Busting Baby Sleep Myths

Whether or not your baby sleeps through the night, remember your success as a parent is defined by so much more.

Without a doubt, sleep deprivation is one of the biggest challenges I have faced to date while raising A. The lowest points were after her twelve week birthday. We went to bed together one evening as normal and instead of the couple of hours I had become used to, she woke up after forty-five minutes. And then forty-five minutes after that. And…well you get the picture. For a long time, she woke very frequently. She was *gasp* a couple of months shy of four before she really consistently slept for most of the night.

I cannot count the hours I spent googling baby sleep. Sleep became an all-consuming topic for me. I read everything. Worried about everything. I was determined to find out WHY my baby would not sleep. I lacked a lot of knowledge about what is normal sleep, not just in babies, but in toddlers and preschoolers. I wasted a lot of time. While we did find some triggers for her frequent waking, some of it was just personality. Miss A is now a bright, inquisitive, smart and curious pre-schooler and sleep, well sleep is boring isn’t it? Her father also gets by happily on less sleep than average. Indeed, some studies have suggested the way our children sleep, may actually be largely genetic.

I really want to say one thing I think a lot of parents need to hear, so listen up. If your baby doesn’t sleep through the night, it is unlikely to be your fault.

Here are some of the most common myths about how and where babies sleep:

Your baby should be sleeping through the night by *insert arbitrary figure here*

A lot of popular information suggests babies should be capable of sleeping through the night from an early age. In reality, instead of talking about “sleeping through the night” we should talk about babies sleeping in ‘consolidated blocks’. In many scientific studies, ‘sleeping through the night’ is defined as sleeping a 5 hour period between midnight and 5am. Not quite the picture parents have in mind! Research has shown huge variance in when babies start to sleep in consolidated blocks and whether they settle themselves, or ‘signal’ (read yell their little heads off) for assistance. We don’t know why there is such a big difference, though many feel the answers lie in the personality of the baby.

BASIS suggests it is completely normal when infants wake frequently for the first year and beyond. Indeed, they say 13% of year old babies, still do not sleep in a consolidated block of 5 hours or more regularly. Gives us a slightly new perspective on those baby sleep books!

Toddlers definitely shouldn’t be waking up at night though right?

Though there seems to be a huge divide about when babies should sleep through the night, it feels like most people are in agreement that toddlers definitely should. However, again, the research doesn’t particularly back this idea up. Studies have shown that toddlers often continue to wake up during the night and need input from their parents, well into the second year of life.

Sarah Ockwell-Smith, someone who has spent an awful lot more time talking in an evidence-based fashion about how children sleep than me, suggests sleeping through is more like a roller coaster, than a linear trajectory. Basically, children are all different, and some may sleep “well” from babyhood, others may well be into their pre-school years before they consistently start to “sleep through”. Both are normal.

Formula or solid food helps babies to sleep better at night

Yeah, I had high hopes for starting solids too. My baby was totally going to sleep through once she was on solid foods! Except she didn’t. Also, formula fed babies still wake up frequently at night, the difference is, you also have to go downstairs and make bottles when they do. When people insist babies fed formula sleep better it is frankly insulting to their hard-working parents, who are up with bottles in the middle of the night. Seriously, it’s not like safe formula prep at 2am is the easy option! I wish we would stop saying that it is. These pervasive myths are by far best addressed by this lovely video from the team at Swansea University (I apologise if the catchy tune gets stuck in your head!):

If you stop feeding your baby at night, you will get more sleep

Sometimes night weaning might be helpful, and sometimes- it might not. This is because advocates of night weaning often forget that night waking is not just about food for babies. Development spurts often play their part. It is particularly common to hear parents asking about night weaning when they are smack in the middle of a leap. This may be absolutely the worst time to attempt night weaning. Your child is waking because they need reassurance, pulling away might actually make things worse or result in a lot of distress. Successful night weaning often depends on whether the child (and the mother) is truly ready.

I gently night weaned my preschooler when she was three. I’ll be honest, at first it made absolutely no difference to her sleep, and in fact, she still wakes up and asks for a cuddle and a drink. So if you are considering night weaning, it might be a good idea to think carefully about how you will feel if sleep does not improve. If your child still wakes up, will night weaning still help you feel more rested? For me, it made quite a lot of difference as I struggled to sleep through night feeds, but could sleep through a cuddle. If you are a mum who finds you can sleep through the night feeds anyway, it may make less difference.

Most gentle parenting and breastfeeding advocates do not suggest night weaning babies under twelve months old. These babies may still need night feeds. Which leads us on to…

A baby no longer needs to breastfeed at night once they have reached a certain age or weight

It is common for people to suggest babies do not “need” night feeds once they are six weeks/six months/double their birth weight etc…

Firstly, can we define ‘need’? Breastfeeding is, as well as a way to satisfy hunger, a relationship. A breastfeed is a cuddle, immunity, reassurance, warmth. How many times a night might you wake and have a sip of water, adjust your blankets, reach out for a warm body to snuggle into?

Secondly, this doesn’t take into account that all babies are different, and all boobies are different! Have a read about milk storage capacity here. Some mothers may need to feed more frequently to give the baby the same amount of milk per feed as her friend. This is not a mother with a supply problem, but natural variation. In order to support a healthy milk supply, breastfeeding works best when babies are fed to cue. In the first year milk is the most crucial part of baby’s nutrition and what is important is not how much baby gets per feed, but how much they get in twenty-four hours. A set rule for everyone just goes against basic biology.

In many cases, breastfeeding is a far easier way to get baby to sleep more quickly, and get better quality sleep. Use that magic while you can!

