10 Apr

ME time!

There’s no doubt that becoming a mother is a transformational experience. Initially absorbed in your new baby, obsessing over feeding or nappies or sleep, spending more time with new friends who are also new parents, evolving into a family instead of a couple: so many new things, so many changes. Some of us rail against it, fighting to get back to a long-lost ‘normal;’ others let it flow over us, knowing they won’t be small for very long. But all of us are fundamentally changed by the experience, whether we intended that to happen, or not.

One mother’s sense of lost identity is another mother’s sense of growth. We might mourn our freedom, high heels, spontaneous nights out, spare cash, hot cups of tea and the chance to finish a thought. And becoming a mother changes the way you are in your existing roles: you’re a different daughter, once you’re a mother. You’re a different wife or girlfriend. You’re a different sister, and a different friend.

For some people, going back to work renews one’s identity. For me, it brought it home to me how meaningless my work really was – and this despite working in the social compliance industry, which really does do a certain amount of good in the world. But paying to leave my baby with someone who didn’t love him as much as I do never felt right; trekking into Reading on a train with a hundred other miserable faces didn’t fill me with joy; the pressure to achieve miracles in a job that was both too easy and too hard was soul destroying. In the end I had to admit that I didn’t want my old identity back, I wanted to create a new one.

Maternity leave felt like a limbo between one state and the next: not enough time to adjust, and the looming return to work with its tantalising promise of a return to my old, easy life. Except it didn’t give me that, because all the mothering remained to be done outside my working hours, and I was still a different person in all my relationships, except my working relationships where motherhood seemed to count for nothing.

A few weeks after my return to work, I answered an ad in the NCT newsletter to train as a Breastfeeding Counsellor, not realising at the time that this was where my new identity would finally make sense. It’s now eight years since I sent that email, and I can barely recognise my pre-pregnancy self in the me that I am now.

Working in breastfeeding support appeals to my contrary nature (it’s controversial), my social and political conscience (breastfeeding is undervalued – and feminist), and my desire to do something good in the world. I like to be busy and it certainly meets that need. There’s a lot of interesting science stuff to know about. And with the addition of my work as a postnatal doula and other small related roles, I’ve been able to scrape a self-employed living at it, so I no longer have to answer to an employer. Nothing could make me happier.

My training with NCT and my ongoing reflective practice have helped me to develop empathy, listening skills, and a love of working with people instead of spreadsheets and schedules. I feel like a bigger person, a nicer person, and a person with more going on in her world than ever before. My whole life is so varied, and full of people; and for me, life since becoming a mother is glorious technicolour compared with the grey I can remember from before.

Views expressed here are my own, and do not represent the views of NCT.

08 Apr

Book review: The Roar Behind The Silence, edited by Sheena Byrom and Soo Downes

The first impression I had of The Roar Behind The Silence was that it is so densely packed: 50 chapters contributed by midwives, researchers, parents, obstetricians, doulas, antenatal teachers and one eloquent anaesthetist, covering such a huge range of thought: many different perspectives on why kindness, compassion and respect matter in maternity care.

Surely this ought to be a no-brainer. The implication that kindness, compassion and respect matter is right there in the word “care,” but it’s very clear from some of these stories that in our risk-averse culture, mothers are sometimes dehumanised in the baby production system. This is ground that has been covered by many authors, but Roar comes at a time when compassionate care is right in the headlines, a time when it is really important to agree on what this means, and how to make it happen.

The book is divided into three main sections. First, stories and persepctives from maternity care, including Mel Scott’s harrowing stillbirth story, and obstetrician Alison Barrett’s understanding of where the midwife stands from the consultant’s perspective. Next, principles and theories underpinning current practice and possible new ways of working. And finally Making it happen: solutions from around the world – both in terms of global experience, and different approaches to practice. This last section is probably the most useful and informative, setting the bar much higher than a healthy baby as the only valued outcome.

