Q&A: Breastfeeding

Mater midwives and lactation consultants Judy Cunningham and Susie Oram today chatted with mums online about breastfeeding. Our experts answered questions ranging from breast soreness, whether to wake bub up to feed and how to approach breastfeeding in the face of previous challenging experiences.

For those who missed today's chat, we have saved the questions and answers for you below.

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Questions and Answers

How do I know when my baby is hungry?

Babies have a clever way of communicating when they are ready for a feed. This is known as ‘cueing’ or ‘feeding cues’. Ideally, you want to offer a feed when your baby is exhibiting early feeding cues. These are behaviours such as a quiet, alert wakeful state, grunting or squeaking, mouthing, turning head to the side or fist sucking. This is when your baby is most organised and primed to feed, so is more likely to attach well and easily at the breast and feed and settle more effectively. 

If there is a delay in responding to these cues, babies will progress to the late feeding cues. Feeding behaviours become more disorganised and it becomes more difficult for your baby to attach at the breast and feed well. Typical late feeding cues include agitated movements, turning red in the face and importantly crying.

My six week old baby has started feeding more than usual. Is this normal?

As your baby grows their demand for breast milk increases. In order to provide this, the baby will demand more frequent breastfeeds, usually for the period of 24-48hrs. Babies tend to have growth spurts around 6 weeks of age and they can cluster feed at this time. It's often normal for babies to feed up to 12 times a day during this period of growth.

I've taken my premmie baby home, he's now 36 weeks.  My friends tell me to never wake a sleeping baby to feed him but I've been told to wake him every three hours.  Which one is right?

You should be waking your baby if he is still asleep after four hours, but this also means if your baby wakes himself up after less time, you will feed then. Premmie babies can be sleepy and if left to wake for their own feeds, they may not take in enough nutrition throughout the day. They can be sleepy because they're still developing. It's also often necessary to continue to express once or twice a day to keep your milk supply above what your baby is drinking, to maintain a good supply.

Is it normal to have quite a painful letdown, my left breast is always tender and sore, no lumps, but my 7 week old is a good feeder. I’m just always a little sore?

It shouldn't be tender and sore after seven weeks. We would really recommend that you see your GP or you could come in and see one of our lactation consultants at the Breastfeeding Support Centre. A letdown can feel like intense tingling in your breast, but it shouldn't hurt and it should settle within seconds. You shouldn't have prolonged pain.

Can I drink alcohol when breastfeeding?

The current Australian guidelines recommend that, for women who are breastfeeding, not drinking alcohol is the safest option.

Alcohol in your bloodstream passes into your breast milk and reaches concentrations similar to that in your blood. The level of alcohol in your breast milk will decrease as you metabolise the alcohol in your blood stream. Your baby will metabolise and excrete alcohol more slowly than you will. Even relatively low levels of alcohol intake may reduce your milk supply and possibly cause irritability, poor feeding and sleep disturbances in your baby.

You should avoid alcohol in the first month after birth until breastfeeding is well established. After that:

• your alcohol intake should be limited to no more than two standard drinks a day 
• if you wish to drink alcohol you should consider expressing in advance. It is not necessary to express and discard breast milk, except for your comfort when you are not feeding for an extended time. 
• It takes approximately two hours for the average woman to completely eliminate one standard alcoholic drink, four hours for two drinks, six hours for three drinks, and so on.

For more, you can see our brochure here: http://brochures.mater.org.au/Home/Brochures/Mater-Mothers-Hospital/Alcohol-use-during-pregnancy-and-breastfeeding

You've mentioned the Breastfeeding Support Service ... what can you help with and do I need a referral? 

To make an appointment with the Breastfeeding Support Centre, please phone 07 3163 8200. No referral is required. We are open 7.30am to 4pm, Monday to Friday. Our last appointment in the afternoon is usually 2.30pm. It costs $100 per visit and if you have private health insurance you may be entitled to a rebate. A consult generally lasts for about an hour and a half.

At what age is my baby’s tummy big enough to skip the midnight breast feed?

Basically your baby can go longer between feeds at night when they are ready: there is no set age. Generally, the more frequently babies feed during the day can lend itself to them sleeping longer between feeds during the night. In very hot weather, babies might sleep more during the heat of the day and wake more for feeds during the evening when it's cooler.

My bub seems really constipated. I have done massage, used a warm face cloth, pear juice. I am breastfeeding and topping up with formula... do you have any other suggestions? My baby is 3 weeks, 5 days. 

