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Breast Milk and Alcohol: Busting Myths and Demystifying the Science

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The importance of mothers and babies keeping close

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The importance of mothers and babies keeping close

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I'm sitting on the sofa, cradling my daughter's doll, while she and my husband hover at my sides, arms outstretched.

"Try to be more grabby," I instruct. "Less jazz hands, more gimme-gimme."

Five minutes later and our 10-second video is a wrap. I add a caption and some music, and post it to Instagram ― only to watch it metaphorically explode overnight.

It seems that I'm not the only mom out there who has sat to one side, sweating and leaking milk, while somebody else "helped" by holding my newborn.

The thing is, though, holding my baby amid the rawness of postpartum was the only thing I didn't need help with. It was the one thing in the world that I had covered. My hands were full, sure, but in all the best ways ― the ways that soothed my anxiety and even settled the all-over leaking.

Biologically, this feeling of inherent "rightness" makes a lot of sense. Scientists have dubbed a mother's body as the "ecosystem" from which babies thrive after birth . And the thriving is dyadic. Just as a mother's body regulates a baby's physiological systems ― from the nervous system to heart rate and temperature ― so too does close proximity with her baby regulate a new mom's physiology.

Research into the changes that take place inside a mother's postpartum brain goes some way in explaining the reasoning behind this maternal regulation. When a baby is born, a mother's amygdala - the part of the brain that plays a key role in emotional regulation - increases in activity. This heightened activity sensitizes a mom to her baby's needs and creates a feedback loop whereby the more we respond to and connect with our babies, the more the reward centers of our ever-changing maternal brains light up .

We're essentially neurologically motivated to remain close to our newborns. We're wired to pause, postpartum, and absorb the details of our new baby's face while they sleep in our arms or on our chest.

Biology, it seems, doesn't hold postpartum "bounce back" culture in high regard.

And yet, the expectation to "bounce back" isn't just confined to our bellies and thigh gaps, as might be assumed from every "wellness" program aimed at new moms. No, the expectation runs so much deeper. From a lack of maternity leave, to an influx of visitors postpartum, bounce back culture thrives just as vibrantly in our workplaces and homes as it does in our measurements.

As moms, we're expected to be back to "normal" functioning within a flash after childbirth. We're expected to welcome and host visitors. We're expected to smile and pour drinks as our visitors meet the new life we've just grown and delivered into this world.

And the stinging point for many, if the response to my little video is anything to go by, is that all too often, this scenario is dressed up as "help."

"Here, let me take her for you..."

"I'll hold the baby while you get things done..."

"You look like you need a break, give her to me..."

When I had my first baby, I had plenty of offers of "help." Friends all but lined up to come over, sit on my sofa, and hold her sweet newness in their arms. But while I sat to one side, still bleeding and in total shock after a traumatic birth, I couldn't help but wonder who or how this supposed help was actually helping.

What I really needed was help that made a genuine difference to our now-upside-down-and-inside-out daily lives.

The first time around, I needed the basics taken care of.

Any and all food, dropped off ideally. Because learning, healing and nursing ― all on exactly zero sleep ― is ravenous work.

I needed somebody to hold the space for the emotional roller coaster that I found myself riding. To sit and listen, to validate, to bring cake.

The second time around, I needed food (of course), but also somebody to come and rejoice in my eldest. Not to "take her off my hands," but to fill up her cup with the type of play that I wasn't able to fulfill myself. Active, loud and energetic play that left her in rounds of giggles. Or somebody to take care of the dishes in the sink without even mentioning it ... so that I could snuggle up and read big sister a story while holding her softly snoozing baby brother, without having my brain race off to the endless household chores that lay waiting.

I needed help, in the most basic and practical of terms, that actually helped.

These are the cries of moms who have been there, or are there right now, in the sweat-laden, bleary-eyed trenches of early motherhood. These are the comments that are still rolling in.

Listening, validating, supporting.

This is the help that helps. This is the help that allows us to breathe deeply and settle in with our new babies, while the periphery is miraculously taken care of.

Because if one thing is for sure, postpartum is raw and messy. And within the rawness, nestled between the emotional highs and lows, there's an opportunity. An opportunity to show up and support a new mom, in a society that barely even recognizes her.

A mom of two and a lactation consultant, Louise supports families with breastfeeding and normal infant sleep(lessness). You'll find her on Instagram.

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Here's One Thing You Can Stop Doing To 'Help' New Moms - And What We Really Need

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I'm sitting on the sofa, cradling my daughter's doll, while she and my husband hover at my sides, arms outstretched. "Try to be more grabby," I instruct. "Less jazz hands, more gimme-gimme." Five minutes later and our 10-second video is a wrap.

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Bras recommended by members of NWL Breastfeeding.

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Why you might want to put the baby books down:

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Why you might want to put the baby books down:

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College of Human and Health Sciences, Swansea University

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Why you might want to put the baby books down...

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Here's an article I've written about going back to work and continuing to breastfeed for mums with babies over 6 months old:

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Here's an article I've written about going back to work and continuing to breastfeed for mums with babies over 6 months old:

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HOW TO MANAGE GOING BACK TO WORK WHEN YOU'RE BREASTFEEDING AN OLDER BABY:

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HOW TO MANAGE GOING BACK TO WORK WHEN YOU

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My article on managing going back to work when breastfeeding an older baby. 

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My article on managing going back to work when breastfeeding an older baby. 

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HOW TO MANAGE GOING BACK TO WORK WHEN YOU

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A lovely article from Vogue on making friends after becoming a mother. 

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A lovely article from Vogue on making friends after becoming a mother. 

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Last weekend, while sitting in my local leatherette-clad greasy spoon cafe, wiping up my lasagne sauce with a pile of chips (you betcha) and humming along to the strains of Magic FM, my son decided to fill his pants like a man facing down a bungee jump after a four course buffet. As the cold realisation that there were no baby changing facilities dawned on me like an icecube down my neck the small, middle-aged owner, rather than rolling her eyes at yet another demanding customer, took me through to a room in the back, laid a clean teatowel down on an empty sideboard and left me to change my baby beside a stack of tinned tomatoes half my height. On a train down from Liverpool a few weeks ago, a half Yemeni, half Iraqi dentist gave me breastfeeding tips as she managed, somehow, to repin her headscarf, feed her daughter and offer me a chocolate eclair all at the same time. When I needed the toilet it was her, rather than any of the empty-handed men on the train around us, who offered to hold my baby so I could wee without the need for contortion. In both cases, the help was offered immediately, without judgement, in good humour and simply because those women knew how it felt to be me. We had an unspoken, unbreakable thread of empathy and mutual understanding that age, religion, language, income or taste in power ballads could not break.
Read more: Bringing Up Baby: My First Family Holiday
I'll be honest; I dreaded making "mum friends" in precisely the way I'd dreaded making "school friends" and "uni mates", meeting "other couples" and "travelling companions", going out with "work friends" or any of the other, many forced social groupings that life entails. Much easier, I thought, to just impregnate my existing friends (after all there is, in the words of my mother, "plenty of sperm swimming about"). But two amazing things happened. Firstly, old friends, women I'd almost lost touch with, acquaintances, people I'd known at school, family friends and a huge swathe of other peripheral angels flew to my side the minute I pushed out into this new life. They sent letters, food, baby clothes, toys, blankets, breast pads, sanitary towels, chocolate, pyjamas, even nappy ointment and teething powder. Secondly, and with enormous relief, I learned that the "mum friends" I met through NCT - those women I'd met under the strip lights of a salvation army hall on Tuesday nights, turned out to be funnier, kinder, more droll, more patient and more genuinely entertaining than I had ever dared hope. The floodgates opened and, suddenly, there were mums I wanted to meet at every turn.
Read more: Bringing Up Baby: Motherhood Is A Full-Time Job
The nods of recognition, the held open doors, the looks of weary sympathy as you fight a flailing demon into yet another set of knitted sleeves; the spontaneous conversations in public places; the offers of help - babies open up a portal to another, kinder, more social world where women see and are seen by each other. For the first time since school I genuinely feel like I'm in a gang, only this time instead of furry animal stickers and spiral laces our hallmarks are Baby on Board badges and plastic buggy covers. I'm in the club, you see. And I love it.

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Bringing Up Baby: The Birth Of A Thousand Friendships

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Since she had a baby four months ago, Nell Frizzell has met more funny, interesting, kind and generous women than entire years previous

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Breastfeeding is a primary physiological function:

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Breastfeeding is a primary physiological function:

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Breastfeeding is not something women simply choose to do, it is an instinct, a biological imperative. Tomsickova Tatyana/Shutterstock

Women are increasingly opening up about their breastfeeding struggles. However, as individual as each story is, many have a core theme - it wasn't working and no one could tell them why.

Given the breadth and depth of medical knowledge, why do women still not have answers if they can't breastfeed? Why do GPs have such little training on the breast, breastfeeding and human milk? Why are women who are struggling left to hunt down their own support, due to cuts in breastfeeding support services?

Why? Because for some reason breastfeeding is still seen as a lifestyle choice that women can give or take, rather than it being a primary physiological function of a bodily organ, which helps to protect maternal physical and mental health. If you ask a mother why she wanted to breastfeed, she will say how it helped her baby's health. True, but there is another primary reason why breastfeeding is important - a woman's right to have her body function as she expects.

Breastfeeding is a biologically normal function for women's breasts. This is not to be confused with a biological or social imperative (something someone feels like they should do). It is not the breasts' only function - far from it - but we are mammals, with mammary glands to feed babies. "Biologically normal" doesn't necessarily mean easy, or that it will always work, however. But plenty of normal physiological functions - including walking and talking - are aided in their development by guidance and support, just like breastfeeding should be.

So as with any other bodily function, the breast deserves a bank of research and knowledge to enable it to function well, and answers and treatment options if it does not. If you can't smell anything you can usually visit a doctor who will perform tests on your nose, rather than telling you that your sense of smell doesn't matter and that someone else can just smell your dinner for you. But many women experiencing breastfeeding difficulties are simply told there are no tests, to stop persevering, and to give their baby a bottle of formula. They should remember that the main thing is that their baby is fed.

Breastfeeding is not simply a logical choice based on some health benefit, but an urge, an instinct. And breastfeeding is useful to women, not just as a milk delivery system but as a convenience and means of mothering. Just as we quite enjoy having a sense of smell, women can enjoy breastfeeding. They can feel empowered, healed and calmed by it. And wanting that - expecting that - is fine.

Formula milk can be life saving and some women may feel it works best for their family, but for others it can never replace the experience they hoped to have as a mother. They don't want to simply give a bottle instead. Complications and stopping breastfeeding before a woman is ready can be a huge strain on maternal mental health. Women will grieve their loss - and should be allowed to.

Reproductive health

When men's bodies don't work, the impact on their physical and mental health is widely recognised. The effect of erectile dysfunction, for example, is well recognised. There is even research into whether men are satisfied with treatment of it. In fact, five times as much research is conducted into erectile dysfunction than premenstrual syndrome and dysphoric disorder, despite the latter affecting five times as many women.

Looking deeper into the issue of reproductive health, a trial into the male contraceptive pill was halted because men were experiencing a few of the complications that many women put up with daily. Research is even conducted into men's satisfaction with their sex lives when they have a partner with endometriosis - an excruciatingly painful condition which many women are left battling alone each month because it receives little funding.

We don't ask what the health benefits are to our bodies working as they should in other ways. We just accept people want their bodies to work. Yet the debate over whether investing in breastfeeding is worth it or not, based on whatever the latest confusing write up of a research study shows, is battled frequently in the press.

