Yesterday, I set up a survey on the subject of sex and breastfeeding.
(https://www.surveymonkey.com/s/breastfeedingandsexuality)

I’m speaking at the Association of Breastfeeding Mother’s conference in June on the subject and although surveys have been done before, I wanted a chance to gather some raw data of my own from women currently breastfeeding.

Inevitably it’s a sensitive subject.  Men and women are out there now carving new roles for themselves as parents and working out how to meet the needs of everyone in the family at the same time. And they are tired. And sometimes sore.

And we don’t live in a world that has really got its head around breastfeeding and sexuality.

We encourage women to breastfeed but we blush at the idea that a breastfeeding woman can simultaneously be a sexual woman.

There are mothers feeling isolated and uncomfortable because they continue to feel their breasts are sexual while they are feeding. They worry something might be wrong with them.

There are mothers feeling isolated and uncomfortable because they can’t comfortably see themselves as sexual women while they are feeding. They worry something might be wrong with them.

Perhaps by talking about this a little bit more, we can realise what a huge range of ‘normal’ there is and maybe no one need feel alone.

We ask fathers to support breastfeeding unequivocally and we ask them to put their own needs and desires to one side for a while. Are they even allowed to express them? The views of fathers in a breastfeeding family are the subject of another survey.

For now, I’m focusing on breastfeeding mothers and in less than 24 hours, I’ve had 132 responses to the survey.

It was just over a year ago when I took a call from one particular breastfeeding mother. She was still feeding her 18 month old and they were co-sleeping. She wanted to talk about sex. My immediate assumption was that her partner was uncomfortable with the situation, sex was infrequent and she was looking for ways to try and resurrect their sex life for his benefit. Perhaps she was struggling with her libido. I made all these assumptions in a micro-second.

But in fact, SHE was desperately unhappy with the amount of sex her and her husband were managing to have. And she wanted support with night weaning so she was less tired in the evenings.

Because at the moment, they were only managing to have sex about once a week and they were both completely miserable.

There’s a big range of normal.

Of the 132 women who have so far responded:  woman aged 31-35 make up 34.8% of the respondents.

26% are 25-30.

25% are 36-40.

I first asked how long they had been breastfeeding and I’m only focusing on those currently breastfeeding as I’m not sure our memories can be entirely reliable if we’re looking back after our breastfeeding experience has finished.

A lot of my followers on Twitter are breastfeeding beyond 12 months which may not represent the average experience of the general population but I think provides some interesting insight into how breastfeeding might affect sex in the longer term.  A lot of the initial response probably came through Twitter.

14% are still feeding at 3 yrs+.

Overall 47% were still feeding beyond 12 months and the rest were scattered in the age groups below 12 months.

5 women had been breastfeeding less than a month.

I asked how long after the birth of their most recent baby they had resumed having sex. It was completely up to the individual woman how she chose to define sex. 

30% had had sex before their 6 week check-up.

67% had started having sex again by the time their baby was 3 months old.

89% had restarted by the time their baby was 6 months old. And of course, a chunk of respondents had babies younger than this and had yet to restart.

How did the women feel breastfeeding had affected their libido? Predictably the majority, 63%, said their libido was lower but felt this was about new parenthood and not necessarily about breastfeeding. Tiredness was a theme that came up again and again in the comments.

20% felt their libido was the same as before they were breastfeeding.

And 15% felt their libido was lower because of breastfeeding.

How often are breastfeeding mothers having sex?

1% every day.

14% more than twice a week.

23% about once a week.

20% more than once a month.

29% less than once a month.

And how often do breastfeeding mothers initiate sex? 35% never initiate it. 65% do.

How do breastfeeding women feel about their breasts being touched during sex?

29.8% prefer not. 24% aren’t sure about nipples being touched. 22% say ‘any breast contact is popular’.

I then asked women how they felt their partners’ views about sex had changed now that they were breastfeeding. The vast majority felt there was no change. A small group felt their partner was more enthusiastic (sometimes due to increased breast size). A small group felt their partner was wary of touching their breasts and concerned about triggering a letdown ( a milk ejection reflex).

Some women were unhappy their breasts were being touched less and wished their partners were less reticent. Some women preferred their breasts not to be touched and were also wary about milk appearing.

Are breastfeeding women happy with their sex life?

9% say ‘Yes, very’.

39% say ‘Yes, pretty much’.

39% say ‘No, I wish I had sex more often’.

2% say ‘No, I wish I had sex less often’.

12% are unhappy for other reasons.

And how has being a breastfeeding mother affected their feelings about their self-image and their body? Some typical quotes:

I love it more than ever, I respect the magic of being a woman much more and I know I'm a goddess

I don't think BFing has changed it. But pregnancy did. I was happy with it during pregnancy, but now weight 20 pounds more than before, and my tummy looks deflated and lumpy.

It's actually made me feel more sensual

Breastfeeding has been a positive factor. My libido has crashed due to PND [Post-Natal depression].

I feel more powerful & strong, and this confidence makes me feel sexier.

I feel flabby, droopy and unattractive despite my partners reassurances. I'm sure I'd feel more like having sex if my baby slept for more than 2hrs together!

I love my breasts and that they are feeding my baby. I don't like my post baby body. I don't know how much of my aversion to sex is from birth trauma and how much is due to breastfeeding.

I feel more comfortable about not being perfect.

Feel pleased with myself that I’ve managed it for so long but often get 'touched out'. Body shape is ok, much like pre birth. Be nice if attractive nursing bras didn’t require a second mortgage.

I love it my breasts are very slightly bigger than before and I feel very womanly.

I see myself as a mother before anything else, and my leaking breasts reaffirm this. I do not feel at all sexy or sexual.

I'm overweight, with big saggy old boobs. Breast feeding makes me feel that my body is doing great things, even if it doesn't look it's best. It's the best thing about my body at the moment

103 women responded to the question about self-image. 66 either said breastfeeding had not affected their self-image or expressed positive feelings about their breastfeeding body – pride, self-confidence, a sense of womanliness. 37 felt more negatively about their body and their self-image.

I hope more women will respond to the survey. It’s completely anonymous and I have no way of tracing the respondents. At the conference, I will be speaking to a lot of breastfeeding counsellors, breastfeeding supporters and healthcare professionals. We all benefit from knowing more about how breastfeeding mothers are really feeling.

And as breastfeeding mothers, we benefit from not feeling alone and from knowing that there is almost certainly someone out there somewhere who feels the same as we do.

You can find the survey here:

https://www.surveymonkey.com/s/NJZR9PB

https://www.surveymonkey.com/s/breastfeedingandsexuality

I’m sometimes asked by mums-to-be or their family with chequebook poised, what do people need to breastfeed?

