MN WEBCHAT GUIDELINES 1. One question per member plus a follow-up question if appropriate, ie once you've had a response. 2. Keep your question brief 3. Don't be disappointed if your specific question doesn't get answered and do try not to keep posting "What about me?". 4. Do be civil/polite. See guidelines in full here.

Webchat on breastfeeding with UNICEF's Sue Ashmore and Carmel Duffy on Monday 8th November 1 - 2pm

(106 Posts)
RachelMumsnet (MNHQ) Thu 04-Nov-10 10:52:24

Sue Ashmore and Carmel Duffy from UNICEF will be joining us at MNHQ on Monday 8th November at 1pm to answer all your questions on infant feeding, support for breastfeeding in the NHS and anything else related.

Sue Ashmore is the Programme Director of the UNICEF UK Baby Friendly Initiative, which works with the health-care system to ensure a high standard of care for pregnant women and breastfeeding mothers and babies. Sue?s background is in midwifery and, as an infant feeding adviser; she supported her hospital in Sheffield to become one of the first Baby Friendly accredited hospitals in the country. Carmel Duffy is a Deputy Programme Director for the UNICEF UK Baby Friendly Initiative, where she is responsible for the development and monitoring of education and training. Carmel has recently been involved with the development of a specialised course for health professionals working in neonatal units that emphasises the importance of breastmilk as part of a family-centred approach to care for this vulnerable group.

Add the date to your diary and if you're unable to join us, please post your questions to Carmel and Sue on this thread.

LoveBeingAMummy Thu 04-Nov-10 14:38:54

Hi Ladies

What do you think is needed to change the perception of women who think bf'ing is gross and that the highly processed milk from another animal is 'normal'?

(I am aware that for lots of people ff is something they dont have a choice about, this is certainly not directed at them)

Lulumaam Thu 04-Nov-10 17:18:23

Hi Sue and Carmel

How do I persuade the trust I doula at to get rid of the Nestlé stuffed vending machines in the AN clinics and by the cafe? I don't think it sits well with Baby friendly? grin I've brought it up at the MSLC but nothing happened. I've spoken to the HoM and Consulant MW but nothing happened.. How further up the trust should I take it and is there any pro forma info I can use?

How can a unit be baby friendly and line the pockets of Nestlé?

thankyou

hildathebuilder Thu 04-Nov-10 17:36:47

As the mother of a very premature baby how can we help the NHS balance the need for BF mothers of babies in neonatal units, nicu, scbu etc to be able to spend time with their babies in order to BF with the needs of hospitals and their staff to follow some routines with babies, ensure privacy during ward rounds and also just deal with the fact that there is not the space to allow premature babies mothers to stay in hospitals.

How can we encourage more hospitals to have milk banks and loan pumps for those with a plentiful supply of milk to become milk donors rather than spend the money on formula.

Many many premature baby mothers want to breastfeed but end up using formula as it is easier to get the babies home (by proving that they can feed) if they will take a bottle of formula given it is not possible to visit 24-7 for several weeks. How can the NHS staff be encouraged to let the mothers take their babies home to really give BF a chance to get established.

Thanks

TruthSweet Thu 04-Nov-10 19:54:55

HI Sue and Carmel - Thank you for coming to speak to us. I'm really interested in the BFI as a BFing peer supporter, as breastfeeding mother how has been a in-patient at a hospital recently and as a breastfeeding mother of an recent in-patient.

My local hospital is aiming for Baby Friendly Status and by all accounts the Maternity team is on board but the rest of the hospital seems at best unaware or at worst obstructional and hostile to bfing mothers and babies.

The in-patient wards seem bemused by mothers bfing past about 6 weeks and unwilling/unable to allow dyads to remain together or provide support for mothers that are separated from their bfing baby to maintain their milk supply.

The Children's ward is better and allow parents to stay but most staff are woefully under-informed about bfing. I had a consultant paed. today ask me how a child could self wean from bfingconfused and why doesn't my 3 y/o eat solids yet (I'd just explained she only has one bfeed a day).

Can it be emphasised that Baby Friendly Initiative should apply to the whole hospital not just Maternity/SCBU. Or am I misinformed and is this not the case and BFI is only for the neo-natal period on the Maternity wards?

Are there plans to have as a requirement for BFI status 'pool' breast pumps that could be used by any ward, bfing trained staff that could visit other wards than Maternity ones, rooming-in with bfing babies/children where the mother is the patient (where clinically appropriate), etc?

gaelicsheep Thu 04-Nov-10 22:16:44

Hello both. I have given birth in two hospitals, one in England and one in Scotland, both of which have baby friendly status. In both hospitals I have received pretty poor breastfeeding support, which basically amounted to shoving the baby onto the breast and leaving me to it, and both times I have left hospital with cracked nipples. I am sure you will agree that those first few days are absolutely key to establishing successful b/f and leaving hospital with cracked nipples makes the subsequent days and weeks so much harder than they need to be.

What is UNICEF doing to ensure that hospital staff in Baby Friendly hospitals actually take on board the training they receive and provide decent support and advice to the mothers in their care, so far as resources permit?

kveta Fri 05-Nov-10 09:07:19

Hello, I won't be able to join the chat on Monday as I go to the nursery to feed my DS at that time!

I just wanted to ask if there is a similar initiative for workplaces, given that many women stop breastfeeding to return to work, and in the current economic climate, many more will be trying to get back into the workplace than they used to. I've been incredibly lucky to work at an institute which is very supportive of breastfeeding mothers - they have a 'lactation suite' (a room with comfy chair, table, sink, lockable door, and stack of trashy magazines - the only thing missing was a fridge for storage of expressed milk), a nursery on-site which encourages mothers to come and feed their babies when it's needed (the waiting list is shocking though), and great flexible working policies. I am very aware that most workplaces do not offer anything like this level of support, and wondered if there was a mother-friendly initiative which could encourage work places to improve their support (obviously not just for breastfeeding mothers).

thank you

LeninGuido Fri 05-Nov-10 14:56:58

Are we likely to see any initiatives around normalising natural-term breastfeeding? No one was more surprised than me that DS1 went on, and on, and on. I had many wobbles and concerns over the 4 years he bfed for but it was clearly very important to him. He stopped more or less on his own in the end. It would have been so helpful not to have the 6 months/ up to two years 'milestones' going around in my head.

flyingzebra Fri 05-Nov-10 21:42:24

Hi Sue,

Do you have any tips to help us distinguish the midwives who think they know something about breastfeeding from the midwives who actually know something about breastfeeding?

That's not meant to be a facetious question, btw, but I've been badly letdown on the breastfeeding front by midwives who are absolutely confident that they know what they're talking about, even though they are wrong!

flyingzebra hear hear.

Can midwives be made to complete a "breastfeeding" diploma as part of their training to gain an official symbol on their hospital I.D. badge! IMHO though, it is the older midwives (and health visitors) who are set in their ways.

Then we as new mums would know who to trust, believe - and call on.

GraceK Fri 05-Nov-10 22:07:26

Am posting now as may miss the chat if off for a walk with DD2 (almost 7 mths) trying to get her to sleep! Will the Iniative have some effect on the sudden change of emphasis that comes when your baby hits 6 mths -from "no food / just breast milk" to " why aren't you putting more effort into weaning / stuffing 3 meals a day into them"? This has happened to me in the last month when taking DD2 to be weighed. I was shocked by this sudden change in emphasis & it must surely encourage many women to give up bf-ing soon after 6 mths, when continued feeding would benefit both mother & child for months to come.

Also as someone with v inverted nipples, can I just mention that neither the nhs or Nct mentioned nipple shields to me. Luckily my mother forewarned me & a lovel nurse in Special Care (for DD1) got me one so that she could latch. We then fed happily with them for 22 mths. Why does no one look at your nipples in ante natal care even if you raise such concerns? Leaving it til you have a hungry baby & engorged breasts is no help to anyone.

Apologies for posting two issues. Hope you have a chance to consider both issues even if you can't answer both within the time of the chat

SparklePffftBANG Fri 05-Nov-10 22:31:17

Looking forward to this webshat, hoping I can get my lunch break to co-incide with it (must remember not to go shopping!)

My question is, since most women do start breastfeeding but then the figures fall off at 6 weeks. What do you think the main reason for that is - lack of support to people who want to bf, or people placing more emphasis on the first couple of feeds, either because they are in hospital with expectations to fulfil, or because they believe the benefits of colostrum are worth it, but then don't want to continue? What can be done about it?

Also, what can I do, as a breastfeeding mum, to help?? I have trained as a peer supporter, don't think I would be much good as a counsellor, but would love to get involved somehow?

SparklePffftBANG Fri 05-Nov-10 22:31:45

sorry, contravened the 1 question rule, so please ignore my second one

Without wishing to stomp all over Lenin's point...

"Do you think UNICEF could be more explicit about the bf recommendations being at least two years for developed countries?"

So many people believe that the two years minimum advice is only for poor developing countries without our nutritional opportunities hmm and it would be really helpful to point them to a clear recommendation from UNICEF that applies specifically to the UK too, with the benefits that even babies from developed countries gain from bf for so long.

Thanks

gaelicsheep Fri 05-Nov-10 23:42:03

Hello again. I'm thinking that my question about the quality of support and advice available in hospital could be usefully looked at long with CountessVonKnackerstein and flyingzebra's. They are absolutely right that half the problem is that you have no clue who anyone is, who to ask, who has and has not been trained, and who to believe. One of the ladies who helped me first time around, probably the most helpful actually in terms of taking the time, turned out to be a nursing auxiliary. I doubt she'd been on the breastfeeding management course.

