Breastfeeding is quite literally one of the most natural things in the world, yet for many of us it just doesn’t seem that easy!  From sore nipples to mastitis, tongue-tie to twins, the one thing you can be sure of is that you’ll have one or two questions along the way!  Here, expert midwife Nikki Khan answers some breastfeeding questions from real mums…

  • I am booked in for a c-section in 10 days, how will this affect the way my milk comes in? The baby is very big for dates, so they have recommended the c-section at 38 weeks, will this have an impact do you think? I’ve heard people recommend expressing colostrum a day or two before the section to ‘get things going’ – is that a good idea?

You are likely to have enough going on just before going in for a c- section and although some mums swear by pumping a day or two before caesarean, it is not always necessary. What is more important is that your little one gets an early feed in within the first hour of birth. The theatre and midwifery staff by giving skin to skin contact as soon as possible and initiating a feed lying down in the first hour after birth. If you have a spinal this is not a problem although if you need a general anaesthetic there may be a slight delay in the first feed and depending on the drugs used during the operation some babies born by caesarean can be little drowsier in the first 24 hours. Therefore you may need to be a bit more proactive in waking your little one for feeds every 3-4 hours but you will be guided in this by the midwifery and paediatric staff at the hospital

  • My nipples are so sore, cracked and feeding (latching on in particular) is really painful – what can I do to relieve the pain? I’ve tried all the usual ointments, but nothing is helping and when I tried nipple shields, my daughter couldn’t latch on properly.

You poor lady! Firstly you need to address why they became sore and check your latching technique, so that once the nipples have healed, the problem will not recur. Positioning is paramount for both you and your baby and using a good nursing pillow is essential to ensure the position of the baby is maintained during the feed in the early days. Even though the nipples are cracked, if your baby is positioned correctly, the nipple will not be further damaged. So ‘nose to nipple’; ‘tummy to tummy’ and you take baby to the breast not the breast to baby! Changing the way you feed can also help. If you normally feed in a rugby hold, try the cradle hold as this enables your baby to feed on a different, less sore part of the nipple. Try expressing a little milk on to the nipple after a feed and leaving them exposed to the air can help. Also if one side is particularly sore you could rest that side & gently hand pump from it to maintain supply to give the nipple a chance to heal. Good luck!

  • Does what I eat directly affect the baby when breastfeeding? Are there any foods that I should be avoiding?

There are certain things to have in moderation when breastfeeding such as alcohol (1-2 units per week), and caffeine as about 1% of your daily cup of coffee can appear in breast milk. Some mums avoid foods containing nuts especially if they have a tendency to asthma or are allergic to peanuts themselves. Certain foods can also trigger colic in breastfeeding babies and these include broccoli, onions and spicy foods! It is advisable to ensure you keep your fluid intake at between 1-2 litres a day and a Vitamin D supplement is often recommended! So try to maintain a healthy well balanced diet and you will be fine !

  • I’m currently breast and formula feeding but when I miss a breast feed and replace with formula they get quite hard towards the next feed and curious to know if this would decrease the amount of fatty milk I make? I’m worried there is too much fore milk as sometimes my babys poops are a little green in colour where as when I was exclusively breast feeding they were just yellow?

As you are mixed feeding now, your breasts are still working on a supply and demand basis so if you miss a feed that is usually a breast feed the milk will still be produced . If it is not used for that feed it will reabsorb eventually. It is essential that your baby has the benefit of foremilk and hindmilk during the feed, so one breast should be emptied before offering the second one to ensure your baby benefits from the fatty content of the hindmilk. The change in poo colour is to do with the different consistencies of milk as many artificial fed babies are more prone to constipation

  • I want to express, so that my husband can give our son the occasional feed. When is the best time to start expressing?

Expressing can start once breast feeding is established to avoid any problems with ‘nipple confusion’ when feeding expressed, breast milk via bottle. For some mums this may be around the 2-4 weeks stage, but each baby and mum are different.

  • Breastfeeding has been going really well, my little girl is latching on and seems to be really settled, so far! The only problem is that my breasts are very hard and getting more and more sore – I’ve been feeling unwell too today, does that sound like I’m getting mastitis? Is it possible to produce too much milk?

 As breastfeeding works on supply and demand, it may be that the breasts are being over stimulated if you are expressing too, and your baby is unable to empty the breast fully at each feed. Signs of mastitis are when the breast is hard with red areas and tender to touch. If associated with cracked nipples, it can cause a high temperature & you may feel overtired and unwell. Warm flannels or compresses before a feed can ease discomfort & aid milk flow and cool flannels after a feed can ease the discomfort and heat on the breast. However, as you are feeling unwell it would be worthwhile seeing your GP as mastitis often needs treatment with antibiotics.