Responding to your baby every time they cry at night, makes children dependent and clingy

This is so far from the truth it makes me laugh. There is a wealth of research which suggests responsive parenting promotes healthy, secure and confident children. See Unicef’s “building a happy baby” leaflet or look into “attachment theory”. Not responding to children has been shown to do exactly the opposite of making children independent. Sleep training is a divisive subject and a blog post of its own. I will simply say, it isn’t the magic bullet people suggest, and that more information on it can be found here.

Responding to your baby does good things for both of you!

Bed-sharing is *the* most dangerous way for your baby to sleep! Don’t do it!

So this one was a massive bug-bear of mine. We previously have not been having nuanced conversations with parents about where breastfed babies should sleep. Positively, the tide seems to be turning a little recently, with the Lullaby Trust, Unicef UK, BASIS and PHE collaborating on new safe sleep guidelines which finally discuss bed-sharing in the mix.

Why is it important to talk about this? Because otherwise parents do not talk to their health visitors about this for fear of judgement. And then, they do not get the information they need about how to bed-share safely. On any given night 22% of babies will be bedsharing with their parents. Blanket recommendations not to bedshare have been clearly shown not to work and may have even increased the risk of SIDS for our babies.

We have historically focused more on the risk of bed-sharing to breastfed babies than we do on the increased risk of SIDS from other practices which parents might turn to instead- like sofa sleeping or giving formula instead to help their baby to sleep. Why have we not talked more about the impact of alcohol, smoking and drugs on SIDS rates? Risks which are so much greater? Why are we still not getting our knickers in a knot about the relationship between poverty and SIDS rates and holding society accountable for that? Focusing our support and resources on all of these things would have so much more impact.

Unicef Co-sleeping Guidance for Health Professionals

For a long time health professionals have been in a tricky spot. Advocating 6 months exclusively breastfeeding yet having to advise against one of the tools that help many people to achieve it. Studies suggest “breast-sleeping” (i.e. bedsharing as a breastfeeding mother) supports breastfeeding, with mothers showing increased responsiveness and increased breastfeeding overnight (see below for links to a wealth of research information). Mothers who bedshare also tend to breastfeed for longer than mothers who do not.

I could go on about this forever, but I won’t. I am glad the guidance is finally start to shift in line with the reality for many families. If you are considering bedsharing with your baby, read evidence-based information and decide what is right for your baby. Safety guidelines are really important if you go ahead. You can see these in the new guidance I have already linked, as well as here, and here, and here.

If I could wave a magic wand and change one thing, what would it be? I would love to do away with this culture where parents who announce their child is sleeping well get congratulated. I slept well for years before children. I am pretty sure nobody said “well done” every time I woke up after a full 8 hours. Nobody insinuated this made me a better person, or that it was because of the big dinner I had that night. I want to stop having to reassure and comfort tired parents in breastfeeding groups who think their baby is broken. Not because it annoys me to do so, but because this crippling pressure is unfair to them. We create it with expectations which are so off-kilter from reality it is ridiculous. I would love people to start showing empathy to parents rather than judgement. Maybe help them out around the house, or make them a coffee. In the absence of a magic wand, I hope the myths busted in this blog help. Watch this space, and subscribe or like me on Facebook, Instagram or Twitter for news of upcoming blogs about how to cope with frequent night waking, and gentle night weaning.

You can find more good information about sleep here:https://www.basisonline.org.uk/

Recommending reading about infant and child sleep:

Bedsharing research:

For more papers from Prof Helen Ball

Evidence based bedsharing info from BASIS site

Prof. James Mckenna’s work here

Image Credit: https://www.basisonline.org.uk/co-sleeping-image-archive/

Updated: 27/03/19

Tips for Breastfeeding a Baby With a Tongue Tie

When my daughter was born we had issues establishing breastfeeding. Feeding her was painful, and her weight gain was slow because she was tongue-tied. My memories of the early days of motherhood are still a haze to me, but by far one of my clearest (and saddest) memories was of looking at my perfect baby girl, willing her not to wake up. I couldn’t bear to feed her again. My nipples were bruised and cracked. I was on strong painkillers, because I had an emergency C-section, yet even with those, the pain far outweighed the wound I was recovering from. For various reasons, I was feeding my daughter for seven weeks before her tie was fully released and feeding started along the slow path to improvement. I won’t dwell too much on my story, perhaps I will tell it more fully one day on another blog. The purpose of this one is to share a few things I found helped me during the long weeks, plus a few things I have learned during my training in breastfeeding support.

There may be many reasons you are waiting to have a tongue tie division or indeed you may have decided the procedure isn’t the right decision for your family. Here are a few ideas and tips for you to consider.

Seek experienced feeding support whatever position you find yourself in. Find a lovely boob group too. Whatever happens on your breastfeeding journey, remember it is a journey. Sometimes a division isn’t an instant fix. Ongoing experienced support and moral support can be really helpful. Find a breastfeeding group here.

A breastfeeding counsellor or IBCLC can help you experiment with different positions. Some positions which work well for tied babies include laidback breastfeeding, the rugby hold, the straddle hold. Pay particular attention to the fundamentals of good attachment as this may be a harder to achieve with a tongue tied baby.

Get skin to skin! Skin to skin feeding can really help encourage a baby’s natural latching reflexes and has the added bonus of removing layers which separate you and the baby. It may just make that bit of difference.

Experiment with exaggerated latch techniques. These can be really helpful to encourage a deeper attachment. Options include tilting the nipple (“flipple”) or shaping the breast (“breast sandwich”).

It can be really helpful to use a couple of different positions while feeding when feeding is painful. This is because it stops the same part of the nipple being hurt and potentially damaged at every feed.

