Karen Hall | Motherworldly

22 Nov

What does your NCT Breastfeeding Counsellor do for you?

Sometimes I think I have the best job in the world. I meet parents-to-be at the most exciting time, towards the end of pregnancy, and help them to think about what they want for the first days and weeks of their babies’ lives. I find the subject of breastfeeding endlessly fascinating, and could easily fill twice as much time as I usually get to spend with parents antenatally. Since I qualified 3.5 years ago, I have learned so much from the people I work with, and I like to think that my approach constantly evolves and improves to take account of the different decision-making processes used in different families. I have grown to be more accepting of different styles of parenting, and to value parenting in itself, in all its different facets.

At the moment I am very busy facilitating breastfeeding sessions on antenatal courses in Wokingham, Twyford, Reading, Bracknell, Crowthorne and Camberley, and sometimes as far afield as Marlow and Slough.

For the last four years, we have had a weekly drop-in breastfeeding support group at Brambles Children’s Centre. This started slowly but has gone from strength to strength. We see around 350 new parents a year at the group, and have a great working relationship with the Health Visiting Team, who work across the corridor from us at the baby clinic. Unfortunately the Children’s Centre management has decided to close down the group, choosing to direct their funding towards more targeted and measurable working. We are not yet sure if this will involve NCT, but it’s certainly very sad not to be working from Brambles anymore.

I also host the Bumps and Babies group that meets on the first and third Wednesday of the month at the Bradbury Centre in Wokingham. Every other meeting has a speaker or an activity, but the group mainly has a social support function, giving new mums the opportunity to get out of the house and meet people. I’m there to provide breastfeeding support if it’s needed.

Breastfeeding Counsellors can work on the NCT’s national Breastfeeding Line (0300 3300 0700) listening to and supporting mothers and fathers across the country. I usually do three hours a week on the line. I also get local calls from parents I have met on antenatal courses; most days there is at least one call, text or email, and sometimes these turn into home visits. All of this part of my work is voluntary. You may also have seen me on Facebook on the NCT page and Wokingham Gossip Girls, just reminding people that support with breastfeeding is available.

When I started my training, my son was eight months old and not taking well to solid food, so introducing solids has always been a subject of great interest to me. I run Introducing Solids Workshops locally, and I’m part of NCT’s Introducing Solids Team, developing our policy, working on the website and information centre to communicate about the subject, and delivering study days for other Breastfeeding Counsellors to be able to run workshops.

People ask me if this is a full time job, and I can honestly say that there isn’t time for much else, although it isn’t full time paid work. I’m very lucky to have a supportive and understanding partner, as well as support from the local team of antenatal teachers within NCT. Sometimes my job is hard work, frustrating and draining, and it feels like you’re carrying the weight of parents’ disappointment and anxiety; sometimes you don’t do anything at all and not doing anything works for that family; and sometimes it’s the most satisfying and interesting work I could ever imagine doing.

[This post is a description of one working week. These are my views and my words, and I do not speak for or represent NCT]

07 Nov

Book Review: Confident Birth, by Susanna Heli

Confident Birth is an attractive book with a well-argued premise that empowering women with confidence in their own bodies and a good understanding of what happens during birth is a deeply positive move. Heli asks why we should be so afraid of childbirth, when maternity care has never been better; perhaps a quick dip into Birth & Sex would provide some insight: Kitzinger points out that we may have medically safer outcomes, but the psychological experience of contemporary childbirth may be something to fear. Heli focuses on the modern expectation of painless instant gratification in a consumer society, and explores the role of pain in labour, to help women develop tools and strategies for listening to their bodies and making positive decisions.

The first section of the book explores our attitude to pain and childbirth, with some exercises for the pregnant women, and short birth stories to illustrate her points. The second section offers four tools for coping with pain in labour, and the third section offers useful guidelines for the support person.

Confident Birth is aimed at the pregnant woman who wishes to prepare herself for a positive experience of birth. It uses language of empowerment and trust in the body and the instincts. It skirts the mystical, and while occasionally idealising labour (for example, describing it as “something to deepen our emotional intelligence” p.19), Heli does not demonise intervention. The gentle, encouraging tone makes it highly suitable for expectant parents; there is a good clear description of what labour is actually like, including physical and emotional sensations, and what the woman might need at different stages. It would also make an excellent handbook for a birth doula.

