Managing engorgement

A large proportion of the families I work with are in the very early days of life with a new baby. This can often feel overwhelming as day and night can blur into one as the emotions of having a new baby join the family, recovery from birth and sheer level of tiredness all combine.

One particular problem that can often add to the stress is early days engorgement. This is experienced as breasts which become overly full with milk making them hard, heavy and painful. In some cases, babies can then find it tricky to latch onto a breast as it is almost like trying to latch onto a beach ball!

Engorgement, though painful, can easily be managed through effective feeding. Step one is to keep feeding your baby responsively. As a reminder, responsive feeding means feeding in response to feeding cues from your baby (bringing their hands to their mouths, opening and closing their mouths, turning their heads and crying, which is a late feeding cue) and also in response to your breasts feeling full. Remember, newborn babies need to feed at least 8 times in 24 hours so, if you have a sleepy baby, keep them waking them at least every 3 hours. In between feeds use cold compress on your breasts to help relieve inflammation and use gentle stroking massage towards your armpits to help drain fluid through the lymphatic system.

If your baby is struggling to latch then use a little hand expression to help soften the breasts before latching. Reverse pressure softening is also a useful tool to help move fluid away from the nipples.

As your baby continues to feed effectively engorgement should ease by itself but, if problems aren’t improving, do seek help from your midwife, an IBCLC or health visitor.

Feeding responsively

We all want to do the right thing when it comes to feeding our babies but it can feel very difficult to work out how and when to feed. Some people talk about feeding every 3 hours, some say you never wake a baby, others that you should feed on demand or to your own schedule.

So, some ground rules. First of all, it is impossible to spoil a newborn baby. If your baby is asking to be picked up then picking them up and responding to this is not going to set up bad habits but rather help them to feel safe and secure in the world outside the womb. By responding to your baby’s cues, you are laying the foundations for secure relationships for many years to come. It is also impossible to over-feed a breastfeeding baby- breastfeeding in response to feeding cues is always the right thing to do. There is a risk of over-feeding with bottles so make sure you are following paced bottle feeding!

Secondly, a newborn baby needs to feed at least 8 times in 24 hours after the first day (many will feed for more than this and that’s normal behaviour). This may not sound like much but it feels very different when doing it. In reality, this means a new baby shouldn’t go more than 3 hours from the start of the last feed to ensure they get in that minimum feed level until they are back to birth weight. If you have a sleepy baby it is worth waking them regularly.

Most babies will tell their parents they need to eat regularly with feeding cues, such as bringing their hands to their mouths, turning their heads (see the baby in the picture), opening and closing their mouths or sticking their tongues out. It is far easier to feed your baby at the early signs of hunger rather than waiting for later cues, such as crying. However, in reality we can’t all always get to our babies before they cry. Don’t beat yourself up about it! If you are struggling to get a crying baby to take a bottle or to breastfeed then give them a cuddle, put them in skin to skin contact if you’re able to and keep talking to them to reassure them that you’re there. Responding to these feeding cues is the first part of responsive feeding.

If breastfeeding, the second aspect of responsive feeding is in response to how the feeding parent is feeling. If a breast or chest feeding parent feels full and needs some relief then it is entirely appropriate to wake their baby and get some help with managing this. It is not all about the baby!

Help! My baby only sleeps on top of me

Picture the scene, you’ve just given birth to the most perfect human being (or beings) the planet has ever seen. They’re gorgeous and you can’t stop staring at them. And they’re soooo good! Sleeping and not asking for anything, just a little food every now and then. Fast forward 24 hours and the same perfect baby or babies has had a personality transformation. They want to feed constantly and the only place they’ll sleep is on you. Sound familiar?

It’s really hard. You’re sleep deprived and recovering from birth and could just do with a little sleep. But you’re terrified of falling asleep with your baby or babies in an unsafe environment. You’re also worried that if you keep letting them sleep on you they’ll grow into a child who can only sleep with their parents. Many parents experience this. First of all, in the early days it is way too early to be setting up habits that you may not want in the future. Second of all, there are children everywhere sleeping with their parents every night so don’t beat yourself up if that’s what you’re doing.

Why does your baby only want to sleep on a parent? Easy. They’ve just been born and they’re looking for the comfort, warmth and security of the womb. A parent’s heartbeat, scent and motion is comforting for them and helps to regulate their systems. This comfort is calming and a calm, relaxed baby who is full with oxytocin is far more able to grow their brains optimally than a baby whose systems are flooded with stress hormones.

But how can you make it easier to manage? Not so easy. Your baby will not want to sleep on top of a parent forever and this is just a phase, I promise. After feeding your baby it is really helpful for a caregiver to cuddle a baby for a further 20-30 minutes to help lull them into a deep sleep before putting down. Some parents also find putting something with their scent in a crib or cot helps to make it a more comforting environment for their baby. However, remember to remove anything from a cot once you’ve placed your baby inside to keep it a clear, safe sleeping environment.

A lot of parents really benefit from learning more about how their babies sleep and BASIS is an amazing resource for this https://www.basisonline.org.uk. The website also includes lots of information on safe co-sleeping. Plenty of parents find the only solution is to go with it despite plans pre-baby but, if you do co-sleep, ensure you are following guidance on doing it safely.

Paced responsive bottle feeding

As lactation consultants, we know that many families struggle to access information on bottle feeding. The reasons for this are varied. For many, bottle feeding may not have been the original plan and parents are now desperately scrabbling around for information on bottles whilst looking after a newborn baby. Some parents feel judged for asking for information on bottle feeding so keep quiet about their feeding plans when speaking to midwives. This is heartbreaking as all parents should have access to timely and correct information needed without judgement. Others may have seen loads of babies bottle feeding and assumed it is as simple as just putting a bottle in a baby’s mouth and tipping it up,

A really important aspect to be aware of with bottle feeding is the risk of over feeding. It is impossible to overfeed a breastfed baby as they will self-regulate whereas a baby with a bottle in their mouth is unable to do this. Another crucial aspect of baby feeding is that it is about more than nutrition. However a parent feeds their baby, it should be an opportunity for bonding and an enjoyable experience for both parent and baby.

When bottle feeding some parents believe there is a set amount to give at intervals during the day. Remember your baby is a human being and we don’t sit down at regular intervals and eat the same number of calories each time. It would therefore be unrealistic to expect this of your baby. Ensure you are feeding in response to feeding cues from your baby, such as bringing their hands to their mouth, turning their head or smacking their lips.

In the early days it is helpful to limit bottle feeds to a baby’s immediate caregivers to help a baby with bonding and feeling safe and secure during feeds. Feeds can be given in skin to skin contact to maximise oxytocin (the love hormone) which helps to build a strong bone and supports healthy brain development. Hold your baby in a semi-upright position, look into their eyes and chat to them whilst feeding. Try to avoid pushing the teat into your baby’s mouth and instead gently rub the teat on their top lip until they open their mouth. The bottle should be held fairly horizontally. This means that your baby is able to draw milk out and the flow doesn’t become too fast. If you notice your baby spilling milk from their mouth, splaying their fingers and toes or trying to turn away, this can indicate the flow is a little too much so give them a break.

It can be tricky to work out how much to feed your baby so, every now and then, give them a break and look for feeding cues. If your baby is showing they’re still hungry, give them the bottle back and allow them to continue. However, if they are relaxed and happy, pause there. A bottle feed doesn’t need to be fast!

UNICEF has great information for parents on bottle feeding if you’re looking to know more: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle-feeding.pdf