Confidence Interval

I am full of self-doubt. I would like to have a label to tell me who I am and what I think, but these things never seem to be sufficiently static. Even when I think I am certain about something (eg. there are no gods), I remember that certainty is about the worst possible position. Certainty leads to one-true-wayism, and while reading Richard Dawkins has shattered my respect for religious belief, I’m not comfortable with the view that all believers in gods are fools. This paradox hurts, so I reserve the right not to respect homeopaths, and that makes me feel a bit better. I may sound stridently certain at times, but I can almost entirely assure you that I rarely make a firm statement that hasn’t been reflected upon and doubted from many angles, and I can often reel out a bunch of caveats if you raise a questioning eyebrow. So for example, the majority of women are physically able to breastfeed babies: in itself, a scientific fact. BUT it’s not a purely physical skill. There are cultural elements (women are put off breastfeeding by fear of getting them out in public, for one example); social elements (“none of my friends breastfeed, they think I’m a freak”); family influences (“my mother-in-law wants to give him a bottle”); commercial pressures (formula adverts use language that subtly undermines confidence in breastfeeding); emotional issues, the sheer responsibility of being the only person who can feed the baby, worries about body shape, weirdness of breasts being put to a non-sexual use, loneliness, anxiety and pain. This list is not exhaustive.

When I talk about breastfeeding to an antenatal class, I know they expect me to idealise it. Sometimes I react against that and terrify them with too much reality. My aim is to be realistic, but more than anything else, to help them open up their minds to the idea that breastfeeding is complex and challenging AND rewarding, and that there are people out there who understand the challenges and don’t judge mothers for experiencing them.

Almost daily, I talk to a new mum who is encountering challenges. Sometimes it’s the same old story from three women in a row; those are the ones about weight gain, sleep, routines. The more unusual stories are often more harrowing.

The most common thing is pain, and I find that lots of the people I meet antenatally expect it to be painful because of a misconception that babies suck nipples. This is the myth we bust, if you’ll excuse the choice of word, with the use of a knitted boob. The nipple goes far back into the baby’s mouth and is not sucked, and should not rub on the gums or the tongue. Milk is extracted by a sort of gentle squishing of the breast tissue by the baby’s jaw, and this should not feel painful. Personally, I advocate an approach where mum lets baby find the nipple using his or her own feeding reflexes, because experience and my reading have shown me how successful that can be, and mums usually look comfortable like that.

But again, it’s not the only tool in the box, and some women do prefer to sit upright. I think there’s a psychological hit in imitating the position (bolt upright, knees at a right angle, baby across the chest) that most books describe as ‘right.’ Here at the coalface, I can tell you that the right position is the one the mother is most comfortable in.

Sometimes she will be most comfortable in a position that doesn’t require any connection at all between her breast and her baby. What a lot of mixed feelings that invokes for me, but it’s not my job to persuade her otherwise, and if she wants to tell me her story, I will listen and learn.

I feel much more strongly, as you know, about babies being left to cry. I could probably pin the entire downfall of society on the utterly flawed belief that babies need to exercise their lungs. Intuitively, and scientifically, I know that denying comfort harms a baby. So this is much more difficult for me to square with my NCT mother-centred training, and when a mum tells me her baby ‘needs’ to cry himself to sleep, I shudder (on the inside). How horrible that must be for both of them.

But what can I say? With breastfeeding, I can confidently and respectfully explain, for example, that there are no discrete substances called foremilk and hindmilk, therefore you cannot control your baby’s fat intake by somehow making him or her stay longer at the breast. (nb. that’s not the language I use in a counselling situation). In the case of crying, I can only listen, reflect, and suggest some reading material.

And then there’s all this stuff about birth that I’m just starting to learn about, and I read Ina May Gaskin and think “yes! of course!” and then I read some anti-HB stuff and worry that I’ve got it all wrong, because there are statistics and research that don’t support what I’m feeling. This is my trouble: I’m not sure I can ever categorically say ALL the research supports what I’m saying. I’ve passed my Understanding Research module and I know what confidence intervals and medians and randomised controlled trials are, but it always seems like someone else’s research might trump the studies I’ve got in my hand, and I just don’t have the confidence, myself, to decide.

Maybe I don’t want to be certain; I should just shut up and listen instead.

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