tag:blogger.com,1999:blog-56473405396043053112024-02-21T16:28:03.707+00:00Lonely ScribeBooks, birth, breastfeedingLonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.comBlogger47125tag:blogger.com,1999:blog-5647340539604305311.post-2143387261054983562017-01-20T12:13:00.003+00:002017-01-20T14:00:24.256+00:00Talking about breastfeeding: ways of changing the conversation<div class="MsoNormal">
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<span style="color: red;">"My friend/colleague/doctor has looked into it and says there is no convincing evidence of benefit for breastfeeding in high-income countries. What can I say to him/her? Have you got any links or pointers for having the discussion?"</span></blockquote>
I've been asked variations of this question many times, sometimes face to face and sometimes online, and I've had conversations directly with the people who have made the original statement. Often I've felt a sense of being a rabbit in the headlights: how to sum up, rationally and in a nutshell, why I think breastfeeding matters so much, in the UK or elsewhere? I can't always remember the details of research, and often find it hard to summarise the complexities of the reality and politics of the situation, but at the same time I really want to communicate with people about breastfeeding and have them go away from our conversation thinking about it. When I hear myths I want to challenge them; when I hear that people have very different views from mine I want to explore why that is. It isn't easy to do!<br />
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However, as with many things, I find that practice has made these conversations a little easier. I now find that instead of launching in to a spiel about breastfeeding, understanding where someone's viewpoint has come from is the first step. Why did the friend/colleague/doctor decide to look into breastfeeding in the first place? Was it because of a personal decision or experience, or is it an area of professional interest? How did they come to their conclusions? I genuinely want to hear about how and where people are finding their information.</div>
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Then, I often find myself acknowledging where the other person is coming from. This time the person saying they had no convincing evidence for breastfeeding in high-income countries was a scientist in an unrelated discipline who had made a personal survey of breastfeeding research, and had examined the methodology of studies with a critical eye. That's something I can get on board with - I've done it myself, and of course we should be critical of research! Having established some common ground between us, I can acknowledge that there are indeed problems with the way some breastfeeding research is done, and that there are those who think that the importance of breastfeeding is overstated. I have now put myself in a position where I can explain why I don't agree without it seeming like an argument, rather than a discussion.</div>
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Another useful thing can be to establish what it would take to convince someone to think beyond their current position. In this case, the person who asked me the question thought that only a cast-iron randomised controlled trial (RCT) would be good enough to convince the scientist. That's good to know, because I won't be able to give them what they want. RCTs can't ethically be done in infant feeding. But because I know what the person wanted to find, I can explain why it doesn't exist, which must be the next best thing. Having the conversation in terms that suit the context is very important; I have very different conversations with people depending on who they are and what the situation is. I would not talk to a sleep-deprived new mother about meta-analyses and the ethics of research! </div>
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So how did I answer the question? I tried to include what I thought would make sense to the scientist who had voiced their opinion: recent meta-analyses in peer-reviewed journals. I tried to address their personal concerns about the validity of the research, and to show that the effects of breastfeeding in high-income countries have been studied. I also tried to suggest a few topics for further reading, and to introduce the idea that the burden of proof should not really be on breastfeeding, which is normal behaviour for humans, but on the long-term safety of formula milk. I wasn't trying to 'win' by presenting a cast-iron case; I was trying to show that alternative viewpoints are possible and credible.</div>
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I ended by inviting further contact if it's wanted or needed, now or in the future. Being open to further dialogue is really important for breastfeeding advocacy; what I really want is for people to be able to come back to me with more questions or discussion points, because then we keep communicating - and maybe I can put them in touch with other people or organisations, or suggest sources of information. It's amazing what that sort of networking can achieve; if you can be the person others seek out when they want to know something about breastfeeding, that's fantastic.</div>
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All this is important in a wider context too. The <a href="http://thethoughtfulpublisher.blogspot.com/2016/11/the-wbti-report-on-breastfeeding-in-uk.html">recent WBTi report</a> , and Unicef Baby Friendly's <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/join-our-change-the-conversation-campaign/">'Change the Conversation'</a> campaign, have shown what we need to do to improve breastfeeding rates in the UK, and highlighted the difficulties we have when talking about breastfeeding and advocating for policy change. Every conversation we have with another individual about it is a tiny step on the road towards improving the situation, for the benefit of mothers and babies. If we can make those conversations count, while avoiding arguments and entrenched positions, we're all doing our bit to make the world a better place.</div>
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I'd love to know how others handle this sort of conversation/question, and other thoughts on ways to change the conversation about breastfeeding. I've included my email in response to the question at the top of this post below for anyone who is interested (and because it can be useful to have links in one place!); what do you think?</div>
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<span red="" style="color: red; font-size: normal;">Hello,</span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">Here are some links/discussion points that you could raise.</span><span style="background-color: transparent;"> </span></span></blockquote>
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<span red="" style="color: red; font-size: normal;">First, a 2016 meta-analysis is one of the papers in a Lancet special series on breastfeeding, which specifically tackles the question of breastfeeding's relevance in middle and high income countries:<br /><a class="x_OWAAutoLink" href="http://www.thelancet.com/series/breastfeeding" id="LPlnk769546" target="_blank">http://www.thelancet.com/series/breastfeeding</a></span></blockquote>
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<span style="color: red; font-size: normal;">(It's worth noting that in the absence of RCTs, which, as discussed, are unethical in bf because you can't randomise babies to receive what you know is a poor substitute for breastmilk (when I say poor, I mean that formula lacks oligosaccharides, HAMLET, lactoferrin etc that have known immunological effects in the infant), meta-analyses are one of the better tools we have.)</span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">Second, this set of papers in a 2015 special issue of Acta Paediatrica; the editorial sums up the issues with bf research (also common to nutrition research in general) and explains how researchers have attempted to allow for the flaws in studies to reach their conclusions: <a class="x_OWAAutoLink" href="http://onlinelibrary.wiley.com/doi/10.1111/apa.2015.104.issue-S467/issuetoc" id="LPlnk441899" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/apa.2015.104.issue-S467/issuetoc</a></span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">There has been an RCT of a breastfeeding support intervention in Belarus that showed that increasing breastfeeding rates (by supporting the mothers to bf for longer and more exclusively) reduced rates of some infections: <a class="x_OWAAutoLink" href="https://www.ncbi.nlm.nih.gov/pubmed/11242425" id="LPlnk925015" target="_blank">https://www.ncbi.nlm.nih.gov/pubmed/11242425</a></span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">Here you can download the evidence-base for the Unicef Baby Friendly Standards, which have been developed specifically for the UK: <a class="x_OWAAutoLink" href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/the-evidence-and-rationale-for-the-unicef-uk-baby-friendly-initiative-standards/" id="LPlnk673207" target="_blank">https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/the-evidence-and-rationale-for-the-unicef-uk-baby-friendly-initiative-standards/</a></span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">This report looked specifically at the costs to the NHS in the UK of not breastfeeding: the conclusions are conservative and based on good-quality evidence for just a few diseases: <a class="x_OWAAutoLink" href="http://discovery.dundee.ac.uk/portal/files/1290558/Preventing_disease_saving_resources.pdf" id="LPlnk498183" target="_blank">http://discovery.dundee.ac.uk/portal/files/1290558/Preventing_disease_saving_resources.pdf</a></span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">Finally, here is the link to the very interesting work that looked at the evidence base for health claims made in ads to health professionals for formula milk; arguably the burden of proof should be on the intervention to show that it does not cause lasting harm; in my view we do not have this proof (far from it). The flaws in the research we rely on for the safety of formula are at least as bad the flaws in the bf research! <a class="x_OWAAutoLink" href="http://www.firststepsnutrition.org/pdfs/Scientific_and_Factual_booklet_for_web.pdf" id="LPlnk956610" target="_blank">http://www.firststepsnutrition.org/pdfs/Scientific_and_Factual_booklet_for_web.pdf</a></span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">Other areas that are well worth consideration are thymic size/immune system development, the differences in microbiome between bf and ff infants, and the epigenetics of bf; here the research is in its infancy, but the picture so far suggests far more substantial differences between bf and ff infants than we have previously thought, with consequences for long-term health.</span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">I'd also encourage a look at the evidence for the health of mothers, not just infants; for example the research on ovarian cancer, osteoporosis and heart disease.</span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;"><span style="color: red;">If you want to put us in touch or pass on my email address, that's fine - I'm always happy to discuss.</span><span style="background-color: transparent;"> </span></span></blockquote>
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<span style="color: red; font-size: normal;">Good luck! </span></blockquote>
Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com2tag:blogger.com,1999:blog-5647340539604305311.post-69952153174586587092016-11-15T11:26:00.000+00:002016-11-15T11:26:09.612+00:00The WBTi report on breastfeeding in the UK - and why we need it<div class="MsoNormal">
Since I got back from the Unicef Baby Friendly <a href="https://www.unicef.org.uk/babyfriendly/training/conferences/annual-conference-2016/">conference</a>
last week, it’s all been a bit eventful in the breastfeeding world – there was a poorly written and researched <a href="https://www.newscientist.com/article/2111610-strict-breastfeeding-rules-dont-work-and-can-hurt-young-babies/">article </a>published in <i>New Scientist</i> (the Unicef response is <a href="https://www.unicef.org.uk/babyfriendly/response-to-new-scientist-article/">here</a>), longer-term breastfeeding was discussed (again) on <i><a href="http://www.itv.com/thismorning/hot-topics/sophie-rose-ill-breastfeed-my-son-until-hes-eight">This Morning</a></i>, with a GP who didn’t
know her stuff on the subject, there was a furore in the <i>Daily Mail</i> and on social media over a mother refused
a parking voucher from Tesco because she only bought infant formula (see Baby
Milk Action’s excellent discussion of this <a href="http://www.babymilkaction.org/archives/11320">here</a>), and we discovered that the <a href="http://www.cphvaconference.co.uk/">CPHVA conference</a>, for health visitors, has sessions (and no doubt exhibition stands)
sponsored by formula manufacturers. The publication of the WBTi (World
Breastfeeding Trends Intiative) report on breastfeeding in the UK couldn’t be
more timely – it’s abundantly clear that we need a strategy if we are to
counter the anti-breastfeeding culture that we have in the UK.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivvxwZhBofysG4a97J42T_xw2NOLiQpbErTrTXrxtU1iqhl0dpur8cFc0LROnGWhTnpND_SR_lCBWLeqQ9_h0blEhK8RyD0VhdZmrSD14e2GSBdLtkwjIDRU77kBxhJVHj4Uqysu1ElUbu/s1600/WBTi+cover.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivvxwZhBofysG4a97J42T_xw2NOLiQpbErTrTXrxtU1iqhl0dpur8cFc0LROnGWhTnpND_SR_lCBWLeqQ9_h0blEhK8RyD0VhdZmrSD14e2GSBdLtkwjIDRU77kBxhJVHj4Uqysu1ElUbu/s320/WBTi+cover.jpg" width="223" /></a>The <a href="https://ukbreastfeeding.org/wbtiuk2016/">WBTi report</a>, published today (15 November) and launched at the House of Commons tonight, is the
culmination of two years of work by a huge number of people and organisations.
Using a system developed by <a href="http://www.ibfan.org/">IBFAN</a>, data has been collected for 10 ‘indicators’ –
these correspond to policies and programmes recommended in the <a href="http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/">WHO Global Strategy for Infant and Young Child Feeding</a>, which the UK supported when it was
adopted by the World Health Assembly in 2002. In other words, although the WBTi
system has been designed to be used internationally, it is very relevant for
the UK and shows how we are doing against criteria that our government has
signed up to. The idea is that the process is repeated every 3-5 years to
track trends. On the international <a href="http://worldbreastfeedingtrends.org/">WBTi website</a> you can see how other countries have scored.<o:p></o:p></div>
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The report begins with a series of 'Report Cards' that sum up the findings in a simple scorecard, with each country of the UK given a total out of 150, and an amalgamated score for the UK as a whole. The UK scored 81/150. England has the lowest score of all the four nations at 80.5/150; Scotland and Northern Ireland score much better, in part due to the fact that all their maternity units are Baby Friendly. For comparison, Afghanistan scored 80/150 in 2015. If like me you think that this isn't good enough, then the great thing about this report is that it offers a way forward. The work that's been done has identified the gaps in UK breastfeeding policy and made recommendations - that have been agreed upon by the contributors to the report (a host of breastfeeding organisations and public health bodies, among others) - that we could act on, right now.</div>
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The report's recommendations echo a growing consensus that currently, women in the UK who want to breastfeed are being failed - not only by a lack of skilled support for breastfeeding (the table in Indicator 5, which shows which health professionals have training in breastfeeding, is well worth a look), but also by an entire culture and society that undermines it. Other recent publications, including the <a href="http://www.thelancet.com/series/breastfeeding"><i>Lancet </i>series</a> on breastfeeding, a special issue of <i><a href="http://onlinelibrary.wiley.com/doi/10.1111/apa.2015.104.issue-S467/issuetoc">Acta Paediatrica</a></i> and Unicef's <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/">Call to Action</a> make many of the same points. Dr Amy Brown, of Swansea University, has written extensively about the subject in her book <i><a href="http://www.pinterandmartin.com/breastfeeding-uncovered.html">Breastfeeding Uncovered</a></i>.</div>
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Turning the situation around is not impossible. We know, from a mountain of published evidence, what works. The main problem - and one of the chief recommendations of this report - is that there is no national strategy on infant and young child feeding, no national coordinator and no means of sharing good practice UK-wide. To address this would be relatively simple and relatively cheap - what's needed is the <i>political will</i> to tackle it. From better national leadership on the issue, other improvements could follow: we could fully implement the Code, we could address gaps in the training of health professionals, we could collect better data, we could ensure that infant feeding is considered in the formation of other policy (like the obesity 'plan')... and then, as all these areas interact like cogs in a machine, we would see a shift in society's attitudes, increased breastfeeding rates, improved health outcomes and cost savings... and happier, better supported mothers. (This isn't just conjecture - see the breastfeeding gear model, which uses Brazil and Mexico as examples, on p68 of the report.)</div>
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This report, with its overview of the current situation, could be hugely important - it can inform what we do, and where we direct our campaigning efforts. Do read the whole thing if you can, and reflect on what you could do to make a difference.</div>
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Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com5tag:blogger.com,1999:blog-5647340539604305311.post-71299675940617031642016-05-04T12:17:00.000+01:002016-05-04T12:17:17.880+01:00Not #scientificandfactual at all – how UK breastmilk substitute ads to health workers break the rules<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkRvGlRpt3yyqW3FcyRflZqyDDi9XEQztZwxk9XOggZKLJFdQxqC3hotOwk05N1isWOuuuiKAb09qPuECPuina6b59-axJdpW0cg1oBpXIjMMO4IPj9L09YPHQlKslebPuf4k29uaBlOZK/s1600/Report_Scientific_factual.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkRvGlRpt3yyqW3FcyRflZqyDDi9XEQztZwxk9XOggZKLJFdQxqC3hotOwk05N1isWOuuuiKAb09qPuECPuina6b59-axJdpW0cg1oBpXIjMMO4IPj9L09YPHQlKslebPuf4k29uaBlOZK/s320/Report_Scientific_factual.png" width="228" /></a>Most readers of my blog will know that in the UK infant formula (first stage,
or from birth formula) cannot be marketed to parents, or be discounted or
promoted in shops. Manufacturers use follow-on formula to get around these
advertising restrictions, but there are still rules that they must follow and they
can be pulled up by the Advertising Standards Agency for breaking them. When shops
break the rules on infant formula promotion – by discounting it, or positioning
it in premium spots in store – they can be reported to Trading Standards. It’s
far from a perfect system; no prosecutions have been brought, and companies are
not fined nor have to apologise for infringing the rules, but the principle of
challenging misleading marketing does at least exist. <a href="http://www.babymilkaction.org/">Baby Milk Action</a>, with
the help of its members and the public, <a href="http://www.babymilkaction.org/monitoring-uk">monitors</a> advertising to parents and
compiles a report ‘Look What They’re Doing in the UK’ to expose the companies' tactics.</div>
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When it comes to advertising aimed at health professionals,
however, the situation is very different. Many people don’t know that breastmilk
substitutes <i>can</i> be marketed to healthcare
professionals: in journals and magazines, on professional websites and at
conferences and study days. Although the Department of Health has regulations
stating that this advertising must be ‘scientific and factual’, there is no
monitoring and no mechanism for reporting marketing that breaks the rules,
other than to complain directly to the Department of Health.<o:p></o:p></div>
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<a href="http://www.firststepsnutrition.org/">First Steps Nutrition Trust</a>’s recently published resource <i><a href="http://www.firststepsnutrition.org/pdfs/Scientific_and_Factual_booklet_for_web.pdf">‘Scientific and Factual – a review of breastmilk substitute advertising to health professionals’</a></i> looks more
closely at the science used to back up the claims made in advertising in
professional journals and magazines. We know from research that advertising is
effective – why else would the companies spend vast sums on advertising space? –
and that adverts that carry simple, easy-to-understand messages relating to the
reader’s own scientific knowledge are very ‘believable’. The companies know
this too, and they also know that few health workers will have the time or
resources to investigate the references given in tiny print at the bottom of
carefully crafted adverts. Graphs, charts and statistics create the appearance
of ‘a scientific basis’, even when what they show is not scientifically correct
or objective.<o:p></o:p></div>
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The resource looks in detail at adverts that appear in publications
including the <i><a href="https://www.jfhc.co.uk/jfhc/default.aspx">Journal of Family Health</a></i>,
the <i><a href="http://www.journalofhealthvisiting.com/">Journal of Health Visiting</a></i> and <i><a href="https://www.bda.uk.com/membership/publications/DieteticsToday">Dietetics Today</a></i>, but the same and
similar adverts appear in many other publications aimed at health professionals
in a wide range of fields. When the references given to support the claims made
in the adverts are scrutinised, the findings are often shocking.<o:p></o:p></div>
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An advert for Cow & Gate Comfort milk, marketed as
relieving colic, which shows an emotive image of an exhausted mother, appeared in
the <i>Journal of Health Visiting</i> in
March 2016. The main claim, in red type, is that ‘95% of paediatricians
reported an improvement in common infant feeding problems with a formula <i>like</i> Cow & Gate Comfort<sup><span style="font-size: xx-small;">1</span></sup>’
[italics added]. Closer reading of the reference given reveals that the study,
funded by Numico (Danone) did <i>not</i> use
Cow & Gate Comfort milk; the test formula had different energy, protein,
carbohydrate and mineral content. NHS Choices says that there is no evidence
for any treatment that is beneficial for colic, which resolves itself. The
conclusion that the advert is deliberately misleading is inescapable.<o:p></o:p></div>
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SMA, now owned by Nestle, has been rolling out a new product,
SMA PRO, and many stores have illegally cleared stock of the previous formula
by marking it down in price to make way for the new product (lots of examples have been posted on the Baby Milk Action <a href="https://www.facebook.com/babymilkaction/">Facebook page</a>). An extensive advertising campaign to health
professionals has accompanied the roll-out. <i>Dietetics
Today</i> carried two adverts for SMA PRO in March 2016, a shorter one-page ad
and then a longer, more ‘scientific-looking’ ad – this in itself is a tactic
designed to reassure the reader that the information given in the simpler
advert is supported by the ‘science’ given in the more complex version. The
main claim in the simpler advert is that SMA PRO is ‘Clinically proven<sup>1</sup>’.
This is supported by one reference to a poster presentation given by Nestle
employees at a conference – not a peer-reviewed publication as required by the
Department of Health regulations. The poster reports a meta-analysis of four
studies looking at infants fed with Nan milk (another Nestle product). It is
not clear whether this Nan formula is the same as SMA PRO. It is impossible to
know how the manufacturers can use this evidence to claim that SMA PRO is
clinically proven, or what it is ‘clinically proven’ to do. That such shaky
evidence can be used to support a headline claim on a new product shows just
how confident the companies are that they will not be challenged.<o:p></o:p></div>
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There is much, much more detail in the resource, which has
painstakingly reviewed all the scientific papers the companies have cited to
support their claims. If, having read it, you’re outraged by how misleading these adverts are, there are plenty of suggestions
for action on the First Steps Nutrition Trust website. Health professionals can
demand change, by complaining to the journals and professional bodies that
carry advertising and allow it at events, and writing to the Department of
Health regulators. The Royal College of Paediatrics and Child Health voted at
its AGM in April to <span style="color: #cc0000;">‘decline any commercial transactions or any other kind of funding or support from all companies that market products within the scope of the WHO Code on the marketing of breast milk substitutes’ </span>– other professional organisations can be lobbied
to pass similar resolutions. For more information, and links to further
reading, see the campaign pages on the First Steps Nutrition Trust <a href="http://www.firststepsnutrition.org/newpages/Infant_Milks/your_campaign.html">website</a>.
