Dealing with midwives "Unfortunately"

[khosking]

Hi I wonder if anyone can help or can give us advice as to the best course of action to take?
My wife and I have just had our second child and want to bfeed as we did with our first. Our first was 8lb 11oz, but dropped off a couple of centiles from her birth weight and was not back to birth weight until approx 6 weeks old. (she had a tongue tie, which was not noticed for over 24 hours, and which subsequently became infected, we were advised to take our 5 day old child with an infected mouth to our local medical centre where the doctor asked us if we thought there was a problem before prescribing a course of antibiotics that was the wrong dosage - a fact that was spotted by a diligent pharmacist and vetoed by the paediatrician at the hospital) Despite having an apparently healthy and very strong baby who was holding her head up from pretty much day one and who was clear eyed and alert, the miscellaneous midwives who visited our home on a daily basis (weighing our daughter pre and post poos!) contrived to undermine my wife's confidence as a new mother and our decision to breastfeed. Each of them examined her feeding technique before agreeing that she knew how to do it... We were sent for a number of blood tests (having to return to hospital in once instance because, we were told one friday that "there is a problem with the bloods" - on tuesday we found out that the problem was that someone had left the previous blood samples out overnight and this invalidated the results!) There was enormous pressure on us, particularly my wife, to start bottle feeding just because our daughter was not following their graph properly. My wife and I were/are acutely aware of the health of our child/children but could not say enough times that "there is nothing wrong with her". Such was the midwives and health visitors obsession with the baby not performing according to their graphs that they ignored an extended case of mastitis that turned into a breast abcess (this was drained nastily, painfully and daily with a massive needle without pain killers as these would have effected the breast milk?.) Following this general trauma I still remember the day that my wife took our daughter to the health clinic after we had been officially signed off by the midwives, "How heavy is she"? I asked?

"They didn't weigh her" was the reply.
That my wife somehow managed to avoid Postnatal depression says a great deal about her strength of character. That she endured considerable physical hardship in order to give our child the "best start" (as we felt and as so much literature suggests) considering the antagonistic nature of the people who were entering our home and judging our parenting as inadequate, inept, uncaring and somehow lacking something that would make them happy - i.e. pouring much advocated formula down our daughter's throat in order to bring the child in line with their graphs.

Now it seems that history is repeating itself. Our second child 10lbs at birth, (born at home with not so much a snifter of gas or air - midwife 1 arrived approx 4 mins before the birth midwife 2 arrived 10 mins after midwife 1?) She too has lost some of her birth weight (a week in hospital on IV antibiotics twice a day) and once again we have finger pointing and huffing and puffing and suggestions of formula to top up the child :-( This is something we have actually considered to get the midwives off our backs. BTW Our child is healthy, alert and strong with good poos and plenty of wees. Once again my wife has been in tears. Once again we are apparently mute when we say we have family history showing a weight loss in the first few weeks of our number one daughter without any apparent long term ill effects. It seems that Post-natal depression in the mother is not something that is considered when charts/graphs are involved?? Surely a relaxed and confident mother who is reassured and helped and encouraged by her midwife/health visitor/NHS support structure to enjoy the early days of her newborn would be better for all involved as opposed to ladling on the stress just so that they can sign us off and we are no longer their problem.

I for one would like my wife to avoid having a breakdown. I would like for her not to be depressed. I would like for her to be able to phone me and update me on her day, NOT refrain from phoning me because she is in tears. I would like to not be angered by the disregard for our wishes concerning our daughter. We would like to be viewed for what we are which is informed 2nd time parents who are aware of the fragility of life and who would rush our child to the nearest hospital, doctor, nurse, midwife if we felt that something was wrong. Unfortunately this is not the case and we find ourselves being browbeaten by a profession that will forget about us once we hit a tick box.

From talking to other parents I have discovered that the majority of people have shared our experiences. Unfortunately it seems the "blame culture" has turned a caring profession into one that seeks to satisfy the boxes without considering the people involved).

In the meantime I have heard today that daughter no 2 has gained a modicum of weight therefore we have been granted a weeks reprieve - although German Measles, good for the immune system/bad for weight gain, may effect that by next week :-(

Apologies for the rant but the whole business leaves me fuming. What is our recourse, if we have any, as parents to the pressure put on us at this time? Theoretically the midwifery service can cause all sorts of problems for us if they choose to? It seems that there is nowhere that we can turn to who might be able to provide support for us at this point? Any suggestions welcomed.

Ok I'm a little confused, why is your daughter in hospital? Has she got German Measles?

Many many sympathies. You sound like a wonderful father and husband, and your wife like a wonderful mother.

