The support we had from the NHS in the first few weeks was SHOCKING. DS looked like a famine victim at one point, having been born on the 50th centile. He slipped to the 9th centile by week 4 and it took until he was about 5mo before he lost the gaunt look.
As my husband said to one MW: "Breast is best until there is a problem and then you just shrug and suggest formula instead of identifying & addressing the underlying issue(s)". I spent hours with the NHS in those first 4-5 weeks and quite frankly those connection points were mostly a waste of time.
The best support we had was either charitable (NCT, LLL or online) or we paid for ourselves, which not everyone can afford.
However we experienced poor weight gain, poor milk transfer, thrush, mastitis, low milk supply, double pumping 8 times a day, finger/tube feeding, SNS, bottle feeding, cup feeding, FF top ups, BM top ups, fenugreek, domperdone, PTT snip - all within the first 3 - 4 weeks!!!
The story has a happy ending though as at 32mo he is still bf and he looks like the little rugby player he should.
Thank goodness for a postnatal doula, fabulous IBCLC, the NCT bf drop in and the local LLL group, as well as the LLL resource pages online, kellymom and the Dr Jack Newman pages. And of course not forgetting Daisy the Medela hospital grade double pump we hired for 3 - 6 months.
DS had a PTT. It was the IBCLC who noticed at week 2. by the end of week 3 things were getting desperate. The NHS were suggesting formula more urgently but not helping us to establish bf alongside. As a family with a history of diabetes, cardiovascular problems & other such illnesses I felt passionately that giving DS the best start in life was by EBF. I was crushed when he had to have formula. However I knew from my research that there are very few women on the planet who are physically unable to bf so I was adamant I wanted to try everything, even if the NHS was useless.
The PTT was eventually snipped at home by a 2nd IBCLC. Having been told by some HCPs that "TT/PTT is a myth" or "whats that" or "no need to snip as it wont make a difference". It did make a difference to me, to my boobs. Not straight away but within a week or so. This also coincided with a better weight gain. hurrah! was it really pure coincidence? I dont think so.
MWs and GPs and other HCPs who are dealing with new mums and babies should all be better trained to deal with weight loss and bf issues. & they should also be wise enough to know when they dont know the answer but know who to refer to. This would save a lot of time.
FRom the hospital to the community they all need better training. I was told in the hospital everything was fine by someone who I thought was a MW. I asked her to send me the infant feeding co-ordinator but she refused to even follow up on my request on the basis they were all trained as well as she would be and my latch looked fine. I was in agony and it was only day 2...... Problem is these hospitals treat everyone like they are the infants and I was disempowered. It was truly awful so I left the hospital with a child who was barely getting anything out of me. Poor mite.
One of the community MWs was a sweetie (interestingly she also had a private LC practice) but just after the PTT was snipped, and when DS was looking truly skeletal, I saw her on a Sunday afternoon at the clinic. She went over his notes again and heard about the gains we had made in terms of PTT snip. She noted his weight gain was insufficient but we made a plan to keep at it and to meet again in a couple of days. However that evening she called me in a tizz. Clearly her supervisor had told her off. She was telling me I had to go to A&E. I pointed out that going to a London A&E with a newborn was hardly sensible,unless she could tell me why. She was almost shouting at me. I declined the invite and told her I would see her in a few days as agreed. She had rattled me though (& in fact she called my GP and got a locum to call me to do the same number and accuse me of all sorts of things when I refused) so I consulted with the local LLL leader and NCT adviser and then called my medical insurance to get a private Paed appointment, to which my doula accompanied me as DH was out of the country. The private Paed was fab, v supportive, not patronising (as many of the MWs were) and said DS was fine and all he needs is for the calories to keep coming.
I was lucky that this MW, who sadly I never saw again as one doesnt after week 4, was so supportive that when we identified I now had a low milk supply which was not responding to feeding & pumping and I discussed domperidone with her she spoke to my GP for me to get the higher dose as recommended by Dr JAck Newman.
FWIW I think the rule that MWs only remain responsible for a mother/baby dyad up to week 4 is ridiculous, particularly for cases like mine where bf was not properly established until somewhere between week 7 and 12, rather than the usual weeks 4-6. If MWs were properly trained then surely they would have been the proper set of HCPs to look after us until then , rather than the HV?
IT all felt like a box ticking exercise. not fit for purpose. not fit for our situation. most unsatisfactory.
IMO I do not see how a community MW can run a regular clinic for babies up to 4 weeks WITHOUT proper (& regularly updated) bf training. It is a waste of those connection points with the mother/baby dyad. In each clinic it should be mandatory for at least 1 of the HCPs to either be as qualified as a IBCLC or to be a qualified IBCLC. Only then will the mother baby dyad in the UK get the proper support they so desperately need.