Infant feeding support

Breastfeeding

How To Tell Breastfeeding Is Going Well

Hand expressing

Expressing Your Milk Before Your Baby Arrives

BFN Expressing Leaflet 2019

Resources in different languages:

Foreign language resources - Baby Friendly Initiative (unicef.org.uk)

Twins and more

Feeding twins, triplets and more (MBF) booklet - Baby Friendly Initiative (unicef.org.uk)

Formula feeding

Infant Formula And Responsive Bottle Feeding Leaflet

Bottle Feeding Leaflet  

Responsive Feeding Infosheet - Baby Friendly Initiative (unicef.org.uk)

Relationship building - Building a happy baby a guide for parents

Responsive Feeding Infosheet - Baby Friendly Initiative (unicef.org.uk)

Relationship building resources - Baby Friendly Initiative (unicef.org.uk)

Global health media- Videos

Positions for Breastfeeding - Video - Global Health Media Project

Attaching Your Baby at the Breast - Video - Global Health Media Project

Is Your Baby Getting Enough Milk - Video - Global Health Media Project

Nipple Pain - Video - Global Health Media Project

Breastfeeding Support Groups

Tuesday 

09.30- 11.00

Charnwood Children’s Centre, Purcell Ave. Lichfield, WS13 7PH                  

01543 431 586 / 0300 303 3924 

10.30 -12.00 

Stoke Library, Stoke Local Centre, South Wolfe Street, ST4 4SZ,               

0300 303 3298

Wednesday 

10.30-12.00 

Westfield Children’s Centre, Buccleuch Road, Longton, ST3 4RF           

telephone 0300 303 3298 for further information

11.00 - 12.30 

Springfields Health & Wellbeing Centre, Lovett Court, Rugeley WS15 2FH, 

0300 303 3924     

13.30 - 15.30 

FAB Mums Norton, Norton Children’s Centre, (Stoke on Trent) ST6 8JW

0300 303 3298

Thursday 

13.00 - 14.30 

Landywood Children’s Centre, Holly Lane, Great Wryley, WS6 6AQ, 

01922 415632 / 0300 303 3923 

Friday  

13.30-14.30

DROP IN for Breastfeeding Support - Silkmore Children’s Centre, Exeter Street, Stafford ST17 4EG

01785 221 047 / 0300 303 3923

Your local Health Visitor Hub for information & support:

• West Hub - 0300 303 3923 (covering Moorlands, Newcastle, Stafford, Stone, Seisdon)
• East Hub - 0300 303 3924 (covering East Staffs, Cannock, Lichfield, Rugeley, Tamworth)
• Stoke Hub - 0300 303 3298 for all Stoke-on-Trent areas

Infant Feeding Help And Support on Return Home 

Local Support

www.uhnm.nhs.uk visit the Maternity pages for further information on support in your local area.
 
24hr Infant feeding support Help-line for All mothers discharged from the University Hospital North Midlands only: 01785 230059
 
Royal Stoke Breastfeeding Co-ordinators 01782 672212 or bleep through main switchboard 01782 715444 bleep 15811

www.uhdb.nhs.uk visit the Maternity pages for further information:

24 hour breastfeeding support at Samuel Johnson Community Hospital for Mothers discharged from Burton Hospitals (within the first 28 days following birth or when under midwifery care) —Telephone 01543 412905 Antenatal (Breastfeeding)

Workshops: 

• Lichfield & Burton To book telephone  01283 566333 (ext 4351)
• Tamworth: telephone for info and to book: 01827 475222  

National Breastfeeding Helpline 09.30 - 21.30 each day. 

Webchat service also available - see website for details www.nationalbreastfeedinghelpline.org.uk
 
Staffordshire parents/carers -  
a text messaging service where you can get confidential advice and support from the Midlands Partnerships Families’ Health and Wellbeing team.

For further information search ‘infant feeding’ at: www.mpft.nhs.uk

A Little Bit Of Science 

New babies have a strong need to be close to their parents, as this helps them to feel secure and loved. When babies feel secure they release a hormone called oxytocin, which acts like a fertiliser for their growing brain, helping them to be happy babies and more confident children and adults. Holding, smiling and talking to your baby also releases oxytocin in you, which helps you to feel calm and happy.