Recognising breastfeeding as a bodily function rather than a lifestyle choice, and investing in the scientific field of human milk would benefit everyone, not just those who are able to breastfeed. We would have better answers for those who cannot breastfeed, and for those who are struggling to produce sufficient milk. We would have greater investment in donor human milk facilities so that more sick and premature babies could have the option. Rather than some women being forced to choose between breastfeeding or medication (despite evidence showing that the majority of medications are safe), we would have a clear evidence bank that medical professionals could refer to. Those breastfeeding would be part of a system that protected their decision rather than simply promoting it with support.

Women's bodies matter too. And that is the real reason why investing in breastfeeding matters.

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Breastfeeding isn't just about the baby - women's bodies matter too

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Women are increasingly opening up about their breastfeeding struggles. However, as individual as each story is, many have a core theme - it wasn't working and no one could tell them why. Given the breadth and depth of medical knowledge, why do women still not have answers if they can't breastfeed?

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A long and very interesting article about the profound changes that happen in the brains of new mothers:

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A long and very interesting article about the profound changes that happen in the brains of new mothers:

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IN THE WEEKS AFTER my first son was born, I squandered hours of precious sleep leaning over his bassinet to check that he was still breathing, or Googling potential dangers that seemed to grow into monstrous reality by the blue light of my smartphone. Among them: The lead paint my husband and I had discovered recently - a real but manageable risk - had turned our new home into a hazard zone. I cleaned our floors incessantly but still imagined a cartoonish cloud of poison dust following us as I carried the baby, so tiny and fragile, from room to room.

When the doctor screened for postpartum depression during my six-week checkup, she noted that my responses to the questionnaire were somewhat mixed though my score was within the normal range. She asked whether I had thoughts about harming myself or my child and, when I said no, she moved on. But I was struggling. Before baby, I had managed a tendency toward low-level worry. Now, it was as if the volume had been turned up. Among the biggest worries I faced was worry itself.

The way I saw it, motherhood made me feel this way, and I would be a mother forevermore. Would I always be this anxious? And would my baby suffer for it? I feared that something deep within me - my disposition, my way of seeing the world, myself - had been altered.

In truth, something very foundational had changed: my brain.

What I didn't know then - what I wish I had known then - was that I was in the midst of the most rapid and dramatic neurobiological change of my adult life. The unmooring I felt, and that so many new mothers feel, likely was at least in part a manifestation of structural and functional brain changes, handed down through the millennia by mothers past and intended to mold me into a fiercely protective, motivated caregiver, focused on my baby's survival and long-term well-being.

In the past two decades or so, researchers have begun documenting the makeover of the maternal brain. But while the transformation thought to occur is stunning, the brain remains almost entirely absent from the popular conversation about what it means to become a mother, even as a woman's body - the status of Kate Middleton's baby weight, for instance - is open to discussion ad nauseam.

Entering into motherhood is "a major event" for the brain, says Jodi Pawluski, a researcher at University of Rennes 1 in France who focuses on what she and her colleagues call the " neglected neurobiology" of the maternal brain. "It's one of the most significant biological events, I would say, you would have in your life."

Women experience a flood of hormones during pregnancy, childbirth, and breast-feeding that primes the brain for dramatic change in regions thought to make up the maternal circuit. Affected brain regions include those that enable a mother to multitask to meet baby's needs, help her to empathize with her infant's pain and emotions, and regulate how she responds to positive stimuli (such as baby's coo) or to perceived threats. In the newborn months, a mother's interaction with her infant serves as further stimulus to link her brain quite tangibly to her baby's.

Some effects of those brain changes may moderate over time. Researchers have found that the anxiety or hypervigilance that many new mothers feel, for example, peaks in the first month postpartum and then diminishes. But they suspect that other effects linger, shaping mothers even well past their child-rearing years and even influencing their relationships with future grandchildren.

In one key study, a team of researchers used anatomical magnetic resonance imaging to look at the brains of women who were not pregnant but hoped to be. The researchers followed up with images soon after childbirth and again two years later. For comparison, they scanned women who had never had a pregnancy.

After childbirth, the volume of gray matter in the mothers' brains changed dramatically, particularly in regions involved in social processes and "theory of mind," or the ability to attribute emotions and mental states to other people - key in raising a human. The degree of change, enough that researchers could easily sort the women who had had a pregnancy from those who hadn't, surprised Elseline Hoekzema, a lead author on the 2016 paper who studies pregnancy and the brain at Leiden University in the Netherlands.

"I've never seen anything like this in any of the data sets I've worked with," Hoekzema said by e-mail. "In a way, it's no surprise given the very extreme nature of the hormone floods that women are exposed to during this period, but still I hadn't expected such remarkably robust findings and this degree of differentiation."

The more brain change the mothers experienced, the higher they scored on measures of emotional attachment to their babies, a finding that echoed past studies. And the changes in most brain regions remained two years later.

The researchers also scanned men, those who became fathers during the study period and those who did not have a child, and found no comparable change in gray matter volume. (Other studies have found that fathers, including gay fathers raising children without maternal involvement, experience significant changes in brain activity, but those changes depend on exposure to the child. The more time a man spends as primary caregiver, the more activated the parental network in his brain becomes, and researchers suspect a similar effect may be present for others in a parental role.)

The brain scans seemed to validate the rapid, pronounced, long-lasting change in mothers that a much bigger body of animal research has found. Reviewing a range of studies, Pawluski and her coauthors wrote in a 2016 paper that as a developmental period, pregnancy is as formative as puberty. "Under healthy conditions, the female brain transforms into a motivated, maternal mechanism," they wrote.

Researchers are a long way from being able to say what changes in the brain mean for an individual woman's experience of new motherhood or how they interact with the physiological demands of that phase of life, such as breast-feeding and sleep deprivation. They are just beginning to investigate how the maternal brain is affected by trauma, such as abuse and poverty, or by substance use. Importantly, they can't yet say whether postpartum mood disorders are the result of something gone awry in the typical changes that a mother's brain goes through or whether they are caused by a triggering of other brain circuitry.

Doctors, pregnancy books, and mom blogs typically do alert women to the standard list of symptoms of postpartum depression, sometimes including other postpartum mood disorders, such as severe anxiety or obsessive compulsive disorder. They encourage women to seek help if they experience symptoms such as hopelessness, excessive worrying, trouble bonding with baby, or a loss of interest in friends and family, especially when those symptoms interfere with their ability to take care of themselves or their child. As many as 1 in 5 women will develop postpartum mood disorders at some point after giving birth, and educating people about those conditions is critical. But these sources typically spend very little time on the neurobiological changes all mothers can expect to face.

What would happen if we gave expectant mothers even a basic understanding of how and why their brains change? Would it help them to cope with the unfamiliar emotional experiences that very often are part of a healthy experience of new motherhood? Might it open a door for women who experience more problematic symptoms to talk with their loved ones or their doctor? Could it even help some women to feel empowered by their own biology?

As I read and researched, my anxiety began to feel manageable. But my frustration grew. So many women feel changed by motherhood in ways that can be unsettling and confusing. Here was information that might provide comfort to some: In most cases, not only are these changes normal, they also are productive, helping women to become the parents that their babies need. Why hadn't I known this sooner?

IN THOSE FIRST HARRIED WEEKS of new motherhood, I paged through a stack of hand-me-down parenting books while the baby slept. I was looking for something that could explain how I was feeling. In a worn copy of Infants and Mothers: Differences in Development by famed pediatrician and child development expert T. Berry Brazelton, first published in 1969, I came to a section about bringing home a newborn and read this: "Caring concern will become the foundation for learning to be a parent."

Many new mothers say that they feel like crying "most of the time" and wonder if that means they aren't cut out for being a mother, Brazelton wrote. "It must be reassuring to know that this is a common result of the physical and psychological readjustments that follow delivery. These will pass. They may even be an important part of her ability to become a different kind of person - a 'mother,' rather than a young girl."

I'd think about that passage often in the months to come as I dug into the research. The pregnancy tracker app that I had looked at almost daily before giving birth to see how my body was changing used an animated diagram of a woman from the neck down. Yet, half a century ago, Brazelton, who died in March, had sensed what researchers have begun to validate today using brain-imaging tools and animal models: that mothers become "a different kind of person."

Brazelton, then about to turn 98, answered his cellphone when I called in spring 2016, just as my son was turning 1. We met for lunch at Concord's Colonial Inn. He had traveled with a caregiver from his home on Cape Cod to attend the funeral of a former colleague from Boston Children's Hospital. I told him my story, what the passage from his book meant to me during some particularly dark days, and how it spurred my interest in the neurobiology of the maternal brain. Then, it seemed, our therapy session began.

The anxiety I experienced was typical, he said: "You're frightened and you don't feel adequate and you're working very hard to pull yourself together, to start facing this child that you've fallen desperately in love with for the first time in your life, and you realize what a major responsibility that is and what a turning point in your life it is. . . . I see getting disorganized and thrown into a frenzy like that as a major opportunity to reorganize yourself and pull yourself back together and become the new person that you want to be."

Brazelton said that had been his philosophy since he began practicing in Cambridge in 1951. "At that point, everything that went wrong with the child was blamed on the parents. And the parent was already feeling inadequate and guilty, so it re-enhanced the feeling of failure. It seemed to me that was the opposite of what we ought to be doing. We ought to be building up a mother's self-esteem, so she can pass that on to her child."

Brazelton said he was encouraged by the federal task force recommendation made just a few months before our meeting that all women who are pregnant or who have recently had a child be screened for depression, and he hoped a movement among pediatricians to be more involved in maternal mental health would grow.

By that point, I felt sure he would agree with my conclusion: Shouldn't we be better preparing mothers about well-documented brain changes they could expect, before baby is born?

"I don't think that most mothers are ready for that kind of information," Brazelton said. "It would scare a lot of people. I don't think they'd want to think their brains are going to change. They'd be frightened about which way it was going to go."

If mothers raised the topic with him, he said, he would be glad to talk about it. Otherwise, it might add too much to their fears.

I fumbled with my words, dismayed and confused. The conversation had been so uplifting. Here suddenly was the heavy idea that women can't handle information about their own bodies, their own brains. "Isn't that a very, in a sense, old-fashioned idea?" I asked, self-conscious even as I said it about posing such a question to someone of Brazelton's experience and stature. He took the question differently than I meant it and talked about the challenges of working mothers who lack social support. Our lunch ended soon after. People were gathering at the church.

BRAZELTON WAS A PROGRESSIVE DOCTOR in his day. He listened to mothers at a time when others discounted them. That's what drew people to his writing and to his popular cable TV show, What Every Baby Knows. Yet his comments to me seemed anchored in the idea that motherhood - women in general, perhaps - requires careful handling, an old idea that remains pervasive.

The truth is, it's easier to talk about decorating the nursery than about the gripping fear that sends you into a full-body sweat the first time you take baby to the grocery store. It's more comfortable to debate baby names and stroller brands than to discuss the depth of loneliness that can come at 2 a.m. when you are awake again with a crying baby.

"There is stigma [attached to] talking about challenges," says Liz Friedman, a founder of MotherWoman, which organizes a network of perinatal support groups across Massachusetts. "We don't want to tell pregnant women about challenging births," says Friedman, who now runs Group Peer Support for Parents. "We want to keep this facade that motherhood is everything we've ever hoped for and pregnancy is blissful. . . . We feel like we are raining on people's parades and dramatizing our own struggles and scaring people, and we don't want to do those things."

"Yet," she says, "we do need to talk about this."

Some of the obstacles to a more open conversation are deeply rooted - ancient, even. The belief that a woman's uterus puts her at risk for "hysteria" goes back about 4,000 years. Today, of course, the idea that her brain is muddled by motherhood fuels pregnancy discrimination in the workplace and elsewhere. The research on "mommy brain," the forgetfulness or general fogginess that many women report experiencing, is somewhat mixed. Deficits in memory and cognitive function that have been detected are generally small, are thought to disappear over time, and may be a function of the brain adapting to its new role.

