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Friday, 28 September 2012

The gift of liquid love: Human milk for human babies

Once, I breastfed a child who wasn't biologically mine.

My sister was going for a day surgery procedure. I was going to look after her five-month-old, my niece, whilst she was out. The day before her surgery, she was worried about expressing milk, and my niece wouldn't take a bottle. It was actually my brother, listening to us weigh up the options, who said, "why don't you just feed her?" pointing at me. My son was three weeks old at the time, and my milk was flooding in abundance.

It was like a well, duh, head-slapping moment. Why hadn't we thought of that? Problem solved! If my niece needed a breastfeed while my sister was out, I would breastfeed her.

As it turned out, my niece only fussed for a breastfeed once the next day. I took her in my arms, politely offering my breast, not rushing her or assuming she would take it. But she latched on like it was the easiest thing in the world, had a feed and then went back to playing. It was so easy, simple.

If new mothers are afforded practical support, nurturance, and correct information, breastfeeding will work just fine, about 95% of the time. 

But what about those 1-5% of women for whom breastfeeding is physiologically challenging, or just not possible? For example, women with insufficient glandular tissue (IGT), or some hormonal imbalances, or who have had breast surgery? What happens if they want to provide the normal nourishment of human milk for their babies? What do those women do? 

Before infant formula was first invented in the late 1800's, babies whose mothers were struggling or unable to breastfeed would simply be nursed at the breast of another lactating woman. Perhaps she was a sister, an aunt, a cousin, or a trusted friend. 

In today's culture, this is far, far more difficult. Not only because we live in isolation and a lactating cousin doesn't often live next door, but because formula manufacturers have done a wonderful job at convincing us that their product is the next best thing – or is even superior – to human milk. Additionally, we face a culture that sees breastmilk as a bodily fluid to be feared and shied away from.

Brogey, mother of two, found out the hard way that IGT was going to cause problems for her breastfeeding relationship:
"When I had my first child, it never occurred to me that I wouldn't be able to breastfeed. It was just what you did to feed your baby... What I wasn't prepared for was a baby who screamed all the time. A baby who I couldn't settle, who would feed for an hour and come off screaming." 
Brogey recalls a traumatic, intervention-filled birth that saw her baby separated from her and sent to the special care nursery, and given artificial infant formula without her knowledge or consent. In addition, her baby was fed to a schedule in hospital, and so, assuming the medical staff knew best, she adhered to this 3-hourly schedule when she brought her baby home, unaware of the importance of breastfeeding according to a baby's need, rather than a clock.
"I wasn't aware of the benefits of demand feeding, and so when we got home I tried to continue with a rough 3 hour schedule also. At the hospital they had me trying to express but I could never get more than 3 droplets." 
Although Brogey began asking for help, she found very little practical support. Her baby, seemingly unsatisfiable, also began to lose an alarming amount of weight, and produced few wet nappies.
"...each day I started introducing more and more goat formula supplements in desperation. I didn't want to use bottles, and was unaware of the risks of formula, or the availablity of donor milk... I tried explaining [to breastfeeding counsellors] that he was still losing weight daily even with the supplements, and asked about where to get a supply line, to no avail. No practical advice was given, no direction to real life support. So I kept adding bottles."
Exhausted, unsupported, and unaware where she could source the help she desperately needed, Brogey weaned her baby, and sunk into a pit of despair.
"By 4.5 weeks I threw in the towel. He was screaming and pulling away every time I offered him the breast, but would guzzle down a bottle and finally sleep. It was clear that I was a failure, and that he would be better off without me, and I spiralled into PND, leaving him to cry it out alone as I sat and sobbed on the floor."
Before Brogey became pregnant again two years later, she felt determined next time would be different. As she began researching, she came across information about insufficient glandular tissue. It dawned on her that this description seemed to account for many of her problems.
"I started researching in earnest. Finally I came accross info on IGT and it seemed to fit me perfectly...I saw an IBCLC who said that my breasts were not the 'worst' she had seen, and I wouldn't know until I tried again."
Now, aware that IGT would have been a major contribution to her struggles breastfeeding her first baby, Brogey was also aware that the circumstances surrounding her baby's birth had only compounded the problem, making the production of breastmilk not only a struggle, but reducing breastfeeding to a painful, traumatic, confusion-filled chore.
"I hoped that I could change it this time, that maybe it was environmental, after all, traumatic birth, intervention, separation, bottles, formla, etc. Maybe if I did it all right this time, it would work. I got a supply line and my friend who birthed 2 months before me pumped every day so I had a stash of [expressed breastmilk] EBM at the ready." 

