Tuesday, May 28, 2013

Triumphant Tuesday: How I Defeated My Meddling Inlaws

Failing at breastfeeding can often turn usually compassionate and courteous family members into bitter, green-eyed saboteurs. When a headstrong member of the group ruptures the status quo by successfully breastfeeding, the rest of the kin can close ranks on her. Her success makes them look bad.

This is the story of Marcia, a South African currently residing with her husband and their two children in France. Thousands of miles away from her native country and her own supportive family, Marcia faced an array breastfeeding hurdles which she overcame under the watchful resentment of her in-laws:


Marcia.
I am a South African currently residing with my husband and our 2 children in France. I’m the mother of 2 beautiful children: a boy of 4 years and a girl of 18 months old.

My Wise Mother

Although my mother breastfed all her children, which added up to 8 years of her life in total, it never occurred to me as something I would do.  I did not want to end up looking like her with a child stuck to my breast for the rest of my life!  It was only when I got pregnant with my son and started researching that I realized breastfeeding was something I was going to do.  The line “Breast is best” stuck on me and because I wanted the absolute best for my baby, my mind was made up.  I was going to do it and that was it!


Before the birth of my son my mother gave me a crash course in breastfeeding.  She said no matter what you are being told, for example: “Your supply is low, your milk is pale, your baby seems sickly/ constantly hungry/ underweight”, NONE of these are true!  You just keep on feeding.  So I thought of Dori from Finding Nemo and instead of singing “Just keep swimming” I replaced it with “Just keep feeding.  Just keep feeding.”

… and so I did


  • In NICU (my son spend his first 2 nights there after struggling to regulate his body temperature because he was born prematurely at 35 weeks); 
  • Whilst recovering from a c-section;
  • Through mastitis;
  • Through growth spurts (where I was feeding every 2nd hour round the clock);
  • In numerous foreign countries;
  • On airplanes, in the family bed, in the bath, while studying, while asleep;
  • Thousands of miles from home in a country where nobody spoke the same language as me, which meant no medical professionals to turn to;
  • With no friends or family close by to take over when I felt tired, down or just wanted a break;
  • Alone when my husband would be out of town (he is a professional rugby player and being a rugby widow is nothing new to me).


"My daughter's birth".
One particular hurdle has undoubtedly strengthened my resolve in breastfeeding perhaps more than any other: discovering that I have unsupportive, uninformed and jealous in-laws. 

My in-laws loved getting into a breastfeeding debate with me. However the more they tried to put me off, the stronger I felt about nursing. I certainly became a breastfeeding advocate with time.

Excuses, Excuses...

I have researched the excuses they come up with for not breastfeeding but can't find the answers. One said she had really bad inverted nipples. The nipples shields did not even help so she pumped for the first 6 weeks after the birth of her baby but then eventually gave up because of mastitis. With her second child she said she could not breastfeed even if she wanted to (needless to say she did not even attempt it that time) because the baby had reflux and some twist in her intestines, which meant she could not keep the milk down. She ended up giving her baby thickened formula. 


My mother in law is the worst of all. She likes claiming that it’s easier to breastfeed for someone who is small chested than someone with big breasts. This is now her excuse for her 2 daughters giving it up so soon. I keep telling her that all the women in my family (my mother, aunt and grandmother) have huge boobs and they all managed feeding for a long time... and a lot of African black women are big chested as this runs in their genes. She says although the anatomy of breasts are all the same, small boobs ‘handle easier.’ As I type it here I just realize again what I lame excuse it is!

I pushed through despite them and breastfed my two children for 15 months and 12 months respectively.  I feel so proud about this.  Neither of them have ever had any of the common childhood illnesses like bronchitis, tonsillitis, middle ear infection or gastritis. They are confident and popular.  They achieve their milestones before the others and they are part of a happy loving home.


"My son feeding".
My view on breastfeeding is that it is something flexible and convenient. You can do it even though you have never been pregnant (so even adopting mothers can do it), through times of hardship, war, hunger, sickness etc.  You can do it even if you have to go back to work.  You can do it with triplets, with implants, being pregnant, small chested, big chested etc.  You don’t have to constantly stress about what you are eating or be under the impression you can’t have a glass of wine.  These are all old wife tales proven to be untrue.  You can breastfeed no matter who you are and you should!  The benefits are endless! 


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Tuesday, May 21, 2013

Triumphant Tuesday: When Pacifiers and Nipple Shields Are Friends in Disguise

Pacifiers and nipple shields have a bad rap, and rightly so. However if used sparingly, and no earlier than 4 weeks, they can act as transitory crutches, enabling mothers to breastfeed for longer. In fact, if a mother is set on using interventions, then pacifiers and nipple shields are more compatible with breastfeeding than formula top ups.

This week’s triumphant mom found breastfeeding to be a turbulent journey. When a bad latch led to severe nipple damage, she hesitantly introduced a pacifier and nipple shield to provide temporary respite from the pain.



My pregnancy was problem-free.  I travelled, I studied, I worked, I rested as I needed and took a pregnancy multi-vitamin.  My due date according to last menstruation (and a clockwork 28 day cycle) was February 9th.  The 12 week ultrasound said 14th February.  I did not put on any weight during my pregnancy (which given my high BMI, was never an issue) and I ‘passed’ all the tests with flying colours.  My blood pressure was never an issue, the blood glucose test came back normal, and my baby was growing normally.  I felt great and was looking forward to meeting my baby.

