Let’s imagine baby is due in a few weeks. You’ve probably talked quite a lot about your birth. You have a birth plan. You have some ideas of what you are aiming for.

Now let’s take a few moments to imagine the very first breastfeed.

Perhaps you’ve already had a breastfeeding class. Perhaps you already know about things like skin-to-skin and feeding in the first hour. I hope so. Maybe you’ve even written a feeding plan or spend time visualising your first breastfeed. When you’ve finished reading this, close your eyes and do some imagining. Can you really picture what it will feel like? Not really. However, the same is true of birth. Doesn’t stop us talking about preparing about our birth for hours and hours though!  I think we’re entitled to some 'hypno-breastfeeding' or at least talking through the first breastfeeding with our partner.

After you’ve given birth, the ideal is that baby is placed on your tummy (or higher if the umbilical cord lets them get that far). The baby isn’t washed or separated from you unless absolutely necessary. Sometimes we then let the baby perform a ‘breast crawl’. The newborn has an incredible ability to find the breast and latch on all by themselves. They scoot up the mother’s body and are guided by smell and primitive vision and find what they need. These instincts might be affected if they have had any intervention or are dealing with medication in their system.  Spend some time on YouTube watching breast crawl videos and I defy you not the utter the occasional ‘Whoah!’ http://www.youtube.com/results?search_query=breast%20crawl&sm=3

Send some breast crawl videos to your partner at work and I guarantee the chances of a ‘Whoah!’ or ‘That’s coooool!’ text in return are high.

Whether we let baby do their thing, or whether we give them a helping hand, we would aim to have some skin-to-skin as early as possible and plan to try to do the first feed within the first hour after birth. After that babies seem less alert and may want to sleep for a block of time. It’s a good chance for us to sleep too. That first feed can happen in a hospital bed, in a birthing pool, in the recovery room after a C-section, on a sofa after a home birth.

What should that first feed look like? There are lots of ways to position a baby at the breast and there isn’t one correction position. You certainly don’t have to sit up straight to allow the milk to flow and in fact some early breastfeeding is best done lying down or reclining. Breastfeeding classes sometimes reinforce the myth that we have to sit in a chair to make breastfeeding happen. Really not true or helpful. Have a look at www.biologicalnurturing.com for some ideas. This is also a great article: http://www.mothering.com/articles/natural-breastfeeding/

You may find that your baby can do their own thing and you can stop reading here.  Maybe you don't need to overthink this and take control and worry about the baby's positioning. They could get into position and find something that works and you can just lie back and let it happen.

There are some key principles though and if you feel the need to take control, it can be helpful to understand those.. Your baby will need to open their mouth wide –‘the gape’. They need to take a big mouthful of breast and not just to perch on the nipple with pursed lips. The big mouthful of breast gives their tongue a chance to scoop a big chunk of you towards the back of their mouth and get your nipple past their hard palate.

Feel the roof of your own mouth with your tongue. Can you feel the ridges of your hard palate? Your baby has those too but your nipple won't be rubbing against them throughout a feed. If breastfeeding is going right, the end of your nipple will sit in free space towards the roof of baby's mouth and near the junction of the hard and soft palate. If it’s going wrong, your nipple will rub against the hard palate and will get sore. If a nipple comes out looking compressed/ squashed/ with a white line across it/ tapered at the end like an old lipstick – that’s a clue it’s been pressed against the hard palate and something is going wrong.

Your baby needs a big mouthful and hopefully more of a mouthful below the nipple than above. We ideally don’t want the nipple to enter the mouth centrally but asymmetrically – nearer the roof of the mouth. So if we're lying back, we don't want the baby too high on the breast before they start. If they have to 'reach up' and tilt their head a bit to get there, that's useful. Picture that nipple heading where we want it to go – towards the junction of the hard and soft palate. You might think, but if I put the nipple nearer the top half of the mouth how will it go back far enough? Won’t it get jammed on the roof of the baby’s mouth? Nope. The key thing is giving the tongue as much space on the breast as possible. Then it can scoop as much as possible. The nipple will actually be stretched to two-and-a-half to three times its natural length when feeding. It will be extended by that tongue scoop and negative pressure created by the suck.

So we need the big gape. But there’s no point in having a big gape if other things aren’t right too. The baby’s chin needs to be making contact with the breast and even more than that – usually pressed into the breast a little. This means that the baby’s head will probably be slightly tilted. When you are taking a big bite out of an apple or a burger, you’ll usually lead with the chin. Usually the chin makes contact first with the breast. The nose will probably only rest very lightly on the breast or may not even touch at all. Some women with very large soft breasts find that the baby’s nose is slightly buried in too – don’t panic. Baby nostrils are very clever. They are designed to leave little air gaps around the corners even when the nose is making complete contact. You do not need to push your fingers into the breast to move the breast away so they can breathe. That’s a great way to get blocked milk ducts. Many of our ducts are quite close to the surface of the skin and pushing into the breast with a finger is enough to prevent flow. Try first encouraging your baby’s chin to tilt more into the breast. If the baby’s nose is still buried, it might just be about the consistency of your breast. The baby will prioritise breathing and come off if there’s a problem. That’s one reason we don’t hold the baby on the back of their head or put pressure on the back of their head – we need to give them the freedom to be able to come off. Holding the back of the baby’s head firmly to push them onto the breast can repress the sucking instinct and cause a baby to become quite distressed.

The baby’s bottom lip will ideally be a bit flanged out. A bit like a fish lip. This gives the tongue more chance of being where it needs to be – over the gum ridge and scooping breast tissue. If the lip is tucked back, the tongue is probably not far out enough. The top lip doesn’t need to be flanged out. In fact if the top lip is, that can be an indication the gape isn’t wide enough. However here’s a thing – once the baby is on the breast and feeding we can’t check lips and latch anymore. If a baby is positioned properly we probably can’t even SEE the lips and the cheeks are hiding them by making close contact with the breast. If you can see lips or see breast tissue moving in and out of lips, your baby probably doesn’t enough breast in their mouth. Be a bit wary if someone wants to check your latch by pulling at your breast or pulling baby’s cheeks. Best to check latch by watching as the baby goes onto the breast, watching how they naturally feed and looking at the shape of the nipple once it comes out of the baby’s mouth.

So we’ve got the big gape.

The more-of-a-mouthful-below-the-nipple.

The chin contact and chin driving into the breast with a head tilt.

The baby’s body should also be in a line. That’s to say ear, shoulder, hip all facing the same way. Try drinking a glass of water with your neck twisted to one side.

Baby will also be close and tight to your body if we’ve got a hope of getting that chin close enough.

What’s happening with their hands? In the early days, hands can seem a little inconvenient. However they are an important part of a baby’s sensory tools so we try and avoid swaddling when breastfeeding and soon the hands will be your friends. Ideally a baby won’t be wearing any clothing at all or be wrapped in anything when they have that first feed.  You might have a sheet or blanket lightly around both of you. In the early days, if a baby can’t get their face to the breast, they’ll try and get there with their hands. We don’t want the hands to end up on the baby’s chest or tucked at their neck as this will push their upper chest away from you which pushes the chin away which means a shallower latch. Baby’s hands shouldn’t be between your bodies. We also don’t want bulky clothing between you or bras containing breast pads squashed between you. One of the reasons skin-to-skin is so great for breastfeeding is you don’t have to deal with all the unhelpful fabric in the way!

