breastfeeding

How do we prepare women to breastfeed?

Women at the hospital where I work are scheduled to receive breastfeeding information at their 26 week check-up visit.

It’s my favourite visit even though it can be tricky getting through all the information required to be imparted during this time. I make up for this by talking fast!

The midwives have a checklist we have to work through (another of my not-favourite thing) but it covers the essentials – benefits of breastfeeding to mums and babies – (don’t forget dads! They can get better sleeps for years if things pan out…) rooming-in policy, non-giving of formula to babies being breastfed without a medical indication, non-use of dummies in hospital, resources for support after leaving hospital and so on…

We are meant to start by asking how women are “choosing” to feed their babies. Seriously, about 99.9% of women we see – from very varied communities and backgrounds want to breastfeed. Sometimes I would breach protocol and ask “how are you going to breastfeed your baby?”

A Norwegian-born woman in my ABA group told me how the question astounded her: “in Norway no-one would ask – there is only one way to feed a baby!”

Then we are meant to chat about the benefits of breastfeeding. From my days of teaching breastfeeding education classes in the community I know that everyone (and their dog)knows the benefits of breastfeeding (especially the dog, right?). “Breast is best” is a health message breathed in like air. It doesn’t keep women breastfeeding, but it probably starts them thinking that its something they might like to do.

I skip this info – “you will be well aware of the health benefits of breastfeeding to you and your baby”. Lots of nodding…

Then I tell a story to them. It’s the story of what happens when their baby is born and they start to breastfeed.

My plan is to normalise the experience and to be realistic about what the first days with a  newborn are like. Prospective parents are unlikely to hear about this from other people… in fact the families I look after post-natally seem to generally be overwhelmed by their experience in the first days. It is such a short and stunning period of time for new parents that it is quickly forgotten. But this moment is an opportunity to consider what a baby’s first days are like – physiologically, and then to relate this to the experience of breastfeeding in the early days. which we know as midwives is a cruel, intense but life-changing time for parents and their babies.

Here are some things I say:

After your baby is born he or she will be handed directly to you and placed skin to skin with you. Your baby will be dried off while lying on you and be closely observed in the important first minutes as she breathes air into her lungs for the first time.

We know that skin-to-skin is not just a nice thing to do, but actually helps your baby transition to life beyond the placenta. Babies in skin-to-skin contact with their mothers stabilise their breathing and their heart rate and their temperature better. And something else happens too…. babies start to look for the breast. Babies will literally crawl towards their mothers nipple, attach and feed if left undisturbed after birth. I get to see this all the time in my job.

If you want to see babies do this too you can search “breastcrawl” on YouTube and see lots of newborn self-attaching.

We like newborns to self attach if they can because when they do it themselves, they do it properly. Not only that, when they get it right the first time – they go on to do it right time after time from then on.

I talk then about how that first feed should take an hour or even two hours. And about how babies are awake and alert for the first hours after birth – so that they can breastfeed well.  I also mention how oxytocin in the mother’s circulation is making more colostrum available to the baby in that first feed than it will over the next 24 hours – oh, and also how the breastfeed will help to contract the woman’s uterus during this time – to deliver the placenta and limit her blood loss.

Nothing beats the faces of parents-to-be at 26 weeks listening to all this – I think this is often the first time they have really thought about the nuts and bolts of this almighty adventure they’re embarking on! And then we talk about how babies usually have a giant sleep after this – maybe for six hours. More nodding.

How often do new babies need feeding? More is more in the colostrum world – small amounts frequently is key. Thick gooey colostrum – more medicine than milk at this stage.

Every feed is also a good learning time for mum and bub. Also extraordinarily comforting and reassuring for a new baby in a giant world of weirdness.

Sleep? I hear you ask… mmmm – not so much. Here’s what the postnatal ward is like on any given night – it’s party time!