Myth: Babies become spoilt and demanding if they are given too much attention. 

Reality: When babies’ needs for love and comfort are met, they will be calmer and grow up to be more confident

New babies have a  strong need to be close to their parents, as this helps them to feel secure and loved.

Getting Started

During pregnancy, your baby’s brain is growing very quickly and you can help this growth by taking some time out to relax and talk to him, to  stroke your bump and maybe play some music to him. Encourage other close family members to do the same.

You can help your baby’s brain development during pregnancy by talking, reading, stroking and playing music.

Meeting Your Baby For the First Time

After your baby is born, hold him against your skin as soon as possible, and for as long as you want. This will calm him and give you both the chance to rest, keep warm and get to know each other.

If you want to breastfeed, this is a great time to start as your baby might move towards the breast and work out the best way to suckle for himself. Breastfeeding also releases lots of oxytocin in baby and mother, which will help you to feel close and connected.

If you choose to bottle feed, giving the first feed in skin contact while holding your baby close and looking into his eyes will also help you bond.

Early Days

Keep your baby close to you so that you start to recognise the signals he makes to tell you he is hungry or wants a cuddle. Responding to these signals will make your baby feel safe. Cuddling your baby next to your skin allows him to smell you and hear your heartbeat, which will comfort and calm him. This will also help you to feel calm and relaxed and will help with breastfeeding.

Breastfed babies cannot be overfed so you can use breastfeeding to soothe your baby and as a way of spending time together, or having a rest whenever you both want.
If you are bottle feeding, hold your baby close during feeds and look into his eyes. Learn to notice his cues that he wants to be fed and when he has had enough. If you and your partner try and give most of the feeds yourselves, this will help build up a close and loving bond with your baby. Continuing skin-to-skin contact can calm and comfort you both at  any time.

Myth: It’s important to get babies into a routine as this makes your life easier

Reality: Young babies are not capable of learning a routine. Responding to their cues for feeding and comfort makes babies feel secure, so they cry less, which makes your life easier too. 

Finding Your Rhythm

Having a new baby can be challenging. However, as time goes by you will start to understand what your baby needs. This will help you settle into a rhythm that is right for you both. Responding to your baby’s needs for food and comfort will not only support his brain development but will also help him feel secure, so he will cry less, which helps make your life easier too. Holding your baby when he is crying helps him to feel loved and secure, even if he doesn’t stop crying straight away. Research shows that babies who are responded to in this way grow into more confident toddlers who are better able to deal with being away from their parents temporarily, rather than becoming clingy and spoilt. This again can help make life less stressful for you.

Myth: You should leave babies to settle alone so that they learn to be independent.  

Reality: When babies are routinely left alone they think they have been abandoned, and so become more clingy and insecure when their parents return.  

Slings and parent-facing prams can help make your baby feel secure.

Myth: Babies benefit from lots of toys to help them learn.

Reality: Looking at your face is the best way for babies to learn. Talking, listening and smiling triggers oxytocin and helps your baby’s brain to grow.   

Finally, it can be reassuring to know that, despite all the pressure to buy expensive equipment and toys for your new baby, you don’t really need to spend lots of money. What matters to your baby and his future development is having parents who love and care for him.

Becoming a new parent can be wonderful, but it can also be difficult. Persistent crying might indicate that your baby is unwell. Speak to your midwife or health visitor if you have any worries about being a new parent.

Unicef and The Baby Friendly Initiative 

Unicef works around the world, including right here in the UK, to keep all children healthy, happy and safe. We help more children than any other humanitarian organisation. We keep them safe when war or disaster strike. We provide life-saving food, clean water and vaccinations. We protect them from violence and exploitation. We give them a safe place to laugh and play. We help get them into school and give them the chance of a better future. All over the world, we’re working with our partners and supporters to make the world a safer place for every child.

Here in the UK we’re putting our years of experience working for children around the world into practice in the places that reach them day in, day out. We’re working with the hospitals where they are born, the schools where they learn and grow, the communities and the services that shape their lives to make sure every child has the same chance to shine.

