Breastfeeding With HIV, is Breast Still Best? Interview With Expert Pamela Morrison

It is 1995. HIV/AIDS is still adolescent, having burst into world consciousness less than 15 years ago. In upscale Zimbabwe a woman is newly diagnosed as HIV-positive and she is distraught. Her eight month old baby is refusing the bottle. He wants the breast but unknown to him, his mother’s breasts have just been deemed dangerous vessels capable of delivering to him a deadly virus. His mother has no way of knowing if she has already transmitted the virus to her son. Nor does she know how risky it will be to continue nursing him.

She turns to Pamela Morrison, an international board certified lactation consultant in the capital, Harare. But Pamela does not know the answers. Neither do the doctors at the Ministry of Health.

This was the heart churning encounter upon which Pamela Morrison began her quest to have the right answers about infant feeding for women who carry the HIV virus. Twenty years later Pamela continues the mission of counselling and guiding HIV positive mothers, though now with the guide of formal policy and the wisdom of decades of accumulated evidence standing behind her.

I caught up with Mrs. Morrison while she was working and waiting – waiting for the birth of her first grandson. She was not too busy to share with us.

Here in Trinidad and Tobago and the Caribbean, the idea of breastfeeding by HIV positive mums would come as a surprise to many as policy here tells these mums to avoid breastfeeding and use replacement milk formula instead. This contrasts with some resource-poor countries where formula feeding is not a safe option due to formula costs, lack of access to clean water and basic sanitation. In this scenario it is actually safer for a baby’s HIV positive mother to breastfeed her baby, even if she is not receiving anti-retroviral therapy (drugs that suppress the HIV virus, which we will call ART for short). We asked Pamela about this.

“The fact that in the absence of anti-retroviral therapy 85% of HIV-exposed breastfed babies do not become infected has always intrigued researchers. Certain factors in mothers’ milk serve to protect a baby from postpartum HIV transmission and in fact, over 2000 patents have been taken out on the components of human milk, many of which are being developed or genetically engineered as anti-AIDS drugs.”

Pamela lists off several protective components. You don’t have enough fingers to count them all. Breast milk is a living, active substance. Consider human milk oligosaccharides, an abundant component, concentrating on the surfaces of the infant’s gut. There it “serves as a decoy receptor to inhibit HIV binding, a prebiotic promoting the growth of desirable bacteria, and a probiotic to protect against HIV transmission.” Don’t we love it when the good guys win? Pamela tells more, “Then there is bile salt-stimulating lipase, a major human milk glycoprotein, which functions in milk lipid digestion and inhibits viral invasion, including HIV transfer to CD4 T cells. Lastly there have been recent press reports about a host protein called Tenascin-C in breastmilk which was found to neutralize HIV binding, and which helped to explain why the majority of HIV-exposed breastfed infants are protected against mucosal HIV-transmission.”

Yet HIV is sometimes transmitted by breast feeding, despite Mother Nature’s strategies for protecting infants. Without ART and supportive guidance from health care workers this occurs in roughly 15% of cases. By contrast, where optimal ART and health care are received by mother and infant, transmission risk is slashed below 1%, to almost zero. Independent of ART, exclusive breastfeeding makes a tremendous difference to the safety of breastfeeding for babies of HIV positive mothers. Countries with policies that encourage these mothers to breastfeed promote exclusive breastfeeding rather than mixed feeding since mixed feeding makes transmission so much more likely.

Pamela explains, “Exclusive breastfeeding means that the baby receives no other foods and liquids apart from prescribed medicines for the first six months of life. Premature introduction of other foods and liquids to the baby before age 6 months leads to disturbances of normal gastrointestinal flora,[ie the bacteria that are supposed to be in the gut and serve as a guard against harmful bacteria], exposure to dietary antigens, and inflammation resulting from infection with pathogens, all of which result in small sites of trauma and inflammation in the lining of the infant’s gut. When the infant’s compromised gut is exposed to HIV in breast milk the damage allows the virus to enter the bloodstream. Exclusive breastfeeding for six months not only reduces the risk of HIV transmission, it also reduces a child’s chances of acquiring other diseases.”

