Feeding your baby

The Rotunda Hospital Dublin
Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D

UNDERSTANDING BREASTFEEDING

The Rotunda Hospital recommends breastfeeding because it is the best start in life for babies. We are accredited as a ‘baby friendly’ hospital, which means that we provide care, which is researched based and recognised as best practice, so that pregnant women and new mothers receive the support they need to breastfeed successfully.

We support informed decision making for women and we will support mothers whatever decision they make about feeding their baby. It is not necessary to make this decision until after you have held your baby skin to skin after birth. We recommend that you take the time to read through this section and discuss any questions you may have with your midwife or doctor.

You will hear lots of opinions and stories about other people’s feeding experiences. While much of the advice and information you get from friends and family will be very useful, some of it may confuse rather than guide you. In this section we aim to give you the information that you need to help you decide what is best for you and your baby.

If your baby is born prematurely or is unwell then it will be vital that you provide breast milk for your baby. You will be advised and supported by the midwives on how to establish and maintain your milk supply.

How breastfeeding works

The first milk your breasts produce is called ‘colostrum’. This milk is ideal for your baby for the first few days. It is made in small quantities so your baby will feed frequently, which is perfectly normal. The more your baby feeds the more milk you will produce. As well as providing nutrition for your baby,Colostrum contains large numbers of antibodies and an abundance of other molecules that helps your baby to fight infections. 

After about three days your breasts may become engorged. They may feel heavy and full. This is normal and is due to an increase in the blood and milk supply to your breasts. It usually settles within 24 – 48 hours with frequent feeding and if necessary by using cold compresses on your breasts between feeds. Sometimes when this happens you may have to hand express to soften the areola (area around the nipple) so that the baby can attach properly to the breast. 

When your baby is feeding effectively at the breast, at the begining of the feed the milk is higher in water and carbohydrate and lower in fat content. After the first “let down” and as the feed progresses the fat content increases. 

It is important that you don’t restrict how long your baby spends feeding. Babies will vary the length of their feeds. Just like us, they may fancy a quick snack or will want to settle in for a full three-course feast! Offer your baby the second breast when baby stops feeding effectively with long deep bursts of sucking and swallowing. Always offer your baby the second breast although they may not take it. Offering the second breast increases your milk supply. The more milk baby removes, the more milk you make. Throughout a breastfeed your baby’s sucking will send messages to your brain to ‘order’ milk for the next feed. 

Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D

BREASTFEEDING IN THE EARLY DAYS

If there is a medical reason why you cannot give your baby skin to skin contact immediately after birth, your partner can hold your baby skin to skin. If you have a caesarean section under general anaesthetic, skin to skin contact can start when you are alert and awake. Babies that require non emergency transfer to the neonatal unit will be given skin to skin contact and an opportunity to breastfeed before transfer. Babies requiring immediate transfer to the neonatal unit can have skin to skin contact as soon as their condition improves. 

Baby led feeding means that no restrictions are placed on the frequency or duration of breastfeeds for healthy babies. If there is a medical reason why your baby needs scheduled feeding, this will be discussed with you. Your baby is likely to want to feed frequently, and it is important that your baby feeds a minimum of 8 times in 24 hrs in fact your baby may want to feed  10 to 12 feeds  in 24 hrs,this is normal in the early days. 

Signs your baby wants to breastfeed

Your baby will usually give you plenty of warning when they want food. 

Early signs to watch for are when your baby: 

  • Eyes fluttering 
  • Moving their hand to their mouth
  • turns its head looking for the breast
  • opens its mouth and puts out its tongue. 

After these early signs your baby may then start to: 

  • make noises; 
  • cry loudly. 

Responding to early feeding cues allows your baby to navigate and latch to the breast in a quiet alert state. When you see these early signs, it is a good time for you to prepare for feeding by going to the bathroom, have a glass of water at hand and make yourself comfortable. Babies cry for lots of reasons not just for feeding. In time you will recognise your own baby’s signals and what they mean. Sometimes to get your baby ready to feed you may have to calm and comfort them first. 

Putting your baby to the breast

It is important that you find a comfortable position. If you are sitting down to feed, try to make sure that: 

  • your back is well supported; 
  • your lap is almost flat; 
  • your feet are flat on the ground Or supported on a foot stool/other support; and 
  • you have extra pillows to support your back and arms or to help raise your baby to the level of your breasts. 

