Interview 08

Age at interview: 39

Brief Outline: Struggled to feed first baby, feeling very isolated in the Middle East. Second baby easier, fed through gastroenteritis infection. Both babies had short time in Special Care.

Background: At the time of interview, this 39 year old, White British woman had a 17 month old daughter (breastfed for 8 months). She also had a 5 year old daughter, whom she had breastfed. A Head of Midwifery, she was married to a chartered surveyor.

More about me...

A midwife by profession, who has helped countless women with breastfeeding, this woman was shocked at how much she struggled to breastfeed her first child. The baby was born in the Middle East and she was on her own all day because her husband worked very long hours. She blames her inability to exclusively breastfeed her fussy, crying baby beyond six weeks upon her isolation from family and friends combined with the lack of postnatal support from health services. In contrast, her Omani friends received the support of their female relatives and she discusses the differences between British and Middle Eastern practices surrounding childbirth and breastfeeding. Her second child was born in the UK and she looked forward to having her own community midwife and health visitor. Breastfeeding was a much more pleasant and satisfying experience this time except that her relationship with her health visitor foundered over her baby's slow weight gain. She avoided going to the clinic to have her baby weighed relying instead upon the encouragement of a supportive paediatrician. Both babies spent short periods in Special Care and she discusses this along with the jaundice that her second daughter developed about six days after birth. This mother's return to work coincided with her youngest daughter catching a rotovirus and being admitted to the Paediatric Ward. At the time she was mixed breast and bottle feeding but was able to re-establish breastfeeding for the duration of her daughter's illness and beyond. As a result of the differences between her first and second births she is a firm believer in the benefits of skin-to-skin contact in establishing breastfeeding and the longer-term relationship between mother and child.

Away from family and friends, she was very lonely, her baby was unsettled and she weaned...

I think, looking back on it, it, I was lonely, and I don't think I didn't actually get postnatal depression, I wonder how but I didn't, I was lonely and I guess I was quite tense, I spent probably, up to eighteen hours on my own in a typical day, and I guess all that then fed into an anxiety around breastfeeding so.

What aspect, what was it that you were anxious about? Do you remember?

I think that I, it was, anxiety overall about the fact that I was, I was probably so lonely and on my own that then, it negatively affected the way that feeding went. I remember my first baby crying a lot, I think that it felt like she cried for twenty hours a day, and I mean I can remember my mum-in-law came out to be with me for about three weeks after I came out of hospital because I'd had a caesarean section and I can remember the two of us being in tears with this baby crying so much, I mean she's an experienced mother of two and so I think that, looking back on it, yeah my baby cried a lot, I was probably anxious about that, which fed into her anxiety, and we just didn't gel really as a, as a mum and baby, we love each other to bits now but we didn't gel as a mum and baby I think for, probably, the first six months of her life. So it was, yeah, feeding was probably one symptom of all the other things that were going on around my anxiety about being somewhere that I, really wished I hadn't been really, being so far away from people that I felt close to.

So you said the weight gain was fine?

It was, looking back on it, it was excellent, she was a scrappy little two point four kilo baby born, and if I'd had my lets say, my midwifery head? Yeah am I? No don't want it? No okay, right okay.

Just say my midwifery head.

So, yeah she was a scrappy little two point four kilo baby born and that was at term so she, you know, so she was little. Looking back on it she was actually feeding really quite well and her weight gain was good and, so I think that I was probably anxious about, you know, being lonely and didn't want to admit it and I kind of, if it makes sense, I took it out on the feeding, and the feeding became the problem but actually the feeding wasn't the problem, it was the fact that I was on my own all the time because I couldn't drive at that point, so I really was stuck, on the ninth floor of this huge apartment block, and I do remember you know, my husband and I we laugh about it now but, I used to take my baby for walks around the car park, and there was nothing else to do and just, you know, and all that I think fed into what I portrayed as an anxiety about feeding so, interesting.

Is there anything else you want to say?

Nothing other than, I do think, and again it's only based on my experience, it, it may not be accurate but, I do think that how women do with feeding, whether they live up to their expectations is something that I think potentially they carry with them for a long time. So, and I think that it does go on to perhaps affect the relationship they have with their baby for some time to come. I do still occasionally have, have guilt feelings about the fact that I didn't do as well at feeding first time round, you know, I'm really very close to my oldest daughter but you do, I do sometimes reflect and think 'goodness how did I manage to have done so, so badly at it?' but then you look at the way I was living and you think 'of course that I, you know, why it didn't go according to plan', so.

After a caesarean section she had skin-to-skin contact with her daughter for four hours before...

