Saturday, 29 December 2007

Social Services Take Note!

I'm delighted to be able to pass on the news to you, that UK Social Services have had to take a u-turn in the case of Fran Lyon and her unborn daughter Molly.

This news is wonderful on several fronts:

Hopefully, it means Fran can come back to the UK in the future, without wondering if Molly will be snatched at the airport. I'm sure Molly's grandparents will find this of some comfort.

Fran's courage in not only going to the press and fighting her case openly, but the immense courage she showed by leaving the UK, and all her loved ones and possessions, have been shown to be wise and considered decisions.

Social Services have felt the power and strength of those fighting for Fran and Molly, and should be heeding the change in wind: we will not stand for inept, occult and anonymous removals of children from their mothers. There are guidelines - use them!

Those that turn a blind eye to the increasing number of these cases - where children are being removed, or threatened with removal without reasonable cause or due process of the guidelines - will hopefully rethink their complacent position that "there must be more than meets the eye" to this, and always assume Government agencies are acting correctly. Such assumptions do no one any good, least of all the decent and competent Government officials who are as outraged by this sort of stuff as everyone else!

I also hope it will shed more light into the dingy and unsatisfactory Family Courts system.

If we shout loudly enough - they will have to listen. :-)

Personally, I'm delighted for Fran. it will be interesting to see how much wider coverage this story gets in the national press....

Fran, wherever you are - may you have an easy labour and plentiful milk!

Tuesday, 25 December 2007

Away in a manger...

The sharp cold air was fresh on his cheeks. The birth had been so intense, so filled with dread and joy, that he was drained. His beloved had done so well, without anyone but he to help, and he'd heard her praying into the baby's ear when she'd finally lifted him up to her face. God's Love had breathed upon them, all three, he had felt it move through him and fill the air with light. She'd handed the warm and sleepy babe to him, as she moved to make herself more comfortable. His hands had shook, and his heart and soul opened at the warmth that flooded into him, the smell of a newborn filling him with awe. He had felt thunderstruck, far more than he had when the news of the pregnancy had been delivered to him. He knew he would die for this babe, and love it no more than any other that might be delivered of his own loins. The little one had opened a sleepy lid, and his heart had been pierced and remade again, in the second they had looked into each other's eyes.

His beloved had settled back down, and extended her arms. He had gently settled the baby, his Son in God, onto her chest. the baby had nestled there for a moment, them wriggled around, finding his mother's nipple once more. He'd gone to help, to move the baby slightly, but his wife to be had stayed his arm with a gentle smile, and her wisdom reached out to him, just as it had through the birth. All was as it should be, all was as it would be.

Just then the stable door had burst open, and an aged matron from the town finally bustled in, with a young girl in tow. She'd stopped and stared, a huge grin on her face at the sight of the mother and infant finding each other.

"It's here then, everything all right?" Joseph nodded, unable to speak past the lump in his throat. The matron took charge, and he found himself outside in the sharp air whilst orders were given to the young girl, and everything finished with "..and don't disturb that baby as you go!"

He could hear the to-ing and fro-ing inside, as he sat in the silence and considered the stars in the sky, and how the world have been remade and nothing could ever be the same again. Plans began to form, for how best to transport the two people his world now centred upon, for the long journey home. It was bright and clear, far brighter than he thought it should be, and he'd begun to search the skies for the moon, to see just how bright this light could be, when figures drew closer. He shrank inside, hoping there would be no trouble, and relaxed quickly enough when some shepherds smiled and waved their greetings. By the time they were close enough to converse, he'd settled into his role as Proud Father, and he spoke with the whisper of God in his ear, and determined to not be surprised at any events of the night.

The shepherds settled down outside with him, and lit a fire and cooked food and hot drinks, as they awaited the matron's pleasure. Joseph had not realised how tired and hungry he was, and then wondered about Mary...? As if reading his thoughts, the lead shepherd knocked on the stable door, and the matron opened it.

"Not yet, she needs peace for her and the babe." The shepherd nodded, and handed over a cup.

"We collected the herbs fresh, from the hills, as we came down. Made it fresh here, just now. For her milk." The matron sniffed the brew and smiled "You've one or two of your own, to make this that well! She'll be happy with this, I'll be bound." And she closed the door firmly.

Joseph conveyed his thanks to the man, who was rough and gruff and wrinkled from a life outdoors. He shook the thanks away "I've had seven of my own, man, and I know how it feels these first few hours. The herbs were there for the taking, and a newbabe born - what else would we do with them! The mothers hate the drink 'tho, it's bitter... as bitter as her milk will be sweet!" They all laughed and sat around the fire, telling stories of the births in their families, and how their own sons had found their place in the world.

Joseph crept in last, when the door was finally opened to the visitors. Mary was clean and fresh and her sweat ridden hair had dried. The babe was snuggled onto her, the head barely seen over the warm shawl that encompassed them both. Her gaze never left the baby's face. The shepherds sat in quiet wonder, and gave gifts. More herbs, a warm fleece, a new born lamb. Joseph began to allow confusion into his mind, as they all sat in quiet wonder and adored. How could...? What was ...? But the voice of God whispered to his soul again, and he felt the calm acceptance return. Was not every birth a miracle, and should not all babes be worshipped?

His gaze, in turn, never left the sight of his son, peacefully settled upon his mother's breast.

The matron and her apprentice left with the shepherds. "She's a good girl, that one, done well. No problems I could see. The baby is sucking well and all should be well. I'll return when I can." He settled in the hay beside them both, whispering gently as she lifted the sleeping baby this way, then that, marvelling at how he knew how to find his mother's nipple, how to curve upon her breast and fall asleep once more. Somehow, this was so much more special than all the sleeping, feeding and loved babies that he'd ever seen before. So much more special than any other baby who had ever fallen asleep upon his mother's breast.

He dozed slightly, then awoke, as footsteps once more made their way to the stable. His eyes were dazzled by the gold woven into the cloth, his nose and throat flooded with the rich perfume and spiced air that entered. But nothing was richer to him now, than the sight of the mother and child in each other's arms, nothing more sweet to him, than the smell of a newborn nursing upon his mother's milk. Thus he held his own amongst the jewels and silks and marvelled at how well his beloved coped with the richness and wisdom now kneeling at her feet, and the depth of the revere from everyone as they adored the child.

The eldest of the three, spoke to him at length before he left. In absence of another mother to be there, he felt that Joseph should attend in detail to the baby's needs. Joseph nodded, and listened to another long tale of newborns and milk and comfort. Another huge bundle of herbs was pressed into his hands, with directions for making sure the baby was left alone with the mother as much as possible. He nodded, puzzled, for there was a shadow in the face of this king, and fear, well hidden, deep in the folds of this ancient face.

The puzzling did not last for long, as no sooner had their footsteps faded, than light and air filled the scene and Joseph once more was delivered unto the word of God.

He felt he had aged a thousands years in the few moments it took for the message to be passed on. Gazing down at the sleeping mother and babe, their breaths intertwined and their hearts beating as one, Joseph felt such pain and fear grip him as he almost lost his mind. The baby was curled around Mary's body, as if holding onto her heart, his little fists held a few strands of her hair. She was slumbering gently, everything in her attending to the child. The babe would move, she would move. A hand would raise, check him, stroke his cheek, settle him in her arms a little more, and she'd drift off. The thought of any harm coming to this little miracle... the thought of death and pain being wrought against any mother, a newborn torn from her arms.... bad enough, but the thought of this mother, this child... his child.... He fell to his knees and tears fell silently to the stable floor.

He prayed as he packed, prayed as he planned and prayed as he slept at their feet, guarding them against the door. When they rose, the baby was strapped firmly against Mary's chest, so it would be warm and fed and cared for in the miles that lay ahead. Eager to be gone as quickly as the angel had bidden them, Joseph helped Mary up onto the donkey, the warm fleece padding for her to sit on. She was in pain, and tired, but all was well with her and her son, so nothing else mattered.

