Ebm baby feeding
Feeding expressed milk | introducing bottle
When can you start feeding your baby expressed breast milk? What’s the best way to do it? And should you be concerned about ‘nipple confusion’? We answer your questions about expressed milk feeding
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When should I start giving my baby expressed milk?
If your baby is healthy and breastfeeding is going well, there’s no need to rush into giving her expressed milk. For the first four weeks, you’re working together to initiate and build your breast milk supply while she learns to breastfeed efficiently. While there is limited data,1 it is thought that unnecessarily introducing bottles during this crucial first month could interfere with these processes.
But if your newborn struggles to latch or suck for any reason, then start expressing milk as soon as possible after the birth. Read our articles on overcoming problems in the first week and feeding breast milk to your premature baby or infant with special needs for more advice, as well as getting support from your healthcare professionals.
How can I feed expressed milk to my baby?
There is a range of expertly designed feeding solutions that can help you give expressed milk to your baby, depending on your and her needs.
For example, Medela’s innovative Calma teat will only allow milk to flow when babies create a vacuum by sucking. This means they can feed from a bottle using the same technique, tongue motion and jaw movement they would at the breast.2,3 Developed with breastfeeding experts from the University of Western Australia, Calma allows your baby to suck, swallow, pause and breathe just as she does when breastfeeding.4 By maintaining babies’ natural sucking behaviour, Calma is designed to make it easy to switch from breast to bottle-feeding and back again.
Medela also makes conventional bottle teats in two flow versions. And all our teats can be attached directly to the bottles you express milk into, minimising the risk of spillages.
If your newborn needs expressed milk, but you don’t want to offer her a bottle until she’s become used to breastfeeding, you could use a baby cup designed for short-term feeding.
This allows your baby to sip or lap your expressed milk – be careful to avoid spills! It’s advisable to have a healthcare professional on hand the first time you use the baby cup, to make sure you’re both getting the hang of it.
For babies who need expressed milk supplements in addition to regular breastfeeding, a supplemental nursing system (SNS) can be helpful. This has a thin, flexible feeding tube that can be fixed alongside your nipple to give your baby expressed milk while you’re breastfeeding her. This allows your baby to stay at your breast longer, which further stimulates your breasts to help maintain your milk supply, and also helps improve her breastfeeding skills. It can be useful for mums with low milk supply or with adopted or surrogate babies.
If your baby can’t create the suction needed to breastfeed – perhaps because of a disability, congenital condition or weakness – you could try a feeder designed for babies with special needs. These allow infants who can’t suck to feed using gentle compression instead.
What’s the best way to introduce a bottle?
If breastfeeding is going well and you’ve decided it’s the right time to give your baby a bottle of expressed milk, follow these tips:
Take your time
Don’t wait until your big night out or first day back at work to introduce your baby to the bottle. Start trying with a small amount of expressed milk, in a relaxed and unhurried way, a couple of weeks beforehand. Gradually build up to giving a full feed of expressed breast milk from a bottle.
Pick your moment
Ideally your breastfed baby should be alert, but not too hungry, the first time she has a bottle of expressed milk, so that she is as relaxed as possible.
Delegate feeding duties
Your baby may be confused or frustrated when you offer a bottle, as she’s used to your breast. It might be easier if someone else gives the first bottle, and you stay out of the room so your baby can’t see or smell you.
Not too hot, not too cold
Your baby may be more likely to take the expressed milk if it’s around body temperature, 37 °C (98.6 °F).
Dip and sip
Try dipping the bottle teat into some expressed milk before offering it, so it tastes and smells of your breast milk. Then gently stimulate your baby’s top lip with the teat to encourage her to open her mouth.
Positioning for bottle-feeding
Feed your baby on demand and cuddle her in a semi-upright position. Never bottle-feed her while she’s lying flat or prop her up with the bottle, in case of choking. Go at her pace, with as many pauses as she needs – you can even try switching sides during the feed.
Be patient
Don’t worry if she doesn’t take to the bottle straight away – it may take several tries. If she pushes the bottle away or becomes upset, comfort her and wait a few minutes before trying again. If she still won’t drink from the bottle, wait a few more minutes and then breastfeed her as normal.