Even as we've gained a more nuanced picture of how neurology and genetics influence mental health in the population at large, researchers are playing catch-up when it comes to maternal mental health. Generations of scientists were uninterested in the topic, says Dr. Peter Schmidt, chief of behavioral endocrinology at the National Institute of Mental Health, who has studied postpartum issues since 1986. Schmidt focuses largely on determining the triggers for postpartum depression or psychosis.

"Nobody cared, really, because they were women's issues," he says-not seen as the serious matter of public health that they are. Male researchers who were interested sometimes experienced pushback from women worried about "a longstanding misogynism that women are impaired by their reproductive system."

The field has broadened considerably in recent years, Schmidt says, with a growing interest in the maternal brain, specifically, newer technology available to study it, and the publication of high-profile papers that have proven to investigators that studying maternal mental health is "not career suicide." Notably, the number of women researchers has grown, too.

There's also a recognition of gaps in understanding how men and women differ. The American College of Physicians in May issued a call to close those gaps by including more women as subjects in clinical research and regularly reporting gender-specific data in the results of those studies.

If women have been too often absent from scientific studies in general, it follows that there has been "an invisibility" of the mother, says Dr. Alexandra Sacks, a reproductive psychiatrist in New York and coauthor of a forthcoming guide to the emotions of pregnancy and new motherhood.

Parenting research is typically focused on the child. Researchers I interviewed said they often get a version of this response when they apply for funding to investigate the maternal brain: What about the offspring? The emphasis on babies "is understandable," Sacks says, "but it's time to also recognize the mother's health story."

That's beginning to happen, says Dr. Samantha Meltzer-Brody, director of the perinatal psychiatry program at the University of North Carolina and president of Marce of North America, a group that advocates for maternal mental health research, clinical care, and education. For a long time, she says, she felt like one of a few vigilantes in her field, pushing to get mothers struggling with postpartum mood disorders the support they needed. Recent years have brought a "huge sea change," though there's much more to be done.

Participation in postpartum support groups has swelled. The American College of Obstetricians and Gynecologists recently recommended redesigning postpartum care to include a fuller assessment of a woman's mood and emotional well-being. And the first drug for treating severe postpartum depression could hit the market soon. Meltzer-Brody was principal academic investigator on clinical trials that found brexanolone, made by Cambridge-based Sage Therapeutics and administered intravenously over about 2½ days, significantly reduced symptoms in women with severe postpartum depression.

Still, while postpartum disorders have begun getting the attention they desperately need, less time is spent helping women to understand the range of what is typical for a healthy postpartum experience and developing a new idea of motherhood that does not romanticize it. "That's where we need to go next," Meltzer-Brody says.

I started thinking about a map of the maternal brain as a kind of tool to cut through the romanticization, the history of scientific neglect, the invisibility of mothers. The map would be a tangible measure of the profoundness of new motherhood - one that demonstrates with certainty that the changes women experience "are biological and not constitutional," as Dr. Leena Mittal, director of reproductive psychiatry at Brigham and Women's Hospital, puts it.

What we know about the maternal brain so far demands more investigation, Mittal says. But she and other clinicians I spoke with were less convinced that a routine discussion about typical brain development is warranted during prenatal care. One worried about women who feel the pressure to do everything just right during pregnancy, and how learning about how a woman's neurobiology connects with infant bonding might add to that pressure. There are no specific conclusions that doctors can draw from the brain research to help an individual make choices about how best to care for herself and her baby, Mittal says.

"What we know at this point is interesting and very much the beginning," she says. "What it really, truly means in terms of targeted treatment - that's the goal."

DOCTORS AND OTHER PROVIDERS who care for pregnant women have a lot to cover. Many women learn about even very common physical effects of pregnancy - diastasis recti, for example, or a separation of the abdominal muscles that can contribute to low back pain and pelvic floor dysfunction - not from their doctors, but from friends or family members. Maybe the evolution of the maternal brain will be like that, a topic discussed more commonly in breast-feeding classes and mothers' groups.

That would be helpful, of course. But is it enough? For one thing, many women don't have access to those support networks or don't connect with them until they find themselves struggling.

Kate Worrall doesn't remember any of the medical professionals she saw during pregnancy and through labor talking with her about her brain or the emotional context of new motherhood, beyond rote language about identifying postpartum depression. The 33-year-old lobbyist from Sharon was unprepared for the range of emotions she felt when she brought her son Tommy home from the hospital in December 2015 or when short winter days during maternity leave began bleeding into long, sleepless nights.

"I felt a little bit more lost than I had anticipated," she says.

She had never struggled with anxiety before having a baby. But the challenges of comforting a screaming child and getting him to sleep stirred up a feeling of helplessness that she says she still struggles with today, though she eventually found a therapist who could help her cope.

"I did feel blindsided by it," she says.

She was surprised when friends started telling her they had had similar experiences. As she awaited the arrival of baby Colin, born in June, she at least felt more prepared this time. Now, she said she makes it a point to talk with other expectant mothers about the mental and emotional challenges of motherhood. But Worrall says this isn't just a matter for mothers to talk more openly about. She sees the anxiety she still experiences as part of the biological changes of motherhood that should be covered during prenatal care. "Like with all sorts of mental health, it needs to be just a component of the broader physical health," she says.

If that education is done thoughtfully, it could even be empowering.

A mother's brain is a powerful thing.

A surge of oxytocin at childbirth triggers changes that allow a woman quite literally to sync to her baby through a coordination of biology (synchronized brain responses and heart rates) and behavior (matching responses in gaze, touch, and vocalizations). That intense connection teaches a baby from the very first day how to relate to another person, says Ruth Feldman, Simms-Mann Professor of Developmental Neuroscience at the Interdisciplinary Center in Herzliya, Israel. When we connect with friends, romantic partners, and colleagues and even as we view ourselves as a member of a sports team or as part of a nation, we "repurpose the basic machinery" established in the connection between mother and baby, she explained in a 2017 paper on the neurobiology of human attachment.

The parental brain incorporates human-specific functions such as empathy with ancient ones aimed at protecting the young for the survival of the species. That complexity makes it "a peak expression of human evolution," she says. In fact, she speculates that the parental bonding phenomenon came first. Before there were humans.

"Who we are is about parents," she says. "The maternal brain is the key."

Feldman thinks we should talk about it. Women experience so much change during pregnancy and new motherhood, she said. "If they understand it more, where it comes from and also how natural it is and how important it is for the child's brain and the child's development - it helps you go through it."

Research on the maternal brain is still relatively new, and talking about the findings requires some careful consideration, Feldman says. "But the fact that it would take some mindfulness on how to disseminate this information doesn't mean we shouldn't give it."

I anticipated the emotional roller coaster of motherhood as I was expecting my second child last summer. Knowing what may be coming didn't make the ups and downs any less real, but it made them less scary. I worried plenty. But I didn't worry about the worry.

I wonder how things would have been different the first time around if I'd known more. I might have coped better if I'd understood that some of what I was experiencing was just my brain- this dynamic, empathy-teaching, humankind-shaping maternal brain - doing exactly what it was supposed to do. Maybe, at the very least, it would have helped me to put down my smartphone at night and get some sleep.

Chelsea Conaboy is a freelance writer and editor focused primarily on health care. She lives in Portland, Maine. Send comments to magazine@globe.com. Get the best of the magazine's award-winning stories and features right in your e-mail inbox every Sunday. Sign up here.

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american college of obstetricians and gynecologists

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Pregnant women don't learn about profound brain changes - The Boston Globe

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IN THE WEEKS AFTER my first son was born, I squandered hours of precious sleep leaning over his bassinet to check that he was still breathing, or Googling potential dangers that seemed to grow into monstrous reality by the blue light of my smartphone.

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A mum's experience of going back to work at 4 weeks:

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Traditional practices that support new mothers

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Traditional practices that support new mothers

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Is ours not a strange culture that focuses so much attention on childbirth-virtually all of it based on anxiety and fear-and so little on the crucial time after birth, when patterns are established that will affect the individual and the family for decades? - Suzanne Arms.

As citizens of an industrialized nation, we often act as if we have nothing to learn from low-income, developing countries. Yet many of these cultures are doing something extraordinarily right-especially in how they care for new mothers. In their classic paper, Stern and Kruckman ( 1983) present an anthropological critique of the literature. They found that in the cultures they studied, postpartum disorders, including the "baby blues," were virtually nonexistent. By contrast, 50% to 85% of new mothers in industrialized nations experience the "baby blues," and 15% to 25% (or more) experience postpartum depression.

Ken Tackett

What makes the difference?
Stern and Kruckman noted that cultures who had a low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. These cultures, although quite different from each other, all shared

5 protective social structures

Ken Tackett

1. A distinct postpartum period. In these other cultures, the postpartum period is recognized as a time that is distinct from normal life. It is a time when the mother is supposed to recuperate. Her activities are limited and her female relatives take care of her. This type of care was also common in colonial America, when postpartum was referred to as the "lying-in" period. This period functioned as a time of "apprenticeship," when more experienced mothers mentored the new mother.

2. Protective measures reflecting the new mother's vulnerability. During the postpartum period, new mothers are recognized as being especially vulnerable. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are prominent in the postpartum rituals of rural Guatemala, Mayan women in the Yucatan, Latina women both in the United States and Mexico. These rituals also mark the postpartum period as distinct from other times in women's lives.

3. Social seclusion and mandated rest. Postpartum is a time for the mother to rest, regain strength, and care for the baby. Related to the concept of vulnerability is the widespread practice of social seclusion for new mothers. For example, in the Punjab, women and their babies are secluded from everyone but female relatives and their midwives for five days. Seclusion is said to promote breastfeeding and it limits a woman's normal activities. In contrast, many American mothers are expected to entertain others-even during their hospital stay. Once they get home, this practice continues as they are often expected to entertain family and friends who come to see the baby.

4. Functional assistance. In order for seclusion and mandated rest to occur, mothers must be relieved of their normal workload. In these cultures, women are provided with someone to take care of older children and perform their household duties. As in the colonial period in the United States, women often return to the homes of their family of origin to ensure that this type of assistance is available.

5. Social recognition of her new role and status. In the cultures Stern and Kruckman studied, there was a great deal of personal attention given to the mother. In China and Nepal, very little attention is paid to the pregnancy; much more attention is focused on the mother after the baby is born. This has been described as "mothering the mother." For example, the status of the new mother is recognized through social rituals and gifts. In Punjabi culture, there is the "stepping-out ceremony," which includes ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When the mother returns to her husband's family, she returns with many gifts she has been given for herself and the baby. The following is a description of a postpartum ritual performed by the Chagga of Uganda. It differs quite a bit from what mothers in industrialized countries may experience. ￼

Three months after the birth of her child, the Chagga woman's head is shaved and crowned with a bead tiara, she is robed in an ancient skin garment worked with beads, a staff such as the elders carry is put in her hand, and she emerges from her hut for her first public appearance with her baby. Proceeding slowly towards the market, they are greeted with songs such as are sung to warriors returning from battle. She and her baby have survived the weeks of danger. The child is no longer vulnerable, but a baby who has learned what love means, has smiled its first smiles, and is now ready to learn about the bright, loud world outside (Dunham, 1992; p. 148).

What American mothers experience

Ken Tackett

By contrast, American mothers often find that people are more concerned about them before the birth. While a woman is pregnant, people may offer to help her carry things or to open doors or to ask how she is feeling. Friends will give her a baby shower, where she will receive emotional support and gifts for her baby. There are prenatal classes and prenatal checkups, and many people wanting to know about the details of her daily experience.

