Breastfeeding In Swimming Pools

In the last few months the hot topic seems to have been asking mums to stop breastfeeding in the public swimming baths.

Imajica Gilroy was told she couldn't breastfeed at Parkside Pool in Cambridge as it was "unhygenic".  For anyone in the area, there is a breastfeeding flash mob planned there Sat 17th August @ 1pm. 

Manchester Aquatics Centre allegedly told Stephanie Wilby it was "indecent exposure", and Stephanie claims the staff likened it to someone urinating in the pool. Breastfeeding flash mob there planned Friday 16th @ 10am.  Stephanie also claims staff shouted at her to stop immediately, causing a scene - but I don't want to dwell on that as I think it detracts from the real issue.

What's interesting about swimming pools is that unlike other venues, even pro breastfeeding mums often say if the rule is no eating this should apply to all.

So I wanted to reply to a few common comments :)

1.  Breastmilk could get in the water.
If we're concerned about breastmilk getting in the water, all lactating mums should be stopped from swimming in case they leak.  I'm also wondering why when breastfeeding we would expect milk to be pooling around the mother in the water, er no it's going into baby!

b)  Even if breastmilk gets into the water, it is antibacterial, antimicrobial and doesn't pose a health hazard.

Lots of things that do pose a health hazard end up in the water.  It's rather ironic that Manchester Aquatics Centre allegedly likened it to someone urinating in the pool - because I'm sure plenty of toddlers have a sneaky pee in there, and have they ever tested for "leakage" in those without great pelvic floor muscles when doing the breaststroke?  Perhaps they should ban them too! Sweat, urine, mucous, saliva, hair, dead skin and faecal matter - not to mention sun cream, perfume and cosmetics - are among the pollutants introduced by bathers into pools.  Lordy a breastmilk bath is looking more desirable by the minute.

2.  Baby could vomit after feeding.
This is kind of a futile argument with babies though given a) they can puke anytime, even an hour or two after a feed.  b)  If the mum is leaving the area to feed as expected and then returning with baby, he may still vomit.  Some babies just don't posset, my first only ever did twice, both times after we had tried colief.

Those who have babies who are prone to refluxing copious amounts are hardly unlikely to breastfeed in the pool anyway, mums don't lose their brains when they get a baby - often the person most aware and conscious is the mum.

Important point to note:
Swimming pools are chlorinated.  

Swimming pools are chlorinated.  

Swimming pools are chlorinated.

I feel a need to repeat this as any argument over "water contamination" is wiped out with this point.

Chlorine is known to kill almost all kinds of bacteria, as well as viruses and protozoa - hence why it's used in pools. When chlorine isn't used, the bacteria in pools is comparable to that of a toilet - without anyone breastfeeding.

6.  It's indecent. 

Sorry but I'm frequently glad my eyes have an avert function when at the public baths, budgie smugglers anyone?  Aside from this it breaks the law to ask a mother to stop breastfeeding on the grounds of decency.

7.   If the rule is no eating, that means everyone.
This rule is clearly to avoid Big Mac and chips finding their way into the water, imagine if everyone took snacks!  Babies sometimes need feeding several times in an hour, whereas adults can consider the fact they are going swimming and eat more in advance.  They can also wait when hungry because they don't survive solely on a substance digested quickly and have bigger stomachs.

Furthermore the breast isn't just food,  I think a lot of people still struggle to grasp that babies don't just seek the breast when hungry.  They can do so for comfort, reassurance at a new situation (like swimming), or because they want to warm up if feeling chilly.  Furthermore we know babies don't always transfer milk - so they may not in fact be "eating" in the pool at all, they could be sucking for comfort. Are pacifiers, a nipple replica also banned?  What if they suck their own fingers?  Is sucking mum's finger OK but not her nipple?

8.  I think the mum should have got out and done it in the changing rooms.
Why?  It's not always convenient for mum to hot foot it off to the changing room, she may have an older child to supervise who cannot be left.

9.  It's unhygienic for baby.
How?  When attached to the breast the baby forms a seal, there is less likelihood of them ingesting water than when they're swimming in it. Mothers are also hardly likely to have their baby's face half in the water, don't believe me, you can see a great example here.  Some baby swimming classes involve submerging both mouth and nose under water, yet I've never heard anyone express concern that is unhygienic.

If you think pool water is that gross despite the chlorine, perhaps better off not taking your baby at all. Ultimately it's the mother's choice whether she feels it's a hygiene risk to her baby or not?

10. Other babies have to wait so why should breastfed babies be any different!
Oh no, I would be quite happy for a mum to bottle feed her baby or use a pacifier in the pool too! Not suggesting certain babies get special treatment, all have the same needs whether met by breast or bottle; our society has been intolerant of babies and children for long enough.

Unlike no petting, bombing or ducking - I can't think of a single plausible, logical reason why a baby cannot feed in a pool.  Nor has anyone else been able to offer one other than the rules say so.

Which tells me the rules need changing :)

With regard to Stephanie's case above, a spokeswoman for Serco said:

"We are fully supportive of mothers breastfeeding their child whilst in our centres.  Serco’s operating practices are to encourage breastfeeding in a safe and comfortable environment for both the mother and child rather than it taking place in the swimming pool."

Serco are you seriously suggesting breastfeeding in the pool is more dangerous than a baby swimming in it?  If so why?  I also trust we can let mums choose to decide where they are most "comfortable"?

