Breastfeeding, And Why Smugness Came Before A Fall

This was originally written for Professor Amy Brown who was compiling one of her books. I don’t think it’s been used in print and I’ve re-discovered it on my hard drive so I thought I’d share here.

When I got pregnant with my first child I went into research-mode and looked for THE best way to do every single aspect of pregnancy and baby-care. (Unfortunately, I was also a smug first-time mom to be and didn’t hold back in telling everyone why my way was going to be THE best way and questioning why on earth wasn’t everyone doing the same as me. God I cringe so hard. Sorry, everybody I came into contact with then!)

A huge part of this was, of course, how I was going to feed my baby. Breast is best hun, so despite having no clue whatsoever of what breastfeeding entailed I decided that was that and I was going to breastfeed my son. I wasn’t breastfed myself – a fact I knew only because my mom took great delight in telling everybody that I never cried as a baby and just stood in my cot waiting for a bottle. We’ll just skip past that little attachment issue in waiting there…In fact, to the best of my knowledge I only ever saw one person breastfeeding during my childhood; a friend of my mom’s giving her newborn twins milk. Now I look back and know how much hard work that would have been and I’m slightly in awe!

Of course, smugness goes before a fall. Literally, in my case. I fell down the stairs on my due date and damaged my coccyx which set the scene for a really traumatic-feeling end to my pregnancy, and my labour couldn’t have deviated further from my birth plan if it had tried. It traumatised me so much it nearly stopped any future children from being considered, and it definitely impacted on my ability to bond with my son in those early days. Frankly, I wanted nothing more than to hide in bed until all the pain went away. So having a baby who didn’t immediately latch on and do something “natural” was more than I had the ability to cope with at that point. I just didn’t have the stamina or desire to add fighting to feed my baby into the mix – and it really did feel like a fight. He wouldn’t latch, every position hurt, my nipples hurt, my coccyx hurt, my stitches hurt, I was too anaemic to sit upright. In my drug, hormone and tiredness addled state I thought expressing would be the best option in the short-term. So that’s what I started to do. My very first time at the pump produced about 10mls of colostrum which would have been great except it was red, so of course I thought I was poisoning my baby with infected milk. It really wasn’t easy this parenting lark.

I carried on pumping, putting baby to the breast as often as I felt I could which in hindsight is nowhere nearly enough to have done anything particularly useful. And I carried on pumping. And I carried on thinking that we’d crack breastfeeding soon. And I carried on pumping. And I started to think that perhaps one of us just couldn’t do it. And I carried on pumping. And I stopped putting him to the breast. And I carried on pumping. And I carried on pumping.

Thankfully I responded well to the pump. I could nearly always keep up with his demand, despite him taking so much milk each day. He was diagnosed with reflux and drank milk to soothe the pain, invariably vomiting it across the room in an exorcist-style propulsion of milk and mucous. When your hard-pumped milk was so rapidly discarded there really was a point in crying over spilt milk.

I don’t know how I kept up the regime of expressing for 5 months. One of the overriding memories I have of those early months with him is frantically rocking his bouncer to stop him crying while I urged my boobs to be faster at filling those bloody bottles. It was intense. Having gone through the newborn period with two subsequent children I’m filled with regret at how much I missed with the pump-feed-wash-sterilise routine. Even more regret that I was never told things that would have eased the intensity of exclusive pumping – like the fact you don’t need to sterilise breast pump paraphernalia! (note: current NHS guidelines have been revised to say that now it is recommended to sterilise breastmilk equipment).

My husband was as supportive as he could have possibly been and made it as easy as he could possibly have made it (apart from that one fatal misunderstanding where he binned an entire freezer drawer full of milk stash – that one still smarts!) but he didn’t ‘get’ it. It would have been really nice to be able to talk to people who had been there. People who had breastfed, people who had expressed, people who I didn’t mind being vulnerable in front of. But there was nobody. None of my friends had yet had children and my family weren’t breastfeeders. Even the most well-intentioned support doesn’t quite hit the spot when it’s from somebody with no experience of the issue.

Years have passed and more babies have happened. After success feeding my second-born I trained as a breastfeeding peer supporter and have been volunteering at community support groups for several years. She was breastfed until the hallowed WHO guidance of 2 years, self-weaning shortly after her birthday. My third-born is showing no signs of stopping, we’ll address weaning if and when it becomes a problem. A small, irrational part of me probably thinks longer-term breastfeeding makes amends for the fiasco that was my son’s first months. The bigger, more rational part of me knows that’s bobbins and I did the best I could have done, which is all any of us can do, really, isn’t it?

