Our thanks to Mary Nolan for writing for us on the subject of parenting advice, confusion and consistency. Mary is one of our main session speakers at the Growing Families: Facts, Fiction and Other Stuff event in Manchester this October, and will be delivering the section on Understanding Baby, in conjunction with Helen Ball of the Durham University Parent-Infant Sleep Lab.
Mary trained as a nurse in the 1970s and then as a childbirth educator with the NCT. She has worked with parents across the UK and has trained educators in Australia, New Zealand, Ireland, Belgium and Germany. She has published several books including, ‘Antenatal Education: A Dynamic Approach’, ‘Home Birth: The Politics of Difficult Choices’, and chapters in ‘Essential Midwifery Practice: Intrapartum Care’ edited by Denis Walsh and Soo Downe. Her PhD examined the impact of antenatal education on women’s choices around pain management in labour and her research into women’s and men’s experience of early labour, what women want from antenatal classes, and health visitors’ engagement with new fathers has been published in peer-reviewed academic and professional journals.
My father is 88 years old – a truly splendid octogenarian who maintains a keen interest in a world which he sometimes finds confusing. He is not slow to remind us – with a twinkle in his eye – that advice is like fashion; it comes and goes and if you hang onto what you wore/were told in the 50s/80s/00s, you’ll eventually find yourself ‘on trend’ and doing ‘the right thing’ again after being out of fashion and doing ‘the wrong thing’ for a couple of decades!
He’s particularly keen to point out that the parenting my mother considered appropriate – three meals a day (sitting at the family table) and only water and fruit in between, and bed-time before 8pm are now being advocated again. (Along with real butter which my Dad loves!)
It’s hard today being a mother or a father or a kinship carer or anyone who has charge of children and wants to do the best they can to ensure they are physically, emotionally, socially and spiritually healthy. And people like myself, who are in the business of parent education and research, don’t always make life easier – although we are totally committed to finding the very best evidence to give to parents and co-parents.
Helping out at a playgroup the other day, I was startled to hear two young mothers (mid to late twenties) talking about what kind of milk to give their babies. The babies in question were adorable little girls of around 4-6 months of age. The babies were sitting in their pushchairs smiling amiably at each other and occasionally demanding some attention from their moms which was very willingly given. I presumed that the mothers were discussing breast milk v formula, or different kinds of formula. Not so. The mothers were discussing when to give cow’s milk and whether it should be full fat or semi-skimmed. The conclusion they came to was that it was all right to change from formula (which both babies were receiving) to full fat cow’s milk at 6 months of age. The World Health Organisation and the Department of Health recommendation is not to give cow’s milk before a year at the earliest. It’s one of the few recommendations that has been consistent over quite a long period of time.
These were clearly devoted and conscientious mothers with healthy and happy babies. So how could they have got hold of such wrong information?
It’s not just mothers, of course, who are victims of the confusion that inevitably arises when health information changes from one week to the next, or is transmitted in a confused way or is different according to which health professional you speak to. Health professionals are confused as well. While leading a seminar recently for a bright and dedicated group of student midwives, I found myself in a debate with one young and ardent student about whether caesarean section was as ‘good’ as vaginal birth. I mounted the usual (and, to my mind, correct) argument that caesarean can be a life-saving operation for some mothers and babies and that we are fortunate to have easy access to it, but that vaginal birth has many advantages that may affect the new baby for the whole of their life. I therefore suggested that it is the midwife’s role to support women and their birth companions physically and emotionally to have a straightforward vaginal birth whenever possible. The student quite definitely did not agree with me and felt that vaginal and surgical birth should be presented as equal options.
You might be thinking now that I have made these two stories up for the sake of this Blog – but, actually, I haven’t. Both are true and both incidents occurred in the last month.
Research into health promotion is very clear that conflicting and inconsistent advice leads (who would have guessed?) to conflicted and inconsistent parenting. And that inconsistent parenting doesn’t help young children to feel secure and ‘get a grip’ on the world. The baby and toddler are busy developing a template for life. Their fast-growing brains are trying to sort out which behaviours lead to which responses. As humans, we all need to feel pretty certain that our actions will have predictable outcomes if we are to function effectively on a day-to-day basis and avoid becoming anxious and indecisive. As a very young child, I need to know, for example, that food arrives at certain times and that eating it makes me feel content; that smiling at dad and reaching out to him elicits a warm playful response, and that pulling grandma’s hair hard makes her sad. I need my mom and dad, or whoever is looking after me, to do things in ways that I come to recognise as ‘how things are done in our family’. If mom and dad are continually changing the way in which they look after me because the advice they are receiving is always changing, that’s not particularly good for me as the little person on the receiving end of that inconsistent parenting.
For me as a birth and parent educator, and an academic who’s interested in how to transmit accurate health and child care messages, the age of social media is challenging. Twitter and Facebook can function rather like a game of Chinese whispers with a message starting out as one thing and becoming something very different by the time it reaches the hundredth or the thousandth or the ten-thousandth recipient. For parents and co-parents, trying as hard as they can to be not just ‘good-enough’ parents, but excellent parents, ever changing advice is a nightmare.
It’s a conundrum. So what advice would I give about advice???!! I think exactly the same as I would have given when I first started practising as a parent educator about 30 years ago. Choose one person who you have reason to believe knows what s/he’s talking about and understands the way in which you want to parent, or one website that has been recommended to you by a health professional, or one book that is authoritative (the reliable ones generally have reference lists so you can check the research on which they’re based) and stick with that person or information source. As a very wise friend once said to me (rather shockingly, I thought at the time), ‘Even better than loving your children is being consistent’.
Shel Banks IBCLC, Chair of the Local Infant Feeding Information Board (LIFIB) is speaking about Infant Milks at the Growing Families conference in Manchester this October. In this thoroughly researched blog post Shel showcases the work of the LIFIB with an independent review of the Haakaa silicone breast pump.
