Wild Birth

Life as a birth keeper

Thursday, 20 July 2017

Cultural Barriers to the Initiation of Breastfeeding

Breastfeeding peer support on the post natal ward is different to supporting new families in the community clinics. Here in the ward I draw upon my breastfeeding support skills and my experience as a birth doula combined.  The whole emotional and hormone-rich atmosphere is almost like being in the birth-room still, but not quite. I'm with mothers and babies their partners at one of the most intense and pivotal times of each of their individual and family lives. Arrival on earth, adaptation to new environment, and the beginning of feeding from the breast instead of being fed via the umbilical cord...it's a big day for everyone.

I am mindful of the specialness of this time, and of the new family's need for privacy, combined with their needs for varying degrees of breastfeeding support. I'm mindful of the need to balance imparting only the most necessary information with supporting the prevailing right brain state of the mother. I am privileged to bear witness to some incredibly special moments. The first time a mother saw her baby's open eyes. The first time a grandmother saw her brand new grandson. Parents unwrapping and inspecting their child for the very first time. Having someone like me spending time with new mums and babies and their partners on the ward to help with the initiation of breastfeeding is only a very small part of how our culture needs to change to support breastfeeding families. The information about how breastfeeding actually works, and what can mess it up, needs to be out there in our species collective consciousness so that we all know what the hell we're doing when it comes to the nurturing and nourishment of the youngest and most vulnerable among us...because they're our future, right?

  I see the coterie arrive from delivery suite a few hours after birth, mum and belongings wheeled on her bed, dad wheeling the newly born one in a Perspex crib, across the first threshold from birth room to a new place, where mums recover in their beds, and wrapped and hatted babies sleep in Perspex cots. Pretty hats and knitted blankets. Mobile phones taking pictures, one mil syringes collecting colostrum for reluctant feeders. Lots of them. (You never see that on the soaps when there's a new baby)  Baby asleep in the Perspex. Mum high and awake and shattered at the same time. How is this supposed to work?  'About 2 hours after birth, newborns often go into a long sleep stretch, especially when mother and baby are separated.' ~ Nancy Mohrbacher , italics mine.

So when and how are mothers and babies first separated? We might not consider a mother recovering in bed, and her baby next to her in his Perspex crib to be separated, but the baby may feel differently about that. For the duration of pregnancy, the baby's environment has been his mother, and that is the environment where he best recovers from birth and adapts to life outside the womb. His earth-side environment is her skin, her belly, her breasts. Where the birth has been straightforward and the baby healthy, the first separation from the baby's point of view, usually happens in the delivery suite, not long after birth.  Usually, the expectation is that he will be weighed, and dressed. Usually, when the time comes to move to the post natal ward, he is put into a Perspex cot, covered with a blanket, and wheeled to the ward whilst his mother is wheeled on her bed. 

Most mammals would struggle with this kind of disturbance to their basic need to be undisturbed at this crucial time, but the thing about human mothers is that we bravely and selflessly adapt to the 'needs' expectations and culture of those around us.

I wasn't prepared for the number of babies and mums who would need help to get breastfeeding started, unlike the home-births I've seen as a doula where this has never really been a thing. (Of course babies born at home can also struggle to latch at first for a number of reasons and sometimes for no apparent reason) As a doula, I prepare families for the Golden 'hour' after birth when mum's oxytocin levels are the highest they will ever be in her life. Oxytocin is the hormone concerned with love, trust, lovemaking, bonding, and feeding.  We plan to make sure to guard this precious time, and it might last for an hour, two hours, eight hours, depending on the mother's needs and wishes. The room remains warm and dark and quiet, just as it had during labour, to not interrupt the flow of hormones which keep the labour progressing. Now those same hormones are peaking even higher, the ecstasy of that hot wet little body on her skin, eyes meeting for the first time...precious time...so easily lost.  It's a continuum...lovemaking, labour, bonding, breastfeeding...same hormones, same simple requirements of privacy, safety, warmth and a neocortex undisturbed by too much language, talk, or thinking.