When you’re pregnant, what do you need to add to your list and what can you usefully do to get ready?

A lot of people are desperately keen to breastfeed and are determined to make it work but most of their commitment to breastfeeding in pregnancy is buying a super expensive breast pump, a bunch of bottles and a steriliser.

Hold your horses.

That might all prove to be useful and especially useful if you are intending to be one of the many women who provide breast milk to their child once they return to work - but there are other things to prioritise in the beginning. 

If something goes wrong, a breast pump might be your salvation but companies like Ameda can dispatch you a breast pump to arrive the next day and it will be hospital-grade and fully serviced and you won’t be stuck trying to patch through with the breast pump you probably bought for a completely different purpose. (http://ameda.co.uk/ameda-elite-hospital-grade-breastpump-rental-program)

The most useful thing you can do in pregnancy is get information.

That’s better than getting anything else.

Because unless you live in Alaska, most other things can be sourced efficiently and effectively should the need arise and having a house full of them may not send the best message to your psyche.

That might sound trite, but your belief in your own potential and your belief that breastfeeding is going to work and your faith that it probably will is part of your arsenal. Those who start with a ‘hmmmm, well, I’m going to give it a go and just see what happens. If it doesn’t work, at least I gave it a shot’ might be missing a piece of the puzzle. Your commitment and your understanding that you are a big piece of why this is going to work is pretty crucial.

Of course, for some people it might not work out. But the truth is that for the vast majority of people who really want it to work, it does. If you are prepared, if you know where to get help and when help is needed and you get help soon enough – the chances are you WILL be OK.

Those who give up early on and are unhappy about it, didn’t recognise when problems were occurring, didn’t realise what was normal breastfeeding behaviour for a newborn and struggled to find help when they needed it.

So what pieces do you need for your puzzle?

1.       Read about breastfeeding. 

 This can start early. Do you really need to read a lot about the benefits of breastfeeding? Possibly not, but you might still not have an understanding of why exclusive breastfeeding is recommended.

Read some studies – not just a couple of pages in a jolly leaflet. This stuff matters.

You may well spend hours carrying around a book of baby names.  Devote hours to this as well. Take some time to really understand what breastfeeding does for your baby and what NOT breastfeeding may do. There are links to many many studies here:  http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/

But read some books too. Books like ‘The Food of Love’ by Kate Evans or ‘The Womanly Art of Breastfeeding’ published by the La Leche League or Dr. Jack Newman’s ‘Guide to Breastfeeding’ or his ‘Ultimate Book of Answers’.

Make sure you have an understanding of the relationship between ‘supply’ and ‘demand’ in breastfeeding, what a good latch and body position looks like and what is a normal pattern for the first few days.

2.       Think about how breastfeeding might link with your other parenting choices. 

 Research tells us that the majority of mothers who breastfeed sleep in the same bed as their baby for all or at least part of the night for at least some of their breastfeeding experience.

They might start out believing strongly that this won’t happen to them but somehow along the way, it seems to end up feeling like the best choice.

It’s important it doesn’t happen accidently but happens with careful thought.

Bed-sharing isn’t safe for all families but with the right precautions it can aid breastfeeding and make a family safer as a result.

You can read some important guidelines in the UNICEF ‘Caring for your baby at night’ leaflet: http://www.unicef.org.uk/BabyFriendly/Resources/Resources-for-parents/Caring-for-your-baby-at-night/

If you want to look at this issue even further, take a look at some of the work of Dr Helen Ball (http://www.dur.ac.uk/sleep.lab/projects/bedding-in/). Her study on where infants sleep in the post-natal ward and how this impacts on breastfeeding is a real eye-opener. Also have a look at the work of Dr James McKenna: (http://www.naturalchild.org/james_mckenna/)

Using a sling - not a structured upright baby carrier where the baby’s weight is compressed onto their lower spine, but a wrap or sling that allows your baby to rest in their natural position and with their baby weight evenly distributed – is something that also seems to fit naturally into the breastfeeding relationship. You can read more about this exciting world of shopping possibilities on www.thebabywearer.com and how the decision to ‘wear’ your baby is about so much more than shopping or ease of travel on the bus.

3.       Write a feeding plan.

 Got your birth plan? Write a feeding plan too. One sheet of A4 that explains to everyone around you what you consider important:  your priorities for skin-to-skin and that early feed, what you want to happen in the event of a c-section or your birth going in an unexpected direction. On that sheet have phone numbers of helplines and local support and some key phrases to help you focus on what early latching and positioning will look like.

4.       Find that local support

 Don’t leave this until you are sitting there in a dressing gown with sore nipples, wondering what happened to the last couple of days.

While you are pregnant, do your research. You want 3 types of support – someone on the end of a phone, someone who can come to your home, and local groups where other mothers meet and you can develop a network of peer support and coffee friends.

Your midwife might be able to point you in the direction of all three.  But if not, get hassling.

In the UK, there are FOUR charities that support breastfeeding: The Association of Breastfeeding Mothers (ABM), The NCT, the Breastfeeding network (BfN) and the La Leche League. Their contact details can be found on my links page. There are FIVE breastfeeding helplines. One for each of the charities and a fifth – the National Breastfeeding Helpline – funded by the Department of Health and staffed by the ABM and BfN.

In different parts of the UK, different charities are more active than others. You might have an active La Leche League group round the corner from you – with a dedicated La Leche League Leader and a network of supportive mentors. Or an NCT or ABM counsellor who does home visits and is a devoted volunteer. Or a Breastfeeding Network supporter who runs some local drop-ins and is a star. You might have to phone the charities to find out who is in your area.

Find who they are, talk to them WHILE you are pregnant and even better, if you can, go to a group and see some people breastfeeding. This might sound a bit weird but it really isn’t. It makes a huge difference to see some good latching and different positions and talk to others about their early days. You will be welcomed.

If someone asks you what lovely present they can buy you -  the babywipe warmer or the cashmere booties? – ask for a session with a qualified lactation consultant (IBCLC). Get one round to check your latch and positioning in the first few days and answer a thousand different questions about breastfeeding and check to see you are on the right path. You can find who is your local LC by checking www.lcgb.org listings. Ask them to show you their IBCLC badge and check they have professional indemnity insurance.

You should also find some of your antenatal education focuses on breastfeeding. This will vary enormously depending on the type of class you are able to find. It’s a good place to find out who is active locally and start to build up the network of peers who may see you through some tough times.

5.       Tell the people you love why breastfeeding matters.

 Buy your mum ‘The Food of Love’.

Get your partner to read the UNICEF page which links to relevant studies.

