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

08 Jan

Prepare for the worst

This week I’m hearing a lot from the 3rd Annual Birth Trauma Conference, particularly about mental health after birth, and how well prepared – or not – women feel. Milli Hill pointed out in a tweet what a straw man it is to blame antenatal preparation alone:

“Blame goes to antenatal teacher, or the woman herself…but oddly never to the system that doesn’t give women optimal chance of straightforward birth but instead often traumatises her. #birthtrauma18”

There are two things to look at here. One is how possible it really is to cover birth trauma and an issue as serious as postnatal psychosis, in a group of 8 couples (for your average NCT class), in a limited period of time and alongside other huge important topics, and in a context that is intended to empower women in the birthplace? The other is, how much impact does antenatal education have in the face of the barriers to straightforward birth including but not limited to lack of continuity of care, time pressures put on women by staff with time and protocol pressures on them, lack of real informed consent, and a society-wide assumption that birth is difficult and dangerous, and a healthy baby is all that matters? It’s a lot easier to say “NCT set me up to fail” than to acknowledge that the entire system sets women up to fail.

I spend much of my working hours and my voluntary time chipping away at the system, and write and broadcast constantly about those big issues. So let’s just look at that one smaller issue, how we tell a group of already-fearful pregnant women that birth might leave them with PTSD, without undoing all the work of empowering them to trust their bodies and birth their babies with as little unwanted intervention as possible. I can’t speak for all antenatal education (and let’s not forget that NCT isn’t the only provider of antenatal courses), but I can tell you about my own. I do this in small groups, providing a set of handouts and a case study for each group. The case studies cover baby blues, postnatal depression (men and women) and relationships and expectations after the birth. The handouts also mention postpartum psychosis. The ensuing discussion covers risk factors, symptoms, self-care, support, and so on. Some groups really engage with this, and often when someone has experience of depression, they make very valuable contributions. I’m always aware that there may be people who have experienced it and will stay very quiet. Once I observed an antenatal session where the practitioner covered feelings after birth immediately after doing a relaxation, and left the lights down low; in that atmosphere of safety and calm, a woman shared the story of her antenatal depression and it was powerful.

I just want to say that if even NCT, who have the best trained and most rigorously assessed antenatal practitioners out there, can’t always get this right for women, perhaps we need to go back and take on the difficult task of addressing the big issues, and work together instead of blaming – which potentially puts people off accessing valuable support and education. It’s also worth noting that antenatal educators of any brand don’t operate in a cheerful idealistic vacuum: we sit on Maternity Voices Partnerships, we campaign, we listen to women, we make and listen to podcasts, we are mothers; and we are involved in the system and we are active in trying to make it better. “Setting women up to fail” is an unfair accusation.

31 Dec

A trilogy of book reviews

These are the last three books I have read in 2017, a very satisfying year when it comes to reading. I am not sure how I have managed to find the time, but hope that a less crazy 2018 might mean even more reading time!

A Midwife’s Story – Penny Armstrong & Sheryl Feldman

In this memoir of midwifery among the Amish community, Penny Armstrong reflects on her growth and development as a midwife. It’s fascinating to see her confidence in straightforward birth in a home environment increase through experience. She is well-placed to make the comparison with hospital birth in the 1970s, and it is horrifying to note how little has changed. The vignettes of Amish life are also charming, and this is a well-written memoir – certainly the best story of midwifery I’ve read, thanks to writer Sheryl Feldman’s well-judged turn of phrase. I found it utterly absorbing.

[Disclosure: Pinter & Martin sent me a free review copy of this book; you can get a 10% discount on your copy if you use the offer code SPROGCAST at checkout on their website.]

How To Have A Baby – Natalie Meddings

How To Have A Baby is a doula in a book. It’s nearly a big enough book to fit in an actual doula, and crammed with wisdom (just the “big necessaries,” writes Natalie Meddings) sourced from her own experience and the stories of many mothers. Meddings’ tone, like the ideal doula, is firm but gentle, calm and encouraging.

The book takes the expectant mother through the usual route of pregnancy and planning, into labour, birth and the unexpected, and out the other side to feeding and newborn days. Descriptions are clear and “tips and tricks” are shared helpfully at every stage. Meddings is pragmatic and honest. Birth is discussed in terms of an involuntary bodily function, and how to create the optimal conditions for this to happen. Induction is presented as “a ticket on the intervention rollercoaster” (p116) which is an interesting choice of words, however the pages explaining induction are practical and compassionate, giving a clear idea of what happens and what can help.

