Can we have a MN campaign to stop HVs advising people not to BF?

[threefeethighandrising]

It seems like so many HVs are still advising mothers not to BF for no good reason.

Can we have a MN campaign to re-educate them? Or at least a standard letter of complaint that mothers can send to the NHS when their HV tries to encourage them not to feed, against the overwhelming evidence that it's a good thing to do, for mother and child. The WHO advises feeding until 2. No HV should advise a mother who is happily feeding her DC to stop before then, if ever!

Why are they still doing this? It makes me !

I think a standard letter would be a very good idea. In fact standard letters for a lot of things would help - BFing, formula preparation advice, cosleeping, home-birthing to name just a few.

All too often people don't know what to say, who to say it to or how to back it up.

It's not always clear to mothers though if they are being given bad advice. We are all told to ask our HV is something is wrong so we expect to be given accurate advice. How will a mother know if she's being given bad advice?

I think it would be better if HVs (who are really, really busy anyway) would refer mothers to a BF group like LLL, NCT, Baby Cafe etc so that they can get in-depth, accurate information and support. Of all the people that go to the BF group I go to, not one of them was referred there by a HV, which is sad.

"I think it would be better if HVs (who are really, really busy anyway) would refer mothers to a BF group like LLL, NCT, Baby Cafe etc so that they can get in-depth, accurate information and support. Of all the people that go to the BF group I go to, not one of them was referred there by a HV, which is sad."

I agree it would be great if the HV service could partner with some BF experts, such as the ones you mention, in some way. I'd be surprised if someone else hasn't thought of it already, I wonder if there's been any success?

How do HV get training on BFing at the moment I wonder?

"It's not always clear to mothers though if they are being given bad advice. We are all told to ask our HV is something is wrong so we expect to be given accurate advice. How will a mother know if she's being given bad advice?"

True. However there other occasions when parents know they're being given duff advice but they're not really sure how to challenge it.

The last time I saw a HV, for example, she didn't offer any words of encouragement when she learnt I was still feeding my nearly 2 year old. Then when I mentioned he still woke in the night she told me I should stop feeding him to sleep. I explained that he had no problems getting to sleep, the BFing was working a treat there. She still said I should stop feeding him to sleep as she reckoned it wasn't a good idea to go to bed on a full stomach .
She didn't offer any alternative suggestions for his wakefulness e.g. asking about his bed / curtains / daytime activity / whatever, she was sure it had to be BFing.

I ignored her, and I meant to get round to complaining but I never did, mostly because I didn't know how to word it. If there had been a standard letter available I would have used it I think.

"In fact standard letters for a lot of things would help - BFing, formula preparation advice, cosleeping, home-birthing to name just a few."

Good idea!

It would need to be well-written evidence-based stuff. And it would be important to get to the tone right so it was obvious the intent is to educate and support parents and HVs. If it seemed like an attack on the HV profession it wouldn't work.

If I had the time I would start a project to do this, ideally with a relevant expert organistaion (e.g. LLL). (Busy studying, working, freelancing and being a mum this year!)

Perhaps next year ...

What sleep experts? I'd love to see some links if you have any.

Sorry, I don't mean that to sound sarcastic, I am interested to read any research that you've read on it.

Worth a new thread in the MN campaigns section? I can help after mid-September writing but it's a big undertaking. maybe you could contact MNHQ to get the ball rolling?

First we'd need to know what people want to complain about most, then research the correct advice, govt guidelines and other supporting evidence. After that we could start writing!

If you want to mastermind along with MNHQ I don't mind helping with legwork.

she didn't offer any words of encouragement when she learnt I was still feeding my nearly 2 year old.

Was she aware you were struggling with the choice and needed encouragement ?

I think to be fair, it can be quite hard to tred the line between taking a guess that that somebody is feeling insecure about a choice and needing encouragement, and avoiding irritating those who are not. Who might resent what to them feels like a patronizing pat on the head.

Threefeethigh - how do you know that the health visitor was wrong to suggest that not feeding to sleep might improve your child's wakefulness if you ignored her suggestion? A health visitor suggested exactly the same to me, I stopped feeding to sleep and my son now sleeps a lot better while still enjoying breast feeding.

In my experience I have found health visitors are tremendously supportive of women in their choices and also (tactfully) promote breast-feeding wherever possible. I hate the criticism of health visitors because when my son was undergoing treatment for cancer mine was a godsend.

"And IIRC sleep experts generally advise that toddlers learn to settle themselves to sleep. In that context it doesn't matter whether you are BFing him, or rocking him, or murmuring soothing lullabys in his ear - when he rouses naturally in the night his sleep cues are no longer present. I think that your HV was right, you were just too busy getting on your high horse to listen properly."

