Chapter 4: Feeding, Day and Night

From the Diary

Week 1 at home. I thought feeding would be the one thing that came naturally, and it is the thing I think about most. Our daughter wants to feed all the time, day and night, and every time she latches on I hold my breath because it hurts. The midwife came this morning and watched a whole feed without saying much at first. Then she gently brought the baby closer, with her chin against my breast and her nose free, and the pain changed from sharp to something I could manage. She also showed me a way to hold our daughter along my side, under my arm, so that nothing presses on my wound. I cried a little after the midwife left, but it was the good kind of crying.

Week 2. A feeding helper came to see us today, because the midwife thought another pair of eyes could help. The feeding helper asked me how I was, not only how the baby was, and that almost made me cry again. She said that many mothers find the first weeks hard, and that it often gets easier as the mother and the baby learn together. My husband sat beside us with a notebook and wrote down everything she said, and he has kept writing ever since: wet nappies, dirty nappies, which side, how long. In the middle of the night he whispered the latest results to me like a sports reporter, and I laughed so much that our daughter stopped feeding to look at me.

Week 3. My husband is back at work, and we decided together that he will give one bottle of infant formula in the night so that I can sleep a few hours in a row. The idea was mine. But when I heard him in the kitchen making the bottle, carefully, exactly as the instructions on the tin say, I lay in bed and felt guilty. I had told myself so many times that I would only breastfeed. My mother called the next day and said, "A fed baby and a mother who has slept a little. I do not see the problem." My husband's parents phoned too, with three different pieces of advice that did not agree with each other. I wrote down my mother's sentence and stuck it on the fridge.

Week 4, a quiet night. Tonight I woke on my own, before anyone needed me, and lay listening to my husband feeding our daughter in the next room. He was talking to her in a low voice about nothing at all, about the rain and his train and how she has his ears. The guilt has become smaller this week. I still breastfeed most of the day, the soreness is almost gone, and our daughter is gaining weight, which the nurse told us with a smile at the check-up. At two in the morning my friend from the parents' class sent a message: "Are you awake too?" I was, but for once it was only because I wanted to be.

Breast Milk, Infant Formula or Both

Babies can be fed with breast milk, with infant formula, or with a mix of the two, and each of these is a real and caring way to feed a child. Some parents know before the birth what they want to do. Others decide along the way, as the parents in the diary did, when they see how feeding goes for their baby and for their family. Breast milk is made by the mother's body and changes as the baby grows. Infant formula is a milk made especially for babies, so that a baby who does not have breast milk, or not only breast milk, still gets what the baby needs to grow. Whatever you choose, your baby needs to be fed when hungry, held and kept close, and you can give all of that with a breast or with a bottle.

Breastfeeding is a skill that the mother and the baby learn together, and the first days are often the hardest. In the first days the breasts make a small amount of thick, early milk, and over the following days the milk usually becomes more plentiful. The way the baby takes the breast into the mouth, called the latch, makes a big difference. A wide-open mouth that takes in a good part of the breast, not only the nipple, is usually more comfortable for the mother and helps the baby feed well. Some tenderness at the start is common. Pain that stays through the whole feed, nipples that crack or bleed, or feeds that go on and on without the baby settling are good reasons to ask a midwife, a nurse or a feeding helper to watch a feed, as the midwife in the diary did. Small changes in position often help a great deal.

A few signs in the breasts are worth knowing about. When the milk comes in, the breasts can feel very full, hard and uncomfortable for a while, and the midwife or feeding helper can show you gentle ways to ease this. A hard, red, painful area on one breast, especially if you also feel feverish or unwell, as you might with a flu, is a reason to contact your doctor or midwife soon rather than waiting for the next visit. These things happen to many breastfeeding mothers and they can be helped. They are not a sign that you are doing something wrong.

Infant formula needs care in a different way. Prepare it exactly as the instructions on the package say and as your midwife, nurse or doctor explains, with the right amount of water and the right amount of powder, never a little extra of either, because the balance matters for the baby's health. Wash your hands first. Clean the bottles, the teats (the part the baby sucks) and the other equipment in the way you have been shown, because a young baby is more easily made ill by germs than an older child. Ready-made liquid formula, where it is used, has its own instructions to follow too. Milk left in the bottle after a feed is thrown away, not saved for later. If you warm a bottle, check the temperature by letting a few drops fall on the inside of your wrist, and avoid warming it in a microwave, which can leave very hot spots in the milk.

