Learning Regret

Picture the scene: In the full darkness of the middle of the night, a hot, sweaty, tear-stained Thomas is in the middle of our king sized bed, searching. He’s systematically peeling back the edges of the duvet, reaching for the straps of my vest top first on one shoulder then, as my hand gently dissuades him, the other. Foiled again, he shuffles down the bed, feeling for the bottom edge of my clothing, trying with all of his might to push it up over my stomach.

His wails are enough to wake the street, never mind the neighbours.

And in that moment, in the middle of our unmade bed, I feel simply awful. Somehow, despite all my best efforts, I’d ended up here, in the middle of the night, denying my son his biggest comfort whilst he was unwell.

What Thomas was searching for was my breasts.

And when his eyes sought out my face in the darkness and locked on to my own, when he cocked his head slightly to the side and whispered

“No boobies?”

I thought my heart might break.

Because now that we’ve not fed in over a month, there is no going back. But Thomas doesn’t, or didn’t, understand that.

Breastfeeding was never, ever about me. I didn’t start out feeding Thomas for myself, and I certainly didn’t carry on for twenty months to satisfy myself. I’d be lying, though, if I said there hadn’t been times in the last six weeks that I haven’t missed the closeness and routine of our feeding. The milk-drunk look that washed over a tired Thomas’s face. The warmth and weight of his body across mine. But I was happy to know that feeding had ended on his schedule and he was content.

Until that night, this week, when he couldn’t have been further from content. If I’d thought he’d already begun to forget about my boobs, I was very, very wrong.

No, I’ve been left with the distinct feeling that what the weaning process has taught Thomas is what regret feels like. Because I’m in no doubt that he’d go back if he could.

It’s been a tough week.

Mummy and Thomas

What Lactivism Isn’t, Or Shouldn’t Be

If you’ve read any of my previous breastfeeding posts, you’ll know that I’m pro breastfeeding. And, yes, we’re still going strong at almost 20 months. This doesn’t, however, mean that this is what I think is “right” or it’s what I believe everyone else should do too. Far from it.

I do lurk around on a few breastfeeding and so-called “lactivist” forums. But I really, really hate the word “lactivist”. I think it sounds unnecessarily confrontational and so often seems to immediately alienate anyone who chooses not to breastfeed, or struggles to breastfeed. My opinion of the term is not helped by some the self righteousness I’ve come across on these forums. Like the woman who was incredulous that her “friend”, who also identified herself as a lactivist, wanted to give up breastfeeding at two years, for a host of carefully considered reasons.

It has struck me that some women truly believe that lactivisim is about forcing others to start, and then to continue, breastfeeding. That it’s about increasing breast feeding rates at any cost.

But it shouldn’t be.

To me, lactivism, or breastfeeding promotion, is about ensuring that every single pregnant woman and new mother has access to balanced education about the risks and benefits of all feeding options, and help and support to ensure they can process that information and make a properly informed decision about how they want to feed their baby. Because just telling women that breastfeeding is better because… x, y and z reason, isn’t helpful if a woman doesn’t have the capacity to process that information and its relevance to her life. It’s also about ensuring that women who do choose to try breastfeeding have the necessary support to get over difficulties they may encounter.

It’s not about attacking other feeding options, drawing battle lines, defining a single “right” pathway to follow or telling people what to do.

It’s simply about helping people make choices once they are in possession of all the facts, and not only when they begin their breastfeeding relationship, but at any point during.

Choice is key. We do all, ultimately, have the right to make our own choices. But I suspect that many women do not even attempt to breast feed because of misinformation, or a lack of information, or an inability to understand the information. And many more give up because it isn’t what they expected (another rant forthcoming on the marketing of breast feeding as easy and natural) and because the support they need isn’t there when they need it.

If I felt every person who does not breastfeed was happy about that decision, or had been properly informed in making it, then I would be happy. But until that day, lactivism needs to focus not on blindly recruiting breast feeders, but on cultivating a generation of women who really understand the options for feeding infants and can hopefully in turn pass that knowledge on to their sons and daughters.

