Tuesday, 18 December 2012

Positive Birth, home birth, choices in childbirth

I've been mulling this piece over for several days since I attended the first meeting of a new Positive Birth group in Derbyshire on Saturday. I've delayed writing it because I had reading to catch up on. First I read about the changes to the home birth service at Homerton Hospital in Hackney (where the team that supports home birth has been cut so that it can no longer provide a 24/7 service, without consultation and leaving women already booked for home deliveries in the lurch). More about that here (and do sign the petition, which has nearly 1,000 signatures already). In support of that campaign, this post has plenty to say about the illusion of choice in childbirth. Then I saw this article in the Daily Mail about the reality of working as a midwife in hospital today. And then, just as I was about to start writing, I read Louise Carpenter's important article in the Observer about the Freedom for Birth movement and the importance of the ruling in the European Court of Human Rights (Ternovsky vs Hungary) which upholds a woman's right to choose the circumstances of her birth. You can read the father's perspective on one of the case studies cited in Carpenter's article here.  Finally, I at last got round to watching the free abridged version of Freedom for Birth - A Mothers' Revolution, a film about women's maternity rights around the world. Phew. Have I got anything left to say?

I want to draw out a few threads from all this discussion. As someone who's involved with birth at a personal, local level (I've had three NHS home births in the last six years, and work with mothers postnatally as a volunteer breastfeeding peer supporter, often debriefing birth and breastfeeding experiences) and at a wider level as a publisher of birth and breastfeeding books, interacting with our authors and readers, it's fascinating to see how the 'big picture' and real women's lives intersect.

What I hear from the women I meet and talk to about their experiences of birth and breastfeeding is that, although it may seem as though we have choices about our maternity care in this country, the reality is that those choices are constrained. Almost every woman I've ever spoken to has said that at their first antenatal appointment, or 'booking-in', they were asked 'which hospital will you have the baby at?'. Right from the outset there's a presumption that women will birth in hospital, which shuts down further discussion and information-sharing. Just consider how differently that conversation might go if the midwife instead asked 'have you had any thoughts about where you might give birth? If you want to explore some options you could go along to this group that meets monthly, or look through these booklets, then come back to me with any questions'. (Similarly, women might feel differently about discussions of infant feeding at antenatal appointments if instead of being asked 'are you planning to breast or bottle-feed?' they were asked 'have you given any thought to feeding? If you'd like to explore some options you could go along to this group where you'll get plenty of information to help you make a decision.')

Inviting women to share what they already know, and directing them to accessible sources of accurate information and support that can increase their knowledge and help them make their own decisions, is surely at the heart of woman-centred care. This is where Positive Birth and other antenatal groups, both free and paid-for, can really come into their own - by meeting with other mothers, and sharing information and experiences, women can become aware that they do have choices - not just about where to give birth, but about everything to do with their pregnancy, birth and early parenting experiences. It's this same idea that underpins Lonely Scribe's publishing philosophy and our 'stories to inspire and inform' series, which already includes Home Births and Breastfeeding, is expanding next year to include Twin Births and Water Birth.

"Birth isn't something we suffer, but something we actively do and exult in." Sheila Kitzinger, Freedom for Birth.

The question of how you empower ordinary women to own their experiences of birth, feeding and parenting when the prevailing culture is one of deference to a medical model of childbirth and formula feeding is at the heart of all this. I've recently heard a midwife describe how readily women submit to interventions and examinations that may not benefit either them or their babies simply because they are suggested by an authority figure (midwife, doctor, consultant), even when no reasons for the procedure are given. (This was in specific reference to repeated vaginal examinations during labour.) Do women know that they can refuse vaginal examinations if they want to? If they don't know that they can refuse, can they give informed consent?

Another common complaint I hear is about risk and how it is presented. It's not something that is easy to communicate and health professionals struggle along with the rest of us in making sense of the facts and figures of scientific research. However, unless our doctors and midwives are to make our decisions for us - disempowering us in the process - they must learn to talk about risk in a different way. It is not ethical or accurate to tell a mother keen to avoid an induction at 41 weeks that she will end up with a dead baby unless she consents to the induction. Similarly, breastfeeding mothers are routinely misled about the risks of co-sleeping. Many health visitors condemn the practice outright - instead of acknowledging the beneficial effect on breastfeeding - and shut down the debate, leaving mothers unsupported and uninformed (see the UNICEF research on the topic here.)

Home birth is a topic close to my own heart and one that throws up many more ways in which choice can be constrained. I've met and talked to many women who've planned home births, whether they eventually gave birth at home or not. They almost all have stories to tell of how their choice was belittled or overridden and how they had to fight just to be 'allowed' to book the home birth they wanted. And that's within a system that theoretically supports women's choices! I regularly hear of women open to the idea of home birth being discouraged by midwives who say 'well, there might not be a midwife available on the day. If you ring and no one can come out to you, you'll have to go to hospital anyway.' The implication is that it isn't worth booking a home birth because you might not get one! Women understandably don't like the idea of being all set for a home birth only to find that no midwife is available, so they book for a hospital delivery 'just in case'. I find this situation unacceptable. A home birth service needs to be fit for purpose. It's a woman's right to choose to give birth at home and the NHS has a duty to support that. I heard recently of a case where a woman chose a home delivery of a breech baby. The hospital could not provide a midwife with the necessary experience, and in the end paid for an independent midwife to attend the delivery. That's great, and I'd like to hear that sort of story more often, particularly as independent midwifery is under threat (another way in which choice may soon be limited).

Another example that I have direct experience of is to do with access to water birth. I visited the new delivery suite at Derby Royal hospital before the birth of my second child (I went with a pregnant friend, I'd already booked my home birth!). We saw the huge, well-equipped pool room. I admired the filling system that fills the pool from a ceiling tank in minutes. Someone asked what happened if you wanted a water birth and the room was occupied? Our tour guide simply shrugged. I've since met many women who've had water births in Derby Royal, and many who could not, because the room was occupied. You do not really have a choice about whether you use water for pain relief or to give birth in - it's a lottery. And this at a newly-refurbished, flagship baby-friendly hospital.

I blogged recently about the Infant Feeding Survey and what it showed about the influence of place of birth on breastfeeding rates. Women who had home births had the highest rates of breastfeeding, both initially and in the early weeks (women who used birth pools and TENS machines also had higher rates than average of breastfeeding). I've been thinking about why this is. The report's authors suggest that it may be explained by the 'profile of mothers' that fall into these groups and to an extent I agree with this and understand what they mean: not all women have the means or the opportunity to arm themselves with the information and confidence they need to choose home birth, or water birth, or breastfeeding in today's society, and those that do tend to be in certain social groups. However, what really interests me is whether through activism - groups, blogs, discussions, information, support - we can empower more women, across society, to become active participants in their own care during pregnancy, birth and early parenthood.

There are those who will say that it is all very well engaging in this discussion, but the NHS is under strain and there's no way we can justify changes to maternity care. I bring up again a point I made in my blog about the UNICEF report that showed that programmes of breastfeeding support were cost-effective and showed a quick return on investment: a time of financial difficulty is a great time to be examining what the NHS does and where it could improve services, improve health outcomes, and save money. We've seen the report about breastfeeding. I'd love to see what would happen with a modest increase in home birth nationwide, both in terms of cost-effectiveness and longer-term health outcomes (tied in with the increased rates of breastfeeding associated with home birth). This study does some of it, but was published before the UNICEF report. I wonder whether, in time, research will show that Positive Birth groups, the Freedom for Birth movement and other grassroots initiatives will improve the lives of mothers and babies. I think they will. 