Yes, I agree gaelicsheep, the person who helped me start breastfeeding successfully most of all was a friend who is a midwife, but she wasn't on duty.
She came to my hospital to see us and stayed for hours.
Do you know, she got stick from her manager for that?
Why should she have got negative vibes and "oh she thinks she knows everything" comments, jealousy perhaps? hmm

suzikettles Sat 06-Nov-10 15:22:32

I gave birth in a Baby Friendly hospital and the midwives were very supportive of bf - really they were. However, midwives were few and far between and trying to support many women and babies. The consistent people on the ward were HCAs and they weren't supportive (it wasn't explicit - but you could tell that their attitude was "just give a bottle and us all a break").

One woman in particular acted almost as a gatekeeper to the midwives. She answered your buzzer and only got a midwife if she felt your request merited it. My requests for help with latching did not merit disturbing the "very busy" midwives and I left hospital with my nipples in shreds and what turned out to be the start of a very nasty infection. Thankfully I had an amazing Community Midwife who turned things around for me.

I have other friends who have found midwives very supportive but doctors dismissive of the worth of bf.

So (sorry - long preamble blush), how much emphasis is put on getting all staff on board when Baby Friendly status is awarded? And how is this checked up on to ensure it's not all lipservice?

sungirltan Sat 06-Nov-10 18:55:07

don't know how to word this but....

it seems as if there are women who want to bf and will do it hell or high water, then there are women who don't want to, no matter what but in the middle there are women who are open to giving it a go but when they have problems bf they seem to be let down by mv/hv when they should be referrred/signposted to specialist support. it seems like telling the mother that 'oh its ok, you gave it a try, never mind, time for formula' is acceptable when i think that bf professional help should be recommended and be accessable to all mothers who want it.

i think what i'm getting at is do you think bf support (counsellors, latch on groups, peer supporters) should be explained and promoted to all new mothers?

EauRouge Sat 06-Nov-10 19:08:03

Hi Sue and Carmel, very much looking forward to the webchat.

My question is- do you think if the NHS changed their 'just don't do it' policy on co-sleeping and instead gave advice on safe co-sleeping it would make a significant difference to BF rates?

WelshCerys Sun 07-Nov-10 00:33:41

Hi Ladies

I fed my youngest until his 8th year - of course only occasionally and he was enjoying a 'normal' diet the rest of the time. All well and good - and that was a few years ago. But at work the other day talking to none other than a social worker, heard her saying that she thought feeding an older child was unnatural and wouldn't hesitate to confront a parent who was doing so. Wow! She acknowledged it isn't against the law but saw nothing wrong with getting heavy about it, including interviewing the child in question. Hope this problem isn't endemic in a profession that yields so much power in many families' lives. What do you think about all this?

gaelicsheep Sun 07-Nov-10 00:49:30

Sorry, I know it's only one question each but I've just thought of another. Perhaps someone else might want to ask it, otherwise just ignore. smile

A number of NHS areas are training groups of peer supporters. Is there any evidence as to how effective these peer supporters are wrt improving breastfeeding rates/success in those areas?

BollocksToThis Sun 07-Nov-10 16:32:41

Increasingly maternity units are discharging postnatal women within very short timescales, sometimes just 6 hours after delivery. And in many areas the days of daily midwife visits until day ten are a thing of the past, with some women seeing a midwife only once or twice within that period.

How can this possibly be compatible with the BFI, and what are your thoughts on NHS-funded breastfeeding counsellors visiting daily instead, for those mothers who wish support?

explorerescueprotect Sun 07-Nov-10 17:18:55

Hi, I work as a breastfeeding peer supporter within a city that is working towards Baby Friendly accreditation. In the past few months I have worked with 8 women whose babies have been diagnosed by midwives as tongue-tied and yet there is no provision locally to rectify this. I am aware that frenulotomy is not always the answer and that good bf support on attachment and positioning is vital. However, when the bf support has been provided, and women are still struggling there is nowhere for them to go other than exclusively expressing or moving to formula milk. The HCPs Local Infant Feeding Guidelines state that NICE recommends snipping tongue tie as an option but this is contradicted by local clinical policy which is not to perform the procedure. It all seems pretty-unBaby Friendly to me. Does Unicef have a view on tongue-tie and its potential treatment?

rubyslippers Sun 07-Nov-10 19:02:44

Where to start with this?

Most of the issues I wanted to raise have been done already

I especially agree with the post re the advice on feeding until 2 years old

I have had to justify myself on 2 recent occasions to friends about why I am "still" feeding

I think the key to successful breastfeeding is expectations ... So for a MW or HV to be able to reassure a mum that a baby feeding very frequently, and cluster feeding is ok for example and doesn't mean your milk isn't enough or you need to top up

I think we need to temper the idea that babies should go 3 hours between feeds and then drift off to sleep in their Moses baskets

Co-sleeping was the key for me to successfully feeding in the early days so can this be encouraged? My Baby friendly hospital rooms babies with mums but not in their beds ...

gaelicsheep Sun 07-Nov-10 20:31:39

Ditto ruby. I was talking with DH about the co-sleeping in hospital thing just last night. I suppose the worry is exhausted mothers, possibly still under the influence of drugs etc. But if there are no contra indications I think it should be encouraged. With bigger beds.

TigerFeet Sun 07-Nov-10 22:16:06

Hi, I'd be really interested in your views on the role of peer supporters.

Myself and many of the other mums from our local group recently completed training and are now active peer supporters at our weekly support group. We now outnumber the non-peer supporters attending the group and w're really struggling to recruit new members. We are working hard to publicise the group but we seem to be finding it very hard to overcome the breastfeeding=boob wielding nutter myth.

Do you have any ideas that might kick start our recruitment drive?

gaelicsheep Sun 07-Nov-10 22:43:56

That would make an interesting thread generally TigerFeet. I know a few b/f mothers and I'm the only one who's ventured to the support group - 4.5 months in with problems mostly solved, and only because I'm interested in training as a peer supporter! I think a b/f group is a bit single issue, plus the last thing a struggling new mother wants is to have to try and feed in front of others. IMO peer supporters could be more effective in other ways.

Gaelic & Tiger I am a peer supporter in an area where Breastfeeding rates were appalling, they are slowly improving with the help of a range of initiatives. One in particular is the ability of our group to speak to mums antenatally. We have found that meeting a mum before birth makes her more likely to make contact with us after, often sooner, when a problem may arise.

I think another thread may be helpful to discuss this.

cantthinkofagoodname Mon 08-Nov-10 09:34:46

I have a 7 month old daughter and have noticed that whilst breastfeeding upto 6 months is generally applauded by HCPs and wider society, after 6 months is a different story. Degree educated family are telling me that breastmilk has no benefit after 6 months, many of my (largely middle class, professional)peers from antenatal class switched to formula at 6 months and even HCPs have advised me to switch to follow-on milk to ensure my baby gets enough vitamins!

Why do you think this myth that breastmilk is only for 6 months prevails and what can be done to address it?

twinsplus3 Mon 08-Nov-10 11:22:34

Hello. I am being TUPEd (transfure of undertakings protection of employment) at work and have been told i will be on a new shift pattern finishing at 8 pm insted of 6 pm once a week for ETO (Economic, tecnical or organisational) resons. This is a problem as I wont be home untill 9 pm and my twin daughters usualy have a breasfeed and go to sleep at 7pm. Twice in there lives so far I have had to leave them with my partner and my milk from a bottle at bedtime and one of my daughters just screamed and cried herself to sleep, I cant bare to think of this happening on a weekly basis. Work is fine for me to pump there but my girls want the milk straight from me at bed time. I have a meeting on friday were I will be able to raise this are there specific things I can say to support my case. My girls are 1yr 2 wks and I do think this makes It harder for work to understand why bf still matters. Will be out when discussion happens but anyadvice greatfully appriciated

thefatcontroller Mon 08-Nov-10 11:24:38

Dear both,

There is clearly a lot being done by Baby Friendly and others to support breastfeeding mothers.

Is anyone looking out for bottle feeding mothers?

Looking forward to your reply.

scrappydappydoo Mon 08-Nov-10 11:26:06

I'm not going to be in unfortunately but would also like to know how we 'educate' hv in particular on bfing.

I had one hv reduce me to tears at dd2s 8mth check up She was shocked that I was 'still' bfing. She told me that she was feeding too much (12 times in 24 hrs). She encouraged pushed me to switch to formula as it would make dd2 sleep through the night hmm, I would know how much milk she was getting so I wouldn't 'overfeed' her etc etc I walked out in the end as I knew she was wrong and have never been back and now do not trust hv advice at all.

There are countless similar stories on mn and it worries me how many mothers are given wrong advice and just accepted it because they do not know better. So How can we ensure that hcps have access to the best updated advice?

RadoxBabyBel Mon 08-Nov-10 11:27:35

I'd echo the experiences of cantthinkpfagoodname, above. The situation is even worse post 12 months. I picked up my copy of the toddler years yesterday and was told that breastmilk post 12 months has no nutritional value! What should be done to address these ideas - which I find v common even in health care professionals?

AbricotsSecs Mon 08-Nov-10 11:33:14

Message withdrawn at poster's request.

crikeybadger Mon 08-Nov-10 11:37:41

Agree with scrappydappydoo about Hv's.