This year’s big thing in the infant feeding related products world seems to be the Haakaa silicone breast ‘pump’. Coming from New Zealand, the company information on Facebook says they are a “baby brand that provides parents with Safe, Natural, Non-toxic, Eco-friendly baby products” http://www.haakaa.co.nz/ The ‘buzz’ around this product is so strong that people all over the UK are importing from the other side of the world so they can get their hands on this item, and leaving rave reviews! I have been hearing a lot about them and wanted to have a good look at what the fuss is all about.
This new-ish product is essentially a clever combination of two items which have been around for a long long time – breast shells and breast relievers.
Breast shells are designed to be tucked into the bra of a lactating woman, and the hole goes around the nipple so that any leaked milk is caught in the ‘shell’. The shape of the part which touches the breast, and the size and placing of the hole, creates gentle pressure on the lactiferous ducts behind the areola and actually encourages milk flow and so stimulates leakage. Two examples here:
Breast relievers are designed to pump milk from the engorged breasts of lactating women when the baby they have been feeding cannot or does not wish to be fed. They rely upon a combination of suction (creating a vacuum which draws the milk out), rhythm (which might stimulate the ‘let-down’ reflex) and pressure on the lactiferous ducts, which stimulates milk flow. These devices have been around for well over 100 years and are still used today. See this one in the British Science Museum
which was apparently in production between 1870 and 1901 although many like this were used much more recently – but also this one which is one of many similar ones available online now.
Where these have been promoted as breast ‘pumps’ in the past I have been a little concerned as this suggests the milk is being saved for use in feeding baby, and I’m never sure how one would effectively clean the ‘bulb’ – which both gets squeezed to create the vacuum / pumping, and also serves to store the collected milk. Nor whether the plastics or rubberised materials used, might leech substances into the milk – which is a worry if this is to be used for feeding baby, but of less concern of course if it is purely used to relieve engorgement and the resulting milk is discarded. However I don’t know many lactating women who are happy about the idea of discarding breastmilk!!
So when I first saw the Haakaa in a breastfeeding group online I was impressed by the simplicity of the design and the ethos behind it – namely that it’s simple to care for, and non-toxic!
How does it work?
For this we can turn to the company’s own website: “Simply suction to your breast and let the pump do the work for you as it draws your milk using suction”. It’s true – the reports I have had tell me that the flange is placed on the breast, nipple lined up with the ‘neck’ of the device, and then the bulb is squeezed to compress which expels air from the bulb and creates a vacuum around the flange on the breast, securing it to the breast. Mums tell me that they then feed their baby on the other breast and while they are feeding the device fills up with their milk! The device has a scale on the side up to 90ml but I suspect it would accommodate 100ml – whether it could do this without falling off the breast as the vacuum reduces and the device itself becomes heavier with milk, is another matter – but you could hold it on.
How is it different from other pumps?
Most breast pumps work in a similar way – there’s a flange or funnel which sits on the breast, a hole and tube which accommodates the nipple, and then something on the other side to provide the vacuum in a rhythm so that it does actually pump the breast. Usually there’s some sort of valve so that the milk once removed from the breast is released into a bottle via some sort of ‘one way’ affair and cannot come back out again into the body of the pump. Whether hand pump or electric, whether double or single, costing £10 or £200 – all the same basic design. So there are at least 4 parts, of which at least 2 are moving. Usually many more than 4, and first time assembly for the exhausted new parent is akin to completing a passport application using only your mouth to hold the pen! But the Haakaa is just one piece of silicone and not really a ‘pump’ at all – no valve, no pumping required – though the manufacturers do say that you COULD squeeze and release the ‘bulb’ at the bottom, which contains any milk, if you choose to – it isn’t necessary. Because it involves no ‘pumping’, in spite of the dictionary definition of pump only meaning to move liquid through suction or pressure, for some reason I’m a little uncomfortable calling it a ‘pump’ and am finding myself using the word ‘device’ to describe it!
How can it be cleaned?
Unlike any of the more complicated ‘moving part’ pumps there’s only one piece to this device which makes it far simpler to wash inside and out (in hot soapy water) and of course no assembly required. Unlike its predecessors the breast reliever, Haakaa’s device is also dishwasher safe (not sure how to position it so that it would definitely get washed and rinsed thoroughly, however – dishwashers tend to send small light things like this spinning around inside the machine during the cycle, in my experience), and because we don’t want any nasty things leeching into baby’s milk they are made from 100% food grade silicone and certified BPA, PVC and Phthalate free. So it’s as simple as it looks.
Which brings us to a troubling issue with these devices:
Since these devices have become popular, almost inevitably some copycat devices have spring up on the internet – some in China, some in Malaysia. Examples here
Some look identical to the Haakaa, some do not, and are not. The authentic Haakaa pumps are available only from New Zealand at present, costing $27NZ (about £15) and it’s not currently possible to buy them from the UK, without relatively high transport costs. The main (New Zealand-based) websites selling them would charge around £27 to sell and deliver one to an address in the UK, within about 2 weeks.
However, the copycat pumps are available through amazon and other mainstream retailers, claiming prices from as little as £3 delivered! From the families I have spoken with who have ordered these copycat pumps, I know that the very cheap ones often do not turn up at all, and sometimes the refunds have been impossible to secure, also that even the £12-20 ones have been arriving without proper packaging – this is one example given to me by a local mum
As you can see – the packaging isn’t quite as sophisticated!
These copycat pumps are often more ‘solid’ than the authentic Haakaa, made from a material that feels more rigid to the touch, and weighs more – 100g compared to 74g. This suggests they are not made to the same standards as the authentic Haakaa. Reviews on some of the copycat pumps on eg Amazon.com suggest that this thicker silicone actually causes pain when it is suctioned onto the breast, and there have been reports of burns to the skin, like chemical burns, from users – the reviews on some of the third party selling sites containing these damning claims have now been removed as far as I can see.
