Quality Care > Breastfeeding FAQs

Breastfeeding FAQs

What are the common struggles new mothers face when learning to feed their babies. What can they do to remedy these issues?

Breastfed babies feed frequently, particularly in the newborn period, and mums need to know this is normal and to be expected. Support is essential – empowering support that promotes confidence and self-efficacy. Going to a dedicated breastfeeding education session, or a breastfeeding group in the community during pregnancy can make a big difference as peer support is very helpful. Midwives talk about what helps to get breastfeeding off to a good start with their pregnant clients, and they include partners and whānau whenever possible so they know what to expect and how to be supportive too. The Baby Friendly Hospital Ten Steps to Successful Breastfeeding supports evidence-based breastfeeding friendly practices after birth, such as skin-to-skin contact between mother and baby. BFHI also support skin-to-skin with women who plan to bottle-feed too.

Some say supplementing with bottles early on actually hinders your ability to breastfeed, while others say mix feeding is good - what do you say?

Most of the research based evidence shows that it is better to establish breastfeeding first even if you are planning to mixed feed. For healthy infants, unnecessary supplementation can interrupt the supply-demand physiology of breastfeeding, and ultimately reduce mum’s milk supply. Most women can take up to six weeks before they feel that breastfeeding is established well. It’s a new skill for first time mothers, or mothers with other children who are breastfeeding for the first time. Practice is needed. Midwives support mothers for the first six weeks in their own homes and can provide information about all aspects of infant feeding. If supplementation is needed – then it’s discussed, and initiated, as the principle is - feed the baby.

Giving up on breastfeeding can be quite stressful for mothers due to emphasis on it. How do mothers know they're making the right decision?

Midwives work in partnership with women and provide evidence-based information as a foundation on which women can make their own decisions. Breastfeeding is considered to be a public health intervention so supporting breastfeeding is a key component of health promotion activities. This does not mean that women who make a decision to not breastfeed, or to stop breastfeeding are not supported.

All mothers and babies need to get off to a great start and information about how to use formula and bottle-feed is given to parents when needed. It is important to provide compassionate support for women who planned to breastfeed but stopped breastfeeding for whatever reason. A recent study by Borra et al found that for mothers who were not depressed during pregnancy, the lowest risk of postpartum depression (PPD) was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk of PPD was found among women who had planned to breastfeed and had not gone on to breastfeed. In NZ we have between 94-96% of women who plan to breastfeed. Supporting these women to breastfeed as much as we can is important, but we also recognise that some women will mixed-feed or stop breastfeeding for a range of reasons. Providing information so that women feel supported with their decision making is something midwives do during pregnancy and right through until the end of the postnatal home visits.

How can parents know they are feeding properly

Staff and midwives working at maternity facilities explain to parents about the signs of an effective breastfeed, and they observe mothers and babies feeding. Then Lead Maternity Carer midwives follow up on breastfeeding, if the woman has birthed in a maternity facility, when mother and baby are at home. Signs parents are told to look out for – soft sounds of swallowing; change in the baby’s sucking pattern from fast suckles at the beginning of a feed, to slower ones as the milk starts to flow; nappies – output poos and wees; sometimes mums see visible milk at the end of a feed, or if the baby comes off the breast in the middle of a milk let-down, or if the baby spills a little bit with a burp (which is normal); weight gain. Breastfeeding mothers often feel the difference in their breasts when the milk ‘comes in’ – often around sixty hours after birth but this can be later. Before the milk comes in the baby gets small amounts of colostrum. Average amount of colostrum taken in the first 24 hours by the baby is 30mls. Once the milk ‘comes in’ mothers can usually feel that their breasts feel softer after a breastfeed. Some mothers feel their let-down reflexes – but not all. There is a wide range of normal in terms of sensation.

What are the signs a newborn baby has serious health issues in relation to feeding? Such as weight loss/dehydration

Babies are monitored for wakefulness in terms of feeding. Most babies wake frequently for feeds. Babies born before full term do not always wake for all feeds so mums are taught how to wake the sleepy baby for a feed. This in itself would not be considered a serious issue – it’s one that would be monitored by staff. If women have delayed lactation for any reason they are supported to express breast milk to stimulate supply, and so that colostrum can be given to the baby. This is monitored by staff as well. Mothers with complicated medical histories, or those with previous breastfeeding issues, or those who have had complicated births, or caesarean sections, may also be seen by a hospital-based lactation consultant. If at any point, in the first 24-48 hours, the delay in lactation is an issue then there is a conversation with the mother about supplementation. The bottom line is always – feed the baby. Some women use donor breast milk and some use formula for supplements. If there is concern about a baby, baby blood sugar levels are monitored as well. Any mother and baby who have not initiated breastfeeding well before they go home, have a comprehensive feeding plan put into place. This could include expressing milk, continuing to work on the breastfeeding, and feeding the baby via bottles with donor milk or formula. Babies’ weight gain is also monitored and feeds are observed.

Signs of severe dehydration:

  • Sleepiness.
  • Irritability.
  • Less elasticity in the skin.
  • Eyes and fontanelle appear sunken.
  • Dry mouth.
  • Decreased number of wet nappies

If you have any concerns let your LMC know.

Most babies lose weight after birth how much weight loss is okay, and at what point should they gain weight?

A 5-7% weight loss during the first 3-4 days after birth is normal. Any loss above this is a sign that the breastfeeding needs to be evaluated. Weight check at five days (baby should be gaining rather than losing weight by day five) is a good idea so if there are feeding issues these can be sorted early.

Babies should regain their birth weight by ten days to two weeks. If the baby has been unwell or is premature, it may take longer to regain birth weight. If baby does not regain birth weight by two weeks breastfeeding needs to be re-evaluated.

USEFUL LINKS

Video about latching mums are taught about latching – how the baby latches at the breast and what to look out for in terms of signs of effective latch.