20 Jun

Book Review: Why Starting Solids Matters, by Amy Brown

The subject of starting solids divides parents into those who trust their instincts and those who do not. Those who trust their instincts will enjoy this book, which offers evidence to help them make decisions; but they won’t need it. Those who do not, will find it insufficiently instructional. This is the eternal dilemma of the subject, and Amy Brown recognises that.

This is not a manual for introducing solids. It’s a really good resource, though, for anyone supporting parents in either state of mind. It is a sensible, well-researched little book, casting no moral judgement on any of the different options, even as it sets out the compelling arguments for waiting until around 6 months, and enabling babies to self-feed.

Why Starting Solids Matters gives us an interesting history of infant feeding, which lays foundations for the following chapters. It acknowledges the sparsity of good evidence around allergies, and really makes its point about the importance, above all else, of responsive feeding.

Closing with a ten-step summary and a long list of resources, and thoroughly referenced, Why Starting Solids Matters ticks all my boxes for a thoroughly useful book. I fervently hope that it will be as widely read as it deserves.

[Disclaimer: The publishers sent me a free review copy. You can buy it from their website, and get 10% discount with the code SPROGCAST]

09 Jun

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

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

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

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

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

06 Jun

Book Review: Breastfeeding Made Easy, by Carlos Gonzales

Carlos Gonzales writes as though he is giving a TED talk. In places, his stridency is amusing; but mostly it is just strident. I cannot tell if it would come across the same way in the original Spanish, or if this is a tonal quirk of the translation, but I did experience the same sense of being exhorted to follow his well-argued directions in his earlier books, and for this reason I would be very unlikely to share them with parents.

Breastfeeding Made Easy is a dense book filled with much confusing detail, and is quite outdated. For example, on p53 he discusses “foremilk and hindmilk,” a concept from which most breastfeeding authorities have moved on. Gonzales is, furthermore, highly prescriptive in his approach to positioning and attachment, and there is no mention at all of laid-back breastfeeding. He makes several sweeping statements that many parents would rightly disagree with. Here’s one:

breastfeeding stops being an issue when the baby starts eating solids (p84)

To which I say: hm, define “issue.”

The book also swings from exhaustively detailed advice such as that given on maternal diet (which in fact has very little impact on milk quantity or composition), to peculiar inclusions in the list of maternal conditions that may affect breastfeeding such as myopia – which, obviously, doesn’t affect it at all.

There are far more useful breastfeeding books available; this one is little more than an eyebrow-raising curiosity.

[Disclaimer: I was given a free copy of this book by the publishers Pinter & Martin]

05 Jun

Book Review: The Sensational Baby Sleep Plan – Alison Scott-Wright

I have come across this book a few times, and eventually someone gave me a copy so that I could read it cover to cover at my leisure. Having flicked first to the breastfeeding section and read the advice not to drink champagne lest it give the baby wind, I was tempted to drop it straight in the bin. But no, I persisted, so that you don’t ever have to.

Alison Scott-Wright is very much from the same school as Clare Byam-Cook, whose awful book she recommends; and really you don’t need to know much more than that. If you consider your baby to be a time-consuming, manipulative bore with no feelings, the Plan will suit you just fine. However if you wish to meet your tiny human’s needs following your parental instincts and the best available evidence, and your well-meaning aunt has given you a copy of this book, perhaps treat it as a “how not to parent a baby” guide.

Feel free, in the latter case, to ignore ASW’s basic premise that breastfeeding is really too difficult to bother with; a position that must be continually supported with anecdata from clients having trouble getting breastfeeding to work under the rules she prescribes. Feel free not to ensure your legs are at a 90 degree angle to your body (p41), not to restrict feeds to 3-hourly as soon as possible (p43), not to express five times in 24 hours in addition to breastfeeding on demand (p46), and take with a huge pinch of salt that breastmilk may be made unnatural and impure by environmental pollution. Amuse yourself instead with the mental image of cows living in clinical conditions, wearing nappies and using the finest organic antibacterial gel on their udders at milking time. Should you decide to use formula, please please disregard her instructions for making up bottles in advance, which is in direct opposition to evidence-based guidance from the NHS.

