It was late afternoon on a dark November day and I was at the end of my tether. Week 6 of breastfeeding and I was wincing with pain every time my baby latched on. The doctor had diagnosed thrush and prescribed a cream for me, instructing me to express all feeds until I am ‘better’. Luckily I’m not one to accept things without questioning and this diagnosis rang alarm bells. Surely, if it’s thrush then my baby would also show signs of it? And what would be the point of treating me without treating my baby? Logic kicked in. This can’t possibly be right.
I sat in my pyjamas and pondered what to do. Believe it or not, since giving birth this was the first time I’d not managed to get dressed by lunchtime – things were obviously bad! Fed up with the constant pain when feeding I started to resent my baby as if she was hurting me on purpose. I dreaded every feed. The only option seemed to be to give up breastfeeding.
Thoroughly confused and worried, I decided to call the NCT Breastfeeding line. A counsellor talked me through the problems I was having and she agreed that I shouldn’t accept the doctor’s advice. She suggested that it was a problem with the latch. I’d religiously followed the ‘nose-to-nipple’ mantra – what more could I possibly do?
“Have you tried biological nurturing?” she said.
I hadn’t. It sounded like a washing powder.
Biological nurturing – what is it?
Biological nurturing is often described as a ‘new’ approach to breastfeeding. It wasn’t discussed in my antenatal classes and most people I mention it to have never heard of it. The technique is based on a baby’s natural instinct to search for the breast when hungry – the adorable and relentless ‘pecking’ they do to any shoulder they encounter. Letting your baby search for the nipple by themselves is said to be the best way to get the most natural latch. No need to direct them or tip them this way and that, just let them make their own way towards what they’re after: hence why it’s also called ‘breast crawl’ or ‘baby led attachment’. This newborn instinct is said to lessen from around 6 weeks of age so if you want to try this technique, it is recommended to do it sooner rather than later.
“I did have an experience of this one morning when my baby was about 4 weeks old. We were lying in bed and he was sleeping on my chest, the next thing I know he had wriggled up to my boob, latched on a perfect latch and had a really good feed. I had an over supply of milk for a long time and usually had to express a few ounces before each feed (which also used to choke him at the start), but I was really amazed that this didn’t happen on this occasion. I never realised that this was the biological nurturing method or I would have explored it further. I remember being really amazed at how such a small baby could find his way to food instinctively.”(B, mum to Adam)
The turning point
A couple of hours after my call to the NCT line I settled myself on the bed with my daughter for her feed. I remembered what the counsellor said and took a deep breath. I couldn’t believe it. There was no pain. No tears. No gritting my teeth. My baby had latched on like a dream.
A simple technique
I found the ‘rules’ for getting a good latch in the traditional cradle position really hard to get right. Trying to remember where my baby’s nose was pointing, whether ‘tummy was to mummy’ and where her chin was resting left me tense before I’d even started. Biological nurturing was described to me in a matter of seconds and I didn’t need diagrams.
3 easy steps
STEP 1: Sit back and relax.
STEP 2: Lay baby lengthways down your chest with their head between your breasts.
STEP 3: Allow baby to wriggle to the nipple, guiding and supporting them as necessary.
If it needs a mantra then it’s ‘chest to chest, chin to breast’. The appearance of a good latch is as with other positions: mouth over plenty of the areola, chin to breast and nose clear. Like any method, it does still require a little trial and error. Biological nurturing relies on using a baby’s natural ability to find the breast to maximise the chances of a more natural, more comfortable latch. It is thought that by allowing the baby to attach itself, it increases the chances of it taking to breastfeeding more easily thus avoiding some of the problems that mums can have with feeding in the early days. Of course, with something as personal as breastfeeding, mums find what works for them and their baby. Biological nurturing was something simple that worked for me.
