Declining the health visiting service

[Sleeplessem]

I’m 29 weeks pregnant with my second and I’m thinking about opting out or declining the HV service past the 6 week weight check. I’m happy to have the 1 year and 2 year development reviews, it’s just the weight clinics. Does anyone know if you can actually do this? My reason for not wanting to go, isn’t bashing health visitors as a whole (I know there are good and bad in every profession, although I do think in health care you can’t have ‘bad eggs’) but it is based on the abysmal advice and service I had with my first.
I think of my local area there are just one or 2 HVs that provide advice in line with NHS guidelines, the rest of what we’ve been told is utter nonsense and ultimately caused a lot of stress unnecessarily so I’d rather avoid if possible.

Reasons below:
My actually HV is ok, but incredibly lazy. Refused to help support breastfeeding and said I was only allowed 3 chances to get it right and then I had to move to formula (made no sense at the time either). She’s also given advice that directly contradicts the nhs, ie around water to babies under 6 months and snacks under 12 months.

My daughter was a low birth weight but classed as constitutionally small, birth notes explain this, but at every weight check we we berated about her size, until 6 months she tracked consistently between 2nd and 9th centile and then after 6 months between 9/25th. She’s stayed in this place til 2, it’s clearly where she is meant to be. We’ve been told she’s too small still but they refused to write referrals to a paediatrician for further investigation rather insisted she needed to be force fed. I was told social services would be called if I carried on breast feeding (under a year she was having solids too), that she’s too pale and that’s a sign her diet is lacking, (it’s not her blood work is fine which they had a recent print out for, they are also saying this as she mixed race as she doesn’t have a sickly complexion but she is fair). There are more comments such as these but these are the ones off the top of my head. Basically weight clinics were nightmare, always saw a different HV and this sort of issue was constantly brought up with an undertone of accusations of neglect and each of the issues they raised they refused to refer. We paid private so get her seen by a paediatrician who we now see 6 monthly on the nhs as hes aware of the issues the HVs raised , was disgusted and wanted his notes on her medical records, he also monitors her growth. We paid for a paediatric dietitian who evaluated her eating and said she’s fine and developmentally normal, both of these consultants were aghast at the comments made and how there was no clinical basis. It was attributed to not understanding child growth and poor breastfeeding training. We bought a proper calibrated baby scale during lockdown when weigh in clinics stopped so I will monitor dc2s weight gain. I’ve a great relationship with the infant feeding team and know they’ll support in the case of breastfeeding issues and likewise my daughters paed is fantastic so would pay private to go to him and he’d refer back to nhs.
In summary my reasons for not wanting the HV weight checks is just to avoid the headache. But equally I don’t want them calling social services as that would be a headache too.

Anyone else opted half out like I’m considering? Again I’m happy for the checks up to 6 weeks and then the 1 year and 2 year development check, but in the interim it’s been a complete 0 value add. Tbh even the development checks we do with the paed but I’m happy to do them with the Hv too xxx

"Disagree on where their ‘main value lies’ the vast majority of mothers and babies won’t be circumstances with SS involvement, so thus the majority of their encounters will be to provide infant feeding guidance and introducing solids guidance and blimey if they can’t get that right when it’s the cornerstone of what they do. "

No, you aren't getting it. The point of having a universal service is so that a trained professional gets to see every child at home if possible to ensure that the baby is well and is progressing as expected. It's an opportunity to pick up on issues that in combination with other factors may trigger a safeguarding alert. How do you determine who should and shouldn't be seen otherwise? It's just not as simple as families who already have SS involvement.

You can say, 'oh it doesn't work, they missed a case near me'. But doesn't that indicate that more not less checks are needed? The 5 mandatory (and yes it's mandatory in terms of the service delivery model required of local authorities) are a bare minimum in terms of touch points with healthcare professionals in the early years of a child's life. How else are we googling to stand any chance of picking up cases of abuse?

For every horrific case that you have heard of because it hit the headline there are countless others that are being identified and managed and of course who knows how many that remain undetected?

I haven't read it all apologies.

I would have gone to weigh in clinics etc if they were open. None were open in our area due to covid 🤷🏼‍♀️

Last time I seen my HV was 3 months (now 6 month old) that was cause I kicked off a massive stink about her not being since since like day 10 or something. I had a couple calls. But that was it.

