Tag Archives: breastfeeding

27 Apr

In the red tent

I will be spending this weekend on study days all about processing ideas of birth and motherhood, and in preparation for that [and to avoid doing my tax return], I have been collecting up some bits and pieces to take with me.

The first thing I was asked for was easy: a poem or short piece of prose about birth or parenting. I’ve chosen an extract from Naomi Wolf’s book Misconceptions. The review linked here is rather critical, which makes me interested to re-read the book, as it has been a long time since I looked at it. However there is a page describing the experience of breastfeeding which I found graphically accurate the first time I read it. It’s too long to quote the whole thing here, but it ends: I had never in my life been able to make someone so happy so simply. That gives the impression of an idyllic description, but the entire quote is far from that.

The second thing I have to bring is a favourite short birth story that makes a point, and this I had to think about. I hear lots of birth stories and on reflection I find it hard to pull out a whole story in any kind of coherent detail. I thought I could use my own story, or a fictional birth story that I wrote, but both felt a bit like cheating. Then I remembered reading the story when my son was just over a year old, of journalist Leo Hickman supporting the birth of his third child at home, with the help of the ambulance operator. From the transcript you can tell that the operator is reading instructions from her screen, but she is so calm, clear and encouraging throughout, even when Hickman reports to her that the baby is still inside the sac, and then that there is a large quantity of meconium. She remains cool but not detached, and steers him through an unimaginably alarming experience. If you’re brave, you can listen to the whole call here.

Finally, I need a picture or a small object that holds special meaning for me in relation to birth or parenting. That I am going to have to think about.

I’m looking forward to spending the weekend with my colleagues talking about birth and motherhood in a supportive and safe environment. I think it will be both motivating and educational, and best of all, we are encouraged to bring our knitting!

24 Apr

Regression to the mean

Most weeks, someone will tell me they ‘swear by’ some remedy for one of the many woes of early parenting, and assure me that it has worked wonders. And then they will turn and tell the mum sitting next to them, who [unless healthily sceptical] will unquestioningly accept the recommendation without asking two very important questions:
1. Is there any evidence that it works?
2. Is there any evidence that it does harm?

Infacol is a prime example of a medication recommended widely and unscientifically by mums everywhere, but more worryingly, by GPs and Health Visitors, who must surely know that there is no evidence that it works. Breastfeeding Network has a useful paper [pdf] on colic which discusses Infacol and other remedies, concluding the research is a bit thin on the ground and there are various things you can try; and particularly for the breastfed baby, getting some support with breastfeeding may be key.

Here’s another one: Lansinoh prevents nipple pain. It doesn’t. Its only function is to heal damaged tissue. Nipple pain is almost always prevented (and resolved) by good attachment, and no amount of lanolin cream will facilitate good attachment. In fact, large amounts of it, making the breast slippery, will make it harder for the baby to stay comfortably latched on. In addition, the heavy marketing of Lansinoh reinforces mums’ certainty that breastfeeding will hurt, and is therefore a barrier to doing it at all.

Blogger Scepticon takes a look at amber teething beads and basically demolishes them as a remedy for the pain of teething. Teething is a tough time for parents as well as babies, and parents may feel helpless to alleviate the pain and misery, so it’s no wonder there’s such a market in remedies that are only anecdotally effective.

And when we are talking about our babies’ health, anecdotal is just not good enough. There is an ethical obligation on health professionals not to recommend something just because they have no other answers, but the fact is that few health professionals have the time to sit with an anxious parent and help her to work through her worries and gain confidence in what she is doing. Hence the quick fix: a formula top-up, controlled crying, dummies, all of which can be shown to cause harm.

But the anecdotes of one mum to another seem to carry even more weight at this vulnerable time, and is an inevitable result of the peer-support that we encourage. It’s hard to take that away from new parents, but it’s equally important to encourage them to ask those questions rather than accept at face value the claim that something works.

Regression fallacy.

21 Feb

Support, Advice, and Parental Instinct

As a breastfeeding counsellor, I am sometimes asked why my antenatal classes do not go into great detail about problem solving when things go wrong. The pat answer to this, of course, is that every new family is unique, and I can’t possibly account for all the possible scenarios. I’m also wary of introducing a lot of potential pitfalls, and therefore undermining my own work to show that breastfeeding can be a straightforward experience, and that being well-prepared with an understanding of how it works is more useful than being armed with copious detail about problems that may not occur.