My due date arrived, February 9th.  I woke at my usual time in the morning, feeling ‘off’.  I suggested to my husband that he may need to be available.  He decided to go to work and tie up loose ends, then come home.  By morning tea time, I was thinking it was labour (my plug was lost, and my off feeling was now a pulling down feeling coming in waves).  I swivelled on the big ball, walked up and down the hall, and by 11am decided it was labour.


The Birth

My husband was instructed to waste no time and head home.  He was home by 12, and made lunch.  As he ate, he timed my contractions.  They were steady, 5 minutes apart and lasting 1 minute.  So by 2pm, we were at the hospital.  About 4pm, I was feeling restless and ‘over it’ (transition), and got into the bath.  By 5pm, I had birthed my baby into the water.

Emergency: Whisked to Another Hospital

A few minutes after my baby was born, the gorgeous and peaceful birth became a panic.  The midwife discovered that the unclamped cord had come away from the placenta (we later learned it had been a velamentous cord insertion).  My baby was small (2.6kg) and pale.  It was assumed there had been blood loss and with baby being small, it wouldn’t take much to cause a drama.  So we were transferred to the NICU at a different hospital (my placenta was hurriedly removed so that I could follow the ambulance).

At 7pm we were at the NICU.  Here it was determined that my baby was fine, just small, and a glucose drip was given as a precaution.  The nurse said that if my baby breastfed overnight, we would be fine to go home the next day.  I was placed on the ward, and was to be called up to the NICU when needed.

Two hours after birth, my baby was given to me for the first breastfeed.  I had been waiting for this moment for what felt like a lifetime.  Baby latched without effort, and fed for as long as needed.  I was called up over night, and repeated the process. But this successful pattern of feeding was not to last.

Hospital Negligence

Unfortunately, a misguided NICU nurse turned up the glucose drip.  This meant my baby did not ask for a feed.  Consequently 6 hrs passed between baby’s last feed (and subsequent increase in the drip) and my waking up realising.  At 8am, we tried to feed, without luck; the nurse poked and squeezed me, sighed and made me feel terrible.  This was not what was meant to happen.

When the registrar arrived at 10am he was furious that the drip was up, and said that we would have to stay as the drip needed to be dropped down slowly, breastfeeding would increase and we could then go.  By 5pm that night, this process was complete, and we were both put on the ward for another night of observation.


My husband over-nighted with us on the ward.  Finally we were together as a family.  I fed my baby on demand, for as long as it took, and dutifully recorded wet and dirty diapers.   We were released about 10 am the next day (36 hrs post birth).

The next 6 weeks were the most difficult in my life.  Breastfeeding was the greatest challenge.
My baby seemed to be a slow feeder.  Each feed took an hour (sometimes more).  And baby fed every 2 hours.  My mother had breastfed twins, so if she could do it, I could manage one!  She told me that she had focused on breastfeeding, that she made herself comfortable and just fed.  She read while she fed, so that is what I did.

Nipple Damage

One night, in my tired state, I attempted to lay down and feed.  I had seen a friend do it.  It seemed straightforward.  But I got a bad latch which I ignored.  The damage led not just to grazes, but to chunks out of my nipples.  The pain would shoot down my back as my baby fed (toe curling, tear inducing pain).  It got to the point where I would dread each feed.  The anticipation of the feed was enough to make me cry.


As the weeks went by, my baby thrived, was putting on weight, growing nicely, was alert and reasonably happy.  But breastfeeding was not a joy.  Something was not right - maybe it was the latch, maybe it was just that the damage wasn’t healing...I didn’t know.

Introducing a Pacifier

At 4 weeks old, I introduced a pacifier.  I had never wanted to use a pacifier, was aware of nipple confusion and did not wish my baby to become dependent on it.  But all baby did was suck, suck, suck!  The pacifier seemed to help.  Yet still the damage to my nipples was not healing and I was at a loss.  I had gone through two tubes of Lansinoh.

Introducing a Nipple Shield

As we approached 6 weeks, I rang the Australian Breastfeeding Association helpline.  I don’t know if it helped or not, maybe it did.  But against advice - I got nipple shields.  The first pair I got were too small (I had mistakenly chosen based on my baby’s mouth, not my nipples).  So I got a second pair.  I used the shields at every feed for 3 days.  I even managed to feed in public (under a muslin wrap so I could attach the shield without exposing myself).  On the 3rd night I woke to feed, and latched baby on.  We fed painlessly.  It was a joy.  This is what breastfeeding was supposed to feel like.  Then I realised, I had forgotten the shield.  I was breastfeeding without the shield!


From that moment on, we never looked back.  I breastfeed my baby for four years. I breastfed through pregnancy, and tandem fed for 2 years.  I am now a doula.

I know my success came down to self -determination.  In my mind, there was no alternative.  Breastfeeding would work.  There was no reason for it not to.”




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Monday, May 20, 2013

Our Masculine Culture Harms Breastfeeding

Whilst indulging my inner bookworm at the local city library, I unwittingly stumbled upon a book written by a man called Geert Hofstede. Hofstede is an influential Dutch researcher well-known (in the social-psychology clique at least) for his research of cross-cultural groups and organizations. He played a major role in developing a framework for assessing and differentiating national cultures. Reading his jaw-dropping, hugely under-utilised trove of research has radically deepened my understanding of why we suck at breastfeeding in our society. It triggered an epiphany of sorts. And his book wasn’t even about breastfeeding!

I have always known that our culture is hostile towards breastfeeding at worst, and apathetic at best. Who’s to blame for this? I had all the usual suspects lined up: capitalism, the patriarchy, rampant individualism, formula company greed. However maybe the net of blame is far, far broader than I ever imagined.

