Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

The consequences of passive breastfeeding support...

"Keep at it and things will click..."

This seems to be the new buzz phrase in my area at least.  It seems to come into play when a mum has a problem that the midwife/health visitor/peer supporter/even breastfeeding counsellor or infant feeding advisor (IFA) can't seem to help resolve; standard "positioning and attachment" support don't work (the key to solving all lactation problems apparently, besides the just wait approach)  and they're stuck at where to go. 

But even I've been taken aback recently by just how passive some of the care provided is - and what could often potentially be the consequence.

I've seen mums with scabs covering the entire tip of the nipples, coming out misshapen post feed.  Very very low weight gain or static (to the point of being of concern to me - but weirdly in this situation nobody seemed too concerned that at three weeks baby had remained static since the day 3 loss.) Babies never showing signs of sation after mums have been sternly instructed to only use one breast.  Who have all been told to "stick at it it will click".

For some mums, should they not contact alternative support - I often don't see how things will resolve.

One mum in particular lived a long way from me, I contacted (with mum's permission) her HP's myself to ask if they could please refer her to their IBC:LC Infant Feeding Advisor (IFA) - because the weight situation made this a clinical case that needed to run alongside specialised HP's (and I knew an IFA covered that area, but mum was getting nowhere asking her health visitor!).  The reply was that she had never done that before so wasn't sure.  It was only when I expressed concern at the weight situation, the health visitor sat and worked out the weights - right before panicking!

Place your bets on what comes next?

"OK it's time to give a formula top up", mum was told.  "You've tried this and stuck at it long enough now - but baby clearly needs "more"."

So it went from "stick at it", with no other effective help - to top up....And I see this over and over....Often before weight loss has got so significant, but not always; there is a massive gap in effective care at this crucial time.

I see growth charts not completed, because mums have (incorrectly) been told the charts are based on bottle fed babies and so there's no point.  I see weight recordings that alternate between metric and imperial measurements  - making a quick assessment of how things are progressing weight wise impossible.  I see mums that have spent four/five weeks plus dealing with conflicting advice, spending hours doing things that realistically are never actually going to improve anything!

For those who say mum can't have tried hard enough - let me tell you that I've seen mums who have seen no less than five, six or seven, health care professionals in total to specifically help with breastfeeding.  These ranged from a peer supporter to midwives (and "breastfeeding specialist midwives"), and health visitors.  Mums who are on the phone constantly asking for help - yet was persistently told things were "fine" or to "stick at it and they would improve" or the gem of the lot "this is what breastfeeding is like".

In reality what is often happening is that due to baby feeding so ineffectively at the breast, supply by now determined by baby's appetite - dwindles fast.  But at this crucial point nobody notices that...

In the end I located the IFA myself and fed the mum back into the system.

The trouble is if nobody finds the cause of the problem, but keeps treating the symptoms - no amount of "persistence" will improve things if there is an unresolved underlying fundamental issue.  Mums are left with a reduced breastmilk supply - because of all that had gone before!  We also know that more evidence now suggests those first few weeks of breastfeeding can be crucial in supply later ie 4-5 months.

The trouble comes when nobody finds this cause.  Some mums express with ease and can up supply and top up with this milk alongside breastfeeding; other mums really struggle to express and increase supply by expressing  - even with continued persistence, determination and very frequent expressing.  It can be soul destroying.  So if the root cause isn't found - where can this mum go but an alternative milk?

For some mums, even if they get past the initial pain, or weight issues - other problems may remain; a forever windy/unsettled/refluxy/colicky/never settling infant, often not resolved by swapping to alternative milk and a bottle.

I can see how women can believe they truly couldn't breastfeed - that they tried everything they could think of yet nothing worked; that they reached a point they simply couldn't take anymore trying.

Let's always remember that we don't know someones back story or what they endured trying to breastfeed.  That it's not always a case of just "trying harder" or "persisting longer"; in the above case persistence alone would never have resolved the issues - it's about effective help, emotional and mental support and accurate information - and most importantly it's about getting it at the right time.

