20 Jun

Book Review: The Hormone of Closeness, by Kerstin Uvnas Moberg

The Hormone of Closeness: The role of oxytocin in relationships, is the second book I’ve read by Kerstin Uvnas Moberg on the subject of oxytocin, the hormone involved in childbirth, bonding and so much more.

Moberg posits an explanation of attachment theory wherein oxytocin underpins the child’s sense of security through enhanced wellbeing, increased calm, and a sense of satisfaction. She terms the innate and evolutionarily necessary need for closeness and contact with others as “skin hunger,” to equate it with hunger for food. This casts touch and its effects in a useful new light, showing how breastfeeding is about so much more than the transfer of milk, for the mother and the baby.

While much of the evidence in the book is drawn from lab studies on rats, her arguments are logical and compelling. Lay readers might skip the scientific stuff about what goes on in the brain, and read instead the fascinating description of the mother-baby relationship in the first place, which is then drawn into the wider context of our social interactions, stress levels, and the way we live.

Looking forward to the implications of the development of synthetic oxytocin, Moberg acknowledges that artificially increasing oxytocin levels, thereby increasing the tendency to trust, might not always be a good thing, particularly in a setting where we would not naturally be trusting. Evidently it would be better for the individual, and for society as a whole, to find natural ways to increase the world’s oxytocin levels. To illustrate this, she looks at the doula phenomenon, where a trusted woman present at birth can have a positive outcome, by allowing the birthing mother to tune into her body and allow levels of oxytocin to rise, facilitating labour and bonding with the new baby.

She finishes by looking at the possible consequences of our increasingly separate lives, and with a call on behalf of future generations to consider how to bring back social closeness, that “all of us on earth could live in peace and harmony with one another.” [p157]. This is an enlightening and affirming read.

***

To order The Hormone of Closeness with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

[Disclosure: review copy provided by publisher]

14 Jun

Breastfeeding in front of other people

Emma is a mum of two girls and juggles motherhood with running two small businesses with her husband. She has kindly shared some of her thoughts about breastfeeding in public.

Breastfeeding in public isn’t always easy. I’ve breastfed both of my daughters. I breastfed my eldest until she was 27 months and I’m still breastfeeding my youngest at 22 months. Up to around 5 months both times, I had letdown problems – mainly because of oversupply. I produced a lot of milk and would find I would spray, leak or soak a muslin or several breastpads with the milk I was producing. Breastfeeding discretely wasn’t always easy. Once my girls got to about 3-4 months they would come off my breast mid feed and look around, leaving me spraying everywhere. I preferred to use quiet breastfeeding rooms if I could to minimise the distractions. With my second baby, I found I had to lie down to stop the milk flowing so quickly so feeding in public was very difficult as you can’t exactly lie down in the middle of a cafe! Once I was trying to feed her in a very noisy, busy restaurant in the middle of Cardiff (Jamie Oliver’s actually). Our table was in the middle of the restaurant and there was a draft blowing on us and people kept walking past. She wasn’t really old enough for solids yet so her only source of food was milk. I ended up going upstairs and sitting on a stool in a quiet corridor outside the disabled toilet (which was occupied). I felt like a total idiot when a man came out of the toilet with his son. It was that or sit on the toilet in the ladies – not very pleasant!

I stopped breastfeeding in public both times around 9/10 months in, once most of the daytime feeds had been replaced by solids and restricted feeding to quiet moments at home or in a friend or family member’s home. This is partly because both of my daughters were quite inquisitive and would detach from my breast and have a look around. It was also because they were more likely to help themselves and the position they were feeding in was more toddler like. This made me feel uncomfortable.

I have mostly found cafes, restaurants and so on to be quite accommodating if you ask if there’s somewhere quiet you can go. I’ve not always felt comfortable asking and sometimes others with me have felt more awkward than me around me breastfeeding.

Things that annoy me:
Signs for feeding that imply bottle feeding like a bottle icon – as seen in lots of motorway service stations.
Places that don’t have a breastfeeding/bottle feeding room.
Breastfeeding/bottle feeding rooms (I don’t mind being mixed together) that smell of poo and aren’t clean.
Separate rooms for feeding choice – seems a bit weird to do that but perhaps it’s because people other than mothers can bottle feed and breastfeeding mothers can feel uncomfortable?
The implication that because your baby is over 6 months you should move over to a bottle. The adverts on tv for follow on milk don’t help this. I know many do choose to and have to if they are going back to work but for those of us making the choice to carry on, it makes it harder.

