I had an interesting discussion with a group of health professionals the other day. One of the midwives presented a piece of research she had completed for her Masters in Nursing. The qualitative (phenomenography) study looked at 'the experiences of postnatal women who choose to artifically feed'. The study was conducted in 2010 in a BFHI (Baby friendly hospital initiative) accredited hospital. This study has highlighted a couple of key issues and got me thinking:
1. There are posters around the hospital that say, "I look up to my mum because she breastfeeds". On one hand, this is literally what happens when you breastfeed your baby. The baby gazes up at his/her mum as they lay drinking at her breast - as can be seen in the poster. This is from the perspective of a breastfeeding mother and as I have seen that poster many times and have been a breastfeeding mother, that is exactly what I thought. On the other hand, from the perspective of a bottle feeding mother, does a poster like this make a women feel that if you bottle feed, you will be looked down upon, denoting feelings of 'I'm a bad mother' if I bottle feed'. This was some of the feedback provided in the study. It was argued that we can not be responsible for the guilt a mother feels for bottle feeding her baby, however as much as we are not responsible for the guilt, I feel we should also not be doing anything to foster these emotions either. We can not turn a blind eye to these 1 in 5 mothers that choose to bottle feed because we don't like or agree with their choice. As maternity health professionals, we are first and foremost patient advocates, providing 'women centred care'. Women centred care means focusing on the women's unique needs, expectations and aspirations rather than the needs of the institution or profession and recognises the women's right to self determination in terms of choice, control and continuity of care from a known caregiver etc. This is what we strive for above all else. Has our desire to improve the breastfeeding rates in Australia ( a major known health benefit for mother and baby) come at the cost of providing women centred care for mothers who choose to bottle feed. (It must be said that all mothers in the study were very happy with the care they received overall during their hospital stay but there were things that could be improved upon in relation to their choice to bottle feed their babies and the hospital is looking at ways to improve this.)
2. As part of BFHI accreditiation, the milk room in which formula is kept is locked to all mothers. It can only be accessed by staff. Mothers are given a demo on how to make up formula but when their babies need a bottle they must buzz a staff member and the staff member gets it for them, preventing the mothers from entering the formula room. The themes that emerged from the women included 'once I have made my decison to bottle feed, I want to be supported' and 'teach me - I want to be independant'. Not being able to make up their own bottles made women feel helpless and disempowered. Whilst I'm sure this was not the intention, how can a hospital support and empower bottle feeding mothers whilst still remaining BFHI accredited? Maybe the BFHI need to look at some of the requirements imposed on hospitals to receive and maintain accreditiation in the interest of women centred care and patient advocacy.
It is a double edged sword on which we sit as we try to improve the breastfeeding rates in Australia. We must educate our families about the benefits of breastfeeding, but I have to wonder if obtaining BFHI accreditation has in some unintentional way, sacrificed being 'women centred' for women choosing to bottle feed for the sake of it. What are your thoughts? I wonder what other hospitals are doing about this issue?
Hi Jillian,
ReplyDeleteThis is fantastic for the stimulation of dialogue! As a health professional, my first motivation has, is and always will be patient advocacy. Midwifery is unique in nursing care in that the interests of two individuals are if import. I believe that midwives have always had the interest of the mother and baby as a priority. Therefore, it behoves the professional to equally advocate for two individuals. Breastfeeding advocacy perfectly encapsulates the best care for the baby. So too, does it help with the mother/child bond. However, for a multiplicity of reasons, some women choose/need to bottle feed. I believe that the genuine, creative and innovative abilities of midwives and a genuine desire to advocate for mother AND baby will drive solutions that meet these needs. As an aside, I was able to breastfeed my five children but have close relatives who had varying degrees of success and support.
Good luck with the forum Jillian.
Thanks Glo, I also think midwives are very resourceful and I look forward to coming up with innovative ways to overcome this issue. Do you have any ideas or did Lisa? I would appreciate if you could forward this blog onto her as well as I am sure she would have some valuable input.
ReplyDeleteI would appreciate someone some BFHI giving their viewpoint in relation to these issues.
ReplyDeleteHi Jillian
ReplyDeleteGood to see you in blog land.
