I'm a bit cross about the box ticking on my hospital notes. What do you think?

[BroccoliSpears]

I was having a read through my Midwifery Record. There's a page titled 'Postnatal Breastfeeding Checklist'. It says...

"ALL of the following topics should be discussed with all breastfeeding mothers before they return home"

Without reproducing it in full, it goes on to list positioning & attachment discussed / observed / mother's confidence, hand expressing taught, help offered, baby led feeding explained, room & bed sharing discussed, teats, dummies, nipple shields, importance of exclusive bfing, support group details given and explained, leaflet given and explained.

Now, I did find a leaflet and some details of local babycafe groups in the paperwork when I got home, and I think I was asked if ds was feeding okay. I'm a bit surprised though to see big ticks in all the boxes next to the above points, and someone's signature to say it's all been discussed / explained. None of it was.

Actually I'm doing fine with the breastfeeding, but I'm cross because they don't know that but have signed off anyway. With dd a couple of years ago I had the most horrendous time - weeping at every feed for weeks - I wonder if someone signed to say the above had been explained to me then too?

What do you think? Am I silly to feel cross? I really can't decide if it's worth a letter, or if I should just be happy bfing is going well, and accept that hospital staff are busy.

Send a letter. It may mean a review or more training and that may help someone in future who is not coping so well as you.

Broc, send a letter....this is poor postnatal care, and they need to know. You don't have to be unkind or rude, but it will help another mother, that's for sure.

So I suppose my next question is who would I best send a letter to?

Director of Midwifery!

Have you all seen this from Nice?

www.nice.org.uk/guidance/index.jsp?action=byID&o=11943

can I ask - how come you got to see your hospital notes? Or does everyone (except me) get to see them...

Yes it is definitely worth a letter to the Head of Midwifery and the Chief Exec (if only because it will make the HoM think harder if she knows a copy is also with the CE).

I had a similar experience when DS2 was born. Both he and I were too exhasuted to bf at first. He would latch on but drop straight off. I wasn't bothered as I was confident that it would all be fine once we'd recovered a bit but was a bit surprised to find out once we'd been transfered to the ward that that according to my notes he was "feeding well".

Agree with the others that you shoudl write a letter.

i think you're right to complain. i always remember after dd was born i got a midwife coming up to my bed telling me how to hand-express.

'feel for pea-sized lumps'
'i can't'
'feel for them'
'i've tried, there aren't any'
'yes there are'
'no, really there aren't'
'och, i've got things to be doing, look, when you find them, squeeze them'

and thus was my 'explained hand-expression' box ticked, no doubt. i am dealing with my hospital about bfing now...

I have had this antenatlly already (third pregnancy). Loads of boxes ticked which there is no way they discussed with me (I would definately remember if they discussed sex whilst pregnant!) I have a meeting with the head of midwifery (for something unrelated) in June and shall be pointing this out to her!

If you can feel lumps Aitch you have problems! Sounds like she needs some extra lessons on breastfeeding, that hospital isn't going to get Baby Friendly standard. I sort of know what she was trying to tell you, but it was wrong anyway!

If you can feel lumps it's a sign of a blockage, so not good. I know women who had them that said they could get milk by pressing on them, but I don't think she was suggesting that. I think she was telling you to look for glands. You don't express by just randomly pressing on glands.

I know sometimes I seem like I am angry at formula, but it's HCPs like that who I'm angry at and probably not so much them even, because they're as let down as the mothers when they're not having the education available to them.

jeez I'd be SERIOUSLY alarmed if I found pea-sized lumps - blimey

The 'sweet spot' for expressing can feel a bit like peas, and the midwife was not wrong there, though of course she should have been more helpful.

