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Can a system designed around support for the masses offer truly individualised care?


To pick apart this question we have to start with one fundamental characteristic of any large system. Guidelines.


When you develop a system to support thousands of women and their babies annually, you need to be able to put some guidelines into place so that the people caring for the users know how to respond when various aspects of their care stray from a predetermined concept of normal. Normal...there’s that word. What exactly is normal?

In all the years I’ve been supporting women, I’ve been listening to birth stories, I’ve been listening to feeding stories and I can honestly say, not a single experience was like another. These stories may have had similarities, but the factors within their stories varied so much that the possible avenues of care were endless. It’s actually why I like doing what I do, because every family I visit with, and talk to, will push me to think of all the different factors and pathways to explore for their particular scenario. Let’s look at just a few of the guidelines around what we perceive as normal and what determines the systematic care pathways for our birth and breastfeeding journeys.

  • a cervix dilates half a cm in an hour, taking longer could be determined as failure to progress

  • if your waters go and labour doesn’t commence within 24/48 hours (depending on area) then mother should be induced

  • a mother who has reached 41 weeks should be booked for induction

  • preventative antibiotics are given to babies in many situations, including Group Strep B and assisted deliveries

  • a baby that loses more than 10% of its birth weight will be put on a top up feeding plan

  • at 10cm dilation a mother is encouraged and guided to push her baby out

How do these guidelines sound to you? Some may strike you as odd, whereas some may seem like valid reasons to route a mother down a specific care plan. What is the evidence for these guidelines and should they determine how women are moved through the system?


Let’s take a very common scenario that affects about a third of the UK birthing population, the post dates induction. One mother at 41 weeks may respond well to a chemical induction for post dates and deliver her baby within hours of labour commencing. She may also then go on to initiate breastfeeding without any major concerns and have a positive experience all around. Another mother may also undergo chemical induction that results in very slow dilation of the cervix despite extremely painful contractions. Her baby may become distressed, resulting in a cascade of interventions, and a traumatic assisted delivery of baby, who then struggles to latch at the breast. Which of these women is normal? Could we safely say that the mother who didn’t respond to the chemical induction was abnormal, if the guidelines assume that the average woman should be induced post dates? If we look at the mother who would be labelled as having a “failed induction,” is it possible that her dates were off, or that her baby and body weren’t ready and they just needed another week or two (or more) to begin the process of birth? Did we look at either of these mothers as individuals and consider whether there was a need for the induction? Were there medical reasons causing a concern over the baby, or was it just a guideline that baby’s gestation was 41 weeks and so induction was being offered to minimise the (less than half a percent) risk of stillbirth. When we’re looking at a national induction rate of around 20-30%, many of which are down to post dates, then we have to look at whether we’re considering the individual that we are caring for, or whether we are making a blanket decision based on guidelines framed for an “average” person/birth scenario. And this then brings me to whether a statistic like .3% still birth rate is worth inducing 20% of women over, when it is likely that this will then give you more than a .3% risk of negative birth experiences, including PTSD and PPD. Are we sitting women down and informing them of the risks of still birth, with facts, and then informing them of the risks of induction? When induction isn’t going to plan and the mother isn’t labouring as planned, are we then observing her at each stage and discussing her options at each stage so that she can make an informed decision about what she’d like to do next? Are we having these conversations? Are we even able to have these conversations? Is it possible for a system that is already stretched thin, both in resources and funding, to assess everyone as an individual? Is there room to incorporate women into the decision making conversations and alter their care pathways to suit their individuality? There’s that question again, “Can a system designed around support for the masses offer truly individualised care?” Do you know what I think? NO. Not where we’re at now. Not when we don’t have continuity of care, not when language used still only serves to coerce a mother down a certain path. Not when so many guidelines still aren’t evidence based and undermine the unique nature of every birthing woman.

Systems for the masses cannot serve the individual.


Women need to take control of their care. They need to know their options in advance, they need to go into birth educated about likelihoods and risks and ready to push conversations with professionals. They need to have birthing partners and doulas who are also well informed and there to support the individual birthing her baby in a system designed around a patriarchal ideal. Because when a woman is a statistical norm framed by a guideline, she will inevitably end up travelling a care plan designed for someone else.

