Author Archives: Karen Hall

25 Mar

Breastfeeding and going back to work

In that chaotic blur of cuddles and tears that is the first few weeks with your baby, when you’re taking it one feed at a time, it’s possible that you might miss your working day. The luxury of time to sit at your desk and think, drink a cup of tea while it’s still hot, chat with other adults about matters non-baby, oh those were the days!

And as your baby grows and you settle into your new roles, perhaps the thought of work recedes for a little while; but towards the end of your maternity leave, you have to start making decisions. Whether you will go back or not; would you need to apply to change your hours; what sort of childcare you might need… and if you’re still breastfeeding, how on earth are you going to manage that?

During pregnancy and in the early weeks of motherhood, my assumption was that I would stop breastfeeding at six months, ready for when I returned to work at seven months. I interviewed several childminders and chose the one I was most comfortable with, and her assumption was also that I would be providing formula for him during the day. I arranged the date I would start back at work; and, all this in place, proceeded to wean from the breast.

Only I had failed, yet again, to consider what my son would agree to. Not only did the little terror categorically refuse to eat food of any sort, lips sealed head turned and expressing RAGE with every part of his being; but he was also absolutely not prepared to countenance the nasty bottle I kept trying to tempt him with. It was distressing for both of us. It was distressing for my partner, when he tried to give a bottle. It was a disaster.

Dani says of her daughter,

it never occured to me that she wouldn’t be ok when I returned back to work when she was a year old … it resulted in us both getting very upset & her wanting to feed even more, probably as reassurance more than anything, but I knew she had to be ok to go without when the option wasn’t there & I didn’t know how to prepare her for that without stopping the majority of feeds in the day.

Both Dani and I eventually made the decision not to wean, but to follow our babies’ lead and carry on breastfeeding when we returned to work. In practical terms, by six months in my case and a year in Dani’s, our milk supplies would have been robust enough to cope with a more chaotic feeding pattern, so for example I could feed my son on my days off and at night, and needed to express for the first few weeks back at work.

Ann tells what it was like to arrange to express at work:

My company bought a reclining garden chair for me to sit in, and put it in the shower room (which isn’t as bad as it sounds), it was actually quite pleasant …Except expressing takes ages. I was hand expressing. Every day. For two hours at the beginning to get the 400mls of milk A needed every day.

But two hours was difficult to fit in when I was working on two projects, and I was leaking if I didn’t manage to get away at the right times to express, so I had constantly sore boobs.

Then [I had to work] on site, and the medical room only had a mag lock, and you couldn’t lock it from the inside once you were in, and anyone who had a pass could walk in. And it was also used as the Muslim prayer room. And yes, I was walked in on. Twice.

My bottles of expressed milk in the office fridge caused some raised eyebrows. Ann sensibly recommends putting them in an opaque make up bag. It’s useful to know that expressed milk will keep at room temperature for a few hours, and longer in a cool bag, so you can take it home, refrigerate it, and send it with your baby the next day. If your baby will drink it, which mine did not.

My childminder was frankly horrified, and found it very hard to look after a baby who did not eat a thing from drop-off to pick-up. With my head full of going back to work, I feel I took my eye off the ball and failed to see that for my baby, it wasn’t just the milk he was going to miss, it was me.

In a similar situation, Dani actually made the decision to stop working altogether:

I handed my notice in at work, using the remainder of my annual leave I’d accrued on maternity leave to cover my notice period & once I took the pressure off to reduce her feeds, we came out of a 2 month long fog. I felt happier, L seemed happier & I accepted that was how it was going to be. What I didn’t count on was a childminder who wasn’t to be beaten & she wanted to give L another week.

With a few changes, L settled in and Dani did go back to work. She says I think that letting her do it at her own rate was what helped her eventually be ok without. There is hope for those mummies with boobaholic babies, L shows it can be done!

But babies develop and adjust to change at different rates, and Ann, no longer expressing but still feeding all night, feels that they are not there yet:

I want to continue, but at 17.5 months, I’m desperately tired, and have been horribly ill, and I’m honestly wondering whether it’s worth continuing or not.

