18 Jul

Book review: Why Breastfeeding Matters, by Charlotte Young

You may be familiar with Charlotte Young, the sometimes-ranty but always well-informed blogger known as The Analytical Armadillo, one of the few reliably evidence-based information sources to be found online. Her wealth of knowledge is collected here into 16 neat chapters on the how and why of breastfeeding.

Like other books in the Why It Matters series, this is small but dense, covering how breastfeeding works; the wide range of normal baby behaviour and parental strategies for coping with it; expressing, formula and mixed feeding; and a couple of good chapters on the socio-cultural context of breastfeeding, and the impact of the formula milk industry.

Young is very aware of being a passionate supporter of breastfeeding mothers, in a bottle-feeding society, so much of her work is around myth-busting, whether she’s addressing the nonsense idea that breastfeeding mothers must eat a bland diet, or the notion that Mommy Wars is a feminist advert. She is careful to reference everything; perhaps a little less careful not to sometimes come across as sarcastic.

If you’re looking for an accurate breastfeeding text that pulls no punches, gives both the practical side of things and the context, and explains all of this logically and clearly, then this book is highly recommended.

[Disclosure: I obtained a free review copy of Why Breastfeeding Matters from the publishers. You can order a copy and get 10% discount using the code SPROGCAST, from their website here]

20 Jul

How bottle manufacturers undermine breastfeeding and evade UK advertising rules, a guest post by Megan Stephenson

If you’re on social media, and you have had a baby recently, you’re seen as a feast of insecurities for many predatory companies. Most are fairly innocuous, they’ll cost your family money, but not have an impact on your babies health. But some, in particular the bottle manufacturers, are aiming to reduce the amount of breastfeeding you do. Since many of the health impacts of not breastfeeding are dose-responsive (that is, the more you do the more impact they have) this is not just about money any more.

The particularly egregious examples are the ones where they claim that they won’t have an impact on breastfeeding (how can this be? Surely every time the baby is having a bottle, they are not at the breast), that baby can’t tell the difference, and that you can switch between breast and bottle easily. This is actually against UK advertising laws because they have no solid evidence (this means properly conducted research trials, “my friend said” is not enough). So, how do they get away with it? I hear you cry. Well, easy, the company isn’t saying it, they are sharing real life reviews. Of course they are paying the social media companies to share them with you, so it’s still advertising.

If it IS possible to switch easily between breast and bottle (and I’m not convinced that anyone has proved that any bottle makes this easier than any other) how does this impact on breastfeeding? Does it mean that when a mother breastfeeds in a public place, she is no longer protected? Because she could have used a bottle for public and breast at home. How about breastfeeding as babies get older? Well, you could use a bottle and still breastfeed at night. What about maternity leave – why not go back to work at two weeks, leaving a bottle for day time and breastfeed at night? Once again, breastfeeding is consistently undermined.

Megan Stephenson is an NCT Breastsfeeding Counsellor

13 Jun

Mommy Wars Much?

Yesterday the Royal College of Midwives released a new position statement on infant feeding. It includes the stunning new idea that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected.’

Inevitably there is a two-pronged kneejerk reaction to this. The Daily Mail and all radio talk shows trumpet an end to ‘Breastfeeding Tyranny,’ which is that thing where anyone remotely connected with supporting breastfeeding mothers is cast as the tyrant (or other even less savoury words); and parents who have had a difficult experience of breastfeeding complain about a) pressure from midwives, and b) pressure from everyone else.

Meanwhile the above-mentioned tyrants divide themselves into separate camps, those who criticise NCT and those who are NCT (and some have a foot in both camps). In the first camp, we have those who criticise NCT for not covering formula and bottlefeeding in antenatal sessions [Spoiler: we do! Have a look at our Infant Feeding Message Framework, which has been revised this year, but nothing new on formula in there, we’ve been covering it for years]; and those who criticise NCT for not cheerleading about breastfeeding enough (usually members of other breastfeeding charities who exempt the NCT from their non-judgemental approach).

As usual, I’m not here to speak for NCT, despite being proud to have been an NCT breastfeeding counsellor for a decade. However I do want to congratulate everyone responding to this new position statement on perpetuating the divisions in infant feeding. Nice one.

How about instead of the kneejerk reaction, we take some time to reflect on the context in which this statement and the responses to it occur. You really don’t have to look very far for reasons why women feel unsupported, whatever feeding decisions they make. We know very well that the majority of women in the UK see a number of different and busy midwives during pregnancy, and still get asked whether they plan to breastfeed or bottlefeed, without the time it would take to have a nuanced and informative discussion about this. Just asking that question frames it as an either/or choice, never mind the evidence that decision making about infant feeding is so much more intricate than that. The path women take is influenced by their family history and social context, by adverts that tell them their nipples will hurt and news stories that tell them they’ll be thrown out of Sports Direct. By every person who ever tells them not to beat themselves up if they can’t do it.

