Sally Inch, midwife and breastfeeding expert at Oxford's John Radcliffe Hospital, and Dawn Chandler, Prima Baby health visitor and mum, answer your questions.
My nipples are cracked
Q. I've been feeding my daughter for three weeks but my nipples are very cracked. What am I doing wrong?
Dawn says - Your baby may be latching on in the wrong position. Try bringing her to the breast so your nipple is at the top of her mouth and her chin is as far as possible from the nipple stem while still getting the nipple into her mouth. Don't let her suck on the end of the nipple.
Your nipples can take anything from a day to a few weeks to heal. Letting air get to them can help, as can changing breast pads frequently and using a nipple cream. Nipple shells worn inside your bra can help air get to the breasts. If your breasts are engorged, express a little milk before feeding so the ‘let down' isn't so painful when your baby latches on. Breastfeeding shouldn't be painful so if there's no improvement, speak to a breastfeeding counsellor. Your health visitor or midwife should have a contact.
Is my baby getting enough milk?
Q. I'm breastfeeding and worried my baby isn't getting enough milk. How do I know?
Dawn says - Every new mum worries they're not giving their baby enough. You can't see how much goes in so look for signs. Listen for sounds of swallowing and milk in the corner of your baby's mouth. You can squeeze your breast during a feed and if milk comes out, you know it's there. If the breast is soft after a feed then your baby's taken milk. If she's content after a feed it's a good sign, as is yellow-mustardy stools or six to eight wet nappies in 24 hours. Most breastfed babies lose weight initially but are normally up to their birth weight by day 10. They should continue to gain from then on. If you're still worried, consult your health visitor.
How can I avoid mastitis?
Q. I'm breastfeeding and terrified of getting mastitis. Is there anything I can do to prevent it?
Dawn says - Mastitis is an inflammation or infection of the breast that results in flu-like symptoms, such as a temperature and feeling generally off-colour. Areas of the breast become hard, red, sore and hot. Non-infectious mastitis is where a duct becomes blocked with milk. This can be caused by poor positioning, or low immunity, often the case when you're not taking care of yourself as well as you should. Cracked nipples can also lead to infections. Symptoms include hot breasts that are hard in one place.
Mastitis normally occurs in just one breast, and usually within the first month when feeding is not yet established and your baby may be feeding erratically. The best thing to do is get antibiotics from your GP and continue feeding. If you stop, the duct will become more and more blocked.
Massaging the breast during each feed from under the armpit down towards the nipple may prevent mastitis, as this keeps the milk flowing steadily through the ducts. ‘Emptying' the breast with a good feed can also help. It's important to keep your immunity levels up by taking special vitamin supplements for new mums and eating properly.
How long will the pain last?
Q. My breasts are so engorged. What can I do to relieve the pain and how long will it last?
Dawn says It depends why they are engorged. If you're a breastfeeding mum and the milk has just come in three of four days after the birth, this is a positive sign. Your breasts might feel painfully full and hard, but this will only last 24 to 48 hours. Wear a supportive nursing bra with no underwiring both day and night, and try breastfeeding frequently, every two to three hours, to establish feeding. If your baby's unable to latch on because the breast is full, express enough to relieve the pressure, but no more.
Washed Savoy cabbage leaves with stalks removed, cooled in the fridge and inserted in your bra can be soothing. Heat can aggravate the discomfort, so avoid direct heat to your breasts, like showers, unless you want to assist the ‘let down' reflex. Paracetamol and gently massaging the breast during feeding will also help. If your breasts are engorged because you're giving up breastfeeding, the pain will last several days while the milk dries up. It's best to wean your baby off breastmilk by cutting down on feeds over several weeks.
Should I give water?
Q. I'm expecting my baby during the summer. Will I need to give her a drink of water in between feeds if it's really hot again this year?
Sally says The simple answer to that is no. All the fluids your baby needs are in breastmilk. Your baby may take shorter, more frequent feeds to quench her thirst during the hot months but you don't need to give extra water. Babies in hot and humid climates round the world can manage perfectly well on breastmilk, no matter what the weather. In many parts of the world, it's dangerous to give water to babies because of contamination. Human milk has evolved over the years to meet the needs of different lifestyles and climates.
How do I express milk?
Q. I'm due to return to work soon but want my four-month-old son to carry on having my milk. How easy is it to express?
Sally says There are three methods of expressing: by hand, using a hand pump or with an electric pump. You need to find what's best for you. Some mums get to grips with hand expressing yet cant use a pump. Once you have found out what works best, the next step is to build up a supply of milk. This means about three to four weeks before you're due back you need to start expressing milk after as many daytime feeds as possible, and then freeze it.
You'll have to express while at work, so decide where you'll do that and how you'll store the milk until you get home. You need to put freshly expressed milk straight in the fridge if you can, but it is safe at room temperature for six hours.
Can I breastfeed after a boob job?
Q. If I've had breast implants, will I be able to breastfeed?
Dawn says Most women with implants should be able to breastfeed, although this can depend on the type of surgery you've had. If the implants were put in through an incision under the breast, you should still be able to breastfeed in the usual way. If the surgery involved the area around the nipple, your milk ducts may have been affected. However, you may still have some intact from the upper part of your breast tissue, so don't assume you can't breastfeed. Ask your midwife for advice. In terms of safety, research indicates it's fine for mums with silicone implants to breastfeed.
I'm not sure how long to feed my baby
Q. How long should I breastfeed for? Is a baby still benefiting after a year?
Sally says Six months of exclusive breastfeeding with no formula, water or solids is ideal if you can. But don't worry. If you do have to give the occasional bottle of formula within that time, it won't undo all the good breastfeeding has done. It means your baby's digestive system will have to deal with foreign protein.
There are indications that early introduction of solids is associated with asthma and obesity in children of seven years. Keep going with a couple of breastfeeds a day until she's a year old if you can. The World Health Organisation (WHO) also recommends breastfeeding up to the end of the second year. The milk is not so much providing nutrition at this stage, but it's a great way to combat illness and infection. For example, a mum who's getting a cold will be making antibodies that go directly into her breastmilk to protect her baby long before she starts sneezing. Some babies wean themselves off the breast earlier than the mum planned so feeding up to the end of the second year may not work out.
