breastfeeding | Motherworldly

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.

22 Nov

Book Review: Truly Happy Baby, by Holly Willoughby

Truly Happy Baby – Holly Willoughby

First, a confession. My name’s Karen and I have no idea who Holly Willoughby is. Having browsed her book, I understand that she is a photogenic mother of three. I assume she’s also some sort of television personality, former pop star, or reality TV type. Why her views on how to parent your baby are important escapes me completely, but an antenatal session rarely goes by these days without someone mentioning her wonderful book.

So I have acquired the wonderful book, and set out to see just how wonderful it truly is.

Holly explains in her introduction that, on becoming a mother, she became the expert on motherhood, and immediately knew she would write a book telling other mothers all the things that nobody else tells them. This is a subject I may have touched on before. Holly’s approach is encouraging: trust your instinct, don’t expect too much too soon, be led by your baby. These are all very important points. She’s also going to be as honest as she can, and give you lots of top tips that worked for her, but you should still do your own thing because every baby is different, and everything will be alright because love.

The book begins with a chapter on feeding, in which she shares some useful information but in the most mealy-mouthed way in order to be inclusive of mums who give formula. In the first few pages Holly provides a useful shopping list, some nonsense about what to eat to “improve the quality and quantity of the milk you are producing” (p17) and a recipe for lactation cookies. There are some pictures to demonstrate positioning, none of which are laid back and there are some helpline numbers for support, none of which are the NCT. She also perpetuates the unhelpful idea of foremilk and hindmilk. Solutions offered for painful nipples are lanolin cream and nipple shields, and absolutely no mention of positioning and attachment, or skilled support.

Moving on to expressing, she points out that “you’ll feel like a cow” (p29), but does at least mention the role of oxytocin in expressing milk.

On formula, she lets us know that she paid a premium for one with a probiotic; other useful information she might have included is that all baby formula must be made to the same standard, and different manufacturers use different names for the same added, unnecessary probiotics. She does describe the recommended method of making up formula, but on the facing page another one of her great tips is not to bother doing it like that because it’s just too much faff to feed your baby safely.

I love the section on winding, in which she says “there’s never a good reason not to wind” (p43) and then goes on to give a good reason not to wind (i.e. your baby doesn’t have wind).

On weaning, again Holly plays fast and loose with the guidelines, because “ultimately it’s up to you.” (p46) Of course this is true, but how can she expect the poor harried mother to decide when the information she shares is so contradictory?

You’d think by this time I would have stopped reading in order to maintain my famous calm, but I couldn’t help dipping into the chapter on sleep. So far so good, we have lots of information about safe sleeping conditions; however within two paragraphs she tells us that co-sleeping is not a good idea, but she did it anyway… on a sofa bed! So about as unsafe as you can get. Remember, she says, do what works for you. Every baby is different. She can’t say that enough, she says. (She can).

Unsurprisingly, Holly recommends getting into a routine from three months. There are lots of nice clock-shaped charts, which she recommends not trying to follow too closely because they worked for her but every baby is different, etc. Apparently turkey is a good food for getting a baby to sleep, who knew. Let’s skip the bit about sleep training, and move on to the useful stuff on getting support for your own sleep deprivation.

The next chapter is on wellbeing, and is actually a very useful and comprehensive guide to caring for a newborn. I’d be inclined to pull this bit out of the book and offer it to people who feel they need some sort of baby manual; it’s far better than the rest of it.

Chapter four, named Lifestyle, seems to be an extension of the wellbeing chapter, with a few extra bits about how to register a birth and how to go on holiday with a baby. None of this is particularly ground-breaking or unavailable online.

And finally, Looking After You. Here we learn about piles and postnatal depression. Interestingly, we get fewer personal anecdotes in the pages about resuming your sex life, but Holly does advise that it’s scientific fact that new mothers don’t love their partners for the next 18 months. No reference is provided for this fascinating piece of research.

So in summary, Holly Willoughby has three babies, but all babies are different and you should do what’s right for you. For £16.99 you too can benefit from this profound wisdom.