What about holding your breast? Hmmm. Be careful about this. A leading cause of nipple soreness and damage is a mum holding her breast and ‘offering’ it towards the baby or ‘putting it in’. Nooooo. The breast is then going to slip subsequently and probably end up on the hard palate again. And holding breasts is a great way to end up with those blocked ducts again. Not to mention the fact that you’ll be doing this breastfeeding lark for a lot of hours and you’re going to appreciate having a hand free. Be wary of anyone who tries to ‘help you out’ by holding your breast or touching your baby. None of that should be needed. Be firm that people should help you with encouragement and words at this early stage. Touching is a last resort.

There’s a phrase we use a lot: “baby to breast”. That means that the baby moves TO YOU. You don’t move to the baby. Find yourself a comfortable position with good back support and the baby moves to you. If you lean forward, sit bolt upright, push the breast about, lift the breast up - you are risking problems. If you don’t feel you can move the baby towards the breast, check how you are holding them. Do you need to hold them very much at all if they are lying on you? Perhaps you’re holding them just around the head and it feels a bit like your yanking them from the ears? Look at placing more of their body on your arm if you’re using the cross-cradle or cradle hold. If you feel the need to lift the breast, are you using a breastfeeding cushion/ pillow that’s too high? We all have a different amount of space between our lap and our breasts. Breastfeeding cushions perpetuate a myth that we’re all roughly the same shape. For some women, a commercial breastfeeding pillow will be far too high. Their breasts hang such that the baby need only rest on their lap. For some people, it’s far too low. If we lean back slightly, the baby’s weight will be resting on our torso and we should not need a cushion at all. Also look at the angle of our nipples. Some of us have nipples that come out at right angles from our body. So baby will come onto our body at a right angle. A lot of us have nipples that point down slightly, so baby will need to come slightly up from under the breast to make sure both cheeks are making contact with their breast. They will be looking slightly up towards our shoulder, rather than towards the middle of our backs.  If we put that baby to the slightly drooping breast at a right angle, their bottom cheek wouldn’t be making contact and some breast tissue on the lower side wouldn’t be far back enough in the baby’s mouth. Try and breastfeed with your breasts in their natural shape and things will be a lot easier.

So:

Big wide gape with bottom lip out like a fish lip.

The more-of-a-mouthful-below-the-nipple.

The chin contacts on the breast and chin driving into the breast with a head tilt.

Baby’s body close and tight to yours.

The baby’s body should be in a line. : Ear/ shoulder/ hip

Baby to breast, not you leaning forward and ‘offering’. Try lying back if you can.

Breast in its natural shape wherever possible

Both cheeks touching breast. Lips not even visible.

Mum comfortable.

That’s too many things to make a clever mnemonic out of. BMCLBNCC?

What will it feel like?

It feels like a teeny being sucking your nipple to about 3 times its natural length and then massaging your breast with its tongue while creating a vacuum and wiggling its chin up and down .

However that doesn’t quite capture the magic.

It feels exciting and important. It feels like this tiny person is connected to you in ways you couldn’t quite imagine. Oxytocin hormone is flying everywhere and you feel quite blissful. Some people say powerful. Perhaps a bit tired too. Exhilarated and peaceful – you can be both of those things at once. The beginning of a really important journey. Perhaps the most valuable journey of your life.

Again this week, I read a comment by a leading breastfeeding expert tutting over the use of nipple shields. 

Of course, this person has decades of experience.

Of course, there are plenty of times when nipple shields are used incorrectly and over-enthusiastically .

Of course, when they are used without seeking access to other breastfeeding support they can mean supply issues, continued nipple pain and damage and a situation that can be challenging to unpick.

But can I please just take one moment to say that sometimes they can be bloody marvellous.

I’m not ‘supposed’ to say that. I’ve heard lactation consultant colleagues say, “Oooh, I hate nipple shields.” I’m meant to be down on them and focus on all the disadvantages.

But sometimes I just feel they need a little bit of defending.

I don’t know what’s going on with tongue tie at the moment. It seems like every breastfeeding drop-in group I visit has at least a third of babies who are post-frenotomy (tongue tie ‘snipping’) or they have been diagnosed and are waiting to be seen. Obviously the proportion of babies who come to get breastfeeding support will inevitably include more struggling with tongue dysfunction - however the numbers still seem ludicrous.

 I’ve seen mums who are breastfeeding several months after an initial nightmare month living with tongue-tie and a nipple shield has made all the difference.  Tongue tie is often accompanied by a high-arched palate or ‘bubble’ palate as when a baby is in utero the tongue hasn’t been pressing up against the soft bone of the palate due to its restriction and the palate doesn’t end up being smoothed into the typical gentle arch. And although babies can feed just fine on flatter nipples and even inverted nipples, they often do like to feel something touching their palate and triggering their sucking reflex. And if that palate is an extra centimetre away, that can be tough.  A baby may struggle to get purchase. They may appear to be searching for something and become frustrated. Finding a way to get baby to latch on and stay on may not always be easy.

Babies with tongue tie and high palates can latch on effectively but it’s not easy for everyone to find those ways on their own.

There are ways to get babies to latch on beautifully to flat nipples but it’s not easy for everyone to find those ways on their own.

In some cases, nipple shields can be a useful tool. The baby receives that palate stimulation and settles into a fabulous rhythm of deep swallows and great chin movements, milk is transferred and it’s hard to see what’s so evil about that.

Those who demonise nipple shields might have talked about the need to ‘work harder’ to find a latch that works. That’s fine - but when it’s 2am and mum is exhausted and baby is exhausted a bottle of formula may well be an appealing choice when your nipples are already sore and feeding has never been easy.

If we make nipple shields the ‘bad guy’, you may find that less feeding happens at the breast. Not everyone has a breastfeeding specialist sitting in the corner of their bedroom behind the nightlight. Or even access to good quality breastfeeding support throughout the week in the day time.

This morning I worked with a mum who had nipples that looked naturally quite different. One had a wide barrel shape and a length of about 15mm. The other was a slight dome rising no more than 3mm above her areola. She had been feeding successfully on one breast but when it came to the flatter side, baby was confused and frustrated. He had never really latched on for more than a few moments. Several weeks on, she was feeling desperate. She had been supported to try many positions by several breastfeeding counsellors and lactation consultants. She had visited a cranial osteopath. But the reality was that her son was used to the sensation of the longer nipple and the other side was less straight forward and he was struggling to move between the two. Perhaps she could only feed from one side and express the other? Perhaps she could just lactate on one side?

She tried a shield today and, for the first time ever, he moved immediately to deep chin movements, audible swallowing and mum said, “Yay!”.

She actually said “Yay!” quite a few times.

I would defy someone who had spent time with that mum and heard her history and worked with her to then say, “I hate nipple shields”.

There are certainly times when they don’t work well. I’ve also been to a group and a mum has shown up using shields to help her cope with sore nipples. The low point came a couple of nights ago and she couldn’t continue feeding  just on the breast. Even in that moment, it’s hard to argue it would’ve been better for her to stop breastfeeding and use a bottle in order to ‘rest’ completely. The shields allowed her to keep going and avoid the complication of using a bottle. However the shields were not her solution. Thankfully she sensed that and knew to come to a group and get support but I wonder how many women don’t. Her positioning and attachment could certainly have done with some improvement. She was leaning forward and ‘offering the breast’ and then pushing it in baby’s mouth without really waiting for a gape or bringing the baby to her. Her nipple was coming out after a feed flattened and compressed and was visibly damaged along the ridge where it was flattened. There were lots of things that could be improved. And the shield didn’t help with any of that. But it helped with her psychology and she came to the group. It kept her going.

