Breastfeeding: Q&A with Medela's Lactation Consultant

As promised, I am continuing my breastfeeding series and today I have a Q&A with Medela's Lactation Consultant Sioned. I asked her some questions about combination feeding, increasing your milk supply and advice for the early days of breastfeeding. I hope you enjoy it.

What are the best ways to increase your milk supply? 

The best way to increase your supply is to feed more often and effectively drain the breast. In the first week after birth your breast cells are given the blueprint for making milk with a surge in milk cell production around birth. This blueprint primes the milk cell to make maximum milk and how much your breast can store at one time so the more you feed and empty the more milk you make. 

Go back to basics and check that baby is latching on well and doing lots of active sucking and swallowing. If this is not right then the breast will diminish supply.- chat to midwife, breastfeeding specialist to check this. 

You cannot make more milk cells if you are experiencing feeding difficulties and often what happens is that when the breast isn’t emptied well the milk storage capacity reduces under the influence of Feedback inhibitor of lactation hormone, the cells stop making milk and eventually die off. This is why it is important to feed frequently in the first few weeks to get supply established. 

So to increase supply you can support breastfeeding by expressing after feeds or sneak in additional feeds or pumping sessions. Go back to basics and don’t use a pacifier and feed to cues, so lots more sessions on the breast. Also check that you are having night time feeds too – no longer than 5 hours between feeds at night. 

Look after yourself too – have a good few hours of quality sleep. What is good about breastfeeding is that you fall into a deeper rejuvenating sleep quicker, boost your prolactin levels. You also need to eat well, lots of small nutritious snacks are recommended. 

Be cautious about going down the herbal and medication pathway without getting the basics first. There are some risk factors with all medications and you need to explore both herbal and medication on your health as well as what gets into the milk. 

What is the perfect plan for combination feeding? 

Get breastfeeding well established first. Invest in 4-6 weeks of exclusive breastfeeding and explore the option of expressing and using expressed breast milk as an alternative to using formula in a bottle.

 Be cautious about how often you feed formula as this will have an impact on your milk supply if you are not expressing at the same time as a feed. Therefore minimise using a formula bottle to occasionally in the week 

Also the feeding device you use is also important – calma is not designed to be used with formula and some babies do get nipple teat confusion and don’t feed after a conventional teat on the breast as it is a totally modified suck to regulate the free flow of milk. 

Try and minimise formula to occasional use, look at the teat that you are using try a slow flow to make baby work harder to drain the milk and also give the milk at a warm temperature, same as body temperature so that it is similar. Feed to baby cues. 

I know that many mums give up with breastfeeding during the first week. What's the most important breastfeeding advice for the first week of baby's life, to keep mums going? 

Be realistic and get plenty of advice and support. Your body is designed to make milk and the switch on for this is the birth of your baby and delivery of the placenta. 

The first few days are difficult and by day 2 your baby will start to get hungry and feed every hour to remove the colostrum this is perfectly normal, by day 3-5 your milk will come to volume and you often get fullness and engorgement and baby find it difficult to latch so hand express a little and get the nipple softer and pert to help with a deep latch. 

Your nipples are tender and may be sore as they are getting lots of practice by baby so apply nipple cream to keep them well moisturised and use and massage a little expressed breastmilk to help with healing. 

If it hurts it’s not right! Take baby off and try different feeding positions – make sure your baby can get a wide mouth so look on youtube for Rebecca Glover attachment and positioning for additional tips. Go back and chat with your midwife. 

Go and visit a local breastfeeding group in the last few weeks of your pregnancy so that you can get tips and also meet up with mums and get to know the breastfeeding specialists and peer supporters. Remember to get their telephone help lines and website for support out of hours. If you are unsure give them a call or drop in. 

Pin the helplines on the refrigerator door for easy phoning. 

Be realistic – your baby is designed to feed frequently and often – your milk is so easy for your baby to digest he will feed 8-16 times a day but it does get better and easier as you both gets lots of practice. Prepare for your first week at home – minimise visitors and going out so that you can invest in building the foundations for effective feeding. 

Prepare meals for the freezer in portion sizes. Have your partner to prepare a sandwich and healthy snacks for you to graze on throughout the day. Everyone wants you both to achieve your goal so chat and involve grandparents and discuss. Get lots of support.

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As you might know,  I didn't get a chance to establish breastfeeding in the early days, as my baby was tube fed and then bottle fed with my breastmilk and formula in neo-natal. Hence why my breast cells didn't get the 'blueprint for making milk' they were supposed to get. It sucks, but I am now doing ok with breastfeeding with just one formula top-up a day. If you're in the same situation, don't worry - I will talk about my experience and how I built up my supply in an upcoming blog post.)

Sandra