Breastfeeding – advice and explanations from the midwife
Many pregnant women have a desire to breastfeed their baby after it is born, as breastfeeding is often associated with togetherness, and attachment to the baby. Breastfeeding is physically possible for most women regardless of their breasts’ size and physical appearance. Breastfeeding is something that you need to learn and practice together with your baby. Read this article for advice on breastfeeding.
Whether you are a Single Mother by Choice, lesbian couple or a heterosexual couple it is not guaranteed that your baby immediately starts eating. It may take time for the baby to learn the right sucking technique and for the mother to learn that her milk is good enough for the baby. When you are breastfeeding, it is not possible to see how much milk the baby receives, and therefore you must trust that your baby gets the needed nutrition.
For some, the insecurity of not knowing how much milk the baby gets, can be a cause of concern even though the baby is thriving and gaining weight. I recommend that you prepare for breastfeeding before the birth by reading about it, so you know the process, and what happens in the body when your baby is born and the milk starts to come. You can read more about how to prepare for breastfeeding and the first time in the blog post "The first weeks after birth".
Your breastmilk is specifically designed for your baby. It adapts to your baby's needs and contains all the nutrients and fluids your baby needs. Breastmilk is the best nutrition for your baby and breastfeeding has a wide range of health benefits for both mother and baby.
Because the breastmilk adapts to your baby´s needs, it contains all the important vitamins, minerals, and antibodies that your baby needs. Research has shown that breastmilk furthermore reduces the risk of asthma, allergies, and otitis media, and that women who breastfeed have a lower risk of developing postpartum depression, a reduced chance of getting breast cancer or ovarian cancer, and a possible reduced risk of getting type 2 diabetes.
The first milk that appears right after birth is called colostrum. Colostrum is a thick, yellowish liquid that has a high protein content and contains antibodies that help strengthen your baby's immune system right from birth. The colostrum comes in small amounts and will be replaced with the real milk after a few days. The real breastmilk is thinner and whiter in colour than colostrum. You will be able to feel the difference in your breasts when the real milk starts to flow. Your breasts become larger, heavier, and the blood vessels become more visible. It can be difficult for your baby to get a proper grip around the nipple because the breasts become overfilled and hard. Therefore, it may require extra work in the beginning, but when the amount of milk has adapted to your baby's needs it will become easier.
If it is too difficult for the baby to get a proper grip around the nipple, it may be an idea to hand-pump some of the milk, so the breast gets softer. Remember, however, that you must not stimulate too much when pumping, both with hand and breast pump, as it may increase your milk production. Breast milk acts as supply on demand. The more the baby sucks or you pump out, the more milk you produce. In that way, you should end up producing exactly the amount of milk your baby needs.
What happens if the breastmilk does not come?
If the breastmilk does not come within 3-4 days after the birth, it is important to actively do something to increase the production. A reason for the missing milk production could be that your baby is using the wrong sucking technique or that you have started breastfeeding too late. To give the milk production the best chances of success, it is important to start breastfeeding within six hours after birth. Using breastfeeding pacifiers can also affect milk production, as the breast is not stimulated sufficiently. It is often recommended to use a breast pump along with the use of breastfeeding pacifiers to help increase the milk production.
Other reasons why the milk does not come within 3-4 days can be:
- Physical or mental stress
- Large blood loss after birth
- Complicated birth or caesarean section
- The baby was not placed on the breast within six hours after birth
- The mother suffers from PCOS
- Metabolic disease in mother
- Breast surgery
If the sucking technique is wrong, it is important to correct it as fast as possible. It may be necessary to seek help from a breastfeeding counsellor or a midwife, who can help get the baby’s mouth in the right position around the nipple. In addition, it might be a good idea to start pumping out, to increase your milk production. Start pumping after every breastfeeding, on both breasts, so that you do not "take" the milk from your baby, but get the breast stimulated in connection with a breastfeeding being over.
What is the difference between thin and thick breastmilk?