Shields don’t help with sore nipples. They can exacerbate issues where babies have insufficient gapes and the baby just then transfers their insufficient gape onto the shield. But if the shield means that mum can cope with breastfeeding until she does manage to get the right support, if they stop her giving up, then that surely is a positive.

Shields are connected to a lower milk supply. Possibly because hormones aren’t being stimulated in quite the same way even through the modern thin silicone shields. Possibly because the people who resort to using the shields have issues that are the true cause of milk supply reduction. It can be wise to stimulate your supply using some additional expression if you are using shields and keep a closer on on baby’s weight gain. However I’ve also seen shields get a mum through a difficult couple of days when she had too MUCH milk. After struggling with oversupply and overactive letdown, her baby choking and spluttering with every feed, she found using the shields tided her over until she was able to get proper support and information. The baby was able to come to the breast without being flooded and her alternative would’ve been expressing and bottlefeeding.

If we demonise nipple shields, we reduce options. Options that actually might help when the next breastfeeding group is in two days time and the breastfeeding helpline isn’t open for the next 10 hours. And when the temptation is to pick up a bottle when it’s really not want you want to do.

You can use a shield and practice good body positioning and nose to nipple and head tilting and gaping. The baby works at the breast and is held close and does lots and lots of useful and valuable things and transfers milk as it gradually thickens and this is all still breastfeeding.

If you’ve been a breastfeeding supporter for a gazillion years and you’ve always managed to get babies to latch on superbly and you’ve never needed to use a shield – that’s dandy. But I will hold my hand up and say that sometimes I’ve worked with mothers who did use a shield and it made them happy and they felt great and the baby felt great. They went on to reach their breastfeeding goals, often weaning off the use of the shield with very little difficulty.

I think sometimes nipple shields deserve a teeny little ‘yay!’ They aren’t right in MOST situations and good quality breastfeeding information usually means that they are not needed.  If they are going to be used, they should be used with support from someone who is qualified in breastfeeding. But in a minority of cases, they can be bloody marvellous.

This post was originally written for http://www.nurturingmumsuk.com/ 

The first few weeks are often a blur for new mums. The learning curve is steep and you survive day to day – remembering to shower and put food in the fridge for yourself if you are lucky. For those mums still in the middle of that blur, the thought of the eventual return to work can be one that provokes anxiety.

You can’t imagine how it will feel to leave this new special person in your life.

How do you people cope with drop-offs to childcare and getting back to work after potentially several night-wakings?

What do you do if you don’t want to give up breastfeeding?

As a breastfeeding counsellor and lactation consultant, I’ve been supporting breastfeeding mums on their return to work for the last 6 years and there are a few things that are worth bearing in mind.

Here are my SIX top tips for returning to work as a breastfeeding mum.

1.       Don’t think about it.

OK, now I don’t mean that too literally. My message is just that if you are going to take 6 months, 8 months or a year off work and you spend several months of that stressing about the return to work, you will be seriously missing out.

STOP yourself thinking about it too much. If you stare at your gorgeous three month old and think fleetingly, “How can I ever leave you?” (which is how nature very much wants you to feel), that is fair enough. But if you spend chunks of your maternity leave feeling anxious and worrying about practicalities, you will be wasting the special times you do have together.

This time is precious. Your baby now is not going to be the same person when you return back to work. They will sleep differently, feed differently, and interact differently. You will not be leaving THIS baby but an older one.  So get your childcare sorted (which you may well have thought about in pregnancy anyway) and other than that, there’s not too much more to do! If you intend to express milk at work, it’s a good idea to write to your employer about 2 months before you go back to work to talk about arrangements. And then just carry on as normal. If your 4 month old baby won’t take a bottle and that starts you panicking because you have to go back to work at 8 months, don’t think about it. An 8 month old baby can breastfeed when you are with them in the morning and evening, take a sippy cup, drink from an open cup – you will have options. And a four month old baby that refuses a bottle may not if you try again after leaving it for a few weeks. It’s very easy to set yourself into a panic when the truth is that things usually work out with the right information and the right support.

2.       As mentioned, speak to your employer.

http://www.hse.gov.uk/mothers/faqs.htm#q14

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-back-to-work.aspx

The recommendation is that you inform them that you will be returning to work as breastfeeding mum so they have a chance to assess your health and safety and what provisions you may need. Your employers are required to keep you safe. They also have a legal requirement to allow you to ‘rest’ as a breastfeeding mother. Sadly, in the UK, there is not a clearly established legal right to express breastmilk at work and it’s important you talk to your employer so they have advanced warning and you can come to an arrangement. Some women need to have break times re-organised or a room found. Although there is no ‘legal right’ the VAST majority of employers understand that it is in their interests to try and meet your needs and provide you with facilities. Your morale matters and a baby receiving breastmilk is less likely to suffer from illness meaning less time off work for you. There are health and safety executive recommendations and many employers understand the benefits of supporting you as much as possible. However, employers will be more likely to be accommodating if you give them warning and explain your needs clearly.

3.       Talk through your schedule with a breastfeeding counsellor or lactation consultant.

Drop-ins are not just for people with problems with positioning and attachment. It’s really common for a mum to come along a few weeks before their return to work to talk about how they hope to organise their feeding and pumping schedule and how to organise things practically. I’ve included some typical scenarios later on.

4.       Practise pumping.

Is the breast pump you are using a home something you are familiar with? Do you have a backup if you need to pump at work? Is it worth sourcing a double pump if time is an issue or even hiring a hospital grade electric breast pump for a few months which can just stay at work? You’d be looking at paying around £45 a month (http://www.ardobreastpumps.co.uk/breastpumps_for_hire)

There are tricks such as preparing the breast using massage and warm compresses. And we know that women who finish a pumping session using hand expression techniques can increase their output considerably.

http://lllrochester.weebly.com/uploads/7/9/5/4/795404/marmet_technique_tearoff.pdf

It’s also not a bad idea to build up a bit of a freezer stash before you go back. If you start pumping for one extra session each day and storing that in a freezer bag (store them flat and build up layers of thin flat bags which defrost more easily and take up less space), you will have some wiggle room if you need it. It’s not entirely predictable how pumping will go at work and some women find that their pumping output decreases towards the end of the week and then a weekend of normal breastfeeding boosts it back up again. If you have that freezer stash, it will take away some of their anxiety.

5.       Get your kit.

So you need a pump and some bottles and some breastmilk storage bags. What else? Surprisingly not much. You don’t need to store freshly expressed breastmilk in the fridge at work if you don’t want to. You can have a freezer block and an insulated bag and put any expressed milk in there. It is fine in that for 24 hours. So if you store it like that at work, put it in the fridge when you get home, then that milk can be given to your baby’s carer for the next day.

http://www.breastfeedingnetwork.org.uk/pdfs/BFNExpressing&Storing.pdf

It’s also really important to note, you don’t need to wash and sterilise the pump between pumping sessions. Breastmilk is fine at room temperature for up to 6 hours. So you certainly don’t need to wash a pump between your 11am pumping session and your 2pm one. Lots of working mums use a technique called ‘wet-bagging’, putting a pump in a plastic bag between sessions and then putting it back in the fridge. Then simply take it out next time and wipe any wet parts with paper kitchen towel if you don’t fancy cold drips against you! This also saves precious time.

