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Sharon Trotter RM BSc

Midwife, Breastfeeding Consultant and Neonatal Skincare Advisor

Nursing in Practice 2008 - breastfeeding

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Breastfeeding basics: advice for new mums

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Despite numerous initiatives to support breastfeeding mothers, breastfeeding rates continue to drop dramatically within weeks of delivery. This appears to be due to lack of confidence and not, as often mentioned breastfeeding technique. Sharon Trotter explains how health professionals can reverse this trend and boost the confidence of new mothers.
Recent figures published by the Department of Health show that although the initiation of breastfeeding has risen by 7 percent to 77 percent in the past five years, the drop-off rates in the first few weeks of life are alarmingly steep with only 1 percent of mothers still exclusively breastfeeding their infant by six months of age (NHS 2005).
Exclusive breastfeeding during the first six months of life provides for all the nutritional needs of a baby. Half of these needs can still be met by breastfeeding in the period from six to 12 months. From 12 to 24 months a baby will still receive a third of its nutritional requirements from breast milk alone (WHO 2006).
Early drop off in breastfeeding may be influenced by a number of factors. A generation of bottle feeding mothers is partly responsible for eroding the primary skills needed to support and empower women during breastfeeding. Such skills need to be relearned so that women can once again tune into their own instincts and their baby’s needs. New mothers no longer have the luxury of long hospital stays or the support of an extended family to help them establish successful breastfeeding (NPEU 2006) .
Breastfeeding technique plays its part, however, confusing diagrams or hands on manipulation can be deconstructive. Successful breastfeeding has more to do with building and sustaining confidence. Cultural issues (such as the association of breasts with sex in western society) also play a part and it will take time for attitudes to change. Such are the issues that the Scottish Government had to pass legislation Guaranteeing women’s rights to breastfeed in public (English legislation is set to follow suit shortly) [OPSI 2005].
4This is helpful, but we still have a long way to go before breastfeeding is accepted as the infant feeding norm. According to a new telephone poll conducted by Kamillosan one in four top British restaurants bans breastfeeding (Kamillosan2008a) .
Kamillosan also surveyed 3,500 mums across the nation and the survey reveals new mums are terrified at the thought of breastfeeding in public. Thirty-eight percent of mothers prefer to breastfeed in public lavatories than face disapproving glares from strangers. A fifth of mums are so worried about other people’s opinions they opted to leave the baby screaming for milk rather than breastfeed (Kamillosan 2008b).
In fact, the natural bonding experience is ruined for many by negative reactions, inappropriate comments and blatant stares. A staggering 54 percent of breastfeeding mothers say they have been subjected to unwanted attention.
The question remains as to why, with all evidence pointing to a need for consistent advice and ongoing support for breastfeeding, especially in the early days after delivery, mothers are still left wanting? (Dhandapany et al 2008) [back to top]

Inconsistent advice - is this the biggest barrier to success?

In an online poll, 125 mothers reported their top three breastfeeding problems (Trotter 2008). Eighty percent of those problems were directly associated with conflicting advice. This led to physical difficulties (such as sore nipples, blocked duct, mastitis, thrush and tongue-tie) as well as psychological problems (mainly lack of confidence caused by conflicting advice). When it comes to breastfeeding advice, midwives are the key source of information for new mothers.
A National Childbirth Trust (NCT) survey found that 77 percent of women receive breastfeeding information from midwives during their pregnancy, while 20percent get information from health visitors and 7 percent from GPs (NCT 2006). Yet, nearly half of the women surveyed said they did not receive as much support as they needed regarding breastfeeding. As a result of this, more than 50 percent of women stopped breastfeeding sooner than they would have liked.
Women who took part in the Healthcare Commission 2007 survey of NHS maternity services were asked about the advice and support they had received from midwives and other healthcare professionals in relation to feeding their baby (breast or bottle) [Healthcare Commission 2007]. Almost two thirds of women surveyed felt that they did not receive consistent advice, practical help or active support and encouragement.
NICE guidance for routine postnatal care of women and their babies recommends that all maternity care providers (whether in a hospital or primary care setting) should implement an externally-evaluated structured programme that encourages breastfeeding using the Baby Friendly Initiative as a minimum standard (see Resources) [NICE 2006].
Currently, only 10percent of women give birth in a fully accredited Baby Friendly hospital. Although breastfeeding rates are considerably higher in such units, there remains a reluctance to implement this standard. This is despite the fact that hospitals with low breastfeeding rates can see these double when they become Baby Friendly. Even hospitals with relatively high breastfeeding rates can see this increase by at least 10percent with associated savings due to reduced instances of childhood illnesses such as gastroenteritis, asthma and middle-ear infection. A national breastfeeding helpline was launched in February 2008 with a yearly funding of £150,000 (DoH 2008). This service is staffed by trained volunteers from the Breastfeeding Network and the Association of Breastfeeding Mothers who answer calls from their own home. The lines are open from 9.30am to 9.30pm. This falls far short of the 24-hour service breastfeeding mother’s need, as problems are unlikely to be confined to daylight hours. The fact that this service is run by volunteers places undue pressure on women who are likely to be busy with young families of their own. Until provision is made for a fully funded helpline (manned by lactation consultants – possibly as part of the NHS 24-hour advice service) women are unlikely to receive the support they deserve when they need it.
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Building confidence is the key to success