Thursday, 22 November 2012

Infant feeding survey 2010: a closer look

The publication of the full results of the Infant Feeding Survey 2010 on 20 November prompted a slew of articles in the press, with the BBC, Telegraph, Independent and Daily Mail all covering the story. However, in my view the most interesting points arising from the figures are not those that have been widely reported so far.

Last month I blogged about UNICEFs report into the cost-effectiveness of breastfeeding support programmes and how they directly impact maternal and child health in the UK. The full Infant Feeding Survey 2010 reinforces many of the arguments the authors of that report made in their assessment of the state of breastfeeding in our society. The survey is a lengthy document and there is so much information to be gleaned that it would take more than one blog to cover it all - so I'm going to mention a few points for starters and hope that others do the same.

Formula milk
If I were a formula company executive, I'd be pretty pleased about the results of this survey. British babies are consuming a lot of formula. They're also getting plenty of follow-on formula (a product designed entirely to circumvent the tight regulations covering the marketing of infant or first-stage formula). At Stage 3 of the survey, 69% of all  mothers had given their baby follow-on  formula, an increase from 53% in 2005. 31% of mothers did not understand the difference between infant formula and follow-on formula. All those adverts must be doing something! Some 89% of mothers report seeing adverts for baby milks on TV, radio or in the press, and 79% said these were adverts for follow-on formula. Rates of exclusive breastfeeding (which is recommended by WHO and the UK Department of Health up to six months) are much lower than the headline figures for breastfeeding initiation: 69% at birth, 46% at four weeks, 23% at six weeks. So by six weeks, more than three-quarters of UK babies have been given formula, water or solid foods. At six months just one per cent of babies are exclusively breastfed.

What's going on here? My feeling is that at least part of the explanation for these figures is the lack of confidence mothers have in themselves and their milk; a cultural doubt that breastfeeding really works. (The fact that mothers of second or later babies are more likely to exclusively breastfeed, and for longer, adds weight to this idea: experience brings confidence.) The survey itself concludes: "These findings illustrate the fact that the main reason why so few mothers follow the recommendation of feeding exclusively until six months is due to the introduction of formula, either to replace or supplement breastmilk." Elsewhere in the survey, where the incidence of feeding problems is discussed, the figures reveal that the highest levels of feeding problems are reported by mothers who are combination feeding. It's certainly my experience as a peer supporter that once formula has been introduced, and mothers' confidence in breastfeeding eroded, the road back to exclusive breastfeeding can be tricky. All this is surely an argument for supporting mothers for whom breastfeeding is working well not to reach for the formula in the first place, and a tightening of the restrictions on the marketing of infant formula (to health professionals) and follow-on milk (to everyone).

When mothers were asked their reasons for using follow-on formula, the most popular answer (20%) was that they thought it had more nutrients or was better for the baby. This is not true of either breastmilk, which is by far the best milk nutritionally for babies of any age, or infant formula.

Less than half (49%) of mothers are making up formula bottles according to the latest guidelines (making one feed at a time, within 30 minutes of boiling, water in bottle first, then powder). This may be a substantial increase since 2005 when the figure was only 13%, but it flags up (to me) the fact that mothers who choose to use formula are either not getting the right information or choosing to ignore it. In my experience a lot of mothers who stop breastfeeding are given no information about bottlefeeding at all. This is a missed opportunity, particularly when we know from the figures that so many mothers are using bottles and formula: surely these mothers deserve accurate, unbiased information that will promote the health and safety of their babies? Mothers need to know how to prepare formula safely, and during those conversations support can be offered that might lead to them offering expressed breastmilk instead, or adopting practices (such as paced bottlefeeding) that will benefit their children. Breastfeeding supporters cannot opt out of discussions about formula entirely, and if they do so they leave mothers unsupported and reliant on the formula manufacturers for information.

Breastfeeding and returning to work
In Chapter 2 of the survey, which deals with initiation, prevalence and duration of breastfeeding, there's an interesting section about the impact of mothers returning to work on breastfeeding rates. This is one area where it seems that clear progress has been made: in 2005 mothers returning to work before six months were more likely to stop breastfeeding, whereas in 2010 "There was  no clear relationship between the age of the baby when the mother returned to work and duration of breastfeeding, which suggests that returning to work per se did not have much bearing on mothers’ decision to stop breastfeeding in 2010." This is evidence that nine months of paid maternity leave and up to a year of leave in total has had a positive impact on breastfeeding rates. It's interesting to consider this in the light of the recently-announced changes to parental leave that will allow parents to share leave and perhaps encourage mothers to return to work earlier once again, and adds to what we already knew about breastfeeding rates being higher in countries with generous maternity leave arrangements (Norway, Sweden).

Information and support that mothers are given
Following on (!) from the points made above about mothers' confidence in breastfeeding, I found the following figures tough reading: "Just under half of mothers breastfeeding in the hospital, birth centre or unit (48%) were informed about how to recognise that their baby was getting enough milk and nearly two in five (37%) felt they were confident enough to recognise whether or not their baby was getting enough milk." There's a clear call to action there for midwives, doctors and breastfeeding supporters: all breastfeeding mothers need this information.

Home births, water births, pain relief
The 2010 survey is the first to include detailed information about where babies were born, with some very interesting results. Breastfeeding initiation is highest among mothers choosing a home birth (88% compared with 81% overall). This could be down to a variety of factors, including access to consistent support in the community, and predisposition of these mothers to breastfeed. However, these mothers also have the highest rates of continued breastfeeding in the early weeks: at one week 82% were breastfeeding compared with 70% overall, and by two weeks 81% of home birthers were still breastfeeding compared with 67% overall.

And as for the effect of pain relief on breastfeeding rates: "Mothers who used a TENS machine continued to have the highest breastfeeding rates after one and two weeks from birth (86% and 83% respectively, compared with 70% and 67% overall). Those who used a birthing pool were also more likely  than average to breastfeed initially (89%) and at one week (81%) and two weeks (79%).  However, these rates could be explained by considering the profile of mothers who used a birthing pool or TENS machine during the birth." Mothers who used pethidine had the lowest rates of breastfeeding initiation, 77% against 81% overall.

It seems there is important information here for women planning their births. My feeling is that the impact on breastfeeding of some of these decisions is often overlooked. Interestingly, mothers delivering in consultant-led units, and having complicated births, also had high breastfeeding rates, perhaps reflecting an increased level of support in hospital. That's information worth sharing with mothers too - a difficult birth does not, in itself, mean that breastfeeding won't work.

I've found reading the survey fascinating and there is so much more to come out of it - I've barely scratched the surface. It has highlighted for me the areas where breastfeeding supporters have the most work to do. Reaching groups that tend not to breastfeed has got to remain a priority, and supporting mothers throughout their breastfeeding journey is clearly important too - with good support tailing off as the weeks pass, mothers are left without information and many begin supplementing with formula unnecessarily. Antenatal information about breastfeeding needs to be realistic, practical and mothers need to know where and how they can access support once the baby arrives. Perhaps the greatest challenge, in a nutshell, is combating misinformation, which booby-traps mothers at every stage. Whether that's misinformation from peers, health professionals, formula manufacturers or the media, it needs countering with evidence-based information and good support. And at the same time, we all need to work towards making society more breastfeeding friendly too. It's a tall order, but not, I think, an impossible dream.

Friday, 19 October 2012

Breastfeeding, guilt, feminism, the media... and UNICEFs new report

As is normal for me, when new breastfeeding research is published and discussed widely in the media, I've found myself alternately depressed and encouraged by the response to the publication yesterday of UNICEFs reportPreventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK.