16 Nov

Book Review: Trust Your Body Trust Your Baby, by Rosie Newman

Rosie Newman’s book aims to inspire confidence and trust in a mother’s own instincts, through pregnancy and birth, feeding and mothering. It is a book for women who need help with the paradigm shift of becoming a new parent. One of the things that really comes across is the value of surrounding oneself with like-minded, positive people. Newman is well-read and draws extensively on the literature of attachment parenting and straightforward birth.

Trust Your Body Trust Your Baby is sensibly structured with a logical progression, starting with a practical chapter on preparation for the baby’s arrival. The birth chapter gives an interesting history of obstetrics, an explanation of the role of hormones, and a valiant attempt to convey the reality of labour.

The following chapters cover life after birth: establishing breastfeeding, sleep, attachment, and the emotional and psychological adjustment. All of this is extremely good stuff that I would recommend to new parents; it is well-referenced and although it comes from a firm base in attachment parenting, and includes a great deal of Newman’s own experience, it is written with empathy and compassion for both the mother and the baby.

The last chapter is on elimination communication, and might make some new parents wonder if this really is the book for them, or whether it is too far from the mainstream. My clients tend to think The Baby Whisperer is a “a bit of a hippie,” so I’m conscious of wanting books like this to be accessible. Of course there is a huge part of me that really doesn’t want to pull any punches, too.

I was writing this review at a very quiet breastfeeding drop-in. Two mothers came in and we were talking about the conflict between trusting your instincts as a mother, and coping with the pressures of modern life, lack of sleep, lack of support, and the weight of expectations that babies should behave in a certain way by a certain age (both babies were 3 months old and not behaving in a certain way at all). So I gave one of them the book; may it help her find her way.

[Disclosure: I received a free review copy of this book from the publishers. You can get your own copy here, and a 10% discount using the code SPROGCAST at the checkout].

01 Aug

RCPCH discovers barriers to breastfeeding

The Royal College of Pediatrics and Child Health has today published new recommendations that women should be supported to breastfeed for as long as they want to. While I’m fully behind that suggestion, I can’t help feeling like this isn’t exactly a new way of thinking. It’s almost as though the RCPCH have just stumbled across the fact that the UK has the lowest breastfeeding rates in the world, and despite their well-established links with the formula industry, are finally catching up with the rest of us.

Their report quotes UNICEF‘s five year old figure of a £40m saving to the NHS if women were supported to breastfeed for a little longer, and this is a compelling argument of course, but what really matters is respect and support for women’s choices, and societal change to make those choices realistic and achievable, so that no mother is judged either for her decision to breastfeed, or for her decision not to.

I do applaud the recommendation to normalise breastfeeding within the PHSE curriculum in schools, but having seen the cringey sex-ed video shown in Year 5, I would love to see this done in a modern, straightforward and unembarrassed way, preferably facilitated by people specifically trained in this sort of education. NCT Breastfeeding Counsellors, for example.

And yes, please do bring back the Infant Feeding Survey, for which funding was withdrawn in 2010, showing just how much of a priority breastfeeding is for policy makers at the very highest level.

Of course I am pleased to see large and influential organisations like the RCPCH talking about the barriers to breastfeeding in our society, and particularly so when there is such a strong media response, raising awareness across the UK. Now let’s see those recommendations put into action.

21 Jun

Book review: The Importance of Dads and Grandmas to the Breastfeeding Mother, by Wendy Jones

I would consider Dr Wendy Jones to be one of the most trustworthy resources on breastfeeding in the UK, particularly in her specialist area of breastfeeding and medication. This is a general book about breastfeeding, aimed at fathers and grandmothers. The dad-focus is on how to help (and a little bit of how not to) given that fathers may not fully appreciate the importance of their role to start with; and the granny-focus is on reframing some of the older generation’s expectations and preconceptions, given that they may have done things differently themselves.

Jones lays out the rationale for her advice, with a detailed explanation of what breastmilk is and how breastfeeding works. Each chapter includes a summary of take home messages, and she covers many “But what if…?” scenarios. Well-referenced, with a decent index and a list of helplines, this could be a very useful book. It’s worth pointing out that it covers formula feeding, sterilising equipment, and expressing in some detail too.

