17 Jun

Breastfeeding support matters, but it’s not all about the individual

Will breastfeeding, too, one day have its historian-chronicler who tries to unravel the train of events leading to the early 21st century’s failed mass alternative-nutrition child-feeding trials?
James Akre in the Huffington Post

I recently heard a talk by researcher and breastfeeding advocate Maureen Minchin (and interviewed her for Episode 15 of Sprogcast), in which she discussed exactly this question. Her new book Milk Matters picks up from and expands upon her 1985 book Breastfeeding Matters, a detailed and dense book covering both the political history of breastfeeding in modern times, and specific information on the management of breastfeeding which is useful for both mothers and health professionals alike. In person, her tone is as assertive and her views as uncompromising, as they come across in this book. In 1985, Minchin wrote “Those who conceal information, for the sake of sparing mothers anxiety, are doing greater harm.” She still firmly believes this.

Quoting, with irony, an old Cow & Gate advert, Minchin says that “what you feed them now matters forever.” Her milk hypothesis is that breastmilk is the bridge from the womb to the world, enabling the baby to develop a healthy microbiome, which regulates the immune system and optimises development. Furthermore early nutrition is the single biggest influence on gene expression following birth.

There is plenty of evidence for this, and emerging evidence that exposure to cows’ milk protein actively interferes with gene expression, triggering a trajectory of growth not only for the life of that baby, but if she is a girl, for her children and grandchildren too. More details about this can be found in her presentation here.

Minchin accurately predicted a backlash against honesty about the risks of not breastfeeding, and cites the huge vested interests of the baby milk industry, which has successfully divided mothers for decades, co-opting the phrase “breast is best” to create an aspirational ideal, and undermining breastmilk as the normal infant food for our species.

Why is it so hard to talk about breastfeeding in a positive and helpful way, that doesn’t incite an emotional response? The day after hearing Minchin speak, I was at the Association of Breastfeeding Mothers (ABM) annual conference in Birmingham, listening to speakers who truly understand the challenges of supporting individual mothers, in a social context that is not supportive of breastfeeding. The health, social, and emotional issues are the background noise against which we all work with mothers; but too much of what society knows about breastfeeding comes from a middle class media that categorises women according to the way they feed their baby. As Lactation Consultant Sally Etheridge pointed out at the ABM conference, “just because a mother isn’t breastfeeding, it doesn’t mean she didn’t want to.”

Earlier this year, a report in The Lancet demonstrated that the UK has the lowest breastfeeding rates in the world. Whose responsibility is it to change this? Those whose vested interests lie in women breastfeeding less would have us believe that anyone offering breastfeeding support is a member of the Milk Mafia, with an earnest belief in boosting those numbers bleeding nipple by bleeding nipple. Breastfeeding happens within a complex socio-economic context, and a focus on public health rather than on individuals does not preclude individual support. In fact the goal of most breastfeeding supporters is to help improve individual mothers’ experiences, to support their feeding decisions, and to empower women to make those decisions. According to researcher Heather Trickey at the ABM conference (also on the next episode of Sprogcast), it is not the responsibility of the feeding supporters, or of any individual mother, to improve breastfeeding rates; it is the responsibility of society, of the health services, of government. The only people who gain from pussy-footing around women’s feelings about breastmilk and formula are those who make a profit from exploiting mothers, to the detriment of public health.

[Cross-posted from the Huffington Post]

01 Jun

Book review: The Secrets of Birth, by Kicki Hansard

The Secrets of Birth is a book born out of Kicki Hansard‘s extensive experience of supporting birthing women. This book is intended for pregnant women, and aims to reveal five secrets that will help them during birth and the transition to motherhood.

The five secrets can be sorted into two main themes: the first three tell us that childbirth is a normal physiological process, and the last two that becoming a mother is a major personal transformation. This is useful and interesting information, and Hansard covers important topics including straightforward birth, hormones, skin to skin, and the benefits of a calm, safe environment, very effectively.

She goes on to discuss the transformational process of birth, a time when women have “nowhere to hide,” (p72) and a great opportunity for growth. I would have liked to read about this in greater detail, as few books (Naomi Stadlen excepted) seem to focus on this except in the most superficial way.

Hansard obviously has a wealth of experience with women in the birthplace, however this comes across as being a fairly small section of society, since the first chapter discusses at some length the pros and cons of engaging a private obstetrician; and of course the majority of her experience refers to her own clientele, a self-selecting group of people who hired a doula. There are several parts of the book which read like a manifesto about the state of birth in the UK, which may not be generally useful for expectant parents. The language and concepts discussed are more appropriate for birth professionals. One could argue that this subject matter needs to be more widely talked about (but one cannot then argue, for example, that the NCT is “too academic” (p16) in their approach).

I am always wary of birth professionals who appear to set themselves up in opposition to other birth professionals, and some of Hansard’s secrets seem to imply distrust of obstetricians (p12), midwives (p15), hypnobirthing (p38), and even the father as birth partner (p32). While much of the book is based in the author’s experience and personal opinion, there are some well-referenced and useful points, and good signposting to a range of sources. The short section on natural caesarean is one of the book’s highlights. The final chapters consist mostly of birth stories, supporting the various points made earlier in the book.

While The Secrets of Birth is probably not the first book I would offer a pregnant woman, I think it would be a very interesting read for doulas in training, or anyone supporting a birth or a new mother.

[Disclosure: Kicki sent me a review copy of her book – thanks!]