This book is divided into clear chapters by breastfeeding subject, but unlike many other books I have read on the subject, the book has a definite medical focus, and the more social aspects of breastfeeding, such as sleep and duration of breastfeeding, feature in more brief chapters at the end of the book. As a breastfeeding mother, I think I came to this book with a natural skepticism about what a male doctor has to say on the matter. Wherever mothers come together the tales of bad advice and incorrect information from health professionals make your hair curl! Dr Newman runs a prestigious infant feeding clinic in Canada, and his co-author is a La Leche League leader who has written or co-written several other books on breastfeeding, including a personal favourite The Womanly Art of Breastfeeding.
This book offers great practical advice for breastfeeding mothers and their supporters in the form of clear step-by-step guides to techniques and photographs, but also by giving links along the way to further information and especially videos from Dr Newman's website. This means that the book provides a larger amount of resources for dealing with problems than many other books. Where lack of experience is the problem, this is often the difference between breastfeeding and not breastfeeding for a mother and child. For example, this book offers several pages on recognising and dealing with post-birth oedema in the breasts, a problem I experienced and none of my midwives recognised. I had a nasty bout of mastitis before I stumbled across Dr Newman's resources. This book is committed to the La Leche philosophy of "breastfeeding solutions to breastfeeding problems," and recognises that not only is artificial milk deleterious to the breastfeeding relationship, but also bottles, because of the harmful effect of nipple confusion to the breastfeeding relationship. This is an unpopular point to make. but the authors combine it with a range of practical suggestions for alternatives. One slightly controversial suggestion they make is that in the case of low supply, it might be better to introduce solids alongside breastfeeding from an early age, such as 4 months, rather than introduce a bottle of artificial milk. This is an interesting proposition, and weighs the risks of early weaning lower than the risks associated with artificial milks and the use of a bottle. It follows Newman's commitment that the breastfeeding relationship should be preserved at great lengths, and his understanding that the relationship is about more than nutrition, immunity, or future health: it is an essential feature of the relationship between mother and child.
One of the rather brilliant results of the medicalised nature of this book is that it deals with the instances where mothers are sometimes unnecessarily urged by medical professionals to give up breastfeeding. In the chapters on medication, maternal illness, and children with special requirements, Dr Newman gives a rough guide to these instances, and when if ever breastfeeding should be discontinued for the benefit of the child. So many mothers are advised to stop or suspend breastfeeding in order to take a medication for themselves that would not actually harm their child through breastfeeding, and the breastfeeding relationship is lost through the ignorance of the person supposedly giving care.
One theme that recurs throughout this book is the conviction that low supply is common, and the true cause of many breastfeeding problems that are commonly misdiagnosed as reflux and other conditions. The authors attribute any fussing or pulling off from the breast to reduced flow. This book suggests that breast compression to speed up flow, and immediate use of domperidone (a drug that can boost milk supply), are the best options. To my mind this neglects the important relationship between the baby and the breast, and the supply-and-demand nature of breastfeeding. Although Dr Newman's solution is no doubt effective, I believe that if we can trust the mother's body and the baby to work it out between themselves, they usually can. The problem lies in the fact that our society does not allow them the space and time to do so. New mothers feel that they should be up and doing housekeeping, back at school or work, and should not spend the day topless with a naked baby, letting the breastfeeding relationship regulate itself.
Despite these small reservations I think every Health Visitor and General Practitioner should read this book. They are on the front line of supporting breastfeeding families and their education on the subject is patchy at best. This book makes a fantastic reference guide to solving the most common, and some less common, problems encountered. The photographs and linked videos are an incredible resource for supporters of breastfeeding families. It is a real shame that the photographs in this book have to be in black and white, because I squinted at a few and still couldn't work out what I was supposed to be seeing, so I hope that a hard backed, colour photo copy is available for medical reference.