My 2nd daughter was similar in that she only gained 1lb in 3mo after birth, in fact for 2 months she actually lost weight. I was lucky in that she gained in the first month, when most attention is paid, it was after that that she lost weight. She went from the 99th to the 9th centile, but like your DDs is happy, healthy and developing normally- just destined to be petite. Anyway, I was lucky because they'd seen some weight gain and after the first month there is less attention, so I just carried on bfing and ignoring any suggestions to give her a bottle, and she is now slowly gaining weight. I also saw my gp who looked at her and talked to me and said he was happy she was healthy and trusted my instinct and I should carry on bfing.

You do not have to do as the HV says. You do not have to have your DD weighed. YOU are the parents and as you said you would KNOW if she wasn't right and get medical attention straight away. I really hope you can find a medical professional who can back you up, as I did.

I totally agree about your wife- good milk production is linked to calm and in the mother and I know when I was stressed and worrying about my DD it was harder to feed her. Having you on her side will be a major help, but also try and encourage her to rest and relax as much as possible, drink lots of water and eat well, and talk to others in a similar situation. She's be more than welcome to PM me if she'd like, plus there are lots of other supportive mums on here who would be happy to offer help and support.

Wow, Its YOUR baby. You don't have to follow rules, do what anyone tells you or stop listening to your parental instincts. My DS(3) is 4.5 months now, he was last weighed....errr god knows when. I know he is happy and healthy. HV's can seriously undermine your confidence if you let them.

La Leche League would probably support you at this moment in time. You can find and contact your nearest group here.

The midwives and health visitors do their best. Unfortunately they are often overstretched for time, receive very little training in breastfeeding support, and often their concern as you say is "box ticking" rather than in-depth support that new mothers often need. This support is provided fantastically over much of the UK by volunteer-run groups such as NcT, LLL, ABM and sure start volunteers. Perhaps your wife would consider becoming a peer supporter once your DD has recovered, of course. I don't think men can be peer supporters, but if you speak to some people involved in the various groups, there might be something you could do in the form of campaigning. Even if not, learning about the current situation and writing to your MP might be a start.

Is there a breastfeeding support group locally that you can go to? As long as your baby is providing wet nappies and is happy and healthy, that is the key indicator that breastfeeding is going well. It is normal for babies to have some weight loss in the week or so after birth.

Midwives do not know a lot about breastfeeding and often feel quite threatened by their lack of knowledge. You and your wife need support from health professionals who know what they are talking about. There is also a lot of misunderstanding of what a centile chart is - too many mws think that every baby should be above the 50th.

You can also phone the La Leche League for help.

I agree you want some knowledgeable support. If you know of a local breastfeeding support group, then I'd definitely get along to that. If not, or if you'll have to wait a few days, then the phonelines are brilliant.

I know bugger all about breastfeeding as I last BF last century, but you sound like a lovely supportive husband.

Ignore the health visitors and don't bother visitng them - there are a huge number of simply incompetent ones.

You would probably get better advice on here.

Wow quick responses, thanks everyone.
FYI SORRY I MADE A MISTAKE IN MY EARLIER POST IT'S NOT GERMAN MEASLES - POTENTIALLY WE HAVE CHICKENPOX IN THE HOUSE - OOPS

@Tribble.... Wife and No2 daughter admitted to hospital post birth as little one was a bit cold and took a while to warm up, while in her CRP was 14 so she was put on a 5 day antibiotic course + 24 observation afterwards. (In retrospect this was possibly good as it meant my wife had a week of enforced "Rest" as much as you can in a hospital where people are prodding and poking at you all times of the day and night :-)

The antibiotics cleared up whatever unspecified infection that she had (cultures showed nothing) and both are now home. No2 daughter is settling in and feeding on demand which is often and No1 daughter (22months) is being absolutely lovely with her which is nice. My wife is in good spirits overall but gets upset nearly everytime we end up dealing with the midwives :-(

As I said earlier she has apparently put on weight since the last weigh in which should hopefully keep the MW's at bay until they no longer care.

We are lucky in the sense that we have a strong marriage and are both resilient as people, but I can easily see how new mums can get driven into Post Natal Depression because of the treatment that they receive.

I have just spoken with my wife regarding the support groups, using the doctor and breastfeeding groups, (she was going to one, which was run by sure start, with No1 daughter but stopped when we weaned at approx 1year) and although we are not members of the NCT and I have not heard of LLL or ABM (?) it's nice to know that there is support out there.

