Friday, 28 November 2014

BabyFriendly 2014: a conference report

I've just got back from the UNICEF BabyFriendly Conference in Newcastle. I'm full of thoughts, ideas and inspiration and wanted to mention a few points before I get caught up in other work again.
Dr Kasja Brimdyr speaking at BabyFriendly conference

Breastfeeding and politics are never far apart, and the opening address was a reminder of that. Dr Dan Poulter, MP is the Parliamentary Under Secretary of State at the Department of Health and the Conservative MP for Central Suffolk and North Ipswich. He spoke about the vital importance of the first few years of a child's life in terms of development, health and longer-term outcomes, about relationship-building supported by the BabyFriendly standards, and he talked about increased numbers of midwives in training and money that's been invested in improving the environments of maternity facilities.

Unfortunately for Dr Poulter, I wasn't really in the mood for his carefully-worded speech. Earlier in the week I'd read this article about Newcastle - the host city - which explains the utter hopelessness of the city's financial situation and the impact cuts are having on family services (spending on children and family services, via Children's Centres, has been cut by 40%). When asked how much worse it will get, the city council leader replies '[With cuts to] transport for kids with special educational needs and disabilities. That is in the pipeline.' The day before conference I had read this article too, about how families with disabled children are being forced into grinding poverty - the article itself is hard enough to bear, but read the comments for many more real-life examples. Closer to home I've been filling in consultation documents about cuts to family services in my own area. As volunteer peer supporters affiliated to the Children's Centres we deliver our breastfeeding groups, hold our training sessions and support families there. Recently I've also been supporting Cambridge Breastfeeding Alliance's campaign to secure funding to continue their incredibly valuable breastfeeding drop-ins, the victim of cuts to children's services in Cambridge, as well as the RCMs campaign for fair pay for midwives (Dr Poulter told us - again - that more midwives are in training, but - again - didn't address the question of whether there would be jobs for them when they graduate...)

He went on to talk about breastfeeding statistics - another area of concern for me: I've been emailing the Department of Health, writing to my MP and signing this petition to contest the decision to cancel the Infant Feeding Survey 2015. This survey is of immense value to anyone working in breastfeeding as it gives detailed information about national breastfeeding rates, introduction of solids, continued breastfeeding, use of formula milk and so on. Many of the conference speakers referenced the survey in their presentations. According to Dr Poulter the government will be improving the quality, quantity and timeliness of breastfeeding statistics at targeted local level - I'm not sure how, or how the national picture will be monitored, and he didn't elaborate.

So far, so depressing... fortunately, the rest of the conference was a genuine celebration: of 20 years of the BabyFriendly initiative, of accreditations across the country, of the hard work and dedication to supporting mothers and babies that underpins the whole thing, and looking ahead to how the achievements of BabyFriendly can be made sustainable into the future. It's hard to pick out my personal highlights, but I particularly loved Dr Nikk Conneman's presentation about gentle, baby-centred neo-natal care that fully involves the parents: when asked how he handled ward rounds in his unit (when parents are often asked to leave their baby's bedside), he replied 'I don't do ward rounds' and the audience broke into spontaneous applause: I think because it's so refreshing to meet someone so prepared to change the system if it isn't working for the babies and parents. Laurel Wilson's engaging talk about the emerging new science of epigenetics and breastfeeding was described by someone sitting near me as 'mindblowing'; we now know that how a baby is fed can influence the way their genes are expressed, and that breastmilk is packed with genetic material (the only way that this can be transmitted other than through sexual reproduction). It's a topic I can't wait to read more about, and it's closely linked to the work that's going on into the microbiome.

Dr Kasja Brimdyr talked about skin-to-skin in the first hour after birth - there was so much in her presentation that I found fascinating, particularly her observations about the effect of epidural fentanyl on infant responsiveness in the first hour (which ties in with a post I wrote about the effect of epidural on breastfeeding). The fentanyl (a commonly used epidural drug) delays the stages a baby must go through to find the way to the breast and latch on. It doesn't mean they won't or never will, but it may take longer, and those babies need even more skin-to-skin time to facilitate it. She cautioned against paying 'lip-service' to skin-to-skin; it shouldn't be interrupted or hurried if at all possible. Kerstin Uvnas Moberg touched on epidural too - explaining how it blocks the release of oxytocin, causing subtle changes that may affect breastfeeding behaviour.

There's so much more I could mention, but my take-home message was one of positivity and belief that the work we're all doing in breastfeeding really matters. One delegate asked how, given the daily pressures on midwives and breastfeeding supporters, we could give mothers and babies the best possible care? It's a frustration we all share at times, and the answer Sue Ashmore gave was simple but inspiring: keep doing your best, keep trying, keep the BabyFriendly standards at the heart of what you do, and it will be good enough. We don't need to be perfect to make a difference.

