02 Dec

Book review: Biological Nurturing, by Suzanne Colson

On reading the second edition of Biological Nurturing, I am reminded of what a powerful influence the first edition has been on my work as a breastfeeding counsellor, both in terms of how I talk about positioning, skin to skin, and the transition from womb to world in antenatal sessions; and how I support mothers with breastfeeding after the birth.

Suzanne Colson has vast clinical experience and research experience of what is now widely known as her method: biological nurturing. Biological nurturing is far more than just laid-back breastfeeding; it is a deep understanding of the needs and abilities of the breastfeeding dyad, almost a philosophy of positioning. It is a mother-centred process, using gravity and both parties’ instinctive behaviour, to achieve comfortable and effective breastfeeding.

It could be argued that this is simply a rediscovery of ancient behaviour: the way women breastfed long before male experts took over all the thinking and management of it, to spare our pretty little heads. Colson describes some of the social and cultural movement away from instinctive breastfeeding, using her own science to show how wrong those 18th and 19th Century men of science were about what we do. As she tells us, “you cannot teach mothers to do this,” (p158) because it is instinctive behaviour, highly dependent on the hormonal environment. So the role of a breastfeeding supporter is to enable that environment to be right for the mother and the baby, and to have confidence that this innate behaviour works.

Colson has a great deal of research to support her work, presenting it here in detail, and yet with accessible language and even QR codes so that the reader can access video clips. She is critical of the deeply entrenched, prescriptive ways that some midwives manage early breastfeeding, and this might be a difficult – but essential – read for those who work in that way. It is a fascinating and useful book for anyone supporting breastfeeding, and for mothers who are interested in a much deeper level of knowledge than they will get from your average book on breastfeeding.

[Disclosure: I was sent a review copy of Biological Nurturing. You can obtain yours, with a 10% discount when you use the SPROGCAST code, from Pinter & Martin].

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 Dec

Book Review: Why the Politics of Breastfeeding Matter, by Gabrielle Palmer

This small book in the Why It Matter series from Pinter & Martin is a distillation of Palmer’s earlier, bigger book with a similar title: a good starting point from which to explore this huge and frankly upsetting subject.

Palmer begins with the well-established health case for supporting and protecting breastfeeding: more than 2,000 baby deaths per day worldwide, as a broad headline; and many far-reaching consequences that affect families every day, in the developed world and beyond. The history of commercial baby milk substitutes going back over 100 years is clearly explained, showing how the creation of a market, rather than the health and wellbeing of infants, has always been the industry’s main motivator. The book explores the ethics of testing the product on the market – also known as giving untested formula milk to babies; as well as the growth of the close relationship between health professionals and manufacturers. This relationship has led to the complete undermining and misunderstanding of normal breastfeeding, to the point at which breastfeeding failure is now framed as a “flaw of women’s bodies” (p45); meanwhile historical practices at the time of birth, and social pressures to parent in certain ways, sabotage the breastfeeding relationship and contribute to this vicious circle of ignorance.

Palmer explains why the ongoing Nestle boycott matters, why the WHO developed the International Code for the Marketing of Breastmilk Substitutes in 1981, and how the milk manufacturers created unnecessary products like follow-on milk in order to exploit its loopholes. One unanticipated side effect of this was to present breastmilk purely as a food product, erasing the importance of the breastmilk relationship, and making it harder for society to value this fundamental aspect of motherhood.

The huge implications of all of this for global issues like poverty and climate change are introduced towards the end, leaving the reader potentially feeling angry and cheated by big business; and hopefully ready to fight for change.

Disclosure: I was sent a free review copy of Why The Politics of Breastfeeding Matter by the publisher; you can order it here, with a 10% discount at the checkout, using the code SPROGCAST.

