Monday, 17 November 2014

Dr Jack Newman's Guide to Breastfeeding

Dr Jack Newman's Guide to Breastfeeding, Jack Newman and Teresa Pitman, 2014, Pinter & Martin

Shout it from the rooftops! The famous "Dr Jack" has issued a new edition of his breastfeeding book, and I was thrilled to get a review copy because he's such a well-respected man, has coined so many of the phrases that have been incorporated into the narrative of breastfeeding, and has some fantastic material available online.

It's a huge book, and dense, and I couldn't stop myself from opening it straight away. I've really taken my time reading it, though - partly because there's so much of it, and partly because I feel so many different things about it so I've been trying to sort these out in my head before writing about it.

One-line verdict? Yes, buy it if you're interested in breastfeeding, particularly if you're involved in any way at all with supporting breastfeeding mothers. But, don't make it your only breastfeeding book.

I could expand on it like this or, more easily for me, give you a few examples of what I loved and what I didn't.

I loved the authoritative tone. This man is an expert, and not afraid to say so. He has vast experience of mothers in his clinic, and writes with extreme confidence about what has worked for them and what will therefore work for others. It's an exciting contrast to most other current breastfeeding books, which are written by women and tend to reflect that in their tone and style. Now, let's be clear, The Womanly Art of Breastfeeding is hands-down my favourite and is, as the title might suggest, exceedingly womanly in tone. It might have been written by a favourite sister or aunt, and I love it so much for this - I feel the authors are standing right alongside me. But, (and this is a big, personal, FOR ME, but) it's refreshing to read a man's point of view, when I spend most of my time these days communing with women.

I didn't love the flipside of this tone, which is the description of "the mother" and "the baby" rather than "you" and "your baby". It's one thing that suggests to me that the book is best suited to breastfeeding supporters rather than breastfeeding mothers. It also, to my mind, doesn't do justice to Teresa Pitman's contribution - she's listed as co-author but the book is written from the "I" point of view but that "I" is clearly Dr Jack, even though I've no doubt she's contributed significant amounts to the book.

I loved the challenge of some of the assertions, making me think more about some of the breastfeeding truths I have held to be self evident...the best example would be the assertion that if a baby of, say, four months, isn't growing sufficiently on breastmilk alone, it's better in many cases to introduce solids rather than formula milk (this is a gross simplification of the argument - you'd need to read it in full for the nuances, and the intermediate steps that are suggested). I subscribe to the "middle of the first year is usually the right time for the gentle introduction of solids" idea, and was slightly shocked at seeing an expert advocating introduction at four months. The argument sort of makes sense, though, and challenges me to think harder about what is "best" in a situation where breastfeeding isn't going too well.
He also writes in such a powerful way about the virtues of at-breast supplementation, and the evils of sippy-cups, and again this isn't the only truth, but it's just wonderful to see such strong views expressed so consistently. It forces me to examine exactly what I believe and why.

I didn't love the way that claims are sometimes flung about without citations to support them. Another thing about the WAB is that, perhaps because it is so warm and fuzzy, its authors take great pains to support all of their factual statements with proper, up to date, references to research. Dr Jack doesn't feel the same need to do this because, well, he's Dr Jack, and what he says goes. I've no doubt that there's science behind the factual statements, but I was frustrated by not being able to flick to a reference and then go and read more behind a claim - I don't want to believe it just because he says so.

I loved the scientific explanations of areas such as how drugs pass into breastmilk, and how breastmilk helps immunity. These were pitched at the right sort of level for me, written with the same authority as the rest of the book, and have enhanced and deepened my own understanding. I've not seen another popular breastfeeding book that does this, and it's a really positive dimension to the book that would on its own justify adding it to your library. I'm not in a position to tell mothers a drug is safe or not to take, but where she's got information about it already, I like it that I'm in a better position to explain this to her and help her understand it - it's a new go-to reference for me, along with a copy of Hale that I was lucky to inherit.
In general, all the technical stuff is just great - I've not seen anywhere else a step by step set of instructions on using gentian violet, or such a thorough systematic explanation of reasons for breast pain, or such good illustrative pictures of positions and techniques (though I didn't much like the one that showed Dr Jack's white-sleeved arm reaching in and expressing an anonymous breast).

