“Don’t panic if you have flat or inverted nipples, it’s often perfectly possible to breastfeed,” reassures Sioned Hilton, a lactation consultant, neonatal nurse and health visitor, who has worked with Medela in the UK for more than a decade. “Remember your baby latches on to a mouthful of breast, not only the nipple itself, when feeding effectively.”

But in the earliest days, when your baby’s mouth is still tiny and her sucking is less efficient, inverted or flat nipples may make it harder for her to start – particularly if she is premature or unwell.

“If your nipple is flat or inverted, it may not reach the roof of your baby’s mouth to stimulate her palate and trigger her sucking reflex,” Sioned explains. “This could mean she has problems latching, or can’t stayed latched on for effective milk transfer.”

How to tell if you have flat or inverted nipples

Flat nipples¹ don’t protrude very far from the areola (the darker area surrounding them), even when stimulated.

An inverted nipple dimples inwards at the centre. It may look like this all the time, or only when stimulated. Sometimes inverted nipples retract back so they are level with the areola, or they may even sink down into the breast tissue.

One or both nipples can be affected, and it’s estimated up to 10% of first-time mums have at least one inverted nipple.² If you’re not sure whether your nipple is inverted, try the ‘pinch test’: compress your breast gently, with your thumb and forefinger either side of the areola. Most nipples will poke out, but if yours retracts or pulls inwards, creating a hollow at the end, then it’s inverted

Preparing inverted or flat nipples during pregnancy

You may find that, as your breasts change during pregnancy, your nipples begin to protrude more by themselves. If not, and you’re concerned that their shape could make breastfeeding difficult, you can wear nipple formers. These soft, flexible silicone discs fit discreetly inside your bra and place gentle pressure on your nipples, helping draw them out.

“Nipple formers can be worn from week 32 of a normal pregnancy,” advises Sioned. “Start with just an hour a day and build up to around eight hours. If you have an incompetent (weakened) cervix or are otherwise at risk of delivering pre-term, chat to a healthcare professional about the best time to start using them, as nipple stimulation can bring on contractions.

“You can continue to wear the nipple formers once your baby is born,” she adds. “Try popping them inside your bra 30 to 60 minutes before you’re due to breastfeed.”

“I have inverted nipples and, after two or three weeks of trying to get my baby to latch, was on the verge of switching to formula,” remembers Nina, mum of one, Germany. “I sought help from La Leche League and a lovely lady visited and encouraged me to keep going. She suggested nipple formers, which really helped. Somehow my little boy started to understand what to do! Breastfeeding was then great and we kept going until he was 21 months old.”

Helping your baby latch on to flat or inverted nipples

If your baby will suck happily on your finger but seems less interested in your breast, it’s a sign your nipple may not be reaching her palate when she latches on. She may become frustrated and pull away and cry, or even fall asleep at your breast. If this is happening, ask a lactation consultant or breastfeeding specialist to check her latch.

There are several techniques you can use just before each breastfeed to form your nipples into an easier shape for your baby to latch on to. Sioned suggests:

• rolling your nipple between your thumb and forefinger to encourage it to stick out
• compressing your breast just behind your areola with your fingers in a ‘V’ or ‘C’ shape to push your nipple outwards
• touching your nipple briefly with a cold compress or ice cube to make it erect
• hand expressing or using a breast pump for a couple of minutes before a feed to pull your nipple out more

“I have one flat nipple, but only found out when Austin had difficulty feeding on that side,” says Jennifer, mum of two, UK. “There’s nothing anatomically wrong – it just doesn’t perk up as much, which makes the latch a bit trickier. Before feeding on that side I always tweaked and squeezed it a bit and eased it into his mouth. It was a bit tricky early on but got a lot easier as time passed.”

Using a nipple shield to help baby latch on

If none of the above work and your baby is still struggling to maintain her latch, your lactation consultant or breastfeeding specialist may advise you to feed your baby through a nipple shield.This is a thin, flexible piece of silicone, shaped like a nipple, with holes in the tip for your milk to pass through.

The nipple shield offers your baby a larger, firmer target, as well as stimulating her palate to encourage her to suck. In general nipple shields should be considered as a short-term solution. If problems or pain occur, consult your lactation consultant or breastfeeding specialist, who will ensure your baby is latching well with the shield in place. You’ll also need to monitor your baby’s weight gain to ensure your milk supply is building to meet her needs.³

Over time, as your baby’s suck gets stronger and your nipples become more accustomed to breastfeeding, you might be able to breastfeed without the nipple shields.

“My nipples are rather flat. A healthcare professional recommended nipple shields for my two babies, and I used them with great success,” says Anne-Sophie, mum of two, Sweden. “My secret to make them stick to the skin is to wet the edge slightly before use.”

Breastfeeding with pierced nipples

Many women with pierced nipples find it has no impact on their ability to breastfeed – although you’ll need to remove jewellery before feeds as it’s a choking hazard and could graze your baby’s tongue, gums or palate.

“I had a nipple piercing, but removed it a year later when I got pregnant as my breasts felt sensitive,” says Kellie, mum of three, UK. “I breastfed my daughter exclusively, and then her two younger brothers, with no issues whatsoever. If anything, the pierced nipple was the favourite!”

Other mums find breast milk leaks from their piercing holes, or suspect scarring from the piercing is reducing their milk supply⁴ – although there has been limited research in this area.

“It’s impossible to know how a piercing will affect breastfeeding until your milk comes in,” says Sioned. “Get advice from a lactation consultant or breastfeeding specialist if you’re worried. And remember babies can get all the nutrition they need from just one breast if there’s a problem with the other.”

If you can’t breastfeed with flat or inverted nipples

If you’ve tried everything and breastfeeding’s just not working, you still need to feed your baby.

“The most important thing is a well mum and baby,” says Sioned. “Exclusive pumping, so your baby has expressed milk at every feed, might work for you. Or you could try a supplemental nursing system so your baby can practise feeding from your breast while being topped up with expressed milk through a tube. This means she still gets the breastfeeding experience and stimulates your milk supply, which in turn may help you express more milk.” 