In Trinidad and Tobago cultural practices include cleaning a new baby’s tongue daily with honey or among Muslims, giving the newborn a taste of something sweet, like a bit of a date that has been pre-chewed. Do such habits undermine exclusive breastfeeding?

“Indeed they do, for the reasons just described and even where concern about HIV is not a factor such cultural practices increase the risk of infection.   It might also be worth pointing out that honey is not recommended for babies under a year because of the risk of botulism. [a rare form of food poisoning that can lead to paralysis and death]. Pre-masticated [pre-chewed] food has also been shown to be a risk factor for HIV-transmission if the person feeding the child is HIV-infected.”

Pamela is currently based in the UK where formula feeding is the recommended policy for infants of HIV positive mothers. In the UK, as in Trinidad and Tobago, exclusive breastfeeding for the first six months is not a cultural norm. Indeed, far from it. So it does come as a surprise to know that the UK has guidelines for HIV positive mothers who want to breastfeed. The history that Pamela gives us may surprise even more: “It’s currently estimated that 72% of HIV-positive mothers in the UK were born in countries of high HIV prevalence where breastfeeding is the norm and where decisions about infant feeding and weaning are often made by extended family members, rather than by the mother herself. Formula-feeding identifies these mothers’ HIV-positive status to their communities within the UK. Furthermore conditions for safe formula-feeding may not be sustainable for HIV-positive mothers who are also asylum-seekers, or in detention centres. Those deported receive only enough formula for the flight home. [with their infants placed at sudden risk of under nutrition and life threatening infection] Consequently the British HIV Association (BHIVA) and the Children’s HIV Association (CHIVA) held a public consultation to take the views of health providers, mothers and others about whether the guidance prohibiting breastfeeding, should be changed and in 2010 it was.

“Current BHIVA/CHIVA pregnancy management guidelines include recommendations for combination antiretroviral therapy (known as cART) during pregnancy and the option of managed vaginal delivery for women with an undetectable* HIV viral load at term. Thanks to these interventions, mother-to-child HIV transmission is now very low, at 0.1%. The current BHIVA/CHIVA infant feeding guidelines, issued in November 2010 permit breastfeeding in a mother who really wishes to do this.

“The impact of these revisions has been profound. Now it is possible for HIV-positive mothers to discuss their wishes with their clinicians and make evidence-based decisions on which method of delivery and feeding would be safest for them. And then they can receive support to breastfeed as safely as possible if that’s the feeding method chosen.”

This is a welcome relief from the extraordinary scenarios that previous policy led to. “Because such a high percentage of HIV-positive mothers in the UK were born in Eastern or Southern Africa where breastfeeding has very important cultural and traditional significance, when these mothers are advised not to breastfeed it causes considerable stigma and distress. There have been reports of mothers hiding in their bedrooms, afraid to let family and neighbours see them bottle-feeding! Furthermore, in the past, when parents appeared to be refusing planned interventions such as bottle-feeding, it was recommended that children’s social services become involved.”

Devastatingly this meant making legally binding arrangements to “protect” the newborns by removing them from their mothers’ care. In the Caribbean formula feeding carries no stigma but carrying the HIV virus certainly does. In fact, this stigma is such that many HIV positive parents would choose the increased risk of other chronic diseases (diabetes, high blood pressure, breast cancer) to the low risk of HIV, if given the choice of how to feed their babies. So in our society formula feeding the baby of an HIV positive mum seems like the most sensible thing to do. Besides this, the other chronic diseases strike in later life and can be warded off by sensible lifestyle habits. What does Pamela say to this?

