the good mother

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

 

 

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