The formula for life

Save the Children launched a report today on breastfeeding, Superfood for Babies, in their words calling the report "a global call to action to rediscover the importance of breastfeeding and to support mothers to breastfeed their babies – especially in the poorest communities in the poorest countries." Now I'm all for public health messages that ensure we're all well informed about the choices we make, but the report's recommendation that made the headlines in the UK, that there should be cigarette style health warnings on boxes of formula, made my blood boil.

Parents (that's right, parents, not just mothers, not that you'd believe it from reading the press around this that fathers are also involved in decisions about caring for their children), choose to formula feed their babies for many reasons, none of which are anyone else's business. And I just don't believe that any of those people do it because they don't want the best for their children.

What such a recommendation does is make parents feel guilty for decisions they have made when trying to do this best. That's why the breast is best slogan is wrong. Best in what way? Better than a mother so exhausted she has a breakdown? Better than infected cracked nipples? Better than slow decline into malnourishment? Better than being able to leave your baby and go out and earn a living? Sod it, who has the right to say it's even better than being able to wear an outfit with the confidence you won't leak all over it? We make decisions as individuals to suit our specific circumstances, and I just don't believe most people make decisions for anything other than the greater good of their family.

What's more, the recommendation is ridiculous. Once you have decided, or realised, that formula will be part, or whole, of your baby's diet, there is only a small window in which you can change your mind. Milk supply is difficult enough to establish in the first place, but almost impossible to re-establish. Do Save the Children really want people who stopped breastfeeding a week ago, a month ago, six months ago, to feel shit every time they give their child food?

I owe many people in the National Health Service a debt of gratitude for the care they have given me and my children. Midwives, surgeons, radiologists, fetal medicine experts, cleaners and so on. But one that sticks in my mind is the paediatrician who told me kindly when my daughter was (literally) slowly starving, that we don't actually have an obligation to breastfeed our children, but we do have an obligation to feed them. What did we do in the end? You can find the answer elsewhere on the blog. For the purposes of this post it's irrelevent. Not that you'd believe it from the headlines, or the parenting forums, but it's not us v them when it comes to breastfeeders and formula feeders. We're all parents, all muddling through, all trying our best, all hoping to keep our children safe. And fed.

Because that's the thing about formula - it feeds children safely. Contrary to popular belief, there were no halycon days in the past when all women contentedly breastfed their happy chubby babies. No, the past is littered with dead or malnourished children who may have survived had formula been on offer. Lack of milk, inability to breastfeed or circumstances that make breastfeeding difficult are not another kind of yuppy flu that only exist in modern times. They have always existed, but the outcomes were far worse than today. Cigarette style warnings Save the Children? Don't be ridiculous - bottlefeeding doesn't kill, it actually does the opposite. Sure, put large public health messages on boxes of formula, but make them accurate. 'Formula saves lives', that's what they should say.


Related post: The great unsaids - bottle feeding

Some things I like

1) Ninjabread Men! It's what happens when good gingerbread men go bad. Get them here: Ninjabread Men




2) Cookie monster mug - with space for your cookies. Get them here.

* The first two finds courtesy of the Soup Dragon Facebook page

3) This rainbow cake made with copious amounts of food colouring - I have no doubt the organo-fascists of north London will run a mile which is exactly why I intend to serve it for afternoon tea next time anyone comes over.

4) This article on breastfeeding and bottle feeding by Hanna Rosin from The Atlantic magazine in April 2009 sent to me by a friend following my previous post on bottle feeding.

The great unsaids - bottle feeeding

I'm still harping on about breastfeeding and bottlefeeding I'm afraid, not least because it's been in the news again recently with the Time Magazine cover of a mother feeding her three year old.

Before I had a baby I was a little judgemental about those who did not breastfeed. I wondered why they didn't just try harder or persevere, why they put their own needs - for sleep, for comfort, for convenience, for sanity - before their babies.

Then I had a baby and breastfeeding did not work immediately. It never worked to a point of exclusivity and we've (mostly) happily mix-fed from week 1. But I was at the hospital where I had my daughter the other day and saw one of their breastfeeding posters and I remembered something a midwife had told me when my daughter and I were there in the days after her birth. The midwife was en route to a party to celebrate a new breastfeeding policy they had just implemented in which they would not just actively encourage breastfeeding, but discourage bottle feeding to the point of not helping a mother bottle feed.

Even then, befuddled by birth and parenthood, I knew this was a bad idea. Not the supporting breastfeeding, but the other side of it. Amongst the mothers I know most want to breastfeed if possible - who wouldn't after seeing all the breast is best messages - and at least half have struggled. But to only emphasise the positives of breastfeeding instead of helping parents do whatever it is they decide to do, has bad repercussions.

First, it makes mothers feel like failures by suggesting we do not want the best for our babies. And second, it stops the dissemination of information telling us how to safely feed our babies formula.

In the nearly eighteen months since I became a parent I am still yet to find comprehensive science-based information on making a bottle. Instead we had to find our own way.

For example, a health visitor told me to boil water for my daughter's bottle then let it cool for half an hour. Using half an hour cooled water would, she explained, sterilise the milk powder the water was poured onto. Now I'm no scientist but I know this is utter bollocks. Perhaps making up the milk and boiling it would sterilise it (and I suspect it wouldn't - any chemists out there know?), pouring lukewarm water onto it will not. Plus doing this in the daytime is just about okay if you do not leave the house, but are you really going to do it in the middle of the night when you have two hours of sleep at a time? I suspect there is more danger to the parent in handling boiling water while half asleep than there is to the child in having a made up bottle kept in the fridge for a few hours - but the problem is we just don't know because no one tells us.

