Archive for July, 2009

Judgement against Aptamil

July 22, 2009

Well, it seems that at least the Advertising Standards Agency has recognized that ‘immunofortis’ is a silly made up word and that Aptamil’s claims to be  the best formula and to support the immune system are crap. The ASA has told Aptamil to stop using these claims in advertising, although it can apparently continue to put them on the label (?!) Press release here

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UNICEF Baby-Friendly response to recent media coverage

July 22, 2009

I have had too much going on recently to read all the mud-slinging crap and write a good ranty review. But I thought I would share this link as it is a good, straight-forward summary of the latest research and how the media is distorting things.

Baby-friendly response to recent media coverage about breastfeeding

And thus it begins…

July 21, 2009

World Breastfeeding Week is coming up (see info here).

Unfortunately, what this also means is that the deluge of vehemently anti-breastfeeding articles is already flowing from the corporate media, breaking over us like a tidal wave. This week has seen outrageous ‘journalism’ from The Times, The Guardian, and The Independent thus far. Rest assured, I am formulating my responses. I really wish I didn’t have to, and to be perfectly honest I did consider just sticking my head in the sand and going ‘lalala’ because it’s all too depressing. But then I remembered that: First they ignore you, then they laugh at you, then they fight you, then you win. This has definitely escalated to the fighting stage, so wahey, we must be getting somewhere.

Specific rants to follow, just bear this in mind when reading the papers this week. It really is all an industry plot to get their black propaganda in first so that WBW has as little positive impact as possible. Don’t let them get to you.

A discussion of baby-led versus scheduled feeding

July 16, 2009

If you are reading this blog, you probably know all about this already, but what the heck. I had to write  about this for my training, and it came out kinda ranty, so I thought I might as well post it here.

 

Baby-led feeding, sometimes also referred to as feeding on demand or on cue, means breastfeeding the baby when the baby needs or wants it, as opposed to scheduled feeding which dictates feeding the baby based on arbitrary factors, usually the length of time since the previous feed. Scheduled, or restricted, feeding is a historical anomaly that began to develop in the 19th century as male doctors began to involve themselves in the lives of women and babies. Their assertion was that applying the new ideas of science, with its rigorous measurements and strict rules, would be greatly preferably to leaving such important matters as baby and child-rearing to women, who in their eyes were uneducated, ignorant, and tended to base decisions on the whimsy of instinct rather than a firm, scientific foundation. From these beginnings, a whole philosophy of baby and childcare developed, based around the idea that babies and children must be controlled, that neither they nor their mothers know what is best for them, and the only way to ‘achieve good results’ was to keep to rigid schedules for feeding, sleeping, and in some theories, even excreting. This approach has been absolutely devastating for the breastfeeding relationship, not least because of its complicity in the normalization of artificial feeding (which is easier to keep to a schedule).

Until the interference of modern medical personnel and childcare theorists, all breastfeeding was baby-led. We can see by comparisons with other mammals and primates that successful suckling depends on the close bond between mother and baby, in which the mother is attuned to the baby’s needs and cues, and the teat is available in the first instance.

Let’s look at the mechanics and specifics of baby-led feeding as compared to scheduled or restricted feeding.

From the mother’s point of view

Establishing the milk supply

In the very first days, a mother’s milk supply is automatic – stimulated by her own hormones, the colostrum will flow whether or not the baby suckles. However within 48 hours, the system is beginning to switch to demand-and-supply, where the act of the baby nursing is what stimulates further milk production. This switch-over, and milk production from here on, will be adversely affected if feeding is limited or restricted. It can be said that in the neonatal period, the newborn is not only feeding because he is hungry, but he is also placing his order for the next day. If he is allowed only a limited time at the breast, his hunger may be sated enough to stop him from crying, but he may not have stimulated enough milk production and so tomorrow there may not be enough milk. It is therefore essential that the baby be nursed whenever he cues, to stimulate production and establish a good milk supply.

