Breastfeeding: what the antenatal classes don't tell you

I breastfeed. I knew when I was pregnant that I wanted to do breastfeed once baby was born, and I read up on it. I also attended NHS antenatal classes promoting breastfeeding, where due to my reading I was able to contribute quite a lot in discussions.
Despite this, I was not prepared for the reality of breastfeeding. 

I feel disappointed in the information being offered; if myself, as someone who actively sought information to ensure my breastfeeding journey would be a success, was not prepared, I suspect most mothers won't have been. I feel like the NHS staff delivering the antenatal classes vetted the information they were giving to portray a solely positive picture of breastfeeding so as not to put anyone off, therefore missing out important information. This, coupled with budget cuts affecting the availability of breastfeeding support, is likely to be a key factor in the alarming drop seen in statistics of women who begin breastfeeding (81%) compared with the rate of breastfeeding mothers reaching 6 months (34%) and 1 year (0.5%) milestones (source). These 2016 stats are at least better than the 2010 stats shown on the Unicef website (referenced as the last UK wide survey) of 81% initiation, declining to 24% at six weeks, 17% at 3 months, 1% at six months, giving no data for breastfeeding rates beyond this point.

In this post I will give some of the information I wish I knew when I started my breastfeeding journey that I've had to learn along the way, largely from the online communities of breastfeeding mothers I have become part of. I am not health or breastfeeding trained, just someone who has been there (6 months strong and no stopping me yet!) who hopes they might be able to help someone else to get there too.

Cluster feeding 
Without a doubt, the number one thing I wish I'd known about breastfeeding from day one is the behaviour of cluster feeding, and how normal this is for a breastfed baby to do. Cluster feeding is a (newborn) baby's tendency to feed for long periods of time very frequently, usually at a predictable time in the evening. I distinctly recall reading this article on around day 4 or 5 of my babies life outside the womb and gaining so much more confidence and understanding just knowing that this is normal. 

Why is it important? My experience of (neonatal) nurses and health care professionals around my baby just after his birth was an experience of constant data taking. In order for me to be a key player in my son's care, I had to record just about everything I did for him, from nappy output to feeding: when he fed, how long for, and when I could say so, how much milk. This kind of information is only relevant to bottle-fed babies - I can not possibly tell you how many millilitres of milk my breastfed baby was consuming, and to try and measure it only made me stressed, guilt-ridden, and upset. When my baby cried for more after a 45 minute feed, the neonatal nurses worked to distract him, stating he couldn't possibly want more milk after such a long feed and questioning my supply. When you know about cluster feeding, which I argue all neonatal nurses and health care staff working with babies should know, you understand that these kind of responses are not necessary and that limiting baby's access to the nourishment and comfort of their mother's breast can only be damaging to both parties. Cluster feeding is a baby's way of communicating to a mother's body how much milk needs to be produced - creating a supply from the demand. It is necessary to allow a newborn to cluster feed in order to establish breastfeeding. 

My memories of cluster feeding are emotionally wide ranging. Life with a newborn is hard. Life with a newborn who has spent time on a neonatal ward is arguably harder - the added stress and anxiety can only perpetuate the lack of sleep all new parents experience. I recall one of my lowest points was sitting up in bed in the early hours of the morning (after very little time sleeping) with a newborn who wanted to feed for nearly an hour, grumpy and exhausted, while my husband desperately tried to keep me from falling back to sleep. The highs of cluster feeding are definitely the times when I just sat back on the couch, prepared with snacks and the tv remote, cuddling up with my tiny boy and knowing him and that moment were all that needed to matter (although the during and post bath feeds with skin to skin cuddles were pretty great too, as was the sight of his happy little milk drunk face).

Cluster feeding is often associated with developmental leaps (identifiable with the wonder weeks tracker), but tends to occur most within the first six weeks in which your body is establishing your milk supply. I definitely found breastfeeding easier after the first six weeks.

Mastitis and engorgement 
Mastitis is always mentioned but never fully explained - it is caused by blocked milk ducts and gives hot and swollen breasts and general flu like symptoms and can be treated with antibiotics. I've been lucky enough not to have had mastitis yet, and it is not an inevitability! There are precautions you can take to reduce your chances. Firstly, pumping breast milk is not recommended before six weeks unless medically necessary (my boy was on top ups of milk via bottle to help weight gain so pumping necessary to avoid formula) because your body is still working out supply and demand and you will be cueing your body to produce more milk than you are using. Secondly, to avoid one breast becoming overly full, either offer and empty both breasts at every feed, or offer alternate breasts at each feed to ensure both are being used equally throughout the day. If you feel a build up of milk in one breast, hand expressing the excess milk to make yourself more comfortable can be done without affecting supply, or if possible offer this breast to the baby when your body is cueing you to do so! There are two sides to feeding on demand - mum's demand and baby's! You may also be able to feel when a blocked duct is beginning; a hard patch in your breast where milk is building up. You can encourage this to shift by massaging the area while baby is feeding, applying a cold compress, or placing a warm flannel on the breast while in the bath and hand expressing.

Milk safety and expressing
The antenatal classes did tell me how to hand express, but there is quite a lot of information available about this online too. The classes also mentioned harvesting colostrum (early milk) by hand expressing into syringes after 37 weeks of your pregnancy but before the birth of your baby. This is recommended for babies which you know will be low birth weight or require special care at birth, but you can't always know these things and the colostrum can still be useful to a healthy baby, as well as being able to be stored safely for up to six months in a freezer. Because nobody personally recommended this to me, I didn't do it, but I wished I had when my boy ended up in neonatal and I had to do hand express colostrum into syringes for him anyway. As long as you wait until 37 weeks in your pregnancy (because breast stimulation has the potential to bring on labour) then you have nothing to lose by harvesting colostrum for your baby, but lots to gain: colostrum is stuffed full of antibodies and other good stuff for your baby and a little goes a long way as a newborn has a tiny stomach. 

Safe breastmilk storage: 
-At room temperature for six hours
-In the fridge for six days
-In the freezer for six months

As long as you wash your container before use with hot soapy water, any container is safe to store breastmilk in. Sterilisation is required when formula feeding, and while there is no harm in doing it anyway, it is not required for items being used for breastfeeding, which would have been useful in the eaarly days when we were just so tired!

Latching and tongue ties
Antenatal classes did teach me the basis of latching a breastfed baby using the CHINS acronym: 

• cuddle in close (hold baby close to you, facing into your body)
• head free (don't hold their head in a restrictive manner)
• in line (baby's face and stomach are facing into you)
• nose to nipple (baby will naturally pull their head backwards, moving their lips to the nipple)
• sustainable (you arent going to end up with a dead arm/ sore back/ unlatch baby and reposition if it is painful)

(More info here)

This helped me to have an idea about how to get my baby latched, but the face to face support at the hospital helped me to perfect the technique. Unfortunately, poorly baby struggled to latch on my bare nipple and we had to use nipple shields at first, which meant I later had to work to wean him off these. 

Latch issues are not just baby struggling to latch and feed well; some women need face to face support to perfect latches which are uncomfortable or even damaging to their nipples, and it is not uncommon that babies are born with a tongue tie which needs to be cut before they can latch properly. Tongue ties can often also be overlooked, missed or misdiagnosed. 

That's all for now, though watch out for a post in another six months about the boob gymnastics and ups and downs of breastfeeding a toddler and do comment if you think I've missed anything!