• Breastmilk is the most precious gift a mother can give her baby, providing nutrients necessary for healthy growth and antibodies that protect your baby from disease. The time spent breastfeeding also helps to foster a stronger bond with your baby.
    The benefits are so great, that Health Professionals recommend that your baby should be fed exclusively breastmilk from birth to six months, and then that breastmilk be given in addition to solid foods until at least 12 months.
    Breastfeeding is such an important part of the amazing journey of motherhood. Our colleagues in Singapore have put together a comprehensive website that covers a variety of topics relating to breastfeeding, including:
    ⦁ Learning about the wonders of breastmilk
    ⦁ Hints for continual Breastfeeding
    ⦁ What should I do? (Mother’s edition)
    ⦁ What should I do (Baby edition)
    ⦁ To First Time fathers

    See here: http://ba.pigeon.com.sg/
  • Burping Babies – Optional or Compulsory? When a just-fed baby emits a burp a beer drinker would be proud of surprised accolades arise among spectators and along with congratulations to the back-patter.  Baby burps are normal and common but not compulsory!  If baby does not easily volunteer a burp or two after feeding don’t worry – the wind will come out one way or another. Parents may think the baby MUST burp before resuming the feed and spend much time and energy trying to get it to happen however if it is not worrying the baby parents need not worry either. Some babies burp easily and a lot, others hardly ever. On a serious note – spending time “winding baby” during and after feeds can result in reduced milk transfer and weight loss rather than weight gain.  Take home message: Responding to baby’s cues to resume feeding is more important than getting a burp up.

    Lois Wattis

    Learn more about Lois: http://www.newbaby101.com.au/

     Lois Wattis is a Registered Nurse and Midwife, Lactation Expert and a Fellow of the Australian College of Midwives. Working in both hospital and community settings, Lois has enhanced her midwifery skills and expertise by providing woman-centered care to hundreds of mothers and babies, including more than 50 women who chose to give birth at home.
  • WHY?
    Most mothers will express their breastmilk for their baby at some time and it is common for mums-to-be to have a breast pump on their baby shower wishlist.  While expression of breastmilk most frequently occurs after baby is born, in certain circumstances such as when a Mother has diabetes, hand expression and collection of colostrum before baby is born may also be recommended.  Antenatally expressed colostrum given to the newborn in addition to breastfeeds provides a valuable means of maintaining optimal blood glucose levels in these babies’ early days of life.  Mothers expecting twins may also choose to have a little bank of antenatally expressed colostrum ready to ensure both babies receive adequate amounts of this precious resource while the Mother’s milk supply is establishing in the early, busy days.
    Hand expression is most appropriate in the early days after your baby is born because the quantities of colostrum produced are small.  This is nature’s design.  Babies have very tiny stomachs and only need to take small quantities of colostrum at each breastfeed.  The colostrum is easily digested so feeds need to be frequent and given whenever baby cues to breastfeed.  If a pump is used to collect small volumes of colostrum (less than 10mls) most of the precious liquid sticks to the inside of the flange and is difficult to retrieve to give to the baby.  Hand expression and collection with a small syringe is the most efficient means of collecting and storing colostrum, however it does take some practice and patience to successfully obtain and deliver it to your grateful newborn.

    Some reasons a Mother may need to express colostrum and breastmilk include:
    * The baby is born premature or unwell, and is unable to breastfeed
    * The Mother has sore or injured nipples which need a rest from latching baby to feed
    * The Mother has uncomfortably full or engorged breasts which need to be drained to assist baby to latch and to avoid blocked ducts and mastitis
    * The baby needs to stay in hospital but Mother has been discharged.
    * The baby has problems latching or refuses to breastfeed
    * The Mother needs to leave the baby with a caregiver

    Good hand hygiene is essential when handling the breasts, feeding and expressing equipment.
    Hand Expression – Your hands are always available so here is how to hand express:
    The Marmet Technique prepares the breast for expression and stimulates the milk ‘letdown’.  Massage each breast in a circular motion all the way around – This takes a few seconds. Stroke the breast lightly, passing the fingers gently over the nipple and areola – this just takes a couple more seconds. Gently hold the breast and give it a little shake.  That’s it!  Your breast is ready to begin hand expression.