Preventing sore nipples

Much outdated advice says that limiting frequency and time at the breast will help prevent sore nipples, but this is absolutely untrue, and indeed the reality is quite the opposite. If the baby has been denied milk, he will come to breast ravenously hungry and frantic, and it may well be more difficult to get him positioned and latched on well. He may then be frustrated, and might start chomping or pulling at the nipple, desperate to stimulate the let-down as quickly as possible. If, on the other hand, he has been put to the breast as soon as he asks for it, he is likely to be calmer. The mother can take her time getting herself and the baby into a comfortable, well-supported position, and ensuring that he latches on well. A good latch is the most important aspect to preventing nipple problems, and most other feeding problems, and it is much easier to obtain with a calm baby who is just getting a bit peckish than with a frazzled baby who’s been crying for milk for an hour until the appointed time was reached.

Preventing blocked ducts and mastitis

Scheduled feeding can be a contributing factor in both of these breastfeeding problems. The best way to avoid both is regular, effective removal of milk from the breasts, and the best way to achieve this is by nursing the baby whenever he wants, no matter how frequently or how long that might be.

Bonding with the baby

In our society many mothers have had little interaction with newborns before they are faced with their own, and as a result many are anxious, unsure of what to do, and worried that they might be getting it wrong. It seems to make sense to turn to books and experts that give clear instructions of what to do. Many new parents find the idea of a plan comforting – it seems less scary when you know you should feed the baby at 8.15 for five minutes, then change the nappy, then go for a walk, etc. But the reality is that the babies have not read these books, don’t know that they are supposed to keep to a schedule, and rarely do. This can start a very negative, stressful spiral that can quickly get out of control, as the mother tries to follow instructions, reads and re-reads the book, watches the clock, notes down the details of feeds and bowel movements, but the baby just cries and fusses, and it all gets worse and worse. The more the mother tries to conform to the plan, the more stressed both of them get, and the less attention she is paying to the baby. She may begin to feel that she doesn’t know her baby, cannot understand him, and isn’t able to meet his needs effectively. Contrast this with a mother who is not trying to work to a plan or a schedule, but is prepared with the idea that things may be very unpredictable for a while. She doesn’t look at the clock, or check in the book to see what to do next – she watches the baby. After a few days, she might have learned that a few minutes before the baby starts crying, he chews his hand, or turns his head to the side – now she knows one of his early hunger cues. This means that she doesn’t have to wait until he cries to know he wants milk. This may mean that he cries less, and she feels a sense of accomplishment as she gets to know her baby better, and is able to anticipate what he needs.

Getting out and getting on with things

Many scheduled-feeding advocates praise this method as a means of ‘getting your life back’, but many mothers find the opposite to be true. Once the mother has gotten comfortable with feeding and with feeding in public, nursing on cue is often the least restrictive to a mother’s time. She doesn’t need to plan to be in so that the baby can be put in his cot at 12.05, or worry about losing track of time while in town and missing a designated feed – she just needs to pay attention to her baby.

From the baby’s perspective

Needs met as they arise

It’s hard to imagine feeling hungry, going to the fridge to get a bite to eat, and being told that you must wait 45 minutes before you can have anything. Or being thirsty, but not being allowed a drink. Or feeling sad or frightened and asking your partner for a hug, only to be told that it isn’t the right time and you will have to wait. But this is exactly what we do to babies when we feed them to a schedule. It is worse, actually, because very young babies have no sense of time – to them, a minute can be an eternity, so they’re not waiting ‘just a few minutes’, they may be feeling that they are waiting forever, or that their needs will never be met again. And breastfeeding meets all of these needs – hunger, thirst, emotional support – and many more besides. We do not dictate to other adults at what times they are permitted to feel hungry, thirsty, or upset, so it makes no sense to do so with babies. We also need to remember that with very young babies, their wants are their needs. They are not capable of ‘manipulating’ us as some theorists suggest – they simply do not have the brain structures required for that level of rational thought. The need for emotional support and love is just as real, and as physical, as the need for food and liquid.