6.       Breastfeed when you can.

Your supply is more likely to be maintained if you breastfeed when you get the chance. Is your childcare near work or home? Could you visit your baby at lunchtime?  Could you work from home for one day a week for the first few weeks? You could breastfeed early in the morning, then once more at drop-off, once more at pick-up and again at home later in the evening. Those 4 feeds would be enough breastmilk overall for a baby of 8 months or more. You may not need to be carrying bottles back and forth. And breastfeeding at the weekends and during holidays will help to boost your supply.

Here are the stories of three mothers I have supported (names and some details have been changed):

Carla is going back to work full-time at 6 months. Her son is an enthusiastic exclusive breastfeeder and she’d like to avoid using formula if she can. When her son is 4 months old, she writes to her boss (she is a PA in a law firm) and explains she would like to express her milk at work. Her boss explains the company procedure of having a small office set aside for pumping and there is also a fridge available. Carla explains she intends to express around 3 times in the working day and one of those times will be during her lunch break. Her boss is fine with that. She has a double electric pump which she starts using from 4 months and she gives her son a bottle every other day to get him used to it. She finds he prefers to sit a bit more upright and usually takes 3-4oz from the bottle.

She starts solids around 10 days before she goes back to work and he takes small amounts initially and Carla knows his breastfeeding schedule will remain unaffected for a while. The week before she starts work, they visit the nursery together and he has a few hours there. He then has two trial days where Carla practises her expressing schedule and the nursery workers give him a bottle and some solids.

On her working day, she breastfeeds him as normal at 6am. She drops him off at nursery at 7.45am and offers again and he takes a small feed. At work she expresses at 11am, 1.30pm and 3.30pm. She collects her son from nursery at 6pm. He is keen to breastfeed when she arrives and they breastfeed at nursery. She breastfeeds him again at home at around 10pm as a dreamfeed.  He wakes once at around 2am and she breastfeeds him again.

While he is at nursery, the carers give him bottles and offer solids and he usually takes around 12oz in total while they are separated. As he has 3 good breastfeeds in addition to that in 24 hours, Carla isn’t worried. Carla expresses more milk at work than her son takes in a bottle at the moment. Over the next few weeks, she moves to expressing only twice. Carla ends up offering exclusive breastmilk until 12 months and then she gradually introduces cow’s milk.

Phoebe is returning to work at 10 months. She is a graphic designer and works from home with some client visits necessary around London. Her daughter breastfeeds around 4 times in 24 hours and enjoys solids which she started at 6 months. Phoebe doesn’t enjoy pumping and finds it difficult so would rather avoid it if possible. She finds a child-minder who lives near her home. Phoebe breastfeeds at 8.30am and drops her daughter at the child-minder. If she is working from home she visits at lunchtime for another breastfeed. She then collects her daughter at around 4pm and takes her home to breastfeed at 6pm and around 11pm. While her daughter is at the child-minder, she eats solid food and drinks water. The child-minder doesn’t give her milk. When Phoebe has a client visit, she sometimes hand expresses for a few minutes into a plastic bag when she can grab a private moment. This is just to stay comfortable when she feels particularly engorged. This will help to reduce her risk of blocked ducts and mastitis and help to maintain her supply. She doesn’t keep the milk. Phoebe continues breastfeeding her daughter until she is 18 months old. At the end she is only breastfeeding in the morning and evening and Phoebe doesn’t feel the need to use any hand expression when they are separated.

Catherine is returning to work at 8 months. Her son breastfeeds around 6 times in 24 hours. He started solids at 6 months. He doesn’t particularly like bottles and usually only takes around 2oz max. Catherine finds that he will take more milk from an open cup called a doidy cup. He will also more likely to take it if she mixes the breastmilk with ripe banana and makes a smoothie! Catherine gets through a lot of bananas! She works 4 days a week (and at 12 months will go back to being full time). Catherine is a teacher. Her headteacher has struggled to find her a private room for pumping but has given her the key to the medical room and if that is in use, she uses a stock cupboard and she has told staff that when her scarf is on the door, please knock! Usually the medical room is empty. Her colleagues have agreed to relieve her of playground duty while she is breastfeeding. She breastfeeds her son at 5.45am and again at 7.45am at the child-minder. She arrives at school at 8.15am. She expresses at 10.45am during morning break. She expresses for 10 minutes. She expresses again at lunchtime for 15 minutes and at around 4pm for another 10 minutes. She has to use a double pump as her pumping time is restricted. She remains at school for meetings and lesson preparation and collects her son at around 6pm. She breastfeeds him at 7pm and 10pm. He wakes to feed between 1-2am and Catherine is happy for that to continue for the time being as he feeds and goes back to sleep quickly.

With the child-minder, her son takes around 3oz of breastmilk in his smoothie, 2oz mixed into a porridge and another 1-2oz from his doidy cup. She also makes sure his solids contain good sources of fats and calcium. Sometimes she struggles to pump in her breaks as she really needs to continue working. She finds herself dipping into her freezer stash and as time goes on, the child-minder sometimes uses formula to make up the porridge. On the weekends and on her day off, he breastfeeds more frequently.  

There are many women who effortlessly combine breastfeeding and working. If it sounds hard, remember that in the USA there is no statutory maternity leave and women often return to work after just a few weeks. However they have 16% of babies exclusively receiving breastmilk at 6 months and the UK manages 1% (http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf).

Working and breastmilk are not incompatible. With modern electric breast pumps and using breastfeeding support available locally and through the National Breastfeeding Helpline, it’s never been easier. However if we could get the statutory right to pump at work it would certainly help. Contact your MP if you feel the right to express at work (as exists in 92 countries throughout the world) is something UK mums should be entitled to. 

So I wrote to Lynne Featherstone, my MP, previously the government’s equalities minister.

 I said I had been concerned that the recent conversations about flexible parental leave had made no mention of breastfeeding. Perhaps a mother returning to work two weeks after birth might need a teeny weeny bit of help if she was going to make breastfeeding work – and follow the government’s own recommendation to breastfeed exclusively for 6 months? The NHS website states: “Exclusive breastfeeding (with no other food or drink) is recommended for around the first six months of a baby's life. After this, breastfeed alongside other foods for as long as you and your baby wish. This might be into their second year or beyond”.

Lynne Featherstone appreciated that breastfeeding was an important area and wrote to Nick Clegg to ask more about the government’s commitment to this issue.

Here is the government’s reply.

“Dear Lynne

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness; breastfed babies are generally healthier; increased staff morale and loyalty, and a subsequent higher rate of return to work; lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice.

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding, women who return to work whilst nursing will continue to:

·         Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

·         Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk.

·         Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers

I would like to thank you for bringing this matter to my attention.

Jo Swinson MP

Shall we unpick this letter?

Dear Lynne,

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.


[How many breastfeeding women do you think have been surveyed to arrive at this opinion? 
Do you think the government is aware that a breastfeeding baby takes about the same amount of milk at 6 weeks as they do at 6 months and there is remarkably little variation? 
Do you think the government knows that the vast majority of women pump about 90% of available milk in the first 10 minutes of pumping? 
And with a double electric breastpump, this may mean that a mother of a 3 month old baby need only spent 30 minutes pumping during a working day of 8 hours? 
Talk to mothers of 3 month old babies, 5 month old babies, 8 month old babies – you’ll find that the ‘very individual’ requirements are actually pretty boringly not that individual, pretty easy to work out and that the MAXIMUM a mother may require is really not so burdensome and using that as a guideline does not result in the crumbling of an economy]

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness;  breastfed babies are generally healthier;  increased staff morale and loyalty, and a subsequent higher rate of return to work;  lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. 


