12 Apr

Donating Breastmilk

Donated breastmilk can save the lives of premature and sick babies, whose immature digestive and immune systems are at even greater risk if given formula milk, than healthy term babies.

Here’s an article from The Daily Record about twins born at 24 weeks, who relied on donor milk for the first weeks of their lives:

Lynsey said: “I’m just so grateful. I’ll never be able to thank people personally but I’m convinced Emma wouldn’t be here without the donated breast milk from other mums.

Thayer Prime writes about her own experience of donating milk. She’s the only donor to her local milk bank, and will soon have to stop.

Here are the details of the UK Association of Milk Banks, in case you think this is something you could do.

01 Apr

Images of Breastfeeding

Part of our job is to normalise breastfeeding, and to fight against the systematic undermining of breastfeeding within our culture. Facebook has been deleting photographs of breastfeeding women for years, because someone somewhere finds them offensive. The Guardian and NCT have finally got on the case.

Rowan Davies in The Guardian stated that A society that is not prepared to accept the odd flash of nipple is a society that is not prepared to accept breastfeeding

She invited readers to:

try a little Facebook-busting. If you’d like to mail your pictures of nipple-accessorised breastfeeding to your.pictures@guardian.co.uk, the fearless folk at Comment is free will post them on the Guardian’s Facebook page, and see whether Facebook takes them down

And here’s what they reported:
The beautiful breastfeeding images Facebook is missing out on

Belinda Phipps, CEO of NCT, commented:
Sorry, Facebook – on breastfeeding you seem rather confused

And just to refer back to that original remark about normalising breastfeeding, The Alpha Parent has a lovely post showing breastfeeding depicted in children’s literature.

Finally, Victoria Beckham tells us that she SPENT ALL SUMMER WITH MY BOOBS OUT BREASTFEEDING …AND I LOVED IT!

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

15 Mar

Book Review: Birth Matters, by Ina May Gaskin

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

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

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

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

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

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

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

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

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

***

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

27 Feb

My experience of baby-led weaning

Now that we are advised to wait until around six months to start, our babies have better co-ordination and more mature stomachs than they did at four months, and so it is possible to skip the stage of aeroplaning mush into their mouths and then scraping it off their chins, and offer finger food right from the start. This is known as baby-led weaning (BLW), and the main principle is that the only person to put food in the baby’s mouth, is the baby himself.

I started weaning my son the traditional way, at 23 weeks, with great excitement and anticipation of him quickly becoming as much of a food-lover as I am. I did consider the baby-led weaning approach, but felt that it would not work for us, because I would be returning to work a month later, and therefore no longer had the opportunity to breastfeed on demand. As with most things, my son had a completely different agenda to me, and resolutely refused to contemplate the spoonfuls of delicious runny baby rice that I offered him. For a few days he had some interest in pear, carrot, and potato; but as soon as the novelty wore off, he closed his mouth, turned his head away, and cried; and that was his final say in the matter.

BLW puts the baby in charge of his own eating, on the basis that if parents offer a range of interesting, nutritious, and suitable food, then the baby can choose what he eats, and this allows him to move gently towards a solid diet. The goal is not to force your baby to eat, but to let him experience the tastes and textures of food at his own pace. It encourages the development of motor skills, and because the baby quickly moves on to eating the same food as the rest of the family, he also benefits from learning social skills at shared mealtimes, when he can participate in eating actively, rather than passively. As long as parents can relax and accept that it might take longer for the baby to consume significant quantities of food, this approach is more fun, less stressful, and much, much messier than traditional weaning on purees. At this stage, milk is still the most important source of nutrition, so it doesn’t really matter how much solid food baby eats, as long as he gets plenty of milk.

The BLW philosophy is to follow the child’s cues, and start when he indicates he is ready to try some solid food. First signs of readiness include losing the tongue-thrust mechanism (where anything put into the mouth is pushed back out again), having the ability to sit unsupported, and starting to develop a pincer grip with the thumb and forefinger. Our experience was that this tentative ability came on very quickly, when sufficiently motivated by such interesting items as peas and roast potatoes.

The first foods we offered were fruit, rice cakes, and steamed or roast chips of vegetables. We found that if you leave the peel on hard fruit like pears, the baby can pick them up more easily, and will suck the flesh and spit out the peel. Of course you should never leave your baby unattended while eating, but don’t be too alarmed by a little bit of gagging: this is a normal part of learning to manipulate food in the mouth, and is not the same as choking. We moved on to breadsticks and toast, pieces of cheese, and small lentil patties (an early favourite). Breakfast cereals were less successful in our case, but could work well with a different baby (my constantly teething son liked his food to be soft but still insisted on using his own hands, hence breakfast usually consisted of one weetabix with 2oz milk – perfect finger-mush). Later on we tried poached fish and chicken, and finally just shared our own meals with him.