Nutritional composition of the milk

When they are in control of the frequency and duration of feedings, babies are astoundingly good at regulating the nutritional composition of their milk. If the weather is hot, they will nurse little and often to get more of the thirst-quenching foremilk. If they are in a growth spurt and needs lots of extra calories, they will nurse often and for long periods, both to stimulate more milk and to get higher concentrations of fat from the hindmilk. This amazing bio-feedback regulation is completely destroyed by scheduled feeding, because the baby is no longer in control. This may leave the baby hungry and thirsty in the short term, but if feeding is severely curtailed for an extended period, it could potentially lead to dehydration, inadequate weight gain and growth, and failure to thrive. Unfortunately a baby exhibiting any of these problems will often be offered formula, if poorly-educated health care workers who do not understand how breastfeeding works convince the mother that she does not have enough milk (see the first point, above), or that it is of poor quality, or that the baby is inefficient.

Learning about hunger and satiety

There is some research to indicate that babies who are breastfed on cue are less likely to have eating or weight disorders as adults. Why? There are many possible reasons, but one theory is that when a baby is in full control of its hunger and its food source for the first part of its life, this helps correctly build the physical, chemical, and neural pathways that control feelings of hunger and satiety, and that once established, those pathways are permanent for life. A cue-fed breastfed baby starts to feel hungry, gets milk, takes what he needs and no more, and is satisfied. This is a healthy approach to eating. A baby fed to a schedule may have to wait, feeling more and more intensely hungry, and when finally fed may take more than he needs. This is because the switch that tells the brain that the stomach is full takes a little while to work, and if a person bolts his food is haste because he is ravenous, he can eat too much before the brain knows what has happened.

 

Babies need to be fed at all sorts of times, and for all sorts of times. It is in their best interest that they be fed as often as they need it, no matter how often that might be, and that their needs be met when they arise, so that they never need to get to the point of hysterical crying. It is often said that crying is a newborn’s only way of communicating, but that is not so. From birth, all babies will try to communicate their needs in all sorts of subtle ways, such as fist-sucking, turning their heads, wriggling, a change in noises. The ear-piercing cry that we expect to hear is in fact their last resort – it’s an alarm, it means something is terribly wrong, and it means that we’ve missed all the other signals they’ve been sending. It is also almost never heard in societies where natural, baby-led feeding is the norm.

In conclusion, baby-led feeding is the best possible way to establish and maintain a successful, mutually happy, and healthy breastfeeding relationship. It ensures the sufficient milk supply which is essential for good growth and weight gain, helps prevent nipple and breast problems, and helps the nursing dyad to bond and strengthen their relationship.

The White Ribbon Alliance for Safe Motherhood

July 10, 2009

A woman dies every minute giving birth because of a lack of trained health workers, poverty, and isolation.

Watch this video.

And this one.

And then visit the White Ribbon Alliance site for more information.

 

I don’t really feel I’ve got much more to add on this.

The feminism of menstruation…

July 5, 2009

Well, reams have been written on the topic of menstruation from a feminist perspective, all more eloquent and articulate than I can replicate here. So I won’t try. This is, you guessed it, a little rant about something out there in cyberspace, to be found at this address (sorry, facebookers only) or see it direct from the source on this site.

For those who haven’t seen it, it is the latest in viral marketing from Tampax. It has a load of videos of a middle-aged woman dressed in a naff dress suit circa 1954 accosting women in the street with a box and saying ‘yoo hoo, it’s Mother Nature, I have your present for you, your period’, and such charming text as ‘suddenly, gift is a four-letter word’, ending with the logo: Tampax, Outsmart Mother Nature.

Why why why do I have to write about this? Why should any of us even have to be thinking about this kind of crap anymore? What century is this anyway?

Yes, menstrual cycles and monthly bleeding can be a pain, literally. Especially for women who suffer from disorders ranging from extremely heavy and painful periods, to prolonged or frequent bleeding, or extremely infrequent and therefore unpredictable and nerve-wracking bleeding.

But not a single woman should ever be made to feel that this is A Bad Thing. Can we please get past the idea that this is some horrible taboo that must not be spoken about? 

