reading

Breastfeeding Made Easy makes breastfeeding as clear and as simple as it is naturally meant to be, regardless of whether you are a perky A cup or luscious L cup!

Packed with step-by-step colour illustrations and troubleshooting sections for every conceivable challenge, you’ll discover how the Miskin Method will help you to:

• Establish and maintain an abundant milk supply simple by feeding in line with your body and baby

• Get comfortable and be efficient by choosing feeding positions that suit your baby and your unique body shape

• Enjoy a good stretch of sleep after a great day’s breastfeeding – yes, you really can have your cake and eat it!

Written by Geraldine Miskin, an independent breastfeeding specialist, who has honed her unique method through years of helping mums find pragmatic and sustainable solutions, Breastfeeding Made Easy will educate, empower and equipe you to get breastfeeding right quickly and smooth over any bumps you encounter during the way.

About the Author

Geraldine Miskin is an internationally recognised independent breastfeeding specialist who has over 20 years’ experience working with families through her private practice in West London, UK.

While studying to become a paediatric nutritionist, Geraldine worked as a nanny and maternity nurse before changing her career path. She was chosen out of over 300 applicants to complete a unique 18-month internship with a leading board-certified lactation consultant, before studying human lactation in depth.

Having seen first-hand a real need for guidance based on individual circumstance, anatomy and lifestyle while working as a maternity nurse, Geraldine set about learning the science behind breastfeeding, believing that birth, anatomical variations as well as baby’s ability to feed, greatly influenced breastfeeding outcomes.

She developed a unique algorithm and methodology called the Miskin Method in 2007. Her practice-based research has deduced two fundamental points: namely that babies breastfeed and mums make milk and that supply is driven by drainage not demand, which have revolutionised parents’ and professionals’ approach to breastfeeding.

Geraldine is the founder and co-owner of Miskin Maternity, an agency providing maternity nurses extensively trained in the Miskin Method and exclusively delivers the breastfeeding workshops for the Bump Classes with Marina Fogle.

The benefits of breastfeeding are well documented and extend to both new mother and her baby, lasting for years beyond the breastfeeding period and even into adulthood. Breastfeeding plays an incredibly important part in determining and contributing to a young baby’s health. It reinforces and promotes bonding by frequent contact between mum and baby and provides protection against infections, as well as individually tailored nutrition.

Breastfeeding has played a prominent role in many communities around the world throughout history and appears to come more easily if the new mother is well supported by her extended family. The family provides structure, wisdom and role models; enabling her to gain the confidence and skills she needs to breastfeed.

In today’s society, many new mums don’t have this close-knit network around them, often living far from their extended families. As a result, they have fewer examples of successful breastfeeding, less support and greater pressure to get breastfeeding right on their own.

In this book, Geraldine Miskin shares her expert experience, skills and unique Miskin Method, combining the science and art of breastfeeding and putting both into practice. Her advice, understanding, top tips and clear illustrations will help mums and babies to calmly overcome any difficulties and go on to enjoy and benefit from successful breastfeeding.

When there are so many breastfeeding books on the shelf already, why do you need to read this one?

Firstly, I see you as an individual and, while it is essential that your new baby gets everything that he needs, I believe it is paramount that your needs are also considered and met. My method, the Miskin Method, is a mum-and-baby-focused approach. It’s gentle enough to use from birth and pragmatic to ensure that you get great results. This is how and why I’m different.

Secondly, in these pages you will learn how everything works and fits together – as well as what you can do if it doesn’t. Background information is key to guiding you towards choices and solutions that will make your breastfeeding experience wonderful, effective and rewarding.

Thirdly, the Miskin Method is a fresh, flexible and practical approach that is based on five key elements that I will briefly outline here. I’m not trying to turn you into a breastfeeding specialist, but I want to give you an insight into how five individual elements can transform your breastfeeding experience.

I see the five key elements of my method as similar to five baking ingredients that we all have at home – namely milk, butter, eggs, flour and sugar.

You can combine these ingredients in different ways to make delicious cakes, biscuits and puddings, then, once you have got the basics right, you can add cocoa, vanilla extract, nuts, coconut flakes or anything else you can think of to make the recipe ‘yours’. Breastfeeding is just the same, and these are the five ingredients you need to consider when creating your perfect breastfeeding ‘recipe’. As with baking, once you’ve mastered the breastfeeding basics you can adapt them to suit you and your baby as he develops and grows.

It all starts with you, so decide what you’d like to achieve and find out how to do it before your baby arrives. If by nature you like routine, follow a routine. If you don’t like structure, don’t bother with routines. Either way is fine.

