The WHO recommends that all babies are breast fed for at least the first 6 months of life, and that breast fed babies need no other food or drink for the first 4-6 months of life.

Northumbria Health Care Trust aim to encourage and support breastfeeding mothers and their families. No commercial information encouraging the use of artificial milks will be displayed within the Maternity Unit. All Health Centres and Antenatal clinics should have prominently displayed and easily available information on breastfeeding and its benefits. All Health Care professionals who care for mothers and babies should be fully aware of breastfeeding benefits and actively encourage and help mothers to establish and maintain successful breastfeeding.

Breastfeeding has many advantages to both mother and baby:

(UNICEF AND WORLD HEALTH ORGANISATION)

Breastfeeding should be as unhurried and stress free as possible. Privacy should be maintained if required and the mother encouraged to find a comfortable position in which to feed. It is preferable to feed the baby immediately to prevent it becoming too distressed before being offered the breast, particularly if the mother lacks confidence in handling her baby. The mother should be shown verbally how to latch her baby on with as little "hands on" interference from the midwife as possible. It is very important to give praise and encouragement at this point, avoiding negative phrases which may diminish the mother's confidence in her ability to breast feed.

The baby should be placed facing the breast with his head, shoulders and body in a straight line. His neck should be slightly extended so that his chin is against the breast and his nose or top lip is opposite the nipple. The baby should always be moved to the breast, not the breast to the baby. The nipple should be gently brushed against the baby's mouth to elicit the search reflex. Once his mouth is gaping wide he should take the nipple in his mouth. Mothers should be warned that it is normal to feel a sudden pain for the first few sucks. If feeding is painful for longer than this it may be a sign that the baby is not properly attached and the mother should be shown how to gently ease her baby off the breast before trying again. The mother should be reassured that this initial sharp pain will only last for a few days.

All babies should be roomed in with their mothers to enable them to get to know their own babies' signals as quickly as possible and to allow quick access to the baby when he needs a feed. However it is recognised that some mothers may need help with their baby, particularly through the night, or if the mother has had a difficult birth and is exhausted or in pain. Exhausted mothers need to be treated with particular sensitivity, whilst actively encouraging breastfeeding.

Babies should be given the opportunity to breastfeed as often and for as long as they require. Early and unrestricted feeding encourages a good milk supply. Once breastfeeding is established the composition of breast milk changes during the feed from more watery low calorie foremilk to fat-rich higher calorie hind milk. Because of this it is important that one breast
is emptied at each feed with the baby being offered the second breast afterwards if necessary. Breast engorgement may sometimes be caused by limiting feeds, which causes the baby to be hungry more frequently, thereby taking large amounts of foremilk only which is quickly replaced. The baby may fail to gain weight despite the mother appearing to have an adequate milk supply. (RCM 1991).

Formula feeds should only be used in exceptional circumstances, and after discussion with the mother. Liaison with Paediatric staff will also usually be necessary in these circumstances. Babies who may require milk other than breast milk include:

Breast milk should be expressed and stored or discarded in these circumstances, to ensure future milk supply. It is preferable that babies who require expressed breast milk or formula are given it by cup, spoon or tube feeding rather than a teat and bottle.

The importance of night feeds

Milk production continues through the night and night feeds provide a substantial amount of the baby's milk intake in a 24 hour period. Night feeds should be encouraged not only to stimulate the breasts but also to help the mother to practice breast feeding while her breasts are soft. As hospital stays are often short these days it will give the mother more opportunity to overcome any problems she may encounter while help is easily available.

Expression of breast milk

Mothers may need to be shown how to express their breast milk for
the following reasons:

Breastmilk may be expressed by hand, by hand pump or electric pump. Mothers should be instructed on the importance of cleaning and/or sterilisation of all equipment used, particularly if the milk is to be stored and given to her baby later.

Mothers should be given both written and verbal information on how to hand express their milk as well as how to operate a hand or electric pump. Some breast pumps are more effective on some women than others, and the mother should be advised to try a few different pumps if possible if she is going to purchase her own.

Mothers who need to express their breastmilk on a long term basis e.g. pre-term baby on Special Care Baby Unit, often need particular help and encouragement. They will need to express their milk 6-8 times a day, including at least once during the night, to maintain their milk supply.

Storage of breast milk

Breast milk can be stored for up to 24 hours in the refrigerator, one week in the freezer compartment of the refrigerator and up to 3 months in the freezer. It should be stored in sterilised plastic airtight containers which should be labelled and dated and used in rotation. Breast milk should be defrosted in the fridge and can be kept for up to 24 hours. If it is defrosted to room temperature it should be discarded if not used. Breast milk should never be re-frozen.

Some common problems which may occur when breast feeding

Health Care Professionals should be regularly trained and updated on problem prevention and problem solving.

Post partum care of the breastfeeding mother and baby

On-going help is available from:

References and other useful reading