“In countries where formula-feeding is commonly practised, it would be fair to say that the culture accepts that bottle-feeding carries little risk to health, whereas the small risk of HIV transmission through breastfeeding tends to be exaggerated. As you point out, formula-feeding is not without risk, even in highly industrialized countries and almost every health outcome is improved for breastfed babies. For instance, a UK study published recently showed that exclusive and sustained breastfeeding could prevent 53% and 27% of hospitalizations due to diarrhoea and lower respiratory tract infections respectively.”

I have witnessed the tragic misery and suffering of infants dying of AIDs in the late 1990’s, before the Prevention of Mother To Child Transmission (PMTCT) programme was established, after which transmission to newborns was sharply reduced. The key tools of this programme were testing pregnant mothers, giving ART during pregnancy and labour and providing formula free of charge for their infants. No matter how we argue that breast is best and HIV is just a chronic disease, it’s a disease that can only be managed by expensive long term use of drugs that do have side effects. Isn’t the small increased risk introduced by exclusive breastfeeding too much risk in a nation where replacement formula has been made available and infant death due to infectious disease is the exception and not the rule?

Pamela is cool, rational as ever. “I think it’s difficult to oppose these arguments. As we discussed, in many industrialized countries, formula-feeding is seen as a perfectly acceptable lifestyle choice and there is the perception that a 1% risk of transmission of HIV through breastfeeding is 1% too high.   The tragedy of the HIV and infant feeding debate is that there is neither a clear benefit to one course of action nor a clear risk to another. In fact it’s quite the opposite: it’s always been a dilemma of competing risks. The best that we can hope for is that each mother can make a decision about how to feed her baby, in consultation with her doctors, who can provide her with enough background research to make an informed choice on the least likely risk to her baby in her circumstances.”

Generally, free and informed choice is the ideal we aspire to. In matters of health and safety though, public policy sometimes dictates the course of action to be urged, sometimes even enforced. The World Alliance for Breastfeeding Action (WABA) supports current the World Health Organisation’s guidelines, urging countries to have one main policy for HIV positive mums (exclusive breastfeeding or no breastfeeding). The guidelines sway counsellors away from placing the burden of choice on mothers.

Pamela says, “The World Health Organisation (WHO), says infant feeding practices should support the greatest likelihood of infant HIV-free survival. WHO believe that national or sub-national health authorities should decide whether health services will principally counsel and support HIV-positive mothers to either breastfeed and receive antiretroviral interventions or avoid all breastfeeding. The decision should be based on the socio-economic and cultural contexts of the populations served including the main causes of maternal and child under nutrition and infant and child mortality.”

Pamela adds that a colleague of hers once suggested that this “should be further tailored to the needs of particular areas – eg in areas of Trinidad and Tobago where economic conditions are such that the population resembles the poorer nations, then child survival might well be best served by a recommendation to breastfeed. Where mothers’ living conditions are more like those enjoyed by mothers in wealthy nations then the recommendation not to breastfeed might be justified. In other words, maximizing child survival will require tailoring recommendations to each mother’s unique and individual circumstances.”  

This of course sounds reasonable and logical but policy change must be guided by hard facts. An article by Anna Ramdass in the Trinidad Express of October 4th 2012 described higher than expected infant mortality statistics for Trinidad and Tobago with progress in reducing these figures lagging behind other Caribbean islands but this article reported no actual proven connections between HIV, formula feeding and death by infectious disease.

Backing away from policy discussions and returning to the sphere of personal choice, now that HIV transmission has been shown to be less than 1% when mothers with undetectable viral loads breastfeed exclusively for the first six months and wean from the breast around baby’s first year, are mothers who know this asking to breastfeed? “Yes, indeed, they are. An increasing number of mothers have become aware of the up to date research results, and seem to be putting two and two together; if – thanks to provision of current anti-retroviral therapy and knowledge about the protective effects of exclusive breastfeeding – breastfeeding in the context of HIV carries such a low risk (stated to be virtually zero) then they are keen to explore with their healthcare providers whether they can safely breastfeed, and they are asking for help to do so.”