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 ÂŁ90,000 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
http://margaretmccartney.com

06 Jun

Precious Vessel

The media week started well, with the heartwarming story about Finnish baby boxes, which I’ll write about later. And then it all went downhill with the release of an amazing report from The Royal College of Obstetricians and Gynaecologists on Chemical exposures during pregnancy.

The RCOG “encourages the study and advancement of the science and practice of obstetrics and gynaecology.” On this occasion, they have taken this to an extreme, by advising women to avoid any possible exposure to chemicals, which may or may not have a harmful effect on their developing baby. While they do explicitly state that none of these harmful effects are proven, this is not how it comes across in the media. Dr Michelle Bellingham, co-author of the report, goes a step further on Radio 4 by asking what harm it does to follow this advice, to err on the side of caution.

So what harm does it do, to tell women not to use cleaning products, shower gel, or make up; not to buy new furniture (presumably including cots and car seats); not to eat any processed or packaged food? Astonishingly, this is presented as “practical” advice. The message it sends is that women themselves are of little importance compared with the package they are carrying. Our job is to breed, and we had better do it well, and if this means no deodorant for nine months, suck it up. In a world where we are made to feel uncomfortable using our breasts for their original purpose and we are expected to glow throughout pregnancy; we are now expected not to wash.

And as the report itself states, there is little or no evidence that any of these items actually do any harm, so this controlling advice is utterly spurious, and the idea that it is supposed to be in any way helpful to women is disingenuous.

Meanwhile any useful evidence-based guidelines are more likely to be ignored by women overwhelmed with conflicting and impractical instructions. On the one hand: good, we are grown-ups, we can make up our own minds. On the other hand, this is a real fail for those of us trying to provide evidence-based support during pregnancy and early parenthood.

Further Reading
The NHS’ excellent Behind The Headlines series takes the report apart here.
Sense About Science dismisses the usefulness of the report and the media coverage here.
Fran Yeoman responds as a new mother, in The Independent.
Risk Sense asks Is everything a risk when you’re pregnant?

04 Jun

What’s wrong with this poster?

2013-05-29 14.13.44

Walking past the Tesco store in Beverley, in the East Riding of Yorkshire, I glanced through the window into the cafe, and saw this huge poster. “Here to help,” it says, in big friendly letters. “Hungry baby? We’re happy to warm your milk for you.” There’s a smiley face, and the name of the ten year old who designed it.

That’s kind, you might think. They’re giving out free jumpers, which on a miserable drizzly day seems like a nice thing to do. And then you would realise that the poster assumes that you are bottlefeeding. And statistically, they may well be right [let’s trot out those stats again: 81% of mothers initiate breastfeeding, 58% are still breastfeeding at six weeks, 12% at four months].

While the poster does not explicitly state that breastfeeding mothers are not welcome, and under the Equalities Act 2010 they are required to accommodate breastfeeding mothers, the underlying assumption that anyone with a baby in the cafe will have a bottle of milk with them simply undermines breastfeeding, and that contributes to the rapid drop-off in breastfeeding rates in the UK. There is no poster welcoming breastfeeding mothers; there would not be room for one anyway, as the bottlefeeding poster takes up the entire wall. And it would make no sense to put up a poster stating that both breastfeeding and bottlefeeding mothers are welcome. That, however, was the response from @UKTesco, when I tweeted about the poster: please be aware, breast feeding is always welcome at the store 🙂

You might think I’m getting a bit stale if I continually bang on about not dividing up the breastfeeding mothers and the bottlefeeding mothers into separate camps. The statistics above tell us that a huge proportion of breastfeeding mothers also bottlefeed, so the distinction is very vague anyway. How hard can it be to make all mothers feel welcome, and advise them that facilities are available for whatever kind of feeding they need to do?

