Why are so many health visitors a bit rubbish?

[waiting78]

Just read the thread about spoiling a 3 month old baby by interacting with it and it reminded me of something I've often wondered when reading threads on here.

Health visitors are highly qualified people. They are nurses or midwives who then undertake further study to become HV.

So why oh why do they have such a bad reputation? Loads of threads on here seem to indicate many HVs give bad or outdated advice on weaning, sleeping, breastfeeding etc. From personal experience I know their knowledge on immunisations isn't always up to date. Is it simply that only the bad ones get talked about, or something else?

Aren't they mainly intended as a first line detection service for child neglect and abuse?

I saw a really interesting post from an HV on here a while back saying the majority of their work is around child protection and they lack the time and energy to devote to 'normal' families.

I get the impression that not a lot of time and money is put into their CPD, hence some of the outdated advice. Round here they have all been trained in up to date breastfeeding advice as part of the Baby Friendly initiative, but before that it was patchy to say the least. The same probably goes for other subject areas.

Caseload is definitely a factor too. In my area (big London borough with lots of deprivation) they basically don't do 1 and 2 year checks unless you ask for them. They simply have too many "problem" cases on the go to put a lot of time into general advice on sleep and weaning, for example.

Peppermint you are right, if the hv works in an area where child protection is required there time is mostly spent on that. The last area I lived in the hv was on her own for a few months and that's all she had time to do and worked extra to fit new baby visit in. I Find the problem with hv is that they are told one thing when they train and that's what they stick to whether it's right or not or relevant to you.

The nurse who does my jabs/smears at the clinic used to be a HV, and I expect she was awesome (she's very practical, intelligent, and friendly yet professional) - she gave it up because she found the whole thing too frustrating paperwork, silly rules (she suggested doing jabs at the same time as weigh-ins and was told that she couldn't - even though it would have been much more efficient).

My HVs came round, thrust some leaflets at me, asked a few questions and went away again. (oh, and gave me the wrong appointment time for my 6 week followup so I arrived to find the whole place empty). I think they could tell that I was fine and so haven't bothered me again!

Didn't have HVs at all when I had my first baby somewhere else. Midwives for the first 6 weeks, then handed over to the health service who would periodically send me appointments for jabs - all perfectly fine.

Yeah I suspect they have high case loads and its good that they spend time on child protection issues. That's where the resources are needed.

But I think some of them are just crap. In my experience I've met 2 really good ones and 2 really bad ones. The weaning advice and discussions about sleep/weight gain have been really quite unhelpful and have worried me as a first time mum.

Now I'm about to have my second I'm so much more confident about things. It's hard though because they are in a position of expertise so you want to listen to them!

Unfortunately I've never had experience of a good HV although I'm sure they do exist. In fact, my friend had an excellent HV when she had PND.

One told me that my breast milk wasn't nutritious enough and I should be bottle feeding. This is because my DS was 'slipping' from the 98th centile to somewhere in the 80s. He was still a big healthy boy, just starting to deviate towards the norm as children do. That was the last time I took him to the baby clinic.

Another one took it upon herself to call me and my GP repeatedly, because the same son had pulled elbow and had been to the hospital to have it pushed back in. This was about the 6th time it had happened and a raft of paediatricians had told me there was nothing they could do and he would eventually grow out of it (he did). She caused me a lot of stress and made me feel that I was doing a very poor job of looking after my son.

I suspect issues arise because of a variety of factors including:

• 1) have to err on the side of caution especially in relation to weight etc, based on the principle of 'defensive medicine'.

• 2) as others have said above, main training/role is to spot children at risk of serious health or welfare problems and so supporting breastfeeding, advising about sleep etc is less of a priority.

• 3) communication skills: sleep deprived new mothers are often already feeling insecure and confused (I know I was), especially if there are any problems with feeding or sleeping. I think it's easy for HVs to forget this. One encounter I had would have been very different if exactly the same advice had been given in a more sympathetic manner

-4) They are given a big responsibility in that monitoring weight gain and feeding, especially of newborns, is often the only point of contact with the health service. However it is not their role or training to diagnose disease or make a holistic clinical judgement of the whole baby in the same way that a GP would, so there is a tension there. Presumably they get into trouble if they sent every baby with slightly slow weight gain to the GP but on the other hand it's hard for them to say for certain there's nothing wrong.