Breastfeeding boy

This topic has been on my mind for a while, but I was prompted to finally write this down now during National Breastfeeding Awareness Week.

TTC Whilst Breastfeeding

(If you are not prepared for a heavy dose of TMI regarding my menstrual cycles, or a bit of a biology talk, you may wish to move along and come on by again another day!)

Once we passed the six month breast feeding milestone and it became evident that breast feeding was definitely a routine that was going to stay, I had one caveat. I always said that I would be happy to give up at a year – even if it meant forcing the issue – if my periods hadn’t returned, in order to think about conceiving another child. Whilst I’m committed to breast feeding and assured of all the benefits it offers, giving my child a sibling, and hopefully a long term companion, is also important to me. And I think the overall benefits of being able to do that, to me, would justify curtailing breast feeding at that stage despite understanding its ongoing benefits.

As it happened, my periods returned when Thomas was ten months old. Although I know that the presence of menstrual cycles doesn’t always equal the existence of normal fertility, I took it as a good sign since I was obviously fertile before. So I stopped thinking about the possibility of quitting breast feeding in order to conceive. And that, in a nutshell, is how I have found myself trying to conceive whilst still feeding my first child.

I can’t honestly say though, that the role of breast feeding in our conception journey doesn’t frequently cross my mind. Almost every day, when we settle down on the sofa for a snuggly pre-bathtime feed, it crosses my mind that this may be a modifiable factor that will prevent a successful conception.

It’s not big news that breast feeding affects the hormonal balance in your body. Most specifically for trying to conceive, it raises the level of prolactin (the so-called “milk hormone”). Prolactin is the hormone responsible for the suppression of ovulation. As the number and frequency of breast feeds (especially night feeds, as prolactin levels are naturally higher at night) reduces so does the level of prolactin in the body which eventually allows ovulation to occur and normal menstrual cycles to reappear.

Sounds simple.

But this is the human body we’re talking about. And fertility. Neither of which are, unfortunately, simple.

Even if ovulation is occurring, the higher than average levels of prolactin can contribute to a decrease in the number of developing ovarian follicles. The follicles produce progesterone in the second half of the cycle (the luteal phase) which helps maintain the uterine lining for pregnancy, and ultimately would go on to help support an early pregnancy. When the level of progesterone drops, the cycle ends and menstruation begins. The decreased number of follicles present in a lactating woman ultimately mean a lower progesterone level which may cause luteal insufficiency (too little progesterone to support a pregnancy) or luteal phase defect (the luteal phase doesn’t last long enough for implantation to occur).

Ovulating and having periods, it turns out, isn’t enough.

I didn’t know all this about the relationship between prolactin and progesterone levels, despite being aware of both hormones and their role in the body, when my periods first returned. My first couple of cycles were 30 days, which is very average for me. But then, before Christmas, everything seemed to stall. Over ten days late I couldn’t help but get my hopes up that we had already done it. But it simply turned out to be a very long cycle. When the same happened again at the start of the year, I began to look more seriously at the effect of breast feeding on hormones and pregnancy.

And I panicked.

More than was probably reasonable. After all, I have one happy, healthy child. The balance of odds suggests that I will one day be able to have another child.

But I’m impatient. I used to think that women trying to conceive their second, or third (or more!) child couldn’t possibly find it as hard as trying for your first since you already have one child. Of course I’m thankful for Thomas every day, but the desire to give him a sibling, and to have a small age gap, is huge. And that age gap pressure doesn’t exist with your first child.

Complete weaning crossed my mind. But I wasn’t sure, and Thomas definitely wasn’t ready. So I decided to look at other options, beginning with charting my basal body temperature to get confirmation of whether I was ovulating at all. A clear thermal shift, showing a move from oestrogen to progesterone dominance was reassuring. But what charting also revealed was that my luteal phase had shortened from my pre-Thomas length of 12 days, to 9-10 days. Which is borderline for luteal phase defect.

