How to Breastfeed: Interview with Olivia Hinge
As part of World Breastfeeding Week, we've been looking at feeding and lactation to help provide useful advice and insights for new parents about to start their baby feeding journey. That's why we wanted to speak with midwife and lactation consultant, Olivia Hinge.
For anyone who isn't aware of who Olivia is and what she does, Olivia is a mum of two and, having breastfed both her children, she knows from experience the kind of ups and downs that can come up through your breastfeeding journey. She draws upon her experience and education as a lactation consultant to provide lots of handy advice and content on her Instagram page. So, we were thrilled to chat to her about some of the most commonly asked questions and concerns when it comes to this topic.
Watch the interview or scroll down to read the full transcript.
IB: What advice would you give to expectant mums who are planning to breastfeed?
Olivia: Things like birth plans are really big. People love writing them. We do loads of research but things like the postnatal period and how we’re going to feed our baby we tend to just think, oh – that’ll just happen – and we don’t really think about it. So my biggest piece of advice is to put as much time and effort into your postnatal period planning. Ask yourself, how might I get help if I need it? Where could you find it? Talk to your loved ones and people closest to you about whether breastfeeding means a lot to you and discuss how you might want them to support you as well.
Someone saying, “just pump and I’ll bottle feed the baby for you”, may not be the best and easiest route for someone who wants to breastfeed. Actually saying to them, I’d love it if you could come around and hold the baby for a contact nap for me or if you could do some cleaning or bring some food for us. It’s working out your postnatal landscape and making sure before your baby arrives, you know where you can get help with infant feeding. Whether it’s going to be privately accessed or via the NHS. With the NHS, how do you access it? Do you have a self-referral system or does a healthcare professional need to refer you? Explore charities like the Association of Breastfeeding Mothers or The Breastfeeding Network. Do they or something similar have any infant feeding cafes near you?
Also consider creating a virtual village as well. Lots of us may not know someone who’s breastfed or we might feel like we don’t necessarily ‘look like’ someone who breastfeeds. You could be thinking, I don’t know anyone else who’s done this so is it wild for me to think I can do it? Not at all.
Looking to social media for Facebook support groups or following people on Instagram and connecting with other mums in the comments or in a forum can really help you think, actually there is no one type of person that breastfeeds. It’s just one of those things that our bodies are built to do. So, planning for your postnatal period is really important.
I think also, everywhere in the UK, it’s very variable in terms of what support is available. Some places have amazing support and others not so much. You’ll find that breastfeeding is really sold to you as a new parent and then it can be a bit like, okay yes, great you’ve had a baby – see you later. Often there isn’t that support and a lot of women can feel like they’re failing because they haven’t managed to do what they wanted to do when it comes to feeding their baby. I think that’s so unfair.
I talk a lot about the fact that people don’t fail in breastfeeding. You are failed by society and by our healthcare system. There’s very little consistent, evidence-based support that’s accessible via the NHS in the UK.
Skipping back to preparing to breastfeed, harvesting colostrum is one thing that could be a practical way to prepare. What would your advice be on that?
I love colostrum harvesting. Just to explain what that term means, colostrum is that very first milk that baby drinks and it’s available in the breasts from around 16 weeks of pregnancy. Lots of people have no idea it’s there, it doesn’t leak or anything like that but your body will have been preparing for baby.
From 36 weeks in a low risk pregnancy with a singleton, so not twins or multiple babies, you could discuss with your midwife or obstetrician whether they think harvesting colostrum would be a safe idea for you. If so, you can hand express the colostrum and store it in a little oral syringe and put it in your freezer.
So I always think that the colostrum is a little bit like concentrated squash. Your milk ‘coming in’ (usually between days 2-4) is like adding the water so suddenly the volumes are very big. We’re quite happy for babies to have very little colostrum. It’s very little and very frequent in those first few days. Because it’s so rich in antibodies and immunological factors, we see the importance of baby just having that but we also need the volumes to increase around day 2 to 4. Sometimes if babies are very sleepy or your milk is delayed coming in, they may need extra milk in that time. It might be that baby has their blood sugar levels monitored if mum has diabetes or has had certain medications. So rather than instantly reaching for formula, if you’ve harvested colostrum – you’ve got that skill immediately to be able to hand express more for your baby and/or you might have more in your freezer that you can also give your baby. It’s not to say that formula is a really bad thing, that’s not true. For lots of babies it can be lifesaving but what happens sometimes is, we give formula in very large amounts that the baby wouldn’t receive at the breast, which makes them sleep longer and go to the breast less and it can start this really tricky cycle of giving these top-ups of formula and that’s where we find that people really struggle to establish their milk supply because we’ve started that cycle of formula giving.
