29 Dec

The Incompetent Mother

The majority of breastfeeding mothers stop breastfeeding before they are ready, and long before their babies are ready. I will bore you with only one statistic: the World Health Organisation recommends exclusive breastfeeding until the age of six months, but in the UK, fewer than 2% of babies are breastfed for that long, whether exclusively or not.

The knee-jerk response to this is actually not to blame the mothers who stopped before six months, or indeed who never started (although those mothers perceive blame anyway, because feeling guilty is what parents do); but to blame healthcare professionals and volunteers for failing to provide adequate support, to blame employers and economics for forcing women back into a workplace ill-equipped to facilitate breastfeeding; and to blame “society” for disapproving of breastfeeding in public.

These factors do play a part, particularly where the people supporting mothers in the early days with their newborn babies fail to help, and put the blame on the mother by telling her she will never feed, because her breasts are too small, her nipples are the wrong shape, she hasn’t got enough milk, etc etc. A mum I’ve been supporting, despite having such copious milk that she was able to hand-express it prior to giving birth, was then told that she couldn’t feed because she had inverted nipples. One wonders why she had never noticed this before. A few days later another midwife advised her that that was rubbish; in fact her child doesn’t latch on because she has a tongue-tie. But what a great way to make the mum feel responsible for not being able to feed her baby, just because the original midwife couldn’t find a way to help her.

But there are deeper reasons, higher barriers, which are much harder to tackle, not least of which is the guilt that makes open discussion so difficult. But most mothers are not responsible for the difficulties they encounter in breastfeeding, and therefore it is inappropriate for them to feel guilt. Anger, sadness, and more anger, and perhaps acceptance that they can’t change what has happened, but not guilt.

“Guilt is only appropriate when, with full knowledge and free consent, you deliberately chose something detrimental to your baby for some trivial selfish reason.” – Maureen Minchin

The very existence of artificial milk undermines mothers’ belief in their own abilities to feed their babies. The fact that we believe we must have our babies weighed and checked regularly erodes our confidence, and allows an opening for doubts to creep in, widened by the conviction that artificial milk will cure all ills: it will make your baby sleep [research does not show this]; it will help your baby gain weight [so will effective breastfeeding]; it will resolve lactose intolerance [just plain nonsense; what do these people think the sugar in cows’ milk is?].

Added to this is the assumption at policy-making level that there is a widespread need for artificial milk, which at its worst has prevented – in America – publicity about recalls of faulty products. Apparently it is better to maintain the status quo, avoid panicking parents, than to tell people the truth about the nature of the food they are giving to their babies. Surely they have a right to know?

Meanwhile the subtle negatives about breastfeeding appear in literature from supposedly pro-breastfeeding books (What To Expect When You’re Breastfeeding… And What If You Can’t?), to apparently supportive retailers (Boots’ nipple cream advert offers the information that the worst thing about breastfeeding is the inevitable sore nipples, therefore all mothers must need to buy their cream, which cures it. Wrong. No cream will cure pain that is caused by incorrect positioning of the baby at the breast; but correcting the positioning will); to – of course – the babyfood manufacturers (Aptimil follow-on milk, for “when you decide to move on from breastfeeding” – as apparently we all should do before one year, when a child can drink unmodified cows’ milk). The prevailing mythology is that a breastfeeding mother needs to eat more (500 calories extra per day is normally quoted), implying that breastfeeding takes something out of you.

The pressure to get our babies into routines that are usually incompatible with breastfeeding, which works best when the infant is fed on cue in the early weeks; added to the insistence that mothers need to be separated from their babies for their own sanity, and the idea that fathers and grandmothers can best bond with the new baby by being involved in feeding, makes a recipe for inherent difficulties. Routines, separation, and messing with the milk supply by expressing milk or giving the odd bottle of artificial milk are all contributory factors in mastitis and in perceived or actual loss of milk supply.

Finally, the pervasive images of bottlefeeding make that the normal way that people expect babies to be fed. The Richard Scarry book that I bought for Bernard, having enjoyed it myself as a child, shows one newborn being bottle-fed on her (rabbit) mother’s lap in hospital, and one naughty wakeful child being bottle-fed by her (doggy) father, to get her back to sleep. Meanwhile, how are breasts portrayed by the media in general? As sexual objects belonging to men.

Each of these points deserves far more than a paragraph in a blogpost (perhaps one day I will find the right PhD opportunity!), but surely even this brief outline of the huge barriers to making breastfeeding normal demonstrates one of the most important things I have learned over the last few months: that mothers themselves are the last people to blame for low breastfeeding rates.

Originally posted elsewhere on 15th May 2008

07 Dec

Nursing In Public

We often spend time in an antenatal class discussing the perceived horrors of ‘getting them out’ in public places. With varying degrees of support from partners, other family members, and complete strangers, I can see why it is such a huge barrier, adding to the breastfeeding-related anxiety for mums-to-be.

