What midwives are supposed to tell you about formula feeding, but usually don’t{0}

I have a few hazy memories of when I gave birth to my daughter.  One is looking down at the registrar obstetrician stitching my clacker back up, then seeing the consultant come over, say, slightly alarmed, “What are you doing here?” and then rapidly taking over when it became obvious that whatever she was doing, it wasn’t good.

Another is gingerly creeping down the ward corridor in the middle of the night (very gingerly – even the magic-fingered consultant couldn’t fix my bits THAT quickly) heading to the nurses station, and asking for a bottle of formula.  My daughter had been born about 20 hours previously, and for a large part of that time she’d been on my breast.  But she kept on crying, these hoarse little cries.  I’d had the midwives check my latch, the volunteer breastfeeding consultant had come with her jaunty knitted boob and had given her approval, but still she sucked, and still she cried.

Because I had had a breast reduction many years before, I was prepared not to be able to breastfeed at all.  When I started leaking colostrum in the shower at around 36 weeks I was pleasantly surprised, and excited to give breastfeeding a red-hot go. But when my skinny little baby wouldn’t stop crying in that ward I knew what was wrong.  Whatever I was giving her, it wasn’t enough.  So, while I was fully committed to breastfeeding, I knew that at that time, what she needed was milk, so I asked for a bottle of formula.

The young midwife looked a little harried, asked if I was sure, and when I responded that I was, she said she can get a bottle for me, I just have to sign The Form.

Ahhh…The Form.

The Form tells me that my hospital follows the Unicef Baby Friendly Initiative which supports and protects breastfeeding, step 6 of which is “Give newborn infants no food or drink of than breast milk, unless clinically indicated.” It then proceeds to give me a list of terrible things that might happen if I choose to ignore The Sixth Commandment.

I questioned my decision (as The Form was clearly supposed to make me do) and then remembered my hoarse little baby, signed the bloody thing and got given a 100ml ready-to-feed bottle by the midwife.  “Don’t give her too much,” she warned me, and I was sent on my way. That was it.  No, “let me come and show you how to do this.”  No mention of potential holds, or feeding her skin-to-skin, or warnings not to give her the same bottle after an hour.  Nothing.

Unfortunately, in the quest to promote breastfeeding, education about bottle feeding has become taboo. In a 2013 paper in the journal Midwifery, ‘The midwives aren’t allowed to tell you’  Scottish researchers described a strong perception amongst new mothers that midwives aren’t allowed to help women to bottle feed or give them advice on how to prepare a feed.

This is often accompanied with perceived or actual pressure to breastfeed, as any woman can tell you but plenty of researchers have also noted, including the University of Kent’s Dr Ellie Lee, and Australian researchers Virginia Schmied and Athena Sheehan.

A typical comment from one mother to Schmied and Sheehan:  “The professionals make you feel that you should continue breastfeeding at all costs.  You can tell they don’t want you to bottle feed.  They never even mention bottle – you have to kind of ask, and sometimes even when you do ask about bottles they don’t answer your questions – they just keep saying, ‘Oh no, you can do it.”

There are plenty of self-evident reasons why this is wrong.  For starters, while bottle feeding is perfectly safe, incorrectly preparing and giving a bottle can lead to all sorts of problems including infection, overfeeding and underfeeding.  Then there’s the lack of respect for a woman’s choice, and pressure coming from supposedly impartial professionals.  But all this aside, believing that nurses and midwives can’t inform mums about how to use formula at all is in contravention to both national health guidelines and the Baby Friendly Initiative. 

Let’s be clear in what you are supposed to be taught, as a bottle-feeding parent:

Ante-natally

– It is not against Baby Friendly standards to discuss formula and bottle feeding

– Parents can be verbally instructed in how to make up feeds, and should be told how to feed sensitively and responsively

– However, routine instruction in how to prepare bottle feeds is not supposed to be part of group sessions.  Should a parent request a one-to-one demonstration this can be provided, but it is encouraged to be put off until after the baby is born

Post-natally

– The BFI says mothers who have chosen to bottle feed should be instructed in how to make up a feed before they leave hospital.  They should also be told how to sterilise, and given a leaflet on how to prepare and give feeds.  In case you haven’t seen the Unicef leaflet, it’s here, and for the super-interested, here‘s the accompanying leaflet for health professionals

– Mums should be told the importance of feeding skin-to-skin, and feeding on demand

– Health professionals can’t advise on which brand of formula to use.

That’s it.  It’s pretty clear – hospital staff, even at Baby Friendly hospitals, are supposed to instruct parents in how to make up bottles, and make sure they’re comfortable doing so before they go home.

So why is this information so often not delivered?

For one, midwives and nurses sometimes interpret guidelines too rigidly, (as found in this research paper.)  Sometimes, on a busy maternity ward, mums and babies simply fall through the cracks when staff are rushed off their feet.  And as one British researcher found, many midwives simply lack knowledge about formula and bottle feeding.  When half of  all British mums have used some formula by the time their baby is a week old, this is unacceptable.

Changes to the BFI made in 2013/14 will hopefully start to see better information and more support of families, however they feed their babies (because with all of this is mind, let’s not forget that breastfeeding mums often feel let down by health professionals too.)

But there it is, in black and white.  It is the mandated duty of midwives, nurses and other health professionals to make sure parents know how to safely prepare and give a feed.  Let’s hope that soon we start seeing hospital environments where this is the norm, rather than the exception.

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