Their advice is often outdated or just plain wrong which undermines breastfeeding. Are hvs covered by the BFI or is it just mws?

My question for Sue and Carmel is:

What single thing would reduce the high rate of women who give up breastfeeding without really wanting to?

crikeybadger Mon 08-Nov-10 11:45:44

oh and thefatcontroller-

if you go the the bfi homepage, there is a section called 'A guide to infant formula for parents who are bottle feeding' smile

SueAshmore Mon 08-Nov-10 12:22:09

testing

CarmelDuffy Mon 08-Nov-10 12:23:10

test

LeninGuido Mon 08-Nov-10 12:56:43

Welcome!

RachelMumsnet (MNHQ) Mon 08-Nov-10 12:58:41

Sue Ashmore and Carmel Duffy have braved the rain and have joined us at Mumsnet HQ for the next hour to answer your questions. Welcome to Mumsnet Sue and Carmel...

AbricotsSecs Mon 08-Nov-10 13:00:13

Message withdrawn at poster's request.

CarmelDuffy Mon 08-Nov-10 13:00:51

Hi everyone - lovely to be here - hope my typing keeps up to pace and my spelling does not confuse too much

SparklePffftBANG Mon 08-Nov-10 13:02:24

hi

CarmelDuffy Mon 08-Nov-10 13:02:59

scrappydappydoo

I'm not going to be in unfortunately but would also like to know how we 'educate' hv in particular on bfing.

I had one hv reduce me to tears at dd2s 8mth check up She was shocked that I was 'still' bfing. She told me that she was feeding too much (12 times in 24 hrs). She encouraged pushed me to switch to formula as it would make dd2 sleep through the night hmm, I would know how much milk she was getting so I wouldn't 'overfeed' her etc etc I walked out in the end as I knew she was wrong and have never been back and now do not trust hv advice at all.

There are countless similar stories on mn and it worries me how many mothers are given wrong advice and just accepted it because they do not know better. So How can we ensure that hcps have access to the best updated advice?

It is such a shame that there are still some health professionals who think that follow-on milk is superior to breastmilk. It just makes you see how effective the milk company advertising is. The law regulating the advertising of formula milks is much weaker than the international Code of Marketing and this is the reason there are adverts for follow-on formula on our television sets. A MORI poll conducted by UNICEF and the NCT found that many mothers thought they had seen adverts for infant formula rather than follow-on milks and the companies use the promotion of follow-on milks to advertise their company name. It comes back to education however and your question illustrates just how important it is for health visitors to attend breastfeeding training so that they can appreciate the importance of breastmilk beyond the six month period.

SueAshmore Mon 08-Nov-10 13:03:48

Hi Good to join you all, I am looking forward to the chat. This is the first time I have ever done a web chat. Mumsnet have been very welcoming and patient with my naive questions about technology.

Indith Mon 08-Nov-10 13:05:34

<tries to think of something intelligent to say>

CarmelDuffy Mon 08-Nov-10 13:06:19

TigerFeet

Hi, I'd be really interested in your views on the role of peer supporters.

Myself and many of the other mums from our local group recently completed training and are now active peer supporters at our weekly support group. We now outnumber the non-peer supporters attending the group and w're really struggling to recruit new members. We are working hard to publicise the group but we seem to be finding it very hard to overcome the breastfeeding=boob wielding nutter myth.

Do you have any ideas that might kick start our recruitment drive?

Hi tigerfeet - Gaelic and Tiger mentioned the importance of meeting women in the antenatal period as it is good to have a friendly face when you first turn up at a new group. I have found this to be useful in the past. Hopefully your local midwives and health visitors can also help promote your groups and give out friendly fliers. My experience is that these groups do tend to start off slowly but feedback from people who have attended is the best publicity there is. I am not sure how long you have been running but be patient and they will soon see you as the measured sensible people that you are and be queuing up outside your door!

SueAshmore Mon 08-Nov-10 13:07:05

twinsplus3

Hello. I am being TUPEd (transfure of undertakings protection of employment) at work and have been told i will be on a new shift pattern finishing at 8 pm instead of 6 pm once a week for ETO (Economic, technical or organisational) reasons. This is a problem as I wont be home until 9 pm and my twin daughters usually have a breastfeed and go to sleep at 7pm. Twice in there lives so far I have had to leave them with my partner and my milk from a bottle at bedtime and one of my daughters just screamed and cried herself to sleep, I cant bare to think of this happening on a weekly basis. Work is fine for me to pump there but my girls want the milk straight from me at bed time. I have a meeting on friday were I will be able to raise this are there specific things I can say to support my case. My girls are 1yr 2 wks and I do think this makes It harder for work to understand why bf still matters. Will be out when discussion happens but anyadvice greatfully appriciated

Hi – this sounds really hard, I do sympathise. If you haven’t already done so, it is a good idea to be aware of your rights as a breastfeeding mother. Follow this link for the Department of Health guidance on this.

It can be best not to try and replicate breastfeeding when mum is not there, especially with older babies like your girls. So if your partner gives them a drink in a cup and then offers cuddles, stories etc, they will start getting used to a mum routine and a Dad / partner routine. Most children quickly get used to it being different when mum is not around and life then gets easier.
Sue

tabouleh Mon 08-Nov-10 13:08:47

Hi Sue and Carmel - I think that the Baby Friendly Initiative is a great one and hope it can be rolled out everywhere.

(I feel that I was failed by the NHS wrt to BF advice etc. DS ended up in hospital and diagnosed "failure to thrive" and formula top ups suggested.)

So my question is about formula.

I feel that that a key part of Baby Friendly should be PROPER info and advice about formula feeding: differnet formulas/how to feed and most importantly preparation.

Your website has the only decent leaflet about formula - so well done for that.

But why on why can that info not be properly
explained to parents?

Why do HCPS not explain that formula is not sterile and that to make it safe it needs to be made with water which is 70 degrees?

Why do they not explain alternatives to making a fresh bottle each time (carton out and about/in middle of night/you can make bottle up to 2 hours before feed finished/water in a flask at 70 degrees - and yes make in advance cool rapidly store in fridge for a minimal time)?

So many just say "oh well you're supposed to make in advance but you can just make with cool water".

Your own leaflet on this page is rubbish I'm afraid - it is 5 years old and it fails to mention that to get water at 70 degrees it needs to be 1 litre boiled and left for 30 mins - it also fails to mention that there are some safe alternatives to making fresh.

And as for the leaflets in other languages - well some of them do not mention the 70 degrees at all. I emailed babyfriendly mid July and was told

"I have spoken with our website and resources editor and we are getting all of our leaflets updated over the course of the summer."

I feel passionately about safer infant feeding - and working towards higher BF rates is part of that of course. But at the moment where we are living in a formula feeding culture - let's make sure that HCPs can give advice on how to actually safely feed formula. That should be easy. Then get on with increasing knowledge of BF.

Please can I have your thoughts on safer formula feedng?

Thanks!

SueAshmore Mon 08-Nov-10 13:09:05

LoveBeingAMummy

Hi Ladies

What do you think is needed to change the perception of women who think bf'ing is gross and that the highly processed milk from another animal is 'normal'?

(I am aware that for lots of people ff is something they dont have a choice about, this is certainly not directed at them)

Hi LoveBeingaMummy – Great name by the way – This is a complex question, the UK has one of the most entrenched bottle feeding cultures in the world and this results in all of us seeing bottle feeding all the time and considering bottle feeding as the normal or default way to feed a baby. Breasts on the other hand are associated with sex (to put it bluntly!) Therefore it is hardly surprising that some women have the reaction they do to breastfeeding. To turn this around is a big job, but not impossible. Firstly, we need to ensure that the women who want to breastfeed are enabled to be successful. Therefore, health care practices need to improve, with better policies and training as described by UNICEF and new mothers need more support to carry on breastfeeding.

The research shows that mothers are more likely to breastfeed if there is one person in their lives who believe that they can do it, that is why peer support programmes, support groups etc are so important, especially for women who live in areas where few people breastfeed.

We also need to make education for breastfeeding in the antenatal period better and more accessible to the women least likely to breastfeed. You can’t make an informed choice if you don’t have clear and unbiased information to assist you. Once more mothers breastfeed, then it will become better understood and less strange to the women around them. Also there will be less mothers out there who have horror stories connected to their breastfeeding experience, putting off their family and friends.

Then we need to think about how breastfeeding is portrayed in the media etc. Social Marketing campaigns have been shown to be successful in changing attitudes and I think we also need to tighten the law. It is illegal to advertise formula milk and yet the companies get around the law all the time, giving out misleading information and seductive adverts to make bottle feeding look like the sensible / normal choice to make.

CarmelDuffy Mon 08-Nov-10 13:11:57

crikeybadger

Agree with scrappydappydoo about Hv's.

Their advice is often outdated or just plain wrong which undermines breastfeeding. Are hvs covered by the BFI or is it just mws?

My question for Sue and Carmel is:

What single thing would reduce the high rate of women who give up breastfeeding without really wanting to?

This is a complex issue and it is difficult to come up with one single factor. However from our point of view education is key to ensuring health care staff provide support and up to date evidence based information to mothers.

SueAshmore Mon 08-Nov-10 13:14:59

TruthSweet

HI Sue and Carmel - Thank you for coming to speak to us. I'm really interested in the BFI as a BFing peer supporter, as breastfeeding mother how has been a in-patient at a hospital recently and as a breastfeeding mother of an recent in-patient.