Baby Milk Action is urging the UK parliament to enforce marketing restrictions
on the promotion of formula to parents too – see more on their website <a href="http://www.babymilkaction.org/archives/8787">here</a> or
make a <a href="http://www.babymilkaction.org/donate">donation</a> to support their work.</div>
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Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com0tag:blogger.com,1999:blog-5647340539604305311.post-92111815892596831512015-11-20T18:09:00.000+00:002015-11-23T09:38:34.271+00:00UNICEF Baby Friendly conference 2015 - the morning after<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_A9ZML_TxtLLt1N5f8zzPuKJoq3Xj3Y9YHZDR15Rm52Vn16abSkgRFZp_hSjfTC0clbV8OOQTiLn6QsEMU_ydDDkVH4IgiHkc9wnZx5oTmbo69ph_QhMQKeBUPdO-QwweeX-pqh_JoIw/s1600/CUKjpsqWwAAJx4H.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_A9ZML_TxtLLt1N5f8zzPuKJoq3Xj3Y9YHZDR15Rm52Vn16abSkgRFZp_hSjfTC0clbV8OOQTiLn6QsEMU_ydDDkVH4IgiHkc9wnZx5oTmbo69ph_QhMQKeBUPdO-QwweeX-pqh_JoIw/s320/CUKjpsqWwAAJx4H.jpg" width="320" /></a>I'm back at my desk after two days at the <a href="http://www.unicef.org.uk/BabyFriendly/">UNICEF Baby Friendly</a> conference 2015 in Harrogate. Like last year I've come away enthused, inspired, outraged and with a whole heap of work to do...<br />
<br />
The presentations by <a href="http://www.birthingandbreastfeeding.com/">Christy Jo Hendricks</a>, IBCLC, and Dr Helen Crawley of <a href="http://www.firststepsnutrition.org/">First Steps Nutrition</a>, showed us examples of downright dishonest marketing from the formula companies, including a tin that made extravagant health claims for the product, with an asterisk(*). On the side of the tin, in tiny writing, it said '*study applies to an earlier version of this milk'! Even after years of breastfeeding advocacy it seems I (and many others in the audience) can still be shocked by this sort of thing. A US parent information leaflet, sponsored by a formula company, said on the first page 'most doctors* recommend...', while the wording below said '*in this publication doctors refers to midwives, obstetricians, paediatricians and any other health professional you trust'! This is unbelievably misleading. As Christy Jo memorably said: 'Don't go to a formula company for advice about breastfeeding. That's like going to the butcher to ask for advice about being vegetarian.'<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqKBAZ8Us3vxHrw_kfzFkXuPN0QS9usuY-z3FUYmD2FB0FKl5FKRV_z6cVaspnDcmvYKpk9yA42nx0Rh4aTCifc3Jkuaq0EJJNrAgpbxs0FHF_n6NtzOacKV82__Arfwv-cu11WPiooM1-/s1600/CUHClU6WIAEg-An.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqKBAZ8Us3vxHrw_kfzFkXuPN0QS9usuY-z3FUYmD2FB0FKl5FKRV_z6cVaspnDcmvYKpk9yA42nx0Rh4aTCifc3Jkuaq0EJJNrAgpbxs0FHF_n6NtzOacKV82__Arfwv-cu11WPiooM1-/s320/CUHClU6WIAEg-An.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr Helen Crawley getting the audience fired up.</td></tr>
</tbody></table>
<br />
<br />
On the issue of formula company sponsorship of health events aimed at professionals it was great to see some direct action as a result of the conference session. A health visitor in the audience reported that the <a href="http://www.cphvaconference.co.uk/">CPHVA conference</a>, sponsored by <a href="http://www.cphvaconference.co.uk/exhibiting/">several formula companies</a> and related organisations, was taking place in Manchester (overlapping with Baby Friendly - coincidence?). The result was a petition, to be delivered to CPHVA, that will carry the names and membership numbers of health visitors who were at the Baby Friendly conference, asking them to ditch the formula company sponsorship that is a clear conflict of interest for health professionals who want to work within the Code. Hopefully this, along with continued pressure on social media, will prompt a change in direction. National breastfeeding organisations like <a href="https://www.laleche.org.uk/">La Leche League</a>, the <a href="http://abm.me.uk/">ABM</a> and the <a href="https://www.breastfeedingnetwork.org.uk/">Breastfeeding Network</a>, along with Baby Friendly, have shown that it is perfectly possible to organise Code-compliant conferences for large numbers of delegates without input from the formula industry.<br />
<br />
If you came away from the conference angry, why not join <a href="http://www.babymilkaction.org/join">Baby Milk Action</a>? They campaign tirelessly against the formula companies, exposing the marketing tactics and bringing cases to the Advertising Standards Authority and Trading Standards on behalf of the parents who are paying for all this slick, misleading marketing when they buy formula. There's tons of information on the Baby Milk Action <a href="http://www.babymilkaction.org/join">website</a>, and if you work for a facility that would like training on the Code, you can contact them directly.<br />
<br />
If I sound evangelical it's because I think organisations like <a href="http://www.babymilkaction.org/">Baby Milk Action</a> and <a href="http://www.firststepsnutrition.org/">First Steps Nutrition</a> are absolutely vital if we are to push back against the widespread, normalised use of formula - a theme that Professor Mary Renfrew explored in her presentation about shifting the curve: she suggested we turn our breastfeeding drop-off rate graph upside down, and look at reducing formula use instead. Between them the speakers had lots of solutions to the problem: tackling the media stance on breastfeeding, reinstating the Infant Feeding Survey in England, freeing research from company influence and forcing companies to release their research, implementing the Code and empowering mothers, through support and education, to resist the marketing and reduce dependency on formula. What's frustrating is that we know what works - the problem is getting the support and funding needed. Infant feeding in the UK is an issue with a unique set of political and social challenges, something that was highlighted when Sue Ashmore talked about the long-term sustainability of Baby Friendly; it's not a programme that can run and then stop. If that happened, our gains would be eroded because of the constant pressure from industry and a lack of political commitment, so what's needed is a way of embedding the Baby Friendly standards into the very bedrock of facilities; an advanced award. (The consultation about how to do this is <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/Achieving-sustainability-a-consultation/">here</a>, do get involved if you can.)<br />
<br />
With this in mind it was fantastic to see Alison Thewliss, MP at the conference. She's already secured and participated in debates about breastfeeding and a family-friendly parliament, and is setting up an All Party Parliamentary Group on Infant Feeding and Inequalities, which will meet for the first time on 24 November. I've written to my MP asking her to support this and encourage others to do the same.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf_K0HaXHdjaui4fWzku2xU-bOT3rQxQQX0AXkiULkHXZJqEaXiP-ou5T1qwsIwer1B8wLgL7CXo3YcS5wSv6RJY38VquzmGnBMsw9c9wmsXOddSjL9gFiSHKI8j13E9OTN1dZKFm1IMI-/s1600/12227234_10154881683928084_727585971532294175_n.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf_K0HaXHdjaui4fWzku2xU-bOT3rQxQQX0AXkiULkHXZJqEaXiP-ou5T1qwsIwer1B8wLgL7CXo3YcS5wSv6RJY38VquzmGnBMsw9c9wmsXOddSjL9gFiSHKI8j13E9OTN1dZKFm1IMI-/s320/12227234_10154881683928084_727585971532294175_n.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Me on stage with Sue Ashmore and Robin Grille</td></tr>
</tbody></table>
Other personal highlights of the conference for me were chairing in the morning session on day two - I was nervous, but very happy to be representing the bloggers and Tweeters who campaign for breastfeeding on social media. I realised I will never, ever get bored of listening to Hollie McNish, and I helped out on the Pinter and Martin stand and talked to a lot of people about books (I love my job!). I came home with a new reading list of my own - Robin Grille's<i> <a href="http://www.amazon.co.uk/Heart---Heart-Parenting-Robin-Grille/dp/0646575457">Heart to Heart Parenting</a></i> landed on the mat this morning. Can't wait for next year in Birmingham...<br />
<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com0tag:blogger.com,1999:blog-5647340539604305311.post-65552353771676116292015-06-03T21:05:00.000+01:002015-06-03T21:05:02.134+01:00Why shouldn't formula companies sponsor training events for health workers?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgknc-nI8D9tHnPQlCT1epfxcHBRwVjL7Jcp4KFu3utkfetGbXmecm33GbqrE5evRulZaUSXfFsHLzC3Lzl8TFstKCxfIf7_NqusL_lKY0QdUMnlKBwx6Dn2SrVeSz6U5If0r5U05fojq4m/s1600/Conference+room+image.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgknc-nI8D9tHnPQlCT1epfxcHBRwVjL7Jcp4KFu3utkfetGbXmecm33GbqrE5evRulZaUSXfFsHLzC3Lzl8TFstKCxfIf7_NqusL_lKY0QdUMnlKBwx6Dn2SrVeSz6U5If0r5U05fojq4m/s1600/Conference+room+image.jpg" /></a>An <a href="https://www.pavpub.com/jfhc-professional-manchester/">event </a>is taking place in Manchester tomorrow - billed as a <i>Journal of Family Health Care</i> 'free conference bringing together health and social care professionals - designed to improve outcomes for mothers, babies and children.' Among the exhibitors are Nestle, HiPP Organic, and Danone Nutricia Early Life Nutrition; Nestle Nutrition UKs Head of Medical and Scientific Affairs, Dr Liz Greenstreet, is giving a presentation about 'optimal growth and feeding issues in the first 1000 days'. Other <a href="http://www.cphvaroadshow.co.uk/">similar events</a> take place regularly in the UK and elsewhere.<br />
<br />
As a volunteer for and member of several impoverished organisations, I can understand how tempting it is to snap up funding that is on offer to make it easier to arrange events and training. It can be hard to see where the harm is; a sponsor pays for an expert speaker, the topic is not related to infant feeding, the sponsor may not even directly promote their products at the event. The sponsor is not the 'brand' itself, but their 'Nutrition Foundation', or educational or charitable arm, which has been set up, apparently, with the aim of providing high-quality education for health professionals. We all know that our NHS is underfunded and under threat. Why not use some money from private companies to fill in some of the gaps? Health workers work hard - long hours, modest pay and benefits. Who doesn't love a free lunch and a day out at a <a href="http://www.babymilkaction.org/archives/982">study day or conference</a>? It's a welcome break from the stresses of working in a creaking organisation. The trouble is that there really is no such thing as that free lunch.<br />
<br />
To understand the problems, we need to start by understanding the market for formula and baby food (for the purposes of this post I'm talking about the UK, but similar situations exist in many countries).<br />
<br />
- the market for infant formula depends for its existence on women who do not or cannot breastfeed. When breastfeeding rates increase due to effective initiatives and good support, the market for formula milk decreases. More breastfeeding means fewer profits for the formula companies; it's a direct relationship.<br />
<br />
- the formula companies are no different from most other companies - they exist to make money for their shareholders. To fulfil their duties to their shareholders they must maximise profits. This means that they must design marketing and sales strategies that aim to increase the market, and their share of that market. Job advertisements for posts at formula companies show this explicitly. (More on this, from Baby Milk Action, <a href="http://www.babymilkaction.org/archives/982">here</a>.) Much like the energy companies that fight to drill for oil - although we know that burning the oil they produce will contribute to catastrophic climate change - formula companies must aggressively promote a product that is known to carry health risks in order to satisfy the demands of investors.<br />
<br />
- formula companies are regulated by laws in many countries. The <a href="http://ibfan.org/the-full-code">International Code of Marketing of Breastmilk Substitutes (and subsequent Resolutions)</a>, drafted by the World Health Organisation and adopted at the World Health Assembly by nearly every country in the world, forms the basis for the law; in the UK our laws do not fully implement the Code but they do restrict the marketing and promotion of first infant formula. Because they are limited by the law, companies must continually try to find new ways to market their products that get around the restrictions. Since they cannot market directly to mothers, they must target those who have contact with them - health workers. (Follow-on milk - an unnecessary product - was invented to get around these restrictions too. In countries where all formula advertising is restricted, follow-on milk does not exist.)<br />
<br />
- formula companies are regulated because breastfeeding is the normal way to feed babies, and formula feeding carries known health risks for mothers and babies. Formula milk may be an infant's sole source of nutrition and must be suitable and nutritionally adequate (though it is not, and can never be, close or similar to breastmilk) so there are strict regulations about its composition. This means that the differences between products are very small, and often claimed differences do not stand up to scientific scrutiny. What really matters to companies is 'brand awareness'. What can they do to ensure that the buyer of formula, whoever that is, chooses one brand and not another? One answer is to get that brand, or information about it, on to materials that will be seen by their target market (which is hard, because they are restricted from marketing directly to mothers), or those that advise them - midwives, doctors, health visitors, community nurses and so on.<br />
<br />
You might think that health workers should be immune to the effects of marketing - surely they know all this, and can make their own informed decisions? In fact research shows that none of us are immune to marketing. The effects of even small, trivial gifts such as pens and notepads have been shown to cause the recipient to <a href="http://www.themarketer.co.uk/archives/masterclass/how-to-make-the-most-of-promotional-merchandise-and-giveaways/">feel good about the giver</a>. Larger gifts, such as free study days (which delegates might otherwise have to pay for themselves, or apply to their employers for the money) have a greater effect. The speaker paid by the sponsor feels good about the sponsor too. Might that influence the content of what they say? It certainly suits a formula company to have both health workers and experts feeling good about their name or brand. When a health worker who attends a study day goes back to the office and tells colleagues about the event, might they mention the sponsor by name? Or show others the programme for the day that carries the sponsor's logo? It's only a short step from here to saying to a new mother, 'Well we're not supposed to give advice, but xxx is meant to be good'. (Hands up if you work in breastfeeding and have heard that one before?)<br />
<br />
To sum up, sponsoring an event may benefit the sponsor in many ways:<br />
<br />
- goodwill from the participants/organisers<br />
- promotion of the name/logo/brand - on advertising for the event and materials given out<br />
- networking opportunities for staff from the sponsor organisation who may attend the event<br />
- product promotion (some events allow product promotion/stands by sponsors)<br />
- the chance to obtain personal/workplace contact details from participants<br />
<br />
Given the above, I think it's clear that formula companies should not be sponsoring training - any training, not just in breastfeeding - for health workers, and that organisations should have policies in place to avoid conflicts of interest.<br />
<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-64497433821032260272015-04-23T12:10:00.001+01:002015-04-23T12:11:30.819+01:00The Guardian and Danone infant feeding roundtable - and why the politics of breastfeeding matter<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB676yDPpd5i0OOTNXlEInUmLFYghwpZvOwDi1I6HJ4yaVSR2hE0_t_V0SCIRqAaKFi1s4_6aZNn3sg0TqbA5kmvdfdWCMOYVwrOGeLmlM8XvUwKoV-j6103l7_edwzeExebCRcepRZGXt/s1600/GuardianDanone.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB676yDPpd5i0OOTNXlEInUmLFYghwpZvOwDi1I6HJ4yaVSR2hE0_t_V0SCIRqAaKFi1s4_6aZNn3sg0TqbA5kmvdfdWCMOYVwrOGeLmlM8XvUwKoV-j6103l7_edwzeExebCRcepRZGXt/s1600/GuardianDanone.jpg" height="191" width="320" /></a>A couple of weeks ago I <a href="https://twitter.com/Lonely_Scribe/status/584428850102296579">Tweeted</a> my disappointment that the Guardian had decided to run a roundtable discussion in association with Danone Nutricia; yesterday <a href="http://www.pressreader.com/uk/the-guardian/20150422/282218009329545/TextView">an article</a> reporting on the debate appeared in the paper's society section; a full page, with the Danone Nutricia Early Life Nutrition logo clearly displayed, and an explanation that the content is editorially independent (which presumably means that the journalist, <a href="https://twitter.com/JoannaMoorhead">Joanna Moorhead</a>, wrote her piece reporting on the discussion without having the text approved by Danone). As Helen Crichton, head of public affairs for Danone Early Life Nutrition took part in the discussion itself, and Danone was able to suggest topics to be included in the discussion, the term 'editorially independent' is at best only partially accurate.<br />
<br />
Mike Brady, Baby Milk Action's campaigns coordinator, has already published an excellent response to the Guardian article; you can <a href="http://www.babymilkaction.org/archives/3595">read it her</a>e. What follows is my personal response to the article, which attempts to explain some of the reasons it made me so uncomfortable/furious.<br />
<br />
<b>Participants</b><br />
Paul Lindley, founder of Ella's Kitchen<br />
Helen Crichton from Danone itself;<br />
Judy More, freelance dietician. Her <a href="http://child-nutrition.co.uk/bio/">website </a>reveals that she is on the editorial board of the <a href="http://www.jfhc.co.uk/">Journal of Family Health Care</a>, which runs training events sponsored by formula companies including Nestle, Danone and Hipp Organic, and that she has worked for the Infant and Toddler Forum:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"The Infant & Toddler Forum is supported by an educational grant from Danone Nutricia Early Life Nutrition. The views and outputs of the group, however, remain independent of Danone Nutricia Early Life Nutrition and its commercial interests."</span></blockquote>
Professor Paul Gately from Leeds Metropolitan University. He has previously been a speaker at an <a href="http://www.infantandtoddlerforum.org/health-childcare-professionals/study-days/2012">event</a> sponsored by the Infant and Toddler Forum.<br />
<br />
Four of seven panel members have a clear conflict of interest in the discussion, because they are currently, or have been in the past, paid by companies that make profits marketing and selling products aimed at babies and young children. Judy More and Paul Gately's conflicts of interest were not made clear in the article; I found their earlier links to Danone with a simple search.<br />
<br />
A major problem with this sort of 'invitation' roundtable discussion sponsored by a formula company is panel selection. Anyone who's had any sort of training on the International Code of Marketing of Breastmilk Substitutes, who works in breastfeeding, public health or in a Baby Friendly accredited NHS Trust should refuse to be involved. (For more about health worker conflicts of interest, see <a href="http://www.babymilkaction.org/nosponsorship-poster">here</a>).<br />
<br />
<b>Content/discussion</b><br />
Reading the article I found myself occasionally incredulous. Paul Lindley (Ella's Kitchen) is quoted as saying, 'Food is what brings people together, but they're not eating together very often and very young children aren't learning the art of conversation or the joy of eating with others.' This from a man who founded a company that makes pouches of ready-made pureed baby food that babies can slurp alone in their pushchairs without making a mess! Is it just me?<br />
<br />
Dr Lucy Cooke said 'There's a lot of confusion about breastfeeding. The Department of Health says breastfeed to six months, but baby foods say 4-6 months on the jar'. Both Lindley and More, who should both surely understand the Code, the Department of Health guidelines and how information is given to new mothers, given their work, instead perpetuated the confusion, with Lindley appearing to advocate early weaning by saying that the earlier you give children vegetables, the more likely they are to eat them later on. What he didn't say was that early feeding (before six months) with pureed foods like apples, carrots and parsnips, which his company supplies in pouches, displaces breastmilk in a baby's diet and may reduce their overall nutrition rather than improve it.<br />
<br />
I was also deeply uneasy about the suggestion that 'one change that would make a huge difference was to encourage better collaboration between the government and the food industry'. T<a href="http://www.dailymail.co.uk/news/article-2550655/How-food-giants-woo-ministers-Sugar-campaigners-fears-secret-stitch-meetings.html">he food industry already has extensive access to contacts in government</a>, and will lobby hard for its own interests. There is plenty of evidence that if companies are not regulated, then they will not restrain their marketing practices voluntarily. If the industry is so keen to do good, surely it should first put its own house in order: in the case of Danone, with 39 pages of marketing Code violations worldwide in the IBFAN <i><a href="http://www.ibfan-icdc.org/index.php/publications/publications-for-sale">Breaking the Rules, Stretching the Rules 2014</a></i> report, it would seem that the company has plenty of work to do before embarking on seemingly generous public health campaigns. Ella's Kitchen too could look at its early weaning guidance and labelling so that it better reflects the information that mothers are actually given.<br />
<br />
And mothers <i>are </i>often given good information; but we didn't hear anyone talking about it in this debate because of the inherent conflict of interest. Health visitors, midwives and breastfeeding supporters could have painted another picture; one where <a href="http://www.unicef.org.uk/BabyFriendly/">UNICEF Baby Friendly</a> and the <a href="http://www.firststepsnutrition.org/">First Steps Nutrition Trust</a> are sources of clear, independent information for parents. The LIFIB (Lancashire Infant Feeding Information Board) is a great example of how information from companies can be critically reviewed and challenged before being passed on to health professionals (see @The_LIFIB).<br />
<br />
I could go on, and on. I won't, but I will leave you with this quote from my forthcoming book with Gabrielle Palmer for <a href="http://www.pinterandmartin.com/">Pinter and Martin</a> <i><a href="http://www.pinterandmartin.com/why-the-politics-of-breastfeeding-matter.html">Why The Politics of Breastfeeding Matter</a>, </i>which sums up my thoughts.<br />
<blockquote class="tr_bq">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZetCxA1ji74LwLYSLYzWzelWOjcJjMzhx1lPTaTnCvCg1fleGGtEqaERWDCA_FlMAq1rHsK-0EyFus41TabjWkGIuYe3kEKCOTkj_I-hCYL28NsJ6dngRzB_rFXAncBAdboI9j7UYI6ic/s1600/9781780665252.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZetCxA1ji74LwLYSLYzWzelWOjcJjMzhx1lPTaTnCvCg1fleGGtEqaERWDCA_FlMAq1rHsK-0EyFus41TabjWkGIuYe3kEKCOTkj_I-hCYL28NsJ6dngRzB_rFXAncBAdboI9j7UYI6ic/s1600/9781780665252.jpg" height="200" width="128" /></a><span style="color: #cc0000;">"When ‘knowledge’ comes from company promotion [which is what Danone-sponsored activities are] and poorly trained or corrupt health workers, parents and children suffer. <b>Knowledgeable and supported families, who are aware that breastfeeding is normal, that artificial feeding carries risks, and that cheaper, safer baby foods can be made from locally available ingredients, end up healthier and less poor.</b> The Code states that governments are responsible for ensuring that objective and consistent information on infant and young child feeding is provided. But it is hopeless to invest public money in providing such information if it is eclipsed by promotional untruths."</span></blockquote>
<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com4tag:blogger.com,1999:blog-5647340539604305311.post-49824179463152874582015-03-05T11:03:00.002+00:002015-03-05T11:03:53.079+00:00Nutrimum: new product, same old formula company tacticsThis morning the <a href="http://www.firststepsnutrition.org/">First Steps Nutrition Trust</a> newsletter hit my inbox (if you don't get this already I highly recommend it). They've issued a <a href="http://www.firststepsnutrition.org/pdfs/Statement_on_nutrimum_Mar_2015_final.pdf">statement on nutrimum</a>, a new product on the market that I'd heard about thanks to a <a href="https://www.facebook.com/ynm2006/photos/a.719443204748582.1073741827.194143293945245/1057731340919765/?type=1&theater">Facebook post</a> from Michael Walne at <a href="https://yournutritionmattersuk.wordpress.com/">Your Nutrition Matters</a> (who is busy writing evidence-based nutrition books for the Pinter and Martin <a href="http://www.pinterandmartin.com/why-it-matters.html">Why It Matters</a> series at the moment).<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ECzXO4LElKJOqgjSSE3Rtv-8P5CvrJJTidvP03RxbB5n-MULUucyTmL3vUg9q-2IXB8wZvcX-ABeY3DEHPUMGxkY1F4cq9YPTMwnQUEDJeF6V0FJDWE1dYeUvI_UNolPoBDuE6qvz7Me/s1600/Nutrimum_Boots.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ECzXO4LElKJOqgjSSE3Rtv-8P5CvrJJTidvP03RxbB5n-MULUucyTmL3vUg9q-2IXB8wZvcX-ABeY3DEHPUMGxkY1F4cq9YPTMwnQUEDJeF6V0FJDWE1dYeUvI_UNolPoBDuE6qvz7Me/s1600/Nutrimum_Boots.jpg" height="216" width="320" /></a><a href="http://www.nutrimum.co.uk/">Nutrimum</a> is a range of cereal bars and granola aimed at pregnant and breastfeeding women, made by Nutricia, owned by <a href="http://www.danone.co.uk/">Danone</a>, which makes Cow & Gate and Aptamil infant formula. The new products are currently available through <a href="http://www.boots.com/">Boots</a> stores and are heavily marketed on the <a href="http://www.boots.com/en/nutrimum">Boots website</a>, with advertorials accompanied by 'buy now' prompts. The advertorials stress the importance of maternal nutrition during pregnancy and breastfeeding; the clear implication is that the nutrimum bars and cereals can form part of the healthy diet that is being discussed. <b>Associating general nutrition information with specific products is a deliberate strategy.</b> Marketing products that combine food<br />
and supplements through a store such as Boots, which although it has dropped 'the chemist' from its name still has a reputation for selling pharmacy products, also helps to support the idea that these products are somehow 'scientific' or 'beneficial' (they aren't). <b>Using partner organisations for 'reputation transfer' is a tactic often used by formula manufacturers</b>: for example in 2013 Danone sponsored a 'Big Toddle' in aid of <a href="http://www.barnardos.org.uk/">Barnardos</a> to promote its Cow & Gate brand.<br />
