Breastfeeding: your questions answered

Breastfeeding woman

Breastfeeding expert Jane Scattergood answers Mumsnetters' questions on breastfeeding: from how to prepare during pregnancy to the help available to those who are struggling.

Can you explain in detail what to do to establish breastfeeding in the first 12-48 hours? Especially if my baby is sleepy. And how to fend off midwives who push you to formula feed if baby is slow getting started. How long can a newborn go on tiny drops of colostrum?

Having skin-to-skin contact with your baby straight after the birth will help to keep them warm and calm, and steady their breathing. It's also a great time to have your first breastfeed. The fluid your breasts produce in the first few days after birth is called colostrum. It's usually a golden yellow colour. A breastfed baby takes small but increasing amounts of colostrum then milk over the first few days. Colostrum is a very concentrated food, so your baby will only need about a teaspoonful at each feed. Expect to feed around 10 to 12 times every 24 hours at first.

When you first start breastfeeding, you may worry that your baby isn't getting enough milk. It can take a little while before you feel confident that your baby is getting what they need. The most reassuring signs of adequate intake in the early days include the passing of meconium (the first sticky black poos). Babies pass small amounts of urine in the first few days; look out for around three to four wet nappies in 24 hours at first.

What does she recommend during pregnancy to prepare for breastfeeding? I’m especially interested if anything can be done for inverted nipples.

The most useful preparation in pregnancy is to arm yourself with information, so talk to your Midwife or Health Visitor. The hormonal changes pregnancy brings to your breasts are sufficient preparation for most women. Flat or inverted nipples do cause worry for some women, but the baby actually needs to latch onto your areola (the darker skin that surrounds the nipple) and not the nipple itself. A protruding nipple is not crucial for milk to emerge from the breast. The good news is that no nipple shape automatically makes breastfeeding impossible. You might need extra help and support with latch and positioning when you start feeding, so ask during pregnancy if you are worried about nipple shape. Find local support from your Midwife or Health Visitor or check here.

What help is out there for people who are struggling to breastfeed?

Qualified health care professionals such as Midwives and Health Visitors, and locally trained volunteer mothers (peer supporters) are there to help you get breastfeeding off to a good start. If you need to speak to someone between Midwives and Health Visitors appointments, you should find their contact details in your baby’s red book. You can always contact the National Breastfeeding Helpline on 0300 100 0212 (9:30am to 9:30pm, daily) and find out about local support groups from your Midwife or Health Visitor or check here. Start4Life provides parents and parents-to-be with trusted NHS advice on pregnancy and early years, including tips on supporting breastfeeding. The Start4Life Breastfeeding Friend, on Amazon Alexa and Facebook Messenger provides breastfeeding support to new mums at any time of day.

Any tips for stopping biting when my baby gets teeth?

When babies are effectively attached to the breast, they use their tongue and jaw, not their gums or teeth. Sometimes mothers breastfeeding an older baby will describe problems with biting. As babies develop they explore the world by ‘mouthing’ objects, licking, sucking and biting… it hurts if the ‘object’ is you! If you feel a bite during a feed, take your baby off the breast by breaking the suction (insert a clean finger between your breast and your baby’s mouth). Wait a few seconds, and then latch your baby on again – you might need to repeat this, and you might feel sharpness because of where your baby’s teeth are situated in your chosen feed position. Altering position will alter your baby’s latched mouth position and might resolve the problem.

Any tips for avoiding mastitis?

Mastitis is often caused by a build-up of milk within the breast. This is known as milk stasis. You can help reduce your risk of milk stasis and mastitis by: breastfeeding exclusively for around six months, if possible; don’t give bottles or over use a dummy; encourage your baby to feed frequently, particularly when your breasts feel full; ensure your baby is well attached to your breast during feeds (ask for help and support if you are worried); let your baby finish their feeds and come off the breast themselves; avoid suddenly going longer between feeds; avoid pressure on your breasts from tight clothing, including bras. If you are worried about mastitis speak to your Midwife, Health Visitor or GP. Breastfeeding your baby when you have mastitis won't harm your baby and can help improve your symptoms.

Do any foods or drinks help to increase your milk supply or is this a misconception?

