Monday, 15 December 2014

How to Get Pregnant Whilst Breastfeeding

Mother Nature is a hypocritical sod. Check this out: The raison d'etre of your existence is reproduction. So why then, does good ol’ Mother Nature muzzle our fertility while we’re lactating? And is there anything we can do to get pregnant without pulling the plug on breastfeeding? In this post I will answer both questions in turn. What gives me the confidence to speak about this issue? Firstly, I've been there (conceived under 6 month postpartum whilst exclusively breastfeeding), secondly, I've conducted a shed-load of academic research into breastfeeding fertility.

A word of warning before we begin: As a result of reading this, you may find yourself up the duff, toot sweet. Want closely-spaced siblings? Dream of tandem-feeding? Read on!


Aunt Flo takes a vacation

While breastfeeding a lot of mothers notice that ‘shark week’ no longer occurs every month. Yet, as with many physiological happenings that appear idiotic, Mother Nature has a plan. You see, every time you bring your baby to your breast, you are sending your body an important message: “I have my hands full here, this baby needs me!” Because breastfeeding is such an intensive energy-draining practice, your body halts the baby production line so that you can focus your energies on the little cherub you’ve just popped out. Aunt Flo (your menstrual cycle) goes AWOL.

Whilst this is frustrating for the broody mom wishing to get knocked up, it is legit in evolutionary terms, it makes sense. Our bodies evolved in circumstances where moms were carrying their babies 24/7 (we lived in herds and never settled in one spot for too long), where foraging for food and catching prey required significant physical exertion, where babies would suckle every 15 minutes, and where we relied on our own body heat to keep us warm. We modern moms like to whinge that we’ve got it tough, that we’re soooooo busy with multitasking overload, but we don’t know SHIT compared to our prehistoric sisters. 

Mother Nature knew that if babies were ever going to survive longer than their shrivelled cord stump, Mom couldn’t be getting pregnant anytime soon. If she did, she would be too knackered to do all that maternal stuff. And so, by the wonders of natural selection, we inherited an epidemiological quirk: our fertility pauses during lactation, a phenomena known as, yup: ‘lactational amerrhoea’ (took me several days to learn to pronounce that shit, and I still say it like ‘men’s diarrhoea’).


Interesting, but can I successfully breastfeed *and* get pregnant?

Yes, you can!


Okay, how? 

Practically every lay article ever written on breastfeeding fertility has offered the following solutions to the ‘get pregnant whilst breastfeeding’ conundrum: 1. Give your baby a pacifier. 2. Space feedings. 3. Stop night-nursing. 4. Introduce solid foods. 5. Failing all that, wean baby from the breast.

Each of these suggestions is a simplistic anti-breastfeeding knee-jerk scraping of the barrel. They all involve reducing breastfeeds in an attempt to kick-start ovulation. Recall that breastfeeding sends your body the message: “I’ve got my hands full looking after this baby”. The above solutions aim to send the contrary message: “My baby doesn’t need me that much”, or even: “my baby is dead”.

Each solution has varying degrees of success - good for your fertility, not so good for your baby. Folks who offer the above solutions have clearly not read all of the fertility research. We can’t blame them. Most of the research into breastfeeding and fertility focuses on developing countries because fertility is a huge issue to those folks. In countries where survival means strenuous daily physical activity and poor nutrition, postpartum fertility can mean the difference between life (mom doesn’t get pregnant and so can sustain her infant), or death (mom gets pregnant and infant #1 perishes).

However, if you dig around the vaults of epidemiological fertility research (and here’s where being a PhD student has slapped me on the back and bought me a pint), you can discover the dichotomy between lactational amerrhoea in developing countries and lactational amerrhoea in prosperous Western countries.

In essence:

The key to getting pregnant is sending your body a new message: “I’ve got my hands full…BUT it’s still safe to get pregnant right now”. How can you do this? Forget Fertility Friend, your new BFF may just be your local grocery store...


Introducing the ‘Relative Metabolic Load Hypothesis’

Despite its fancy label, this theory is straight forward. Ever since scientists learnt how to precisely measure reproductive hormone levels in saliva and urine, a new body of evidence opened up: the relationship between maternal nutrition and fecundity; or in other words: what you eat while breastfeeding affects your fertility status. Woah, goosebumps! Exciting, no?