I didn't love the "case studies". Some of them made useful points, but I felt that some were included mainly to illustrate the way Dr Jack heroically stepped in and saved a foolish woman from the error of her ways. Actually, that's slightly unfair - they're generally about how other healthcare providers didn't give good advice, but the structure of some of them - a straight telling of the story, with interjections in italics describing what Dr Jack thinks is wrong with what a mother had been told - is a little bit sneery. I suppose again this tells you about my own background and my previous loves - I want to read mothers' stories in their own words, like the two fabulous Flower books (Adventures in gentle discipline and Adventures in tandem nursing), with a bit of heart to them. And the mothers I work with, on our helpline, or in meetings, or one to one on my sofa, or at a noisy dropin - they're not case studies to me. They're rich and complex and often vulnerable people, or at least they're in a vulnerable time of their lives, and for the time I'm with each mother I'm really "with" her, not detached in the way that would let me see her as a case study. You'll see this isn't something wrong with the book - it's a very natural reflection of who the author is, ie a proper real clinical doctorman, not a provider of mother-to-mother support. But for me, as a person, it was less appealing.

I loved the pieces on colic and on late-onset low milk supply. On colic, there's nothing revolutionary in there but it's warm, reassuring, sensible, and feels reassuringly systematic, a sort of "try that, then this" - it's a chapter I'd be really happy to recommend directly to a breastfeeding mother, rather than needing to be mediated through a supporter. And the stuff on late-onset supply problems is fascinating because he essentially says that you can sometimes get away with sloppy technique in the early weeks if you have a great supply, but the effects then can show later, when your supply stabilises but your baby's not taking milk well (there are other reasons too). Again, challenging, and a difficult way of thinking to present to a mother, in fact I think I misjudged it the other day with someone, making it sound as though she was storing up problems - but it's informed my thinking, and deepened my knowledge, and will be a section I go back to again and again. 

In summary I really did enjoy it, and it's already got some pages bookmarked and has taken a place on my reference shelf: in fact, I've already had cause to pull it out in conversation with a mother. I'd unequivocally recommend it to someone who already has WAB and wants to expand their library to give them more technical information for supporting mothers, but I'd then say well, read it with your critical eye on, question whether all the facts are truly facts, and don't forget that it's legitimate to come to breastfeeding support from a different place, a motherly place - don't be so dazzled by his masculine authority that you forget there are many ways of skinning a cat. Mothers are, in my view, the ultimate experts on their own babies, not in a brainless "happy mummy, happy baby" way, but in a careful learning of listening to your own instincts and your own baby, and learning each other's language. Nothing can override this, not even a very knowledgeable doctor.

Maybe only one reader of my blog will "get" this last line, and he may not have made it to the end of this post, but if he has, just for him, the line that springs to mind is "Which Claus of Innsbruck cast in bronze for me". Anyone else, I'm happy to expand on that if (as seems unlikely) you're interested.

I should make it clear that I had a review copy from Pinter & Martin, my favourite publisher in the whole world apart from Mother's Milk Books, though I'm also developing quite a crush on Praeclarus Press, and these are only the ones that cover mothering-y stuff, don't get me started on my fiction list. Also, in case this looks familiar, I wrote a shorter review of the book for inclusion in LLLGB's "Breastfeeding Matters" members' magazine, with one of my other hats on.

Thursday, 13 November 2014

Digital footprints, or trying to interact

I made a bold statement on twitter today - I'm planning to spend a week or two really consciously deepening my digital footprint. Perhaps this phrase has common use, perhaps not: I'm using it to mean I want to acknowledge online content that's held some meaning or pleasure for me, whether that's through a simple "like" or "favorite", a share or retweet, or a comment on a blog.

Some of this has come about from a conversation with a friend the other day where I was explaining how I use online material. I always have facebook and twitter open as tabs on my browser, and whenever I get a couple of minutes at the PC I glance through, and open up any links that look vaguely interesting as new tabs. Then one of my boys needs me. Some hours, or days, later, I might have some at-PC reading time, and then I'll cast my eyes over the million open tabs, and read through some of the things I've opened earlier.

I love this way of getting myself lots of great stuff to read, but I fear I've become a passive and lazy consumer, and it bothers me that, particularly when I'm reading people's personal blogs, it's just rude to take, take, take, and never even acknowledge. So, I want to put myself out there, and to engage with anyone who's written something that entertains me or makes me think, instead of nodding silent approval in my head and closing the tab. I love it so much when anyone comments on my blog, even when it's a one-worder - the feeling that you're not talking into completely empty space is so very gratifying.

To help persuade myself, I brainstormed some of the things that stop me from commenting - there are plenty, but none of them are great reasons.