Breastmilk production is about supply and demand. Most mothers will comfortably make enough milk for their baby. The more you feed your baby the more milk you will produce; effective latch and frequent feeds, and confidence in your body’s ability to meet your baby’s needs are the key here. Breastfeeding mothers should avoid processed foods and be guided by the Eat Well Guide. Breastfeeding can make you feel thirsty, so have a drink to hand throughout the day – especially when feeding your baby. Everyone, including pregnant and breastfeeding women, is advised to take a daily supplement containing 10mcg of vitamin D.

A commonly reported helpful food is oats and some women use herbal remedies to boost their breast milk supply. Fenugreek is the most common herb used by breastfeeding mothers. While there's no clear evidence to suggest oats or Fenugreek work, some women report finding them helpful. It's a good idea to talk to your GP or Health Visitor before taking any herbal remedy while you're breastfeeding.

A lot of GPs and other medical specialists (outside allergies) still seem blissfully unaware that breastfed babies can react to allergens a mother has eaten. My son ended up very ill before he got better because I was laughed at by a GP when I asked if it could be something I had eaten. What is the general advice if you think your baby might be reacting to something you are eating?

Breastfeeding generally helps protect against allergies and intolerances. Babies are more likely to develop allergies if there's a history of eczema, asthma, hay fever or food allergies in the family. If your baby has a family history of these conditions, breastfeeding them exclusively for around the first six months will help lower their risk. There is evidence that mothers’ food and drink intake can affect the constituents of breastmilk, the best studied substances being alcohol and caffeine. If you are worried about symptoms such as dry itchy skin, rashes or eczema first consider irritants such as bubble bath, soap, washing powder or fabric conditioner. If you are worried that your baby has intolerance to something that you are eating speak to your Midwife, Health Visitor or GP. You can find trusted advice about different foods and possible intolerances at Start4Life.

I’m returning to work when my daughter is seven months old. Can I still breastfeed her morning, evening and overnight but leave a gap of up to 11-12 hours? Can the body adjust to this schedule?

It's up to mothers to decide how long they want to breastfeed. Returning to work doesn't mean you have to stop. Workplace regulations require employers to provide suitable facilities where pregnant and breastfeeding mothers can rest. It’s best if you notify your employer in writing. The Health and Safety Executive (HSE) recommends that it's good practice for employers to provide a private, healthy and safe environment for breastfeeding mothers to express and store milk. The toilets are not a suitable place to express breast milk. The HSE website has more advice for new and expectant mothers or advice can be found through the helpline on 0300 003 1747.

In preparation of returning to work, reduce feeds during what will be your working day hours slowly. This might be happening naturally anyway as you introduce solid foods at around this time. Slow reduction in feed frequency will help avoid milk stasis and mastitis. Hand express if necessary to relieve over-fullness during your working hours. Your body will soon adjust and you will be able to get through the working day comfortably. Don’t forget breast pads for end of the day fullness and possible leaking. Breastfeeding on return from work is a great way to reunite with your baby at the end of the day.

My little boy is 23 months and I'm breastfeeding at nighttime. I'm about seven weeks pregnant now, when will milk stop for my little boy? How can I best prepare him for no milk?

There is usually no reason why you should stop breastfeeding during pregnancy. For some women with a very high risk of miscarriage, there is a hypothetical risk associated with the release of oxytocin (the let-down reflex hormone) which also has a contracting effect on the womb; women who have experienced multiple miscarriages should talk to their Midwife or Doctor about breastfeeding during pregnancy. Many women continue to breastfeed throughout pregnancy and go on to feed both their new baby and their older child together. Your body will provide enough nutrients for both your older child and your unborn baby. It’s a good idea to make sure you are taking 400mcg Folic acid and 10mcg of vitamin D, Healthy Start Vitamins provide both. At around about the middle of pregnancy, milk production may change or reduce due to the effect of the pregnancy hormones and your feeding patterns may change naturally at around this time. Your breasts will make colostrum for your new baby regardless of you feeding your older child.

If giving cow’s milk, whole milk should be given to children until they are two years old, as they need the extra energy and vitamins it contains. Semi-skimmed milk can be introduced once your child is two years old, as long as they're a good eater and they have a varied diet. Cow’s milk does not taste as sweet as breastmilk and might need slow introduction.