Interestingly the copycat pump shown above donated by a local mum has a different pattern on the silicone to the Haakaa, but the design is identical and it’s just as squishy – even came shrink- wrapped squished in the post as you can see above! BUT it weighs LESS than the authentic Haakaa – so the copies are getting more sophisticated but still are not the real thing.
The authentic Haakaa pumps are certified BPA free. BPA is Bisphenol A – an industrial chemical used in the production of polycarbonate which is a hard, clear plastic, used in many consumer products. BPA is also found in epoxy resins, used as a protective lining on the inside of some metal-based food and beverage cans. It also leeches into liquids and is now thought to be carcinogenic, to which end it has been banned from the production of baby bottles since 2011 in the EU.
Copycat pumps make some claims on the advertising and packaging but we cannot of course be sure if these are true. One mother I spoke to was concerned about these copycat pumps and, fearful she had bought one, she emailed the seller to ask if they were safe and what testing they had had. The response she received was that they had no idea, they were just selling and sending them out. In the UK/EU the importer actually has the responsibility for the safety and conformity of imported products, the ‘CE markings’, so if a UK resident is importing things from abroad then as the importer, THEY are responsible for checking that the products are appropriately CE marked for conformity to required standards.
Are they any good?
Assuming we’re now talking only about the authentic Haakaa silicone pump, what most families will want to know, I imagine, is are they any good?
If you go online and search for Haakaa reviews, a few clicks will bring you many many positive stories, lots of five star feedback, youtube videos and so on. The point is it’s a simple idea, and it works. Gentle pressure on the lactiferous ducts, plus gentle vacuum as the bottle expands, plus feeding baby or active pump on the other breast to create a ‘let-down’, will elicit a flow of milk into the device. Some women find they could completely fill it, others just an ounce – but as many mothers have told me – they have always failed at expressing, they are no good at it, and this device gives them an ounce they would never otherwise have had! Mothers who have trouble with leakage while feeding on the other breast and so use lots of breast pads, are finding this saves them lots of breast pads and leakage AND gets them some milk to store.
A word of caution though – a quick search of reviews online shows that some babies think it’s a great game to knock them off the other breast as they are feeding, and because of the design, a knocked Haakaa pump can spill ALL the milk collected – up to 4 ounces – all over the place. So now you have been warned about that, there’s no use crying…!
Lots of rave reviews however, and little images sent in of milk collected in them!
Are there any drawbacks?
However because they apply the gentle pressure on the lactiferous ducts AND a gentle suction too, they will encourage continued leaking and can exacerbate the issue for anyone for whom leaking is already an issue; so as breasts are really supposed to work individually – assuming you are feeding only one baby! – if you have a problem with leaking from one side when the other is ‘working’, or perhaps a slightly different but related issue such as an over-supply, perhaps it’s better to manage that rather than encourage more of the same by collecting the milk in a device like this. See someone qualified and experienced in supporting mothers with breastfeeding issues – perhaps from the voluntary sector (ABM, BfN, LLL or NCT) or an IBCLC www.LCGB.org/Find-An-IBCLC has a list of local practitioners.
Nutritional content of milk collected
One final drawback of these devices which should be noted before going ahead and encouraging their use, is that they also only collect ‘drip milk’ which is not suitable for use as a full feed for baby, as it’s the watery carbohydrate-rich milk not the fattier richer milk. Fat soluble nutrients will be contained in the fattier richer milk in greater quantities.
If it’s used as an occasional drink to be left when mum isn’t able to feed then probably the only negative issue would be baby being more dis-satisfied. However if you fed nothing but ‘drip milk’ to a baby it would not do well. In milk banking ‘drip milk’ is not suitable for donation because it is not whole milk, essentially it’s skimmed milk.
A very quick search for evidence to corroborate my assertion about ‘drip milk’ when chatting online about the potential drawbacks of this device, brought me this from 1978 http://www.ncbi.nlm.nih.gov/pubmed/571325 – the author of that piece Alan Lucas does take money from the infant formula industry (though this was long ago so not sure whether this pre-dates the industry money) and so some may pooh-pooh the impartiality of his work, but we cannot dismiss everything he does on that basis alone – he has come up with some interesting stuff! And industry-funded work is often extremely informative too – no sense throwing the baby out with the bath water so to speak!
I know too from my experience working with UKAMB for these past many years, and as a member of the 2009/2010 Development Group for NICE Guidance on Milk Banking that the donation or collection of ‘drip milk’ is not recommended as it is not suitable for fully feeding growing babies, because of the nutritional shortfalls it may have. However, as an antidote, of course one could hand express a little of the much fattier richer milk from the other breast after a feed, to even up the nutritional composition, and make it more suitable for using as a full milk feed. The best ‘how to’ guide I have seen online for massage before pumping and expressing by hand is to be found here http://sw4.bestbeginnings.org.uk/
Because of the vacuum, it’s slightly less drip milk than milk which is REALLY dripping out, but not much more than the milk elicited by the breast shells which apply pressure to the areola. In the photos posted online the colour of the milk is suggestive of higher water / carbohydrate content and lower fat content. But of course composition of breast milk will be slightly different from mum to mum and from one session to another!
Other online blogs about this product
Most of the blogs I found seem to be rave reviews about the product, or akin to an instruction manuals, rather than a look at how they work and why it’s so important to get an authentic one and not a copycat: however in this FB post from May, Ellen from New Zealand, who is a midwife, compares the ‘China Cheapie’ to the authentic Haakaa pump, and shows that they cheaper one is less flexible and much heavier.
