The NHS has been telling new mums to breastfeed in order to lose weight and get back into shape after giving birth. Yes, really.
On its Start4Life website – a programme that supposedly supports pregnant women and new mums – the health service told women about ‘seven things you might not expect when your baby’s born’.
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Number seven on the list was the fact that you might look pregnant for a while after giving birth.
“It can take six weeks for your womb to go back to the size it was, and even longer to lose any extra weight,” the site said. “Breastfeeding is a great way to get your body back, as it burns around 300 calories a day, and helps your womb to shrink more quickly. Also try to eat healthily and take gentle exercise.”
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The advice sparked outrage online after it was shared by London-based writer Maggy Van Eijk, who has a three-year-old daughter and is 38 weeks pregnant with a baby boy.
“Toxic AF from the NHS’s week by week pregnancy guide,” she tweeted ”[Breastfeeding] is not a weight loss tool. Your body never went anywhere – you don’t need to get it ‘back’, it’s just changing, evolving and growing and it will keep doing so until you’re deceased.”
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HuffPost UK contacted the Department of Health and Social Care about the criticism and the wording on the NHS site has now been changed.
Still, it’s worth asking how something like this made it onto the NHS website in the first place.
toxic af from the NHS’s week by week pregnancy guide
😑 BFing is not a weight loss tool
😑 your body never went anywhere – you don’t need to get it “back”, it’s just changing, evolving & growing and it will keep doing so until you’re deceased pic.twitter.com/PoHuVsT8C4
Speaking to HuffPost UK, Van Eijk says she’s found most of the week-by-week guide helpful during pregnancy, but it was “such a shock” to see Start4Life include breastfeeding as a “weight loss hack”.
“It was such outdated language, really steeped in diet culture which new mums especially really don’t need,” she says. “I did breastfeed with my first but it was hard work and I pumped at first because I was so adamant to keep trying. The pumping and feeding became an obsession.
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“Instead of letting go and opting for formula I filled my fridge and freezer with milk. Basically equating the amount I could produce with how good of a mother I was being. It wasn’t healthy and there are so many other signifiers of good parenting we should be showing new mums. Not how you feed your baby and especially not what your body looks like.”
Other women share her view, with many on Twitter pointing out that this “tip” only added to the shame some women feel if they can’t breastfeed.
This advice also contributed to my feelings of being a failure as a mum – I couldn’t breastfeed my baby and we all know ‘breast is best’ and I wasn’t going to lose my ‘baby weight’ – both failures on my part! Still makes me feel v miserable nearly 13 years on!
Not only grim, but breastfeeding is not in my book any kind of way to feel like you’ve ‘got your body back’ even if that was a thing, as you are giving it over to full time food production for a tiny human – it’s setting people up to fail if they are expecting anything else 😬
This always just adds to my feeling of failure for not being able to BF and not losing weight very easily after each of my babies, and I thought they were the ones who were meant to be supporting us!
Hate this BS. You have grown a human inside of you, of course your body will change and that’s perfectly fine. You don’t need to feel bad about it. I was offered a diet plan when I first found out I was pregnant which I firmly declined. https://t.co/ETredhwSHv
Start4Life was initially a Public Health England initiative, which now falls under the UK Health Security Agency (UKHSA). Start4Life content is published on the NHS website, with NHS-branded leaflets also given to pregnant women.
HuffPost UK contacted each of the bodies, as well as the Department of Health and Social Care, for response to the criticism.
A Department of Health and Social Care spokesperson said: “The Start4Life website provides guidance and advice for new and expectant families.
“Our insight has shown that some women find this information helpful, however, we keep the wording of public health initiatives under review, and in response to some of the feedback received we have updated the website today.”
The Start4Life advice now reads: “It can take six weeks for your womb to go back to the size it was. Breastfeeding can speed this process up as it makes your womb contract. Find out more about your body after the birth on the NHS website.”
Still, the response from women is clear: new parents are already under enough pressure to be “perfect mums” and “snap back into shape” after giving birth. The language used by a publicly-funded initiative really does matter.
Keeping a tiny human alive is a huge achievement – it doesn’t matter what size you are or how many packets of biscuits you consume in the process.
Update: This article has been updated to reflect that the Start4Life website has amended its advice.
During medical training, in health textbooks, in posters or at the doctor’s office, we often see health conditions or body parts represented with white figures.
