Thursday, December 20, 2012

Mother's milk--and others' milk--in Japan

Any sharp-eyed person reading this blog will probably have noticed that I am raising my daughter, Little Seal, in Tokyo. I've never really talked about Japanese breastfeeding culture on this blog--probably because, in the self-perpetuating metaworld of the Internet I blog primarily about stuff I read about online (in English). Nevertheless, the "Japanese breastfeeding experience" has been one factor shaping my attitudes towards breastfeeding and breastfeeding advocacy; here are a few things that might be interesting to outsiders.

Breastfeeding is normal: As the International Breastfeeding Journal comments, rates of babies receiving "any breastfeeding" in Japan are quite high. Rates of exclusive breastfeeding, however, are lower than in many comparable countries. This fits with my own observations, which are that nursing is normal here, but giving the odd bottle of formula is common as well.

Public breastfeeding, however, is not: On the other hand, Japan is not Norway where apparently women whip their boobs out everywhere without a thought. Nursing in public is not common here.That said, I've seen more NIP in the last couple of years, maybe partly as a result the increased popularity of those much-despised nursing capes which every Japanese baby store now carries. Incidentally, ..I've have had zero issues with NIP in 21 months, and have never heard of anyone being harassed or told to stop. People just ignore you...

A room of one's own: Nursing rooms (bonyuushitsu)--equipped with sofas, changing mats and sometimes bottle-making facilities--are found in most department stores and stations. I made occasional use of them (they are useful for distracted babies or if you want to get comfy), but mostly I just couldn't be bothered dragging all the way there--I'd rather nurse under a cover. I like to think that every woman who nurses in public in Japan makes it easier for other women--Japanese or foreign--to be a bit braver and give it a try.

Hospitals--mixed report: Considering Japanese hospitals' fixation with natural, vaginal birth (thank God Cecile was breech and came out the safety hatch), you might think that this would be Baby Friendly Hospital territory. Nope. My own hospital--not Baby Friendly but definitely breastfeeding friendly--was wonderful, but the majority of hospitals appear to be stuck in 1963: compulsory rooming-out 24/7, strict three-hour schedules, and formula in a bottle for the baby until your milk comes in. Since you stay in the hospital for 5-7 days, these things matter. A friend of mine had a baby who, after latching on just fine, wanted to feed all night and sleep all day in defiance of the feeding schedule. My friend was told that this meant there was a "latch problem" (there wasn't) and that she should start pumping and sterilizing bottles. She was collapsing with exhaustion by the time she got home. What a mess.

Post-partum seclusion: Japanese custom dictates that the first four to six weeks postpartum are a period of rest, where you are supposed to focus on healing from birth and getting used to motherhood while your parents, in-laws or other relatives take care of the house and help with the baby. This custom is called satogaeri bunben ("hometown-return delivery), although these days it's becoming more common for the woman to stay in her own house while the relatives come to her.

Extended nursing: Japanese culture reveres the mother-child bond, and close and prolonged physical contact--breastfeeding, bed-sharing, bath-sharing--is seen as completely normal. These cultural expectations definitely have their downside--Japanese culture is still not very supportive of mothers who work outside the home. On the bright side, however, I have never had any weird reactions for nursing a toddler here, including from my mother-in-law. My British parents, meanwhile, are a different story.

Dayweaning before nightweaning? Japanese people are mildly surprised to learn that Little Seal sleeps through the night in her own room, because it's really common for children to sleep with their parents here. Perhaps for this reason, a lot of Japanese mothers continue to breastfeed their toddlers throughout the night even when they are no longer doing so during the day--especially in the case of boys. This is odd to me, because I tend to think of nightweaning as something that happens before day weaning. I remember explaining the concept of nightweaning to a Japanese mum at a La Leche League meeting... she was astonished!

Nipple pinching and breast massage: Japanese midwives and nurses are very... "full on" when it comes to manhandling your breasts (with or without permission). Breast massage in Japan is believed to improve milk quality; it was also inflicted on me to unclog a clogged duct. My God, it was painful.

Food and drink: While under the nurse's dominatrix-like hands (and therefore in no position to argue) I was also scolded for eating too much chocolate and fatty foods and thus causing the clogged duct in the first place. The Japanese are convinced that everything you eat and drink is powerfully connected with your milk. Japanese mothers tend to be stunned to hear that I will nurse after drinking a couple of beers.

Earthquakes! Japan is a notoriously disaster-prone country, a fact that was brought home to me by the fact that I gave birth the day after the 11 March 2011 earthquake. I can still remember the sinking feeling in the pit of my stomach as I opened my Facebook page from my hospital bed and saw my newsfeed was full of reports of Tokyo shops being stripped of baby formula as parents began to engage in panic-buying. Followed by an official warning not to use tap water for making up bottles due to excessive levels of radiation. Ten months later, there was a recall of formula due to high cesium levels. What gives?

Incredibly, however, RTF liquid formula is impossible to find here, and formula feeding families keep bottled water, regular feeding bottles and powdered water in stock as earthquake preparation--hardly adequate, especially since parents are now advised to scald formula powder with hot water for young babies even in non-disaster conditions. Following 3/11, RTF had to be flown in from overseas. The advantages of RTF were discussed in the national press following 3/11, but nothing happened and the subject has since been dropped. A poster on my mother's group suggested that Japan's low fertility and high breastfeeding rates mean the market here may be too small to support such a product. I really think Japan needs to sort this issue out, however. The 3/11 earthquake hit mostly aging and depopulating areas; if/when the big one hits Tokyo... well, we have a lot more babies here.

Closing thoughts
Breastfeeding in Japan is very "normal" in every sense: it's commonplace and always has been, but that also means that you don't really get the fervent lactivism politics that you get in the west--especially in the United States and Britain where breastfeeding is still trying to recover from its nadir in the 1950s and 1960s and is surrounded by a lot of bristly insecurity as a result. So nursing to me felt like the usual and expected thing to do. The earthquake experience certainly gave me a new awareness that breastfeeding can have some real safety advantages even in the developed world.

I do think it's interesting that breastfeeding rates are basically high in spite of the dodgy hospitals, the widespread use of supplementation and the fact that so many women feel they can't nurse publicly. One possible explanation is that these factors may be less important than generally thought. Alternatively... a doula I have met in Tokyo once suggested to me (regarding Japanese hospitals) that Japanese society is so supportive of nursing in other ways that this enables mothers to overcome the rocky start they get at the hospital, and perhaps this is true of the other things as well. Maybe offering bottles of formula whenever you are out in public is likely to prang your supply if you also cosleep, for example, because you make up for it with more nipple stimulation at other times? Who knows? Some research might be interesting.

I suppose this is part of the reason why I don't have a lot of patience with the more extreme and dogmatic forms of lactivism which have been widespread in the west in recent years; because I have seen with my own eyes that you can have widespread and "normalized" breastfeeding without obeying every point of the "correct breastfeeding" checklist. I nursed in public and never gave any formula but used a crib and sleep trained and worked; most Japanese mothers cosleep and don't go to work, but send their babies to the hospital nursery and give a bottle in public. Somehow, we all make breastfeeding work for us... most of the time.

Further reading: Factors Associated with Exclusive Breast-feeding in Japan

Thursday, December 6, 2012

Insider info on Kate Middleton's pregnancy--a BFWOBS exclusive!

A few days ago, people all over the planet were overjoyed to hear of the news that the Duchess of Cambridge and future Queen of England Kate Middleton, was expecting her first baby--a baby that will one day occupy the throne of England.

As the world's focus intensifies on what is quite literally the most important news event since Bill Clinton boned Monica Lewinsky, BFWOBS can bring you some thrilling insider information about what is set to become the most watched pregnancy on the planet, which hopefully will fill in the gaps until poor old Kate is released from hospital and can be photographed again.

