Crap HCP advice of the week

[JollyPirate]

Okay - nail my colours to the mast here and admit to being a HV but I read dreadful advice having been given by HCPs as reported by people here. Sadly I also hear it from some of my clients so feel I must dedicate a thread to the topic.

Three contenders from the last week.

GP (to a mother whose baby has reflux)
"switch to formula as it might be that breastmilk does not agree with your baby"

GP (again) to a mother whose baby also had reflux) "here's some Gaviscon"
Mother "but I'm breastfeeding"
GP (not explaining that you can use Gavisocn even if you are breastfeeding)"wait until you are bottle feeding and then start using it"

AND to prove it is not only GPs (and they are by no means the biggest offenders as I suspect MOST misinformation comes from HVs who should absolutely know better)

HV (to a breastfeeding mother whose baby had gone a nano amount off a centile line)
"I think you are going to have to start topping up" (and yes I DID tackle that one).

On the other hand, my GP is wonderful and breastfed her babies until they were 2 years old and we had a great conversation about tandem feeding. Although my HV did mutter darkly about DS1 taking all the hindmilk so poor old DS2 would starve...

Oooh just the usual 6 month weaning advice being based solely on developing countries. Actually she said 'third world countries'... grrrrr

Its been suggested by a HV that I switch one of DD's breastfeeds to cows milk from a cup...have decided not to as shes only 8 months old.

well, my doctor told me yesterday to stop breastfeeding dd (1 yr old in 2 weeks) as it is now completely unnecessary and anyway, my milk is apparently no longer enough for her, she needs other milk to complement her solid food...

JollyPirate: it is very difficult for HVs to tackle other HVs, and it's great you did so.

I would say about half the mothers I speak to as a breastfeeding counsellor report some very questionable/entirely wrong/utterly unhelpful advice on breastfeeding from an HCP. I agree, most misinfo comes from HVs, and I don't understand why. I mean, you knew topping up is not helpful in the case you mentioned - why did your colleague not?

I have just been to the GP about my BFP. She was asking about my cycle and I said it was all over the place as DS (who was with me) still breastfeeds.

To her credit, she just said, ok, how old is he, and wrote it in the notes.

I had kind of been expecting some nonsense telling me that I had to stop, so not all bad!

I think now reading this and other advice on mumsnet that i could have probably continued bf instead of topping up on formula thus milk gradually stopping. mabey their scales were a bit wrong, i know that when my dd was weighed they were having problems with them. Also baby having lots of wet nappies though stooles were greenish(she was newborn). I wish that i had discovered Mumsnet much earlier, i have read now that greenish stools are not necessarily a bad thing. i wish i had known then what i know now. in the future, i will know much better.

I once asked a GP whether there was any risk that the impetigo ds had round his nose could transfer onto my nippls. He said "No, as long as you wash your nipples as you usually would after each feed" .

When a lactation consultant HV found out I was feeding ds at 36 weeks pregnant with dd, she said "You CAN feed both of them, but it's really not necessary for your ds to breastfeed now". This felt to me like encouragement to stop, and I was staggered at it from a LC, especially as ds was only 2 months over the WHO minimum bf age at the time.

I love the idea that GP's think we rush off to shower and brush down our breasts after every feed!

I don't really have any stories - everyone I've dealt with has been brilliant. And I'm forever grateful to the midwives I saw in the week or so after DS was born, as he wouldn't latch on, and they didn't once suggest giving up and bottle-feeding, it was all about how they were going to help me breastfeed, and reassuring me they'd seen it loads of times before and the baby always latched eventually.

My HV is lovely, but sometimes she's a bit 'too' impressed with DS's weight gain being totally from breastmilk, and that I'm still feeding him. It's nice to be told I'm doing well, but it feels like the implication is it's unusual to be able to keep your baby on the chart line if you're breastfeeding.

Ah centile charts tiktok - my personal bug bear and irritation. In fact it is not an exaggeration to say I would like to see a public burning of the bloody things. A tool for winding up parents and not much else.

