How Breastfeeding Works

Well, I’m not.  Not being made to feel guilty.  But I do feel guilty sometimes.  I will explain why.  As is probably pretty clear from this site, I read a lot about breastfeeding.  I think about it a fair bit - things will occur to me when I’m commuting to work, so I have a notebook with copious scrawled jottings, “do something about BFN Drugline; remember to look up thing about tongue tie; check statistics for exclusive bf in Norway; order report from Baby Milk Action; etc, etc”.

So, even though I haven’t had any formal training as such, I do feel pretty well-informed about infant feeding.

My problem comes when someone asks me about it and someone overhears, tuts, sighs and gives me a lecture about making women who couldn’t breastfeed feel guilty.  I used to go for this and believe it was a valid point, but the more I think about it, the less logical it seems.  And I know, where feelings are concerned logic often takes a back seat, but hear me out.

First of all, readers of this blog or those who know me from elsewhere know that I’m not unkind, I don’t want to make anyone feel guilty and I would never knowingly say something hurtful.  But I’ll be damned if I stop talking about breastfeeding (especially when I’m asked outright!) just because it “might” make women feel guilty.

I’d like to unpick the guilt thing, if I may.  Why would women feel guilty about their infant feeding experience?  Because they were 100% happy with their decision?  Because they had total free choice to make it?  Or because they aren’t actually all that happy about being told how wonderful breastfeeding was whilst they were pregnant and deciding that that was what they wanted to do, only to be left to fend for themselves once the baby was born by health professionals who hadn’t much of a clue how to support breastfeeding?  I’d say the latter is the more common situation - women forced into formula feeding against their wishes.

How do we alter this for the future?  Is it really best not to talk about it in case we make the women who can’t change their own experience feel guilty?  Without the benefit of a time machine, we’re unable to alter the past - but we can make things better for the future.  It may well be that discussion about how best to encourage and support breastfeeding for future mothers does make some women feel uncomfortable.  But unless we do something about it now, women will go on having dreadful experiences of breastfeeding, which is surely not a situation anybody wants?  Except, perhaps formula manufacturers - they use the “don’t make women feel guilty” line as a key marketing strategy to stifle debate around infant feeding.  Please don’t buy into repeating it - it does a very great disservice to women.

Some of the most impressive women I’ve met in the time I’ve spent learning about breastfeeding are those who had a feeding experience they didn’t expect or desire and found themselves stopping breastfeeding sooner than they would’ve chosen - but who want to talk about what happened to them and to stop it happening to other women.  It’s more thinking like that we need if anything’s to change for the better in future.

 So far, I’ve been told it’s best not to talk about it for fear of making women feel guilty by a GP, a local councillor and an MP (all men, incidentally).  So should I feel guilty if I’m asked about breastfeeding and I stop talking when someone tells me to because I might make women feel guilty?  Or should I say, politely, that I think it’s too important not to talk about it?  You could guess what I do say, in fact

I’m lonely.

I keep writing posts and I know lots of people read them, but you’re not commenting.

I won’t bite, I promise.  I won’t breastfeed you either.  Honest.

If I’m not making you want to post, tell me here what I can write about that will.

There’s a link at the top of this page called “post here” - you can post anything you like there.  Well, preferably breastfeeding-related.  But on this post - post anything at all.  Just post!

Please post details of events near you here.  I’ll be back later to add to this myself!  Thank you!

(Edited) I posted this the other day without introduction and I thought I ought to add something to explain why I feel this is an important addition to the site.  So often women think that breastfeeding is something you need to do for a long time in order for it to make a difference, so why should they start when, for instance, they’re going back to work early, or when they know family commitments will make it difficult to breastfeed for any length of time?  This list is one of the clearest illustrations I have found to describe exactly why each day is important.  It’s also one of the best encouragements for women finding it hard, at whatever stage - from finding latching difficult with a newborn to finding it wearing to feed a toddler who’s discovered they can ask for milk…and get it! - and all the stages in between.  Please don’t get me wrong - breastfeeding’s not all work, work, work (a whimsical aside for those of you who remember the NatWest ad!).  But it can be tough and it’s nice to have a reminder of why you’re doing it!