This book is an excellent resource for birth planning. Meddings is very concerned with consent and human rights, both of which she covers very clearly; and this is her real strength. I much prefer these well-referenced and forthright pages, to the liberal sprinkling of homeopathy etc alongside the useful coping suggestions.

You are waiting to hear what I think of the breastfeeding information, so I won’t keep you in any more suspense. With contributions from Maddie McMahon, the importance of early feeding and skin to skin is discussed, and Meddings describes the newborn feeding reflexes and how to support the baby to self-attach. It is a little surprising when she goes on to describe a rather prescriptive way to hold the baby, which does not support those reflexes so well, given her let-nature-take-its-course-and-things-will-work approach to other aspects of birth and parenting. And sound the klaxon for “breastfeeding granola,” which looks delicious but should correctly be termed “granola,” given that breastfeeding experience is not generally influenced by the consumption of roasted oats and nuts and so on.

Matters are redeemed by the rest of the new-baby/new-mother section, referencing such respected authors as Naomi Stadlen and Deborah Jackson, and with plenty of exhortations to eat cake.

I think this book is jam-packed with stuff that would be useful during labour and birth, and it would set up a new mother nicely for those early days and beyond. Practically speaking, the book is probably a bit too chunky to carry around with you and make notes in, as Meddings suggests in the beginning; in fact I think it would work brilliantly as a loose-leaf binder (or perhaps an app), so the reader can pull out relevant sections as needed (which would facilitate reading whilst feeding). Some websites and numbers are given to access support but there could be a lot more of this. On the whole a very highly recommended book for practitioners and parents-to-be alike.

[Disclosure: Natalie sent me a free copy of her book to review – thank you!]

Eleven Hours – Pamela Erens

The last book I finished reading this year was perfect to follow these two, and I think I may even have bought it myself. In Eleven Hours, Lore is in labour, cared for by Franckline who is also in the early stages of pregnancy. As Lore’s contractions come and go, we learn both women’s sad stories: Franckline’s lost babies, and Lore’s lost love. Franckline’s midwifery is full of empathy and kindness, but this is starkly framed by the harsh restrictions and requirements of hospital policy, and the insensitive words and actions of her colleagues.

Lore arrives in the maternity ward alone, with a five page birth plan. Franckline is the only one to read and respect this, and does her best to steer things back towards Lore’s wishes, even as events keep on sliding off track. The labour progresses slowly, and then takes an unpredictable turn. Gripping fiction, and a great way to wrap up Meddings and Armstrong, and 2017.

18 Dec

Milk Machine

It makes me feel like a cow, she said.
Just to look at it now.
Its friendly pastel plastic
Fills me with dread
And I can’t get out of my head
The sound of a robot baby
Taking my milk.
It fills me with dread
When I think of the nights ahead,
The stirring and snuffling noises
That will pull me
From my warm bed;
When I think of the nights,
There’s no light
At the end
Just shattered sleep,
Shattered me,
Overwhelmed with dread,
And with longing
That somebody else
Could do this instead.
I’ll be a cow if it means
It’s not just me
Getting up in the night
To sit in the dark
And long for my bed.
I’ll be the cow,
But it fills me,
It fills me with dread.

12 Dec

Book Review: The Expectant Dad’s Handbook, by Dean Beaumont

This book came out a few years ago to accompany Dean Beaumont’s DaddyNatal antenatal course for men. It covers pregnancy, labour and birth, and life after birth, in a chatty but intelligent style, while keeping the focus firmly on the partner’s role in supporting the new mother or mother-to-be. I like Beaumont’s approach of describing the situation and the options available, and then exploring what the partner can do to give support.

As with all such books, the first chapter I looked at was the one on breastfeeding. Unlike the birth chapters, Beaumont gives no ‘how it works’ information, which is disappointing given that I often find the men in an antenatal session to be fascinated by the science. In a scant five pages, there is a little too much focus on how dads can get it wrong, and of course the inevitable suggestion that they can help out by giving a bottle, with little exploration of the complications that this can introduce. Formula feeding doesn’t get so much as a sidelong glance.

However, this is the weakest part of the book, and in fact the information on labour and on life with a new baby is thorough and evidence-based. I would recommend this book to an Expectant Dad, but I’d also suggest something a bit more comprehensive on feeding, alongside.