“I have inverted nipples. After a disastrous breastfeeding experience with my first son, I was determined to succeed with my second,” says Babettli, mum of two, Italy. “I got advice from experts and tried nipple formers and nipple shields, but without success. In the end pumping exclusively using a hospital-grade Medela Symphony double electric breast pump was the best option for us. I pumped every feed for four months.”

Caring for different types of nipples

You may need to take extra care of your flat or inverted nipples as your baby might suck on them more strongly, which could make them sore at first. For tips on combatting sore nipples, read nipple care for breastfeeding mums. 

If your nipples retract after feeding, any dampness could make them sore and increase the risk of infections, including thrush. Pat them dry after a feed before they have the chance to sink back.

Flat and inverted nipples can be harder to deal with if your breasts are engorged – when even nipples that are usually erect can temporarily flatten. Read our article on breast engorgement for advice.

The great news is that repeated breastfeeding or pumping can alter your nipple form, so breastfeeding might get easier as your baby grows. And you may not have any problems at all if you have another baby – as Leanne, mum of two, UK, found:

“Second time round breastfeeding was a dream,” she says. “Nearly four months of expressing for my first son had helped stretch out my flat nipples and my second son latched straight away without nipple shields. He’s still feeding now at nine months.”

The post Breastfeeding with flat, inverted or pierced nipples appeared first on Medela South Africa.

You need lean protein too – good sources include chicken, eggs, pulses, lentils, fish and lean beef – and healthy fats, found in olive oil, nuts, seeds, avocados and oily fish such as salmon or mackerel. Oily fish is good for your health and your baby’s development, but you shouldn’t have more than two portions – around 140 g (5 oz) – of oily fish (or more than one portion of swordfish, shark or marlin) a week, as these may contain pollutants.¹

Do I need to take any breastfeeding vitamins?

Vitamin D is key. It’s essential for healthy bones, for both you and your baby, and we get most of it from sun exposure. If you live somewhere that doesn’t have a lot of sunshine, especially during winter, your body may struggle to make enough vitamin D so supplements are recommended² – your healthcare professional can advise you.

You should also ensure you’re getting enough calcium, as this is depleted when breastfeeding.³ Aim for four servings a day from dairy foods, such as milk, yoghurt and cheese, or non-dairy sources, including nuts, tofu, sesame seeds and leafy green vegetables. A serving could be half a cup of green veggies or a small 50 g (1.5 oz) piece of cheese.

Which foods should I avoid while breastfeeding?

The good news is, apart from limiting how much oily fish you eat, there aren’t any specific foods to avoid when breastfeeding your baby. Caffeine and alcohol are also fine, within sensible limits – read on for more advice on this below.

And unless you are allergic to peanuts yourself, there is no reason to avoid peanut-based foods while breastfeeding. In fact, the latest research suggests that if you eat peanuts while breastfeeding and introduce them to your infant’s diet within his first year, he is less likely to develop a sensitivity to them.⁴

Do I need extra calories when breastfeeding?

Breastfeeding mums need around 500 more calories a day than non-breastfeeding mums,⁵ but every woman is different, and your energy needs will change during your breastfeeding journey. The amount of calories you require will depend on your baby’s age, size and appetite, as well as your own body mass index (BMI), how active you are, and factors such as whether your baby is exclusively breastfed or not, or if you’re feeding twins or multiples.

Can I diet during breastfeeding?

You could diet during breastfeeding, but it’s not a good idea to try to lose lots of weight while breastfeeding – you need to make sure you’re getting the nutrients that you and your baby need. The fat you gain in pregnancy is used to make breast milk, so breastfeeding will help you to lose any weight you’ve put on.

If you notice your weight creeping up or dropping by more than around 1 kg (2.2 lb) a week, ask yourself if you’re getting a healthy, balanced diet, adjust it if you need to, and talk to your healthcare professional if you want more advice.

How can I find time to prepare healthy food?

It’s tempting to focus on feeding your baby rather than yourself, but you need to make sure you’re not just fuelling up on biscuits and sweets. It’s understandable, but it’s not going to do your body any favours.

Go for quick, nutritious, meals such as scrambled eggs with spinach, or chicken stir fry with brown rice. Porridge is brilliant in the morning because it gives you a slow release of energy from the oats and soluble fibre – if you’ve been breastfeeding at night you need to replenish your energy levels.

Have chopped fruit and vegetables in the fridge ready for quick snacks or keep a bag of unsalted nuts in your changing bag. Both are easier than trying to peel a satsuma one-handed when breastfeeding!

Do I need more water when breastfeeding?

Breastfeeding can make you feel thirsty, so it’s important to keep well hydrated. Everyone should be aiming for six to eight glasses of fluid a day – even more when breastfeeding.⁶ As a rule, sip a glass of water, milk or unsweetened fruit juice whenever you’re feeding your baby.

I love coffee: Do I need to avoid caffeine?

As with anything you eat or drink, caffeine does get through to your breast milk – so you’re advised to limit your intake while breastfeeding. Official recommendations on caffeine limits vary from country to country, but most advise not having more than 200 to 300 mg (0.007 to 0.01 oz) of caffeine a day (300 mg is equivalent to two mugs of filtered coffee or four mugs of tea). Talk to your healthcare professional about what’s right for you. Don’t forget, caffeine is found in colas and energy drinks too, and there can be up to 50 mg (0.002 oz) in a small bar of plain chocolate.⁷

Can I drink alcohol while breastfeeding?

Many breastfeeding mums choose to stop drinking alcohol. However, occasional light drinking while breastfeeding has not been shown to have any adverse effects on babies.⁸ Alcohol is best avoided until your baby is over three months old, though, and then enjoyed as an occasional treat, such as a small (125 ml/4.2 fl oz) glass of wine.

If you do have an alcoholic drink, make sure you allow at least a couple of hours for the alcohol to go through your system before your next breastfeed.⁹Alternatively, you could have a small drink while you’re actually breastfeeding your baby, as by the time the alcohol is in your system, he will have finished feeding. Or for total peace of mind, if you’re planning to have an alcoholic drink you could express and store milk beforehand and give that to your baby for his next feed.

