Webchat on breastfeeding with UNICEF's Sue Ashmore and Carmel Duffy on Monday 8th November 1 - 2pm

[RachelMumsnet]

Sue Ashmore and Carmel Duffy from UNICEF will be joining us at MNHQ on Monday 8th November at 1pm to answer all your questions on infant feeding, support for breastfeeding in the NHS and anything else related.

Sue Ashmore is the Programme Director of the UNICEF UK Baby Friendly Initiative, which works with the health-care system to ensure a high standard of care for pregnant women and breastfeeding mothers and babies. Sue?s background is in midwifery and, as an infant feeding adviser; she supported her hospital in Sheffield to become one of the first Baby Friendly accredited hospitals in the country. Carmel Duffy is a Deputy Programme Director for the UNICEF UK Baby Friendly Initiative, where she is responsible for the development and monitoring of education and training. Carmel has recently been involved with the development of a specialised course for health professionals working in neonatal units that emphasises the importance of breastmilk as part of a family-centred approach to care for this vulnerable group.

Add the date to your diary and if you're unable to join us, please post your questions to Carmel and Sue on this thread.

x post!
I went to a breastfeeding group soon after training ended, where a new mum came in who was having major problems. The leader of the group said "You've trained as a peer supporter, you'll be able to help her"

So it seems even the professionals don't know what our role is

@sungirltan

don't know how to word this but....

it seems as if there are women who want to bf and will do it hell or high water, then there are women who don't want to, no matter what but in the middle there are women who are open to giving it a go but when they have problems bf they seem to be let down by mv/hv when they should be referrred/signposted to specialist support. it seems like telling the mother that 'oh its ok, you gave it a try, never mind, time for formula' is acceptable when i think that bf professional help should be recommended and be accessable to all mothers who want it.

i think what i'm getting at is do you think bf support (counsellors, latch on groups, peer supporters) should be explained and promoted to all new mothers?

Yes Sungirltan it is really important that breastfeeding women are provided with the contact details of breastfeeding support both locally and nationally. There is a wealth of knowledge and experience out there and we should all be working together to improve services and support for women. One of the Baby Friendly standards is that women are provided with information on what support is available and how to contact that support before they are discharged from hospital so that they are aware of the help available.

Do you think that the ban on promoting formula for under 6 months, but allowing it for other products above 6 months causes more complications than a full on ban?

@neenz

I tried to help a friend of mine to BF her second child. I went to visit her in hospital 24hrs after the birth and she said the baby was latching on OK. The MW came in and asked whether the baby had had a wee. My friend said no. The MW said 'If she doesn't wee in the next few hours we'll have to give her a cup of formula'. I was shocked and felt that what was needed was for mum and baby to spend some time alone, skin to skin and feeding.

My friend stopped BFing the nexy day .

Was the MW correct with her advice or not?

Sad to say that the advice was not correct. Firstly the midiwfe should have observed a breastfeed if she was concerned about whether or not the baby was feeding effectively. Sometimes it is difficult to determine whether a baby has wee'd in the first 24 hours especially if he/she has also pooed a lot of dark meconium into the nappy. Whilst urine and poo are important indicators of whether a baby is getting enough breastmilk they are part of a wider picture and the midwife should have conducted a full feeding assessment rather than undermine your friends confidence with such a throwaway remark.

Do Baby Friendly accredited maternity units have to stop allowing Bounty people on their wards?

I ask because when you go on the Bounty business website (not the one for parents) it actually boasts about Hipp Organic milks - they specifically say their WHOLE range - have been successfully pushed by Bounty. This blatant advertising cannot be consistent with baby friendly ethics.

Will try and find a link.

@WelshCerys

Hi Ladies

I fed my youngest until his 8th year - of course only occasionally and he was enjoying a 'normal' diet the rest of the time. All well and good - and that was a few years ago. But at work the other day talking to none other than a social worker, heard her saying that she thought feeding an older child was unnatural and wouldn't hesitate to confront a parent who was doing so. Wow! She acknowledged it isn't against the law but saw nothing wrong with getting heavy about it, including interviewing the child in question. Hope this problem isn't endemic in a profession that yields so much power in many families' lives. What do you think about all this?

One of the things we have observed over the years working in the very emotive field of breastfeeding is that everyone has an opinion and some people are very forceful in expressing their opinions. It is difficult to comment on a whole profession as this may just be the views of one individual and one would hope that she would not have the power to act alone. It does seem strange that she would be concerned about something that is done in a loving and nurturing way when there are horrific stories of child abuse being conveyed in the media.

