Infant Feeding Antenatal Information

When a baby is born, they will show certain patterns of behaviour. If placed in skin-to-skin contact with the mother and left undisturbed, they will start showing signs of looking for the breast. They will display a sequence of behaviours that begins immediately after birth and ends with them attaching to the breast and having their first feed.  

Getting breastfeeding off to the best start in this way can help your baby learn how to breastfeed, stimulate your milk supply, and help you and your baby bond and rest after birth. It provides your baby with nutrients, and positively influences their microbiome. A person’s microbiome describes the thousands of species of bacteria which exists peacefully in our body, mainly in our gut. Our microbiome is essential for our health and is influenced by how we are born and how we are fed as babies.

Interventions during labour and birth can have a “ripple” effect; one intervention may lead onto another and a straight forward labour can end up becoming an emergency situation.

As an example, a woman having a straight forward pregnancy could accept her labour being induced and as this can potentially lead to a long, tiring experience, she may happily accept pain relief during labour. She may decide to have an epidural which makes her comfortable, but causes her labour to slow and prevents her from adopting upright positions. Her baby moves into an unfavourable positon in her womb during labour and cannot move down in her pelvis to be born. Her baby then shows signs of becoming distressed as the baby's heart rate drops during a contraction; the doctor decides the safest action would be for the baby to be born by emergency caesarean section.

Pain relief such as the epidural, pethidine and diamorphine travels in your blood stream to your baby’s blood, and as a result can influence how your baby behaves after birth. Pain relief can cause your baby to be sleepy and potentially delay or take away the inborn breastfeeding reflexes baby possesses, and as a result they cannot display the behaviours needed to have their first feed.

An emergency situation such as an instrumental delivery or caesarean section, and a potentially negative birth experience, can impact upon how well you feel after birth. If you feel poorly, in pain and tired, you are less likely to feel able to breastfeed comfortably. You may decide to give formula feeds as you recover, but by not breastfeeding or expressing, your milk supply is delayed and reduced. Your baby becomes used to a bottle teat and struggles to learn how to breastfeed. Without good support, returning to breastfeeding can become very difficult.

A caesarean section can be a lifesaving procedure when performed in the right circumstances. It can, however, impact upon breastfeeding as the situation can potentially cause separation of mother and baby, and it can take longer for breastmilk to increase in volume. A baby’s microbiome is colonised by his mother through vaginal birth, skin to skin contact and breastfeeding; a baby born by caesarean section will not “seed” its microbiome the same way as a baby born by vaginal birth.

Mode of birth can be something out of our control, however antenatal education is essential to being informed about the birthing process, knowing your options and being able to make informed decisions about your own care.

Making a birth plan (or birth “preferences” list) can help inform those supporting you about what you want and assist them in providing that for you.

Aspects of your birth plan such as undisturbed skin-to-skin contact with your baby after birth can help breastfeeding get off to good start, no matter what mode of delivery. Ask your midwife to delay routine procedures like weighing baby, and giving vitamin K until your baby has had his first feed in skin-to-skin contact with you. Keep your baby close to you and respond to him when he is showing feeding cues or just wanting a cuddle! Feeding frequently can stimulate your supply, and lots of rest can speed up your recovery.     

Babies are born instinctively expecting to be placed on to their mum’s chest. This close contact is known as skin to skin, and both mum and both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and to help boost a mother’s milk supply.

Skin-to-skin contact is also vital in neonatal units, where it is often known as ‘kangaroo care’, helping parents to bond with their baby, as well as supporting better physical and developmental outcomes for the baby.

There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers in many ways.

• Calms and relaxes both mother and baby
• Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
• Stimulates digestion and an interest in feeding
• Regulates temperature
• Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection – see more about this in the microbiome section
• Stimulates the release of hormones to support breastfeeding and mothering.

Additional benefits for babies in the neonatal unit:

• Improves oxygen saturation
• Reduces cortisol (stress) levels particularly following painful procedures
• Encourages pre-feeding behaviour
• Assists with growth
• May reduce hospital stay
• If the mother expresses following a period of skin-to-skin contact, her milk volume will improve and the milk expressed will contain the most up-to-date antibodies.