Hofstede’s research revealed an interesting phenomenon: each country has a gender. A country’s culture is either predominantly masculine or predominantly feminine. The United States, for example, is deemed a ‘masculine’ country whereas Norway, for example, is a 'feminine' country.

Hofstede describes culture as “the collective programming of the mind which distinguishes the members of one group from another”. Whether a country is masculine or feminine describes the effects of that country's culture on the values of its members, and how these values relate to behaviour.

Take a gander at this fairly inconspicuous-looking table. It shows a selection of countries and their respective masculinity ratings. Study it, worship it:


Notice that gender is rated on a scale of 1 to 100 with 1 being most feminine and 100 being most masculine. So the most feminine country is Sweden (with a rating of 5) and the most masculine country is Japan (rating of 95). No country is 100% masculine or feminine, rather most sway largely towards one gender.

The book that started it all.
Hofstede called this the ‘masculinity/femininity index’. It established a major research tradition in cross-cultural psychology and has also been drawn upon by researchers and consultants in many fields relating to international business and communication.

Okay, but what does this have to do with breastfeeding?

One important point that anthropologists have always made is that aspects of social life which do not seem to be related to each other, actually are related. Inspired by this belief, I cross-referenced Hofstede’s index with numerous breastfeeding studies and discovered some astonishing correlations! In a nutshell:

The masculinity/femininity of a society reflects a basic and enduring anthropological fact about that society’s approach to breastfeeding.

From my research into the gender of countries and how this impacts upon breastfeeding, five significant topics arose: Values, Family Life, Politics, The Media, and Women’s Liberation.

VALUES:


Masculine societies differ from feminine societies in their relative priority given to 'ego' versus social goals. So in a masculine society men are supposed to be assertive, tough, and focused on material success; women are supposed to be more modest, tender, and concerned with the quality of life. Conversely, in a feminine society, both men and women are supposed to be modest, tender and concerned with the quality of life. Interestingly, Hofstede found that whilst American females score as more feminine than American males, they also score as more masculine than Dutch males. This illustrates how in masculine societies, male-ness is the normative standard, coveted by both men and women.

Prenatal education in a masculine country.
The distinction between masculine and feminine societies is even found at the basic level of how a country’s inhabitants communicate with one another. In masculine countries there is a predominance of ‘report talk’ – transferring factual information – versus ‘rapport talk’ in feminine countries – using conversation to exchange feelings and establish relationships. In the field of breastfeeding, we see these respective conversational styles reflected in the way health professionals and other breastfeeding advocates counsel mothers. In masculine countries breastfeeding support relies heavily on the presentation of ‘facts’ (the benefits of breastfeeding, how breast tissue functions, the mechanics of latching, etc), whereas in feminine countries there is emphasis not only on physiological detail but also on the psychological and social realities of breastfeeding. For instance, in the most feminine country in the world – Sweden, there is a widespread network of lay groups who provide breastfeeding support and a system of more experienced mothers who volunteer to be available to provide telephone support for new mothers (Sharples 2001). Also in addition to antenatal classes, all Swedish parents (both mothers and fathers) are encouraged to attend discussion groups and other ‘parent craft’ gatherings throughout their child’s early years (Larson 2008).

Feminine societies prefer to concentrate on strengthening relationships like this, and consequently, there is a lot less emphasis on 'stuff' (aka baby products) and a lot more emphasis on time spent with the baby. Meanwhile in a masculine society, the dominant values are money, material stuff and progress. These ethnocentric values have important implications for breastfeeding. The act of breastfeeding is intertwined with relationship maintenance and altruism. It is as far removed from materialism as one can get - there is no consumption involved, no cash payoff. Thus the mechanics of breastfeeding are in direct conflict with the values of masculine societies, whilst harmonising with the values of feminine societies. We see this reflected in the day to day child-rearing rituals of the respective cultures:

In feminine societies, it is assumed that mothers will want to breastfeed. There are few baby bottle decorations or baby bottle designs on shower invitations. Co-sleeping is common. Newborns aren’t swaddled and skin to skin is established practice. Babies are fed, not on schedule, but when they want. Infant formula is used only as an exception to the rule. Is it any surprise then, that Sweden is considered the global leader in terms in implementing the Unicef Baby Friendly Initiative: an international program for improving the role of maternity services to enable mothers to breastfeed. Four years after the programme was introduced in 1993, all of the then 65 maternity centres in Sweden had been designated "baby-friendly".

And it's not just babies that benefit from living in a feminine society; when Save The Children published a report revealing the best and worst places to be a mother in 2013, the top 7 countries were all highly feminine on the Hofstede scale (Finland, Sweden, Norway, Iceland, Netherlands, Denmark and Spain respectively). In case you’re curious, the report assessed maternal well-being based on five factors: Maternal health; Under five mortality rate; Women's education; Women's income; Women's political status (Save The Children 2013).

But wait, perhaps you're thinking Japan is the most masculine society yet don't Japanese women maintain a very close bond with their children much later than other Western parents, and don't Japanese children typically cosleep much later? There is a common misconception that these factors automatically translate into robust breastfeeding rates, but sadly this is not the case. While the majority of Japanese mothers recognize some benefits of breastfeeding, their overall knowledge and attitudes towards breastfeeding are neutral at best and more positive towards the use of infant formula (Inoue et al 2013). Indeed, the overwhelming masculinity of Japan bears down, crushing breastfeeding rates. Japan is ranked far down on the Save the Children score chart at 31st for maternal well-being behind other masculine countries like the US and the UK, and unsurprisingly, Japan has even worse breastfeeding rates than those countries (ABC News 2007).