Many of these images seem outdated or inaccessible to large parts of the population. Now, one medical student has taken matters into his own hands.
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Chidiebere Sunday Ibe, 25, from Ebonyi State, Nigeria, began illustrating Black patients, children and babies. Recently, his drawing of a Black foetus and mother has gone viral on Twitter and TikTok, amassing hundreds of thousand views and likes.
The image has clearly struct a real chord with people, especially those not accustomed to seeing their skin tones reflected in standard medical imagery.
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The aspiring neurosurgeon wanted to show people what certain conditions look like for Black people – and also normalise the diversity of our bodies.
For some people, it was the first time they’d seen a Black foetus and many called for more representation like this.
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When we spoke to Ibe about his illustrations, he told HuffPost UK: “This image was created like every other image, I never expected it to be viral. The whole purpose was to keep talking about what I’m passionate about – equity in healthcare – and also to show the beauty of Black people.
“I feel great seeing it going viral, I never expected it and it feels good that the message is out and it will challenge current systems.”
Ibe points out that we need to see more images like this, and more people behind the scenes creating them.
“We don’t only need more representation like this, we need more people willing to create representation like this, this would help make such images more accepted,” he says.
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Chidiebere Ibe
Chidiebere Ibe is an aspiring neurosurgeon.
For Black people working in healthcare, seeing Ibe’s images has meant a lot – it’s not often they see their race reflected in the industry. Rebekah Agboola, a 27-year old nurse from London, says the picture made her do a double-take.
“The image was shocking,” she tells HuffPost UK. “I’ve never seen a Black baby in an image like this before – it makes you take a second look. It shouldn’t be shocking as it’s a simple medical illustration. However, having started my journey into this world as a sixth form student looking at medical images, I didn’t commonly see illustrations of Black and brown people unless it was something to do with skin conditions and even then it was rare.”
Agboola says such illustrations go beyond representation to having a positive impact on people’s health and wellbeing.
“I think that it is important to make sure that there is more representation because it will greatly improve the treatment of our patients,” she says.
In August 2020, as part of Black Ballad’s weeklong takeover of HuffPost UK, Black women spoke out about the discrimination, microaggressions and substandard care they received during pregnancy, shining fresh light on the findings of a major motherhood survey, also conducted by Black Ballad.
“Routinely, Black and other minority patients do not receive the same care due to initial symptom presentation and if it is made clearer that our symptoms can sometimes look different and that clinicians need to give their examinations more thought we can help reduce this issue,” Agboola says.
“This picture shocked me but I was so glad to see it and want to see more.”
Rebekah Agboola
Rebekah, a nurse, has never seen an image like this before
Since the release of Ibe’s pics, the Royal College of Midwives (RCM0, has also said it will be amping up efforts to diversify.
Jane Bekoe, the RCM lead on its Race Matters programme, told us: “Positive representation of race is important in all aspects of our lives and society, because the world should reflect accurately all the people living in it. This applies just as much to portrayals of Black and minority ethnic people within healthcare, so illustrations such as this are a positive and necessary step forward towards real equality for us all.”
The RCM is working to ensure changes happens, Bekoe added, following its first celebration of Black History and Culture Month this year. In January 2022, it will hold a webinar on decolonising the midwifery curriculum, which will be led by the RCM’s student midwife forum.
In 1994, one of Rwanda’s darkest moments in history took place – a genocide that saw the death of 1,100,000 people – of which 800,000 people were Tutsi, an ethnic group that were minorities in comparison to the majority Hutus.
At the time, Alice Musabende was 13-years-old. Her parent, grandparents, and siblings all died during the war. The now mum-of-two had only a few surviving members of her family; her aunt, uncle, and their kids. In 2005, as part of her studies, Musabende left Rwanda for Canada, building a life for herself; she married (but has since separated), and had two precious boys.
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She began working as a journalist and academic, later moving to the UK to work at the University of Cambridge. But despite her writing and hours of research into what happened, Musabende found it almost impossible to articulate the reality of the violence which was unleashed on her people.
“I have spent so many hours, countless of times, writing and reading and trying really to capture the magnitude of the horror. And I still haven’t,” she tells HuffPost UK.
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Now, her two children, aged five and eight, have questions about their grandparents, their home in Rwanda, and how their mother feels about it all.
So, in an attempt not to “run away from her demons”, Musabende had to find a way to voice the unspeakable horror she endured at such a young age. Which is how she began making a radio show with the BBC to start the story.
