Also known as breast-feeding

I usually drone on about getting your baby out. Preferably loudly expressing its utter disdain about the indignity of being born.  If  they can voice their objection, they are hale and hearty! Once the placenta is delivered, once our baby has recovered from the shock of birth, and following a golden hour of skin-to-skin, we can proceed to the fourth stage of labour.

What could be more natural?

Well… funny you should ask!

You can probably guess, loyal reader, what I’m going to say: it may (like labour) be the most natural thing in the world, but that don’t make it easy. We don’t want to blame the baby, but she hasn’t read the manual and so, even though the mother has often studied like the class swat, there’s a certain amount of luck involved. It was always thus, if you think about it, and humans have been trying to help (with varying degrees of success) since time immemorial.  To this end, wet nurses have been employed, any number of substitutes have been tried, women have been sold various paraphernalia for expressing, and have been put on many so-called milk-production diets.

It’s an inconvenient fact that breast is best. Look, it doesn’t give you or your baby super powers. It won’t make them geniuses. Or supermodels. Which is a shame, because it does create extra an burden for the mother which is difficult to share. But it reduces the baby’s risk of infection by passing on lovely antibodies, and we all know how I feel about an antibody! Anything you are immune to, so is your baby via your milk. Extra kudos to you if you’ve had your pregnancy vaccines! Oh, and it’s free. If you are lucky enough to make this work (and yes, there’s an element of luck, no getting around that) then you will save a fortune. They don’t give away the alternative, and even though the supermarket own brand formula are just as good (and much cheaper) than the ones you see adverts for, I know you’ll be getting the overpriced one with the fancy bottles and the posh teats which promise to banish collick and wind. They lie. All babies get windy and colicky. Even the breastfed ones.

Although there are work-arounds which allow others to share the infant feeding burden, these often require extra effort, time and money. To be fair, there’s no effortless way to feed a baby, it’s a 24/7 job that you never quite master because the rules keep changing according to the baby’s random growth spurts and other unknowable whims. This applies regardless of how you choose to feed.

Expressing and formula gives the mother a bit more flexibility but she’ll need to sterilise bottles, buy either formula or a breast pump, and either feed or organise for someone to feed the baby. But exclusively breast feeding creates an invisible umbilical cord which can limit her ability to get back to work. There are no easy answers. Early return to work can be eased if you have what you need: an understanding boss, a decent pump, somewhere private (preferably not a toilet). This can enhance a woman’s career progression (albeit at a cost, namely exhaustion). A long maternity leave, while a much appreciated luxury, can hold her back.

Returning to work is obviously not a woman’s primary concern when she is beginning her breast-feeding journey. This new challenge begins around an hour after she’s just spent too many sleepless and painful hours expulsing a baby from her body, so the timing kinda sucks. (Pun intended!) Some babies accept the change in food delivery status (from passive flow via the  umbilical cord to active suckling) without a fuss. Many (especially firstborns) not so much. Luckily, your midwife is here to help.

We start antenatally, when we give you little syringes and encourage you to express a few drops of colostrum. That’ll be one less skill to learn when your brain is short-circuiting from the effort of birth. Whether or not you managed to catch a few drops of liquid gold in the pre-baby period,  you’ll know how the taps work, and that makes it easier to get milk flowing.

Pregnancy is also a good time to discuss breast-feeding, if only to defuse anxiety. We know that, much like birth, women hear horror stories about cracked nappies and sleep-free nights, babies that refuse to latch and others that won’t let go… we know that no-one hears about the success stories, those are too banal. If you’re one of the many for whom breast-feeding was reasonably straightforward, you also don’t want to brag about it because you are aware that others found it harder.

