How much does your doctor REALLY know about breastfeeding?

When M was very little we were frequent visitors to our local GP’s surgery due to her (as yet undiagnosed) silent reflux.  She was in a lot of pain and every day it was a struggle to get her to feed at all.

Usually one of the first questions the doctor (and it was never the same one twice!) would ask us was ‘what milk have you got her on?’.  The first time I was asked this question M was just 8 weeks old.  I was a bit confused (and for some reason, embarrassed), but I answered ‘mine’.

‘Oh’ came the reply – she seemed surprised.

And so began a very upsetting and frustrating journey into trying to find someone who could help us to soothe our breastfed baby.

That day our GP didn’t suggest we call a breastfeeding advisor, nor did she suggest contacting a lactation consultant.  To be fair to her, she didn’t suggest I gave M formula (no, it was a consultant who did that), but I can honestly say she wasn't able to offer me any more meaningful help than to suggest that we give her infacol and calpol.

Over the next few months we went on to see numerous GP’s (both at our own surgery and at various out-of-hours clinics), several paediatricians and two consultants from the children's hospital. Not one of them suggested we see a lactation consultant, even though they were obviously aware that I was doing all I could to maintain breastfeeding at that time.

I had always assumed that medical professionals knew about breastfeeding. I assumed that if, (like with any other problem) they didn’t know enough about it, they would refer me on to someone more specialised.  Turns out, I was wrong!

Now I'm sure there are exceptions to this. I know there are GP’s who are brilliant at handling breastfeeding problems. There are paediatricians who are incredibly supportive of breastfeeding mums. Some have even gone out of their way to do additional training in breastfeeding support and many will have breastfed themselves.

However, whilst I was doing a bit of digging online (into the challenges women face in overcoming breastfeeding difficulties), I came across a study published in 2006 entitled ‘A training needs survey of doctors’ breastfeeding support skills in England’, and it shocked me.

This survey was the first in the UK to assess and compare the training needs of UK GPs and paediatricians.  In total just 57 GP’s returned the survey along with 120 paediatricians. 
The first paragraph on page 2 reads:

‘In England, there is no central responsibility for coordinating breastfeeding education and assigning standards for practice, and post-registration education for breastfeeding is not mandatory for any health practitioner group. None of the UK professions require core content on breastfeeding in pre-registration training, even midwives[…]' The training needs questionnaire was circulated to NHS ‘primary care and maternity services, in London, the West Midlands and Leeds, across both rural and urban areas…. The response rate overall was not possible to determine, but was in the region of 7% for the paper version, and 29% for the electronic version.’

Here are just a few of the findings (you can read the rest of the report here) 

• only 1/3rd of GP's and just over half of the Paediatricians felt they were competent* to prescribe medication to a nursing mother,
• 3 out of 4 GP's and half of Paediatricians did not consider themselves able to give good breastfeeding advice to mothers after a c-section,
• more than 1/3rd of GP's and 2/3rds of Paediatricians admitted they were not confident in their ability to advise about thrush,
• 4 out of 5 GP's (80%) and 70% of Paediatricians felt unable to competently advise a mother who’s child was refusing the breast.
• Less than third of GP’s and less than half of the Paediatricians knew the correct government guidance about the youngest age solid foods should be introduced.
• More than half of the Paediatricians and more than a fifth of the GP's surveyed, thought that the World Health Organisation only advise exclusive breastfeeding for 4 months (or less). As you probably know - the actual WHO reccommendation is to exclusively breastfeed for six months before beginning to introduce solids.  It's worth remembering that introducing anything other than breastmilk into a baby's system early can be damaging to their health.  You can read more about this here. 

Perhaps most worrying of all, only 8.8% of the GP’s and only one Paediatrician admitted that they did not know the current government advice about when to begin complementary food. 

‘Worse still’, the researchers say, ‘the rates on ‘do not know’ are very small, suggesting factually incorrect beliefs.’.

And these were the ones who bothered to complete and return the questionnaire!

* The competence scale used in the research had four response options. These were: expert, competent, adequate and not competent. The first two were combined in the research to give a 'threshold level of competence'.

So what does all this mean in real terms?

It’s hard to say. You might be lucky and have a GP who is really clued up on breastfeeding. You may encounter a hugely supportive paediatrician in hospital who is willing to go the extra mile to help you breastfeed.  If so – hurrah!

However, you won’t have to look far within your group of friends (or online) to come across stories of doctors getting it wrong.  It’s not hard to discover a hospital paediatrician who prefers to give the ‘known quantity’ of formula instead of the ‘unknown quantity’ of human breastmilk, even to the very sickest babies.

I had a few such encounters with consultants along the way, and were it not for the fact that I was born with a healthy disdain for ‘authority figures’ I might well have given up breastfeeding after just a few months – believing it was better for my daughter.

I estimate that we were probably seen by 8 GP’s and at least 3 paediatricians over roughly a 3 month period.  It is hardly surpising (given the figures shown above) that I found it hard to find anyone who could help with my daughter’s breast refusal.  One of the consultants suggested we wean her at 12 weeks old - I didn’t do it. 

