Gentle First Year: The Essential Guide to Mother and Baby Wellbeing in the First Twelve Months

Most textbooks on breastfeeding explain that the breast milk flows in two stages: the fore milk and hind milk. Whilst I respect this viewpoint, I reject the concept that there are two types of milk. I am also sceptical of rigid feeding times in the first two weeks. Some babies are better than others at breastfeeding, and their skill can make a big difference to how long a feed takes. Another important factor is how quickly the mother ‘lets down’ her milk. Again, some are faster than others, which determines how long the baby is on the breast. I therefore advise my mothers to relax if their baby stays on an individual breast for just 20 minutes.

Breastfeeding Problems in the Second Stage

This second stage of breastfeeding is characterized by engorgement and leaky nipples, and mastitis is most common at this point. This is because it takes a few weeks for the milk supply to even out. Mastitis occurs when residual milk becomes compacted and the surrounding tissues inflamed. If you suffer from mastitis but are leaving the baby on for 40 minutes or more, check the baby’s latch (see box, correct latch technique and tips). Poor latch technique is incredibly common and can lead to prolonged and inefficient feeding. Sometimes the difference between a good and poor latch can be a matter of millimetres, so I strongly recommend seeing a specialist/counsellor at a breastfeeding clinic who can analyse and correct your latch. (Your midwife/health visitor will be able to give you details of your local clinic.)

Mothers sometimes get into a habit of feeding their baby in one position, or they favour one side over another. Vary your routine, but always start each feed on the same side you finished the previous feed. Some mothers keep a notebook next to their feeding chair to remind themselves of whether it’s left or right this time, but you can also try reminding yourself by pinning a ribbon around the front clasps on your breastfeeding bra or wearing a hair band on the corresponding wrist. I laugh that you can always tell the more practised breastfeeding mothers – they’re the ones who absent-mindedly cup their breasts (one side will be heavier than the other) or gently press the upper breast area in the café or in the park. They become so fine-tuned to the subtle difference between breast swell and heaviness, they check their breasts unconsciously!

Introducing a Feeding Routine

This is also the time to introduce more of a feeding routine, rather than baby-led demand feeding. I recommend a schedule of feeding every three to four hours in a 12-hour day. I have noticed that when babies are introduced to breastfeeding within an hour of birth, they naturally seem to want to feed at more regular intervals and sleep for longer intervals between feeds.

THE THIRD STAGE

By four months, into the third stage, the leaky nipples and feeling of engorgement/heaviness have gone. It is common for many mothers to think their milk supply is drying up and so stop breastfeeding. This is usually an incorrect assumption. Often the lack of engorgement is just a case of the milk supply being highly regulated – both in quantity and timing – as the breasts adapt very quickly to their natural role. They’re still full, just not swollen. It’s worth remembering during this ‘doubting’ period that breast milk provides all the nutrition that most infants need up to six months of age, and that it is still the best option for your baby. Unfortunately, this advice tends to fall on deaf ears, as in the UK only 28 per cent of mothers are still breastfeeding by four months, and 21 per cent by six months.

Breast milk provides all the nutrition that most infants need up to six months of age.

Bear in mind, too, that milk supply is a question of mental attitude. Milk is produced by the hormone prolactin and is let down by the hormone oxytocin, both of which are regulated by the pituitary gland in the brain. So although milk comes from the breast, it is controlled by your brain. If you believe in your ability to produce milk and wholeheartedly want to carry on breastfeeding, you will produce sufficient milk.

If you are worried about your milk supply, consider using an electric pump (so much better than the manual ones) very gently for 15 to 30 minutes at the end of the day. You may well have scarcely any milk (1–2oz) at this time for the first few days but that will very quickly build up as your body responds to the new demand. Also, keep an eye on your diet, particularly once you start weaning (from four to six months) and begin to drop feeds. That is the most dangerous time for breastfeeding as the reduced number of feeds is registered as less demand by the brain, so less milk will be produced. Avoid skipping meals (in fact you must try to eat up to 500 calories more, each day). Drink at least two litres of water per day and avoid alcohol. Exercise only gently and rest/sleep properly. You’d be amazed at what effect tiredness has on milk production!

How To Make Great Milk

WHAT TO EAT

The hormones in your body naturally make milk after birth (even whilst you sleep), but quality control is your responsibility. Those of you who followed the gentle birth method will be used to a fairly controlled diet. If you are new to the gentle way, this may come as something of a shock: I advocate a sugar-free, wheat-free diet during pregnancy to moderate the weight gain of both mother and baby, and minimize fluid retention.

For at least the first month after birth (and longer if they can bear it), I encourage my mothers to stick to their antenatal diet but for quite different reasons. In the womb, your baby will have ingested what you ate, and so have become accustomed to your dietary tastes. After birth, your milk will be uniquely and subtly flavoured according to your preferences, and it is my personal belief that many instances of colic/wind in babies can be attributed to the mother’s sudden change in dietary habits.

You can go for a low-wheat, rather than no-wheat diet, and keep sugar to a minimum – but rather than thinking about restrictions, you should try to think about what your diet can do for your milk.

Try to think about what your diet can do for your milk.

The way to view it is that until the baby is fully weaned, breastfeeding is, to all intents and purposes, another segment of pregnancy – your baby is still as dependent on you for nourishment as she was in utero. Of course, watching your diet is another sacrifice for you, and after nine long months of pregnancy and a tiring birth, you may well have had enough, but you’re on the home straight, and this is a relatively short period of time in the grand scheme of things.