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The First Steps Nutrition Trust <a href="http://www.firststepsnutrition.org/pdfs/Statement_on_nutrimum_Mar_2015_final.pdf">statement on nutrimum</a> explains how the products undermine public health by stating that women should stop taking other supplements (which will have been recommended to them by midwives or health visitors in accordance with current guidelines) while consuming the products. Folic acid (which is recommended for those who are planning a pregnancy and pregnant women) and vitamin D (recommended for all pregnant and breastfeeding women) supplements are widely available in supermarkets and pharmacies at low cost, or may be free on the Healthy Start scheme. The nutrimum products are expensive: the cereal bars cost £4.99 for five bars, or £1 a day. A large part of the cost of the product will go on marketing. (<b>As with infant formula, the marketing is paid for by those who buy the product.</b>) Equivalent vitamin D and folic acid supplements cost just pennies per day. The cereal bars and granola are highly processed and high in sugar; the main ingredient (listed first in the ingredients list) in the bars is glucose syrup (sugar). A crucial difference between granola/cereal bars and vitamin supplements is that the granola/bars are <i>food</i> - they will fill you up, and increase your blood sugar levels, potentially displacing more nutritious foods (vegetables, fruit, nuts, eggs, meat) in your diet. Tablets and liquid supplements do not have this effect.<br />
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<b>When formula companies stress the importance of nutrition while breastfeeding, they do so in order to make breastfeeding seem difficult, expensive and inconvenient - an unachievable ideal.</b> Mothers who doubt the quality of their breastmilk may turn to formula for 'reassurance' that their babies are getting all that they need. In reality there is little difference in the nutritional profile of breastmilk worldwide: mothers everywhere, despite wide variations in diet, produce milk that will nourish their babies and keep them healthy. A mother needs good food for her own health, not to support breastfeeding. Mothers in the UK (where nutrimum is marketed) have access to better, cheaper food than these highly processed cereal products that are high in sugar and expensive. As First Steps Nutrition say:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">'Good nutrition from food is perfectly possible for pregnant and breastfeeding mums and we show
how nutrient requirements can be met through simple, cost effective menu choices in practical
eating well resources. The money spent on these supplements could be more wisely used buying fresh and minimally processed foods for the household.'</span></blockquote>
<b>Formula companies target medical and health workers to promote their products</b>. Perhaps the most disturbing part of the First Steps Nutrition statement on nutrimum is the section about how <b>company representatives have contacted infant feeding coordinators and NHS staff</b>. An email to an infant feeding coordinator in February 2015 states that the product is:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">‘designed to meet all the nutritional requirements for mum during pregnancy…and that neonatal nurses are particularly interested in Nutrimum for breastfeeding mums with babies in special care baby units’</span></blockquote>
It's this that makes me actually want to scream. For the last few months I've been working on a short book about the politics of breastfeeding, and this type of contact with health professionals, implying that the product is beneficial for mums breastfeeding special care babies (for which there is certainly no evidence), is reminiscent of all the marketing abuses I've been writing about. That this isn't infant formula doesn't matter. These products offer no benefits, play on fears mothers have about their own and their babies' nutrition, and the profits will line the pockets of the world's second biggest baby milk manufacturer. Thank goodness for the work of First Steps Nutrition and other organisations like <a href="http://www.babymilkaction.org/about-us">Baby Milk Action</a> that scrutinise and monitor the companies. Do visit their websites and join or donate to support their work if you can. And if you work with mothers, tell them that these products are unnecessary, expensive and heavily marketed (and that if they buy them, <i>they</i> are paying for the marketing).<br />
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<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com2tag:blogger.com,1999:blog-5647340539604305311.post-50713078538922377852014-11-28T09:57:00.003+00:002014-11-28T10:00:09.128+00:00BabyFriendly 2014: a conference reportI've just got back from the <a href="http://www.unicef.org.uk/BabyFriendly/Health-Professionals/Conferences/This-years-conference/">UNICEF BabyFriendly Conference</a> 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.<br />
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<tr><td class="tr-caption" style="text-align: center;">Dr Kasja Brimdyr speaking at BabyFriendly conference</td></tr>
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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.<br />
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Unfortunately for Dr Poulter, I wasn't really in the mood for his carefully-worded speech. Earlier in the week I'd read <a href="http://www.theguardian.com/news/2014/nov/24/-sp-is-saving-newcastle-mission-impossible">this article about Newcastle</a> - 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 <a href="http://www.theguardian.com/society/2014/nov/25/disabled-children-cuts-no-conscience-austerity">this article too</a>, 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 <a href="http://bfsupportmatters.org.uk/">Cambridge Breastfeeding Alliance</a>'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...)<br />
<br />
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 <a href="https://www.change.org/p/rt-hon-david-cameron-mp-reverse-the-decision-to-cancel-the-2015-infant-feeding-survey">signing this petition</a> 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.<br />
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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 <b>how a baby is fed can influence the way their genes are expressed</b>, 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.<br />
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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 <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/10/epidural-and-breastfeeding-call-for.html">the effect of epidural on breastfeeding</a>). 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 <i>even more </i>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.<br />
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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.<br />
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<i>Were you at the conference? I'd love to know what your personal highlights were. Leave a comment below...</i>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-32991087915084091192014-11-13T19:09:00.000+00:002014-11-13T19:09:02.189+00:00Exciting times...<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">My desk today.</td></tr>
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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.<br />
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I've done quite a bit of work for <a href="http://www.pinterandmartin.com/">Pinter and Martin</a> 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 <a href="http://www.pinterandmartin.com/coming-soon.html">Pinter and Martin site itself</a> and other bookselling websites.<br />
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The first three books in the series are <i>Why The Politics of Breastfeeding Matters by </i>Gabrielle and Palmer and Susan Last<i> </i>(eek!)<i>,</i> of which more below, <i>Why Doulas Matter</i>, by <a href="http://maddiemcmahon.com/">Maddie McMahon</a>, and <i>Why Hypnobirthing Matters</i>, by <a href="http://www.katrinaberry.co.uk/">Kat Berry</a>; these will be published in March 2015. The next three, to be published in summer 2015, are <i>Why Pre-conception and Pregnancy Nutrition Matters</i>, by Michael Walne (of <a href="http://yournutritionmattersuk.wordpress.com/about/">Your Nutrition Matters</a>), <i>Why Breastfeeding Matters</i>, by Charlotte Young (aka <a href="http://www.analyticalarmadillo.co.uk/">The Analytical Armadillo</a>) and <i>Why Baby-Led Weaning Matters</i>, 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!<br />
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The manuscript for one book has been delivered, the second is well advanced... and I find myself, as joint author of <i>Why The Politics of Breastfeeding Matters</i>, 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.<br />
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Another project I've been involved with is Laura Dodsworth's fabulous photograph/interview book <i><a href="http://www.barereality.net/">Bare Reality</a></i> - 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 <a href="http://www.barereality.net/">looks amazing</a>.<br />
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As if all of the above wasn't enough, I'm thrilled that Milli Hill's book <i>Water Birth: stories to inspire and inform</i> 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 <a href="http://www.positivebirthmovement.org/">Positive Birth Movement</a>, had a third baby and become a columnist for <a href="http://www.bestdaily.co.uk/">Best </a>- 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.<br />
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Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-53752716938930911552014-08-22T11:45:00.000+01:002014-08-22T11:45:30.370+01:00Why 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 <b>breastfeeding past six months</b>, 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 <br />
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<tr><td class="tr-caption" style="text-align: center;">Breastfeeding my poorly 23-month-old</td></tr>
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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).<br />
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There's a lot of focus (at least in my area of Derbyshire, where we've been working towards, and recently obtained, full <a href="http://www.unicef.org.uk/babyfriendly/">Baby Friendly</a> accreditation in the community (DCHS) and the county council (DCC)) on <b>improving rates of breastfeeding initiation and continuation</b> (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 <a href="http://www.unicef.org.uk/">UNICEF</a> 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, <i><b>at least initially</b></i>.<br />
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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 <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/UK-Breastfeeding-rates/">fewer than 1% of mothers exclusively breastfeeding for six months, and only 34% breastfeeding at all</a> 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.<br />
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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.<br />
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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.<br />
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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 <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/why-breastfeed.aspx">NHS</a> and <a href="http://www.who.int/topics/breastfeeding/en/">WHO</a> guidelines, which recommend breastfeeding to two years and beyond, are much more important for her own health and that of her baby.<br />
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What's missing, in all of the above, is an understanding and appreciation of the <i><b>flexibility</b> </i>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?<br />
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It's been heartening to see <a href="https://twitter.com/BoobyandtheBead">Sharon Spink</a> in the news in recent months <a href="http://www.dailymail.co.uk/news/article-2613012/You-wouldnt-childs-favourite-teddy-away-Mother-breastfeeds-five-year-old-daughter-says-WONT-stop-Charlotte-asks-mummy-milk.html">talking about breastfeeding her five-year-old</a>, after <a href="http://www.itv.com/lorraine/hot-topics/poll-is-breastfeeding-a-four-year-old-ok">Michelle Atkin</a> did so earlier in the year. And I loved <a href="http://www.news.com.au/entertainment/tv/the-voice-viewers-react-to-contestant-dallas-james-partner-breastfeeding-their-child-backstage/story-fn8yvfst-1226910159200">this story</a> 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'.<br />
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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 <a href="http://www.babymilkaction.org/">Baby Milk Action website</a>; good information about formula milk is available from <a href="http://www.firststepsnutrition.org/">First Steps Nutrition</a>.)<br />
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<i>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...</i>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-66044764882908071922014-03-12T13:29:00.000+00:002015-04-23T09:44:39.692+01:00Making the case for independent midwifery: The Baby's Coming by Virginia Howes<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2vFpG28PNcnwB7vkFwV3CSQmUblrFy_sY4LMYrT3_LFV6xnwSmkqE3tYDAz07MtfZPctVlXUhyphenhyphenJPmeGR9Si4d2Alc90TnFd3aPeL3zAEXEmh_nTgaNFeQQ9wvwO7_Wqy-rrx0UX9-zFJS/s1600/The+Baby's+Coming.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2vFpG28PNcnwB7vkFwV3CSQmUblrFy_sY4LMYrT3_LFV6xnwSmkqE3tYDAz07MtfZPctVlXUhyphenhyphenJPmeGR9Si4d2Alc90TnFd3aPeL3zAEXEmh_nTgaNFeQQ9wvwO7_Wqy-rrx0UX9-zFJS/s1600/The+Baby's+Coming.jpg" height="320" width="240" /></a>Virginia Howes's book <i>The Baby's Coming - A story of dedication by an independent midwife</i> was published this week, just as the Department of Health announced that the government would not support independent midwives' proposed insurance solution, which means that when new EU legislation is implemented later this year independent midwives will become illegal. To anyone who has had any involvement, however remote, with independent midwifery - even if they've done no more than watch Virginia on TV in ITVs <i>Home Delivery</i> - this must seem like total madness: independent<br />
midwives are highly skilled and offer choice and high-quality care to women with a wide variety of needs, relieve the pressure on an over-stretched NHS and save £13 million per year in costs to maternity services. You can read more about the situation facing independent midwives in <a href="http://www.express.co.uk/life-style/life/463970/Virginia-Howes-risks-jail-after-delivering-500-babies-as-an-independent-midwife">this article</a> in the <i>Express</i>, this <a href="http://www.huffingtonpost.co.uk/angela-horler/independent-midwives_b_4933724.html?utm_hp_ref=fb&ncid=tweetlnkushpmg00000067&src=sp&comm_ref=false">blog by Angela Horler</a> on the Huffington Post, or on the <a href="http://www.independentmidwives.org.uk/">Independent Midwives UK</a> website.<br />
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Reading <i>The Baby's Coming</i> this week, then, means that I have read it with an eye on the wider picture too. And, having read it, it couldn't be clearer to me that if independent midwifery is outlawed then we will have lost something of immense value, and outcomes for the women who would choose independent midwifery if they could will be less favourable as they are forced to birth in circumstances they wouldn't have chosen - either within the NHS or alone and unsupported.<br />
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Although the book is in many ways an entertaining read, packed with wonderful birth stories, moments of humour and everything that birth junkies like me love to read about - it's also profoundly political, stuffed full of clear demonstrations of where there is room for improvement in our maternity services. In a climate where choices in childbirth are becoming limited within the NHS, due to the suspension of home birth services, the closure of stand-alone midwife-led birth centres and fear of litigation - and all this despite a European law that enshrines a woman's right to choose the circumstances of her birth - it seems to me that we need independent midwifery more than ever.<br />
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I'm involved with the <a href="http://www.positivebirthmovement.org/">Positive Birth Movement</a>, and at meetings we share positive experiences of birth and discuss how women can make their own choices and work with their caregivers to ensure their needs are met; in the process we often hear how difficult this can be and debrief previous experiences. Virginia's book, it seems to me, could be seen as almost a manual for mothers and their caregivers for how respectful, woman-centred maternity care should be delivered, whether in home or in hospital, within the NHS or outside it. There are 'scripts' in its pages that mothers (and midwives) could use to great effect and that's a real strength of these stories - they are an antidote to the 'am I allowed'/'will they let me' position that so many women find themselves in and they show how, even in difficult circumstances, you always have a choice about your care and your informed consent should always be sought.<br />
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I had all three of my children at home - with NHS midwives - and I love how the book, again through real-life birth stories, gives a truly realistic picture of what home birth can be, both when all goes well and when there are complications. (I absolutely loved the story of the parents who planned a home birth, went into hospital for monitoring, found all to be fine, then dashed back home again to have the baby in the pool as planned!) Parents considering home birth can read the book and get a sense of the 'back up' that's in place, whether the care is independent or NHS, and feel reassured. On the whole the book is immensely reassuring; it's a long way from the 'drama' of birth on television shows like <i>One Born Every Minute</i>. Even through the (admittedly very unusual!) story of a breech birth that took place <i>in a moving ambulance in a snowstorm</i> there is never a sense of panic, more a sense of wonder that birth can often unfold spontaneously even in the strangest of circumstances. I also relished the moments where traditional (yet evidence-based!) birth wisdom - so easily overlooked in more medicalised births - was in evidence: Virginia describes how something as simple as getting out of the pool could slow down labour enough to give her time to arrive to be with a nervous father worried about having to catch the baby, and how labours that are progressing well can be stalled by people coming in and out and talking to the mother, or turning on the lights. She often talks about the subtle signals women give about what is happening in their labours, without the need for vaginal examinations or calculations of 'rates of progress'. There's valuable knowledge here that we would all do well to take note of.<br />
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It's probably clear by now that I loved this book (I've ordered a few copies for my mobile book stall so I'll be spreading the word...) And I'm with Virginia in hoping that it doesn't become a historical document in the near future: if you can join in the campaign to save independent midwifery, please consider doing so. You can go to the <a href="http://www.independentmidwives.org.uk/">IMUK website</a> and take it from there - lobby your MP, donate to the fighting fund, sign the petition.<br />
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Finally, I wouldn't be an editor worth my salt if I didn't flag up the fact that there are a few proofreading errors in the book, and that some of the dialogue sounds a bit clunky (that's down to the fact that someone decided not to use any contractions - strange, given the subject matter! - so instead of 'I'll' 'I'm' or 'We're' these are spelled out in full). These are minor niggles, didn't spoil my enjoyment of the book and can no doubt be corrected in future editions (of which I hope there are several, revised and updated to include many future birth stories!)<br />
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<i>I received a review copy of the book from Headline; my opinion of it is, of course, my own!</i><br />
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<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com4tag:blogger.com,1999:blog-5647340539604305311.post-43398207640656316562014-02-27T13:29:00.002+00:002014-02-27T13:48:22.422+00:00New breastfeeding research: approach with caution!<div class="separator" style="clear: both; text-align: center;">
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You may have seen <a href="http://www.dailymail.co.uk/health/article-2568426/Breast-milk-no-better-baby-bottled-milk-INCREASES-risk-asthma-expert-claims.html">this article</a> in the <i>Daily Mail</i>, with the provocative headline:<br />
<b>"Breast milk is 'no better for a baby than bottled milk' - and it INCREASES the risk of asthma, expert claims"</b>. Having done some digging, including reading the <a href="http://www.sciencedirect.com/science/article/pii/S0277953614000549">abstract</a>, <a href="http://paa2012.princeton.edu/papers/121767">extended abstract</a>, <a href="http://researchnews.osu.edu/archive/sibbreast.htm">press release</a> and the full text of the scientific paper (Colen, C.G., Ramey, D.M., Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons, Social Science & Medicine (2014), doi:10.1016/j.socscimed.2014.01.027. - available via ATHENS, or to purchase online) that this article is based on, and <a href="http://www.examiner.com/article/are-breastfeeding-benefits-overstated-overrated-or-the-healthiest-way-to-go?cid=rss">other reports</a>, it's clear that the findings of this study should not be dismissed out of hand simply because they appear to contradict what we think we know about the long-term impact of breastfeeding on child health.<br />
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I recently heard scientific research described as 'like a jigsaw puzzle, except that there are no straight edges, and no picture to follow on the box' and thought that this was a useful way of thinking about it. Each new piece of research fits in somehow, but the how and where of it can take a long time to unravel. What's interesting, and what moves our understanding forward, is continuing to delve deeper, and, instead of dismissing results that we instinctively feel are 'wrong', asking 'How did the researchers obtain these results? Are their methods sound? Why did they get the outcomes they did? Are there clues in their work about other things we need to know before we can draw a sensible conclusion? Should we be acting to alter our recommendations or behaviour based on this research, or not?'</div>
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Of course, the above has nothing to do with the poor reporting of the research in the media (for interest, compare the<i> <a href="http://www.dailymail.co.uk/health/article-2568426/Breast-milk-no-better-baby-bottled-milk-INCREASES-risk-asthma-expert-claims.html">Daily Mail</a> </i>article with <a href="http://www.examiner.com/article/are-breastfeeding-benefits-overstated-overrated-or-the-healthiest-way-to-go?cid=rss">this one</a> for an illustration of how different two reports based on the same press release can be). My hackles rose at the line 'The NHS recommends that mothers breastfeed for around six months' - it doesn't, <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/why-breastfeed.aspx#close">it recommends exclusive breastfeeding for around six months and continued breastfeeding alongside other foods after that, with no maximum duration specified</a>. That the most basic of fact-checking hasn't been carried out makes me suspicious of reading too much into the <i>Mail's</i> slant on the story (that, and past experience of the <i>Mail</i>'s anti- breastfeeding/anti-breastfeeding supporter agenda). Looking closer at the piece it follows the press release fairly closely, except that in certain telling ways it exaggerates the impact of this study, despite the authors taking care in their discussions to take a fairly moderate view. Something as simple as the Mail choosing to include a bullet point beneath the headline that reads "Dr Cynthia Colen says the benefits of breastfeeding <i>are</i> exaggerated", when in fact the press release says "A new study comparing siblings who were fed differently during infancy <i>suggests</i> that breast-feeding <i>might</i> be no more beneficial than bottle-feeding for 10 of 11 long-term health and well-being outcomes in children age 4 to 14." (my italics) serves to overstate the importance of this one study in the context of all the research into breastfeeding, artificial feeding and maternal and child health that is currently being carried out. Characterising Dr Colen as a generic 'expert' is another case in point; she's a sociologist, and an assistant professor - but what does this tag of 'expert', as applied by the <i>Mail</i>, mean? That she's more expert than other breastfeeding researchers? That she's the 'best expert' on breastfeeding that there is? There are plenty of other intelligent, committed, qualified researchers into breastfeeding currently working on research that may or may not support the findings of this paper - but the way the Mail uses the term 'expert' here suggests to the reader that this particular paper is somehow more important than others. I've <a href="http://thethoughtfulpublisher.blogspot.com/2013/05/bedsharing-and-breastfeeding-in-media.html">talked before about the danger of believing that each new research paper moves everything 'forward'</a> and it's helpful to remember it here - there are countless blind alleys and twists and turns in the quest for knowledge, and avoiding hyperbole when reporting new research would be a good start in making this more generally understood.</div>
