The Essential Guide to Breastfeeding in North East Essex 01255 202714

The Essential Guide
to Breastfeeding
in North East Essex
2012/13
designed by nature, made by mum
Local
Breastfeeding
Support
01255
202714
Available 9am – 5pm
Monday to Friday
Out of hours please leave a
message or call the National
Breastfeeding Helpline:
0300 100 0212
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Please keep
this handy
with your
maternity
notes
What’s in this issue...
4. North East Essex Community
Breastfeeding Guidelines
County commitment to families
5. Making Milk
What happens when
6. Breastfeeding Positions
Different ways to position your baby
8. How to spot when your baby wants to be fed
What are your baby’s feeding cues
9. Good Attachment
A picture guide to attaching my baby properly
10. Hand Expressing
Why’s and how’s of hand expressing
11. Physical Challenges
Troubleshooting common problems
12. Baby’s Nappies
What is normal and when
13. Myths and Misconceptions
Topping up, not enough milk, mastitis...
14. Myths and Misconceptions
Returning to work
15. Breastfeeding and the family
How family members can help
16. Special Circumstances
Breastfeeding - Preterm or poorly baby, while
pregnant, older children or children
17. Introducing other foods
When to introduce other foods, recognising the signs and first foods your baby might try
18. Children’s Community Services
The Children’s Community Services team
19. Local Breastfeeding Support Team
How ‘Pink Ladies’ can support breastfeeding
20. Volunteers working with the Children’s
Community Services & ‘Pink Ladies’
‘Breastfeeding Champions’ are volunteer
mums who have breastfed their baby
21. ‘Baby Beginnings’
Breastfeeding Support Groups
22. Support & Information
National and Local Helplines and Websites
23. Breastfeeding friendly venues
Breastfeeding friendly places across
North East Essex
The Real Baby Milk project wouldn’t be possible without the support and
help from so many people and organisations
Real Baby Milk was started by Cornish mum of three, Arwen Folkes, in 2005 after having a challenging time
breastfeeding her first baby but succeeding due to the right information and support being available to her.
The Essential Guide is designed to enable women to have easy access to the correct information and support
that is available to them, giving them the best chance of succeeding too. Real Baby Milk is not for profit and
run by mums, for mums.
Many people and organisations have supported the project over the years and we are grateful to them all –
but in particular: Helen Shanahan, Stephanie Heard, Mary O’Connell, Cornwall Council Family Services, Royal
Cornwall Hospitals Trust and the volunteer mums across Cornwall all ready to support you and your baby.
Hayley Hill – Breastfeeding lead for Anglian Community Enterprise CIC (ACE) has been a
particular help putting together this guide and we’d like to say a big thank you to her for her
patience and hard work bringing it all together.
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Keep in touch
with Children’s
Community Services
and the ‘Pink Ladies’.
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www.facebook.com/
BabyBeginningsBreastfeedingSupport
Follow us on Twitter @ baby_beginnings
Look out for further leaflets
in our series of publications
2 realbabymilk.org
Local Breastfeeding Support: 01255 202714
Skin to skin
Keeps baby warm
Calms baby’s heartbeat
Reduces mum’s and baby’s stress levels
Regulates baby’s breathing
Helps with baby’s first feed
Why breastfeed?
Breastmilk is your way of providing your baby with all the nutrients he/she needs. Breastfeeding not only
benefits your baby but you too. The World Health Organisation recommends exclusive breastfeeding
for about the first 6 months and continued breastfeeding alongside other foods beyond your baby’s first
birthday. This will give your baby the best start in life. However, any amount of your breastmilk will always
be good for your baby’s health and wellbeing
Helps protect you against
P
P
P
P
P
Breast cancer
Ovarian cancer
Osteoporosis (weak bones later in life)
Obesity (helps you lose weight)
Diabetes
Helps protect your baby against
P
P
P
P
P
P
P
Severe diarrhoea and vomiting
Chest infections
Asthma
Eczema
Ear infections
Obesity
Diabetes
Getting off to a
good start...
Early skin to skin contact with baby This
is important for all babies for their health
and well-being and tells your body it’s time
to make milk!
Early feed Baby receives vital colostrum,
‘nature’s first vaccine’ and your milk supply
is kick started.
Baby led feeding Let your baby lead the
feeding, feed them whenever they ask.
Frequent feeding will tell your body when
and how much milk is needed
Make sure your baby is well-attached Ask
a midwife or visit a support group for help.
Learn how milk is made - understand what
your body is doing!
realbabymilk.org 3
Parent’s Guide to the North East Essex
Community Breastfeeding Guidelines (ACE 504)
Staff support the right of all parents to make informed
choices about infant feeding. All our staff will support
you in your decisions. Breastfeeding is the healthiest
way to feed your baby and we recognise the important
benefits which breastfeeding provides for both you and
your child. We therefore encourage you to breastfeed
your baby.
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How we will help mothers to breastfeed successfully
All staff have been specially trained to help you
breastfeed your baby.
During your pregnancy, you will be able to discuss
breastfeeding individually with a midwife, health
visitor or breastfeeding supporter who will answer
any questions you may have. A midwife and
breastfeeding supporter will be available to explain
how to put your baby to the breast and help with
feeds in the early days. A health visitor will provide
support later on.
A midwife will show you how to express your
breastmilk before discharge home from hospital
and will give you written information about this.
A health visitor and breastfeeding supporter will
discuss hand expression.
We recommend you hold your baby against your
skin as soon as possible after birth and keep him or
her near you whenever you can so that you can get
to know each other. We will give you information
and advice about how to manage night feeds. We
will encourage you to feed your baby whenever he
or she seems to be hungry (baby led feeding) and
we will explain to you how you can tell your baby is
getting enough milk.
We recommend that you avoid using bottles or
dummies and nipple shields while your baby is
4 realbabymilk.org
learning to breastfeed. This is because they can
make it more difficult for your baby to learn to
breastfeed successfully and for you to establish a
good milk supply.
Most babies do not need anything other than
breastmilk until they are around six months old. If
for any reason your baby needs some other food or
drink before this, the reason will be fully explained
to you by the staff. We will help you recognise when
your baby is ready for other foods (normally at
around six months) and explain how these can be
introduced.
We welcome breastfeeding on our premises and
can give you information on breastfeeding friendly
places to help you breastfeed when you are out and
about.
