Goodbye Mimi

Any day now could be the last time I'll ever breastfeed. It's such a bittersweet time.
On the one hand, I've been looking forward to the last breastfeed for about a year, because it's just a bit uncomfortable feeding a growing toddler/pre-schooler. On the other hand it'll be the end of mothering small children, and in a way we're still hanging on there in that respect.

We haven't nursed in public for a long time now, and only very occasionally in the presence of good friends. That's ok, I appreciate that it's not the norm to nurse beyond a year, and the few negative comments I got did hurt so we kept it hidden. But I'm too defiant to keep it hidden good and proper, after all, I'm not a blogger if it wasn't for a certain happiness to share what matters to me.

All in all I breastfed just over 5 years, and considering the rubbish start to it I had, when I literally kept going just for one other feed, and repeat, I am happy and somewhat proud of this achievement. Not in a way that should make anyone feel less than good about themselves, but there's no harm in feeling good about something.

Snowflake sure was attached to her mimi, This recommended weaning approach of "don't offer, don't refuse" would probably mean she'd still be exclusively breastfed. I had secretly hoped for self weaning but it became pretty clear that this child won't self wean. We've been trying seriously to fully wean for about a year (a process that took a month with Cubling). This is what she says about mimi: "It's so yummy, it tastes like chocolate, cheese, yoghurt and strawberries". Tonight, for the last time ever, I fed her to sleep. This magic moment when you watch your baby relax all muscles and surrender to sleep.The calmness, oneness, the being in the moment of it.

She hadn't asked for mimi in 4 days but I needed at least one last feed that was a proper closure, rather than the reluctant, half asleep 4am one that was the previous potentially last feed. Of course I don't know if this was it for good, but we're not far off.

While I'm a bit nostalgic about moving on, it's the right time too. This child of mine is growing up, she is independent and really doesn't need this particular comfort anymore.

I'm holding on to the memories, lest I forget, recalling them in these last suckles.
Syringe feeding her colostrum in hospital, my mucussy c-section baby.
The frst proper milk feed, still in hospital, and her milk drunk face captured on my phone.
The amazement when I realised that breastfeeding could be pain free. The anger when I realised that something could have been done about the pain I'd experienced 3 1/2 years earlier and that it was only now that I found out about tongue tie and lip tie.
Waking up due to fullness and this tiny moany cry right beside me, instead of sleeping through and possibly waking up to her never waking up again.
Feeding her through her illness, keeping her nil by mouth twice pre-op, and the comfort that those hospital feeds brought us both. When it seemed that her health is outwith my control, it gave me something I felt I could do for her.
Feeding her in almost every place imaginable.
Feeding her through smaller illnesses, when she regularly refused all other food, she never refused this, which was reassuring.
Walking out of the GP surgery after a tirade of how I should stop breastfeeding instantly (she was 10 months), without a word because I knew there was just no point in arguing.
That first feed to reconnect after nursery pick up when I returned to work. That last feed before leaving her, in the nursery chair (she never took the formula offered, and opted to wait for my milk on my work days)
Being confused by people saying how it's so hard for me to be still breastfeeding when actually, it's not.at.all. Breastfeeding was never a sacrifice I made, and somehow people still saw it as such.
Being amused at my beloved Mr Cartside telling everyone who cared to listen, regardless of how well we knew the person, how she's still breastfeeding, at 1,2 and then 3 years of age, and secretly enjoying how uncomfortable this disclosure made some people (and understanding their discomfort).
Far too many breastfeeding discussions initiated by me in the office (although I really didn't mean to)
Learning so much about the politics of breastfeeding and infant nutrition and how we as a society are being conned for profit.
Developing and expanding an interest in infant nutrition, and realising how critical an area this is for the nation's health.
The delight when Save the Children took up the importance of breastfeeding in the first hour after a baby's birth and took on Danone and Nestle. And developed a proper breastfeeding policy (too late for my babies but it's there for those soon to be born).
The chuckles had when my request for a room suitable for private expressing in the new office was passed on to the project manager responsible for setting up the new office. It was clear she (!) had never considered the idea of expressing milk and that someone would do this at work (surely, working mums don't breastfeed? They do? Really? How bizarre)
And of course the endless cuddles while feeding, the smiles while feeding, the relaxation and time out it gave me, the excuse to sit down and stop and admire my miracle baby.
The pride when my then 3 year old told the nursery that while the baby they were role playing with had a bottle, her own baby drank mimi. Even a 3 year old can challenge the normalisation of bottle feeding.
And here's hoping that my youngest, who won't see me nurse another baby, may remember in some way how nice mimi was and pass it on to the next generation.

And that's only the memories of my youngest's breastfeeding journey.

Lip tie

I'm raging mad.
Today I found out about a condition in babies which can cause a poor latch when feeding, and lead to serious difficulties with breastfeeding. It's called upper lip tie. Like tongue tie, it can mess up latch and lead to poor milk tranfer, lack of weight gain in baby, pain for mum and suffering for both.

Guess what, both of my girls have it. The severe type at that. That's the one where the tie goes from in the middle of the top front teeth to the upper lip.

Now, when I was a new mum, breastfeeding wasn't at all off to a good start. I really struggled, and having had a good friend who was also a health visitor and had drummed into me to get support for every.single.feed in hospital, I sought support. Midwives, volunteers, health visitors, support groups, online forums, books. I did it all. And still I was in agonising pain for 8 weeks, and still my baby never seemed satisfied. I have pictures of her with eyes so tired of crying, crying that was put down to colic. I had to call Crysis even, I didn't know what to do anymore. We had days where she cried for hours and nothing would soothe her. At 12 weeks I caved in and supplemented with formula, I could not see my baby be hungry any longer.

At no point was tongue tie/lip tie mentioned or indeed checked. I only found out about tongue tie when my second was born. And only now, I found out about lip tie.

Lip tie does not necessarily lead to difficulties breastfeeding, but it may because it can restrict the movement of the mouth and lead to a shallow latch, which in turn means milking the breast doesn't work so well. I had no major issues with my younger girl, she fed frequently and was also slowish gaining weight but she was always happy after feeds and clearly not going hungry. There was also clearly a lot of output the other end. As for me, I had no pain or soreness at all with her. Both have the exact same severity of lip tie -so in one case it made life really difficult, in the other it didn't have an impact (though I wonder if it may have had an impact on her reluctance to take to solids).

So in this anger at the omission of the medical profession to look my baby in the mouth instead of praising how well I was doing and ignoring the obvious signs of something not being right (my instinct had always told me, but I didn't know the tell tale signs of insufficient milk transfer then), here's my shout out to anyone who ever struggles with breastfeeding: read up on tongue ties and lip ties, and how to remedy. It might be what's wrong and it often goes undiagnosed. The snip is quick and easy.

I'm angry that I was sent to baby massage class to help with the colic (or improve my bonding with baby), rather than remedy what was really wrong. There was lack of output the other end, a baby who looked forever tired and kept falling asleep at the breast but who would never stop suckling because she wasn't full. I nursed 12 out of 24 hours for 6 months. I was exhausted. I was in pain. I told so many people and nobody, yes, nobody took it seriously.

What is beyond me is why babies aren't check as a matter of course. It only takes a minute, and can avoid months of suffering.

Postscript: Here are some of the best resources on lip tie I found online. Lip tie doesn't have to mean difficulties with latch, but it can, especially because it can come hand in hand with a posterior tongue tie (which is hard to spot and often overlooked).

http://thefunnyshapedwoman.blogspot.co.uk/2011/03/introducing-maxillary-labial-frenulum.html
http://www.plus2point4.co.uk/2011/07/19/breastfeeding-with-a-lip-and-tongue-tie/
http://mothernurturebreastfeeding.com/tongue-tie-lip-tie-and-frenotomy/
http://www.brianpalmerdds.com/pdf/Bfing_Frenum03.pdf

Wondrous Weaning

My kids may be well past their weaning ages, but if there's one thing I remember vividly it's that weaning was a daunting mountain for me as a first time mum and that the information out there wasn't really in line with what I was looking for. I was concerned with low weight gain, and when presented with having to prepare purees, there was a whole range of vegetables that I'd never cooked in my life. As an almost vegetarian household I also had to make decisions about if, how and when to introduce meat to my child's diet. I remember the patchy information provided by the health visitor team, which effectively presented us with leaflets and 3 purees of varying consistency, and gave an opportunity to buy a masher and puree tool at discount prices.