@DinahRod

To get access to good bf support is actually not easy. There was so much that conflicted e.g. about cup feeding, syringe feeding, expressing, and with latching the bf mw told me I was doing everything right, my dc was just a 'little tinker'. And as soon as he dropped 10% of his birth-weight there was talk about re-admittance to hospital (not great if you have other children to care for)...no wonder mothers see bottle-feeding as the easier option.

Conflicting information is one of the commonest complaints from breastfeeding mothers. Sometimes this is because the situation changes and the health professional is responding to this, but unfortunately sometimes it is because of a lack of training which leaves the health professional not sure what to do next. See our previous responses re our work to improve training and practice within the maternity services. I do have a great deal of sympathy for mothers who just feel it is easier to bottle feed when they have faced problems as you describe. Our job is to keep working to improve the service so that this is far less common and then mothers will be in a position to make an informed and free decision whether or not to breastfeed. Currently, it is not much of a choice if you are in a position where you feel you have to stop because it just isn?t working and there is no one able to support you to carry on. Sue

Thanks for your answer, hope you don't mind a follow-up question.

In situations where MWs are 'pushing' formula on mums when it is not necessary how does that fit in with BFI and is it OK wrt to hospital giving away the formula for free?

How many days should a BFing mother get post-birth before she is told 'you have to give the baby formula now cos it is not getting any/enough BM'?

Thank you for answering our questions

Sorry, I meant that if the MWs don't think BFing is going well (as with my friend) is it 24hrs/48hrs or longer before they should start offering formula.

My cousin BF for a week - after a week the MW said the baby had not put on enough weight and she would need to top up. After a week! She was FFing within a week .

Why are MWs still giving out this poor info?

If you know a woman who failed at BF the first time round, how can you convince her to try again the second time? I thought it was going to be easy as it is natural, everyone does it etc but failed completely. Now I am worried that next time I will be to afraid of failing and the pain and guilt that goes with it to try. I had people at the end of a phone last time but I think I needed someone there in person. Would you recommend paying for someone private? (Sorry, bit garbled!)

@rubyslippers

Where to start with this?

Most of the issues I wanted to raise have been done already

I especially agree with the post re the advice on feeding until 2 years old

I have had to justify myself on 2 recent occasions to friends about why I am "still" feeding

I think the key to successful breastfeeding is expectations ... So for a MW or HV to be able to reassure a mum that a baby feeding very frequently, and cluster feeding is ok for example and doesn't mean your milk isn't enough or you need to top up

I think we need to temper the idea that babies should go 3 hours between feeds and then drift off to sleep in their Moses baskets

Co-sleeping was the key for me to successfully feeding in the early days so can this be encouraged? My Baby friendly hospital rooms babies with mums but not in their beds ...

I think you are spot on with your comments regarding frequency and patterns of feeding. We do cover this in some depth on our course and it is part of the Baby Friendly assessment. However, the belief that breastfed babies should feed at regular intervals and only a certain number of times a day persists. In the UK it is so part of our general belief about normal infant behaviour ? all based on bottle feeding of course, and it has proved extremely difficult to get across that this is not how breastfeeding works. I agree that if we could crack this misconception with both health professionals and mothers, we would be a long way to solving many perceived problems about breastfeeding.

See my other answer regarding bed sharing

@tabouleh

Hi Sue and Carmel - I think that the Baby Friendly Initiative is a great one and hope it can be rolled out everywhere.

(I feel that I was failed by the NHS wrt to BF advice etc. DS ended up in hospital and diagnosed "failure to thrive" and formula top ups suggested.)

So my question is about formula.

I feel that that a key part of Baby Friendly should be PROPER info and advice about formula feeding: differnet formulas/how to feed and most importantly preparation.

Your website has the only decent leaflet about formula - so well done for that.

But why on why can that info not be properly
explained to parents?

Why do HCPS not explain that formula is not sterile and that to make it safe it needs to be made with water which is 70 degrees?

Why do they not explain alternatives to making a fresh bottle each time (carton out and about/in middle of night/you can make bottle up to 2 hours before feed finished/water in a flask at 70 degrees - and yes make in advance cool rapidly store in fridge for a minimal time)?

So many just say "oh well you're supposed to make in advance but you can just make with cool water".

Your own leaflet on this page is rubbish I'm afraid - it is 5 years old and it fails to mention that to get water at 70 degrees it needs to be 1 litre boiled and left for 30 mins - it also fails to mention that there are some safe alternatives to making fresh.

