Why aren't breastfeeding counsellors employed on postnatal wards?

[ShinyHappyStarOfBethlehem]

Is there some conspiracy with formula companies? Or is is just LOW low down on the NHS's list of priorities? Or is it not considered important at all?

My friend had her first baby recently. She was of the mind that she would 'try' breastfeeding but would not torture herself if it didn't work out. Which is fine.

However, her baby, now 4 weeks old, is bottle fed.. which was always going to happen (except on the outside chance that he had taken to the breast immediately and without hesitation and she had felt 100% confident.. unlikely in an inexperienced first time mum).. because she got zero support on the ward!

He was born.. she expressed a wish to breast feed him, he was put the breast but not overly interested (not uncommon and not an indicator that breastfeeding is 'not going to work out') and she later was woken to the midwife telling her she was 'taking him to give him a bottle because he's hungry...' I know for a fact this is far from uncommon and in many cases, probably a majority, when this happens, it's the beginning of the end of the breastfed child who might have been!

I am not saying that all mothers should breast feed (IMO don't see why vast majority can't give it a go and at least give colostrum but that's just me) nor should they be made to persist when distressed and certain when they would like to bottle feed.. but there really ought to be someone on the ward, employed for the purpose of breastfeeding support, separate from the busy midwives, who can be there to educate, advise, assist and support.. otherwise it's just down to how busy the midwives are and worse still, how they personally feel about the importance of breastfeeding. Which is outrageous really.

How many more breastfed babies would there be if some initial support on the ward was just something that happened?

But would a bf counsellor make bottlefeeding mothers feel even more got at ?

I'm sure you are right about the bf rates rising if there were such a scheme in place though.

I would say it's all down to cost

they are starting to be in our area and I am starting to train to be one in the new year

I read an article...in our area mums in 'regeneration' zones (lower socio0-economic usually) have a lower uptake of breast feeding but those that do last for longer...whereas in other places in our region, mums have a higher initial rate but don't last

that is very generally speaking of course

Popsycal I think that is the case nationally. Last time I looked it was.

Not I don't think it would make anyone feel 'got at' Algeronon.. the BF counsellor/advisor wouyld be there for anyone who was wanting to breastfeed.. wanting to try.. or undecided.

I think it would be fantastic if there could be a breastfeeding counsellor on every ward.

Not going to go into story, but although I managed to carry on bfding the hospital was no help and my baby ended up dehydrated and in NICU at 48 hours old. I was still not given any support with bfding, by those who also refused to give my baby a bottle (suggested by the dr) as you can't do both.

Am still at the lack of help and support I was given.

I would say it is for the same reason we no longer have an obstetric physio at our maternity hospital - no joined up thinking.

Somwhere along the line no-one has really thought out that investing a bit of cash at the post natal ward for breastfeeding counsellors
would help breastfeeding in the long run - the thing that we're all told is the best thing we can do for our babies.

I had appalling breast feeding support for with DS1 and it was only because I was more assertive (and I had MN!)that I managed it with DS2

there was a bf counsellor employed at the hospital where i had ds. she was worse than useless.

they did say (in response to my complaint) that were hoping to get lots of volunteer counsellors attached to maternity ward but i have no idea whether that has happened.

I was extremely lucky that our hospital had a breast-feeding counsellor. She was wonderful - she taught me to express, helped me stand up to the paediatricians who wanted my dd force-fed with formula, she helped me out with positioning and latch, and when I was struggling and about to give up after the first few of weeks, she came to my home on her day off.

Her advice and information was so much better and more geared towards breast-feeding than any of the midwives - who were helpful enough but who were badly informed about breast-feeding, and were quite happy to provide Aptamil at the drop of a hat without any attempt to help new mothers breast-feed.

I agree that there should be someone available for expert breast-feeding advice on all post-natal wards - not to shove breast-feeding down new mother's throats, but for advice and help when it's needed. But giving midwives information is equally important - being better informed about breast-feeding might mean that less women in your friend's position have their babies taken away and given a bottle. And educating women that they have the right to refuse to have their babies given formula would be useful too.

there was one on the ward where I had my children, but this wasn't enough really - it was a large ward and they were chucking mothers out at 5 hours after birth, so there was no way she could see many mothers.

