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Wednesday, 13 January 2016

Of course breast is not 'best' – it's normal


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Hello everyone!

Having been flat out with other writing for quite some time, I'm pleased to dust off the cobwebs (blogwebs?) to present a guest post for you. 

This post was written in response to an article published in Australia's Daily Life: 'Breast is Best' has become another way to control women's bodies'. Author Kasey Edwards argues that breastfeeding advocacy robs women of their right to bodily autonomy. Although this piece far from the first to argue against breastfeeding promotion and protection, it is a good example of the sociocultural messages still facing women who want to breastfeed or women suffering breastfeeding grief or anger, and the myths that breastfeeding advocates continue to debunk – over and over and over.

In response to this article, Jessica Armstrong – mum of one, science geek, feminist and breastfeeding peer supporter and advocate – deconstructs the tired old discourse of arguing whether or not 'breast is best' with particular acumen. I loved Jessica's response, and I hope you will, too.



GUEST POST: Of course breast is not 'best' – it's normal


For a long time now, breastfeeding advocacy has discouraged use of the message that 'breast is best'. This particular line of reasoning fell out of favour many years ago, because breastfeeding advocates realised it was the wrong message to send to mothers. (Little Leaf ed: Why? Because there isn't anything 'gold standard' about breastfeeding at all. Human milk evolved as the biological norm for human babies. It isn't a magic bullet, it isn't a guarantee of a super-baby immune to any illness or disease with an IQ of 230. Breastfeeding is, quite unremarkably, nothing more than normal, and offers human young the chance to grow and develop as optimally as their genetics and environment allows.)

As the World Health Organization says
'Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.' (emphasis added)
The only people who are still using the 'Breast is best' message are the hopelessly out of date, or formula apologists constructing a strawman argument. So please, if this message ever strikes you, take this argument outside and set fire to it.

If you think the fight for breastfeeding support has been won you are sadly ignorant of the facts. Go and read the comments section on any article about breastfeeding in the mainstream press and you will see just how much work there is to be done on educating the public about breastfeeding. There is very little support from workplaces for breastfeeding mothers. Recent legislative changes have not suddenly morphed into cultural changes in workplaces and there is still much more to be done in this area. 

Nuance is a thing people can have. I am a breastfeeding supporter, lactivist and radical feminist. I don't actually care how a woman as an individual feeds her baby. Because I respect her bodily autonomy. But I will fight for the rights of women in general to breastfeed their babies any time and any place they wish, and their right to good support in doing so. I will not be silenced – because in doing so, the patriarchal ideas of the silently suffering mother are perpetuated. If you are struggling with feelings of guilt or shame in relation to motherhood, try repeating 'How I feed my babies says nothing about my skills as a mother' or 'I will not allow patriarchial ideas about motherhood to shame me'. Setting women to disparage each other, argue amongst themselves, and police each others behaviour is yet another way that the patriarchy robs us of our power. Resist.

There is a non-exhaustive, enormous body of excellent research about breastfeeding. Resist cherry-picking from studies (and headlines) designed to appeal to those with a vested interest in the findings. For example, Dr Julie Smith at the ANU has done research into the costs to Australia of not breastfeeding. Those Boomers who were not breastfed as babies are costing our health services a whole lot extra because of increased rates of chronic disease – asthma, diabetes, obesity, cancers – among this cohort. So while society may not have 'crumbled' (although, rates of mental illness are at epidemic proportions) we are all having to pick up the bill for what they did not receive.

While we are at it can we please, please, please avoid applying population level studies to individuals. Science does not work that way. Studies may show increased risks for various diseases in people who were formula-fed, but they cannot be applied to you, or your children directly because we cannot yet determine your individual risk for any given disease. Also small increases to risk factors might not seem much by themselves, but they can have big impacts when applied to whole populations. Like Australia. Or the world.

A mish-mash of anecdote, personal experience, unsupported opinion and absolutely no self-reflection is sadly common amongst articles such as this one in question. For every doctor who has pushed breastfeeding, there is another who has told a mother to wean unneccessarily. Pumping may have been a nightmare for one, but other women embrace it. Also, did that group of mums you overheard know that they were becoming national spokespeople for breastfeeding support? Do I really need to point out that ideas discussed in a private setting do not represent what is being advocated for by actual breastfeeding supporters?

Finally, the question I pose to those who continue to argue this 'breast isn't best' message – who are you actually angry with? Women who promote breastfeeding and provide advocacy and support? Because these women are your sisters, and they are fighting for the very thing you seem to want - actual, real support for new mothers. Not platitudes, not 'try harder' because that is not support. Support is asking a woman what she would like to achieve in a given situation and then helping her get there. Support is giving practical suggestions that work for an individual woman's situation. Support means turning up, sitting beside a woman and really listening to what is going on for her. Very few mothers receive that in my experience. 

I call on all mothers, irrespective of how you feed your babies, to come together and demand better support for new parents. Collectively, we could do so much better in our help for new families. Other women are not our enemies. We are being let down by a broad lack of respect for women in our culture, a lack of respect for mothering and for those with care-giving responsibilities. 


It's time to stop blaming breastfeeding supporters for trying to talk about these things, and instead, get angry with a society that did not support you when you were most vulnerable.


By Jessica Armstrong

A huge shout out to Catherine of Bellabirth (follow her Facebook page here) for introducing me to Jessica. 

Thursday, 29 January 2015

Why the ‘mummy wars’ are a myth designed to keep women quiet


Similac's Mother 'Hood video has taken the Internet by storm


In a stroke of marketing genius, infant formula manufacturer Similac has launched an advertising campaign with a video parody. With already over three million YouTube views, Similac calls for ‘an end to judgement’ with #SisterhoodUnite.

