Thursday, February 14, 2008

Contented Mother ... (5)

This is a very long excerpt from Chapter 4 on Breastfeeding (The lazy mother's best friend)...

Jemima and I are unashamedly passionate about breastfeeding and I am lucky to have had a mostly easy time of it so far. I know that this is not the case for many women so I hope my positive experiences will encourage new mothers and that what I have learnt along the way can be of some help.

Quick rant
Before I get positive though, I just have to get a few things off my chest. Breastfeeding has had a pretty bad press in Britain over the years. Things are slowly changing but nine times out of ten if you confess to being pro-breastfeeding you are immediately stereotyped as a hippy, bra-less mother whose leaky boobs swing low beneath her milk stained T-shirt as she marches against formula companies, banner held high, her still feeding 10-year old on her hip. I object. I am no militant lactivist. Just because I believe breast is best does not mean that I look upon bottle-feeding mothers with scorn in the park, or ‘tut-tut’ loudly behind them in the formula aisle of the supermarket. For a while I belonged to a breastfeeding group, (don’t laugh) and we really were a fairly conventional bunch: there was me, a hairdresser, two midwives and several businesswomen. Half of us had gone back to work part-time. Yes really, contrary to popular belief the smart lady on the commuter train dressed in a suit and heels could well be going to breastfeed her child that night when she gets home from work.

So fed up am I of the way breastfeeding is portrayed by much of the press in this country, that I hope to train to be a breastfeeding counsellor one day. I think it is a subject shrouded with great ignorance and judgement, in the place of more education, information, and most of all – support. 99.9% of women are physically able to breastfeed. It’s the most natural thing in the world right?

Somebody help us!
It was only when I became a mother myself and began to hear other women’s stories that I realised that breastfeeding can be the cause of much pain, guilt and unhappiness to many women. This is particularly so in industrialised nations where we have less personal support from family and friends and more professional advice and intervention. We still hear horror stories of women being sent home from hospitals without having properly latched the baby on yet, health professionals forcing the mother to give a bottle of formula against her will (or even knowledge!) or midwives trying so hard to make the baby take the breast that both mother and child end up utterly distressed and put off for life. Of course there are many wonderfully supportive and sensitive health professionals and NHS and NCT breast-feeding counsellors out there, and the incidence of breastfeeding at birth has increased significantly in the last five years, largely thanks to them. However without the continued support networks that many other societies have, is any wonder that so few women in the UK continue to breastfeed beyond the first few weeks?
I read recently that 90% of UK women who stop breastfeeding by six weeks would have liked to have continued for longer. The most common reasons for stopping are pain and concerns about not producing enough milk. Both of these are largely avoidable with the right information and support.

Take my breastfeeding group for example. (I believe I asked you not to laugh). Organised by the NCT, we were basically a group of women who were still breastfeeding after five months and beyond. Some of us were happy about continuing, others were not sure and wanted to talk about it or just meet other women doing the same thing. We met at each other’s houses each month for an evening of informal chat, with or without our babies. Sometimes we had a breastfeeding counsellor with us but usually it was just mothers who came and went according to their need.

Why five months? This is the time when many women are thinking about continuing to feed beyond six months, but are feeling pressured to stop because everybody else is. Feeding beyond six months is still relatively uncommon in Britain. I think people confuse the advice to exclusively breastfeed for six months with stopping when you get there. I remember one friend saying: “I’ve done my bit – he can have real food now”. She seemed to think that one replaced the other, when actually this is not the case. The World Health Organisation recommends mothers continue to breastfeed until her child is at least two years old.

Five months is also the time when babies start to wake at night. This is a time of great developmental change. Many babies start to sit up and generally become more mobile. Sometimes they wake simply because of the extra stimulation brought about by the developmental changes, and sometimes the extra activity means they are burning more calories and getting hungrier. There are myths, upheld by many health visitors and doctors, that if you start to give solids at this stage it will help them sleep. Sometimes women came to the group because they are tired from waking at night but want to continue to feed anyway, and just need to hear from other people doing the same thing. Five months is also the time when many women start preparing their return to work and want to know if they can continue to feed.

