mums and babies survey - hcypf...7 “i was told by family and friends that breast feeding can be...

1

Mums and Babies

Survey

Highland Children’s Forum

June 2017

2

Introduction

Priority outcomes for maternal and

infant health and wellbeing are part

of For Highland’s Children Service

Plan (FHC). Some of these targets

are missed but the reasons why

are not always clear. Highland

Children’s Forum was keen to hear

from mothers about the support

they received and how it might be

improved. This report asked new

mothers about their experience of

support from pregnancy through to

early parenthood, with particular

interest in the health and wellbeing

of the mother and the

establishment of infant feeding.

FHC target for exclusive

breastfeeding is to achieve 33% at

the 6-8 week review. The current

rate is 31.3% reported in

Performance Report – Children’s

Services June 2017.

Internationally, the UK has one of

the poorest breastfeeding rates

(Lancet 2016). There is an

increasing body of evidence of the

benefits of breastfeeding from the

World Health Organisation, UNICEF

and the Lancet . Breastfeeding

improves the health, intelligence

and social capacity of children and

therefore ultimately is an

investment in the wellbeing of

individuals and the overall

economy of a country (Lancet

2016). Breastfeeding Uncovered

(Brown 2016) considers the

support offered

to mothers and

looks at barriers

to breastfeeding.

Brown presents

steps to improve breastfeeding

rates, summarised in appendix 1.

Some of the barriers described and

proposed solutions are echoed in

the responses from participants in

the survey.

NHS Highland Mental Health

Improvement Group has a priority

to improve perinatal mental health

support. Recent research published

in the Lancet (No health without

perinatal health Lancet 2014)

found that there can be negative

impact of perinatal mental health

issues on the child’s development

and mental health up to

adolescence. In Highland there is a

perinatal mental health nurse to

whom mothers can be referred,

mentioned by some respondents.

Better Mental Health For All

(Faculty of Public Health 2016)

outlines the importance of

universal support of mothers in

pregnancy and early parenting for

the mental wellbeing of the

developing child. The Royal College

of Midwifery (2012) recognises that

supporting women well through the

transition in to parenthood can

improve the mother and child

relationship and therefore the

development of the child.

http://www.who.int/features/factfiles/breastfeeding/en/

https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/breastfeeding-in-the-uk/

http://www.thelancet.com/series/breastfeeding

3

Method

A Survey Monkey was designed to

ask:

Where mothers got most

information about their pregnancy,

birth and early parenthood.

About maternal health and the

support participants received, in

terms of both physical and mental

health, during the antenatal,

delivery and postnatal period.

Information and support about

infant feeding.

Support in the ongoing health and

development of their baby.

Lastly respondents had the

opportunity to say what support

had been most helpful, where there

are gaps in support and what might

improve support in the future.

The Survey link was shared with

health managers to cascade out to

practitioners and from there to

mothers. The survey was also

shared via breastfeeding and other

parenting support groups online.

Initial responses tended to be from

a particular range of mothers (in

their 30s, married and home

owners). This particular

demographic is likely to represent

mothers who are in supportive

home situations. The lack of

representation of mothers in less

supportive home circumstances

was concerning, as these are likely

to be the mothers most in need of

support from services.

It was felt that offering the survey

as an online link may have limited

access and so the survey was

produced in hard copy, which

health professionals or others could

pass on to mothers. Stamped

addressed envelopes were provided

to enable anonymous survey

return. Hard copies were

distributed through Family Nurse

Partnerships and Health Visitors

who requested that format. The

deadline for response was

extended meaning the survey was

live for 3 months.

4

Question 1

About Participants

75 mothers returned the survey, 8 as hard copies posted back.

Bar chart comparing maternal age of respondents with maternal age of general

population in Highland (2016).

This is less than 5% of mothers in Highland. The age range of respondents

corresponds to the age range of mothers in Highland in 2016 as shown in the graph above. The greater proportion of mothers in the 30 + group participating

meant there was a consequent lower proportion of mothers in their twenties.

74 respondents indicated their relationship status, 44 were married, 23 in a

relationship and 5 were single.

0

10

20

30

40

50

All ages4 Under 20 20 - 24 25 - 29 30 - 34 35 +

Maternal Age

Percentage Maternal Age Highland 2016 Percentage Maternal Age Mums and Babies Survey

5

Bar chart of the percentage of respondents reporting living in urban, rural or remote

areas of Highland and percentage of respondents in different housing situations.

Respondents were asked to indicate if they lived in an urban, rural or remote

area of Highland (68 responses) and what their housing situation was (70 responses). These responses have been roughly compared to Scottish

Government Urban-Rural Classification for Highland and the Highland Housing Strategy “Housing Tenure”. In both instances, the comparison is not accurate as the classifications were not identical. The Scottish Government have a 6-fold

classification, and respondents were offered a 3-fold classification of urban, rural or remote. Respondents may have had different ideas about what

constituted urban, rural or remote. There is no percentage given in the Highland Housing Tenure for young parents living with wider family, but the

percentage presented is for those in Highland who are living rent free, who might be assumed to be living with family. The larger proportion of respondents

to the general population living in council accommodation could be due to age and stage of respondents.