Follow any popular parenting pages on social media and you will have seen it. The Huffington Post called it, ‘A playful reminder that judging other parents is absurd.’ Mamamia said, ‘Ever been judged by a fellow parent? Then this video is for you … hilarious.’

‘Welcome to the sisterhood of motherhood’, says Similac. ‘Time to put down the fingers and the subtle suggestions … And, just like the sister who’s got your back, we’re there to help you … with confidence—and zero judgment.’

That’s right, folks. An industry that makes millions in profit wants nothing more than to help. Honest! And they mightn’t judge you personally, but they will bolster stereotypes to enable you to judge the s**t out of each other.

Depressingly, the amusement in this video comes at the expense of enforced labels—the aggressive breastfeeders thrusting their chests (under a cover, obviously); the nervous ‘helicopter’ parent with hands clamped over swaddled baby; the snarky be-suited ‘working’ mum; and of course, the sausage-wielding dads making jokes about boobs.

Clichés aside, what makes this campaign so brilliant is what you don’t see. You don’t see an ad. (Mars ‘Earth’ bar, anyone?) Viewers are led to believe that the company instead empathises with us, that they get us. They make us laugh—and weep. As a result, within moments they’ve established our trust.

What happens when we trust someone? We listen.

Playing beautifully on the women-are-their-own-worst-enemies shtick, the subliminal implication here is that discussion of conflicting information is mean. By appropriating ‘sisterhood’, by reiterating that ‘no matter what our beliefs, we’re parents first’ we’re reminded that anything said contrary to what someone else says must be letting the sisters down—it’s war.

So everyone should, as Similac says, ‘end the subtle suggestions.’ And humour makes compelling argument—because who wants to be that parent? The mother who judges others, who uses her breasts as weapons of mass destruction?

Why would a formula manufacturer call for quiet? Because by talking about infant feeding amongst each other, by sharing information—even by intelligent debate and argument—there’s a chance more women will overcome the hurdles society places in front of them to meet their own parenting goals.

And that might include breastfeeding for longer than companies like Similac would appreciate.

Over the past century, growth of infant formula has un-coincidentally heralded the dramatic decline of breastfeeding rates. ‘The development of artificial baby milk has been a marketing success story,’ writes Gabrielle Palmer in The Politics of Breastfeeding: When Breasts Are Bad For Business, ‘not least in the skill with which the competing product has been destroyed. Women are not paid for producing breastmilk ... those who market [formula and supplies] benefit financially from keeping breastfeeding in check.’

Australians spend about $132.8 million a year on infant formula. Even mining billionaire Gina Rinehart is investing in the ‘white gold’ boom, set to export as much as 30,000 tonnes of the stuff annually to China.

And what is the only competitor to infant formula?

The humble human breast.

Fortunately for formula manufacturers, patriarchy has done a stellar job of convincing women that their bodies are defective, their sole purpose in life is sex, and that their arguments are petty, catty, and pointless.

Kudos, patriarchy. First create the problem, then withdraw and make it look like the women are just squabbling amongst themselves.

For any woman, breastfeeding or not is an emotional and individually complex bodily experience. To reduce it to a choice akin using cloth or disposable nappies is insulting. But it’s also insidiously brilliant—because it enables the continuation of offence whenever discourse around breastfeeding and its common cultural or rare physiological hurdles arise. In short, it allows the accusations of judgement! Guilt! whenever someone says, ‘I’m sorry you were given poor advice. Would you like some help?’

No, Similac’s ad is not likely to inspire a woman’s switch from breastfeeding to formula. But it is likely to keep her quiet about struggling or not wanting to give up—along with shaming into silence voices who might help her if she wants it.

In Australia, the majority of women who initiate breastfeeding cease or introduce formula before they wanted to. No decision is made in a vacuum. Stupendous profits are made by companies maintaining women’s dislike and fear of their own bodies. And they all claim to be doing it for us. To make our lives better, happier, easier. Vast industries make money when women believe their bodies are flawed and faulty—including manufacturers of artificial baby milk.

In Australia, increased breastfeeding rates would save an estimated $60-120 million annually in public health care. Globally, optimal breastfeeding has the potential to prevent almost a million child deaths a year—about one death every 40 seconds.

Formula companies have done an exceptional job convincing women their breasts don’t work. That’s not a petty ‘mummy wars’ issue, that’s a worldwide health crisis.

While these facts are confronting, it’s important to point out that they are not judgments of parents who use formula. There’s supply of information and then there’s criticism. Judging other parents over life differences is absurd. Instead these are criticisms of the corporations who cleverly market to maintain a lucrative facade of trustworthiness at the expense of global wellbeing—at the expense of women’s belief in their bodies.

This video is not a benevolent community service announcement. It is an advertisement for infant formula. It might not look like it, but it is. And it's an advertisement for formula through the implicit misdirection of stifling discourse about the 'competition'—breastfeeding support.

Make no mistake, there’s no altruism in encouraging the silence of information sharing. ‘Let’s all play nice mummies and get along’ is passive aggressive and infantilising. There’s no progress in degrading adult discourse to ‘judgement’. Especially when it comes to highlighting where women are being used and let down, over and over and over again.

The mummy wars? I don’t buy it. We’re bigger than that.

Friday, 5 April 2013

How to get your baby to sleep through the night

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A Google search for this phrase brings up over 59 million results. So I thought I'd add one more!

I give you the tried and tested* 5-step method, proven to get your baby sleeping through the night.

Step 1
• Have a baby

Step 2
• When you are ready for bed in the evening, take your baby to bed with you.
• Turn out the lights.
• Put away the clock.