Another example is sterilising. We steriled my daughter's bottles, of course we did. First in a saucepan. Then in a steriliser. Then the dishwasher. Then the microwave. Then with sterilising tablets. (Not one after the other of course - I mean these are all techniques we have used). Now we give them a jolly good wash using washing up liquid and water. But you know, you decant the milk powder into the bottle using a measuring spoon that lives in the box of powder. A spoon you touch with your (usually, but not always, clean) hands. Are you meant to sterilise the spoon then?

Here are four simple measures I want for new parents who choose (or don't choose) to bottle feed:

1) Clear scientific guidance on how to make a bottle, both in an ideal world, and then also in the real world where you leave the house, are exhausted, need a bottle immediately to placate a screaming child and the fuse blows on the steriliser.

2) Reassurance that above all a well fed baby is a happy baby. Happier than one screaming for milk that isn't there, happier than one digesting blood from cracked nipples, and happier than one with  a mother so tired she can barely hold the baby to her breast without falling asleep.

3) An end to the misinformation about milk production. It will not dry up if you miss one feed. Probably not if you miss several feeds. Not if you feed from the same breast twice in a row. Not if your baby sleeps for five hours in a row. Not if you have a glass of wine. Not if you have two glasses of wine.

4) Perhaps the most important - messages that those who bottle feed love their babies just as much as those who breastfeed.


Only when this is done will we be able to have a sensible conversation about feeding our babies.


Related post: The Truth About Breastfeeding

Ways to improve postnatal care #6: Be consistent

When we were in hospital in those very early days, and feeding wasn't working out as planned, I had a flurry of people come to my bedside and try to help me. There were midwives and nursery nurses and breastfeeding counsellors and peer supporters, and they all had different advice. From changing breast to trying a different hold to setting a time limit to letting the baby go for as long as she wished, from squeezing the nipple first to massaging the breast to hand expressing to machine expressing to topping up with formula to not topping up with formula, everyone had a different view. And then the shift would change and I'd see a new lot of midwives and nursery nurses and breastfeeding counsellors and peer supporters all of whom had different views again.

I suspect any single one of them would have worked had their advice been consistent, or had I been able to choose one and have the confidence to follow their advice even when their colleagues were telling me something expressly contradictory. Would it really be so difficult to be consistent, or at least have a plan to enable women to try one thing properly before moving on to the next?

Related posts:
Ways to improve postnatal care #1: Don't call me mum
Ways to improve postnatal care #2: Change the sheets
Ways to improve postnatal care #3: Help us buy the basics
Ways to improve postnatal care #4: Allow partners 24 hour access
Ways to improve postnatal care #5: A debrief for all new mums
Why I love the NHS

The truth about breastfeeding

A lot of articles and blogs I have read about breastfeeding difficulties are either defensive or apologetic. I am going to attempt to be neither.

Both my baby and I struggled with breastfeeding. Hand problems (Carpel tunnel syndrome followed by tenosynovitis) meant I struggled to hold my baby to the breast. Post birth surgery meant my body was tired and full of drugs. My baby was a little poorly and also a little sleepy. Sucking was difficult. Even without all of this we may have found breastfeeding hard. Many mums and babies do. 

But when the paediatrician said yes, breast is best but really the key thing is to feed your baby, we had no choice. We gave her formula. This gave her the strength to learn to breastfeed. But my supply was low. The way to raise it, said the health visitors and midwives, is to feed the baby at least every three hours and express in between. As each feed could take an hour this left very little time for anything else. I gave up on it quickly. 

A health visitor told me to massage my breasts while feeding to encourage milk flow. I was already tired and emotional with low milk supply. After that I was tired and emotional with low milk supply and bruised breasts. 

The baby lost weight. Lots of weight. Then we started formula feeds as a matter of course, starting with breast and 'topping up' with formula. The baby started to put on weight. Since then in fact we have mix fed. At nearly ten months we still do. It works for us. 

Breast is best. I get that. It has huge benefits for the baby and it's convenient. When it works that is. But the adverts that say this, the ones with peachy looking breasts and rosebud nipples attached to a perfect baby looking blissed out, they do us a huge disservice, because they make it look so easy that if we struggle we think we've failed. Far better a campaign that says breast is best but boy is it hard and please persevere anyway. Have a picture of a mum with bags under her dull sleepless eyes and bulgy veins on her breasts and raised nodules on her nipples and a slogan that says 'It might be shitty but it might get better if you carry on.' Such ads might stop women feeling like failures. 

We're led to believe that breastfeeding is so natural that it's like one of those crafts we've lost in the modern age, like thatching a roof, painting frescoes and making our own soap from horses hooves. We feel that before formula existed women must surely have found it easy because they had no choice. 

Actually here's what I think happened to those women and babies for whom it wasn't easy.  Women whose babies had died acted as wet nurses for some babies. Other babies were fed cow's milk, water and other liquids and some of these got ill and others didn't. Some women had the village wise woman or an older relative sit with her day in day out helping her, tweaking the nipples into shape and helping her hold the baby, until they could do it alone. And some babies, well some got weaker and weaker and died. We're lucky to live in a time where there is an alternative. 

The more people who, head held high, say breastfeeding is difficult and you are not a failure if you struggle and you are not a failure if you stop, the better. Breastfeeding rates in the UK are low and I know the authorities are keen to increase them. But lying to us about breastfeeding and pretending it is easy and pretending it works for everyone is, I am sure of it, the wrong way to encourage people to do it.