Try again with the bottle at a different time of day.
How much expressed milk should I give my baby?
Every baby is different. Research shows that in babies aged one to six months, one baby may take as little as 50 ml during a feed while another may take as much as 230 ml. Start by preparing a bottle with around 60 ml, and see if your baby needs more or less. You'll soon learn how much she typically takes – but don’t ever pressure her to finish the bottle.
How can I ensure bottle-feeding is safe for my baby?
Always clean and sanitise your breast pump set and bottles according to the instructions, and wash your hands before pumping, handling milk or feeding your baby. Follow our guidelines for storing and thawing your expressed milk safely.
If warming your breast milk, place the milk bottle or bag into a bowl of warm water or a warmer, or run it under a warm tap (max 37 °C or 98.6 °F). Never warm breast milk in the microwave or on the stove top.
Will my baby cope with switching from breast to bottle?
Mums sometimes worry that if they introduce a bottle too soon, their baby will get accustomed to the artificial teat and struggle to return to breastfeeding.
Others are concerned about the opposite problem – if they don’t get their baby used to a bottle early she may never accept one later. Both of these problems are commonly referred to as ‘nipple confusion’.
Experts disagree on whether nipple confusion is really an issue.1 Certainly sucking from a conventional bottle teat that doesn’t require a vacuum to be created is less effort for a baby than sucking from mum’s nipple, as the milk flows more freely and gravity lends a hand. And some babies do seem to have a preference for breast or bottle, and never take to the other. But many babies switch happily between the two.
If you’re still struggling to feed your baby expressed breast milk, speak to a lactation consultant or breastfeeding specialist.
References
1 Zimmerman E, Thompson K. Clarifying nipple confusion. J Perinatol. 2015;35(11):895-899.
2 Geddes DT et al. Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only.
Early Hum Dev. 2012;88(6):443-449.
3 Segami Y et al. Perioral movements and sucking pattern during bottle feeding with a novel, experimental teat are similar to breastfeeding. J Perinatol. 2013;33(4):319-323.
4 Sakalidis VS et al. Oxygen saturation and suck-swallow-breathe coordination of term infants during breastfeeding and feeding from a teat releasing milk only with vacuum. Int J Pediatr. 2012;2012:130769.
How to combine breast and bottle feeding
It can take several weeks for you and your baby to feel happy and confident with breastfeeding.
Once you've both got the hang of it, it's usually possible to offer your baby bottles of expressed milk or formula alongside breastfeeding.
This is sometimes called mixed or combination feeding.
Why combine breast and bottle?
You may want to combine breastfeeding with bottle feeding if you:
- are breastfeeding and want to use a bottle to offer your baby some expressed breast milk
- want to breastfeed for some of your baby's feeds, but give bottles of formula for 1 or more feeds
- are bottle feeding your baby and want to start breastfeeding
- need to leave your baby and want to make sure they have some milk while you're away
Introducing formula feeds can affect the amount of breast milk you produce.
There is also a small amount of evidence to show babies may not breastfeed as well because they learn to use a different kind of sucking action at the bottle than at the breast.
These things can make breastfeeding more difficult, especially in the first few weeks when you and your baby are still getting comfortable with breastfeeding.
Your breastmilk supply will usually not be affected if you start bottle feeding your baby when they are a bit older, you are both comfortable with breastfeeding, and you breastfeed every day.
Introducing formula feeds
If you're combining breastfeeding with formula feeds both you and your baby can carry on enjoying the benefits of breastfeeding.
If you choose to introduce infant formula:
- it's best to do it gradually to give your body time to reduce the amount of milk it makes – this helps lower your chance of getting uncomfortable, swollen breasts, or mastitis
- if you're going back to work, start a few weeks beforehand to give both of you time to readjust
- if your baby is 6 months old or more and can drink milk from a cup, you may not need to introduce a bottle at all
For more information, see drinks and cups for babies.
Giving your baby their first bottle
It may take a while for a breastfed baby to get the hang of bottle feeding, because they need to use a different sucking action.
