Breastfeeding Advice with MAM’s Expert Midwife
Continuing our look into the topic of feeding your baby for World Breastfeeding Week, we were delighted to chat to the lovely Zoe Watson, who is a registered nurse and midwife, as well a consultant midwife for MAM - a leading manufacturer of feeding, teething and oral healthcare products.
After our live Instagram chat with lactation consultant, Olivia Hinge, we asked you for any other questions you might have around breastfeeding. We took those questions and put them straight to Zoe, so we now have another opportunity to get some expert tips and tricks on breastfeeding your little one. So let’s dive straight in…
Watch the interview or scroll down for the full transcript.
IB: What are the best positions for breastfeeding after a C-section?
Zoe: First and foremost, when you have your baby in theatre, ask for baby to be put skin to skin with you after the birth. As well as being lovely for a cuddle and great for bonding, it’s also really good to stimulate baby and get them ready for that first breastfeed as they can smell mum and all of that.
I’ve also looked after mums whose babies have started breastfeeding on the theatre table as well because they’re close to mum’s breast, they just latch on so that’s great, it just gets things going.
After that point, perhaps you’re in recovery and you’re feeling more yourself so able to start feeding, it’s really important that you make sure you’re comfortable. If you require any pain relief or anything like that, make sure you ask for it. Also ask your midwife or recovery nurse for lots of support with pillows for example, to make sure you feel comfortable. Those things are really important for anyone breastfeeding but especially if you’ve just had a big operation on your tummy, you could feel a bit sore.
So, make sure your comfort levels are addressed first and ensure you’re not feeling sick or anything like that. Once you’re at that stage, start having a look at different feeding positions. It’s always good to do some research online beforehand, especially if you’re having a planned C-section.
*Zoe presents her feeding demo doll*
One of the most common ways we think of breastfeeding babies is the cradle hold but if you’ve just had a C-section and you’re laid back in a bed, this might not be the easiest position for you. You might find the laid back position easier – this is where mum is lying back and baby is lying down her body. Baby can then be positioned on a diagonal so that they avoid the area where you’ve had your incision (so where your C-section scar will be). They can be more koala over one of your legs, depending on how you’re sitting and how you feel most comfy.
The other position to try would be the underarm position (otherwise known as the rugby hold) and this is good if you’re more sat up right. Again, get plenty of cushions to help you. That’s where you lay baby under your arm. Baby latches on with their head facing towards your breast and their body wraps around the side of you. Again, completely avoiding where you’ve had your C-section.
Another good one which is good when you’re perhaps a bit more mobile and back home would be laying down on the bed. If you’re in hospital, you’ll need someone to assist you to get the bed completely flat. You then lie on your side and you have baby feeding alongside you. The bed will take all the weight of baby and you should be free from baby touching your tender areas, no pressure on your belly at all.
What tips would you have for any pregnant ladies hoping to breastfeed?
One of my top tips would be, even if you can’t attend a breastfeeding group (which if you can do, they’re amazing) have a look on the NHS website and other trusted sources to familiarise yourself with different breastfeeding positions.
I know when I breastfed my daughters, one of my girls preferred one side so I would feed her in the cradle position on one breast and then transfer her to the other in the rugby ball hold because it didn’t mean turning her around, so she was happy.
It’s just good to have that knowledge there ready to go so that if you do find something tricky, you have other positions to try.
What do you do when baby gets to crying pitch and won’t latch on?
Ah, yes – that’s very difficult. First of all, babies do cry and sometimes it’s so difficult, especially if it’s your first baby. You’re thinking, what’s wrong? Am I doing something really wrong here? Try not to panic. Easier said than done but just try not to panic. Go back to the basics and think, does my baby need anything? Sometimes you can be there really trying to get baby to feed, they’re due a feed and you’re thinking, why aren’t they feeding? That’s all you’re focussed on but actually, baby could’ve done a great big poo and need their nappy changing.
So, try and ground yourself. Stay calm and think, okay – does baby need anything? Is the room really hot or cold? Do they need a fresh nappy first? Once you’ve addressed all of those things and you know from a comfort perspective, there’s nothing that could be upsetting baby. They could’ve got themselves over hungry or something like that.
One thing I will say is that it’s incredibly difficult to get a baby that’s crying latched onto the breast. The best thing to do is just get baby calm again and then try and latch them on again. Skin to skin is always going to be your best friend for that one. Strip baby off down to their nappy and then tuck them up to your chest so they’re nice and close to you. If you hold them in that more laid back position on the bed or settee while you’re holding onto them in that skin to skin position, you may even find that as they calm down, they’ll latch themselves on. If they don’t, keep them calm; keep that skin to skin going until things have settled down and then try to latch them back onto the breast again.