What happens during skin-to-skin contact?

When a mother holds her baby in skin to skin contact after birth it initiates strong instinctive behaviours in both.

The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies’ instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother’s breast and achieve self attachment it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

After birth, babies who are placed skin-to-skin on their mother’s chest will:

• initially cry briefly – a very distinctive birth cry;
• enter a stage of relaxation, where they display very little movement as they recover from the birth;
• start to wake up, opening their eyes and showing some response to their mother’s voice;
• begin to move, initially little movements, perhaps of the arms, shoulders and head;
• as these movements increase the baby will draw up their knees and appear to move or crawl towards the breast;
• once they have found the breast, they will tend to rest for a little while (often this can be mistaken as the baby being not hungry or not wanting to feed);
• after a period of rest the baby will start to familiarise with the breast, perhaps by nuzzling, smelling and licking around the area. This familiarisation period can last for some time and is important so should not be rushed. Sometimes it is tempting to help baby to attach at this time but try to remain patient to allow them to work out how best to attach themselves.
• finally baby will self-attach and begin to feed. It may be that mother and baby need a little help with positioning at this stage.
• once baby has suckled for a period of time, they will come off the breast and often both mother and baby will fall asleep.

Most term healthy babies will follow this process, providing it is not interrupted by anything, for example taking the baby away to weigh, or the mother going for a shower. Interrupting the process before the baby has completed this sequence, or trying to hurry them through the stages may lead to problems at subsequent breastfeeds.

If mother has been given a lot of analgesia during labour baby may be drowsy and this process can take longer.

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You may have read the term” Microbiome” before, or perhaps you have discussed it at your antenatal appointments. 

Our ‘gut microbiome’ is made up of the trillions of microorganisms (including bacteria, funguses and viruses and other microbes), which live in our gut. Having a healthy balanced and well-functioning microbiome is important for our health and wellbeing, affecting things such as how we digest and metabolise food, how we feel in ourselves, and in new babies it may also influence a lower chance of allergy, illness and colicky symptoms, as well as supporting healthy growth and many more benefits.   

Babies begin to pick up their families’ microbiome, first in some small amount in utero, and then predominently as they pass through the vagina at birth, then being placed in skin to skin with their mother in the hours after they are born, and in any time in skin to skin with either parent, and also receiving their mother’s milk, all help our babies develop their microbiome.  As you read on though out this information you will find out more about developing a healthy microbiome.

For the past 50 years or so, doctors and midwives have mostly routinely clamped and cut the cord immediately after the baby was born, with no evidence that timing of that clamp and cut had any significant impact. However, evidence now shows that there are benefits in delaying cord clamping.

Cords cut before 60 seconds after delivery are classed as early cord clamping, and anything after 2 minutes is classed as ‘delayed cord clamping’ but ideally, a cord should not be cut until it has stopped pulsating – i.e. all the blood has flowed from the placenta to your new baby. Look on Twitter for the hashtag #waitforwhite

If the cord attached to your baby is left for as long as possible, not only will your baby receive extra blood, but it can increase birth weight, can boost your baby’s blood volume by up to a third and can increase your baby’s iron reserves for up to 6 months. Research shows that ‘placental transfusion’ (allowing the blood to move from placenta to baby via the cord) is mostly complete by 3 minutes.

Iron deficiency anaemia, the most severe form of iron deficiency, affects around a quarter of pre-school children globally and 3-7% of the population in Europe. This deficiency can go on to affect a child’s brain development.

The solution is to keep the baby attached for as long as possible to make sure he or she has a good amount of iron stored up for the future.

If you allow nature to take the intended course and delay the clamping and cutting of the cord, you and your baby are still attached, therefore no one can take your baby away from you. All a midwife needs to do can be done with your baby in your arms, with their skin against yours. That is a moment no one in the world can ever take away from you. And it’s doing good stuff at the same time!