I'm much more relaxed this time around, but weaning was still a worry. By now I'd heard of baby led weaning and when Snowflake refused the spoon, I didn't worry and just let her eat whatever I was having. She didn't eat much and still doesn't, but she delights in food now and gets utterly excited about the announcement of "dinner time".

In a way I felt a bit let down both times around with the support available at this critical time in a baby's life.
Put it into context, we are experiencing an explosion of childhood obesity, with 30% of primary aged children in Scotland being overweight or obese. It's not just about kids being a bit heavier than they should, obesity leads to shorter lives, and these short lives are not as fun filled (with a family history of obesity and obesity related illnesses, I know this all too well).

So it strikes me that a bit of support and information that makes sense at this crucial stage might be a good idea. I did a bit of research on what's been proven to be the good and the bad in weaning for later life health and found out some interesting facts that even after 5 1/2 years of being a mum were new to me.

The risk of obesity and overweight is increased significantly if a baby is breastfed for less than 4 weeks AND solids are introduced before 16 weeks. This increases the risk of obesity a staggering 6 times. There is also an increased risk of obesity if a baby is formula fed AND solids are introduced after 6 months, though not as pronounced. So for the formula fed infant it's important that solids are introduced no earlier than 17 weeks and no later than 26 weeks. For breastfed babies, there is no significant increase of obesity risk depending on when solids are introduced.

Now we all know the guidelines to introduce solids no earlier than 17 weeks but ideally no earlier than 6 months. However, a whopping 51% of infants in the UK are introduced to solids before they are 16 weeks (this statistic is quite recent, Bolling et al.: 2007). This means that half of our children are put at a six fold risk of obesity from when they are not even 4 months old.

Then there's the interesting subject of protein. I won't go into the details because you'll just get all bored on me, but the bottom line is that a weaning diet rich in protein significantly increases the risk of obesity and overweight. Protein would be dairy and meat. So a diet rich in Carbohydrates is much better, and it's important to keep protein intake below carbs intake (= too much cow's milk can be bad): "Children who were overweight at 5yrs consumed significantly higher protein as a percentage of energy than non overweight children." (Scaglioni et al.: 2000)

Third up is earliest weight gain - which may be linked to protein intake. Infants who cross growth centiles upwards are hat significantly higher risk of obesity and overweight. This is particularly prominent in the first weeks of life, but the effect carries on through the first year: "Emerging evidence therefore strongly supports the first few post-natal weeks as a critical window for programming long-term health in both humans and animals" (Singhal/Lanigan: 2007). Researches aren't clear what causes this upward movement, and as it's observed mainly in formula fed infants, it may be something to do with formula being too rich in protein (although there are another few suggested causes, such as breast milk ingredients keeping insulin receptors happy and formula fed babies not being able to fully self regulate food intake). Anyeay, I wish I'd known this one earlier, it would have spared me all the worry of both my girls moving downwards on their percentiles... All I was concerned about was to get them up as high as I could, and I'm sure this is an instinct most parents share.

I also looked into the approach to weaning and how this may make a difference. There is one small study that indicates that spoon fed babies tend to be at higher risk of obesity than infants who feed themselves (baby led weaning). However the study is so small and the difference between the groups not big enough to allow for any conclusions. At the same time, the results, even if limited, indicate that baby led infants choose carbohydrate rich foods above protein rich foods which may indicate that they make food choices which are healthier for them.

So the bottom line is that it's most important to ensure solids are not introduced before 17 weeks and that most of the energy of the weaning diet comes from carbohydrates and not from protein. For formula fed babies, it's better to introduce solids before 6 months (but no earlier than 17 weeks), while for breastfed babies it doesn't matter.

References:
1.Rebecca Kendall. Weaning: Risk Factors for the Development of Overweight and Obesity in Childhood - A Systematic Review (2011)
2. A. Singhal and J. Lanigan. Breastfeeding, early growth and later obesity (2007)
3. Susanna Huh. "Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children" (2011)
4. E. Townsend and NJ Pitchford. "Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample (2012)

So Breastfeeding is Harmful Now

I've been following with mild interest the whole debate about the Time cover (for those who don't know, it features a very tall 3 year old standing on a stool and breastfeeding, both mum and toddler look straight into the camera and apparently this pose has tickled the nation because, let's face it, we don't do breastfeeding beyond 6 months, do we now, and above all we don't take pictures of it because it's just gross, isn't it?)

I was actually not particularly bothered or interested; just amused by the furore which in itself speaks volumes of course.

But what tickled my funny bone was a throwaway comment about the "attachment parenting crowd" in the Daily Mail. Not that I take the Daily Mail particularly seriously, but if a medical Dr a) claims that breastfeeding a child beyond 12 months is potentially harmful and b) uses a label to dismiss and patronise people, I can't let it go uncommented.

So, Attachment Parenting. I've always had an issue with the term, simply because it creates two types of parenting approaches - and the attachment parenting one seems to be the unusual one, the hippy, earth mama type of parenting, that is even from the onset weird and ever so slightly incompatible with our modern world.

The problem with this is that secure attachment is vital for every.single.child. Secure attachment develops in the first year. If it doesn't, the child will have serious difficulties in later life, this includes low self esteem, mental health issues, anger issues, will have a higher risk of addictions, a higher risk of neglectful parenting and a higher risk of being involved in antisocial behaviour and crime. Children lacking secure attachment in the first year cost our society, but they're also suffering from it big time. And setting the balance right later is costly and very difficult, sometimes even impossible, to achieve.

The bottom line is that we should all have a massive interest in ensuring we have securely attached children. It's in the interest of the child, and society as a whole.

Attachment parenting is therefore not an unusual leftwing approach to parenting but should really be mainstream to ensure secure attachment happens in the first year of life. And that's based on research and evidence, not on opinion.

Now, you don't need to breastfeed to have a securely attached child. It arguably makes it a tad easier but you can have a perfectly attached child and formula feed. But responsive care, not leaving to cry, and yes, not crying it out or controlled crying is part of it. It doesn't mean that controlled crying WILL harm a child, just that it may and does harm many children. So I wouldn't touch it as a matter of principle. Still, health visitors regularly recommend crying it out or controlled crying to encourage a baby to sleep through the night and every time I hear it I feel like shouting, and handing out some hard fact research how it can damage the newborn brain and how were really and truly don't want to do it because we can't turn back the clock once the damage is done.

Like not letting a child cry herself to sleep, breastfeeding beyond a year is seen as odd, when really it's the biological norm. I honestly don't understand why mums are so consistently pushed towards early weaning. My own GP told me to stop breastfeeding when Snowflake was just 10 months. She stood up and lectured me as if I was a stupid child needing a lesson. I let her and just left without a word. The look on the face of another mum when I explained that a sleep over wasn't in the cards for us at 20 months old still feeds rather a lot at night that spoke volumes of how that was a state of affairs that was totally beyond her ken. The constant questions at work why I don't want to go on training or meetings that involve overnight stays in some part of the UK, the feeling of being a broken record by saying that I don't think I should wean before age 2 for the convenience of my work if my job can be done without overnight stays.

The statement that breastfeeding beyond 12 months can be harmful really got me though. It's of course factually wrong. What is right is that not breastfeeding a 1 year old increases risks of various illnesses, just as not breastfeeding increases the risk of anything from cot death to obesity in later life. So the opposite is true. But we never talk about this do we?  I supplemented with formula from when Cubling was 12 weeks. I could not find any information on why that would be harmful, and I was sure that as long as I continued to breastfeed it was just as good. It's only now that I know it wasn't and I'm rather angry that this information was not available to me in spite of having read far and wide about breastfeeding. I'm also angry that the feeding issues I had with her never got addressed although I visited a clinic weekly.

I am all for choice. Women aren't stupid, and it's up to anyone to make their own choices. But misinformation doesn't lead to informed choices. And stigmatising breastfeeders and/or those who won't let their babies cry to sleep as "attachment parenting crowd" will once again out us as the "others", make us a laughing stock of parents, when actually we do what is the biological norm and what has the best developmental and health outcomes. How many mums will have stopped breastfeeding early because of the social and cultural pressure to do so? How often have I had to justify myself for feeding beyond a year, or hear dismissive comments or see "the eye roll"? How often have I been criticised for not teaching my child healthy sleeping habits (when in fact waking during the night is proven to be healthier than sleeping through)?

It's a mad world. Oh, and don't call me an attachment parent. I'm just a mum (who is still learning a lot about how to be a better parent than she is because I may not leave my child to cry but I'm not a perfect parent).

