Breastfeeding: What If It Doesn't Work?

Breastfeeding_1.jpgWe all hear that 'breast is best', but sometimes no matter what you do it just doesn't seem to work.  When things go wrong it can seem like an impossible task, so here are ten useful tips that might help make things a little easier…




It can be difficult to know if your baby is getting enough milk when you're breastfeeding and the temptation is to give extra just in case - but this isn't always necessary.  It's actually quite normal for breastfed babies to feed more frequently and it doesn't necessarily mean they're not getting enough!

One way we can check is by weighing babies around day 5 of life to see if they have lost weight.  Every baby loses weight after birth and they usually regain this by 2 weeks' age.  In general, up to 10% loss is OK, but any more than this usually means that feeding isn't quite sorted.  

Why is this important? Because too many babies are being readmitted to hospital due to these feeding problems and the majority can be avoided!  It's often a supply/demand balance - either you aren't quite able to meet baby's demand yet or they just haven't got the hang of the mechanics.  Either way, it means that you might have to initiate some extra measures to get things back on track.



Stressing out about feeding problems makes the whole process more difficult and can reduce your milk production.  Breastfeeding isn't as easy as people think so don't worry if you don't get it right straight away.



There's lots of help available.  Speak to your midwife/doctor or try a local 'breastfeeding cafe' which are often run by breastfeeding counsellors.  Having the support of a friend or partner can also go a long way - even if they can't do the feeding bit!  There are lots of online breastfeeding support services too who can also be a great help.  My general rule for new parents: if someone offers help, take it!



Well-grown babies don't feed a great deal in the first 24-48 hours as they take time to get the hang of it and their stomachs start off really small (they grow with time).  Luckily they are born with energy reserves to keep them going until things get sorted.  Premature or small babies may not have much of these stores on board and so you may have to intervene sooner.



Putting your baby directly in contact with your skin (especially after birth) can help them start feeding.  Just remember to put a cover over the top to stop them getting cold!



Sometimes babies don't feed so well because of a physical issue (e.g. 'flat nipples', large breasts).  Trying different feeding positions or something like a nipple shield may do the trick.  If your baby has a significant tongue-tie then this may cause problems too and may need addressing early - speak to your midwife if this is the case.



Make sure you get plenty of rest and eat well yourself.  It's not just baby's nutrition that is important!



In the initial stages, hand expressing a small amount of 'early milk' (or colostrum) may whet baby's appetite and help get things going.  Your midwife should be able to show you how to do this.



Sometimes we have to give babies extra milk via bottle to tide things by - there is nothing wrong with this.  You can do this by topping the baby up with extra milk after each breastfeed.  This can either be milk you have expressed or formula.  Top-ups don't have to be used forever - only until the breastfeeding is sorted out and the amount you offer can be decided in discussion with your midwife/doctor.  Don't get too fixated on each individual feed - it's the overall intake over the whole day that counts.



Although feeding on demand is ideal, when things aren't going right you may be asked to be a little more regimented (especially if there is too much weight loss).  In the early stages, you may be asked to feed every 3 hours at least and keeping a record of how things go.  Express between feeds (6-8 times per day) to encourage milk production and give you milk for any required top-ups.



When all else fails there is NOTHING wrong with either using extra or even switching to formula milk.  After all, when things are desperate it's getting milk in that's most important - whatever milk that may be.  Breast milk is ideal, but baby formula is a good second best - it certainly will NOT harm your baby.  No one formula is better than others - just try them and see which one you and baby prefer.  Often people will voice concerns about babies getting 'nipple/teat confusion', but many professionals don't believe this exists in reality.


I see lots of breastfeeding problems and always remind people that it isn't easy and doesn't work for everyone - so don't feel bad if things aren't perfect.  There may be a medical reason why you can't breastfeed or it takes longer to establish - such as problems during the pregancy, labour or if you've had a C-section.  


If possible get some help or support to see if you can keep going, but if you're not winning then extra steps might have to be taken.  We're seeing far too many babies being readmitted to hospital with feeding problems and dehydration, most of which can be prevented by following simple, sensible advice.  However, don't worry if you can't do it because some people can't - that's OK!  It's also about what's right and what works for you and your baby.


Likewise, no-one should ever make you feel bad for using formula milk.  On balance, it's far more important to make sure your baby gets enough milk, regardless of whether it comes from the breast or formula.  Whilst it's not as good as breast milk, formula is not harmful per se, although there are some situations where it is not advised (your doctor will advise you if these apply).


You may also want to explore the option of donor breast milk, but please be careful about using unofficial or unregulated sources - see my blog about donor milk here.


Remember: breast may be best, but breastfeeding is still a CHOICE - it's not the law!