You may have already heard about the benefits of having skin to skin cuddles with your baby at birth. Skin to skin is an important first step in getting to know your baby and keeping you both calm and relaxed. We will support you to have skin to skin with your baby immediately after birth or as soon as possible if there are any medical complications.

Skin to skin means what is says - your baby's bare body  laying on your bare chest, with no clothing or wraps between you. Your baby may have a nappy and hat on.  A warm blanket will be placed over you both to keep you warm and covered. You and your baby can gaze into each others eyes and begin your special relationship. This 'getting to know you' is a very important part of the bonding process. While your baby lays on your skin he or she is getting covered in your family bacteria strains to help them be well in your home environment. The baby's heart rate, breathing, temperature and blood sugar level will all stablise. This is a very important first step for all mothers, however you intend to feed your baby.

Skin to skin in the first hour of life improves breastfeeding outcomes as babies use their instincts to search for the nipple. Feeding early, in this first hour, helps establish your milk supply in the many months ahead. If you are choosing to formula feed your baby you may decide to let your baby have their first colostrum feed while having skin to skin or your midwife can show you how to express this small amount of milk for your baby's first feed.

Skin to skin is not just for straight after birth. You and your baby will continue to appreciate the special bond this brings, it is a great way to calm you both when times are stressful. When breastfeeding is going well skin to skin helps to keep your milk supply going as hormones are released through the touch. When you are struggling with breastfeeding, skin to skin helps to teach you how to respond to each other and learn how to feed together. If you are formula feeding, skin to skin remains an important bonding and calming time with your baby.

Skin to skin is for your partner too. Once your baby has had their first breastfeed and after the first hour, your partner will also enjoy skin to skin with your baby. Bonding, family bacteria exchange, and the calming effects are important for them too. Sometimes if you are unwell after the birth your partner may be asked to do skin to skin until you are ready. Skin to skin with your partner is also a great way for them to support you in the early weeks after the birth so you can rest.

If your baby is unwell and needs to be transferred to the Special Care/Neonatal Unit skin to skin will be encouraged as soon as the baby is stable enough. This is often called Kangaroo Mother Care and will be done as often as possible while your baby is in this area. Be prepared to sit with your baby doing skin to skin for at least an hour, to reduce the amount of times your baby is disturbed. There may be tubes and equipment connected to your baby but the nurses will help you to manage to get comfortable and keep baby safe. Skin to skin can help with reducing pain for your baby, keeping them calm, and helping to establish breastfeeding when they are ready.

Sometimes skin to skin will not be safe. If you are very tired and/or medicated after your birth you may find it difficult to stay awake and safely care for your baby during skin to skin. Having your partner or support people sit with you during this time can be an option of still keeping your baby in skin to skin contact. Your partner may choose this time to have skin to skin while you rest. Or your midwife can support you to settle your baby into their bassinet so you can sleep.

The First Hour - Skin to Skin time with your baby (video) - https://youtu.be/OnX7nnae6SM

Colostrum is the early milk you begin to produce in your breasts during pregnancy. Some women will express this milk in the last few weeks of pregnancy.  If you have specific medical conditions that may mean your baby may need extra food in the first few hours after birth it will be discussed with you. Your midwife can answer more questions about this. You can also ask for referral to the Antenatal Lactation Clinic to speak to the Lactation Consultant for more information.

Colostrum's function is to protect - helping the good bacteria (probiotics) establish a healthy gut and lining the baby's gut to prevent bad bacteria from attaching and making the baby unwell. Even just one dose of colostrum can have these health benefits for your baby. It also provides small but nutritious food for your baby to sustain them while waiting for your milk supply to 'come in'.

A baby is born with a very small stomach size. When born near their due date and with some body fat stores, colostrum is all they need for the first few days of life. Sometimes if your baby isn't able to suckle at the breast you may be shown how to hand express  the thick, yellow colostrum. This is fed to the baby and can help your milk to come in around the third day after birth. It is important to start this process in the first hour after birth if your baby can't breastfeed as this helps you to have plenty of milk in the months to come.

If your baby is unwell or born premature they may sometimes need more calories to keep them well and growing while waiting for your milk supply to get going. This will sometimes be with formula and will be discussed with you.

Most babies do not need anything more than colostrum in the first few days. The amount increases over the first few days with your full milk supply usually 'coming in' between the 2nd and 4th day.