Were you at the conference? I'd love to know what your personal highlights were. Leave a comment below...

Thursday, 13 November 2014

Exciting times...

My desk today.
I've not written as many blog posts as I'd like over the last few months. It's not for want of material - there's always plenty to comment on in the world of birth and breastfeeding - but other projects have been taking up most of my work time (which is squeezed in around the demands of the three small people in my house). But now, as the the pile of work on my desk grows ever higher, I can reveal what I've been up to.

I've done quite a bit of work for Pinter and Martin in the last couple of years, in my freelance editorial capacity - editing and proofreading some of their most recent titles. Earlier this year Martin Wagner asked me to go a step further and commission a new series of books: to be called the Why It Matters series. So I've been hard at work finding and talking to authors, finalising titles and overseeing the first few books in the series, and it's now starting to come together. A formal announcement, and new website, will be coming from Pinter and Martin very soon - but for the eagle-eyed the books are already listed (albeit without jackets) on both the Pinter and Martin site itself and other bookselling websites.

The first three books in the series are Why The Politics of Breastfeeding Matters by Gabrielle and Palmer and Susan Last (eek!), of which more below, Why Doulas Matter, by Maddie McMahon, and Why Hypnobirthing Matters, by Kat Berry; these will be published in March 2015. The next three, to be published in summer 2015, are Why Pre-conception and Pregnancy Nutrition Matters, by Michael Walne (of Your Nutrition Matters), Why Breastfeeding Matters, by Charlotte Young (aka The Analytical Armadillo) and Why Baby-Led Weaning Matters, by the pair of them working together. I am so excited to be working with all these wonderful authors, each one passionate about the vision of the series - to provide evidence-based, clear information that will genuinely help new parents, and anyone involved with them, to make properly informed decisions. More titles are planned for next autumn and beyond... watch this space!

The manuscript for one book has been delivered, the second is well advanced... and I find myself, as joint author of Why The Politics of Breastfeeding Matters, with Gabrielle Palmer, with a lot of work still to do on my own manuscript. In fact I've realised that I've been procrastinating about getting on with it and I've had to address a whole heap of doubts: about my ability as a writer/editor, about my time management skills and about whether I actually know enough to do justice to Gabrielle's work - it has been hard to buckle down. I hope I've turned a corner with it... let's see. It would be ironic if I failed to deliver my own manuscript on time, given that I've spent a good proportion of my career coaxing authors through the writing process! I need to take my own advice, I think, and just get on with it. Please feel free to nag me.

Another project I've been involved with is Laura Dodsworth's fabulous photograph/interview book Bare Reality - which you may have seen in the press or online as she ran a phenomenally successful Kickstarter campaign in September. I'm editing the text of the book and am delighted that Laura has actually now linked up with Pinter and Martin to publish and distribute the book - the jacket has just been announced and it looks amazing.

As if all of the above wasn't enough, I'm thrilled that Milli Hill's book Water Birth: stories to inspire and inform for my own tiny company, Lonely Scribe, has reached the proof stage and should be published very soon. It's been a long time since we started the project - and in the meantime she's set up the Positive Birth Movement, had a third baby and become a columnist for Best - but it's wonderful to finally be approaching publication. Here is a sneak peek of the jacket - watch out for news of when the book is published.

Friday, 22 August 2014

Why are we working hard to get mothers to breastfeed, then encouraging them to stop?

This week I've been thinking about the messages mothers get from their health professionals, peers and the older generation about breastfeeding past six months, and how this plays out in our culture of infant feeding in the UK. (This train of thought was sparked off by several conversations I've heard
Breastfeeding my poorly 23-month-old
recently between mothers - mostly first-time mothers - and health visitors, Children's Centre workers and doctors. It's not my intention to be particularly critical, more to explore what we are actually saying to mothers, and the effect it has).

There's a lot of focus (at least in my area of Derbyshire, where we've been working towards, and recently obtained, full Baby Friendly accreditation in the community (DCHS) and the county council (DCC)) on improving rates of breastfeeding initiation and continuation (measured at 6-8 weeks). All the hard work, by DCHS, DCC and volunteer organisations such as BEARS, the peer supporters I am involved with, is really paying off and we were delighted to get the UNICEF endorsement - part of which involves interviews with mothers themselves - that shows how far we've come in recent years and how much better we are doing in supporting women who want to breastfeed, at least initially.