*****

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

02 Nov

I’ll have what she’s having: A review of Birth & Sex by Sheila Kitzinger

I bought Birth & Sex after hearing Sheila Kitzinger speak with an energetic passion that belies her frailty, a few weeks ago; the talk was part revision of the history of obstetrics, and many parts eye-opener.

A few days later I read on a skeptical website a description of orgasmic birth as “the ultimate first world problem.” [Deliberately unattributed]: making women feel guilty for not having an orgasm during labour. It’s that familiar argument that informing people about how things could be is mistaken for setting impossible aspirational targets for all women. Throughout the book, Kitzinger dips into history, revealing how birth has become depersonalised, the mother and her needs sidelined, and the only goal a healthy baby.

After a fascinating chapter on genital anatomy and an exploration of sex in pregnancy, she goes on to explain the processes that impact on a woman’s experience of labour. She is not telling women that they should have an orgasm during birth, any more than that they should have an orgasm every time they have sex; but describing conditions which it is often in the woman’s power to create, that allow her to behave spontaneously. In fact the comparison with having sex is instructive, since goal-oriented sex is likely to be less satisfying than loving, fun, comfortable, spontaneous and uninhibited sex, all of which are applicable to birth.

Kitzinger shows how other cultures celebrate birth movements, for example in north african bellydancing; but how the gradual introduction of a bed into the birth environment forces women to accept a more passive role, and has gradually led to a production line approach, “without wasting doctors’ time, and free of any female emotions that might complicate the process.” [p.69]

She goes on to explore the use of language around birth, rooting this right back in the usurpation of female mother goddesses by a male creator, taking the power of fertility away from women. In modern terms, the medical language used to describe birth using the terminology of risk and words like “delivery” put the power in the hands of the doctors. The language used by women following a traumatic birth is significantly similar to that used by rape victims; I have heard examples of this myself and have to ask if empowering and informing women can really be a bad thing.

With a slightly disappointingly small section on breastfeeding, the book ends with a discussion of sex after childbirth and how this might be impacted by a traumatic, violating experience or a positive birth that can enhance the way a woman feels about her own body. Kitzinger also considers the impact of the birth on a woman’s partner and his or her feelings about sex; along with the impact of the transition to parenthood. I love her description of the first year after birth as “chaos and glory” for the couple [p.148].

Birth & Sex does not seek to demonise intervention, but asks for perspective in its use, and reminds us that birth is a complex psychosexual experience with the potential to be life-enhancing. In the prevailing culture, how much choice do women really have? This book takes on one small segment of a society in which women’s bodies are still objectified and their minds still belittled, to an astonishing extent. To deny women this information is to deny them choice and consent in the way they live and labour.

*****

To order Birth & Sex with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

10 Sep

Book Review: Toxic Childhood, by Sue Palmer

I picked this book up for £1 at Wokingham NCT’s Nearly New Sale, purely out of curiosity. I would say that I have entirely grown out of my organic/green parenting frenzy, partly through poverty and partly from being exposed to science debunking quite a lot of it.

Palmer does state in her preface that the book is largely her own opinion based on largely qualitative research and extensive interviews. This comes across very clearly throughout the text, and may alienate a lot of parents who choose not to follow her highly directive recommendations.

The main message of the book is that childhood ain’t what it used to be, and everyone would be much happier if our kids roamed free in the fields until teatime, then feasted on vegetables from the allotment and played wholesome games until they went to bed. Palmer develops her arguments well, supports them with a wealth of anecdote, and offers suggestions for detoxing childhood both at a family level and at a policy level. This is all very well-meant, but the parents who read this book are quite probably those who already give some thought to things like the effects of TV and junk food on their children. However I feel that the Brave Old World solution is not the right one for my family, and I worry when books dictate parenting styles without leaving room for individual circumstances and inclination. The TV, the internet, junk food and the dangerous streets are realities that our children have to learn to cope with, and it is hard to find a balance between protecting them, and preparing them. I did not feel that Toxic Childhood made many positive suggestions about embracing change.

05 Sep

Book Review: My Child Won’t Eat, by Carlos Gonzalez

After enjoying Gonzalez’ Kiss Me! so much, and with a long standing interest in the subject of solid food, I looked forward to reading My Child Won’t Eat, and hoped it would have some useful information that I could pass on in my Introducing Solids Workshops.

The book is sensibly divided into Causes, Solutions, and Prevention, and uses a rich selection of anecdotes to illustrate the points made in each section.