PS: I've left out any reference to co-sleeping. There is a pattern in that co-sleeping is vilified as a cot death risk when on closer inspection, it actually reduces the risk of cot death if practised safely. Another topic where parents are told they are harming their child when in fact they are not. I'd also recommend reading The Analytical Armadillo's take on the Daily Mail article which quotes some research evidence which I was too lazy to quote.

This is not a Guilt trip

When the most recent research findings about another outcome difference between breastfeeding versus formula feeding hit the headlines, the reaction was once again predictable. There were those who rejoiced in yet another reason why breastfeeding is good for your baba and those who complained how it guilt tripped parents who didn't/couldn't breastfeed or how breastfeeding is once aspect of parenting and surely so many other parenting choices will have an impact on child behaviour.

There was even voices that pointed out how useless the research was, how it was a waste of money because it wouldn't make a penny of a difference to mums in their choice whether or not to breastfeed.

Now, unlike others who seem to have made up their mind that this piece of research was a waste of money, I believe that as with all research, only time can tell if it was or wasn't good value for money - but hey, that's what research is about! If you questioned every research project in relation to value for money and usefulness, there is a real potential that no research, no progress, would ever happen. It's bad enough that a lot of research has to be funded privately and thus often by people with dubious agendas - but the bottom line is that we need a variety of research to learn, to further ourselves, to progress.

So why is research on impact of infant feeding criticised and always ends up opening a can of worms? Why is there a problem with presenting facts? And, above all, why does anyone feel guilt tripped by the reporting of facts?

It's all about that elusive mad woman in the attic. Guilt. Mother's guilt more precisely because when did a dad last feel guilty about working full time, or his child not being breastfed?

Why do people feel guilty in the first place? Personally, I feel guilty when I've done something knowingly that I shouldn't have done while I had the option of doing something different, i.e. when I chose to do the wrong thing against my conscience.

Now, let's look at the choice between breastfeeding and formula feeding: as far as I can tell, there is a limited number of scenarios and where guilt does or doesn't come in:
a) mum wants to breastfeed, sometimes desperately so, but encounters difficulties, doesn't get the right support and stops. Guilt factor? There shouldn't be one. Mum should be angry about lack of support, and complain.
b) Mum can't breastfeed. This is rare, but for medical conditions or some situations, this might be the case. If you can't breastfeed, why would you feel guilty about it?
c)There is the situation where the mother, in full knowledge of all facts, chooses to formula feed, based on her individual circumstances and with very good reasons.
Guilt? Why? Sometimes life isn't as ideal as we wished it was and we weigh up risks and benefits and come to an informed conclusion that's fine, isn't it? Done, dusted.
d) Mum just doesn't want to breastfeed for one reason or another. Maybe she finds it yucky (yes i've heard that). That is society (culture/peer group) who's given mum that idea, again, mum's not to blame, it's very hard to oppose peer group pressure. Maybe she wants to keep going out/party/continue a life pre-baby or even doesn't want to be tied down to the baby all the time (which admittedly breastfeeding does) - or more likely conforms to peer group pressure to not be seen tied down by baby. Even I feel this pressure to just continue as usual, I see the looks I get when I used a lunch break to feed my baby, the apologetic "she doesn't take a bottle" that I still offer in explanation as if I had to justify myself. It's hard to breast feed exclusively, even if you're in a generally supportive peer group, how hard must it be if you're not? Again, mum shouldn't feel guilty if she gives in to this pressure.

So why do we feel guilty? Why do we read into every presentation of facts that demonstrates why it's better to feed human milk to human babies, rather than modified cow's milk that anyone formula feeding should feel guilty?

Research findings present us with facts. I don't get why fact finding is criticised. To claim that it won't have an impact on infant feeding choices is presumptious in my view - if we had figured out exactly what impacts on infant feeding choices, we wouldn't have those unbelievably low breastfeeding rates in some parts of the UK that I've quoted before (just as a reminder, there are various areas in Glasgow where rates are as low as 8% at the 6-8 week checkup - compare this to 95% in some countries). Now, these rates are too low by any standard and we absolutely need to do something about it. It's not about guilt tripping those who've made their choice - that's done and no research will change those choices or bring back the lack of support or whatever else that led to them, but it's about our future generations, it's about all those mums-to-be out there who are making their choice now and in future.

In a climate where everything non-statutory is being cut, breastfeeding support is waning and becoming more than patchy. And if there's one thing that's needed, it's quality support. It's vital that at least some voice out there keeps the importance of infant feeding on the agenda because there is an established link between low rates of breastfeeding and health inequalities in later life. Of course this is not just due to breastfeeding, and of course other parenting choices impact too (such as quality time spent with child every day, such as healthy weaning diet, such as access to exercise) but we can't exclude breastfeeding just because it doesn't sit well with us and formula has become oh so convenient like ready made meals. And as long as formula companies are allowed to market their product in rather questionable ways, shouldn't information marketing/promoting human milk be welcomed at the very least as a healthy balance? And how about we mums take a stance to market our product, regardless of how we fed our kids? It's cheap, convenient, high quality, no risk and tastier. Nevermind the feel good factor of being able to supply all your child needs. How come it's ok for formula companies to take airspace, advertising space in neonatal packs and the like, when research demonstrating the goodness of human milk is criticised? How come that at prenatal breastfeeding workshops facilitators are accused of being pushy when all they do is provide information and allow debate, and sometimes are even accused of being breastfeeding nazis (Breastapo is the word that I take real issue with. Nothing excuses using the evil of the Nazis in a wordplay on those promoting breastfeeding. Nothing.).

Back to the whole guilt issue. Guilt is a personal feeling. Information doesn't make us feel anything. It's neutral. How we respond is our personal choice. So to everyone who feels guilty, nobody is making you feel guilty or trying to do this, honestly. Unlike the suggestions on many platforms, news media or blogs, the research is not publish to make people feel guilty or to hit them with the breastick. Often, guilt is a sneaky feeling that turns something which should have an outward direction inward towards and against a person. Thus, instead of feeling angry with the lack of support to succeed in breastfeeding, we feel guilty for not managing. It's destructive at worst (PND anyone?) and unproductive at best.

How about we just stopped feeling guilty? How about we replace it with responsibility, knowledge and confidence?

It's in the words where normality is created (or denied)

So they found yet another "benefit" of breastfeeding. This time it's all about the child's metabolism: "It could impact your child's metabolism." The article goes on to describe the different behaviour of the metabolism of a breast fed versus a formula fed baby.

What strikes me as wrong about this article is that it talks of "benefit of breastfeeding" and breastfeeding having an effect on the child's metabolism.
This implies that the "normal" way to feed a baby is formula feeding. And if you're brave and breastfeed, hey, you may reap a benefit!

However, it's really formula feeding that impacts on the child's metabolism. This is because in a world where the baseline is breastfeeding (we're mammals, hello?), this does not have an impact but is just the way things are, because human milk is what human babies drink. The research, then, shows that formula feeding has a negative impact on the metabolism of the baby. Yet somehow, this is not the way the media puts it and it leaves me wondering why.

Is it because the media is daft and unwittingly promotes the normality of formula feeding? Or is it out of fear of guilt tripping any formula feeding mums? (NB: the whole guilt tripping thing about formula feeding is another post in the offing, so I leave that unelaborated for now - let me just say that I think nobody should ever feel or be made to feel guilty) Or could it be that they fear the wrath of the baby food industry in the form of being sued?

Am I missing something or is it just me who finds it odd that breastfeeding is labelled as having benefits all the time, but formula feeding is never labelled to have a potential negative impact? As if, by breastfeeding, you're giving your child something extra. When in fact, by giving formula, the child gets something less.

Then there's the invariable comment on the fact that one breast fed child had allergies while a formula fed child didn't. As if anecdotal evidence ever won against scientific facts. My baby had pneumococcal meningitis, which is linked to formula feeding, yet she hasn't had a drop of formula so far. You know what? There are no guarantees. If you breastfeed you have no guarantee your child will never have allergies or will not fall ill with a tummy bug or be forever healthy. And of course there will be lots of formula fed children who won't get allergies, who won't have tummy bugs. Yet it's still true that formula feeding increases the risk and that every parent should know that formula feeding carries these risks - and then make an informed choice between the two. And not end up topping up like I did without knowing that this innocent little bottle of formula destroyed a virgin gut at 12 weeks, and again at 20 weeks when told to do so by a German pediatrician. (I don't feel guilty about this because at the time I didn't know. Now I do and wouldn't do it again).

