Bf counsellor - how to be a good one?(48 Posts)
I qualified as a bf counsellor in the last month and am very excited about hopefully starting to help people.
What do you think makes a good bf counsellor?
If you had a really good bf counsellor why were they excellent?
What should I avoid doing?
Any tips greatly appreciated - I want to avoid as many pitfalls as I can.
Thanks for that McBaby - I think you have some really good advice there.
Agree with a lot of what has been said already. Definitely don't make ff out to be 'bad' - I felt so much better when feeding my first to know that if it all went wrong, there was still a perfectly good baby-feeding method available.
The other thing I would say is, always call/visit when you say you will! This sounds ridiculous, but with both my babies I had phonecalls promised that never occurred. Combined with the midwives and HVs agreeing one day/time and then visiting at another, this was veryaannoyed and left me feeling like they didn't really care.
Warn mum about cluster feeding and reassure her that it doesn't last forever
Listen to what mum tells you and don't dismiss concerns "the attachment looks fine" when it's not and is uncomfortable
Don't promote the positions that worked best for you when bf - look at and listen to the mum and find what will work best for her
Pay attention and if she has eg unusually large or odd shaped boobs help her adapt the usual poses to work for her
Don't bang on about BN or advanced bf techniques (bf in sling, bf in bath!) when a mum is just struggling to get baby to latch to start with!
Hth - well done on qualifying, it is a great vocation to take up, I hope it will be v rewarding for you!
Cakes that is really interesting about knowing there was the ff option - that it helped you carry on bf for longer. I think you are absolutely right about turning up - I remember waiting for mw appointments and as getting dressed was such a challenge it was very frustrating when no one came. Sorry to hear you had the same
Any more thoughts anyone has would be very gratefully received!
Meringue thanks so much for that good advice. I can see bf in bath is daunting at first - I remember thinking even getting into the bath with my pfb was the greatest challenge.
And you are so right about positions. Neither Rugby ball nor cross cradle ever worked for me and neither did bn, but they will be great for many mums.
When I first started bf I was in hospital with a baby just out of neonatal unit who'd been tube fed. I had all sorts of more talky, back seat approaches, though ultimately ruined by a fairly spiteful nurse. In the end a fairly old school midwife helped me in a very physical way. I was so fed up of the long delay to get to be with my baby properly and be able to feed together, and wanted out of the hospital so we could just be together, I found her approach wonderful. She basically latched the baby on for me, plenty of grabbing my boobs, attaching baby, plenty of feeling like a cow. I wouldn't have thought I'd appreciate that but at that moment it was exactly what I needed. I was desperate to get to 'normality' and wanted over that hump fast. It worked, baby still exclusively breast fed at 6 months although that also took plenty of bloody mindedness to counter various hospital attempts to undermine it. I mention it as I subsequently realised hers was an old school approach but I don't think it should be ruled out. Of course it could also be hugely off putting in many situations.
Listen to the mother and what she wants, that may not actually be ebf, possibly mixed feeding, or pumping, let her talk it through and she will come to her own decision without feeling pressured, and then give her the information which will help her to keep giving her baby breastmilk for as long as she wants. acknowledge her feelings about what she is finding hard about breastfeeding, and work towards a solution that is workable for her and her family situation.
Know all the signs of a baby in trouble, a jittery baby with a high pitched scratchy cry who is sleeping lots may have low blood sugar and need help from a hcp. Likewise crusty lips, sunken fontanelle for dehydration, look for excessive jaundice etc and refer appropriately.
Know how to spot tongue tie.
Never judge or be judgemental, there is no right and wrong way to feed a baby as long as its not harming the baby the mother should do what she feels most comfortable with, women instinctively want the best for their babies.
Also know the signs of pnd and refer to hv/mw for help. I never used to mention to the mother that I thought she had pnd, I would call the midwife after the visit and mention that I thought the mum was a bit down and ask her to keep an eye on things.
Bf counselling can be tough sometimes as you can see health problems but because you aren't a hcp you are very limited in the help that you can give and obviously can't diagnose or prescribe.
One thing I do know is that women who are given confidence and information to make their own choice often feel happier with that choice and don't suffer from the guit aspect which often triggers pnd.
Agree with what has been said already. Rookie you sound like a great listener so I have no doubt you'll be a great bfc.
I remember a dreadful bfc who came to me in hospital when I had DD1. I realise I should be grateful for any kind of support really especially from a volunteer but this lady really upset me. She was very militant, wearing a lanyard with the repeating slogan "Breast feeding is best feeding". She told me she thought it was only a matter of time before a person sued in the Court of Human Rights for not being bf as a baby. Now that sounds bonkers but at the time I was hormonal as hell and I lapped it up. She told me that DD was lazy, and when we were readmitted to hospital one week later with a very dehyrdrated jaundiced baby she said "oh, I knew I'd see you back <due to her feeding problems>" yet she had never said to me when I should seek medical help (ie a floppy yellow newborn sleeping 8 hours without food). I was utterly gutted, I can remember every conversation we had and yes! She was another one who picked up my baby without permission and also lunged in to grab my tit to move or squeeze it without warning. She also had bad breath (sorry).
