Support from hospital staff
Most, but not all, of the women we interviewed gave birth in some form of maternity or birthing unit. Emotions ran high in the neonatal period and they spoke powerfully of the impact of the support and care that they received from staff on the quality of their experience. Many mentioned the need to be able to trust the people who cared for them and to have confidence in their professional experience and knowledge. It often came down to the support of one specific person, usually a nurse or midwife, offering the right advice and encouragement at a crucial moment. Many women were offered support and advice in the middle of the night when their baby was a bit restless and found it very comforting.
When her baby wanted to feed constantly she received help with attaching her. She appreciated the...
Okay so that first feed obviously was a bit difficult because you weren't sure whether you were doing the right thing?
Yeah I just didn't know how to get started, I didn't know how to hold her or how to prop her up or, how to get her latched on, yeah so it was, it was difficult.
After that did you get better help?
Yeah I did there was a change in staff, over that actual night and she was then hungry, and they go through that phase of where they just feed constantly and I was just began ringing the buzzer and getting them to come and help and she would just, “She's come off again can you help me get her latched on” and they did they helped, and then it was fine. And then I went out to the small hospital and the way they did it was whenever you fed, no matter when it was, no matter what time, they wanted to come and check, and it was a smaller hospital so they had time. But they came and they brought you tea and toast and they propped your feet up and they made sure your baby was latched on so it was really nice, the experience every time you got up for a feed it wasn't, “Oh no, I've gotta get up and feed” and then they were really good, that was a really good experience.
They obviously made you feel good too?
Yeah, it was like a treat because you were getting a cup of tea, and you were getting looked after, and them encouraging, saying how well you were doing, because it is it was hard to begin with when they go through that long, long, long feed in the first few days, yeah it was good, it was fine.
There was a 'nurse', in a one-to-one session in the middle of the night, who taught her how to...
What sort of things did she do or tell you that helped?
Well one of the things that she was saying to me was that Michael was a lazy feeder, so he was, he was, you know, he would suck and then he'd have a bit of a pause and, you know, sort of like, and I think she was concerned that my feeds were going to turn into, you know, one hour plus sessions when really you're sort of looking at, well I've been led to leave sort of twenty to thirty minutes perhaps and so she was giving me tips for things like tickling his feet, or tickling, and blowing on his ear while he was feeding so this would just encourage him to actually keep, you know, sucking and making the right moves, so I think that was very helpful because I think otherwise I would've just left him to do at his pace and that could've made things into a very drawn out process and, and who knows it may not have made me want to carry on for as long as I have.
What about the positioning and attachment did she help you with that?
Not as much, she certainly looked at it, she felt that we had pretty good positioning and she looked again at the way that he was attached so she felt that, as I say it was more him than me that, that we had but she did look over that but she was more interested in the way that he was feeding when he actually got on there.
An invaluable piece of advice from a midwife allowed her to feel comfortable feeding all night....
Several women appreciated the opportunity to spend extra time in hospital to take advantage of the freedom from other responsibilities and the availability of expertise in order to feel confident about their breastfeeding before going home with the new baby.
The 'nurses' helped her breastfeed straight after a caesarean section and even though her baby...
Can you describe that feeling of a good latch?
I think for me it was the fact that she seemed able to, she seemed to have enough of the nipple in her mouth and she seemed to be able to suck so that she, if you like, didn't seem to be wasting any of her energy, she seemed to be sucking and getting milk, sucking and getting milk, sucking getting milk, and she seemed to quite comfortable, so it was almost like there was this sort of, like a seal, you know a kind of a seal on my nipple and, and as I say having sort of literally the nurse, you know, showed me that pull Lily's lip down for me, and having done that a few times it then became quite natural for the pair of us really, so.
A bit like learning to ride a bike?
Yes absolutely I mean kind of once we'd done it two or three times I thought 'that's it, that's what you do' and then Lily seemed to also understand what she had to do I mean, I was very lucky with Lily she seemed to instinctively know what to do, she didn't seem to have any problems latching on, the initial difficulty was really just about the fact that they needed to get food inside her, because she was little and her blood sugar was low, her body temperature was low as a consequence of the blood sugar, we just had to get some food inside her so we had to feed her, feed her formula feed for the first few days.