None of these decisions are easy, and all come with a payload of guilt, one way or another. If you’re in the tiny percentage of mothers in the UK still breastfeeding beyond six months, it’s hard to access relevant support. It may feel like your peers have all stopped feeding long ago, or that the groups you’ve been going to are mainly focused on feeding newborns; in any case once you’re back at work you no longer have access to the drop-in groups and the whole thing can be very isolating. I retreated very much into online support from various forums where being a ‘toddler-feeding weirdo’ was a point of pride; now I meet such people all the time through my work, and make an effort to put them in touch with each other, so the peer support can continue. If you find yourself reading this and wondering where the help is coming from, or asking yourself who is going to understand, please get in touch, or call one of the breastfeeding helplines, where most of the counsellors answering calls will be or have been, like you, in that tiny percentage.

NCT Breastfeeding Line 0300 33 00 700 7 days a week 8am–midnight

Ann writes at beta parent and is @pixeldiva on twitter.
Dani is @boo_bowglin on twitter.

13 Mar

Announcement!

Today I met with my mentor Maddie McMahon, and after an interview which took place over a pleasant lunch, I am now a Recognised Doula. Here’s an explanation of Mentored and Recognised Doulas from the Doula UK website:

Mentored doulas
A Mentored Doula has completed a Doula UK approved Preparation Course and is involved in Doula UK’s Recognition Process. This means that she has a Mentor providing support and supervision within a framework for reflective practice until she has gained sufficient experience to become a Recognised Doula. A Mentored Doula’s fees reflect her previous and current experience, her expenses and the going rate in her area.

Recognised doulas
A Recognised Doula has been evaluated by a Doula UK Doula Mentor at the end of the Recognition Process, as having sufficient experience to practise without on-going mentoring. Doula UK nevertheless continues to provide support for all its members.

01 Mar

Comfort Milk

In the last few days we have been hearing news of a shortage of Cow & Gate Comfort Milk and Aptamil Comfort Milk. Danone, the owner of both brands, is reported to have run out of an important ingredient, maize starch, which is a corn-based thickener.

Parents use Comfort Milk for babies who are colicky, have wind, or are prone to possetting (bringing up a little milk after feeds). These are also symptoms of lactose intolerance, as described on this NHS website.

Comfort Milk, according to their website, is “Specially developed with reduced lactose to assist with the dietary management of colic and constipation, keeping your baby more comfortable and giving you a helping hand when it comes to maintaining your little one’s health.” If your baby is constipated, it would be advisable to talk to your GP or Health Visitor.

Packets of Comfort Milk are currently going on eBay for huge sums, to parents desperate to give their baby their usual milk. If your baby usually has a Comfort Milk, and you are unable to get hold of it, you can give any other suitable formula milk instead; switching brands will not harm your baby. All infant formula is made to a set government standard, within very narrow guidelines, and therefore all brands have the same nutritional content. If your baby is under six months, it is important to give milk that is suitable for newborns. Follow-on milk can be used for babies over six months, but is nutritionally unnecessary, and you can continue giving first milk if you wish.

First Steps Nutrition has a good document about different types of milk.

NHS has a step-by-step guide to making up a bottle of formula safely and hygienically.

If you are worried about your baby, you can talk to an NCT Breastfeeding Counsellor on 0300 330 0700

Lots of supportive information about bottlefeeding can be found on our sister website.

25 Feb

What I’m Really Thinking

I’ve always assumed The Guardian’s What I’m Really Thinking column is meant to be a caricature, not something to be offended by. I know that last week’s anonymous piece by ‘The Child-Free Friend’ is not meant to represent the views of all childless people, and I admit that ten years ago I could have written it myself. I can quite smugly tell you that now I’m no longer childless, I finally have some empathy with parents, but that’s not to say that I speak fluently the language of child, that I find all babies beautiful, or that I ever want to change a nappy [unpaid!] again. I’m sure I’m not the only parent in the world who doesn’t really notice other people’s children until they make an annoying noise. That’s why I’m a doula, not a childminder; doulas care for mothers.

