"Breast-feeding Militia" or "Bottle-feeding Defensive"?

[CalaLilly]

I have been struck by a conversation on another forum I visit that there seems to often be very polarised views on these methods of feeding and that people often (though obviously not always) join a camp. From the safety of each camp it's easy to be patronising or insulting about the other camp for example you can say "Breast feeding is repulsiive and really shouldn't be done in public" or "bottle-feeding mothers are selfish and haven't done the best they could for their baby".

The thing that makes me most sad is that it seems near impossible to see the middle ground and to unite together as "mums", resigned to the fact that motherhood is tough and the nutrition aspect is a challenging part of that. I personally love the Baby Friendly Program but I think that, in addition to many benefits, it has served to pronounce this split.

Have others noticed this division? How can we unite... if indeed we should unite? How can we provide robust education on why BF is so great and also good support for Mum's trying it without making Mum's feel pressurised or a failure if they bottle feed?

Want to add (thinking about Academicmum's post about mums being given a 'warts and all' picture of bf), that any attempts to enlighten women as to the realities of bf need to be rooted in an understanding of how our hospital and postnatal practices ruin breastfeeding for many women right from the start, and set them on track for long term problems. How many midwives are going to do that? In other words, the 'warts' aren't generally a feature of normal, physiological breastfeeding, but are a result of poor bf management in hospitals, parents own lack of knowledge of (and an unpreparedness to accomodate) biologically normal (ie breastfed) infant feeding behaviours, a lack of social support and a lack of confidence in breastfeeding.

In other words - you can't explain the lived reality of the experience of bf for most women in this country without getting fairly political about it!

Chillybangbang, although the 'warts' shouldn't be a normal part of breastfeeding, it is precisely parents own lack of knowledge and unprepardness to accomodate biologically normal infant feeding behaviours which I feel needs to be addressed. For me, ds2 is breastfed but at the start I got comments even from my own mum (who BF me and actively encouraged me to BF) of "oh you are feeding again" etc etc in the early days. Even in the hospital (I was in for 3 days because of c-section), the midwives started commenting on "oh are you feeding him again", "you're feeding him a long time" etc. Then as I was leaving one of the doctors said "you know you've done really well with BF so far, many women just give up when actually feeding a lot in the early days is perfectly normal". Now if only they'd said that earlier instead of the snidey comments about frequent feeding...

Good on that doctor though!

But you know what you say rings a very loud bell for me, thinking about what I've seen over the past few days.

What I observed on the posnatal ward was this:

Women sitting looking depressed in bed with their baby in the cot next to them. Almost no one was holding their baby. Even the ones that were holding their babies had the babies very well wrapped up so that there was no skin to skin contact. The midwives didn't encourage the women to hold their babies or to feed them. I was told to take a bottle of SMA in to a mum. The midwife had told me earlier she was intending to breastfeed but when the mother asked for a bottle of milk the midwife got it without question and gave it to me to give to her. I went in and said 'Do you want to breastfeed?' and the mum said 'Yes'. I said 'Well, why don't you put your baby to the breast then and lets see how you go'. I unwrapped the baby and put her in her mums arms, where she latched on and fed for 45 minutes. I did this twice: women who had expressed an interest in bf but who were too intimidated or uncomfortable (several had had c-sections) to latch their babies on without help, and no help was being offered, only bottles. The only women who were visibly feeding were giving bottles. The small number of women who were bf had their curtains drawn so nobody could see them. Honestly, I could have cried.

One Albanian woman who had no English had been readmitted with a 5 day old baby who was very unresponsive and wasn't feeding well. She wandered about the corridors looking frightened and angry. The staff said to me that I had to watch that she didn't try to steal anything, and said she had a 'bad attitude'. The whole day I observed her she didn't pick up the baby once. Nobody encouraged her to pick up her baby, who was very jaundiced and still. The husband came in and tried to give the baby a bottle a coupld of times but I didn't see the mother try to feed the baby. Eventually a friend of hers who had come in to visit her approached me and said 'She needs to express her milk. She is scared that her milk is drying up because the baby hasn't fed'. At which point the midwives started rolling their eyes and huffing about the fact that the pump wasn't working. I couldn't believe that nobody was acknowledging or had taken into account that this mother wanted to breastfeed. - and this is with a baby who was so in need of his mother's milk. Why didn't someone get take this mum back into her cubicle, ask her to get into bed, unwrap that baby and put him skin to skin? Why wasn't attention paid to the fact she was a bf mother who wasn't bf? There was no attempt made to protect her milk supply. I bet she won't be bf at all in a fortnight's time. Women are so vulnerable to having their attempts at feeding sabotaged by midwives who don't put the prioritise the management of bf.