I realised how important a group like this can be the night that Pip, midwife and mother of an eight-month baby girl, told us that if she hadn’t joined the group three months earlier, she would have definitely given up breastfeeding. Not because we are a bunch of bullies, I hasten to add, but because she was struggling and thought it would always be hard. She had no idea that she was, at five months, just weeks away from the stage when everything gets easier, the feeds get quicker and are less frequent. She had not wanted to give up but needed to hear that it would get better.

You just can’t beat sharing in this way with other mothers. We are all different. We range from the very nervous: “how do I know how much milk she is getting?” to the pissed off: “he’s using me as a dummy” to the positively horizontal: “I spent all day cooking for a party today with baby in the sling helping herself to milk whenever she liked! She kind of got in the way a bit when I was serving drinks though!” The first was Pip, which we all found fascinating because we naively presumed that as a midwife she would be more relaxed, but I suppose it’s a whole different ball game when it comes to your own baby. As she points out, she is in the business of delivering babies, but after one week she has no more contact with them. The last was Nicky, the incredibly cool hairdresser, who washes, cuts and blow-dries while wearing her baby. And the middle one could probably have been any one of us on a particular day.

The things I have learnt from this sort of forum are invaluable. For example, for a while I had very painful blocked ducts and what felt like the on-set of Mastitis. I was about to ask the doctor for antibiotics when someone suggested I try feeding Jemima on all fours. Hmmmm… well despite feeling very indelicate - down-right bovine actually - straddling my baby in this fashion, I have to say it worked. I also discovered that if a woman has had a really tough time breastfeeding at first and has decided to give up, she can try again a few weeks later when things have calmed down. That is surely something that all women should be told by their midwives right from the start?

I know there are many excellent ante-natal breast-feeding workshops about but the one I attended left much to be desired. Did anyone else find the plastic doll with a closed mouth less than ideal preparation for latching a real a baby on? Someone could make a fortune by designing the model baby doll, with moveable mouth and neck. I would definitely recommend you choose a class where they invite a real mother with a real baby to demonstrate breastfeeding. When Jemima was four months old, the NCT invited us to a breastfeeding workshop, so that several very pregnant women could watch and ask questions. As I told them my story, showed them how to feed and described how it felt, I realised how little I knew before having Jemima, compared to what they were learning then.

Before attending my own NHS workshop, I had had little reason to give much thought to breastfeeding. I assumed it was natural, right and something everybody did. Although it might be hard to begin with, it would very likely turn out fine in the end wouldn’t it? My only real experience of it was being around my sister Alex who breastfed both her children (her third was born soon after Jemima) until they were both a year-old. She had made it look like the simplest thing in the world. I don’t think it ever occurred to me to ask her how it felt. I hardly noticed she was doing it most of the time. Apart from when Tom decided to try out his new teeth. I do remember the odd scream now I think about it! So at the workshop I was surprised at how many women associated breastfeeding with pain, embarrassment, exhaustion and awkwardness.

Rather than address these fears openly, the trainer tried to convince us that these were all myths, and brushed over them quickly. There was little realistic discussion of what ups and downs one might expect, what it might feel like to fail at first, how long it might take, and how to negotiate with your midwife. Nor were there any first-hand stories from breast-feeding mothers.

The best bit was the video we were shown, Breast is Best. This classic depicted middle-class Norwegian mothers feeding their new-borns in bed, with their beautifully chiselled, loving husband looking on adoringly in the middle of the night. That’s just not normal. When I was up feeding in the night James, tired-eyed and with several weeks of stubble, would grunt, mutter something about the light and roll over and back to sleep. That’s normal! The guy had to get up for work the next day for goodness’s sake. Mind you Norway does have some incredible maternity and paternity policy so maybe this husband didn’t have to go to work. This might explain how he was also capable of bringing his wife flowers and breakfast (containing all the right food groups) in bed, the next day. Oh yes, and then there was the four-year-old in uniform tugging up her mother’s shirt on her way to school for a vigorous suck.