So did you need much help from day three onwards to, to get to that stage of exclusively feeding?
No, not really, no I didn't really need much help, because I think Lily having gotten over her initial problems just energy really, just seemed to know what to do, she just instinctively knew what to do, and, you know, I was in hospital and I guess I was, because I was in hospital I had nothing else to do I mean I wasn't at home, I wasn't being sort of distracted by anything else, so I was able just to sit and feed her and she really fed virtually all the time. I don't know that she was getting that much milk necessarily but we were just doing the kind of the, the breastfeeding and that kind of thing, so that by the time we came out of hospital I was quite confident that I could breastfeed her, and I guess having been in hospital for that amount of
It was not only maternity care staff members who were important. Those mothers who were themselves very ill or who had very ill babies spoke of the impact that staff on both adult and neonatal intensive care wards, who often had little breastfeeding knowledge, could have upon breastfeeding outcomes (see 'When extra care is needed for mother and/or baby').
In adult intensive care, no-one thought to express her milk. One nurse/midwife held her baby to...
How did that make you feel?
Frustrated. Because I, I think me natural instinct as a mother took over and I didn't particularly matter, it was her that I were concerned with, I wanted to be able to take, to take, to be the mother and I felt that everybody else was being the mother. My sister-in-law and my sister stayed at the hospital to look after me daughter through the night so that she weren't on her own because my husband was spending time with me and, even though they were doing that, and I'm eternally grateful, it was all things that I felt I should be doing, it was my time and it was really difficult because I didn't have the energy to do anything about it, so after I think five days, I insisted that they move me and, it weren't, it, you know, intensive care's not a nice place to be.
At any stage did anybody pump your breasts or anything, or were you lying there for three days'
'with nothing happening?
No, nobody, nobody expressed any milk, I wish that it would, obviously hindsight's a wonderful thing, if I could have known then I wish that I would have given my permission prior to that happening, but nobody, nobody'.
She and her baby required specialist care after birth and were separated. Her baby was cared for...
And she was put straight on my chest and she suckled in delivery I'd been very clear about that, when the initial diagnosis [of the baby's heart trouble] had been made I'd said, “What about breastfeeding and delivery?” it was almost my first question and they said, “Oh yeah no problem, no problem at all”, they needed to fit a drip to her within the first hour of delivery but plenty of time to feed at the breast, and the consultants were very keen that I should, very supportive and, yeah I'd made it quite clear to the midwives [laughs] and so, out and on, straight on and yes she suckled straightaway.
Another magic moment?
Absolutely, another magic moment, pure magic. Tainted a bit by the knowledge that she was soon to be taken away but still magic. So then she was taken away, checked over, brought back quickly.
She suckled okay?
Oh yeah, she suckled fine.
So she suckled okay at that first feed?
She suckled fine you wouldn't have known anything was wrong she looked quite normal, the SCBU nurses took her away, took her into SCBU where she was three times the size of any other child because she was born eight pound ten, and boy did she need, need every ounce of it, they fitted the drip and then because SCBU was full she moved up into the Cardiac Ward, the Paediatric Cardiology Ward. I on the other hand was waiting to be sewn up, because I had this huge third degree tear, and so picture this if you will I was laying on the bed, I was expressing on the one side by hand, the midwife was expressing on the other side [laughs] and trying to suck off the colostrum with a syringe [laughs] desperate to give my baby what she needed expressing colostrum is the hardest thing I have ever done, it's just so hard, it just doesn't come, it's not made to be expressed. And we got about one ml, no, one ounce out I think, over about an hour and a half, it was incredibly hard work but we chatted and we laughed and, the anaesthetic worked [laughs] but it was quite clear that I wasn't going to be able to express enough for her, she couldn't come back out of the Cardiology Ward and because I'd had an epidural they weren't prepared to release me from being checked over regularly by a midwife until all my bits and pieces were working properly, quite rightly. And so that's when I requested milk bank milk for her and initially I don't think SCBU were very keen, I think it's a very tightly controlled supply they don't have enough. And they relented and gave it to her and I was very grateful and I think the next couple of nights she had milk bank milk and during the day I would get wheeled over because part of the problem was I was in a different building, I was in the Maternity Ward because I was still recovering after, you know, a trauma, a very traumatic birth and she was in the Cardiology Ward, I long for the