There was certainly plenty of media attention for the story: newspaper articles, blogs, TV, news programmes. Having blogged about the report myself, I kept a close eye on how it was being reported by others. I found myself increasingly disappointed in the way it was handled (if not surprised). Lorraine Kelly, on ITV, framed discussion of the report as 'Is there too much pressure on women to breastfeed?' and a poll, conducted among viewers, concluded that 60% of respondents thought there was. (I linked yesterday to a great post on 'pressure': you can find it here). Lorraine's guest, Natalie Cassidy, was actually a great example of someone who was both culturally at a disadvantage when it came to breastfeeding (she explained how her father would not want to see her feeding, and how she'd felt, even among family, that she needed to go into another room) and the victim of poor support (she'd been told, and felt herself, that the latch was fine, but her story of cracked and bleeding nipples, and a baby with poor weight gain, suggested problems that could have been resolved with more skilled help). However, the context of the 'debate' meant that her contribution perpetuated many of the ideas that breastfeeding supporters are working hard to challenge - about breastfeeding as something that is difficult, time-consuming, painful, isolating. Dr Hilary Jones made a few points 'in favour' of breastfeeding, but the whole thrust of the discussion missed the point of the new report entirely (of which more below).

At 7pm on Channel 4 presenter Cathy Newman interviewed a breastfeeding mum feeding her three-week old baby on air, again questioning her on the 'pressure to breastfeed' angle, which she handled with aplomb, and Krishnan Guru-Murthy refereed a 'debate' between report author Prof. Mary Renfrew and Dr Ellie Lee from the Centre for Parenting Culture Studies in Kent (whose role was to present 'the other side'). This set-up did not make for illuminating discussion: it consisted of Dr Lee claiming that the report was one-sided, based on flimsy evidence and just one more stick to beat women with, while Prof Renfrew had to use up her minutes of air-time refuting these points rather than talking about the importance of the new report.

Have you spotted a trend? That trend continued... on Newsnight at 10pm three women were interviewed (very briefly!) about breastfeeding: one breastfeeding support worker, one bottle-feeder (again a good example of cultural barriers to breastfeeding: she explained how in her family two generations had bottle-fed, and she'd always thought of it as normal, and thus felt challenged and pressured when, during antenatal appointments, midwives explained the risks of bottle-feeding.) The third lady, calmly breastfeeding her young baby, explained how she'd planned to breastfeed and had welcomed the support she was given, although she qualified this by saying that the information she'd had 'was very biased in favour of breastfeeding.' Arguably this is spot on - breastfeeding and artificial feeding are not comparable. Gabrielle Palmer, in the Politics of Breastfeeding, sums this up very well:

'The infant feeding issue is often represented as one of individual choice between two parallel methods,"the breast or the bottle". Neither the products nor the method are equal and the true cost to society and the individual is seldom mentioned or measured [except, perhaps, in this new report?]. Women have the right to choose how they use their bodies and they cannot (and should not) be forced to breastfeed, but that does not mean that evidence about the risks of not breastfeeding should be censored.' (p7)

Newsnight then featured a 'debate' hosted by presenter Emily Maitliss between Rosie Dodds of the NCT, Francesca Entwhistle, a midwife and lecturer, and Charlotte Faircloth (of the aforementioned Centre for Parenting Culture Studies), who also had a piece in the Independent. (In which she said, among other things, that we spend enough money promoting breastfeeding already - £6m per year. Nestle spends £42m promoting its products.) It was an interesting discussion, although for me it was again derailed by the opposition set up between Faircloth (who described the report as one-sided and explained that as a feminist she believed we should not blame women for society's ills and  make them feel guilty about feeding; she also dismissed the notion that breastfeeding could address health inequalities) and the other contributors, who had to explain, again, that the report was not designed to make mothers feel guilty and that the evidence shows that 81% of women want to breastfeed and are forced by many circumstances to give up before they want to. Once again, the key message of the report played second fiddle to a different agenda.

A comment piece today by Victoria Summerley returns again to the question of guilt/pressure. It seems that despite the best efforts of the report's authors, and those of commentators welcoming the findings, we can't get away from these entrenched positions. Gabrielle Palmer again:

'I know that stating these facts can be painful or even enraging to some women who have not breastfed their children, but the continued denial of the risks of not breastfeeding and the value of breastmilk, supposedly to spare women's feelings, is a patronising deception. The whine about "not making mothers feel guilty" is such a cop-out... No woman need feel guilty for 'failing' to breastfeed, though she has the right to feel angry or sad for being denied support when she needed it.' (p85)

So what is the point of the report, and what is wrong with the way it's been covered so far? This is a report about the economics of breastfeeding. It presents information about infant feeding in a new way - we have not previously had these figures, of cost savings and potential returns on investment, available for the UK in this form. The report is a tool for the decision-makers who have to manage the limited resources of our health service in tight financial times.

Where were these decision-makers yesterday? Where were the health ministers, politicians, economists, health service bigwigs? Yesterday someone commented on my blog that her PCT had recently laid off three IBCLCs who had increased initiation and continuation rates in their locality. An interview with the person who made that decision would have been interesting in the light of the new report, surely? Where were the tough questions, the demands for assurance that the new report will be taken seriously? The report itself contains two fascinating case studies of areas that have implemented breastfeeding programmes that have improved breastfeeding rates and cut costs: Lancashire and Harrow (Harrow now has admissions for gastroenteritis of 16% below the national average). No one involved in these programmes was interviewed yesterday to explain how they had implemented change and seen results.

I think, so far, the mainstream media has taken the view that this new report on breastfeeding is a 'women's issue' and has covered it accordingly. I find that more than a little patronising. The report's main message, which is that programmes of breastfeeding support are cost-effective, improve public health and address health inequalities, is being lost among the bickering about 'guilt' and 'pressure'.

Some suggestions for what to do if you're irritated about this: Read the actual report - it's well worth it. Email your MP about it. Join Baby Milk Action - they are respected lobbyists in the political arena. Buy and read The Politics of Breastfeeding and become more aware of the issues. Support breastfeeding, and women who want to breastfeed, however you can - by doing it yourself or supporting those who do. It's perfectly possible to campaign for breastfeeding politically and be an enthusiastic, sympathetic and genuine supporter of women at an individual level as well.

Thursday, 18 October 2012

Good news for breastfeeding supporters: it can save the NHS £millions and improve public health

Supporters of breastfeeding have long thought that increased rates of breastfeeding would both save the health services money, and improve public health. Given all that we know about the risks of not breastfeeding it seemed obvious, and indeed it has been the underlying policy assumption behind much of the work to support breastfeeding in recent years. But until now, there was no UK-specific study to quantify how much money might be saved, and the scale of the improvement in public health. That has changed today with the publication of UNICEF's new reportPreventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. You can find the report, and a summary of the findings, on the UNICEF website.

As a passionate supporter of breastfeeding - I'm the mother of three breastfed children, a volunteer peer supporter in the NHS in Derbyshire and the editor of Breastfeeding: stories to inspire and inform, a collection of real-life accounts of breastfeeding designed to encourage and support mothers - the report made fascinating reading: although it aims to answer the question of how much money could be saved by increasing breastfeeding rates in the UK, in doing so it touches on many other aspects of the reality of breastfeeding in today's society.

What the report shows, in a nutshell, is that not breastfeeding is costing the NHS a lot of money. Or, to look at it the other way round, breastfeeding could save the NHS a fortune every year if it could only invest in the programmes, of training, information and support, that would enable women to breastfeed and to keep going for longer. The good news is that these programmes are relatively cheap (under £500,000 in the first year for an area the size of Lancashire, less year-on-year) and show a rapid return on investment, maybe even within one year. The NHS has precious few opportunities for such cost-effective health interventions - let us hope that the health planners and commissioners seize on the findings of this report and act on them immediately.

