I'm NOT a Gina Mum, but for those of you who are ......

[susanmt]

Our new HV is HEAVILY into this. It reminded me of fp's posts about her friends coming to stay.
The thing which mums were really questioning at the playgroup today was that children should not be read bedtime stories as it is a 'prop' to help them go to sleep, there should be no singing or rocking or cuddling or stories once you go into the bedroom, just in the cot and 'night night'.
I read the book when my daughter was small then got rid of it, and was given a copy by a friend when my son was born, but managed to dispose of that one too as I don't like the advice/tone of it.
So two questions (I promised the other mums I would do some research and get back to them!!)

1. I this right about bedtimes? Surealy bedtime routines are a good thing?
2. Surely a HV should not be pushing one way of doing things so heavily - I think it is unprofessional and am wondering about complaining. Does anyone agree?

Off to read myself a bedtime story now .....

Can I just say to everyone who has posted subequently to mine about mixed breast and bottle feeding that I totally AGREE with your sentiments.If combining breast and bottle is going to maintain breast feeds then that is great.
However, it must be remembered that when breastfeeding is being established ( that takes at least 3 weeks ), the introduction of formula can be the kiss of death. If there is a milk production problem then supplementation is not going to solve that. If the nipples are bleeding then the problem is attachment at the breast. If that is wrong, milk production will not be adequate because the breast stimultion to produce milk is not there. If attachment is good and there is still inadequate milk despite frequent feeding then there is lactation failure which can be remedied by the mum taking Domperidone 10mg, three times a day for 10 days ( increases prolactin levels). If a baby is dehydrated and not thriving then it will require supplementation until the breastmilk supply has improved by these and other means.

The reason that formula is avoided if possible is that even one bottle can predispose a baby to develop asthma, eczema and other allergic responses. The evidence is vast that one bottle leads to another and breastfeeding fails.
If a mother has got to the point that she is going to change to bottle I agree that not enough encouragement is given to combine feeds. Far better that a mum contines to give some breastfeeds than none at all.

I definately agree that health professionals have a lot to answer for and it is appalling that mothers feel they cannot discuss their problems honestly and feel they have to lie so as not to be judged.

Mears

That's great about the Domperidone.

No-one ever mentioned that I could take medictaion to stimulate lactation.

Would it be free?

Monnie,
You can get it free when it is prescribed by your GP. Alternatively you can buy it over the counter - it costs about £3.95 for a pack of 10.
It's original use is for stomach bloatedness. Maxalon has been prescribed previously to increase milk production but Domperidone has few side effects if any wheras Maxalon could cause depression.
Our hospital has used medication for some time now, especially for mothers with premature babies whose milk supply is dwindling. It should be used when other means have failed such as correct positioning and frequent feeds.

Mears - as Monnie says no-one ever mentioned the existence of Domperidone or any other medication to stimulate lactation - and I've never heard of it until today.

After 24 days of constant feeding, with nothing offered other than "stick with it, and we'll see you again in another 3 days" it seemed I was in a long dark tunnel with no light at the end of it. Had anyone said to me that if in another few days things hadn't started to improve then there was a possibility of medication to help there might have seemed to be a light at the end of that tunnel. Maybe then I would have been able to hold out for another few days and not had to resort to the once a day bottles.

Perhaps it is that lack of hope of any solution which makes so many people give up completely?

There's medication???? Why wasn't I told? It was a running joke at the hospital at the pathetic amount of milk I produced. They would laugingly dribble in the few drops I produced down the stomach tube then top her up with formula. None of the medical staff mentioned any problems with formula and allergies/asthma.

I have posted my experiences with Domperidone on another thread.
It was very helpful for me.
Mears am I right in thinking it is a newish treatment?
Do you think most midwives/HVs are aware of it?
Is there any reason it is not promoted/mentioned a bit more?

Hi Jasper - it is fairly new to us but we have been using Maxalon for a while now. I've put more info on the Domperidone thread.

There are plenty of reasons why 'mixed feeding' has drawbacks - some of them have been mentioned by I'll do a round up!

it is exclusive breastfeeding that appears to give maximum protection against atopic illness (note - this is not the same as saying breastfeeding prevents eczema/asthma. But most* of the research indicates a reduced risk

• giving formula has an impact on the milk supply. For some mothers, this is not crucial...I have known some women continue for some time giving both. But you have no good way of knowing what the impact will be on you. You milk supply may dwindle in response to the point at which you genuinely are unable to sustain it. This is especially the case early on.

