breastfeeding | Motherworldly

23 May

Basics of Breastfeeding

While the basics of breastfeeding are the same, the experience is different for everyone. If you need help or support, call our NCT Feeding Line on 0300 3300 700, 8am-midnight, every day.

1. Colostrum is the first food for your baby. This protein-rich substance is packed with antibodies, and mothers start producing it during pregnancy.

2. Following the baby’s birth, it is the birth of the placenta that triggers build-up of the hormone prolactin, which controls the mother’s supply of milk.

3. In the first few days, babies feed very frequently (around 10-14 times in 24 hours). Each feed stimulates the release of more prolactin, and builds up the milk supply.

4. Spend as much time with your baby skin to skin on your chest as you can. This encourages newborn reflexes such as mouthing, rooting, and stepping, which help babies to position themselves and latch on.

5. Lots of skin to skin contact helps to stimulate the milk supply too. It also calms the baby, regulates his/her temperature, and helps to populate their immune system. Skin to skin with dad is great too!

6. Around 3-4 days after the birth, the volume of milk increases, sometimes dramatically, and the breasts may get engorged. If this happens, gentle hand-expressing, a warm flannel, or a bath may help.

7. A good position for breastfeeding is any position where the mother is comfortable and the baby’s body is fully supported by her body, not just her arms.

8. Feeds can last anything between 5 minutes and 45 minutes. Follow your baby’s lead, and try not to restrict the length of the frequency of feeds, because this may mean they don’t get enough milk.

9. If breastfeeding hurts (beyond the first few seconds), this is usually a sign that the baby is not well latched on. This can make feeds less effective, and reduce the supply of milk. Hold your baby comfortably so that he/she can open wide and get a good latch. If you need some face to face support with this, there are many local drop-in groups you can go to.

10. Newborn babies need to be close to someone most of the time, so there is plenty of opportunity for dads to help out with soothing, settling and cuddling, and babies will usually sleep well on their father’s chest.

17 Feb

Fed Is Best misses the big picture

There is a growing movement of vociferous breastfeeding skeptics, more organised and insidious than the usual lone voices of disappointed, angry, grieving women whose breastfeeding experience was not what they had hoped for. I have ignored it for long enough, but they now seem to be everywhere I look, and their words are dangerous and damaging.

As is so often the case, this “backlash” arises from one sad incident that happened to one articulate and privileged woman whose baby failed to thrive in circumstances where, if I understand it correctly, no baby could have thrived. I will refrain on commenting on a situation about which I know very little, as any well-trained and mother-centred breastfeeding supporter should. But this movement has easily, inevitably snowballed, gathering followers from that huge group of women who have been failed by society at a most vulnerable time.

This is a group of parents who are so upset that breastfeeding did not work for them, that they would prefer it not to work for anybody. Rather than campaign for better support and a more breastfeeding-friendly society, they present breastfeeding as an unnecessary choice, that mothers would be better off without. As with much of the anti-breastfeeding literature, we see the people who offer breastfeeding support portrayed as cruel, evangelical bullies and the well-evidenced disadvantages of formula milk downplayed.

In the past decade, I have written this again and again: we do not need to divide mothers and babies into the false categories of Breastfeeding and Formula Feeding. The first rule of infant feeding is to feed the baby, but “fed” is only best if “not fed” is the only alternative. And with better knowledge about breastfeeding and a more supportive environment, not fed should not happen. A woman with the confidence to trust her own instincts does not restrict feeds just because she has been told her baby’s stomach capacity is small; a well-informed woman who wishes to breastfeed understands that frequent feeding is what builds up a milk supply, and the delightful contents of every nappy can reassure her that this is happening; an educated health professional can support her with this knowledge.

Those key elements, maternal instinct and good information, slip through the cracks. And why do they slip through the cracks? Because in western society we believe, in the face of the evidence, that breastfeeding does not work. And why do we believe that it does not work? Because the voices of anger and disappointment are louder than the voices of women who just got on with it because it was no big deal.