The picture painted in the report of the current state of breastfeeding in the UK is bleak. Across the country some 81% of mothers begin breastfeeding (although this varies from 42.5% to 92.5% by locality), but the number exclusively breastfeeding at one week drops to 45%. At 6-8 weeks the rate of any breastfeeding varies from 19.4% to 83.2% by locality. By five months 75% of babies get no breastmilk at all. Just 1% of mothers are exclusively breastfeeding at six months (see WHO guidelines). Women are clearly encountering problems or social barriers to breastfeeding and stopping early, often before they want to, and this is certainly my experience of working with breastfeeding mothers, even though I live in an area with high rates of breastfeeding initiation.

The costs of not breastfeeding, for the purposes of this report, are the costs to health services. (The costs to families of artificial feeding are not included). And the savings, even at modest increases in breastfeeding rates, are not to be sniffed at: for the five illnesses where the best quality evidence exists (gastroenteritis, necrotising enterocolitis (NEC), acute otitis media (ear infection), lower respiratory tract infections and breast cancer in mothers) the annual savings amount to over £40 million per year. Then there’s another set of outcomes (SIDS, cognitive outcomes, obesity) for which the authors couldn’t carry out the same statistical analysis as for the ‘top five’, but where cost savings are still suggested, and a further list of outcomes where breastfeeding is likely to have an effect (diabetes, ovarian cancer, cardiovascular disease, among others) but where more research is needed. That £40 million, it seems, might be just the start.

In terms of achieving the suggested increases in breastfeeding rates, the report acknowledges that breastfeeding promotion and support have not yet been consistently implemented, even in the areas where breastfeeding rates are lowest. The social, economic and political barriers to breastfeeding are clearly explained:

‘…an unsympathetic public attitude to breastfeeding outside of the home, an acceptance of formula feeding as a normal and safe way to feed babies, a lack of expertise and experience of breastfeeding among health service staff and, in many communities, a dearth of practical experience of breastfeeding among grandparents… Breastfeeding is... commonly associated with images of sexuality, or of feeding difficulties, rather than being seen as a normal, unremarkable, and fundamental aspect of parenting… As a result, when women encounter serious but preventable problems with breastfeeding (such as embarrassment and isolation when breastfeeding in public, painful breasts and nipples as a result of not understanding how to effectively attach the baby to the breast, and anxiety about their milk supply), they may struggle to find appropriate care and support. This may lead to their families, friends, and health professionals advocating that they solve the problem by using formula instead... Women’s choice to start or to continue to breastfeed is therefore constrained by the culture and community in which they live.


One of the great strengths of the report is that it shows how putting programmes of breastfeeding promotion and support in place will show a rapid return on investment, as well as improving health outcomes for mothers and babies and addressing health inequalities (babies who are not breastfed are at increased risk of ill-health, and the babies most likely not to be breastfed are in the lowest socio-economic groups). The case studies in the report show how this can be achieved in practice.

There is more good news. The report takes what the authors call ‘a robust, systematic, conservative, UK-specific approach’ - it’s likely that, if anything, the cost savings to the NHS (and, by extension, the other positive outcomes) have been underestimated by the methodology used. It is clear from the findings that the more common breastfeeding becomes, particularly exclusive and continued breastfeeding, the higher the cost savings to the health service will be. This is great news for those of us already working in supporting breastfeeding: it confirms that our aim to encourage mothers to breastfeed and to keep going for as long they want to is not only the right thing for individual mothers and babies, but also for society as a whole. It also busts the old myth about breastfeeding only being best for developing countries where they don't have clean water or enough money for formula - this report, which uses only evidence from the UK or comparable industrial societies, couldn't be clearer about the impact of not breastfeeding on British babies.

The report both calls for a wider debate on infant feeding and contributes to that debate. The findings have implications that reach beyond the health service; we all have a role to play in normalising breastfeeding and every individual can make a difference. Breastfeeding your baby in public, smiling at another mother doing the same, or becoming a peer supporter - all these can help, in a small way, to change how breastfeeding is viewed in our society. Ultimately, we'll all be better off.

NB: It's important to be clear, in talking about improving breastfeeding rates and the risks of not breastfeeding, that we are referring to changing behaviour across the whole population of the UK. People's individual circumstances will vary, and what mothers need to know is that any breastfeeding will provide some protection against illness, and more breastfeeding will provide a greater protective effect. It's not the intention - of the report or this post about it - to put pressure on individual women to breastfeed (see here for a great post about pressure). But wouldn't it be great if, in the course of the discussion of the report, we could open a few people's minds to the idea of breastfeeding, or breastfeeding for longer?

Thursday, 20 September 2012

A 1930s childhood and its lessons for today

The Heart is Highland - Memories of a Childhood in a Scottish Glen by Maisie Steven, now in its third edition and very proudly published by Lonely Scribe, is a book that is close to my heart. It was on my desk, waiting to be edited, on my first day in my first proper publishing job as a desk editor. More than ten years on, it's still one of my favourite books, and Maisie is one of my most cherished authors.

If you've read this blog before you might think that The Heart is Highland is something entirely separate from Lonely Scribe's parenting books, coming under the heading, on our booklist page, of social history and memoir.

Recently, however, I've been considering the book in a new light and wondering whether, in fact, it ought to sit more closely alongside those parenting books. It paints such a vivid picture of a rich and happy childhood that maybe we should be thinking of it as a way of gaining some valuable perspective on the way in which we parent our children today.

There isn't space here to tell of all the delights that are in the book, which is a child's-eye-view of each month of the year in the beautiful Highland glen where Maisie and her sister lived with their parents during the 1930s. It's a lovingly detailed and engaging story, peppered with quirky characters and episodes from community life (it bears comparison with Call the Midwife and All Creatures Great and Small - and, like them, would be wonderful adapted for television). 

The author herself makes a case for the book being seen as more than just a nostalgic look at the past, when she says in the introduction:
"It would be a pity if these reminiscences were to be seen as mere nostalgia for the past; better, surely, to take from them something positive for the future... For me what seems to shine through is just how much more quality of life means than standard of living, and how happiness is not, contrary to the message of today's aggressive advertising, dependent upon material possessions. Surely we can choose in different ways to regain that lost simplicity."
This strikes a chord with me as a modern parent trying to navigate my three small children through a complex world. I try, in my own way, to give my children a taste of the kind of childhood Maisie enjoyed. We keep chickens, grow vegetables, cook, read and explore the outdoors with our children. They are lucky enough to have much in common with the young Maisie, although they are growing up nearly a century later. I've found it fascinating to re-read the book now that I'm a mother myself.

And the author herself, the product of this Highland childhood? I've been privileged to know Maisie for more than ten years - although we've never met in person - and she's now in her eighties. In all the time I've known her she has been unfailingly open-hearted, honest and generous, cheerful, willing to work to deadlines and quick to make suggestions. She's dealt in a quiet and dignified way with all that life has thrown at her in recent years (including the death of her husband, and a stroke that affected her ability to write). She's a mother and a grandmother, a qualified dietician and the author of several books, including The Good Scots Diet - and The Heart is Highland is a book that she once thought she'd never write. Thankfully her son Kenneth, also a writer, gently encouraged her to pick up her pen. As Maisie explains in the book's introduction:
"...I made a very tentative start with the month of January. And then a strange thing happened. As if a cupboard full of old treasures had been opened and the contents spilled out onto the floor, all kinds of memories began to surface - of people, places and events, and of customs and traditions, some of which I had not thought of for more than half a century."
Maisie's skill, at both remembering and then capturing on the page the scenes of her childhood, makes The Heart is Highland a book that I hope will continue to find many new readers. It's truly a book that speaks across the generations.

You can like the book's Facebook page using the link on the right: I'll be posting updates and maybe a few more extracts there.

