Comments for health professionals
When asked what they would like to say to health professionals, the women we spoke to overwhelmingly said they would urge them to give support, encouragement and reassurance without creating pressure or guilt. They remembered, with fondness and gratitude, those who were able to do this but were critical of those who were not.
She remembered with warmth in her heart the professionals who were helpful but also wished that...
She thought that health professionals can be patronising and need to be clearer in their advice...
To be a bit more clearer about their advice. To not to be so patronising because they do talk down to you and make you feel like, like what they say is the law you have to do it, and I think to actually sit down with you and read through the, the pamphlets that they give you, and explain to you what everything means, because most mums can't read, that's another issue as well you know. And they give you all these things and you're like you're just looking at it, most of my friends can't read and they're just looking at it and I have to read it to them and explain to them what they're meant to do and how they should do things, there's not a lot of explanation you know, especially with the breast pumps as well, it's not as clear as it should be.
She did not find the professionals that she dealt with very helpful and is critical of the...
How long did you stay in hospital, do you remember?
Ten days, I had to stay ten days, 'cause of the issue of flipping, letting my daughter's dad see her. So, basically my specialist midwife said to me, “Mind your p's and q's” when, when she heard that [partner] was outside. And so I assumed that, that's alright I can go out as long as I minded my p's and q's, nobody told me any.
What does that mean?
Nobody told me anything about if you take your baby out to show him we'll probably get a care order, but you know what happened? When they found out that I'd gone out with the baby the midwife who'd just told me, “You can go and see him for a little while but mind your p's and q's”. Suddenly made a big show and came back and got my file open, wrote down that she'd advised me not to see him, she made a fuss about going on about the guy on the door saying, “Oh you shouldn't have let this happen, you can lose your job”. Big meeting, the Social Worker comes down, the Social Worker's really happy 'cause the Social Worker's been saying, “She should, I should get a care order all along”, and like I've been fighting all the way with groups of people persuading them, “No I'm [laughs] I'm going to be an alright mum, I'm going to yoga, blah-blah-blah,” and the Social Worker's really pissed off that I managed to keep the baby before the, you know, in the pre-birth protection meeting. So she was like really gleeful, you see the glint in her eye when, when suddenly, you know, she's got the evidence that she can get the care order. I'm sitting there like really miserable because I'm totally lost you know? And then when we went to London and went to the protection meeting I remember vividly being in this protection meeting I'm seething with this midwife for landing me in it and she's there, and she's trying to pretend it's all, that she didn't do that to me, she just sort of.
And how old is your baby at this stage?
She's about four months.
And fully breastfeeding?
Fully breastfeeding and I remember her letting rip, you know? And I was, I might have even breastfed her at that child protection conference, I don't know if I did or not I probably, I was probably too scared to. But I know when she let rip, I don't even know I might've breastfed after she let rip, I don't know, it wouldn't surprise me if that's what happened, or I just gave her a cuddle, I think I was too embarrassed to breastfeed in front, there was just so many people there, you know?
And what was the outcome of that meeting then?
I got her off the protection register, and like they were saying, “Oh like it's very unusual for a kid to get off the protection register after four months”.
Why do you think that was?
Why do I think? Well 'cause every time I had to do one of these big meetings I argued my case, you know, argued my case and, you know, you're talking about ten, sane, rational, professionals out there and all they're dealing with is this sort of like tilt of institutional prejudice one way or the other but they're fucking rational people. So I would just give them my case and, what could they do? You know, a policemen sitting there, he's not going to think I'm dangerous.
What would you like to say to the health professionals or Social Workers?
What would I like to s
Health practitioners should tell women that breastfeeding sometimes doesn’t happen, and to be more supportive of mothers who use infant formula.
