The Virtual Big Breastfeeding Café 2020 | Lactation Consultant Sioned Hilton Answers New Mum Questions About Breastfeeding

As part of the Virtual Big Breastfeeding Café held on 6th May, Medela’s in-house lactation consultant Sioned Hilton answered questions from new mums live on our Instagram page. We wanted to share her expert advice, including the frequently asked questions as we know it may help many of you!

Lactation Expert, Sioned Hilton, shared her expert advice on what to expect from the first 48 hours of breastfeeding live on Facebook on the 6th May as part of the Virtual Big Breastfeeding Café, which you can watch here.

Alongside this, Sioned also took part in a live Q&A, answering questions from our Instagram and Facebook followers, it certainly was a fantastic day full of tips and advice! We wanted to share a key selection of questions and topics, which Sioned has covered for new mums, we hope you all find this useful!

Can you please tell us more about harvesting/expressing milk BEFORE baby arrives?

There is no recommendation for mothers to harvest their milk before baby is born, unless it is on midwives’ advice. If you do need to express before baby is born, it’s important that you discuss this with your midwife to make sure you are provided with sterile containers and labels, and guidance on how to hand express. It’s important for you to know if your birthing unit has space for this expressed milk, as they might not have a freezer, so all your precious liquid gold could end up going to waste!

If it is recommended that you express before birth, from 35 weeks’ gestation you can hand express for about 5 minutes on each breast. Remember – you are not really ready to be producing milk, so even small drops are great. Catch these in a sterile syringe and label as ‘antental colostrum’ and the date. Freeze in a zip-lock bag. Take these with you in a freezer bag with an ice block when you go to the hospital and ask your midwife to put it in the freezer, so they are ready if needed.

The chances are that, if all goes well, baby will be breastfeeding every 1-3 hours for the first 24 hours, so it won’t be needed!”

Can I start to express milk in the first two weeks? I’d love to combi feed.

“It is best to concentrate on getting breastfeeding started and milk volumes up before you start to express. However, if your baby is in special care, it might not be possible to breastfeed. Even if baby is a little sleepy or jaundiced, your midwife might start you expressing, and this is done from birth.

You may also find that when you milk comes in, a little expressing with your hand might ease that full, engorged breast and help baby to latch on. Some mums may also experience mastitis, with which the recommendation is to feed baby more, but if not possible, you can express after each feed to help remove more milk and resolve the inflammation.

Whilst it is best to establish your supply and get lots of breastfeeding practice, it is best to wait till baby is around a month old until you start to express and combine breast and expressed milk feeding.”

When is good to express? Should I express at the same time as feeding baby on the other breast?

“There is no right or wrong time in the day to express, it’s what suits you and your baby. Some mums find a mid-morning suits them, as that’s when baby may sleep for a longer period of time. If baby is only feeding from one breast, pumping at the same time or just after makes best use of those milk hormones for let-down and your time. You might start to pump when your partner gives baby your expressed milk, or during the night if this suits you and baby. Remember, baby comes first, and pumping is just an extra feed opportunity to boost production output.

When is best to start pumping and how many times a day?

“It is best to concentrate on getting your breastfeeding started and milk volumes up before you start to express. This is usually about the 4th postnatal week. How often is down to your baby’s feeding pattern and why you want to express. For example, if you are planning on returning to work and your baby is feeding 8 times a day, you will need to pump for those feeds that fall within your working day after you go back to work. If you are wanting to exclusively express, then 8 or more times in 24 hours and a night pump is recommended to get your supply established.”

Do I need to express through the night even is baby sleeps through? Baby is 16 weeks.

“If your baby is not waking for feeds, and is growing and gaining weight, there is no need to express. However, if you are uncomfortable, experiencing leakage and the first feed of the day is a little more troubling than the others, then of course you can. If you find that your baby wants more milk, then it is probably easier to do a dream feed than to pump. Remember, it’s a two-way relationship, some babies still need night feeds (2/3 of all breastfed babies on average), and it may just be for a few nights until baby starts to teethe.”

Questions about nipple shields and nipple care also came up a lot, Sioned answers some of the most common queries below.

Baby wouldn’t latch in hospital, so I’ve been using nipple shields – are these bad?

“No, nipple shields have a place. For some mums, they keep you breastfeeding. Try and feed without them, you may only need them in the early days as you both learn to breastfeed. If you do need them long-term, that’s also fine – it’s the breastfeeding that’s the important thing!

How much expressed milk should I give a 8-week-old?

Sioned says: “This is difficult to define as it really does depend upon several factors: how often the feeds are, does baby have one or both breasts, what time of day it is, and your breast milk storage capacity being just a few of these!

Your 8-week-old baby may have times when they have longer gaps between a feed, or may cluster feeds together. The average volume of feed can vary between mothers, from as little as 54mls/ feed to 234mls/ feed. If your baby feeds often they may actually take less volume per feed than a baby that feeds only 4 times a day and takes 234mls each time.

A good place to start is jotting down every time your baby feeds, and whether it was from one or both breasts.  I recommend starting with a volume of about 60mls, and if baby takes less, then reduce it next time. If they take more, add another 30mls.  A normal range would be 60-120mls, maybe a little more, maybe a little less.

Your breasts make the same volume of milk, so if baby feeds more, the more daily volume of milk you will make. As your baby grows, your breasts don’t increase the production capacity.”

My 6-week-old baby can only latch using the Medela nipple shield, is that okay long-term?

“Yes, it’s fine to use them for as long as you need. Make sure that baby feels well, gains weight and drains your breast effectively. Over a few feeds, try without the shields, try during a feed to see if at times baby can feed without them, because sometimes they can be a faff. If nipple shields are needed, you can keep using them, but you probably need to replace them every 10 weeks or so, or if baby starts to chomp more when teething.”

How can I avoid sore nipples, and not give up!

“Tender nipples are normal, and they can be quite sore. They are similar to when your lips are chapped and you start to lick them, making them even dryer! Massage a little expressed milk onto the tip of each nipple or use a lanolin-based ointment like Purelan. Make sure that baby is latched onto the nipple deeply, so that there is some of the areola below the nipple in baby’s mouth, and their lower lip curls a little while their upper lip flattens out.

You can also try a different feeding position such as laying back, where baby is more in top, so that they fall more forwards, rather than the cradle hold, as baby’s head is heavy and as your arms tire and drop, baby will slip onto the nipple.
Set goals, one feed at a time, and if your nipples are really sore and cracked, you can use a nipple shield to help buffer and heal them. Talk with your midwife or health visitor to get some support if needed.”

Thank you so much for all of your questions for Sioned, make sure to tune into our Facebook and Instagram pages for more expert advice.