Whatever your birth options, your active participation is a big help in getting breastfeeding off to a good start. Making informed choices about where and how you give birth is the first step.
Even when medical concerns limit your choices, there may be more options available than your medical team shares with you. Take time to do research and discuss your preferences and choices with your birth partner. If you find you can’t give birth in your preferred place, you can still follow the suggestions on this page for helping birth go well.
Consider a birthing place where you can participate actively, whether you are having a vaginal or caesarean birth. Options may include giving birth in hospital, at home or at a birthing centre. Your choice may affect which midwifery team(s) care for you during pregnancy and labour. Think about giving birth supported by caring people you feel comfortable with. Follow your instincts to find a place where you can feel safe and private during and afterwards. If you feel stressed in labour, your body naturally produces ‘fight-or-flight’ hormones that may slow down labour and delay birth. If you feel in control, you are less likely to need unnecessary birth interventions that can affect breastfeeding.
Questions to ask
Which midwifery team(s) will be looking after me during my labour?
Will I be able to get to know the midwives beforehand?
Are options such as a low-tech birthing room or birth pool available, and how often are they used?
If I give birth at home or in a birthing centre, what will happen if I need to move to hospital?
Do the staff encourage labour in a variety of positions—for example, walking, standing, kneeling, kneeling while leaning forwards and holding on to something, or being on all-fours?
Will I be encouraged to hold my baby in skin-to-skin contact as soon as he is born and to continue to hold him afterwards as often and as long as I want?
Hospitals
A hospital that is a certified UNICEF Baby Friendly Hospital, or is working towards certification, will be implementing the UNICEF Ten Steps to Successful Breastfeeding programme. It’s a good idea to plan a hospital visit before making up your mind. The website www.birthchoiceuk.com also has information on options, including statistics on caesarean section rates. According to The World Health Organisation, caesarean rates of more than 15% do not make birth safer.
Who will support you? In addition to a midwife, many mothers choose to have their partner, friend or other family member as a birth companion. Some mothers employ a doula too. A doula is a trained, non-medical labour-support person who can support you and your partner at home during labour, in hospital and in the days after the birth.
Photo courtesy of Kimberly Seals Allers
Labour
It can help to think of labour as ‘work’, with each contraction bringing you nearer the birth. After spending nine months keeping your baby nourished and nurtured in your womb, your cervix has to change tactics and open up for the birth. You’ll feel your muscles working hard with the unfamiliar exercise. Most mothers can ease into an unmedicated labour which often has a wave-like natural rhythm. Breathing and relaxation techniques can be a very effective way of coping with the ebb and flow of contractions.
Ways to help labour go well
Preparation: talking to other mothers, reading and attending antenatal birth classes will help you feel more ready. Write down your birth preferences and discuss them with your midwife. But be prepared to go with the flow if your circumstances or feelings change. If you have older children make sure you have organized someone to care for them, wherever you plan to give birth.
Read about LLLGB’s Antenatal Breastfeeding Classes here.
Privacy: consider who you want around you during labour, and ask those supporting you to protect you from unwelcome visitors. In hospital, create your own privacy by treating the room as your space. Keep the door closed, bring your favourite music, your own pillow and wear your own clothes if possible.
Eat and drink when you feel like it, especially in the early stages of labour. This gives you more energy to manage your contractions, the birth and those amazing first hours after your baby arrives. Prepare for it to take time: labour gradually develops from the normal Braxton-Hicks ‘warm-up’ contractions of your uterus, into stronger contractions that usually become painful and harder to ignore. Some women find contractions stop and start over a period of days or even weeks.
Every labour is different, even if you’ve had a baby before. As labour progresses you’ll probably become more inwardly focused, concentrating on the work you are doing and less inclined to chat to the people around you. Your body will release natural pain-relieving endorphins. Towards the end you will feel like pushing.
Listen to your body: move around and change position when you are uncomfortable or if labour doesn’t seem to be progressing. Follow your body’s urges; lie on your side and rest if you feel tired; wander about or go outside for a walk if you feel like it. You’re not ill—and you don’t have to labour or give birth in bed. Lying on your back during labour generally delays birth and makes it all harder. It might also mean you need more pain relief medication which can interfere with breastfeeding.
Cutting the cord only after it has stopped pulsating reduces your baby’s risk of anaemia in the first year of life.
Labour interventions
Knowing beforehand about possible interventions will help you to ask questions and decide whether to accept what you are offered. You might want to discuss these possibilities with your midwife. However, in the unlikely event of an emergency, medical staff will need to take action quickly to ensure the safety of you and your baby but they will tell you what is happening.