We will give you contact details of your local
breastfeeding supporter and a list of people
you can contact for extra help and support with
breastfeeding, or who can help if you have a
problem.
Hayley Hill - Breastfeeding Lead
Tel: 07768 401239
[email protected]
Making Milk
What happens when?
At Birth
Day 2 / 3
Mum’s breasts produce very special milk –
‘colostrum’. This is thick and concentrated and
may be clear, white, yellow, green or red in
colour! These colours are normal and colostrum
contains precious antibodies to protect baby from
infections. Colostrum has a strong laxative effect
which the baby needs to clear its gut of sticky
meconium poo. Colostrum comes in very small
amounts as the newborn baby has a stomach the
size of a marble and is meant to take frequent
small feeds. The amount he takes gradually
increases over the first few days.
Baby feeds furiously and appears very hungry.
Baby is actually sending signals to mum’s
breasts to let them know it’s time to make more
milk. Mum can think baby is starving and that
she hasn’t made enough milk for her baby. In
fact, there is no need to panic - as long as baby
is fed when he wants and for as long as he
wants, the right amount of milk will be made.
Giving formula milk will interfere with this
process and less breastmilk will be made.
Day 3 / 4
Day 5
Mum’s milk starts to ‘come in’, her breasts often
feel heavy and there is also a hormone surge
at this stage which can make mum feels very
‘bluesy’. Mums can often feel highly emotional
and may associate this with breastfeeding. This
is all normal and begins to settle down within
24-48 hours. If mum continues to feed the baby
whenever he asks, for as long as he wants, her
body will know how much milk is needed.
Baby may lose a little weight - this is very
normal for all babies, provided that the weight
loss is less than 10% of baby’s birth weight. If
the weight loss is close to or greater than 10%,
your midwife will discuss this with you and help
you make a plan to increase the effectiveness
of feeding. Either way it’s important that baby
continues to feed on demand (at least 8 times
in 24hrs), so mum’s breasts make plenty of milk
and baby soons regains the weight.
Around weeks 3, 5/6 & 12
Baby has a feeding frenzy, also known as a growth spurt, which may last a few days. This is normal and is
the baby’s way of telling mum’s body that he is growing and developing and needs mum to make more
milk. Mum may worry that she is not making enough milk and be tempted to give formula. However, giving
formula will interfere with the ‘supply and demand’ process and may reduce mum’s breastmilk supply.
If mum continues to follow baby’s feeding cues, feeding as often and for as long at the breast as baby
requires, she will make the right amount of breastmilk to meet baby’s changing needs.
realbabymilk.org 5
Breastfeeding Positions
There are several ways to hold a baby to breastfeed, and we hope you find this
guide to them useful - but it is important to note that all of them have things
in common:
The position must be comfortable for you to stay in throughout the feed.
The baby needs to be held close to your body, facing your breast.
The baby’s nose should be opposite your nipple at the start
The baby’s head, neck and body all need to be in a straight line (head and neck not twisted)
The baby’s head must be free to tilt backwards as he is brought into the breast.
P
P
P
P
P
Cross Cradle Hold
P
Useful when you are just learning
1Use your fingers under the baby’s neck, so the weight of her head is supported, but make sure her head is free to tilt back between your thumb and finger.
2 The palm of your hand supports your baby’s shoulders and you can press on her shoulders to bring her into the breast
when ready.
3Your forearm can tuck the rest of the baby’s body close to you
while she feeds.
Underarm Hold
Useful if you have:
P A small or pre-term baby
P A Caesarean section
P Large breasts or inverted nipples
6 realbabymilk.org
1
2
3
4
The baby is usually held on a pillow, just
under breast height, turned slightly
towards you.
It is very important that the baby is held
very close to your side but is not able to
touch anything (eg the back of your chair
or your cushions) with her feet, otherwise
she will push with her legs and will come
too far forward.
Support your baby’s neck and the weight of her head in the same way as in the cross cradle hold - so her head is free to tilt back.
When the baby feels your nipple against
her nose, her head will be free to tip back
between your finger and thumb as you
press her shoulders in towards your breast.
Lying Down Hold
Useful if you have:
P Painful stitches or haemorrhoids
P A Caesarean section.
P Also helpful if you are tired and need to feed and
rest, but make sure it is safe for your baby if you
were to fall asleep while feeding.
1You need to lie on your side with your head on the pillows and
your shoulders on the mattress.
2 Bend your legs slightly but not enough for the baby’s legs to
touch your thighs.
3 The baby should be on his side facing towards you with his nose
opposite your nipple. Make sure none of your arm is pressing on
the back or top of his head. His head must be free to tilt back.
4 You need to press on the baby’s shoulders with your upper hand
(or sometimes the fingertips of your lower hand) to bring him
to the breast when he is ready.
Cradle Hold
The position most mums
use instinctively
Your hand needs to be supporting
your baby’s shoulders and make sure
he is free to tilt his head back out
over your wrist.
The “Laid Back” Approach
Another way to enable
baby to access the breast is
to place baby on your body
and allow her to self attach.
You need to be reclining
so that baby feels secure.
You may need to support
baby and /or your breast.
Positioning you and your
baby in this way can help
to gently encourage skin to
skin and body contact, and
to enjoy closeness without
either feeling any pressure
to ‘get on with’ feeding.
Instead, this position
encourages your baby to
use natural reflex behaviour to help him/her find the breast
and feed effectively when ready. Enjoying time together
in this way helps you and baby to have eye contact while
feeding and for both of
you to relax and make
the most of these
special times. NB: also
known as Biological
Nurturing, see www.
biologicalnurturing.
com for more
information.
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How will I know when my baby needs to be fed?
Feeding Cues: P Hands to mouth P Turning head
PLicking lips
P
Mouthing
P Squeaking noises PLight fussing
P
Rooting (moving mouth and head as if looking for a feed)
Safe Sleeping
The safest place for your baby to sleep is in
a cot or a crib in your room for the first 6
months. It is important never to fall asleep
with your baby on a sofa or armchair.
Bringing your baby into your bed means
you can breastfeed in comfort. There are
important points to consider before taking
your baby into bed with you.