The Unicef UK Baby Friendly Initiative is revolutionising healthcare for babies, their mothers and families, as part of a wider global partnership between the World Health Organization (WHO) and Unicef. We enable public services to better support families with feeding and developing close, loving relationships, ensuring that all babies get the best possible start in life.

Visit The Unicef UK Baby Friendly Intiative Website for more

Caring For Your Baby at Night

Becoming a parent is a very special time. Getting to know your new baby and learning how to care for her needs can be one of the most rewarding experiences of your life. However, it can also be challenging, especially when you are tired and your baby is wakeful and wanting to feed frequently during the night.

It might be reassuring to know that it is both normal and essential for your baby to feed during the night. Babies grow quickly in the early weeks and months of their lives and have very small stomachs. Therefore they need to feed around the clock to meet their needs.

"I try to keep the room cosy and peaceful at night"

While it can be frustrating when your sleep is disturbed during the night, it can also be a lovely quiet time to be with your baby away from the bustle and distractions of daytime. Babies rely on the security and comfort of being close to their parents and need this at night as well as during the day.

Getting Some Rest

It’s important to make sure you create the right environment to help you get as much rest as possible.

Keep the room fairly dark – switching on the light wakes everyone up and is not usually needed when you are feeding and comforting your baby.

Keep your baby close. The safest place for your baby to sleep is in a cot by the side of your bed. This means you can hear your baby and respond to her needs before she starts crying or becoming distressed, and reach her easily without having to get up.

Try not to stimulate your baby too much. As soon as she starts waking, offer her a feed so she doesn’t get too upset and difficult to settle. Talk to them in a soft, quiet voice and avoid changing their nappy or clothing unless really necessary.

Breastfeeding

Many women choose to feed their baby whilst lying in bed. Ask your midwife or health visitor to help you find a safe and comfortable position.

Early Feeding Cues:

• sucking fingers 
• restlessness
• murmuring sounds

Tips For Partners 

■ Make sure your breastfeeding partner is comfortable.

■ Pass her things, so she doesn’t have to reach for them.

■ Bring her drinks and snacks and make sure that she has a glass of water at hand as breastfeeding can be thirsty work.

■ Give plenty of support – breastfeeding is important for your baby’s and your partner’s health

Bottle Feeding

It is important to be organised in order to reduce disturbance when bottle feeding at night. Powdered milk is not sterile and can cause infections if made up in advance. Therefore you will need to make up feeds during the night. However, you can make this easier by having bottles and teats ready sterilised, the powder measured out and boiled water kept in a vacuum flask. The vacuum flask does not need to be sterilised but should be clean and only used for your baby. The water used to make the feed needs to be above 70°C. If the flask is full and securely sealed, the water will stay above 70°C for several hours.

You may also choose to use ready-to-feed milk at night.

Ask your midwife or health visitor for information on how  to make up bottle feeds safely.

Never force your baby to take more than she needs in the hope that she will sleep for longer as this can cause her to become colicky and distressed and may result in her becoming overweight in the long term. Don’t add cereal or any other substance to feeds as this is dangerous for your baby. Always follow manufacturers’ guidelines with regard to amounts.

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart. Giving infant formula to a breastfed baby will reduce your milk supply. You do not need to eat any special foods while breastfeeding, but it is a good idea for you, just like everyone else, to eat a healthy diet.

When Babies Don't Settle

There may be times when your baby remains unsettled after feeds. Placing your baby in skin-to-skin contact with you and gently rocking can provide comfort. Your partner can help with this too.

If you are breastfeeding you can offer your breast again even if your baby has just fed. Babies find the suckling comforting and there is no risk of overfeeding a breastfed baby.

If you have had a particularly disturbed night, try to take time out  to rest during the daytime. Visitors can wait – or help by taking over chores or looking after other children while you and your  baby catch up on sleep.

If your baby is crying for long periods she may be ill and require a medical check.

“Skin-to-skin really helped my baby to settle down. We enjoy the time together.”

Putting Your Baby Down To Sleep

To keep your baby safe and to reduce the risk of sudden infant death (sometimes called cot death) always make sure:

 ■ You put your baby down on their back to sleep, never on their front or side.