“My baby has a preference for my left boob and I can spend 20 minutes trying to get him latched on my right but with this method he wiggled himself down and latched on perfectly all on his own! He is three weeks old today and last night was one of the best nights we have had as it was so relaxed not fighting each other to get a good latch.”(M, mum to 3-week old)
The science bit
I wanted to write this based on my personal experience rather than trawling through lots of research. However, the ‘science bit’ is fascinating. A baby’s tendency to search for the breast is a ‘primitive neonatal reflex’ (PNR). This is a spontaneous reaction to stimuli that is innate rather than conditioned or taught. Left to do so, a newly born baby has the ability to find its way to the breast within an hour, provided it has not been affected by drugs administered to the mother during labour. Research suggests that the feeding positions recommended for biological nurturing encourage these natural reflexes to emerge. This is how Dr Suzanne Colson, probably the most prolific advocate of the technique, describes the results of early research:
“The key components of BN [biological nurturing] were a range of semi-reclined maternal postures … These appeared to act in synergy …which appeared to maintain close mother/baby body contact enhancing the expression of PNRs, facilitating … infants to find the breast, self attach and feed even whilst asleep”. *
Dr Colson concludes that:
“…[t]his study… challenges the effectiveness of established maternal breastfeeding postures where the focus of consistent advice is skills teaching within a fixed system of positioning and attachment.”
The suggestion is that the more upright positions mothers are taught to adopt, for example with the cradle position, don’t encourage the baby’s natural reflex to latch on in the way a reclined position does. This leads to a question: how can biological nurturing be a practical technique that is flexible enough to suit a mum’s normal everyday routine?
Not as impractical as you might think
Biological nurturing is often discussed as a technique for establishing a latch in the early days and for bonding. The mother must be reclining and skin to skin contact is encouraged. Some advocates overplay this aspect and thus portray the technique as one that is only practical in your own home, in bed and in private. It is therefore often dismissed as impractical. Yet it is a technique that can be used throughout your time breastfeeding. Even though a baby’s natural instinct to root may lessen, you will by that time have established a comfortable feeding position of your own grown out of baby led attachment. When I first tried biological nurturing, I was indeed semi-reclined and semi-clothed – the ‘prime’ conditions according to medical and scientific experts. Following that first attempt, I soon moved to a more upright position, continuing to utilise the principles of letting the baby lead. Who am I to question science, but it still worked!
Can I do it when I’m out and about?
The short and encouraging answer is yes. It isn’t necessary to have skin-to-skin contact or to be semi-reclined. Neither of these would be appropriate in a public place even for the most liberal of mums! Sitting in a chair, I simply placed my baby’s legs either side of one of my legs and aimed her in the direction of the breast on the opposite side of the leg she was straddling. That way she was more or less in a vertical position and easily held. In fact, if left to attach on their own, most babies do adopt this diagonal position. Even with a big and long baby, this position proved immensely comfortable and practical. The key is to use the basic principle of biological nurturing – the baby’s self-attachment – combined with what is practical and works for you in the environment you’re in.
Conclusion
“The bottom line is that you have to be relaxed for breastfeeding to go well and most situations – in hospital, with people watching and barking instructions, sitting up in uncomfy bed, feeling tense, still sore from birth do not encourage this to happen as naturally and easily as it should.” (L, mum to Emily)
Breastfeeding may be a natural process but it isn’t the most natural thing in the world to get right. It’s not easy and no one should ever feel a failure if they struggle with it or decide to stop. Finding a position that is comfortable is vital to success: relaxed mum, satisfied baby, victorious breastfeeding! Biological nurturing proved a simple solution to the particular problems I was having and made breastfeeding click into place when it seemed impossible to carry on. This technique should be added to every mum’s toolbox for successful feeding.
www.breastcrawl.org – includes an amazing UNICEF/World Health Organisation (WHO)/World Alliance for Breastfeeding Action (WABA) film: http://breastcrawl.org/video.htm.
William’s birth story
I honestly thought that baby number 2 would arrive early. Aren’t they supposed to? I’d finished work 6 weeks before my due date just in case I had to give birth in the office assisted by someone I wouldn’t show my face to let alone my lady bits. But as the due date approached there were no signs of anything imminent. In fact, the baby felt like it was well and truly bedded and I was contemplating how it would feel to be pregnant forever.
