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Monday, 20 October 2014

Dear Tizzie: From one mother to another on breastmilk supply – you are enough

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Dear Tizzie,

I came across your post on Facebook today about starting your wee babe on solids. They grow up fast, don’t they?!


You shared your concerns:
'I was worried about starting CiarĂ¡n on solids, I didn't know how I was going to fit it in to our already full day. But ... I feel like a weight was lifted off my shoulders now he is getting food from somewhere else other than me, I don't have to be as worried about how much he is getting and was it a good feed, did you feel this relief?'
As many of your fans commented, it is reassuring for your readers to know that you suffer the same insecurities as them: How will I find the time in my busy day? Is my baby getting enough milk from me? Is my milk ‘good’ enough? Am I enough for my baby?

It’s okay to feel this way! After 200 years of aggressive artificial baby milk marketing, breastfeeding knowledge and confidence is at an all time low. That’s sad, huh?

But the good news is, many mums find relief from these common worries by being reassured about how their milk supply works.

Essentially, breastmilk supply works like this: milk removal causes milk production.

Pretty straight forward, right? The baby sucking at the breast stimulates nerve endings in the nipple, which causes a surge of milk-making hormones in the mother’s body. These hormones, combined with the removal of milk from mother’s breast, give the body a clear message: make milk for our baby!

Breastmilk contains, amongst that huge host of great stuff, a protein called Feedback Inhibitor of Lactation (FIL). Sounds fancy, but it’s really just a chemical that, when left sitting in the breasts, tells the body to halt milk production for now. Because if the body kept making milk while there was lots of milk still sitting in the breast, the woman would end up with mastitis, you see. A woman’s body is very clever like that! So when breastmilk is removed, the volume of this FIL protein is lowered, and the body is free to make milky abundance.

Babies need to go to the breast for many reasons: sometimes they’re thirsty and they will have a quick drink, sometimes they’re hungry and they will take a longer feed, sometimes they’re uncomfortable or unhappy and need the comfort sucking at mama’s warm breast can provide.

Humans evolved for our bodies and our babies to match perfectly. A baby is driven by instinct to control his mama’s milk supply by signalling for the breast when he needs it: some babies will need to suck frequently (almost around the clock!) and others a little more infrequently, or at uneven times throughout the day. But you can relax—all babies eventually fall into their own pattern and daily rhythms as they grow older.

So, the more milk removed, and the more frequently the baby suckles, the more milk mama’s body will make. It really is that simple!

Another reassuring fact to remember is this: breastmilk is a constant secretion. Like blood, it is something our bodies produce constantly. So the breast is never truly ‘empty’. Provided baby goes to the breast when baby needs, you cannot ‘run out’ of milk.

So how do we know if our baby is getting ‘enough’ from us? We live in a culture of fear that a crying baby, or a baby who wakes frequently or needs help getting to sleep, is a baby lacking milk. This simply isn’t true. (Again, you can blame the formula manufacturers and 19th century doctors for this myth.)

The signs of a well-fed baby are: lots of wet, clear nappies (a sign of good hydration), the occasional soft poo (breastmilk is a natural laxative—a well-breastfed baby will never be constipated!), good skin tone and bright eyes, crying with energy and gusto (a dehydrated or malnourished baby will have a weak, high-pitched cry or may not have the strength to cry at all), and a baby who has some content periods and communicates well for the breast. And finally, a baby should be expected to grow in length and head circumference, and gain some weight, over the space of a month.*


The use of dummies, 'top-up' bottles of formula or EBM, or scheduling feeds can all negatively affect a breastfeeding relationship by stopping the baby from directing mama's milk supply as he needs. So it's best to just toss any of those things away, okay?

Now, let’s talk a little about the ‘right’ age to introduce solids. Indeed, there’s a bit of conflicting advice about, isn’t there? After all, there’s a lot of money to be made in convincing parents their baby needs food! ($117.7 million in Australia alone in 2012) But rest assured, despite the occasional junk-science study saying otherwise, the World Health Organization still recommends exclusive breastfeeding for 6 months.

Now of course, this isn’t a fixed-to-the-day date that will suit every baby. All babies are different, and some might display readiness for solids earlier than 6 months, and others much later. (Neither of my children were much interested in solid foods until they were about 12 months old!)

Back in the days before parenting ‘experts’, human babies began eating solid foods when they showed they were ready: sitting up, able to bring their hand to their mouth purposefully, and when their tongue-thrust reflex was gone. The tongue-thrust reflex is that pesky reaction that causes baby to spit rice cereal back at you, no matter how much you spoon it in! It’s a survival response that nature designed to stop baby from choking before they were able to chew. In other words, until they have the readiness to chew, push food to the back of their throat and swallow it, their tongue will reflexively poke it all back out.

