Articles published on this blog are my opinion only, and may not necessarily reflect the views of any organisations with which I am associated. Please be aware that articles posted on this blog are not intended as a substitute for professional medical advice. If you have a medical problem relating to breastfeeding, please seek further advice from a Lactation Consultant (IBCLC) or trained Breastfeeding Counsellor.

Tuesday, 11 October 2011

Milk to go! Breastfeeding in a sling.

When I got my first sling, I flicked through the instruction booklet and noticed that it mentioned there was a way of breastfeeding your baby in the sling. I remember thinking that breastfeeding in a sling would be a pretty cool trick to master, particularly because my baby always seemed to decide he wanted feeding every time I was standing in the school playground. Very convenient (!).

However, I quickly discovered that even tying my wrap sling was a skill which took several attempts to learn: during my first attempt, I managed to tie my legs together, resulting in an uncoordinated, comical dive across the living room, much to my husband's great amusement...

Once I'd mastered tying my wrap sling, I wore my baby practically everywhere and every day, but it wasn't until I had my 3rd baby that I mastered breastfeeding in my sling.

I have found and compiled some useful video instructions demonstrating how to breastfeed in different types of sling.

How to breastfeed in a stretchy wrap sling:
(Or not... this baby doesn't want to perform... hehe)

How to breastfeed in a non-stretchy / woven wrap sling:

Clear instructions with pictures can be found here

How to breastfeed in a ring sling:

How to breastfeed in a Mei Tai:

How to breastfeed in a structured carrier (like the Ergo):

The ability to breastfeed in a sling is a really useful skill, especially if you have older children to chase after. However, it's not absolutely necessary, so don't worry if you don't get the hang of it!

As one of the wise ladies on my facebook page once said:

"Breastfeeding is a skill. Babywearing is a skill.
Learn the two before combining them"
~Kai Blackley

Tuesday, 13 September 2011

I can't rescue you, BUT...

When I read "Don't ask me to save you" by Kath Harbisher, the Singing Doula, I found the article struck a particular chord with me, in the voluntary work I do as a breastfeeding peer supporter. So, with Kath's kind permission, I echo her words here:

When I meet you after the birth of your baby, I don't want you to ask me to rescue you.

When I meet you, you might still be coping with the aftermath of a traumatic birth, or a birth which wasn't what you'd hoped for. You may recently have been discharged from the care of a health professional you have come to depend on for advice. Or your care before or during birth might have been fragmented. You may be struggling to bond with your baby, on top of all the other things you have to learn as a new parent. You might not have got off to a great start with breastfeeding. You might still be coming to terms with the loss of a previous breastfeeding relationship.

You might not even realise that you are asking me to rescue you. And I understand that - I've been there.

But please don't ask me to rescue you. Because I can't do that.

Because "when most women talk about birth trauma and bad birth experiences, when you dig down to the root of the emotions, more often than not, it's about loss of power and control [...]. It's about having your decisions and choices questioned, ignored and over-ruled. Sometimes it's about things, to which you never consented, being forcibly done to you against your will. It's about being made to feel stupid and insignificant for believing you had choices at all." (1)

I appreciate that you might not yet have had time to process your birth experience, or recognise that this may be how you're feeling. I can see that you might not be the happy, empowered, self-confident mother you could be. But I still cannot rescue you.

I cannot give you advice, because if I give you advice about your breastfeeding relationship, I become just another person who's telling you what to do. I become just another person making decisions for you which might be wrong for you or your baby, ignoring the fact that there may be more than one way forward, that you have choices. If I do that, I am disempowering you. If I do that, I am simply making you walk from one cage to another. Or trapping you even more in the prison you're already in. And even if your birth experience was everything you'd hoped for, I'd still run the risk of trapping you. And if I do that, I am failing you.

But what I can do is show you a way out of your prison.

I can offer you ideas, information and support so you can start making your own informed choices about your breastfeeding relationship. Every breastfeeding relationship is unique: I can show you where to find further information so you can evaluate it for yourself, and you can choose a way forward which feels right for you and your baby. And I can support you, because you are your baby's mother, and I have faith that you will make the best and safest feeding decisions on behalf of your baby.

I can show you the way along a different path: a path along which you might take ownership of your breastfeeding relationship, find empowerment through informed choice, and find your own voice to start speaking up for yourself and your baby. A path along which you can set yourself free.