After she has her baby, however, mother-focused support rapidly declines. Typically, a woman is discharged from the hospital within 24 to 48 hours after a vaginal birth, or 2 to 4 days after a cesarean section. She may or may not have anyone to help her at home-chances are no one at the hospital has even asked. Her mate will probably return to work within the week, and she is left alone to make sure she has enough to eat, to teach herself to breastfeed, and to recuperate from birth. The people who provided attention during her pregnancy are no longer there, and the people who do come around are often more interested in the baby. There is the tacit-and sometimes explicit-understanding that she is not to "bother" her medical caregivers unless there is a medical reason, and she must wait to talk to her physician until her six-week postpartum checkup. There probably are resources in her community that may help, but she has no idea where they are, and feels too overwhelmed to seek them out for herself. So she must fend for herself as best she can.

Ken Tackett

Is it any wonder that many women find the postpartum period to be extremely stressful? One popular book written for new mothers (Eisenberg, et al., 1989) describes this transition as "the reverse Cinderella-the pregnant princess has become the postpartum peasant" with a "wave of the obstetrician's wand" (p. 546).

Here are some comments mothers have shared with me.
I felt like I didn't matter. I felt like they weren't interested in me after I had my baby. My husband said, "Of course they are not interested. You've had your baby." After the birth, I had several people tell me that the most important thing was that I had a healthy baby. Yes, that is important. But what about me? No one pays attention to the fact that you've had major surgery. They would have paid more attention if I'd had had my appendix out.
As a culture, we have woefully neglected the needs of new mothers. But this was not always so. Historically, we recognized the importance of a community of women helping women, who provided this much needed practical and emotional assistance. In so doing, they provided a chance for postpartum women to recuperate and assimilate the major change that had taken place in their lives. Chances are it will be many years before there are organized efforts aimed at providing care for new mothers. The good news is that a grassroots movement has begun that seeks to meet the needs of postpartum women.

In store

The word " doula"-from the Greek word for servant-is becoming part of our vocabulary. A postpartum doula is someone who takes care of postpartum women by providing practical and emotional assistance (Lim, 1995; Webber, 1992). Friends, family or a woman's partner can be doulas. Or women in some communities might be able to hire a professional doula. In either case, the doula movement is in response to the lack of postpartum care available from traditional care providers.

In the following account, doula Salle Webber describes her care for new mothers and the types of support and assistance that they need.
In my work as a doula, my focus is on the mother. I want to provide whatever it is that she needs to feel comfortable, nourished, relaxed, and appreciated: to facilitate a harmonious transition for both mother and child in those profound first days and weeks after birth.
A mother needs someone who cares about how many times the baby woke to nurse in the night, how many diapers were changed, how her breasts are feeling. She may need her back massaged or her sheets changed, or she may need someone to provide an abundant supply of water or tea, salads ready-made in the refrigerator, a bowl of cut-up fruit. She needs to be able to complain about how little her mate understands what she's going through, and perhaps, some gentle reminders of all the contributions he has made. She needs someone to hold the baby so she can take a shower or even go to the bathroom; someone to answer the phone when she's napping; someone to water her plants or garden, to clean the kitchen and bathroom, to keep up on the family's laundry. She may have many questions and concerns that only an experienced mother can understand. She needs patience and kind words and a clean and calm environment (Webber, 1992, p. 17).

While our culture continues to lack supportive postpartum rituals, the work of individual women can make a significant difference. Many are surprised that this decidedly "low-tech" intervention can work. Yet this is perhaps the most important lesson we can learn from the cultures that Stern and Kruckman described.

We must begin to change the way we think about providing care for new mothers. This care should not stop once the baby is born, but should continue throughout the postpartum period.

In conclusion, we have learned that women can make a comfortable and peaceful transition into motherhood. Postpartum mental illness is not inevitable and in many cases can be prevented. It is time that we recognize and meet the needs of postpartum women. The health of our families depends on it.￼￼￼￼￼￼￼￼￼￼

References

Eisenberg, A., Murkoff, H.E., & Hathaway, S.E. (1989). What to Expect the First Year. New York: Workman.

Lim, R. ( 1995). After the Baby's Birth: A woman's way to wellness. Berkeley, CA: Celestial Arts. New edition: ( 2004). After the Baby's Birth: A Complete Guide for Postpartum Women.

Stern, G. & Kruckman, L. ( 1983). Multidisciplinary perspectives on postpartum depression: An anthropological critique. Social Science and Medicine, 17, 1027-1041.

Webber, S. (1992). Supporting the postpartum family. The Doula, 23, 16-17.

Kathleen Kendall-Tackett, PhD, IBCLC, FAPA

Dr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women's health. She is Editor-in-Chief of two peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the Board for the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett specializes in women's-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2016 Outstanding Service to the Field of Trauma Psychology from the American Psychological Association's Division 56.

Dr. Kendall-Tackett has authored more than 400 articles or chapters, and is currently completing her 35th book, The Phantom of the Opera: A Social History of the World's Most Popular Musical. Her most recent books include: Depression in New Mothers, 3 rd Edition (2016, Routledge UK, in press), Women's Mental Health Across the Lifespan (2016, Routledge US, in press, with Lesia Ruglass), Psychology of Trauma 101 (2015, Springer, with Lesia Ruglass) and The Science of Mother-Infant Sleep (2014, Praeclarus, with Wendy Middlemiss). Her websites are:

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Why Does Our Culture Focus So Much on Childbirth and So Little on The Time After?

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Save Is ours not a strange culture that focuses so much attention on childbirth-virtually all of it based on anxiety and fear-and so little on the crucial time after birth, when patterns are established that will affect the individual and the family for decades?

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Suggestions from members of NWL Breastfeeding:

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You are very welcome to join NWL Breastfeeding, a Facebook group some mothers I've supported and I created a few years ago. It's a wonderful source of information, support and friendship. We have over 1000 members: pregnant women, new mothers, mothers of older babies, and very experienced breastfeeders. Several of my colleagues are also members, and we keep a close eye on posts to make sure all the information exchanged is accurate and evidence-based. It's a secret group, so to join you'll need to send me a friend's request on Facebook (Cordelia Uys). As soon as I've added you to the group, I promise to 'unfriend' you. Here are some comments by members of NWL Breastfeeding on why they think it's worth joining the group: 

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You are very welcome to join NWL Breastfeeding, a Facebook group some mothers I've supported and I created a few years ago. It's a wonderful source of information, support and friendship. We have over 1000 members: pregnant women, new mothers, mothers of older babies, and very experienced breastfeeders. Several of my colleagues are also members, and we keep a close eye on posts to make sure all the information exchanged is accurate and evidence-based. It's a secret group, so to join you'll need to send me a friend's request on Facebook (Cordelia Uys). As soon as I've added you to the group, I promise to 'unfriend' you. Here are some comments by members of NWL Breastfeeding on why they think it's worth joining the group: 

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REASONS TO JOIN NWL BREASTFEEDING 18th April 2017

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Once mothers get to 6 months of breastfeeding, the can join NWL Marathon Breastfeeders, which is a closed group.  

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Once mothers get to 6 months of breastfeeding, the can join NWL Marathon Breastfeeders, which is a closed group.  

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The friendships made when you become a mother:

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Last weekend, while sitting in my local leatherette-clad greasy spoon cafe, wiping up my lasagne sauce with a pile of chips (you betcha) and humming along to the strains of Magic FM, my son decided to fill his pants like a man facing down a bungee jump after a four course buffet. As the cold realisation that there were no baby changing facilities dawned on me like an icecube down my neck the small, middle-aged owner, rather than rolling her eyes at yet another demanding customer, took me through to a room in the back, laid a clean teatowel down on an empty sideboard and left me to change my baby beside a stack of tinned tomatoes half my height. On a train down from Liverpool a few weeks ago, a half Yemeni, half Iraqi dentist gave me breastfeeding tips as she managed, somehow, to repin her headscarf, feed her daughter and offer me a chocolate eclair all at the same time. When I needed the toilet it was her, rather than any of the empty-handed men on the train around us, who offered to hold my baby so I could wee without the need for contortion. In both cases, the help was offered immediately, without judgement, in good humour and simply because those women knew how it felt to be me. We had an unspoken, unbreakable thread of empathy and mutual understanding that age, religion, language, income or taste in power ballads could not break.
Read more: Bringing Up Baby: My First Family Holiday
I'll be honest; I dreaded making "mum friends" in precisely the way I'd dreaded making "school friends" and "uni mates", meeting "other couples" and "travelling companions", going out with "work friends" or any of the other, many forced social groupings that life entails. Much easier, I thought, to just impregnate my existing friends (after all there is, in the words of my mother, "plenty of sperm swimming about"). But two amazing things happened. Firstly, old friends, women I'd almost lost touch with, acquaintances, people I'd known at school, family friends and a huge swathe of other peripheral angels flew to my side the minute I pushed out into this new life. They sent letters, food, baby clothes, toys, blankets, breast pads, sanitary towels, chocolate, pyjamas, even nappy ointment and teething powder. Secondly, and with enormous relief, I learned that the "mum friends" I met through NCT - those women I'd met under the strip lights of a salvation army hall on Tuesday nights, turned out to be funnier, kinder, more droll, more patient and more genuinely entertaining than I had ever dared hope. The floodgates opened and, suddenly, there were mums I wanted to meet at every turn.
Read more: Bringing Up Baby: Motherhood Is A Full-Time Job
The nods of recognition, the held open doors, the looks of weary sympathy as you fight a flailing demon into yet another set of knitted sleeves; the spontaneous conversations in public places; the offers of help - babies open up a portal to another, kinder, more social world where women see and are seen by each other. For the first time since school I genuinely feel like I'm in a gang, only this time instead of furry animal stickers and spiral laces our hallmarks are Baby on Board badges and plastic buggy covers. I'm in the club, you see. And I love it.

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Bringing Up Baby: The Birth Of A Thousand Friendships

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Since she had a baby four months ago, Nell Frizzell has met more funny, interesting, kind and generous women than entire years previous

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A mother's diet can protect nursing babies:

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A mother's diet can protect nursing babies:

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Research published in the Journal of Experimental Medicine today indicates that a mother's diet can protect nursing newborns against food allergies. Conducted by researchers at Boston Children's Hospital and Harvard Medical School, the study offers an explanation for how breastfeeding can promote tolerance to the foods that most often cause allergies. The study received support from Food Allergy Research & Education (FARE), the world's largest private source of funding for food allergy research. Michiko Oyoshi, the senior author of the study, received FARE's Mid-Career Investigator in Food Allergy Award in 2015.

In mice, milk from mothers exposed to egg protein gave protection against egg allergy not only to the mothers' own offspring, but also to fostered newborns whose birth mothers had not received egg. Newborns gained an insignificant degree of protection from mothers who were exposed to egg during pregnancy but did not breastfeed them. The protective effect was strongest when the newborns were born to and nursed by mothers who were exposed to egg before and during pregnancy and breastfeeding.

The study's findings are consistent with new dietary recommendations for pregnant and nursing mothers. Previous research had not been conclusive, with some studies indicating a protective role for breastmilk, and others suggesting that children could become allergic to foods they encountered through their mother's diet. Pregnant and breastfeeding mothers were sometimes cautioned against consuming foods that commonly cause allergy, such as milk, egg, peanut, tree nuts, soy, wheat, fish and shellfish. More recently, feeding peanut foods to infants at high risk for peanut allergy was shown to decrease, not increase, the babies' likelihood of developing allergy to peanut. Allergists now recommend that, unless mothers already have diagnosed food allergies, they should not avoid allergenic foods while pregnant and nursing.

"This elegantly designed and controlled study shows that mothers should feel free to eat a healthy and diverse diet throughout pregnancy and while breastfeeding," said Dr. James R. Baker, Jr., FARE CEO and Chief Medical Officer. "Eating a range of nutritious foods during pregnancy and breastfeeding will not promote food allergies in developing babies, and may protect them from food allergy."