In feminine countries, families are
nurtured by the welfare state.
So what makes the United States' and Japan's treatment of mothers and babies pale in comparison to the Netherlands? One of the obvious differences between these countries is the latter’s welfare system. Americans consider the Dutch tax system – which makes the Dutch welfare system possible – as almost criminal. It effectively robs the Dutch of the opportunity to fulfil the goal of becoming rich. That Dutch people have a different set of values, expressed in a willingness to pay higher taxes to maintain a welfare state, is hard for many Americans to understand. Yet caring for other people is one of the dominant values in feminine societies such as the Netherlands. Which brings us to...

FAMILY LIFE:

Feminine societies encourage both men and women to be tender and to be concerned with family relationships. Conversely, masculine societies expect only women to show these attributes. Perhaps unsurprisingly then, parenthood is more positively valued in feminine than in masculine cultures, and the well-being of children plays a more important role in parents’ ways of arranging their lives.

For example, when given the choice between higher salaries versus shorter working hours, both men and women from masculine countries preferred higher salaries. We can see how this would affect breastfeeding rates: the more hours a mother spends working, the less direct contact she has with her child to maintain supply. Similarly, the more hours a father spends working, the less direct contact he has with his family in order to support the breastfeeding relationship. In masculine societies many mothers are slaves to the office breastpump. Whereas for mothers in feminine countries, pumping is rare due to generous parental leave facilitated by a culture which prioritises family well-being.

In masculine societies the dominant ethos is that you ‘live in order to work’. In feminine societies you ‘work in order to live’. In the workplace of a feminine society, equality, solidarity, and quality of work life are stressed. Meanwhile in the workplace of a masculine society, equity, mutual competition and performance are stressed. When people feel pressured to perform and compete, they are compelled by their society to prioritise career over family life.

Whilst both men and women in masculine societies are expected to be competitive in the workplace, the same cannot be said for home life. Domestic and caring responsibilities are, on average, significantly less equally distributed in masculine societies. For instance, masculine societies are apt to downplay or neglect fathers’ roles in the facilitation of breastfeeding.  Numerous studies have highlighted the reluctance of masculine societies such as the United States, the UK and Australia to recognise the father’s role in breastfeeding support (Tohotoa et al 2009; Rempel and Rempel 2010; Sherriff et al 2011; Vaaler et al 2011; Maycock et al 2013; Allcutt 2013). The existence, or absence, of paternal support can often ‘make or break’ the success of the breastfeeding relationship.

In masculine countries ‘Family Values’ are a reference to religion and tradition. In feminine countries on the other hand, Family Values mean time with your family. With long working hours and minimal parental leave as staples of masculine society it should come as no surprise that feminine societies are much more child-centered. The freedom, care and ability to 'just be a kid' is an essential part of childhood in feminine countries. This is complemented by access to quality health care without the stress of worrying about being hit by strange bills, quality daycare, schools, and University education. In Hofstede's words: “Masculine societies have sympathy for the strong, whereas feminine societies have sympathy for the weak.”

Feminine countries protect the weak.
In feminine countries, babies are allowed to develop at their own pace; to attempt to ‘discipline’ them in matters that they cannot understand is considered a mark of parental ignorance. In fact, in 1979, the Swedish parliament passed a law forbidding corporal punishment, making Sweden the first nation in which parents were forbidden to strike their children. The law is widely known and accepted.

However in masculine countries a degree of ‘baby training’ is the norm, with sleep and feeding schedules commonly advocated by experts.  In the US for example, the belief that children - even newborns - are manipulative of their parents is quite common. Mothers must resist "giving in" to their babies' (unreasonable) "demands" for fear of spoiling them. Babies cannot be trusted to know and communicate their fundamental physiological, psychological, and developmental needs (La Leche League 2000). Beliefs such as these interfere with breastfeeding by discouraging mothers from picking up their babies and breastfeeding them whenever they root or cry. In masculine countries bottles are introduced to infants so that others can feed, pushing babies towards premature independence and facilitating the separation of mother and child. Pacifiers are also introduced so the child will not depend on mother for all his suckling needs, which in turn diminishes breastmilk supply.


THE MEDIA:


A characteristic of feminine culture is scepticism and dislike of ‘hype’. Advertising in general is exaggerative by nature, which arouses scepticism in the consumers of feminine countries. This cultural trait makes the inhabitants of feminine countries less receptive to marketing, and this is good news for breastfeeding. In fact, in Scandinavia (Denmark, Sweden and Finland - all feminine countries) follow-on milk promotion is banned. In Norway (the second most feminine country in the world) all advertising of artificial formula milk is banned completely.

In line with this scepticism, sex and violence in the media are taboo in feminine societies, whereas these acts frequently appear in the media of masculine societies. In the UK, recent campaigns have highlighted the prevalence of such media and its negative impact on breastfeeding rates (see: Ashton 2013).

Over in feminine societies, breasts are everywhere, but often in non-sexual ways. Breastfeeding in public is the norm. In fact, a mother using a hooter-hider American-style would be considered bizarre in Sweden.

Considered "gross" in masculine countries.
In masculine countries, the sight of a baby latched at its mother's breast is cause for outrage. For instance in 2006, the editors of US BabyTalk magazine received many complaints from readers after the cover of the August issue depicted a baby nursing at a bare breast. Even though the model's nipple was not shown, readers—many of them mothers—wrote that the image was "gross". In a follow-up poll, one-quarter of 4,000 readers who responded thought the cover was negative (NBC News 2006). In a 2004 survey conducted by the American Dietetic Association, only 43% of the 3,719 respondents believed women ought to have the right to breastfeed in public.