Step 3
• When the baby makes a noise, pop out a boob. Attach baby.
• Get comfortable, and doze off back to sleep.

Step 4
• Repeat Step 3 as required until the sun comes up.

Step 5
• When your baby is 18 years old, I guarantee you, he/she will be sleeping through the night without needing you! (Unless of course she/he calls from the pub at 2am needing a lift home. Then popping a boob out might not work. And besides, someone else may have already tried that with them earlier that evening.)

In other words, let it go, mama. Babies wake; some a little, some a lot. But it's normal, normal, normal and you have the perfect resources to cope with it. It'll pass. In the meantime, get people to look after you. You deserve it!

Happy sleeping!
Peace and love to you. xo

*Sort of tested, my oldest baby, with whom this method was employed, is almost 6 years old. So no phone calls from the pub yet.

Saturday, 9 March 2013

Put away the clock: The beauty of nighttime breastfeeding

 
"Is she sleeping through the night?"

This is probably one of the most common phrases a new parent will hear.

I just typed 'baby sleep' into Google, and it returned 362 million results—with the top hits headed 'getting a baby to sleep', 'help your baby to sleep', 'teach your baby to sleep'.

Where does this obsession, this market, this world-wide 'problem' come from? Homo sapiens, human beings as a mammal, have been breeding for thousands of years. We need little encouragement to eat or drink or to reproduce. Have we really evolved into such an intelligent, complex species yet managed to somehow make a complete mess of something as essential to survival as sleep?

Baby Sleep—a highly lucrative market
News.com.au recently published an article that perplexed me somewhat. Entitled Broken sleep 'normal' for parents with breastfed babies, the article was an attempt to reassure parents that it is perfectly, biologically normal for breastfed infants to wake multiple times during the night to breastfeed. However, after citing the study that claims to reassure parents of the normalcy of night-waking in breastfed infants, the article summarises with a quote explaining the success of introducing solids to seemingly solve night-waking, and a quote from Tizzie Hall claiming baby routines have some benefit in persuading a baby to conform to adult sleep stretches: 
'"In my experience, breastfed babies who follow a routine will sleep through the night sooner than a baby fed with a bottle," Ms Hall said.'
In other words, it might be 'normal' (news.com.au's use of inverted commas would imply otherwise), but you can (and probably should) try and fix it.

Anyone who has cared for a newborn could probably tell you why we are so obsessed with 'baby sleep'. The sun goes down, and the digits on the clock glow like accusations into the night. Counting the minutes, adding up the hours, pacing the halls with an infant who cries or stares happily at you, and you wonder, as your eye-lids droop like paperweights, if you'll ever sleep more than forty-minutes in a row again.

Babies don't sleep like adults. Babies snatch little snippets of sleep around the clock, waking irregularly and requiring parental assistance to be soothed to sleep. A newborn in particular still runs on 'womb time': where in utero they were held and fed constantly, 24/7. So newborns often take a bit of adjustment to get used to the outside world, the day/night cycle, and the strange and unsettling new sensations in their digestive system that is hunger, fullness, wind, bowel movements.

Additionally, more often than not, our adult lifestyles simply aren't conducive to accommodating the tiredness that results from prolonged interrupted sleep. We have work schedules to adhere to, we have other children to take to school and to care for. We have large houses to clean, meals to prepare, mountains of clothing to wash. And more often than not, as mothers we're alone in those houses and our partners are held to their work commitments by rules and regulations that leave little wiggle-room for parental flexibility.

In an article that explores the discrepancy between biologically normal infant sleep and western cultural infant-care practice, Dr James McKenna et al write:
'... evolutionary pediatrics makes it clear that notions about what human infants need and why, especially as regards nighttime sleep and feeding patterns, seems to reflect far more about what societies want parents to be and infants to become (self- sufficient and independent) rather than what infants actually are—exceedingly dependent, and unfinished ‘‘extero-gestates’’ to use Montagu’s (1986) description. Indeed, especially in early human infancy—and from an evolutionary point of view—reference to the mother’s body is critical to understanding not only what infants need but what they can and cannot do and why. After all, as Hrdy (1999, p. 69) aptly puts it: ‘‘For species such as primates the mother IS the environment . . .’’ meaning that practically nothing about a human infant makes sense except in light of the mother’s body.'  (McKenna et al, 2007)  
The way we expect our babies to sleep (separately from parents, without breastmilk, independent of parental assistance, and for exceedingly long stretches) is at complete odds with how our biology instructs babies to sleep: close to mother's body, rousing frequently for the survival and comfort of mother's breasts and nutrients of breastmilk.

As a society we do, however, show a tolerance to some level of interrupted sleep in the early weeks. But for some reason, our culture tends to frown on this pattern continuing any longer than a handful of months. By the time our babies are several months old, most people expect the baby to sleep long stretches uninterrupted, and to need little or no parental assistance to settle upon waking. Consider again the news.com.au article linked above:
"... breastfeeding mum Melanie Lawrence managed to get daughter Scarlett, now six months, to sleep through the night only at five months when she introduced some solids."
Despite the fact that the World Health Organization (WHO) continue to urge parents to breastfeed exclusively for a minimum of six months, many parents feel pressured to feed solids earlier in order to achieve longer stretches of sleep. For other parents, the well-meaning advice might be to give a bottle of formula to a breastfed baby, or to leave baby to cry, or to pat baby in the cot, or any other manner of 'fix' to 'get' a baby sleeping longer stretches.
'The dominant expectation for these initial months is parental sleep deprivation—their infant’s sleep patterns do not match their own, and parents, desperate for a ‘‘good night’s sleep,’’ seek the magic solution for achieving a somnolent baby. Baby’s grandmother advises a large bottle of formula at bed time so that baby will not wake to be fed in the night. Others suggest adulterating the formula with baby ce- real for greater infant satiation or medicating baby with proprietary infant pain killers or colic remedies ... to ‘‘knock the baby out.’’ Friends sing the praises of ‘‘Ferberizing the baby’’ or similar infant sleep training programs employing an oxymoron known as ‘‘controlled crying.’’ Parents, who feel all else has failed, resort to the painful approach of ‘‘crying it out’’—and while their infant screams alone in an adjacent room, they lie awake racked with guilt, forcing themselves to resist respond- ing, reassuring each other ‘‘it is for his own good’’—until the infant eventually collapses from exhaustion into sleep.'  (McKenna et al, 2007)  
It stands to reason, then, that anyone with a wakeful older baby or toddler feels like a complete failure. I've been there!