The high percentage of respondents in their thirties who were married and

home owners are likely to include many planned pregnancies in financially

secure and emotionally supportive environments. Mothers who are in lower

socio-economic groups, are single and or young are more likely to be facing

challenges in terms of emotional support and financial security. It would have

been useful to hear from a greater number of these parents who are likely to be

in more need of support from professionals and services during their pregnancy,

childbirth and early parenting.

0.00

20.00

40.00

60.00

80.00

Urban Rural Remote HomeOwner

Council Private Rent With Family Tied Housing

Housing Situations of Respsondents Compared to Highland

Percentage Highland Percentage Respondents

6

Results

Question 2

“During your pregnancy please indicate from where or from whom you

got most of your information?”

Chart showing from where respondents got most of their information

Most information came from health professionals except about meeting baby's

emotional needs, which mostly came from family. However, much information

was also obtained from family and friends or from online. The quality of this

information is likely to be variable in terms of evidence-based messages about

maternal health and infant development (Brown 2016). The availability of apps

to follow different aspects of the child's development may be helpful or may

produce unnecessary anxiety for mothers.

Respondents were able to add comments (full comments in appendix 2). 41

comments were provided referring to information from: the NHS; health

professionals; hypnobirthing; online/books information; family and friends;

breast feeding support workers; Infant Feeding Advisor; breastfeeding support

group/text support and peers.

0 10 20 30 40 50 60 70 80

About your baby’s developmental checks

About your mental health

About your physical health

About meeting your baby’s emotional needs

About meeting your baby’s physical needs

About breastfeeding

About child birth

About ante-natal care

About pregnancy

Where Most Information Came From

Health professionals Family and Friends

Parent Support Groups Natural Childbirth Organisations NCT/hypnobirthing

Online support Other

7

“I was told by family and friends that breast feeding can be very difficult to

begin with but it does get easier. This helped to prepare me and encouraged

me to persevere. The antenatal classes told us the benefits of breastfeeding

and talked about how to latch correctly however I feel if more mums were

prepared to expect it to be difficult to begin with, they might be less likely to

give up so soon.”

“Lots of information available online regarding baby's development e.g.

weekly e-mail updates. Also lots of information on kick counting etc. to

ensure baby safety. Information available on childbirth is very thorough

online and in books, lots on pain relief, choices for delivery etc. This helped

me to formulate my birth plan.”

“Sharing experiences when attending pregnancy yoga, asking questions and

receiving good advice.”

“Midwives teaching hypnobirthing. Breastfeeding meetings with infant feeding

advisor.”

Question 3

Respondents were asked about their health during pregnancy

Chart regarding mental and physical health in pregnancy

0 10 20 30 40 50 60 70 80

How well managed was any mental health conditionduring your pregnancy?

How well managed was any physical health conditionduring your pregnancy?

How well informed did you feel about maintaining yourmental health?

How mentally well did you keep in your pregnancy?

How well informed did you feel about maintaining yourphysical health?

How physically well did you keep in your pregnancy?

Health During Pregnancy

Very well Quite well Well enough Not very well Not at all well Not applicable

8

When comparing physical health with mental health, 54 respondents had kept

quite well or very well physically and 62 had kept quite well or very well

mentally. For respondents with a medical condition through pregnancy, in a

ratio of a medical condition being very/quite well:well enough:not very/not at

all well managed, for physical health conditions the ratio is 43:12:5 and for

mental health 16:6:7, indicating that mental health conditions were less well

managed than physical health conditions. The ratio regarding how well informed

respondents felt in maintaining health during pregnancy also indicated that

women felt less well informed about maintaining mental health (45:13:16)

compared to physical health (54:14:8). This would suggest that improvements

could be made in terms of supporting women to maintain mental wellbeing in

pregnancy and also in managing any mental health condition during their

pregnancy.

Respondents were able to add comments, (full

comments in appendix 3), 32 comments were

received, 12 of which were further information about

medical conditions experienced. There were 7 positive

comments about health support in pregnancy for

conditions including: pre-eclampsia; twin pregnancy;

blood condition; severe morning sickness; mental

health support and early recognition of a potential

problem.

There were 13 negative comments about health

support in pregnancy which included: lack of support

for mental health condition; lack of support for

physical health condition; inconsistent staffing and misdiagnosis.

“I felt that the midwives I saw dealt with any queries I had very well and

listened to me when I had minor concerns. I had an instance where I found that

my skin was very itchy and since this could be linked to a potential complication

the midwife I spoke to made an appointment for me to have a blood test for the

following day (the appointment was made out of hours, after an antenatal

class).”

“Saw peri-natal [mental health] nurse as I was at risk of Post-Natal Depression

(family history). Main help to me was hypnobirthing keeping me calm, positive,

relaxed about birth.”

