3 babies

Two weeks off for Christmas and some time to indulge in my hobbies. One of the first things I did was to photograph my friends babies....something I'd been looking forward to all year. Despite there being a month between my friends due dates, the babies actually arrived 9 days apart. 

First born was Alice - born at home as planned on the 25th November. 

Then came Siena on the 30th November - who was born by Caesarean Section, not quite as originally planned as Mum had hoped for a VBAC at home. However as her amniotic fluid began to leak at 34 weeks, it was decided that the safest option was a planned Caesarean. 

And finally came Sam's baby, who arrived in hospital on the 4th December. I think the world of Facebook held it's breath awaiting the arrival. All of Sam's friends knew that Sam was in labour. We'd witnessed the snow updates, and the worries about whether or not a midwife would make it to her house for the homebirth she had planned. We then witnessed the updates about her contractions beginning and then her leaving to go to the hospital. I've talked about Sam in a previous post and how she lost her first son Malachi. Sam was desperate to have a little boy, and we were all praying for a little boy for her.  When her updates went quiet, we knew that there was a good chance that the baby had been born. Finally the update that we had all been waiting for....her family was complete and baby Bauer had been born. As it turned out, being in hospital rather than at home, had been the very best thing for them. 

Two days before Christmas I took the opportunity to photograph the three of them together and I felt so very very lucky.

What kind of midwife do I want to be?

All of the posts about breastfeeding, discussions with friends about breastfeeding and then listening to qualified midwives talk about breastfeeding got me to thinking about what kind of midwife I want to be. I don't have these grand illusions that I can get every woman breastfeeding their babies. I don't think I can change the world after all. So what can I do? What kind of difference can I make?

Well this is my dream....I want to support those women that do want to breastfeed. I want to help them have skin to skin with their babies, to breastfeed as soon as possible after the birth of their babies. I want to make sure that women know where and how to access support should they want and/or need it. I want to provide women with accurate information, without ramming it down their throats. Then following this, I hope that gradually more and more woman have a positive breastfeeding experience, and that this drip feeds to more and more women, that breastfeeding can be easy and enjoyable. That breastfeeding becomes commonplace to be seen everywhere and that women can learn by example, just like women used to do.

I also want to ensure women know about their choices for birth - whether that is where to give birth, what position to give birth in or whether it is how to still feel in control should they need a Caesarean delivery. I want to be able to support women in their choices without cynicism. Of course, I also want to be able to know what to do in the event of an emergency, or when things don't go to plan. And when things don't go to plan, I still want to be able to support women in their choices. I want to be able to help women know what their choices are. I want them to still be able to have a positive birth experience knowing everything possible was done.

I have no doubt that some people think my dreams are daft, that I am aiming too high. But if I can support one woman, help one woman to feel that I made a difference, then it's a start. I am writing this in the hope that I don't forget my dreams; that I remember what is in important to me and that I try and keep to it as much as I can. I'll aim for making a tiny difference and hope that I succeed.

The good and the bad

I have often heard of others poor experiences of breastfeeding support in hospitals, and I cannot deny that my own experience wasn't that great either. However I have also witnessed first hand some wonderful support from both midwives and Maternity Care Assistants.

This is Clare's experience of breastfeeding support:
"Before I had my first baby, I had always assumed I would breastfeed him. I didn’t really give it much more thought, so when James was born 7 weeks early by Caesarean section, weighing 5lb 1oz, and taken away from me to the Special Care Baby Unit (SCBU) it was a real shock that I wasn’t able to breastfeed him. At first, he was fed through a tube in SCBU, but they switched to bottle-feeding without discussing it with me first. I didn’t really question this, as I just assumed that the hospital knows best. I was given a pump to express milk with, not shown how to use it and left to get on with it.