He didn’t really start to eat well until he was nearly a year old, but mealtimes where I could relax and let him dictate how much he ate were always the most pleasant ones. He has always eaten better at the family table than on his own, and we have the attitude that there are no things he doesn’t like, just things he doesn’t like YET. Around 12 months he started trying to feed himself with a spoon, and over the past year he has progressed to a fork, and now likes to wave a (baby-friendly) knife around while he eats as well.

At two years old, my son has eaten (and likes) a far more varied diet than I remember as a youngster (or even in my twenties!), from olives to salsify. He also eats things that I don’t like much, like spinach (mixed with cream cheese and combined with pasta makes a good mushy, messy finger food) and fish.

There have been many ups and downs, especially when he is teething, poorly, or tired. Some days he eats more, and some days he eats less, and some days he has a healthy diet, and some days I let him have a sausage roll. I try to look at the bigger picture, and consider that overall he has a good diet and enjoys his food, which, looking back, is what I wanted in the first place.

BLW works well in a family where the parents feel able to relinquish control over what the baby eats. You decide what to offer, and he decides what to accept; there is no batch-cooking of mush, no counting spoonfuls, and no train-coming-through-the-tunnel-and-INTO-your-mouth! It is important to be able to top up with milk on demand, but at least that way you can be sure that the little tummy isn’t filling up with less-nutritious solid food, to the detriment of milk, which still provides the main source of calories and other nutrients that the baby needs to in order to grow.

June 2008

21 Feb

Support, Advice, and Parental Instinct

As a breastfeeding counsellor, I am sometimes asked why my antenatal classes do not go into great detail about problem solving when things go wrong. The pat answer to this, of course, is that every new family is unique, and I can’t possibly account for all the possible scenarios. I’m also wary of introducing a lot of potential pitfalls, and therefore undermining my own work to show that breastfeeding can be a straightforward experience, and that being well-prepared with an understanding of how it works is more useful than being armed with copious detail about problems that may not occur.

This is a dilemma for me, because to be realistic about breastfeeding as experienced by the majority of new mothers in the UK, I have to acknowledge that there are challenges. So one of my main objectives is to raise awareness of the huge amount of support available to new parents. If time permits, we compile a list, and the group is always impressed by how many people they can think of who might be able to help them over the first few weeks of their babies’ lives. Here are some of the ideas I usually see:

The real trick, though, is in figuring out which of these are sources of trustworthy information (or practical help); and which are, probably with the best intentions in the world, recycling myths and misinformation, or unhelpfully comparing your baby with theirs. But each of these different sources of support has its function, whether it’s sympathy and a cup of tea, the loan of a dvd box set to while away a marathon feeding session, or reassuring confirmation that what you and your baby are going through at any particular stage, is completely normal.

It can also take courage not to follow advice that does not feel right, especially when it comes from a figure of authority. So another of my objectives, both antenatally and postnatally, is to empower new parents to have confidence in their own parenting. We are among the first generations of parents to raise our children in isolation form the extended family, and there are huge commercial interests in undermining parental instincts.

It’s tough being a new parent in the 21st century, but remember that there are reliable sources of help, many of which are under-utilised. So don’t feel you have to struggle on alone, but do pick your support carefully.

Originally written as a guest post for the liberating blog, Free Your Parenting.

13 Feb

Introducing solids, research, and guilt

Last week the British Medical Journal published an interesting study comparing outcomes for children who have experienced different styles of weaning, entitled Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample.

This sparked my interest for a number of reasons, one of which was a response on twitter complaining that research showing ‘pureed foods will make your babies overweight’ just makes parents feel guilty. This commenter went on to complain that the study, of 155 families, was an unrepresentative snapshot; and that was interesting too, because the study showed two main results: Baby-led weaning (BLW) babies were more likely to be underweight, AND puree-weaned babies were more likely to be obese in later childhood. So actually, you’re damned if you do and damned if you don’t, and guilt is once again a diversion from the actual information.

As I have written before, parents are entitled to information so that they can make decisions. The study is available in full on the BMJ website, so we really cannot get away with blaming the media for misrepresenting the facts. It’s quite easy to read, too.

I dusted off my memories of the ‘understanding research’ BA module I did last year, and had a good look at the article. I noticed that there were one or two flaws, but as far as preliminary research goes, it gives some interesting starting points. I thought that the sample size of 155 was not problematically small, but I noticed that the samples seemed to be drawn from quite different pools: mumsnet for the BLW families, and the local toddler lab for the puree families. However the researchers matched the samples for social status and all the usual factors.