There is no money in breastfeeding that works, unless you count the savings made in better overall health outcomes (and families who don’t have to shell out for formula): if anyone was really counting that, the governments of the western world would be investing in breastfeeding support and promoting a society that is truly supportive of breastfeeding mothers. Instead we have one where vitamins are marketed to them in case their milk isn’t good enough. One where lanolin cream is advertised for when their nipples hurt, as if this were inevitable. One where babies are expected not to inconvenience their mothers by requiring to be fed and to be held. One where qualified doctors can flatly deny science and continue to speak with the authority granted by their white coat.

It is a scientific fallacy to believe that cows milk, modified in a factory and dried into a powder, is better for human babies simply because it is sometimes more readily available. And it is a fallacy of privilege to believe that it is always readily available. It is not uncommon even in the UK for parents using formula not to follow the guidelines when making it up: too much powder (to make the baby grow), too little powder (to make the pack last longer), or water that is not hot enough to kill the bacteria (because it’s inconvenient, or they just don’t know, or they haven’t got a kettle). An 800 g tub of a popular formula costs £12.99 and would last roughly ten days for a newborn and five days at six months, if you feed according to the instructions on the side of the pack. Babies need breastmilk or a suitable formula until they are a year old. Breastfeeding support is free at the point of access. So tell me which of these is the choice of the privileged family?

Perhaps it is only the affluent and educated who can afford the privilege of lashing out at the passionate but inadequately funded network of people who could have helped them, and of missing the big picture of what is wrong in a world that let them down so badly.

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.

15 Dec

Book review: Nobody Told Me, by Hollie McNish

Like many people, the first I knew of Hollie McNish was her poem Embarrassed on YouTube, which suddenly appeared everywhere I looked. I loved the poem for what it said (“I spent the first feeding months of her beautiful life/Feeling nervous and awkward and wanting everything right.“). I loved her delivery and I loved her: she just looked like an ordinary person I could hang out with, and I can see why she became such a poster girl for the ordinary experience of breastfeeding.

Nobody Told Me isn’t just a collection of poems, it’s the journal of Hollie’s transition from pregnancy through to three years, and somehow in her honesty she manages to convey both her own unique experience, and the universality of early motherhood. The reader witnesses the bleakness of the early days: terror, tinged with wonder; and her growth as a mother, into enjoyment of toddlerhood, and finally a recognition of all she has achieved.

Reading Nobody Told Me repeatedly made me weep, as I recognised with real feeling the floundering, bleeding, and nighttime feeding; the absolute reliance on an amazing supportive bloke; and the guilt-ridden enjoyment of a night away from home.

Hollie’s focus grows from the personal to the political (and this felt familiar too), as she experiences social judgement on all fronts, and also fights conventional stereotypes and lack of diversity. People comment on her child’s mixed race, tell her she’s too young to have a child or should be married, and find her overly strident when she objects to all the characters in storybooks being “he” by default. She’s so right, and we should all be rebelling against this – as a poet she is in a position to articulate this nonsense and say it loud.

Hollie McNish is so articulate and her poems hit the nail on the head over and over again. This would be a fantastic book for someone expecting a baby; for me, it’s almost a memoir.

08 Dec

Book Review: Breastfeeding Uncovered, by Amy Brown

Before reading Amy Brown’s book, I became aware of a highly critical review of it, written by someone who admitted to not having read it. She felt pretty strongly that the world doesn’t need any more books exhorting women to breastfeed.

Having actually read it myself, I get the feeling that Amy Brown would agree with that sentiment; and while Breastfeeding Uncovered: Who Really Decides How We Feed Our Babies comprehensively demonstrates the importance of breastfeeding for babies, mothers, and society, this is not a book telling mothers that they must breastfeed, but rather one that explains the complex range of reasons why so many of us don’t. It’s not even a book that is explicitly aimed at mothers, since it isn’t a how-to-breastfeed manual; and it is likely to be useful to a wide range of readers including new fathers, grandmothers, health professionals, and anyone supporting a breastfeeding mother. It also might be a helpful read for mothers who have stopped breastfeeding and perhaps have mixed feelings about that decision. And one final demographic: I’d recommend this to policy makers, politicians, budget holders, and anyone involved in public health promotion – these are the people who can really use this information to protect and support breastfeeding in a society that just doesn’t seem to get it.