This is a dilemma for me, because to be realistic about breastfeeding as experienced by the majority of new mothers in the UK, I have to acknowledge that there are challenges. So one of my main objectives is to raise awareness of the huge amount of support available to new parents. If time permits, we compile a list, and the group is always impressed by how many people they can think of who might be able to help them over the first few weeks of their babies’ lives. Here are some of the ideas I usually see:

The real trick, though, is in figuring out which of these are sources of trustworthy information (or practical help); and which are, probably with the best intentions in the world, recycling myths and misinformation, or unhelpfully comparing your baby with theirs. But each of these different sources of support has its function, whether it’s sympathy and a cup of tea, the loan of a dvd box set to while away a marathon feeding session, or reassuring confirmation that what you and your baby are going through at any particular stage, is completely normal.

It can also take courage not to follow advice that does not feel right, especially when it comes from a figure of authority. So another of my objectives, both antenatally and postnatally, is to empower new parents to have confidence in their own parenting. We are among the first generations of parents to raise our children in isolation form the extended family, and there are huge commercial interests in undermining parental instincts.

It’s tough being a new parent in the 21st century, but remember that there are reliable sources of help, many of which are under-utilised. So don’t feel you have to struggle on alone, but do pick your support carefully.

Originally written as a guest post for the liberating blog, Free Your Parenting.

25 Jan

Book review: Successful Infant Feeding, by Heather Welford

This comprehensive book takes a broad view of infant feeding, including how-to sections for both breast and bottlefeeding, along with an interesting examination of the history and politics, and the social and emotional aspects of the subject. It gives enough detail to be useful to breastfeeding supporters and other health professionals, without being too dense for parents and parents-to-be.

I warmed to the book immediately on reading the opening chapter, about babies’ development over the first year. This sets the subject of feeding nicely into the wider context of babies’ needs; and yet, without pulling any punches about the risks of formula feeding, manages to be inclusive and non-judgmental about the range of choices that parents make. Importantly, Welford acknowledges that, for many parents, formula feeding is not a choice willingly or happily made, and that it is very hard for health professionals to get the right tone when it comes to supporting parents in making decisions about feeding.

This book is useful because as well as accurate how-to information, it also touches on a range of special situations and common concerns, briefly explains the WHO code, and looks at how individual babies’ feeding patterns might change over time. It even includes enough information on the introduction of solid food to render the purchase of anything by Annabel Karmel completely unnecessary.

The language used is crystal-clear and helpfully free of value-laden terms. I have already heard myself reciting bits of it in antenatal classes (while hoping that Heather won’t want any royalties!), have sent a copy to my sister-in-law who is expecting her first baby, and recommended it widely. It is the book that our profession has been waiting for, and should be on the reading list for anyone working with new parents.

15 Jan

Can breastmilk be made in a lab?

This is not intended as a ‘breast is best’ post, simply a list of the reasons why it would be impossible to make an exact replica of breastmilk in the lab. There are already many, many resources on this subject, and this is only intended as a simplified list.

  1. Breastmilk changes all the time according to the needs of the child. For example, in hot weather, it has a higher water content. As the child gets older and starts to toddle, the antibody count increases to counter the increased exposure to pathogens. If a baby is exposed to pathogens, an interaction between his saliva in the mother’s milk ducts causes appropriate antibodies to be made in the milk. Formula does not contain antibodies.
  2. Breastmilk also changes during each feed, becoming increasingly high in fat as the baby drinks. This is what causes baby’s internal appetite control to kick in. The fat content of formula does not change.
  3. Breastmilk contains antimicrobial and immune factors. Few of these can be made in a lab.
  4. Breastmilk contains the digestive enzyme lipase, which helps the immature gut to digest the milk. This is why it takes longer to digest formula milk, which is one of the reasons bottlefed babies go longer between feeds.
  5. The flavour of breastmilk changes according to the mother’s diet. Babies experience different tastes before starting solid food.
  6. Breastmilk contains human growth hormones. Formula milk, which is made from cow’s milk, contains bovine growth hormones.
  7. There are other ‘human’ factors which are impossible to make in a lab, including human iron. Breastmilk also contains lactoferrin, which helps the baby to digest the iron in breastmilk. As formula does not contain lactoferrin, the iron content has to be much higher in order for the baby to absorb sufficient quantities. High levels of iron can cause the gut to bleed, resulting in anaemia. Other micronutrients and vitamins are added to formula in high quantities, for the same reason.
  8. Some babies are allergic to cow’s milk protein. No babies are allergic to human milk protein.
  9. Breastmilk contains lactose, cholesterol and fatty acids that aid human brain development. Formula milk does not.
  10. Breastmilk is sterile. Formula powder is not. Ready-made formula is sterile but requires a lot more handling than breastmilk, which usually goes directly from breast to baby.
  11. No country has a government standard for formula. There is a minimum standard, but other than that, there are no rules for what can or can’t be added. Most ‘new’ ingredients are added for marketing, rather than health, reasons.
  12. Babies get more than just milk and its constituents, when they breastfeed. The benefits of lots of skin to skin are well-established.