Skin-to-skin is where a newly born person gets great comfort in his new environment, and prepares to feed.  Skin to skin with her baby is where a person who has just given birth forgets her pain in a flood of hormones so high she is capable of an ecstatic state (just how much depth of experience new mothers are robbed of in our culture where we do not prepare properly and give this time the respect it calls for) and begins to bond with the person she must now nurture and nourish.

As a doula
, at a homebirth, I might see her still wrapped up in her bed skin to skin with her new one when I leave, hours after the birth.  She may still be there when I return the following day.  I encourage frequent, prolonged periods of gorgeous, ecstatic, uninterrupted cuddling and loving and will bring you teas and cakes and soups and nourishing foods that you love, and get on with the stuff that needs doing whilst you do glorious wonderful nothing but cuddling.

As a breastfeeding peer supporter, on the ward, I will sometimes witness something different. A tense, slightly bewildered and anxious looking mum...baby hasn't fed, is still asleep, and the midwife is asking her to express colostrum into a syringe. 

'Skin to skin? Oh yes, we did that on delivery suite. I don't think it worked though, he still isn't waking for a feed'

as she looks at her baby wrapped up in his Perspex cot. This is how popular media portrays a woman and baby in a postnatal ward, the baby alone in his see through box. This represents a 'satisfied' baby put 'down to sleep' until the clock dictates another feed...which is 'normal' isn't it?  How our language betrays the scant intellectual knowledge we humans collectively have about how breastfeeding works. Babies are still hardwired the same as they were tens of thousands of years ago, expecting to be carried and held most of the time, with free access to the breast for very frequent feeds. How different are our cultural norms, and the culture of separation begins early. There are some outdated ideas still firmly rooted out there about the cuddling of babies. Spoiling them and rods for backs are the obvious. More deeply, I suspect that in cuddling our own infants we are connected back into how we were cuddled and parented ourselves as babies. Or not of course. Sometimes  all of this stuff combined with the thinking brain gets in the way of instinctive behaviour. The answer lies in the action.

How to unwrap this situation? By suggesting she unwraps her baby, and try some cuddling together with him if she wants. 

 By suggesting t
he Biological Nurturing (aka BN, or laid back breastfeeding) position which will release a flood of hormones, and works whether skin is touching skin, or not.  By explaining that her baby won't get cold when undressed down to a nappy, if his chest and abdomen are against hers, and both of them are covered with a snuggly blanket. Explaining (preferably in a more teachable moment, during ante-natal preparation) that after birth, babies display breastfeeding behaviours when laid on their mother's abdomen (or across her chest if there's a delicate Caesarean incision) and that these behaviours are in-born reflexes, stimulated by being on their mother's belly, smelling her skin and her milk, and are Nature's design to help the baby to begin feeding.  By explaining that babies don't need to be wide awake before going to the breast. By telling this mama that having her baby on her like this, the feeling of his weight and skin, the smell of his head without that pretty hat (that intoxicating scent!) will prepare her body for feeding, with a flood of hormones.... Oh wait... I don't have to tell her that now that her baby is on her because she's living it. I'm watching as she's melting into the dyad that they are together, changing from tense and anxious to flushed and loved up, glazed, not listening to me anymore. Those hormones are working their magic. I swear I can sense the rise in oxytocin that's present here. I'm just there to reflect that back to her, smiling, nurturing her increasing confidence in her own body's ability to nurture this new little being.  These two are where they belong...together.

How to further unwrap this situation?  It's simple, but complex, because it's wrapped up in culture, habits, and expectations and 'because that's how we've always done it'.  I am a lay person, who pops up to the ward for a bit to help out. Do I dare to suggest to the hardworking overstretched angels that are our midwives with far more knowledge and experience than I, that I have a suggestion to improve the way breastfeeding is initiated on the ward? Changing culture isn't easy.  My suggestion is simple, and it has been said by greater people than I, many times before.

I suggest that, where possible, we don't separate mother and baby.  There, I said it. 