Wednesday, 12 September 2012

Giving breastfeeding mothers a break

We all know the feeling of desperately needing some time to ourselves. Whether it's time to have a bath in peace, to read a book, to go to an exercise class or just to sit with a cup of coffee, as mothers we often crave a few minutes (or, better, a few hours!) to just be free of the constant demands that small children make on our attention. It doesn't make us bad mothers to want this alone time. Being a parent is hard work, no question. Whether you've got one newborn, or a larger brood, the daily shepherding of little humans through their daily lives can be delightful, but also exhausting, repetitive and - at times - lonely and boring. And in today's society the other pressures on mothers are great - we are constantly bombarded with (often contradictory) messages about what we 'should' be doing: getting our babies into routines, sleeping through, eating solids, so we can get our lives and our bodies back...

This can weigh particularly heavily on a new breastfeeding mother. Even mothers for whom breastfeeding is working beautifully often feel they are somehow not doing 'enough'. I hear a lot from new mothers about 'getting started expressing', not because they need to be separated from the baby, but to give their partner a chance to do feeds, or to allow them to go on a long-planned hen weekend, or because grandma wants to have the baby for a day. Mums often sound ambivalent about this - the hassle factor of expressing and bottle-feeding to please others can seem like an extra burden. I also hear a lot from mums who are tired out from constantly feeding the baby, trying to keep on top of the washing and cleaning, shopping and cooking meals - and their partner doesn't get home until late in the evening. They think their lives would be easier if they weren't tied to the baby by breastfeeding, and expressing and bottle-feeding, or feeding formula, seem (or are made to seem, by others and the media) like the keys to more 'freedom'.

I think we have a problem here that's a real threat to breastfeeding: it becomes the 'fall guy' for the other problems of new motherhood. Feeling overwhelmed by the responsibility of caring for your new baby? Blame the breastfeeding that keeps you tied to the baby 24/7. In need of a break? You can't have one if the baby won't take a bottle. Want to keep up with your hobbies and interests, or see your friends? Not while you're breastfeeding! Want to eat a curry, go for a few drinks, have an evening out? Not if you're still breastfeeding! (Note the 'still' - it's part of the not-so-subtle pressure to stop breastfeeding early). Partner won't look after the baby? How can he, if you won't bottle feed? Baby won't sleep at night? Breastfeeding's the culprit. No time to yourself to exercise, get your hair done, go shopping? Yep, breastfeeding's the problem. I say, this is all rubbish. It's not about the breastfeeding. It's about society's attitudes and how they play out in individual families. I truly believe that breastfeeding is more flexible than many people think, and I think it's possible to balance your life as a breastfeeding mother with the other parts of your life that are important to you.

Of course life will never be the same now you have a child (breastfeeding or not). That's not a bad thing! This is a new chapter. You will not 'get back' to how you were before. But you will be able to enjoy the things that made you happy before you became a parent, albeit in a new, different, possibly even better way. Some things may be off the agenda for weeks, months or even years (I loved long tramps over hills and dales before children), but new opportunities will come along to compensate.

It's not selfish to put you, and your little family, at the centre of things for a while. If you want to turn down invitations to distant, child-free weddings, do so; if you don't want to let the grandparents have your child overnight, you don't have to. If you don't want to be bothered with expressing and bottle-feeding, you can forget all about it and just carry on breastfeeding for as long as you like. Be polite but firm when dealing with those who have an opinion about what you're doing. Part of parenting is learning how to make the choices that are right for you and your family and standing by those choices. And the choice to continue breastfeeding, and thus to not accommodate requests that conflict with it, is very valid. 'Can't you just give the baby a bottle?' is an often-heard question, to which 'no' is a perfectly acceptable answer.

So, some practical tips about how to get a break as a breastfeeding mother, that don't assume the breastfeeding is the problem. First, and perhaps most importantly, work out what it is that's important to you. Presumably the breastfeeding is important to you, because you did it (yay!) and you're still doing it (yay again!). But you'd love some time, to just do something. Let's see how that might be achieved. Obviously it helps if you've got some support - a partner, family nearby, friends. But even if you're on your own, there are things you can do to carve out some time for you, while continuing to breastfeed. Marshall your resources: if you've got support, draw on it. Tell people what you need and ask them to help make it happen. If you don't have support, see if you can get any (breastfeeding groups are a great place to start).

When my children were newly born I couldn't bear to be physically separated from them, even if they were only downstairs. This lasted several weeks and seemed to be part of my instinctive response to my baby - along with the gut-wrenching feeling I got when they cried, and the way I sprang awake, fully alert, when they made so much as a murmur. (And the way my boobs leaked at the first cry of hunger, from my own baby or someone else's.) Don't rush the first few weeks. Get what help you can to enable you to just be with your baby, let them sleep on your chest, feed as long as they like, let the house go to the dogs. Read this poem.

However, even in the early weeks, you may want a little time - to take a shower, for example? I remember agonising over how I could have a shower when I was alone with the baby. What if she woke and needed feeding? I put her in a bouncy chair and took her into the bathroom with me, then showered at breakneck speed. I soon realised that wasn't very relaxing and took to getting up early (while my husband was still at home), having a shower and then going back to sleep! Or I'd shower at night. The point is, you can change these things around. Try things out. You'll get to know what works.

With a tiny baby you can feel as though you literally never put the baby down. Slings can be a godsend and enable you to do things around the house and get out for a walk, but it can feel liberating to have a few minutes to yourself without a baby physically attached to you. Luckily, other people can wear slings and carry your baby too - so get your husband or partner to go out for a walk with the baby in the sling (or pram, if the baby likes the pram) while you do... whatever you like. Watch telly, do chores, paint your toenails. Or go out for the walk too, just not holding the baby! I used to love hanging up the washing while someone - anyone! - held the baby for ten minutes. I was outside, in the sun, with my arms temporarily free, alone with my thoughts. I learnt to savour those moments.

When you're up with the baby in the night, and doing a lot of night feeds, it can feel as though you never get comfy in bed or have space to yourself. When my second baby was not sleeping well my husband would take him downstairs when he got up for work, and look after him for an hour so I had the bed to myself for a much-needed extra hour of sleep. I loved him for it.

It can be helpful to focus on what you can do. You have lots of 'thinking time'. You can plan, make lists, decide what you will do in the future when you get chance. (That future comes sooner than you think!) I wrote two-thirds of a novel while on maternity leave with my second baby - when he napped, I typed. I imagined and planned the scenes while breastfeeding, then wrote them up when he was asleep. It's not a great novel - it's not even finished! - but it's a testament to the fact that I managed to keep a little bit of head space for myself and my ideas while at home with a small baby.

I missed reading when my babies were small. Either I was too tired to read, or I couldn't hold the book and turn the pages while breastfeeding (other mums I know were more adept than me!). A friend having her second baby deliberately made the choice to sit up and have the light on during night feeds so that she could read while feeding at night, reasoning that she might as well make best use of the time if she had to be awake. Now I have a smartphone I would browse and read on that if I were spending hours on the sofa feeding a newborn. (Sadly my breastfed baby is now 23 months old and she wants to play on the smartphone while feeding.)

Getting out of the house alone - just for a while - can really make you feel as though you've had a break. At weekends I used to feed the baby, hand her to Daddy, then go out for an hour or so, often to buy something for lunch. It needn't have been shopping - it could have been a haircut, a walk round the park, a coffee with a friend. Leaving a breastfed baby for an hour with a trusted friend or family member is definitely doable.

