Issue 101 is out now
Melissa Corkhill

By Melissa Corkhill

13th January 2009

Jo Middleton looks at some of the common issues experienced in the early days of breastfeeding and discusses ways to overcome them

Melissa Corkhill

By Melissa Corkhill

13th January 2009

Melissa Corkhill

By Melissa Corkhill

13th January 2009

During pregnancy most of the focus is inevitably on your growing tummy. However, changes to your breasts should not be ignored – they may not swell quite so noticeably, but what they are doing to prepare themselves for nurturing your baby is just as important. In fact, swelling or sensitive breasts are often the first sign for women that they are pregnant at all. Understanding how your breasts change during pregnancy and after birth and how they make milk can help you avoid some of the common problems that unfortunately have become so common in the medicalised western world.

During pregnancy, breasts tend to swell as glandular tissue multiplies and fat is laid down and it is this period of rapid growth that causes the long term changes in breast shape. It is a myth that breastfeeding gives you saggy or smaller breasts – it is in fact pregnancy that has the biggest impact on breast size and shape. There is actually evidence to show that breastfeeding followed by gradual weaning is the best way to help return breasts to a similar size and shape as their pre-pregnancy shape.

Preparing for breastfeeding There is not a lot that you can do physically during pregnancy to prepare for breastfeeding. Some people may tell you to scrub your nipples or in some way try and ‘toughen them up’ but this has now thankfully been shown to be unnecessary – we can all breathe a sigh of relief there!

One very useful thing you can do is to meet with other women who are already breastfeeding and to watch them feeding their babies. It is amazing how many new mums have never actually seen anyone breastfeed – no wonder it doesn’t seem to come naturally if it has been such a secret all this time. If you have no breastfeeding friends seek out your nearest breastfeeding support group and go along for a few sessions. Not only will you get to see breastfeeding in action but you’ll also have a ready made group of supportive friends to go back to once your baby is born.

In terms of planning you may find it useful to specify in your birth plan, if you have one, that you do not want your baby to be given any kind of supplements, dummies or artificial teats unless approved by you. You’d be surprised how free and easy well meaning hospital staff can be with formula milk.

Read up in advance about the basics of breastfeeding and attend an antenatal breastfeeding class if you can. Information is your ally when it comes to breastfeeding – knowing about the numerous physical and emotional benefits of breastfeeding, both for you and your baby, will help keep you motivated if the going gets tough.

Immediately after birth Get your baby to your breast as soon as possible after birth. Babies who are breastfed in the first hour after birth tend long term to be better breastfeeders than those who are made to wait. By this I don’t mean swaddle your baby up quick and force your nipple in their mouth; it shouldn’t involve any kind of stress or panic. Instead, make time for lots of skin-to-skin contact with your baby. This contact is important for so many reasons as well as for the positive effect it has on breastfeeding. Babies who have at least an hour of skinto-skin immediately after birth have more stable temperatures, heart rates and sugar levels, are more likely to latch on and to latch on well, are less likely to cry and are more likely to be breastfed for longer. All non-urgent, routine procedures should be put-off to accommodate this crucial step.

The first week The first few days after birth are a really important time for breastfeeding. The milk that is produced in these first few days – colostrum – is amazing stuff, packed full of antibodies. It is also a great opportunity for you and your baby to get lots of practice at latching on while your breasts are still soft. At this stage you should be seeing a ‘little and often’ pattern to feeds. A newborn’s stomach is only about the size of a walnut and can only hold tiny quantities at a time. During the first week you should be looking to feed at least 10-12 times in any 24 hour period. Look out for signs that your baby is hungry like rooting and hand sucking and put your baby to the breast as soon as you see these. Don’t wait until your baby is crying, it will only make the feed more difficult for you both, and don’t limit your baby’s feeding times.

Frequent and unrestricted feeding should minimise the engorgement you are likely to experience when your milk ‘comes in’, normally between two to five days after birth. The engorgement common at this stage is not simply a case of too much milk, it is actually caused by a massive increase in the flow of blood and lymph fluids to the breasts in preparation for milk production. Your breasts may feel hot, swollen and uncomfortable and the skin may appear taut and shiny. Engorgement can make it difficult to latch your baby on as the areola can be firm and the nipple stretched flat, making it hard for your baby to get enough of your breast into their mouth. Expressing a little milk before each feed just to soften the areola area can help with this.

This type of engorgement (known as vascular engorgement) is perfectly normal and should settle down in a week or two if you continue to feed normally.

“As a newborn’s stomach is only the size of a walnut, he will want to feed little and often”

The first six weeks Once the initial engorgement has settled down you should find you are generally much more comfortable and latching on will be easier. As in the first week, it is important to offer the breast at the first signs of hunger and to feed frequently. Most babies will still be feeding eight to 12 times a day and you may notice patterns begin to develop. However, it is common for feeding habits to change from day to day so don’t worry if your baby seems much hungrier one day than the next.

One very common behavioural pattern of babies in the early months is cluster feeding. This is a period in the day of a few hours – often in the evening – where your baby seems to want to feed constantly! This is very normal (if not a little tiring!) and does not mean you aren’t producing enough milk or that your baby is not satisfied.

Growth spurts are also common during this stage and show themselves as a few days where your baby will seem overly fussy at the breast and want to feed more often than they usually do. Again, this is quite normal and does not mean you do not have enough milk. Listen to your baby and watch for signs they are hungry, feeding as often as you need to, even if it seems more frequent than usual.

The first six weeks of breastfeeding can be hard, there is no denying that, but the rewards are worth it if you persevere. Many people describe the six week mark as a watershed for breastfeeding. It is for many the point at which everything begins to fall into place – feeds become more comfortable and relaxed, supporting pillows are done away with and the experience really does become a rewarding one.

It is important to remember that you are not alone and that if you do experience any problems they can be overcome with the right support. If you have any concerns or difficulties with any aspect of breastfeeding, call one of the breastfeeding helplines – trained counsellors are available to help you, no matter the scale of your problem.

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