Image credit: Robin Fellows-Weir, Photographer and Filmmaker rfwphotovideo.co.uk Email: thunderbirdrobin2002@gmail.com

Instagram: @robinfwphotography

#birth #careplan #breastfeeding #doula #BirthSystem #BirthRights #InformedConsent #consent #HospitalBirth #HomeBirth #Freebirth #Induction #Guidelines #NICEGuidelines #AugmentedLabour #Dilate #Procedures #NHS #MaternityCare #Maternity #IndependentMidwife #IndependentMidwifery

In the midst of the Covid-19 crisis, I have to admit I've not been too badly impacted by things, because I mainly work in isolation going in and out of parent's homes on my own. Global illness aside, breastfeeding support is still in high demand, and the need to feed babies a diet of breastmilk is even more crucial when illness is on the rise. However, my volunteer peer support projects, which run groups have had a hit to attendance and speaking to others who run group support sessions, they've all seen a dramatic decline in attendance. Some groups have taken the decision to temporarily halt group session, while opting for telephone and online support. This has really had me thinking a lot over the last few days about what sort of impact this will have on the well-being of an already fairly isolated and minimally supported population of people. As I said, I am regularly invited into homes to sit with a family and talk with them through their struggles around parenting and breastfeeding. Over the course of a couple of hours we will go through plans for how to positively move forward to get them to a point of reaching their feeding goals. This can have a huge impact to the direction of the feeding journey, but it is only one element determining the success of the parenting journey. What I often tell parents when we make plans is that they would benefit from going out to groups, finding a social network that they can lean on a bit when things are seeming difficult; a group they can message at 2 am for an empathy moan, or go out for a cuppa with to get through what would otherwise be a lonely day without adult conversation. On days when everything feels like an uphill battle and baby is grizzling at everything, just getting out can make all the difference to our sanity. I can offer factual support, informative resources and knowledge for how to move a breastfeeding journey forward towards a desired goal, and I'm always happy to offer emotional support via text on a wobbly day, but there is something very different about the mothering/parenting network built with other parents in a similar place to you. Mothering in today's world can be a very isolating activity at the best of times. Depending on your location, social events and baby groups can be minimal or nonexistent; breastfeeding support can follow in a similar vein. In most cases a mother in a partnership, residing in Britain, has about two weeks of support from her partner before she is left to parent on her own for about eight hours a day; some days in extreme isolation. There is sometimes an option to enroll in a term or two of an activity, like baby massage, swimming, or yoga. This can be the highlight of the week, the thing to look forward to on a weekly basis. Sadly, though, at the moment we are seeing that even these groups are being temporarily halted as a precaution to keep mothers and babies from contracting the coronavirus, but also because the cost of running a group for a potentially empty room can be too much for a self-employed person to maintain. So I come then to my current train of thought where I'm pondering the risks to the well-being of the mother and her postpartum journey when she's being advised to self isolate, or when her resources in the community are being closed. Are we at risk of isolating an already very isolated population of people? We already know that the regular level of isolation felt by mothers can have detrimental effects to their mental and emotional well-being. Processing birth and the new role and intensity of mothering can require us to talk through our thoughts and emotions, something we can't do when we are spending day after day in a quiet house changing nappies and feeding babies. What about the mother that needs their local breastfeeding support group to be able to access face to face help with latching and friendly peer support from other mothers assuring them that they also have/had the same struggles.


I know some professionals that have cut groups are opting for online groups using video calling. Some are offering live streams of their instructional courses, others are offering one to one video calling and telephone support, all of which are wonderful options for parents that are looking for the practical support. My professional opinion, though, is that the current panic around contracting an illness, that as of yet does not seem to have evidence to show it is deadly to the healthy population, panic that is resulting in national outcry to self isolate and take extra precautions to not interact too closely with others, could leave many new mothers struggling to develop crucial parenting networks, and access necessary support to be able to positively develop in their mothering role, not just in the short term, but for the long run, as well. Is there any way around this? Are we being too quick to pull back on these group sessions? By cancelling groups are we re-instilling a feeling of panic? We only have to look at toilet roll shortages and hand-wash shortages to see that somethings are self perpetuating. Is there a way that we can give parents the facts around the illness and immunity and allow them the option to make that informed decision for themselves as to whether they should or shouldn't attend a group before it is withdrawn as an option all together? I'd be interested to know your thoughts on what has been labelled a"pandemic" and whether the risk to you of attending a group is greater than the benefit or whether the benefit would feel more than the risk?