Meanwhile in 2010 in the UK, another highly masculine country, the deputy editor of leading parenting magazine Mother & Baby described breastfeeding as "creepy." Kathryn Blundell told readers that she bottlefed her child from birth because, "I wanted my body back [and] to give my boobs at least a chance to stay on my chest rather than dangling around my stomach."

Then of course, there’s the ethnocentric dictator we call Facebook. The US online social networking site described photos of breastfeeding (baby latched on, no nipple visible) as ‘indecent’ and promptly deleted them from the site while cancelling the Facebook accounts of the mothers in question. The company said it removed the photos because they violated the 'pornographic' rules in the company's terms and conditions (Moses 2007).


POLITICS:


In politics, feminine societies believe that preservation of the environment should have the highest priority, whereas masculine societies believe highest priority should go to economic growth. We see this played out in relation to formula trading. Formula consumption contributes to economic growth (in the form of generating wealth for the few) whilst causing environmental decay. Correlatively formula companies’ hold dominance in the market of masculine societies. In Mexico for example (masculine country with a ranking of 69) the government currently pays about $35 million a year on cans of infant formula from Nestle, which receives more than 96 percent of the public money spent on formula (Fox News 2013). Whereas the presence of formula companies in the markets of feminine societies is slim to none. In fact, the supermarkets in feminine countries offer limited stock because demand is so low.

Masculine societies value consumption and the production of goods, and the formula trade complements this paradigm nicely; whereas, breastfeeding reduces consumption and does not produce any goods. Conversely, the lesser importance placed on economic growth by feminine societies, along with their higher value placed on environmental preservation makes feminine societies a perfect fit for breastfeeding.

It is interesting to note that despite the converse priorities given to economic growth by masculine and feminine societies, the gender of a country is entirely unrelated to national wealth: there are just as many poor as there are wealthy masculine, or feminine, countries. Differing priorities do not necessarily produce disparities in wealth.


WOMEN’S LIBERATION:


When it comes to the stormy issue of ‘women’s liberation’ both feminine and masculine societies have their own idea of what it means. Feminine societies interpret women’s liberation as meaning that men and women should take equal shares both at home and at work. Masculine societies think differently. They translate women’s liberation to mean permitting women to enter positions hitherto occupied by men.

Exploiting this cultural mannerism, formula companies in masculine countries market their products as enabling the independence of mothers. Competing with men is what women’s liberation looks like through a masculine lens. Whereas in feminine countries, a ‘complementary’ approach to liberation stresses the interdependence between male and female roles.

We see this reflected in the amount of paid and unpaid parental leave for mothers and fathers sanctioned in each society. For instance, in feminine societies, employers now expect their employees to take parental leave no matter their gender.

Sweden (the most femineine country with a Hofstede rating of 5) provides working parents with an entitlement of 16 months paid leave per child at 80 percent pay, the cost being shared between employer and the state (Sternheimer  2010). To encourage dads to take a greater paternal involvement in child-rearing, 2 months out of the 16 is reserved for the "minority" parent, in practice usually the father, and some Swedish political parties on the political left are pushing for legislation to oblige families to divide the 16 months equally between both parents (forsakringskassan 2013). 80% of fathers now take a third of the total 13 months (Bennhold 2010). This is in line with the characteristic of feminine societies encouraging both men and women to be tender and to be concerned with relationships. Norway, another highly feminine country (rating 8), has similarly generous leave (Norwegian Embassy 2013).

How about feminine countries with slightly more masculine leanings? (Say, those with a 30-40 rating on the Hofstede scale). In Estonia (30 rating) mothers are entitled to 18 months of paid leave. Fathers are entitled to paid leave starting from the third month after birth (paid leave is however available to only one parent at a time). In Bulgaria (40 rating) a father can take the whole of a mother’s maternity leave and receive 100 percent salary for a full year. Interestingly Portugal (rating of 35) is the only country in the world to have mandatory paternity leave (albeit only a week in length).

In comparison, how do more strongly masculine countries operate their parental leave? Hofstede considers any country with a rating over 60 to be strongly masculine. In the UK (rating of 66), female employees are entitled to 52 weeks of partly-paid maternity (or adoption) leave, whilst fathers are only entitled to 2 weeks partly-paid paternity leave. This discrepancy between maternity and paternity leave is in line with the characteristic of masculine societies believing that predominantly only women should be tender and to be concerned with relationships. We see the same discrepancy in other masculine countries. Lebanon (rating of 65), gives mothers 7 weeks of maternity leave at full pay, whilst giving fathers only one measly day at full pay. The Philippines (rating of 64) gives mothers 60 days of leave at full pay (78 days for c-section deliveries) whilst fathers only get 7 days leave at full pay and interestingly, the father must be married to get this!

Canada is a more androgynous country with a slight masculine leaning (rating of 52). In addition to 15 weeks maternity leave, parents in Canada get 35 weeks leave which can be divided between both mother and father in any way they like.

How does this relate to breastfeeding? You’ll not be surprised to read that mothers returning to work in the first 6 weeks are less likely to breastfeed, and if they do, the period of breastfeeding is significantly shorter than other groups who returned to work between 7 to 52 weeks (Tanaka 2005). In general, the longer the parental leave, the longer the rate of breastfeeding (Berger et al 2002). This is not only true of maternity leave but also true of paternity leave. Fathers’ presence facilitates breastfeeding success (Tohotoa et al 2009Rempel and Rempel 2010Sherriff et al 2011Vaaler et al 2011Maycock et al 2013Allcutt 2013).