Royal traditions
Family protocol at the House of Windsor dictates that the mother-to-be must carry the baby in her "uterus" for around nine months. Rumor at the Palace has it that this could cause Kate's stomach to "become larger" during her pregnancy. While it's not known how Kate plans to give birth, an insider source at the Palace has revealed to BFWOBS in an exclusive interview that the birth will almost certainly be either a vaginal delivery or a cesarean section: "I can confidently state that the Duchess will be having an elective med-free, home cesarean waterbirth, either with or without an epidural. There's no doubt this will be a very special experience for her."

Kate Middleton "could be carrying conjoined twins"
Experts say that there is a distinct possibility that Kate could be carrying conjoined twins, a rare condition in which two babies are joined together at one or more parts of the body. "Cases of conjoined twins have occurred occasionally throughout human history, and the Royal Family have refused to release any ultrasounds, so it's entirely possible that Kate could be carrying them. Also, she comes from Buckinghamshire where there was a case of conjoined twins reported back in the mid-1960s, which surely increases the odds," said a Pregnancy and Baby Expert we spoke to. The Palace has refused to comment on the conjoined twins rumor, leading to a further flurry of media speculation about possible constitutional ramifications.

Tragic news--Baby will be "unable to walk or talk" for first year
Sadly, it appears that not everything about this pregnancy is set to go to plan. An acquaintance of Kate Middleton has disclosed that the baby Kate is carrying is likely to be incapable of walking or talking until it's around 12 months old. "Obviously this has come as a real blow to Kate," said our source, "but she's a strong person and will deal."

Join us at BFWOBS next time for....

Pictures of pregnant women with Kate's head crudely photoshopped onto them, accompanied by captions like "Shocking: What Kate could look like in her third trimester."

Advice on motherhood for Kate, given by random women we stopped in the street! Real live mums (just like you!) offer tips such as "Be prepared for sleep deprivation," "It's important to love your child and raise him or her in a good environment" and other similarly original remarks.

Special offer--Available only from BFWOBS! Are you looking for a commemorative gift item to mark Kate's pregnancy that is both useful and aesthetically pleasing? Well and good. If not, why not buy the Kate Middleton Pregnancy Commemorative Denture Cleansing Product Holder Mat Protector Stand, crafted from 100% genuine vinylette and decorated with a computer-generated image of what our future heir to the throne may (or then again, may not) possibly look like. $55.99 (batteries not included).

MORE pointless speculation!

Vote in the BFWOBS poll!
Do you think that requiring Kate to carry the baby inside her for the full duration of the pregnancy (while Wills gets off scot-free) is an outdated and sexist Royal tradition?
  • Yes
  • No
  • I don't know
  • I don't care
  • I'm a grumpy republican... piss off

Wednesday, November 21, 2012

Skipping sippy cups?

No, you are not imagining things; that sippy cup really is designed to look like a pasty-white plastic tit. Needless to say, the only sippy Baby Seal would drink from was the one I was embarrassed to carry around...
It's become popular recently for breastfeeding mothers to skip the bottle and going straight to a sippy cup. However, some mums take this a stage further and go straight to an open cup. By the way, "some people" actually includes me... sort of. Since Little Seal hated bottles and was very slow to learn to drink from a sippy, I ended up more or less going straight to a little regular cup--supported/steadied by me in the early days, obviously. It wasn't until later that I discovered that "skipping the sippy cup" was a Thing.

Why are some people anti-sippy? Well, one point sometimes made is that they aren't necessary. The alternative name "trainer cup" implies that they are an essential step to learning how to drink, but this is of course nonsense; babies learned to drink from cups just fine before sippies were invented, and getting water out of a sippy involves an entirely different set of skills compared to drinking from an open cup. The real raison d'etre of sippies that they are spillproof and therefore a convenience to parents. Here in Japan, most daycare nurseries apparently insist that toddlers over 12mo use open cups only--a fact which amazes some Westerners when they first see all these tiny tots independently drinking from these little cups (without spilling... no doubt due to that mysterious ability that daycare workers have to get children to do things that they would never ever do at home).

Some lactivist-y people are anti-sippy because of fears that babies who start to enjoy the autonomy of wandering around with a cup will be more likely to self-wean early from the breast. Skipping sippies is relatively popular among baby-led weaners, which is a bit surprising, really; sippies actually allow early self-feeding and autonomy earlier and it's a rare baby who can manage an open cup independently at 6mo. However, mainstream pediatricians and dentists also tend to recommend skipping/severely limiting sippies. Extensive use of these cups has been linked with speech problems, possibly because in order to get liquid out of them--especially ones with valves--you have to push your tongue into a peculiar position which isn't used in the formation of sounds. And the very spillproof-ness of these cups can be a bit of a menace. Parents are tempted to put juice in and let toddlers wander away from the table with them (no way would you do that with an open cup, unless you like having disgusting sticky all over your house); sucking on the cup keeps kiddo quiet, so you let them have it a bit longer; and then you find yourself giving them a sippy with juice to stop them wailing in the car seat, and so on, and before you know it, the kid is spending half the day with a chewed-up plastic stub in their mouth and juice/cow's milk pooling around their teeth. The other thing about sippies is that they are often a bit... gross. They get all chewed-up, they have all these little cracks and crevices for germs to breed, they get thrown around and dropped and picked up and put in the mouth again and discovered under the car seat covered in two weeks' worth of fluff and lint and dog hair... you get the picture.

The case for sippies
That said, when at 9mo Little Seal finally took to one of the sippy cups we offered (after I got frustrated one day and ripped the valve thing out... I felt vaguely guilty afterwards, as if I'd vandalized the cup, then an online search revealed that loads of parents do this), the dreaded sippy also turned out to be useful in its own way, and I can't quite imagine never using anything but an open cup with a toddler.

Why? Well, for one thing, kids don't seem to drink quite as much from open cups as they do from sippies. I've found it useful to "add in" a little drinking from the sippy at times when it just seemed like she needed more fluids. Also, I'm not sure how you are supposed to nightwean if you never do bottles or sippies; how do you give them a sip of water if they do wake up? Open cups of water in a dark bedroom when you're tired sound like a disaster waiting to happen. Finally, I'm told that car-using parents find a sippy of water useful when they are on the road.

Cups, cups, cups
Back when we were in the bottle-refusal trenches, I did briefly wonder whether the famous Doidy cup (a funny little open cup with tilted sides) might be the answer. I think I'm glad I didn't bother, since the impression I get from Mumsnet is that there are a lot of Doidies gathering dust in people's cupboards. The Doidy's tilted sides allegedly make it easier for babies to control the flow of liquid and thus drink independently; the reality seems to be that the vast majority of babies need some help with a Doidy until toddlerhood, much like with an ordinary open cup (as one Mumsnet poster put it "The myth of the Doidy cup: 4 month old baby sips delicately at the clever slanty cup of healthy beverage.  The actuality of the doidy cup: 15 month old baby tips contents of clever slanty cup all over own chest. Cries. Change clothing and repeat. Buy cup with spout.") Also, in my experience, babies spill from open cups mainly because a) they plonk cups down clumsily and b) they think it's fun to chuck water everywhere... not because they can't control the water flow. I think if you use any type of open cup with a baby, realistically you need to be prepared to help them out with it for quite a long time unless you like soggy children and drenched floors.

A lot of parents seem to be using straw cups these days due to concerns about sippies. If I could do things again, I think I would have given these a try with Little Seal. It's handy if a baby can drink from a straw early on. That said, the other issues of sippy cups--grunge/germs, temptation to let the kid sip juice or milk all day--still remain with straw cups, so I think there's still a case to be made for introducing an open cup in the first year as well. Also, I wonder how long it'll be before "they" (dentists, pediatricians, whatever) discover some sort of problem caused by sucking on a straw all day long...

