Everything you need to know about breastfeeding

Feeding is one of the first special experiences parents and their newborns will share and it’s an area every parent is keen to get right from the beginning.

Vicki Scott, a Baby Feeding and Well Being Advisor for Philips Avent, said: “Having a baby can be a steep learning curve for many new parents, opening up a whole host of new topics and terms which you may have little experience of.”

Heart presenter Emma B, herself pregnant with her second child, caught up with Vicki to get her advice on breastfeeding.

Emma: After the baby’s born and you get home and you sit in the living room with the baby in the car seat and say “OK, what’s next?” Where’s the instruction manual? How are you supposed to know what to do?

Vicki: Unfortunately there is no instruction manual but there is lots of advice out there. Mums will get a visit from community midwives and, later on, health visitor access as well.

In some areas, midwives are really pushed for time. There are fewer than we would like and they sometimes don’t have the time that mums might need. But, the help is out there. There are breast feeding clinics around, cafes and support groups, while the internet is a great source of information about where to go and look.

Feeding diaries are also a great help so mums can record all the feeds so that when the midwife does come, you can say, “My baby’s fed three times today” and the midwife might think that’s not enough and mum could encourage the baby to feed more.

Is the baby peeing and pooing enough? They can write that down too… all these things are a sign of the baby’s well being. That’s what’s important, not the routine that you’re in in the first few weeks. It is more important that the baby is gaining weight and everybody is happy.

Emma: What are the first things we should do to make breastfeeding more enjoyable?

Vicki: Always try and be as relaxed and comfortable as possible and have a glass of water near by, it can be thirsty work.

Emma: Should we be worried about the state of our boobs and nipples in the approach to breastfeeding?

Vicki: Babies actually breastfeed, they don’t nipple feed so as long as baby gets enough breast tissue in their mouths as they learn, they draw the nipple out.

Inverted nipples are due to short nipple ducts. Good positioning and attachment and technique that doesn’t have to be a problem. You can use devices like the Nipplette before pregnancy. During the first six months of pregnancy, it gently lengthens the ducts and draws the nipple out. You can use this for a few minutes before feeds, although the milk can affect the suction, but it can help.

Emma: I remember on one of the first days feeding my little girl having very sore nipples and one even bled a bit. How can we avoid cracked nipples?

Vicki: It’s the most common complaint and the most common reason why mothers stop in the first few weeks. But it is so preventable and treatable. It’s all to do with the technique. It shouldn’t hurt when the baby is breastfeeding. If it does, mum needs to take the baby off and learn how to put the baby on properly and start again.

Emma: Where do we get that help?

Vicki: Make the most of the midwives and learn how to do it before baby arrives. Go to a class, look at pictures, books and DVDs. But really make the most of the midwives after the birth to get off to a really good start.

The Avent Baby and You DVD shows fantastic guidance on technique, how to hold your baby and how to get the baby on the breast. The nipple should be round when the baby comes off. If it looks pinched, like the end of a lipstick that’s not a good sign and that can lead to cracks.

Always look at the technique first. In the meantime, nipple creams are good.

Emma: In terms of looking after your breasts especially in those first few weeks when they are so engorged, I’ve heard that lettuce leaves and warm flannels can be good?

Vicki: Cabbage leaves are good for engorgement, in that temporary phase in the first few days when your milk comes in, cold from the fridge! Apparently they have anti-inflammatory enzymes and they are the perfect shape to fit in your bra!

So give them a clean, put them in the fridge, then give them a crinkle and pop them inside your bra - they feel lovely. Warm flannels are good for relieving mastitis or for encouraging milk to flow before you feed your baby.

Emma: How can you avoid mastitis?

Vicki: It’s important to try not to miss feeds and keep the milk moving in the breast. Mastitis can happen in two ways.

Firstly, when the breasts are over full with milk and the baby is not latching on, so it’s important that mum doesn’t go out without her baby and miss a feed because the pressure builds up inside the breast.

Secondly, sometimes when mum gets a cracked nipple, infection can travel up inside the breast that way. So avoiding sore nipples is another way to avoid mastitis.

The signs of mastitis are a red patch on the outside of the breast. So everyday have a look at your breasts on the outside and if you see this red patch, that can be a sign.

Emma: There is an ongoing debate that breast feeding is best and there’s a lot of pressure for mums to do it and to do it well. Why is it so important that we try and is it the be all and end all if we’re not very good at tit?

Vicki: If a mum can do it for the recommended time for all the major health benefits - which is six months - then fantastic. But it’s not for every mum, it has to be said, and I’m there to support mums whatever choices they make. Some mums have to stop after a week because of problems.

Emma: And you’re not a failure if that happens?

Vicki: No, it is really tough. Some mums are so exhausted, they have to deal with everything and the crying baby and the feeding and it is really tough so just give it your best shot.

Most mums have that desire to do the best for their baby but if it doesn’t work out, it doesn’t work out and a bottle and formula is there as a back up if you need it.

