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Key takeaways

• Latching and positioning are skills you and your baby learn together.
• Breast milk provides ideal nutrition and protection for your baby.
• Expressing and storing milk safely allows for flexible feeding.
• Seek help early for challenges like sore nipples or engorgement.

The basics of breastfeeding

Breastfeeding is a skill that you and your baby learn together. It can take some time to get used to.

Latching on

Latching on is how your baby attaches to your breast to feed. Good attachment helps prevent sore and cracked nipples.

To help your baby latch on:

• Hold your baby's whole body close. Their nose should be level with your nipple.
• Let your baby's head tip back a little, so their top lip brushes against your nipple. This encourages your baby to open their mouth wide.
• When your baby's mouth opens wide, their chin should touch your breast first. Their head should be tipped back so their tongue can reach as much breast as possible.
• Your baby's chin should be firmly touching your breast, and their nose should be clear. Their mouth should be wide open.
• You should see more of the darker nipple skin above your baby's top lip than below their bottom lip.
• Your baby's cheeks will look full and rounded as they feed.

Signs of effective attachment include:

• Your baby has a large mouthful of breast.
• Your baby's chin is firmly touching your breast.
• Your baby's mouth is wide open.

Breastfeeding positions

There are many different positions you can try. Find what works best for you and your baby. Always get comfortable before a feed, using pillows if needed. Your shoulders and arms should be relaxed.

General principles

Ensure your baby's head and body are in a straight line. It is hard for your baby to swallow if their head and neck are twisted.

Hold your baby close to you, facing your breast. Support their neck, shoulders, and back. This allows them to tilt their head back and swallow easily.

Always bring your baby to the breast. Let them latch themselves. Avoid leaning your breast forward into your baby's mouth, as this can lead to poor attachment.

Positioning techniques

Your baby needs to get a big mouthful of breast. Placing your baby with their nose level with your nipple encourages them to open their mouth wide. Do not hold the back of your baby's head. This allows them to tip their head back. Your nipple then goes past the hard roof of their mouth, ending up against the soft palate at the back.

Do not feed your baby while they are in a sling or carrier. Take them out first for a safe feeding position.

Popular breastfeeding positions

• Cradle hold – Sit in a comfy chair with armrests, lying your baby across your lap with their head on your forearm and nose towards your nipple. Ensure your baby's ear, shoulder, and hip are in a straight line.
• Lying on your side – This position is good for caesarean recovery or night feeds; lie on your side comfortably with your baby facing you, tummy to tummy. Ensure your baby's ear, shoulder, and hip are in a straight line.
• Laid-back nursing – This is also known as biological nursing. Lie back in a comfortable, semi-reclined position with cushions and place your baby on your front, tummy to yours.
• Rugby hold – This is also called the clutch. Sit in a chair with a cushion along your side and position your baby under your arm. Their hips should be close to yours and nose level with your nipple. Support their neck with your hand.

Understanding your baby's hunger cues

Your baby will show signs when they are hungry or thirsty. Early signs of hunger include:

• Rooting
• Moving their eyes or head from side to side
• Wriggling
• Waving or sucking fists
• Making murmuring noises
• Licking their lips
• Opening their mouths as if searching for your breast

Crying and distress are late signs of hunger. It is harder to breastfeed a distressed baby. Responding to early cues helps make breastfeeding easier and calmer. Keeping your baby close helps you recognise these signals. If your baby is agitated, try calming them using these techniques:

• Cuddling
• Giving skin-to-skin contact
• Talking
• Stroking

Colostrum

The fluid your breasts produce in the first few days after birth is called colostrum. It is thick and usually a golden yellow colour. Colostrum is a very concentrated food. Your baby only needs a small amount at each feed, about a teaspoonful.

Colostrum is rich in protein, antibodies, and vitamins. It also contains anti-infective agents, living cells, and minerals. It is easy for your baby to digest.