My verdict
So, all in all, going straight to an open cup--for 90% of water consumption, anyway-- turned out to be quite a nice way of doing things. You do have to supervise more and have a little more tolerance for spills--but then, if you're only doing water in the cup, this isn't usually a real problem. And I love not having to drag grotty sippies around with me. Some restaurants only have thin glasses which a young child could bite through causing serious injuries (sturdy glasses are OK); in these cases I ask for a mug or a straw, or just feed water on a spoon. The other useful thing I worked out was to keep the cup out of reach, offer it at intervals and teach Little Seal to point to it when she wants to drink. If the cup is right there in front of a toddler, the temptation to dump the contents all over the floor (just to check that gravity is still working) can become irresistible.

The sippy in our house is only for water; cow's milk comes in an open cup. However, I suspect that using an open cup only for milk is probably only practical if you are doing extended nursing, with cow's milk as a sort of supplement; if I were only doing cow's milk/toddler formula, I think I'd use a sippy/straw cup--not sure a toddler would reliably drink enough milk from an open cup. I do think that the pediatrician's rule of "juice only in an open cup (with or without straw)" is a good rule to stick to, as it means that juice stays in its rightful place as something sipped occasionally at mealtimes, not an all-day pacifier. You see, as it happens I'm awful with the TV... you know, putting it on for a few minutes (cue mummy-guilt spasm) multiple times a day when I need to immobilize Little Seal or get essential stuff done, so I think I'm probably better off not having the temptation of juice or milk in sippies for keeping Little Seal quiet; I bet I wouldn't be self-disciplined enough to restrict usage.

To sum up; I think using open cups as the main drinking device for older babies and toddlers can work, but better to be a bit flexible and consider adding in a sippy or straw cup when it seems to make sense. Happy drinking!

Sunday, November 11, 2012

When mainstream babycare gurus go bad

I should have known better, really. A few weeks back I cobbled together a list of "No-BS Breastfeeding Resources" comprising various books, websites and blogs which I reckoned were "credible, science-based and reasonably representative of how most of us actually mother." On the list I included Robin Barker, author of the bestselling Australian book Baby Love. I had not, I should confess, read any books by Barker, but trusted that they were likely to be sound, since they had been recommended by more than one person I respected.

So I open up Facebook one day and lo and behold, there is an article by Barker, "Duration not initiation is the real breastfeeding battle," which deplores the fact that according to a recent Australian Institute of Health and Welfare (AIHW) report, only 15% of women in Australia are exclusively breastfeeding by the six-month mark.

Now, before we all get into a flap about Oh My God Nobody's Doing Any Breastfeeding... here's the thing. The AIHW defines "exclusive breastfeeding" as nothing by mouth except breastmilk and certain medical supplements: no water, no solids and not even a single bottle of formula. Given those criteria, I'm actually astonished that the figure at six months is as high as 15%. I don't think I know any mother who would meet those standards. Not me, for a start: Little Seal had a bottle of sugar water in hospital (soothing for her and reassuring for me, as I was panicking about dehydration) and started small amounts of solids from four-and-a-half months, based on my own carefully researched decision. Now, I kind of resent the implication that these actions of mine now turn me and my child into some kind of Official Public Health Problem; yet when we take "exclusive breastfeeding to six months" as a barometer for correct infant feeding practices, that is the inevitable implication. The ridiculous thing is that in Oz, the pendulum in recent years seems to have swung back towards encouraging small tastes of food from four months or so in an effort to reduce food allergies, a point made by several commenters on the Barker article. (By the way, if a mere nip of sugar water negates the "exclusive breastfeeding" label, does this mean that we also have to be terribly careful when washing our babies' faces, lest a few drops of water make it into their mouths? How many cubic milliliters of water represent the level that breaches the "exclusive breastfeeding" threshold? How about when your baby starts putting their hands in their mouth and there's dust and detritus and cat hair on them--wouldn't that disturb the virgin gut just as much as a tiny bit of rice cereal? We could go on like this all night, really.)

Okay, so that was a bit dodgy. But my jaw really dropped when I saw some of the ideas that Barker floats as possible proposals for increasing the breastfeeding duration of Australian women. Better maternity leave, funding for research into breastfeeding problems and funding for experienced staff to help women... no problem. But "Infant formula in the first six months by prescription only." What?

Now, the formula-by-prescription-only thing comes up regularly in infant feeding discussions, so I really should not have to spell out the reasons this would be a terrible idea, but things like "The government of Iran is not a role model" "Screaming baby, new mother with stitches where the sun don't shine, pharmacy halfway across town" and "Gee, we've run out of formula again. Giving a newborn some cow's milk from the carton isn't that bad... right?" are flashing through my head like visions from some bad dream. Not to mention that whole tedious business about women being able to, you know, control their own bodies and all that. Material written by Barker quite recently on breastfeeding that I have been able to find (this, for example, written in 2004) comes across as eminently sensible, as does Baby Love judging by the Amazon reviews; so seeing her suddenly come out with such an extreme idea does make me start to wonder if (as some parenting bloggers have suggested) we have indeed seen in recent years a hardening of the rhetoric on breastfeeding and a shift towards more extreme positions.

The alternative explanation, of course, is that Barker (who is well into her 70s) is out of touch or starting to lose it a bit. This last thought is one that also occurred to me a few months ago when I came across an utterly bizarre article called When Should You Stop Breastfeeding in the Daily Mirror by Miriam Stoppard--another popular mainstream childcare writer who is now in her 70s and who I had always vaguely assumed represented a fairly sane and sensible voice in the world of infant feeding politics.
"...For years, we’ve followed the World Health Organization guideline that where possible babies should be breast-fed for six months. Recently, the Institute of Child Health put forward the case for mixed feeding from four months. I’m with them. Many mothers wean their babies around four months anyway and in the Third World it’s often an economic necessity. ...The mother on the Time cover believes in letting her child decide when breast-feeding should stop. I’ve never heard anything so irresponsible. No young child should be asked to shoulder the burden of such a decision... My guide is the appearance of teeth. Nature arranges for them to erupt when a baby needs food that has to be chewed. That should be when breast-feeding is gently suspended."
I'm not going to go through a word-by-word commentary on this confused and confusing mess of an article. I would say that when you are actually a babycare writer by profession and this is supposed to be your "area," it shouldn't be too much to expect some basic fact-checking. The WHO actually recommends two years of breastfeeding and six months of exclusive breastfeeding. Throughout the article, Stoppard keeps muddling the two definitions of weaning--"introduction of solid foods" versus "cessation of breastfeeding." A baby who is just starting to have a few teaspoons of food per day is still going to be dependent on breastmilk for most nutrition for many more months; you don't suddenly go from "no solids" to "all solids and no breastmilk/formula." It also makes no sense to say that solid foods should accompany tooth eruption (my grandmother was born with a tooth; should she have had solids from birth?) and in any case, isn't it a bit odd to say that after saying that babies should have solids at four months? Most babies don't get teeth that early. Finally, Stoppard must have led a very sheltered life if allowing a child to self-wean is the most "irresponsible" thing she's ever heard of. I'm sure she does not have a shred of evidence to suggest that this is in any way psychologically damaging, as she claims.

It's a bit rough, really. We have people pressing us in on all sides, telling us that we must breastfeed, but that we're disgusting or irresponsible if we do it for too long. If these pearls of wisdom were coming from an extremist like Dr. Sears or Gina Ford (the British babycare world's Queen of Routine), that would be one thing; when they come from writers who you always vaguely supposed represented the voice of sanity in all things baby-centered, it's a bit of a shock. It certainly points up the difficulty of trying to find and share breastfeeding-related resources that are moderate, science-based and non-judgmental... well, non-judgmental about things that don't matter, anyway. I mean, if you fill your newborn's bottles with a homemade Weston Price concoction of pureed liver and raw egg yolks, I will judge you.

