely important to me. I struggled with breastfeeding my son in the early weeks, but eventually got on track with it and have continued to feed him until now – I plan to tandem breastfeed if he still wants to continue after the baby’s birth.

So I would like my baby to stay close to me at all times and not be swaddled – I would like to remain in skin to skin contact for several hours after the birth, so that baby can feed off and on whilst lying on me.

If complications arise and I need to be separated from him/her, I would like Tom to be able to have skin to skin with baby whilst I am out of action. I would like baby to be brought to me as soon as possible if we are separated, and have help with positioning baby on me for feeding if I am in pain from a difficult delivery (e.g. c-section).