Such interest is coming not only from the UK and the African continent but from North America, Australia and from countries as resource rich as Denmark and Germany. As a lactation consultant yourself, you continue to counsel and support clients directly. What would you say is the role of the lactation professional in supporting HIV positive mothers? Pamela Morrison   “I think the role of the lactation professional is two-fold. Firstly, it is to provide information. I receive queries from HIV-positive mothers, or their breastfeeding counsellors from all over the world. They are all searching for enough information to protect individual HIV-exposed babies. Usually these mothers want to breastfeed, but healthcare providers citing out of date studies showing a high risk of transmission are warning against breastfeeding.   I feel that my role is to share with my clients the most up to date information and research that I can find so that they can discuss this fully with their own doctors. Ideally, a decision will be reached that will keep the baby safe, that the mother is happy with, and that the clinician can support. Secondly, if the decision is made for breastfeeding, then the lactation professional can work with the mother to make sure that she “manages” her own lactation in the safest possible way. In this respect, the HIV-positive mother is no different from any other mother in that she needs information about breast and nipple care, about individual variations in her milk production from day to day, and how to be reassured that her baby is getting enough breast milk. Over 99% of mothers have the capacity to exclusively breastfeed their babies, ideally for the first six months- but in the context of HIV exclusive breastfeeding is especially important and it is vital that the mother knows how to avoid and remedy common breastfeeding problems. It is not difficult to help mothers achieve this happy outcome.”

Due to the fear of stigma I can imagine an HIV positive mother seeking the support of a breastfeeding counsellor or consultant while withholding her HIV positive status. “Yes, I’ve worked with mothers who I’m almost certain knew that they were HIV-positive but would not tell me. When a mother seeks help with breastfeeding, the lactation consultant or breastfeeding counsellor is extremely privileged to be invited to share in a very intense and special time as the mother gets to know her newborn. But when a mother is being less than frank, it could have a profound impact on her baby’s health and survival. It may not be appropriate for such a mother to be encouraged to go on providing small quantities of breast milk (effectively mixed feeding) if she finds she has trouble with exclusive breastfeeding. Yet we would certainly recommend this strategy to enhance the health of the baby when the mother does not have HIV, but if she has not disclosed her status, this would absolutely be the wrong advice. I want to give individual mothers the very best information, tailored to their circumstances, that I can. I can’t do that unless she’s absolutely open with me. It’s times like this when I would like to see HIV recognized as just one more medical condition, like say diabetes, or Crohn’s disease, rather than something shameful to be hidden.

“Ideally the disclosure about positive HIV status would come at the earliest opportunity so the breastfeeding counsellor can give the mother the information which is most relevant to her and her baby, and so that we can supply references and journal articles etc. for her to share with her doctors.   We are all working for the same goal – a happy healthy mother with a happy healthy baby – and it can be a very positive experience when we all work together.”

  *undetectable viral load or levels refers to extremely low levels of HIV virus in the body fluids of someone who is HIV positive. It does not mean that the person is cured and continued use of Anti-Retroviral Drugs is required to maintain these low levels.  

Pamela Morrison began her career as an international board certified lactation consultant in Harare in 1990. While in Zimbabwe, Pamela also worked as a BFHI Facilitator and Assessor, as well as serving on the Zimbabwe National Multi-Sectoral Breastfeeding Committee and the national BFHI Task Force. She has also served on the World Alliance for Breastfeeding Action (WABA) Task Forces for Children’s Nutrition Rights, and for HIV and Infant Feeding, and the ILCA Ethics & Code Committee. After moving to England in 2005, she was employed until 2009 as a Consultant to WABA. She is currently the ILCA media representative on HIV and continues to do volunteer work for WABA.

This interview was first published by Fresh Start in the December 2014 issue. Here is the link to the original article:

The photograph of Mrs. Pamela Morrison does not appear in the original article. Warm thanks to Mrs. Adepeju Oyesanya, editor of Fresh Start for suggesting it and for the very generous and knowledgeable and meticulously professional Mrs. Pamela Morrison for sharing her time, experience and expertise.

