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Frequently Asked Questions about Breastfeeding

These questions and answers are meant as a general guide. You should always contact a Breastfeeding Counsellor if you think that you need skilled help. [Contact]

1. How do I prepare for breastfeeding my baby?

The best preparation you can do is to become well informed about the management of breastfeeding by reading, talking to people who have positive experiences of breastfeeding and by taking a course in Breastfeeding such as that given by The  Association of Breastfeeding Counsellors.

It is more your mind that you have to prepare than your body or anything else. It would also benefit you if the baby's father, the baby's grandparents and any people who will be helping you to become as well informed as yourself about breastfeeding.

2. What do I need to buy to breastfeed successfully?

Nothing. What you need is confidence in yourself as a female to know that you will make the milk that is necessary for your baby.

3. How often do I need to breastfeed my baby?

Ideally breastfeeding should be on demand for the first couple of weeks – this means feeding whenever and for as long as baby wants. In the first 24–48 hours babies do not tend to feed very often but then become quite demanding for a day or two to build up the milk supply. It is estimated that babies breastfeed about 8 to 12 times in 24 hours.  The pattern is likely to fall into a breastfeed every two or three hours. This depends on your baby. 

4. Is my baby getting enough milk?

It is very rare that a mother does not produce enough milk to satisfy the needs of her baby or babies - if they are more than one. The more the baby breastfeeds the more milk will be produced. Breasts will make enough milk to feed twins and triplets. Both baby boys and baby girls will stimulate as much milk as they need from the breasts. Always remember that no two babies are the same so do not compare babies! 

5. Do I need to change breasts during a feed?

No. At the start of a feed the milk does not contain much fat - this is called Foremilk and it satisfies the baby’s thirst. As the feed continues from the same breast the fat and protein content increases – this is called Hindmilk and this satisfies the baby’s hunger.

When the baby lets the nipple slip away appearing satisfied offer the second breast which may or may not be accepted.

6. How can I tell if my baby is positioned properly?

It is important that you first sit comfortably. The mother should have her feet resting firmly on the ground and her back straight. Baby’s head should be resting on the mother’s forearm and the body resting on her and held close to her by the same arm. Mother’s other hand could be used to hold baby’s hand from interfering with baby’s mouth latching–on to the breast. Do not hold your breast at all. The baby’s shoulders and chest should be turned towards the breast. The baby’s nose should be level with your nipple.  When baby feels this cradle baby will open the mouth wide.  Bring baby towards the nipple. Baby should have a good mouthful of breast.

Check whether baby is suckling properly – the tongue should be enveloping the brown circle (areola) underneath the nipple and the lower lip curled out under the nipple.  Always bring the baby to the breast, never take the breast to the baby.

Good attachment

  • more areola visible above baby’s mouth than below
  • baby's mouth wide open
  • lower lip turned out
  • chin touching breast

Effective suckling

  • slow deep sucks, sometimes pausing

Good position

  • baby’s body straight (not bent or twisted)
  • baby facing breast, start with nose to nipple (looking up at mother’s eyes)
  • baby's body close to mother’s body
  • baby’s whole body supported (not just the head, or the bottom)

7. My nipples are sore.

Some nipple soreness is common but there should be no signs of damaged skin or bleeding. This would suggest the baby is not being well positioned at the breast.

8. My baby is 4 days old and my breasts have suddenly become very uncomfortable!

This is normal and means that you have started to make more milk than colostrum. 

Engorgement is when the breast becomes very hard and painful. It can be the result of giving bottles at the stage when the mature milk comes in. It is caused when the breast is not being emptied regularly either because baby is being given bottle- feeds or because of pumping or because of long breaks between breastfeeding.   This discomfort lasts for around 3 days after which the breast becomes softer and comfortable.

Feeding the baby gives the best relief. Expressing small quantities (a teaspoonful) of milk by hand, whenever the breast feels painful, relieves it and keeps the nipple and areola soft so that the baby can latch on for feeding.

But if baby finds it hard to latch on the mother  - father can always help by suckling on the engorged breast! After emptying the breast of some milk use a cold compress to relieve the heat and inflammation of the breast.

9. Do I need to give water in between breastfeeding?

Breastmilk contains all the water a baby needs even in very hot weather. For the first six months nothing is required by the baby except breastmilk.

10. What should I eat and drink when breastfeeding?

You should eat a varied, well-balanced diet as suggested by the food pyramid guide.

 

 The pyramid layers represent the size of amounts of food from that food group that should be eaten. For example the bottom layer is bigger than the one above it -therefore more food from the bottom layer should be eaten. While the topmost layer is much smaller -therefore very little from that food group should be eaten.