Reasons To Be Proud

First Feed:

• For baby - helps to stabilise baby’s blood sugars and protect baby’s gut.
• For mother - a great opportunity for the first skin-to-skin cuddle.

1 Day:

• For baby - the antibodies in mother’s colostrum provide natural immunity from infection. 
• For mother - helps womb to contract to normal size.

2-3 Days:

• For baby - sticky black meconium is cleared more readily from baby’s bowel. 
• For mother - instant relief for hot, swollen breasts when milk comes in.

1 Week:

• For baby - transition to world outside womb is eased. 
• For mother - frequent feeds mean time to sit or lie down and for you to get to know each other.

2 weeks:

• For baby - food & drink always ready at the right temperature, adapting to the baby’s needs. 
• For mother - hormones help you to get back to sleep after night feeds.

4 weeks:

• For premature babies - lower risk factors for heart disease in later life. 
• For mother - saves time sterilising and making up bottles.

6 weeks:

• For baby - half the risk of chest infections now and up to 7 years old.
• For mother: Breastfeeding likely to be easier and you can go out and about without bottle feeding equipment.

2 months:

• For baby - lower risk of food allergy at 3 years old if breastfed only.
• For mother - reduced risk of ovarian cancer in later life.

3 months:

• For baby - five times less likely to get diarrhoea now and a reduced risk for the whole year.
• For mother - fewer visits to gp as baby is less often ill.

4 months:

• For baby - Half the risk of ear infections.  Less risk of asthma now and protection continues for up to 6 years.
• For mother - feeling of empowerment at having been solely responsible for growing your baby for 4 months.

5 months:

• For baby - five times lower risk of urinary tract infections.
• For mother - a lovely way to reconnect with the baby if you go to work.

6 months:

• For baby - lower risk of eczema now and up to three years old.
• For mother - less risk of osteoporosis in the long term.

1 year:

• For baby - three times less risk of becoming obese by age six and a lower risk of heart disease as an adult.
• For mother - no need to by formula milk at all saving at least £450 this year.

2 years:

• For baby - likely to have higher average scores in intelligence tests.
• For mother - expect fewer visits to orthodontist when baby is a teenager.  Risk of breast cancer reduced by 8%.

 (This first published by the NCT, but I can’t find it on their site now, so have reproduced it here.)

Just came across this story about a little girl, Isabella Sciulli, born premature, whose mother worked hard to establish a good breastmilk supply, but very sadly died whilst the baby was still in intensive care.  Her husband and friends knew she didn’t want her baby to have formula, so organised breastmilk donations for her.

Really worth watching the news item on the link too - it’s sensitively reported and very moving.  I donated breastmilk when my second son was born and it’s struck a chord with me to see a baby receiving donated milk.  I would urge anybody in the UK thinking about donating milk to get in touch with UKAMB.

If you’re breastfeeding, everyone wants to tell you how to do it.  Their opinion (based on nothing more than fresh air and a touch of the mentals in many cases) is gospel and they WILL be affronted if you don’t pay attention to it.

Now, this is easier to ignore if it’s a well-meaning but a trifle barking relative.  You can say, “Yes, Gran, thanks for that, I’ll be sure to scrub my nipples with steel wool to toughen them up, thanks for that,” and then do no such thing (do NOT do this, it is NOT a good idea…!).

But what about when it’s a midwife, GP, paediatrician or health visitor?  Somebody who ought to know about infant feeding and have some understanding of breastfeeding?  What then?  It can take courage of conviction to go against professional health advice - but so often, advice about breastfeeding is based upon personal experience of the member of medical staff giving it out, not on latest research or established fact.

Take, for example, the GP I saw at a hospital who discovered I was still breastfeeding my eldest son at 12 months.  Horrified, he told me, sneeringly, ”Do it for six months if you must,” and “They bite, you know!” (that latter as if he was James Herriot talking about a baby piglet, not a small boy).  Because, of course, all mothers of breastfed babies enjoy having their nipples gnawed…  I explained politely the WHO said to breastfeed for at least two years and…cutting him off as he opened his mouth to protest…that this wasn’t solely advice for developing countries.