Oh huge differences and I've said to friends since I always knew the value of sort of earliest possible contact between mother and baby post birth, skin to skin contact.

How did you know that? How did you know about those things?

I mean I knew about it through, you know, through reading and through life experience beforehand but I'd never appreciated it because, second time round, with my second baby, I had my planned caesarean section and within seconds, you know, she was sort of having skin-to-skin contact with me, and she needed to go to Special Care but didn't go to Special Care until she was about four hours old. For the four hours in-between her being born and going to Special Care she was constantly with me, sort of just keeping warm and feeding, her colour then went a bit grey and she misbehaved herself and had to go to Special Care, but feeding her is so much easier and I am sure it is because we had those four hours together before she was, we were separated and she went off then to Special Care for sort of, I think it was twenty, about, about thirty-six hours, a day and a half we were apart. And so I think having had my second baby in, almost the, the same birth method, caesarean section, both went to Special Care, the second baby for slightly longer, I kind of you, sort of, yeah wax lyrical really about how important it is for mothers and babies to have that time together, that skin-to-skin contact together. Probably because it seemed, in my little mind anyway, to make such a big difference to me and my baby second time round.

She was isolated from family and friends with her first baby but had their support with her...

Quite surprisingly for me, the first time I actually really struggled with establishing breastfeeding with my first baby. Second time round I found establishing breastfeeding and keeping it going much easier, it, struggling first time round came as quite a shock because I just thought 'Well it's easy to breastfeed, I've helped probably hundreds of women breastfeed over, over many, many years and it, looking back on it I think it was because I was living about four and a half thousand miles away from my family, I had all the kind of.

So why was that important do you think?

I don't, isolated I think, I had never really appreciated how important it was to a, a young mum with a baby being, having support of close family and friends. My husband and I were both working abroad, my husband worked long, very long days, and I would get, I was on my own for sixteen, eighteen hours a day with a young baby on the ninth floor of an apartment so, a very nice apartment but, you know, I had a caesarean section, my husband went back to work I think, probably day three or day four, and after that I was on my own. And being the Middle East where we lived there was no community midwifery service, so once you left the hospital that was it. And, I just really, I struggled with many aspects of baby care although I was competent before I had my baby, in caring for a baby, you know, baby bathing and that kind of thing, and breastfeeding I just found very difficult. But I think it was, it was part of the whole life picture that was going on at the time. I think, you know, it all kind of knitted in together really the, the isolation that I felt and or the sheer loneliness.

Do you want to go into that a little bit more because I gather you were in the Middle East?

I was, yeah, I was, working in the Middle East and, it just felt, I was very far away from people that were, you know, my family, my sisters, my mum-in-law, who I'm very close to and, my husband now reflects back and says, you know, that he wasn't able to support me because of the fact that he worked so hard and such long hours. And until then I guess that, [oh] I hadn't really appreciated how important it was for example to have the support of a community midwife or a health visitor because there was nothing, if you had a problem you, you went to see a paediatrician. And I found an excellent paediatrician but you couldn't go and see him every five [laughs] minutes or, you know, when you felt a bit lonely, that wasn't his function and, so, I did struggle with breastfeeding. Having said that, looking back, I did do it albeit for a short time, I fed my first baby exclusively for six weeks and then kept it going with expressing and giving some artificial milk, and some breastfeeding for, I think a further three months so I did try and I'd, I hang on in there and actually looking back now at a, you know, her paediatric charts and things, she gained weight and she did well, so, despite the, you know, the sort of difficulties around my home life, I suppose I did it in some shape, although it wasn't as good as I would have liked it to have been.

What sort of help did you get after the second one, other than from health professionals?

Odd, my Mum-in-law was just, well no she's not just down the road, she's twenty-eight miles away but I treated it as though it's just down the road [laughs] 'cause she's always up and down the road in her car. My husband was able to work more flexibly, he had, although he was up in London, he's got fab employers and, and they sort of, you know, working from home one day a week wasn't a problem. And he was just able to be home more, he didn't do the sixteen, eighteen hour days that he ha

Her first baby was born in the Middle East. She talks about the support that Omani women received...

I'd like to just talk a bit more about different cultural practices and'

[Mmm].

'I'm trying to get what you know and understand of'

Yeah.

'and your experiences in the Middle East'

Yeah.

'compared to your experiences here. In the hospital, were there any major differences that you would put down to culture?