Vitamin K & The Newborn

V I T A M I N  K  A N D  T H E  N E W B O R N

Babies are born with proportionally low vitamin K. We don’t know why yet, although there’s a few theories that it could be due to babies being born without all their systems fully functioning, or some kind of residual consequence of some other mother-baby mechanism. As mothers need to be intaking high doses of vitamin K for it to pass through breastmilk in sufficient quantities to protect their baby it seems unlikely to be an evolutionary response although my anthropological days were left behind at uni so, I may well be wrong.

Vitamin K helps blood to clot and prevent uncontrolled bleeding. Due to low vitamin K in babies, they’re at risk of something called ‘Vitamin K Deficiency Bleeding’ or VKDB. Some of these at risk babies have known risk factor but about a third don’t. This includes what type of birth the baby experienced, as it had been mooted at one point that assisted deliveries and caesareans increased the risk.

We started giving babies vitamin K after a Swedish study in 1944 was released which showed a 5 times reduction in newborn deaths of 2-8 day old babies due to uncontrolled bleeding. Manufacturing and commerciality interests pushed the dose given higher which triggered their own problems in the baby, so the dose was reduced back down and remains at 1mg although this is still twice as much as was given in the original study. At this time it was only being given to babies with suspected risk factors of bleeding, however in 1978 a study was released which discovered that late onset VKDB was a problem for exclusively breastfed babies and very quickly it became policy to universally offer to administer vitamin K. A small study did indicate that parents who refused to give their babies a vitamin K dose could raise the levels of vitamin K sufficiently to pass through breastmilk at protective quantities by the mother taking a supplement of at least 5mg daily.

Vitamin K is usually given via one injection within 24 hours of birth, although parents have the option to have oral doses given instead. If given orally this is done over the course of 3 doses, 2 of which are normally given to the parents to give at home. Side effects of the injection are a potential allergic reaction to the ingredients, or a small reaction at the site of the injection, plus of course a small amount of pain when carrying out the injection itself. The oral dose isn’t quite as effective at minimising the risk of VKDB and there’s the potential for further doses to be forgotten to be given in the sometimes chaotic environment of a newborn household.

One of the concerns some parents have about vitamin K doses is that a 1992 study was released that indicated an increased risk of cancer in children. Helpfully most UK health authorities and authoritative bodies made no official statements to help families make their decisions but instead fence-sat and passed the buck spectacularly to parents. Further studies showed that the risk of tumours remained the same whether children received vitamin K or not, however remained unclear about the increased risk of developing leukaemia. However, the most recent studies and reviews have concluded categorically that there are no links between vitamin K and an increase of cancer of any types.

So what are the actual statistical risks we’re looking at? The most recent studies show the numbers as follows:

  • Untreated babies risk of developing VKDB: 4.4-10.5 per 100,000
  • Oral treatment: 1.4-6.4 per 100,000
  • Intramuscular treatment: 0-0.62 per 100,000

Although small risks anyway, by choosing vitamin K to be given by injection the risks are all but eliminated.

If you choose to decline vitamin K there are things that you should watch out for in your baby. These are:

  • Active bleeding from the nose, mouth, gums, umbilical stump or any treatment site (heel prick test for example)
  • Blood present in urine, faeces, or vomit
  • Unexplained bruising or bigger than expected bruising (at a vaccination site for example)
  • – The fontanelle (soft spot of the head) appearing different to normal (which could indicate bleeding on the brain)
  • If baby starts acting differently; although this is a particularly difficult one as baby’s not been around long enough to have a ‘norm’.

As an aside, some trusts will refuse to divide a tongue tie if your baby hasn’t received vitamin K, so something to bear in mind.

As ever, this is my interpretation of what I’ve read and understood, and so any mistakes are my own only. My resources for this topic are below.

NICE Guidelines

Evidence Based Birth

Article with paediatrician E Hey in BMJ

You and Your NICU Baby

Having a baby in nicu is a strange old time in ways that many people don’t get.

You become fiercely protective of them but you have to put your trust in others to look after them.

You often have to inhibit your natural instincts to hold and comfort them because they need more treatment than you can give. You’re often told when to cuddle, when to feed, when to visit…but they’re YOUR baby and they need you there more than ever.

You need to be looked after because you’ve just given birth but you don’t want to spend time thinking about yourself, only your baby.

Life moves on outside the artificial environment of nicu and you don’t feel quite like you belong with all the bright lights, noises and people…but you don’t feel quite like you belong among the doctors, nurses and equipment either.

We were lucky. Our time in nicu was short and either through family-friendly practice or our own sheer bloody mindedness we didn’t leave the unit. Other people aren’t in the same position and the impact on their lives, minds, attachment is immeasurable.

Baby Stockport NICU

What On Earth Is The Fourth Trimester?

I wrote this blog post for The Daisy Foundation all about what the fourth trimester is and how you can help yourself in that time.