Make sure people know how important this is to you and what a normal breastfed baby does in the first few weeks and what growth spurts are and what cluster feeding is. Tell people to spend an hour on www.kellymom.com and they’ll learn some things that will help them to become members of your team.

For many of us, the first time we see breastfeeding up close is when we will do it ourselves. That’s not always going to end well.
 
 We don’t live in a culture where we’ve absorbed latching and positioning and normal breastfeeding behaviour since we were little girls. We live in a culture where bottle-feeding has been the norm for decades and as infants, fewer of us were breastfed than at any time in history.

If we want to change that, it's down to us.

Pregnancy is a great time to learn more and take responsibility.

It’s exciting and scary all at the same time – as are most things that are important in life.

And one little warning - once you start reading, it’s not always easy to stop!

I’m hoping it’s a myth that the term ‘Breastfeeding Nazi’ is thrown around willy-nilly. Usually I’ve seen it being talked about in the context of what a bloody stupid phrase it is and how could anyone possibly use it and be so dismissive of concepts like genocide, fascism and racism.

But I have to assume it’s been spoken in anger a few times genuinely. I’ve heard a minor celebrity chuck around the phrase ‘breastapo’. I imagine it can’t simply be restricted to a tabloid column.

It seems to refer to the idea that there are a group of breastfeeding supporters (who might call themselves ‘lactivists’) who are focused on demeaning mothers who use formula milk with their babies and see the role of breastfeeding promotion and protection as synonymous with making formula-feeding mothers feel rubbish.

I don’t know where these people are. I’ve been to conferences, breastfeeding picnics, training days, informal get-togethers, committee meetings with Breastfeeding Counsellors and professionals and Lactivists and I’ve yet to meet someone who would fit this description.

Oh, how I wish I would meet one because it would be a joyous moment to be able to sit one down and have a conversation with one of them and ask them what the hell they are playing at.

And if I ever met a mother who had met one of these people (haven’t had that experience either), I would ask them to write a letter to whatever organisation they were from and complain just as I urge people to complain about poor experiences at the hands of health professionals.

 I know enough about the training offered by the NCT, Breastfeeding Network, Association of Breastfeeding Mothers and the La Leche League to find it highly unlikely anyone who has completed that 2 years+  training focusing on listening and empathy and helping an individual woman to reach their goals could ever be blatantly unkind to a mother who is not breastfeeding.

If someone gets through the training of any one of those organisations and can fit the criteria of a ‘breastfeeding Nazi’, those organisations would definitely want to hear about it.

I have to imagine the real ‘breastfeeding Nazis’ are the untrained or the sketchily trained: Women who don’t understand why breastfeeding might fail and are unable to empathise with why a mother might choose to use formula; Women who have their own personal issues that they have yet to come to terms with and lack any delicacy in their ability to deal with fellow human beings in many areas.

This is why I believe I am not one of these people:  I have spent countless hours with families who struggle to breastfeed for a host of complex reasons. I absolutely know how hard it can be for some people and how painful it can be – physically and emotionally. I know it doesn’t work out for everyone despite their best efforts. And I spent a lot of time trying very hard not to upset people.

I often meet people who have already chosen to use formula by the time they seek professional support with breastfeeding. This is true of a lot of IBCLCs.

What on Earth would be the point of alienating these families on the first meeting?

What a breathtaking lack of intelligence and skill that would represent on my part.

90% of the time when a parent tells me they have given their baby formula, it is a fragment of a long story and not the focus of anything useful. It was something they chose to do in that moment based on a series of complex factors. In many many cases, it was the right thing to do at that time. In some cases, it was a decision based on desperation or a misunderstanding (like not knowing young babies might cluster feed for a period of 24 hours) but it was still a decision based on the best knowledge they had at that time.

Of course, I meet the people who desperately want to make breastfeeding work.

I rarely meet the people who don’t even want to try.

But don’t assume those of us qualified in breastfeeding are intent on treating those women with disrespect either.

We reflect on why families may not choose to breastfeed in our training and we get that a mother using formula in a cafe may have a background that includes issues such as insufficient glandular tissue, hormonal abnormalities, a history of breast cancer, breast surgery, significant childhood burns or sexual abuse.

We WILL NOT be the people raising our eyebrows at the mother mixing her formula bottle. Lactation Consultants and qualified breastfeeding counsellors should be the LAST people to do that because even if you weren’t one of those people and you simply didn’t fancy breastfeeding, we will still go out of our way to offer a smile.

We want you to walk away and remember our face as a friendly person.

You might want to give breastfeeding a go next time. You might need us in the future.

You might have a friend who is struggling with breastfeeding, perhaps a friend who is mixed feeding, and we want you to feel we are a person you can trust. We hope that we are.

A Lactation Consultant is professionally REQUIRED to support an individual mother to reach her goals. If a mother tells us she wishes to wean at 3 months, we support them to do that. If a mother wants to breastfeed once a day and formula feed the rest, we support them to do that.  We work with a lot of people who want to try and return to 100% breastfeeding after using some formula but we also work with a lot of people who simply don’t. They want to continue using some formula and THAT is their decision. We are professionally required to support them and we do so warmly and empathically.

A few times I’ve been in conversation with a new mum who is exclusively breastfeeding successfully and they ask a question about whether to introduce the odd bottle of formula.  Maybe they have a friend who does it and they don’t have to 'worry about pumping' or they’ve heard a rumour it might give longer blocks of sleep. They want to talk it through. These mums are asking for information and in those cases I do give it. I talk about why exclusive breastfeeding is recommended and how occasional formula use can change the Ph level of their baby’s gut. I discuss how this will then affect the bacterial colonisation of the baby’s gut and the symbiotic relationship between friendly bacteria and our human immune system and how these friendly bacteria help the breastmilk to protect the baby’s blood stream from allergens and pathogens. I talk about how giving formula might impact on a mother’s milk supply. I talk about the research surrounding formula feeding and sleep and how the digestion of an increased proportion of dairy casein proteins may have a negative impact on a baby’s sleep cycle and healthy sleep as well as a rumoured positive one.

I usually find that a mother asking this question has read a lot about the benefits of breastfeeding and has perhaps attended some antenatal breastfeeding education but is completely unaware of how formula use might change things. We might throw the term ‘exclusive breastfeeding’ around but it’s rather stunning how many people don’t understand what that actually means and even why it’s the recommendation.

Would I give all that information to a mother already formula-feeding? 

Extremely rarely.  Because it would be inappropriate and usually painfully unhelpful.

I give it to women who HAVE the choice about whether to exclusively breastfeed and are mulling that decision over. If a woman has the luxury of making that choice, they usually respect someone who gives them straight information appropriate for their situation. And if I meet that mum next week and she chose to use formula despite the information I gave, that was her choice. I want her to want to come next week.