As reported above however, newer copycat pumps are now on the market which look much more like the authentic pump, and behave in a similar manner – the pattern on the pump is different on the one I have (authentic Haakaas have a bamboo pattern – this one is flowers!), but the shape, feel and function are almost identical. The main factors pointing to a copycat pump rather than an authentic Haakaa device are the packaging – this one arrived in the shrink-wrap shown earlier, and stuffed into a plastic mailing envelope, not the cardboard tube of the Haakaa pump – and the weight is just 5g less. So we have no idea what it is made from or where it was made.
As with everything, Buyer Beware – and in this case, you definitely get what you pay for – so if the Haakaa is the pump for you then be sure you order a genuine Haakaa!
One final note – the Haakaa UK Facebook page suggests that the pumps may be available in the UK to buy soon. They’ll still be more expensive than the ‘China Cheapies’ but they’ll be easier to get hold of than currently.
Family Links is a national charity dedicated to empowering children, parents, families and schools to be emotionally healthy. We are honoured to have them as Oak sponsors of our event in Manchester this October. This blog has been written for Growing Families by Sarah Darton, Director of Programmes at Family Links.
Infant mental health is a concept that may sound unfamiliar to many people. As a parent and former health visitor, I’ve known and worked with hundreds of wonderful new and expectant parents, all of whom want the best for their children. The words “mental health” are often met with the understandable, yet false, perception that this is an issue to worry about when children are older, and then only in the context of “ill” health.
In actuality, and as many practitioners will know, good mental health is something that can be nurtured from the womb right through adolescence and into adulthood. The first ever Infant Mental Health Awareness week was held in June this year, with the focus on “building babies’ minds”. Something that many parents may not be aware of is that babies are born with nearly all their nerve cells already present in their brains, but the ways in which these nerve cells connect and work together is easily influenced by their experiences, both in the womb and throughout their early years and later childhood.
As the Director of Programmes for Family Links, I now deliver training to practitioners who work with all kinds of parents, to help them support parents in fostering good mental health in themselves and their children. One of the key things I talk about in my work is just how important parents are in the development of their baby’s mind, and that there is support and advice to help them. A practitioner’s role in empowering parents to nurture their baby’s mental health can be absolutely vital.
But let’s start at the beginning. What is mental health?
Mental health is a continuum that stretches from mental wellbeing at one end to mental illness at the other, and we can all be at different places along that continuum at different stages in our lives. There is often a perception that mental illness is a purely genetically determined issue. While it’s certainly true that there will be medical reasons behind mental illness, parenting has a very significant role in brain development and how genes are expressed.
Practitioners can help parents to nurture their baby’s mental wellbeing by encouraging them to get to know their baby in the womb, to begin thinking of them as a little person with their own needs and feelings. For example, practitioners can explain to parents that babies can hear them from about 26 weeks of pregnancy, and therefore encourage them to talk and sing to their babies, and help them understand why shouting or violence at home is so detrimental to babies’ development.
One of the most important factors in infant mental health is how parents manage their own mental health. Practitioners can be key to identifying when a parent is anxious or stressed, and letting them know that it’s normal to have some anxieties but it’s a positive thing to seek help if they need it. Even when a baby is in the womb, the parent’s emotional responses are having an impact on the development of the baby, and potentially their future mental health and wellbeing. Low level anxiety is common amongst expectant mothers, and we also know that high levels of anxiety in pregnancy are detrimental to infant development. If a mother is feeling very anxious, it’s important that they ask for help from their GP, midwife or health visitor. Family Links’ Welcome to the World antenatal programme also prepares expectant parents for challenges both mothers and fathers may encounter and supports and encourages the development of an understanding of the baby’s physical and emotional needs, in the womb and after delivery.
Modelling good mental wellbeing and looking after our mental health as parents goes hand-in-hand with helping babies to develop a sense of security and healthy self-esteem once they are born. Parents can help develop this by tuning into their baby, and practitioners can support them by equipping mums and dads with strategies to achieve this connection. Some of these strategies could include talking and playing with the baby, gentle massage or stroking, singing, laughing and smiling, taking pleasure and delight in them so they develop the sense that they’re special and lovable, and that the adults in their lives are dependable. The idea of “turn taking”, when parents reflect back their baby’s sounds and expressions, is crucial, as is an understanding that babies need to take a break sometimes and will turn away when they need to. This is not because they are rejecting their parents’ attempts to engage but because they are easily over stimulated and need rest.
Babies are born ready to be social, and positive interactions with parents and care givers are helping their brains to develop in healthy ways. Parents also need to help babies when they’re distressed by cuddling, rocking, singing and soothing. These actions help babies to form the pathways in the brain that enable them to calm themselves as they get older, so they’ll be able to manage stress and challenges more easily in later life. Babies brains have not yet developed to a point where they could deliberately annoy their parents; their cries or signs of distress are their ways of communicating that something’s not right and they need adult help to enable them to settle.
All this early interaction is like an “emotional immunisation” that will help protect children as they grow and are exposed to things that might knock them or create stress. Just like an immunisation against physical illness, so we can also provide that resilience against emotional stressors. And practitioners can be key to giving parents these strategies and the confidence to carry them out.
For me, the cornerstone supporting all this is helping parents to realise just how important they are, not just for practical care, but for emotional care of babies and children. We need to encourage parents to realise they’re special, and that includes fathers who sometimes feel their role is just to support the mother – their relationship with their baby is special in its own right. And practitioners are in a unique position to support, nurture and empower parents to reach for help if they need it, and develop good mental health in their children.
Sarah Darton MA BSc (Hons) DipHV RGN is Director of Programmes at Family Links. Prior to working for the charity, Sarah worked in the NHS for 30 years as a health visitor, child protection nurse & health and outreach manager for a Sure Start children’s centre.
