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]

11 Feb

My complaint to the BBC

Dear BBC

I wish to raise a complaint with regard to the choice of Clare Byam-Cook, who was represented as a “breastfeeding expert,” a “breastfeeding counsellor,” and a “lactation consultant” on Woman’s Hour on Monday morning. With respect, she is none of these things, and I am deeply unimpressed that BBC researchers were unaware of this, despite complaints every single time she appears.

The information given out by Byam-Cook about tongue tie, milk supply, and the baby’s latch at the breast were fundamentally incorrect. Since the purpose of this piece was to explore the reasons why women feel unsupported and do not breastfeed for long in the UK, I am surprised that this misinformation was perpetuated without comment. This is negligent of the BBC.

Byam-Cook was also allowed to talk about her video and book, and mention that she is available for private consultations. I understood that the BBC was required to adhere to certain standards about allowing advertising. If this had been advertised on ITV I would be making a complaint to the ASA, since her book contains many factual errors that would undermine the breastfeeding experience of most women.

Please do not bother to send me your standard response, as I have read it. I take issue with the statement that ” Unlike other breast feeding counsellors, she doesn’t believe that breastfeeding is the be all and end all.” As a Breastfeeding Counsellor, I am very well aware that breastfeeding is one part of the complex experience of becoming a parent, and I have supported parents in many different situations, making many different decisions. The word “counsellor” should convey to you that we listen and support individual mothers, without an agenda. Nonetheless, breastfeeding is an important public health issue, as shown in last week’s article in the Lancet; and the BBC has a responsibility to give out correct factual information, as well as the helpline numbers from the four reputable organisations whose counsellors are trained to support women in an evidence-based, parent-centred way.

Kind regards
Karen Hall

11 Feb

How not to talk about breastfeeding on the radio

On Monday, BBC Woman’s Hour had what they described before the programme as a “ding dong” about breastfeeding. Ironically I missed the first fifteen minutes because I answered the phone, just as the programme started, to a mother who was concerned about her milk supply. Then I tuned in and cringed to hear the brusque tones of Clare Byam-Cook, a self-appointed “expert” on breastfeeding, telling listeners all about her magic techniques for getting babies to feed, and explaining where we, the trained breastfeeding supporters, are going wrong.

I have issues with the BBC allowing this person to promote her book and simultaneously undermine the work of the breastfeeding counsellors who criticise it. I’ve read her book and it’s hard to see how anyone could have much chance of breastfeeding for long, following its guidance. Callers to the show spoke of pressure, conflicting advice, and not being listened to. Byam-Cook dismissed the issue of tongue tie as “just a trend,” thus dismissing the experiences of thousands of mothers who have struggled to feed their babies precisely because of this. Estimates vary, but it seems that tongue tie affects 5-10% of babies, many of whom will be able to breastfeed, and some of whom are so badly tongue tied that they cannot drink from a bottle. Because it can be hard to identify a tongue tie, and midwives are not universally trained to do so, many mothers struggle with long or painful feeds, and many give up in despair. This is not a positive decision for them, and to hear that it’s a non-issue that doesn’t need to be resolved must hurt in so many ways.

Her fundamental lack of understanding of the way breastmilk is produced is shocking (“it is absolutely not true” that the more you feed, the more milk you produce). The well-established, basic principle is that milk removal creates milk production, therefore the more effectively a baby feeds (that is, on cue, for as long as he/she wants to, without discomfort for the mother), the more effectively the mother produces milk to meet that baby’s needs. Yes it is true that sometimes a baby feeds more (for longer, or more frequently) because the feeding is not effective; breastfeeding is complex, and breastfeeding counsellors are trained to listen to mothers and try to understand the situation so that they can offer appropriate support.

Listeners were also treated to her description of how to get a baby to latch on and feed (“mouth to nipple and squeeze the breast.”) Breastfeeding counsellors all over the country must have been banging their heads on the desk at this point; how many painful feeding experiences have we witnessed, where a woman has been told to squeeze her breast and force the baby on to it? No one-size-fits-all approach can ever be appropriate when we’re talking about human bodies, but there are strategies involving comfort, closeness, and biological reflexes that can make things much easier for both mother and baby.

I understand exactly why BBC Woman’s Hour invited Byam-Cook on to the show: a discussion between two International Board Certified Lactation Consultants about the shocking lack of support for new mothers would not have made such exciting radio. Or would it? As Dr Pat Hoddinott pointed out, the media has to share responsibility for the low breastfeeding rates in the UK, and shows like this are very much part of the problem, not part of the solution.

If you are a new parent and need some support with breastfeeding, there are several helplines run by women trained in listening, and with evidence-based knowledge about how breastfeeding works, including the NCT Breastfeeding Line 0300 330 0700 open 365 days a year, 8am-midnight. We talked about breastfeeding support in our very first episode of Sprogcast, which you can find here.

