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One of the joys of my work is to assist mothers to breast feed well. Having looked after mothers and new born babies since 1978, I feel confident in giving practical advice about this important area of parenting.

I know that this is a complex field for many mothers. It is one where there is too much emotion and too many opinions on what and how you should feed and these opinions are often linked with guilt and judgement.

Let me state my opinion at once. Breast feeding is great if it goes well. The large majority of mothers in our culture can breast feed successfully but will gain some benefit from using top-up bottles of either expressed breast milk or formula at certain times. My aim is to support a woman’s feeding choices. In terms of your baby being healthy, happy and well-adjusted as an adult there are much bigger issues in play than whether they breast fed for one week or one year. Breast milk is neither gold or silver or any other element. It is food and it contains essential nutrition for the new born baby. I would vastly prefer that a mother fed happily with a breast-bottle combination than fed unhappily from sore nipples with limited volumes of milk. It is important to me that mothers both succeed in meeting their babies’ needs for growth and nutrition and that mothers enjoy the feeding experience.

Research into breastfeeding concerns was conducted by the US and published in the Paediatrics Journal (the official journal of the American Academy of Paediatrics).  The article is included below. The researchers identified common breast feeding problems and concerns for mothers. Their main point was that feeding problems lead to failed breast feeding. I agree and therefore try to manage and avoid these problems to the best of my ability.

1. Difficulty with breast feeding (experienced by 52% of participants)

• In this research, the term ‘difficult’ is a little vague however it probably means that the mother is not feeling confident with the process.
• Certainly breast feeding is a learned skill and many mothers take a number of days to find the correct position, timing, and length of feed for her and her baby.
• The main teaching from me is that a mother needs understanding and gentle support in these early days. It is common for mothers to report to me that the support given was not as flexible as they wished. Making a mother feel guilty about her feeding choices is, in my opinion, unprofessional and unethical.
• Mothers should not be disappointed if it takes several days to settle into a rhythm and a style that works for them.
• A common problem in the first few days is low supply. This can be helped with top-up bottles of formula after a short breast feed. This is particularity true for the first three days until a mothers’ milk ‘comes in’

2. Breastfeeding pain (experienced by 44% of participants)

• Painful nipples are common and this is supported by these numbers i.e. 44% of mothers were experiencing some pain.
• Breast feeding should be painless almost all the time.
• Nipple pain is almost always caused by a combination of events:
  • The feeds are a little too long (i.e. longer than about 8-12 minutes per breast)
  • The sebum (moisturiser) is removed by the baby’s suckling
  • The nipple becomes dehydrated and cracks
  • Once cracked it becomes sore and can bleed.
• Avoiding nipple pain can be done by:
  • Limiting feeds to 8-12 minutes per breast
  • Stopping the feeds if the baby is using mum as a dummy
  • Shortening the feeds to 5-8 minutes if the nipples start to become sore
  • Applying a water-proofing cream or ointment to the nipple after the feed. The aim is to prevent the nipple becoming too dry and cracking.
• One minor word of caution. Women with red hair often have quite delicate skin and may need to be very careful in caring for the nipples. Prolonged sucking at the breast in a red head is likely to lead to cracked, sore, bleeding nipples and then trouble in maintaining the breast feeding.

3. Milk quantity (experienced by 40% of participants).

• The volume of milk does vary from woman to woman.
• Milk volume varies through the day.
• Volumes are generally better in the morning and less at night.
• In some women, one breast produces more milk that the other.
• Some women have milk with higher energy density (full cream) some have lower energy (skimmer). These variations are caused by genetic differences and are beyond your control.
• Encouraging milk volume is important:
  • Empty each breast at each feed to the best of your ability
  • Maintain high quality nutrition for the mother (i.e. eat and drink well)
  • Be aware that while breast feeding, a mother’s energy needs increase by 50% to 100%. This is the most energy expensive time of a mother’s life.
• If in doubt (i.e. mothers is concerned that the baby is still a little hungry at the end of the feed) then add more milk. This will be most common in the evening and in babies growing strongly and who are destined to be tall. At these feeds, offer a top-up bottle of either expressed breast milk or formula.
• Do not leave a baby hungry at the end of the feed or they can lose confidence in the feeding and become cross about the feed even before it begins.

So in summary:

Breast feeding is something that I am very committed to supporting and I enjoy seeing mothers succeed in this area. I will always support a woman’s feeding choices as long as those choices meet her baby’s needs for growth.

All the best

Sleep well

Dr Brian Symon

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PEDIATRICS

Vol. 132 No. 4 October 1, 2013 pp. e865 -e875 (doi: 10.1542/peds.2013-0724)

Breastfeeding Concerns at 3 and 7 Days Post-partum and Feeding Status at 2 Months

Erin A. Wagner et al

OBJECTIVE:

We characterised breastfeeding concerns from open-text maternal responses and determined their association with stopping breastfeeding by 60 days (stopping breastfeeding) and feeding any formula between 30 and 60 days (formula use).

METHODS:

We assessed breastfeeding support, intentions, and concerns in 532 expectant primiparas and conducted follow-up interviews at 0, 3, 7, 14, 30, and 60 days post-partum. We calculated adjusted relative risk (ARR) and adjusted population attributable risk (PAR) for feeding outcomes by concern category and day, adjusted for feeding intentions and education.

RESULTS:

In 2,946 interviews, 4,179 breastfeeding concerns were reported, comprising 49 subcategories and 9 main categories. Ninety-two percent of participants reported ≥1 concern at day 3, with the most predominant being difficulty with infant feeding at breast (52%), breastfeeding pain (44%), and milk quantity (40%). Concerns at any post-partum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0–infinity]). The concerns yielding the largest adjusted PAR for stopping breastfeeding were day 7 “infant feeding difficulty” (adjusted PAR = 32%) and day 14 “milk quantity” (adjusted PAR = 23%).

CONCLUSIONS:

Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity.