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The most important piece of advice I received while pregnant did not come in the form of a well-intentioned Google spreadsheet, though there were a lot of those. Instead, it came from a stranger, an Australian woman who approached me after I had done some public speaking late in pregnancy. Her advice wasn’t about how many muslin swaddles to buy, or what to wear in the delivery room — though I had been thinking a lot about both those things. Instead she had a highly specific suggestion about something I had hardly thought about at all, beyond knowing I wanted to do it: breastfeeding.
“Get Midwife Cath’s book,” the woman told me, with an urgency I couldn’t yet understand. “My daughter followed her BBB plan and was getting six hours sleep a night from the get-go.” Sleep deprivation was what I had specifically feared about motherhood. So even though six hours didn’t sound that miraculous, I did as she said and ordered The First Six Weeks, by Midwife Cath (a.k.a. Cath Curtin).
Cath is a midwife, but she is also a gifted marketer. She enjoys a reasonably high profile in Australia, as midwives go, for tending to football WAGs and their babies. There is a Midwife Cath podcast. And her signature recommendation has its own neat initialism, BBB, which — surprisingly — has nothing to do with breasts, but rather stands for Bath, Bottle, Bed.
Cath, you see, wants new mothers to sleep, which is hard when babies wake up demanding to have their golf-ball-size stomach filled every 90 minutes. Under an exclusive-breastfeeding regimen, there’s only one person who can meet that need, a connection weirdly hard for me to grasp in the abstract. Cath proposes that from the moment mother and baby arrive home from the hospital after giving birth, and for six weeks thereafter, another person should give the baby a bath and a bottle of formula at 10 o’clock at night so Mom can sleep for an uninterrupted stretch — maybe even the six hours I was promised.
Cath has her original name for this routine, but you might know it simply as supplementing. Topping off breast milk with formula is not a new idea, especially for mothers of multiples or premature babies, or for women who have struggled with milk supply. And when I started talking to friends, I discovered plenty of them had chosen to do some amount of it. But The First Six Weeks was the only parenting book I came across which gave women permission to do so for the sake of their own well-being.
Still, the World Health Organization and the American Academy of Pediatricians advise exclusive breastfeeding for the first six months of an infant’s life. Plus, most books, including canonical ones like What to Expect in the First Year, make even one bottle a day sound like a last resort — a desperate measure capable of impacting a mother’s milk supply. Cath maintains that in treating thousands of women over four decades she has seen a “caloric top-up” of one bottle a day make no difference either to the baby’s development or a mother’s milk supply. But as I began faithfully BBB-ing, and enjoying a good night’s sleep in the process, I wondered about just how important that word “exclusive” was.
Confessing a bottle-a-day habit to my child’s pediatrician, she shrugged, told me it was fine, and moved onto the next part of the checkup, which concerned congested sinuses. Seeking further reassurance, I ran the BBB idea past Dr. Amanda Van Pelt, an attending physician at the Children’s Hospital of Philadelphia. “I see more formula supplementation in babies who need the calories for growth, not so much that Mom can get extra rest,” she said. She seemed, if anything, a little bewildered by the notion of optional supplementation. But with the caveat that she hadn’t come across any specific studies, she didn’t see anything wrong with it. “One bottle of formula is not going to be harmful to the baby.” What about the harm to breasts in sleeping for six hours straight that early on? Her response was reassuring: “Your breasts will not explode.”
Van Pelt’s one concern was that the optional bottle supplementation would create a “slippery slope,” where a BBBer would abandon the breast. But that seemed unlikely. After all, in my experience, American hospitals do a pretty good job of emphasizing the health benefits of breastfeeding. (The structural impediments against breastfeeding in the U.S., not least of which is a nonexistent national parental-leave policy, are for another day.)
While BBB worked well for me and others, Cath’s animosity to pumping might be confusing to some readers. At one point in the book, she vaguely links pumping with mastitis, and at another, dismisses it as “joyless.” (Are all parts of mothering expected to be joyful?) But for the most part, I loved the routine: Six hours of sleep made me a more present mother when awake, and my husband was glad to have found a way to be more actively involved. (“I feel less useless,” was how he put it.) BBB was, in short, a win-win, which made those first few weeks calm in a way I didn’t think possible.
Cath, whose full name is Cathryn Curtin, was not surprised to hear of my positive experience when I called her recently. (They say never meet your heroes, but Cath was the warm, no-nonsense midwife of my dreams.) “Women need a physical and emotional break from the baby,” she said. “BBB takes the pressure off and encourages women to breastfeed for longer.” Before publishing her book in 2016, Cath was nervous about the reaction from colleagues about using the f-word: formula. “I took a deep breath and thought, I’m experienced, I’m confident, I’m going to do it. Formula is food.” She received pushback. “How long have you got?” she said, when I asked for examples. “All I want to do is formula feed. I’ve probably never breastfed. I don’t understand breastfeeding. It’s all untrue, by the way.”
I was curious about Cath’s journey, detailed in the book, from a self-described “breastfeeding radical” to a pragmatic advocate of supplementation. She said that when she trained as a nurse in Melbourne in the ‘70s, breastfeeding was seen as a fringe, hippie thing. (My mother, who gave birth to me in the early ‘80s in Paris, was told by the French doctors that breastfeeding was a bad idea because of what it would do to the look of the décolletage.) Cath found herself rebelling against the norm in hospitals at the time, which was to have babies sleep in a nursery the first three nights, where they would be fed formula, to enable mothers to get some rest. What was wrong with that system, I wanted to know. “Oh, absolutely nothing,” she said with a laugh. “In hindsight I think it was very sensible, and I think the babies actually breastfed better.”
Over time, she came to believe that the toll inflicted on mothers pressured in the early days to exclusively breastfeed wasn’t worth it, and that providing the option of a bottle can lead to women feeling able to breastfeed for longer. “There’s so much fear around breastfeeding these days,” Cath said. “That it’s going to go somewhere, or that we’re going to lose it. But our bodies want to keep our babies alive. It’s primitive.”
Looking back on the first six weeks now, it makes implicit sense to me that one feed a day from a bottle would probably not have derailed my long-term breastfeeding goals. But everything seems heightened during that period, every decision a fraught one. And, to make matters worse, so many of the experts seem to preach an all-or-nothing approach.
Does Cath think that perhaps the pendulum has swung too far — that in talking up the undeniable benefits of breastfeeding for baby’s development, we are forgetting that mothers have their own human needs? “Put it this way,” she said. “Someone accused me when the book came out of caring about the mother’s health. Of course I care about the mother’s health! If a mother is well rested and feeling good about herself, her baby is going to thrive.”
Cath sighed, preparing to state something which she clearly thought should be obvious. What I got was a koan which could apply to life beyond breastfeeding: “If we can let a little bit go, everything works a little bit better.”
Midwife Cath’s new book, After the First Six Weeks, is available from Allen & Unwin.