Since February I’ve been trying two things to help. After extensive research on its safety (especially whilst still feeding) and efficacy, I opted to try Agnus Castus, which allegedly helps balance female hormones and specifically is thought to reduce prolactin levels. I am also taking a B vitamin supplement which is thought to help lengthen the luteal phase, although I can’t claim to understand the mechanism.

My last cycle was 28 days, possibly my shortest ever, so something is probably working – although I’m also open to the fact that it could be coincidence. However, I had a ten day luteal phase, which is right on that borderline again.

I’m so not ready to quit feeding. But it’s also no longer a secret that I’m desperate for another baby. I suppose I’m hoping that somehow, I can have it all.

Breastfeeding a Toddler

When Thomas was born, even before Thomas was was born, I was determined to breast feed for six months. I was prepared to be open minded and go with flow with almost everything else about parenthood, but breast feeding was the one thing I was prepared to do almost anything to try to succeed at.

I won’t lie. It was tough going to begin with. I think the first thing that needs to be scratched from breast feeding education is that it’s what nature intended, and that it’s easy. And even the snippet that almost everyone can breast feed. (Something less than 1% of women physically cannot do it. Another small number of women can’t do it due to true medical or practical reasons). Those things may be true, but when you’re a new breast feeding mother, they aren’t helpful. Because if you are struggling, finding it painful, draining and down right difficult, the last thing you need is the added reminder that this is supposed to be straightforward and natural. That’s a recipe for feeling like a failure. Motherhood is littered with guilt and feelings of inadequacy without adding in unnecessary pressures.

For us, it took a while for breast feeding to click. I struggled with cracked nipples and over supply and I battled through ductal thrush. But once it did, it was indeed easy. Not having to worry about the faff of bottles. Having milk instantly available anywhere, at any time. Milk at the right temperature and without any worries about sterility.

And once it clicked, I knew that I’d have no problem meeting my six month goal. But I didn’t really think beyond that.

No one ever really talks much about the how-to of stopping breast feeding, beyond warning that you shouldn’t do it suddenly if you want to avoid engorgement and possible mastitis. There is information out there, but you have to actively search for it. And what hadn’t occurred to me without looking for that information, or having experienced it first hand, was that stopping isn’t as simple as saying “all done”.

Six months isn’t some magical watershed where your child will suddenly stop needing or wanting milk. Thomas had no idea that he was six months old and certainly had no desire to stop. And even if you do stop, you’ve still got to introduce something its place, which at this stage is most likely bottles and formula. To me it hardly seemed worth introducing all the hassle I’d loved avoiding in the first six months when carrying on was so simple. So carry on we did.

I still didn’t really give any thought to where it might end. I wasn’t averse to feeding beyond a year, but I wasn’t desperate to do it either. I certainly wasn’t determined to allow self-weaning, although I wasn’t against the idea. The only thing I will admit is that I’ve never really wanted my child to have a conscious memory of breast feeding, so I suppose that means I definitely wouldn’t want to go past three.

As it turns out, we’re still going at approaching 16 months. After his first birthday, I began a policy of “don’t offer, don’t refuse” which meant that I wasn’t going to purposely offer him a feed, but if he made it clear he wanted one, I wouldn’t deny him. Around this time I started to get some comments about breast feeding. They were a mixed bunch. Some people congratulating me – which felt odd because feeding is just something we do. But I suppose it is an achievement. Some people started asking when we would stop. A few went further and comments of “bitty” began to crop up. Whilst I still didn’t feel in a rush to stop, I did begin to feel more self conscious about public feeding, and if I’m honest I did actively seek to prevent it happening. But again, if he really needed or wanted it, I wasn’t going to deny him.

At the beginning of this year, still with no strong feelings either way about giving up or carrying on, we took steps to stop offering the morning feed. And Thomas has asked for, and had, just one single morning feed in the two months since. At one point, it looked a lot like he was going to give up his one remaining regular feed, which he has between dinner and bath time. He’s now become much more forceful in his communication about wanting that feed again though, so for now we’re still very much carrying on.