My local hospital is aiming for Baby Friendly Status and by all accounts the Maternity team is on board but the rest of the hospital seems at best unaware or at worst obstructional and hostile to bfing mothers and babies.

The in-patient wards seem bemused by mothers bfing past about 6 weeks and unwilling/unable to allow dyads to remain together or provide support for mothers that are separated from their bfing baby to maintain their milk supply.

The Children's ward is better and allow parents to stay but most staff are woefully under-informed about bfing. I had a consultant paed. today ask me how a child could self wean from bfingconfused and why doesn't my 3 y/o eat solids yet (I'd just explained she only has one bfeed a day).

Can it be emphasised that Baby Friendly Initiative should apply to the whole hospital not just Maternity/SCBU. Or am I misinformed and is this not the case and BFI is only for the neo-natal period on the Maternity wards?

Are there plans to have as a requirement for BFI status 'pool' breast pumps that could be used by any ward, bfing trained staff that could visit other wards than Maternity ones, rooming-in with bfing babies/children where the mother is the patient (where clinically appropriate), etc?

Nice to talk to a peer supporter. I think my answer may leave you feeling a bit frustrated, so apologies in advance. We do only assess the maternity unit and to a lesser extent, the neonatal unit. Our hospital assessment tool is based on a global tool from the World Health Organization and UNICEF designed to assess the care of mothers and babies in the first days after birth. We would love to take the standards into the areas you mention for all the reasons you describe, but don’t have the resources to do so. In the UK, we have taken the maternity standards and expanded these to cover community care for breastfeeding mothers and have also developed standards for universities which educate midwives and health visitors. While we have a lot of supporters who do a lot for the Initiative without financial reward (for which we are forever thankful!), our actual staff hours are quite small and mainly taken up with teaching and assessing. Developing and then running each accreditation programme is a very big undertaking and we have to be careful not to spread ourselves to the level that we are ineffective.

There are a number of brilliant infant feeding advisors working in maternity units who have trained and supported staff in others areas of the hospital to implement better standards for breastfeeding, and organised breast pumps etc, as you suggest. However, they do this on top of their work to implement Baby Friendly.

Sue

crikeybadger Mon 08-Nov-10 13:14:59

Thanks. However, with public sector funding cuts aren't the training courses (like the BFi ones) going to be one of the first things to go?

Indith Mon 08-Nov-10 13:16:27

How do you think we can change the problems encountered by so many women on the wards when trying to bf? Much of the time the MWs would like to help but they simply cannot devote an hour to sit by a mother and help her feed, a mother can be given a bottle to feed her child, the woman in labour needs the MW more.

A group of us trained as peer supporters a while ago and there has been a lot of talk about getting us on the wards to sit with mothers but there seems to be a lot of inaction and a lot of red tape and we are far from it which seems a shame as while peer supporters may not be able to sort out more severe problems, I do believe that they can take the load of the MWs by just being there to hand hold and chat to.

SueAshmore Mon 08-Nov-10 13:16:48

gaelicsheep

Hello both. I have given birth in two hospitals, one in England and one in Scotland, both of which have baby friendly status. In both hospitals I have received pretty poor breastfeeding support, which basically amounted to shoving the baby onto the breast and leaving me to it, and both times I have left hospital with cracked nipples. I am sure you will agree that those first few days are absolutely key to establishing successful b/f and leaving hospital with cracked nipples makes the subsequent days and weeks so much harder than they need to be.

What is UNICEF doing to ensure that hospital staff in Baby Friendly hospitals actually take on board the training they receive and provide decent support and advice to the mothers in their care, so far as resources permit?

Hi Gaelicsheep

I am sorry to hear about your experiences and completely agree that it is not good enough. Your question is a really important one and I can only answer it properly by explaining how the assessment procedure works, therefore, I hope you don’t find this too long winded.

Our assessments are based on interviews with staff, pregnant women and breast and bottle feeding mothers. We also interview managers and check policies, guidelines etc. There are 41 criteria for the maternity assessment.

As an example, to assess whether the unit provides adequate support to mothers to help them position and attach their baby for breastfeeding, we will interview a random selection of relevant staff and ask them to describe how they would teach a mother. We look for all the key points in the right order and the communication skills needed. We then ask a random selection of mothers if they have been supported to learn how to position and attach, what this has consisted of and how they are doing now. We then check the written material provided, training curriculum for staff etc.

Obviously, if we had interviewed you, the unit would have failed on your interview because you weren’t offered adequate support and you experienced cracked nipples. However, when we have interviewed the selection of mothers and staff, their answers are all fed into a scoring system and we come out with a percentage score for each criteria. Therefore, if we interviewed 40 mothers and 30 stated that they had had good care, the result would be 30 out of 40 = 75%.

The pass mark for most criteria is 80%, which means that 20% of staff can still have inadequate skills and 20% of mothers not get the care. This may seem lax, but you have to bear in mind that when units first start working towards Baby Friendly, initial internal audits can easily have scores of 20% or even less.

Once a unit is accredited, they are obliged to submit internal audit results each year and we provide them with an audit tool to do this. We carry out a standard re-assessment after 2 years and then every 1-5 years after that, depending on how well they are doing.

We welcome feedback from mothers about accredited units and do get this quite regularly. We always discuss this with the unit concerned and offer them support to improve. If we get concerned about negative feedback, we can do spot checks, which are short notice visits where we talk to a random selection of mothers. Our external committee of experts, the Designation Committee, make decisions regarding who keeps and who loses awards. We do remove awards, but only when we run out of options to encourage improvements. The aim is always to improve care, not to be punitive.

Our ultimate aim is to enable the health service to provide Baby Friendly standards of care for all mothers, all of the time, and for this to happen it has to become the normal culture or ‘just what you do’. Unfortunately, we started from a very low base in the UK. Before Baby Friendly, few health professionals had received any meaningful training on breastfeeding and policies and routines did not take breastfeeding into account at all.

Over the past 15 years there have been very large improvements and many people are now working really hard to improve care. When I hear stories like yours I could cry, but then I remind myself that there are around 900,000 babies a year born in the UK and thousands of health professionals are responsible for their care, so it was always going to be a big job!
Sue

CarmelDuffy Mon 08-Nov-10 13:17:03

thefatcontroller

Dear both,

There is clearly a lot being done by Baby Friendly and others to support breastfeeding mothers.

Is anyone looking out for bottle feeding mothers?

Looking forward to your reply.

Hi thefatcontroller
The Baby Friendly Initiative wants all mothers to receive a high standard of care regardless of feeding intention. If a mother has made a fully informed decision to bottle feed we would encourage her to hold her baby in skin-to-skin contact after birth so that she and her baby can enjoy all the benefits associated with skin contact. We then encourage mothers and babies to remain together so they can learn to interpret feeding cues. It is important that mothers are provided with information on how to make up bottles of formula as safely as possible and we check to ensure that this has been done during assessment. However there is so much more that can be done to support bottle feeding mothers. It is important for babies that they are not bottle fed by a wide variety of people and so we would encourage mothers (and fathers) to be the main feed givers of their baby. Holding baby close and making eye contact during feeds promotes bonding and social interaction for both bottle and breastfed babies.

SueAshmore Mon 08-Nov-10 13:19:31

kveta

Hello, I won't be able to join the chat on Monday as I go to the nursery to feed my DS at that time!

I just wanted to ask if there is a similar initiative for workplaces, given that many women stop breastfeeding to return to work, and in the current economic climate, many more will be trying to get back into the workplace than they used to. I've been incredibly lucky to work at an institute which is very supportive of breastfeeding mothers - they have a 'lactation suite' (a room with comfy chair, table, sink, lockable door, and stack of trashy magazines - the only thing missing was a fridge for storage of expressed milk), a nursery on-site which encourages mothers to come and feed their babies when it's needed (the waiting list is shocking though), and great flexible working policies. I am very aware that most workplaces do not offer anything like this level of support, and wondered if there was a mother-friendly initiative which could encourage work places to improve their support (obviously not just for breastfeeding mothers).

thank you

Sounds like you are fortunate in your employer. Unfortunately, there isn’t a Baby Friendly for workplaces, although I agree with you that it would be a good idea. Breastfeeding mothers returning to work do have certain rights though see http://www.babyfriendly.org.uk/pdfs/breastfeedinga ndwork.pdf for more details
Sue

CarmelDuffy Mon 08-Nov-10 13:20:43

Lulumaam

Hi Sue and Carmel

How do I persuade the trust I doula at to get rid of the Nestlé stuffed vending machines in the AN clinics and by the cafe? I don't think it sits well with Baby friendly? grin I've brought it up at the MSLC but nothing happened. I've spoken to the HoM and Consulant MW but nothing happened.. How further up the trust should I take it and is there any pro forma info I can use?

How can a unit be baby friendly and line the pockets of Nestlé?

thankyou

This is a tricky one. All health care facilities working towards Baby Friendly accreditation must adhere to the International Code of Marketing of Breastmilk Substitutes, which means that they cannot advertise formula milks, bottles, teats and dummies. Within healthcare facilities, this means there must be no leaflets, posters, pens, diary covers, weight charts, etc produced by formula or bottle and teat manufacturers given to mothers or used in health care premises. The purpose is to ensure that only accurate and unbiased information, free from the influence of commercial marketing, is used. This does not stop families from receiving information regarding bottle feeding - UNICEF and the Department of Health produce material to support good practice.