But what is meant by separation? I never saw my mother again after she birthed me. That's separation. My second son was ill immediately following his premature birth and was in special care for weeks. That was separation. My first son spent his first night in the hospital nursery down the corridor as was the culture 30 years ago, and we no longer do that now we know that it's separation too.  But what about the more subtle forms of separation like the expectation that babies will be dressed before leaving delivery suite for the post natal ward? With a hat on. I know the midwives always ask, 'do you want me to dress your baby?' but which mum straight after giving birth is going to say 'No thank you, actually I would prefer to transfer to the ward wrapped up with him on my chest in skin to skin.'?  That would be like me saying 'No thank you I'd like a small glass please' when I've asked for a New Zealand Sauvignon and the bar person says 'Large glass, yes?'  Of course, I nod and smile and say 'Yes please!' Upselling is just manipulating cultural compliance after all.

Labouring women need privacy, safety, warmth and no neocortical stimulation to ensure that adrenaline is at a minimum so that oxytocin can flow. Same for early initiation of breastfeeding.  What happens when women leave the house in early labour to go into the hospital to give birth?  Many times, that labour slows right down because being disturbed has adrenalized her.  The same can happen if women have to change rooms in the hospital in early labour.  Mammals choose to birth in familiar surroundings, because the adrenaline is lowest here. For human mammals, 'birthing' doesn't end when the placenta is born. It incorporates that hour or so afterwards when on the  un-medicated mother's chest the healthy term baby displays up to 20 different inborn behaviours which have the purpose of finding the breast and transferring milk. The mother is experiencing an oxytocin high and bonding is happening. The sensitivity around this time is acute.

Moving away for a moment from the birth room to normal life, there is a thing called the 'Doorway Effect' . I just experienced it when I sat down at the kitchen table to write this and it started me thinking and making connections. I've got my coffee, my notebook, my reference books, and been typing for a few minutes. Suddenly I remember that I'm expecting a call and my mobile is still charging upstairs. I get up, and charge upstairs myself. I head for the bedroom, I know that I'm headed for the bedroom, but when I get in there....what the hell am I doing in here?  I know I came up here for something...but what? That's the Doorway Effect. Basically the brain only hangs onto thoughts and information for a limited period of time, before discarding it in order to keep room clear for new stuff to come in. To the brain, leaving one room for another seems like a good time to purge the memory in favour of whatever is going on in the new space.  Something happens in our brains when we move from one space to another. Returning to the birth room, we could  at the very least consider the possibility that moving out of the safe birth space to transfer to the postnatal ward might cause a rise in adrenaline and a corresponding drop in oxytocin. Is there also a corresponding 'Doorway Effect' where birth room conditions such as privacy and  and expectations of behaviour are left behind to make room for the next experience of being on the ward among strangers, all before the birth room occurrences such as bonding and breastfeeding initiation are fully complete. 

I think that wherever possible, our cultural habit should become that mums and babies are not separated, especially when something potentially stressful, like moving rooms, is happening to either of them.

The 'Doorway Effect' has been found true for intellectual experience, but what about the birth experience? What about that timeless space where two souls who have spent nine months as close as two people can get, finally get to look one another in the eye? Might that magic hormonal spell be broken by the passing through of the doorway from familiar birth space to the busy post natal ward full of strangers and their crying babies? Might there be an ancient, mammalian survival mechanism whereby bonding temporarily shuts down in favour of survival, in the presence of adrenaline? Might this interrupt the initiation of breastfeeding Might we mitigate the effect of this using skin-to-skin during transfer to the ward?

I don't know the answer to these questions, but I do know that larger numbers of women are struggling with initiating feeding on the ward than I expected.  I do know that when we unwrap the baby and get them back together I can see the effects of the increased oxytocin flow.  I do suspect that unless myself or a midwife suggests to many mothers that they resume skin-to-skin or at least cuddle their baby, many babies would remain sleeping in their Perspex world whilst their mothers wait for them to wake up and those precious golden first hours and oxytocin highs ebb away.

  I suspect that changing the culture that expects mothers and babies to be separated like this for more time than they spend cuddling together might help with breastfeeding initiation

I also suspect that if we didn't separate them in the first place, with that simple, innocuous expectation that babies need to be clothed more than they need skin-to-skin in the first hours, that we might possibly see fewer struggles later on in the ward.