It's hardly surprising to find that most doctors cannot advise when it comes to breastfeeding problems - as well as having no training in breastfeeding support they are also constantly bombarded by advertising from formula companies.  Some rules on formula advertisements do not apply to medical journals, so specialist formulas and 'first milks' can also be marketed directly to doctors.  Formula companies have specialist websites through which they can target their marketing directly at Health Care Professionals - and whereas an ad on television which breaks the WHO code can be reported to the advertising standards agency by the public, code breakages in these specialist websites are much harder to police.  If you've got five minutes, take a look around some of these websites - they're certainly eye-opening!  Formula companies also pay 'celebrity doctors' to help promote their products - for example Dr Hilary Jones. They are also frequent sponsors of medical conferences.

formula ad from the British Medical Journal (rear cover)  2010

A 2006 report published in the 'Archives of Disease in Childhood' focused on the influence the formula industry has on doctors and pediatricians, and concluded: 

'If breast feeding, with all its benefits, is to be established as a majority activity, we paediatricians must learn to recognise the elaborate web woven around us by formula manufacturers, which currently ensures our goodwill and support for a product that we may acknowledge, but would mostly not wish to actively promote. Fifty years ago nearly everyone, including doctors, smoked and it was perceived to be a necessary and inescapable part of our culture. Now it is unimaginable that we would smoke in front of our patients or accept gifts from cigarette manufacturers. It is time for a similar shift to take place with respect to formula milk. Just because many mothers currently choose to bottle feed their infants and a tiny number of infants cannot be breast fed, it does not mean we should be seen to be endorsing a product that causes net damage to the health of children. The time has come for paediatricians to recognise the influence of IFMCs, shake off their silken chains, and become truly uncompromised advocates for breast feeding and against the hazards of formula milk. '

In the end it was a GP (not my own) who had previously specialised in paediatrics who knew enough about our problem to help us, and who was able to reassure me that breastfeeding really was the best option. I suspect he was also someone with a personal interest in breastfeeding issues.

Worryingly the report identified that:

'if the GP or paediatrician you encounter has a genuine interest in breastfeeding support, they are more likely to have educated themselves. If they do not have this interest it seems unlikely that they will have sought out training.'

How can we know that the advice we’re getting is good advice?

Vincent Iannelli MD has this to say on the subject:

‘A good way to tell is if at the first sign that you are having problems breastfeeding, your doctor recommends supplementing with a bottle, changing to formula or 'just keep trying….  Another way to tell if your doctor supports breastfeeding is by the type of anticipatory guidance that is offered at your doctor visits. Is breastfeeding even mentioned?  How is it discussed?’

The UNICEF 'Baby Friendly' Initiative has certainly improved the levels of breastfeeding support available in the hospital maternity units which have been awarded an accreditation.  To locate your closest Baby Friendly hospital, click here.  However, a huge number of breastfeeding issues are not dealt with in this setting, so how can you locate good support if you’re in difficulty?

The numbers listed at the side of this blog are a good place to start. These helplines are staffed by breastfeeding counsellors from well-known organisations with a wealth of experience in dealing with common breastfeeding concerns.

Organisations such as the La Leche League, the Association of Breastfeeding Mothers and the National Childbirth Trust can offer support through groups and provide access to trained breastfeeding counsellors.  Some areas now offer peer-to-peer support schemes which can help a great deal if your problem is a straightforward one, and many women find this is enough to resolve their difficulty.  Click here for more information.

If your situation requires more in-depth assistance, you may be able to access an appointment with a lactation consultant (IBCLC) through your local hospital.  Sadly many hospitals do not currently have this resource.  To the best of my knowledge it is not common practice for a GP to suggest such a referral, and you may also find it is not something you can access through the NHS.  You can find a list of IBCLC’s here.

As things currently stand, a large number of women are being failed by their medical professionals - and they don't even know it.  Like me, they don’t realise that not all GP’s and paediatricians have a good understanding of breastfeeding.  They put their faith in the hospitals, midwives and doctors to give them the best advice and support.  After all, breastfeeding is ‘pushed’ quite hard antenatally – so we just assume that the follow-up care will be there for us once we have our babies in our arms.  Sadly this is often not the case.

We often hear women saying 'I couldn't breastfeed' or 'I didn't make enough milk' - but can we really be sure that they weren't booby-trapped by poor advice?  Often a mother will approach her Health Visitor with a problem in the weeks following birth.  They might have concerns following one if the frequent 'weigh ins' and will be advised to see their GP.  What is the GP going to do?  Without an understanding of breastfeeding management many GP's will simply advise the mum to 'top-up' with formula - and that very often spells the end of breastfeeding.  If the study I've quoted is in any way representative, it would seem that very few of them are comfortable admitting a lack of knowledge.

With hindsight I realise that a solution for the problems I encountered whilst trying to feed M would most likely have been pinpointed much more quickly had I simply asked about them at a La Leche League meeting.  If only there were more of them in my part of the world!

I’m not sure how much has changed in the five years since this report into 'training needs' was compiled.  UNICEF offers on-line breastfeeding training for GPs (find out about it here), but it is fairly brief, and by no means compulsory - and that's a real problem.  Perhaps if more of us asked our Practice Managers to promote this training in their practice then things might improve slightly, but in my opinion until adequate breastfeeding training is a compulsory part of medical training then we're still fighting a losing battle.

The research concludes:

‘the survey has shown that there are many areas of breastfeeding care and support where doctors are not fully skilled even by their own admission, and knowledge of public health policy and guidance on breastfeeding is markedly poor.'

It seems to me that the only way to be sure that the advice you’re getting is ‘good advice’ is to ask someone who specialises in breastfeeding problems.

General practitioners are just that – general.  Paediatricians are specialists in the medical care of infants, children, and adolescents.  Both may have good advice to give you on breastfeeding issues, but there are no guarantees.

Breastfeeding problems are a specialist area – if you’re struggling, talk to a breastfeeding specialist.

“But I breastfed my baby and he still got asthma!”