Breastfeeding Uncovered addresses social, cultural and political issues; examines the impact of transition to motherhood; and talks about the reality of breastfeeding for modern families. There are some lovely clear explanations, for example the SIDS statistics in relation to bedsharing; and I found myself trying to memorise certain facts and phrases for use in my own work.

Amy Brown’s voice comes across very clearly, and initially I wasn’t sure if I would find the occasional sarcasm a bit annoying. But she uses it to make such good points that it’s pretty hard to get annoyed. She really just tells it like it is.

If I had to find gaps in this thorough work, I would like to see a little more mention of highly qualified volunteer Breastfeeding Counsellors such as those trained by NCT and ABM, who occupy the space between Lactation Consultants and Peer Supporters. There is also a vast network of support now available on social media and websites like Netmums, but perhaps that’s scope for the next book.

The real strength of Breastfeeding Uncovered is its firm grounding in an absolute wealth of evidence, both from the author’s own research and from many other reputable sources. Haters gonna hate, but they can’t actually argue that Amy Brown is wrong, or that she doesn’t understand the complexities of infant feeding, or that she is exhorting mothers to do things her way; to do so would indicate that they too have not read the book.

You can get a copy of Breastfeeding Uncovered here, with a 10% discount if you use the code SPROGCAST at the checkout.
Disclosure: Pinter & Martin sent me a free review copy of this book.

17 Jun

Breastfeeding support matters, but it’s not all about the individual

Will breastfeeding, too, one day have its historian-chronicler who tries to unravel the train of events leading to the early 21st century’s failed mass alternative-nutrition child-feeding trials?
– James Akre in the Huffington Post

I recently heard a talk by researcher and breastfeeding advocate Maureen Minchin (and interviewed her for Episode 15 of Sprogcast), in which she discussed exactly this question. Her new book Milk Matters picks up from and expands upon her 1985 book Breastfeeding Matters, a detailed and dense book covering both the political history of breastfeeding in modern times, and specific information on the management of breastfeeding which is useful for both mothers and health professionals alike. In person, her tone is as assertive and her views as uncompromising, as they come across in this book. In 1985, Minchin wrote “Those who conceal information, for the sake of sparing mothers anxiety, are doing greater harm.” She still firmly believes this.

Quoting, with irony, an old Cow & Gate advert, Minchin says that “what you feed them now matters forever.” Her milk hypothesis is that breastmilk is the bridge from the womb to the world, enabling the baby to develop a healthy microbiome, which regulates the immune system and optimises development. Furthermore early nutrition is the single biggest influence on gene expression following birth.

There is plenty of evidence for this, and emerging evidence that exposure to cows’ milk protein actively interferes with gene expression, triggering a trajectory of growth not only for the life of that baby, but if she is a girl, for her children and grandchildren too. More details about this can be found in her presentation here.

Minchin accurately predicted a backlash against honesty about the risks of not breastfeeding, and cites the huge vested interests of the baby milk industry, which has successfully divided mothers for decades, co-opting the phrase “breast is best” to create an aspirational ideal, and undermining breastmilk as the normal infant food for our species.

Why is it so hard to talk about breastfeeding in a positive and helpful way, that doesn’t incite an emotional response? The day after hearing Minchin speak, I was at the Association of Breastfeeding Mothers (ABM) annual conference in Birmingham, listening to speakers who truly understand the challenges of supporting individual mothers, in a social context that is not supportive of breastfeeding. The health, social, and emotional issues are the background noise against which we all work with mothers; but too much of what society knows about breastfeeding comes from a middle class media that categorises women according to the way they feed their baby. As Lactation Consultant Sally Etheridge pointed out at the ABM conference, “just because a mother isn’t breastfeeding, it doesn’t mean she didn’t want to.”