Breast feeding a toddler is very different to breast feeding a newborn. Obviously. He eats three good meals and two snacks each day. He doesn’t want or need to breast feed every couple of hours. Night feeds are the exception not the rule. He’s generally quick and efficient, rather than drawing each feed out to forty minutes or more. Physically he’s much bigger. And wrigglier. And more inquisitive and distractable.

The former points make breast feeding a toddler much easier and more pleasurable. The latter make it much harder and much less enjoyable. He’s capable of really hurting with his thrashing and pulling. And he can get distracted after a few minutes, go away to do something else, and then come back to it a few minutes later. He treats me like a milk bar when he pulls my top up, but then stands by the sofa to feed from me.

But suddenly, for the first time in several months, I really don’t want to stop.

Because breast feeding is still my go-to parenting solution and weapon of choice. If Thomas is really upset, it’s the one thing that will instantly calm, comfort and quieter him. Although feeding to sleep is a long stopped habit, when he is over tired, it still works better than anything else we’ve tried. And when he is I’ll, it’s nothing short of magical.

That last point has never been more apparent that in the last 10 days where we have battling the gastrointestinal bug from hell. I never knew so much diarrhoea and vomit could come from something so small – and that’s saying something, because Thomas has always been a sicky child! And I’m still figuring out how to truly banish the smell of sick from a carpet (any hints gladly received!). During the long week where he hasn’t really eaten at all, breast milk has provided him with nutrition and rehydration without upsetting his stomach further. When he’s cried in confusion, or just because he feels lousy, breast milk has been his comfort source of choice.

It’s at a time like this that I’m most grateful that I still have breast feeding to fall back on. For now, no matter how many disparaging comments I get, we’ll be carrying on. Because the boy clearly isn’t ready to stop, and I’m not willing to give up the most useful tool in my parenting box.

A Blog Comment is Not Enough to Respond to Kirstie Allsopp

I ventured back on to Twitter for the first time in over a year last week. That very morning happened to be the morning that Kirstie Allsopp vented her spleen at the NCT via Twitter. Since it seems that I follow Kirstie, I happened to catch it. I was a bit indifferent, to be honest. I could see where she was coming from to a degree, but it wasn’t something I felt strongly enough about either way to get involved.

Back on Twitter last night, I followed a link to a blog post which she made as a follow up: 140 is not enough for the NCT. If you haven’t read it, the general gist is that the NCT cause women to feel guilty if they fail to deliver their babies via a natural, drug free labour, or fail to breastfeed, because of their pro-natural stance and their focus on natural birth in their antenatal classes. The NCT is allegedly responsible for a widespread feeling of inadequacy amongst new mums.

And suddenly I was drawn in. To the point that I actually left a comment.

The problem is that my comment, despite being on the first page, is now lost amongst so many others. So I wanted to get this down here as well, because I really believe in what I wrote (and was heartened to see a couple people specifically agree with me).

I still agree with Kirstie, up to a point. She’s absolutely right that in an ideal world, women shouldn’t be left feeling guilty about their birth experiences, or feeding choices. She’s also right that the NCT are potentially in a position to spearhead the sort of changes women in this country need to see.

But she’s fundamentally missing the point about what those changes are and why they are needed. It is bordering on naive to assume that it’s simple to stop women feeling guilty about anything to do with parenthood, when it’s a cornerstone of the experience. And I think she is wrong to place blame so directly at the door of the NCT, apparently crediting them with some sort of power or influence over women that I simply don’t believe they have.

The fact of the matter is that women do feel guilty and disempowered by the experiences they have during labour birth. But this isn’t, cannot be, due solely to what one parenting organisation allegedly teaches in its popular antenatal classes. In fact, I find the assumption that women are incapable of making up our own minds about what sort of birth experience we would prefer, and that we have no expectations at all about birth until we step in to our NCT classes at 30+ weeks of pregnancy ridiculous at best, and patronising at worst.

In reality, women feel guilty when the reality does not meet their expectations. But there are multiple influences on women which shape their expectations. The media, books, friends and family experience, cultural expectations and just plain personal preference. Not what they are told from a single source. Most women have far more intelligence than that. And most women are also their own harshest critics.