I think it is a symptom of a system that is set up to meet criteria, policies and 'tick charts' rather than women. I can't speak for those in hospitals who have to promote the agenda rather than follow the woman's lead. The homebirth women who choose to AF (not many but some do) control their environment ie. have their bottles etc accessible; don't have to look at posters; don't have disapproving looks from those around them and don't have midwives who have to push the agenda. I had one client state that this was one of the nicest things about homebirth - not having to explain her feeding choices to everyone.
Why do women feel they need to explain any choice they make. I have noticed some women even ask can I pick up my baby - like they need permission, which I find really sad. I suppose that question could open up a whole other subject.
ReplyDeleteYou mentioned 'controlling their environment' which brings us back to women centred care - right to self determination in terms of choice and control. A common theme for all women involved in maternity care.
Hi Jillian, my most fabulous midwife! Interesting....
ReplyDeleteJust adding comment as a mother and not a professional here, but after successfully breastfeeding my 3rd child for 12 months then really struggling with my 4th, I have to say left me feeling cheated.
Whilst the health service placed me in the Riverton Centre and did all they could to help me feed my child, they were quick to throw in the towel WITH me and put Billy on formula. I felt as though I had let everyone down at the centre, let alone myself and my child. Breastfeeding is a time to treasure and every mother should be encouraged to do so. I must say though that I persevered to the point of insanity and beat myself up terribly and I didnt feel "whole" for a long time.
Two weeks after throwing in the towel, the wonderful team at Royal Brisbane Birthing centre advised me to see an Osteopath. It came to light after the session of cranial osteopathy that Billy could not move his neck and would have contributed greatly to him not being able to turn his head to feed. If only I had known. :-(
Good Luck with the blog Jilly xx
Hi Jillian
ReplyDeleteI know that I have spoken to you about many of these issues in person over many years. As a paediatric nurse, I see the mothers and families after they have left hospital. Many of the families we see are formula fed, and the reason for this could be a myriad of things. It is unfortunate thought when many of our families talk about the feeling of failure and worthlessness that they feel, when they choose not to breastfeed or are unable to breastfeed. It is astounding the number of mothers that we have come back to the ward with babies who are failure to thrive or with parenting difficulties, who make the formula up incorrectly. With a large number of our mothers leading chaotic lives, coupled with illiteracy they are unable to read the back of the can and also unable to avail themselves of attending an appointment with a health care provider. This results in an ED presentation and subsequent admission of a baby. Could this be avoided?
I am a staunch advocate of breastfeeding and have just recently finished feeding my baby (up to 14 months). I was a well educated health professional who would give breast feeding advice to my familes, but when breastfeeding my own baby, I had immense difficulty. If it was not for the fact that I have a very close colleque and friend that is a midwife and made regular visits to my house to help me, I might not have succeded. Breastfeeding is HARD, and do we spend enough time letting women know that, and offering them continued support once our of the maternity environment.
I think all nurses and midwives should remember that a hospital is our workplace and we feel comfortable there. Hospital to our patients is not comfortable and the staff are in a position of power (even if you don't think so), we are the rulers in this kingdom (which is an unfortunate thing). I think a quick turn out of the drivers seat, and as the patient does every health care worker good. You are very vulnerable in that bed.
Thanks Jill I will continue to read your blog with interest, you raise some great points.
Claire Cox
Thanks Rachel, I think every women has a unique view on on how far they are prepared to go to breastfeed. Some will give up with sore nipples, other persevere through expressing, mastitis, cracked nipples and breast refusal. Some feel guilt at not acheiving their dream to breastfeed, others are relieved to have finally given up and return to having a drink or being unattached. Some just want to feed for 3 months, others 3 years. I think one of my major thoughts centres around choice - that it is each individual woman's choice that must be supported. It doesn't mean we need to agree or disagree, the choice is the mother's and the mother's only. Also your entry highlights that breastfeeding can be really difficult for what ever reason. I was speaking to a paediatric nurse the other day who said despite all her knowledge and support, she did not realise how hard breastfeeding was going to be and would definately have given up if not for the support and patience of a lactation consultant. Why does it come so easy for some and not for others? I read some amazing stories in the Australian Breastfeeding magazine 'Essence' of pure determination and drive to fufill what some women (like you) see as an absolutely amazing time to be treasured - I'm sure all these women would like their choice supported.