Bear in mind that alcohol can temporarily reduce your milk yield,⁸ so if you do have a drink your baby may seem hungrier and want to feed more.

If I eat adventurously, will my baby be a less fussy eater?

Your breast milk carries the flavour of the foods you eat.¹⁰ So by enjoying a varied breastfeeding diet and exposing your baby to different tastes, he might end up liking those flavours later down the line.

If you like spicy dishes, there’s no reason to avoid them when breastfeeding either. When I had my first child, I ate a lot of spicy food. I took her to Sri Lanka when she was two and – although this may be a coincidence – she ate everything!

Is something I’m eating disagreeing with my baby?

Young babies are often fussy or gassy, and mums naturally wonder if this is caused by something they’ve eaten. Chances are it isn’t. Research suggests the proportion of infants who are allergic to something in their mother’s breast milk is only a little over 1%.¹¹ Cow’s milk, egg, corn, or soya proteins in their mum’s diet are the most common allergy culprits, rather than the spicy foods, hot sauce or cruciferous veg that mums sometimes worry will cause a reaction.

If your baby is allergic to something in your milk, this could cause excessive vomiting, a rash, blood in their stools or persistent congestion. If your baby has a food intolerance, you’re likely to notice symptoms such as fussiness or crying after a feed, reflux, explosive stools and bringing his knees up to his chest. Seek a healthcare professional’s advice if you suspect something is wrong. They may advise you to cut out a particular food for a couple of weeks, then reintroduce it to see if there’s any difference in your baby.

You could also keep a food diary: write down everything you eat and drink and any symptoms in your baby, and you might see patterns. Remember, always seek advice from a healthcare professional before eliminating a food group, such as dairy, as you need to make sure you’re getting the nutrients it provides from other sources. You may be referred to a dietitian or other specialist, depending on where you live.

Will being vegetarian affect my breast milk?

As long as you’re eating enough calories and are getting all the nutrition your body needs –carbohydrates, protein, fats, vitamins and minerals – you should be fine. Those on a vegetarian and vegan diet while breastfeeding should make sure they’re getting plenty of vitamin B12, vitamin D, calcium and omega-3 fatty acids, so choose foods or supplements that will keep you topped up with these vital nutrients.

If you are on a vegetarian, vegan, macrobiotic or other special diet you might want to seek additional advice from your healthcare professional to make sure you’re getting all the nutrients you and your baby need.

The post What to eat while breastfeeding appeared first on Medela South Africa.

But despite advances in how baby milk powder is formulated and manufactured, it doesn’t come close to matching the health benefits of your breast milk. Human milk has evolved over millions of years to be the perfect food for human babies. It’s much more complex than other mammals’ milk, as it builds our more complex brains and unique digestive and immune systems.

In contrast, cow’s milk, from which most formula is made, meets the specific needs of calves. It’s not safe for human babies to drink, so has to be processed intensively when made into formula for infants.

“Did you know the salt [sodium] content in cow’s milk is pretty much at toxic levels for babies?” says Professor Peter Hartmann, an internationally renowned specialist in breastfeeding and milk production, based at the University of Western Australia.

“In fact, in the early 1980s, cow’s milk was known to be toxic to laboratory animals such as rabbits or rats. These days, if any compound is toxic to a laboratory animal it’s not pursued in drug studies. So, by today’s standards, they wouldn’t have been allowed to make formula! Meanwhile mother’s milk has very low concentrations of sodium.”¹

What’s in breast milk?

From colostrum that coats and seals your newborn’s stomach lining, to mature milk that helps your baby grow strong, each drop of your breast milk contains thousands of beneficial components, including:

• antibodies to protect against illnesses²
• hormones that promote bonding and regulate appetite³
• stem cells that may support organ development and repair⁴
• white blood cells that fight infection⁵
• beneficial bacteria that protect your baby’s digestive system⁶
• prebiotics called oligosaccharides that support a healthy gut⁷
• long-chain fatty acids to help develop your baby’s brain, nervous system and eyes^8,9
• enzymes to support his digestive and immune systems²
• nucleotides and hormones that help develop healthy sleep-wake patterns¹⁰

One of the benefits of breast milk over formula is that it’s a living fluid. It adapts to your baby’s changing circumstances. So if your baby becomes ill, your body makes extra white blood cells and antibodies that travel into your milk and help fight infection.⁵

“The protective properties of mother’s milk are fundamental and unique to the evolution of lactation,”explains Professor Hartmann. “But we don’t yet have the data to understand the full extent of all the protective elements and what they do, as breast milk is so complex.

“Take oligosaccharides – there are more than 200 of them.¹¹ They’re the third most abundant component of breast milk – yet we have little idea about what they do! They possibly have very complex structures because it gives them affinity for particular proteins, and when the oligosaccharide and the protein come together they have biological effects.

“Really, if you don’t know about it you shouldn’t muck around with it! Breast milk’s the normal thing.” Read more about breast milk in What’s in your breast milk?

What’s in formula milk? 

Ingredients vary by brand and country, but typical baby formula milk is made of processed skimmed cow’s milk with added emulsifiers and stabilisers to help the oils and water mix when you make up the feed. It may also contain:

• lactose (a natural sugar found in milk) and/or other sugars such as corn syrup, fructose or maltodextrin

• plant-based oils, such as palm, rapeseed, coconut, sunflower and soybean oil
• fatty acids, usually derived from fish oil
• vitamins and minerals from plant and animal sources
• a couple of enzymes and amino acids
• probiotics (in some formulas)

NB Different types of baby formula, such as goat’s milk, hypoallergenic and soya formulas, may have a different mix of ingredients.

“Scientists have shown there are more than 1,000 proteins in breast milk¹² – and the best formula companies are looking at increasing just one or other of them,” explains Professor Hartmann. “What’s more, people have only just been able to synthesise some of the many oligosaccharides found in breast milk. So copying a couple of proteins and oligosaccharides is not going to get you breast milk!

“As far as cow’s milk is concerned, excess protein has to be added to bring the number of amino acids up to the level that baby needs,” he continues. “But that excess protein will be metabolised and broken down into components that can be converted into fat.