    The Marmet Technique

    Position your index finger and thumb opposite each other on the breast just past the outer edge of the areola as shown in the first diagram.  Press directly backwards towards the chest wall as shown in the middle diagram, then close the index finger and thumb towards each other (third diagram), and release.  Repeat this action in the same location several times and watch for tiny beads of colostrum to appear from the nipple pores.  Collect each drop with a small syringe, drawing it into the barrel of the syringe and it will fall into the chamber if gently tapped.  Repeat the collection process for each drop that appears, and continue until all the milk has been expressed from that location of your breast.
    Rotate the fingers around the ‘dial’ of the areola to access a number of areas on each breast. Imagine it is like a clock so your finger and thumb are placed at 6 o’clock/12 o’clock; nine o’clock/3 o’clock and so on.
    Hand expression will be comfortable if the nipple is not rolled or pulled or extended during this expressing motion.  Your fingers should not slide over the skin or stretch it during hand expression. View http://newborns.stanford.edu/Breastfeeding/HandExpression.html to watch a demonstration of this technique.
    Use the Marmet Technique again before expressing the opposite breast. The Marmet technique will also be helpful to stimulate letdown if you are expressing using a pump.

    Expressing using a breast pump
    There are many types of breast pumps available and the choice can be rather daunting – especially if it is Dad who has been sent shopping to buy one when an unexpected ‘situation’ has arisen which requires mechanical help.  You will need to decide whether to hire or to buy, whether to get a manual pump or an electric pump, single or double, and which brand to choose.
    How it is best to pump really depends on why the pump is needed.
    Is it only needed for occasional use such as collecting breastmilk a few times over a couple of days because you are planning a night out without your baby?  If so a manual hand breast pump will probably be adequate for the job.
    Are you expressing for a premature baby who will be in hospital for a number of weeks?  In this case a good quality electric pump is ideal.  Whether to hire a hospital grade electric pump for this purpose or buy a good quality pump will involve some arithmetic to compare the costs and expected timeframe that regular expression of breastmilk will be necessary.
    Whichever way the decision process goes, it is essential that the breast pump flange size matches the mother’s nipple, areola and breast size.  Many women require a larger size flange than is supplied with the breast pump (the Pigeon Manual and Electric Breast Pumps come with two different sizes of flanges), so seeking advice from a midwife or lactation consultant about your specific requirements will save money and potentially pain and injury as well. 

    Most women find their supply is most plentiful in the first half of the day so collection of ‘surplus’ milk will probably be easiest between the hours of about 5am and Midday.  I suggest expressing after baby has been breastfed and settled.  Mum has a drink and something to eat, then sits down to express.  If baby has fed from one breast only, express the opposite breast.  If baby has fed from both breasts express from both breasts.  How long to express?  Continue until the milk flow slows down.  Massage the breasts again, and continue pumping or switch to hand expression.  Remember frequency of breast drainage will enhance the volumes of milk produced, rather than the length of time between expressions or how long pumping is continued.

    Expressing following a breastfeed will result in collection of rich hindmilk.  If you are wanting to collect milk to give to baby as a ‘top up’ to enhance your baby’s ability to settle to sleep, or if your baby has been ‘windy’ and passing explosive greenish poo, increasing the amount of hindmilk baby receives will help slow baby’s gut function and aid settling.
    Expressing in the early weeks after your baby is born will not lead to over-fullness or oversupply.  Early lactation is driven by the hormonal changes after the birth rather than ‘supply and demand’.   Supply and demand (or actually it is the other way around – baby demands – supply increases) dominates the lactation process from a few weeks after the birth and is regulated in response to baby’s changing needs as he grows.