He gave her the bitter herbs to chew, to keep her sustained throughout the journey, and they escaped Bethlehem without notice. Throughout the long trek ahead, the baby snuggled into the warm folds of flesh, safe from wind and sun, and grew strong from his mother's milk. Love poured from Mary's breasts, into the baby's heart, and the family thrived.

Tuesday, 11 December 2007

Christmas Spirits

It's that time of year again. Town Centres as filled with harassed people rushing to and fro, office parties are packing out the pubs and large pine trees are being stuffed into small cars.

Magazines are filled with advice and hints and tips: how to baste the turkeys, pre-prepare the veg and survive the relatives. Oh yes, and how long to pump and dump for if you are the mother of a breastfeeding baby and off for a night out with the girls.

So how long do you pump and dump for? Answers vary from 12 to 48 hours, depending on the source. Other answers abound, including the seemingly standard one in the UK lower end mags: feed formula whilst you've been drinking.

Because as we know, breastfeeding babies are at risk from alcohol exposure from their mothers having a good night out.

Except we don't know that, actually. What we know is the opposite. What we know, as opposed to what we think we know, is that there are no adverse effects reported on breastfeeding babies whose mothers are drinking alcohol in moderation.

You may be forgiven for not knowing, we know this, as so many sources tell us otherwise. From the aforementioned advice columns, to Government hand outs and your own Health Visitor. Many of them will go on about risk of transfer, liver damage in the infant and reduced motor development in toddlers.

They'll say this, because they read guidelines, and scan to the bottom of them, and see names like "Mennela" and "Little" and think "Oh yes, that's those studies that proved...." and then they'll tell you that the info is correct and You Cannot Have A Drink Like A Normal Person. You Are The Mother Of A Breastfeeding Baby And You Must Suffer For Your Cause.

Complete hogwash. :-) You Are The Mother Of A Breastfeeding Baby And You Too Can Have A Drink If You Want One.

Let's look at why you can go out with the girls and have some Christmas Spirits if you want some:

Both the Menella and the Little studies have been widely discredited. Little actually discredited Little. This is quite important, as this is the 'main' study that stated there was health risks to children for mother's drinking. She did a baby study, and said that babies of mothers who drank alcohol, were one point behind on a scale of motor development at 12 months. One point.

She then redid the entire sequence a few years later, and could not replicate her results. She herself found she was wrong. She couldn't find any difference between breastfeeding babies whose mothers had drunk alcohol, and those who hadn't.

But still, her original research is endlessly quoted as The Reason to restrict mothers of breastfeeding babies in their enjoyment of alcohol.

This link is a nice debunking of both the original studies.  Edit: try this one instead.

So where does this lack of evidence leave us? Well, it leaves us, as always, with us knowing the facts and making our own informed choices.

So what are the facts on breastmilk and alcohol?

Well, simply, your blood alcohol level is your breastmilk alcohol level. And alcohol goes into the blood quite quickly, and leaves at a steady rate. How fast it goes in, depends on your weight and if you have eaten near the time you drank the alcohol.

If you are quite skinny, and had an empty stomach, a glass of wine will hit your bloodstream, and your milk, at its highest point in about 30 minutes. If you are heavier, or had a meal, it could take between 60 and 90 minutes to hit you, with the 60 minutes being the most probable.

So, between 30 and 60 minutes after you swallowed the glass of wine, the highest alcohol rating would be in your milk.

Alcohol filters out via your liver, at the rate of approx one unit of alcohol, per one hour. So, an hour later - no alcohol in your blood, or your breastmilk. None. Zilch. Nada. Zip.

So, if you drink a glass of wine with one unit of alcohol in it - anywhere between 90 and 120 minutes later, it will have disappeared from your blood, and your breastmilk.

If you were binge drinking, and had five units of alcohol in that one quick drink - it would take 5 hours to process out. So, between 5 hours 30 minutes later, and 6 hours later - those five glasses of wine you had within a couple of minutes, would all be gone! Note how unrealistic this is. :-)

Where does this info leave you if you want to go out and party? Well, you have two choices if you've decided you're going to drink. Space the drinks and time the next feed, around the alcohol processing rate, and ensure baby doesn't get a drop of alcohol. This may be important to you if you have a very young baby. Immature livers are immature livers, and a liver that's still growing... it's up to you if you want to introduce any alcohol to it at all. But you can drink some, and make sure your milk is clear of any alcohol at all. Do the arithmetic. Not quite the moment they always told you about in school, where algebra would save your life one day - but another very useful moment in the life of add, multiply and subtract.

If your baby is older, say over 3 or 6 months, and you don't mind it getting a smidgen of alcohol - and that's all it gets, a smidgen - then go ahead and drink. For, although your breast milk has your blood alcohol level, it also has to go into the baby and be digested along with its food (your breastmilk) and only a tiny amount goes through into the baby. In fact, the real issue on you drinking alcohol isn't the alcohol, it's... Are You Safe To Care For The Baby? If you're over the drink drive limit - are you too pissed to be the caregiver? I'd say yes - your mileage may vary, but really, shouldn't you have someone else to bring the baby over for a feed and then take it off you whilst you sleep it off? I think so. :-)

There are two issues, really, with mothers drinking. One minor, one major.

The minor one is... if you've booked the night off, and partner is doing the babysitting, and has some expressed breast milk to feed the baby whilst you're off... be aware your breasts will likely become engorged if you skip too many feeds. Think ahead, plan ahead. Pack extra breastpads, so you can change frequently in case you start to leak. You may want to also pack some old muslin cloths, for if your get too uncomfortable, you can always slip away to the loo , and hand express some milk off into the cloths, then throw them in the bin. A true 'pump' and 'dump'. After all, few mothers go out on the Xmas razz with a breast pump, storage containers and a cool bag in their handbags.

Although, I have seen some seriously big handbags in my time. :-)

The major issue, is if you are a mother who is drinking regularly. Are you exceeding your 14 units per week? Are you having those 14 units is a short space of time (binge drinking)? If you are, you need to look at what you are doing. But not for the baby... for you. For the issue with a mother who is drinking over this amount on a regular basis... is the health of the mother.

Alcohol and health IS a serious issue. I'm not advocating alcohol, I'm advocating informed choice. If you are drinking over the recommended amounts, regularly, you need to look at yourself, and ask some hard questions. Not to satisfy me, or some Government official, or your GP, but to satisfy yourself about what you're doing why you're doing, and if it's an acceptable risk. And it's your risk, and your life. But you do have a baby to think of... because babies do better with healthy mothers. :-)

And also, please note, the discussion of breastfeeding babies and alcohol is completely different that that of being pregnant. Consuming too much alcohol in pregnancy does damage babies. If you are pregnant, you really will need to go out and do the work, and the thinking, for yourself.

So where, does this leave us? Well, it leaves me with a rather nice Shiraz. Whatever your decisions, and your choices, enjoy the season!

(Oh yes, and let's just deal with the formula one shall we? Put it like this.. you've gone out, intending to have a couple of drinks, spaced out over the evening. But, somehow, that went for a burton, and you've staggered in the door so pissed you can barely stand, with your breasts about to explode and wondering where both Hubby, and the baby are. Hubby stands there, holding your hair out of the toilet bowl, whilst you throw up, and you both debate the fact that as you've been gone for several hours longer than you thought, all the EBM is gone. What to do with hungry baby? Utterly pissed mother's breastmilk, or formula? Breastmilk. Less risk. Okay? Glad we cleared that up. :-)

"A mother should not drink alcohol while breastfeeding? Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers."

Dr Jack Newman

Saturday, 1 December 2007

Breastfeeding Babies and HIV+ Mothers

Today is World AIDS Day. When I was a volunteer in AIDS and HIV+ issues in the early 1980s, we hoped Acquired Immune Deficiency Syndrome would be gone by now. In some senses, it has, as the treatments now available for people with Human Immunodeficiency Virus active in their bloodstreams, are so effective, AIDS itself can be prevented from being developed for years, allowing infected people to live happy, healthy and fulfilled lives.