The families self-reported on weaning styles, and the researchers acknowledge this as a weakness, since there is no strong definition of baby-led weaning, and it is not a discrete question. Many babies will experience some purees and some finger foods, in varying quantities. This could be addressed by a larger, prospective study following cohorts of children from birth well into childhood.

I also noticed that although the matched sample shows no significant difference between breastfeeding rates in the two groups, it is not clear whether or not the researchers controlled for duration of breastfeeding. The reason this interests me is that baby-led weaning does work well with (but isn’t restricted to) babies who continue to breastfeed well into toddlerhood. This is because if the baby is self-feeding, they are unlikely to consume very much for the first few months, and so will continue to rely on milk as an important source of nutrition probably until they are around a year old. I am just speculating here, but maybe the longer-term breastfeeding family can be a bit more relaxed about how much the baby eats; the researchers do state that BLW is is associated with reduced maternal anxiety about weaning and feeding and a maternal feeding style, which is low in control. I would posit that this is more likely to be the breastfeeding mother, but further research is certainly needed in that area!

I feel strongly that this is another area of parenting where the word ‘should’ does not apply. Many families need some support to find a style of introducing solids that works for them, and there are so many other complex factors, particularly relating to maternal control, that will affect the outcome for the child. As with breastfeeding, few people make the decision based solely on the publicised health outcomes: cost, expediency, social expectations and pressures will all play a part.

I’m starting to do a lot of Introducing Solids Workshops for parents over the next few months, and find the area really interesting. If you are interested in coming along to a workshop in Wokingham, Bracknell, Reading or Bagshot, get in touch.

08 Feb

Book Review: The Oxytocin Factor, by Kerstin Uvnas Moberg

On the whole, this is an interesting book exploring the magic of the hormone oxytocin, its widely varied effects, and the gaps in our knowledge about it.

The author describes the ‘calm and connection’ system, and contrasts this with the ‘fight or flight’ system, which has already been widely researched. She posits that modern life gives little opportunity for human beings to enjoy the various conditions of rest, relaxation, and pleasant interactions, which cause a natural increase in levels of oxytocin.

The book is divided into parts, and begins with an explanation of the physiological processes involved in the calm and connection system. All this makes a lot of sense, although much of it is based on research with rats.

The section on the effects of oxytocin is the most interesting part of the book. It shows that oxytocin increases sociability, curiosity and nurturing behaviour, and decreases anxiety and fear. It enhances recognition and calm, and alleviates pain. It improves the ability to learn; and, in different circumstances, either raises or lowers blood pressure. It moderates body temperature and enables a mother to moderate her baby’s body temperature. It regulates appetite and makes digestion more effective. It aids growth and healing, and the flow of breastmilk, and the contractions to birth our babies. All of these different effects have the result of enabling animals to grow and to reproduce.

The chapter on breastfeeding is fascinating. However I noticed here and elsewhere some remarks that I know are not supported by evidence, including that mothers who have had a c/section have more difficulties in breastfeeding, the assumption that colic is a stomach disorder, and the assertion that breastfeeding women must avoid alcohol. This leads me to wonder how much of the rest of the content of the book is actually based on real evidence of human experience and behaviour.

Certainly the final section of the book is almost entirely based on speculation about the gaps in our knowledge, and uncritically discusses the role of oxytocin in acupunture and other complementary medicine.

I found much that was useful in this book, particularly on the subject of bonding, and specifically in relation to fathers, which is very relevant for me in my work. However I found the speculation in the final chapters vague and disconnected. I was surprised, given the original assertion that modern life is not conducive to natural oxytocin release, to read that the author is looking forward to oxytocin being available as an drug that can be administered for various conditions. I had expected the book to conclude that human beings need to use our knowledge of natural oxytocin to engage in more behaviour, or create more circumstances, where oxytocin is naturally maximised; not just to pop a pill to achieve all those beneficial effects.

***

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

25 Jan

Book review: Successful Infant Feeding, by Heather Welford

This comprehensive book takes a broad view of infant feeding, including how-to sections for both breast and bottlefeeding, along with an interesting examination of the history and politics, and the social and emotional aspects of the subject. It gives enough detail to be useful to breastfeeding supporters and other health professionals, without being too dense for parents and parents-to-be.

I warmed to the book immediately on reading the opening chapter, about babies’ development over the first year. This sets the subject of feeding nicely into the wider context of babies’ needs; and yet, without pulling any punches about the risks of formula feeding, manages to be inclusive and non-judgmental about the range of choices that parents make. Importantly, Welford acknowledges that, for many parents, formula feeding is not a choice willingly or happily made, and that it is very hard for health professionals to get the right tone when it comes to supporting parents in making decisions about feeding.

