Many parents, including myself, have encountered a range of health professionals including doctors, nurses, midwives, health visitors and dieticians who are less than supportive of this approach. They may even be downright negative or antagonistic about your childrearing decisions, as though they are somehow new-fangled and dangerous! Why is this? Why are child-rearing practices common in most of the world, and common in the UK until recently, viewed with such suspicion? Well, I guess I can look back to my own nurse training and experience on the wards to help me answer this.
Fundamentally, parents assume a high level of training and knowledge about birth, child development and child nutrition from our NHS practitioners, and actually, this is not necessarily the case. Each role is highly specialised. While the NHS is keen to promote breastfeeding, as a paediatric nurse, I received no training on how to support a breastfeeding mum. I’m sure the role of breastfeeding in terms of nutrition and immunity was at some point mentioned on my course but we were not trained in helping a baby latch on or how to help a mum to maintain her milk supply if the baby can’t feed. I think we were supposed to just pick it up. You could argue that this is an essential skill for staff working on wards with newborns. I am prepared to bet that doctors do not get this training. It is the role of midwives, health visitors and lactation consultants, and, as we know, they are in short supply, lacking the time to give the help and support they may well want to give. This is, of course, the irony in televised debates about breastfeeding – the medical expert they whip out is never a lactation consultant or a midwife, it is a male doctor who has probably had next to nothing in terms of lactation training or experience!
Conflicts are also cultural – while parenting may feel like it should be about instinct, warmth and closeness, the NHS runs according to a scientific work culture. In health, we work on numbers, percentages, weights, millilitres, on hourly routines and schedules. Evidence-based practice for successful outcomes. With unwell children or babies failing to thrive, we have to keep strict records of input and output and weights. Writing “had a 5 minute breastfeed” is very unsatisfying. We want to write, “took 100ml”. It doesn’t matter whether it is formula or expressed breast milk but part of doing our job is making sure the baby is getting the target fluid intake for adequate hydration, nutrition and growth. In this situation, it is unsurprising that mothers of babies in Special Care Baby Units feel pressured to accept bottle-feeding; staff are convinced it is the only way to know whether the child is feeding properly. We know about the manifold benefits of breast-feeding. For sick babies, we think about milk in tummies, ticks on charts, and for good reason.
Also, us medical people are deeply paranoid. We have seen very sick babies, traumatic births and deaths, tragic accidents. We want to minimise risk as much as we can. I know two female doctors who opted for elective C-sections because they had become too scared of natural delivery – they had developed a skewed vision of birth during their training and practice and perceived a major operation within the familiar medical environment a safer, more predictable prospect. Similarly, no one is more fearful of home birth than a doctor or nurse working in A&E or the Neonatal Unit because they only see the cases where things don’t work out as planned. After a placement in NICU, I myself chose to have both my children in birth centres in hospitals, medical help at hand. Once you are in that mind-set it is very hard to overcome it. Any risk must be avoided – relating to birth, sleeping arrangements, or even baby-wearing – after all, what happens if you fall over?? Have you thought about the head injury your baby could sustain??
Then there’s the liability question. In an increasingly litigious culture, health professionals are under pressure. Co-sleeping has been a hugely controversial issue in this country, particularly in relation to sudden infant death. Health visitors and midwives must advise that the baby sleeps in a cot near the parents’ bed but when a parent expresses an intention to co-sleep, the practitioner should give advice about how to do so safely – avoiding alcohol and drugs, preventing suffocation under bedding etc. NHS professionals are always at risk of being struck off or sued if they give incorrect advice or care and it is small wonder that health visitors may err on the side of caution and advise against co-sleeping to protect themselves from any perceived risk. After all, their career is at stake.
I guess the thing is, people working in health are working to government protocols, NICE guidance, trust policies. In a way, it doesn’t matter what our personal view or experience is, we are representatives of a service. I personally have toyed with training as a health visitor – helping parents and young children find their feet, family friendly hours, what’s not to like? But then, it would involve a lot of hypocrisy on my part. I don’t think I could tell a mum not to co-sleep. I slept with my parents when I was little, both my babies have slept in our bed. I don’t think I could advise parents to try controlled crying, a recommended option according to the Solihull Approach leaflet given to me by my health visitor. It might work for some people, but I cannot leave a baby to cry.
That’s actually a good thing about my paediatric experience. We never let babies cry if we could possibly avoid it. Right now, across the country, nurses, health care assistants and students are rocking babies at nursing stations or singing them to sleep in equipment cupboards or treatment rooms so their mums can get a bit of shut-eye. I have even seen the Paediatric Nurse Practitioner, in charge of the whole hospital on a night shift, stopping to shush and swaddle.
Nowadays too, the NHS is focused on family-centered care. We recognise the importance of attachment and try to keep families together as much as possible. After all, all a child really wants and needs is the person they love the most, be it mummy, daddy or granny. So for child inpatients, rather than sending parents home like they did in the 50s, we find a way so that they can stay 24 hours, either in a put up bed next to their child or in local accommodation Kangaroo care is also now widely encouraged in Neonatal Units across the country and is a brilliant way for Dads to bond with new infants too. For all the negative publicity about NHS staff these days, in paediatrics at least, I only ever saw people who genuinely cared and usually went above and beyond to help families experiencing tough circumstances.
So while we may end up frustrated and irritated by our encounters, I guess it’s helpful to recognise why health professionals act the way they do and also accept their good intentions. If you find a good one, be it a GP, midwife, health visitor or nurse, hang on to them. Someone who reassures you, empowers you when you feel vulnerable and helps you trust your instincts is a good person to have around. After all, these people give you advice but you are in charge. Because no one knows your child like you do.
Original version published as a guest post on Attachment Feminism