Newborn babies are more like teenagers than any other group I can think of. They behave like angels all day and evening through visiting hours and then at about ten o’clock they all wake up and want to feed. Not once, not twice, but continuously – until about 4am. Then by 6am they are all fast asleep. When the morning shift starts at 7am they find a ward full of sleeping mothers and babies. It’s natural.

Mornings are very settled times. Then the feeding frenzy begins again after lunch…or at least we’re all trying to get babies to feed again in search of that holy grail – more sleep overnight. Good luck.

Sounds great doesn’t it? Everytime your baby wriggles is a good time to try a feed. Don’t wait for your baby to cry.

Expect lots of sticky black meconium nappies in the first few days. Not much wee until your baby’s digestive system and kidneys start to fire up – and the colostrum increases in volume (that’s happening all the time by the way, as you keep feeding). Black tar poo is replaced by darling green numbers and then mustardy slops that smell like fresh mown grass! yum! Now watch out for the wee fountain on the change mat. Not just for boys!

Now your baby’s tummy is expanding as the volume of feeds increases. And then…..your milk comes in and Everything Changes.

But I tell them not to worry about all that just yet.

The most important thing that I mention is that through all this time there will me midwives like me supporting them.

We are mostly friendly dragons who love babies.

We midwives know lots and lots of things about lots of different babies – but probably very little about your baby. In eight hours you will know more about your baby than us. We can give you info about some principles and tick off important tasks like teaching you to bathe the critter (after 48 hours) or showing you the phone number for the ABA breastfeeding helpline or teaching you “what to do when you get home” (my script for that one still needs work). So just ask us. The questions will start to really flow when we visit you at home in the first week.

A lot of the time we do a version of cheering you on from the sidelines. Cause it’s hard and tiring and being in hospital is mostly crap. But soon you will go home and your milk will come in … and Everything Changes. So now you know.

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Joining the Circus

I have a friend who is pregnant with her first baby.

In the last few weeks I have been thinking about what books would be helpful for her to read in preparation for motherhood.

So I read a few.

To be honest there were few such books around that I thought would be helpful at all. My first child was born 16 years ago, but I have been working and thinking (!) as a midwife since then, and there seem to have been few bright moments in the Transition to Motherhood genre.

The books I have just read were a mixed bunch.

I think I can envisage the editorial meetings – “maybe a few more funny stories about the [INSERT: ridiculous health professional] who tried to help you to breastfeed/get your baby to sleep/push your baby out of your vagina/join a parents group”….never mind how hard people may have worked to help you.

Many of the writers who share their stories of becoming a mother oscillate between themes of “I’m special because this is what happened to me” and “my experience is an archetype of what becoming a mother is”.

Most worrying is the theme of belittling health professionals and structured support systems as being “not for them”.

“I’m not much of a joiner”.

What does that even mean?

Several writers talked about their reluctance to join a new parents group where the only thing members had in common was the lottery of giving birth. What was the reason for their reluctance?

New parents groups are a phenomenon of living in the Maternal and Child Health system of the People’s Republic of Victoria, and are also present in other states of Australia.

Maternal and Child Health Nurses, who work for local councils, organise groups for parents to meet when their babies are between 6 weeks and 3 months old. Usually there are structured meetings for 6 weeks or so at the Centre. After that groups may continue to meet informally at members’ homes or playgrounds or community centres or playgroups.

Research about mothers and parents and playgroups indicates the strong social role that such groups play in a context where isolation is more prevalent – especially for mothers and children. These groups have also been found to provide, at the basic level, an opportunity for mothers and families to receive care – different to other modes such as clinic or home visits.

What worries me is that prospective mothers reading these books get the idea that these groups are daggy or a waste of time – especially if they aspire to be the uber cool inner city types that these authors often are.

I also worry that these attitudes add to the ongoing narrative of:  “we only like to hang out with people who are like us”.

Isn’t this the narrative of an oppressed group?