Bed sharing is not appropriate if:
• Either parent is a smoker
• Either parent has been drinking or
has taken drugs which make them
very sleepy
• Pets or older children are also sharing the bed
• You are sleeping on an old or sagging
mattress
• You or your partner are overweight
• Your baby is formula fed
Parents must ensure baby cannot:
• Fall off bed
• Get entangled or overheated or
become covered with pillows or duvet
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How do I know if my baby is
attached properly?
P
Your baby should have a large mouthful of breast
P
Your baby’s chin should be indenting the breast
P
Your baby’s cheeks should be full and rounded
P If any areola is visible, there should be more
above the top lip than below the bottom lip
P Your baby’s suckling pattern should change
from rapid sucks to slow rhythmic suckling, and
swallowing may be heard.
P Your baby may pause from time to time, and will
start suckling again without coming off or having to
reattach.
P Your baby should be relaxed and contented
throughout the feed and should come off your breast
on his own when he is finished. Your nipple should
look the same shape as when the feed started
P The feed should be pain-free and comfortable
for you, although the first few sucks may feel quite
strong.
P Initial attachment may hurt for 10-20 seconds
if your nipple is already damaged but the rest of the
feed should be pain-free.
Good Attachment
Good attachment really is the key to successful breastfeeding. Use this guide to
get it right from the start, but if you find you are still struggling - ask for help!
Before you start - Make sure baby’s head, neck and body are in a straight line - a baby cannot suckle or
swallow easily if the neck is twisted. Good attachment is difficult for a baby to maintain if his body is
twisted at the waist. The baby should be held so that the back of his shoulders is supported, and his head
is free to tilt back. Please see Page 6/7 for tips on positioning baby so that he can attach effectively to the
breast. If you are at all unsure about the attachment of your baby, seek help from your midwife, health
visitor or maternity support assistant. You can also visit your local support group. Someone observing how
your baby feeds can really help to get it right.
1. The baby should face the breast with nose to
nipple - this allows the baby to tilt his head back so
that the nipple is aimed at the roof of the mouth
2. When baby gapes wide open,press on the back
of his shoulders to bring him in quickly - and you
will need to move quickly!
3. Chin and tongue leading, head tilted back, the
nipple goes into the back of roof of mouth as baby
is brought towards the breast.
4. Attachment shouldn’t be painful, baby should
keep suckling and should let go on his own at the
end of the feed. The nipple should look the same
shape as before the feed.
To see more examples of good attachment, see the ‘Breastfeeding, by Mums, for Mums’ DVD
(£7.50) - it is available from www.realbabymilk.org/shop
realbabymilk.org 9
Hand Expressing
Why express by hand?
Storing expressed breastmilk
PIt can be used to help the baby attach
to the breast
P It can help to prevent or relieve
engorgement
P It is particularly useful for milk in very
small quantities, e.g colostrum
P It can be used to help clear
blocked ducts
PIt can be more effective than a pump
P It’s free - no equipment needed!
Breast milk should be expressed into a sterile
container if the baby is under 6 months old.
For healthy term babies it can be stored at :
P Room temperature for up to 6 hours
P At the back of the fridge (not the door)
for 5 days at 4° or lower
P In the freezer at -18° for up to 6 months
P For preterm or vulnerable babies, check with your local Neonatal Unit
for guidance as storage is likely to be
more cautious.
1. Roll your nipple between your finger and thumb to make it stand
out. Make a C-shape with your thumb and either your index or
middle finger, and cup your breast.
Feel back from the end of the nipple to where the breast tissue feels
different, about 2-3cm from the nipple, as shown in Fig.1. You may
feel a change in the breast tissue at this point, sometimes it feels
‘knobbly’, sometimes slightly firmer. You are now touching the skin
above the dense, milk-making tissue
2. Holding your finger and thumb in this C-shape, press back
towards your rib cage, as in Fig.2.
This brings your finger and thumb back into the dense, milk-making
tissue, away from the ducts near the nipple.
3. Bring your finger and thumb together, so that they press into the
milk-making tissue, and milk will begin to appear in droplets, as
shown in Fig.3.
Use a sterile cup or bowl to collect it, and try to build up a rhythm.
Try not to slide your fingers over the skin, as this will hurt and it
will be more difficult to express milk. When the flow slows down,
move your finger and thumb around the breast or express from the
other side, and you can keep changing breasts until the milk slows
or stops.
Practice makes perfect!
If you are doing this when your milk supply is not yet established,
you may need to repeat these 3 actions a few times to get the
colostrum to flow and you may get 1-10mls (up to 2teaspoons
full). You can keep moving your finger and thumb around or use
the other hand to take milk from all around the breast, but the
technique should remain the same each time. If your milk supply is
established, the milk may spray out in several different directions.
If you are not able to breastfeed
your baby directly, you need
to start expressing as soon as
possible after the birth, preferably
within 6 hours. Keep doing it at
least 8 times in every 24 hours,
including at least once at night,
until baby is feeding properly.
10 realbabymilk.org Pst... ‘Expressing Breastmilk by Hand’ DVD (£11.50) available at www.realbabymilk.org/shop
Physical Challenges
There are very few challenges which should cause you to finish feeding. With the
right help and information, most challenges are temporary hitches. This page
has some tips and our website has even more www.realbabymilk.org
Too much milk?
- Milk supply usually tailors itself to baby’s needs
within 6-8 weeks
- Try leaning back once baby is attached so milk comes
out slower
- Try feeding from same side at two consecutive feeds.
Fullness on other side will help your milk supply to
decrease - watch out for mastitis though.
- Expressing extra milk for the freezer may help but
Blocked Ducts / Mastitis
be careful not to overdo it as you can end up making
Symptoms of mastitis are usually redness and
even more milk.
tenderness of the breast, flu-like feelings (fever, shivers).
Again these are often caused by poor attachment
Cracked / Sore Nipples?
which doesn’t allow the milk to flow freely and can
Cracked and sore nipples are nearly always caused
cause blockages. If this occurs try to
by poor attachment. Try to get to a support group or
- Feed baby as often as possible, if too sore then
ask your midwife to look at how your baby attaches
express. It is important to keep the milk flowing.
and feeds. If nipples are scabbed apply breastmilk and
- Ibuprofen can help reduce swelling.
promote moist healing. If nipples are bleeding / too
- Paracetamol can reduce high temp.
painful to feed, try expressing for 12- 24 hours to rest
- Hot shower/bath/flannels to help milk flow
them and try again with the right help to
- Cabbage leaves to relieve pain and throbbing. If all
get the positioning and attachment right.
the above are not working within 24 hours, then
antibiotics may be needed, maybe sooner if the nipple NB: Blood might sometimes pass
into the milk, this is not at all
is damaged. Try to look after yourself as much as
harmful to your baby and is
possible during recovery; relax, rest and eat well.
not a reason to stop.