At birth, pressure does come from midwives who encourage early breastfeeding in the knowledge that the option will disappear for that mother if they don’t try to protect it; what a difficult position for those midwives to be in, within the time constraints of their workload. What would be a better way to address this at such a crucial time? There is no easy answer, because this demands cultural change and an end to society operating on the assumption that breastfeeding is difficult and women will be judged for not doing it. Locally, the well-trained volunteer breastfeeding support has been withdrawn from the wards and now also the children’s centres, because there is no longer funding to run the project, adding to the burden on midwives to handle this with sensitivity, kindness and accurate information. Within the time constraints of their workload.

And then there is the rest of the breastfeeding journey, and I know from encounters with women of all ages who tell me, when they find out what I do for a living, stories that some of them have carried for decades. Women feel guilty when they struggle to breastfeed and when they choose not to continue, and they feel angry when they don’t have the knowledge or the support to make decisions they feel happy with; and these stories matter to them. NCT is the best-known of a number of different charities that support breastfeeding mothers, and so of course it is the one that wears the sash of shame about judging and putting pressure on women. NCT is also the one that does most of the antenatal education, including on breastfeeding and on formula and bottlefeeding, and so of course is perceived as a source of guilt and judgement largely because of the impossibility of adequately preparing parents for the realities of life with a new baby. “All my friends found breastfeeding really hard, I’m not going to beat myself up if I can’t do it,” they tell me before their babies are born. And afterwards? “Why didn’t you tell me it would be so hard?” What words, what activities, what level of reflection will square this impossible circle, without changing the entire context?

And that’s why I’m so frustrated, this morning, with all the news and social media that does nothing but reinforce the assumptions and the cultural context within which breastfeeding can be hard, but breastfeeding support can be harder.

24 May

Basics of Expressing Breastmilk

1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won’t latch on, or to relieve engorgement. Once breastfeeding is established, many families share feeding using bottles of expressed milk.

2. Different pumps may be useful in different circumstances. Hospital-grade electric pumps can be hired locally. If you are only expressing now and then, a manual pump might be suitable. Colostrum can be expressed by hand without a pump.

3. Expressed breastmilk can be stored at room temperature for about 8 hours, in the fridge for 5 days, and in the freezer for 6 months. Defrost in the fridge and warm if necessary by putting the container of milk into hot water.

4. If you are giving both breastmilk and formula milk, you might want to offer them separately, giving the breastmilk first to maximise the amount taken, rather than diluting it with formula.

5. Expressed breastmilk can be given to the baby with a syringe, a spoon, a feeding cup, or a bottle. These will need to be sterilised.

6. If you are only expressing and your baby is not feeding at the breast, it is helpful to express very frequently: around 10 times in 24 hours, including once during the night, to mimic the feeding pattern of a baby.

7. Expressing in addition to breastfeeding usually increases the milk supply. Expressing instead of breastfeeding may decrease the milk supply.

8. Closeness with your baby stimulates release of the hormone oxytocin, which helps the flow of milk. Closeness with your breastpump is less likely to have this effect. Some women find that their milk does not flow easily for the pump. Therefore, the amount of milk you can pump is NOT a good indication of the amount of milk you can produce.

9. Warmth, gentle massage, and the sight/sound/smell of your baby can stimulate oxytocin and help milk to flow. Sometimes expressing in a warm bath can be effective.

10. The best time of day to express is whenever you have the time. Breasts produce more milk when they are frequently used, so it is possible to express before, after, or even during a feed. If you can’t find time to express, and you don’t have to, then leave it for a little while until things settle down.

For support with any aspect of infant feeding, you can call the NCT Feeding Line from 8am to midnight, every day, on 0300 3300 700.

22 May

Basics of Formula Feeding

1. All brands of formula are made to the same standard, so no brand is better than another. You don’t have to stick to the same brand.

2. Each brand produces several stages/types of milk. The only one suitable for a newborn baby is Stage One/First Infant Formula. This is suitable until the age of one, when your baby can have ordinary cow’s milk.

3. Formula comes in ready-made liquid form, or as a powder. The liquid is more expensive, but quicker to prepare. The powder is not sterile, so it is very important to follow the instructions for making it up, to prevent the growth of bacteria.

4. Your baby will tell you when he/she is hungry, by smacking their lips, rooting (head-turning), and sucking their fingers. Crying is a late hunger cue, so try to respond to these early cues, to minimise everyone’s distress.

5. When you bottlefeed, hold your baby close and upright, so you and your baby can make eye contact. Enjoy the opportunity for a cuddle.

6. Pace the feed: Hold the bottle close to horizontal, touch it to your baby’s lips, and allow them to latch on to the teat. When they let go of the bottle, it’s okay to offer it again, but don’t insist they finish the whole feed. Your baby can tell when he/she has had enough.

7. Newborns and breastfed babies trying bottles for the first time often prefer a slow-flowing teat. Be patient while they learn this new skill.

