Response to Breastfeeding announcement

[MyOtherUserNameIsAUnicorn]

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

Seeing should read weeing 😀

I can see why you think Baby Friendly provides training in spotting all these signs that things aren't going well... except, on the ground, in the hospitals, they're not. What is happening in reality doesn't match what Baby Friendly say they're doing. Are they following up on this stuff?

I don't know. But a friend I've made since having DD had a very similar experience at the same hospital three years earlier. She had been better prepared for BFing through her own reading and was friends with local lactation consultant so ended up quoting advice to the midwives about making sure the baby was fed, then dealing with the issues causing problems - they still wouldn't let her have formula, and kept trying to insist she just kept putting baby on breast, but she insisted on her DH bringing in formula and fed it to the baby. So, they don't seem to have learnt from that problem as three years later all midwives are still parroting the same line. The unit was accredited by Baby Friendly the whole of that time so what checks are being made??

RidingMyBike, I am not a BF assessor so not directly familiar with accreditation, but I do know they respond to complaints, and I am personally aware of hands-on follow ups to complaints. No one can 'not allow' a baby to have formula - as your friend found, all parents can supply and give their own if they choose to. Midwives and other HCPs may make a clinical decision not to supply it, if they judge it not to be necessary (just as no one can demand a drug, or medical intervention, if the HCPs involved disagree with clinical need). Obv I have no way of knowing exactly what happened in your friend's situation.

@tiktok so, is that contacting BF directly with a complaint? Or somewhere else?

Directly, yes. I haven't checked recently to see if this is still the case, but they had a section on their website which was a form to feedback (positively or negatively) on experiences in Baby Friendly hospitals, and I know from personal experience (not mine, but someone I know) that this was followed up with the unit concerned.

Having Baby Friendly accreditation is not a guarantee of good practice. However, it does mean that complaints can refer to that policy. I think this is the case across all institutions and organisations anywhere - you can have policy, training, guidance....and yet things depart from this.

Ok, thank you. Will have a look.

What the hell is happening to our species? It seems that humans are actually losing the ability to lactate. There are so many posts from women on this site who couldn't produce enough milk to feed their babies. Yes, I'm sure this happened in the past as well - but surely not at this level, or humanity would have died out long ago. I wonder if it has something to do with the fact that so many people are on medication for various conditions nowadays.

@Valanice1989 when I returned to work from maternity leave I found accounts from 1915 ( 100 years before my daughter was born) where the authorities were trying to set up milk banks in cities because so many babies were dying or failing to thrive. 15% of babies didn't survive to their first birthday - some of those would have died from birth injuries or diseases we now vaccinate against but some of those were babies where breastfeeding didn't work out but before formula was available. So BFing does have a certain natural failure rate and it's higher than certainly I was led to believe. There are countless historical accounts of babies just failing to thrive and passing away - people had large families because they expected to lose a few along the way, whereas now any baby death is treated (rightly!) extremely seriously.

There are also a lot of women now who wouldn't once have been trying to feed babies - they and/or the baby wouldn't have survived the birth, infertility, medical conditions that we now survive and can conceive whilst having them. It's known that all those things can affect milk supply (haemorrhage, infertility, PCOS, diabetes to name but a few) but again the information doesn't seem to be widely available.

Yes, there are a lot of babies which could have been breastfed but haven't, for various reasons, some of which is down to choice, or not getting support/info (I have helped several women combi-feed who had no idea it was possible.

Formula was originally invented to feed those babies who were failing to thrive - it was meant to save lives and stop those babies becoming susceptible to illness or disability. Obviously it's since got tangled up in all kinds of issues around advertising, especially in developing countries, but it was originally invented to solve the problem that breastfeeding didn't always work.

And milk supply naturally varies - Once upon a time some women who produced gallons of milk would have been employed as wet nurses, whilst others would have struggled to produce enough for one baby - just like now some women can bf twins perfectly successfully whereas others will have to supplement. It's natural variation

** obviously people also had large families because lack of contraception...

Lot of half truths and misunderstandings in your posts, RidingMyBike 😳. Yes, there was concern at the start of the last century about babies not being well nourished. The main cause of this was industrial practices which kept women and babies apart from each other - the urban working class were not able to feed their babies ad lib and as we know, BF works best when mothers and babies are kept close together without restrictions on frequency of feeding. A mother only feeding her baby once or twice a day will find her supply drops. A mother working in a sweatshop, factory or wheverer was at risk of not being able to maintain a supply and babies were fed on gruel, or cows milk that went off quickly and so on.