Honestly - it was the most demoralising experience.

Chilly, what horrendous stories.

IMVHO we do need to address BF support. You know what, if you spend your whole time telling people that they need to do X wonderful thing and then when they say well show me how they say Oh well, sometimes it doesn't work out, never mind, no-one will think any the worse of you (which is my reading of how the medical profession deals with a lot of women) it is only natural that a great deal of people sold down the river in this way will end up concluding that X thing is a total crock and all this lovely stuff is completely made up / doesn't matter / is way overstated / is just another way to make normal mums feel bad.

My personal bugbear is baby magazines saying "hoping to breastfeed" as though it is some marvellous thing like a visit from Santa which may or may not happen. WTF is wrong with "intend to breastfeed"? This acknowledges that things may not go to plan, but it was a perfectly reasonable expectation to have that it should work.

Many many many people I've met and seen on forums have heard stories from people unsupported to carry out their intention to BF who have then gone on to tell other people that actually BF is a bit of a pipe dream and they shouldn't get their hopes up. Now actually, for folk who don't have the time, energy and family support to drag the help out of HCPs and shout at the ones who say stupid things, I think this is a reasonable and valid view at the moment. BUT IT SHOULDN'T BE.

Those storys are so sad and what I think many HCPs don't realise is that sometimes just the tiniest bit of encouragement can make a disproportionately large difference (in the right direction!). I think I was more successful at BF with ds2 because he was my second and I was that much more confident in handling a newborn (and they gave me a private room which at least gave me some peace and quiet to sit and do nothing but feed and sleep). So many midwives I think don't appreciate that for first time mums they get given this small baby and are told OK and now its up to you, with little help/advice and bottles just seem to be so easy when you are scared to even pick up your child. Its this kind of rabbit in the headlights feeling!

Chilly, what you have described is tragic. Sabotage is the right word, and it's all down to tim and money. You don't need to teach someone very much about bottle feeding a baby formula. Establishing BFing takes time, effort and support, and many hospitals are sadly lacking in all three.

I was very lucky at Southmead Hospital in Bristol (and I am ashamed to say I felt a bit sniffy in advance about giving birth there) where women who made the decision to FF were able to do so without pressure, but I was encouraged to feed in the delivery room, to lie down with DS to the breast as much we wanted, and given lots of help with latching.

I felt self conscious about BFing on the ward (particuarly as I didn't really know what I was doing) and did keep my curtains closed, but if I ever have another baby I will sit BFing for all to see.

Very powerful and articulate posts, Chilly.

chilly, where was that? Name and shame!

Thanks moondog.

georgimama, it was no coincidence that the ward I was on was two midwives down so everyone was very, very busy.

But it's about more than staffing. It's about ....... priorities. I said to one of the midwives, 'I'm interested in why the women who have said they want to bf are asking for bottles before they attempt to put their babies to the breast' and she went into a long rant about how in her day they had all bf their babies, but that women these days just don't want to do it. And I was thinking, but these women are taking their lead from you. If you aren't encouraging them to pick up and feed their babies they are probably arriving at the conclusion that you don't think it's very important. There is a midwife who works on that ward who is a bf counsellor, who goes in to women and gets their babies feeding - but she can't be everywhere at once. On the day that I was there she'd been called off to staff the labour ward, which is something that happens a lot. (have to say - she's such a wonderful person. When I arrived on the ward she grabbed me and pulled me into one of the cubicles, stood me in front of the mother and said [try to imagine this in a strong Ghanain accent] 'Mummy - this is Chilly. She is excellent' ) But it's almost like having her there makes all the other midwives think that they're 'off the hook' with breastfeeding - if she's not around they just hand out formula in response to bf problems. There's no sense that creating a bf friendly environment is everyones responsibility - all midwives, doctors and hc assistants.

Stealth - I would love to name and shame, but I've just started work there and am paranoid about the whole confidentiality thing. I don't want to get sacked before I've even finished my orientation!

What you've been doing is fab though Chilly. You'll just have to become a BFing supporter to the mums who want help (as much as you can in the time available to you) as it sounds like you're really good at it.

Agree about priorities, and attitude.

