Speaking at Unicef conference on "Mumsnet and feeding: What are women talking about?" Help needed:)

[carriemumsnet]

I'm giving a talk at the UNICEF UK Baby Friendly Initiative Annual Conference next week in Liverpool and could do with some help. The title is "Mumsnet and feeding: What are women talking about?" and I want to give examples of best and worst practice.

I don't want it to turn into a 'them and us' experience and be over critical, but at the same time I want to give an honest reflection of people's experiences of deciding whether to breast or bottle feed, trying to carry on breastfeeding, starting feeding, weaning etc - and a highlight what helped you, what worked, what we can encourage and how we can work together with health professionals - as well as give examples of worst practice, and case studies of what absolutely doesn't work and needs to be addressed.

If there's anything else you'd like me to say in addition to this, please feel free to post it here. I can't guarantee I'll include everything, but it's always useful to have anecdotes and experiences for the Q and A session!

If anyone's attending the conference - do come and say hello - it'll be good to see a (hopefully) friendly face:)

I didn't discover MN until my baby was several months old, and if I had when I was preg, I would have had a very different idea of bfing:
-that it can be very hard, tiring, demanding, emotional.
-that there is help out there, but internet help might be better than in RL with HCPs.
-that extended bf is common
-that co-sleeping is normal and ok
-that bfing in public is also normal and ok (i had never seen anyone do it, but it is talked about a lot here so people must do!)
-that bf/ff is such a big issue. I literally did not know this until I started MNing.

I am a well informed professional person but I knew hardly anything about bfing when i gave birth!

It scares me actually to look back.

However I do think there is a huge bias towards extended BF on MN which is not replicated in the population as a whole, and that difference is sometimes not helpful to (non-extended bfing) MNers, if you see what I mean. Same goes for BLW which is related I guess.

I would also like to second the need for tongue-tie training and treatment, it takes two seconds with a pair of surgical scissors for a nurse to snip a tongue-tie (sorry if TMI), but although NICE now recommend this, this depends on the nurses, breastfeeding counsellors and consultants/doctors at the birth check being able to recognise tongue-tie and pass you on to the appropriate person.

My two were both severely tongue-tied, the first never ever latched properly even though we breastfed (painfully) to 10 1/2 months and even though about 5 supposed specialists (breastfeeding counsellors, the midwives, HV, consultant) all saw her about feeding problems. It was finally snipped on the NHS when she was over two and was developing speech problems. Second time around I was alert for it, spotted it, asked the junior doctor/nurse to snip it there and then in the hospital, but again, no-one felt confident enough to diagnose or treat it and I paid privately at three months to have it done at a tongue-tie clinic after really very painful breastfeeding.

Why is this still a problem? They don't have to recommend tongue-tie division, just be able to spot it, discuss pros and cons of snipping, see if there are any current issues (pain on breastfeeding/speech/choking on eating) and do the snip if necessary. It's a minimal easy procedure and they can train nurses to do it easily, and would save resources from sending HV/midwives/bf counsellors to endlessly discuss position/latch when actually what they are suggesting is physically impossible for many tongue-tied babies.

Not that I feel strongly about this or anything...

I am EBF my 5 month old DD, which to a large part is due to mumsnet.

I went to NCT classes and was brainwashed :) that breastfeeding was best. My DD was born by EMCS and small (4.8lb) so I was in hospital for 4 days.

What shocked me was the completely conflicting advice given to me by practically every HCP on the ward. This was not exclusive to BF, including one MW would told me to strip DD and do skin to skin, followed about 10 mins later by another one who told me off for not having clothes on the baby. Grrr.

Some MWs were helpful in getting BF established, others were worse than useless. A nursery nurse came in and told me my baby was crying because she was hungry and that she had to have a cup of formula. I was in so much pain and sleep deprived I let her, because...she is a HCP and knows best right? Well not according to the paediatrition I saw the next morning who was furious that someone had "given your baby chemicals!"

It seemed to me that there was no BF or (indeed other) consistent policy in operation, and they all did what they felt was best, which caused me a lot of uneccessary stress and upset.