But I shouldn’t have had to tell him this - it’s pretty basic infant nutrition, isn’t it?  Apparently not.  Some other gems I’ve heard are, “You must drink milk to make milk,” “You won’t be able to breastfeed your second if you’ve not breastfed your first, because the milk doesn’t come in if you don’t use it up the first time,” and ”There’s no goodness in breastmilk beyond six months,” (some HCPs say three months, some a year - whatever, it’s still illogical that something so perfect for the child should suddenly turn into something akin to chip fat at an arbitrary point in time!).

It’s pretty disgraceful that the people most women rely upon to provide them with information about feeding their baby are so often woefully misinformed, or allow their own prejudices or experiences to colour the advice they give.

I would say to you to challenge any advice you’re given that seems a bit off - ask for the research that backs it up, tell them that what they’ve told you isn’t right after doing your own research - but above all, have confidence in your body to breastfeed, don’t let anyone tell you you need to be eating or drinking anything special in order to do it and DO post your tales of lunacy and misinformation here for us to shake our heads over and, well, OK, laugh at a bit.  And do also post stuff you’ve been told that you’re not sure about - I’ve heard many of the myths that are often trotted out and can provide you with some lovely links to research and feed back to your health professional - nicely, of course…!

When I was pregnant with my first son, discussion of feeding method was fairly limited.

 At 13-week booking appointment:

 Midwife - “How will you be feeding your baby?”

Me - “With the placenta, for some while to come, I hope! Ha-ha-ha!”

Midwife - “Ha-ha, yes, very good.  And after the baby’s born?”

Me (serious again and with the optimism of a first-time mum-to-be) - “I’ll be breastfeeding.”

Midwife (ticks box)

I had one session at a parentcraft class antenatally as well, where we did a bit of myth exploding and talked about latching on and feeding on demand - but it wasn’t massively detailed. 

And that was it.  Nothing else.  Fortunately, I have a cousin who is a breastfeeding counsellor and I talked to her about it a lot - she sent me a book and some leaflets, and I knew she was there if I needed help.  But even after my son was born, there was no support postnatally from NHS staff.

With my second son, I didn’t expect much conversation about breastfeeding antenatally.  I was again asked how I’d be feeding and I said with more actual conviction that I would be breastfeeding (having done it for a fair while with my first son).  Some midwives asked if I’d breastfed before and some were impressed I’d breastfed while pregnant (several friends had been told by healthcare professionals that they couldn’t breastfeed whilst pregnant, so I mentioned it to every HCP I saw in order to do my own mini myth exploding!).  And after my second son was born, as documented elsewhere on here, I had too much interference with initiating breastfeeding (because I’d had gestational diabetes and they wanted to give him formula, even though he was asymptomatic and feeding well).

I know that midwives are busy, maternity units are stretched, there are funding issues throughout maternity services - but this means there’s often not the time to ask women what they want from their midwives; how much information is appropriate and at what stage in the pregnancy.  For instance, is detailed discussion of things such as mastitis really going to be ideal at a booking appointment?  I don’t think so!

So, I’d be grateful if you’d post how much discussion you had with your midwife antenatally and whether you felt you were well informed about the various issues surrounding how you were going to feed your baby.  Specifically, I’d like to know whether you were told about the “benefits of breastfeeding” or the “risks of formula feeding” - or both.  And anything else you feel was noteworthy, either because it was useful to you or because it was utterly useless!

Going back to work.  Breastfeeding.  Quite frequently, I have heard people give the former as a reason why they can’t do the latter for any length of time - sometimes at all.  But often, with a bit of logistical jiggery-pokery and some planning, it’s completely possible to combine breastfeeding with working, even full time.

I thought I’d write about my personal experience of returning to work, in the hope that it helps women who are concerned about how to make it all happen.