- it usually helps to give the first few bottles when your baby is happy and relaxed – not when they're very hungry
- it may help if someone else gives the first bottle feeds, so that your baby is not near you and smelling your breast milk
- you might want to try using a different position for bottle and breastfeeding
See more advice on how to bottle feed.
Restarting breastfeeding
If you want to start breastfeeding more and give your baby fewer bottles, it's a good idea to ask your midwife, health visitor or breastfeeding supporter for support.
These tips may help too:
- Hold and cuddle your baby as much as possible, ideally skin to skin. This will encourage your body to make milk and your baby to feed.
- Express your breast milk regularly. Expressing releases the hormone prolactin, which stimulates your breasts to make milk. About 8 times a day, including once at night is ideal. It may be easier to express by hand to begin with – your midwife, health visitor or breastfeeding supporter can show you how.
- Try bottlefeeding while holding your baby skin to skin and close to your breasts.
- If your baby is latching on, feed little and often. Do not worry if your baby does not feed for long to begin with. See tips on how to get your baby properly positioned and attached.
- Choose times when your baby is relaxed, alert and not too hungry, and do not force your baby to stay at the breast.
- Decrease the number of bottles gradually, as your milk supply increases.
- Consider using a lactation aid (supplementer). A tiny tube is taped next to your nipple and passes into your baby's mouth so your baby can get milk via the tube as well as from your breast. This helps to support your baby as they get used to attaching to the breast. Your midwife, health visitor or breastfeeding supporter can give you more information.
See more tips on boosting your milk supply.
Help and support with mixed feeding
If you have any questions or concerns about combining breast and bottle feeding:
- talk to your midwife, health visitor or breastfeeding supporter
- call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm, every day)
- find breastfeeding support near you
Video: why combine breast and bottle feeding?
In this video, 3 mothers discuss ways to combine breast and bottle feeding.
Media last reviewed: 14 March 2023
Media review due: 14 March 2026
Page last reviewed: 8 October 2019
Next review due: 8 October 2022
International guidelines for emergency contraception
According to the EBM Guidelines "Postcoital contraception", the most effective method of postcoital contraception is the placement of a copper-containing IUD within 5-6 days of unprotected intercourse.
The best effect from the use of tableted hormonal postcoital contraceptives is observed within 12 hours after unprotected intercourse.
In this article on estet-portal.com, we will consider the features of the use of postcoital contraceptives, which are described in modern international protocols.
Levonorgestrel as an effective and safe means of emergency contraception
Tablet media intended for emergency postcoital contraception, the drug of choice is levonorgestrel.
Levonorgestrel is safer and more effective than the Yuzpe regimen (combination of ethinyl estradiol and levonorgestrel).
Levonorgestrel 1.5 mg orally is given as soon as possible, but no later than 72 hours after unprotected intercourse.
After more than 72 hours have passed since unprotected intercourse, the use of levonorgestrel is useless. In such cases, consideration should be given to other methods of emergency contraception (eg, insertion of an intrauterine device).
Pregnancy due to the timely use of levonorgestrel occurs in 1-2.5% of women. Possible side effects of this drug include mild nausea.
Emergency contraception: do not overuse
Use of ulipristal acetate as emergency contraception
Current international guidelines also recommend the use of ulipristal acetate as emergency contraception.
Uripristal acetate is a synthetic selective progesterone receptor modulator.
This drug can be used at a dose of 30 mg within 120 hours (5 days) of unprotected intercourse.
When uripristal acetate is used within the first 72 hours after unprotected sex, the contraceptive effect is similar to that of levonorgestrel.
In a study where emergency contraception was given to women between 72 and 120 hours after unprotected intercourse, the pregnancy rate was 2.1%.
Possible side effects include abdominal pain and nausea, less often dry mouth, irritability, and headache may be present.
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Features of emergency contraception during breastfeeding
According to the EBM Guidelines "Postcoital contraception", breastfeeding is not a contraindication to the use of levonorgestrel as emergency contraception. However, international protocols recommend skipping one feeding session after taking Levonorgestrel.
Following the use of ulipristal acetate as emergency contraception, international guidelines recommend stopping breastfeeding for one week.