■ The cot is beside the parents’ bed for at least the first  six months.

■ The mattress is firm and flat – soft beds, bean bags and sagging mattresses are not suitable.

■ Your baby is not overdressed or covered with too much  bedding (no more than you would use yourself).

■ The bedding must not be able to cover the baby’s head.

■ The room is not too hot (16-20ºC is ideal).

■ The room where your baby sleeps is a smoke-free zone.

Download the health professionals’ guide to this leaflet at Caring For Your Baby At Night Leaflet

If You Decide To Share a Bed With Your Baby

Some parents choose to sleep with their baby in bed and some fall asleep with their baby during the night while feeding and comforting whether they intend to or not. Therefore it is very important to consider the following points:

• Keep your baby away from the pillows.
• Make sure your baby cannot fall out of bed or become trapped between the mattress and wall.
• Make sure the bedclothes cannot cover your baby’s face or head. 
• Don’t leave your baby alone in the bed, as even very young babies can wriggle into a dangerous position.

BEWARE 

• It is not safe to bed-share in the early months if your baby was born very small or preterm.
• Do not sleep with your baby when you have been drinking any alcohol or taking drugs that may cause drowsiness (legal or illegal).
• Do not sleep with your baby if you or anyone else is a smoker.
• Do not put yourself in a position where you could doze off with your baby on a sofa or armchair.

What's Happening Tonight?

Having an alcoholic drink? Don’t have baby in your bed tonight as you will be less responsive than normal. It’s best to have another adult on hand to help with baby if you have drunk alcohol or taken drugs that make you less aware than normal.

Going on holiday or staying with family or friends? Make sure your baby’s sleeping position is safe even when they are not at home: bed positions, mattresses and duvets may not be the same as at home.

Letting your partner sleep? If you feed baby in another room be aware that falling asleep with baby on a sofa or armchair increases their risk of injury and sudden infant death.

Baby unwell? It’s natural and important to keep baby close to you if they are not well. Be careful not to overdress them or use too many covers, especially if they are running a temperature.

Remember breastfeeding protects your baby against Sudden Infant Death Syndrome (SIDS) and the more you breastfeed the greater the protection. Babies need to feed during the night so talk to your midwife or health visitor about feeding positions which help you rest and minimise risk to your baby.

About Unicef

Unicef works in more than 190 countries to keep children safe around the world. Unicef UK’s Baby Friendly Initiative works with hospitals, in community healthcare settings and universities to help them protect, promote and support breastfeeding and to strengthen mother-baby and family relationships. Visit unicef.org.uk/babyfriendly

More Information

The Community Practitioners and Health Visitors Association (CPHVA) is the UK’s leading professional organisation for health visitors, school nurses, nursery nurses and other community nurses working in primary care. The CPHVA is a professional organisation within the Unite trade union representing the professional interests of practitioners throughout  the UK.

The Baby Sleep Information Source (BASIS) provides research-based evidence about infant sleep for parents and health professionals. Established by Anthropologists at the Durham University Parent-Infant Sleep Lab in collaboration with Unicef UK, the National Childbirth Trust and La Leche League, BASIS runs as a non-profit-making outreach project of Durham University. Visit www.basisonline.org.uk

The Institute of Health Visiting (iHV) is a UK Centre of Excellence supporting the development of high quality health visiting services. There are five pillars to our work: research, quality assurance, education, leadership and partnership working. Visit the website which has a Families section: www.ihv.org.uk

The Lullaby Trust provides expert advice on safer sleep for babies, supports bereaved families and raises awareness on sudden infant death. For more information about SIDS and risks, visit www.lullabytrust.org.uk or call free 0808 802 6869. For bereavement support call the free helpline on 0808 802 6868.

The Royal College of Midwives (RCM) is the UK’s only trade  union and professional organisation led by midwives for midwives. The RCM promotes midwifery, quality maternity services and professional standards and influences on behalf of its members  and for the interests of the women and families for which they care. Visit www.rcm.org.uk

020 7375 6144

bfi@unicef.org.uk

unicef.org.uk/babyfriendly

The University Hospitals of North Midlands promotes breastfeeding as the healthiest choice of feeding for both mothers and their babies. We strongly encourage you to breastfeed. However we wish to support both breast and formula feeding mothers and enable you to feel confident with your feeding before going home.

