20 Dec

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

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

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

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

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

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

04 Feb

Welcome to The Motherland

New guidance from the British Medical Association recommends a change of language, from “expectant mother” to “pregnant person,” in order to recognise trans parents who may not identify as women. I confess that this is very confusing for me, and my confusion arises from how, then, we should define motherhood. There is also a conflict between my inclination to accept whatever terms people want to use for themselves, but also to value motherhood in a way that does not easily allow me to erase the “womanness” of it.

Please don’t imagine that my point of reference for motherhood is limited to floating around in a cloud of organic breastfeeding loveliness. In fact, I think that might be the core of the dilemma: this question of whether to use the word “mother” is just terribly reductionist, as though motherhood can be only one thing.

Motherhood emerges in so many different forms, perhaps uniquely for every single person who has – but there’s the problem – has what? Given birth? Some mothers adopt. Parented? Are women who miscarry or suffer stillbirth not mothers? The literature is at pains to emphasise that they are. Does that mean that women whose pregnancies end in abortion are also mothers? Some of them might feel that way; it was certainly the start of the journey into motherhood for me.

Clearly there is not one single event that turns a person into a mother. Motherhood is more like a place you go to, where you experience new things, which you may have expected or not, and which you may enjoy or not, and which change you, but do not turn you into a specific and new type of person. As with travelling, those experiences will affect you to some extent, but will be assimilated into your existing self.

A close friend tells me that she always knew she wanted to be a mother, by which she means give birth to and raise children, yet a decade in she still feels that this isn’t the real her, these boys aren’t really hers (this existential angst must necessarily co-exist with doing the laundry and preparing packed lunches). On the other hand, I never particularly yearned for motherhood (and I overheard my own mother, when I was six months pregnant, remarking “Karen was never very maternal.”) And yet I simply could not be the person I am now, and do the most fulfilling work I have ever done, without it.

It seems acceptable for other people to identify me as a mother, but I would prefer them to understand that I am not solely – or even mostly – that, while still being that to my very core. Yet having argued that neither being pregnant, nor being a parent, are intrinsic to motherhood, I think we could explore the possibility of having a term that isn’t gendered, to represent having travelled to this place, should it be necessary to reveal that element of one’s identity.

What of fathers, who now are expected to take on more of the nurturing role traditionally associated with motherhood? Up to 50 weeks of parental leave can now be shared in the UK, so dads can take on the majority of the parenting from very early in a child’s life (and technically a man can “father” a child without even knowing about it, so how can fatherhood then be part of his identity?). Perhaps the word “mother” is only differentiated by being the one who is expected to do the majority of the housework, whether he or she works outside the home or not.

[Cross-posted from Huffington Post]

29 Feb

Maternity Review: Informed Choice and Personalised Care

Yesterday’s publication of the 2016 Maternity Review, glossily titled “Better Births,” gave rise to a mixed response in the press. The 126 page document is a fascinating compilation of statistics and feedback gathered from parents and health professionals, much of which tells an all-too-familiar tale about disconnected care, conflicting advice, families feeling unsupported, and midwives and other health professionals working within the confines of a complex high-pressure environment.

The main recommendations of the report were:

  • Personalised care, with genuine choice, informed by unbiased information;
  • Continuity of carer;
  • Safer care, with professionals working together across boundaries, and a culture of safety, with rapid and transparent investigation of mistakes;
  • Better perinatal mental healthcare;
  • Community hubs so that women can access a range of care from different professionals, including local midwifery practices;
  • Reform of the payment system for maternity services.

Mainstream media were quick to focus on the proposal that women should have a £3000 budget and a choice of birth places and carers. The Times describes this as women being “handed £3000 by the NHS,” a scenario which seems as unlikely as its tone seems dismissive of women’s abilities to think straight if presented with such quantities of money.