One thing does hearten me though. As we all know, in general, the Comments sections on internet news articles are where crazy people go to die. The Comments sections on these two articles, however, actually defy the odds by being more sensible than the articles themselves, with the majority of commentators pointing out the flaws in Barker and Stoppard's reasoning. Perhaps there's hope for the world of online parenting discussion after all.

In the meantime, the two lessons I'll be taking from this are: a) if you run a blog, don't recommend writers you haven't actually read (blush); and b) if you are a doyenne of the babycare advice world, get your facts correct and think before you write, for God's sake!

Sunday, October 28, 2012

No-BS Book Reviews--Choosing Cesarean: A Natural Birth Plan

No-BS Book Reviews: Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull

When I was informed that my baby was still breech at 38 weeks and that a cesarean section was required, I knew that I was supposed to feel angry, saddened and cheated of the chance to have a “normal” delivery; instead, I felt secure, in control and—let’s be frank—pretty relieved. Anyone who wants to know why should read Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull. In this important book, the authors make a convincing case for cesarean delivery on maternal request as a valid form of birth and as the best choice for some women.

Hull is a journalist who blogs at, while Murphy is a urogynecologist (essentially, someone who spends his time propping up busted pelvic floors), and their book reflects this mixture of the medical, the personal and the political. It is a comprehensive guide for anyone considering choosing cesarean or interested in learning more about the issue, discussing not only the case for cesarean but also the practical and emotional aspects of planning and recovering from a surgical birth.

After a personal intro by the authors, Choosing Cesarean starts off with a look at the safety of panned cesarean, doing an excellent job of puncturing the sloppy science and media hysteria which has blighted popular discussion of this type of birth. Stats surrounding cesarean safety are usually based on “mixed” data which combines planned and emergency sections; if you look at the data for planned sections alone, the safety record of this birth type is generally at least as good as that of spontaneous vaginal delivery. Furthermore--and this is another important point which comes up several times in the book--an emergency cesarean is usually the result of a planned vaginal delivery. The book goes on to look at birth satisfaction, noting that satisfaction levels are high and birth trauma almost non-existent among women who choose cesareans. There is a detailed discussion of the pelvic floor and things that can go wrong in vaginal births—all the things which your Lamaze class won’t tell you (one quibble: a diagram of the pelvic floor might have come in handy here). Just a warning, but this part can make disturbing reading, and if I’m honest, I came out of this section feeling like I had dodged a bullet. 

This is followed by a discussion of cesarean rates around the world and the intensely politicized debate which surrounds cesareans. An entire chapter sets out the risks of planning a cesarean in detail; Murphy and Hull never gloss over the details of surgical birth or make it out to be a superficial or cosmetic procedure. The final section of the book focuses on the “how-to” aspects, describing the surgery itself in detail and giving advice on how to plan and recover from a surgical birth, interwoven with stories, hints and tips from real women who have had maternal request cesareans.

We all have our biases when it comes to birth and Murphy and Hull are unabashedly fans of planned cesareans; nevertheless, they are clear at all times that this is only an appropriate option for women who are suitable candidates (committed to having a small family, sure of their conception dates, and fully informed about the risks and benefits of the procedure). They also state emphatically that the fact that chosen cesarean section is a valid choice does not in any way invalidate the desire of other women for natural childbirth and VBAC. The book is well-written, well-edited and clear; in the sections on pelvic floor health in particular it does a good job of explaining some complex ideas in language any layperson can understand.

Any quibbles? Well… one objection which is invariably raised whenever the idea of maternal request cesarean comes up is “The cure for the problems of vaginal delivery (pain, trauma, pelvic floor injury) is not surgical birth, but natural childbirth. These terrible problems are basically caused by women giving birth on their backs in hospital; if we all went without drugs and squatted in labor, they wouldn’t happen.” The evidence supporting this is, well… dubious, to say the least, although there is some evidence that the use of epidural anesthesia may increase the risk of a forceps/vacuum delivery; anticipating and discussing this objection might have increased Choosing Cesarean’s persuasive power. (In my own case, feeling that I had to choose between either unmedicated labor—i.e., hours or possibly days of blinding agony—or an increased risk of an instrumental delivery and all the physical and emotional trauma which that can cause, merely increased my own desire to avoid vaginal delivery if possible… neither of these options sounded very appealing!) I’m also unsure about the book’s title “A Natural Birth Plan”; cesarean birth is certainly valid, but it isn’t natural… and there’s nothing wrong with that. “Natural” isn’t always better.

These are small quibbles about what is fundamentally an intelligent, courageous and important work. I’ve recommended it to more than one person, and my own copy is now well-thumbed. Whether you are planning a cesarean, know you will have to have a cesarean anyway, are not sure either way, or are simply interested in birth politics, you’ll find this book a terrific resource. It’s worth a read.

Wednesday, October 17, 2012

Becoming "the framework of support that we want to see"

I have just added a page of No-BS Breastfeeding Resources to the site, which I'll be updating from time to time. It's based on my previous post, but I added the following paragraph, which I'll just post again here:

A  while back, the Fearless Formula Feeder wrote a blog post in which she expressed disappointment in the way a certain breastfeeding website had behaved--all the more so because this was a website which the FFF had previously considered to be one of the better breastfeeding resources. The site in question had previously been seen making efforts to bridge the divide between breastfeeders and formula feeders and to express respect and support for all mothers, so it had come as something of a surprise when the site (a) ran an interview with a breastfeeding celebrity which had come across to many readers as rather smug and provocative, and (b) deleted comments by some posters (including the FFF) which had expressed criticism of the interview.

When the FFF blogged about this, she drew the following comment from a follower of her blog:
"I cannot conclude anything other than that BFB has gone over to the dark side. It's unfortunate, but it seems that a lot of lactivists, in order to maintain their core readership, find themselves being pushed more and more to the extreme, leaving those in the middle (who are probably a very large majority) marginalized. Breastfeeding bullies–which BFB seems to be increasingly leaning toward–do not just harm bottle-feeding parents. They harm breastfeeding ones, and potential breastfeeding ones too."
while another commented,
"I have always liked Best for Babes as an organization that was “supportive” to all mothers... I just think that at the most basic level, moderate attitudes and being supportive of everyone just doesn't get readers and ad impressions. Showing your ass and leaning toward militancy does."
There's an important lesson here for us all. Sites like Best for Babes, Kellymom and all the others are the way they are because that's their core readership--that's who hangs around these sites and posts the most. As a result, more moderate voices tend to be drowned out, and will continue to be drowned out unless these more moderate people get more proactive about speaking up and expressing some alternative viewpoints... in a sensitive, respectful and non-trolling way, needless to say. Meanwhile, the small number of breastfeeding-related Facebook pages and sites which are committed to discussing breastfeeding in a sensitive and non-extremist way have tiny followings compared with the big lactivist resources. There's an Evidence Based Breastfeeding Facebook page, sure--but maybe people need to start being more proactive about posting on it and inviting people to it (and by "people" I'm including myself, by the way). We need to keep an eye out for good resources, comment on them, share them with others, link to them and bring them into discussions at our mother's groups and due-date-clubs. It's a case of "Use them or lose them."

If anyone reading this page feels, like me, that we need better breastfeeding resources... less antagonistic, more moderate, more representative of the full range of mothering styles, and well, just.... saner... then it's all very well complaining about this amongst ourselves, but the current situation is not going to change unless we all step up and "become the framework of support that we want to see." And that's something which we all need to get behind.

Wednesday, October 3, 2012

Baby regrets... "I wish I'd..."