08 Nov

A poem about being an “idealistic” breastfeeding counsellor

I had a positive birth and a healthy, full term baby
Then I didn’t know what to do
On the few occasions when he latched on, it really hurt
I still don’t know why.

I started expressing on day two
I can’t remember when I stopped
I went to the breastfeeding clinic twice and called all the helplines
The midwives and the health visitors told me he had a good latch
One of the helplines suggested I use nipple shields so I did
Then he latched on, but it still really hurt.

I cried at nearly every feed for about 12 weeks.
I cried when he didn’t gain enough weight
I cried when he wouldn’t take a bottle of formula
I cried when he woke up to feed in the night
I cried when he wouldn’t nap during the day
I cried when my mother told me I had made a rod for my own back
I cried when he cried.

I cried less and less, week by week.
Breastfeeding became peaceful, but still demanding
Breastfeeding felt good
Breastfeeding soothed him immediately
Breastfeeding was the only time when he was still.

I cried when he decided he didn’t need to breastfeed anymore.

[p.s. At least once a week someone calls me for support with a whole range of feeding issues. How can anyone think I’m idealistic about how easy it is to breastfeed?]

25 Oct

Book Review: What to expect when you’re breastfeeding (and what if you can’t) – by Clare Byam-Cook

This is an awful book. I picked it up, out of curiosity, in a charity shop; and I’m glad I did because for the sake of £1 I’ve saved some benighted new mother a lot of heartache in trying to follow the advice within. I’d go so far as to claim that nobody, following the guidance in this book, is likely to breastfeed happily, or for long.

Let’s start with the author biography, which tells us that “most of the advice she gives in this book is based on the knowledge she has gained… it is not based solely on textbook theories.” This sums up the whole problem with the book. We know that people vary, and a sound understanding of the evidence around how breastfeeding works can be adapted to individual circumstances, BUT this book gives us very little of that evidence, a great deal of opinion, and much advice that is likely to be harmful.

Byam-Cook’s introduction sets out her basic premise, which is that women who have problem-free breastfeeding are “lucky,” and that breasts don’t always work properly. While this may be the case, the survival of our species points to it not being the biological norm. Her tone throughout the book tells us that mothers are feckless, and she is the expert: “I then show her what she should be doing … I have no trouble putting the baby on the breast … I move the baby to the correct position.” (p3) It makes my empowering, mother-centred heart weep.

Chapter One. The phrase that leaps out is “it is essential that a breast-fed baby learns to take some feeds from a bottle.” (p5) Other crazy nonsense includes “It might help to rub your nipples with a dry towel … to toughen them up a bit.” (p8); “If your milk supply is low, eat more.” (p10) and “Fizzy drinks are best avoided as they will tend to give your baby indigestion.” (p12). None of these statements are biologically plausible.

Chapter two has factual inaccuracies on pages 13, 14, 15, 17 and that’s before she starts on “foremilk and hindmilk” on p18.

Chapter three on positioning is overcomplicated nonsense, with the suggestion to give water to a baby with the hiccups thrown in, advice to settle babies to sleep on their side [she recommends putting them on their back on p63], and to let them cry for ten minutes before responding. Also, of course, the obligatory dip into complementary medicine, which if it worked would be called medicine.

Chapter four perpetuates a great deal of conflicting advice, dismissal of hospitals and midwives as sources of information, and the Author as The Best Expert Ever. Yet with her self-styled expertise, she still recommends restricting the frequency of feeds once the milk comes in, gets the storage times for expressed breastmilk completely wrong, and reckons fair skinned women have more “delicate” nipples than normal people (p56).

Need I go on? I read this book with a pen in hand, crossing out whole paragraphs at a time. Byam-Cook has no understanding that a baby’s needs are not purely physical, that breastfeeding is a relationship, that milk removal creates milk production, or that milk is not made from the contents of the mother’s stomach. Her basic biology is ludicrous, and her advice undermines breastfeeding, right, left and right again. She attributes more articulate thought to the breasts than to the mother: on p17 they are making assumptions, on p86 they are getting into “a terrible muddle,” and on p99 they are feeling happy. On p95 “the government recommendation of exclusive breastfeeding for six months is unrealistic and unachievable for many mothers.” With that attitude, it is.

Chapter seven lists all the common feeding problems, suggests the use of nipple shields for most of them, and makes absolutely no mention of community breastfeeding support, qualified breastfeeding counsellors and lactation consultants, or helplines. Most of the common challenges for the baby are apparently resolved by giving something in a bottle, whether formula, expressed milk, water or over the counter colic remedies. Byam-Cook goes on to devote a chapter to bottle feeding, which in this 2006 edition advocates “making up all the feeds at the same time each day” (p169), and has hopefully been updated in line with Department of Health guidelines.

Please don’t buy this book. Please don’t give it to anyone. If you are planning to breastfeed your baby, or experiencing any challenges with breastfeeding, contact a reputable organisation and speak to a qualified practitioner.