My small criticisms would be that the pictures are often small and unhelpful (although there are many good diagrams and tables of information), and being in black and white they are not at all useful for illustrating the colours of newborn poo or changes to a nipple after feeding. I disagree with Jones’ description of colic as pain/wind, when so many authoritative sources, including the NHS, define it as unexplained crying. Perhaps it is difficult to take the pharmacist hat off altogether.

Where Jones does take the pharmacist hat off, however, is in her friendly personal tone, and in the “bonus feature” of her own story about supporting her daughters with breastfeeding, which is fascinating and moving.

This is a book I will keep to hand as a good source of reliable information, and I would widely recommend it to breastfeeding supporters, and of course to Dads and Grandmas.

[Disclaimer: Wendy sent me a free review copy of her book – thank you! We had a chat with her on Sprogcast a little while ago; listen here]

09 Jun

Book Review: The Happy Birth Book, by Beverley Turner with Pam Wild

Beverley Turner’s Happy Birth Book was originally conceived as a handbook for people attending her high-end antenatal courses, and covers a huge range of topics in alphabetical order, so that readers may dip in or look up the thing they’re interested in. Hitting the same market at the same time as Clemmie Hooper (and with a matching cover image) and Milli Hill, Turner’s book lands somewhere between the two, closer in tone to Hooper, but in content to Hill. All three focus on active birth, but while Clemmie digresses into shopping lists, Milli and Bev are both encouraging women to get informed and assert their rights in the birthplace.

The Happy Birth Book is good for instructive diagrams, pithy descriptions (she’s especially good on labour), and a few moments of truly gritty realism which made me laugh out loud. There is a lot of ‘Bev’ and therefore a lot of opinion, and rather too much alternative therapy for my personal taste. I wasn’t too impressed by the breastfeeding information, which tends to give the impression that babies can be fed on a regular timetable, that mothers should eat well to maintain a good milk supply, and that breasts need time to fill up between feeds, none of which is scientifically accurate.

The A-Z approach doesn’t feel to me like the most intuitive way to organise the subject matter, and certainly going from skincare to stillbirth to stretch marks is a bit of a bumpy ride. On the other hand, it does make it – as intended – a book you can dip in and out of, and have to hand for extra information as needed. With its cheery, direct tone, it’s a good alternative for readers who might find the more comprehensive Positive Birth Book a bit too dense, and definitely more empowering than most of the mainstream birth books out there.

[Disclaimer: I was sent a free review copy by the author, and also had a lovely chat with her for the July episode of Sprogcast]

06 Jun

Book Review: Breastfeeding Made Easy, by Carlos Gonzales

Carlos Gonzales writes as though he is giving a TED talk. In places, his stridency is amusing; but mostly it is just strident. I cannot tell if it would come across the same way in the original Spanish, or if this is a tonal quirk of the translation, but I did experience the same sense of being exhorted to follow his well-argued directions in his earlier books, and for this reason I would be very unlikely to share them with parents.

Breastfeeding Made Easy is a dense book filled with much confusing detail, and is quite outdated. For example, on p53 he discusses “foremilk and hindmilk,” a concept from which most breastfeeding authorities have moved on. Gonzales is, furthermore, highly prescriptive in his approach to positioning and attachment, and there is no mention at all of laid-back breastfeeding. He makes several sweeping statements that many parents would rightly disagree with. Here’s one:

breastfeeding stops being an issue when the baby starts eating solids (p84)

To which I say: hm, define “issue.”

The book also swings from exhaustively detailed advice such as that given on maternal diet (which in fact has very little impact on milk quantity or composition), to peculiar inclusions in the list of maternal conditions that may affect breastfeeding such as myopia – which, obviously, doesn’t affect it at all.

There are far more useful breastfeeding books available; this one is little more than an eyebrow-raising curiosity.