I recall hearing a saying amongst natural horsemanship circles: 'people don't have problem horses—horses have people problems.' I think the same is true with human infants. It's not the baby that has a 'sleep problem'—it's that the adult/s in the house aren't equipped to deal with the biologically normal interrupted sleep of an infant.

How are babies so different from what we culturally expect—and try desperately to obtain via a myriad of sleep 'programs'? And what affect does this have on our babies, and our mothers?
'.. arousals lead to the baby breathing more stably over time, and to more variable heart rates and breathing. Variability in breathing patterns of infants is good and a sign of health, ordinarily, and such variability is  often associated with more substantial inhalations of oxygen, leading to shorter apneas in deep stage of sleep from which awakenings can be difficult (see Richards et al  1998). Moreover, if practice makes perfect than the more arousals induced by various forms of co-sleeping the better the arousal skills that potentially can act protectively in response to a cardiac or pulmonary crisis.  
Babies are not designed to sleep through the night in the first six months, at least, of life. They are designed to wake often to breastfeed. Breastmilk does not have dense calories i.e. caloric staying power that keeps a baby sleeping, in the way that cows milk does, for example as it is obviously designed for optimal cow brain growth and development.' (Dr James McKenna)
Human babies are designed to sleep alongside their mother, to breastfeed frequently, and to wake frequently to ensure survival. Breastfeeding reduces the risk of SIDS. But our (patriarchal) cultural preference is for babies to sleep independently and to re-settle alone. We have a high breastfeeding initiation rate that drops significantly within weeks—thusly stripping parents of Mother Nature's intended sleep-inducing mechanism: the close, quick and easy comfort of a mothers breast throughout the night.

Human infants are born exceptionally immature. Human infants are designed to receive breastmilk; breastmilk is designed to be quickly and completely digested, and to be consumed frequently and in small doses to aid such digestion in an immature gastrointestinal system and to accommodate and nourish the rapid body and brain growth human young undergo in the early years.

Breastfeeding releases a hormone called cholecystokinin, (CCK) in both mother and baby. CCK causes both mother and baby to feel sated at the end of a feed. Breastmilk also contains CCK.  (1) Moreover, prolactin, the hormone responsible for lactogenisis II (milk production) and sometimes referred to as the 'mothering hormone' naturally occurs in the mother's body in higher levels at night. (2)

Quite simply, babies and their mothers are designed to stay close to each other, and to rouse frequently to breastfeed throughout the night.

There is no truth to the myth that a co-sleeping baby will never sleep independently. Otherwise, mosts humans would still be sleeping alongside their parents. It's what we've done as a species for pretty much the majority of our existence, and what most of the world continues to practice. It's just we in the West that do things (oddly) a little differently.

My now five-year-old slept alongside me and breastfed frequently through the night since birth. She began to go longer stretches at night without breastfeeding some time in her third year, and she was gently night-weaned when she was about three. She remained sleeping alongside me in bed, sometimes in her own bed that was pushed up to mine, sometimes rolling right over to sleep under my arm. Just recently, she quite suddenly declared that she would like her own room. She goes to sleep with a cuddle from myself or my husband, in her own room, and stays there until she wakes in the wee hours of the morning and creeps in alongside me, usually without waking me at all.

Feeling exhausted? From one breastfeeding mother to another, from one mother of wakeful babies to another, I suggest you put away the clock. Time serves no purpose in your bedroom but to remind you of something that our culture, despite all it's good intentions, just doesn't have biologically right.

Learn about safe co-sleeping and breastfeeding laying down. Minimise your priorities in the day (do you really need to mop that floor today, or can it wait until tomorrow?) Ask for practical help with cooking and housework, surround yourself with nurturance and good support. Forgive yourself for not being perfect, remind yourself that you are wise and your baby is normal—and will outgrow this. Eventually. And in years to come you will look back and miss those cuddles.

Peace and love to you. xo


References:
(1) Bodribb, Wendy. Breastfeeding Management (3rd edition). 2006. Pg 101.
(2) Bodribb, Wendy. Breastfeeding Management (3rd edition). 2006. Pg 7.

Friday, 18 January 2013

The problem with what Kochie said


If you live in Australia, you've probably seen the furore whizzing around social media in the past two days.

The Courier Mail, 16 January 2013 reports:
"A mother of three has been forced to leave a public pool in tears after staff insisted she stop breastfeeding her 11-month-old baby..."A staff member came up to me and told me I wasn't allowed to feed there, that I had to refrain from feeding out in the open,'' Ms Webster said."
Can you believe this is still happening? Right here in Australia, in 2013. For crying out loud!
"I said I was sure it was illegal to tell me to do that but she said it was a grey area...and had to insist I didn't feed there.''
"Grey area" my ... elbow. What that staff member did? Absolutely illegal in Australia.