21 Oct

Book review: Milk, by Emma Rosen

Emma Rosen knew she had a book in her, and motherhood gave her the material. Milk is, as subtitled, a story of breastfeeding in a society that’s forgotten how. The thing that will stay with me long after reading this, is how strongly I identified with her experience of feeding her first baby; and (although I never experienced this, having stopped at one), how healing I found it to read about her second birth, along with the feeding and mothering experience that I will always wonder if I could have had. I hope this book gets out to pregnant women, in that place where it is hard to grasp the reality of life with a baby, and prepares them just a little bit more to navigate those early months.

Emma’s book alternates between telling her own story, and telling the story of breastfeeding; and in doing so, places her own experience within the wider context of breastfeeding in 21st Century Britain, and in the world, and all of history. There is so much useful information here, and it is thoroughly referenced, too.

For anyone looking for insights into pregnancy, birth, and the world of a new mother, this is a really lovely read, and one that doesn’t shy away form the gritty reality of the physical and emotional changes of this momentous time. This might be the first time I’ve read a book that really succeeds in conveying that reality without either hyperbole or sugar coating. A properly good book.

[Disclaimer: I was sent a preview copy by the author. You can buy it from all the usual places.]

29 Aug

Feeding with a Supplementary Nursing System

Thanks to Jaclyn Currie for this guest post. Jaclyn is a stay at home mum to a busy two year old, British expat in Nova Scotia and La Leche League leader.

We’d been trying unsuccessfully to conceive for almost two years when I was diagnosed with Hashimoto’s. I fell pregnant almost as soon as I started on thyroxine and had a very healthy pregnancy. We moved to Canada when I was around 10 weeks pregnant and there are few midwives in this province but I had excellent care from my doctors, who were very responsive to my birth wishlist! It was only towards the end of the pregnancy I found out there might be a risk of low milk supply but given that I’d planned a natural labour and delivery with a doula in the local maternity hospital, I thought I was doing everything possible to ensure baby would breastfeed well. As I was new to the country I also started attending La Leche League meetings to meet new, likeminded people.

I was referred to the post-dates clinic at 41+5 and hoped to be told all was well and to come back in a couple of days. Baby had been head down for many weeks and was moving well, but unfortunately his heart-rate was dipping dramatically and the decision was made for an emergency caeserean… then thankfully downgraded to monitoring, then induction overnight with Foley catheter, then pitocin to start in the morning.

I had a fast induced labour but managed with gas and air, lots of movement and bouncing! But he wasn’t responding well to the contractions and the decision was made to use the vacuum to help him out (avoided forceps thankfully), but I had lots of tearing and lost around 800ml of blood.

My son was born 9lb with an apgar of 9! Turns out the cord was around his neck but he found his way to my breast easily and I was relieved all was well.

Over the next couple of days I was able to express a little colostrum and the nurse said he seemed to be latching well. He was sleepy though and then had jaundice so he was put under the lights for a couple of days (this can be done in room thankfully). No real concerns around feeding though it was starting to be a little sore on one side.

Finally we got home and he fed ALL the time! I knew this was normal and made myself comfy on the sofa. My son was a happy and sweet soul. He rarely cried and the public health nurse who visited was happy to help with some positioning and tips. I mentioned it was very sore but she couldn’t see a tongue tie. She was a little concerned he didn’t seem to be having enough dirty nappies but was overall content. However between week 2-3 he didn’t gain any weight at all. Looking back at picture, he was a spindly little thing! I was reading everything I could, and had met with my LLL leader who’d suggested some bodywork to help his latch. However, nothing was helping him gain weight so with so much guilt and sadness I realised I was going to have to supplement. I wasn’t well versed in milk-sharing so formula it was (of course, I had some, thanks Nestle *eyeroll*) but I was very wary of bottle feeding him given my desire to breastfeed, and still suspected he had a tongue tie. I had a friend who’d started using an SNS system a few weeks previously (also hypothyroid!) and I asked my LLL leader if she could help me out.