For more information on safe methods of contraception during breastfeeding, see the article
Contraceptives and lactation: effective and safe methods
Non-hormonal intrauterine device as a means of emergency contraception
A copper-containing non-hormonal IUD should be inserted within 5 to 6 days of unprotected intercourse, then used as a regular method of contraception if needed.
If the patient has reason to suspect cervicitis, the intrauterine system should be installed by the doctor at his discretion, depending on the severity of the inflammatory process.
Material for detection of infection (gonococcal and chlamydial) should be taken before the system is established, and a course of antimicrobials should be started without waiting for the results.
Thank you for staying with estet-portal.com. Read other interesting articles in the Gynecology section. You may also be interested in On the verge of fantasy: contraception of our future
Articles
In the wake of the oncology symposium.
Interesting facts that make you think.
Breast cancer - fairly well researched. Risk factors contribute to its development:
- use of aluminum-based antiperspirants (increases the risk by 2%),
- wearing a tight bra with underwire (1%),
- contact with carcinogens (work in hazardous industries, poor ecological state of water and air - a different percentage for different studies),
- excessive physical activity (professional athletes have a risk higher by 3%),
- unhealthy diet (no exact data),
- use of hormonal contraceptives (1.56%),
- Further proven preventive factor is at least 4 years of breastfeeding (that is, 2 children per 2 years, or three children for a year and a half, etc.) - this reduces the risk of developing breast cancer by 80%! Each year of breastfeeding reduces the risk of cancer by 20%.
But there are studies on different groups of women in relation to reproduction and breastfeeding:
no pregnancy and breastfeeding - the risk is 30% higher.
Presence of abortions in anamnesis, no childbirth and breastfeeding - higher by 50%.
Had a baby, but breastfeeding for less than 6 months - 15% higher risk.
While there are no reliable data on in vitro fertilization, but since it uses hormonal stimulation, which is quite strong and aggressive, then hypothetically IVF should increase the risk of breast cancer significantly. Although, breastfeeding a child under 2 years of age should offset this increased risk.
- Another interesting and little known factor is the time between the first period (menarche) and the first birth. Ideally, to reduce the risk of oncopathology, this time should be 5-7 years. The longer this interval, the more atypical cells are formed in the mammary gland, uterus and ovaries, that is, the higher the risk of cancer of the female reproductive system.
- Genetic predisposition - increases the risk from 5 to 10% according to different authors
- Infectious diseases of the reproductive system (sexually transmitted diseases) - higher by 3-10%
It should be understood that all these percentages are reliable statistics, but not a guarantee.
Even a woman with minimal risk, the absence of all risk factors, can develop breast cancer. First, because not everything can be taken into account. Secondly, because the state of the psyche is of great importance in the development of any malignant tumor. Severe stress, deep depression is able to unbalance the immune system and provoke the development of cancer.
However, it is significant that breast cancer is on the rise. And this is due not only to early and thorough diagnosis. Its number is really progressively growing. And knowing these factors explains everything. Girls are now at menarche (the first menstrual period) earlier. If 50 years ago the average age of menarche was 15 years, now it is 12 years. And is not considered precocious puberty menstruation from 9years. At the same time, girls are getting married later, postponing the birth of their first child by 30 or more years. We remember, we compare, if menstruation came at 15, and at 19 she gave birth, like 50 years ago, then this is only 4 years, which is in a safe zone.
Now menstruation is at 12, she gave birth at 30 - this is 18 years old - three times the safe interval, three times the risk of oncological pathology of "female" organs.
Plus, a lot of partners (which means a higher risk of infections), taking hormonal contraceptives (another plus for risk), long-term use of contraceptives inhibits reproductive function, often this ends in primary infertility and IVF is another plus for risk. Let's add here the fashion not to sweat - which means aluminum antiperspirants, erotic lingerie that constricts the chest and disrupts lymph flow, deterioration of the environmental situation and food quality, work in hazardous industries.
In general, it seems quite logical that the incidence of breast cancer is on the rise. And from "who is to blame" logically follows "what to do." The only thing that cannot be influenced is genetics. But other factors can more than cover the genetic predisposition.
And here the recommendations sound utopian, the majority of young girls and their mothers will categorically disagree with them.
