Common breastfeeding queries

It is very important to ensure that the infant is latched on correctly to the breast, and for many mothers this can be the first stumbling block in establishing breastfeeding. Getting the latch correct at each feed is vital. Mothers should be encouraged to ask for help for the first few feeds to get started. If the mother experiences pain when feeding, she can then take the infant off the breast and try again.

The latch is the same whatever the position the infant feeds in – a wide open mouth (like a yawn), tickle the infants lip with the nipple to encourage rooting, bring infant to the breast (chin first). If the infants latch doesn’t look right then take him/her off and try again (ensure the suction is broken before doing so). Always break the suction at the end of a feed by using the little finger in the corner of the infants mouth even if he/she is asleep as damage is often done at this time. Remove hands from the breast when the infant is latched on to prevent pressure on ducts which can lead them to get blocked.

Correct positioning when feeding is very important as infants feed regularly and mothers need to be well supported during feeding times. Mothers need to  comfortable to hold their infant close to the breast without causing neck, shoulder, back or muscle strain. Sitting up to breastfeed is usually more comfortable for mothers – sitting upright with good support for her arms, back and feet. There are a variety of different positions to choose, so try out a few and decide which best suits the mother best. Changing positions can help reduce the incidence of tender/cracked nipples, blocked milk ducts, engorgement.

Engorgement can occur around day 3-5 after delivery for some mothers. It can make latching on difficult, as the breast, especially around the nipple/areolar area, becomes flattened and taut. This is due to swelling of the breast. This can result in the infant becoming fussy or even refusing the breast. Simple measures, such as hand expressing or using a breast pump to alleviate this fullness before feeding can make all the difference. For some mothers if this is not dealt with correctly, it can lead onto blocked ducts and even mastitis. To help prevent this, there are a few treatment methods a mothers can do – apply heat and massage before feeding e.g. heated towel (avoid prolonged heat as it can increase swelling and inflammation), massage by gently kneading the breast with fingertips, massaging from chest wall towards nipple are in a circular motion, frequent feeding emptying each breast fully and cold compression after e.g. cold pack.

Breastfed babies feed frequently as breastmilk is digested more rapidly than formula milk (in 1.5 hours). Breastfeeding 8 – 12 times a day is normal for newborn infants, especially in the first week in order for them to get enough milk as your full milk supply is only coming in. The breasts respond to a supply and demand principle so the more the infant demands feed the more milk the breasts will supply. Avoiding supplementary feeding in order to establish a good supply in the early weeks and preventing nipple confusion for infants.

Some newborns are sleepy and can in the first few days be slow to feed or even refuse the breast. The mother should be reassured during this time. If this happens, offer the breast at each feed, however short the feed as it is a good idea to familiarise the infant with your smell and bonding. However, it is important for the mother to get her milk supply established at this time by stimulating the breasts after each feed, to ensure your supply is plentiful (supply and demand principle).

The Health Services Executive has developed some helpful guidelines for breastfeeding mothers wishing to express¹. The guidelines are as follows:

1. Wash and clean hands
2. Encourage milk flow by:
   • Ensure mother is comfortable by relaxing or taking a warm bath. Having the infant close by is helpful for stimulation
   • Gently massage the breast. This can be done using her fingertipsor by rolling a closed fist around the whole breast
   • Gently roll the nipple between her first finger and thumb to stimulate the release of hormones involved in milk production
3. Mothers can express breastmilk in 3 ways (1) by hand (2) hand pump and (3) electric pump
4. Milk will start to flow within minutes after mother begins to express. Continue to pump from one breast until the flow stops and do the same with the other breast. This should be repeated until no more milk can be expressed from either breast

1. Position the index finger under the breast and the thumb at the top of the breast
2. Gently press backwards towards the chest
3. While maintaining this, press the thumb and first finger together and push the milk along the ducts towards the nipple
4. Release the pressure to allow ducts to refill and repeat steps
5. Mothers can express from both breasts at the same time

1. As not all pumps are the same, it is recommended that mothers try one out before they buy it

1. Electric pumps are easy to use as they work automatically
2. It is also possible to expres from both breasts at the same time using a dual pumping set.

1. All equipment must be sterilised before use
2. When filling sterilised containers to store breastmilk keep milk expressed on different days separate
3. Breastmilk yields that have been expressed on the same day can be combined so that the correct volume can be reached
4. If adding breastmilk yields expressed on the same day, chill the yields separately in the fridge before combining
5. Only combine breastmilk yields expressed on the same day. However, if there is a supply of frozen colostrum, or breastmilk that has been expressed in the first two weeks of breastfeeding, it can be combined with fresh milk to ensure the nutritional adequacy of the milk for the infant
6. If freezing, do not completely fill the containers with expressed breastmilk as breastmilk can expand
7. Label all milk containers using a water proof marker
8. Always use the oldest milk first

• Room Temperature (26°C or below) 6 hours
• Fridge (4°C or below) 5 days
• Freezer (compartment of the fridge) (-18°C or below) 2 weeks
• Freezer (section of fridge with separate main door) (-18°C of below) 3 months
• Separate chest freezer (-18°C or below) 6 months

1. Health Services Executive. Breastfeeding your baby website – https://www.breastfeeding.ie/hse_publications