This book is useful because as well as accurate how-to information, it also touches on a range of special situations and common concerns, briefly explains the WHO code, and looks at how individual babies’ feeding patterns might change over time. It even includes enough information on the introduction of solid food to render the purchase of anything by Annabel Karmel completely unnecessary.

The language used is crystal-clear and helpfully free of value-laden terms. I have already heard myself reciting bits of it in antenatal classes (while hoping that Heather won’t want any royalties!), have sent a copy to my sister-in-law who is expecting her first baby, and recommended it widely. It is the book that our profession has been waiting for, and should be on the reading list for anyone working with new parents.

15 Jan

Can breastmilk be made in a lab?

This is not intended as a ‘breast is best’ post, simply a list of the reasons why it would be impossible to make an exact replica of breastmilk in the lab. There are already many, many resources on this subject, and this is only intended as a simplified list.

  1. Breastmilk changes all the time according to the needs of the child. For example, in hot weather, it has a higher water content. As the child gets older and starts to toddle, the antibody count increases to counter the increased exposure to pathogens. If a baby is exposed to pathogens, an interaction between his saliva in the mother’s milk ducts causes appropriate antibodies to be made in the milk. Formula does not contain antibodies.
  2. Breastmilk also changes during each feed, becoming increasingly high in fat as the baby drinks. This is what causes baby’s internal appetite control to kick in. The fat content of formula does not change.
  3. Breastmilk contains antimicrobial and immune factors. Few of these can be made in a lab.
  4. Breastmilk contains the digestive enzyme lipase, which helps the immature gut to digest the milk. This is why it takes longer to digest formula milk, which is one of the reasons bottlefed babies go longer between feeds.
  5. The flavour of breastmilk changes according to the mother’s diet. Babies experience different tastes before starting solid food.
  6. Breastmilk contains human growth hormones. Formula milk, which is made from cow’s milk, contains bovine growth hormones.
  7. There are other ‘human’ factors which are impossible to make in a lab, including human iron. Breastmilk also contains lactoferrin, which helps the baby to digest the iron in breastmilk. As formula does not contain lactoferrin, the iron content has to be much higher in order for the baby to absorb sufficient quantities. High levels of iron can cause the gut to bleed, resulting in anaemia. Other micronutrients and vitamins are added to formula in high quantities, for the same reason.
  8. Some babies are allergic to cow’s milk protein. No babies are allergic to human milk protein.
  9. Breastmilk contains lactose, cholesterol and fatty acids that aid human brain development. Formula milk does not.
  10. Breastmilk is sterile. Formula powder is not. Ready-made formula is sterile but requires a lot more handling than breastmilk, which usually goes directly from breast to baby.
  11. No country has a government standard for formula. There is a minimum standard, but other than that, there are no rules for what can or can’t be added. Most ‘new’ ingredients are added for marketing, rather than health, reasons.
  12. Babies get more than just milk and its constituents, when they breastfeed. The benefits of lots of skin to skin are well-established.

UK formula companies spend £20 per baby on promoting formula. The government spends 14p per baby on promoting breastfeeding, and we know that ‘promoting’ breastfeeding is unhelpful. Would that £20.14 per baby was spent on supporting breastfeeding mothers, and then the question of whether or not formula could replicate breastmilk would be completely irrelevant.

The Ecologist: Breastmilk vs ‘formula’ food
Dr Sears on comparison of breastmilk and artificial milk
Kellymom on immune factors

10 Jan

Book review: You, Me and the Breast

This is a colourfully illustrated book about breastfeeding. Its simple story follows a mum and baby from birth to weaning, and mentions lots of memorable moments, such as snuggling up in bed with daddy, mama milk to comfort and soothe, and those relaxing moments where one’s ever-active infant becomes still for a little while at the breast.

Although it is clearly presented as a children’s book, I was a little confused about who the target audience was. Some of the information: ‘my nipple darkened… and gave off a rich smell’ sounds unnecessarily technical in a book for a small child. The cursive script was too difficult for my competent five year-old to read himself, and he had a lot of questions about the illustrations (‘which one is her hand?’ ‘why has she got birds in her hair?’).

It was nice to see dad included in some of the pictures, although I have reservations about the depiction of him ‘aeroplaning’ puréed food into the baby’s mouth.

On balance, the more books for children that normalise breastfeeding, the better. It would be good to see this widely available in local libraries and schools.

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To order You, Me and The Breast with a 25% discount, just follow the link and use the discount code KH25 at the checkout.