So I always refer to harvesting colostrum as a little bit like an insurance policy. The likelihood is if you’ve done it, you’re not going to need it but it gives you this confidence and empowerment to go, do you know what, my body’s actually preparing for something that I have no idea if I was going to or wanted to do but my body’s doing it!
In terms of establishing an effective latch, once this has been established, should this eliminate any kind of breast/nipple discomfort?
That’s a really good question as pain is one of the leading causes for people stopping breastfeeding before they want to. I don’t think it’s realistic to say, breastfeeding is not going to be uncomfortable or that if you feel any pain, you’re doing it wrong. I just don’t agree with it as I think our nipples are very sensitive, delicate areas that haven’t really had any exposure to life!
So when your baby goes to the breast, your nipple is going to travel across their hard palate (the bony roof of their mouth) to the soft, sweet spot right at the back where their soft palate is. It’s close to the gag reflex area if you want to feel it on yourself. So as your nipple for the very first time is being stretched two or three times in its length across the bony palate, I would expect there to be a toe-curling ooh, that’s uncomfortable BUT within 30-40 seconds, it should be like, oh – that pain has totally gone. There shouldn’t be any pain or pinching and just a really strong sensation of suction.
Some people find that really strong suction quite intense. I personally found it really intense. It wasn’t uncomfortable, it wasn’t painful but it was an intense sensation. I think it’s really about tuning into yourself and what you’re feeling to say actually, is there a problem?
When your baby comes off the breast, look at your nipple and check, is it the exact same shape as it was before but longer? Or is it now like a wedge or a new lipstick shape? Or does it have a crease along it? These are signs that perhaps you’ve got a shallow latch. That the nipple is being squeezed and compressed against the bony roof of their mouth.
The deep latch is like they’re sucking from inside you. It feels really intense and very strong and deep. That can sound quite daunting to people but it’s not that icky feeling some people get when they touch their own nipple, it’s very different to that so don’t be put off if you don’t like your nipple being touched or anything. It’s totally different.
For the mild nipple discomfort that you refer to, what would you recommend for easing that?
If you’ve got discomfort, you’re not alone. A lot of people get cracks and trauma on their nipple, that’s very common. It’s a sign that we need some help with the positioning and attachment. Usually it’s millimetre tweaks on something; just the way you’re holding baby or something like that. So the first step is get some skilled help. Get someone who knows what they’re doing to double check your latch and positioning. Have a look on Instagram, there’s loads of accounts that show real life videos of what a deep latch should look like and how to get that.
I’ve got a latch highlight on my account with real life babies, which can be really helpful for people. You can buy creams and stuff. I’d be very cautious of a very greasy cream. Most people buy a lanolin cream but actually, lots of people are allergic to it and it so it can make their nipple pain worse. Also, it’s incredibly slippery so even a tiny bit of a baby will mean you put your baby on at a deep latch but because it’s so slippery, they can really quickly slip down to a shallow latch because of this cream. If you can, try and find one that’s lanolin free or what’s seen as one of the most effective ways of helping painful nipples is hand express a little bit of breast milk onto your nipple and let it air dry. Or there are some nipple compresses. They’re like a moist bandage that you can buy from most places.
Again, the most important thing is to get some help to try and resolve what is actually causing the pain.
When it comes to knowing how much milk baby is getting, how can you gage this?
In the UK, we don’t normally weigh babies until between day 5 and 8. It coincides with their heel prick test. Of course, weight gain is going to be our most important thing. We expect babies to lose weight initially but we don’t want them to lose more than 10% but then we should regularly see our midwife or health visitor and get our baby weighed. They’ll put in the back of the red book or a red book app, the centiles and they should be plotting your baby’s growth against those.
