21 Oct

Book review: Milk, by Emma Rosen

Emma Rosen knew she had a book in her, and motherhood gave her the material. Milk is, as subtitled, a story of breastfeeding in a society that’s forgotten how. The thing that will stay with me long after reading this, is how strongly I identified with her experience of feeding her first baby; and (although I never experienced this, having stopped at one), how healing I found it to read about her second birth, along with the feeding and mothering experience that I will always wonder if I could have had. I hope this book gets out to pregnant women, in that place where it is hard to grasp the reality of life with a baby, and prepares them just a little bit more to navigate those early months.

Emma’s book alternates between telling her own story, and telling the story of breastfeeding; and in doing so, places her own experience within the wider context of breastfeeding in 21st Century Britain, and in the world, and all of history. There is so much useful information here, and it is thoroughly referenced, too.

For anyone looking for insights into pregnancy, birth, and the world of a new mother, this is a really lovely read, and one that doesn’t shy away form the gritty reality of the physical and emotional changes of this momentous time. This might be the first time I’ve read a book that really succeeds in conveying that reality without either hyperbole or sugar coating. A properly good book.

[Disclaimer: I was sent a preview copy by the author. You can buy it from all the usual places.]

29 Aug

Feeding with a Supplementary Nursing System

Thanks to Jaclyn Currie for this guest post. Jaclyn is a stay at home mum to a busy two year old, British expat in Nova Scotia and La Leche League leader.

We’d been trying unsuccessfully to conceive for almost two years when I was diagnosed with Hashimoto’s. I fell pregnant almost as soon as I started on thyroxine and had a very healthy pregnancy. We moved to Canada when I was around 10 weeks pregnant and there are few midwives in this province but I had excellent care from my doctors, who were very responsive to my birth wishlist! It was only towards the end of the pregnancy I found out there might be a risk of low milk supply but given that I’d planned a natural labour and delivery with a doula in the local maternity hospital, I thought I was doing everything possible to ensure baby would breastfeed well. As I was new to the country I also started attending La Leche League meetings to meet new, likeminded people.

I was referred to the post-dates clinic at 41+5 and hoped to be told all was well and to come back in a couple of days. Baby had been head down for many weeks and was moving well, but unfortunately his heart-rate was dipping dramatically and the decision was made for an emergency caeserean… then thankfully downgraded to monitoring, then induction overnight with Foley catheter, then pitocin to start in the morning.

I had a fast induced labour but managed with gas and air, lots of movement and bouncing! But he wasn’t responding well to the contractions and the decision was made to use the vacuum to help him out (avoided forceps thankfully), but I had lots of tearing and lost around 800ml of blood.

My son was born 9lb with an apgar of 9! Turns out the cord was around his neck but he found his way to my breast easily and I was relieved all was well.

Over the next couple of days I was able to express a little colostrum and the nurse said he seemed to be latching well. He was sleepy though and then had jaundice so he was put under the lights for a couple of days (this can be done in room thankfully). No real concerns around feeding though it was starting to be a little sore on one side.

Finally we got home and he fed ALL the time! I knew this was normal and made myself comfy on the sofa. My son was a happy and sweet soul. He rarely cried and the public health nurse who visited was happy to help with some positioning and tips. I mentioned it was very sore but she couldn’t see a tongue tie. She was a little concerned he didn’t seem to be having enough dirty nappies but was overall content. However between week 2-3 he didn’t gain any weight at all. Looking back at picture, he was a spindly little thing! I was reading everything I could, and had met with my LLL leader who’d suggested some bodywork to help his latch. However, nothing was helping him gain weight so with so much guilt and sadness I realised I was going to have to supplement. I wasn’t well versed in milk-sharing so formula it was (of course, I had some, thanks Nestle *eyeroll*) but I was very wary of bottle feeding him given my desire to breastfeed, and still suspected he had a tongue tie. I had a friend who’d started using an SNS system a few weeks previously (also hypothyroid!) and I asked my LLL leader if she could help me out.

It was such a learning curve, but I suppose equally so would bottle feeding. I hated giving him formula but he drank so much and immediately started gaining weight. He was thriving on every drop of milk I made, plus 8-12oz of formula a day. It was still agony, and we had him assessed at 7 weeks, with a posterior tongue tie diagnosed and revised. Thankfully around 9 weeks breastfeeding finally felt comfortable and easy, even with the tube. I very quickly gave up supplementing overnight so we could get more sleep, which he seemed fine with.

