I am mad as hell

I spend a big chunk of my life talking to new families and supporting them. I offer breastfeeding support at 3 children centres in North London. I meet a lot of people in the first few days after they’ve just given birth and often see them through the following weeks or months.

I have taken approximately 700 helpline calls in the last 4 years and the majority of those were from parents in the first month post-partum.

It’s an honour to be in a position where I can feel I am making a real difference to people’s lives.

But sometimes I feel like climbing to the top of the BT tower and screaming from the top of my lungs, “I’m mad as hell and I just can’t take it anymore.” (as Peter Finch did in his Oscar-winning performance in the film ‘Network’, though he was less concerned about boobs).

Something has gone fundamentally and criminally wrong in the way breastfeeding is supported in this country.

It’s gone so wrong, it’s jaw-dropping. Some of it is surreal. Some of it is literally incredible.

Typical story:

Mother gives birth in a hospital. She might come across a midwife who is able to offer her some initial breastfeeding support. She may come across 5 who all tell her something slightly different, using slightly different phrasing. Oh – and one grabbed her breast and shoved it towards the baby.

Mother leaves hospital and she is sore. Something is going not quite right with breastfeeding. She perseveres and her midwife visits in the next couple of days. However she is never given even a rough idea of when the visit might occur – just a day – so she can’t plan her baby’s feedings to correspond with a visit and when she gets lucky the midwife can attend only briefly. She says something else that contradicts entirely something the new mother was told in hospital.

The mother is getting sorer.

She calls a helpline. Maybe the National Breastfeeding Helpline. The breastfeeding counsellors there are well-trained and they can help.

But let’s pause for a moment – this new mother has spent many hours in a hospital under professional care. She’s under the care of a midwife. And her best shot now rests in the hands of a volunteer who trained with a charity – a charity which counts the pennies and struggles to meet their goals as government grants disappear. This volunteer has one child watching Peppa Pig in the room next door, another asking for crackers and dinner on the hob.

Can this mother get a home visit from a trained breastfeeding counsellor? That is utterly dependent on whether she happens to live near a volunteer who has a home life which can support that possibility and the money for transportation. A counsellor may come and visit but no one will be paying her expenses. Often a counsellor might not be available and will do the best she can over the telephone.

A midwife might come again. She might even say, “the baby’s latch looks OK” and when the mum seems doubtful she will refer the mum to some local support groups.

These local groups will again often be run by volunteers and may be in children’s centres where funding has been slashed and there are now closed for certain days of the week or for several additional weeks each year.

Maybe the mum has had a c-section and can’t travel.  The breastfeeding counsellors on the telephone have tried but they suggest a face-to-face consultation with a trained expert is really needed to find out what is going on.

The mum pays £60-75 for a consultation with a lactation consultant she finds through the Lactation Consultants of Great Britain website (lcgb.org).

The IBCLC immediately identifies the baby has a tongue-tie and needs a small procedure at the local hospital. The tongue is released the next week and the baby goes onto to breastfeed successfully for many months.

That story is not freakish or strange. It’s pretty standard.

The baby’s tongue tie was supposedly ‘checked’ by the paediatrician in the hospital. It wasn’t picked up by the midwife. The telephone support wasn’t able to pick it up. Luckily that mother had the money to pay to see an IBCLC or breastfeeding probably would have ended within a few more days.

Or maybe the baby didn’t have tongue-tie. Perhaps the IBCLC just gave some support with latching and positioning that for some reason the midwife was unable to give.

I write out that story and I see faces of mothers and babies flash in front of my eyes. The mother with the 6 week old who had been struggling to breastfeed with damaged nipples and had finally made it to a breastfeeding group and we could see the baby was significantly tongue-tied within a minute. The father who tried to describe the range of advice they had received in 24 hours: feed from each breast for 10 minutes, for 30 minutes, just stay on one breast, stay on one breast until the baby loses interest and then offer the other. The mothers who are confused and distressed at the most emotional time in their lives.

This system is FAILING.

I sound like I’m blaming midwives. I’m blaming the system that governs them. I don’t believe for one second a midwife would CHOOSE to only get to spend 20 minutes with a desperate new family and then thrust some information about groups and dash out of the door. Hospital midwives might be supporting 10 women on a post-natal ward overnight.  Several of them might have had c-sections and not even be able to lift their own baby. Hospitals might employ a lactation consultant who probably only works office hours. You might even bump into some volunteers who offer breastfeeding support on the ward. But a common tale is a mother desperate to get out of there. Or maybe the dad is phoning a helpline from the pavement outside the hospital (there’s been a good selection of those in my 700 calls).