In those early days, there’s a UNICEF breastfeeding mother’s checklist available online here. What that will give you is for each day, however old baby is, how many wees and poos to expect from your baby. That’s really, really important.
In those early days when your brain is absolutely fried and you basically don’t know your arse from your elbow, writing down how many feeds in 24 hours is having and how many wees, how many poos, and really importantly, what colour is that poo? Because we’re going from that black, tar like meconium to a very liquid (can be explosive) yellow poo. We really want to be at that liquid yellow poo by about day 5 or day 6.
So, pre weigh-in we’re looking at wees and poos. After this, it’s wees and poos with expected weight gain and tracking centiles afterwards. This will be the job of your health visitor after you’ve been discharged by the midwife. Up to about day 10-14, most people are with their midwife first.
If someone is struggling to harvest colostrum, what do they do in between baby being born and their milk coming in?
If you’re struggling to harvest colostrum in the pregnancy, I’ve got a video on my Instagram grid all about how to do it. You can always ask your midwife as well. It might be a slightly more unusual request but a community midwife is very used to showing someone how to hand express. If it’s once your baby has been born, your midwife will happily help you and have the time to be able to do that.
If you’ve struggled to hand express in the pregnancy, when you’ve had your baby, even if baby goes straight to the breast and feeds well, you should quickly say to your midwife – can you just show me how to hand express? If you’re happy to, the midwife is very happy to wear gloves or wash their hands and actually show you the pressure and the direction on your boob. They can either put their fingers over your fingers if you don’t want them touching you or they can show you the pressure and the direction and then you’ll see. We shouldn’t be moving our fingers. Our fingers stay in the same place on the breast and it’s the direction and pressure that changes.
What’s the safest way to defrost colostrum from the freezer?
Because it will be stored in 1ml syringes, they’re very long thin tubes. You can put them in your hand; under your armpit or in your pocket and it will defrost within 15 minutes. You can always run it under a warm tap and it will defrost really quickly.
Moving onto post-birth, how can you encourage milk flow within the early days?
Within the first 2 weeks, we have this golden window to turn on as many milk making cells in our breasts as possible. That stretches to 6 weeks but those first 2 weeks are really, really important. So you want baby to go to your breast really frequently. We want at least 8 breast feeds in 24 hours. That’s generally for the first 6 months of their life. You also want to establish a really effective latch.
When we talk about latch, I mean the way in which the baby’s mouth and body is positioned to your body and the way in which their mouth goes to the breast. It shouldn’t just be sitting on the nipple, it’s actually breastfeeding so you’re looking for a big, wide mouth. Your midwife should be able to help you get the latch and positioning really good.
If we have a deep latch, your baby’s mouth is asymmetrical at the breast. Their bottom lip is much lower on the breast and their head is tilted back (Olivia mimics the position with her hands). That means for the effort that your baby puts into going to the breast, they get the maximum reward. If we are emptying the breast, we are requesting the body to make more. So the way our body makes more milk is by removing more.
If you’re having problems with a very sleepy baby or one that has tongue tie; they aren’t really efficient at the breast then hopefully your midwife will be supportive and encourage you to stimulate the breast more and empty it more. Whether that’s by trying techniques like pumping or switch feeding where we put baby to one breast then the other, switching over frequently, or hand expressing after feeds – there are lots of techniques that we can do but you really need someone skilled to help you. Looking at your whole picture and your baby to say, I think this might be our root problem, let’s try this for a bit and see if it addresses it.
Are there any foods that you would recommend for encouraging a strong milk supply?
There’s lots of anecdotal stuff and cultural stuff including certain foods people may want to eat to help with their milk supply. Nothing is going to beat an effective latch and frequently removing milk from the breast. If you enjoy the foods recommended – so if you love porridge, eat it but eating lots of porridge isn’t going to compensate for efficient breastfeeding.
And going back to routine, what do you have to say on this when it comes to breastfeeding?
In society, we seem to think a routine is really important. Actually, strict routines and scheduled feeds are really detrimental to breastfeeding. Always think of us and our babies as cave people. Would a cave woman have had somewhere to put her baby? No, she would’ve held her baby constantly. Would she have had a clock? No. She would’ve looked at her baby and said, I don’t know what’s wrong with you but you look hungry so I’ll whack you on my boob and hopefully that will solve the problem. And that’s what we should be doing to responsively breastfeed.
