Support in postnatal wards

[hunkermunker]

Just thought I'd see if something constructive could come out of the last few days conversations about breast and bottle feeding.

I have the opportunity to talk to someone who can make a difference to breastfeeding support at the hospital where I had DS soon. What should I say to her? I'm not sure that anything I say will actually make a difference, but I figured it'd be nice to have a range of opinions. And where better than MN to find those, eh?!

okay

my thoughts on this:-

1)all staff should ask women's permission before grasping their breasts to aid latch - i think this is absolutely fundamental

2)ensure consistency of advice

3)provide better support to women with poor feeders/jaundiced babies

4)have HCAs arrange to wash breast pump bits and bobs for women who have to express - bfing, cupfeeding and expressing on a 3 hourly schedule is bl**dy knackering without having to struggle to a ward kitchen to wash up

5)have better arrangements for food for bfing women - say access to sandwiches at convenient time?

6)better arrangements for support on discharge to women who had trouble establishing bfing

Fantastic stuff M2S. I left hospital knowing I didn't know how to feed DS, but desperate to get out of there. It was too hot, I had a bizarre toddler belonging to the woman opposite me staring at all day(!), and whenever I asked for help, they either totally ignored me or manhandled my boob into DS's mouth.

DS had jaundice for the first few days and lost quite a lot of weight, then he started to gain very well, but it still hurt me for five weeks. I realise this is piffling compared to what some endure, but I just want to try and make it better for women at that hospital in the future. I'm not the only one who was let down there, not by a long way.

Thanks for the ideas

Hello hunkermunker!

How about not supplying any formula at all and making it clear that those who want to bottlefeed will have to take full responsibility for supplies in the same way that poor heroic b/feeding women have had to do everything themselves, usually because the midwives are too bloody busy bottle feeding the babies of women having a good snooze.

(And before someone else gets their knickers in a twist, ALL those unable to breastfeed are exempt ok!!!!!!!???????)

That is what they are working at in my local hospital after a poor woman recovering from a c-section fell out of bed and hurt herself trying to attract the attention of the midwives, who were all bottlefeeding in the nursery.

PS This is the same hospital that employs a bright spark who invited an SMA representative to come and give a presentation at a breastfeeding study day. Priceless!!

Private rooms!

Poor girl opposite me was having trouble getting baby latched on - less than helpful staff stuffing her boob into the baby's mouth & making ominous pronouncements about formula whilst she cried, the baby cried, her dh cried...all in full view of the other 3 of us in the room who felt desperately sympathetic but didn't know what to do or say to help - quite obvious she needed to be on her own with the baby, her dh & someone sensible to help in order for it to work!

never saw a midwife bottlefeeding a baby at my hospital.

also some form of arrangement where bfing support can still be provided during the early evening shift handover period. for about 1.5 hours each evening there were no midwives available to assist due to handover.

Did at mine - the baby in the bed diagonally opposite screamed and screamed, then the midwife took him off to give him a bottle and his mum a rest. I was stuck in a corner and ignored. I'm wondering now if it was because I'd had a water birth and no drugs - perhaps they thought I was an earth mother type who knew it all. I wasn't I could've done with some help!

so there was something my hospital did right for bfing mums

was amused tho that the hospital had HCAs shove my formula top up bottles out of sight, as no formula bottles could be visible in case it looked like they were promoting bottlefeeding. i do think less attention should be paid to the cosmetics, and more to the practicalities of supporting bottlefeeders

oops meant breastfeeders, of course, freudian slip!

Hi, hm....I think there are some great ideas here. The basics of bf support are in the 10-steps for Baby Friendly, but I don't think it says anything about the importance of 'hands off'. There are papers about 'hands off' in the midwifery journals (get your contact to look them up - if you want specific references, you can contact me via CAT above) and so much I read on Mumsnet, hear from mothers who speak to me, and what I have experienced myself convinces me that pushing breasts and babies around is disrespectful, uncomfortable and unhelpful. Breastfeeding counsellors are trained to be hands off - I never touch a mother and only ever touch her baby with permission - and I don't see why midwives can't be, too.

I think that new mums have little dignity left anyway - having a baby puts paid to that! So having a midwife grabbing hold of your boob doesn't seem as strange or invasive as it might otherwise. Thinking back now, how on earth the woman thought that doing it, then saying 'there, that's how you do it' and buggering off would actually be the miraculous answer, I don't know! Think that's the tack I'll question!

What about inviting a couple of mums who have already established breastfeeding back to the hospital to talk about their experiences and demonstrate baby latching on? In an informal way, so no-one feels pressured.

Hunkermunker, I had what sounds like a similar experience re the 'help' provided by the midwife -she stuffed my breast in little DD1's mouth, said "There, that's it." then toddled off. (Problems followed of course.)
Something that may help, and which I think has helped me this time round is that my midwife involved my DH in breastfeeding advice/support, explaining to him what he could do to help and why. He was good last time around, but several arguments arose when he didn't understand what was happening or what to do to help which only served to worsen the situation and we both felt helpless! I think it is helpful for ladies who have partners for those partners to understand what their role could be. Just because they aren't giving a bottle, doesn't mean they can't help.
Does this make sense, or sound way out?

Or, I mean not necessarily a partner, but maybe whoever is there to support the mum in hospital, a family member or friend could be involved to aim to assure that the mum isn't left completely alone in the world of breastfeeding once at home. Also, it can be such a confusing time anyway, it might be hard to take it all in at the time so may help to have support from a friend/relative who's been specifically involved?