“That’s one of the problems with formula – babies do too well on it. Parents often think they’re doing fine because they’re growing like mad – but actually that may not be good for the long-term health of formula-fed infants.¹³ So formula companies are now trying to bring down protein levels in their milk to prevent babies from getting too fat.”

Breastfeeding vs formula: Health benefits

Look at the bigger picture when deciding whether to give your baby breast milk or formula. Breast milk isn’t just a food. It has an important protective function, reduces your baby’s likelihood of diarrhoea, gastroenteritis, ear infections, colds and flu, and thrush^14–16 and halves his risk of sudden infant death syndrome (SIDS).¹⁷

You may have heard that breastfeeding your baby improves his chances of doing well at school,¹⁸ but did you know it’s been linked to better behaviour,¹⁹eyesight²⁰ and teeth alignment²¹ too? Your breastfed baby also has less risk of becoming obese, and his lifelong chances of getting type 1 and 2 diabetes,^22,23 and certain cancers^24,25 will be lower. Read more about breastfeeding benefits for babies. [LINK Benefits for baby]

Breastfeeding also burns up to 500 calories a day,²⁶ which may help you lose weight more quickly after the birth. And the longer you breastfeed, the lower your own risk of developing breast,²⁷ uterine²⁸ and ovarian cancers,²⁹ heart disease,³⁰ and type 2 diabetes.²² Read more about breastfeeding benefits for mums.

Breastfeeding vs formula: Practical advantages 

Breastfeeding is usually easier on your purse. One estimate is that families who breastfeed exclusively save USD 1,200 to USD 1,500 during their baby’s first year.³¹

And while breastfeeding may not stop your baby waking at night, it will save time during feeds and help you both get back to sleep faster, so you can expect an extra 40 to 45 minutes’ rest each night.³²

In fact, breastfeeding saves you more time in general, as you don’t need to do as much washing up, sanitising, boiling water and prepping bottles of formula – your milk is always ready at the right temperature.

In addition, the foods you eat flavour your milk so your baby experiences new tastes at every feed, and may enjoy a wider variety of foods when you start introducing solids.³³ Breastfeeding could even encourage healthier eating, as research shows breastfed babies of mums who have fruit and vegetables regularly enjoy eating these foods more than babies of mums who don’t.³⁴Formula, meanwhile, always tastes the same, and even using different brands can’t recreate the complex flavours of your milk.

Finally, have you considered the environmental benefits of breast milk? With no intensive farming, factory emissions, transportation or packaging involved, breastfeeding is better for the planet as well as for you and your baby.

For more information on what’s in breast milk, read our free ebook The Amazing Science of Mother’s Milk now.

The post Breast milk vs formula: How similar are they? appeared first on Medela South Africa.

If your baby is healthy and breastfeeding is going well, there’s no need to rush into giving her expressed milk. For the first four weeks, you’re working together to initiate and build your breast milk supply while she learns to breastfeed efficiently. While there is limited data,¹ it is thought that unnecessarily introducing bottles during this crucial first month could interfere with these processes.

But if your newborn struggles to latch or suck for any reason, then start expressing milk as soon as possible after the birth. Read our articles on overcoming problems in the first week and feeding breast milk to your premature baby or infant with special needs for more advice, as well as getting support from your healthcare professionals.

How can I feed expressed milk to my baby?

There is a range of expertly designed feeding solutions that can help you give expressed milk to your baby, depending on your and her needs.

For example, Medela’s innovative Calma teat will only allow milk to flow when babies create a vacuum by sucking. This means they can feed from a bottle using the same technique, tongue motion and jaw movement they would at the breast.^2,3 Developed with breastfeeding experts from the University of Western Australia, Calma allows your baby to suck, swallow, pause and breathe just as she does when breastfeeding.⁴ By maintaining babies’ natural sucking behaviour, Calma is designed to make it easy to switch from breast to bottle-feeding and back again.

Medela also makes conventional bottle teats in two flow versions. And all our teats can be attached directly to the bottles you express milk into, minimising the risk of spillages.

If your newborn needs expressed milk, but you don’t want to offer her a bottle until she’s become used to breastfeeding, you could use a baby cup designed for short-term feeding. This allows your baby to sip or lap your expressed milk – be careful to avoid spills! It’s advisable to have a healthcare professional on hand the first time you use the baby cup, to make sure you’re both getting the hang of it.

For babies who need expressed milk supplements in addition to regular breastfeeding, a supplemental nursing system (SNS) can be helpful. This has a thin, flexible feeding tube that can be fixed alongside your nipple to give your baby expressed milk while you’re breastfeeding her. This allows your baby to stay at your breast longer, which further stimulates your breasts to help maintain your milk supply, and also helps improve her breastfeeding skills. It can be useful for mums with low milk supply or with adopted or surrogate babies.

If your baby can’t create the suction needed to breastfeed – perhaps because of a disability, congenital condition or weakness – you could try a feeder designed for babies with special needs. These allow infants who can’t suck to feed using gentle compression instead.

What’s the best way to introduce a bottle?

If breastfeeding is going well and you’ve decided it’s the right time to give your baby a bottle of expressed milk, follow these tips:

Take your time

Don’t wait until your big night out or first day back at work to introduce your baby to the bottle. Start trying with a small amount of expressed milk, in a relaxed and unhurried way, a couple of weeks beforehand. Gradually build up to giving a full feed of expressed breast milk from a bottle.

Pick your moment

Ideally your breastfed baby should be alert, but not too hungry, the first time she has a bottle of expressed milk, so that she is as relaxed as possible.

Delegate feeding duties

Your baby may be confused or frustrated when you offer a bottle, as she’s used to your breast. It might be easier if someone else gives the first bottle, and you stay out of the room so your baby can’t see or smell you.

Not too hot, not too cold

Your baby may be more likely to take the expressed milk if it’s around body temperature, ­37 °C (98.6 °F).

Dip and sip

Try dipping the bottle teat into some expressed milk before offering it, so it tastes and smells of your breast milk. Then gently stimulate your baby’s top lip with the teat to encourage her to open her mouth.

