A breastfeeding support question - how can those offering the support do it best?

[hunkermunker]

What questions should a midwife (or other HCP) be asking you to establish how you feel about infant feeding, in order to provide the right level of information and support for you?

Personally, I think not enough emphasis is put on how a woman feels about breastfeeding - is she very keen to do it, did she have a bad experience last time, etc, etc.

Is there anything else? What would you have found/did you find most useful wrt bfing? Is there anything that's a definite no (I'm assuming judgement of any sort is Not Good here)?

JARM - I don't want to rock the boat but I have to say I didn't get on with Bestfeeding. Maybe I'm the only one.

It did my head in that they said, "baby will always come off by himself when he's had enough."

Drove me mad.

It wasn't until I read a book that wasn't about breastfeeding at all that I learned that many babies do fall asleep on the breast and this can be normal too.

Also some of the advice on positioning I found was tailored towards women with nice pert boobs. They actually said if you have big boobs you might need to support them for the whole feed, so one hand supporting baby, another hand supporting boob.

So how do you MN?

I just found it very prescriptive and - sorry sorry sorry to everyone who loved it - a little patronising, especially the pictures of "which position is right? which is wrong?" with ticks and crosses.

It was even slightly discouraging about baby lying on top of Mum to feed! Which of course is bolleaux; have a look on google for "breast crawl" and see that this is the most natural position there is.

(It made me think about the public information films we watched when at school!!)

To be honest, the book I found most helpful is no longer in print but you can buy it off Amazon anyway. Sheila Kitzinger, Breastfeeding your Baby.

It's a teensy bit out of date now, but the many many many many photographs of positioning alone are worth their weight in gold. For example, I didn't know if you had big boobs you could actually hold baby between your knees! 'twas a revelation (which really helped me).

Sorry again to everyone who loved it - each to her own I know, I just wanted to put across an alternative viewpoint.

Oh the SK book is written in such lovely, non-medical language... honestly it will make you feel just grand.

Breastfeeding your Baby Amazon link.

Ooh look, it got a good review from someone.

Sheila Kitzinger kicks ARSE!!

i agree with GILLl that lots of info given when pg but not enough when baby actually comes ie latching probs, blocked ducts, growth spurts etc. when i was on post natal ward i was in a bay with 3 other women who were all FF (their choice, not saying anything against that) who all got more support than i did. One midwife called me mother earth because everytime she came to check on me dd was happily latched, a lovely comment i know but support shouldnt only be given when there are problems, all new mums need to be reassured that they are doing a good job.

when i did the training to be a bf supporter 8 months later, i learnt much more.

LOL on "baby lying on top of mum to feed" mine have to breastcrawl right over the top and down the side again under the ol' armpit to get to my (saggy) nipples

but yeah - why isn't breastcrawling suggested when baby is born? so many untrained nursing auxiliaries (not even midwives I think) forcing baby onto my nipple with no idea what they were doing. These were the same women who who brought the food in hospital in a ward where the policy was to make women to walk to the lunch room leaving their screaming babies behind 'because it's good for women to socialise with each other'. Yep it is good but its even better to let them get food brought to them so they can concentrate on latching in great pain after their C sections or 3rd degree tears!

Strikes me another thing is a bit of joined up and BF friendly policies need to stretch to whole hospital wards to start things off well...

I found that what helped me the most was visiting a breastfeeding clinic when dd was 2 weeks old - having a BFC (as opposed to extremely busy midwives) look inside dd's mouth and at my nipple, and check the latch was invaluable. Seems obvious but no one had done this properly before then - hence the joys of bleeding, cracked nipples and peeved dd up to then.

The advice given at the clinic that 4-6 weeks was our learning period really helped me not to stress too much in the early days - totally agree with the need for realistic info about the amount of time you spend breastfeeding at the start. I kept thinking 'she can't be hungry' when she probably was - like previous posters I wish I'd just stuck her on straight away at every whimper in the early days.

Wish I'd had the info about the clinic given to me on leaving the hospital - would've made the first two weeks much easier if I'd been able to get there sooner!

I think that it's the lack of concentrated help for the first few feeds, I know it's hard in overcrowded and shortstaffed wards, especially if its the middle of the night. When I had both my dd's it was the middle of the night by the time I got on to the ward, and the midwife on duty made me feel like a total pain in the arse, for asking for help with the first feed. It also didn't help having a different midwife helping with each feed, they all showed me different things, and most of them just shoved my nips in and said "there you go, thats a good latch" the fact that it was agony to feed from start to finish was just because they needed to "toughen up". It would be wonderful if each ward had a bfc on duty all the time, who could help (more than one mum at a time if necessary)and stay throughout the feed - but I think I may being a little optimistic!

I read lots of books (including the ones recommended on here) before having dd1, but just found that what they said bore no relation to the reality of wriggly, screamy newborn and shaky, hot, terrified new mum!