My own involvement with the Australian Breastfeeding Association came about at least partly in order to deal with general societal ambivalence about breastfeeding. ABA meetings were a haven where you could breastfeed your older toddler with freedom.  [*sorry freaked-out new mums].

Not that my mother’s group were anti-breastfeeding. But I guess I had a bigger aspiration to be involved in community-based breastfeeding support.  The added benefit of these meetings was that there were women with babies and children of all different ages attending. Having a child who didn’t walk until he was almost two and breastfed for several years longer than that was definitely less of a drama at ABA meetings.

Grassroots groups like mother’s groups or playgroups are inherently subversive. I wanted to be a part of that – an autonomous collective of sleep-deprived nobodies – no-one could control us (not even the maternal and child health nurse once we busted out of her centre).  No-one was interested in us except us.  But we were building the sorts of networks that help you when you have another baby or go through IVF or you need a job locally or need someone to have a cup of tea with when these kids finally and suddenly have their first day at school.

Why wouldn’t you want to be a part of that?

Not a joiner? That’s ok. But your child will need other kids at some point – they can’t play with you in the café for ever.

Nor should they.

 

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August Sander’s People of the 20th Century.

Breastfeeding support – what makes it good.

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I’m reading  a lot of research that considers  the best ways to prepare and support women to breastfeed.

Truth is, we really don’t know for certain what’s the most effective way to do it.

One theme that seems to be coming through is that the what isn’t so much of an issue as the how.

When women are asked about what care was helpful to them, they talk about having their feelings acknowledged and being listened to.

Graffy and Taylor (2005) undertook a randomised controlled trial in the UK to measure the outcomes from a particular model of breastfeeding support. As well as this, they asked the women in the trial about what they thought constituted “Good Breastfeeding Support”.

The authors summarised it in 5 points:

1. women wanted good information about the benefits of breastfeeding. This was so they could defend their decision to breastfeed when they were questioned (as they expected to be) by their family and friends (!).*

2. women, as I mentioned above, wanted their feelings acknowledged and wanted to feel listened to.

3.  women wanted practical tips for breastfeeding such as different positions for feeding.

4. they also wanted reassurance and encouragement to breastfeed.

5.  Provision of resources for what to do if they were having trouble – someone to call or make contact with.

Not a bad list.

I would defy any midwife to not know how to provide the elements these women were after.

One of the big points here is that women aren’t expecting a huge amount from their caregivers. Mainly time, patience, a listening ear and some encouragement. You don’t need to solve all their problems….but hey, preventing some would be excellent.

As midwives, we can do this by helping them get to know their new baby – to read the baby’s cues, to offer the breast when the baby is quietly alert, to hold the baby close any time.

To believe them when they say they have tried to feed.

To stay with them when they are going to try.

You don’t need all the answers – you will have seen enough babies to know the range of what is normal – and be amazed by the immense variation in this!

Something I tried to mention to women in clinic when we were talking about breastfeeding at the 26 week visit (probably should have had a chat about it at every single visit…) was: “as midwives we know a lot about lots of different babies …but not so much specifically about yours – you will very quickly become the expert on your baby – you can use us midwives to help along the way with figuring it all out”.

My experience as a volunteer breastfeeding counsellor and then training to be a lactation consultant helped me realise there are more important things than “knowing all the answers” to breastfeeding problems when we are supporting women to breastfeed.

So much more is about walking beside them on the journey.

 

*just by the by…I think this issue needs unpacking (and highlighting) a bit more.  Never mind criticism of the health message “breast is best” – when women are being judged on their decision to breastfeed by their own families!

Maternal and Infant Nutrition and Nurture …oh my!

10 things I learnt and loved about #MAINN2014.

This conference is usually held each year in Grange-over-Sands in the UK, by the University of Central Lancashire. It is a conference dedicated to presenting and discussing research on infant feeding with an emphasis on alternative, contextual approaches to the subject. This year it was held at the University of Western Sydney in Parramatta. These are some of my personal highlights…in no particular order and with ruthless editing to make it digestible to others. Thanks to Virginia Schmied from UWS for making it happen.

