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...

Grief, expectation and the mind of toddlers

It is just over two weeks until the due date of my niece/nephew. Sudden realisation has kicked in that my sister in law is almost full term, and things could happen any time. Her pregnancy has passed so quickly, and only today did we get reasonably organised-even though I still don't know the route to the hospital. Me and a mutual friend will be her birth partners, which I'm both looking forward to immensely while being ever so slightly anxious if I'll be any good at it. So I'm glad I won't be alone, although it will be tricky to be ready with the 4 children between us. But we will, of that I'm sure.

This weekend, we visited the place where I last saw my brother in law. It was the hardest day in a long time, where with all the efforts of holding back tears I could not. And who cares anyway if tears well up or not, nobody's business but mine. Cubling's toddler mind displayed unexplained memory and knowledge. She'd done something similar before. For the first time in 7 months she asked for her cousin's daddy: Where x's daddy? Where uncle x? By name and description. Not once, not twice, but about 10 times in a day, and the following days, all triggered by the visit to the place where she too last saw him, as if he was still there, and could be plucked from memory. How I wish that was true. I didn't know if to stop her inquisitive and innocent two year old mind and mouth because it pains us so much to hear the question, yet she has a right to know, as much as it's a parent's instinct to keep all things death away from our children. I tried to explain, and she mouthed the words after me, understand she did not. Much like all of us. Above all, she missed him as we acutely did too.

I haven't explicitly blogged about this before, because words just won't come. And it felt very wrong at the time to blog about this. I felt uncomfortable to the extreme. I still feel uncomfortable and still unsure if I should talk about this here, yet don't see how over the next weeks I can keep blogging without bringing these facts into the open. Everything I'll be doing, much like half of my time in the past 7 months has already been, will be shaped by these facts. They are part of me and as much as I'd like to keep them private, I need to share them in some form here for upcoming posts to make sense.

So what happened? My brother in law, a healthy young man, got the flu, sought medical treatment, was told to just rest and that he'll be grand, only to end up in hospital some hours later when all was too late. He passed away on Christmas Day. My sister in law was 7 weeks pregnant with their second child.

For my part, I've tried with all my might to focus on the positives, because the loss is so big that it threatens to take over everything every single day. Still. I've used this blog for tracing the good moments we've had, while feeling always guilty to even suggest that any good could ever come from this. It's just that good things do happen and all we can try and do is focus on them, not to forget, but to keep going. I don't want to delve into cliches, simply what happened was so utterly wrong, shouldn't have happened, wasn't something we ever imagined could happen. It's good to have toddlers the same age who, when thrown together, take the intensity of parenting away to give respite. Well, they do fight a fair bit, they're two-year-olds after all. Having a family who truly sticks together. The baby. So hard to look forward to, yet so important to do so. Trying to take Cubling's cousin as an example who doesn't realise what's gone, just knows what's there, even though he holds on to that so much harder than before. I hold on to the memory of that last day spent together, how perfect it was, how happy he and his family were. How he showed Cubling giant squids, dolphins, mermaids and sea horses that day. And clearly, she must have remembered in some way because her questions came out of the blue as soon as she saw the giant squid model, without warning.

At this point in time, the grief seems momentarily being overtaken by a burst of activity, the practicalities of welcoming a new life into this broken world.

11 weeks

First of all, a preliminary note. I'm posting this rather personal entry because it affects mainly me. I know that friends of mine may read this who did or didn't know I was pregnant. While I would prefer to tell everyone in person, this is difficult just now, sorry.

20th May 2009: I'm 11 weeks pregnant. Exactly. One week to go before I can officially relax and tell everyone the good news. When out of the blue, there's blood. Not a lot, but fresh. Strangely, during this pregnancy, I was more relaxed about miscarriages, I didn't worry too much. With one difference: considering the lack of pregnancy symptoms (especially in comparison to my first pregnancy) I never quite felt pregnant. Add to that the knowledge of a thing called missed miscarriage (where baby dies but is not miscarried for a while or not at all) which I didn't have last time around, this was indeed on my mind.

I didn't expect blood.