For the record, I was formula fed, I do have allergies and a tendency towards weight gain. There may be a link, but who can tell? It might be just in my genes. I don't blame my mother at all - she was told she couldn't breastfeed (though I doubt that this was really the case) and at the time this was not questioned and formula was considered to be as good. She did as best as she knew. Today we know better and there should be sufficient and quality support to help everyone to successfully breastfeed who wants to breastfeed, and information for every parent to be that doesn't just talk about the "benefits" of breastfeeding but also the risks of formula feeding, so that they know the facts and don't find out, like me, after well over 2 years of breastfeeding. And all of this without the guilt tripping of course.

4 months and weaning onto solids

Yesterday was Snowflakes four months' birthday.

Today there's a whole debate going about when is the best time to introduce solids to a breastfed baby.

I look at her and introducing solids is the furthest from my mind, such a small baby, and I don't want to see her grow up any quicker than needs be.

Of course the research fails to mention that early cutting of the chord depletes iron stores by 33%, so if chords weren't cut so quickly, the whole debate would be nil and void, and we could simply sit back and let baby take the lead. It seems odd then that the headlines don't ask for delaying chord clamping rather than introducing solids between 4 and 6 months.

It's not that I'm an advocate of waiting at least 6 months. It's just that those headlines are confusing.

I've seen babies who were clearly ready for weaning in their 5th months, and I've seen others who only started on solids at 8 months because they were clearly not interested. Cubling was 24 weeks, and basically she watched me eat and grabbed the food off my plate. That's readiness, not shoving a spoon into a choking mouth.

Physiologically, babies are less likely to choke at 6 months. They are less at risk of SIDS. They are less at risk of an immature gut. They are thus also less at risk to develop food intolerances. On the other hand, if it's all about iron, I do wonder how you would feed red meat to a 4 month old. The link to gluten intolerance incidentally is based on a combination of late weaning and formula feeding, so it seems to me beside the point to create a link to breastfeeding and weaning after 6 months.

Above all, there is no evidence that the report is based on research that is conclusive. No new evidence, just a question mark, so what's the point of these headlines?

I've got a feeling that there is none.

I'll be back watching my girl and not worrying so much about when to introduce her to solids. We'll get there, and for now I'm enjoying the still puree free time.

*************

Snowflake:
- is slowly getting into a routine of naps, but still has lots of sleep vs very little sleep days. We had two evenings in a row where she slept for 2 hours, and I was rejoicing, started a sewing project and all that. Tonight we're back to square one and half awake cluster feeds all evening.
- still mostly hates car journeys, though sometimes will tolerate them (no rhyme or reason)
- quite likes her pram, though not today
- wants to be worn facing outwards when awake
- kicks her legs wildly when hungry or tired
- loves grabbing my hair, my necklace, my top
- loves chewing/sucking on fabric and eating her fists (until she makes herself sick...)
- will sometimes have a long nap in the pram now, or on the bed.
- loves to be played with and we can now even delay feeds with interesting play
- definitely laughs now, though it's a very special laugh: mostly without any sound, just a wide open mouth, occasionally accompanied by a quick dirty laughing sound. Very sweet.
- loves the bath, tummy time if not too long, and her big sister still gets the biggest smiles
- is still exclusively breastfed much to my surprise. I was determined to take things easy this time around and not fret about the odd formula feed. And look at it, the instant formula cartons and new bottles are untouched. I have no idea how often she feeds, don't watch the clock, I think feeding to sleep is the best thing since sliced bread and I'm only ever so slightly hoping that maybe the evening clusterfeeds (which are really due to overstimulated and tired baby that can't quite drop off to a good sleep) could become a thing of the past. I can see it coming though and am not too worried.
- is totally fascinated by lights

The Normality of Breastfeeding

I live in a place where breastfeeding is the exception rather than the norm. It came as a surprise to me when I was first presented with this fact, about 10 years ago, when a friend of mine had a baby and was the only new mum in the 13 bed ward who was breastfeeding. I also remember being asked in a questionnaire why I chose to breastfeed - and that my reason (because it's the normal way of feeding a newborn) was not an option.

It makes me wonder if the low breastfeeding rates in certain places may be related with formula feeding being perceived as the norm, and if re-establishing breastfeeding as the norm may lead to improved breastfeeding rates.

One example where formula feeding was established as the norm was when someone decided to base the growth charts on formula fed babies. This has since been changed - so this time around, Snowflake is measured against growth charts of breastfed babies (and following her line spot on) while Cubling was measured against formula fed babies (and kept dropping as time went on, giving me a lot of worry if I was doing the right thing). Although these charts gave me worry with Cubling, I never questioned them. But now that I'm more relaxed about weight gain, and can see my own different attitude and how the new chart gives me confidence that things are going well, I realise how crucial this change is. Hopefully it will give confidence to many breastfeeding mums, and more than that, demonstrate that the norm against which baby growth is measured is that of a breastfed baby.

At nursery, Cubling has been learning all about babies. It's been a great theme, just at the right time. She comes home and continues the role play with her favourite teddy (she's not into dolls as such, her teddy is her baby, it's a girl and her name is Snowflakes middle name). She tells me all about why babies cry, that they can't walk yet, that they visited the baby room and how proud she is that she has a real baby at home. She'll change nappies, wipes teddy bums, dresses teddy for bed and outdoors. And she's filling up bottles to give milk to teddy.

Mummy cringes. All my nursing and my daughter at 3 years already fills up bottles (of the breast pump at least, but bottles they are nonetheless).
I cringe even more because when I dropped Cubling off at nursery one day, and Snowflake was crying (I didn't get the timing of feeds right), a nursery teacher passed and asked Cubling if her baby sister needed a bottle.
Bless Cubling, she just retorted by saying "no!" and pointing to her breast.
What it shows though is that at nursery, the message given out to our youngest is that the normality of baby feeding is the bottle (filled with formula, why else would you measure milk?) - possibly out of a false sense of prudishness (I'm guessing). It's an opportunity lost, an opportunity to re-establish the normality of breastfeeding in an area of Glasgow where the rates are bound to be doddling around the 10% mark.

And I'm particularly disappointed because this is a nursery that prides itself in its eco status, it's environmental awareness and does generally so well in these areas. Shouldn't this not also translate into some gentle encouragement of the message that breastfeeding is normal? It's not about promoting breastfeeding, just about treating it as the norm, to which there will always be exceptions.

Have you experienced situations where breastfeeding wasn't/isn't treated as the norm? Should I take this up with the nursery?

6 weeks

It feels like only yesterday that Snowflake was born, and now she's 6 weeks already. The 6 week mark is also important for me because I can now drive again - a blessing to get to places beyond a walk's distance, but also a curse as the nursery run now is my responsibility again. The thought of having to be at Cubling's nursery for 9am makes me laugh hysterically, the earliest I've made it anywhere so far with the two was 10.30am.

It can be done, I'm sure, and I'm determined to rise to the challenge. At least I don't feel petrified as I did when hubby's 2 week's paternity leave were over. This coincided with the height of baby blues, and something very close to panic attacks whenever I thought about having to manage to get two girls through the day. It was manageable, even if Cubling didn't get exciting craft activities on a daily basis and had to learn how to entertain herself a good deal more than she's used do. And she did.

Snowflake was kind on us as far as the sleeping goes - while rather fussy in the evenings and not ready to sleep before midnight (and sometimes much later than that), she's had a long sleep during the night most nights, and only now settles into a feed me every 3-4 hours pattern (still great, I can get used to that). It feels as if having had broken nights for so long with Cubling has made the transition easier. Yes, I could do with more sleep but I'm functioning and get some good nights even.

Snowflake loves her sling. It's a Kari-me which I got from my sister in law, although soon I will be trying out the Hop-Tye I bought and got shown how to use at the last Glasgow sling meet (everybody was quite taken by it, it is a lovely mei-tei come sling, and pretty too). The great thing about the sling is that Snowflake falls asleep instantly in it, while I can get on with rather a lot of things. Compare this to my attempts to settle her for naps in a cot/pram - she'll wake within 5-10 mins.

We've had lots of smiles since week 3, especially for Cubling. It's so beautiful to see how the two girls interact already - Cubling loves looking after her sister, engaging with her, and tells me as soon as she cries, possets or wakes up. Snowflake on the other hand keeps her best smiles for her big sister, who in turn declared to her little sister only last night: "Ich liebe dich".

In the last week, Snowflake has taken much more of an interest in the world. She enjoyes watching me in her bouncy chair (i.e. I don't have to carry her all day) as long as I keep talking to her. Days are still different and there is no routine at all, but maybe that'll come naturally in the next weeks when we have to get up early and just get on with Cubling's busy timetable.

