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.