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In Unspeakable, Musabende asks for help and guidance from other genocide survivors, second-generation holocaust survivors, a therapist who works with AIDS orphans in South Africa, and a publisher of stories in Rwanda.
She explores identity, generational trauma, and the place of storytelling and with the help of these other voices, she tries to piece together the answer to one fundamental question: how do I tell my kids about my trauma?
Alice Musabende
Mum-of-two Alice Musabende is figuring out the words to explain what happened in Rwanda 27 years ago
Firstly, says Musabende, she has had to come to terms with her own past.
“For the last 20 years, I’ve focused so much on me,” she explains. “I’ve done therapy, I tried to figure out how to live with PTSD, to understand how I will actually live a life without family, without anyone. I thought I was really getting a good handle on it. Then I moved here and in the middle of trying to reconfigure being a single parent and my work, I remember just one day thinking, ‘Oh no, I’m going to have to tell the boys about the genocide.’
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“That bit was way more complicated than anything else I have done, mainly because the story of the genocide, for me, is extremely painful, but I think it’s painful for all the other survivors as well. Because I’ve spent so many years trying to run away from it, it was so hard.”
Growing up, Musabende was aware of the ethnic persecution of her Tutsi people – her family members had been arrested on suspicion of being part of rebel forces, and her granddad’s land had been seized.
After travelling to Ottawa for her graduate studies, Musabende recognised signs of PTSD in herself. She explains: “In school I couldn’t really function. I had a really difficult transition, I did so many things that we now associate with post traumatic stress disorder but at the time no one told me what it was.
“It wasn’t until I started different forms of therapy to make sense of what I was going through. Through those sessions, I wanted to find the essence of who I was, I wanted to be okay. I wanted to have joy, and I wanted to be able to use my brain to serve, to study and perhaps maybe even teach.”
In 2017, Musabende went back to Rwanda for the first time. Two years later, she took her two sons to show them where their family came from – so they could understand the great beauty, as much as the trauma, of her birthplace.
“I remember arriving in Rwanda and looking at these tiny humans and thinking, ‘This is their home, but I don’t know if they know that this is their home as well.’ That’s when things just started percolating in my head, I was like: ‘How do I do this, what do I say?’ She took her eldest boy, six at the time, to where her house used to be – now just a plot of land since it was destroyed in the genocide.
“I told him that’s where my home used to be and that’s where my brother and sister used to live. We were walking on this plot, he looked down, saw a piece of cloth, picked it up and said, ‘Do you think this was your sister’s dress?’ And I hadn’t seen that one coming. It was a bit of a struggle but I couldn’t cry.
“My words just left me. That’s when I realised he has questions. He has real questions where he’s trying to figure out where he fits into a story that’s so obscure and mysterious to him.”
Alice Musabende
Alice has since taken her children to Rwanda to show them the country
And Musabende had questions of her own, which is how the documentary came about. “I couldn’t write about it,” she says. “I don’t know how to write about it, so I thought to just ask people what they think.”
She was terrified. “I thought, ‘Oh, am I traumatising my children by telling them these horrible things?’ Previously I’d thought it’s best not to say anything as you don’t upset them. But I know that they want to know. They’re not asking tough questions. Their questions are like ‘Do you miss your mum?’ or ’Do you think your mum would have loved me?’Those things are so difficult because they send you right back to that place where you wish you didn’t have to go.
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Unspeakable is Musabende’s attempt to bridge the gap between that place she has avoided for the past 27 years “and the place I am in now, as a parent hoping to raise healthy, well-grounded, empathetic children.”
Alice Musabende
Alice’s radio show Unspeakable comes out today
It’s not just genocide she has to talk to her children about. By virtue of being a mother to two young Black boys, Musabende knows that she will become accustomed to difficult conversations.
“Raising Black boys in a western culture that’s always telling them so many things about them that are false, it’s an even bigger responsibility to tell them about where they come from, what happened to them and tell them exactly who they are, so that when they get out there, they know in their hearts that they’re valued, that they are loved, that they are cared for.
“It is my job to tell my kids who they are. I haven’t quite figured out how to tell them the full story of my history so you’ll see in the documentary, I’m still learning, it’s a long journey.”
Unspeakable airs on BBC Radio 4 on Fridays and is available on BBC Sounds.
Approaching conversations about trauma
Alice Musabende wants to share the following advice for fellow parents.