ReplyDeleteHi Jillian,
ReplyDeleteThe milk room is not only locked to Artificially feeding mothers it is also locked to breastfeeding mothers and Special care nursery mothers. I have always been weary of open milk rooms - the risk of tampering with milk tin, mixed up feds, EBM and not to mention the monitoring of inputs in babies being given artificial feeds - overfeeding can cause serious problems with the new born. The accreditation as a BFHI (baby friendly health initiative) hospital is not just an achievement for the hospital staff but also an outward sign that mothers and babies receiving care in our facility are receiving the best accredited care available in our health care districts.
I feel to be balanced the issues of "public health" initiatives and women's choice need to be separate.
Breastfeeding and the promotion of Breastfeeding has been recognised as providing benefits to our communities. Benefits through improvements in health outcomes.
While the choice is the mothers - all choices are not equal and there are risks to using formula - that can not be down played.
Breastfeeding is the biological norm, not breastfeeding and using a substitute exposes the mother and baby to significant risk. Life style choices that expose people to significant health risks need to be treated as such by all health professionals. Health professionals do not hesitate to point out the risks of smoking, high fat diet, no exercise or unprotected sex. Why is employing informed consent any different in the case of using Artificial breastmilk substitute. Hospitals and heath professionals don't debate the "feelings" of the smoker who is denied access to a cigarette or educated about the risks of their choice.
BFHI is about promoting a healthy life style choice as normal. The communities the women who access our facilities live in are predominately artificial feeding historically - It will take effort and commitment to affect and facilitate change. The women also see the Hospital and health professionals as "people to look up to". We can use this influence to address the artificial feeding culture in a small way (along with other projects)by promoting breastfeeding as the normal choice.
It is also worth remembering that being seen to promote or agree with Artificial feeding is against the MAIF agreement to which all health professionals are to abide by. This includes attending conferences sponsored by ABMS manufactures such as Wythe or Nestle.
The link below is about the importance of putting breastfeeding forward as the normal choice.
http://www.bobrow.net/kimberly/birth/BFLanguage.html
While this approach (to promote breastfeeding) may appear harsh and non inclusive at first. Health care is about making policies for the best possible health outcomes and protecting people through the provision of information so that they can make the best choice possible for them with ALL the information.
Yo
I agree that as health professionals we should be promoting the choices that have the best health outcomes ie. breastfeeding. It really interests me that we go all out to encourage women to feed naturally because of the fantastic health benefits and risks of AF. But, we do not do the same regarding birth. If we were promoting the safest births with the best outcomes (physical and emotional) our maternity care would look very different. If we explained the risks of syntocinon vs natural oxytocin; the impact of epidural on birth outcome, etc...
ReplyDeleteCan you imagine if like Denmark the public health care system refused to fund hospital births for low risk women because it is not cost effective and home birth is healthier. I am not advocating this. I think choice is important - it is just interesting which choices we get all fired up about and promote culturally.
Thanks Jillian for stimulating thinking and debate!
EXCELLENT POINT!
ReplyDeleteI agree, the falsehoods of empowered "choice" buzz word and advocacy regarding birth is a little hard to take (especially here in the land of Oz). Meaning there is a real sense of paternalism to the advocacy employed by some health care professionals and it is even reflected in a debate regarding feeding methods. Women are strong and intelligent, they can cope with the truth and as Health professionals we need to fight to provide them with true and real informed consent not informed coercion - as we see in our processes surrounding birth.
Setting up information sharing to our clients so that factual "birth as a normal physiological process" is the norm and compliance with interventionist practices in not fostered.
As with using ABMS the risks of stepping outside that normal process are outlined and understood fully. This is were antenatal learning sessions (not lectures or compliance sessions)would facilitate better decision making as we have found with breastfeeding classes in our facility.
Yo
Hi Jillian, Finally I found your blog! Thanks Yo! It is time consuming to join, but so worth it to read your thoughts. Thanks for your input, it is great to look at things from others perspective, certainly thought provoking. Look forward to more insights.
ReplyDeleteMelinda
Thankyou to everyone who has left comments. There is certainly alot to consider in this debate. Just to confirm the intention of this blog - it was to generate discussion about different women's viewpoint and whether or not we are women centred when it comes to women who bottle feed. I was hoping to identify new ways to maintain BFHI accreditation and also support women who choose to bottle feed their babies by giving them access to make up their own formula in a BFHI accredited hospital. I feel being able to access their own formula when their baby needs it (as opposed to having to ask staff for it) and practice making it up encourages independance and empowers women, and these points were echoed by women in the research mentioned in my initial blog.