Fortunately with DD2 I had a lovely bfc who understood that I was so wrecked that I couldn't remember long lists of instructions and jotted notes for me! She was also gentle and admired my baby and talked to me as though I was special rather than just one in a long trail of women who needed cajoling into bf that day. Remember the women you are dealing with may be very vulnerable, bf problems can seriously lead to PND, so being gentle and not too business-like is ideal.
I later mentioned the first bfc to my hv and she knew exactly who I meant. [Sad]
I had a couple of advisors while trying to establish bfeeding. The moment for me was when she said " you have a lovely supply". That actually made me feel that it would be possible.In the end I fed DS for 14 months and DD for 28 months.
Bear in mind that you are dealing with women who are stressed, shocked, physically exhausted, feeling like a failure, often in extreme agony and confused from too much conflicting advice. Speak gently and don't assume that all the information has gone in. Don't snap "Why are you holding the baby like that?"
For me like others on here, it is all about the kind supportive attitude at a time when you are ridiculously sensitive.
I was desperate to bf DS1. He was born after a very traumatic labour lasting three days, emergency delivery, heavily bruised and screamed with hunger. He was heavily jaundiced and the doctors would not discharge him without formula top ups.
I saw the bf counsellor who was very brusque, told me that DS1 - who had been skin-on-skin attached to my nipple for eight hours wasn't hungry, that his stomach was tiny, he only
needed a dribble of colostrum and I was misreading his signals. He was going crazy screaming all the time.
I was so upset as I felt like I was incompetent. She tried to hand express colostrum for me and couldn't get anything out (found this a bit humiliating).
I then got terribly engorged the next day and she said this was because I was spending so much time trying to feed screaming DS1 and limit it 10 mins on each breast and he'd get plenty. Again, I was misreading the signs, all he needed was a tiny amount and I just needed to try harder to hand express the colostrum.
It was a lovely healthcare assistant on the ward who borrowed me an electric pump and suggested expressing a little from my heavily engorged boobs, cup feeding it to DS, who then calmed down as he wasn't so starving and put more effort into latching on. She was amazingly supportive and kept telling me (she was Finnish) that DS1 was beautiful and so amazing but he was very insistent - all said in a lovely non-critical way - so I was doing my very best.
This was successful and I fed DS1 on demand until he was a toddler. What I found so negative about that first bf counsellor was her attitude that as a new mother, I couldn't possibly understand my newborn's cries. Yes, I know they have small stomachs and colostrum should be enough but he still gets the immense hunger anger as a toddler! He fed every 45 minutes as a baby until he was about five months old! She didn't spend enough time with me to really understand my baby and then dismissed my concerns.
I am now bf DS2 (3.5 weeks) who has been a chilled out baby for whom colostrum in tiny amounts was immediately satisfying. He latched on easily and we made it through another round of hideous engorgement with reverse pressure softening and cabbage leaves. He has put on nearly a pound and a half since birth (never lost an ounce).
The difference is partly down to me being more relaxed and having bf experience, I am sure. But mainly this is a baby with a totally different reaction to hunger. He feeds every 1.5-2 hours (not every 45 minutes) and simply doesn't get nearly as frantic about eating as DS1 did. And as it turns out, I got just as engorged second time round when DS2 was nibbling delicately at colostrum, so I think that is my body rather than anything else.
Sorry this is long but I am a passionate breastfeeder. I also found Kellymom a great resource that I wish the bf counsellor had told me about. But mainly I wished that she had listened to me.
Good luck - you sound lovely and I hope you have a wonderful career as a bf counsellor!
Oh to add, the bf counsellor also was sceptical in front of me about whether DS1 had needed formula top ups for his jaundice.
This made me feel awful even though the paed doctor had ordered it. She may well have been right that the doctors were too hasty to give formula, but she made me feel like everything was already ruined for bf. and let's face it, how many first time mums following birth and surgery feel strong enough to argue with a specialist baby doctor about anything?
Instead, she could have said: "oh well, at least now you know the jaundice is improving and let's get this breastfeeding going as you are doing such an amazing job..."
Again, it wasn't that she needed to do anything differently, just approach it all in a more positive way.
I had that as well Ruby. The bfc being distrustful of the other medical staff for topping up. Even if you do disagree, don't do that in front of the new mother as it leaves her totally bewildered and frightened about her baby being harmed.
Great you are a bfc, rookie
I am a bfc with NCT and I just don't recognise some of the descriptions of bfcs here - and the problem is that people call themselves breastfeeding counsellors when they are not actually breastfeeding counsellors! This is perfectly legal, sadly, but it's very confusing for mothers.
Breastfeeding counsellors from NCT, LLL, ABM, BfN, never touch the mother's breast; they don't work in hospitals (they may visit, but they are not employed by the NHS); they never latch the baby on for the mother; they don't contradict what the doctor has said; they should not be critical or judgmental.