UK formula companies spend £20 per baby on promoting formula. The government spends 14p per baby on promoting breastfeeding, and we know that ‘promoting’ breastfeeding is unhelpful. Would that £20.14 per baby was spent on supporting breastfeeding mothers, and then the question of whether or not formula could replicate breastmilk would be completely irrelevant.

The Ecologist: Breastmilk vs ‘formula’ food
Dr Sears on comparison of breastmilk and artificial milk
Kellymom on immune factors

10 Jan

Book review: You, Me and the Breast

This is a colourfully illustrated book about breastfeeding. Its simple story follows a mum and baby from birth to weaning, and mentions lots of memorable moments, such as snuggling up in bed with daddy, mama milk to comfort and soothe, and those relaxing moments where one’s ever-active infant becomes still for a little while at the breast.

Although it is clearly presented as a children’s book, I was a little confused about who the target audience was. Some of the information: ‘my nipple darkened… and gave off a rich smell’ sounds unnecessarily technical in a book for a small child. The cursive script was too difficult for my competent five year-old to read himself, and he had a lot of questions about the illustrations (‘which one is her hand?’ ‘why has she got birds in her hair?’).

It was nice to see dad included in some of the pictures, although I have reservations about the depiction of him ‘aeroplaning’ puréed food into the baby’s mouth.

On balance, the more books for children that normalise breastfeeding, the better. It would be good to see this widely available in local libraries and schools.

***

To order You, Me and The Breast with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

29 Dec

The Incompetent Mother

The majority of breastfeeding mothers stop breastfeeding before they are ready, and long before their babies are ready. I will bore you with only one statistic: the World Health Organisation recommends exclusive breastfeeding until the age of six months, but in the UK, fewer than 2% of babies are breastfed for that long, whether exclusively or not.

The knee-jerk response to this is actually not to blame the mothers who stopped before six months, or indeed who never started (although those mothers perceive blame anyway, because feeling guilty is what parents do); but to blame healthcare professionals and volunteers for failing to provide adequate support, to blame employers and economics for forcing women back into a workplace ill-equipped to facilitate breastfeeding; and to blame “society” for disapproving of breastfeeding in public.

These factors do play a part, particularly where the people supporting mothers in the early days with their newborn babies fail to help, and put the blame on the mother by telling her she will never feed, because her breasts are too small, her nipples are the wrong shape, she hasn’t got enough milk, etc etc. A mum I’ve been supporting, despite having such copious milk that she was able to hand-express it prior to giving birth, was then told that she couldn’t feed because she had inverted nipples. One wonders why she had never noticed this before. A few days later another midwife advised her that that was rubbish; in fact her child doesn’t latch on because she has a tongue-tie. But what a great way to make the mum feel responsible for not being able to feed her baby, just because the original midwife couldn’t find a way to help her.

But there are deeper reasons, higher barriers, which are much harder to tackle, not least of which is the guilt that makes open discussion so difficult. But most mothers are not responsible for the difficulties they encounter in breastfeeding, and therefore it is inappropriate for them to feel guilt. Anger, sadness, and more anger, and perhaps acceptance that they can’t change what has happened, but not guilt.

“Guilt is only appropriate when, with full knowledge and free consent, you deliberately chose something detrimental to your baby for some trivial selfish reason.” – Maureen Minchin

The very existence of artificial milk undermines mothers’ belief in their own abilities to feed their babies. The fact that we believe we must have our babies weighed and checked regularly erodes our confidence, and allows an opening for doubts to creep in, widened by the conviction that artificial milk will cure all ills: it will make your baby sleep [research does not show this]; it will help your baby gain weight [so will effective breastfeeding]; it will resolve lactose intolerance [just plain nonsense; what do these people think the sugar in cows’ milk is?].

Added to this is the assumption at policy-making level that there is a widespread need for artificial milk, which at its worst has prevented – in America – publicity about recalls of faulty products. Apparently it is better to maintain the status quo, avoid panicking parents, than to tell people the truth about the nature of the food they are giving to their babies. Surely they have a right to know?

