13 Jun

Mommy Wars Much?

Yesterday the Royal College of Midwives released a new position statement on infant feeding. It includes the stunning new idea that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected.’

Inevitably there is a two-pronged kneejerk reaction to this. The Daily Mail and all radio talk shows trumpet an end to ‘Breastfeeding Tyranny,’ which is that thing where anyone remotely connected with supporting breastfeeding mothers is cast as the tyrant (or other even less savoury words); and parents who have had a difficult experience of breastfeeding complain about a) pressure from midwives, and b) pressure from everyone else.

Meanwhile the above-mentioned tyrants divide themselves into separate camps, those who criticise NCT and those who are NCT (and some have a foot in both camps). In the first camp, we have those who criticise NCT for not covering formula and bottlefeeding in antenatal sessions [Spoiler: we do! Have a look at our Infant Feeding Message Framework, which has been revised this year, but nothing new on formula in there, we’ve been covering it for years]; and those who criticise NCT for not cheerleading about breastfeeding enough (usually members of other breastfeeding charities who exempt the NCT from their non-judgemental approach).

As usual, I’m not here to speak for NCT, despite being proud to have been an NCT breastfeeding counsellor for a decade. However I do want to congratulate everyone responding to this new position statement on perpetuating the divisions in infant feeding. Nice one.

How about instead of the kneejerk reaction, we take some time to reflect on the context in which this statement and the responses to it occur. You really don’t have to look very far for reasons why women feel unsupported, whatever feeding decisions they make. We know very well that the majority of women in the UK see a number of different and busy midwives during pregnancy, and still get asked whether they plan to breastfeed or bottlefeed, without the time it would take to have a nuanced and informative discussion about this. Just asking that question frames it as an either/or choice, never mind the evidence that decision making about infant feeding is so much more intricate than that. The path women take is influenced by their family history and social context, by adverts that tell them their nipples will hurt and news stories that tell them they’ll be thrown out of Sports Direct. By every person who ever tells them not to beat themselves up if they can’t do it.

At birth, pressure does come from midwives who encourage early breastfeeding in the knowledge that the option will disappear for that mother if they don’t try to protect it; what a difficult position for those midwives to be in, within the time constraints of their workload. What would be a better way to address this at such a crucial time? There is no easy answer, because this demands cultural change and an end to society operating on the assumption that breastfeeding is difficult and women will be judged for not doing it. Locally, the well-trained volunteer breastfeeding support has been withdrawn from the wards and now also the children’s centres, because there is no longer funding to run the project, adding to the burden on midwives to handle this with sensitivity, kindness and accurate information. Within the time constraints of their workload.

And then there is the rest of the breastfeeding journey, and I know from encounters with women of all ages who tell me, when they find out what I do for a living, stories that some of them have carried for decades. Women feel guilty when they struggle to breastfeed and when they choose not to continue, and they feel angry when they don’t have the knowledge or the support to make decisions they feel happy with; and these stories matter to them. NCT is the best-known of a number of different charities that support breastfeeding mothers, and so of course it is the one that wears the sash of shame about judging and putting pressure on women. NCT is also the one that does most of the antenatal education, including on breastfeeding and on formula and bottlefeeding, and so of course is perceived as a source of guilt and judgement largely because of the impossibility of adequately preparing parents for the realities of life with a new baby. “All my friends found breastfeeding really hard, I’m not going to beat myself up if I can’t do it,” they tell me before their babies are born. And afterwards? “Why didn’t you tell me it would be so hard?” What words, what activities, what level of reflection will square this impossible circle, without changing the entire context?

And that’s why I’m so frustrated, this morning, with all the news and social media that does nothing but reinforce the assumptions and the cultural context within which breastfeeding can be hard, but breastfeeding support can be harder.

03 Jun

Book Review: Inducing Labour: Making Informed Decisions, by Dr Sara Wickham

Sara Wickham’s new book Inducing Labour: Making Informed Decisions aims to explain the process of induction to parents and to professionals. It very clearly covers the how and why, and comprehensively goes into the risks and benefits of the most commonly encountered scenarios. Wickham argues strongly for women’s bodily autonomy and individualised care, and the whole book is set firmly within the evidence base. Her discussion of the evidence was for me (and unsurprisingly!) the strongest point of an all-round excellent book, and I was prompted to reflect on her point that we all interpret the evidence according to our existing biases.