If baby struggles to transfer milk effectively while feeding

If feeds are very lengthy, painful or your breasts don’t feel relieved afterwards- there are a couple of things you can try. Breast compressions can improve milk transfer. Switch nursing can keep an ineffective feeder from falling asleep too soon at the breast and maximise milk intake. Combining both techniques can be particularly effective. Using both techniques during a feed might look like this; offer boob one, when the baby looks like their sucking is slowing (fluttering) or getting sleepy use compressions to speed up the milk flow again. You might find that sleepy baby springs awake again because babies often respond to milk flow! Once compressions become less effective, switch baby to side two and repeat. Once the same thing happens, then offer the first side again, and continue switching until baby signals they are done. You will ideally offer 4 sides minimum per feed.

Patience and support are important when feeding tied babies. Feeds may take longer than average and babies may feed more frequently to compensate. It can be helpful to reflect on your wider support network. Can someone help around the house or with other children while this is going on? Can your partner/family/friends offer any extra support?

Keep a close eye on nappy output and weight gain, and keep in contact with that experienced breastfeeding support I talked about earlier. An experienced supporter can help you to decide if your baby needs additional supplements of expressed milk and give you information about how best to do this while protecting your milk supply.

Sometimes the baby may be doing well but you may be struggling with engorged breasts, blocked ducts and even bouts of mastitis. If this is the case, firstly ouch, I am so sorry! One thing to consider may be expressing milk for a short amount of time after feeds to soften the breasts. This may also protect your long-term milk supply. If you need support with blocked ducts this factsheet might be useful.

“I can’t carry on! Feeding is too painful!”

Nipple shields are often considered by mothers in this situation. There can be some pitfalls to using shields, but if it is a choice between a shield or a bottle, a shield might be the better option. Ideally, shields need to be used with support from experienced breastfeeding support. Attention still needs paying to try to achieve a deep latch. Here is some more information to consider while using a shield.

I can empathise when mothers decide to use a bottle because they have tried so many options, and feeding is just too painful. Sometimes a mother may have nipple damage and just can’t bear feeding on demand at that time. I know how tough it is. If this is you remember to talk to your breastfeeding support person. In an ideal world you will still offer the breast for at least some feeds in a 24 hour period. As babies get bigger often latching can improve. It may also help with transition back to fully breastfeeding if this is what you want to do. Continuing to offer the breast, even if it is only a small amount to practise breastfeeding, protects your options down the line. If mixing breast with bottle, paced feeding techniques can be helpful to reduce the risks of bottle flow preferences. There are also alternatives to bottles, for example syringe or cup feeding.

If your baby is not breastfeeding much, or not at all, you may find the following information links useful:

Information on expressing: https://www.laleche.org.uk/expressing-your-milk/

Maintaining milk supply if the baby is not directly breastfeeding: https://kellymom.com/bf/got-milk/basics/maintainsupply-pump/

If using bottles or formula continuing to express when baby has a bottle can help support your milk production. Remember skin to skin is not only great for supply, but does good things for both of you, so keep baby close however you feed them. If you are using some formula it is important to prepare it safely.

Nipple damage

If you have sore nipples but no open wounds, there is no evidence a cream is more helpful than using your own milk rubbed into the nipple.

If you have bruising, the usual treatment for bruising can be helpful such as cold compresses after feeds.

If you have open wounds, moist wound healing may be helpful. This is essentially treating a cracked nipple like a cracked lip and not allowing it to dry out. Cracks in nipples that dry out may split open again at every feed, and this can be very painful. Keeping the crack soft can help healing from the inside out. There is no evidence any one cream is better than another, some mums prefer a lanolin based cream but soft white paraffin (Vaseline) can be just as effective and cheaper. Do use a new pot though and not something that’s been knocking about in the medicine cabinet for donkeys years! Both of these options are safe to breastfeed with, no need to wash off. Just wipe any excess off before feeds.

While we are on the subject of washing, if you have cracked nipples it is essential the wound is kept clean to prevent infections. Some mums use a fragrance-free soap (some babies can be bothered by strong perfumes), others prefer a salt water rinse like the one suggested here.

It might be helpful to start feeds on the least sore or damaged side, babies tend to suck more vigorously at the start of a feed. If you do this, listen to your body to make sure the other breast is still adequately having milk removed, via expression if necessary, to help avoid any engorgement or loss of supply.

If you are in a lot of pain feeding here is information on analgesics which you can use to help.

When you have a long wait for a tongue tie division, I know it can feel impossible. Like an eternity. Those early weeks can feel like months even when things go smoothly. I can totally empathise how overwhelming it might feel. I can’t tell you whether to stick it out, or what is best for you but I can tell you that you are stronger than you know you are.

I remember one day being asked why I had persevered with breastfeeding for so many weeks despite painful challenges. This is something I’ve considered a lot because on that day I couldn’t give an answer.  One thing I have come to understand is often it isn’t really about “the milk”, it is about an inner desire for this connection to our babies. Focusing on that can be more motivating than anything else. Try to remember why you started breastfeeding and why it is important to you. Encourage your partner to remind you of this. Hold on to any moments that are positive. Remember any breastfeeding you can do is significant. Setting small goals can be helpful- try to think about making it to the next day, or next week rather than longer term. This will all pass someday. By setting small goals one day you might suddenly realise you have stopped setting goals to get to next week and will know that the worst is behind you.

Whatever you decide to do, make sure you have support so you can talk it through and feel empowered to make decisions you feel at peace with. Finally, remember, there are lots of us out there to support you. You got this mama💚.