Positioning for bottle-feeding 

Feed your baby on demand and cuddle her in a semi-upright position. Never bottle-feed her while she’s lying flat or prop her up with the bottle, in case of choking. Go at her pace, with as many pauses as she needs – you can even try switching sides during the feed.

Be patient

Don’t worry if she doesn’t take to the bottle straight away – it may take several tries. If she pushes the bottle away or becomes upset, comfort her and wait a few minutes before trying again. If she still won’t drink from the bottle, wait a few more minutes and then breastfeed her as normal. Try again with the bottle at a different time of day.

How much expressed milk should I give my baby?

Every baby is different. Research shows that in babies aged one to six months, one baby may take as little as 50 ml during a feed while another may take as much as 230 ml. Start by preparing a bottle with around 60 ml, and see if your baby needs more or less. You’ll soon learn how much she typically takes – but don’t ever pressure her to finish the bottle. 

How can I ensure bottle-feeding is safe for my baby? 

Always clean and sanitise your breast pump set and bottles according to the instructions, and wash your hands before pumping, handling milk or feeding your baby. Follow our guidelines for storing and thawing your expressed milk safely.

If warming your breast milk, place the milk bottle or bag into a bowl of warm water or a warmer, or run it under a warm tap (max ­37 °C or 98.6 °F). Never warm breast milk in the microwave or on the stove top.

Will my baby cope with switching from breast to bottle?

Mums sometimes worry that if they introduce a bottle too soon, their baby will get accustomed to the artificial teat and struggle to return to breastfeeding. Others are concerned about the opposite problem – if they don’t get their baby used to a bottle early she may never accept one later. Both of these problems are commonly referred to as ‘nipple confusion’.

Experts disagree on whether nipple confusion is really an issue.¹ Certainly sucking from a conventional bottle teat that doesn’t require a vacuum to be created is less effort for a baby than sucking from mum’s nipple, as the milk flows more freely and gravity lends a hand. And some babies do seem to have a preference for breast or bottle, and never take to the other. But many babies switch happily between the two. 

If you’re still struggling to feed your baby expressed breast milk, speak to a lactation consultant or breastfeeding specialist.

The post Feeding your baby expressed milk: Your questions answered appeared first on Medela South Africa.

But being away from your baby doesn’t mean he has to stop having your breast milk. With the right information and equipment, you can express on the go to maintain your milk supply, store breast milk while travelling, and transport milk home for your baby.

Planning for travelling and pumping

If you’re travelling by rail or road, consider whether you can express on the move or need to plan stops. Train carriages often have electrical sockets but no private space, and roadway services may have a private room but not always sockets. Many electric breast pumps can also be battery-operated – just make sure you carry enough batteries! Some pumps have a built-in rechargeable battery, which makes them even easier to transport, as you can simply plug in to charge when required.

“I used to travel regularly for work, so I expressed milk in many different places,” says Karen, mum of one, Netherlands. “I always informed the organisation I was visiting in advance, telling them that I needed a few breaks per day, and a private place to sit. I had a good breast pump with a battery, so I could express anywhere.”

“When my girls were babies I worked largely from home but often had to travel by train to meetings several hours away,” remembers Hazel, mum of two, UK. “At home I used a Medela Swing Maxi double electric pump after breastfeeding, to build up a supply of expressed milk so my partner could do the feeds when I wasn’t there.”

Yolande, mum of three, Kenya, says: “I attended a three-day conference overseas, away from my breastfed nine-month-old. I confirmed with the hotel beforehand that I would have a fridge in my room and identified where in town I could get dry ice. I pumped throughout the conference, put each milk bag in a portable cooler, and transferred them to my hotel fridge each evening.”

Air travel with a breast pump 

If you’re flying, contact your airline in advance to let them know you’ll be travelling with a breast pump and/or expressed milk and ask about any rules for carrying these in your cabin bag or checked luggage – the rules for frozen milk may be different to those for liquid.

Airline staff may also be able to advise you where you can express in the airport and on the plane.

“On the morning of my flight, I packed my milk bags into a cooler with dry ice,” says Yolande, mum of three, Kenya. “At the airport I showed the check-in agent the airline’s instructions on flying with frozen breast milk. The milk travelled from New Orleans to Nairobi, via Atlanta and Amsterdam, and by the time I got home almost 30 hours later, it was still perfectly frozen.”

Essentials for expressing on the go

Having the right kit is vital for successful pumping, particularly if you’re doing it for extended periods.

A double electric breast pump enables you to express simultaneously from both breasts, saving valuable time as well as yielding 18% more milk on average than pumping from each breast in turn.¹ Or you may prefer to use a single electric breast pump, a manual pump, or even express by hand.

You’ll also need to contain your milk – either in a plastic bottle or breast milk storage bag – and somewhere to keep it frozen or cold, such as a cooler bag. It’s also useful to pack a travel-sized hand sanitiser gel and a plug adaptor if travelling abroad.

“I expressed everywhere I went – in the car, on planes, in public toilets, you name it,” says Aisling, mum of one, Ireland. “I always had a stock of storage bags and an electric pump, a portable charging battery pack and a manual pump for emergencies.”

Pumping when you’re staying away from home

If you need to stay away from home, contact your accommodation in advance to book a room with a fridge or ice box, or ask to use the hotel fridge or freezer for storing milk. Pack plenty of breast milk freezer storage bags as well as a breast pump and cooler bag. Transport frozen milk home using ice packs, but if the milk thaws during the journey make sure you use it within 24 hours. Some mums even courier their milk home in dry ice, as discussed above.

Storing breast milk while travelling

Sometimes travelling mums express simply to relieve engorged breasts or keep up their milk supply. But if you want to save the milk for feeding to your baby, then you need to make sure it remains safe to drink. Store your milk in sanitised plastic bottles or breast milk storage bags and label it with the pumping date so you know how long it’s safe to use.

“While away, I used a Medela Harmony manual breast pump so I could express on the train, at the office, in restaurants, or wherever, without needing an electrical socket or batteries,” says Hazel, mum of two, UK. “Mostly I pumped just to maintain my supply and ease discomfort, but sometimes I would take a freezer pack and storage bags with me to bring the milk home.”