#covid19 #coronavirus #breastfeeding #immunity #illness #BreastfeedingGroups #SupportGroups #NewMum #NewMom #PostNatalSupport #PostNatal #PostPartum #PostPartumSupport #4thTrimester #FourthTrimester #MentalHealth #PPD #PostPartumDepression #Depression #BabyBlues

So I'm not usually one to rant with my professional hat on. I usually try to stay quite civil and cordial and then take my grumbles and scream into a pillow, or I take them to my safe space and spew out all the swear words there. I am not a fan of reading public rants from professional pages, but here I go writing my own right now! I've had a few days (more like a few years) of being confronted with what can only be described as parents receiving shocking breastfeeding support and then finding themselves in a pretty crap position, only to then feel that maybe this is the end of their breastfeeding journey, because 1) they don't know there's more skilled breastfeeding support than a midwife or health visitor 2) they can't see the value in accessing further support beyond what they've received from the local midwives and health visitors in their trust.


This is by no means the fault of the parent! This rant is not in any way directed at the parent. It's directed at a culture, at a system, that doesn't see the value in specialist breastfeeding support. A system that pays lip service to breastfeeding and talks about how they recognise all the"benefits" of breastfeeding and how they support parents who "choose" to breastfeed and then leave mothers and parents (in most areas in the UK) without any specialist breastfeeding professionals to actually get support from. And I'm not talking about the person that's been given a title as the "breastfeeding person" in the hospital without actually undertaking a high level of specialist training to be shelling out support in what is often a critical situation where a baby won't even latch to the breast, where a baby might be losing too much weight straight after birth. Yes, there are actually people out there that are breastfeeding specialist health professionals. 🙋 In some hospitals around the country there are International Board Certified Lactation Consultants (IBCLCs) hiding away in the halls and parents don't even know they're there or that they can access their help.


None of us knows what we don't know. It's ludicrous. How can we know what we don't know? We can't. Most parents rock up to the start of their parenting journey thinking, "I'll give breastfeeding a go. If I have any issues, I'll ask the midwives." This way of thinking relies heavily on a profession that does not have the capability to offer skilled breastfeeding support (and I'm not talking about the midwives that happen to be IBCLCs, because the majority aren't). There is little to no funding to train IBCLCs within the NHS, and in most situations around the country, you have to make a case for the value of having an IBCLC, which many trusts don't see why they can't just offer someone a bit of training around breastfeeding, call them the breastfeeding person/infant feeding person and bob's your uncle, sorted. This train of thought in itself shows just how unbelievably ignorant we can be about the skill set of an IBCLC and what they can offer to a mother or breastfeeding parent.