Australian law states:
In Australian Federal Law breastfeeding is a right, not a privilege.
Under the federal Sex Discrimination Act 1984 it is illegal in Australia to discriminate against a person either directly or indirectly on the grounds of breastfeeding. Direct discrimination happens when a person treats someone less favourably than another person.
Yesterday morning, David 'Kochie' Koch, a presenter on Australia's leading breakfast television programme, Channel 7's Sunrise, had this to say following an interview with the mother in question:
Koch: "I think that's fair enough, to say, hey, can you be a bit discreeter, sorta go up on the grass or something like that..."
Co-presenter Samantha Armytage: "Really? ... I think if you want to breastfeed on the side of the pool you should be allowed."
Koch: "Well, no, not in high traffic areas, I know my daughters are really discreet and things like that, would go to a quieter area, that's a high traffic area on the side of the pool in the middle of summer on a hot day..."
Later that same program, Koch went on to say:
"Ladies I wonder whether she should have been more discreet. I totally agree with breastfeeding in public, but I think you've gotta be a bit classy about it, that feet on the edge of the pool, isn't discreet enough.... but I'm concerned for the safety if the baby wriggled and fell in the pool...I think there's a safety issue there... I think, theres, em, like, that's why you have mothers—or move back that's a high traffic area, I can understand how people were uncomfortable with it in such a high profile place."
Although he tried to backtrack and cover his words with a half-hearted attempt at safety concerns, clearly, his main point was that a breastfeeding woman should do so out of the public eye.

Social media is aflame with emotions and opinions from all sides of the fence. Overwhelmingly, most commenters are in support of breastfeeding mothers. But there are plenty that have taken Kochie's comments and run with them. And not in a good way for breastfeeding women the world over. There is always the negative minority, clinging to their almost clichéd ignorance in comment threads (for example here and here and here).

Here's the first problem with what Kochie said:

Stating that a woman needs to exercise discretion when breastfeeding confirms the misguided belief that breastfeeding is something that needs to be hidden.

Breastfeeding is breastfeeding. Nothing more, nothing less. Breastfeeding is simply a baby taking in nourishment and comfort from his or her mother.

However, to suggest a woman needs to be "discreet" about breastfeeding implies that breastfeeding is, somehow, a naturally exhibitionist act—it isn't. Breastfeeding only becomes explicit when someone else views it that way. And how does someone become offended by breastfeeding? By having an unnatural view of what breasts are actually for.

Despite what they'll tell you, those narrow-minded neanderthals who have a problem with the sight of a woman breastfeeding her baby don't have a problem with a bit of a flash of breast skin. Lets face it—breasts are everywhere.


The reason that those narrow-minded neanderthals get so uppity about the sight of a woman breastfeeding is because they believe the baby is committing an adult act. They cannot see breasts as anything other than sexual.

For far too long, there has remained a patriarchal assumption that a woman's body is, first and foremost, for the purposes of a man's sexual pleasure. Breasts are seen as sex objects before their primary mammalian function. So for a vocal few, the prospect of a baby sucking on a nipple causes all kinds of cognitive dissonance. 

In my opinion, the only time that breastfeeding stops being a naturally discreet act is when woman believe they should cover up—because then it's like a freaking neon sign pointing to something they are doing, that they are purposely covering up.

Oh-so-discreet!
The only way that breastfeeding will become as uncontroversial as it should be is by seeing it happening. Breastfeeding is not a big deal. A breastfeeding mother is not 'flopping' her boob out, or 'flashing', or trying to prove some kind of political point. She is simply feeding her child.

Here's the second problem with what Kochie said: 

A celebrity stating that a breastfeeding woman needs to be "discreet" enables the continued oppression-via-ignorance of breastfeeding women.

It doesn't matter how well-intentioned or benign Kochie's comments were in his own mind. Outwardly, what he said was critical of breastfeeding in public. His suggestions that a woman be "discreet" or "a bit classy" confirm the misguided viewpoint that breastfeeding should be hidden. So, for those with a problem seeing a breastfeeding dyad, it's a very slippery slope from Kochie's personal 'opinion' of: "I  totally agree with breastfeeding in public, BUT..." to this:

Or this:
Yes, because excreting bodily waste is totally the same as providing life-giving sustenance to a child.
I hope these people don't operate heavy machinery with that mindset.
You see my point? Kochie (and his supporters) can believe that what he said was mundane and respectful, but he's forgotten the reach of his opinion. As a prominent public figure, he has a responsibility for—and a very powerful ability to persuade—public opinion.

Implying that a woman needs to be respectful of others when breastfeeding her child is a little bit like victim blaming. The problem with someone's sensitivity to public breastfeeding does not lie with the breastfeeding mother — it lies with the person who finds it offensive. In those instances, that person has a right to exercise that thing that holds their head up, and look away. Or move. And then, get some therapy.

Breastfeeding rates in Australia are depressing enough without having prominent public figures, such as Kochie, adding to a mother's burden. Breastfeeding mothers face enough roadblocks without having to worry about what a few other narrow-minded neanderthals people might think.

Oh okay, Ryan, if you have to.
Support for breastfeeding must be unconditional. Caveating "support" with a "but" totally negates that support. Kochie, unless you acknowledge that you committed a rather large faux-pas, you will always be yet another roadblock in the true liberation of women.

Wednesday, 9 January 2013

Breastfeeding boundaries: Why it's okay to say 'no' to your toddler

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Learning to breastfeed a newborn can feel like the most difficult task in the world. 

When you're sleep deprived, exhausted and aching or traumatised by birth with sore nipples, a crying baby and a world that erects breastfeeding hurdles in front of you faster than we can say, 'where's the Lansinoh?', breastfeeding can seem like an insurmountable task. Our far-less-than-optimal breastfeeding rates are illustration to that.

