Breast milk adapts and changes according to your baby’s needs and the environment you find yourself in. It often does so without you even noticing, until you find that your baby’s feeding patterns have changed or notice that your milk has suddenly become very watery when you express.

As we move into the summer months, I am frequently asked whether breastfed babies should be supplemented with water and how to manage breast feeds when babies seem to want to feed a lot more frequently. Here are a few pointers to consider.

• Breast milk is primarily made up of water with other components suspended in it. When your baby feels hungry, he will ask for milk and when he is thirsty, he will also ask for breast milk.
• You may find it helpful to keep a note of a three hourly rhythm when you offer him a big feed, maybe from both breasts if he will have it. If he asks for milk in between the three hourly feeds, consider this as a drink of water, rather than a full feed and offer him milk again when his next three hourly feed is due.
• If you do this and find that his poops turn spinach green, feed from one breast at a feed (let’s say the right breast at 7am). If baby needs another feed or drink before the next feed is due, offer him the same side you fed from (i.e. the right breast). When the next feed is due (let’s say at 10am), offer him the second side (left breast) and if he needs a drink before the next feed is due at 1pm, only offer baby the left side.

Ensure that you are maintaining your fluid intake so that you too are well hydrated. In doing this, you will be able to provide enough fluid rich milk to keep your baby hydrated, so that you can both enjoy the summer.

There are times when supplements are necessary and no matter how hard we try, we simply can’t ignore this fact. However, there are many instances when a new mum feels confused and worried about her baby and thinks that formula is the answer. Let’s explore some two common situations in which a mum may feel she needs to supplement soon after birth.

My newborn baby has jaundice
In order for your baby to effectively pass the excess bilirubin, she will need to have a number of bowel moments as this is how the body flushes it out. Naturally a mum who has not felt her milk come in will be concerned that her baby is not getting anything from the breast. Whilst this is understandably stressful, it is important to remember just how small your baby’s tummy is. Your baby really doesn’t need a large volume, just 1-2 tablespoons. Colostrum has a laxative quality which your baby needs in order to get rid of the bilirubin. Giving your baby formula in this instance is not going to help, as it takes a lot longer to digest. In fact, giving your baby formula may make matters even worse. (Bertini,2001; De Carvalho 1985)

My baby’s blood sugar levels are too low
Eeek, yes this could cause you to reach for the formula if you didn’t know that your baby’s blood sugar levels will naturally drop within the first 2-3hours after birth, as she doesn’t have the constant hit of glucose she received in the womb via the umbilical cord. Keep your baby close to you, preferably skin to skin and if she is not able to latch, hand express a little colostrum and even just rub that onto her lips. Breastfed babies are better able to cope with low blood sugar levels than babies who have had formula. There is no benefit to treating low blood sugar levels or hypoglycemia without symptoms with a formula top up (Boluyt, 2006) and simply giving a supplement routinely is totally unnecessary.(ABM,2006) In fact, I have found that when my clients are told to top up, it really affects their confidence and often leads to mums feeling the need to continue with top ups which in turn negatively affects breastfeeding long term.

Keeping your baby close to you soon after birth has so many benefits, which is why if you are reading this and have not yet had your baby, it is something worth remembering. When your little one is born, her gut system is sterile and she is only introduced to the bacteria in or on your body. If there is any harmful bacteria present and she is able to access the breast at will, she will receive antibodies through your colostrum.

This will help her regulate her blood sugar and get that all important hit of laxative she needs. If your baby is taken away from you, she will be introduced to unfamiliar bacteria and will not have access to the breast, as readily as if she were right next to or on top of you.

Breastfeeding is a positive and pain free experience for many mums, unfortunately we often hear more about breastfeeding problems than the ease with which some mums feed.

Many of the mums I meet are told that pain whilst breastfeeding is to be expected. This is not true, pain often accompanies breastfeeding when poor or conflicting information is given.

But what happens when we have tried everything and the mum is still in pain? We go back to the drawing board, start from scratch and get second opinions where we can.