Each antenatal visit is an opportunity for us to discuss an aspect of health promotion. Breast-feeding is just one of them. I’m usually more interested in how you’re doing, both physically and emotionally. If you’re struggling with heartburn or housing, you’re not in a good place to learn about the benefits of breast-feeding. So I’ll get you seen by our fabulous obstetricians who will prescribe you something that actually works (gaviscon doesn’t always touch the sides) and I’ll write to the housing department of your local council (although, not gonna lie, I’m not sure how much that helps…) then we can talk about feeding options (breast is best, but you have choices) . Or pregnancy vaccines (you should, they protect both you and your baby, but you have choices). Or labour, including the bits you desperately hope won’t apply to you (they might, but we’ll take really good care of you and you have choices).

We respect your choices. Even when we disagree. But at least hear us out, or pretend to. We don’t expect you to change your mind, we know you’ve given your preferences lots of thought and consideration and we respect that. We can guess what you have heard or seen from well-meaning relatives and possibly-less-well-intentioned social media. We understand why you might not trust us. But here’s the thing: you’ll never know what disasters we routinely, quietly, unassumingly prevent precisely because they didn’t happen. The research is clear, though: we make you safer. And yes, we are aware, safer isn’t perfect. We are sorry about that. We are constantly working on that. But vaccines protect, and breast is best.

For some mothers,  breast simply doesn’t work. If you are one of those mothers, I know how hard you tried and I admire you enormously. Breast-feeding shouldn’t hurt, and if it does, for whatever reason, it’s crazy to persevere. You tried, your baby got a bunch of colostrum and possibly much more. That’s enough.

Anyway, you’re now in labour, armed with all the information you need to make informed choices. Your iron levels are good, your blood pressure is good, your blood sugars are stable, your immunity is tip top, you’ve even managed to express some colostrum. Your labour midwife’s mission is to make this as untraumatic as possible. You’ll agree, she has her work cut out!  Because, there’s no easy way to say this, but birth is hard. We aren’t terribly well designed for it. Our survival as a species has always relied on having trained helpers who have been taught ways to ease the process. Not so long ago, that didn’t amount to much and you would put your affairs in order before labour. Thank heavens for modern obstetrics. Not perfect. But better.

One of the many advantages of good obstetrics is that the baby is delivered in good condition. Crying lustily. Well oxygenated. Good reserves. Good tone. All these things really enhance the initiation of breast-feeding because these babies are both motivated and able to suck efficiently, thereby activating the milk production system. Not so long ago, we’d let you push for hours, and while you could give yourself immense credit for delivering your baby unassisted (no mean feat) but both you and your baby would be bone crushingly exhausted and neither was in a good state of mind for the fourth stage. Babies needed resuscitation, which is unbelievably stressful and could lead to separation from their mothers. Not conducive to breast-feeding. Mothers so tired that their desire for sleep overrode all impulses to breast feed. Pretty depressing. I’m not advocating unnecessary interventions, just timely ones when needed. My job is to work where that line is and act accordingly so that the baby is born to suck.

We will literally bend over backwards to help you get off to a good start. Midwives develop superhuman abilities to adopt and maintain crazy postures while initiating that first feed. We shouldn’t because our spines totally disapprove. But oh, the satisfaction you get when a reluctant baby gets the hang of it! It’s joyous and momentous!I remember finally getting Firstborn Son to latch. It took three days. It was a stressful time, I cannot lie, but I’d taught many mothers how to express in my PME (pre-motherhood era). I found it invaluable; at least he was never at risk of hunger. He finally figured it out after his godfather (a neonatal paediatrician) had stern words with him. Ok, it probably wasn’t exactly like that, but that’s how I remember it! I will admit to feeling some pressure to succeed on account of being a midwife.  But I also know I wouldn’t have persevered had it been painful. For the same reason that I felt no guilt about having an epidural (even though I’d been aiming for a home birth…) which was an epically good decision! Mothers, even those who are midwives are only human even though we are kinda expected to go above and beyond, and behave like hard-core angelic saints. This is unhelpful. Martyrdom is not required and guilt is unnecessary. Even new mothers need to sleep. Although breast-feeding should be encouraged as much as possible, sharing the load, any way that works for each individual mother is good sense. Breast (where feasible) is best but sharing is caring!