Find support after a bad birth:
Birth Crisis (UK)
Solace for Mothers (USA)
The Birth Trauma Association (UK)

(1) Harbisher, K (2011) Don't ask me to save you
Many thanks to Kath Harbisher for her thoughts, input and kind permission to use her article.

Monday, 18 July 2011

Am I a food martyr? - Breastfeeding the allergic baby and making dietary sacrifices

"You never really understand a person until you consider things from his point of view [...] until you climb into his skin and walk around in it."
~ Atticus, To Kill A Mockingbird - Harper Lee

When I support a mother to breastfeed, I am trying to see the world from her perspective; to appreciate the challenges she might be facing, and if she wishes, offer her ideas and information so that she might choose a pathway through her breastfeeding journey which works for her and her baby. There are however, some obstacles to breastfeeding I struggle to imagine what they would really be like to experience.

For just over a year now, I have observed a friend of mine breastfeeding a baby with multiple allergies, almost unable to fathom what it would mean to face something like this myself. Before I continue, I must point out that "Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think" (1). If you are concerned that your breastfed baby may have a food sensitivity, this article on Kellymom is essential reading, and contact an appropriately qualified breastfeeding specialist (UK telephone helplines are listed on the right).

Along with everyone else, I greatly admired what I perceived to be a deed of heroic undertaking when my friend eliminated a long list of everyday foods from her diet in order to continue breastfeeding her baby. She insisted that she wasn't doing anything extraordinary, but I thought she was just being modest, doubting that I would be capable of such sacrifices myself. And I told her so. And one day she finally turned around and challenged me to live for a week on her diet... and I heard myself accepting.

I admit I panicked a bit as the agreed week drew closer. Wheat, dairy, eggs, soya, meat, nuts and nightshades (includes tomatoes, potatoes, red peppers, aubergines, chilli, paprika and cayenne) were strictly off the menu, so I found myself wondering what on earth I was going to eat. And I very nearly wimped out of it: I am still breastfeeding two babies myself and I didn't really know what I was doing meddling with my food intake - perhaps the whole idea had been a bit rash? However, curiosity got the better of me... and a promise is a promise after all.

Why was I bothering to do this? I was asked. If I was in that situation, wouldn't it be easier to just give my baby some kind of hypoallergenic formula? I simply wanted to understand how to better support mothers like my friend. Support is key to a successful breastfeeding relationship. Supporting a breastfeeding mother of an allergic baby means first and foremost respecting that she is a breastfeeding mother, and that her baby is breastfeeding. She shouldn't have to endlessly justify herself for eliminating foods from her diet and continuing her breastfeeding relationship. The breastfeeding itself isn't actually the problem: it is certain foods in the mother's diet that the baby cannot tolerate. Eliminating those foods eliminates the problem. If the mother switches to infant formula, there is a long list of ingredients to check, and there are absolutely no guarantees that the baby will tolerate that either. Even if it did, not breastfeeding places the mother and baby at much greater risk of developing other short and long-term health problems. Why introduce so many other risks for the sake of a chance that it might solve just one problem?

The week got off to a bad start. Life with four children is rather hectic, so I ended up diving almost completely unprepared into my first day. No preliminary research, no recipes, practically no idea what I was in for. Would the breastfeeding mother of an allergic baby realistically have time for a huge amount of preparation before starting an elimination diet?

After the initial shock of the first couple of days, I realised that eliminating that long list of foods from my diet wasn't the painful experience I'd expected it to be. Although rarely included on my usual shopping list, alternative foods are actually plentiful and delicious. I found that the real challenge for the mother of an allergic infant is that there is a lot to learn, and fast. And everything she learns, she learns as she goes.

It's a steep learning curve, and lack of time is an issue. It takes time for a mother to inform herself about making changes to her diet. Potential vitamin deficiencies need to be looked into - I decided that taking a vitamin supplement would be a wise move for me, especially since I was learning about a new diet as I muddled along, and I wasn't confident I had every vitamin and nutrient covered. Finding alternative foods and figuring out ingredient substitutions which work well in recipes can be a tricky and time-consuming business at first, and can require quite a bit of experimentation and creative thinking, especially if she's eliminating a lot of foods from her diet. It takes time to become fluent in ingredient-speak, to become conversant in all the different words for an ingredient you have to avoid, all the different ways manufacturers sneak different forms of these ingredients into their products. It takes time to find a range of products she can eat, recipes she can work with, to cook from scratch if necessary. And, as I learnt from one or two catastrophic culinary experiments, there is far less room to make mistakes on a diet like this - she can't just order a takeaway if she messes up an evening meal. And would a new mother realistically have time to indulge in culinary experimentation? Being the mother of a new baby is demanding at the best of times, but add in parents who are already exhausted from caring for a baby who has been unusually fussy and unhappy for some time, as well as all the things a mother needs to know in order to successfully navigate her way through breastfeeding a baby with food allergies, and it is very easy to see how starting out can be daunting.