First of all, accept you don’t know how to say it all
“That realisation that I don’t know how to talk to my children was the beginning of my quest because for a very long time, I just pretended that it wasn’t there. Once I sat down and I thought, ‘I know I have to, and I don’t know how,’ that was the beginning.”
Find a safe space to make sense of the trauma yourself
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“I wouldn’t have been able to have this conversation five years ago. I had to do so much of my own work in self-healing, therapy, in figuring out how to listen. It took me so much time to get here.”
Seek guidance, talk to others who might understand
“You’ll be surprised about how many people are struggling to address these serious issues with their children. There are parents everywhere trying to figure out how to say things.”
Know that the conversation is hard but important
“You can’t just focus on the fact that you are transmitting trauma. You also have to know that by processing things, by seeking to figure out what the appropriate language is, you’re also ensuring that your kids will be more resilient, because you are being more resilient.”
Celebrate yourself for all that you’ve overcome
“We often forget to celebrate our resilience but ultimately, we should really look at ourselves and think, ‘We are here. We made it. We have children and they seem somewhat okay.’ That’s a win for me.”
Useful websites and helplines
Mind, open Monday to Friday, 9am-6pm on 0300 123 3393.
Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI – this number is FREE to call and will not appear on your phone bill).
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CALM (the Campaign Against Living Miserably) offer a helpline open 5pm-midnight, 365 days a year, on 0800 58 58 58, and a webchat service.
The Mix is a free support service for people under 25. Call 0808 808 4994 or email help@themix.org.uk
Rethink Mental Illness offers practical help through its advice line which can be reached on 0808 801 0525 (Monday to Friday 10am-4pm). More info can be found on rethink.org.
One in four women who experience a severe injury during birth regret having their child. It’s taboo to admit, but with more than 600,000 women giving birth in England and Wales alone each year, we need to talk about this.
A new survey of mothers affected by birth injuries lays bare the physical and psychological impact on women, which can last years into their child’s life.
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The overwhelming majority (85%) of mothers who suffered severe injuries say their experience damaged their relationship with their child, with 14% saying this harm was permanent. One in three (34%) said they saw their child as the cause of the injury while, heartbreakingly, three in 10 (31%) thought their child would be better off without them.
The research, from birth injury charity The MASIC Foundation, surveyed 325 women who self-identified as having suffered severe perineal trauma when giving birth. The sample size may be small, but the research adds to growing concern about women’s health outcomes after giving birth in the UK.
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While it’s important to acknowledge that millions of women around the world give birth each year without problems, it’s equally important to say this isn’t always the case – and women are increasingly talking about their negative experiences and demanding better care.
HuffPost UK has previously reported on the gaps in NHS postpartum care that widened during the pandemic. In a separate survey of mums, the majority (91%) said they were not given enough advice during pregnancy about postpartum recovery.
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We also know that Black women are five times more likely to die during childbirth than white women. A controversial proposal to tackle this – inducing labour at 39 weeks for pregnant black, Asian and minority ethnic women as a matter of course – has been called “racist” by some doctors and midwives.
In the latest research, 78% of women surveyed said they have traumatic memories of birth and 52% said they face embarrassment due to symptoms of their injury.
Estersinhache fotografÃa via Getty Images
This rings true for Catherine*, who had a prolonged labour following induction with her son, which then required an episiotomy and ventouse (vacuum delivery).
She had a third-degree tear (defined as a tear that extends into the anal sphincter), but it was initially misdiagnosed as a second-degree tear, meaning she wasn’t offered the correct treatment. Her undiagnosed injury left her in too much pain to sit down or attend mother and baby groups, leaving her “essentially house-bound” for her maternity leave. After a year – and hitting a brick wall with the NHS – she accessed help at a private clinic.
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The damage has been permanent, though, and she’s still prone to toilet urgency and accidents. Catherine now carries pads, wipes, Imodium and spare underwear everywhere she goes. She quit a job she loved as she was struggling to manage her condition, and has been diagnosed with PTSD.
““My confidence, my me-ness, the essence of who I am, has been destroyed.”
– Catherine, 44, Bristol
“My confidence, my me-ness, the essence of who I am, has been destroyed,” says the 44-year-old, from Bristol. “My relationships with my child and my partner have suffered.”
Catherine has struggled to talk to friends about her experience – or even watch programmes when childbirth is mentioned – and has counselling each year in the run-up to her son’s birthday.