If we start stretching out feeds and making our baby wait longer, it can cause so many issues with weight gain, milk supply, contentment of your baby and be really stressful for you. One of the things people tend to say is, I’ve got to wait X amount of time for my breast to refill and it’s not true. A third of our milk supply always remains in the breast. It’s a little bit like the ice machine on a fridge. If you take ice out, more ice is made. And it’s exactly the same with the breast.
We also know that breasts that are emptied frequently produce higher fat milk so that reflects why babies might cluster feed. Cluster feeding is when they feed really, really frequently within the space of a few hours. That’s usually because they’re growing so they want fattier milk and they know what they need. So really trust that if your baby is growing well and your milk supply is good, trust them. If your baby is cluster feeding 24/7 then absolutely get help but cluster feeding once or twice a day for most babies is totally normal. If you’re worried though, check in with your health visitor or midwife.
So responsive feeding is the way forward, for the first few months, at least?
Yes, for the first few months. Some people then like routine and scheduling but I would always encourage you to look at your day as a whole. So you have your morning cup of coffee at the same time, look at what you’re doing to feel a sense of control. I know a lot of us modern women are like, I need to know what’s happening and I need to control it. Babies are very hard to control and it make us feel like we’ve lost our brains a bit!
It can be hard not controlling our babies but try to look at your daily rhythm that you and your baby do. You get up around the same time, you have your breakfast and a cuppa, you let the baby feed. Then you have a shower. Structure yourself rather than the baby – it’s usually a better way of going about it.
For anyone who might want to start introducing the bottle to be able to express their milk, what’s the earliest you would recommend doing this?
You hear a lot of the time people say, don’t do that pre 6 weeks. There’s a bit of yes and no to that. When our baby is first born, our body doesn’t know, are we producing enough milk for one baby or five babies? If we start expressing really early, our body will go wow, let’s go absolutely wild and you’ve got the potential to produce huge amounts of milk, which for a lot of people you think, brilliant – that’s what I want! All of my friends have stopped breastfeeding because they didn’t have enough milk when usually that’s not actually the case. It’s because they haven’t had any skilled help to work out what’s going on.
But having too much milk causes lots of issues for you and your baby. What I would say is you want to have a milk supply that’s established and enough for your baby. I would also say that you really want your baby’s latch to be good. You know that your baby can go to your breast and you’ve learnt your dance together and feel confident with the latch.
As you introduce the bottle, the bottle is a much easier way to receive milk and a baby can sit very shallowly on the teat of a bottle and basically just lie back and chill. Then they start to expect the same from the breast. We really want to be doing a paced bottle feeding technique, which I have a video on my Instagram account about, and if you are going to express, you’ve got your latch nailed. Your milk supply is good and you’re only expressing what your baby is going to drink.
Unless you’re returning to work or know you’re going to be away from your baby, absolutely do not try building a freezer stash early on because your body will go bananas! If you can wait 4-6 weeks, I would and then only really express what your baby needs.
I’m conscious we haven’t even scratched the surface of this topic but for anyone looking for help or advice on breastfeeding, where should they go?
On social media, there are loads of ‘parenting experts’ that have blue ticks and some of them have millions of followers. But actually, what’s their speciality and what are their qualifications? If you’re looking for advice and information on infant feeding, I personally wouldn’t take advice from anyone unless they’re a specialist. I’m an IBCLC (International Board Certified Lactation Consultant) so sort of your top tier of the lactation feeding stuff. You’ve got breastfeeding counsellors that are amazing; peer supporters or specialist midwives and health visitors. Do be critical of who you’re taking advice from and look at what their qualifications are. If they’ve got them, they’ll publicly state them so don’t get wrapped up in the number of followers or celebrities. A lot of big celebrities or influencers who’ve had children are brilliant at sharing their experiences, which are great for making people feel less alone but you can also think, she’s doing this so that means I should be doing that. Remember, it’s not always the safest or best thing to do for your baby just because they’re doing something one way.
Thanks Olivia. I know you have some amazing snippets of advice on your feed so please do give Olivia a follow @olivia_lactation_consultant.
For more advice on infant feeding, check out our article Breastfeeding: What do I need to know? which links to numerous expert-led resources.