Pregnancy and Birth Across The Pond: From Trinidad to London

The long walk to the Women’s Health Department in the Sutton hospital was almost déjà vu. The physical building resembled that of Port-of-Spain’s General Hospital. I suspected both institutions had been designed in the same era.

In many ways, public health care in Trinidad and Tobago resembles the UK’s National Health Service (NHS). Both systems are state funded, claim to be under financial pressure and are heavily criticized by the public they serve. The NHS today is frequently in the spotlight with problems that are old thorns for Trinidad’s General Hospitals: unacceptably long waiting times at the Accident and Emergency; overcrowded wards; patients unable to access non-emergency care at their local centres; shortages of doctors; questions over expenditure by administration; client deaths linked to inadequate care.

It’s well known that the human resource element in Trinidad and Tobago’s public health system has not in recent decades been able to support its clients by spoiling them for choice.

I chose private care for my first and second pregnancies in Trinidad because this allowed me the luxury of choice; which doctor or midwife to see; when to schedule appointments; which hospital to choose; what to include in my birth plan; if to have a doula; even some choice over my post-birth breakfast menu!

I wanted to avoid the unpredictability of being attended to by various strangers. Relationship building takes time but builds trust. Trust facilitates confidence and confidence makes birthing easier, on the mind, if not on the body.

For my third pregnancy I found myself living in the UK. I chose to be a client of the overburdened NHS for my third pregnancy, would I be satisfied with my options?

Well, the policy of the NHS is to encourage home births where possible since studies of UK and similar populations show that home births cost less but add no significant increased risk for “low risk pregnancies.”

Waiting to see the midwife for the first visit 12 weeks into my pregnancy, I found myself in torrents of tears after looking at the cards and photographs posted on the walls from families that had chosen home births. An emotional bomb had hit me unexpectedly. Underneath the nausea and fatigue there was a little human being under development who would, by God’s Grace, be joining us just six months into the future. Reality hit home.

The midwife loaded my answers to her numerous questions into her computer programme. The programme did its analyses, reducing the error of human misjudgements. I was deemed “low risk” and a candidate for home birthing. This, despite me being almost two years short of the big Four Zero!

I was thrilled.

The midwife who was responsible for managing home births in the area was an amazing woman. Like my obstetrician in Trinidad, she gave me all the time in the world when my questions needed to be asked and my anxieties needed to be addressed.

She emphasized my right to choose a home birth. She showed me the assessment criteria for home birth to be met towards the end of the pregnancy but expressed her conviction that the client’s right to choose should prevail. She referred to women who did not meet the criteria but whose preference for home births was respected despite contradicting medical advice; one woman was diabetic; another was giving birth for the seventh time. “We cannot refuse to come, once we have the staff,” she insisted.

Pregnancy care under the NHS offers more routine screening blood tests (including assessment of body iron stores and degree of Down Syndrome risk) and shorter waiting times than typical community health centres in Trinidad and Tobago. On the other hand, under the NHS low risk women have half the number of routine clinic visits on their schedule and perhaps because I never appeared over or under weight I was only ever weighed once.

To my surprise and horror I was expected to bring urine in a narrow glass tube supplied by the clinic, wash the tube and use it again for the duration of the pregnancy! Yes, the NHS has been under great pressure to manage its expenditure but I have to admit their system is more environmentally friendly than the use of styrotex cups!

Midway through my nine months I learned of a card for pregnant women which entitled me to free medicine and dental care for the pregnancy and first year after baby’s birth. Well off I went to the dentist, grateful for my savings of a few hundred pounds and mindful of the money previously spent because I did not know about this ‘pregnancy privilege!’  There were no doctors at the community clinics I attended so though the midwife could recommend iron, she couldn’t write a prescription and I had to wait my turn at the GP’s office again – or pay at the pharmacy.