Breastmilk can be divided into thin and thick milk. Once the milk has been produced and is stored in the mammary glands, it will "separate" so that the fat particles stick to the inside of the mammary glands and the liquid milk in the glands contains a lower amount of fat. When the milk starts to run, the "thin milk" with a lower fat percentage will come first, followed by the thick milk with a high fat percentage as the mammary glands are getting emptied.
You can distinguish the thin and the thick milk on the colour. The thin milk will be milky white, with a bluish tinge. This is due to the low fat percentage. The thin milk can be compared to skimmed milk. The thick milk has an off-white colour and can be compared to whole fat milk.
For your baby to gain weight, it is important that he/she gets the fat, protein-rich milk that comes at the end of the breastfeeding. Therefore, it is important that your baby empties one breast during the meal before switching to the other breast. Your baby needs to work harder to receive the thick milk, and you may be able to feel your baby's sucking technique changing along the way.
How often should my baby eat?
There are no specific rules for when and how long your baby should breastfeed. But in general, a new-born baby should eat at least eight times a day. The baby should have free access to the breast and should be offered breastfeeding when he/she shows signs of hunger.
Previously, there was consensus among health care professionals that a baby should be breastfed every 3-4 hours. That is simply wrong and untrue. A baby should have free access to the breast as breastfeeding has a lot of other positive effects than receiving nutrition. It acts as comfort if the baby is restless, upset or just needs to be close to you. It is important never to deny the baby access to breastfeeding. Recent studies show that new-borns’ stomachs benefit from frequent breastfeeding and that breastfeeding every hour or more is not unusual at all. A new-born’s stomach is very small and cannot contain large amounts of milk. Frequent breastfeeding is therefore necessary. In addition, breastmilk is digested faster, and to keep blood sugar stable the baby will demand to breastfeed frequently. Frequent breastfeeding is therefore NOT a sign of too little milk or too little nutrition in the milk but just a sign of a healthy baby.
The National Board of Health also recommends that infants are fully breastfed until they are 6 months old and partially breastfed for 12 months or longer.
How do I make sure that my baby gets enough breastmilk?
During the first few weeks, the content in the diaper tells you whether your baby receives enough breastmilk. A minimum of five or six wet diapers a day and stools every day, is a sign of your baby thriving. In addition, the stool should change colour during the first four or five days after birth. After six weeks, your baby should continue to have heavy diapers every day. But if your baby is fully breastfed, there may be up to two weeks between the stool diapers. This is due to breast milk being specially designed for your baby and the body therefore digests all the breast milk.
Too little breastmilk
A lot of new mothers will at some point worry about their milk production and whether they have enough milk to feed their baby. For most women there is no need to worry, but for some this will cause them to stop breastfeeding.
The signs of having too little milk are:
- Few wet diapers and few diapers with stools
- That the child is lethargic and passive
- The square fontanelle on top of the baby's head has sunk in
- Low weight gain or weight loss
- Lack of well-being
If you experience some of the signs above, I recommend that you consult a midwife or a breastfeeding counsellor. There are several measures that can be used to increase milk production. The reason for having too little milk is often found in the amount of milk being removed from the breast. When the milk is removed from the mammary glands, a signal is sent to the brain that more milk needs to be produced. But if the breast is not emptied sufficiently, there will be no signal about producing more milk.
The following issues may also be the reason for having too little milk:
- A breastfeeding position which results in the baby not getting a proper grip around the nipple
- A sucking technique which may be complicated by a tongue tie or tension in the cheeks
- Stress hormones that inhibit the downflow reflex of the milk
- Too little breastfeeding
- Too long sleep stretches - especially at night
- Supplementation with infant formula without pumping out
- The use of breastfeeding pacifiers
The important thing is to get milk production started and send a signal to the brain about producing more milk. This can be done in many ways. One way is to lie skin to skin with your baby, as this helps trigger the hormones needed to produce milk. Offer your baby the breast as often as possible and change side frequently so that the breast is stimulated to produce more milk. In addition, it may be an idea to pump out either with a breast pump or by hand. This should be done right after breastfeeding so that you do not take the milk from your baby but instead empty the breast completely and stimulate it to produce more.