Breastfeeding lying down can be very comfortable and handy if you have had a caesarean section and for night feeds. Lie on your side with a pillow supporting your head and back, with another pillow between your legs. Once your baby is feeding well, you will be able to feed them comfortably anywhere without needing pillows. 

Laid back feeding or biological nurturing is a lovely natural position that enables baby’s feeding reflexes to engage. 

feeds. Lie on your side with a pillow supporting your head and back, with another pillow between your legs. Once your baby is feeding well, you will be able to feed them comfortably anywhere without needing pillows

Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D

YOUR BABY'S POSITION

There are various ways that you can hold your baby for breastfeeding. Whichever way you choose, here are a few guidelines to help make sure that your baby is able to feed well: 

  • Hold your baby close to you. 
  • Baby should be facing the breast, with head, shoulders and body in a straight line. 
  • Baby’s nose or top lip should be opposite the nipple. 
  • Baby should be able to reach the breast easily. 
  • Remember always to move your baby towards the breast rather than your breast to the baby. 

Attaching your baby to the breast

It is important to make sure that your baby latches onto the breast correctly, otherwise, baby may not get enough milk during the feed and your nipples could become sore. 

Position your baby with their nose or top lip opposite your nipple. Tease the baby with the nipple in a downward direction. Wait until the baby opens its mouth and guide the baby onto your breast so that its lower lip touches the breast as far away as possible from the base of the nipple. This way, your nipple points towards the roof of your baby’s mouth. In the laid back position there is very little guidance needed,a term alert baby navigates the breast instinctively in this position. When your baby is properly attached to the breast you will notice that:  

  • your baby’s mouth is wide open and they have taken a big mouthful of breast tissue; 
  • Your baby’s cheeks are full 
  • your baby’s chin is touching the breast; 
  • your baby’s bottom lip is curled back; 
  • feeding should not hurt you; 
  • if you can see any of the areola (the brown skin around the nipple) more should be visible above the baby’s top lip than below its bottom lip; and 
  • your baby’s sucking pattern will change from short sucks to long deep sucks with pauses. 

Feeding should not be painful. If you feel some tugging when the baby first attaches to the breast, this sensation should fade quickly and then the feeding should be comfortable. 

If it is uncomfortable throughout the feed, this can mean that your baby is not attached properly. Remove the baby from the breast by: 

  • placing the tip of your little finger into the side of the baby’s mouth so that the suction is broken. 

You can then help your baby to reattach correctly. If the pain continues, ask a midwife for help. 

Tips for successful breastfeeding

  • You and your baby will have skin to skin contact after birth. This is a great opportunity for your baby’s first breastfeed. 
  • ‘Rooming in’ is hospital policy. This means that you keep your baby near you throughout your stay in hospital so that you get to know your baby and their feeding cues. 
  • Good positioning and attachment. 

Breastfeeding support while in hospital

The midwives will assist you with breastfeeding while you are in hospital. Make sure that a midwife checks that your baby is positioned correctly and is well attached to the breast during your stay in hospital. The lactation midwives are available in the hospital Monday to Friday. The midwives on the wards will contact them if special assistance is required. Once you are discharged from hospital you may ring the lactation midwives for support by phoning 01 817 1700 or you may attend the breastfeeding support group sessions held weekly. 

Patterns of breastfeeding

Responding to baby’s feeding cues is critical to long term milk supply. Responsive feeding also helps your baby to feel secure and has positive effects on their long term eating behaviours. 

Babies feeding patterns vary enormously and it is normal for them to feed very frequently in the first few weeks. If you just feed your baby whenever they are hungry, you will produce plenty of milk to meet their needs. This is called ‘demand’ feeding. Each time your baby feeds, messages are sent to your brain, which then sends signals to your breasts to produce more milk.  

If your baby does not breastfeed at least eight times in 24 hours, you may notice that you do not produce enough milk to meet your baby’s needs. Therefore, whenever your baby is hungry put them to the breast. If your baby has been fed and is still unsettled, check if the nappy needs changing or if your baby just wants a cuddle or to be soothed. If none of these settle your baby then offer them another breastfeed. 