Some families give both breast milk and formula, and some give expressed breast milk in a bottle. Expressing means taking milk from the breast, by hand or with a breast pump, so that someone else can feed it to the baby later. A mix can make feeding work in many situations: a mother who needs a longer sleep, a mother who will go back to work later in the year, a baby who needs a little more milk. If you want to keep breastfeeding while also giving some bottles, a midwife or feeding helper can explain how to do that in a way that suits your body and your baby. If you want to move to formula only, they can help with that too. The right choice is the one that keeps your baby fed and your family well.

Feeding Cues and How Often

Babies show that they are hungry long before they cry. These early signs are called feeding cues. A hungry baby may stir and wake, turn the head from side to side as if searching, open the mouth, make small sucking movements or smacking sounds, and bring the hands to the mouth. Crying is usually a late sign of hunger, and a baby who is already crying hard may need to be calmed a little before a feed can start. Learning your baby's cues takes time, and in the first weeks it can feel like guessing. Watching for the small signs, and offering a feed when you see them, often makes feeds calmer for both of you.

A newborn feeds often, day and night. A newborn's stomach is small and milk is digested quickly, so frequent feeds are normal and are not a sign that something is wrong with the milk or with you. Some feeds are long and some are short. Many babies have times of the day, often in the evening, when they want to feed again and again within a short time, which is sometimes called cluster feeding. It can be tiring, and it can make a parent worry that there is not enough milk, but it is a common pattern. Your midwife or nurse can tell you how often a baby of your baby's age usually feeds, and whether your baby needs to be woken for feeds in the first days.

Feeding in the night is part of the first months for almost every family. It helps to keep night feeds calm and quiet, with a dim light, few words and a nappy change only if one is needed. Over time this helps your baby begin to learn that night is different from day. If you feed your baby in bed or in a chair at night, think ahead about what would happen if you fell asleep during the feed, because that is very easy to do when you are tired. Chapter 8 explains safe sleep, including why falling asleep with a baby on a sofa or in an armchair must be avoided, and how to plan the night so that your baby stays safe.

Babies often swallow some air while they feed, especially from a bottle, and burping can help them feel more comfortable. You can hold your baby upright against your shoulder, or sit your baby on your lap with one hand supporting the chest and chin, and gently rub or pat the back. Some babies burp easily and some hardly at all, and both are normal. It is also common for a baby to bring up a little milk during or after a feed, so a cloth over your shoulder can save a lot of washing. If your baby often brings up large amounts, seems to be in pain during feeds or is not gaining weight, mention it to your doctor or nurse.

Bottle feeding has its own rhythm. Hold your baby fairly upright and close to you, and let your baby take the teat into the mouth rather than pushing it in. Keep the bottle tipped just enough for the milk to fill the teat, and allow small pauses, so that your baby can show you when the baby has had enough by turning away, slowing down or letting the teat slip out. Never leave a baby alone with a bottle propped up on a pillow or a rolled cloth, because the baby could choke and cannot push the bottle away. A bottle feed is also a time to be close. Eye contact, a warm body and a quiet voice belong to every way of feeding.

Signs That Feeding Is Going Well

Many new parents worry most about one question: is my baby getting enough? With a bottle you can see the milk go down, but with breastfeeding you cannot, and that uncertainty is hard to live with. The midwife or nurse who follows your baby looks at a few simple signs together, and you can learn to watch them too. No single feed tells you very much. What matters is the pattern over a whole day and over the weeks, and that pattern is something you and the health worker can look at side by side.

Nappies are one of the clearest signs. A baby who is getting enough milk has wet nappies regularly through the day and night, and dirty nappies too. In the first days the stools change from dark and sticky to lighter and softer, as Chapter 1 describes, and that change is itself a good sign that milk is going in. The number of wet and dirty nappies to expect changes with age, so ask your midwife or nurse what to look for at your baby's age. Writing it down for the first weeks, as the husband in the diary did, can be a real help when day and night begin to feel the same and you cannot remember what happened at the last feed.

Weight is the other sign that health workers follow. It is common for a newborn's weight to drop a little in the first days and then rise again, and the midwife or nurse weighs your baby at visits or check-ups to see that the weight is moving in the right direction over time. One weighing shows only one moment; the line over several weeks tells the real story. Between weighings, a baby who is feeding well usually seems content after many feeds, has times of being awake and alert, and seems well in the ways the midwife has shown you. A mother who is breastfeeding may also notice that her breasts feel softer after a feed.

Some signs are reasons to contact a doctor straight away rather than waiting for the next visit. These include a baby who stops feeding or is too sleepy to feed, a baby who has far fewer wet nappies than before, a baby who seems very floppy or is hard to wake, a yellow colour of the skin or of the whites of the eyes that is getting deeper, a fever (ask your doctor or midwife which temperature they want you to call about), or a baby who seems unwell in a way you cannot explain. You do not need to be sure that something is wrong before you call. Health workers would much rather hear from a worried parent than have that parent wait at home. Trust your feeling that something is not right.