When no one knew what was going on in the 80s, when people were mysteriously dying of simple infections that were running rampant through their system, the current situation - where both cause and transmission routes are known, and drugs can slow down replication and deal with symptoms - would have been seen as an almost complete triumph. Although this state of affairs doesn't represent a cure, it does, effectively, mean that the disease should be under control.

What we couldn't see back then, although the evidence was there, is that HIV transmission, and the development of AIDS subsequent to infection, would become an economic issue. It would be about resource poor people, in resource poor countries, not about the biology of the infected person.

At the height of the panic in the UK about HIV, when the UK Gov was pushing leaflets with images of giant carved granite headstones through every letter box, who could have seen that HIV and AIDS was going to develop into a major killer of mothers and their children? That poverty, and the diseases of poverty, would feed into the virus, and devastate family life for generations? Looking at it now, I'd like to think that anyone with a modicum of common sense and the slightest understanding of power, could have seen it plainly (and many did so). But it passed me by.

I just couldn't see a world where treatment was available, but not provided as there wasn't enough money, or political desire to do so. Where transmission routes are clearly known, but culture opens the doors to the virus. Where religion can defend behaviour that puts women's lives at risk to their husband's culturally sanctioned promiscuity, but the same religious viewpoint can condemn the wife for trying to protect her own body. I was a naive soul, in the 1980s. 'Patriarchy' was an outdated term, that could not possible apply to the life I, and others, were living.

Oh, it only that were true! For if it was, I doubt very much I'd be making this post today... for there would be no need to highlight the report I'm about to reproduce here for you! No need to point out that the battle ground over HIV is drawn out on the bodies of poor and dispossessed women. That who controls female bodies, and who has a right of access to them, and how that access is undertaken, are cultural issues, and the self-determination of the woman herself is often the last element considered... and that this impacts greatly with HIV status. That women are both continually put at risk of HIV infection, by the cultural status quo around them, and then their behaviour in response to that status proscribed. Women who had have little to no choice on putting themselves at risk of infection, who then have little to no choice on how their bodies are treated post-infection.

Terrible, isn't it? You're sitting there shocked, and sympathetic, and nodding in agreement, aren't you? Absolutely wrong, that the least enfranchised of us have the least control of their bodies, isn't is?

Is it?

Seriously, is it? Do you think women who are HIV+ have a right to control their bodies? Do you think mothers who are HIV+ have a right to determine what they do with that body? Do you, for instance, that an HIV+ woman, who is becoming a mother, has the right to consider allowing her baby access to her breasts? Does the baby of an HIV+ mother have the same right to breastfeeding as other babies? Does the same right of access to the mother's body if the mother desires, apply to her baby? Do you think this?

I do.

Why I think this, is a complex affair, and one that requires careful analysis of culture, from several perspectives. Not surprisingly really, as we're discussing breastfeeding babies, and one thing that's patently clear is that as soon as you discuss them, you have to engage with cultural values that are hostile to a baby's need to nourish at the mother's breast.

So let's unpick some of the reasons why some of you are sitting there shocked, that such a terrible thing has been said - that mothers with HIV+ status should be allowed to make the same feeding choices as everyone else.

To begin with, let's address the nature of the risk. Do you know what the risk of transmission is, to an exclusively breastfeeding baby? What maternal transmission rates are, if the baby is receiving only the mother's milk for the first six months of life, as is the WHO Gold Standard? Well, the transmission rate on those babies is.... 4%.


So 4 in 100 babies, will absorb HIV from the mother. 96 babies out of a hundred, will not do so. Has that shocked you? Were you expecting much higher figures? How many babies did you think become infected, through mother's milk? Where did you get that idea from.....? Hmm... ?

Is 4% too high for you? All right for the 96, but not to good for the 4? Agreed, it would be better if it was zero, I'll give you that.

Of course, it can be zero, or near as damn it. If you treat the mother with anti-viral drugs during the pregnancy and breastfeeding, which costs the same as formula feeding the baby... the transmission rates are so low they are zero in the groups tested - less than one, to be absolutely clear. so, you can have a range of risk for transmission in breastfeeding from 0% to 4%.

Is 4% still simply too high? Are you sitting there thinking "Even at 4 percent, mother's shouldn't be allowed to take this risk with their infant's life." Do you feel it's legitimate to condemn such mothers, and in some cases, separate them from their babies and enforce formula feeding upon them? Do you think Governments should do everything in their power to get the message through to those mothers that they cannot allow their babies to breastfeed? After all, 4 percent of them will become infected!

Well, you are right, 4 percent of them will be. On the other hand... in the resource poor areas, 15% of them will be dead within three months of birth, as a result of the formula feeding. That's 15 dead babies, versus 4 infected babies.

Do these figures seem right to you.. that more babies will die from the formula use, than would have acquired the infection if they are breastfeeding? Does this tally at all, with the news reports, the debates, the general conversations you've heard over the past few years?

Could it possibly be true, that exclusively breastfeeding by HIV+ mothers improves the health of their babies in resource poor areas?

Well, it is true - and the WHO have finally come out and stated so, unequivocally. Shouting to be heard over the clamour of formula marketeers who have made great profit from scaring every one over 'the need to formula feed if you are HIV+' and the cultural frenzy in the resource rich west of the spectre of the 'dangerous breast' infecting innocent babies.

I've appended the report in full at the bottom of this post: do read it. Foot notes are on the original link above.

Now, I've said this is about culture, as much as anything, and have really only spoken about medical research and statistics. Where is the culture? Well, I'm willing to bet it's in the heads of some of the people reading this, who are saying.... "well yes,that's probably okay in those poor places... but the rich West can't afford those 4 babies to be infected, so let's formula feed them when we know the formula is safe."

And the culture there... is... that formula is safe as long as the water and preparing areas are clean.

And this isn't so.

Not only is powdered infant formula not a sterile substance, it can carry bacterial contamination from manufacture, it is potentially harming to the newborn stomach. Simply, newborn gut lining is not designed to ingest cow's milk, no matter how modified it is. The newborn gut is a route of infection, for many infections, if it is compromised by having anything else other than human milk poured into in the first six months of life. It takes six months for the gut to mature on its own, and develop immunities to strange proteins (such as cow's milk) coming into contact with it.

A gut that has had anything other than mother's milk in it, for those first six months, is compromised. That's why formula fed infants, in the resource rich West, with its seemingly stringent hygiene conditions, still have far higher rates of vomiting, sickness, diarrhea and serious stomach infections that those babies who are breastfeeding. Their immune system is compromised by lack of breastfeeding, the formula itself compromises their stomach lining and it often carries bacterial contamination.

But culture states this can't be true... because formula is nice and safe and sterile and scientific, and breastmilk comes out of not nice, unsafe and not scientific female breasts. Infected breasts. Well, they may be infected with HIV, but the milk coming out of them protects and builds the lining of the baby's stomach, and there is evidence to suggest the proteins in human milk destroys HIV. So HIV+ mothers are still doing the best they can by their infant, by letting them breastfeed exclusively. Fewer will die from contaminated formula. Fewer will die from infections taking hold in their compromised gut.

Culture says not, of course. News headlines, campaigns by formula marketeers, everyone who's scared of HIV.. the voices against breastfeeding seem to crescendo when an HIV+ mother enters the room. Science, rational and evidence based research, leaves through the back door. Fear based instinct rules, and the 'obvious' and 'safe''conclusion - prevent the mother from breastfeeding at all costs - emerges. Remove her right to make an informed choice on behalf of her baby, and tell her she cannot nurture her baby at the breast. She isn't allowed to decide which set of risks she wants to apply to her feeding choices: she must choose formula.