But what happens to mothers after six to eight weeks? Peer supporters at breastfeeding groups often have experience of breastfeeding for much longer than six to eight weeks - so they are well placed to offer ongoing support to mothers who continue breastfeeding. But not all mothers attend the breastfeeding groups, and as their babies grow they have more contact with health visitors, practice nurses and Children's Centre workers at baby weighing clinics, developmental reviews and vaccination appointments, and their friends, relatives and casual acquaintances will all have something to say on the subject of continued breastfeeding too. As the weeks and months go by mothers are exposed to an awful lot of misinformation - hardly surprising when as a nation our breastfeeding rates at six months and beyond are so low, with fewer than 1% of mothers exclusively breastfeeding for six months, and only 34% breastfeeding at all at the six-month mark. Our society's collective knowledge about breastfeeding past six months is thus sadly lacking, something it is well worth bearing in mind when weighing up how much importance to attach to people's comments.

When I took my youngest daughter for her vaccinations at a year old I mentioned to the nurse that she was still breastfeeding (as there was a box to tick in her red book for 'still breastfeeding at all at first birthday'). She said, dismissively, 'oh, we don't need to collect that information'. She then went on to tell me how, if she ever had children of her own, she would definitely bottle-feed them, based on her experience with puppies! I was taken aback, but it was only later that I wondered whether, if I'd been a first-time mum rather than an old hand, I might have been more affected, even unconsciously, by the way she casually diminished the importance of breastfeeding.

I've recently heard a mother of a ten-month-old baby, still happily breastfeeding, advised to cut his daytime feeds in order to give him 'healthy' snacks, and to reduce and stop his night-time feeds as he 'doesn't need it nutritionally'. This mum didn't ask for help to stop breastfeeding; she was worried about her baby's wakefulness at night (for which she was advised controlled crying, despite saying that she didn't want to go that route - a whole different post...). The mother of a seven-month-old baby, who is mixed feeding - breastfeeding with one bottle of formula at night - was again advised to offer snacks in the daytime and encouraged to hurry her baby on to more solids rather than breastmilk so that he will 'cut down on his feeds' - she was told that the baby should ideally be moving to three meals a day plus two healthy snacks, and, somewhat confusingly, that he should still be getting a pint of milk a day, which would equate to '2 or 3 breastfeeds at the most', and she was told that her baby needed vitamin drops as part of the same conversation. The implication was that these mothers were now meant to be transitioning away from breastfeeding, when the reality is that for infants under a year, breastfeeding is still a hugely important part of their overall nutrition, and can continue alongside other foods for as long as mother and baby want. We are doing mothers and their babies a disservice if we are, even with good intentions and an eye on the nutrition guidelines, shepherding them down a path that leads to reduced feeds and an early end to breastfeeding.

Another mother I know of, who had a rough start to breastfeeding and was worried she might have to stop despite having fed her first child for a year, was told not to worry as the 'target' was six to eight weeks! The problem here is not the sentiment - I'm sure this person was trying to say something reassuring to a mum who was struggling - but that actually, her comment misrepresented the situation entirely. The immediate target for increasing breastfeeding rates may be the six to eight week measure in terms of the breastfeeding strategy in the county, but for that individual mother the NHS and WHO guidelines, which recommend breastfeeding to two years and beyond, are much more important for her own health and that of her baby.

What's missing, in all of the above, is an understanding and appreciation of the flexibility of breastfeeding an older baby, toddler or child: the way it continues to provide valuable, tailored nutrition, how it can fit in around solid food, going back to work and changing night-time routines, and the way in which it can continue to be hugely important to mothers and their babies for years to come, both in terms of nutrition, and in terms of their relationship (I wish more people could experience breastfeeding an older child who is poorly and miserable and can't stomach anything else, for example). Children grow up so quickly - why hurry the weaning process if there's no need? Why can't we support and encourage women to breastfeed in the longer term, and then support and encourage them when, for whatever reason, they or their children want to stop?

It's been heartening to see Sharon Spink in the news in recent months talking about breastfeeding her five-year-old, after Michelle Atkin did so earlier in the year. And I loved this story about a mother breastfeeding her toddler on Australian TV. I hope that stories like these, and the debates they provoke, will help us as a society to improve our collective knowledge of longer-term breastfeeding so that we can offer better support to mothers, who in many cases have struggled to establish breastfeeding, only to have it suggested, after a few short months, that they should be 'moving on'.

There's a point to be made here, too, about how that 'moving on' message is one that's frequently heard and seen in advertising for follow-on formula and 'growing-up milk'; if we think babies and toddlers need milk, what better milk for them than that of their own species, delivered by their own mothers, rather than an unnecessary product developed to circumvent the regulations governing the advertising and composition of infant formula, which exists to line the pockets of the big baby food companies? Those companies work hard to target health professionals and mothers to get their messages across - so it is not just that our collective knowledge is lacking, it is also being undermined by those with vested interests. (For much more on this see the Baby Milk Action website; good information about formula milk is available from First Steps Nutrition.)

I'm sorry the blog has been so quiet in recent months; I've been busy working on all sorts of exciting projects, of which more news in future posts...