When the breastfeeding facts fail us ~ by Anne-Marie Ablett

One December night last year, I dialled 999. My 9-month-old baby was already struggling to breathe, and it was getting worse: his constant, moany cries became weaker and weaker as he worked himself into a state of utter exhaustion. By the time the paramedics arrived, he was pale, listless and silent. We were blue-lighted into the hospital, and ended up on Children’s Ward, where he spent the following four days on oxygen and steroids. We eventually went home with asthma inhalers. Although the diagnosis wasn’t asthma (doctors don’t tend to diagnose asthma until a child is much older), it was clear he’d been having severe respiratory problems.

 

Suddenly it all made sense: my third baby had been a fantastic, contented little fellow… right up until he hit around 6 months old, when he became the baby who never slept. We blamed teething, and wondered whether it was something to do with starting solids. Perhaps he was just a grizzly baby? Of course, there was no shortage of those quick to blame breastfeeding, and I felt under immense pressure to ‘just give him a bottle’ to get him to sleep. Stubbornly, I refused to believe that this could be a breastfeeding problem (and was eventually proved right), but sleep-deprived and confused, we never realised that the poor child couldn’t breathe.

I never thought anything like this would happen. After all, isn’t breastfeeding supposed to protect against a multitude of diseases and allergies, including asthma?

Research suggests:

• Breastfeeding is “associated with a lower incidence of asthma in young children” (Asthma UK 2008)

So where does this leave those of us whose breastfed children are at some point hospitalised because of respiratory illness or go on to develop asthma?

Perched on the hospital bed with my baby, the situation did strike me as being a bit odd: I was breastfeeding my baby, yet here we were – in hospital. I’d breastfed my baby, but he’d become ill anyway. But by that point, breastfeeding had become such an integral part of my identity as a mother, that the idea of ‘giving up’ breastfeeding because it apparently hadn’t protected him from respiratory illness was absurd. If anything, my baby’s illness made me more determined to continue breastfeeding, for longer.

A few months later, I bumped into a mother with a baby about the same age as my third child. It turned out that both babies had been hospitalised with respiratory problems at about the same time. The mother explained that her older child had asthma and had been formula fed. When her second baby came along, she’d made a real effort to breastfeed because she’d heard it would protect against asthma. And then that baby too ended up in hospital with respiratory problems. So she’d decided it was pointless continuing to breastfeed, and switched to formula.

So why would two breastfeeding mothers react in such different ways?

Part of the problem is that mothers aren’t always given all the facts:

Yes, research suggests:

• Breastfeeding is “associated with a lower incidence of asthma in young children” (Asthma UK 2008)

Which is usually as much as a mother will learn about breastfeeding and asthma.

But there’s more to it than that! Research also suggests:

• Breastfeeding is associated with “lower instances of persistent wheezing and coughing” (Asthma UK 2008).
• Asthma and wheeze are “resolved significantly earlier in breastfed children than those who were not breastfed” (Asthma UK 2008)

 A bigger part of the problem is that breastfeeding facts always assume “breast is best”: in other words, breast is special, extraordinary, superlative. If breastmilk is “best”, its nutrients, antibodies and other constituents become above and beyond requirement. If breastmilk is “best”, the protection from disease it offers is a nice bonus, but not really necessary. And imagine the disillusionment when your baby gets sick despite being breastfed, especially if you’ve made a special effort to do so! In reality though, breastfeeding is just a normal, biological function.

If breastmilk is normal, it becomes necessary, therefore NOT breastfeeding carries a risk, the question becomes:

“what is the impact of depriving a child of [breastmilk]?” (Thomas 2010a)

If the above research findings on Asthma UK are presented from the perspective that breastfeeding is normal, the same research suggests:

• NOT breastfeeding is associated with a higher incidence of asthma in young children.
• NOT breastfeeding is associated with higher instances of persistent wheezing and coughing.
• Asthma and wheeze take significantly longer to resolve in children who were NOT breastfed than those who were.

 NB: NOT breastfeeding includes not only artificial milks, but also the introduction of solid foods prior to 6 months of age.

Next time you read a statement about the benefits of breastfeeding, why not try changing it around so it becomes a statement about the risks of NOT breastfeeding?

MYTH: If I breastfeed my baby, he won’t develop asthma.

FACT: Evidence suggests that babies who are NOT breastfed are at HIGHER risk of developing asthma. However, if my breastfed baby develops asthma, he is accounted for in the statistics too: he simply belongs in the smaller group of children who are breastfed and do develop asthma.

So, if your baby does have respiratory problems or develops asthma, is there any point in continuing to breastfeed? Absolutely! When your baby is sick, this is when your baby most needs you to breastfeed him. Breastfeeding still makes sense because:

• NOT breastfeeding could increase the number of times your child experiences breathing difficulties.
• NOT breastfeeding means any respiratory problems could take longer to resolve.
• Your breastmilk contains antibodies, anti-inflammatory components and other constituents that help your baby to fight respiratory illness (and other illnesses besides). NOT breastfeeding would deprive him of these.
• “Sick babies are more likely to [breastfeed] than to take anything else by mouth, so [breastfeeding] is important to keep baby hydrated.” (Bonyata 2002)
• “Sick babies need more comforting. What better way to do this than at the breast?” (Bonyata 2002) Comfort sucking (or non-nutritive sucking) at the breast is of huge neurological, psychological and physical importance to a baby (Thomas 2010b), particularly when that baby is sick.
• This issue is just one tiny part of the greater breastfeeding picture: there are so many other reasons to carry on breastfeeding!

