BF counsellors' education about mixed feeding

[Spindelina]

Trying not to make this sound angry. Trying not to be upset. Bear with me!

I (and a surprisingly large number of people who have come out of the woodwork) have had babies who have lost more than 12% of birthweight, been re-admitted to hospital for the breast / formula top-up / pumping regime from hell.

When I got discharged, I contacted a local BF counsellor, hoping to get some advice and encouragement to get back to ebf. The advice I (a very tired and upset new mother who was already feeling dreadful about starving my baby and then giving her the formula) got was that I shouldn't have introduced the top-ups, and that she didn't know anything about FF.

I know I'm not the only person to have made contact in these circumstances. Granted, not having to do it in the first place is the best way forward and the approach to be encouraged. But surely knowing something about mixed feeding, how to do it well, and how to get back from there to ebf would be a useful thing for BF counsellors to know about?

I've discussed this at length with friends and we came to the conclusion that they just don't have the time. BF support is so underfunded that they have to really ration their time, and someone who has had a rocky start and had to introduce top ups is going to be a tough one when they could use the time to help five new mums who would benefit from a bit of help and will have an easier time of it.

Completely wrong of course, there should be enough support for everyone who wants it.

:( about your experience.

In my area (North Staffordshire) the support for BF / mixed / FF is really good and extremely knowledgeable. I agree with ShhhhGobacktoSleep that the BF supported is generally underfunded. In areas of poor BF rates, they will have more funding, as such more support. But it will depend entirely on the BF counsellor/infant feeding coordinator and their knowledge.

Perhaps you should volunteer for a Peer Support Course; it is experiences like yours that can help new mums during those hellish first few weeks?

I'm mixed feeding still. DD is 11 weeks, on about 500ml of formula / day, happy, healthy, and gaining weight.

We did try cold turkey at 10 days, but she didn't put on any weight for 4 weeks.

Should say I'm also angry and upset at lots of other people - the midwifery commissioners for lack of funding, the midwives who didn't spot our problems, useless, useless HV for so many things. And myself for not being more assertive when I knew things weren't right.

But I had such high hopes for the NCT BF counsellor!! She did reassure me my latch looked OK, but instead of practical advice about pumping, how to manage small amounts of formula, and general advice on A Plan, I got a lecture on the wisdom of weighing at 3 days and how dreadful it was that we'd distended her poor little stomach with ebm and formula. Which, frankly, I could have done without. Gah.

Don't think it helped that it was August and everything had shut for the summer, either.

I would expect more if she was nct. 'Bf counsellor' can cover a lot of things but afaik to be an nct bf counsellor you have to study for a long time. Did you contact her via the helpline?

I would expect more if she was nct. 'Bf counsellor' can cover a lot of things but afaik to be an nct bf counsellor you have to study for a long time. Did you contact her via the helpline?

Spindelina, really sorry you felt let down by the help on offer.....don't just tell us, though, tell NCT. All NCT breastfeeding counsellors are part of a supervision system and you can give feedback to the national organisation (see the website) and it will be followed up.

You said:

"She did reassure me my latch looked OK" - that's good, and observing a feed is something even midwives and HVs often don't do.

"but instead of practical advice about pumping" - she should know about expressing and the different techniques, and have offered to share it even if you did not ask her.

"how to manage small amounts of formula, and general advice on A Plan" - here you are asking for something she may have felt was outside her remit. Using formula with a baby who has already had medical/hospital/midwifery intervention, and whose situation is still under question, may be something that is best discussed with the midwife....but she still should have given you pointers to discuss with the midwife, questions to ask, avenues to explore. I am very experienced and even I would not come up with a definitive Plan (we don't give 'advice', by the way) for you.

" I got a lecture on the wisdom of weighing at 3 days and how dreadful it was that we'd distended her poor little stomach with ebm and formula" If you felt lectured, then she was not doing her job properly. She may have given you the info about distending the stomach, by way of explaining that the volume of formula/ebm your baby had been having was not physiological and you did not need to keep that same volume up. It can be sensible to weigh at 3 days, but it's not necessarily right to tell someone this at the stage you are at :(

However.

The people you should also feel let down by are the people whose paid job it is to ensure your bf gets off to a good start. Babies who end up in hospital because of feeding difficulties have not suddenly become compromised - you had days of midwifery care, and they missed the problems.

