HSE’s attitude to breastfeeding throws babies out with bathwater
The Baby Friendly Health Initiative (BFHI) set up by the WHO and Unesco in 1991, which runs in 156 countries and has been in Ireland since 1998, has just been totalled.
The HSE stopped its funding last year and, after a year’s pleading and campaigning, the charity this week called it quits.
The HSE’s terse statement on Tuesday said that a review of the BFHI it carried out last year
recommended a revised model for breastfeeding support in health services be developed “in line with the Maternity Strategy and the HSE National Breastfeeding Action Plan 2016-2021”.
In fact, both of these HSE strategies are strongly grounded in the Baby Friendly initiative.
The HSE action plan even undertakes to audit exactly how many of our maternity units are meeting the standards to be designated Baby Friendly hospitals and promises that by 2021 all our maternity hospitals will be implementing the Baby Friendly rule-book, the WHO/Unicef 10 Steps to Successful Breastfeeding.
Despite this, the HSE last year told BFHI that they were reviewing the organisation and curtailed their funding before this review had taken place.
On foot of this unpublished review, they axed BFHI’s funding for this year. The HSE refused offers of discussion or mediation and thus broke the terms of BFHI’s grant aid agreement. They simply told the hospitals that BFHI was over.
Six of our 19 maternity units, University Hospital Waterford; South Tipperary and Cavan General Hospitals; University Hospital Limerick; Portiuncula; and the Rotunda have the coveted status which will soon be of merely historic value.
Eight others — the National Maternity Hospital, University Maternity Hospital Cork, Tralee General, St Luke’s, Kilkenny, the Coombe, Wexford General, and the Midland Regionals in Mullingar and Portlaoise — were progressing towards BFHI status.
This week the HSE says it’s planning to monitor the implementation of the WHO/Unicef 10 Steps itself.
This is self-regulation at its worst, particularly when you remember how abysmally our health service has so far fared in supporting mothers in Ireland to breastfeed.
Fewer than half of our babies are exclusively breastfed on leaving hospital while the figure in the UK is 81%, never mind the 90% in Australia.
What’s more, the breastfeeding rate goes down the longer a mother stays in hospital in Ireland, falling on average nearly 10% between birth and discharge.
BFHI was designed specifically to deal with practices such as those in Irish hospitals which discourage and even sabotage women’s best efforts.
When I interviewed Genevieve Becker, until this week the part-time co-ordinator of BFHI, for my 2010 book Mother Ireland: Why Ireland Hates Motherhood, her focus was not on women who wanted to bottle-feed but on those who wanted to breastfeed and weren’t given the chance.
I identified immediately because when I had my babies in the National Maternity Hospital in the 2000s so many of the 10 Steps were ignored that the entire staircase was demolished.
My babies were offered bottles in both public and private wings of the hospital. In the private wing I was repeatedly asked if I wanted my babies to sleep apart from me.
I was also told my babies would be fed every four hours when newborn; breastfed babies must feed whenever they wish.
I was told I was too tired to exclusively breastfeed and a nurse practically pleaded with me to introduce bottles for “combined feeding”.
None of this should happen in a Baby Friendly hospital implementing the 10 Steps which stipulate that babies should sleep near their mothers and feed from her whenever they want without distracting teats or dummies.
That is the only way most mothers can ever establish a decent milk supply before they face the big bad world.
Our breastfeeding rate has shown tiny improvements in the last decade. There is, however, no reason to believe that a practice which is as entrenched in our health service as bottle-feeding as in ours is no longer promoted in Irish hospitals.
The 10 regional co-ordinators for breastfeeding strategy in Ireland which have been called for repeatedly in official HSE policy are still nowhere to be seen.
The HSE says it’s not the money which is stopping it continuing the funding of the BFHI and that’s believeable, given at its height it was only €50,000 a year. So if it’s not the money, what is it? Control?
Genevieve Becker is outspoken and puts our appalling breastfeeding statistics in their wider cultural context. When I asked her in 2010 why the State’s support for breastfeeding was so poor she said simply:
“Because we don’t value children in this country. When you value children as the future of a country then you value their mothers and all the pieces fall into place.”
She saw those mothers sometimes ill-served by maternity hospitals when giving birth and said that experience impacted on their ability to breast-feed. She was not afraid to say the word “patriarchy”:
“There’s two things that men can’t do that women can”, she said. “Breastfeed and give birth. They’ve nearly taken away breastfeeding and they’ve done their best to take away birth too.”
There’s no point in a quality assurance scheme which isn’t completely independent and the BFHI was surely that.
As if to prove the point, in the wake of the HSE’s threatened withdrawal of their funding BFHI commissioned an independent survey of directors of midwifery and clinical midwives which found that some hospital staff did indeed resent BFHI’s rigour.
However a huge majority — 88% — found BFHI’s supports and resources useful or very useful. Most wanted the service expanded to include paediatric and community services. Most believed that without BFHI breastfeeding rates would decrease as policies like keeping babies skin to skin with mammies would be harder to implement.
The target of BFHI status facilitated one clinician quoted to audit her own practice while another said: “I hold our status as a BFHI hospital high up there as one of the greatest achievements of the hospital and one of which I am most proud.”
How does that clinician feel today? How do the staff in the six Irish Baby Friendly hospitals feel, after all the work they have put into implementing the 10 Steps, to see the entire Baby Friendly Health Initiative thrown out — and the babies with the bathwater?
Will the minister for health now demand the return of Baby Friendly, funded from his own
department like Hiqa, to force a health service which has failed mothers and babies, to catch
a grip and latch on?
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