That's interesting (and i would also be interested in seeing the research on this) however you haven't understood my post.

I talked at length with the HV about this, and it was clear that her position was that feeding my DS to sleep (as in when he first goes to bed) was making his tummy full and that was waking him up (nothing was mentioned about self-settling). She offered this as fact, not one of many possible explanations - she didn't explore any other avenues.

That doesn't seem very scientific to me.

FWIW I think I see where you're coming from OP, and I agree.

Generally, HVs are very short on knowledge of BFing and sometimes they can really undermine a relationship that's working. When it's not working they frequently don't have the knowledge to help.

In my region we have "Little Angels", PCT funded peer supporters, who will do peer support training specifically for HVs. We also have BFing nurses at the hospital who will also do the same. If I get a lady who complains about her HV, and I feel it's a reasonable complaint, I contact the HV and give them and explanation of the complaint, and recommend the PS training. Mostly they want to know more and appreciate the suggestion.

I do get really irritated by it, too, but recognising that they just don't get the training, and that they really do the best they can with what they (don't) know, then moving forward positively seems to work.

A campaign to train MWs and HVs about BFing would be a good idea, I think. At a minimum they should be peer supporters!

I must say, the positive support for HVs on this thread is very reassuring. Considering that one generally only hears the bad stuff, it's easier to feel that it's worse out there than it really is :)

On the other hand, the level of training that HVs and MWs - and doctors - are given about infant feeding is utterly shocking and a disgrace.

I have to say, I have very poor experience of health visitors, both regarding BF and in general. With all my first 3 DC, admittedly the youngest is 7, there was no BF support at all, nor from midwives. For this reason I misunderstood what was normal behaviour for a BF infant with my first 2 DS's and gave up BF.

With the third I had to exclusively express as he was born with Downs Syndrome and just couldn't latch on or feed from the breast due to very poor muscle tone and being sleepy. I did not get one bit of advice about how to go about exclusively expressing, except to 'try expressing in the bath' and even when I said to my midwife anbd HV that DS was sleeping through the night for at least 8 hours (from birth) they didn't suggest I needed to express at night to keep my supply up. When, at 3 week sold my milk was drying up and i told the HV I felt I had no choice but to switch to formula and expressed my disappointment at this, she didn't once ask any questions to find a possible cause, nor suggest any way to keep my milk up. She simply said 'it's probably best'. I genuinely thought my milk had just dried up and there was not a thing I could do about it.

Not BF related, but the HV then insisted on visiting weekly, saying DS3 was failing to thrive, questioning me on what he was eating, how much formula, how many solids etc. We all knew DS had a heart condition, but the HV didn't once mention this as a possible cause of the failure to thrive or suggest seeing a doctor for advice, she simply accused me and kept asking how I felt about DS having Downs. (fine actually!) At 6 month sold, during a routine appointjent with a heart specialist they said he needed emergency open heart surgery, which he had two days later.

It worries me that I seem to have had quite good support compared to many, but it was still woefully inadequate.

It's all very complicated isn't it. Maybe it would be helpful if there was more clarity about what HVs do and don't do. They are nurses, so can advise on general health and wellbeing of babies but can't diagnose conditions, that would be for the GP.

I'm also interested in the focus there seems to be on only provided advice which is based on articles in peer reviewed journals. I would have thought like most professionals the body of knowledge a HV draws on is explicit research evidence but also tacit knowledge gained from the hundreds of babies they see. For example in mechanical engineering you can read all the articles you want about engine failure, but sometimes you just take a squint at an engine and have a hunch. I suppose I'm saying there's an element of all professions which is instinct rather than pure evidence.

Bringing it back to breastfeeding, when my son was suffering badly from reflux he would scream at top volume most of the day and night while I battled to feed him. At one point he screamed when I picked him up and stopped when I put him down. I saw a HV at a clinic and was obviously distressed about my bond with him. She said something along the lines of 'it wouldn't make you a bad mother to move him to formula - he could yell at the bottle not you'. I said I would persevere with breastfeeding and she was enthusiastic, but when I was up once again with a screaming vomiting baby for hours in the middle of the night I would repeat to myself what she said and ironically her comment helped me through the reflux and to continue breast feeding.

I don't want HVs to follow scripts or parrot research. I want them to be well trained and have a broad range of experience to draw on. Most of all I want them to ensure mothers and babies are well bonded and happy, which sometimes might mean suggesting formula. I suppose the question is how much more tax we are willing to pay for a properly resourced and trained health visiting service.

There's a difference between actively spending time encouraging it, and offering a 'oh jolly good! Glad to hear it!' because they actually understand the guidelines.
A HV who doesn't know the guideline, or support them is a little worrying.