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I've read the full paper and, I've got to confess, I am no statistician, so I am not best-placed to comment on whether the methodology is robust. At first glance, as an interested lay-person, it seems like a useful study, carefully designed to address some of the difficulties of previous studies, with some interesting results. The questions that immediately sprang to mind as I read it, which I would love others to examine in more detail, were the fact that the sample size of the differently-fed siblings was small - could it be that the numbers aren't sufficiently powerful to show statistical significance? I also wondered about breastfeeding duration - the researchers asked whether breastfeeding was initiated, and how long (in weeks) it went on for, but I couldn't find any numbers for this in the paper - what was the mean duration of breastfeeding in these families where one child was bottle-fed and one child was breastfed? If we are talking about the difference between two months or less of breastfeeding and bottle-feeding from birth, I would expect the results to show less of a difference than if we were comparing six months, or a year of breastfeeding against bottle-feeding from birth (based on the research I've read that shows a dose-response effect of breastfeeding on infant health). I found myself wondering about the scenarios in which one child in a family is breastfed and the other bottle-fed and how those might appear in these statistics - a common scenario in our culture of infant feeding in the UK, which I come across regularly as a breastfeeding peer supporter, is that a mother tries breastfeeding with her first baby, stops early due to a lack of support, then doesn't 'put herself through all that again' with subsequent children. I also wondered about whether the results of this study could be extrapolated to the UK or other Western cultures - the <i>Mail</i> certainly seems to think they can, as it was very unclear in their article that this was actually a US study (despite it being clear in the title of the paper itself). Differences in the racial and socioeconomic profiles of our respective societies might be important (indeed, the researchers note that one of the features of the differently-fed group is that the racial profile is different from that of the other two comparison groups, with the highest proportion of black/Hispanic families - although they urge caution in attaching too much significance to this).</div>
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Something else that was interesting to me is how the authors of the paper position themselves in terms of the research and debate surrounding infant feeding. In the introduction the authors write:</div>
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<span style="color: #cc0000;">"Scientifically, disparities in infant feeding practices raise the critical question of the degree to which unobserved heterogeneity between children who were breastfed and those who were not may be driving the frequently noted positive association between breastfeeding and a wide variety of childhood outcomes. <i>If this is the case, a well-intentioned, narrow emphasis on breastfeeding promotion would, at best, fail to realize positive benefits and, at worst, be a source of oppression for women who do not nor cannot breastfeed.</i>" (my italics)</span></blockquote>
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This all sounded familiar to me and there's a reason for that, which becomes clear at the end of the paper:</div>
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<span style="color: #cc0000;">"A truly comprehensive approach to increasing breastfeeding in the U.S., with a particular focus on reducing racial and SES disparities, will need to work toward increasing and improving parental leave policies, flexible work schedules and health benefits even for low-wage workers, and access to high quality child care that can ease the transition back to work for both mother and child. Hopefully, this multifaceted approach will allow women who want to breastfeed to do so for as long as possible <i>without promoting a cult of “total motherhood” in which women’s identities are solely constructed in terms of providing the best possible opportunities for their children and the risks associated with a failure to breastfeed are drastically overstated (Wolf, 2011).</i>" (my italics).</span></blockquote>
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I think this at least sets the paper in context (for more, see my previous post about <a href="http://thethoughtfulpublisher.blogspot.com/2013/02/joan-wolf-and-others-is-breast-best.html">Joan Wolf</a>). I should have guessed from the clue in the title of the research paper, 'Is Breast Truly Best?', which itself echoes the title of Wolf's book.</div>
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Let me be clear - I'm not dismissing the results of this paper. But just as its authors urge caution about overstating the benefits of breastfeeding in order not to oppress women, I urge caution about the importance we attach to the findings reported here, and suggest that we view them instead as one small piece of a very large jigsaw, and as a point of departure for asking further important questions.</div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 10px;"><br /></span>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com25tag:blogger.com,1999:blog-5647340539604305311.post-15795033531182760182014-01-28T13:37:00.000+00:002014-01-28T13:37:02.906+00:00Doctors and breastfeeding - a follow-up postSometimes blogging completely takes me by surprise. Last week I posted about <a href="http://thethoughtfulpublisher.blogspot.co.uk/2014/01/doctors-and-breastfeeding-room-for.html">GPs and breastfeeding</a>. Compared to some of my posts, hardly anyone read it - which is, of course, fine - but those who did then engaged in such fascinating and lengthy debate, on Twitter, on Facebook and by email, that a follow-up post is the result. I guess sometimes you just have to put things 'out there' to get to the heart of the matter.<div>
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(I should probably say that I was in two minds about even posting last week's <a href="http://thethoughtfulpublisher.blogspot.co.uk/2014/01/doctors-and-breastfeeding-room-for.html">piece</a>. I have enormous respect for doctors, the standard of their training and the work they do in tough times for the NHS. On the other hand, I think that when we're considering an issue as thorny as how to raise breastfeeding rates in our society, we have to look critically at everything that might be having an impact and wonder about how changes can be made. Sometimes we'll be barking up the wrong tree. Sometimes new insights will come.)</div>
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One point that I don't think I made well enough last week was actually about breastfeeding supporters (I include myself) and how we respond to articles in the media or comments by individuals. While I think it's right that misinformation be challenged, I can't help feeling that there's an irony in the fact that we can Tweet and blog up a storm - in what is sometimes quite an aggressive way, if only due to the sheer volume of complaints - in response to a media doctor's quote in a magazine, but have no meaningful way of addressing the same misinformation when it's dished out to women one-to-one by a GP or other health professional.</div>
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Some of the comments by doctors in response to my post took me to task - rightly - for calling for more training for GPs when their time and budgets are so sorely stretched, and when every other 'single-issue' group thinks the same about their area of interest. It was pointed out to me that if a GP must do 50 hours of CPD each year, and <a href="http://www.unicef.org.uk/BabyFriendly/Resources/Training-resources/E-learning-for-GPs/">the breastfeeding training</a> takes half an hour, then that means that breastfeeding must be in the top 100 things the GP considers that year (and that's assuming they all take half an hour; some will obviously take longer. Some topics GPs are contractually obliged to cover). When you start to consider the list of things that GPs need to be abreast of (!) you can see why breastfeeding doesn't automatically push itself to the top of the list, particularly in areas with low breastfeeding rates where GPs see very few breastfeeding women, or in areas where there are reasonable breastfeeding support services away from the GP.</div>
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Something that came out of this discussion for me was the idea that there is work to be done in increasing awareness among GPs, possibly via representation to the<a href="http://www.rcgp.org.uk/"> Royal College of General Practitioners</a>, of the public health aspect of increasing breastfeeding rates and the potential beneficial impact on GPs - the cost implications of fewer appointments for ear infection, gastroenteritis and lower respiratory tract infection are outlined in this <a href="http://www.unicef.org.uk/Latest/News/breastfeeding-report-nhs-savings/">UNICEF report</a>. I would love to see a case study showing this in practice.</div>
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Another point that was raised, and which I found fascinating, was the degree to which GP services vary across the country. I mentioned some of our local frustration with tongue-tie referrals via GP - and discovered that in North London tongue-tie referrals can be made by a midwife or IBCLC at a drop-in group, rather than by the GP, and that in Bristol, although four people across the city can snip tongue-ties, one is off sick and thus waiting times are around four weeks (a long time in the context of a troubled breastfeeding relationship). In some GP practices in the south-east parents can self-refer to an in-house GP for tongue-tie cutting, although the long-term availability of that service can't be guaranteed. Is there anything that can be done about this variability? It was suggested to me that breastfeeding supporters engage with CCG pharmacists and educationalists to discuss issues of prescribing for lactating mothers and best practice in treating breastfeeding women and infants, and I wonder if there's an opportunity - somehow, for someone - to do that work.</div>
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Finally, some really interesting ideas surfaced from the discussion. These included finding ways to have more IBCLCs working in or alongside the NHS, perhaps in larger GP practices or rotating between several practices, and the idea of increasing the numbers of peer supporters by offering <i>them </i>a £200 voucher incentive (<a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/11/breastfeeding-incentives-in-media.html">as opposed to the mothers themselves</a>). I also loved <a href="http://breastfeeding.nichq.org/Newsroom/Breastfeeding-Training-Requires-Creativity-01-2014.aspx">this link</a> about innovative ways in which breastfeeding training is being delivered to busy doctors and nurses in the US.</div>
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In the end, it's a problem with no easy solution. But another common theme of the discussion was frustration with the way things are - on both sides. Perhaps we (and by we I mean anyone with an interest in breastfeeding) can start by broaching the subject with our own GP practices - we might at least open a dialogue that could be beneficial. Some great resources for doctors are Wendy Jones's book <a href="http://www.amazon.co.uk/Breastfeeding-Medication-Wendy-Jones/dp/0415641063/ref=pd_sim_b_1"><i>Breastfeeding and Medication</i></a> and Dr Thomas Hale's <a href="http://www.amazon.co.uk/Medications-Mothers%2527-Milk-15th-Thomas/dp/0984774637/ref=sr_1_1?s=books&ie=UTF8&qid=1390472041&sr=1-1&keywords=hale+medication+and+mothers+milk" style="font-style: italic;">Medications and Mother's Milk</a>. The <a href="http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk-information-and-factsheets.html">Breastfeeding Network's factsheets</a> are another excellent source of information for GPs.</div>
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<i>Thanks to all those who contributed to the discussions of the original <a href="http://thethoughtfulpublisher.blogspot.co.uk/2014/01/doctors-and-breastfeeding-room-for.html">post</a>.</i></div>
Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com0tag:blogger.com,1999:blog-5647340539604305311.post-10964992056501667952014-01-22T20:54:00.001+00:002014-01-30T11:03:53.996+00:00Doctors and breastfeeding - room for improvement<div style="text-align: right;">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOXuC8f69UEclFZ0eqmhyphenhyphenLYr0JXNnZmjO53nX9BBQV1UzBt7x2isfaWoUU6aBbJvDam4C18780EMHK3GQg29Mz2C6xmQDc9lUfOewY5bZslS8RxMG2MFxsMLzdIy2NH2MCxY3XIhdxAJMt/s1600/42+Michelle+pic+blond+boy.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOXuC8f69UEclFZ0eqmhyphenhyphenLYr0JXNnZmjO53nX9BBQV1UzBt7x2isfaWoUU6aBbJvDam4C18780EMHK3GQg29Mz2C6xmQDc9lUfOewY5bZslS8RxMG2MFxsMLzdIy2NH2MCxY3XIhdxAJMt/s1600/42+Michelle+pic+blond+boy.JPG" height="132" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image from <i><a href="http://www.amazon.co.uk/Fit-Bust-Alison-Blenkinsop/dp/1905179103">Fit to Bust</a> </i>by Alison Blenkinsop,<br />
published by Lonely Scribe. It appears opposite<br />
a page criticising Dr Jessen for overlooking the <br />
importance of breastmilk for toddlers in 2010.</td></tr>
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This post has been prompted, in part, by the Twitter-storm yesterday about Dr Christian Jessen's comments on breastfeeding, published in <i>Closer </i>magazine this week. He complained he'd been misquoted; <i>Closer </i><a href="http://www.closeronline.co.uk/2014/01/dr-christian-in-twitter-breastfeeding-storm">issued an online clarification</a> - my feeling was that although he <i>had </i>been misquoted, there was still quite a lot wrong with what he'd actually said. Luckily I don't need to take his words to pieces - the fabulous <a href="http://www.analyticalarmadillo.co.uk/2014/01/the-award-for-magazine-doctor-who-talks.html">Analytical Armadillo, IBCLC</a> and Tracy at <a href="http://evolutionaryparenting.com/dear-dr-christian/">Evolutionary Parenting</a> have already done a brilliant job, complete with plenty of references to actual research. Baby Milk Action have issued <a href="http://info.babymilkaction.org/news/campaignblog220114">a comment</a>, and Milli Hill has written a piece for <a href="http://www.bestdaily.co.uk/your-life/news/a545907/how-did-dr-christian-get-breastfeeding-advice-so-wrong.html"><i>Best </i></a>about it.<br />
<br />
Coincidentally, I was thinking about doctors and breastfeeding yesterday anyway. I came across <span id="goog_609490075"></span><a href="http://www.derbyshiremedicinesmanagement.nhs.uk/images/content/Prescribing%20Guidelines/Prescribing%20%20for%20oral%20thrush%20in%20babies%20(2)%20doc%20revised%202013.pdf">this PDF</a><span id="goog_609490076"></span> about the management of thrush in breastfeeding women, written by an Infant Feeding Specialist in Derbyshire, which distils current thinking and best practice for doctors and prescribers, and circulated it to our group of peer supporters. We encounter a lot of mums who struggle to get the treatment they need from GPs and I thought it might be helpful if we could point them to this resource. We shouldn't really have to: I don't think it's unreasonable to expect GPs to have an up-to-date working knowledge of breastfeeding.<br />
<br />
Dr Christian Jessen is a high-profile example (there are others: Dr Ranj Singh, Dr Carrie Ruxton, Dr Ellie Cannon) of a doctor who is regularly invited to comment on general health matters, including breastfeeding, despite having no specialist knowledge in the field. In this, he's not unlike GPs across the country who see breastfeeding mothers in their surgeries day in, day out. What comments like Dr Jessen's show, writ large across our national media, is how little our doctors often know about breastfeeding - not only in terms of actual lactation, but also in terms of how a breastfeeding relationship affects the lives of mothers and their babies. The implications of this are profound: the high-profile media doctors' inaccurate pronouncements undermine the efforts of those striving to improve breastfeeding rates, in pursuit of gains in public health and reduced cost to the NHS, and provoke online rows that often divide breast and bottle feeders and reinforce tired stereotypes. And<br />
GPs in their surgeries nationwide, if they do not have training in breastfeeding or prescribing for breastfeeding mothers, are being equally unhelpful.<br />
<br />
Every peer supporter I know has a story to tell about breastfeeding advice from GPs (sometimes unsolicited when attending for something unrelated!). Here are just a few examples we've come across recently in our own area:<br />
<br />
- a mum told to stop breastfeeding for 48 hours while on high-dose antibiotics. It transpired she wasn't taking a high dose and that it was safe to continue breastfeeding.<br />
- a mum told to stop breastfeeding for two weeks (!) in order to pump all feeds to 'see how much she was making'.<br />
- a mum referred to GP to request a tongue-tie referral (HV sent mum to GP after peer supporter raised issue). In our area this simply requires GP to fax consultant. However, GP insisted that tongue-tie would split on its own, that it didn't affect feeding (it was) and that he would prescribe Gaviscon for the infant's reflux (which was probably due to the tongue-tie...)<br />
- one mum mentioned the <a href="http://www.who.int/topics/breastfeeding/en/">WHO guidelines</a> to her GP, and was told they only applied in developing countries (they don't).<br />
- a mum with persistent ductal thrush was told no further treatment was possible, despite having been told by another GP at the same practice to come back for stronger/longer meds if necessary. Dr eventually looked it up and realised this was true.<br />
- a mum whose GP called her 'ridiculous' for still breastfeeding her 18-month-old.<br />
<br />
Earlier this week I saw a status from Wendy Jones, on her <a href="https://www.facebook.com/pages/Breastfeeding-and-Medication/326510154041002">Breastfeeding and Medication</a> page, bemoaning the number of calls she's had recently from mothers of young babies, <i>who've never experienced pain-free breastfeeding</i>, who've been 'diagnosed' and treated for thrush which is not resolving. These women need help with position and attachment (and possibly tongue-tie!), not thrush treatment, and their GPs should realise this.<br />
<br />
I;m not interested in bashing doctors here. We can't leave doctors out of breastfeeding. They have a crucial role to play, particularly where, as is the case in my area, there's no way of referring women on for BFC or IBCLC support for breastfeeding problems. If the peer supporters and health visitors can't help, mums must go via the GP for any onward referral. But our GPs need to be up to speed, and the examples above show that many are not.<br />
<br />
I've done a bit (and only a bit) of digging into where the problems arise. GPs in practice now may have followed quite different training pathways from each other. It's entirely possible that a doctor qualified as a GP having never done an obstetrics/gynaecology/paediatrics rotation in training, which it seems is where exposure to breastfeeding problems would come in. However, even then trainee doctors may have been warned off by midwives from giving breastfeeding advice - disempowering them from the start and leaving them with the distinct impression that breastfeeding is something dealt with by 'others'. While this might be true in a teaching hospital situation with highly trained midwives and infant feeding specialists on staff, it doesn't help that doctor a few years later when faced with a waiting-room full of mothers and babies. Not all doctors find it easy to say to patients that they are unsure about something and need to look it up; not all doctors are aware of the importance of breastfeeding to the breastfeeding mothers themselves. Some doctors have personal experience of breastfeeding issues - and I don't discount the value of that - but in the absence of additional training, using one's own experience to advise patients can cause its own problems. Indeed, peer supporters, health visitors and midwives who are trained to support breastfeeding mothers are encouraged to debrief their own experiences and then leave them aside when dealing with other mothers, whose circumstances may be very different, to concentrate on giving good, evidence-based information.<br />
<br />
There is some good news: doctors-in-training today should have at least a cursory knowledge of breastfeeding. At Keele University, for example: "...there is formal teaching about breastfeeding, to support problem-based learning in the context of a growing family, for students in their first year. Thereafter students will meet the issues [diagnosing and treating breastfeeding problems like thrush and mastitis, prescribing for lactating women] as part of their learning on placements – they have units on Child Health and Women’s Health in secondary care; and extensive patient contact in primary care placements (22 weeks across the curriculum, of which 15 are in final year). <i>One difficulty is that much of the peri- and ante-natal care that GPs used to do is now done via midwives and students have much less contact with them for learning opportunities." </i>(my italics)<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNDHHGMYMA-kFWzIbTTupte1DAzZu2kRNEzeaIvW8QGv_sjsDRbs5FStxYO3l9OuLWYvAGM_NBgCJmpbfygzW8NRxAl7Jh7JUA7r1WowEJBugRELfdajXW7yUqrUyjKlWjBqnw6HIPhFaB/s1600/GP+learning.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNDHHGMYMA-kFWzIbTTupte1DAzZu2kRNEzeaIvW8QGv_sjsDRbs5FStxYO3l9OuLWYvAGM_NBgCJmpbfygzW8NRxAl7Jh7JUA7r1WowEJBugRELfdajXW7yUqrUyjKlWjBqnw6HIPhFaB/s1600/GP+learning.png" height="203" width="320" /></a>What more can be done to improve GPs working knowledge of breastfeeding? In Derbyshire, where we're aiming for full Baby-Friendly Accreditation, we're encouraging local GPs to do the <a href="http://www.unicef.org.uk/BabyFriendly/Resources/Training-resources/E-learning-for-GPs/">UNICEF Baby-Friendly GP E-learning module</a>: it costs around £10, takes around 25 minutes to complete, and is endorsed by the <a href="http://www.rcgp.org.uk/">Royal College of General Practitioners</a>. The problem is that many doctors don't know that it even exists! Mothers everywhere: contact practice managers at your local surgeries and ask them if your GPs can do this training. It counts for their CPD (continuing professional development). If mothers are better informed, they can push for better service from their GPs. Ask your GP to check whether medication is suitable while breastfeeding, or ask them to look up the relevant Breastfeeding Network fact sheets on the condition they're treating. Ask them who else might be able to help with a breastfeeding problem. Ask your peer supporters which local GPs are most clued-up about breastfeeding.<br />
<br />
I've focussed on GPs today but really, the same applies to any doctor who meets breastfeeding women and their infants regularly. I'm not suggesting all doctors should be breastfeeding specialists, and I understand the pressures that GPs and indeed all doctors operate under - but I would like to see fewer women on the receiving end of poor advice.<br />
<br />
You can read my follow-up piece to this post <a href="http://thethoughtfulpublisher.blogspot.co.uk/2014/01/doctors-and-breastfeeding-follow-up-post.html">here.</a><br />
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<i>What do you think? Have you had poor breastfeeding advice from a GP? How do you think the situation can be improved? Leave your thoughts in the comments!</i>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-77463545181914137012013-11-12T13:12:00.000+00:002013-11-12T13:56:11.554+00:00Breastfeeding incentives in the media spotlight<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMPg8DJMOkmybQq5zpDDEuD0HFdJ_nYYacdxdkEnj_frNRnDIoq5Im9OynNE2w6YCxPgKnuhgb9Ittpv4b0Xw5aTv6sd8MxprCKW-g3ShMMCyTjkd5t_E4PGT1zFUl_NSMhC_XDNyQIPF5/s1600/new+BEARS_logo.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMPg8DJMOkmybQq5zpDDEuD0HFdJ_nYYacdxdkEnj_frNRnDIoq5Im9OynNE2w6YCxPgKnuhgb9Ittpv4b0Xw5aTv6sd8MxprCKW-g3ShMMCyTjkd5t_E4PGT1zFUl_NSMhC_XDNyQIPF5/s200/new+BEARS_logo.jpg" width="157" /></a>It all began last night - our breastfeeding peer support line had a call from a <a href="http://www.bbc.co.uk/5live">Radio 5 Live </a>researcher. As the only BEAR with any previous radio experience (one interview on local radio when <a href="http://www.amazon.co.uk/Breastfeeding-Stories-Inspire-Susan-Last/dp/1905179049">my book</a> came out!) I was chosen to return the call. They wanted to talk about <a href="http://www.shef.ac.uk/news/nr/breasting-incentive-for-new-mums-1.325892">this press release</a> from the University of Sheffield, which describes ongoing research into whether a scheme offering voucher incentives to new mothers might work to increase rates of breastfeeding initiation and continuation<b> in areas where 6-8 week breastfeeding rates are very low</b>. Derbyshire is one of the areas the researchers are looking at.<br />
<br />
Where <a href="https://www.facebook.com/pages/BEARS-Breastfeeding-Support-across-Amber-Valley/222869781137145">BEARS</a> is active, in Amber Valley in Derbyshire, we have areas where breastfeeding rates are very high, and areas where they are very low. Derbyshire as a whole is very committed to breastfeeding: we are aiming to achieve <a href="http://www.unicef.org.uk/babyfriendly">UNICEF Baby-Friendly</a> full accreditation in the community next year. This means that a lot of groundwork in supporting breastfeeding has already been done. We have networks of peer supporters, like BEARS, who run breastfeeding support groups, attend antenatal sessions, go to baby clinics and answer calls on a helpline. We can make home visits to new mums too. We work alongside paid peer supporters, who in the target areas I mentioned above see all new breastfeeding mums on day 3 or 4 after the baby is born. Good statistics are collected and analysed at a county level. All those involved in supporting new mums have had up-to-date training, and we recently had a breastfeeding conference to celebrate our achievements so far and lay out the plan for future improvements. It's important to remember this context when considering whether the incentive scheme might work: here, it would be running alongside all this other support that's already in place. (This point has been overlooked in discussion in the media!)<br />
<br />
I hadn't come across the story, so did some digging beforehand to try to prepare for my radio appearance. My first port of call was the University of Sheffield Public Health <a href="http://www.shef.ac.uk/scharr/sections/ph/research/breastmilk">page on Breast Milk Policy</a>, which explains the idea in more detail. The project, currently in its second phase, looking at the feasibility of the intervention, is a study by researchers - it is <i>not </i>policy, or something that 'will be brought in' as has been widely reported. The page states:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"The results of this study will be used to inform commissioners and other public health decision makers as to the acceptability, feasibility and cost-effectiveness of behaviour change support in the form of vouchers to mothers to breastfeed in neighbourhoods with low breastfeeding rates. If effective, the intervention could have a major impact on the long-term health of the population, reducing the risk of disease in infancy, childhood, and adulthood."</span></blockquote>