Oh, sorry about this but I've just had a flashback! The midwife in the hospital didn't stop there, she added "see, her jaw's moving, that's how to tell they're feeding ok"!!!

one thing I am a bit confused about is how soon after birth should one try to bf? i tried skin to skin as soon as they finished stitching me up, nothing doing (sleepy ventoused baby!), then when I got up onto the postnatal ward the midwife had another stab (and I must confess I just wanted to go to sleep at that point )- again very little doing anyway (still sleepy ventoused baby, I assume!)

please, watch the nightshift midwives. there was i was told a hospital policy to support b/feeding, but that went out of the window when the agency-supplied nightshift came on. in the wee small hours one n/s midwife told me scare stories about how no doctor would let me leave the hospital until d had regained birthweight. formula was there as a sort of quite explicit threat. obviously the hospital protocol did not apply after dark!
there was was one senior midwife who was sold as the bfeeding expert. i asked to see her straight away for pointers but it took her nearly 24 hrs to get to me.

mtos: skin to skin is great, and it is great to continue it on the postnatal ward - a sleepy baby needs all the stimulation and closeness he can get, to help him wake up enough to feed. Long, unproductive struggles to 'get the baby to feed' make mother and baby unhappy....skin to skin allows the mother to spot the little moments when she can offer the breast and make it easier for the baby to take it. HTH

How about ensuring that staff other than midwives are also given training on supporting BFing? My third baby had to go into special care for a day and it was an extremely upsetting experience for me, not because he was ill (which I knew he wasn't and was proved right) but because I felt they really were not geared up to support BFing mothers. They seemed to be ok for mothers who were expressing however, probably because they are set up around the needs of premature/very sick babies who are possibly not able to BF directly. They only wanted me to come up every 4 hours (he was inevitably asleep whenever I did) and would not phone down for me if he woke up in between because "they were too busy". It was really difficult to be comfortable while feeding or have any privacy. His blood sugar levels dropped and I ended up having to give him some formula as I felt it was the only way I would get him released.

Ask them to think about support for seriously ill women who hope to try and re-establish breastfeeding.

I developed a serious infection after having one of my children which the doctors battled with for a number of days to prevent it becoming gangrenous and require surgery to cut out.

I was on a morphine drip and had no hope of breastfeeding (wasn't conscious for a lot of the time anyway).

I think I was an embarrassment to the hospital tbh - I was whisked off to the room furthest away from everything - it was a very isolating experience.

When I felt a bit better, I spoke to the breast feeding counsellor about re-establishing feeding and she said it would be possible and she would come and see me, however she was always busy and would promise to come back to me etc, but didn't.

I did manage a few weeks of giving my own milk (could only express and bottle feed).

Moondog - a midwife did feed my baby a bottle a couple of times (dh did the rest). I was having a rest because I was unconscious .

actually i think the issue of support for bottlefeeding mothers is a bit of a redherring now I think about it - firstly because as PMDD says there may be very good reason for the mother not bottlefeeding her own baby, but also because I don't think that support for bfing mothers should be at the expense of support for any other mums.

This is a really interesting thread. I decided that I would try breastfeeding and see what happened.

However, we ended up in hospital for weeks as ds got severe physiological jaundice and spent time in special care. The reason why I introduced mixed feeding so early (even in tiny amounts) was that I was petrified of dehydration and the fact that he wasn't recovering from jaundice. I breastfed in part for about 3 months then suddenly realised bottle feeding had took over more than breast feedimg...

Anyway - had I had a 'normal' experience in hospital, these are the things I would have liked to see (some of which did happen in my hospital)

1. A short chat with a midwife soon after the birth to discuss breastfeeding, positioning, how you know that they are getting the milk, when and if to swap boobs, how to deal with sore nipples, how regularly to offer a feed. This last one still bugs me today - as NO ONE told me to try to feed every 2 hours when ds was severely jaundiced...and I have since learned that this would have been beneficial. How to encourage sleepy feeders.

2. No groping of boobs

3. Provision of a 'quiet place' to breastfeed should you wish to have it during visiting hours (not everyone wants to feed in front of everyone's relatives

4. The opportunity to meet with other mothers who have breast fed - and are still in the ealry stages but further on than me (say with babies around 2 months old)

I really don't think banning formula in hospital would help - also, asking people to be responsible for own formula etc may lead to many babies becoming ill due to poor sterilising (perhaps - just guessing!)

Also, I think a debriefing kind of chat before leaving the hospital would help - going over the basic of breastfeeding again. ALthough I know that health professionals can't be seen to promote bottle feeding over breast feeding, I do think that more info on safe bottle feeding could be provided (by whom i dont know) so that if breastfeeding mums do chose to add an occasional bottle of formula, then they know how to do so safely.

Agree with the no grabbing option too. Midwives at my hospital were very, very quick to suggest formula e.g while I was attempting my first feed with no support! Even the most supportive midwife was happy with the general nipple-in-mouth option. Fortunately I had read enough to know about latching on etc but got NO information on this from them.

I had mastitis within a week so was obviously doing something wrong. Two weeks later we are ok, but I really consider me and ds self taught on this one!!

Agree that post natal support v important too, but those early days are so crucial. I found the range of approaches almost bewildering!

I think the problem is that midwives have quite enough to do without being breastfeeding counsellors, and I think that mothers who are having real difficulty feeding need real experts to help them. IME, midwives are simply not experts on how to help mothers breastfeed (and perhaps they shouldn't be? - discuss!) but the NHS has to decide if they want midwives to be trained as thoroughly as bf counsellors, or to hand the job over to the experts.

I desperately needed a bf support group in the hospital on the ward. Would have helped enormously.