• second stage formula - the sort demented was advised to give - is casein dominant. This acts to keep the baby 'satisfied' not because it is higher in calories than 'first stage' formula or breastmilk (they're all more or less the same in calories) but because there is a substance called casinmorphin in the casein which acts as sedation (useful to cows, in the wild anyway, who need to be able to leave their young quiet and safe from predators while they go somewhere else, not being able to carry them like other mammals). So the idea that the formula is more satisfying is spurious - though of course it can be more satisfying if the breasts really are not producing enough

• bottle feeding/formula risks introducing bacteria into the baby's system - not all that much of a risk if you are careful about hygiene and preparation, though, probably. But the recent death of a baby in Belgium from contaminated formula shows that there is an outside chance of something serious. Occasionally, formula batches are recalled because of contamination issues, in the processing or storage; babies are sometimes damaged by this contamination.

• mixed feeding means more work - the feeds have to be prepared and the bottles and teats have to be cleaned

Noe of this is to say that babies don't ever need formula. It drives me crazy to hear of mothers who have clear problems with bf being told to 'persevere' - this is madness. Babies who lose 25 per cent of their birthweight - like Mines' baby - are clearly not feeding effectively, but too often, health care professionals are not spotting this. I would imagine, Mines, that as well as unhappy unproductive feeds your baby was also not poo'ing very much if at all. Your probs should have been spotted and resolved earlier.

Breastfeeding can and should be fixed before a crisis happens in which formula then becomes the emergency option. I think there is a role for medication in some instances, but mostly, it's boring old postioning and attachment that ensures a good milk supply. Feeding for 6 hours at a time and still feeling the baby is miserable (another example from recent posts) is not normal ...it is an insult to mothers to tell them to persevere without looking at everything to make the breastfeeding a better experience.

Mixing formula feeding with bf is sometimes a life saver, and it does sometimes allow some breastfeeding to continue. But in the majority of cases, the right help at the right time would avoid mothers needing to use it.

I agree with everyone how sad I am that nobody told me about any medication to improve supply (BTW thanks for the info Mears - funny how mumsnet has more info than entire hospitals!). My ds lost a lot of weight was he was born, and I felt desperate. he had latched on well, I wasn't in pain particularly and my nipples were fine, but the milk just took an age to come in. Every time he was weighed, I cried so much even the midwives look shocked. And when they eventually gave a bottle of formula I thought that was it - my breastfeeding plans had all gone out of the window. I was heartbroken. Of course, that wasn't the case at all, and I'm stil b/feeding at 8months (and he loves it so much I actually wonder how on earth I'm going to ever stop.) I felt very angry that I'd read so much about 'nipple confusion' but actually couldn't find any evidence/studies on it. I'm sure that it actually puts women off breastfeeding because after a bottle has been given, they think, 'well that's that then. He'll never feed off me again so I might as well give up.' My son was never confused about preferring a nice warm mummy to a cold plastic nipple! So, let's hear less about nipple confusion and more about anything that can improve supply. I'm going to tell my poor friend who is still struggling to feed her newborn about it right away.

Yes, you'll notice that nipple confusion was not on my list!!

Anyone who talks about nipple confusion or implies that babies can't manage to go back to the breast after a bottle just hasn't been keeping up with the research.

There is no good evidence for nipple confusion, but there is for nipple 'preference' - the babies aren't confused, in fact they are very sensible!!

They will reject a non-productive breast in favour of a productive bottle. So if there are problems with supply, and with positioning, it is vital to address them at the same time. Someone who knows what they are talking about can help suggest ways to amend positioning and the supply should be kept up with frequent feeding, and poss. expressing. The baby needs to be kept in close physical contact with mummy, too, so every opportunity is taken to support his instincts to feed at the breast and to enjoy the taste and smell of his mum.

That way, you minimise the baby's chances of preferring the bottle. I think there is good evidence (on the basis of observation and experience) that messin' about with cups and syringes to deliver expressed breastmilk or formula (apart from with pre-terms) is not worth it....the baby manages a bottle teat fine and gets the milk into his tum more easily. Sometimes, giving a baby the chance to get a bunch of calories in in this way perks him up so he can suck at the breast better.

What Melly described at her friends antenatal classes happened to me. I went along to the session and it was announced that this week is "feeding". Breastfeeding is best for your baby and we are going to watch a video.