I know this isn't the answer to all the problems that mothers and babies experience with breastfeeding, and I'm not reinventing the wheel here, I know. I feel this area needs looking at again from the perspective of the baby whilst we are asking ourselves why so many mothers and babies struggle with breastfeeding in hospital.

There is a large body of research supporting skin-to-skin for bonding, temperature regulation, metabolic regulation including blood sugar stability, breathing regulation, and the initiation of breastfeeding. A Cochrane Review article based on 30 studies concluded that skin to skin soon after birth lead, among other benefits, to more likelihood of breastfeeding and breastfeeding for longer. (Moore, Anderson, & Bergman 2007)

References: Breastfeeding Answers Made Simple ~ Nancy Mohrbacher  IBCLC FILCA 2010
An Introduction to Biological Nurturing ~ Suzanne Colson RM Ph.D 2010


Wednesday, 26 April 2017

Menopause and Me.

This is my story.  I totally get that it may not be like this for other women.  I believe in the power of stories, which is why I want to tell this one.

This is me on Saturday 15th April, 2017.  Two days after my 53rd birthday, preparing to spend an evening drinking wine, laughing with friends and dancing our fucking socks off to loud, live rock.

Three years ago I was recovering from the urgent hysterectomy I'd had to have that February, following a winter of almost constant bleeding.  It stopped the night I held my daughter and son-in-law as they birthed my gorgeous butterball of a grandson, and waited until I had encapsulated his placenta for her, and with permission buried a small piece under my tree, where my babies' placentas are, before returning with vengeance. (I like to tincture the leaves of that tree.  I recon they will have sucked water up from that rich root soil, which will contain the essence of all of us...what a powerful healing that could be.  Bit of Crone wisdom for y'all, right there)

I didn't want to have a hysterectomy.  All my life I that was the one operation I didn't want to have.  My mum had one, when she was 22, 23 years before I was born (work that one out)  and I thought it was so cruel to take away such a precious and magical part of a woman.  When I was a nurse in the '80s and 90's we hysterectomized women left right and centre. The youngest I saw was 25.  Nobody was going to do that to me.   Until they had to, of course. 

August 2013,  I'm going on holiday to Devon, and worrying about a placenta not yet due,which was bound to arrive whilst I was on my holiday.(It did)  It got me to thinking about tincturing my menstrual blood for my menopause, for jewellery, to honour the deep, impossibly magical, synchronous mystery of my blood cycle, which I could not imagine life without.  She was due, there would be one of  the deepest tidal swells in the world and a full moon.  I packed my tincturing kit.

But she didn't come.  I laughed at the irony...late because of the holiday maybe.  The lovely days crept by and I agonised over the thought that she had left me.  Left me without the chance to say goodbye, without a last exploration of her muddy depths, or magical heralding dream (fireworks in the night, the hot, sweet dragon's breath, warm soft grass on my feet, soaked with blood, stained-glass windows blazing beauty with a midnight sun) That dream last year, of a spectacular, majestic sailing ship on a red sea...that ship has sailed...preparing me for the loss of her. more about menstrual dreaming here

Tide out, clear skies, we went down to the beach in the sunshine and looked out to the blue timelessness and played like a kids in rock pools with shells.  Later we returned to our hotel and behind the old Victorian bricks and the sunny net curtains waving in the breeze we made hot and sweaty love, my safe place...on our holidays after all.  How would love be without her? 'and the dry stone, no sound of water..' knowing I am no longer fertile?  Desirable? Desiring? Dry, old? What lies ahead for this body that has loved and lost and lived and borne and suckled five babies?   After sleep, we went back down to the beach, now under 10 foot of angry slate grey ocean below lowering clouds and a blood red gold sunset, and she came to me suddenly one last normal time.  And I did get her into my tincture bottle, under the full moon through the window glass and old tiles on the shelf, sounds of the late night pub below. Human life, cells dividing all the time. Time.

