Breast vs bottle

All Mums face the choice of how to feed their newborn baby - by breast or by bottle. There's no doubt that breastfeeding has several important advantages over the bottle, and indeed the UK Government supports a campaign that "Breast Is Best" and is actively encouraging new mothers to breastfeed.

The advantages of breastfeeding include:

  • it is natural food which is designed especially for your baby - it contains all the carbohydrates, fats, proteins, vitamins and minerals your baby needs in the early months of life
  • the constituency of the milk develops along with your baby to suit its growing needs
  • it is much easier for your baby to digest than formula milk, preventing constipation
  • breast milk contains unique antibodies and enzymes which offer your baby protection against infection
  • breastfed babies are less likely to suffer from common infections such as gastroenteritis or respiratory tract infections
  • breastfed babies have been shown to score higher in IQ tests later in life
  • it is convenient, available at any time without the need to sterilise a bottle and expressed at the correct temperature
  • it protects Mum against early breast and ovarian cancer
  • it helps the womb to contract and burns up calories so Mum can get back to her pre-pregnancy figure quickly
  • it's free!

Breastfeeding can begin immediately after birth. In most maternity wards, baby can be nursed by Mum straight after delivery. Many mothers and babies find this early close contact very comforting and it helps to encourage breast milk production. This depends on stimulation, so the amount of breast milk produced will be proportional to how much baby feeds.

How to breastfeed

During breastfeeding, both Mum and baby should be in a comfortable position and a safe environment. Mum should be sitting upright so her back and arms are well supported. Keep a glass of water and everything you need nearby so you don't have to move unnecessarily.

Turn baby's body towards Mum and support the shoulders rather than the neck. This way baby's head can tilt back a little and the nose is clear. Position the baby at breast level just short of the nipple.

Suckling is a reflex which most babies will display if they are at the breast. However, if you are having trouble encouraging the baby to latch on, gently stroke the baby's cheek or lips. This will encourage a wide-open mouth and the baby will search around for the nipple. This may take a little time, so be patient.

The nipple should be taken well into the baby's mouth - right up to the areola - so the breast milk is accessed correctly. When the baby is feeding you will be able to see the jaw moving and observe frequent swallows. 

Remember that breastfeeding should not be painful. If the baby is not quite latched correctly, gently put the tip of your little finger at its mouth. This will encourage the baby to break its seal and let go so you can rearrange position and try feeding again. Use the same manoeuvre to release the baby when breastfeeding is complete. 

Your baby will tell you when they want to stop, but most mothers find around 10 minutes at the breast before switching to the other side is best for comfort and position, and also to stimulate baby's interest.

How often should I be breastfeeding?

Newborn babies will need to be fed 8 to 12 times per day (about every two to three hours). Don't limit your baby's time at the breast. Most feeds will last around 10-20 minutes. You will know your baby is feeding well by seeing plenty of wet nappies - probably six to eight a day. 

Your family doctor or practice nurse will be monitoring your baby's weight and it should increase by 100-200g per week. Some babies can be sleepy throughout the day, but you should encourage feeds every few hours. If your baby is not feeding so often, or is not gaining weight, continue to offer the breast every two hours and seek advice and assessment from your GP.

Weaning

Breastfeeding is recommended for the first six months of life. At around four to six months of age you can start to introduce solids to baby's diet. Introducing any new food should be done gradually and with patience. Try one new food or taste at any one, and start with one teaspoonful to begin with. Boiled mashed food such as carrots, potatoes or bananas are good to start with. 

As a baby develops, it will start to be able to chew and mix soft foods. At around six to eight months, you can start to introduce a basic diet of porridge and milk, with a wider range of mashed vegetables and fruits.

Medications during breastfeeding

Medications should be used cautiously during breastfeeding as some may be passed on to baby through breast milk. The general advice is that, as in pregnancy, you should seek your family doctor's opinion before taking medication.

Your doctor will advise regarding any regular medication you take for conditions such as diabetes or epilepsy. Remind your doctor you are breastfeeding if they plan to prescribe antibiotics or any other new medications.

As with pregnancy, drinking alcohol is not advised during breastfeeding. A recent study suggested that alcohol may even reduce the amount of breast milk expressed.

Breastfeeding on the pill

Breastfeeding tends to lower fertility, as hormone levels during breastfeeding mimic those of pregnancy. However, that does not mean it is an effective contraception. The combined contraceptive pill (containing oestrogen and progestogen) may interfere with breastfeeding, and is not recommended during breastfeeding in the first six months after birth.  Barrier methods such as condoms are probably the most reliable form of contraception during breastfeeding.

Breastfeeding problems

The most common problem for breastfeeding Mums is sore or cracked nipples which may develop an infection (mastitis). This usually occurs in the first six weeks after birth, although when baby has weaned, the build-up of unexpressed milk may also cause problems.

The breast and nipple may be swollen, and if an infection develops the breast will become red, tender and painful. You may experience systemic symptoms such as a flu-like illness, fever and headache. Your doctor may need to prescribe antibiotics which can be taken safely during breastfeeding.

It's important to continue breastfeeding as this will stop unexpressed milk from clogging the lactation glands and becoming infected. Your baby will not be at risk from the infection. Unfortunately some women may go on to develop an abscess, although this can be easily drained under local anaesthetic.

Good hygiene while breastfeeding will help to prevent mastitis. If you find you are starting to develop cracked or sore nipples, cabbage leaves worn inside a nursing bra should help to soothe the breasts.