It was such a learning curve, but I suppose equally so would bottle feeding. I hated giving him formula but he drank so much and immediately started gaining weight. He was thriving on every drop of milk I made, plus 8-12oz of formula a day. It was still agony, and we had him assessed at 7 weeks, with a posterior tongue tie diagnosed and revised. Thankfully around 9 weeks breastfeeding finally felt comfortable and easy, even with the tube. I very quickly gave up supplementing overnight so we could get more sleep, which he seemed fine with.

We started BLW at 6 months, which he loved but ate very little. He always preferred to breastfeed. Around 8 months it started being a battle to get the tube into his mouth, and at 9 months he would yank it out of his mouth. I decided at this point it wasn’t worth the battle for the 1-2 oz he was having so we stopped supplementing at this point. I was so worried, and his weight did fluctuate until he started properly eating good portions at mealtimes, around 15 months.

It was such a battle, and so many people didn’t “get” it; I had people laugh out loud at the tube, and wondering why I didn’t just give him a bottle… but I am sure given his tongue tie he would definitely have preferred it to my low supply boobies! He was 2 in May and still loves to breastfeed often. It brings us both a lot of peace and calm. I felt so much guilt for the longest time, but I am so glad we persevered.

07 Aug

Book Review: The Positive Breastfeeding Book, by Amy Brown

Amy Brown’s Positive Breastfeeding Book is presented as a companion to Milli Hill’s Positive Birth Book, sharing a cover design, a friendly, chatty tone, and an absolute compendium of information. 29 detailed chapters are interspersed with quotes from mothers and breastfeeding supporters, and interviews with some very respectable figures from the breastfeeding world, including Heather Trickey, Helen Ball, and everyone’s hero Dr Wendy Jones.

This book pulls no punches when it comes to explaining the impact and the importance of breastfeeding, and breaking down the cultural and commercial barriers that women face in a breastfeeding-unfriendly society. It takes a logical journey through the subject matter, from getting off to a good start, accessing good support, facing and resolving the challenges, to stopping breastfeeding. My favourite section is the lovely list of suggestions for how partners can support breastfeeding women, not one of which is to give a night time bottle. The book also includes two chapters I have never before seen in a breastfeeding book: infant feeding in an emergency, and a chapter on induced lactation that specifically addresses the needs of trans parents. This feels like a book very much for our time.

Technical information about breastfeeding is plentiful and accurate, supported by references and additional resources, such as videos to watch on hand expressing and the breastcrawl. At the end there is a chapter by chapter list of still more websites and books.

The Positive Breastfeeding Book is exactly what it says on the cover, and a very useful manual both for breastfeeding mothers and anyone supporting them.

[Disclaimer: I was sent a free copy of The Positive Breastfeeding Book by the publishers; you can obtain your own copy here, not forgetting the 10% discount code SPROGCAST at the checkout]

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.

20 Apr

Book Review: Your No-Guilt Pregnancy Plan, by Rebecca Schiller

I’ve been waiting for this book for years – since my own pregnancy, in fact.

Rebecca Schiller, director of Birthrights, has created a manual for pregnancy, birth and the early weeks of parenthood, that is mother-centred and evidence-based, and achieves that incredibly difficult feat of getting the right tone when balancing those two things.

Your No-Guilt Pregnancy Plan – A revolutionary guide to pregnancy, birth and the weeks that follow skips the “your baby is the size of a walnut/pear/skateboard” theme that most writers on this subject consider to be mandatory, and focuses on what is happening to the woman: how she might be feeling, how her body is changing, how the pregnancy/baby affects her world. It includes exercises and checklists to help women reflect on their goals and enjoy the experience; and is kept completely up to date with an accompanying set of links to further reading and support on Rebecca’s own website.

As with most such books, there is a chronological approach. However some things you will not find in most such books are a clear emphasis on the rights of women, on the basis that when women are well cared-for and respected, outcomes improve for them and for their babies. It’s a very realistic book, and a fine example of giving information without advice. With one or two small exceptions, this book is about the reader, not the writer.