Of course, there may be a reason why delayed cord clamping may not be an option for you and your baby. The World Health Organisation tells us that early cord clamping i.e. before the magical 60 seconds, is not recommended unless resuscitation is needed. Sometimes newborns don’t like being forced out of their cosy environment into a bright new world and they might need a little helping hand to come round and breathe on their own. If this is the case, then it is best to get them started and cut the cord unless there is a mini resuscitaire available, which enables resuscitation with the cord intact.

Our standard policies in our hospitals now include a 2 minute delay before clamping and cutting the cord, whether your baby is born by standard vaginal delivery, or c/section.

Remember, #WeightCanWait! Although one of the first things new parents want to know is what the baby weighs, think of the advantages of waiting just a little bit longer for that information.

For more information see bloodtobaby.com

Breastfeeding has huge benefits for mums and babies that will last a lifetime. Even in providing those first few breastfeeds to your baby, can impact on there health and immunity as they grow. Breastmilk provides your baby with the building blocks for a healthy future and gives them the best start in life.

Mum’s milk is made up of hundreds of components that gives your baby all the nutrients they need for around the first 6 months of life any beyond. It helps to protect your baby from infections and other diseases, and as a mum, it also reduces your chances of getting some illnesses later in life, such as breast cancer.

Breastfeeding also helps you and your baby to build a close and loving relationship. So while you are feeding your baby, the emotional and physical bond between you grows stronger.

Breastfeeding is the natural and healthiest way for a baby to feed, for both baby and mother.

Colostrum is the first form of milk made, and it is very protective. It helps to regulate your baby’s blood sugar, protects from infection, increases bowel movements and is easy to digest. It is highly concentrated, full of protein and nutrient dense, so a little goes a long way in your baby’s tiny tummy. It’s also low in fat and easy to digest.

Colostrum plays a crucial role in developing a baby’s first stages of development and his immune system. It is tailor made for your newborn baby. Colostrum is potentially available from the mother’s breast from around the middle of a full term pregnancy, however the hormones of pregnancy mean that it is not produced except on demand.

For more information on this you can speak to your health visitor, midwife or breastfeeding peer supporter, or visit unicef.org.uk/babyfriendly/about/benefits-of-breastfeeding/

Also see the DH Leaflet Off to the Best Start.

There are benefits to having colostrum ready at the point of baby’s birth, and where mother’s health conditions or other issues put baby at risk of hypoglycaemia (low blood sugars) immediately after birth, sometimes midwives will suggest that colostrum is collected and stored in the weeks before baby comes.

Antenatal colostrum banking means expressing and then storing this colostrum so that it can be given to baby if they need it, when they are born.

Some babies have more chance of having a low blood sugar in the first few hours after birth. An early feed, within the first 30-60 minutes of life will help to minimise this.

Any mother to be can express colostrum from 36 weeks of pregnancy onwards. Other women who might find antenatal colostrum banking helpful because their babies will be at increased risk of low blood glucose levels after the birth, include:

• Women taking beta blockers to control their blood pressure
• Women whose babies are expected to be small at birth (less than 2.5kg)

You can also start expressing during labour, or when admitted for induction of labour.

When Antenatal Colostrum Expression is not recommended

 There are certain circumstances where antenatal expressing is not recommended, for example:

• Threatened or actual premature labour
• Having surgical suture in place.

Please discuss with your midwife or obstetrician if you are thinking of commencing expressing colostrum in the antenatal period.

We advise that you do not start hand expressing regularly before 36 weeks unless your Midwife has advised otherwise.

The amount obtained can vary from none at all, to a few drops, to a teaspoon full or even more. Any amount collected will be valuable for your baby.

The amount expressed during your pregnancy does not indicate how much milk you will produce after birth.

When you express you might feel your uterus going hard and relaxing - these are Braxton Hicks contractions. Don’t worry about these unless they begin to feel like period-type cramps or mild labour contractions. If this happens whilst you are at home you should stop expressing and rest. If they don’t stop and you think you are in early labour you should ring the Birth Suite for advice. 