Bibliography and References

Asthma UK (2008) Breastfeeding protects against childhood asthma

Bonyata, K (2002) My baby is sick – should I continue to breastfeed?

Thomas, C (2010a) Ask the Armadillo – what’s in breastmilk?

Thomas, C (2010b) Baby is using you as a dummy – it’s just for comfort!

Is nothing sacred?

When I go to the supermarket with M I have got into the habit of buying her a magazine to 'read' whilst she sits in the trolley.  She sticks the stickers to me and to the trolley, plays with the free toy, points to all the different pictures, and names everything.

M is a big Peppa Pig fan.  We've seen the live show, we Sky+ it so she can watch it (don't judge me!) and she has a two Peppa Pig 'handbags', five books, Peppa Pig's castle, Peppa Pig's car, a mini George Pig, a Peppa Pig nightie, two pairs of Peppa Pig socks, a set of Peppa Pig playing cards, and a Peppa Pig doodle toy.  She doesn't know it yet, but we've already got her a Peppa tea set and some Peppa dominoes for Christmas.

Like I said, she's a big fan.....

Today we were in Sainsbury's and she wanted the Peppa Pig magazine.  Fair enough.  I headed off round the aisles and she started pointing and reading.

'Gig gig!' (Peppa Pig),
'Daddy' (self explanatory),
'Mummy Gig',
'Ball',
'Bottle'.

Eh? 

'Ook Mummy, bottle!'

So I ooked.

Ok.

Some of you will think I'm getting this a little out of proportion. 
Some of you will be wondering how my breastfed not-quite-two-year-old knows what a 'baby bottle' looks like. 
Some of you may even be shocked to learn that I have formula-feeding friends and M has grown up seeing some of her friends getting bottles....

Some of you, may (like me) be wondering WHY the H*LL A PIG WOULD USE A BOTTLE?

So I had a look to see what it was all about (cue much screaming as I tried to wrestle the magazine from her sticky paws...).   Turns out this issue is all about Peppa's baby cousin Alexander.  Awwww.  It says so on the front cover, along with two bottles of 'milk'.

Now the 'Mr Tumble' episode annoyed me....   But THIS?  This has REALLY got my goat (or my pig, whichever you prefer)!

You see, Peppa Pig is funny, and it's clever, and it's 'PC' and I don't mind watching it.  Add to that the fact that we've spent our hard-earned cash on their bumpf for quite a few months now.  Mr Tumble is small fry compared to Peppa - she's big time (the magazine is also sold in Australia, and New Zealand, just going by the various prices on the cover....), and the cartoons are translated into tons of other languages (just take a look on youtube).

In total I counted 20 bottles with teats in this issue of the magazine (issue 71 for anyone who's interested....).

TWENTY!

Even a mummy pig has at the very most only 14 teats...
You can even follow the 'trail of bottles' to find baby Alexander :(

Now, admittedly we don't know what was in these bottles - we could argue that it might have been expressed pig milk - but seriously, it's just not good is it? 

You might say 'well, perhaps Alexander's mother is at work and she had to send the bottles' - but you'd be wrong because Aunty Pig is right there wearing a fetching pink polka dot dress.

So why can't Peppa's Aunty feed baby Alexander? 
Are we so uptight that we can't show a baby being fed by it's mother?

Just for clarification, here is how baby pigs are meant to get their milk:

Are we so worried about offending formula feeding mums that we don't show our children the NORMAL way babies are fed? 

*Are the people who wrote the magazine afraid that they'll get complaints if poor parents have to explain to their children where milk for babies REALLY comes from?*

Is it any wonder our children grow up with a distorted picture of normal human (or pig) behaviour?

Is it any wonder that young women and their partners think of bottle-feeding as normal?

Don't the creators of these programmes and these magazines have a moral obligation to teach young children about the normal, healthy way to bring up babies? 

I think they do.

Now I have just one question, given that Christmas is only around the corner:

How on EARTH am I going to get away with boycotting Peppa Pig?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

*Peppa Pig's Official Magazine is published by:

Redan Publishing Ltd edited by Caroline Jenkins with Editorial Designers Debra Harrison and Kelly Price.   

Suite 2
Prospect House
Belle Vue Road
Shrewsbury
SY3 7NR

You can email 'Peppa' at peppapig@redan.co.uk or info@redan.co.uk and their telephone number is: (+44) (0)1743 364 433

Their website is:
http://www.redan.co.uk/I will be sending them a link to this blog and I would love it if anyone who agrees with me would do the same.

Did Breastfeeding help you lose weight?

One of the members of the DBM Facebook group posted on the wall today saying she'd like to 'dispell the myth' that breastfeeding helps you lose weight. 

What do you think?

Were you one of those ladies for whom the pounds just 'fell off' through breastfeeding, or was it a bit more complicated than that for you?

Whilst we know that breastfeeding burns extra calories, it can also give some women a voracious appetite! 

Some people believe that the body hangs on to a little extra fat whilst you're breastfeeding just in case there's a sudden 'famine', (or in my case when the cake shop shuts...).

For others it's more like 'baby lipo'!

What is your experience?

Vote in our poll!

CLICK HERE

Learning to love.

It's fair to say that breasts are considered 'womanly' in our society - but this story shows that what is pleasing to the eye is not always pleasing to the heart.  Sometimes we find love where we least expect it - in this case, self-love.

I am extremely grateful to the writer for sharing her story with us all. 

I like to think I'm a pretty good judge of people, but lady - you really took me by surprise!