Of course my Beloved was not at home when it happened. He doesn't go out much, so it was really sod's law. NHS 24 reassured me that at least I wasn't miscarrying just this moment and it could wait until the next morning, that I needed a GP referral to early pregnancy unit as I hadn't had my booking in appointment yet (which is in week 15 of my pregnancy, how about that) and should phone them as soon as their practice opened. So I did. GP gave me the number of the unit, no referral necessary after all. Just that the next appointment was still 27 hours away. Another day and night of worry ahead of me. In a way, that's fine, I know that there's nothing they can do should I miscarry. Of course it would be nicer to have reassurance or certainty earlier, but to be honest, does it matter? I even considered not to phone at all, if it's just for my peace of mind or certainty, it's surely not a medical necessity to be seen by someone.

The internet is a great and terrible thing. I posted on a forum in search of reassurance and got it. Good. Next I researched miscarriage symptoms and was informed that 50% of women who have fresh bleeding in the first trimester will miscarry.

My baby has a 50-50% chance. That is bad. I've lost people on much better odds.

All I can do is wait until tomorrow and try and stay calm and not so guilty about my brisk walk yesterday which I somehow fear is to blame. Or maybe it was Cubling, kissing baby in mummy's tummy goodnight and wanting it out to play with. Maybe baby took the request just a tad too serious.

22nd May. Appointment date. I had more bleeding last night, it stopped overnight though. I was devastated last night, hopeful again this morning. And very reluctant to drive to the hospital. My thoughts were that if I was to get bad news, I'd rather not have them, that I'd rather have uncertainty than bad news.

The appointment went something like this: chat to determine my details and symptoms, nurse/midwife/doctor agreed that it was looking good and that the scan would probably have a good outcome. Next was the scan. Sonographer said something about my bladder being too full, my womb towards the back and not being able to see a baby. Was I sure of my dates? Oh yes. I'm very sure of my dates. At that time I knew something was wrong. They had to perform an internal scan and there it was, a 6 week old embryo with no heartbeat. I looked. I didn't see much, thankfully, just a shade . The staff were very good and professional, handing me tissues and giving me and hubby a private room, above all, giving time before doing any talking. Amidst the frustration and sadness, I have to admit I was incredibly glad that I was not to miscarry an 11 week old foetus, and that none of my actions last week could have caused my baby to die, in spite of the frustration of having thought for so many weeks I was pregnant when the embryo had died even before I told my family about it. I also feel scared of what's to come, and my hope for a second child has dwindled a little bit.

Hubby and I came home to sister in law and two toddlers who gave me massive hugs. I'm so very lucky to have Cubling, and whatever the future has in store, we are so blessed with this amazing little girl who doesn't stop smiling, giggling, laughing and shrieking.

what I've been up to

I admire some bloggers. Particularly those with more than one child who manage to blog more frequently than me. I mean, I love blogging, but sometimes, even for as long as a whole week, there's no energy left in me at all. Ok, there were nights with little sleep (which I can only in part blame on Cubling). There was a girlie night in watching Sex in the City (what utter rubbish!) and a fabulous gig by the amazing Duke Special.

Apart from that, I was too tired to blog, knit, make cards for two imminent weddings which I won't be able to attend. Lethargy took over, and all I could manage was browse the internet until my eyes fell shut.

My mind was rather occupied by the flu. Not in the sense that I had it, but the media coverage of the (swine) flu. It seemed clear to me way before the official announcement that something in the reporting wasn't right. As someone who needs to evidence anything I do in my day job, with facts, numbers and analysis, the information didn't add up. Expected, suspected prefixed to infections and deaths in Mexico, and numbers going up then down, to me sent out warning signals that really, nobody seemed to know a thing. I was sceptical of the danger, and didn't quite believe that there was a real threat. Still, better cautious than not. The best thing in my view that came out of the whole pandemic shebang is that antiviral drugs are now available and health services take the flu seriously. I can't see how the pandemic is more of a threat to us than seasonal flu. However, I kid you not, seasonal flu is a threat to us. Especially if health professionals underestimate symptoms reported to them and by negligence cause devastating and unspeakable loss. So, as ever, we interpret big stories from personal perspectives. And all I can say is that it's a good thing we learn about watching flu, and to have a health system on alert. I don't want to go into numbers, but flu kills lots of people every single year. I hope never to have to see the adverts before Christmas again that tell us not to contact the doctor if we have the flu and rather just to get on with it.
And our Christmas will never be the same again.