My argument is that she requires support, proper information and the freedom to choose for herself and her baby. She may choose formula, particularly in the West, where practices may reduce the transmission rate of HIV to zero. Equally, she may choose to be treated by anti-viral drugs and to breastfeed. The point is, the choice is hers, and we should be doing our damnedest to support each woman in that choice. To make sure their babies can have access to the breast, if the mother wishes it, and that every mother - rich or poor - has the freedom to choose what's best for her and her baby. And that's a choice free from bigotry that demands that HIV+ status automatically means that mother's cannot allow their babies to breastfeed. Today's report finally makes that clear to all and updates the data previously being used to build arguments that deprived breastfeeding babies of their mother's body.

In the wider issues around this, the twentieth World AIDS Day, you may also like to have a look at Nelson Mandela's 46664 site. Self determination is the best way forward for everyone, not just breastfeeding babies! :-)

- - - - - -

WABA World AIDS Day Statement
Press Release
Embargo: 1 December 2007


A decade of uncertainty has fuelled an agonizing dilemma about the least risky way to feed HIV-exposed babies.

Research presented in 2007 finally points conclusively to the need for renewed protection, promotion and supportof breastfeeding. The Final Report of the 2006 World Health Organization HIV and Infant Feeding Technical Consultation1 provides welcome revised recommendations. New evidence clarifies that the most appropriate infant feeding option should continue to depend on a mother’s individual circumstances, her health status and the local situation, but should take greater consideration of available health services. HIV-positive mothers should breastfeed their babies exclusively for the first 6 months of life, and continue partially breastfeeding after 6 months unless conditions are already in place to show that replacement feeding is safe.

Commenting on the dilemma of competing risks between HIV transmission through any breastfeeding vs no breastfeeding, Dr Hoosen Coovadia was quoted this year as saying, “If you choose breastfeeding, you would of course have HIV infection. You would have about 300,000 per year in the world. But if you avoided breastfeeding, the mortality would be about 1.5 million per year. So on the balance of probabilities for poor women in the developing world, there is no other choice than to breastfeed their infants. You shouldn’t devise policies for the rich few. There are some, but the majority of HIV infected women are poor.” 2

His subsequent paper showed that HIV transmission through 6 months’ exclusive breastfeeding by South African mothers was 4%.3 Cumulative 3-month mortality due to replacement feeding was 15.1% vs 6.1% for breastfeeding. Early weaning vs continued breastfeeding substantially increased morbidity and mortality of infected and uninfected babies in Uganda 4, Malawi, 5 Kenya,6 and Zambia 7. Researchers concluded that the risks should be anticipated and PMTCT programmes should strongly encourage breastfeeding into the 2nd year of life. .

Specific HIV and infant feeding counselling was less effective than group information, videos and pamphlets in achieving exclusive and extended breastfeeding in Zimbabwe.8 Intriguingly, 84.5% of mothers recruited into the ZVITAMBO study did not wish to learn their HIV-status, 9 thus avoiding a recommendation for early weaning for HIV-exposed babies, leading instead to an extremely high rate of HIV-free survival.10

Finally, providing antiretroviral therapy (ART) to mothers only during pregnancy and birth begs further scrutiny. While only ~1% of HIV-infected mothers currently receive it, ART for eligible mothers could reduce MTCT in resource-poor settings by over 75%.11 In Rwanda12 and Tanzania13 triple-therapy dramatically reduced transmission of HIV during 6 months exclusive breastfeeding to 0% and <1% class="blsp-spelling-error" id="SPELLING_ERROR_25">iral therapy (HAART) for mothers recruited into the DREAM study in Mozambique, Tanzania and Malawi.14 Acknowledging the difficulty in telling a woman that she can avoid transmitting the infection to her child, but that little can be done for her own health, researchers provided HAART to mothers from the 25th week of pregnancy through 6 months exclusive breastfeeding.

Cumulative HIV transmission to infants was similar to rates reported in high-income countries and lower than those of formula-fed babies, being 2.2% and 2.7% respectively, with postnatal rates of 0.8% and 1.8%.

Political will and strong leadership are needed to reverse the decade-long erosion of breastfeeding accompanying the global PMTCT effort. <BR>

Characterization of formula-feeding as a safe infant feeding option can no longer be justified; contamination of powdered infant formula can occur intrinsically from raw materials, during manufacture 2/2 or from extrinsic sources.15 16 Its cost has been very high in terms of infant malnutrition and mortality, and indisplacement of funding away from treatment for HIV-positive mothers. Rational and humane strategies are needed to simultaneously

o improve the health and survival of HIV-infected women,
o lift the burden of an impossible choice from mothers as they contemplate how best to feed their babies,
o prevent transmission of HIV to exposed infants, and
o protect food security for young children.

WABA calls on national and international leaders to close the gap between rich and poor countries regarding access to treatment, and to use current evidence to enact universal public health measures fostering overall child survival, both within and outside the context of HIV.

For more information, kindly contact:

Pamela Morrison IBCLC
Co-coordinator WABA Breastfeeding and HIV Task Force
Rustington, England