Congratulations broccoli !
I would write a letter it's disgusting that women are treated this way .
When mu dd was born (2.5 now ) i had wrote that I wanted to bf however I had a traumatic birth and was out of it and the MW gave her to my mum with a bottle of FF .
About three hours later on the postnatal ward I asked a MW to help me get her latched on and she told me that because she had had a FF I couldn't bf and that she would fetch me a bottle .
My community MW went crazy when she found out and made an official complaint and it was only through her help that I BF my DD until she was 1.5

Hospital notes box ticking:
It's all bollocks isn't it.
If boxticking helps a good but overworked MW remember what to discuss then great.
But no boxticking can make a bad midwife into a good one, or we'd all be midwives given a sheet of ticky boxes wouldn't we?

These things were designed with the best of intentions and instead lead to WRONG THINGS being recorded.

I am angry because "baby feeding well" was recorded time and again in my notes and a few days later the same baby was admitted with dehydration so something was evidently wrong somewhere! I do hazily remember mw's asking eg "is he feeding ok" and not explaining how to tell diff between feeding and simply sucking with poor latch.

blinking, my SIL had a GA a few weeks ago, they left my nephew with Mum and my brother and said he'd be ok until SIL had come round. There was no need for a bottle, you have to worry about some people!

Ah OK, that's different to how I was taught. We weren't told to tell them to feel for anything other than lumps that could be blockage. We weren't told to squeeze anything, as such, either.

'Squeezing' isn't really what you do, but feeling for the sweet spots does help....they are actually the ends of the ducts which are slightly swollen with milk (not 'glands', Tink...these don't actually make milk). They used to be thought of as 'reservoirs' as if they were always there as part of the anatomy of the breast, but it's now thought not to be the case.

With established breastfeeding, they are not as evident anyway.

but i really, really, really didn't have any. believe me, i searched for an hour.

Aitch - I believe you!!

They may not have been palpable - maybe the ends of your ducts were not swollen, it doesn't matter. You should still have been helped to find the best position to place your fingers and the best way to compress out the milk, for the best 'yield'.

i've often wondered about this, though. i'd only had dd three hours previously, my milk (such as it was) hadn't yet come in... would there have been something to find so soon?

she must have meant pea SHAPED not SIZED

lol. you what?

Aitch, you would have had colostrum, and sometimes, mothers expressing colostrum do find a 'sweet spot', but honestly, I don't really know what the significance of not finding anything palpable would be at that very, very early stage...my guess is 'all it means is the colostrum is not there in sufficient volume at the end of the ducts to swell them'.

i don't mean with reference to myself, though. it was obviously the practice to to this talk so early, so would most people have been able to express at that stage or was it merely for the convenience of the nurse?

See what you mean....I cannot see the benefit to anyone of in-hospital expressing in the absence of any problems, and it sounds to me as if she was ticking the box for 'show mothers how to maintain a breastmilk supply if they are separated from their babies by hand expressing' or similar, which is one of the steps in Baby Friendly.

Have been thinking more about the attitude towards feeding. On my ward there were 6 women:

1. Me. Wanted to BF. Did. No probs (though no advice given for cracked, sore nipples either when I mentioned it. It fixed itself with Lansinoh and a better latch).

1. Woman cheerfully telling everyone that she BFd her first but her milk never came in this time so she had to FF this baby. No one pointed out that her baby was only 4 hours old and it was normal not to have milk at this stage. She was also worried a couple of hours later that her baby had "only" had an ounce of formula. Midwives helped her to get the baby to take more formula.

1. Can't remember who was in bed 3.

1. Woman wanted to FF. Did. Lots of help and advice given on how to FF.

1. Woman wanted to BF. Found it very painful. Swapped to FF within first 12 hours. I don't know how much BF support she was given. None that I saw, but I may have missed it. Definitely no BF councillor involved.

1. Woman wanted to BF. Was very worried that she had no milk and baby was crying because hungry. Repeatedly asked midwives about lack of milk. Swapped to FF within first 12 hours.

Now, I know very little about BFing, only what I learned through BFing my dd, and the various problems I had with that, but it struck me that three of the above women would have been happy to BF and would probably have achieved it with a little support and knowledge. And all this in a ward plastered with BREAST IS BEST posters.