In SCBU James’s weight was monitored constantly, and when I started to try breastfeeding, rather than just expressing milk for him, on about day 5 or 6, he lost weight on that day. This meant that we couldn’t take him home and the nurses insisted on feeding him from the bottle themselves to make sure he took in enough food. This was incredibly upsetting and in the end I gave up attempting to breastfeed in the hospital. I decided to carry on expressing and wait to try when I got home.

I had no one to turn to for advice on how to start breastfeeding from this point and was panic stricken that if James hadn’t gained enough weight by the time the midwife came to visit at home he would be taken back into hospital. Every time I tried to feed, he wouldn’t latch on, so I would switch to giving him a bottle for the rest of the feed. My milk never really came in and after 6 weeks of trying, expressing milk and feeling totally shattered I gave up on breastfeeding completely.

I felt that I had failed James and it still upsets me to think about how little support I was given in the hospital to establish breast (rather than bottle) feeding before bringing him home. I am convinced it is because he was healthy in all other respects and they needed the space in SCBU for another less fortunate baby.

Fast forward to August 2008 and the birth of my second child, a baby girl called Claudia, also born by Caesarean section for breech, this time it was a (sort of) planned section and was at 39 weeks, so a lot calmer all round.

As you can imagine I was pretty determined to succeed at breastfeeding this time, having failed spectacularly with James. I had read up a lot on what to expect, including stories from mums who hadn’t managed to breastfeed first time round but did it second time around.

Claud latched on with relative ease very shortly after she was born. The midwife showed me how to latch her on and then I was left to get on with it. She was sleepy-ish for the first couple of days but she seemed to be doing well and I was happy. Cue day 3 and the visit from the paediatrician who wanted to top her up with formula on day 3. She had very slightly low blood sugar and my milk hadn't yet come in. Not unknown in women who have had C-sections!! Luckily I knew this and argued my corner. The midwives were hugely supportive when I explained what had happened with James and we all agreed that I would put her to the breast more, so that she was getting more in that way and they would monitor her blood sugar. Luckily for us her blood sugar went up and everyone was happy. Hurray, we could go home!

So what happened next? Well, my milk came in and any pain I had eased off. She fed and fed and fed and fed some more. I remember getting very fed up at how often she was feeding. And her sleep was rubbish. But we carried on. We learned how to co-sleep, which helped a lot and the feeds settled down a bit. They really eased off at around 9 months, when she really “got” solid food, and started at nursery. This was a good job, because I was really really sick of breastfeeding at that point! Eventually I wasn’t feeding her during the day at all, just morning, evening and all through the night! Although I had originally intended to give up breastfeeding at around 5 months in preparation for going back to work, that didn’t quite happen as she refused point blank to take a bottle. I had to delay my return for 3 months, which thankfully I could, and then she simply didn’t have milk while she was there. That was hard, but we did it!

I do feel very proud to have succeeded at breastfeeding second time around, and I would urge anyone who didn’t manage it first time to give it a second go if you feel you can. I had woeful support after having James, and very little (in terms of help on technique etc) after having Claud. Luckily for me, Claud was a natural and we never really looked back."

Breast is Best?

The WHO (World Health Organisation) guidelines state:

"Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproduction process with important implications for the health of mothers. As a global health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production."

So there you have it - the official guidelines from those in the know....so why is there so much debate over breastfeeding? Why are people surprised to see babies older than 6 months breastfeeding? Obviously I am only talking about in the UK here, as I can't speak for anywhere else. I think the answers are quite simple really:

1) Breastfeeding can be hard work to get established. It can be painful and sore.

2) Breastfeeding is often hidden away as something private, particularly with older children. Therefore unless you know someone who breastfeeds, your experience with it may be very limited or even non-existent. 

3) It's an emotional topic and when breastfeeding doesn't work out for someone, it can affect how they feel about it. 