During the day, keep your milk in a fridge or freezer before transferring it to a cooler bag. If you’re using a shared fridge label your container clearly so no one puts your carefully collected milk in their coffee!

Transporting your breast milk

Take expressed milk home or to a childcare setting in bottles or bags, inside a cooler bag with a freezer pack. If your ice packs are defrosting then ask for a bag of crushed ice from a fast food outlet or cafe. Bear in mind that breast milk is safe at room temperature for up to four hours. In the fridge it can be kept for three days and in the freezer for up to six months.^2,3

“Work were very supportive and flexible with my need to express,” says Karen, mum of one, UK. “I travel a lot in my job, and wherever I was I would just ask to use a room and store milk in their fridge. I even did this at conferences and events. I only once left a bag of breast milk in a conference centre’s fridge!”

The post Travel with your breast pump: Expressing on the go appeared first on Medela South Africa.

Here are our ten top tips for pumping at work.

1: Know your rights

In many countries you are legally entitled to express breast milk for your baby at work and your employer should allow time for regular breast pumping.

2: Be prepared

Make sure you have everything you need to pump, collect, store and transport your breast milk. The most obvious thing is a breast pump (a double electric breast pump is quickest and gives the best milk yield).¹ You may want to get a second breast pump for work so you don’t have to take one back and forth each day. Other useful equipment includes:

• collection bottles or milk storage bags  
• a cooler bag for transporting your milk
• microwave sanitising bags 
• nursing pads and a spare top in case of milk leakage
• clothes that allow easy access to your breasts  

3: Talk to colleagues

You’re not obliged to tell colleagues you’re pumping, but letting them know may help with understanding and acceptance. You could seek out a colleague who’s also expressing to be your ‘pumping buddy’ and give one another mutual support.

4: Find a space

Your employer should offer a private room (not a toilet) for you to pump in. This might be a medical or interview room, or anywhere you can express comfortably without being disturbed.

5: Think about storage

Have somewhere safe and cool for storing breast milk. If it’s a shared fridge, clearly label your milk in breast milk storage bags or bottles.

6: Keep things cool

Milk you express one day can be given to your baby the next, so there’s normally no need to freeze it. When kept chilled in the fridge (and in a cooler bag when transported between work and home), breast milk remains safe for your baby to drink for three days – or up to five in very clean conditions^2,3 – read our article on breast milk storage for more guidance.

7: Time it right

Pump milk whenever your baby would usually breastfeed. This will help you collect enough for his feeds and maintain your breast milk supply.

8: Practice makes perfect

Arrange a practice day so you can do a trial run of pumping at work. Or make your first day back a Friday, so you can get the hang of expressing and transporting your milk before tackling a whole working week.

9: Take a break

If your baby is cared for close to where you work, then breastfeeding breaks – where you breastfeed your baby in his childcare setting – might be a good alternative to pumping.

10: Look after yourself

Combining work with parenting and breastfeeding is tiring – especially while you’re getting used to it, or if your baby still wakes at night. Take it one day at a time, look after yourself, and rest assured things should become easier as your baby gets older and you both become accustomed to this big change.

Pumping at work: Mums’ stories 

These mums all had different experiences pumping at work, but found a way of fitting it into their daily routine.

“I always had a cooler bag with me”

“I raised the issue of pumping with my line manager three months before returning to work. He ordered a blind to be installed on my lockable office door for privacy.

“I hand-expressed into a breast milk bottle in my office and kept the milk inside a labelled cooler bag in the kitchen fridge. When I was out of the building I would nip somewhere private. I always had a bottle and cooler bag with me.

“If I couldn’t express enough milk during work hours I topped it up by pumping when I got home. Then there was always plenty for my son to have at nursery the next day.” Lily, mum of two, UK.

“My company was very supportive”

“Pumping at work wasn’t difficult as my company offered good facilities and was very supportive. They gave me all the time I needed.

“Logistics-wise it required preparation to have clean equipment every day and I always had to carry my breast pump. Nowadays my company has its own multi-user breast pump in the nursery room and gives a free pumping kit to each new mum, so there’s no need to bring in equipment.

“Be prepared. Take it with humour if possible and try to relax and enjoy the moment.” Aleyda, mum of one, Netherlands.

“It was difficult to find a room to express in”

“There were certainly challenges for me to overcome when pumping at work, including the inadequacy of the available space and the awkwardness of communicating with HR staff or male managers who didn’t always understand my needs.

“With my first baby, I was at a big firm that arranged a room for me to express in. But I found it hard to take breaks and pump enough milk to keep up with what my baby needed. I wanted to keep using my laptop while expressing so my work didn’t pile up, but the room didn’t have a suitable table for this. I only lasted two weeks before having to supplement with formula.

“With baby number two, I was determined to persevere. My workplace was much smaller – a sports venue – so it was difficult to find an appropriate room. At first, I was given the first aid room, but it was really cold and anyone could walk in. Eventually they found a better room but sometimes the key would go missing!

To other mums I’d say: know your rights and use them! Be confident your employer wants to have you at work – any issues are often down to disorganisation and lack of knowledge, rather than hostility. It can be tough, but it’s worth it. I also recommend Medela pumps.” Elisabeth, mum of two, UK.

“I can work and pump at the same time”

“As well as my breast pump, I needed a hands-free pumping bra, nursing pads for leaks and easy-access clothes to save time. I can work and pump simultaneously but lots of friends can’t and have to relax while they express.

“My workplace has several ‘moms’ rooms’ for expressing ­– I have to book slots. I move around a lot, so I have to book rooms in different buildings and around key meetings.

“The biggest challenges are conferences or events when people don’t send an agenda so I don’t know when I can sneak out. And when things over-run I just have to leave!” Natalie, mum of one, US.

“No one begrudged my pumping breaks”

“In the first few months, I would breastfeed my son at home in the morning and be at work at 10:00; pump once or twice at work; pick him up from creche around 17:30, breastfeed him there; take him home, freeze the pumped milk, and breastfeed him again before bed.