'I've had a pretty ambivalent relationship with my breasts in the past.  For pretty much all of my teenage years I considered that I didn't have any!  I was a late bloomer.  I was small, extremely petite and flat as a pancake.  I desperately wanted breasts. I envied other girls curves. I felt really pretty unhappy about my body.

When I left school at the age of 18, I was a 32AA.  I started to feel a little more confident over my university years, but mainly because I had discovered some really good padded bras and had worked out what looked good on me.  When I was 24 I just decided that I was going to get a boob job.

I really don't know what sparked this off - things were going very well for me.  I had a great social life, good job, boyfriend, lots of interests, but I just suddenly decided that I had been unhappy about my boobs for long enough, and now that I could afford to, I would do something about it.

I was sure I wouldn't breastfeed, so wasn't worried about that.  My grand plan was that after I had a baby I'd have developed boobs anyway and could have the implants removed.  Sorted!  I did my research over the next couple of months, found a place I liked and 3 weeks later I had gone from a small 32A to a full 32C. I was delighted.  They looked amazing.  I immediately felt that these were the boobs I was meant to have.  At last I was able to walk into a shop, pick up any size 10 and know it would look great.  I could wear any style - no gaping clothes - perfect sizing.  My confidence sky-rocketed.  I made huge amounts of changes in my life over the next couple of years.  I felt great.  I did feel a little sad that I had had to do something so drastic to myself in order to feel like this however.

Blokes started to look at my boobs. This both annoyed and exhilarated me. I'd never experienced this before.  Although I was pleased my wonderful boobs were being noticed, I simultaneously felt really sad that the reason these particular blokes were noticing me was due to something false.  Five years later I started having some pain. I completely panicked about the implants and I just wanted them out - RIGHT NOW!

Off I went to a surgeon and asked him to please take them out. He talked me out of it.

He clearly recognised that I was panicked and not thinking clearly. He advised that the pain was muscular, not implant related and advised that I had so little breast tissue that the result would not be good if they were removed. He told me that if I were to have them removed I would need a lift in order to remove excess skin that had been stretched. This would involve moving the nipple and could interfere with breastfeeding. By this stage I was thinking of pregnancy and thought I probably would breastfeed. I left very despondent.

My attitude towards my great boobs started to change again.  They still looked great, and I loved that, but I started to feel a bit concerned about what long term repercussions there would be.  I gradually started to feel some kind of regret.  I can't truely call it regret, as they had raised my confidence and I couldn't be sure if I would have made the same choices or be the same person if I had not had the implants.  I definitely felt that with the knowledge I now had, however, I wouldn't choose to do it again.

Another couple of years later I got pregnant and went back to the surgeon.  By now I definitely wanted to breastfeed.  He reassured me that I would have no problem breastfeeding, in fact it may be easier as the breast tissue was pushed forward, and there would be no risk to the baby.  He recommended that I do breastfeed, but advised that there was no benefit to feeding after 3 months (yeah right - but I knew no better then!).  So the plan was to feed the baby for 3 months, let my boobs settle back to normal and then have the implants out and see if a lift was needed depending on whether I had more glandular tissue after pregnancy and breastfeeding.

During pregnancy my boobs became massive for my frame. I went from my ideal 32C to a 36D.  Not that big really, but for the rest of my body they looked way too big (remember this is really a shift from natural 32A to 36D).  I disliked them being so big, and wondered what my own boobs would be like while pregnant.  I read and read about pregnancy and breastfeeding and once again the view of my breasts began to evolve.  I really wanted to breastfeed, and I made my birthplan around successful initiation of breastfeeding. I learned about hypnobirthing, I learned about skin to skin, I learned about drugs which interfered with breastfeeding. My birthplan went slightly awry on the day as they all do :) but breastfeeding initiation went well. We had our skin to skin and my son fed within a few minutes. We started a mutual love affair with breastfeeding.

We had some common problems - cracked nipples in the first week, oversupply, fast letdown, lots of leaking, silent reflux which was very distressing for both of us, a blocked duct - but I could see and feel how wonderful breastfeeding was, and I was hooked!  By the time we had got to 6 weeks I thought I would be able to feed for 6 months.  By the time I had got to 3 months I thought I could stretch it to a year, and so it went on.  In the back of my head I was trying to work out what I was going to do about these boobs. I wanted to get pregnant again.  If I had to have a breastlift I would need significant time, maybe a year, for my tissue to heal before I could get pregnant.  If I went ahead and got pregnant now I would want to feed that baby for a couple of years as well.  So I thought that this surgery was starting to get pushed out for another 3 or so years.  I'd had the implants in for 10 years at this point, and had always read that was the average life span and I didn't want to push it.  I did a lot of research again, and made a decision. 

I felt entirely differently about my boobs now than I had 10 years before. My boobs were womanly. They were doing the most womanly thing possible - they were feeding my child, and I loved them for that.

They were doing that even though they were small.  They now had a purpose, a function, and that was more important than how they looked.  I went back to the surgeon and asked him if he could just remove the implants, not do a lift and continue to breastfeed during the whole process.  After a lot of discussion about my reasons and the importance of breastfeeding to me, he agreed.  When my son was 19 months old I popped in for my day procedure, had my general anaesthetic, had my implants removed and very carefully fed my son later that day.

So there we have it - a few myths busted I hope. 

Yes it is possible to feed with implants.  Yes it is possible to have surgery while breastfeeding.  It is possible to feed after an explant, and you can have small boobs and LOADS of milk.