Back home, two weeks later on a glorious September morning, I was on the floor cutting out designs when I thought I had spilled my coffee. My legs were hot, wet, soaked. It was my blood. They finally stopped it in December, in hospital, as yet another bag of some kind soul's blood dripped into my arm.  And she had to go. So did my ovaries. More about my experience here

Straight after the operation, back home, I could feel the hormonal difference.  My dreams were quiet, my upper body flushed, and my head ached.  After a month or so, the headaches went, and three of nana's 'power surges' a day became my new normal.  As my body healed I gave thanks for my habits of weight training and good food in the last few years, this helped me to get back to myself.

 You'll never be able to weight train again said my surgeon.  I returned to extremely gentle exercise 6 months later.  Three years on and I'm slinging heaver lumps of metal around that gym than ever before...but I have learned to listen to my body, and to be careful with her.  If I do that, and feed her well, she lets me dance through the night, stack torches on the rack at bonfire time, ride on a ZX9 at 150 miles an hour round the M25 at 3am with the other fucking lunatics, swim for hours in freezing sunny Devon coves with my crazy children, and dream new dreams.  She is calm now, without the glorious drama on the high seas of hormones, but she is deep.  I am still exploring the hidden depths now my ship is in harbour.  I'm climbing those cliffs, and loving my new view.

And do we still make hot, sweaty love? 

What a journey that was. Is. I couldn't lose my love life, I just couldn't, but  I could feel that nerves had been cut.  There was no pathway for my feelings to be felt.  I would grow them again with time, with utter determination to not say goodbye to this part of me. The urgency of keeping this part of my life pressed like a weight.  We got back to that at six weeks on my gentle, subtle, desperate insistence, just like years before, after the babies...six weeks...always the magical date.  'Am I hurting you?' Just like back then. No, no, I'm fine.  So much to delicately negotiate in both our psyches, I couldn't be delicate with my body, it would just have to cope, which it did, and does.  It isn't the same, my body has been through so much, too much, but it's deep, so deep to have such history.  My feeling sensations is returning, my desire is returning.

So my secret is caring for my body, determination, belief in the power of the female, purchase a good vaginal moisturiser, or coconut oil which tastes nicer, and have at least 5 orgasms a week by yourself or with help, whether you need them or not, and soon you will.  Read this book eat well and exercise. Find help from a holistic practitioner if you need.  With love, to Crones and Crones-to-be. Your body shows your life history and this makes you truly beautiful xxx

Jil Wild Manning
Fertility & Maternity Reflexologist
Doula UK recognised Birth Doula

Tuesday, 11 April 2017

Breastfeeding Intelligence. Preparation for breastfeeding.

This all sounds very nice, but why do you need to prepare for breastfeeding?  It comes naturally, right?

So yes, lactation follows the birth of a baby, or strictly speaking, the birth of the placenta (the drop in placental progesterone following the birth of the placenta allows a rise in prolactin which triggers milk production in quantity)  Following birth, the vast majority of term healthy babies will demonstrate a series of breastfeeding behaviours designed to help them find and latch onto their mother's breast, just like any little baby mammal...and their parents don't do antenatal classes to learn it, so why do humans need to?

The short answer to that is intrinsic in the difference between us and other mammals; namely, that large, overdeveloped neocortex, or 'new brain' of ours, the one that gets us into so much trouble, the one which enables us to be conscious of our own existence, and to think about things.  Other mammalian mothers' brains and behaviour with regards to birth and breastfeeding is instinctive, and without the intrusion of hers or anyone else's 'thinking brain'. For humans, breastfeeding is both a learned and an instinctive behaviour, for babies as well as for mothers.

Did stone-age woman and her partner attend Saturday morning 'how-to' classes with other expectant parents for information, tea and cake?

They (probably) did not.

They absorbed the information of how breastfeeding works in much the same way as hearing people learn language; by growing up surrounded by it all the time, every day, and they had the huge advantage over us in that they lived in a breastfeeding culture.   Before the invention of artificial feeding, everyone was breastfed as a baby and small child...maybe not all the time by their own mother, but exclusively breastfed just the same.  Women would very probably have shared the feeding of their babies with other women, and the survival of our species, until a relatively very short time ago, depended and in fact, thrived upon this extremely successful biological function.