ReplyDeleteThere is unequivocal evidence to support the benefits of breastfeeding and the promotion of breastfeeding as the best way to feed our babies, this is and never has been a point that needs debating. However despite all the evidence and information giving that occurs, women still choose to bottle feed their babies with artificial formula - whether through choice or circumstances beyond their control.
It is our responsibility as health professionals, to support their choice by providing them with the best information to do so in the safest manner? We could argue paternalistic view points, 'not every choice is equal' and public health initatives for ever, but at the end of the day every women has a right to decide what is best for her family, whether we agree with it or not. This is the basis of women centred care. It is found in our Australian Nursing & Midwifery Competency standards (The over arching framework of women centred care that recognises the woman’s right to self determination in terms
of choice, control, and continuity of care - ANMC 2006)& our Code of Ethics 2008 (Value statement 5 - Midwives value the
woman’s legal and moral right to self-determination. It is the basis of the midwifery profession.
IF we want women to be empowered and independant, surely giving them access to be able to make up their on formula can only benefit everyone. It could be argued that this has nothing to do with protecting breastfeeding and everything to do with supporting a women's choice that we personally don't agree with. Women make choices every day that we don't agree with, but our job is not to agree, it is to support and empower women to make their own choice, ensuring they have all the necessary information to do that. How we go about this greatly affects them (I will talk about this in another post) but at the heart of this must be women centred care - putting the women & her baby first.
As for new ideas to enable mothers to make up their on formula & maintain BFHI accreditation, I would like to put forward the following suggestion: that the laundry room with 2 sinks, power points, clean benches, separate from the SCN and in the middle of the postnatal ward, be converted to a milk making room that is locked and the number code given to bottle feeding women. Surely the importance of doing your washing (for women who mostly stay 48 hrs & could give it to a relative) pales in importance to ensuring women have adequate oportunity to learn how to safey make up their babies bottles and promotes independance which 'supports, respects and encourages a mothers' informed choice of infant feeding' - a BFHI statement.
I will endeavour to contact Bridget Roache the QLD BFHI contact for further guidance in this matter and look forward to any more comments you may have in this area.
I found 'Midwife thinking's' comments very timely, that it is intersting to see what choices we all get fired up about. Sometimes I think that fire and passion is displaced from the intended target. In the case of BFHI, the intended target is to encourage more women to breastfeed, by making breastfeeding the norm and supporting practices known to promote the health and well-being of all babies and their mothers. "A 'Baby Friendly' facility is one where a mothers' informed choice of infant feeding is supported, respected and encouraged". Note the words 'mothers informed choice of infant feeding' - again a women centred approach.
ReplyDeleteWe must do all we can to promote breastfeeding, but as stated by BFHI - the mothers' informed choice must be respected & supported.
I have looked at my own passion in this area and wondered why this topic captured my interest enough to blog about it. After all I am a mother who has breastfed my 4 children til they were 2 -3 years old and I am a midwife who always has and always will fully support and promote breastfeeding. Then why do I feel so strongly about this topic? On reflection, I think at the heart of me and why I am a midwife is that I first and foremost believe in empowering a women, in supporting a women to be the best mother she can be. I am not a breastfeeding midwife only or a natural birth midwife only, I am a women centred midwife and my belief in this philosophy was examined when I attended the research meeting where this paper was presented. It made me question our intention if we were prepared to limit a bottle feeding mothers opportunity to make up her own bottles for the sake of BFHI accreditation. I wanted to come up with a way to acheive both maintenance of BFHI and independance and support for bottle feeding mothers.
One point that was mentioned in the discussion was that as health professionals we must not be seen to be promoting or agreeing with artificial feeding as per the MAIF agreement. "The aim of the MAIF Agreement is to help ensure safe and adequate nutrition for infants:
ReplyDelete• through the protection and promotion of breastfeeding;
• by ensuring the proper use of breast milk substitutes when they are necessary* on the basis of adequate information; and
• through appropriate marketing and distribution.
*Note: The word ‘necessary’ is used here to include mothers who have made an informed choice to use breast milk substitutes".