“With my son, I love him dearly, he is the best thing in my life, but his birth caused the injury and it is difficult to square the two,” she says.
“Every year I dread his birthday and the reminders of my traumatic experience. It is not fair on him or on me – his birthdays are not a happy occasion, but every year I have to pretend it is.”
While her partner has been understanding, Catherine says “he also carries his own guilt about what happened”. Their physical relationship has also been impacted hugely. “I feel like a shell of my former self at times,” she adds.
Like Catherine, 69% of mothers surveyed said the impact of a birth injury was both physical and emotional. Almost half (45%) said they have had postnatal depression as a result and 29% said it has affected their ability to breastfeed their baby, with 18% stopping earlier than planned.
Elizabeth*, who now has a 10-year-old daughter, describes the period after birth as the “worst time of [her] entire life” and is still impacted by her birth injury a decade later.
Aged 30, she had a fourth-degree tear (a tear that extends further into the lining of the anus). Six days after delivery, she passed faeces vaginally and was in extreme pain. She was then readmitted to hospital and found to have a recto-vaginal fistula, causing an infection in her vagina and bowel.
““I am ashamed to say that at times I wished I had never become a mother and I grieved for the life I had before.””
– Elizabeth, 40, Hampshire
Although she’s had further treatment, she still experiences rectal incontinence, which has affected her ability to socialise and work. “I often avoid eating out as this stimulates my bowel,” says the now 40-year-old, from Hampshire. “I always need to know where the toilets are.”
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Her birth injury meant Elizabeth was forced to give up her beloved hobbies of horse riding and swimming. For a long time, she was in too much pain to even walk her dog. “I am ashamed to say that at times I wished I had never become a mother and I grieved for the life I had before,” she says. “I paid such a high price to have a baby.”
Jen Hall, a MASIC spokesperson, is sadly unsurprised by Catherine and Elizabeth’s stories, after having a “brutal forceps delivery” that left her with physical and psychological damage herself.
“Nobody warns you that having a child can leave you with life-changing injuries and no woman should have to go through this without support and proper medical care,” she says.
Most of these injuries are “entirely preventable”, she adds – the result of something going wrong during birth or a failure to identify risk factors beforehand, according to MASIC. The charity is calling on the government and the NHS to roll out a programme of training for medical professionals.
The Obstetric Anal Sphincter Injury (OASI) care bundle – a package of training which has been praised by the Royal College of Midwives – has been trialled in 16 maternity units across the NHS and is being extended to a further 20, but this still leaves three in four (76%) maternity units yet to be reached.
The charity is calling for it to be rolled out nationwide. They’ve also set out a seven-point plan for better care, calling for:
Improved identification, diagnosis and treatment of birth injuries in the NHS.
An education programme for obstetricians and midwives so that severe injuries are recognised at birth and treated in line with best evidence.
A primary care education programme so that all women are asked at contacts following birth about signs and symptoms of OASI/incontinence, with appropriate referral pathways for those with symptoms in line with the NHS long-term plan.
Information about the risks of OASI given to all women antenatally.
Women’s concerns to be listened to and not dismissed as “normal” postnatal experiences.
Specialised psychological treatment and support for women after OASI injury and an end to the stigma and taboo of talking about these injuries.
Dedicated OASI clinics nationwide.
HuffPost UK has contacted NHS England and the Department for Health and Social Care for a response. We’ll update this article if they provide a statement.
Without change, women like Catherine do not feel like they can have a second child. “I feel like I was someone the birth just happened to,” she says. “At the time I was happy to place my faith in the medical professionals dealing with me; I had no reason not to. Whilst birth is normal, natural and inevitable, and women’s bodies are designed to do it, unfortunately as we all know it isn’t always that simple. The people who were meant to help me through it let me down.”
• Surnames have been omitted to offer anonymity to interviewees.
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Useful websites and helplines
Mind, open Monday to Friday, 9am-6pm on 0300 123 3393.
Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI – this number is FREE to call and will not appear on your phone bill).
CALM (the Campaign Against Living Miserably) offer a helpline open 5pm-midnight, 365 days a year, on 0800 58 58 58, and a webchat service.
The Mix is a free support service for people under 25. Call 0808 808 4994 or email help@themix.org.uk
Rethink Mental Illness offers practical help through its advice line which can be reached on 0808 801 0525 (Monday to Friday 10am-4pm). More info can be found on rethink.org.
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