Brogey and baby Junipah, only moments old.
Photo: Nurtured by Jen
Brogey's second baby was born at home. The birth was a vastly different experience from her first: euphoric birth hormones, skin-to-skin contact, and a mama and baby kept together as they should be. However, Brogey knew almost immediately that this alone would not suffice for her to produce enough breastmilk for her baby.
"I had a blissful homebirth, everything was right this time. But again by day 3... no engorgement, nothing like that. Bub was on me 24/7, attached to the breast most of that time. This time however I knew that was normal and good, but on the third night she was screaming, her wet nappies had dropped off, and I had to grieve the fact that I wasn't going to be able to do this myself. I cried with my friend and then I defrosted some of the colostrum and fed it to her with the supply line. She slept. Over the next two weeks I kept increasing the supplements according to her need, and I pumped just in case it helped too. I was also on a cocktail of herbs and also motillium in large doses. I had been antenatally pumping and taking herbs too. I stopped all of this at around the 8 week mark as it was making no difference except drain money. I invested in Lact-Aids .. .and I called out to my community for support and donations."
Although having insufficient glandular tissue means Brogey will never be able to produce quite enough breastmilk for her baby on her own, the positive circumstances surounding her baby's birth and the empowerment she gained meant that she was able to embrace and enjoy the breastfeeding she could do, and gave her the clarity and confidence to fully research her options and seek support. And breastmilk. Lots and lots of breastmilk, generously donated by other women, that entirely supplements her baby's nutrition. Her baby suckles at her breast and receives what milk is produced in her breasts, along with donor milk that comes via a tiny tube attached to her nipple. Her baby knows no different. 

She is breastfeeding.

Her second baby has never had infant formula. 

Instead, she has been nourished with a constant supply of generously donated breastmilk, from lactating women all over the country. For Brogey, there was no question – her daughter would have human milk, whether from her own breasts, or from the breasts of other women.
"We have only come close to running out [of EBM] twice. Once in those early days when I was still in a bit of denial, and once about a month ago. Junipah is 9 months now! We have been so blessed and supported by our community, and mamas holidaying from overseas, and interstate. I have had milk shipped and brought to me on planes. Junipah has had over 30 donors. [When] I discovered donor milk was an was never a question after that as to what we would use if I did in fact have IGT. Of course we would do everything in our power to provide her with human milk. That is what she deserves ... She has been wetnursed by at least 7 women also."
Along with the vastly different, joyous mothering experience this time around, Brogey describes the blessing provided by these donations of breastmilk. Donor breastmilk is the ultimate gift, but also the most simple, obvious answer:
"I feel so blessed to have these women in my life. It's just become a part of our life now, picking up milk, filling the Lact-aids and shoving them down my top ... they allow us to have a breastfeeding relationship! My mothering experience this time around is so different! I am confident that we will get to 12 months and beyond with donor milk, and I hope to be breastfeeding her until she is at least 2."
Breastmilk is a complex, rich, life-giving, living fluid. Breastmilk is positively alive with billions of living bacteria designed perfectly for a human infant's developing gastrointestinal system. It contains irreplaceable living antibodies, it contains stem cells that provide instructions for the growing human body. Human infants are designed solely to be fed this living fluid.

