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 concerns.

Skin to skin means what is says - your baby's bare body lying 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 other’s eyes and begin your special relationship. Skin to skin is a very important first step for all mothers, regardless of how they intend to feed their baby.

Your bare chest is a warm and safe place for baby to start life outside the womb. Your baby can hear your heartbeat and feel you breathe while they smell, touch, and get to know you. They can also use their instincts to help them breastfeed during this time.

Skin to skin in the first hour of life:

• Calms and relaxes both mother and baby.
• Regulates baby’s heart rate, temperature, and breathing.
• Stimulates digestion and breastfeeding behaviour/instincts.
• Protects baby from infection as baby’s skin is colonised with their mother’s healthy bacteria.
• Stimulates the release of hormones to support breastfeeding and mothering.
• Promotes bonding and the relationship between parent and baby

Skin to skin in the first hour of life improves breastfeeding outcomes as babies use their instincts to search for the nipple. Breastfeeding in this first hour, helps establish your milk supply.

Even many mums who have decided to formula feed decide to offer the first feed as colostrum while having skin to skin with their baby. 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 of your baby. When you are struggling with breastfeeding, skin to skin helps to teach you how to respond to each other and learn how to breastfeed 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, your partner may 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. Spending time doing skin to skin with your baby is also a great way for your partner 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 Nursery (SCN), skin to skin will be encouraged as soon as your baby is stable. This is often called Kangaroo Mother Care and will be done as often as possible while your baby is in SCN. Be prepared to sit with your baby doing skin to skin for at least an hour each time. There may be tubes and equipment connected to your baby, but the nurses will help you to get comfortable and keep baby safe. Skin to skin can help with reducing pain for your baby, keeping them calm and secure. It also helps with their development and helps to establish breastfeeding when they are ready.

Sometimes skin to skin will not be safe. If you are very tired and/or medicated after giving birth, you may find it difficult to stay awake and safely care for your baby during skin to skin. Having your partner or support person sit with you during this time can assist with keeping your baby safely 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.

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 where your baby may need extra food in the first few days after birth, this will be discussed with you. Your midwife can answer more questions about expressing colostrum in pregnancy; see the page “Expressing your first milk” below.

Colostrum's function is to protect your baby – it helps good bacteria (probiotics) to establish a healthy gut and lines the baby's gut to prevent bad bacteria from attaching and making the baby unwell. Even just one feed of colostrum can have health benefits for your baby. Most babies do not need anything more than colostrum in the first few days. The amount of colostrum increases over the first few days with your breast milk supply usually surging between the 2nd and 4th day after the birth.

If your baby is not able to suckle at your breasts in the first days after birth, you will be shown how to hand express colostrum to feed to your baby (using a syringe or small cup). Expressing colostrum will help your milk to surge around the third day after birth. It is important to start this process in the first hour after birth if your baby does not breastfeed as this helps you to have plenty of milk in the months to come.

If your baby is unwell or born prematurely, 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 this will be discussed with you.

Babies 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 your baby’s way of telling you they are ready to eat. They are quite subtle. Your baby may lick their lips and open their mouth seeking something to suck on, and 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, they may only feed a few more times during 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.

If you are not breastfeeding, do not 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 at night. Ask your partner or support people to sit with your baby while you have a nap during the day, 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, this is very normal as your baby wants to feel safe and close to you. Continue to offer small, frequent amounts of milk and do not 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 nutritional requirements your baby needs. We do not recommend any particular brands.

Between the second and fourth day after birth you will notice your breasts will begin to feel heavy and warm and the veins may appear more prominent. This is because your breasts are filling.

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 these needs.

You can expect your baby to have 8-12 feeds in 24 hrs in the first six to eight weeks for both breast and formula feeding babies. As baby grows you can expect feeding sessions to become shorter as babies get better at getting their milk. They may feed a little less often as their stomach size grows to fit more milk at each feed, and your milk changes to sustain baby for longer between feeds. Nighttime 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.

At around 6 months old, 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 and messy time. Continuing breastfeeding through the introduction of new foods may protect against allergic reactions. Continuing to breastfeed until your baby is two years old or older continues to provide many important health benefits to both you and your baby.