A good place to start is with baby. We need to check your baby for a tongue tie. Now I know that currently tongue tie is very ‘fashionable’, in fact I think ‘tongue tie’ now surpasses ‘colic’. As we are currently in a tongue tie trend – and some people will happily come round to your house to cut your baby’s tongue for you – doctors and paediatricians are concerned and are advising parents to take caution.

The thing is that we are all tongue tied to a degree and tongue ties come in various shapes, thickness’s, levels of flexibility. I myself am still learning about the complex structure of the tongue. There are some wonderful ladies who specialise in tongue tie and run professional clinics in hospitals (a good place to be if you need medical help).

If you are a mum of a young baby and you feel like you have tried everything. Tongue tie has been ruled out already and you are still no closer to enjoying pain free feeds, get yourself to a tongue tie clinic and have your baby checked.

Where can I go?
North London – the Royal Free Clinic. Jean Waldman and Pippa Faulkes are brilliant.
West London – Chelsea & Westminster – a team run by Mr Haddad are excellent.
South London – St Georges
East London – the Homerton

There are also private routes you can go but I would always advise mums to go to a clinic rather than having the tongue tie divided at home, just to be careful and regardless of how tired you are.

It is difficult to know why babies suddenly decide that breastfeeding is not for them, but usually this is only a temporary glitch and breastfeeding returns back to normal within a few days. Whilst in most cases breast refusal takes mum by surprise, there are a few situations that can lead to nursing strike. Let’s look at the practicalities of managing breast refusal.

Firstly it is important for you to realise that your baby is not rejecting YOU. Many clients feel that they have done something wrong or that their baby doesn’t like them and whilst this may feel like personal rejection, it is more the method of feeding that your baby is not getting on with. When we can determine which element of breastfeeding your baby is not happy with, we can resolve it and breastfeeding will usually go back to normal.

Knowing that your baby is getting enough food is generally the primary concern when little ones go on nursing strike. If your baby is refusing to even latch onto the breast, you will need to express both breasts every 3 hours to maintain and protect your milk supply. Offer your baby expressed breast milk as frequently as he or she fed from the breast. I find the Medela Calma bottle to be the most suitable, as the baby still needs to create a sealed chamber of negative pressure to draw the milk out of the bottle. All other bottles will begin to drip milk when turned upside down, which makes milk transference easier than breastfeeding and can lead to further refusal.

As you are maintaining your supply by expressing, you can now focus on keeping your baby hydrated. Monitor your baby’s output. If your baby is older than 6 weeks, we won’t expect to see many dirty nappies, however the wet nappies should be heavy and clear.

Offer your baby the breast after a short bottle feed. Bottle feeding first will take the edge off your baby’s hunger and will take the pressure off you. Do as much skin to skin with your baby before and during the feed. Many mums find having a nice warm bath with baby, quite effective too.

What are some of the common causes of breast refusal and what can you do to rectify it?

Oversupply or fast let-down
If you can hear your baby gulping and spluttering at the breast at each feed, which usually leads to your baby pulling off the breast and struggling for breath, it would be reasonable to suspect that this could be a cause of breast refusal.
Feed lying down when possible, feed lying back with baby prone or on top of you facing down it is easier to manage when out. Block feed so that you only feed from one breast every 4-6 hours when baby needs a feed. This will allow your body to reduce milk production and flow.
If you are concerned about your supply but find the flow difficult to manage, you could try using nipple shields. These will break the stream of milk, making it easier for baby to manage.

Low milk supply or poor sucking reflex
When baby’s aren’t able to access the milk or find feeds exhausting, bottle feeds will seem like a far easier option and this may lead to breast refusal. There are many ways to boost and increase your supply, so explore some of these and see if feeds become less stressful. Also get some help to assess whether your baby is actually able to milk and drain the breast. Sometimes babies aren’t able to suckle properly and though they have been on the breast for hours, they have not even had a single drop. Speak to your breastfeeding specialist about alternative feeding options.