Providing breastmilk for babies and mothers in need is about more than simply addressing a nutrient need, it is also about providing empowerment and joy. It is about sharing a truly selfless, life-giving gift, uniting parents around the world. Even if a woman physiologically cannot breastfeed, she can rest assured that her baby is receiving the absolute next best thing: the living milk of others.

World Milksharing Week 2012 is September 24 – 30. The aim of World Milksharing week is to celebrate milksharing and to promote human milk as the biologically normal nourishment for babies and children.
"We hope that by raising awareness about milksharing, families will never again feel forced into feeding breastmilk substitutes –an act which is not without risk to the health of the child. The incredible sense of community that is created among donor and recipient families who partake in milksharing is to be celebrated."
Human Milk 4 Human Babies is a global milksharing network, connecting mothers in need with mothers whom have spare to give:
"HM4HB is a global milksharing network, a virtual village, comprised of thousands of people from over fifty countries. We are mothers, fathers, adoptive families, grandparents, childbirth and breastfeeding professionals, volunteers, supporters, donors, and recipients that have come together to support the simple idea that all babies and children have the right to receive human milk." Human Milk 4 Human Babies
All mothers deserve to feel nurtured and supported; and all babies deserve human milk.

Wednesday, 12 September 2012

I'm sorry, is my uterus in the way of your politics?

Careful, she'll eat you alive!
A study just released reporting the rates of medical intervention in birth has Australian obstetricians in a knot of indignant furore. Published in BMJ Open, the study examined almost 700,000 women giving birth in New South Wales hospitals from 2000 – 2008, and reported an alarming result.
"Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no obstetric intervention compared to 35 per 100 women giving birth in a public hospital."
Yesterday, obstetricians responded to this report with their shorts in a knot and their nostrils flaring. An immediate response from RANZCOG stated:
"This paper appears to be an open criticism of those women who make the choice to access a model of care that provides them with one-on-one continuity of care with a specialist medical practitioner... If women take out private insurance so that they can make these choices, it seems unfair to criticise them. It is simply impossible for women to have an epidural either without informed consent ... and to suggest otherwise is completely false."
But what I find interesting, is that whilst this study and the media articles reporting it are slanted to highlight the disparity in intervention rates between public and private hospitals, a rather damning fact is being cunningly slid aside.

Lets look at those figures again:
• 35 in 100 women giving birth without intervention in public hospitals.
• 15 in 100 women giving birth without intervention in private hospitals.

In other words, this means 65% to 85% of women are being subjected to medical intervention in childbirth in a medical setting. Medical interventions including induction or augmentation of labour, forceps or ventouse extraction, episiotomy, epidural analgesia, and caesarean section.

I'm going to repeat that, just so it sinks in:
Over half of all women are being subjected to medical intervention in childbirth in a medical setting.

Why isn't that the headline?

The difference between public and private hospital, whilst quite marked, is being used as a smokescreen to hide what I believe should be the really concerning figure.

Why are so many women – over 1 in 2 – receiving medical intervention for the births of their children? Is it necessary? And what is this doing to our mothers and babies? How is this setting women up for motherhood?

The fear surrounding childbirth in our culture is very prevalent. It is a rare woman who has been raised to see pregnancy and childbirth as a reverent state to behold, a right of passage to honour and an act to look forward to. As a result, many women believe they need medical intervention (and yes, I was one of those women) and often look forward to the induction at their due date, or the epidural that relieves them of having to feel the pains of their labour.

And whilst this is – and should unequivocally be – a womans right, I wonder if womens bodies were revered instead of shamed, and birth a joy to be cherished instead of feared, would women still line up for their synto and epidural, or major abdominal surgery? I doubt it. I have experienced a typical, ordinary hospital birth and a joyous, empowering, indescribable homebirth. I can tell you without exception, I would not set foot in hospital to birth again, unless medically necessary.

And here is where the grey area begins. Medical necessity.