Most of the chapters are short and the book could be read in an ad hoc way; however I found most of the contributions compelling, and read it straight through, making a few notes. I was struck by the prevalence of social media in many of the chapters, as a way to share experience and compassion with colleagues and other interested parties; though it might also be worth acknowledging the downside of potential for kneejerk reactions in such a public space.

I particularly enjoyed the two contributions from anaesthetist Robin Youngson, who perfectly summarises the impact of relationships – good and bad – and the importance of kindness in all aspects of care. Which should, as I said, be a no-brainer.

I’m hoping to talk to co-editor Sheena Byrom for our next episode of Sprogcast, and looking forward to asking her how she chose and organised the contributions.

Disclosure: Mark very kindly sent me a copy of this book!

18 Mar

The value of breastfeeding in pounds, pence, and Brazilian dollars

This morning we are hearing on the news about a study from Brazil that demonstrates an economic value to breastfeeding, evidenced through measuring IQ, educational attainment, and income at the age of 30. It’s a fascinating study with a large cohort, followed up over 30 years, and of course it is causing the usual furore.

Here is the paper in full: Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age and I would recommend actually reading it before you commence your ranting, since I have seen on social media this morning so many straw man arguments standing up against it.

This research set out to examine the claim that “breastfeeding can also increase individual income, and thus contribute to economic productivity,” as previous studies have not demonstrated this. Inevitably detractors will argue that there is more to life than economic productivity, with which I would certainly agree. However the value of a study like this is in providing evidence of a real economic value to breastfeeding, which could sway policy makers into increasing funding for breastfeeding support and education. We already have plenty of evidence that breastfeeding rates would increase if effective support was more widely accessible; surely some fund-holding decision maker somewhere can join the dots?

What this research does not set out to do, is to judge individual women for their feeding decisions. And yet that is the strongest reaction I have seen today: this kind of report makes women feel guilty. Self-appointed and unqualified “expert” Clare Byam-Cook called the research controversial on TV this morning. The controversy is in this kind of response to it, not in the research itself. The research does not say that you are a bad parent if you don’t breastfeed, and it does acknowledge the many other factors in both nature and nurture that contribute to the outcomes measured – but the researchers did control these variables quite thoroughly and still demonstrated a correlation.

As a breastfeeding support worker who scrapes a living and works mostly in a voluntary capacity, I appreciate anything that might influence future policy making, and I rail against society-imposed guilt imposed on individual mothers who make hard decisions in difficult circumstances, when effective support has not been available to them.

13 Feb

“I knew I only wanted her as my doula.”

After a difficult, highly medically intervened birth with my first son, I wanted a different experience and had read that Doulas have a high success rate in low intervention births.

I knew Karen after the birth of my first child as she had supported me with breast feeding issues. We have stayed in contact and I knew I only wanted her as my doula.

Karen was there throughout, offering calm and rational support to me and my partner. She reminded me that I didn’t want an epidural and timed and monitored all of my contractions as I never made it to the delivery suite I was not really monitored by NHS medical staff. I think if Karen hadn’t been there, there would have been more supervision and intervention by the ‘professionals’

Immediately after giving birth, Karen helped to get my baby onto my breast, but then she stepped back and let me and my partner enjoy our first few moments with our new baby.
Karen seems to have a sixth sense about when we needed her.

I found my labour to be a much calmer experience where I genuinely felt in control.

Karen is one of the calmest people I have ever met which is why I wanted her at the birth of my second child, She is also an experienced post natal doula and breast feeding counsellor so I knew she could meet a variety of mine and my families needs.
She has a professional but warm approach and I felt completely comfortable around her from the first day I met her. She has a very gentle approach to children and we share many values and beliefs around families which I think helps, but I also know she is not judgemental in any way.

– Helen, December 2014

12 Feb

Book review: Guilt-Free Bottle Feeding, by Madeleine Morris

The stated purpose of the book Guilt-Free Bottle Feeding is to debunk the myth that mothers should feel guilty if they do not breastfeed, and to provide objective, evidence-based information about bottle feeding and formula. It meets this second aim admirably, with clear and detailed sections on different formulas and tried and tested techniques. This final 45 pages of the book would be an extremely useful resource particularly for Breastfeeding Counsellors who are encountering an increasing number of questions and requests for support around formula.

