FREQUENTLY ASKED QUESTIONS
Choose the FAQ category you are interested in from the horizontal navigation below. Then click on the + signs at each FAQ to reveal the answer to the question.
Choose the FAQ category you are interested in from the horizontal navigation below. Then click on the + signs at each FAQ to reveal the answer to the question.
You must be feeling quite desperate. Fortunately once treated correctly, the engorgement will dissipate quite rapidly. It is normal to have full heavy breasts round 2 to 5 days after your baby’s birth. This discomfort dissipates after a day or two if your baby is able to drink often and relieve your breasts.
However when your breasts become very swollen, tender, lumpy, and your baby becomes distressed when he tries to feed, your breast are probably engorged.
Sometimes the swelling extends all the way to the armpit and your nipples may appear flattened and sore and the baby may suck, but not receive much milk. If you develop a fever then please consult your doctor.
The main cause of engorgement is when babies are restricted to feed according to a schedule.
It is also possible that your baby may find it difficult to latch if your breasts are very full. This is easy to remedy by expressing some milk to soften the areola (dark area around the nipple).
When your breasts become engorged, take a shower or bath and express some breast milk to reduce the swelling and allow the baby to drink as much as he wants to.
Feed your baby frequently, every two to three hours. Should your baby not feed from both breasts, express the full breast just enough to make it comfortable.
Wear a supportive bra, even during the night. But be sure that it isn’t too tight.
Apply cold packs or cool cabbage leaves to the breast for a short period after breastfeeding to soothe the pain and help relieve swelling.
If you have further problems, contact a lactation consultant.
Breastfeed often to prevent engorgement. This is important as when breasts become swollen, they are more prone to infections.
If a blocked duct is not treated in time, inflammation may occur in that part of the breast. This becomes painful and inflamed and one may develop a high fever. It can be accompanied by a cold, shivery feeling or by a bad headache and general body pain. Mothers often think they have the “flu”, but have no sore throat.
The symptoms are caused by inflammation rather than an infection. In most cases the inflammation is in the tissue between the milk lobes and not in the milk ducts. As the milk itself is not affected, it is not necessary to stop breastfeeding.
The following treatment can be useful to relieve the condition:
If you have recurrent breast infections, some of the following might be a factor:
The good news is that it is possible to increase your milk supply, however, the even better news is that it is unlikely that you need to, as you are probably supplying exactly what your baby needs.
Many women think their milk supply is low and start questioning their ability to provide enough milk for their babies when they no longer feel a strong letdown reflex or their breasts no longer feel full. This is especially true, four to eight weeks after birth. This is a normal and natural sign that your body has adjusted to your baby’s feeding requirements.
Your baby’s sudden increase in appetite also does not always mean that you are not producing enough milk to satisfy his or her hunger. A baby’s active appetite could mean a growth spurt, in which case your supply will increase when your baby feeds more often.
It is seldom true that a mother is unable to produce enough milk for her baby’s needs. Usually there is an explanation and remedy for a low milk supply:
More breastfeeds will produce more milk, so feeding your baby more often will result in more milk being produced by your breasts.
Pay attention to your own need for rest, relaxation, proper diet, and fluids.
If at any time your baby seems not to be thriving, do consult your doctor.
Kangaroo Care, also known as skin to skin care, is essential for better weight gain and recovery of these babies. Cup feeding or tube feeding can be done with mother’s expressed breastmilk. By giving her baby expressed breastmilk and doing skin to skin care a mother makes a vital contribution to helping her baby fight infections and grow better. Most private hospitals provide multi-user electric breast pumps. They are also available for hire from Milk Matters (082 895 8004 or 021 6595599).
Learning to breastfeed is a gradual process for tiny premature infants. Allow him to spend time at the breast even if he does not suckle at first. It may take some time before he learns to suckle effectively.
Dad also plays an important role when giving skin to skin care to his little son or daughter.
Also see Dr Nils Bergman’s site www.kangaroomothercare.com
Nipple creams or laser treatment by an experienced physiotherapist will only help to heal the nipples when one corrects the latch as well.
Fortunately the problem of painful nipples can be easily resolved once you have had the correct assistance.
In the absence of an accompanying condition such as thrush, sore nipples are caused by an incorrect or poor latch. This means that your baby is not taking enough of the breast (nipple and areola, dark area around the nipple) into his mouth when breastfeeding.
