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Thursday, 28 June 2012

Cavewomen Didn't Have Breast Pumps – Breastfeeding Works


Cavewomen didn't have breast pumps.

Cavewomen didn't have breastfeeding pillows, or breastfeeding capes, or nipple shields or books that dictated arbitrary feeding times and schedules. And they certainly didn't have formula.

But what the cavewomen probably did have was something we often don't – faith. Faith in the physiological process of breastfeeding: a simple continuation of pregnancy and birth. Faith because they grew up seeing breastfeeding every day; they knew it was the only way to feed their young. And on the rare occasion that it didn't work or a mama couldn't for whatever reason, there was always a sister or aunt or friend there to help out with a willing hand. Or breast.

It is commonly accepted in western culture that 'breastfeeding is best, but it's hard.' Recent statistics show that although 96% of mothers initiate breastfeeding, by 3 months old the exclusive breastfeeding rate is only 39%. Remember that in terms of human life on the planet, formula is a very recent invention, having only been around for about 150 years. If these statistics were indicative of the human mammal's actual physiological capacity to nourish their young, humans would have died off a long, long time ago.

The fact that I am sitting here writing this post (and you are reading it) is testament to the fact that breastfeeding has worked overwhelmingly well for millennia – and humans have thrived.

So why then, in today's culture, does breastfeeding often seem so hard?

Well, here's is a list of things that can (and often do) compromise a breastfeeding relationship:
  • Birth trauma to mother or baby
  • Cesarean section, assisted delivery or analgesics used during birth (ie. epidural, pethadine)
  • Post birth separation of mother and baby
  • Imposition of routines or timed, restricted or scheduled feeding
  • Use of dummies (pacifiers)
  • Use of bottles (for 'top-ups' with formula, or expressed breastmilk 'so they get used to a bottle' etc)
  • Lack of physical support for the mother: ie. no one to help with the housework or cooking
  • Inexperience in seeing other women breastfeed
  • Inexperience or lack of understanding of normal newborn infant behaviour
  • Separation of mother and baby: ie. baby sleeping in a separate room
This list is non-exhaustive – these are just the most common factors. And common is the operative word here; arguably, a new mother in the west is exposed to many - if not all - of these points.

Mothers aren't often told that these things might make breastfeeding difficult for her and her babe. She isn't informed that the epidural might affect her babe's suck reflex, making his latch difficult for a few days, making it harder for him to milk the breast. She isn't informed that topping up with formula is often not only unnecessary, but can have a cascade effect toward early weaning. She isn't told that keeping her baby close helps keep her milk-making hormones flowing, and she isn't encouraged to ignore the housework and rest with her baby.

She isn't told these things. She isn't reminded that these problems are not her fault - but the fault of a society that just doesn't know a lot of truths about breastfeeding.

She also isn't told that the majority of problems caused by any number of these setbacks can be worked through with the right information and support.

With faith – in herself, in her body, in her baby.

In the early days with a newborn, breastfeeding can seem hard. But although learning to breastfeed can take some time and patience from the mother and child, it's not breastfeeding per se that is so exhausting - it's life with a newborn that is so tiring. With a newborn in the house, when days and nights seem an endless parade of exhaustion, interrupted sleep, and constant breastfeeding, life can seem so overwhelming.

From the moment of conception, women are led to believe that their bodies are faulty and untrustworthy. Pregnancy is fraught with a list of tests and a check boxes of things she cannot eat, activities she cannot do. In birth, the control is rarely something in the hands of the woman.

Following on from a pregnancy perhaps filled with medical checks and tests, a hard or tiring or traumatic birth, suddenly a needy newborn and sore nipples and a constant need to have your breast out can just all seem to much. There is too much beyond our control. So the idea of taking some control – any control – can seem appealing. For many women, although they grieve the idea of giving up breastfeeding – being able to give up something understandably represents the taking of some control.

So, however sadly, she feels she must wean; and in our culture, this is so very easy to do. For the cavewomen – it wasn't. (And lucky for us, right?)

In the vast majority of cases, a woman can breastfeed just fine. More than fine - most lactating women have the capacity to feed two or three or even more babies.

So what is the one thing that can mean breastfeeding success?

Faith.

Unwavering faith; to adopt a kind of 'there-is-no-alternative-to-breastfeeding' approach.

Like the cavewoman did.

It's a bit like learning to walk. At first, we may stumble and fall down. But by watching others do it, and by holding the hand of someone more experienced, we eventually find our own balance, and walking becomes so easy we don't have to think about it.

