Top 5 most asked breastfeeding questions for a midwife:
1. Should I express antenatally?
Antenatally expressing can be a great way for you to learn how to express colostrum from your breast, but also enables you to save up a stash of colostrum in case your baby needs it after birth. Some babies need more fluids in the early postpartum period, the mother and baby may be unexpectedly separated for a period of time, or if your baby has low blood sugar after birth (especially if you have diabetes in your pregnancy) meaning that colostrum can be given in preference to formula. Interestingly, if you have a family history of cow’s milk protein sensitivities, having formula in the early postpartum period can increase the risk of the baby developing this condition. Therefore, having a stash of colostrum reduces your baby’s chance of receiving formula in those early days and improves the woman’s ability to breastfeed exclusively.
You can express colostrum from 37 weeks gestation (it is not recommended earlier in case you put yourself into labour), collect your drops in a sterile syringe in the fridge over 72 hours and then freeze it to take to the hospital with you. Did you know that the average amount of colostrum mothers expressed during the DAME study was 5ml total during the antenatal period? So, any amount of colostrum you can get is amazing and it’s important to not get disheartened when expressing a few drops at a time.
You should always consult your healthcare provider before expressing any colostrum antenatally, especially if you have any medical conditions.
You can find our new Antenatal Colostrum Expressing Kit now here.
2. Is my baby getting enough?
It can be concerning with breastfeeding not being able to calculate the amount of breastmilk your baby is receiving, and this can be (understandably) worrying for many mothers. These tips can help you have confidence in your milk supply and in knowing that your baby is getting enough:
- Baby is settled in between feeds.
- Baby is having expected amount of wet and dirty nappies (at least 6 very wet nappies in 24 hours).
- The baby is alert and has good body tone, not lethargic.
- Baby is putting on weight as expected.
- The soft spot (fontanelle) on the top of baby’s head is not sunken and is pulsating.
- Baby’s eyes look bright and responsive.
- Baby’s mouth appears moist and pink.
- Baby is sucking well at the breast and not falling asleep really quickly.
- You are not worried.
As a mum and midwife, I know it is so important that you trust your gut and if you are worried at any time, to seek medical advice from a trusted healthcare provider. If you are very concerned about your baby, call emergency services in your country.
3. How can I increase my milk supply?
There are many ways that you can try to increase your milk supply. Some things may work for one person and other things for other people. So, it is important that you find the things that works for you. First thing to note is that breastmilk supply works on supply and demand – meaning the more milk is taken out and the more the breasts are stimulated, the more milk the breasts will make. Every time the breast is stimulated it sends a message to the brain to ‘let down’ the milk.
Here are some ways that you can increase your milk supply:
- Breastfeed more often by waking baby for snack feeds or making sure they feed regularly at the breast.
- Try to relax during feeds to encourage your milk to let down quickly.
- Pump for about 5-10 minutes after each feed, especially night feeds when your prolactin levels are the highest. At the start you won’t get much, if any, milk out. after feeds but as you continue with this regime you will start to see an increase.
- Power pumping: pumping 20 minutes, then 10 minutes rest; 10 mins pumping, then 10 mins rest; 10 mins pumping, then finished.
- Nourishing food: Lactation cookies, supplements or herbs (such as fenugreek and blessed thistle).
- Water: Breastmilk is 70% water, so it is important you’re getting enough water into your body to produce enough milk.
- Oxytocin: Oxytocin (the love hormone) helps your body to release breastmilk. You can release oxytocin through skin-to-skin contact, looking at your baby lovingly, smelling your baby’s head, breastfeeding somewhere dark and quiet.
Research suggests that shorter and more often pumping increases milk supply more effectively than longer more spread out pumping. There are also prescription medications that can help increase your milk supply, you should talk about your options with your GP.
4. Cluster feeding
Cluster feeding is a term that almost every mother has heard of, but what does it actually mean?
Cluster feeding is a part of normal newborn behaviour and is thought to be due to a baby wanting to increase their mother’s milk supply. The hormone for breastfeeding, Prolactin, is highest in the evening and night therefore, babies usually cluster feed at night. In addition to babies’ cluster feeding in the evening, many mothers may feel like their breasts aren’t as full by the afternoon and this may be misinterpreted as not having enough milk. Similarly, some babies may be hungrier in the evening and want to “fill up” before sleeping for longer periods overnight.
Sometimes cluster feeding can be overwhelming and exhausting. Here are some ways to help you deal with cluster feeding:
- Try to relax, follow their lead, and tell yourself the reason why they may be cluster feeding is to increase milk supply and is nothing that you are doing “wrong”.
- Reduce surrounding stimulation for the baby to rule out an overstimulated baby. For example, sit in a dark room and feed baby while gently shushing or singing to baby.
- Give baby a calming, quiet bath.
- Ask for help from a partner, family member or friend.
- If you know your baby tends to cluster feed at the same time each evening, you can make dinner early or have an afternoon nap in preparation thus reducing your worry about getting baby to bed so you can do these tasks.
- Know that this period is normal and won’t last forever.
If you are concerned about your baby or that they are not putting on weight, having enough wet/dirty nappies or are not settled in between feeds then it is important to see your healthcare provider.
5. Can I breastfeed a toddler while pregnant?
It is generally safe to breastfeed an older child while you are pregnant as long as you continue to drink enough water and eat a well-balanced, healthy diet. Throughout pregnancy your breastmilk will change as it prepares for the arrival of the new baby and may taste differently to your older child. Your body will even revert to making colostrum towards the end of your pregnancy. This may cause your older child to wean if they do not like the taste. If your child does not mind the flavour change and you don’t have any medical conditions during the pregnancy it is safe to continue breastfeeding.
Breastfeeding an older child does not mean that your unborn baby will be deprived of nutrients, in fact the body will give all of the required nutrients to the baby before the child who is breastfeeding.
Some women report pain during breastfeeding from increased nipple tenderness during pregnancy. Therefore, it is completely up to you whether you are comfortable breastfeeding your older child while pregnant and if you want to continue or try to wean the child.
Anymore questions, pop them in comments below.
By Lauren Brenton - Clinical Midwifery Specialist, Childbirth Educator, Mama of 4