And it wasn’t it was just I couldn’t physically do it. Then I would like them to be more open with persons like us. I know the target is to get as many people as they can to breastfeed but the hard thing, the ones that want to breastfeed and can’t. It’s hard, it’s hard to recover from that one. It’s - and you aren’t, you’re having these hormones all over the place [laughs] so it doesn't help like if you’re having somebody bashing you because you can’t breastfeed. It would be nice if there is that kind of support as well, and there is some support for moms who are, who happen to have to give the babies formula. And there is more information about formula. If you look at, if you look in the GP practices you will find everything about breastfeeding, the type of food you have to eat and all sorts of literature, DVDs, leaflets, photos, photocopies, everything. When you’re trying to find information about formula, nothing. And then it’s kind of like you feel ashamed of asking as well because it’s wrong. It seems to be wrong. And it’s not wrong like how many children have grown up on formula and they are happy, healthy, successful and - I don’t know why do they have to like, it’s like a myth, it’s like I don’t know. It’s terrible.
Maryam wants health practitioners to explain to young mothers where they can go for help and support. Not to just handout an information leaflet.
…So it would have been a good idea when they give the leaflet to explain to the parent maybe to tell them to read and show them the address when they need help, you know. So when, because when they give them just a leaflet they will just chuck it in the bin they don’t bother to read. Sometimes it is not because they don’t want to read it it’s because they don’t have time or they’ll forget. In this country I realise that a lot of parents they have problems with forgetting, I have as well I forget things easily, yes so it would have been a good idea when they give them then they explain to them like if they need help this is the place you go or this is the number that you can call.
Many women emphasised that it was important for health professionals to listen to what they were saying, to respect a woman's right to choose what is right for her and her baby and to support her in that decision. One woman said that “where things have gone wrong it is when people have heard what they wanted to hear, rather than what I was actually saying” and another said “nobody's listening to what I'm saying, I can't do this anymore, it's just too painful”. Many said that the health professional support they needed was not always about giving advice but often about spending time with them, having empathy and a sympathetic ear (see 'Getting support for breastfeeding').
She said that breastfeeding is not a technique, it is an experience and that professionals need...
I think you have to find one person you, you respect and you trust, and perhaps stick to one, one version of things, but I think what would be, so much more healthy for the professionals that deliver advice is that they could say, 'There are many ways to do this'. I've had so many times where this one person delivering the advice would tell me, 'This is the way you should do it, like this, like that, like this, you know, your position must be like that, baby must be like that, and that this is the way to do it, there is no other way'. It seems that, you know, each person has got their own ways and they want you to, to just stick to it, in fact there are many ways to do things and it would be healthier if they could just say, 'Well try this and for a period of time and if it doesn't work we'll do something else'.
I was very uncomfortable with one thing as well when I had advice, I went to a breastfeeding clinic and there was, I suppose when you, when I had the breastfeeding clinic you quite, you need help and I think breastfeeding can be very emotional, there is a lot of tension, if it doesn't go well it's, it's very difficult on the mother I think, and the thing I found very difficult is that I arrived at this breastfeeding clinic and you had all these women sitting in a circle and, you know, really trying their best to do the positioning and, what I found amazing is that nobody asked me how old my baby was or how I was feeling, you know? Before they started saying, 'This is wrong you have to do this', so it was very clinical in a way, there was no, I think breastfeeding is very emotional as well and this is a big part of it, you have to listen to the story of the women breastfeeding, so that you can understand, you know, perhaps their emotional state because it really will affect the way she is positioning her body and, you know, how she would relate to that baby. So if there is a problem, I don't know, is that, you know, one mother might think it's because of her and her technique, one mother might think it's her baby not doing it right and it's possibly a number of things but, you need to listen to the woman before you start giving this technical advice, it's not a technique it's an experience to me, and very much I found the advice I got was really, sort of heartless and a bit cold and very hard because you already feel like you are doing something wrong, and very much the advice I got just, you know, highlighting what I was doing wrong and, just being given a set of things to do, but it was actually quite disheartening in a way, because you had confirmation you were doing something wrong and I don't know, you know, you would wish somebody to sit with you for about half an hour and not be given a list or, you know a drawing or something, so perhaps there should be more, more time and more attention given to the history of the woman and her baby. I was really disappointed and I think they're doing a really great job and it needs to be there but they need more money and they need more time, because at the moment I don't think that the advice or the way it's given is possibly not, not great, could be improved upon, and it's very much the experience of my friends that have been there too, you arrive there in a very needy state and what you get is even more of a, 'Come on do, do this better', you know, it's, there is not much time given for the care of the woman. I think, and that was really disappointing, and I know they're doing their best and I know they have a lot of women coming to them and they'll need like, two or three of them running this clinic, and so they're, they're doing their best but there should be more, you know, funds and more time, more people. I think what I mean to say is that in giving advice to a woman b
