Are three breasts better than two?

As we all know, toddlers like to switch sides when nursing--sometimes to the point of driving Mummy mad. Why have one breast when you can have two? Little Seal, however, seems to feel that even two breasts are not enough--she not only switches from right to left incessantly, but has also developed a bizarre habit of rooting around in my armpit and screaming in protest at the fact that I don't have another mammary gland for her under my arms (what a mean Mummy).

One day recently when she did this, my mind suddenly flashed back to something I'd read a while back about how a lot of women have rudimentary breast tissue in the underarm area, which is why swollen armpits are common when your milk "comes in." A google search soon plunged me into the bizarre world of multiple breasts.

Turns out the swollen-armpit thing is just the tip of a large and varied iceberg. Somewhere between 1% and 6% of all women have some degree of supernumerary breast tissue. In most cases (polythelia) this is just under-the-surface tissue, but in more extreme cases (polymastia) you have actual nipples as well--sometimes forming very noticeable extra breasts. These are most often found along the "milk lines"--pathways stretching from the groin up into the armpits. Litter-bearing mammals, of course, normally have milk-bearing teats up and down these lines; at some point in the evolutionary process our mammalian predecessors lost all of these except two. Charles Darwin considered the appearance of multiple breasts in humans to be an example of atavism--the survival or reappearance of a primitive trait in a more "highly-developed" species, like, for example, the occasional human baby that is born with a tail. (Could Little Seal's armpit-rooting be a kind of vague instinctive memory left over from the time when our furry ancestors actually had functioning breasts going up and down their abdomens? Who can say?)

The "throwback" theory is lent credence by the embryonic development. One of the eeriest things about pregnancy is the way the embryo's development over the weeks and months seems to repeat evolutionary history in miniature--the unborn child develops a tail which then falls away, and later grows a coat of fur which is then shed and reabsorbed, and so on. Over the first couple of months, "milk lines" in the fetus develop into mammary ridges, but in around the ninth week all these ridges recede and disappear except for the two which later become the "breasts" we are familiar with. In a few embryos, presumably, the surplus ridges do not fully disappear and instead continue to develop into rudimentary breasts. The atavism theory has appeal, but it doesn't seem to fully explain the extra-breast phenomenon, given that such tissue can also appear outside the milk lines--on the legs, in the groin and even on the sole of the foot.

As I mentioned above, it's not unusual for women to report swollen armpits at the very start of breastfeeding, and droplets of milk leaking from the armpits are far from uncommon (judging from all the questions on Yahoo Answers--that perennial mecca for people with weird and embarrassing body-related questions). In extreme cases, extra breasts have been known to have fully functioning nipples and produce useful amounts of milk.

An often cited case from 1827 refers to Therese Ventre of Marseilles, France. Her mother had a supernumerary breast beneath her normally positioned right breast. Ventre had a supernumerary breast beneath her normally positioned right breast. Ventre had a supernumerary breast on the side of her left thigh. This breast enlarged during puberty, and when she became pregnant, it produced milk. It was offered to her infant who took it willingly. She apparently nursed five children during her life from all three of her breasts. (Southern Medical Journal Supernumerary Breast Tissue: Historical Perspectives and Clinical Features, Department of Pathology and Laboratory Medicine, Emory University School of Medicine)

In our own time, however, extra breast tissue is more likely to cause issues with breastfeeding. In several cases, women presenting with swelling under the arms have had the sites biopsied, only to reveal that the lump is merely extra breast tissue and that milk is now leaking uncontrollably from the site of the biopsy--a "milk fistula." Breastfeeding Materials advises that such milk is likely to dry up on its own, just as any milk supply will ultimately dry up if there is no suckling; however, in this case here, the mother's milk fistula did not cease until she finally weaned her baby. Presumably, her accessory breast and normal breasts had enough tissue in common that they shared the same feedback mechanism, and stimulation of the regular milk supply thus tended to stimulate the milk production in the armpit as well. Who knows? In any case, the good news is that this troublesome extra tissue was removed through surgery, leaving the mum free to nurse her future babies if she wanted.