I never thought I’d need my 40-week midwife appointment. I’d practically guffawed when the midwife had told me to book one. But there I was at the surgery, hauling myself up onto the bed – not a hint of grace or dignity left. The midwife informed me that the baby’s back was now to my right side and his head was only two to three fifths engaged. Two weeks previously the baby had been so perfectly placed! I left the midwife clutching a long list of ways I should and shouldn’t be sitting and moving. I also left with the delightful prospect of a ‘sweep’ at my next appointment and, perhaps after that, an induction. A birth with minimum intervention felt like it was slipping away.
Two days after my due date, it finally felt like things might be on the move. When you’re on child number two you expect to know what you’re doing, but it felt like the first time all over again. Having been pretty comfortable all day, albeit with a bit of back ache, I picked my daughter up from nursery as usual. But as the evening progressed I got less comfortable and couldn’t sit still for long. I don’t remember thinking that it might be the start of it all, just that it was a bit ouchy and time to grind on the birthing ball.
By about 11pm I was getting regular pains and, although I still wasn’t convinced I was in labour, we thought it was time to go and collect my mum and bring her back to the house so that she could look after my 2-year-old daughter should things start to happen in the night. When my mum arrived the birthing ball was getting an awful lot of rotary action.
By the time I went to bed I was downloading a contraction timer app on my phone (and then cursing it when midway through the night I discovered the free version only took a limited number of readings then deleted the whole flipping lot of them!). Whilst I writhed in pain every 7 minutes or so my husband was busily tapping away on his Blackberry sending work emails. And, yes, that really, REALLY irritated me!
At about 5.30am I rang the hospital. I suspected that they’d tell me to wait a bit longer before I came in. I must admit I lied a little bit about how regular my contractions were so that they wouldn’t tell me to stay at home. It worked and at 6am I crept into my mum’s room to tell her that we were off to produce her next grandchild. I then went and kissed my toddler, knowing that the next time I saw her I’d be introducing her to her little brother.
The next bit is where you can all go off and make a drink. Between our 6.30am arrival at the Birth Unit and around 12pm very little happened. When I arrived I was about 4cm dilated but, despite the ongoing contractions, I didn’t dilate any further. The contractions were bad enough to be straight on to the gas and air but they didn’t become any more regular or intense.
At some point during the morning the midwife gave me a sweep to speed things up. She concluded that my waters had already broken. I thought this was plausible as I’d had some dampness (in hindsight probably a wee). It was nothing near the torrent I’d released with my first child but, to be honest, I was so desperate for things to move on that I didn’t admit I suspected that my waters hadn’t broken. Likewise, when the midwife asked whether it felt like I needed to push, I didn’t say “no”, I said “errr, a bit”. Terrible web of lies!
Around midday, the midwives decided that I needed to be transferred to the doctor-led delivery suite and put on a syntocin drip. The thought terrified me. Looking back, I wonder whether my slow progress was linked to the fact that I was so darned scared. The adrenalin had kicked in and undone all the good work of the birth-inducing hormones. Having had a short and straightforward labour with my first child, I was so convinced that this birth would be quicker. I’d hoped a sneeze would do the trick! But when I realised this wasn’t happening the fear took over. Things weren’t going as I’d planned.
Off the midwives went to fetch a trolley so that I could be transferred. My husband and I got my belongings together and we were ready to go. As I sat up on the bed to shuffle onto the trolley there was a “POP” and a gush – there was no doubting that my waters had at last broken!
From that moment on things progressed quickly and I finally started to need to push. But I was still frightened. I remember focusing on the picture on the wall that depicted a table and chair looking out onto a beach and tried to imagine I was there. This didn’t stop me screaming at one point “I CAN’T DO IT!”, which was met by a chorus of “YOU CAN!” from my husband and the midwives. (Apologies to anyone who may have been in the Birth Centre at that point trying to have a quiet and relaxed birth.) I didn’t believe them that the baby was actually coming as the pushing seemed to be going on forever and with nothing to show for it.