I’m a case in point. If you’ve read any of the archives, you’ll know that I desperately did not want a caesarean for lots of complex reasons. But almost as strongly, I simply wanted, still want, to give birth vaginally. I find it difficult to articulate exactly why I feel this way, and this post is not really the place. But from a discussion I started on a popular parenting forum last year, I know that I’m not alone in feeling this way.

I was destined to feel disappointed in myself if I failed to achieve a vaginal birth. I was well prepared for a caesarean by – you guessed it – my NCT classes. I knew all about the practicalities of the surgery and what would happen before, during and after. But no parenting class could have dealt with complex emotions and prevented the feelings I was left with. Even if the NCT had told me that caesareans were actually the very best thing and we all should be having them, I’d still have felt the same way. I felt as though my body failed me – for not the first time in my life – because it failed to act in the “physiologically normal” way, and the way I wanted it to. At then end of it all, my son was born, but I did not give birth. I didn’t resent the medical intervention per-se, I just hated the fact that it was necessary. I feel sad because my reality was very far removed from my ideal birth experience – an ideal that was formed in my head long before I even fell pregnant, let alone signed up to NCT classes.

I have been fortunate to be able to breast feed Thomas, but given how important that was to me, I’d have been similarly devastated had breast feeding not worked out. But my feelings of failure and fear would have been related to my own concerns about the potential risks of cow’s milk based formula and autoimmunity – bugger all to do with whether an antenatal teacher, midwife or health visitor had simply told me that “breast is best”. I’d have felt awful because my belief was that for us breastfeeding was indeed best. The mismatch between reality and desire would have have been hugely difficult to overcome.

Obviously it is impossible to ignore the very many comments that Kirstie has received from women who claim to have been negatively affected by their NCT experiences. The NCT has a responsibility to provide accurate information in a balanced and non-judgemental way. Clearly there is room for improvement if women are genuinely being excluded from post-natal reunions because they had a caesarean or epidural (for the record, that would have left a post natal reunion of one in our group – and even the one had a ventouse!). However what we cannot know is exactly how those women would have felt had they never been involved with the NCT. I strongly suspect that self-imposed expectations would lead to the majority of these women still feeling exactly the same emotions regardless.

So the question becomes, who is there to pick up the pieces? And the answer, all too often, is no one. It was certainly a battle for me to get follow up and support to deal with my birth experience. Other women I know who had traumatic experiences have still not been able to get any follow up support to help them deal with this. Antenatal classes cannot cover every possible outcome before the event, but tailored, individualised follow up support could, and should, be available.

It may be true that the most important outcome is a healthy mother and a healthy baby, but to tell a traumatised new mum that she should simply “be grateful” for those things is an enormous insult. It implies that she isn’t. But being delighted with your new baby and regretful about what you experienced to get there are two separate things. One doesn’t cancel the other out, and women deserve proper support and help to cope.

This is the issue that Kirstie is missing: The almost universal lack of post natal support for all women. Not just women who attend NCT classes. Not just women who have caesareans. Or those who can’t breastfeed. But every woman who becomes a mother. Every woman who wants it deserves access to proper post-natal support to help them deal with the unique experience they have had and the challenges they are facing in the early weeks.

We are facing an epidemic of women feeling traumatised, guilty and inadequate about many aspects of parenthood. Rather than pointing fingers of blame, rather than attacking the NCT for what they are, or are not, doing in their antenatal classes – which in reality affects only a small minority of new mothers – let’s start looking for proper solutions to benefit ALL women.

No More Morning Milk?

Today, the first day of the new year, we decided to really try to implement a change that we’ve been debating for a few days but failing to actually do. This morning when Thomas woke up, Ian went in to him and took him straight downstairs where he offered him a sippy cup of cow’s milk. No coming in to our bed. And definitely no boobies, for pretty much the first time in his life.

Why the change?

Honestly, I think we’re ready to wean. And by “we”, I mean all of us. I’ve loved breast feeding, and it’s always been important to me, but I no longer have strong feelings about stopping and nor do I have strong feelings about carrying on. Ian is ready to support us whatever we choose. And Thomas – Thomas is the one showing the most signs of being ready for this change. Doing this is the only way to find out for sure.