Nestle is a multinational company which produces a vast range of products. They produce infant formula, but not in the UK (we are of course aware of all the issues relating to their marketing of this in developing countries). This means that Nestle products fall out of the remit of the UK Baby Friendly standards and so we do not prohibit the sale of products such as coffee or chocolate in health care premises. However, the international boycott of Nestle is run by Baby Milk Action, and you may want to contact them for further information at www.babymilkaction.org

SueAshmore Mon 08-Nov-10 13:21:00

LeninGuido

Are we likely to see any initiatives around normalising natural-term breastfeeding? No one was more surprised than me that DS1 went on, and on, and on. I had many wobbles and concerns over the 4 years he bfed for but it was clearly very important to him. He stopped more or less on his own in the end. It would have been so helpful not to have the 6 months/ up to two years 'milestones' going around in my head.

Hi LeninGuido

In the UK only 2% of mothers exclusively breastfeed for the first 6 months as recommended by WHO and UNICEF and the majority of mothers who stop in that time say that they would have liked to breastfeed for longer. With so far to go, your question feels more like a dream than a possibility. One of the problems we have whenever discussing or writing about longer breastfeeding, is that there is very little evidence to support us and the reason for this is that so few babies are breastfed for this length of time. Logically, young children will only breastfeed if they want to and when they stop wanting to or lose the sucking reflex they stop! There is no convincing evidence of harm from longer breastfeeding, with the protests being largely cultural and a lot of ‘common sense’ reasons for continuing – antibodies provided to protect from infection, excellent nutrition, building a strong and loving relationship with mum and giving both parents a highly effective way to help them calm fractious and tired toddlers. Much breastfeeding evidence suggests that the longer breastfeeding goes on the greater the benefits. Maybe if we have success at enabling more mothers to successfully breastfeed in the first few weeks, some will carry on for longer and the studies can then be carried out and our gut instincts proved right.
Sue

CarmelDuffy Mon 08-Nov-10 13:22:31

crikeybadger

Thanks. However, with public sector funding cuts aren't the training courses (like the BFi ones) going to be one of the first things to go?

Indeed crikeybadger that is a concern. However we would hope that health chiefs would recognise that a small investment in training staff to support breastfeeding will result in big improvements in long term public health with accompanying cost savings to the NHS. Our university award ensures that student midwives and health visitors receive in depth breastfeeding education throughout the course. There is interest from a number of universities but we would like to see all university midwifery and health visiting courses accredited as Baby Friendly.

SueAshmore Mon 08-Nov-10 13:23:40

flyingzebra

Hi Sue,

Do you have any tips to help us distinguish the midwives who think they know something about breastfeeding from the midwives who actually know something about breastfeeding?

That's not meant to be a facetious question, btw, but I've been badly letdown on the breastfeeding front by midwives who are absolutely confident that they know what they're talking about, even though they are wrong!

Hmmm, you could politely ask them? I appreciate that this would have to be sensitively done though

What to look out for - UNICEF Baby Friendly run a breastfeeding management course designed to give midwives and health visitors the basics they need and we also run a train the trainer course to help trusts develop their own staff training. Obviously in- house training is only as good as the person running it, but in many places it is fantastic. Some of the voluntary organisations run very good training too. Baby Friendly also have an accreditation programme for university courses, so you could ask newly qualified staff if they trained in an accredited university.

Remember though that acute staff shortages leave many midwives and health visitors very, very pressured and that it isn’t their fault as individuals if they have been given no opportunity for training, many would dearly love to attend.

If you are not happy with the standard of care you receive, could we make a plea that you let the organisation know. I know this is hard when you have just had a baby, but it is really important. We at Baby Friendly spend a lot of time trying to persuade reluctant NHS managers to take this seriously. Some are fantastic, but I can’t remember the number of times we have been told that it is not a priority. The profound effect of poor care for breastfeeding on mothers, babies and their families is often not understood higher up the hierarchy.

Letters of complaint from mothers are taken very seriously and are responded to and monitored. You could ask what training the staff have had, what progress has been made towards Baby Friendly accreditation and what plans there are get the unit to full accreditation. If you go to the awards section of the Baby Friendly website you can see what progress has been made in individual units and there is a mechanism by which you can write a letter to the Chief Executive. If the unit is fully accredited please can you let us know and we will take it forward.
Sue

CarmelDuffy Mon 08-Nov-10 13:24:13

hildathebuilder

As the mother of a very premature baby how can we help the NHS balance the need for BF mothers of babies in neonatal units, nicu, scbu etc to be able to spend time with their babies in order to BF with the needs of hospitals and their staff to follow some routines with babies, ensure privacy during ward rounds and also just deal with the fact that there is not the space to allow premature babies mothers to stay in hospitals.

How can we encourage more hospitals to have milk banks and loan pumps for those with a plentiful supply of milk to become milk donors rather than spend the money on formula.

Many many premature baby mothers want to breastfeed but end up using formula as it is easier to get the babies home (by proving that they can feed) if they will take a bottle of formula given it is not possible to visit 24-7 for several weeks. How can the NHS staff be encouraged to let the mothers take their babies home to really give BF a chance to get established.

Thanks

Dear hildathebuilder It is as you say so important for mothers to be able to have free access to their babies in neonatal units and crucial that preterm and sick babies receive breastmilk. Some experts believe that breastmilk is as important (if not more so) than technology for the wellbeing and development of preterm babies. We know this can be done, because there are neonatal units in Sweden where parents are encouraged to be with their babies at all times and they are encouraged to be fully involved with their care whilst being supported and supervised by the nursing staff. If parents are unable to be there for period of time other designated family members are encouraged to visit the units to offer comfort to the babies in their absence. In this country there is at the present time a real drive towards encouraging ?family centred care? which promotes a more holistic approach to the treatment of babies in neonatal units. But you are right that there is still a long way to go. It is a real challenge for mothers to sustain milk production when their baby is preterm or unwell and they need additional support to help them succeed that this. Knowing that by providing breastmilk they are contributing in a unique way to their babies health is really important for mothers. UNICEF UK has recently developed a specific course for staff working in neonatal units to help them improve their knowledge and skills and therefore improve standards of care within their hospital. We have also been really pleased to see some neonatal units take into consideration the importance of parental involvement when they have refurbished or built new units incorporating areas for parents to relax and stay overnight if they wish. The European Association for Children in Hospital states that children in hospital should have the right to have parents or parent substitute with them at all times and that accommodation should be offered to all parents and they should be helped and encouraged to stay. Although this generally does apply to children on a pediatric ward somehow it seems that neonatal units fall outside the directive and we should ask ourselves why this should be accepted.

SueAshmore Mon 08-Nov-10 13:25:13

verylittlecarrot

Without wishing to stomp all over Lenin's point...

"Do you think UNICEF could be more explicit about the bf recommendations being at least two years for developed countries?"

So many people believe that the two years minimum advice is only for poor developing countries without our nutritional opportunities hmm and it would be really helpful to point them to a clear recommendation from UNICEF that applies specifically to the UK too, with the benefits that even babies from developed countries gain from bf for so long.

Thanks

This is a good point. The recommendation is for all countries and yet, I too have had to explain this on occasion. Will give it some thought.
Sue

Guacamole Mon 08-Nov-10 13:25:29

I am a first time Mum who is currently (literally) breastfeeding my son, he is 7 months old. I was with a group of 7 Mum's in my 'Parentcraft' classes, I am the only one breastfeeding at 7 months. Most stopped around the 3-6 month mark. Where has this 'switch to formula at 6 months' come from. I am being hugely pressured by friends and family to switch to formula, 'I've done enough' and I've also been told it will interfere in him taking solids. I can't see myself going to the full WHO 2 year mark, but I'd like to at least make 1 year. What can I say to make them realise I don't need/shouldn't stop just yet?!

SparklePffftBANG Mon 08-Nov-10 13:26:40

just out of curiosity Guacamole, why couldn't you see yourself bf to 2 years?

SueAshmore Mon 08-Nov-10 13:27:00

suzikettles

I gave birth in a Baby Friendly hospital and the midwives were very supportive of bf - really they were. However, midwives were few and far between and trying to support many women and babies. The consistent people on the ward were HCAs and they weren't supportive (it wasn't explicit - but you could tell that their attitude was "just give a bottle and us all a break").

One woman in particular acted almost as a gatekeeper to the midwives. She answered your buzzer and only got a midwife if she felt your request merited it. My requests for help with latching did not merit disturbing the "very busy" midwives and I left hospital with my nipples in shreds and what turned out to be the start of a very nasty infection. Thankfully I had an amazing Community Midwife who turned things around for me.

I have other friends who have found midwives very supportive but doctors dismissive of the worth of bf.

So (sorry - long preamble blush), how much emphasis is put on getting all staff on board when Baby Friendly status is awarded? And how is this checked up on to ensure it's not all lipservice?

There are several issues here. Firstly, is the acute shortage of midwives in the NHS. The birthrate has risen in the UK over the past decade, but this has not been matched in terms of funding or increased staffing for the maternity services and this was not a well staffed service to start with. As an ex-midwife myself, my heart goes out to all those desperately trying to do a decent job in such circumstances.

However, I do take your point about the variability of support and enthusiasm for breastfeeding. We assess many hospitals and community services every year and know that one individual can make or break breastfeeding for mothers and that we are a long way from a harmonious service. Also we mustn’t forget mothers who bottle feed here, they too need education and support which is not always consistent or even available.

