Your questions answered (Ch 3)

I have very small breasts and am worried that I may not be able to produce enough milk to satisfy my baby’s needs.

Breast size is totally irrelevant when it comes to producing breast milk. Each breast, regardless of shape or size, has 15–20 ducts, each duct with its own cluster of milk-making cells. Milk is made within these cells and pushed down the ducts when the baby sucks.
During the early days, make sure your baby is put to the breast frequently. Most babies need a minimum of eight feeds a day to help stimulate the breasts and establish a good milk supply.
Always make sure that your baby totally empties the first breast before putting him on the second breast. This signals the breast to make more milk and also ensures that your baby gets the important hind milk.

My friend was in agony when her milk came in. Is there anything I can do to help relieve the pain of engorgement?

Put your baby to the breast often and do not let him go longer than three hours during the day between feeds or 4–5 hours at night.
A warm bath or warm wet flannels placed on the breasts before a feed will help the milk flow and, if need be, gently expressing a little milk by hand will make it easier for the baby to latch on.
Damp flannels chilled in the fridge and placed on the breasts after a feed will help constrict the blood vessels and reduce the swelling.
Take the leaves just under the outer leaves of a cabbage, chill in the fridge and place on your breasts inside your bra between feeds.
Wear a well-fitting nursing bra that supports your breasts. Make sure that it is not too tight under the arms and does not flatten your nipples.

Many of my friends had to give up breast-feeding because it was so painful.

The main reason women experience pain in the early days is because the baby is not positioned on the breast correctly. The baby ends up chewing on the end of the nipple, causing much pain for the mother, more often than not resulting in cracked, bleeding nipples and a poor feed for the baby. A pattern soon emerges of the baby needing to feed again very quickly, giving him even more opportunity to damage the nipples.
Make sure that you always hold your baby with his tummy to your tummy and that his mouth is open wide enough for him to take all of the nipple and as much of the areola as he can manage into his mouth.
Apart from ensuring that your baby is well positioned, it is important that you are sitting comfortably. The ideal chair should have a straight back, preferably with arms so that you can position a cushion to support the arm in which you are holding the baby (see here). If you do not support your arm, it will be much more difficult to position and support your baby properly. This can cause him to pull on the breast, which will be painful for you.

I have a three-week-old baby and am getting very concerned over the conflicting advice. Some people say give both breasts at each feed, others say one is enough.

Be guided by your baby. If he feeds from one breast, is content to go three hours between feeds, and is gaining weight steadily each week, one breast is obviously enough. Please remember that the three hours goes from the beginning of one feed to the beginning of the next feed.
If he is looking for food after two hours, or is waking up in the night more than once, it would be advisable to offer him the second breast. You may find he only needs the second breast later in the day when your milk supply is at its lowest.
Whether your baby has one or two breasts at a feed, always check that the first breast is completely empty before putting him on the second. This can be done by gently squeezing the area around the nipple between your thumb and forefinger.

Do I need to avoid certain foods while breast-feeding?

You should continue with the same varied, healthy diet that you followed throughout your pregnancy. In addition, you should include small healthy snacks between meals to help keep your energy levels up.
Ensure that you eat plenty of protein either poultry, lean meat, fish. Vegetarians and vegans should eat the equivalent in beans, pulses and grains, etc. I have noticed that on the days when some of my breast-feeding mothers did not eat enough protein, their babies were much more unsettled.
Some research points to dairy products as the cause of colic in certain babies. If you find your baby develops colic, it may be wise to discuss how to monitor your dairy intake with your health visitor or paediatrician.
Artificial sweeteners and caffeine should be avoided. Remember that caffeine is not only found in coffee, but also in tea, soft drinks and chocolate. I have found all of these things can upset most babies.
Strawberries, tomatoes, mushrooms, onions and fruit juice, if taken in large quantities, have left many of my babies very irritable. While I do not suggest cutting out these from your diet, I would suggest that you keep a record of any food or drink consumed 12–16 hours prior to your baby showing signs of tummy ache, explosive bowel movements, excessive wind and crying fits.
While working in the Middle East and Far East, I observed that breast-feeding mothers followed a much blander diet than normal, and that highly spiced foods were omitted from their diet. Perhaps it would be wise to avoid very spicy food in the early days.

My two-week-old baby wakes up yelling for a feed, only to fall asleep after five minutes on the breast. He then demands to be fed two hours later, leaving me absolutely exhausted.

Always make sure your baby is fully awake before you attempt to feed him. Unwrap him in the cot, take his legs out of his baby-grow and allow the cool air to get to his skin, and give him time to wake up by himself. Then you can start his feed.
It is very important that sleepy babies are kept cool while feeding. He should not be overdressed and the room should not be too warm. Have a play mat next to you on the floor and the minute he gets sleepy, put him on it. If necessary, remove his baby-grow, as this will encourage him to stretch and kick. Within a few minutes he will probably protest about being put down, so pick him up and give him a few more minutes on the same breast. This procedure often has to be repeated two or three times. Once he has had 20 minutes on the first breast, burp him well and change his nappy. He can then be put back on the first breast if he has not emptied it, or transferred to the second.
If possible, get your partner to do the late feed with expressed milk. This way, you will at least manage to get an uninterrupted few hours’ sleep for one part of the night.

My son is 16 weeks old. Over the last two weeks he has become increasingly difficult to feed. He dropped the middle-of-the-night feed at around 11 weeks old yet, despite not feeding after the late feed, he is fairly disinterested in his 7am feed, taking as little as 60ml (2oz). He then cries on and off until I feed him at 11am. When I feed him earlier than 11am he then does not sleep well at lunchtime, waking up after an hour looking for a feed. When I feed him then, it puts the rest of the feeds out for the afternoon.

To get your son more interested in his 7am feed, try cutting back on his late feed. Although he will need a small feed at this time, probably until he is weaned on to solids, try reducing it gradually to 90–120ml (3–4oz) and see if he is more interested at 7am. If this helps him feed better at 7am then continue to reduce the amount he takes then to 90–120ml (3–4oz).
If you find that by cutting back on the late feed your son starts to wake up earlier in the morning, I would recommend that you go back to giving him more at the late feed and accept that for a short while he will only take a smaller feed in the morning. This is better than him waking up earlier and needing to be fed again in the night.
Until he is feeding better at 7am you will have to feed him earlier than 11am, possibly by 10.15am, but I would suggest that you top him up around 11.15–11.30am to ensure that he has taken enough milk to ensure he sleeps well at his lunchtime nap.
You may also find that when he goes through a growth spurt he starts to take his morning bottle much more quickly and may even start waking up earlier, looking for a feed. When this happens I would suggest that you go back to giving him more at the late feed to ensure he gets through to 7am. You may have to do this for a week or so, and perhaps even continue with a larger feed until he is weaned. However, if he started to get fussy about the morning feed again, you would then have to cut back on the late feed once more.

You May Also Like

Guide to sleep required during the first year