Avoiding Hospital Booby Traps

This blog is not intended to scare moms to be - but as a hospital trained midwife it’s important for you to understand the realities of breastfeeding in many hospitals. This blog is also not intended to be disrespectful to staff who do their best to provide sensitive, evidence based care under very difficult circumstances. We all wish we had more hours in the day or a second set of hands to help moms get the support they need during this vulnerable time.

Understanding the pressures on staff and the culture within the hospital means you can line up education and support ahead of time. Mindfulness practices are associated with more breastfeeding confidence and less overwhelm. Your mindfulness practice will be such an important tool to support self-advocacy. As you’ll see staff are pulled in so many different directions it’s impossible to give breastfeeding moms the support you need in those important few days. You’ll need every tool in your mindfulness toolkit to not allow a challenging hospital culture to impact your journey when you’re feeling overwhelmed - especially on the 2nd day when baby begins clusterfeeding.

I’ve already written about some of the challenges that come with starting breastfeeding in a busy hospital. Let’s take a look at what midwives and nurses say about their experiences supporting new moms as staff make up the hospital culture.

Hospital culture can sometimes inadvertently create barriers to starting breastfeeding. While healthcare facilities play a crucial role in promoting and supporting breastfeeding, certain aspects of hospital culture can make it more challenging for new mothers who are already feeling overwhelmed with the difficult positions still being taught. The majority of staff taking care of you do want to see you succeed but demands on staff can make it very difficult.

‘It's the basic weighing and things, but not time to really sit and talk with you [about breastfeeding]

‘It was much harder than I thought it would ever be. I thought it was just one of those things you just do. But I actually, really struggled with it.’

‘I just assumed it would be something that came naturally and you do what you do, so it hadn’t really entered my mind to start on formula or anything like that. And I cried the first time I put her on a bottle.’

A perceived inability to meet babies’ needs could be a devastating realisation.

‘Particularly if you come from knowing how to do everything, and then all of a sudden you don’t know how to do it. I can control the room of a hundred kids and I can’t control one baby!’

Note the outdated upright position and complicated hold. This is not an optimal approach for breastfeeding success. Save this position for when you are more recovered.

Here are some ways in which hospital culture can be a barrier to starting and continuing breastfeeding.

Lack of Education: In some hospitals, staff may not receive adequate training on breastfeeding support. This can result in a lack of knowledge about proper breastfeeding techniques and positions, making it difficult for new mothers to get the guidance they need.

These comments came from newly qualified nurses in Australia.

“I had no experience with breastfeeding …” (Taylor).

“I was starting from zero” (Riley).

“I was supposed to help her, and I was supposed to know what I was doing. But I didn't” (Charlie).

“… at the beginning, I felt like I was trying to avoid patients that needed breastfeeding support because I just felt like I wasn’t good enough” (Riley).

Short Hospital Stays: Many hospitals have relatively short postpartum stays due to cost constraints or other factors. This can put pressure on new mothers to establish breastfeeding quickly, potentially causing stress and anxiety. Staff often don’t have time to sit for the full feed as they have so many other tasks they have to get through. Consider hiring a postpartum doula to come to the hospital and continue support at home.

Formula Supplementation: Some hospitals have a routine practice of supplementing breastfeeding with formula, often without clear medical reasons. This can interfere with establishing a consistent breastfeeding routine and undermine your confidence in your milk supply.

Limited Support Staff: High staff-to-patient ratios can make it challenging for staff to provide individualized breastfeeding support to every new mother. This lack of support can hinder the initial stages of breastfeeding.

Inconsistent Advice: In some cases, different healthcare providers in the hospital may offer conflicting advice on breastfeeding, causing confusion for new mothers.

‘… every nurse had a different opinion and with me having issues latching on, they would each come in and grab me …’

Cultural Norms: Hospital culture can sometimes prioritize the convenience of healthcare providers or institutional protocols over the specific needs and preferences of breastfeeding mothers.

In one study several midwives talked of the intense relief experienced when a baby was fed, and the midwife was liberated from a potentially time consuming activity. Supporting mothers who have inverted nipples and wish to breastfeed can be a complex activity that requires patience, and considerable time and effort from the midwife (Dewey et al., 2003). This excerpt below illustrates the relief felt when spared this experience:

“I’m sure that every midwife feels that sometimes you are relieved when a woman's bottle feeding. If you’re tired, the ward's busy; you are relieved, especially if the woman's got inverted nipples. You think “That's back breaking work for a midwife”. You do feel a certain (relief) “She's bottle feeding”

Marketing of Formula: Some hospitals receive marketing materials and free samples from formula companies, potentially influencing the promotion of formula feeding over breastfeeding. The following excerpt is from a UK study - ‘Breaking the rules’ in baby-feeding practice in the UK: deviance and good practice?

Several midwives described how they used strategies that were contrary to practice espoused by policy. For example, bottles of artificial milk were frequently offered to breast-fed babies by these midwives: If she’s absolutely shattered and sleep deprived it’s the worst sort of deprivation you can have. It might be better that the baby has a bottle for Mum’s sake so that she can come too mentally, physically and psychologically. (Joanne) In fact, bottles of artificial milk were considered to be essential for successful breastfeeding when mothers were struggling: I know from experience, I’ve seen them and they’ve said I really don’t want to feed any more and I’ve said ‘Right, we’ll give the baby a bottle, you go back to bed, have a sleep. I’ll look after your baby in the nursery’. (Lucy).

Limited Lactation Consultants: Access to lactation consultants can vary between hospitals. Some hospitals may have dedicated lactation support teams, while others may have limited resources, making it difficult for mothers to receive timely assistance.

Rooming-In Practices: While rooming in (keeping the baby in the same room as the mother) is generally encouraged, some hospitals still have practices that involve separating mothers and babies for extended periods, which can disrupt breastfeeding initiation.

Lack of Privacy: Inadequate facilities for breastfeeding or pumping can make it challenging for new mothers to breastfeed comfortably and without interruption.

It's also important to note that many hospitals are actively working to address these issues and promote breastfeeding-friendly environments. However, variations in hospital culture and practices still exist. In most cases staff really are doing their best - it’s just not the optimal place for learning about breastfeeding while also recovering from birth with minimal sleep.