But once you get past the newborn bit, when you've grasped an understanding of supply and demand, why your baby needs to breastfeed around the clock and everything clicks into place, suddenly, you're off and running. Huzzah! Breastfeeding is easy!

And then the baby grows into a toddler. You battle the cultural roadblocks to term breastfeeding; you notice the baby that once nursed while curled in your arms now sprawls bodily across the couch.

Suddenly, you find yourself dealing with breastfeeding annoyances not encountered before. A two-year-old that insists on carrying out a dental exam whilst breastfeeding, fingers worming insistently into your mouth. Pinching, squeezing, scratching at your neck, throat, other breast. An eighteen-month-old who simply won't breastfeed without tweaking, twisting or pulling the other nipple. A three-year-old who wants to stand up and breastfeed, or roll around on the couch and breastfeed in a kind of unstoppable breastfeeding gymnastics. A toddler whose voracious appetite to nurse rivals that of any eager newborn, constantly demanding a 'boobie' every time Mama looks even sideways at a chair.

And when you try and gently put a stop to any of it, or even dare saying 'not right now' to the umpteenth breast request that morning, you're met with deafening, rage-filled tantrums.

Enough! You find yourself screaming inwardly. Just get off me!

Without a doubt, the most common complaint from a mother breastfeeding a toddler are those above. Pinching, wriggling, constant, constant boobing, and just not taking 'no' for an answer.

But the minute we bemoan our boobalicious toddler, all we tend to hear is 'why don't you just wean him'? Or, 'you wanted to breastfeed—now you'll never stop him.' (The kind of well-intentioned but completely misguided advice that you file alongside advice to bottle-feed or sleep-train when you were exhausted with the newborn.)

So you put up with it. And put up with it. Until one day, you never want to see that child ever again and you decide that breastfeeding is the single most horrendous thing you've ever done in your entire life. We worry that everything they warned us about as an infant has come true—did attending to our infant's every need really spoil this child?

While it's important to lovingly, promptly attend to all of an infant's needs (especially for breastfeeding or cuddles) to teach them that the world is a safe, loving place and that they are worthy of love and affection, a toddler needs to learn a new kind of compassionate worldly lesson: boundaries.

How can it be so hard to find a middle ground, where boundaries are respected, but breastfeeding can continue?

Firstly, let me begin by saying it's completely normal for a toddler to want to breastfeed all the time. Just as it's normal for a newborn, a toddler is going through immense physical and neurological growth. Toddlers are inherently driven to move, to explore, to experience and conquer new sensory and motor challenges, and breastfeeding provides comfort, normalcy, hugs, and nutrients to get through it. While their understanding of the world morphs and changes at a rapid rate around them, Mama's breast stays the same – warm, loving, comforting, relaxing. Who wouldn't want that to return to every five minutes?  (Conversely, it's also normal for a toddler to suddenly seem uninterested in breastfeeding for enormous chunks of the day, or even days at a time. Relax—this is normal, too, and will pass. But that's a topic for another blog post.)

But while it's important to respond promptly and gently to your newborn or infant's cues to breastfeed, it is equally important to respond to your toddler's cues with a new kind of gentle parenting – boundaries. As parenting author Pinky McKay says:
"Now is the time to guide and protect your toddler with a new kind of parenting that includes setting appropriate limits: just as absolute freedom is confusing... too many rules can make little ones feel so trapped that their only option is rebellion." (1)
Toddlers are driven to seek out boundaries, and to test what happens when they are pushed. Testing limits is the only way to ascertain what and where social limits are. How do they find these limits? By testing them. Humans are social animals, and our young are driven to fit with the herd—just as we are. They need to know how to behave, what is acceptable, and what isn't. So while we need to gently, firmly show them our boundaries, we also need to remember that flexibility and empathy are important, and remember that excessive rules, restrictions or punishments are unnecessary.

Moreover, toddlers are inherent narcissists. Empathy doesn't develop until somewhere around their fourth year, so they simply cannot understand why they cannot have everything they want, and right now. So whilst it is unrealistic to expect a toddler to comply unquestioningly with your request to stop tweaking your goddamn nipple, it is additionally unfair (on both of you!) to simply put up with it when you hate it so much you want to throw them across the room.

Welcome to the world of parenting a toddler, where the loving, firm assertion of boundaries is one of the most common things you will do all day. Over and over again. And often, to the ear-splitting tune of shrieks of rage.

It's okay to say no. It's important to say no. But do it gently, and with compassion.

Lets say you sit down to breastfeed your toddler:
  1. He goes to grapple with your other breast. Gently, you move his hand away, and say 'Hands off. I don't like that.'. 
  2. He goes for the breast again, more insistently. Gently, firmly, you take his hand away and say 'No. I don't like that.' 
  3. Perhaps he gets cross. Perhaps he fusses, or screams, or gets angry. 
  4. It is perfectly okay to sit with him through any outburst, to verbalise his feelings, but remain firm that the other breast is out of bounds. 
  5. He might scream and rage and tantrum for a few minutes, or maybe longer. Maybe a lot longer. Remember, he's learning to deal with overwhelming feelings, and strong emotions need an outlet. That's what you're there for—a safe space to let out his feelings. Even if you're the cause of those feelings! 
  6. Perhaps this happens many times a day (and night) for many days (and nights) until your toddler eventually gets the message: Mummy doesn't like me tweaking her other nipple. But he will get the message, eventually. I promise!
Or, lets say your toddler asks you for a breastfeed that you're just not in the mood to give. Here's the big difference between breastfeeding a newborn and breastfeeding a toddler—while a newborn simply cannot wait for mama's breast, a toddler can—despite the fact they'll act like they can't!
  1. Try and say 'yes'—but make it when you're ready. Perhaps, 'yes, when I've finished what I'm doing.' Or 'yes, before lunch.' Or 'yes, before bed tonight.'
  2. Repeat points 2 - 6 above.
Providing a safe, compassionate outlet for your toddlers big emotions, and providing comfort and security, teaches him the skills to manage and handle those big emotions as he grows. Just as you comforted your baby when he cried—now you comfort your toddler.