This is the issue that needs to be addressed IMO. Surely on a maternity unit, where you can't leave until the baby is feeding well there should be a consistent policy, advice, guidelines and support on how to actually do it? Is that really asking too much?

Totally agree with the points made upthread, that the NHS is very pro breastfeeding when you are pregnant and then appalling once you have actually given birth and need to breastfeed!

There should be standard guild lines across all hospitals, as I am sure there are with other clinical guidelines.

Apparently they can organize someone to come in a take your fecking photo (don't get me started on allowing Bounty people on the wards) but not a consistent support process to get people to breastfeed, which according to all their literature results in healthier babies, children, adults and therefore less drain on NHS resources.

Madness.

Thank god for mumsnet, where I got the information and support I needed to carry on when I was (literally) biting down on a chopstick, yes, a chopstick, for the first week because of the pain.

Thank you mumsnet, not so much the NHS.

Consistent, honest, knowledgeable support from pregnancy to beyond birth. From HCPs and charities alike. Preferably, and I know this is a huge ask, accessible when you need it and from someone who knows you and with whom you've had the chance to build a rapport.

feeding in the small hours is the worst time when it's going wrong. In my case with DD, even had I known that help was there first thing that might have helped. And someone who knew me enough to tell me to "man up (), this can be tough but you'll get through it and I'll help" as opposed to the stock message of mood lighting and fluffiness and how normal,easy and natural this is, and babies survived in the Middle Ages being bf (yes, some did, but an awful lot of them died, too. We are now in the 21st century thanks.). Made me feel guilty as hell, a guilt only assauged when DS was born and I did manage to feed him. For an hour and a half a time . but that's what he wanted and that's what we did.

With the consistent, knowledgeable support I think everyone should have.

Carrie - great opportunity!

Here's some suggestions:

HCPs to read* mumsnet, esp the breast and bottle feeding folder
telling people hurting is normal is wrong* wrong wrong - I have helped too many women with shredded nipples because they thought it was normal for things to hurt and that gritting your teeth was the way to resolve it. Hurting is common but it needs investigating...always. Maybe it will just go when the baby's mouth gets bigger and mother and baby become more expert, but it could be an oral anomaly, or something that would improve with a different latch...whatever

• the most common problems on mumsnet are

• mothers not knowing how to recognise their baby's are feeding well in the first week or so - they need support and guidance on this
• babies' weight causing concern and mothers not being told how to address it except by 'give formula'
• babies' weight causing concern but it not really being something that needs worrying about
• mothers being very confused about the safe way to make up formula feeds (this has not been communicated well to mothers)
• people in the very early days and even hours after the birth, sometimes from the postnatal ward, contacting mumsnet with (potentially) serious problems about feeding....when the best course of action is to have someone in real life look at them and their baby. This may be partly a reflection on how we all get info in the internet age, but it's still not right that they feel unable to get appropriate help on the ground
• really, really bad conflicting and confusing and sometimes plain wrong advice from HCPs....sometimes this is a misunderstanding, but even when it is, it indicates communications need improving
• myths mothers have heard from HCPs like eating a better diet is important to improve quality and quality of milk, that the baby has to stay on X minutes, plus a lack of understanding about foremilk/hindmilk
• worries that their baby is feeding too much compared to what babies of a similar age 'ought' to be doing

Gosh that's a whole long list - but any of these appear every day on mumsnet :)

Justfeckingdoit's two stories about conflicting advice are very typical - this sort of thing happens a lot.

I had no problems BF my first baby so I don't really have much to add about what the best way to address issues are/is except two things I have noticed.

1. Young mums don't breastfeed that much. I was a young mum that did do it, but I was cripplingly embarassed about doing so beforehand because I didn't want anyone to see my boobs - fair enough that's something that doesn't seem all that important after a while. But saying "oh don't be silly, bf is natural so you shouldn't care." doesn't help when you DO care. Proper advice about how to feed discretely without being confided to bogs is much more useful. Feeding discretely advice, btw depends hugely on the individual woman's breast size. Pulling your top up leaves you half naked and very obviously feeding if you only have small boobs. In that situation pulling your top down (with something over your shoulder if necessary) is much better.