Support is vital to breastfeeding mothers of  babies with food sensitivities - they simply have different needs to other breastfeeding dyads. 

There are a number of ways that relatives, friends and breastfeeding supporters can make life easier for breastfeeding mothers of allergic babies, especially during the first few weeks while they adjust to their new eating habits. The mother might need:

  • help with researching information about eliminating foods from her diet, especially with picking out the information that is relevant and useful to her. Useful organisations and websites include:
Kellymom's article Dairy and other Food Sensitivities in Breastfed Babies - a goldmine of information and links
Botanical food family list from the Calgary Allergy Network - don't forget to check out the rest of this informative site too
Living Without - a magazine for people with allergies and food sensitivities - articles, research reports and recipes for all sorts of food allergies
Pig in the Kitchen - great blog by a family catering for children with multiple food allergies
The Vegan Society - plenty of ideas for those avoiding meat, fish, dairy or eggs
Coeliac UK - information for those avoiding gluten - information for those avoiding wheat
Eggless Cooking - ideas for those avoiding eggs
Go Dairy Free - information for those avoiding dairy
How To Do A No Nightshades Diet
Tomatoes are Evil - hilariously obsessive anti-tomato website

We know they're in there...
Image credit: Tomatoes are Evil
  • extra pairs of eyes to read food labels, which is a time-consuming job. Arm yourself with a list of the ingredients she has to eliminate from her diet and check ingredients lists in the supermarket for her, making notes of the foods she can eat. Even better: go shopping for her!
  • help with looking for recipe ideas. Offer to find her some quick and easy recipes which are safe for her to eat.
  • help with cooking. Make her something she is able to eat: a meal, a tasty treat, or a nutritious snack. Remember the takeaway isn't an option, so make her a meal she can freeze, just in case an experiment with new ingredients doesn't go to plan.
  • to get out of the house occasionally. Why not invite her to your house for lunch or dinner and make a meal which caters for her dietary requirements? Make sure you eat the same meal as your guest. Or find a restaurant or cafe which would be prepared to cater for her dietary requirements, and invite her to eat out with you. Make sure she can take the baby with her and that the establishment is positive about breastfeeding.
  • company. Two heads are better than one! Offer to accompany her on her special diet for a few days and see what new foods and recipes you come up with together. You'll end up with a much better understanding of what everyday life must be like for her.
I have been struck not so much by the hardship of making dietary 'sacrifices', but by the realisation that this journey can be a lonely one. Every mealtime is a reminder that the mother has stepped away from the crowd, that she is flying solo at a time when it is natural to desire to connect with others sharing similar experiences. In the UK, where in 2005 just 22% of infants were exclusively breastfed at 6 weeks of age (2), breastfeeding has been the road less travelled for a number of years. So if when she breastfeeds, a mother is already treading the road less travelled, breastfeeding a baby with food intolerances is a journey even fewer mothers have taken. I was lucky: my friend guided me through many of the problems I encountered, so I wasn't completely alone. In reality though, it's hard to find the much-needed community of mothers who can share their experiences of breastfeeding an allergic baby and make the path easier to tread for those that follow. After a week or so of trawling the internet, I found just one online forum: Breastfeeding babies with food allergies/intolerances/sensitivities, hosted by the Australian Breastfeeding Association. The triumphs of getting together with other people to pool ideas can be enormous: imagine our delight when we created a proper birthday cake for my friend's baby's first birthday!

The great news is that once the initial hard work is done, it really pays off. I noticed that once I'd tracked down alternative foods, it was simply a matter of getting into good habits: managing my food shopping differently, paying extra attention to food labels, changing my store of basic ingredients, and changing the recipes I use regularly. It's worth remembering that the baby may not outgrow his need for a special allergy diet once weaning starts and he grows older, which means that the mother has got a wonderful head start on knowing which foods are safe for him to eat, and she's already in the habit of being able to provide for his dietary requirements. 

