Thursday, 23 June 2011

The Myth of Insufficient Milk

In our modern world, very few mysteries remain.  We can measure the distance from the earth to the stars, and explain the voids between.  We can travel to the bottom of the darkest oceans, and reveal their secrets.   We can see inside our own bodies, our veins, our cells, and we can even know the sex of a baby long before it is born.  Little wonder, then, that when we ask ourselves, 'How much milk is my baby getting?', and we can't provide an answer, we find this disconcerting, to say the least.

Breast milk, and in particular, the quantity that has left our own body and is now residing happily in our baby's stomach, is difficult to measure.  We might try pumping, so that we can see how many millilitres we can produce, but this does not give any real indication of how much our baby is actually getting out.  Not only are babies mouths unsurprisingly more efficient than a plastic sucker, but the actual loving act of nursing and looking down at our babies face has been shown to encourage 'let down'.   And as for let down, some of us, myself included, don't feel any sensation at all when our milk is coming out, and in my case, I have hardly ever even caught a glimpse of the seemingly magical fluid that has now sustained and nourished two human beings for the first six months of their life and beyond.

So, we can't measure our milk, and in some cases, we can't even feel it or see it.  We might be just about able to hold our nerve, but what if our baby is not behaving as we had expected?  The tiny soul who is entirely dependent on us for her survival suddenly begins to cry a great deal, or wake up hourly throughout the night.  It is at these times that the doubts can begin to creep in, and they can often be fuelled by the comments of friends, family and even professionals: 'Are you sure they are getting enough milk?' 'Do you think they could be hungry?', 'What about just one bottle of formula at bedtime?', and so on.

Such comments are part of a wider cultural picture of treating babies as problems that need to be fixed, rather than simply accepting them as they are.  It is our expectations that we need to change, not our babies.  When a new mother tells us that her baby keeps waking her up at night, we should be offering reassurance that this is perfectly normal and entirely to be expected, rather than attempting to advise her on what can be done to get her baby to stop being so needy.

As well as being overwhelmed by her small baby's intense levels of dependency twenty four hours a day, a new mother might also be feeling shocked or even traumatised by her birth experience, in which she may have 'failed to progress', or 'needed intervention'.  Her confidence in her body and its ability to function normally and without outside help may well have been undermined.  She could not birth her baby naturally - it stands to reason that she also may not be able to feed it naturally.  She may wonder, perhaps I am not making enough milk for my baby, or, worse still, perhaps my milk is lacking in some way?

Further doubt and anxiety may be added by advice to place the baby on a routine of feeding and sleeping.  This idea of spacing out breast feeds according to the clock dates back to the 1940's, and it is no co-incidence that this is also the moment in time that women began to report trouble with their milk supply.  If we try to space out nursing sessions too widely and, for whatever reason, choose not to nurse on demand, we may well be jeopardising our chances of continuing to breastfeed. We need to nurse on demand during the first few weeks in order to establish our milk, and even the Queen of Routine, Gina Ford, acknowledges this, urging mothers who follow her program to pump in between the routine feeds to keep their supply up. 

Of course, if a new mother succumbs to the voices of doubt - be they inner or outer, valid or invalid - and reaches for the bottle of formula, then this is when the real Booby Trap is set in motion.  For once we introduce milk from a source other than ourselves, we interfere with the chain of supply and demand, and our own supply actually will begin to diminish.  That which we most feared, and sought to remedy, will in fact become reality.  And in some cases, our motivation to continue breastfeeding can also diminish, and we become added to the statistics of women who wished to nurse their babies, but for whom it did not work out.

'Insufficient milk' is one of the most commonly given reasons by mothers for stopping breastfeeding sooner than they would have otherwise intended.  And yet the stats just don't add up.  Whilst around 25% of women state that a lack of milk was their main reason for stopping nursing in the first two weeks of their babies life, research has shown that in fact only a tiny percentage of women are actually physically unable to produce enough milk.  A major piece of research published in the journal Medical Anthropology states that in only about 5% of cases is there something making it impossible for a woman to breastfeed. Another article from the NHS cites the figure for insufficient milk being as low as 0.2 to 1%.

It's important not to ignore the real human stories behind these statistics. Whilst the numbers of women who are genuinely not producing enough for their babies may seem low at perhaps 5 or less percent, this still amounts to many women for whom the breastfeeding experience is a tale of anguish, frustration and loss. And, perhaps sadder still, our stats tell us that there are many more women who don't actually have any physical problem with their supply, but who are doubting their ability to feed their baby naturally due entirely to external factors such as poor advice and support or negative cultural messages. In these cases, women who desire to nurse their babies are having their hopes dashed for no good reason.

It is hard to believe in something that we cannot see, feel or measure, particularly when something as hugely important as the welfare of our baby is at stake.  But the message needs to be spread: in the majority of cases, 'insufficient milk' is a construct, a misconception, an invention, a myth.  If you are having doubts that your milk is enough for your baby, don't feel panicked into drastic action, but instead nurse as much and as often as you can, and seek good reliable advice. (see below).  Above all, believe in your body, it was built to nurse your baby.


