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.]

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.

22 Apr

Modern Living and Mucky Kids

My reading material lately has been exhorting me to switch off my screens, talk to my child, and get out into the garden a bit more, to get my hands muddy. According to both Mama, and The Microbiome Effect, we are becoming physiologically and psychologically damaged by modern life.

According to Antonella Gambotto-Burke, mothers are damaging their children by existing in a society that doesn’t value motherhood. She longs for a time when children were healthier and happier, but doesn’t pinpoint exactly when that might have been. Recalling my own childhood in the 1970s and 80s, it’s true that I spent more time outdoors, but that might be because we lived in a Cumbrian village, not a Berkshire commuter town. I can also remember my mother working full time as well as running the home, and my father being far less hands-on and involved than my partner is in the home and in co-parenting our child. AGB claims that modern fathers are vanishing from their children’s lives, and an epidemic of divorce is ripping society apart. Again, my parents’ divorce when I was 15 was tough at the time, but the real tragedy would have been the misery of them staying together, especially if they had stayed together for the sake of my brother and me. I am certain that prioritising the children does not necessarily mean preserving the marriage.

Call me a hard-nosed bitch, but I can’t think of a time when children have been a higher priority both socially and within families. Look at the lengths some parents go to, to acquire them. We also have a wealth of knowledge about attachment and brain development, as well as a supportive network of health and social care professionals to help us use this knowledge. I’m not saying it’s adequate; the rate of closure of Children’s Centres is appalling; and there are countering social and financial pressures that keep parents at work more than most of them would probably like. But it is a lot more than my mum had. I wouldn’t say that society is failing mothers more now than at any time in the past; I would say that motherhood has never been a valued role, but to romanticise earlier times seems unhelpful.

Meanwhile in The Microbiome, Toni Harman tells me that now she knows what she does about the human microbiome, she aims to live a microbial life, getting a dog and doing the gardening, and eschewing the anti-bacterial in all its forms, because of the potential long-term effects on our health of a too-clean lifestyle. I discussed this with her for episode 13 of Sprogcast, and again it seems like modern technology is damaging babies, in this case by not seeding the gut with good bacteria at birth. Too many caesarean births and not enough breastfeeding means that the human race is gradually losing its ability to protect itself from disease. Scientists supporting this viewpoint make some strong theoretical arguments, but as yet the evidence simply does not exist. My fear is that a focus on speculation about damage to the microbiome distracts from the big issues around birth and breastfeeding, where we do have plenty of evidence about long term health consequences.

Having said that these books challenged me, I did find some points to agree with, and have tried to cut down on screen time at home. My partner and child indulge me but are less than thrilled about no-screen Sundays. The kid has disappeared off to play outside; I really must get him digitally tagged in some way…

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.

18 Jan

The Long Run

Our local NCT branches (Wokingham and Reading) are raising money to pay for training a group of Breastfeeding Peer Supporters. These are mothers trained in listening skills and basic breastfeeding knowledge, who can then support other new mothers at drop-in groups and clinics. It costs quite a lot but the return to the local community is great.

I’ve been convinced to have a go at running the Reading Half Marathon, to raise some money towards it. Having never run further than 7.5 miles, the thought is pretty scary. I’m collecting motivation points here: JustGiving Page

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?]

23 Jun

Baby Shock

I meet a lot of new parents, and have come to recognise the glazed stare of someone at the height of sleep deprivation, and anxiety, coming to terms with the reality of life with a newborn baby.

Of course my sample is skewed by the fact that my job entails being there to help when there are difficulties. Many new parents have strong support networks, realistic expectations, and enough confidence in their own instincts, to enjoy these first weeks and sail off into the parenthood sunset.

Feedback from antenatal sessions tells me that parents-to-be sometimes feel they would like more preparation for parenthood. They request practical things: nappy changing always evaluates well but clients would like antenatal teachers to tell them how to get their babies to sleep. Everyone tells you about the sleepless nights to come, usually with a wry smile; but nobody tells you what it feels like. It isn’t like working shifts or travelling across timezones, because of the emotional and hormonal whirlwind going on around you, the physical recovery from birth, and the realisation of immense, relentless responsibility. You can’t sleep this off, and anyway, opportunities to do so are rare.

New parenthood is such an unpredictable and chaotic time, but gradually instincts emerge and you start building knowledge and confidence in yourself. You get to know your baby, and perhaps start to see why we can’t tell you, in advance, how to manage this little person. Your family and your baby are unique, and things are going to shape up in their own way. Only a tiny percentage of babies are “in a routine” by six months of age, but more than half are sleeping through the night. At a recent Introducing Solids session, mothers of four and five month old babies talked about how their babies had slipped into natural rhythms, whether they as parents had tried to manage this, or not.

Life with a new baby might be a big unknown, but you can prepare for it by gathering around you the people you trust to give you care and support, by not expecting too much in terms of “normal” life, and preparing mentally for meeting and getting to know your unique little one when he or she arrives.