Your breast shape and size will influence all of your decisions – such as how often to feed and whether to offer one or both sides at each feed (see here). Your breast and nipple will indicate how you should position baby at your breast and latch him in order to ensure that breastfeeding is comfortable for you both (see here). And, lastly, these physical components will also determine how easy expressing milk will be (see here).

The size of baby’s mouth and the shape of his palate affect how much breast tissue he can scoop up when he latches (see here). This in turn determines how well you and baby fit together and how easily he can access your milk.

Your baby’s age influences his ability to breastfeed and how much energy he has to do it. There will also be milestones as his gets older – such as growth spurts – when you should expect his feeding patterns to change (see here). Your baby’s size typically indicates his tummy capacity, however some tiny babies drink much more than babies double their size, so always follow your baby’s lead and monitor his weight gain (see here).

Your medical history will indicate whether or not there are concerns about milk production. If you don’t have an underlying medical condition that reduces supply, you will have enough milk for your baby (see here).

As your baby goes through labour and birth, he gets pushed, squeezed and turned until he is born. Understandably he may feel stiff or tight by the end of it. Tightness affects how comfortable baby is in a certain position, how wide he opens his mouth and how easily he is able to transfer your breast milk. This tightness is only temporary, but it can make your early feeds tricky (see here).

These five essential breastfeeding ingredients vary quite a bit between mums and babies – you only have to look at your friends to see how different they and their babies are to you and your baby.

Breastfeeding can and will work for you when you consider and embrace your uniqueness. Current breastfeeding rates prove that the stale, one-size-fits-all, bog-standard advice doesn’t work. It’s time to get personal – and this book will give you the skills to do just that.

These are my top 10 practical tips that will transform your breastfeeding experience and give you confidence to know that everything is going well right from the start.

Rather than aiming for a bulls-eye latch with your nipple in the centre, aim for an off-centre latch that looks like this. Your nipple will be out of the way and baby will get your milk really easily (see here).

The quicker your nipple gets to the back of baby’s mouth, the more comfortable the latch will be. You only have a very small window of opportunity to get your breast to where it needs to be before baby starts to close his mouth (see here).

When feeding, focus on how often your baby swallows, rather than how long he feeds for. It is much better for your baby to swallow frequently and feed for 10 minutes than suck for ages before swallowing and so stretch out the feed for 60 minutes. (See here for tips on monitoring swallows.)

It’s lovely to have baby at your breast, but if he constantly snoozes, you’ll be there all day.

Breast compression delivers milk into your baby’s mouth, keeping him awake and ensuring he feeds effectively. It is a much better technique to use to keep him feeding efficiently than blowing on his face or tickling his feet. (See here for advice on how to do it.)

Your baby will sleep well at night if he gets the bulk of his milk during the day. If your baby doesn’t wake on his own for daytime feeds and prefers to feed more at night, you can wake him and feed him during the daytime to encourage him to sleep better at night. (See here.)

Your breast size doesn’t determine how much milk you produce in 24 hours but it does influence how much milk you produce in one go. To ensure your baby gets enough milk over the course of the day you need to feed in line with your cup size to maintain a healthy supply (see here).

In the first week, before you are able to weigh him regularly, you can track the changes to baby’s poo to see that he is getting enough colostrum. This will give you confidence that he is getting what he needs, even if you feel as if you don’t have much to offer him. (See here.)

After the first week, you will know that your baby is getting enough milk if he gains the expected amount of weight. Further more, the extent of his weight gain will tell you whether he is feeding enough, too much or not enough. (See here for weight gain information.)

When you feed at regular intervals, your body knows what to expect and milk production will be really straightforward. As much as possible, find a feeding pattern or rhythm that works for you and baby and stick to it.

Any milk that you drain from the breast is automatically replaced. To make more milk, feed more often or express if baby is not feeding well. Any breast that makes some milk can make more milk. (For the skinny on low supply, see here.)

When you give up on a ‘good day’ you know that you have done your best and exhausted all your options. Don’t give up breastfeeding when you are at your lowest ebb because then you’ll wonder whether you gave up too soon and in the heat of the moment. Give breastfeeding your best shot and know when to call it a day without feeling any guilt. (See here for how to wean baby off the breast.)

Whether this is your first, second or third baby, this book will help you prepare for breastfeeding. It will be an invaluable reference tool from birth and as your baby grows because it was written with you in mind.

You are looking for a book about breastfeeding because it is important to you; you want to do your very best for your baby and you want to make sure that you know how to breastfeed from the start. You know that many babies breastfeed well and without any problem but you want to be prepared and confident about your role as a mother, so that you can enjoy feeding and caring for your baby.