I suppose now I just mum's net and hope I'm doing the best.

@ChequerBoard

"Disagree on where their ‘main value lies’ the vast majority of mothers and babies won’t be circumstances with SS involvement, so thus the majority of their encounters will be to provide infant feeding guidance and introducing solids guidance and blimey if they can’t get that right when it’s the cornerstone of what they do. "

No, you aren't getting it. The point of having a universal service is so that a trained professional gets to see every child at home if possible to ensure that the baby is well and is progressing as expected. It's an opportunity to pick up on issues that in combination with other factors may trigger a safeguarding alert. How do you determine who should and shouldn't be seen otherwise? It's just not as simple as families who already have SS involvement.

You can say, 'oh it doesn't work, they missed a case near me'. But doesn't that indicate that more not less checks are needed? The 5 mandatory (and yes it's mandatory in terms of the service delivery model required of local authorities) are a bare minimum in terms of touch points with healthcare professionals in the early years of a child's life. How else are we googling to stand any chance of picking up cases of abuse?

For every horrific case that you have heard of because it hit the headline there are countless others that are being identified and managed and of course who knows how many that remain undetected?

No I do get it, I’m not saying chuck them all in the bin or even that a universal service isn’t necessary BUT it needs to be competent in infant feeding as they are the main point of contact for new mothers, surely this goes without saying. It’s simply not good enough to provide outdated and frankly dangerous advice. I’m aware not all HV do this, however unfortunately it’s been MY experience with the vast majority of MY local HV team. Hence why I don’t particularly want to go to the weight clinics. But I am happy to have the 5 day, 2 week and 6 week check as well as the development checks (preference would be these over the phone- which I imagine will be permanent moving forward).

You mentioned before the 5 mandatory checks, well pre covid In my area they weren’t doing the full 5. We never had an ante natal check. It would have actually been quite reassuring but whatever.

My anecdote about missed abuse is merely to illustrate the relative failing of MY HV service and the lazy attitude of MY HV. Not a statement that the whole service needs to be binned.

This thread has got me thinking. If the NHS offered a digital service where you could access up to date guidance on issues such as breast feeding, weaning etc perhaps with a 'live chat' option to enable you to ask specific questions or raise concerns do you that is something you would find useful?

Just pondering how the advice & guidance part of HV role could be delivered in a more consistent way.

I think you'll find it's a different hv world now. My granddaughter was born a year ago and unless my daughter contacted them there was no hv initiated contact. No weigh ins, no clinics, nothing. When my daughter did contact them for advice she rarely got directly through to them, had to leave messages and sometimes had to chase them. She's an anxious ftm and found it very frustrating. Their tone towards her was always impatience, subtle criticisms, and no helpful suggestions. She came away from these interactions feeling rubbish and more anxious.

@ChequerBoard

This thread has got me thinking. If the NHS offered a digital service where you could access up to date guidance on issues such as breast feeding, weaning etc perhaps with a 'live chat' option to enable you to ask specific questions or raise concerns do you that is something you would find useful?

Just pondering how the advice & guidance part of HV role could be delivered in a more consistent way.

Re weaning (which should be introducing solids) yeah a live chat option is cool with accountability of course, no health professional should be ever recommended force feeding or making accusations of neglect without proof. However, breastfeeding support is so much more valuable face to face. It’s near impossible to assess a latch over the phone or webcam, that trained support needs to be there face to face. There is tremendous pressure put on mothers with this ‘breast is best’ narrative only for mothers to be let down at every juncture in terms of breastfeeding. Health visitors and midwives need better mandatory breast feeding training conducted by an IBLBC and regular refresher courses as the absolute minimum. They need to be able to spot a poor latch, poor milk transfer, tongue tie and unsustainable feeding patters.

They also need to regular mandatory updates to training to even get basic vocab choices right, ie introducing solids instead of weaning, clinical guidelines for referral to do with faltering growth (not failure to thrive) (above 91st centile 3 sd drop= referral, below 2nd 1sd drop and the rest 2 sd drop). The fact that this isn’t there right now is shocking.