It helps your baby have their first poo. It helps them fight infections. Even a small amount of colostrum is beneficial for your baby.

Supply and demand

Your breast milk is produced on a supply and demand basis. The more frequently your baby feeds, the more milk your body will produce. The amount of milk your baby drinks also directly influences your supply. This is especially important in the first few weeks.

Feed your baby as often as they want and for as long as they want. This is called responsive feeding. It is also known as on-demand or baby-led feeding.

Responsive feeding helps establish and maintain a good milk supply. It also helps your breasts feel comfortable and avoids engorgement. Trying to feed to a schedule could cause your milk supply to drop.

Benefits for you and your baby

Breastfeeding offers many benefits for both you and your baby.

Benefits for your baby

Breast milk is tailor-made for your baby. It contains all the nutrients your baby needs for the first six months. It has vitamins and minerals. It is always available.

Breast milk is a living fluid. It is full of antibodies and other factors that strengthen your baby's immune system. It provides protection against infection and helps them digest nutrients.

Breastfeeding protects your baby from diseases and infections. It reduces the risk of:

• Diarrhoea and vomiting
• Sudden Infant Death Syndrome (SIDS), a rare condition where a baby dies suddenly and unexpectedly
• Obesity
• Cardiovascular disease, conditions affecting the heart or blood vessels in adulthood

Breast milk also contains antibodies, hormones, and other nutrients. These are important for premature babies' healthy growth and development.

Benefits for you

Breastfeeding helps your womb (uterus) get back to its normal size after birth. It makes your womb contract. This speeds up the process.

Breastfeeding releases oxytocin, which is known as the love hormone. This can help you feel calmer. It boosts your loving bond with your baby.

Breastfeeding protects your health. It lowers your risk of:

• Breast cancer
• Ovarian cancer
• Osteoporosis (weak bones)
• Cardiovascular disease (conditions affecting the heart or blood vessels)
• Obesity

Breastfeeding is free and convenient. You do not need to sterilise bottles and teats.

Expressing and storing milk

Expressing milk means taking milk out of your breasts. You can then store it and feed it to your baby later.

Why express breast milk?

There are various reasons why you might express milk:

• Premature or ill baby – If your baby is premature or has problems after birth, they can still have your expressed breast milk.
• Returning to work or study – Expressing allows your baby to continue receiving breast milk.
• Full breasts – If your breasts feel uncomfortably full.
• Latching difficulties – If your baby cannot latch on or suck well.
• Boosting supply – To increase your milk supply.
• Introducing solids – You may want to include breast milk when introducing solid foods.
• Before birth – Expressing small amounts of colostrum before your baby is born can provide extra milk in the first few days.

If you do not need to express milk straight away, wait until you and your baby are comfortable with breastfeeding. Then you can start expressing regularly.

Types of breast pumps

You can express breast milk by hand, with a manual pump, or with an electric pump. Choose whichever is more comfortable for you.

• Manual breast pumps – These hand-operated pumps are cheaper and simpler to use. They are also lightweight and quieter, though they may take longer than electric pumps.
• Electric breast pumps – These pumps do the work for you and can be quicker than manual pumps; you may also be able to hire one.

Breast pumps are designed to copy your baby's sucking action. Always read the instructions and familiarise yourself with your pump. Ensure your pump and all parts are clean and sterile before use.

If using an electric pump, start slowly on the lowest suction setting. Building up slowly is important. A high setting straight away can be painful or damage your nipple.

How to express milk

It can take a while to get the hang of expressing. Allow 30 to 45 minutes when you first start. Once you are used to it, it may take 15 to 20 minutes to empty both breasts. Do not rush the process. Distracting yourself with a book or TV may help.