Social and political factors have always impacted on infant feeding.

Fornula was not invented as a benign product. It was invented to make money. The first commercial formulas were introduced in the 1860s, based on dried products like pea flour. Its still a commercial product.

Milk supply does vary between individuals. But the biggest driver of supply is simply frequent, effective removal of milk. Some women who have a smaller production and storage capacity may need to feed more frequently than others to build a supply.

We know this from I) an understanding of the physiological and biochemical processes 2) observational studies of BF in cultures with fewer restrictions on BF

It's actually impossible, I think, to be sure how many women are physiologically unable to make sufficient milk. There are baby factors and maternal factors at work, plus social factors...but no one should be told that 'everyone' can make enough milk, because whatever the number, it is just not true.

What really jumps out at me here is the yawning chasm in mothers' education and knowledge about the mechanisms of breastfeeding BEFORE they give birth. Women are encouraged to research pregnancy and birth to the nth degree, and know every little sign that might mean they should go for a scan, or that labour might be imminent.
But SO MANY seem to give birth and not have a clue about the danger signs in newborns e.g. counting nappies, or the importance of nursing very often indeed when the baby is born- hospital staff still regularly telling people to feed every 2-3 hours, when you can and should be doing it much more often to get your supply off well. Also being taught to recognise signs babies give for wanting to nurse that are well before crying.
So much trauma could be avoided if there was a detailed antenatal education on how the whole thing works, warts and all, and the things you should be keeping an eye out for, so you can raise merry hell if you're sadly let down by any health professionals.

Thank you for the encouragement people! I got a letter written and emailed to Baby Friendly today and have also contacted Patient Safety Learning. Maternity Outcomes Matter is developing a new website so I'll have another look there next week.

I hope you get a helpful response, RidingMyBike.

InFrance, I think it’s not realistic to expect women to have a detailed understanding of the mechanics of bf before they do it. You can certainly learn all you need ‘on the job’ though I think it’s useful to be prepared for feeding frequently. It’s supposed to be part of midwives’ and Hvs’ training to help mothers bf, especially getting started. They should be doing so!

Thanks @tiktok had a very quick response back from Baby Friendly, but disappointed with it. They've outlined their policies and said 'this is what's supposed to happen' (which I'd already said I knew was meant to happen) and that I should complain to the hospital. Which I'd already said I'd done, and I'd specifically asked them about what checks they make on the hospitals - both in terms of numbers of babies developing problems and what staff are trained to do.

So I'll have to write again. I think it was a standard response - it was quite lengthy and also arrived quite quickly.

Yes - write again. It's not good enough.

Hi Tiktok,

Respectfully (as I know you are very knowledgeable and help hundreds of women on here), I totally disagree. It's blatently clear that women cannot "learn all they need on the job" otherwise 80% of women wouldn't be giving up before they want to?

It's surely as useful for women to know key things for BF as it is for them to know details of giving birth before it happens to them? Birth can be totally overwhelming emotionally (never mind physically) and many women just aren't in a state to read up/google once baby is there and it's already not going well. We teach women about early labour signs etc precisely so they're prepared before it all kicks off; why don't you think this is useful for BF when it's clear that current system is failing hugely?
Many basic, easy-to-understand messages would help women overcome poor BF care (which seems to still go on despite training) if they're pre-warned. Why wait until after baby is here to tell them about how many wet/dirty nappies they should expect, or other warning signs to look out for?
Same with knowing in advance how milk supply works (i.e. very frequent feeding is normal and helpful) so they can ignore advice that still routinely gets given to feed every 2-3 hours!

We should trust that women can handle this information, it won't overwhelm them and could really empower them to better explain situations where they know things are wrong.

I don't want to hijack this thread and am not trying to have a go, I was reacting in the first place to RidingMyBike's
first post where she said:

"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. "

There seems to be a common thread that women go into labour knowing an awful lot about different possibilities that could happen to them– from how contractions might feel, to the different complications that can occur. Yet their level of knowledge for BF (which well over 80% of women start out trying to do) is so limited, yet it's just as crucial for the safety and well-being of the baby as pregnancy and birth. I think relying on staff care or BF support groups/helplines after the fact is the wrong way round, that's all.

Yes @InFrance2014 I think some better quality advance info about BFing would be ideal.