Falling down can hurt; it can be frustrating and even embarrassing. But once mastered, it's as easy as breathing.

And for the significant majority of the population, learning to walk works out fine.

There are a small number of cases where physiological breastfeeding can be difficult or not possible. These cases include women who have insufficient glandular (milk making) tissue through breast surgery such as mastectomy or reduction, or breast hypoplaysia. In some cases, women with Polycystic ovarian syndrome (PCOS) or other severe hormonal imbalances may be unable to produce sufficient milk. Estimates of these cases are around 1-5% of women.

This doesn't seem to accurately represent the 61% of Australian mothers who, by 3 months postpartum, are not exclusively breastfeeding.

The World Health Organization (WHO) recommends that in the case of a woman being unable to breastfeed, the milk of another human mother is the next best option for her baby.
"The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances...For infants who do not receive breast milk, feeding with a suitable breast-milk substitute – for example an infant formula prepared in accordance with applicable Codex Alimentarius standards..." (World Health Organization Global Strategy for Infant and Young Child Feeding, page 10, para 18)
Put simply, this means that the WHO recommends the following:
  1. Breastmilk from the mother's breast.
  2. Expressed breastmilk from the mother.
  3. Breastmilk from a healthy wet-nurse or a human-milk bank.
  4. Breastmilk substitute (ie. infant formula) 
So for those small amount of cases where a woman is physiologically unable to breastfeed adequately, breastmilk from another human is the next best option. Luckily, as the awareness of the importance of human milk for human babies grows, milk sharing is becoming an option more available to many women.

All mothers (and their babies) deserve unconditional support and the right information. All mothers deserve to be able to make informed choices that suit them and their family. And all women – whether breastfeeding fully, partially or or not at all – deserve to feel completely comfortable with those choices. And with the right information, I believe they can.

So, if you're about to become a new mother, or if you have a new baby (congratulations!) and wish for breastfeeding success – do it like the cavewomen did. 

Don't give up. Hold someone's hand. 

Breastmilk is something that all babies can have – and it's something that every mother has the right to the pleasure of providing.

Peace and love to you. xoxo

    Monday, 18 June 2012

    How Birth Defines Us


    We all begin with birth.

    Why is birth – very act of continuing humanity – dividing women across the world? Why are women having to defend – and fight for – their rights to birth as they choose?

    Yesterday, Mia Freedman's opinion piece in the Herald Sun titled "A healthy baby is not enough for some new mothers" targeted women who make birth plans as being "Birthzillas." 
    Mia Freedman writes: "... there are some women who live for [birth plans].  I call them Birthzillas because just like a Bridezilla focuses on the wedding, not the marriage, the Birthzilla appears more interested in having a birth experience than a baby.
    Birthzillas usually speak about "empowerment" and "control" and use a lot of personal pronouns. Their own experience is invariably at the centre of their narrative even though they will always claim  (and probably believe) that they're acting selflessly and for the good of the baby."
    Since when did a woman wanting bodily "empowerment" and "control" become something to criticise?

    Birth is arguably one of the most poignant moments in a woman's life, with potential lifelong implications for the health of herself and her baby. Why should she be expected to just lay down and become a passive recipient of whatever is handed to her? A birthing women needs to consider whatever is important to her, and conversely what she wishes to avoid.

    Tara Moss, author and UNICEF Patron for Breastfeeding for the BFHI makes some important examples of which a birthing woman has a right to express her desires:
    "For instance, unless specifically requested, many hospitals do not automatically offer valuable skin-to-skin time, where baby is simply placed on mother’s chest straight after birth... Do you want pain medication offered, or would your rather ask for it yourself? Do you want to avoid certain optional medical procedures, like an episiotomy? Do you want cord blood saved for cord banking? The list goes on."
    A woman should have a right to express what she does or does not consent to having happen to her body and her baby during birth. That is a basic human right.
    Mia Freedman writes: "Men? They couldn't care less... Men generally leave the room when [birth] comes up. It's just not that interesting to them."
    Although I know plenty of men who do take an active interest and role in the births of their children, I am unsure of the author's logic behind this point. Men don't give birth. It stands to reason that it's not a subject they will approach with the same level of emotion and consideration as women because it's not something they can biologically do.

    Is this why we are encouraged at every turn not to care about our births? To dismiss childbirth as a brief, biological act of little importance because it's something that men don't appear to care about? I'm not sure what men Mia Freedman associates with, but they're obviously not the same ones I do. You know, adult men. With a brain. And a maturity level greater than that of a pumpkin.
    Mia Freedman writes: "... among privileged women with access to safe and affordable care, I've noticed a growing fixation on the birth process. For many, it's about control."
    Control. Why might a woman want control over her birth experience? Perhaps for the same reason she'd like control over the conception?