Anxious about milk supply?
- Are baby’s wet and dirty nappies as expected for his
age? See page 12.
- Can you hear baby gulping and swallowing?
- Do you feel full before a feed, softer afterwards?
- Is baby settling between feeds?
- Is baby gaining weight?
It is common to feel anxious because you can’t actually
see how much milk is being made.
If your answer to all five is yes, then rest assured your
baby is getting enough milk. If not, seek support.
Not enough milk?
- First, check your positioning and attachment with a
professional or at a support group. A poorly-attached
baby can sometimes limit the milk flow.
- How often are you feeding your baby? Demand
feeding is the very best way to ensure that your body
knows how much milk to make, but your baby should
be feeding at least 8 times in every 24 hrs.
Full Breasts - Difficult to attach
- Try expressing some milk before attaching baby, to
relieve the pressure.
- Try different positions
- Keep feeding on demand so breasts do not become so
full between feeds
- Is your baby sleeping too long between feeds? Try
waking baby to feed at shorter intervals.
realbabymilk.org 11
Baby’s Nappies - what’s normal?
It can be a little surprising to see what changes your baby’s nappies go through.
A breastfed baby will poo a variety of colours over a relatively short space of
time. This page will help you to understand what is going on - and show you
that what you see are signs of a well fed baby.
Day 1-2
Day 3-4
Day 5-6
Older Breastfed baby
Top tip: It is sometimes difficult to
tell how wet a disposable nappy
is due to it feeling dry. A wet
disposable nappy generally feels
heavier than when it is new and if
you are really unsure try pouring
three tablespoons of water into a
new nappy to see what difference
it makes.
12 realbabymilk.org
Day 1-2: The meconium nappies.
Your baby’s first poos will be black/dark green or brown/black
and very sticky. Babies are born with meconium already in their
bowel and it is very normal. Baby will also be having 2 or more
wees a day.
Days 3-4: Wetter nappies and greener poos
Nappies at this stage are known as “changing stools”, the poo
will be turning a more green colour and this is a sign that your
baby is taking in more milk and digesting it. A baby of this age
should have at least 2 poos a day. Baby will also be having three
or more wees a day and wet nappies will feel heavier.
Days 5-6: Yellow poos
Your baby has cleared all the meconium (see day 1-2) from his/
her bowels and all babies of this age should be having at least
2 yellow, soft/runny poos, each of a size to cover a £2 coin, per
day. This is a minimum - many babies will poo far more than
this! This is nothing to worry about and is a good sign that the
baby is getting plenty of breastmilk. Your baby should also be
having at least 6 heavy wet nappies per day.
Older Breastfed baby “mustard” poos
As your baby gets older, the poos get yellower and are
sometimes described as resembling mustard.
They should stay soft or runny, and may look “seedy”, this is
fine and perfectly
normal. Until the baby
is at least 4 weeks old,
you should continue
to see at least 2 poos
a day as described
above. After this, some
exclusively breastfed
babies may go several
days between poos.
This is normal as long
as the baby is feeding
enthusiastically,
having plenty of wet
nappies and gaining
weight.
Myths & Misconceptions
Don’t let them distract you! Use our checklist!
A lot of the things you will hear people say or suggest about breastfeeding can be out-dated or just plain
wrong! We have corrected some of the most common myths here on this page
‘Big babies need top-ups’
O
If a baby is allowed to feed as frequently as they want
then a mother will make as much milk as is needed.
Artificial “top-up” feeds can and will interfere with
this natural process.
‘You don’t have enough milk!’
O
Often growth spurts are seen as signs of insufficient
milk supply. At key stages a suddenly hungry baby is
actually letting mum know it’s time to make more
milk. If mum feeds on demand through this and
avoids artificially “topping up” then her supply
will respond.
‘Mastitis means stop feeding’
O
It used to be thought that mastitis meant you must
stop feeding through the affected breast. It has since
been found that a mastitis-affected breast should be
fed from as often as possible to allow the milk to flow
and for the best chance of shifting the inflammation.
In fact, if a breast with mastitis isn’t fed from then
the mastitis will more than likely get worse.
‘You can’t breastfeed more than
O
one baby’
It is perfectly possible to breastfeed more than one
baby, either multiples (twins or more) or baby and an
older child (tandem feeding). There are lots of health
and practical reasons why this may be a good idea.
See ‘Breastfeeding in special circumstances’, page 16 .
‘10 minutes on each side’
O
This is now known to be wrong advice.
The latest advice is to feed for as long as baby
wants (“baby-led feeding”) and to allow baby
to finish feeding on one side before offering
the other.
O
‘Breastfeeding when pregnant
is dangerous’
Breastfeeding during a pregnancy is safe for
the majority of mothers. It can help maintain
a close relationship with the older child and
between siblings when the baby is born. See
‘Breastfeeding in special circumstances’, page 16 .
O
‘Breastfeeding an older baby or
child is pointless and wrong’
The health effects of breastfeeding don’t
disappear when a baby gets older, they
continue, for mum and baby for as long as
the breastfeeding continues. It is not possible
to force a baby or child to breastfeed and
continuing to breastfeed for as long as mum
and baby wish is a perfectly natural and normal
aspect of parenting. See ‘Breastfeeding in special
circumstances,’ page 16
realbabymilk.org 13
Myths & Misconceptions
O
‘You will have to stop breastfeeding when you go back to work’
With a little forward planning, it is perfectly possible
to continue to combine breastfeeding and working. If a
mother intends to return to work very soon after the baby
is born (for example if they are self employed), then it is
essential that she ensures that breastfeeding is established
and that she feels confident with feeding before starting
back at work.
Any mother who returns to work when her baby is less
than six months old and exclusively breastfed will need
to consider where and when to express her milk in order
to maintain supply and meet her baby’s needs. Many
different settings are suitable for expressing, especially if
hand expressing or non electric pump are used.