“You need to make your pumping plan clear to your employer and colleagues early on so they can respect that. No one begrudged my pumping breaks – in fact quite the opposite. It helped that there were other parents in my department, including two new mums who also pumped. It makes a huge difference having people around you who you can share experiences with.” Jess, mum of one, Argentina.

The post Pumping at work: Tips and mums’ advice appeared first on Medela South Africa.

If you’re breastfeeding and want to continue, you also need to think about how you’ll maintain your milk supply and ensure your baby can continue to have your breast milk when you’re not around. This often means expressing breast milk at work and storing and transporting it safely, so that your caregiver can feed it to your child.

What are the benefits of continuing breastfeeding when back at work?

Returning to work can be a wrench when you’ve spent many weeks or months one-to-one with your new baby. Continuing to breastfeed is one way to sustain the important bond between you and ease you both into a new routine.

Breastfeeding can also be a lovely way to reconnect when you spend more time apart, as Peggy, mum of one, Switzerland, found: “I returned to work when Penelope was six months old. By then, I was still breastfeeding her just before leaving for the office and when coming home. That remained our special time together.”

Bear in mind, too, that your baby can still enjoy all the health-giving and protective properties of breast milk if you return to work. There are many components in your breast milk that fight infections and help your little one recover faster if she becomes ill. Studies even show that breastfeeding mums take less time off work than those who don’t breastfeed, because their babies are ill less frequently.¹

When should I return to work?

Some mums don’t have much choice over when to go back. It might be determined by your employer, maternity laws in your country, or financial need. If you’re fortunate enough to have flexibility, weigh up the pros (such as income, career progression, mental stimulation or social contact) and the cons (being apart from your baby, childcare costs or complicated logistics) and speak to friends and colleagues about their experiences before deciding.

Bear in mind that breastfeeding and expressing while at work, and caring for a baby or toddler too, can be physically and emotionally draining. However, some mums also find that pumping provides welcome respite during a busy working day.

“Coming back to work and focusing on my job for eight hours was hard, so I kind of enjoyed the breaks for pumping,” says Monika, mum of three, Switzerland. “It was time for myself when I could sit down, close my eyes and relax.”

What about childcare?

Choose a childcare provider who’s happy to give your baby your expressed breast milk and/or welcomes you breastfeeding when you drop off and collect your baby. Discuss this before you sign up, and explain your needs clearly.

Ask how they’ll store your breast milk, and make sure you supply enough sanitised bottles and teats. Also discuss how your baby likes to have her milk – warm or cold, while being held, or feeding independently under supervision (if aged six months plus) – so she’s more likely to accept it.

If you’re lucky enough to have family members on childcare duty, leave them with plenty of milk and instructions. Gimena, mum of two, Argentina, found it took her daughter a little while to get used to a new way of feeding: “I returned to work four hours a day when my daughter was nine months old,” she says. “I would get up early to pump and then leave my husband with a bottle of expressed milk. In the beginning she wouldn’t take the bottle but we kept offering and eventually she did.”

What should I ask my employer?

Get in touch with your employer as soon as you know you intend to return to work, even if the date is months away. You’ll want to discuss your working hours and how they can support your continued breastfeeding. You may want to return part-time or consider a job share, or do ‘compressed’ hours so you work longer days but fewer of them.

“I had six months’ maternity leave, and afterwards it felt OK to start working again. I now work part-time, 60% of the week, and that’s perfect for me,” says Andrea, mum of two, Switzerland.

If you work for a large organisation, contact your human resources department to discuss their breastfeeding policy. If no staff members have expressed milk before, be a trailblazer and become the first.

If you intend to express milk at work, give your employer plenty of notice. In many countries employers are legally obliged to provide a private space where mums can pump, regular breaks for expressing, and somewhere to store breast milk safely. Find out if your country has employment guidance for breastfeeding mothers and read up on it.

“My advice is to have a plan prior to returning to work,” says Shalena, mum of two, Canada. “Determine your needs – how often you need to pump, how long for, and where. Explaining that your needs will change as your baby grows is also important. Make sure you know your rights and responsibilities, and be confident setting out your plans.”

An alternative to pumping at work is to organise childcare close to your workplace so you can take breaks to breastfeed your baby at her usual feeding times.  

How should I prepare for my return to work?

If you’re breastfeeding, practise pumping and giving your baby milk from a bottle or cup a few weeks in advance, to get both of you used to feeding this way.

You also need to work out the best expressing choice for you. This might be an electric breast pump, a manual one, or even expressing by hand. The efficiency, cost, portability and quietness of the pump may all influence your choice. 

Encourage family and friends to bottle-feed your baby expressed breast milk so she gets used to being fed by other people. Your baby may be more willing to take your milk from someone else if you aren’t in the room.

“We introduced a bottle of expressed milk quite early on, months before I returned to work, so I was confident it wouldn’t be an issue when I went back,” explains Lily, mum of two, UK. “We tried a variety of bottles and teats before we found one my son would take.”

Having carefully planned your return, it’s time to think about the logistics of expressing at work – check out our articles on pumping at work, storing and transporting your breast milk safely, and pumping while away from home.

The post Going back to work as a breastfeeding mum appeared first on Medela South Africa.

How long should I breastfeed for?

The World Health Organization (WHO) recommends breastfeeding for two years and beyond – and this applies to families around the world, not just in developing countries.¹

“It’s important to note the WHO doesn’t set a maximum breastfeeding duration,”² says Dr Leon Mitoulas, Medela’s Head of Breastfeeding Research. “From an anthropological perspective, breastfeeding for between two-and-a-half and seven years would be optimal.³ However, cultural norms today generally entail weaning at a much younger age.”

The WHO’s recommendations are supported by a recent surge in research into the first 1,000 days of a child’s life – from conception to the second birthday.⁴ Dr Mitoulas explains: “Scientists have discovered the right nutrition, and other factors, have the most profound impact on growth and long-term health during this time. Evidence unequivocally demonstrates that breastfeeding is uniquely beneficial during that crucial 1,000-day window.

“Breastfeeding can be considered a food, a medicine and a signal all at the same time,”⁵ he adds. “And these trifold benefits certainly continue beyond two years.”