Thanks again to everyone for responding
Have a good day
:-)

Just wanted to add that your commitment and involvement is probably the deciding factor here in supporting your wife to carry on BF. I know from when I struggled with DD1 that my DH's support was critical and I wouldn't have had the confidence to carry on if he hadn't been supportive. DD2 was much easier, DD3 is due next month and even now I know I will need his help to get feeding established.

I would echo previous comments about seeking out a BF support group. Additionally, your local hospital may have a breastfeeding co-ordinator who might be able to help. Centile charts are based on bottle-fed babies so are not always helpful for BF babies. If you live in a SureStart area then you should be able to access a breastfeeding specialist through them.

Good luck to you all. It's not very joined up thinking, is it, when there's so much emphasis on breastfeeding being best for babies but practice on the ground doesn't always seem to back that up.

Ah right, I was going to say that if your LO was ill it wouldn't be surprising that she wasn't gaining weight. I know if I'm ill, the first thing I go off is my food. It can be like this with LO's as well.

details of La Leche league groups.

List of ABM groups.

The charts they use now will be ones based on breastfed babies.

Once she gets back to her birth weight, it's advised to get them weighed every 4 weeks. This is only a guide though and of course you don't have to see a HV.

If they start pushing formula, then I think you're perfectly within your rights to ask the HV why this is necessary and better than breastmilk. As long as your wife is feeding responsively, offering both breasts at each feed, and ensuring she has a good latch, then there really should be no cause for concern.

I realise that your previous experience has probably knocked your confidence, but there is absolutely no reason why history should repeat itself.

One last thing, if you feel unhappy about the care you have received from the midwives, you really should put your concerns in writing to the hospital.

agree with others. That's to say, you do not have to see a hv and may well be better off with support from a breast feeding councillor ie. Nct. You do not have to be a member, call the helpline and they can help or put you in touch with someone who can visit you at home.

Please put in a complaint if you feel you can face it.

In you op you mention your wife not being able to have painkillers due to bf. Ime hcp's have a terrible knowledge of what medication can be taken while bf. Generally they just say no without real justification. You can check for yourself, i think the resource is called "Hales"? Someone on here will know if you search. I am hard pressed to believe that all painrelief is contraindicated when bf.

Sorry you have had such a hard time. I hope it picks up for you all soon.

It's worth trying to contact your local NCT breastfeeding counsellor even if you are not members. Our local breastfeeding counsellor is wonderful and would be happy to talk things through and come and help - most of them seem to be pretty altruistic peope geniunely wanting to help out and I can't see them turning you back.

To be honest it drives me potty that they spend all this time telling you how marvellous and fantastic is pre-birth, and then at the first set back seem to be only to keen to ram formula down babies throats. I realise it is probably lack of education / time and far too much pressure from the whole every child matters thing, but it is still so infuriating. My younger sister has just had a similar experience where it was suggested that a) her breasts were too small and then b) her breasts were too engorged to breastfeed - fortunately with lots of family support she persevered and her son is piling on weight.

I'm sure you're doing so already but make sure she is drinking lots (that is harder than you might imagine when you've got an older toddler) and eating properly. Roughly where do you live? If you let us know a county then I'm sure someone will come up with a much more specific suggestion re support groups.

You sound like a lovely husband and father BTW. Good luck.

Avoid the midwives unless you find one you like and then insist on only seeing her would be my advice. GPs and HVs can also do weight checks, and if there are serious health worries, you should see a doctor anyway. My experience was that the GPs were far more sensible about DD's weight - they looked at her, saw she was healthy and happy and were happy that I was seeing a BFC and BfN clinic for bfing support. An MCA at the hospital made me cry so much in the early days. I wish we'd refused to go to the clinic there! My HV was actually also great about DD's weight, but I understand that isn't the norm.

You do not have to keep seeing the midwives. It's your child, you have vast powers over what can/should be done to your child and you can decide who she sees. As long as you make sure she's not in danger - e.g. so do get her weight checked to make sure she's not losing again - then it's your call. Try to remember that. I know how hard it is.

As long as the baby isn't actually losing weight and is healthy & happy, keep reminding your wife all is fine and she's doing a great job.

What a fab husband you are. You and your wife sound really great.

Agreee with japhrimel - don't see the midwives. If they're calling on home visits don't be at home. If they're making your wife turn up at the surgery or wherever, just don't go. 'Forget' appointments. You don't have to have your baby weighed at all. What's the worst they can do? Call social workers - I can see it now 'we're concerned about the baby because the parents are doing everything they can to breastfeed the baby, and the baby is healthy and everything, very loved, secure, great family background, supportive husband, etc etc, just they won't give formula...' Seriously, a social worker won't be rushing over because you insist on breastfeeding. I doubt anyone would do anything until your baby has to be taken in to hospital - and that just isn't going to happen.

