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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speech made on leaving the best job ever…

WitchesIt’s almost a year since I left work to start full-time study as a PhD student. So ended ten years of part-time and casual work as a midwife in a major metropolitan maternity teaching hospital.

I hosted an afternoon tea in the postnatal ward – and I made a little speech, because I grew up in a family where making a speech was a way of marking an occasion… and because it all felt like a big thing to be doing.

This month I have started doing a few shifts back there … just to remind myself of the realities of clinical work and to catch up with friends and colleagues. It feels ok.

Jen’s end of work speech. 2/1/2014  

I have loved working here – although some days are better than others! I have great colleagues who care about the women they provide care for. I have met so many inspiring, interesting women and families and had the privilege of sharing what is a life-changing event with them. They personify what I think this place is all about – the highs and lows of human existence. And they let us experience this with them!
Our work as midwives is so important.

Didn’t catch that? I’ll say it again – our work is so important.
From the booking visit in clinic to the last home visit …. Sure we have expertise: we know plenty of stuff about normal pregnancy and birth. But we’re more than that – we’re another woman, we like having a chat, we care about the whole woman and we meet women where they are.
So then we write the dicky little sentences in the antenatal record about holidays planned, sickness in the family, concerns about another child, how last time’s experience is effecting this pregnancy…
And sometimes we are one of the very few people who have taken the time to listen, to care about what’s happening to this woman in her life. We may well be the only positive educational experience she has had. We can be part of a life-changing time for her – diet, exercise, relationships, doing something amazing for herself and her family by bringing a baby into the world.
So I’m leaving being a midwife because I love being a midwife so much! And people have asked me: “why are you leaving and doing this?”
The project I will do about Lactation Consultants is a means of learning how to do research. The masters sparked it for me – I realised there was so much research out there that can help our clinical practice, answer our questions, help us ask more and help us to live with the doubt.
Anyway, so that’s what I’m going to do. And maybe I’ll come back to help you guys do some research too.
Just one thing to finish with … I don’t think we’re very good at letting each other know how fabulous we are. Do me a favour – tell your colleagues – don’t just thank them for their help, but tell them how you admire their practice, their attitude to women, their commitment to caring, their ability to help a woman birth her baby.

And enjoy your work. Thanks

Scientific Motherhood

ModernPriscilla1929-03When I was studying midwifery, approximately 100 years ago, I decided to write an essay on parenting advice.

It was probably a pretty crappy piece of work.

The internet was not really something you surfed back then. Research was all about library books on shelves and some midwifery journals (paper ones, in the library).

None of which seemed to have anything to say about this topic.

I can’t remember the major texts I cited back then, but I do remember coming to the conclusion that parents should be encouraged to trust their own instincts with regard to parenting.

Controversial stuff for a student midwife with no experience of parenting at all. Partly, I think I was overwhelmed with the prospect of teaching new parents about something I knew nothing about. Hand it over to them, sister. It made sense.

Turns out maybe I wasn’t so wrong.

The last hundred years or so in the industrialised world has seen a bunch of people termed “parenting experts” telling parents how to raise their children. Given that not so long before that children were usually seen as economic units: mini- adults suited to working in confined areas, like chimneys and sweat shops, I guess it was nice at least that someone took an interest in whether they lived or died.

Mothers were also seen to be solely in charge of child raising (see my post on the Cult of the Mother). Sounds good, but unfortunately they ended up caught in a trap: when concerns arose over infant mortality rates in urban areas in the US, mothers took the lionshare of the blame. Mothers were collectively blamed for poor hygiene, poor diet, not breastfeeding or breastfeeding poorly.

Germ theory made a few things clear, but it took years for the message to get out: babies got ill because of exposure to viruses and bacteria, viruses and bacteria thrived in dirty drinking water, poor people often had to rely on contaminated drinking water…should do something about that dirty drinking water.

The new profession of paediatrics leapt into the task of developing formula for babies whose mothers were unable to breastfeed them.  This was much needed, when so many babies died before their first birthday.  This unfortunately turned into a way to feed babies when women were having problems with breastfeeding, and then, into just a different way to feed your baby. Formula feeding was, initially at least, managed by the medical profession. Paediatricians’ main work was largely in infant feeding plans.

Parenting books started to be written in the 1920’s, but Dr Spock was the breakthrough text in 1946 with his Baby and Child Care. 

The book was predicated on the idea that parents “know more than they think”. There was gentle encouragement for parents to “trust their instincts”. Unfortunately most of the information in the book related to bottle fed baby behaviour. Again parents were gently encouraged to breastfeed, but if it proved difficult, there was always bottle-feeding.

And there were regular reminders to consult with your doctor to check that your instincts were indeed right.

Today there are approximately one gazillion people who write and blog and speak about parenting. Some of these instruct  inflexible and routinised methods to make absolutely sure babies will sleep for long periods.

The good ones let parents know about normal baby and infant behaviour to help them adjust their expectations of what “normal” is (it’s a cycle on the washing machine last time I checked).

Then gentle encouragement to go for that elusive goal: “what works for you”.

A thing I say when talking to parents-to-be in antenatal clinic: “we midwives know a bunch of stuff about lots of babies, but not about your baby …. pretty soon you’ll be the expert there.”

Here are some links to good baby stuff:

http://www.pinkymckay.com

http://raisingchildren.net.au

https://www.breastfeeding.asn.au

 

 

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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