As for my colleague's advice well. Funny how I never hear anyone say "he/she's fallen off the centiles you need to start topping up with breastfeeds" to parents of formula fed babies. Sadly what they sometimes say is "perhaps you'd better begin weaning". And then I want to scream. Thankfully I have not heard anyone advise this where I work as the 6 month advice is so well accepted (but not always among the parents).

Yes, JollyP....but why do you know all this, and they do not???

I mean....I can understand GPs. They cannot know everything. I wish they would know when they don't know, but not knowing is understandable.

Babies and feeding is one of the core issues at the heart of every HV's practice.

So why are some of them so hopeless?

Tbh tiktok I think it's bugger all training. Most HVs have never had any training in interpreting centile charts or in breastfeeding. Epidemiology was a core subject for the academic side of my training in 2001 but anyone trained before that seems not to have had such input.

Despite the investment in epidemiology our year spent just two hours on a breastfeeding workshop and 50% of that was taken up with anatomy of the breast. Shocking when you consider that breastfeeding is such a major public health issue. Add to that a hugely understaffed service and you have a problem.

Our PCT is looking at target figures of 40% of women breastfeeding for 6 months or more. To try and achieve this they are about to invest in the UNICEF traing for all the HVs. For some they will be preaching to the converted - for others there will be a huge learning curve. Watch this space methinks.
Personally I would like to see (in addition to the training) much more investment in community mothers type programmes and in lactation consultants/breastfeeding supporters. There is a very successful Community Mothers programme not so far away from me. They have been a round for at least the last 12 years and are very good at what they do - more so than some of the HVs in the same area.

Other issues?
Don't get me started on the "Freebies" given out to HCPs by the babymilk companies....... Diary cover anyone? Very innocuous and innocent looking. Doesn't even sport the name of the milk. But those colours, that design - now where have I seen that before?

Little wonder that when breastfeeding fails through lack of support the parent heads straught for the tin which has the familiar colours and design - and they don't even realise they've been exposed to the advertising. These companies are very clever and the advertising can be very subtle.

Anyway - gone off on a tangent but those are just some of the reasons.

A few I have heard:

The seemingly automatic diagnosis of reflux and push of gaviscon and/or the suggestion of thickening with cereal, just because baby is spitting up fairly frequently. Have never seen so many babies on meds for "reflux" as I have in the last several years.

Baby needs to be introduced to solids at about 4 months so that he can "learn" how to swallow for when he has full on solids at 6 months.

Just recently had a mother with twins, one who became jaundiced and had to be readmitted...she was told she couldn't breastfeed him for several days until his levels went down.

2 hours on breastfeeding - I'm shocked (and as an NHS employee myself that takes some doing )

I've heard the 2 hours on BF thing before. I looked into doing HV training a while ago and was quite at how long it actually takes, yet still fails to properly inform on one of the main issues.

I am 'only' a peer supporter and I have had 16 hours training on BF and listening skills, and read literally dozens of books on BF.

doulalc I too was told by one MW that my jaundiced son (then aged 3 days) MUST go on formula during light therapy otherwise he will become dehydrated. This made me cry as I was working so hard to establish BF after being poorly after the birth. I also told the midwife as soon as I arrived on the ward that I was very keen to establish breastfeeding and she said 'oh don't worry if you can't - you can always give formula.'

Pleased to report DS (7m) has never had formula. about all the women I know who were told by HCPs that they didn't produce enough milk rather than telling them how to establish and maintain supply. Especially one who was told she was 'starving' her child.

One of my HV was most put out when I explained in a weaning class that no I wouldn't be weaning my 98th centile dd early because she was clearly very happy exclusively bf and sleeping through 10 hours at night, not to mention that I have food allergies!

Fortunately I saw the "infant feeding consultants" for my bf problems.

Pretty much every woman I know who has actually kept up with all HV appointments has been told at some point that they do not have enough BM, or need to introduce formula for [random reason].

The stronger/more confident/better informed ones speak up and question it and then bitch about it afterwards. And then often stop going altogether and carry on BF.

