One of the most common things I see when parents contact me after one of my antenatal classes, come along to Baby Cafe Bromley or ask me to visit them at home is this:
Breastfeeding didn’t get off to the best start in hospital.
Sometimes there was a medical reason for introducing formula. Sometimes breastfeeding was difficult and nobody quite knew what to do. Sometimes a bottle was offered because baby wasn’t feeding as expected. And sometimes parents simply didn’t get the support they needed in those first precious days.
Then they get home.
And by week one or week two, they’re worried about their milk supply.
Quite often, they’ve ended up on what is known as a triple feeding plan: breastfeed the baby, give a top-up of formula or expressed breast milk, and then express milk themselves.
So they’re breastfeeding, bottle feeding and expressing.
And they’re exhausted.
They’re constantly feeding, preparing bottles, expressing, washing and sterilising equipment and worrying about whether their baby is getting enough milk.
There is no time to breathe. No time to rest. No time simply to be with their baby.
And sometimes, by the time they contact me, they’re wondering whether they’ve left it too late.
It probably isn’t too late
This is one of the things I really want parents to know.
If breastfeeding hasn’t gone according to plan in the first few days or weeks, that doesn’t necessarily mean your breastfeeding journey is over.
Your milk supply doesn’t suddenly become permanently fixed in the first few days after your baby is born.
Milk production continues to develop and become established over the early weeks. For many mothers, their supply is becoming more fully established around four to six weeks.
That gives you time.
So if breastfeeding didn’t get off to the start you hoped for, there is often still plenty that can be done to support your milk supply.
Breastfeeding works largely on supply and demand. The more milk that is removed from the breasts, the more signals your body receives to make milk.
That might mean feeding your baby at the breast frequently, offering the breast at every opportunity, having lots of skin-to-skin contact and, where appropriate, expressing milk to provide additional stimulation.
But before you start adding yet another thing to your already exhausting list, there is something else worth considering.
Are you sure your baby is showing you that you don’t have enough milk?
Babies don’t always behave like a bottle
This is something I see particularly often when a baby has had quite a lot of bottle feeding.
Parents understandably compare what they see when their baby takes a bottle with what they see when their baby breastfeeds.
But babies don’t necessarily behave in the same way.
When a baby has a bottle, milk can flow relatively quickly and continuously. They may take a substantial amount of milk and then become very sleepy and content.
At the breast, feeding is different.
Milk flow changes during a feed. Your let-down reflex means that milk becomes available as your baby feeds, and the pattern of swallowing can change as the feed progresses.
Your baby may feed actively for a while, slow down, come off the breast and appear completely satisfied.
And then, five or ten minutes later, they may start rooting around again.
They may nuzzle into you.
They may grizzle.
They may turn their head from side to side looking for the breast.
And a worried parent can quite reasonably think:
“Oh no. They’re hungry again. I haven’t got enough milk.”
But that behaviour isn’t necessarily a sign that you don’t have enough milk.
It may simply be your baby’s way of saying:
“I’m ready for some more.”
And that’s where offering the other breast comes in.
There isn’t another breast available when you’ve given a bottle. The milk is all in the bottle.
But when you’re breastfeeding, your baby can feed from one breast and then move on to the other. They may have a little break and then decide they’re ready for another feed.
This is normal newborn behaviour.
Of course, we always need to look at the whole picture when we’re assessing whether a baby is getting enough milk. Wet nappies, weight gain, feeding patterns and how the baby is behaving are all important.
But we shouldn’t assume that a baby who wants to breastfeed again shortly after a feed automatically means that mum doesn’t have enough milk.
A recent example
I had a call this week from a couple whose baby was just eight days old.
Breastfeeding hadn’t got off to a great start in hospital and, for various reasons, they had ended up doing quite a lot of formula feeding.
Mum was also trying to express because she was worried about her milk supply.
But she wasn’t getting much milk when she expressed.
She was understandably panicking.
“My baby is only eight days old. I don’t have enough milk. What are we going to do?”
But here’s the thing: eight days is very early.
You aren’t necessarily going to express large volumes of milk at eight days. And the amount you can express isn’t necessarily a reliable measure of how much milk your breasts can produce for your baby.
When we talked through what was happening, it became clear that some of her worry was coming from the way her baby was behaving.
Baby was fussing and rooting around after feeds, and mum had interpreted this as evidence that she didn’t have enough milk.
Once we talked about normal newborn feeding behaviour, it suddenly made sense to her.
And that’s important.
Because sometimes the biggest problem isn’t actually the milk supply.
It’s the fear that you don’t have enough milk.
Triple feeding isn’t supposed to be forever
There is another part of this that I feel really strongly about.
Triple feeding can have a place. Sometimes it is exactly what is needed for a period of time to make sure a baby gets enough milk while protecting or increasing a mother’s milk supply.
But it is incredibly demanding.
And I’ve seen parents given a triple feeding plan when their baby is just a few days old and then left to get on with it.
Who checks in with them a few days later?
Who asks:
How are you coping?
How much sleep are you getting?
Is this still necessary?
Is your baby now feeding more effectively?
Can we reduce some of the expressing or top-ups?
What’s the plan for moving forward?
Because a feeding plan that was appropriate on day four may not necessarily be appropriate on day ten or day fourteen.
Babies change incredibly quickly in those first few weeks.
And parents need support to adapt the plan as their baby changes.
You haven’t failed
If you’re reading this because breastfeeding hasn’t gone how you imagined it would, please don’t assume you’ve failed.
And please don’t assume that because your baby has had formula, or because you’ve been expressing, or because you’ve been using bottles, that you’ve somehow missed your chance to breastfeed.
Sometimes breastfeeding gets off to a complicated start.
Sometimes you need help to understand what your baby is doing.
Sometimes you need someone to look at the whole picture rather than simply telling you to feed more, express more and try harder.
And sometimes you need permission to stop, take a breath and ask:
“Do we still need to be doing all of this?”
If you’re worried about your milk supply, please get some skilled breastfeeding support rather than trying to work it all out on your own. Use the UK Breastfeeding Directory to find expert infant feeding support in your area.
There is often more time, more flexibility and more possibility than you realise.
It doesn’t have to be perfect from day one.
And it may not be too late.
Where to get support
NCT Infant Feeding Line open 8am to midnight, every day of the year: 0300 330 0700
National Breastfeeding Line available 24 hours a day, every day of the year: 0300 100 0212.
Find local expert support in the UK Breastfeeding Directory.
If you’re local to Bromley, pop in and see me at Baby Cafe Bromley on Monday mornings. Or book a private 1:1 home visit.
Read Sherry’s book The Confident Mother.
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