The blog or article writer is too important to care what I think or whether I liked it  - this hits me when I know someone has a mass of followers, or when the piece already has 300 comments. What will it add if I also say "great post!"?
Well, on this one I tell myself that it must be very boosting to have 300 people commenting on your post, but probably even more boosting if the other 500 who read and enjoyed it were to say so too. Also, the vanilla "great post!" comments are quite dull, so the challenge for me is to say what I liked about it, even if it's only a line or two - I've troubled myself to read it, so why not trouble myself to think for just a couple of minutes longer about why exactly I thought it was so great?

I don't have anything to add - the writer already covered it so well  - this applies to some of the more polished blogs that I read regularly. Basically I'm awed by the writer's skill or knowledge or experience or sheer articulacy, and I don't want to sully their page with my adolescent admiration or pretentious attempts to join in. Yes, I know. I think with this one I just need to believe that if someone is putting their content "out there" then they probably are interested in responses to it, even if they're a bit incoherent.

I don't want to look like a stalker - is this just me? When a blogger posts regularly I may well read all of his or her posts, but fear being "that commenter" who always pops up and says something, as if they were unhealthily obsessed with the blogger. This is probably most relevant to the blogs with a smaller readership and few comments- do I look lurky and weird if there's exactly one comment per post, and it's always from me?
Here, I need the courage of my convictions. It shouldn't matter if I'm the only commenter, and I also need to look at my own responses. I've never read a comment on this blog and thought "oh no, her again" - it wouldn't occur to me. When people comment regularly I love it, they become one of the audience that I have in mind when I'm writing, and actually I mourn it when they stop, because I fear they've become bored of me.
If I'm enjoying someone's work, I should be proud to tell them that every time I enjoy a piece of it, and if they're putting so much out there, then it suggests they're happy to get plenty of feedback.

He/she never responds to comments - again, a loaded one for me. We "shouldn't" (no, I don't know where I'm getting this normative statement from) only comment on blogs to get validation in return, so it "shouldn't" matter if the author doesn't acknowledge comments, or only acknowledges the particularly interesting ones (which may well not be mine). It does sting, though, particularly if you've tried hard to add something to the discussion, an intellectual contribution or an honest offering of your own story.
This might be one where I need to monitor what happens. I do think that if I was visiting someone's blog really regularly, always commenting, and never hearing anything in return, I might need to take this as a strong indication that the author isn't that interested in engaging with me. But, I also need to bear in mind that I'm not brilliant at responding to comments myself, even though I'm always thrilled to read them. Perhaps I see them at night on my phone then don't get round to a response when I get to the computer, or perhaps I can't think of anything to add to the conversation, and am not good enough at accepting that a gracious acknowledgement is still much better than silence.

I disagree with what's said in the post - if I find something really offensive, I might not want to engage because I suspect the author isn't someone I want to spend my precious time with. But if it's an interesting debate, and I feel a kinship with the author, then I'd enjoy a bit of constructive disagreement, and would hope he or she would, too.

I found the post uninteresting  - here I let myself off the hook. If it just didn't spark anything for me, and it's someone I've never read anything from before, I think it's fine just to let it go, as you would with a neutral stranger at a bus stop. If, on the other hand, it's someone I know and usually enjoy reading, perhaps I can still engage, by adding to their topic. After all, something had made me click on the link originally, even if it was only an interesting title - by commenting, I might get some conversation that takes us further into that subject.

I'm worried about "mixing causes" - not just in the LLL sense, but more generally. My online persona is somewhat confused - here on the blog I talk quite a lot about books and quite a lot about babies, with the books being all sorts of things; on facebook, my children are the main subject; on twitter there's quite a bit of work stuff. I don't really make the link very explicit - while my identity isn't hidden here, it's also not exactly shouted, and I don't use many photos or names; I don't generally share my posts via facebook (though I think I might with this one - trusting that only the very interested will get through it); I only tend to tweet about book-related posts not the more personal ones. Still, I'm aware that anyone interested can link up the three and it's just a little bit weird for me. If I comment on an accountancy blog using my blogger profile, then people mainly interested in FRS 102 might stumble upon my post about my miscarriage; if someone comes across from the Pinter & Martin book club they might be baffled by the posts on here about other books, and even more baffled by the financial instruments tweets.
I'm not sure why this is a problem, though - I'm not on a quest to accumulate followers (except, in another sense, aren't we all?) and I'm not ashamed of any of the personal experiences I share on here. If someone I was at school with when I was 15 and am now halfheartedly facebook friends with finds me on this blog and reads my outpourings, what's the worst that can happen? She can laugh at me. I'll live.