Hand expressing

To express breast milk by hand:

1. Wash your hands well.
2. Have a sterilised container ready to collect your milk. This could be a feeding bottle or a wide jug.
3. Get comfortable in a warm, quiet room.
4. Gently massage your breasts to encourage milk flow. Start with long strokes from your armpit towards your nipple.
5. Cup your breast in one hand. With the other hand, form a C shape with your forefinger and thumb.
6. Place them a few centimetres back from your nipple, just outside the areola. The areola is the darker skin around your nipple.
7. Gently press your thumb and fingers together. Release your fingers and repeat in a rhythmic movement.
8. If no milk appears, adjust your fingers forward or back to find the right spot.
9. Do not squeeze down on your nipple, as this can make you sore. Expressing should not hurt.
10. When the milk flow slows, move your hands around your breast. Express from a different area.
11. Once you have expressed as much as you can from one breast, repeat on the other breast.

Expressing with a pump

To express breast milk with a pump:

1. Sterilise the pump before use.
2. Gently massage the breasts for a few minutes to encourage milk flow.
3. Place the pump's breast shield or funnel over your nipple.
4. Pump manually if using a manual pump. Switch the electric pump on if using an electric one.
5. Once you have finished, wash and sterilise the pump and all its parts.

Storing breast milk

It is important to store breast milk correctly so it is safe for your baby. Breast milk contains anti-infective ingredients that limit the growth of unwanted bacteria. However, it should still be handled and stored carefully.

Hygiene and storage containers

• Always wash your hands before expressing and handling breast milk.
• Always use a sterile container with a lid, not just a collection jug. You can buy disposable containers.
• Label storage containers or syringes with your name and "breast milk". Include the time and date.
• Put them inside a clean, sealed bag or box.
• Store your breast milk in the fridge or freezer as soon as possible.
• Store it away from meat products, eggs, or any uncooked foods.

Breast milk storage times

Store breast milk in small quantities to avoid waste.

• Room temperature – Freshly expressed milk can keep for 6 hours without refrigeration.
• Fridge – Store milk at the back of the fridge (4°C or colder) for up to 8 days. If the fridge is warmer or you are unsure of the temperature, use the milk within 3 days. Newly collected milk can be cooled and added to previously stored milk on the same day.
• Ice compartment of a fridge – Up to 2 weeks.
• Freezer – Up to 6 months at -18°C or colder. Leave at least one centimetre of free space at the top of the container, as milk expands when frozen.

Breast milk cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Defrosting and warming milk

• Defrosting – The best way to defrost frozen breast milk is in the fridge, which usually takes about 12 hours. Once fully defrosted, it must be used immediately.
• Quick defrost – If you need it sooner, place the bag or container in a jug of warm water or hold it under running warm water.
• Warming – You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. To warm it, place the bottle in a jug of warm water or hold it under running warm water.
• Do not use a microwave – Microwaving can create hot spots in the milk. These can burn your baby's mouth.
• Never re-freeze – Do not re-freeze defrosted milk.
• Leftover milk – Once your baby has drunk from a bottle of breast milk, it must be used within one hour.
• Discarding leftovers – Throw away any leftover milk after this time.
• Minimising waste – To avoid waste, offer your baby only a small amount at a time.
• Storing unused milk – Keep the rest in the fridge and top up the bottle as needed.

Common challenges and finding support

If you have any problems with breastfeeding, ask for help as soon as possible. This helps sort out issues early.

Sore or cracked nipples

Sore nipples usually happen because your baby is not well positioned and attached at the breast. Putting up with it can make pain worse.

If expressing with a pump, ensure the funnel is the correct size. If friction occurs, you may need a larger breast shield. If the skin around your nipple (the areola) is pulled into the funnel's neck, a smaller size may be needed.

Always use the highest comfortable vacuum setting that produces milk. A high setting will not speed up milk flow and can make nipples sore.

Speak to your midwife, health visitor, or a breastfeeding specialist for support.

Concerns about milk supply

You may worry that your baby is not getting enough milk. It takes time to feel confident.