    "among the identified risk factors were a history of psychological problems, trait anxiety, obstetric procedures, negative aspects in staff–mother contact, feelings of loss of control over the situation, and lack of partner support. All participants stated that during their labour they had experienced intense feelings of not being in control. The belief that the baby would be harmed, pain and ineffective pain relief, previous traumatic experiences, unsupportive staff and expectations towards childbirth that were not met were factors that were supposed to have contributed to feelings of lack of control."

    Image source

    One of the leading causes of maternal death in Australia is suicide

    So a woman looking for control over her birth experience? A woman standing up for her bodily rights? That's a good thing. 

    Consider for a moment: the building of a family home.

    First, the foundation is laid. A solid foundation, with the strength and stability to hold up the entire structure and everything that goes on within it, for – hopefully – a lifetime. 

    The house, the piece above the ground, is the place within which the family weaves their lives. They tend to the garden, they furnish and decorate and warm the interior. One could argue that the house – the part visible from the street, and the place where the family lives – is the only part that really counts.

    But underneath that house is the foundation. For as many years as the house stands, the foundation holds it all up. Solid, strong.

    But what would happen if that foundation was cracked? What if it's importance were brushed aside - ignored because after all, it is only one minor, invisible part of the house? Considered for only one day, while the concrete is poured and those first few bricks are laid above.

    If that foundation were cracked – whether a little, or a lot – if it were unstable or untrusted or lacking in strength – what would happen to that house, and to everyone living within it? 

    As you can probably see, I'm using the foundation and it's house as a metaphor for birth and life. 

    Birth is the foundation of life. The very thing onto which we graft our lives, and move onward from. To claim that birth is irrelevant is as wise as claiming that a building's foundation has little value; or perhaps that our spines don't really matter.

    I don't often talk about my first birth.

    Not because it was traumatic for upsetting for me, but because it was so unremarkable. So culturally normal. Like many women, I believed it would be more painful than I could bear; this fear prevailed and led me to believe that I could not cope with the pain of a long active posterior labour. An epidural was administered at my request. On my back, with no ability to feel my contractions meant that my baby was finally extracted via ventouse. 

    What followed for me, was a disconnection that spiralled into severe postnatal depression

    Although the birth was only one part of my journey into motherhood, and there were other factors that contributed to my PND, I do believe that my disconnect started for me when the epidural was administered. Perhaps, if the analgesia had not inhibited my oxytocin flow; if my baby had not been pulled from my numb, passive body, we could have been off to a better start.

    Photo: http://nurturedbyjen.com/
    If our society encouraged and supported birth as a positive experience, my foundation into motherhood could have been more secure. If our society allowed for the empowerment – the control – of women over their own birth experiences, the global implications for widespread security and confidence into life could be wonderful.
    Mia Freedman writes: "[empowerment for birth experience] baffles me. It's a bit like going to Paris and obsessing about the in-flight entertainment instead of, you know, PARIS. 
    Just because we fight for a positive, empowering birth experiences does not overrun our love for our babies. Conversely, just because we grieve our traumatic birth experiences doesn't mean we are unappreciative of our babies survival. 
    Mia Freedman writes: "The game of My Birth Was Better Than Yours is an ugly, destructive one... I could bang on and on about my birth experiences. But I'd prefer to tell you about my kids."
    While I don't talk a lot about my first birth, I often talk about my second birth. Not because I don't love or appreciate my children equally, but because I feel I have more to say about my second birth. Not because I am trying to hold my birth experience above anyone else or claim that it was "better" than anyones, but because I believe that women have a right to hear that birth doesn't have to be awful and excruciating, and a woman needn't be disempowered or dismissed regarding her desires for birth.

    Talking about birth doesn't mean we don't talk about our kids. Believe me – I talk about them far more than I talk about their births.

    Advocate for women's birth choices don't necessarily want everyone to birth at home; nor do they believe that medical assistance is never necessary at a birth. People who advocate for "empowerment" and "control" in birth simply want the woman to be at the head of the table. So whether she chooses to freebirth under a tree, or an elective caesarean – the choice should unquestionably be hers. 

    A positive birth experience for the mother and baby – whatever that may be for the pair – sets up a good foundation for motherhood, and life.