But come he did and at 1.30pm (and after three-quarters of a tank of gas and air) my handsome baby boy arrived. The first words he heard may well have been me apologising profusely (again) to the midwives for having done a poo. William was weighed and as the midwife’s finger climbed higher and higher up the weight conversion chart, we realised that I’d squeezed out a 10lb 11oz whopper. Amazingly, I’d avoided any tearing and for this I thank the midwives for their instructions on when to push/not push and my ability to obey them! The midwives were amazing. For one midwife, William was the biggest baby she’d ever delivered and for the other it was the first baby she’d delivered since qualifying. He was special to everyone.
So what did I gain from my birth experience as well a healthy and chubby son? A profound lesson that whilst planning your birth options is necessary, don’t expect things to go exactly to plan. And if they don’t, don’t panic. Wonderful advice in hindsight!
This post is from the UK
Boy’s blues? What to do about male postnatal depression
Postnatal depression (PND) in women remains an issue not discussed nearly widely enough. Even less discussed is PND in men. Many people don’t even know or think that it exists. However, a study by the Medical Research Council (MRC) in 2010 highlighted how common male PND can be. It claimed that 1 in 5 fathers will have experienced depression by the time their child is 12 years old.
The research
The MRC’s study (Incidence of maternal and paternal depression in primary care, September 2010) was conducted between 1993 and 2007 and involved almost 87,000 families. It looked at both men and women, identifying those suffering with depression and following them through the first 12 years of their child’s life. The study found that parents are more likely to experience depression in the first year after the baby arrives: no real surprise there given the huge upheaval a new arrival brings. What is most interesting about the research is that it points to PND being more common in men than previously thought, suggesting that there can be more to the ‘boys’ blues’ than simply a temporary difficulty in adapting to a life changing experience.
The findings show that PND is most common amongst mothers, with 14% experiencing depression in the first year. More unexpected is the 4% of men found to be experiencing depression in the same period. Going beyond that first year, the study found that 25% of mothers and 10% of fathers suffer depression by the time their child is 4 years’ old.
Postnatal depression – why men?
Why men? Why not? It is widely assumed that PND is connected to hormones and the process of pregnancy and giving birth and therefore affects only women. This is a myth as there are many other contributing factors beyond the influence of hormones. The majority of these factors are common to the experience of mothers and fathers: sleep deprivation, the change in your relationship with your partner, the general stress of looking after a new baby. (Interestingly, if PND is connected to hormones alone then this doesn’t necessarily discount men. Some studies identify the drop in men’s testosterone levels after a baby is born as a trigger for depression. )
For a father, a contributing factor can be the pressure placed upon him to be the ‘hunter gatherer’, providing for his family whilst his partner is at home. In the same way as a woman returning to work, a man is forced to juggle an endless list of competing priorities. This is made worse by factors such as sleep deprivation and, more often than not, the lack of time and space to adjust to their new life. Two weeks of statutory paternity leave is barely a chance to take a breath.
Studies have indicated that the following factors can influence a man’s chance of experiencing PND:
Lack of good sleep.
Changes in hormones.
Personal history of depression.
Relationship stress – with a partner, parents or in-laws.
Excessive stress about becoming a parent or father.
Non-standard family (such as being unmarried or a stepfather).
A lack of support from others.
Economic problems or limited resources.
A sense of being excluded from the connection between the mother and baby.
The sense of exclusion from the mother/baby bond is a significant one, particularly if the father is working full-time. At no fault of either parent, fathers can feel like backseat drivers in the new family dynamic simply because they do not have the same opportunity as the mother to spend time with the baby. Failure at relatively simple tasks such as changing a nappy can leave men feeling not quite the ‘wonder dad’ they hoped they’d be.
Symptoms of PND in men
Symptoms in men can be different to those identified in women. The following are symptoms that researchers claim are specific to the male experience of depression:
Increased anger and conflict with others.
Increased use of alcohol or other drugs; misuse of prescription drugs.
Frustration or irritability.
