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.