Baby's are born with a small stomach size which slowly stretches over the first few days and weeks. Knowing how much and how often to feed your baby can sometimes be confusing. Being able to recognise when your baby is wanting to feed ('feeding cues') is something the midwives/nurses will teach you as you learn to care for your baby.

Feeding cues are when your baby is telling you they are ready to eat. They are quite subtle as your baby licks their lips and opens their mouth seeking something to suck on, they will squirm a lot but may not have their eyes open. Crying is a late sign of hunger and you will need to settle the baby before trying to feed. Having your baby close to you, sharing your room, is a perfect way for you to recognise the early signs of hunger.

The first day - babies will usually feed well within the first hour of birth while they are skin to skin. After that they may need some time to rest after their birth, just like you. If they are well and born near their due date then they may only feed a few more times over the rest of the first 24 hours. Trying regular skin to skin and expressing small amounts of colostrum for them can help if they do not show any interest in feeding. This will ensure they continue to get the milk they need and will help your milk to come in.

If you are not breastfeeding, don't expect your baby to drink large volumes of formula. Offering small, frequent volumes of milk will ensure your baby has enough milk without causing vomiting.

The second and third day, and especially the night, are very busy for newborn babies and their mothers. Expect your baby to do their best and most frequent feeding of a night time. Ask your partner or support people to sit with your baby while you have a nap in the afternoons so you are ready to be up with your baby in the night. Feeding frequently is very normal and does not mean that you do not have enough milk. Babies feed for more than just food - breastfeeding provides comfort, pain relief and reassurance as they get used to being out in the world. This frequent feeding will also cause your hormones to rise and to help bring in your milk.

If you are formula feeding still expect this frequent waking as this is very normal as your baby wants to feel safe and close to you. Continue to offer small, frequent amounts of milk and don't be tempted to overfeed your baby in the hope of more sleep. There is no 'set amount' for a well term baby, let your baby show you what they need as the days progress. All formula made in Australia meets National Food Standards and will cover the nutitional requirements your baby needs. We do not recommend any particular brands.

When your milk comes in - many women wonder how they will know if they have enough milk for their baby. Between the 2nd and 4th day you will notice your breasts will begin to feel very heavy and warm and the veins may appear more prominent as your breasts fill and become firmer. You may have heard of a 'let down', which is when the milk flows faster for your baby as the hormone called oxytocin is released. Some women will experience this as a tingling sensation in their breasts, usually after a few weeks of breastfeeding. It is not necessary to feel this sensation. You will notice the way your baby slows their sucking and swallows more often after a let down, your other breast may leak, and you may feel very sleepy and thirsty quite suddenly.

Knowing if your baby is getting enough milk is a worry for most parents. From the first days to the months ahead it can be very stressful.

Your breasts can give you a good indication of how much milk the baby has drunk. Once your milk has 'come in' feel your breasts before the feed starts and then again at the end of the feed. They will feel firm or very heavy before the feed.  They should feel softer and lighter when your baby has finished. If you cannot feel a difference then it is important to have your midwife or Child and Family Health nurse watch you feed to see how well the baby is attaching to your breast. You can work together to make this better, especially if you are feeling any pain.

Your baby's nappies are also a good way to see if your baby is getting enough milk. At least 5 heavy wet nappies in every 24 hours and regular soft, yellow stools by the end of the first week. In the first few days babies do not have many wet nappies, the urine can look yellow and may have orange crystals or  'urates' which are very normal. The early stools are black and sticky (meconium). As your milk increases you will notice there will be more urine and it will be paler in colour. The meconium stools become more liquid and change colour to greens and browns, and by the end of the week will be loose and yellow.

Weight changes - your baby will be weighed on their day of birth and then on the 3rd or 4th day. It is normal to expect up to 10% of their birth weight to be lost initially and is very normal. By then you will be noticing your breasts are starting to fill with milk, the wet and dirty nappies are slowly increasing and your baby will look more content after a breastfeed. The next time your baby is weighed you will notice an increase in their weight. It may take around 2 weeks for them to get back to their birth weight. This is very normal. If you or the nurses/midwives are concerned about weight you can discuss ways that can help your baby get more milk.

The 'let down' is when breast milk begins to flow rapidly for your baby. Babies suck quickly at the start of the feed to stimulate the release of a hormone (oxytocin) that will cause milk to be pushed out of your breast. Some women may experience this as a tingling, 'pins and needles' type sensation in their breasts, others may notice their breasts feel suddenly very heavy and warm. It is not necessary to experience these feelings. You can notice a let down by looking at the way your baby is sucking and swallowing, changing to deep and slow sucking with a swallow occuring regularly that you can hear and see. You may also notice that your other breast begins to drip and that you feel suddenly very tired and thirsty. There is usually a number of 'let downs' in each feed as sucking patterns vary and milk flow changes for your baby's needs.