My son is still feeding (now 2 yrs), and showing no sign of stopping. He loves my new-original boobs. I love my new original boobs. They are still a 32A. At my followup my surgeon was amazed at how well they looked, and agreed that I had made the right decision not to go with a lift. They are small, but pretty pert, they are lactating and they are all me.'

Image courtesy of http://www.imageafter.com/

The “Breasts Feeling Full = A Good Thing” Myth

 by Anne-Marie Ablett

Nearly nine years have passed since my first (fairly disastrous) breastfeeding experience. One of the things I recall is feeling a sense of pride because I frequently got a really full feeling in my breasts: I could feel I was producing plenty of milk. I would wait for my breasts to feel full – and, if I’m honest, fairly uncomfortable - before I latched my baby on, believing the full feeling was a good thing: it indicated nature’s bottles were full of milk ready for a feed. So I was understandably confused when I was told my baby’s weight gain was too slow and she was failing to thrive. Lacking proper information and support, the only advice I received to remedy this was to give her formula top-ups, which spelt the end of our breastfeeding relationship.

Thankfully, I have since received far better breastfeeding support, have gone on to successfully breastfeed three subsequent children (two of whom I am still breastfeeding) and have become a LLL breastfeeding peer supporter. Though I now realise that the experience I had with my first baby is not uncommon: I often encounter mothers who, like I did, believe they need to feel full before they feed their baby, and who worry unnecessarily when their breasts no longer feel full.

MYTH: Breasts are like bottles, which empty and need to be refilled. I need to wait for my breasts to fill up before I feed my baby.

FACT: Feeling full isn’t necessarily a good thing. This full feeling means milk is accumulating in your breasts, which tells your body it is making too much milk. This milk isn’t being used by your baby, so your body thinks there is no demand for it, and starts to reduce your milk supply. Frequent removal of milk is key to building and maintaining a good milk supply.

This might seem like crazy, upside-down logic, but it works. For those who are interested, here’s the sciency bit:

THE UPSIDE-DOWN SCIENCE OF MAKING MUMMY MILK

  

FACT: If your breast is full, your milk production is SLOWER.

FACT: If your breast is emptier, your milk production is FASTER.

“Evidence exists that there are two interacting mechanisms regulating the rate of milk synthesis.” 

 ~ van Veldhuizen-Staas 2007

The first mechanism involves Feedback Inhibitor of Lactation (FIL). FIL is a whey protein present in your milk, which is thought to slow milk production in each breast independently when it is full. When milk accumulates in the breast, FIL accumulates in the breast and milk production slows down.

The second mechanism involves prolactin and prolactin receptor sites. Inside your breasts you have milk-making cells (called lactocytes). On the membranes of these milk-making cells are prolactin receptor sites. Prolactin receptor sites behave a bit like locks: they need a key to make them work. This key is called prolactin. Prolactin is “the major milk-stimulating hormone” (West & Marasco 2009, p6) that travels along your bloodstream and temporarily binds to the prolactin receptor sites (the locks), which then sends a message to the milk-making cells to stimulate milk production (a little bit like starting the ignition in your car). It is thought that as the breast fills with milk, the shape of the milk-making cells change, so that prolactin can no longer bind to its receptor sites. This tells your body it is making more prolactin than it really needs, so your prolactin levels drop. Milk synthesis slows, and eventually stops.

Frequent removal of milk is important because:

•  FIL is removed from the breast. This speeds up milk synthesis.
•  prolactin can bind effectively to prolactin receptor sites on lactocytes, which stimulates more milk production. Your baby’s suckling at the breast actually increases prolactin levels in your blood, which increases milk production. Prolactin levels are highest after frequent feeding “when the breast is most fully drained of milk” (LLL GB 2009) (this is usually at night).

If you didn’t 'get' all that, don’t worry! The most important bit to remember is this:


FACT: If your breast is full, your milk production is SLOWER.
FACT: If your breast is emptier, your milk production is FASTER.

Your body is constantly fine-tuning your milk supply to exactly meet your baby’s needs. This means there may be occasions when your breasts will feel fuller, including:

• when your milk “comes in” a few days after the birth of your baby. Your body doesn’t yet know how much milk your baby (or babies!) is likely to demand. So your body may simply respond with copious milk production, resulting in an (over)full feeling in your breasts.
• at certain times over the first few weeks as your body is fine-tuning your milk supply.

As long as you are feeding on demand, the initial overzealous milk production is gradually adjusted and continually regulated to exactly meet your baby’s needs. As your milk supply becomes more efficient, your breasts lose their feeling of (over)fullness and will feel soft most of the time.

MYTH: If my breasts feel empty and my baby still wants to feed and feed and feed, it means something is wrong.

FACT: Feeling empty is actually a positive thing! This empty feeling means your baby is removing milk efficiently from your breasts, which tells your body to make more milk. If your baby wants to continue suckling on a breast that feels empty, this tells your body that your baby is demanding more milk, and so your body starts to increase your milk supply. Allowing unrestricted suckling at the breast is important for helping your milk supply adjust appropriately to your baby’s needs.

Feeling empty does NOT mean you’re not producing enough milk for your baby, or you need to give your breasts a break to allow your milk supply to ‘catch up’.  Feeling empty does NOT mean your milk is too thin or drying up, so there’s no need to supplement with artificial milk or introduce solid foods prematurely.  There is no need to worry about whether your baby is getting enough milk if he/she is gaining weight well and producing plenty of wet and dirty nappies.  Feeling empty does NOT mean you need to worry that your baby is using you as a dummy or that your baby needs a pacifier.