8. Spend as much time with your baby skin to skin as you can. This calms and soothes, and helps to build your baby’s immune system.

9. In the early days, your baby has a tiny stomach and needs small amounts of milk, very frequently. If you are able to give your baby colostrum at this time, even for a single feed, this is a very healthy start for them.

10. If you are in any way unhappy or unsure about your situation, you can talk to a Breastfeeding Counsellor. We won’t try to dissuade you from your decisions, but will listen and support you. You can call the NCT Feeding Line from 8am-midnight, every day, on 0300 3300 700.

17 Dec

Baby’s First Year, by Netmums with Hollie Smith

Having read the atrocious Netmums book on sleep, I had quite low expectations of Baby’s First Year. I was also looking at a 2009 edition, and presume that it has been modernised a little since publication. Nonetheless, I found it to contain a good range of highly practical tips, and a reasonably close representation of the evidence with regard to many of the subjects it covers.

Apart from the usual mythology about cabbage leaves and hindmilk, the breastfeeding sections are pretty accurate, although I was disappointed that breastfeeding is referred to as “extended” from seven months onwards. This easily-navigated little manual is also good on formula feeding, expressing, colic, and sex; but there is a huge gaping hole where the discussion of attachment and emotional development should be, which of course allows them to advocate the cruel and damaging practice of controlled crying. Tellingly, they refer to the “handful of child psychologists… [who] believe it could be damaging,” versus “a great many other experts” (none of whom are named) who think it’s fine. Nothing in the book is referenced, so really they can and do just say what they please.

The book is also quite poor on introducing solids, recommending waiting until six months but with only an aside about baby-led weaning (this being one of the topics which they may have updated, to reflect its increasing popularity).

Personally I am left cold by the many quotes pulled from Netmums message boards, but I guess that is their USP, and you can always skim them like I did. For a manual of the basics, Baby’s First Year is good on the first six months, but the second half is probably too general to be useful to most new mothers, who I expect would be figuring things out for themselves by that time, or seeking out more specialised guidance for the issues they might be experiencing. I’d tear this book in half before giving it to a friend, and wrap it with a copy of Sweet Sleep.

12 Feb

Book review: Guilt-Free Bottle Feeding, by Madeleine Morris

The stated purpose of the book Guilt-Free Bottle Feeding is to debunk the myth that mothers should feel guilty if they do not breastfeed, and to provide objective, evidence-based information about bottle feeding and formula. It meets this second aim admirably, with clear and detailed sections on different formulas and tried and tested techniques. This final 45 pages of the book would be an extremely useful resource particularly for Breastfeeding Counsellors who are encountering an increasing number of questions and requests for support around formula.

The bulk of the book, however, features an army of straw men, and is written in a hectoring, defensive tone, with many statements about “lactivists” which border on being offensive. For an example of all of the above, see page 137 where the zealous lactivists deliberately manipulate and prey upon mothers’ emotions; page 138 where breastfeeding advocates’ real agenda is “to make formula feeding parents feel like shit;” and the jaw-dropping claim on page 88 that there is money to be made from breastfeeding support.

Morris’ writing is very much embedded in her personal experience of breastfeeding and her feelings about it, supported by her friend Dr Sasha Howard who also shares her own experience of breastfeeding as well as that of supporting families as a paediatrician. They exhort a change in message on feeding choices, asking for more realistic, nuanced antenatal breastfeeding education, to include more detail on formula feeding; and more compassion for mothers who do not breastfeed. If this sounds frustratingly familiar, that’s because this is very much in line with NCT’s current Infant Feeding Message Framework.

Unfortunately the way Morris presents this itself lacks nuance and understanding of how breastfeeding support works. She is deeply opposed to any language of risk, positing that rather than enabling informed choice, this language comes across as bullying and guilt-inducing. Reading this book made me doubt the validity of my own perspective on breastfeeding; could it really be true that the media is completely biased towards breastfeeding (p.90-96), that no celebrity ever makes a negative statement about her own breastfeeding experience (9.108), and that breastfeeding “advocates” wilfully misrepresent the research on breastmilk in order to pressure mothers (p.75)? Could my bias really be so deeply embedded that I don’t see this at all? Then I would definitely have to identify myself with the lactivists.

This book provides a great deal of material upon which to reflect. Morris’ sadness and anger about her own experience of breastfeeding and of not breastfeeding undermine her claims of objectivity. Much of this anger is directed towards breastfeeding supporters. She has had no difficulty in finding case studies: 15 of them, only three of which are about women who had no intention of breastfeeding. The others are women who were – in her words – “forced to bottle-feed.” (p.47). This seems a strong enough argument for not destroying women’s confidence in the people who could help them.

Where ‘Guilt-Free Bottle Feeding’ comes into its own is in the genuinely objective and useful practical section, but the preceding 150 pages are a tough read, and tell us nothing that we do not already know about perceptions of breastfeeding support.

Disclosure: I was given a free review copy of this book.
Views expressed here are my own, and do not represent the views of NCT.