Feeding is going well - ok we had one night when she wasn't to be satisfied and at 2 am I decided that maybe a bottle of expressed milk might be a good idea. And it worked (once she realised that that thing in her mouth would yield milk if sucked - which in itself took awhile). There's nothing better than the ole weighing in which confirms that she's putting on weight beautifully and that it's all thanks to magic mummy milk. Well, I think it's magic, and won't cease to be amazed by how I can provide all it takes for a baby to grow.

So then, wish me luck for the 9am nursery runs next week!

I hate labels, and who doesn't?

The one and only German blog I follow (I know, it's sad, but I haven't found any that keep my interest) is 123windelfrei. It's an attachment parenting blog and has really well written and researched posts. The most recent post is about pressure exerted by some mothers on others, and how some seem to believe that if only you do everything according to the Attachment Parenting book, all ills will be avoided and your child will be picture perfect. Only that, of course, there are no guarantees, and Attachment Parenting doesn't work.

At the same time, a comparison was made that implies you are an Earth Mama if you breast feed, wear your baby, and co-sleep. Which made me defend my choice to wear baby, highlighting why it works for me (no pushing of pram after c-section, so it gets me out and about above all).

I thought a lot about this blog post (do read it if you read German), and how I came to even read her blog, as well as the label of attachment parenting and earth mama. And many other labels for that matter.

As to AP, I didn't even know the term until Cubling was about 6 months old. I don't follow AP, I do have the Sears book but only skim through it on occasions. However, I've learned what works for baby - in Cubling's case this was carrying her (she would scream in the pram, honest, we tried!) and I ended up cosleeping because it allowed me to get some rest and cope with her 2-3 hourly wakings so I could still function at work. I breast fed until she was almost 2 years (I weaned her at that point). Now, I wear Snowflake to sleep, breast feed and happy to co-sleep should this prove the only option to get sleep (so far it's not needed). I do not believe in crying it out just because it felt wrong to me. Basically, I've tried things and stuck with what worked and that happened to be rather close to AP (Incidentially, I don't do EC and wouldn't even consider doing it, and apparently that goes with AP).

Similarly, when I think about what is good for me (I am selfish!) and for my children, and how to contribute towards a future world that is fair and has resources for all, I try to make choices that work towards it. I consider what is important, what makes sense, and I try to look at everything from different angles so I don't end up in a dead end. I'm looking into creating a more sustainable lifestyle, into which changes are doable for us and acceptable for us, and I blog about it in the hope of discussing it with a wider community and maybe even inspiring others to think along new avenues - as I do when I read other blogs.

And yet I react against any implication of being labelled. And maybe many people hate to be labelled and shy away from making changes, choices or talking about it for fear of being labelled. I'm not an earth mama, just selfish and trying to get sleep and peace, and a happy child above all (like all of us). As far as the bigger picture is concerned, I'd like to have food in 40 years time, I'd like to have a planet that hasn't gone into chaos and where people can live and make a life without fighting for food, oil and other resources. I'm not a green warrior, honestly.

What bothers me is the discourse that puts labels on us and as a consequence alienates people from one another. Take AP and what 123windelfrei found when she was told by a mum that she must have done something wrong if her child developed cavities. There are no guarantees of course, but following AP religiously, and believing it to be the solution for everything is just plain wrong. It then becomes an ideology and you'll get people like me, who previously were quite happy with the label, suddenly backing off and not wanting to ever be labelled with it again. As a consequence, people may also end up changing their ways, e.g. stop co-sleeping/breast feeding a toddler (or stop "admitting" to it) just to avoid being labelled, thus de-normalising such practices (which to me is the greatest danger of all).

Similarly I'm at odds with other labels. I'm exploring the Transition idea at the moment, to great detail in fact. It's a perspective on things that I share and that inspires and motivates me. It's outlook is positive, realistic. Both many people practicing AP and involved in Transition, however, are at odds with my view on vaccinations and I find it truly difficult to be sat at a table with people who all agree on the evil of vaccinations when I see it as a blessing.

So again, the label doesn't cut it for me because we are diverse and who will ever fully fit the label and all that comes with it? Exactly, nobody. So let's not be so categorical, let's discuss and yes, even argue (I love a good argument as long as it's good natured). Just somehow I feel that labels do more harm than good. I'd rather describe myself as a mum who breast feeds (for a variety of reasons, not out of ideology), co-sleeps (because it works for me and I love cuddling my girls), and carries her baby (because she's happier that way and will sleep, and I can get on with chores or playing with the big sister while my hands are free). I'm not an attachment parent, I'm not an earth mama or an eco warrior, even if I use cloth nappies (I actually use them mainly because they are cheaper and nicer though I won't pretend that it doesn't feel good to pat my back about reducing my contribution to landfill).

Let's label each other less, and listen - and in the end do - more. Let's do this gently and with generosity towards each other.
Sermon over.

Early baby days

You can't help but compare. I guess it's human nature and sometimes I feel terrible doing it, but really, there's no judgement involved in the comparisons I make and I try my best to let Cubling know about it. Cubling was a colicky baby, and her personality from the start was on the energetic side. It's joyful watching her now, she is such a forceful little girl, with so many ideas, so much energy, so much that amazes us every single day. As a baby, without the ability to communicate other than through crying, it was a hard road to be travelling on - for all of us.

Consider the scene of the first bath: with Cubling, we tried to entice her with dimmed lights, a warmed up living room, gas fire on, relaxing music in the background, everything at the ready, candles lit. And she screamed the house down. Not a single bathtime was enjoyed in those early days. Evenings from 5pm were filled with inconsolable crying (and we tried, oh lordy, we tried to console her). I felt guilty not for being a bad mum, but for causing her so much suffering by simply having had her.

Now look at Snowflake, a picture of bliss and curiosity as we gently lower her into the baby bath, which we've set up on the kitchen table so I don't have to bend down. We're not particularly organised, not everything goes smoothly, there is only dimmed lights, no other enticement. She's clearly enjoying it.

Snowflake also sleeps a lot. Cubling was good at keeping herself awake all day and evening, getting increasingly overtired and fretful. Snowflake sleeps. Mostly anyway (we do get overstimulation too on occasional days). She sleeps such long stretches that I worry, and that I wake her to give her a feed. I know I should just enjoy it while it lasts, but if you're used to a baby who sleeps for 30 mins max, and never goes more than 2 1/2 hours between feeds, a 4 or even 6 hour sleeping stretch is rather mindboggling.

Which neatly brings us onto the feeding. With Cubling, it was so bloody hard. I was sore beyond words, she fed forever and then again. She never seemed contented after a feed, didn't poo and generally didn't give me all those ticks to assure me that she was getting enough. She clusterfed every single evening, and I never ever saw milk. There was no posset, no vomit, no milk leaking out the side of her mouth. Now look at Snowflake - she feeds quickly, efficiently, goes sometimes for long stretches between feeds, but other times also clusterfeeds (not too often). When she does feed, she likes to feed a lot and often overdoes it, so there's a lot of milk making its way out. She comes off herself, looks contented, the last milk drop dripping out of her mouth. There are plenty of wet nappies, regular dirty ones. I don't monitor frequency or length of feeds, and above all, I don't worry. Did I mention that I'm not sore? The discovery of pain free breastfeeding, I never thought it did actually exist. To be fair, I was a little bit sore when on day 1, Snowflake initially was a reluctant feeder (due to c-section delivery and being mucusy) and I had to hand express - that did hurt. But as soon as she latched, all was fine.

It's not all roses though - Snowflake suffers from wind and often cries when awake. We have had 2 long clusterfeeding nights, and one whole day where she was fretful and couldn't get herself to sleep. And while she sleeps a lot, this will only happen if I carry her - put her into the pram and she'll be awake within 10 minutes.

But still, it's oh so good not to have to worry about milk supply or what the heck is wrong with an incessantly crying baby. There are those who say it's because we're more relaxed this time, all I can say is that personally I'm anything but relaxed, simply because there's two little ones now. It kind of relaxes me though that feeding is clearly going well. It feels like all the hard work last time is finally paying off, and breastfeeding is truly the easy option.

##Photo: Snowflake is sporting a lovely handknitted cardigan by J, and this is the most likely the one and only face on photo for the blog, so enjoy!.##

An infant feeding research dilemma

Just after Snowflake's birth, we were asked if we'd be willing to take part in a piece of research on infant feeding. The research was explained to me and once both parents had consented, we embarked on a route of rather a lot of data gathering. Part of this is noting down every feed in the first 9 days, regular measurements and a poo and feeding record at certain intervals (my initial enthusiasm is a bit dampened because the whole thing is a pain in the bum, especially with a cluster feeding baby and a mummy who doesn't wear a watch).