Thursday, 29 November 2007

The Guardian prints Janipher Maseko's Story

 Those of you who only know me through this blog, will have missed the huge amount of support that was rallied in May 2007 for JanipherMaseko and her newborn son, Collin.
Janipher was separated from her 2 week old son, who was exclusively breastfeeding, and her 13 month old daughter, Chantelle, and sent toYarl's Wood IDC, where she was left without either her children, or lactation support.
This week the Guardian finally ran an interview with Janipher, that took place when she was released. It's of note that public concern over the status of asylum seekers in this country, is so low, that this article hasn't managed to be placed until now. It was a feature at the time, when demands that Collin be returned to his mother's breast as soon as possible were rising, that media and news sources were not in the least bit interested in covering the story.
Makes you wonder what else we don't hear about, as we're not so fussed, doesn't it?
There are aspects to Janipher's story that are worth highlighting here:
Breastfeeding babies in prison, have better support than those in detention. In recognition of the nutritional demands on the mother, for breastfeeding babies during the night, extra food and fluids is supplied to all mothers in their cells for night-time consumption. This support was never extended to Janipher, in respect of Collin, when he was finally returned.
Janipher was initially forbidden from baby-wearing Collin, and forced to put him in a buggy as she tried to get him, herself and Chantelle up and down the stairs at Yarl's Wood. A chaplain intervened, and provided a baby sling, and Janipher was finally allowed to use it after the decision that it was forbidden from 'health and safety' grounds was challenged.
Chantelle regularly went to bed hungry at Yarl's Wood. Food was supplied only in the designated areas, and at set times. If Collin was sleeping, or Chantelle sleepy and uninterested in food at feeding times, no help was forthcoming in making sure she got food when she was up to it. Janipher was prevented from leaving the feeding area with food to take upstairs to the sleeping Chantelle.
Chantelle regularly fell out of bed at Yarl's Wood, as there are no cribs or cots in the accommodation supplied. No bed rails. Janipher was forbidden from putting the mattress on the floor, but eventually did so despite being told off.
Chantelle had very bad eczema, and her ointments were taken off Janipher and locked in the medical cupboards which were only available during office hours. Chantelle would spend hours in the night, screaming in itchy and inflamed distress. Eventually, after several phone calls from irate medical people on the outside, Janipher was finally given the cream in order to be able to administer it at night.
Formula is rationed at Yarl's Wood. It is also made up centrally, at set times, and handed out to the mothers to be carried around for several hours at a time without refrigeration. No child over 12 months of age is allowed any at all, even if they are not eating. Janipher was forced to ask for formula for Collin, and then feed it to Chantelle in order to keep her hydrated.
Baroness Scotland, after questions were tabled about Collin and Janipher by Lord Avebury, apologised in the House of Lords for the 'mistakes' that led to Collin being removed from his mother's breast. This may help out some of you who still believe "That there is always more to it." whenever stories such as this do finally make it to the public eye.
Section 9 of the Immigration Act was responsible for Collin, Chantelle and Janipher being thrown out into the streets by Social Services. Under Section 9, entitlement to food and shelter can be withdrawn from asylum seekers who have been refused asylum at the end of the appeals process: so children can not only be hungry, but thrown into the street, as two week old Collin was. Provision should have been made for how vulnerable the Maseko family were, but provision was not made. Shortly after their release from detention, Section 9 was rescinded for vulnerable mothers with infants. However, it still remains on the statute books and can be applied if the Government choose to do so, on any family. It is still used to prevent food and shelter being given to male asylum seekers. Are you aware that the UK acts in this way? Removing food and shelter from vulnerable people who are forbidden to work, in order to 'persuade' them to leave?
Collin and Chantelle Maseko are stateless. Did you know that the UK enacted legislation that prevents children such as Collin and Chantelle from being given citizenship even 'though they were both born here legally?
Saturday November 24, 2007
Janipher Maseko fled Uganda after her mother died and she was raped by armed rebels. She was 13 when she arrived in the UK. She was looking for a place of safety. This is what she found.
I came to this country five years ago, a desperate young teenager, alone, in search of help and safety. The last thing I expected was that I would end up sleeping on the streets in one of the richest countries in the world, hungry, cold, tired and bleeding. If, by telling my story, I can prevent the same thing happening to just one other woman and her children, then it will be worth speaking out.
I arrived in England on August 29 2002. I was 13 years old. My mother died when I was 12, and I became a domestic worker in Kampala, Uganda, because I needed to support myself. But I was raped, first by my employer, who threw me out when I told his wife, then by armed rebels, who broke into the house where I was staying in the night and assaulted me.
Somebody helped me to escape and told me I would be safe in Britain. All I had with me when I arrived were my passport, my birth certificate and a few clothes. As an unaccompanied minor, I should have been allowed to stay in the UK until I was 18, but they didn't believe my age so I was only granted the right to stay for two years.
I didn't understand much of what was said to me at the airport, where I was interviewed, but I was so happy because I thought, "Now I am in England, I will be safe." I was put in a house in west London, with some other young people, and went to college. I worked very hard and did well and although I was shy and very quiet to begin with, I soon made friends.
I really wanted to stay in this country and continue my studies, so in 2004 I applied for an extension. However, I was away, on a trip to Suffolk organised by social services, when I was called for an interview at the Home Office and I didn't get the letter about it.
The next thing I knew, I got a letter refusing the extension in 2005. I appealed, but on the day of the hearing I was 10 minutes late getting to the court because of heavy traffic. The duty barrister allowed my claim to be withdrawn, so the process of removing me from the UK started without me really having had a chance to put my case. I kept trying to get another solicitor, but none would take my case.
At college, I had met a man who became my boyfriend. I didn't know much about sex and babies, and I became pregnant. I love my children now, but I did not want to become a mother so young. By the time I realised I was pregnant, it was too late and there was nothing I could do about it. I had my daughter, Chantell, in March 2006. I very much wanted to carry on studying, and I completed a foundation and intermediate course in health and social care in the same month my daughter was born.
I was pregnant again when my claim was refused in September 2006. My boyfriend had left me by now. Then, in March 2007, all my benefits were cut and I was thrown out of my flat with my one-year-old daughter. I was eight months pregnant and I had no money, nowhere to stay.
My college friends tried to support me, but they didn't have much themselves. They would give me £1 or 50p to buy biscuits and a drink for Chantell. At one point, she had a really high temperature and was very sick and I didn't have the £2 I needed to buy her Calpol.
I contacted the council and spoke to a manager from social services. He started shouting at me, "You are an illegal immigrant, an asylum seeker. We're not going to help you." I was so badly in need of help that I slept on the pavement, with Chantell, outside Hillingdon hospital.
I was allowed into hospital for a few days to give birth, to a little boy called Colin. The social services gave me pink clothes for him, even though he was a boy, but they were the only clothes I had. Chantell had been taken into foster care while I was in labour, but they brought her back to me and we were put into a bed and breakfast, but only for a few days.
I stayed briefly with a friend, but soon I was sleeping out on the streets of Brixton, south London, without food, without proper clothes, struggling with a sick one-year-old and a newborn baby. I had Chantell in a pushchair and I covered Colin in a big black jacket. I was in pain, bleeding heavily, and I couldn't walk. I was desperate. I had £10 in the whole world.
My only chance was a college friend who now lived in Brighton. I bought a ticket and we got on the train. When we got there, they put us on the train back to London because I hadn't paid the full £40 fare. I got off the train at Crawley and managed to slip through the barrier. I was looking for a bus to take me to Brighton. I ended up sleeping outside. I was very cold, very hungry and very tired. It was raining. Passersby heard me crying and called the police.
The police called an ambulance and they took my children away to Brighton hospital. I was taken to a local police station. My breasts were engorged because I had just had a baby and was feeding. A doctor saw me and asked if I wanted a breast pump, but I never got one.
I was still bleeding from the birth. My clothes were filthy. For three days, I was given no shower, no clean clothes. I was just given food three times a day. Every so often, a police officer would slide open the hatch and say, "Are you OK?" That's all.
I was transferred to Yarl's Wood immigration removal centre in Bedfordshire. I arrived at midnight. I told them I had just had a baby and had been separated from my kids, but they just gave me a paracetamol. I was distraught. My children weren't with me. I was crying all the time. I couldn't eat. They put me on antidepressants.
During the two weeks I was there, no one organised for me to see my kids or told me how they were. Whenever I asked one of the officers, "Please, I have to see my kids. I am breastfeeding. I am in pain," all they said was, "Have a paracetamol." I was told to take drugs to dry my milk. But I wanted Colin back, I wanted to breastfeed because I knew it was best for him.
Eventually, another woman in Yarl's Wood wrote a fax for me and sent it to the Black Women's Rape Action Project. A woman called Cristel Amiss called me back. She was shocked to hear my babies had been separated from me and said she would contact her breastfeeding network. She was in touch with me every day after that. One breastfeeding expert, Sheila Kitzinger, got Lord Avebury, a Liberal Democrat peer, to write to the minister for immigration.
Around the same time, one of the officers at the centre came to me with a smile on his face. "Good news, Janipher. We have booked you a flight back to Uganda." There was only my name on the notice of removal directions. I was distraught at the thought of being deported without my children. I know of at least one woman who is now back in Uganda while her children are still in foster care in this country.
I was frantic. I had one week until the plane left with me on it. I called Cristel for help to have the flight cancelled. They sent out an email to lots of people, many of whom sent protests to the Home Office, and thankfully my children were returned to me that week. Chantell was like a stick, she had eczema, her nails were too long. Colin was like a small rat. He was losing his appetite, he was very sick. The children had not been bathed the whole time they were away.
Yarl's Wood is a real prison. There is a lot of racism and intimidation from the staff. You are locked up for 24 hours a day. They take your phone. You have no access to the internet. It's a horrible place for kids. The food is awful. It is the same every day - days-old reheated jacket potatoes, partially cooked fried eggs, food with hair, dirt and worse in it. There never seems to be enough and the serving people are rude. I saw a lot of people suffering. I personally knew one woman who had tried to commit suicide and I heard of other women who wanted to take their own lives out of desperation. While I was there, we went on hunger strike in protest against the conditions.
Lawyers with Birnberg Peirce got involved in my case and worked with campaigners to stop my removal and to issue a fresh human rights claim for me to remain in the UK. Finally I was released - to yet another bed and breakfast and then, after another big battle, they offered me a one-bedroom flat. That's where I'm living now. I have financial support while I await the outcome of my asylum claim.
I am terrified of going back to Uganda. When a failed asylum seeker arrives at Entebbe airport with a deportation order, they are often handed over to a security organisation. Children over three are taken away from their parents. Those detained frequently disappear, never to be seen again.
I am now 18 years old. I would like to have the chance to stay here, bring up my children and train to do something useful. When my mother was dying, she used to say to me, "I lost all my family and I have no one. If you get a chance, Janipher, be a doctor or a midwife or a nurse. Help people if you can." And that's what I want to do.
As told to Melissa Benn
· BWRAP can be contacted at the Crossroads Women's Centre in Kentish Town, London, on 020-7482 2496 or by email at