Keeping babies close and learning about their needs

After your baby is born is an important time for you both to get close and get to know each other. A lovely way to welcome your baby to the world is to spend time holding them in skin contact, which will help your baby to feel safe, warm and reassured. This is a good time to offer the first feed, and feeding support will be available to you while you are in hospital.
 
Keeping your baby close helps you to continue to get to know each other and more easily recognise the signals that tell you if your baby is hungry, thirsty or would just like a cuddle .Responding to these signals before your baby gets upset will help them feel safe and secure.
 
For breastfeeding mothers we will support you to become confident in how to feed your new baby. Also we will advise you on ways of encouraging good milk production, and how to recognise that your baby is feeding well.
 
If you have not really decided about feeding and many mothers do not during pregnancy we would encourage you to remain open minded, you may feel very differently once your baby has arrived.

I would like to breastfeed do I need to bring in formula just in case?

No, your breastmilk is all your baby needs. Giving formula to a breastfed baby only makes establishing breastfeeding more difficult, and will affect your milk supply. Some babies can take a while to learn to breastfeed and staff will help you to have lots of skin contact, hand express and give this milk to your baby until he is more ready to feed.

What do I need to bring with me if I wish to formula feed my baby?

For mothers who choose to give formula to their baby we want you to feel confident about sterilising feeding equipment and making up feeds. For this reason we have asked mothers who have made a decision to formula feed to bring in the following equipment and formula: 

• Some small cartons of First stage infant formula suitable for a new born baby (Starter packs are designed to be used with the teat provided and are not suitable for decanting milk into other bottles) 
• A standard feeding bottle
• A standard teat.
• A bottle brush.

By using your own teats and bottles from the start your baby will get used to these and will be less likely to be confused. The maternity unit will provide a steriliser and use of a fridge and we will show you how to sterilise your feeding equipment. This will give you the opportunity to practise sterilising your equipment before going home and give staff the opportunity to discuss making feeds correctly. Any mother who requires help because they are unwell or immobile will be assisted with sterilising feeding equipment until they are able to do this themselves.
 
The University Hospitals of North Midlands NHS Trust does not provide formula milk to new mothers who have made an informed choice not to breastfeed.

Will there be much wastage of formula milk?

You should bring small cartons or bottles of ready to feed formula. This can be decanted into your feeding bottle and the remainder stored in the fridge with a label stating the date and time of opening as well as your name and unit number. Starter packs should not be decanted.

Which brand of formula?

There are several brands available with different company names. There is no evidence that one brand is better than another. You should use Whey dominant first milk and this should be used for the first 12months.

What if I forget to bring formula with me?

A member of your family will be able to purchase formula form a local supermarket/shop, many are open 24hours. Some mothers may choose to breastfeed until the formula can be purchased.

How can I find out more about feeding my baby

Please talk to your community Midwife about more information around feeding your baby.
 
If you have any questions please contact your community midwife or speak to a member of the Infant feeding team in the maternity unit.

The UHNM Infant feeding team can be contacted on 01782 672212

How can I tell that breastfeeding is going well?

Nappies 

The contents of your baby’s nappies will change during the first week. These changes will help you know if feeding is going well. Speak to your midwife if you have any concerns 

*Urates are a dark pink/red substance that many babies pass in the first couple of days. Talk to your midwife if you see them in your baby’s nappy. They may be a sign that baby needs to feed more. 
 
** With new disposable nappies it is often hard to tell if they are wet, so to get an idea if there is enough urine, take a nappy and add 2-4 tablespoons of water. This will give you an idea of what to look/feel for. 
 
Midwife contact number- 01782 672300 
 
Breastfeeding support- 24/7 – 01785 230059(The County Midwife Birth Unit)
 
The Royal Stoke Infant Feeding team- 01782 672212
 
Community Breastfeeding team- Stoke and North Staffordshire mothers only- 0300 7900 163 

The parent led breastfeeding  support groups listed opposite offer a warm welcome to breastfeeding mums and their babies; providing a valuable chance to meet up with other parents, share ideas and practice breastfeeding when out and about.  

