To ask how you'd feel if your midwife asked you this question?

[SeattleGraceMercyDeath]

I'm a midwife at a large unit currently going for BFI status and we have been instructed to ask all women regardless of their stated intentions if they want to give their baby a breastfeed.

So even if a woman comes in very clear in their mind that they want to bottle fees and for whatever reason they don't want to breastfeed we have to ignore that and ask them if they will offer a breastfeed instead.

I have had a heated debate with the breastfeeding coordinator as I refuse to do it as I feel it will undermine my relationship with the bottle feeding women I look after.

So if you have made the decision to bottlefeed how would you feel if your midwife ignored that information and instead asked you to give your baby a first breastfeed, would you as the coordinator feels, think that you might have your mind changed or would you think 'that midwife hasn't listened to a word I say' and feel under pressure or made to feel guilty.

I'm prepared to have my mind changed but it just feels so wrong to me!

Tbh I really don't think that talking about bfing should be done just after you have given birth.
Who on earth will have their mind clear enough to actually have a discussion about it,unless they already clearly know all the ins and outs?
And talking about it earlier, when the woman is in labour in the middle if contractions or under the influence of diamorphine? IMO both of those are a NO-NO. The one time it should be discussed is before hand.

I think I would just ask the woman 'if she would like to give the baby a breast feed?' Once the baby is her arms. And does she think she would need some help to do so? rather than then leaving her on her own to do so
The tone of Boise is essential here, more than the words. Whether you want to force them to do so will be a cutely felt I think and the woman will be in a vulnerable position which is why it's even more crucial nit to force her to do something she doesn't want to do.

Seattle

Assuming that all pregnant women plan to BF is ignoring the first principle of nursing and midwifery care- individualised, which recognises the personhood of the woman/patient.

I know you personally are not responsible for this but it needs challenging by all MWs and HCP's before this insidious process turns care into even more of a sausage factory.

In the scheme of things......so what? If you don't want to BF just say no. If the MW suggests you let baby have some colostrum as suggested above or sensitively asks the question then so what?

lagoon I think that what the OP is saying g is that she is out in a position to 'push' the women to give it a try 'just in case they might actually do even though they hadn't planned to'.
Sensitive questions are always ok.

Thing is though if you are on medication you will probably have had this conversation several times over prior to actual delivery of your baby.

I met with the obstetrics team, a paediatrician and my own consultant (and a thread on here!!) before actually giving birth and we'd discussed it to death tbh. And whenever you meet anyone new you go over the same old ground again - like a broken record. Although I don't really blame anyone for not reading my huge notes it was all over my hand held ones.

Incidentally noone asked about my meds when I was on the ward I just had my prescribed stash in my bag(as I was told to do) and whilst I wasn't surprised, the poor on call doc was (when I went down with a hideous chest infection) when I said I was immunosuppressed and needed some antibiotics.

As an aside I did try to bf Ds1 so had to stop my medication 2 weeks before my due date to get it out my system so post birth is too late to change your mind anyway in my case. Ds 1 bf was a complete disaster for other reasons and despite only being off the meds for 4 weeks in the end it took 6 months to get me back stable again (and that partially influenced the advice of my consultant with ds2.)

Stuff breastfeeding, can midwives and maternity services get on with the vitally more important task of ensuring all women are safe and well-cared for during labour.

This would be acceptable:

"I know you stated you would like to bottle feed, but we are required to ask if you would like to try a breast feed first"
"No thanks"
"Ok"

But the second a person starts pressuring or trying to guilt trip me would be the moment I got annoyed.

The best thing our pediatrician did for us on our hospital release check up when I said I wasn't sure if I wanted to breast feed anymore was to tell us that she has healthy FF babies and sickly BF babies. Then she gave us some free formula samples and recommended some bottle brands.

The point is, we got information on how to successfully bottle feed, and important information on formula feeding. We got to make a fully informed decision, and parent based on our life style and what would work best for us. Of course, this is also in the US where our rarely paid maternity leave is up in 3 weeks, so lots of people here are FF so they can work and leave their babies at daycare.

I feel for you OP, tough job you have. Slightly appalled by how aggressive some pp are on this thread. I am not sure why anyone would get angry about someone double checking on something as important as baby feeding. The midwife's role is to advise parents and help babies and I think it is also their duty to encourage women if possible to breastfeed and to provide assistance for those that struggle. There is no need to bite anyone's head off about it or throw a little paddy.

I don't think id really be bothered and just realise that you are doing your job.
That said I'm not easily bothered or upset with things.

I wouldn't do it.

There is too much bullying of women going on at the moment and I think your instincts not to ask women who are clear about their decision are correct.

as an infant feeding coordinator working towards BFI tell your breastfeeding coordinator this is not a BFI requirement.

What is a requirement is to offer all women skin to skin contact at birth
(note the offer), many babies will move towards the breast and feed, some women who planned to formula feed may let the baby self attach and choose to offer a breastfeed, others will ask for formula. Midwives should encourage the first feed in skin to skin contact regardless of method.