The rewards are great: the immediate reward is a much happier, healthy baby. I am amazed at the difference my friend's dietary changes made to her baby. Changing my diet had some unexpectedly positive effects for me too: by mid-week, I realised I didn't actually miss many of the foods I wasn't allowed to eat; in fact, I was surprised to discover how much better I felt and how much more energy I seemed to have. By the end of the week, I decided that some of the alternative foods I'd discovered were here to stay.

My friend was right. This 'restricted' diet wasn't such a huge sacrifice after all. And so my perspective on the issue has changed completely: if I had a baby who couldn't tolerate some of the foods in my diet, of course I'd be motivated to make changes to my eating habits and carry on breastfeeding! Eliminating foods isn't martyrdom or a mark of supreme alpha mummy dedication. It is simply adaptation. It is accepting that, in a society which all too often decries breastfeeding as "The Problem" and touts infant formula as "The Solution", for every breastfeeding problem there is a breastfeeding solution. The truth is not that cutting foods out of your diet is hard; it is that we mothers are far more resilient and resourceful than we give ourselves credit for. Biology isn't stupid. If it encounters an obstacle it changes, adapts in order to survive. Examples of this are everywhere in nature - so why do we react with so much surprise when this same behaviour is displayed within a breastfeeding dyad?

Recipe: An extra-special birthday cake

This cake is adapted from a recipe I found here, and is wheat-free, gluten-free, egg-free, soya-free, nut-free, nightshade-free and vegan.

Dry ingredients:
120g polenta (granules, not the ready-made stuff)
150g rice flour
150g light muscovado sugar
3 teaspoons baking powder
Wet ingredients:
Juice & rind of 1.5 lemons
200ml olive oil
150ml warm water
150ml coconut cream

Mix all of the dry ingredients together in a bowl, then beat in all of the wet ingredients using a fork. The resulting mixture will be quite sloppy & should almost fill the cake tin. Bake at 180 degrees C for about 45 minutes, or until the top of the cake is cracked, and when the centre of the cake is tested with a skewer, it comes out clean.

To make a gorgeous chocolate cake, the lemon rind and juice can be substituted with about 50g cocoa (look for cocoa which is made from 100% ground cocoa beans).

The recipe also makes very nice cupcakes... mmm...

Last edited: 21/07/11

(1) Bonyata, K (2011) Dairy and Other Food Sentitivities in Breastfed Babies
(2) NHS Information Centre (2007) Infant Feeding Survey 2005

Friday, 24 June 2011

Cupcake Challenge

A few weeks ago on facebook, I spotted that someone had come up with a fundraising idea for my local hospital. Upon reading the poster, I signed up immediately: dubbed a "Cupcake Challenge", it presented me with an opportunity too irresistible to miss. The winner was set to win all the funds raised to donate to a hospital ward or charity of their choice. Purely by accident, the "Cupcake Challenge" was held during Breastfeeding Awareness Week, so it seemed fitting to create cupcakes in the hope of raising some funds for the hospital's breastfeeding peer support programme.

These were my entries...

"yummy mummy milk"

One for my Welsh friends: "llaeth mam" (mummy milk)

"baby's first immunisation"

"every feed counts"
- inspired by the UKAMB's slogan "every drop counts"

"fresh milk daily"
- inspired by dairy tankers.
I've always wanted to borrow this slogan for the benefit of breastfeeding!

"supply on demand"

"meal deal"

"the wonder isn't the bra"
-inspired by Best for Babes in the US

"life-saving equipment"
- also inspired by Best for Babes in the US

"experts in infant nutrition"
- inspired by flicking through a few infant formula websites. I just thought I needed to point out who the real experts are...!

Tuesday, 10 May 2011

Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.

What do the terms "foremilk" and "hindmilk" mean?

In The Breastfeeding Answer Book, "foremilk" and "hindmilk" were defined as follows:
  • "Foremilk" is the milk the baby receives when he begins breastfeeding, which is high in volume but low in fat (1).
  • "Hindmilk" is the milk near the end of the feeding, which is low in volume but high in fat (1).
Actually, the terms "foremilk" and "hindmilk" only really refer to samples of breastmilk taken right at the beginning of a feed ("foremilk") and samples of breastmilk taken right at the end of a feed ("hindmilk"). Even then, the advantage of using these terms is debatable.