But this is so often easier said than done. Why is it so hard to say no?

Because more often than not, healthy boundaries were not modelled to us. What wasn't modelled to us as children (and what often isn't modelled to us as adults), can be darn hard to model to our own children.

I was raised by a classic martyr. My mother would give, and give, and give, and then snap and take away everything—and blame me for the fallout. Rather than saying 'no' when she'd had enough, she'd fear my big emotions and keep saying 'yes' until she just couldn't take it anymore. Then, it became my fault for pushing her too far. Of course, a child needs to understand that they've pushed someone too far, but we need to be careful with blame, or inducing shame. All I remember is being called 'naughty' or 'bad-tempered' or 'ruining everything' rather than hearing her say that she was uncomfortable with what I was doing.

Open, honest communication, owning our feelings, teaches children how to do so themselves. It shows them how to respect our own feelings enough to respect others, too.

It happens in adult relationships, too. We put up with things unnecessarily, we skirt around the real issues and we're passive aggressive instead of being open and honest.

When my first child was born, her needs absolutely floored me. I was so confronted by her constant need for me. But rather than feeling capable of taking brief moments of time to myself, my options seemed to be to become a slave to it, or disconnect altogether. Or worse.

This is why our personal boundaries are so important. They mark where our limits begin. And when our boundaries are pushed, or disrespected, we feel angry and resentful. So it's important for our health, for our relationships, to respect our boundaries – before we become so resentful and used-up that we snap altogether, and deny our toddlers their very real need for breastmilk and breast-comfort.

There really is no quick-fix 'way' to guide a toddler to respect our boundaries. It's inevitable that if we say 'not right now' to a breastfeed if we're not feeling like it, they might (or very likely will) have a tantrum. But try not to be discouraged by that. Try and see it as a learning opportunity—a parenting opportunity.

And remember to take some time for yourself, too. A tantrum over a breastfeed can feel incredibly confronting for a mother. Make sure your own cup is full—you need, and deserve, loving support from your partner, family, and friends. Make sure someone tells you what an awesome thing you are doing.

In fact, allow me to tell you—this thing you're doing? Awesome. You're doing a beautiful thing.


References:
(1) McKay, Pinky. 2008. Toddler Tactics. Pg. 59. Penguin Books.

Monday, 20 August 2012

A breast abscess: the physical manifestation of postnatal depression


A small, silver scar at the top of my left breast, just down from my armpit, is all that remains of a story that could curl the toes of many.

If you're squeamish, read on with caution. There's no overly graphic photographs: but I'll spare no detail in the prose. So perhaps don't read this and eat.

I've never shared much of this story because it always seems so secondary to the bigger problems I was suffering at the time: the debilitating mindset of postnatal depression. (You can read more about that here and here.) I'm sharing this story now because I think it is an important illustration that even the most severe of breastfeeding complications needn't always equate to weaning; and that often, breastfeeding complications are intricately tied with what's going on in our mind.

When my first baby was about a week old, I awoke feeling a bit achey and feverish, with some pain in my left breast. My milk was flooding in, so both breasts were a bit tender anyway. My mum took one look at me and said I had mastitis. Instantly, I was terrified. The idea of going to the doctor, of getting dressed and getting out of the house with this baby was more fearful than I could contemplate. I was annoyed; I didn't need this. I was struggling enough with this new baby – I didn't have time to think about what was wrong with me, too.

Only a few days out of hospital, I called the midwives on the maternity ward, unsure what else to do. The midwife pithily told me to use cold packs between feeds for the pain, to use warm packs before and during feeds to aid milk flow, and to aim the baby's chin toward the blockage during feeds. She said to go to the doctor for antibiotics if my temperature rose above 38.1 degrees.

So now I had a basic set of things to do; but I still didn't know what mastitis actually was, what caused it, what I should expect, or how quickly I should recover. But, conversely, I also didn't know that I needed to know these other things.

This went on and off for a few weeks. Some days I would feel feverish and achey, others not so much. If I was feeling feverish I'd start with the hot/cold packs; but that was about it. It began to just become another annoyance of mothering; another straw on the camel's back that was my overwhelming burden.

The day before my 6-week postnatal checkup with my GP, I suddenly felt annoyed with this persistent lump in my left breast. My entire life had been flipped upside down and I felt like nothing was going right. So, in the shower, I dug my fingertips into it; pressing and pushing and feeling intensely angry that it wasn't going away. I remember crying.

Bad move.

The next day, at my GP's appointment, he asked me if I was happy, and I shrugged and responded that I didn't know. We talked briefly about postnatal depression, and I pretty much brushed it off. He then asked me how breastfeeding was going, and I mentioned the mastitis. Once he took a look at the affected area, now a blue-purple lump that was exquisitely painful to touch, he calmly said it had abscessed, and he recommended draining it with a needle – much like a big pimple. Was I okay with that?

Was I okay with that? With, you know, sticking a needle into the painful, festering bruise on my breast?

So whilst my husband held our 6-week old baby, I removed my shirt and lay on the clinic table. A nurse instructed me to put my left arm back behind my head, and she placed a surgical sheet with a hole in it over the raised purple lesion on my breast. She carefully covered my skin with antiseptic, whilst I winced with pain at her touch.

