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?

Must be the nasty expensive feeding bras... I agree about midwives, it so depends on their attitude to bf. When ds was 24 hours old and had had no food whatsoever, one told me when I asked for help to try to latch him on that it didn't matter if he didn't feed for a few hours! He ended up not having a proper bf until day 3 (other than two quick goes with counsellor's help) and was really poorly. Still feel cross about it.

The community midwives here in North Wales are brilliant as lots of them are bf counsellors too.

They are lobbying for nursing bras to be made avaailable on the nHS.

It is frankly staggering that the issue of optimum feeding of a neonate is not a core principle of a midwife's training.

Increased b/f rates would save this country millions of pounds.

In my local hospital (which is taking the plunge and going for baby friendly status,there was a big hooha a couple of years ago because a breastfeeding mother who had had a c/s and was receiving less than ideal support noted that bottle fed babies were being whisked off at night to be fed by the mws so that the mothers should rest.

I gather the policy now is that if it is your baby, you have responsibility for fedding it,whether you chooose breast or bottle.

When I saw my MW at the docs a view weeks ago and she asked me is I would write to the director of midwifery about my experience of lack of BF support. At my local birth centre the MW are all willing to go in their own time to have specialized BF training but they want the PCT to payt for and they refuse to. So I've written and told everyone else who wanted to BF in my area but gave up due to lack of support.

From my experience the MWs were all for you BFing - but when anyone had any problems and needed support and explanation (like when baby wanting to feed constantly before milk in or latching on poorly) and mum was saying 'perhaps I should just give a bottle' they were very quick to get the milk for them and agree how much more settled/happy baby looked after a couple of oz of formula.
Mixing BFing and non BFing mums in a bay is also a recipe for bottle feeding - who wants to be the one whose hungry baby is crying all night and keeping everyone awake...the peer pressure to give a bottle was immense...

Portandlemonaid asks: "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?"

Bfc tutors have groups of more than 2 to 3 - I said '2 to 3 more' than what they have at present, in my 'vision' Unlimited funds would not make a difference, because it is capacity that is needed ie more people who can do it. I suppose you could offer tutors (say) £30K to do it as a full time job - where are the new bfc trainees to come from? Even if you offer prospective trainees say, £20k a year just for training, they will not just appear. This is a job that people do not want to do full time, on the whole. They want to do it around the needs of their families and other jobs. They like it that way!

Here's a radical idea: why not expect the people whose job it is already - the midwives - to support breastfeeding in maternity units to do this job properly? You don't need huge extra sums of money - they are already being paid. You don't need huge extra numbers (apart from areas where there is a shortage of m/ws). You don't need extra tutors because they are there already, too.

All you need do is change expectations, so the training includes rather more about bf, and change priorities, so midwives who fall short of good practice are given sufficient support and training to do the job effectively.

There will never be enough trained breastfeeding counsellors - volunteer or paid - to help the 450,00 mothers who start breastfeeding every year. But we already have (in most areas) enough midwives.

Absolutely agree Tiktok. It is the role of the midwife to support breastfeeding. Midwives who give crap advice need to be named and shamed. Heads of midwifery need to ensure their units are going for babyfriendly status which ensures adequate training of staff.

Mothers also have a responsibility to learn about breastfeeding BEFORE their baby arrives. Babyfriendly hospitals have breastfeeding workshops to increase mothers knowledge before the event.

Babyfriendly Initiative

I agree about the naming and shaming mears. I was lucky enough to have good bf advice first time round. Second time and in a different hospital it was shocking. I did raise the issue with my community midwife afterwards as I felt that had I been a first time mum, the midwives' advice would have done more to jeopardise my breastfeeding chances than support me.

It's often not so much crap as advice as no advice.. and no support.. and a new/inexperienced mum just accepts that the midwife knows best when they breeze professionally in with comments such as "baby is hungry" and you are knackered and bruised and battered and shocked from the birth. I am just a mother.. not a professional anything baby related... but it happened to me.. and a pretty large number of people I know.

Midwives supporting bfeeding, Tiktok? Bit radical!

Seriously though - would be fab, wouldn't it? Rather than rolling their eyes and sighing heavily if you say no to formula

(Present company excepted, natch, Mears )

SJ, I guess that's why the midwife I had was so shocked and appalled - I said "er, that's not happening" to her and I swear she physically recoiled

"How very dare you! I'm a midwife, don't you know!"

(Not you, Mears )

I had that rolling the eyes and sighing when I refused pethidine, hunker.

Different thread I know.

What with the advances in medical science... should we just clone Mears, (a great many times obivously!). Problem solved?

Gillian, I think there must be a unit at midwifery school - maybe it's an optional one that they take instead of bfeeding support training? Like there's one for sucking one's teeth and going "it'll cost ya" at mechanic school.

SJ, that is a very, very good idea!

All the midwives on my postnatal ward were v pro bf. All seemed to have half decent training and we were encouraged to ring at all hours of the day and night to have latch checked etc if we were having any problems.

Most mothers were at least attempting bf although anyone who wanted to bottle feed was helped to, no questions asked. Mothers were encouraged to try to hand express some colostrum if babies were sleepy or reluctant to feed.

I had a lot of trouble and was referred by my community midwife (also v pro bf) to an excellent team of bf counsellors based at the hospital and have been seeing them twice a week. We're getting there and I almost certainly would not be bf'ding at 2 and a half weeks in without their support (cracked nipple, mastitis, infected nipples...so far ).

The only thing I would say could be improved was that the midwives were run ragged on the ward so couldn't spend much time with you. Also, the auxiliary staff often answered the buzzers and tended to have the attitude that you were wasting the mw's time if you were wanting bf'ding help - .

So, 9/10 for my hospital...shame they're closing it down in 2008...

Shona,that sounds more like it!!
Hang in there kid,and demand help as and when you need it.
(Congratulations by the way.)