A photo on Wikipedia "helpfully" shows two 25ml samples of human breastmilk: "foremilk" on the left and "hindmilk" on the right:

The problem with showing a sample of breastmilk from the start of a feed together with a sample of breastmilk from the end of a feed is that it tells us nothing about what happens to the breastmilk in between the two samples. Mothers end up mistakenly believing that their breasts make two different types of milk, and wonder how long they must feed for before the "foremilk" magically switches over into "hindmilk" (2).

So if the terms "foremilk" and "hindmilk" are misleading and there's no "magic switch" from one to the other, what really happens?

Since The Breastfeeding Answer Book was published in 2003, research in human lactation has advanced (2), so we now understand more about how breastmilk is produced:

Your breasts make just ONE type of milk

There is no magic switch between two different types of milk over the course of a feed. In fact, there is no sharp distinction between breastmilk at the start of a feed and breastmilk at the end of a feed (3). "Milk does indeed change consistency during a feed - but this happens gradually rather than suddenly" (4).

Why does the consistency of breastmilk change over the course of a feed?

The answer lies in what happens to the fat in breastmilk when breastmilk is
  • produced:
Your breasts are continuously making just one type of milk, containing 'sticky' fat globules that tend to stick to each other and to the milk ducts in the breast as breastmilk is produced (2,3,5).
  • stored in the breast:
Breastmilk produced between feeds moves down towards the nipple and collects in the breast, leaving increasing amounts of fat globules 'stuck' together further up the milk ducts (3).
  • and emptied from the breast:
When let-down occurs, the milk ducts dilate (5) and the milk is ejected from the breast. The milk removed at the beginning of a feed may be lower in fat because the fat globules are still 'stuck' further up in the milk ducts (6). As the feed progresses, multiple milk ejections occur (5) and the breast is emptied, more and more fat globules become dislodged and the breastmilk increases in fat (3,6). This has the overall effect of a gradual increase in fat content of breastmilk in each breast independently as milk is removed.

How do we know that the increase in fat is gradual?

Studies involving several mothers have been conducted in which samples of breastmilk were taken at intervals over the course of a feed. The evidence from these studies suggests that the fat content of breastmilk increases gradually as the breast becomes progressively emptier over the course of a feed (7,8).

It's much easier to explain this gradual increase in fat content using pictures..., revealing the crazy lengths I'm prepared to go to so I can prove a point, I visited The Countess of Chester Hospital, where several wonderful people enabled me to take consecutive small samples of breastmilk from one breast only over the course of one pumping session, and professionally photograph the results. The samples were then taken to the Cheshire and North Wales Human Milk Bank, where the fat content of each sample was analysed.

This is the snapshot we got of the gradual increase in fat content of my milk over the course of one pumping session:

A snapshot of my breastmilk:
At the time the samples were taken, I was tandem feeding. My youngest baby was just over 8 months old, had started baby-led-weaning, and was still about 90% breastfed.
Each test tube contains around 6ml of breastmilk.
Note the gradual colour change of each breastmilk sample. This is the gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).

Remove test tubes 2-11, and the result is a picture similar to the one on Wikipedia:

This shows a sharp contrast between the breastmilk at the very beginning and the breastmilk at the very end of a feed only - it tells us nothing about what happens to the breastmilk in between the two samples. Only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.

So what's that stuff that rises to the top of expressed breastmilk?

When breastmilk is left to stand for a while, it separates into two layers. This isn't the separation of "foremilk" from "hindmilk"; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk (4).

The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised.

"Whole homogenised milk is identical in fat and nutrient content to whole standardised milk however it has undergone a process known as "homogenisation" which breaks up the fat globules in the milk. This spreads the fat evenly throughout the milk and prevents a creamy layer forming at the top." (9)

After a while, the breastmilk in our test tubes separated into two layers (click on the image to open a larger version in a new window):

Note that the breastmilk in test tube 1 does, in fact, contain a layer of fat.

Note also the increasing thickness of the fatty layer that collects at the top of the breastmilk from test tubes 1-12. This further demonstrates a gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).

Again, removing test tubes 2-11 shows only a sharp contrast between the thin fatty layer that rises to the top of the breastmilk at the very beginning, and the much thicker fatty layer that rises to the top of the breastmilk at the very end of a feed.