2. The other thing is that when I was talking to my MW about bf during this pregnancy she said that she was not allowed to give any advice or suggest bottle-feeding if the mother doesn't bring it up first.
   I know not all MWs stick to this (particularly in the very early days) but it seems silly to me, as it means most parents will make up their first few bottles on their own, perhaps incorrectly having not had the correct advice. I mixed-fed DD and I only realised I was making up her 1 formula bottle incorrectly 7mths down the line. Which is ridiculous, and could have caused issues if she was totally ff.

That's a great list tiktok.

I would add that women talk about not just a lack of support, but downright cruelty at the hands of HCP at times.

My neighbour in the postnatal ward, crying in pain and exhaustion after a truly horrendous delivery of twins, was snapped at by a midwife who told her 'Stop crying or your milk will dry up.'

When I asked for help with the first attempt at latching on, because I had tubes and drips everywhere and couldn't sit up, the midwife just grabbed my breast, grabbed DS' head and mashed them together, then walked off without a word.

Hopefully these are rare occurrences. But I have read too many stories like this on MN to think that they are extremely rare.

I would love to see volunteer mums on the ward helping with BF

Oh yes - head ramming and breast pushing.....:( :( :(

This feels incredibly invasive and disempowering. I think some midwives feel they are being gentle and kind, but it almost never feels that way when you are on the end of it. Quite apart from that, it's not uncommon for babies to 'turn off' the breast after even one episode of handling like this, and they become more difficult to feed.

Midwives in hospitals may not see the result of their intervention because the mother is home soon afterwards - with a fighty, struggly, or sometimes over-sleepy baby :(

I would also add to the list the medications issues.

many women post-natally need to take painkillers or other meds like antidepressant, asthma meds.

all too often the gp's and other hpc are not aware of the information that is available on the internet and tell mothers to stop breast feeding.

tiktok is that true???

Because yes, when the midwife did that, DS did latch on briefly. But that was the one and only time Every time I brought him near the breast after that he would scream and turn away, there was never any hope of getting him latched.

I'm actually quite upset now

Thinking a bit more about my first 24hrs with DD in the post-natal ward (left a lot to be desired) I'm sure no-one asked me how BFing was going, how I was feeling, what sort of night I'd had.

Pretty sure I was just asked things like "Has she had a wet nappy ?"
Fair enough they could probably see she was feeding OK, but a little encouragement, even praise, would have been great.

Please carrie use your platform to campaign for more humanity and support post-nataly, especially whilst in hospital and with our first DCs ! It would make such a difference to the first days, weeks, and months.

Hope you're OK dreaming
Sorry you had rubbish support

dreamingbohemian, yes, it is true. Any experienced breastfeeding counsellor has come across mystery 'breast refusers' (not talking about strikes, in older babies, but young babies) who turn away from the breast for no obvious reason - the baby can be distressed and/or angry, or he may go rigid, or he may just drop off to sleep in an attempt (it is inferred from his behaviour - obviously you can't ask him) to reduce the sensory overload and discomfort of being forced on the breast. We ask mothers what happened in the first days and there is almost always an experience of someone 'trying to get the baby on'.

The research on it is not that extensive but there was a study that compared babies whose first feed was helped by a hands-on midwife who more or less did the positioning and attachment 'for' the mother, and ones who were just supported without any physical handling, and the mothers in the 'no handling' group continued bf for longer.

Actually, even if there was no research, it's one of these situations where you know that if it it feels intrusive to the mother, it may well feel like that to the baby, too.

Babies are exquisitely sensitive to touch and handling - we know that.

This sort of refusal can be repaired - things that can help include co-bathing, biological nurturing positions, skin to skin, and lots of calm patient love.

Really sorry you had that bad experience.

Thanks Juggling and Tiktok.

God I knew I had rubbish support but now I'm really angry that it was even worse than I thought!