I am breastfeeding my two-year-old son a couple of times a day. We've been TTC our second child for ten months without success (we got pregnant with our son on the first try). My periods have returned and are fairly regular – but could breastfeeding be affecting my fertility?

Exclusive breastfeeding can result in an absence of periods and reduced fertility, this is called lactational amenorrhea, but feeding a two-year-old a couple of times a day would not have this effect. The fact that your periods have returned and are regular indicates that breastfeeding is not affecting your fertility. Some women do get pregnant while continuing to feed an older baby or toddler; some may conceive when breastfeeding ends. This may be due to all sorts of other factors though, not wholly related to breastfeeding. Two-year-olds can easily affect the quantity of couple time! Most women conceive within a year of having regular unprotected sex – see your GP if worried. Look after your health in this pre-conception time: eat well, reduce alcohol, don’t smoke and take Folic Acid 400mcg daily.

My son who's two years and four months old breastfeeds at bedtime. What are the benefits of him still feeding at this age?

The World Health Organization recommends exclusive breastfeeding for six months and continued breastfeeding with other foods up to two years of age and beyond. Your milk is still a nutritious food and can help support your son’s wellbeing, especially if he is a fussy eater. There may be some benefit in protection from illness or make illness less severe beyond two years of age, certainly an unwell breastfed toddler will want to cuddle and feed and breastmilk has protective antibodies and is readily absorbed. Breastfeeding is a special time, especially the bed time feed, both you and your son can continue to enjoy that special relationship.

I am currently breastfeeding my (almost) three-year-old, and am 22 weeks pregnant with his sister. When the baby comes along will she still get everything she needs if my son is still breastfeeding too?

It is perfectly possible to feed both a newborn baby and toddler or older child together. It’s helpful to prepare your three-year-old with picture books and stories about his new role as big brother and to show him pictures of new babies feeding. When your baby arrives you will continue to produce colostrum with mature milk arriving after three to five days. As with any newborn expect to feed around 10 to 12 times in 24 hours. Some mothers feed their newborn first before offering the breast to their older child to make sure that the baby is getting all they want and need. Once mature milk comes in and is plentiful (because breastfeeding is supply and demand and you have two demands) the first part of a feed can come a little too fast for a newborn, just watch how this goes and adjust your position a little, give her a little time to come off, catch her breath and return to the breast once the let-down surge has abated a little.

As an HCP in the system, does Jane see her role as exclusively 'outwards', advising and supporting parents, or does she have an 'inwards' role, too? Many HCPs need educating about breastfeeding, and they are deeply cynical of people outside the system, such as mothers trained as supporters by the breastfeeding charities.

Breastfeeding support requires action all across the community and health care systems. Local communities can really help by creating breastfeeding-friendly environments, local mothers can become peer supporters and joined up conversation across services and professions helps provide the right support, at the right time, in the right way. Public Health England aim to support this multilevel activity. Breastfeeding is a priority issue for PHE as part of its role to improve the health of the whole population by sharing our information and expertise.

As part of our Maternity Prevention work stream, we are committed to increasing the number of women who are able to initiate and sustain breastfeeding. This requires a breadth of support and action at a range of levels, from gathering the evidence on what works, supporting health professionals to do their job effectively, providing information and advice for women, to helping ensuring our work and social spaces support women and their babies to breastfeed. The Health Visiting High Impact Area 3 Breastfeeding can be used by practitioners and commissioners to support evidence-based interventions based on local need. The All Our Health Programme includes the evidence on breastfeeding and is a framework of evidence to guide healthcare professionals in preventing illness, protecting health and promoting wellbeing. PHE also commissions a dedicated breastfeeding helpline open 9:30am-9:30pm, 365 days a year, provided by the Breastfeeding Network and the Association of Breastfeeding Mothers.

The decision to commission infant feeding support rests with local systems, and to support them PHE has published an Infant Feeding Commissioning toolkit in partnership with Unicef to support the commissioning of interventions to improve breastfeeding rates across England. Through this, local authorities and their partners are encouraged to provide a comprehensive universal service with access to specialist support when needed. The guidance includes a recommendation to ‘Provide mother to mother support schemes – telephone, one-to-one and groups’. There are brilliant examples all over the country of how services in a range of settings, from hospitals to community peer-to-peer support, have helped women to continue to breastfeed for as long as they want to.