Are you struggling with breastfeeding, combination feeding, weaning onto the bottle, introducing formula or weaning off the breast? Breastfeeding/chest-feeding and infant feeding problems in the early days can occur when you least expect them. In this post, I will explore some of the main stumbling blocks when it comes to infant feeding in the first few days and weeks, and what you can expect from an initial and follow up appointments at Melyn.
*For the purposes of, and ease of reading this article, I shall refer to infant feeding as breastfeeding, however I acknowledge that not all parents are breastfeeding; some may be chest-feeding, infant feeding, combination feeding, exclusively pumping and bottle feeding expressed milk. Some hurdles face most parents, however they may be feeding their babies, others may be more specific.
So you've done pregnancy, survived childbirth and you're responsible for the wellbeing of a very tiny human. You would think that feeding them would be the easy part considering it's so important for the survival of the human species! For lots of new parent, it takes a bit of time, practise and patience to establish breastfeeding. It doesn't matter whether you are a new parent or a parent of many, each baby and feeding partnership is different and comes with it's own unique learning curves and challenges.
Skin to Skin
Newborns are born with a lot of reflexes designed to help them locate the breast, to root and latch on, and efficiently remove milk. New parents are also primed to produce milk, ideally matched to meet their baby's needs. This is why skin to skin is so important in the minutes to hours after birth. Not only does it help establish your baby's microbiome, skin to skin initiates their ability to locate and latch on to a breast, it helps regulate their heart and respiratory rate, helps regulate their temperature and releases the hormone oxytocin in both baby and parent. Oxytocin helps boosts your milk supply and milk ejection reflex (letdown reflex) increasing the transfer of milk to baby. Sometimes early skin to skin cannot happen due to baby or parent (or both) being unwell or needing to be separated, however as soon as it can happen, spending lots of time with baby up against your skin can really help.
Frequent Feeding
With tummy's the size of a walnut, newborn babies will want to feed very frequently, little and often, often dozing in between feeds and cluster feeding at certain times a day (often the late afternoon and early evening). Not only does this make sure you do not run away and leave them to fend for themselves, it helps them regulate their temperatures (which they are currently not great at doing), their heart and respiratory rates, prepares their immune systems, reduces pain or discomfort they may be experiencing, comforts them and reassures them. All they have known up until this point is your body, your sounds, your smell, your movements, and without an internal body clock telling them it's an unreasonable 1.30am, they are blissfully unaware of much that is going on beyond 'you'. So do not be disheartened if your new bundle doesn't like being put down, feeds around the clock, is grizzly in the early evening (just as you're wanting a shower or a hot meal); it is evolutions' way of making sure we very quickly get 'in sync' with baby.
Day 3 to 5, Milk Comes In
For the last weeks of pregnancy and the first few days after birth, your breasts will be producing a thick, golden substance called colostrum. This is rammed full of nutrients and things that help baby's immune system, it acts as a laxative to help baby pass their first stools (poo) and is very easy to digest, another reason newborns feed frequently in the early days. At around day 3-5 postpartum your colostrum will slowly shift to more mature milk, becoming paler in colour and more watery. It is accompanied with a lot of changes in your hormone levels and can be an emotional and overwhelming time. Your milk supply suddenly increases so you may feel engorged and this is a time where your risk of blocked ducts and mastitis, and sore or cracked nipples increases as you are trying to perfect baby's latch. Feeding frequently and on demand, responding to early feeding cues, can help with regulating milk supply and allow you to feel more comfortable. Remember, it is a two way relationship so if you're feeling overly full and uncomfortable, it is perfectly fine to wake baby for a feed to give you some relief. Hand expressing and reverse pressure softening can also be useful if baby is struggling to latch on to an engorged breast.
You may find your breasts leak between feeds, your milk ejection reflex is fast causing baby to struggle with flow rate. This usually subsides as your milk supply settles down over the next 6-12 weeks to meet baby's needs and baby gets bigger and more able to keep up. In the meantime, temporarily unlatching baby during your first milk ejection reflex can help if your flow rate is too much for them to cope with. If you find you are the opposite and struggling to increase milk supply, stimulate that milk ejection reflex or are under pressure to increase baby's weight gain, then the following may be beneficial:
Get comfortable: The hormone oxytocin (aka the love hormone) plays a big role in getting your milk flowing and for this hormone to kick in, you need to be comfy, relaxed, thinking of breastfeeding and close to your baby (ideally) or something that smells of them (for those who are separated from baby).