Supernumerary breasts have, in some historical periods been associated with witchcraft--Anne Boleyn was rumored to have one, although that may say more about Boleyn's enemies than about Boleyn herself. In other times, extra breasts have been considered a sign of super-fertility (think of all those multi-boobed goddess figurines), but there's no evidence of this. On the contrary, there is some evidence linking extra breasts with elevated rates of certain congenital problems, especially abnormalities of the urinary tract such as "supernumerary kidneys, failure of renal formation, and carcinoma of the kidney."

So while the image of being able to feed a baby from multiple breasts is appealingly bizarre, it seems fair to say that in the real world, three breasts are definitely not better than two. Although most nursing toddlers and babies would probably disagree with me about that.

"We are a charity" is not an excuse for failing to listen to people

The National Childbirth Trust (Britain's largest parenting charity) is in the news again. It all started when pregnancy writer and blogger Linda Geddes appeared in a Radio 4 discussion about the NCT. As you'd expect from the author of Bumpology (a promising looking new book which adopts a science-based approach to pregnancy and birth), Geddes expressed some critical ideas about the NCT during the discussion, claiming in particular that the organization's classes gave her poor advice and unrealistic expectations due to their overwhelming ideological bias towards natural childbirth, discussed here and here. The interview might have passed without much comment had Kirstie Allsopp (a well-known British TV presenter) not tweeted about the show, echoing Geddes' criticisms and describing the NCT as "a very politicised, dogmatic and in my experience, scary organisation."

This is far from being the first time the NCT has been criticized for being overly obsessed with natural childbirth, breastfeeding at all costs and so on. Allsopp had another similar spat with the NCT last year, I had my own little go here, and this thread from Mumsnet gives a decent overview of the complaints that many NCT members have about the organization. Many women have fantastic experiences joining the NCT and participating in its classes and workshops because there are many great people who work with the organization. There are also a lot of crunchaloons who are giving the NCT a bad name. Every time the NCT is criticized in this way, the organization protests that the criticisms are unfair, that the organization is inclusive and is becoming more so, that they are making efforts to embrace different ways of giving birth and to expand beyond the "middle-class mothers" who make up their core group and so on. How genuine these protestations are is kind of questionable, however, as Pauline Hull of Cesarean Debate recently pointed out.

But there is one defense of the NCT which I'm constantly hearing, and it is really starting to annoy me: the defense that "These complaints are unfair. NCT is a charity, not a business, and it's staffed by volunteers, many of whom are mothers themselves. You can't expect it to be run perfectly."

Now, here's the thing. If you talk to anyone who has worked on the ground in, say, the developing world or among disadvantaged groups anywhere, they will tell you that this kind of attitude is at the heart of what is wrong with so much charity and philanthropic work--the idea that charities (unlike businesses or governments) do not have to be accountable for their actions or responsive to feedback, the idea that people receiving charity should be grateful for whatever they get (even if it's crap), the idea that that it doesn't matter if charities upset people because even badly-run charity work is better than nothing at all, and the idea that ITS MEEN to criticize anyone who works in a charity, because charity workers do nothing except from the goodness of their hearts and you surely can't have a problem with that, right?

Well, actually it's all a bit more complicated than that. Because the problem is, charities have their own agendas which are sometimes not completely altruistic--for example, trying to further their own political, social or religious views (fundamentalist churches "fighting AIDS in Africa" through abstinence-only education being merely one of the more egregious examples). Sometimes charities do actively harmful things to the people they are trying to help, often as a result of these agendas, which means that it's not always true that bad charity work is better than nothing at all. Sometimes, bad charity work is indeed better than nothing at all--but that doesn't mean that it couldn't be better, or that charities shouldn't be aspiring to do better. No private-sector business would be okay with the sort of feedback the NCT was getting from a lot of posters on that Mumsnet thread. Maybe the NCT could do with operating a bit more like a business--a process that starts with listening to the people you are supposed to be serving.