Therefore as part of safe infant nutrition, the MAIF agreement includes mothers who have made an informed choice to use breast milk substitutes - this is after receiving all the pro breastfeeding information they get. Is it not then our responsibility to support them in their choice? This doesn't mean we promote artificial formula or agree with it, it just means we are respecting their choice and will provide them with appropriate information to do so safely - as per the MAIF agreement.
I think Rachel's comment regarding the issues we get really fired up about was an excellent point also.
ReplyDeleteWorking within the public hospital system we have the rhetoric of choice and empowerment pop up daily. But do we as midwives really support a womens choice and can a woman really make an empowered choice or give informed consent without all the information.
In Obstetric wards/Clinics womens choice to not have VEs and IOL or not attend ANC and have routine bloods, attempt a VBAC or breech are challenged repeatedly and not supported. IF a clinician makes the call that the women should comply with the advised or routine path because the risks as assessed by them are too great. The woman is completely disregarded and most time ridiculed for her thought processes and "Choices". Midwives participate in the systematic dis-empowerment and coercion of women as a matter of daily practice. Because they use their Obstetric knowledge to judge the choices women make pertaining to their own pregnancy/Labour/births and baby care.
I don't see the Laundry room as a valid option, firstly because there is still access to the room by more than one person (who are not bound by a code of conduct or professional standards) and secondly the laundry room is used frequently by the women who access the facility. The women are majority low socioeconomic demographic, many would not have access to washing machines of their own. They usually have very few changes of clothes and underpants. I feel that removing access to this would disadvantage the women.
Advocating for women who choose to Artificially feed is a non event. They are not discriminated against which is backed up by statistics collected at this very facility (Breastfeeding initiation is over 80% and by 3 months the decline is phenomenal - why because the pressure to bottle feed is so great), they are not forced to breastfeed. The formula is locked up and dispensed like any other substance with potential risks. If there are women who actively do wish to manage their own artificial feeds they need only buy premix formula and bring their own feeding paraphernalia(Which has happened taking responsibility for washing in hot water and air drying in their rooms as they would do at home). It is simply a matter risk management by Hospital administration in my opinion. The potential dangers of other patients is always a risk as I have stated earlier.
Paternalism is part of Obstetric and Hospital care and I doubt the influences will ever disappear. Unless women take their power back and refuse to comply with routine cattle call obstetric care and birth at home where their autonomy is protected.
Yo, I would like to ask you if you feel it is important for women who choose to artificially feed to have the opportunity to make up their own bottles in hospital and if not why?
ReplyDeleteI (and quite of number of the midwives at this particular facility) have personally invested much effort into the BFHI process and I believe adamantly that protecting breastfeeding is best served in a hospital setting by the implementation and strict adherence to the protocols set out by the BFHI body.
ReplyDeletePersonally I think that advocating for safe choices (social sanctioned choice) such as being champion for artificial feeders or women who choose elective sections is playing into the birthing machine and keeping women and shackled to only sanctioned choices. HT once got very animated about this very topic and indicated that paying lip service to womens choice in birth was leaving her feeling empty, when the facility only offer and allows certain choices.
If the "choices" of women are truly respected by the hospital system then a women wanting to have a birth plan,breech,VBAC or decline an IOL, VE's or a NT scan would not be the subject of hot housing and set up to be "worked on" at each clinic visit and even in Labour.
I truly believe that it is of more importance to focus efforts towards protecting womens right to bodily autonomy. This is were all midwives should be acting along side the women we work for to affect policy and safeguard womens right to true informed consent.
Women who have lost control seek to gain some back. This is most obvious as a clinical midwife, when a women who has been through the birthing machine (classified high risk because of BMI, Dr appt's all the way through, no continuity, endless scans to check on fetal wellbeing, GD and diabetics clinic, uniformed IOL, coerced epidural, coerced section, poor support for breastfeeding) finally says enough and goes for the formula. Choice champions declare - it's her choice, making her own bottles empowers her - where were the choice champions when she was suffering all the systematic dis-empowerment.
So No I don't think making up bottles is important or empowering.