At the same time, Baker notes that maternal and early childhood diets do not cause food allergies in children. Most children do not develop food allergies, regardless of how they are fed., while some children develop allergies even when fed an optimal diet. "More research is needed to untangle the factors contributing to make food allergies much more prevalent in recent decades."

The food allergy protections described in the study are dependent on specific proteins, some provided by the mother, others by the offspring. By identifying these proteins and proposing a mechanism through which mother and offspring contribute to the development of food tolerance in the newborn mouse, the research opens new opportunities to study how the protections break down in the case of food allergy and how such breakdowns might be prevented. Preventing food allergy is critical because there are no approved treatments for this serious and potentially life-threatening condition that affects 15 million Americans.

The mouse study found that when a nursing mother is exposed to a food protein, her milk contains complexes of the food protein combined with her antibodies, which are transferred to the offspring through breastfeeding. Aided by a protein in the offspring's gut lining and some immune cells, the food protein-antibody complexes are taken up and introduced to the offspring's developing immune system, triggering the production of protective cells that suppress allergic reactions to the food. These protective cells persist after antibodies from the mother are gone, promoting long-term tolerance to the food.

A similar mechanism may offer protection to human infants. "Humanized mice," in which some proteins of the mouse immune system have been replaced with human immune proteins, were protected from egg allergy by human breastmilk containing complexes of egg white protein and human antibody. Oyoshi's research team is now enrolling human mothers in a study that will compare breastmilk from mothers of children at low risk or high risk for food allergy and will examine the contents of breastmilk before and after the nursing mother eats peanuts.

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Mother's diet can protect nursing newborns against food allergies, research shows

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Research published in the Journal of Experimental Medicine today indicates that a mother's diet can protect nursing newborns against food allergies. Conducted by researchers at Boston Children's Hospital and Harvard Medical School, the study offers an explanation for how breastfeeding can promote tolerance to the foods that most often cause allergies.

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You are also welcome to join NWL Perinatal Mental Health, which is a closed group. 

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You are also welcome to join NWL Perinatal Mental Health, which is a closed group. 

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You can check the safety of any medication you need to take while breastfeeding here: 

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You can check the safety of any medication you need to take while breastfeeding here: 

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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Here are the NHS recommendations on diet, alcohol, caffeine, vitamins and medications:

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Here are the NHS recommendations on diet, alcohol, caffeine, vitamins and medications:

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You don't need to eat anything special while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet.
A healthy diet includes:

at least 5 portions of a variety of fruit and vegetables a day, including fresh, frozen, tinned and dried fruit and vegetables, and no more than one 150ml glass of 100% unsweetened juice

starchy foods, such as wholemeal bread, pasta, rice and potatoes

plenty of fibre from wholemeal bread and pasta, breakfast cereals, rice, pulses such as beans and lentils, and fruit and vegetables - after having a baby, some women have bowel problems and constipation, and fibre helps with both of these

protein, such as lean meat and chicken, fish, eggs, nuts, seeds, soya foods and pulses - at least 2 portions of fish a week is recommended, including some oily fish

dairy foods, such as milk, cheese and yoghurt - these contain calcium and are a source of protein

non-dairy sources of calcium suitable for vegans include tofu, brown bread, pulses and dried fruit

drinking plenty of fluids - have a drink beside you when you settle down to breastfeed: water and skimmed or semi-skimmed milk are all good choices

See more detailed advice about healthy eating.

Small amounts of what you're eating and drinking can pass to your baby through your breast milk. If you think a food you're eating is affecting your baby and they're unsettled, talk to your GP or health visitor, or contact the National Breastfeeding Helpline on 0300 100 0212.

Vitamins and breastfeeding

Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10mcg of vitamin D.

From late March/April to the end of September, the majority of people aged 5 years and above will probably get enough vitamin D from sunlight when they are outdoors. So you might choose not to take a vitamin D supplement during these months

You can get all the other vitamins and minerals you need by eating a varied and balanced diet.

Ask your GP or health visitor where to get vitamin D supplements. You may be able to get free vitamin supplements without a prescription if you're eligible for Healthy Start.

You're entitled to free NHS prescriptions for 12 months after your baby is born. You will need to show a valid maternity exemption certificate to prove your entitlement.

If you did not apply for a maternity exemption certificate while you were pregnant, you can still apply at any time in the 12 months after your baby is born.

Healthy snack ideas for breastfeeding mums

The following snacks are quick and simple to make, and will give you energy and strength:

fresh fruit

sandwiches filled with salad, grated cheese, mashed salmon or cold meat

yoghurts and fromage frais

hummus with bread or vegetable sticks

ready-to-eat dried apricots, figs or prunes

vegetable and bean soups

fortified unsweetened breakfast cereals, muesli and other wholegrain cereals with milk

milky drinks or a 150ml glass of 100% unsweetened fruit juice

baked beans on toast or a baked potato

Healthy Start vouchers

You can get Healthy Start vouchers if you're pregnant or have a young child under 4 and are getting certain benefits or tax credits, or you're pregnant and under 18.

These can be spent on milk and fresh or frozen fruit and vegetables, or they can be put towards formula milk if you're not breastfeeding.

You can't use vouchers to buy fruit and veg with added fat, sugar and salt or flavourings, such as oven chips and seasoned stir fries. You can also get Healthy Start vouchers for free vitamin supplements.

For more information or an application leaflet, visit the Healthy Start website, or call the helpline on 0345 607 6823.

If you're already receiving Healthy Start vouchers, ask your midwife or health visitor where you can exchange the vouchers for vitamins.

Eating fish while breastfeeding

Eating fish is good for your and your baby's health, but while you are breastfeeding you should have no more than 2 portions of oily fish a week. A portion is around 140g.

Oily fish includes fresh mackerel, sardines, trout and salmon.

All adults should also eat no more than 1 portion a week of shark, swordfish or marlin.

See more about eating fish while pregnant or breastfeeding.

Caffeine and breastfeeding

Caffeine can reach your baby through your breast milk and may keep them awake.

Caffeine occurs naturally in lots of foods and drinks, including coffee, tea and chocolate. It's also added to some soft drinks and energy drinks, as well as some cold and flu remedies.

Caffeine is a stimulant and can make your baby restless. It's a good idea for pregnant and breastfeeding women to restrict their caffeine intake to less than 200mg a day:

1 mug of filter coffee: 140mg

1 mug of instant coffee: 100mg

1 250ml can of energy drink: 80mg (larger cans may contain up to 160mg caffeine)

1 mug of tea: 75mg

1 50g plain chocolate bar: up to 50mg

1 cola drink (354mls): 40mg

Try decaffeinated tea and coffee, herbal teas, 100% fruit juice (but no more than one 150ml glass per day) or mineral water. Avoid energy drinks, which can be very high in caffeine.

Peanuts and breastfeeding

If you'd like to eat peanuts or foods containing peanuts, such as peanut butter, while breastfeeding, you can do so as part of a healthy, balanced diet (unless, of course, you are allergic to them).

There's no clear evidence that eating peanuts while breastfeeding affects your baby's chances of developing a peanut allergy. If you have any questions or concerns, you can talk to your GP, midwife or health visitor.

See more about food allergies.

Got a breastfeeding question?

Sign into Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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You don't need to eat anything special while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet.

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Here's an article by Emma Pickett, Chair of the Association of Breastfeeding Mothers, on breastfeeding in public: 

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Here's an article by Emma Pickett, Chair of the Association of Breastfeeding Mothers, on breastfeeding in public: 

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In one of my voluntary roles, I am sometimes asked by national and local media to comment on breastfeeding issues. Today I was asked to comment on whether businesses on Kent should offer more...

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Here's information on drinking alcohol while breastfeeding:

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Here's information on drinking alcohol while breastfeeding:

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By Kelly Bonyata, IBCLC

Guidelines

Current research says that occasional use of alcohol (1-2 drinks) does not appear to be harmful to the nursing baby. Many experts recommend against drinking more than 1-2 drinks per week.

Per Hale (2019), "mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal."

The American Academy of Pediatrics Section on Breastfeeding notes: "ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, or 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk."

There is no need to pump & dump milk after drinking alcohol, other than for mom's comfort - pumping & dumping does not speed the elimination of alcohol from the milk.

If you're away from your baby, try to pump as often as baby usually nurses (this is to maintain milk supply, not because of the alcohol). At the very least, pump or hand express whenever you feel uncomfortably full - this will help you to avoid plugged ducts and mastitis.

Alcohol does NOT increase milk production, and has been shown to inhibit let-down and decrease milk production (see below).

Never share a bed or other sleeping surface with your baby if you have been drinking. Drinking affects your natural reflexes, and drinking and bed-sharing has an increased association with sudden infant death syndrome (SIDS).

What if you drink too much? If you have drunk enough alcohol to make you feel disorientated or cause vomiting, do not breastfeed until you are sober. Make sure someone who is not intoxicated is present to care for your child(ren). If possible, express your milk for comfort and to help maintain your supply (milk expressed while intoxicated should not be fed to baby). Binge drinking has not been studied adequately, and is not recommended during lactation.

In general, if you are sober enough to drive, you are sober enough to breastfeed. Less than 2% of the alcohol consumed by the mother reaches her blood and milk. Alcohol peaks in mom's blood and milk approximately 1/2-1 hour after drinking (but there is considerable variation from person to person, depending upon how much food was eaten in the same time period, mom's body weight and percentage of body fat, etc.). Alcohol does not accumulate in breastmilk, but leaves the milk as it leaves the blood; so when your blood alcohol levels are back down, so are your milk alcohol levels. One 2007 study suggests that lactating women may metabolize alcohol more quickly compared to non-lactating women (Pepino et al 2007).

Always keep in mind the baby's age when considering the effect of alcohol. A newborn has a very immature liver, so minute amounts of alcohol would be more of a burden. Up until around 3 months of age, infants detoxify alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.

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Effects of alcohol on breastfeeding and the breastfed baby

Alcohol does not increase milk production. In fact, babies nurse more frequently but take in less milk in the 3-4 hours after mom has had a drink, and one study showed a 23% decrease in milk volume with one drink (Mennella & Beauchamp 1991, 1993; Mennella 1997, 1999).

2+ drinks may inhibit let-down (Coiro et al 1992; Cobo 1974).

One study showed changes in the infant's sleep-wake patterning after short-term exposure to small amounts of alcohol in breastmilk - infants whose mothers were light drinkers slept less (Mennella & Gerrish 1998).

Daily consumption of alcohol has been shown in the research to increase the risk for slow weight gain in the infant.

Daily consumption of alcohol (1+ drinks daily) has been associated with a decrease in gross motor development (Little et al 1989).

Additional information

Drinking Alcohol & Breastfeeding, from La Leche League International

Alcohol and breastfeeding, from The Breastfeeding Network, by Wendy Jones PhD, MRPharmS

Alcohol and Breastfeeding, from the Centers for Disease Control

Beer as a Galactagogue - A Brief History by Hilary Jacobson

Malt as a Galactagogue - A Brief History by Hilary Jacobson

Alcohol and Motherhood by Carol Huotari, from Leaven, Vol. 33 No. 2, April-May 1997, pp. 30-1

Social Drugs and Breastfeeding: Handling an issue that isn't black and white by Denise Fisher, BN, RN, RM, IBCLC. Discusses nicotine, alcohol, caffeine, marijuana, heroin, and methadone.

References

[most recent references listed first]

Hale, Thomas. Medications and Mothers' Milk, 2019 edition. Springer Publishing, 2019: 275-277.

Wilson J, Tay RY, McCormack C, Allsop S, Najman J, Burns L, Olsson CA, Elliott E, Jacobs S, Mattick RP, Hutchinson D. Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Drug Alcohol Rev. 2017 Sep;36(5):667-676. doi: 10.1111/dar.12473. Epub 2017 Mar 13.