In terms of culture, well having babies in the Middle East, in Oman, was very much women's work and so there tended to be an awful lot more women visitors. Breastfeeding would only really be done in front of husband, you know, it wouldn't be acceptable if, I mean you just wouldn't get visited as a post-natal woman by a close family friend who happened to be male, that just didn't happen. But breastfeeding was very much the norm and if you asked a woman when she was pregnant, you know, 'Will you breastfeed?' she'd look at you as though you were daft and said, 'Well of course'. You know, so it was very much the norm and artificial feeding really in the hospital I was in was only for medical indication so having, having spent quite a few years in the Middle East you then come back and you see all the advertising for baby milk and things like that, and it is, it felt really strange to walk into somewhere you know, like a, a high street chemist or whatever and see all these tins of baby milk because it wasn't that common to see it in the Middle East it was in a special part of the supermarket and you'd have to go and look for it rather than it being sort of staring you in the face. So breastfeeding was the norm, having said that, women spent much more time in the home. So, me going back to work when my, in the Middle East, when my first baby was three months, old was relatively uncommon. And I think that probably helped, you know, there wasn't this pressure to get back on to the, almost like a treadmill of life as there often is in, in the U.K. so that helped I think, probably women to, in the Middle East to breastfeed from much, much longer, and my understanding is that it's almost, breastfeeding is mentioned very positively in the holy Koran and, you know, it is considered as standard to feed your baby for up to two years, so it's all kind of inextricably tied up really, breastfeeding, faith and also quite a lot of government pressure as well to breastfeed in the Middle East because they see it as good for the health of the nation, as much more positive reinforcement of feeding your baby.

So you said when you left the maternity hospital that was it, you were on your own?

Yeah.

What's your sense of how other women would have been?

Well as an Omani woman you would have had an extended family, so for example, I have, I still have friends who are Omani, and I do know that they would have left hospital and have gone to their mother's home, they would have stayed there for up to forty days, and then not come back home to the, the husband's home, the family, the marital home until that forty days. And for that forty days while they were with their mum, their mum, their sisters would have basically looked after them, the mum herself, the mother of the baby feeds the baby, there's no domestic work to do, you wouldn't think for a minute of going into the kitchen to make a meal for anybody. It was, I think that was probably really crucial, husband would visit, the mother's family home, so his mum-in-law's home, and but he's very much a visitor, and he'd go after his allotted time and go back home and, you know, there was this huge famil

In desperation, she gave her baby artificial milk which made her baby sleep but quickly led to...

I remember it precisely it was six weeks, and I mean it was the middle of the night and it wasn't the done thing in the Middle East for women to be out on their own and I remember thinking, she was screaming, my husband was sleeping, bless him he'd probably done, I don't know, an eighteen hour day or something and I'd gone into the sitting room to feed her, I couldn't get her to settle and I remember taking the baby to him and saying, 'Right that's it I'm off to the garage' and off I went, across the road, by myself, in this sort of Middle Eastern nightdress thing that I really shouldn't have been going out in, I just turned up at the garage and bought some local artificial milk, gave her eight ounces and she slept [laughs]. And, you know.

How did that make you feel?

Actually, I think probably pleased because it was the first decent sleep I'd had, I think I recall that she slept for four or five hours and I remember waking up in a terrible panic the next morning, both of us did, because we both slept, my husband and I and thinking, 'Oh my God something's happened', because she'd never slept like that before. And, I think in terms of feeding, if I'm really honest, that first artificial feed was the beginning of the end for breastfeeding because then you very quickly learned to associate that artificial feed equals baby sleeping, breastfeeding doesn't. So I did continue to, you know, to try and express and feed her myself but if I'm really honest the breastfeeding and expressing got less and the artificial feeding got more. I mean weight gain and things hadn't been a problem so it wasn't like I suddenly ended up with a big chubby baby then, you know, and all our problems were solved, because I still had, you know, the overwhelming problem of being lonely and on my own, although that's about that stage at where I'd been able to start driving the car again and getting out and about, probably slightly before then. But, I did, it did mean that, when I sort of reviewed how I felt about breastfeeding first time round, but I did feel quite guilty about it, and you kind of watch things like is she going to get eczema and other such things and no she never has but you, I did feel that I'd failed her really in terms of not having fed her for as long as (a) I wanted to, and (b) I thought I would. I just had this kind of idea of myself as a mum that, you know, I'd still be breastfeeding at a year and, the, how I was going to manage expressing my milk when I was back to work full time, well I never got that far did I, you know, had this sort of pump and all the stuff and buying daft things like the bags for freezing my breastmilk, I think they went in the bin but, so, I had this image of myself, how I was going to do and I do remember feeling very disappointed that I didn't do as I was going to do, if that makes sense?