Heather - I'm with you!
The Medscape article resonated so much with me
(which is why I shared it with ~3000 of my
closest friends...) precisely because its outcome
so much reflected my own experience of working
with newly delivered mothers and babies in
maternity units in Zimbabwe. The national policy
was to aggressively protect, promote and support
breastfeeding. Healthworkers were not given the
choice about whether they agreed or not with the
policy, and woe betide them if they paid
lip-service to anything other than
breastfeeding. Consequently, bottles and
dummies/pacifiers were not permitted, even if
moms brought them in themselves, and healthy
full-term babies were never given
formula. Instead, their mothers were helped to
breastfeed. An LC (me!) was called in for
mothers who seemed not to buy in to the policy,
to provide extra assistance with latching and
give one to one info from an "independent" source.
My observation is that the system worked because
there was a clear chain of responsibility. The
policy was set by the Ministry, who informed
hospitals that breastfeeding was to be promoted
and supported. Matrons, tutors and doctors
simply carried out orders and could then "blame"
the higher powers if junior nursing staff didn't
agree with it. Nursing staff who wanted to keep
their jobs complied. Reluctant mothers were
cajoled and persuaded to breastfeed at least
while in the hospital (3 days for vaginal
deliveries, 4 or 5 for C/secs) but the nurses
could _appear_ to be sympathetic by appearing to
"blame" the matrons, senior sisters or paeds and
OBs for the seemingly inflexible requirement to
breastfeed - as could I! We could all explain
that this hospital supported breastfeeding
because bottle-feeding was not so safe - and they
wanted to have the healthiest babies possible, didn't they?
The whole thing worked brilliantly. In practice,
nursing staff absolutely needed to know how to
help mothers breastfeed, because there was no
alternative, and of course the babies couldn't be
allowed to just starve. Once staff had the
skills, there seemed to be whole-hearted
underlying support for what was happening.
Problems were identified and addressed very
quickly, not least because mothers and babies
could not be discharged home until babies could
latch and seem satisfied at the breast. And to
make sure, babies were weighed on Day 3 and kept
in, and given intensive help to breastfeed, if
loss exceeded 10%. In 1991, one of the
paediatricians half jokingly confided to me that
he _knew_ that some mothers had bottles waiting
in the car for the drive home, and some of them
would indeed abandon breastfeeding at 3
days. But many more fell in love with it during
those first three days and kept going. By 2003
it was unusual for me to hear about a mother who
didn't breastfeed at least for the first six
weeks. Finally, I had quite a few English and
French clients confess to me months later that
they were so glad their babies had been born in
Zimbabwe because had they been "at home" they never would have breastfed.
It's so sad when we promote infant feeding choice
as if it is _not_ a serious health
matter. Having had the experience of seeing how
well a firm commitment to breastfeeding can work
in practice, when everyone is speaking from the
same page, even if it's because they have to, I
simply can't understand how we pander to the
apparent politically correct notion of supporting
a mother's choice not to breastfeed. Especially
when we, of all people, _know_ that the health
consequences are so important. But to make it
work properly, someone right at the top has to be
brave enough to set the policy that we can all
"support". Otherwise we're just portrayed as a bunch of fanatics. Sigh!
Pamela Morrison, IBCLC
Rustington, England
-------------------------------
>SAN FRANCISCO The right interventions can
>improve breast-feeding rates at hospitals, even
>when motivation and knowledge are lagging, a new
>study shows. The results >were presented here at
>the American Public Health Association 140th
>Annual Meeting.
Very interesting....and it should speak to the
leaders and managers within institutions and
agencies who tear their hair and roll their eyes
and despair that 'attitudes' need to change among
healthworkers before we can expect breastfeeding
rates to change.
I think attitude change is fab, of course, but
while we are waiting, how about just *doing* the
stuff we know enables and empowers women to have
the confidence and the skills to breastfeed
happily? You know - doing the stuff because it's
policy and because you are not doing your job if
you don't, and if you don't do your job, you will
be accountable as to *why* you are not doing your
job?
So (for example) if a bf baby gets formula while
in the care of the agency, this is recorded, and
the reasons recorded (and not just 'mother's
choce') , with it also being recorded which
healthworkers were involved in her care at the
time, and whether they undertook to have a
coversation with the mother to enable her to be
aware of the impact of formula on health and on
her choice to bf.
This *is* done in some units that I know of, and
actually, attitude change seems to follow!
Heather Welford Neil
NCT bfc,tutor,UK
--
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