    Yes, we are defined by our births. Both our own birth, and those of our children. Our births stay with us whether we consciously remember them or not. 
    "Whenever and however you intend to give birth, your experience will impact your emotions, your mind, your body and your spirit for the rest of your life.Ina May Gaskin

    Thursday, 14 June 2012

    Dirty Little Secrets: I'm Going to be Brutally Honest...

    Speak up? Or forever wish for peace?

    Did you know that infant formula isn't sterile?

    Up until a few years ago, I didn't. Like almost every other person on the planet, I knew there were germs on the bottle, on the teat, and in the water. But the formula? Well, I thought that was the clean part.

    I was wrong. Just like almost every other person on the planet.

    Despite the clinical-looking tin, powdered infant powder (PIF) can actually contain potentially life-threatening bacteria such as Enterobacter sakazakii, a pathogen that can cause meningitis (inflammation of the membranes covering the brain and spinal cord) or enteritis (inflammation of the small intestine). Although infections are quite rare, prognosis from infection is poor and has a high mortality rate.

    Why don't they tell us that?

    Enterobacter sakazakii
    Image source

    Occasionally we'll hear of polite, down-played formula recalls when the milk powder contains crushed up beetles; or has been tainted with toxic chemicals such as melamine; but potentially life-threatening bacteria that can be present no matter what formula brand, no matter what country, no matter whose kitchen bench it's mixed on? Why aren't we told about that?

    According to the World Health Organisation (WHO), the safest way to prepare infant formula is to add the powder to just boiled water – no cooler than 70 degrees celcius – to kill any bacteria in the powder, and then rapidly cool the mixture before feeding to baby.
    "Taking care to avoid scalds, pour the appropriate amount of boiled water that has been allowed to cool to no less than 70 °C, into a cleaned and sterilized feeding cup or bottle. To achieve this temperature, the water should be left for no more than 30 minutes after boiling. ... [the] risk is dramatically reduced when powdered infant formula (PIF) is reconstituted with water that is no less than 70 °C, as this temperature will kill any E. sakazakii in the powder... When PIF is prepared with water cooler than 70 °C, it does not reach a high enough temperature to completely inactivate E. sakazakii present in the powder. " (1)
    Yesterday, I found myself in a conversation about this. I mentioned the WHO recommendation of adding water hotter than 70 degrees to the powder, and pointed out that most parents don't know this.

    Usually, parents dutifully boil the water, pour it into several pre-sterelised bottles, and then line the days bottles up on the bench to cool, then adding the formula powder to the cooled water just before feeding.

    So when I brought it up, I was asked why this wasn't on the instructions on the tin.

    Well, this is what WHO have to say about that question:
    "Currently, the instructions on many PIF products lead to PIF being reconstituted with water that is around 50 °C. But, according to the FAO/WHO risk assessment, reconstitution with 50 °C water generally results in the greatest increase in risk, unless the reconstituted formula is consumed immediately. Under no circumstances is risk reduced when PIF is reconstituted with 50 °C water. Manufacturer's instructions should be reviewed in the light of the findings of the risk assessment." (2)
    I postulated that perhaps the formula manufacturers don't put this on their tins because it would also kill the 'good' bacteria they add to the powder, in order to make their product sound healthier.

    At this, I was dismissively mocked as a conspiracy theorist, who must believe formula feeding parents to be "idiotic morons."

    After I winced, I let it go. Feeling a little sad, I wondered what I could have said differently.

    But after mulling it over, I realised that it wasn't my thoughts that had caused the hurt. It was the feelings my thoughts had provoked.

    Because sometimes, it's easier to lash out and protect ourself – to place the blame on others – than face a potentially upsetting thought: that we may have done something wrong.

    Freud would call this a form of 'projection' – a defence mechanism that reduces anxiety by allowing us to express our feelings without being conscious of them; thus potentially avoiding pain.
    "Psychological projection ... is a psychological defense mechanism where a person subconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, usually to other people. Thus, projection involves imagining or projecting the belief that others originate those feelings." – Wikipedia.
    In other words, rather than facing our own feelings, we subconsciously put them onto someone else. We make our problems a fault of theirs. That way, the internal pressure of our strong emotion can be eased, but in a way that feels safe: the feeling is never really brought into our consciousness, so we feel safe from it.

    Psychologist and author Robin Grille says:
    "What we project onto [others] says a lot more about us than about them." (3)
    One doesn't have to be a follower of Freud to understand this concept. We all understand it; it's no surprise that the following have found their way into our everyday language:
    'Don't shoot the messenger...'
    'I'm sorry, but...'
    'To be brutally honest...'
    After all, if it wasn't potentially upsetting – why would honesty ever be "brutal?"