You have probably heard from friends – or learnt from previous experience – that breastfeeding doesn’t always come naturally, and when it goes wrong, it’s difficult to find solutions that work when you are sifting through tons of conflicting advice.

The truth is that many mums struggle with breastfeeding because they don’t understand that 80 per cent of breastfeeding success is down to what your baby does or doesn’t do at the breast.

There is so much conflicting advice about breastfeeding because until now there has not been an algorithm available that takes your uniqueness into account; one that will ensure that you are given information relevant to you and your baby instead of a one-size-fits-all version.

So I have written this book to help you give breastfeeding your best shot. It’s packed with practical knowledge that I’ve distilled from over two decades of helping thousands of mums feed their babies. There are tons of full-colour diagrams to help you see solutions quickly and easily, and alternative options to try when one doesn’t work for you and your baby.

Relevant chapters are grouped together so that you can find all the information you need in one area easily within a few pages, with the ‘nuts and bolts’ chapters placed right at the start so they can be found in a hurry.

I’ve dedicated a large chunk of the book to troubleshooting chapters, not because I expect you to have problems but because I know that when it isn’t easy, you need as much insight and practical help as possible to get breastfeeding right.

There are also useful products and services lists for you to look at before your baby arrives. You don’t need much if breastfeeding is going well but it’s helpful to know what’s available, as well as how and when to use products if breastfeeding isn’t straightforward and you need a little help.

If you are lucky enough to be reading this book before baby arrives (and do try to – it’s good to be prepared), familiarise yourself with the first six chapters as a priority. Then take this book into hospital with you when the big day comes, so that you can create good habits right from the start. Once baby arrives, you can dip in and out of these chapters until you feel these steps are second nature.

I’ve done my very best to make this book as practical as possible and not preachy, and I hope it will soon become your very breast friend.

You have cared for and nurtured your baby for months while he was developing in your womb. Now, as your baby comes into the outside world, your body is perfectly capable and ready to continue its role in providing all the nutrients he needs.

The close contact with you that breastfeeding brings makes him feel secure in unfamiliar surroundings, and because he gets this sense of security with each feed, this strong and safe bond is reinforced repeatedly throughout the day, every day.

Your breast milk is a unique source of food; it is packed with anti-infective and growth-promoting components, enzymes to aid digestion in an immature gut, fatty acids that are important for brain development and a vast array of nutritive properties. There is nothing like it; your milk is an incredible living fluid which is not only species- and family-specific (did you know that your milk matches 50 per cent of your baby’s genetic make-up?) but also environment-specific, and its make-up changes frequently throughout the day.

Your breastfeeding relationship is designed to keep you and your baby together, so take the pressure off yourself to get baby sleeping through the night as soon as possible and try to enjoy being a mum and just getting to know him.

A good breastfeeding experience is largely based on the confidence you have in your body’s ability to provide what your baby needs.

How it all works

Your body is primed to produce milk as soon and as often as your baby needs it – before he even asks for it. In fact, you are so in tune with your baby that he can trigger a milk ‘let-down’ by crying, rooting, foraging for the nipple and suckling.

Without you doing anything special, your body releases milk in response to your baby’s needs and in readiness for a feed. During the feed, you continue to produce and release milk until your baby is full, satisfied and looks blissed out and drunk on your milk.

During pregnancy, your glandular tissue or milk-producing tissue develops in preparation for breastfeeding. This often alters your breast size or shape and is usually the first indicator that you are pregnant.

Ordinarily it is fat that gives your breast shape and contributes to its size, and as the fat in your breast is replaced by glandular tissue, you’ll feel that your breasts are heavier but not much bigger. It is only when the glandular tissue develops and the fatty tissue stays put that you are most likely to notice an increase in your breast size.

More often than not, the fat in your breast is replaced by milk-producing tissue that develops during pregnancy, irrespective of whether or not you choose to breastfeed. Breastfeeding per se isn’t responsible for changes in the shape of your breasts; because fat gives your breast shape, after pregnancy or when you stop feeding your breasts may feel softer and look flatter as the fat has been replaced by milk-producing breast tissue.

What your breast looks like inside

Your breast is essentially made up of four parts: alveoli or milk sacs, milk ducts, fat and connective ligaments. Imagine the inside of the breast as a bit like a bush; the nipple is the stump of the bush, the milk ducts are the branches, and the clusters of alveoli are the leaves.

Your milk ducts carry milk from the alveoli to the nipple. Small ducts connected to your milk sacs feed into larger ducts that deliver milk to your baby via your nipple. They are naturally collapsed and only dilate or open to allow milk flow.