There is a petition here to ask Manchester Aquatics to review their policies

Councillor Rosa Battle, executive member for culture and leisure at Manchester council, said: 

"We have asked the Manchester Sport and Leisure Trust and Serco to investigate this incident thoroughly and to take action immediately if it is established that any members of staff behaved inappropriately towards Stephanie.  We have also asked that the Trust and Serco review their existing policies, to make sure that they reflect the law.".

Update:

"Lifeguards at Manchester Aquatics Centre told they CAN’T stop mums breastfeeding"

"Now the M.E.N. has seen an internal memo sent to staff warning them not to discriminate against breastfeeding mums and warning ‘we must comply with the law’." - read more here

When To Introduce a Bottle To a Breastfed Baby?

A few months ago I received a call from a confused mum; her baby was 3 months old, breastfed, and that night he had refused his daily bottle.  Mum couldn't understand why, after all they had given a bottle once per day since week 2 as advised to "get him used to it".  He had always taken it without a problem why now should he refuse?

I get asked when should parents introduce a bottle a lot, and like the mum above many are told early introduction equals success, and conversely if the bottle isn't introduced early then baby is likely to refuse or struggle with technique.

What's the deal?

Firstly expressing:

In the early days of breastfeeding (once milk has "come in") your body is trying to establish how much milk your baby needs and thus how much to produce.  It does this based on what is removed, so if you feed baby and then express, your breasts will replace a feed plus more to replace the amount expressed.

Mums often plan to express so dad can give a feed and allow a longer stretch of sleep, but in the early days this often proves rather impractical as missing a feed results in overfull, painful breasts - meaning mum ends up pumping again whilst dad gives the bottle.

Some mums deliberately choose to cultivate an oversupply early on, usually if they want to build a stockpile for some reason ie they want to feed baby now, plus add a regular amount to the freezer.  Otherwise an oversupply can be problematic, leading to engorged painful breasts between feeds, faster flowing milk and increased leaking (as an example at the extreme end of the scale, one mum I worked with had to sleep with a super absorbent nappy taped over each breast at night).

Bottles:

I've spoken to so many mums over the years who have diligently given a bottle every day, or every week from a young age to ensure baby would be used to taking it.

This doesn't however account for the fact babies have personalities. 

Some will take that daily/weekly bottle fine until one day they decide out of the blue that they don't want it thanks; others will continue to take a bottle just fine.  Some will refuse a bottle in the early days, then one day decide actually OK they will drink from it.  Others that aren't offered a bottle when young will take it just fine when offered at any age.   The same can also happen to a baby fed exclusively from the bottle.  I've worked with mums struggling to get the necessary amount of formula or expressed milk into baby because they fuss or refuse the bottle, take hours to consume small amounts or leak, splutter and gulp.

Introducing a bottle and finding baby takes it, really only tells you they will do so at that point in time.  It is no indicator of how baby will respond at any point in the future.

It seems a standard expectation (particularly with first babies) that mum will of course express and bottle feed at some point, imagine not being able to leave baby!  Some mums have no alternative but to do so if they need to work or be separated.  On the flipside if you don't need to, it's also OK if you don't want to, mums often tell us that the expectation she will want time away, is greater than her desire to actually do so.

Babies naturally settle into a more predictable pattern of feeding, and so some mums find it's easier to work things in and around this rather than expressing.  From around 4 months some soft spouted cups are suitable if you don't need bottles on a regular basis, and things like a doidy cup can be used even earlier.

Nipple confusion, real or not?

This really depends on who you ask!  In my experience the biggest risk in terms of bottles is if a baby hasn't completely mastered the breast and/or has reduced milk transfer, the flow from a bottle can cause some to quickly show preference to the easiest milk source, causing them to fuss earlier and earlier into breastfeeds (although as the breast isn't just food, they will often be happy to return to it afterwards).  Others in this situation will refuse a bottle outright too, but ultimately the key is resolving the initial problem, the bottle is a symptom.

Although more and more bottles are claiming to be "like the breast", realistically to baby they are still poles apart.  No bottle can deliver the smell, sounds and scents of mum (think Heston Blumenthal style dining). None are made of the same substance as nipples or let down in milk ejections as the breast does.

This can cause some to become impatient waiting for the breast to "letdown", which is why mums are often advised to use the slowest flow teat and encourage sucking without milk beforehand, with regular pauses during the feed.

For an infant refining his breastfeeding technique, I like an analogy Lisa at Everyday Miracle uses.  Imagine you are just learning to use a knife and fork, but at some feeds these are swapped for chopsticks - something that requires a totally different action and technique.

The added difference however is that the bottle requires far less effort than the breast, and the baby may try out techniques that work on the bottle when at the breast:

"When bottle feeding occurs, only the buccinator muscles and the orbicular muscle(s) of the mouth are exerted without stimulating other muscles. They concluded sucking only during breastfeeding promotes correct muscle activity, and thus proper development of the oral motor structures" (1) 

It's important to note however....

That giving a bottle doesn't mean baby wont be able to breastfeed effectively again.  I get asked quite frequently whether its worth persisting with breastfeeding if baby has had a bottle, could learning this incorrect action permanently hinder skills at the breast and be the cause of their problems?

Dig a little deeper however and a lot of mums experiencing problems now, who introduced a bottle in the early weeks when trying to establish feeding, did so because they were experiencing a problem; pain, baby that wouldn't leave the breast and settle, slow weight gain - whatever.  So we always have to question what came first, the chicken or the egg?

Even after a bottle baby can still refine, improve and develop their technique at the breast. Conversely some mums never need or want to use one and that's fine too :) 

1) The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers BMC Pediatrics 2009, 9:66 doi:10.1186/1471-2431-9-66