Breast compressions: Gently holding your breasts can help stimulate a milk ejection reflex, and once it has started, gently compressing the breast using a c-shaped hold can help increase the flow rate. This is particularly useful at increasing milk transfer to babies who are struggling to regain their birth weight or who need help removing bilirubin if jaundiced.
Offer both breasts: even if baby isn't interested, often by swapping breasts after they have finished the first, just stirs them enough to latch on to the other; this can be combined with breast compressions to increase milk flow so baby starts actively feeding again. Be sure to start with the second breast FIRST at the following feed if possible.
Getting Latched
Baby's often need a little practise at getting a decent, pain free and efficient latch. You are aiming to get your nipple to touch the soft palette (behind the hard palette, which is just behind the gum line). There are lots of videos available, and it is something I check in clinic, but you are wanting baby to come up underneath the nipple, level with their nose and their chin should touch your skin first as they tilt their heads back with a nice wide gape, before latching on deeply with a nice secure seal. There are many reasons this doesn't work out including incorrect baby positioning, oral dysfunctions, coordination difficulties, pain restricting movement, tongue tie, baby's maturity or the anatomy of your breast/nipples. However it is incredibly important that feeding is pain free and not causing any mis-shaped or damaged nipples. It is also important that baby is actively feeding and gaining weight as expected, producing the number of wees and poos for their age/stage in development, that they are happy and content during and after feeds and that you are happy and confident with your feeding relationship.
An incorrect latch can be a risk factor for engorgement, blocked ducts, milk blebs and mastitis so do seek help and support during the early days and weeks for a face to face appointment to check all is well.
What happens during an Infant Feeding consultation?
During an initial consultation, which lasts 45-60 minutes, I will go through a thorough medical history of how your pregnancy went, details of your birth including whether you had an assisted birth or a C-Section, whether baby was born prematurely or early term and whether there were any complications. I will also ask how your feeding journey has been so far including any interventions you may have had. I will ask you to describe a typical feed and a typical 24 hours of feeding and we will cover any problems or difficulties you are currently encountering. Lastly, I will cover baby's medical history including how their weight gain is going, how they are passing wees and poos, if they have any signs of neck or jaw problems, sleeping difficulties, colic or any suspected allergies or intolerances. Ideally I will get the chance to watch baby have a feed and will do a complete newborn examination checking for any anatomical or physiological restrictions that may be hindering their feeding. You will be given a complete report of findings during the initial consultation, an explanation of treatment options and if you would like to go ahead and it is appropriate to do so, baby will be given a gentle treatment during this appointment which may include massage, gentle stretches, chiropractic treatment and cranio-sacral therapy (sacro-occipital therapy, SOT). Any referrals or signposting will be made, support and exercises demonstrated for you to continue with at home so that you are empowered to continue to support your feeding relationship outside of clinic. Baby's usually respond really well to treatment, however I usually suggest a follow up appointment to see how you are getting on and will discuss with you a treatment plan if a series of treatments are required.
Breastfeeding is a wonderful thing and parents deserve to be supported in their infant feeding journey however it transpires. Do get in touch if you feel you need a bit of extra help along the way, so that you can move through this time with greater ease and support.
References:
Eckerman, H.A., Meijer, J., Cooijmans, K., Lahti, L., Weerth, C. (2024). Daily skin to skin alters microbiota development in healthy full term infants, Gut Microbes, 16(1), Available at: Daily skin-to-skin contact alters microbiota development in healthy full-term infants - PMC (nih.gov) [Accessed 30.3.24].
La Leche League International (2021), Breastfeeding skin to skin helps baby build a healthy immune system (online) Available at:Breastfeeding Skin-to-Skin Helps Baby Build a Healthy Immune System - La Leche League International (llli.org) [Accessed 29.3.24]
NHS (N.D), Skin to skin contact with your newborn (Online) Available at: Skin-to-skin contact with your newborn - Start for Life - NHS (www.nhs.uk) [Accessed 29.3.24].