All of these things demonstrate a gastrointestinal readiness for foods other than breastmilk. Again, for parents, it comes down to watching your baby. Most parents I know understood their babies were ready for solid foods when the baby kept stealing their dinner from their plate!

A healthy baby with free and unrestricted access to the breast will, in almost all cases, do just fine. Rare instances where breastmilk supply may be compromised by physiological conditions include mastectomy or some breast surgeries, rarely in cases of polycystic ovarian syndrome (PCOS), or insufficient glandular tissue (Hypoplasia or IGT). Now, granted, I don’t know you personally so perhaps one of these rare cases apply. Even if that is the case, there are ways to ensure baby gets a good supply of human milk.

I hope this information—things women have known inherently for all of human existence—helps you feel more confident.

Lots of love,

Kim xo
Cert IV Breastfeeding Education (Counselling) | Mother of two | Breastfed for 7 years


*It goes without saying: if in doubt, get it checked out. See a good doctor.

Thursday, 16 October 2014

The Sleep Doctor isn't alone


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Earlier this week, the now-controversial Australian GP Brian Symon, aka ‘The Baby Sleep Doctor’ was removed as a speaker from Melbourne’s Pregnancy, Baby and Children’s Expo following an onslaught of concerned parents, professionals and public approaching the Expo.

Alarm arose over Dr Symon’s appearance at the PBC Expo after a story was aired in The Daily Telegraph on 11 October 2014. In the article, that has since been removed from the site, Symon’s advice to parents of healthy, well-fed children over than six months was quoted as:
‘The steps start with the child having dinner at about 5.30pm, followed by a bath and being in bed about 7pm. They are then read a story and given positive reinforcement before the light is turned off and the bedroom door is closed … As hard as it is, do not re-enter the room until 7am the next day—unless you fear the baby is unwell … The child will cry but do not enter the room. If your baby cries for three hours and you eventually go to them they will know their reward—you—will be given to them if they cry for long periods.’
Several parents then went on to detail their experiences using Dr Symon’s advice, and their accounts included hours of babies screaming and crying, vomiting, and even one parent having to hold the door closed whilst the child threw objects at the door.

While the discussions that are now taking place regarding Dr Symon and his techniques are important, what isn’t being said is how entirely unoriginal his advice actually is. Although one recent unfortunate-for-him article has seen him receive backlash, Brian Symon is far from the first person to spread this kind of advice, and nor is he alone.

‘It is with great pleasure I see at last the preservation of children become the care of men of sense,’ wrote Dr William Cadogan, British physician in his essay An Essay Upon Nursing and the Management of Children in 1748 ‘…this business has been too long fatally left to the management of women, who cannot be supposed to have proper knowledge to fit them for such a task.’

Although Cadogan was a proponent of exclusive breastfeeding, he warned against ‘overfeeding’ for fear of diarrhoea, and therefore advocated only four-hourly feeding and forbade feeding at night.(1)

Gabrielle Palmer, author of the bestselling The Politics of Breastfeeding, writes, ‘Cadogan pioneered a dynasty of well-intentioned but dogmatic men whose ideas influence ... to this day. Throughout the 19th and 20th centuries, Doctors Budin, Cooney, Pritchard, Truby King and many more strove with amazing energy and zeal to manage infant feeding the way they thought best. Somehow they ignored, or were frustrated by, the fact that women’s bodies had their own way of working.’

From these early pioneers of rigid schedules and routines, we have evolved over two centuries into an industry that today gives us so-called ‘baby whisperers’ and ‘sleep experts’ that includes Dr Brian Symon with authors such as Tizzie Hall, Gina Ford, Elizabeth Sloane, Tracy Hogg, Jo Tantum and many others.

So whilst children enduring Symon's advice are locked in rooms uncomforted, Tizzie Hall has often been quoted as advising of babies vomiting for "attention"; Elizabeth Sloane forbids eye contact and instead utilises loud knocking on the door as comfort; Gina Ford reckons women should just 'grin and bear it' in more ways than one.

And to be honest, between Cadogan's 4-hourly feeds and nothing overnight, to Tizzie Hall's 3-hourly feeds and only 1-2 feeds overnight (2), have we really come very far?