However, the groups are not regularly attended by a Heath Professional so if you feel breastfeeding is not going so well or have concerns regarding the health of your baby it is advised that you attend one of the health led support groups (see website below for further information) or seek advice from your Health Visitor, Midwife or GP

For further information search ‘infant feeding’ at: www.mpft.nhs.uk

Helpline operates 09.30 - 21.30x 365 days

Webchat service also available - see website for details

www.nationalbreastfeedinghelpline.org.uk

Monday

10.00 - 12.00  Breastmilk Mummies, East Staffs Children’s Centre, Waterloo St, Burton DE14 2NJ 01283 233400

10.00 - 11.30  Milk Fairies, Leyfields Children’s Centre, Masefield Dr, Leyfields, Tamworth B79 8JB  

Contact Ellie  on 07598926785 or email: milkfairiescic@gmail.com 

10.00 - 11.30  Spark Baby Bistro, Spark Springhill, Mossbank Avenue, Burntwood WS7 4UN 
sparkbabybistro@outlook.com

12.30 - 14.30  Holy Trinity Church, Chesterton, ST5 7HJ  (see Facebook group - Chesterton Stay and Play)

13.45 - 15.15  Cannock Chase Children’s Centre, Cannock Rd, Cannock WS11 5BU, 01543 469894 - see facebook page 

Tuesday 

10.00 - 11.30  Bosom Buddies, Crossing Community Centre , Station Approach, Stone ST15 8ER (Breastfeeding Friendly)     

Thursday 

10.00 - 12.00 Burslem Breastfeeding Café at the Coffee Lounge, Swan Bank Church, Swan Square, Burslem ST6 2AA  see ’Burslem Breastfeeding Café’ Facebook page for details

10.00 - 11.30  Werrington, Werrington Library ST9 0JS  see Werrington’s breast babies Facebook page for details

12.30 - 15.00  Leek Breastfeeding Group,  Leek Community Fire Station, Springfield Rd, Leek ST13 6LQ  see Leek Breastfeeding Group Facebook page for details (IBCLC Clare Watson attends last Thurs of month)

13.00 - 15.00  Milk Fairies, Glascote Children’s Centre, Hawksworth, Glascote Heath, Tamworth B77 2ER Contact Ellie  on 07598926785 or email: milkfairiescic@gmail.com 

13.15 - 15.00  Cheadle Breastfeeding Group, Bishop Rawle Primary School, Royal Walk, Cheadle ST10 1QA. Contact - cheadlefabmummies@gmail.com 

13.35 - 15.30  Bump to Boob Breastfeeding Support, Fegg Hayes Hub, Fegg Hayes Rd, S-o-T  ST6 6OR Contact - Sally 07833 415 120 Friday

10.30 - 12.00  Breasts and the City, Deaflinks, The Ellis Centre, Wellesley Street, S-o-T ST1 4NF  £2 donation, free  parking. Contact Melinda on 07901 678 943 

Monthly NCT Lichfield & Tamworth Breastfeeding Brunch - see facebook page for details  Facebook/lichfieldtamworthnct 

MPFT and UHNM are not responsible for advice given at these groups.

Introduction

A new standard requiring health care facilities to explain a responsive feeding style to mothers was introduced as part of the review of the Baby Friendly Initiative standards in 2014. This was in recognition of the fact that the terms ‘demand’ or ‘baby-led’ feeding did not adequately describe the way that successful breastfeeding works.

Since 2014, health care facilities working towards Baby Friendly accreditation have made great strides in educating staff and mothers to understand responsive feeding.

However, recent assessments have revealed that there is still some misunderstanding about what responsive feeding is and how it works in reality.

Responsive breastfeeding explained

Responsive breastfeeding involves a mother responding to her baby’s cues, as well as her own desire to feed her baby. Crucially, feeding responsively recognises that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and mother.

For example, when a mother breastfeeds her baby responsively, she may offer her breast when her baby shows signs of hunger or when her baby is distressed, fractious, or appears lonely. Breastfeeding can help settle her baby after an immunisation, if her baby is unwell or to reassure him or her in an unfamiliar environment.