Wow, I have read the comments on the blog and I thank you for your thoughts. To be honest, as I sit here after reading them all I feel sick. I absolutely agree with women's choice and would always seek to support it. I have breastfed 4 children and know it is the best option. However, there is a journalist statement that says.. I do not agree with what you are saying..but I would fight to my death to defend your right to say it. I think what is being said here is, women need to have informed choice and if we give them all of the information they will certainly see it our way and make the choice that we want them to make. Unfortunately this is not the case. Women will choose to bottle feed. As mentioned earlier the drop off rate from breastfeeding in the first few months is huge. By the figures given above, 80% of women breastfeed in hospital. That means that 20% don't. Are we throwing these women to the lions to protect the 80%?
ReplyDeleteIt was stated that there are huge risks involved with bottlefeeding. Absolutely correct. But what is happening is that these women's needs are not being met, for the good of the 80% the 20% and their babies are being put at risk. Are we really happy to sacrifice 20% of our population of new born babies (more when they go home) and force their mothers to find the information on how to bottlefeed correctly from sources that may be less than optimal?
I absolutely think that women need to be self sufficient, they need to be taught how to make up bottles and given every opportunity to be assessed on how they are managing, before they go home. To not do so is throwing them to the lions.
Thankyou Lisa,
ReplyDeleteI too think it is very important for women to be self sufficient and have every opportunity to make up their bottles in hospital before they go home. This is facilitating & supporting safe infant nutrition (as per BFHI guidelines)to women who have chosen to artificially feed their babies. I hope that this discussion has generated much thought and encouraged relection amongst maternity health care workers, in particularily midwives to examine their own practices and see if they truly practice in a women centred way - no matter what the mother's choice. I also hope we can come up with a new way to facilitate this supportive environment for bottle feeding mothers in a BFHI accredited facility.
A very vital part of BFHI is ensuring women who chose to af are given the correct education. Have a read of the booklets and you can easily see that if a facility is accredited than a part of that is to educate and empower women who af
ReplyDeleteI have never ever had a woman complain about me getting them a bottle, but have had complaints that midwives do not do so with grace and courtesy. Whilst I am now in a management position, i do have 20 years of experience as a midwife. I have had maternity leave, but the majority of my time has been working on the floor. I hope not to lose that, but it is a challenge to keep my clinical skills and balance that with an already full day. The women and families that we care for are challenged in many ways. I would fight tooth and nail to keep the laundry room, as I see it in use day after day. Our families have little support, finances and even clothing. This is why I supply my own washing powder for them.
ReplyDeleteHow do others feel about mother's having the opportunity to make up their own bottles?
ReplyDeleteDo you see it as important for women to have the chance to practice making up their own AF in hospital? I am very interested to hear people's view on this as I assumed this was a given.
I agree with Melinda, after reading the BFHI documents, it is very clear that as part of a BFHI accredited hospital, we must educate and empower women who AF. The women in the research were wanting to be independent and want to be able to make up their own formula, so how can we best educate and empower women to do this?
I know a northern regional hospital provides each AF mother with a steam steriliser and teat /bottle brush which they use during their stay to clean their own bottles / teats that they have to bring in. They wash their bottles in their room and then take them to the microwave to sterile them and make them up. This is done in an area that is part of the postnatal ward but out of the thoroughfare of the unit which has only a sink and a microwave on the bench. All AF & related equipment is kept in the mothers room's. The sterilising units are then sent to the sterilising department for decontamination between patients.
Does anyone else know of other ways to solve this issue as understandably, not all units have a spare room they can use for making up formula?
I agree that the laundry room should not be used as an alternative. I think it was only suggested as part of a brainstorming of possibilities.
ReplyDeleteI also agree that women are unlikely to complain about being given a bottle if it is done in a timely and respectful manner, particularly if they are already aware of the procedures of the unit. Just because they don't complain does not mean that they would not rather do it themselves.
I have read the BFHI guidelines and know that there is content that supports AF mothers in a BFHI accredited facility. However, having a policy and an intent does not always translate into practice. Every one of the mothers in this study identified that they did not receive adequate information regarding bottlefeeding. According to the literature this is a common problem that is particularly significant given the new WHO guidelines for making up bottles and Claires comments regarding hospital admissions.
How about using the same HOT (hands off) technique that is used to educate and support breastfeeding mothers. When a woman needs a bottle, she is taken to the milkroom by the midwife who stands with their hands behind their back (figuratively)while the mother makes up the bottle. This would provide an important opportunity for interaction/education/assessment and eliminate any issues of tampering. Yes, it would increase workloads, but how much time do we spend with bottlefeeding mothers in comparison to breastfeeding mothers? Are they not all equally important (the whole point of the debate), especially given the devastating risks associated with AF.