It also helps to know what is ordinary and needs no worry. Babies have growth spurts, days when they suddenly want to feed more than usual, and these pass. Babies feed for comfort as well as for food. Some babies are quick feeders and some take their time. A baby who brings up a little milk, hiccups after a feed, or falls asleep at the breast or the bottle is usually doing something very ordinary. When you are unsure, the midwife, the nurse or the feeding helper is there to answer exactly these questions, however small they may seem to you.

The Feelings Around Feeding

Feeding a baby is not only about milk. For many parents it carries strong feelings: pride when a feed goes well, worry when it does not, pain, tiredness and, very often, guilt. Some mothers feel that breastfeeding is a test of being a good mother, and they feel that they have failed if it is hard or if they choose formula. Some feel pressure from family, from friends or from things they have read or seen. Like the mother in the diary, many parents find that the guilt is loudest in the first weeks and becomes quieter once they see their baby growing well. Feeding your baby, in whatever way works for your family, is good parenting.

Pain and difficulty with breastfeeding can affect a mother's mood a great deal. When every feed hurts, or when feeds take up most of the day, it is natural to feel low and tense, or even to dread the next feed. These feelings are not a weakness. They are a sign that you need support, and support exists: the midwife, the nurse, a feeding helper and, in many places, groups where parents feed their babies together and share what helps. In the first days after the birth the baby blues can make all of this feel heavier, as Chapter 3 explains. If feeding worries fill your days and your mood stays low most days, for more than a couple of weeks, tell your doctor, midwife or nurse; Chapter 6 explains why this matters.

Some mothers cannot breastfeed, or decide not to, for many different reasons: their health, medicines they need, past experiences, work, the needs of another child, or simply what feels right for them. That is their decision, and it deserves respect from everyone around them. Some mothers stop breastfeeding sooner than they had planned and feel sad about it, and that sadness also deserves room. It can help to talk about it with someone kind who does not judge. It can also help to remember that the closeness between a parent and a baby is built in many small moments every day, in holding, talking, bathing and comforting, and not only during feeds.

The other parent has an important part in feeding, whatever kind of feeding the family uses. With breastfeeding, the other parent can bring the baby to the mother, help her find a comfortable position, bring a glass of water and something to eat, change the nappy before or after the feed, burp the baby and settle the baby back to sleep. With formula or expressed milk, the other parent can take whole feeds, as the husband in the diary did, so that the mother can sleep for a longer stretch. Being part of feeding often helps the other parent feel close to the baby, and less like a helper standing outside. Chapter 9 says more about the other parent's own feelings.

Nights are easier when they are planned in the daytime, not decided in the dark when everyone is tired. Some families share the night in turns. Some agree that one parent takes one feed so that the other can sleep. Some ask a family member to stay for a few nights. If you are raising your baby alone, think about who could come for an afternoon so that you can sleep, and who you could call in the night if you need to hear a kind voice. A plan that is talked through, and changed when it stops working, protects everyone's rest and patience. Chapter 8 looks more closely at sleep for babies and for parents.

A Checklist of Things to Prepare

A feeding corner: a comfortable place to sit, a pillow to support your arm or your baby, a glass of water and a small snack within reach. Feeds can take a long time in the first weeks, and comfort makes a difference.

The names and numbers of the people who help with feeding: your midwife, your nurse, a feeding helper and any parents' group near you. Keep them where you can find them quickly when a feed is not going well.

A simple notebook for the first weeks, for feeds, wet nappies and dirty nappies. It helps you answer the questions at visits and check-ups, and it helps tired minds remember.

Your questions for the next visit or check-up, written down as they come: how many nappies to expect at this age, whether the weight is going well, whether the latch looks right. Small questions are welcome.

If you use bottles, enough bottles and teats, a way to clean them as you have been shown, and the formula instructions kept with the formula. Read the instructions again when you are tired, rather than guessing.

A night plan agreed in the daytime: who does which feed, who changes the nappy, who sleeps when. Agree to look at the plan again after a week and change it if it is not working.

One kind sentence for hard moments, like the one the mother in the diary put on the fridge, reminding you that a fed baby and a rested parent matter more than doing everything one way.

The reasons to contact a doctor straight away, written down near the place where you feed: a baby who stops feeding or is too sleepy to feed, far fewer wet nappies, a baby who is very floppy, hard to wake or seems very unwell. Knowing them in advance makes it easier to act calmly.