Finish your induction before you rock the boat too much!!

For the c-section mums as well who are unable to get out of bed for the first 12-24 hours midwives seem to act like they are doing a major favour everytime you ask for help to get your baby out of the cot. For me, I just developed a thick skin and continued to ask for help, but I think many others might get intimidated and do whatever they need to to cause least disturbance to the staff.

Academicmum makes the point much better than I did about lack of parent preparation/realistic picture of what BF is about making a big difference. It's not all snuggles and bonding and its misleading the way its glossed over at antenatal groups etc.

BarrelOfMonkeys - I don't think the challenges of bf are generally 'glossed over' as a deliberate policy at antenatal groups. It's more the case that there often isn't time to deal with more than the basics on positioning, latch and normal feeding behaviours.

Also - we know that bottlefeeding is also not without its problems. We know (from the DOH Infant Feeding Survey) that ff mums are much more likely to report that their baby is unsatisfied after feeding, more likely to report vomiting, constipation, colic and illness. How much time would you spend discussing these things? Presenting bf as uniquely challenging while presenting ff as uncomplicated is a distortion of the truth.

I think you've got to get the balance right - being very negative about bf without emphasising that the majority of bf problems are a) avoidable and b) transitory could really put women off even attempting to breastfeed.

Thanks georgiemama - I've just been keeping my head down and working my socks off. I think if I want the midwives to take me seriously I've got to show that I'm working as hard as they are. I'm also keeping my mouth shut and my ears and eyes open. The effort's nearly killing me! Thank the lord for mumsnet so I can unload it somewhere!

"Also - we know that bottlefeeding is also not without its problems. We know (from the DOH Infant Feeding Survey) that ff mums are much more likely to report that their baby is unsatisfied after feeding, more likely to report vomiting, constipation, colic and illness. How much time would you spend discussing these things? Presenting bf as uniquely challenging while presenting ff as uncomplicated is a distortion of the truth."

That's all true, but FF is easy for the parents isn't it? I mean the actual mechanics of the feeding. And it's impossible to prove that the baby wouldn't have had all those problems if they hadn't been formula fed (although we know it's likely not), so the colic/constipation/vomiting gets chalked down to the baby being a baby, not the fact that they are a FF baby. Whereas the frequent feeding, tiredness, nipple cracking, latch problems that are the downside of BF are quite clearly and obviously due to BF.

I agree that it is important to be honest with BF mothers that 2 hourly feeding marathons, sore nipples and tiredness are par for the course in the early days. But unfortunately none of that sounds particularly encouraging.

Sorry if you've written it above and I've missed it chilly, what is your job role?

I agree with what all of you have said. I have three DC and FF DS1, Mixed fed DS2 and BF DD.

For me its all about how I feel, a happy mummy = a happy baby.

I would never jusge someone by how they chooses to feed, its a personal choice and although I understand its a very emotive subject, we are all Mummies trying to do our best, whether FF or BF.

I had a C-section with DD and was struggling with latching, and had a fantastic midwife for a while, until the shift changed and then had another who just acted like she would rather be anywhere else and everything was too much effort, she wouldnt help me latch and she did say to me 'your daughter is hungry, you should try a bottle' If this had been my first I probably would have agreed, but luckily I was more determined this time.

wastingmyeducation - I'm a maternity support worker. I'll be mostly based in the community so won't be spending much time on the postnatal ward in future, more's the pity really.

You talk a lot of sense, I'm sure you'll help a lot of women!

Would want to add - feel I should change my name to yours. I'm a graduate and this is a career change for me. It's the first non-professional job I've had since graduating, and I'm on half the salary I used to be. It's a very strange experience. It makes me realised how hierarchical the NHS is. The minute you put that gray tunic on people start to treat you like a know-nothing numpty who doesn' count for anything. On the upside they are also much less guarded around you so you see and hear some very enlightening things!

People make such assumptions don't they?

Sorry to go off the topic, but FioFio do you mind if I ask what was wrong with your daughter? I ask because ds2 has for the last few months not fed well (lots of time and energy every day trying), eats solids unreliably and dropped from the 9th to the 0.4th centile. He is now classed as previous failure to thrive since he is following the 0.4 line more or less but every day is still a struggle with him. The HV just makes nasty comments and he always charms everyone at the appointments with the paed. They can't find any reason why he won't eat and just keep telling me to "feed him more". Its interesting to see someone else in a similar position.