Reflux, ear infections, blocked noses
All of these and a whole lot more can lead to sudden and ‘unexplained’ breast refusal. Have your baby checked out by your GP, as with a little treatment, these can be easily resolved and breast feeds can resume as normal.

As breastfeeding awareness continues to increase, I wonder how we can assist and educate mums about the practical aspects of breastfeeding – from the infants point of view. I do smile when I chat to prospective parents, who are often disbelieving that there is anything more complicated to breastfeeding, than getting baby to ‘suck the breast!’.

As far as breastfeeding goes, they are right. It is only when they start reading routine books and the like that throws a spanner in the works.

Learning more about how an infant feeds, will hopefully change the way mums are advised in hospitals and in the community. To achieve that though, we need professionals working on the front line to be aware of this first, or we will be left fire fighting.

We have learnt a lot about how a baby transfers milk from the breast in the last few years. As breastfeeding and human lactation is still such an incredibly young subject, we find as professionals, we are continuously climbing the ever-changing steep learning curve.

We know that a mum produces colostrum – a low volume, high density fluid – for the first few days after the delivery. Colostrum has many benefits but from a feeding point of view, the consistency of colostrum allows baby to practice the suck, swallow, breathe sequence necessary for when the ‘milk comes in’.

To start with, babies have to hold their breath before swallowing, so a slow flowing fluid affords them this possibility. If the colostrum was flowing quickly, you can appreciate how confused and stressed the baby would become, as he or she would have no control and would be forced to swallow continuously, with little opportunity to pause and breathe.

Most babies of second or third time mums find themselves in this position, as milk comes in sooner, giving the babies less time to practice this suck, swallow, breathe pattern. We find they cough and splutter frequently at the breast or simply pull away in protest, causing pain and trauma to nipples.

In 2007 – 2008 we learnt that the peristalsis motion of the infants tongue during breastfeeding, did not transfer milk but created a negative pressure in baby’s mouth which enabled him to transfer milk. We learnt that the baby used less and different muscles when bottle feeding compared to breastfeeding (Gomes 2006) – which put breastfeeding supporters on their guard in fear of nipple-teat confusion.

What is should be teaching us is that there is a natural progression in infant feeding patterns and offering a bottle too soon, will stress a little one unnecessarily. To avoid introducing teats and bottles, babies should be kept in close contact, preferably in skin to skin contact with mum, whilst establishing breastfeeding.

I appreciate that there are many instances where babies need to be offered an alternative to breastfeeding, in order to remain hydrated, but I would like to suggest that to start with, bottle feeding is not ideal.

Finger feeding is safe and teaches your baby that he or she will only be rewarded with milk when he or she is sucking. Whilst finger feeding is not a long term solution, it is definitely much easier and comfortable for both mum/dad and baby.

If you are committed to breastfeeding your baby, there are alternatives to bottle and cup feeding, whilst you are resolving breastfeeding problems and establishing a good feeding pattern. Don’t be afraid to ask for help.

Keep baby as close to you as possible, so that you can respond to hunger cues quickly, before your baby begins to feel frustrated and too hungry to latch.

Is this what breastfeeding in 2010 in one of the worlds most liberal countries looks like? In a country where boundaries are pretty much non existent when it comes to the sex industry, I find it outrageous that mums are being thrown out of shops, told to face the wall in a library or worse.

Whilst breastfeeding is gaining momentum, breastfeeding rates in the UK are still very fragile. Mums are enthusiastically taught the many benefits of breastfeeding from peers, childbirth education courses, the press, the Government.

Why are mums given all this information? Well, because the benefits of breastfeeding are really something special and we want to encourage mums to give breastfeeding a chance, in spite of the negative associations. Be reassured that many mums do find breastfeeding easy and pain free.

Getting out to feed in public can seem daunting for some new mums, and again many who I have met, don’t leave the house for weeks because of it. The question I am asked frequently is how to breastfeed in public discreetly? Whilst there are beautiful breastfeeding covers, I feel that trying to breastfeed ‘discreetly’ can add more pressure on a new mum.

