Breastfeeding: A Midwife’s Perspective

Our final guest post comes from Harriet, an experienced midwife in the NHS. She has worked in a variety of settings, from hospitals to homes – she even had a little accidental cameo in One Born Every Minute. She’s also Mummy to 2 gorgeous pups, Lola and Nellie, as well as being a yogi.

As a midwife one of my favourite parts of my role is supporting and empowering women who want to breastfeed. This starts with conversations during pregnancy about breastfeeding, exploring the woman’s plans about feeding her baby, and I can help start the couple prepare for their breastfeeding journey. After birth, I love watching babies snuggle skin to skin, making their way to the breast, and looking up at their mum. Supporting mothers with that amazing first feed is so rewarding, empowering them to learn with their baby and begin their breastfeeding journey is one of the best parts of the job. Breastfeeding can also be challenging, and I try to prepare couples for the reality of a journey which is not always plain sailing, it is entirely normal to have wobbles, and moments of self-doubt, but there are so many victories and moments of pride to be found also. I always try and involve partners, sisters, grandparents, friends in breastfeeding conversations if they are visiting, because they are absolutely vital in supporting the mother on her journey once she is at home.

Top tips for a breastfeeding mum:

• Try to go to a breastfeeding group or class, with your birth partner too, so that they can learn how to support you with feeding. Team work makes the dream work!

• Get comfy, you may be there a while feeding! Keep hydrated, and it takes roughly 600kcals a day extra to breastfeed, so keep the snacks and meals coming.

• Ask your midwife to show you a few different positions to feed in, as this is helpful to alternate where the pressure on your nipple during sucking and helps drain all the breast.

• Responsive feeding is best- babies show signs they are hungry, like rooting for the breast, sucking hands, craning their neck to try and find the breast. Ideally do not use dummies, as this can mask these signs and lead to confusion between dummies and the nipple.

• You know that feeling when you’ve waited over an hour for your meal at a restaurant and you’re ready to go to a drive- through instead because you’re so over waiting? Babies cry as a last resort for a feed, so always try and start feeding before baby reaches this point. It is also a myth that you can cuddle or feed a breastfed baby too much, babies want to be close and held, this is entirely natural and they won’t become ‘spoilt’.

• Ask your midwife to show you how to hand express, in case when the milk comes in your breasts get engorged. Sometimes babies struggle to latch onto a bigger and swollen breast, so expressing a little milk off before feeding baby can help her to latch.

• Your baby will get all her food and drink from good breastfeeding, and like us, sometimes she will want a snack, or a quick drink, perhaps a comfort feed, or a big 3 course meal, so it is normal for feeds to vary in length.

• It is normal for breastfed babies to feed frequently in the early days, this is your baby’s way of ordering plenty of milk. Hormone levels are higher at night, so your baby is clever and is likely to feed more overnight, or cluster feed. Don’t worry, you’re doing a fabulous job, and naps in the day are really important to prepare for night feeds.

• Visual guides are helpful, like Youtube, ‘off to the best start’ and popping along to a breastfeeding group can be helpful and reassuring.

• Don’t compare your baby’s feeding pattern to a bottle fed baby- the milks have very different components and are digested very differently, so the two are not comparable. You are not starving your baby, just because she doesn’t sleep through the night like your neighbour’s baby.

• Key phrases to help remind you of good positioning are:

1. ‘Tummy to mummy’- have baby skin to skin ideally to aid bonding, let down and brain development. Keep baby’s tummy turned in towards you with her head, neck and body in a straight line.

2. ‘Nose-to-nipple’- line baby up so that her nose is opposite the nipple, this will stimulate her to open her mouth and take a wide latch of the areola (darker area around the nipple.)

3. ‘Angle of the dangle’- Our breasts are all different shapes, sizes and are all angled differently. It’s best to work with your body, and move baby accordingly to line up with you. Resist the temptation to move the breast towards baby, as this can cause problems with the latch (once you let go, the breast will move back to where it usually is!)

I would love to see more women breastfeed in the future, but I think a lot has to change in our society and healthcare for that to happen. Why do we as a society deem it normal to supplement with cows-milk and continue to drink it way into adulthood, but so many feel uncomfortable being around a mother breastfeeding her baby like nature intended? It’s sad to think that the UK has the lowest breastfeeding rates in the world, and a large part of that is to do with how we as a society view breastfeeding. We do not nurture or support new mums enough to breastfeed. Despite this, there are so many amazing groups, social media accounts and teaching tools available, and there is always someone to turn to for advice and reassurance. As professionals we can give a lot of support and advice, but we are not with women for long, and there is a lot more we could be doing as a society to increase breastfeeding.

So, the next time a friend mentions to you she is thinking of breastfeeding, but is worried what her friends might think, remember to give plenty of words of encouragement and perhaps you could invite her round for coffee with your other friend who’s breastfed for 6 months, so she can give some tips and explain she felt the same at first. When you’re next in line at a café and you see an awesome new mum breastfeeding in the corner, why not pop over with a glass of water and a slice of cake, and remind her she’s amazing and she’s welcome to feed her baby wherever you are. It’s part of a midwife’s job to start a mother and baby off on their breastfeeding journey, but it’s up to all of us to love those mothers and nurture them along the way. Who can you reach out to today to support on their breastfeeding journey?

Thank you, Harriet. What fantastic tips for mums-to-be and those who want to support new breastfeeders! How well they are supported can make or break a mum’s experience of feeding.

Who can you reach out to today to support on their breastfeeding journey?

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A Labour of Love

It seems appropriate that my first post on this blog is about my labour. Do not fear, those of you with a faint heart. There will not be gore. Merely a retelling of the most precious moment in my life.