Initially, my understanding of the research was that it attempted to increase knowledge of how breastmilk and formula affect the development of obesity and heart disease in the population. There seems to be some understanding that if an infant is breastfed exclusively for even just the first 10 days, this leads to a significant reduction of cases of obesity and heart disease compared to formula fed babies. What is not established is why exactly this is so. The research tries to compare three groups of babies - those breastfed exclusively for the first 10 days, those fed exclusively on a normal formula and those fed on a newly developed formula which mirrors breastmilk in that it contains less calories from fat (less than normal formula). So the idea is that the calories from fat content in formula milk in the early days may set up the body in a way that it will require more fat and carbohydrates in the future.

Breastfed babies who take part in this study (i.e. Snowflake) provide the base line against which negative effects in relation to obesity/heart disease of either formula are measured.

The background to the effort is that because so many mothers decide not to breastfeed, if a formula could be designed which was closer to breastmilk in that it had the same beneficial effect on preventing obesity and heart disease, this would significantly improve the nation's health.

So here is my dilemma: I'm taking part in a study which, in effect, may lead to the promotion of formula feeding. While I accept that some mothers can't breastfeed and some choose for very good reasons not to breast feed (and I'm supportive of this choice), I'm also dismayed at the low breastfeeding rates particularly in the so called "deprived" areas of Glasgow (and the country), the link between poverty and low rates of breast feeding cannot be denied and it contributes to creating health inequalities from the point a baby is born, arguably earlier. I've talked about the significance of promoting breastfeeding from a poverty and health equalities perspective before.

I accept that it is easier to change formula than it is to change culture. I'm not sure if it's the right way or if it will most likely lead to even more mothers not breastfeeding. My worry is also that the knowledge obtained through this study, which is supported by the NHS, funded by pharmaceutical companies, may eventually be used by formula manufacturers who don't have the same ethics that the current funders and researchers have. It's all good and well to assure me that breast milk will always be best for baby, but a formula that can be marketed as preventing obesity and heart disease just like breast milk must be extremely attractive for less ethically committed manufacturers.

For now I've done my research and all the background of the study is kosher, but once the knowledge is out, can there be control over how it's used? And another question, who am I to decide that the only way to improve the nation's health is to go the long way and change culture, would it not actually be better to change what we can as soon as we can? If this new, fat reduced formula is better for the infant's health than the formula currently available, and if particularly mothers living in deprived communities aren't going to breastfeed anyway, is the ethical thing to do not to support the development of an improved formula that will help reduce health inequalities?

I have no final answer to my questions, but would be interested to hear what you think about all of this.

Competition time: Win a Boppy Nursing Pillow

A little while back, I was offered by the PR of Boppy to review their nursing pillow. It's a product that I can only recommend - when breast feeding Cubling a firm nursing pillow like Boppy as the saving grace for my back because she fed, well, rather a lot. Something like every 2 1/2 hours for up to one whole hour, so we spent a lot of time nursing. With her securely tucked onto the nursing pillow, I managed to read, blog, read blogs, and nap (I know you're not supposed to do that, but I have a very light sleep which keeps me alert and I did it responsibly). Cubling, the nursing pillow and me were best pals.

Now Boppy is offering one lucky winner the chance to receive one of their lovely nursing pillows - lovely because they are firm, flexible and functional, but also because they come in beautiful and washable covers which make them extra attractive.

So to enter the competition for a Boppy nursing pillow (which will also make a great present in case you're not pregnant or have just had a baby), leave a comment below. The winner will be drawn on 2nd September 2010 (unless Tiddler makes an early appearance in which case there may be a tiny delay).

Good luck!

Nursing pillow - ticked

This post is a sponsored post.
 
My bump looks like I'm about to give birth. Yes, I still have 7 weeks to go, or going by my experience last time, maybe 9. That's a scary thought, because already I'm carrying Loch Lomond in my feet and can't imagine my bump can grow any further.

Still I'm kind of living in denial and haven't made any preparations. No equipment, no nothing. I don't even manage to put a list together of stuff that we need.

I've also been asked what I would like for the baby as a present. I really appreciate that question because I much prefer sharing my preference than receiving something that we don't really need and which won't get used. But I can't for the life of me think of anything. Ok, I'm looking for a baby carrier (the one I have in mind is too expensive to be on a wish list) and size 1 shaped cloth nappies (again, a set is on the expensive side and my favourite brand now makes them birth to potty size, which is good in theory but rather rubbish if you already have size 2). Bouncy chair and moses basket will be borrowed because they may or may not work with baby and I'm not going to spend money on something that is not used, while I'm happy to buy the alternatives of the co-sleeper (already bought) and electric swing (they always pop about second hand and I'm far too frugal to buy it new). Sterilizer might be useful for just in case situations, but not essential as hob and pot would do. That's as much as I can think of. Clothes, blankets are ticked, and I simply can't think of anything else.

A nursing pillow was still on my wish list - I was given one which is ok, however,  I'm looking for a very specific style, the (borrowed) one which I used last time for at least a year, so it was definitely getting good use. So when I received an invitation to review Boppy, a nursing pillow which looked very much the part and is also rather pretty, I jumped at the opportunity. From the website it looked like just the nursing pillow that I'm looking for, the type that really makes breast feeding easy on your back and comfy for both mum and baby. Today it came through the post in a lovely bag which was a hit with Cubling.

I had to giggle a bit because I'm probably the worst person ever to test this nursing pillow because I have a rather big bump in the way... So I gave it to hubby and tried it on myself over the bump to much general amusement. The great thing about this nursing pillow is that it's very firm. I like that. It's the type where you can lay baby on and it's well supported while nursing. It'll also be great as a sitting aid once baby can sit but not yet unaided.

It offers very pretty fabric covers which are washable, which makes them hygienic. The one I got sent is a bit pink for my liking (especially should this baby be a boy) but nevermind, it's pretty and Cubling will love it. There are lots of other covers which are not so pink, so you'll be spoilt for choice.

The one criticism I would have is that it's a bit on the small side, especially around the sides. It'll be great for nursing a baby in cradle position, but not so good for side nursing - there doesn't seem to be enough space to place baby securely. It may work in the first few weeks but I doubt that I could do that nursing position with a baby older than 3 months with this pillow. Which may be all you need, and you could always use another pillow/cushion at the side if needed (or even extend the space with an armrest).  Similarly, the general size of it is a bit on the small side - I'm not a small person and can see that especially in the first weeks when I'll still have some bump and extra kilos left, it'll be a bit small on me. It does stretch though and it will do, just that it could be a bit bigger for slightly bigger women (and definitely for women who are more than slightly bigger).

So on the whole I'm pretty happy with it, the firmness of it is the greatest asset as it won't slip on your waist, and does lift baby significantly when seated. It's so firm that it could almost work as a babycarrier (although I wouldn't recommend doing that), so if that's what you like, Boppy is just the right nursing pillow for you, provided you're not a size 16 or above (that's an estimate).

To tell people about the nursing pillow, they've designed a little game, Mom's Revenge, which you can play if you fancy it - it offers some playful and useful advice and myth-busting on breast feeding and how to make your mother in law and your other half do the slave labour be a supportive family member.

Wanna play? See if you can beat my high score!

breastfeeding revisted

Thanks to Mummy Whisperer's comment and fabulous blog project, which is bound to result in a few posts about my first experiences as a mummy, and just in time for this week's World Breastfeeding Week, I've decided to give baby blanket knitting a break and reflect on my experience of breast-feeding, with the benefit of hindsight.

There's been a lot of discussion going on about this topic, and this contribution is really just a personal reflection, in the hope that it may be of use to those who find themselves in a similar situation. My experience though is very individual, and will not mirror that of others. Having lots of friends with different experiences, some of whom very reluctantly stopped breastfeeding, others who never touched a tin of formula has shown me that no two mummy-baby pairs are the same.

When I was pregnant, there was no question that I would breastfeed. I didn't even think about it. It's what my boobs are for, and though the thought of milk coming out of them was utterly unthinkable and very strange indeed, I never anticipated any problems. At one NCT workshop, a fellow pregnant woman mentioned something about pain. I had never heard of pain and simply filed it as a myth, especially as the NCT breastfeeding counsellor insisted that pain was due to wrong latch. I read all the info, had an NCT and NHS workshop. I had no issue to feed in public.

