Having diabetes should not prevent you from breastfeeding.

Why should I consider breastfeeding?

• Breastfeeding is the best form of nutrition for babies
• It is especially good if your baby is breastfed for at least 6 months
• It helps you and your baby to build a strong bond

Health benefits for you

• Less risk of ovarian & breast cancer
• Return to your pre-pregnancy figure faster
• Less risk of weak bones later in life

Your baby is less likely to get:

• Tummy upsets
• Infections (such as ear or chest infection)
• Eczema
• Asthma
• Obesity
• Childhood diabetes

Can I breastfeed?

Yes, having diabetes should not prevent you from breastfeeding your baby. If you have gestational or Type 2 diabetes, normally controlled without insulin, breastfeeding will be the same as for women without diabetes. If you normally need insulin to control your diabetes, you will need to be aware of a few extra points of information,

Will my breast milk be the same as milk from a woman without diabetes?

If your diabetes is well controlled, your milk will have the same composition. Insulin does not pass into the breast milk.

I take insulin for my diabetes. What extra care do I need to take if I am breastfeeding?

• You will need to lower your insulin dose immediately after the birth and monitor your blood glucose levels carefully to get the correct insulin dose
• Hypo’s will be more likely to occur – you could need up to 40-50g extra carbs daily.
• Eat regular meals containing carbs and always have some food nearby to eat before or during feeds.
• Always carry a carb snack with you when you are out with your baby.
• You may need a supper snack to cover your baby’s night-time feed.
• Continue to monitor your blood glucose levels regularly & seek advice from your diabetes team regarding insulin dose.

Can I breastfeed if I am taking tablets for Type 2 diabetes?

You can take either metformin or glibenclamide if you are breastfeeding. Other diabetes tablets should be avoided. Discuss this, and any other tablets you are asked to take with your diabetes team or your doctor.

Tips for getting breastfeeding established

At 36-37 weeks you can express and store colostrum. Expressed colostrum can be given to your baby if they can’t breastfeed after birth or if their blood-glucose is low & baby needs extra milk.

Unless your baby needs special care, make sure you have skin-to-skin contact with baby as soon as possible after the birth.

Whilst you are enjoying this skin-to-skin contact, start breastfeeding. Your colostrum is the best food for your baby and will help your baby’s blood glucose stay at safe level. Ask the midwife to help you get baby latched on correctly.

Continue to breastfeed frequently by baby-led feeding and at least every 2-3 hours.

It can take almost 3 days for your milk to come in. In the meantime, your baby is getting the vital colostrum which will maintain their blood glucose levels.

What if my baby needs to go to the Neonatal unit?

You will be encouraged to visit your baby as often as you wish. You will also be supported to hand express breast milk so that the vital drops of colostrum can be fed to your baby.

More information on breastfeeding

Ask your midwife for the booklet “Off to a good start” as well as the practical breastfeeding support available such as peer counsellors, baby cafes and breastfeeding groups.

Colostrum Harvesting: Guidance for women who are diabetic and pregnant

Mothers with diabetes

During your pregnancy you will have the opportunity to speak to a midwife about how you want to feed your baby. Your midwife will complete an “infant feeding” checklist throughout your pregnancy. A decision on how to feed your baby does not need to be made right away, but hopefully the information will help you to make an informed choice with regards to infant feeding.

How could breastfeeding be important to me?

It is known that exclusive breastfeeding for the first 6 months has many health benefits for both mother and baby. Research shows that babies who are breastfed may be less likely to develop childhood diabetes.

Research also suggests that cow milk antibodies in artificial milk may act as a trigger for diabetes.

In the first few hours after birth your baby may have a temporary period of low blood sugar. The reason for this is due to your high circulating blood sugar levels, having encouraged your baby’s pancreas to produce lots of extra insulin.

After delivery, early skin to skin contact between you and your baby will be encouraged. This is beneficial in relationship to breastfeeding and reducing infant crying. If a mother and baby have undisturbed skin contact it will keep the baby warm, calm and is reassuring for both of you. Early feeding of babies of mother with diabetes is recommended to prevent neonatal hypoglycaemia and help with breastfeeding.

Ensuring that your baby receives regular feeds with extra milk, if required, will help to prevent low blood sugar. Expressed breastmilk can be used if available.

After 24 hours your baby’s blood sugar levels are unlikely to drop, but in the unlikely event of persistently low blood sugar levels, a paediatrician (baby doctor) will explain the plan for feeding, which may require an intravenous sugar “drip”.

Is there any preparation I can do during my pregnancy?

Sometimes as early as 28 weeks, some mothers may find they leak small amounts of colostrum (the first milk) from their breasts.

At around 36 weeks, if you wish & do not have any contra-indications, we will encourage you to practice hand expressing (rather than pump) some colostrum, which you can keep in the freezer, in reserve for after your baby is born. This may help to prevent you from having to use artificial milk.

Contra-indications for colostrum harvesting

• History of preterm labour
• Current preterm labour
• Cervical incompetence
• Cervical suture in situ
• Multiple pregnancy

How much colostrum will I get?

The amount obtained varies from mother to mother. It can range from a few drops to as much as a teaspoon. Do not worry if you do not leak any colostrum, as it is no reflection on your ability to breastfeed successfully.

How often can I express?

You can express as often as you like. A good time may be when you are relaxing in the bath. Start with 3-5 minutes on each breast using gentle hand expression 2-3 times daily.

The total time expressing once proficient should only be 5-10 minutes per session However, if you notice an increase in tightening of your uterus or contractions you should speak to your midwife.

Collect the colostrum into a sterile syringe – packs are available from your midwife. Label the milk with your name, the date and time & place the syringe in a zip-lock bag before placing in the freezer (to be frozen at minus 18◦ C).

When you come into hospital, leave your colostrum at home until it is needed. Frozen colostrum can be transported to hospital in the sterile syringes in a cool bag containing an icepack. Once thawed it should be used within 24 hours.

If you have not had the opportunity to express any colostrum at home, the midwives will help you once you arrive. Please ask if this is not offered; colostrum can be kept in reserve should it be needed.

Useful resources

UNICEF video guide on how to hand express
Abm: Advice on expressing your milk before your baby arrives