Gonzalez’ basic premise is that babies and children can be allowed and trusted to regulate their own appetites; and that it is the parents’ expectations that are wrong. If parents stop worrying about it or trying to force their children to eat, they will still eat the same amount, but it will all be much less stressful. They won’t eat any more than they did before, but they won’t waste away either.

This premise is entirely sensible and based in the science relating to appetite control, and Gonzalez uses the perspective of the child to argue that mealtime battles are confusing and unhelpful when it comes to creating a positive attitude to food.

The book includes a large section on breastfeeding, which, as the author acknowledges, is likely to come too late for the parents of babies or toddlers eating (or not eating) solid food, at whom the book is targeted. Perhaps this would be more useful for health professionals and other people supporting those parents.

I found some of Gonzalez’ recommendations to be highly directive and some of his language is really quite judgemental. On the subject of introducing potential allergens, he writes:

Before one year, introducing many different foods only means buying more tickets for the allergy lottery.
p.118

which is sweepingly dismissive, and not in line with current recommendations from the Scientific Advisory Committee on Nutrition, whose review of the evidence concludes that there is currently no clear indication that early (or late) introduction of certain foods either prevents or triggers allergies.

I am not sure I learned anything new from My Child Won’t Eat, but the book gave me plenty to reflect on, and has helped to develop new perspectives and different ways of explaining things to parents.

*****

To order My Child Won’t Eat! with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

12 Jul

Book Review AND GIVEAWAY: Kiss Me! by Carlos Gonzalez

Subtitle: How to raise your children with love

Dr Carlos González sets out his stall very clearly in the first pages of his book:

This book assumes all children are essentially good, that their emotional needs are important, and that we as parents owe them love, respect and attention [p13]

He demonstrates this last point over and over again, by taking the statements of various childcare experts and graphically substituting the word ‘child’ with ‘wife’ or ‘colleague’ or ‘prisoner,’ revealing shocking double standards in our expectations and our treatment of children.

The book is roughly divided into two main chapters, the first of which presents children’s behaviour in terms of survival, adaptation, and genetic predisposition. González reframes disobedience as instinct, explaining for example a toddler’s preference to be carried rather than walk as a deep instinctive drive for safety and security.

The other half of the book is given over to demolishing various parenting theories including sleep training, therapeutic crying, and smacking. It is particularly gratifying to read his meticulous critique of Dr Christopher Green, that unpleasant advocate of smacking, whose basic assumption is that children are all ungrateful tyrants in need of taming.

González’ style is ranty in the extreme, and occasionally it is hard to tell if he is being sarcastic. This book gave me a lot to reflect on with regard to the way I talk to new parents and try to help them understand their babies’ behaviour. But however much I enjoyed this most arid humour, and however valid his premise and instructive his examples, I am wondering whether I would recommend Kiss Me! to new or expectant parents.

González writes with great empathy for children, but much less for parents; who, he explains, are inevitably confused by woolly and non-evidence based ‘advice’ from authoritative experts. His suggestion to combat this is that all parenting books should state on the cover what the author’s basic philosophy of human nature is.

Kiss Me! is an interesting book, and its most useful chapter focuses the mind on understanding, respecting, and empathising with children. Despite his strident tones, this is a very healthy approach to parenting.

***
I’ve got a copy of the book to give away to a commenter. I’ll draw names out of a hat on Thursday 19th July, and the book will be sent to you.

To order Kiss Me! with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

19 Jun

Toxic Milk

This week, The Guardian continues it’s one-newspaper ‘backlash’ against breastfeeding with an article from Florence Williams about The Wonder of Breasts.

Williams starts with some really interesting stuff about the changing components of breastmilk and how they act to protect and nourish the developing infant. But then halfway down she launches into a terrifying rant about how every chemical with which you have ever had contact has accumulated in your body and is poisoning your baby through your milk.

She then makes the fascinating, many-layered statement:

The breastfeeding lobby is sometimes reluctant to highlight breast-milk contamination because they don’t want women to have another excuse not to breastfeed.

From where I’m sitting in my comfy seat in the breastfeeding lobby, I am blissfully ignorant that most women want an excuse not to breastfeed. For one thing, I don’t see it as my job to gatekeep the information, just as I don’t deliberately protect women from the risks of formula feeding, on which more later. If you will forgive me for mentioning it yet again, parents need to be able to make an informed choice that suits their circumstances and their inclinations. This article undermines informed choice by scaremongering and not giving the entire picture, and it insults women who want to breastfeed, especially those who are finding it hard, or who have given up after a struggle, and did not have the luxury of needing an excuse.