For more information and support:

Association of Tongue-tie Practioners for information about tongue tie

If you need support or someone to talk to fast about the issues you are having try the National Breastfeeding Helpline

Facebook tongue tie support group

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Review: Why Mothers’ Medication Matters

Author: Wendy Jones

Publisher: Pinter and Martin

ISBN: 978-1-78066-585-6

Why mothers medication matters review

“There is evidence out there for the vast majority of drugs that should enable mothers to continue breastfeeding while obtaining the medical treatment they need… none of this is difficult. If we value breastmilk for its wonderful properties, practice evidence-based medicine, and respect mothers, we could transform women’s experience of seeking treatment.” Wendy Jones “Why Mothers’ Medication Matters”

A while ago, I had the privilege of reviewing this wonderful book, my review has now been published, so I am excited to be able to share it with you all here.

Wendy Jones is an inspiring figure in the field of lactation. A massively experienced Breastfeeding Supporter for the Breastfeeding Network and a qualified pharmacist; Wendy has tirelessly worked to help parents who breastfeed. Any breastfeeding supporter or counsellor should be aware of the brilliant “Drugs in Breastmilk Information Service”. This wonderful resource tirelessly gives information to lactating people about medications they may need to take during breastfeeding.

Prescribing medication for breastfeeding parents can be difficult for health professionals yet parents often need medication, whether it is short-term use of painkillers, antidepressants, or drugs to treat chronic conditions. Women are often given misinformation about what medications they can and cannot take.

In this book, Wendy Jones sets out to give mothers and health professionals information they need to make decisions about medication and to reassure fears that parents may have about adverse effects on babies of drugs passing through breastmilk.

Wendy Jones opens her book with an introduction to her subject, providing heartstring tugging examples of why better support around medications and breastfeeding really matters. Putting a human face and empathy on what could easily be quite a dry subject matter is something she continues to do throughout the book. The case studies are really moving, covering examples like postpartum women on a maternity ward being told they could only take paracetamol while recovering from c-sections or episiotomies and mothers dealing with weaning decisions after being given a cancer diagnosis, among many others.

Further chapters explore topics like why prescribing for lactating people can be so fraught with confusion, drugs during pregnancy and birth and their impact, treatment of chronic health conditions and depression as well as looking at ‘lifestyle’ drugs including alcohol and recreational drugs. The chapter on over-medicalisation of common issues like infant reflux, CMPA and colic are a must read for any peer supporter, particularly those among us who provide support on online forums where suggestions of reflux and CMPA are common. Some of the facts and studies Wendy discusses are truly eye-opening and the book is well referenced with a focus on remaining evidence-based.

why mothers medication matters book

Wendy ends her book with a discussion about where women can go on to get support around prescribing issues, and talking about milk donation. The final chapters are a heartfelt overview of the differences between breastmilk and formula milk and why we shouldn’t be assuming “formula milk is fine” if a lactating parent needs medication and her conclusions about why medication matters for breastfeeding parents.

This book is about so much more than medication; it is a wide-ranging overview of issues breastfeeding parents may face dealing with their healthcare. The ideal length and level of detail for a breastfeeding peer supporter, as well as a good introduction to the topic for training breastfeeding counsellors and health professionals I would whole-heartedly recommend “Why Mothers’ Medication Matters to anyone.

Buy “Why Mothers’ Medication Matters” by Wendy Jones and other excellent titles from the ‘Why it Matters’ range, over at Pinter & Martin

Why mothers medication matters review by Oxytocin and other stories

*I draw no income from my writing, my blog features no ads, be reassured links given to purchase this title are completely independent and not affiliate! #adfree

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The 12 Days of Boobin’! Christmas Tips for Breastfeeding Mums

Enjoying the holidays, and breastfeeding your baby are not mutually exclusive

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It’s beginning to look a lot like Christmas! Soon many of us will be spending time with friends and family, and while we may look forward to the holiday, some may find the idea of breastfeeding over the Christmas break brings up a few anxieties.

First of all, in my view, there is one brilliant advantage to breastfeeding over the Christmas period, You have the perfect excuse to slip away and get some quiet time (hopefully with a box of choccies to keep you company) because “baby feeds better without distractions”. Another bonus- you also have the perfect excuse for turning down events you don’t really want to go to. Maybe that’s just me. I am happiest in PJs with a glass of wine.

Other people may prefer to drink their wine wearing their party gear, and worry that this breastfeeding malarkey means they are going to miss out on all the fun.

I know often concerns revolve around family members, particularly breastfeeding in front of them. Some people worry that Auntie Lynda will go on (and on) about how she thinks the baby should be on bottles/formula/Christmas dinner and all the trimmings by now.

christmas breastfeeding meme

So here are a few of my thoughts on how to make life easier as a breastfeeding mum over the Christmas holidays.

Baby Wearing

Worried about baby being passed around like the tin of Roses, during peak cold and flu season? Wear your baby! You will be surprised how much less well-meaning relatives will demand a cuddle when they see a baby all cosy in a sling.

Wearing Your Baby has the added advantage of keeping them close, which leads me onto my next point…

Expect Baby to Change Their Feeding Habits

Often over holiday periods, things are busier and babies are more stimulated. It is easy to miss feeding cues, or breastfeeds. During long journeys, a baby might sleep more than usual. Lights and music and new people often mean distracted babies that don’t feed as well or cue for a feed less. Quite often babies are being passed around for cuddles. Sometimes Uncle Gary might decide he can soothe the crying baby himself rather than passing them back to Mum. Sometimes mum is distracted entertaining friends and family or making food.

Building in times during the day to breastfeed might be a helpful way to combat this, or alternatively see above; Wear baby more so they stay close! If you are undertaking long journeys build in some rest breaks to allow time for boobin’.