Please see previous answers regarding how Baby Friendly works and what we do to encourage consistency. I think we need to see this as a process. The fact that you have both seen supportive and knowledgeable staff demonstrates that they exist. In fact, there are now many thousands of health professionals who understand the importance of breastfeeding and the basics of how to make it work and that is a tremendous leap forward. In the early 1990s it was so few, they generally all knew each other!

However, we are still living in one of the most entrenched bottle feeding cultures in the world and health professionals are part of that culture. Not all are educated yet and not all are convinced even when they have had education. Some have such issues from their personal experience that it is too painful to admit there is any value in breastfeeding. Some fear the loss of power if mothers are so much more important to babies than the ‘qualified’ professional, many are really worried about putting too much pressure on mothers to breastfeed – note how they are accused of this very regularly in the media.

Unfortunately stories like yours are much too common. Whilst we see evidence of some exemplary care in maternity units throughout the country we do also hear stories like yours which saddens us but makes us more determined to keep on pushing for improvements in care. Your wonderful community midwife is an example of how just one person can turn things around and I am so glad that you found that support. The gatekeeper on the ward however is an example of how just one person can also jeopardize breastfeeding and it is why it is crucial that education and training is mandatory for all staff involved with caring for mothers and babies – and that includes doctors who have little or no breastfeeding education during medical training.
Baby Friendly requires that all staff are educated according to their role. The more this happens, the better care will be. In our experience it doesn’t matter who gives the care, it is the quality that counts. If shortages of midwives and health visitors mean that health care assistants are asked to give care, so be it. As long as they are properly trained. More trained staff = more breastfeeding mothers = more understanding of breastfeeding = a more breastfeeding culture.

Sue

SueAshmore Mon 08-Nov-10 13:28:19

EauRouge

Hi Sue and Carmel, very much looking forward to the webchat.

My question is- do you think if the NHS changed their 'just don't do it' policy on co-sleeping and instead gave advice on safe co-sleeping it would make a significant difference to BF rates?

This is not an NHS policy per se, however, it has been adopted in some Trusts.

Our position is that families should be given full information to enable them to decide how best to care for their baby at night. Bed sharing is associated with successful breastfeeding however, there are certain circumstances when bed sharing is dangerous. If parents are clearly informed of the benefits, risks and alternatives then they are in a position to make up their own mind and do what is best for them and their child. Simply telling parents not to bed share is not evidence based practice and also potentially dangerous. For example, a parent believes it is dangerous to bed share and so goes downstairs to feed their baby on the sofa, they then fall asleep on the sofa which is much more dangerous than if they had just stayed in bed. However, they don’t know this, because the staff in their local health service have been told to discourage bed sharing and so are terrified to talk about the issue for fear of being in trouble.

Our position is that parents should have a chance to discuss this and be given written information prior to leaving hospital, this should then be reinforced by the community team when they are at home. Staff should be trained to understand and explain this issue appropriately.

Helen Ball did a Mumsnet webchat recently – have a look at that for more information.

Sue

DinahRod Mon 08-Nov-10 13:29:19

To get access to good bf support is actually not easy. There was so much that conflicted e.g. about cup feeding, syringe feeding, expressing, and with latching the bf mw told me I was doing everything right, my dc was just a 'little tinker'. And as soon as he dropped 10% of his birth-weight there was talk about re-admittance to hospital (not great if you have other children to care for)...no wonder mothers see bottle-feeding as the easier option.

SueAshmore Mon 08-Nov-10 13:30:01

BollocksToThis

Increasingly maternity units are discharging postnatal women within very short timescales, sometimes just 6 hours after delivery. And in many areas the days of daily midwife visits until day ten are a thing of the past, with some women seeing a midwife only once or twice within that period.

How can this possibly be compatible with the BFI, and what are your thoughts on NHS-funded breastfeeding counsellors visiting daily instead, for those mothers who wish support?

Meeting Baby Friendly standards is very hard when postnatal care is so stretched. However, our job at UNICEF is to define adequate, evidence based care and then work with the health service to find ways of providing that care. We are not defining excellent care or the ‘icing on the cake’, we are defining basic, safe care (more the cake board!) and so stand very firm against watering down definitions of ‘good enough’ to fit into current political climates.

Interesting, I think this can be very helpful to NHS staff and managers. When the bottom line of an acceptable standard is defined, then ways of meeting that standard can be explored. I have had a number of visits recently where unacceptable holes in service (not necessarily just related to breastfeeding) have been identified and action plans drafted to address them as a result of working towards Baby Friendly accreditation.
Sue

SueAshmore Mon 08-Nov-10 13:32:08

explorerescueprotect

Hi, I work as a breastfeeding peer supporter within a city that is working towards Baby Friendly accreditation. In the past few months I have worked with 8 women whose babies have been diagnosed by midwives as tongue-tied and yet there is no provision locally to rectify this. I am aware that frenulotomy is not always the answer and that good bf support on attachment and positioning is vital. However, when the bf support has been provided, and women are still struggling there is nowhere for them to go other than exclusively expressing or moving to formula milk. The HCPs Local Infant Feeding Guidelines state that NICE recommends snipping tongue tie as an option but this is contradicted by local clinical policy which is not to perform the procedure. It all seems pretty-unBaby Friendly to me. Does Unicef have a view on tongue-tie and its potential treatment?

6 or 7 years ago UNICEF Baby Friendly were a major supporter of the campaign to get frenulotomy accepted as a safe procedure to enable breastfeeding. We have come a long way since those days and now this procedure is accepted and carried out in many areas. We do share the concern you have hinted at - that in some cases it may now be being overused, with the procedure offered when support with positioning and attachment is what is needed. However, it is not helpful for it not to be offered at all.

Offering frenulotomy is not part of the Baby Friendly standards and so not something that we have much influence over on a local level. However, if you go to our website, you will find a list of places that do provide the service - http://www.babyfriendly.org.uk/page.asp?page=154. In the absence of anything more local, your only option is to suggest mothers travel to the nearest centre to get the procedure carried out.

Sue

CarmelDuffy Mon 08-Nov-10 13:34:17

GraceK

Am posting now as may miss the chat if off for a walk with DD2 (almost 7 mths) trying to get her to sleep! Will the Iniative have some effect on the sudden change of emphasis that comes when your baby hits 6 mths -from "no food / just breast milk" to " why aren't you putting more effort into weaning / stuffing 3 meals a day into them"? This has happened to me in the last month when taking DD2 to be weighed. I was shocked by this sudden change in emphasis & it must surely encourage many women to give up bf-ing soon after 6 mths, when continued feeding would benefit both mother & child for months to come.

Also as someone with v inverted nipples, can I just mention that neither the nhs or Nct mentioned nipple shields to me. Luckily my mother forewarned me & a lovel nurse in Special Care (for DD1) got me one so that she could latch. We then fed happily with them for 22 mths. Why does no one look at your nipples in ante natal care even if you raise such concerns? Leaving it til you have a hungry baby & engorged breasts is no help to anyone.

Apologies for posting two issues. Hope you have a chance to consider both issues even if you can't answer both within the time of the chat

Hi GraceK
As an ex health visitor who worked when mothers were advised to wean or introduce solids between 4 and 6 months( but in reality meant 16 weeks I remember colleagues saying to parents ‘your baby will be 16 weeks on Monday and you will need to begin introducing baby rice etc’. There was also a lot of concern that if solid food (what a misnomer – it was actually slush!) was not introduced the ‘window of opportunity’ would be lost and babies would struggle to accept or tolerate foods. Thankfully the policy now recommends introducing solids at around 6 months which makes so mush more sense in that babies are definitely more developmentally able to deal with other foods. However old habits die hard and the pressure to quickly get babies onto 3 meals a day continues. Some health professionals worry about the baby’s iron stores running out as if this happens suddenly when the baby hits the six month mark rather than it being a gradual process. Introducing other foods should not be treated like a science but should be part of a natural progression. Encouraging babies to experiment with tastes and textures when they show an interest is so much better than force feeding them mush. And of course as you say breastfeeding is still an important part of their diet throughout.

The Baby Friendly training programme for health professionals covers appropriate introduction of solids and since the introduction of the recommendation to introduce solids at 6 months, there has been more interest in this issue and health professionals are becoming better educated about this. However, again it is still patchy.

To answer your question about nipple shields – I am really glad that they worked for you but not everyone is so lucky. The problem is that they can reduce the amount of milk a baby gets from the breast because they limit the amount of breast tissue the baby takes into his/her mouth. As breastfeeding works on a supply and demand basis this can then lead to reduced milk production and the cycle continues. We don’t check nipples in the antenatal period anymore is because babies are pretty good at working with what they have got. They don’t have any pre-conceived ideas of what their mother’s nipples should look like and if they have an opportunity to have unhurried skin-to-skin contact they can generally work out for themselves how to feed from big, small or even inverted nipples!

CarmelDuffy Mon 08-Nov-10 13:35:23

Indith

How do you think we can change the problems encountered by so many women on the wards when trying to bf? Much of the time the MWs would like to help but they simply cannot devote an hour to sit by a mother and help her feed, a mother can be given a bottle to feed her child, the woman in labour needs the MW more.

A group of us trained as peer supporters a while ago and there has been a lot of talk about getting us on the wards to sit with mothers but there seems to be a lot of inaction and a lot of red tape and we are far from it which seems a shame as while peer supporters may not be able to sort out more severe problems, I do believe that they can take the load of the MWs by just being there to hand hold and chat to.