None of her terrible advice about feeding has very much to do with sleep, so let us move on to ignoring what she says about that. ASW likes to cherry-pick the research and twist it to fit her entrenched opinions. So for example she quotes Sue Gerhardt on early emotional development and uses this to argue in favour of her cruel and neglectful plan. If she had read more than the back cover of Why Love Matters, she would find herself in the uncomfortable position of having to reflect on how damaging her advice must be.

ASW does not, however, make any reference at all to the UK’s foremost authority on infant sleep, the work of Professor Helen Ball and Doctor Charlotte Russell at the Durham Infant Sleep Lab, where they undertake rigorous research and provide useful evidence-based information to support parents. And for this reason, the reader may also be at liberty to ignore the “baby’s daily sleep requirements” (p72), fully debunked by Charlotte Russell on Sprogcast last year. On p80, ASW dangerously disagrees with current safe sleeping guidelines, overruling the Back To Sleep campaign on the basis that she tends to believe that the babies for whom her plan does not work must surely have reflux; and also ignoring the increased risk of SIDS for a baby sleeping in their own room before the age of six months. It would also be absolutely acceptable to take no notice whatsoever of her claim that she “often advises introducing solids… from 16 weeks,” (p85) or her recommendation that parents water down formula or limit breastfeeds at night as early as 4 weeks, thereby depriving the baby of essential nutrients and comfort – surely a far more serious risk to the child’s physical and emotional wellbeing than that posed by sleep deprivation.

All parents can definitely disregard the long parent-blaming list of ways they can get their babies’ sleep wrong on p155; and unless the baby has a medical diagnosis of reflux, they can also take no notice of the 50 pages devoted to that subject. In fact, even with such a diagnosis, it might be wise to ignore the unqualified ASW’s unqualified opinions on this matter, and seek the support of a trained specialist.

ASW’s promise is that if you follow her “flexible” plan TO THE LETTER, then your baby will sleep through the night by 8 weeks. She has had 100% success with this. The only reasons why this incredible plan might not work are if the baby has reflux, or if the parents have been doing it wrong. Even teething “should not be used as an excuse” (p92). But never fear, silly parents, if you have got yourself into such a “hopeless situation” (p157), there is still hope! You can adopt her cosily-named “sleepy time” reassurance technique (p170) which is basically leaving the baby to cry, even if they “vomit to order” (p193).

This sleep is indeed sensational: sensationally cruel, ill-informed, and quite possibly harmful. I do not recommend this book.

30 May

Book Review: Birth Work as Care Work, by Alana Apfel

Birth Work as Care Work is an important introduction to the subject of intersectionality in the birth movement, drawing out themes of oppression and inequality through the stories of women.

Alana Apfel and her contributors identify the challenges of a profit-driven healthcare system dominating birth, and a society where “white volunteerism” overlooks the real lived diverse experience of birthing women in communities that are not their own. Apfel creates a space for birth workers to be heard on both a personal and a political level, including four beautiful birth stories.

I found this book challenging to read as a white middle class cis woman, because although I am steeped in a culture of empowerment, of being “with woman,” and of respect and awe of the birthing body, the contributors are quite deliberately not talking to me. Reading it has been a good lesson in making myself aware of the water I swim in, and not trying to “fix” others’ experience from within my own frame of reference.

This is a recommended read for anyone interested in the broad political and social context of birth, and wiling to feel like our work is radical, valuable, and important.

[Disclaimer: The author sent me a free copy of her book]. We will be chatting with Alana in Sprogcast Episode 27.

24 May

Basics of Expressing Breastmilk

1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won’t latch on, or to relieve engorgement. Once breastfeeding is established, many families share feeding using bottles of expressed milk.

2. Different pumps may be useful in different circumstances. Hospital-grade electric pumps can be hired locally. If you are only expressing now and then, a manual pump might be suitable. Colostrum can be expressed by hand without a pump.