I had to take iron due to blood loss, but I have stopped taking it over the last two days. I was topping her up with 60mls three times a day as my milk took a long time to come in. She lost a lot of weight, but we are now above her birth weight so have cut the formula back to once a day and will only top her up if she seems unsettled and my breasts are empty.

A baby who is feeding well at the breast may have 3 or more yellow poos a day until they are 5-6 weeks old. After 6 weeks, when your milk supply is matching your baby's needs, your baby may only poo once a week. The more breast milk your baby has, the less chance for constipation. It's not about the frequency of the pooing - if it's hard pebbles, that's constipation, but if they're less frequent but still soft and yellow, that's pretty normal. 

If you're concerned though, please make an appointment to see your doctor. It also might be good if you express after some feeds until you are able to replace any top-ups that you need to give with breast milk as formula can pre-dispose them to constipation, as well as slow down your milk supply. 

It's important to keep an eye on the number of wet nappies (at least 5 heavy wet nappies a day) and yellow soft poo. Frequent breast feeding is also important (at least 8 times in 24 hours), even if it's every couple of hours for a few days to boost your milk supply. The constipation should then resolve itself.

I am due with my third bub at the Mater Hospital at the end of May.  I only breast fed my son for 6 days and breast fed my daughter for 24 hours (she had severe silent reflux and CMPI).  I would really like to try and breastfeed my third bub but am a bit scared of my failure rate.  

When at the Mater Mothers I did ask for assistance with latching and the midwives would put bub on and leave the room - I never really got the gist on how they attached them properly and when I went home I really struggled and suffered with bleeding nipples, blisters etc.  Any tips?

We're sorry to hear you're worried about breastfeeding your next bub. We would encourage you to come in for an antenatal breastfeeding consultation so that we can talk to you about what has happened previously and to help you put some strategies in place for after you deliver. Even though it has been difficult in the past, with this baby breastfeeding may be a very different experience for you. There are also lactation consultants who can visit you on the ward and assist with the early days of breastfeeding. Please remember that breastfeeding isn't instinctive, it's something that is learned and we're here to help so you have the best experience with your baby!

I am planning to go back to work but would still like to breastfeed if possible. Can I feed my baby formula as well as breastfeed?

Great question! If it is possible for you to express your breast milk at work, this might be a good option. Generally workplaces should provide an area for breastfeeding women to express (and this isn't a toilet!). Aside from that, if you'd like to use formula during the day and breastfeed only in the evening, your milk supply will start to adjust. The longer that your baby gets some breast milk, the greater the benefits to both you and your baby. We've got more info in a brochure, if that helps: http://brochures.mater.org.au/Home/Brochures/Mater-Mothers-Hospital/A-guide-to-breastfeeding

This will be my third C-section - and I have found my milk doesn't actually come in until day 4 but both of my previous bubs have screamed every half hour for a feed and didn't appear to be getting much to drink.  

I even expressed with a machine while in hospital and nothing came out.  How do I know if bub is getting enough? I think this was another reason why I gave into formula last time.

It's normal for milk not to come in until day 4.  There is no real way for us to tell if they are getting enough in the first few days, but if you feed your baby frequently (8-12 times) in a 24 hour period and by watching how they drink, we can help you get an idea of whether bub is getting enough. The colour of their poos will also change as a sign that they're getting colostrum to drink. If they're getting stressed out, perhaps do some skin-to-skin contact as they'll likely be happier. But we can cover all of this with you, and give you some extra resources, when you come in for an antenatal appointment.

Just wondering how I tell if bub has gotten to the hind milk or not. My two week old has on average 10 minutes on each side and has the occasional little vomit after feeds.

That sounds pretty normal. There is no obvious point where fore milk finishes and hind milk starts, but the emptier your breast becomes (lighter and softer) the higher the fat content will become which is good. Just make sure the first side feels softer before changing to the second side. Having said that, if your baby isn't unsettled, then it sounds like you're doing a good job! Babies often bring up a bit of extra milk after a feed.

My three-month-old refuses to feed when we’re not home. This has been going on for a few weeks now. She's exclusively breastfed and doesn't take bottles. She also feeds two hourly so I can't really leave the house! Is this normal? Is there anything I can do?

That’s pretty normal because babies at that age can be easily distracted by their surroundings! They like to see who mum is talking too, what's going on around them and so on. It sounds like she's on track developmentally. Because of all the distractions, they will generally feed more at home when there are fewer things to look at. You can try feeding in a quiet place when out to minimise distractions or, if the baby is pulling off to look around, perhaps change positions so they can see more while feeding.