We had 2x 3 hour NHS antenatal classes (one led by physio, the other by a midwife) about pregnancy, labour and birth, which covered everything from exercising safely, dealing with back pain and incontinence to the stages of labour, active birth positions, what happens during a c section, even c section under general anaesthetic. So a mixture of positive stuff and preparation for worst case scenarios. DD's birth was difficult but I found it empowering because I was prepared.

In contrast the same hospital's BFing antenatal class went on and on about the benefits of BFing (to an audience of women who'd arranged a morning off work to attend so were already very interested in doing it) but provided little info about anything practical.

I knew to expect cluster feeding as we were told newborns feed often and it was vital to feed on demand. What we weren't told was how to spot when cluster feeding isn't cluster feeding but a desperately hungry baby.

We were given the impression that BFing would work as long as we bf as soon as possible after the birth and fed on demand. It would have been far more helpful to learn that not all women have enough milk (as the RCM statement acknowledges), how to spot this and what to do about it (including when there is enough milk and the woman just needs reassurance). Along with other signs of problems (eg tongue tie) and where to get help.

It would also have been very useful preparation to learn about the amount of time, rest, food and water required to get milk supply going. It's apparent from MN that many couples are ill-prepared for really needing the other half to step up with all the household stuff, meal prep etc so that the woman can just concentrate on feed, feed, feed. Often this goes far beyond
the paternity leave period, leaving the couple struggling, especially if they have no family support. If I'd known this in advance I'd have signed up for some kind of ready meal delivery service as it was a nightmare managing once DH returned to work (long hours and long commute away).

The lack of family support is a real problem. I mean we can provide better information to antenatal women, look out for tongue tie and teach how to get a good latch but there isn't any easy inexpensive way to help all the women who don't have much if any practical support.

I cant even begin to imagine how I would on demand breastfeed a second child while meeting the first child's needs. I'm struggling to feed and keep myself clean when my husband is away.

LOL yep, I remember thinking in the early days that actually the NHS would improve BFing rates by providing home helps and meals on wheels for families with newborns instead...

I know the idea that antenatal preparation would improve the BF experience and BF rates is seductive - why wouldn't people do better if they had had some instruction in advance?

The problem is there is no evidence at all for the effectiveness of antenatal BF education. None.

In fact, the studies that have been done show it makes no difference. There is even speculation it is harmful. When it's done badly, unrealistically or pressurisingly, it could raise women's expectations and hopes.

These studies postulate that if it is done, it needs to be combined with excellent postnatal care and social support....both of which have been shown to be more effective, in isolation from antenatal BF education.

Everything you need to know about BF can be explained and supported after the baby is born, with the right time, the right knowledge and the right input from the right people 😀 . The real trouble is that this is not forthcoming.

Poor postnatal care and poor knowledge coupled with poor social support from families and society at large are the death of BF for many women. You won't fix this with antenatal education, even if you could reach the 50 per cent of women who have no antenatal education at all.
I'm not saying antenatal ed about feeding is always irrelevant...but the research indicates that in general, it is.

Hope that explains my comments 😀

@tiktok I think you are being disingenuous. You said "Midwives and other HCPs may make a clinical decision not to supply it, if they judge it not to be necessary (just as no one can demand a drug, or medical intervention, if the HCPs involved disagree with clinical need).". Formula is food. It's not a drug or a medical intervention. It's food. It is outrageous to suggest as you have done that feeding a baby is comparable to giving a prescription medication. It smacks of privilege to say the parents can go get formula anyway if the midwife refuses - the mother is by definition recovering from birth, she may not have anyone else to ask to get formula, she has asked the midwife for formula and been told no. Many many women would accede to the authority of the supposed expert in that situation. Even if the baby is being fed adequate quantities of breast milk, all that will happen if the parents offer formula is the baby will refuse it or will spit up excess. It's not a "clinicial decision", it's a power trip by undertrained and misguided personnel to deliberately deny a helpless infant food. How are you not outraged by this? Mothers should not be put in these situations. Even if the baby appears to be feeding well, and isn't showing clear warning signs of harm, if the mother wants to supplement with formula, why would or should the midwife have any veto over that decision? This is exactly how babies like those mentioned earlier in the thread get hurt.

Its never going to happen but yesterday during DDs epic evening cluster feed while DH was working late I was thinking how I could really have done with a 15 minute carer visit, someone to hold baby for 5 mins so I could use the toilet and heat me a ready meal and make me a cup of tea.