Expert tips: What a new mum needs to know about breastfeeding

Claire Fitzpatrick is a clinical midwife specialist in lactation at Midland Regional Hospital Portlaoise where she also gives weekly antenatal classes on Preparing to Breastfeed.

Here she offers some of her tips and advice for new mums.

• A way to prepare for breastfeeding is to attend an antenatal workshop so that you can know what to expect and what is normal. If you know what's normal you can get help when it's not.
• The two main reasons that breastfeeding doesn't work out are that women believe they don't have enough breastmilk, or that women are in pain. There are very few women who don't produce enough milk, and we know that it's not normal to be in pain.
• After birth keep your baby close. Uninterrupted skin to skin contact is so important physiologically for both baby and mother, and will help with that first feed within the first 90 minutes of life.
• Babies want to be beside their mother as they transition to the outside world. They will not be happy in a crib. New mums often worry that they are forming bad habits, but that's not possible.
• Keeping them close means that breastfeeding is more likely to go well. People might say, "I'll take the baby", but keep them near. Mother your baby, and allow everyone around to mind you. People should dote on the mother, rather than the baby.
• Babies often have a quiet first 24 hours but will feed most of the second night. This is when the mother's prolactin levels peak – that's the hormone that helps make milk. If the mum doesn't understand this, she thinks she doesn't have enough milk, whereas she's doing exactly what she's supposed to be doing.
• It helps to know how much your newborn may feed – after the first 24 hours about 10-12 feeds a day, reducing to about 8-10 times as the weeks go on. Babies behave very differently than when they are formula fed.
• A normal length of a feed is anywhere between 15 and 40 minutes. Let your baby feed for as long as they want on one side, before you offer them the other.
• Learn to recognise early hunger cues: turning their head, opening their mouth, moving their hands toward their mouth, and starting to root. When your baby is stretching, and going red, and biting their hand, they're really saying "c'mon, I'm hungry". And if your baby is crying that is a really late stage of hunger. You'll want to calm your baby down first, and then feed.
• Positioning and attachment are essential for successful breastfeeding. Hold your baby facing you, with their nose opposite your nipple, so they have to look up to latch on. Wait for a wide open mouth, and bring your baby to you, rather that moving down to your baby.
• A deep latch is the most important. The baby should be feeding on areola, not the nipple. It can be tender for the first few seconds of a feed, but that should ease. Breastfeeding shouldn't hurt. It's often a sign of a shallow latch, and that can lead to blocked ducts, mastitis, and poor weight gain.

• During a feed there shouldn't be smacking or clicking sounds. Their cheeks should look plump, not sucked in. They shouldn't be pulling off and on. After a feed a woman's nipple should look round and soft, just like it did before the feed; not constricted, like the top of a lipstick.
• If you'd had a few shallow latches, and you've got bruises or cracks on your nipples, then it can be sore until that heals. Keep them moist with lanolin cream or compresses. Use your own anti- bacterial breastmilk on the area. There are different honey or silver based dressings that lactation consultants will recommend. Some women buy little silver cups. I don't have any research to support their use, but women find them good. Don't use breast pads with plastic on the back.
• Engorgement is normal around day five, as your second milk is coming in-the first milk is colostrum. It will settle down after 24/48 hours. You can use a warm compress before a feed, like a warm facecloth or pack, and a little light massage. Allow the baby to feed as often, and as much, as they want, and afterwards use a cold compress or cabbage leaves from the fridge-the greener the better. A protein in cabbage does suppress your milk supply, so don't use it too often; three times a day for 20 minutes is plenty to ease engorgement. This is the time when a baby establishes how much milk it wants a mum to produce, so expressing to reduce engorgement will actually send a signal to produce more milk than your baby needs.
• Wet and dirty nappies tell us that a baby is getting enough to feed; about three to four dirty and five to six wet a day after the first week. Your baby being active, and waking up looking for feeds, is a good sign that they getting plenty, that they have energy.
• Avoid underwired bras. You don't want anything that is going to constrict any area of the breast, because that can cause a blocked duct. If you wear your baby in a sling, which is really good, be wary that it's not causing constriction, and be careful of your seatbelt on long car journeys.
• Even though it's natural, breastfeeding takes time to learn. Babies need to learn too. It takes perseverance in those early days. You've probably never had this extent of broken sleep before, or tiredness. But, it's so worthwhile, and it becomes so easy and convenient. On my first baby I was a nurse and midwife, and had just qualified as a lactation consultant. But I was also just a new mammy. I did get sore. It did take me a while to learn, and I got mastitis. But, from watching my sisters, I knew that I would get through it; and I went on to breastfeed him for a year and a half.
• Remember if it starts to feel painful look for help. That's what lactation consultants like myself are here for. We see women in the postnatal period on the ward, but a lot of women don't realise they can contact us when they are home. Voluntary groups such as La Leche and Cuidiú are also amazing for support and advice, and there are great resources, advice, and infographics about breastfeeding from the HSE's MyChild on www2.hse.ie/babies-and-toddlers/.
• National Breastfeeding Week is a HSE-led event, marked each year from October 1st to 7th. This year's theme is Feeding the future: Supporting breastfeeding through a pandemic and beyond. For more information and helpful breastfeeding tips and tricks, visit mychild.ie.