Sunday, 17 April 2011

Health Visitors

Well, you might have noticed, but although this blog hasn't been going for very long, I've already given Health Visitors a couple of mentions.  I'm passionate about good evidence based care for women during a really important time in their life: pregnancy, birth, and new motherhood.  The Health Visitor plays a vital role in helping mothers to bond with their babies, and care for them night and day.  They can influence the decision to breastfeed and its success or failiure.  They are there for women who may be becoming depressed.  They offer advice on health, sleep, feeding, weaning, growth, and much much more.  And yet in my personal experience, I have been offered some poor advice by them, and I have heard similar stories from many other mothers. 

I feel that this is an important issue and one which should be discussed.  Health Visitors surely all mean very well and would want nothing but excellence for new mothers and babies.  I would imagine it is a question, as always, of funding for training and development.  Perhaps if we gather together enough stories from mothers whose care has been lacking, we might be able to make a case for this.

Here are a few of my personal experiences with Health Visitors:
  • When my baby was a couple of weeks old, the HV told me that I was holding her 'too much' and that I needed to start 'putting her down', or I would create a 'bad habit'.
  • She told me that under no circumstances should I sleep with my baby in my bed, and that if I did there was a real risk of death by over-laying.  This is not evidence based advice.
    • When I told her in the clinic that one of my breasts felt uncomfortable, she took me off to an empty room and told me to show it to her.  She did not ask me to undress behind a screen or follow any of the procedures I believe are standard for such examinations.  I am not a particularly prudish person, but I do remember feeling a bit 'pushed around' by her approach.
    • The Nursery Nurse told me that babies were just like dogs, and that you just had to train them to do what you wanted.  She said that if I responded to my baby every time she cried at night I would create a bad habit.
    • When my daughter was just over six months old, I asked the HV for advice about sleep, as my daughter was waking very frequently to nurse.  She told me to 'Pack her full of as much solids as possible, then she'll sleep, and if she keeps waking up after that, just give her water.'  When I replied that I didn't think you were supposed to rush solids, and that I had read that that breast milk should remain primary in the diet for the first year of life, she replied, and I quote, "Nonsense.  Milk is just a drink now."

    I had a different HV for my second baby, who has seemed to be slightly less draconian, or maybe I was just slightly more draconian, and thus discouraged her from giving advice.  However, in our few brief meetings, I have still had some concerns:

    • She had not heard of or read the book, 'The No Cry Sleep Solution'.  This book about gentle night time parenting has sold millions of copies and been translated into 18 languages.  I would expect someone who is paid to give advice about babies and sleep to have at least heard of it, and preferably read it.
    • I overheard her advice to the breastfeeding mother of a 4 week old baby who was not getting much sleep.  She suggested that the mother did not pick the baby up every time it cried, but to pat it while it lay in the cot instead.  She also suggested the the mother try using a dummy, with no caveats, despite UNICEF advice that 'all breastfeeding mothers should be discouraged from using teats and dummies during the establishment of breastfeeding.'  Both of these pieces of advice risk jeopardising attachment, milk supply and the breastfeeding relationship in such a small baby.
    • When my own baby had some weight gain issues around four or five months, on two separate occasions she and the Nursery Nurse both told me, 'Don't worry, it's not long til she starts solids'.  I felt that this statement betrayed a lack of confidence in breast milk and undermined my hard work as a breastfeeding mother. 

    Health Visitors are in a position of great power.  It is said that the hand that rocks the cradle rules the world, and often the Health Visitor is giving advice to the cradle rocker about everything from the size of the crib to the frequency of the jiggles.  New mothers are often shocked, exhausted, perhaps traumatised by a difficult birth, and looking for advice and guidance in a world that has lost much of its community wisdom.  Health Visitors are often the only people that first time mums can turn to for help, and if they are being paid to give advice to such vulnerable people, they should be well read and up to date with the latest thinking and research.  Advice should be evidence based and not founded in their own personal views or parenting approach. 

    If you have a story to tell about Health Visitors, good or bad, please post it as a comment below, or email it to me via my blog.

    We are the cradle rockers, so if a change needs to be made, let's make it.


    8 comments:

    1. My first experience of a health visitor was fantastic - I lived in a small village and you actually got a proper appointment in a private room - so much nicer than the bun fight that is most "baby clinics"... When we moved we had the same health visitor for nearly a year and she was great. More than happy that I was having the babies close together, encouraging of breastfeeding, baby led weaning, home birth etc etc. But then she left...

