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.


  1. Can I be that one reader? Because that last line is my belief about this mothering gig. I know my kids in a way a doctor never will and I'll choose to trust my instinct over their training any day.

    1. Oh, it's a fascinating sort of collision, isn't it? We can learn our own hearts for understanding when we need an expert to help us, because it's not as simple as saying "in all health matters I know better than a doctor", and I'd never encourage a mother to ignore medical advice, but we've gone so far from trusting our own instincts that we're too eager to let a man in a white coat guide us. ("We" in a very general societal sense, not you and me).

  2. thank you for such a thorough and thoughtful review. i can see myself viewing the book through a similar lens, having been a LLL leader.

    1. Thank you, Dawn. I didn't know you'd been one too...we should have a secret handshake!

    2. i think we do - in person ;) now, what to use virtually . . . that requires some thought. <3

  3. thank you so much for many resources.