I took the tour of the hospital’s labour ward and birthing centre. It was delightful to have the option of a water birth in a private room at a birthing centre but in the end the attractions of a homebirth won me over. In theory I could have rented my own birthing pool and had a water birth at home but the labour proceeded so efficiently when it did get going that I doubt I would have even made it into any pool.

A must read if you are interested in birthing naturally and in understanding waterbirth!

Gentle Birth Choices by Barbara Harper, a must read if you are interested in birthing naturally and in understanding waterbirth! I really wanted a waterbirth after reading this and after being introduced to the subject at the Mamatoto birthing centre in Belmont, Trinidad. But in the toss up between the inconvenience of renting or buying – and filling (then emptying and maybe selling) a pool at home, versus using the waterbirthing facilities at the hospital’s birthing centre in Sutton, home birth pool free actually won! Any my early labour was so long while my active labour was so short, there would have been no time to get in and out of the pool anyway!

After the birth, our doula (labour support person), made the midwives tea and brought them fruit and chocolate we’d set aside for them as refreshments. We took photos together. NHS policy emphasises the role of the midwife in helping mother and baby to get started with breastfeeding and the midwives were happy to wait for baby to have her first feed before weighing her.

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it  wasn't for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it wasn’t for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

Midwives and the district health visitor made at least four visits to our home in the two weeks that followed. It was wonderful not to be roasting our newborn at the bus stop in what was a sweltering hot summer. It was comforting to know that the system actively searches out mothers at risk of postnatal depression. The home visits also seek to help and support breastfeeding and even though this was my third time with a nursling, they had some useful reminders and assurances for experienced mums too.

Despite the conscious efforts by midwives both in the UK and T&T to encourage, inspire and support breastfeeding, not many women breastfeed exclusively for the first six months. In the UK new mothers are less likely to have the family support needed to facilitate sustaining breastfeeding and despite knowing that best is breast, despite baby latching on and breasts full of milk,  the sheer quanta of time required to breastfeed means that many busy mums – even stay-at-home mums – are defeated before they begin.

Reading about breastfeeding is a useful part of preparing for your new baby. You won't have time to do much of it once the little one arrives.

Reading about breastfeeding is a useful part of preparing for your new baby. You won’t have time to do much of it once the little one arrives.

The Birth Book by Sears and Sears

Read as much as you like but be sure to attend birth preparation classes too! Nothing replaces the insights of experienced women. Nothing replaces the sharing and caring, the camaraderie amongst pregnant women. The Birth Book by US paediatrician Dr. William Sears and his wife, registered nurse and midwife, Martha Sears.

Nursing Mother, Working Mother by Gale Pryor

You may have thoughts of pumping and working but don’t rely on optimism or even on Gale Pryor’s brilliant book, Nursing Mother, Working Mother. By all means, learn what you can from books such as this one but your strategy and how best to execute it must come from women who’ve done it successfully, from understanding the obstacles you might face and maybe even from working with the breastfeeding counsellors and consultants whose experience and guidance can sometimes be a make or break factor.

While breastfeeding and ‘low tech birthing’ for low risk mothers with adequate antenatal care are cost effective for the national purse, in Western society freedom of choice is upheld as a sacred principle. Yet with dire predictions that nations’ health bills will be strained by ageing populations heavy laden with Alzheimers’, cancers and other chronic diseases, will a push towards natural birthing and breastfeeding be forced into policy? And isn’t policy impotent all by itself? In the UK, home births and exclusive breastfeeding remain the exception and not the norm, despite the policy support they enjoy.

For women to embrace breastfeeding and low tech birthing as gold standards to be aspired to where possible, the following would be imperative:-

  1. Conveying the information and reassurance needed for women to embrace such options with conviction.
  2. Providing adequate and flexible maternity and paternity leave
  3. Providing easily accessible and relevant antenatal classes for all
  4. Providing workplace support for mothers who wish to pump milk at work
  5. Providing competent and widely accessible breastfeeding support for mothers after birth.
  6. New training and retraining for a wider cadre of supporting health care workers.