Eating different foods in moderation will ensure adequate amounts of the various nutrients to stay healthy.

As a general rule no food should be eliminated from your diet simply because you are breastfeeding. Mothers who know they have an allergic reaction to a certain food should not be having that food even if they were not breastfeeding!

You should drink enough to satisfy your thirst. There is no truth in the saying that you have to have a large glass of water before each breastfeed. It is better to lessen your intake of caffeine drinks like coffee, tea and colas and take more water instead.

11. One of my breasts feels painful and there is redness and swelling where I feel the pain!

Pressure, caused by a full breast, forces milk through the ducts into the surrounding breast tissue, causing inflammation, swelling, redness and pain. Sometimes milk from one of the ducts does not flow easily because of some pressure on the breast while sleeping or caused by tight clothing and the duct becomes blocked.

As soon as you notice a red patch or any hardness empty the breast as soon as possible giving special attention to the side with the problem. A Breastfeeding Counsellor can help you do this well.

Sometimes the inflammation causes milk to enter the blood stream and this causes fever and flu-like symptoms. If symptoms are still present after 24 hours and an infection occurs a course of antibiotics may be necessary but it is important to continue breastfeeding. Emptying the breasts ensures quicker recovery.

12. I am not feeling well, can I continue to breastfeed my baby?

Yes, by the time you feel symptoms your body would have started to produce antibodies to fight that particular infection. These antibodies will then be present in your breastmilk and will help protect your baby from that infection.

It is important that if you have to visit the doctor to explain that you are breastfeeding so if any medication is prescribed it will be compatible with breastfeeding. You should avoid buying over-the-counter medication. 

13. Since yesterday baby never seems satisfied and my breasts feel really soft and empty!

Babies sometimes feed continuously for about a day every so often. This is the growing baby’s way of increasing the milk supply from the mother. It happens because the baby is going through a growth spurt. In a couple of days the pattern is likely to go back to usual. The breasts feel empty because feeding is frequent.

14. I need to return to work when my baby is 3 months old, is it worth starting breastfeeding?

Yes. You should not have to choose between breastfeeding and working.

Ask the management for the use of a small room with a table and chair, a small fridge and a sink with running water that you can use to express milk in when you are at work. The milk will be stored in the fridge for you to take home and give to the baby’s carer. Express your milk regularly every three hours so as not to upset the pattern. Your carer will be giving baby the previously expressed milk at the same time!

Alternatively, you could enquire whether any nurseries are in the vicinity of your workplace and go to breastfeed your baby there every three hours. It is your Right to expect to be supported by your employer to continue to breastfeed.

Breastfeeding can be very special to a working mother as only she can give that to her baby, so their special bond continues. 

15. How long should I breastfeed for?

The World Health Organisation (WHO) recommends exclusive breastfeeding for the first 6 months. Exclusive breastfeeding means that no food or drink other than breastmilk is given to baby, not even water.

Breastmilk continues to be the main food for a baby and WHO recommends that breastfeeding should continue for two years or more.

16. When and how do I start feeding different foods to my baby?

When baby is about six months old, tasting different foods from your lunch and dinner introduces baby to the joys and skills of licking, tasting, swallowing and eating. Using a spoon is not important at this stage.

If baby shows enough interest in your food you may puree some fruit and vegetables purposely for baby. At about 8 months protein foods like chicken, meat and beans/pulses can be added to the vegetable puree. At about 9 months give baby finger foods that are easy to melt once in baby’s mouth – like thin slices of cheddar cheese, slices of tomatoes, thin slices of banana.

When cooking, cut vegetables in very small bits and boil in very little water for a short time so as not to lose nutrients. Fresh food can be frozen in small quantities. Tomatoes and fruit provide more nutrition when given to baby raw.

17. Will the size of my breast affect my ability to produce enough milk ?

The size of the breast has got nothing to do with milk production since size depends on the amount of fat present in the breast. 

Women have breasts of different sizes and shapes that are both affected by the amount of fat and other factors like genetic inheritance. This varies from one woman to another but the milk producing tissues in the breast is more or less equal in all women and it is its development during pregnancy that affects milk production.

Small and big breasts make milk alike.

18. Will breastfeeding make my breasts sag ?

It is not breastfeeding that will cause your breasts to change shape but the process of pregnancy itself and becoming a mature woman. 

During pregnancy the breasts increase by about 500g as the body starts to prepare the breast to make milk, whether a mother will breastfeed or not.  This increased weight will cause the breast tissue to stretch but with a proper supporting bra, sagging can be prevented.