3. Expressed breastmilk can be stored at room temperature for about 8 hours, in the fridge for 5 days, and in the freezer for 6 months. Defrost in the fridge and warm if necessary by putting the container of milk into hot water.

4. If you are giving both breastmilk and formula milk, you might want to offer them separately, giving the breastmilk first to maximise the amount taken, rather than diluting it with formula.

5. Expressed breastmilk can be given to the baby with a syringe, a spoon, a feeding cup, or a bottle. These will need to be sterilised.

6. If you are only expressing and your baby is not feeding at the breast, it is helpful to express very frequently: around 10 times in 24 hours, including once during the night, to mimic the feeding pattern of a baby.

7. Expressing in addition to breastfeeding usually increases the milk supply. Expressing instead of breastfeeding may decrease the milk supply.

8. Closeness with your baby stimulates release of the hormone oxytocin, which helps the flow of milk. Closeness with your breastpump is less likely to have this effect. Some women find that their milk does not flow easily for the pump. Therefore, the amount of milk you can pump is NOT a good indication of the amount of milk you can produce.

9. Warmth, gentle massage, and the sight/sound/smell of your baby can stimulate oxytocin and help milk to flow. Sometimes expressing in a warm bath can be effective.

10. The best time of day to express is whenever you have the time. Breasts produce more milk when they are frequently used, so it is possible to express before, after, or even during a feed. If you can’t find time to express, and you don’t have to, then leave it for a little while until things settle down.

For support with any aspect of infant feeding, you can call the NCT Feeding Line from 8am to midnight, every day, on 0300 3300 700.

23 May

Basics of Breastfeeding

While the basics of breastfeeding are the same, the experience is different for everyone. If you need help or support, call our NCT Feeding Line on 0300 3300 700, 8am-midnight, every day.

1. Colostrum is the first food for your baby. This protein-rich substance is packed with antibodies, and mothers start producing it during pregnancy.

2. Following the baby’s birth, it is the birth of the placenta that triggers build-up of the hormone prolactin, which controls the mother’s supply of milk.

3. In the first few days, babies feed very frequently (around 10-14 times in 24 hours). Each feed stimulates the release of more prolactin, and builds up the milk supply.

4. Spend as much time with your baby skin to skin on your chest as you can. This encourages newborn reflexes such as mouthing, rooting, and stepping, which help babies to position themselves and latch on.

5. Lots of skin to skin contact helps to stimulate the milk supply too. It also calms the baby, regulates his/her temperature, and helps to populate their immune system. Skin to skin with dad is great too!

6. Around 3-4 days after the birth, the volume of milk increases, sometimes dramatically, and the breasts may get engorged. If this happens, gentle hand-expressing, a warm flannel, or a bath may help.

7. A good position for breastfeeding is any position where the mother is comfortable and the baby’s body is fully supported by her body, not just her arms.

8. Feeds can last anything between 5 minutes and 45 minutes. Follow your baby’s lead, and try not to restrict the length of the frequency of feeds, because this may mean they don’t get enough milk.

9. If breastfeeding hurts (beyond the first few seconds), this is usually a sign that the baby is not well latched on. This can make feeds less effective, and reduce the supply of milk. Hold your baby comfortably so that he/she can open wide and get a good latch. If you need some face to face support with this, there are many local drop-in groups you can go to.

10. Newborn babies need to be close to someone most of the time, so there is plenty of opportunity for dads to help out with soothing, settling and cuddling, and babies will usually sleep well on their father’s chest.

22 May

Basics of Formula Feeding

1. All brands of formula are made to the same standard, so no brand is better than another. You don’t have to stick to the same brand.

2. Each brand produces several stages/types of milk. The only one suitable for a newborn baby is Stage One/First Infant Formula. This is suitable until the age of one, when your baby can have ordinary cow’s milk.