Often there are breastfeeding-friendly ways round even quite complicated arrangements. In my book Breastfeeding: stories to inspire and inform, one mother tells how she attended her sister's wedding in South Africa when her breastfed baby was just 12 weeks old. She planned in advance, pumped a stash of milk, got the baby taking bottles, then flew out to SA for the weekend, attended the wedding, pumped while she was there, then came home and carried on breastfeeding. A friend of mine had evening Paralympics tickets but her baby point-blank refused to drink from a bottle. We talked it over and in the end she brought her daughter's bath and bedtime earlier over a few days beforehand so that the baby (who sleeps well at night!) went to bed earlier and my friend could get to the Olympic Park in time for the event. As mothers, particularly first-time mothers, it can seem difficult to adjust routines that seem to be working well - but breastfeeding, and babies, can be more flexible than we think, if we give them chance.

This post has covered a lot of ground - but it boils down, again, to the importance of support for breastfeeding mothers. Sensitive support, that addresses the real issues and doesn't shift the blame onto breastfeeding, can make all the difference.

Wednesday, 29 August 2012

Breastfeeding: peer support in action

I love the work I do as a peer supporter of breastfeeding. It's one of the reasons I wrote Breastfeeding: stories to inspire and inform, which in some ways is peer support in book form (more about that in the introduction to the book!). Today something happened to remind me, once again, of the power of sharing our experiences with other mothers.

When I trained as a peer supporter we were encouraged, as a group, to share our breastfeeding stories with each other. I spoke about my first daughter Evie (that's her in the picture below) and our problems with feeding, and also about my second child, who was completely different and a guzzler from the get-go. I think I was feeding my third child, then only eight weeks old, while I was actually talking! That was in January 2011.

The full story of my breastfeeding journey with Evie is in the book, but I'll summarise here: she had silent reflux*. She would arch her back and cry during feeds, was hard to settle, didn't feed for long or very often, gained weight slowly and went on total nursing strikes. She popped on and off the boob during feeds, making feeding in public messy. She was manifestly uncomfortable much of the time. At five weeks I mentioned the idea of reflux to my health visitor, who firmly told me to put the idea out of my mind, then left without suggesting anything that might help. For the next five months I struggled on, until, after a referral to a paed, Evie was finally diagnosed with reflux and started on infant Gaviscon. Things improved from that moment on and I fed her much more happily until she self-weaned at eleven months, having never been a baby who got much comfort at the breast.

Fast-forward to today. BEARS, our group of peer supporters in Amber Valley, Derbyshire, has a Facebook group (actually, we have two - one for everyone to join, and a closed one for us to talk amongst ourselves). It's a great way for us to stay in touch with each other, and we can pool our experience to better help the women we support. Today the question of reflux came up. And that's when one of the other peer supporters posted this:

"I remember you telling us the story of the silent reflux when we were training... I told my friend about it and how similar it sounded to you so I suggested she ask the doctor about it and the doctor agreed she had all the symptoms... so you passing on your story stuck with me and therefore helped my friend and her baby :) It's amazing that you've helped someone and you didn't even know it :) They are both doing fabulous! She's now 12 weeks old and on meds for the reflux and one very happy breastfeeding baby girl who has doubled her birth weight and some more!"

This is just a great example of peer support in action: shared knowledge meant that this mother could get the help she needed and she and her baby are happily breastfeeding. I feel great to have been involved, however indirectly - and it's stories like this that keep us doing what we do.

*You can read more about reflux here: http://kellymom.com/health/baby-health/reflux/ If you're concerned about your baby, seek help: peer supporters, breastfeeding counsellors from the major breastfeeding charities, IBCLCs and infant feeding advisers should have the information you need or be able to point you in the right direction.

Tuesday, 14 August 2012

Dr Miriam Stoppard in the Mirror: first, do no harm

I woke up this morning and read this article by Dr Miriam Stoppard in the Mirror. Not good. Not even remotely good. In fact, I can't think of one single thing in the entire piece that could be classified as good. (In contrast, this article from earlier in the year, also in the Mirror, was really very, very good).

I'm not going to go through the article and correct all the errors of fact about breastfeeding, even though, as an editor, it's very tempting to get the red pen out. I'm not sure there would be anything left at the end. Except, perhaps, the opening line: "There’s no keener fan of ­breast-feeding than me. I always advocate breast milk as the perfect food for babies from birth to weaning." I can't help thinking that if Dr Stoppard had left it at that, no harm would have been done. Sadly, she goes on to make a mockery of her opening line by going on to talk a lot of nonsense about breastfeeding that actually undermines it, rather than demonstrating her commitment to it.

And I'm left fuming, once again, about the insidious harm this sort of article does, to everything that breastfeeding supporters (peer supporters, IBCLCs, breastfeeding counsellors, health care professionals) are working towards. We're all actively engaged in trying to create a culture that is more supportive of women and their decisions about feeding their babies, and when yet another 'celebrity' doctor weighs in with an inaccurate opinion piece it feels like a kick in the teeth.

I spend a good proportion of my time trying to bust breastfeeding myths - as a peer supporter I work with women face-to-face at baby clinic, and take my turn answering calls to our helpline, I've published my own book on the subject (Breastfeeding: stories to inspire and inform) and work with other authors on Lonely Scribe's list of parenting titles, which includes the wonderful Fit to Bust by Alison Blenkinsop. I hear recycled breastfeeding myths - plenty of which crop up in Dr Stoppard's article (such as the comment "my guide is the appearance of teeth"*) - all the time, and try, gently and with accurate information, to encourage mothers to get past these cultural stumbling-blocks to breastfeeding. So when articles like this appear in the popular press it feels like all my hard work, and the hours of my time given to volunteering to support women, is being undermined.

Dr Stoppard, casually and with an utterly infuriating lack of knowledge and research (even the most cursory review of the current literature would surely have corrected some of her errors - for example, her representation of the World Health Organisation's recommendations on infant feeding, which are clearly stated on their website, is completely flawed), uses her position, as a doctor and author, to peddle unhelpful myths, spread misinformation and undermine the work of those who are trying to support women to feed their babies in the way that they want to, for as long as they want to. Along with other doctors in the public eye (those of us who support breastfeeding have also recently taken issue with comments made by Dr Ellie Cannon and Dr Christian Jessen), Dr Stoppard would do well to undertake some additional, up to date training in breastfeeding, and supporting breastfeeding, before putting pen to paper.

I've reserved some of my anger for the editors that commission, or agree to publish, this type of article - they are by no means blameless. As a commissioning editor of books, I have to acquaint myself with the subject matter before agreeing to publish an author's material - I need to know if their views are mainstream, out on a limb or plumb crazy, and I need to know whether the material will be well-researched and properly referenced, and where it sits in relation to other writers on the same topic, in order to decide whether it will find a market, both in terms of its content and its commercial appeal. In the past I would have been weighing these decisions based on the aims of the company I worked for; these days, as one half of Lonely Scribe, I'm fortunate in being able to commission work that fits with my personal philosophy: high-quality, well-researched material that really will both inspire and inform readers.

* on the subject of teeth: my third daughter, still breastfeeding at 22 months, got her first teeth at 13 weeks old. All three of my children have breastfed long past the time when their teeth came through. Breastfeeding can be an ideal help with soothing teething pain. Babies rarely bite - many try it once or twice but they can be discouraged from doing so and there are plenty of suggestions online about how to handle this. (An alternative reading of the situation would be to suggest continuing to breastfeed until the 'milk teeth' are replaced by adult teeth, which causes children to outgrow the ability to latch, at the age of 6 or 7.)

Tuesday, 31 July 2012

An editor is never really on holiday...