In fact, there is evidence that supplementing and use of dummies could cause more harm than good: if your baby is sucking on an artificial teat, he is not stimulating your breast, and so the messaging system which tells your body to keep up with his demand for milk is disrupted.

Normal breastfeeding behaviour includes periods when baby needs to feed more frequently, such as:

• cluster feeding (which often occurs in the evenings),
• during growth spurts
• around developmental milestones (such as rolling over or crawling).

Although frustrating and tiring, these periods of increased breastfeeding are absolutely normal.  They soon pass. During these times, your breasts will feel very soft. Although you may notice that your milk flow is slow, this doesn’t mean your milk production is slow!

FACT: If your breast is emptier, your milk production is FASTER.

Which is why it is important to make sure you empty your breast fully when your baby feeds. However, not all babies will want to feed from both breasts. If this is the case, simply make sure you empty one breast and offer the other side first next time your baby wants to feed.
Your body is constantly fine-tuning your milk supply to exactly meet your baby’s needs.

“Your body does not like to waste precious resources” (West & Marasco 2009, p10).

As your body becomes more efficient at supply and demand, your breasts will feel soft most of the time. This is normal.

“Milk production is designed to succeed” (West & Marasco 2009, p13)

http://www.easternandcoastalkent.nhs.uk/your-health/baby-matters/keep-calm-and-carry-on-breastfeeding/

 References:
Mohrbacher, N et al (2003) The Breastfeeding Answer Book
Abbett, M (2008) A mother’s (and others) guide to BREASTFEEDING Issue 8
La Leche League of Great Britain (2009) Breastfeeding Peer Counsellor Programme
Van Veldhizen-Staas, C (2007) Overabundant milk supply: an alternative way to intervene by full drainage and block feeding in International Breastfeeding Journal 2007, 2:11 doi:10.1186/1746-4358-2-11
West, D & Marasco, L (2009) The Breastfeeding Mother’s Guide to Making More Milk
www.kellymom.com/bf/

Adoptive nursing ~ not what you might think!

This was sent to me today by email.  I don't know where the story originated - but I thought some of you might enjoy it.  I have adapted it slightly to suit the blog.

"Debby Cantlon, bottle-fed an infant squirrel after it was brought to her house, Cantlon plans to release it back into the wild.

When Cantlon took in the tiny creature and began caring for him, she found herself with an unlikely nurse's aide: her pregnant Papillion, Mademoiselle Giselle.

Finnegan was resting in a nest in a cage just days before Giselle was due to deliver her puppies.

Cantlon and her husband watched as the dog dragged the squirrel's cage twice to her own bedside before she gave birth.

Cantlon was concerned, yet ultimately decided to allow the squirrel out and the inter-species bonding began.

Finnegan rides a puppy mosh pit of sorts, burrowing in for warmth after feeding, eventually working his way beneath his new litter mates.  

Two days after giving birth, mama dog Giselle allowed Finnegan to nurse; family photos and a videotape show her encouraging him to suckle alongside her litter of five pups.

Now, Finnegan mostly uses a bottle, but still snuggles with his 'siblings', rolling atop their bodies, and sinking in deeply for a nap.

Finnegan and his new litter mates, five Papillion puppies, are just like family.

Finnegan makes himself at home with his new litter mates, nuzzling nose-to-nose for a nap after feeding.

"

How lovely is this?

I think we can all learn something from this little pooch with her strong maternal instincts and open heart. 

About me - an 'Accidental Activist'

Please click here to read my own 'mother story'.

Mute musings.

For breastfeeding bed-sharing mummies.

This video of advice and information comes from Kathleen Kendall-Tackett, PhD, IBCLC
More on this here.

Make an on-line slide show at www.OneTrueMedia.com

Yes, you can go back to work AND continue to breastfeed!

Some of us work to live, and others live to work.  Work is just a fact of life for most of us.  Unless you're really lucky one of the bridges you'll eventually have to cross once you've established breastfeeding is the management of your return to work.

Although the formula manufacturers would like you to think you need to combine feed at this point, it's often not necessary at all - but only if you know how to work the system and demand your rights.

If you don't want to stop breastfeeding (and many mums find they really do not!) but are worried about your return to work, this post is for you.

If you live in the UK your right to continue to breastfeed is protected by law.  There is no 'time limit' put on it - you are protected whether your baby is 6 months, or 6 years old.  You might have your own time limit in mind, but if you do let that be decided by you and your child and not by anything else.

Perhaps surprisingly in Northern Ireland (where we have the lowest breastfeeding rates in the whole UK), we have some of the tightest regulations when it comes to breastfeeding rights in the workplace.  Presumably this is because of our appalling record on human rights and the subsequent tightening up of the discrimination laws here.  However, wherever you live in the UK your breastfeeding rights are protected by Health and Safety law.

In order to ensure your employer understands their legal obligations there are procedures you will need to ask them to follow.

1/  You must inform them in writing before you return to work that you intend to continue breastfeeding.  Because you are a breastfeeding mother and this raises additional Health and Safety questions, they are required to carry out a Health and Safety Assessment.

(This might sound a bit OTT but if, for example, your work involved dealing with chemicals or infection risks then you can see why it becomes relevant).  You can include a letter from your GP or midwife in your risk assessment.

2/  If risks are identifed then your employers are required either to remove the risk (by adjusting your working environment to allow you to continue to work), or, where suitable, reassign you (with the same terms and conditions).  If neither of these things are possible then they must suspend you (with pay) for as long as is necessary to protect you and your child from the risk.