[Which makes it sound delightfully like we all sit around a table, share a flagon of ale and come up with agreements that make everyone feel warm and fluffy. Would you like to meet the mother of an 8 month old baby who was told by her employer he was not willing to provide ANY time for expressing?]


Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice. 


[If an employer employs a disabled person he has to make ‘reasonable adjustments’ to accommodate that person in the workplace. This might include a change to working hours or providing a special piece of equipment. But it’s apparently burdensome and unthinkable to imagine an employer might make reasonable adjustments for weeks or months to allow a baby to continue to have access to breastmilk. A room, a fridge, ten minutes here and there. Really too hard? We don’t even need the fridge.]

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.


[Hang on now, dear Government. So do you WANT mothers to stay home for 6 months? Do you want babies to receive exclusive breastmilk for 6 months and to continue to breastfeed alongside solids after that, or not? Or do you want mother to return to work as quickly as can be conceived – perhaps only 2 weeks after giving birth – and return to a workplace with ‘no specific right’ to breastfeed or express (your words)?
 Are we saying that breastfeeding for 6 months is a luxury some women might choose to indulge and if you want or need to return to work, hard luck? 
And don’t think I haven’t noticed that a government minister appears to have misunderstood the government’s recommendations on breastfeeding and has confused the ‘exclusive breastfeeding for 6 months’ with a recommendation to ‘breastfeed for 6 months’. I noticed.]

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding [Nope, no specific right for the mother NOR the baby. Have we read the United Nations Rights of the Child Article 4: “You have a right to special care and protection and to good food, housing and medical service”?], women who return to work whilst nursing will continue to:

•             Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

[So let’s get this straight, the breastfeeding mother has a legal right to ‘rest’? 
Would you mind awfully if she take along her breast pump while she ‘rests’ and pops something in a mini-fridge after she’s ‘rested’.
 But oh, hang on, people can get tired in very different ways? Getting tired is a very individual thing. That’s surely very hard to legislate when it’s all so individual but yet that one seems to have made it into law. 
Can we just declare now that the mention of ‘rest’ for the breastfeeding woman is one many of us could write essays about. It was a concept from a different world – a world before the electric breast pumps of today and the modern working practices of modern women. CAN WE SWAP IT FOR SOMETHING ELSE PLEASE?]

•             Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk. [Have the right… also have the right to go to our employer and ask for a special day when everyone dresses up as Spiderman. Doesn’t mean the request will be granted.]

•             Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers [comprehensive guidance on how to provide a place and time for ‘rest’ – these women may even need to lie down. And “You may provide a private, healthy and safe environment for employees to express and store milk, although there is no legal requirement for you to do so”. So guidance on how employers can meet their legal requirements won’t take long then, hey?]

I would like to thank you for bringing this matter to my attention. [Thanks Jo, Hope you don’t mind if we come back to you on a few things. Here’s one thing: employers have to keep mother and their babies safe. The guidance says ‘There may be risks, other than those associated with pregnancy, to consider if an employee is still breastfeeding on their return to work. These will depend on her working conditions but could include:

working with organic mercury

working with radioactive material

exposure to lead

This list is not exhaustive (see EC guidance  for further information). You will need to consider any other risks that could cause harm to the mother or child’s health and safety, for as long as she wishes to continue to breastfeed’.

You do realise, don’t you, that a mother denied the right to breastfeed is at greater risk of blocked ducts, mastitis and possibly breast abscesses? That’s even the ones who aren’t working with organic mercury. That’s all breastfeeding mums. And that a baby whose mother ends breastfeeding early will be at greater risk of health problems? So how about we make it a legal requirement that an employer makes ‘reasonable adjustments’ to accommodate breastfeeding women?

We don’t want a legal right to ‘rest’ and lie down. We want a legal right to give our babies breastmilk if we return to work. I promise nothing will crumble. It’s not scary and it’s not hard. Let’s just focus on that word ‘reasonable’.]

Jo Swinson MP

I recently supported a mum who had some initial struggles with latching. This is what breastfeeding supporters see every day.

It’s normal for us to work with mums taking a little while to get the hang of latching and positioning. It’s normal for us to work with mums who are a bit sore.

While it may feel normal for us - when you are in the middle of that experience, it feels like the end of the world.

You dread each feed.

 You fear that things are going to get worse.

And you don’t really understand what’s happening.

Is this normal? Is breastfeeding meant to feel like this? How much pain is meant to be tolerated? When should I get support? Why can’t I work out what’s going on? Is my baby getting enough milk? When can I take him off? Is it now? Please?

The mum who I was working with had been online and tried to find the stories of other people struggling with latching. And surprisingly she found very few. There are breastfeeding stories out there but it appears many people who have struggled with latching don’t think their story is worth sharing.

However it can very extremely valuable for mums to learn that struggling with latching is normal and people come out of the other side of the experience with support and with time.

So what IS normal?

Here’s an easy rule: if you are in any discomfort, why not get someone with training and experience in breastfeeding to check your latching and positioning?

Who cares what’s normal! If it hurts, let’s check.

Better to be over-cautious and get help just in case. Far better to go to a group and be reassured in a couple of days you will feel more comfortable than continue to struggle at home and wonder if this will improve all on its own.

 In the vast majority of places in the UK, mothers can access trained support – from midwives, breastfeeding counsellors, IBCLCs (lactation consultants), La Leche League leaders, and peer supporters. Even if you are unable to leave your home, people may be able to come to you.

And in a worst case scenario, if you really can’t see someone face-to-face, volunteers on the national helplines are trained to talk about latching over the phone. That often sounds bizarre but when counsellors ask you about the placement of your cracks or damage, the shape of your nipple or how feeds feel – we are able to build up a remarkably useful picture.

Even if your tenderness is within ‘normal range’ and your latch is fine, no harm will come from getting support sooner rather than later. Don’t wait.

Before you give birth, find out what resources are local to you and make sure you know where to go in the early days.

 The truth is that some tenderness in the first few days may be normal (and that’s first few days, not weeks). Our nipples are being stretched to 2 to 3 times their natural length to place correctly beyond the junction of the baby’s hard and soft palate on the roof of their mouth. That stretching may take a little bit of getting used to. There may be some discomfort in the first 10-20 seconds as that stretch occurs. For the FIRST FEW DAYS.

But pain throughout a feed?  This shouldn’t be tolerated at any point.

What’s also NOT normal is a nipple that comes out of a baby’s mouth misshapen. If a nipple is placed correctly it comes out at the end of a feed (in the first few seconds it leaves the baby’s mouth) longer than normal but rounded at the end like a jelly tot. If it’s sitting in the soft tissue beyond that hard and soft palate junction, the end of the nipple can’t get squashed and flattened.

But if the nipple is pressed against the hard palate (perhaps because the baby’s bottom lip is too close to the base of the nipple, or the chin isn’t close into the breast, or the baby’s gape isn’t wide enough), that nipple may come out wedge-shaped, flattened, tapered like a lipstick just out of the tube or with a white stripe across it. It might also get distorted if a baby isn’t using their tongue effectively.

If a nipple comes out of a baby’s mouth like that. Or a nipple starts to get cracked and visibly damaged, then you really shouldn’t delay in getting some help.

