Michelle Tant

(February 2018) As a breastfeeding counsellor with experience in facilitating breastfeeding antenatal sessions with over 500 partners of potentially breastfeeding mothers I have shifted my focus over the years from simply helping partners to understand the way feeding works, to helping them to visualise what life will be like as a fully involved parent, enabling their partner to have a positive breastfeeding experience as well as helping their babies to receive the optimum nutrition he or she requires. Becoming a midwife however has really opened my eyes to the realities of integrating partners in the early neonatal period. There have been improvements in the involvement of partners throughout labour and birth and many NHS Trusts do allow partners to stay for the first night following the birth of their baby in response to mothers saying they want this to happen. However as midwives, what is our expectation of the level of involvement and why do we think they are staying? It is...

(February 2017) Something a little different today. There is a scenario which many midwives may be familiar with. It is constructed from my imagination/experience and so no fears about confidentiality though I suspect you may feel you recognise it. Have a read and then consider my questions at the end. A woman has a normal vaginal birth of her first baby around mid afternoon. She is absolutely over the moon and desperate to breastfeed; it was in her plan and she really feels it is the best thing for her baby having been to antenatal classes and done a bit of reading. She is thrilled when her little boy latches on first time and assures you that it doesn’t hurt. You can see that baby has a good latch, he stays on for a good 20 minutes before dozing off and she is transferred to the postnatal ward. You hand over to the midwife that the baby has fed well and they are both for routine postnatal care including feeding support. The following day you are assigned to the postnatal wa...

 (November 2016c) As a breastfeeding counsellor I am frequently asked about antenatal hand expressing from a gestation of 37 weeks, regarding both the rationale and technique. Colostrum is the first milk produced and is present during pregnancy and until the mature milk comes through at around 2-3 days. Colostrum is particularly important in the protection of the newborn as it transitions from being inside the uterus in a sterile environment to being on the outside, exposed to the bacteria present in our environment. Colostrum is high in protein, carbohydrates, vitamins, bacteria- fighting leukocytes as well as a high concentration of the secretory immunoglobulin A (IGA) which acts as a sort of 100% organic vaccine, protecting the vulnerable membranes in the lungs and gastrointestinal system. Furthermore colostrum acts as an antibacterial paint, sealing off the naturally permeable newborn gut. Speaking of the gastrointestinal system, colostrum acts as a laxative...

(July 2016) In my antenatal breastfeeding sessions one of the most common subjects brought up independently is that of safe sleeping and the avoidance of cot death, also known as sudden infant death syndrome (SIDS). There is invariably thinly disguised fear evident in the room combined with, in my experience, a desire to talk about it but avoid it at the same time. After all, talking about the potential death of a child makes for uncomfortable discussion. Currently in the UK there are approximately 288 unexplained infant deaths per year. This includes babies 0-12 months though a small percentage of the total (6.6%) were between 12 and 24 months. Since the launch of a safety campaign (Back to Sleep) in 1991, the incidence of cot death has reduced by 65%. Recommendations include primarily putting the baby to sleep on their back, in the same room as the parents for the first 6 months of life with their feet to the bottom of the bed. Further research has added to the recommendation...

 (February 2016) On January 30, 2016, an article was published in the Lancet reporting the conclusions of a review of 28 systematic reviews and meta-analyses of studies related to the outcomes and statistics of breastfeeding. The key findings were remarkable in their significance to both infant’s and women’s health as well as the global state of health and economy. I was particularly interested to see what was said about the UK because in my experience a common defence of a trend away from breastfeeding in high income country is that the risks from formula feeding are not applicable to regions with safe water supply. In practice and when formula milk is made up appropriately this is probably correct however I don’t feel this view adequately addresses the risks of not breastfeeding. I was saddened to read that with rates of less than 1%, the UK has the lowest breastfeeding rates at 12 months in the world. This is just part of the story though. I decided t...