This article was first published by Fresh Start, the on-line magazine of Best Start, the breastfeeding and advocacy organisation run by the very dedicated and amazing Adepeju Oyesanya. Thankyou for the privilege of publishing with Fresh Start, Adepeju.

The article was first published on page 20 of Fresh Start’s May 2014 edition, link below:

The original publication did not include the photographs that are part of this post.

Moments of Pregnancy; Love, Tears and Magic.

When a woman confirms her pregnancy, how does she feel? Elated, excited, depressed, disappointed, surprised? Or none of the above. She might just feel numb. And here friends, is where we begin.

You and your baby are unique and your first forty or so weeks together are too. Your thoughts, feelings and experiences may be nothing like what friends and relatives expect for you. As I write this I’m carrying pregnancy #3 and it certainly has not been just the same as for #1 or #2! So you don’t have to feel excited, thrilled and expectant in the first weeks or months. It’s fine if nausea and uncertainty overshadow everything in the early days. If you are miserable, find that trusted friend to talk to.

It’s possible to have an enviable “perfect pregnancy”, marked only by a change in body shape (sexier than ever as the months go by), an increase in appetite and maternity leave forms – but for many women having a “normal pregnancy” there are all sorts of changes. Fatigue might hit you for six. “How could a creature the size of a kidney bean be making me so tired?” you ask. Give it a rest, mum. Baby Making is hard, detailed and technical work. So sleep when you need to. The world will continue without you. If necessary, accept help without guilt should it come your way. There’s plenty of time to return the love with kindness of your own when you are feeling better.

Interest in sex sometimes (thankfully not always), drops to an all time low in the early months. Do reassure your partner that this won’t last forever. Acknowledge and respect his feelings even if you can’t accommodate them. Remember he might be silently panicking, imagining being pushed aside, replaced by his baby. Tell him the truth: lots of women feel a resurgence of their sexiness and desire by the middle of the pregnancy. Could he just be patient and loving till then? And by then with your growing tummy, you might have to find new twists on old positions in order to make sex work for both of you!

Many mums-to-be find that nausea and vomiting resolve by mid-pregnancy if not after the first three months. However mid-pregnancy may bring with it aches and pains as the weight of your child takes a toll on stretching ligaments and back muscles. Gentle stretching exercises taught at antenatal classes, but also available on-line and in popular books like “What to Expect When You Are Expecting” go a long way towards strengthening muscles and reducing discomforts.

Sadly I was often too tired to find the time for more than a few of these exercises myself but go for it if you can!

Sadly I was often too tired to find the time for more than a few of these exercises myself but go for it if you can!

Still, with a bit of lower back pain each time, I did make time for The Cat and it always made a positive difference!

Still, with a bit of lower back pain each time, I did make time for The Cat and it always made a positive difference! Source: Yoga for Pregnancy

Baby’s movements by mid-pregnancy increase your bonding with your little one. For some women warm feelings and positive anticipation don’t begin till the movements do. Later, baby’s movements can be felt – and sometimes even seen by baby’s daddy and siblings, making the baby more real in their minds and helping them too to begin bonding.

As pregnancy progresses women often worry if all the fat gained will ever be lost. After all, so many mothers blame their pregnancies, often their very first or only pregnancy, for fat that hangs on for several decades to come!

Here are two strategies to help you make sure your pregnancy fat is useful fat that will be lost in good time:

  #1 Eat healthy during pregnancy and afterwards. Minimize or cut out fried foods, sugar, sugary drinks and sweeteners and ensure daily intake from all food groups. Be guided by appetite, avoid delaying meals and stop when full. Weight gain should then be only what your baby needs from you during pregnancy.