In an incredibly short space of time in the length of human history, our highly developed brain has taken us on a wild and crazy magic carpet ride resulting in the creation of art, civilisation, war, cities, technology, medicine, space travel, religion, cultural beliefs, money, patriarchal values, artificial milk, and advertising.  Add to this the destruction of tribe, community, extended family, and the loss of female autonomy and traditional knowledge and wisdom in reproductive matters.  Add in the loss of understanding of the basic needs of a mother and her baby to be together with a priority on their respective healthy physiological functioning.

We put our trust in the medical community, and in cleverly advertised life-styles and societal norms, rather than in our bodies, instincts, and biological norms. We have thoroughly, completely, subtly and blatantly assimilated artificial feeding of babies into our idea of what is culturally normal, and in doing so, we have lost much of what would support breastfeeding mothers and their babies.  We have lost the idea that breastfeeding is normal.  We have lost the knowledge about how a breastfed baby behaves, how breastfeeding works, how frequently babies want to feed, how to know that they're getting enough milk, about the fact that they absolutely expect to be in someone's arms, or worn on someone's body most of the time. More from me on our prevalent culture here

Advertisers, media, friends, family and the medical profession who connect with mothers can subtly or blatantly question her ability to feed the small human that she has just spent 9 months miraculously growing and maintaining inside her body.  Breastfeeding as a biological function is far more successful than pregnancy, and why wouldn't it be...nature is not going to invest so much energy in growing a person, and safely birthing them, only to shrug her shoulders and say 'ah well, she couldn't feed her baby, she didn't make enough milk' or 'her milk wasn't good enough'. No.  Nature in her wisdom is going to make sure that her milk is a living, dynamic, adaptable, tasty complete nutrition with immunological factors, cancer-killing cells and other remarkable properties, delivered in a way that in itself is nurturing and contributes to social and emotional health and brain development. And, Mother Nature has also ensured that milk can easily be produced by mums who are busy with other children, busy with life, maybe stressed, and who have neither the time nor inclination to worry about 'eating healthily'.

So how come everyone knows someone who couldn't make enough milk to feed their baby?

A tiny proportion of women will not make any or enough milk, and for specific reasons having to do with pathologies related to her breasts themselves, or the endocrine system which governs milk production. Retained placenta can inhibit the production of milk. A Caesarean section or a large blood loss can delay the milk coming in, but the milk will come.  A lot of the women who didn't have enough milk probably did have enough to begin with, and probably could have made enough if they and the people around them had understood the way breastfeeding works, on a demand and supply basis.  If they had known that the fact that their baby wanted to go to the breast frequently was normal new born behaviour, and not an indication that their baby wasn't thriving on the breastmilk.  If they had known the importance of regular frequent feeding or pumping if not feeding in the first two weeks.

  The reason that so many women give up breastfeeding because of a perceived lack of milk or doubted the quality of it and its ability to nourish their babies, is because these women were failed.

They were not properly supported. It's because of a lack of the basic understanding and knowledge of how breastfeeding works, and what has to happen and when, to ensure that it can do it's miraculous thing.  Because breastfeeding is not bottle feeding only with breasts.  Because babies need to learn to breastfeed too, and any interruption in the form of dummies, nipple shields or artificial teats in the first six weeks or so, can set some babies back really severely so they can't empty the breast properly next feed. Which, unless mum takes appropriate action, impacts the milk supply.

The learned part for the parents is a bit like learning to drive.  You've sat there watching your mum drive when you were a kid...maybe she even let you drive her truck around the field a few times...you know what to do.  So do you just book your test and wing it?  Or do you take a few lessons to make sure that you know what you didn't know you needed to know when the time comes?  So that you can concentrate on passing your driving test on the day, rather than trying to cram in new intellectual knowledge at a time when you want to be focussing your energy on doing what you need to do. 

That's why you need to prepare before birth for breastfeeding your baby.

Check out my website BreastfeedingIntelligence.co.uk like the Facebook Page for course dates. Or get in touch at breastfeedingintelligence@outlook.com to discuss one to one courses in your own home at a time and date that suits you.
Jil Wild Manning
Fertility & Maternity Reflexologist
Doula UK recognised Birth Doula
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