    Hindsight can cause a lot of tough feelings, even more so when it comes to parenting – because then it becomes not just about us, it's also about our children. I don't think any parent ever wants to feel anything other than complete confidence and pride in their parenting, and happiness and safety for their children.

    Is that why we tend to 'sugar coat' some information for our parents, or just withhold it from them altogether?

    And is that why then, when the truth does come out, or when one voices an opinion conversely to another, there is often criticism and accusations of judgement flung about?

    Regret, anger and grief are hard emotions to deal with. Especially in parenting, and especially in a culture that tends to frown upon a display of 'negative' emotions. From infancy, our anger and defiance are often shamed or ignored or treated as 'problems' to be 'solved,' rather than as genuine, healthy expressions of the myriad of feelings capable of the human psyche.

    Our feelings don't go away by repressing them, blaming others for them, or pretending they don't exist.

    So when someone tells us something that hurts to hear - what should we do? Should we blame that person and accuse them of insulting us, judging us, or attempting to make us feel or do something we don't want to? How about instead, we act like adults and acknowledge how we feel? We could say to ourselves: Hey, that hurt. Why? That comment made me angry - why? What can I do about it? Can I ask them to clarify? Can I assertively explain that I'm hurt by that, and we can work through it together?

    When we learn something new that we wish we'd known earlier, what can we do to forgive ourselves? Can we acknowledge that we were wronged in some way? Or can we take responsibility for ourselves and our own actions? 

    Perhaps we can make a positive use of our hindsight and help others? Perhaps we can extend the respectful, mature adult treatment to others that we wish had been extended to us?

    I'll finish with a wonderful thought to leave you pondering: A Buddhist concept known as equanimity.

    Author Sarah Napthali says:
    "Equanimity is a concept so life-giving and nourishing. It's the ability to perceive all aspects of our lives with acceptance and patience rather than our usual extreme reactions. Equanimity is the ability to keep calm whatever is happening. When something normally considered 'bad' happens, you can handle it - it doesn't derail you." (4)
    Recognise our feelings, our emotions. Acknowledge them. Own them. Be okay with them all.

    Only once we've seen our emotions, given them names, teased them all out of the tangled web of feeling that arises every now and then, can we move forward with peace.

    References:
    (1) World Health Organization, 2007. Guidelines for the safe preparation, storage and handling of powdered infant formulaPg 17.
    (2) World Health Organization, 2007. Guidelines for the safe preparation, storage and handling of powdered infant formulaPg 19.
    (3) Grille, Robin. 2005. Parenting For A Peaceful World. Pg 221. Longueville Media.
    (4) Napthali, Sarah. 2003. Buddhism for Mothers. Pg 49. Allen & Unwin.

    Thursday, 7 June 2012

    Compassion's Paradox: When Caring is Labelled Criticism



    Warning: this post will be rambling, probably very un-articulate (is that even a word?) and likely filled with typos. I just have to get it out.

    I'm feeling very sad about the world today.

    Yesterday, it was homebirth and sleep training, this morning I wake and it's breastfeeding's turn. (And yes, they are all links from the same website – but I didn't have to look far. And incidentally what does that tell you? I digress.)

    It seems that no matter where you turn as a mother, you're going to cop it. If you've read any of my past posts I'm sure you'll know that I'm no stranger to the contradictions and the heart-wrenching feeling of having to go against your instincts just to try and fit in.
    "...But I’m cackling at the idea that breast feeding mothers need all the support and help they can get but bottle feeding mothers can rot in hell... It’s this attitude that has me happily brandishing my boobs in public but slinking away to the car to give him his top up, lest some judgemental bottle nazi see me feeding my child formula."
    Says one commenter when people tried to point out that a give-away of baby bottles was against the MAIF agreement...Out comes the Nazi comment...

    But here's what's breaking my heart today: Being, shall we say, left-of-centre, means that what I say is not always the majority opinion. The majority opinion is the easy route, the safe route, the one that raises few alarm bells in others and provides a nice, comfy, sturdy platform on which to sit. And hide.

    So when someone does something different from that (lets say, chooses a homebirth), or speaks out agains the practice (lets say, sleep training) - it is easy to target them. It's easy to flame them. Because they're in a minority.
    "Each to their own, if you want a holistic home birth good for you, if you [sic] baby dies because he or she is not close enough to proper medical intervention at a hospital well sorry you have to live with that for the REST OF YOUR LIFE."
    Says one commenter on an opinion piece on homebirth. Closed-minded much?