(October 2015) I was inspired by a recent study day to refresh myself on breastfeeding A&P and this is the result. I am bowled over time and again by the cleverness of breastfeeding and I am working on a piece about colostrum (honest to goodness the cleverest food ever) which I hope to share at some point but today it’s all about the breast and supply. We will start on the outside with the nipple, or papilla which is a projected part of the breast where the lactiferous ducts end their journey (more on those later!) and the milk comes out. The nipple is surrounded by an areola of varying size, it isn’t important how big it is. It is generally darker than the surrounding breast tissue and this helps the baby to locate the nipple on its first expedition to the breast. The areola has a number of oil secreting glands called (brilliantly I might add) Montgomery’s Tubercles and these help to protect and lubricate the areola. The breast tissue which started to develop in pubert...

 (September 2015) Image credit: http://www.thensmc.com/resources/showcase/be-star?view=all Since qualifying as a Breastfeeding Counsellor I have worked with over 500 fathers in antenatal breastfeeding education. The overwhelming impression I am given from them is that of a desire to be involved and to support their partners throughout the process. This desire is borne out in the research (Sherriff et al 2009; Rempel and Rempel 2010; Brown and Davies 2014) and what is interesting is that it also shows that mothers whose partner are supportive are more likely to have a positive breastfeeding experience (Meedya 2010). Image credit: http://beingdadboston.weebly.com/photo-credits.html I have subsequently become increasingly interested in supporting this need, particularly as my class experience shows me that often partners have the view that in order to help their partner they must feed the baby, thus ‘relieving’ the mother of the ‘burden’ of breastfeeding....

 (May 2015) Parents in my antenatal sessions express a number of anxieties about breastfeeding and the early parenting experience however one stands out above the rest; pain. My own dissertation findings highlighted that partners were also worried that it would be painful, with an additional anxiety about how to protect her from this difficulty. Much of breastfeeding antenatal education is focussed on achieving pain free breastfeeding and in supporting women in their feeding problems, sore nipples is a recurrent issue. It has been said that “If you’re doing it properly then it shouldn’t hurt” and this statement has sat uncomfortably with me for a very long time. Ultimately it blames the woman for her own pain, and regardless of her proficiency at positioning and attachment, this sort of language does not empower or encourage women. Furthermore it may well be that her technique is ‘textbook perfect’ but there may be another reason for the pain such as a tongue tie, Raynaud...

When I started as a Breastfeeding Counsellor, I used to cram as many things as I could into my antenatal classes. A year later and some more direct experience supporting brand new mothers in their early breastfeeding experience and I find my classes to be a bit different. I used to go to great pains to tell parents how they could do it properly, not quite step by step, but almost. I'd justify this approach by thinking about how I would have appreciated the information before I breastfed my first child. It took being on a postnatal ward with a brand new mother with an hours old newborn to remind me in exquisite shock just what it is like to be a new mother. It took me right back and I started to think long and hard about just how I felt in those first 24 hours. Morphine induced haze aside, when the mist started to clear, I was overwhelmed with the enormity of the task ahead and the minute and beautiful creature in my arms. The realisation that all the information I'd bee...

Mothers milk is the gold standard in infant nutrition. It provides absolutely everything a child needs in order to survive and thrive. It is food and drink. It continually adapts in order to pass on mothers antibodies and immunities. We know that it literally saves lives, reduces chances of illnesses such as gastroenteritis, ear infections and more. There is evidence to suggest that colostrum actually lines and seals the babies immature gut to help prevent infections. We know that it also reduces the incidence of obesity. We know that in mothers that it reduces the risk of ovarian and breast cancer, diabetes and helps you to lose weight as an added bonus. These things are just the tip of the iceberg. We know that artificial milk, or breastmilk substitute does not even come close. Try as they might, the manufacturers cannot perfectly imitate mothers milk. It is unable to support the babies immature immune system in the same way that mothers milk can. However we (breastfeeding ...