The chances are that if you’re a new parent you’ll have uttered one or more of the following phrases; “my baby will only sleep on me!”, “my baby hates their cot!”, “my baby will never be put down!”, often alongside an existential crisis and the idea that you don’t know what you’re doing, you can’t do this, you’ve broken your baby and that you’re a rubbish parent. You ask and search around for help and the nagging doubts you have of yourself – that you’re not parenting in the right way – are cemented because so frequently these questions are packaged as a problem to be overcome, to be worked on, to fit in to the “good baby” narrative that is so frequently forced on new parents (and yes, from which many so-called ‘experts’ exploit new parents into shelling out many, many pounds).

Yet picture, if you will, the life your baby has had while growing inside the womb. Dark within the confines of your uterus, warm and protected by your body, comfortably hammocked, rocked by your movements, the swoosh of amniotic fluid in their ears. Their every primal need met instantly by your body that they’re connected to. Then they are born. The world is a vastly different place to everything they have known to this point. Temperature changes, the feel of nappies and clothes on their skin, sights, smells, feelings of hunger and thirst, all these wonderful things we take for granted in this world are brand new sensations for babies. When you appreciate this, you suddenly take in the enormity of life as a newborn and understand why babies cry to be held close by you, to be nestled in your warm embrace, able to smell you and hear your familiar heartbeat. Wanting to be with you is not a problem to be fixed; what baby is biologically designed to need is often not what our environment and culture encourages.

If we look at and treat the first three months of a baby’s life as a transitionary period, the so-called fourth trimester of pregnancy, a lot of the heartache and pressure we place upon ourselves as parents can be reduced. If we understand antenatally that when baby appears we must treat them as though they’re still in utero, that terrific pressure of wondering why our baby won’t be put down, why won’t he sleep in his cot, what am I doing wrong will disappear. You are not doing anything wrong. Your baby is behaving exactly as he should. You’re doing a great job. Let’s repeat that, because it’s so very important. You are doing a great job by tending to your baby’s needs.

There are some great ways of replicating that womb-like environment for a baby, many of which help to soothe him, reducing crying, and reducing the effect of their crying on you. Because let’s not forget how important you are in this picture. A phrase which is uttered almost as often as “my baby won’t be put down” is “a happy baby is a happy mom” and it’s certainly true that if a baby is crying your own stress levels will rise, making it more difficult to understand and react to what your baby is trying to communicate with you. But remember, none of these are guaranteed to work all the time for all babies because every baby is different and will react in different ways at different times.

Movement: Your baby is used to moving when you move. Which is why so many will be soothed to sleep by the gentle rocking motion of a car or pram, and why so many parents have developed their own baby-sway which is often so well-used that you can see it in practice when baby isn’t even with them!

Noise: Forget the lullabies and soft music: anything that mimics the swoosh of amniotic fluid will help soothe your baby best. So some serious SHHHHHHing, the hoover, Ewan the Dream Sheep or one of the multitude of YouTube videos.

Water: A nice deep bath mimics the feeling of the amniotic fluid around your baby while they were inside you, and can soothe (or at least distract!) from a troubled soul. Even better if you or dad can get in the bath with them as the skin-to-skin contact will do wonders for both of you.

Sucking: Sometimes a baby is cross because they’re hungry, so it’s important to be led by their feeding cues rather than a schedule, whichever way you choose to feed them. But sometimes babies crave non-nutritive sucking, similar to when they suck on their own fingers in utero. If you’re breastfeeding offer the breast even if you don’t think baby is hungry, and if you’re bottle feeding try a dummy or a clean finger.

Babywearing: Slings and carriers aren’t just a good way of not getting the pram muddy when you go for a walk! They’re a really useful tool to enable you to keep your baby close-by while you go about your day. Research has shown that babies who are carried in slings cry less than their non-slinged counterparts, not just while they’re being carried but throughout the day. That’s a pretty compelling reason to babywear, right?

Skin-to-skin: Not just for the golden hour after birth, but helpful at any age. Skin-to-skin contact can help regulate your baby’s temperature, regulate their breathing and heart rate, reduce stress hormones (in both of you!), and can boost oxytocin (the love hormone) production in you both.

Co-sleep: 50% of babies in the UK bed-share at some point before they are 3 months old. Many because their parents recognise that they will both get better sleep when they’re close to each other. Make sure that this is planned, and safe.

Many of these methods of recreating the womb-like environment for baby can be used in conjunction with another. Sometimes one will work where it didn’t yesterday. Dad may find one works best for him while you find another works best for you. All of this is ok. These are tools to add to your growing parenting toolkit and nothing will unilaterally work for all babies and all parents in all situations. And that’s ok. Enjoy your fourth trimester <3