BF support - preaching to the converted

[fleacircus]

It's clear from the BF threads that people feel the support they've received often isn't up to much, and that many mothers stop BF before they would otherwise choose to. I've always been surprised that so few women breastfeed, but my own extremely painful experience over the last three months has made me realise it's often nothing to do with choice. In fact, given the struggle I've had to get any help at all, I'm amazed that anyone manages at all.

Anyway, I've been immensely grateful to MN and to these boards, but I'm very aware that an awful lot of women aren't lucky enough to have the resources (educational or financial) to fight for support. So I've written to my MP to suggest two things that would have made a huge difference to me: that postnatal wards routinely check for and correct tongue tie; and that one of the early postnatal MW visits be replaced with a visit from a BFC. I can't believe that the training costs involved would outweigh the longterm financial gain, given the preventative health benefits of BF for both mothers and babies.

So - and I'm sure this has been done before - if you feel strongly enough to post on MN about it, please take the time to write to the people who can actually change things! I'm more than happy to email a copy of my letter to anyone who'd like a look, just CAT me.

flea - glad to hear things are going better.

The tongue tie thing should already be in place - it's in the NICE guidelines on postnatal care. Of course it needs to be fully implemented.

But replacing a postnatal visit with one from a breastfeeding counsellor just isn't going to work. I would hate this to become government policy!

There are approximately 450,000 breastfeeding mothers every year in the UK. There are perhaps 500 trained breastfeeding counsellors, many of them with jobs, full and part time, and many with young children themselves. How are you going to get 500 people to do 900 visits (do the maths!) each - that's about 4 every working day, probably a full time or more or less full time job. What about areas with no breastfeeding counsellors? Will the ones outside these areas have to travel? I am a breastfeeding counsellor - I certainly don't want a job visiting postnatal mothers every day, as I would have no time for anything else, including other bfc work.

To train enough breastfeeding counsellors for your plan would mean increasing the numbers at least 10-fold - and that means first of all training trainers, which takes years and years. Then managers to administer it...and that's before deciding how much to pay 'em!

The answer is far simpler than that - train midwives (whose job it is to support breastfeeding) in the skills for the work they do.

Breastfeeding counsellors can only ever be an adjunct to the system, offering support and information. Peer counsellors - of whom there are more - stay in the job about 2 years and then move on, and they are not qualified to handle the more difficult problems anyway...they could not routinely visit postnatal mothers instead of a midwife either.

Sorry to pour cold water on the idea, but I don't want other people writing letters to their MPs with it

Our PCT employs a FT BFC. She runs a clinic and you can go and see her
This seems to work quite well

Agree with Tiktok that MWs need more training on bf

Smallwhitecat, good point. However, many, many women are discharged in your situation. 2 days is not enough to be sure breastfeeding is 'established'. A better move would be to tick the box saying 'full breastfeeding' or 'partial breastfeeding'.

Re-admissions should be monitored, and the breastfeeding experience and support taken note of. Virtually every readmission for dehydration should be looked at as a failure of the system to i) alert the mother to signs of good breastfeeding ii) recognise when the discharged mother is going to need expert help at home

It is perfectly reasonable for the hospital to record what you were doing at the time of discharge, but not to call it 'established'. Then, good monitoring would track the breastfeeding stats through the system, via HVs rather than GPs, and the PCT (not the hospital) should analyse these figures.

It would be an impossible nightmare to get GPs to check on every mother at 8 weeks (how?) and send the figures back to the maternity unit, and for them to update their stats, matching names on the GPs list to their database....I can tell you, it would not happen.

Take your point Tiktok - in fact in the letter suggested either training for MWs or training more BFCs, as I didn't know specifics of numbers.

Smallwhitecat - I had a similar experience. MW asked me if BF was going OK and as far as I knew, as a new and inexperienced mother wanting to get things right, it was. I was discharged from MW care after 10 days, as a successfully BF mother.

