Newborn feeding

Skin to skin is when you hold your baby with their skin directly against yours.

This helps to calm your baby, steady his or her breathing and heart rate and keep them warm. We advise skin to skin straight from birth for at least the first hour. This is a really great time to start your first breastfeed as your baby will be alert and keen to feed. Your midwife will help you. After birth you can hold your baby in skin to skin as often as you want to and it is a really special way for your partner to hold your baby too.

There are lots of different positions to breastfeed in. Your midwife or maternity support worker will help you to try different positions and find which work best for you.

Whatever the position, there are some basic principles which remain the same:

• Keep your baby’s head a body in a straight line – this allows them to swallow easily
• Hold your baby close, supporting his or her neck, shoulders and back. Allow your baby to tilt their head easily and avoid holding on to the back of their head.
• Make sure you are comfortable before you start the feed. Bring the baby to your breast rather than taking your breast to the baby.
• Remember nose to nipple – starting with your baby’s nose opposite your nipple allows your baby to tip their head back with a wide mouth and latch on to both the nipple and breast tissue which will achieve a good latch.
• Your baby’s cheeks will look full and round as they feed.
• The first few sucks may feel strong but if you are feeling pain, remove your baby from the breast and re-position.

Watch this really useful NHS video about position and latch. Or this video from Unicef.

• Your baby has a large mouthful of breast when they are feeding. If you can see the dark skin around your nipple, you should see more dark skin above your baby’s top lip than below your baby’s bottom lip
• Your baby’s chin is firmly touching your breast
• Your baby’s cheeks stay full and round during sucking
• Your baby takes rhythmic long sucks and swallows. It is normal for your baby to pause from time to time as you do when eating
• It doesn’t hurt when you are feeding
• Your baby finished the feed and comes off the breast on his or her own and is settled after the feed.

• After the first two weeks your baby should be gaining weight. (It is normal for babies to lose a little bit of weight after they are first born)
• Your baby has wet and dirty nappies (see table below). In the first 48 hours your baby is likely to have only two or three wet nappies but they should become more frequent with at least six every 24 hours by day 5 onwards. At the beginning your baby will pass a black sticky stool (poo) called meconium. By day three the poo should change to be lighter, runnier and greener and by day five should be yellow in colour. From day five your baby should be passing about 2 yellow poo’s a day – remember it is normal for breastfed babies to pass loose poo’s
• Your breasts and nipples should feel comfortable. If they are sore, ask for help from your midwife or health visitor
• Your baby will be content and satisfied after a feed and will come off the breast on their own
• If you are worried that your baby is not getting enough milk, talk to your midwife or health visitor

Breastmilk: average volume produced
Age	Amount per day	Amount per feed	Wet nappies/day
Day 1	37 mls	2 – 7 mls	0-1
Day 2	84 mls	14 mls	2 – 3
Day 3	408 mls	38 mls	3 – 4
Day 4	625 mls	58 mls	4 – 5
Day 5	700 mls	70 mls	6 +
3 months	750 mls		6 +
6 months	800 mls		6 +

It is not only normal but essential for your baby to feed during the night.

Your baby is growing quickly and has a tiny stomach which means they need to feed around the clock to meet their needs. This can be challenging and frustrating especially when you are tired and your baby is waking frequently to feed during the night.

It can also be a really special time with your baby away from the bustle and distraction of daytime, babies rely on this security and comfort at night as well as during the day. If you can, try and rest during the day when your baby sleeps.

UNICEF: Caring at night

Hand expressing

Hand expressing is a really useful technique to learn, especially if your baby is a little sleepy in the first few days after birth or needs to go to Special Care. You can start hand expressing whilst you are pregnant from 36 weeks. Watch this really useful video for more information.  You can also have a look at our leaflet.

Breast pumps:

There are lots of different pumps available to express breast milk, from day 2 following birth.

We sell the ARDO Calypso for £125 however there are lots of other brands also available in the shops and online.  Remember to follow the manufacturer’s instructions for keeping your pump clean.

Storing expressed breast milk:

You can store breast milk in a sterilised container:

• in the fridge for up to five days at 4C or lower
• for two weeks in the ice compartment of a fridge
• for up to six months in a freezer

Leaflets:

BSUH: See our postnatal booklet

Start 4 Life: Off to the best start

UNICEF: Building a happy baby

Support groups:

There are lots of support groups available locally.  Some are run by health care professionals and some are peer to peer support.  Follow the links below for the most up to date classes.

Breastfeeding Drop-Ins in Brighton and Hove

Breastfeeding Drop-Ins in West Sussex

Breastfeeding Drop in at the Princess Royal Hospital: Wednesdays 10am – 12 noon in Bolney Ward.

Websites:

The Breastfeeding Companion has a large selection of informative videos on breastfeeding

 The Breastfeeding Support website has lots of useful information and troubleshooting

Association of Breast Feeding Mothers

Helpline: 0300 330 5453

• Voluntary organisation originally founded by breast feeding counsellors.
• Offer counselling by trained counsellors (helpline: 0300 330 5433)
• Information resources

Maternity Action

• K. Charity
• Committed to ending inequality and improving health of pregnant women, their partners and young children.

Baby Milk Action

• Non – profit organisation campaigning against interests of infant formula companies and is the UK coordinator for violations against the WHO
• International Code of Marketing of Breast milk Substitutes.

Best Beginnings

• Charity run in support of ending inequalities in child health. Free online access to ‘Bump to Breastfeeding’ DVD.

