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!

My last post read back as a bit aggressive, sorry (didn't mean it to sound that way at all, just matter of fact).

To be completely honest OP if you are working for the NHS you should be promoting what is best for the baby's and mother's health -- which in the early days, at least, is to bf. There's nothing wrong with suggesting the mother try a bf just as there's nothing wrong with suggesting the baby have a vitamin K injection, or their immunisations, etc. In fact it's (scientifically) pretty unprofessional not to.

Mothers may not want to do whatever it is for their own private reasons, but state health workers are not there to champion personal choice -- they're there to promote best health according to what the profession as a whole knows.

Scarlett I feel the same way as you do, and so do lots of other women.

Scarlett - That is interesting re 'parasite'. Did you feel that way during pregnancy too? It's an emotion I sometimes struggled with during pregnancy itself (but never on bfing), which is why I am wondering.

more does the mother's mental health get excluded from that equation?

Something I noticed on the postnatal ward was that every midwife did ask the question, and I mean every midwife and since I was there for 4 days and they changed shift every 8-12 hours, I was probably asked the same thing by both "my" midwife and the supervising midwives a total of nearly 20 times! It was quite a big hospital and I didn't get the same midwives back on later shifts very often. I really wish I didn't have to keep repeating myself, whatever the question and whatever the answer.

Morerogermore- I really hope that as a real life person, and not a robot, that the OP would be able to provide advice that encouraged both personal choice and the party line? I'd hate to think that midwives purely read from a script. I thought that a more empowering nhs would recognise that individuals do have choice and that parent autonomy is important and should be encouraged.

Further down the thread someone provided a suggestion that the OP state that she could show a new mother how to breast feed if she was interested. I personally think that is enough.

Penguins, not as far as I remember - I was ok with being pregnant, but had nightmares about giving birth to a 'thing' that crawled up me and latched on; I requested 'clean and wrapped' too because of that (didn't want delivered onto stomach).
I had a c-section in the end for both boys in the end though so that took some of the horrors away.
It's not something that stayed with me though, once the birth was over with I was ok.

The whole ff or bf is just relevant for such a small period of time which is why I am always shocked at how heated it all gets, I just hate that it is assumed that every woman wants to do it deep down, she just needs convincing - it riles me!

Thanks for answering. I do agree re assuming people want to deep down. I suppose where I was coming from was that so much changes in labour and birth (you think you do/don't want epidural but find the opposite etc) that there was no harm in a sensitively worded, one off " is ff still the plan" type question. Not badgering or guilt tripping though.

Penguins "is ff still the plan?", Is actually a better way of wording it I think - it acknowledges your previous sentiment and does not seem like an attempt at persuasion like "would you like to try bf; what about bf; will you be giving the colostrum feed" etc.

winner I'm not sure BF is best can be described as a party line, it's just true and also statistically there are very few women who can't do it. I understand lots don't want to and that's always been the way, but since doing it is of no detriment to the mother and a huge benefit to the baby then why not encourage it? Is it that different to encouraging mothers to eat healthily while pregnant - or would that be down to personal choice too?

treacle obviously if the mother has mental health issues she should be receiving specially tailored care, but it's wrong to assume de facto that mentioning something as natural as being pregnant or giving birth should be likely to trigger mental health issues.

I think it depends on how the lady has previously shown her desire to formula feed. If it is written I to her birth plan,mbut there has been no verbal mention of it, I think it would be fine for the midwife,soon after birth to ask if she would like the baby put to the breast. It would be fine then for them to say yes or no.

If there has already been a discussion about it during labour, it might still be acceptable after birth to ask 'now that you've given birth and have your baby in your arms, do you think you'd like to try a breast feed' again, said in a non-pushy tone, so that the mother can easily say yes or no. If they then say no, I don't think any more should be a said about it at that point. I think IT IS FINE to ask at this point and not undermining of the patient/healthcare professional relationship. Going through birth and suddenly finding you are a mother does change the way some people feel. Some people were totally anti breastfeeding, or anti pain relief, or whatever until they experienced labour or holding their baby. People do change their minds and asking the question just gives them a chance to do that and also to recognise that just because they expressed one opinion before, they can change their mind.