25 Mar

Breastfeeding and going back to work

In that chaotic blur of cuddles and tears that is the first few weeks with your baby, when you’re taking it one feed at a time, it’s possible that you might miss your working day. The luxury of time to sit at your desk and think, drink a cup of tea while it’s still hot, chat with other adults about matters non-baby, oh those were the days!

And as your baby grows and you settle into your new roles, perhaps the thought of work recedes for a little while; but towards the end of your maternity leave, you have to start making decisions. Whether you will go back or not; would you need to apply to change your hours; what sort of childcare you might need… and if you’re still breastfeeding, how on earth are you going to manage that?

During pregnancy and in the early weeks of motherhood, my assumption was that I would stop breastfeeding at six months, ready for when I returned to work at seven months. I interviewed several childminders and chose the one I was most comfortable with, and her assumption was also that I would be providing formula for him during the day. I arranged the date I would start back at work; and, all this in place, proceeded to wean from the breast.

Only I had failed, yet again, to consider what my son would agree to. Not only did the little terror categorically refuse to eat food of any sort, lips sealed head turned and expressing RAGE with every part of his being; but he was also absolutely not prepared to countenance the nasty bottle I kept trying to tempt him with. It was distressing for both of us. It was distressing for my partner, when he tried to give a bottle. It was a disaster.

Dani says of her daughter,

it never occured to me that she wouldn’t be ok when I returned back to work when she was a year old … it resulted in us both getting very upset & her wanting to feed even more, probably as reassurance more than anything, but I knew she had to be ok to go without when the option wasn’t there & I didn’t know how to prepare her for that without stopping the majority of feeds in the day.

Both Dani and I eventually made the decision not to wean, but to follow our babies’ lead and carry on breastfeeding when we returned to work. In practical terms, by six months in my case and a year in Dani’s, our milk supplies would have been robust enough to cope with a more chaotic feeding pattern, so for example I could feed my son on my days off and at night, and needed to express for the first few weeks back at work.

Ann tells what it was like to arrange to express at work:

My company bought a reclining garden chair for me to sit in, and put it in the shower room (which isn’t as bad as it sounds), it was actually quite pleasant …Except expressing takes ages. I was hand expressing. Every day. For two hours at the beginning to get the 400mls of milk A needed every day.

But two hours was difficult to fit in when I was working on two projects, and I was leaking if I didn’t manage to get away at the right times to express, so I had constantly sore boobs.

Then [I had to work] on site, and the medical room only had a mag lock, and you couldn’t lock it from the inside once you were in, and anyone who had a pass could walk in. And it was also used as the Muslim prayer room. And yes, I was walked in on. Twice.

My bottles of expressed milk in the office fridge caused some raised eyebrows. Ann sensibly recommends putting them in an opaque make up bag. It’s useful to know that expressed milk will keep at room temperature for a few hours, and longer in a cool bag, so you can take it home, refrigerate it, and send it with your baby the next day. If your baby will drink it, which mine did not.

My childminder was frankly horrified, and found it very hard to look after a baby who did not eat a thing from drop-off to pick-up. With my head full of going back to work, I feel I took my eye off the ball and failed to see that for my baby, it wasn’t just the milk he was going to miss, it was me.

In a similar situation, Dani actually made the decision to stop working altogether:

I handed my notice in at work, using the remainder of my annual leave I’d accrued on maternity leave to cover my notice period & once I took the pressure off to reduce her feeds, we came out of a 2 month long fog. I felt happier, L seemed happier & I accepted that was how it was going to be. What I didn’t count on was a childminder who wasn’t to be beaten & she wanted to give L another week.

With a few changes, L settled in and Dani did go back to work. She says I think that letting her do it at her own rate was what helped her eventually be ok without. There is hope for those mummies with boobaholic babies, L shows it can be done!

But babies develop and adjust to change at different rates, and Ann, no longer expressing but still feeding all night, feels that they are not there yet:

I want to continue, but at 17.5 months, I’m desperately tired, and have been horribly ill, and I’m honestly wondering whether it’s worth continuing or not.

None of these decisions are easy, and all come with a payload of guilt, one way or another. If you’re in the tiny percentage of mothers in the UK still breastfeeding beyond six months, it’s hard to access relevant support. It may feel like your peers have all stopped feeding long ago, or that the groups you’ve been going to are mainly focused on feeding newborns; in any case once you’re back at work you no longer have access to the drop-in groups and the whole thing can be very isolating. I retreated very much into online support from various forums where being a ‘toddler-feeding weirdo’ was a point of pride; now I meet such people all the time through my work, and make an effort to put them in touch with each other, so the peer support can continue. If you find yourself reading this and wondering where the help is coming from, or asking yourself who is going to understand, please get in touch, or call one of the breastfeeding helplines, where most of the counsellors answering calls will be or have been, like you, in that tiny percentage.

NCT Breastfeeding Line 0300 33 00 700 7 days a week 8am–midnight

Ann writes at beta parent and is @pixeldiva on twitter.
Dani is @boo_bowglin on twitter.