We started BLW at 6 months, which he loved but ate very little. He always preferred to breastfeed. Around 8 months it started being a battle to get the tube into his mouth, and at 9 months he would yank it out of his mouth. I decided at this point it wasn’t worth the battle for the 1-2 oz he was having so we stopped supplementing at this point. I was so worried, and his weight did fluctuate until he started properly eating good portions at mealtimes, around 15 months.

It was such a battle, and so many people didn’t “get” it; I had people laugh out loud at the tube, and wondering why I didn’t just give him a bottle… but I am sure given his tongue tie he would definitely have preferred it to my low supply boobies! He was 2 in May and still loves to breastfeed often. It brings us both a lot of peace and calm. I felt so much guilt for the longest time, but I am so glad we persevered.

27 Aug

Book review: New Walk, by Ellie Durant

New Walk is the first novel of midwife Ellie Durant, and a fitting companion-piece to Alice Allan’s Open My Eyes from the same publisher. It tells the story of Chloe, a Leicester teenager who has been the responsible member of her family in the years since her mother died, and has finally decided to do something for herself, and applies to study midwifery.

The main philosophical theme of the book is that dilemma between selfishness and responsibility: do women have the right to decline medical advice? Or to choose what happens to their own bodies? And who has the power?

Chloe is a likeable character going through some tough times, supported (or not) by a diverse cast. The plot may not twist much, but it is soundly structured, satisfyingly ended, and well decorated with the details of Chloe’s learning about pregnancy and birth. Ellie Durant writes confidently about what she knows, giving this novel a sincere and grounded feel. It’s light reading with some darker tones: great summer lit.

[Disclaimer: I was sent a free copy of New Walk by the publishers Pinter & Martin. Get yours here with a 10% discount at the checkout, using the code SPROGCAST]

07 Aug

Book Review: The Positive Breastfeeding Book, by Amy Brown

Amy Brown’s Positive Breastfeeding Book is presented as a companion to Milli Hill’s Positive Birth Book, sharing a cover design, a friendly, chatty tone, and an absolute compendium of information. 29 detailed chapters are interspersed with quotes from mothers and breastfeeding supporters, and interviews with some very respectable figures from the breastfeeding world, including Heather Trickey, Helen Ball, and everyone’s hero Dr Wendy Jones.

This book pulls no punches when it comes to explaining the impact and the importance of breastfeeding, and breaking down the cultural and commercial barriers that women face in a breastfeeding-unfriendly society. It takes a logical journey through the subject matter, from getting off to a good start, accessing good support, facing and resolving the challenges, to stopping breastfeeding. My favourite section is the lovely list of suggestions for how partners can support breastfeeding women, not one of which is to give a night time bottle. The book also includes two chapters I have never before seen in a breastfeeding book: infant feeding in an emergency, and a chapter on induced lactation that specifically addresses the needs of trans parents. This feels like a book very much for our time.

Technical information about breastfeeding is plentiful and accurate, supported by references and additional resources, such as videos to watch on hand expressing and the breastcrawl. At the end there is a chapter by chapter list of still more websites and books.

The Positive Breastfeeding Book is exactly what it says on the cover, and a very useful manual both for breastfeeding mothers and anyone supporting them.

[Disclaimer: I was sent a free copy of The Positive Breastfeeding Book by the publishers; you can obtain your own copy here, not forgetting the 10% discount code SPROGCAST at the checkout]

20 Jul

How bottle manufacturers undermine breastfeeding and evade UK advertising rules, a guest post by Megan Stephenson

If you’re on social media, and you have had a baby recently, you’re seen as a feast of insecurities for many predatory companies. Most are fairly innocuous, they’ll cost your family money, but not have an impact on your babies health. But some, in particular the bottle manufacturers, are aiming to reduce the amount of breastfeeding you do. Since many of the health impacts of not breastfeeding are dose-responsive (that is, the more you do the more impact they have) this is not just about money any more.

The particularly egregious examples are the ones where they claim that they won’t have an impact on breastfeeding (how can this be? Surely every time the baby is having a bottle, they are not at the breast), that baby can’t tell the difference, and that you can switch between breast and bottle easily. This is actually against UK advertising laws because they have no solid evidence (this means properly conducted research trials, “my friend said” is not enough). So, how do they get away with it? I hear you cry. Well, easy, the company isn’t saying it, they are sharing real life reviews. Of course they are paying the social media companies to share them with you, so it’s still advertising.