If you need advice about this or any other aspect of breastfeeding consult your local LLL Leader or ring their helpline 0845 120 2918, or the ABM helpline 08444 122 949.  For detailed information about low supply I highly recommend this and other reading from the wonderful site kellymom, and this article from The Baby Bond.


This article was amended on 15th March 2012.

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Friday, 10 June 2011

Breastfeeding Beyond One: A Gallery for Breastfeeding Awareness Week

Welcome to the Breastfeeding Beyond One Gallery!

My recent post, Ten Reasons to Keep Breastfeeding Beyond One, has been my most popular so far.  For this reason I have decided to create for UK Breastfeeding Awareness Week a photo gallery, a 'virtual nurse-in' if you will, of 'over-ones' being breastfed.  I really hope that by bringing these images together we can offer support and normalisation to those who have decided to nurse their children beyond one.  Often it is assumed that feisty and educated women don't ever have moments of self doubt or insecurity and therefore don't need encouragement or approval.  This is not the case - I know because I am one!  It is always great to feel the solidarity of others who have made similar choices and who are often swimming against the cultural tide.

I also hope that the gallery will raise awareness of extended breastfeeding as an option for those who might not otherwise have considered it.   

Seeing Is Believing:
In a society where many women feel unable to nurse in public, we rarely get to see babies and children being fed from the breast.  This matters.  Nothing better illustrates why it matters than a story taken from the excellent book, Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, by Meredith F. Small.  She tells of how a gorilla who had been born and raised in captivity, gave birth to an infant, but held it incorrectly to her breast and was unable to nurse it.  The keepers had to bottle feed it to ensure its survival.  During the gorilla's next pregnancy, as an experiment, the keepers asked breastfeeding women to nurse their children in view of the gorilla's enclosure.  When her second baby was born, the gorilla turned her baby to her breast correctly and was able to successfully feed it herself.

In our topsy turvy world, it is usually considered ok to admit to leaving your child to cry themselves to sleep, but somehow more taboo to share with others how you snuggle your toddler to your breast at bedtime until they drift off in your arms.

By sharing these beautiful images of loving moments with their children, the women who have chosen to participate in this Gallery are helping to break down this taboo, and doing a great service to all mothers, present and future.  I am extremely grateful to them for their contribution.

Post Script, August 2011: Since I created this gallery, it has been immensely popular, and even now it is still being viewed by people every day.  It has even been noticed by Roy K Philip, Paediatrician and Neonatologist, and President of the Irish Paediatric Association.  He stated: "The more our teenage girls see breastfeeding in our society, the less taboo for them later.  Practice, praise and promote breastfeeding.", and congratulated all involved in the gallery on their efforts.

If you would like to add an image to the Gallery please email it to mamamule@hotmail.co.uk.


All images have been removed from this post due to child protection concerns.
More info: http://mamamule.blogspot.com/2012/02/should-we-share-images-of-our-children.html










































  













Saturday, 4 June 2011

Leaving the House

5.57am.  I'm awake after a nursing session, so I decide I might as well get up.  A few years ago I wouldn't even have considered being up this early unless I had a plane to catch or I was leaving a strange man's flat in a hurry.  But recently I have started experimenting with rising even before my children, so that I can try and snatch half an hour of peaceful tea drinking and contemplation, and get a head start on the day.  There's plenty to do, and after all, it is only just over three hours before we need to leave the house.

6.04am. I get roughly one centimetre into my cup of tea before I hear the baby stirring on the monitor.  I get back into bed with her, snuggle up, and nurse her for a few minutes.  She sits up, grins and starts babbling.  She blows some raspberries on my exposed belly.  We share the joke.  She bites my arm in excitement.  I tell her off, I feel bad, I kiss her, I take her downstairs.  I start to unload the dishwasher and set things up for breakfast with her on my hip.  She gets heavy so I put her on the floor.  She climbs into the dishwasher and starts to pull out the cutlery.  I pick her up again.

6.42am. The three year old appears.  She talks away like a living Python sketch while I mix her porridge, one handed.  She makes her usual Mariah Carey style demands for several separate spoons for each different breakfasting function.  I lay them out, wearily, and then place a line of blueberries and grapes in front of the baby.  She drops them, one by one, on the floor, laughing as they are eaten by the dog.  I sit down and try to start my cereal.  The three year old needs a drink.  I fetch it and sit down again.  I eat another spoonful.  The three year old spills her drink and starts yelling.  I get up, comfort, mop up.  I sit down and try to finish my food whilst offering spoons of yoghurt to the baby.  She cries and pushes my hand away and splatters me in Petit Filou.  I rub it in to my dressing gown with a tea towel while I microwave my tea.