If you are formula feeding your well, term baby, let your baby guide you with how much milk they need. Don't be tempted to over feed your baby and expect small frequent feeds in the first few weeks as their stomach is small. Offer smaller amounts in the bottle and as baby grows and they empty that amount and don't appear content then try increasing the amount you offer. Watching their nappies will show you they are getting enough milk with regular wet nappies and stools. Weight changes are similar in the first week for babies who are formula feeding - an initial loss is still normal.

Knowing how often to feed your baby is a common question for new parents. Newborn babies feed frequently for many reasons, including hunger. Sometimes they need to feel you hold them to feel safe and secure and sucking is a natural way to comfort them. They may be cold, hot, overwhelmed, thirsty or uncomfortable. Breastfeeding can meet all of these needs.

8-12 feeds in 24 hrs should be expected in the first 6 to 8 weeks for both breast and formula feeding babies. Newborn babies have small stomach size and a need to feel safe and secure in the arms of their parents. Breast milk provides all the requirements for your growing baby including food and protection from many illnesses. 

As baby grows you can expect each feeding session to become shorter as babies get better at getting their milk, their stomach size grows to fit more milk at each feed and the milk itself changes to sustain baby for longer between feeds. Night time feeding becomes a little easier but you can still expect a baby to wake in the night for feeding and comfort for many months to come. This is normal as your baby's brain and body grows so quickly and they meet their many developmental stages.

Around 6 months babies will be ready for the introduction of family foods. Milk feeds remain important in their diet as they learn the new tastes and textures of solid food. Your Child and Family Health Nurse can provide more information on the types of foods and ways to introduce them to your baby. This is a fun, if messy, time. Continuing breastfeeding through the introduction of new foods is protective of allergic reactions.

Looking after yourself is important for all new parents. Catching up on sleep when you can during the day will help you with the sometimes difficult nights. It can often be hard to accept help when it is offered but people who you know and trust understand how hard this newborn period can be. Giving you time for sleep, helping with other children and housework, or providing a much needed meal can help you manage the needs of a new baby and feeding. Offering bottles to a breastfeeding baby will often not have the desired effect of sleep for a tired mother and can affect your milk supply. Ask your partner or support person to cuddle your baby after a breastfeed or take them for a walk in the pram or sit with the baby while you sleep or shower or have a break by yourself. Partners also need support. Things will get easier.

If you find yourself feeling sad or anxious please seek help. Your midwife, Child and Family Health nurse and GP are all good people to talk to and can refer you on for care if needed. The following websites have information and support for both parents:

PANDA (Perinal Anxiety and Depression Australia) https://www.panda.org.au/

Beyond Blue https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/anxiety

COPE (Centre of Perinatal Excellence) https://www.cope.org.au/

The following websites can provide you with more information on both breast and formula feeding -

The Australian Breastfeeding Association - https://www.breastfeeding.asn.au/

This video is very helpful for learning to breastfeed - https://www.breastfeeding.asn.au/resources/public-resources/breastfeeding-basics-video?fbclid=IwAR12IRVbOYsSUVtYWx8qeMcwInqv043Ux08EibJHaSTLByyaGlR0QqF781w

Raising Children Network - https://raisingchildren.net.au/newborns

Your midwife and Child and Family Health nurse can also provide further information and support. You can access contact details for these on the ISLHD website under the "your services" tab at the top of this page and selecting either "Maternity and Women's Health" or "Kids and Families".

Here are some other ISLHD breastfeeding videos that we hope you enjoy:

Breastfeeding Myths and Mysteries (video) - https://youtu.be/hfqbegibdyY 

'Ngaminjang Djama' Breast Milk Talk (video) - https://www.youtube.com/watch?v=ykGxKBgMA0Y 

Antenatal expressing - some women may be encouraged to express colostrum during the last few weeks of pregnancy. This can provide extra milk for babies in the first few hours/days when they may need a little extra. This can include women with diabetes in pregnancy (gestational, Type 1 or 2), polycystic ovarian syndrome, those expecting very small or large babies and multiple births.