I spoke to one midwife (who went on to train as an IBCLC and become a specialist feeding midwife) and  she recalled  hiding in the nurse’s station because she knew a mother needed breastfeeding support and she just didn’t feel up to the job.

And why is there even such a thing as a midwife who specialises in breastfeeding? Surely that demonstrates the flaws in our system eloquently. Why aren’t ALL midwives specialists in breastfeeding? If they are not, can we please get some people who ARE into new families' homes in the first couple of weeks?

Can I blame the system that governs health visitors too? The system that results in some golden health visitors who know exactly what they are doing. And others who see a baby struggling to gain weight and literally have nothing else to say other than ‘top up with formula’. They know nothing about how a mother might improve the efficiency of latching and positioning or use breast compressions with a sleepy baby or how a mother might develop her own milk supply or use expressed milk as a top-up.

This whole system is based on luck and fluke and more often a lack of lucky fluke.

And thousands of mothers and babies are being failed every single day.

The last full national infant feeding survey to be published recorded that 90% of mothers who gave up breastfeeding in the first 2 weeks wanted to continue.

That’s such a massive group of women being failed in hospitals and by a lack of community support up and down the country. They are starting new motherhood with a struggle and sadness and that can never be recovered from entirely.

And these mothers can be so angry. And of course they should be. They’ve been fed a lie that we are a breastfeeding-friendly NHS and a breastfeeding -supportive system. Wouldn’t you assume your midwife had a clue about breastfeeding beyond the basics? You might even assume they had equal training in breastfeeding to a breastfeeding counsellor – whereas a midwife might have had a TENTH of the training that volunteer handing out crackers has received. Wouldn’t you assume a paediatric consultant knew how to identify a tongue-tie in an infant? And would be looking for one?

We live in a country which mumbles the phrase ‘BREAST IS BEST’ (Oh, how I hate that phrase because breast isn’t ‘best’, it’s just normal). We have the posters and the snazzy pens and the helplines but it’s a system built out of balsa wood. Held together by PVA glue mixed with water.

The support IS NOT THERE.

What should happen?

Let’s start by aiming for UNICEF baby-friendly status across the country and get people properly trained. Let’s look at the quality of night staff and agency staff in hospitals in particular.

But before we even get there, let’s give everyone who deals with mothers and young babies ONE sheet of paper that describes a handful of basic facts:  the importance of mother and baby skin-to-skin, what a good latch and body position looks like, how a young baby might feed on one breast for 10-45 minutes and may or may not want the other side, how to tell if a baby is swallowing, what nappies look like in the first week, how cluster feeding and growth spurts work.

Put that on one side of A4. Give everyone an hour to look at some online videos of good latching and a bit of breast compressions. How much would that cost?

Give health visitors another sheet about latching and positioning, techniques to increase milk supply and ways to optimise breastfeeding management. Of course, some know this and a great deal more. But let's give out these sheets and start conversations where the golden ones have open dialogue with the health visitors that need the basic information desperately.

I think those 2 sheets of A4 could do a lot. And they already exist in various forms but who has the inclination and money to distribute them. Would all midwives and health visitors read them?

Because there are midwives who believe their ’10 minutes one side, 10 minutes the other side’ is right and their overconfidence is hurting new families all over the country.

There are GPs advising mothers to stop breastfeeding because they have mastitis or misunderstanding the symptoms of nipple thrush and their overconfidence is hurting new families all over the country.

Distribute those A4 sheets and give those hours to watch videos and of course it saves money in the long-term.  Some babies aren’t readmitted with dehydration or with gastroenteritis in their first year. Some employees have less absence when their 7 month old baby is still breastfeeding and has a reduced likelihood of ear infection or respiratory infection.  And a reduction in likelihood of illnesses and conditions carries on into adulthood. A baby girl breastfed is less likely to develop breast cancer herself.  How much training do you think can be paid for out of the bill it would cost to treat one woman with breast cancer?

Train health professionals in breastfeeding to an adequate level and we save money over decades.

But it’s not happening and those of us passionate about breastfeeding are picking up the pieces. And the health professionals in the system can only be stretched and miserable too.

I’m mad as hell and it appears I just have to take it. Because this is the ‘big society’ where money leeches out of the NHS and the people handing out crackers give the frontline breastfeeding support.

What will change it? If every mother and father who had received poor information in hospital or in the community subsequently wrote a letter to say so – the system would start to notice. If hundreds and thousands of letters came pouring in, that cannot be ignored.

So the next time you meet a mother who tells you about an experience that falls short of what they deserve, urge them to write that letter. It’s a small start.

There are a million other things we could do but we can at least start there. Let’s at least start telling people we’re mad.