    So why do we do it? (I'm using the collective pronoun 'we' to describe those people who speak out against medical birth practices, harsh baby-raising practices, and the insidious undermining of breastfeeding by formula manufacturers, or the patriarchal cultural assumption that breasts are for sex therefore full-term breastfeeding is a no-no. Yes I know, it's a generalisation. But it will do for today.)

    We do it because we CARE. Because we believe that what we are saying could HELP people. Perhaps it won't help everyone, perhaps it will only help a small few; but because mothers - women - deserve to have someone stand up for them, and to help them if they so desire it.

    And lets face it, with an Australian breastfeeding initiation rate of about 95%, and a steady drop from there into weaning that occurs faster than those mothers would like - they DO need the help.

    I'm not going to go into the stats about why homebirth is safe, why empowering women to trust their bodies can make a better world, about why sleep-training is harmful to babies, about why bottle-feeding is not only a physical health risk but an psychological one. But the stats are there, trust me, and I believe they have the potential to make a better world.


    So I'm sad today because my sisters and friends who speak out against cultural norms are being vilified. Who turn their compassion for humanity into a message are being labelled as selfish, insulted and seethed at as 'making mothers feel guilty'.

    I'm sad today because speaking out takes courage, it takes passion. Sometimes that passion carries us and makes the inevitable blows easier to deflect. But sometimes, it's tiring. And for me, today is one of those days.

    Onward tomorrow, eh...?

    How Breastfeeding Fell From Grace – and Our Children Have Paid the Price


    Although I consider her pretty much weaned, my almost-5-year-old occasionally breastfeeds. It has only been over the past few months that she has stopped asking daily for "mama milky." 

    From the moment of her birth, by first-born was a voracious breastfeeder. Day and night, she seemed to be constantly at the breast. So by the time she was 2 weeks old, I wondered what was going wrong. Why did she want to nurse so much? Was there something wrong with my milk? 

    But then I learned about supply and demand. I learned that it is normal for human babies to need the breast quite frequently - some babies, almost constantly - but that our culture is just overwhelmed by a staggering amount of breastfeeding myth and misinformation.

    So after that hurdle, there was no looking back. Despite doing several battles with mastitis, severe postnatal depression, a breast abscess, a biting 9-month-old, a wakeful 12-month-old – we got through it all. But no sooner had it begun to seem easy, than people began asking: "Is she still breastfeeding?" and "when will you wean her?" and "when are you supposed to wean? Isn't 6 months the cut off?" 

    So how did it come to this? Why was I so determined to not only overcome those common early breastfeeding hurdles, but to breastfeed into the fifth year of my child's life, far beyond Australian cultural norms? Was it because I was determined to make some kind of political statement? Was it because my child was overly dependent? Was it because I was some kind of smothering mother who wanted to keep my child in an unnatural infancy? 

    Was it because I'm just weird?

    The answer to all of those questions is no. 

    The truth is this: it's not about what wanted or needed – it's about what my child needed. And if my child didn't need to breastfeed anymore, she wouldn'tIt's as simple as that.

    I only started research into breastfeeding 'older' children - the scientific facts, the anthropological research, the feminist musings – when people started asking questions.

    Because here's what we don't tend to realise:

    You don't suddenly go from breastfeeding a newborn, to hoisting a leggy 4-year-old onto your lap. It doesn't happen overnight. There doesn't suddenly come a tangible point when it goes from 'perfectly fine' to 'weird' and then you choose to buck that line and blow raspberries to society from the other side.

    Although our children grow up quickly, when they are at your breast multiple times a day the progression from infant to toddler to child is so slow that you don't even notice it. 

    Breastfeeding them becomes as natural and normal and everyday as bathing them, helping them dress, holding their hand. 

    You've all heard it, but I'll quote it again: the World Health Organization recommends breastfeeding up to 2 years of age and beyond. 

    The physical, immunological and emotional health benefits of breastfeeding extend well beyond infancy. In fact, they continue as long as the breastfeeding relationship does. It's dose dependent: so while a little breastmilk is good, a lot of breastmilk is better.

    Anthropologist Kathryn Dettwyler says:
    "The minimum predicted age for a natural age of weaning in humans is 2.5 years, with a maximum of 7.0 years."
    So okay, I hear you ask, if it's so biologically 'normal' - why is it so profoundly uncommon in western culture? 

    The answer to that is complex, and takes into account many thousands of years of human cultural evolution.

