Book Review: What to expect when you’re breastfeeding (and what if you can’t) – by Clare Byam-Cook

This is an awful book. I picked it up, out of curiosity, in a charity shop; and I’m glad I did because for the sake of £1 I’ve saved some benighted new mother a lot of heartache in trying to follow the advice within. I’d go so far as to claim that nobody, following the guidance in this book, is likely to breastfeed happily, or for long.

Let’s start with the author biography, which tells us that “most of the advice she gives in this book is based on the knowledge she has gained… it is not based solely on textbook theories.” This sums up the whole problem with the book. We know that people vary, and a sound understanding of the evidence around how breastfeeding works can be adapted to individual circumstances, BUT this book gives us very little of that evidence, a great deal of opinion, and much advice that is likely to be harmful.

Byam-Cook’s introduction sets out her basic premise, which is that women who have problem-free breastfeeding are “lucky,” and that breasts don’t always work properly. While this may be the case, the survival of our species points to it not being the biological norm. Her tone throughout the book tells us that mothers are feckless, and she is the expert: “I then show her what she should be doing … I have no trouble putting the baby on the breast … I move the baby to the correct position.” (p3) It makes my empowering, mother-centred heart weep.

Chapter One. The phrase that leaps out is “it is essential that a breast-fed baby learns to take some feeds from a bottle.” (p5) Other crazy nonsense includes “It might help to rub your nipples with a dry towel … to toughen them up a bit.” (p8); “If your milk supply is low, eat more.” (p10) and “Fizzy drinks are best avoided as they will tend to give your baby indigestion.” (p12). None of these statements are biologically plausible.

Chapter two has factual inaccuracies on pages 13, 14, 15, 17 and that’s before she starts on “foremilk and hindmilk” on p18.

Chapter three on positioning is overcomplicated nonsense, with the suggestion to give water to a baby with the hiccups thrown in, advice to settle babies to sleep on their side [she recommends putting them on their back on p63], and to let them cry for ten minutes before responding. Also, of course, the obligatory dip into complementary medicine, which if it worked would be called medicine.

Chapter four perpetuates a great deal of conflicting advice, dismissal of hospitals and midwives as sources of information, and the Author as The Best Expert Ever. Yet with her self-styled expertise, she still recommends restricting the frequency of feeds once the milk comes in, gets the storage times for expressed breastmilk completely wrong, and reckons fair skinned women have more “delicate” nipples than normal people (p56).

Need I go on? I read this book with a pen in hand, crossing out whole paragraphs at a time. Byam-Cook has no understanding that a baby’s needs are not purely physical, that breastfeeding is a relationship, that milk removal creates milk production, or that milk is not made from the contents of the mother’s stomach. Her basic biology is ludicrous, and her advice undermines breastfeeding, right, left and right again. She attributes more articulate thought to the breasts than to the mother: on p17 they are making assumptions, on p86 they are getting into “a terrible muddle,” and on p99 they are feeling happy. On p95 “the government recommendation of exclusive breastfeeding for six months is unrealistic and unachievable for many mothers.” With that attitude, it is.

Chapter seven lists all the common feeding problems, suggests the use of nipple shields for most of them, and makes absolutely no mention of community breastfeeding support, qualified breastfeeding counsellors and lactation consultants, or helplines. Most of the common challenges for the baby are apparently resolved by giving something in a bottle, whether formula, expressed milk, water or over the counter colic remedies. Byam-Cook goes on to devote a chapter to bottle feeding, which in this 2006 edition advocates “making up all the feeds at the same time each day” (p169), and has hopefully been updated in line with Department of Health guidelines.

Please don’t buy this book. Please don’t give it to anyone. If you are planning to breastfeed your baby, or experiencing any challenges with breastfeeding, contact a reputable organisation and speak to a qualified practitioner.