The bulk of the book, however, features an army of straw men, and is written in a hectoring, defensive tone, with many statements about “lactivists” which border on being offensive. For an example of all of the above, see page 137 where the zealous lactivists deliberately manipulate and prey upon mothers’ emotions; page 138 where breastfeeding advocates’ real agenda is “to make formula feeding parents feel like shit;” and the jaw-dropping claim on page 88 that there is money to be made from breastfeeding support.

Morris’ writing is very much embedded in her personal experience of breastfeeding and her feelings about it, supported by her friend Dr Sasha Howard who also shares her own experience of breastfeeding as well as that of supporting families as a paediatrician. They exhort a change in message on feeding choices, asking for more realistic, nuanced antenatal breastfeeding education, to include more detail on formula feeding; and more compassion for mothers who do not breastfeed. If this sounds frustratingly familiar, that’s because this is very much in line with NCT’s current Infant Feeding Message Framework.

Unfortunately the way Morris presents this itself lacks nuance and understanding of how breastfeeding support works. She is deeply opposed to any language of risk, positing that rather than enabling informed choice, this language comes across as bullying and guilt-inducing. Reading this book made me doubt the validity of my own perspective on breastfeeding; could it really be true that the media is completely biased towards breastfeeding (p.90-96), that no celebrity ever makes a negative statement about her own breastfeeding experience (9.108), and that breastfeeding “advocates” wilfully misrepresent the research on breastmilk in order to pressure mothers (p.75)? Could my bias really be so deeply embedded that I don’t see this at all? Then I would definitely have to identify myself with the lactivists.

This book provides a great deal of material upon which to reflect. Morris’ sadness and anger about her own experience of breastfeeding and of not breastfeeding undermine her claims of objectivity. Much of this anger is directed towards breastfeeding supporters. She has had no difficulty in finding case studies: 15 of them, only three of which are about women who had no intention of breastfeeding. The others are women who were – in her words – “forced to bottle-feed.” (p.47). This seems a strong enough argument for not destroying women’s confidence in the people who could help them.

Where ‘Guilt-Free Bottle Feeding’ comes into its own is in the genuinely objective and useful practical section, but the preceding 150 pages are a tough read, and tell us nothing that we do not already know about perceptions of breastfeeding support.

Disclosure: I was given a free review copy of this book.
Views expressed here are my own, and do not represent the views of NCT.

29 Dec

Tongue Tie: the other side of the divide

Recently I read a blog post about one mother’s experience with her baby’s tongue tie. It was a familiar story: the tongue tie was not picked up for several weeks, during which time breastfeeding was painful and the baby fed ineffectively. By the time the tongue tie was divided, the mother’s milk supply was severely compromised because of that ineffective feeding, and shortly afterwards, she took the decision to stop breastfeeding completely. She feels angry and let down by the health professionals who did not diagnose the tongue tie sooner, by the NCT for not telling her about tongue tie in the antenatal breastfeeding session, and by society for insisting that breast is best, and making her feel like a failure.

I have heard this story so many times, and after reading it I spent quite a lot of time reflecting on why I find it so painful to read, and also on just why it is such a common tale.

What is tongue tie?
Definitions of tongue tie vary from source to source, but all seem to agree on the basics:

Tongue-tie is a problem that occurs in babies who have a tight piece of skin between the underside of their tongue and the floor of their mouth. – NHS Choices.

UNICEF adds that this tight piece of skin stops:

the tip of the tongue from protruding beyond the lower gum. It varies in degree, from a mild form in which the tongue is bound only by a thin mucous membrane to a severe form in which the tongue is completely fused to the floor of the mouth.