Anywhere that is private, clean, warm and comfortable
may be used, whether this is an unused office space,
storage area, rest room (not the toilet!) or even a car with
blinds on the windows if out and about.
For a very young baby, mum will need to express as often
as possible when separated from the baby, much as the
baby would naturally feed. It is important to remember
that it is the frequency and effectiveness of expressing
which matters rather than the volume of milk gained, since
it is this which will stimulate and maintain the supply. If
mums return to work when their baby is over six months
old and taking foods other than breastmilk, it is still well
worth expressing milk at work to be fed to the baby by
cup or bottle. If mum expresses two or three times during
a typical eight hour working day, then this will probably
provide sufficient breastmilk for the baby’s needs alongside
solid foods. Mum can then feed their baby
at the breast as normal during days off
and enjoy the convenience of this.
Storage of expressed milk can be
very straightforward. It may be most
convenient to take a cool bag to work,
complete with ice packs to keep the
temperature inside quite low (below five
degrees, like a fridge). Breast milk, unlike
doorstep or formula milk, is very stable
and does not go ‘off’ very quickly. Please
see page 10 for storage information.
If a mother does not wish to express milk
at work, it is still possible to continue to
breastfeed. Baby may be given formula
milk (if under one year) when mum is
not available and then feed at the breast
when mum returns. The breastmilk supply
will respond to the demands made and
breastfeeding can continue combined
with bottle feeding, giving at least some
of the health benefits of breastfeeding.
Mums who choose this course of action
may need to express a little in the first
days back at work in order to keep their
breasts soft and comfortable and reduce
the risk of mastitis.
14 realbabymilk.org
Breastfeeding & the family
There are lots of ways for family members to help care
for and become close to baby
Skin to Skin
This is a very calming, soothing way to be close to your baby
and a great way to build your special relationship. Also an
excellent way to calm an unsettled baby.
Talking to your baby
Babies as young as a few hours old love to see a friendly,
smiling face. They also copy and mimic your facial
expressions such as sticking out your tongue and cooing.
Talking to your baby helps stimulate their face muscles and
encourages speech development.
Changing baby’s nappy
This is a chance to get down to baby level and have
some eye contact with baby, and of course, you’ll see
just how much breastmilk baby must be getting!
Relaxing with siblings
Just letting your older children relax with the new baby
helps siblings bond and enjoy each others’ company.
Bath Time
Most babies love bath time and it can be a good
opportunity to make eye contact and to have fun with
baby. It also helps to build confidence in handling baby.
realbabymilk.org 15
Special Circumstances
Breastfeeding twins or other multiples
Breastfeeding older babies or children
Breastfeeding twins or other multiples (triplets
or more) is challenging but also very important
in keeping the babies healthy and providing
opportunities to bond with each baby. It is extra
important if the babies are premature, very small
or need special care for any reason. As with any
baby, it is important to get a breastmilk supply
established, preferably by feeding the babies at the
breast soon after birth and at least 8 times each in
every 24 hours or expressing milk at least this often
if any baby is unable to feed directly at the breast.
It is very useful to have help in positioning the
babies in the early days so as to be able to feed two
simultaneously and save time on feeding.
Breastfeeding of babies over the age of a year is
not common in the UK. However, this is much
more common in other countries and the World
Health Organisation recommends continuing
breastfeeding into the second year of life and
beyond. Mothers who breastfeed older children may
choose to do this for a variety of reasons. Continued
breastfeeding may bring health benefits for babies.
Breastmilk continues to contain antibodies from the
mother’s mature immune system and this may help
protect older babies and children from common
infections such as colds and stomach upsets.
Breastmilk also continues to provide a valuable food
source for older babies – milk is an important part
of the diet for young children and the milk of their
own mother is specific to human children’s needs.
Read more on www.realbabymilk.org
Breastfeeding while pregnant
If you are breastfeeding when you become
pregnant with another baby, it is absolutely fine to
continue to breastfeed the older child throughout
your pregnancy for all but a very few women.
It may help you to keep your toddler calm and
contented when you feel tired or unwell, and your
toddler will continue to benefit from your milk
and from the comfort and closeness he gets from
breastfeeding. Many toddlers wean themselves
off breastfeeding while mum is pregnant, because
the milk supply does decrease, but some toddlers
and some mums like to continue throughout the
pregnancy, right up to the birth of the new baby.
When breastfeeding of an older child continues
following the birth of a new baby, it is important
to ensure that the new baby is fed first and is fed
according to their demands. It may be convenient
to allocate a specific breast to each baby/child,
according to preference or once the younger
baby has established breastfeeding. Continuing
to breastfeed the toddler and the new baby is
called tandem feeding, and many mums find that
continuing to breastfeed the toddler helps the older
child to adjust to and accept the new baby.
16 realbabymilk.org
Breastfeeding a preterm or ill baby
Breastfeeding is extra-important if your baby is
born preterm or is ill. Such a baby is particularly
vulnerable to infections and needs the milk which
is specifically designed for a human baby, whatever
stage of development they are at. If your baby is not
able to breastfeed directly, you need to express your
milk at least 8 times in every 24 hr period including
once at night, until your baby is mature enough
or well enough to be taking effective breastfeeds.
You may need to give supplements or medicines as
well as breastmilk, but in all but a few very unusual
illnesses, your milk is the best thing for your baby to
help him grow or recover.
Introducing other foods
Introducing your baby to foods other than breastmilk (or
formula) is an exciting new stage of development. Lots
of parents look forward to it, but also some parents may
worry about it. Firstly, you may not be clear about when
you should start to offer solid foods and the information
which you find, for example on the labels of ‘weaning
foods’ may not help! Most babies do not need any food or
drink other than breastmilk (or formula) until about six
months. The Department of Health states that ‘around
six months is the best age for introducing solids’. It is
still possible to buy packaged baby food that is labelled
as ‘suitable from four months’, however giving any food
before six months when your baby’s digestive system
is still developing may increase the risk of infections
and allergies.
Recognise the signs that your individual baby is ready to
try some foods. In the past, it was thought that babies who
woke for feeding during the night, or who started feeding
more frequently during the day, or who started to show
interest in other people’s food were ready to start solid foods.
