​RACGP BREASTFEEDING POLICY

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Breastfeeding should be promoted as the most appropriate method for feeding infants and one that offers protection against infection and some chronic diseases. General practitioners should encourage and support exclusive breastfeeding in the first 6 months, then the introduction of complementary foods and continued breastfeeding thereafter. It is recommended that breastfeeding continue until 12 months of age and thereafter as long as mutually desired.
 Mothers have the right to breastfeed wherever and whenever their baby has the need.
Breastfeeding mothers in the paid work force should be supported to continue breastfeeding.  
​Royal Australian College of General Practitioners (RACGP)
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At Premier Health we support this policy and offer a Lactation Consultant to support your informed decision to breastfeed.​ ​

Dale Hansson
​RN, Lactation Consultant, Dip Breastfeeding Management, CFHN ​Certified with IBLCE until 2027

Breastfeeding is the normal way for infants to be fed. Many families experience difficulties after a new baby arrives. When you choose to breastfeed and prepare, it can be confusing when it doesn't seem to be "natural". Like many new experiences, breastfeeding takes time to learn. Your body secretes hormones in the first 4-6 weeks, which help you to maintain breastfeeding while you establish your supply.  This buffer may mask early problems. A baby may feed and grow well initially because of these hormones but if he isn't removing milk effectively, it may take until 6 weeks or more before he starts to show signs that things are not going as well as you thought.
Breastfeeding is a very robust activity, and there are many ways to manage breastfeeding challenges. Mothers usually know if something is not right, and this should be taken seriously. Many mothers are told everything looks right, even when there is pain and concern. You can check your nipple yourself after the feed; if it is misshapen, then it isn't right. You can't tell if everything is OK by just looking from the outside! 
​Trust yourself and enjoy your baby!
Book an appointment - call 02 9581 8888 or email [email protected]​

FREQUENTLY ASKED QUESTIONS 

Do I need a referral?
No, no referral is necessary and you may be doubling up on cost as we can help with feeding difficulties even if there is no tongue-tie.
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Do you cut every baby that comes to you?
No, definitely not. Frenotomy is a medical procedure that requires informed consent and identifying what outcome we want from the procedure is important to us. However, it is important that all costs have been explained before arriving for an appointment so there are no surprises. 

What age babies do you treat?
We treat babies up to 12 months of age

Do you treat babies who are not breastfeeding anymore?
Yes we do. Many babies with ties have difficulty breastfeeding and it is not unusual for bottle-feeding and formula to be suggested ways to manage these difficulties. Unfortunately many babies still have problems feeding despite their parents buying every teat, bottle and formula recommended to them. This is because the true reason for the feeding problem has not been addressed. 

My baby is gaining weight so why would it help to get the tongue-tie released?
Many babies with tongue-ties can feed and grow, some quite successfully. However many have other difficulties, reflux symptoms, swallowing air and difficulty with the milk flow and the vacuum. Many come on and off, cause pain and can go on to have difficulty managing solid food and drinking water.

Do you require all babies to have had Vitamin K?
No we don't. We keep careful statistics about bleeding post-procedure and of the less than 2% of babies that bled more than we expected, none were babies that had not received Vitamin K.

Will the tongue-tie reattach?
There is always a risk that the tie will grow back. The time can vary quite a bit, sometimes months after the procedure another frenulum can grow. According to our statistics, our re-snip rate is less than 1%. We recommend very gentle aftercare because when we trialled more aggressive aftercare in 2013 (as is frequently recommended by other providers) our re-snip rate doubled and both parents and babies were very distressed. If required, it is much kinder to retreat.​
What happens during the consultation?
We will need to ask some questions about feeding, birth and medical history, look at your baby, including the mouth, watch a breastfeed and identify if there are strategies that can improve any problems you may be having. The advantage of working within a medical centre is the proximity of skilled medical support.
Even though our practice is seen as a place to treat tongue and lip-tie this is really just part of a wholistic approach to managing feeding concerns.
Being able to identify if a frenulum is impacting feeding and if there is an identifiable outcome that can be achieved by treatment, cannot be separated from the consultation. The mother-infant relationship is the most important consideration. and we are happy to provide consultations on everything to do with infant feeding, not just ties. 

What about if I am bottle-feeding?
We welcome all families with feeding difficulties at Premier Health, we know that having a challenging breastfeeding experience is not always solved by bottle feeding and issues with comfortable relaxed feeding continue after weaning from the breast. We hope you will find a safe and welcoming place to help you with feeding your baby, no matter the feeding method.

If there has been concern expressed about growth
Breastfeeding is very important for immune protection, keep breastfeeding, this is not a time to wean! It is extremely unlikely that your body cannot make enough milk for your baby but it is possible that you baby is not getting all the milk you have available or can make for a variety of reasons.
Those reasons need to be explored thoroughly before considering interfering with breastfeeding. Mothers should question negative messages about their supply and seek assistance. The difficulty is finding individuals who trust breastfeeding, mothers and babies unconditionally and will respect the biological norm of the mother/baby bond. A woman who has breastfed successfully to natural term weaning is the first choice, not health professionals. 


Have you been given correct breastfeeding information? 

NHMRC Infant feeding Guidelines for health Workers recommends:
       - unrestricted access to the breast
       - around 8 to 12 feeds in 24 hours - do not obsess about intervals
       - night feeds are very important 
       - bottles interfere with establishing and maintaining breastfeeding

The NHMRC states this about growth:
     - breastfed babies growth should be averaged over 4 weeks
       - growth charts are screening tools only
       -  concern about a single measurement is a reason to explore, not give supplements!

The World Health Organization(WHO) has conducted extensive research into infant growth and developed Growth charts and their studies and charts can be found easily on their website.

Key messages to families from this research are:
     - Breastfed babies grow in spurts
       - This cannot be measured accurately by measuring the weight weekly
       - Length and head circumference are equally important for wellbeing
       - Brain and skeletal growth is much more valuable that a random measurement of weight
       - Growth measurements should be sequential using the same equipment
       - Neurological milestones are also important indicators of wellbeing

If you are worried about growth/milk supply:
       - Feed more often 
       - Feed for comfort
       - Change sides when baby pauses or fusses 
       - Encourage the let-down reflex (Milk Ejection Reflex) - deep breathing, dropping your  shoulders, thinking happy thoughts etc

Common management strategies that will harm your supply
     - Restricted times 
       - Using weekly weights without checking overall well-being, output and feeding behaviour
       - Being told you baby is asleep and "tired" from feeding

babies will pause as you do when eating, even with their eyes closed and are often waiting for you to have another milk release (let-down), then they will suck and swallow again. Babies are clever and know not to waste their energy FEEDING. they are NOT lazy, babies having trouble feeding, are shallow or causing pain,  pause longer and take longer to FEED. this is sensible, don't restrict them!
       - Interval recommendations  - for example - being told to feed every so many hours
       - Being told to "drain" your breast

this is not possible, breasts are never empty, and milk will be sitting in the other breast waiting to be removed, and when it isn't, the body thinks you don't need it! This is very harmful advice - be FLEXIBLE. the baby can finish on either side
       - Foremilk and hindmilk is not a thing!
Your milk is always mixed, fat ratio is related to fullness and emptiness of the breast, time of day, how far into the feed you are, it is NEVER separated into foremilk and hindmilk (unless you express and let it separate on the bench) so trying to do this is a wild goose chase!

Relactation
Relactation and return to full breastfeeding is possible, see this information sheet from breastfeeding Advocacy Australia.