The decision to breastfeed can mean better health for mum and baby. Breastfeeding is the natural, physiologic way of feeding infants and young children, however for some mums it may not appear to be very natural.

Long, difficult labours, tired infants, tired mums and the adjustment to being a mum for the first time can impact on the experience. As a mother, midwife and public health nurse, I am a promoter of breastfeeding, however I do realise that for some people it can be quite difficult in the beginning and new mums have told me how guilty they feel when it doesn't work out.

With correct information, good support and patience, most people can breastfeed successfully. I have met many mothers who found second time round a totally different experience.

Ante-natally

Women's experience of giving birth can affect the beginning of breastfeeding. You may like to consider filling in a birth plan with your midwife/obstetrician. A birth plan is a written plan where you consider how you wish to go through labour, putting baby to breast in the labour ward etc.

If we had all grown up watching women breastfeed we would not need to learn the skill, we would know how it works. In countries where breastfeeding is the norm, no one has to go to classes or read a book. As we did not see a lot of breastfeeding while growing up, it's an art we have to learn!

There are many support groups out there. Contact your local maternity hospital, health centre or GP for times and venues. Attending a group prior to giving birth can provide useful information and build your confidence.

The Health Promotion Unit have produced a wonderful DVD, Breastfeeding Perfectly Natural, which provides an introduction to the subject for expectant parents.

Attend ante-natal classes where breastfeeding will be discussed in great detail. Ensure you eat a healthy diet and get plenty of rest, especially during the last few weeks of pregnancy so as to arrive in hospital in optimum condition for labour and breastfeeding.

In hospital

The trick to breastfeeding is getting the baby to latch on well. Place the baby at the breast immediately after birth. Research has shown us that given the chance, many babies, only minutes old, will crawl up to the breast from the mother's abdomen, latch on and start feeding all by themselves.

This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Your midwife will help you to get started.

Keep your baby in the room with you. Mothers and babies learn how to sleep in the same rhythm. A baby shows, long before he starts crying, that he is ready to feed. His breathing may change or he may start stretching. His mum will awaken, her milk will start to flow and her baby will latch on easier.

It can be difficult to put the baby to the breast if he is frantically crying, then mum may get anxious which in turn may affect her let-down reflex.

Avoid using artificial nipples until breastfeeding is established. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Avoid supplementing your baby with water or formula until breastfeeding is established.

While in hospital get help from the midwives or lactation consultants in the hospital.

At home

It is important to get as much support as you can when you come home because it can seem that you are doing nothing but feeding. You will need help with your other child and household chores.

Your public health nurse will visit at home and give you support with breastfeeding. She/he will have information on support groups in your area. La Leche League and Cuidiu breastfeeding counsellors will also be happy to provide information.

A good friend or relative who has breastfed will be of great support to you when you go home. This is like a buddy system where you can depend on her to help you. Try and source this special person before you have your baby.

How it works

Your breasts produce milk in response to your baby feeding at your breast. The more your baby feeds, the more milk your body makes, provided that your baby is correctly positioned. If you reduce feeding you will make less milk.

The 'let-down' reflex

Your baby's sucking causes milk to gather behind the nipple, ready for feeding. This is called the 'let-down' reflex. Some mothers feel it as a tingling sensation. You will notice quick sucks changing to deep swallows once the milk has begun to flow.

Anxiety or tiredness can stop this reflex, so it is important to rest and relax as much as you can while breastfeeding.

Common difficulties

• Feeding restlessly -- Your baby is restless at the breast and doesn't seem satisfied by feeds. It may mean that he is sucking on the nipple alone and so not getting enough milk.

Ask for help in making sure baby feeds in the right position.

• Engorged breasts -- A few days after the birth your breasts may become very swollen and uncomfortable. The answer is to breastfeed. A good support bra will help too, but make sure it isn't too tight.
• Sore or cracked nipples -- If your nipples are sore when you are feeding, your baby's position may need adjusting.

In the first few days the nipples may feel tender when the baby latches initially; this subsides. If it doesn't you may need the midwife to look at your baby's position.

If you develop cracked nipples, expressing a few drops of your milk after the baby is finished nursing and rubbing it gently into your nipples should help.

Also, in my experience, Lansinoh is invaluable in promoting healing of sore nipples. This is available at your local pharmacy.

Your baby's Weight

It is normal for babies to loose weight in the first few days -- it can take up to 14 days to return to the birth weight. After this the normal rate of weight gain for a breast-fed baby is 125-250g per week for the first three months.

Useful Contacts

• lalecheleagueireland.com
• enquiry@cuidiu.com
• www.alcireland.ie
• www.hse.ie/breastfeeding
• Breastfeeding Perfectly Natural DVD available from www.healthpromotion.ie/breastfeeding