For some reason, I have all these regrets about her little newborn hands and feet. They were so tiny and precious. I wish I'd made prints of them in ink, gradually getting bigger over the weeks and months. And I wish I'd taken some film footage showing the way she used to move her little hands about when she was a newborn... they were always fluttering and opening and closing and spreading like little starfish in the sea, as if they were marveling at the freedom of the open air. In fact, I wish I'd filmed all sorts of things when she was tiny... like the way she used to make suckling movements with her lips when she slept, and how floppy her head was. I didn't even discover our new camera had a film button until she was two months old (yeah, I know). Now all those little newborn movements are long gone and I only have my memories.

Like all parents, I wasted a fair bit of money on things she didn't like. I spent a fortune on a beautiful Mio baby hammock. She hated it, and I was too nervous to use it what with the earthquake aftershocks and all (I gave birth on 12 March in Tokyo, about 16 hours after the earthquake). Oh well, at least I got a couple of beautiful pictures of her in it. She didn't like the mesh feeder or the swaddle blanket either.

I wish I had actually packed my hospital bag well in advance. The morning my waters broke I still had half my stuff scattered all over the living room. "No need to finish packing it just yet. Everyone knows first babies are always late," I had thought. Ha.

Oh, and I wish I'd depilated my legs beforehand--or rather, got a proper all-over waxing job at a salon. God knows what my obstetrician thought of me.

I wish I'd given Little Seal Vitamin D drops. She has never had any signs of Vitamin D deficiency, but still it might have been a good idea.

I wish I'd bought a proper camera as soon as I got pregnant and taken lots more bump shots. I don't regret not getting a belly mould though... that's just weird.

I wish I hadn't flipped out so badly when she had colic between 5 and 10 weeks. I did and said some very silly things which I am extremely embarrassed about now (so embarrassed that I'm not even going to say what they are). Turns out Mum was right. They do grow out of it.

I think my choice of pram (a Maclaren XT) was basically a very good one in almost all respects, but I wish I'd chosen something with a rear-facing option. I remember Little Seal being quite frightened of the pram sometimes when she was little and was being wheeled about in busy, crowded city streets, unable to see my face, and I'm sure it's contributed to her dislike of the buggy even now. It would be lovely to be able to go for a walk together and communicate face-to-face while I also get a bit of much-needed exercise. I actually use the sling a lot, even these days, but it would be nice to change it up and use the pram too. (And anyone who wants to snark on mothers who want to put their toddlers in a rear-facing buggy can go jump in a lake. Seriously. Some of us have jobs, and face-to-face time with our toddlers is a precious commodity).

I wish I'd bought more slings while Little Seal was tiny. I had no idea just how much I was going to be using carriers... a lot, as it turned out. While I think my chosen carriers (Beco Gemini and Beco Butterfly) were really, really good ones, I think it would have been fun to have a couple of mei tais in there as well. And a ring sling! Buckle carriers like the Beco aren't really ideal for a newborn, in my opinion. And it might have been fun to get into wrapping. Yes, I know wraps are really granola-looking, but they are also really pretty and interesting.

Oh, and I wish I'd bought a babywearing coat too. Turns out it would have been a good investment. I hate having to walk around inside an overheated shop in winter with my coat on because Little Seal  is strapped on on top.

Knowing what I did now, I wish I'd been just a little more conscientious about getting a tad more solid food inside her. I was pretty good about choosing iron/zinc-rich foods for her for the most part (even then I was highly suspicious of the breastmilk-is-all-they-ever-need mentality prevalent online), but I do also remember lots of lazy days when I just plugged her into the boob and surfed the web, and at mealtimes just chucked bananas and rice cakes (which she didn't always eat) in her general direction. Hmmm. Oh, and I wish I'd been a bit more careful about oral hygiene and not passing on dental-caries-causing bacteria--I cringe now to think that I actually prechewed some meat for her once or twice. I know they all get colonized by these unpleasant bacteria eventually, but it surely makes sense to keep it away from their mouths as long as possible.

I wish I'd had Little Seal's cord clamping delayed. At the time, the benefits were in doubt and there was some concern about an increased risk of jaundice (which now appears to be unfounded).

I wish I'd tried Baby Sign. Not because of any of the (dubious) benefits that are sometimes claimed for it, but because it would have been so cute. And cool. And interesting. I've heard of babies as young as four months signing "milk" in their sleep... magical.

I wish I hadn't driven both of us crazy with trying to get her to accept a bottle, when in retrospect it really wasn't necessary at all (note: this was for me in my situation. For most breastfeeding mothers, life will be a lot easier and pleasanter if the baby will drink from a bottle). If I had another baby in similar circumstances--i.e, working from home and using at-home childcare for the first nine months at least--I would probably not even bother with the bottles, and just go straight to cup-feeding and start solids at 4-5 months.

I wish I'd kept a more detailed account of the pregnancy and birth and the first year.

And just briefly... a few things I'm glad I did:

I'm glad I didn't spend money on little clothes and toys, because people give them to you anyway, and I needed my money for other things (like the hospital).
I'm glad I read baby books during my pregnancy rather than pregnancy books (pregnancy takes care of itself, mostly; if it doesn't, you need to see a doctor, not read a book about it. But babies.... well, you don't have so much time for reading once you've got a newborn, let's face it).
I'm glad I prioritized sleep from the start, and that I got tough and nightweaned at 8 months.
I'm glad I started the potty early, since this is now really starting to pay off.
I'm glad I chose a really good hospital, with nice food and nice nurses and great breastfeeding support. Even though it was damned expensive.

And I'm really glad that I breastfed, even though I was slightly ambivalent about the idea when I was pregnant. I know that the pros and cons of different feeding methods work out differently for us all, but for me, breastfeeding has turned out to be one of the best mothering decisions I ever made--largely problem-free, healthy, convenient and cheap, not to mention emotionally fulfilling, empowering and just plain cool (my body producing life-sustaining food for an infant... how amazing is that?) And it's that feeling, ultimately, that keeps me passionate about the subject and blogging about it here.

Wednesday, September 26, 2012

No-BS breastfeeding resources (an ongoing project)

Suppose you're a normal mother-to-be who is planning to breastfeed... or, maybe thinking about it but not committed either way. You're looking forward to doing the sort of things the ordinary, everyday mothers around you do--you're planning a hospital birth with lots of nice drugs, you want to get your baby onto some vague sort of routine so you can plan the day, you'd certainly like baby to start "sleeping through" sooner rather than later, and you'll want to be able to leave your baby with your husband/mother-in-law/babysitter regularly so you can go out. You might go back to work while your child is still young.

Or maybe you're a second-time mother. You tried to breastfeed the first time round--oh, so very, very hard. And it didn't work out. Trouble is, by then you'd already spent months reading all the books and blogs--the ones that told you in no uncertain terms that your formula-fed child was going to be stupid, asthmatic and fat, that you wouldn't "bond" properly, and that anyway this was all your fault because you didn't have an all-natural birth bouncing up and down on a yoga ball, and because you caved and let the nurses take baby to the nursery for a couple of hours because you were too exhausted to see straight. A spiral into gloom, anxiety and hystronic post-partum depression was more or less guaranteed. Now you're girding your loins to try breastfeeding again. But the thought of reading those books again... the ones that were whispering in your ears at 3AM every morning while the tears rolled down your face...

I think you can see why most breastfeeding resources--the books, the blogs, the forums--are problematic for either one of these women. Such resources are heavily oriented towards natural birth, "natural" parenting, and natural just-about-everything-else, and waste no time in telling you about the horrors that await you and your child should you weaken and allow even a single bottle of that ghastly white stuff. And they are full of sloppy science, urban legends and pet theories.

Other books (usually not "breastfeeding books" but rather general how-to-look-after-your baby books) talk about routines and sleeping-through-the-night (almost fanatically, sometimes) yet fail to get the basics right regarding breastfeeding. For example, Gina Ford tells exhausted new mothers to start pumping pretty much from Day 1 in order to stretch out the gaps between feeds. Claire Byam-Cook and Tracy Hogg (the Baby Whisperer) tell women to measure how much milk they are producing by doing a "yield," i.e., pumping and measuring their output, apparently unaware that there are many women--including Yours Truly--who have a good supply but are mediocre at pumping. If I had followed these writers' advice, I would have been convinced that I was starving Little Seal with every feed.