Writing on a smartphone is a nightmare  - well, this one's true. But it's where I come back to the point that engagement matters, and that casual interaction with any material doesn't do it justice. I need some kind of system for marking things for follow up if I read them on my phone and want to comment, or I need to get quicker at using my phone keyboard, or I need to permit myself sometimes to write only short comments, because this is still better than the "read and run" approach.

I'm too busy writing my own stuff to write about other people's stuff  - meanness! I want to be more generous. I want to say you, "mummy blogger" who thinks you're talking to yourself, you're not, I read that account of your day and I felt every minute of it with you. I want to tell these indefatigable book reviewers that I love what they're doing for me, that they let me feel sometimes that I've read things I've no time for, and they've let me feel clever and inspired. I want the people who write about writing to keep on writing about writing so that sometime I can move from reading about writing to actual writing, and how can they know I want them to do this unless I tell them so, and tell them which bits I loved, and why?

This is what it comes down to. I love the range and depth of what I find to read across the internet, and particularly on blogs, and I want this environment to stay this rich, and to get richer, and I want to be woven into the tapestry, not to be at the sides watching in silence.

Think of it as Kipling, substituting "internet" or the hideous "blogosphere" for "garden":

Our England is a garden, and such gardens are not made
By singing:-" Oh, how beautiful," and sitting in the shade
While better men than we go out and start their working lives
At grubbing weeds from gravel-paths with broken dinner-knives

I'm off out with my dinner-knife, coming to a gravel-path near you.

Saturday, 8 November 2014


When you start to learn the basics of throwing pots, you're desperate to get going. You watch a demonstration, someone sitting there with the clay singing through their hands, rising, falling, charmed like a snake, soothed and coaxed into beautiful symmetry, smoothed by the patter of their words.

Then you try it yourself, sling a lump on the wheel, start it moving, have a stab at getting it centred, then rush, rush, get your thumb in there, start pushing, pulling, you want it to grow, you want to make a thing like you just saw her make! And it collapses. A tiny assymmetry at the start gets amplified with each turn, but by the time the sides are coming up it's too late, you can't do anything about it, so you keep going, maybe turn the wheel faster, pull harder, try and push it back where you wanted, mutter, look around, chuck more water on, then BAM it's down, it's off, your whole top edge has seared off sideways and is slumped in the water catcher, while the remnants of the base spin on, mocking you with their broken misshaped edges.

The key is to centre the clay, and I don't think it's a skill you can explain, because it comes from somewhere way beyond and behind language. All you can do is get it in roughly the right place on the wheel, set it going, put your hands there and feel, feel where it's not right then brace one hand, firmly but without gripping to make dents, and place the other one just so, on the top, angled down, press it exactly right and breathe with it. It's moving all the time, you can see it as trying to get away from you or you can say wait, this clay is singing to me, it's urging me to get it centred, to make it whole and clean and complete and ready to begin, and you relax your whole body apart from your listening hands, and switch off your brain apart from the bit that can pick up this song, and you wait, and lean, and adjust, and balance, and suddenly there it is, that sweet spot, like a humming glass, it's centred. If you have to ask whether it's right, then it's not, there's no mistaking it when you've got it.

Of course you can mess up the pot from there, and I usually do, and of course getting your clay centred isn't something you do right once then never struggle with again. But when it works, oh the physical and spiritual joy of it, the satisfaction of knowing that you listened well.

Why this, now?
Because it's exactly the same feeling as coaxing a baby down to sleep in your arms or a sling. There's a pattern of movements which can be reliable, but to make it work you have to pour your energy into a special focus on the feel of your baby's body, where the tension's going, how to correct his motion with yours. One sway-step might work to step him down from the world to begin with, but it changes as he floats away. In the critical few minutes between awake and asleep, your breathing has to align, your movements constantly reflecting and stilling his, your senses all alert to where his attention might prickle and grab and splutter to the surface, distressed at being pulled out but unable to resist for himself. It's a musical kind of magic, a skill you relearn every time, and the sweetest of sweet spots when it works - if you listen hard enough, you can feel the moment when it's truly sleep, the moment when once more you have done your job well.

As for the rest of the analogy, no, I don't think I believe my children will grow up wonky if I don't always do very well at helping them to sleep. But I do think the start matters, I think we set patterns and more importantly these early years define our relationship, how well we can listen to and respond to each other, how smooth the dance can be.

And one day I'll get the chance to cover my hands in clay again.