The writer is of the opinion that since parenthood is self-inflicted, parents deserve exactly zero amount of sympathy, even from a friend who claims to “care about you and your life,” when they express sadness at missing pre-parenthood freedoms. How can she possibly complain about the relentless demands of parenting, when this is what she signed up for? I’m sure you don’t have to offer to babysit for a night, to try to imagine that however much you love your child, there are always going to be times when you long guiltily for a night out that doesn’t take months of planning, an uninterrupted lie-in, or even just five minutes when nobody is asking anything of you. These are the things parents aren’t allowed to say, and because we aren’t allowed to say it, it comes as a shock to many new parents, to find that the child has no off-switch, our leisure time can no longer be filled by going to the gym or watching a Lord of the Rings triple bill, and the money drain never stops. So she didn’t sign up for it, exactly. A huge amount of doula work and breastfeeding support is about helping when reality doesn’t meet expectations.

As for your friend thinking that your life choices are less sincere, enduring or fulfilling, I had to laugh at how a paragraph about feeling judged could be so judgemental. This is why I knew that the writer didn’t stand for all childless people, because choosing to be childless is just one of many lifestyle choices, and most of us tend to think that the things we choose are better than the things other people choose. And most lifestyles are not simple binary choices.

It’s just as hard for parents to hold on to their non-parent friends as the other way around. It’s hard to have a conversation when part of your brain is permanently allocated to childcare, especially when you’re aware that the person you’re chatting with doesn’t like your snot-encrusted marmalade-fingered darling, is bored by their latest achievements, and just doesn’t get how your priorities are different now. And we’re tired. All the time. Like when you’re jetlagged or you’ve been working hard to meet a deadline or you’ve run a marathon, and those are lifestyle choices too, and you would expect some understanding.

Motherhood is pretty complex, and many non-parents seem to perceive it only at a very superficial level. We’re all childless before we have kids, we’ve all stood in your shoes. Now why don’t you try and stand in mine?

04 Feb

Evidence is overrated!

As a confirmed skeptic, my title is deliberately provocative, but reflects the tail-chasing propensity I have to apply skepticism to skepticism. I absolutely have to be evidence-based in my work, and I’ve completed a BA module in understanding and using research, but I still worry that I’m as guilty as the next person of cherry-picking it to suit my own views.

When it comes to birth and parenting, the quality of evidence available is not great. Much of the subject matter is undefined or too complex to boil down to a testable hypothesis, and RCTs on babies are ethically difficult. On top of that, parents being such a super marketing demographic, there are an awful lot of vested interests.

Most people working in this area are emotionally invested in some way, and not all the organisations supporting parents have a rigorous reflective practice and supervision structure, allowing them to debrief to the extent that they don’t carry any value judgement at all into their work.

This muddies our use of evidence.
There is some research on how hard it is to adopt new learning, when prior knowledge is deeply embedded. Hence out of date practices and misinformation propagated through on the job learning. If new evidence is not a good fit with what we already ‘know’, it is difficult to re-align oneself. We see this with adherents to scientifically implausible theories for example within alternative therapies, where belief is very much stronger than evidence.

There is also research [pdf] suggesting that GPs often base their breastfeeding advice on their own experience or that of their partners. In fact this rule applies to most people: if it worked for you, you may well suggest it to someone else, especially since the urge to problem-solve may be overwhelming. One GP spoke to me at length about something that she called “yeast mastitis.” A yeast infection of the breast (thrush) and mastitis are two entirely separate conditions, with different (but sometimes related) causes and different treatments. This is fairly basic stuff.

Parents are certainly titled to evidence-based information, and there are some good sources such as NHS and NCT websites; but this should include information about the limitations of the evidence, and where professionals supporting parents are unsure, untrained, or inexperienced, they should be clear about their boundaries and limitations. More damage is done by the supportive making up of answers than by handing over a reputable helpline number.

Evidence can be used as a stick to beat parents with (perfect example: “breast is best”), and then on the other hand it really is overrated as a decision-making factor compared with pressing lifestyle issues and social influences. Science journalist Linda Geddes, a busy parent of two who knows the evidence behind exclusive breastfeeding to six months, still chooses formula milk for her four month old when it is more convenient to do so. She weighs the risk, according to the evidence, but also in the balance are the fact that her two children are “simultaneously clamouring for their dinner and I don’t have time to sit and breastfeed.”

This is not a value judgement, but an excellent illustration of the way evidence is balanced and sometimes negated by parents’ lifestyle and needs, when making decisions. For me, it’s the evidence about sending a six month old to daycare that makes uncomfortable reading.

