Response to Breastfeeding announcement

[MyOtherUserNameIsAUnicorn]

I thought this was interesting UNICEF's response to yesterday's announcement.

www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/06/Response-to-RCM-position-statement-on-infant-feeding.pdf

I was infuriated by the UNICEF response. I took part in the research which the Midwives' new position statement is based on and was SO SO pleased when I saw that had been released - that things seemed to have improved and that midwives would support parents however they want to feed and provide decent information about both breast and bottle.

I gave birth in a BFI hospital and went to a very very poor quality NHS BFing antenatal class, which left me with the idea the only possible problem was too much milk. In the first week all the midwives I spoke to ignored my concerns about DD's feeding - leading to being admitted to SCBU with hypernatraemic dehydration. We were given the incorrect advice about sterilising. Midwives ignored anyone on the ward who had chosen to ff. i would love to see improvements and midwives offering impartial support and advice without pressuring women to bf with incorrect information.

I've been in touch with the Baby Friendly people - to complain
about my experience. They claim that they support offering advice
about giving bottles and that they ok formula being given for medical reasons but that isn't the experience I had nor what any of the midwives I encountered seemed to have been trained in. I don't know if it's just the NHS not having the resources available to do it properly but all the midwives I came across seemed to have been trained in telling women to avoid formula at all costs and to deny that BFing difficulties occur...

It is rather depressing that they're claiming 92% of maternity units in this country have done something about Baby Friendly accreditation. If I had a second I would avoid a BFI hospital at all costs as it's just not worth the risk of damage to your baby. But it looks like it would be very difficult to avoid these hospitals.

It’s a Stevens that doesn’t really say much, unless I’m missing something. It’s a bit woolly. It’s funny though @ridingmybike as I gave birth in a BF hospital (had premie that couldn’t feed at 1st) and despite having pumped tons and tons of milk they simply asked me which formula I wanted to use! If my dh hadn’t been speaking for me at that point (I was a bit out of it) they would have ended up feeding my baby formula completely unnecessarily and against my wishes. I think it totally depends on the staff you get on the day. Baby friendly didn’t seem to mean too much at mine, although it’s a very good unit in general.

Stevens? Statement!

Sounds good to me.

I gave birth in a baby friendly hospital and had tremendous support to BF. I would not have made it without that support. There wasn't any judgement towards women who FFed.

Riding my bike - there is no evidence at all that babies born in a Baby friendly hospital are at risk of anything. It’s ridiculous scare mongering to say there is risk of ‘damage’.

Poor postnatal care can unfortunately take place anywhere. Women using formula who feel under-supported or isolated or judged = poor postnatal care. There is nothing in Baby Friendly that endorses this.

Yep, this is what I don’t get about the BFI - it doesn’t seem to bear any relation to what’s actually happening in hospitals!

This is the response I received from them when I asked about the content of the BFing antenatal class
^We don't provide the content for antenatal classes in Baby Friendly accredited hospitals - however, as part of our assessments, we will review the curricula to check that key topics are included e.g. skin-to-skin contact, breastfeeding and bottle feeding responsively. A key part of the Baby Friendly standards is supporting health professionals to provide personalised, mother-centred care, including early identification of any feeding problems and treatment as appropriate. We are sorry to hear that you did not receive this level of care - we are continuing to work with health services across the UK to improve care. You can find more information about our standards here: www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/guide-to-the-baby-friendly-initiative-standards/^

They certainly weren’t covering all those key topics at the antabatal class - the only mention of bottle feeding was not to do it, and if you really really really had to express then definitely not before six weeks. Nothing about bottle feeding responsively, although there was loads about skin to skin and BFing on demand.

I don’t think the NHS has the resources to provide the mother-centred personalised care they mention above. The midwives seemed to have been trained in a very basics of BFing ‘one size fits all’ approach and were extremely patronising about my concerns over lack of wet nappies etc.

Yea you had poor care. UNICEF BFI also has a statement on how they support ff families.

www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/How-the-Baby-Friendly-Initiative-Supports-Parents-who-Formula-Feed.pdf

Antabatal class?! I’d have been better off going to one of those I reckon!

I do now recall that my hospital mentioned at our antenatal that they would happily support parents to ff if that was their choice. Must be hit and miss in different hospitals.

So if the BFI people are saying they check maternity units to make sure they’re providing this support and advice how come it is so bad - the unit I was in was accredited to level 3!

This is what I mean - I’ve also seen the BFI statement about babies suffering from hypernatraemic dehydration (as mine was) and it bears no relation to what was actually going on in the hospital.