Hi Indith

There are a number of maternity units in the UK who have sucessfully brought peer supporters into the wards to offer additional support to breastfeeding mothers. I am more that happy to put you in touch with some of these hospitals so you can get more information about the process involved. If you can email the helpdesk at bfi@unicef.org.uk
hopefully we will be able to help. I appreciate it can be frustrating when you feel that there is a lot of red tape and beaurocracy but hospital trusts also have a responsibility to ensure that both you and the mothers are protected and therefore there does need to be a certain amount of red tape. Good luck though.

CarmelDuffy Mon 08-Nov-10 13:36:12

SparklePffftBANG

Looking forward to this webshat, hoping I can get my lunch break to co-incide with it (must remember not to go shopping!)

My question is, since most women do start breastfeeding but then the figures fall off at 6 weeks. What do you think the main reason for that is - lack of support to people who want to bf, or people placing more emphasis on the first couple of feeds, either because they are in hospital with expectations to fulfil, or because they believe the benefits of colostrum are worth it, but then don't want to continue? What can be done about it?

Also, what can I do, as a breastfeeding mum, to help?? I have trained as a peer supporter, don't think I would be much good as a counsellor, but would love to get involved somehow?

Indeed SpaklePFFtBANG It is really sad to see such a huge drop off in breastfeeding at 6 weeks and even sadder to know that many of the women who stop breastfeeding did not want to but were forced to because of problems such as pain or poor milk supply which could have been prevented had they received the right support. As Sue said in response to an earlier question – women will succeed if just one person really believes they can do it and that belief along with skilled and knowledgeable support is often sadly missing. It is wonderful that you have trained as a peer supporter because just by believing in women you can do so much to help. Go for it!

neenz Mon 08-Nov-10 13:40:09

I tried to help a friend of mine to BF her second child. I went to visit her in hospital 24hrs after the birth and she said the baby was latching on OK. The MW came in and asked whether the baby had had a wee. My friend said no. The MW said 'If she doesn't wee in the next few hours we'll have to give her a cup of formula'. I was shocked and felt that what was needed was for mum and baby to spend some time alone, skin to skin and feeding.

My friend stopped BFing the nexy day sad.

Was the MW correct with her advice or not?

CarmelDuffy Mon 08-Nov-10 13:40:42

gaelicsheep

Sorry, I know it's only one question each but I've just thought of another. Perhaps someone else might want to ask it, otherwise just ignore. smile

A number of NHS areas are training groups of peer supporters. Is there any evidence as to how effective these peer supporters are wrt improving breastfeeding rates/success in those areas?

Hi Gaelicsheep – There is evidence that peer support programmes can work really well and we do know that health professional input alone is not enough to give mothers all the support they may need to continue breastfeeding. The evidence suggests that it is a ‘package’ of care that is needed – good hospital care, good NHS community care and then interventions to provide mothers with on-going support. Peer support programmes are primarily designed to provide the on-going support. Their success depends on how they are run. Some have been extremely successful, while others less so. The Baby Friendly Initiative for the community requires that the programmes are audited and evaluated regularly and then changed if they are not meeting mothers needs.

We do have some concerns about the fact that there is no national standard for either the training provided for peer supporters or the remit they have within their role. We worry that in some areas there is a huge amount of responsibility placed onto peer supporters and there may not be the support available for them should things go wrong. Health professionals should have ultimate responsibility for women in their care and if peer support is provided there should be robust systems in place to protect everyone involved including the peer supporter. We also worry that in the current economic climate health chiefs could see peer support as a cheap option which could potentially leave them more vulnerable.

SparklePffftBANG Mon 08-Nov-10 13:42:03

Thanks, that's interesting. When we were trained as peer supporters, we assumed to begin with we'd be there to provide some advice. We were told very early on that that wasn't the case and that we were there to listen and not to judge (obviously, not debating that), or really make any comments about the decisions the mother makes.

However, from what you say, our roles should be to be encouraging and believing in women (and to know when to stop) and to be able to help women get the relevant advice from professionals.

SparklePffftBANG Mon 08-Nov-10 13:44:26

x post!
I went to a breastfeeding group soon after training ended, where a new mum came in who was having major problems. The leader of the group said "You've trained as a peer supporter, you'll be able to help her"

So it seems even the professionals don't know what our role is

CarmelDuffy Mon 08-Nov-10 13:47:07

sungirltan

don't know how to word this but....

it seems as if there are women who want to bf and will do it hell or high water, then there are women who don't want to, no matter what but in the middle there are women who are open to giving it a go but when they have problems bf they seem to be let down by mv/hv when they should be referrred/signposted to specialist support. it seems like telling the mother that 'oh its ok, you gave it a try, never mind, time for formula' is acceptable when i think that bf professional help should be recommended and be accessable to all mothers who want it.

i think what i'm getting at is do you think bf support (counsellors, latch on groups, peer supporters) should be explained and promoted to all new mothers?

Yes Sungirltan it is really important that breastfeeding women are provided with the contact details of breastfeeding support both locally and nationally. There is a wealth of knowledge and experience out there and we should all be working together to improve services and support for women. One of the Baby Friendly standards is that women are provided with information on what support is available and how to contact that support before they are discharged from hospital so that they are aware of the help available.

mafog Mon 08-Nov-10 13:50:10

Do you think that the ban on promoting formula for under 6 months, but allowing it for other products above 6 months causes more complications than a full on ban?

CarmelDuffy Mon 08-Nov-10 13:50:51

neenz

I tried to help a friend of mine to BF her second child. I went to visit her in hospital 24hrs after the birth and she said the baby was latching on OK. The MW came in and asked whether the baby had had a wee. My friend said no. The MW said 'If she doesn't wee in the next few hours we'll have to give her a cup of formula'. I was shocked and felt that what was needed was for mum and baby to spend some time alone, skin to skin and feeding.

My friend stopped BFing the nexy day sad.

Was the MW correct with her advice or not?

Sad to say that the advice was not correct. Firstly the midiwfe should have observed a breastfeed if she was concerned about whether or not the baby was feeding effectively. Sometimes it is difficult to determine whether a baby has wee'd in the first 24 hours especially if he/she has also pooed a lot of dark meconium into the nappy. Whilst urine and poo are important indicators of whether a baby is getting enough breastmilk they are part of a wider picture and the midwife should have conducted a full feeding assessment rather than undermine your friends confidence with such a throwaway remark.

tellnoone Mon 08-Nov-10 13:51:10

Do Baby Friendly accredited maternity units have to stop allowing Bounty people on their wards?

I ask because when you go on the Bounty business website (not the one for parents) it actually boasts about Hipp Organic milks - they specifically say their WHOLE range - have been successfully pushed by Bounty. This blatant advertising cannot be consistent with baby friendly ethics.

Will try and find a link.

tabouleh Mon 08-Nov-10 13:53:35

<<panics that my post was too long/contoversial and is too difficult to answer... grin>>

CarmelDuffy Mon 08-Nov-10 13:53:41

WelshCerys

Hi Ladies

I fed my youngest until his 8th year - of course only occasionally and he was enjoying a 'normal' diet the rest of the time. All well and good - and that was a few years ago. But at work the other day talking to none other than a social worker, heard her saying that she thought feeding an older child was unnatural and wouldn't hesitate to confront a parent who was doing so. Wow! She acknowledged it isn't against the law but saw nothing wrong with getting heavy about it, including interviewing the child in question. Hope this problem isn't endemic in a profession that yields so much power in many families' lives. What do you think about all this?

One of the things we have observed over the years working in the very emotive field of breastfeeding is that everyone has an opinion and some people are very forceful in expressing their opinions. It is difficult to comment on a whole profession as this may just be the views of one individual and one would hope that she would not have the power to act alone. It does seem strange that she would be concerned about something that is done in a loving and nurturing way when there are horrific stories of child abuse being conveyed in the media.

LeninGuido Mon 08-Nov-10 13:54:13

<catching up>

Thanks for answering my question Sue, good point, you're right.

SueAshmore Mon 08-Nov-10 13:54:23

DinahRod

To get access to good bf support is actually not easy. There was so much that conflicted e.g. about cup feeding, syringe feeding, expressing, and with latching the bf mw told me I was doing everything right, my dc was just a 'little tinker'. And as soon as he dropped 10% of his birth-weight there was talk about re-admittance to hospital (not great if you have other children to care for)...no wonder mothers see bottle-feeding as the easier option.

Conflicting information is one of the commonest complaints from breastfeeding mothers. Sometimes this is because the situation changes and the health professional is responding to this, but unfortunately sometimes it is because of a lack of training which leaves the health professional not sure what to do next. See our previous responses re our work to improve training and practice within the maternity services. I do have a great deal of sympathy for mothers who just feel it is easier to bottle feed when they have faced problems as you describe. Our job is to keep working to improve the service so that this is far less common and then mothers will be in a position to make an informed and free decision whether or not to breastfeed. Currently, it is not much of a choice if you are in a position where you feel you have to stop because it just isn’t working and there is no one able to support you to carry on. Sue

LeninGuido Mon 08-Nov-10 13:56:55

"Logically, young children will only breastfeed if they want to..."

So right, it really annoys/ed me when people would say 'are you still bfing him?'. I wasn't forcing him or even encouraging him at all, quite the opposite at times.

neenz Mon 08-Nov-10 13:57:03

Thanks for your answer, hope you don't mind a follow-up question.

In situations where MWs are 'pushing' formula on mums when it is not necessary how does that fit in with BFI and is it OK wrt to hospital giving away the formula for free?