1. Exploring the highs and lows of the Baby Friendly Initiative with Fiona Dykes from the UK and Danielle Groleau and Sonia Semenic from Canada. Good to know that there are people interested in the way that health professionals (midwives) live with the 10 steps and the culture of the accreditation.  Fiona spoke about the problems with a “top- down”approach with any behaviour change, but also about the promise of relationships in breastfeeding support.

Sonia spoke about the challenges of introducing the 10 steps into NICU units worldwide: there is a general pre-occupation with infant growth, calories and volume. There are also significant challenges associated with baby illness and feeding. It will be so exciting to see the progress with this work.

Danielle’s work looked at the varied impacts that BFI facilities seemed to have on women’s breastfeeding behaviour in the longer term. She highlighted the  need for more research into the impact of BFI on women from low income groups. She also spoke very clearly about the sociological theory that shines a light on the the problematic issues of breastfeeding cessation amongst women from low income backgrounds and breastfeeding in public. Symbolic capital…mmmm.

2.Renee Flacking reporting on her ethnographic study of four NISC units: 2 in Sweden, 2 in UK. eleven months of fieldwork (phew!).  Her comparison of the different models of care was effective in demonstrating the many benefits of the “womb” model: continuous skin to skin with mother (and/or partner), a separate, private space that allowed families to “focus within”, with the baby as the context.  Interactions between mother and baby “effortless”. Importantly, parents can “be who they are”. Her description of the “standard” nursery care with one uncomfortable chair for mama highlighted the culture in many nurseries of parents being expected to stay an hour or three, but not for longer.

3. Investigations of the impact of peer support for breastfeeding in the UK with Gill Thomson.

Nursing Mothers and the Australian Breastfeeding Association have done this en masse in Australia over the past 50 years. Yup, we reckon it works. Kate Mortensen from ABA is investigating breastfeeding peer support globally and the RUBY study  (Ringing Up about Breastfeeding) will examine the impact of telephone peer support for breastfeeding mums in Melbourne, as presented by Heather Grimes from La Trobe University… it’s already under way.

4. Shanti Raman’s ethnographic study of families in Bangalore,India: “nothing special, everything is normal”. How pregnancy and childbirth is part of the discourse of everyday life in India, and how it is woven into the rich repertoire of celebration and ritual. This resonated with my own experience of providing care for Indian families in Australia… somehow enviable in our culture where pregnancy and childbirth seems so “other”.

5. Gold star to Charlene Thornton for making me like stats!  Her “normal woman” enables effective comparison between care models. Some juicy details: C/S rates, inductions and episiotomy in  private compared to public.

6. Deborah Lupton – renowned health, food and  now digital sociologist.  Enjoyed her quick summary of her own work and directions over the past 20 or so years, with some emphasis on the sociology of risk: “The precious foetus” and more. Mothers place so much pressure on themselves to perform as guardians of their children. Children are both beloved and reviled in our society. Food for thought …

7. Examination of the breast pump discourse: Helene Johns, Kath Ryan and Athena Sheehan. Soft touch indeed. The impact of advertising culture on breastfeeding culture: when breastfeeding comes to equal breastmilk.

8. Talking at meal breaks.  To anyone and everyone – so friendly! What is it about people who do research into breastfeeding and birth? I’d like to think we are uncorrupted by wealth or status!

9. Meeting strangers at dinner. Actually, turned out to be new friends.  This was the kind of conference where, no matter who you spoke to, they were interested and involved in breastfeeding research  and/or clinical practice. Often both. I found out a great deal about what breastfeeding support looks like in Queensland. I also was delighted to share my own plans for research (thanks guys!).