Meanwhile the subtle negatives about breastfeeding appear in literature from supposedly pro-breastfeeding books (What To Expect When You’re Breastfeeding… And What If You Can’t?), to apparently supportive retailers (Boots’ nipple cream advert offers the information that the worst thing about breastfeeding is the inevitable sore nipples, therefore all mothers must need to buy their cream, which cures it. Wrong. No cream will cure pain that is caused by incorrect positioning of the baby at the breast; but correcting the positioning will); to – of course – the babyfood manufacturers (Aptimil follow-on milk, for “when you decide to move on from breastfeeding” – as apparently we all should do before one year, when a child can drink unmodified cows’ milk). The prevailing mythology is that a breastfeeding mother needs to eat more (500 calories extra per day is normally quoted), implying that breastfeeding takes something out of you.

The pressure to get our babies into routines that are usually incompatible with breastfeeding, which works best when the infant is fed on cue in the early weeks; added to the insistence that mothers need to be separated from their babies for their own sanity, and the idea that fathers and grandmothers can best bond with the new baby by being involved in feeding, makes a recipe for inherent difficulties. Routines, separation, and messing with the milk supply by expressing milk or giving the odd bottle of artificial milk are all contributory factors in mastitis and in perceived or actual loss of milk supply.

Finally, the pervasive images of bottlefeeding make that the normal way that people expect babies to be fed. The Richard Scarry book that I bought for Bernard, having enjoyed it myself as a child, shows one newborn being bottle-fed on her (rabbit) mother’s lap in hospital, and one naughty wakeful child being bottle-fed by her (doggy) father, to get her back to sleep. Meanwhile, how are breasts portrayed by the media in general? As sexual objects belonging to men.

Each of these points deserves far more than a paragraph in a blogpost (perhaps one day I will find the right PhD opportunity!), but surely even this brief outline of the huge barriers to making breastfeeding normal demonstrates one of the most important things I have learned over the last few months: that mothers themselves are the last people to blame for low breastfeeding rates.

Originally posted elsewhere on 15th May 2008

07 Dec

Nursing In Public

We often spend time in an antenatal class discussing the perceived horrors of ‘getting them out’ in public places. With varying degrees of support from partners, other family members, and complete strangers, I can see why it is such a huge barrier, adding to the breastfeeding-related anxiety for mums-to-be.

Recently I asked a group ‘who are the first people you are likely to breastfeed in front of?’ and the answers that came back were: your partner, the midwives, your close family. One dad objected strongly: that’s not true, he said. You don’t have to do it in front of any of those people. He was profoundly uncomfortable with the idea of any kind of ‘public’ feeding.

But if the WHO guidelines recommend exclusive breastfeeding for the first six months, an inability to leave the house must have a serious impact on the new mother’s life.

That doesn’t mean you have to be completely brazen and bare all, on a bench outside the town hall, the very first time you do it, hence my question. By the time you are ready to go out for long enough that you are likely to have to feed your baby, the chances are that other people will have seen you do it already. But here are a few ideas to consider, that might make it a less daunting prospect:

  1. Baby Steps
    Consider making your first outing to somewhere you know will be safe, non-judgemental, and with lots of other mums and babies. At NCT Bumps and Babies you will meet mums with babies of all ages, and a whole variety of different feeding experiences behind them. Or find a local breastfeeding support group. Or if you did antenatal classes and have a group of friends, organise a coffee morning at someone’s house. If the wallpaper is different, you might feel less isolated.
  2. Getting Them Out
    If you’ve been schlepping about at home wearing just a nightie for the first week or so, you might not have thought about the impact of wearing or not wearing the right clothing.
    There are countless beautiful and expensive nursing tops available, with mysterious openings and clever tucks and folds. All you really need is a loose shirt, perhaps two layers (vest and t-shirt works well), that you can pull up; and the one essential piece of kit is a nursing bra, ideally the sort with a drop-down cup. You pull the top layer up, the bottom layer down, drop the cup and attach the baby, who then covers up most of the exposed flesh.
    Things to avoid: bras that are not designed for this kind of easy access, tight tops, dresses, lots of buttons.
  3. Cover Up
    I am by no means saying that a nursing mother needs to cover herself as though ashamed of what she is doing, but if it makes you feel more comfortable, you could use a light scarf or a muslin square to disguise the fact that you are breastfeeding. I am skeptical about ‘nursing aprons’ and other devices that are designed to be worn while breastfeeding, because they don’t make the process any less discreet.
  4. Safe Places
    Get to know the places you know you can go, where you will feel safe and comfortable. Large stores often have a baby feeding area; smaller stores might have a changing room with a plastic chair next to the nappy bin. Coffee shops are a haven for mums, especially during the working week; just don’t sit in the window!
  5. Your Rights
    In England, the Equality Act 2010. specifically prohibits discrimination against breastfeeding mothers. Nobody can ask you to leave a public place on the grounds that you are breastfeeding.