Working with parents is about providing evidenced information and decision making tools and confidence in themselves as parents. Evidence does not make something right or wrong when it comes to parenting, and we absolutely cannot use it either to dictate or to judge what parents do.

15 Jan

Book Review: Bumpology, by Linda Geddes

Bumpology is an attractive and accessible book with a very clear and logical layout, which compensates for the lack of an index. It is as easy to dip into as it is to read from cover to cover; I know because I did both.

This is a marvellously comprehensive collection of research evidence and occasional comment upon the lack of research evidence, for all the advice and received wisdom relating to pregnancy, birth and early parenthood. As Geddes says, the science is out there, but it often takes some digging to find it.

Geddes looks at the big issues such as place of birth, breastfeeding, and all those things you’re told you can’t eat during pregnancy; as well as bringing in some colourful sections on how the growing baby develops in the womb, what senses function from birth, and the role of newborn reflexes. This in itself is a useful part of learning to empathise with the baby, and might influence parenting choices.

I am used to reading far more dogmatic books (from all over the birth and parenting spectrum), so this measured tone is very refreshing. Research in this area on the whole appears to be very thin, often studies are very small or based on the behaviour of lab animals. The book does not offer many definitive answers, but its general message is not to take advice for granted, since much of what we are told from the moment we even start to think about having a baby has no basis in fact. This very important point was made by Octavia Wiseman in a recent Midirs article (July/August 2012:p22), pointing out that much health advice is risk-averse, undermining parental choice, and that “explaining to women the limitation of our evidence base is the first step to take when asking them to make ‘informed’ choices.”

It is lovely that the text is scattered with anecdotes about the author’s personal experience, but for the most part this book is about facts not feelings. It largely ignores ‘soft’ aspects such as how parents feel about risk, and how mothers experience birth and early motherhood. Statistical comparisons of different aspects of birth look at outcomes and define those in terms of health of the baby and mother, taking little account of how women feel during and after the experience. For example lying down or being mobile during labour may make no difference to the outcome in statistical terms, but different women may experience these scenarios as more or less positive. Lying down in a room full of medical staff may feel disempowering; a woman being made to walk around may feel bullied. Working with parents both antenatally and postnatally, I know that scientific evidence may not always be the most important factor when making decisions. A good example of this would be the decision to share a bed with your baby: whether, according to various studies, this increases the risk of cot death; or whether it increases your child’s self-esteem, are less likely to influence the decision to bedshare than the fact that it might just be easier not to have to get up in the night. This does not, of course, detract from the fact that parents can and should be made aware of the evidence in order to make an informed decision; and to be fair, Geddes does not set out to explore the qualitative aspects of parenthood, but to present the facts and figures, and bust the myths: a very worthwhile mission.

I would recommend Bumpology to anyone expecting a baby, but I think it is also essential reading for anyone working with parents, antenatally or postnatally. It is so important for us to get our facts right, to counter the myths and enable parents to be confident in their decision making. Very few of the books I’ve seen are so robustly evidence-based, and an awful lot of people working with parents will repeat advice without giving any critical thought either to the evidence behind it, or the effect it might have in an individual situation.

Bumpology Blog
Sense About Science
Linda Geddes on Radio 4’s Today Programme with Belinda Phipps, CEO of NCT

14 Dec

Book Review: Feed Yourself, Feed Your Family

Feed Yourself Feed Your Family is an attractive La Leche League book packed with information and useful tips. The chapters are ordered chronologically, covering pregnancy, new parenthood/breastfeeding, starting solids, and feeding a family. Each chapter includes a selection of recipes considered appropriate for that particular chapter of your life.

I was concerned that a chapter on eating for breastfeeding would fall into the trap of implying that breastfeeding is demanding if you don’t eat special food, but in fact the book explicitly states that this is not the case (however it does mention the need for 350 extra calories, which is not supported by evidence). This section is brimming with suggestions for food you can eat with one hand, and food you can get other people to cook for you. I especially liked the comment that “you are passing on your culture through your milk,” (p68) and have quoted that in antenatal classes and see the parents nodding.