Foods to choose:

Small fish (high in omega fats) such as sardines, kippers and herrings

Lean proteins

Vegetables

Oats

Salads

Fruits

Lots of water (room temperature)

This will create a nourishing, rich milk upon which your baby will both thrive and settle. I think that poor-quality milk is a prime suspect in fractious, irritable babies.

FISH SOUP AND GREAT MILK

In the tropics where I grew up, the fisherwomen’s baskets were full of small coin-like fish, or little elongated fish or sardines. They were all grouped together under the common name podimeen, which literally means ‘small fish’. I distinctly remember my grandmother advising my mother to make a light soup of these fish and consume it daily to improve the quality and quantity of breast milk to feed my younger siblings. Perhaps you could modify a suitable recipe from your cookbooks at home to take whilst breastfeeding?

POSTNATAL PUDDING

Something I recommend highly, but which is quite a cultural departure for most of my mothers, is the postnatal pudding, raagi kallie (a common name for a nutritious pudding or paste). In southern India, this pudding is made from a grain called raagi (‘finger corn’ in English), but you can make kallie using ground millet grains.

Recipe for Raagi Kallie

Take a cup of powdered grain and add to a pint of boiling water in a saucepan on the hob. Stir the mixture all the time. As it begins to thicken, add two tablespoons of ghee (clarified butter) and a tablespoon of powdered jaggery (palm sugar) till the whole mixture takes on the consistency of firm dough.

The end product is warm, moist and very tasty – little wonder that it’s an intrinsic part of the immediate post-partum programme in India. Formulated especially for the needs of the new, breastfeeding mother, it contains high levels of calcium, protein, fat and carbohydrate, which all provide amazing nutrition for good breast milk production. Of course, you’ll have precious little time to make this yourself, so following the red tent concept (see the importance of bonding), ask someone close to make it for you. You may feel like this is another favour to ask other people to do for you, but people always want to help when there’s a new baby and I’m sure your partner, mother, best friend or doula would be delighted to make it for you during the first two weeks after the birth. The ingredients themselves are cheap and can be easily found at larger supermarkets or at Asian grocers (I found jaggery at Tesco).

WHAT TO DRINK

So your diet should be optimal, and so should your fluids. Keep off alcohol, especially spirits, but if manners or sanity dictate accepting a small tipple, limit it to one small glass of wine on very special occasions. If you can’t completely give up tea or coffee, please at least give up coffee and drink just cups of weak tea – but if your baby is unsettled or windy, you’ll have to come off it altogether. Herbal and green teas are ideal. Many midwives swear by fennel/nettle tea for reducing wind/colic/fretfulness in babies. Please remember to drink at least two litres of water per day, as hydrating yourself will boost your milk volume and quench your baby’s thirst. Keep a bottle of water next to your feeding chair and another next to your bed so that it’s always to hand – many mothers report a mad thirst as soon as they begin a feed.

PROBIOTIC SUPPLEMENTS

As with the gentle birth method, I advise you to top up your diet with probiotics to help encourage the growth of friendly bacteria in your gut and prevent thrush (which is very common in the first week after birth). And a supplement of digestive enzymes will ward off indigestion and prevent bloating, both of which are problems due to the massive hormonal shifts after birth. By extracting every morsel of goodness from your diet, these supplements will help boost the quality of your milk; and by eliminating wind from your digestive system, the milk you pass on to your baby should be correspondingly flat.

EXERCISE

Strenuous exercise should be avoided for the first few weeks, certainly the first three, and ideally introduced after six weeks. This is because your body is still tired from the birth and trying to recover. You will probably find that you are losing a lot of weight in these first few weeks anyway and added exercise could have a big effect on your milk production, especially in the early days. Your body needs an extra 500 calories per day just to breastfeed (that’s more than double the excess you needed during pregnancy) so do conserve your calories, or the quality of your milk will suffer.

COMPLEMENTARY THERAPIES

If you think your milk supply is low by the end of the first week, homeopathy can really help your milk come in. I recommend the following, three times a day for three days:

Sepia 30c – If you are exhausted

Cocculus 30c – If you are exhausted with broken sleep

China 30c – If you are exhausted from breastfeeding

I also prescribe to the mothers at my clinic a homeopathic remedy that supports breastfeeding. I source this remedy from a revered 95-year-old homeopath in India. The formula decidedly improves the quality of breast milk and is great for the early days during transition from colostrum to more copious quantities of breast milk. He has named it Lactors and the remedy includes Calc flour 6c, Lecithin 6c and Asafoetida 6c (see Resources for details).

Reflexology has long been known to improve lactation, and I always perform some reflexology on the new mothers at my clinic. It has now been formally trialled at one of the main teaching hospitals in London to see if it can improve breast milk production for mothers of premature babies, and the results were favourable. I hope this will mean a more widespread take-up of reflexology among postnatal health professionals such as midwives and health visitors, and at breastfeeding clinics.

Case History: Reflexology and Breastfeeding

One of my colleagues referred a mother of Asian origin to me, just one week after her baby was born. She was unable to produce any breast milk at all.

I prescribed deep reflexology three times a week, concentrating on the pituitary and hypothalamic reflex areas in the brain, as well as on the breast reflex and digestive areas. I also prescribed my favourite homeopathic remedy, Lactors, which improves breast milk production. Along with this I advised her to make a soup of small-boned fish like sardines or whitebait (see FISH SOUP AND GREAT MILK). She was advised to pressure-cook the fish – to really pulp it so that the bio-available calcium could be extracted from the fish to help her lactation. I also recommended a daily drink made from an infusion of fennel seeds (see below).