So I don’t go up to the mother who is feeding formula to her premature baby and talk to her about risk of SIDS. That conversation may arise if a mother has opened a dialogue or if they are encouraged by the amount of breastmilk they are now able to express - if that information might be motivating or helpful. But there may be times when it would be the least helpful thing possible to say.

Lactation Consultants and Breastfeeding Counsellors tip-toe. We are careful. We know that we live in a society where not everyone gets the information we would like them to have about breastfeeding but  we also know that we are unable to look inside everyone’s heads and see if that information is there.

If we get it wrong, please call us on it. Because the requirement for professional reflection and self-improvement exists every day and after every interaction.

I want there to be exceptionally good quality antenatal education. I want every woman who wants to be able to breastfeed, receive the support to be able to do so. Because it’s often the women who don’t, who become the angriest.

They are so angry at the system failing them, the information they were not given, the helpline call that was never answered, the things their antenatal class did not tell them - that they understandably want to lash out on occasion. The Breastfeeding Counsellors might seem like the just the sort of smug bunch who deserve some of that lashing.  We are often in love with our own breastfeeding experience – perhaps nauseatingly so.  We talk about it being ‘the best experience of our lives’. We might wear little badges and T-shirts. It’s easy to see just how frakking annoying this all might be to the person whom breastfeeding didn’t work out for.

However it’s too easy to perceive a raised eyebrow or imagine someone turning away from you in conversation when you are livid and sensitive and in pain.

We may not always understand each other's motivations.

Accepting you do not understand someone’s decision (to breastfeed the 3 year old, to formula feed the 3 week old) does not mean that person should not be treated with kindness, care, consideration.

If anything we should try harder to be kinder to the people we do not understand. It's how dialogue happens, how we learn how to support fellow human beings, how the future gets better.

It’s in professional codes of conduct and it needs to be in every action, gesture, glance between every mother.

I spend a big chunk of my life talking to new families and supporting them. I offer breastfeeding support at 3 children centres in North London. I meet a lot of people in the first few days after they’ve just given birth and often see them through the following weeks or months.

I have taken approximately 700 helpline calls in the last 4 years and the majority of those were from parents in the first month post-partum.

It’s an honour to be in a position where I can feel I am making a real difference to people’s lives.

But sometimes I feel like climbing to the top of the BT tower and screaming from the top of my lungs, “I’m mad as hell and I just can’t take it anymore.” (as Peter Finch did in his Oscar-winning performance in the film ‘Network’, though he was less concerned about boobs).

Something has gone fundamentally and criminally wrong in the way breastfeeding is supported in this country.

It’s gone so wrong, it’s jaw-dropping. Some of it is surreal. Some of it is literally incredible.

Typical story:

Mother gives birth in a hospital. She might come across a midwife who is able to offer her some initial breastfeeding support. She may come across 5 who all tell her something slightly different, using slightly different phrasing. Oh – and one grabbed her breast and shoved it towards the baby.

Mother leaves hospital and she is sore. Something is going not quite right with breastfeeding. She perseveres and her midwife visits in the next couple of days. However she is never given even a rough idea of when the visit might occur – just a day – so she can’t plan her baby’s feedings to correspond with a visit and when she gets lucky the midwife can attend only briefly. She says something else that contradicts entirely something the new mother was told in hospital.

The mother is getting sorer.

She calls a helpline. Maybe the National Breastfeeding Helpline. The breastfeeding counsellors there are well-trained and they can help.

But let’s pause for a moment – this new mother has spent many hours in a hospital under professional care. She’s under the care of a midwife. And her best shot now rests in the hands of a volunteer who trained with a charity – a charity which counts the pennies and struggles to meet their goals as government grants disappear. This volunteer has one child watching Peppa Pig in the room next door, another asking for crackers and dinner on the hob.

Can this mother get a home visit from a trained breastfeeding counsellor? That is utterly dependent on whether she happens to live near a volunteer who has a home life which can support that possibility and the money for transportation. A counsellor may come and visit but no one will be paying her expenses. Often a counsellor might not be available and will do the best she can over the telephone.

A midwife might come again. She might even say, “the baby’s latch looks OK” and when the mum seems doubtful she will refer the mum to some local support groups.

These local groups will again often be run by volunteers and may be in children’s centres where funding has been slashed and there are now closed for certain days of the week or for several additional weeks each year.

Maybe the mum has had a c-section and can’t travel.  The breastfeeding counsellors on the telephone have tried but they suggest a face-to-face consultation with a trained expert is really needed to find out what is going on.

The mum pays £60-75 for a consultation with a lactation consultant she finds through the Lactation Consultants of Great Britain website (lcgb.org).

The IBCLC immediately identifies the baby has a tongue-tie and needs a small procedure at the local hospital. The tongue is released the next week and the baby goes onto to breastfeed successfully for many months.

That story is not freakish or strange. It’s pretty standard.

The baby’s tongue tie was supposedly ‘checked’ by the paediatrician in the hospital. It wasn’t picked up by the midwife. The telephone support wasn’t able to pick it up. Luckily that mother had the money to pay to see an IBCLC or breastfeeding probably would have ended within a few more days.

Or maybe the baby didn’t have tongue-tie. Perhaps the IBCLC just gave some support with latching and positioning that for some reason the midwife was unable to give.

I write out that story and I see faces of mothers and babies flash in front of my eyes. The mother with the 6 week old who had been struggling to breastfeed with damaged nipples and had finally made it to a breastfeeding group and we could see the baby was significantly tongue-tied within a minute. The father who tried to describe the range of advice they had received in 24 hours: feed from each breast for 10 minutes, for 30 minutes, just stay on one breast, stay on one breast until the baby loses interest and then offer the other. The mothers who are confused and distressed at the most emotional time in their lives.

This system is FAILING.

I sound like I’m blaming midwives. I’m blaming the system that governs them. I don’t believe for one second a midwife would CHOOSE to only get to spend 20 minutes with a desperate new family and then thrust some information about groups and dash out of the door. Hospital midwives might be supporting 10 women on a post-natal ward overnight.  Several of them might have had c-sections and not even be able to lift their own baby. Hospitals might employ a lactation consultant who probably only works office hours. You might even bump into some volunteers who offer breastfeeding support on the ward. But a common tale is a mother desperate to get out of there. Or maybe the dad is phoning a helpline from the pavement outside the hospital (there’s been a good selection of those in my 700 calls).

I spoke to one midwife (who went on to train as an IBCLC and become a specialist feeding midwife) and  she recalled  hiding in the nurse’s station because she knew a mother needed breastfeeding support and she just didn’t feel up to the job.

