Breastfeeding

Breastfeeding is the best way to feed a baby and has short and long term benefits for both mother and baby

Breastfeeding mothers need

  • Support from family, partner, friends and clinic staff

  • Time to rest and enjoy baby

  • Healthy foods — including water, bush foods, vegetables, fruit, breads, cereals, meats

  • To avoid smoking, alcohol and other substances

Supporting breastfeeding

  • Keep baby and mother together after birth and in early days and weeks of life to enable breastfeeding and bonding
  • Promote skin-to-skin contact between mother and baby throughout the postnatal period, especially before and after breastfeeding
  • Encourage mother to recognise when baby ready to breastfeed — Figure 4.3. Offer help if needed

Figure 4.3  Signs that baby is hungry

Baby feeding cues © State of Queensland (Queensland Health)

Breastfeeding assessment
  • Offer a private space to do a breastfeeding assessment
  • Ask about breastfeeding history and any current problems
  • Check breasts for abnormalities, trauma or other issues — See Breastfeeding — common issues
  • Observe a breastfeed to check positioning, latch and that baby has an effective suck and swallow
    • Allow mother to position and adjust baby

Table 4.3 Attachment

Figure 4.4   

Figure 4.5   

Positioning baby

  • Make sure mother is comfortable and can see her breast as baby latches 
  • Unwrap baby so arms and hands are out and able to move and mother and baby have skin to skin contact
  • Mother brings baby close to her body
    • Tummy to tummy — baby's head and shoulders facing breast
    • Bottom tucked into mother's tummy, nose out
    • Baby's nose and mouth at level of mothers nipple
  • Mother supports baby behind shoulder/neck area — Figure 4.6
    • Avoid grasping or holding baby's head to position baby at breast

Figure 4.6   
  • Mother touches baby’s cheek with nipple to encourage baby to open mouth
  • When baby’s mouth wide open and tongue down, mother can move baby toward her breast, baby’s mouth to her nipple
  • Reassure mother it may take a few tries to attach baby to breast
  • Different positions may help baby to get attached and feeding

How to know breastfeeding is going well

  • Mother responds to baby's hunger signs — see Table 4.3 
  • Baby has at least 8-10 feeds every day and feeds for 10-40 minutes each breastfeed
    • Baby cannot be overfed on breast milk, will drink the right amount for good growth
    • If baby sick or not feeding well, it might not feed as long as it needs to
  • Baby wakes themselves when wanting a breastfeed and is content after feeding
  • Mother feels breasts soften during and after feeding
  • Baby passes around 6 wet nappies each day
  • Baby is growing well (weight and length)

If help needed

  • Refer to midwife/lactation consultant for help if mother, family or clinic staff worried
    • Early referral can reduce long term feeding problems
  • Check for and treat breastfeeding issues — See Breastfeeding — common issues
  • Medical consult for mother and baby

Expressing and storing breast milk

  • Breastfed baby may need to be looked after by someone else (eg if mother goes to hospital)
  • Mother may also express breast milk for sick or preterm baby
  • If baby is very young — encourage mother to express enough breast milk to give baby for the time she will be away and to continue to express when away from baby
  • Older baby may be having other food or water. Give these until mother returns
  • Can hand express — Figure 4.7 or use manual or electric breast pump — Figure 4.8
  • Support mother with expressing — make sure she has the correct information and help, advise her that baby will continue to have the benefits of breast milk
  • Midwife/lactation consultant can help if needed

Figure 4.7   

Figure 4.8   
  • Store breast milk in clean, sealed plastic container
    • Fridge — up to 72 hours at the back where it is coldest and not in the door
    • Freezer inside fridge — up to 2 weeks
    • Freezer compartment of fridge (with separate door) — up to 3 months
    • Deep freeze — 6–12 months
  • Expressed milk separates into layers. Shake container before giving to baby
  • Warm bottle of breast milk in hot water if needed. Warm to body temperature only
    • Fine to use thawed and doesn't have to be warmed
    • Do not use microwave to thaw or heat milk
  • Talk with midwife or lactation consultant for more information

Special circumstances

Medicines

  • Do not give medicine to breastfeeding mother without checking it is safe — check with doctor or midwife, a medicine reference book or contact your closest Pregnancy Drug Information Centre for more information

Preterm babies

  • Breast milk is especially good for preterm, small, sick babies
  • If baby not able to breastfeed — try other methods of giving breast milk
  • Express into baby’s mouth, cup feeding, finger feeding — refer to midwife/lactation consultant

Maternal blood-borne viruses

  • Sometimes mother advised not to breastfeed or to breastfeed for a short time only to lessen risk of passing virus to baby (eg HIV or HTLV1 positive — See Human T Cell Leukaemia Virus type 1 (HTLV-1))
    • Talk with local public health unit, sexual health specialist, paediatrician and lactation consultant to make individual breastfeeding plan
  • Mothers with syphilis, hepatitis A, hepatitis B, hepatitis C can breastfeed their babies
    • If hepatitis C positive and cracked or bleeding nipples — advise to express and discard milk until bleeding areas healed
    • Talk with someone experienced in this area — PHU or lactation consultant

Alcohol and other substances

  • Usually best for baby to breastfeed even if mother smoking or drinking alcohol
  • Advise mothers
    • Not drinking alcohol is the safest option when breastfeeding
    • Baby will get alcohol and other substances through her breast milk.
    • Nicotine may reduce milk production
    • Adult who has been drinking alcohol should not sleep next to baby
    • Talk about best way to take care of baby if she is drinking. Ask about family support and involve other services for help
  • If mother does drink, advise to
    • Avoid drinking immediately before breastfeeding
    • Think about expressing milk in advance if she is planning to drink
    • Limit alcohol to no more than 2 standard drinks a day
  • If mother does smoke, advise
    • Keep baby away from passive smoke. Don't smoke just before or while breastfeeding

Older babies

  • Exclusive breastfeeding for about the first 6 months is best for all babies. This means breast milk only — no other food or drink, not even water
  • At around 6 months — start healthy iron-rich solid foods and boiled and cooled water in a cup — See Infant, child, youth growth (0-17 years)
  • Continue to breastfeed until 1–2 years or longer if mother and baby want — any breast milk is good for older babies and prevents infections

Next pregnancy and new baby

  • Some women keep feeding older child when pregnant with another baby. Usually quite safe and should be supported
  • Some mothers continue feeding older child after new baby is born. May feed babies together or at different times
    • Important that new baby is fed first and has plenty of time at the breast
    • Usually enough milk for both but growth of both children, especially new baby needs to be monitored
  • Toddlers can be very demanding so woman needs to understand that new baby must not miss out on feeding
  • New baby needs to put on at least 150–200g each week. If growth poor — urgent medical consult

Suppressing lactation

  • Woman may want to stop milk supply (eg very sick, baby died or given to someone else)
  • Women start making milk at about 20 weeks pregnant so mother may need help with suppressing even after loss of very preterm baby
  • Advise minimal handling of breasts (avoid massage or stimulation) and wear a firm bra
  • If has been breastfeeding — may need to express some milk for comfort and decrease over few days until milk supply decreases
  • May take a few days. Advise to take paracetamol OR ibuprofen — See Pain management (acute)
  • If concerns medical consult and talk with midwife or lactation consultant

Supporting resources

  • Australian Breastfeeding Association website
  • Raising children network website