If you find that this isn’t calming baby down, another great thing to try, if you’ve got to the stage where your baby is ready to have their baths and things, you can try getting in the bath with them. That warm water (make sure it’s not too hot for them and it’s safe for baby) around you both can act as a slight distraction and could be comforting for them if it’s a bit of trapped wind or something that’s making them cry. Try to then latch them onto the breast again.
It’s surprising how slight distractions and tweaking things slightly can really help baby to calm down and latch on.
If all of these things don’t work and you know baby is due a feed, you can try a little bit of hand expressing. Just express a few drips of milk and with your clean finger with short nails, you can finger feed it to baby. This will give them a little taste for the breastmilk and it might just calm them down a little and reassure them that you’re there and ready for them to latch on and have a feed.
Obviously if your baby is crying to the point that you’re concerned, seek medical advice for them but the chances are, they have a little bit of trapped wind or they’re over hungry so they’re getting a little bit frantic at the breast.
The next question is, I’d like to share feeds with my husband, how do I go about introducing a bottle to my baby?
That’s a really common question. The first thing that’s most important is if you’re introducing a bottle to a breastfed baby, you need to make sure your breastfeeding is well established. That can take several weeks. We used to say 6 weeks for everybody but now we know that’s not really the case. You might have a really experienced breastfeeding mum whose breastfeeding has been going ‘text book’ from the very beginning and she might get to 5 weeks and say, I know this is all happening as it should. Baby’s doing well, no concerns; milk supply’s regulated, I’m going to start introducing a bottle now. Whereas you might have a mum who’s had a more challenging time with breastfeeding and it might take more like 8 or 9 weeks until she gets to a place where she feels super confident that introducing the bottle is the right time.
So, wait until the breastfeeding is established. Make sure you’re emotionally ready and that it’s what you want to do. In that time, if you’ve got a partner; a co-parent, a friend who’s chomping at the bit to bond with baby because you’re breastfeeding, there are so many ways you can bond with a baby apart from feeding them. Sing to them, read to them, skin to skin – there are lots of things you can do. Encourage them to bond with baby in all those other ways while you’re waiting to get to the right stage to introduce the bottle.
What are your top tips for expressing breastmilk?
Make sure you only express what milk you need. You don’t want to go wild with it because your breasts work on supply and demand. Your breasts get used to the loose feeding pattern that your baby follows on the whole. If you then suddenly go hell for leather with expressing, your body can’t tell the difference between baby cluster feeding and you pumping. What can happen then is you come into this huge over supply of milk which sounds great but it can actually cause quite a lot of problems. So express the amount of milk that you need for each feed – you can incorporate this into your daily routine, whatever works for you.
What bottle should you choose when introducing a bottle to a breastfed baby?
When it comes to feeding your baby with a bottle of expressed milk, find a bottle that works for you and your baby. Go for a slow flow teat as that’s what breastfed babies prefer as it’s nice and slow, it mimics the way they feed from the breast more. If you give them too fast a flow, it can confuse them and they don’t like it as much.
You should also adopt paced bottle feeding. Instead of holding baby in the cradle position and holding the bottle directly above their mouth, which allows milk to flow really fast, hold baby slightly more upright and hold the bottle more horizontal to their mouth. The milk should be just tipped into the teat, which slows down the speed in which baby is taking that milk. Give them breaks in between, burping them perhaps in between and just take your time. This mimics when they feed at the breast. The sucking and stopping and taking little pauses.
Make sure when you introduce the bottle, baby’s not feeling super hungry. If a baby is really hungry and they’re breastfed, all they’re going to want is the breast. They will think, I don’t want that that thing I’m not used to, I want the breast – they just won’t entertain it. Make sure baby is happy and nibble-ish so you can then give them the bottle and start trialling it.
If your baby is reluctant to take the bottle, sometimes it can help to point baby outwards so they’re able to look around while you give them the bottle for a little bit of distraction.
If your baby is reluctant to accept the bottle, what would your advice be?
Speaking from personal experience, I breastfed both of my daughters. With my first, I knew I should’ve given her a bottle because it maybe would’ve given me a breather every now and again to go and have a baby-free coffee with my friends and for my own mental health. Because the breastfeeding had gone well for me and I felt that bond with my baby, I felt protective over my breastfeeding too. I didn’t want anyone else to feed her as it felt like it was my job. When it then came to introducing the bottle to her, it was tricky to get her to take the bottle but we got there in the end.
With my second, I was more open-minded as my first daughter was only two years old so I had to juggle my time. She did have the odd bottle of expressed milk and I think because she had the bottle earlier, she took to it fine.
I have to say, there is no ‘right’ time to give that first bottle though. It’s very personal. I remember when my first daughter was only a few months old, a fellow midwife asked me if she’d had a bottle yet. She then suggested that if I did want to leave her, I should’ve really given her a bottle at 6 weeks old. I then thought, oh no – I’ve ruined it but I hadn’t! It just depends on the baby.
