Getting ready to breastfeed

Making the decision to breastfeed your child is one of the best decisions you will make as a parent. Almost all women are physically able to breastfeed their child. The human body adapts itself throughout pregnancy to ensure that most women will be able to produce enough milk to feed their baby.

Few women or their partners, however, pause during their preparation for childbirth to consider that preparation for breastfeeding begins well before your breasts begin to swell in the early stages of pregnancy.

Your own childhood experiences, how you feel about your body and the quality of your relationships with your family, friends and partner will all impact on how you feel about and prepare for breastfeeding.

You may feel overwhelmed at the emotions you feel when you are pregnant or are beginning to feed your baby for the first time. Some women feel that they have become 'complete', others feel that they have been 'taken over' by their child and that their life is no longer their own.

All of these emotions are valid and normal. Taking the time to acknowledge these feelings and working out ways of dealing with them will help you and your baby have a successful breastfeeding partnership. Remember, physically making milk is only one part of breastfeeding. Balancing your changing body shape, your work, your expectations of yourself, your family and your partner and your own past experiences all contribute to successful breastfeeding.

One of the best things you can do to have a satisfying breastfeeding experience is to make sure that you have one or two people who you can really count on to support you in your decision to breastfeed your child.

The ideal food

Breastfeeding has long been known as the ideal food for babies and infants. All major health organisations recommend that women breastfeed their babies until they are at least six months old. Breastmilk has many benefits:

• it is cheap, safe, environmentally friendly and ready for use at a moment's notice
• it's the perfect food and easily digested (it is made especially for your baby). Breastfed babies are less likely to get fat; they are also very unlikely to get constipated
• it changes as your baby's needs change - a breastfed baby will take just as much milk as they need
• it helps protect your baby against infection - the first milk (colostrum) is particularly high in the mother's protective antibodies
• it reduces the risk of allergies.

Starting to breastfeed

You and your baby may only take a couple of days to become good breastfeeding 'partners' or you may take up to six weeks - like all new skills it comes easier to some than others. Most of us have seen women breastfeeding babies from time to time. Unfortunately, most of the women we see casually feeding their babies at bus stops or cafes have been feeding for quite a while - and like most things practice makes perfect.

The first feed should be soon after the birth. Your milk supply will still be developing and when you put your baby to the breast he or she will be receiving colostrum - a yellow fluid which contains all the nutrition the baby needs for the first few days of life.

Colostrum is also full of antibodies which help to protect your baby from bacteria, and make his or her immune system strong. No other food or fluid is required in these first few days. If you have never seen a newborn baby breastfeeding you may be suprised at how long it may take to complete a feed.

Some babies will take up to 45 minutes to feed - sometimes dozing off to sleep in the middle. As the newborn baby does not yet have full control of his or her head you will need to gently position the baby's mouth near the nipple.

Positioning the baby for breastfeeding

Trying to write how to position a baby correctly on the breast is a bit like writing the instructions for teaching someone how to knit - it is much easier to be shown. Your midwife will help you and your baby get breastfeeding started. Every women and baby will develop their own breastfeeding style.

Your midwife will help you develop a way of feeding that will suit you both. Most midwives will spend some time helping you 'attach' or 'latch' the baby to the breast correctly. This is because most problems that occur with breastfeeding are caused by the baby not positioning their mouth correctly on the breast.

Before each feed, take the time to position yourself comfortably, so that you are relaxed. You may need to use some pillows to support yourself or the baby for the first few weeks or months of your baby's life. Your baby's arms should be unwrapped (so they can explore your face and breast) and their body well supported. Have your baby's mouth at the same level as your nipple.

The mouth should go over the nipple and the areola (the brown area around the nipple). After the feed, to release the nipple, break the suction by gently placing your finger in the corner of the baby's mouth. Do not pull the baby off without doing this as you will hurt your nipple.

The 'let down' reflex

The 'let down' is the reflex action that allows the milk to be pushed along the milk ducts towards the nipple. Some women notice a tingling, pins and needles feeling or fullness. Leaking from the breast can occur. The 'let down' is important so that the baby gets not only the early milk but also the milk higher up. The milk higher in the breast is full of good healthy calories and fat, which the baby needs.

If you are anxious, have sore nipples or are not relaxed, your 'let down' may be slow. When you feel more comfortable about breastfeeding and your milk is well established you will be able to breastfeed anywhere.

Supply and demand feeding

The best way to build up and maintain your milk supply is to feed your baby as often as he or she needs it. This is known as demand feeding. The more the breasts are emptied the more milk is made. If the breasts remain full, milk is produced more slowly. Your baby will control their milk intake, therefore feed for as long as your baby wants.

Your baby should have at least six feeds every 24 hours. A few babies swallow air but many don't. To bring up wind, hold your baby over your shoulder, or seated on your lap with your hand gently resting on their abdomen and the other hand supporting the back.

Babies are all different

Every baby is different. Some will sleep well all night, others will be wakeful. This does not necessarily mean your baby is not content or that you are not a good mother. If your baby is gaining weight, has plenty of wet nappies, and is mostly content, they are probably getting enough milk. It is not unusual for breastfed babies to go for a number of days without a bowel motion, sometimes as long as 10 days.

Bowel motions are usually yellow in colour. Think carefully before giving artificial teats or pacifiers (dummies) to your baby. Avoid using bottles while establishing breastfeeding. However, if you need your baby to be fed expressed milk at times, it may be helpful to introduce the bottle to your baby after six weeks of age. Try not to introduce a bottle until you are sure that you and your child really have breastfeeding completely under control. Some babies will take both the bottle and the breast and others won't.

Looking after yourself while breastfeeding

Tiredness is an occupational hazard of parenthood. Being tired or overstressed can reduce your milk supply. If you can, sleep or rest in the afternoon. You will probably be amazed at how much milk you make when you are asleep. Spend time with other women and their babies, but resist the temptation to compare your baby with other babies. Each baby is special and different.

Encourage your partner to talk to you and/or his friends about any problems which arise. The sudden changes the birth of a baby brings can be very confusing and new demands can have an effect on your personal life together. Any problems should be discussed and dealt with as soon as possible. Eat food from each of the following groups every day:

• fruit and vegetables
• bread and cereals (some wholegrain)
• milk products (milk, cheese, yoghurt, ice cream)
• lean meat, chicken, fish, eggs, peas, beans and lentils.

Breastfeeding women need protein and calcium. Have healthy snacks between meals such as fruit or cheese. Alcohol and cigarette smoking should be avoided while breastfeeding. Medicine should only be taken if your doctor advises. Some oral contraceptives can affect your milk supply. Be guided by your doctor.

Further information

Also see the Ministry of Health's website, promoting the benefits of breastfeeding www.breastfeeding.org.nz and offering detailed information for mothers, supporters, employers and health practitioners about breastfeeding. You can also phone the Healthline (including Well Child line) on freephone 0800 611 116 for advice about breastfeeding.

You can also talk to your midwife. She may be able to put you in touch with a lactation consultant if she feels it is appropriate. 

Other support options include Plunketline (run by Plunket), La Leche League, and your local Parents Centre - see contact details for these organisations under 'Further information and support' below. 

Written by Anna Mickell RCpN. Reviewed by everybody, August 2008.