This photo tells us nothing about what happens to the breastmilk in between the two samples. Remember: only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.

Showing us pretty pictures is nice, but how much fat did the breastmilk samples actually contain?

Before I continue, I must stress that this is just a snapshot of my breastmilk. It is unlikely that the results shown here will be an exact reflection of what happens to every mother's breastmilk. However, it does provide a rough idea of what happens, so here are the results of the analysis of each sample of my breastmilk:

TS = Total Solids, ie. the bulk of the rest of the milk
Protein, carbohydrate, fat and TS values are in grammes per 100ml

If looking at raw data isn't your thing, here's a line graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples (fat content is shown in red).

The graph clearly shows there was a gradual (if slightly wobbly) increase in fat content as the breast is emptied. Quite plainly, there is no arbitrary "magic switch" between two different types of breastmilk during a feed.

Remember, though, that all of this is just a tiny piece in a vast breastfeeding jigsaw...

Although it is true that the fat content does gradually increase as the breast is emptied, it is important to understand that the difference in fat content between milk at the beginning of a feed and milk at the end of a feed can vary greatly from mother to mother. Not only this, but it can vary greatly over a 24 hour period, even among individual mothers (2). The difference in fat content can also depend to some degree on the amount of time elapsed between each feed (this is truer the younger the baby is) - another reason why it might not be a good idea to wait for your breasts to "fill up" before a feed.

The fuller the breast,

  • the lower the fat content of the milk
  • the greater the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

The emptier the breast,
  • the higher the fat content of the milk
  • the lower the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

This is not simply a case of the longer the feed, the higher the fat content: if there is a shorter gap between feeds (such as during periods of cluster feeding), the milk at the beginning of a feed may not necessarily be low in fat (2,10).

"Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,10)

Whilst fat is important, we can and do get far to preoccupied with the issue of fat content - take another look at the graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples:

Did you spot the line labelled 'TS' (Total Solids)? That line represents all the other components of breastmilk which are important too!

The most important thing to remember is this:

In the vast majority of cases, as long as you are:

  • breastfeeding on cue
  • and allowing your baby to come away from the breast spontaneously at the end of a feed,
there is no need to worry about what's in the breastmilk your baby is getting. ALL of the components of breastmilk are essential for the growth and the physical and mental development of your baby, not just its fat content.

Last edited: 25/09/11

If you liked this article, please consider making a small donation to Cheshire and North Wales Human Milk Bank (a charity which does a fantastic job of getting breastmilk to our most vulnerable babies), without whom this article could not have existed.

Many thanks to:

Lynda Coulter (Cheshire and North Wales Human Milk Bank) for very kindly agreeing to analyse the samples of my breastmilk.
Janet Beech and Linda Gendler (Cestrian Ward, The Countess of Chester Hospital) for entertaining my mad idea and helping to co-ordinate the experiment.
Becca Williamson (Bosom Buddy breastfeeding peer supporter) for being my extra pair of hands.
Jenni Ross (Medical Photography, The Countess of Chester Hospital) for taking such excellent photos of my breastmilk samples.

This article has been republished as a guest blog on Acorn Pack


Saturday, 2 April 2011

Putting pizza back on the menu

Life is full of quietly inspiring people. One such quietly inspiring person is a friend of mine, who is generous and kind and always seems to be helping everyone else out, but asks very little of others herself. Life wasn't easy for her after the birth of her youngest baby: he always seemed unsettled, was an expert producer of green nappies, had trouble gaining weight and spent his entire little life scratching constantly at his inflamed skin. As time went by, it became increasingly apparent that this fussiness was not normal. Thinking he must be allergic to something, she tried eliminating various foods from her diet to see if it made any difference. Avoiding some foods seemed to make small improvements, but she could never quite put her finger on the exact culprit. After enduring this for months, she took him to have a test to find out whether he was allergic to anything. When the results came back, the list was surprisingly extensive. Her baby has multiple food intolerances, including some serious, life-threatening allergies. The cuplrits are:
  • wheat
  • dairy
  • eggs
  • soya
  • tomatoes
  • potatoes
  • red peppers
  • aubergines
  • chili
  • cape gooseberries
  • tobacco smoke
Obviously, the baby cannot eat anything on this list now that he has started solid foods. But my friend cannot touch anything on this list either. Because she is breastfeeding him, and the allergens from these foods have been passing into her breastmilk.