3. Formula comes in ready-made liquid form, or as a powder. The liquid is more expensive, but quicker to prepare. The powder is not sterile, so it is very important to follow the instructions for making it up, to prevent the growth of bacteria.

4. Your baby will tell you when he/she is hungry, by smacking their lips, rooting (head-turning), and sucking their fingers. Crying is a late hunger cue, so try to respond to these early cues, to minimise everyone’s distress.

5. When you bottlefeed, hold your baby close and upright, so you and your baby can make eye contact. Enjoy the opportunity for a cuddle.

6. Pace the feed: Hold the bottle close to horizontal, touch it to your baby’s lips, and allow them to latch on to the teat. When they let go of the bottle, it’s okay to offer it again, but don’t insist they finish the whole feed. Your baby can tell when he/she has had enough.

7. Newborns and breastfed babies trying bottles for the first time often prefer a slow-flowing teat. Be patient while they learn this new skill.

8. Spend as much time with your baby skin to skin as you can. This calms and soothes, and helps to build your baby’s immune system.

9. In the early days, your baby has a tiny stomach and needs small amounts of milk, very frequently. If you are able to give your baby colostrum at this time, even for a single feed, this is a very healthy start for them.

10. If you are in any way unhappy or unsure about your situation, you can talk to a Breastfeeding Counsellor. We won’t try to dissuade you from your decisions, but will listen and support you. You can call the NCT Feeding Line from 8am-midnight, every day, on 0300 3300 700.

22 Apr

Andy’s Birth Story

It was that strange time of year between Christmas and New Years, my Wife Amanda had just hit 38 weeks so we decided it was time to get absolutely everything organised for our pending arrival, putting away the christmas decorations and getting all the clobber out we had bought for the baby. After relaxing in front the TV my wife called out my name from the downstairs toilet. Subconsciously thinking about the spider I had seen by the front door a few days prior, thinking I was going to rescue her from an Arachnid, I was met by a worried looking wife saying ‘I think my waters have just broken.’ My first thought was our baby had taken us getting organised as a hint we were ready for him/her to come out already! You could have had given me 100 guesses at that point and I would have not guessed that’s why she had called my name.

A quick call and trip to the Maternity block confirmed everything was starting to happen, then knowing we would be parents within the next 24 hours or so was very surreal indeed, I always knew it was going to happen at some stage but not right now! To this stage Mandy hadn’t really had major pains, just light period type of cramps; being a Brit I thought a cup of Tea would make things more comfortable, but by the time I got up to the bedroom contractions had already started. We tracked contractions via a mobile phone app and after 2 hours of contractions (1 less severe hour and 1 10/10 pain score hour), following directions from labor ward to stay at home until we’ve had 2 hours of severe contractions, I remembered a warm bath could be of comfort. As soon as my wife’s ass touched the water she said she felt like she needed to push. Trying to control the nervous wobble in my voice speaking to the triage midwife, remembering being told previously if my wife needs to push at home to call an ambulance, I was asked if I felt my wife could get up there in time, now the thought of a home birth scared the crap out of me tbh so I agreed to get up there sharpish! Walking back in the bathroom to tell Mand the plan, saw what I thought a leg hanging out which fortunately turned out to be a bit of blood and mucus I guess.

After a rapid 3am drive in –3° conditions perhaps ignoring the odd red light or 5, with Mandy hanging off the headrest and interior handle, really really wanting to push, we arrived outside maternity. Mand was wearing my dressing gown and her favorite K Swiss which she had always said she didn’t want to arrive looking like a scruff bag, I also smacked my head on the tailgate due to cold gas struts not fully opening the boot as quickly, I will admit to shouting a few choice phases, glad nobody else was outside as we looked a right pair turning up!