Milk is collected in small syringes that the midwives can provide. You store them in the freezer, labelled with your name and date/time of expression, and bring them in to hospital for the day of birth. Studies show it is safe for most women to express colostrum in pregnancy but your doctor or midwife can confirm this for your own circumstances.

Antenatal expressing is always done by hand, 2-3 times per day from 36 weeks or as advised by your midwife/doctor. It works best if your breasts are warm, so after a shower is ideal. You can expect to get nothing or a couple of mls, every woman is different, and it does not prove how much milk you will make after the baby is born. Most women will find they can get a little bit more with practice and time. You will not 'run out' of colostrum and you cannot make your milk come in while you are pregnant.

If you experience any cramping pain stop expressing unless you are close to your due date or you have a planned caesarean section. If it does not go away call your midwife or birthing unit at the hospital. There should be no change to your baby's movements.

For more information - https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum

After the baby is born - hand expressing is a useful skill after your baby is born too. You will be shown how to do this by the midwives. If your baby cannot attach, is premature or unwell, or your breasts are too full, hand expressing is a gentle way to remove colostrum and breast milk. You could express just a little or a whole feed, depending on the reason.

Technique - wash hands and find a comfortable position. Gently stroke you breast lightly towards the nipple, around the whole breast. Place your thumb and forefinger opposite each other, 2-3cm back from the nipple and push back into the breast. Press your fingers towards each other, firmly but not so as to cause pain, then release and repeat until you have small beads of colostrum or until you have a let down if your milk is already in (after baby is born). Continue this pattern and collect the milk in a clean container. Store the milk in the fridge or freezer until needed.

This video shows you how to express colostrum/early milk (both before and after baby)-

This video shows you how to hand express with a full milk supply -

Storing - please refer to the Australian Breastfeeding Association website - https://www.breastfeeding.asn.au/bf-info/breastfeeding-and-work/expressing-and-storing-breastmilk

Please talk to your midwife if you have any more questions about hand expressing.

• It is important to be safe when taking medications during pregnancy and breastfeeding. This can include those the doctor prescribes, over the counter, or herbal supplements.
• Women are sometimes incorrectly told they cannot breastfeed because of a medication
• Getting the right advice is important. You may be able to continue without a problem, or change the way you take the medication. Sometimes there is a different medication you could try that is safer
• Most medications are safe in breastfeeding
• To be sure, you or your doctor can contact Mothersafe. This a service for pregnant and breastfeeding women and medications - Phone: 9382 6539 (Sydney Metropolitan Area) Phone: 1800 647 848 (Non-Metropolitan Area)
• The Mothersafe website also has fact sheets on common medications and drugs including alcohol  - https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe/factsheets
• The Australian Breastfeeding Association also has information on their website - https://www.breastfeeding.asn.au/
• The Lactmed database also has information on medications and chemicals for breastfeeding women for you or your health professional - https://www.ncbi.nlm.nih.gov/books/NBK501922/
• These are all free services

During your pregnancy -

• A virtual breastfeeding education group runs most weeks
• Discuss with your midwife or Antenatal Clinic staff about booking in
• This is for all parents, whether you are first time or you need a refresher
• Both parents are welcome to attend from the comfort of your own home using your phone, computer or tablet

After discharge with baby - 

• Most women will have a midwife from the hospital follow you up at home after discharge to help with feeding and your after birth care
• A Child and Family Health nurse will contact you after discharge to make an appointment with them - they are very skilled in infant and young child feeding 
• After-birth breastfeeding education groups are also run - ask your Child and Family nurse for more information or go to their Facebook group  https://www.facebook.com/ChildandFamilyHealthISLHD
• Your midwife or nurse may refer you to a Family Care Centre for extra breastfeeding support
• The Australian Breastfeeding Association - Breastfeeding Helpline 24 hours a day, to speak to a counsellor and get some advice call 1800 686 268
• You could also look for a private Lactation Consultant (IBCLC) through LCANZ - https://www.lcanz.org/find-a-lactation-consultant/

ISLHD is excited to be able to share with you a new breastfeeding app created and reviewed by the University of Wollongong and ISLHD.

The Milky Way Breastfeeding app is based on the World Health Organization's 'Ten Steps to Successful Breastfeeding' and the Australian government 'Infant Feeding Guidelines'. It has easy to understand information to help you breastfeed successfully.

It is available both for both android and Apple devices through your smart device app store, and takes up little space in phone storage. Search "The Milky Way Breastfeeding app" or look out for the posters with QR codes in the hospital Antenatal Care Unit.