For these reasons, I've decided to start compiling a comprehensive list of breastfeeding resources which I reckon are credible, science-based and reasonably representative of how most of us actually mother. I'll keep updating this as I come across more sources, but this is a start. There's some practical stuff here; there are also discussions of breastfeeding research and politics to muse on, or to wheel in as counter-evidence when someone online is talking bollocks.


Actual breastfeeding books
As I moaned here, it is very hard to find breastfeeding books that don't seem to be written by someone with the shining light of the fanatic in her eyes. Marianne Neifert (in Dr. Mom's Guide to Breastfeeding and Great Expectations: Essential Guide to Breastfeeding advocates for breastfeeding but manages to do so without the harshly judgmental tone of other lactivists. She is almost alone in the breastfeeding book annals in her outspokenness about the difficulties and barriers many breastfeeders experience, and in stating frankly that low supply really exists and is not a myth. Most importantly, her books get all the nuts and bolts right; they are full of great, practical information about how the breasts work, the mechanics of breastfeeding, latching, troubleshooting, pumping and much, much more--everything you'll get in the Womanly Art of Breastfeeding, in short, but without the scaremongering and condescension. By the way, it was Estherar at Mainstream Parenting who first put me onto this book.; check out her review here

Solids ("weaning")
Weaning Made Easy is a fun yet evidence-based approach to weaning (=solids introduction, not breastfeeding cessation) which avoids the tedium of the gourmet-icecube tray approach (making overelaborate purees and then spending mealtimes trying to get it all inside the baby) and the pitfalls of the Gill Rapley baby-led weaning method (potential iron/zinc shortages, babies going for months on end without eating anything, neverending mess). It encourages parents to offer different foods in a variety of ways, including soft finger foods and purees of nutritious-yet-hard-to-eat things, based on sound nutritional principles--always with a stress on the individuality of each child and the need for you to feel comfortable with what you are doing. Which, I suspect, is how most people would wean anyway if we didn't have babycare writers telling us how to do it...

I have half a dozen infant sleep books on my shelf (ordered by my husband in a fit of Amazon-inspired shopping mania). There they sit, their spines almost uncracked. When it comes to sleep there's only one book I use--Good Night, Sleep Tight by Kim West--and it's never failed me yet. This book (by a sleep specialist who's helped countless families) is moderate, eminently sensible, and flexible enough to work with a whole range of parenting "styles"--while she emphasizes sensible routines and self-soothing, she is also extremely sensitive to the needs and feelings of babies and young kids... and she has a gentler alternative to cry-it-out for those who can't quite face Ferberizing. She also breastfed both her daughters, and that's important because breastfeeding and formula feeding have subtly different dynamics that affect sleeping patterns. A lot of "sleep books".... well, they may give lip service to "bottles/breastfeeds" in their routines, but you can tell it's really formula feeders they have in mind. When a sleep book is written from the point of view of a breastfeeder, it makes the breastfeeding mother feel "This is advice that's realistic for my baby. I feel we have a chance of succeeding with this." With sleep advice it's vital to feel confident that it's achievable and practical for your situation, or you'll never be able to put it into practice. West is not super "into" bedsharing, but discusses it in a sensitive and nuanced manner--the various reasons people bedshare, how to do it safely, how to combine it with learning good sleep habits, and how to transition away from it when the time comes--unlike some other writers who just scold and shame parents who take their babies into bed with them. She is even not-rude about mothers who nurse longer than 12 months (not common in parenting books).

The Happiest Baby on the Block is a mildly attachment parent-y book with some good and practical advice for getting through the colicky weeks months. Generally I'm all for keeping babies on a loose routine, but when colic is wreaking its merry hell, sometimes you just have to grit your teeth and do what's necessary to get through the day. I recommend going straight to the second half of the book and ignoring the first section, which goes on a bit too much about how primitive tribespeople's babies don't have colic because they are carried round all day long (or something).

Other possibilities (recommended by others--I haven't read them)
Milk Memos (nursing and working) sounds like a good and non-judgey read, looking at the Amazon reviews. Child of Mine: Feeding with Love and Good Sense (feeding in general) was recommended by a blog reader. Baby Love (baby's first year) by Robin Barker got a good write-up from several people: "No nonsense; and she calls a poo a poo."

Blogs and websites

Ah yes, Kellymom. I've moaned about Kellymom a few times on this blog (and will be writing a longer post on them in the future). And yet I've sent struggling new mothers off to Kellymom for information several times, and there is presumably a reason for that. Kellymom can be really useful as long as you confine yourself to the “How many wet/dirty diapers should my newborn be producing?” kind of stuff, and bear in mind that this is an attachment parenting promotion site more than anything else. I've compiled a list of pages that I think give decent advice, but with everything that comes from Kellymom keep your skepticism close at hand. If it smells like bullshit, it may well be.  Confirm with other sources if you are not sure!

Low supply
Milk supply worries
Breastfeeding and medications
Weight gain (but see the FFF also here and here for your pinch of skepticism)
Milk supply and the older baby
Newborn basics
Much of the other stuff on the site is dodgy, especially the stuff on weaning age, solids/iron and the exaggerated benefits claimed for nursing, especially extended nursing. The forums have some pretty crazy ladies.
PS: Stay away from the sleep advice on that site if you value your sanity.

Science of Mom
A blogger I have a girl-crush on. The post on why breastmilk is so low in iron shreds some myths and misunderstandings about iron and breastmilk. It's refreshing to see a mother who can describe the joys of nursing past a year while questioning some of the dodgy data being used to push this choice onto all mothers. Meanwhile, can breastmilk clear up an eye infection? Possibly yes (admittedly, most of the breastfeeding sites have similar information, but it's nice to see Science of Mom actually confirming this with some data). Other posts cover breastmilk and prematurity, maternal diet and colic, improving milk production in the NICU and more.

Seattle Mama Doc combines evidence-based advice (sleep, breastfeeding, nutrition and more) with a kind and non-judgmental tone that makes for reassuring reading. She's worth a read!

Good Enough Mum
A terrific set of posts from a terrific blogger. She writes about nightweaning for a breastfeeding mother, and breastfeeding the second time around, gives her view on the "Watch your language" thing, and on why brutally unpleasant lactivism is everyone's business, while giving her vision for what positive breastfeeding promotion could look like. She also shreds some of bad science surrounding extended nursing--it's not as beneficial as you think (which doesn't mean you shouldn't do it if you want to)--and takes issue with the idea that a single bottle of formula will ruin your child's "gut" forever.

Fearless Formula Feeder
The majority of breastfeeders will use formula at some point, yet most breastfeeding resources say little about formula other than "Don't" followed by a list of terrifying reasons why--or descriptions of "correct formula preparation" which one suspects have been presented with the deliberate intention of making formula use look as intimidating as possible. That's why the Fearless Formula Feeder site (and upcoming book) can be the breastfeeding mother's friend. Learn the real deal about combo feeding and supplementing, jaundice, the mechanics of formula feeding, spotting formula allergy/intolerance, why you can't use goat's/cow's milk as a formula replacement, growth charts for formula-fed and breastfed babies and much, much more. Suzanne's site is extremely respectful of all safe feeding choices for babies... and what's more, it manages to be scientifically rigorous, well-written and nice--three things that are very hard to combine in online writing.    

Mainstream Parenting, while now defunct, is still a great source of skeptical commentary and mythbusting, some of which covers breastfeeding.


Skeptically Speaking's 15-minute podcast on breastfeeding is well worth a listen for an interesting scientific slant on lactation.