We were away on holiday last week, in Scarborough. We had a great time, and great weather - and the kids loved the beach, the pool and the change of scene. I took some proofreading work with me in hopeful expectation, and didn't do it, which is perhaps a good thing - it is important to have proper time off, even when you love your job and are self-employed. But I realised that I am never really off-duty. This was the most amusing typo of the holiday by far, and I couldn't resist photographing it:

In second place came a label on a Model-T Ford at the wonderful Scarborough Fair Collection, which declared that the model was in production from 1098-1927. That's a long time!

And I was disheartened to see, on a cafe menu, "specialtity tea's" - I could forgive them the spelling, perhaps, but not the apostrophe as well.

Regrettably, I've forgotten the name of the pub I saw which was festooned with an advertising banner displaying the pub's name and details of forthcoming events. Sadly, the pub's name was spelled wrong on the banner, which was hung right next to the foot-high letters on the pub wall showing the correct spelling. Whoops.

This week I'm back at my desk and finally tackling my pile of proofreading - hoping to avoid blunders of my own!

Thursday, 12 July 2012

New books, please!

It seems strange, so soon after the launch of Breastfeeding: stories to inspire and inform, to be thinking about future projects. There's still so much work to be done to spread the word about that book, that it would be easy to do nothing else. But a commissioning editor (one of my many hats!) always needs to be thinking about the future, because books, as projects, have such long lead times.

So with that in mind this week I'm turning at least some of my thoughts to Lonely Scribe's forthcoming titles. Next on the list is a biography of Peter Scott, son of Scott of the Antarctic and founder of the Wildfowl and Wetlands Trust. That's a new edition of an existing biography, so in some ways there is less work for us to do: we don't need to copy-edit, but we do need to proofread because the text has been scanned in, which can generate errors. We also need to create a new jacket for the book.

After that we've got a lovely book on the horizon: The Anthology of Hope, compiled by Campbell Steven. This book deserves a blog post all of its own, and it will get one, but for now, to whet appetites, I will just say this: it's a collection of inspiring snippets of texts, one for every day of the year, a mixture of secular and religious, organised into themes. It was originally self-published and represents a real labour of love by its author. Lonely Scribe hopes to find many new readers for this little-known gem. (Maisie Steven, Campbell's wife, is the author of our delightful memoir of a Scottish childhood, The Heart is Highland. That book too deserves a blog post of its own; I will add that to my lengthy to-do list!)

Thirdly, at the launch of Breastfeeding I met up with my good friend Verity Croft, who contributed her story of breastfeeding twins to the book. She's both a twin, and a mum of twins (and, indeed, her twin has twins). Verity's also a passionate advocate for natural birth and a childbirth educator who has run her own birth preparation classes. We've agreed that a book provisionally entitled Twin Births: stories to inspire and inform, to sit alongside Home Births and Breastfeeding, would be a great addition to our list. She's already got the project well underway and is busy inviting contributors to the book. If you, or someone you know, would like to be involved, contact us. There's now a Facebook page for that book where we hope to get some discussion going, so 'like' it to keep abreast of developments! We're hoping the book will be published in spring 2013.

Thursday, 28 June 2012

The book is launched!

Last night was the big night. It was time to see whether all the planning and preparation would result in a successful launch for Breastfeeding: stories to inspire and inform. In the run up to the event I found myself engaged in a number of tasks not traditionally associated with book launches: ironing tablecloths, baking (frankly mediocre) boobie fairy cakes and cutting out circles of fabric to top jars of chutney and jam. More WI than wafty literary-type stuff. (The cakes and jam were for the stall held at the event by BEARS, the breastfeeding peer supporters I volunteer for.) After that I finally sat down and finished my talk about the book. I certainly left it until the eleventh hour - I must work better under pressure.

The venue for the launch was the Strutt Centre in Belper, Derbyshire: it's an amazing place. A former school, it's been saved from being turned into flats and is now a community venue staffed entirely by volunteers. We had a large, airy room, with drinks and nibbles laid out along one side, and plenty of space for us to set up tables for BEARS and, most importantly, the books.

I'd found myself fretting about whether anyone would actually turn up: I needn't have worried. More than thirty guests soon arrived and things got underway: our lovely author Alison Blenkinsop was there to promote her own book, Fit to Bust; people got chatting to each other; a start was made on the food and drink, cakes and crafts were purchased. And we all cooed over the three nursing babies, without whom it wouldn't really have felt like a breastfeeding event. Then it was time for the talk. I'd been dreading it slightly, it having been some time since I had to stand up and address a room full of people, but I had practised in front of the mirror and I think I pulled it off, despite a tendency to say 'um' too much, and to laugh (or giggle nervously?) at my own jokes.

You can read what I had to say here.

After that I tried to get round to talk to people - it was great to have a wide range of people with a common interest in the room, and it was fascinating that so many people already knew each other in some capacity or another. I made some valuable new contacts and picked up a list of follow-up work that will keep me busy for the next few days, and I was immensely flattered by the number of people who asked me to sign their books. Like a real author! In the background my husband did a sterling job selling books, taking photographs and keeping people supplied with drinks.

All in all it went very well. Here's to the continued success of Breastfeeding: stories to inspire and inform! And watch this space, because some great future projects were discussed, including Twin Births: stories to inspire and inform, and Water Births: stories to inspire and inform. If you'd be interested in being involved with either of those, contact us.

Susan Last's talk for the launch of Breastfeeding: stories to inspire and inform

Talk delivered by Susan Last at the launch of Breastfeeding: stories to inspire and inform on 27 June 2012, during National Breastfeeding Week.

Good evening ladies (and token gentlemen), and a special welcome to Ivy and Emily, our nursing babies. Thank you very much for coming along tonight to help celebrate the launch of Breastfeeding: stories to inspire and inform during National Breastfeeding Week. It’s really great to see so many of you, and from so many different backgrounds - we’ve got mums, contributors to the book, peer supporters, IBCLCs, NHS health professionals, independent midwives, doulas… all with a common interest in breastfeeding and supporting women.

I thought I’d start by saying a few words about how the book came about. When I had my daughter Evie, back in 2006, I didn’t give much thought to breastfeeding. I intended to breastfeed and I assumed that it would be easy enough. As it turned out she had silent reflux which went undiagnosed for nearly six months and feeding was a struggle throughout that time. I did a lot of learning about breastfeeding to try to sort it out and it was while I was doing that research that I thought it might be useful to write up my story so that others could benefit from it. A friend of mine, then a student midwife, had put together a book about Home Births, and I asked her if she thought a similar approach would work for Breastfeeding. That’s how the idea  got off the ground, but the book was a long time in the making. I invited contributions and conducted interviews in snatched moments over the next few months  - and the months stretched into years as I had two more children, moved house, trained as a peer supporter… life was very busy! Then in 2010 a friend and I set up Lonely Scribe, our own publishing company, and I became determined to finish the book so that Lonely Scribe could publish it to sit alongside Home Births, and our other breastfeeding book, Fit to Bust. (I must just say at this point what a pleasure and an honour it is to have the author of Fit to Bust, Alison Blenkinsop, here tonight!)

So here it is [holds up book]. It’s a book that I hope adds something new to the breastfeeding literature. I think the approach, giving women space to discuss their breastfeeding journeys at length,  is very powerful: these stories, peppered though they are with breastfeeding challenges, are overwhelmingly practical and positive. I hope that they are, as the book’s subtitle suggests, both inspiring and informative. When I explained the book to my neighbour, a former midwife, she exclaimed ‘Oh, it’s like a group session in a book!’ And it is, in a way, except that with a book you can pick it up and refer to it again and again when you’re in need of a boost. I very much hope that the book will be read by pregnant women and new mothers, because the women who contributed are such fantastic role models for breastfeeding (although they probably don’t think of themselves that way!). It’s great to see so many of them here tonight. Thank you again, ladies, for making the book possible.

