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I'm mad as hell

11/28/2011

15 Comments

 
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.

15 Comments

Babywearing: comfortable concept, uncomfortable reading.

11/24/2011

8 Comments

 
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)



8 Comments

The Dangerous Game of the Feeding Interval Obsession

11/20/2011

328 Comments

 
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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 chat 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 baby care 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 more frequently 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), weight gain and nappies are fine 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.

Of course breastfeeding isn’t just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I’ve not met a parent of a baby who thinks that’s true. Just as we don’t measure our sips of water, sweets and snacks, we also don’t measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love. That's not going to achieve much other than a flat phone battery. And you could miss out on some magic that you can't go back and live again.

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

Originally written 2011. Updated July 2016.

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My book is available now from Amazon.co.uk and from other retailers.

"You may be worried about breastfeeding and worried that it might ‘not work’. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it’s not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us. 

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported. 

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit. 

Success comes when we tap into those instincts and when we know when to get help when our instincts aren’t answering all of our questions. 

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let’s not start this journey by imagining you’ll be someone who won’t make it...!)"

http://www.amazon.co.uk/dp/B019JE5E44

328 Comments

It's not rocket science. It's biology.

11/19/2011

5 Comments

 
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.

5 Comments

The Breastfeeding dad

11/18/2011

12 Comments

 
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.

 




Picture
Picture
My book is available now from Amazon.co.uk and from other retailers.

"You may be worried about breastfeeding and worried that it might ‘not work’. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it’s not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us. 

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported. 

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit. 

Success comes when we tap into those instincts and when we know when to get help when our instincts aren’t answering all of our questions. 

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let’s not start this journey by imagining you’ll be someone who won’t make it...!)"

http://www.amazon.co.uk/dp/B019JE5E44

12 Comments

A word on breastfeeding out and about...

11/15/2011

2 Comments

 
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.



Picture
My book is available now from Amazon.co.uk and from other retailers.

"You may be worried about breastfeeding and worried that it might ‘not work’. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it’s not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us. 

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported. 

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit. 

Success comes when we tap into those instincts and when we know when to get help when our instincts aren’t answering all of our questions. 

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let’s not start this journey by imagining you’ll be someone who won’t make it...!)"

http://www.amazon.co.uk/dp/B019JE5E44

2 Comments

My professional code

11/14/2011

1 Comment

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

1 Comment

    Author:
    Emma Pickett IBCLC

    Find me on twitter: @makesmilk

    Find me on pinterest: 
    https://www.pinterest.com/makesmilk/youve-got-it-in-you-a-positive-guide-to-breastfeed/

    A Lactation Consultant supporting families in North London.

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