Hands up everyone who is going to breastfeed. Thats everyone then, good, oh no just one person who isn't.

She then came up to me when everyone else was watching the video and asked me why I wasn't going to breastfeed. I felt like a leper and my husband was fuming. I had been a bit undecided but it made moe more determined than ever to stick to my guns and bottlefeed.

We watched the rest of the video and left the class.

I got a standard letter from the surgery today saying the matter is being looked into.
We'll see what happens!

Let us know what happens, Susan...an interesting situation.

Yes, do keep us posted, Susan.

Have been invited to the surgery next Monday to discuss the issue with the Practice Manager, who handles complaints. Surely it should be someone who actually someone who knows the issues involved, like the hv herself, a nurse/midwife or one of the GP's? What do you think?

So I've been told....theres a set procedure in surgery complaints. All complaints no matter what have to go through the practice manager 1st. Only then can it go up the scale...I was told this by the odbudsman, medical regulating body when I tried to complain about the practice manager at our surgery. As HV are officially connected to a surgery that means you have to 1st go through the practice manager...bear in mind though I'm only passing on what I was told.

Wow susanmt, I just read back to your original post! I have never heard anything so ridiculous in my life...not reading bedtime stories?!!!!? My favorite childhood memory is of my father reading to the family everynight before bed. He did this until we went off to university. I haven't noticed any major hangups that my brother and I have developed from this upbringing other than a lifelong appreciation for literature.
Good for you for following through and complaining. I received no end of useless suggestions from the hv and midwives at the hospital (sorry mears, I know there are many good midwives out there...I just didn't get any of them). I had one midwife tell me when she found me with my newborn breastfeeding baby sleeping next to me in bed (I had just had 40 hours of labor and a c-section and couldn't even sit up, much less touch my son in the bassinet they stuck him in) that it was a really bad habit to have your baby sleep in bed with you and that I was spoiling him!

Thanks for persevering and letting us know, too, susanmt....actually I think it's good that the practice manager should know what's going on. She will then (presumably) give the HV a chance to respond, which is only fair, and you might get a better chance of a policy change. If she (prac. man) needs more understanding of the issues, then I'm sure you will be able to fill her in.

Yes, let us know how the meeting goes. I think it is good that it is the PM you are seeing, as it might be helpful if the person you are complaining about is not in the room. (Can you tell I am a complete chicken about these things?)

DOH!! Totallyy got the dates mixed up - went to the surgery this morning instead od NEXT monday and of course there was no manager!!
I am convinced I lost my brain when I had my kids, I really am!

I am a Practice Manager (please don't hate me!) and the idea of the PM dealing with the complaint is that she/he should be the "middleman", if you like, and allow both you and the other parties to have your say fairly, calmly and in full. It would be likely that there will eventually be a meeting convened between you and the HV/GP if that is what you feel comfortable with, as a part of the reconciliation process. As mentioned, it is really important that she/he knows what's going on at the practice as it may be that complaints begin to build a picture of a situation.

In terms of making a complaint about the Practice Manager, there should be a section in the practice compaints policy which mentions who would deal with this at the practice - if someone wants to complain about me then the Senior Partner would handle it (thank God it's never happened)

HTH

thanks Zoe, I'll let you know how it goes!

Wish me luck - just off for my meeting! With list made of complaints about HV and copy of CLBB to show what is being distributed with their money!
HHHHElp why have I decided to do this?

Back!
Had a really productive meeting with a lovely practice manager who was really helpful and understanding. I explained that I was complaining from my own pov but also on behalf of other mums in the area, and she took their comments down too.
I showed her the book that was being handed out and she was genuinely shocked that this was hapenning. Turns out the hV had been given a book budget to set up a free lending library of parenting/pregnancy books which she could offer to lend any of us who needed advice - she had been given a LIST of books to get, CLBB was on it but so were things like 3in a Bed, she had just chosen to put her spin on the idea!
I made my point about her being really dictatorial and unsupportive of b/feeding, (she told me I'd never manage to feed such a big baby and should start him on a bottle right away!!!!), her pressurising partns of 2 yr olds to start potty training (luckily mine is!) and her habit of turning up unannounced rather than phoning to see if it would be convenient!
I also pointed out what bloss said about the bedtime story bit being a personal variation on the book.
Left the book and the list with the PM, she's now going to see the HV and then arrange a meeting with me, PM, HV and one of the docs.
Still shaking, but proud of myself!!!

well done!!