I wanted to get a sense of the rationale for assessing the idea of an incentive scheme. Earlier this week I'd seen the news that <a href="http://www.bbc.co.uk/news/uk-scotland-24880356">toothbrushing in Scottish nurseries</a>, a simple, low-cost public health measure, had shown good outcomes and saved money in dental costs. The University of Sheffield <a href="http://www.shef.ac.uk/scharr/sections/ph/research/breastmilk/fi">cites other schemes</a>, such as one successful project in Scotland in which pregnant women were given financial incentives to stop smoking during pregnancy, as convincing evidence that it is worth considering whether the approach might be applied to breastfeeding. In my late-night research session I also came across <a href="http://www.kingsfund.org.uk/sites/files/kf/field/field_document/paying-the-patient-kicking-bad-habits-supporting-paper-karen-jochelson.pdf">this study by the King's Fund</a> that supported the idea that payment schemes could be used to modify behaviour in a public health context, even if only to a limited extent.<br />
<br />
Next I talked to other breastfeeding supporters, both from BEARS and, on Twitter, across the country to see what they thought of the idea, hoping to be able to represent them better on the radio. It was a fascinating discussion; it led me to <a href="http://www.abettermedway.co.uk/healthyeating/breastfeeding.aspx">this interesting scheme</a> that's already underway in Medway, in Kent. Emma Pickett, IBCLC and co-chair of the <a href="http://abm.me.uk/">ABM</a>, pointed out that it demonstrates our understanding of how breastfeeding benefits entire communities, and that spending relatively small amounts of money on public health interventions can reap great rewards, both financially and in terms of improved health for mothers and babies. I was reminded of the <a href="http://www.unicef.org.uk/Latest/News/breastfeeding-report-nhs-savings/">UNICEF report</a> I <a href="http://thethoughtfulpublisher.blogspot.com/2012/10/good-news-for-breastfeeding-supporters.html">blogged about </a>last year, which showed that even small increases in breastfeeding rates could lead to large savings for the NHS - the headline figure was £40 million and was a conservative estimate. As local peer supporters we had concerns about the details of the scheme on the ground, and we were certain that any scheme would have to be tied in with the existing support, but we agreed that if it encouraged more mothers to at least consider the possibility of breastfeeding then that would be a good thing.<br />
<br />
So I approached my radio interviews this morning (you can catch them <a href="http://www.bbc.co.uk/programmes/p01jtbn3">here</a> at 1:07:53, <a href="http://www.bbc.co.uk/programmes/b03h3jb6">here </a>at 2:24 and <a href="http://www.bbc.co.uk/programmes/p01kbzks">here</a> at 1:25:23) cautiously positive about the scheme, and tried to talk about how such a measure could never replace the kind of peer support we offer, but might work alongside it to encourage a few mums who feel breastfeeding isn't for them to give it a try. I'm not sure how well the interviews went - let me know what you thought in the comments! - but I was interested to see, when I got home from the studio, how the debate continued to unfold across the various media channels; on TV, radio and on <a href="http://www.mumsnet.com/Talk/breast_and_bottle_feeding/1908893-Being-paid-to-breastfeed-your-thoughts">Mumsnet</a>. Somehow the way in which the story has been reported has provoked many of the same old comments about breast and bottle feeding that we've come to expect, and the <a href="http://www.bbc.co.uk/programmes/b006wr3p">Jeremy Vine</a> show trotting out Katie Hopkins to talk all over one of the actual researchers didn't make for particularly illuminating discussion. One Mumsnetter, TarkaTheOtter, hit the nail on the head:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"I expect the reporting on this is being a bit disengenous. Sounds like an academic study on the role of incentives in public health rather than a proposed govt initiative."</span></blockquote>
The way in which this story has been reported, as if it were an actual, real-life policy that's about to be implemented, rather than a small feasibility study making up part of a research study that might one day inform policy-making, forces people to form opinions, comment and potentially get angry or emotional in a way that is at odds with the reality of the situation. Nicky Campbell covered the story on <a href="http://www.bbc.co.uk/programmes/b0070htg">Your Call</a> with painful stories from women who'd had a tough time breastfeeding and hadn't had access to the support they needed and wanted; I feel for those women and I give my time as a volunteer peer supporter because of them, but I don't think their experiences should prevent us from truly examining all the potential ways in which we might work to raise breastfeeding rates in this country.<br />
<br />
Reflecting on all the talking, Tweeting and interviews that have gone on today some unintended consequences have made me smile. First was the surprise of the 5 Live researcher when I explained that research shows that it's pregnancy, rather than breastfeeding, that causes saggy boobs (strike one for evidence-based education!), second was explaining twice on live radio that breastfeeding isn't best, it should just be normal, to people unfamiliar with that idea (strike two!) and third was meeting the leader of Derby City Council in the lobby at Radio Derby, who told me that the council chamber has a breastfeeding welcome sign on it. Nice.<br />
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<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com3tag:blogger.com,1999:blog-5647340539604305311.post-67089845106002806822013-10-28T21:26:00.000+00:002013-10-29T07:17:36.174+00:00Breastfeeding in swimming pools - Virginia Howes takes up the causeEarlier in the year <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/08/breastfeeding-in-swimming-pools-what-do.html">this post</a> about breastfeeding in swimming pools became one of my most read ever - and I'm disappointed, after all the debate about those cases, to be revisiting the subject again so soon.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkOusghKEqfLQNeb2BapbDeWBahNDzg9RRqtrm9o856IZsnqGAo6zcMvdsIixPkCdNxVmyTgvZRWfO7MMI1TEnZ-4_263CnU9GtoKSVsv-Fhc-sVF-sLPo_LOX4emAHEVdnvxjECponjyV/s1600/Virginia+and+Sophie.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkOusghKEqfLQNeb2BapbDeWBahNDzg9RRqtrm9o856IZsnqGAo6zcMvdsIixPkCdNxVmyTgvZRWfO7MMI1TEnZ-4_263CnU9GtoKSVsv-Fhc-sVF-sLPo_LOX4emAHEVdnvxjECponjyV/s320/Virginia+and+Sophie.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Virginia and Sophie Howes</td></tr>
</tbody></table>
On 26 October, Sophie Howes, a midwife and mother of two, was feeding her baby at the edge of the pool, partially submerged in the water, at the <a href="http://www.ashfordleisuretrust.co.uk/centres/e/the-stour-centre">Stour Centre in Ashford</a> when she was approached by the manager and asked to move to somewhere where she couldn't be seen. Apparently one of the lifeguards, a woman, was so 'offended' by the sight of a baby breastfeeding that she was 'unable to do her job properly'. Sophie, who left the pool and continued to feed her baby during the conversation (apart from one moment when the baby let go to look up at the manager - a mental image that has really made me smile) refused to move and pointed out that the manager was breaking the law (you can read what the law says <a href="http://www.maternityaction.org.uk/sitebuildercontent/sitebuilderfiles/breastfeedingpublicplace.pdf">here</a>). The manager, however, insisted she move, citing 'company policy' (which she said she would email to Sophie later). Upset by the incident Sophie and her party left the centre.<br />
<br />
And that might have been the end of it - another day, another breastfeeding mother discriminated against and belittled for responding to the needs of her baby, while going about her normal daily business - but Sophie is the daughter of Virginia Howes, independent midwife and star of ITV's <i>Home Delivery</i>, campaigner and author, who, as an outspoken advocate of the rights of women and their babies has both encouraged Sophie to complain about her treatment and taken up the cause: as she sees it, not only was the way that this individual case was handled indefensible, but it is also evidence of a widespread lack of awareness of the law that applies to breastfeeding mothers in our society. The law, as I said in my <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/08/breastfeeding-in-swimming-pools-what-do.html">previous post</a>, is there to protect women and their babies from being harrassed or victimised. As I wrote then:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"Regardless of how other individuals might have acted, or chosen to feed, or cover, or not, <b>the law protects us all</b>, whatever we decide to do. A mum who fed out of the pool, or in the changing room, or in the lobby, or under a towel, or at home before bringing the baby in, has just the same right to be respected by staff as the mum who, for whatever reason, fed in the pool itself."</span></blockquote>
And in this case, respect was the last thing Sophie got. When Virginia Howes called the centre manager to discuss the incident, the manager claimed that if a lifeguard, or a member of the public, was offended by seeing a woman breastfeed, in the pool or in the cafe, then it was the manager's duty to speak to the mother and ask her to move, because it is a public place! This is totally backwards, since <i>the breastfeeding mother</i> is the party protected by the law. If nothing else it highlights a serious lack of training at the Stour Centre, and I suggest that it's unacceptable for the manager of a public leisure facility to have such a lack of understanding of her responsibilities in this area. (I refer her to my previous post about <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/08/breastfeeding-in-swimming-pools-what-do.html">what should have happened</a>!) And as for customer service...<br />
<br />
You might expect, in the face of the high-profile coverage of the other swimming pool stories, and given the widespread response to this latest discrimination, that the pool, the council and everyone concerned might swiftly issue an apology and attempt to make amends. Unfortunately, that hasn't happened. You can read the correspondence on Virginia Howes' <a href="https://www.facebook.com/virginia.h.midwife">Facebook page here</a>: the pool's representative has attempted to justify the position taken by the manager. Many of her 'health and safety' points were robustly debunked by the Analytical Armadillo, IBCLC <a href="http://www.analyticalarmadillo.co.uk/2013/08/breastfeeding-in-swimming-pools.html">here </a>the last time the issue was debated; and indeed, many of those commenting on the campaign have pointed out that baby swimming instructors often <i>recommend </i>that babies are fed in the water to stop them getting cold! It also seems telling that the promised 'centre breastfeeding policy' has not materialised, despite repeated requests.<br />
<br />
When I first heard Sophie's story I was saddened - as I always am when breastfeeding mothers and their babies are targeted - and I've been appalled at the response to the many complaints that have been lodged. But this time I think the issue will not be swept under the carpet - Sophie and Virginia have so many supporters that the campaign that ensues might succeed where others haven't. If they can raise awareness, and break down some of the barriers to breastfeeding that currently exist in our society, then that will be a great thing. And I can't help feeling just a little bit excited about that.Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com94tag:blogger.com,1999:blog-5647340539604305311.post-57803362031366105022013-10-16T13:04:00.000+01:002013-10-16T13:04:38.052+01:00Epidural and breastfeeding: a call for better information<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsAkcxCRaR3e3tC6n4BSnhhMW7iewKOrdTm33CnINQajhcvSRwFdqK0WQL9KZ7Cmv3SwtdwINWqK0_mt115OnSvB1407n3ZenH4QHv-bL8DmyQ7vIM6fBFjm83K3-RRe89WwqnTml3wPwF/s1600/epidural-150x150.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsAkcxCRaR3e3tC6n4BSnhhMW7iewKOrdTm33CnINQajhcvSRwFdqK0WQL9KZ7Cmv3SwtdwINWqK0_mt115OnSvB1407n3ZenH4QHv-bL8DmyQ7vIM6fBFjm83K3-RRe89WwqnTml3wPwF/s1600/epidural-150x150.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="background-color: #f2f2ee; color: #666666; font-family: Georgia, Times, 'Times New Roman', serif; line-height: 16px;"><span style="font-size: xx-small;">Image by ammateo - Creative Commons</span></span></td></tr>
</tbody></table>
Earlier this year a single line in Michel Odent's recently published book <i><a href="http://www.amazon.co.uk/Childbirth-Future-Sapiens-Michel-Odent/dp/1780660952">Childbirth and the Future of Homo Sapiens</a></i> (Pinter and Martin, 2013) jumped out at me: <b>'The most common technique of epidural anaesthesia (with an opioid analgesic) has documented negative effects on the quality and the duration of breastfeeding.' </b>It piqued my interest because I couldn't recall ever having come across a discussion of the effects of epidural on breastfeeding: intravenous pethidine, yes, but epidural? I started by looking up Odent's reference and reading the <a href="http://www.ncbi.nlm.nih.gov/pubmed/16306734">original research paper</a>; <a href="http://www.ncbi.nlm.nih.gov/pubmed">Pubmed </a>then led me <a href="http://www.ncbi.nlm.nih.gov/pubmed/12583645">to this study</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/17980469">this one</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/15321436">this one</a>. While all the studies call for further research, they also all show demonstrable effects of epidural on breastfeeding behaviour in mothers and babies.<br />
<br />
I was surprised not to have come across this information before, having had three babies in the last few years and having trained as a breastfeeding supporter. I did antenatal classes with the NCT, and while I clearly remember the discussion about pethidine making infants drowsy, and the impact this could have on breastfeeding, I don't remember breastfeeding problems being talked about as a possible side-effect of epidural, although the increased risk of instrumental delivery was certainly made clear. Indeed the <a href="http://www.nct.org.uk/birth/pain-relief-during-labour">NCTs page on pain relief</a> in labour states clearly that pethidine may make the baby drowsy and thus make breastfeeding harder to establish, but does not make the same explicit link for epidural. When I was pregnant I was given <a href="http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/Info%20for%20Mothers/archives/Pain%20relief/2005_oct_OAA-Pain_Labour.pdf">this leaflet</a> on pain relief in labour - which claims that with epidural <b>'Breast-feeding is not impaired, in fact it is often helped.'</b>! (I'd be interested to know whether mothers are still being given this leaflet - let me know in the comments! - as I have numerous problems with it that might provoke a whole new blog post...) The <a href="http://www.nhs.uk/Conditions/Epidural-anaesthesia/Pages/Sideeffects.aspx">NHS Choices page</a> about the side-effects of epidural is brief, does not mention breastfeeding, and gives no indication of absolute risk (using figures such as 1 in 100) to enable women to make an informed choice. <b>It seemed that accessible, up-to-date information about the potential side-effects of epidural, including on breastfeeding, was hard to come by</b>.<br />
<br />
I've never had an epidural - through luck, preparation, or most likely a combination of the two, I had three unmedicated home births. But I have had a spinal headache caused by a dural tap during a lumbar puncture (a complication that occurs in 1% of epidurals) - which was so awful that when faced with having the same procedure again years later, I collapsed in tears in front of the doctor, to his surprise and my own. A side-effect of that dural tap was a three-day separation from my older breastfeeding baby! So I was interested to find out more about the effects of epidural, particularly on breastfeeding. And when I started talking about it I found that women were quick to share their own experiences: from a very limited sample of just a few mothers I heard stories of a newborn whose sucking reflex was inhibited because of a reaction to the epidural, and of a mother who experienced such uncontrollable shaking as a result of the epidural that she could not hold or feed her baby for several hours after birth. Another mother described how the effects of the epidural (the need for a catheter, and the tingling in her legs) affected her movement for 12 hours after birth, leading to problems getting her baby out of the crib and into a good position for breastfeeding. A search of the <a href="http://www.thealphaparent.com/2013/10/triumphant-tuesday-breastfeeding-baby.html">Alpha Parent's Triumphant Tuesdays</a> series of posts shows that many of the women, who have overcome considerable difficulties to breastfeed, gave birth with an epidural. But these were anecdotes, and I needed more data.<br />
<br />
An internet search for articles led me to the La Leche League International page; their <a href="http://www.lalecheleague.org/ba/nov99.html">article</a> is interesting, but dates from 1999. One of the best resources I found is Sarah Buckley's well-referenced article <a href="http://www.sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby">Epidurals: risks and concerns for mother and baby</a> (2005), which specifically discusses breastfeeding. In addition to these I've also looked at <i><a href="http://www.amazon.co.uk/Birthing-Practices-Breastfeeding-published-Publishers/dp/B00E6T66N6">The Impact of Birthing Practices on Breastfeeding</a></i> by Mary Kroeger with Linda J. Smith, <i><a href="http://www.amazon.co.uk/The-Hormone-Closeness-Oxytocin-Relationships/dp/1780660456">The Hormone of Closeness</a></i> by Kerstin Uvnas Moberg, <i><a href="http://www.amazon.co.uk/Birth-Matters-Ina-May-Gaskin/dp/1905177585/">Birth Matters</a></i> by Ina May Gaskin and <i><a href="http://www.amazon.co.uk/Childbirth-Age-Plastics-Michel-Odent/dp/1905177542">Childbirth in the Age of Plastics</a></i> by Michel Odent in terms of what they say about epidural and breastfeeding.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-2GavHlq0CtR-9SKlvp6-xtp7U9dCy3dstARFvfMheeiBSFYBfxOJjHya3gBXWb4YRTp8mqkBaeEN04bE4L1nNqt3BIyzTTYUvvhwb25GBZHSZagb_16oIQpfEnVZZhn2JVMIhp8_TPbz/s1600/Hormone+of+Closeness.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-2GavHlq0CtR-9SKlvp6-xtp7U9dCy3dstARFvfMheeiBSFYBfxOJjHya3gBXWb4YRTp8mqkBaeEN04bE4L1nNqt3BIyzTTYUvvhwb25GBZHSZagb_16oIQpfEnVZZhn2JVMIhp8_TPbz/s200/Hormone+of+Closeness.jpg" width="125" /></a>So what did I learn from all this research? There is now a growing body of work focussing on the critical importance of a woman's natural oxytocin (synthetic oxytocin, used in induction and to augment labour, acts differently) in promoting behaviours in mother and infant that help to establish breastfeeding and attachment, with <b>a woman's oxytocin levels reaching a lifetime peak just after she gives birth - unless she has an epidural</b>. As Uvnas Moberg explains:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"An epidural anaesthetic not only blocks the activity in the nerves in the spinal cord that transmit pain, but also in the nerves that lead to the release of oxytocin normally triggered when the baby's head is pushing against the cervix. Consequently, mothers who receive an epidural also have lower levels of oxytocin during labour." (p.64)</span></blockquote>
A potential side-effect of epidural is <b>a drop in blood pressure</b> (natural oxytocin acts to <i>increase </i>a woman's blood pressure slightly during labour); this may mean that the mother is given fluids via a drip (IV). A baby born to a mother given additional IV fluids may lose more weight than expected in the first few days, leading to concerns about breastfeeding, but this weight loss is is due to the infant excreting the excess fluids. (See <a href="http://www.nancymohrbacher.com/blog/2011/10/31/newborn-weight-loss-and-iv-fluids-in-labor.html">this article</a> by Nancy Mohrbacher for more.) <b>If a new mother's confidence in breastfeeding is dented, it can be hard to repair.</b><br />
<br />
Kroeger and Smith's chapter on pain relief concludes:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"Strong evidence exists from randomized controlled clinical trials that epidural anesthesia can lead to poor progress of labor...need for oxytocin augmentation, a longer second stage, a lower rate of spontaneous vaginal delivery, increased maternal fever, and increased evaluation and treatment of newborns for suspected sepsis...Observational evidence shows that epidural and narcotic analgesia affects inborn feeding behaviours and adversely affects breastfeeding." (p.114)</span></blockquote>
A <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000331.pub3/abstract;jsessionid=F90D76C4D4DC46E934274709C5BFA090.f01t03">Cochrane Intervention Review</a> was carried out in 2011:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">"The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes </span><span style="color: #cc0000;">with epidurals would be helpful."</span></blockquote>
To draw together a few threads: <b>epidural is often associated with synthetic oxytocin</b> (synthetic oxytocin induction provokes painful labour, epidural slows labour progress, synthetic oxytocin augments labour...); <b>this hormonal disruption can interfere with feeding behaviour</b>. An increased <b>risk of instrumental delivery after epidural</b> means pain, stitches and a higher incidence of birth trauma for mothers, and the risk of bruising, swelling and trauma for the infant, <b>which can interfere with early establishment of breastfeeding</b>. IV fluids can distort assessments of baby's weight and dent confidence in breastfeeding. There's an <b>increased risk of post-partum haemorrhage</b> (PPH) after an instrumental delivery; this can lead to breastfeeding problems too, as described in <a href="http://www.ncbi.nlm.nih.gov/pubmed/20504372">this paper</a>.<br />
<br />
There are obvious problems, in our birth culture in the UK, with raising the issue of epidural as a contributing factor in breastfeeding problems. Epidural is common and widely regarded as easy and safe; indeed, there's a cultural perception of it as the 'ultimate' in labour pain relief. (The Lindo Wing, where the Duchess of Cambridge gave birth, reportedly has an epidural rate of 100%). Its efficacy (at relieving pain, although more than 10% of recipients report inadequate pain relief) is seen to outweigh the potential side-effects, although, as this post aims to point out, the true scope of these potential side-effects may be poorly understood, even among health professionals. There's also the (I think) separate issue of women's <i>access </i>to epidural: to be clear, I believe women should have access to the pain relief they need, when they need it - although I want them (and their care providers) to be as armed with the facts as they possibly can. There was a fascinating and in-depth <a href="http://www.mumsnet.com/onlinechats/david-bogod">discussion on Mumsnet</a> with consultant obstetric anaesthetist David Bogod about epidural that covers many important points (although I disagree with him about breastfeeding!).<br />
<br />
Good information empowers everyone. If midwives, maternity support workers, peer supporters and health visitors were more informed about some of the issues I've raised above, it might mean that more women who want to breastfeed, but are considering epidural or through circumstances have ended up with one they didn't plan for, are well supported. All breastfeeding supporters know that women having breastfeeding problems often need to talk through their births, and that this often gives many clues that shed light on their current difficulties: better information about the effects of epidural on breastfeeding can improve how we support these mothers.<br />
<br />
The other side of the coin, of course, is providing women with genuine alternatives to epidural if they want to avoid the risks discussed. Some suggestions:<br />
<br />
- <a href="http://apps.who.int/rhl/reviews/CD003766.pdf">continuous support in labour</a> - shown to reduce need for epidural and thus reduce likelihood of instrumental birth.<br />
<br />
- consider a home birth - research shows that <a href="https://www.npeu.ox.ac.uk/birthplace/results">home birth is safe</a>, particularly for second or subsequent babies, and there are no epidurals at home deliveries (although of course you can transfer in if you do decide you want one). Booking a home birth can keep all options open for low-risk mothers. Information from the <a href="http://data.gov.uk/dataset/infant-feeding-survey-2010">Infant Feeding Survey 2010</a> showed the highest rates of successful breastfeeding initiation and continuation in mothers who birthed at home; at least part of this could be down to the fact that these mothers have neither synthetic oxytocin nor epidural.<br />
<br />
- avoid induction if possible.<br />
<br />
- hospitals should increase access to water for labour, if not birth itself, for a greater proportion of mothers, not just those at lowest risk. Continuous foetal monitoring (CFM) has been shown to have no benefit over the midwife listening to the baby's heart at intervals, so why can't more women labour in water? Michel Odent (in <a href="http://www.amazon.co.uk/Childbirth-Age-Plastics-Michel-Odent/dp/1905177542">Childbirth in the Age of Plastics</a>) describes how labour immersion provides pain relief and also an increase in oxytocin...<br />
<br />
- Finally, I've just read a case-study, in <a href="http://www.birthrights.org.uk/">Birthrights</a>' new <a href="http://www.birthrights.org.uk/wordpress/wp-content/uploads/2013/10/Birthrights-Projects-and-Perspectives.pdf">Projects and Perspectives</a>, published to coincide with their Dignity Forum on 16 October, of an Ayrshire maternity unit that has begun offering free Hypnobirthing courses to, among others, women who can't have opiate medication or epidural. I'd love to see this programme extended.<br />
<br />
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<i>What do you think of this post? Too long, too technical? Let me know in the comments - I'd love to hear from you.</i>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com16tag:blogger.com,1999:blog-5647340539604305311.post-39541753523018278982013-09-19T10:57:00.000+01:002013-09-19T11:58:51.019+01:00Advertising infant formula - WHO cares?<div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5cK8osIs-LGdVwvvQhnrx9IlZmgqcTmqykMXRE-5epTj3yrwC_SaIN5bWtvOVujPgqo16eHswrBhwAnWCksl9nH9oyiaE-HRLPKtg1wfgrZOd01saaXDoZmlh9FqnVdaNdfp2pLFJiMQI/s1600/Ocado+article.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5cK8osIs-LGdVwvvQhnrx9IlZmgqcTmqykMXRE-5epTj3yrwC_SaIN5bWtvOVujPgqo16eHswrBhwAnWCksl9nH9oyiaE-HRLPKtg1wfgrZOd01saaXDoZmlh9FqnVdaNdfp2pLFJiMQI/s200/Ocado+article.jpg" width="200" /></a>Last month, online retailer <a href="http://www.ocado.com/">Ocado </a>distributed, in print and online, a magazine that carried a feature advertising first-stage infant formula. They've now (after an initial delay) amended the online version of the magazine, which you can see <a href="http://digital.edition-on.net/links/7152_ocado_life_autumn_2013.asp">here</a>. The article on p34 originally had an image of a box of six ready-to-feed SMA bottles in the 'S is for Sleep' section (see right) - in fact the whole section looked as though it spelt out S.M.A. The first problem? It's illegal in the UK to advertise first-stage infant formula: the relevant legislation is <a href="http://www.legislation.gov.uk/uksi/2007/3521/contents/made">here</a>.</div>