Haastrup MB, Pottegård A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol. 2014 Feb;114(2):168-73. doi: 10.1111/bcpt.12149. Epub 2013 Nov 7.

AAP Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. PEDIATRICS Vol. 129 No. 3 March 2012, pp. e827 -e841.

Pepino MY, Steinmeyer AL, Mennella JA. Lactational state modifies alcohol pharmacokinetics in women. Alcohol Clin Exp Res. 2007 Jun;31(6):909-18. Epub 2007 Apr 13.

Health Council of the Netherlands. Risks of alcohol consumption related to conception, pregnancy and breastfeeding. The Hague: Health Council of the Netherlands, 2005; publication no. 2004/22. (Paper is in Dutch but the executive summary is also in English.)

Koren G. Drinking alcohol while breastfeeding: Will it harm my baby? Canadian Family Physician 2002;48:39-41.

Little RE, Northstone K, Golding J; ALSPAC Study Team. Alcohol, breastfeeding, and development at 18 months. Pediatrics. 2002 May;109(5):E72-2.

AAP Committee on Drugs. Policy Statement: The Transfer of Drugs and Other Chemicals Into Human Milk. PEDIATRICS Vol. 108 No. 3 September 2001, pp. 776-789.

Mennella JA. Alcohol's Effect on Lactation. Alcohol Research & Health 2001; 25(3):230-234.

Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers' milk. Alcohol. 2001 Nov;25(3):153-8.

Mennella JA. The transfer of alcohol to human milk: Sensory implications and effects on mother-infant interaction. In: Hannigan JH, Spear N, Spear L and Goodlett CR, eds. Alcohol and Alcoholism: Brain and Development . New Jersey: Lawrence Erlbaum Associates, Inc., 1999. pp. 177-198.

Mennella JA, Gerrish CJ. Effects of exposure to alcohol in mother's milk on infant sleep. Pediatrics. 1998 May;101(5):E2.

Mennella JA. The human infant's suckling responses to the flavor of alcohol in mother's milk. Alcoholism: Clinical and Experimental Research 1997;21:581-585.

Coiro V, et al. Inhibition by ethanol of the oxytocin response to breast stimulation in normal women and the role of endogenous opioids. Acta Endocrinol (Copenh) 1992 Mar;126(3):213-6.

Mennella JA, Gerrish CJ. Effects of Exposure to Alcohol in Mother's Milk on Infant Sleep. Pediatrics 1998 (May);101(5): e2.

Mennella JA, Beauchamp GK. Beer, breast feeding and folklore. Developmental Psychobiology 1993;26: 459-466.

Mennella JA, Beauchamp GK. The transfer of alcohol to human milk: Effects on flavor and the infant's behavior. New England Journal of Medicine 1991;325: 981-985.

Little RE, Lambert MD, Worthington-Roberts B. Drinking and smoking at 3 months postpartum by lactation history. Paediatr Perinat Epidemiol. 1990 Jul;4(3):290-302.

Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol. 1973 Mar 15;115(6):817-21.

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Breastfeeding and Alcohol * KellyMom.com

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In general, if you are sober enough to drive, you are sober enough to breastfeed. Less than 2% of the alcohol consumed by the mother reaches her blood and milk.

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Here’s information on diet and breastfeeding:

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Here’s information on diet and breastfeeding:

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A very honest article about the loss of one's old self after becoming a mother: 

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A very honest article about the loss of one's old self after becoming a mother: 

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Here’s a fascinating article on the changes that happen to a woman’s brain when she becomes a mother: 

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Here’s a fascinating article on the changes that happen to a woman’s brain when she becomes a mother: 

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https://www.theatlantic.com/amp/article/384179/

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From joy and attachment to anxiety and protectiveness, mothering behavior begins with biochemical reactions.

The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live. I always liked Walker's description because it's more precise than the shorthand most people use for life with a newborn: Everything changes.

Because a lot of things do change, of course, but for new mothers, some of the starkest differences are also the most intimate ones-the emotional changes. Which, it turns out, are also largely neurological. Even before a woman gives birth, pregnancy tinkers with the very structure of her brain, several neurologists told me. After centuries of observing behavioral changes in new mothers, scientists are only recently beginning to definitively link the way a woman acts with what's happening in her prefrontal cortex, midbrain, parietal lobes, and elsewhere. Gray matter becomes more concentrated. Activity increases in regions that control empathy, anxiety, and social interaction. On the most basic level, these changes, prompted by a flood of hormones during pregnancy and in the postpartum period, help attract a new mother to her baby. In other words, those maternal feelings of overwhelming love, fierce protectiveness, and constant worry begin with reactions in the brain.

Mapping the maternal brain is also, many scientists believe, the key to understanding why so many new mothers experience serious anxiety and depression. An estimated one in six women suffers from postpartum depression, and many more develop behaviors like compulsively washing hands and obsessively checking whether the baby is breathing.

"This is what we call an aspect of almost the obsessive-compulsive behaviors during the very first few months after the baby's arrival," the maternal-brain researcher Pilyoung Kim told me. "Mothers actually report very high levels of patterns of thinking about things that they cannot control. They're constantly thinking about baby. Is baby healthy? Sick? Full?"

"In new moms, there are changes in many of the brain areas," Kim continued. "Growth in brain regions involved in emotion regulation, empathy-related regions, but also what we call maternal motivation-and I think this region could be largely related to obsessive-compulsive behaviors. In animals and humans during the postpartum period, there's an enormous desire to take care of their own child."

There are several interconnected brain regions that help drive mothering behaviors and mood.

Of particular interest to researchers is the almond-shaped set of neurons known as the amygdala, which helps process memory and drives emotional reactions like fear, anxiety, and aggression. In a normal brain, activity in the amygdala grows in the weeks and months after giving birth. This growth, researchers believe, is correlated with how a new mother behaves-an enhanced amygdala makes her hypersensitive to her baby's needs-while a cocktail of hormones, which find more receptors in a larger amygdala, help create a positive feedback loop to motivate mothering behaviors. Just by staring at her baby, the reward centers of a mother's brain will light up, scientists have found in several studies. This maternal brain circuitry influences the syrupy way a mother speaks to her baby, how attentive she is, even the affection she feels for her baby. It's not surprising, then, that damage to the amygdala is associated with higher levels of depression in mothers.

Amygdala damage in babies could affect the mother-child bond as well. In a 2004 Journal of Neuroscience study, infant monkeys who had amygdala lesions were less likely to vocalize their distress, or pick their own mothers over other adults. A newborn's ability to distinguish between his mother and anybody else is linked to the amygdala.

Activity in the amygdala is also associated with a mother's strong feelings about her own baby versus babies in general. In a 2011 study of amygdala response in new mothers, women reported feeling more positive about photos depicting their own smiling babies compared with photos of unfamiliar smiling babies, and their brain activity reflected that discrepancy. Scientists recorded bolder brain response-in the amygdala, thalamus, and elsewhere-among mothers as they looked at photos of their own babies.

Greater amygdala response when viewing their own children was tied to lower maternal anxiety and fewer symptoms of depression, researchers found. In other words, a new mother's brain changes help motivate her to care for her baby, but they may also help buffer her own emotional state. From the study:

Thus, the greater amygdala response to one's own infant face observed in our study likely reflects more positive and pro-social aspects of maternal responsiveness, feelings, and experience. Mothers experiencing higher levels of anxiety and lower mood demonstrated less amygdala response to their own infant and reported more stressful and more negatively valenced parenting attitudes and experiences.

Much of what happens in a new mother's amygdala has to do with the hormones flowing to it. The region has a high concentration of receptors for hormones like oxytocin, which surge during pregnancy.

"We see changes at both the hormonal and brain levels," the brain researcher Ruth Feldman told me in an email. "Maternal oxytocin levels-the system responsible for maternal-infant bonding across all mammalian species-dramatically increase during pregnancy and the postpartum [period,] and the more mother is involved in child care, the greater the increase in oxytocin."

Oxytocin also increases as women look at their babies, or hear their babies' coos and cries, or snuggle with their babies. An increase in oxytocin during breastfeeding may help explain why researchers have found that breastfeeding mothers are more sensitive to the sound of their babies' cries than non-breastfeeding mothers. "Breastfeeding mothers show a greater level of [brain] responses to baby's cry compared with formula-feeding mothers in the first month postpartum," Kim said. "It's just really interesting. We don't know if it's the act of breastfeeding or the oxytocin or any other factor."

What scientists do know, Feldman says, is that becoming a parent looks-at least in the brain-a lot like falling in love. Which helps explain how many new parents describe feeling when they meet their newborns. At the brain level, the networks that become especially sensitized are those that involve vigilance and social salience-the amygdala-as well as dopamine networks that incentivize prioritizing the infant. "In our research, we find that periods of social bonding involve change in the same 'affiliative' circuits," Feldman said. "We showed that during the first months of 'falling in love' some similar changes occur between romantic partners." Incidentally, that same circuitry is what makes babies smell so good to their mothers, researchers found in a 2013 study.

The greatest brain changes occur with a mother's first child, though it's not clear whether a mother's brain ever goes back to what it was like before childbirth, several neurologists told me. And yet brain changes aren't limited to new moms.

Men show similar brain changes when they're deeply involved in caregiving. Oxytocin does not seem to drive nurturing behavior in men the way it does in women, Feldman and other researchers found in a study last year. Instead, a man's parental brain is supported by a socio-cognitive network that develops in the brain of both sexes later in life, whereas women appear to have evolved to have a "brain-hormone-behavior constellation" that's automatically primed for mothering. Another way to look at it: The blueprint for mothering behavior exists in the brain even before a woman has children.

Perhaps, then, motherhood really is like secret space in a woman's brain, waiting to be discovered. "Although only mothers experience pregnancy, birth, and lactation, and these provide powerful primers for the expression of maternal care via amygdala sensitization," researchers wrote, "evolution created other pathways for adaptation to the parental role in human fathers, and these alternative pathways come with practice, attunement, and day-by-day caregiving."

In other words, the act of simply caring for one's baby forges new neural pathways-undiscovered rooms in the parental brain.

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What Happens to a Woman's Brain When She Becomes a Mother

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From joy and attachment to anxiety and protectiveness, mothering behavior begins with biochemical reactions. The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live.

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A beautiful article about becoming a mother by my colleague Ali Monaghan: 

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A beautiful article about becoming a mother by my colleague Ali Monaghan: 

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I wrote this yesterday, for a dear friend's Mother Blessing, and I thought I would share it here as well (with her permission):

I give you two beads, shaped like a nautilus shell. The nautilus is very special-it's one of the oldest known fossils on our planet, but it also tells the story of growth and maturation. It starts as a very small shell to protect the animal inside. Then, as the sea creature outgrows the first small chamber, it has to create a new, slightly larger shell to accommodate its slightly larger body, which it adds to the front of its old shell like an extension on a house. This how the Nautilus grows, spiraling around and around with each new addition. The Nautilus is all about growth and evolution, and to my mind, the perfect metaphor for becoming a mother.

Your entire world is about to change. Very soon you're going to find that you're too big for your old self, and you'll have to grow and change to accommodate this new person you're about to become. Growth is inevitable. But every time you spiral around your center, the newer parts of you will strengthen the older parts of you. You will feel lost for awhile-awkward and clumsy, uncomfortable in your new role. You will mourn who you used to be, before you were a mother-we all do, now and then. But gradually you will get used to your new self and how much bigger you've become-and how much stronger you've become-and how much more beautiful you've become. And to your baby, you will be his entire world. His ENTIRE world. And you will grow as big as you need to be, to be the mother that he needs. But at the very center of your larger shell, the person you've always been will still be there, too. And at some point, you'll realize she hasn't gone anywhere. She will wait for you to find her again, and you will. You will be both-your new, larger self, and your older, smaller self. And you will love him so much. And he will love you like you are his entire world. Because you will be.