Food: Nutritional benefits of extended breastfeeding 

Once your baby starts eating solids at around six months, you might think your breast milk becomes just a ‘drink’ that complements them. In fact, the opposite is true – your baby will only get a tiny proportion of his calories and nutrients from food when he first starts solids.

“The undisputed best start for babies is exclusive breastfeeding for the first six months. But even after your baby starts eating complementary foods, breast milk provides significant nutrition,” says Dr Mitoulas.

When exclusively breastfeeding, a baby typically consumes 750 to 800 ml (26.4 to 28 fl oz) of milk each day. At nine to 12 months old, he could still take around 500 ml (17.6 fl oz) a day, which provides about half his daily calories. By 18 months, he’ll probably have about 200 ml (7 fl oz) a day, which is about 29% of his calories.⁶

It’s true that after six months your baby needs other foods for nutrients that he may not get from your breast milk or his own reserves, including iron, zinc and vitamins B and D.^1,7 But even in his second year of life, breast milk provides significant amounts of other key nutrients, as Dr Mitoulas explains:

“At this stage, breast milk provides about 43% of a baby’s protein, 60% of his vitamin C, 75% of his vitamin A, 76% of his folate, and 94% of his vitamin B12.”⁸

Medicine: Health benefits of breastfeeding after six months

Whilst the message to promote exclusive breastfeeding for six months is well known, there is not much information on the role of breastfeeding and human milk beyond six months, once complementary foods have been introduced to an infant’s diet. This is despite organisations such as the WHO recommending the provision of human milk beyond six months.¹

Continuing to breastfeed after six months has been shown to lower the chances of some childhood and adult illnesses and, if your baby does get ill, helps him recover more quickly.

Breastfeeding protects your baby from infection and illness, so much so that it’s even considered a form of ‘personalised medicine’, with potential lifelong effects,” says Dr Mitoulas.

For example, breastfeeding for longer than six months has been shown to protect your baby against certain childhood cancers, such as acute lymphocytic leukaemia and Hodgkin’s lymphoma.9 Breastfeeding might also lessen his chances of developing type 2 diabetes,¹⁰ although this effect is confounded, or attenuated by factors such as smoking, gestational weight gain, preterm birth and other factors. There are also benefits for your baby in terms of sight ¹¹ , dental problems,¹² and obesity.”¹³

Your breast milk can also reduce your baby’s risk of diarrhoea and sickness,¹⁴gastroenteritis, colds and flu, thrush and ear, throat and lung infections.⁹,¹⁵This is especially helpful as he gets older and starts interacting with other children or going into childcare, where germs can be rife.

Breastfeeding can also be a lifesaver, as Dr Mitoulas points out: “The consequences of not breastfeeding between six and 23 months can be dire in low- and middle-income countries, where babies who aren’t breastfed are twice as likely to die from infection as babies who are breastfed, even partly.”¹⁶ And breastfeeding is not just about the benefits of your milk, it’s also wonderful for nurturing and calming your baby. Nothing soothes an upset infant or toddler like a nursing session with mum. As your baby grows, a feed helps with everything from teething and vaccinations to the inevitable knocks and scrapes or viruses that occur along the way. For many mums, breastfeeding can feel like a miracle worker.

Signal: Enhanced benefits

The act of being close to your baby, instantly responding to his needs and engaging in lots of eye contact also sends signals between you. Scientists think these could affect many aspects of your child’s development, from appetite to academic performance. The longer you breastfeed, the stronger the positive outcome is likely to be.

Breast milk contains thousands of active molecules,” Dr Mitoulas explains. “These range from enzymes that help digest fats¹⁷ and hormones that regulate appetite,¹⁸ to immune molecules that promote immune system development.¹⁹

Did you know that breast milk is actually alive? Every day your baby drinks millions to billions of living cells²⁰ – there are thousands of them in each millilitre of your milk, including stem cells,”²¹ he continues. “Each one of these cells has a specific job in terms of keeping your baby healthy, and research is ongoing to discover exactly how these components benefit an infant during long-term breastfeeding.”

One thing that’s already known is that extended breastfeeding has a positive impact on a child’s IQ. Studies show a consistent three-point IQ advantage for children who were breastfed over those who were never breastfed.²²

Breastfeeding beyond six months has even been linked to fewer behavioural problems in school-age children²³ and improved mental health in children and adolescents.²⁴

Shouldn’t I switch to follow-on formula after six months?

The health claims on the packaging may look impressive, but there is no better milk for your baby than your own.

No formula milk contains all the antibodies, live cells, growth factors, hormones or helpful bacteria, nor the array of enzymes, amino acids and micronutrients found in breast milk.²⁵ Your milk adjusts to provide your baby with more infection-fighting antibodies and white blood cells when he’s ill²⁶ – something formula simply can’t do. Read Breast milk vs formula: How similar are they? for more information.

Breastfeeding after six months: Benefits for mums

Extended breastfeeding isn’t just brilliant for your baby – it’s also great for you. By continuing breastfeeding beyond six months, you lower your lifelong risk of developing heart disease,²⁷ type 2 diabetes²⁸ and cancers of the breast,²⁹ ovaries³⁰ and uterus.”³¹ And breastfeeding mums often find their periods don’t return for many months – and possibly for as long as two years.³²

“The desire to get back to their pre-pregnancy body weight is a significant one for many mums,” says Dr Mitoulas. “One study showed that a mother’s body mass index (BMI) is 1% lower for every six months of breastfeeding.”²⁴

Not to mention that after six months, breastfeeding is very convenient. Your breasts produce the right amount of milk when they need to and you don’t have to clean equipment or take anything with you when going out. You may also find you’re increasingly only feeding at times that fit your routine, such as before work, after childcare pick-up, and at bedtime. And even if you’re back at work, you can use a breast pump to express milk for your baby so he can continue enjoying the advantages.

With so many potential benefits, it’s perhaps not surprising a growing number of mums are choosing to practise ‘natural-term’ or ‘full-term’ breastfeedingand letting their child decide the right time to stop.

The post Breastfeeding beyond 6 months: What are the benefits? appeared first on Medela South Africa.