Something to consider?
I dont work on the ward much but I have had women apologise for asking me to get their formula for them...."sorry to bother you but if I could get it I could do it myself"! Surely this is completing the cycle of control instead of empowerment? I also work in the ANC where women ask about midwives still being there as the breastfeeding nazis! Surely there is a more appropriate answer to this debacle? For the record I have breasfed 5 kids up the 12 months and am a great advocate of breastfeeding! Sue
ReplyDeleteThanks Lisa and Sue for your comments. Great to see some new ideas coming forward about how best to tackle this issue. I like the HOT idea. Provides a wonderful opportunity for education as stated by Lisa. If we are able to take mother's into the milk room to show them the initial demonstration, then I would imagine we would be able to do this for all feeds. Great point offered by Lisa on the amount of time we spend with bottle feeding mothers
ReplyDeleteSue, I note with interest your reference to 'breastfeeding nazi's'. I would hope that if we are to truly improve the breatfeeding initiation and more importantly the maintenance rates, then 'breastfeeding nazi's' as women refer to them as, need to be a thing of the past / a very long distant memory.
ReplyDelete"I disapprove of what you say, but I will defend to the death your right to say it."
ReplyDeleteVoltaire,"The Friends of Voltaire", published 1906, by S. G. Tallentyre
I agree with every fiber of my being Lisa.
I apologise, because I have apparently failed to get my point across though. I am not stating here that bottle feeding mothers be ignored in favor of breastfeeding because they have not chosen the choice I would choose. They are (as Melinda stated) given information and instruction in preparation, they are supported with home maternity services.
What I am suggesting is that the "empowerment" of these particular mothers has been seized as a cause to be championed by midwives who do not choose to support the "empowerment" of mothers against the many and varied forms of Obstetric coercion/bullying. Refusing to act as advocates in less "safe" instances may jeopardise their good reputation as efficient Obstetric nurses.
Also
Lisa said "I think what is being said here is, women need to have informed choice and if we give them all of the information they will certainly see it our way and make the choice that we want them to make" - Doesn't this concept as you have so succinctly summarised underpin every health initiative.
I too apologise, Yo, because I am a bit passionate and over the top sometimes. I think that perhaps we are coming at the question from two different perspectives. I hear that what you are concentrating your discussion on is supporting women's choice in the whole of the birthing experience. Would it not be so much better if Australia could adopt a similar system to NZ with Home Births and midwifery led care. The major difference that I can see (correct me if I am wrong) is that NZ midwives have the support of the medical profession. Australian midwives are unlikely to have that support any time soon (as you mentioned earlier). I think that it needs to be noted that the Australian AMA had a very large part to play in the downfall of the Whitlam government. If they can bring down a government their strength and control is a real force to be reckoned with. Midwives have been campaigning and fighting for the cause for support for home birth and women's choice for some time and I believe it will take quite a bit longer before any in roads are made with the medical profession.
ReplyDeleteMy point of reference, where I am coming from is that midwives make the decision in the area of postnatal care and support for feeding choices. We debate with midwives regarding the best way to support women in their choices for feeding.
All that I am saying is that 100% of those women in this study stated that they did not get enough of the information or instruction on how to bottlefeed. The majority of them did not even step foot in the milk room for their entire hospital stay. I feel that that places them at risk. We have such a short time that they are in hospital to make a difference to the health of their baby.
I guess I was seeking to pick my battles and start with an area where midwives have control and can make a difference to how women are treated.
I guess that I just wanted to emphasise that I do not know of any midwife that would promote AF over BF. I think that I too have failed to make my point. Although there is a BFHI statement that says women who choose to AF will be supported and educated in their decision, women are saying they are not receiving the information they need. Giving people written information is not always effective if they are too busy to read it (if they can read at all).
ReplyDeleteThere is a little saying about teaching which goes something like this: Tell me and I forget, show me and I remember, let me do it and I learn. Women need the opportunity to practice while they are in hospital, where there is support for them, before they go home to do it on their own.
I can only speak for myself, but I think that just because you are seeking to support the decision of a woman to AF does not mean that you do not also seek to support her decisions in birth and to empower her in her choices.