I could have breast fed my first but he ended up bottle fed due to an appalling lack of support and conflicting advice.

I was 20. I so wanted to bf and fully understood the advantages.. but I struggled with the latch, and subsequently with my supply and then later, when he failed to gain weight, indeed lost weight, I assumed it was my fault and that of my milk. Nobody tld me this was unlikely. The visiting midwives (at home) all said different things and there was no continuity of either the m/w themselves or their advice! One day one would day give him a bottle, the next day one would come and say' if you want to bf, you still can! I was confused, upset and in tears every day.. the poor baby was put on and off the breast, the formula went in and out of the cupboard, the steriliser on and off the shelf, and my family who were trying to support me, nearly round the bend!

At 5 weeks, by then fully bottle fed to my distress, and still losing weight and constantly pooing.. he was diagnosed with cystic fibrosis.. the source of his inability to gain weight without medication, and I learnt almost immediately that breast is absolutely ideal beyond description for babies with CF because it is is the most digestable food in existance. He wouldn't have even needed much in the way of digestive medication until he was weaned, if only someone.. anyone!.. had been on hand to give me some professional advice!

I later went onto breast feed my second child for nearly and year and my third child for two years. I had the confidence to persist by then.

Even if every quaified breastfeeding counsellor in the country was employed full time on a maternity ward - which would never happen as most of us have jobs and other responsibilities anyway - you would not even scratch the surface.

There are only a few hundred bfcs, with whole swathes of the country with no one at all.

It's not the answer - can never be the answer.

The answer (or part of it) is for training of all midwives to be far better than it is, and for breastfeeding support to be seen as important enough for everyone in touch with a new mother to know about it. Shiny, you are spot on when you say midwive's pesonal feelings come into it, too.

It's also important for mothers who have had poor support to write to the PCT and the head of midwifery about it, with full details.

But there will never be a time when breastfeeding counsellors can provide anything but a tiny amount of help.

It's cost-related.

The hospital I had the DSs at was less than shit-hot at bfeeding support. I've been back twice now to discuss it and in the NY will chase up why they've not been back in touch with me

The director of midwifery said that she would love more mums to bfeed, but I got the feeling that there are more "critical" things to spend their budget on.

I think it would save money in the long run to employ people to support bfeeding though - because of the longer-term cost implications of ffeeding to the NHS (no doubt I'll get people posting "oh but my friend's baby was bfed till he was 18 and was the poorliest child I ever knew!" posts now ).

Not even if there were a great many more trained and employed for that express purpose TikTok?

You'd need a budget like the formula companies have to train that many, SJ.

Would be a better use of their resources than the "bfeeding support helplines" though...but I guess they'd be a bit...biased, perhaps?!

Shiny, it's not just a question of money, but capacity.

It takes about 2-3 years to train a bfc, who trains in her own time. Tutors to train the bfcs take a year or more to train and of course they have to be experienced as bfcs - I think the minimum is 3 years in practice. This is the case for NCT and the other organisations are pretty similar. There are about 30 NCT tutors, and probably the same no. again in the other orgs - so let's say 60 tutors altogether. Some, not all, are working at capacity, but lets say that at any one time, each of those tutors could take on an avarage of 2-3 more trainees. And that together, the organisations manage to train another 10 tutors in one year (don't forget tutors leave, so that would not be an extra 10).

Do the maths!

It isn't going to happen that we get enough to have even one person on each maternity ward in the UK.

You could, and some places do, train up healthcare assistants to specialise in breastfeeding support. You could develop a year-long vocational course, and you could, eventually, have them as specialists. This would take a long time to have one or two of them on every ward....in status, though, they will be quite lowly compared with midwives, and will not have the clout to over-ride bad advice.

We have to look at what has been shown to work. Places with good bf statistics i) have the official Baby Friendly status ii) have a senior person whose job it is to support bf iii) are supportive of midwifery inservice training in bf iv) are likely to ask midwives to explain their practice if it is seen to be unsupportive of breastfeeding.