19. How will I know that the baby is getting enough milk?

A well-fed baby -

  • has a healthy looking skin colour, is alert and has a strong cry

  • has bright eyes and you will notice that clothes are becoming smaller

  • who is less than 6 weeks passes about 3 motions a day and wets about 3-4 disposable nappies.

  • should have clear and inoffensive urine

  • will gain weight steadily

  • is normally contented after a feed and your breasts will feel softer

Remember that a fussy baby may have other reasons other than hunger

e.g. colic, excessive heat or cold, tiredness and illness.

20. Will I be able to breastfeed if I give birth by Cesarean section?

Although you will need more support and help after the operation, there is no reason to give up breastfeeding.

Many mothers have breastfed successfully even after serious medical interventions during labour. It is important to inform everyone attending the birth that your intention is to breastfeed and that you do not want to give anything else to baby even if you are still under sedation.

It is important that as soon as the baby is born someone puts baby to your breast.

21. How safe is it for me to bring baby to sleep in my bed?

Breastfeeding babies are more likely to sleep on their side and on their back. These two positions are safer than when babies sleep face down.

Most babies do not distinguish between night and day and will wake up for a feed whenever they feel the need – day or night! Mothers are likely to feel very tired when their baby wakes often during the day and night. Tired mothers may fall asleep sitting on a chair or sofa while holding their baby. This puts baby in a high risk of dropping off the sleeping mother.

In many cultures co-sleeping is normal and helps mothers to sleep or at least dose off while keeping their baby lying near them and able to suckle without much effort on the mother’s part.

Mothers who smoke, drink alcohol or take medications should not bring their baby to sleep in their bed as they may be too intoxicated to notice if a baby is in danger.

22. How can I prevent my baby biting my nipple?

Mothers breastfeeding older babies are likely to be concerned about the possibility of their baby biting them during a feed.

Babies may have an urge to press their gums together sometimes. It seems that babies bite because they are going through some discomforting phase like having a blocked nose or coughing or teething. The ‘biting’ may be more ‘a holding on to the nipple’ while wanting to do something else like laugh, sneeze or breathe but it nevertheless does hurt the mother.

The baby does not realize that this new behaviour is causing pain to the mother. However baby must learn that it is not acceptable. When baby bites, the mother should bring baby closer to the breast and break the suction by inserting her finger in baby’s mouth. If mother lets out a cry, baby may be startled enough to let go of the nipple. The baby will wonder if the mother’s cry and anger had anything to do with baby pressing the gums together and will likely try it again sometime. Each time the mother could show her hurt. The extent of this should not be excessive as baby may think that it is the breastfeeding and not the bite that is causing this unpleasant reaction from the mother and decide to stop breastfeeding altogether.

Do not keep mentioning the incident to others as this will keep reminding baby of the ‘bad deed’. Baby does not intend to hurt mother!

23. I am pregnant.  Can I continue to breastfeed my two year old son?

Unless there is any indication that the unborn child is in any danger breastfeeding the older child is normal and can continue for months after the new baby is born. However, breastfeeding the newborn should be given more importance.

An unborn child may be in danger if the mother notices bleeding and/or has strong contractions.

24. My nipples never stand out, can I breastfeed?

While having a nipple that protrudes is helpful, it is possible for mothers with other types of nipples to breastfeed. 

Babies do not nipple feed but they do breastfeed. Babies take in a portion of the breast while breastfeeding and work with their gums and tongue to squeeze the milk out from the ducts into their mouths. The mother’s hormone oxytocin helps to eject the milk from the breast without much effort on the baby’s part.

25. When should baby be weaned?

Babies should be breastfed at least till they are about two years old as breastmilk remains their staple diet. Weaning means that babies will be given another milk instead. Babies older than 12 months may have fresh cow’s milk.

Weaning babies from the breast is never an easy task especially when the baby is not ready for it. Baby-led weaning is much easier as there are no crying spells that make mothers feel guilty for wanting to stop.

However, when a mother decides to wean it is better for the weaning to take place gradually by cutting out a breastfeed at a specific time for a few days. Then cutting out another breastfeed at another specific time until baby will be having only a couple or so breastfeeds a day.

The support of others is important. It does not help if in the middle of watching TV the father encourages you to feed when this is a time that you had decided to cut out a breastfeed! Stick to your decision if you are sure it’s for the best.


Copyright, Association of Breastfeeding Counsellors.

http://www.breastfeedingmalta.org/

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