While I'm thinking about it (and I often am) I wanted to jot a few things down about the latch.   So many things come back to it, so its well worth revisiting. A significant proportion of breastfeeding problems come back to an incorrect, or inefficient latch.   Sore nipples - almost always a poor latch Other things to cause soreness - tongue tie, Raynauds   Poor milk supply - an inefficient latch - baby not feeding very efficiently, so not draining the breast effectively and stimulating further breastmilk production Other things to cause poor supply - baby not feeding very often, extreme malnutrition in the mother   Mastitis - Infected blocked ducts are often caused by poor drainage of the breast. Engorgement may then result in mastitis. If the latch isnt right, then particularly in the early days, engorgement may result.   My Tips for a Great Latch   * A baby can breastfeed from many 'directions' hence the various 'holds' like cradle and rugby ho...

I tried recently to pin point the moment in my life when I realised that what I really wanted to do with my life, in fact, needed to do with my life, was to be a midwife.   Truth be told although there was a moment of the seed being planted, it has taken a while for me to really grasp the enormity of this choice. Being a midwife is not just about catching babies and it is so important to really think, I mean really think about it. I don't suppose anything can prepare you for the inevitable sad side of the role but equally I don't suppose you'd be human if that side didn't affect you.   I've always known I wanted to work with people and so it was no real surprise that I ended up in the housing industry. Loads of opportunity to support people but ultimately I am still asking of people. They have to pay the rent and I have to ask for it.   When I was trying to get pregnant I discovered a thirst for knowledge about how it all happens, I was absolutely fascinated. ...

I tried recently to pin point the moment in my life when I realised that what I really wanted to do with my life, in fact, needed to do with my life, was to be a midwife. Truth be told although there was a moment of the seed being planted, it has taken a while for me to really grasp the enormity of this choice. Being a midwife is not just about catching babies and it is so important to really think, I mean really think about it. I don't suppose anything can prepare you for the inevitable sad side of the role but equally I don't suppose you'd be human if that side didn't affect you. I've always known I wanted to work with people and so it was no real surprise that I ended up in the housing industry. Loads of opportunity to support people but ultimately I am still asking of people. They have to pay the rent and I have to ask for it. When I was trying to get pregnant I discovered a thirst for knowledge about how it all happens, I was absolutely fascinated. When I got p...

There has been a call from Lesley Backhouse, chair of The Breastfeeding Network to scrap the slogan. No its not a backtrack on policy, its an attempt to shift the balance towards breastfeeding being the normal and usual way to feed a baby, rather than formula being the norm and breastfeeding being something slightly out of reach and unusually exceptional. "We've got to knock breastfeeding off this pedestal," said Lesley Backhouse. "It implies something special, whereas breastfeeding is the physiological norm, and suggests that formula is the standard way to feed babies. "Breastfeeding is the only case where the biological norm is expressed as the exception rather than the rule,". Of course breastfeeding IS exceptional, ie its amazing properties, its extraordinary ability to sustain and improve life, to improve life prospects even in terms of surviving childhood, reducing obesity and common childhood illnesses, right up to reducing pre-menopausal bre...

This year has felt like one attack after another on breastfeeding. There's been the ongoing Facebook debacle; photos of breastfeeding being removed while Playboys pages are continued to be allowed to flaunt more flesh than a whole convention of breastfeeding mothers. Then there was the ridiculous opinion piece in the British Medical Journal which many newspapers, including The Daily Fail regurgitated as fact, further undermining the benefits of breastfeeding. Just this week I saw a short piece in Practical Parenting magazine about the Chinese developing GM cows to produce human milk! One sentence says the milk will have more nutritional content in it, though its unclear whether it means than breastmilk or than formula milk. And now this. http://www.independent.co.uk/life-style/health-and-families/health-news/campaigners-livid-as-whitehall-axes-breastfeeding-week-2287445.html Our beloved government in its wisdom has cut national support for National Breastfeeding ...