And as for the leaflets in other languages - well some of them do not mention the 70 degrees at all. I emailed babyfriendly mid July and was told

"I have spoken with our website and resources editor and we are getting all of our leaflets updated over the course of the summer."

I feel passionately about safer infant feeding - and working towards higher BF rates is part of that of course. But at the moment where we are living in a formula feeding culture - let's make sure that HCPs can give advice on how to actually safely feed formula. That should be easy. Then get on with increasing knowledge of BF.

Please can I have your thoughts on safer formula feedng?

Thanks!

Thank you for your kind comment about our recent leaflet. Like you we believed that the information avaliable for mothers who are formula feeding was really patchy and much of it out of date. We want to ensure that all mothers however they choose to feed their babies receive appropriate information to enable them to feed as safely and effectively as possible and it is crucial that mothers are provided with the latest information on making up formula feeds. I am sorry that you accessed some outdated material form our website. we are currently revamping the entire website and hope to make it the best breastfeeding website in the world :) so hopefully all outdate material will be removed when we make the change over.

Other products are promoted well before 6 months - I was given a "weaning" bounty bag with all the products marked 4 months. I was pleased to learn later that the dental health woman who comes to talk to baby/toddler group parents about teeth is horrified by such products as the apple juice (even after 6 months).

So many stories in this thread bring back bad memories for me - I didn't manage to bf DS1 and felt terrible about it, but am still feeding DS2 at 21 months after a bad start.

serendippy, you could try and contact/meet any local bf groups in your area before baby arrives - are you working or at home with first child? I know my group was open to pregnant women as well as bf women.

@Serendippy

If you know a woman who failed at BF the first time round, how can you convince her to try again the second time? I thought it was going to be easy as it is natural, everyone does it etc but failed completely. Now I am worried that next time I will be to afraid of failing and the pain and guilt that goes with it to try. I had people at the end of a phone last time but I think I needed someone there in person. Would you recommend paying for someone private? (Sorry, bit garbled!)

I would want to debrief with you exactly what happened and look at where things could have been different and then discuss with you your options for this baby. It would be worth finding out whether your maternity unit has an infant feeding advisor and asking for an appointment to talk to her, she can help you make a plan. There may also be a peer support programme in your area and again you could ask to talk to someone from the programme. Another alternative is to ring the NCT helpline or the National Breastfeeding Helpline. Even if you don?t breastfeed you can still enjoy skin contact etc with your baby ? see Carmel?s answer on care for bottle feeding mums. Very best of luck Sue

@neenz

Thanks for your answer, hope you don't mind a follow-up question.

In situations where MWs are 'pushing' formula on mums when it is not necessary how does that fit in with BFI and is it OK wrt to hospital giving away the formula for free?

How many days should a BFing mother get post-birth before she is told 'you have to give the baby formula now cos it is not getting any/enough BM'?

No mother should be left in a siutaion where problems with feeding are discovered way down the line. The Baby Friendly standards are that mothers are helped with breastfeeding until they are confident to do so. From January one of our standards will be that when mothers are discharged from hospital they have a discussion and are provided with information on how to recogise that feeding is effective and where to seek help if they have a problem. A further feeding assessment should be carried out again at day 5-6 and again at handover to the health visitor. Most breastfeeding problems are preventable with good support and when we read about stories in the media about babies being readmitted to hospital because of dehydration it is ofen breastfeeding that is portrayed as the problem when the reality is that no one has picked up on feeding prblems earlier and put practices in place to overcome them

Thanks elkiedee I have actually just sent you a message as was so impressed to see that you are still BF at 21 months! There is no BF group in my small town unfortunately, maybe by the time I have another! It is great to read about all the steps towards better supporting BF, have been cheered up by this webchat Also by the advice anout FF and making it safer rather than 'it is not as good, don't do it, therefore we will not advise you' which can be found.

Sue and Carmel have to close now. Thanks to all for your questions and big thanks to Sue and Carmel for joining us today for such an interesting discussion. We'll be archiving the discussion later in the week.

Thanks for answering, Sue will try and contact an infant feeding advisor, didn't even know such things existed!

Thank you :)

Phew! How fast the time has gone. It has been lovely chatting to you all and it makes us more determined to carry on trying to improve standards within the health service. You also have a powerful voice and it is important that you ensure your local health trusts hear what you have to say. Visit our website on www.babyfriendly.org.uk to see how you can do this. Bye bye and thanks again for all your interesting questions and comments. Carmel