7.38am. We move on to the bath phase. I get in first, and start washing my hair, but just after I get the soap on I have to leap out again because the baby is playing with the loo seat and slams it shut on her fingers.  I get back in, rinse, then they both get in with me and we have some time pouring water into pots and playing with flannels.  I enjoying lying back and just watching them, except when I have to intervene to break up fights or prevent drowning.  Reluctantly, because it means the end of being still for the rest of the day, I get out and get the baby out and dried while the three year old plays.  Then the three year old doesn't want to get out.  I tell her we can pretend she is a baby and that I'll wrap her in a towel and rock her and sing Mama's gonna buy you a Mockingbird.  She loves this.  We do it, and the real baby looks on jealously.  I worry she feels left out, so I do it for her as well.  The three year old sulks.

8.12am.  Now to get them dressed.  The three year old insists that they must first 'boing' on my bed.  She bounces away and the baby is beside herself with laughter.  Any attempts of mine to interrupt this game are met with violent protest.  I try to be stern.  I count to three.  Wriggle, giggle, bounce.  The trousers are on.  I kneel on the bed, holding out the top and pleading.  She ignores me.  I grab her, tickle her and force it over her head.  She struggles, half giggling, half crying.  She soon bounces off, and I dress the baby, who also protests fiercely.  I find my own clothes from yesterday on the floor and decide they'll do.  I try to whack on a layer of mascara.  I get one eye done, and hear the sound of vomiting behind me.  Too much bouncing and giggling has made the baby slightly sick.  I rush to her, make sure she's ok, and change her top.  I return to my eye make up, only to find that in the commotion I have mislaid my mascara.  I can't find another one, so I have to paint the lashes on my other eye with a rather ancient liquid liner I find lurking at the bottom of my make up bag.

8.41am.  We assemble in the living room.  I put 'Beebies' on while I frantically shove nappies, wipes, and other paraphernalia into a bag.  It seems like we're nearly ready.  The girls seem fairly contented.  I need the loo, so I decide to risk it.  I'm half way through when there is a crash and the cry goes up.  My expertly trained ear tells me an injury has occurred, but that it is not life threatening.  I scrabble for the loo roll whilst frantically shouting, "I'm coming, I'm coming".  I dash to the rescue.  They have both fallen off the sofa, and in the process bumped each others heads.  I do my best to cuddle them simultaneously.  The furore dies down.  I load the car.  I think we might be ready to leave.  I glance at the baby, who is strangely quiet.  She meets my gaze, her eyes look like they are appealing for help, and slowly her face is turning deep red.  She is doing a poo.

8.57am.  I take her back upstairs and lay her down to change her.  She won't keep still and is wriggling all over the place.  I grab a wipe, and try to gently pin her to the floor whilst singing and flipping my wet hair around animatedly. She falls for it briefly, but then just at the wrong moment she suddenly rolls over and makes a break for freedom, leaving an unmistakable stripe across the knee of my jeans.  Cursing, I finish the job, and lug her to the bedroom, where I plonk her in front of the full length mirror while I dig around for a clean pair of trousers.  All I can find is a pair of drawstring tracksuit bottoms I bought during a brief yoga phase in the late nineties.  I put them on.

9.09am.  As I pick her up to leave I catch a brief glimpse of myself.  My hair is wet and unbrushed, my make-up looks plain weird, and my Carry On Breastfeeding boobs bulge ridiculously under an ill-fitting and ill-judged shirt already smeared with yoghurt and snot.  The trakkies complete the look, and I amuse myself slightly by the thought, The best I can hope for these days is a good Gokking.  I used to watch that show and feel sorry for his teary eyed, saggy old subjects; now I not only relate, but I find myself thinking, "Those elasticated trousers look practical, I wonder where they're from".  I heave her up again, make time to snuffle her hair, and then race towards the stairs.

9.10am.  I meet my partner on the stairs.  He is heading back to his office with a coffee and a chocolate biscuit.  I once read somewhere that new mothers, exhaustedly feeding their babies in the dark small hours, are often shocked by a sudden and unexpected desire to murder their sleeping partners.  I can fully believe this, and frankly, it's just the tip of a bloody big iceberg.  I am constantly jealous of him as he shuts his office door and I hear the sigh of his chair as he sinks into it.  He is constantly jealous of me as I disappear off to sunny parks with his girls.  We are forever having 'my-grass-is-not-as-green-as-your-grass' debates / arguments. I think the answer is probably that my grass is greener, but that he gets to sit down on his.

9.12am.  We are running late, but finally heading towards the door.  The three year old has taken her shoes off again, and is felt-tipping her feet.  I tell her she can have a piece of chocolate if she gets in her seat right now, and it works. I load in the baby.  I return to the living room for a final check.  I survey the scene of total chaos and run a hand through my damp and knotted hair.  Nearly three and a half hours since I woke up, we are ready to leave the house.  It makes sense really.  It used to take an hour when there was just one of me.  Now there are three times that many, and at least one of us is incontinent.