This hypothesis suggests that ‘shocking’ your body through nutrition can kick-start fertility. In one study (Lunn et al 1984), a substantial increase in food consumption during lactation had negligible effects on milk production and milk quality but – and here’s the magic – it hastened the return of menstrual cycling, and shortened the interval to next conception!  Yup, turns out the female reproductive system is highly sensitive to metabolic energy availability. It’s the same kind of process as seen in anorexia, only in breastfeeding, the mechanism is way more sensitive (Rosetta and Taylor 2009).

What you eat during lactation has an important effect on fertility – an effect independent of nursing frequency (Frisch, 1978John et al., 1987). Consider this curious fact: Moms that nurse with high frequency get pregnant just as fast as moms who nurse much less frequently... providing they meet the threshold of ‘well-nourished’ (Worthman et al 1993; Valeggia and Ellison 2004; Ellison 2001; Lipson and Ellison 1996). Let’s just soak that up for a moment: Stuffing your face while breastfeeding can increase your fertility. I’ll say it again: Eating more food can increase your chances of conception. 


OMG! So how does it work? 

The studies show that resumption of menstrual cycling is closely coordinated with changing insulin levels, and whaddya know: insulin is a pretty badass stimulator of ovarian estrogen production (Willis et al 2001). Insulin reflects changes in metabolic energy balance (Valeggia and Ellison 2009), it’s a signal to your body that food is available.

So, if you want to increase your chances of getting pregnant while breastfeeding do what scientists refer to as ‘creating favourable energetic conditions’. A sudden burst of energy-dense food consumption can trigger the following cascade: Firstly, mom experiences a brief period of insulin resistance above her average levels, and then, usually a few weeks later, her ovarian cycling resumes. Within this time period, she may notice that her body begins to produce fertile quality cervical fluid (gunky eggwhite vaginal discharge) as her hormone levels pass over that all-important estrogen-threshold. To illustrate, take a gander at the diagram below (taken from the wonderful Weschler 2003). It shows your hormone levels as your body repeatedly attempts to ovulate, and then succeeds:


In other words: Sudden gorging can increase your chances of getting pregnant because it raises your insulin levels higher than your body is used to. Elevated insulin then stimulates ovarian steroid production, causing estrogen levels to rise. (Science, I could hump your leg right now!) Rising estrogen stimulates your fat cells to bring the insulin levels back into the normal range. This whole process serves to jump-start ovarian function as maternal energy availability rises above the demands of milk production. It’s all about reassuring your body that it’s safe to breed. No need to reduce breastfeeds.

This amazing process – your body’s intuition – is a pattern that we humans share with both chimpanzees and orang-utans (Ellison 2001; Emery Thompson 2005). Energy dense foods are cues we can use to satisfy our body’s drive to synchronise reproductive success with energy availability. But before you get all health-police on my butt, I’m not suggesting you should start auditioning for ‘Fat: The Fight Of My Life’ or anything like that. Rather, I'm suggesting that increasing your energy intake is a temporary strategy with the purpose of reassuring your body that food reserves are plentiful. You can always opt for those energy dense foods that come in healthier guises (nuts and honey are stellar examples), but dayuuuum, just look at that cake!


In a nutshell…

You CAN (quite literally) have your cake and eat it. It is possible to nurse all hours under the sun and still conceive. The duration of lactational amenorrhea is inter-related with the relative metabolic load of lactation: fertility will stall if the body experiences lactation as a heavy burden. So, whilst infant feeding behaviour determines absolute metabolic load, maternal nutrition impacts upon relative load. Tonight, we feast!

Good luck, and enjoy the BFP!


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Monday, 1 December 2014

The Formula Feeder Doth Protest Too Much

If you’re been alive for the fast five or so years, you may have noticed something peculiar: the emergence of a new zeitgeist of contempt for breastfeeding. Even a cursory look at the lifestyle section of many online newspapers reveals a contemporary back-catalogue now groaning under the weight of the collective bitching of a vocal minority of failed breastfeeders.

In this post I question the motives of these failed breastfeeders, let’s call them ‘formula apologists’ – the folk who make it their raison d'etre to criticise breastfeeding - that is, to criticise its promotion and its significance. You see, nobody comes immaculately to the infant feeding debate. Its discussion can never be abstract. As I discussed in the chapter of my book aptly titled ‘Defensiveness’, the agenda of these people is not as transparent as they would hope. Ask yourself this question: by virtue of being failures, do these people really qualify as noted dispensers of feeding advice? Do they have the well-being of all mothers in mind, or just mothers that ad credence to their personal experience? In most instances, these ‘formula apologists’ are engaging in a massive case of ex post facto justification. To explain, I’m going to run you thorough some of their most prolific whinges:


WHINGE #1: SCIENCE IS POLITICALLY INCORRECT

Formula apologists lament about something they call the "scientisation of parenthood” and the "de-authorisation of the mother" (Lee 2011; Furedi 2008). These made-up rhetorical devices are a vain attempt to politicise a sound and rational advancement: scientific authority has come to trump parental convenience in our moral consciousness (boo hoo, guilt, torment, condemnation, etc). They sob that "the freedom of the mother to shape her mothering practices has been compromised" (!!!!) (ob cit).