And why is there even such a thing as a midwife who specialises in breastfeeding? Surely that demonstrates the flaws in our system eloquently. Why aren’t ALL midwives specialists in breastfeeding? If they are not, can we please get some people who ARE into new families' homes in the first couple of weeks?

Can I blame the system that governs health visitors too? The system that results in some golden health visitors who know exactly what they are doing. And others who see a baby struggling to gain weight and literally have nothing else to say other than ‘top up with formula’. They know nothing about how a mother might improve the efficiency of latching and positioning or use breast compressions with a sleepy baby or how a mother might develop her own milk supply or use expressed milk as a top-up.

This whole system is based on luck and fluke and more often a lack of lucky fluke.

And thousands of mothers and babies are being failed every single day.

The last full national infant feeding survey to be published recorded that 90% of mothers who gave up breastfeeding in the first 2 weeks wanted to continue.

That’s such a massive group of women being failed in hospitals and by a lack of community support up and down the country. They are starting new motherhood with a struggle and sadness and that can never be recovered from entirely.

And these mothers can be so angry. And of course they should be. They’ve been fed a lie that we are a breastfeeding-friendly NHS and a breastfeeding -supportive system. Wouldn’t you assume your midwife had a clue about breastfeeding beyond the basics? You might even assume they had equal training in breastfeeding to a breastfeeding counsellor – whereas a midwife might have had a TENTH of the training that volunteer handing out crackers has received. Wouldn’t you assume a paediatric consultant knew how to identify a tongue-tie in an infant? And would be looking for one?

We live in a country which mumbles the phrase ‘BREAST IS BEST’ (Oh, how I hate that phrase because breast isn’t ‘best’, it’s just normal). We have the posters and the snazzy pens and the helplines but it’s a system built out of balsa wood. Held together by PVA glue mixed with water.

The support IS NOT THERE.

What should happen?

Let’s start by aiming for UNICEF baby-friendly status across the country and get people properly trained. Let’s look at the quality of night staff and agency staff in hospitals in particular.

But before we even get there, let’s give everyone who deals with mothers and young babies ONE sheet of paper that describes a handful of basic facts:  the importance of mother and baby skin-to-skin, what a good latch and body position looks like, how a young baby might feed on one breast for 10-45 minutes and may or may not want the other side, how to tell if a baby is swallowing, what nappies look like in the first week, how cluster feeding and growth spurts work.

Put that on one side of A4. Give everyone an hour to look at some online videos of good latching and a bit of breast compressions. How much would that cost?

Give health visitors another sheet about latching and positioning, techniques to increase milk supply and ways to optimise breastfeeding management. Of course, some know this and a great deal more. But let's give out these sheets and start conversations where the golden ones have open dialogue with the health visitors that need the basic information desperately.

I think those 2 sheets of A4 could do a lot. And they already exist in various forms but who has the inclination and money to distribute them. Would all midwives and health visitors read them?

Because there are midwives who believe their ’10 minutes one side, 10 minutes the other side’ is right and their overconfidence is hurting new families all over the country.

There are GPs advising mothers to stop breastfeeding because they have mastitis or misunderstanding the symptoms of nipple thrush and their overconfidence is hurting new families all over the country.

Distribute those A4 sheets and give those hours to watch videos and of course it saves money in the long-term.  Some babies aren’t readmitted with dehydration or with gastroenteritis in their first year. Some employees have less absence when their 7 month old baby is still breastfeeding and has a reduced likelihood of ear infection or respiratory infection.  And a reduction in likelihood of illnesses and conditions carries on into adulthood. A baby girl breastfed is less likely to develop breast cancer herself.  How much training do you think can be paid for out of the bill it would cost to treat one woman with breast cancer?

Train health professionals in breastfeeding to an adequate level and we save money over decades.

But it’s not happening and those of us passionate about breastfeeding are picking up the pieces. And the health professionals in the system can only be stretched and miserable too.

I’m mad as hell and it appears I just have to take it. Because this is the ‘big society’ where money leeches out of the NHS and the people handing out crackers give the frontline breastfeeding support.

What will change it? If every mother and father who had received poor information in hospital or in the community subsequently wrote a letter to say so – the system would start to notice. If hundreds and thousands of letters came pouring in, that cannot be ignored.

So the next time you meet a mother who tells you about an experience that falls short of what they deserve, urge them to write that letter. It’s a small start.

There are a million other things we could do but we can at least start there. Let’s at least start telling people we’re mad.

Definition
Babywearing [verb] : carrying a baby in a soft pouch, sling or wrap - sometimes for several hours in a day. Babywearing is often about a physical convenience but advocates also believe it has an important emotional and psychological benefit to the mother/ baby dyad.


Why do you think babywearing often seems such a natural step for a breastfeeding mother? Why is it that when you go online the parenting sites that are openly supporting breastfeeding past 12 months inevitably have a membership also passionate about slings and babywearing?

It doesn’t seem much of a stretch to suggest that when a mother achieves the biological norm of breastfeeding successfully, babywearing naturally follows and is often an integral part of that instinctive natural parenting style.

If we are advocates of breastfeeding, then babywearing is profoundly and intimately connected with that and should be. There is evidence that is hard to ignore. It’s not fashion any more than breastfeeding is fashionable.

It is not the babywearers who should justify themselves but those found really only in modern industrial societies who value a baby’s ‘independence’ and ‘self-reliance’ over their natural evolutionary instincts.

As Meredith Small says in her book, ‘Our Babies, Ourselves’: ‘during 99% of human history the pattern  of infant eating, sleeping and contact was thus – human infants were carried all the time, probably slept with their mothers and fed frequently throughout the day’.

A society losing touch with the concept of mother/child physical closeness finds that losing touch with breastfeeding is really not far behind.

And is it really just coincidence that as breastfeeding rates climb again it becomes less and less unusual to see a baby in a Moby Wrap in the supermarket queue?

To promote babywearing and discuss it as the biological norm obviously can make other mothers who choose not to do it uncomfortable or even feel guilty (here comes the 'uncomfortable reading' bit). There are able-bodied mums who would be perfectly capable of baby-wearing but will instead strenuously support their desire to travel around town with £400 worth of baby tank in the belief this is more 'convenient'.

A Bugaboo Cameleon currently retails at Mothercare for around £765. For that price, you could get a decent sling and actually hire someone else to walk alongside you carrying your baby for you.

The anti-babywearing group make statements like:

 ‘It wasn’t right for my family’,

‘Not all babies are the same’,

‘I didn’t do it with my baby and she was perfectly happy and healthy’

‘My friend did it with her baby and she was so attached she could never put her down’

‘Perhaps it was the best thing for my baby but I don’t think it was for me and of course – a happy mother means a happy baby’

Or

‘I tried it but I could never get comfortable. I tried to find someone to show me how to do it properly but I could never get the hang of it so I gave up’.