As a breastfeeding consultant and author of Breastfeeding - the essential guide, I am all too aware of the common concerns (not necessarily problems) associated with the early days of breastfeeding (Trotter 2004). As already explained, these may include a variety of conditions that must be diagnosed promptly by someone who really understands how breastfeeding works and is able to help correct any aspect of the breastfeeding technique. Central to this process is confidence building. Being a new parent is stressful. Evidence shows that mothers who receive support from someone who believes they can breastfeed will breastfeed for longer (BBC News 2008). Such level of supportive advice from someone mothers trust, together with support from peers (family, friends or breastfeeding support group) is of most help. [back to top]


It is ironic that the introduction of artificial baby milks in the 1950s, as a way of enticing women into health clinics, has led the trend towards bottlefeeding as we know it today (Palmer 1993). The multimillion-pound promotion of these baby milks uses ever more sophisticated marketing techniques to lull parents into thinking that these products are the next-best-thing to breast milk. In reality this could not be further from the truth and the ill effects of widespread formula feeding on infant health and indeed on public health are huge. These include increased financial pressures due to ill-health on our already overstretched health service. This situation will not change overnight, but the more aware we become of the short- and long-term benefits of breastfeeding for mother and baby, the more we will understand the need for effective breastfeeding support to be a top priority rather than an afterthought (NPEU 2006). To achieve this, we must ensure that health professionals are adequately trained. However, it is also essential for support to be targeted more effectively in the early weeks of breastfeeding and for a national helpline manned by lactation consultants to be established.
There are very few difficulties that cannot be resolved and even fewer reasons why women cannot establish successful breastfeeding. [back to top]

Breastfeeding toolkit

Health professionals should have access to a Breastfeeding Toolkit in order to provide for the needs of new mums. An example of one such tool is described in an article by Nikki Lee, a lactation consultant. She introduced me to the delights of co-bathing as a tool to assist in the recovery of breastfeeding (Lee 2005). When mum and baby experience skin-to-skin contact in a warm bath, the mother’s levels of circulating oxytocin are raised. Her nipples then become more erect and it is easier for the baby to attach to the breast.
The following advice forms part of my own Breastfeeding Toolkit for new mums. I hope you will find this helpful when supporting new mothers in your care. This is what you may like to suggest:

  • Surround yourself with positive support and always include your partner
  • Get help with positioning and attachment from the start – this does not mean “hands on” manipulation of mother and baby but one-to-one explanation and reassurance
  • Be inventive – there are 360° of attachment so finding the perfect position for you and your baby may take a while and a certain amount of trial and error. You will know when you have achieved this because feeding will be comfortable
  • Breastfeeding should not hurt – if you are in pain get help from someone who really understands breastfeeding. To have a friend or a breastfeeding counsellor who is experienced in breastfeeding would be a great help at this time. Contact your local breastfeeding association (National Childbirth Trust, Association of Breastfeeding Mothers, Breast Feeding Network or La Leche League) for details of your nearest support group
  • If your nipples do become sore:
    - Correct your positioning and attachment to prevent any further damage.
    - Use a soothing ointment (chamomile, lanolin or similar natural plant-based formulations all work well) to protect them while they heal. Moist healing works twice as quickly than if left dry (Palfreyman et al 2006 & Huml 1999)
  • Biological nurturing - this is a mother-centred approach. It suggests new ways to hold and cuddle babies and aims to increase the enjoyment of breastfeeding. This can greatly help with positioning and attachment (see Resources)
  • Listen to a baby’s cues - breastfeeding can only work when it is baby led
  • Stimulate your breasts - just the smell, sight and touch of your baby will help to do this. This includes co-bathing (see above)
  • Unrestricted breastfeeding should be encouraged, especially overnight, as this helps to promote and maintain a steady milk supply
  • It takes around six to eight weeks for the delicate balance of milk supply and demand to be established, so do not be tempted to introduce bottles or formula feeds
  • During this time I do not recommend expressing as this will not stimulate milk production as well as direct feeding. Expressing also defeats the object when breastfeeding is so convenient
  • Try not to be separated from your baby – close contact (not necessarily skin-to-skin) greatly helps to stimulate milk-producing hormones
  • Close contact with dads should also be encouraged. This will help promote a closer bond as you all settle into your new family unit, no matter how big or small
  • Growth charts used in the UK are based on bottlefed babies so weight gain for your breastfed baby may appear to be slow. These growth charts will be replaced with World Health Organization (WHO) breastfeeding growth charts soon
  • As long as your baby is waking up for feeds, taking feeds well and having wet and dirty nappies, you can be reassured that they are getting enough milk
  • It is not unusual for a baby to feed between 12 and 20 times a day in the early weeks. But this will settle down – promise!
  • Breastfeeding will help you to lose the extra weight your body gained during pregnancy
  • Breastfeeding is much more than just a way of feeding your baby milk. It provides the emotional and psychological stability your baby needs to become self-confident, relaxed, independent and secure
  • Above all enjoy breastfeeding – with each feed you will get a rush of endorphins, which are basically “happy hormones”. This makes you and your baby feel good and is nature’s own stress-buster
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BBC News (2008). More breastfeeding support needed. Available from: http://news.bbc.co.uk/1/hi/health/7245218.stm

Department of Health (2008). National breastfeeding helpline launched. Available from: http://nds.coi.gov.uk/Content/Detail.asp?ReleaseID=352806&NewsAreaID=2

Dhandapany G, Bethou A, Arunagirinathan A, et al. Antenatal counselling on breastfeeding – is it adequate? A descriptive study from Pondicherry, India. Int Breastfeed J 2008;4:5.

Healthcare Commission. Women’s experiences of maternity care in the NHS in England. Key findings from a survey of NHS trusts carried out in 2007. Available from: http://www.healthcarecommission.org.uk/_db/_documents/Maternity_services_survey_report.pdf

Huml S (1999). Sore Nipples: A new look at an old problem through the eyes of a dermatologist. Practising Midwife.2 (2).

Kamillosan (2008a). Telephone poll of 100 restaurants to gauge reaction of breastfeeding in public. Available on request from info@kamillosan.co.uk .

Kamillosan (2008b). Online survey of 3500 mothers regarding views breastfeeding on breastfeeding in public. Available on request from info@kamillosan.co.uk

Lee N. Breastfeeding recovery: more tools for the helpers. Midirs Midwifery Digest 2005;15:229-33.

National Childbirth Trust (2006). Midwives top chart for breastfeeding information. Available from: http://www.nct.org.uk/press-office/press-releases/view/13

National Perinatal Epidemiology Unit. Recorded delivery: a national survey of women’ experience of maternity care 2006. Available from: http://www.npeu.ox.ac.uk/downloads/maternitysurveys/maternity-survey-report.pd

NHS Information Centre. National infant feeding survey. 2005 Available from: http://www.ic.nhs.uk

NICE (2006). Postnatal care: routine postnatal care of women and their babies. Costing report. Available from: http://www.nice.org.uk/nicemedia/pdf/implementation_tools/cg37costingreport.doc

OPSI. Breastfeeding etc (Scotland) Act 2005. Available from: http://www.opsi.gov.uk/legislation/scotland/acts2005/asp_20050001_en_1

Palfreyman SJ, Nelson EA, Lochiel R, et al. Dressings for healing venous leg ulcers. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001103.DOI: 10.1002/14651858. CD001103.pub2 http://www.cochrane.org/reviews/en/ab001103.html. (accessed on 22/5/08).

Palmer G. The politics of breastfeeding. London: Pandora; 1993

Trotter S (2004). Breastfeeding: the essential guide (ISBN: 0954838106). Scotland, TIPS Ltd.

Trotter S (2008). Online poll of top three breastfeeding problems carried out between 2007-2008 by www.tipslimited.com Available on request.

World Health Organization. Child and adolescent health and development. 2006. Available from: http://www.who.int/topics/breastfeeding/en/

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© Sharon Trotter 2013
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