With my first son, I returned to work part time when he was six months old.  He had a voracious appetite for breastmilk, which I hadn’t quite anticipated, so I was expressing to catch up all the time (he’d get through a pint when I was away for him for a full day, and slightly less when I worked a later shift).  This is a less than ideal way of doing it, because I didn’t always get enough while I was at work to cover what he drank, so my first suggestion is to stockpile milk whilst you are on maternity leave.  With my second son, I went back to work part time when he was nine months old, then full time when he was a year old.  I stockpiled beforehand with him and he decided he preferred not to drink expressed breastmilk (EBM) so I donated most of it to the milk bank!

I found it easiest to express milk in the morning, preferably with my baby feeding on the other side at the time, but every woman is different, so try different things.  Some women find they can express the most milk when they’re thinking of their baby, or looking at a photo of them; others find it easier if they don’t think about expressing or babies at all, but read a book or magazine while they’re doing it.  I’ve also heard of women who find the milk ejection reflex kicks in when their partner whispers sweet nothings into their ear, but best not to do that if you’re in a hurry, I guess 

I used to take my sterilised pump in a coolbag to work, along with a bottle to express into and several gel ice packs.  I found it less bulky to use bags to store the milk in, so would take a handful of them and split whatever I expressed between them.  It’s important to store breastmilk in small quantities, because if you store in “full feed” quantities, chances are your baby will decide not to be hungry - and it’s pretty galling to hear of the 4oz of hard-won EBM that was tipped away while you were at work because your baby decided 2oz was ample!

I didn’t sterilise or even wash my pump between expresses - instead, I used to put all the covers on it and put it back in the coolbag.  I actually felt I’d be making it dirtier by washing it in a communal sink at work and drying it with paper towels, rather than leaving it with a bit of soon-to-be-chilled breastmilk in it - don’t know if that’s true or not, but I was reassured when I read these breastmilk storage guidelines which say you can store breastmilk for far longer than you might imagine.

I used to express in a meeting room (although most of our meeting rooms have glass walls, so it could be hard to find somewhere appropriate!), or most often in the loo (rather nice, clean, self-contained ones with own basins and plenty of surface on which to spread out a clean towel and rest various expressing accoutrements, fortunately!).  I’ve also only had supportive comments from colleagues, which has been a great help.

I fully appreciate that expressing breastmilk isn’t something every woman can do at work.  Some jobs can mean it’s nigh on impossible to find time and privacy to express, sometimes it can be tough to find somewhere to store your milk and sometimes colleagues can make life difficult.    Employers aren’t currently legally obliged to provide facilities for expressing, although they do have to provide “suitable rest facilities” for employees who are pregnant or breastfeeding.

Maybe you’re worried about going back to work in a few months’ time, because your baby is breastfeeding a lot now.  Probably other people have been saying unhelpfully ill-informed and panicky doom-laden things about how you’ll never get your baby to take a bottle if you don’t train them to for months in advance of your return to work.  But do remember that young babies change daily - and the baby you’ll be leaving to go to work in a few weeks or months is likely to be very different.  That doesn’t always mean that they won’t want copious EBM (like my first son with his drinka pinta milka day!), but they are also likely to be eating a bit of solid food by the time you go back to work, which takes the edge off your responsibility for providing all the calories.

If you decide it’s too awkward to express at work, for whatever reason, do consider continuing to breastfeed when you’re with your baby, even if you give formula when you’re not.  It’s a lovely way to reconnect at the end of the day and it means you sit or lie down when you get in from work for a bit too - now, that can’t be bad!  I found that as my babies got older, my supply adjusted easily between feeding quite a few times a day and only a couple of times.

There are also some useful links on Kellymom, as ever, to help with pumping at work.

I hope this is helpful - I do think it’s important to shatter the myth that if you’re going back to work, you can’t breastfeed for any great length of time.  Of course, this will be true for some women, with some jobs, but the great majority will be able to breastfeed successfully for as long as they and their babies want, with a trusty breastpump and a coolbag.

Did you express at work?  How were your colleagues about it?  How did you find the experience?  Or perhaps you’re returning to work soon and hoping to continue to breastfeed - please post questions here and I’ll do my best to answer them!