Wednesday, 28 November 2007

The Response from Essex Social Services

Many people have contacted me over the somewhat formulaic response to their requests for information about breastfeeding babies and their care via Essex Social Services.
The response from Cllr Tracey Chapman states:
"However, in general terms we can assure you that in all cases where there are concerns about the welfare of a child we undertake a full assessment of all the circumstances to decide on the action that needs to be taken to ensure he or she is appropriately safeguarded. In the case of very small babies this will include an assessment of the benefits to the child of ongoing breastfeeding, together with all the other factors that contribute to his or her safety and well being. Such assessments are undertaken in line with national government guidance."
As Essex have thus stated that they follow national guidelines on how to treat breastfeeding babies, I then contacted the Department of Children, Schools and Families, to request a copy of them.
The Department, who were very helpful, and took the time to have an extensive conversation with me on the details, have stated that there are no official guidelines currently published by them. They are currently under review, jointly with the Department of Health, and have not been published because of this.
We discussed that there must be previous guidelines, from prior to the formation of the Department, presumably with the Department of Health's input. Agreeing on this, the Department said it would investigate on my behalf, and see if they could track down any and all prior guidelines - but given the nature of the search, looking into previous work that will have been done some time ago by another department that no longer exists, it may prove time consuming.
I said I'd contact the Department of Health, as they are the ones who would put forward the health based guidelines to Social Services. I will keep you updated.
Which brings us to the really pertinent question: which national guidelines are Essex following?
It is an entirely legitimate act for any member of the public, to request information on precise guidelines being followed by any Government department. They should be able to answer directly, with the name of the legislation, or the guideline, the date of the document, who issued it, and how they then ensure they follow the procedure.
It is incredibly reassuring to hear that Essex is following the national Government guidelines: for it should then be a simple matter for them to be able to quote the legislation, or guideline, when asked to do so.
Again, I will keep you updated.

Human Rights versus Hegemony

This is an archive post, of writing of mine previously posted in other areas on the internet.

This post was in response to a mother with a terribly sick toddler, who was staying at a Ronald McDonald family hospice unit, being asked not to breastfeed her child in public areas in the hopsice. Despite it being illegal to prevent breastfeeding in Texas.
Human rights versus Hegemony
Those of us working hard to improve the world by support breastfeeding and breastfeeding mothers, can often be disheartened by the ongoing list of nursing mothers splashed across the media for being asked to remove themselves and their hungry infants from planes, parks, swimming pools and restaurants. Women such as Emily Gillette and Jessica Swimely find themselves in tense and humiliating experiences, whilst the rest of us find ourselves debating once more in the usual burst of comments, both pro and anti, on the curious concept of “nursing in public”. Such media hiccups are a two edged sword for all of us. On one hand, they do raise awareness of the problems nursing mothers face in a hostile culture, on the other hand, it makes more mothers fearful that they will be personally approached and censored when nursing their own infants. Equally, we have an opportunity to engage in meaningful discourse with others, as well as within our own ranks, but at the same time can find ourselves in a cycle of repeated view and counter view that is both worn and apparently inescapable.
The Swimely case in particular, has raised much of this depressing circular discussion, as the details of the ‘requests’ RMH made to the family, have facilitated a great deal of discussion within breastfeeding support communities and in general debate. The fact that it was an ongoing situation, with a family in immense need of long term support, has allowed us to see inside people’s thinking a great deal more than in a ‘one off’ situation such as a hungry infant removed from a plane or a restaurant. Sustained discourse has occurred, as each solution and counter solution was analyzed and comments passed on the various aspects of the struggle that Tobin was having in getting human milk, and human nurture, as he recovered from his brain operation. Many of the comments, from within our own community, have been about how difficult it is to balance everyone’s viewpoint in this debate. That the other adults and children in the common room required care and concern also. Many have stated that whilst Jessica and Tobin had a right to nurse in the common room, the agreement that Jessica and her family should alert others to it first, and give them time to leave the common room if they wished to, is both sensible and sensitive.
These comments reflect a view, often expressed in such discussions, that in a culture of different personal standards and tastes, acting to protect the other parties involved when contemplating nursing in public, is a sensitive and laudable act. That others need to be considered in the equation and it is a small thing to ask, for them to be warned in advance. Some have even pointed out that as Jessica was nursing twin toddlers, the reactive stance of ‘offended’ onlookers was more understandable. Every comment has usually started with “I agree that Jessica had a right to nurse but….” The ‘but’ goes on to explain that there all sorts of reason why people might be offended by an older infant being nursed, an infant being nursed in front of other children, and infant being nursed in front of a… the usual collections of reasons. The comment usually then ends with a plea for us to understand that progress can only be made if we try and ‘rub along together’ as opposed to end up in seeming combative situations such as calling in lawyers and the press.
This view, seemingly common sense and humane, suggests that all parties have equal rights in the matter and progress will be made if the rights of the ‘onlooker’ are also respected. In this case, that Tobin’s need to be nurtured is of equal status as the rights of the onlooker.

This is complete nonsense. There is only one right here: Tobin’s right to nurse. That’s why there was a law stating so, no matter how ineffective it turned out to be.

Tobin has an inalienable human right here that is being denied. The right of a human child to human milk, to nurture and nourish when its psychobiology requires it. 

The offended onlooker does not have any rights to be protected. The offended onlooker has a personal issue, a feeling of discomfort and unease, that requires handling. A cultural dissonance, that needs acknowledged, responded to, engaged with and hopefully smoothed away. The nursing dyad has no such personal issue in this paradigm. The nursing dyad is not operating out of a cultural context. The nursing dyad has supreme importance and protection in this scenario. 

There is a simple truth here, that is so awesome and complete in its simplicity, that it is in danger of being overlooked: breastfeeding an infant is not a lifestyle choice. It is not a cultural convention. It is not a personal statement. It is a biological imperative. It is our essential nature. It is an essential element of our species, and the continuation of it. It is a biological norm. 

We do not choose to breastfeed. We can choose not to. Likewise, we do not choose to breastfeed in public. We can choose not to. Breastfeeding is not a cultural construct. Not breastfeeding, is. Nursing an infant when the infant needs it, is a biological norm. Deciding that this needs to be done in a certain place, at a certain time, or in a certain way, is a cultural value. 

The problem with many of the arguments that occur when this debate rises again and again, arguments about tolerance, offence, understanding that other parents are going to be askance at nursing toddlers… is that these arguments place nursing within a cultural paradigm. It positions the debate in one of opinion, feelings and cultural mores. In doing this, it assigns equal right to all participants, not to have their feelings etc ‘offended’ and that they all have equal standing in the debate: no one position is more valued or ‘protected’ than the other. Different cultures often do things so differently from each other, that problems and tensions arise when people of the differing cultures meet are best met with discussion, sharing views etc. All laudable comments on such problems as they arise in a multi-cultural society. 

However, breastfeeding is not a cultural activity. Therefore it does not belong in the cultural difference paradigm. As a biological normative behavior, it exists in a complete different paradigm: that of human rights. 

Quite often, when this sort nursing argument is raging, someone will say “Would you ask a black person to go eat in their room if someone else was offended?” and a huge debate will fall open about whether or not that was an appropriate thing to say. One side will scream its not appropriate to reference colour, the other will say “Why not?” and off the merry go round will go. 

Well, raising colour is an appropriate comparison to make, and I present it to you now, as an example of what I mean by the basic difference between arguing about a cultural convention and a biological norm. 

Being black is a biological norm. In fact, it is the biological norm. Being white is actually the absence of being black. To discriminate against someone on the basis of colour, is to discriminate on their essential biology. It is to discriminate against their right to exist: it impinges on their human rights. There is no logic, rhyme or reason to such discrimination. It is a cultural construct imposing lunacy on the essential nature of humans. No one decides to be black. It is not a cultural concept. It is not a lifestyle choice. It is an essential artifact of human biology. It is. 

As is breastfeeding. 