It is also important to mention that soft breasts are NOT necessarily a sign of too little milk but rather that the milk has adapted to the right amount for your baby.
Can you use infant formula as a supplement to breastfeeding?
Infant formula is a supplement to breastfeeding with low milk production or for babies who are not being breastfed at all. Infant formulas are made from cow's milk which has been treated and added iron as well as all the nutrients found in breastmilk. However, the concentration of nutrients in infant formula are higher, because they are not absorbed as well as the nutrients in breastmilk. The extra nutrients are excreted in the urine and are not harmful to the baby. Infant formula is very similar to breastmilk, and it is important to keep in mind that if breastfeeding is not possible, it is no shame to use infant formula. Your baby will receive most of the same nutrients as they would if they were breastfed. As a new mom, it can feel like a shame and a huge defeat if breastfeeding fails. It is important to remember that everyone is different and that you are not a better mother because you are breastfeeding.
If you start supplementing with infant formula in a bottle, there is a risk that milk production will decrease as the baby eats less from the breast. It therefore does not solve the problem of too little milk, as milk production is produced based on the demands of the baby. There are other ways to supplement with infant formula while breastfeeding if you experience that the child does not get enough to eat. This could be a Lact-aid system or giving formula in a cup afterwards. A breastfeeding counsellor can help you with this.
If you choose to give breastmilk substitute as a supplement in a bottle, but would like to maintain breastfeeding and milk production, it may be an idea to pump out using a breast pump. By pumping your breasts, you can maintain the demand for milk and keep production up.
Another challenge by starting on breastmilk substitute and bottle feeding may be that your baby will refuse the breast afterwards as the milk is more easily accessible through the bottle. The baby is then used to not working as hard for the milk, which may cause the baby to prefer the bottle over breastfeeding. In completely new-borns, it can also confuse the baby's sucking technique, as the technique is different sucking on a bottle than the breast. It may be better to give the supplement in a small cup rather than the bottle, as the baby does not have to deal with different ways of sucking.
In older babies, where breastfeeding is well established, it is often not a problem to give a bottle of breastmilk substitute every now and then. It is not something that will affect milk production unless it happens daily. Then milk production will decrease because the baby gets a meal less from the breast.
Can I still breastfeed if I am infected with Covid-19?
Yes. In fact, the National Board of Health and the WHO recommend that you continue to breastfeed despite being infected with Covid-19, as the benefits of breastfeeding outweigh any risks. It is important that you do NOT let yourself be isolated from the child and continue to give the child the closeness and security he/she needs.
No studies have shown Coronavirus in breast milk in breast-feeding mothers. Therefore, there is no reason to be nervous about or to stop breastfeeding due to the risk of Corona infection.
Some mothers experience that their milk production can decrease if they have a virus in the body. This is normal and milk production will increase again when the disease is over. It is important to remember to take care of yourself with fluids and rest while you are sick.
UNICEF and the midwives' association has carried out the following guidelines if you are infected with Covid-19 and breastfeed a new-born:
- Breastfeed if desired
- Follow the general hygiene advice about hand washing, etc.
- Wash the breast with soap and water before breastfeeding
- Use a mask during breastfeeding or other close contact to your baby to reduce the risk of infection
It is also recommended to get vaccinated for COVID-19 while breastfeeding. If you want to read more about Covid-19, we can recommend our research study on whether or not Covid-19 is transferred through sperm.
None of the WHO-approved vaccines currently being used contain the live virus, so there is no risk of passing the virus to your baby via breastmilk.
My name is Julie, and I am a trained midwife working at Cryos Customer Care. I have been a midwife for 6 years and have experience from many different maternity wards, including a stay in Uganda. I provide Cryos’ blog with expert knowledge about fertility, pregnancy and birth. I hope to bring you a step closer to make your dream of having a baby come true.Julie