Induction
What can happen: the drug syntocinon (artificial oxytocin) is used to induce or speed up labour. It produces stronger, and possibly more painful contractions than your own naturally produced oxytocin. This often leads to further interventions, such as pain relief medication, an assisted delivery or a caesarean section. What you can do: avoid routine induction if you and your baby are healthy. Consider whether there is a family history of ‘overdue’ babies. Review your dates, weigh up the risks and talk to your midwife about waiting a little longer to see if labour will start naturally. Some believe that having sex can help you go into labour.
Medications
What can happen: pethidine, epidural anaesthetics etc cross the placenta into your baby’s bloodstream. He may feel groggy and have difficulty coordinating latching on and sucking at the breast for up to two weeks after the birth. What you can do: Using non-medical pain relief such as water, massage, moving around and TENS can reduce your need for medical pain relief. If your baby is affected by medications, keep him in skin-to-skin contact as much as possible, even when he’s asleep. Use Biological Nurturing™ laid back breastfeeding positions so you can watch for baby feeding reflex cues like mouthing movements, lip twitches or sucking whilst asleep and help him take the breast. Until they are feeding well, frequently express drops of your colostrum directly into their mouth.
Intravenous (IV) drips
What can happen: IV drips are used for certain induced births and caesarean births. Fluid from IV drips may cause engorgement in the early days. This makes it difficult for your baby to latch on deeply at the breast and may lead to nipple damage. Their birth weight may also be higher from any excess fluid which they then lose in the first few days. What you can do: A few hours delay in weighing your baby may give a more realistic birth weight. Frequent feeds will help you avoid or reduce engorgement as your milk volume increases. To relieve engorgement, soften your breast by gently pressing swelling away from the nipple with your fingers (a technique known as reverse pressure softening). You can also hand express some milk.
Birth interventions
Episiotomy and assisted delivery with forceps or ventouse
What can happen: cuts and tears that need stitches may make sitting upright uncomfortable in the days after birth. Forceps or ventouse delivery can also leave your baby feeling sore, bruised and with a headache. What you can do: move around in labour and choose your own positions for the birth: kneeling while leaning forward, being on all-fours etc. When breastfeeding, use Biological Nurturing™ positions to get comfortable and to help your baby recover. These and side-lying positions also limit pressure on your baby’s head.
Caesarean section
What can happen: a caesarean is major abdominal surgery. You will take at least six weeks to recover from the birth and need help looking after your baby. Your baby may be affected by the anaesthetic (epidural or general) and be less able to feed well at the breast for the first few days. What you can do: Insist on skin-to-skin contact with your baby as soon as he is born. You could write this in your birth preferences beforehand, just in case. If a general anaesthetic is required, a family member can be present and hold your baby skin to-skin until you are able to, and help you hold him if you’re feeling shaky. Avoid any routine bottles—your baby can wait a short time for you. If possible reading our pages on caesarean birth and antenatal expression of colostrum before you go into labour. Biological Nurturing™ and side-lying positions can help you get comfortable whilst breastfeeding. Or try an underarm rugby hold.
Syntometrine injection
What can happen: once your baby is born, the placenta separates from the uterine wall. A routine syntometrine injection may be offered to assist this as many believe that this injection reduces the risk of excessive bleeding. Following a normal birth, few mothers need the injection. Side effects of syntometrine can include nausea or a headache, which may affect the early hours you spend with your baby. What you can do: discuss this intervention with your midwife when writing your birth preferences. Keep warm and undisturbed. Skin-to-skin contact with your baby and breastfeeding immediately after birth encourages oxytocin production. Oxytocin contracts your uterus so your placenta is expelled naturally.
Separation
Sometimes and for various reasons you may be separated from your baby following birth. Plan to be in close body contact with your baby as soon as possible as this is the best way to establish breastfeeding. Separation because of health concerns may make breastfeeding harder, but it’s still possible.
Hold, or at least touch, your baby immediately after the birth or as soon as you can. Once you are together again make up for lost time by spending as much time as possible snuggling together skin-to-skin or lightly dressed. If your baby is in special care you can still touch and stroke him and may be able to hold him against you in ‘kangaroo mother care’ for long periods of time. And if he can’t feed at the breast straight away then expressing your milk for him is important. Many mothers say that this is the single most important thing they have done while they are waiting to start breastfeeding.
The first 24 hours
Your newborn baby already knows your voice and smell—and you are their whole world. He needs to be in continuous close contact with you and to have your milk as soon as he is ready. Breastfeeding is known as the fourth stage of birth. Lean back with your baby snuggled up against you, skin-to-skin, in full body contact.