3/  Your employer must provide you with a space in which to rest (and in NI express milk) but they are not legally obliged to provide you with a fridge/ storage facility for any expressed breastmilk.  Many people find that a cool bag is sufficient to allow them to keep milk cold until they get home.  The rest space must not be a toilet.

4/  Employers are not legally obliged to have a 'breastfeeding policy' of their own but many do.  This can include things like information about rest-breaks, and milk storage facilities etc.  If your employer does not have one yet, by approaching them and discussing your situation you may find they decide to implement such a policy.  This would be a great service to other mothers coming after you.  

But what's in it for them?
How can you convince your employer to make it work for you?

Tell them why it makes good business sense.

• Breastfed babies are sick less often.  This means parents take less time off to look after them.  A study done in 1995 showed that mums of formula fed babies take twice as many one-day absences as breastfeeding mums do. (Cohen R, Mrtek MB &; Mrtek RG; American Journal of Health Promotion, 10 (2), 148-153.)
• Employees who feel valued and supported are more productive and report higher morale than those who are not.  Supportive breastfeeding policies ease a mother's return to work and enable a breastfeeding mother to return sooner than she otherwise might.  (Galtry J. (1997). Lactation and the labor market)
• An earlier return to work by a satisfied employee reduces the costs of recruting, hiring, and training temporary staff.  If the company is a small one and the position has not been covered, other staff are likely to experience greater stress affecting their productivity, morale and health the longer the employee is off work. 
• Family-friendly policies in the workplace improve a companies public image and this has a positive effect on recruitment.
• Lactating mothers report lower levels of stress (Mezzacappa ES, Katlin ES Health Psychol. 2002 Mar;21(2):187-93).  Stress is thought to supress the immune system making you more succeptible to illness.

What else can you do?

• If you're in a union, you can request their help in approaching your employers.  If you're not, you might consider joining one. 
• Prior to returning to work begin to express and store breastmilk to give to your child.
  
• Find childcare close to your work so you can breastfeed just before work and just after.
• Work out how you will provide your baby with breastmilk when you're not around - you might need to get them used to using a bottle.  This website has great advice about doing this.
• Consider in advance how you will express and store milk at work.
• Explain to your employer that you need to be able to express milk in privacy during your rest breaks.  In NI this is already a legal requirement.  Although in other parts of the UK it is not yet a legal requirement, it is considered 'best practice' by the Health and Safety Executive (see links below). You can also argue that your employer is putting you at increased risk of blocked ducts and mastitis if they do not provide you with this facility.  A toilet is not considered a suitable facility.
• If your employer doesn't understand that nursing mothers need rest breaks, explain to them that breastfeeding burns up to 500 calories per day.  Other examples of ways to burn 500 calories include the following:  1 hour of rowing, 1 hour of running up stairs, 1 hour of cycling, 1 hour of rock climbing. 
• Remember that if your employer is unhelpful and seems to be forcing you to curtail or end your breastfeeding then they are putting you at an increased risk of some illnesses including breast and ovarian cancer, as well as osteporosis. They are also putting your child at increased risk of illness whatever their age. The longer you breastfeed, the lower the risks to you and to your child.  
• If you do not feel that your employer is being sympathetic there are a number of things you can do. 1/ speak to your human resources department or union;  2/ contact your occupational health department (if you have one); 3/ contact the Health and Safety Executive; 4/ contact one of the other organisations listed below; 5/ discuss your situation with an employment lawyer.

Most employers will see the good sense in supporting your desire to breastfeed.  Some will be less helpful!  However, they are legally obliged to carry out a risk assessment and act upon it, and they must provide you with a suitable rest area. 

You might feel intimidated if you're the first person in your workplace to approach your employer about breastfeeding rights at work.  It is understandable to be anxious about this, but remember - the law is there to protect you.

In order to normalise breastfeeding for our sons and daughters we all need to play our part in breaking down these barriers and demanding our rights at work.

Useful links:

http://www.breastfeeding.nhs.uk/en/materialforclients/downloads/leaflet_4.pdf

http://www.hse.gov.uk/pubns/indg373.pdf

http://www.healthpromotionagency.org.uk/Resources/breastfeeding/pdfs/returntowork.pdf (NI)

http://www.equalityhumanrights.com/

http://milkmatters.org.uk/services-offered/employers/

http://www.equalities.gov.uk/
www.hseni.gov.uk
http://www.breastandbottlefeeding.com/

www.cellhealthmakeover.com/burn500.html

Useful addresses:

HSE Information Services
Caerphilly Business Park
Caerphilly
CF83 3GG

Infoline: 0845 345 0055
Fax: 0845 408 9566
Textphone: 0845 408 9577
e-mail: hse.infoline@natbrit.com
Website: www.hse.gov.uk


Department for Work and Pensions
Website: www.dwp.gov.uk


Department for Business Enterprise and Regulatory Reform
Enquiry Unit: 020 7215 5000
Fax: 020 7215 0105
Textphone: 020 7215 6740
Website: www.berr.gov.uk


Equality and Human Rights Commission
Helplines: 0845 604 6610 (England) 0845 604 5510 (Scotland)
0845 604 8810 (Wales)
Website: www.equalityhumanrights.com


Maternity Action
The Grayston Centre
28 Charles Square
London N1 6HT
Tel: 020 7324 4740
Website: www.maternityaction.org.uk


Tommy’s, the Baby Charity
Nicholas House
3 Laurence Pountney Hill
London
EC4R 0BB


Tel: 0870 777 7676
Fax: 0870 770 7075
e-mail: mailbox@tommys.org
Website: www.tommys.org