days when one can have a specialist mother and baby unit where we could both have been looked after in the same ward, I understand the difficulties with that but that would be lovely. So I'd get wheeled over in a wheelchair, and I'd feed her, except the first time I went over I couldn't do it, I physically couldn't hold her, I was too exhausted to hold her up. Thinking back on it now I should've said I need a bed, and I should've taken her into the dayroom, wires attached, and I'm sure they would've done it actually, and laid down to feed her, or insisted that someone came to held, hold her but, you know, they're busy and whatever, the problem is I was exhausted, I didn't think of it, and they're paediatric nurses not neo-natal nurses, so they're not trained in breastfeeding either. They were immensely supportive but
Many women talked about how busy the delivery suite was at the time that they gave birth and were very generous in the allowances they made for over-stretched and occasionally poorly informed staff members. However, for some, this was a less than satisfactory experience, particularly for those women who were reluctant to bother busy midwives to ask for help and for those who felt that they were being bullied or blackmailed into getting breastfeeding going properly or bottle feeding before they could go home. As a result of unsatisfactory care, negative staff attitudes and a general dislike of hospitals, several women discharged themselves early.
Her hospital stay was so horrendous that she discharged herself early. She did not get the...
No, nothing. I actually left the next day because it was horrendous, it was really horrendous. The way they, they treat the women in that hospital was disgusting.
What do you mean?
Well I had problems with a lot of leaking with my breasts and instead of showing me what I can do and how to help me they just left me to sleep in a soaking bed the whole night. So I left the next day, I was advised not to but I left because it was just horrendous. I'd rather go home and do it myself and learn myself than, you know. They just make you feel like you have to do it, they don't show you how to do it or explain anything to you, and because it was my first baby and I was nineteen it was even harder so, I just left.
Did you ask anybody for help?
I did ask and they all said they were busy and not to press the buzzer unless it was an emergency [laughs].
How did that make you feel?
I just [laughs] I just felt so angry, I was in so much agony and I was so tired I just wanted to go, I'd rather go home and like let my husband look after me than stay there, so I just left.
She had an unplanned pregnancy and it took her a while to accept her baby after the birth. She...
I'm afraid I wasn't really interested, I didn't take to her straight away, I did after all, it took me a while, I got up and I had a shower and everything and, you know, later on I did feel much better but first of all I really didn't wanna know my child [laughs] as awful as that sounds.
Why do you think that was?
I don't know. With, me and my boyfriend had a chat afterwards because he was really concerned about why I was being that way, but we had a chat afterwards and we did come to the decision that maybe it was because I didn't want the baby in the first place, it was an unexpected pregnancy, and, you know, I had so many hopes and things before I, I wanted to go to university, I had all my GCSEs, I've done NVQs and things like that ready to go and do my nursing, and then suddenly, you know, [laughs] I was pregnant and I've got this baby on the way and everything's on hold, you know, I've gotta put that off, I was, I was really quite upset about that but it was too late to terminate the pregnancy and I don't think I'd a done it anyway, to be honest, I think that was the main reason why I acted the way I acted.
So how long did it take you to come right?
I went, she went, she went off to see, all my family were outside, she came back to me, she went to sleep, it was, about five, six o'clock in the morning when she woke and it wasn't until she woke, then I'd been to sleep as well, it wasn't until she woke that I was like right, okay, no one's here to look after this baby so [laughs] I'm going to have to stop her crying [laughs], somehow, so I took her out and I sat in the chair with her and just stopped with her for a second and just looked and then I was a bit like okay, that's my baby [laughs] wow.
And what did you do with her?
I attempted to breastfeed her, yeah the midwives hadn't asked me if whether I wanted to breastfeed I was quite annoyed with that they didn't actually ask me how I was feeding her until the next day, it was, it the, the evening of that next day they came to me and said, “Oh how are you breastfeeding your babe?” I was like, “Well I've been breastfeeding her since five o'clock this morning so” but because I'd been to the workshops and things with Sure Start I was well away, I knew how to position her, I knew what I was doing, although I was upset, I was crying a lot because I couldn't get her latched on, but she on and off fed for about three hours I was there, just keep, kept putting up with it, you know, putting her on, she'd suckle for a bit and then she'd let go, have a scream, and just on and off like that, I was quite surprised they didn't hear her actually [laughs].