In any case...take a look at the sort of complaints being levelled at the NCT in that Mumsnet thread. I mean, if most of the complaints about the NCT were things like "the venues for the classes are cramped" or "my email inquiry didn't get answered straight away," well... okay, maybe these issues would be somewhat understandable in an organization run by volunteer mums in their spare time. But I really don't see how complaints about instructors demonizing cesarean sections, epidurals and bottlefeeding in NCT classes have anything to do with its charitable status. There is no reason on earth why an unpaid volunteer can't give classes and workshops that offer a balanced view of birth and infant feeding; it's not as though it would cost more to do this. (And to be fair, many or most NCT instructors are offering reasonable and balanced advice; it's just that the NCT doesn't seem to be very good at weeding out the instructors who spend their classes beating the "obstetricians-are-out-to-get-you" tom-toms and telling mothers that they won't bond with their babies if they have surgical births, etc.)

If there are some NCT instructors who are saying things that are contributing to depression and anxiety in new mums, and if the NCT is failing to do anything about this because of its agendas and beliefs, then that is a problem, regardless of whether or not the organization is a charity or not. And the NCT needs to start engaging with this issue unless they want the complaints to continue and get louder.

Bullshitometer: Formula is the fourth best choice according to the WHO

The first Bullshitometer post I ever wrote (on the global average age of weaning) taught me that sometimes crunchy bloggers basically invent their own WHO sources. So I smelled a Bullshitometer post in the making regarding a certain bit of internet wisdom that has been doing the rounds on parenting blogs and message boards for quite a while--the whole "WHO says that formula is the fourth best choice" thing, which comes up most often when discussion focuses on donor milk--and especially milk donated via informal milksharing schemes.

There are lots of versions of this one knocking about. Jack Newman gives one version (stating that the formula-is-the-fourth-best-choice thing is WHO policy, but not giving any references) in The Ultimate Breastfeeding Book of Answers. I've also seen some really scary versions which actually rank goat's milk above commercial infant formula (yikes). The most commonly cited version, however, is a piece of text which is quoted as being the official WHO wording:

"The second choice is the mother’s own milk expressed and given to the infant in some way. The third choice is the milk of another human mother. The fourth and last choice is artificial baby milk (infant formula)."

This ubiquitous bit of text boasts more than 400,000 Google results. However, when it came to trying to find the original source--and yes, with the fanatical zeal of a stalker I really did click through every single link on seven or eight pages of results--all anybody seemed to have were links back to other breastfeeding-related blogs and pages containing the same bit of text, not to any original WHO document. 

I broadened my search and this time struck gold in the form of the famous "Watch Your Language! "essay by Diane Wiessinger, containing the following text.

"Breastfeeding is best; artificial milk is second best. Not according to the World Health Organization. Its hierarchy is: 1) breastfeeding; 2) the mother's own milk expressed and given to her child some other way; 3) the milk of another human mother; and 4) artificial milk feeds (4)." 

The footnotes give the source of this information as "(4) UNICEF, WHO, UNESCO: Facts for Life: A Communication Challenge. New York: UNICEF 1989; p. 20."Aha! I eagerly searched for the document, wondering if this document could be the source of that "The second choice is the mother's own milk..." bit of text--only to discover that "Facts for Life: A Communication Challenge" is not online and that the hard copy is out of print... which is not really very surprising, given that it was published in 1989.

The current WHO stance
The Who/Infant and young child feeding publications is the right place to hunt around if you want to find out what the current WHO stance on expressed milk vs. donor milk vs wetnursing vs formula. Here is what the WHO's "Global Strategy for Infant and Young Child Feeding" (2003) has to say.

18. The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered un suitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.

So, no apparent hierarchy, just a list of possible options and a suggestion that we make our own decisions. Which raises suspicions that the whole "WHO says formula is fourth best" thing might be just an internet urban legend that got started because someone glanced at the above paragraph and erroneously thought that the possibilities were being ranked in the order of best to worst, rather than merely listed.