One of the biggest areas of concern involved issues around knowledge about breastfeeding. Firstly, several women thought that health professionals had a different focus on breastfeeding from themselves (see 'Monitoring baby's growth') in that they:
- had practice guidelines to follow and they needed to ensure that they followed them to the letter in order to protect themselves from things going wrong at a later stage,
- were involved in the early days of breastfeeding and not so concerned about the longer term consequences of their actions,
- sometimes said that breastfeeding was best but perhaps did not really believe that or have confidence in it,
- either had no personal experience of breastfeeding (which sometimes made it difficult for them to understand how women felt) or, if they did, drew too much or inappropriately upon their own experiences in advising women without giving enough recognition to the fact that each person's experiences, emotions and needs were different,
- were far too heavily focused upon weight gain as a measure of their baby's growth and development and therefore were too quick to recommend infant formula and,
- were reluctant to acknowledge when they did not know and to refer them to the appropriate person who did.
She was annoyed about the early introduction of infant formula which impacted upon her...
Well I was just a little bit annoyed at the with my first one about the intervention I think it was a little bit too, I think they were a bit too quick to give them formula milk, or to offer a bottle in hospital and I was, when I was in that ward with another lady with my second son I saw she was having the same sort of problems as me, I overheard anyway and they were offering, you know, lots of pipettes and cups and stuff and I don't know I just, it's really hard to know who knows what's the best to do but I just do worry that they, the pediatricians think about the baby's health first but not the long term problems with the mother and feeding. And I mean giving formula on the first night I thought that was a bit crazy, I don't know, on the first day I don't know why they were topping her up with formula because I thought I had quite a lot, I don't think they had much they didn't get much colostrum anyway early on, and she was taking, you know, anything I was expressing lots of colostrum, you know, and I thought that would have been enough really. I mean that was, that wasn't very good really I was a bit annoyed about that. Other than that I think that the whole country just needs more, I think people are still very funny about people breastfeeding in public and, I don't know the country still needs a lot, a long way to go I think before it's really established and I'm talking about general middle class sort of people like, you know, most of my friends and they don't like feeding in public so uneducated people whose parents didn't breastfeed I mean I don't know what chance they've got of really feeding to be honest. They probably give up straightaway after they left hospital, which is quite sad, especially if they, you know, I think to keep going for six weeks through all the problems you really need a lot of support and if you haven't got the support there it's not going to happen I don't think, it's a problem. It's funny that something that's supposed to be so natural is so hard early on, I didn't realise it would ever be quite so hard, for me, I think some people will find it easy but I didn't.
She valued the advice and support from her family more than her health professionals, who may not...
I mean my experience with health professionals has, has generally been supportive around breastfeeding, I must say that I didn't turn to health professionals for support in my situation because I had more significant people in my life who I had relationships with, my sisters and my mum, my sisters mainly, who could provide instant support or words of encouragement or advice at any time of day or night, in a way that just isn't possible from somebody who you've only got a professional relationship with. So it wasn't that I didn't trust or value the professional's point of view it was just that I had people whose opinion I valued more. I found it very difficult to take advice from people on breastfeeding who've never breastfed, and I do think there's an issue with that. Because you can read however many books and leaflets you like and know the physiology of the breast and the developmental benefits and so on, but if you've never actually done it for weeks on end, I find it very difficult to understand how you can provide real support. And so on a couple of occasions with health visitors I had who had no children for instance, that their, their words fell on deaf ears really, they didn't bear any validity for me because I just didn't feel that the person could possibly have an idea what they were talking about. So to health professionals I would say that if you've got experience that can really be helpful to share, but if you haven't got experience of it then maybe it's best helping the person to find a more appropriate person to advise them really.