Growing Families organiser Emma Jane Sasaru is an NHS infant feeding support worker, blogger and perinatal mental health survivor and campaigner. She campaigns to raise awareness of perinatal PTSD and birth trauma after suffering for many years following the birth of her first daughter. Emma Jane runs Unfold Your Wings, a place of support and hope. She also helps train health professionals on the effects of PTSD and birth trauma on families, as well as working nationally with the #MatExp campaign and with her local trust to improve maternity services and access to perinatal mental health services. Emma Jane has a particular focus on families who experience neonatal care. She blogs about parenting and her journey of recovery from PTSD at Loving Baby, and is co-hosting the Growing Families breakout session on perinatal mental health with clinical psychologist Ruth Butterworth.
Here Emma discusses emotional wellbeing and the weight of expectations upon new mothers.
When it comes to growing our families, having a baby is an especially challenging time, not only is pregnancy a time of change for your body, but hormones are running riot making tears flow over the smallest of things. It is a time of excitement, joy, worry, fear, anticipation and change. If you haven’t had a baby before there is a lot to ponder, worry about the birth may occupy much of your mind, and thinking how you will care for your new arrival will have you making many trips to the store for every known gadget and baby item. Even if you have had a baby before every pregnancy is different and worry over the new addition to your family can add to feelings of anxiety.
After baby arrives your whole world changes again. Pregnancy and birth has taken a toll on you both physically and emotionally. Depending on your birth, physically healing can take time. Birth may have taken many hours, even days, and you will need time to recover. Your body will be surging with hormones preparing itself to nurture your new baby and you may well be feeling the after effects of nurturing and growing your baby for nine months. All this is happening at the same time, as you are getting ready to enter the new phase of caring for your baby.
Let us also not forget the new arrival! Here finally is your beautiful baby, but wow nothing could have prepared you for the impact their arrival has made on your life. Suddenly you’re responsible for another human being. This little human is reliant on you for everything, twenty fours hours a day, seven days a week, at a time when you are physically and mentally exhausted.
So when we think of the journey you have taken to welcome your beautiful baby into the world, and now the journey you are about to start on to care and nurture and grow this precious new life, the question we could ask is, do we expect too much of ourselves and how can we protect out emotional wellbeing?
Lets take physically, we have already said that pregnancy and the birth has taken a toll on your body. Now you are caring for a newborn, if breastfeeding your body will be working hard to produce milk. Also your body will be trying to recover from pregnancy and birth. Sleep doesn’t seem to come hand in hand with a new baby, which again has a massive impact on our health and emotional wellbeing. But often as new mothers we expect too much of ourselves. Despite the demands of a new baby often we try to ‘get back to normal’. We worry about having a clean house, making sure the cooking, washing and ironing is all done. There can be a rush to be out and about soon after birth, I have known moms that have gone to supermarket on the way home from hospital only a few hours after giving birth.
Of course there is also the visitors lining up to see the new bundle. It is only normal that everyone wants to see your new baby and of course you want to show everyone your beautiful baby, but when sleep is in short supply and when trying to get to grips with the demands of being a mother, making conversation and entertaining guests can be overwhelming and exhausting. Expecting you to be able to do everything and see everyone with new baby to care for can be emotionally draining. To recover from pregnancy and birth requires time, rest and support.
As a new mum it is so important that you give yourself time to recover from pregnancy and birth. Rest and sleep are important, as is making sure you are watered and fed. Being realistic about what you can and cant do is hard, but its important you don’t over load yourself and so make yourself even more exhausted. Asking and accepting help will give you the support you need to recover, everyone can lend a hand especially those eager visitors! A cup of tea, a sandwich, washing up those few plates or running the hoover over will all help to make the early weeks easier. Realising that your wellbeing takes priority over the things you normally do can be hard, it requires you to ‘let go’ and allow things to give a little. This may ago against the grain especially if you are a very organised and orderly person. But giving yourself time to recover and time to bond and nurture your newborn will help protect your mental wellbeing.
Why is this important? Because if you demand too much of yourself and try to do everything it can impact on your relationship with your baby. Bonding can be difficult if you are completely exhausted and this can then impact on things such as feeding. I once visited a mom who said she was exhausted from feeding her baby all the time, however after talking to her in some depth it transpired that it wasn’t the feeding that was exhausting her but the fact that in between feeds she wasn’t resting but cleaning, ironing and preparing a meal for over thirty guests! Her baby was five days old. It can be easy if trying to do too much to start to resent the sudden constant demands of this new little person leaving you feeling overwhelmed, anxious and even depressed. Especially in the early days and weeks your greatest asset is patience as it will stop you expecting to much of yourself but instead allow you to be kind to yourself, accepting help which will allow you to do what is most important, which is get to know your lovely new baby.
In what other ways can you expect too much of yourself?
If you walk into a bookshop and go to the parenting section there will be shelves after shelves of books on how to parent. Add to this the advice from health professionals, on-line forums and family and friends then soon how to care for your new baby feels like the most confusing job on the planet.
Is he sleeping through the night, what does he weigh, how much are you feeding him, why is he not weaned yet, he should be walking by now don’t use those nappies, that bottle is too cold, when you were little we used to………..
The list is endless, from nappies to slings, from breastfeeding to formula feeding, from sitting up to walking what is expected of us and our babies is never ending.
Everyone will have there own ideas on what is right and what is wrong for your baby. Bombarded from every direction it is easy to feel like nothing you do for your baby is right. Self-doubt and anxiety can eat away making even the most confident of moms feel despondent and unhappy. Of course there are certain milestones that your baby will be checked against to make sure that developmentally all is progressing well. Also, there is advice and guidelines that are given to protect your baby such as the safe making up of formula or how to make sure your baby is sleeping safely. Often though motherhood can feel like a huge competition, baby groups can be filled with talk of who is eating solid foods first, talking first, walking first and gaining the most weight.
