In fact, I now realize, there are lots of things that could have been done differently that might have made those early days go better. For starters, the advice I was given in the first week or so was not only unhelpful, it was actually counterproductive. Whereas I’d been happy to feed continuously to help my milk come in, there was the breastfeeding counsellor telling me I shouldn’t need to feed again once I’d offered both sides, and that any more would just make me sore, so when my son was desperate for milk the following nights I didn’t understand and interpreted his breast refusal as meaning he wasn’t actually hungry. Whereas, if the state of my son’s nappies (hard pellets and urate stained urine) had been taken as they should have been, as a warning sign of a supply/transfer problem, we might have been able to up the feeding/skin to skin and move more quickly with the tongue tie referral, as it was I was simply reassured that everything I was experiencing was ‘Normal in breastfed babies’, and left to keep going as I was right until the moment of truth of weighing, and the desperate need to top up.
As for the top up advice itself – while I understand the importance of making sure a baby isn’t dangerously undernourished, and making sure that they have the energy to be able to feed, I’m convinced that 30mls after every feed is much more than necessary for a baby whose blood sugar is still at safe levels. I could tell, the first time I woke my baby to feed him after he’d had a formula top up, that he just wasn’t that interested in nursing – why would he be? He’d had a whole ounce of formula only a couple of hours before, and was happily sleeping it off. All that happened was that my breasts lost their chance of having any association with food, and for him were just an annoying thing to be woken for to nibble on, long before he was really hungry and ready for his bottle of milk. In the meantime, I became more and more stressed about catching up with all the formula, losing all confidence in my milk supply. If I had to top up again I’d use the SNS from the start to keep the breast/food association, would not top up every feed, and would allow my baby to wake naturally after any top up. I also wish they’d suggested a babymoon as soon as the weight loss issue had become clear – far more chance of success then, rather than three weeks in with dwindling supplies and in the middle of a nursing strike. And I wish the breastfeeding clinic had had more understanding of the realities of pumping. The fact is that many women have difficulty letting down to the pump even if there is plenty of milk there in their breasts, but there are ways of increasing pump yields, e.g., through combining pumping with compression and hand expression, not to mention getting the flange size right. Instead all I got was ‘Something’s wrong’, and another big knock to my confidence, with next to no guidance as to how to put things right.
Yes, there’s plenty I could have done differently had the advice been better, and it’s frustrating to say the least to know that I worked so hard following suboptimal advice, much of which might actually have been counterproductive rather than helping things. I would like to complain, or at least to sit down with some of the people whose job it was to advise me and talk about where they could have supported me better. I have learned a lot about how breastfeeding works, how to avoid or overcome some of the problems I faced, and to be honest I’m angry at the amount of quite basic information I’ve been able to pick up from a few books and an internet connection, that was seemingly unknown to those people being paid by the NHS who I trusted to support me with this. It’s not right that, to stand a chance of overcoming what are some fairly standard hurdles with establishing breastfeeding, you have to know more than the professionals do, and be willing to ignore much of what they tell you. My hospital was awarded its stage 1 Baby friendly accreditation (policies and procedures) in November 2008, the month my son was born. Its stage 2 assessment (staff education programme) is due this month, when I’ll be having my second baby there. I hope that this means that in the meantime they’ve made some improvement, but to be honest I don’t hold my breath. I hope I will one day sit down and write that letter of complaint – but it’s taken me two years to write even this, so realistically I don’t know if it will ever happen Instead, when my midwife asks me what my plans are for feeding my next baby, I give her the potted version of my story and of why, while I’ll try my best to breastfeed, I don’t honestly have a clue what we’ll end up doing, and just bite my tongue and smile sweetly when she responds, ‘Oh well, you know we’ll support you whatever you choose to do’.
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