More feeding = more signals = more milk 

Each time your baby feeds, the milk supply is being built up. While your baby is learning feeds may last quite a long time. Many mothers worry that frequent feeding means that they do not have enough milk to feed their baby. Providing that your baby is properly attached to the breast, this is very unlikely to be the case. Ask the midwife if you are unsure. Once you and your baby are used to breastfeeding, it is usually very easy. The milk is always available at just the right temperature. In fact, there is really no need to think about it at all. Your baby lets you know when it is time for the next feed. 

How do mothers know if breastfeeding is going well?

Breastfeeding is going well when your baby: 

  • is alert and waking for feeds; 
  • has a minimum of six wet nappies, yellow and seedy in consistency, and four soiled nappies every day after the first week; 
  • is gaining weight after the first week; 
  • settles and sleeps between feeds; and 
  • your breasts or nipples are not sore. 

Looking after yourself

It is important that you rest, eat well and drink for your thirst. Avoid alcohol and limit how much caffeine you take in drinks like coffee, cola and tea. 

Breastfeeding is nature’s way of making you take it easy for the first few weeks after the birth. This is good as your body undergoes huge changes in the days following the birth and lots of rest will help you to recover. 

Try to have as much help around as you can. If you have other children, arrange relatives and friends to help you with them. 

Your partner will have the job of caring for you while you feed your baby. They can spend plenty of time with your baby between feeds while you are resting. 

There will be no shortage of nappies to change or cuddles to give your baby. It is a good idea to have the freezer stocked with meals and foodstuff before the baby arrives making it easier for you and your partner. 

While you may be excited to introduce your precious new baby to all your family and friends it is actually a good idea to keep visitors to a minimum for the first week or so. Newborn babies do not like being over-handled and can become upset and fretful if passed from one person to another. 

Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D

CONTINUING TO BREASTFEED

Growth spurts

Babies grow all the time. However, they do have growth spurts, which occur around three, eight and 12 weeks. At this time the baby feeds more often and this increases your milk supply. This usually lasts for about 24 – 48 hours and then the feeding pattern returns to normal.

Reasons for expressing milk

You may want to express milk if:

  • your breasts are too full for the baby to attach;
  • your breasts feel full and uncomfortable;
  • your baby is too small or sick to breastfeed; or
  • you will be away from your baby for more than an hour or two.

You can express milk:

  • by hand;
  • using a hand pump; 
  • using an electric pump.

Whichever way you choose, when you express your milk it may take a minute or two to start flowing. Milk can be continuously expressed from one breast only for a few minutes before the supply slows down or appears to stop. Milk should then be expressed from the other breast, then go back to the first breast and start again – about ten minutes on each breast altogether. Keep changing breasts until the milk stops or drips very slowly.

When expressing, you can encourage your breast milk to flow by trying some of the following.

  • Try to be as comfortable and relaxed as possible. Sitting in a quiet room with a warm drink may help.
  • Have your baby close by. If this is not possible have a photograph of your baby to look at instead.
  • Have a nice warm bath or shower before expressing, or apply warm flannels to your breasts.
  • Gently massage your breast. This can be done with your fingertips or by rolling your closed fist over your breast towards the nipple. Work around the whole breast, including underneath. Do not slide your fingers along your breast as it can damage the skin.
  • After massaging your breast gently roll your nipple between your first finger and thumb. This encourages the release of hormones, which stimulate your breast to produce and release the milk.

As you get used to expressing your milk you will find that you do not need to prepare so carefully. Just like breastfeeding, it gets easier with practice.

Hand expressing

This is a free and convenient way of expressing milk and is particularly useful if you need to relieve an uncomfortable breast. These instructions are a guide but the best way to learn is to practice so that you find what works best for you. With practice it is possible to express from both breasts at the same time.  We encourage all breastfeeding mothers to learn how to hand express before their discharge from hospital.

Techniques for hand expressing

Each breast is divided into around 15 sections, each with its own milk ducts. It is from these ducts that you express the milk. It is important that you rotate your fingers around the breast to ensure that milk is expressed from all the lobes.