In a recent article in The Australian, Australian College of Midwives spokesperson Hannah Dahlen is quoted as saying:
"...our [college] position is that home birth is a safe option for low-risk women only, when attended by a competent midwife..." 
I'm curious: why does the Australian College of Midwives feel it is their right to state for whom homebirth is a "safe option," over the birthing woman herself?

As a pregnant women, the safety of my birth choices are mine – and mine alone – to assess. Risk, and feelings of comfort and safety are entirely subjective. What feels like a low risk to one, may feel like jumping from a plane for another.

So when it comes to childbirth, what exactly is "low risk," and more importantly, whose label is that to place?

Some obstetricians will tell you that going any number of days over 40 weeks pregnant places a woman or her baby at risk, where others might be happy to 'let' a woman go a little longer. Some obstetricians will tell you that a vaginal birth after previous cesarean section (VBAC) places a woman or her baby at risk, while others are happy to 'let' a woman 'trial' a vaginal birth. Some midwives will tell you that a breech baby is a higher-risk birth. That birthing multiples is a higher risk. Some women feel that a vaginal birth at all is a risk or discomfort they are not prepared to take, and opt for an elective cesarean section.

Whilst some of the above points may be valid in terms of medical science, it is within the application of this science to a woman's bodily autonomy where I think we must be very careful. Because whilst one woman may feel the most comfortable with an elective caesarean section at 38 weeks pregnant for her breech baby, another may feel that the risks of surgery are greater than the risks of birthing a breech baby vaginally. Risk is personally subjective.

For a long time, womens right to bodily autonomy in birth (amongst other things) has been ignored or belittled. Whilst the Powers That Be squabble over law and regulations and beauracracy, women have become the collateral damage of this ridiculous argument.

If women desire a natural, intervention-free birth they are either threatened or mocked and labelled. Now, apparently, these shocking rates of intervention are all the fault of women requesting them. According to Dr Rupert Sherwood, he blames the women:
"In this era of internet and social media, women have never been better informed. Indeed, many women have access to the same information as their doctors. In particular, the private hospital patient is more likely than most to have carefully researched her options prior to making choices about care."
Whilst a small percentage of woman might be freely choosing these interventions, the truth is that most of these interventions are unnecessary (700,000 medically-deemed low-risk, primiparous woman remember?) so someone is making her believe she needs them. A labouring woman is vulnerable, hospitals have policies to adhere to and litigation to avoid. Obstetricians are, first and foremost, trained to see birth as a painful, medical event full of risk and from which a woman should be 'delivered'. Far closer to the truth, is that these interventions are being pushed on women, and if women don't want them, they are bullied and threatened, and made to believe they have no choice.

Another obstetrician, Dr Rob Buist, claims innocent victim, and blames a woman's increased wish for "continuity, choice and control," or the public hospitals for traumatising women and sending them into his hapless arms:
"It is also possible that when compared with the public system women perceive the private system to be safer for themselves and their babies – a view that can be supported by the scientific literature... And like many private obstetricians I see a small but steady stream of women coming through my door who gave birth to their first babies in the public system. Most were physically and/or psychologically traumatised by their “normal” births and a small number lost their babies."
I have to assume Dr Rob Buist has just gotten all defensive about his practice in general and moved on from the study in question, otherwise he needs to look up the meaning of 'primiparous'. And I especially love how he has enunciated "normal" in inverted commas - as though it's something abnormal.

Damned if we do, and damned if we don't huh?

These rates of intervention are very concerning. Not only for health and wellbeing outcomes for mother and baby, but because they come at significant public expense, in an already over-crowded hospital and health care system. We know that homebirth offers an exceptionally low rates of intervention for mother and baby, and keeps otherwise healthy people out of hospital.

So, I have an idea. How about giving birth back to women? How about we stop squabbling over medical bureaucracy, red-tape and finger pointing, and just let women be?

As it is a woman's right to choose how and with whom and where her baby was conceived, then it should also be her right to choose how and with whom and where her baby is born. 

It really is that simple.