So, how does your country measure up?

To see how the masculinity/femininity of a country measures up to its breastfeeding prowess, let’s look at the raw data from four countries: the UK, the US, Sweden and Norway:

United Kingdom:


At 66 on the Hofstede scale Britain is a masculine society – highly success oriented and driven. Hofstede comments:

“A key point of confusion for the foreigner lies in the apparent contradiction between the British culture of modesty and understatement which is at odds with the underlying success driven value system in the culture. Critical to understanding the British is being able to 'read between the lines'. What is said is not always what is meant. In comparison to feminine cultures such as the Scandinavian countries, people in the UK live in order to work and have a clear performance ambition.”

Breastfeeding stats: At three months, the number of mothers breastfeeding exclusively in the UK is 17% and at four months, it is 12%. Exclusive breastfeeding at six months remains at a depressing 1%. (Unicef 2010).


United States:


The United States score 62 on the Hofstede scale and is considered a “masculine” society.  Hofstede comments:

“In America behaviour in school, work, and play are based on the shared values that people should “strive to be the best they can be” and that “the winner takes all”. As a result, Americans will tend to display and talk freely about their “successes” and achievements in life, here again, another basis for hiring and promotion decisions in the workplace. Typically, Americans “live to work” so that they can earn monetary rewards and attain higher status based on how good one can be.  Conflicts are resolved at the individual level and the goal is to win.”

Breastfeeding rates: At three months, the number of mothers breastfeeding exclusively in the US is 46.2% and by six months the number drops to 25.5%. The number of US babies receiving any breastmilk at 1 year stands at 34.1% (US Centers for Disease Control and Prevention 2012).


Sweden:


Sweden scores 5 on the Hofstede scale and is therefore a feminine society. Hofstede comments:

“In feminine countries it is important to keep the life/work balance and you make sure that all are included. An effective manager is supportive to his/her people, and decision making is achieved through involvement. Managers strive for consensus and people value equality, solidarity and quality in their working lives. Conflicts are resolved by compromise and negotiation and Swedes are known for their long discussions until consensus has been reached. Incentives such as free time and flexible work hours and place are favoured. The whole culture is based around 'lagom', which means something like not too much, not too little, not too noticeable, everything in moderation. Lagom ensures that everybody has enough and nobody goes without. Lagom is enforced in society by “Jante Law” which should keep people “in place” at all times. It is a fictional law and a Scandinavian concept which counsels people not to boast or try to lift themselves above others.”

Breastfeeding rates: At three months, the number of mothers breastfeeding in Sweden is 80% and by six months the number is 67% (Statistik om amning 2010).

Norway:


Norway scores 8 on the Hofstede scale and is thus the second most feminine society (after the Swedes). Hofstede comments:

“This means that the softer aspects of culture are valued and encouraged such as leveling with others, consensus, “independent” cooperation and sympathy for the underdog. Taking care of the environment is important. Trying to be better than others is neither socially nor materially rewarded. Societal solidarity in life is important; work to live and DO your best. Incentives such as free time and flexibility are favoured. Interaction through dialog and “growing insight” is valued and self development along these terms encouraged. Focus is on well-being, status is not shown. An effective manager is a supportive one, and decision making is achieved through involvement.”

Breastfeeding rates: At three months, the number of mothers breastfeeding in Norway is 87% and by six months the number is 80% (Småbarnskost 2-åringer 2009).

Your country not listed here? You can discover whether your country is masculine or feminine at Hofstede’s site HERE and compare it with your country’s breastfeeding rates on the Unicef site HERE.


Anaïs Nin, a French-born novelist, once remarked:

“We don’t see things as they are, we see them as we are”.

Nin’s sentiment perfectly captures the essence of ethnocentrism: we view human behaviour through the lens of our particular cultural experiences.

However if we adopt a cultural-relativistic perspective, we are confronted with a sobering truth: breastfeeding success is largely dependent on simply being born in the ‘right’ country.



Postscript: Apologies to Swedish border control, who will now be flooded with a barrage of crunchy American moms seeking to emigrate.

Tuesday, May 14, 2013

Triumphant Tuesday: Resisting Sabotage from Health Professionals

Whilst most health professionals believe that ‘breast is best’, very few are trained in breastfeeding or lactation; fewer still have successful breastfeeding experience of their own. So it’s hardly surprising that a lot of health professionals sometimes inadvertently, sometimes even intentionally, sabotage mothers, preventing them from actualizing their breastfeeding goals. I discussed the reasons behind this phenomenon here. Suffice to say the impact on breastfeeding rates has been destructive. It seems, where health professionals are concerned, mothers in their droves are imprudently deferring to their alleged expertise. The casualties of this approach are, of course, their babies.

However what follows is the story of one woman who would now bow to the ‘professionals’. She was subjected to a group of health professionals that orchestrated not one, not two, but FIVE attempts to sabotage her breastfeeding success:


The plan was to breastfeed. Period. I didn't know much about it - didn't read a book or really do any research, I just knew that it was what was best for baby, and selfishly speaking, it would help me shed the baby weight that much faster (in my informal and unscientific study I noticed that the women I knew that had babies and breastfeed were not only skinnier post baby, but they managed to keep the weight off 2 and 3 years down the road - I was in!) Breastfeeding was so much the plan that we didn't buy/register for bottles or any of the paraphernalia that comes along with formula feeding.