Note the varying degree. When a tongue is bound by a thin mucuous membrane, this is usually visible even to the inexperienced practitioner, as you can see it at the tip of the tongue, and it often causes the tip of the tongue to be heart-shaped rather than pointed. “Completely fused” would probably also be obvious. However, there are all the degrees in between these two, which are much harder to spot, harder to diagnose, and harder to resolve. Most practitioners agree that an assessment of the function of the tongue is actually far more useful than making a diagnosis on the basis of what you can see in the baby’s mouth. There is a good tool for assessing both; however I feel that this still misses out a hugely important factor: the mother’s experience.

Suspect and Signpost
As a Breastfeeding Counsellor, my remit with regard to tongue tie is to suspect, and to signpost. I’m not clinically trained, nor am I insured to feel about with my fingers under a baby’s tongue. I do have a number of years’ experience in supporting breastfeeding mothers, and it would appear that there is absolutely no situation where it’s completely obvious what to do. In the last few years I have seen a tongue tie so severe that a Lactation Consultant later said that the baby would not have been able to bottle feed, never mind breastfeed; this was not picked up by the hospital midwives or paediatrician. I have seen clumpy little tongues on babies who pile on weight regardless, owing to their mothers’ robust milk supplies. I have seen mouths with every appearance of a a tongue tie, which on referral to the NHS clinic have come back with the diagnosis ruled out. I have witnessed a midwife dismiss tongue tie as “definitely not,” and gone on to support that mother to finally have it divided six weeks later. I have seen babies whose tongues look completely normal, but on listening to the mother’s story I hear familiar warning bells; and having tried everything we can think of to improve positioning, there is no improvement. I can suspect tongue tie all I want, but if the clinicians to whom I signpost parents disagree, then mothers are left with very little they feel able to do.

So if tongue ties are so variable in both appearance and impact on function, what sort of clinical training would grant me the apparently magical ability to diagnose consistently and reliably, and send mothers and babies to get the treatment they need? So while I am, in theory, supportive of NCT’s ongoing campaign for better services for babies with tongue tie, I have some reservations about how this might be done. In fact, as usual, I feel that it would be helpful to campaign for better services to support parents of newborn babies, full stop.

In conversation with one of the lead breastfeeding midwives at a local hospital, she expressed irritation at the number of referrals she gets where tongue tie ends up being ruled out. In accordance with NICE guidelines, she would prefer conservative management of tongue tie, and better help with positioning and attachment for all mothers. It seemed that she felt the people providing breastfeeding support in the community should be doing a better job. Apparently this is a widely-held view among health professionals and parents alike, so here I’d like to point out that most of our work is done on a voluntary basis, nor do we get paid for the time we spend doing training, and in many cases we pay for our own training.

As one of those who works in the community providing breastfeeding support, I do have the advantage of being able to spend time listening to a mother and observing her baby feed. If I suspect a tongue tie then I will always explain this to the mother and inform her of her options. I don’t make the decisions for them, and I do explore positioning and attachment, and other things that might improve breastfeeding for both of them. The options I inform her of will always include a referral to someone who can rule tongue tie in or out, but frankly anyone who is 100% certain that they can rule a tongue tie in or out at a glance needs supervision.

The NHS is not in a position to grant every midwife the specialist skill of identifying tongue ties, and the experience to do so, overnight. The voluntary organisations even less so. This is simply impossible, never mind the cost, the fact that tongue tie division is an invasive procedure, and – I’m afraid – the lack of clinical evidence to support it. Here is the NICE guideline on that:

Current evidence suggests that there are no major safety concerns about division of ankyloglossia (tongue-tie) and limited evidence suggests that this procedure can improve breastfeeding. This evidence is adequate to support the use of the procedure provided that normal arrangements are in place for consent, audit and clinical governance.

Hindsight
Once I fractured my wrist. Initial x-rays showed no fracture, but six weeks later as it had healed, the x-ray clearly showed where the fractured bones were knitting together. Mothers who realise later on that their babies have or had a tongue tie can look back and understand why they had such difficulty breastfeeding, and this can only feel bitterly disappointing, on the basis that if it had been diagnosed and treated, everything would have been fine. In fact not all tongue tie divisions are successful; some regrow and some are just not completely divided. Many babies seem able to breastfeed despite a tongue tie; and many retrospective diagnoses are probably just plain wrong. This brings us back to increasing support for parents, training midwives not just in identifying tongue tie but in effective all-round breastfeeding support, and supporting the voluntary breastfeeding organisations to do more.