    It should also be understood that it is not only the breastmilk  volumes  which change as baby grows, but also the constituents of the breastmilk produced which constantly change as the baby matures.
    If you need to express every feed for her baby the following video provides valuable information about maximising milk production with hands-on pumping: -http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

    Hand expression can take place anywhere, anytime that it is needed.  If the milk does not need to be collected, hand expressing in the shower or into a hand basin is an easy and effective way of relieving the discomfort of over-full breasts if your baby is not available or ready to breastfeed.
    Many workplaces now provide facilities for breastfeeding employees to express in privacy and comfort. The Australian Breastfeeding Association has developed guidelines to assist employers to support mothers to return to work and continue breastfeeding.  “Creating a supportive breastfeeding environment can deliver significant cost savings by improving retention rates, encouraging earlier return to work, reducing the need for sick leave & carer’s leave, and reducing recruitment and re-training costs. BFW provides practical resources and information for companies looking to support their employees to maintain breastfeeding.” https://www.breastfeeding.asn.au/bf-info/breastfeeding-and-work/expressing-and-storing-breastmilk

    Breast milk can be stored in a clean container – in a refrigerator for up to five days at 4°C or lower, and in a freezer for up to six months.

    Defrosting/thawing frozen breast milk is best done slowly while refrigerated.  If the milk is needed quickly, sit the container in warm water and swirl it frequently as it is thawing.  Thawed breastmilk should be used the same day, and any breastmilk left in a bottle which has been fed to the baby should be discarded.  Never re-freeze thawed breastmilk.

    Warming breast milk – place the bottle in a container of warm water and bring it to lukewarm temperature.  Never microwave breastmilk or formula to heat it as this method can heat unevenly and possibly lead to burning your baby’s mouth. Also nutrients may be destroyed if heated above 60 degrees celsius.

    Cleaning expressing equipment after each use is important.  Parts need to be squeaky clean but do not need to be sterilised/disinfected for a healthy term baby.  All parts which have been in contact with milk or skin need to be rinsed using cold water, then washed thoroughly with detergent and hot water and then rinsed with hot water.  Store all washed equipment in a clean container with a lid.  If the Breast pump flange needs to be used more than once while away from home it can be rinsed thoroughly with cold water and placed in a clean snaplock bag or clean plastic tub with a lid until the next use, and washed later when those facilities are available.

    Always refrigerate expressed breastmilk as soon as possible, and use a thermal travel pack with frozen blocks when transporting breastmilk.  Label all stored breastmilk with the date and time it was collected.  Breastmilk storage bags are space-savers in the freezer and easy to thaw ready for baby.  Successful expression of colostrum and breastmilk will prove to be a valuable and satisfying skill for you to acquire which can support and enhance your  breastfeeding journey.

    Lois Wattis

    Learn more about Lois: http://www.newbaby101.com.au/

     Lois Wattis is a Registered Nurse and Midwife, Lactation Expert and a Fellow of the Australian College of Midwives. Working in both hospital and community settings, Lois has enhanced her midwifery skills and expertise by providing woman-centered care to hundreds of mothers and babies, including more than 50 women who chose to give birth at home.


    Expectations regarding your baby’s sleep can be the source of great anxiety if you believe your baby is not sleeping ’well’ or ‘enough’.
    Understanding how variable babies’ sleep patterns are from baby to baby, and from week to week according to individual feeding, growth and developmental stages can help relieve  your concerns, and help you to ‘go with the flow’ of your baby’s individual needs.

    When babies are born they must adapt to their new world and will be comforted by familiar sensations experienced in the womb:
    Warmth – close to their mother’s body in skin to skin contact
    Security – contained in soft wraps and held in loving arms
    Nurture – receiving food as frequently as needed – warm, nutritious and sweet breastmilk and the delicious comfort of suckling mother’s breast.
    Movement and soft sounds– gentle rocking and swaying simulating mother’s movements as she went about her day whilst pregnant, and the soft vibrations and sounds of her voice.
    Light, sound, touch, pain, clothing, poos and wees, sucking, swallowing and breathing are all new experiences for your baby. It should not be surprising that they takes some time to adapt to sleeping in a place away from his mother, and needs to revisit the familiar comforts often for reassurance that all is well in this new strange world.
    You will learn to read your baby’s signals to understand their various awake and sleep states
    – yes, there are more than two! When awake, babies can be quiet alert, active alert or crying, which is your baby’s principal means of communicating a need. Your baby’s sleep states transition between active sleep and quiet sleep. Drowsiness upon waking transitions to the quiet alert state often combined with feeding cues – the perfect time to feed baby. Young babies often move from state to state quickly so parents who swiftly respond to baby’s changing cues encounter fewer feeding and sleep problems.