@tiktok my baby was made seriously ill by a BFI hospital - if we hadn’t ignored the midwives and given her some formula ourselves on day 5 we’d have been in the brain damage and risk of death category. As it was we still ended up in SCBU for four days whilst her sodium levels returned to normal.

So not scaremongering - I’d rather that didn’t happen to any other mothers and babies.

Baby friendly is no guarantee of anything. A baby poorly enough by day five to need a further four days in special care to rehydrate has had very poor postnatal care indeed and you were right to complain. Babies not feeding effectively and this being missed has been an endemic problem in maternity units - it’s even missed in Baby Friendly units despite Baby Friendly, not because of Baby Friendly.

RidingMyBike, you’ve found out yourself that the guidance and training from Baby Friendly as an organisation is not reflected in what you experienced (which was awful). You are scaremongering when you say babies are at risk of damage in a Baby Friendly Unit. Like it was a general thing, like it was the fault of Baby Friendly.

@RidingMyBike so sorry to hear this and @tiktok very interesting if I'd spent another day in hospital trying to get breastfeeding going I think we would have ended in the same situation. My little girl was showing early signs of dehydration and jaundice and I completely lost faith in breastfeeding and went straight to formula feeding. She was starving living off expressed colostrum only for 4 days. As it turned out some days later and at home my milk finally came in after a EMCS, so I expressed and then FF. I really thought my BF journey was over, it was a pity looking back as I just needed help and the confidence to make it BF work, but it would seem everyone put me in the box of FF and that was that.

Of course it was the fault of Baby Friendly - apparently they're meant to check up on what hospitals are doing if they're accredited. After our awful experience we were told that the midwives weren't allowed to even mention formula, lest they be seen to 'promote' it. I was in for 3 nights after the birth and saw how the ff mums were treated. There was a steady stream of mums and babies being admitted to SCBU with dehydration and/or severe jaundice - it wasn't just us having problems.

Apparently this isn't actual BFI policy, but this was the staff training that had been provided in this hospital - the staff were very 'on message' about it. The hospital was accredited to level 3 (which seems to take time to achieve). So the BFI has approved what they were doing over a period of time.

RidingMyBike, the hospital will be checked up on, following your complaint. It's absolutely not acceptable for midwives to say they cannot mention formula - how ridiculous and how untrue.

Your observation of a steady stream of readmissions to Scbu - that is likely to be linked to early discharge. When babies are discharged after a few hours or a couple of days, the issues that might have been spotted and resolved in hospital if they had been in longer send them back there. There's no necessary link with Baby Friendly. In any case, your experience does not mean that in general babies are at risk of 'damage' because of Baby Friendly. Baby Friendly does not wipe out the effects of poor postnatal care.

I'm inclined to believe RidingMyBike's story.

Firstly, healthcare is now supposed to be much more open about receiving feedback from patient experiences and it just makes sense to actually believe what the patient's story is. They know their experience best, they lived it and have the clearest understanding of what the factors were that led up to those problems.

If we are hoping to improve patient safety in hospitals it just makes no sense to ignore the factors that patients are saying that led up to the problems that they experienced. If someone says that they felt the baby needed formula supplementation but there was reluctance by staff to give it, why would we not pay attention to that?

Secondly with regard to linking those concerns into policy. Well, many BF promotion campaigns, articles and policy statements DO declare that "virtually all mothers can make enough milk", so, there DOES seem to be a clear link between such claims and the problem that the poster reported which was that she wasn't, and that people were ignoring this as a possibility. Were they ignoring it as a possibility because they had been repeatedly given literature claiming not enough milk could not happen?

Finally one of the baby friendly steps is to avoid all supplementation unless medically indicated. This is a part of the policy. The poster's story seems to link in to that specific part of policy guidance. She was not told to give baby supplement until baby was medically unwell.

See a link there? or no?

Correct, there is no evidence (yet) in terms of robust data linking readmissions to baby friendly status. But there is a thing called the precautionary principle - where if the health of babies is a concern, and a bit of policy says to avoid giving formula until the baby needs it medically, and then we see babies medically unwell - might there not be a link there?

There is data linking less supplementation with higher rates of readmission for jaundice, BTW. Controlling use of supplementation is a key component of baby friendly policy (step 6).

Hi @bigmamapeach thank you!

Part of the problem was that I simply had no idea that formula supplementation existed. I believed what I'd been told by the midwives about colostrum being all that was needed until milk came in and that newborns cluster feed a lot. And that milk delay/ supply problems were very rare (they didn't give a figure but implied it was more like one in thousands of births) Also that giving any formula at all was a really bad thing to do as it would ruin BFing. I had a checklist (in postnatal pack) of how many wees/poos to expect on each day after birth and those just weren't happening as they were meant to - but every time I said this to a midwife (both on postnatal and on the maternity phone line) it was ignored or dismissed as 'first time mums don't know what wet nappies are like'. and that it was just cluster feeding.