These arguments sound familiar to those of us working in the frontline of breastfeeding support.

And just as we may tip-toe the line between promoting breastfeeding and NOT making those who choose to formula feed feel guilty, there is some evidence that is impossible to ignore with babywearing too. Whether or not we make past or present mothers feel uncomfortable cannot be the driving force. New families are entitled to the correct information and then they can use that to make the choice that feels right for their family. But without information, there is not a genuine choice being made.

Our society – that is the Western industrialized society – is an unusual one.  As Gabrielle Palmer wrote in Politics of Breastfeeding: “Western culture seems to have a drive to separate mothers and babies. The goal of independence starts at birth and mothers who want to stay with their infants most of the time are viewed as ‘possessive’ or ‘eccentric’.”

In the society where babywearing is rare, breastfeeding rates are lower. Why? We can assume babywearing makes breastfeeding easier, more effective, more likely to continue. 

Perhaps there are also reasons deeply seated in our culture. The society that wants a baby to be self-reliant as soon as possible, self-soothe and sleep independently then creates adults who as parents have less inclination to babywear or embrace breastfeeding.

Anthropologists have noticed an undeniable pattern.

Dr. James Prescott has made a career out of identifying the origins of violence and social alienation. In a series of studies for the American National Institute of Child health and Human Development, he found that he could predict with an 80% accuracy the peaceful or homicidal violent nature of 49 tribal cultures from a single measure – was the baby carried for the majority of the day for the first year of life?

Jean Liedloff in ‘The Continuum Concept’ places a very very high emphasis on this ‘In Arms Phase’. And if this is missed the child lacks a fundamental piece of their confidence and emotional development. So we can assume those reading (and writing this) are deficient then? Well, she would say ‘yes’.

She says “normal deprivations are now so tangled in the meshes of our cultures that they are almost unremarked except at such extremes as manifest themselves in cost and danger to the rest of us (through violence, insanity and crime for example)”.

Noone wants to be told they have made parenting mistakes. It is the sort of discussion that cuts to our core and there is noone angrier than a mother who is told, 'perhaps you didn't make the best choice'.  I didn't babywear my first child anything like the way I wore my second. He spent time occasionally travelling here and there in a popular brand of upright carrier which I have since learnt resulted in his body weight being compressed on his lower spine and did him no favours either physically or emotionally. Will he be emotionally stunted? A damaged adult? A less responsive father?

I don't know.

Has it been painful reading and researching babywearing? Learning how true babywearing optimises infant respiration, heart rate and growth and reduces crying? Remembering how he spent hours lying in a moses basket with no human contact? I was physically able to carry my baby in a sling for a significant portion of the day but I didn't. Largely because I had never heard it was a good idea. I had never come across a discussion of the evidence and noone had ever mentioned it to me as a possibility. Carriers and slings were simply for getting from A to B. They weren't 'better' than prams. They were just easier than on the bus.

It's not easy reading about what he might have missed out on. But I am not about to stick my fingers in my ears and say, 'La La La La La' and ignore the overwhelming evidence.

It would have been better for him to spend more of his first year in a sling. It would have made his life easier and my life easier.

In a society which prizes mother/baby separation, the promotion of babywearing and breastfeeding is an inevitable struggle.

We may blame the 20th century baby 'scientists'  for instilling us with the strong sense that sleeping through the night, longer feeding intervals and baby self-soothing are the ultimate goals. But in the 21st century the core values appear to be the same.

For Tracy Hogg, 'the baby whisperer', and another best-selling nanny 'guru', the central aim for parents is assumed to be independently sleeping babies with appropriately spaced intervals between feeds.

In ‘Secrets of the Babywhisperer ‘, we are told that on the fourth day a baby should start their EASY routine – feeding ‘every 2 1/2 to 3 hours’. When Hogg discusses babywearing she says, “Parents often don’t know when the comforting ends and the bad habits begin. They continue to hold the baby way past meeting his need...Instead of holding him endlessly, pick him up when he starts to cry but put him down as soon as he is calm...You might have to pick that baby up twenty or thirty times or more”.

It seems that for many baby 'gurus' and sadly for some health professionals in the community too, the baby is not to be trusted. Rather than being seen as a sophisticated product of evolution it is mistaken or at worst attempting to manipulate.

When a baby wants to be constantly held something is wrong. Mothers can create ‘rods for their own back’ with constant attention. It is not in some 1950s nightmare where people talk of how you can spoil a baby.

When we trust baby and trust our own maternal instincts to hold, to respond to cues – breastfeeding is more likely to succeed and humans fit their evolutionary expectations.

Unless we face up to the juxtaposition between our society’s desire to increase breastfeeding rates while simultaneously valuing the separation of mother and baby what can the future be? Will breastfeeding rates simply plateau?

Why do we think breastfeeding is a good idea? It’s not just about nutrition, white blood cells, enzymes and lower rates of diabetes – it’s also about nurturing and emotional health. As Gabrielle Palmer again says, ‘it’s not just the milk that counts’.

Babywearing aids breastfeeding and also aids us to meet the goals that breastfeeding also strives to meet.  When we speak to a mother struggling to ‘put a newborn down’  and pushing against her maternal instincts or guiltily 'confessing' she let her baby sleep near her let’s not assume she has chosen her parenting style or was even consciously aware she had options.

In the future a decent sling may be seen as important to a baby’s overall health as a car seat. And future generations may look back on our sluggishness to babywear as I look back on my parents’ generation in the 1970s who didn’t breastfeeding in their millions and commented they 'didn’t even realize it was important’.

Further reading:

A collection of articles here: http://www.thebabywearer.com/index.php?page=bwbenefits

Hunziker UA, Garr RG. (1986) Increased carrying reduces infant crying: A randomized controlled trial. Pediatrics 77:641-648
The Baby Book. William and Martha Sears
The Continuum Concept. Jean Liedloff.
Dream Babies: Childcare advice from John Locke to Gina Ford. Christina Hardyment.
Why love matters: how affection shapes a baby's brain. Sue Gerhardt.

Our babies, Ourselves: how biology and culture shape the way we parent. Meredith Small.


For support with babywearing:
http://www.slingmeet.co.uk/

Copyright Emma Pickett 2011 (portions appeared previously in Association of Breastfeeding Mothers magazine and in an ABM conference report)

It’s not rocket science, it’s biology. Part 2.  

Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal.  24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number – 90 minutes, 2 hours, 3 hours – as a measure of something sacred.