As society becomes increasingly wary of the risks involved with sleep training such as cry-it-out and controlled crying, those making huge whacks of money from this advice distance themselves from the concern by arguing semantics, claiming their techniques don’t use those methods.
"I'm not a fan of controlled crying, and for most people that term conjures up horrible upsetting images of screaming babies being left in their room for hours. I call my program 'controlled comforting' ... I think the longest I ever ask parents to stay outside the nursery is maybe 10 minutes." Elizabeth Sloane
‘I do not recommend controlled crying, as walking in and out of the room will only tease your baby. It will make him emotional and he will continue to sob after falling asleep. Rather than this ‘cry yourself to sleep’ method, I recommend the ‘laying down approach.’ Tizzie Hall
‘Nowhere in Gina's book or on this website does she say that controlled crying should be used with young babies of three weeks old. She advises that as a last resort controlled crying could be used with older babies…’ Gina Ford
And so, whilst researchers, physicians, psychologists and a host of neuro-specialists increasingly share the science behind why sleep training being a bad idea (hint: learned helplessness), those who stand to make money (a lot of money) selling this advice label their techniques something else and counter claim their own science to convince parents that their particular brand of advice is gold:
Brian Symon's Facebook page
Now, we could all sit around and argue science all day. I don't doubt that there is evidence that suggests sleep training 'works' in achieving a baby who sleeps with minimal (or no) parental involvement, because if any animal is denied something for long enough they will eventually cease signalling for it. Furthermore, with a baby who appears outwardly 'fine' and who sleeps more according to the biologically-warped views of social expectation a parent is more likely to report feeling more confident, of having improved mental health outcomes.

But at what cost?

And more to the point—why has the simple fact of being biologically human become a topic for which we need scientific approval?
Robin Grille, Australian psychologist and author says, ‘Does it not seem a little eerie that we treat this as an issue of “science”? … do we need a laboratory report to tell us it is OK to respond to a child? What else? Do we wait for test results to confirm that we need a hug? Do we argue the statistical significance of our need to breathe clean air? Do we need to cite medical journals to endorse our urge to eat?’

Before I became a mother, my perceptions on infant care were that of dominant culture: don’t worry if/when breastfeeding doesn’t work, quickly establish routine and independent sleep habits, and don’t let the baby change you.

And then, I had a baby of my own. While my entire body cried out to hold her, to be with her, society told me that she was being 'spoiled', that she was not a 'good baby' simply because she cried. And suddenly, the child in me who’d been left to cry-it-out as a baby, who’d always apparently been ‘fine’, actually wasn’t fine. I wasn’t fine at all.

And nor are the 1 in 5 adults at any one time suffering metal illness—nor the almost 100 per cent of adults who will in their lifetime suffer mental illness. Take a look at the nightly news, or your social media feed, or the newspaper headlines—violence, intolerance, hatred, disconnect, fear—to see just how ‘fine’ we as a society we really are.

It wasn’t science or studies or peer-reviewed double-blind randomised controlled trials that convinced me to hug my baby, it was the warm voice of another mother, another woman, comforting me to do so and validating how I felt.

The quiet power of positive voices is a heartening triumph. That a group of concerned individuals can murmur, ‘hey, this isn’t right’ and have their voices heard is a wonderful thing for parents and their children, and for us as a society.

Because this advice is still so widespread, we need to keep being that voice. Keep being that source of comfort in a sea of disconnect that says, ‘of course it’s okay to hold your baby.’

So, in the words of Peggy O’Mara, “Don't stand unmoving outside the door of a crying baby whose only desire is to touch you. Go to your baby. Go to your baby a million times. Demonstrate that people can be trusted, that the environment can be trusted, that we live in a benign universe.”


1) Palmer, Gabrielle. The Politics of Breastfeeding: How Breasts are Bad for Business Pg 23-24. (Pinter & Martin, 2009)
2) Hall, Tizzie. Routine Breastfed Baby Aged 1-2 Weeks (2008)

Monday, 16 June 2014

Breastfeeding: Can’t or won’t? It should be up to her


I read a thoughtful and honest article on Essential Baby today, from a writer sharing her painful experience with breastfeeding.

On this blog, I’ve written predominantly about breastfeeding from a positive perspective: the how and the why and the what’s-so-awesome. I’ve written like this because as a breastfeeding counsellor, the most overwhelmingly common phrase women come to me with is, ‘I’m having XYZ problem – please help me keep breastfeeding.’

But what about when women don’t want to breastfeed?

In her article, 'I stopped Breastfeeding because it felt awful', Amy Gray writes:

'I feared judgement from others and quickly learnt to tell people I couldn't, instead of wouldn'tfeed. I’d tell them I just didn't have the fuel in my breasts to make milk ... It was easier to tell these people “I can’t” instead of “I won't'"
I think this is an incredibly important point. There is a huge distinction between can’t and won’t. The most commonly cited reason for early weaning is, “I couldn’t.” This isn’t technically accurate—most women are biologically capable of breastfeeding. And when I hear women’s experiences and stories (and as Gray astutely points out in her article: There will always be armchair experts who will softly cluck they could have saved someone with their wisdom...) often the reason is more accurately, ‘I didn’t want to.’

