UNICEF Baby Friendly Initiative training.

[DillyDaydreaming]

Don't know if other areas are doing this but all HVs, midwives, nursery nurses and community staff nurses in the 0-19 children's team are doing this training locally. It is excellent - just a two day course but have learned so much - and I generally think I am pretty good at supporting breastfeeding mothers. I have more info to support with now so it's great and some of my more... ahem... entrenched colleagues are getting a much needed update.

I actually felt sad yesterday in realising how much some of the info I learned might have supported me when I was struggling.

Biggest thing I've learned - this is brilliant - brace yourselves ladies lol :-

Birth weights are thought to be largely inaccurate as the type of birth, the drugs used etc can make a huge difference. They did consider locally not weighing a baby until Day 3 but women want their babies weighed (of course they do). Sooo - latest advice is to look at the weight on Day 6 and use that for a starting point when considering weight loss or gain.

In our area they worry if a baby loses more than 10% of it's birth weight - apparently in other areas they go up to 15%-20% before babies are reviewed.
Last year around 150 breastfed babies were sent back to the paediatrician by MWs/HVs/GPs because of this 10% rule and all were found to be healthy so currently this is being looked at too.

If they just succeed in getting people to look at the baby and NOT the centile chart I will cheer.

I am in Essex.

Dilly, are you sure this is what they told you?

Have you got references?

Not weighing till day 6 and taking that as a baseline?

Or have I misunderstood you?

No - they are weighing at birth but saying that because so many things affect birth weight it shouldn't be used as the baseline when assessing weight loss in breastfed babies. All babies locally seem to be weighed at birth and on day 6. What they are saying is that unless there are serious concerns about the baby then the weight on Day 6 can be considered as a baseline.

I think the policy is being rewritten at the moment and in future a weight will be recorded on Day 3 for baseline measurement. I have seen babies recorded as having lost over 10% of birthweight when evidently they are well, thriving and happy, having 5-6 dirty nappies a day and plenty of wet nappies. In those cases I must admit I do then doubt the birth weight so having a more accurate baseline would help. I will check for references with regard to this - typically our PCT has no money so all handouts, articles etc are being emailed to us.

Will let you know when I have them - not back in work until tomorrow.

Oh I hope to God they do change that. I live in Essex. Had a lovely home birth but was then admitted on day 6 as DD had lost 12% of birth weight. The hospital stay caused huge amounts of stress and they did nothing other than make sure DD was taking on sufficient milk which meant expressing and syringe-feeding and topping up with formula. There was no support whatsoever in hospital for BF and after 2 weeks of struggling we gave up and now FF :(

There are some brilliant midwives out there who just aren't being backed-up by docs or allowed to use their initiative because of this daft 10% rule.

Ah, I understand.

Weight is absolutely only part of the picture. I would prefer better training in assessing the 'whole baby' and the feeding effectiveness - it's true that some babies appear to have lost more than 10 per cent, but they are ok. They are feeding well, their wees and poos are normal, and they are feeding often and enthusiastically. Whipping them back into hospital often does produce needless anxiety.

OTOH, bfcs do come across babies who are not doing well at all, but the HCPs involved do not spot it. The babies go for days not feeding well and then because of a policy of 'do not weigh' no one gets alerted to the situation until, say, day 6, and the baby has deteriorated a lot and the weight causes panic stations.

It's no good changing a weight rule, or even having one in the first place, without addressing the wider issue of feeding assessment - and it's this that would make me ask questions, I think.

I have done the Unicef Breastfeeding Management course and it's brilliant! Wish it could be undertaken by all MW and HV's asap. Could potentially have a big impact on the information and support mums get. Not only does it put weight charts into perspective, the course provides amazing detailed information regarding the components of breast milk and what they all do. Nourishment is just one part of it. Think it's a big eye-opener. I am fed up with mums giving up BF'ing because the HV has frightened them into artificial feeding over a perceived weight issue rather then assess how the BF is going and help them to find ways to increase baby's weight (if genuinely needed) whilst preserving BF'ing :(

Missing babies who are not feeding well is a scary thought - There's been some research (if my memory serves me correctly) about weighing on Day 3 and then again on Day 6 to try and identify these babies earlier. As you say though - unless the support is there to actually help women succeed with breastfeeding then it's all pie in the sky. Without support it'll be a case of weigh day 3, weigh day 6 and supplement those who are not thriving when it would be better to put in good support initially and train staff to assess how feeding is going so early difficulties can be resolved.

Sadly when I take over the damage has often already been done -I see too many women on the first visit who have never successfully breastfed and are struggling, babies who have been rammed onto the breast who now fight and arch their backs when Mum tries to help latch them on (clumsily put but am sure you know what I mean), nipple shields still in use etc etc. Frankly I take my hat and everything else off to women who persevere through all of this and succeed. The fact that babies who don't do well are being missed by HCPs is dreadful

Have had the breastfeeding policy emailed to me today and it's the midwifery one which is under review so will be interesting to see what comes from it.