    As the early weeks of baby’s life unfolds a pattern emerges, and you can begin to relax and embrace your new life-style. This does not mean your baby is dictating the terms of existence forever after. It means that you are meeting your baby’s needs responsibly and sensitively as your new family becomes a cohesive, functioning unit.

    You will quickly learn to recognise and respond to your baby’s early “tired signs” to avoid them becoming overtired. An overtired baby may find it very difficult to go to sleep even though rest is what he desperately needs.
    A newborn baby will become tired when they have been awake for an hour or more – including the time taken for feeding. The movements of your baby’s arms and legs become jerky, they may yawn, frown, fuss, and look away from stimulating toys or faces. Their hands may be in fists, their arms become tense, and they may arch backwards when being held. Fussing turns to crying and when very overtired they may ‘lose the plot’ and it can be difficult to calm an overtired crying baby.
    To calm and settle a tired baby, remove them from a stimulating environment to a quieter zone, change their nappy if needed, cuddle them close and reassure them in a relaxed soothing voice, and offer a feed if baby seems hungry. When your baby is calm and their need of comfort (eg. nappy change) and hunger are met, a state of drowsiness will follow. Your baby can then be swaddled and either cuddled until drowsy or asleep, or placed gently in his bed to drift off to sleep (New Baby 101 Free App includes a video “How to Swaddle Baby Safely”).

    If your baby does not settle easily, stay with them with your hands resting on them for reassurance so they feel they are still being held. Rhythmic patting gently on his bottom often helps babies to relax. Sometimes your baby will settle more easily laid on their side. This is fine if you are with them. They can be gently moved onto their back when they are asleep, or on their side if they prefers it.

    If your baby does not settle when expected, it is likely they actually need to be fed some more. Don’t ignore feeding cues when your plan is to settle your baby to sleep – the need to feed will over-rule your best efforts to settle them. If in doubt, offer another feed. This will save you time and energy in the long run, and will not “spoil” or over feed baby. Young babies under 3 months old need feeds in multiple instalments. They often need “topping up” after a bowel movement and nappy change to feel full again and ready to sleep. Follow your baby’s cues and the bliss of dreamland will soon be yours.
    Young babies are dominated by their needs for food, comfort and sleep rather than the environmental stimuli of light and dark, day and night. Newborn babies are oblivious to day and night and do not develop circadian rhythms until about 2 months of age. However, the breastfeeding mother’s cycle of sleep/wake hormones gradually influence her baby’s circadian rhythm to develop, and the environmental cues of the morning and evening help establish baby’s rhythm in sync with the family over time.

    One strategy I have found to be helpful for babies and parents in the first few months is to avoid baby having a long sleep during the daytime – unless of course the Mother needs to go to bed to sleep as well. Most babies will naturally have a longer sleep at some time during the 24 hours of each day. It’s quite OK to wake your young baby to feed during the daytime if they do not self-waken after four hours have passed since the start of the last feed. This will ensure your baby has a consistent food intake through the daytime and they may be more able to have the longer stretch of sleep during the night time hours. Bliss!

    Most parents crave order and predictability from day to day so knowing what patterns to expect as your baby develops physically and mentally will make adaptation to their new lifestyle easier for them too. “Getting into a routine” will happen naturally in response to baby’s individual developmental patterns which the parents will recognise and adapt to as they unfold.

    Following the highly structured and inflexible routines offered by “sleep trainers” are an outdated, “one-size-fits-all” concept which lock parents into rigid timeframes too. When something happens which confounds the ‘routine’ the parents are challenged to somehow get back on track, and many experience added anxiety and a sense of failure if their baby does not “fit” into the routine devised by the ‘sleep experts’ who do not know the baby’s or  family’s unique story.
    Babies respond to their needs being met rather than a rigid series of actions to enable sleep to follow. Responding appropriately to baby’s early ‘tired signs’ is the most important message to take on board. Health professionals now recognise there are potential hazards for babies’ physical and mental development associated with rigid feeding routines and sleep training. Cue-based responsive parenting enhances baby’s wellbeing and parents’ confidence in caring for and understanding their baby’s changing needs.