While my initial motivation for putting the book together was to help other mothers, since I began the project I have become more of a political campaigner for breastfeeding. I had my eyes fully opened by Gabrielle Palmer’s book The Politics of Breastfeeding, and I now hope that this book can, in its own small way, be part of the campaign to support breastfeeding in the face of the aggressive promotion of formula milk. We live in a society where breastfeeding is often undermined, whether that’s by advertisers in magazines that influence editorial content, by big business lobbying government, or by your Aunty Sheila telling you that you’ve got to drink milk to make milk and your baby should be on four-hourly feeds.

My own firm belief is simply that the more babies that get breastmilk, the better, and the more breastmilk those babies get, the better. So I’m trying, in a very personal way, to make that happen - I’ve breastfed my own children conspicuously in public, I work as a peer supporter, and my book aims to normalise breastfeeding and really make it seem possible for women. In some ways an awareness of the political landscape of breastfeeding has made me a better breastfeeding supporter, because I now realise that mothers are not only struggling with breastfeeding on a personal level, with whatever problem they are presenting us with, they are struggling in a society that can at times be downright hostile to breastfeeding. However, I don’t want to overstate the political side of things! When it comes down to it, this is a very gentle book that leaves most of the political debate to one side.

This isn’t meant to be a long speech, and there are many people in the room more expert than me when it comes to talking about breastfeeding, but I would like to draw out one or two threads from the book that might be of interest to us all when we are talking about and supporting breastfeeding in the community.

I’ll start by reading you a quote from the book, from Laura’s story:
‘Having reached my lowest point I went to BIBS, a local breastfeeding group, in the hope they could tell me what I was doing wrong, but it turned out I wasn’t doing anything wrong. Newborn babies are meant to feed a lot, and when someone said that as long as she was on my breast the tigers wouldn’t get her, it somehow made sense to me. At that group for the first time someone told me I was doing well. I’d breastfed my baby for four weeks.’
I think we can all recognise this new mother’s struggle - it’s one we see a lot as breastfeeding supporters.

Also, I was talking to my husband’s grandmother last weekend. I was telling her all about the book and the aim of it, and she said ‘I never had a word of encouragement from my mother-in-law, or my husband. They said I should use a bottle to see how much they were getting.’ That was in the 1950s - Ray’s grandma is well in her 80s. It reminded me again just how important breastfeeding is to mothers: these memories are still clear even after so many years. What these two examples show is how vital words of encouragement are, and how easy they are to give.

The women in the book talk about lots of different types of support - NCT, La Leche League, websites, health professionals, friends and family, peer supporters. It’s clear that a supportive environment makes all the difference in moments of doubt. And all of us in this room are doing our best to make our society more supportive of breastfeeding, which is something we can all be proud of.

An idea that became clearer to me as I worked on the book was that breastfeeding is both a practical and an emotional experience, and new mothers learning the ropes need support on both fronts. Examples of the practical side might include techniques for position and attachment, how to disengage by means of a finger in the corner of their mouth a baby that is not latched on comfortably, how to feed in public and knowing how to tell that breastfeeding is working well (all those pooey nappies!). On the emotional side are the sometimes overwhelming feelings of new motherhood: being the one responsible for nourishing your child, and keeping them safe, and having to rejig your family life and relationships to take account of the new baby. The stories in the book are a fascinating insight into the way that these two aspects of breastfeeding interact. It’s why as breastfeeding supporters we learn about the importance of asking open questions and listening, because it’s then that you can work out how best to support someone on both a practical and an emotional level.

Another idea that I mention in the introduction is something that becomes clear when you look at a wide range of people’s experiences of breastfeeding in some detail. The differences between babies, and people’s situations, are enormous, and people’s expectations of breastfeeding are also often badly skewed. Many expect that there will be breastfeeding answers, when in fact there can be a frustrating lack of them. There are just so many variables, and each mum and baby pair is unique. One of the strengths of breastfeeding support, and of this book, is that it offers mothers a range of suggestions to try: these may solve the problem, or may allow the time required for the problem to solve itself. We need to remember that new mothers’ expectations of their babies behaviour may not match with the reality, even when technically the breastfeeding is working fine, and to support them accordingly. Women need to understand how their experiences can vary significantly from those of others but still be very valid. I hope that this book will help with that kind of understanding.

I’d like to just finish off by saying that I hope you will all read the book, and enjoy it, and find it helpful when talking to new mothers, either in a personal or a professional capacity. I’d love to have any feedback about it, so by all means email me about it! If you like the book, do tell your friends, family and colleagues: we are a tiny company with tiny budgets for advertising so we rely on word of mouth. If you can, get online and post on Facebook, or review the book on Amazon, or blog about it… anything that helps spread the word. There’s also the possibility of a second edition in the future, so if you or someone you know has a story worthy of inclusion, let me know. I’m also beginning work on a new book, Water Births, in the same format, so if you’re interested in that project, I’d be pleased to hear from you.

That’s it from me now, I hope you enjoy the rest of the evening. Do see Alison Blenkinsop about her book, Fit to Bust - it’s a great resource for anyone involved with breastfeeding and it’s very funny. BEARS have their stall over there and are happy to talk to anyone who’s interested in the work we do as peer supporters in Amber Valley, and they are also doing a Breastfeeding Millionaire quiz - I expect you all to get full marks!

Once again, very many thanks to you all for coming, and I hope to get around to speak to everyone. But I need to have a glass of wine first. Thank you!

Thursday, 21 June 2012

Editorial advice

Leafing through a folder of old paperwork I found this, which was given to me by my managing editor when I started my first job as an editor of non-fiction. It's unattributed, and a quick Google didn't uncover the source, although some of the comments would appear to be those of William Safire (author of a column in the New York Times Magazine called 'On Language', and may be in his book: How Not to Write: The Essential Misrules of Grammar (Norton, 2005). Editors, and authors, take note! The list is funny, but a reminder of the importance of accuracy and good style.

1. Verbs has to agree with their subject.

2. Prepositions are not words to end sentences with.

3. And don't start a sentence with a conjunction.

4. It is wrong to ever split an infinitive.

5. Avoid cliches like the plague. (They're old hat.)

6. Always avoid annoying alliteration.

7. Be more or less specific.

8. Parenthetical remarks (however relevant) are (usually) unnecessary.

9. Also, too, never, ever use repetitive redundancies.

10. No sentence fragments. No comma splices, run-ons are bad too.

11. Contractions aren't helpful and shouldn't be used.

12. Foreign words and phrases are not apropos.

13. Do not be redundant; do not use more words than necessary; it's highly superfluous.

14. One should never generalize.

15. Comparisons are as bad as cliches.

16. Don't use no double negatives.

17. Eschew ampersands & abbreviations, etc.

18. One-word sentences? Eliminate.

19. Analogies in writing are like feathers on a snake.

20. The passive voice is to be ignored.

21. Eliminate commas, that are, not necessary. Parenthetical words however should be enclosed in commas.

22. Never use a big word when a diminutive one would suffice.

23. Kill all exclamation points!!!

24. Use words correctly, irregardless of how others use them.

25. Understatement is probably not the best way to propose earth-shattering ideas.

26. Use the apostrophe in it's proper place and omit it when its not needed.

27. As Ralph Waldo Emerson said, 'I hate quotations. Tell me what you know.'

28. If you've heard it once, you've heard it a thousand time: resist hyperbole; not one writer in a million can use it correctly.

29. Puns are for children, not groan readers.

30. Go around the barn at high noon to avoid colloquialisms.

31. Even if a mixed metaphor sings, it should be derailed.

32. Who needs rhetorical questions?

33. Exaggeration is a million times worse than understatement.

34. Proofread carefully to see if you any words out.