It's not quite so simple, though. Remember that 1989 "Facts For Life" publication alluded to above? Well, since 1989 the WHO has published some updated versions of the same publication (2002 and 2010). Here's what they have to say on the subject of what-to-do-if-you-can't-breastfeed-from-the-breast:

"Facts For Life" 2002:

"The best food for any baby whose own mother’s milk is not available is the breastmilk of another healthy mother. If breastmilk is not available, a nutritionally adequate breastmilk substitute should be fed to the baby by cup. Infants who are fed breastmilk substitutes are at greater risk of death and disease than breastfed infants.... The best food for a baby who cannot be breastfed is milk expressed from the mother’s breast or from another healthy mother."

"Facts For Life" 2010: 

"Bottle feeding and giving a baby breastmilk substitutes such as infant formula or animal milk can threaten the baby’s health and survival. If a woman cannot breastfeed her infant, the baby can be fed expressed breastmilk or, if necessary, a quality breastmilk substitute from an ordinary clean cup... A mother’s own milk is best for low-birthweight babies. However, not all of these infants are able to feed from the breast in the first days of life. For them, other options are available. In order of preference, they are: expressed breastmilk (from the mother); donor breastmilk (only if the donor is HIV-tested and the milk is correctly heat-treated); and infant formula. All of these should be given by cup, spoon or paladai (a cup feeding device), or medical tubes used by a trained health worker in a health facility." 

Well, that's... confusing. In its "Global Strategy for Infant and Young Child Feeding" the WHO merely sets out the different feeding options (wetnursing, donor milk, expressed mother's milk and formula) that are available without establishing any kind of hierarchy--indeed, "the choice.... depends on individual circumstances" seems to be explicitly stressing that there isn't any hierarchy. Meanwhile, in the 2010 "Facts For Life" the WHO states that expressed milk is superior to formula, makes no reference to wetnursing, and puts donor milk in a higher category than formula--but only if it's heat-treated and screened, and only for low-birthweight babies (for whom formula seems to pose greater risks). It's unclear what the WHO position is on, say, unpasteurized milk donated through informal milksharing schemes, or on whether these guidelines still apply for babies of normal weight. 

Bullshitometer verdict
First off the bat, I do think people need to stop reciting that much-quoted bit of text that starts with "The second choice is the mother's own milk..." given that nobody seems to know where it comes from and given that the most likely source I've found appears to be a document published in 1989 (which is an awfully long time ago) and not listed among current WHO publications.

But, leaving aside that particular quote, what about the general idea of "formula as fourth choice"--is this actually WHO policy? Frankly, the WHO's current policy on the hierarchy (or absence of hierarchy) regarding donor milk, expressed mother's milk, wetnursing and formula appears to be about as clear as mud, with two current WHO documents basically saying different things. I don't think that we can state explicitly that "The WHO says formula is the fourth best choice" until the WHO itself clarifies its stance--and that also means going into details like "What if it's a choice between unscreened breastmilk and formula?" "Is breastmilk that's been in the freezer for a year better or worse than formula?" "What about communities with high rates of HIV?" These little points make a difference when we are balancing the different benefits and risks involved.

What would I do if I couldn't breastfeed directly from the breast? Okay, I guess I'd do the exclusive-pumping thing. Mostly. For a while. I mean, I don't think I'd try to be the little hero who sets grandiose goals of exclusively pumping to a year and never using formula, because I wouldn't want to look back and feel like I spent a lot of time with the pump which I could have spent enjoying my child.  Since I'm not living in the year 1700, I won't be sending a child of mine out to live with a wetnurse (but wetnursing can be life-saving in developing countries). I would not be okay with using breastmilk donated by a milkshare scheme stranger or de-stashings that had been sitting around in someone's freezer for months on end, but screened milkbank milk or recently-pumped milk from a trusted friend would be warmly welcomed. Ultimately, how we choose to feed our babies when direct-feeding-from-the-breast is not possible (or desired) surely comes down to individual factors, including the environment we live in and our own tolerance levels for different types of risk. Simple hierarchies of A>B>C>D fail to express the complexity of these real-world decisions. 

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

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

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!

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!