Earlier this year, a report in The Lancet demonstrated that the UK has the lowest breastfeeding rates in the world. Whose responsibility is it to change this? Those whose vested interests lie in women breastfeeding less would have us believe that anyone offering breastfeeding support is a member of the Milk Mafia, with an earnest belief in boosting those numbers bleeding nipple by bleeding nipple. Breastfeeding happens within a complex socio-economic context, and a focus on public health rather than on individuals does not preclude individual support. In fact the goal of most breastfeeding supporters is to help improve individual mothers’ experiences, to support their feeding decisions, and to empower women to make those decisions. According to researcher Heather Trickey at the ABM conference (also on the next episode of Sprogcast), it is not the responsibility of the feeding supporters, or of any individual mother, to improve breastfeeding rates; it is the responsibility of society, of the health services, of government. The only people who gain from pussy-footing around women’s feelings about breastmilk and formula are those who make a profit from exploiting mothers, to the detriment of public health.

[Cross-posted from the Huffington Post]

15 May

Reading Half Marathon

A few years ago, I took it upon myself to start running. This seemed a bit bonkers at the time; I’m not unfit but I’m not young either, and it took a year (including time off for a sprained ankle) to comfortably run 5k. Fast forward to January this year when our local NCT Committee started to talk about fundraising to train Breastfeeding Peer Supporters. We need about £5000 to train a group of 12 women to support local mothers, and when someone suggested running Reading Half Marathon in March, for some reason I thought it seemed like a good idea.

I lost no time in booking my place, otherwise I would certainly have changed my mind. I don’t really enjoy running, I just do it so that I can eat cake. Luckily my son is now in school, and my work is quite flexible, so I was able to fit most of the training into the working week. I looked at various training plans but since I don’t understand words like “fartlek” I just decided to increase my mileage week by week. This turned out to be moderately successful, and three weeks before the race, I ran ten miles on Saturday morning, and actually enjoyed the whole thing (as well as the enormous lunch I ate afterwards).

A few days later, I enjoyed another 5 miles, but then the twinges started in my left leg. I now know I had torn my plantaris – the muscle running down the side of my leg and joining to my foot. This is likely to be because I increased my mileage too rapidly. At the time, I took the decision to stop running, and swim regularly until race day, and accept that I would probably walk some of it.

On the day of the race, I met up with some friends who were there to give support; they went off to wait at the bottom of the first big hill, and I joined the queue for the start. As a slow runner, I was starting near the back, and it took about half an hour for me even to reach the start line. I managed to pace myself well at the beginning, and was so distracted by the crowds and the costumes and all the charity t-shirts around me, that I barely noticed the first couple of miles. Then I came to the hill, and my friends waved and offered me jelly babies (which I refused; I hate jelly babies). Having run up the hill twice already in training, I knew exactly what to expect, and proudly powered up it. By the top I was very glad to know the first drink station was soon approaching.

I continued steadily on through the university, down Kendrick Road, and into town where my boyfriend and son were waiting to cheer me through at 6.5 miles. They then cut across while I ran round Forbury Gardens, and waved again at 7.5 miles. As I ran away from them, I started to feel despondent: I was only half way, and running all that again felt like such a big ask. And then it turned out that there was another huge hill connecting Oxford Road and Tilehurst Road, which came as a horrible shock. The only thing that got me up that hill was knowing I had another friend who had come all the way from Milton Keynes just to cheer me on, waiting at the top of it.

After that it was run-walk all the rest of the way; my head lost the battle before my legs did. Even though I knew there was going to be some walking, I was still disappointed by it. Yesterday I booked my place in next year’s Half, and there are two things I will do differently: train more gradually, and arrange for targeted support from mile 8 onwards. Like a new mother breastfeeding her baby, I know now that the more support I have, the more likely I am to have a positive experience and a satisfying end to my journey.