Avoid interruptions until after they have had their first breastfeed. Weighing and washing need to wait—this is much more important. Watch as he nuzzles your body and uses their legs to push himself to your breast. They may turn their mouth towards your breast—the rooting reflex. Their head may bob around as he tries to latch on or he may just lick for a while. They may take a look around at their new surroundings. But sometime soon they’ll probably take a big mouthful of breast. They may feed for quite a while or they may take a few sucks and fall asleep, waking on and off, sucking and feeding whilst asleep.
Your baby’s instinctive feeding responses work when he is asleep too and will help him find the breast, latch, suck and drink. Your body will respond by releasing prolactin and oxytocin, the hormones that make and release milk. These hormones also help you bond with your baby making mothering easier and more natural.
Some babies will feed on and off for an hour or two, others more continuously for a shorter time. Keep your baby on your body or close by while he sleeps so you’ll notice when he is ready to feed. A young baby’s sleep cycle lasts about 60–90 minutes. Transitioning from light to deep sleep may be hard for him and it helps to hold him as he goes into deep sleep.
And so to sleep
If your baby has an enjoyable feed just after birth, they may sleep for up to six hours. This gives you time to rest and eat. Hold your baby as much as you want—ideally skin-to-skin wearing just a nappy and a blanket over their back to keep him warm.
If a baby is wrapped and put down, they won’t be reminded to rouse and feed. If you think they need a feed you don’t need to wake them. With them snuggled against you it’s easy to gently encourage them to latch on while they are in a light (REM) sleep. Watch for rapid eye movements under their closed eyelids, arm and leg movements, sucking activity and changes in their facial expression and then encourage them to latch on.
If your baby doesn’t feed within an hour of the birth, they may sleep deeply. Keep them skin-to-skin with you and drip expressed colostrum into their mouth every hour or two until they are ready to latch on.
If your baby doesn’t feed frequently over the next few days, hand express colostrum and drip it into their mouth every couple of hours, including at least once between midnight and 5am to boost your milk producing hormones. When your baby is awake, you will probably want to gaze intently at each other and enjoy getting to know one another. Read the section on Wakeful Nights for more on sleep.
If your baby needs special care
You are still the most important person to your baby. They will recognise your voice and smell and they need your milk as soon as they can take food. Breastmilk protects a baby from NEC (gut damage) and other illnesses so ask staff to show you how to hand express. If you are well, start hand expressing within six hours of the birth; if you are unwell, as soon as you feel able.
Until your baby is able to breastfeed:
Express milk 8–10 times in 24 hours to build your milk supply, including once during the night. You can switch to using a pump as your milk increases. Talk to your baby and touch them as much as possible. Ask staff when you can start skin-to-skin contact with them. This helps your milk production and your milk ejection reflex (let-down). It also calms and stabilises your baby and feels wonderful.
Early Days
Day 2
Give your baby plenty of chances to learn to breastfeed by holding them in skin-to-skin contact most of the time. You can wear a gown or loose pyjama top and wrap it round them, or cover them with a blanket. Expect your baby to feed 8 to 12 times in 24 hours, including night feeds. Relax and enjoy these special hours together.
Days 3 to 5
Your colostrum will start to change from golden to bluish-white as you produce more milk. Your breasts will start to feel full, even engorged or sore, making it harder for your baby to latch on well. They need to get a deep latch so feeding won’t make your nipples sore, so: breastfeed (or express) frequently. If your breasts feel softer and more comfortable after feeding, your baby is getting milk.
Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe. Use a cold compress for 15–20 minutes between feeds to reduce swelling, or place cold cabbage leaves inside your bra. Apply moist warmth to your breasts for up to two minutes just before feeding to help your milk flow.
Problems with feeding
If your baby is sleepy from a difficult birth or medications used, they may not feed well. You can drip hand expressed colostrum directly into their mouth or give it to them by cup, spoon or syringe. As you produce more milk, you can use a pump until your baby is feeding well. Ask for help to get breastfeeding established. When they latch on, it should feel comfortable for you (after the first few sucks).
If your baby is finding it hard to latch on
When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. Reverse pressure softening has a similar effect by moving fluid away from the nipple area: press all five fingertips of one hand around the base of the nipple.
Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.
Falling hormonal levels after the birth can make you feel emotional, upset or weepy. This is absolutely normal and typically lasts just a few days.
Jaundice
Jaundice is common and normal in newborns. Getting breastfeeding off to a good start can prevent it becoming a problem which needs treatment. If your baby has jaundice, frequent breastfeeding and/or expressed breastmilk will help clear the yellow bilirubin pigment. If further treatment is needed, our page Jaundice in Healthy Newborns has more information.
