Having a baby? Planning to breastfeed? Don't read the papers...

Two articles have been bothering me this week: Helen Rumbelow's 'Your mother-in-law was right: breastfed babies don't sleep through the night' in The Times and Anna White in the Telegraph: 'Is baby-led weaning a load of mush?'.

The two pieces had much in common despite their different subjects. Both were judgemental, short on facts, and failed to accurately represent the best research we currently have about infant feeding. Helen Rumbelow suggested that there was some sort of conspiracy going on: 'This is what your health visitor, midwife, baby sleep book, the NHS and the National Childbirth Trust [an easy target perhaps, in the wake of the Kirsty Allsopp/NCT stand off?] won't tell you: your mother-in-law was right'. She claims the 'news', that breastfed babies wake more often at night, has been 'hushed up' in an effort to persuade women that breast is best. The implication, although she doesn't state it specifically, is that if you are breastfeeding and suffering from sleep deprivation, the solution is obvious: give up breastfeeding. I've blogged before about how this isn't supportive of women who are breastfeeding and consider it important. They don't want to give up breastfeeding, they just need more sleep. There are other ways to achieve that than to give the baby artificial milk, and any good breastfeeding supporter will have a range of suggestions that may help (including, but not limited to: co-sleeping, sleeping apart from your partner so that they get an unbroken night and can support you in the evening/morning, getting help from family or friends so you can nap in the day...). Elizabeth Pantley's book The No-Cry Sleep Solution has many breastfeeding-friendly ways to gently encourage your baby to sleep longer stretches.

What annoyed me most about the article was not its undermining of breastfeeding (although I didn't like that either). No, what got to me more was the assumption that babies waking up at night was a bad thing, as opposed to something normal. This is backwards: we should be asking why artificially-fed babies sleep so soundly and considering whether that is really desirable. We know that breastfeeding has a protective effect on the incidence of SIDS; it is likely that the waking patterns of breastfed infants are part of the reason for that. (See Isis for sound information about normal infant sleep.) Rumbelow goes on to draw her own conclusions from what is admittedly interesting research; I take issue with her interpretation, however, which continues to undermine parents who've decided not to artificially feed or sleep train their babies. She glibly asserts that 'Once a baby is weaned onto solids at six months, it is developmentally ready to sleep through the night', and goes on to claim that 'the type of mother to breastfeed her kid in the UK gets her heart broken every time her baby cries at night. And she could totally get a better night's sleep if she just adopted a harder line.' From where I stand, on the front-line with breastfeeding mothers, the whole picture is a lot more complex than that. Breastfeeding is not just about food, for one thing; night-wakings are not all about nourishment, at any age - growth spurts, development, separation anxiety, the child's (and mother's) personality all play a part. The research is valuable, and I'd be interested to read more about it, but I don't think Rumbelow did it, or breastfeeding mothers, justice in her piece. About the only thing I could agree with was the idea (not her idea, but that of the researcher she spoke to) that the research could lead to parents being given a more realistic picture of what to expect from their breastfed baby's sleep habits.

Anna White in the Telegraph did a similar job of undermining those mothers who've decided to ditch the spoon and puree method of weaning in favour of baby-led weaning (BLW). It clearly doesn't matter that the evidence in favour of baby-led weaning is sound, or that health visitors are now recommending it to mothers. (I've been talking to mothers about BLW, breastfeeding and cow's milk this week myself; I mentioned this NHS booklet and Gill Rapley and Tracy Murkett's excellent books Baby-Led Weaning and Baby-Led Breastfeeding). No, for Anna White BLW is a 'craze' that has 'divided mothers'. Really? Or is that just the aim of this sniffy article?

Reading on, it becomes clear to anyone who has read anything about BLW that Anna White has missed the point, since she claims that 'you have the faff of preparing dinner for two and a finger-food buffet for one' - in fact, BLW is easier as the baby can just have bits of whatever you're having. Case in point - steak, homemade chips, grilled tomato and broccoli, followed by melon with blueberries and strawberries. Sounds good to me - and it would all be baby-friendly too. If you start BLW at six months, you can skip the 'smooth puree, one-taste-at-a-time, veg first' scenario completely (those guidelines applied to babies who, we now know, were starting solids earlier than they should have).

I think what I most objected to in the piece was the suggestion that by choosing the new 'fad' of BLW, parents were somehow caving in to their children in an unhealthy way: 'This early selection process gives children the freedom to turn their noses up at food making it difficult to later on enforce such rules as no greens, no pudding. Staple values end up in the bin once you hand over control on a plate.' I can only suggest that Ms White does a little more research, which suggests that breastfeeding, followed by BLW, gives you the best shot at raising a child who is comfortable eating a wide range of nutritious foods and can trust their own appetite. And I have to wonder, since it became clear at the end of the article that she has not yet had any experience of starting solids with her own children, whether her views might mellow with experience in the months ahead.

While writing the above I've had my attention drawn to a third article, this time in the Daily Mail - no surprise there - about the home birth shown on Nursing the Nation on ITV1. Journalist Kathryn Knight's piece, entitled 'Would you ask your neighbours round to watch you give birth? Natalie did, not to mention her four other children, mother, best friend and a TV crew!' Subtext: what will these crazy women get up to next? The tone echoes the articles already discussed, coming across as deeply critical of anyone who makes a choice outside a narrow range of the so-called normal. 'Most would see Natalie’s choice as bizarre. After all, mothers generally prefer this most private of events to take place in front of no one other than their partner and a medical professional.' That sounds to me more like Knight's personal view of the matter than a fact. The same personal feelings are to the fore when she writes 'It’s a brave woman indeed who seeks to share these most primal and unflattering images of herself with the nation.' Unflattering? The pictures that accompany the article are beautiful, as was the film! That this mother was willing to share the positive experience of her birth with others is a great thing; exposure to positive stories of pregnancy and birth is known to have an impact on women's own births. When they know what their bodies are capable of, fear, and its capacity to put a brake on the physiological process of birth, recedes. This is what the Positive Birth Movement is all about.