Remembering that we do not choose to breastfeed… we can only choose not to. All babies are born to breastfeed. It is not a cultural concept. It is not a cultural artifact. They are not making a lifestyle choice. They are following their biological, and psychobiological, imperatives. They are doing what humans do: they are suckling for nurture, for nourishment and for survival. It is. 

That is why they need the protection of the human rights paradigm, not the cultural one. 

When laws are passed to protect the nursing dyad, these laws are not about protecting cultural difference. It is not about soothing cultural dissonance. It is not about protecting feelings, emotions or opinion. It is about protecting the essential normative biology of a nursing dyad. It is to prevent cultural suppression of an innate human characteristic. Just as being black, is an innate human characteristic. 

I reiterate: breastfeeding is not a lifestyle choice. It is not something you choose to do. It is something you can only choose not to do. If you accept that an infant has an inalienable human right to human milk, and to comfort and soothe on the mother’s breast, you must also hold up its right to do so when it needs to – regardless of how offended the ‘onlooker’ in. By all means soothe the onlooker – but don’t make it the responsibility of the mother to do the soothing.

Keeping debates on nursing infants within the cultural paradigm is completely and utterly redundant in our current society. It was once the only place the debate could take place, and we must thank, and support, the previous generations in their struggle in that paradigm. Many nursing mothers here and now, are only here because of the work of previous generations, who in the Great Drought sought to change personal opinion where and when they could. Slowly, gently, and in a ‘let’s all get along nicely’ way. Wonderful women fighting a small, slow battle, inch by inch. Thank you. 

However, we are not there anymore. Keeping the debate in the cultural paradigm is not only no longer useful – it is detrimental to progress. Keep it in the cultural battlefield and you do several things, all of them invidious: 

For starters, we place all the pressure on the individual mother, and her infant. Jessica Swimely carried the entire pressure of this battle on her head as she sought to both feed and soothe a hungry and distressed infant and somehow appease cultural suppression at the same time. The law designed to protect her, failed. Some of us in the breastfeeding support community also failed her, but suggesting it was entirely reasonable that she clear the common room before nursing. By keeping the cultural paradigm in mind, we make it about the mother making the inroads into culture. We makes statements as a society that breastfeeding is to be protected … but we leave the individual mother to take the flack. She must make the choices daily, on where and when her child’s psychobiological needs are suppressed by the hegemony. She carries the burden. 

As does the infant. 

In addition, we get all the cultural ‘debates’ that take up the time and energy and prevent progress. The female human breast is ‘sexual’ and it’s understandable that others will be offended. Erm... no! The female human breast is not sexual. It does not carry a biologically determined normative function of ‘sexual attraction’. (Enlarged breasts actually mimic the true sexual attraction – the human bottom. Large breasts are not biologically standard.) Culture dictates whether or not it is a sexualized organ. Keep the debate in cultural mores – keep having endless arguments about seeing sexual body parts. Some laws have even identified this as part of the protective law and stated legally that a nursing breast is not a sexual artifact. When you accept, and promote, the concept that nursing an infant is a cultural debate, you actually end up undermining what you’re trying to protect – by constantly allowing the ever rolling debate on such trivial points as to how much of a breast can be seen before offence is caused. Unless it’s a non-nursing breast, in which case you’re allowed rather a lot of it in advertising cars, underwear and beer! 

You also create space for the debate to include when and why weaning should occur and further undermine normal nursing practices from establishing. It is relevant that many of the high profile cases lately have been about nursing toddlers. Every single time a breastfeeding supporter has comment on the RHM situation about how it is understandable that people have reacted badly to nursing twin toddlers, a dagger has been struck in the heart of many of us. Two extremely pernicious concepts have bobbed to the surface here in the to-ing and fro-ing debates.
One is the myth of the ‘indiscreet’ women, making it harder for laws to be passed, as she ‘whips it out’ and alienates people. The irresponsible and insensitive mother who fails us all by being brazen with her breasts.
The other is the notion that those of us nursing toddlers in public are making it harder for acceptance, as we are acting so far out of the cultural norm. The mothers who need to understand that nursing older infants needs to be done privately to prevent more outcry.
Shame! Shame on you! How can you possibly justify discussing a woman’s body, and her biological imperative to nurture her infant in such negative and unjust terms? How can you stand up and say you support breastfeeding, but you can see that those nursing toddlers are better advised to hide more than the others? How can you undermine the very women fighting longest and hardest to establish normative nursing patterns.? How can you justify suggesting that women nursing in public hinders breastfeeding awareness?

Yet you do all of these things, when you argue about breastfeeding as a cultural issue. Because the very nature of cultural debate is to state that all sides have some points to make, and must be accommodated. 

Breastfeeding is not a cultural artifact. Breastfeeding is a biological norm. The ability of the infant to access their mother’s milk when and where it chooses, is a human rights issue. The right of the human infant to nourish and comfort itself at the mother’s breast when it requires to, is an inalienable human right. A woman having control of her own body, in order to nourish her infant regardless of cultural suppression, is her inalienable human right. 

These are human rights, not cultural debates. We can act in order to get along nicely where possible, but the right of the human child to breastfeeding is paramount. 

And lest we forget…. the cost of the lack of nursing, is death for many human babies. In the USA, 2 babies per thousand die for being on formula. The figures are probably similar for most western nations. Many many more get ill, and in the UK, the cost to the National Health Service of treating formula fed infants with resulting infections runs into millions every year. This cost is long before we start totting up the treatment for the long terms risks of heart disease, diabetes etc – or the misery and pain that blights many lives when diagnosis of the most serious illnesses are made.
In the wider world, 3 500 babies a day die for lack of breastfeeding. In the time it’s taken me to write this – over 7 000 babies have died. And in the global village we live in, the lack of nursing in the West, feeds into that statistic. Women in the West feeding their infants in closed rooms, are not seen by their own communities and by the expectant mothers around them… but they are also not seen by the mothers of the Third World, desperate to give their babies ‘the best’. These women only see white, affluent and incredibly healthy babies and mothers… on the sides of cans of expensive formula. By keeping our nursing mothers bundled in the corner, or locked in bedrooms with their toddlers, or asking the common room to clear before feeding them… we contribute to the problem. But that’s okay, because the father over there, feeding his sick baby formula, is appeased.
Women choose not to nurse because they live in a culture that disapproves of it. We cannot change this, by working within the culture to ‘smooth it all out’. We cannot dump the responsibility on the individual nursing mother to prevent offence. We must act to protect her rights to nurse, and her child’s right to nurse. Their human rights. Full stop. Period. End of. Working in terms of the sensibilities of the onlooker to nursing, was once useful. Yesterday. Or even the day before yesterday. We can acknowledge how useful it was, and how much was achieved, as we move on to tomorrow.
The right of the human infant to receive sustained nurture and nutrition when it needs it, is a human birth right that must be protected. The right of a mother to share her essential biology with her infant must be protected. We must take it upon ourselves to uphold that essential, primal right, and empower all mothers to protect their own dyad at all costs. Let us have no more hungry infants removed from our view. Let us have no more mothers pressured into ignoring their infant’s hunger from fear. Let us stop pretending that the act of feeding a child via a bottle, is even a pale comparison of the real thing: a warm, responsive and loving human breast, adjusting its own output and content to perfectly match the psychobiological needs of the infant and the mother! Cultural values that suppress this union, be they medical, social, or family based, need to be challenged and refuted at every opportunity. We must support the dyad and protect their rights. Right?