Oh also (sorry going on a bit here), when I had a bfc come round to my house, dd was asleep, and so she went home. Another one came back the next day, but like the mw at the hospital just got me to latch on and then left, rather than stay for the whole feed. I just wondered whether it was normal for them to go so quickly, I was desperate for someone to stay with me for a whole feed, but it just never happened.

Hazeyjane, a mw in the middle of the night told me "some babies just can't latch on. Would it really destroy you to give him a bottle?"

Thats terrible Mossy.
There is another thread about partners being able to stay when you've just given birth. I think that if they did, at least it would be easier to fight for what you want and help to get it when you are feeling battered and weak as a kitten. I agree with the poster earlier that said that partners should be included in the b'feeding training, because they are the ones who will be there in the middle of the night when things are going wrong.

what a brilliant idea for a thread.

I have to go and gte DD from school, but I'm adding this to my threads I'm on so I can comment later

I agree with tutu that it would have helped to have been specifically told that some babies feed nearly all the time for the first few weeks/couple of months. I knew demand feeding meant there wouldn't be a predictable 4-hourly routine but I was shocked at quite how much DS wanted to feed.

Also I would have liked it to be mentioned somewhere, in any of the breastfeeding material I was presented or read, that not all babies do the "brush his cheek or nose or lips and he will open his mouth" thing. Everything I read claimed that all babies did that as an automatic reflex and as DS didn't I had almost convinced myself that he had some weird kind of neurological damage .

My one huge worry about breastfeeding, especially with DD (my first) was that I would get turned on by it, that scared me to death.

I had, up until then, obviously only ever had any kind of breast stimulation in a sexual way, and was desperate not to be a pervert.

Fucked up, I know, sad, definitely.

I really worried that if I allowed my baby to suck my nipples that I would be unavoidably turned on and that would make me a paedophile.

This is one reason I honestly believe a lot of people who say 'it's not natural, it's not me' etc have for not trying it, but at the same time dare not actually voice those worries, because then that may make them a pervert too.

Everyone elses suggestions are really great, the reality of breastfeeding is not as plain sailing as some make it out to be and that definitely needs to be more well known, but not turned into a scare tactic for those unsure.

Anyone leaving hospital should get an extra 5 minutes with their midwife or whoever does the little chat before they leave, I remember being asked about contraception, given phone numbers for out of hours services etc, but not one number of breastfeeding support, I had a poxy little book, and when I was sat up for hours feeding at a few weeks old, This book did not tell me anything I needed to know, if XDP's mother hadnt breastfed all four of hers, one til about 4, then I would never have known it was normal during growth spurts.

hazeyjane

I don' t think these can have been 'proper' breastfeeding counsellors - we simply don't do the things you describe. We would always stay for a whole feed. If this bfc was from one of the volunteer organisations, you can complain to them.

Ok, I know feel like the only person in the world that ever had that worry.............

I've just typed the longest message in the world and lost it!
so in short :

Tiktok, she was from the NCT, I never thought about complaining because until looking on mumsnet (too late for help with b'feeding from you guys ) I thought that maybe this was normal. I will complain now though, because she was actually really rude, and made me feel like crap.

Whilst in a complaining mood, I have started writing a letter of complaint about the maternity service, at the hospital where I had my dd's (now I have moved from the area- I am a big big coward), because I think that the treatment that you receive and the coditions in the ward, especially in the post natal ward, is a huge factor in a failure to b'feed. The hospital that I was in had baby friendly status, and I wonder if anyone knows whether they have to reach targets of mothers who are b'feeding on leaving? I ask because on both my checkout notes I am down as b'feeding even though I hadn't managed a successful feed by the time I was discharged.

They do have to improve their statistics, but I can't find where I read this! I'm sure it was on their site.
Are you complaining just to the hospital or to the baby friendly society? They have to reassess each hospital every 2 years, so if you were to write to them I would have thought they could check up on the present status.

Hazeyjane sorry you had an awful time. I totally agree that lack of care in the maternity ward is a major factor in setting up breastfeeding problems (I also checked out with "feeding well" on my notes when dd had had nothing but a couple of brief painful chews in 24 hours).

Anyway, for what it's worth, here is my personal wish list, for improving the situation:

• honest and practical information for women ante-natally, not just a breast is best lecture - including possible complications and what to do about them (and I don't mean just getting the cabbage leaves out for mastitis). Same information for hv's while we're at it.

• much better knowledge in the maternity wards about all aspects of breastfeeding, but particularly on physiological reasons why mothers and babies may find it hard to get a good latch, with routine checks for tongue-tie where mothers are reporting feeding problems. It's not always just about positioning.