    Your baby’s sleep patterns will change from time to time associated with growth and developmental phases, sometimes called “wonder weeks”, so don’t despair if the settling strategies that worked for weeks suddenly don’t work and your baby resists sleeping when they have slept easily in the past. Flexibility is the answer to these times of change and will have you many wasted hours trying unsuccessfully to coax a baby to sleep when it just is not what they need.
    Often mistaken for “wind”, these unsettled times are usually driven by hunger and more feeding will be the answer to the situation because your baby’s nutritional requirements are in a state of change in response to growth. If your baby does not need to feed, they simply won’t.

    Next try a strategy involving movement – pram/stroller, car, swing, rocking in arms. In the end it is a matter of ‘try this, try that’, but always give the new strategy at least 15 minutes before moving to another settling strategy. It often takes that amount of time for baby to ‘re-set’ and respond by calming down. Take some deep breaths, close your eyes and relax yourself in order to recharge your own energy, and focus on your lovely little person. All parents experience these challenges at some time, it is part of the parenthood deal! If you are finding it very hard to cope, talk about it with a close friend, your Child Health Nurse or GP. Don’t despair, help is nearby.

    Lois Wattis

    Learn more about Lois: http://www.newbaby101.com.au/

     Lois Wattis is a Registered Nurse and Midwife, Lactation Expert and a Fellow of the Australian College of Midwives. Working in both hospital and community settings, Lois has enhanced her midwifery skills and expertise by providing woman-centered care to hundreds of mothers and babies, including more than 50 women who chose to give birth at home.
  • How to make bottle feeds comfortable for baby – Paced Bottle Feeding
    Whether you are feeding your baby expressed breast milk or infant formula there are some key points to know to ensure it is a comfortable experience for your baby. Bottle feeding can easily become uncomfortable and even frightening for a baby if the milk flows too quickly, and the baby can’t pause and breathe between sucks without milk continuing to flood into the mouth. Spluttering, gagging and vomiting can result if baby can’t “pace” the feed the way they naturally learn to do when breastfeeding.  Bottle feeding can also result in baby taking more milk than they want, resulting in overfeeding.  Here are some tips to help baby and caregivers enjoy the bottle feeding experience.

    Offer the feed based on hunger cues, ideally early cues such as stretching, licking the lips, turning the head when waking. Baby’s cues progress quickly to mid cues like sucking the hands, and becoming agitated and crying are LATE cues.
    Select a wide-based bottle and a teat with a shape that encourages baby’s mouth to maintain a wide gape, similar to a breastfeeding latch. Teats with a narrow nipple at the end tend to result in pursed lips and a shallow gape, even if the base is wide. Choose a teat with a flow rate suitable for the age of the baby. Crosscut teats which stop flowing when baby stops sucking allow baby to control the feed better than teats with holes.

    Hold baby in an upright or semi-upright position, with the head resting back a little. Positioning baby resting against the chest of the person giving the bottle can simulate a breastfeeding position.
    When offering the teat, first stroke the baby’s lips gently, inviting him to open his mouth. Never force the teat into the baby’s mouth, instead allow baby to seek the teat.

    Encourage baby to take the teat deeply into his mouth achieving and maintaining a wide latch. If baby drinks too fast, tip the bottle down or remove it to slow the pace of the feeding.

    Allow baby to control the feeding pace. Turning the head and pushing the teat out of the mouth are signs baby is uncomfortable, or needs a break. Responding to baby’s discomfort signs by allowing a few minutes’ break several times through the feed allows baby to rest, and to bring up wind if needed. He will show hunger cues again when he is ready to continue the feed.

    Head turning and pushing the teat out of the mouth are also signs baby has had enough and is finished feeding. Paced bottle feeding allows baby to engage in similar feeding communications they would demonstrate during a breast feed. A paced bottle feed should take 15-30 minutes, however timing will vary according to the age of the baby, the volumes being offered and how hungry the baby is at the start of the feed.

    Following paced bottle feeding principles will reduce the risk of overfeeding and its consequences – gassiness, spitting up and vomiting, and childhood obesity.

    Lois Wattis

    Learn more about Lois: http://www.newbaby101.com.au/

     Lois Wattis is a Registered Nurse and Midwife, Lactation Expert and a Fellow of the Australian College of Midwives. Working in both hospital and community settings, Lois has enhanced her midwifery skills and expertise by providing woman-centered care to hundreds of mothers and babies, including more than 50 women who chose to give birth at home.