- Email: [email protected]
Individualising breast feeding policies
Journal of Neonatal Nursing (2012) 18, 88e89
www.elsevier.com/jneo
LETTER FROM NEW ZEALAND
Individualising breast feeding policies Let me say here and now, that I totally support breast feeding as the best nutrition for babies. All my three were breastfed; in fact ironically I was a closet breast feeder, determined to feed my babies despite family pressure and negative comments such as “He should be beyond all that now”. Back then it was considered that it was all a bit inappropriate to be feeding for so long. Now it would be applauded. This experience underpins my commitment to assisting mothers to feed their own babies but just how we do this is challenging me. How breast feeding is taught and enforced is quite the contentious issue here in New Zealand. Following “WHO e Ten steps to successful breast feeding” (http://www.unicef.org/newsline/tenstps.htm) is ideal, and yet elevating this very natural experience to an academic process that can only be taught effectively by a lactation consultant, and by following rigid inflexible guidelines, by default sends a message to mothers that it is a hard skill to acquire. Indeed, we are now having mothers armed with a birthing plan who only want a lactation consultant to assist them! I had considered becoming a lactation consultant prior to going out to my remote contract at Bamaga, feeling that, with all my neonatal years of experience, not to mention my personal experience as a mother of three, I have something, possibly a breast feeding “skill” to offer new mums. I do have a genuine passion to help new mothers and their babies establish breast feeding. I find there is nothing more satisfying than watching a new mum breast feeding her baby (especially if it has been a struggle to get the all important deep latch) and to facilitate that special physical attachment. But it is the emotional attachment that is intrinsic to breast feeding that is wonderful to see. There is joy in the moment as
the mother realises that she can do it and the baby has that relief and “food at last” contentment; when the rest of the body visibly relaxes and the feeding is enjoyed. It is getting to this moment that is the greatest challenge; at least it is in the metropolitan environment. In the remote setting it is not an issue. Breast feeding is just done! There are no consultants to advise, but it is just learned from watching other friends do it, having mum to show you or an auntie’s help. But certainly not from a consultant! I did see an example of this here when the postnatal staff were too busy to assist a teenage Samoan mother with her new baby. Her mother and auntie drew upon their own experiences and put the baby on the breast without so much as a glance at the “WHO e Ten steps to successful breast feeding” (http://www.unicef.org/ newsline/tenstps.htm). Indeed, I too, have fallen foul of the ‘WHO Ten Steps.’ and my ability to even assist a mother to breast feed has been questioned by a lactation consultant. My crime e I elected to use a nipple shield on a nearly day 3 baby. Technically the milk had not come in and according to the hospital policy a nipple shield should not be used until lactation is established. Furthermore, I did not get a consent form signed to introduce the offending shield, primarily because I didn’t realise that a consent form was now mandatory. Documentation indicated that the use of a shield had been discussed with the mother and I further elaborated on the pros and cons of using a shield. The scenario was not unfamiliar in that the mother was feeling so hopeless and inadequate, indeed desperate, that she couldn’t latch her baby. Meanwhile the baby was not just desperate but downright furious at not being able to latch effectively. I elected to use the nipple shield to not just facilitate the
1355-1841/$ - see front matter ª 2012 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jnn.2012.03.001
Letter from New Zealand
89
physical attachment but an emotional attachment, too. The introduction of the shield instantly changed the tense, fractious situation into delight and relief for both mother and baby. It was quite simply wonderful to witness and gave me and the mother a feel-good moment. Not so wonderful to be challenged and rebuked for doing so. Even when I gave a rationale for my decision, I was advised that my knowledge of breast feeding policy was seriously lacking and I needed to update my education. I was subsequently taken to task by the lactation consultant from every conceivable angle and left in no doubt that what I had done was wrong. When I mentioned that I had not just used it for the effective transfer of milk but for the emotional wellbeing of both the mother and infant, I was told quite clearly that is not a clinical indication to use a nipple shield. I don’t believe the emotional wellbeing of the mother can be left out of successfully establishing breastfeeding. I think attachment and bonding is all important and isolating the physical process from the emotional process is causing more issues in how we manage breast feeding. In