The new BFI standards are very clear about offering information and supporting women's choice and never asking feeding intention at any point. They also are exceptionally clear that parents who choose to formula feed should be offered information and support as should parents who choose to breastfeed.

Ask your infant feeding coordinator where this is in the BFI standards. I am tired of breastfeeding advocates being demonised and misunderstandings like this don't help.

I am also sick of the misunderstanding of the BFI standards, you don't not ask antenatal feeding intention because you assume breastfeeding you don't ask because evidence suggests it pigeonholes people very early on, rather than allowing them to make an informed choice based on the circumstances they find themselves in. Honestly BFI standards are such basic care that if midwives aren't doing it anyway I'd question the standard of care they are giving.

Assuming BF is a bit of an odd assumption. How does this work with treating mothers as individuals and not making assumptions about them?

It would piss me right off. However you say it it's pressure.

writerwannaebe 83 .i just thought she would bugger off quick .i have no problem with anyone feeding there baby where ever how ever they feel like .

I realised early on in my first pregnancy that the best way to get the breast nazis to leave me alone was to tell them that I was going to BF.

After DS was born, one of the MW asked me why I was FF when I had advised her that I was going to BF. I told her that I lied. In the same way that she lied to me when she promised to get me an epidural.

To answer the OP, I would be pissed off if I was asked the question, especially if I found out it was for a tick boxing exercise and not for the benefit of my baby.

PicandMinx

My experience tells me that the mid to long term support for breastfeeding isn't there.

No use offering colostrum, post birth when there is no follow up when problems/queries arise later.

So I don't think you should be asking if someone is clear already. If you must, then preface it with "I'm required to ask" or similar.

I realised early on in my first pregnancy that the best way to get the breast nazis to leave me alone was to tell them that I was going to BF.

I haven't even given birth yet but this has already occurred to me with just with my experiences at the midwives clinic and the antenatal classes. I am intending to try - but from early on realised that saying "yes" is really the only answer that will shut down the converation, and tbh if i was intending to FF I'd probably be lying through my teeth also.

Just cos I don't need the frowny-face, where they may as well say "So you're intending to let your baby down fro Day 1, are you?"

I was asked during the labour would I bf or bottle feeding. I said I would like to try bf but I wasn't dead set on it. Basically if I found it tough I was going to stop. When my daughter was born she was immediately put on my chest and straight away the midwife was trying to get me to bf. I felt after a traumatic 13 hour labour and having not eaten in 18 hours I would have liked a few minutes. I didn't even get to eat my tea & toast!
If after stating I wanted to formula feed and was asked again I would be annoyed because I would feel its undue pressure. Amongst my friends we all know about bf and it benefits but if we still choose to ff then that's our business. The last thing you need after having a baby is to feel like your choice is being questioned.

I think the nest way (similar to a poster above) would be to say
"Hi xx, how are you getting on?, I remember/see on your notes you plan to bottlefeed, do you have any questions or support you'd like with that" then after answering any questions say "you might have already ruled this out, which is fine, but some women like to give one feed to help with immunity (etc) before moving on to bottles, is that something you'd be interested in trying" if they say no, absolutely leave it there with no neg comments. If they say yes - help them, if they say maybe say "there's no pressure, would you like to think about it for a few minutes and I'll come back to see what you've decided".

I read only the OP's posts so don't know if this has been said...

Could you have a pamphlet instead? Just a litte "Did you know..." which lists the ability to:

1. Breastfeed
2. Express / bottle
3. Formula

As well as the pros for each method ensuring it reads balanced?

Maybe some women don't think about expressing for the colostrum before formula feeding so it wouldn't hurt to ask.

What if it was the other way.

Imagine a mother that had decided to bf asked if she didn't want to 'try' bottle feeding just once. (It actually happens more often than you would think)

It is insulting and undermining.

So is the converse.

Mothers should be supported in their choice. By all means give them all the data that shows that bf is better, but if they don't want to then respect that!

I bf both of mine, btw despite the best attempts of the medical establishment here

As an amusing anecdote, a friend of mine is a childminder and as a part of getting accredited had to sit an exam where she had to say in a multiple choice question that formula was just as good for babies as breast milk, and had other ancillary benefits too. And they had some young 'biologist' teaching this to a whole class of mostly mothers...

Nestle still rules in France!

I'm a midwife at a large unit and the breast feeding co ordinator tried to implement this (quite aggressively) a couple of years ago. On a professional level I understood all the possible benefits of implementing it but on a personal level I felt like it was under minding a woman's right of choice. It made no difference to the breast feeding rates but was highlighted Frequently as a negative aspect of care on patient satisfaction surveys

I think it depends how it is phrased. It could be awful for patient relationships.

I think that, all that 'my boss says' stuff would put up real barriers. It implies that your care is based on protocols and that your own ability to use your judgement is limited, which undermines trust. I also think that the question should acknowledge previously stated intent. I bf, but if I didn't, something like:

"I know you've said you plan to ff. Do you want to try offering a bf for the colostrum or shall I get you a bottle?"

would have been ok with me.