Midwives should never make mothers feel guilty

[mears]

I have seen this comment many times from mnetters feeling that they have been made to feel guilty by midwives when they choose to bottlefeed for any reason.

I would just like to say that it can be really difficult to support women through any difficulties that they might be encountering without seeming to say 'breast is the best' way to feed a baby.

When a woman has made the decision to breastfeed, the absolutely worst thing the mum can do with a full term healthy baby is introduce a bottle of formula within the first week. Formula does not correct feeding problems, it compounds them especially if given via a teat.

Babies suck the breast differently than a teat which works in a different way. Mothers need to know how to latch babies properly and know when they are feeding effectively. Babies that are constatly at the breast are usually not latched on properly (causing sore/cracked nipples) or may actually be at the breast but sucking infrequently. Babies are often rooting to get on, then once they are there falling asleep. These babies are best to be stimulated to stay awake during a feed by gently stroking them, blowing gently on their cheek etc. All babies feed better when they are 'skin-to-skin'.

Because there are solutions to breastfeeding problems, midwives will try and dissuade mothers from giving formula. Yes you can express when a feed has been missed because a baby's stomach is full of formula, but a pump is not as effective as a baby at stimulating milk production. It is also the last thing that a tired mum wants to have to do. Also mothers feel undermined when a baby glugs milk out a bottle when they have faffed around at the breast. A baby full on breastmilk will always suck formula from a teat because it is something different. The amount of formula that a baby takes does not equate to how much EBM they need. Mothers then feel they are not producing enough. Confidence is then shattered.

When trying to support a woman through this time, midwives can come across as trying to make women feel guilty when they say they want to give a bottle. The woman needs know the downsides of giving a bottle at this stage. If she wants to still do that, then that is her choice. She should not feel guilty about it. It may make establishing breastfeeding harder in the longrun, but some women find they are still able to do that.

Unfortunately a number of women feel sad that they haven't been able to continue and often that is as a result of poor support from professionals. Sometimes women do not realise that the 'lovely midwife who told me my baby was starving and to give her a bottle' is the one who has encouraged her to fail in her attempt to breastfeed her baby.

Some women try breastfeeding and find that the experience is not one they enjoy. I personally think it great when women say clearly 'I hate this and want to bottle feed'. No problem I say, which formula do you want to give.

No-one should have the ability to make anyone else feel guilty. Women need information to make the right choice for them. Some women will decide that they cannot cope with the demands where breastfeeding has got off to a poor start. They have no need to feel guilty. They are making a choice that is right for them.

Breastfeeding going well is a wonderful experience. Women can get breastfeeding off to a good start by learning as much as they can before delivery and also by having professionals around who can advise them well. Unfortunately that does not always happen

good post mears, very well put. I think it is a bit of a cop out to say if women are having problems, well it doesn't matter, just give a bottle of formula. it does matter, as so may posts on here talking about mixed feelings etc even years afterwards will prove.
it's harder to give the right but it is worth it imho.

Littlefish, don't feel guilty, sweetheart. Mastitis is utterly vile and makes you feel appallingly ill (I only had it mildly and I've not felt that ill for a very long time) - you should have been supported by the people who were responsible for your care without you having to know without being told where to go to find help.

I totally agree with your post hunker.

When I had my first DS nobody came near me because I was a midwife. He was 12 hours old and hadn't fed and the sweat was lashing off me as I tried to get him fixed (didn't appreciate the effort it took!). Anyway, this old auxilliary nurse came in and helped me got him on, but once she knew I was a midwife I didn't see her for dust. I was so fortuinate that I knew a lot and my mother was very pro breastfeeding. I still remember the sister of the ward coming through to me on the 3rd day (you stayed in for 5 days then) to tell me how sorrry she was that he had lost so much weight. He was 8lb 4oz when he was born and dropped to 7lb 8oz. If I had been an 'ordinary' mum I would have panicked. Fortunately I was confident in my abilituy although I wasn't very efficient at feeding by then. I bought 'Breast is Best' by Andrew & Penny Stanway and ever looked back. I actually stayed with my mum for the first week as DH was working. She did all the work while I just looked after and fed DS. That is one of the problems of today - not enough family support.