I’m no chemist so I don’t have a clear answer to this, but the first thing I would want to know in order to feel fully informed is whether the chemicals found in breastmilk, at those doses, is harmful. ‘PCBs,’ she says, ‘at elevated levels […] can interfere with thyroid function.’ Are these elevated levels? I do know that the UK government monitors the chemical levels in breastmilk (purely as an environmental pollution measure) and that they are decreasing, and this is supported by this excellent article from Best For Babes.

I would also want to see a straight comparison with the chemical levels in formula milk, which for those of you who did not know is made out of cows’ milk. Cows, which arguably have a more restricted diet than humans, are also subject to environmental pollution. The nutrient balance in cows’ milk is significantly different from that in human milk and lacks many of the interesting ingredients discussed by Williams in the first part of her article.

Then I would want to consider the potential for pollution or contamination during manufacture, storage, and making up of formula milk, which in its powdered form is not sterile. And finally, I would compare the relative risk of exposure to these chemicals with the risk of not breastfeeding, for both mother and baby.

That, then, would be an informed decision.

BabyCenter has a nice Q&A on toxins in breastmilk written by former NCT Breastfeeding Counsellor Caroline Deacon; and an article published in 2008 in the journal Environmental Health gives some interesting perspective on communicating about the presence of chemical substances in breastmilk.

06 Jun

What backlash?

The recent Time article has provoked quite a controversy, not least (in my opinion) the decision not to use that cover in the UK. According to The Guardian, this controversy about a photograph of a mother breastfeeding her 3 year old constitutes a ‘backlash against breastfeeding,’ and at the weekend they published Zoe Williams’ wide-ranging thoughts on this matter.

Williams’ article is littered with factual errors, assumptions, judgemental remarks, and references to ‘protests’ that never actually happened. She refers to extended breastfeeding in the first paragraph, but then goes on to discuss ‘breast is best,’ attachment parenting and government policy on health promotion, without ever coming back to her initial, rather impolite remarks that breastfeeding advocates are ‘evangelical to the point of dogmatism,’ and that she thinks we think ‘extended breastfeeders make [us] all look a bit weird,’ and that this is why we don’t discuss extended breastfeeding very much. In fact, we don’t discuss it much because it doesn’t happen much. If fewer than 2% of babies in the UK are exclusively breastfed at six months, just try and quantify the number who still get any breastmilk at all by the age of three years.

Williams goes on to dismiss the ‘benefits’ of breastfeeding as mostly syllogistic, methodologically flawed, and generally ignored by parents, while also noting that “I didn’t care whether of not the health benefits were real, I’d do it again even if it made the baby’s IQ go down,” thus negating the point of her entire argument against the ‘benefits’ of breastfeeding: like most mothers, she is not basing her decision on health or any other benefits. Mothers are biologically driven to nurture their young.

I use the term ‘benefits’ very cautiously. Breastfeeding is the baseline; it is formula milk that needs to prove its case. Research into breastfeeding may be methodologically flawed (because how can you carry out randomised controlled trials on babies?), but there is certainly no robust research showing health benefits for formula. As for the research, Analytical Armadillo has recently posted an excellent round-up of some very current research from a number of peer-reviewed journals. Williams’ guru in this matter is one Joan Wolf, who supports her view of parenting as a world of extremes, without nuance.

Moving on to attachment parenting, Williams quotes feminist criticism of co-sleeping which describes “putting the child in the bed between the father and the mother.” This is an unsafe practice, and UNICEF guidelines for safe co-sleeping can be found here. The feminist angle here seems pretty spurious, pitting notional extremes of motherhood against each other. Feminism, surely, means we all have the right to choose our own pathway?

Mothers do not divide neatly into two camps: Breastfeeding Mothers versus Formula Feeding Mothers. As Williams points out, the majority of mothers in the UK do initiate breastfeeding (though she quotes an imaginary 91%; the most recent Infant Feeding Survey gives an initiation rate of 81%). NHS South Central provides some interesting data on duration of breastfeeding; locally, we have a high initiation rate of 88%, down to 79% by five days, 72% at two weeks, and just 58% of mothers are still breastfeeding at six weeks. Therefore most of the mothers in the supposed Formula Feeding camp are mothers who have breastfed for at least some amount of time, some of whom will have made a positive decision to stop; but we know that 90% of the mothers who have stopped by six weeks would have liked to continue for longer. So it’s not the case, as William proposes, that the majority of people are not taking any notice of the public health messages about breastfeeding. In the 2005 Infant Feeding Survey, 84% of mothers said they were aware of the health benefits of breastfeeding; those who stopped before six weeks cited, in the majority, lack of support. Williams lightly dismisses the struggles and the disappointments felt by women who choose formula feeding because it’s the only choice they have.