Trolls With Wooden Spoons
Trolls (you have to join; oh, and despite the name, the group has nothing to do with the internet phenomenon of "trolling") was created by a bunch of escapees who had become disillusioned with the craziness and horrible moderation on that site. So it's crunchier than I am, yet is also one of the few places where you will seldom get extremist natural-parenting stuff pushed at you; people started this site to get away from all that. And it's full of experienced breastfeeding mothers. There is a refreshing absence of pretension and bullshit on the site. The Woo-Busters page is a good place to get a second opinion on anything which sounds like woo but you are not quite sure!

NB: Avoid Trolls threads on carseat safety or Thanksgiving.

Mammals Suck... Milk! looks at the science of lactation across the animal kingdom, including human beings. Not a "how to breastfeed" blog, certainly, but fascination stuff and great background information.

Tuesday, September 18, 2012

Bullshitometer: Food before one is just for fun

Poster A: I’ve been doing baby led weaning for the past few months, but I’m starting to get discouraged. DD is 10mo and eats basically nothing. She plays with pieces of food, gums them and drops them on the floor. Occasionally a bit of food will actually make it into her. She has plenty of breastmilk and seems okay, but my health visitor is starting to get on my case about it, saying she’s going to become anemic because my milk isn’t enough! I don’t know who to believe any more. 
Poster B: Just keep repeating to yourself: Food before one is just for fun. Your LO is doing fine—playing with food is all they actually NEED to be doing at this stage. 
Poster C: Your HV doesn’t know what she’s talking about. Breastmilk is a good source of iron, because it’s so bioavailable (see Kellymom). Anyway, it doesn't make any evolutionary sense that babies would need anything other than BM before they are able to feed themselves--what did tribal babies do before pureed babyfood and iron supplements? Keep on doing what you are doing, mama! 
Poster D: Babies eat when they are ready. If she isn’t willing and able to self-feed, that means her gut isn’t mature enough. Trust your instincts and remember that food is just for fun until they’re one. 
"Food before one is just for fun" has become a common phrase heard on the ‘net in recent years, probably due to the popularity of lactivism and baby led weaning (BLW). Lactivism tends to assert that breastmilk is the perfect food—the more breastfeeding the better, pretty much. BLW (in its true form, I mean, not as a newfangled term for finger foods alongside mashed food) is a philosophy asserting that babies should self-feed all foods right from the start, and that the development of the motor skills needed for self-feeding—sitting unassisted, picking things up, chewing and so forth—are actually signs that your child needs food for the first time. In parts of the parenting universe where BLW and “natural” childrearing methods are popular, therefore, it’s not uncommon to hear of babies who are seven, nine, 12, 15 months or even older and still virtually exclusively breastfed, while their relationships with solids amount to little more than playing with food before chucking it on the floor.

When mothers express anxiety at this state of affairs, the responses given tend to be more or less as given in the above exchange, and “Food before one is just for fun” is much heard. But how true is this? Breastmilk is a wonderful food, but do babies really have no need at all for solids in their first year?

A metallic problem
As I discussed in a previous post, in terms of calories, most mothers—assuming their supply is decent and they are prepared to do some night feeds—are probably capable of meeting the calorific needs of a baby through breastmilk alone until at least the age of 12 months. Breastmilk is a highly nutritious, digestible and well-absorbed food that really does contain most of the things a body needs—there is certainly nothing to be gained from crowding it out of the diet too quickly. And yet there are a couple of exceptions which keep coming up again and again in the literature; basically, iron and zinc. Because breastmilk isn't a very good source of either of these. And both iron and zinc are very important for a child’s developing brain.

What the World Health Organization says
The WHO's views on the role of solids for 6-12mo babies are set out comprehensively in its Guiding Principles for Complementary Feeding of the Breastfeed Child (2004, most recent edition). I don't know where the "food before one..." meme came from, but it's not from the WHO. After reiterating its support for delaying solid foods for six months, the WHO goes on to stress (repeatedly and explicitly) the importance of complementary solids from the middle of the first year onwards:
"Breast milk can make a substantial contribution to the total nutrient intake of chil- dren between 6 and 24 months of age, particularly for protein and many of the vitamins. However, breast milk is relatively low in several minerals such as iron and zinc, even after accounting for bioavailability. At 9-11 months of age, for example, the proportion of the Recommended Nutrient Intake that needs to be supplied by complementary foods is 97% for iron, 86% for zinc, 81% for phosphorus, 76% for magnesium, 73% for sodium and 72% for calcium (Dewey, 2001)." 
"...the Expert Consultation concluded that the potential health benefits of waiting until six months to introduce other foods outweigh any potential risks. After six months of age, however, it becomes increasingly difficult for breastfed infants to meet their nutrient needs from human milk alone (WHO/UNICEF, 1998)." 
"Average iron intakes of breastfed infants in industrialized countries would fall well short of the recommended intake if iron-fortified products were not available (WHO/UNICEF, 1998)" 
Iron- and zinc-fortified foods are encouraged on the grounds that without fortified foods or meat, it is difficult to meet babies' micronutrient needs. (Yikes, "solids are important" AND the dreaded rice cereal... no wonder none of the crunchy sites post links to the Complementary Feeding guidelines.) Incidentally, I quoted the WHO not because I think they are the top authority on everything (their recommendations do often tilt towards the developing world), but because the WHO is really, really, really pro-breastfeeding. If even they are stating explicitly that breastmilk is generally not enough to meet babies' micronutrient needs for much beyond six months, I think we should probably sit up and listen.

That Kellymom page
The evidence most often cited in support of the "babies-under-12-months-don’t-need-solids-or-additional-iron" idea is the Kellymom page on iron. The message that is often taken home from this page is that (a) Breastmilk is an awesome source of iron because it is so bioavailable to the infant; and (b) In any case, babies are born with enough iron to last them for their first year of life.

Now, breastmilk iron is unusually bioavailable (which means, roughly, that a high proportion of its iron is actually usable by the baby); but the amount of iron found in breastmilk in the first place is so low that even with a high absorption rate, the absolute amount available to the infant is still not very high--as Science of Mom discusses here in her excellent post, even with breastmilk's unusually bioavailability a baby aged 6-12 months would need to drink 4-13 liters of breastmilk a day to get enough iron. Most babies don't drink much more than a liter a day.

As for babies’ iron stores… the Kellymom page doesn’t actually say that babies are born with a year’s worth of iron inside them. It actually says that babies are born with enough iron for “at least the first six months” provided that they are (1) born at term; (2) at least 3000g/6.5lb at birth; and (c) born to mothers without gestational diabetes. It goes on to say that babies will certainly need to have additional iron from somewhere-or-other “toward the end of the first year”; so even Kellymom is not actually saying that babies need no food whatsoever for the first year.  Also, check the dates on the sources given towards the end of the page. There is a 1999 American Association of Pediatrics report, but not the Association's well-publicized 2010 Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age), which emphasizes iron for breastfed infants much more strongly (Seattle Mama Doc has an excellent summary of the report--see Further Reading below). Basically, the conclusions of the AAP committee regarding breastfed infants are that breastfeeding exclusively past four months—not six—creates an increased risk of iron deficiency, and that therefore babies older than this should ideally be either supplemented with iron or given iron-rich complementary foods. It also states explicitly that “Exclusive breastfeeding for more than 6 months has been associated with increased risk of IDA [iron deficiency anemia] at 9 months of age.”

By the way, I think the Kellymom people could do with updating their entire list of sources—it has at least one broken link and a lot of old/tiny studies which in many cases appear to be cherry-picked or misunderstood. For example, the Kellymom page states rather vaguely that babies “have been shown” to maintain normal iron stores and hemoglobin levels up to nine months… but the only evidence it gives in support of this turns out to be a single very small (30 infants) study that took place in Honduras back in 1995. (I am, of course, being flippant: of course Kellymom is not going to update their source page, because the people at Kellymom have already decided that iron supplementation and encouraging baby to eat enough solids are generally Bad Things, so they are not going to link to any paper which seems to contradict these ideas—even though the AAP's conclusions are up-to-date and based on a review of 77 studies.)