You can try the whole distraction thing by walking around the room with baby; using a gentle motion with baby in your arms while they’re facing outwards. Have someone else other than the breastfeeding mum give the bottle so that baby can’t then smell you as they obviously associate you with the breastfeed. It might help for mum to leave the room as if they see you (it depends on the age of the baby) they may well think, hang on – you can come back!
Speaking as a mum who has breastfed, I found it easier to leave the room when my girls were having their first bottles as I wanted to share my thoughts on how they were being fed.
This bit of advice leads nicely onto the question, ‘I have a wedding next month, so I’ll be away from baby for a night. How can I start to prepare for this?’
If you have an event coming up such as a wedding and you’re thinking two months ahead, for example, I would definitely say to try and introduce that bottle as soon as you know there’s this time coming up where you’re going to be separated from your baby. The last thing you need is to be stressing, especially if you have something nice planned. If you leave it to a few days before and baby then won’t take the bottle, all of a sudden it feels like a big disaster and it’s really worrying. So try and get yourself in a bit of a routine beforehand where you know baby will accept a bottle and they enjoy that feed and it all works well.
When it comes to pumping, if you’re away for a night, be led by your baby for how often they feed. You don’t need to go wild. Your breastmilk will store in the fridge and the freezer for a certain amount of time so just make sure you’ve got a stash there ready but don’t go wild with power pumping the week before. You could then end up with really full breasts that could feel uncomfortable when you go away. So pump as and when, as part of your normal routine to build enough milk for your baby for that night.
To alleviate those full breasts when you’re away, should you take a breast pump with you?
Yes, definitely. Some people choose to hand express but again, speaking from personal experience, you can feel really uncomfortable. If you’re away from baby overnight and they still feed overnight, even if they don’t feed much overnight but they feed first thing in the morning, you could wake up and your breasts could feel incredibly full. They can feel so full they feel uncomfortable and so you need to relieve them for comfort and also when they’re very full, they can leak. If you’re away for an event or at an evening dinner, you don’t want to be dealing with leaky boobs! So I would definitely recommend taking a pump away, even if it’s just a manual pump for relief. Or, you can take your electric pump with you, whatever you’ve got and whatever works for you. In some places, there’ll be a place for you to store that milk so it doesn’t mean you have to throw it away either.
MAM sell a variety of pumps. Can you please tell us the difference between a single and a double breast pump?
Basically, they’re both electric breast pumps and both do the same job but the single breast pump will pump one breast at a time. The double breast pump will pump both breasts simultaneously. It’s really down to personal preference which pump you want to get. I think for most mums who are breastfeeding and who choose to express the odd bottle for baby or who are maybe returning to work and need to pump a little on their lunch break, usually a single pump works quite well because you might’ve just fed baby on one breast so you then pump on the other.
However, there are definitely situations where a double pump is brilliant. You might choose to exclusively pump and feed baby your breastmilk by bottle so having a double pump, you’re going to get a simultaneous let-down so it will speed up the process, as opposed to doing it one at a time. If your baby is on the neonatal unit because they’ve been born prematurely, for example, you will take baby your expressed breastmilk. So if the mum knows she’s not going to be able to put baby to her breast for a little while, having a double pump at home can be really handy as you need to keep that pumping frequent to retain your milk supply up for when baby can eventually latch onto the breast.
So, it’s all down to your personal situation and preference. I would definitely say if you’re not sure, ask your midwife or a feeding advisor because they’ll be able to assess your personal circumstances and make suggestions.
Would your advice be to buy a breast pump before or after you’ve started your breastfeeding journey?
It completely depends how you imagine your breastfeeding journey going. If you’re planning to breastfeed, it’s still advisable not to pump in those first few weeks while you're establishing your breastfeeding. It may be that you want to wait and see how your breastfeeding is going first and then you choose to buy a pump if you’re happy with how it’s going and you’re looking to get back to an exercise class you love or something, in which case you’d want to introduce the bottle.
Other people like to be really organised and think right, I know I have to go back to work when baby’s 3 months old but I absolutely want to breastfeed, that’s the pump I want. Then go ahead and buy it before.
There’s no right or wrong answer, it just depends on your personal preference.
Jumping back to the right time to introduce a bottle to baby, is your advice the same regarding soothers and dummies, should I wait 6 weeks before introducing these?
I would say, yes. I used soothers with both of my daughters and I breastfed them both until they were toddlers – there were no problems. I’d definitely wait until breastfeeding is properly established, just so you know. That first period of time (approximately 6 weeks) while you’re waiting for breastfeeding to be established, try and keep it to just you and your baby. Putting them to the breast and letting it all settle down because you don’t want to give baby a soother at that point and mask cluster feeding because that could knock your milk supply. You just want to make sure that everything is going well with breastfeeding first – you’re confident baby is latching on, they’re gaining good amounts of weight, you’re not getting sore and milk supply is regulated, if you choose to introduce a soother at that stage, that’s absolutely fine.
Thanks so much, Zoe!