As a breastfeeding support worker, she was aware of unsupportive practices amongst health...
Secondly, many women mentioned receiving conflicting advice and lack of continuity in their care from their health professionals. Some thought that health professionals should “all sing from the same hymn sheet”. Others felt that consistency was important but also realised that there were many different ways to assist with breastfeeding situations and that no two mother and baby pairs were the same. Thus, flexibility and tailoring advice to individuals was essential. A few said that they were bombarded with too much advice and information. Several said that they thought it was important for them to find one person, who might or might not be a health professional, whom they respected and trusted and then to rely on their support and advice (see Interview 25 above).
She thinks that consistent advice and continuity of care would mean one less stressful burden for...
Consistent advice would be great, I know it's hard but if everyone was singing from the same hymn sheet it would make a world of difference to a lot of mothers, that's what I feel. Having my midwife on holiday during my first pregnancy, disadvantage that I didn't get one person to look after me for my first ten days, advantage I saw five different midwives I think in that period of time, who gave me different techniques of breastfeeding, but the disadvantage was that I never got the same information each time, very confusing, there should be something out there to say I don't know [laughs] some leaflet that as a pharmacist in their store could keep or would be given out in the Bounty packs consistency of advice that's so important because it is confusing as it is being a new mum. I mean breastfeeding is probably just one of the parts there's everything else to do. I remember when my first baby was born just looking at him and thinking, 'It's been about ten hours, I should change his nappy now, I haven't got a clue how to?' And just carried on looking at him and waited till the midwife came around and said, 'Could you give me a hand? What should I do? Should I get water? Should I use wipes?' I never even thought about those things before baby was born, it was just one thing you just thought you got on with and did but I was just terrified of doing my first nappy, so there are a hundred and one things going round, if the advice about breastfeeding was the same from everybody it'd make it'd be one less burden or one less stressful thing you wouldn't have to think about, that would be the best thing.
She advises health professionals to encourage women and women to find someone who they know and...
I suppose I would say to encourage women as best they can to try breastfeeding, to keep at breastfeeding, to try and help them resolve problems that are bound to come up for a lot of women, not to think that it's the best thing to do is to, to give up. I mean I do know lot of people say that their health visitors have said, 'Oh the baby's not gaining enough weight' and as a result they've given up breastfeeding and then afterwards they've regretted it, and wished that it hadn't come to that. And I'm sceptical that that's always the best solution, I don't think that, I think there's a lot of fuss about weight gain and in some cases it may be warranted but I think in a lot of cases it may not be and it's caused women a lot of anxiety and I suppose in the early days it would be good if there wasn't lots of conflicting advice, it would be good if you had someone that you knew and trusted that could help you and you didn't just sort of get one person coming in for two seconds and then another person telling you something completely different. I think there should be more Breastfeeding Clinics, if only there were.
She said that health professionals need to believe in breastfeeding, be better trained and be...
I think be a bit more supportive. I found that more with the health visitor and doctor really that they want, one minute they was like really for me breastfeeding and then the next minute, perhaps it was, but I felt they was against me a little bit because of her weight wasn't coming on and that, and they referred us to the consultant and stuff, that they need to decide whether they believe in it or not first before they voice their opinion rather than, just saying, 'Oh breastfeed', because generally it's what they should be saying to you, but if they don't believe in it then sometimes it can come through or if they've never done it themselves.
But I just think perhaps it was because of the weight they was concerned, with the weight rather than the actual breastfeeding, they wanted to make sure that she was fine which is, is fair enough because she is the most important one and they didn't want her health to suffer from it, which in the end we did have to give her some bottles. But not for very long, we did go back to fully breastfeeding again then once she'd put a few pounds on, she was a bit more stronger then and she wasn't feeding for as long either, so she's only taking a half hour to feed and she was feeding every three hours which was a lot better for me because I was a bit more energetic then, wasn't so worn out. And I just, I think there should be more training then with midwives with the breastfeeding which I think is starting to come in a bit more now, they are starting to do a lot more with it because they are, the government are trying to push for mothers to breastfeed. I think there should be a lot more nurses like the lactation specialists because she's just the only one for our County for like the whole of the County so, and she's just run off her feet sometimes and like she's only there for people that have problems. But I think there should be an opening somewhere for people to go, and, to speak to somebody like her even if they think their feeding's fine, just to still go and just to check that it is fine, just to have like a check to make sure that they are, baby is attached and they are feeding well, rather than just getting, getting longer down the line and the problems starting to build up and then going to see somebody and I think perhaps if we saw, if the mother was interested in breastfeeding like from birth then, perhaps if we saw somebody on a maternity ward like the day after baby was born or whatever, have like a lactation specialist just to give us some hints and show us some positioning's and that or just have somebody to come home with us [laughs].
