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.