Personally I found my hospital superb when it came to staff helping with Bfeeding, each member had been trained (and their policy was on so many walls about it) v different experience to another hospital I had first son it, and when it came to leaving they gave me lots of info on where to get further help and the groups that are run within my area (though I went once still haven't the guts to go back again)
The hospital did not refer to it as established, it was just the method I was feeding at the time that was taken note of.

I just wish there was more awareness of what's involved before the birth too when it comes to BF. I was so determined to BF after my section I went and bought a couple of books (seen areas now in the NCT book that could be gone into more but still don't feel I was aware of most of the things I am now aware of.

As with flea am also eternally grateful for the support I have found on here, ds2 has many strangers to smile at for still being on the breast

Tiktok - "It would be an impossible nightmare to get GPs to check on every mother at 8 weeks (how?) ..."

Here all babies are examined at 8 weeks anyway - would just be one more question. Not sure about the admin side though ...

I am about to undertake training to become a peer councillor and one of the suggestions that we made was to be allowed to go into antenatal classes and speak from a practical and emotional (ie understand how hard it is but once established its soooo much easier etc) point of view rather than the mechanics.

There was even the suggestion of going onto the postnatal wards ...

There is a check box for "breastfeeding fully / partly / not at all" in the immunisation pages of our red book, but I certainly wasn't asked about it at any immunisation appt.

I'd like to see everyone experiencing what I did in hospital. Basically they wouldn't discharge me until they had seen 3 good feeds (without assistance) - this took nearly 3 days and I expressed and syringe fed until we got the hang of it.

I'd like to see this as standard practice to prevent what happened to a friend. She had a nice easy labour and was discharged 6 hours after birth, but struggled with BF and a few days later was back in hospital when her DS lost more than 10% of his bodyweight. She was actually advised to switch to formula and has been FF since (DS now 17wks), but wishes she had persevered - and had the right support.

I appreciate this would put further strain on an already stretched system but I felt I got the support I needed to BF successfully, and feel others deserve the same

I agree about monitoring dehydration readmissions - but those are critical cases. There must be many many women who stop BF without their babies being readmitted; I was very nearly one of them. DD was born on 75th centile and is now on 98th, and I think that's one of the reasons I found it so hard to get my problems taken seriously.

I'm not trying to suggest my letter as a model, just pointing out that posting on here is a fantastic way to get (and to give) advice and support but wont change anything.

bluenosesaint, the 6-8 week check is not done everywhere and not done everywhere by GPs. Asking about feeding should be a part of any assessment, but the data would then have to be recorded and sent back somewhere and then recorded again and sent on and then matched with hospital data....it ain't gonna happen as a routine, believe me.

I know of one area where something like this was attempted, with HVs filling in forms and sending them in so bf stats at 6-8 weeks could be recorded (not even matched with maternity unit data). The amount of whip cracking to get the HVs just to send in their data was amazing...and they still got only a small proportion of the forms.

In some areas it could be done electronically - a hand-held device could send data to the maternity unit where software then did the data management. The NHS is a long way from getting a system like that underway

flea, you are right about the near-miss dehydration cases. People in the field know that many babies are dehydrated but not quite bad enough to go back to the hsopital...those babies are usually put on formula with no attempt to fix the bf

My experiences were different with all four but I really depended on the help from MN with dd2. I am sure that she would have been bottle fed if not for tiktok and other patient MNers. I do try to offer the same when I see desperate threads and I would love to take some training so that my advice was sound rather than anecdotal...

I think that it is shameful how little support mothers get in general.

smallwhiecat - i too was ticked off as bf established, but i hadnb't a clue and no one saw me, 2 days later ds was jaundiced and the mw said he had hsrdly had any liquid at all.

Yes tiktok, i had a feeling that it wouldn't apply to every area.