I'm a mother of three children that I birthed. I've experience three very different births. For the second and third baby I did a lot of reading and researching about birth and what constitutes a birth risk and what I might want to do in certain risky situations in labour and birth. My mother gave birth. I have lots of aunts and friends that have given birth. Bear with me, I have a point... I have heard a lot of birth stories from supporting parents and I have some experience on that level. I've done a doula course and sat through training that involved quite a bit about birth and the mother and the baby. If you had some questions about birth, I'm confident that I could point you to some great links that could answer your questions and maybe give you some ideas that you hadn't considered. But if you're in labour and I'm there supporting you and shit just got real and something isn't feeling right and you're asking for some help getting your baby out. Who do you want coming to help you? Me? With my doula course (which isn't medical, btw) and my personal experience of pushing a baby out and my experience of supporting some people with the theory of birth? Or do you think you'd want a midwife who did ALL that training and did years of studying and shadowing other midwives? The midwife who has had to take an exam to get her qualification, who has to maintain her knowledge with continuing professional development, and who has extensive experience helping parents bring their babies into the world in tricky situations? Who do you want coming to help you? Please don't say me...because I know that I don't know enough to help you in that sticky situation. I 100% know this, so I'd step out of the way and I'd let that midwife do her thing. If breastfeeding isn't going to plan and shit is getting really real and you're sat there in pain, or your baby isn't even going to the breast, or you're having to top up for whatever reason, or things are just not working like you think they should. Who do you want helping you? The person that might have breastfed their baby or babies? The person that might have done the 18 hours of training required of a Baby Friendly Initiative (BFI) health professional, may have gone to some other training courses and put in some personal time to read a bit on breastfeeding? Is that who you want helping you when you are in that sticky situation? Or do you think you'd want an IBCLC (International Board Certified Lactation Consultant) who did ALL that training, including at least 1000 breastfeeding specific clinical hours, a 90 hour lactation specific course, other various courses, and then sat a board exam to receive their qualification? The IBCLC who has extensive experience with tricky situations and who can look at the mother and baby dyad as a whole unit and try and work out the deeper reasons for why things aren't going to plan? Who would you want helping you? You wouldn't go to a dermatologist when you need to seek support from an oncologist, you wouldn't ask a gynaecologist for support if you really need to speak to a urologist. These are all specialists that have studied their area specifically and have a bank of knowledge so extensive in their area. So we shouldn't be sending parents to midwifes when breastfeeding isn't working. We should be sending them to LACTATION consultants, likewise lactation consultants shouldn't be supporting parents in birth, they should be supporting parents and babies with breastfeeding. So this is about the moment when a load of people start raging at me and telling me how wrong I am and that this is most definitely the place of the midwife to help with breastfeeding. By all means, help with breastfeeding, and if that mother says that everything is great and they thank you for the help and then move on successfully breastfeeding, then it's been a fabulously successful encounter and there's then no need to refer to an IBCLC. But if that mother is struggling, if that baby is struggling, then they need a referral, and I'm not apologising for saying it. If that particular hospital doesn't have an IBCLC, for whatever reason, then that dyad should be referred to outside support. THIS IS IN LINE WITH NICE GUIDELINES!!!! It grates on me like nobody's business when I hear, "We aren't allowed to refer parents out of the NHS." Yes. Yes you are. You actually have a duty to refer a parent out. When you don't, you are saying to that parent that you are the most knowledgeable on that topic, and that there is no value in their seeing someone else besides you. We have allowed ourselves to be duped by a system that undermines breastfeeding at every turn. You remember what I said about lip service? You know about our breastfeeding rates? We have gone on for far too long thinking that we can push parents along a system where they get little to no skilled support with feeding their baby, keeping our lips sealed about the fact that there are other people out there that might be able to offer them a bit more help, because it's a knock to our own self esteem that someone else might have the knowledge in an area that we've been claiming expertise on for so long. It's about time we make this about the parent and drop the egos. For as long as I've been doing this (and I now know it's been going on for so so much longer) shit has been getting very very real, yet still not enough people have been stepping out of the way.



Cover Image was taken from the Unicef BFI Call To Action Video.


#breastfeeding #midwife #HealthVisitor #BreastfeedingSupport #BabyFriendlyInitiative #BFI #HealthProfessionals #BreastfeedingStruggles #birth #KnowWhatYouDontKnow #UNICEF #LactationConsultant #SkilledSupport #BreastfeedingRates #BreastfeedingStatistics

© 2019 by J'Nel Metherell, IBCLC

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Serving Milton Keynes, Bedfordshire, Northamptonshire, Leighton Buzzard, and North Bucks in England, UK

Specialising in issue  including but not limited to sore nipples, painful damaged nipples, slow weight gain, baby not gaining weight, low supply, increasing milk supply, making more breastmilk, feeding twins and multiples, colic, reflux, silent reflux, insufficient glandular tissue (IGT), weaning,introducing solids, baby led weaning, baby vitamins, formula top ups, top ups, breastpump, exclusively pumping, return to work, growth spurt, cluster feeding, frequent feeding, intolerance, allergies, feeding an older baby, night weaning, sleeping through the night, breastfeeding, doula, postnatal support, babywearing, birth, fourth trimester, baby carriers, baby sling, postnatal depression, postpartum support, drugs in breastmilk, breastmilk, breast reduction, breast augmentation, implants, blood in nappy, bottlefeeding, dummies, bedsharing, co-sleeping