"“I use the breast for comfort, and then the nutrition just takes care of itself.”

She can also offer her breast to meet her own needs, for example before she goes out, before bedtime or because she wants to sit down, rest and have a cuddle with her baby.

Therefore, breastfeeds can be long or short and at varying times in the day, depending on why the mother and her baby have decided to feed. The key to understanding responsive feeding is that it is what ultimately makes both breastfeeding and early parenting easier. Feeding becomes the first and usually most successful action when responding to a baby’s needs. It is important that mothers are aware that their baby cannot be overfed or ‘spoiled’ by ‘too much feeding’ and that breastfeeding will not, in and of itself, tire a mother any more than the normal tiredness that all mothers have when caring for their newborn baby.

Whilst responsive breastfeeding is (or becomes) instinctive to many mothers, others can struggle in the UK culture where there are often very strong attitudes regarding what constitutes a ‘good’ baby and the routines that should be achieved. Family and friends, baby-care ‘experts’, books and the media frequently reinforce the message that limiting feeds and enforcing a daily routine will make life easier. Therefore, mothers will
often fight their instincts to respond whenever they or their baby wants to feed, and instead try and fit their baby into what they see as the desired pattern of feeds. All babies and mothers have different needs, and many babies may need to feed more frequently than the desired pattern dictates. This can leave the baby unsatisfied and distressed, which in turn undermines the family’s confidence in the adequacy of breastfeeding. Limiting feeds to fit into this routine can also threaten the mother’s milk
supply, and reduces the chances of successful ongoing breastfeeding.

Responsive bottle feeding explained

In the UK we have a strong bottle feeding culture; by one week of age over half of all babies will have received formula milk via a bottle, and by six weeks this rises to three quarters of all babies. Many breastfed babies also receive breastmilk in a bottle. Although true responsive feeding is not possible when bottle feeding, as this risks overfeeding, the mother-baby relationship will be helped if mothers are supported to tune in to feeding cues and to hold their babies close during feeds. Offering the bottle in response to feeding cues, gently inviting the baby to take the teat, pacing the feeds and avoiding forcing the baby to finish the feed can all help to make the experience as acceptable and stress-free for the baby as possible, as well as reducing the risk of overfeeding. Supporting parents to give most of the feeds themselves (particularly in the early days and weeks), will help them to build a close and loving relationship with their baby and help their baby to feel safe and secure.

Introducing responsive breastfeeding to staff

While most health professionals understand that babies should not be fed to a schedule but rather fed on ‘demand’, there remains a common belief that a ‘normal’ feeding pattern is to feed every 3 hours or around 8-10 times a day.

This impression starts in the early days when there is often a need to ensure that sleepy or ‘at risk’ babies feed often enough, and is then reinforced later when mothers are reassured that frequent feeding is temporary and their baby will soon settle into a routine. Staff need to be supported to understand that breastfeeding is about much more than food. It is also about love, protection, comfort, rest and relationship building.

This needs to be covered in training and updates, giving enough time to explore what a responsive style really means, including considering the staff’s own personal experiences and how this impacts on their beliefs about when babies should be fed and what they believe to be a successful breastfeeding experience.

New information, particularly where the older information has been ‘common knowledge’ for a significant time, can often take a while to embed; revisiting the messages and thinking about a variety of ways to put the information across may be needed to help staff to learn.

Introducing responsive bottle feeding to staff

Since the introduction of the Baby Friendly standards related to responsive bottle feeding, there have been many reports from infant feeding leads that staff have quickly and enthusiastically embraced the concept and the chance to offer more positive support to bottle feeding mothers. While this is excellent, there have also been reports of staff gaining the impression that this standard means that bottle feeding is almost as good as, or an adequate replacement for, breastfeeding. This impression has been
reinforced through the bottle feeding industry that has begun to use the concept of responsive bottle feeding in marketing strategies.