• 5) the statistical generation and point of the centile curves seems to be poorly understood by all sorts of people, not just health visitors. There often seems to be a confusion between 'dropping centiles' and 'losing weight'.

My HV told me DD was behind in development and needed monitoring. But they'd assessed her on the targets for a 12m baby not a 10m one, so of course she's going to be slightly behind?

We don't get a regular HV in out area just whoever is free, so I've started asking specifically for the lovely, knowledgable one who helped us when DD had latch issues and colic. And I can totally see how they struggle when they don't even see the same babies each time they do a check or get to specialise in an area. They're so overworked here that they once got me to give advice to a newer mum at weighing clinc because Id had the same problem the week before - how is that a decent service for the other mum?

Our really good one retired. The new ones are on probation and very cautious. They all seem to have one area they know (eg food or sleep) and others they don't.

I ring the hv help desk and ask for a 2nd opinion sometimes ... They always give more common sense answers!

I have 3 deistic t memories of HV:

1. Being given a printed list of questions to determine my MH. I "passed"

1. That the baby's ulcerated haemangiona meant it was "getting better". Not what GOSH said when we finally got sent there.

1. Having returned home from a blue light trip to A&E receiving a phone call to make sure the baby was ok. I said "yes, thanks" she said "well, that's good" no further follow up at all which really surprised me.

Maybe the good ones are sent to families with lots of issues, and the rubbish ones to normal families who don't really need them?

I'm very lucky, mine is great, on the ball, very competent and supportive. She helped me through my PND and is great with DS. Others I've spoken to a clinic have also been helpful. But I know from friend's experiences, not all of them in our area are so good. Some if them, like in any job have become jaded and often disagree with new advice (just like our parents generation).

I do think though in the most part they provide a great service, it us just the poor ones that get talked about.

mine were mostly crap

we live in a tiny house and I happened to mention ds woke early due to dh turning on the shower in the morning right next to his room, noisy old shower/plumbing and mega thin walls........she said oh there must be something wrong with baby if the shower wakes him up, thats never happened to me...she lives in a massive house where they probably have en suites and her babies werent near showers at 5 am.....stupid cow, I worried for months before sussing her out.

As PP mention ... They are totally unaware of mh. I have "ANXIETY: VERY COMPETENT MUM" scrawled on the front of my red book by the hv boss (ie zero risk to child but be careful how you say things) and they either question me like I'm rocking in tge corner not coping ... or use such scary/thoughtless words the other hv at the next desk does eyebrows at them!

another told me to stop drinking milk incase ds was allergic to it since I insisted on bf'ding!

Actually re the MH thing, mine knew very little indeed. Two of our triplets were stillborn, when our survivor came home from hospital I dutifully took him to be weighed as per his consultant's wishes. The HV wanted to know why I wasn't more cheerful now he was home (um...funeral to arrange for two others?), whisked me in to see the GP and insisted I be given anti-depressants.

I never did have PND (or take the pills), I did however have an overwhelming sense of grief, and having anti-ds thrust at me every time I went near the HVs just made me stop going.

Poor DS2 has been seen by them all of 3 times, he's 2 next months :o

Rue

I still haven't had a satisfactory explanation from any HCPs about why it's necessary to see the HV. If something is wrong with DD I'll take her to the GP. In the meantime I'm perfectly capable of weighing her with our luggage scales and laying her on my tape measure to see her length (I've been filling in her red book myself)... I did ask if I had to take her and the HV said no.

Rue that's a terrible story and I am so sorry.

It's all lack of training, not so much so she'd know exactly where Grief slips into depression or how to counsel you but just a bit of training so she felt able just to talk to you, listen. It's a panic reaction, "shit what can I do, shove onto gp."