The videos seem to suggest that the primary reason to be annoyed with menstruation (if you’re a woman) and horrified/repulsed by it (if you’re a man, presumably a straight man) is that it stops you having intercourse. Which isn’t strictly true anyway, but my point was really… really? Are we STILL in a place where pleasing our man is the sum total of our ambition in life? Are we as a society still in a place where a woman who is sexually unavailable to her man is a liability, or useless, to be shut away in her bower until the all clear?

As to outsmarting mother nature. Well first of all let’s just state the obvious and point out that using Tampax (a very controversial product, by the way, responsible for huge environmental damage and quite a few very sick women thanks to Toxic Shock Syndrome and chemical leaching from the chlorine-saturated cotton) will not actually prevent you from getting your period or make it go away. All it will do is produce a lot of waste (incidentally, try these instead).

And then we need to ask, why the fuck should we want to outsmart mother nature? She has given us incredible power, the power to create new life. Sure, it might hurt sometimes or stain our panties at inconvenient moments, and many women will choose never to have children, a completely valid choice when freely made. But this is still part of who and what we are. And I say, fuck with that at your peril.

A little rant about advertising

July 4, 2009

Well, I will try to keep it little, anyway. There’s sooooo much to say on the matter that it’ll be hard, though.

Apparently Aptamil brand artificial baby milk (I do not use the term ‘formula’ because that is a pseudo-scientific nonsense word invented by doctors and milk makers in the early 20th century to make their product seem more sciency and appealing) in the UK is now advertising itself as ‘containing immunofortis’. Which, I’m sure I don’t need to point out, is yet more pseudo-scientific mumbo-jumbo. Look how little has changed! The babymilk makers are still doing their utmost to wow us with their jargon, while they still continue to aggressively push a product that very, very few babies actually need.

Please, don’t get me started on the recent spate of television adverts in the UK for these products. It is illegal under the International Code of Marketing of Breastmilk Substitutes (the Code)  to market breastmilk substitutes to mothers directly.  The babymilk companies get around this in the UK by advertising ‘follow-on milks’ which are intended for use after 6 months. They state ‘not intended as a breastmilk substitute’. Really? So are they suggesting that you should be feeding your child breastmilk and artificial milk, and no solid food? Because the WHO guidelines advise exclusive BFing up to 6 months, and then the introduction of complementary foods, and continued BFing for AT LEAST TWO YEARS. So if follow-on milks aren’t replacing breastmilk, I guess it’s the solids? Ahem. 

And naturally all these ads are choc-full of pseudo-science and statements which demonstrably undermine continued breastfeeding. Nevermind that the children in these ads usually appear to be under 6 months old, so the ads really are advertising at parents of younger babies…

Then there’s the continued barrage of advertising aimed at healthcare practitioners. This is also illegal under the Code, but who cares? Certainly not the babymilk makers. I have recently heard a midwife say that she isn’t swayed by advertising. So why, pray tell, do the companies spend gajillions of pounds on it? They have a legal obligation to defend their stockholders’ money – trust me, they don’t waste it. They spend huge amounts on advertising to HCPs because IT WORKS. When you go to see the midwife and she calculates your due date using a little wheel that says ‘Aptamil’ that plants a seed in your mind that, should you end up feeding your baby artificially, that’s the brand to choose. And she looks at that logo a hundred times a day. So when you go and ask her what brand to use, are you really going to tell me that having that logo burned into her retina won’t make her think of it first? Well, the babymilk makers are banking on the fact that it will, and they’re laughing, all the way to the… bank.

So, to sum up the rant for the evening:

all advertising of artificial babymilk, whether to parents directly via TV adverts for ‘follow-on milk’, through branded freebies in hospital packs (illegal, but rampant), branded ‘parenting clubs’, etc etc, and to HCPs via free pens, due date calculators, and sponsored conferences in the Bahamas (I will leave ranting about babymilk companies sponsoring scientific research for another post), is wrong. 

The manufacturers don’t make this stuff to fill a pre-existing demand, they create the demand and then push their products on an unsuspecting public, all through the glories of advertising.