Your thoughts on breastfeeding policy and what could be done to improve it/ increase breastfeeding rates

[JustScreamMumsnet]

Hello Mumsnetters, we've managed to get a meeting with the person running the Government's breastfeeding initiative and would like to pass on Mumsnet's top suggestions for improving breastfeeding policy and to outline the key issues.

So let rip! But do bear in mind that there's probably bugger all in the pot, so, much as we'd all love to have a one to one breastfeeding counsellor for the first 48 hours for all type thing - that's probably not a realistic suggestion at this point.

Yes, training for HVs and GPs, and honest information about the things that can go wrong.

Agree v much with everything eyeseyes has said.

Can I share something with you?

With DS3 I really wanted to breastfeed but lacked confidence and after the birth wobbled and asked the midwife to fetch me some formula. The midwife did not question my request and went to fetch the formula but while she was out a cleaner came in to sweep the floor. She asked me whether I was going to breastfeed and I burst into tears The cleaner said 'oh my darling, why don't you give it a go? I breastfed all my 5. Just put him the breast and he'll do the rest' I did, while the cleaner encouraged me and reassured me gently and I never looked back - I breast fed him for a year... I wish I could thank that woman (my eyes are filling with tears thinking about her )

The midwife offered me no breastfeeding advice - the cleaner did. I don't know what the answer is but there really is something wrong there....

wow, gingertoo, that really does say something about the mindset of the HCPs.

shocking

ginger that's lovely

Makes a point as well that it's not just the message, it's the way it's delivered. If she'd harangued you about "breast is best" it would have had a completely different effect. We need people to be kind and gentle to us as well as encouraging and sharing information. It's a vulnerable time.

The midwife may have thought she was doing the right thing by making it your choice but it sounds like you needed someone to listen. Sadly time seems to be in short supply in a maternity ward.

I've just thought of another one which should have smacked me in the eyes a bit earlier TBH....

But after 3 Caesareans, the last one the very best, managed by a wonderful team of (female, I might add, perhaps irrelevantly) anaesthetists at North Staffs Hospital (not widely known for its progressive practices ), I am CONVINCED we need a training policy in surgery and recovery rooms to support BF also.

I insisted on having my baby immediately, skin to skin. I insisted on keeping him there until I was ready to give him over to someone else. They were a bit 'hmm' and 'ah' about this but because it was a planned section, and I was lippy assertive, it just became my choice. It was marvellous; and THEY thought it was marvellous too: they commented how they thought actually they should do many more sections like this, and there was, actually, no real reason not to where there were no other complications.

It was fine: my DH helped me hold him at first and then he was sort of tucked into my gown with a pillow along my arm once they were happy BP etc was OK.

If there isn't such guidance - given the shocking CS rate in the UK - there ought to be.

I'd suggest is TWO growth charts in the heath books, one for breastfed babaies, one for formula babies.
I'd also suggest these are in all mum to be literature, so they will know there will be a difference and they will know what to expect.

Also suggest a reduction in advertising of formula milk.

Also suggest at the ante natal classes, a breastfeeding Mum could come in and show or tell what happens and maybe explain how it works!
My MW asked me to come in and chat to the other Mums at an antenatal class 3 months after I'd had DD, some Mums stopped me in the street after they'd had their babies and said that my "chat bit" was the best "bit" about the ante-natal, and they were still breastfeeding. Made me v chuffed.

And, since I'm on a roll now, the HCP training needs to get over all the guff about how difficult it is to BF after a CS. Yup, a bit of additional support might be needed, women need to be reassured about pain-relief (because being in pain really doesn't help) and hospitals need to be MUCH more tuned in to what life is like on the ward for women with CS (and possibly other major tears/blood loss etc) who wish to BF.

For example, the aforementioned hosp was utterly shite at recognising simple things like the fact that I needed more pillows, and while their policy of two per bed might well be fucking regulations, the alternative to me having a coupla extra is NOT FEEDING MY FUCKING BABY which needs a slightly higher priority... And if - and in 3 deliveries it has always been this way - the MW are too stretched to help you every time you need to lift your baby in the first 24 hrs, then they need to RELAX THE FECKING VISITORS POLICY for women who can't get out of bed yet.