Wakeful nights
While your baby is small, you will find some nights are particularly wakeful, including the second night just before your milk ‘comes in’. Your baby may want to feed very frequently, doze off and then wake again, protesting if put down.
Keep your baby close so they can feel your presence and hear your heartbeat, just as in the womb. Let them breastfeed frequently—it will boost your milk production.
If you need to put them down to sleep, wait until they fall into a deep sleep. You could cover them with a sheet or blanket while feeding, then lay them down on the cover to avoid contact with a cool surface.
Avoid using mittens—their hands are familiar and soothing, mittens feel strange. And the touch of their skin on your breast boosts oxytocin and your milk.
It’s never too late to try breastfeeding
If your birth is more difficult than anticipated, you and your baby have problems or are separated for any reason after the birth it may take you both a little longer to feel closely connected and get breastfeeding going well.
If this happens to you, keep your baby with you. Decline offers from others to look after him—ask them to do something practical to help you instead. Relax together with your baby snuggled up against you in Biological Nurturing™ laid-back breastfeeding positions, either lightly dressed or in skin-to-skin contact. Spend as much time as possible with their whole body against yours.
Take a warm bath together and focus on just admiring him. Breathe in their special smell, nuzzle and kiss him—some mothers even get an urge to lick their babies. All these can encourage your baby’s natural instinct to feed and help you feel more motherly and that you belong together.
How often will my baby need to feed?
Babies have tiny tummies so they can’t wait long for food. Even adults rarely go longer than a couple of hours without a drink, snack or meal. Breastmilk is quickly digested so in the early weeks a baby needs to nurse pretty constantly— at least 8–12 times in a 24-hour period, including feeds at night. You release more of the milk-making hormone prolactin during night feeds. Late afternoon/ evening feeds are often closer together too. This ‘cluster feeding’ is normal.
As your breasts adjust, they will feel softer. It doesn’t mean your milk supply has dropped. From Day 3 onwards 3–5 poos (at least the size of a 2p coin) per 24- hours are reassuring signs. Frequent feeds are a gradual transition from continuous feeding in the womb. Hunger is a new sensation for your baby so try not to make him wait until he’s too desperate to feed well.
Watch for:
Mouth movements, including smacking or licking their lips.
Sucking on lips, tongue, hands, fingers, toes, toys, or clothing.
Rooting, head bobbing or nuzzling against whoever is holding them.
Fidgeting or squirming a lot.
Fussing.
Crying
Crying is nature’s emergency siren and a late sign of hunger. It’s designed to summon help quickly. As well as being stressful for you it’s stressful for your baby. Crying raises cortisol levels (which can affect brain development) and increases your baby’s blood pressure. Life will be happier for everyone if you can respond quickly. Once you get to know your baby better you’ll be able to work out what they need most of the time as soon as they start to fuss, long before they need to cry. And thye’ll learn to relax knowing that you’ll look after them.
Sucking patterns
Watch your baby’s pattern of sucking. They will suck rapidly until milk starts to flow. Once the milk is flowing you’ll see a pattern of suck–swallow–suck–swallow. The frequency of sucks gradually slows as the feed progresses.
Once swallowing movements start to trail away and your baby relaxes and gets sleepy, it can be useful to change sides. This can prompt them to take some more.
Getting rest
Many mums feed lying down in bed at night (or in the day) to get more rest. Research shows that keeping your baby close while they are asleep protects against Sudden Infant Death Syndrome (SIDS) but you should never sleep on a sofa or chair with your baby. Do not share a bed with your baby if any adult in the bed smokes, has drunk alcohol or taken prescription or other drugs. Talk to an LLL Leader and read our page Safe Sleep & the Breastfed Baby as you decide how best to manage night-times.
Visitors
It’s OK to set limits on visiting—in fact it’s a really good idea. The first few days are a very special chance for you and your partner to get to know your baby peacefully together. If the birth was difficult it may help to write down your birth story or talk to someone about your feelings to help you come to terms with how it all happened.
Support
No matter how birth goes, with good friends and support, most mothers and babies breastfeed.
Calling an LLL Leader or going to your local LLL Group while pregnant means you’ll make breastfeeding friends and have access to support and information right from the start. If you have problems in the first week, or if your baby isn’t feeding well, seek help as soon as possible.
As well as your midwife or health visitor, you can contact an LLL Leader. You can also find lots of information on common concerns in the first weeks in our Further Reading section.
Written by Rachel O’Leary, Sue Upstone, Karen Butler and mothers of LLLGB.
Kimberly Seals Allers’ photos on this site are used under a creative commons license of Black Breastfeeding 360°http://mochamanual.com/bb/
References
An Introduction to Biological Nurturing: New Angles on Breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010. Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010. Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.
