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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