Sabotage attempt #1


My son was born on June 18th, weighing in at 6lbs13oz. He was a natural, unmedicated, vaginal birth. As soon as he was born he was in my arms and we had some wonderful skin to skin time. I tried to breastfeed immediately but did have to fight off the midwives as they wanted him to be cleaned, weighed and measured before feeding. He settled the argument by peeing on me. When I did try and nurse him, it took a moment but he was able to latch and had a seemingly decent feed.

Almost as soon as we got to the post-partum ward things shifted and the joy and elation we had experienced by having that initial feed were soon displaced. For such a little guy he was a great sleeper - in fact he would sleep longer than the three hours he was 'supposed to' and thus did not get the feedings he needed. If I tried to wake him for feedings, he would grizzle and resist.

When he was awake and hungry it felt like him and I were on two different pages. I had a good supply, and he had a good suck (trust me, we were checked by multiple nurses) but we could not make feedings work.

Sabotage attempt #2

I really had to fight to get some help. When I first asked to see the Lactation Consultant I was told that feeding was going too well to get help - despite the fact it really wasn't!

Sabotage attempt #3

Eventually I went to a breastfeeding clinic to meet with the LC. This mini seminar really surprised me as this LC told the group that after the first 24 hours, formula is the same as breastmilk and even offered tips for getting baby to take a bottle! Ugh.

Finally she came over to see me but my little boy wouldn't latch. He wasn't interested. He wasn't hungry. She told us to page her when he was hungry so she could see what we were doing and figure out why we couldn't get the latch sorted out.

Sabotage attempt #4

What was super frustrating was when he did get hungry (after going *much* longer than the nurses were comfortable with him not eating) I am struggled to get him latched - just as we have something close to success the pediatrition on call comes in for rounds and we have to un-latch him so he can be examined by the doctor - who as it happens was far too busy to wait for the feed to finish. Apparently there were too many babies born and he was running behind trying to see them all.


Before we left the hospital the LC gave us a feeding plan and instructions on what to do if we weren't able to get my little boy latched I was to express some milk into a syringe and feed him that way to help calm him. That was it. Nothing beyond that, no support for what if things still didn't work. Nothing.

At home feeding really was a struggle - things did not get better. There were times where it would take over an hour to get the baby latched - and it was a horrible hour. He would arch his back and scream because he was so hungry and I would end up crying because I didn't understand why this supposidly natural process wasn't coming naturally. It was so hard!

Finally after a feed where it took 2 hours to get the baby latched I gave up and hand expressed some milk into a bottle and we fed him that way. I felt like such a failure. The next day my husband went out to buy a pump. Although he always supported my desire to breastfeed, he struggled when we couldn't get the latch. His mantra was 'feed the baby' which is right of course, but he couldn't understand why the thought of expressing and using bottles was so hard. In his mind it was still breast milk and that was the important part, so did it matter if it was from me or a bottle? It mattered to me.

That day I hardly left my bed. I felt like such a horrible mother, like I had failed my son and that I wasn't good enough. I felt so horrible I didn't even want to see my baby. When I was staying in bed and feeling horrible my husband brought the baby over to get cuddles from me, reminding me that he still needed me. I honestly think if we hadn't been able to sort out breast feeding I would have sunk into a very deep depression.

Sabotage attempt #5


My husband called around to find some support for us. He called every number we had. The earliest appointment we could get was in two weeks! I was devastated. A few days later a public health nurse called us back, I was the one to take the call. I told the nurse what was going on, how for the last few days things had been rough, and that it was getting to the point where he would scream for 2 hours. She replied “and it took you this long to call us?” Uh no, but it did take them this long to call us back. Either way, her comments made me feel even worse than I already did - I was at the lowest I had ever been.

My friends and family really didn't understand the emotional response I was having.  I had a healthy baby and breastmilk or formula made no difference to them. One was not viewed as better than the other.


Thankfully we were able to get into see the public health nurse post partum support clinic the next day. Of course, as is Murphy's Law, my son got hungry and latched no problem. The appointment was 90mins so we were able to really talk about what was going on and how I was feeling. He did get hungry again during this appointment and finally the nurse was able to see how he would scream and we just couldn't make things work. Again, she checked my supply, his suck and told us that we just had “bad communication.” There was no reason I shouldn't be able to breastfeed him. Although meant to be positive, comments like this really hurt because it was a struggle. It wasn't easy or natural! Just because we *should* be able to make it work doesn't mean it was going well - clearly it wasn't. Thankfully - through all of this, she did give us some positioning tips and that seemed to make a world of difference.

After that appointment things improved. I felt better mentally with regard to giving bottles - my husband had the fantastic idea that if latching wasn't going well we would give him 1oz in a bottle, just to take the edge off. Once he was calmer we would try and relatch to finish the feed. It worked wonders!

After using this method for a few days we really figured out the proper positioning. It got to a point where the expressed milk wasn't required as my little boy was latching almost immediately and able to get in a full feed. Just as we were getting things sorted out with the latch I got engorged and experienced horrible pain for days as we tried to unclog the duct and deal with this new obstacle.

We win!


My son is now in the 90th percentile for weight, and feeding is going great! It wasn't easy. We needed help to make things work, and more so we needed the strength to stick to what we knew was best.

I don't understand mothers who don’t try to breastfeed. It is clearly the best both for mom and baby. Unless there is a legit medical reason not to, why wouldn't you? Having fought through the bad latch and difficult times I know that it isn't easy. It takes work and being unwilling seems selfish and lazy.