The easiest way to correct a latch is to change your feeding position. It would be best to go to a reputable clinic or consult a lactation consultant in your area for help with this.
Also read more about positioning and latching in our Breastfeeding Basics section, and try
If you have successfully corrected the latch, your nipples may still be tender to start with but by the time you have counted to ten, they should be feeling markedly better, if not 100%.
Should your nipples continue to be painful, take your baby off the breast and try again.
Taking the baby off the breast incorrectly can also cause painful nipples. Avoid hurting your nipple by inserting your smallest finger into the corner of his mouth to break the suction and simultaneously take him off the breast.
A blocked milk duct may cause a lump, pain and redness in the breast. Your baby may also become fussy at the breast as the milk flow may be slower than before.
This occurs when the milk ducts become blocked so that milk cannot pass through to the baby. The milk glands behind the ducts then fail to drain completely causing increased pressure and pain.
The condition is often linked to:
Breast rejection can occur in the first weeks – often for unknown reasons – but also in older babies and toddlers. The mother may want to try the following suggestions:
Make sure the baby is healthy and well. His mouth may be sore due to teething or thrush, his nose may be blocked or he might have earache or some other infection.
As the baby gets older he will feed for less time at the breast. He is strong and more efficient at breastfeeding and therefore he drinks more quickly.
Try different feeding positions. Holding your baby in an upright sitting position rather than lying down, often encourages feeding. Standing or walking while feeding can help.
Cuddle your baby before feeding and try to relax while feeding. Severe tiredness and tension may slow the release of milk and the baby may become frustrated. Try massaging the breasts before and during the feed.
Don’t force your baby to feed.
Try feeding when baby is still drowsy after a nap or as he goes off to sleep.
Express a few drops of milk onto the nipple before starting to feed or offer expressed breastmilk from a spoon or dropper to whet his appetite.
Feeding in the bath could also be helpful.
Regardless of the size of breasts, big or small, they can all produce the amount of milk required. This is provided of course that the ground rules are followed:
Nipple size and shape:
In the past much attention has been paid to nipple size and shape. The key answer to this is that babies do not nipple feed, they breastfeed. Meaning, the nipple is the vessel through which the milk flows and the breast is what the baby latches on to. Early successful latching is more about the baby’s initial ability than the shape or size of the mother’s nipple.
In rare instances nipple shields could be useful, but are most often used unnecessarily.
Many mothers find that they leak milk during or between feedings, especially in the early months while milk production is still stabilising. Leaking or spraying milk is completely natural, although it can be a little embarrassing.
Once your body has established the right milk supply for your baby, you may find that leaking stops completely. This usually happens after the first six to 10 weeks of breastfeeding.
Leaking is caused by the release of the hormone oxytocin which triggers the let-down reflex. Full breasts or something that triggers your letdown reflex – hormones released during sex, hearing a baby’s cry, or even just thoughts of the baby – can cause your breasts to leak.
Leaking breast can be best dealt with by:
During the first few days the baby passes sticky, black stools (meconium) which gradually change to loose (sometime very loose) mustard – coloured stools. They may also vary in colour from bright orange to green.
After the first few weeks, it is perfectly normal for some babies to pass six or more stools per day and for others to pass only one stool every seven days when they are a little older. Exclusively breastfed babies do not become constipated.
Yes, there certainly is.
Formula feeding indicates that a baby is getting formula milk, but he could be getting it from either a cup or a bottle.
Bottle feeding indicates that a baby is getting either expressed breastmilk or formula milk from a bottle.
Yes, it certainly is recommended that your baby is fed by cup rather than with a bottle and teat, when you are not present. This would be relevant whether your baby is getting expressed breastmilk or formula, in the cup.
The reason for the recommendation is that feeding with a teat can cause ‘nipple confusion‘. Some young babies may have nipple confusion whereas older babies probably learn very quickly that the milk flow from a teat is instantaneous and that she does not have to wait for her mother’s let-down reflex when drinking form a teat.
Teats and dummies must be avoided in particular when babies have difficulty in latching. The sucking action on a dummy or teat is very different from suckling at the breast.
Should you prefer to teat-feed your breastfed baby, when for instance going back to work, it would be preferable that someone other than yourself does it. Some babies then learn to associate their mothers’ with breastfeeding and accept teat-feeding from others.