09 May

Book Review: You’ve Got It In You, by Emma Pickett

You’ve got it in you is a chatty, positive little book packed with very useful information for breastfeeding mothers. In fact it begins with the decision to breastfeed, explaining the importance of gathering your support and doing your research well before the birth of your baby. It then takes a roughly chronological journey through the experience of breastfeeding, starting with the importance of skin to skin and a gentle transition into the world. The contents of the book are so closely aligned to what I would say myself that it’s impossible not to read without nodding constantly, going ‘yes, yes, yes.’ It’s all so very sensible.

Emma Pickett’s friendly (sometimes a little brisk) narrative voice can be heard clearly throughout the book; it might feel like having a kind and experienced breastfeeding counsellor sitting alongside you, giving you both reassurance and information at critical times. I found the switch between “we” and “you” and “they” slightly confusing, and sometimes this gave it a slightly nanny-like tone; but in general the language used is clear and accessible, and this is definitely a book I would offer to a new mother, whether she needed help, or just as a companion.

The detailed signposting in the book could be extremely useful, however the weblink formatting doesn’t really work in print, and of course there is the danger of going out of date. This is where a QR code or some other way of accessing online references would be useful. Reading this academically, I wanted to see more references to support some of the information given, partly so that I could share it myself with confidence. Some pictures might also be helpful, in the section on positioning and attachment.

In addition to good quality information for breastfeeding mothers, the book also includes a handy little chapter for grandparents, information about safer bedsharing, and even details of how to train as a breastfeeding counsellor yourself. This would have been a great book for me as a new mother, but I also recommend it to anyone supporting new families. It’s one of the best books on breastfeeding that I have read.

[Disclosure: Emma sent me a review copy of this book]

21 Mar

Media manages to shut Jamie Oliver up over breastfeeding. Nice one.

As soon as Jamie Oliver opened his mouth, it was open season for bashing the breastfeeding supporters once again. To be fair, his choice of words was poor. ‘It’s easy, it’s more convenient, it’s more nutritious, it’s better, it’s free,’ he said. Well, it’s certainly free.

Cue a whole cornucopia of articles arguing the rest of those points, largely from journalists who experienced a variety of difficulties in feeding their own babies, most of whom seem to be using this most inappropriate platform to debrief their feelings of guilt and anger and disappointment.

The typical argument goes something like this:

He’s a man. How dare he stand up for women?
It’s not even true. How dare he say that breastfeeding is a good thing? Lots of women can’t do it. I couldn’t do it.
Breastfeeding support is all about pressuring you to continue. All my friends said so too.

This argument is generally concluded with either “I actually fed my baby for 18 months but don’t beat yourself up if you can’t;” or “I gave my baby formula and she’s fine and I’m fine so shut up.”

And this is how journalists manage to perpetuate the social and cultural difficulty of breastfeeding. I have no problem with them reminding us that breastfeeding can be hard; this is supported by experience and by evidence. The sadly now-discontinued Infant Feeding Survey showed in 2010 the drop-off rate from around 80% to around 55% of mothers breastfeeding their babies by six weeks, and 34% at six months (none of this is exclusive breastfeeding, just a baby getting any breastmilk at all). The 2005 survey showed that 90% of the mothers who stopped by six weeks, had planned to breastfeed for longer. This is the statistic that we should be shouting about, because this represents all that guilt and anger and disappointment.

We need to stop setting up straw man arguments like the Smug Self-Righteous Lactivist, and ask why councils are closing down breastfeeding support services run by highly-trained breastfeeding counsellors and attended by huge numbers of mothers. To take one example, 17% of all new mothers attended the Hampshire drop-ins, and 98% of them would recommend the service to others. This doesn’t speak of pushy, pressurising, “well-meaning” (translation: “ineffectual”) supporters who spout about “breast is best” and insist you carry on no matter what.