Wednesday, 14 November 2007

Request for Support For Breastfeeding in the UK

This is a request for support on behalf of a breastfeeding mother and her infant, in the UK.
It is also about supporting a wider issue - that of the status of breastfeeding within the UK.
Apologies for the length, and detail, of this case - but it is vitally important that the details are made clear.
In June 2007, Essex Social Services took the decision to remove an exclusively breastfed infant from its mother's arms, without benefit of a court order, or discussion with the mother. They sent a team of social workers out into the streets, located the young mother and baby, and physically removed the baby from her arms, driving off with the baby in a car. They left the mother alone in the street.
She had not known they were looking for her, prior to complete strangers arriving in front of her, and pulling her baby from her arms. She immediately reported the incident to the police, such was her shock.
The mother, Miss W, was exclusively breastfeeding her infant, Baby E, who was five months old. Social Services did not offer any care or support to Miss W, in terms of her medical needs on having her baby removed with no warning, or extend any information on how she should deal with her engorged breasts or how to extract her milk for her baby. Miss W's mother arranged a breast pump and lactation support the next day, and Miss W began a regular pumping regime to maintain her supply and to collect expressed milk for her baby, no mean feat for a distressed 18 year old living on her own.
4 days later, Miss W was allowed a short access visit with her baby. During this supervised visit, Miss W began to breastfeed Baby E, who was frantically rooting at her mother's breast. Social Services requested she did not do so, as the baby had only just learned to cope with a bottle, and having access to her mother's breast would 'confuse her'.
Miss W breastfed her baby, with her family's support, and continued to do so for several weeks, during the access visits. She was not permitted daily access with her baby. This entire sequence - removing a breastfed baby without regard to the breastfeeding needs, either of the infant or the mother, and not allowing regular daily access for breastfeeding, contravenes the European Convention on Human Rights, a fact that appears not to have worried Essex Social Services. Miss W also requested her pumped milk be given to her baby - a request Social Services did not facilitate. They have since stated that she should have been responsible for collecting and delivering the milk to her baby - even thought Miss W didn't know where her baby was.
It also goes against regular Government assurances that breastfed mothers and infants will not be separated unless in the most extreme of circumstances. Gradually, despite the best attempts of the Miss W and her family, Baby E began to refuse the breast, and is no longer receiving her mother's milk.
Whilst the removal of the baby had occurred without a court order, and whilst the family succeeded in engaging a solicitor in that first week, the baby has not been returned. The secrecy in the Family Courts system, has meant that the family have had to stand back, silently, and fulfill all requests made to them, by Social Services, in the hope of Baby E's return. Baby E had been placed on the Child Protection Register a few days prior to the removal, for unfounded, and unproven, allegations of potential harm that cannot be discussed due to the secrecy. They were however, allegations, and Baby E had never come to any harm in any way, and the allegations for the Child Protection Order are not a feature of subsequent paperwork by Essex Social Services. In short, the reasons cited for the protection order, do not appear at all in subsequent arguments for keeping the baby from her mother.
What does appear in subsequent arguments however, is that Miss W has demonstrated to Essex Social Services that she does not understand the needs of Baby E, and has no bond with her. Specifically, they cite Miss W's insistence on breastfeeding her baby, as evidence that she does not understand the needs of her baby's health and well being. They actually draw attention to the incident where, on the first access visit after 4 days of being separated from her baby, she carried on breastfeeding her baby despite Social Services' request that she do not do so, and state that this incident is part of the evidence that the baby should not be returned to her.
This is the exact wording in the report:
“I think Miss W would not be able to offer sustained and committed care to Baby E at the moment because she is too immature to meet Baby E’s needs as a priority. Miss W is ‘headstrong’ and is likely to take advice she thinks is right regardless of any advice that might be given, an example of this is breastfeeding Baby E when the Social Worker had advised her that this would probably disrupt Baby E’s ability to take the bottle.”
“Miss W told me that when she attended for Contact after Baby E was removed from her care she used to breastfeed her despite what she had been advised. Miss W refused to accept that breastfeeding Baby E at this time might have been confusing for Baby E.”
At the emergence of this detail in the confidential reports into Miss W and Baby E, Miss W and her family felt that they had no option but to break their silence and ask for support from the wider community. They have been in touch with many statutory and voluntary agencies throughout this nightmare, and have continued to slog along in the hope that the mess would be sorted. However, given how proud the family were that a young, troubled and not always even tempered young woman had successfully exclusively breastfed her baby despite her problems, and that this success was being cited as reasons to keep the baby from her.. they felt they could stay silent no longer.
The family are not convinced Baby E will ever be returned to them, but feel that they must speak out in order to prevent this happening to other breastfeed infants in the United Kingdom.
If you wish to help, we ask that you contact the following County Councillor who has the responsibiity to liase between Government and Essex Social Services:
Cllr Tracey Chapman
Children Schools and Families
Essex County Council
County Hall Market Road
Chelmsford CM1 1LX
phone (Essex County Council): 01245 430430 and ask for the Cabinet Support Office
fax: 01245 438420 (mark for Cllr Tracey Chapman)
you may wish to consider cc'ing to
Ed Balls
Secretary of State for Children, Schools and Families
Department for Children, Schools and Families
Sanctuary Buildings
Great Smith Street
phone: 0870 000 2288 FAX: 01928 794248
Gordon "Every Child Matters" Brown
10 Downing Street
FAX: 020 7925 0918
We ask that write in the first instance to express your concerns over the breastfeeding issues this case has raised.
If you are a medical professional, with skill in the areas of lactation and in understanding the bond of the breastfed infant, we ask you specifically state to all concerned your professional opinion of the actions of Essex Social Services in the this case, and your professional opinion of the statement that by breastfeeding her baby during access visits the mother did not understand the needs of her infant.
(Given the secret nature of Family Courts, direct appeals on behalf of the family will be ignored, and you will receive a letter back stating the family's circumstances can not be discussed. For this reason it is vital that if you write to support, you state clearly you are discussing the actions of Essex Social Services, and the serious implications of any Social Services department making negative judgements upon breastfeeding an infant. You should stress you are engaging in the wider issue of the breastfeeding relationship being so disrupted, and the precedent being set about breastfeeding itself being cited in such a way.)
You may also wish to mention the issue of Baby E's Human Rights, and how they have been ignored by Essex Social Services. This is not an isolated case, and the UK courts have already judged that this behaviour - removing an infant from the mother's breast without care to ensure daily access for breastfeeding - does not meet the imperatives of the European Convention on Human rights (*In the matter of unborn baby M; R (on the application of X and another) v Gloucestershire County Council. Citation: BLD 160403280; [2003] EWHC 850 (Admin)
In the past, letters such as these, from experienced medical professionals as well as concerned individuals have had an effect on outcomes.
Letters from countries outside the UK appear to carry a great deal of weight at Downing Street. You do make a difference.
Please cc any and all correspondance to the Victoria Climbie Foundation as they are supporting the family and are collecting evidence on behalf of Baby E.
In particular, you may wish to comment on your feelings, professional or otherwise, on the status of any 'Social Worker' who feels qualified to advise a young mother to sacrifice breastfeeding in favour of using a bottle. You may also wish to discuss the importance of the breastfeeding relationship in general, and in particular how important it was for Miss W to breastfeed her baby on that first access visit, as this will not only be useful to the family, but will help establish the needs and rights of all breastfed infants. At the moment, this statement - that the baby should not have been breastfed after an enforced seperation in order to protect the baby for bottle feeding - stands uncontested: we must ensure it is contested to the best of our knowledge and ability. Other infants may need this protection in the future.
If you wish to help the family directly, as opposed to bringing attention to the appalling actions of Essex Social Services and the implications for all statutory and voluntary agencies within the UK , you should contact:
The Victoria Climbie Foundation
28 Museum Street
LondonWC1A 1LH
phone: 020 8571 4121 fax: 020 8813 9734
This link will take you to a petition in support of the family at the Foundation's website.
If you are resident within the UK, we ask you also contact your local MP to register your views on this matter.
Likewise, if you feel you need to have more access to details of this case, in order for you to make an informed choice on the facts, you will have to approach the Victoria Climbie Foundation - as the Family Courts secrecy prevents anyone doing so openly.
Finally, and thank you for making it this far down this request, please propagate this message as widely as you can, in the appropriate forums: this family wishes the wider community to know what has occurred here, and have few opportunitites to tell their story. Please pass their story on.
Thank you.
"In the end, we will remember not the words of our enemies, but the silence of our friends." Martin Luther King