“I felt that there was poor continuity of care. At each ante natal appointment, I

would see different Midwife's, which I found difficult having to explain issues I

9

had regarding medical conditions. I felt that there was also little person centred

practice and often things were more of a tick box exercise and leaflets being

handed out.”

“Saw a series of different community midwives at beginning of pregnancy. Not

really given opportunity to discuss anxieties relating to pregnancy and previous

issues. Ended up arranging to see a psychologist myself.”

“Nobody checked to see if I was ok given that I had lost 3 babies before.”

Question 4

Respondents were asked about their health in the three months

following childbirth

Chart regarding postnatal physical and mental maternal health

Responses indicate that postnatal health was generally good for this cohort,

with only 7 respondents reporting feeling not very or not at all physically well

and 8 respondents feeling either not very well or not at all mentally well.

Information about maintaining health and management of a health condition

were also more likely to be good postnatally with little difference between

mental and physical health.

13 respondents commented (full comments in appendix 4) on this question with

4 positive experiences and 10 negative experiences shared. Negative

experiences tended to be when people had not felt listened to and where help

had been delayed or poorly managed.

0 10 20 30 40 50 60 70 80

How well managed was any mental health condition afterchildbirth?

How well managed was any physical health condition afterchildbirth?

How well informed did you feel about maintaining yourmental health after childbirth?

How mentally well were you in the three months afterchildbirth?

How well informed did you feel about maintaining yourphysical health after childbirth?

How physically well were you in the three months afterchildbirth?

Postnatal Maternal Health


10

“The health visitor came to visit me before the birth of my baby so we had

been introduced before the baby arrived. She was very helpful, supportive

and offered a good deal of encouragement during her routine visits.”

“I had high blood pressure after birth and this was well managed by staff

within Raigmore. I remained on ward until it was under control with

medication. Baby was in SCBU after birth for 2 weeks which was traumatic

for me as mum. I dealt with it well enough at the time however I'm unsure

that my upset/struggles were taken seriously by hospital staff.”

“Post-partum rash was treated by GP as allergic reaction separate to

pregnancy. Six week check-up was rushed with GP showing me to baby

changing facilities so I could feed baby (I would have been happy to feed in

appointment so I could discuss issues I wanted to). HV skirted over mental

health issues especially in relation to stress I experienced of baby being re-

admitted to hospital, prior to that community midwives signed us over to HV

without adequately monitoring babies weight, felt rushed through post-

partum process as pregnancy was not problematic, and felt not treated

holistically in any way."

Question 5

Respondents were asked about their experience of their most recent

birth.

Chart regarding respondent experience of most recent birth

0 10 20 30 40 50 60 70 80

How helpful was the preparation you had for the birth ofyour baby?

How helpful were any NHS classes that you attended inpreparation?

How helpful were any natural childbirth classes that youattended in preparation?

If you had a birth plan, how helpful was that to you inthe delivery of your baby?

If you had a birth partner, how helpful were staff insupporting that role?

How helpful were staff in enabling you to make decisionsduring the delivery of your baby?

Birth of latest baby

Very helpful Quite helpful Helpful enough Not very helpful Not at all helpful Not applicable

11

Overall respondents had felt the preparation for childbirth was very or quite

helpful (2/3 of respondents). The usefulness of a birth plan was less well

established, 24 respondents found it not very/not at all helpful. There were

some comments received about the birth plan being ignored, but also about

emergencies arising and processes being too rushed to allow decision making.

There were also comments about feeling poorly prepared. Any of these may

have influenced the usefulness of having a birth plan. This may merit further

investigation.

Comparing the helpfulness of NHS ante-natal classes to natural childbirth ante-

natal classes, while less respondents had accessed natural childbirth classes,

these had been more helpful in preparing them for childbirth. However, as there

is often a cost and a motivation required to opt in to natural childbirth classes,

this might not reflect the situation if all parents had the opportunity to attend

natural childbirth classes.

In terms of staff enabling decision-making for the mother during childbirth over

half of respondents had felt support had been quite or very helpful but a third

had found it only helpful enough or not very/at all helpful. Again this may

reflect emergencies occurring where the delivery progressed quickly and

decision making felt rushed. However, it may be that greater care in

empowering mothers in childbirth to make decisions and enabling them to feel

in control would be beneficial. It would seem that staff were good on the whole

at supporting birth partners to be involved.

28 respondents added a comment (full comments in

appendix 5). There were 10 positive experiences and 30

negative experiences shared. The positive experiences were

mostly about the helpfulness of the midwives and about the

helpfulness of the hypnobirthing classes. One mother had

had a home birth and had found the midwives very

supportive. The negative experiences were about: poor

information or preparation; the birth plan not being

followed; feeling rushed or pushed into decisions. Some of

the other negative experiences referred to the complications

of particular births requiring emergency medical

intervention or the difficulty in travelling across Highland to

Raigmore Hospital.

“At last check before planned section, things had changed and I had option to

go for vbac. Staff allowed plenty of info and time for myself and husband to

make this decision.”