There's two reasons why I believe it's important to differentiate between 'can't' and 'won't' when it comes to not breastfeeding. Firstly, because saying "I couldn't" when technically one could perpetuates common myths about why breastfeeding doesn't work, potentially at the detriment of other women (who might really, really want to breastfeed, but falsely believe they 'can't'.) And secondly, because women should have an unconditional right to dictate what they do and don't do with their own bodies. And a woman who chooses not to breastfeed, for whatever reason, should feel supported to own that choice.

But of course, we live in a culture where women are damned if we do, and damned if we don't.

A woman’s choice not to breastfeed doesn’t happen in a vacuum. And women choose not to breastfeed for a myriad of complicated and deeply personal reasons.

Anyone who’s ever breastfed, or is close to anyone who has, would be aware that in our culture, we perpetuate two main messages about breastfeeding:
1)   Breastfeeding is best
2)   Breastfeeding is hard.


And surrounding these two conflicting messages are a vast and complicated web of other, equally conflicting and emotionally nuanced messages: ‘Feed like this, feed like that. Baby should behave like this, baby should behave like that. Feeds should be X long, at X intervals. No, feeds should be XYZ long, at XYZ intervals. Baby should gain X amount of weight, at X days/weeks/months. Don’t feel guilty, don’t judge, don’t neglect your husband, don’t do it in public, and whatever you do, remember that all good mothers breastfeed.’

Just as a woman’s body is policed in day-to-day life (size, shape, hair, and countless more) and in pregnancy (what foods to eat, what tests to have, what not to do) and in birth (time limits, cervical dilation progress, interventions) so too is a woman policed in breastfeeding.

In our culture, breasts are seen primarily as sexual objects, as play-things for men. A significant proportion of women suffer sexual abuse in their lifetime. For most women (myself included), a baby’s sudden and intense longing for her breasts is incredibly confronting – when for all of her post-pubescent life, her breasts have been mostly tucked away as little more than a fashion accessory. We rarely grow up around, or see in every day life, breastfeeding women. 

With the burden of all the above – along with the overwhelm of constant, insidious formula marketing, the ubiquitous bad breastfeeding advice, and the sleep-deprived, emotionally-difficult and hormonal state of new motherhood – it is little wonder that breastfeeding can cause many women discomfort, revulsion, pain, and even trauma.

More often than not, breastfeeding hurdles can be overcome with the right information and support.  (And here I'm being a softly-clucking armchair expert.) However, finding the ‘right’ information can be incredibly difficult—mostly because the inherently female act of breastfeeding has been long-derided and written-off as flawed in our patriarchal culture. But the right information helps only if the mother desires it.

And admittedly, this is something that has taken me about five years as a breastfeeding counsellor to understand.

For many years, I have joined breastfeeding discussions armed with what (I hope) has been empathy and helpful, positive breastfeeding information. But increasingly I wonder if my direction is not quite right. I staunchly, unconditionally support a woman’s right to do only as she wishes with her own body. So what about when she doesn’t want to breastfeed?

Although most women do inherently wish to breastfeed, for many, when breastfeeding aversion becomes so severe it’s because the experience of breastfeeding has, from birth, snowballed in a cascade from slightly difficult to supremely horrific. For other women, breastfeeding aversion exists from the start, due to highly personal trauma or other reasons. However, regardless of what a woman’s reasons are for deciding not to breastfeed, she should be supported to own that decision, unconditionally, and owe no explanation.

My youngest child has just recently weaned, ending almost seven years of continuous breastfeeding for me. I certainly haven’t loved every moment of it. Some of my breastfeeding moments downright sucked. (Pun intended). Just like parenting often sucks. Just like my work. Just like my writing. Just like everything in life, breastfeeding has its ups and its downs and it isn’t always romance and earth-mother flowy-haired bliss.

Absolutely, breastfeeding comes with its science-backed list of healthful things. But for me, breastfeeding was about discovering that I wasn’t the flawed women and mother society said I was. Alongside the physiologically unremarkable normalcy of it, I breastfed to remind myself that I was actually capable, and functional, and the sole authority to make decisions for me, my body, and my children.

But I’m sure other women have other reasons to breastfeed. Or not.

I would love for our cultural messages about breastfeeding to be this:
1)   Breastfeeding – it’s why we have breasts
2)   Breastfeeding – they’re your breasts, and you know best.