However, we now know that while these are important
developmental stages, they do not necessarily show that a
baby is ready to start eating. Instead, the things to look out
for, at about six months are that your baby can sit up, wants
to chew and is practising this with toys and other objects and
can reach out and grab things accurately. These abilities will
contribute to making weaning your baby easy and enjoyable.
First foods you might like to let your baby try: Mashed fruits
such as banana or avocado or cooked mashed apple or pear,
or try cooked mashed parsnip, carrot or sweet potato. When
you’ve tried a few things, try some combinations or add some
mashed meat, fish or chicken.
Some parents prefer to let the baby feed him/herself right
from the start (sometimes called baby led weaning), if you
want to try this then offer foods which baby can pick up and
Top tip: If you would like more
information and advice about introducing
other foods (also known as weaning)
contact your health visitor or visit your
local ‘Baby clinic’ where you can discuss
any concerns or worries.
(Health visitor contact details
can be found on page 18)
eat, such as steamed broccoli florets
or carrot sticks or pieces of apple or
melon. Remember that starting solid
foods is all about experimentation
and enjoyment, try not to worry about
how much your baby eats, just keep
offering opportunities to try new
things and let your baby’s appetite
guide you both. As your baby eats
more, the need for milk will become
less and the appetite for solid food will
increase but each baby will vary in the
time this process takes.
While all this is going on and your
baby is getting used to a variety of
foods, it is still really important to
continue to breastfeed your baby on
demand. Your breastmilk still provides
a valuable source of nutrition for your
baby and the health benefits for both
of you last throughout the time you
are breastfeeding and beyond. The
Department of Health recommends
breastfeeding for at least a year and
says that continuing to breastfeed
after this will also be of benefit
for health.
realbabymilk.org 17
Children’s Community Services
Who are Children’s Community Services?
Anglian Community Enterprise (ACE) provides
health services throughout North East Essex. The
Children’s Community Services team comprises
of health visitors, school nurses, nursery nurses,
breastfeeding supporters, school nurse assistants,
immunisation nurses and clerical staff who all work
with parents, carers, children and young adults
aged between 0 – 19.
The role of the health visitor
A health visitor is a specialist nurse who provides
support and guidance by working in partnership
with you to ensure your child reaches their full
potential. The Nursery Nurse is a qualified member
of the team who works together with the health
visitor to support you with information and
advice on:
•
•
•
•
•
•
•
•
•
Breastfeeding
Introducing other foods (weaning)
Fussy eaters
Growth and development
Common childhood illnesses
Accident prevention
Behaviour
Becoming a parent
Common concerns such as: crying, teething,
sleeping, potty training and bedwetting
• Postnatal depression
• Stopping smoking
The role of the School Nurse
Children’s Community Services
team contact details:
The school nurse looks after your child’s health
needs when they start school. They provide advice
and guidance, which helps parents and their
children to make healthy life choices. School nurses
act as a link between school and other services,
for example they can refer to other agencies when
complex issues arise that can affect health and
ability to learn. School nurses work closely with
nursery nurses and school staff nurses to provide
health promotion and education on a variety of
subjects.
Tendring : 01255 670220
The role of the immunisation nurse
Clacton: 01255 201655
The immunisation nurse works with the team
to deliver routine childhood immunisations.
Breastfeeding and immunisations are one of the
most important defences for
protecting children and
young people from series
disease. The immunisation
nurse supports the public
and health professionals
by offering information
about different diseases,
immunisations and
vaccinations.
Harwich & Mistley: 01255 201253
West Clacton (Jaywick & Brightlingsea):
01255 687150
West (Shrub End): 01206 747141
North East (Highwoods): 01206 747371
Central Colchester (Greenstead): 01206 747827
South East (Monkwick): 01206 747101
Immunisation Team: 01206 518521
Breastfeeding Helpline: 01255 202714
Unsure who to contact? Telephone: 01255 206257
and we will direct you to the appropriate team.
18 realbabymilk.org
Local Breastfeeding Support Team - ‘Pink Ladies’
Who are ‘Pink Ladies?’
‘Pink Ladies’ are mums who have breastfed their baby and are
trained breastfeeding supporters, they work together with
Midwives and Health Visitors to support breastfeeding. ‘Pink
Ladies’ can visit you at home during your pregnancy and can offer
breastfeeding information and support to help you make an
informed choice about how to feed your baby.
Contact: 01255 202714
What does a Breastfeeding Supporter do?
The ‘Pink Ladies’ visit the postnatal maternity units daily
Monday to Friday at Colchester, Harwich and Clacton
to support you with breastfeeding. We aim to contact
all postnatal mothers within 48 hours of notification of
discharge home from hospital or soon after a home birth.
Breastfeeding supporters can also arrange to visit
you at home.
A breastfeeding supporter will usually visit the Neonatal
Unit (NNU) daily Monday to Friday at Colchester to offer
extra support to mums, dads and partners who have been
separated from their baby, they will also visit Children’s
ward by invitation.
If we do not contact you after the birth of your baby, it is
generally because we do not have your contact details, so
in this instance please contact us on: 01255 202714 either
before or after the birth of your baby.
Support in the early days and weeks after the birth of your
baby is normal and can help you overcome any challenges to
become confident with breastfeeding.
‘Pink Ladies’ breastfeeding supporters
can offer support and information
on the benefits of breastfeeding,
including:
•
•
•
•
•
•
•
•
•
•
Preparing for birth, skin-to-skin
and early feeds
Positioning and attachment
Early days and weeks after the
birth of your baby
Expressing and storing of breast milk
Overcoming challenges
Feeding your pre-term baby
Breastfeeding twins or more
Feeding and returning to work
Exclusive breastfeeding
Offering some breastmilk
realbabymilk.org 19
Champions working with Children’s
Community Services & ‘Pink Ladies’
‘Breastfeeding Champions’
Breastfeeding champions are local mums who have
breastfed their baby and decided to undertake
training to support and promote breastfeeding
in the community. Some attend their local ‘Baby
Beginnings’ groups and share their knowledge and
experiences of breastfeeding with other mums and
mums-to-be.
‘Workplace Breastfeeding Champions’
Workplace breastfeeding champions are usually
mums who have breastfed their baby, returned to
work either full or part-time and are passionate
about supporting and promoting breastfeeding.
