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		Infant Feeding in Emergencies: A Guide for Mothers (WHO, 1997, 48 p.)
			(introduction...)
			Foreword
			Introduction
			Why is breastfeeding so important?
			Are commercially-made baby milks as good as breastfeeding?
			Why are commercially-made baby milks not so good?
			But can every woman breastfeed?
			But why don't the experts tell us this if breastfeeding is so important?
			Do babies also need tea and water?
			When do babies need more than just breast-milk?
			So a sick baby should go on breastfeeding?
			Do breastfed babies get fewer diseases?
			But my friend's baby got ill and he was breastfed
			So breastfeeding is like a medicine?
			People say that stress stops the milk, so during stressful times how can we breastfeed?
			What about women who have lost a lot of weight? Can they produce milk?
			Do we need special nutrition for breastfeeding?
			But what about anaemic women? Does breastfeeding drain their strength?
			Someone told me breastfeeding stopped you getting pregnant, but isn't that just a story?
			How does breastfeeding work?
			What about women with small breasts or flat nipples?
			You said the baby has a part too. What can he do?
			Why is the baby's suckling-action important?
			How does a baby stimulate the milk?
			The first principle of breastfeeding: good attachment
			Why does good attachment not always come naturally to the baby?
			Why does the baby not always get this right?
			Sometimes it is hard to get a baby close because he is swaddled and his clothing gets in the way
			Even if my baby attaches well, how can I be sure there will be enough milk?
			You said earlier that milk changes during a feed. Can you explain that?
			But I thought you must feed from both breasts?
			You said earlier that confidence was important but not everyone has that. What can we do?
			I know women with breastfeeding problems. Can they be helped?
			My mother told me that you always get sore nipples and you just have to put up with them
			What about special creams for sore nipples? How can we get them during an emergency?
			With this baby-led feeding how can I be hygienic and wash my nipples?
			So if I get my baby well-attached, I will never get sore nipples?
			You say breastfeeding should not hurt, but what about the engorgement that every woman gets a few days after the birth?
			You mentioned blocked ducts, mastitis and abscess. Are they common and how can we treat them?
			All these problems make breastfeeding look too difficult
			You said earlier that you can breastfeed even if you have stopped completely. How can this be done?
			Food supplies can be precarious. How can we feed the babies over 6 months who need more than breast-milk alone?
			What about premature or very small babies?
			I can see the reason for expressing milk for sick or premature babies, but must all women learn to express?
			How do I express milk?
			I can see that breastfeeding is possible in most cases, but we still have to face the times when it is not possible: emergencies create orphans, abandoned babies and severely ill or wounded mothers
			Is it possible to feed a baby artificially without a bottle?
			How do you cup-feed a baby?
			A final word

You said earlier that you can breastfeed even if you have stopped completely. How can this be done?

Even if you stopped breastfeeding several months ago you can probably still squeeze a drop of fluid from your breast. Your milk-making system has not completely shut down. Re-starting breastfeeding after you have stopped is called relactation. Women who have never given birth have breastfed adopted babies, this is called induced lactation. The first is easier than the second.

The three principles of easy breastfeeding still apply.

· Good attachment
· Supply and demand
· Confidence

The aim is to persuade your baby to play her part. If she is now fully bottle-fed, she may have temporarily forgotten her natural skill to breastfeed and she needs reminding. Some babies just restart suckling easily, others need gentle persuasion. The delicate period is when you want your baby to suckle a lot to stimulate the milk, but she still needs to get enough to eat. She needs to be hungry enough to suckle effectively at the breast, but not so hungry that she gets frustrated when the milk supply is still low.

Every baby is different. Some babies who are bottle-fed, attach well at the breast. Others are so used to the bottle they do not work at the breast. Ask someone to give you emotional and practical support through the first days: for example perhaps a relative or friend could help with housework, queue for food or care for your other children. You will need to spend a lot of time with your baby at the beginning.

· Put your baby to the breast frequently, at least 10 times in 24 hours.

· Offer your breast whenever she wants to feed. Never force the breast; try to remind her how pleasant breastfeeding can be.

· Make sure that the position and attachment are right and comfortable for both of you.

· Whenever possible, enjoy skin-to-skin contact, even when the baby is asleep.

· It helps to sleep all night with the baby skin-to-skin.

· Do not use a dummy.

· Whether you are bottle-feeding or cup-feeding gradually reduce the amount of milk in these feeds as your milk increases.

· Use gentle hand expression to stimulate the breast.

· If you can squeeze a droplet of milk onto your baby's tongue, do this to awaken her interest.

· You can try dripping artificial milk from a spoon onto your breast so that it trickles into the baby's mouth while she suckles.

If the baby is getting frustrated before the milk comes back you can try making a breastfeeding supplementer. Only use this method if you know you can sterilize the equipment for every feed. Ask a health worker for very fine infant feeding tubes. Put donated expressed breast-milk, commercial baby milk or diluted cow's milk in a cup, jar or other available container.

Place the end of the tube along your nipple, so that the baby suckles the breast and the tube at the same time. Hold the tube in place, ideally with surgical tape (Figure 7).

Figure 7

Ask someone to hold the cup, if you find it awkward to hold. To start off the milk can be held higher than your breast and baby. As soon as the milk flows through the tube, hold it lower. The idea is to make the baby stimulate your breast-milk by effective suckling, so only a trickle must get through the tube. Reduce the milk in the cup by a teaspoonful¹⁰ at each feed as the breast-milk increases.

¹⁰ If a teaspoon is inappropriate, use an equivalent local measure for up to 5 ml, for example, a soft drink bottle cap.

Stay confident. Many women, including grandmothers, have successfully restimulated breast-milk, many years after they stopped breastfeeding.