I’ve just seen this story in the Daily Mail from earlier in the week.  According to this article:

“New mothers dread breastfeeding their babies in public because of stares and criticism - and one in eight have actually been asked to stop, a report out today reveals.

Fully 38 per cent, almost two out of five new mothers, prefer to feed out of sight - even in public lavatories - rather than face stares and glares from strangers.

And a fifth are so worried about other people’s opinions they have sometimes opted to leave the baby screaming for milk rather than breastfeed.”

I wanted to counter some of the negativity with my own experience, but also to widen it out to talk about ways to increase your confidence, things you can say to people if they do challenge you and to talk about some of the things on sale for so-called discreet breastfeeding and whether they’re helpful or will draw attention to you and not in a good way.

The first time I noticed anybody taking any sort of undue interest in what I was doing, I was feeding my first son, aged about four months, on a bench in Kew Gardens.  I was sitting with a friend, chatting, when I noticed a man staring at me.  As he walked past, he continued to stare, turning his head so that he was looking over his shoulder as he got further away.  I couldn’t think what he was up to or what it was about me that he could find so fascinating, for which I blame sleep deprivation!  When it finally clicked that he was probably staring at me because I was breastfeeding, I thought it was hilarious - agawp, he’d nearly walked into a rather large tree!

But it’s all about perception there.  He may simply have been stunned by my beauty(!) and not realised I was breastfeeding at all.  I had no flesh on display, there was nothing other than the rhythmic motion of my son’s head to denote breastfeeding occurring.  Since that time, I’ve had people come up to me for a peek at the baby I’m seemingly cuddling who’ve been flustered when they’ve got right up close and discovered said child is latched on.  But the overwhelming tone from friends, family and strangers alike has been “aww, sweet!”.  I have found older ladies in Marks & Spencer cafes the most effusive in their praise of breastfeeding - perhaps if you’re feeling a bit low about it all, you could go and have a cup of tea and a toasted sandwich, feed your baby and hope to happen upon one of them in a chatty mood.

But this leads me on to another, closely related subject.  I often see other women breastfeeding their babies out and about and find myself wondering how to strike the balance between being supportive and looking mental.  It’s a veritable tightrope - a friendly smile held a little too long becomes the grinning grimace of a lunatic; a cheery “Well done you” said with the best of intentions might be construed as patronising.  I usually opt for a brief smile, possibly coupled with a quick friendly narrowing of the eyes, conspiratorial-like.  Of course, I need do or say nothing - but I prefer to be positive.  I just would like to know the best way to be positive without looking like a grinning buffoon.

As for how to breastfeed discreetly, if you’re worried about other people seeing acres a bit of flesh, and you don’t want to splash out on relatively expensive special tops, one thing you can do is wear a stretchy vest underneath your top and pull the neck of the vest down and your top up (this works even with larger breasts <ahem>).  This has the added bonus of keeping all that post-pregnancy belly well hidden too; for me, I didn’t worry at all about exposing breastage - it was all about the tummy!  Also, I actually bought a couple of these Belly Huggers,  which are nice for when you don’t really want a vest under your top.

You can also buy “hooter hider” contraptions that are intended to cover up breastfeeding.  These come in many and various styles and colours and with a multitude of “features” (one has a burp cloth attached so you can carry round posset stylishly, maybe?).  I know some women find them useful, but I think if you’re intending to breastfeed past about six weeks, you will look like you’re trying to stuff an octopus into a haversack if you attempt to cover up your baby with one of these, so it might not be quite the discreet experience you’re hoping for.  If you do want to cover up like this, perhaps treat yourself to a pashmina or use a muslin.

 So, what has been your experience of breastfeeding in public?  Have you bared all, covered up, been praised, shouted at or something else?  Any good comebacks for people?  I had loads prepared, but never had cause to use them!

I don’t pretend to know a vast amount about the science behind this (well, I could pretend, but it would be very clear rather quickly that I was doing just that!) - but I thought this was an interesting and positive story and I wanted to add it to the blog.

Apparently stem cells found in breastmilk could be used to treat spinal injuries, diabetes and Parkinson’s Disease - and could potentially be used as an ethical alternative to embryos.