Emma: What, when why and how would you express?

Vicki: I love the fact that women can express milk and it gives you that flexibility and that freedom so that you can keep giving your baby exclusively breast milk but have a bit of a life as well.

Not every mum wants to feed in public. Mums shouldn’t worry about breast feeding in public, the more the better, get it seen, get it out in the public again. But sometimes mums want to express so that dad can give the baby one of the night feeds or so that you go out and leave baby with a childminder, at nursery or simply because she doesn’t want to breast feed in public or when there are extended family members around.

Emma: Can you do that straight away?

Vicki: Having a breast pump and knowing how to use it is really important, even before the baby arrives. Mums can use it to their advantage, even in the first week because some of those problems can arrive in the first week, like stimulating milk flow or sore nipples. It can even help mums to get over mastitis or if the baby comes early… so see the pump as tool that can help you breast feed for longer really.

Emma: If you haven’t used a breast pump before… I’m not attached to the wall in a shed am I?

Vicki: There is some really chic equipment out now. The Philips AVENT ISIS manual pump, I used every day for six months. It’s very gentle, quiet and economical to buy and as effective as some of the bigger pumps that are still out there. They also make an electric pump which takes away the hard work because some mums find it quite difficult.

Emma: I broke mine in the middle of the night, I think I was being a bit too vigorous!

Vicki: Again, some mums only take five minutes to express, some mums take 15-20 and some mums take even longer. The more you practice and the more you relax, it should take less time. An electric pump takes away that work element.

Emma: Can we keep the expressed milk? In a bottle or in a bag?

Vicki: This is one of the most common things I end up talking about at the baby shows, when we show new mums and dads the little VIA Cups that we have.

You can keep breast milk in the freezer for three months. I wouldn’t recommend that you start expressing for the first two weeks if you can get breast feeding established first then that’s great. But then after that, those small amounts that you can put together for a few weeks later to make a feed. Breast milk should not be stored in the fridge for more than 24hours.

It really does give you that flexibility, so even if you have expressed a tiny amount, that’s your precious breast milk. Put that in the freezer in a little sterilised pot and then you can take it out when you need it and defrost it gently and then you’re ready to go.

Emma: What are the basic rules around bottles and milk and sterilisation?

Vicki: All milk feeding equipment should be sterilised before you use it and at least every 24 hours in a steam steriliser - ideally either a microwave or one that plugs into the wall.

When you’re storing milk, expressed milk should only be kept in the fridge for 24 hours or frozen for three months. And then if mums have warmed up a bottle of expressed milk to feed they should use that within an hour and then throw it away - you shouldn’t use the rest later.

If you think your baby won’t take all of that milk just warm it up a bit at a time, pour out in to a bottle what you think you’ll use and then keep the rest in the fridge. And then you can always then freeze that at the end of the day of you don’t use it.

Emma: So when you decide to stop breastfeeding how do you manage that change? How does my body adapt to this routine? What’s going to happen to my boobs?!

Vicki: One of things I hear a lot is, “I don’t want to breast feed in case I get saggy boobs” and I have to say that it’s pregnancy that causes your boobs to go saggy, so I’m afraid once you’re pregnant it’s too late!

So don’t let that put you off breastfeeding or having babies full stop!

The way to wind down breastfeeding when you decide you do want to stop is to do it slowly to avoid mastitis and inflammation. It’s the reverse of how your breast milk comes in.

Breastfeeding works on supply and demand so the more often a mum feeds a baby in the first couple of weeks, that builds up the stimulation of her supply. The more milk the baby takes, the more she’ll supply. So mums wanting to reduce breastfeeding should reduce the amount of time and the frequency she’s feeding. Maybe do half a breast feed and finish off with a bottle of formula.

Or if you’re expressing, express less and less each day so that her body gets the message that the baby’s not needing that milk anymore. It reduces the hormone prolactin and it’s that hormone that makes milk.

And then buy a wonderbra at the end of it! Saggy boobs don’t happen to everyone, everyone’s different. Some women find that they have bigger boobs after they’ve had a baby, so you can’t speak for everyone!

Vicki Scott
Vicki Scott is one of the UK’s leading babycare experts with a wealth of experience gained working as a nanny, midwife, nursery and maternity nurse, babycare consultant and lecturer for nearly 20-years. She started working with children as a NNEB nanny in 1989 and has subsequently gained an advanced diploma in Midwifery Studies which saw her working for the NHS as a staff midwife for five years.

Since then, Vicki has worked for private clients as a maternity nurse, providing 24 hour care and support to new mothers and babies in their homes. She has also been involved with training many of the nannies and maternity nurses working with the esteemed Night Nannies organization and running various ante-natal classes across London including the New Baby Company.

In 2003, Vicki launched her own service, Baby Confidence (www.babyconfidence.co.uk), which provides private clients with courses and advice on breastfeeding and the care of newborns across London. Vicki is also Mum to a two year old little girl, Poppy.