If you are in hospital being induced, you can let your midwifery team know, and continue expressing can be relaxing and help induce labour as the hormone oxytocin is released.

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Responsive feeding means responding to a baby’s needs, which might be via feeding cues, or when baby needs feeding because they are not taking as much as we would expect for an infant of that age and stage. It could be thought of as feeding your baby emotionally, as well as nutritionally.

Recognising feeding cues is key to supporting responsive feeding; feeding cues may include, moving head and mouth around, sucking on fingers, some small noises or mouthing - with crying being a late cue, which may indicate that the infant is frustrated because we have not picked up cues earlier.

It is equally important that parents are able to recognise cues to stop feeding. In a breastfed baby this can be simple as letting baby remain at the breast for as long as they wish and allowing them to come off by themselves, and for a baby who is bottle feeding, parents can be supported to watch baby and follow the cues for when they need a break:; these signs will be different from one baby to the next, they may splay their fingers and toes, let spill milk out of their mouth, stop sucking, turn their head away, or push the bottle away.

Babies are just people, so their feed frequency, feed times and feed volumes will often differ from feed to feed and day to day.

Bottle feeding your baby in a paced, responsive way

The relationship between infant and their parent or other adult carer will be helped if the carer is supported to ‘tune in’ to feeding cues, and to hold their babies close during feeds.

However, responding to all apparent feeding cues by offering milk when baby is bottlefed is not biologically appropriate, and this risks overfeeding, digestive discomfort and also reflux type symptoms. 

Pacing the feeds and avoiding any encouragement for baby to finish the feed when they are slowing, can all help to make the experience as acceptable and stress-free for the baby as possible, as well as reducing the risk of overfeeding.

Ensuring that just 1 or 2 adult carers give most of the feeds themselves (particularly in the early days and weeks), will help them to build a close and loving relationship with their baby and help their baby to feel safe and secure.

Key Points to responsive paced bottle feeding

• Feed baby when they show feeding cues
• Hold baby close in a semi-upright position so you can see their face and reassure them by looking into their eyes and talking to them during the feed
• Alternate the side of the adult’s body on which baby is held
• Begin by inviting baby to open their mouth: softly rub the teat against their top lip. Gently insert the teat into baby’s mouth, keeping the bottle in a horizontal position (just slightly tipped) to prevent milk from flowing too fast
• Watch baby and follow the cues for when they need a break; these signs will be different from one baby to the next: they may splay their fingers and toes, spill milk out of their mouth, stop sucking, turn their head away or push the bottle away. Gently remove the teat or bring the bottle more horizontal to prevent or slow further milk flow
• Forcing a baby to finish a feed may be distressing, and can mean baby is overfed.

More information is available on the Unicef website here.

If you have decided to formula feed or find yourself giving formula supplements to your baby, then it’s important to note that First Infant Formula, which is whey-based, is the only formula they will need in the first year of life.

It doesn’t matter which brand you use as they are all very similar, so you can choose one based on price or local availability. You can swap and change between the standard first infant milks if you would like to.

You can choose cows’ or goats’ milk-based formula, but you should only use soy based formula after discussion with a health professional who is appropriately skilled to advise on this. 

There is no evidence that the special milks such as ‘hungry baby’, ‘comfort’ or ‘anti-reflux’ milks do any good, and in fact they may not be safe for your baby. Speak to your midwife, health visitor or other appropriately qualified person before switching to a different type of milk.

There is no need for ‘second stage’ or ‘follow on’ milks from six months; stick to a first infant milk throughout the first year.

When your baby is one year old, they will be getting more of their energy, vitamins and minerals from food, and full fat cows’ milk can be their main milk drink rather than infant formula.

If you have any concerns, or want to know about other milks at this stage, ask your health visitor or other appropriately knowledgeable person.

A simple up to date guide on infant milks can be accessed at First Steps Nutrition Trust.

Also see the DH leaflet Guide to Bottle Feeding.

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart. Giving infant formula to a breastfed baby will reduce your milk supply. You do not need to eat any special foods while breastfeeding, but it is a good idea for everyone to eat a healthy diet