Was it hard? Did it hurt? Was it as bad as people say? 

These are just some of the questions I’ve been asked about labour… And just some of the questions I asked others about labour before I experienced it myself. I spent the first half of my pregnancy being terrified of the seemingly inevitable pains of labour, but the second half was different. All the women I spoke to spoke of pain and tiredness, but mainly of an indescribable feeling. Something they couldn’t quite explain to someone who hasn’t gone through it. And so, around 22 weeks, I began to look forward to labour. I accepted that there would be pain, discomfort, tiredness and that things might not go as planned. I placed those fears at the foot of the cross, and I began to look forward to going through an experience which I have heard talked about for so many years, but never understood. I looked forward to being bound together with all women, through time and across distant lands, by an experience that I had dreamt about for so many years, but never imagined. I looked forward to labouring, with my husband by my side, and meeting the little girl I had so desperately wanted since I was just a girl myself. So… Was it hard? Yes. Did it hurt? Yes. Was it as bad as people say? It depends on what you’ve heard. For me, in the end, yes and no.

My labour was long. Really long. At around 10 o’clock on Monday night, I had some cramping in my abdomen. This came and went at 20-30 minute intervals until my husband and I went to bed around midnight. I actually didn’t think anything of it. We were goofing around and he was making me laugh in the way only he can. I was definitely distracted; I certainly wasn’t thinking, “I’m in labour!” It was when two of these cramps came about 10 minutes apart and had grown in intensity that I began to wonder if this was it. So, I left our bedroom, grabbed my stopwatch, and headed to the bathroom. I stayed there until 3 o’clock in the morning, when my contractions were down to 5 minutes apart and I went and woke my hubby.

“Are you sure?”

“Yes.”

“Really?”

“Yes.”

And on it went for a few moments, until he accepted that I wasn’t joking, and I was certain. So, we prepared our living room for the home birth we wanted (just a few waterproof sheets on the floor, along with old towels), and I set about controlling my breathing and getting through each contraction. At around 7am we had our first visit from the community midwife, who told me I was only 1cm dilated and I should ring when the contractions got down to 2-3 minutes and were quite intense. So that’s what we did. And another midwife came out, but I was only 2cm dilated. So she went away. And then another came out sometime on Tuesday evening. To be honest, all the days and nights blended into one. This midwife stayed until just after midnight, when the midwife I’d had all my antenatal care with came on duty. I called for her around 4am, when I was certain that the contractions were getting to the unbearable stage, which, I thought, must have meant I was in ‘established’ labour. Wrong. You see, despite the fact my contractions had been every 2 minutes since Tuesday afternoon, I was still only 2cm dilated. My beautiful baby’s head was really low, the midwives kept telling me. It wouldn’t be long, once I got to 5cm. It’s just that that was taking a long time. 

So, when, at 8 o’clock on Wednesday morning, my midwife told me that I was still only 2-3cm dilated, that was it. After over 17 hours of contractions, and no sleep, I gave up on my planned home birth. By 9.30am, my hubby and I were booked in a room at Royal Lancaster Infirmary, eating hot toast and drinking tea.

   
  Our journey up there must have been bewildering to the average Lancaster commuter. I decided I couldn’t cope with the speed bumps of Dallas Road, so went around the one way system. In rush hour. In Lancaster. I remember having the window down because I was too hot and felt nauseous. I remember the pain getting worse as we set off. I remember groaning and moaning as we waited at every set of traffic lights. I remember the look one young woman gave me. I remember it all, and it makes me laugh.

Dosed up on morphine, I was able to rest. I can only describe it as an out of body experience. I couldn’t feel anything. Not just the pain, but everything. My mind went wherever my pain did. Surreal, but blissful. I rested, the midwives kept the doctors away, and then headed up to sleep on the ward. Thankfully, around 11pm on Wednesday night, everything really heated up again, and I was finally 5cm. The following 10 hours whizzed by in a blur. They included lots of gas and air; an uncomfortable monitoring belt; an epidural (not originally wanted, but pure bliss); lots of wires and things attached to my body (7 in the end); and a wonderful Greek midwife. Finally, at 9 o’clock, just as new midwives arrived, I was ready to push.

   
 My husband really came into his own at the moment. He moved to the foot of the bed, and was my number 1 cheerleader. All I remember was drifting off to sleep between pushes, and the music playing from my iPhone playlist. Oh, and wondering why the midwife was telling me to really push now, as if I wasn’t pushing as hard as I could. Then, around quarter to ten, three thing happened. The duty midwife came in to tell me the doctors were itching to come in and give me a helping hand, as everything had been going on for a while. My husband went out of the room and told the doctors they were neither needed, nor wanted. And I realised that I really could push much harder. So I did. And at 10.02am on Thursday 21st January 2016, my beautiful daughter came into this world.
   
 So, was it as bad as people said? Yes, in that I experienced tiredness like never before. It was a marathon and so much longer than I was expecting. But at the same time, no. Of course, I had an epidural, so I don’t know how it would have been au natural, but that was the situation I was in. What made my experience so incredible were the wonderful midwives who guided me along the journey. Mainly though: Kelly, who was with me for a considerable amount of time as I laboured at home, and then provided my postnatal care; and Sheena, a South African student midwife. She was on her final placement, and she delivered my daughter. I couldn’t have felt safer, and those who have her as their midwife in the future will be very lucky. The midwives were brilliant throughout, and I felt empowered and in control all the way. Vive la NHS!!

There you have it. My labour of love. It was everything I hoped for, even though it was so different from what I’d imagined. It brought me my beautiful daughter, and I couldn’t be happier.