Is that what you mean by being more supportive?
Yeah, just having somebody there on the ward because I did feel on the ward after I'd had the baby the midwife sort of left you to get on with it a little bit and they're so run off their feet as well that I didn't like to keep saying, 'Oh can you come and help me with this.' And 'Baby's not feeding very long' and that and, perhaps even if like auxiliaries or something took an opening in, into just learning like the different ways of positioning which I know that some hospitals are doing that now, in this area which is I think will be of benefit to mothers, breastfeeding mums in hospital, just to have that little bit of support at the very beginning rather than having the problems and, and then going about them then when their baby's like a month or two old when the baby's already, it's quite hard to get them out of the habit then, whereas if you catch it in the early days they're still learning so you can adapt it, adapt it to them then.
Thirdly, many women questioned the training about breastfeeding that their health professionals had received. There was almost universal praise for the knowledge of lactation consultants (health professionals with highly specific expertise in breastfeeding support) and lay breastfeeding counsellors (women with personal experience and in-depth knowledge of breastfeeding). Several women suggested that there should be lactation consultants on all postnatal wards and that all women should be seen by a lactation consultant in the early days in order to prevent, identify and assist with problems before they become too difficult. Some of the women we spoke to were trained professionals themselves (such as midwives, pharmacists, doctors and a nanny) and several were critical of their own training in breastfeeding saying that what they had received was very basic or even inappropriate.
As a pharmacist her training focused on infant formula but all knowledge went out of the window...
Did you learn anything about breastfeeding in your pharmacy training?
I learnt the basic as in it's best for baby, that's the advice that should be given. I remember learning more about formula milks as a pharmacist a whole training package, which milk when kind of thing but being a pharmacist went out of the window when I gave birth. It meant nothing, I don't think I trusted my instincts as being a pharmacist for the first for my first child I remember ringing colleague pharmacists one who's which is a best friend of mine just double confirming, 'I can give Calpol, can't I?' just wanting the reassurance what I was doing was okay second time round I have to say I am a lot more confident I know things are ok I'm not so hesitant about doing anything as much as I was first time round but being a pharmacist went out of the window [laughs] it didn't mean anything.
Her medical training did nothing to prepare her for the practicalities of how to breastfeed or...
Just muse with me for a little while about the training you had about lactation as an undergraduate.
I had remarkably little training about breastfeeding when I was, when I was training, in fact I, you know, I learnt all the physiological mechanisms of breastfeeding all the hormonal things that went on and so on but nothing about, you know, even why it was important actually in, we probably had like five minutes of a lecture saying, 'Oh yes it's important for mother-child bonding and it's, you know, good nutritional value', etcetera, etcetera, but that was probably about it, and certainly nothing about how to breastfeed or how to teach somebody to breastfeed, we were given to understand that it was all very straightforward.
So this training did not prepare you for your breastfeeding experiences?
No, not at all, I don't think it helped at all, in fact I think it was, it was negatively helpful in fact it, it made me think it was a lot easier than it was, and it just didn't prepare for it at all.
Many women talked about what they perceived to be a lack of resources for health professionals to enable them to do their job. They spoke of busy postnatal wards where staff members did not have the time to give the help and support that they requested. A few made a plea to save birthing units where they received more personalised and individual care. They spoke of under-funded breastfeeding clinics with lactation consultants run off their feet trying to assist the women who required their help.
Last reviewed November 2018.