If it IS possible to switch easily between breast and bottle (and I’m not convinced that anyone has proved that any bottle makes this easier than any other) how does this impact on breastfeeding? Does it mean that when a mother breastfeeds in a public place, she is no longer protected? Because she could have used a bottle for public and breast at home. How about breastfeeding as babies get older? Well, you could use a bottle and still breastfeed at night. What about maternity leave – why not go back to work at two weeks, leaving a bottle for day time and breastfeed at night? Once again, breastfeeding is consistently undermined.

Megan Stephenson is an NCT Breastsfeeding Counsellor

13 Jun

Mommy Wars Much?

Yesterday the Royal College of Midwives released a new position statement on infant feeding. It includes the stunning new idea that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected.’

Inevitably there is a two-pronged kneejerk reaction to this. The Daily Mail and all radio talk shows trumpet an end to ‘Breastfeeding Tyranny,’ which is that thing where anyone remotely connected with supporting breastfeeding mothers is cast as the tyrant (or other even less savoury words); and parents who have had a difficult experience of breastfeeding complain about a) pressure from midwives, and b) pressure from everyone else.

Meanwhile the above-mentioned tyrants divide themselves into separate camps, those who criticise NCT and those who are NCT (and some have a foot in both camps). In the first camp, we have those who criticise NCT for not covering formula and bottlefeeding in antenatal sessions [Spoiler: we do! Have a look at our Infant Feeding Message Framework, which has been revised this year, but nothing new on formula in there, we’ve been covering it for years]; and those who criticise NCT for not cheerleading about breastfeeding enough (usually members of other breastfeeding charities who exempt the NCT from their non-judgemental approach).

As usual, I’m not here to speak for NCT, despite being proud to have been an NCT breastfeeding counsellor for a decade. However I do want to congratulate everyone responding to this new position statement on perpetuating the divisions in infant feeding. Nice one.

How about instead of the kneejerk reaction, we take some time to reflect on the context in which this statement and the responses to it occur. You really don’t have to look very far for reasons why women feel unsupported, whatever feeding decisions they make. We know very well that the majority of women in the UK see a number of different and busy midwives during pregnancy, and still get asked whether they plan to breastfeed or bottlefeed, without the time it would take to have a nuanced and informative discussion about this. Just asking that question frames it as an either/or choice, never mind the evidence that decision making about infant feeding is so much more intricate than that. The path women take is influenced by their family history and social context, by adverts that tell them their nipples will hurt and news stories that tell them they’ll be thrown out of Sports Direct. By every person who ever tells them not to beat themselves up if they can’t do it.

At birth, pressure does come from midwives who encourage early breastfeeding in the knowledge that the option will disappear for that mother if they don’t try to protect it; what a difficult position for those midwives to be in, within the time constraints of their workload. What would be a better way to address this at such a crucial time? There is no easy answer, because this demands cultural change and an end to society operating on the assumption that breastfeeding is difficult and women will be judged for not doing it. Locally, the well-trained volunteer breastfeeding support has been withdrawn from the wards and now also the children’s centres, because there is no longer funding to run the project, adding to the burden on midwives to handle this with sensitivity, kindness and accurate information. Within the time constraints of their workload.

And then there is the rest of the breastfeeding journey, and I know from encounters with women of all ages who tell me, when they find out what I do for a living, stories that some of them have carried for decades. Women feel guilty when they struggle to breastfeed and when they choose not to continue, and they feel angry when they don’t have the knowledge or the support to make decisions they feel happy with; and these stories matter to them. NCT is the best-known of a number of different charities that support breastfeeding mothers, and so of course it is the one that wears the sash of shame about judging and putting pressure on women. NCT is also the one that does most of the antenatal education, including on breastfeeding and on formula and bottlefeeding, and so of course is perceived as a source of guilt and judgement largely because of the impossibility of adequately preparing parents for the realities of life with a new baby. “All my friends found breastfeeding really hard, I’m not going to beat myself up if I can’t do it,” they tell me before their babies are born. And afterwards? “Why didn’t you tell me it would be so hard?” What words, what activities, what level of reflection will square this impossible circle, without changing the entire context?

And that’s why I’m so frustrated, this morning, with all the news and social media that does nothing but reinforce the assumptions and the cultural context within which breastfeeding can be hard, but breastfeeding support can be harder.