Carrie, please file this under 'Why MN Is More Helpful than RL Support'

I'm trying to reassure myself now by the fact that DS has always been happy and healthy and seems to really love his mama

But damn, that's really upsetting. Pleeeeeease let's get some better support for new mums.

This is all a bit OT for carrie, sorry....! But maybe not - the point is that midwives and other HCPs should be aware of the evidence on how best to support bf and not only is this not always the case, some persist in behaviours which fly in the face of it.

dreaming, I said there was not a huge amount of research but in fact NICE's own 'evidence into practice' briefing cites 'hands off' as one of a number of important points midwives and others should follow. If you google 'Promotion of breastfeeding initiation and duration Evidence into practice briefing' you can get the PDF. If your experience is not that distant maybe you could write to the maternity unit and tell them what happened and say it made (and makes) you sad not to have breastfed - that yes, you have put it into perspective now, but that it made a difference to you at the time (and WTF are they gonna do about it, huh?!)

I think the single thing that helped me most was the fact DP was 100% supportive of me bfing. So my plea would be to talk to the partners as well as the mother, because they help so much when at home, when out and about, so that when I was out on my own, I didn't think twice about bfing.

Also agree with SPB upthread about dispelling myths. I've heard the biting one so often, from all sorts of people. Ridiculous.

Wow - thanks. Not sure how I'm going to squeeze all that into 35 mins .... but it's all really really useful stuff, so thanks for sharing all your views. Now just have to sit down and write the darn thing

FannyBazaar - I'll see you there, please try not to heckle

Thanks again
Carrie

Good luck Carrie!

And thanks tiktok I'll think about that.

tiktok though you won't know it as I lurk more than post, I spent a lot of time on the BF board and your support and encouragement to other mums who were having all the same problems I was, was the reason I kept going.

Love BF now, but a week in with a baby with a tiny mouth I thought I'd never say that!

So thanks from both of us and so sorry that so many people don't get the right support. Makes me pretty angry actually.

:)

Hmm... my only comment on this (apart from still thinking that the bf bit was the only thing that actually went 'right' about my whole birthplan...) relates to aftercare in hosp. I had an emcs - however, luckily ds had a feed in recovery - and DH was really helpful as he'd been to the NCT bf session. Everyone that saw Ds feed said how well we were doing. Until the 3rd night that is. Then Ds woke at midnight (I'd not slept by then due to busy ward) and wouldn't settle for a feed or anyway at all. The sister came after about 30mins of disturbance and said I wasn't feeding him right - but he still latched on then immediately shook his head even trying everything she suggested. I later worked out that he actually had colic starting rather early - this was exactly as he was for much longer periods when he was several weeks older - but being told at midnight that you're doing it all wrong is devastating, particularly if you were thinking that that was the only thing that had gone to plan.

Notwithstanding a bad night then, we didn't give up, and we got through colic and despite going back to work I managed to continue bf until he was 22mo.

In terms of bf around and about, it does seem more common now to see bf going on as a fact of life - which is good. Whilst I find this very encouraging, by the time my ds got to 4mo, he was so inquisitive that it was impossible to feed unless I was somewhere calm and quiet - so having somewhere to go, not necessarily a room shut off somewhere (and certainly not the changing room as the only option) would have been really helpful.

very interesting tiktok re the head pushing etc. This happened with me the moment DS1 was born following a very traumatic delivery. I had a spinal block, was high as a kite on pethadine and the MW grabbed my breast and forced it into DS1's mouth. I was quite but thought it was normal. My attempts to feed DS1 after that were unsucessful. When DS2 was born this didn't happen and BF him was far easier and a much better experience.

The tongue tie thing is a big issue for me at the moment.

Between 4 and 10% of people are tongue tied, (although not all tongue ties will interfere with breastfeeding). That's a lot of people!!

I talked about ds1's feeding problems with at least half a dozen HCPs at the time and not one of them (looking back, knowing what I know now) had a CLUE about breastfeeding, never mind tongue tie.

Why not?????? That's what we need - HCPs to know their stuff!