18 comments:

  1. Charlotte, this article describes my experiences with my first baby exactly. No one seemed able to help and the problems just spiralled out of control wildly. I'm also someone who just doesn't seem able to pump. Even now I get little/nothing.
    And baby #1 was exactly as you described after he went onto formula - windy/unsettled/refluxy/colicky and add to that projectile vomiting after most feeds. We were in such a mess, he lost so much weight, became very lethargic and gaunt looking, I had utterly destroyed nipples, dreadful mastitis and eventually an abscess in my breast and yet essentially the only help I got was of no help at all. The it was - just give him a bottle. It's so frustrating that you have to really educate yourself and arm yourself with details of where to get proper help rather than it being obviously readily available to everyone.

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  2. Thanks for this Charlotte. Its sadly so common. Sometimes it is something that could be fixed SO simply with the right help at the beginning too. :(

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  3. This is an interesting post. I believe you are correct, but what is the answer? If a woman has troubles breastfeeding and contacts her midwife, LC, LLL, etc., and still has difficulties, what should we do?
    I find many new mothers have trouble relaxing. They go to a party TOO soon, or have their in-laws over to "help" and those are really the problems and no one wants to address them. Did mom spend 3 days naked in bed with her newborn at the breast? Or did they feel moved to clean or play hostess or care for older children? How about a 6 week babymoon?

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  4. Charlotte, I think you're right that the focus seems to be all on positioning and attachment to the exclusion of almost everything else. So my son't tongue tie was missed for 4 months because the latch was "textbook". Conversely my daughter's latch was a bit shallow, but it wasn't that sore and she regained her birth weight and more in the first week. Yet people did insist on fiddling and interfering which led to her refusing the breast and then expressing, formula, worsening cracked nipples, mastitis, the works.
    Check the latch" seems to be the new buzz phrase, but people seem to forget that this is not the only indicator of whether things are going well or not.
    Sylvina

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  5. This is an EXCELLENT breakdown of the stuff that makes me gnash my teeth on a regular basis. It hits a personal not for me, since in Lily's first two weeks she not only had insufficient gain or static weight, but actually LOST weight (this was after and beyond almost regaining her birth weight, I know the initial small drop was normal). And yet, several of the closest people to me insisted everything was fine, despite my growing panic. Look at those chubby cheeks. Look how peacefully she's sleeping. It's fine! And my favorite: Trust your body.*

    I am lucky we ever recovered from it, though it took 5 months in grand total to resolve all her issues. Thanks for writing this up so eloquently. Sharing!

    *A fine sentiment in most circumstances. NOT when the red flags are waving frantically in our faces.

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  6. Many Hands House, I think the answer is not an easy or quick one - I think we need FAR SUPERIOR training and education for lactation consultants, and we just plain need more, period (though only as stated, if the training is up to par). I hope that within a few generations, breastfeeding has grown back to its original status as the cultural as well as the biological norm, and peer support is all that is needed most of the time, but until then, we need as many excellent, brilliant, devoted LCs (primarily IBCLCs, though there may be exceptions) as we can possibly get out there. And they need to be accessible across all social strata.

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  7. Petra Hoehfurtner27 March 2011 at 03:07

    In my experience this problem is created because too many health professionals don't have enough breastfeeding training, which often leads to the attitude: If it looks fine, everything is allright. Add to that NHS/Council directives e.g. Tongue Ties don't cause breastfeeding problems, therefore don't need exploring and you get a cocktail which leaves mums alone in their wish to breastfeed.
    Underlying all off this is the basic attitude that breastfeeding can't work. If you have a baby e.g. with difficulties, a lot of things get explored, but rarely (or very late in the process) is questioned if the formula could cause the problem. if you have a breastfed baby with a problem, breastfeeding is automatically at fault - you either have to give up straight away or stick it out and then give up (at least you gave it a good try). It is heartbreaking to see how many women come to believe that they can't breastfeed or it is not working, because of them; when in fact it is our society/system who lets them down. (Petra LLL Breastfeeding counsellor and Lactation consultant)

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  8. for latching issues all i have to say is nipple shield! yes maybe its a clutch but w.e works for baby to get the best nutrition is a great option in my eyes! i recommend every mom to be to get one in advance so they dnt give up and give in to bottle feeding.

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  9. Dou-la-la, I disagree that IBCLCs are the answer. Especially since after this year those allowed to sit for the exam are going to be very different. The new qualifications focus more on getting med-pros certified. Actual ability to help mothers and babies succeed in a breastfeeding relationship is now secondary.

