today's Guardian parents' section - MWs don't get bf training before qualifying!

[CarolinaMoon]

anyone else find this rather :

'Sally Inch Infant feeding specialist at the Oxford Radcliffe Hospital Trust

Astonishingly, there's no requirement for midwives to be taught about breastfeeding as part of their pre-registration training. It seems such a basic thing to do, and of course many people assume midwives are experts in breastfeeding. But breastfeeding is a learned skill - I trained as a midwife, but it wasn't during my training that I learned about it, it was by watching women and learning from them, as well as from other skilled experts and feeding specialists.

What figures show is that the biggest fall-off in breastfeeding rates is between birth and two weeks, and that's precisely the time when they're in the care of midwives. So what I say is, give them a clear and uniform training so they all know what they need to know. We wouldn't let a midwife qualify if she hadn't been taught how to deliver a baby, and she shouldn't be allowed to qualify if she hasn't been taught how to help a woman breastfeed.'

[Carla]

Doesn't surprise me in the least.

[bakedpotato]

My MW, very nice woman, said she was trained in b-feeding. However, she was pretty rubbish when it came down to it (I was really struggling to start with). I realised how poor her advice was when I sought out a BFC who really did make a difference (admittedly only when I was feeding with her right by my shoulder, but still...). However, I only managed to be organised enough to see the BFC once, as it involved leaving the house and she only ran the occasional weekly clinic nearby.
It would have been amazing if MW, who came to see me so regularly in the first fortnight, had been able to give really constructive advice. I managed to stick with the b-feeding (just), but I can't say she helped with that. Seems obvious that properly trained MWs could make a massive difference to national b-feeding rates.

[Caligula]

Shocking but thoroughly unsurprising.

Someone should consider training HV's as well - or at least advising them that they haven't been trained, so they at least know they know nothing. That would be a start. I can understand why they're not trained - it's an extremely time-intensive thing, supporting a mother to bf and there's an argument about whether it should be part of their remit, because to do it properly would not fit in with all the other stuff they have to do. But at least they should be trained not to sabotage.

[kerfuffle]

Midwives have an extremely varied role, and our profession dictates that we are updated and competent in all aspects of professional practice. lhlowever, I don't think I will be the only midwife to admit that often we have a preference and an aptitude for a particular aspect of care.Also, our level of expertise can be limited in certain areas. I love labour ward whereas many of my colleages prefer antenatal and postnatal care. I have always been an advocate for breastfeeding and helped women feed their babies wbhichever method they choose. The majority of the time I am a help. Sometimes I feel I need help from someone with more experience and in-depth knowledge when certain difficulties arise.i dofeel the training I recieved as a student was fairly limited in a practical sense. As a qualified midwife I am responsible for providing my own updating training, I have to do it in my own time, and I have to pay for it myself which is often v. expensive. I therefore tend to choose subjects that are of particular interest tto me. I think the solurtion to this problem is to allow midwives to choose their own area of expertise and tailor the training accordingly.We are often expected to be a jack of all trades which invariably results in unhappy parents.Sorry if this sounds like an excuse.

[tiktok]

kerfuffle, I think the point is it shouldn't be up to individual midwives how well they are trained in breastfeeding. Clearly, some will have more of an interest in it than others and there should be opportunities to specialise, but the basics of breastfeeding should be taught as a matter of course to all midwives - as it says in the paper, we expect all midwives to come out at the end of training able to deliver a baby.

I think there is a lot of emphasis on encouraging breastfeeding and precious little on helping to make it work

[moondog]

Tiktok,the mws who looked after me are all b/f counsellors. I rather naively thought all of them have the same level of expertise until jolted into reality by mN!!

[kerfuffle]

Yes I agree. The basics of breastfeeding are taught to all midwives, but mypoint is that sometimes you need a much deeper level of experience and knowledge. I have experience of this on a personal level also as I did no recieve the help and support I needed as a breastfeeding mother and ended up with poor supply. My community midwife, my health visitor and several breastfeeding councillors could not give me any useful practical advice or help, there needs to be some changes made.

[fastasleep]

I've been saying what Sally Inch said since I was pregnant with my first! It still amazes me.

[kerfuffle]

You will be glad to know that I am seriously considering a career change. Since my own experience with breastfeeding I am doubting my ability to be the kind of midwife I am required to be to fulfill the needs of the women in my care. I used to think I made a difference, but since experiencing a difficult childbirth and breastfeeding experience myself, and listening to the opinions on MN ,I think this is a task beyond me.