03 Jun

Book Review: Inducing Labour: Making Informed Decisions, by Dr Sara Wickham

Sara Wickham’s new book Inducing Labour: Making Informed Decisions aims to explain the process of induction to parents and to professionals. It very clearly covers the how and why, and comprehensively goes into the risks and benefits of the most commonly encountered scenarios. Wickham argues strongly for women’s bodily autonomy and individualised care, and the whole book is set firmly within the evidence base. Her discussion of the evidence was for me (and unsurprisingly!) the strongest point of an all-round excellent book, and I was prompted to reflect on her point that we all interpret the evidence according to our existing biases.

This is a book written for women, addressing “you” the pregnant mother, but without holding back any technical points or difficult statistics. It is also an important read for antenatal teachers, midwives, and anyone supporting women to make decisions about their care. There are, for example, some useful points that a woman can use for agreeing a “due date” with her midwife or consultant, and some questions that are helpful to ask in order to ensure care is personalised rather than simply following a protocol. Above all, there is really clear information about the impact of induction in a number of different situations, and a good breakdown of statistics for example on the risk of stillbirth in older mothers, and how likely it is that earlier induction would make much difference to these stats (answer: not very likely).

In fact the message that comes across most clearly is to trust women and to trust women’s bodies. The evidence that induction routinely improves outcomes is simply not there, and anyone needing to argue that point with a clinician would find this book a really useful resource. In a culture where the baby’s safety is prioritised over everything, it is good to read a practical, straightforward discussion of why intervention is often not the best way to do no harm.

I was sent a free review copy of Inducing Labour. You can get more information here, and your own copy from here.

20 Apr

Book Review: Your No-Guilt Pregnancy Plan, by Rebecca Schiller

I’ve been waiting for this book for years – since my own pregnancy, in fact.

Rebecca Schiller, director of Birthrights, has created a manual for pregnancy, birth and the early weeks of parenthood, that is mother-centred and evidence-based, and achieves that incredibly difficult feat of getting the right tone when balancing those two things.

Your No-Guilt Pregnancy Plan – A revolutionary guide to pregnancy, birth and the weeks that follow skips the “your baby is the size of a walnut/pear/skateboard” theme that most writers on this subject consider to be mandatory, and focuses on what is happening to the woman: how she might be feeling, how her body is changing, how the pregnancy/baby affects her world. It includes exercises and checklists to help women reflect on their goals and enjoy the experience; and is kept completely up to date with an accompanying set of links to further reading and support on Rebecca’s own website.

As with most such books, there is a chronological approach. However some things you will not find in most such books are a clear emphasis on the rights of women, on the basis that when women are well cared-for and respected, outcomes improve for them and for their babies. It’s a very realistic book, and a fine example of giving information without advice. With one or two small exceptions, this book is about the reader, not the writer.

And so we come to the breastfeeding section, which you know I looked at first. It’s good. It covers the basics of milk supply and positioning, some of the early challenges, and where to go for help. This sits alongside clear guidance about formula feeding, and not a lactation cookie in sight.

The final chapter of the book helps the reader to refer back to relevant sections of the book, in order to create a personalised plan for pregnancy, birth and afterwards, including a going into labour checklist, and a ‘little black book’ of support for the early days, so you don’t have to figure it out when you need it.

This is the most realistic, practical and informal guide I have seen, and goes straight to the top of my pile of recommendations.

[Disclosure: I received a free review copy of Rebecca’s book.]

08 Mar

What Mothers Are

I’m reading a very interesting book called The Selfish Society by Sue Gerhardt; and while I really like where she’s coming from, it did get me thinking about the general assumption that motherhood is mainly defined by sacrifice.

The things you’re expected to give up, on becoming a mother, include your pre-baby figure, your sleep, your ability to concentrate, your social life, your sex life, and your peace of mind.

The counter-argument to this is always but motherhood is so rewarding; see various mummy-bloggers’ cute anecdotes about hilarious nappy changes, first words, adoring gazes at 4am, and so on. While this is all very well, it does seem to relegate the mother’s enjoyment of life to a second-hand experience.

There don’t seem to be many sources that acknowledge the positive changes that motherhood brings about, specifically for the mother (and I’m not just talking about the oxytocin high of breastfeeding). Motherhood (and arguably, we could say ‘parenthood’ but I’m just writing about me today) can bring about huge personal growth. Understanding and accepting that you are such a key part of someone else’s world is a huge responsibility, and might be impossible for non-parents to grasp in its entirety; but when you take stock of the resources you didn’t know you had, the range of functioning you can manage on limited amounts of sleep, and the sheer protective strength you can find, all this adds up to quite a superhero status.