the process of my dialog with the afore mentioned lactation consultant, I indicated I would be more than happy to up-skill and was sympathetically advised that I would need evidence of at least 80 h of current breast feeding education before I could even consider becoming a consultant, and that experience does not count, and may well even be a liability, and that my current practice could be detrimental to accepting evidence-based guidelines for breast feeding. I am quite certain that with my breast feeding training that I update every year, I am mindful of the ‘WHO ten steps to successful breast feeding’. I follow them to the letter as a rule, but there are exceptions and I like to think I make a good judgment call. As it happens this mother came to see me shortly after the error of my ways had been
pointed out to me and couldn’t thank me enough for assisting the breast feeding process as it was going very well. The psychological and physical hurdle had been well and truly overcome. She had been advised that using a nipple shield was not recommended practice but it had made all the difference for her and so, to keep everyone happy, she signed the consent form retrospectively. Then there is the f word that has everyone in a tizzy if not a near melt down! Just one sip of Breast Milk Substitute (AKA formula) will seriously compromise the infant, predisposing it to all sorts of ill health in its lifetime, irrespective of the diet that it may be subjected to as it grows up. It also predisposes mothers to using the f word to express their anxiety and guilt (as opposed to their EBM), not to mention feeling a failure for having not achieved the exclusively fully breastfed rating. Heaven forbid if the nutrition is delivered in a bottle unless it is breast milk. There was much breast beating, near riot and civil commotion recently when one of our rugby players was photographed feeding his baby daughter with a bottle, for a smoke free advert. You would think he had committed child abuse for all the ballyhoo it created. Here was a young dad, tenderly looking after his daughter, still in the family unit but berated for bottle feeding; no one asked if it was EBM, assumptions and judgments were made in an instant. He was demoted to a second class father for doing a first class job providing a role model for young fathers to be involved with child care. Breast feeding is only one aspect of the infant mother relationship. Till next time... Judy Hitchcock Wellington Hospital, NICU, New Zealand E-mail address: [email protected]
Available online at www.sciencedirect.com
Available online 30 March 2012
www.elsevier.com/jneo
LETTER FROM NEW ZEALAND
Individualising breast feeding policies Let me say here and now, that I totally support breast feeding as the best nutrition for babies. All my three were breastfed; in fact ironically I was a closet breast feeder, determined to feed my babies despite family pressure and negative comments such as “He should be beyond all that now”. Back then it was considered that it was all a bit inappropriate to be feeding for so long. Now it would be applauded. This experience underpins my commitment to assisting mothers to feed their own babies but just how we do this is challenging me. How breast feeding is taught and enforced is quite the contentious issue here in New Zealand. Following “WHO e Ten steps to successful breast feeding” (http://www.unicef.org/newsline/tenstps.htm) is ideal, and yet elevating this very natural experience to an academic process that can only be taught effectively by a lactation consultant, and by following rigid inflexible guidelines, by default sends a message to mothers that it is a hard skill to acquire. Indeed, we are now having mothers armed with a birthing plan who only want a lactation consultant to assist them! I had considered becoming a lactation consultant prior to going out to my remote contract at Bamaga, feeling that, with all my neonatal years of experience, not to mention my personal experience as a mother of three, I have something, possibly a breast feeding “skill” to offer new mums. I do have a genuine passion to help new mothers and their babies establish breast feeding. I find there is nothing more satisfying than watching a new mum breast feeding her baby (especially if it has been a struggle to get the all important deep latch) and to facilitate that special physical attachment. But it is the emotional attachment that is intrinsic to breast feeding that is wonderful to see. There is joy in the moment as
