Sunday, 10 May 2015
Gurgle's modern guide to breastfeeding
Breastfeeding is best for baby, but it's not always plain sailing. In an extract from her new book, Keep Calm: The New mum's manual, Dr Ellie Cannon offers reassuring advice for mums who just want to do the right thing
As a GP, I have to ask all new mothers how they are feeding their babies at the six-week check. More often than not, if a patient of mine is not breastfeeding she apologises to me. Sad and guilt-ridden, I have mums in my surgery saying to me, 'I'm sorry Dr Cannon, I'm not breastfeeding.' At times, I'm not ashamed to say, this has even made me teary.
You don't need to apologise to anyone about how you feed your baby. Bottle-feeding mothers are not second-class mothers who need to apologise. Just like breastfeeding mums shouldn't have to apologise for getting their boobs out in the library (as long as it's to feed the baby), bottle-feeding mothers should never feel they have to apologise. Some believe that every woman can breastfeed, but I really don't think that this is the case.
In fact, I hands-down refuse to acknowledge that every woman can breastfeed. It just doesn't make sense given all the mums I've seen who have tried so hard and failed. Women who really wanted to feed but physically couldn't. Of course, it's natural and our bodies are designed for it, but bodies don't always work to the grand evolutionary plan. Have a think back to labour: you go into labour and your cervix starts to dilate. At least it's supposed to dilate, but it doesn't for all women. What about all those cervixes that don't dilate, so the baby has to be delivered by Caesarean section? Midwives don't say to those women: 'Listen love, you really should be using your vagina for the birth of the baby, so we won't be offering you a Caesarean.' That would be crazy, right? It might be the most natural way, but it doesn't always work in reality. Some boobs just don't work well, just like some cervixes. The end. No apology necessary.
Crying over spilt milk
Many women feel they don't make milk, or it dries up, or breastfeeding is very painful or even just uncomfortable. No one can tell you you're wrong and you have to persist because that is the natural way. Mammary glands, like babies, do not all follow the textbooks and do what they're supposed to do. And that is fine. It's disappointing often for women who give up breastfeeding, but it's reality and it happens often. It can even change with each child: I had one baby who was easy-peasy to feed while the other one definitely hadn't read the instruction manual.
But as a doctor, do you Believe Breast is Best?
I do. I 100 per cent believe breast milk is the best thing to feed a baby: taking all other factors out of the equation (ie the mummy) and simply looking at breast milk versus formula milk, we know breastfeeding is the optimal way to feed a baby. This is undisputed medical information.
Breastfeeding is rightly recommended as the first choice by the World Health Organisation, the Department of Health and all medical establishments. There are scientifically proven benefits of breastfeeding as breast milk fully meets a baby's dietary needs. In countries where clean water is a rarity, it is positively life-saving. Thankfully, that doesn't apply to the UK. But it still has benefits: it has antibodies, it is packed with the right nutritional ingredients and don't forget it's free – a virtue not extolled enough! We know breastfed babies have fewer allergies, tummy infections and ear infections. Some of the other claims about breastfeeding are rather over-played/complete codswallop: for example, breastfed babies are not superior intellectually, nor are they closer to their mothers and they are not guaranteed to be happier than their bottle-fed peers.
While breast milk may be the best option for your baby, if breastfeeding isn't actually working then we can't say it's best. If it's making you miserable or ill, then that clearly outweighs the advantages of the milk itself and breast is no longer best. It's a balancing act. Let's be sensible about it.
It's all gone tits up but I want to carry on...
Excellent. If you want to carry on breastfeeding and it is going wrong, then you need to quickly find yourself some help. And you need to find yourself good-quality assistance: therein lies the problem, as it can be hard to find good help.
Breastfeeding advice is generally confusing, conflicting and we all give you different opinions. I'm sorry about this, but you need to be warned. Time and time again I hear this, so you need to be savvy. Potentially a midwife, a breastfeeding counsellor, a health visitor or a GP may be able to help you, but you have to find a good one. GPs have little or no training in breastfeeding – the only reason I know about it is because I did it: it certainly isn't something I learnt about at medical school.