10. Being at UWS in Parramatta. Home of the Whitlam Institute. The campus is an oasis from the traffic and noise of the bustling city.  It’s also a stunning combination of old architecture and new as well as useable and attractive open spaces.  An amazingly culturally diverse community in Parramatta and a calm and beautiful walk each day along the beautiful Parramatta river. Harbour? Who needs a harbour?!

 

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More women doing it for longer.

There has been some talk lately about the pressure placed on women to breastfeed their babies.

Ninety-six percent of women in Australian initiate breastfeeding when their baby is born (Australian National Infant Feeding Survey, 2011), which is a cracking good statistic by world standards. It’s definitely up with the leading leaders in Northern Europe.

The well-worn promotional phrase “breast is best” may well be at least partly responsible for this excellent initiation rate, although breastfeeding advocates are well aware of a more pressing problem – that of keeping women breastfeeding.

In the first week after birth, many, many women who had planned to breastfeed either give their babies infant formula or stop breastfeeding completely. This is despite the best efforts to promote the World Health Organisation’s (and Australia’s National Health and Medical Research Council’s) recommendations that advise there are specific health benefits to babies when they receive ONLY breastmilk in the first six months of life.

The latest figures state that 15 percent of Australian babies are receiving only breastmilk just as they turn six months old.

The question of why this is happening is certainly of interest to breastfeeding advocates and researchers. There is every reason to believe that women who start to breastfeed plan to continue doing so, but as for many health behaviours, the reasons why women enact and sustain breastfeeding are extremely complex, and, I would say, intimately related to the context of their lives. This means that messages like “breast is best” have some power in people’s decision-making, but may not sustain their health behaviours over time.

More influential in the medium term for women breastfeeding their babies might be things like how much time off work a woman has after her baby is born, how supportive and knowledgeable about breastfeeding her friends, partner and family are, how much timely support she gets from health professionals if/when she has difficulties, how comfortable she is breastfeeding in public or even in front of other family members in her own home, and how much she actually enjoys the activity of breastfeeding.

Madeleine Morris’ new book, Guilt-free bottle feeding argues that women have too much pressure placed on them to breastfeed. Earlier, I assumed that 96 percent of Australian women were breastfeeding because they wanted to. It is unsurprising then, that when 96 percent of Australian women start off breastfeeding, our health system is somewhat geared towards supporting them to continue. The known health benefits to mother, baby and community of women breastfeeding might also explain the enthusiasm with which that support is offered.

As for individual guilt, it is generally unhelpful to blame those who helped you try to achieve the goals you set for yourself. Better to protest about the values of a society that purports to like the idea of breastfeeding, but doesn’t provide sufficient affordable, skilled support and education to those trying to do it.

Morris argues that there is really very little difference between breastmilk and baby formula, despite regularly stating throughout the book that of course breastmilk is the best and first choice for feeding a baby. Also confusing is her argument that women want to breastfeed because it is an activity that is inextricably linked in our society to the ideal of a good mother. Rather, the evidence we have suggests that women start and continue to breastfeed because of the health benefits it confers to babies.

There are also many women who struggle to breastfeed in public, whether because of overt comments or because they are worried about the possibility of comments being made. This situation is not likely to be reflective of a society head over heels in love with breastfeeding mothers.

The bigger question remains: if most women start off breastfeeding, why do so many start giving formula as well or stop completely?

To be honest, we don’t know enough about how best to support women to breastfeed. The Cochrane Collaboration’s review paper on support for breastfeeding women particularly mentions the lack of research examining women’s satisfaction with breastfeeding support. My doctoral research will ask women about their experience of care with lactation consultants. I will also observe lactation consultants in practice and talk to them about their work. I am excited by this opportunity to learn about women’s experiences of getting help to breastfeed. It will also be great to observe and talk with the health professionals who support women to breastfeed every day.

There is a happy ending to this story: the Cochrane review also notes that any form of breastfeeding support is most effective in populations with high breastfeeding initiation rates.images-6

Fixing breastfeeding

 

There is no doubt that concerns about infant mortality rates in the USA at the end of the nineteenth century played a role in motivating the medical profession to find new, safe ways of providing nourishment to small babies.