the mother realises that she can do it and the baby has that relief and “food at last” contentment; when the rest of the body visibly relaxes and the feeding is enjoyed. It is getting to this moment that is the greatest challenge; at least it is in the metropolitan environment. In the remote setting it is not an issue. Breast feeding is just done! There are no consultants to advise, but it is just learned from watching other friends do it, having mum to show you or an auntie’s help. But certainly not from a consultant! I did see an example of this here when the postnatal staff were too busy to assist a teenage Samoan mother with her new baby. Her mother and auntie drew upon their own experiences and put the baby on the breast without so much as a glance at the “WHO e Ten steps to successful breast feeding” (http://www.unicef.org/ newsline/tenstps.htm). Indeed, I too, have fallen foul of the ‘WHO Ten Steps.’ and my ability to even assist a mother to breast feed has been questioned by a lactation consultant. My crime e I elected to use a nipple shield on a nearly day 3 baby. Technically the milk had not come in and according to the hospital policy a nipple shield should not be used until lactation is established. Furthermore, I did not get a consent form signed to introduce the offending shield, primarily because I didn’t realise that a consent form was now mandatory. Documentation indicated that the use of a shield had been discussed with the mother and I further elaborated on the pros and cons of using a shield. The scenario was not unfamiliar in that the mother was feeling so hopeless and inadequate, indeed desperate, that she couldn’t latch her baby. Meanwhile the baby was not just desperate but downright furious at not being able to latch effectively. I elected to use the nipple shield to not just facilitate the
1355-1841/$ - see front matter ª 2012 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jnn.2012.03.001
Letter from New Zealand
89
physical attachment but an emotional attachment, too. The introduction of the shield instantly changed the tense, fractious situation into delight and relief for both mother and baby. It was quite simply wonderful to witness and gave me and the mother a feel-good moment. Not so wonderful to be challenged and rebuked for doing so. Even when I gave a rationale for my decision, I was advised that my knowledge of breast feeding policy was seriously lacking and I needed to update my education. I was subsequently taken to task by the lactation consultant from every conceivable angle and left in no doubt that what I had done was wrong. When I mentioned that I had not just used it for the effective transfer of milk but for the emotional wellbeing of both the mother and infant, I was told quite clearly that is not a clinical indication to use a nipple shield. I don’t believe the emotional wellbeing of the mother can be left out of successfully establishing breastfeeding. I think attachment and bonding is all important and isolating the physical process from the emotional process is causing more issues in how we manage breast feeding. In the process of my dialog with the afore mentioned lactation consultant, I indicated I would be more than happy to up-skill and was sympathetically advised that I would need evidence of at least 80 h of current breast feeding education before I could even consider becoming a consultant, and that experience does not count, and may well even be a liability, and that my current practice could be detrimental to accepting evidence-based guidelines for breast feeding. I am quite certain that with my breast feeding training that I update every year, I am mindful of the ‘WHO ten steps to successful breast feeding’. I follow them to the letter as a rule, but there are exceptions and I like to think I make a good judgment call. As it happens this mother came to see me shortly after the error of my ways had been
pointed out to me and couldn’t thank me enough for assisting the breast feeding process as it was going very well. The psychological and physical hurdle had been well and truly overcome. She had been advised that using a nipple shield was not recommended practice but it had made all the difference for her and so, to keep everyone happy, she signed the consent form retrospectively. Then there is the f word that has everyone in a tizzy if not a near melt down! Just one sip of Breast Milk Substitute (AKA formula) will seriously compromise the infant, predisposing it to all sorts of ill health in its lifetime, irrespective of the diet that it may be subjected to as it grows up. It also predisposes mothers to using the f word to express their anxiety and guilt (as opposed to their EBM), not to mention feeling a failure for having not achieved the exclusively fully breastfed rating. Heaven forbid if the nutrition is delivered in a bottle unless it is breast milk. There was much breast beating, near riot and civil commotion recently when one of our rugby players was photographed feeding his baby daughter with a bottle, for a smoke free advert. You would think he had committed child abuse for all the ballyhoo it created. Here was a young dad, tenderly looking after his daughter, still in the family unit but berated for bottle feeding; no one asked if it was EBM, assumptions and judgments were made in an instant. He was demoted to a second class father for doing a first class job providing a role model for young fathers to be involved with child care. Breast feeding is only one aspect of the infant mother relationship. Till next time... Judy Hitchcock Wellington Hospital, NICU, New Zealand E-mail address: [email protected]
Available online at www.sciencedirect.com
Available online 30 March 2012