Sorry. I just realised how angry I was about those things. All over again.

vulpusina excellent suggestions.

and i am glad you are angry enough to want to change it. although im not glad you had to experience it.

2 growth charts should definitely happen.

'reassured about pain-relief (because being in pain really doesn't help)'

Agreed - I didn't have a section, just a 2nd-deg tear, but I was SOBBING during every feed in the 2-3 weeks following birth because the cramps brought on by feeds were so intense. My stitches were painful enough that I couldn't walk much for several days and in hospital the MWs all hemmed and hawwed and acted like I was just being a wimp when I asked for something for it so I could just get out of bed to go to the toilet by myself.

TBH, I don't even know if BFing hurt my nipples in those first weeks because I was in so much pain elsewhere I couldn't register anything else.

IMO saying that if you're doing it right it won't hurt is really harmful. If you're doing it right the latch may not hurt (much), but you WILL feel the milk coursing through (an odd feeling on the best days) and the hormone cocktail WILL cause other pain and [emotional] side effects.

I think I only made it BFing because I ignored staff and kept DD in bed with me (in part because it was too painful to get up). I laid her on one side, feeding, and when she stirred I rolled the lot of us over to the other side and kept on feeding. I must have done something right as she went from the 9th centile to the 70th in six weeks - on the non-BF chart!

These have all been said above I think but I can't resist shouting in agreement:

1. Drop the "breast is best" guilt fostering line. If a mother is committed to bottle feeding, it isn't going to change her mind. If a mother wants to BF and it all goes wrong, it makes you feel terrible. Save the "breast is best" line for those who are pressuring mothers into giving up BF.
2. Support, support, support. Consistent, sympathetic, practical support from people with detailed knowledge.
3. Sort out the midwife staffing system so that somehow one gets to see and build up a relationship with one midwife. Not always possible, I know, but the current system doesn't seem designed to allow it at all (and it's even worse if you have the audacity to choose an out of area hospital).
4. Reality check, from mothers, families, HCPs and support charities (yes, NCT, I mean you). It can be VERY hard, you are not a failure if it's not the most natural thing in the world, you will feel like a wrung out dishcloth and it is acceptable to look like one. You do not have to be supermum. My experience was skewed by my own unrealistic expectations and the fact that no-one was honest enough with me to say just how hard it could be.
5. Check out countries with good BF rates, like Scandinavia and New Zealand, and work out how they do it.
6. Accept that the above might mean spending some money. The reduced strain on the NHS as babies start to show all the health benefits the NHS is so keen on telling us about should be a start in clawing some of it back. And maybe there isn't enough to have a personal doula for every new mother, but little changes can be made too.

And don't even get me started on the Meals Policy. 'Yes, dear, you CAN only have your meals in the TV room, because we do it that way so you can socialise with other mothers. No, you can't have it by your bed, your baby will be fine, it's a locked ward. So it will scream a bit, who will know?' This is a hosp with Baby Friendly status.

OK, they didn't actually say that last sentence but that is what they meant.

Women who have to stay in hospital longer for whatever reason are by default more physically and emotionally vulnerable. And more exposed to the kind of attrition of bureaucratic senselessness that eats away at BF confidence.

Total rethink needed on the wards, so they are run in the interests of mothers and babies, not staff neutralised to people's feelings by working there too long.

It's also important to recognise that any woman on a post natal ward, even with a straightforward labour and birth, is going to be physically and emotionally vulnerable for a start though.

There didn't seemed to be any communication between wards when I had DS.
The midwives seemed to think I was making a huge fuss when I couldn't seem to pick him up out of his cot to breastfeed due to no sleep after a 4 day labour.
Lo and behold, they ended up having to take him off me for a few hours in the second night and give him formula while I passed out

There must be some safe way of designing a cot with an open side onto the bed so that those who find it easier breastfeed lying on their side can do so - it was the only way I could get a any flow going.
Before anyone says it: I found there wasn't much chance of falling asleep on him while the ward was lit up like a bloody football pitch 24 hours a day!

