I hate complaining about something and not offering any solutions. And while my solutions often fall somewhere between “just hold hands and love each other” and “smite them all”, I often come up with something that works.
So, with that in mind, here are my thoughts on creating a positive, empowering and mother & baby friendly breastfeeding environment. I focus on my local hospital, the IWK, and my province but the information I provide can be used by anyone.
First, let’s start by acknowledging that statistics show that NS moms are great at initiating breastfeeding.
However, we have a steep drop off at the 3 month mark (based on the Maternity Experiences Survey) and this is where our “problem” lies. To make navigating the survey easier I have included a link to all the tables within the survey, http://www.phac-aspc.gc.ca/rhs-ssg/pdf/tab-eng.pdf
In the paragraph above I placed the word problem in quotation marks because ,according to the stats gathered in this survey, maternal-care health providers in NS are not succeeding in our breastfeeding goals. The MES did not ask moms if they wanted to breastfeed after 3 months or why they stopped breastfeeding after 3 months. (I chose 3 mths because that’s where our big drop off was, you can fill in any time period you’d like to)
I was going to comment on these omissions being the opposite of mother & baby friendly and were also kinda judgmental (to say the least) but I’ll let you decide which questions would have been appropriate and how you felt about the survey itself.
I know the MES had set parameters and was designed to gather certain information and this is why it didn’t ask every question I would have like them to. Perhaps, if we were developing a survey designed for a smaller, NS only sample we could ask questions similar to the two I proposed above.
Oh, would you look at that, I DID comment on the survey…
But I digress, let’s get back to empowering mothers.
The very first thing that doulas, lactation consultants, nurses, midwives, doctors, Healthy Beginnings Home Visitors, etc. have to remember is this- the decision to breastfeed or NOT breastfeed, has nothingto do with us. When we bemoan our stats, when we bang on about breastfeeding long after mom has said no thank you, we are effectively telling her, and the world, that we don’t believe Nova Scotian moms have the ability to decide what is right for them and their children.
Moms and babies have to be our guides, not the other way around. Given the opportunity every mother has the ability to intuitively parent, it is our duty to create a space for that opportunity.
Two notes: In the past I have made some ass backwards comments about a mother’s ability to intuitively parent. I am both embarrassed and saddened by the knowledge that I was responsible for putting that crap into the universe. Please accept my apologies.
Also, the irony of chastising the medical community for being preachy and judgmental while being preachy and judgmental is not lost on me. I’m not going to change anything but I did want you to know I was aware.
And now back to empowerment, where it is time to leap into Shannon’s imaginary world of Mom and Baby Friendly Nova Scotia. Are you ready! Jump!
First, let’s explore a few things we could do to make the Nova Scotian breastfeeding environment even more empowering, positive, inclusive and mother-friendly.
1. Create milk banks or milk shares. If a mom/adoptive parent/single dad/grandparent want to offer their baby breastmilk, but can’t for whatever reason, milk banks are a wonderful solution. Milk shares/banks are available in other jurisdictions why not ours? Banked breastmilk should be the second option available to caregivers, not formula.
2. Comprehensive, up-to-date and cohesive training for everyone working with breastfeeding moms and babies. This covers the first 2 steps under the WHO/UNICEF Baby Friendly Initiative.
3. No breast pumps offered within 24 hours of birth. Encourage manual compression, finger feeding and feeding on demand. Educate moms and their support team on subjects such as when to expect your milk to come in, how to tell if baby is feeding while at the breast, breast massage, feeding on demand, etc. New moms need support & a baby at their breast, not a machine.
4. Lactation consultants and/or postpartum doulas available on the 5th floor. This will create a non-medical, one on one, individual relationship.
5. Moms and their extended families leave the hospital with a complete list of breastfeeding supports available in the HRM. Breastfeeding Support in the HRM
6. At least 18 hours of breastfeeding training for student nurses and medical residents.
7. Encourage co-sleeping in the hospital. Educate moms and their partners on the benefits of co-sleeping. Here is a handout designed by Dr.Sears with research studies attached. http://askdrsears.com/html/10/handout1.asp
8. Educate mothers and their support team on the benefits of using a sling and/or carrier. Have slings available in the hospital. http://www.slingguide.co.uk/benefits.php
9. Optimal utilization of doulas. Public Health and hospital nurses are overworked and stretched to the limit. It is time to pull together and work as the comprehensive team we have the potential to be. So, just to be clear, USE DOULAS!
Here is an sample excerpt from my imaginary breastfeeding booklet:
Welcome to the world of parenting! At the [insert place of employment] we are here to support you in your birthing and parenting choices. We know that your breastfeeding relationship will be as unique and special as you are and we want to support you in every way we can. In this booklet you will find a list of community supports, information regarding nipple & breast care, co-sleeping & babywearing information, as well as support tips for your friends and family.
Page 1- A complete list of breastfeeding supports available in the HRM. Breastfeeding Support in the HRM
In this list you will find peer phone support, weekly breastfeeding support groups, information about doulas (volunteer and private), a list of Family Resource Centres and much more! (this is not part of the booklet but I thought it might interest my blog readers: here is a link to a study out of McGill on the benefits of peer support, it is not conclusive but it is a wonderful start http://highwire.stanford.edu/cgi/medline/pmid;20043705)
Page 2-nipple and breast care (including information on cabbage leaves, compression, nipple vs. breastfeeding, what engorgement will be like, massage, cotton vs. disposable breastpads, breast milk for sore nipples, etc.)
Page 3- co-sleeping is an important piece to a newborn’s cognitive development and attachment, milk supply, sleep!, and creating a seamless breastfeeding relationship
Page 4- baby wearing- everything on page 3 plus ease of use, nothing to fold up, much easier to bring on public transit, makes discreet feedings easier to accomplish (if discreet feedings are your choice)
Page 5- The “Call Me If I Can Help” page. This is a section for the names and phone numbers of people who offer to help. That way when mom needs help, she or her support person can open the book and find someone to assist in a matter of seconds!
For more information or to clarify any concepts I didn’t flesh out please email me and/or visit the Breastfeeding Committee for Canada, the national authority for the WHO/Unicef Baby Friendly™ Hospital Initiative (BFHI) in Canada.
Another really great resource is the BC Baby-Friendly Network http://www.bcbabyfriendly.ca/index.html
A shift in birthing and breastfeeding practices has begun. More and more breastfeeding communtiy leaders are speaking out and saying “Breast is not best because it’s incomparable”. The word “best” implies that breastmilk is top dog in a baby feeding heirarchy but the reality is CAN NOT be compared to anything else because it is in a positively singular category.
Breastfeeding needs to be in our cultural DNA. We need to support and educate whole communities not just individual moms.
Let’s work together to make Nova Scotia a leader in positive, inclusive, mother & babyfriendly healthcare.