Yet you come on mumsnet and describe the shortcomings of a volunteer who you are asking to clear up a situation caused by (or at least ignored by) the paid professionals. I agree the bfc was less than what you needed and her manner sounds poor, but if you are going to feel angry and upset, make sure your anger and upset also include the midwives and others.....and the hospital too, who discharged you without a plan. That's their job, and they failed.
Complain.

Tiktok, you are right. That second post was unnecessarily ranty. And personal. Interesting point about the stomach - definitely possible that she said one thing and I heard another. And the criticism of weighing and intervention as early as day 3 was aimed at the HCPs, not me.

My original point was surprise at lack of knowledge & experience about my situation, given how common it seems to be. But, actually, if she had come up with a plan, she would have been undermining the job the HCPs should have done. I guess it's almost a given that the NHS, and particularly HVs are rubbish at dealing with BF problems, so I wasn't surprised by their failure. With hindsight my expectations of the NCT were unrealistic.

I shall complain to the NHS and feed back to the NCT.

Thank you all for your kind words.

Thanks, Spindelina - I do see you realise you were also let down by others :(

Actually, weighing at day 3 can be a good and helpful thing. Where bf is clearly going well it's not necessary (though it's not a bad thing to do, given that midwives often miss breastfeeding that's not going well).

No bfc should tell you that you 'shouldn't have introduced top ups' - that sort of bluntness is just unhelpful. But often, it falls to the bfc to explain to a mother why things have gone wrong, because otherwise mothers feel that they have done something wrong themselves, or that their problems have just been bad luck. When the reasons for difficulties are understood, the way through them can become clearer.

Is it possible that in explaining how bf works - that more frequent, effective feeding builds up and maintains supply - so you can tackle any issues with supply, you then realised that top ups might have been avoidable? If she really did say 'you shouldn't have introduced top ups' in that direct way, she needs to learn not to say it!

Do give feedback though - it really does help.

Just to add, if on reflection you think, as you say now, she may have said one thing and you actually heard another, then be kind with your feedback! :)

Re: weighing. On day 2, I expressed concern to a midwife, who watched me feed and told me DD was a 'natural feeder'! So I have no doubt our problems would have gone unheeded without the weigh-in. Bfc's opinion was that 3 days is too early.

I'm not knowledgable enough to say whether the top ups were necessary. (Although I absolutely believe they were avoidable if the problems had been sorted earlier.)

I think 3 things were or should have been discussed between md and Bfc.

1. What had gone wrong
2. What the HCPs had done about it
3. What to do now.

There was much discussion of 2, which is where the criticism of the weighing and top ups came in. It was more 'top ups shouldn't have been given' rather than 'you shouldn't have...', but I did feel pretty complicit. Maybe that's my problem though. .

There was some discussion of 1. I'm still not sure what I would to differently though.

There was very little discussion of 3. Which is what I was (possibly unfairly) hoping for.

Thanks again - my thoughts are definitely clearer than the earlier rant.

I'm sorry you didn't get the support right at the beginning, and I'm sorry she wasn't supportive when you needed help after hospital. Can promise you its not like this everywhere. And cannot imagine ever telling a woman off for topping up if she came to me for help

Sorry to hear you had a hard time and feel let down. I had a similar experience with my dd2. She was admitted to hospital on day 5 having lost 18% body weight. Felt like the worst mum ever. Was in a few days and got to within 10%. Neonatal staff were really supportive and encouraging. At home I breast fed at every feed and than offered full top ups. She usually took about half at the start. By day 14 she was about 100gms off her birthweight so community midwife suggested abandoning formula. Within 4 days she reached her birth weight so it is possible. I did not contact any breastfeeding support group as I sucessfully breastfed ds.
However, I am still cross about experience with dd1. Was basically bullied by hospital to give formula as she appeared jaundiced. In the end I abandoned breastfeeding as I received no encouragement to mix feed and attempt to build up supply.

So bad oxford my LO was jaundice, borderline being admitted but when MW called paed doc he said to wait 12 hr first and do a feeding plan (she was too sleepy to feed).

MW showed me how to hand express as I didn't have a pump and left me some syringes. I had a couple of cartons of formula for 'emergencies' so we gave a small bit of that just to rouse LO (I didn't manage to express much as milk hadn't come in) and then she started to latch ok again. MW stayed with us through all this and phoned in the evening to check up before she came round again the next day. Gave instructions to feed every 2-3 hrs min.

I've never had to give any more formula so I'm v grateful to that MW for the help and advice. Shame people have such different experience of HCP such as OP. Just wanted to say there are some good ones - sorry y didn't get the help you needed.