<br />
So far, so simple. Ocado were pulled up on their mistake, and they responded with an apology:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">The SMA First Infant Milk product was included in the feature by mistake. The mistake occurred purely through human error and we are satisfied this is an isolated incident. We are very sorry that this has happened and we have made some changes to the ocadolife production process to ensure this cannot happen again. We take compliance very seriously at Ocado and as a responsible retailer we have voluntarily approached the relevant authorities to discuss this matter with them. We can also confirm SMA did not provide any funding for the inclusion of their product in the feature and we also extend our apologies to them for our error. </span></blockquote>
An end to the matter? Not really. The whole incident brought some of the issues affecting infant feeding in the UK sharply into focus. So much is wrong with the picture. That this image of formula milk appeared in the 'sleep' section of the article reflects a common misconception that formula feeding aids infant sleep (when in fact it <a href="http://www.lullabytrust.org.uk/breastfeeding">increases the risk of SIDS</a>). That the image appeared at all demonstrates a worrying lack of awareness of the law among editors, copyeditors, proofreaders... And a storm of comments on Facebook (I saw them on the <a href="https://www.facebook.com/AssociationofBreastfeedingMothers">Association of Breastfeeding Mothers</a> page, and on the <a href="https://www.facebook.com/ocado">Ocado </a>page) demonstrated just how poorly the general public understand the law itself, and the reasons for it (which reminded me of the comments made about breastfeeding in swimming pools that I blogged about <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/08/breastfeeding-in-swimming-pools-what-do.html">here</a>.) A small selection:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">I don't see what's wrong with this. Some people formula feed, so what!!!</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">In today's world of equality and freedom of choice its a disgrace that such a law even exists... it hits a bit of a raw nerve when I read so many people trying uphold a law that in my opinion should never have been passed.</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">...not allowing advertising of first milk is making some mothers' failure at breastfeeding even more apparent... don't we need to be looking at the nhs midwifery service and the support (or lack of) that new mothers receive rather than the advertising...?</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">If these infant formulas were actually bad for baby and caused harm... then they wouldn't be allowed to be produced never mind advertised.</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">Adverts are allowed for everything else under the sun claiming to be healthy such as high sugar cereals, breakfast bars and alcohol!!!... but adverts aren't allowed when it comes to offering choice or advice on formula milk!!!</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">So why is it illegal to advertise formula?</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">I just don't get why people are so up in arms about a very small picture in a publication.</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">The law exists because of pressure groups who don't feel that people should be allowed to make their own choices.</span></blockquote>
<blockquote class="tr_bq">
<span style="color: #cc0000;">The problem with this law is that it prevents the balanced info that you claim you want parents to have. </span></blockquote>
Let me make it clear. <b>The law exists to protect mothers and young babies, whether breastfeeding or artificial feeding</b>. We know (and by we, I mean that it is common knowledge) that breastfeeding is the normal way to feed human infants, and we know, thanks to an ever-expanding wealth of scientific research, that not doing so carries a host of increased health risks for both babies and their mothers. Yes, <a href="http://www.unicef.org.uk/Documents/Baby_Friendly/Research/Preventing_disease_saving_resources.pdf">even in the UK</a>. It seems logical then that the marketing of breastmilk substitutes for infants, which are artificially-fed babies' sole source of nutrition, should be subject to checks and controls.<br />
<br />
It's also clear, from even the most cursory look at the advertising practices of the formula manufacturers, that they will go to great lengths to promote their products, often making pseudo-scientific claims that do not stand up to scrutiny (cases have been brought against them, and won), adding ingredients of unproven benefit and cynically targeting health care professionals when they are denied direct access to parents. <a href="http://info.babymilkaction.org/">Baby Milk Action</a>, and the <a href="http://www.babyfeedinglawgroup.org.uk/">UK Baby Feeding Law Group</a>, monitor the activities of the various formula companies: you can find a great deal of further reading on their websites (my most-read post ever is about this topic too, <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/04/baby-milk-shortages-formula.html">here</a>.) It seems obvious that companies aiming to maximise their profits are not best placed to offer objective information about formula feeding.<br />
<br />
The above has been known for some time, and is recognised worldwide. Hence WHO (the World Health Organisation) created the <a href="http://www.who.int/nutrition/publications/code_english.pdf">International Code of Marketing of Breast-milk Substitutes</a>, adopted in 1981, the aim of which is to:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">...contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.</span></blockquote>
Can anyone find anything there to disagree with? It sounds perfectly sensible. In 2003, WHO and UNICEF, as part of a <a href="http://www.who.int/nutrition/topics/global_strategy/en/">global strategy for infant and young child feeding</a>, called for governments to <span style="color: #cc0000;">'review progress in national implementation of the Code, and consider new legislation or additional measures as needed to protect families from adverse commercial influences.'</span> Unfortunately, <b>in the UK we have still only partially implemented the WHO Code</b>, which, as Emma Pickett IBCLC, co-chair of the <a href="http://abm.me.uk/">ABM</a>, explains:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">...could be argued to have done more harm than good. It has led directly to the 'invention' of follow-on formula, which is not subject to the same advertising controls as first-stage formula. In countries that have fully implemented the Code, there is no follow-on formula at all - if it really were a distinct and medically necessary product, </span><span style="color: #cc0000;">as the manufacturers would have UK parents believe,</span><span style="color: #cc0000;"> surely it would be available worldwide? Here in the UK we have evidence from the </span><a href="https://www.gov.uk/government/publications/diet-and-nutrition-survey-of-infants-and-young-children-2011">Diet and Nutrition Survey</a><span style="color: #cc0000;"> that 32% of parents have given follow-on formula </span><i style="color: #cc0000;">before six months: </i><span style="color: #cc0000;">proof, if any more were needed, that advertising really works.</span></blockquote>
She also describes a situation that breastfeeding supporters everywhere will recognise:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">You meet mothers every day who use formula alongside breastfeeding and
end exclusive breastfeeding because the messages they receive from
advertising are far more powerful than the information they are drily
given about the benefits of exclusive breastfeeding. The TV adverts
stick in the mind long after someone mumbling something about gut flora
and allergy prevention.</span></blockquote>
It's grimly ironic that those parents complaining about the law against advertising first-stage formula are the very same parents that are being ripped off, both financially and through misinformation, by the formula manufacturers. <a href="http://babymilkaction.org/news/campaignblog310712">Rough calculations</a> (companies won't reveal their figures) suggest that of an annual spend by parents of £436.54 on Aptamil powdered formula, for example, between £231 and £349 goes on marketing and profit. Still think the companies are acting in the best interests of consumers?<br />
<br />
As for where parents should go for better information, <a href="http://www.unicef.org.uk/BabyFriendly/Parents/Resources/Resources-for-parents/A-guide-to-infant-formula-for-parents-who-are-bottle-feeding/">UNICEF</a>, <a href="http://www.firststepsnutrition.org/news.html#infantmilksorgetting">First Steps Nutrition</a>, <a href="http://www.which.co.uk/baby-and-child/nursery-and-feeding/guides/choosing-the-right-formula-milk/are-some-formula-milk-brands-better-than-others/">Which? </a>and others all have guides to artificial feeding for those who need them, freely available on the internet.<br />
<br />
But there's even more to it than this. Want to see how deep the rabbit-hole goes? In <a href="http://www.thealphaparent.com/2013/08/deconstructing-infant-formula.html">this post</a> on the Alpha Parent James Akre describes our culture of acceptance of formula feeding thus (my italics):<br />
<div>
<blockquote class="tr_bq">
<span style="color: #cc0000;">Given the mass of compelling scientific and epidemiological evidence about the harm caused by routine artificial feeding, it’s hardly farfetched to qualify as <i>collective delusion</i> the unquestioned faith that the general public and health professionals alike in many settings continue to place in infant formula...<br /><br />...Infant formula will sustain life in a pinch, and thank goodness this is so. But as I describe elsewhere, from a nutritional and developmental standpoint, <i>most people do not understand just how hugely inferior it is to breast milk...</i>The idealized view of normalized infant formula feeding that manufacturers are so adept at portraying – and, regrettably, so many consumers, health professionals and politicians are inclined to accept – doesn’t allow for even a hint of this disenchanting reality.</span></blockquote>
Given all the evidence, why do you think we haven't fully implemented the Code in the UK? And why don't we make more use of the laws we have? Don't be fooled into thinking that the reasons have anything to do with any doubts about the benefits, in terms of public health, of doing so. It's an uncomfortable truth that we cannot rely on governments to act as they should, even in the face of overwhelming evidence and firm guidance from WHO (which has no power to compel countries to implement the Code). The pressure, on governments and other organisations, from vested interests within the baby food industry and elsewhere, is immense: the power of corporations, at the highest levels of politics and policy-making, cannot be dismissed as conspiracy theory. When so much profit is at stake, the interested parties will do all they can to exert an influence. This month a <a href="http://babymilkaction.org/sites/info.babymilkaction.org/files/WN%2008,09%20WN10%20Feedback%20pdf%20SENT%20AGAIN.pdf">letter </a>appeared in the <i><a href="http://wphna.org/worldnutrition/">Journal of the World Public Health Nutrition Association</a></i> about conflicts of interest in the area of infant nutrition:<br />
<blockquote class="tr_bq">
<span style="color: #cc0000;">...concerned with the equally deep penetration of the transnationals and their associated or supportive organisations, into the scientific community, into nutrition policy-making at the highest level, and into public health programmes that affect the health and lives of hundreds of millions of people.<br />We see this largely as a consequence of the failure of elected governments to fulfil their first duty, which is to govern. We also feel that some policy-makers and many scientists, including those working at the highest level, underestimate or overlook the consequences of their own actions.<br />The influence of Big Food can be subtle, and may, in the opinion of reasonable people, be seen to affect the judgement of public policy agenda-setters who act in good faith and whose personal integrity is not at issue. We are not questioning the motives of any of the people mentioned in this letter. We are though, deeply concerned about the possible effects of their activities.</span></blockquote>
Our specific situation in the UK is part of a global issue that has far-reaching implications for mothers and babies. Just today Baby Milk Action posted this <a href="http://info.babymilkaction.org/pressrelease/pressrelease18sep13">press release</a> on their website about formula companies bribing hospitals in China - yes, those same formula companies that advertise and sell products in the UK.<br />
<br />
I've covered a lot of ground: from a tiny image of first-stage formula in an Ocado magazine, to global politics, nutrition policy and economics, in one helter-skelter ride. And really, this is still only scratching the surface. I just hope I have gone some way towards showing <b>how that one little article is part of a much bigger picture that should concern us all</b>.<br />
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Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com6tag:blogger.com,1999:blog-5647340539604305311.post-51099878681278608692013-08-15T15:27:00.001+01:002013-08-15T16:09:03.916+01:00Breastfeeding in swimming pools - what do our reactions say about us?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ5-oX_ZE1wVDGq3Dk8iQpuPM0VTNnD4kgdAXnlhiYZGOUkIZ20sMjwOMFOc121w33MllhikbGN0UKUEvVOrLCDxkgeTq1YXDRIS6j-RFKkRZBet6I0gRDWUe-HkR84_kXbYb375OTaAiq/s1600/Susan+and+Evie+in+pool.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ5-oX_ZE1wVDGq3Dk8iQpuPM0VTNnD4kgdAXnlhiYZGOUkIZ20sMjwOMFOc121w33MllhikbGN0UKUEvVOrLCDxkgeTq1YXDRIS6j-RFKkRZBet6I0gRDWUe-HkR84_kXbYb375OTaAiq/s200/Susan+and+Evie+in+pool.jpg" width="200" /></a></div>
There have been two reports in recent months of mothers breastfeeding at public swimming pools and being told off for it by staff: you can read them <a href="http://www.cambridge-news.co.uk/News/Young-mum-told-to-stop-breastfeeding-at-Cambridge-pool-because-of-no-food-or-drink-rule-20130717055500.htm">here</a> and <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/mum-told-stop-breast-feeding-5717148">here</a>. Both stories provoked a storm of comments, both on the newspaper report pages themselves and across the internet, including on <a href="http://www.mumsnet.com/Talk/in_the_news/a1804738-Mum-told-to-stop-breastfeeding-her-baby-at-local-pool">Mumsnet</a>, several breastfeeding pages I follow on Facebook and on the <a href="http://www.bbc.co.uk/programmes/b006wr3p">Jeremy Vine show</a>. Most of those commenting on the story seem to have missed the point completely, which is that <b>whatever your personal feelings about the appropriateness or not of breastfeeding in a public swimming pool, women's rights not to be harassed or victimised for doing so are <a href="http://www.maternityaction.org.uk/sitebuildercontent/sitebuilderfiles/breastfeedingpublicplace.pdf">enshrined in law</a>.</b> It is ironic then that the venom of the commentators is almost entirely directed at the women involved, and not the staff who approached them or the management of the respective pools, who may (investigations ongoing) have been acting illegally.<br />
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The comments about both incidents have deeply saddened me, as a breastfeeding mother, a breastfeeding supporter and as a human being. Even given what we all know about the accuracy of newspaper stories (the Cambridge story was reported with claims that the mother in question was in a jacuzzi at the time - it transpires that there is no jacuzzi at the pool, and in fact she was seated on the poolside with only her feet in a toddler pool area), nevertheless other women (and men) have been quick to weigh in with the full force of their opinions about what they would have done in the circumstances, what they think about the pool's policy, all sorts of very revealing nonsense about the 'ickiness' of breastmilk, and so on. This deeply unpleasant tendency to attack the actions of others when they act in ways that we ourselves would not does not reflect well on us as human beings - it is closed-minded, divisive and makes our society look downright hostile to some of its more vulnerable groups, including breastfeeding mothers. Regardless of how other individuals might have acted, or chosen to feed, or cover, or not, the <b>law protects us all</b>, whatever we decide to do. A mum who fed out of the pool, or in the changing room, or in the lobby, or under a towel, or at home before bringing the baby in, has just the same right to be respected by staff as the mum who, for whatever reason, fed in the pool itself.<br />
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<br />
The law on breastfeeding in public in England says that you cannot be 'harassed or victimised' for breastfeeding in a public place, and this specifically includes parks and leisure facilities. (There are no health and safety issues in a public swimming pool to qualify as an exception under the legislation - for a detailed examination of the 'hygiene worries' of Joe Public, see the Analytical Armadillo's excellent post <a href="http://www.analyticalarmadillo.co.uk/2013/08/breastfeeding-in-swimming-pools.html">here</a>). So it is the actions of the staff that are important: in both cases, in the newspaper reports of the incidents and in the mothers' further comments online, it seems clear that the staff were rude, uneducated about breastfeeding and the law and upset mothers attending to the needs of their small children, who were paying customers of the leisure centre. The involvement of management (also uninformed about breastfeeding) compounded the problem rather than fixed it. This shows how little understanding there is of breastfeeding within organisations and is symptomatic of how, as a society, we consistently fail to take it seriously enough. Apart from anything else the mothers' treatment is appalling customer service that no one deserves. It seems to me to be part of the same kind of casual disrespect that is shown by those who are racist or sexist in public - it's ill-informed nonsense, which is why as a society we have legislation to protect people from it.<br />
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<i>What should have happened</i><br />
<b>Day 1 of lifeguard induction:</b> 'This is a family pool and we encourage all members of the public to access our facilities. Our policies reflect the welcoming environment we try to create: we run family sessions, women-only sessions, and baby swim classes alongside our programme of school lessons and public swimming sessions. One relevant point of law that you need to be aware of is that breastfeeding mothers have the right to feed their children in any part of our facilities and you should not ask them to move or stop breastfeeding as this is against the law. If another patron raises the issue with you, take that person aside, explain the law and our policy, and refer them to management if they are not satisfied. You can, if you wish, inform mothers that we have a dedicated infant feeding room for their convenience, but they are under no obligation to use it. This is entirely separate from our policy on no food and drink in the pool area, which is there simply to maintain our high standards of cleanliness around the pool.'<br />
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<b>Another day:</b> mum is breastfeeding in the pool, lifeguard notices. 'Mum feeding her baby. Oh right. Wonder if she knows about the room? I'll just nip down and tell her.'<br />
Lifeguard: 'Excuse me, madam, [smiling] I'm sorry to interrupt - I just wanted to check that you know we have an infant feeding room next to the changing rooms, which you're welcome to use if you want to.'<br />
Mum: 'Thanks, but I need to stay here because I'm watching my toddler over there.'<br />
Lifeguard: [smiling again] 'No problem at all madam, enjoy your swim.' Walks off.<br />
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In my example the general public, observing (if they even notice) sees the interaction as an endorsement of breastfeeding rather than an attack on it. Smiling mum, unconcerned lifeguard - subliminal message: BREASTFEEDING IS NORMAL. No news story.<br />
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<i>Full disclosure:</i> I have breastfed in the changing rooms, on the poolside, and actually in the water at public swimming pools. At the time I didn't give it a second thought - I was just responding to the needs of my baby. Never had a comment from anyone, either member of public or member of staff.</div>
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Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com7tag:blogger.com,1999:blog-5647340539604305311.post-52540261896667233492013-07-09T14:48:00.000+01:002013-07-09T14:48:08.633+01:00Public, positive messages to support a woman's right to breastfeed<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjtix0UYHC7M69S9HwRb2k5V9Z_jFeW0YTjPeYmGuGnxz-y8CrWWXh3sG7YiZFJV-NoH1LgNa-0L5RIObvqmJZB9sdgM6QUih9a_lNHjXqlPIjIBkP_kwEGKZ6cOrThXUHCz9IU79VePIa/s1600/1352039657.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjtix0UYHC7M69S9HwRb2k5V9Z_jFeW0YTjPeYmGuGnxz-y8CrWWXh3sG7YiZFJV-NoH1LgNa-0L5RIObvqmJZB9sdgM6QUih9a_lNHjXqlPIjIBkP_kwEGKZ6cOrThXUHCz9IU79VePIa/s200/1352039657.png" width="200" /></a></div>
I've been delighted to observe and be part of a movement for improvements in birth and maternity services that is gaining momentum (see <a href="http://www.huffingtonpost.co.uk/toni-harman/human-rights-in-childbirth_b_3479033.html">this article</a> by Toni Harman in the Huffington Post.) In the UK the <a href="http://www.positivebirthmovement.org/">Positive Birth Movement</a>, with its network of positive discussion groups, and the establishment of <a href="http://www.birthrights.org.uk/">Birthrights</a>, has done much to foster genuine, productive debate about women's experiences of birth in today's society. Writer Milli Hill has been commissioned to write a positive birth column after her piece <a href="http://www.bestdaily.co.uk/your-life/news/a492364/is-kate-being-bullied-about-her-birth.html">Is Kate being bullied about her birth?</a> was a runaway success for <a href="http://www.bestdaily.co.uk/">bestdaily</a>; home birth advocate and journalist Beverley Turner, of <a href="http://www.telegraph.co.uk/women/mother-tongue/10134296/Why-is-blokey-BBC-Radio-5-Live-airing-a-show-about-vaginas-and-babies.html">Radio 5s Bump Club</a>, has also had a number of <a href="http://www.bbc.co.uk/blogs/5live/posts/The-rise-of-the-C-section">positive articles</a> published in recent weeks. There's a real buzz about positive birth at the moment and it's great to see.<br />
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Conversely, National Breastfeeding Week 2013 has left me feeling a little flat. Not because there weren't some great things going on - both on and off-line - but because, as the figures revealed in the papers during the week showed breastfeeding rates taking a small dip for the first time in years (and Rebecca Schiller so clearly articulated in <a href="http://www.guardian.co.uk/commentisfree/2013/jun/26/breastfeeding-support-funding-cut-sets-mothers-fail">her piece in the Guardian</a>), without government-level <i>strategic </i>support for breastfeeding, all the efforts of everyone who is passionate about supporting women to breastfeed are just scratching the surface. As Schiller summed it up: 'if policymakers aren't funding enough midwives or a centralised system of breastfeeding support we simply set women up to fail.' (In my own area, with no funding for National Breastfeeding Week, the NHS, through which we work as peer supporters, couldn't support the events we ran in any way.) She also pointed out that the constant breast v bottle debates in the media (<a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/02/joan-wolf-and-others-is-breast-best.html">which I've critiqued in other posts, like this one</a>) are falsely polarised and damaging to both sides, with women suffering guilt, fear of judgement and lack of support, regardless of feeding method.<br />
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I can't help wondering whether the key to improving our dialogue about breastfeeding lies in learning some lessons from the movement for improving birth. If we alter the fundamental question at the heart of all the arguments, what happens? In the introduction to his forthcoming book <i><a href="http://www.amazon.co.uk/Gift-Life-Breastfeeding-Made-Easy/dp/1780660200">A Gift for Life</a></i> (Pinter and Martin, pub date Sept 2013) Dr Carlos Gonzalez, author of <i><a href="http://www.amazon.co.uk/My-Child-Wont-Eat-mealtimes/dp/1780660057">My Child Won't Eat</a></i> and <i><a href="http://www.amazon.co.uk/Kiss-Me-Raise-Your-Children/dp/1780660103">Kiss Me! How to raise your children with love</a></i>, Spain's answer to <a href="http://www.breastfeedinginc.ca/content.php?pagename=drjack">Dr Jack Newman</a>, writes:<br />
<blockquote>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhybS7jrUSBs0ZGVbWat5y-83bd2-5cIjDtC3O7UhWvWln6EN-wKwFGZrtqQzxdU-3SIUUwjpMTSciLV09idcDNaflvjoZy5XJYxVvbQ1So15G-8Ot1Fd3P-xbeJbvECaY4Op81QaI2nY7K/s1600/gift+for+life+jacket.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhybS7jrUSBs0ZGVbWat5y-83bd2-5cIjDtC3O7UhWvWln6EN-wKwFGZrtqQzxdU-3SIUUwjpMTSciLV09idcDNaflvjoZy5XJYxVvbQ1So15G-8Ot1Fd3P-xbeJbvECaY4Op81QaI2nY7K/s200/gift+for+life+jacket.jpg" width="125" /></a><span style="color: #cc0000;">"...lactation isn’t a tool for achieving health, but rather an integral part of health itself. Not a means, but an end. Telling people to ‘avoid artificial lactation because it causes diarrhoea’ now seems to me as absurd as exhorting them to ‘avoid blindness because blind people are more likely to get run over’. Lactation is no more a way of avoiding infection than being able to see is a way of avoiding accidents. <b>They are both normal parts of a healthy life.</b> I know now that lactation is not an effort, much less a sacrifice, that a woman makes for the good of her child, but <b>rather that it is part of her life, of her own sexual and reproductive cycle. It is a right that no one can take away from her.</b></span></blockquote>
<blockquote>
<span style="color: #cc0000;">I am aware that some women don’t want to breastfeed. This is fine. A right isn’t the same as a duty. Many people don’t go on marches or vote in elections, but they still have that right." </span>(my emphasis)</blockquote>