I wish you every blessing as you start out on this new adventure. I wish you health, and happiness, but more than anything else, I wish you time. The time goes too quickly-everyone will tell you this. So many people will tell you this that it will actually become annoying. Of course, of course, it goes too quickly, cherish every moment! They will say things like that-old ladies on the bus and aunts and grandparents and random strangers in waiting rooms-and you will think to yourself that there are moments you don't want to cherish. It's hard, to be a mother. It's so unbelievably hard. The old ladies forget this part of it, I think. The work is invisible, and often unappreciated, and not valued by our society, and the worry will etch lines into your face and make your heart feel like a stone, sometimes. There is always so much to get done, and never enough time to do it in. And the days can feel like months, and the months can feel like years. You will wish for the time to go faster-we all do, sometimes.

But at some point you will look back and realize it did pass in the blink of an eye (because it does that, as well; it's both interminable and lightning quick at the same time). So my wish for you is that every now and then, not always and not constantly, but moments here and there, you can catch the time and hold it with both hands, for just a second. I wish that for you there will be time to do nothing for an entire afternoon except hold him. There will be time to let him fall asleep on your chest. There will be laundry to do, and meals to prepare, and groceries to buy...but there will be time to ignore all of that, and curl up on the bed with him and take a nap together, just the two of you. There will be time to sniff his warm little head, and kiss his nose, and stroke his feet. There will be time to make him laugh. To tickle him and play peek-a-boo. Time to go on walks together, just the two of you, to push a buggy down the street on cold, blustery days, and balmy summer days. Time to look at the leaves in the trees, to watch the way the sunlight catches them or the wind shakes them-he will be fascinated by things like this-and time to do nothing but watch him watching the leaves.

This is what I wish for you. There will be so much to get done, and so many new concerns. But I wish you pockets of time. Little moments, caught here and there.

I wish you lots and lots of time.

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I wrote this yesterday, for a dear friend's Mother Blessing, and I thought I would share it here as well (with her permission): I give you two beads, shaped like a nautilus shell. The nautilus is very special-it's one of the oldest known fossils on our planet, but it also tells the story of growth and maturation.

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Is ours not a strange culture that focuses so much attention on childbirth-virtually all of it based on anxiety and fear-and so little on the crucial time after birth, when patterns are established that will affect the individual and the family for decades? Suzanne Arms.

As citizens of an industrialized nation, we often act as if we have nothing to learn from low-income, developing countries. Yet many of these cultures are doing something extraordinarily right-especially in how they care for new mothers. In their classic paper, Stern and Kruckman ( 1983) present an anthropological critique of the literature. They found that in the cultures they studied, postpartum disorders, including the "baby blues," were virtually nonexistent. By contrast, 50% to 85% of new mothers in industrialized nations experience the "baby blues," and 15% to 25% (or more) experience postpartum depression.
What makes the difference?
Stern and Kruckman noted that cultures who had a low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. These cultures, although quite different from each other, all shared

5 protective social structures

1. A distinct postpartum period. In these other cultures, the postpartum period is recognized as a time that is distinct from normal life. It is a time when the mother is supposed to recuperate. Her activities are limited and her female relatives take care of her. This type of care was also common in colonial America, when postpartum was referred to as the "lying-in" period. This period functioned as a time of "apprenticeship," when more experienced mothers mentored the new mother.

2. Protective measures reflecting the new mother's vulnerability. During the postpartum period, new mothers are recognized as being especially vulnerable. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are prominent in the postpartum rituals of rural Guatemala, Mayan women in the Yucatan, Latina women both in the United States and Mexico. These rituals also mark the postpartum period as distinct from other times in women's lives.

3. Social seclusion and mandated rest. Postpartum is a time for the mother to rest, regain strength, and care for the baby. Related to the concept of vulnerability is the widespread practice of social seclusion for new mothers. For example, in the Punjab, women and their babies are secluded from everyone but female relatives and their midwives for five days. Seclusion is said to promote breastfeeding and it limits a woman's normal activities. In contrast, many American mothers are expected to entertain others-even during their hospital stay. Once they get home, this practice continues as they are often expected to entertain family and friends who come to see the baby.

4. Functional assistance. In order for seclusion and mandated rest to occur, mothers must be relieved of their normal workload. In these cultures, women are provided with someone to take care of older children and perform their household duties. As in the colonial period in the United States, women often return to the homes of their family of origin to ensure that this type of assistance is available.

5. Social recognition of her new role and status. In the cultures Stern and Kruckman studied, there was a great deal of personal attention given to the mother. In China and Nepal, very little attention is paid to the pregnancy; much more attention is focused on the mother after the baby is born. This has been described as "mothering the mother." For example, the status of the new mother is recognized through social rituals and gifts. In Punjabi culture, there is the "stepping-out ceremony," which includes ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When the mother returns to her husband's family, she returns with many gifts she has been given for herself and the baby. The following is a description of a postpartum ritual performed by the Chagga of Uganda. It differs quite a bit from what mothers in industrialized countries may experience. ￼

Three months after the birth of her child, the Chagga woman's head is shaved and crowned with a bead tiara, she is robed in an ancient skin garment worked with beads, a staff such as the elders carry is put in her hand, and she emerges from her hut for her first public appearance with her baby. Proceeding slowly towards the market, they are greeted with songs such as are sung to warriors returning from battle. She and her baby have survived the weeks of danger. The child is no longer vulnerable, but a baby who has learned what love means, has smiled its first smiles, and is now ready to learn about the bright, loud world outside (Dunham, 1992; p. 148).

What American mothers experience

By contrast, American mothers often find that people are more concerned about them before the birth. While a woman is pregnant, people may offer to help her carry things or to open doors or to ask how she is feeling. Friends will give her a baby shower, where she will receive emotional support and gifts for her baby. There are prenatal classes and prenatal checkups, and many people wanting to know about the details of her daily experience.

After she has her baby, however, mother-focused support rapidly declines. Typically, a woman is discharged from the hospital within 24 to 48 hours after a vaginal birth, or 2 to 4 days after a cesarean section. She may or may not have anyone to help her at home-chances are no one at the hospital has even asked. Her mate will probably return to work within the week, and she is left alone to make sure she has enough to eat, to teach herself to breastfeed, and to recuperate from birth. The people who provided attention during her pregnancy are no longer there, and the people who do come around are often more interested in the baby. There is the tacit-and sometimes explicit-understanding that she is not to "bother" her medical caregivers unless there is a medical reason, and she must wait to talk to her physician until her six-week postpartum checkup. There probably are resources in her community that may help, but she has no idea where they are, and feels too overwhelmed to seek them out for herself. So she must fend for herself as best she can.

Is it any wonder that many women find the postpartum period to be extremely stressful? One popular book written for new mothers (Eisenberg, et al., 1989) describes this transition as "the reverse Cinderella-the pregnant princess has become the postpartum peasant" with a "wave of the obstetrician's wand" (p. 546).

Here are some comments mothers have shared with me.
I felt like I didn't matter. I felt like they weren't interested in me after I had my baby. My husband said, "Of course they are not interested. You've had your baby." After the birth, I had several people tell me that the most important thing was that I had a healthy baby. Yes, that is important. But what about me? No one pays attention to the fact that you've had major surgery. They would have paid more attention if I'd had had my appendix out.
As a culture, we have woefully neglected the needs of new mothers. But this was not always so. Historically, we recognized the importance of a community of women helping women, who provided this much needed practical and emotional assistance. In so doing, they provided a chance for postpartum women to recuperate and assimilate the major change that had taken place in their lives. Chances are it will be many years before there are organized efforts aimed at providing care for new mothers. The good news is that a grassroots movement has begun that seeks to meet the needs of postpartum women.

The word " doula"-from the Greek word for servant-is becoming part of our vocabulary. A postpartum doula is someone who takes care of postpartum women by providing practical and emotional assistance (Lim, 1995; Webber, 1992). Friends, family or a woman's partner can be doulas. Or women in some communities might be able to hire a professional doula. In either case, the doula movement is in response to the lack of postpartum care available from traditional care providers.

In the following account, doula Salle Webber describes her care for new mothers and the types of support and assistance that they need.
In my work as a doula, my focus is on the mother. I want to provide whatever it is that she needs to feel comfortable, nourished, relaxed, and appreciated: to facilitate a harmonious transition for both mother and child in those profound first days and weeks after birth.
A mother needs someone who cares about how many times the baby woke to nurse in the night, how many diapers were changed, how her breasts are feeling. She may need her back massaged or her sheets changed, or she may need someone to provide an abundant supply of water or tea, salads readymade in the refrigerator, a bowl of cut-up fruit. She needs to be able to complain about how little her mate understands what she's going through, and perhaps, some gentle reminders of all the contributions he has made. She needs someone to hold the baby so she can take a shower or even go to the bathroom; someone to answer the phone when she's napping; someone to water her plants or garden, to clean the kitchen and bathroom, to keep up on the family's laundry. She may have many questions and concerns that only an experienced mother can understand. She needs patience and kind words and a clean and calm environment (Webber, 1992, p. 17).

While our culture continues to lack supportive postpartum rituals, the work of individual women can make a significant difference. Many are surprised that this decidedly "low-tech" intervention can work. Yet this is perhaps the most important lesson we can learn from the cultures that Stern and Kruckman described.

We must begin to change the way we think about providing care for new mothers. This care should not stop once the baby is born, but should continue throughout the postpartum period.

In conclusion, we have learned that women can make a comfortable and peaceful transition into motherhood. Postpartum mental illness is not inevitable and in many cases can be prevented. It is time that we recognize and meet the needs of postpartum women. The health of our families depends on it.￼￼￼￼￼￼￼￼￼￼

References

Eisenberg, A., Murkoff, H.E., & Hathaway, S.E. (1989). What to Expect the First Year. New York: Workman.

Lim, R. ( 1995). After the Baby's Birth: A woman's way to wellness. Berkeley, CA: Celestial Arts. New edition: ( 2004). After the Baby's Birth: A Complete Guide for Postpartum Women.

Stern, G. & Kruckman, L. ( 1983). Multidisciplinary perspectives on postpartum depression: An anthropological critique. Social Science and Medicine, 17, 1027-1041.

Webber, S. (1992). Supporting the postpartum family. The Doula, 23, 16-17.

Kathleen Kendall-Tackett, PhD, IBCLC, FAPA is a health psychologist and International Board Certified Lactation Consultant, and the owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women's health. She is Editor-in-Chief of two peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the Board for the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett specializes in women's-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2016 Outstanding Service to the Field of Trauma Psychology from the American Psychological Association's Division 56.
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What can we learn from the cultural postpartum rituals of low-income, developing countries?

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Breastfeeding in Public:The Equality Act (2010) protects breastfeeding mothers against unfair treatment (everywhere in the UK except Northern Ireland!). It states that it is sex discrimination to treat a woman less favourably because she is breastfeeding, and therefore, by implication, trying to prevent a mother from breastfeeding is against the law:

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Breastfeeding in Public:The Equality Act (2010) protects breastfeeding mothers against unfair treatment (everywhere in the UK except Northern Ireland!). It states that it is sex discrimination to treat a woman less favourably because she is breastfeeding, and therefore, by implication, trying to prevent a mother from breastfeeding is against the law:

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The Equality Act, passed by Parliament in April 2010, comes into force this month, making this protection a reality and giving mums the freedom to breastfeed when away from home.

Under the new law, mums cannot be discriminated against, asked to leave a venue or treated unfavourably because they are breastfeeding when out and about in England and Wales. Support from local services can also give mums the confidence to breastfeed wherever they are, creating an example for younger people.