Williams’ main premise seems to be that the government is trying to brainwash mothers into breastfeeding out of misguided social policy. She misses the point, and she misunderstands the research, but at least she gets a plug for her own book.

27 Apr

In the red tent

I will be spending this weekend on study days all about processing ideas of birth and motherhood, and in preparation for that [and to avoid doing my tax return], I have been collecting up some bits and pieces to take with me.

The first thing I was asked for was easy: a poem or short piece of prose about birth or parenting. I’ve chosen an extract from Naomi Wolf’s book Misconceptions. The review linked here is rather critical, which makes me interested to re-read the book, as it has been a long time since I looked at it. However there is a page describing the experience of breastfeeding which I found graphically accurate the first time I read it. It’s too long to quote the whole thing here, but it ends: I had never in my life been able to make someone so happy so simply. That gives the impression of an idyllic description, but the entire quote is far from that.

The second thing I have to bring is a favourite short birth story that makes a point, and this I had to think about. I hear lots of birth stories and on reflection I find it hard to pull out a whole story in any kind of coherent detail. I thought I could use my own story, or a fictional birth story that I wrote, but both felt a bit like cheating. Then I remembered reading the story when my son was just over a year old, of journalist Leo Hickman supporting the birth of his third child at home, with the help of the ambulance operator. From the transcript you can tell that the operator is reading instructions from her screen, but she is so calm, clear and encouraging throughout, even when Hickman reports to her that the baby is still inside the sac, and then that there is a large quantity of meconium. She remains cool but not detached, and steers him through an unimaginably alarming experience. If you’re brave, you can listen to the whole call here.

Finally, I need a picture or a small object that holds special meaning for me in relation to birth or parenting. That I am going to have to think about.

I’m looking forward to spending the weekend with my colleagues talking about birth and motherhood in a supportive and safe environment. I think it will be both motivating and educational, and best of all, we are encouraged to bring our knitting!

24 Apr

Regression to the mean

Most weeks, someone will tell me they ‘swear by’ some remedy for one of the many woes of early parenting, and assure me that it has worked wonders. And then they will turn and tell the mum sitting next to them, who [unless healthily sceptical] will unquestioningly accept the recommendation without asking two very important questions:
1. Is there any evidence that it works?
2. Is there any evidence that it does harm?

Infacol is a prime example of a medication recommended widely and unscientifically by mums everywhere, but more worryingly, by GPs and Health Visitors, who must surely know that there is no evidence that it works. Breastfeeding Network has a useful paper [pdf] on colic which discusses Infacol and other remedies, concluding the research is a bit thin on the ground and there are various things you can try; and particularly for the breastfed baby, getting some support with breastfeeding may be key.

Here’s another one: Lansinoh prevents nipple pain. It doesn’t. Its only function is to heal damaged tissue. Nipple pain is almost always prevented (and resolved) by good attachment, and no amount of lanolin cream will facilitate good attachment. In fact, large amounts of it, making the breast slippery, will make it harder for the baby to stay comfortably latched on. In addition, the heavy marketing of Lansinoh reinforces mums’ certainty that breastfeeding will hurt, and is therefore a barrier to doing it at all.

Blogger Scepticon takes a look at amber teething beads and basically demolishes them as a remedy for the pain of teething. Teething is a tough time for parents as well as babies, and parents may feel helpless to alleviate the pain and misery, so it’s no wonder there’s such a market in remedies that are only anecdotally effective.

And when we are talking about our babies’ health, anecdotal is just not good enough. There is an ethical obligation on health professionals not to recommend something just because they have no other answers, but the fact is that few health professionals have the time to sit with an anxious parent and help her to work through her worries and gain confidence in what she is doing. Hence the quick fix: a formula top-up, controlled crying, dummies, all of which can be shown to cause harm.

But the anecdotes of one mum to another seem to carry even more weight at this vulnerable time, and is an inevitable result of the peer-support that we encourage. It’s hard to take that away from new parents, but it’s equally important to encourage them to ask those questions rather than accept at face value the claim that something works.

Regression fallacy.