My DH BTW never felt excluded needing to feed baby with EBM. This is another presure new mums do not need IMO. He loved watching all our babies feed close up. Once they were fed I passed the over to him and they lay sleeping on his chest. There is too much emphasis on dad's giving bottles to bond. That in itself can be a killer for breastfeeding.

wish i had mn when i had mine

i have breast fed five children - though i do not like it well its ok but i know they love it!!
i NEVER KNEW WHAT A LET-DOWN WAS TILL MY THIRD!!!! Sorry for caps but its true - i just bugled along blindly with one half starved and another topped up on formula ...no one ever taught me how to do it!!

Mears, it's incredibly, incredibly hard to get a newborn latched, isn't it?!

I remember thinking when I was pg with DS2, having only stopped bfeeding DS1 four months before he was born, "I'm fairly sure I'll be better at this".

Well, I was. Just. It only took two weeks this time to sort it out (though I did get mastitis on day 10 - day 10 seems to be when I feel incredibly ill, post-birth - happened with both boys). I think one of the reasons it was easier is the number of times I bfed DS2 in the first 24 houts (you may remember his blood sugars weren't raising as fast as the midwife wanted and she wanted to give him formula...).

But to latch a newborn? First of all, their rooting reflex is so strong, it's like you're touching their mouth with a static shock, not a nipple. Woe betide you if you've got them nearly latched and you touch the opposite cheek from the direction you want them feeding - they'll suddenly root off over their shoulder madly...! And as soon as they get the merest hint of nipple (or breast...!) in their mouth, they suck with great force - never mind if they're properly latched or not!

I found myself going "Oh, it's just about OK, I can live with that level of pain" when DS2 was just about latched right - then lathering on Lansinoh after the feed and hoping his mouth had got bigger for the next one. And I'm meant to know what I'm doing!

I'd read about the virgin gut (here as well as nipple confusion before DS1 was born and that was a strong enough reason for me not to give him "just one bottle".

It's bloody hard to strike the right balance between talking about breastfeeding and why you think it's a good thing and why more women should be encouraged and supported to do it and making women feel guilty for not wanting to or being able to. I do, however, think that women who "just don't want to do it" should be encouraged to explore their reasons for not wanting to.

mears, I agree. Too often, mothers assume the dads are going to feel 'left out' and tie themselves in knots to avoid this happening. I hear from many mothers who are expressing (with the hassle that can bring) solely so the dad can have a part in feeding. I don't think dads realise that it's not all that easy or convenient to express, and they like to think they are helping by giving a bottle - everyone's motives are positive, but most grown-up adult men (surely) understand that they can bond in all sorts of ways without weilding a bottle. If expressing so dad can give a bottle works for people, then go ahead - have fun! But don't make it another thing on the 'to do' list.

I also hear from mothers who are cowed into not asking for help. They don't admit to the midwife that they are still in pain. They are scared to say just how difficult bf is, in case the midwife or HV orders them to stop and to give a bottle (which does happen).

To clarify, DH never felt excluded not bottlefeeding - he just knew how to get me to keep breastfeeding. Reverse psychology works well on me

HM, it can be difficult to get a painfree attachment, but it's not inevitably difficult. In the right circumstances, with the right patient, loving, unpressured atmosphere, it just happens...really!

I think that can be harder to achieve in a maternity unit, to be honest.

Tiktok, sorry, my post does make it sound like it's impossible - I know it's not, I'm just impatient and have a high pain threshold

Seriously though - I did have pain-free feeds with both DSs in the early weeks, more with DS2 than DS1 though. I found it MUCH easier to achieve this in the daytime than at night, hence my oft-mentioned "never give up breastfeeding at night" mantra

Long story, I've taled about it before when I was JulieF. Basically brought up in a culture of bottlefeeding being the norm, brainwashed into thinking it was hard work, felt uncomfortable and yukky about it, then staffing problems meant I never saw the same midwife twice so didn't have the chance to discuss things other than being told what I "MUST" do by a hospital midwife who knew nothing about me or my circumstances.

I thought I wouldn't cope with nreastfeeding and going back to work meant it was pointless anyway. That coupled with public humiliation in the antenatal classes made me rebel.

Only after the birth I realised my mistake and time around I had much better support and knowledge and people who actually listened to me and what my needs were without withholding informaation.

It's funny, DS1 was a real feed-around-the-clock baby (no bf for first 36 hours or so, shields for months, low supply). But he was very well bonded to his dad, who had lots of practice swinging him about and singing to him to keep him happy when I took a few minutes off.

so was my ds - dp was much better at settling him than I was in the early days (perhaps because he didn't have any norks smelling of milk and getting in the way?).

