Hands Off The Breast!28th December 2016
I had a six month old baby when I started breastfeeding peer support training. One of things I remember clearly, was feeling really baffled by the ‘hands off’ approach I was being taught to master. How can you teach anyone to breastfeed if you don’t show them exactly how to do it? As a shiny new peer supporter, whilst I was shadowing on home visits, I was even stopped mimicking the hands on support of a Health Visitor, when she asked me to support a mum after she had done some hands on support herself – looking up to somebody you are shadowing it is so easy to pick up bad habits.
My own experience of breastfeeding support with all of my children had been midwives manhandling my breasts, often without asking and I just allowed them to, because I did not know any better. I didn’t protest, I was in the care of midwives who knew their stuff, right? I am a new mother, shiny new to breastfeeding a newborn and they know what to do to help, because they see it countless times in their job. It taught me nothing, but reliance on the midwife to do it for me. Pressing a buzzer everytime my baby would not latch and being told by a frustrated Midwife, “we can’t do this at home you know!”
What I quickly realised during my training is that practical support to breastfeed is wholly doable without using your hands on a woman’s breasts. The language we use, the description of motions we need to go through to find good positioning and attachment. Getting comfortable in your space, whether that be sat up or lay down. Describing where baby’s chin should be, how to hold them so their head can gently tip back. Explaining what ‘nose to nipple’ means in a way mum can understand.
Hands off breastfeeding support is sometimes in the tools we carry. We are often found with a bag full of our knitted or crocheted boobs, our little handmade bottle top mouths, breastfeeding dolls. There may be a couple of NG tubes for a make shift SNS or finger feeder, oral syringes and cups to support dyads if baby is not feeding well or mum is dreading every feed whilst she awaits her nipple trauma to heal from the poor latches in the first few days.
The Royal College of Midwives have a great article on their website. It describes good attachment and how to support the dyad with any issues. It points to resources for further reading and how to recognise good signs of feeding for both mum and midwife. Skin to skin at birth is mentioned and rooming in with baby. An important point is made about taking the time to support the mother with breastfeeding. All fabulous points which are easily achievable, except for maybe the time it takes for a newborn and a new mum to get to know each other in those first feeds-we all know how busy a postnatal ward midwife is. Yet it is this point in the article which shouted out at me:
✲ Maintain a ‘hands off’ approach (Inch et al, 2003) to encourage the mother to learn the skill and respond to the baby’s cues
Facebook groups are full of mums describing how their midwife showed them how to breastfeed by holding mum’s breast, squeezing the areola into a sandwich and shoving baby on and on and on again until baby either screams louder or latches on. Whilst it has to be mentioned that some women will welcome this hands on approach, many others do not and several things can occur from this method of teaching.
Breast refusal is real. Baby refuses to be put into a nursing position because they know what is coming, or suspect that being in that position means they will be forced to do something they are unable to do. Can you safely drink a glass of water if your head is tipped back and a glass forced to your mouth? What would you reaction be to somebody forcing your mouth towards that glass?
Tension in baby’s neck and shoulders from being forced to the breast can occur, making it difficult for baby to then go through the motions she needs to breastfeed. Tipping back a stiff neck hurts. Imagine that glass of water coming to you. Do you tense up? Do you try to writhe away from the hands that are on your neck and shoulders as they are pushing you towards the glass, and the glass towards you. Is your head and neck moving quickly in order to remove yourself from the situation?
What has mum been taught by using a hands on approach? Has she taken away the skills needed to master breastfeeding in her own home? The wisdom she needs handing down to her to so she can gently reposition her baby if the latch is uncomfortable, is that what she learns from a hands on approach? Whilst mum tries to concentrate on what your hands are doing, is she listening to your words as you talk?
A recent experience in a hospital of somebody I know triggered me to write today. I arrived late in the evening to a mum who was struggling after caesarean to position herself and her baby and really just needed somebody to give her a hug whilst she cried and hold the baby whilst she slept for a couple of hours after not sleeping for days.
As I arrived on the postnatal ward, mum was sat on the edge of the bed, baby in arms at the breast, with a head bobbing baby, licking around and rooting. Mum was visibly upset, exhausted and overwhelmed. A midwife walked in, looked around the room and said “awww are you OK?” Mum did not respond. The midwife then proceeded to ‘help’ mum with her head bobbing baby. Velcroing together mum’s breast and her new baby, mum moved away from the midwife. The midwife’s hands followed. Again, mum moved. The midwife said “oh OK, I see you don’t need help now”. And off she went back into the corridor, leaving the door open, which I closed behind her.
I do not know if this particular midwife had already introduced herself to mum earlier in the evening. She was certainly not asked if it was OK to manhandle her breasts, or her baby. Hands on breastfeeding support to an already upset mum without consent (which is another more lengthy discussion), is not the way to do things. Mum was not asked if she wanted some help. She was not asked anything at all about why she might be upset or how they might be able to help.
Breastfeeding support training is limited in some Midwifery courses and even scarcer in practice. Some University courses and hospitals offer a more enhanced level of training regarding infant feeding. Midwives often complete some very basic training, 2 or 3 days usually, sometimes less. Some go on to do further training in community or are seconded into Infant Feeding roles and are offered the IBCLC route to further enhance their clinical skills to support infant feeding.
Not all hospitals have infant feeding coordinators. Many are still left with very basic training and no capacity to support families with complex issues, or even somewhere to signpost to. Some have amazing support systems in paper with paid peer support, IBCLCs in community and hospital and volunteers within groups, yet still struggle to form a complete service due to a lack of funding. Hands off breastfeeding support requires time and patience. Hands on techniques can mean a busy midwife can be in and out of a room or house in minutes.
My wish for 2017, as a Breastfeeding Counsellor and Doula who sees families failed by the lack of support they experience, is to see all Midwives and Health Visitors, GP’s, Paediatrics Doctors, IBCLCs, Peer Supporters and Breastfeeding Counsellors come together as one. Those who wish to complete further training to move forward and encourage local networks and families to back you and your community in approaching the CCGs (Clinical Commissioning Groups) for your area and campaign for change. Campaign for more funding and more comprehensive training in infant feeding so that NHS staff can support families in infant feeding and that all hospitals and all community settings have somewhere to signpost to if they have not got the capacity to train all staff.