I just can’t work out why there was so little effort to try and work with human lactation.  Wet nurses were (perhaps rightly) widely condemned, but lactation advice seemed to consist solely of offering something else to feed the baby. This complementary feeding almost inevitably led to weaning because of reduced ( or further reduced) feeding at the breast and then reduced stimulation to make more milk.

What about human milk banks? They seem not to have been thought of … formula was the substitute.

Milk sharing must have been endemic, just from the view of infant survival. And it’s a different phenomenon to wet-nursing: a trusted friend or family member provides the milk (and perhaps the breast), rather than a financial transaction. It is an act of trust between mothers. And then there’s the safety of having milk provided to your baby, that another mother is giving her baby. Many of you will know of the special “cousin” or sibling relationship that milk-sharing confers on babies as they grow up in Islamic cultures.

Dr Virginia Thorley is a Lactation Consultant, ABA counsellor and historian who has written about milk sharing:http://www.virginiathorley.com/Links.html

A pervasive and  general mistrust of the functioning of women’s bodies was certainly at play: breastmilk couldn’t be trusted to be consistently wholesome (not surprising given the prescribed conditions necessary for this), women’s bodies were unlikely to be able to produce enough of the stuff, and if there wasn’t enough, you had to give something else instead.

The parallels with men managing childbirth are obvious. Why trust nature when intervention could help so much? Also consider the manipulation of nature with regard to the regulation of rivers and mechanisation of agriculture…

Formula was apparently more attractive because medical practitioners were able to manipulate its contents according to “the baby’s needs”. The implication is that mothers were harder to manipulate! You bet.

But also there was a fundamental distrust of mothers’ ability to care for their babies in general. “Maternal education” was seen as vital to improving infant survival. This was done by means of pamphlets and booklets being produced. But the paediatrician or family physician was seen as the authoritative key to infant well-being. And as he knew little about lactation physiology, most mothers would be bottle-feeding before long.

Thank-you doctor!

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bash the breastfeeding supporter

Is it me?

Probs it is me.

It’s like when you notice women with prams everywhere when you’re pregnant.

Seems to me there’s a bit of beating up of breastfeeding supporters and advocates going on.

Allegedly they (we) are making women feel guilty about not breastfeeding.

Even when a woman has had a bilateral mastectomy for breast cancer (if you must know) … see Emily Wax http://www.theguardian.com/lifeandstyle/2014/oct/18/breastfeeding-mothers-formula-breast-cancer%5D

A couple of my thoughts on this:

1.96% of women in Australia initiate breastfeeding. In my professional experience, first-time mothers who plan to bottle-feed their babies from the go-get are as rare as inverted nipples*. I’m guess I’m saying this is a very small group of women to be getting an awful lot of words written about them. They in no way should be judged for their decision, but I would hope that their decision is an informed one.

2.Women who are feeding their babies at least some formula are more and more numerous as time goes by…85% of Australian mothers, in fact, just before their babies turn six months old. So formula feeding to some extent in our culture is not a rare occurrence, although as to why this is….it’s complicated. But women who are formula feeding shoudn’t really feel like a marginalised group. By six months they are firmly in the majority.

What happens?

Lactation Consultants and midwives and peer counsellors who provide care for women and their newborn babies really  want to help the 96% of mothers  fulfil their goal of breast-feeding their babies.  Women need some/none/mega amounts of support to do this.

Some breast-feeding supporters are over-enthusiastic in the way they explain breastfeeding, or in the way they explain the benefits of breastfeeding. It’s all a pretty embarrassing scenario really, with breasts and nipples and crying babies and stuff.

And it’s also in the context of recovering from childbirth (with maybe one third of women recovering from major abdominal surgery), no sleep, managing visitors and a lack of privacy in hospital, perhaps a lack of general support from home too…

All in all it’s a very challenging environment to be teaching people about a new life skill. No wonder misundertandings arise.