Some people seem to get asked the question by every healthcare professional they meet. Although being asked by every single person you come into contact with might be a bit annoying, I think we can build up this annoyance in our own minds as health care professionals. It isn't an out-of-place question to be asking in a hospital, to a new mother. Being given several opportunities might help someone who is anxious to decide to just give it a go. There are other questions which are routinely asked by every healthcare professional too, just in the task of getting up to speed about this particular patient. Asking about breastfeeding g could be seen as one of these.
However, I think there is a difference between light-heartedly asking a quick question and trying to push someone who doesn't want to into it. It is this which is annoying and damages the relationship between healthcare professional and mother, not a brief, simply answered question. So it needs to be a genuine question, which the mother can give any answer to, without feeling it is the wrong answer. And it needs to be put in a way that they feel like any answer is acceptable. A few people will be offended, even by that, but I don't think it should put health care professionals off asking. Most people will simply answer an honestly asked question......and a few who wanted to ff, will decide to try a breastfeed.

So, don't be put off asking, but ask in the right way.

more, I suppose I should have been clearer, I didn't really mean that mentioning bf to someone might cause them some sort of mental health crisis. It was more for those mothers who know that they can't do it, and have explained why they can't do it, and are often upset about not being able to do it. When you're already emotional and upset and hormonal, it could easily be very upsetting to have to listen to 'I know you've said x but I have to ask you anyway...'. It would have upset me and I'm normally someone who is fairly thick skinned. It just feels like the mother is some sort of a vessel whose comfort or happiness doesn't enter into the equation.

I suppose it isn't that different to suggest healthy eating in pregnancy! You ask once if they'd like assistance or advice, and then after that you treat people like adults- i.e. make sure that they understand that if at any future point they need help, they can ask for it. You don't keep on about it at ever juncture.

There is a difference between encouragement and asking the same thing repetitively so that you can fulfil a tick-box exercise.

Most mothers seem to be asked how they intend to feed before they are in labour- i.e. at a midwife appointment previously. If it is in their notes they state they would like to FF I think an offer from the OP that she's happy to show them how to breastfeed if they are interested, but if they want to stick to FF (as detailed in their notes) that's okay too.

sorry for typos!

If it was done in a tactful no pressure way then it would be fine. As long as it wasn't a case of "oh are you absolutely sure you want to bottle feed? Breastfeeding is the best for your baby for this reason, that reason etc." After the woman had clearly stated they wanted to bottle feed... I can't see an issue with "have you thought about giving baby your colostrum at first?" Or something along those lines. Some women might not actually know anything about BFing and this could spark an informative conversation with them. It's important women are informed fully of the options, there will be many that purely go off the biased opinions of friends or relatives.

Oh yes treacle I understand in that instance. That should be on their notes/in MW's head and then they shouldn't ask. That must have been very difficult for you.

ChocolateWombat - I disagree with much of what you have said.

If it is in a woman's birth plan then it really isn't necessary to ask again. If you had the sort of birth that I had, where the birth plan went out the window (not through the fault of the HCP), then not following the birth plan where it is possible to (which is the case for bf/ff) would really make the mother feel that no one has read her birth plan at all. In my case it was clear that the MW was trying to salvage any parts of our birth plan she could and throw in the nice bits of anyone else's too, because everything else that had happened had been really shit. She clearly cared and was following our wishes as far as possible.

Your suggestion of "now that you have given birth..." just sounds patronising.

Being asked the same question by every HCP you meet isn't ok. It gives the impression of disjointed care with insufficient handovers/not looking at notes. At best this is just a poor impression, at worst this indicates inadequate and dangerous care. I am not a walking set of medical records. I may not remember the details as accurately as a written record and having no medical training, I don't know what is important to tell each HCP I see and what isn't. HCP need to be getting this information off each other at handovers and from notes, not relying on patients to tell them.

In busy wards, where mothers may come I to contact with many staff in a short space if time, there cannot always be full handover to every single person.
In reality,what is often happening, is that staff are reading the notes as they are meeting the mother. Asking about breastfeeding is just a routine question,often with no intention to push it....asked as a way of getting up to speed with someone. You personally require no medical knowledge to answer that question. They would not rely on you for knowledge that really was medical.
It isn't the only question that is asked frequently. Midwives or Doctors may also ask if you had an episiotomy, an assisted birth etc etc as a way of getting up to speed with your case. Often these questions are for information, not to push an agenda.
And believe it or not,people DO change their minds from what was on their birth plan. It would be poor care to just read the plan and then rigidly tom stick to it without ever asking the mother about it......so asking again about pain relief, preferences for the injection to remove the placenta, cutting the cord and breast feeding are all part of that. Health care professionals assume nothing about the presences of the patient, even if they are written down, because people frequently change their minds.
I am sorry if you thought my phrasing that a midwife might use was patronising. It was an example and of course midwives are capable of choosing their own words for the situation. It is better to risk the chance that someone might be offended by the question (and actually few people really are) than to not ask it and assume, removing the opportunity for someone to choose.