Alternatively, baby might be out of sorts, cranky, overstimulated and want boob ALL THE TIME, also normal! In fact, in these situations, nursing can be a godsend. It is often much easier to calm a baby with a breastfeed.

Nursing also gives you an excuse to get out of peeling the sprouts or doing the cooking. I may or may not have personally used this as an excuse to sit on my bum eating Christmas cake (“It’s for the baby!”).

Make time to express if you are apart from your baby

If you are away to a party, or out for the day Christmas shopping you may want to build in some time to express. This is more important the younger your baby is. Not removing milk from your breasts may lead to engorgement and blocked ducts, and eventually lowered milk supply.

If you do find you develop some blocked ducts or engorgement, following self-care is important, this is great information from the Breastfeeding Network.

If your baby is having bottles while apart from you, making sure responsive feeding methods are used can be helpful. Click the link for a video demo.

Alcohol and breastfeeding

Most sources suggest a moderate intake of alcohol while breastfeeding is fine. You can still have a glass of wine or two and breastfeed. However -and this would be true however you feed- as a parent you need to be careful you are still fit to care for a small child. Bedsharing after drinking alcohol is also a no-no. If you fancy a blowout, expressing some milk in advance might be helpful, as well as enlisting a babysitter.

Some useful links:

Pass the stuffing, please!

Christmas is often a time when the food police come out to tell you that you can’t eat your veggies because “baby might get windy” or that you need to avoid the stuffing or after-dinner mints because the sage or peppermint might “lower your milk supply”.

The good news is, there is no evidence-based research showing foods themselves will make your baby gassy (unless they already have a known allergy or intolerance to a certain food), and you would need to be eating absolutely VAST quantities of stuffing/mint for there to be any effect on your milk supply, so tuck in, and don’t worry.

In case you overdo things, many indigestion remedies are safe to take while breastfeeding. All on the link there. You’re welcome.

Don’t feed the baby!

baby food christmas breastfeeding

I’m not talking about breastfeeding here of course! However, older babies that have solids may be filled up with Christmas ‘treats’. It can be helpful to put aside some time for boobin’ toddlers too unless you are planning on weaning.

Sometimes, you may need to watch out for relatives trying to feed younger babies solids. Remember, some relatives may be from a generation where babies were given solids much younger than they are now, and may have no idea this isn’t OK. If you suspect this might happen, it might be helpful to be upfront; for example saying something along the lines of “It is important to me that the baby is closer to six months before giving them food, the research now suggests this is best for babies, and this is also what our health visitors have recommended”.

You may even want to think about ‘recruiting’ any prime suspect onside, have them “watch out for anyone who might give baby solids accidentally”. It is amazing how well giving people some trust and responsibility can work in your favour.

If well-meaning relatives are convinced giving baby Christmas dinner is the key to a full nights sleep- show them this!

Dealing with criticism

Make sure people know that you are proud of your breastfeeding relationship and that you see it as a good thing. If your relatives don’t see this as a chore they can relieve you of, you might find their attitude changes.

If you feel your choice to breastfeed is questioned, or that those surrounding you aren’t supportive, the “pass the bean dip” approach can be useful: https://twolittlegrasshoppers.com/tag/the-bean-dip-method/

If you have an older nursling, and you are worried about people questioning why you are “still breastfeeding”, Kellymom has some useful suggestions here too: https://kellymom.com/ages/older-infant/criticism/

Family members are generally well-meaning. They may be basing their ideas on outdated things they have been told. They might be open to learning about how recommendations have changed if you approach the subject gently.

Remember, you are the advocate for your baby/toddler/child. They cannot stand up for what they want. Give yourself permission to be unashamed. You do not have to answer to anyone else about your feeding relationship. Your boobs, your baby, your choice.

christmas babies

Choose clothing that provides easy boob access

Worried about feeding in front of family members? Consider practicing in front of a mirror, seeing how little is exposed might reassure you a little, especially if you use the “one up, one down” technique.

If you don’t feel comfortable getting your boobs out in front of family (maybe you have an inappropriate drunken uncle or two), the muslin trick is an inexpensive tip. Using a large muslin, tie one corner to the strap of your bra, and use the loose cloth to cover up any exposed areas. Or employ your partner on distraction duty to get uncle Roy into the kitchen for another sherry if that’s what makes you feel happier. Or, if like me you like a bit of a breather, use it as an excuse to get a bit of peace and quiet. When it comes to feeding, it is about what makes you feel more comfortable first and foremost.

If you need a party outfit or even some new fashion ideas for breastfeeding friendly clothing, why not join Can I Breastfeed In It? They are a UK facebook group, which have fantastic tips and ideas for feeding fashion (and they even have a selling page so you can grab yourself a bargain too).

christmas with a baby

So there you have it, some helpful tips for enjoying Christmas while continuing to breastfeed. Is there anything you think I have missed? What are your tips for breastfeeding over the holidays?

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Does Big Business Really Want to Help you Breastfeed?

When advice and help isn’t all that it seems

Breastfeeding Support

Boots, it seems, want to help you to breastfeed. They now produce a leaflet which you can pick up in store, and have a section on their website devoted to it. I see photos of this leaflet shared on breastfeeding groups, usually with the caption “Found this in Boots, isn’t it brilliant they have this?”

As someone who volunteers in infant feeding, this sort of thing sets off my cynicism alarm. Retailers are in business to sell you things, altruism usually isn’t high on their list of priorities.

hmmm breastfeeding

Confession time: I’m going to be picking on Boots a bit here. They are one example in truth, they certainly aren’t the only brand to do this sort of thing. Other companies also like to give out information about breastfeeding. Infant formula or bottle companies, for example, often do this too.

Let’s dissect the website information on Boots.com a little and see what we find.