12

“The midwives were very good at offering as much information as possible. I

met the doctor during my labour and she was keen to suggest an epidural,

although I had stated in my birth plan that I would prefer to ask for any pain

management and not be directly offered (in keeping with the hypnobirthing

class I had attended). The midwife in charge however, reassured me that she

had read my birth plan and didn't push me to discuss the epidural any further

and stuck more closely to the hypnobirthing ethos.”

“I didn't feel well informed about was happening (I was transferred to another

hospital to be induced) no one examined me when I arrived at hospital and

the induction process wasn't explained to me."

“I had to travel by ambulance from Caithness general hospital to Raigmore

which didn't lend itself to putting into practice the relaxation methods or pain

relief options that we were taught at the antenatal sessions. The antenatal

classes weren't very informative about what to expect and the

logistics/practicalities of labour on the A9.”

Question 6

Respondents were asked about feeding their baby.

Chart about infant feeding

0 10 20 30 40 50 60 70 80

If you have a partner, how well supported did he or shefeel to be involved in the feeding of your baby?

If you began by bottle feeding, how supported did youfeel in that choice?

If you stopped breastfeeding before 6 weeks, how wellsupported did you feel in making that decision?

If you encountered difficulties such as poor baby-latching, sore nipples or mastitis, how well supported

did you feel through these difficulties?

If you continued to breastfeed, how supported did youfeel in the first month of establishing breastfeeding?

If you began with breastfeeding, how supported did youfeel in initiating breastfeeding?

How well supported did you feel before the birth of yourbaby in making your choice over feeding?

Feeding your baby


13

Overall, most respondents reported feeling

very well or quite well supported in infant

feeding. Only 2 out of 75 respondents ticked

not applicable to initiating breastfeeding. 10

respondents responded to starting with bottle

feeding, suggesting that at least 8 respondents

quickly turned from breastfeeding to bottle

feeding. The remaining 65 respondents

reported establishing breastfeeding in first

month, 5 of whom had stopped breastfeeding by 6 weeks.

The proportion of respondents breastfeeding at 6 weeks is 80%, much higher

than the 33% target of For Highland’s Children Service plan target or the

reported 31.3% in the Highland Children’s Service performance report of June

2017. This is likely to be because the survey was shared amongst breastfeeding

support groups. It would have been helpful to hear from more mothers who are

not exclusively breastfeeding at 6 weeks.

33 respondents made comment about the experience of feeding. Overall, there

were 26 positive experiences and 42 negative experiences shared.

Positive comments were mostly about good support from the community team

(Midwives and Health Visitors), the Infant Feeding Advisor and other

breastfeeding support.

The most common negative experience shared was that of poor

support in hospital to initiate breastfeeding followed by

comments about the difficulty in establishing breastfeeding,

with people reporting pain, poor latching and tongue-tie not

being identified early enough. Some people felt pushed either to

bottle feed, breastfeed or not to express. Respondents spoke of

guilt and feeling a lack of success was their fault.

“The breastfeeding advisor who came to my home was a god send. The advice

she gave me in the first few weeks was invaluable and I think if it wasn't for

her I couldn't have breastfed for 13months.”

“Poor support in maternity ward, which delayed breastfeeding. Much better

community support (community midwife, infant feeding support workers)

which ultimately helped me to start breastfeeding 2 weeks after birth.”

“Sent home with tongue tied baby. I had cracked nipples and the pain was

horrendous. I questioned why this wasn’t picked up in the hospital. It wasn’t

checked for at my first home visit but then a different midwife on the 2nd visit

14

identified it. I had to wait two weeks to get it snipped when it could have been

done on labour ward before we left.”

“In Caithness there seems to be an anti-breastfeeding mentality with several

health professionals telling me they would not breastfeed if they had kids.

Where I lived previously breastfeeding was the norm and bottles were for

those who struggled with breastfeeding. The support workers here have a

difficult job when their colleagues undermine them.”

“Was told I had caused mastitis by expressing (only done because of bleeding

nipples), made me feel like it was my fault.”

Question 7

Respondents were asked about the health and development of their baby

Chart regarding health and development of baby

There was no option to comment on this question. This

was an accidental oversight in the survey design.

0 10 20 30 40 50 60 70 80

How helpful is the free information given out about childdevelopment (such as Play@Home)?

How helpful is the Red Health Record in keeping track ofyour baby's health?

How helpful is the Red Health Record in keeping track ofyour baby's development checks?

How helpful is your Health Visitor been in supportingyour child's health and development?

How helpful has your Health Visitor been about anyconcerns you have had about your baby's health and

development?

How helpful has the Family Nurse Partnership (formothers under the age of 19 years) been in supporting

your child's health and development?

Health and development of baby

Very helpful Quite helpful Helpful enough Not very helpful Not at all helpful Not applicable

15

Question 8

Respondents were asked to describe the type of support that had been most helpful in becoming a parent.

Chart indicating what support was most helpful

53 respondents commented.

The value of breastfeeding support workers and groups was most frequently

mentioned as the most helpful support. Given the high percentage of

respondents who were breastfeeding at 6 weeks this is perhaps not surprising.