And so we come to the breastfeeding section, which you know I looked at first. It’s good. It covers the basics of milk supply and positioning, some of the early challenges, and where to go for help. This sits alongside clear guidance about formula feeding, and not a lactation cookie in sight.

The final chapter of the book helps the reader to refer back to relevant sections of the book, in order to create a personalised plan for pregnancy, birth and afterwards, including a going into labour checklist, and a ‘little black book’ of support for the early days, so you don’t have to figure it out when you need it.

This is the most realistic, practical and informal guide I have seen, and goes straight to the top of my pile of recommendations.

[Disclosure: I received a free review copy of Rebecca’s book.]

28 Jan

Nature is Clever

Towards the end of my pregnancy, I remember being advised by friends that it was very important to get out as a couple as soon as possible after having the baby. I know this was coming from a well-intentioned place, but I’m glad I’m grounded enough to know that that wasn’t for me. Talking to new parents, I encounter a wide spectrum of parenting styles, and if you will allow me a sweeping generalisation, the ones who are having the easier time tend to be the ones who don’t put themselves under pressure to ‘get back to normal’ or ‘show the baby who’s in charge’ right from the start.

It may sound deeply obvious, but having a baby is a massive life event. It impacts on the couple as a couple and as individuals. Anthropologists have observed some interesting stuff about how the behaviour of men and women towards each other changes following the birth of a child; new mothers have a deep evolutionary need to remind our partners that they are responsible for us (for example, compulsively addressing him as ‘daddy’). Sorry, Old-Fashioned Feminists, but evolution takes thousands of years, and human behaviour (and biology) still works as though we live in clans with defined roles. My point is that pressure on a new couple to behave as if nothing has changed jars with our instincts and with the reality of life with a new baby.

Consumer-driven Twenty-first Century Western society, of course, has all the solutions for this. New parents can buy whatever they need to help create distance between themselves and this utterly dependent small creature: mechanical rocking chairs, under-mattress breathing detectors, artificial milk; there’s really no need to be at the beck and call of a baby, and it doesn’t do it any harm, does it?

I hate to talk about benefits and disadvantages. I prefer to talk about normal behaviour, biological expectations, and so on. Nature is very clever. Here’s an example: skin contact stimulates the release of oxytocin. What is oxytocin? It’s a hormone that makes you feel good. Remember orgasms? That’s oxytocin. Touching releases oxytocin; holding hands, kissing, nibbling someone’s ear, that all releases oxytocin. When your child grazes his knee and you kiss it better, that releases oxytocin. Oxytocin helps a woman to labour, and releases milk to feed her baby. Cuddling a newborn baby releases oxytocin. For both parties. Wrapping him up in a blanket and leaving him to cry himself to sleep in another room releases adrenaline, which suppresses oxytocin. For both parties.

Last week a couple came round for some help with feeding. It took a while to get mum and baby comfortable, but eventually we found a way [no surprises to anyone with any breastfeeding knowledge: mum reclined, baby self-attached]. The baby fed. Mum said: why does it make me feel so…. good? That’d be oxytocin, along with relief from anxiety and a sense of satisfaction.

Originally posted elsewhere on 2nd February 2011

18 Dec

Milk Machine

It makes me feel like a cow, she said.
Just to look at it now.
Its friendly pastel plastic
Fills me with dread
And I can’t get out of my head
The sound of a robot baby
Taking my milk.
It fills me with dread
When I think of the nights ahead,
The stirring and snuffling noises
That will pull me
From my warm bed;
When I think of the nights,
There’s no light
At the end
Just shattered sleep,
Shattered me,
Overwhelmed with dread,
And with longing
That somebody else
Could do this instead.
I’ll be a cow if it means
It’s not just me
Getting up in the night
To sit in the dark
And long for my bed.
I’ll be the cow,
But it fills me,
It fills me with dread.