Where i work, we are currently installing massive databases to deal with huge amounts of information - it would need something along the lines of this.
It is a lengthy and costly process and i agree, the NHS is unfortunately a long way off indeed

I was asked on a routine visit from HV at 6 months whether i was still breastfeeding. I answered yes and asked how the information would be used. "It won't" she replied.

Tiktok - can you check your email please?

Me too, bellabear and smallwhite cat - didn't manage a good feed at the hospital at all but my notes said "breastfeeding well". I phoned the hospital in the small hours 2 days after we were discharged and asked to be readmitted because dd wasn't feeding at all and I was sure she was getting dehydrated. They said no and told me to give her formula. Mw diagnosed jaundice the next day, but couldn't help with the feeding (she watched and said things like "hmm positioning is good, she doesn't seem to be interested - try again later").

I had no idea how common my experience was until I discovered mumsnet, and I agree, fleacircus it is incredibly frustrating that we all go round in circles on this subject without anything getting done in the real world.

I often wonder whether the experiences on mumsnet could be put together into some kind of meaningful report that could be used for lobbying on this subject. Maybe something like this would carry more weight than individual letters to MP's.

I'm never quite sure whether to be relieved (in a "thank god it's not just me" sense) or outraged that so many of us have had similar experiences with establishing bf. My ds had to be readmitted the day after we left hospital because he was dehydrated - now seems doubtful he had anything at all to eat for those first three days .
I've been wondering, given that he was admitted to a different hospital to the one he was born in, whether anyone would have joined the dots? ie if the first hospital, which discharged us saying bf was "established" (even though i'd asked for support several times, as my notes confirm; and even though we knew even then he wasn't asking to feed; and even though the bf peer support worker had spent an unsuccessful hour trying to help us get him to open his mouth...), even knows what happened afterwards?
Would it be worth me writing to the first hospital? BTW ds is still exc bf at 23 weeks, thanks in no small part to the second hospital and the wonderful paediatrician who, faced with my dehydrated, not-feeding, way-too-sleepy baby, asked if i wanted to persevere with bf and when i said yes, told me: "then we'll help you to do that".
they're not all clueless [relieved emoticon]

Butterflies, write to them. They will not have joined the dots at all.

(A peer supporter should not be helping with a non-latching, non-feeding new baby, apart from giving social support and encouragement - it's way outside their boundaries )

I'm afraid it is a bugbear of mine that the NHS is so keen to be seen to support bf but the actual support isn't there. Fundamentally, go back I guess 2-3 generations before formula was widely used, women had mums, cousins, sisters and neighbours all breastfeeding and able to support the new mum to do the same. I knew very few mums bfing before I had ds - I knew many more who attempted it but gave up after a day or two because they weren't given enough help - one woman was simply left to it - she wasn't even shown how to latch her lo on! the reason why I managed it was because DH and I bullied the MWs at our hospital into giving me the help - plus I had read lots of the bfing threads on Mumsnet when I was pg to get an idea of any problems that I might come across.

Thanks Tiktok, I will write. Presumably to head of midwifery? I've only recently started to get cross about it, having spent a good few months feeling terribly guilty for "starving" my poor boy and not knowing how to bf him. Reading threads like these on MN have saved us! And now I realise that when I told the midwife on day 2 that he was sleeping all the time and not interested in latching on at all, it was not best practice for her to tell me that "all the other mothers complain that their babies cry all the time" and that I should be grateful for the rest...

Oh, and the peer supporter did, to be fair, tell us that she wasn't really equipped for this, but she was the only person in the first hospital who spent any time with us at all and she was very encouraging in general about sticking with bf. She also said we needed more specialist help, but it never came.

Write to Head of Midwifery, yes, CB, and copy in the chief exec of the PCT, and the chair of the Maternity Services Liaison Committee (your local PALS will have details).

It's good you have some insight into what went wrong - you're right, a sleepy baby on day 2 is a red flag. Shame about the peer supporter being the only person to help....