Generally speaking, breastfeeding counsellors are trained to listen and support women (and sometimes men); to give them a safe space to figure out what they want to do and how they want to do it; and to share information to help with that decision making. Breastfeeding counsellors don’t use words like “easy” and “convenient,” mainly because their experience is of working every single day with women who are not finding it easy or convenient. Nor do they use such phrases as “breast is best,” since they are well aware that parents tend not to make feeding decisions on the basis of evidence about nutrition. No, parents make decisions on the basis of what’s happening to them at the time. Telling a struggling mother to continue doing something that is making her miserable, because it is best for her child, is contrary to the philosophies and the training of all the UK breastfeeding support organisations.

Yes, Jamie oversimplified breastfeeding in his statement on the radio, but that was a droplet compared with the oversimplification of the state of breastfeeding that followed, media-wide. Well done for enabling a backlash that prevented someone speaking out for supporting women.

17 Mar

If only someone had told me…

In the first few weeks and months of parenthood, new mothers and fathers very often comment on the range of knowledge they were missing, and skills they didn’t have, to cope with this new experience. If they paid for antenatal classes, at least they have someone to blame for the gaping mismatch between expectation and reality; but the majority of new parents do very little formal preparation, and unsurprisingly say the same sort of things.

To misquote Tolstoy, “each new family is new in its own way.” This presents a challenge when it comes to helping a couple to prepare for parenthood. Living in the midst of extended family, as they might have done 100 years earlier, the whims and wiles of the newborn baby would have been somewhat less mysterious; or at least the family elders could have helped to unravel some of those mysteries. New mothers might have found themselves less isolated. New fathers might have had more clearly-defined roles. And there would have been none of this pesky research into attachment and brain development, less pressure to have it all, and not so much of an expectation to be the perfect parent.

“I wish someone had told me that cluster feeding is normal… that formula isn’t evil… what ‘broken sleep’ really means…” they say, or write, with the authority of the first fully enlightened human being to have studied this matter. Emerging from the newborn fug into the crystal clarity of a new mum or dad who is finally getting a bit of sleep, the simmering resentments about the truly unexpected turns in their road, and the vast range of surprises that society simply forgot to mention, become pronouncements upon The Things I Have Learned, From Which You Too Must Benefit.

As an antenatal educator, I am often advised of the many ways in which I failed to prepare people for what it’s really like to have a baby, and find yourself relentlessly on call to a tyrannical but adored bundle of cute, who speaks no language that you know, and for whose health and well-being you are entirely responsible.

And I know I would have mentioned cluster feeding, and can think of any number of reasons why they might not have really taken it on board: were they focused on the impending birth to the extent that this was too abstract to be meaningful? Did they think this would never happen to them? Was it one small forgotten detail, many weeks ago now, lost in the fog? Is it actually possible to convey the real intensity of early breastfeeding, with the language we have at our disposal?

I also know I didn’t say that that formula was evil. In fact I may well have given examples of making a positive decision to use it. I explained about milk supply and responsive parenting and feeding cues, but I don’t believe that formula is evil, so why would I have said it? Is it perhaps that they expected me to say that, and didn’t really listen to what I actually said? Or did someone else say it, and they misremember it as being me?

As for sleep: well, some babies sleep, and some babies don’t sleep, and your interpretation of broken might be different from mine. The challenge is to drill down through platitudes and unrealistic expectations, without frightening the living daylights out of people who can’t predict what’s coming their way. In a society where people with some medical or scientific authority still insist, in the face of the evidence, that babies “should” sleep in a certain way, it’s not surprising that the sporadic and uncontrollable nature of newborn sleep should be hard for parents to manage.

I call for people to carry on being this honest about their experiences as new parents, but not to assume their experience is universal, nor to blame the people offering information and support for the fact that parenthood is not, in every way, as you expected. Join your voice to ours in increasing the support available. Ask the government not to cut funding to essential services such as Children’s Centres and breastfeeding support groups. And don’t be part of the problem by telling other parents-to-be what to do: every new family is new in its own way.