I personally think that “self-weaning” doesn’t necessarily need to mean completely stopping feeding without prompting. I think there can be signs that a child is ready to stop and that they may need help fully acting on that. Thomas feeds from me in the mornings because he has the opportunity. I sleep with my top-half naked. We bring him in to bed when he wakes in the morning. Boobies is what he knows, so he goes for it. I went down the route of “don’t offer, don’t refuse” in the daytime a while ago, but I’ve only recently realised that I obviously am offering in the mornings with this set up. But I don’t think he’s actually that bothered. He bobs on and off, distracted by what is on our bedside tables, by books and by the baby monitor. I have no idea how much milk he actually gets.

And I’m certainly not enjoying it. He invariably head-butts me several times during his exuberant bed bouncing – two days ago he made my lip bleed. He frequently pulls off stretching my nipple back spaghetti stylie… Which hurts! If I thought he was enjoying it too, then I’d go on, but I don’t want to keep doing something I’m starting to hate if he isn’t fussed.

Had we got him up this morning and he screamed blue murder at being offered cow juice from a plastic sippy cup and then proceeded to claw at my clothes the minute I was in range, I would have capitulated in an instant. Of course I would.

But it didn’t happen.

He drank about a quarter of the cup before Ian brought him back upstairs to change his nappy. I’ll shamefully admit I’d dozed back off to sleep, but I got up at this point and dressed myself so there was absolutely no easy boob access – so they weren’t on obvious offer. By the time I got downstairs, Thomas was in the middle of the living room floor in his monster pyjamas, dancing to a musical toy. Over the course of the next 20 minutes, he drank most of the remaining milk in the cup and didn’t once paw at me or ask for milk in any other non-verbal way.

He ate his breakfast a bit earlier than normal, but ate the same quantity of Weetabix and toast as usual. It’s now just past lunchtime and he hasn’t yet asked for my boobs at all.

The new morning view
The new morning view

I think we can call that success. And I’m wearing a non-nursing bra during a “normal day”. Since he was born, I can count the number of times I’ve worn a non-nursing bra on the fingers of one hand – only when I’ve been dressing up to go out and my nursing bras wouldn’t work. Underwires feel odd these days. But in a good way.

We are ready to begin the end. I won’t be stopping the evening feed straight away. I think that would be too unfair on Thomas – too sudden. And selfishly I don’t want to be dealing with engorgement or mastitis. We’ll see how the new morning routine goes once he’s back at nursery and we’re back at work. It’s not a one way street, because I am being led by him. But it feels right, and it feels good.

Thrush

The day after I wrote my last breastfeeding post, Thomas and I had our six week post-natal check. Everything was fine. My wound has healed really well, and I’m about average on the new parent stress scale. Thomas is gaining weight fine and passed all his checks with flying colours. Our GP even commented on how strong he is, and as if to confirm it, Thomas lifted his head and turned to look!

What did come out of the appointment though was a diagnosis of breast thrush. My GP seemed pretty certain that this was the culprit for the escalating post feeding breast pain I was struggling with. Since Christmas was approaching me, he wanted to give us both a prescription, even if I then decided I wanted to hold off treatment, at least we would have the option. Having researched it as thoroughly as time allows, there are no real adverse risks associated with the treatment, so we opted to give it a go. I needed to wait until the following day for enough fluconazole to come in to stock at our local pharmacy, but I’ve now completed a week’s worth of treatment. In addition to thrice daily fluconazole, I’ve been applying Daktarin cream to my nipples, and Daktarin oral gel in Thomas’s mouth.

They say the proof is in the pudding. I’m now convinced that thrush was the issue, because without changing anything else our breast feeding relationship has suddenly transformed. No more pain during, or especially after, feeding I no longer feel the need to sit around naked as often as possible, or squeeze my breasts to the point of deformity to ease the discomfort.

And it’s magic.

Finally, finally, I feel like we’ve got this whole feeding thing down. Finally, I’m starting to actually enjoy it.