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  10. Passive support happened to me, with the result being I gave up at 14 days; fortunately, the pump worked for me and I became and exclusive pumper. Next time, I plan to line up ACTIVE breastfeeding help before baby is born.

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  11. this is similar to what happened with my first. Despite ongoing pain throughout each feed, everyone said his latch 'looked fine'. Everyone from LLL Leader to BFC struggled to find any reason - and his weightgain was fine (which is the only thing that kept me going. If I'd had concerns about his health i would have thrown the towel in). There was no trauma to my nipples either.

    The pain eased off slowly from 8 weeks but came back with number two. The best anyone could come up with was that I was oversensitive to the Milk Ejection Relex (IIRC?/)

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  12. Anon a LLL leader IS a BFC? Did you get the pain the same when hand expressing?

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  13. SO true. I was told my son had a "weak latch" and tutored to keep working on it, then told to pump to try to boost my supply-- but no one seemed to be able to explain why he might be having trouble. I realize now he had an upper lip tip, but I had to figure that out for myself and it was too late to prevent supplementing with formula. Very frustrating, and I wish so much I had had better help.

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  14. "A LLL leader IS a BFC? Did you get the pain the same when hand expressing? "

    Sorry, I saw a LLL leader *and* andother (NCT trained) BFC...

    I got some pain when expressing, but not as much.

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  15. I think any bfc would echo what you say, AA. Mothers often tell me 'xyz has seen me feed and they say the latch is perfect' - I had a mother with what I call a 'hot cross bun nipple' (split across both ways with bright red raw flesh showing) whose HVs and everyone else had told her this, and to 'just persevere'. The other thing that irritates me is when they say 'I wonder if it is thrush?'

    I hardly ever see thrush - in fact I can't remember the last time I felt a mother and/or baby had this, but it's some years ago now.

    Creative and sensitive suggestions on how to amend the whole positioning thing can be so effective (not always, I know, and of course some babies have oral problems like TT), and can improve soreness and address weight gain issues.

    I also hear about poor weighing practice just as you describe, and mothers who are told the rubbish about one side only, timing and scheduling feeds, and one just this morning, a mother who had been told not to let her 2 week old baby fall asleep at the breast (WTF?), and to wake him up (jiggling, tickling, and so on) . (this was not a low weight/sleepy baby situation) Mother in bits, convinced she was 'doing something wrong' (her words) and had already supplemented.

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  16. Heather - the mum with the hot cross bun - what was the issue (out of interest)?

    Thrush was mentioned - lots - to me, but wasn't the issue. As was vasoplasm, which I don't think was the whole story, but a contributory factor.
    (sorry - nak)

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  17. We certainly deal with similar issues here in Canada. IBCLCs are in short supply, mothers are told in hospital the latch looks fine, trained and experienced health professionals miss basic infant assessment things, like a muscle tone inappropriately high making comfortable latch impossible, or tongue tie, or toricollus. It's as if the baby's head is the only thing that matters in breastfeeding, and who cares what the body or inside of the mouth is like anyway? I find this very frustrating, as just this week I spotted a baby across the room at a breastfeeding support group who on closer inspection did indeed have a very high palate (and a lip tie, and a tongue that pointed when he tried to stick it out). No wonder he was falling off the breast. Lucky for him, mom has lots of milk right now. But that may not last.
    If I can spot this baby across the room, why can't a health professional see this close up and know what they are looking at? I'm an IBCLC, but I have largely worked as a volunteer. I don't do this eight hours a day, five days a week, seeing newborn after newborn nurse. It's very frustrating to see moms given the run around, and basically blamed for their problems, when they have gotten no help. People may have been very "helpful", but in actuality, it was worse than nothing. If you know you're getting nothing, you don't expect it to fix anything.

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  18. Man, I can so relate to this post and the comments. I was told all of this "rubbish about one side only, timing and scheduling feeds, and one just this morning, a mother who had been told not to let her 2 week old baby fall asleep at the breast (WTF?), and to wake him up (jiggling, tickling, and so on) . (this was not a low weight/sleepy baby situation)"

    Thankfully I found a la leche person who is also a doctor and she "saved" us by giving me affirmations and encouraging my intution. Sadly, I 'missed' the power of those first few weeks and really, really hope that my little boy and I don't experience the 4 month dip in supply.

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