Older babies are often curious and want to know what is going on around them. The chances of these little guys not pulling off the breast, are pretty low. Not that that is the nursing mums problem. I feel that if the general public have a problem with mums nursing their babies, that they shouldn’t look and keep their opinions to themselves.

The problem is that many people have an opinion when it comes to breastfeeding as it evokes strong emotions. I feel it is important for mums to do what they are comfortable with. If you are confident to go out and breast feed in public with or without a cover, do. If you are not comfortable and you choose to express and bottle feed instead, I believe that is your choice.

You are never going to please everyone, so just do what feels right for you. In time, you may find that public breastfeeding really doesn’t bother you.

Long story short – to the general public…just leave mums alone. If they want your opinion, good or bad, they will ask for it.

To somebody in Government – maybe you could enforce on the spot fines to companies or establishments who prevent mums from breastfeeding. Put your weight behind this and prove your support for breastfeeding mums!

Primark – you are first on my hit list!

An article in yesterday’s Telegraph claims that out of the 1260 mothers who took part in a recent survey, 44 percent lacked physical support and a further 55 percent found they received insufficient information and advice in the weeks after having their first baby.

I have no doubt that midwives would support mums more if they were physically able to but clearly they are struggling to keep their heads above water. Keeping mums afloat whilst they are fighting to keep their heads above water, is a difficult and seemingly thankless task.

I respect and admire midwives. They are passionate about what they do and I am sure many of them will feel that they are unfairly being blamed for the ‘lack of service’ mums report. They will feel down hearted in spite of many forgoing breaks, even loo breaks to support mums! I have also heard many stories where midwives have stayed with mums long after their shifts had ended, in order to give continued care and support until the baby is delivered.

Midwives may even be feeling angry and frustrated this morning when they learn that their best just isn’t cutting it. You just have to look at the aggression in the comments following the article to see that midwives feel that they are being let down by Government and are handicapped and unable to provide a service which allows them job satisfaction and a chance to make a positive contribution to many mums births.

Last week I had a rant about new research enlightening us on how beneficial breastfeeding is when babies are breastfed for 6months. The article implied that mums could and should do better based on the many benefits of breastfeeding and breast milk. Surely this must seem utterly ridiculous now that the ‘true’ state of affairs has been aired.

Is it any wonder that breastfeeding rates in the UK are so low? Many would say it is an absolute miracle that mums breastfeed at all, following the hospital experience that these mums describe. How are mums who physically and emotionally traumatized, after their deliveries supposed to care and nurture a baby, as they are in such a mess themselves.

The Government needs to shape up and sort this out. We need our midwives to feel appreciated and supported, so that they are able empower and care for new mums in a professional and supportive manner. We need more midwives and at this rate I would be very surprised if many don’t simply say: “Thanks but no thanks!” and where would that leave us?

I know for a fact that many breastfeeding mums in the UK will feel their blood levels rise this morning as they read the latest breastfeeding article. We seem to live in a culture where there is a great deal of ‘one-up-man-ship’.

For some mums, breastfeeding comes really easily. They have few complications (if any) when trying for a baby, throughout the pregnancy and the delivery. After a magical birth breastfeeding comes naturally, their babies thrive and are sleeping for 6 hours straight at 10days. These mums can cope with the breastfeeding support and advice on offer and will most probably feed for 6 months or longer.

But what about the mums who don’t have a straight forward time, who have difficult pregnancies and deliveries that end up in emergency sections or ‘who knows how many’ stitches or tears?

What about the babies who have had their heads squished so badly they can’t open their mouths or suckle properly? Or even the mums who grin and bear cracked bleeding nipples that hang on by a thread because a tongue tie has gone unnoticed for weeks?

These mums don’t think that breastfeeding is unnatural and selfishly choose to move onto bottles because it is the norm! OH NO! they move onto bottle feeding because they don’t have the support to get breastfeeding right, so that it works for both mum and baby, so that they both enjoy all the marvellous health benefits on offer.

These mums are devastated that they aren’t able to give their babies the ‘BEST START IN LIFE’ etc etc and every time there is new research, that psychological knife gets pushed even further into their already wounded heart.