If this happened everywhere, then things would change. It's the responsibility of every midwife to practise safely and effectively. How would a bfc have stopped a midwife from taking your friend's baby to give it a bottle? Unless she was there at that moment and had the status to say 'stop!'....which would not happen.

I often hear pleas for bfcs to be in maternity units and in some places they are there. But it can never be a general thing - have I convinced you??

Yes Tiktok. Sadly

Perhaps the answer then, is volunteers. I'm sure they could be very helpful and knowledgeable. I have often thought I could do it if I had time..

Shiny, sorry, no.....the answer cannot be volunteers. They need to be trained, and there are not enough of them. Bfcs are all volunteers. You are up against the problem of capacity not money.

Sometimes, peer supporters (a basic training of maybe 10 sessions) go onto maternity wards to introduce themselves. That's fine - but they do not have the skills or the authority to sort out women's bf problems, and they should always defer to the midwives for this.

But there has to be a way forward?? It can't be ok to just accept the situation? Surely more trained BF counsellors would help and then perhaps cause a trickle down effect.. If breastfeeding became somewhat more commonplace, then perhaps it would be more like it used to be.. girls would see their mothers, aunts, sisters doing it and go on see it as something natural and 'usual'.

I totally aknowledge what you are saying Tiktok (and it stinks! Not your knowledge.. the situation!).. but.. can't help thinking something is better than nothing..

Perhaps maternity nurses just need to be kept more up to date with current thinking on breastfeeding and also be given "top up training" in helping new mothers.

Given that a lot of people are kicked out of hospital within 12 hours, there doesn't seem to be a whole lot of point to having dedicated people there. Money better spent helping people at home, IMO.

I had my last baby in Ireland and out of 4 wards on the floor (of about 8 to 12 women), they had one ward for breastfeeding mothers, multiples and C-sections. Sad, that only around 10 of 40 to 50 women were b/feeding, but moving on.

The nurses on the b/f ward were SO helpful and were put there becuase they knew what they were talking about. I had the matron sitting with me for 30 mins helping me at one point. However, I was in for 3 days, as is the norm there and I really only needed the help on Day 2 when the baby really started to feed. If I'd been chucked out on Day 1 (as in the UK) then I'd have needed the help at home.

Granted, they didn't try to feed the baby formula, but I don't think that would happen much if hospitals had a breastfeeding "specialist" maternity nurse on each shift.

New mums are generally there for at least a couple of days I believe even now.. and if breastfeeding can be established even before the milk comes IME it can only get easier once it arrives.

I so agree. When ds was born the breast feeding counsellors were so supportive BUT were only able to give me 20 mins per day for the first two days. This meant that he only got two proper breast feeds on those days as I couldn't get him to latch on myself at first and the midwives were too busy to help. We were lucky as he cottoned on to what he was supposed to do on day 3 and I fed him for 6 months but I'm sure many women at the same hospital will have given up after a few days.

Blimey, I must have been really lucky. I had BF specialist midwives and a nursery nurse come around and help me. And there was a log of my BF attempts etc, so that there was consistency over shifts.
It did really help, one MW even hand expressed for DD when she wasn't latching much, which was a bit weird, but did the trick!

Hypothetically, though -- if there were unlimited funds available and bfc tutors and bfcs could be paid a good wage, enough to do it as a full-time job, so that bfc tutors could take on more than 2-3 trainees each and full-time paid bfcs could cover more women at once, and because there were more trainees coming out of the tutoring system you were getting more and more bfcs? Would that not make a difference?

I think TikTok is right, midwives really need to encompass breastfeeding as part of their job, which I believe theoretically it is. It is all down to the individual midwife's attitudes. I believe women really do need midwives support with breastfeeding more than the midwives really appreciate.

I remember going to an antenatal class on the NHS, and the midwife going through the pros/cons of breastfeeding, and one of her cons is that breastfeeding is more expensive than bottle feeding , never did work that one out.