The book has a slightly american tone, although it’s clear that much of it has been ‘translated’ into British English. Some of the food standards given are american, though this doesn’t detract from the clear, factual approach. My biggest concern with the book was the amount of salt added to almost every recipe, some of which included salt in the cooking, again before tasting, and then a garnish of bacon. The Starting Solids section could have had more emphasis on baby-led weaning, good finger foods, and how to work family meals that baby can eat too.

I didn’t think I could review a recipe book without trying out some of the recipes, so we tried five of them last week. Here’s how it went:

Monday
The Slow Cooker Split Pea Soup (p182) was very convenient for such a busy day; all the ingredients went into the slow cooker at lunchtime, and it just smelled more and more delicious over the course of the afternoon. Recipe books for me are inspiration rather than instruction, so most things get altered in some way. I added pancetta to this vegetarian recipe, to make it more acceptable to my partner and son, both of whom like veggie food but are sometimes a bit tentative when it comes to pulses. The soup went down an absolute treat, and there was enough left for lunch next day. Both of them said they would like me to make it again.

Tuesday
Tortilla Pie with Black Beans (p48) was another hit. This was tasty and cheesy, though it was a mistake for me to plan it for swimming night when I had one hour to cook and eat before rushing out to teach. This vegetarian dish slipped through the net no problem, though it was suggested that we could try it with chicken as well.

Wednesday
We were less enthusiastic about the Chicken & Sugar Snap Pea Saute, which seemed like an odd combination of nice things that didn’t really go together. It was also quite tricky to figure out what would go with this, as it didn’t lend itself well to pasta or rice, so ended up being served with chips.

Thursday
The plan was to make Froelich Family Rice (p137), however on reviewing the recipe at 5pm on Thursday I realised that it involved over an hour of cooking just to produce minced beef with rice. So I’m afraid I cheated completely, got out a packet of rice with vegetables, and cooked up the beef with some herbs, mushrooms and tomatoes, and mixed it all together. The end result was much the same, and they just stopped short of licking the bowl clean.

Friday
I try to include fish in our diet every week, despite not really liking it much myself, so on Friday I made the Fish Chowder (p229), using white fish instead of salmon which I cannot stand. This was the added-saltiest of all the recipes I tried, with salt added twice in the cooking as well as a stock cube and a bacon garnish. This seriously undermined the promise that the book is giving the reader “a blueprint for a lifetime of healthy meals” (p8). As I had forgotten to get the bacon out of the freezer, this was a moot point. My partner and son enjoyed the chowder, though my son as usual when bread is available did mostly eat the bread. I tolerated it and felt virtuous.

I would recommend this book because every chapter there has sensible information and guidance, including practical ideas for cooking while your baby or toddler is around. I would not go out and buy it just for the recipes.

*****
To order Feed Yourself Feed Your Family with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

10 Dec

Running 10k

I can’t do it.
I’ve never done it before.
It will hurt.
My mum couldn’t do it.
It will be really time-consuming.
It’s tiring.
I’m not sure my body’s up to it.
I don’t know how to do it.
I don’t want to do it in public.
I have to do it all, my partner can’t do it for me.
It might be better to drive.

Oh well, I’ll give it a go. But I won’t beat myself up if I can’t do it.

The British 10k, 14th July 2013

05 Dec

Book Review: Vaginal Birth After Caesarean

Vaginal Birth After Caesarean: The VBAC Handbook, by Helen Churchill and Wendy Savage, is a neat little book absolutely packed with useful information for mothers considering a VBAC, and those supporting them.

It is worth reading just for its forthright introduction explaining exactly why the authors choose not to adopt the tentative and controlling jargon often used by health professionals. The careful use of language in the book is in itself empowering.

Reading this book, I learned that 70-80% of VBACs are successful; that the risk of VBAC is lower than the risk of a planned Caesarean; and that the reasons commonly given not to “try” to have a VBAC do not appear to be evidenced across the board. Even the section dealing with higher risk groups shows that in most cases a VBAC can be possible.

The second part of the book includes several VBAC stories, not all of which were successful; however the stories demonstrate and affirm the wide range of experience even within this segment of birth and labour.

This is a useful and succinct guide, and I highly recommend it.

*****
To order aginal Birth After Caesarean with a 25% discount, just follow the link and use the discount code KH25 at the checkout.