But the ones who are struggling, or exhausted, or unsupported, etc - they take the crap advice to heart and often act on it, and even when they didn't want to they end up stopping BF. I will gently try to say, 'but you don't have to', or 'have you read/heard/tried xxxx' or 'is that what you want', but I don't have the (percieved) level of expertise that women trust their HV to have.

Have to say, all the HV's I've seen with each of my 3 DC have been encouraging and helpful about bfing. My first two were also fantastic about co-sleeping, but the last one gave me a (misinformed and rather offensive) lecture, so I stopped taking my 3rd baby very early on, to the child health clinics, so I could avoid her... Hope to avoid her after having my next baby due imminently, but who knows...

The only consistently-bad-about-breastfeeding HCP's I've met were some of the nurses and Doctors in SCBU. scarily poor advice, lack of support, and general dis-encouragement. Surely they MUST have studied bfing for more than 2 hours?

I agree re the advice given in SCBU. DS1 was slightly prem, was a little jaundiced and just didn't quite have enough energy to BF properly. I wanted to breastfeed but he was losing weight. THe nurses seemed obsessed with positioning and one shift would contradict the last. I also got the impression from the nurses that they would have been delighted if I'd said I wanted to formula feed. It was a breast feeding consultant who was based in the hospital that suggested that I express and give him milk via a syringe (after cup feeding was a complete failure). Within two or three days he started putting on weight. I've been recommending to anyone and everyone who I know that is pregnant that if they have any problems breast feeding that they may want to contact the consultant as she was so much better than the nurses.

Oh, and when we did get DS1 home and he lost another ounce a midwife told me that if he lost another ounce she was going to readmit him to hospital. No pressure then. I wish someone had told me that babies that have feeding problems often lose another ounce or so once they come home. Was that midwife unaware of that?

Oh we did have one midwife that wanted to readmit DS to hospital at about 5 days old as he had urates in his nappies, which apparently he shouldn't have had by that time. She rang the paed at the hospital to get his opinion, and it was quite amusing as he was obviously saying to her "no don't be silly, I don't need to see the baby, leave the poor parents alone".

I was really lucky in that I could always express tonnes of milk (well back then I could, harder since I returned to work) so there wasn't anything midwives could say about giving him formula instead. It was getting milk into him at all that was the problem, but they were all really positive about helping me to breastfeed.

I don't actually know how much my HV knows about breastfeeding - he was latching okay by the time I started seeing her, and as his weight was good she always said "oh I don't need to speak to you about feeding, you're obviously doing brilliantly."

I have to say our GP practice and HVs are generally marvellous and our superb child health doctor has never said a bad word about breastfeeding and indeed did everything to buoy up my confidence at the six week check both times.

BUT at the same time, as a parent of now two slowly gaining, slow to start, smallish babies there is still an insidious suspicion. It's the "how often is he feeding?" type questions, which I know have to be asked, but I now conclude have no right answer if your baby is not one of those massive roar up the centile types (who all turn obese at six months anyway ) I have definitely felt "guilty until proven innocent" about my breastfeeding, i.e. I have to prove it's not crap and the only way I could possibly actually do that would be to switch to formula and see if it was "better."

In many ways, I feel that the obvious howlers are far easier to innoculate people against - you can get an antenatal class and say "no-one produces watery breastmilk" and then anyone in the class would know if you're told to express and see if it looks too thin that you're working with an idiot. But when it's just subtle undermining of the "hmm you must be doing it WRONG let me make some half-arsed suggestion about hindmilk" species it's much harder to know what to do or think.

If that makes any sense at all...

My gp is rubbish and my hv is fab - I'm doing this by instinct and to hell with them

dxx

my HV about my co-sleeping (in order to help with breastfeeding) at a breastfeeding support group:

well in this country we like to get them out of our bed.

Don't get me started on SCBU nurses. One horrid nurse told me on day 3 of DS1's life that if I didn't give in and ff him she'd take him off me and admit him to SCBU where they would give him formula. She upset me so much with her manner that I dreaded going back to hospital when DS2 was born. Luckily I was able to discuss my fears with the Head of Midwifery...