The latch wasn't painful exactly in the beginning - I used to take ds off and try again if it was - but my nips were definitely more tender. After a few weeks, I could barely tell if he was feeding or not .

Great points.
Yes,a lot of guff spoken about fathers 'bonding' by bottlefeeding babies.

Bond by doing some fucking housework I say!!!

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Ah Pruni,that really is such a sad little scenario.

Hear, hear Mears. I was a Midwife, am now a HV and I bottlefed my son from 10 weeks after a long haul and struggle to breastfeed. I still feel that breast is best but looking at my happy, healthy (if slightly challenging) 3 year old I wonder just what I worried about in introducing formula when I did. I spend alot of time supporting other breastfeeding Mums with a good deal of success - but it doesn't always work and sometimes a Mum will decide - "that's it - I want to bottlefeed" and then heave a sigh of relief. I've been there too, bought the T-Shirt and there are too many other things to beat ourselves up over.

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I think that this is one of the best threads I've read here for a while.

Re the dads bonding thing, my DH always does bathtime and that's his 'bonding' time. I've never bothered to express (seems too much like hard work to me, all that sterilising etc) so DH has never fed DS milk, however, when he is home he can now oversee mealtimes instead. I don't think that DH has lost out because I bf.

I think a lot is to do with attitude, too, though. Because someone in your position, Pruni, facign what seems like terrible difficulty and feeling not up to coping with it, well there is a dilemma I think. It would seem the kind thing to do to say - well it doesn't matter, don't beat yourself up, give some formula and it will be fine. And it would seem harsh to say - keep trying, don't give up, because that would seem to be laying on the guilt especially if the woman is really asking the HCP for permission/approval to stop bf.
But there really aren't any glib solutions, because (as I said before) too many women who do give up bf due to difficulties do regret it later. But how to encourage women to carry on, in a sensitive way, without laying on the guilt - well I don't know how to swquare the circle.
I do know, ime, that the difference between a woman who continues to bf successfully from one who doesn't is not (generally) to do with the difficulties they had but much more to do with the support, information and encouragement she received, not just from HCPs but from her family and friends. I think the key thing to remember is that the wider community is not all that supportive of bf, and that the HCP therefore might have to be more positive to compensate for the anti bf (?pro formula?) bias in society.

Pruni - I agree with you about 'proper' education. I thought I had read up enough on bf before the birth, been to the talk given by our midwife etc, but I hadn't thought about finding out about difficulties such as Jaundice.

DS was born with it too and it was only because I refused to let the paed give him formula top ups and certainly no bottles that we are where we are today nearly eight months down the line and still bfing.

I wish I had known that acutally my colostrum was the best thing to shift the jaundice and that if he'd needed any more fluid (because of dehydration from the light treatment) that just simple water would have been enough rather than me trying to force donated ebm into him which he just threw up again and potentially screwing up my supply.

I still want to know why the paed appeared to have no knowledge of the advantages of bf a jaundiced baby. At the time I thought he knew what he was talking about, now I know differently.

Next time (if there is one) I'll be prepared!

Pruni, one thing that might help is having healthcare professionals who knew what they were talking about wrt bfeeding.

Then if you'd asked "Er, he's sleepy, isn't he?" they'd have said, "Yes, but if you're wondering how you'll feed him when it seems like he sleeps all the time, let's talk about it. You can try this, that and the other" - and then made sure that you'd understood and stayed with you while you tried several things to get him to feed.

If DS2 had been my first baby, he would probably have had formula for his "low" blood sugar in hospital. And I would still be sad about it. I actually think DS1 probably had the same blood sugar issues as his brother, but because I'd not been diagnosed with gestational diabetes, nobody knew to check his blood sugar (thank goodness).

Even though, I should still have expressed colostrum antenatally. I asked about it on here (thank you, Mears) and I didn't get round to doing it. I hand expressed on the ward and fed to DS2 - the midwife insisted I use the pump (er, no, it just made my nipples long in a rhythmic fashion and didn't get a drop of colostrum out.

The paediatrician I saw the next day said "I had no idea you could hand express!" [frustrated scream through my ears]

Could this really be a breastfeeding thread without aggro? Looks like it at the moment