Rosie Dodds, Senior Public Policy Officer, NCT, said: "This is a huge win for the charity and we are very pleased. Years of hard work and determined campaigning have paid off, and now mums who want to breastfeed in cafés, shopping centres, swimming pools or other public venues will be free to do so, without any bother or fear of harassment.

"It is important that women know they have this right, and the charity is calling on leisure centres, councils and other venues to do all they can to welcome breastfeeding mums.

"Many congratulations to all those involved in developing evidence and campaigning on behalf of mothers for this right at a local and national level over the years."

From training breastfeeding counsellors to running courses for expectant and new mums to peer support schemes across the UK, working with and for breastfeeding mothers is an important part of the charity's history.

To support mums, NCT runs local breastfeeding sessions. NCT breastfeeding counsellors are available seven days a week to answer questions and provide support. NCT Breastfeeding Line on 0300 330 0771 is open every day, 8am - 10pm.

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Historic month for NCT as women win right to breastfeed in public

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The Equality Act, passed by Parliament in April 2010, comes into force this month, making this protection a reality and giving mums the freedom to breastfeed when away from home. Under the new law, mums cannot be discriminated against, asked to leave a venue or treated unfavourably because they are breastfeeding when out and about in England and Wales.

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Here’s some surprising research into winding:

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Here’s some surprising research into winding:

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A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. - PubMed - NCBI

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Child Care Health Dev. 2015 Jan;41(1):52-6. doi: 10.1111/cch.12166. Epub 2014 Jun 9. Randomized Controlled Trial

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I'd urge all parents-to-be to read this article on PARENTAL EXPECTATIONS:

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I'd urge all parents-to-be to read this article on PARENTAL EXPECTATIONS:

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Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few. Our expectations of what's to come, and what is "best", are naturally based on what we experience around us. Those who already have babies such as family and friends, mixed with our own life experiences, memories of siblings or early life. For many, smaller families may mean fewer memories of siblings as young babies, and it can be rather like wandering into the dark unknown. Even those with lots of young baby practice, may not have lots of newborn 24/7 experience.

Instead as well as looking to those close to us, we often turn to books, magazines, websites and health professionals - who all seemingly have different opinions, but who nonetheless may plant new little seeds of expectation.

Before baby arrives it's common to believe your baby will be the happiest baby around; you will change their nappy when it's soiled, feed them when hungry, provide a nice bed for sleep times and so your baby wont need to cry, his needs will be met. You and perhaps a partner snuggled on the sofa, baby sleeping quietly in the basket next to you. Sure you know babies need feeding at night, but you will have him there right next to you so you can tend to him quickly, fill his little tum before slumber re-ensues.

And for some this may be true.

The reality? Many are not like this, especially in the early weeks - and even then it may require veering from "biological norms" (eg feeding method, sleep training, pacifiers etc) to achieve these expectations based on "society's current perception of the norm".

The one thing I hear over and over from new parents is they had no idea just how hard it would be, why didn't anyone spell out just how challenging being a new parent can be - so for all those parents this blog entry is for you.

Being a parent of a newborn baby can be really, really, insanity inducingly HARD.

No really, harder than that.

From the moment that precious new bundle is placed in your arms, life will never be the same again. It now, at least for a while, revolves around this dinky new being, who co-incidentally didn't read any books, nor pay heed at classes - so doesn't understand any related expectations.

You feed them, change their nappy, wind them, check they're not too hot or cold - yet still they may cry! The comfy bed you lovingly prepared might as well be covered in 9" nails, as they flail and wail every time you try and gently lower them in. Instead of snuggled on the sofa, you are taking it in turns to pace and jiggle the baby, before one of you tries to eat one handed so the other can have a powernap before shift change.

And the nights, who knew they could be so long? Even when you have everything "perfect" still baby squirms, grunts and wants to feed again; how can this be when it was only two hours since we just did all this?

"What do you want from me?" one mum confessed she had asked her baby at 3am after a rather rough night - desperate to sleep, yet desperately trying to stay awake whilst feeding. Whilst everyone had warned her not to bedshare, nobody had mentioned falling asleep upright or on a sofa was more risky, nor that baby naturally may want to feed quite frequently and having to sit up and do this every time was shattering, which made staying awake sitting up nearly impossible. Nobody had even asked if mum knew she could breastfeed laying down. I don't know what else she could want? What do I do?

One mum recently described the sleep deprivation as akin to mind altering drugs, that she dreamt (metaphorically) of a night of unbroken sleep, that she had never realised it would be so hard.

The only point I want to stress more than just how hard having a newborn can be (did I say that already?) is that it is nothing you as parents are doing wrong , let me repeat that a little louder: it is nothing you as parents are doing wrong.

It can be easy to feel that you are the only parent who has an unsettled baby. That given the books didn't describe this, it can't be common - because if you meet every need baby is settled, right? But that's simply not true. Some babies take a little longer than others to transition to life "Earth side" - even. If you've had a long birth, a long pushing stage, a speedy or difficult delivery - so did they. Some may be a little uncomfortable or windy, and don't forget nobody gave them the books. This piece talks about what a normal newborn expects, then compare that to what most parents in current society typically have in mind.. Whilst I don't feel long spells of crying should be just accepted as "colic", and it's always worth seeking help to explore why baby is crying if you're concerned - the point is that it isn't because you've held them too much/not put them in a routine early enough, not ignored their cries etc

The question also has to be - are your expectations realistic? If not adapting your expectations, can be a whole lot easier than trying to change those of a newborn - and given you have the cognitive ability to adapt, would also seem to be the fairer option. Expectations can play a part in how you perceive your baby's behaviour.

Example
expect their baby to wake and feed frequently day and night, understand their baby had no concept of time in the womb, and is used to receiving nourishment from an umbilical cord, rather than at spaced intervals via a breast or bottle. They know breastmilk changes composition so that at night it includes more "sleepy hormones" and helps to create circadian rhythms (sleep patterns).

"RESULTS: The tryptophan in the breast milk presented a circadian rhythm with acrophase at around 03:00. This affected the 6-sulfatoxymelatonin circadian rhythm with acrophase at 06:00 in the breast-fed infants, and also promoted nocturnal sleep. Assumed sleep, actual sleep, and sleep efficiency were significantly increased in the breast fed infants with respect the formula fed infants."

http://www.ncbi.nlm.nih.gov/pubmed/16380706

They heard that after a feed baby has a high level of something called CCK, and they know this tells him he's full; but also that the level drops again after another 10 or 20 minutes post feed, so he thinks he's hungry again - and that he may go through this loop several times, usually in the evening, commonly known as "cluster feeding," before dropping into a solid, longer sleep stretch.

They've been told how to check output and signs baby is transferring milk well - so they can identify normal from a "needs more help" situation - and they've been shown how to recognise baby's earliest cues of hunger, so there's time to work on getting baby to the breast and comfortable before she becomes really hungry and frantic!

In the evening dad/partner (if applicable) hops in the bath for some skin to skin time with baby, and mum builds a nest of pillows, snacks, books, drinks, music/TV remote as desired, ready to settle down for a longer feeding session.

A & B have also been told it's normal for a newborn to want lots of contact and cuddles from parents, when transitioning from a place with constant movement, sounds and security - familiar voices, smells, touch helps ease this. They've read about the theory of the fourth trimester, and it makes sense to them.

To make this work for all of them, they have a wrap which holds baby to them hands free, which they've found also helps if baby is a little windy or unsettled - on really tough days they head off out for a walk with it. They've discovered it's fab for holding the baby when they want to eat, even if at times this means eating whilst wiggling to settle baby, or taking turns wearing baby in the wrap whilst the other eats.

Baby sleeps next to mum, bedsharing safely or perhaps a cot attached to the bed. This means when baby wakes nobody has to sit up, get up or try and keep themselves awake - but can either just feed, or slide baby over (still without getting up) then feed laying down. They've realised the beauty of this is that there is no "lowering down" - which triggers a baby's startle reflex and wakes them up, and that with practice sometimes this can be done with all barely rousing.

Although baby wakes every few hours as expected, mum doesn't feel completely exhausted as when she does sleep she hits more restful sleep levels due to having her baby right next to her. If people offer to help the parents gladly accept offers of practical help, perhaps some meals cooked for them or an ironing pile tackled!

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In contrast parents X&Y picked up a very different set of books when shopping. They expect that baby will slot around them, that they need to do so early to learn to settle themselves and become independent - quickly developing a reliable pattern.

They feed the baby and then place her in the crib, ready to sit and enjoy a meal together. No sooner is the food on the plate than baby wakes and also wants feeding, two hours earlier than expected. After a nappy change they gently place baby in her Moses basket - but she squirms and wakes, like a Jack in the Box every time she's placed back down. When baby wants to cluster feed from 7-10pm, the parents are tired and confused, why is she wanting to feed so frequently? On the one hand they reason, she can't be hungry as she only fed 45 minutes ago, so at first they try dancing, jiggling and rocking to help baby sleep. But when baby continues to cry for a feed, the doubts can start; she must be hungry? What if mum isn't producing enough milk, that must be the case because the book says she should only feed every 3-4 hours? Is it wind? Colic? How do we work out what's wrong? What if she isn't taking enough? You can't see with a breast to check...

During the night, baby sleeps in a separate crib - when she wakes frequently someone has to sit up, retrieve and feed her(staying awake) before putting her back in the basket. As mum tentatively gets back bed, baby cries again - trapped burp this time. After a few minutes wandering round the bedroom baby settles but as mum places her down she startles and cries again. More pacing ensues and dad takes over for a turn. He manages to get baby into the basket, by swaddling to mask her reflexes and gets back into bed, but by now everyone is wide awake. Just as the parents start to fall asleep - you guessed it baby wakes again. After another 20 minutes trying to get baby into the basket, she's used enough energy that she's ready for feeding again thank you.

The next evening events repeat, and then a few more after that - the parents become more dismayed that baby wakes every time food is served, and they feel resentful they've not managed to have a meal alone together since she arrived. They expected something very different.

They decide if they can get baby to wait four hours for her feed, this will stop the habit of frequent feeding, and encourage the routine of long sleeps with infrequent waking they read about - and so introduce a pacifier which at least gives them chance to eat that meal. Over the next few days baby becomes more unsettled, wants to feed more frequently - and mum becomes more convinced there is an issue with her milk supply. The forums mum goes on related to the books she bought, only compound her feelings - parents are congratulated with a "Great Parenting!!" when someone declares their baby has slept a 9-12 hour plus stretch; which of course infers you're clearly not a great parent if you're baby isn't doing the same.

Partner looks at the exhausted mum and says something has to give, they cannot continue as they are - they need sleep and "me time".

When help is offered, the parents encourage family to hold the baby whilst they complete household tasks, trying to keep the house tidy for visitors as though a baby hasn't landed and thrown chaos where there was previously order.
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OK so these are extremes, reality is more often various hues of grey - but you can see how mentally parents X & Y have a much harder time than the first set of parents when baby arrived. It can be at times hard to pick "instinct" apart from "social expectations" - ie is the instinct founded on something we already fundamentally believe to be true and thus expect or is there really an issue. It's always worth remembering that a baby simply does not have sufficient neurological pathways developed to manipulate, control, plan or "scheme" - meeting the needs of an infant leads to long term security compared to the potentially negative implications of trying to train behaviour to suit. Babies don't even develop mature sleep rhythms until the they're several months old, they're not developing habits at the newborn stage, they're purely focussed on survival!

Even with the most realistic expectation, some babies will still be much more intense than others - parents can still be exhausted and overwhelmed. Ditch anything non essential and go wit the flow. Some babies may just need time, others may have an underlying issue they need understanding to help resolve - either way, I hope knowing it is normal and you're not alone or at fault may help, even just a little bit.

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Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few. Our expectations of what's to come, and what is "best", are naturally based on what we experience around us.