The first sections: “Why is Breastfeeding Good For Me?”

Boots have chosen not to linger on the well-documented child health reasons to breastfeed, with a ‘blink and you’d miss it’ section, but they do have time to mention our appearance.

“There are lots of really good reasons to breastfeed, including benefits to mum. These include: It helps you to regain your old figure“.

Here we are, in 2018, with Boots suggesting weight loss is a top three reason to breastfeed. Talking about our body image before they mention the reduced risk of ovarian and breast cancers. I’ll leave you to think about that.

breastfeeding what

“How Do I Start Breastfeeding?”

Then we come to the next section “How do I start Breastfeeding”, where Boots have some advice from Clare Byam-Cook, a controversial figure* in breastfeeding support due to her lack of any breastfeeding specific qualification.

“Hold the baby close, facing the breast, with its shoulders and body in a straight line and it’s neck supported but the head free to extend (use a feeding pillow if more comfortable), offer your breast to the baby…”

ouch breastfeeding hurts

I am wincing reading that description. “Facing the breast” implies a “mouth to nipple” position to me, something most breastfeeding professionals will tell you is a recipe for a painful latch. This is a good demonstration as to why that is (thanks to the Empowered Birth Company for the video). It also says “head free to extend”, a clearer phrase I feel would be: “head free to tilt back”. Thirdly, “Offer your breast to baby” conjures images of a mother holding her breast and smooshing it into baby’s face, this would likely encourage an uncomfortable feed for the mother in an unsustainable position. Finally, we see them suggest “use a feeding pillow if more comfortable”, with a link taking you a range of pillows. I have nothing against pillows as long as they work for the mother, but this should be your first clue this isn’t a selfless exercise on behalf of a retailer.

“Common breastfeeding niggles solved”

The second passage is “Common breastfeeding niggles solved”. If you used the first section to give you information on how to attach your baby, you may need the information here.

My first problem with this section is it is so negative, it almost seems to scream “Breastfeeding will cause you excruciating pain!”

I am not going to sit here and tell you breastfeeding shouldn’t hurt. That would dismiss the lived experience of many mothers. Breastfeeding has a learning curve, and getting to grips with attaching a baby to the breast when hardly any of us see it on a regular basis can be hard. Sometimes, while establishing breastfeeding, mothers experience pain. What I would say is, if this is you, don’t feel like you have to wait for things to “toughen up”, or that the answer is expensive nipple creams. The research just doesn’t support that. A bit of support with attachment or a tweak may make it feel better.

I do question why, in a limited space, a large portion of this leaflet is devoted to pain? Surely some diagrams of attaching a baby instead, might help their mothers prevent some of these issues in the first place?

Well, reading further it becomes clear. They can sell you stuff to help with pain. We see links to nipple cream and a range of nipple shields. I have no doubt nipple shields are useful for some mothers, I know for some mothers, they kept them breastfeeding. However, they can be an absolute faff to use all the time, especially in public. Babies can get overly reliant on them. They also don’t solve underlying issues the mother or baby may have.

Moving on to “engorged breasts”. Here, we see suggestions that using breast-pumps and bottle feeding until the engorgement subsides is a good course of action. This is the section I find most shocking.

Engorgement is most common in the first days after birth. So why encourage parents to pump and bottle feed instead of using simple techniques to soothe and resolve engorgement, such as hand expressing, nipple stimulation and cool packs? Pumping is known to overstimulate supply in the early days (parents are usually advised not to pump unless necessary in the first few weeks). Using a bottle instead means possibly going longer between breastfeeds with engorged breasts! This is not a good thing for breast health or milk supply. Not everyone can effectively remove milk from their breasts with a pump, at least, not as well as their baby. No mention of how early introduction of bottles may be detrimental to breastfeeding in some cases and that the Baby-Friendly Hospital Initiative advises against bottles and teats in early breastfeeding.

Then we come on to the last “common breastfeeding niggle”, mastitis. Hardly a ‘niggle’, is it? Mum is instructed to go straight to the GP, sensible. A bizarre choice though, I feel, to spend so much time encouraging pumping and bottle feeding through engorgement, but offering no well-known self-care methods for clearing a blocked duct.

“Do I have to breastfeed all through the night?” & Other Anxieties

Not content with suggesting you use a pump once, Boots move on to trying to sell you them again (with handy links to their range of pumps). This time it is to get dad involved in night feeds while mum sleeps. Now, I know this is a strategy some parents will try, and if it worked for your family, great. However, they have omitted the facts that:

  • In the early months of breastfeeding, a mother will usually need to pump around the same time in the night, in order to avoid engorged breasts, blocked ducts, and mastitis.
  • Quite often a baby will drain the bottle, but still want boob, because breastfeeding is not all about the milk.
  • Night feedings can be important in supporting milk supply.

Then there is a section talking about new mothers breastfeeding in public. It’s OK though. Boots have a cover for that they can sell you. Oh and don’t forget about all the leaking. Boots can sell you stuff for that too.

This all seems to me, rather than helpful information, to be a fabulous example of how brands who sell you formula, pumps, bottles, and teats may complicate, or even sabotage breastfeeding, knowingly or unknowingly, in their quest to sell you ‘stuff’.

“What Can I Eat and Drink While Breastfeeding?”

So we come to the final section. The way this is written reads as if a mother needs to be hyper-aware of her diet: “good nutrition is more important than ever”. I find this paragraph pretty undermining. A good diet is important for everyone, it is not a necessity for breastfeeding. If it was I would be worried about my own child, since my early breastfeeding diet was 70% cake, 30% toast. Breast-milk is robust, and will in nearly all cases, still be the healthiest option for your child, (even on a 70/30 cake/toast diet). A mother would need to be malnourished for her breast-milk to be impacted.

