Sunday, September 11, 2005

When is a policy not the policy?

This is more than just a grammatical puzzle. Hayley sent me a SMS in the night. The midwife who gave our ante-natal classes, Jackie, was on duty on the ward and she had a long talk with Hayley. As I suspected Jackie confirmed my fears about how the midwives on the ward had been handling Oliver's feeding. She was horrified to find that they were totally contradicting the hospital's policy on breast-feeding which is that it should be baby-driven (ie when he wants it) and without interventions such as the use of cups, teats and bottles of formula milk. We have been using cups when he will not take the breast and topping him up with a prescribed amount of formula in a cup on top of expressed breast milk. And Hayley has been doing this every 3 or 4 hours. Consequently she has barely had any rest. Jackie's view, and also the hospital policy which they should have been following, prescribes that the baby should be left to sleep (especially as he was not even 3 days old) until he wakes and shows signs of wanting milk. The midwives have been making us wake him up every 3 - 4 hours whether he wants to or not. I feel rotten about that now. And I feel angry at the midwives. What is the point of having a policy if you are going to ignore it!

Hayley said that Jackie was fuming and said she was going to write a report to highlight what is going on. Hayley then heard her talking quite heatedly to the staff after leaving her room. Jackie thinks that the reason they give such bad advice and want to intervene so much is that they also work down the corridor in a unit for premature babies. At one point one midwife was even talking about potentially using a tube to feed Oliver. Jackie was aghast at this. As she pointed out, he's 15 days late: you might do that sort of thing with babies that are 15 days early, but not 15 days late after a traumatic birth. You can expect such a baby to take up to three days to really come round and want to feed at a level you'd expect. Until then he will rest and sleep a lot. Oliver has been doing that and his blood sugar has been good on the two occasions it was tested. Plus he is alert when awake, so all the fretting and intervention was completely unnecessary.

Anyway we are now steeled for any further attempts to intervene which we will resist resolutely.

On a more positive note, Oliver woke and fed from the breast for 40 minutes in the night. This is a big step forward. He takes more readily from one breast than the other. Once he is taking from both we are going to bring him home. Our "home" midwives are all in line with the policy and are very good at getting babies to breast-feed. What is more, Hayley will be able to get one-to-one assistance from them once she is at home.

Last night after Hayley sent me the message about her talk with Jackie, I lay awake for an hour feeling furious and frustrated. Then I realised: I was already worrying! Because Hayley is a bit of a worrier, I kind of expected myself to be able to be the less worried partner: concerned but calm. But there I was after 2 days lying awake worrying about him!

I went to see them this morning but left shortly afterwards as they were both having a rest. I sat next to him with my face about 6 inches from his and just watched him as he slept. Then he grimaced and filled his nappy. Even that seemed like a command performance to me.