The Early Days
How to incorporate good breastfeeding support into midwifery care.
The early days of breastfeeding are a sensitive time for the mother-baby-dad. Recovery from birth is still in full swing, mother as well as baby are still getting to know each other, the baby is settling into life outside the uterus while the mother is adjusting to her new role as the mother of this new little human. This is reflected in the great numbers of women who cease breastfeeding in the first few days and weeks after birth. Good breastfeeding support within the framework of postnatal midwifery care is crucial.
NICE (2013) recommends:
- Breastfeeding should be initiated as soon as possible after birth, ideally within the first hour
- Women should receive continuous skilled breastfeeding support at hospital and at home, from a healthcare professional, another mother or a trained peer supporter
- Mothers should be enabled to achieve comfortable positioning, an effective latch and to access help to prevent problems such as nipple trauma and inadequate milk transfer
The above sounds very reasonable, however due to budget cuts, midwife shortages and other political issues, postnatal provision with regards to breastfeeding support or indeed general midwifery in the NHS is whittled down to the bare minimum. Some areas have introduced postnatal clinic visits or breastfeeding assessment phone-calls by minimally trained breastfeeding peer supporters. None of these have been shown to be adequate in providing good supportive midwifery care, which is confirmed by increased admissions for dehydration, jaundice and other issues (RCM 2014)
Within the spectrum of these restraints it is very difficult to incorporate effective and continuous breastfeeding support, which is time consuming and often required during unsociable hours.
What women want;
- Preparation so that expectations are realistic.
- A gentle, supported start to breastfeeding.
- Just someone to sit with them and really hear what they are saying.
- Skilled assessments and help.
- Timely referrals in case of problems.
How midwives can provide this:
- Discuss breastfeeding in pregnancy. Be realistic without being negative.
- Signpost to breastfeeding education and support; many charitable support agencies provide great programs for expectant parents.
- Give out details for NHS (trust based IBCLC) and independent breastfeeding support provision in your area or nationally (such as La Leche League, NCT, Association of Breastfeeding Mothers, IBCLCs).
- Encourage physiological birth.
- Enable mother’s to have immediate skin to skin with their newborns and encourage unhurried breastfeeding initiation.
- Take as much time as you possibly can during postnatal visits. Don’t rush; observe, LISTEN, really hear what the mother is telling you.
- Focus on the whole picture, not just the clinical one. Breastfeeding can go swimmingly, but mother can still feel like she is drowning.
- Acknowledge the big changes in the mother’s life.
- Keep your skill level up to date so you can assess problems in an effective and timely manner and address problems appropriately.
- Be aware of conflicting advice.
- Don’t hesitate to refer to someone more skilled than you. There is no shame in being aware of one’s limitations.
- Utilise the peer supporter network in your area, breastfeeding support works on a social level as well as a clinical one.(Thomson et al 2015)
References McInnes R.J., Chambers J.A.(2008) Supporting Breastfeeding Mother’s: Qualitative synthesis Journal of Advanced Nursing, May 62(4):407-27 NICE (2008) Guidelines, Maternal and Child Nutrition (PH11). NICE (2013) Quality Standard 37. Postnatal Care. Thomson et al (2015) “Building social capital through breastfeeding peer support; insights from an evaluation of a voluntary breastfeeding peer support service in North west England” International Breastfeeding journal 10.15.