This is another one of those concepts that is difficult to get your head around before you baby comes along; and then after a few days of focusing on breastfeeding, may well seem like much less of an issue. But don’t forget that there is a lot of support available from other mums and from groups where mums and babies meet; you don’t have to be stuck in the house.

18 Nov

Book Review: Saggy Boobs & Other Breastfeeding Myths, by Val Finigan

Saggy Boobs & Other Breastfeeding Myths is a fabulous little book! It may be a light read, but it is certainly not light on evidence-based information.

Dispelling breastfeeding myths is one of my main aims in antenatal classes, and the myths appear to be limitless: babies get the runs when you eat curry, champagne gives them hiccups, you end up with boobs like spaniels’ ears, and of course you’re at the beck and call of a miniature tyrant who never learns to sleep, if you breastfeed.

I love the clear, factual answers, especially the response to ‘modern formula milks are as good as breastmilk,’ (p.20) which I might memorise:

Even though modern milks are considerably better than old-fashioned milks they do not replicate breastmilk. They contain no antibodies to fight infections, no living cells, no enzymes and no hormones. They contain higher levels of aluminium, manganese, cadmium, lead and iron than breastmilk. They have significantly higher levels of protein than breastmilk, and the proteins and fats are fundamentally different from those found in breastmilk.
The constituents of formula do not change feed-to-feed, day-to-day like breastmilk and are not species specific. All we can say about formula milk is that it is successful at making babies grow well.

Each page includes the most amazing embroidered illustrations by Lou Gardiner, and the whole book is so unique, accessible and appealing that I think it should be standard issue for expectant mothers. The author and publishers may be interested to know that there is one at every Baby Cafe Local in Hertfordshire.

***

To order Saggy Boobs & Other Breastfeeding Myths with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

03 Oct

Closest to breastmilk

While it’s no longer legal in this country for the milk manufacturers to claim that their infant formula is “closest to” or “inspired by” or (yes, this has happened) “better than” breastmilk, the idea that these companies are beavering away trying so hard to come up with the perfect infant food has a fairly strong hold. As long as they are seen to be competing to be the best infant formula, they can hope that we will overlook the fact that they are all nutritionally inadequate in different ways. This makes their claim to be the best yet more irresponsible, as bottlefeeding mothers tend to stick to one brand.

It is simply impossible to support a claim to be “close to breastmilk,” because the components of breastmilk change constantly. They change from day to day, from feed to feed, according to the age of the child, the needs of the child, and even the weather. Seriously. On a hot day, babies drink thinner, more thirst-quenching milk. If formula manufacturers cannot identify all the ingredients, and cannot establish the function of many of those ingredients that they have identified, and cannot synthesise many of those whose function they do understand, and cannot balance the synthetic ingredients to achieve the same nutritional end result, then how can they possibly be selling something that is supposed, in some way, to be equivalent to human milk?

On top of that, there is the slightest teeny tiny suspicion that sometimes, some of the changes made to the formula might not be entirely attributable to amazing new discoveries about the contents of human milk, but in fact can be attributed to amazing new discoveries about what parents will buy if it is suggested to them that a particular product contains “essential” ingredients for brain growth, prebiotics, or the wonderful immunofortis. And no-one ever calls them to account for the fact that these essential ingredients were missing in the previous formula. Infant formulae are revised over 100 times a year, and each one is more perfect than the last, just as each Mars Bar is the biggest ever.

The bioavailability of nutrients in human breastmilk is high for its human consumers, because of the interaction between the ingredients of the milk, and the body’s mechanism for processing them. If one element is needed to process another, but is not available, then something else will be used, and the balance is upset. For example, too much iron causes a zinc deficiency; yet artificial milk contains twenty times the concentration of iron found in human milk, because cow’s milk lacks human lactoferrin, and therefore the iron in cow’s milk cannot be as easily absorbed by the human infant. Human iron is all absorbed, but the iron added to artificial milk is not, resulting in more waste for the newborn’s body to process, and encouraging the growth of harmful bacteria such as salmonella and candida in the gut. The guts of artificially fed children are already at more risk from such pathogenic bacteria, because they have a higher pH, because the lactose in human milk encourages the growth of friendly bacteria which keeps the pH naturally low. You see? As soon as one domino clicks down, the others start to tumble.

Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine. – Frank Oski, M.D., retired editor, Journal of Pediatrics

Today’s post once again owes a lot to Maureen Minchin – Breastfeeding Matters: What we need to know about infant feeding and the ever-factual Royal College of Midwives’ Successful Breastfeeding. Other sources were Kellymom, and Gabrielle Palmer – The Politics of Breastfeeding.

Originally posted elsewhere on 14th May 2008