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Tuesday, May 7, 2013

Triumphant Tuesday: Tandem Nursing

The Daily Mail suggested it was 'horrifying'. The BBC called it 'extreme'. Yet no health agency puts a formal upper limit on the age beyond which it is appropriate or desirable to breastfeed. With the natural spacing between children being 3 years, if we followed our biological imperative, we would all be tandem nursing! But what are the downsides?

It can be challenging to get pregnant whilst breastfeeding, and once the baby arrives, public tandem nursing can trigger embarrassment, not to mention being assaulted by your own offspring on a daily basis! All these delights are illustrated in Rebecca's triumphant story:


“Breastfeeding my first baby Lizzie threw up its own array of difficulties (you can read about that journey here). After 6 months of breastfeeding her, my periods finally returned. By this stage we were ready to try for baby #2. 

After 4 months of trying whilst fertility charting I suspected I had a luteal phase defect. This is where the lining of the mother's uterus does not grow properly each month. It can make it difficult to become or remain pregnant. The condition is common in mothers while breastfeeding. I took B vits and that same month I fell pregnant!

Nursing Through Pregnancy


I breastfed throughout the whole pregnancy although Lizzie decreased feeds because I guess my supply dropped. I found that the decrease in feeds was a harsh fact that I learnt too late; I wasn't aware that pregnancy can reduce supply and if I had known that beforehand I might not have sought to get pregnant again so soon.

I found one of the hardest factors of nursing whilst pregnant was the intense braxton hicks contractions. I started to feel them at around 17 weeks and they got worse and longer as the pregnancy went on. 

At around 38 weeks I could barely move after each feed. My stomach tensed up to the point of me being marooned on the bed for about 5 minutes. They must have done my body some good because I went on to have an awesome natural water birth at 40 wks 6 days.


The Arrival


When my son George was born they checked him for tongue tie and yes, like his sister, he also had one. I noticed he had a really thick lip tie as well, he didn't flare his lip out whilst feeding. Yet he seemed a good feeder so I decided not pursue it.

Like my daughter, George quickly developed into another two hourly around the clock feeder but he gained weight well and was settled so it didn't bother me too much. By this stage, I was used to regular feeding.

Oversupply




When my milk came in I suffered with major engorgement to the point where I called the milk bank and ended up donating the excess to them. In all I donated 10 litres of breastmilk in 6 months. Lizzie (who was now a preschooler) would ask for a feed, eye up the fullest boob and opt for the other one. I don't think she knew what to make of all this milk!

Soon after my milk came in I developed mastitis - twice which I put down to the sheer volume of milk I must of been producing to feed a baby and a preschooler simultaneously. 


The Scrum of Tandem Nursing

I remember when I was pregnant with George I thought, "Ah feeding two babies - I'll just be sitting on the sofa watching a bit of TV, relaxing with my feet up and feeding my two kids..." Oh no! My kids had other ideas! 


George would never feed for more than 5 mins tops so he would always be finished in a flash with Lizzie being the one to takes ages over a feed. George would like to have a feed then have me rock him to sleep, so he would always get impatient while he waited for Lizzie to finish, and being younger he always won. 

So I had to time everything like a military operation. Feed George first; rock George to sleep; lye George on my front (which he did not like, so he had to be sound asleep before you could get away with this); then feed Lizzie lying down with George lying on me! Then if and when Lizzie had a nap I'd dare not move in case one of them stirred. So the amount of hours I was stuck on the edge of the sofa, boob in Lizzie's mouth, George squirming on my front trying to get comfortable, then the the doorbell would ring... arrgggh! "POSTMAN DON'T YOU KNOW THERE IS A MOTHER IN HERE TRYING TO MEET TWO BABIES NEEDS - AT A CRITICAL NAP TIME!!"

Ouch!

Lizzie and George also like to mess around whilst feeding: pulling my hair, their own hair, each others noses, poking each other eyes! So rather than one of them getting hurt, or a fight breaking out, they have started to pull on my ears which is kind of painful. I have to say they take great delight in pulling one, then the other.


It wasn't all fun and games though. Once we went on a family vacation to Spain where George suddenly developed inflamed gums and at the same time my breasts became sore. I assumed this was thrush so went to see a Spanish doctor. He told me it was not thrush and that George just had a sore throat. He also told me that I should not be feeding a 15 month old baby to which I read him the riot act (aka World Health Organisation guidelines) and my parting shot was that I was 'still' feeding his preschooler sister... (two fingered salute!)


During the vacation the soreness on George’s mouth and my breasts got worse. Turns out that we had Hand, Foot and Mouth virus. OWCH! I carried on feeding my babies, but it was a hard slog. Second to the sheer pain, the hardest part was hiding my face when Lizzie fed. She would come off and cry because she knew she was hurting me. In the end I put my face into a cushion and grit my teeth. Fortunately George wasn't old enough to notice my pain and carried on feeding as usual. He was a big fan of breastfeeding gymnastics, ignorant of the fact that every move had me in agony. It took over a week of this pain before I saw an improvement.

When we got home everything seemed to be returning to normal until I started feeling really cold and shivery. My first thought was 'this is like mastitis' and sure enough one of the sores broke out into a cracked and a blocked duct! Oh no not again. Express, Express Express...


"Milk drunk!"
Now Lizzie has a feed in the morning and one at bedtime. Sometimes she has the odd feed in the day if I'm around. George feeds at the same times as Lizzie, plus few extra feeds in the night.

Breast feeding has always been important to me because I know it will give my children the best start in life on so many levels. It’s only a few years investment and such a small price to pay compared to the benefits that my children will reap for their entire lives.”


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Mengenai Saya

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