I wondered how my life had come to this.

My doctor came in, he was friendly and reassuring but I was still petrified. The nurse murmured to him, "Are you going to use a local anaesthetic?"
"No, the local would hurt more than the aspiration," he answered.
Oh, shit. "Just give me a stick to bite on," I joked weakly.
They all tittered. (Pun intended).

As I took some deep breaths, the sting of the needle bit into tender flesh. But I must admit, after the initial twinge, the pain was bearable – almost a relief. He spent a minute or so drawing up fluid, and he commented that more pus had come out that he had anticipated.

"You'll feel much better with all that out," the nurse said.

I hoped so, but I knew there were more problems filling me at that moment than just pus.

Over the following weeks, as the fog around me thickened, the abscess never seemed to truly heal. Some days it was itchy, some days it was tender, but it never seemed to get better or worse. The area stayed a red or purple, and sometimes was scabbed over.

This isn't my breast, but is quite similar to how my abscess looked
Image source
My baby was often fussy feeding from that breast, particularly on the days when I was feeling achey or sore. But we managed, the other breast seemed to compensate beautifully.

And then suddenly, one day when my baby was about three months old and I was staying at my parents house, my breast began to swell again. The area around the wound became hot, pink and inflamed, and it the pain increased tenfold. But I ignored it. I didn't have the headspace for a physical problem, and besides, it would hopefully just go away again.

Later that night, in bed I lay on my right side, rolled a little forward breastfeeding the baby from my left breast. I could hear her beginning to snuffle, and I thought nothing of it at first, thinking she must just have a runny nose. But over the space of a few minutes her snuffling became more pronounced, and she began to fuss.

I flicked on the bedside lamp, and to my horror, saw her face was covered in pus. Thick yellowish liquid was all over her eyelashes, and all over her mouth and chin and nose. Pus was streaming from the wound in my breast. I shrieked. My mum came into the room, she helped me clean up and we put a dressing over the wound on my breast. I'm sure I spent some more time crying and feeling like an enormous failure; but I just don't remember it.

A few days later, I awoke again in the middle of the night. My shirt felt slick and damp, and as I sat up, I could feel it was heavy and wet all the way around to my back. In the bathroom, I removed a t-shirt covered with pus and blood. As I cleaned the wound, more pus would ooze out. Bending over the sink, I gently applied pressure either side of the swelling, and like a big pimple, it ruptured. I managed to massage out as much fluid as I could, put on a clean shirt, dressed the wound and went back to bed, mortified.

More weeks passed, and sometimes the abscess would leak, but I paid very little attention to it. And then, at 16 weeks postpartum, I finally approached my GP for help with my mental state. As well as prescribing a mild anti-depressant, he referred me to a surgeon to have the abscess incised and drained. He apologised for letting it get this far. I knew he was just being nice; it was I, after all, who had kept it all hidden.

The ultrasound I had before meeting the surgeon revealed a fluid-filled cavity in my left breast the size of a cricket ball. I distinctly remember the sonographer's eyes widening when he enquired how long this had been there, and I apathetically replied, "about three months."

The day before I saw the surgeon for the first time, the abscess ruptured again. It was another huge drain, and left me feeling queasy and revolted. However, my depression was starting to lift, so I was finally able to see the abscess for what it was: a wound, a transient condition that I just needed to pay a little attention to and kick. Just as my depression was not who I was, I wasn't this abscess, and this abscess wasn't me.

Of course, the next day the surgeon saw me, cheerful and without a swollen breast, and decided he wanted another ultrasound. "I'm reluctant to slice you open if I don't need to," he said. I appreciated his sentiments immensely.

This time, the ultrasound was done in a bigger clinic, equipped for more than just imaging. A doctor did the ultrasound, carefully assessed the cavity, and inserted another needle under the guidance of the ultrasound image. I watched him draw almost 20mls of fluid from my breast.

But when the doctor saw the fluid filling the syringe, he seemed happy. Now, the fluid was clear, slightly pink, not at all like the thick, sickly yellow pus I'd become accustomed to. "This is good," he pronounced, "this isn't infected. I'll just drain all this out and you'll be fine."

And I was. I returned to the surgeon, who shook my hand with a smile and said he hoped never to see me again. The feeling was very mutual.

The abscess was gone. I had a handle on my PND. In my mind, it is absolutely no coincidence that the timing of the two recoveries was so well matched. The pressure and pain building in my breast, festering under the surface away from obvious awareness, was a physical manifestation of what was going on in my mind.

I have read many stories from women suffering severe or repeated bouts of mastitis, or abscess, who have felt no choice but to wean. Obviously, people did ask me if I was "still" breastfeeding during my treatments for the abscess. But truth be told, stopping breastfeeding never entered my mind. I knew that weaning would only exacerbate the problem: my milk could take months to dry up completely, and in the meantime, I'd have breasts swollen with unmoving milk, I'd have a baby whose health would be compromised by weaning from my breastmilk, but most of all, I would have nothing left to give my baby. Weaning wasn't an option – I simply had to breastfeed.

And besides, in my mind, I never really made a conscious connection between the abscess and the act of breastfeeding my baby: the abscess was more about my inner turmoil and pain, than the simple act of lactogenesis.

Stories of breast abscess are quite rare; stories of women continuing breastfeeding through treatment even rarer. So I hope my story may help other mothers, who may be going through something similar, and are perhaps hoping to keep breastfeeding: even when everyone around them wonders why.

Further information on mastitis and breast abscess:
https://www.breastfeeding.asn.au/bf-info/common-concerns–mum/mastitis
http://kellymom.com/bf/concerns/mother/breast-abscess/
http://kellymom.com/bf/concerns/mother/mastitis/