The last time that I supported a woman in her birth was about 6 months ago on night shift. (I have worked in BS quite a lot, at a number of different hospitals, but because of other commitments have not been able to much lately) She was a multi 7 from NZ who had a very specific and well thought out birth plan, that included some choices that were not standard practice. I did my best to support her and empower her and she was able to achieve all but one of her choices. After one and a half hours she asked for syntocinon because the placenta was not yet delivered. The family left hospital 4 hours later after having to wake the paediatric reg and explain why the baby check could not wait till the morning. They felt that they had been listened to and supported and empowered in their choices.
There are midwives out there every day who are quietly going about trying to do the best they can to support and empower the women in their care under the circumstances that they are under.
The concept of giving people information for informed choice is interesting, I have always looked at it as... People are intelligent and have the right to choose what is best for them. Give them the information from both sides of the argument, let them make the choice that they want to make and then support them whenever and however possible in their choice, even if you don't agree with what they have chosen.
I guess it is just the way you look at it.
After reading all of the above, and taking note of Lisa's findings from this hospital I will endeavour to do the following:
ReplyDelete- continue to promote and protect BF by informing parents of the benefits of BF and risks of not BF (in ANC and whilst facilitating classes), and continuing to support/educate BF mums in postnatal ward by spending time with them whilst they feed.
- for women who choose to formula feed after all of the above I would like to take more time to take them into the "milk room" and show them how to make up their formula, pouring it all into each individual little bottle (so when they next need formula I am only getting the bottle THEY previously made up), and the next day when they need to make up some more (if they stay that long!)I will endeavour to take them in again and let them make it up again themselves. I kinda thought this was what was meant to happen anyway - they do make it up themselves, we only get each little bottle for them as they need it. I must admit though - this is time consuming and in the past I think we all have gotten a little slack - it is quicker "just to do it ourselves", I see now how this has contributed to Lisa's findings.
Thankyou Melissa, I am sure that little extra time spent with the AF feeding mother and the opportunity to make up her own bottles when required is helping to encourage independance & the opportunity to practice. Maybe this is the compromise to this situation?? My other hope is that this discussion has encouraged midwives to reflect on Lisa's research findings and find different ways to facilitate a small change in practice to improve the quality care for these women. How we implement this change and maintain it will be up to each individual unit & midwife.
ReplyDeleteThankyou to everyone who has contributed to this discussion - for your honesty, your ideas and for your willingness to share your thoughts.
As Lisa quoted - I may not agree with you but I would fight for your right to say it.
I think it is really important to put yourself into the shoes of the mother (& in this case, it was the shoes of an AF feeding mother)
As you are all aware I recently moved districts and have some observations to share from my new health district.
ReplyDeleteI am now living and working in an outback community. The birthing unit is a low risk only unit 40 - 60 births a year (in a small team of 2 FTE midwives and 2 part- time). They have had to address the choice to bottle feed in a very unique way due to the small number of births and sterilization issues. It is also worth mentioning that this area has a low breastfeeding initiation rate of only 60%. I thought it might be interesting to this discussion to share.
The midwives at this hospital provide education sessions and practical instruction in the antenatal period. The mother who identifies she wishes to bottle feed is taught antenatally in her home how to mix feeds, store feeds and wash equipment. She is then required to arrange for the feeds to be brought from home. There is refrigeration available only in a single birthing/family room.
There is no sterilizing available for this purpose and no formula is kept due to wastage issues.
Yo, it is always interesting to hear how different units adapt to different situations. Can I ask, are the feeds for 24 hrs bought in at a time and stored in the one fridge = how exactly does it work?
ReplyDeleteThe woman brings her own prepared boiled water, bottles, teats, caps and formula stored separately. When she wants to feed the baby she mixes it up as if she was out. Her family (husband, Sister, Aunty or Mum) take the rinsed out dirty bottles home, wash them and prepare them as per her chosen method of decontamination and return them with the measured out formula (usually in one of those stack up plastic dispenser things). That is if she is staying longer than the 6 hours or night. The midwives have about 85% one to one continuity of care (ante/birthing and post) so there is a sense of expectation built up over the 9 months with regards to self reliance as there is not a midwife rostered on every shift.
ReplyDeleteOh sorry, the fridge is just the fridge in the family suite which stores other things she may bring in to the hospital.
ReplyDelete