  • 1 Place your index finger under the breast at the edge of the areola, and your thumb on top of the breast opposite the index finger. You may be able to feel the milk ducts under the skin. If your areola is small, you may need to move your fingers away from the edge of the areola. Your other fingers can be used to support the breast.
  • 2. Keeping your finger and thumb in the same places on your skin, gently press backwards towards the chest wall. Press your thumb and finger towards each other, moving the milk towards the nipple.
  • 3 You should not squeeze the nipple, as this is not effective and could be painful. Be careful not to slide your fingers along the breast as this can damage the delicate breast tissue.
  • 4 Release the pressure to allow the ducts to refill.
  • 5 Repeat steps 2 and 4.

Once you have a good technique steps 2 and 4 take no more than a few seconds. You are then able to build up a steady rhythm. This results in the milk dripping and perhaps spurting from the breast

Pumps

There are a number of different pump designs; some are operated by hand, some by battery and some are electric. They all have a funnel that fits over the nipple and areola. It is important both for comfort and effective milk removal that flange size is the correct fit for you,please ask for advice re same. 

Electric pumps

Electric pumps are fast and easy because they work automatically. They are particularly good if you need to express for a long period, for example if your baby is in the neonatal unit. If this is the case, then you should try to express  within the first hour of your baby been born and a minimum of eight times. 

It is recommended to massage the breast prior expressing and always hand express for a couple of minutes at the beginning and the end. It is possible to express both breasts at the same time using some electric pumps that have a dual pumping set. This is quicker than other methods and may help you to produce more milk. If you are expressing your milk because you baby was born prematurely or you are separated from your baby you will be given an expressing pack and guided by your midwife on technique. Please also refer to “expressing breast milk for a premature or ill baby”on HSE website or booklet  available in the Hospital. 

Follow the manufacturer’s instructions very carefully if you use a pump. Whichever method you choose, it is important that you wash your hands thoroughly before you start. You must wash all containers, bottles and pump pieces in hot soapy water before you use them, and you must sterilise them if your baby is very young, in hospital or if you are sharing equipment. 

Storing breast milk at home

You can store breast milk in the coolest part of a fridge (not in the door) at a temperature of 2° – 4°C for up to five days. If you do not have a fridge thermometer, it is probably safest to freeze any breast milk that you do not intend to use within 24 hours.  If your baby was born prematurely or is in the Neonatal unit  breast milk showed not be stored in the fridge for longer than 48 hours. You can store breast milk for one week in the ice compartment of the fridge, up to three months for a premature baby in a drawer freezer or for six months in a chest freezer. If you have a self–defrosting freezer, store the milk as far away as possible from the element. 

  

When freezing breast milk for occasional use at home, you can use any plastic container provided it has an airtight seal and you can sterilise it. Remember to date and label each container and use them in date order. If you are expressing breast milk because your baby is premature or ill, ask the staff who are caring for your baby for advice about storage containers and how to store your milk. If your baby is in the neonatal unit you will be provided with small sterile bottles. 

You can thaw frozen breast milk slowly in a fridge. Standing the container in warm water will also thaw frozen milk. You can store thawed breast milk in a fridge and use it for up to 24 hours. Once it has warmed to room temperature, you should either use it or throw it away. 

You should never refreeze breast milk. Don’t defrost breast milk in a microwave because it may heat up unevenly and your baby could then burn their mouth on a hot spot. 

Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D

BREASTFEEDING SUPPORT GROUPS

In the Rotunda we have a breastfeeding support group, which usually meets every Thursday morning at 11.30 am but please ring to confirm that the session is going ahead. If you have any problems with feeding at home the lactation midwife in the hospital is only a phone call away at 01 817 1700, Monday to Friday.

There are community support groups in your area and meetings are usually held in the local health centre. Your public health nurse will tell you the date and time.

For further information and support, please contact:

La Leche League in Ireland  www.lalecheleagueireland.com
Cuidiú Irish Childbirth Trust  www.cuidiu-ict.ie

Friends of Breastfeeding  www.friendsofbreastfeeding.ie

HSE Breastfeeding Support Network www.breastfeeding.ie

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CLEANING AND STERILISING EQUIPMENT

It is very important that you clean and sterilise all the equipment you use to feed your baby. Cleaning and sterilising remove harmful bacteria that could make your baby sick.

Cleaning

  • Wash your hands well with soap and warm water. Dry them using a clean towel.
  • Wash all feeding equipment well in hot soapy water.
  • Use a clean brush to clean the inside and outside of the equipment to make sure you remove any leftover milk from the hard-to-reach places.
  • Rinse well in clean running water.