“The occasional sweet treat is fine too- goodness knows you deserve a slice of cake”: Wow. Breastfeeding mothers of the world, quite frankly, if you want the whole bloody cake, eat it. Nobody needs permission from a shop to eat cake!

eating cake

Finally, the article ends with some links showing us more bottles, talking about pumps and baby food (we haven’t even managed to breastfeed yet and Boots are talking to you about baby food? Seriously?) Sadly, no links to any organisation which may help you establish breastfeeding (you can find these at the end of this blog).

Companies like Boots may want you to start breastfeeding. Shops want you to buy stuff for breastfeeding from them. Let’s face it, this is how they make money. I imagine they want to sell you some expensive pumps, nipple creams, covers, bottles, and shields. Unfortunately for some, following this sort of information may mean their breastfeeding journey is over sooner than they hoped.

Luckily, if you do have to stop breastfeeding, Boots have a large selection of infant formula they can sell you, often on code-breaking special displays.

I do wonder what is in it for companies, to suggest things like mothers need to follow a healthy diet to breastfeed? Or to give out information which might make breastfeeding painful for a mother? Or lower milk supply? Why devote so much time to suggesting that breastfeeding usually comes with pain and problems?

I can’t answer these questions for Boots or any other retailer. I don’t explicitly know their intentions. I do think we need to be careful where we choose to get our help from, and that the first question we should ask ourselves when a retailer tries to give advice is- “What’s in it for them?”

why breastfeeding

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This is an opinion piece, and all opinions expressed here are my own.

*For an example of said controversy Byam-Cook’s last appearance on ITV sparked a petition for them to use qualified breastfeeding experts in future. The petition was signed by nearly 5000 people.

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Breastfeeding a Baby with Reflux

How to get the support you need

As a breastfeeding support volunteer, I generally avoid sharing my own story as I prefer to focus on the parent in front of me but bear with me because my story is relevant to why this blog has been written and it is one of the reasons I am so passionate about infant feeding support.

My daughter was a “reflux baby” and she was treated with anti-acid medication for a long while, so when I talk to you about reflux, believe me, I know it, and I know how hard it can be.

I joke that when A was born she cried straight away and didn’t stop! My poor baby spent her first weeks wailing, coughing, writhing and red in the face, pretty much all day and most of the night. I felt trapped in the house. I remember feeling so desperate I wanted to cry when the health visitor left me in the house alone, with a baby who did nothing but scream at me. It was a pretty awful introduction to parenting. At 5 weeks old, she was diagnosed with reflux and we were prescribed infant Gaviscon by our GP. Like many parents, I took the prescription gratefully, and the numerous prescriptions that followed. It was the beginning of a journey which didn’t resolve for another twenty months.

What is problem reflux, or GORD?

Reflux simply means “a flowing back” and many babies spit up and vomit without being bothered by it at all. Problem reflux (GORD) has a variety of symptoms, which you can read more about here. Certain conditions can contribute to reflux, for example, it is more common in babies who are premature or babies who have other health conditions.

A baby who is spitting up a lot without distress or without other problematic symptoms it is unlikely to have reflux disease. If your baby is crying mostly during the evening hours yet content most of the day, they may be experiencing normal baby evening fussies.  So while these things can be alarming for parents (and messy!), it is important to be aware of the difference between what is normal and what is “reflux disease”.

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Mums who worry their baby has reflux often say to me, “I think it’s reflux because he just won’t let me put him down in the cot! I think he hates being on his back.” Here’s a secret which might help you feel better: most newborn babies hate being put down and prefer to be held. That’s normal baby behaviour.

Many medications used in the treatment of reflux disease are used “off-label”, they weren’t originally developed with infants in mind, and there are some studies which raise concerns about their use, especially over long periods of time.

If you’ve read all of the above and you are still with me at this point, I’m sorry. Dealing with reflux is a really distressing and difficult thing to cope with, and I know how it can feel relentless and never-ending. Here is some more information for you to consider.

Some common causes of reflux in breastfed babies

(This is not an exhaustive list!)

1. A shallow latch, or otherwise disorganised feeding

If your baby is not attached deeply to the breast or has a disorganised suckle they may take in more air as they feed. When air is expelled it can result in spitting up. Trapped air can also be very painful for the baby. This can result in reflux symptoms such as back arching, crying, and hiccoughs. Babies with shallow attachment may also struggle to transfer milk, leading to a fussy baby who wants to breastfeed 24/7.

This is why NICE recommends a breastfeeding assessment first as part of its quality standards: “A breastfeeding assessment should be the first step in supporting parents and carers with managing frequent regurgitation of feeds associated with marked distress. Correcting the breastfeeding technique for breastfed infants (for example, positioning and attachment) can improve or eliminate the symptoms.”

Sorting out a shallow latch can be as simple as doing a little work on positioning and attachment. Some babies with shallow attachment may have anatomical differences which hinder deeper attachment, for example, tongue tie or a high arch palate.

This is a great resource to help you with attaching your baby.

2. Breastfeeding management

In the UK we have a cultural expectation of having a few hours between feeds and this impacts on how we feed and treat our babies. Instead of smaller, frequent feeds sometimes we encourage our babies to “go longer” and take in more milk, less often. Some babies cope with this just fine but others may struggle, with large volumes of milk hitting the stomach and then coming straight back up. Some babies may protest- loudly!- about having their feeds delayed. So responsive feeding, and watching our babies instead of the clock may help. More about responsive feeding.