A good latch is vital to successful breastfeeding. When a baby latches well, the mother does not experience sore or cracked nipples and the baby is able to get plenty of milk.
Latching and positioning go together. The position of the mother and baby is vital to allow the baby to have a good latch, and for mother and baby to be comfortable.
Find detailed information and diagrams on Positioning and Latching in Breastfeeding Basics.
The best position for breastfeeding depends on the individual mother and baby and their particular circumstances. There are however a few general principles that apply to whatever feeding positions you may choose, and that will lead to your baby being well positioned, able to latch well at the breast and get the milk required.
Detailed information about postioning and latching, with diagrams and a link to videos, is available on our Breastfeeding Basics page.
Good latch, position and regular demand feeding will ensure:
A newborn baby’s stomach is about the size of a marble with a capacity of around 5 ml. By the time he is a week old it is around 50ml. He just can’t cope with too much, too soon.
Breastmilk is also readily digested. Most babies therefore need frequent feeds, round 10 to 12 feeds in 24 hours during the first few days. You could even wake your baby during the day time to fit in extra feeds. He is then more likely to sleep for longer stretches at night. It won’t be long before he settles into his own pattern.
Should you baby still be feeding often and not settling between feeds, after the first few days, have a lactation consultant or breastfeeding expert check your baby’s latch.
Avoid being tempted by well meaning advice about stretching your babies feeds. Take a moment to count how often you have a drink or snack during the course of a day and your stomach capacity? What’s more you have stopped growing and your baby has only just started.
Baby led feeding, otherwise known as demand feeding, means that we learn to read our baby’s cues and feed our baby accordingly, i.e. as often and for as long as our babies want to, and not according to the clock.
The best time to feed your baby is when she indicates to you that she is hungry by turning her head from side to side and/or putting her fingers or fists into her mouth.
Leaving her to cry loudly before offering the breast may be too late as babies often then need to be soothed before they can breastfeed successfully. This statement must also be taken in the right context; there will obviously be times when you are unable to immediately tend to your baby’s needs. As parents we can only strive do our best and no more.
Demand feeding your baby is the ideal way to feed your baby for various reasons:
Demand feeding may seem daunting when you have a newborn baby feeding every few hours but remember, babies outgrow the need for such frequent feeds. As they get bigger because their stomachs are able to hold more milk and the baby gets more efficient at breastfeeding.
The length of feeds may vary from feed to feed; allow your baby to drink for as long as he wants to. This allows your baby to get the milk with the highest fat content at the end of the feed. Should your baby’s feeds consistently last for an extended time and he does not settle well afterwards, have a lactation consultant or breastfeeding expert check your baby’s latch.
Points to note:
Every baby is different and some babies need to breastfeed at night for longer than others. Most babies will require fewer night feeds round 12 weeks, some much sooner.
Trying to enforce fewer night feeds could lead to milk reduction, due to the long intervals between feeds. It would be better to follow your baby’s hunger cues and “cluster” feed him in the evenings if that is what he is asking for. He is then far more likely to have a longer sleep during the night.
There is no denying, having a baby is tiring. Sleep deprivation is no fun. However, well-meaning advice is not always conducive to successful breastfeeding.
Suggestions that can have a negative effect on breastfeeding and breastmilk supply are things such as ‘get Dad to give a bottle of expressed breastmilk at 2am each night’, ‘give a bottle of formula to make the baby sleep longer’, ‘start the baby on solids to make him sleep’, etc. Rather try and breastfeed your baby more frequently during the day so that he needs less milk during the night.
It has been scientifically proven that holding your baby skin to skin and allowing him to breastfeed, when he is ready, will give your baby the best start possible.
Check and negotiate with the hospital and your obstetrician that your baby can stay with you after birth. Should your baby be born via caesarean section your husband could do skin to skin care until you are able to do so yourself.
It would be preferable if your baby were bathed after having breastfed a few times.
Should your baby need medical treatment in the nursery be sure to let the staff know that you want to practice skin to skin care as soon as your baby’s condition is stable.
Skin to skin care is particularly beneficial to you and your baby if you are planning on not breastfeeding.
If you are going to breastfeed your baby, skin to skin care will give him the ideal opportunity to feed successfully.