I felt prepared, and, truth be told, rather smug about it all. Until Cubling was born. It was a long labour, I'd had diamorphine and after 3 hours of pushing without any progress, a last minute spinal for a potential c-section (which became a mid cavity forcepts delivery). Cubling slept and slept and slept. Throughout the 3 days in hospital, she hardly showed an interest in feeding. Midwives hand expressed pithiful amounts of colostrum (this was painful!), sucked it up in a syringe, put it into Cubling's mouth, who spat it out. I was distressed. Cubling slept. I wished she would cry and feed constantly like the baby in the opposite bay. On day 3 she started wanting to feed. It was a Sunday and at each of the 3 instances, no midwife was available to help me get the latch. I didn't get it myself. It hurt, I got very upset and felt helpless. Thankfully, Monday morning brought a trainee volunteer for the breastfeeding initiative to me, who helped me with latch, gave me confidence. Also thankfully, Cubling's digestive system was slow so her weight loss was just below 10% and I got discharged. Her first deed at home was a massive meconium poo (yuck!!!) which surely must have brought her post birth weight loss up to 15 % or so.

At home, she started to feed regularly and in nice intervals, 20 minutes, every 2-5 hours. Then my milk came in, just that in my naivity, I didn't know what this extremely unpleasant feeling was, just that my breast were hard, Cubling could not latch and it felt like I had lumps of... cancer? I consulted books, found out that it wasn't cancer (phew) ways to ease the worst feeling, finally got a latch and ... what a relief! More milk than Cubling could stomach, but oh the bliss to see the white stuff drip beside her mouth. I cried tears of joy. I had milk. I could feed my little girl. I was the king of the castle.

What followed was this though: broken, bleeding and painful nipples for 8 weeks. Painful let down at nighttime for months. Feeding marathons. Effectively, Cubling would never come off herself, would feed incessantly if I let her. She cried blue murder at nighttime unless she was latched on. We had 7 hour long screaming marathons, where I had to phone Cry-sis because I was losing it. They said feed less frequently. Breast-feeding supporter said feed on demand, feed more. Feed on demand was beyond my ability, I literally would have had a baby permanently latched to me. I got a volunteer breast-feeding supporter to visit who said all was fine, I was doing great. When I was still nursing exclusively at 8 weeks, the boxed got ticked and no further direct support was available. What remained was a drop-in (where I met my mummy friends) and the bounty forum, kellymom and the lalecheleague website.

I became the expert on every aspect of breastfeeding. Determined to keep going I would do anything recommended. I took fenugreek tablets, tried a dairyfree diet (to see if the screaming was caused by lactose intolerance) took breast-feeding holidays where I'd do nothing but nurse. I expressed in the morning to top up at night time, just that this meant Cubling would then also scream after feeds in the morning because she didn't get enough. She continued to nurse frequently (I never made it to less than every 2.5 hours), very long (45-1hr, which is when I'd take her off without complaint, any earlier and hell would break loose, she would never finish a feed herself), not put on much weight, be unable to fall asleep, cry a lot, not poo (we went 12 days without one, bliss in a way, but worrysome in others). There were occasional days, once every fortnight, where her hunger in the evening was obvious and all the nursing wouldn't stop the frantic screaming. Then, from 12 weeks onwards, I would reluctantly and with tears in my eyes offer a top up of formula on those days where nothing would settle her. She gulped a whole bottle down, and settled beautifully afterwards. My girl was hungry, no matter what anyone else said, and I could not satisfy her hunger fully, especially in the evenings. It was only a bottle every fortnight, and if I'd had a break during the day/night to actually express, I'd have done that. But with a baby feeding so much, there was no time where I could have expressed any additional amount. I did try. I failed.

She woke a lot during the night, and we slowly took to cosleeping. This way, I could latch her on and not fully wake. It was a life saver especially when I went back to work. I got used to the broken sleep and would do ok if she went 3 hours between feeds, combined with co-sleeping. If there were a few nights in a row that had a higher number/frequency of wakings, it took a real toll on my wellbeing. Yet co-sleeping kept me going, especially whenever yet another tooth came through.

At 4 1/2 months, she took to waking every hour during the night and demanding a feed. She did this for a month. I was shattered, saw a paediatrician in Germany (where I happened to be when the effect of her waking made me short tempered) who told me that probably I didn't have enough milk and that I should offer top-ups after every feed. I didn't have that many bottles to offer 12 top ups a day (that's how often she fed) or sterilising equipment (I was on holiday after all), so I decided to top up at the last feed before her bedtime, and after the first waking. She didn't take a lot, but it helped a bit. After two weeks, she refused this top up bottle and never accepted a bottle offered to her by me after that. Looking back, this episode of constant feeding wasn't about hunger, but probably about teething.

I started solids at 24 weeks, or rather, Cubling did. She grabbed food from my plate and I went along with it. It was from then that Cubling finally gained weight properly. She went from slim to very chubby. I also went back to work at that time, expressing 3 times a day for one 60ml-120ml bottle to give to the childminder, supplemented by a second bottle a day. I did this for 3 or 4 months, giving every minute of a break at work I got, for ever decreasing amounts of milk. It was disheartening, so much work, so little milk. The days I was off were easy - the combination of nursing and solids worked a treat and finally breast-feeding was easy. I stopped expressing when I realised that to stay sane I needed to have at least one break a day and that really, I'd done as much as I could. I continued to nurse on my days off, and Cubling continued to refuse bottles given by me or hubby. She took bottles from the childminder, so we had a good balance.

I continued to breastfeed on demand until Cubling was 17 months old and when she had her full set of teeth. At this point I gently weaned her off night time feeds (she still woke once or twice a night for a feed), so she would not get a feed between midnight and 5 am. This led to her sleeping through to 5am regularly. Because I had planned a holiday away from her when she would be just 2, I felt I should wean her before her second birthday so she wouldn't have the combined difficulty of having to deal with mummy not being there and losing her main comforting tool. I wanted to take weaning easy, and start well before the second birthday. At 21 months I gently weaned her off the bedtime feed, as she seemed much less interested in it, substituting it by reading books which she loved instantly, and at 22-23 months I weaned her off the morning feed (5am), allowing her to still nurse when she insisted (i.e. it took a month to do this).

Looking back, I'm glad I persisted with breastfeeding because it did become very convenient after I introduced solids. However, I would not ever wait so long to offer top ups because I really believe that she went hungry in the evenings on occasions and the distress of seeing her in so much pain cannot be justified by the principle of breast is best. There has to be balance. I longed for support which would take my concerns seriously and not just recite the general advice which I knew anyway: how often did I hear "let her come off herself, don't finish a feed, let her finish" but how on earth can you do this when your baby will not ever come off? I did try, for hours, until I felt my nipples dissolve in a baby mouth. At 5 months, I still fed 12 times a day for an average of an hour each time. That's 12 hours a day. And still she would cry for more for hours in the evenings. Not good. Yet I was also stubborn and whenever I got a suggestion to give a bottle I got very defensive. It's such a delicate subject and what is needed is very delicate support which looks properly into the individual situation and doesn't just recite the manual.
I know I wouldn't embark on this marathon again. I would always breast-feed again, just that I'd be much more inclined to trust my feeling that something is wrong and mix feed. None of the top up bottles led to the end of breast-feeding, as long as breast is offered first, for many mixed feeding can actually extend breast-feeding as was the case for me. At the end, for as many breast-feeding mums I've known, nobody has continued to breast-feed as long as I did. There is no pride in this statement, just the fact that once a balance is reached, breast-feeding may work better and last for longer rather than shorter.

I got myself a lot of support, being proactive and informed, yet still I could have done with more. I longed for someone to have a look at my latch after week 4. Nobody did. I still wonder if the latch was the problem. Some of the best support, the one-to-one home and hospital visit by the breastfeeding initiative, was only offered to me because my GP was based in a health centre in a multiple deprived area. The support wasn't aimed at people like me (who were keen to breastfeed anyway) but at the low breastfeeding rates in that area. There are issues around that (the initiative could count me as a success, when really I wouldn't have done any different anyway, and maybe I took support away from someone else). But really, this support should be there for everyone, which comes at a cost unfortunately, a cost the NHS is probably not able to meet.

Breastfeeding in Emergencies

PHD in Parenting has been ahead of me, but because I have a few things to add to the theme of breastfeeding in emergencies, I won't let her post put me off my contribution to World Breastfeeding Week.