A huge amount of people struggle initially with latching. Many of us have never seen breastfeeding up close until we come to do it ourselves. When we’re pregnant and we’re imagining breastfeeding (if we can psychologically get past thinking about the birth for a moment), we often picture breastfeeding as about ‘popping the baby on’. It’s more than that. And if we lived in a society where we had grown up around breastfeeding and seen it every day, we’d know so much instinctively.

Breastfeeding a newborn doesn’t always feel as natural as we might expect. It’s OK to admit it’s difficult and you need some help. As Rosie, one of the mums sharing her story below, says, “It was about as natural as trying to put a sock on a snake.”

However, changing a nappy can feel a bit like that too. And giving a bath can feel like trying to wash a snake with a baby sponge. We are learning new skills and that can take time.

This is one of the reasons that good antenatal breastfeeding information can be so important. And certainly why seeking out face-to-face support from a breastfeeding specialist once problems start to develop can be so crucial.

Here are some stories of mums I met on Twitter who were kindly prepared to share their experiences. 

Thank you ladies, I hope your stories inspire others:

Helen Ledger: I wish people talked about it more, I really think it’s the last taboo but it’s the most natural thing ever!

I really struggled to latch my first baby to my right breast. It started in the hospital, the chair in the delivery room just wasn't right for feeding & I couldn't seem to get the baby on properly. Then a few days in she would bring up little bits of blood & I just knew it was from me!

I have large areola but small nipples, especially the right one (hope that's not too much info) & I think the end of the nipple was just rubbing somewhere in baby's mouth.

It got to the point where I had a wound on my right nipple that was excruciating to latch the baby on to. I was told to keep trying but to be honest, the pain was so severe I would be in tears every time. Plus, the wound would open every time & I would be back to square one in terms of it healing! I was told to try to avoid expressing but I decided if I wanted to continue breast feeding, it was my only option. I expressed as often as I could from my right breast & fed from my left when baby was hungry.

Soon the wound healed enough for me to latch the baby on again & because I was at home & comfortable & could adjust my position/pillows etc., I got the latch correct, aiming the flat of the nipple up slightly when the baby went to latch on.

I went on to feed my daughter from both breasts until she was 2 years old. My husband was a great support & encouraged me to give it a month before I gave in. Fortunately, by the end of the month it was much more comfortable.

I have also been feeding my second child, who is now 9 months old, successfully.

I think we just don't have a culture of breastfeeding now. I think it should be on TV more. Women don't need to sit with their top off & their boobs out to breastfeed; it should be shown discretely on programmes of influence like Coronation Street etc.

Kate Stinchcombe:  I don't know if you need any more stories about overcoming latch problems to successfully breastfeed.

The short version is that I was trying to prescriptively put my son on to the breast without considering the position of my nipples which, kind of point out to the side! I became very sore with blisters and bits of nipple dropping off etc!

The longer version is that I had a 10lb5oz baby and a 3rd degree tear. After initial skin to skin we were transferred to a main hospital and I had surgery after which I was exhausted and we just didn't get off to a great start. The young midwife told me that the audible clicking noise was a good sign because it meant the baby was getting milk. I regret not complaining once I knew better.

I had mixed experience of support from the midwives possibly because initially I was unsure if this was the way it was meant to be. My mother failed to feed me after two weeks with the same problem so could offer no advice. I had no breastfeeding peers to call on. It was Christmas so all the support groups were shut and the NCT BF counsellor had gastric flu and was too ill to even answer the phone.

On day 8 my own midwife (who had been on holiday) advised me to express for a couple of feeds to allow myself some time to heal. It broke the cycle a bit but I was still dreading every feed.

Eventually when my little boy was 3 weeks old we saw the bf counsellor who advised me on positioning. I slowly gained confidence. Rowan started gaining weight and at about 21 days he was back at birth weight and we were discharged by the midwife. It took about 3 months for us to establish a good breastfeeding relationship. He was always a big boy and hungry but never needed formula and was breastfed until 13 months.

2 years later, I didn't really have any problems with my daughter once I remembered to position her correctly. She has a tongue tie but it never seemed to cause any problems. She's 17 months now and breast milk is still her main food.

That was quite cathartic!

Lucy McGill: Oscar was born at 39 weeks by emergency section for foetal distress. I think he needed a little bit of oxygen, but he wasn't too poorly. We were in hospital for 48 hours after the section, & during this time he appeared to feed - trying to suck at the breast, but for only 30secs or so each time. I was asked by lots of midwives why I kept taking him off- I wasn't, he kept coming off. He was screaming for most of the 48 hours we were in hospital, & neither of us slept much. I was given the 'breast is best' talk lots of times (which was frustrating as I was desperate to breast feed) and I was helped to express & Oscar was syringe fed. The general opinion seemed to be he was feeding, he was just really hungry. I couldn't wait to get home as the advice seemed to be different with every shift.

On day 3 at home the community midwife spotted that Oscar had an elevated tongue tip and every time I tried to feed him my nipple was going under his tongue. The poor thing couldn't latch at all, and other than the little bit of syringed milk, he'd pretty much had nothing at all for those first 72 hours.

Interestingly, my hospital discharge notes say Oscar was 'breastfeeding well'.

The midwife asked what I wanted to do, I said I wanted to breast feed, & for the rest of the afternoon she helped me try to latch him on. I had to hold him in a sitting position next to me, with his head level with my nipple (midwife thought gravity would help the tongue tip), and I would stroke his tongue down, and then quickly try to latch him on with his tongue down. I send hours & hours 'practising' this.

I bought a manual pump & was expressing & cup feeding. So each feed would consist of me practising the latch, then expressing & cup feeding. We'd start a feed, the process would take about an hour and a half, and then we'd have an hour or so 'off', and then start over!  By about the 5th or 6th day, we'd achieve 1 good latch or so a day; by 7th or 8th day, 1 good latch per feed; and by day 10 or so he was feeding just from me. The midwife spent at least another whole afternoon with me (during which she was ringing colleagues to pass on other home visits) possibly longer. Oscar hardly lost any weight at all - I can still hardly believe this!

We went on to battle reflux, cow’s milk allergy, blocked ducts & thrush, but I fed him for 11 months, & owe it all to that midwife (I've told her this). I'm now in my 11th month of feeding no 2 (just mastitis, thrush & blocked ducts & a bit of biting this time!), I still feel so grateful to that midwife (& my husband who worked just as hard as me during those early feeds).

I really feel so strongly that the right support at the right time is key to successful breastfeeding.  The support has to be accessible during that desperate moment - a breastfeeding group next Wednesday is no good!

Rosie Don: I come from a large family of breastfed kids, so there was no doubt in my mind that I was going to breastfeed my baby. I assumed it would be easy, second nature. I had made sure to attend a brief but informative lesson on breastfeeding at the local health centre, which focussed on good position, good attachment. I felt all prepared.

I was determined to have a very natural birth, and, due to missing my first scan, I had a slightly contested due date. Days over my due date, then weeks, then into the hospital for induction followed and my ideal birth seemed a distant dream. Well, at term plus 21days, it felt better to be surrounded by doctors than water! To cut a long story short, we ended up having an emergency C-section, and were exhausted for ages after. I think a midwife must have got Small to latch the first time, while we were still very much post-op. Then we slept.