Workplace breastfeeding champions support
breastfeeding in a variety of community settings
such as Schools, Nurseries, Crèches, Chemists,
Supermarkets and Children’s Centres and come
into regular contact with pregnant women and
breastfeeding mothers.
In agreement with their individual workplace
setting champions undertake breastfeeding
awareness training which includes a ‘tool kit’ of
posters and information which can be displayed in
the workplace.
’GP’s’
Some GP’s and GP practice staff have undertaken
breastfeeding awareness training to support and
promote breastfeeding. GP’s work together with
other health professionals and the ‘Pink Ladies’
to support breastfeeding and help women who
experience challenges to become successful with
breastfeeding.
20 realbabymilk.org
For further information about becoming a
‘Breastfeeding Champion’ or to book your FREE
in-house ‘ Workplace Champion’ training contact
the Local Breastfeeding Helpline: 01255 202714.
Help us promote breastfeeding as the norm.
Mothers comment ‘Breastfeeding Champions’
and ‘Workplace Champions’ keep mums up to
date with support available in their local area
which is especially beneficial to working mums
and mums-to-be.
‘Baby Beginnings’
Baby Beginnings’ groups welcome all new mums and mums-to-be.
Come along, meet other mums and share your experiences - you don’t
need to have a problem to attend.
Tendring
Colchester
Monday 10am – 12noon
Soken House, Triangle Shopping Centre, Frinton
Tel: 01255 670220
Monday 10am – 12noon
Sure Start Children’s Centre,
The Ark Methodist Church,
Jack Andrews Drive, Colchester CO4 9NX
Tel: 01206 8545557
Monday 10.20am – 12noon
Ogilvie Hall, Wignall Street, Lawford CO11 2JG
Tel: 01255 887900
Tuesday 9.30am – 11am and 11.30am – 1pm
(Term Time only)
YMCA, High Street, Brightlingsea CO7 0HU
Tel: 01255 305536
Tuesday 10am – 12noon
Sure Start Children’s Centre,
Hawthorne Avenue, Colchester CO4 3QE
Tel: 01206 861950
Wednesday 10am – 12noon
St. Nicholas Hall, Stour Road, Harwich CO12 3HS
Tel: 01255 887900
Thursday 10am – 12noon
Sure Start Children’s Centre, Shrub End
Community Centre & Sports Centre, Boadicea
Way, Colchester CO2 9BG
Tel: 07954105072
Friday 10.30am – 12noon
Reckitt Lodge, Clacton Hospital,
Tower Road, Clacton
Tel: 01255 201655
Friday 10am – 12noon
Sure Start Children’s Centre, School Road,
Monkwick, Colchester CO2 8NN
Tel: 01206 578978
All details for the groups are correct
at the time of printing, however we
would advise that you ring or check
with the ‘Pink Ladies’ or your Health
Visitor before you make your first visit.
realbabymilk.org 21
Support & Information
Local Breastfeeding Support & Information
Community Midwives - for all antenatal and post natal enquires up to day 28
• Clacton: 01255 201600
• Harwich: 01255 503700
• Colchester: 01206 742369
Local Breastfeeding Helpline – ‘Pink Ladies’
Find us on Facebook:
• 01255 202714
www.facebook.com/BabyBeginningsBreast feeding Support
Available Monday – Friday between 9am – 5pm.
** Requests for same day support and home visits
are accommodated whenever possible but cannot
always be guaranteed.
Children’s Community Services:
• 01255 206257
** Individual team contact details can be found on page 18
Breastfeeding Counselling Helpline 0300 100 0212
National Childbirth Trust (NCT)
NCT have an excellent helpline with trained breastfeeding counsellors available and excellent
articles on their website
Helpline: 0300 330 0700
www.nct.org.uk
Assoc. of Breastfeeding Mothers
The Association of Breastfeeding Mothers is
a charity that trains women in breastfeeding
counselling. Their website holds lots of useful leaflets
Helpline: 0300 100 0212
www.abm.me.uk
The Breastfeeding Network (BfN)
The Breastfeeding Network aims to be an
independent source of support and information
for breastfeeding mothers
Helpline 9.30am - 9.30pm
Helpline: 0300 100 0210
www.breastfeedingnetwork.org.uk
La Leche League (UK)
La Leche are an international mother-to-mother support organisation.
Helpline: 0845 120 2918
www.laleche.org.uk
Also worth a look...
www.babyfriendly.org.uk
info.babymilkaction.org
www.breastfeedingmanifesto.org.uk
www.breastfeeding.co.uk
www.kellymom.com
Disclaimer: Real Baby Milk CIC accepts no responsibility for the
content of websites other than www.realbabymilk.org
Real Baby Milk CIC,
17 Callywith Gate, Launceston Road, Bodmin, PL31 2RQ
Telephone: 05601 536 629
Email: [email protected]
www.realbabymilk.org
www.facebook.com/realbabymilk
www.twitter.com/realbabymilk
Real Baby Milk is a not-for-profit organisation
Company Number. 5963948. The Real Baby Milk logo and name is
trademarked. This guide, it’s information and images within are the copyright
of Real Baby Milk 2011. All information is correct at time of going to press.
22 realbabymilk.org
Request for other formats : Please ask if
you would like to receive this leaflet in
large print, braille, on CD or in any other
languages. If you would like the leaflet in
an alternative format please contact the
PALS team on [email protected].
nhs.uk or 0845 170 8000.
Photographers: Finola Shanahan, Patrick
Shanahan, Katy Blake. Mums and Babies: Donna
& Pebble-Rose; Heidi & Elizabeth; Bella &
daughter; Portia & Ryder; Louise Big; Donna &
Saxon; Lizzie & Evie; Arwen & Amelie; Adeline
& son; Jess & Harvey; Anita & Ethan; Emily &
Millie; Tracey; Hannah; Karen & Amber Stock
Photo’s, iStockphoto.com
Fittings:
Breastfeeding friendly venues
Please find below our list of Breastfeeding Friendly Places: Bronze (H) Mum and Babies
Welcome & Breastfeeding Friendly, Silver (H) Mum and Babies Welcome, Breastfeeding
Friendly and Baby Changing Facilities, Gold (H)Mum and Babies Welcome, Breastfeeding
Friendly, Baby Changing Facilities and coffee shop staff assistance to carry drinks and food to a table.