These were hardly images likely to convince the average woman attending this workshop in South London. We mainly fell into two categories. Very young, black African/Caribbean, and Asian women, some without partners, most on low-incomes, and white 30-something professionals thinking they will have to go back to work to pay the mortgage and maintain their financial independence. To my embarrassment I noticed I was the only one crying at the images of newborn babies finding their way to the mother’s breast – that was just so incredible to watch! I also seemed to be the only one taken in by the fairytale portrayal of breastfeeding. I just hope I was not the only one who ended up enjoying feeding as well. Because I have to say it – breastfeeding really is the lazy mother’s best friend.

The great thing about boobs is that you can whip ‘em out anytime, any place and at night you needn’t get out of bed, let alone go down stairs to warm up bottles. Some of my happiest memories of Jemima are of long hours, sometimes days, in bed feeding, playing, cuddling and feeling an overwhelming closeness to my new daughter. Jemima took her time to get round to feeding, so I tried to relax and trust that she would feed when ready. I spent many hours holding her skin-to-skin, offering her my breast, and letting her refuse it. I also expressed some Colostrum, which we gave to her by syringe. When seventeen hours later she did latch on I was filled with awe and an unexpected joy. After all the anticipation I was able to feed my baby. You just can’t beat that drunk look babies have when they finally pull off the boob, totally saturated and content.

There are countless other benefits of breastfeeding for both mother and child. It enhances the physical and psychological bond between mother and child for many reasons: the intimacy of breastfeeding; the prolonged cradling of the baby; the physical dependence of a child on its mother for milk, and gratification that she is able to provide it, and the constant source of comfort, are all obvious benefits. The ‘love’ hormone Oxytocin, that is produced the moment the baby takes the nipple in its mouth, brings on a sudden feeling of contentment and pleasure for many breastfeeding mothers as well as aiding sleep and protecting against breast cancer. Breast milk is biologically designed for the human infant, contains the right amount of the right nutrients, is easy to digest, gives immunity to certain diseases and viruses, protects against some cancers, helps strengthen jaws, eyes and formation of teeth, and helps ward off allergies! Breastfed babies are five times less likely to end up in hospital than formula-fed babies with gastroenteritis, and half as likely to end up in hospital with respiratory disease in their first seven years of life. Breast milk also protects against diabetes and obesity. Oh and it’s cheap, saves time, and makes travel easy. It’s pretty amazing stuff!

Even when we know all this though, it is not always easy, which is why so many women can not get on with it and decide that using formula is the best thing for them in order to enable them to enjoy their new baby. At first it can be excruciatingly painful and sends your hormones all over the place. Expect to cry, especially around the third day, or whenever your milk comes in. Remember what I told you about Legally Blonde? For a long while it also feels as though you never leave the sofa. I’m sure this is nature trying to make us rest and recover from childbirth. Whenever anyone asks me for one piece of practical advice to give to a new mother, I say this:

“Don’t fight the sofa confinement! Relax and enjoy it, because when they start moving more and feeding less, boy will you miss it. Get in all your favourite DVDs, and books, chocolates, loads of water, and a Teasmaid (do they still exist? A Norwegian husband might be even better, if you can find one) and snuggle down with your baby. And hang on until beyond six months because that is when breastfeeding becomes really enjoyable.”

Yes it’s true. The best-kept secret about breastfeeding is that it just gets quicker and easier the older they get. If only they told you this at ante-natal classes. It is ironic and seems unfair that so many mothers manage to feed until six months, surviving the days when it feels as though you, your cracked nipples and spreading bottom will never rise again, only to give up just when it starts to get easy. After six months the feeds get quicker, your boobs stop changing size and your milk supply easily adapts if you take a day or two off. By eight months Jemima took about three minutes to feed during her daytime feeds and longer at night because she likes to be cuddled close to me before bed. If I added up her feeds over twenty four hours they probably took less than an hour in total. In fact I even found myself trying to convince her to stay for longer so that I could have a rest.

At the end of this chapter...