[Disclaimer: I was given a free copy of this book by the publishers Pinter & Martin]

05 Jun

Book Review: The Sensational Baby Sleep Plan – Alison Scott-Wright

I have come across this book a few times, and eventually someone gave me a copy so that I could read it cover to cover at my leisure. Having flicked first to the breastfeeding section and read the advice not to drink champagne lest it give the baby wind, I was tempted to drop it straight in the bin. But no, I persisted, so that you don’t ever have to.

Alison Scott-Wright is very much from the same school as Clare Byam-Cook, whose awful book she recommends; and really you don’t need to know much more than that. If you consider your baby to be a time-consuming, manipulative bore with no feelings, the Plan will suit you just fine. However if you wish to meet your tiny human’s needs following your parental instincts and the best available evidence, and your well-meaning aunt has given you a copy of this book, perhaps treat it as a “how not to parent a baby” guide.

Feel free, in the latter case, to ignore ASW’s basic premise that breastfeeding is really too difficult to bother with; a position that must be continually supported with anecdata from clients having trouble getting breastfeeding to work under the rules she prescribes. Feel free not to ensure your legs are at a 90 degree angle to your body (p41), not to restrict feeds to 3-hourly as soon as possible (p43), not to express five times in 24 hours in addition to breastfeeding on demand (p46), and take with a huge pinch of salt that breastmilk may be made unnatural and impure by environmental pollution. Amuse yourself instead with the mental image of cows living in clinical conditions, wearing nappies and using the finest organic antibacterial gel on their udders at milking time. Should you decide to use formula, please please disregard her instructions for making up bottles in advance, which is in direct opposition to evidence-based guidance from the NHS.

None of her terrible advice about feeding has very much to do with sleep, so let us move on to ignoring what she says about that. ASW likes to cherry-pick the research and twist it to fit her entrenched opinions. So for example she quotes Sue Gerhardt on early emotional development and uses this to argue in favour of her cruel and neglectful plan. If she had read more than the back cover of Why Love Matters, she would find herself in the uncomfortable position of having to reflect on how damaging her advice must be.

ASW does not, however, make any reference at all to the UK’s foremost authority on infant sleep, the work of Professor Helen Ball and Doctor Charlotte Russell at the Durham Infant Sleep Lab, where they undertake rigorous research and provide useful evidence-based information to support parents. And for this reason, the reader may also be at liberty to ignore the “baby’s daily sleep requirements” (p72), fully debunked by Charlotte Russell on Sprogcast last year. On p80, ASW dangerously disagrees with current safe sleeping guidelines, overruling the Back To Sleep campaign on the basis that she tends to believe that the babies for whom her plan does not work must surely have reflux; and also ignoring the increased risk of SIDS for a baby sleeping in their own room before the age of six months. It would also be absolutely acceptable to take no notice whatsoever of her claim that she “often advises introducing solids… from 16 weeks,” (p85) or her recommendation that parents water down formula or limit breastfeeds at night as early as 4 weeks, thereby depriving the baby of essential nutrients and comfort – surely a far more serious risk to the child’s physical and emotional wellbeing than that posed by sleep deprivation.

All parents can definitely disregard the long parent-blaming list of ways they can get their babies’ sleep wrong on p155; and unless the baby has a medical diagnosis of reflux, they can also take no notice of the 50 pages devoted to that subject. In fact, even with such a diagnosis, it might be wise to ignore the unqualified ASW’s unqualified opinions on this matter, and seek the support of a trained specialist.

ASW’s promise is that if you follow her “flexible” plan TO THE LETTER, then your baby will sleep through the night by 8 weeks. She has had 100% success with this. The only reasons why this incredible plan might not work are if the baby has reflux, or if the parents have been doing it wrong. Even teething “should not be used as an excuse” (p92). But never fear, silly parents, if you have got yourself into such a “hopeless situation” (p157), there is still hope! You can adopt her cosily-named “sleepy time” reassurance technique (p170) which is basically leaving the baby to cry, even if they “vomit to order” (p193).

This sleep is indeed sensational: sensationally cruel, ill-informed, and quite possibly harmful. I do not recommend this book.

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.