Working for an international development organisation, even if my own work is firmly focussed on the UK, there is a lot of information going around on the importance of breastfeeding in emergencies. Particularly because this is a children's charity and our big current campaign is the Child Survival Campaign. In emergencies, all the benefits of breastfeeding and the risks of artificial feeding are very pronounced. Lack of proper sanitation and sterilisation equipment means that breastfeeding, even if the mother is exhausted, is the best option, one that will literally save infant lives. 1.4 million a year to be precise. That's the toll that formula feeding takes in the developing world.

In developing countries, infants 0-6 months old who are not breastfed are 14 times more likely to die, and at the age 6 months - 2 years, they are still 4 times more likely to die than children who are breastfed. 22% of neonatal deaths could be prevented by breastfeeding, reducing the total child mortality of pre 5s by 12%. The breastfeeding pattern in developing countries is that while extended breastfeeding is common, exclusive breastfeeding in the first 6 months is not (39%). At the same time, as developing countries become more wealthy, breastfeeding rates show a tendency to fall significantly (e.g. in Vietnam, exclusive breastfeeding rates fell from 82% to 31% in just 11 years between 1996 and 2007).

So, what are the solutions?
The developing and developped world are united in needing appropriate 1-1 support for breastfeeding mothers, which takes into account cultural, social and economic aspects affecting the mother. This translates to investments in health services. Marketing of formular milk needs to be controlled so that it is truthful. Finally, action to support breastfeeding in emergency situations, because infant mortality is particularly high in these situations and breastfeeding is vital to child survival in emergency situations.

Here are some links for further reading:

World Breastfeeding Week action on breastfeeding in emergencies
http://worldbreastfeedingweek.org/images/english_2009actionfolder.pdf
http://worldbreastfeedingweek.org/images/icdc_%20focus_english.pdf

A Generation On: Baby milk marketing still putting children's lives at risk (Save the Children Media Briefing)
http://www.savethechildren.org.uk/en/docs/a_generation_on.pdf

Save the Children on the Child Survival Campaign which includes action to support breastfeeding
http://www.savethechildren.org.uk/en/docs/newborn_and_child_survival_15_Jan_09.pdf

Coming up: my own experience of breastfeeding, and because I had a rough ride it'll be long...

postscript to my take on breastfeeding lobby

A little while ago I wrote a post on why there is such an overwhelming push to increase breast-feeding rates in the UK. I have a short postscript to this. My post was about the fact that breast-feeding rates are an indicator of poverty and that therefore increasing the rates of breast-feeding is an indicator that poverty is reduced (while acknowledging that in itself, breast-feeding or not of course says nothing about the disposable income of the parents!)

A new project I'll be working on, which relates to reducing child poverty in Glasgow and East Dunbartonshire through making local services work for children and families who live in severe and persistent poverty, gave me access to breast-feeding rates in some of the poorest areas of the UK. The percentage of mothers breastfeeding at their 6-8 week check-up varies in these localities between 10 and 14 %.

Although I knew that the rates would be below national average, I was absolutely shocked about how low these figures are. In many countries, breast-feeding rates are 95% at 6-8 weeks. I felt it would be useful to share this percentage to illustrate how low breast-feeding rates can go if parents live in multiple deprived areas. The connections are complex and there is no real answer, and I look forward to working within this new projects with families and children, listening to them and contributing to making local services work specifically for children and families living in poverty. My suggestion to include antenatal service access in the project has been taken on board.

The data hopefully demonstrates that the push to breast-feed is not to do with individual situations, but the bigger picture. 10% breast-feeding rates have to be unacceptable. Still, we have to acknowledge that behind these statistics are real people with real choices they made, and real reasons to choose not to breast-feed.

On the topic of child poverty, I strongly recommend the three part series "How the other half live" which is currently being shown on Channel 4 on Thursdays, 9pm. Check out www.savethechildren.org.uk for background info on child poverty in the UK (1 in 3 children in the UK grow up in poverty, that's 4 million). The first episode shown yesterday was very moving and gave an insight on the extent of income inequalities in the UK.

What is often overlooked in the breast feeding debate

In recent weeks, the old heated discussion about breastfeeding or not has been making the rounds in the mummy blogosphere. There have been numerous (let's call them pro-choice) posts, such as Little Mummy, and over at Perfectly Happy Mum other bloggers are keen to help everyone breast feed who is able to do so and are sick of being called the breast feeding police (and I apologise having used the term myself, even if jokingly). There are also those pregnant unsure what to do, or new mums struggling with a constantly feeding babe such as Metropolitan Mum (oh I know how bad it can be!).

Something has been overlooked in the debate. And this is where I dare to chip in (of course I also went through a rather horrible and beautiful time breast feeding and touched the formula carton for the first time when Cubling was 12 weeks but that really is another story). Breastfeeding, or rather lack thereof, is linked to poverty (see this breastfeeding and poverty bloggers' carnival), social class and basic health. " poor mothers are less likely to breastfeed and this association remains after controlling for other factors. Also after controlling for other factors, cohabiting and lone mothers, lack of qualifications, being a young mother, having more than one child, being white and living outside England are all associated with significantly lower rates of breastfeeding." (source)

The reason why the "breast is best" message is pushed by the UK health services, government, local authorities and community planning partnerships is little different to the reasons that breast feeding is a life saver in developing countries. In the UK, low breast feeding rates are firmly linked to poverty. That's child poverty, inter-generational poverty, long term, people-can't-manage-to-get-out-of-it poverty. Poverty as persistent as we haven't seen it in a long time.

You see, the breast is best message is not actually aimed at us middle class mums, who are well informed and are able to make up our minds. Mums who, if they decide not to (or end up not being able to) breast feed, will make up for this with hundreds of other ways of being an excellent parent. It's also not meant to send us on a guilt trip if things don't work out. Actually, nobody cares what choices we middle class, secure in our little houses with two disposable incomes or one big one decide to do.

The "breast is best" message is aimed at people in the UK who live below the poverty line and in communities of multiple deprivation, where breast feeding rates are shockingly low, and where people move from not breast feeding to feeding their kids on junk food, causing obesity, health issues and the much quoted difference of 20 years of life expectancy between Shettleston in Glasgow's East End and Bearsden in Glasgow's North West. A life expectancy in the case of Shettleston which is similar to that of developing countries. And I'm not labelling these parents as bad parents, the reasons for this pattern are very complex.

So, government, local authorities, everyone really have looked into how to change this cycle of disadvantage. There are overall aims and objectives, and a vast number of indicators which serve to show that change is taking place. One of these indicators is breast feeding rates at 6-8 weeks postpartum, specifically for instance in aim 12 of the government's 2007 public service agreement to improve children's and young people's heath and well-being, as well as ESD indicator NI53, where breast feeding is linked to higher access of maternal services which in turn means that women who breast feed are more likely to access services. In turn, supporting breast feeding also provides an " impetus to enhance health and children's support services to mothers to sustain breastfeeding and thus give children a good start early in life."

Now I'm not arguing that you eradicate poverty by increasing breast feeding rates. That would be ridiculous and naive. However, if breast feeding rates go up, other stuff has happened which indicates that there are changes in behaviour which, along the line, means that people are enabled to get out of poverty, by themselves or by taking up help to get them there.

If breast feeding rates go up, this tells us a lot about the effectiveness of maternal support services. Again, I'm not talking about 100% breast feeding rates, but something which is better than the 13% in the area where I work for instance. The WABA (World Alliance for Breastfeeding Action) 2005 Progress Report succinctly states that:
"Therefore, we believe that breastfeeding outcomes can be an indicator of a woman’s quality of life throughout childbearing. Does she get adequate food and rest, good health care, maternity protection at work? Is she free from violence and discrimination? Support for breastfeeding demands that we pay attention to the well-being of the woman behind the breasts." It's about supporting the woman, protecting her and enabling her to find suitable support. Where breastfeeding rates are low, this support may not be accessed. It is not about women who do access services and are doing reasonably after giving birth (and may or may not choose to breast feed or bottle feed).

That's why the breast is best message is necessary and in my opinion should continue to be pushed. If we're middle class mums who have had problems with breast feeding of a medical nature, a comfort nature or any other nature feel pushed a tad too hard, please get over it and look at the bigger picture. The UK has the lowest breast feeding rates in the EU, and one of the lowest child wellbeing rates, with one in 3 (please stop and read this stat again!!!) children growing up in poverty in the 5th richest country of the world. There is a link, even if it is a complex one, but if we want to be serious about ending this lamentable state of affairs, it's important to start pushing at all ends.

The breast is best message is one of many ends.