If you're worried about her weight gain, then print off a weight chart for breastfed babies from the internet. (I had one, because my DS was v. small at birth and a slow gainer - and guess what, he's still way below average. But me as an adult - I wouldn't make the 5th centile with my height and weight. Some people are small.) Also, you can buy the special baby weighing scales that midwives have.

Health - you'll know if there's something seriously wrong (doesn't sound like there is) - check for regular wet and dirty nappies, alertness, good loud crying - but you will know. And it's highly unlikely that there ever will be anything.

As ever I am a bit uncomfortable with posts that urge someone to ignore HCPs - we can never know the full story. We don't even known how old this baby is, what the precise weights have been, and what the concerns are.

OP - could this be a breakdown in/poor communication between your family and the midwives?

I don't know what the issue is. It would be normal to lose some weight off birthweight, so I don't know why formula was being advised, unless the weight loss was extreme and extra bf did not address it - now weight has been gained, but how much we don't know. Formula would only be needed if more breastmilk/more breastfeeding was not available.

But not having anything to do with HCPs is of course your right, but would it not be better to tell them 'you are putting us under pressure and we don't accept you are justified'? Then if there are medical/health concerns, you will be in the picture, and if there are none, then they are :)

Thanks again for the responses to this issue, I'm glad that there is some support out there and that our experiences are not isolated.
@tiktok It's not that we don't value the knowledge and support of Health Care Professionals, Paediatricians, doctors, nurses, MWs HVs etc on the contrary we understand that the specialist medical and general knowledge that they possess probably saves the lives of/alleviates the suffering of/improves the quality of life for many children each year. Their knowledge of the health system and of the benefits and social support schemes that a new family may have access to, no doubt helps many new families to adjust to the massive change in circumstances that a newborn brings to the family dynamic. As responsible parents we would be fools to ignore this wealth of knowledge. At the same time, as responsible parents we have utilised other resources available to us, the internet, friends, family, NCT, other mums etc and our own experiences with our No1 daughter. We have a medical history showing that our No1 daughter gained weight slowly. Unfortunately it seems that although we are doing our best to be intelligent informed parents we become mute when we posit an opinion that might contradict the pressing need for a check box. When we do express an opinion that is contrary we are treated as ignorant and uncaring, because the MOST IMPORTANT ISSUE it seems is to sign us off... It is not really a breakdown or poor communication between us as a family and the MWs as to my mind effective communication between two parties warrants that both parties have input. e.g 38 weeks cooks a baby....
MW: ok this is your due date :-)
US: work it backwards please.... sorry but we were not together until... our due date is at least 10 days after yours.
MW: hmmmm no I'll just disregard that and look at my chart.
US?
LATER
MW's: you are overdue.
US: ummm No.
MW's: we'll book you in to be induced :-)
US:?????????????????????? Do you need to see the dates on ferry tickets?

With regards to facts and figures No2 was a 10lb baby, she did not lose over 12% of her birth weight which apparently is a bit of a red flag for them, despite being on IV antibiotics 2x a day for 5 days - spending the first week of her life in hospital. BTW it took over 30 hours from birth before they cut her frenulum despite us telling everyone that we came into contact with (3 MWs and 3 nurses before I was sent off the ward on day 1 - my wife continued to ask and her frenulum was cut the following afternoon). On return home she lost a little rather than gaining (probably as we all established a routine at home and my wife tried to catch up on the sleep she lost at the hospital!!!!) which brings us to where we are now. weight gain was 40grms+/feeding on demand (both sides - after she has had whatever hindmilk she can get)/plenty of wet-pooey nappies, good crying, on the odd occasion she has thrown up following too quick a movement after feeding she has brought up enough to show that she is getting plenty to eat.

With regards to making a complaint. Telling someone (even in the nicest possible way) that in your opinion they are not doing their job right/very well/ that you know better than they do, that their colleagues/friends are not doing their job well or are incompetent or at worst making dangerous decisions tends to get people's backs up. In this instance I'm not sure that arousing the enmity of a seemingly already hostile group of decision makers is the best policy.

It is interesting to note that the centile charts they use are from bottlefed babies. Why do they not have centile charts from breastfed babies too?

@grubbalo we know what your younger sister had to go through :-(

Re resources and location we are in South Glos however the care that each area receives varies. Thanks again. I'm sure things will pan out :-)

Thanks for more details, OP, though it's still not clear how old your baby is and over what period she gained the 40g....though all the other stuff you say indicates a baby who is doing well. I think it is reasonable for the HCPs to be returning in a week to weigh again, after the history.