Knowing if your baby is getting enough milk is something many parents worry about. Your breasts can give you a good indication of how much milk the baby has drunk. Once your milk has surged and your breasts feel heavier and fuller, feel your breasts before the feed starts and then again at the end of the feed. They will feel firm or heavy before the feed. They should feel softer and lighter when your baby has finished feeding. 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.

Your baby's nappies are another good way to tell if your baby is getting enough milk. 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. At the end of the first week, there will be at least five heavy wet nappies in every 24 hours and regular soft, yellow stools.

Weight changes - your baby will be weighed on their day of birth and then on the third or fourth day. It is normal to have up to 10% of their birth weight lost in the first few days. 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 two weeks for them to get back to their birth weight. This is very normal.

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 occurring 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. Do not be tempted to over feed your baby. You should expect small frequent feeds in the first few weeks. Offer smaller amounts in the bottle initially, and as baby grows and they empty the bottle but do not appear content, increase 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.

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 type 2), polycystic ovarian syndrome, or women expecting small or large babies. If you are interested in expressing your milk during pregnancy talk to your midwife or lactation consultant, she will teach you how to express and give you an instruction sheet and small syringes to collect the milk. You store the syringes in the freezer, labelled with your name and the 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 from 36 weeks of pregnancy; your midwife or doctor can confirm this for your own circumstances. You are welcome to call the St George Breastfeeding and Lactation Information and Support Service (BLISS) for advice (9113 2053).

Antenatal expressing is always done by hand, two-three times per day from 36 weeks or as advised by your midwife/doctor. It works better if your breasts are warm and you are relaxed, so after a shower is ideal. You can expect to get a small amount - nothing or a couple of millilitres is normal. Most women will find they can get a little bit more with practice and time. If you are finding it difficult to get any colostrum, ask your midwife to show you the hand expressing technique again. You will not 'run out' of colostrum (your breasts keep making it) and you cannot make your milk surge (‘come in’) while you are pregnant.

If you experience any cramping pain while expressing, stop expressing unless you are close to your due date. If it does not go away call your midwife or the birthing unit at the Hospital. There should be no change to your baby's movements when you are expressing.

For more information:

Antenatal expressing - brochure

First Droplets Website

Australian Breastfeeding Association: Antenatal Expressing of Colostrum

After your 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 during your hospital stay. If your baby cannot attach to your breasts, 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, 2-3 cm back from the nipple and push back into the breast. Press your fingers towards each other, firmly but not to cause pain, then release and repeat until you have small beads of colostrum or until you have a let down. Continue this pattern and collect the milk in a clean container. Store the milk in the fridge or freezer until needed.

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 prescribed and over the counter medications, and 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 your medications without a problem. 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 about 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 
• The Australian Breastfeeding Association also has information on their website 
• The Lactmed database also has information on medications and chemicals for breastfeeding women
• These are all free services

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 meal can help you manage the needs of a new baby. Offering bottles to a breastfeeding baby will 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 the baby for a walk in the pram or sit with the baby while you sleep or shower or have a break for 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 for further care if needed. The following websites have information and support for parents:

• PANDA (Perinatal Anxiety and Depression Australia)
• Beyond Blue: parenting.
• COPE (Centre of Perinatal Excellence)

Videos:

The following videos can provide you with more information on both breast and formula feeding:

• Australian Breastfeeding Association: Breastfeeding basics.
• Breastfeeding Myths and Mysteries.
• 'Ngaminjang Djama' Breast Milk Talk.
• NSW Health: Breastfeeding your baby.
• The first hour: Skin to skin time with your baby.
• Global Health Media: Breastfeeding videos (in many languages)

Websites:

• Australian Breastfeeding Association
• Heat and health for babies and young children
• Lactation Consultants of Australia and New Zealand
• MotherSafe - Medications while breastfeeding
• NSW Health
• NSW Health – Breastfeeding. Good things take time
• NSW Multicultural Health Communication Service
• St George and Sutherland Child and Family Health Nursing Services

Brochures:

• BLISS brochure
• Breastfeeding after breast surgery
• Breastfeeding and returning to work
• Breastfeeding support while you or your baby are hospitalised or unwell
• Breastfeeding tips for new mothers
• Expressing and storing breastmilk
• Increasing your milk supply
• Mastitis
• Nipple shields
• Preparing formula feeds and sterilising bottles
• Supplementary feeds for healthy, full term babies
• Use and care of dummies
• Weaning or supressing lactation