Breastfeeding, Tyranny and the RCM’s new Breastfeeding Statement

“End of breastfeeding tyranny!” scream the headlines. “Midwives instructed to stop shaming mothers!” they tell us, as though this is a new revelation that they’ve discovered, as though anyone, ever, telling women what to do, is something that any reasonable person should support.

Where has all this hyperbole come from?

The RCM has released a new breastfeeding position statement. It says, “Breastfeeding, more than any other health behaviour, has a broad-spectrum and long-lasting impact on public health.” This phrase itself should be repeated (and repeated and repeated) at every opportunity by every person campaigning to improve support for breastfeeding. Why is it that this isn’t the phrase that was picked up by the media and splashed across its headlines? Instead, they decided to focus on the phrase, “[if] a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.” It seems that this message, above all others, has been the one chosen to splash across the front covers. It’s a desperately important message, and one that I wholeheartedly support. It is at the root and centre of the training of breastfeeding counsellors, who are required to offer non-judgemental, woman centred support including to women who don’t want to, or who want to stop, breastfeeding. It breaks my heart to read the awful stories that are abounding today from women who have had midwives who are more worried about their BFI status and breastfeeding stats than the people in front of them and I completely agree that any undue pressure must stop, just as women should not be pressured to NOT breastfeed.

But here’s the problem: The media don’t care about breastfeeding support, nor do they give a hoot about the women and babies who are mixed up in the middle of this. All they want to do is to create enormous straw men. In fact, they aim to create a veritable wicker man, with supportive non-judgemental care, and the consequential negative impacts on women and their babies, being the burning sacrifice, all with the aim of kowtowing to the god of the fruit of newspaper sales.

The RCM’s report is packed with hugely valuable and important statements. Let’s just take a look at a few of them:

  • Clinicians should make every effort to support skin to skin for an hour after birth
  • Maternity units should be appropriately staffed, and sufficient investment made In postnatal care to enable each woman to get the support and advice she needs to make informed choices about feeding her baby.
  • UK-wide Infant Feeding surveys (which were discontinued in 2015) should be reinstated

These are just a few examples of some of the really important details that could have been covered by the media, but which have been ignored in favour of the more colourful, but morally vacuous focus on what they are calling “the breastfeeding tyranny”. A reasonable discussion about the removal of qualified support for women where breastfeeding groups have been decommissioned, or a campaign to upskill midwives who are expected to support women to breastfeed with a few days of training (compared to the two year breastfeeding counsellor course), or perhaps an article on why women are still having their babies taken from their bodies and denied skin to skin – these would all be hugely valuable topics for the media to cover. These would all be game changers for mothers and babies.

Let’s not be under any illusions. The media used the component of the report that it did and ignored the rest because it sells newspapers, and it increases the rhetoric that causes even more stress and distress around infant feeding. This was not intended to support women, nor to help those who have had the horrific experiences that we see in the comments section today, and who we must continue to listen to, hear and demand change for,  but to sell newspapers. Nothing more.

 

 

 

 

ARM Study Day 2018: Conference Review by Ruth Weston

The 2018 ARM study day in Wigan was described by Dr Lesley Choucri as “Midwifery Nourishment” and I couldn’t agree with her more. This was a wonderful day of learning, sharing and refilling our cups ready to go back to our own regions “Stronger Together”.

“Stronger Together” was one of Kathryn Gutteridge’s themes, which came out of her desire to remind us all that we need to stand together during these challenging times. She pointed out that all midwives are midwives, whether they work for the NHS, private companies or as independent midwives. For the good of the profession – and every midwife – we MUST support each other. There is so much horrific bullying, and areas of practice which are lacking in compassion. Can each person make a change by reflecting on their own practice?

Of course, Better Births was an essential part of the ARM study day, and Claire Mathews , deputy Head of Midwifery for NHS England, outlined its implementation with a focus on Continuity of Carer. Because this was a midwifery audience, Claire focused on the understandable worries that some midwives have of how continuity will work for them, especially as some midwives have experience of continuity services where they were given entirely unreasonable caseloads. With a short-term target of around 20% of women to have continuity, Claire recommended that initially trusts worked on encouraging those midwives who were interested in offering continuity to jump in and have a go, lighting the way for others to follow.