I discussed this in my book (sorry to keep plugging the book but it’s relevant folks), and I quote:

“Facts regarding the risks of formula feeding are locked into a Pandora’s Box and treated as hate speech. Woe betide mothers call each other out on their choices – that would cause hurt feelings, they argue. Indeed, formula-apologists are heavily reliant on the rhetoric of emotion, demanding that we be mindful of mothers’s subjective 'feelings', because logic and objective morality muddy the agenda they are seeking to advance. Essentially, they aim to replace a moral view of infant feeding with an emotional view” – Breast Intentions.

To use their words, formula apologists cry that: "contemporary culture requires that the parent – the mother especially – pay serious attention to scientific and expert guidance about ‘parenting’ in order to reduce risks to child health and welfare" (Lee 2011). OMG science, how very DARE you! ..Now readers, is it just me or, isn't science guiding parenting a freekin GOOD thing?? Better to be guided by science than by knee-jerk emotion. Or are the formula apologists suggesting that science is only a good thing if it enhances parental convenience?


These folk pout that It's A Woman's CHOICE How She Bloody Well Feeds Her Child Thank You Very Much, except, like, it isn't really, cause we think women only have "constrained choice". What's constraining this choice, they argue? SCIENCE! It's those science bastards again. Science "presents the evidence about formula feeding as predominatively negative" (Knaak 2005; see also Knaak 2006). But formula isn't negative they argue - at least not for Mom. Many mothers cherish formula as a utensil of liberation! Cited benefits of formula feeding include - and I quote: "convenient", "easy", "providing freedom from the baby", "providing a means of getting back to normal" and this bizarre twist of fuck: formula enables us to "re-establish our identity as non-mothers" (Earle 2002; Lee 2007). Dudes, I hate to say it, but if you want an identity as 'non-mothers', that ship sailed with your last uterine contraction. Soz.


WHINGE #2: BREASTFEEDING IS SEXIST

Yup, you read that title correctly. Your boobs are conspiring against you, those misogynistic globes of torment! Not only do formula apologists downplay scientific evidence, they also whittle breastfeeding into a tool of oppression. Misapplying feminist rhetoric, formula apologists attempt to reconceptualise breastfeeding as a social practice, and a sexist one at that! (Blum 1999; Hausman 2003; Law 2000). They frame breastfeeding as part of political 'gender relations' (Jansson 2009). This reductionist diversion strategy defaces breastfeeding, turning it from a biology to ideology. 

The irony is that whilst many formula apologists claim to be feminists, they are simultaneously playing right into the hands of patriarchal capitalism - a system that defines the male body and mind as the norm and female functioning (hello, lactation!) as a deviation. What’s more, the formula apologists’ response to a normal bodily function is even moreso anti-feminist because it is needlessly reactive and awkwardly paternal:

“The blame-free breastfeeding culture they seek to create, infantalises women, framing them not as active agents capable of controlling their destiny and achieving their goals, but of passive wallflowers at the mercy of forces they are powerless to defy.” (Breast Intentions).

Formula-apologists, on your way, back to feminist school!



WHINGE #3: MORAL ACCOUNTABILITY HURTS OUR FEELINGS

Here’s where the agenda of formula apologists becomes so transparent, if it were a condom it would be illegal. Despite celebrating their ‘choice’ in forcing their infants to consume fourth-best nutrition, formula apologists still demand that they are good mothers. Yup. So, on one hand they want to broadcast this stellar identity as "good mothers", yet recall on the other hand they also want to "re-establish their identity as non-mothers". Taking the proverbial cake, some?


Formula apologists are angry at the notion of being held morally accountable for their decision to formula feed. They're pissed at the notion - there mere thought - that their babies could be regarded as victims of their actions. Check out this lament from Ellie Lee, one of the most outspoken formula apologists: "The health of children in particular has been identiļ¬ed as a potent site for development of risk consciousness in this regard, because of their presumed innocence and vulnerability" (Lee 2007). Notice the sly addition of the word 'presumed'. Kids are ‘presumed’ innocent. 

