The uncomfortable conversations about birth

Almost everything on this page is something people whisper about. Enemas. Elective caesareans. Pills that stop milk. The bottle given quietly on the second night. The fact that breastfeeding at night is genuinely harder than the alternative, and that saying so out loud feels like a betrayal.

Each of these carries a ready-made verdict — usually delivered by someone who was not in the room. This article is not a list of correct answers. It is an attempt to explain what these practices are, why people do them, what the evidence actually says, and where the criticism deserves to be questioned rather than repeated.

Two rules for reading it. First: understanding a choice is not the same as recommending it. Second: nobody makes these decisions in a laboratory. They make them tired, in pain, on a ward, with a partner who is frightened and a clock on the wall.

The enema before birth

For most of the twentieth century, an enema was routine on admission to a labour ward, along with shaving. The reasoning was tidy: an empty bowel means a cleaner birth, less infection, more room for the baby''s head, and — unspoken but real — less embarrassment for the person giving birth.

Then it was studied. Reviews of randomised trials found no meaningful reduction in infection for mother or baby, and no shortening of labour. Routine enemas were dropped from guidelines in most of Europe, including the Netherlands. What remains is a choice.

And here is where the criticism gets lazy. "Enemas are outdated" is true as a policy. It is not automatically true as a personal decision. A lot of people ask for one, or use one at home in early labour, for a reason that no trial measures: the fear of soiling themselves in front of strangers. That fear is not vanity. It can keep someone from pushing properly, from relaxing, from letting the reflex do its work. If removing it helps someone feel unguarded, that is a physiological argument, not a cosmetic one.

The honest position: not medically necessary, not harmful when done gently and early, and entirely reasonable as a comfort decision. What is not reasonable is a hospital doing it to you without asking.

Choosing a caesarean without a medical reason

This is the one that reliably starts an argument. A planned caesarean with no obstetric indication — sometimes called maternal request — is legal and available in many countries, uncommon in the Netherlands, and heavily judged everywhere.

What it actually involves: major abdominal surgery, a longer recovery, higher risk of bleeding and infection, implications for future pregnancies, and a baby that misses the squeeze of the birth canal and the first pass through the vaginal microbiome. Those are not moral objections. They are trade-offs, and they are real.

But the criticism almost always stops at "you should have tried." It rarely asks why someone would choose it. The usual answers, when people are asked properly:

• A previous birth that went badly, or a previous caesarean.
• Sexual trauma, where an examination is not a small thing and a room full of people is not a neutral setting.
• A specific and researched fear of severe tearing and long-term incontinence — a risk that is genuinely under-discussed in the other direction.
• Tokophobia: a clinical, disabling fear of childbirth, which is a diagnosis and not a mood.
• The desire for a known date, in a situation with no family nearby and no second adult on standby.

Some of these are things good care can resolve. A continuous midwife, an honest conversation, a debrief of the previous birth, treatment for the phobia — these change minds far more often than disapproval does. Others are not resolvable, and the person still has to give birth somehow.

What deserves defending is the principle underneath: informed refusal. Someone who can refuse a caesarean can also request one. A body you are allowed to say no with is a body you are allowed to say yes with. The work is making sure the yes is informed, not making sure it is unpopular.

Pills to stop the milk

Cabergoline — and historically bromocriptine — suppresses prolactin and shuts down milk production. It is prescribed after a loss, when a medication is genuinely incompatible with feeding, when someone is not going to feed and wants to avoid days of engorgement and the risk of mastitis, and sometimes simply because someone asks.

The reflex reaction is that this is a betrayal of something natural. Sit with the situations instead. A stillbirth, where milk arriving on day three is a physical announcement of an absence. Someone who is not going to feed and is facing a week of hard, hot, painful breasts while also caring for a newborn. Someone whose treatment cannot pause.

There is also a quieter version: a mother who has decided to stop and is told to just let it dry up on its own. That works, slowly, and it can also mean blocked ducts, fever and infection. Neither route is a character test.

The legitimate criticism is narrower and worth keeping: these pills are sometimes offered before anyone has asked whether feeding was wanted, or offered as the fast option when what was needed was help with a painful latch. The problem is not the medication. It is a decision made on someone''s behalf.

Early formula, and how supply actually works

Milk production is demand-led. Milk removed is milk made; milk left in place sends the opposite signal, through a local feedback protein and through prolactin patterns that respond to how often the breast is drained. This is why the story people tell — "the first bottle started the end" — has a real mechanism behind it, not just guilt.

The sequence is familiar and it is not anyone''s stupidity. Night two, the baby feeds constantly because that is exactly what builds the supply. Someone concludes the milk is not enough. A bottle appears. The baby sleeps a stretch. The breast is not drained during that stretch. The next day there is slightly less, the baby is fussier, another bottle follows, and the loop closes. Within a week the supply matches the reduced demand, which is the system working correctly on incorrect instructions.

Where the criticism goes wrong is in treating this as a moral failure. Nobody in that story did anything unreasonable in the moment. What was missing was information at the right hour: that cluster feeding on night two is the mechanism, not a malfunction; that a small stomach is meant to be filled often; that if supplementing is needed, keeping the breast stimulated in parallel usually protects supply.

