Why is it that new mothers (quite a few MNers almost every day) seem to be given

[Bluebutterfly]

such poor advice about bfing by HV's. I know that there are alot of great HV's out there, but there also seem to be an incredible number who don't understand how to support new mother who wishes to bf properly.

Almost everyday there is a new Mum on MN who is struggling with bfing with a newborn saying that hv is telling her that the baby is losing weight or is underweight or is not on the correct centile etc, etc and undermining the struggling mothers ability to persevere. Why is this? Can anything be done about it?

It's because there is no requirement for HVs to update their knowledge beyond the basics they do when they become HVs. They don't have to go on courses or keep up with new research unless they want to. And an awful lot don't.

IMO, all HVs should complete one of the BFing groups' bfc training and be required to stay up to date with research and practice.

BFing rates in this country will never improve while the majority of HCPs pay lip service to the 'breast is best' message but recommend formula top ups at the drop of a hat.

I agree Olihan, it was not ever a problem for me, partly because ds was a big baby and never did the reasonably normal post-birth drop in weight, and partly because I think I was lucky with a hv that was reasonably clued in. I am always shocked by the number of MNers who have just had their pfb and are overwhelmed by everything and just need adequate and informed support and do not get it for bfing; then they end up feeling that they have failed or are failing to bf even though it is what they wanted to.

I had problems with BF advice from my HV and decided there are three main problems with HVs:

1. They are working alone so don't have anyone other than their own head to bounce things with and when you bounce things in your own head it gets worse.

1. They don't have the time to really help new mothers to BF, it is a lot of time when there is a problem to watch them latch, see how baby behaves etc to get it right. Compare that to the advice for giving a bottle of formula which can be basic and include "make sure you read the packet properly", it's far easier to get them onto formula.

1. They're not always that well trained in BF due to time, money and resource limitations - I am fortunate though that around my area there are two fantastic ladies who train most of the MWs and HVs in BF, there is also a peer training programme that I am about to start.

my hv looked shocked when i told her i was still bf when i went for my ds 8 month check up, she said how i did not need to anymore!

Growth charts in the red books are based on formula fed babies, which put weight on at a different rate to BF babies, so unless your charts say "Breastfed From Birth" at the top, your baby is unlikely to hit all the right centiles. Health Visitors are slowly cottoning on to this! Some of the PCTs have BF charts available, but not all. It makes me mad because weight gain is the one thing that puts a new BF Mum's mind at rest. The "am I doing it right, am I producing enough, is it quality milk" worry being the most damaging to a new Mum's confidence, it's soul destroying when a HV or MW starts muttering about combined feeds or formula. Our local maternity unit is seriously underfunded, MWs are in dire need of BF training because at the moment they are not even in the same book, let alone singing from the same sheet. Each shift change brings a new MW who says "You're doing it wrong, do it like this." TinkerbellesMum I am involved in a peer support group and have done some training and it is so rewarding! You can't beat the feeling when some poor lady comes in and she's right on the point of giving up and you can help her through it and watch her and her baby thrive! And the stuff I learned is mind boggling! The human boob is the most amazing thing!!

i received no breast feeding support in hospital and the treatment i did receive put me off for life!!!!!!!!!!! absolutely dreadful.

it makes me shudder to think now.

The two HVs I saw gave completely rubbish 'advice'. I couldn't believe either of them had actually done any medical training.

Nizmat, you have this wrong about the charts, sorry. I often have to explain this on mumsnet.

The charts used in the UK are not based on bottle fed babies. They are based on several data sets of babies whose feeding was not differentiated. Many of them would have been bottle fed, of course, but the breastfed baby charts that exist are not all that different except for the fact the breastfed baby gains slightly more quickly - until you get to about four-six months (then the breastfed baby 's weight starts to slow in comparison).

Please ask your peer support trainer about this - it's a very common misunderstanding.

Plotting a slow gaining baby on a 'breastfed' chart will not do anything except worry the mother more....because the 'breastfed' chart will show her baby as lighter.

The problem is not the charts but the way they are used. Changing the charts will not make HVs any better , unless they also have training.

We need more bfc at the hospitals and in the community.

tiktok Thanks....am seeking clarification from our lactation consultant as don't want to mislead anyone! Was commenting in good faith. xx

Yes I think at the very least HVs should be given some basic bf training - I mean the 13 hour peer supporter training would be a start.

The charts thing... obviously tiktok is right and the actual chart is not that different - but I did feel that once I got a chart saying "breast from birth" in my red book it made my HV act a bit differently towards me (although a big red sticker in the book saying "this baby is breastfed" would have had the same effect) she adopted quite a hands-off approach towards the weight gain issue because she knew it was different than what she was used to (slow weight gain in ff babies) and "allowed" me to get support from other avenues who had that sort of expertise.

Until the HVs changed and I got an evil one and stopped going!

My HV is really great, she's supportive of me doing BLW and was pleased as she had heard of it, thought it made sense and never gotten around to looking it up and I was her first to do it so I gave her lots of information on it. However, as soon as we had weight problems (about 9 weeks to 13 weeks she weighed 6lb 2oz on each weigh in which were weekly at that point) and she wanted me to start her on formula which was heartbreaking because of everything I had been through already.

Fortunately though a call to the NN-MWs got me into the breastfeeding group where I met the two ladies I mentioned before. They got me onto what I like to call the body building diet and said it was only to appease the HV as they didn't believe there was anything wrong with her (how many 3 month olds sit on your knee and chat to everyone in the room? Which of course looks more bizarre when said 3 month old is smaller than most newborns). I had just managed to wean her back onto the breast when I had (bad advice from peadiatrition) to start giving her solids.

Nizmat, I've seen so many women have problems at the group and none have ever been told they can't do it - even a baby with tongue tie - I hope that I can remember that and not give up on anyone (I'll just take them to the group if all else fails )

hijack - sorry! - tinkerbellesmum what was your body building diet?!

There are serious research flaws in the way growth charts were developed - they don't differentiate between bf babies & bottle fed ones, nor have they been updated to take into account the new advice of deferring solids until at least 6 months, so almost all babies take a sharp dip on the charts at approx 4 months.

For a week I had to feed her every 2 hours and top her up with formula after each feed. Once a day she had a full feed of formula. I was supposed to pump after each feed but there wasn't time in there to do much else, let alone pump too and we were in Majorca!

She stopped that pattern after a week by herself but by then she had gained 2lb - a big leap for her even now, but I think she got back to where she had been. It took until a week or two from starting solids to get her back off of the formula.

The HVs & MWs in my area all get trained using the UNICEF breastfeeding management training. I think it's about 3 days worth of training. They then do various refreshers as required.

Having said that, some are STILL stuck in their ways and give rubbish advice such as "he's a big baby, your milk won't fill him" or "that's odd, it does look like your supply has suddenly vanished at 8 wks as you can't express anything". I'm not sure anything wil change that, unless they are held accountable for what they advise/say.