  • I breastfed my twins who are now 2 with no problems, but with my daughter (6 weeks) I’m finding that by the end of the day I have no milk left. I’m pretty exhausted running around after the twins too, so maybe that’s why, and I know that we’re told our bodies will produce enough milk regardless, but I honestly don’t feel that I am! She feeds and feeds in the evening and we’re both really tired and frustrated. Is this a common problem and have you got any suggestions?

This is not unusual when you are running around after two little ones!! Not getting enough rest can inhibit the let down reflex which releases the milk to the nipple. Also, even though it is considered that your body produces enough milk even if you are not drinking enough, the quality of your milk may not be sufficient, so you should drink between 1.5 to 2litres water a day. Also try some Fennel tea.. It can help stimulate your milk supply & it worked for me when I was breastfeeding!! Finally, I know you’re an old hand at this, but it may be that she is not always crying for a feed at night as she is now 6 weeks, but may have some colicky symptoms or be overtired… Things will improve…Hang in there!!

  • My little man was tongue tied, had it snipped at 8 weeks and improved with feeding and weight gain. He is now 18 weeks and has started refusing, pulling away from me while feeding. He’s getting frustrated and I’m starting to feel rejected. Any thoughts on what could be going on?

If you have been breastfeeding successfully up till now it is unlikely to be your technique, so it may be advisable just to get your GP to check that the tongue tie , even though snipped has healed correctly and not causing the little one any problems. Also you will find that as your baby gets older the duration of the feed is less as he is much more efficient with his technique and he may also be going longer between feeds. As long as he is still gaining weight, continuing to have wet nappies and settled following the feed, there is not a need for concern. He may also need more regular winding as he is coming on and off the breast more with the feeds..

  • At night, my son suffers with wind and tummy ache, which is making things tough for us all. I thought that breastfeed babies were less prone to this than bottle fed babies? Is there anything that I can do, or that I shouldn’t eat to help with this? Any tips gladly received!

It may be that your baby is taking in too much air with his feeds or is coming on and off a lot which can cause him to swallow a lot of air sometimes. So check your latching technique to ensure he is feeding and not just snacking! Breast fed babies can get colic & these symptoms normally present at night from about 3 weeks of age until around 3 months old. Certain foods you eat when breastfeeding can trigger colicky symptoms in babies. Examples of this are foods such as broccoli and onions. Anti colic massage on the tummy can help after a feed as can the calming effect of ‘white noise’, fans, washing machine!!

  • I’m breastfeeding my son who’s almost two weeks old. I’ve been feeling unwell today and I have a very sore throat and tickly cough. Is there anything I can take for this – are cough medicines or lozenges ok to take when breastfeeding?

It is advisable to avoid cough remedies when breastfeeding, so always check with your pharmacist first as cough medicines often have a variety of ingredients some of which cannot be taken when breastfeeding. These include phenylephrine (for blocked noses), phenylpropanolamine (a decongestant found in some cold medicines) & guaifenesin (an expectorant (to bring up phlegm) found in some other cough medicines). Menthol lozenges should be fine but again, always check with the pharmacist first.
Consequently try a simple home made linctus of warm water, honey and lemon juice and rink lots of fluids. The honey helps soothe the throat, relieve irritation & actually works!

  • My little girl is nearly four weeks old and I’ve been breastfeeding her on demand. She seems satisfied when I feed her, but when I try to express hardly any milk comes out. Does this mean I have a poor milk supply?

It can depend when you are expressing. The best time to express is first thing in the morning as due to the high prolactin hormone levels at night, this is the time when both breast are fullest! So feed on one side and express the other one off. If you are expressing after a feed, express off the side that she has not fed much on. So you would feed on the right side and when she has finished, offer the left, but this second side is often never as long a feed as the first breast. Also remember that the pump is never as effective as your baby suckling, so you may need some practice!

  • I really want to try breastfeeding when my baby is born – currently 32 weeks, 8 to go yay! – but I have got very flat nipples and I’ve heard from friends that this can make it difficult for the baby to latch on? Is this true? Is there anything that I should do, have to hand which will help?

Inverted or flat nipple nipples are not usually a problem once breastfeeding is established as the baby will suck the nipple out during a feed as long as he is latched on correctly. There are things in the market such as a ‘Nipplette’ which can help draw out the nipple and is ideally used in the first 6 months of pregnancy but this does not work for everyone! Flat nipples affect up to 10% of women and can make initiation and establishing breastfeeding difficult for both mum and baby. The reason for flat or inverted nipples is because of short lactiferous ducts, which tether the nipple and prevent it coming out. Extra support with positioning and attachment may be all that is needed in the early stages, and remember babies breastfeed not nipple feed!