Our babies also spend a lot of time on their backs, which is no help for reflux. We commonly feed babies in the cradle hold, and then they are placed on their backs in Moses baskets and in prams. However, our babies evolved to be held. You cannot cuddle a baby too much. Simply carrying our infants more and experimenting with other feeding positions can go a long way towards helping babies with a tendency to reflux feeds.

3. Food intolerances and allergies

If your child has been properly diagnosed with GORD, and you’ve had a breastfeeding assessment which found no problems, it’s interesting to note research suggests a significant link between food allergy particularly CPMA. Some studies show a link of up to around 40%. CMPA is discussed in the NICE guidelines as one differential diagnosis for GORD.

Does that mean all parents with reflux babies should immediately be told to cut out dairy products? No, I don’t think so.

As you can see above, there are other things to explore before taking drastic steps, unless your child is exhibiting other clear symptoms of cows’ milk protein allergy. If you want to learn more about CMPA you can read my blog, or the BfN factsheet might be helpful.

Addressing attachment, examining the oral anatomy and considering breastfeeding management first is usually quicker and easier than making big changes to your diet. It is far more likely a more commonplace issue is the problem and it can take 4-6 weeks for both mum and baby to be totally free of dairy protein. Looking at the basics first is really important.

If you are concerned about CMPA it’s also a good idea to speak with a GP or health visitor as you may need support from a dietician.

4. More great reading on the management of reflux and other potential causes here.

You’ve had a reflux diagnosis for your breastfed baby. What now?

We’ve talked about the NICE guidelines above and so we know a breastfeeding assessment may be helpful. It’s worth making sure the person who does the assessment is skilled and experienced in doing this, so you probably want to see a breastfeeding counselor, La Leche League leader or IBCLC.

It might be a good idea to make sure you see somebody who is familiar with tongue tie, just in case this is a factor.

The great thing about doing this is that an IBCLC can help you look at the full picture and consider all the angles such as:

  • Attachment and positioning.
  • Your baby’s suck/swallow/breathe pattern.
  • If there signs of oversupply or milk transfer problems.
  • Indications or risk factors for allergies.

In some cases, after doing all of this, medications can be appropriate and necessary. A pediatrician can discuss with you the risks and benefits so you can make an informed choice about the best way forward.

Coping with a breastfed baby with reflux

I’ve made this into a meme, for easy sharing and saving. Basically, “Think Boobs!” (I know, I’m a cheeseball, but I couldn’t resist):

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Reflux does generally pass and get easier with time. With some help and support, it may pass more quickly. Asking the right questions is the first step to moving forward.
How did my own story end? Well, after getting some support from an IBCLC, my daughter was diagnosed with a cows’ milk protein allergy. We finally came off all our medications and beat the demon that is reflux. She still didn’t sleep in her cot, but that’s okay – I liked the cuddles ❤.

This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure any concerns about your baby are discussed with a medical professional or a health visitor.

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Further reading:

GPIFN: https://gpifn.org.uk/reflux-and-gord/

Kellymom: https://kellymom.com/hot-topics/reflux/

*This blog has been substantially updated from an article I wrote for Breastfeeding Support and Information UK‘s blog “Through the Eyes of a Breastfeeding Support Group” if you like you can still read the original here *

Before You Tell a Breastfeeding Mother to Cut Out Dairy, Consider THIS

Why supporting a breastfeeding parent with their diet is really important if their child has CMPA

giving up milk

I’ve always felt we need to tread very carefully around suggesting dairy elimination for mothers before basic breastfeeding issues have been worked out, and recently I have had personal experience of why it is so important to be mindful.
I don’t consume any milk products anymore, because my daughter has CMPA and I am currently breastfeeding her. I was keen to keep breastfeeding. Breastfeeding a baby with CMPA is really important, it avoids many of the pitfalls of using dairy free formula (like the bad taste), and it protects and safeguards your child’s nutrition. Mothers should absolutely be supported to do this if they need to. At first, I was amazed at how good I felt when I cut out milk (and I still believe it doesn’t agree with me).
2 years in, I’ve recently discovered the downside. I’m currently taking v high strength vitamin D, calcium and omega 3 oils because despite spending so much of my time supporting others and knowing all the recommendations to supplement and be careful with diet, my levels got low, really low. I actually started to feel quite unwell, mentally and physically.
You see, lots of people like to say dismissively “Pfft, we don’t actually NEED milk”, and this is true, however, our bodies do need the nutrients within it. Fats, Calcium, Iodine, Vitamin D. Some milk also has Omega 3 added to it. Non-dairy milk and dairy substitutes often contain lots of Omega 6 (sunflower oils, nut oils etc) but we need a balance of both Omega 6 and Omega 3 at the very least, and while following a non-dairy diet, if you aren’t careful it can be easy to throw this out of balance. Omega 3 is thought to play an important part in reducing inflammation in the body, inflammation is linked to things like joint pain, chronic illness, weight gain, and depression.
Removing dairy from the diet is a huge dietary change, we need to be mindful of that. In my opinion, breastfeeding parents who need to avoid dairy should be offered support with their diet, rather giving them a blanket recommendation to supplement (NICE guidelines), however, unfortunately, the guidance only discusses dietetic input in regards to the child. I feel this is a huge oversight, when treating breastfeeding parents and children it is surely better to treat the dyad, but that aside, things that can help are:
Sometimes, depending on your diet, considered supplementation may be needed.
It is easy to make light of the impact milk elimination might have on a mother’s body, or to forget about this ourselves, especially when we are busy parents whose primary focus is our child. It is easy to let nutrition slip when you are tired and touched out anyway, let alone if you are avoiding a major food group. So if you have an allergic child, I am sending you so much love, I know it is tough! And what you are doing is so important for your babies, and so wonderful, just make sure to take care of you at the same time.
More information and sources: