World Breastfeeding Week: Q&A with Midwife May

Hi! I’m May, and I’m a midwife, Hypnobirthing and antenatal education teacher and recently became a mum to my first baby, Flora. I have been a midwife for 8 years and currently work in Jersey in the Channel Islands. I have spent my career working in all areas of midwifery, but for the past 4 years I have been working as a community midwife which I absolutely love! I feel particularly passionate about informed choice and advocating for women to ensure they remain at the centre of their pregnancy and birth. I was lucky to have a healthy pregnancy and home birth but experienced my own catalogue of breastfeeding challenges with Flora, and I can honestly say it was the hardest thing I have ever done! I think it’s helpful for women to know that breastfeeding isn’t always easy, but any amount of breast milk that you can give your baby is fantastic and so beneficial.

Your Breastfeeding Frequently Asked Questions Answered

How do I know if my baby has had enough?

All babies, regardless if they are breast or bottle fed, should be fed responsively. This means that you respond to their feeding cues and feed your baby as they demand. This can be a tricky idea when we are so used to living by routine, but babies generally do not have routines in the first few weeks and months of life. You can tell your baby has had enough milk if they spontaneously come off the breast, are satisfied and settled between feeds, if they are gaining weight steadily and have regular wees and poos. Your breasts should generally feel softer after a feed, and often you may even feel sleepier and more relaxed too due to the hormonal response during breastfeeding. During the first few days and weeks of life, babies can feed very frequently - perhaps hourly or even more - and this is perfectly normal. Many women worry this means they do not have enough milk, however this is usually not true and is often simply baby’s way of boosting your milk supply. 

Does it hurt to breastfeed?

Breastfeeding can feel tender in the first few days and weeks, however it should not be painful. If breastfeeding is painful, then it usually indicates that there may be an issue with the way baby is attaching to the breast. Never put up with a painful breastfeed, as it can make more problems in the long term. If you feel that breastfeeding is painful, please always seek support and guidance from your midwife or specialist lactation consultant. 

Do I have to alternate between breasts?

You should offer the second breast to your baby if they spontaneously come off the first breast and still appear interested in feeding. However, it is not necessary to alternate breasts during one feed - babies will often be satisfied by one breast during a feed. However, I would suggest then offering the other breast for the next feed to ensure that your breasts are equally stimulated. Some women use a hair band on their wrist to help them remember which breast they last fed from, or record it on an app. However, as the weeks go on, you will soon feel which breast to feed from as it will likely feel fuller and firmer than the other!

How often should I breastfeed in a day?

There is no set recommendation for how often you should breastfeed, as every baby is so different. You should feed your baby responsively - or whenever they demand. As a very rough average, most newborn babies will breastfeed at least 8 times in 24 hours but this can vary hugely and some babies will feed a lot more - which is very normal! Some breastfeeds will be short (for example 5 minutes) and you can think of this as a little snack or drink for baby. Other times the feeds will be long (for example an hour!) and this may be baby’s big three course meal! 

How do I know when baby is hungry?

Crying is always the last resort for a baby to tell you they are hungry. There are lots of other feeding cues that you can look for, including: baby moving their fists to their mouth, head turning as if they are looking for the breast, sucking on their hands or smacking their lips, and opening and closing their mouth. Offering the breast before baby starts crying is often less stressful for both of you!

Can you overfeed your baby?

Women often worry that babies who feed very frequently (which is entirely normal) are having too much milk. However, you can never overfeed a breastfed baby, so please don’t worry! Your baby will also never become ‘spoiled’ or demanding by you breastfeeding and comforting them. Bottle fed babies are more likely to be over-fed, as we may encourage them to keep drinking and finish a bottle when perhaps they are already full. If you are bottle feeding, I would recommend researching ‘paced bottle feeding’ to avoid this.

Does what I eat and drink affect breastfeeding?

The good news is that there are no foods that are off limits when you are breastfeeding - woohoo! However, it is worth noting that what you eat may affect baby in some ways. For example, you may notice that if you eat a very spicy curry then your baby may be a little windier the next day. You may find that you are super hungry and thirsty when breastfeeding - after all, it is hard work and calorie consuming! It’s therefore good to ensure you eat a healthy, balanced diet with lots of high-energy snacks and plenty of water. 

You can drink alcohol when breastfeeding, however it is worth noting that small traces of alcohol will pass through to your breast milk. This does not usually present a problem unless you are drinking very large quantities of alcohol. You do not need to express to clear your milk of alcohol and be aware that the level of alcohol in your milk will fall as the level of alcohol in your body falls. However, remember that your breasts may become uncomfortable and full if you leave long gaps between feeds, and therefore you may want to express for comfort. It is important to remember that you should never share a bed with your baby if you have consumed alcohol, as the risk of SIDS increases significantly. 

How do I know my baby has latched properly?

There are a number of ways to tell if your baby has attached to the breast correctly, and if they are feeding well. These include:

• The breastfeed is comfortable and pain free for you
• Your baby is held close to you, and in alignment with your body
• Your baby’s head is free to be able to move backwards, and their neck is gently supported 
• Your baby has a large, wide-open mouth that is attached to the breast tissue and not just the nipple
• Your baby’s chin is touching your breast and their lower lip is rolled down (although this isn’t always visible, particularly in women with larger breasts)
• You can see more of your areola (the dark skin around your nipple) at the top of your baby’s lips, rather than below their lips
• You should be able to see and hear your baby swallowing; this usually starts with a few rapid sucks and then settles to slower, longer and more rhythmic sucks
• Your baby’s cheeks should stay rounded, and not hollowed, during a feed
• Your nipple should look the same after breastfeeding, and shouldn’t be flattened, pinched or white

It is always beneficial for a midwife or lactation consultant to simply watch you breastfeed in the first few hours and days after birth, and assess if baby has latched well at the breast. This can be hugely reassuring for you too. 

What should I do if baby doesn’t latch on easily?

It is important to say that not all women find breastfeeding easy and instinctive and many women do experience some breastfeeding challenges in the first few days and weeks. Research suggests that whilst many women initiate breastfeeding after birth, there is a sharp decline in those still breastfeeding at 3 and 6 months and this is often due to a lack of support during those first few weeks. Please always seek support and help from a midwife or lactation consultant if you are having breastfeeding difficulties, as often these difficulties can be overcome with correct support and advice in the early days. 

Skin-to-skin contact is a fantastic way of encouraging baby to relax and attach to the breast spontaneously, and there are so many benefits of skin-to-skin contact in the first few days and weeks of life. In the first few hours and days after birth, you may be encouraged to hand express your colostrum into a syringe and this can be dropped into your baby’s mouth if they are reluctant to latch to the breast. Hand expressing colostrum can reduce the likelihood of your baby having formula in the first few days of life. 

What does it mean to express?

Expressing milk involves using your hands or a breast pump to remove breast milk from your breast, which is then usually given by bottle at a later date. Hand expressing colostrum after 36 weeks of pregnancy is a great way to build a small supply of colostrum for your newborn baby in the first few days of life. Hand expression can also be useful in the first few days after birth. However, we wouldn’t recommend using a breast pump to express breast milk for at least the first 6 weeks after birth as doing so can interfere with your body establishing its milk supply. Despite this, there may be times when it is clinically recommended or necessary to express earlier than 6 weeks, and this should be discussed with your midwife or lactation consultant.

When should I stop breastfeeding?

The World Health Organisation recommend exclusively breastfeeding for at least 6 months after birth, and state that there are continued benefits of breastfeeding for up to two years after birth. However, I think the decision to stop breastfeeding is an entirely personal one and there is truly no ‘right’ or ‘wrong’ time to stop breastfeeding. My favourite piece of breastfeeding advice is ‘never give up on a bad day’ and I told myself this numerous times during the really tough days with my own baby Flora. I would encourage all mums to continue breastfeeding for as long as they feel able to, and for as long as they want to. Every single breastfeed and drop of breast milk that you are able to give your baby has huge health benefits for both of you! There is a fine balance between supporting and encouraging women, but also not pressuring them and as midwives we should support and encourage informed choice at all times. 

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Disclaimer: This article is written by a qualified midwife but should not be taken as medical advice. If you are looking for specific advice or are worried about you or your baby please always seek medical advice from your doctor or health care provider. Remember every baby is different and not all advice will work for every mum or baby.