Recently I asked a group ‘who are the first people you are likely to breastfeed in front of?’ and the answers that came back were: your partner, the midwives, your close family. One dad objected strongly: that’s not true, he said. You don’t have to do it in front of any of those people. He was profoundly uncomfortable with the idea of any kind of ‘public’ feeding.

But if the WHO guidelines recommend exclusive breastfeeding for the first six months, an inability to leave the house must have a serious impact on the new mother’s life.

That doesn’t mean you have to be completely brazen and bare all, on a bench outside the town hall, the very first time you do it, hence my question. By the time you are ready to go out for long enough that you are likely to have to feed your baby, the chances are that other people will have seen you do it already. But here are a few ideas to consider, that might make it a less daunting prospect:

  1. Baby Steps
    Consider making your first outing to somewhere you know will be safe, non-judgemental, and with lots of other mums and babies. At NCT Bumps and Babies you will meet mums with babies of all ages, and a whole variety of different feeding experiences behind them. Or find a local breastfeeding support group. Or if you did antenatal classes and have a group of friends, organise a coffee morning at someone’s house. If the wallpaper is different, you might feel less isolated.
  2. Getting Them Out
    If you’ve been schlepping about at home wearing just a nightie for the first week or so, you might not have thought about the impact of wearing or not wearing the right clothing.
    There are countless beautiful and expensive nursing tops available, with mysterious openings and clever tucks and folds. All you really need is a loose shirt, perhaps two layers (vest and t-shirt works well), that you can pull up; and the one essential piece of kit is a nursing bra, ideally the sort with a drop-down cup. You pull the top layer up, the bottom layer down, drop the cup and attach the baby, who then covers up most of the exposed flesh.
    Things to avoid: bras that are not designed for this kind of easy access, tight tops, dresses, lots of buttons.
  3. Cover Up
    I am by no means saying that a nursing mother needs to cover herself as though ashamed of what she is doing, but if it makes you feel more comfortable, you could use a light scarf or a muslin square to disguise the fact that you are breastfeeding. I am skeptical about ‘nursing aprons’ and other devices that are designed to be worn while breastfeeding, because they don’t make the process any less discreet.
  4. Safe Places
    Get to know the places you know you can go, where you will feel safe and comfortable. Large stores often have a baby feeding area; smaller stores might have a changing room with a plastic chair next to the nappy bin. Coffee shops are a haven for mums, especially during the working week; just don’t sit in the window!
  5. Your Rights
    In England, the Equality Act 2010. specifically prohibits discrimination against breastfeeding mothers. Nobody can ask you to leave a public place on the grounds that you are breastfeeding.

This is another one of those concepts that is difficult to get your head around before you baby comes along; and then after a few days of focusing on breastfeeding, may well seem like much less of an issue. But don’t forget that there is a lot of support available from other mums and from groups where mums and babies meet; you don’t have to be stuck in the house.

01 Dec

Book Review: How Not To F*** Them Up, by Oliver James

I read They F*** You Up: How to Survive Family Life about five years ago, enjoyed it very much, and widely recommended it. The follow-up, How Not To F*** Them Up, was sitting on my shelf for nearly a year, and eventually I picked it up and started to read.

Half way through the introduction, I started to skip bits; and then I began to flick through using the ‘Practical Top Tips’ Index; and then I just leafed through the rest. I will not be widely recommending this book.

James claims that ‘solid scientific research’ (p5) divides mothers into three types, and goes on to write unpleasant caricatures of each type. I know which type he would consider me to be, but that does not make me find his descriptions of the other two types any less offensive. We have the selfish, stressed-out Organiser, the martyred earth-mother Hugger, and the dithering, overstretched Fleximum.

James exhorts the reader not to skip to ‘her’ section but to read the whole book exactly as presented, in order to gain a full understanding of herself through reading about the others. This overbearing paternalistic tone persists throughout the book, and may be one of the reasons why I did precisely the opposite.

When James writes about under-threes, I find that he is spot on. His section on the needs of (and myths about) toddlers is clearly evidence-based, and he is relatively open about the harm caused by controlled crying, as well as the pointlessness of the naughty step at that age. However almost every statement he makes about mothers is a patronising generalisation. The case studies are written in a deeply judgmental tone, giving the impression that, whichever camp we are in, we mothers haven’t got a hope of getting it right.

Of course the first section I skipped to was the three pages on breastfeeding, in which James repeats a lot of over-technical information about positioning, attributing it to respected midwife Chloe Fisher. He dismisses Health Visitors as breastfeeding supporters, and then falls into the well-established pitfall of the untrained breastfeeding supporter himself, by basing his advice entirely on his own experience. He repeatedly states that colic is caused by not draining the breast properly. There is no research that conclusively establishes the cause of colic, and advice to ‘drain’ the breast can be very confusing.

This book lacks empathy with the subjects of the case studies and with mothers in general. The useful and accurate information about the needs of babies and toddlers can be found in They F*** You Up. As far as mothers are concerned, though, I would recommend that we all stop reading at page 5, where he states that ‘mothers rarely find anything as helpful as talking with each other;’ and go out and find a Bumps & Babies group or an NCT Early Days course instead.