    Here's a potted account of what happened: 

    Thousands of years ago, archeological evidence shows that humans were, for the most part, a peaceful and egalitarian society. Early prehistoric societies are believed to have been mother-centred, goddess-worshipping matriarchies. According to some anthropologists, the connection between sexual intercourse and pregnancy may not have actually been known. Instead, women were viewed with a sense of magical awe: not only did these beings bleed for days (menstruate) without injury or death; they were a source of sexual pleasure, and they swelled and grew and birthed children from their womb, and in turn nourished those children at their breasts for years! (1)

    Italy, Sicily, Statue of a breast-feeding Goddess from the Temple of Megara Hyblaea
    image source
    Along with other movements, as awareness of the link between sexual intercourse and subsequent pregnancy grew, human associations began to change from that of a goddess-worshiping culture to that of a male-dominated, aggressive society: a patriarchy.

    When a woman is breastfeeding, she is generally infertile. Typical child spacing in early human history meant that most women may have only borne 4-6 children in her lifetime, without the need for contraceptives.

    Take away breastfeeding, however, and combine that with the availability of more food sources due to the growing of crops and rise of food industry, and a woman can potentially bare many, many more children.
    "...on the eve of the Neolithic revolution, there was an estimated [global] population of around 10 million ... By 1700BC, a mere 10,000-12,000 years [later], there was an estimated population of 100-200 million. It is truly a staggering increase in a relatively short time." – Ann Sinnott, Breastfeeding Older Children (p. 237)
    'High class', aristocratic women were for breeding; 'lower class' women were for wet-nursing the young of these aristocrats so they could become pregnant again. In the 15th to 17th centuries, elite women commonly had as many as 20-30 pregnancies – although resultant maternal and child mortality was high. (2). Thusly, breastfeeding began to be seen as lower-class.

    As time went on, demand for labour meant more women moved into the work force. Being away from their children made sustained breastfeeding difficult - if not impossible, and an infant food source became necessary. Coupled with milk-surplus from the rise of commercial dairy-farming, thus came the rise and persuasive marketing techniques of infant formula. 

    Moreover, birth practices moved away from a midwifery, women-centred domain into the hospitals and the hands of (male) physicians. Women were stripped of their biological power from before their infant was even born.

    18th century physician William Cadogan instituted the 4-hourly feeding regime – and advocated never feeding at night. He also expressed a general disregard for the intelligence women - mothers in particular:
    "It is with great pleasure I see at last the preservation of children become the care of men of sense. In my opinion this business has been too long fatally left to the management of women, who cannot be supposed to have a proper knowledge to fit them for the task." – William Cadogan (3) 
    With all this taking place over thousands of years, it's little wonder that breastfeeding barely exists anymore.

    The 2010 Australian National Infant Feeding Survey by the Australian Institute of Health and Welfare shows that about 96% of mothers initiate breastfeeding at birth. But by 3 months of age, only 39% of infants are exclusively breastfed, and that rate drops to only 15% at just 5 months. These figures show that despite an excellent breastfeeding initiation rate, by the time infants are 6 months old, over 85% are not even reaching the WHO recommended 6-months exclusive breastfeeding duration – let alone continuing until natural weaning age.

    If these figures were accurately reflective of homo sapiens biological ability to breastfeed, human beings would be extinct.

    Research has shown that the support of the father is the single most important factor in determining whether or not a woman breastfeeds. (4). 

    While many fathers are indeed supportive and encouraging of the mother/baby breastfeeding dyad, there are often occasions where they are not. One of the most cited reasons for weaning from the breast, (or even not breastfeeding at all), is the misguided belief that fathers need to be able to share the feeding in order to bond with the baby. Additionally, many women report their partners expressing feelings of jealousy towards the baby, feeling uncomfortable with her breastfeeding in public, or complaining about the mother's lack of time for them. (5)
    "My husband began applying pressure to wean shortly before my daughter was one. I reluctantly weaned her ... later, I realised how deeply I resented him for this..." A mother, England. (6)
    Where do these feelings come from for fathers? There are some suggestions that adult men who were deprived of their mothers breast or prematurely weaned in infancy, carry these scars subconsciously for life. Emotions triggered when their partner breastfeeds can stir up feelings of jealousy, grief, rage and sadness, unconsciously linked to their own needs having been denied in infancy. (7) For some fathers, these feelings alone can be enough to demonstrate a lack of support for sustained breastfeeding.

    And of course, I couldn't write this post without mentioning the sexualisation of breasts in our culture.

    Image source
    Did you know that breasts aren't actually 'supposed' to be sexually arousing? Did you know that finding breasts sexually arousing is a product of cultural conditioning?