So do me a favour and before you do more research into the many benefits of breastfeeding (which are already abundantly clear), invest in ways for mums to access proper support and advice to enable them to breastfeed their babies, so that the UK can become a healthier nation.

A greater degree of support (and don’t blame the midwives here either – we need more breastfeeding professionals on the ground who know what they are talking about), will be far more efficient at raising breastfeeding numbers than more research telling mums just how much their baby is missing out on.

Cabbage – A breastfeeding mums friend or foe? If you have been through the breastfeeding process – you may have a soft spot for this smelly little veg due to it’s amazing powers to reduce swelling during the engorgement phase but today we will see whether eating it can be just as good for you as wearing it.

This is a question I am often asked – if I have broccoli or cabbage – will my baby become fussy or ‘gassy’?

Maternal diets are influenced by culture and what mums are warned off in Australia may well be recommended in another country. Babies will also be more sensitive to certain foods than other babies – so it is very much a trial and error process as well. Knowing or learning which foods to avoid when breastfeeding is something all mums hope to master quickly to avoid colic or breastfeeding problems.

I guess question we want answered is – does eating cabbage and gassy foods make our babies gassy or display colic symptoms. Intestinal gas is produced when bacteria in the gut act on fibre ingested by the mum. Neither the fibre of the cabbage or the gas created in the mother’s intestine passes into the mother’s milk to be delivered to baby -so eating this is very unlikely to be the cause of colic symptoms.

Many mums are also told to stay away from acid rich fruits and veggies – but the acidity levels of these foods do not change the pH of breast milk – so this is also unlikely to cause colic or gassy symptoms (Lawrence and Lawrence, pg. 326) It is important to reiterate here that all babies are different and if you notice a direct reaction to certain foods in your diet – see a paediatrician who will rule allergy or sensitivity in or out.

Another question I am frequently asked is whether garlic will cause infant colic. A study revealed that many babies actually took in more milk milk when mums had garlic capsules included in their daily diet as part of the study. Whilst it gave the breast milk a garlic odour, it certainly didn’t put the little ones off. (Menella and Beauchamp 1991)

There have been other studies recorded which were based on mother’s recollection of their diet weeks prior to the onset of colic. It is therefore difficult to decisively conclude to what degree a mother’s diet results in infantile colic. Science certainly suggests that a well balanced healthy diet where mums are able to enjoy all foods in moderation, seems to be a safe and simple option.

As the days grow dark and cold, the temptation to turn on the kettle have a have a nice hot drink becomes almost irresistible, especially when baby seemed to be up every hour during the night. So what’s the deal with caffeine and is it really one of those foods you need to avoid whilst breastfeeding your baby?

Well according to research, you would need to drink quite a lot of very strong coffee before it begins to affect your baby. Only a small percent of caffeine actually passes into the breast milk but this will increase with each cup of coffee or tea that you drink. Naturally there are varying degrees of strength and this also has to be taken into account.

So how much is too much? By a lot, I mean to the tune of five big cups of coffee a day (think 5oz or 750ml) or the equivalent of that but in another form. (Nehlig and Debry 1994)

The main problem with caffeine is that it takes a while to exit the body completely (with an estimated half life of 5 hours in adults and 96 hours in a new born) and it also accumulates in the baby’s system as it is difficult for your baby to process. The over exposure to caffeine can leave both mum and baby wide eyed and bushy tailed, even though they are in desperate need of a little sleep. Just to be safe, avoid strong coffee and maybe restrict intake to 2 cups a day – not too close together.

I have told many of my clients to also be aware that chocolate has stimulating properties, while not as strong as coffee, you still need to bear it in mind when breastfeeding. Chocolate contains theobromine which can result in similar symptoms as caffeine stimulation.

Maternal diets can seem like a long list of foods that you are not supposed to eat, but if you are sensible and aware of how foods affect breastfeeding, you can avoid foods that make baby gassy but still enjoy a few creature comforts.

With that said, I am off to have a lovely Hazelnut Latte!