I am presuming (hoping?) that The Guardian newspaper did nor set out to publish an inflammatory piece about breastfeeding but unfortunately, it seems to have fallen into the media breastfeeding black hole. http://m.guardian.co.uk/lifeandstyle/2011/apr/23/mix-feed-baby-doctor?cat=lifeandstyle&type=article But more important than yet another media #fail are the ridiculous statements by this 'Dr Smith'. What book was he referencing when he said that the immune benefits cross over in the first few weeks, suggesting therefore that there are no further immunity benefits to be gained by breastfeeding for longer than that? I blogged about some of the significant milestones in breastfeeding here - http://michelletant.blogspot.com/2011/02/milestones-that-matter.html and honestly doctor, the facts are easy enough to come across if you look. Then to move along to saying that expressing is faster than a baby feeding directly? While of course there may be individual cases whe...

A friend said to me the other day how her own mother was pressurising her about her weight loss. My friend is 8 weeks post partum. The hurt I felt on her behalf cut me to the core. The one person who is supposed to be a guaranteed cheerleader is your mother. That doesn't stop once you become an adult. In fact if there was ever a time you need your mothers support and unconditional approval, its when you become a mother yourself. Mothering is hard! It's also joyful, rewarding, surprising, fulfilling and utterly mad. But it is also relentless, tiring, heart wrenching and complicated. Who doesn't need the occasional shoulder to lean or cry on? Mothers are uniquely placed to be supportive of other mothers. Who should know this but a mother? Our own mothers have 'been there and done that'... sometimes right, sometimes wrong but they have been there and they know that this mothering lark is not as black and white as the books would have us think. Now ...

Good quality, timely support is absolutely necessary to help mothers to have the breastfeeding experience that they want. We know that of mothers that stopped breastfeeding before 6 months, the vast majority wished that they had continued. The reasons they cite for stopping being pain and failure to thrive among others. Pain is so not necessary in breastfeeding. It's quite often unfortunately that a breastfeeding counsellor will be called to support a mother with cracked, sore and bleeding nips. You can't help feeling that earlier support may well have avoided the issue. Getting a great latch early on is key. Remember that a baby born after 34 weeks has the ability to breastfeed. Babies who are born and put onto their mothers tummies and 'left to it' will find their way and rather helpfully latch themselves on. They don't worry about mummy sitting bolt upright clutching them in a vice like grip and cradle hold, they simply want mummy to be relaxed and al...

Of late I've been wading my way through a number of things, returning to work at the housing association, my pet services business, looking after my family amongst other various bits of life. And I must say I am almost exhausted by it all. The other big thing I've been grappling with is the practicality of becoming a breastfeeding counsellor. Administration was something I hoped would be at a minimum in my chosen profession but here it is raising its ugly head again, it would seem that even person centred jobs are not exempt. The admin side has become such an elephant in the room that I've had to really evaluate my feelings about my new role and about the organization I do work for (I'm self employed and so am like a sub contractor!). There have been times even today where I've wanted to throw all my toys out of the pram, the baby out with the bath water, you think of a cliche and I'm already there. So if the stuff I'm so offended by is so offensiv...

Even before I had my first child, I was sure I would breastfeed. I didn't actually give it that much thought, other than to get measured up for a nursing bra a couple of weeks before the birth. I know, very prepared. My breastfeeding journey is another post for another day, but suffice to say, I knew that human milk was best for human babies. Knowing what I do now, I'm glad I had that determination, after all, I wouldn't be a breastfeeding counsellor without it. Turns out though that breastfeeding was far more amazing than I ever gave it first credit for... First Feed ~ Stabilizes babys blood sugar following birth and super lovely skin to skin contact for mother and baby. Don't underestimate the protective action of this one feed on babys gut. One Week ~ Breastmilk has helped to clear through the sticky black meconium and the uterus is contracting back to its normal size with BF help. Mum is guaranteed decent sofa time as she breastfeeds her newborn - you...