It's not good care for them to use pressure - and I wonder if this is something you could raise not by complaining, but just by saying how you feel about the way things have been handled. Tell them you feel you are being given a 'tick box' treatment and that they seem to want to sign you off...all this can be done fairly politely, mostly :)

The centile charts used will now be breastfed data-based. This has been the case throughout the UK for some time now. The old charts were indeed based on data from ff and bf babies, with no differentiation, but even if for some reason the old charts were still used in your area, it would be irrelevant as there is really no difference in the early weeks.

Mind you, DD2 was two ounces over her birth weight at 12 days old and the generally rather strange midwife refused to sign us off because in her opinion DD2 hadn't put on "enough" weight, and suggested that that was because I wasn't breastfeeding her properly. If I'd been a first-time mother and not had years of reading tiktok's posts on MN it would have severely shaken my confidence.

Khosking -

I had this type of attitude aswell, it still haunts me 5 years on, I wish I'd complained as I've seen other posts about the same hospital on here so they haven't moved on in their practice. I think you should write to the head of midwives. I truly think as a HCP that the only way sometimes we change practice is when we have sensible feedback. You are so eloquent in your posts and clearly have the capacity to write well and explain yourself well and your wife is in no place to write to them. You would be doing for others who don't have such good support aswell.

khosking I don't know what to suggest you should do, I just wish that someone, somewhere, would seriously fix this. My DD is formula fed and has been since 3 weeks, because of this kind of issue. For me it was the lack of BF support, coupled with the charts and the percentages and the pressure, etc. First week with DD was a horrendous nightmare, which led to PND for me.

Crying just typing this, I feel such a failure. I don't know how this could be fixed, and honestly don't have the energy right now, but you are not alone in what you have been through and you're right, there must be a better way.

Dx

Khosking Just wanted to chime in and say that you really are being a wonderfully supportive and involved father and husband - I hope you know how rare that is? I also agree with ohanotherone above, you do express yourself really well, I too would urge you to write to the hospital... it may not change your situation, but it may well help someone else one day.

For what it's worth, my DS also lost weight, and after a week in hospital, we were then having to travel back to the hospital every other day to have him weighed before we were "released" to the midwifes out in the community. I don't want to hijack the thread so won't go into it in detail, but suffice to say that the whole issue turned out to be the poor advice I had from MWs in the hospital, as well as some serious miscalculations (they worked out DS's age wrong, having him as 3 days old rather than 2 which doesn't sound like much but it makes a massive difference in the amount he should be getting per feed, as well as then, after telling me he had to have formula, accidentally calculating his per-feed amount as treble what is should have been, consequently forcefeeding him way too much, resulting in him vomiting out everything...jadajada)
ANYWAY - had some councelling for PTSD and pulled my socks up and 20 months later he is still happily BFing, and has at times been literally off the growth charts. :)

I was just wondering if you could maybe persuade them to weigh her before AND immediately after a feed? (IME, the main reason for pushing formula is that "they'll know how much the baby is getting", and this is one way of finding out!)

Best of luck to the whole family - this, too, shall pass.

link to painkillers and bf info

I really think your DW would benefit from talking to one of the bf helplines. NCt do not require you to be a member to use the helpline.

I just wanted to say that if you and your wife would feel happier dealing with a GP rather than the midwives/HVs then go along to the GP surgery, explain the situation to an established doctor there (one of the GP partners or similar, whom you trust) and ask if weight surveillance can happen at the surgery instead. Any GP worth their salt will a) be able to see that this situation isn't good for your family and b) be able to assess the weight gain, wellbeing and progress of your DD2 from an expert perspective. I've just run this situation by my DH (a GP) and he's furious that you're being made to feel like this.

Our first daughter was IUGR (5lb1oz) with reflux. The constant pressure to 'top her up' with formula so she could stick to her centile was awful - we needed reflux meds, not more milk for her to vomit. We found it hard to stand up to the professionals, depite DH being a professional himself. The midwives/HVs can sometimes have a very one-size-fits-all attitude to baby weight gain, they're very busy and often they are very risk adverse - good GPs (AND good midwives/HVs) tend to look at the whole baby, not just the scales, and are more confident with taking a broader, longer-term perspective on weight gain.

Now, when DH sees babies that HV/midwives have 'sent in' for weight gain concerns, he does his best to reassure parents. Unfortunately by the time the mother and baby see him, about 60% of those that were desperate to breastfeed have already given up, or have introduced formula to the detriment of their supply.