Hospitals may have people they say are 'breastfeeding counsellors' and they may have done some training, but any of my colleagues would be horrified that our practice could be confused with someone handling a mother's breasts etc, calling a baby 'lazy' and other stuff like that. We don't usually even touch the baby, though sometimes, with the mother's permission, we may do (though I never do, and can't remember when I last did so).
If anyone gets less than good help and support from someone purporting to support breastfeeding, then you can complain - find out if she is from one of the volunteer organisations and contact them, or if she is an NHS employee, tell her employers.
That's really interesting Tiktok. The woman in the hospital was called a bf counsellor and wore a badge saying so. In my ignorance, I assumed there was some sort of standard training within the NHS for that job title. I've often seen you giving excellent, super-supportive and unjudgemental advice on Mumsnet so I wish she'd had your training! I can imagine that as a new mother, you feel immense love for the bf counsellor who makes you feel more confident about feeding (rather than less).
Ruby, she can call herself a breastfeeding counsellor, whatever sort of training she has had (and even if she has had none). It's galling for us, as there is no doubt that behaviour of the sort you describe is not supportive or helpful to mothers, and people might think everyone who has the label 'breastfeeding counsellor' is the same
Thanks for your kind words
Not got much to add as I agree with everything above. Just wanted to say that:
- I wouldn't be breastfeeding now if it wasn't for the patient, clear and encouraging advice from our local infant feeding specialist over the phone the day after I got back from the hospital - I was ridiculously clueless about the way breastfeeding worked (especially getting supply established) - she listened, and talked me through exactly what I needed to do step by step (including hospital grade pump while my baby was too weak and sleepy to bf directly). We are doing fine now. So you can make a real difference in your job.
- you sound lovely and the fact that you are asking what people want and listening probably means you will be ace!
- I haven't posted a lot on this section but have read loads, and found the advice and approach of Tiktok (amongst others) brilliantly helpful. So another thanks to you Tiktok, from a creepy lurker
Creep freely, Twitchy Thank you!
Thank you everyone for all the really helpful comments. I am going to read every single post thoroughly and post again later.
Tiktok, as everyone has already said I have learned a lot from you on here too and thank you for the kind words
Hi sorry to high jack the thread OP but who did you do your training with? Thanks!
Have just come back on here - really interesting reading. Re feeding from one breast only, I did feed on demand, which may have helped. Did express from the other side for the first couple of weeks as advised too , and bottle feed the ebm - I'm sure that was important. It's just that, after a while of this, it was really getting me down, and I kind of knew she wasn't going to learn to latch on to that side any time soon, and I knew she was getting enough from one breast, but the professionals just wouldn't believe me - even when, in the end, I'd just using one side for months, and she'd climbed up a percentile, I was still told it was wrong and not sustainable! I guess I would have liked someone to work with me more on a solution, and listen to me when I said how much I really hated the expressing. That said, in all other regards the support I had was great, and I would never have bf at all without it.
I think I assumed the people who were sent to visit me from the hospital were trained but in retrospect, I don't think they were specifically, and I didn't then seek out support from other sources because I thought I couldn't be helped (1 week of horrible engorgement, trouble latching or expressing). Next time I'll be calling one of the organisations mentioned by tiktok. Good luck rookie hope I track down someone like you or tiktok next time.
I've just been reading all the last posts very carefully and have learned a lot from every single one - thank you all so much for explaining your experiences.
So far the consensus seems to be:
- being positive is one of the most important things
- being sympathetic is also very important
- new motherhood is a time that can be very challenging as well as amazing and bf counsellors must remember that
- the right practical info and help at the right time is vital
- it is the mother's choice how to feed and a bf counsellor should always respect that
- It is very important to avoid tactless language eg describing baby as lazy
- the mother knows her own child and situation best and should be listened to
- no bf counsellor should ever contradict the hcp team - this is emphasised in our training
- breastfeeding counsellors can make an enormous difference
I am starting on the helpline soon and still remember my own calls in the early days so well.
I was thinking today how wonderful it is that the various bf organisations exist and that the helplines are available - if it doesn't sound too cheesy, it is a privilege to follow behind all the bf counsellors who have worked hard to make that possible.
Good luck with it Rookie! I found a bf counsellor who made an enormous difference in the early days, when I was told by a midwife to start topping up with formula, but I didn't want to. She spent ages watching me feed (from start to finish), corrected my position and latch, even got my DH involved to see what the correct position and latch should look like. I felt I could then phone her afterwards as well, which I did when my confidence was dipping.
Honestly, without her I wouldnt be still bfing my 20 month old.
What not to say/do...my DH's friend was training to become a bf counsellor. I was talking to her about 'extended' breatfeeding and the fact that my dd was waking up for bf at 14 months. She looked at my dd and said, "naughty satine's DD, if I was your mummy, I wouldn't let you do that. My DS stopped night feeds at 6 months" (or whenever,can't remember exactly). Anyway, I found it shocking. Suffice to say this was the last time I spoke to her!!
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