Therefore, it is very important in staff training to emphasise that breastfeeding is the normal and only truly responsive way to feed a baby and brings significant benefits for health and wellbeing. Responsive bottle feeding is a way of enabling mothers and babies to utilise their innate breastfeeding instincts as much as possible, in order to reduce the risks of bottle feeding and so achieve the best possible outcomes for their baby. It is also worth stressing that responsive bottle feeding can be a way of
introducing, however obliquely, the concept of breastfeeding to families from communities where breastfeeding rates are very low and where practices such as prop feeding are endemic.

Supporting mothers to understand responsive breastfeeding

Starting in pregnancy, it is helpful to consider how to engage mothers in conversations about their expectations around feeding, including what they consider to be normal feeding patterns. Introducing the concept of responsive breastfeeding and how this can make for a more contented baby and easier parenting in the long term, while setting realistic expectations for the very early days of breastfeeding, can be helpful.

In the early postnatal period babies are often sleepy or need to be proactively fed, or conversely, can seem to feed very frequently. It can be difficult at this time for mothers to grasp that there may be a situation where they would choose to offer the breast other than for a much-needed feed. At this stage the goal is to explain ‘what feeding will be like’ or what they are aiming for after the baby is attaching and feeding well. The information can then be reinforced by community midwives and health visitors as mothers may need to hear messages a number of times in order to help them understand.

The key message is to feed the baby whenever you feel like it, whenever it might help –not just for food but as the first tool to support parenting. Responsive feeding makes life easier - it is what babies and mothers are designed to do. 

Supporting mothers to understand responsive bottle feeding

Although the concept of having other people feed their baby can often be a reason to choose to bottle feed, parents will be receptive if it is sensitively explained to them that their baby might feel anxious or confused if lots of different people are involved with feeding them. Supporting parents to use other methods to calm and soothe babies in the absence of breastfeeding such as cuddling, using skin-to-skin contact and generally responding in a timely and appropriate way to their baby’s needs for love and attention will enhance parent-infant attachment.

Support mothers to:

• Recognise feeding cues
• Hold baby close during feeds
• Pace the feeds to meet baby’s needs
• Ensure that the parents give most of the feeds, particularly in the early weeks.

For more information for parents on building a loving relationship with their baby and giving them the best possible start in life, visit the Baby Friendly website to see our Building a happy baby leaflet; Caring for your baby at night leaflet; The importance of relationship building video and our Guide for parents who are formula feeding leaflet.

Other useful resources

Emma Pickett’s blog Breastfeeding: the dangerous obsession with the infant feeding interval
Swansea University’s video: Why you might want to put the baby books down…

References

McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ (2012) Infant Feeding Survey 2010, Health and Social Care Information Centre
Unicef UK Baby Friendly Initiative (2012) The evidence and rationale for the Unicef UK Baby Friendly Initiative Standards (visit www.babyfriendly.org.uk)

Maximising breast milk and supporting re-lactation:

Unicef UK Baby Friendly Initiative Maximising Breastmilk And Re Lactation Guidance 2

Overcoming Breastfeeding Problems: Mastitis - Baby Friendly Initiative (unicef.org.uk)

Mastitis Information - The Breastfeeding Network

Medication and breastfeeding

Speak to your midwife if you have a query about breastfeeding and the medication you are taking, UHNM has a pharmacy helpline that can provide you with evidence based information. The breastfeeding network also have a Drugs in Breastmilk information service and numerous fact sheets: Drugs in Breastmilk factsheets - The Breastfeeding Network

Tongue tie

Tongue-Tie - Baby Friendly Initiative (unicef.org.uk)

Tongue Tie - La Leche League GB

Tongue-Tie Practitioners | Infant Support

Unicef UK Baby Friendly Initiative Maximising Breastmilk And Re Lactation Guidance 2

UHNM Infant Feeding Team carry out Infant Feeding Workshops, Please contact your community midwife when you are 28 weeks and over if you would like to be booked on to a workshop.

When you are pregnant your community team will discuss comforting and caring for your baby and how taking time to think about your baby, talking to baby, noticing baby movements, reading to baby, and getting partners/support person and siblings involved helps to develop the relationship with your unborn baby and is good for your baby’s development. The community team will also discuss with you, your thoughts about feeding your baby so you can make an informed choice and know how to get feeding off to a good start and how to get support in the local area.   

Happybaby Leaflet

Breastfeeding Leaflet