A quick assessment back in the same room as we were in 6 hours previously showed that Mand was 6 cms at this stage, and we were moved to a labor room where we discussed pain relief. Due to Mand having a phobia of vomiting and being concerned Entonox might cause Nausea we discussed all options and agreed to try gas and air with a few contractions to see how it felt. Well after a rather large contraction and Mandy nearly sucking the thing off the wall, she found out it wasn’t so bad but the urge to push was too great. After another ‘inspection’ she had gone from 6 to 10cm in about 30 minutes, although Mandy would admit to having a few cheeky pushes when being told not to! So around 03:30 she was told she could start pushing. Our Midwife, Katy was fantastic and once she had found a position Mand could push in comfortably, forgetting the Entonox and really really concentrating on breathing and relaxation techniques we had learnt about in our NCT classes, made for a very focused and controlled experience. Mand had her head buried in my chest for most of the contractions completely in a zone of breathing and pushing, meaning Katy would tell me what she needed to do and I would in turn communicate with Mand. Keeping breathing slow and controlled, and taking huge breaths to push with seemed to work extremely well and in between visualising walking the dogs, our wedding on the beach or other happy or memorable moments. I remember the guy coming in to visit us in session 5 of NCT saying you might feel like a spare part with doctors, Nurses etc coming in and out but that couldn’t have been further from the truth for us!

After a very quick 40 minutes, our beautiful, perfectly formed healthy Baby Boy was born, the emotion is unrivalled, unexplainable and certainly won’t fade with memory. Seeing my wife holding our son was simply the most emotional, surreal, beautiful thing I have ever experienced. Cutting the cord I was a little nervous as didn’t want to miss and cut his leg off. After having cuddles for a while, he was checked over and weighed, we dressed him together in absolute awe of how tiny our little guy was! On leaving the labour ward it seemed a little strange just to walk out, I will admit to being the type of person that puts the towels straight and leave the room/bed tidy in hotels but it looked like a scene out of the Saw movies, thanks you RBH cleaning staff! We spent a while on Marsh Ward which allowed a few visitors before heading home early evening to start our new lives together, which the first night pretty much went, check on the baby when he made a noise and check on the baby when he didn’t make a noise!

21 Mar

Book Review: The Positive Birth Book, by Milli Hill

This is an interesting and extremely thorough manual for birth, written by Positive Birth Movement founder Milli Hill, whose passion for improving childbirth shines out of every page.

The obvious comparison is with ‘How to Grow a Baby and Push It Out,’ being published around the same time and for a similar audience. But The Positive Birth Book is much less yummy mummy guidebook and more thinking woman’s handbook, with comprehensive chapters looking in depth at the decisions to make during pregnancy, the experience of labour, different kinds of support, ways of working with pain, and a lot less shopping.

Hill takes a strong evidence-based position, referring extensively to NICE guidelines, and with contributions from other very respectable authorities including Birthrights’ Rebecca Schiller and ABM Chair Emma Pickett. Usually I skip through the personal anecdotes, but they have been used really effectively in this book, breaking up an otherwise non-stop march of densely factual information.

A particular strength of The Positive Birth Book is the chapter describing what labour is “really like.” A tricky subject to cover, given all the possible individual experiences, and inevitably it’s a long chapter with some idiosyncratic but accurate descriptions. Hill goes on to argue the case for writing a birth plan, and she’s right that the process involves some engagement with the subject rather than washing one’s hands of any involvement in what might unfold. This is a difficult case to make, knowing that so many women struggle to come to terms with disappointment and grief when birth doesn’t meet their expectations. There is a good case for providing information and some decision-making strategies, which this book also does. A cute ‘visual birth plan’ tool is also offered.

A final chapter provides a taster of post-birth existence, touching on the fourth trimester concept, some basic but happily accurate information about breastfeeding, and postnatal feelings and changes. Here Hill signposts rather than going into much detail, since this would go beyond the remit of this already very detailed book.

I know that much inspiration and information for The Positive Birth Book was crowd-sourced, and the results have been articulately curated by Milli Hill into a really wonderful resource for pregnant women who are keen to do their research and take ownership of their birth experience.

[Disclaimer: I was sent a free review copy of The Positive Birth Book. You can get it from Pinter & Martin, with a 10% discount if you use the code SPROGCAST at the checkout.]