Apparently only 2% of women cannot physically breastfeed either due to medical conditions or for an unknown reason. A common misconception, particularly in the 1960's and 1970's, was an inability to feed due to a lack of milk. It is unlikely that this would truly have been the case for the majority of women who switched to formula milk. This was a time when women were advised to put their babies into 4 hourly routines and not feed them in the night time which is has since been evidenced as being detrimental to milk supply. However it is something that is still said today, and many mothers are still worrying about routines and length of time between feeds, and consequently questioning their ability to produce enough milk. There is also little known about growth spurts, so when the baby is suddenly feeding all day and all night to increase milk supply,  again mother's can question their milk production - sometimes leading to early weaning onto solids; but that's another debate! 

So anyway that's the guidelines and official figures - still doesn't tell you my opinion does it? 98% of women can breastfeed....does that mean that 98% should? No I don't believe it does. Nor do I believe that repeatedly telling people the health benefits is the way to increase the number of breastfeeding mothers. I believe that some antenatal class teachers, some of whom are midwives, are almost frightened to talk about the difficulties that women may have with breastfeeding, worried that it will stop women from even trying. Some midwives don't discuss breastfeeding at appointments for a variety of reasons, such as not having enough time, thinking it's too early to consider, that it will be covered by antenatal classes, that anything that is said won't be remembered anyway etc. 

Some women don't want to breastfeed. They don't want to try and it doesn't matter what anyone says to them, they simply don't want to do it. Is that wrong? Well it might be an alien feeling to my own, but it doesn't make it wrong. We are lucky to live in a country of choice, where formula can be made up safely with clean water and for some women the choice is clear, and they choose formula. 

A lack of support is probably the most common reason for women to stop breastfeeding - whether it is a lack of support from health professionals or family and friends. This can be combined with pain, or a lack of knowledge about how breastfed babies feed. I have alluded to routines and growth spurts already but this aggravated by comments such as "are you feeding that baby again?" or "why don't you give that baby a bottle?". There is no benefit to comments such as this and for a mother who has pain and is unsure what she is doing, it can't help. 

Some women try to breastfeed but stop because of pain and soreness. There can be a number of reasons that there is pain during breastfeeding, most of which can be corrected. If the baby is positioned incorrectly, then the nipple can become very sore, cracked, even bleeding. If the mother is given support and advice before too much damage is caused, then the mother can go on to breastfeed as long as she likes. Poor positioning can sometimes also lead to mastitis as the milk ducts aren't emptied properly but again with the correct support and advice this is easily remedied. Nipple thrush can be another cause of pain to the mother, but also to the baby. Once identified, both the mother and baby must be treated simultaneously or it will continue to be passed from one to the other. Thrush can be a nuisance to get rid of, and it can be a nuisance to get the correct treatment for, but with the correct support and advice, it is easily dealt with. Engorgement is also a common cause of pain for the mother, especially when the milk first comes in. The easiest way to deal with it is feeding the baby although it can make it harder to get the baby latched on, in which case, it can be easier to express a little milk off just to make the breast softer. There are other causes of pain of course, but these tend to be the most common so I have focused on these for now.

However before anyone thinks this is a pro-formula post, it isn't. For me, it is like choosing to buy powdered dried milk in the supermarket instead of the bottles of milk in the chiller. It is a perfectly good substitute but it's not what I would choose - give me fresh every time! Wouldn't you say that's what most people do? Isn't that how breastfeeding should be? The norm? In cultures where breastfeeding is the norm, problems with positioning are practically non-existent. Women are used to seeing breastfeeding, and learn from childhood how to position their babies. They automatically support each other, and after giving birth, the family rallies around so that the mother can get used to her baby and get feeding established, without worrying about visitors and the housework. 

I am proud that I have breastfed my children. Whilst the health benefits didn't matter to me before, they do now. I am glad that I have given them the best start in life but at the same time I am incredibly grateful that I had the right support in order for that to happen. I hope I don't come across as smug about it, but actually help to further the view that breastfeeding can be easy, pain free and enjoyable and that it might just be worth a go?