In what I will call the “birth press,” the response was more mixed, with much applause for the focus on personalised care, continuity of carer, and genuine informed choice. Doula and founder of Birthrights Rebecca Schiller wrote in The Guardian of her expectation of “the inevitable barrage of scepticism about whether we can handle the weight of responsibility for our own health.”

Jane Merrick in The Independent
immediately obliged:

Do all expectant mothers really want personalised care plans, as proposed by the National Maternity Review? […] Although there is no cost to the individual, placing the burden on mothers, with a price tag attached, is yet more pressure and yet another thing for pregnant women to worry about.

There was a widespread response that, since homebirth is generally cheaper than birth in a hospital, the focus on cost efficiencies would see health professionals encouraging more homebirths, even, according to Kim Thomas, author of Birth Trauma, when this is not clinically appropriate. Many birth workers will be reading this with a raised eyebrow; experience suggests that the interests of the baby always trump the interests of the mother, and it would take a huge change of culture for homebirth to be routinely recommended even when it is clinically appropriate.

Another undercurrent in the response among the birthy people is that the report, and particularly the recommendation of the birth budget, opens up the door to privatisation of maternity care, as well as the use of NHS funds for non-evidenced forms of care. The report itself tells us that parents want to be able to make informed decisions:

Many women expressed frustration over receiving conflicting advice from different healthcare professionals throughout their care. Women and their families told us they need to be able to access
appropriate information to enable them to make genuinely informed decisions about their care and where to give birth. They wanted information to be evidence-based and available to them in a range of
formats, including online.

What this report is calling for is a huge cultural upheaval, as well as a change to the infrastructure of birth in the UK. To be able to offer genuine choice of birth place, we would need more midwife-led birth units and more midwives able to support homebirths. Health professionals across the board would need training to bring about a shared knowledge of the evidence base as well as an understanding of the different perspectives they bring to maternity care. I think perhaps the body of the NHS may be willing, but the purse strings are held too tightly by people who do not have this knowledge or understanding.

Cross-posted from Huffington Post.

10 Jun

Baby Boxes or Tickboxes?

This lovely article was all over twitter on Tuesday Why Finnish Babies Sleep In Boxes:

For 75 years, Finland’s expectant mothers have been given a box by the state. It’s like a starter kit of clothes, sheets and toys that can even be used as a bed. And some say it helped Finland achieve one of the world’s lowest infant mortality rates.

The box contains baby clothes, breastpads, nappies and other essentials for the first few weeks, and comes with a mattress that fits in the bottom so it can be used as a crib. A graphic in the article shows the dramatic drop in the infant mortality rate since the box was introduced in 1938, attributed to, amongst other things, the decreased rate of unsafe bedsharing* and increased rate of breastfeeding that the box has helped bring about. 99% of Finnish mothers initiate breastfeeding, compared with 81% in the UK. While these are quantifiable factors that are known to have positive health outcomes, the underlying message to parents that they and their offspring are valued and important must surely also have some impact on early parenting.

Compare this with the pitiful situation here in the UK. Our equivalent state-sponsored freebies come from an organisation called Bounty, which promises free samples in return for your personal details, and then inundates you with adverts and misinformation in the form of a chatty little booklet called Emma’s Diary. New parents receive a small sample of nappy cream, one nappy, and a sachet of detergent (or something similar). The government pays Bounty £90,000 per year to distribute the freely-available Child Benefit Form in amongst all the adverts. Bounty reps collect new parents’ personal data and sell it on to other advertisers.**

What message does this send, in contrast to the Finnish government’s warm welcome to new babies? That mothers and babies are only worth their economic value. That they should be encouraged to buy the nappies and creams and household products that appear to have government, and by reason of being brought to you at your hospital bedside, NHS-approval. That love for your newborn baby can be measured by your willingness to buy a photograph from a stranger. That parents must hurry back to work in order to keep the economy afloat, and can do so thanks to lowering the standards of nursery care but probably not the cost.