It’s difficult to find actual studies of babies in whom solids have been delayed for long periods of time simply because we are talking about a non-conventional parenting style. However, the fact that a significant minority of exclusively breastfed babies are already iron deficient at the six-month mark makes it hard to believe that there are not potential issues with waiting much longer for solids/supplementation (Even the World Health Organization admits that exclusive breastfeeding to six months can lead to iron deficiency in susceptible infants, but asserts that nevertheless, this disadvantage is outweighed by the fact that exclusive nursing for six months in developing countries is associated with lower rates of diarrheal disease and later return of fertility in mothers—both facts which are a lot less relevant for those of us in the developed world).

What does “natural” mean, anyway?
Now I'll be honest; whenever I hear someone talk about "readiness" for anything in a child-development context, I tend to reach for my skepticism; has anyone ever actually proven that the ability to sit up unassisted or reach out and grab things has any particular relationship with babies' ability to digest food or their nutritional requirements for it? And if we accept the "babies need additional iron and zinc" thing already discussed, the idea that babies only start to need solids once they reach certain development stages becomes a bit problematic. Like... okay, are we all supposed to believe that children who are slower than average to sit up are the ones who are handily born with larger-than-average iron stores in their bodies, while the ones born with less iron conveniently start sitting up earlier, or something? It doesn't really make a lot of sense to me, and as it happens the only evidence that I’m aware of on this topic seems to suggest the exact opposite—we know that in fact, iron stores tend to be lower in babies who were born small and/or premature, and these babies are also slower to reach milestones, on average.

Why would human babies and human mothers have evolved in such a way that significant numbers of babies need either iron supplementation or foods from six months at the latest (when many babies are incapable of self-feeding significant amounts of food) to avoid iron deficiency? The Science of Mom article discusses this very point.

It’s possible that breastmilk’s iron levels are low because of a good old evolutionary trade-off. Lower iron levels in the baby's GI tract reduce the risk of infections. Those cave-babies living eons ago were at high risk of gastro infections which were frequently lethal--better to risk developing a slight iron deficiency than to wind up dead from diarrhea. For those of us living in cleaner environments today, breastmilk's iron level may not be optimal and perhaps supplementation may have its merits. Furthermore, the environments where human beings evolved were also places where where (a) babies may have acquired extra iron from eating dirt off the cave floor, and (b) cord clamping was probably delayed.

Another possibility raised by a commenter on the above post is that both mothers’ and babies’ bodies evolved based on the “assumption” that babies would in fact be supplemented with easy-to-eat iron-rich food sources by the middle of the first year if not earlier. Pre-chewing of foods—especially meat—and feeding them to infants from about the middle of the first year is the norm among hunter-gatherer societies, as suggested by this intriguing paper here which floats the possibility that pre-mastication may have developed in humans as a way of providing babies with iron and other micronutrients. As I suggested in my previous post on BLW, this reality is another reason why I would question the “naturalness” of a strictly baby-led, self-feeding-only approach to solids; I think a more “natural” approach to solids might, rather, involve feeding different foods in a variety of ways, including—when necessary—mashing certain foods and helping the baby get them into his/her mouth. After all, if it’s good enough for orangutans….?

Oh the iron-y
Iron deficiency is popularly associated with pallor and general languidity; the truth is a bit more worrying than that. You can’t generally see moderate iron deficiency and it doesn’t necessarily result in your child showing any obvious signs of anemia. But that doesn’t stop it having negative and permanent effects on your child’s growing brain. Iron deficiency really does matter.

There has for a long time been a well-established body of robust evidence (see here, here and here) showing that iron deficiency in infants is associated with delayed milestones, in terms of both motor skills (walking, sitting and so on) and speech/social development. Worryingly, problems appear to persist even after the iron deficiency is caught early and corrected, suggesting that there are “window periods” when sufficient iron is needed for the normal development of particular cognitive functions: when infants who have previously been diagnosed as iron deficient are followed-up years later, they show higher rates of learning-related problems such as inattention, clumsiness and shyness, are more likely to repeat a grade and score lower on IQ tests, even after controlling for other factors such as maternal IQ and lead levels. These correlations are both robust across numerous studies and statistically significant.

Can you imagine the reaction we would see in the parenting blogosphere if a study were to come out which found comparable neurological/behavioral differences between—say—children who had been formula fed and those who had been breastfed? I just don't understand why so many breastfeeding advocates are so cavalier about iron and zinc. These things are important. Of course, an older baby eating very little is a lot less concerning if supplementary iron is given; however, a lot of the crunchy mothers tend to resist the idea of giving supplements, perhaps because they have bought so strongly into the idea that breastmilk is always a complete diet right into toddlerhood etc.; giving a supplement would be tantamount to admitting that that may not always be the case.

Bullshitometer verdict
I think the phrase “Food before one is just for fun” needs to go die a merciful death, to be honest. In all likelihood, the phrase itself was invented by some well-meaning person who wanted to encourage a more relaxed approach to solids among anxious mothers who were engaging in weird little mompetitions with other mothers about who could cram the most “jars” inside their child--and in the process, harmfully crowding breastmilk/formula out of the baby's diet.

But it’s looking increasingly as though this phrase has begun to be interpreted as meaning that solid foods play no nutritional role at all before one year of age—and that therefore, it’s completely fine and not an issue if months and months go by while your older baby eats basically no foods at all and does not receive any micronutrient supplementation either. And the evidence suggests strongly that this is just not true.

Obviously, you can hardly force-feed a child who doesn't want solids, but there is such a thing as being flexible--trying different things (purees, finger foods, spoon feeding, whatever) and seeing what the baby takes to, rather than insisting that a baby who won't self-feed is "not ready" for solid foods and therefore should not have them. And if a baby or toddler is refusing solids in any shape or form, an iron and zinc supplement is a wise idea. Rice-cereal-phobes can take heart, by the way—it’s looking increasingly as though iron is actually absorbed better from natural sources such as ground meat (which also provides much-needed zinc to babies).

Finally, it’s good to see that delayed cord clamping seems to be becoming mainstream, as routine DCC could prevent a fair bit of iron deficiency. When all's said and done, though, DCC appears to improve infants' iron store levels up to six months of age; even if this became standard practice from tomorrow onwards, babies wouldn't be getting a years' worth of iron pumped into them.

I do understand that there is a lot of resistance to the idea that most breastfed babies probably need some solids (or supplements) by six months or so, because so many people are powerfully attached to the idea of breastmilk as being the perfect food. But perhaps, as Science of Mom suggests, “This should not be taken as a deficiency of breast milk but rather as an indicator that it is important and natural for babies to start consuming solid foods around 6 months.” Breastfeeding is best; but we should also be focusing on the nutritional quality of the complementary foods that we offer babies, and in doing what we can to help them eat enough of them.

Further reading
Guiding Principles for Complementary Feeding of the Breastfeed Child: Good background reading, but like all WHO stuff should probably be taken as a very rough guide--trying to make sure your child gets XXX number of solid-food calories a day sounds like a guide for how to give yourself a nervous breakdown
 Guiding Principles for Feeding Non-Breastfed Children 6-24 MonthsFor you bottle feeders; I haven't had a chance to look through it, though!
Why is breastmilk so low in iron: A great post from a real nutritionist (and extended breastfeeding mother!)
Baby Led Weaning (or starting solids) book review and nutritionist weighs in (with her 7 month old daughter!) Another blog post by someone who knows about nutrition
Iron for babies & toddlers: I love Seattle Mama Doc; she is always so reassuring and kind.