Most breastfeeding mothers don't have to watch what they eat because most babies have no problems with what their mother eats (1). So most breastfeeding mothers can eat whatever they like (hurrah!). However, a few babies will have obvious reactions to certain foods their mother eats (1). My friend has one such baby.

When I read the above list, I felt slightly overwhelmed: but those foods are in everything! Even specialist foods for people with allergies substitute foods on that list with other foods which are also on the list. What would my friend eat?!

Yet I watched in awe as she just got on with eliminating each of the foods on the blacklist from her diet. And I watched as her baby went from being a miserable, unsettled baby who struggled with weight gain, irritated skin and never slept, to being a happy, bright, chirpy little fellow with flawless skin and a healthy appetite. The difference has been dramatic.

For further information about breastfed babies and allergies, please take a look at:

So, what's the obvious thing to do for a dear friend whose diet has been impossibly restricted? Invite her round for Pizza Friday of course! (What can I say? I love a culinary challenge!)

Feeling confident I could create a wheat-free, tomatoless, cheeseless pizza, I did a bit of research, scratched my head over ingredients lists in the supermarket, and transformed my kitchen into a laboratory of experimentation. Everyone thought I was completely mad (I'm not disputing that), especially when I explained that I would not be eating normal pizza myself: no, I would be joining her in eating this creation! ...And, with a little help from my husband (he made the pizza base) I did it!!! The result was delicious, and surprisingly like pizza too, albeit a bit more orange.

The following recipe is dedicated to all the unsung heroes out there who have to make dietary sacrifices for a happy breastfeeding relationship. Different people have different allergies, but I'm sure that with a few inventive tweaks here and there, this recipe can be altered to accommodate most people's requirements.

Harry's Special Pizza

The pizza before baking.
(I didn't get a photo after it had baked - it got polished off too quickly!)

Pizza Base (makes 3)
175g brown rice flour
175g gram flour
2 tablespoons olive oil
half teaspoon salt
220ml warm water
1 teaspoon yeast
1 tablespoon sugar
  1. Mix the sugar into the warm water until it has dissolved. Add the yeast to the mixture (this activates the yeast) and leave for 10 minutes.
  2. Place the brown rice four, gram flour and olive oil in the bowl. Sprinkle the salt around the outer edge of the contents of the bowl.
  3. Make a well in the centre of the contents of the bowl and add in the yeast mixture.
  4. Knead the mixture together until dough forms.
  5. Cover bowl with a damp cloth and leave to rise (preferably overnight).
  6. Knock the air out of the dough, knead and separate into 3 balls.
  7. Sprinkle brown rice flour onto a kitchen surface & roll out one of the 3 balls into a pizza base.

No-mato passata

3 medium carrots
1 small onion
a third of 1 butternut squash
a quarter of 1 beetroot
1 clove garlic
a dash of cider vinegar
rosemary, thyme, sage, oregano and basil to taste

  1. Juice the carrots, onion, butternut squash, beetroot and garlic in a juicer. Scoop the pulp out of the juicer and place in a saucepan. Add the vegetable juice and a little water.
  2. Add the cider vinegar and herbs and allow to simmer until the passata has reduced enough to be able to spread on the pizza base.

Cheese-free topping

1 can cannellini beans, drained & rinsed
2 cloves garlic
olive oil
pinch of salt and black pepper

  1. Heat the oil in a saucepan, add the garlic and cook until softened. Add the beans, salt and pepper.
  2. Take the saucepan off the heat and use a hand blender to blend it into a creamy "cheese".

I can't take the credit for this topping: I found it on No Meat Athlete, who found it in Robertson, R (2010) Vegan on the Cheap.

To assemble the pizza, spread some of the no-mato passata evenly on the base. Then flatten chunks of the "cheese" and place it on top. I added ribbons of butternut squash and chopped onion.

Bake for about 10-15 minutes on about 180 degrees C (in a fan-assisted oven). As the pizza dries out a bit during baking, brush all over with a little olive oil about halfway through.

Served with rocket, this pizza is delicious! It's also completely vegan. And for my friend, it means Pizza Friday is well and truly back on the menu.


Mini pizza party bites

(1) Bonyata, K (2010) Dairy and other Food Sensitivities in Breastfed Babies