The social impact of the Finnish baby box undoubtedly goes beyond impressive breastfeeding rates to make parents feel cared for:

This felt to me like evidence that someone cared, someone wanted our baby to have a good start in life.

Both giveaways are aimed at improving outcomes by bringing families into contact with health services. It would be interesting to compare the social return on investment in Bounty Packs, taking account of their negative messages about birth and breastfeeding, with the investment in a few articles of baby clothing and a nice blanket.

*That is, sharing a bed in unsafe conditions; not bedsharing per se.
**The petition against Bounty reps on maternity wards is here.

Further Reading
Come for the box, stay for the life saving services
Alice Roberts: Why are Bounty reps allowed on maternity wards?
Profits from pregnancy: how trusted organisations sell out women to commercial interests

15 Mar

Book Review: Birth Matters, by Ina May Gaskin

Ina May’s new book is a manifesta setting out the philosophy of natural birth, and therefore nothing that has not been said by wise women (and men) countless times before. The value of this work is its comprehensive, detailed, and clear presentation of the information, such that surely no rational human could disagree. It is The Politics of Breastfeeding for birth, and it is a scientific celebration of what nature has achieved and what women are capable of.

The first chapters set the subject in its global context, and birth stories are scattered through the text to remind the reader that while these are global, political issues, they have personal, individual impacts.

I have learned about the cultural loss of breastfeeding knowledge, and it makes a sad kind of sense to me to be reading the same description of society’s attitude to birth: the loss of skills among health professionals and the consequent loss of positive birth stories. This cycle will be perpetuated and added to, and will spread beyond the US increasingly rapidly, as we lose touch with and confidence in our own bodies.

Ina May Gaskin discusses the role of feminism in driving an ‘escape’ from pregnancy and motherhood, a push towards equality between men and women instead of a celebration of the important differences between us. Why should power be measured only in masculine terms and defined by the choice NOT to do something? Ina May’s positive, empowering feminism offers a far wider range of choices.

It seemed crazy to me to take on the belief that the human female is the only mammal on earth that is a mistake of nature… it’s our minds that sometimes complicate matters for us. (p.23)

She quotes Simone de Beauvoir describing the pregnant women as inciting fear in children and contempt in young people, ensnared: “life’s passive instrument.” De Beauvoir, the great feminist intellectual, writes as though she believes what men have said for centuries about women’s bodies: that we are disgusting, inefficient, and inferior to men (who cannot, normally, grow or feed babies); and seems unaware that historically speaking, medical men who profit from managing birth have had personal and financial interests in telling women that it is a dangerous and painful process, that requires the presence of a qualified doctor. Again the parallels with the unethical practices of formula manufacturers undermining women’s knowledge of and confidence in breastfeeding are clear.

Some of the practices resulting from this basic assumption of women’s inferiority and ignorance are barbaric, and many persist in 21st Century western healthcare. The book describes a bleak outlook for maternity care and motherhood in a world where politics and economics are everything. Yet the short-termism of the idea that labouring women must be cured or rescued from themselves costs far more in terms of money, life, and quality of life. How can this be an acceptable situation?

I was struck by the anecdote in which a couple kissed to raise oxytocin levels and aid relaxation and the progress of labour. It helped me to think about the way I talk to antenatal groups about the role of oxytocin in breastfeeding. And also of the way the idea of sex to bring on labour has been reduced to the role of prostaglandin, when everything about it promotes skin contact, eye contact, and a feeling of well-being. In this, I find yet another example of the big picture being reduced to one male-orientated detail.

I was aware that birth in the US was highly medicalised, but the details and the implications of that, as clearly laid out by Ina May Gaskin, are horrifying and depressing. At the same time, the positive birth stories are affirming, empowering tales, a contrasting picture of the good that is possible when women are informed and respected.


To order Birth Matters with a 25% discount, just follow the link and use the discount code KH25 at the checkout.