[tiktok]

Awwww....kerfuffle, you sound low. I really don't think support for breastfeeding should be that hard, and actually knowing you don't know everything is a really good help in that! It's the midwives and HVs who don't know they don't know that are the most useless

Most women do not need a huge amount of help. A small number do, and may need referral for more specialist help. But the majority would be just fine with the basics....and even the basics are sadly lacking.

[mears]

kerfuffle - please do not be so hard on yourself. Being a midwife can be pretty stressful at times.
I can appreciate your points about specialisation and the difficulties and costs of updating. Our hospital is Babyfriendly where there is an amphasis on staff training being compulsory. There will always be midwives who are not good a breastfeeding support, but lack of knowledge should not be the cause. Student midwives do learn about breastfeeding but until they actually experience assisting mothers over a length of time, they will not have the indepth knowledge that will be gained through further training and experience. That is the same for most areas of midwifery.

[kerfuffle]

I agree. I am an experienced midwife, I have been practicing for 12 years prior to having my dd and have never doubted myself. I have always been well respected by my colleagues and have always had favourable feedback from the women in my care. I just think the demands of the job are becoming too great. We have to do our best for women and families and balance this with the constant threat of litigation in the back of our minds. We have to attend study days in our own time. I have to sacrifice spending weekends, Christmas, and other special occasions with my family.Now we are expected to all be expert breastfeeding councillors as well. I don't think I can rise to that challenge, or want to for that matter. Don't get me wrong, I strongly advocate breastfeeding. I encourage women to have skin-to-skin contact with their baby as soon as it is born if possible. I encourage unlimited access to the breast and good positioning. I encourage exclusively breastfeeding until lactation is established. I can help with hand expression and pump expression although I don't often work on the post-natal ward. Unfortunately though, if the woman is still having problems or the problem is more complicated ,I know my limitations and refer her to someone more expert. This, however, does not seem enough.

[kerfuffle]

tiktok, I disagree that breastfeeding support shouldn't be hard. Sometimes midwives spend hours and hours, blood, sweat and tears helping mums to breastfeed. We do want to help, really!
However, it isn't always easy, sometimes the baby hasn't read the book we a re all reciting and someone with a real 'knack' is required. You can't teach that in a midwifery school. That is why I think those midwives with an aptitude for it should be able to become breastfeeding councillors and those with other strengths should learn the basics and then know their limitations. Unfortunately there are many midwives I know who feel the same, and soon you won't have any left to deliver babies. You will have doctors and post-natal nurses instead.

[morningpaper]

Shame that each hospital can't have a lactation specialist.

[bakedpotato]

... who does homevisits

[morningpaper]

My community midwives all had formal breastfeeding training - is that not normal for community midwives? One was a lactation consultant and all the others had unicef (I think) training.

[kerfuffle]

Exactly.

[bakedpotato]

MP, my community MW was similarly trained, but her expertise fell very short

[kerfuffle]

ihave had unicef training, it is a one day training that is pretty basic.It does not arm you for some of the problems that can occur.

[mears]

Do you have Bloomsbury Workshops kerfuffle?

Is your hospital Babyfriendly?

[kerfuffle]

BTW, I think all community midwives should have in-depth training as they are the ones that encounter problems with engorgement, supply, mastitis, etc

[kerfuffle]

Mears, no we don't have Bloomsbury workshops. Our breastfeeding rate is not good enough for baby friendly status.Unfortunately many women in our area don't want to breastfeed from the off. We did try for baby friendly status, a few midwives who had a particular interest were sent on a unicef course and then they gave us all 1 day in-house training days. HCSW's were included.

[mears]

It is sad your unit has not persisted, Our B/F rates are not good but having BF status means that there is an obligation to train midwives and establich good practice. Women and midwives attend bloomsbury workshops which is good for both. Your Head of Midwifery is a bit behind the times if there is not an emphasis on good breastfeeding practivce which is basically what baby Friendly is. All midwives have to participate.

[mears]

Also needs an Infant feeding advisor to co-ordinate it all.

[kerfuffle]

You are right. Our head of midwifery is not commited to much really. All our updating is done off our own back, except for three in-house training days which are mandatory. We pay for them ourselves and have to go in our own time. There is no budget for study leave/study days.