There's a parallel here with the idea (enshrined in law thanks to <a href="http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-102254">Ternovsky vs Hungary</a>) that it is a woman's right to choose the circumstances of her birth. If we see breastfeeding as a woman's right then that frames the whole question of our duty, as a society, to ensure that her rights are respected and supported, in a completely different way. Viewed in these terms, breastfeeding is no longer a 'public health issue', or a 'women's issue'; the right to breastfeed, if she wants to, becomes a completely integral part of the care a woman can expect from maternity and child health services - it cannot be seen as an optional extra, or a 'nice to have', the cherry on the cake once mum and baby have navigated the birth itself. It demands commitment to breastfeeding, and supporting breastfeeding, at a strategic level.<br />
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(For the few women who cannot breastfeed, the logical extension of the idea that breastfeeding is a woman's right would be to have robust systems in place to provide those women with acceptable alternatives; provision of donor milk and supplementary feeding systems, wet-nursing or milk-sharing, for example.)<br />
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So seeing breastfeeding as a woman's basic right, which she is free to exercise or not, is one way of reframing discussion of it. We move on then from divisive breast v bottle polemics, and instead focus on how our society and culture is, or is not, doing what it needs to do to ensure that a woman's right to breastfeed is not infringed. We're part of the way there with laws that protect breastfeeding in public, but we must also look at our failure, in the UK, to fully implement the <a href="http://www.who.int/nutrition/publications/code_english.pdf">WHO Code on the marketing of breastmilk substitutes</a>, and confront what the <a href="https://www.gov.uk/government/organisations/department-of-health/series/breastfeeding-quarterly-statistics-england">recent figures</a> showed so clearly - that breastfeeding in Britain is effectively a postcode lottery (despite <a href="http://www.unicef.org.uk/Documents/Baby_Friendly/Research/Preventing_disease_saving_resources.pdf?epslanguage=en">what we know about its potential to reduce health inequalities</a>). As Rebecca Schiller, in her role as co-chair of Birthrights, says:<br />
<blockquote class="tr_bq">
<div>
<span style="color: #cc0000;">"Women have a fundamental right to autonomy when deciding how and
where to give birth and how to feed their babies. Birth choices are
often made with feeding goals in mind. However, women in the UK do not
universally have equal provision of these birth settings and often tell
us that they are refused entry to them. Birthrights is working hard to
raise awareness of this issue and work with women and health
professionals to ensure that the choices women make around birth - for
whatever reason - are respected, supported and made realistic.</span></div>
<div>
<span style="color: #cc0000;"><br /></span></div>
<div>
<span style="color: #cc0000;">Women most certainly have the right to adequate
levels of postnatal support and the right to make fully informed choices
about how they give birth and feed their babies. If our maternity
service doesn't offer all women the chance to make and realise those
choices through appropriate provision of a range of birthplace settings
and experienced, adequately staffed postnatal services, it certainly
raises the question as to whether, through lack of resources and lack of
evidence-based policy, we are effectively giving an illusion of choice
where often none exists."</span> </div>
</blockquote>
Another way of reframing the discussion of breastfeeding takes a different tack - focussing on public, positive messages about breastfeeding (again, following in the footsteps of the <a href="http://www.positivebirthmovement.org/">Positive Birth Movement</a> and <a href="http://tellmeagoodbirthstory.com/">Tellmeagoodbirthstory</a>). My book <a href="http://www.amazon.co.uk/Breastfeeding-Stories-Inspire-Susan-Last/dp/1905179049"><i>Breastfeeding: stories to inspire and inform</i></a> and its accompanying <a href="http://www.facebook.com/pages/Breastfeeding-Stories-to-Inspire-and-Inform/326859357387631">Facebook page</a> attempt to promote positive breastfeeding stories - a recent favourite is this one from <a href="http://uk.lifestyle.yahoo.com/never-thought-id-breastfeed-im-glad-changed-mind-205200543.html">a mum who never thought she'd breastfeed, but changed her mind</a>. Other groups and individuals are doing their bit to normalise breastfeeding and breastfeeding in public. <a href="http://www.harrowobserver.co.uk/west-london-news/local-harrow-news/2013/07/04/getting-the-breast-message-across-116451-33561027/">Christina Conboys and a group of mums in Harrow</a> have put together a book of fabulous, inspiring photographs called <i>Breastfeeding is Beautiful; </i>spoken-word poet Hollie McNish's heartfelt poem <a href="http://www.huffingtonpost.ca/2013/07/05/hollie-mcnish-breastfeeding_n_3552062.html">'Embarrassed' </a>is being shared all over the web - it sums up brilliantly some of the cultural issues affecting how we see breastfeeding in Britain. I also love the work of <a href="http://www.breastfeedinginpublic.co.uk/">We Do It In Public</a>, a photographic library of normal mothers breastfeeding in all sorts of everyday situations - for (paid) use by organisations, companies, websites and anyone who needs images of infant feeding to accompany their content. And it's a great resource for mothers to browse too.<br />
<br />
The impact of these positive, public messages about breastfeeding cannot be underestimated. They are the antidote to all the little comments that undermine breastfeeding that we all come across every day: about four-hourly feeds, about a bottle before bed to get them to 'go a bit longer', about 'needing your body back', about no nutritional benefit after six months, about formula being 'just as good these days', about how 'he's using you as a dummy'. It works in the same way that positive birth stories counter negative messages about birth. It's well-known that supportive breastfeeding groups (again the parallel with the Positive Birth Movement is obvious), where mothers meet other women with similar experiences to their own, are of immense value in supporting women to meet their breastfeeding goals; that's why the major breastfeeding charities, such as <a href="http://www.laleche.org.uk/">La Leche League </a>and <a href="http://abm.me.uk/">the ABM</a>, put mother-to-mother support at the core of their activities. I recently read <a href="http://publicpolicy.southampton.ac.uk/public-breastfeeding/">this interesting blog</a> about how negative experiences of breastfeeding in public affect mothers and influence their decisions about how long to breastfeed for; if we exchange those negatives for positives we both support breastfeeding and support women.<br />
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It seems to me that raising the profile of breastfeeding in the UK requires (at least!) a two-pronged approach. If we started by accepting that it is a woman's right to breastfeed if she wants to, then that would give us a clear way forward: breastfeeding needs to be at the heart of what we do, in government, in law, and in public life. It's not rocket science. It's just something else that HR departments, TV programme commissioners, editors and policy-makers would need to at least <i>consider</i>, in the way that they already consider diversity, gender, accessibility. And if, at the same time, we could increase the visibility of breastfeeding as it's done, everyday, by thousands of women, then it wouldn't be long before everyone stopped paying so much attention to it. It would just be <b>normal</b>.<br />
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(I'm reminded, in writing this, of feeding my daughter on a trip to the Westfield centre in Derby, a huge shopping mall with multiple, well thought-out parents' rooms. I often suggest to new mums I support that it's a good place for an early trip out with the baby because of these facilities. However, last time I was there and my daughter needed a feed I was close to benches in a large, airy seating area, with all sorts of people sitting on them - older Asian men, Derbyshire grannies and giggly teens. I consciously chose to join them all and feed my daughter there rather than going to the parents' room. I felt, as a confident third-time mum, that I was doing my bit to normalise breastfeeding. It may have backfired, however, as the Derbyshire grannies that cooed over the baby had leaned right over, stroked her head and tried to talk to her before they even realised she was feeding...)<br />
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<i>What do you think of the idea of breastfeeding as a woman's right as a normal part of her sexual and reproductive life? I'd love to hear from you in the comments.</i>Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com1tag:blogger.com,1999:blog-5647340539604305311.post-9141291829669947592013-06-25T07:44:00.000+01:002013-07-04T19:40:56.534+01:00National Breastfeeding Week 2013: some thoughts on breastfeeding support<div style="text-align: left;">
I've been a breastfeeding peer supporter for two and a half years, since shortly after my third child, who <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/05/of-milk-and-memories-how-my.html" style="font-family: inherit;">only recently stopped breastfeeding</a><span style="font-family: inherit;">, was born. In that time I've been constantly reminded of the incredible value in what we do. When I hear women's stories (such as <a href="http://thethoughtfulpublisher.blogspot.com/2012/08/breastfeeding-peer-support-in-action.html">this one</a>) of how they've been supported to overcome problems and achieve their feeding goals, I have a great feeling of pride and good fortune to have been able to be part of their support network. </span></div>
<span style="font-family: inherit;"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTEdG6JtZ8udXbvuIlg1tqSHtfMCoW_3l9UQ0yNJ8hR7BInJncswOBo778Ilal0dX0_aQwytV4lmeDkqAsaJDOyS6qkR6UZjj4VPVdomv0L2e_f8aiemAVcXKjorCkQHGgmNzGGlIgK-r7/s1600/logo+2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTEdG6JtZ8udXbvuIlg1tqSHtfMCoW_3l9UQ0yNJ8hR7BInJncswOBo778Ilal0dX0_aQwytV4lmeDkqAsaJDOyS6qkR6UZjj4VPVdomv0L2e_f8aiemAVcXKjorCkQHGgmNzGGlIgK-r7/s200/logo+2013.jpg" width="200" /></a><span style="font-family: inherit;">Breastfeeding support doesn't begin and end with a new mother and her baby, although they are at the heart of it. It ripples outward and affects others too - the partner who desperately wants to be supportive but doesn't have all the information he needs; the mother-in-law worried about why mum isn't giving the baby water between feeds; the GP who isn't up to date with treating thrush; the pregnant woman wondering how she will feed her baby; the young girls walking past mothers breastfeeding in coffee shops.</span><br />
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<span style="font-family: inherit;">Whatever the ins-and-outs of the latest 'breast v bottle' debates in the papers, on TV or on the radio, peer support, which is truly mother-focussed, exists outside that arena. No one, surely, could have a problem with the idea of women supporting other women, <i>who want to breastfeed</i>, to achieve their goals. </span><span style="font-family: inherit;">In the introduction to my book <i><a href="http://www.amazon.co.uk/Breastfeeding-Stories-Inspire-Susan-Last/dp/1905179049">Breastfeeding: stories to inspire and inform</a></i>, published a year ago by <a href="http://www.lonelyscribe.co.uk/">Lonely Scribe</a> during National Breastfeeding Week, I wrote:</span><br />
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<span style="font-family: inherit;"><span style="color: #cc0000;">"Peer support is not about judging mothers' choices, or breastfeeding evangelism - it's about positive ways of helping those who want to breastfeed, for whom it matters, to continue as long as they want to, and supporting them to make informed choices for themselves and their families."</span></span></blockquote>
With its focus on listening (see this <a href="http://developingdoulas.co.uk/2013/06/18/5-ways-i-listen-to-women/">lovely post</a>), taking time to understand mothers' concerns and making appropriate, supportive suggestions, peer support fills a need that maternity services and health visiting teams can struggle to provide. (Which is not to say that peer support alone is sufficient to properly underpin breastfeeding in the community; for that you need good systems of upward referral for more complex problems, often sadly lacking). Peer support comes in different guises; we are trained by and supervised by the NHS, but in other areas support may be offered through other organisations, such as the <a href="http://abm.me.uk/">Association of Breastfeeding Mothers</a>, <a href="http://www.laleche.org.uk/">La Leche League</a> and the <a href="http://www.breastfeedingnetwork.org.uk/">Breastfeeding Network</a>, or through community interest companies like <a href="http://realbabymilk.org/">realbabymilk.org</a> or <a href="http://www.littleangels.org.uk/">Little Angels</a>.<br />
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<span style="font-family: inherit;">The feedback we get from mothers who attend our groups and see us at clinics, have home visits from us or call our helpline, is that the service we offer, voluntarily and free of charge, is highly valued and hugely important. Women remember kind words, a listening ear and calm suggestions, whatever course their breastfeeding journey takes, and this in itself is important - they may try breastfeeding again with subsequent children, or be more encouraging of their friends, or challenge misinformation when they hear it, based on their interaction with us. That's a responsibility, but one that I welcome; it feels like an incredibly gentle way of changing the world.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiJ2Px4yTpplSOldOsE7LZcR55WxNEiLBRGXDQEQvgU_woTKlM31glfg7koyiHKMKWrFS8Jm0dkun3SD0F4eJH2Vk0xfzKMuoSPSmHncDFuUY7_SaQyvvyK2sMCCgqogpozkT2hVrueQML/s1600/new+BEARS_logo.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiJ2Px4yTpplSOldOsE7LZcR55WxNEiLBRGXDQEQvgU_woTKlM31glfg7koyiHKMKWrFS8Jm0dkun3SD0F4eJH2Vk0xfzKMuoSPSmHncDFuUY7_SaQyvvyK2sMCCgqogpozkT2hVrueQML/s200/new+BEARS_logo.jpg" width="157" /></a></div>
<span style="font-family: inherit;">I'm a peer supporter with BEARS in Amber Valley, Derbyshire. Follow us on Twitter @feedingsupport, and check us out <a href="http://www.facebook.com/pages/BEARS-Breastfeeding-Support-across-Amber-Valley/222869781137145">on Facebook</a> for details of groups and clinics, and our National Breastfeeding Week events. We're running our popular 'Breastfeeding Millionaire' quiz, with a host of fantastic prizes, all week, as well as a Positive Postcard Project (send a positive breastfeeding message to someone, and receive one yourself). And there's a Big Feed picnic in Belper River Gardens on Wednesday 26th June 2013 at 1pm.</span><br />
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Other Keep Britain Breastfeeding bloggers are involved in breastfeeding peer support: look up <a href="http://mummyisagadgetgeek.co.uk/">Mummyisagadgetgeek</a>, <a href="http://lifeloveandlivingwithboys.wordpress.com/">lifeloveandlivingwithboys</a>, <a href="http://circusqueen.co.uk/">Circus Queen</a>, <a href="http://hexmum.blogspot.co.uk/">Hex Mum</a> and <a href="http://www.breastmilkkeepsakes.co.uk/">Twinkle Mummy</a>.<br />
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<!-- start LinkyTools script --><script src="http://www.linkytools.com/thumbnail_linky_include.aspx?id=202895" type="text/javascript" ></script><!-- end LinkyTools script -->Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com17tag:blogger.com,1999:blog-5647340539604305311.post-21976233699941076342013-05-21T22:33:00.000+01:002013-06-25T09:50:08.242+01:00Bedsharing and breastfeeding in the media - an analysisThis morning on Facebook the first thing I read was on one of the breastfeeding support pages I contribute to, from a mum who'd heard reports of the <a href="http://bmjopen.bmj.com/content/3/5/e002299.full.pdf+html">latest bedsharing research, published in the BMJ Open online</a>, on the radio, worried about what she'd heard. I read the paper itself and the various articles about it, as well as a host of responses to it. <a href="http://www.mumsnet.com/Talk/_chat/1761009-New-bed-sharing-and-SIDS-study?pg=1">A thread about the research on Mumsnet</a> had over 300 posts last time I looked, and many of the articles have attracted numerous comments.<br />
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There's no question that reports of research in the mainstream media can have a massive impact on audiences. How could they not, with headlines and subheads like these:<span style="color: red;"> <a href="http://www.guardian.co.uk/society/2013/may/20/sudden-infant-death-risk-greater-parents-share-bed-babies">'Bed-sharing newborns five times more likely to die suddenly than those who sleep in a cot, study shows'</a></span> (Guardian), <a href="http://www.dailymail.co.uk/news/article-2328048/Sudden-infant-death-Risk-times-higher-baby-sleeps-parents-bed.html"><span style="color: red;">"Sudden infant death risk 'is five times higher if the baby sleeps in its parents' bed'"</span> </a>(Daily Mail),<a href="http://www.telegraph.co.uk/health/children_shealth/10069057/Sharing-bed-with-babies-raises-cot-death-risk.html"> <span style="color: red;">'Parents should never allow babies to sleep in bed alongside them due to the risk of cot death, according to research which has prompted the Government to order an “urgent” review into official guidance.'</span></a> (Telegraph),<a href="http://www.bbc.co.uk/news/health-22594587"> <span style="color: red;">'Bed-sharing "raises cot death risk fivefold"</span> </a>(BBC). The <a href="http://www.mumsnet.com/Talk/_chat/1761009-New-bed-sharing-and-SIDS-study?pg=1">Mumsnet thread</a> is full of people questioning their own behaviour in the light of the new research. The Facebook mum is not alone; all over the web there have been concerned parents, who've heard snippets on the radio or seen TV news items, wondering whether this new research can be believed.<br />
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There's a marked tendency in us to feel as though any 'new' report somehow trumps any previous research and this is certainly apparent in many of the comments on media reports - people believe that scientific research is a progression, and that each new finding is more reliable than the last, because it must build on what has gone before. That couldn't be further from the truth. The reality of scientific research is that it is much more complex a web than we might think. The research that is done depends on the interests of researchers, the availability of research funding grants, the whims of senior academics with preferred pet topics, the commercial aspirations of companies with cash, the declared aims of charitable organisations and many more variables. There are endless dead-ends, blind alleys and studies that contradict one another. And once the research is done there's the issue of making something of it, getting it noticed. Academic careers, the standing of institutions and future funding applications depend upon research reputations. Even when, as in this case, there is no suggestion of a conflict of interest among the authors, or of the funding for the study having come from a commercial interested party, there is still a need to publicise research, which is why editors and interested parties got a press release about this paper, which highlighted the most striking aspects of the research (as identified by the authors, or the press office?).<br />
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Another important point to make is that whatever the scientific ins and outs of the data presented in the paper, of which more below, researchers and academics are nonetheless able to draw their own subjective conclusions and have their own <i>opinions</i> about their research, based on their own experiences, culture and background, and this comes across strongly in the discussion/conclusions in the full paper. My feeling is that the paper's authors, while they may not have set out to provoke a media storm, nonetheless wanted to make a 'statement', and a recommendation that we reconsider the current UK guidelines is certainly that. (Several people I've talked to or seen comments from have thought, based on the reporting, that the guidelines <i>are being</i> or <i>have already been </i>changed to reflect this research - this is not true, although the <a href="http://www.bbc.co.uk/news/health-22594587">BBC reports</a> that the government have asked NICE to review their guidance in light of the findings.) I don't think the paper's authors have considered how their findings will be viewed by parents, or that they have much understanding or experience of our culture of parenting and infant feeding in the UK, although they do make some efforts to link their research to the <a href="http://www.unicef.org.uk/Documents/Baby_Friendly/Research/Preventing_disease_saving_resources.pdf?epslanguage=en">UNICEF report on the cost savings associated with breastfeeding</a> that I blogged about <a href="http://thethoughtfulpublisher.blogspot.co.uk/2012/10/good-news-for-breastfeeding-supporters.html">here</a>.<br />
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Matters don't improve when the research is published. In the translation from the press release to finished articles, TV snippets, reports and local radio phone-ins much that is important is lost, and the discussions become less about what the research really shows, and more about the broad brushstrokes of an uninformed debate (much like the breastfeeding/bottle-feeding articles I regularly comment on).<br />
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Making sense of the crowded landscape of information requires time, an in-depth understanding of the subject in question and critical thinking, and the reality is that many of us rely on others to do this for us. (I am a non-fiction editor well used to reading and sifting large amounts of information, with a specialist interest in parenting and breastfeeding, and I still struggle at times to get to the heart of the matter.) Which is why I was delighted, having read the paper and some of the articles in the press, to find that <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-statement-on-new-bed-sharing-research/">UNICEF</a>, <a href="http://www.dur.ac.uk/resources/isis.online/statements/Carpenteretal2013ISIScommentary1.2.pdf">Professor Helen Ball of ISIS online</a>, and <a href="http://www.praeclaruspress.com/carpenter_white_paper.pdf">The Praeclarus Press</a>, among others, had issued detailed statements that dig deeper into the research and expose some of its limitations. Professor Helen Ball also contributed to <a href="http://www.bbc.co.uk/programmes/b006qskw">Radio 4s PM programme</a>, where she discussed the findings with one of the paper's authors, Professor Bob Carpenter.<br />
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I've been interested in the whole media maelstrom from a breastfeeding perspective, because in peer support I'm often asked about sleep in the context of breastfeeding. Since studies suggest that co-sleeping and breastfeeding have an interdependent relationship, and we know that night feeds are important for maintaining mums' supply and on Radio 4 Professor Ball cited her own research that showed breastfeeding rates were twice as high among mothers who bedshared with their infants younger than three months, coupled with the fact that not breastfeeding increases the risk of SIDS, I've always believed, along with many others who work to support families, that black and white advice about bedsharing, as advocated by the authors of the paper, is inappropriate for breastfeeding mothers. I direct parents to UNICEFs leaflet <a href="http://www.unicef.org.uk/BabyFriendly/Resources/Resources-for-parents/Caring-for-your-baby-at-night/">Caring for Your Baby at Night </a>and to <a href="http://www.isisonline.org.uk/">Isis online</a> for more information to help them make informed decisions. The <a href="http://www.nct.org.uk/parenting/sleeping-safely-your-baby">NCT's page about bedsharing</a> (cited by the authors of the BMJ study as evidence of 'a pro-bedsharing lobby', which I thought might be a clue as to their personal hang-ups on the subject) says that up to 50 per cent of parents admit to bedsharing on occasion. On the Mumsnet thread I mentioned above there were many contributions from mothers of infants who resorted to bedsharing as a practical solution to meet the needs of the whole family, and as the mother of three babies who breastfed frequently at night for many months I have been there myself.<br />
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So what of the relative risks for breastfeeding mothers who choose to co-sleep? Some interesting numbers can be extracted from the full paper. In the study, of 1,444 babies who died, 540 were breastfed (any breastfeeding - in this study even babies fed artificial milk at night in an attempt to get them to sleep longer would be in this group) and 940 were bottlefed. Of 1,405 babies who died (the exact numbers change slightly because of missing data), 1,091 had one or two parents that smoked. Of 1,422 babies who died, 607 had been put to sleep on their front (another criticism of the study is that it uses old data, including many babies who slept on their front). Overall, the rate of SIDS in the UK is approximately 3 in 10,000. Among breastfed babies, of parents who don't smoke and whose mothers have not had alcohol or illegal drugs, that is reduced to 1 in 10,000 for crib sleepers in parents' room and is 2 in 10,000 for co-sleepers. Breastfed babies thus have a lower than average risk of SIDS. In 2010 there were 254 unexplained deaths in England and Wales and 723,165 live births. (ONS). Given the above, it is easy to see why Professor Ball commented: <span style="color: #cc0000;">'...both sleep locations for breastfed infants of non-smoking parents in the absence of alcohol experience very few SIDS deaths. It is curious, therefore, that the authors issued a press release to call attention only to this small difference in predicted SIDS rates for breastfed babies of non-smoking parents who bed-share compared to room-sharing – while ignoring the hugely inflated risks associated with hazardous bed-sharing environments. It appears as though the authors choose to target breastfeeding mothers in this way as they are a sub-group with strong opinions about the benefits of bed-sharing, even though the infants of these mothers contribute negligibly to UK SIDS rates.' </span>Without wanting to overstate the case it seems that even in the conclusions of research papers there is an undercurrent that undermines breastfeeding and parenting behaviour that promotes it. Fascinatingly this chimes with something else I read today, <a href="http://www.thealphaparent.com/2013/05/our-masculine-culture-harms.html">the Alpha Parent's look at how societies can be 'gendered'</a> - some of our problems with this research and the reporting of it may be able to be explained by 'masculine' traits in our culture.<br />