Like gingertoo, the only person who was friendly to me was the cleaner.

If I ever have a second child in an NHS hospital, I'd be dressed and out of the door within an hour of labour even if DP had to wheel us.
Never again!

My HV put forward formula feeding top ups as the only option when I got stuck and as a first time mum I was too inexperienced and too tired to know any better than to trust her. I'll always regret that.
Next time around I also wouldn't bother with a HV as they can't seem to remember that these are MY breasts, which means that I dislike them being suddenly grabbed as much as they would theirs.

The staff who work in the post delivery ward NEED to be trained in bfing support. My personal experience at 2 different hospitals in Central London (St. Mary's and Queen Charlotte's) was that the staff were not only not able to help new mothers bf, but they actively discouraged it. When my son was born (almost 9 years ago) I had 40 hours of labor followed by and emergency cs. I was absolutely determined to bf. The staff (midwife/nurse?) on the ward kept telling me (and all the other new mothers) that we should get some sleep and give up our babies to them to bottle feed. I had to fight (hard when you are that exhausted) to keep them from taking my son (who had absolutely no problem latching on and feeding) from me. And one night I saw them secretly bottle feeding a baby whose mother had expressly requested that they didn't bottle feed. My daughter was born at Queen Charlotte's by VBAC on the natural birth floor, but because I had a post partum haemmorage, I was put on in a high risk ward on the regular birthing floor. Opposite me was a poor young girl who had just had her first baby and was desperately trying to bf her. She clearly didn't have a clue of how to do it and her husband kept asking a staff member (nurse?) to come and show them how. The staff kept telling them that she was too busy and that they should just give the baby a bottle. This went on for many hours. In the end, I finally gave them lessons as best I could by shouting instructions across the room (I was too weak from blood loss to get up).
Then, my hv kept telling me that the only way to get my son to sleep through the night was to stop bfing him and give him formula. In fact, when I told her that I had no intention of beginning solids before 6 months (per WHO recommendations which she had never heard of) she wrote down in my son's red book "Keen to wean" at 3 months.

Oh, one more thing. I think it would have been really useful to have the opportunity to see someone breastfeeding in real life up close during on of my pre-natal classes (the plastic demonstration doll was not very useful), or even better at the hospital after I had my baby. My cousin gave me some useful practical advice (like make sure the baby's mouth is not just on your nipple and covers the whole areola) which was extremely helpful and not at all covered in any of the classes I attended. Never mind the useless parade of midwives I saw during my first pregnancy (didn't see the same person twice during the entire 9 months plus 40 hours of labor). None of them ever mentioned bfing, its benefits or more importantly, how to do it. And when I got my first blocked duct, it was my cousin and the internet, not my hv who helped me.

I love that hospital cleaner, gingertoo. Whoever said that the difference that makes a difference (to all sorts of things) can be attitude and kindness just as much as specific policies and interventions is dead right, I think.

Practical information at the midwife / antenatal groups. All the DVD's etc seem to talk about is latch and breast is best. I think that there should be more info on other sides of BF so people don't think they're going in blindly. I exclusivley BF and have done so sucessfully probably due more to the support from mum's netters than my HV / Midwife.

I was full of questions being a first time mum-
what do I wear (total lack of info on underwear/ tops etc) so I would feel comfortable about doing it in public.
How do you know your baby is getting enough milk? (another Q answered on here)
When can you give up?

I could go on and on.
These would have been answered if a currantly BFeeding mum had been at antenatal group.