Breastfeeding supporters know that this postnatal environment is a tough gig. It’s neither “technologic nor dramatic”.

They (we) do it because they feel privileged to be a part of this time with a family and their new baby – and all the promise it holds. Many do it because they themselves had difficulties with their own first or subsequent babies. Some do it because they feel that this time is one of the most important in a new family’s life, even though it’s the cinderella of maternity care (few doctors are interested or present, many midwives are more interested in labour and childbirth, it’s all happening in a pretty tricky environment,as I mentioned earlier, of sleep deprivation, post-operative pain, sore bums, bloody pads and renogotiated family relationships).

I’m saying that we’re not in it for the recognition or the laughs.

But we believe that if women set out to do something like breastfeed their baby, we’ll help them to, even when it gets tough.

Because they, and their babies are worth the effort.mother_BFing

 

*very uncommon indeed.

The challenge of making baby formula part 1.

When physicians in the US decided at the end of the nineteenth century to put their minds to making safer infant formula, they really threw themselves into the task.

Rima Apple’s history of infant feeding in the US: Mothers and Medicine, describes the complexity of the task of modifying cow’s milk to make it ok for little babies.

Possibly for many many years, cow’s milk was diluted with water as a simple substitute for breast milk.

From what I can gather, it seems like most babies would have had as much breastmilk as could be obtained from mother or other(?), with top-ups of cow’s milk or combinations thereof.  The almost official medical view was that most women were incapable of producing an adequate breastmilk supply, and that most breastmilk was of dubious quality (diet, exercise and sweetness of temperament were essential ingredients for ideal milk production).

The solution was to offer a cow’s milk substitute. Sound familiar?

I can only guess that the ill effects of tiny babies drinking raw watered-down cow’s milk were usually counteracted by the benefits of whatever breastmilk they were also receiving. Or not.  In some US cities in the 1890’s more than one third of babies died before their fifth birthdays. Somewhat complicating this was the widespread public view that bottle feeding was indeed dangerous for babies.

Understandably, there were concerns about the bacterial load in cow’s milk that arrived in urban centres from rural areas: raw, unrefrigerated and in open vats. Customers were often seen to take a sip of milk from the dipper to check for freshness and even home delivery of cow’s milk saw the milkman using the same dipper to fill household vessels (clean or cleanish) for every household on his delivery route. The milkman delivers!

So began campaigns to make cow’s milk safer for everyone: promotion of home pasteurisation, legislation that meant lids for milk vats were compulsory, milk stations positioned in urban centres with quality control standards and educational pamphlets for mothers…. and eventually, refrigeration for transport vehicles carrying cow’s milk.

But the real science was in the way cow’s milk was changed to suit a baby human’s digestive system. Complex percentage systems of adjusting the cream and water and milk sugar were devised by physician Thomas Morgan Rotch. He also added lime water (calcium hydroxide) to make the rather acidic cow’s milk more suitable for baby’s digestion.

For family doctors and paediatricians he recommended a chart be used that had 30 different combinations of cow’s milk formulae for babies up to 12 months old. Mothers were expected to consult regularly with their doctor for feeding adjustments in their baby’s first year.

Ironically perhaps, this multitude of different concoctions was designed to reflect the way mothers’ breastmilk varied over time.

And breastmilk continued to be recognised as the best way to feed a baby.But if there was difficulty with breastfeeding, there was little medical understanding of how problems could be remedied, part from offering bottles.

Rotch was influential in his work, but ultimately public health officials demanded simpler systems of devising baby formulae.  Importantly, the medical profession insisted that they be the first point of contact for guiding the mother in feeding her baby.  Manufacturers of baby milks or modifiers usually encouraged this too, or at least with some of their milk products.

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Cult of the mother.

I’ve just spent a good many hours reading a book about the history of infant feeding in the USA.