And it’s crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There’s a disk from a box set in the DVD player, a cup of tea on the go, a recent phone call with a friend. Breastfeeding is going well.  Weight gain is fine.  Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren’t ‘doing it right’. Their friend’s baby ‘goes longer’. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we’re flexible depending on time of day, the temperature, our  mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don’t know any adults that look at their watch and say, ‘Only 30 minutes till my next sip of water or mint!  Not long now’. But yet we expect teeny growing babies to be governed by this artificial notion of time.

I spoke to a new mother last week who was perfectly HAPPY with her feeding routine but wondered if she should start to stretch her baby’s intervals because ‘that’s what you do’. When I explained that it wasn’t necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don’t come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production.  Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that’s all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts ‘refill’. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a ‘problem’ and perhaps the mother even has a supply issue.

It’s scary and extremely frustrating that basic messages about how milk production works don’t reach the people who need them.

So what is normal? Well, how long have you got? Because there’s a lot of normal.  A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Helpline goes like this: “My baby used to sleep in the evenings and now he’s awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he’s on there for ages. Surely there can’t be anything there.” As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But NOT all will.

One of the most popular babycare books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly.  A 3 month old baby might be going 3 hourly intervals but if this isn’t increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn’t know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are ‘better’ and ‘correct’, is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr. Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it’s the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother’s storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast.  Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem? No, it is not. Her baby may continue to feed 2 hourly or even less for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night.  Her friend’s baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend’s baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we’re designed as a species to need feeding more frequently.

But let’s imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby’s intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby’s cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let’s check breastfeeding is otherwise going well:  that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3) and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic ‘interval’ is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home – perhaps learning how to feed in a sling or experiment with different positions for different environments. It’s possible she may be woken at night more than her friend with the longer intervals – though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It’s surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it’s a blink of an eye.

What won’t help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn’t what science tells us is true for all women.

And I’m talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record books records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was ‘wrong’. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK. It really wasn’t for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I’d rather pay attention to my baby.

 

Sources:

Anatomy of the lactating human breast redefined with ultrasound imaging.

DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production.  Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system.  D.B Cox, R.A Owens, Peter E. Hartmann

I’ve got a lot to say about breastfeeding and parenting. Some might be new but a lot of it will be old. In fact that should be spelt as ooooooold. Stone- age old. Pre-stone age old. But it has to said anyway. If I sneak it out during the X-factor live show maybe not many people will notice.

We need  the science bit.

Mammals comfortably split into 4 groups in terms of their parenting styles. These parenting styles are directly reflected in the constitution of their milk – fat and protein and carbohydrate levels vary dramatically among mammals. Guinea pig:  fat levels can be 46%. Human milk: pretty stable at  less than 5%.

We’ve got the cache mammals who hide their young away somewhere hopefully inaccessible from hungry coyotes and potter off and look for food and presumably do other useful things for up to 12 hours. These mammals need to have milk rich in fat and protein and these youngsters are left to fend for themselves. And at birth, the newborn mammal is relatively mature. Think rabbit. You don’t see rabbits hitching a ride on mum’s back. But – hang on - what’s a rabbit going off and doing for up to 12 hours at a time? Let’s not dwell on that bit. They’re cache mammals.

I think you can imagine where I’m going with this.

Nest animals will feed about every 4 hours (Wolves, dogs, cats). The more immature young will huddle in their group and need to feed more frequently than a cache mammal.

Follow animals feed about every 2 hours. Cows and Giraffes are again reasonably mature at birth. They are capable of keeping up.

And carry animals feed virtually continually. Feeds will often be clustered and intervals might be quite short. Fat content of milk is extremely low (Apes, marsupials, us).

In terms of maturity, these carry newborns are as about as dependent as it gets. Without close bodily contact with parents, respiration rate and oxygenation rate, heart rate, growth, stress hormone levels – this stuff doesn’t start to look good.

When it comes to the maturity thing, we are spectacularly rubbish. And you can blame a battle we’ve been fighting for hundreds of thousands of years:  Human pelvis shape Vs. Human brain size. Our brain is enormous and our skull reflects that. But – oooops – we seem to like walking upright and that produces a problem. We need a neat upturned pelvis that holds our weight and gives us nice straight legs. Any more extreme than what we currently have would not be ideal for the easiest birth experience. So nature holds back a bit and we might give birth to a relatively huge-brained baby but brain development is still nothing compared to what it will be. The brain is still barely only a quarter of its adult size. By aged 2, it’s about 80% of its adult size. We do a heck of a lot of our development outside the womb.

Just as little squirmy pink kangaroos are born and wriggle into their mother’s pouch and stay put for as long as they can get away with, so our newborns need us profoundly.

No, this doesn’t mean they need a nutrition fix and then get wrapped up and put back in their moses basket across the room again for several hours. You’ll have caught the bit where we’re not wolves or wild cats.

And nor should we be pulling our hair out if they’re not sleeping through the night for a 12 hour stint at 2 months. Not rabbits either.

You can read more about this if you look into the work of Dr Nils Bergman who has been pioneering Kangaroo Mother Care in South Africa. In his eyes, close contact with baby and frequently offering the breast isn’t about the care of premature or unwell babies. It isn’t some freaky hippy option preferred by the muesli-knitters. It’s just science and it’s who we are as a species. If it makes you sad, by all means try something new and try and find something that works for your family. A lactation consultant can help you try and tweak your baby’s routine.  And yes, constant feeding and unsettled behaviour might suggest a problem that needs addressing.

But know that frequent feeding and a baby ‘that just won’t go down’ is the norm. The baby that feeds and settles and but wakes and becomes unhappy when placed on a cold unhuman surface is the norm. Put clocks away and tap into those millions of years of evolution. Trust that we’ve got to where we are as a species because baby’s exhibit useful cues and we respond. Babies grow with milk and love. And it works.

This message is at the heart of a lot of what we need to talk about when it comes to parenting.

We need to know how things went pear-shaped in the mid to late 20th century and why our breastfeeding rates reached an ALL-TIME low as a species when we tried to impose artificially- constructed ideas onto our biological norm.

We need to know how many of the most popular babycare books on the market today are STILL informed by these 20th century ideas – that were just a blip on the landscape of human society historically and globally.

And there are parents out there right now who think a baby that longs to be in their arms is some kind of personal failing. Phrases like ‘spoiling a baby’, ‘rods for our back’, ‘show them who’s boss’ come from this unnatural blip. Our parents and grandparents embraced the mid-20th century blip and sometimes need desperately to see a validation of their own parenting choices in the decisions that we make. It doesn't make for easy family relationships when we say, "actually we don't feel wearing my baby in a sling or feeding more than 4 hourly is 'spoiling my baby', thanks gran."