      And we had an un-ending succession of different people so I just dropped out of the system. As with you the only advice I was ever given re sleep was the Richard Ferber method of leaving them for going back to them repeatidly leaving a bigger gap. I dont disagree with him if nothing else has worked but it would have been nice to be presented with some options! She took the attitude of - You want her to sleep? Do this.

      My general opinion of anyone in the health care profession involving children is that some are great - some are awful and there are varying degrees in the middle. Once again, as with all my crusades... I want Health vistors and Midwives to all be of top standard, uptodate in training and basing their decsion on fact and experience, not their own personal belief or misguided ideas from the 70's...

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    2. I previously posted about my frustrations with HVs: http://chatty-t.blogspot.com/2010/08/fed-up.html

      I do really think it's the luck of the draw as have heard from some who had fanstastic experiences, as well as others who had terrible ones with HVs.

      Also, after writing the above I didn't return to a HV until my daughter's 1 year appointment at which I had a new woman who also had young children, could relate to being a new mother much more and who looked at my daughter within her own context, rather than as an out of context number on the chart. Aside from sometimes pushing misinformation, this seems to be a common downfall of health visitors. They have standard charts and benchmarks and if children don't measure up to them they often see that as a red flag before considering the wider circumstances and evidence.

      Hear hear to your mission!

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    3. thanks tanya!
      i checked out your post. i've had weight gain issues too with my second baby and it is so hard, very emotive, as we so desperately want them to thrive, and especially when breastfeeding and we cannot see how much they are getting...it's tricky.
      i am getting lots of stories about HV's at the mo and intend to gather them together over the next few weeks and forward to my MP.
      i will be writing a follow up post soon.
      thanks for reading x

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    4. Hi! I'm really glad you wrote about this, because very sadly, I'm sure these sad difficult experiences are shared by so many many mums. I was very lucky in terms of HV, as I had a very calm very experienced HV who had travelled much and it seems had been exposed to many different ways of doing things. However, after she left, I did meet some HVs whose advice I just generally ignored and I went on doing my own thing, co-sleeping, picking her up when she cried, pretty much the same things that you have done, (attachment parenting, I believe). I too looked at Elizabeth Pantry's No Cry Sleep Solution, and did a lot of it.
      We did eventually move G in to her own room, with a little trick, we moved her in to her own room, straight after a holiday, and have never looked back since. But we have also played musical beds etc. I suppose the mantra, this too shall pass, is so very true. I try to remind myself that it won't be long before she's a teen who won't want to be seen with me (I hope not!:)) Good luck and sounds like you're doing great! (Sorry for the long comment)

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    5. I couldn't agree more! I have repeatedly been shocked by how uninformed the advice of HV's and midwives can be. I was better read after a year of having a baby than any health professional I know. Do they not have any continuous professional development? And if they do, what on earth are they learning? Certainly nothing of what I have learnt, and though the books I have read are by their very nature 'popular science' and therefore dumbed down for the lay person, I can sort out for myself the ones that apply with common sense the findings of real science (unlike Gina Nazi Ford).

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    6. thanks lysterical i quite agree. x

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    7. My health visitor experience was neither positive or negative really. She was super-pro breastfeeding, to the point I where on more than one occasion it crossed my mind that if had been a formula feeding mum, I probably would've felt very ashamed for not breastfeeding!
      I can't remember much as the first 6 months of my baby's life were a blur, but I can remember feeling like she didn't have much time and I never knew if it was ok to ring her or not.
      We also had some weight gain issues in the early days where my baby lost over the average amount of weight and took 4 weeks to get back up to her birth weight. I do remember feeling very stressed and I didn't like the almost daily weigh-ins. But my HV kept stressing that it was only a precaution and that my baby appeared to be very alert and fine in every other way, so that was quite helpful, but I still could've done without the constant monitoring. She did mention supplementing with either expressed breastmilk (yeah right! My baby was nursing round the clock, I didn't have time to express!) or formula, but I didn't do either in the end.
      But I have heard some horror stories from other mums regarding their experiences with HVs, so I do agree this is an issue that needs to be addressed!

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    8. thanks Michelle, that's an interesting story. especially of interest to me the suggestion to supplement. you could well have felt vulnerable at this point and reached for the formula.
      i have just emailed the MP so watch this space! x

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