I was particularly struck by Jo Dagustun’s talk on her research into women’s experiences of birth which was an uncomfortable listen for the audience of midwives. Jo explained her PhD research which included women’s experiences of  the maternity system.

The key messages I heard in this excellent, many-layered reflection were:

  • That for women the key antenatal teacher/education was their experience of the maternity system itself.  What women are told in antenatal classes and by professionals about what they can choose, the care they can ask for or receive is over written by actual experience.
  • That women’s experiences of the maternity system, including birth, is of a ‘hostile’ environment; spaces and interactions that do not feel friendly towards the health and wellbeing of mother and baby. Women therefore made decisions on what they saw as the best way of protecting the physical and mental well-being of themselves and their child. Far from this resulting in choices for midwifery led care it often resulted in women choosing a medical birth. It also resulted in women providing partial information or telling professionals what they think is expected rather than the truth.
  • Finally, the women interviewed did not see midwives as a distinct profession with in maternity. Indeed they were not clear what midwives are. Processed through a fragmentary system and seeing multiple professionals, midwives did not stand out. In this context women did not want continuity so much as kindness from the professionals they were with.

This final point provoked a lot of reflection. It is shockingly sad that kindness is not standard in the maternity system. It is also disturbing to realise that midwifery does not stand out to most women in the maternity system. Is this how far the profession has faded? Just another health care professional doing their job? It also has some real consequences for continuity, for instance, who would want continuity from a midwife who did not show kindness?

Finally, Jo, with admirable tact and honesty, presented an example of an interaction between a service user and professionals on social media. What came through to me were professionals who thought they were being kind and helpful but from the service user’s perspective were not. Also, she showed health professionals who wanted the service user to see it from their point of view but did not themselves ‘stand in the shoes of the woman’ – surely a mark of the with-woman profession of midwifery. We need to reflect on how much the maternity system has broken the midwifery tradition of being with-woman and made the midwife a just another health care professional.

In better news, a big shout out needs to happen to Airedale Hospital Trust who have been a shining light on the issue of Independent Midwives and their ability to offer intrapartum care, as Airedale is providing them with indemnity to ensure that they can continue to practice. In return the Trust has these amazing and skilled midwives sharing their experience and knowledge, leading to improved services to women and happier staff. Airedale join several other Trusts across the country who are supporting Independent Midwives in a similar way, as is outlined in the recent IMUK blog.

Aquabirths Hi-Lo Keeling Birth ChairMargaret Jowitt’s Hi-Lo system was on display alongside the Aquabirths stand (see photos to the left for two ways that the Hi-Lo can be used). Also known as the Osborne Kneeling Chair, this wonderful piece of kit is a must for every obstetric room. It is a simple, strong and easily cleaned frame with cushioned supports which women can kneel, lean or sit on. The Hi-Lo is designed to ensure that midwives can easily access women for observations, and the small footprint means that it will fit into most obstetric rooms with ease. A video explaining how the Hi-Lo works is hereSoftbirths Mini birth couch

Aquabirths also had their Softbirths mini birthing couch on display which midwives Deborah Hughes and Deborah Neiger had fun modelling as you can see!  A smaller version of the full birth couch, the mini couch fits into smaller spaces to provide comfort and support to women in different upright birthing positions.

ARM Coordinator, Katherine Hales, rounded off the day with an update on ARM’s campaign for an independent midwifery regulator. The NMC is not fit for purpose as has been discussed on this blog multiple times. ARM now believes that it is essential that midwifery is separated from nursing, and has regulation which focuses on the needs of midwives, which the NMC simply does not do. The focus now is on the midwifery code and midwifery panel being managed by midwives under the umbrella regulation of the Health and Care Professionals Council which oversee many other similar sized groups, such as physiotherapists. This regulator seems to work better to support the professionals it oversees than the NMC does.

All in all, an exceptional day – many thanks to ARM for all their hard work!

#WiganARM18