Yet despite Ellie’s cries of guilt and maternal victimization, in one of her own studies, only 20% of formula feeders stated that they cared about the effects of formula on their babies' health (Lee 2007). (Only 20%! Jeeeze that "good mother" accolade needs some work). And herein lies the big beef harboured by formula apologists, in their own words: "'Health' has attained increasingly moralised connotations, as it is more and more considered to be a state that can, and should, be chosen by responsible individuals" (Lee 2007; Burrows et al 1995; Nettleton 2004; Murphy 2004). Choosing to be healthy, we are told, is a bad thing. Go figure!

The hole is dug further:

"Contemporary culture is thus one that requires parents to agree – even if they do so ambiguously – that they will always put the child first" (Lee 2011). This again, we are told, is a bad thing. (The cheek of it!! Putting kids first!)

If this weren’t pathetic enough, formula apologists then boo hoo over the fact that they aren't being patted on the back and positively rewarded for their mediocrity. One mother who shared her story on a formula-apologist site sniffled that: "Nobody says 'Good for you for feeding your babies!'" ..Well, formula guys, if it makes you feel better, no one ever says to me: "Good for you!" whenever I put clothes on my kids. Perhaps I had better phone the Samaritans.



WHINGE #4: FORMULA FEEDERS ARE THE PERSECUTED MAJORITY

We’ve just looked at how formula apologists believe that individuals (read: mothers) do not have personal responsibility for the choices that they make. So, this begs the question: who does? Their answer to this conundrum is to blame the woolly notion of ‘society’. Society is to blame for the choices mothers make. In arguing this, they appeal to leftwing liberal ideology to shelter them from acknowledging the consequences of their choices. Let's look at this classy charade:

Essentially, formula apologists are fighting for a self-serving utopia in which people - mothers in particular - are free to act without moral consequence. One way they attempt to do this is by over-reliance on collectivist rhetoric and the denial of individual self-determinism. Collectivism (i.e. lamenting that 'society' is to blame for individual women's breastfeeding failures) eliminates their need for moral responsibility.

And then the irony becomes deafening: Despite demanding that others heed their emotional sentimentalities, the pro-formula lobby are not what you could call tolerant. Indeed, they are viciously intolerant of any divergence from their ill-perceived right as mothers to not have their liberty impinged upon by their bothersome infants’ needs:

“A major way formula apologists attempt to strengthen the faux-link between breastfeeding success and luck is to raise concern about the morality of judging. If success is simply down to good fortune in the form of societal privilege and working breasts, then in theory, breastfeeding mothers should not judge those who are not lucky enough to enjoy these attributes, they argue.” – Breast Intentions.

In the eyes of every formula apologist, poor bfing rates stem from a hazy collectivist scapegoat they call 'society'. Whilst, to a degree, I concede that society is responsible towards us, aren't we in turn responsible towards society? Heck, aren't we society?

Another layer to the irony inherent within formula apologism: the main self-appointed advocates for the apologist lobby are middle class educated women who actually do very little to help those disadvantaged women they claim to defend. Despite parroting their rhetoric without really helping anyone, the quasi-political activism they engage in is dedicated to convincing themselves that they are somehow beneficent to those below them. It's Slactivism at it's most pungent. Warm fuzzies aplenty but very little political change.



Conclusion?

It's time we all: woman the hell up, big girl panties and all.

There are two strands to the breastfeeding vs formula feeding debate and you should want to be on the side of the academics. Their discourse is characterised by scientific method over emotion. The other side of the debate is not. It belongs to the bitter bloggers, the columnists and quasi-professional media whores. They see infant feeding as a key battleground in a culture war. Of these two narratives – the academic and the angry – which one reaches the ears of those who need, most immediately, to form a judgement about infant feeding? The mother agonising over whether to continue breastfeeding is ill-served by the voices of bitter failures. For her agony rests in truly wanting to breastfeed, but simultaneously being told by a failed majority that breastfeeding ‘doesn’t matter that much’. Every mother who returns home with a baby in a carry-crib and a body pumped full of hormones deserves much more than cards, flowers, and a laundry-list of sob stories. The ‘breastfeeding doesn’t matter’ formula apologists would do well to heed the desires and dreams of the new mothers coming behind them, rather than undermining them to fuel a personal self-pacifying agenda.


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