This is a book written for women, addressing “you” the pregnant mother, but without holding back any technical points or difficult statistics. It is also an important read for antenatal teachers, midwives, and anyone supporting women to make decisions about their care. There are, for example, some useful points that a woman can use for agreeing a “due date” with her midwife or consultant, and some questions that are helpful to ask in order to ensure care is personalised rather than simply following a protocol. Above all, there is really clear information about the impact of induction in a number of different situations, and a good breakdown of statistics for example on the risk of stillbirth in older mothers, and how likely it is that earlier induction would make much difference to these stats (answer: not very likely).

In fact the message that comes across most clearly is to trust women and to trust women’s bodies. The evidence that induction routinely improves outcomes is simply not there, and anyone needing to argue that point with a clinician would find this book a really useful resource. In a culture where the baby’s safety is prioritised over everything, it is good to read a practical, straightforward discussion of why intervention is often not the best way to do no harm.

I was sent a free review copy of Inducing Labour. You can get more information here, and your own copy from here.

22 Nov

Book Review: Truly Happy Baby, by Holly Willoughby

Truly Happy Baby – Holly Willoughby

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

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

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

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

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

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

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

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

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

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

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

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

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

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

21 Jun

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

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

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

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

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

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

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

09 Jun

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

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

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

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

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

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.

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.

25 Oct

Book Review: Why Doulas Matter, by Maddie McMahon

I love that near the beginning of Why Doulas Matter, MM points out that “on one level, doulas do not matter.” The invisible but steadfast presence of a doula, and how much difference she can make to the experience of birth, is the most important lesson this book can teach you.

This is a book about what doulas do and how they do it, and it also tells you what they are thinking about while they’re doing it. Maddie’s voice comes through very clearly, and unlike other books in the Why It Matters series, this one is far more personal than political. One exception to this is her mini-rant about the politics of breastfeeding, where the most passionate passion of a very passionate woman is clearly revealed.

Why Doulas Matter contains much useful information about birth and breastfeeding, woven into chapters about labour, meeting your baby, breastfeeding, and the postnatal period. One thing I felt was missing was a little more history of women supporting women during childbirth, setting the question of why doulas matter in the context of the 21st Century western world.

This book would be particularly useful for people thinking about what sort of support they might need during and after birth, whether or not that support comes from a doula. It would also be useful for both new and experienced doulas who want to reflect on their role. It answers all the questions you might have about doulas, and much more.

[Disclaimer: I was sent a free review copy of Why Doulas Matter by the publishers Pinter & Martin. You can get a copy here, with 10% discount using the offer code SPROGCAST at the checkout].

21 Oct

Book Review: Why Human Rights In Childbirth Matter, by Rebecca Schiller

This is a small book that should have a massive impact. Doula and human rights campaigner Rebecca Schiller is a great advocate for this important subject, bringing to it eloquence, experience, and a deep understanding of the issues faced by women in childbirth. She is almost uniquely positioned to present the case for human rights in childbirth.

The book is presented in two sections, the smaller second section being a clear and useful guide to women’s rights in birth, with a FAQ approach and a comprehensive set of information.

The bulk of the book examines the matter in more detail, starting with an exploration of the context in which women give birth, both in developed and developing parts of the world. She provides a very good explanation of the Human Rights Act and how it applies to birth, with several compelling examples. This is the first book where I have ever read every one of the real life quotations.

I found that the chapter on Feminisms of Birth particularly resonated. Schiller’s discussion of the political dilemma of campaigning to improve women’s experience, without polarising people into different camps, was enlightening and helpful. She concludes, of course, that the ultimate aim must be respectful, compassionate and individualised care based on the best available evidence, but trusting every woman to make decisions about what happens to her own body.

If you have ever pondered the real meaning of consent, or witnessed a non-consented procedure, or been asked to consent to something you did not fully understand, this book will be meaningful to you. Absolutely everyone involved in birth needs to be aware of the contents of this book, above all the women heading into the system, whatever that system is in their part of the world. Human rights in childbirth really do matter, and Rebecca Schiller is a hero in her tireless advocacy.

[Disclaimer: The publisher Pinter & Martin sent me a free review copy of Human Rights In Childbirth. You can get a copy here, with 10% discount using the code SPROGCAST at the checkout.]