The pressure this puts on you, as a mom, is enormous! All babies are different, all families are different and all ways of parenting are different. Yet the pressure to be doing certain things, by certain times remains. If your little one happens to be small or prefers to crawl and isn’t ready to bravely investigate the world on his feet you can feel like a failure. Trying to make your baby fit in with the expectations of others will only lead to frustration.
The many stages that lay ahead can bring their own challenges and expectations. Introducing solid foods, potty training, tantrums and yes the old ‘is your baby sleeping through the night yet’, can have you convinced you’re doing everything wrong. Everyone else will look like they are perfect parents and they may even tell you so! But no one is. Expecting you to manage every new stage perfectly and in a way that pleases others is a recipe for poor mental wellbeing. A dash of worry, a spot of self-doubt and a spoonful of others expectations then add to this a big dollop of comparing yourself to others and your mental wellbeing will be bitter to taste.
Then before long it’s time to return to work and again things change. After months together you will be expected to leave your little one, sometimes with strangers, while you go off into the big world again. While adjusting to the changes within the workplace, you will also be dealing with the feelings of leaving your baby. Even if you are looking forward to returning to work for adult conversation and time to be YOU again the reality of the new daily schedule can feel overwhelming. Working, looking after a family and making time for you may seem impossible. Some days it can feel impossible trying to juggle all that is expected of you. Expecting yourself to manage this transition with ease is to deny the journey you have been on the last however many months. To leave your tiny person that you have cared for and nurtured without it affecting you is impossible. It is ok for it to take time and there will most likely be tears from you both. Again asking for help, speaking to employers, finding solutions that work for you and accepting it will be hard are ways to protect your wellbeing. At those times in the day when you are struggling most remember the small open arms that will await you at the end of the day.
So, why is expecting too much of yourself a bad thing? Because expecting yourself to be perfect is detrimental to your emotional wellbeing. It’s impossible to do it! Trying to have perfect babies, that do everything just right and at set times, having a house that is always clean and tidy, juggling work and caring for a family while trying to hold down relationships and also be you, with your own identity and life is a massive challenge.
Instead as you grow as a family you have to find what works for you and that will be different for everyone. Don’t compare yourself or your baby to anyone else because you are unique. When I am at work supporting families to feed their babies I always say, ‘these are my suggestions, but it is for you to take the ones that you want and make it into what works for your family’. This is the key, surrounded by information, advice, suggestions and opinions take what works for you and your family. Expecting to do right all the time, pleasing others and keeping up with what others are doing will drain you emotionally. So protect your emotional wellbeing by being kind to yourself, accepting help of those that love you, do what’s right for you as a family. There are no perfect parents; there are no perfect ways to parent. Ultimately what matters most is you and your family are healthy and happy, and your home is a place of love. Yes growing your family can be a challenge, but with love and nurturing, with support and help you can build a family with strong roots that can weather even the hardest storms.
We are delighted to have the Association of Infant Mental Health as Acorn sponsors for our event in October. They have their own conference coming up soon as well, in celebration of their 20th anniversary, and their speakers include Mary Nolan who is also speaking at Growing Families: Facts, Fiction and Other Stuff. Read on to find out more.
AIMH (UK) is an interdisciplinary, not-for-profit organisation that promotes education, research and study of the effects of mental, emotional and social development during infancy.
We provide valuable and effective educational resources, linking academic, scientific, clinical and service-led communities together. AIMH (UK) promotes and supports research and practice in the field and publications which summarise and advocate for universal acknowledgement of the needs of babies and the impact of the early nurturing environment on the developing brain and the future well-being of society. Overwhelming evidence from multiple sources, particularly in recent neuro-scientific findings, that what happens in the first three years of life, lays the foundations for the future well-being of individuals, families and societies.
Stands: £150.00 (includes one free conference place)
Radcliffe Conference Centre, Warwick University Campus
Friday, 30th September 2016. 10am – 4.30pm
Elizabeth Meins (Key-Note Speaker)
Professor, Department of Psychology, University of York
Presentation Title – ‘Tuning In’ : Mind-mindedness, maternal mental health and children’s development
The theoretical context for Dr Meins research is broadly Vygotskian, focusing on how early social relationships relate to children’s cognitive development. Much of her research investigates how early caregiver ‘mind-mindedness’ (caregivers’ attunement to their infants’ thoughts and feelings) predicts children’s subsequent social-cognitive and social-emotional development, particularly with respect to children’s attachment security and theory of mind. Elizabeth’s research has informed the NSPCC’s All Babies Count and Minding the Baby programmes and Baby Steps perinatal education service. She also works with clinical psychologists to deliver a mind-mindedness intervention programme to mothers hospitalised for a range of severe mental illnesses. This research was featured on Radio 4’s All in the mind.
Sir Al-Aynsley Green
Professor Emeritus of Child Health at University College London and President The British Medical Association.
Sir Al was knighted for his services to children and young people in 2006 and has received many markers of esteem including the Spence Medal of the Royal College of Paediatrics and Child Health, and the Prader Prize of the European Society for Paediatric Endocrinology.
President of AIMH (UK), Professor of Public Health in the Early Years, University of Warwick, Acting Pro-Dean for Research and Director of Warwick University’s Infant and Well-being Unit.
This October’s Growing Families event in Manchester will be exploring evidence and expectations around the early days with baby. One of our breakout sessions is entitled “Parenting Under Pressure”, and will be led by Helen Calvert of hospital breastfeeding, by Catriona Ogilvy of The Smallest Things and by Lynne Barton of Entrust Care Partnership. They will be exploring what happens when the parenting journey has additional challenges added to it, such as premature birth, illness or disability.
We are delighted today to have paediatrician Victoria Thomas write for us about partnership working when your child is unwell – a key element of parenting under pressure.