Violent behaviour.
Losing weight without trying.
Isolation from family and friends.
Impulsiveness and taking risks.
Increases in complaints about physical problems.
Ongoing physical symptoms, like headaches, digestion problems or pain.
Problems with concentration and motivation.
Loss of interest in work, hobbies and sex.
Working constantly.
Increased concerns about productivity and functioning at work.
Fatigue.
Experiencing conflict between how you think you should be as a man and how you actually are.
Thoughts of suicide.
A father suffering from PND won’t necessarily experience all of these symptoms. One alone may be enough to identify that there is an underlying problem.
Clinical disorder or identity crisis?
“What a load of rubbish LOL. I agree there is more pressure on men to provide when they have a family so more stressful maybe but PND? You’re having a laugh.”
Quote from an online forum
Sceptics say that research such as that of the Medical Research Council serves to manufacture yet another social disease. They believe that by defining male PND as a condition, it is medicalising what is essentially an identity crisis. At a time of enormous change, not all men will cope with their situation, whether it is the loss of freedom or sense of responsibility that a baby brings. But is that a clinical disorder? Some say no: it is a normal reaction to life’s upheavals. PND in women is acknowledged as a clinical disorder and a serious one, no less serious than any other type of depression. So where is the difference? Both men and women are affected by hormones and difficult circumstances. Are men simply expected to ‘man up’ and ‘get over it’?
It is the latter expectation that may make it harder for depression to be identified in men and explain why the male postnatal experience is still coming to light. If it’s not a sweeping stereotype, men are less likely to admit how they feel, particularly (studies show) when it comes to feelings of guilt and sadness. They are also less likely to visit a doctor. Women who have suffered from PND say that it’s talking about it that helps them recognise the problem is there and take the first steps towards getting help. Men don’t necessarily give themselves this opportunity to acknowledge the problem and seek treatment.
Depression following the birth of a child is of course on a sliding scale from a general low mood (or ‘baby blues’) to PND to more severe (and thankfully rare) postnatal psychosis. Whether or not men can get PND in the same way as a woman can is not actually the issue here. What is important is the clear need for there to be greater awareness of how men can suffer emotionally and mentally and for that awareness to bring with it greater support.
Finding support
“Parents need to be told about the risks of depression for both mothers and fathers and they should also be told about the signs which they should be looking out for in their partner.”
Rob Williams, Chief Executive, Fatherhood Institute
If male PND is yet to be widely acknowledged as an issue then it is little wonder that support is still limited. Organisations such as the Fatherhood Institute (a fatherhood think-tank) are pressing for fathers to be screened for depression in the same way that women are by health visitors and GPs. For example, the Institute has worked with Surrey Parenting Education and Support to create a tool to provide health professionals with interview questions to evaluate whether a father is suffering from PND. Initiatives such as this demonstrate a growing recognition of the need to put a framework in place for supporting men in the same way as women currently are.
Regardless of whether you are a man or a woman, there are practical steps you should take if you are experiencing any level of depression after the birth of your child:
Don’t be afraid or embarrassed to tell someone how you are feeling, whether that be your partner, friends, a health visitor or GP.
Don’t expect to be able manage everything in the way you did before. If help is offered, accept it.
Get as much sleep as you can, even if a short nap is all you can grab.
Eat well and often to maintain energy levels.
If you suspect your partner is depressed, talk to them and encourage them to seek help from a GP if necessary.
Take some time for yourself and your partner.
Talk to other parents with babies – there’s nothing like support from someone who knows what you’re going through. Problems that feel unique to you are more often than not shared by others.
Familiar advice to the new parent but often not heeded when the demands of a new baby take precedence over all else.
Conclusion
Discussions of PND tend to focus on women and this is reflected in the support services currently available. Regardless of whether postnatal depression in men is a medical condition or a non-medical ‘identity crisis’ there is no argument that the arrival of a child has a significant impact on men and women and neither should be overlooked. If ongoing discussion serves to improve support services and encourages men to seek help then it is a positive step – if not a leap – forward.