I have certainly found that HCP in the postnatal ward (and antenatally and during delivery) were relying on me to provide information that was medical. It took me overhearing the conversations that other women were having to find out what aftercare I should be having, having had a blood transfusion and to get pain relief. The MWs seriously didn't seem to know anything at all about me. The impression of incompetence given by the totality of my postnatal care is part of the reason that I am having private care this time round. I would like to see a sound standard of care maintained for all women, before wasting time trying to convert a few women to BF.

I have just finished reading the thread and it brought some things to the surface that I had never acknowledged before now. I FF my first, because I felt a failure at BF. I could not get my DD to latch on, and after a few minutes of trying she would be distressed and hungry, and I would be despairing. I started to dread feeding times, I got nervous every time my baby cried because it might mean she needed a feed and the whole thing would start again. On the few occasions I did establish a good latch I hated the sensation of the milk being drawn out of me, literally hated it, it was painful and the feeling just made me squirm, I don't know why. I was relieved after I finally made the decision, after two days, to FF. It cut out the stress and I felt I could relax and enjoy my baby.

I think I have just realised that if I had not been in hospital, surrounded by people trying to get me to breastfeed, (not help, just get me to do it)
then I probably would have given up the first time I got that horrible sensation and pain. I think I carried on, putting myself under great stress, because I felt I had to, because everyone was telling me I had to try to do it as it was the best thing to do and it would make me a better mother. In fact I was a terrible, anxious wreck until I started FF.

So while I think there are few mothers who can't physically feed, there are many like me who found it a hideous experience.

The second time round I did not bother trying, so asking me if I wanted to give the colostrum feed would have been no good- I would have got the same dreadful sensation all over again.

I don't really know what that adds to the debate, other than if you can't get on with BF than you can't get on with the colostrum feed either, so why put pressure on new mums?

Surely there's a way of saying it which just makes the woman aware that there is support available if she'd like it:
'If you need any support with feeding your baby just ask. We can help you to give a breastfeed if that's something you'd like to try?'

Will this have already come up during prenatal care? If you have already discussed it with the woman, I would consider it intrusive and non-personalized care to ask again with that phrasing after delivery.

That said, when feeding choices are discussed during prenatal care, you could ask the mom why she has made the decision to formula feed. At that point, if there are practical difficulties, you can offer suggestions or point her to resources which might help. If you believe that she has factually incorrect information about breastfeeding or formula feeding, you could try to set her straight.

After delivery, could you instead ask "I know you were planning to . Is that still the case?" That would show the moms that you'd been listening to their choices, while at the same time letting them know that they could still change their minds if they wished.

(Disclaimer - I'm Canadian and not terribly familiar with the NHS. We don't even have any baby-friendly hospitals in my province, but breastfeeding initiation is nearly universal - 97 or 98 percent? - and I found the nurses, at least the younger ones, to be very enthusiastic about breastfeeding, without being pushy about it. During my son's hospital stay, there were a few instances where my feeding choices were not respected, and it made me LIVID and very distrustful of his care providers, but no one even mentioned or considered giving him formula.)

Pico2 I echo your sentiments. My postnatal ward may as well have been staffed by post office workers for all the MW provided in terms of medical support: wrong meds To the wrong people for example, blood tests for the wrong people, 5 hour delay to discharge people because they couldn't work the printer etc etc. I would never have a baby on the NHS again, it was fucking shambolic and yet in one of the swish new maternity units in London. I plan on no more anyway but have no doubt I'd go to the Portland if I did. Sadly I've experienced similar on inn of maternity wards and now have all my care privately (thanks to insurance)- a completely different level of service.

One of the reasons I am going privately is so that I don't have to explain my medical history over and over to each HCP I meet as the trauma of DD's birth and subsequent complications brings me to tears. It really isn't acceptable to have to repeat these things over and over to each HCP you meet.