However, given the desire to increase the number of infants exclusively

breastfed at 6 weeks, promoting breastfeeding support and ensuring

breastfeeding workers are available to mothers would seem to be important.

Health Visitors, available to all mothers, scored highest as being most helpful:

positive comments were also made about the more specialised support from the

Infant Feeding Advisor, Hypnobirthing or the Family Nurse Partnership.

“We have an excellent health visitor who is very supportive and encouraging.

Support from family has also been invaluable.”

0

2

4

6

8

10

12

14

16

18

Most Helpful Support Overall

16

“The text breastfeeding support was amazing, I would have stopped without

her.”

“Support from family has been second to none. Also having a friend with a

baby roughly the same age is great for comparing where they are meant to be

in terms of milestones they're reaching or not reaching, what to look out for

etc.”

“Infant feeding support worker - taking time to understand the problem and

ensuring referrals are made.”

“The family nurse partnership has been fantastic! I love learning about my

child's development and having the support of my family nurse. I feel

extremely lucky to be able to have such a lovely family nurse guiding me and

giving me the best information on what is best for my baby. The family nurse

partnership is very useful and I recommend it to every young mum.”

Question 9

Gaps in Support

Chart regarding gaps in support

The chart above indicates the number of comments about each of the identified gaps. 40 respondents commented on perceived gaps in support, (full comments

in appendix 8).

0

2

4

6

8

10

12

Gaps in Support

17

“No breastfeeding support given in hospital (for either of my babies), figured

it out myself with 1st baby but had to look for help with second baby, lot of

support available IF you know where to look or who to ask.”

“Quite long gap between health visitor checks (I know you can call them

anytime). I think should be one visit at 6 months - just when you start to

introduce solids...”

“Lack of useful antenatal classes, lack of support for breast feeding, lack of

support through having 1 named midwife contact, lack of info on

practicalities of getting to and home from Raigmore in/just after labour.”

“Was supposed to be referred at 12 week check for continued mental health

support but midwife/doctors forgot until third trimester. Got the majority of

support on breastfeeding from family and friends.”

“Lack of family close by to provide support, can't fault health service. They've

been fab.”

Question 10

What might improve services in the future?

Chart of suggested improvements to services

0

5

10

15

20

25

30

What might help

18

33 respondents had ideas about what might improve services in the future (full comments in appendix 9).

Overall 25 comments were made about better information, 9 about staff, 6

about specific interventions and 5 comments recognised that experience was the thing that ultimately helped most. The above charts shows the breakdown

of these comments under each category.

“Need a more consistent approach - advice even from same team differs,

health visitors should keep up to date with latest research especially if they

are providing advice on that matter.”

“Encouraging mums to trust their instincts, through pregnancy, birth and

beyond. To increase the support for breast feeding mothers in hospital and

beyond. Less focus on weight and more on how baby thriving. Increased

education about the benefits of breast feeding- it's not just about nutrition;

it's a way of mothering. Responding to baby was the best advice I received.

No schedules or clock watching.”

“Health professionals should warn mothers about the initial problems that

can come with breastfeeding (mastitis, cracked nipples etc.) so they are

better prepared and don't get discouraged.”

“A little more information about other types of normal emotional changes

during pregnancy could be useful. I was very irritable and didn't realise that

"pregnancy rage" was common, so I felt like I was going a little crazy.”

“need for more practical classes antenatally.....how to bathe a child...how to

recognise colic and what to do...how to change nappies and encourage

developmental stages..”

Discussion

Overall, the support mothers received across the questions scored as either “very helpful” or “quite

helpful” for most respondents in all categories except in the usefulness

of a birth plan and in the support for a partner to feel involved in the

feeding of the baby.

Some very useful information came from the comments respondents made. In a survey specifically

seeking ways to improve support, respondents might reasonably be

more expected to comment if they had a negative or mixed experience

which could be improved upon, although many positive comments

were also made.

19

Information: while health professionals provide most

information about becoming a parent, families, friends, peers and

information from books or online contribute greatly. Information

provided by health professionals could be improved. The information

provided is not consistent across health professionals. There are gaps

in the information provided.

When people were in labour, they had a need for honest and clear

information, even in an emergency situation and for parents not to feel

rushed into a decision where possible.

While Community Midwives, Health Visitors and breastfeeding support

workers did provide useful information and support, sometimes

this was inconsistent and could be improved.

Maternal Physical Health: Some

mothers felt they had received the health support they needed for

physical ante and postnatal health. However, some mothers felt that

they had not been listened to and as a result there was a delay in

recognition of health issues and consequent delay in treatment.

Sometimes referrals had not been timely and communication between

different health professionals had been insufficient.

Maternal Mental Health: The responses would suggest that while

fewer respondents experienced mental health issues or had a

mental health condition, the response was more likely to be not

very or not at all helpful than for physical health issues or conditions.