How long, how long after the birth was this?
This, well she was born at half eleven at night, once I'd gone from the delivery I'd gone up to the, my room so what's that six hours?
Five or six hours afterwards, about five o'clock in the morning she woke, from then, yeah, gave me a chance to have a good rest and whatnot.
So you struggled on your own?
Yeah I did, I did struggle [laughs], I did struggle a lot but my boyfriend came and.
Did you push the buzzer for help or anything like that?
No, I didn't, didn't feel that, you know, I'd, I'll be honest I didn't feel very comfortable there I didn't like being in hospital I had to stay in for the twenty-four hours because she ha
Conflicting advice from a variety of staff members and the lack of continuity in their care because of shift changes led to confusion for some women. There was also some criticism of early intervention in the feeding process, particularly the introduction of bottles of either expressed breastmilk or infant formula to deal with the baby's low blood sugars or jaundice, when breastfeeding alone may have managed the situation (see 'Dealing with difficult times').
Conflicting advice in a busy ward confused this woman and made her anxious until she received...
But it doesn't sound like you got the support you needed in those first four hours to feel confident about getting it established?
No, no I didn't as, you know, as I said before, that night I delivered my daughter, they were very busy which obviously I can understand and, you know, that the staff were coming and going into the room but, you know, nobody offered any help as I say had, I sort of asked and said, you know, 'I want to try and get my baby to latch on, you know, I'm not sure what I'm doing', and as I say the woman did help me for a short period of time but then dashed off somewhere again so yeah, so the initial sort of few hours didn't get, get the help, and I [sighs] trying to remember back when we did get up to the ward [sighs], I'm trying to remember how long after [sighs], we had, we had forms where they, they, you were meant to fill in when you changed your baby's nappy, when you were feeding, times in there, and I'd been told to feed every four hours, you know, the midwife sort of said to feed every four hour. So you're thinking, 'Oh okay right, you know, this is all new to me I'll just do, you know, these are experienced people I'll follow what they say'. Luckily enough now, obviously I've only been in one hospital having a baby so I don't know what other hospitals are like, the city I'm in has a breastfeeding clinic and a centre within the hospital, and later that day one of the ladies from that centre came, was coming through the ward to speak to somebody else and, I'd been, I was buzzing to get the attention of a midwife because due to my blood pressure I wasn't allowed out of bed so I couldn't pick up my baby, and obviously I'm getting anxious because nobody's coming so this woman could see that and actually came over and she was so nice, she was really, really helpful, helped me to, to latch on my daughter, you know, give me a few pointers of what to try and then said, you know, 'Come through to the clinic the next day to, you know, and we'll see how everything's going' because, you know, I was upset at the time, you know, it's, I'm trying to get somebody's attention, I can't get out, my baby's crying, I've been told to, to feed ever four hours which the woman from the breastfeeding clinic sort of looked and went, 'No you just feed on demand when, you know, if your baby wants fed, you know, feed before four hours, after four hours, it doesn't matter'. So, I mean, obviously she was probably more specialised in what she was doing so, you know, I felt a bit more confident with her obviously she couldn't be at my bedside all the time [laughs] so midwives were coming and going and my experience and since speaking to some of my other friends the midwives the staff in the hospital everyone will show you a different way to breastfeed, there's no, you know, set thing, there's older staff who, you know, some will just grab your breast and say, 'You know, shove it into your baby's mouth it'll work', you know, others say 'no do it, you know, do it a different way' and things so, there was no continuity.
How did you deal with that?
It got to the point where I was, you know, I was quite, you know, still quite anxious about this, my mum and my older sister came in to visit obviou
Early interventions in the hospital (infant formula, syringe, cup and bottle feeding) could have...