It was only after our fifth night when I fell asleep holding DD and dropped her because I was so tired from the non-stop feeding/screaming that we decided to ignore all the midwives and DH went out to buy some formula. Our gut instinct was that something was wrong but it felt like we were doing something really bad. Later on that day a more experienced out-of-area midwife came to do day 5 home visit, listened with horror to our story, weighed DD and discovered she'd lost 13% of her weight and sent us straight into SCBU.

RidingMyBike, I absolutely believe your story - don't know why bigmamapeach thinks I don't. Everything you say is credible and not unique. My point is that the unit you were in was not 'being' Baby Friendly, whatever their accreditation. The lack of wees is a red flag and good postnatal care would have reacted to this very significant symptom by weighing your baby before the 13 per cent weight loss was revealed.

Lack of poos is even more significant as it's easier to assess.

You were grossly let down, IMO.

Obviously she was let down. Obviously the care was awful. These stories are not unique and many mothers are starting to identify common themes. I am not ignorant of this area personally. I have friends whose babies were readmitted as well. Readmission for feeding problems is not rare - most mums will know others for whom it has happenned as well. I also have personal experience in another way here and have spent time amongst the professional communities doing bf support - having spoken with infant feeding advisors, baby friendly people, IBCLCs, volunteers etc. Some of the things I have heard there does scare me and echo the themes riding said. I do think the stories of families should be taken more seriously than "just bad apples" causing poor care - as that dismisses the themes that the poster highlighted. A good safety-focussed investigation looking at root causes and what those staff were actually trained to do and believe would be useful.

Riding, there are some groups out there who you could talk to. One group is Maternity Outcomes Matter (mainly focussed on birth issues) but they might be able to help and the other is Patient Safety Learning. These are trying to help identify common themes which often cause error and patient harm and therefore to learn and improve practice. The folks working with PSL know that errors like this are actually very rarely just "individual" and often common themes can be drawn out that need to be identified and acted upon. There is also AVMA and one of the senior people involved there is a paediatrician.

Saying it's just an individualised example of poor care, limits the ability to get to root causes and identify themes which might carry across to other families. In relation to what might have been believed and where those beliefs came from. The rationale for the staff ignoring nappies, not paying attention to weight. Not suggesting supplementation earlier. Etc. Where was their information and training from? What did that information and training say? How does that link into actions. Etc.

Thank you @bigmamapeach for those suggestions - I will look into them.

One of the problems may be that it's hard to complain when you're dealing with a newborn - I eventually got my complaint sent to the hospital when DD was 11 months (the deadline was within a year) but it was ignored twice until I wrote copying it to the Chief Exec's office (I didn't know about PALS). Complaining was time consuming and complicated and requires persistence, confidence and literacy skills - so I wonder how many families actually follow through, making it look like incidents are more unusual than they are.

I looked into doing an FOI request about rates of readmission for dehydration etc but apparently there is no consistent way of recording these things across hospitals?

Bigmamapeach - either I'm not explaining myself well, or you're not reading me right.

The issues raised by RidingMyBike are real. They are not uncommon. They are, I suggest, happening despite Baby Friendly, not because of it. I agree, too, they are systemic - related to poor training, poor supervision and institutional practice which is not following Baby Friendly protocol.

There is no justification for not monitoring newborn wees and poos. It's negligent not to. Babies should be weighed before five days old if there is any sign feeding is not being effective - and lack of wees and poos is a major sign.

Readmissions are monitored and audited. There's a current study into rates and reasons, making use of data already collected routinely (if units are following required practice). Discharge from the maternity unit into the community should be in conjunction with proper midwifery care outside the hospital. In areas with midwife shortages, this is just not happening.

Babies where BF is not going well are missed. Then someone weighs the baby on day five, or six, or seven....and is readmitted because the baby's lost too much weight. But before this happens, there are signs all is not well. The baby is not seeing or pooing; the baby is miserable all the time; the baby cannot be roused to feed (usually a later sign); the baby fights at the breast; the mother is sore and getting worse....none of these signs should be ignored and none happen for the first time on day 5.

Readmission for excess weight loss, or serious jaundice linked to under feeding, or frank signs of dehydration are failures in maternity care. It's nothing to do with Baby Friendly, whose training includes spotting early signs before they become a crisis.