However there is another problem with this poster, which is that it implies bottles could be made up in advance and warmed up. This contravenes NHS guidelines to make up each feed as your baby needs it, because of the risk of food poisoning bacteria in the formula. Perhaps they could go back to offering hot water (over 70 degrees) instead. And perhaps not get ten year olds to devise their policies.

30 May

Book Review: Baby Management for Men, by Henk Hanssen

Author Henk Hanssen claims that fatherhood is his favourite subject, and a real sense of fun comes across in this warm and accessible little baby manual.

In this book, the father is the consummate manager. The family is your enterprise, the mother your producer, the baby your product. [p10]

Heavy on the business-speak and technical jargon, it might not appeal across the board, but beneath the veneer of gentle silliness, the book is packed with practical information. It addresses how the new father’s life will change, how to approach his employer with requests for paternity leave and flexible working hours, and directs the him to think about the kind of father he wants to be. It then goes on to describe in detail the baby’s appearance, likely behaviour, and maintenance required in the first year or so.

You might pick up a book with the title “Baby Management” expecting a rigid, parents-in-charge approach; in fact I would place this well towards the attachment parenting end of the spectrum. Hanssen encourages dads to be hands-on, and quotes evidence to show the benefits of an involved, engaged father, for the whole family.

My few criticisms of the book would include a raised eyebrow that the feeding section starts with expressing before actually addressing the subject of breastfeeding. Granted that’s because the focus is on how a dad can be involved with this, but I would rather see the emphasis on supporting the mother to establish breastfeeding first; there are lots of ways dads can help with this. Hanssen erroneously states that breastmilk can be kept in the fridge for up to 72 hours; most reliable sources state 5-7 days. Other than that, the section dealing with feeding is almost entirely accurate. Sadly when it comes to introducing solids, the advice given is rather old-fashioned purees-only approach.

The section on growth and development is particularly fascinating, and the book is well-referenced. I wouldn’t hesitate to recommend it to fathers-to-be.

*****
To order Baby Management for Men with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

23 May

Sharing a bed with your baby

This week a new study was published in the BMJ which gave rise to headlines regarding the dangers of sharing a bed with your baby: Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies.

The authors of this report combined the results of five studies done in different countries between 1987 and 1998. The amalgamation of these studies gave a sample size of 1472 babies who died, and a control group of 4679 babies who did not. Each individual study compares the conditions of the babies in the two groups. However the individual studies did not look at the same risk factors. The authors were able to draw out some significant factors, and show the level of risk for babies who were in their parents’ bed, compared with babies who were in their own bed in their parents’ room. The risk factors examined are whether the baby was breastfed or bottlefed, whether either parent smoked, the position the baby was put down in (front or back), whether the mother had had alcohol or illegal drugs in the previous 24 hours.

The report concludes that the lowest risk of cot death is where a breastfed baby of a non-smoking, non-drinking mother sleeps on his/her back in the parents’ room, but not in the bed. That is, in the absence of any of the risk factors studied here, the risk of cot death is 0.08 per 1,000 live births. When a baby with the same conditions shares his/her mother’s bed, the risk increases to 0.23 per 1,000 live births. This was reported in the popular press as “FIVE TIMES MORE LIKELY!!”

The Telegraph headline claims that this report “sheds new light on cot deaths”, which is interesting given that the studies in the meta-analysis are more than 15 years old. There are more recent studies the results of which do not support these conclusions. A number of known risk factors are missing from the meta-analysis, including smoking during pregnancy, use of legal drugs such as the strong painkillers often used in the early postnatal period, parental obesity, paternal alcohol use, prematurity, the conditions of the bed itself (was the baby between the parents or on mum’s side, was the baby on a pillow, were other siblings or pets also in the bed, etc). The authors are open about the fact that some of the drug/alcohol data was missing, so they “imputed” this. A cynical mind would define the verb “to impute” as meaning “to make stuff up.”