On waking I was asked if the baby had fed yet, and when I said no, that we'd been sleeping, I was met with a concerned "she really should have had a feed by now", and of course I felt ever so guilty. So I tried to feed her, but I seemed to have too many, or not enough, arms to support her. It was about as natural as trying to put a sock on a snake. I felt a bit of a failure for a moment. She was just too exhausted to latch on, and I was too exhausted to help. The very young midwife said "I'm sorry, but... you just look so uncomfortable" to which I replied - panic very evident in my voice - "yes PLEASE help me, I don't know what I'm doing!”. I have heard some say they felt embarrassed if they had to let a midwife milk them, but I just felt grateful and relieved. Small had her first feed from a syringe.

For the 48 hours we were in the hospital, we spent much of the time skin-on-skin, bonding like crazy. We began to get the knack of this latching-on business. I remember the doctor who examined her saying there was a 'slight' tongue tie, but that it shouldn't cause much problem. Wrong! The week after we came out of hospital was torture. I had read about on-demand feeding and felt it was the best idea, but every second was such phenomenal anguish. I had had some 'advice' (??) from my partner's sister, who said breastfeeding Small's cousin was "the most painful 3weeks of [her] life". I realise now that genetics may have been a factor with this tongue-tie business.

Very soon, within a week, I had nipples cracked, scabbed, bleeding, the shape of small's palate suctioned onto the teat after a feed. I knew the nipple should be further into the mouth than that. I didn't even have any cream, had decided against shields and dummies - I was at my wit's end! Luckily a call to my health worker resulted in her dropping round free sachets of lansinoh (on a bank holiday!) and booking us in for a tongue-tie op in 3days time. The end of our trial was in sight. I couldn't wait to get us to that clinic.

The difference was incredible, after the procedure to cut small's tongue-tie. I wish that first doctor in the hospital had been able just to sort it out there and then. It's only because I was well informed that I didn't give up, and even with all the reading in the world, we all still at some point must be thinking, "Is it supposed to hurt this much?".

It's been exhausting, but so SO worth it, and we're still nursing now at two and a half years. How does it feel? WONDERFUL.

Emma Cantrell: I had latch problems with both my children. With my first I struggled in hospital with no proper help to feed, within 12 hours my nipples were cracked and bleeding. This carried on for 3 or 4 days, I was told by midwives that pain was normal. It wasn't until I told my Mum (a midwife herself) about it and showed her the deep, raw cracks and blisters that she said that it definitely wasn't normal and was a latch problem. She taught me the rugby ball hold, which helped straight away. It took three weeks of painful feeding and a lot of lanolin cream before my nipples healed and feeding was easy and enjoyable.

With my son I felt a lot more confident. However, I started feeding him holding him traditionally across my body and again, there were blisters and cracks. As soon as I saw this was happening again (whilst still in hospital) I asked to see the infant feeding specialist midwife at my hospital. She was brilliant. She helped me with lots of different postures and told me I had 'perfect nipples for breastfeeding’!! Feeding was quickly pain free and has been plain sailing ever since.

Jeanne Russell: I had extreme pain for 6 weeks.  Looking back, I can't believe I stuck with it and continued to breastfeed.  I would wince in pain and cry with each feeding.  My poor nipples were raw, scabbed and in terrible shape.  I finally attended local LLL meeting where the group leader was so kind.  She help me and another first time mom after the meeting for over an hour and a half.  She talked to us about skin-to-skin, understanding how to identify a proper latch - or break a poor latch, and in my case my daughter needed some help getting a deeper latch.  This leader gave us confidence and support in addition to the technical help.  There was no pressure at that meeting and I walked away feeling a little stronger.  From that point on, my breastfeeding experience was very enjoyable and something I became very passionate about.  My daughter nursed for a year and I cherish that time.

At some point during the following year I decided I wanted to pursue this as a potential career change and I completed a Certified Lactation Counselor program and I'm beginning to build a supportive local business. I see this path leading towards meeting wonderful women who just need what I needed in order to continue breastfeeding and enjoy it.  I'm 31 weeks pregnant now and I look forward to my next breastfeeding experience.

Louise King: Before pregnancy I had never really given breastfeeding any deep and meaningful thought and therefore had little opinion on it. ‘Bitty’ jokes and ideas of older children being breastfed made me laugh along with most other people. When I became pregnant, my understanding of the importance of breastfeeding for health benefits deepened.

During our breastfeeding session as part of our antenatal NCT classes. The question: why are you keen to breastfeed?

Out of the group of five couples we all had similar responses – ‘it’s good for the baby’, ‘it helps prevent diseases throughout life for mother and child’, ‘it’s cheaper and easier’. My own reasons were the same; I knew I wanted to breastfeed for all the right reasons, and some perhaps more self-centred – the promised weight loss and laziness essentially!

I knew of course that breastfeeding is so good for the baby, and I knew I would want to give it a good shot, but In all honesty, I wasn’t sure if I would be able to manage it, and rather than thinking I would succeed no matter what, decided to try my best and see how it went – I could always switch to bottle feeding couldn’t I?

However, I had already begun to worry about whether or not I would be able to having heard stories of difficulties from my reading up on the subject and anecdotes from friends. Especially as I have (the dreaded!) flat/inverted nipples! How would the baby latch on was the question in my head above all else, driving me to research how I could assist my unborn child so I could get breastfeeding established, and thus began the journey and the first (of many) purchases to make it all so much easier for me and baby.

#1 Nipple shells to draw out the nipple prior to birth.

I was so caught up in reading up on how to draw out the nipple I barely had time before Elliott was born (2 and a half weeks early) to entertain other common problems with breastfeeding that I had received literature about. Little did I know I would experience quite a few first hand!

Not long after giving birth I managed, with excellent midwife assistance to give E his first feed from the R side. However, getting him onto the L proved tricky. Because I’d had a c-section (Elliott was breech), I stayed in hospital for three days and had plenty of help from midwives. I was also allowed someone to stay overnight – my sister stayed the first night and without her help I don’t know what I’d have done. I remember being quite shocked at the time about the almost barbaric way some of the midwives were putting E onto my breast to help him latch but I now understand it wasn’t barbaric at all. Like us mothers, babies need to learn their own techniques too, and they do not in fact pop out and know where their mouths go.

When I got home the feeding on the R was going well but the L felt all wrong. I have a very clear memory of my Mum hand expressing my L boob in my living room to encourage the milk flow for E in front of my husband, sister, brother-in-law, niece, step-Dad and cat! My brother-in-law later asked my sister ‘was your Mum just milking Lou?” I can laugh now but at the time it really wasn’t funny for me! It was also around this time that my boobs stopped being hidden demurely but looked at and pulled around by all and sundry, something I quickly got used to.

And so the journey continued. The next stage; my milk came in. Nothing can quite prepare a woman for this biological development. Everyone talks about the Pamela Anderson effect but when it happens it’s a real shock. Having huge, hot, tender, swollen boobs doesn’t do the feeling justice. On top of this, I was still finding feeding on the L difficult, so had expressed the L boob, predominantly feeding on the R and feeling (and looking) very lopsided. When E was weighed at eight days old he had (of course) lost weight. I remember feeling so angst ridden. My hormones were going crazy, I had extreme baby blues, crying and laughing (craughing we called it) and I had lopsided tits. Plus my baby was looking scrawny. Did I grab the nearest bottle in order to push aside my fears? No, in fact I didn’t actually ever consider it. I think part of the reason is the amazing help I had from visiting midwives, my NCT breastfeeding counsellor and my family. I persisted and persisted. I bought yet more products to assist. Next on the shopping list were:

#2) Niplette to draw out the nipple,

#3) the My Breast Friend feeding cushion (with a handy pocket for storing said contraptions as well as chocolate).