And for strategy #2 breastfeeding! You may well slip back easily to your pre-pregnancy weight after just 6 months of exclusive breastfeeding! It’s true that birthing and breastfeeding are all natural.

As birth approaches, genuine fear and anxiety about birthing are not uncommon. Many women don’t feel an unwavering confidence in the ability to breastfeed. I admit to nagging doubts in my first pregnancy. After all, I have a low tolerance for pain. I would never even prick myself with a pin for a dare. How then could I endure labour? I remember hearing my first labour story at age 11. It lasted 18 hours!

As for breastfeeding, suppose I couldn’t remember the pictures in the book showing me what a correct latch-on looks like for a nursing baby? Suppose it was all too much for me? And when you hear the doubts rehearsing themselves in your head, that’s your signal to get the support you need.

For me the solution was in finding friends and midwives who built my confidence with their own experiences and knowledge. When a friend affirms, “I nursed both my daughters for two years, no regrets,” then you think, “Oh, if you did, maybe I can too.” “These women chose a completely natural childbirth,” says the midwife with a quiet confidence. And then you find yourself in a deluge of your own tears as you see them birthing, supported by midwives – and then holding their newborns, on the videos and slide shows. You start to believe that maybe you are the agent to birth your baby. You stop seeing yourself as a would-be victim of a painful, unpredictable event. “In these sessions we’re going to learn how you and your birth partner can cope with the discomforts of labour. And these exercises will help your body be better prepared.” Wow! Tears fill your eyes again. This was just what you were looking for!

In addition to birth preparation classes, lactation classes are also available. Lactation classes allow you to explore breastfeeding and build your confidence with professionals who can also assist you during the first 6-8 weeks of nursing baby – when new mums have the most doubts and are most likely to give up.

The first few weeks after birth are usually challenging in one way or another. Resolving as many areas of uncertainty as possible in advance of your precious arrival is a sensible investment.

Breastfeeding By Sheila Kitzinger was the first breastfeeding book I ever read. It's worth ordering on-line. I was blessed to find it in a local bookstore 12 years ago. I couldn't read it without inexplicable tears though. Almost every picture of a nursing baby and mother caused the tears to well!

Breastfeeding By Sheila Kitzinger was the first breastfeeding book I ever read. It’s worth ordering on-line. I was blessed to find it in a local bookstore 12 years ago. I couldn’t read it without inexplicable tears though. Almost every picture of a nursing baby and mother caused the tears to well!

Your Baby and Child by Penelope Leach, tear jerkers

Penelope Leach’s amazing book Your Baby and Child, Birth to Five Years is a must read as birth approaches. It also makes a great baby shower gift. For me, the beautiful pictures provided another source of choking up on tears!

Yet there’s an emotional fortress that you build from real live human support that you can’t get on-line or even from books. Seek it out.

Perhaps in pregnancy we acquire an increased emotional sensitivity for the purpose of connecting both with other mothers and our own babies. So powerful is this sensitivity that you may find yourself feeling connected to mothers and their children everywhere. You shed tears over a mother losing her child to war half the way around the world or for a six year old you never knew personally recently diagnosed with leukaemia.

Later, in the hustle and bustle of parenting your new born, your awareness of this connectedness may fade, but in truth it is one of the most precious lessons that pregnancy teaches us. We are one species and we are connected by sadness and pain, by joy and love, by our common humanity.

This article was first written and published for Fresh Start, the e-magazine of Omo and Best Start. It appears on page 7 of Fresh Start’s August 2013 issue under the title Mummy Matters. Please see the link below in which there are several other articles of interest!

I do thank Mrs. Adepeju Oyesanya for blessing me with the opportunity to share these thoughts and nuggets with my pregnant sisters everywhere. Feel free to share away. Motherhood in all its breath and depth, connects the human spirit like few other things do. We are one in our common humanity and foolish to so easily and often forget our oneness.

The above article has been expanded and edited slightly and all photos are of books from my personal library and were not part of the original publication.