The best person to help you may actually not be a so-called 'expert', but maybe a friend who's done it and gone through problems, or someone you know with an older baby who might know some tricks of the trade. Be wary of people who say only their way is right: it may be you have to try a few things before you feel settled with it. Try one solution at a time, so you can see what is helping. It is very tempting when you're desperate to sort things out, to throw in all the ammunition at once: don't, because you won't know which strategy is really working. Be a bit patient; yes, I know it's not easy.
Breastfeeding doesn't come instantly to every mummy, and taking a few weeks to get to grips with it is normal for plenty of women who go on to breastfeed for years easily and happily. Keep calm. If you want to do it, you will find your own solution: don't panic if it takes some time. Your instinct is still key. If you do get some advice and it seems wrong, move on. Trust yourself at all times.
At any point when you are struggling, if you feel your baby may be not feeding enough, do not ignore that. Get your baby weighed and checked over for dehydration by a healthcare professional as soon as you are concerned. This is vital. It may be that he is not taking enough milk and while you're still learning, you need to give him a top-up of formula. This is not a problem at all. Many of my patients use top-up bottles in this way to ensure their baby is adequately hydrated and fed. This takes the pressure off you when you are struggling and can ensure he's safe.
It's all gone tIts up and I want to stop...
If you want to stop breastfeeding, think about it carefully first. I always get mums to do this before they completely give up, just as a safety net. This is a bit of self-preservation I've learnt from years of seeing mums stop and regret it. It's very difficult to return to breastfeeding once you cut down, and your milk supply reduces, so you have to be sure this is the route you want to take.
I see plenty of mums who give up breastfeeding and then spend the next year reliving it and how it went wrong. This is partly regret, partly guilt and partly feeling like a failure. You can give up whenever it feels right for you, but just slow down and think first so you are comfortable with your decision. Mums who stop breastfeeding because it didn't 'work' do experience guilt and some sadness so be prepared for that.
Think about whether or not you have to give up completely: while we always harp on about the breastfeeders versus the bottle-feeders, there's a very happy camp of mums who are mixed-feeding, so giving a combination of breast milk and formula. So many of my patients do this really well, either on purpose or by chance. A young mummy I know did this recently, as she realised (with no advice by the way, simply instinct) that she had less milk in the evening. So she uses formula in the evening, and breastfeeds the rest of the time. She's happy she's still breastfeeding and her baby is settled. That was her compromise. She calls herself a 'breastfeeder' because she is one. She sits with her antenatal crowd, breastfeeding.
She doesn't hide the fact she gives a bottle, she just doesn't see it as a big deal. If you ask breastfeeding mothers if they also give a bottle, a surprising number will say yes. Mixed-feeding mummies keep their options open and seem to have it sussed. Happily breastfeeding while at the same time bottle-feeding is a real choice not to be dismissed: and it can be a good halfway house if you think you want to stop. It gives you time to think, without giving up too quickly and regretting it. Especially as there's not really any going back once you stop.
If you have given it careful thought, and you are sure you want to stop breastfeeding, then that is absolutely fine. No guilt. No failure. It is your choice, and your choice alone. The only rule is that it is important to stop breastfeeding slowly, so your breasts do not become engorged and sore. You should drop a feed every few days, so your breasts gradually produce less milk. If you no longer want to put your baby to the breast, you can wean production down by expressing instead.
Should I be expressIng?
I think it's very handy to express milk and store it for another day as you never know when you may need to be apart from your little one. It's a safety net to have that little milk bank, but it is certainly not essential. There are two truths to know about expressing breast milk: firstly, not all 'good' breastfeeders are good expressers. Boobs might be more than capable of feeding a baby, but when it comes to filling a bottle with a pump they don't produce much. I know many women who can't produce more than 50ml when pumping but easily feed a baby for months. The second truth is there is no such thing as the perfect pump. While people will evangelise about the electric pump versus the hand pump, you really don't know until you have a go, as it is so individual.
How do I know my baby Is gettIng enough mIlk?
The answer is simple: you will just know. I can assure you of that. Whether you are breast-, bottle- or mixed-feeding the clear signs will be there, and you need to learn to look for them and have confidence in yourself to get this right. That's what you're designed for – meeting your baby's needs – and that is what you will be able to do. Even after four or five days into motherhood you will have learnt the signs that your baby has got a full tummy and is contented; you probably don't even realise you know that. Trust me, you know. You are the woman with the super powers who knows these things. Within days of motherhood, you will be a feeding expert.
A real one.