Mothers and Medicine: a social history of infant feeding 1890-1950. By Rima D.Apple

It has been interesting to learn about the way breastfeeding was viewed at the end of the nineteenth century, just as artificial baby formula was being developed.  Although this is definitely a history of the US experience, we can allow reflections on breastfeeding in Australia where many broad cultural themes were similar, such as the role of science and medicine in everyday life, and the lived experience of women.

The “cult of true motherhood” or the “cult of domesticity” described how women were viewed in the latter part of the nineteenth century: women were defined by their role as mothers, and were entirely responsible for the well-being of their children.  Kind of nice to have the recognition, but at times it would have been a tough load to carry.

In the nineteenth century in the United States, breastfeeding was generally seen as the best way to feed a baby, but the lactating breast was also seen as a sensitive and unpredictable organ: milk supply could be effected by anything from a “fretful temper” to a “fright”, and breastfeeding was likely to overtax the mother’s well-being, causing a “general weariness and fatigue”. Lactating women were encouraged to eat well, exercise a little and cultivate a serene disposition(!).

Go on…breastfeed…just make sure you do it perfectly. Oh, and good luck.

The second best way to feed your baby (should your unpredictable breasts not do your asking, despite your serenity) was for another woman to feed your baby. But wet-nursing was also problematic: how to ensure that this woman from the working class would be eating well, maintaining some serenity and not wasting her precious milk on her own infant? Never mind the enduring view of character being conferred by a baby’s food source.

Infant mortality rates were alarming, criticism of wet nurses widespread. The medical and scientific solution to the problem was to further develop baby formula. Bottle feeding was seen as a thing able to be manipulated by science, unlike the vagaries and uncertainties of that most female of activities: lactation.

And so began an era of medical advice for infant feeding. While mothers were very special people who were expected to take responsibility for their children’s upbringing, they would need a little bit of help from medicine if breastfeeding wasn’t working. That help would be in a bottle of baby formula, perhaps suggested by a doctor qualified in the newest of medical specialties: paediatrics.o-VICTORIAN-BREASTFEEDING-PHOTOS-570

Why do a PhD?

You get that look … you know the one … their face contorts into a pretzel shape (without the salt) … then they say: “oh, you poor thing.”

I’m telling people at a random social gathering that I’m starting a PhD.

The people who know me a little better, who have had the long chats and emails with me about the reasons why more women don’t breastfeed for longer, or have read my multiple Facebook shares of the amazing properties of breastmilk, or have witnessed my frustrations with poor support for breastfeeding mothers, or come along to ABA meetings with me … they smile and say: “of course you’re doing a PhD, and yeah, I know it’s about breastfeeding – what else could it be?”.

I’m doing this study because I want to change the world.

Well, I’m doing it because I want to learn how to do research, and what’s the point of doing research if you can’t create change?

So don’t feel sorry for me, because I am in a very fortunate position.

For the last 18 years I’ve been very interested in breastfeeding. When I was a student midwife, I spent lots of time with women on the postnatal ward, watching midwives help them attach their babies, watching them attach their babies, watching their babies feed, agonising when they decided to stop breastfeeding before they left hospital (despite all my slightly creepy watching!) …wondering when I would be able to actually help any of these women with all… this.

When my eldest child was born, I started learning a bit more. She was a post-term induction, born with her own polo neck sweater (cord around 3 times, tightly) … and I am proud to say that I had grazed nipples when I left the hospital 24 hours later. Ouch. What a midwife.

A kindly lactation consultant helped me attach her firmly and painlessly about 5 days later.  Her words: “this will make you a better midwife Jen”. Damn tootin.

And so a monster was born (that’s me).

For the last six months I’ve been reading about breastfeeding, thinking about breastfeeding, writing notes and mind maps and emails about breastfeeding. All with permission.

So don’t feel sorry for me.

I just hope all this will be enough to change the world … maybe just a little bit.

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