• enough staff on the maternity wards to be able to give new mums help whenever they need it

• a more flexible attitude from hcp's so that they actually observe the individual circumstances of mothers and babies and help them find practical solutions, whatever that involves. And for hcp's to say "I don't know" when circumstances fall outside their knowledge, rather than just making stuff up!!

The sad thing is that the hospital had a midwife led birth centre ( I started both labours there but moved to the labour ward when there were complications), where the midwives were fantastic and the wards were clean and peaceful, but there are only 6 beds, and you can only stay if you have an 'easy' birth (not sure if any births are easy!). I'm sure a lot of resources go into these MW led birth cntres, but it is a shame that the principles behind them can't be translated into the wards that most of us will end up in.

Also could someone who knows, tell me if the best way of helping a baby latch on is to hold the babies head and mothers boob and shove the 2 together, because this happened so many times that I'm surprised my babies heads don't look like bowling balls

hazeyjane, good that you are complaining to NCT about the counsellor. You will need to name names and dates, fo course, and I promise something is always done about these situations.

Seems to me reasonable to put you down as 'breastfeeding' for the purposes of audit, even though you had not done it 'properly' at the time - the descriptor 'breastfeeding' is to distinguish between that and formula feeding which you weren;t doig - it doesn't imply quality. However, it is worth complaining about the help you had - ramming heads on to breasts is known (from research) to be more likely to lead to a shorter time breastfeeding, and I can tell you, we breastfeedng counsellors recognise it as a factor in turning babies off breastfeeding, as well as making their mothers feel like crap, to be honest.....it's disempowering and intrusive.

Tiktok, very interesting what you say about bfc not jamming babies heads onto breasts. I heard Claire Byam Cook talking on a radio programme ridiculing breastfeeding counsellors who 'refuse' to touch the mother (making it sound like political correctness gone mad iykwim). She had a very strange way of summing up her method of getting a baby to latch on, something like 'squeeze and shove'.
All in all, I thought her approach sounded terrible and then I checked out her book and confirmed my own prejudices. Apologies if anyone found her really useful.

charliegal, thanks for rhat snippet of info....Clare Byam Cook does not like breastfeeding counsellors, I'm afraid. The reason we do not touch mothers and babies is partly out of respect for the counsellor-mother relatationship, which is mother-led. It would feel intrusive and invasive to touch. It's also because it is unnecessary - we honestly don't need to do it! You can describe, even shadow a mother's hands with your own, but you don't need to get the baby on 'for' her.

The research on 'hands off' is somewhere on the web - two studies, IIRC, one in Australia, one here, comparing the outcomes of mothers whose midwives put the baby on and the mothers who were supported from the start to do it themselves. Mothers breastfed for longer if they had done it themselves.

In some individual cases, it might help (though I believe 'ramming' never can, and people succeed despite that, not because of it). But a bfc would not be the person to do it.

I would have found more continuity helpful - everytime I saw someone they told me a different set of "rules" and it left me completely confused!

Also less emphasis on Rules full stop would have been helpful. For eg my midwife told me in doomladen tones NEVER TAKE A BABY OFF THE BREAST OR CHANGE BREASTS WHILE HE IS STILL SUCKING HE WILL COME OFF HIMSELF WHEN THE BREAST IS EMPTY.

45 minutes into my first feed my nipple was in agony and DS was still chomping away. I eventually hobbled out into the corridor, still latched on for fear of what trauma might occur if I took him off, and whispered "He's been sucking on one nipple for almost an hour, am I allowed to change sides yet?" A horrified MW said "yes, of course!" When I took DS off his lips were shredded and the skin was peeling off my nipple!

No-one had told DS there was another side so of course the poor pet kept plugging away...

Anyway, I digress. It's funny really, but I think people forget how desperate you are for Golden Rules in the early days and how you can treat their lightest word as Gospel.

Empathy was the biggest support element for me.

I use to attend a very supportive well run breastfeeding support group, run in a children library in South Yorkshire.

When I turned up in the room with a carseat with 8 day old DD in and couldn't move any more. Just the effort of getting up and out of the house, in and out of the car and finally got to the group I was scared, I was not doing well with breastfeeding and feeling very mixed up, tired and hormonal.

The lady running the group came up to me spoke kindly to me, express nothing but empathy and kindness as I wept. She sat me with the group, cuddled DD and gave me a cup of tea and listened. She was an angel.

Every women should have access to a group like this one. Just meeting a range of women some new mums, some second/third time mums. Breastfed children ranged from newborns to toddlers.

All mothers were given chance to talk and ask questions, give advice to other mums etc. The leader only stepped in if people said 'wrong' facts with relevent information.

There was a big LLL Answer Book on the table and we were all encouraged to read up on any aspect of breastfeeding.

The leader also encouraged extended feeding and to train mums who wanted to help this group or another.

I would like every area to have a wonderful breastfeeding support group and every mother given details when they leave hospital.