Ten lessons learned about breast-feeding
1 Breast milk should be worshipped – almost as much as chocolate.
2 Breastfeeding mothers need support to make it enjoyable and easy. 99% of us can breastfeed with the right support.
3 It is entirely normal that the baby wants to sleep and not feed straight away after birth. If I found childbirth traumatic and exhausting, it is likely that my baby did too. We both need time to sleep it off and recover.
4 It is entirely normal for a baby to try to latch on but not succeed straight away. This need not be a problem for the first few days, as long as they are getting colostrum and my milk production is set in motion through regular pumping.
5 When getting the baby to latch on gently offer the breast, without exhausting myself or my baby and without causing stress. Never force it. Try to switch breasts so that the baby does not develop negative associations with one breast.
6 Lots of skin to skin contact is vital to get my milk production going. Keep my baby near my breast at all times
7 Check nappies. If it is coming out, I know it is going in.
8 When your baby bites you (they all try it at some stage) firmly take them off the nipple with your finger and look away. Make it clear that they cannot enjoy the privilege of feeding if they do not respect the boob!
9 If feeding in the night sends them straight back to sleep enjoy it and don’t worry about it becoming a habit. Everything is a phase.
10 It gets easier and easier after six months so don’t give up before experiencing her stroking my face while feeding. Bliss…

Read on - a snippet from Chapter 5


Tara said...

Hi G, I hope you are taking heart from your lesson number 9.... although it is tough when that 'phase' lasts 2 years, let me tell you!

I also think that they are all v. different.... It definitely gets a lot easier after 6 months on lots of levels there's no denying that. But I also think a lot is dependent on the child and the bf relationship you have with them. For example, E has NEVER fed for 3 minutes and then had enough...I think her minimum was around 10 mins even by the age of two....It was also fairly rare that she would just unlatch when she had had enough - only in the early months. After that, I was always unlatching her from her 'dummy' when I could tell she wasn't swallowing any more... From my experience and what I observe of those around me, if your child is still feeding regularly at night when they are around 11 months plus, you can expect them to continue feeding (day and night) for many months beyond...Especially if you co-sleep (and by that I mean in the same bed, not in a separate bed / cot in your room). They will not just suddenly decide they don't want to feed any more during the night if that is their principle sleep cue! (There is reams about this by Dr W. Sears, Deborah Jackson, Elizabeth Pantley plus just have a look at posts on the parenting websites on the subject of night-weaning and you will see I am not alone...) From experience, I feel that if you are not of the 'let them cry' camp (which I most definitely am not) and you don't have a 'Norwegian' husband or someone who doesn't need to get up in the morning to help you, then problem frequent night-feeding is MUCH easier to either nip in the bud (say by 10 mths, which according to Pantley is the age when a human's biological clock actually kicks in for real and thus the age that a baby can be considered ABLE to sleep through the night....!) or much later when you can reason with them - say after the age of two. That's not to put a dampner on things and say that bf isn't wonderful like you say.... IT IS! HOWEVER, I think it is key to remember it is a two-way relationship and it needs to work for both parties and it is worth setting some key boundaries from the outset or that 'phase' really will just be endless.....! T x

Kasia said...

Thanks for sharing Tara. Your message is a great indication of how important it is to look at our children as individuals and provide for their needs accordingly. I enjoy reading the different experiences women have with breastfeeding (and all aspects of childrearing). The more we share with each other, the easier it will be for us to accept our own experience, knowing that every woman and every child is different. I even noticed a big difference between my first son and my second and how they took to breastfeeding. My first son, from the second he was born he took to breastfeeding like fish to water. He latched on right after he was born and didn't let go for a long time. I did have to wake him up for the first few weeks to feed him because he would have just slept all day (not a bad thing in hindsight but I was an anxious first time mom:)Initially it took him over 30 min to finish a feed and he loved it as a comfort measure. I breastfed him for 2 years - no problemo. You would think it would be as easy with the second - I was a pro by then wasn't I? Well, it suprised me to find out, that it can be harder the second time around. I remember the first night after he was born, after being awake for over 24 hours, Ethan, suckled on my breast ALL NIGHT LONG! I don't think he was getting anything and my nipples were screaming in pain and bleeding, but he wasn't happy unless he was suckling. I finally understood why some women may want to give up early on. We persevered and the next day I had supply for twins:) With a bunch of bumps along the road we have established a good mutual relationship about breastfeeding over the last 3 months and amazingly he has put himself on a schedule of 3-5 hours between feedings. He refuses to feed for comfort ??? and is usually done within 5 minutes. It amazes me how different they are. Then again why am I suprised, they are different people and everything else was different - pregnancy, labour etc:)