I also second the post birth care on the wards- I was lucky I had a relativley 'good' labour and had skin to skin for 2 hours after so never had any problems with latch- yet believed I did as it hurt for the first few times Yet as I was able to move around I ended up passing mums who had had a c section their babies and fetching them drinks in none visiting hours as there were no bloody midwives about- and I wanted to be busy

Also I think the media needs to get Bfeeding friendly- more on screen mums BFeeding (not just scary Channel 4 documentories)
A list of Bfeeding friendly establishments- labelled by bfeeders not the company themselves.

I agree with whoever said about the visiting policy. That would have really made a difference for me. The bf counsellor could not get to me in the visiting hours (3-7) as it was the time her own kids arrived back from school and had dinner...etc. If they had hours in the daytime or after 7pm it would have been so much better. I spoke to her on the phone but kept getting told off for using my phone! Dh wanted to just sleep on the hard chair next to my bed the next night because we were both so apprehensive and i told him how they took our DS away for several hours so that I could "sleep" while I just spent a great deal of time, trying to get out of bed and ring for a nurse who kept telling me to calm down and go back to sleep.
relaxing the visiting hours policy for postnatal ward would be a godsend.

I did a breastfeeding peer supporters course and it was wonderful - i met other mums that bf and im sure that encouraged all of us to continue for longer.

We were asked to volunteer to go to Hospital to help new mums but red tape got in the way - we couldnt take our own children - they were still v young and exclusively bf, we had to pay for parking, we had to have interviews, we had to get CRB checked, we could not give answers - we could only give support - none of us bothered

Normalise bf - ban adverts from ff Companies

My HV first time round was useless she didnt give me any advice just kept saying phone a breastfeeding supporter - but i didnt want to phone a complete stranger and discuss my nipples with them - i wanted my mw and hv to help - thats what they are paid to do.

My mw and hv 2nd time round were absolutely wonderful and my mw must have been responsible for doubling bf rates in our area but sadly she left because she just didnt have the time to devote to bf

Training for mws that formula is not the bloody cure all for everything.

DS1 was born in Hospital and had pethidine and was very drowsy - would not feed at all - they were insistent that i make him feed by giving him a bottle - never suggested expressing - just i must make him feed and they would give him a bottle if i couldnt do it

No idea if this has been raised but I would have liked some reminders/reassurance that breastfeeding is not just about the nutritional benefits of milk. So babies feed for comfort, well, that's great . You have an instant, (almost) infallible way to calm your tiny newborn baby day or night, so USE IT!

Feeding to a schedule completely misses the point IMO. They might be hungry only every 3 hours or so, but what about the connection, the comfort, the reassurance, the pause for thought? DEf not on a schedule.

"Compulsory 5 minute online mutliple choice exam for all HCPs who are likely to come into contact with a bfing woman.

Question 1) What is WHO's upper age limit to bf a baby? a) 6months, b) 1yr, c) none.

Question 2) What has more calories, BM or pureed carrot? a) bm, b) pureed carrot

Question 3) What should you do if you're not sure about the solution to a bfing problem? Tick all that apply a) recommend formula and weigh baby daily, b) go on more training c) refer to a bfc d) wing it and make something up.

Question 4) How do you teach a mum about good positioning? a) grab her breast with one had and the babies head with the other and shove the two together. b) give her a leaflet, c) explain in detail and stay with the mother until she has mastered it herself.

etc etc."

Genius Starlight!!!!

Yes, the whole emotional dimension is lacking atm. As others have said, few HCPs seem to understand how important bf is to mums, and no one 'in authority' talked to me about the emotional importance for the baby.

No!! Not two growth charts, ONE, the breastfeeding one. Make bf growth rates the aim, not formula ones, lets be honest about ff babies that are overweight, not make them "ok" by giving them their own growth chart!!!!

Having spoken to hv's in my area (mine is very good for bf btw) there is no follow up on why women stop bf'ing. If you can find out why women stop bf'ing maybe the barriers can be removed.

Also, we got funding for a bf councillor and they used the bloody money to make them a bf co-ordinator for a much larger area!!!!! That person is never going to make it out of the office, more people actually doing the do not filling in paper work would be great.

JustAThoughtTiggaxx