Given the growing evidence for the potential of long term impacts of

perinatal mental disorders on the child (Lancet 2014) and the

resultant cost to society, the support of the perinatal mental health of

mothers is hugely important (Faculty of Public Health 2016). Management

of a mental health condition and any medication needs to balance the

impact on both mother and child (Gask et al 2009). However, the

potential risks to the foetus/child are not inevitable and early intervention

and both psychological support for mothers and parenting support can

ameliorate these effects (Stein et al 2014). The importance of timely

support for perinatal mental health is clear.

Antenatal care: Improvements to

antenatal classes could be made in terms of preparation for the practicalities of early parenting and

also a more honest discussion about breastfeeding, its short-term

challenges and its long-term benefits.

The only natural childbirth classes

mentioned were Hypnobirthing/Wise Hippo. Parents who had accessed

these spoke positively of them with comments saying the classes had

been helpful in childbirth but also in breastfeeding. The course fee starts

at £250 and so is not accessible to all parents-to-be. Comparing the

very positive response from parents who had accessed hypnobirthing

classes and the less positive response regarding the NHS

antenatal classes, it may be worth considering wider access to hypnobirthing so that all parents

who choose this might be able to attend.

Childbirth: The data is not clear

about how to improve the use of birth plans to support mothers in

feeling in control during childbirth. It may be that mothers need to be

supported to develop more flexible birth plans or that health

20

professionals should be more respectful of the choices made by

parents in the birth plan. It may be inevitable that as birth is a dynamic

process things can change suddenly altering the options for the birth

plan.

Infant Feeding: This topic brought the most comments from

respondents, although it should be noted that the respondents were

predominately breastfeeding mothers. The overwhelming

message was that breastfeeding can be difficult to establish and that

there is insufficient support in hospital to get this process off to a

good start. Only one mother had used SCBU, but she had felt breastfeeding support was lacking

there.

While breastfeeding can be difficult to establish, those mothers who had

continued to breastfeed were glad to have made that choice and wanted

other mothers to know that while it might be difficult to start with, it

was well worth the effort.

Some mothers felt pressurised one way or another about feeding. It

was an issue where mothers spoke of “guilt”, “blame” and “fault” as well

as sometimes feeling pressurised by health professionals.

Breastfeeding support outside of

hospital received a lot of positive comments. The breastfeeding support workers, support groups,

peer support and online/text support was truly valued by mothers. The

Infant Feeding Advisor was also seen as a huge support by those

who had accessed this service.

The issue of babies who are tongue tied was raised several times,

usually with the perception that it caused latching difficulties and

therefore increased pain for the mother and increased difficulty in

establishing breastfeeding. The delay in the diagnosis and treatment

of tongue tied babies was seen as a potential barrier to successful

breastfeeding.

In Breastfeeding Uncovered, Amy Brown (2016) emphasises the

importance of supporting mothers to breastfeed by being honest about

both the benefits and challenges of breastfeeding to mothers, families

and society as a whole. Staff: The experience of health

professionals, while mostly good, was not always positive. There was

a perception from some that health professionals were time pressured,

especially hospital staff, and that this meant they were unable to

provide appropriate support. Respondents were seeking

consistent care from health professionals that was kind and

person-centred, where they were listened to, provided with

appropriate information and then supported in their choices.

Continuity of professionals and timely referral were also mentioned.

Peer and family support: The

support from peers and family was mentioned many times along with a recognition that becoming a parent

was an experience that was not easily prepared for, people just had

to go through it.

21

Conclusion

Childbirth is both an intensely personal experience and one which is set in the

heart of family and community: it is unique each time a baby is born, but is also

common to all humanity. This creates a lot of expectations from mothers-to-

be/new mothers of themselves as well as from perceived pressures from the

family/community. There will be varied expectations from mothers, partners

and wider family about the support needed and provided from health services.

For any parent, it is a strongly emotive subject.

Highland Children’s Forum is very grateful to all the mothers who took the time

to complete the survey and share those very personal experiences to contribute

to improved services in the future. Thanks to the those parents who provided

photographs for the report.

The majority of respondents to the survey felt the support they received during

pregnancy, childbirth and postnatally quite or very helpful across most factors.

There are however some areas of improvement that could be made to support

the delivery of better outcomes for mums and babies in Highland.

• Support in the maternity ward to enable mothers to initiate breastfeeding,

ensuring the baby has a good latch before discharge.

• Health professionals who listen to the parents, are person-centred and

provide consistent messages.

• All Health Professionals should be consistent in their message about infant

feeding and sensitive to the deep emotional response of mothers in terms of

feeling blamed or guilty in the choices that they make.

• Reviewing antenatal classes to reflect the content requested by parents and

consider equity of access to specific interventions such as "hypnobirthing".

• Improve information and support for maternal mental health and wellbeing

including timely intervention and appropriate support for any mental health

medical condition.

Becoming a parent is a life-changing time in anyone’s life. There are significant

information and support needs for the physical, mental, emotional and practical

changes that will be experienced. Partners, other family members, friends and

peers are important in providing that information and support along with Health

professionals. The focus of this report has been on services for mothers, but

22

support for mothers is also about working with co-parents and the wider family

who offer much of that support.