And I pumped my L boob every time prior to feeding to encourage the nipple and milk.

But in my naivety I hadn’t realised was how long the whole process took. I felt like a human cow, glued to the sofa, constantly feeding. Everyone kept telling me it got quicker and easier and to make the most of it. I remember resenting being stuck to the sofa watching TV and catching up with Mad Men Season Five (yes, I take this all back now!). Plus, all the feeding on the R had taken its toll. Somewhere along the line I’d acquired an open sore on my R nipple (cue purchase #4 Lansinoh). I went to the doctor who prescribed an antibiotic cream and to return after one week if it hadn’t healed. It didn’t heal. Still I persevered with my breastfeeding, seeing how well my son was doing, gaining weight, pooing and weeing and all the other things they tell you are good signs. I went back and had my first course of antibiotics and was also advised to use nipple shields #5 nipple shields. These helped with what was now I can only describe as going between discomfort and sheer teeth grinding pain. But I still continued breastfeeding. Although hazy now (selective memory obviously), I cried about this nearly every day, my husband frequently tried to persuade me to stop breastfeeding and even my mum (a pro-breast feeder) did suggest once or twice it might not be worth it.

But I refused to give in. I have no idea where I got this belligerence to continue from but I did. Something inside me just had to carry on.

The infection and sore gradually decreased after a second dose of antibiotics but there was still a nagging soreness in my nipple, and I still couldn’t breastfeed without the shield. In desperation I made another doctors appointment and saw a different (female!) doctor who suggested it might be thrush. She took a swab and prescribed me an anti-fungal ointment, with instructions to come back five days afterwards. The cream helped but it still wasn’t right. At this point I really was at my wits end. I was in a quandary. In many ways breastfeeding had become easy, ironically feeding on the L was a cinch and Elliott was thriving. I went back to the same doctor. Although the swab had come back clear she prescribed me the one off tablet for thrush. Within twenty-four hours I had no pain, no pulling sensation, no gut-wrenching trauma and within forty-eight hours I was nipple shield-less! I have not looked back since, and everything everyone said about breastfeeding came true. It is so so easy. No sterilising, no warming, no getting up in the night to get things ready. A piece of piss if you will. On top of this, my son had doubled (yes, doubled!) his birth weight in three months. I did that – me and my boobs.

When I started breastfeeding, even before all the issues, I didn’t know how long I’d carry on for. When things were though I thought maybe six weeks. Then it got easier and I thought, ok, how about three months. Then it got easier still and seven months along we are still breastfeeding, with four teeth in his mouth too.

I don’t now question when I’ll stop. I don’t really think about that I just go with the flow. From someone who laughed at breastfeeding beyond babyhood I do wonder if that might be me. Breastfeeding is so much more than just food; it’s a huge comfort and an incredible bond between baby and mother. I also now understand why the long feeds when the baby is first born really should be cherished; if nothing else nowadays E is so quick the chance of me watching a programme would be a fine thing!

I know breastfeeding is really hard, and without doubt the fact that I have a family full of breast feeders plus positive midwives on hand made my journey easier in many ways, in other ways it was bloody gruelling but I got there and I’m really chuffed that I did.

I received a quick reponse from Lynne Featherstone that was pretty impressive. She said she appreciated my concerns and attached a letter she'd written to Nick Clegg.

In it, she mentioned mothers giving up exclusive breastfeeding due to insufficient pumping breaks and reflected on the possibility to statutory pumping breaks being introduced as part of the flexible parental leave proposal.

It'll be very interesting to see Nick Clegg's response. Where does he go to answer those questions and will he appreciate that this issue can't simply be about employer discretion if new mothers really are going to get back into the workplace as early as he would like them to?

The infant feeding survey fully published on the 20th November revealed only 19% of mothers had resources in the workplace to express and maintain their milk supply.

Flexible parental leave is unlikely to work for anyone if families are being asked to choose either a return to work or a continuation of breastfeeding. No family should have to make that choice in a world of modern breast pumps, fridges and knowledge about the benefits of breastfeeding.

I'm a lactation consultant and breastfeeding counsellor and I run 3 breastfeeding support groups in West Haringey on a voluntary basis for Haringey infant feeding service (Stonecroft children's centre, Rokesly Avenue CC and Highgate Family centre) as well as supporting on the National Breastfeeding Helpline and through my private practice in families' homes.

I'm also on the Central committee for the Association of Breastfeeding Mothers (a charity who train counsellors and run the national breastfeeding helpline alongside our own national helpline). I'm also on the DH breastfeeding stakeholder's committee.

I'm waiting for breastfeeding to be mentioned in the discussions about flexible parental leave and I'm increasingly horrified to realize it isn't being.

If a mother returns to work at 2 weeks or even 2 months, what are the chances that baby will still be receiving breastmilk exclusively? Who is assessing the likely impact on breastfeeding rates across the UK and the long-term health implications?

I frequently work with women transitioning to work and asking about how to express milk at work and liaise with their employers. Last month, a very typical conversation: a mother's employer would only allow her 2 fifteen minute pumping breaks in addition to her lunch hour. This wasn't sufficient to maintain her milk supply. She was ending exclusive breastfeeding. Her employer is under no obligation to consider her individual situation, nor age of her baby nor offer anything other than 'rest breaks' described vaguely under Workplace Regulations. Any other requirements to allow pumping are simply HSE recommendations and have no legal status.

How many times will a mother of a 1 month old baby need to express during a working day if that baby is to remain exclusively breastfed as recommended? Typically every 3 hours as an absolute minimum. She will need access to a good quality pump (which will be expensive), storage facilities and a place as well as a time.

The key risk time for a mother to develop mastitis is 3-8 weeks post-partum. Insufficient pumping is likely to put the rates of mastitis and subsequent breast abscesses through the roof.

I'd like to know who is considering these sorts of issues as we encourage mothers back to work with sore nipples (typically in my groups, a mother will still often be struggling with latching baby on the breast for the first 4-6 weeks). Employers are not ready to incorporate even mothers breastfeeding at 6 months into the workplace. We do not have the American model where employee milk expression is the norm. The current guidance given to employers and the current obligations employers have towards breastfeeding mothers is laughably insufficient if these changes go forward.

I know from my contact with the DH through my participation in the breastfeeding stakeholder's committee that breastfeeding policy and leadership is in a state of 'flux' to put it politely. If these issues aren't considered now as we move forward with flexible parental leave we will have a generation of babies who are not exclusively breastfed in their first few months. Rates will crash after all the hard work of the last 15-20 years and infant hospitalisation in the first 12 months for gastroenteritis and respiratory infection with increase alongside increased risk of adult health conditions in the decades to come. The money that will then drain out of the health service could have been usefully spent educating employers, providing appropriate facilities for pumping and changing employer requirements for facilitating the opportunity for doing so.

Parents have rights to work and earn their living. What are the rights of the infant?

I was honoured to be asked to contribute an article to the blog of the International Lactation Consultant Association. 

Yesterday I was featured on an episode of the US radio/ podcast 'The Boob Group' on the subject of sexuality and breastfeeding. The Boob Group is produced in San Diego and their programmes cover a wide range of breastfeeding issues. Recent programmes have looked at hypoplasia (insufficient glandular breast tissue) and tight frenula (tongue ties) as well as breastfeeding expectations when your baby is a certain age. It's a useful resource.