To help stimulate your milk supply:

• Offer your baby both breasts at each feed.
• Alternate which breast you start with.
• Keep your baby close and hold them skin-to-skin.

If you are worried your baby is not getting enough milk, speak to your midwife, health visitor, or a breastfeeding specialist. Whatever milk you can produce will still benefit your baby. If you are finding breastfeeding or expressing difficult, a feeding specialist can offer practical advice and support.

Breast engorgement

Breast engorgement is when your breasts get too full of milk. They may feel hard, tight, and painful. Engorgement can happen in the early days as your milk supply adjusts to your baby's needs. It can also happen when your baby feeds less frequently, such as when starting solid foods.

To ease the discomfort of engorgement:

• Feed frequently and responsively, including at night.
• Offer your baby a feed whenever your breasts feel full or uncomfortable.
• If you cannot feed, express just enough milk by hand to relieve discomfort. Avoid expressing more than necessary, as this can increase your milk supply and worsen engorgement.
• If your breasts are very full, express a little milk first to soften them. This will make it easier for your baby to latch.
• Reverse pressure softening – This technique softens the areola by gently pressing on its edge inward towards your chest wall for 50 seconds before each feed. However, you should avoid this if you have mastitis, compressed ducts, or a breast abscess.

Allowing breasts to remain engorged could lead to a painful inflammation of the breast (mastitis) or a reduction in milk supply.

Mastitis

Mastitis is when your breast tissue becomes inflamed and painful. It usually affects one breast, but can affect both. Symptoms can develop quickly.

Signs and symptoms of mastitis include:

• A swollen area on your breast that may feel sore.
• Breasts that feel swollen, hot, and painful to touch.
• Red patches on the breast (can be harder to see on brown and black skin).
• A burning pain in your breast, which may be constant or only when breastfeeding.
• Nipple discharge, which may be white or contain streaks of blood.
• A lump or hard area on your breast.
• Feeling tired, run down, and feverish. You may have flu-like symptoms like aching, increased temperature, and shivering.

How to manage mastitis

A build-up of milk can sometimes lead to a blocked duct. This can cause mastitis if not relieved. If you think you have a blocked duct or mastitis, it can help to:

• Gently massage the swelling towards your nipple while your baby feeds.
• Take paracetamol.
• Wear loose clothes and a comfortable, soft bra.
• Ease milk flow by putting a cloth soaked in warm water on your breast. You can also have a warm bath or shower.
• Place a cloth soaked in cold water on your breast to soothe pain.
• Continue to feed your baby and express after a feed.

Do not stop breastfeeding or expressing if you have mastitis. This can make symptoms worse. Your milk will still be safe to use.

See your GP if you still have symptoms or feel worse after 12 to 24 hours. You may need antibiotics. If mastitis is left untreated, it may lead to a painful collection of pus in the breast (a breast abscess).

Finding support

Many professionals and groups can help with breastfeeding.

• Midwives and health visitors – They can give you information and support, and you can contact them between appointments or go to local drop-in baby clinics. Their contact details are in your baby's red book (also known as the personal child health record, or PCHR).
• Lactation consultants or feeding specialists – Some neonatal units have these specialists. They are trained to help with breastfeeding and expressing problems.
• Support groups – Breastfeeding drop-ins, cafes, and centres offer support and a chance to meet others. Information on what's available locally can be provided by:
• Your midwife
• Health visitor
• GP
• Local council

Breastfeeding support helplines

• National Breastfeeding Helpline – 0300 100 0212
• The Breastfeeding Network supporter line (in Bengali and Sylheti) – 0300 456 2421
• Association of Breastfeeding Mothers – 0300 330 5453
• La Leche League – 0345 120 2918
• National Childbirth Trust (NCT) – 0300 330 0700

These organisations have trained volunteers or counsellors. They can provide practical and emotional support. The Lactation Consultants of Great Britain website has a search function to help you find a lactation consultant in your area.