You can use your dishwasher to clean feeding equipment provided it is dishwasher proof. Dishwashers do not sterilise feeding equipment.

Sterilising

Sterilise the clean feeding equipment before you use it, using one of these methods.

  1. Steam 

    This is the best way to sterilise feeding equipment. You can buy plug in sterilisers or microwave sterilisers. Always follow the manufacturer’s instructions.

 

  1. Boiling water

    Fill a large saucepan with tap water (as long as the tap water in your area is safe) and completely cover all the equipment. Make sure there are no trapped air bubbles. Cover the saucepan with a lid and bring to the boil and boil for at least three minutes. Make sure the feeding equipment is fully covered with boiling water at all times. Keep the saucepan covered until you need to use the equipment.

 

  1. Chemical steriliser

Make up a batch of sterilising liquid following the manufacturer’s instructions. Make sure all equipment is completely covered by the liquid and that there are no trapped air bubbles. Leave the equipment covered for the length of time stated on the instructions.

Storing sterilised equipment

You will need to wash your hands and assemble any equipment immediately to keep the inside sterile. Store the equipment in a clean place. If put together correctly it will be safe for use for 24 hours. If not used within 24 hours, you should sterilise it again.

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VITAMIN D SUPPLEMENTS FOR ALL BABIES

Vitamin D is important for healthy bone growth and to prevent certain diseases. It helps lay down calcium in your bones and control calcium levels in your body. Babies must get enough vitamin D in the first year of life when there is rapid bone growth. Babies with very low vitamin D levels can develop rickets – a disease where the bones become soft and weak. Children with rickets have bowed legs and arms as well as other bony changes. Adults with low vitamin D levels can also develop weak bones. Vitamin D may also have a role in preventing some chronic (long-term) illnesses.

Vitamin D comes from the reaction of sunlight on your skin during the spring and summer months. However, you should not expose babies under six months of age to the sun, in an attempt to boost their vitamin D levels or for any other reason, because their new skin can burn easily. Furthermore, babies will not be eating the vitamin D rich foods (oily fish-salmon, mackerel, sardines; whole eggs, liver and some fortified milks and breakfast cereals) in large enough amounts to meet their needs for vitamin D during the first year of life.

For these reasons, all babies, both breastfed and formula fed, should be given vitamin D drops containing 200 IU (5 μg) of vitamin D from the first week of life until they are at least 12 months old. Once your baby is over 12 months you should offer them a variety of foods and drinks containing vitamin D or continue giving them vitamin D drops.

Vitamin D drops for infants are available at most pharmacies. Remember, it is as harmful to take too much of any vitamin as it is to not take enough. Always read the instructions before using any supplements. If you have any questions please ask your doctor, midwife, public health nurse, dietitian or pharmacist.

The names and doses of vitamin D drops available in your local pharmacy are listed in the table below. For the most up to date information on vitamin D, please see the HSE website: http://www.hse.ie/eng/health/child/vitaminD/

 

Name of Vitamin D Supplement Supplier Amount of product to give one dose of 5µg vitamin D each day How to give vitamin D to your baby
Abidec Vitamin D3 Drops Chefaro Ireland, Ltd. 5 drops 5 drops on a baby spoon and then place into baby’s mouth
Baby D KoRa Healthcare Ltd. 0.2 ml of liquid 0.2 ml of liquid using the syringe provided, and place into baby’s mouth
BabyVitD3 Drops Shield Health Ltd. 2 drops 2 drops using the dropper provided, and place into baby’s mouth
BabyVitD3 Pump Shield Health Ltd. 1 pump of liquid 1 pump of liquid onto a baby spoon and place into baby’s mouth
Baby Vitamin D3 Drops Beeline Healthcare 0.5 ml of liquid 0.5 ml of liquid using the dropper provided, and place into baby’s mouth

More information on feeding your baby can be found on this website: www.indi.ie/fact-sheets/fact-sheets-on-nutrition-for-babies-children.html

Understanding breastfeedingBreastfeeding in the early daysYour baby's positionContinuing to breastfeedBreastfeeding support groupsCleaning and sterilising equipmentVitamin D