Well I stayed in the hospital for five days actually because I was so keen to try and get it going and the nurses there were very good actually and I think there was a breastfeeding support group, I think it was La Leche League I went to see a lady there, who tried again but no, no success and I had lots of midwives coming round, I think I must have spoken to about ten or twenty mid, different mid-midwives trying to get advice and some people were more encouraging than others and they were very, they did try but just couldn't get it to work, couldn't get her to feed. I think the paediatrician I feel a little bit angry that she was given like the formula so early on for a start even a little bit and then the bottle, you know, someone said, 'Oh it won't make any difference, if you try a bottle it won't make any difference'. But I don't know, because at first we were cup feeding her, and people said, 'Oh there's no point she was going to get upset with the cup, just give her a bottle'. But I don't know if that was part of it or not, you know, getting her used to something else that was just as nice and I don't know I find it hard to believe a baby would starve, like I find it hard to believe that if I was alone in the wild and I didn't have any other means of feeding her that she wouldn't had have somehow latched on, but that's just.
So it took ten weeks but it was a happy outcome in the end, you know, but [laughs] it's quite stressful along the way, I didn't know if she was ever going to feed, and I don't know why she didn't, and I don't know if the hospital had, you k
Her baby had not breastfed properly on discharge and it was only after readmission to hospital...
I think a, a midwife sort of had a quick look at the baby, you know, and said, 'Oh maybe do it a bit like this' or, but not, not a whole lot to be absolutely honest, plus I was on a high from having had the baby and, you know, I was medicated and, and so I probably wasn't, you know, it wasn't my main consideration at that point I was showing the baby off to my dad who'd come down to visit and that sort of thing, and I suppose it was only really kind of maybe that night when I started to really try hard to, to feed the baby, and I, you know, it doesn't, wasn't working very well and, I mean I, I know people sort of complain about having sore nipples and bleeding nipples and things like that but it, with me it was actually that the baby wouldn't even latch on at all, really. So there wasn't much pain it was just simply that she would just kind of go, 'ah ah ah' like this and, and not really attach to me at all. And I was in hospital for five days in the end and, and I was worried about the baby having low blood sugar 'cause there was some sort of issue about this because I, had possibly been diabetic in the pregnancy and, so they were worried that the baby's blood sugar might drop, and so they were then wanting her to feed, and I felt she wasn't feeding properly and I was getting quite distressed about this, and worrying about, you know, was the, was the baby going to, you know, collapse from dehydration or a lack of sugars or whatever. And I was I think, I was getting more and more het up really and then, eventually they were going to, they wanted to discharge me from the hospital and I wasn't really happy to go because I felt that the baby wasn't feeding and I wasn't really happy to go home knowing that I couldn't feed the baby and, and they kept saying, 'Well why don't you just take her a little bottle of formula', one of these little ones that the hospital had stocks of, and I, maybe, you know, I was being kind of over the top about it but, but I really didn't want her to, I think I'd read somewhere that there was a link between cow's milk and diabetes and there's a lot of diabetes in my family and I was worried about that so I didn't want her to have formula so I was determined to try and make this breastfeeding thing work. But it just wasn't, and she wasn't, and she was crying a lot and, and then she was sleeping for hours on end, I think probably because she wasn't getting enough milk, and I eventually I could feel my milk coming in but that was only because I had been expressing on a [sighs], big sort of, you know, metal breast pump thing from, that the hospital had given me and cup feeding her because it was the only way we could really get the milk into her, or, I don't know if we syringed it, no I think it was with a little cup, we sort of sat her on my lap and poured it into her mouth, 'cause she just wasn't feeding at all off the breast. And, and I actually remember saying to the paediatrician or, or, the day we were going to be discharged, I, we had a follow-up appointment on the Tuesday and this was the Saturday, and they said, 'Are you ' I said, 'it, if I don't, if the baby doesn't feed between now and Tuesday will she die?' and in retrospect I think that's very, really bad that I was leaving hospital thinking that my baby might die because she wouldn't have fed.
When I was about to go home I, I said to the paediatrician that I was worried that the baby wasn't feeding, well and, or at all in fact, I felt, and if by, and this was a Saturday, and if by Tuesday she still hadn't fed would she die? And they said, 'No, no, no she'll be fine, she won't die'. But I don't think I should've discharged feeling like that about my baby [laughs], and to my knowledge there was no breastfeeding counsellor or anybody with that kind of role in that hospital at that time, wh
Last updated November 2011.