For most GPs observation of a full breastfeed is not a standard part of their training. Witnessing normal breastfeeding in the context of a Breastfeeding Support group (eg. Baby Cafe or Drop-In run by Peer Supporters) can:
- Develop an appreciation of the work done by Breastfeeding Support volunteers
- Enable appropriate signposting to local support
- Help to appreciate that the disproportionate presentation of breastfeeding problems seen in consultation can skew a clinicians’s perspective on breastfeeding outcomes
- Help the GP to learn to identify problems with breastfeeding technique
It is important to point out that observing at a Breastfeeding Support group alone will not give the GP adequate expertise for assessing breastfeeding management, and all women with breastfeeding problems should be signposted to experienced supporters.
However, observing breastfeeding support can help a GP to enable breastfeeding mothers to maintain breastfeeding for as long as they wish to (having developed an understanding of the purpose of breastfeeding support) and to be able to reassure mothers that improvements to attachment and positioning at the breast can often significantly improve the breastfeeding experience.
Here GPIFN member Dr Rosemary Marsh talks about her experience attending as an observer at a Breastfeeding Support Drop-In via contacts made through GPIFN. GPs who are interested in undertaking a similar observation are welcome to request to join GPIFN to network with local colleagues. Alternatively, the Health Visitors or area Infant Feeding Lead will have details of local Breastfeeding Support groups.
I attended the group and observed how the support workers approached the mothers and gave support or advice for varied breastfeeding problems. The most stark difference in their approach to that I have come across in Paediatric and GP Practice is that they had so much time available. They were able to let the mothers sit and feed at their leisure over a 1-2 hour period. There was no concentrated observation of technique or latch or ‘history taking’ but this emerged organically by observing how the mothers and babies behaved during a normal feed and by just chatting to the mothers about their experiences…Mostly they simply offered support and just a chance to chat in an environment where other mothers also feeding normalised the process and their experiences.
There were some problems for which they gave little bits of advice for example they explained different possible (feeding) positions and explained when baby was actively feeding vs comfort-sucking from observation of the feed.
They supported the use of supplemental feeds in one mother where it seemed apparent that the baby was not thriving on breastfeeds alone and appeared unsatisfied after feeds (NB this had already been recommended by other professionals so they didn’t change management, simply supported its implementation alongside breastfeeding).
They also gave some advice about possible thrush vs other causes of nipple pain in one mother. This was contrary to the advice the mother had been given by her GP previously but they were quite sensitive in the way they approached the idea that the presentation may have changed with time since she was seen by her doctor and also that the GP’s opportunity to observe the feed and their limited experience of breastfeeding may have made their impression different to that which was most likely today.
If I come across scenarios where mothers are unable to access such groups I can also feel a bit more confident in giving some advice/support which I think will be in line with theirs…The experience has also motivated me to try to spread knowledge of these services, and of common breastfeeding problems, to other colleagues.
Dr Rosemary Marsh, GP Specialist Trainee, MRCPCH