Motherhood can bring about a growth in understanding and empathy, especially in our relationships with our own mothers. We find out things we never expected to know about our own babyhood. For me a lot of things slotted into place when my mum talked to me about how she had felt, aged 21 alone with a newborn baby and a husband who – I’m assuming – was as emotionally disengaged then as he is now.

I particularly notice the contrast in empathy from other parents, compared with childless friends. Of course these are generalisations, and I have some wonderful childless friends who have been supportive and fun and great with Bernard. Those are the ones I prefer to spend time with, rather than the childless friends who assume I want a break from being a mother (how can I get a break from my own identity?), and that I am bored of talking endlessly about how wonderful my child is. Seriously, that subject can never tire for me, so forget it. Do you want to talk about your favourite subject all the time? I thought so. The people I tend to take a break with are other parents, who can share that feeling of enjoying the sense of freedom, while simultaneously missing the little ones. They don’t expect me not to be a mother.

Nor do you see, from the superficial coverage that is widely available, that all those sacrifices are rarely black-and white. Some of us like our new bodies; there’s a reason for being a curvy mama beyond mere indolence and chocolate biscuits! I have a far busier social life than I had before becoming a mother; and those shreds of my pre-baby social life that remain, are the ones I really value. And who expects their sex-life to remain static?

I don’t think motherhood in its conventional sense came very easily to me. But as far as my identity is concerned, it has made me feel better-defined, more purposeful and more confident. I know this isn’t every woman’s experience of motherhood; I was and am exceptionally well-supported, and that makes a huge difference. What I’m saying is that motherhood can be these things, and perhaps on International Women’s Day we should be calling for motherhood to be valued and supported so that for women, it is these things.

Originally posted elsewhere on 8th March 2011

28 Jan

Nature is Clever

Towards the end of my pregnancy, I remember being advised by friends that it was very important to get out as a couple as soon as possible after having the baby. I know this was coming from a well-intentioned place, but I’m glad I’m grounded enough to know that that wasn’t for me. Talking to new parents, I encounter a wide spectrum of parenting styles, and if you will allow me a sweeping generalisation, the ones who are having the easier time tend to be the ones who don’t put themselves under pressure to ‘get back to normal’ or ‘show the baby who’s in charge’ right from the start.

It may sound deeply obvious, but having a baby is a massive life event. It impacts on the couple as a couple and as individuals. Anthropologists have observed some interesting stuff about how the behaviour of men and women towards each other changes following the birth of a child; new mothers have a deep evolutionary need to remind our partners that they are responsible for us (for example, compulsively addressing him as ‘daddy’). Sorry, Old-Fashioned Feminists, but evolution takes thousands of years, and human behaviour (and biology) still works as though we live in clans with defined roles. My point is that pressure on a new couple to behave as if nothing has changed jars with our instincts and with the reality of life with a new baby.

Consumer-driven Twenty-first Century Western society, of course, has all the solutions for this. New parents can buy whatever they need to help create distance between themselves and this utterly dependent small creature: mechanical rocking chairs, under-mattress breathing detectors, artificial milk; there’s really no need to be at the beck and call of a baby, and it doesn’t do it any harm, does it?

I hate to talk about benefits and disadvantages. I prefer to talk about normal behaviour, biological expectations, and so on. Nature is very clever. Here’s an example: skin contact stimulates the release of oxytocin. What is oxytocin? It’s a hormone that makes you feel good. Remember orgasms? That’s oxytocin. Touching releases oxytocin; holding hands, kissing, nibbling someone’s ear, that all releases oxytocin. When your child grazes his knee and you kiss it better, that releases oxytocin. Oxytocin helps a woman to labour, and releases milk to feed her baby. Cuddling a newborn baby releases oxytocin. For both parties. Wrapping him up in a blanket and leaving him to cry himself to sleep in another room releases adrenaline, which suppresses oxytocin. For both parties.

Last week a couple came round for some help with feeding. It took a while to get mum and baby comfortable, but eventually we found a way [no surprises to anyone with any breastfeeding knowledge: mum reclined, baby self-attached]. The baby fed. Mum said: why does it make me feel so…. good? That’d be oxytocin, along with relief from anxiety and a sense of satisfaction.

Originally posted elsewhere on 2nd February 2011