To be seen from
artwork not to
Ardleigh
Brightlingsea
H Batemans Tower Café, Promenade Way
H Mooch @ No 9, 9 Osbournes Court
H Victoria Café, 22a Victoria Place
Clacton
H Charmallies Restaurant, 1-5 Pier Avenue
H Coffee House, The Rar, Valley Farm Road
H Coffee Republic, 45 Jackson Road
H Cup of Coffee, 82 Rosemary Road
H Gossips, 84b Pier Avenue
H Greggs Bakery, 19 Station Road
H Jack’s Diner, Unit 1, Jackson House, Jackson Rd
H McDonalds, 2 Marine Parade West
H New Majestic, 4 Marine Parade West
H Taste, 6 West Avenue
H The Pantry, 58 Rosemary Road
Colchester
Frinton
Harwich
H All Saints Primary School, Beaumont Road
H Children’s Clinic Room, Fryatt Hospital
H Pizzeria Napoli, 1 Midland House
H The Pier Hotel & Restaurant, The Quay
H The Ship Restaurant, King Quay Street
Dovercourt
H Alfresco Diner, 38 The Parade
H Good Taste Café, 24 High Street
H Sea View Café, 29 The Parade
H Seaspray Diner, Walton Pier
H The Bath House, Princes Esplanade
H Walton Pier Bowl, Walton Pier
Breastfeeding Friendly Places were
correct at time of printing.
mm
By SIGNING
this PROOF I
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APPROVAL
SIBILITY for
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accept RESPON ERRORS NOT CORREC
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ALL ADVISE
INCORRECT
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H Boots, 10 Connaught Avenue
H Café 19, 19 Connaught Avenue
H Caxton Books & Gallery, 37 Connaught Avenue
H De Koffs 14 Connaught Avenue
H Dundas & Dooley, 121 Connaught Avenue
H Extreme, 49 Connaught Avenue
H Frinton Free Church, Connaught Avenue
H Finton Medical Centre, 86 Connaught Avenue
H Frinton Patisserie, 34 Connaught Avenue
H Jade, 35 Connaught Avenue
H Jo Jo’s of Frinton, 7 Connaught Avenue
H Last Viceroy of British India, 36 Connaught Avenue
H Lilley’s Bakery, Triangle
H Monique of Frinton, 61 Connaught Avenue
H Perfect Bliss, 44 Connaught Avenue
H Polkatot, 21 Connaught Avenue
H Poppins, 131 Connaught Avenue
H Rowlands Pharmacy, 98 Connaught Avenue
H Sarl Filon, 88a Connaught Avenue
H The Bay Tree Restaurant, 84 Connaught Avenue
H The Garden Café, 3 The Triangle
H Asda Stores, Turner Rise
H Boots, 2-4 Plume Avenue, Shrub End
H Boots UK Ltd, 5-6 Lion Walk
H Café Rouge, High Street
H Colchester Zoo, Maldon Road
H Cornerstone, Sir Isaacs Walk
H Costa Coffee, 5 Culver Square
H Costa Coffee, 12 Lion Walk
H Debenhams, 34 Culver Street West
H Greggs Bakery, 16 High Street
H Hutt Pharmacy, 4 The Square, Iceni Way
H Jenkins Café, 42 St John Street
H JoJo Maman Bebe, 36 Sir Isaacs Walk
H Kiddi Caru, Hythe Quay, Maria Court
H Kingsland Church, 86 London Road
H Lancasters Delicatessen, 11 Headgate Building
H Leisure World, Cowdray Avenue
H Library, Trinity Square
H Marks & Spencer, High Street
H McDonalds, 35-37 High Street
H McDonalds, Tollgate
H McDonalds, Cowdray Avenue
H Oak Tree Coffee House, Unit 4, Highwoods Square
H Pizza Hut, 48-50 High Street
H Pizza Hut, High Street
H Pizza Hut, Turner Rise
H Poppys Victorian Tearooms, 17 Trinity Street
H Sams Diner, 47 Sir Isaacs Walk
H Shrubend Childrens Centre, Sports & Social Club, Bodicea Way
H Slice, 3 Culver Square
H Springlands Nursery, Shrub End Road
H Starbucks, 25 Culver St West
H The Huntsman Tavern, Shrub End Road
H The Leather Bottle, Shrub End Road
H The Mercury Theatre, Balkerne Gate
H Timbers, 22 Trinity Street
H Waitrose, St Andrews Avenue
H Williams & Griffins, 152 High St
H Youth Culture Ltd, Holy Trinity Church, Trinity St
H Fronks Road Surgery, 77 Fronks Rd, Dovercourt
H Jennys Restaurant, 204 High Street, Dovercourt
H Lime Light Café, 190 High Street
H Muppets, 286 High St
H Whitehouse Coffee Shop, Kingsway
sticker size: 130x130
Manningtree
H Café Rio, 21 High Street
H De’ath Bakery & Coffee Shop, High Street
H Lucca, High Street
H Lucca Enoteca, 39-43 High Street
H Manningtree Library, High Street
H Manningtree Station Buffet, Station Road
H Riverside Health Centre, Station Road
H The Crown Hotel, 51 High Street
H The Misley Thorn Hotel, High Street
H The Mogul, The High Street
H The Skinners, Station Road
Mistley
H Mistley Place Park Café, New Road
H Mistley Quay Café
Stanway
H Banquey Chinese Restaurant, 342 London Road
H Boots Tollgate, Unit 8, Tollgate Retail Park
H Just Learning Limited, 342 London Road
H Sainsbury Café, 1 Western Approach
H Stanway Garden Centre, London Road
H Stanway Harvester, 186 London Road
H Toby Carvery, 342 London Road
Breastfeeding Friendly Places
H Ardleigh Hall Leisure, Dedham Road
H Ardleigh Pre-School, Ardleigh Village Hall
H Ardleigh Surgery, Church Rd
H The Cross Inn, Ardleigh Road, Gt Bromley
outside the window
scale
Thorpe & Kirby Le-Soken
H Mansfield Chemist
H Red Lion, 32 The Street
H The Crown, High Street
H The Ship Inn, 35 Walton Road
H Thorpe-le-Soken Surgery, High Street
Walton
The law is on
your side!
The Equality Act
2010 makes it clear
that it’s against the
law for a women to
get less favourable
treatment because
she is breastfeeding
when receiving
services.
realbabymilk.org 23
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