Shared decision making is a popular and well-established concept in medicine, summarised well as ‘the clinician explaining the medical evidence for different options and family members discussing these options in the context of their personal values. With both the medical evidence and personal values delineated, the clinician and family jointly determine the treatment plan’ (Fiks and Jimenez, Acta Paediatr, 2010 October; 99 (10): 1464-1466)
This sounds ideal. Surely as parents and professionals shared decision making should be reasonably straightforward – after all, don’t we all just want what is best for the child or young person? Yet sometimes there seem to be clashes between families and professionals. In this blogpost I’m going to look at some of the reasons why these occur, and what both groups can do to work through or avoid them in the first place.
Time – or the lack of
A ‘business’ ward round or busy clinic where there are dozens of patients to be seen and the team feel under pressure is not the ideal time for complex discussions. There is often no privacy, clinicians are being interrupted by bleeps and queries, and carers have other commitments – the school run for other children, getting to work. Any topic which needs long discussion doesn’t lend itself to this environment. It works much better to come to the conversation with the time it warrants, and it is perfectly acceptable for either party to say words to the effect of, ‘this isn’t the right time for this conversation, can we set aside the time it needs for later/tomorrow/next week?’. By the same token, parents and clinicians are both vulnerable to exhaustion, stress, hunger. No helpful exchange of views was ever had when one or both participants was ‘hangry’! Clinicians and carers both benefit from a chance to rest or refuel before getting into complex discussion wherever possible.
Mismatched agendas and making maps together
It is hard to work together when our thoughts are going in different directions. Setting an agenda jointly helps everyone. Some parents understandably find this challenging, as they feel uncomfortable directing professionals, but it can be much easier once there is clarity around the concerns of both sides. An example of this that sticks in my mind is a respected and brilliant colleague who spent an entire clinic appointment with a teenage girl feeling like he was getting nowhere trying to engage her in the management of her chronic health condition. It was only after the consultation that she emailed him to say she had been trying to tell him that she was pregnant and wanted advice on that topic.
Sometimes communication is like the punchline to that old joke about asking for directions: ‘well, I wouldn’t start from here!’ Sitting down to look at the map together first can help hugely. Some of my work involves optimising nutrition for children with complex medical needs. Talking with families about their background feelings about food and previous experiences is invaluable. It can be all too easy for me to be working off a script about food as medicine, when parents are thinking about the importance of shared eating experiences or the practicalities of managing complex regimens. Opening the dialogue on both sides opens our minds.
Similarly, I have learned of the understandable fear carers experience when meeting a new clinician; the stress of having to tell a story from scratch or the dread that the new professional will try to revisit treatments that have proved to be dead ends in the past. Pithy summaries and focusing in on two or three key areas of concern can help with this. Teams often try to maintain continuity for this reason, but shift systems, clinical commitments, the rotation of clinicians in training and other demands on time can make this more challenging – I am feeling very conscious of this as I am writing this article while on maternity leave! Bringing a previous clinic letter to appointments that summarises key events and issues to the satisfaction of the family can be really helpful as sometimes NHS files go missing.
Well-meaning paternalism (and its consequences)
The road to paternalism is paved with good intentions. So much of the time clinicians intend to make life easier for parents who are going through the most challenging time of their lives – caring for a seriously ill child – but get it wrong. Breastfeeding is a key example of this. Often healthcare professionals well-meaningly meddle with breastfeeding, thinking that it puts additional pressure on a mother already dealing with huge stress. When we do this, we ignore the benefits for both mother and child of breastfeeding, and we override the mother’s right to make her own decisions. When families are given the complete information they need, and the time to absorb it, then they are empowered to make decisions for themselves. Just because we are paediatricians, we must remember not to treat everyone we encounter like children. We do not get the right to decide what is too hard for parents to do.
Where is the patient in this?
One of the joys of paediatrics is learning the art of the triadic consultation: how to work with parents and children and young people at the same time. As children get older, the dynamic of the relationship is constantly shifting. It can be hard for both parents and professionals to recognise this development. I was asked to ‘do the sex education chat’ with several teenagers when I was new to a service, as the professionals who had been caring for the children from babyhood struggled to see them as young adults. We need always to be looking to the young person to tell us what their concerns and dreams are, and accepting that those are what must set the agenda.
Sometimes we all need to take a step back and look at what the child needs; as parents and professionals we each have pieces of the puzzle and we need to put those pieces together to get the whole picture.
Nobody is perfect – neither professionals or parents
Writing this post has made me cringe a little inside, remembering all the times I’ve misread cues or mismanaged conversations with young people and their families. It feels a little like I am claiming I know what I’m doing. In fact, I’ve learned the most from the situations where I got it wrong and the families I work with were forgiving enough to move on from my clumsiness. In the same way, I always remember that families are under constant, immense pressure, and a truly therapeutic relationship incorporates a little grace at those worst times. Anger, tears and questions are all part of the deal.
The most positive partnerships are not those where no one ever makes a misstep, they are the ones where both sides are able to accept and move on from the difficult moments.
Setting out on a journey together
I think the parent-professional relationship works best when we see ourselves as fellow travellers puzzling out a route together rather than the clinician taking on the role of the satnav directing the course. After all, a satnav is all too easily ignored! A satnav cannot understand that I need to pull off the route it wants so I can feed my baby, or because I’ve suddenly remembered I need to stop at the supermarket, but a co-pilot can understand these issues and help me navigate them. Travelling the path together helps us negotiate the obstacles together. And in the end, it is surely in the best interests of the children in our care.
Dr Victoria Thomas
To book your place on “Growing Families: Facts, Fiction and Other Stuff” please click here.
I’m putting on a parenting conference in Manchester this October. I’m organising it with three friends, and we’re not making any money from it. We’re doing it because having worked with and supported thousands of families between us, we passionately believe that there is information to be given out antenatally that can help enormously as parents navigate those postnatal weeks and months. Are you pregnant? Is your partner having a baby? Let me explain why I truly believe this will be the best £30 you spend on yourselves and your child.