This report would suggest that there is much to celebrate in the services offered

in Highland to help mothers with the transition to parenthood. In recognition of

the long-lasting impact of "getting it right" for new parents to enable "getting it

right" for every child, this report has hopefully demonstrated the benefit of

listening to mothers in planning continued improvement to services.

23

Appendix 1 Breastfeeding Uncovered (Amy Brown 2016)

(summary from 18 steps to improve support for breastfeeding in book)

1. Promote breastfeeding as normal in society: challenge unhelpful public ideas

about breast milk and the female body.

2. Promote the normality of breastfed babies feeding frequently and why this is important and about normal infant weight loss and gain.

3. Promote understanding of normal baby sleep patterns and enable mothers to find other ways of getting rest.

4. Be aware of how the experience of childbirth impacts breastfeeding. Give staff more time with mothers in childbirth to reduce interventions and improve

success in breastfeeding.

5. Ensure the hospital experience is “Baby Friendly” with expert support to all

breastfeeding mothers at the start of breastfeeding.

6. Mother the mother, provide all the emotional and practical support they need. Educate fathers to be the practical support they can be.

7. Promote “feed and cuddle your baby whenever you both want” rather than expectations of early routine being adopted.

8. Support employers to be breastfeeding friendly.

24

Appendix 2 Comments from question 2

1. breastfeeding support

2. I have a family nurse and I found all the information she provided extremely

useful

3. Other parents

4. Midwives antenatal support and after having baby

5. Most info from midwives

6. Pregnancy info

7. breastfeeding support workers

8. Online support

9. I was told by family and friends that breast feeding can be very difficult to begin

with but it does get easier. This helped to prepare me and encouraged me to

persevere. The antenatal classes told us the benefits of breastfeeding and talked about how to latch correctly however I feel if more mum's were prepared to

expect it to be difficult to begin with, they might be less likely to give up so soon

10. Hypnobirthing

11. Lots of information available online regarding baby's development e.g. weekly e-

mail updates. Also lots of information on kick counting etc to ensure baby safety.

Information available on childbirth is very thorough online and in books, lots on pain relief, choices for delivery etc. This helped me to formulate my birth plan.

12. the information about baby's health checks

13. The info from community midwives was fantastic.

14. Hypnobirthing and books

15. Midwife and health visitor support in the first few weeks/months

16. Infant feeding advisor

17. Support from community midwife and keeping in touch with Parentcraft group

18. highland breastfeeding support. Mainly Facebook group but also peer support

19. Sharing experiences when attending preganancy yoga, asking questions and receiving good advice.

20. Wise hippo classes taken by local community midwives

21. Advice from a midwife friend not currently working.

22. Hypnobirthing

23. Health professionals

24. midwifes, health workers, breastfeeding support workers...

25. Breastfeeding support workers

26. Development checks/stages

27. Midwives teaching hypnobirthing. Breastfeeding meetings with infant feeding

advisor. 28. Both from the NHS and my own research at the library and parenting books.

Personal favourite is Aletha Solter and aware parenting 29. Had my baby while maternity/labour suite busy did not feel supported to

breastfeed felt baby was put in breast for me instead of having someone to

spend a bit of time to support and show me ways to breastfeed especially needed extra support having had an emcs discharged myself due to lack of

support from staff and community midwife were no more supportive and lack of

health visitor visits. Would be really nice to be able to have offered an infant feeding advisor while in hospital instead of days later after baby had lost weight.

25

My first home visit midwife made me feel like I had failed already as a mother so I pumped and gave up on breast milk after one month. In the hospital although I

expressed wishes to breastfeed I was offered formula top ups. Breastfeeding needs more advocation and support to mothers.

30. Family 31.

32. Ante-natal care info

33. Breastfeeding text support was amazing

34. I like how helpful they all were midwifes were amazing support to me as a first

time mum

35. Online search engines

36. Child birth 37.

38. Online support

39. information about labour

40. Hypnobirthing

41. Info from family and friends

42. Health visitor very supportive with latching difficulties

43. Nhs guidelines and handout info was simple to follow and not overwhelming


1. pelvic pain - nothing helped

2. twin pregnancy meant high risk. However, felt well supported by health

professionals and condition well monitored reducing my fear/anxiety and

improved mental and emotional wellbeing.

3. Inadvertantly given unnecessary antibiotics following mix up of test results

4. I had a low platelet count but it was monitored closely and did not cause any

problems 5. I suffered severe morning sickness during 1st & 2nd trimester. This was well

managed by GP and midwife. No information given regarding mental health or

pre-natal depression, or where to access help if required. Also I had an allocated midwife however I only met her once during pregnancy, all other

appointments were with an alternative midwife within that area. I had pre-eclampsia and baby was delivered at 36 weeks, this was found at my 36 week

check by midwife. Was sent straight to Raigmore and baby delivered naturally

(after induction) 3 days later. 6. eventually diagnosed with class 1 hellp syndrome and had a crash section

under GA at 35 weeks

7. I had a condition that meant I was housebound and isolated and because this was out of the ordinary a lot of the staff couldn't or wouldn't accommodate my

condition when giving advice, arranging appointments etc.