I remain disappointed in the mainstream press and its coverage of birth, breastfeeding and babyhood. I've complained before about the editors that commission this stuff - does it really sell newspapers? It certainly doesn't contribute much to the real and interesting debates that are taking place online, and in Positive Birth discussion groups, homebirth groups and breastfeeding support groups across the country. I'm glad to say it's not all doom and gloom this week - I've been somewhat cheered up by the launch of Birthrights, a new organisation that aims to protect women's human rights in childbirth. Do have a read of their website - there's stacks of important information there for anyone giving birth in the UK today.

The incredible story of An Anthology of Hope

One of the things I love about working in publishing is the feeling of being on the verge of a discovery - always thinking that one day I may stumble across a book that no other publisher has heard of, that is so special that it will make a difference to the lives of hundreds of readers. Lonely Scribe's newest publication, An Anthology of Hope, compiled by Campbell Steven, is just such a book: it has a remarkable history and, I hope, an equally remarkable future.

"This remarkable collection of writings sheds light where there is darkness: all those who have suffered, whether through bereavement, illness, depression or other difficult circumstances, will find comfort and help in its pages."

I've blogged before about Lonely Scribe's relationship with our lovely author Maisie Steven and her delightful memoir The Heart is Highland. Maisie's husband Campbell died in 2002, shortly after the company I then worked for published his own memoir Eye to the Hills (now out of print). In that book he tells the story of a project that was part of his life for over twenty-six years - the compilation of an anthology, of verse and prose, religious and secular, born out of his grief after losing his first wife. When Eye to the Hills was finished, Campbell sent me a copy of the Anthology, which he'd self-published, as a thank you. I am not religious, but I am endlessly fascinated by the power of writing, so I leafed through it with great interest, pausing often to read passages that caught my eye, some old favourites and many I'd never come across before. Over the years I pulled the book out from time to time to look for inspiration in its pages - a quote for a book jacket, words for a wedding or funeral, or just something to spark a new train of thought.

Time passed. One day, Maisie rang me. She was getting enquiries - slowly but steadily - from people trying to get hold of An Anthology of Hope. Copies of Campbell's last self-published edition had long since run out. Could I offer any advice about creating a new edition? It seemed entirely natural that Lonely Scribe should publish the Anthology; I'd been involved with Maisie and Campbell, and their books, for so long that they felt like part of a family. The book would also sit happily alongside our other titles: Maisie's The Heart is Highland, of course, but also our lesser-known volumes A New Heart and A New Spirit, and A Thankful Heart and a Discerning Mind.

So we began work. There was plenty to do: we had only the last printed edition to work from, no electronic files. We arranged for the text to be scanned in, and then began a painstaking process of proofreading for the errors that can introduce. A particular problem is the running together of letters; I chuckled over 'burn' being printed as 'bum' in a childish way, but had nightmares about any such mistakes slipping through the net! There was also the question of a new jacket image: there was no record, or copy, of the image that had appeared on older editions of the book, so we had to source a new one. Luckily I came across the perfect image on Shutterstock.

We're all delighted with the new edition of the book and are hopeful that it will find many new readers. It's been fascinating for me, while working on the book, to reflect on the interconnectedness of all things. Lonely Scribe has another project in the pipeline: a biography of Peter Scott, son of Robert Scott of the Antarctic and the founder of the Wildfowl and Wetlands Trust. One of his father's last letters appears in the Anthology; it begins: 'Dear Mrs Wilson, If this letter reaches you, Bill and I will have gone out together. We are very near it now and I should like you to know how splendid he was at the end...' Immersed as I have been in editing the story of the son, to read this letter from his father seemed to add another dimension to the tale. And, preoccupied as I often am these days with my work in the field of parenting, birth and breastfeeding, and reading the book anew as a mother, the Anthology tugged often at my heartstrings and gave me much to reflect on and reconsider. (I just lost half an hour trying to pick an example - there is just so much that is thought-provoking to choose from!)

"A shower fell in the night and now dark clouds drift across the sky, occasionally sprinkling a fine film of rain.
I stand under an apple-tree in blossom and I breathe. Not only the apple-tree but the grass round it glistens with moisture; words cannot describe the sweet fragrance that pervades the air. Inhaling as deeply as I can, the aroma invades my whole being; I breathe with my eyes open, I breathe with my eyes closed - I cannot say which gives me the greater pleasure.
This, I believe, is the single most precious freedom that prison takes away from us: the freedom to breathe freely, as I now can. No food on earth, no wine, not even a woman's kiss is sweeter to me than this air steeped in the fragrance of flowers, of moisture and freshness.
No matter that this is only a tiny garden, hemmed in by five-storey houses like cages in a zoo. I cease to hear the motorcycles backfiring, the radios whining, the burble of loudspeakers. As long as there is fresh air to breathe under an apple-tree after a shower, we may survive a little longer." - Alexander Solzhenitsyn

I'm proud to think that by publishing the Anthology Lonely Scribe has played its part in a much bigger story. It's truly a book that can 'shed light' - whether in a religious sense or a secular one - and I hope that readers find their own treasures in its pages.

Positive Birth, home birth, choices in childbirth

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

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

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

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

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

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

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

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

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

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

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