    It's fair to say that seeing breasts as sex objects (rather than their primary mammalian intention of nourishing offspring) would have to be the number one reason that breastfeeding holds a cultural taboo.

    A woman's breasts can be scattered everywhere in front of us without batting an eyelid. But pop a baby on that breast? And hello, controversy!

    While those who vilify public breastfeeding like to tote their discomfort under words like: "she should cover up" – I'm going to take the leap that what they're actually saying is: "sucking at breasts is sexual and for adults - not children."

    So it becomes particularly confronting when we see 'older' children suckling at a breast, because it suddenly becomes sexual.

    This couldn't be further from the truth. Certainly, breastfeeding shares some of the loving, tender feelings of sex (and the same hormone – oxytocin) but to suggest that mothers are somehow unable to separate those feelings from sexual arousal is just preposterous. 

    Thanks to Time Magazine, breastfeeding 'older' children is a discussion reignited in the mainstream. But I think we're discussing the wrong angle. Rather than discussing at what age a child should be weaned, we should be discussing why we're even discussing it in the first place. 

    Why did breastfeeding, something imperative for survival of our species, become something so politically contentious? Why was breastfeeding taken away from women and their children?

    If breastfeeding was something that men could biologically undertake - do you think it would be such a taboo?


    References:
    (1, 2, 5, 7) Sinnott, Ann. 2010. Breastfeeding Older ChildrenFree Association Books.
    (3, 4, 6)  as cited in Sinnott, Ann. 2010. Breastfeeding Older Children. Free Association Books.

    Wednesday, 6 June 2012

    Birth Choices: Just Whose Choices Are They?

    Photo by Rachel Ford

    "I would have loved to have a homebirth, but my husband didn't like the idea."

    "My family told me I was crazy - they said too many things that could go wrong."

    "I like the idea of having a homebirth, but this baby is an IVF baby, so it's too precious."

    "My obstetrician said no."

    Right now in Australia, a woman's right to choose her birth place and care provider is becoming more and more limited.

    In 2010, the Australian Government passed legislation that stated that independent midwives required insurance to legally attend home births as a registered caregiver. The thing is, no insurer provides that insurance for intrapartum (birth) care at home. So the government provided an exemption – which ends in July this year.

    The numbers of registered independent midwives practicing in Australia is falling. Many midwives have chosen not to renew their registration and have either retired from midwifery, or instead attend women as traditional birth attendants.

    When a woman chooses to homebirth, not only does she have to research quite thoroughly to find answers, to find out what little options are actually available to her, she often has to jump through legislative hoops, find scarce approval from other care-providers, and deal with a barrage of negative criticism.

    When a woman chooses to homebirth, she does so despite society's fear-based perception of birth, despite being painted with insulting and derogatory stereotypes, and despite constant sensationalist media articles slanted in a deliberately defamatory manner.

    When a woman chooses to homebirth, she usually does so knowing that a hospital is not always the safest place. That obstetricians are not always safe. That routine obstetric interventions are not always safe. She does so knowing full well that birth is only as safe as life.

    Despite a wealth of evidence confirming the safety of homebirth, women who choose to birth their babies at home continue to draw ignorant criticism.

    When a woman chooses to homebirth, she chooses the only option that can provide her with a truly woman-centred model of care; the only option that respects that childbirth is a normal physiological process – not a medical emergency. She chooses the best chance of avoiding trauma such as episiotomy, forceps deliveries, of having virtual strangers repeatedly insert their fingers into her vagina if she doesn't want that. She chooses the only model of care that advocates her as being in control, rather than an upcoming shift change, or a medical policy, or the clock on the wall, or the beuracracy of litigious red-tape.

    So when I hear a woman say that she'd love to homebirth but her husband said no, or that her mother-in-law would never approve, or that her next-door-neighbours-newspaper-delivery-person told her she was crazy, I could weep with sadness.

    Of course, the father's concerns should be discussed and considered, unpacked and faced. But the birth choices are not his to make. The fear is his to work through - not hers to take on.

    A woman's choices should be her own. Women should be respected to own their bodies. Women should feel empowered to trust their bodies, and their babies, and should be supported to make whatever choices make them feel safe – whether that is an elective caesarean section, or to birth at home. It's her choice. It's basic human rights.

    If we respect women, we respect everything a woman can do. If we respect birth, we have the capacity to raise a generation that is born into compassion, into nurturance, into trust.

    After all, who owns a woman's body?

    Her body, her baby, her choice.

    It should be so easy to understand.