Because it’s true that health professionals and parents may focus on the suspected tongue tie to the exclusion of any other breastfeeding issues, particularly improving positioning and attachment, which could sort things out much quicker and – if it really isn’t a tongue tie – more effectively.

I can completely understand the anger that mothers feel when their breastfeeding experience has been disappointing or unhappy, and I understand why those mothers may feel that their experience is universal and if only the NHS and breastfeeding supporters could learn from it, we’d all do a better job. And I agree that we need to keep on listening to mothers and not focus solely on diagnostic tools. But I don’t think tongue tie is something that either we just don’t understand, or want to keep secret. It’s simply more complicated than 1. spot tongue tie; 2. divide tongue tie; 3. all is well.

Views expressed here are my own, and do not represent the views of NCT.

24 Nov

Book Review: Sweet Sleep, from La Leche League

Sweet Sleep is a La Leche League publication, written by some of the well-known names in the LLL world: Diane Wiessinger, Diana West, Linda J. Smith and Teresa Pitman; and as such it sets out a very definitely baby-centred philosophical position, as you might expect. It very nearly does manage to achieve a balanced tone with regard to the fact that not all families breastfeed, and even includes a chapter on how to cope if you don’t have this powerful parenting tool available to you (adoptive families, for instance), but its subtitle clearly states “for the Breastfeeding Family” and this is where its real strength lies.

There is a wealth of advice available online, from health professionals, and among families and friends, for parents who want techniques to “train” their babies to sleep. Sweet Sleep fills a gap for the parents who want to work within their babies’ normal development, with gentle nudges from stage to stage, but allowing for kind and responsive parenting.

Sweet Sleep is packed with practical suggestions, and sensibly begins with a chapter full of immediate ideas for getting more sleep tonight. It focuses straight away on the Safe Sleep Seven, which are rules for emergency bedsharing. Given that statistics show unplanned bedsharing to be far riskier than planned bedsharing, helping parents to plan for it is a really good place to start.

It goes on to explain normal sleep, drawing on anthropology, biology, and worldwide cultural practices. This is followed by safety information, gentle nudges for different ages and stages, and suggestions for different scenarios such as premature babies, twins and so on. The chapter on SIDS and suffocation is comprehensive and well-explained; and finally the book offers suggestions for talking to supportive and non-supportive people about an attachment parenting approach to coping with nights.

This book is well-referenced throughout, and illustrated with quotes from the authors’ own stories and from other families. Once too often I found myself frustrated that the authors touch on a point and promise to explain it more in a later chapter, making me dip about in the book rather than reading it through as I wanted to. I was not particularly surprised that the section on Getting Help/Giving Help only mentions La Leche League, when there are quite a number of other organisations, including NCT, who could also support parents in these situations.

On the whole I found this book useful both in terms of practical help for parents of co-sleeping/breastfeeding babies, and ways of thinking/talking about risk and responsiveness, which I find a lot of new parents and parents-to-be worry about. It’s good to have a book that supports parents to follow their instincts and find their own rhythms.

DISCLOSURE: I was sent a free review copy of this book by Pinter and Martin Publishers. To order your own copy with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

20 Nov

Swaddling your baby

Swaddling is surprisingly controversial. Many parents find that it helps their baby to settle, particularly if they have a strong moro reflex that disturbs their rest, but there is some research suggesting that swaddling might be problematic for a baby’s hip development, and could increase the risk of cot death.

NCT provides a how-to-swaddle video, and some further guidelines on doing it safely are offered by ISIS.

If you are going to swaddle, the Lullaby Trust recommends the following:

  • use thin materials
  • do not swaddle above the shoulders
  • never put a swaddled baby to sleep on their front
  • do not swaddle too tight
  • check the baby’s temperature to ensure they do not get too hot.

Views expressed here are my own, and do not represent the views of NCT.