You’re having a baby! It is hugely exciting. Or scary. Or both. It may have been planned, it may not. When do you announce? Straight away? After the “dating” scan? Just as and when you see people? Months of other people’s advice and views and warnings and stories. Mostly all about THE BIRTH. It looms large doesn’t it? That moment when baby goes from inside to outside, and however it happens, whatever you choose, whatever medical circumstance chooses for you, baby is going to go from inside to outside. Oh my goodness!!
And that’s it really isn’t it? You are flicking through catalogues, browsing the shops, making lists of things that you need (or maybe don’t really need but definitely want because they are cute and come in a range of colours with bunny and teddy motifs). But really it’s all a bit theoretical. Baby is inside, and at the “end” of that journey baby will come out. What happens next is a foggy haze and all you really know about it is that apparently you will never sleep again and, if you are the mother, a lot of people think they know what you should do with your breasts.
Trouble is, it stops being theoretical the moment baby is born. Even if baby is unwell, or you are unwell, and therefore you don’t get those first hours together, you have still become A PARENT. You were a parent beforehand, but that was a bit different. Now baby is here in the world and needs you. And you need them. And you love them. But suddenly it doesn’t seem to be that simple.
You love baby, and baby will be fine. Love suggests care, care suggests attention, attention suggests effort….. Love is all you need. Yet so many things can get in the way of this simple equation. And whilst your love for baby might not change, the way you feel about yourself may take a battering. And that isn’t good for you, or your growing family.
The information you can read about parenting seems to fall into two categories: books about routines and strategies that appear to make life easier for parents but don’t much take into account the needs of baby (and of course anyone can write a baby book. It’s not as though there’s any regulation). And books/websites about the biological and evolutionary needs of baby, that don’t seem to offer many solutions as to how on earth a normal person in the 21st century can meet those needs without losing their mind.
Love is all you need. But the baby books tell you not to cuddle “too much”, not to get into “bad habits”, not to do this or that or the other thing that love tells you is natural because of dire consequences, rods for your own back and a child that still needs you to help it to sleep when it is away at university.
Love is all you need. But sometimes our bodies get confused after birth and present us with mental health problems that make love very very hard to access. Or sometimes physical health issues mean that love is not enough, the skill of medical professionals is required and parents can feel helpless and left out.
Love is all you need. But then the way you thought you would feed your baby is apparently all “wrong” and it doesn’t work and it’s really hard and the advice changes every day and you haven’t slept and baby is so unsettled and WHY IS IT NOT THE WAY IT WAS IN THE BOOKS?? And you start to wonder if you have failed in some way. As if you are not enough.
And what about your partner, or other members of your family? How are your relationships with them affected by all of this? What is their role? How can they help? And do you all have to become totally different people in order to do this thing that everyone said was so simple and now that baby is here suddenly appears to be so complicated?
No, you don’t need to become different people. Having a baby certainly changes you, but not beyond all recognition. You are already capable of doing this, you are up for the challenge! You are ready for the rewards! You just need a few additional items in your toolkit, that’s all.
“Growing Families: Facts, Fiction and Other Stuff” – what tools will it provide?
Understanding Me. Because understanding ourselves is the first step. No book or website or group or system can tell you how to be a parent if it doesn’t take into account who YOU are to begin with. We are not all the same. What can we learn about ourselves that will help us with this new phase of our lives?
Understanding Baby. Because babies have a lot to tell us! What do they expect? How do they behave? What is ‘normal’ sleep & how can we learn to meet their needs? This event will not dictate to you how you should treat your baby. It will be YOUR baby, with its own personality, and you will be the expert on how to care for it, not us. But what we can give to you is an understanding of the latest evidence and information about infants and their ways, to give you a framework in which to understand this little person who is joining your family.
Understanding Us. Because relationships are affected by the arrival of a new baby. How can we best approach these new challenges? Come along with your partner, with your father, with your best friend, with your mother-in-law – who is going to be on your team? What tools do you all need to keep that team strong as your family grows?
And what about all of this other stuff that apparently comes as part of “Package Baby”? Breastfeeding? Formula? Postnatal Depression? Other worrying stories you’ve read in the media. Premature birth? Other scary things that you don’t even really want to think about right now….. Relax, we’ve got you covered. When you book onto the event you can choose two out of six breakout sessions, and depending on which sessions you choose you will get these added to your toolkit:
How to give yourself the best chance of reaching your breastfeeding goals (session led by an International Board Certified Lactation Consultant)
Independent information about infant milks available in the UK, the safest ways to formula and bottle feed, facts versus myths when it comes to infant milks (session led by an International Board Certified Lactation Consultant)
How to nurture your emotional well-being in pregnancy and new parenthood (session led by a clinical psychologist and a mental health campaigner)
Ways to cope when additional challenges are added to the parenting journey such as prematurity, illness or disability (‘Parenting Under Pressure’ session led by three mothers, all of whom have experience of these challenges)
An understanding of the benefits of using slings and baby carriers, and how these can be an essential parenting tool rather than just a fashion statement! (session led by a Babywearing consultant)
An understanding of what a doula can do for you and your family and why many people choose to add to their postnatal team in this way (session led by a doula mentor and member of the board of Doula UK)
Oh, and you’ll get lunch and a goody bag too!
The one phrase I hear the most from mothers at the end of their first year as parents is “I wish someone had told me.” Growing Families is not about telling you, but it is about helping you to choose what information is relevant to you, and making that information available to you from some of the best people that we know. It is about helping you to face those postnatal weeks with confidence, armed with a range of tools that you can use, adapt, enhance or discard, whatever the circumstances of your growing family.