Pores or tiny openings found on the tip of your nipple deliver your milk into baby’s mouth. On average, you will have between 4 and 12 pores on each breast. The pores are mostly found on the nipple tip but sometimes they can also be found on the areola.

You won’t be able to feel individual milk sacs in your breasts because they are tiny and group together to form pea-size clusters. You can often feel these clusters when your breast is full or just before a feed.

Your alveoli are lined with milk-producing cells called lactocytes. Milk is produced in these special cells and then stored inside your milk sacs in readiness for a feed.

The majority of your milk-producing tissue is found within a 3cm radius from the base of the nipple.

How milk is made

To make milk you need two hormones: prolactin and oxytocin. While these two hormones work together to make and deliver milk, each have their own individual roles. Prolactin is responsible for milk production and oxytocin ensures that your alveoli contract and release your milk.

In order to work, each hormone needs receptor cells located where the hormone is used. Prolactin receptor cells are found next to milk-producing cells (lactocytes) and oxytocin receptor cells are found next to the contractile unit of your milk sacs, or alveoli.

The receptor cells are dormant but are activated by feeds in the early days. The more baby feeds, the more receptor cells become active and the more effective your hormones are.

Each alveolus or milk sac has a band of muscles called a contractile unit. These muscles are in a relaxed state while your milk sacs fill up. (Fig. 1)

When baby suckles, your body releases oxytocin, which causes the muscles around your milk sacs to contract and squeeze out the milk. This release of milk is what we call a let-down. Once your milk sacs are empty, they pop open and start refilling again, in readiness for the next let-down. (Fig. 2)

You will have between two and five let-downs in both breasts simultaneously during a feed, which feels like a tingling sensation. Sometimes the tingling is so subtle that you don’t even notice that you have had a let-down until you see the second side leaking.

The more glandular tissue you have, the more milk you will release in one go. This continuous spray is what I refer to as a milk stream. The longer your milk stream continues, the longer your baby has to swallow without breathing before he gets a natural break. You may be told that your baby is ‘hungry’ or ‘greedy’ if he gulps your milk down, but milk flow has more to do with the force of your let-down than how ‘greedy’ your baby is.

This sounds complicated, but it is actually very simple. When your body makes milk it starts by producing a calorie-rich milk and then water is drawn into the alveoli to dilute the concentrate and increase the volume of milk produced.

Your milk is watery at the start of the feed because your alveoli have had plenty of time to draw water in between the end of the last feed and the start of the next. This milk is called foremilk because it is the milk your baby gets at the start of the feed.

As your alveoli empty and refill during the feed, your milk becomes creamier as there is less time available to draw water in between let-downs. This is called the hind milk because it is the milk your baby gets at the end of the feed.

The influences on supply and flow

Your body needs to regulate the milk you supply so that your baby gets a good balance of fore and hind milk at each feed. Again, your body has a very clever way of doing this and it is all down to a protein in your milk called FIL – feedback inhibiter of lactation.

As your milk is made, molecules of FIL enter your alveoli. The amount of FIL in your milk sacs is proportionate to the amount of milk produced, so when your milk sacs are empty, there is little or no FIL present, but as your alveoli fill up, the number of FIL molecules increases too.

High levels of FIL in your milk relay a message to your brain to slow down or stop milk production completely. This way, your body is able to provide what your baby needs while ensuring that you don’t become overfull. So, provided you feed frequently and before your breast becomes overly full, you’ll always have enough milk for him.

There are times when you need to increase your milk flow to make breastfeeding more effective or to encourage your baby to stay awake and keep feeding, especially in the early days. The easiest and most effective way to do this is to compress your breast with a flat hand so that you are literally manually squeezing milk out of your alveoli to create a let-down. I call this breast compression – I will refer to it a lot throughout this book because it is pure gold!

Place a flat hand on your breast and push inwards towards your ribcage. (Fig.1) Ensure that your hand is not too close to your nipple or you will pull it out of baby’s mouth. Push in and hold for 20 seconds – or until he starts swallowing – then stop. Work your way around the breast to drain it completely.

This is one of my top tips because it works within seconds and is very effective. You can forget about blowing on or tickling your baby to keep him awake; just compress your breast and he will get milk delivered into his mouth and will keep feeding.

TABLE OF CONTENTS

About the Book

About the Author

FOREWORD

THE MISKIN METHOD IN A NUTSHELL

THE FIVE KEY ELEMENTS OF THE MISKIN METHOD

10 GOLDEN BREASTFEEDING RULES

HOW TO USE THIS BOOK

PART 1:

CHAPTER 1

How it all works

What your breast looks like inside

How milk is made

The influences on supply and flow