How many days should a BFing mother get post-birth before she is told 'you have to give the baby formula now cos it is not getting any/enough BM'?

SparklePffftBANG Mon 08-Nov-10 14:00:11

Thank you for answering our questions

neenz Mon 08-Nov-10 14:00:38

Sorry, I meant that if the MWs don't think BFing is going well (as with my friend) is it 24hrs/48hrs or longer before they should start offering formula.

My cousin BF for a week - after a week the MW said the baby had not put on enough weight and she would need to top up. After a week! She was FFing within a week sad.

Why are MWs still giving out this poor info?

Serendippy Mon 08-Nov-10 14:02:29

If you know a woman who failed at BF the first time round, how can you convince her to try again the second time? I thought it was going to be easy as it is natural, everyone does it etc but failed completely. Now I am worried that next time I will be to afraid of failing and the pain and guilt that goes with it to try. I had people at the end of a phone last time but I think I needed someone there in person. Would you recommend paying for someone private? (Sorry, bit garbled!)

SueAshmore Mon 08-Nov-10 14:03:50

rubyslippers

Where to start with this?

Most of the issues I wanted to raise have been done already

I especially agree with the post re the advice on feeding until 2 years old

I have had to justify myself on 2 recent occasions to friends about why I am "still" feeding

I think the key to successful breastfeeding is expectations ... So for a MW or HV to be able to reassure a mum that a baby feeding very frequently, and cluster feeding is ok for example and doesn't mean your milk isn't enough or you need to top up

I think we need to temper the idea that babies should go 3 hours between feeds and then drift off to sleep in their Moses baskets

Co-sleeping was the key for me to successfully feeding in the early days so can this be encouraged? My Baby friendly hospital rooms babies with mums but not in their beds ...

I think you are spot on with your comments regarding frequency and patterns of feeding. We do cover this in some depth on our course and it is part of the Baby Friendly assessment. However, the belief that breastfed babies should feed at regular intervals and only a certain number of times a day persists. In the UK it is so part of our general belief about normal infant behaviour – all based on bottle feeding of course, and it has proved extremely difficult to get across that this is not how breastfeeding works. I agree that if we could crack this misconception with both health professionals and mothers, we would be a long way to solving many perceived problems about breastfeeding.

See my other answer regarding bed sharing

CarmelDuffy Mon 08-Nov-10 14:04:28

tabouleh

Hi Sue and Carmel - I think that the Baby Friendly Initiative is a great one and hope it can be rolled out everywhere.

(I feel that I was failed by the NHS wrt to BF advice etc. DS ended up in hospital and diagnosed "failure to thrive" and formula top ups suggested.)

So my question is about formula.

I feel that that a key part of Baby Friendly should be PROPER info and advice about formula feeding: differnet formulas/how to feed and most importantly preparation.

Your website has the only decent leaflet about formula - so well done for that.

But why on why can that info not be properly
explained to parents?

Why do HCPS not explain that formula is not sterile and that to make it safe it needs to be made with water which is 70 degrees?

Why do they not explain alternatives to making a fresh bottle each time (carton out and about/in middle of night/you can make bottle up to 2 hours before feed finished/water in a flask at 70 degrees - and yes make in advance cool rapidly store in fridge for a minimal time)?

So many just say "oh well you're supposed to make in advance but you can just make with cool water".

Your own leaflet on this page is rubbish I'm afraid - it is 5 years old and it fails to mention that to get water at 70 degrees it needs to be 1 litre boiled and left for 30 mins - it also fails to mention that there are some safe alternatives to making fresh.

And as for the leaflets in other languages - well some of them do not mention the 70 degrees at all. I emailed babyfriendly mid July and was told

"I have spoken with our website and resources editor and we are getting all of our leaflets updated over the course of the summer."

I feel passionately about safer infant feeding - and working towards higher BF rates is part of that of course. But at the moment where we are living in a formula feeding culture - let's make sure that HCPs can give advice on how to actually safely feed formula. That should be easy. Then get on with increasing knowledge of BF.

Please can I have your thoughts on safer formula feedng?

Thanks!

Thank you for your kind comment about our recent leaflet. Like you we believed that the information avaliable for mothers who are formula feeding was really patchy and much of it out of date. We want to ensure that all mothers however they choose to feed their babies receive appropriate information to enable them to feed as safely and effectively as possible and it is crucial that mothers are provided with the latest information on making up formula feeds. I am sorry that you accessed some outdated material form our website. we are currently revamping the entire website and hope to make it the best breastfeeding website in the world so hopefully all outdate material will be removed when we make the change over.

elkiedee Mon 08-Nov-10 14:07:16

Other products are promoted well before 6 months - I was given a "weaning" bounty bag with all the products marked 4 months. I was pleased to learn later that the dental health woman who comes to talk to baby/toddler group parents about teeth is horrified by such products as the apple juice (even after 6 months).

So many stories in this thread bring back bad memories for me - I didn't manage to bf DS1 and felt terrible about it, but am still feeding DS2 at 21 months after a bad start.

elkiedee Mon 08-Nov-10 14:10:12

serendippy, you could try and contact/meet any local bf groups in your area before baby arrives - are you working or at home with first child? I know my group was open to pregnant women as well as bf women.

SueAshmore Mon 08-Nov-10 14:14:10

Serendippy

If you know a woman who failed at BF the first time round, how can you convince her to try again the second time? I thought it was going to be easy as it is natural, everyone does it etc but failed completely. Now I am worried that next time I will be to afraid of failing and the pain and guilt that goes with it to try. I had people at the end of a phone last time but I think I needed someone there in person. Would you recommend paying for someone private? (Sorry, bit garbled!)

I would want to debrief with you exactly what happened and look at where things could have been different and then discuss with you your options for this baby. It would be worth finding out whether your maternity unit has an infant feeding advisor and asking for an appointment to talk to her, she can help you make a plan. There may also be a peer support programme in your area and again you could ask to talk to someone from the programme. Another alternative is to ring the NCT helpline or the National Breastfeeding Helpline. Even if you don’t breastfeed you can still enjoy skin contact etc with your baby – see Carmel’s answer on care for bottle feeding mums. Very best of luck Sue

CarmelDuffy Mon 08-Nov-10 14:15:48

neenz

Thanks for your answer, hope you don't mind a follow-up question.

In situations where MWs are 'pushing' formula on mums when it is not necessary how does that fit in with BFI and is it OK wrt to hospital giving away the formula for free?

How many days should a BFing mother get post-birth before she is told 'you have to give the baby formula now cos it is not getting any/enough BM'?

No mother should be left in a siutaion where problems with feeding are discovered way down the line. The Baby Friendly standards are that mothers are helped with breastfeeding until they are confident to do so. From January one of our standards will be that when mothers are discharged from hospital they have a discussion and are provided with information on how to recogise that feeding is effective and where to seek help if they have a problem. A further feeding assessment should be carried out again at day 5-6 and again at handover to the health visitor. Most breastfeeding problems are preventable with good support and when we read about stories in the media about babies being readmitted to hospital because of dehydration it is ofen breastfeeding that is portrayed as the problem when the reality is that no one has picked up on feeding prblems earlier and put practices in place to overcome them

Serendippy Mon 08-Nov-10 14:17:16

Thanks elkiedee I have actually just sent you a message as was so impressed to see that you are still BF at 21 months! There is no BF group in my small town unfortunately, maybe by the time I have another! It is great to read about all the steps towards better supporting BF, have been cheered up by this webchat grin Also by the advice anout FF and making it safer rather than 'it is not as good, don't do it, therefore we will not advise you' which can be found.

RachelMumsnet (MNHQ) Mon 08-Nov-10 14:17:20

Sue and Carmel have to close now. Thanks to all for your questions and big thanks to Sue and Carmel for joining us today for such an interesting discussion. We'll be archiving the discussion later in the week.

Serendippy Mon 08-Nov-10 14:18:25

Thanks for answering, Sue will try and contact an infant feeding advisor, didn't even know such things existed!

SparklePffftBANG Mon 08-Nov-10 14:19:08

Thank you

CarmelDuffy Mon 08-Nov-10 14:22:54

Phew! How fast the time has gone. It has been lovely chatting to you all and it makes us more determined to carry on trying to improve standards within the health service. You also have a powerful voice and it is important that you ensure your local health trusts hear what you have to say. Visit our website on www.babyfriendly.org.uk to see how you can do this. Bye bye and thanks again for all your interesting questions and comments. Carmel

SueAshmore Mon 08-Nov-10 14:23:37

Thank you all for your intelligent and pertinent questions, I have really enjoyed talking to you all. Watch out for our new improved website coming in December, we hope it will be much more parent friendly and we hope you will give us your comments on the site to help us keep improving it. Very best wishes to you all Sue

LoveBeingAMummy Mon 08-Nov-10 16:02:32

Thanks ladies, I do think though we are missing a trick by not doing more to get the message through at a young age, should defo be more part of sex education.

neenz Mon 08-Nov-10 19:59:29

Thanks for the webchat, it was very informative. Come back again soon please because I have thought of loads more questions!

gaelicsheep Mon 08-Nov-10 21:46:04

I am gutted that our power was off all day long and consequently I missed the webchat. Belated thanks to Sue and Carmel for answering my questions.

rubyslippers Tue 09-Nov-10 21:04:34

Thank you for answering my question

Good webchat - thank you

Join the discussion

Join the discussion

Registering is free, easy, and means you can join in the discussion, get discounts, win prizes and lots more.

Register now