While pregnant you have probably noticed how others love to tell you about their pregnancies, mostly emphasizing the negative experiences. Breastfeeding is much the same; everyone has had a “problem” like yours and knows how to resolve it. The difficulty is that you have to differentiate between the good and the poor advice.
My suggestion is that you find a lactation consultant or go to a reputable Well Baby Clinic. Should you live where neither is available, decide on the person (family friend or health worker) whom you trust and listen to him or her only. It is better not to argue with your other “advisers” but to agree with whatever they say and do what makes sense to you anyway. Ignore comments like “are you feeding your baby again?” “Are you sure he is getting enough?”
Yes. Studies show that pasteurising breastmilk kills bacteria and viruses (including HIV) that may be in the milk, yet does not destroy the beneficial properties of breastmilk. It still provides the baby with immunity, vitamins, minerals and the other beneficial components in breastmilk.
No, according to our confidentiality policy donors are not able to meet the babies who receive their milk, or be given identifying information about the recipient babies or their families.
With the agreement of the recipient baby’s family, Milk Matters does share stories of some of the recipient babies but cannot state which donor mothers supplied milk to a specific baby.
Fully disassemble pump – including any valves or washers.
Always wash your hands well before expressing.
Express by hand or pump (see expressing page for more details).
If expressing using a pump, fully disassemble all the pump parts, wash and sterilise before each pumping session.
We prefer boiling or steam sterilising but do recognise that not all pumps can withstand such high temperatures and that you may need to use a cold sterilising solution. Consult the pump manufacturer’s instructions.
Please avoid using bulb-and-funnel pumps as they are extremely difficult to wash and sterilise.
Second-hand or hired breastpumps are not recommended, with the exception of the Medela Lactina multi-user pumps if each user has her own attachments unused by others
The containers that you receive from our depots are sterile. Do not touch the inside of the container or lid.
Should you need to sterilise your own containers:
Containers need not be full – however much milk you express in that session is fine.
A new container must be used each time you express.
Always leave plenty of space at the top of the container to allow room for expansion of the milk on freezing.
Milk Matters supplies donors with sterile containers.
Transport in a coolbox box with ice bricks to your nearest depot.
For details of your nearest depot, or to discuss alternative arrangements should it not be possible for you to go to a depot, please contact Milk Matters.
Please ensure that the breastmilk remains frozen at all times.
A processing fee is charged to the hospital using the milk to partially cover the cost of collecting, screening, pasteurising and dispensing the donor milk. The milk itself is not sold.
Yes, you can donate your breastmilk.
All breastmilk, including breastmilk for a baby of over one year of age, is nutritious and contains antibodies and the other components that babies need.
No, not at all. Whilst ‘premature baby breastmilk’ is ideal for the premature babies we supply with donor milk, they still get far more nutrients, immune boosters, antibodies and protection from ‘older baby breastmilk’ than they do from any breastmilk substitute.
Yes, Milk Matters is based in Cape Town, South Africa. Donors need to be in Cape Town and surrounding areas, including various towns in the Western Cape. Contact Milk Matters to enquire about a depot near you.
That is your choice. How often you express milk to donate is up to you.
Many donors find it best to express at a regular time/s each day, because this helps maintain the extra supply of milk. Some donor express at a certain time, others after each or some feeds, others on alternate days and yet others whenever they can manage it. Do what works for you
That is entirely up to you. Regular small donations of 50ml are just as welcome as donations of larger amounts. Every drop counts.
Once-off donations of frozen breastmilk you have collected but do not need are most welcome. For example, if you have been expressing for your own premature baby and have more frozen milk than you can use, donating it to Milk Matters would mean that another baby would benefit.
Most mothers have enough milk to donate as breastmilk is produced on a supply and demand basis. The more often you empty your breasts, the more milk you will produce.
By expressing extra milk for another baby, you will not deprive your baby in any way. In fact there will be more milk available to your baby as expressing increases milk production. Emptying the breasts often, whether by feeding your baby or expressing your milk, enhances milk production.
It is much more efficient from both a staffing and cost point of view for milk to be collected from depots every few weeks or when a small stock-pile of milk has built up, rather than more frequently. Just as the milk is vital for the survival of the babies, careful use of funds is essential for the survival of Milk Matters.
Whether the milk is stored for a few weeks at a depot first or taken straight to Milk Matters head office, every drop is precious and great care is taken to ensure it all reaches the babies who need it most.