A huge flaw in the report, and in most studies of cot death risk, is the definition of a breastfed baby. In most cases “breastfed” includes partly formula fed babies. We know how fast the rate of breastfeeding falls in the UK (79% at five days; 58% at six weeks), so it is understandably hard to generate an appropriately large sample of exclusively breastfed babies. However all studies show a lower risk for breastfed babies compared with formula fed babies, therefore it makes sense to me that partly breastfed babies should be either a separate data set, or included with the formula fed babies. The report also implies that while bedsharing is associated with longer duration of breastfeeding, the risk of bedsharing is not cancelled out by breastfeeding and therefore this cannot be considered as a reasonable justification of bedsharing. This overlooks the fact that cot death is not the only thing that breastfeeding protects babies – and mothers – against. The long-term risks of not breastfeeding are well-documented, and may, for some parents, outweigh the 0.23 per 1,0000 risk of bedsharing.

Of course the media is generally more reticent in reporting the apparent protective effect of breastfeeding, lest we make mothers feel guilty. This delicacy does not appear to apply to parents who choose to share a bed with their baby* who appear to make up a similarly large group to the formula feeding parents. (This of course implies that huge numbers of bedsharing parents are also formula feeding parents, which is the higher risk). So here is the point at which I climb, with a sigh, on to my usual hobby horse of WHY ARE WE TRYING TO SET PARENTS ONE AGAINST ANOTHER? What is the use of demonising parenting decisions, banning common behaviours rather than informing about risk and how to reduce it?

Whether you choose to sleep with your baby in your bed, beside your bed, or in another room, it is important to be aware of safety guidelines. If you think you will NEVER sleep with your baby, it is still important to be aware of safety guidelines, as for a lot of parents this is not a planned thing, and that in itself increases the risk. Let us not make bedsharing a taboo subject, or a polarising argument. Let us accept that we all parent in different ways, and we are entitled to be well-informed, rather than dictated to, about risk.

*How many parents share a bed with their baby?
Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants.

29 Apr

Book Review: Talking with children about things that matter, by Sheila and Celia Kitzinger

Talking with children about things that matter by Sheila and Celia Kitzinger, is a wide-ranging discussion about the big issues that bother contemporary parents. Although it was written in 2000, and therefore lacks that important chapter on social media and the internet, the contents of this book are highly applicable to the modern family.

The Kitzingers have surveyed parents and reviewed the literature to look into some really big topics, examining the way parents attempt to instil their own values in their children. The book therefore caused this reader to reflect on her own values and upbringing, and feel both optimistic and pessimistic about my son’s childhood.

Pessimistic because this world seems so much bigger and scarier than the one I grew up in, and the task of fitting my boy with tools and strategies seems insurmountable. In a week when teenagers have bombed marathon runners and a world famous children’s entertainer has been arrested for sexually abusing a child, how do I protect him, and how do I send him out there fit to do good, not harm?

Optimistic because many of the issues I find sticky, such as prejudice, sexuality and the environment, seem more openly and easily tackled by his generation. He takes for granted that men can love other men, that skin colour is no more important than hair colour, and that everyone recycles. That doesn’t mean my work here is done, but we’re off to a good start.

This is not a how-to book, but it opens up new perspectives as well as reviewing some traditional points of view such as the value put on an “obedient” child. It’s sometimes helpful to remember that a child who questions authority as a matter of course is perhaps in a safer place than one who always does as he is told. Especially when you want him to put the lego away and put his shoes on for school.

I would have liked the book to go further on the topic of sexuality, and to have explored the implications of an atheist upbringing in more detail. I closed the book with some deep thoughts and intentions about how I can include my son in discussion, not shelter him from the news, and somehow help him to understand how privileged he is. I don’t have the answers to any of this, but I have a few more clues.

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.

13 Mar

Announcement!

Today I met with my mentor Maddie McMahon, and after an interview which took place over a pleasant lunch, I am now a Recognised Doula. Here’s an explanation of Mentored and Recognised Doulas from the Doula UK website:

Mentored doulas
A Mentored Doula has completed a Doula UK approved Preparation Course and is involved in Doula UK’s Recognition Process. This means that she has a Mentor providing support and supervision within a framework for reflective practice until she has gained sufficient experience to become a Recognised Doula. A Mentored Doula’s fees reflect her previous and current experience, her expenses and the going rate in her area.

Recognised doulas
A Recognised Doula has been evaluated by a Doula UK Doula Mentor at the end of the Recognition Process, as having sufficient experience to practise without on-going mentoring. Doula UK nevertheless continues to provide support for all its members.