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<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com6tag:blogger.com,1999:blog-5647340539604305311.post-70841532421114195812013-05-08T12:56:00.000+01:002013-06-25T09:51:11.547+01:00Of milk and memories: how my breastfeeding story endsI knew this time would come eventually. I can't remember when I last fed my baby. It might have been on Friday morning, or last Tuesday. It would have been first thing in the morning, and I would have gone into her room, having heard her calling brightly 'Mummy-Daddy! Mummy-Daddy!' from her cot. I would have gathered her up, warm and sleepy in her pyjamas, still clutching her comfort blanket, and carried her through to my bedroom. She might have said, 'My want my milks', and I would have propped up my pillow, and sat back in bed, and she would have dropped her blanket and draped herself across my lap. She might have said 'That one first, Mummy, then that one [pointing].' She might have paused mid-feed to look up at me and say 'Yummy, yummy, in my tummy rummy!' with a wide grin. Then she might have said, 'All done now, mummy. Can my have some weetabix?' And wriggled down from the bed, and run to the door, turning back to say, impatiently, 'Come ON, mummy!'<br />
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My daughter Ada, my third and very likely last baby, is thirty months old and just about weaned (I think). The morning feeds have been becoming less frequent as the months pass, and they've been short (though very sweet). And this week it feels as though the end is nigh; this morning she said 'Milks?' when I got her up and I said 'Ok', but she shook her head, and squirmed to get down, and spotted her brother through the banisters, and went off to play instead.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhehQWC8fjZWCxu75AS79Q1r5IZNXAbSTgiuF50F6FJc1VeLGoQ4A3s_Vjhr7IFXxUm-uuRrnpBLmWFhqoHAe6gwM36Ef1AHQ1NCo9xrey-w0OEHflBjPPHVi2dYd0I4YcOCwDuJDjiN2yV/s1600/Ada+-+first+feed+(2).JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhehQWC8fjZWCxu75AS79Q1r5IZNXAbSTgiuF50F6FJc1VeLGoQ4A3s_Vjhr7IFXxUm-uuRrnpBLmWFhqoHAe6gwM36Ef1AHQ1NCo9xrey-w0OEHflBjPPHVi2dYd0I4YcOCwDuJDjiN2yV/s320/Ada+-+first+feed+(2).JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ada's first feed, November 2010</td></tr>
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I find myself with mixed emotions: pride when I see how my daughter is growing up and becoming her own person, more separate from me; wistfulness when I recall her babyhood and realise how quickly it has passed; and a gentle sadness that my own experience of breastfeeding, which has brought me so much, in all aspects of my life, is coming to an end. When I wrote up my breastfeeding experiences for my collection of positive breastfeeding stories, <i><a href="http://www.amazon.co.uk/Breastfeeding-Stories-Inspire-Susan-Last/dp/1905179049">Breastfeeding: stories to inspire and inform </a></i>(published when Ada was eighteen months old), I concluded: <span style="color: #cc0000;">'It seems strange to think that I might be approaching the end of breastfeeding when it has been so central to our family life over the last few years. There's no doubt I will look back on it as one of my most precious experiences of motherhood.' </span>I feel very lucky to have had almost another year of breastfeeding since I wrote those words, and that Ada has had such a gradual, gentle weaning. It will be fascinating to see whether, as she gets older, she will remember breastfeeding. A few weeks ago, my older daughter, aged six, came into the bedroom in the early morning while I was feeding Ada. 'Mummy!' she exclaimed in shock as she looked at us, 'I'd completely forgotten that you breastfeed Ada! How could I have forgotten that?' We all laughed, but I was struck by how, when we don't have constant reminders, even things that were once a completely integral part of the family 'furniture' can slip into memory.<br />
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Ada's favourite book at the moment is <i><a href="http://www.amazon.co.uk/Paper-Dolls-Julia-Donaldson/dp/0230741088/">The Paper Dolls</a></i> by Julia Donaldson, illustrated by Rebecca Cobb. We currently read it every single night. It's a beautiful book and the part that brings a lump to my throat, even on the umpteenth reading, is the part where, after the paper dolls have been snipped into pieces by a little boy with scissors, they continue to sing their song:..<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyroWzxbK_6OqEj4C_VbJzkQzu33XIhyphenhyphensKIIZnnxaJ4lzVncgvEoIGsLNr3tI6_RYagADFegiKvsjjjKX_CAcTSc077GPPAuItAO4DMccZEUU_83cZ0OtHsqXqM9l7MmFHg1Pr9ECvWSWd/s1600/the+paper+dolls.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyroWzxbK_6OqEj4C_VbJzkQzu33XIhyphenhyphensKIIZnnxaJ4lzVncgvEoIGsLNr3tI6_RYagADFegiKvsjjjKX_CAcTSc077GPPAuItAO4DMccZEUU_83cZ0OtHsqXqM9l7MmFHg1Pr9ECvWSWd/s200/the+paper+dolls.jpg" width="200" /></a><br />
<span style="color: #cc0000;">'And the pieces all joined together,</span><br />
<span style="color: #cc0000;">and the paper dolls flew... </span><br />
<span style="color: #cc0000;">...into the little girl's memory</span><br />
<span style="color: #cc0000;">where they found white mice and fireworks,</span><br />
<span style="color: #cc0000;">and a starfish soap,</span><br />
<span style="color: #cc0000;">and a kind granny,</span><br />
<span style="color: #cc0000;">and the butterfly hairslide,</span><br />
<span style="color: #cc0000;">and more and more lovely things</span><br />
<span style="color: #cc0000;">each year.'</span><br />
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I'm hoping that buried in the corners of my children's minds, along with all the other lovely things, there are some memories of breastfeeding that will be there all their lives. As for me, it's not so much a corner of my mind as an overflowing treasure chest.<br />
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And in some ways it's definitely not the end of the story: with publishing, writing, peer supporting and campaigning, I think I'll be busy with breastfeeding for a long while yet.<br />
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<br />Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com12tag:blogger.com,1999:blog-5647340539604305311.post-88336859295135448082013-04-12T08:26:00.002+01:002013-06-25T09:52:24.843+01:00Baby milk shortages - formula manufacturers, the politics of infant feeding, breastfeedingThe news that Danone, which makes Aptamil and Cow & Gate formula milks, has imposed sales restrictions on parents in the UK has been all over the media this week. Shoppers are now limited to purchasing two packs of powdered infant formula per day. Supposedly this is to prevent bulk buying and informal export of formula to China - at least, that is the explanation that Danone <a href="http://www.aptaclub.co.uk/baby-milks-product-availability">have given</a> on the brands' respective websites, in<a href="http://www.cowandgate.co.uk/baby-milks-product-availability"> a letter from managing director John Sykes</a>.<br />
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However, there can be no denying that the story has generated massive publicity for the brands involved. For example, in <a href="http://www.bbc.co.uk/news/business-22082146">this segment</a> on the BBC website the mother is filmed using Aptamil formula, and <a href="http://www.dailymail.co.uk/femail/article-2307070/Formula-milk-shortage-stressful-breastapo-piling-guilt-A-anguish-mother-seven-month-old-twins.html">this article </a>from the <i>Daily Mail</i> carries a prominent shot of both Danone brands on supermarket shelves, complete with shelf-edge explanation of the buying restrictions.<br />
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What better way to add cachet to the Danone brand than to let its UK market know how highly prized its products are in China? The fact that millions of Chinese consumers (in a country beset by formula milk scandals, where formula advertising is aggressive and unregulated, and breastfeeding rates are on the way down) trust the brand and will pay inflated sums for it is surely something worth (from Danone's perspective) instilling in the minds of UK consumers. In addition, products in short supply have 'rarity value' - it's like must-have toys at Christmas, or petrol, or limited-edition designer handbags - that 'value', in the minds of consumers, is great news for retailers and manufacturers. Crucially, 'news' stories are not seen as 'advertising', although in practice, as anyone involved in the media knows, they fulfil the same function - there is truth in the old maxim 'all publicity is good publicity'.<br />
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The knock-on effects of all this on our culture of infant feeding on the UK are more subtle. A slew of articles about formula feeding normalises it further - a shortage that affects millions of parents across the UK gives the message that 'everyone' is using formula as opposed to breastfeeding. Images of specific <i>brands </i>accompanying the articles make it more likely that parents, faced with a shelf full of products and with little access to accurate, unbiased information about infant formula, will reach for the product they recognise. As shown by the <a href="http://www.dailymail.co.uk/femail/article-2307070/Formula-milk-shortage-stressful-breastapo-piling-guilt-A-anguish-mother-seven-month-old-twins.html">Daily Mail article</a> mentioned above, a focus in the media on formula feeding can bring with it a wave of anti-breastfeeding feeling. The author of the article claims that <span style="color: #990000;">"the breastapo are out in force, berating the formula feeding pariahs who feed our babies this manufactured 'poison'." </span>I don't believe this or see any evidence of it; all this article shows is that, given a convenient peg to hang it on (news of a formula shortage), the same tired elements of a FF v BF argument that helps no one and only serves to divide women and line the pockets of the formula manufacturers, can be trotted out yet again.<br />
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(A separate, but I suspect related, <a href="http://www.mirror.co.uk/lifestyle/health/vitamin-d-deficiency-long-cold-1797025">article in the Mirror about vitamin D deficiency</a> mentioned Cow & Gate Growing Up Milk by name, causing me to wonder whether the article had been 'inspired' by a Danone press release... the formula companies are very keen for parents to know that children consuming more than 450ml of first stage or follow-on formula per day do not need vitamin D supplements.)<br />
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Consider the context of all this. We already know from the<a href="http://www.hscic.gov.uk/searchcatalogue?productid=9569&topics=1%2fPublic+health%2fMaternal%2c+infant+and+child+health&sort=Relevance&size=10&page=1#top"> Infant Feeding Survey 2010</a> that in the UK many parents are unaware of the differences between infant (first stage) formula and follow-on formula (suitable from six months) - the latter being an unnecessary product specifically designed to circumvent the restrictions on marketing infant formula imposed by the <a href="http://www.who.int/nutrition/publications/infantfeeding/9241541601/en/">WHO code on the marketing of breastmilk substitutes</a>, which is not even fully implemented in the UK. We also know that the formula companies will battle incessantly for market share with a huge array of marketing tactics (carelines, baby clubs, marketing to health professionals, roadshows... the list goes on). All this is funded by marketing budgets, paid for by formula consumers. Increased market share means increased profits. In this sort of climate a shortage of product makes perfect sense as an aggressive marketing ploy.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga99Ja_GFJAvwczfTTTzSIdTRwJCwXU0COG7K6CpSGgi9Als14OQG6fq78xCfpvUAmbRgs0BY2YH1dn4m2EHJkamq0DtxryHN6BqrGVkoje_qNZL0qJOOjge-ueN7vlwPRrkzSvTTV_e_7/s1600/Baby+milk+action+image.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga99Ja_GFJAvwczfTTTzSIdTRwJCwXU0COG7K6CpSGgi9Als14OQG6fq78xCfpvUAmbRgs0BY2YH1dn4m2EHJkamq0DtxryHN6BqrGVkoje_qNZL0qJOOjge-ueN7vlwPRrkzSvTTV_e_7/s1600/Baby+milk+action+image.jpg" /></a>In case you think I'm overstating the case here, I'd like to highlight the work of <a href="http://www.babymilkaction.org/">Baby Milk Action</a>, which has recently published a new report<i> <a href="http://www.babymilkaction.org/shop/publications01.html#lwtduk2013">Look What They're Doing in the UK!</a></i>. In the press release that accompanies the report Mike Brady, Campaigns and Networking Coordinator, says:<br />
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<span style="color: #990000;">"Given the massive production capacity that Danone has in nearby Ireland there is something about this story that does not ring true: it is surely more likely Danone that is prioritising other markets than people exporting supermarket stocks. Danone is locked in fierce competition with Nestlé, particularly in Asia. Danone is gaining massive publicity for its products on the back of this shortage scare, but parents who use formula can heed Department of Health advice and switch to other brands. Claims made that one particular brand is better than another do not stand up to scrutiny. As our <i>Look What They're Doing</i> in the UK report demonstrates, companies are endlessly imaginative in how they push their products." </span><br />
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In the <a href="http://www.bbc.co.uk/news/business-22066243">BBC report on the issue</a>, Nestle, the second largest formula manufacturer in the UK market, said that it had not seen an increase in demand due to unofficial exports, and that there was no shortage of its products. (Nevertheless, some supermarkets are limiting sales of Nestle brands too.)</div>
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It seems to me that what's needed, as usual in reference to infant feeding, is wider access to clear, unbiased information that doesn't come from the formula manufacturers themselves, and <a href="http://www.telegraph.co.uk/women/mother-tongue/9982229/Stop-rationing-information-about-baby-formula-milk.html">this article in the Telegraph</a> made the same point. UNICEFs Babyfriendly initiative publishes <i><a href="http://www.unicef.org.uk/BabyFriendly/Parents/Resources/Resources-for-parents/A-guide-to-infant-formula-for-parents-who-are-bottle-feeding/">A guide to infant formula for parents who are bottle-feeding</a></i>, which is a great place to start. Another good source (aimed at health professionals, but anyone can download the report) is <i><a href="http://www.firststepsnutrition.org/news.html#infantmilksorgetting">Infant Milks in the UK</a>.</i></div>
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It's also not unreasonable, as part of the ongoing discussion, to talk about breastfeeding. It's not shaming of those who use formula to point out that, on a population level, increased breastfeeding would mean both improved public health and less reliance on commercially-driven formula milk manufacturers. The 'shortage' story could be seen as demonstrating perfectly some of the most amazing qualities of breastfeeding: most mothers can produce hundreds of litres of breastmilk (incomparable to formula) for a zero carbon footprint - no food miles, no energy costs of manufacture or reconstitution, no supply-chain issues. </div>
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I've been considering the implications of all this for breastfeeding support. I had a conversation with a formula-feeding mother while I was planning this article: she asked me what, as a breastfeeding peer supporter, I would do if someone asked me about formula feeding. I thought hard about what I could do in this situation, aside from talking to the mother about her reasons for switching to see if there was anything I could help her with before she stopped breastfeeding, and discussing the option of mixed feeding (on the grounds that any breastfeeding is better than none). I realised there's a lot of information I can give, although I would be upfront about my lack of personal experience of bottle or formula feeding. I do, however, know about the most recent guidelines for making up bottles and the reasons for them, and am happy to talk to mothers about them. I have also read the guides above and feel that I could tell a mother that since the composition of formula in the UK is regulated, and claims about differences between brands don't hold water, her decision can be based on price and what her child seems to prefer, and she needn't be restricted to one brand. I'd hope, in doing this, to leave the mother feeling better-informed about her options, and not let-down by a sudden lack of support when her circumstances change. I'd love to hear what other breastfeeding supporters think about this.</div>
Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com12tag:blogger.com,1999:blog-5647340539604305311.post-45928868436288531242013-03-09T18:29:00.002+00:002013-06-25T09:54:16.565+01:00Childbirth Without Fear and the backlash against the breastfeeding backlash...<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW3ewyjwmrbbHzSYSeTEQjrRFih9XKX-l9vcCCBD0YpUfTnvvTC2W7Rd_bscUbmvZmv7KeI5rG4h9sJtC_jea5RDWD5v1wMUX6AIapICWQCkOmNhyEYx6g6Q68ge4Pyou4KeHxd0JFo5tN/s1600/CWF+jacket.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW3ewyjwmrbbHzSYSeTEQjrRFih9XKX-l9vcCCBD0YpUfTnvvTC2W7Rd_bscUbmvZmv7KeI5rG4h9sJtC_jea5RDWD5v1wMUX6AIapICWQCkOmNhyEYx6g6Q68ge4Pyou4KeHxd0JFo5tN/s320/CWF+jacket.jpg" width="200" /></a></div>
It feels like deja vu - earlier in the year I tackled birth and breastfeeding newspaper articles in <a href="http://thethoughtfulpublisher.blogspot.co.uk/2013/01/having-baby-planning-to-breastfeed-dont.html">this post</a>; and this week Helen Rumbelow in <i><a href="http://www.thetimes.co.uk/tto/life/article3706338.ece">The Times</a></i> and Anna White in the <i><a href="http://www.telegraph.co.uk/women/mother-tongue/9915446/Breastfeeding-battle-The-Breastapo-need-to-stop-nipple-gazing.html">Telegraph</a></i> have been at it again.<br />
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I read Helen Rumbelow's <a href="http://www.thetimes.co.uk/tto/life/article3706338.ece">article</a> about the new edition of <a href="http://www.pinterandmartin.com/childbirth-without-fear" style="font-style: italic;">Childbirth Without Fear</a> by Grantly Dick-Read, and its powerful cover image, with some interest, as I've been proofreading it for Pinter and Martin. (I know, I can't believe my luck either.) It's ironic that Rumbelow's piece, which draws heavily on her own experience of birth, and misinterprets many of the main points of the book, perhaps illustrates all too clearly why many of Dick-Read's insights are still relevant today.<br />
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Of the cover she writes that the mother looks more like a model <span style="color: #cc0000;">'than the kind of birthing woman I was, or have ever known... and then there is the matter of the neonate she is sort of sitting on top of...'</span> This is surely part of the point (and one that's well made in the book itself) - our mental images of childbirth are <i>cultural</i> and this unmedicated, upright, spontaneous birth looks, to women more used to seeing birth take place in hospital, unusual - even shocking. According to Rumbelow some American booksellers won't stock the book<span style="color: #cc0000;"> 'because so many readers will assume the image is a spoof; fakery of the kind most women suspect when they hear stories from the likes of Gisele Bündchen, claiming that the birth of her son “didn’t hurt in the slightest”, which is Brazilian supermodel shorthand for “why do all you fat birds make such a fuss?”' </span>Really? It wasn't just that they found it a bit graphic for a US public that combusts when it sees a nipple due to a wardrobe malfunction? The rest sounds to me like Rumbelow's personal view. One of the things I object to about Rumbelow's tone, in this and other articles, is the way it casually dismisses the possibility of valid alternative perspectives - I'm no Brazilian supermodel but I've had three pretty painless births - and I can't see how that kind of narrow focus can add anything to the important discussion of the issues surrounding birth.<br />
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One section of the article I found particularly troubling. Rumbelow writes: <span style="color: #cc0000;">'Dick-Read... had been a pariah but slowly his influence crept into NHS hospitals. “Natural” may or may not be desirable, but from the NHS point of view, a bouncy ball and a warm bath were a lot cheaper than the anaesthetist, epidural and staff surveillance required for a medicalised birth. Accountants realised that pain relief could be marketed as a luxury not a right. An unholy alliance grew up between the bean-bag hippies and the bean-counter NHS cost controllers.' </span>To read this you'd think that there was some sort of conspiracy to encourage natural childbirth within the NHS; in fact, it reflects the increased influence of midwifery - woman-centred care - and the best research we currently have about outcomes (in terms of birth injury, postnatal pain, Apgar scores, <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/">initiation of breastfeeding</a>) for mothers and babies, which informs the <a href="http://www.nice.org.uk/">NICE</a> guidelines, as well as the type of birth <i>women want for themselves</i>. (I can't help thinking that if Rumbelow's suggestion were true, the NHS would be encouraging us all to have home births - even cheaper!) And the situation today, although better than in times past, still has room for significant improvements - for more, see<a href="http://www.the-mule.com/2013/02/stop-googling-your-birth-options-and.html"> this excellent post</a> on The Mule.<br />
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What's clear from actually reading <i>Childbirth Without Fear</i> is that Dick-Read was capable of real insight into women's experiences of birth. He observed carefully, thought deeply, and had an appreciation of the magic, or spirituality, or importance - whatever you want to call it - of birth. He recognised the importance of the right kind of support and for the need for women to be educated about the amazing abilities of their own bodies, and that with these came a reduction in the fear that leads to tension, and thus to an interpretation of the physiological process of birth as 'painful'.He understood how culture affects women's expectations of birth and breastfeeding. (The section about the translation of words describing labour in the Bible is just brilliant.) His style of writing may be of his time, but his work couldn't be more relevant today.<br />
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As with birth, so with breastfeeding. Fortunately, when it comes to Anna White's bitter article <a href="http://www.telegraph.co.uk/women/mother-tongue/9915446/Breastfeeding-battle-The-Breastapo-need-to-stop-nipple-gazing.html">'The Breastapo need to stop nipple-gazing'</a> there's no need for me to go into too much detail - the Analytical Armadillo has already done a great job<a href="http://www.analyticalarmadillo.co.uk/2013/03/anna-white-telegraph-spectacularly.html"> here.</a><br />
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What I find myself wondering is why these particular journalists keep writing exactly this kind of article. Are their editors specifically commissioning pieces that take an anti-breastfeeding, or anti-choice stance, and if so, why? Despite Anna White's claim that <span style="color: #cc0000;">'a growing number of academics are questioning the presumed-to-be empirical evidence promoting the health benefits of giving babies the boob' </span>the <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/">evidence that artificial feeding presents risks to the health of mothers and babies, in the UK and elsewhere</a>, is overwhelming; we also know from the <a href="http://www.ic.nhs.uk/article/2021/Website-Search?productid=9569&q=infant+feeding&sort=Relevance&size=10&page=1&area=both#top">Infant Feeding Survey</a> that most women start breastfeeding and want to carry on but are derailed by numerous factors, lack of information and support chief among them. We also know that <a href="https://www.npeu.ox.ac.uk/birthplace">home birth and 'natural' birth is safe</a> and that women in the UK are entitled to choose it if they wish. Whose interests are served by articles that deliberately pit medics against mothers (Rumbelow says of <i>Childbirth Without Fear</i> that it is<span style="color: #cc0000;"> 'one of the most controversial texts, pitting those in the medical establishment and mothers against each other'</span>), and mothers who feed their children differently against each other? Normally I would suspect vested interests, or the desire to attract certain readers and/or advertisers, but in the case of the broadsheets (as opposed, say, to the parenting glossies or the Tesco baby magazine) this doesn't seem so likely. It's possible that the explanation is simpler - these journalists have emerged from their own experiences of pregnancy, childbirth and breastfeeding in our society with strong feelings, and unlike most people they have a platform where they can work them out in public. It's also possible that those commissioning the articles have experienced, either first or second hand, a type of birth and breastfeeding experience that those of us who support women are working hard to try to improve, through initiatives like the <a href="http://www.positivebirthmovement.org/">Positive Birth Movement</a> and the establishment of <a href="http://www.birthrights.org.uk/">Birthrights</a>.<br />
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I'm passionately interested in women's stories of <a href="http://www.amazon.co.uk/Home-Births-Stories-Inspire-Inform/dp/1905179022">birth </a>and <a href="http://www.amazon.co.uk/Breastfeeding-Stories-Inspire-Susan-Last/dp/1905179049">breastfeeding</a> and find them endlessly revealing and informative, in terms of what they tell us about individual women and the influences that affect their experiences. However, it's always a mistake to extrapolate too far based on one's personal experience: hard as it may be, a more objective view, that puts your own experience in the context of many others, and considers the available evidence with an open mind, is what leads to greater understanding, if not agreement. It's something that peer supporters and breastfeeding counsellors cover in training - to debrief their own experiences, deal with their own feelings and then put them aside in order to focus on how they can best support other women with a different set of influences, values and aims, within a society and culture that exert their own pressures on women and their choices. I don't think either Helen Rumbelow or Anna White has yet been through a process of genuine reflection about their own experiences of birth and breastfeeding; had they, their articles would be contributing to a much more rounded discussion of issues that ultimately affect all women.Lonely Scribehttp://www.blogger.com/profile/16699804881912930230noreply@blogger.com0