And formula deserves its due. It exists because babies died without it. When it is medically needed, or when someone has decided, it is food. The useful conversation is about how it is introduced and whether the choice was informed — not about whether the person using it should feel bad.

Yes, breastfeeding at night is harder

This is the one people are least allowed to say. Feeding at the breast at night is, in the plainest terms, more work for one specific person. It cannot be handed over. It does not come with a shift system. Waking to feed several times a night for months is a real cost, and pretending otherwise helps nobody and quietly pushes people towards stopping when they did not want to.

What is worth putting next to it, honestly:

• Night milk is not the same as day milk. It carries more of the compounds involved in sleep signalling, which is part of how a baby''s rhythm settles.
• Night feeds are a large part of what maintains supply, because prolactin runs highest in those hours.
• Sleep studies comparing feeding methods generally find much smaller total-sleep differences than the exhaustion suggests. The difference is often in who is awake, not how much sleep the household gets.
• Most of the practical relief comes from arrangements, not from stopping: safe bedsharing where the criteria are met, a side-lying feed, a partner who does everything that is not feeding, and a firm reduction of daytime obligations.

None of that cancels the cost. Both things are true: it is harder, and it is worth understanding before deciding it is unsustainable. Someone who stops because it was genuinely unsustainable has made a decision, not a mistake.

The rest of the whispered list

Short entries, same principle: know what it is, know the trade-off, question the reflex.

Induction on request. Guidelines now support offering induction around 39 weeks in some settings, and the old assumption that it automatically leads to a caesarean has weakened. It also means a labour that starts on someone else''s signal, usually with more monitoring and less mobility.

Epidurals. Very effective pain relief with an honest list of trade-offs: less mobility, more monitoring, sometimes a longer pushing stage. "You''ll regret it" is not a clinical argument. Neither is "just take it" from someone who wants the room quiet.

Episiotomy. No longer routine, and correctly so. Still occasionally the right call in the moment. The reasonable demand is that it be discussed rather than performed silently.

Sweeps and examinations. Small interventions that are often described as though they are nothing. They are not nothing. You can decline them, and asking what one is for is a normal question.

Not feeling anything at first. Bonding is not always instant. The delay is common, it is not evidence of a defect, and it is one of the strongest signals that someone should be asked, gently, how they are actually doing.

What happens to the body afterwards. Leaking, prolapse, pain during sex, hair loss, a stomach that does not go back. All common, all treatable or at least addressable with a pelvic physiotherapist, and all discussed far too late.

"When should you stop?"

Breastfeeding. Co-sleeping. Carrying. Rocking to sleep. Sooner or later someone asks when it ends, usually in a tone that suggests a deadline has already passed.

There is no deadline. There is no age at which a child who is still feeding or still sleeping close becomes a problem. The guidance that exists is a floor, not a ceiling: health bodies recommend milk alone for around the first six months and continued feeding alongside food for two years or beyond, for as long as both mother and child wish. That last clause is the whole rule, and it is the part that gets dropped.

Anthropologically, natural weaning in humans lands somewhere in a wide range of years, not months. Culturally, the "acceptable" age moves by decades and by country. Anyone quoting a specific number is quoting a fashion.

So the honest answer is that three things decide it, and none of them is a calendar.

What the child wants. Children do stop. Usually gradually, usually unevenly, often with a regression during illness or a big change. A child who still needs it at two is not behind; a child who loses interest at eleven months has not been failed.

What the mother wants. This is the one people skip. It is her body, her sleep, her nights. Wanting to stop is a sufficient reason to stop — not something that requires a medical excuse. Wanting to continue is equally sufficient, and does not require a defence either. Both are decisions, not verdicts.

What support exists. This is where the father, or the second parent, actually determines the outcome. Almost nobody stops because feeding itself became impossible. People stop because everything around it became impossible: no one taking the night that is not a feed, no one making food, no one holding the older child, no one saying out loud that this is work. The support available is not a background detail — it is one of the three inputs, and it is the only one anyone else can change.

The same applies to co-sleeping. Where the safety criteria are met, sharing sleep is a normal arrangement across most of the world and across most of human history, and there is no age at which it must end. It ends when it stops working for the people in the bed — sometimes because the child moves out on their own, sometimes because a parent needs the space back. Both are legitimate, and either can come first.

If a decision is coming, the useful questions are small and practical: is this a hard week or a settled pattern; would one changed thing — one uninterrupted stretch, one meal cooked, one fewer obligation — make it sustainable; is the pressure coming from inside the household or from a comment made by someone else. Then decide, and let the answer be yours.

Why we published this

Frogwise is meant to be a place where recommendations come with their reasoning attached. That has to include the subjects where the reasoning is uncomfortable, because those are precisely the ones where people are handed a verdict instead of an explanation.

Criticism is not the enemy here. Some of these practices genuinely were dropped for good reasons, and some of them are still done to people rather than with them. But criticism aimed at a person, after the fact, with none of the context, is not information. It is noise, and it lands hardest on someone who has just had a very long week.

Ask what a thing is. Ask what it costs. Ask who benefits from the way it is usually framed. Then decide — and let other people decide too.

This article is general information written by parents, not medical advice. For your own situation, talk to your midwife, obstetrician, GP or a qualified lactation consultant.