New mums who worry that their baby still feeds 2 hourly most of the time at 3 months and that this means something is ‘wrong’ need to know the science of breastmilk and breasts. There are babycare books with sales booming who fundamentally misunderstand how breastmilk storage capacity might impact a mother’s intervals between feeds and have ignored research from the last 2 decades. There are mothers out there who genuinely think they should be aiming for 4 hourly intervals.

More on how biology informs our natural feeding intervals and this new research in the next post.

To be continued.

I worked with a new family for the second time today. I won't go into too much detail but things aren't going well with breastfeeding and mum is in a lot of discomfort.

As I left them today with plans to see them next week, I knew absolutely that the dad was holding them all together. I am not doubting the determination or commitment of that brand new mother recovering from her difficult birth and finding life was tough but that father - of only a few days - had precisely the strength that his new family needed.

He sat quietly while she described her experiences and her perception of what was going wrong, he gently prompted and corrected when it was appropriate to do so and all the time he gave off this force that said, "I know we can do this. I know this is the best thing. We are going to make this work."  He actually said out loud, "We believe in this."


At one point mum was concerned she might not be able to go on and he said softly, "the low point was two nights ago. You've come really far since then. Things are getting better" and he explained how. And she said, "Yeah, you're right" and calmed immediately.

He praised her without being sappy. He took the baby to calm him at just the right moments. He listened carefully to what was discussed because he knew he was part of this breastfeeding thing too.

He knew that in the middle of the night, when she felt she just couldn't cope, it mattered that he'd paid attention to the right positioning and latching. Not least because sometimes it really helps to have that second pair of eyes looking from a different angle and observing whole body position.


Let's just assume for practical purposes that this bloke must be a prat in other ways as no one could be that perfect - however he absolutely knew how to be a breastfeeding dad.


And I see a lot of dads like that.

It's surprisingly often that it's dad who calls the National Breastfeeding Helpline. It's clear something wasn't going right and for whatever reason mum couldn't face making that call. So dad does and almost always manages to get mum on the phone in the end.

And it's dads who research where the breastfeeding groups are, phone the lactation consultants, get the troops lined up when things aren't going well. They give mum the space she needs and over and over again manage to manouver the support just when it's needed. Yes, sure, some of that is because men like to try and solve problems. They see a difficulty and want to fix it in the face of feeling somewhat helpless. But these same 'helpless men' come to consultations and express their worries while empowering and supporting their wives at the same time. It's a subtle and impressive skill. Especially when you're sleep-deprived.


Dads use some of that diplomacy even when things are going well with breastfeeding. Most new parents today weren't breastfed themselves as infants in the 1970s and 1980s. We are the generation of the formula-feeding grannies. Some of those older women become awesome champions of breastfeeding and some struggle to witness something they don't understand. The dads are the knights at the gatehouse - letting through only the right support. They act as the barrier between new mum and mother-in-law who might not know when to step back. They make sure that the new mum and baby can make the nest they need to.

My own husband, who is a chump in about half a dozen different ways, was one of these champions of breastfeeding. It was something he knew nothing about it. But he trusted me. Not for a moment did he doubt my instincts or my drive to try and get this right. When things weren't always straight-forward, he was able to help me find solutions without ever leaving me feeling disempowered. He knew nothing of breastfeeding through pregnancy or feeding older children but he trusted me. He never questioned me or doubted me. He knew exactly when to step in and step back. And it's something I can never thank him enough for. I know it was largely down to his support that I felt able to train as a breastfeeding counsellor and then qualify eventually as a lactation consultant.


And I know that in a few years time, the mother I supported today will feel the same way about her husband.

Most mums won't end their breastfeeding careers as lactation consultants but that same feeling of support will get them through their own challenges. 

Breastfeeding dads might be good at nappies and burping and baths and making sandwiches and passing the remote control but that's a tiny slice of what they can do. They can provide a bedrock where a new mother learns how she wants to be a new mother and where breastfeeding can flourish.

 

In one of my voluntary roles, I am sometimes asked by national and local media to comment on breastfeeding issues. Today I was asked to comment on whether businesses on Kent should offer more breastfeeding facilities to new parents. In the past year, I have spoken on London radio about breastfeeding in public and been asked to give several comments to newspapers.  Breastfeeding in public  is an issue that never seems to go away. Largely because of the ignorance of businesses and services who have yet to update their employees on the ways mothers and babies are protected to breastfeed in public by law. It must be a constant embarrassment for well-know High Street names to have to apologise for the stupidity of people working in their branches up and down the country. But it continues to be necessary.

Mothers and Babies are not allowed to be discriminated against on the grounds of breastfeeding. Their access to businesses and services is not allowed to be restricted. It's not complicated. It really isn't.

The vast majority of the British public don't wrinkle an eyebrow when a baby is breastfed out of the home. But it's the small minority who grab the headlines and give new mothers the wrong impression they will face discrimination. In my 7 years of breastfeeding, I have fed all around the world - on planes ,trains, mountain-sides, cafes, doorsteps, bus stops - and not ONCE have I ever received a negative comment or glance or been asked to stop. The response has either been warm and supportive or indifferent.

Some mums find breastfeeding in public uncomfortable whether or not they might have to deal with an unfriendly comment. They may be struggling with latch and positioning, be feeding an older wriggly child, or feel self-conscious about any glimpses of their post-partum body they might flash to others. For these mums, the offer of a feeding room can make all the difference. It's really not hard for a business to provide one simple room with the right kind of chair and a door. It doesn't need fancy Winnie the Pooh murals or even nappy changing facilities (toilets work for that). A small cafe or business almost always has an office with a chair somewhere even if a separate room cannot be created. We don't mind a bit of stock sitting in the corner of the room and we don't need it fancy. Just clean and the space to sit down. All businesses need is a warm smile and a bit of imagination and THEY will benefit.

To put it simply, mothers have money to spend. We are a powerful consumer force. The Guardian reported this week that the average family spend £5,213 during the baby's first 12 months. This is a vulnerable time for the British High Street. With a tiny bit of effort - the purchase of a couple of Ikea chairs and a bit of paint - that £5,213 is there for the taking. If retailers fail to use a bit of imagination, fail to educate their workforce about the legal rights of mothers and babies, THEY will lose out. Because online shopping with a cup of tea, bit of daytime telly and baby snoozing nearby is an attractive proposition. The postman brings the parcel and noone has to faff around looking for somewhere comfortable to breastfeed.


Breastfeeding rates continue to rise. If UK retailers and businesses don't understand how to harness this powerful consumer market, they will be the ones to suffer.

This link takes you to the professional code of conduct for International Board Certified Lactation Consultants.
http://iblce.org/upload/downloads/CodeOfProfessionalConduct.pdf