Breastfeeding Network

Supportline: 0300 100 0210

• Independent source of support and information for breast feeding women and others.
• Downloadable leaflets for treatment of thrush and mastitis, as well as information sheets regarding storage of expressed breast milk and drugs and breast milk.
• Information on the use of drugs, alcohol and smoking whilst breast feeding.
• Information also available in Bengali/Sylheti,Tamil,Telugu and Hindi

First Steps Nutrition

• Better information and support for good nutrition and food from pre-conception to five years, run by registered professionals.

Infant Sleep Information Source

• ISIS provides information about normal infant sleep for parents and health professionals, based upon the latest UK and world-wide research.

KellyMom

• American website with good evidence based information for parents and professionals

Lactation Consultants of Great Britain 

• For private lactation specialists

La Léche League

Counselling helpline: 0845 120 2918

• International self – help group for breast feeding women
• Local support groups.

National Childbirth Trust

Supportline: 0300 330 0700

• Child birth and parenting charity run by parents for parents.
• Provide a range of services including antenatal classes, postnatal discussion groups and breast feeding counselling.

NHS Breastfeeding site

Helpline: 0300 100 0212

• Funds National Breastfeeding (in collaboration with ABM & BfN

Unicef UK Baby Friendly Initiative

Helpline: 0300 330 0700

• News and research updates
• Supports best practice for all infant feeding
• Breast feeding leaflets for pregnant women and new mothers available in English, Arabic, Bengali, Chinese, Gujarati, French, Hindi, Mirpuri, Portuguese, Punjabi, Somali, Spanish, Tamil, Turkish, Urdu, Vietnamese.
• Bed sharing leaflet, available in English, French, Gujarati, Hindi, Punjabi, Spanish, Tamil, Turkish, Urdu.

Association of Tongue-tie Practitioners

• ATP set up in 2012 by specialist health professionals from the NHS and independent sector who can support parents of tongue tied babies to access safe and effective care.

If you make the choice to bottle feed, please bring in your own starter pack of ready-made infant formula, suitable from birth.  We do not supply infant formula in hospital unless it is needed for a medical reason. However we do supply disposable sterile bottles and teats.

Skin to skin is when you hold your baby with their skin directly against yours. This helps to calm your baby, steady his or her breathing and heart rate and keep them warm. We advise skin to skin straight from birth for at least the first hour. This is a really special time for you and your baby to bond. If you are planning to bottle feed your midwife will bring your baby a bottle of milk at this time. You can hold your baby in skin to skin as often as you want to and it is a really special way for your partner to hold your baby too.

Make feeding your baby a special time for you both. It is a time when you can snuggle up together and bond. When you are feeding your baby, hold your baby close and maintain eye contact, cradle and stroke your baby. This helps your baby to feel safe and loved. Being skin to skin for some feeds is also really important to help your baby feel calm, secure and warm. If you and your partner try to give most of the feeds yourself this can really help to build a close and loving bond.

• Make sure you are sitting comfortably
• Always hold your baby close and look into their eyes to help them feel safe and loved
• Hold your baby fairly upright with their head supported so they can breathe and swallow comfortably
• Brush the teat against your baby’s lips and, when your baby opens their mouth wide, allow them to draw in the teat.
• Look out for your baby’s cues that they have had enough milk. Don’t try and force your baby to take more than they want.
• Your baby may need short breaks during the feed and may want to burp sometimes. Hold your baby upright and gently rub or pat their back to bring up any wind (this may be a very small amount)
• Never leave your baby alone with a bottle propped up as there is a risk they might choke
• Try to make sure that you or your partner feed the baby whenever possible; this is a lovely way for you and your baby to form a really close bond.

All babies are different and will require different amounts of formula. To start with, newborn babies take quite small amounts of formula milk, which gradually increases. Feed your baby when you think he or she is hungry – when they begin to move their head and mouth around or are looking for something to suck –usually their fingers. Babies tend to feed little and often and so they may not finish their bottle. A big feed does not mean your baby will go longer between feeds. Your baby will also need to feed during the night for the first few months.

Further information:
UNICEF: Caring at night

• After the first two weeks your baby should be gaining weight. (It is normal for babies to lose a little bit of weight after they are first born).
• Your baby has wet and dirty nappies. In the first 48 hours your baby is likely to have only two or three wet nappies but they should become more frequent with at least six every 24 hours after the first few days.  At the beginning your baby will pass a black sticky stool (poo) called meconium.  By day three the poo should change to be lighter, runnier and greener and by day five should be yellow in colour.  From day five your baby should be passing about 2 yellow or yellow/brown poo’s a day.
• If you are worried that your baby is not getting enough milk, talk to your midwife or health visitor.

Most infant formula is made from cows milk that has been treated to make it suitable for babies, you can also use goats’ milk based formula.  It is not advised to use other infant formulas unless recommended by your midwife, health visitor or GP.

Infant formulas can be bought as:

• Ready-to-feed liquid formula, sold in cartons which is sterile
• Powdered infant formula, which you make up at home and is not sterile. Always follow the instructions on the packet to make up the formula.

First infant formula is the only type of formula your baby needs until they are one year old when they can start to drink whole cows’ milk.  Whilst there are lots of ‘hungry baby’ or ‘second milks’ available there is no evidence that these milks help babies to settle better or sleep longer, so there is no need to switch to these milks.

At BSUH we do not promote or recommend any particular brand of milk and use whichever is the most economical to buy at the time.

Further information about formula milks in the UK can be seen here.

• Bottles with teats and bottle cleaners. We do not recommend any particular brand; try to choose bottles that are easily cleaned.
• Bottle brush and smaller teat brush
• Formula milk powder or ready to feed liquid formula
• Sterilising equipment

For further information on bottle feeding, sterilising, making up a feed and storing formula milk

UNICEF: Guide to bottle feeding