8. Very thorough care by midwife and hospital consultant

9. I felt that the midwives I saw dealt with any queries I had very well and

listened to me when I had minor concerns. I had an instance where I found

that my skin was very itchy and since this could be linked to a potential complication the midwife I spoke to made an appointment for me to have a

blood test for the following day (the appointment was made out of hours, after an antenatal class).

10. No antenatal classes. Lacking some of appointments I should have had due to

staff shortages. Fobbed off and passed between midwives. Felt wholly unsupported throughout until I was admitted to Raigmore where all staff were

exemplary.

26

11. During first pregnancy I had major back problems. I saw the physio through self referral on the advice of the midwife and although they couldn't sort the

issue while I was pregnant they gave it a good bash ?? 12. I was very low during first 3 months. HV was grea in terms of physical

symptoms and signed me off work. However I lacked knowledge about

depression during pregnancy which would really have helped.

13. Preeclampsia during few final weeks...

14. Saw Laura Patience peri-natal nurse as I was at risk of PND (familly history).

Main help to me was hypnobirthing keeping me calm, positive, relaxed about

birth.

15. I had a straight forward pregnancy

16. twice spells of bleeding was told to go back to normal life and if i miscarried so

be it ( i did bed rest as i found out a lot of other countries get women to do this plus i paid for 2 private scans to check how things were going). i was in a lot of

pain, but no body followed up either- not pubic girdle pain, kept telling

everyone it wasnt in my pelvis- turns out my uterus had flipped back to front and was only discovered at c-section

17. Nobody checked to see if I was ok given that I had lost 3 babies before

18. Needed physio for bad hip

19. Saw a series of different community midwives at beginning of pregnancy. Not really given opportunity to discuss anxieties relating to pregnancy and previous

issues. Ended up arranging to see a psychologist myself.

20. I felt that there was poor continuity of care. At each ante natal appointment I would see different Midwife's, which I found difficult having to explain issues I

had regarding medical conditions. I felt that there was also little person centred practice and often things were more of a tick box excersies and leaflets being

handed out.

21. Have mental health issues, was not referred until end of pregnancy.

22. I was fine and no further information given


1. Felt very fragile emotionally - scored bordeline on post natal depression questionniare then didn't see my Health Visitor again for a few months (sent

community Nurse instead) so felt let down 2. After a c section the physio turned up 2 days later with a leaflet. This would be

of more use before the section.

3. I had high blood pressure after birth and this was well managed by staff within Raigmore. I remained on ward until it was under control with medication. Baby

was in SCBU after birth for 2 weeks which was traumatic for me as mum. I dealt with it well enough at the time however I'm unsure that my upset/struggles

were taken seriously by hospital staff.

4. had to ask for review by consultant re ongoing liver issues post hellp syndrome

5. I was upset my the effect my underlying condition was having on my ability to care for my child however this was overlooked during the post natal checks I

had. The team looking after my condition were great.

6. I struggled to get help with a skin condition after birth.

7. Post partum rash was treated by Gp as allergic reaction separate to pregnancy, Six week check up was rushed with Gp showing me to baby changing facilities so

I could feed baby (I would have been happy to feed in appointment so I could discuss issues I wanted to), HV skirted over mental Heath issues especially in

relation to stress I experienced of baby being re-admitted to hospital, prior to

that community midwives signed us over to HV without adequately monitoring babies weight, felt rushed tho post partum process as pregnancy was not

27

problematic, and felt not treated wholisticly in anyway

8. The health visitor came to visit me before the birth of my baby so we had been introduced before the baby arrived. She was very helpful, supportive and offered

a good deal of encouragement during her routine visits.

9. Only now after nearly 9 months an I receiving much needed support.

10. Little infection - antibiotics. Start of gallstones problems...

11. I have a prolapse which my GP didn't want to examine at first, when I went back

even after an internal exam she said it was all normal. Thank goodness you can

self refer to physio who have been great. 12. was in pain after birth but not around scar area, ended up with sepsis, in

hospital 3 weeks after birth, then recurrent infections. Not much info was passed

back to GP from hospital 13. No information given in regards to these issues


1. Due to pre-eclampsia i was scheduled to have epidural, however baby came

too quickly and natural birth was only option. Therefor staff couldn't really

allow me to make decision/follow birthing plan. Birth plan changed a couple of times between being admitted and baby arriving.

2. had a crash section under GA at 35 weeks so husband not present for birth and limited discussions around same

3. I had to travel by ambulance from Caithness general hospital to raigmore

which didn't lend itself to putting into practice the relaxation methods or pain relief options that we were taught at the antenatal sessions. The antenatal

classes weren't very informative about what to expect and the

logistics/practicalities of labour on the A9

4. I had a home birth. The midwives present were fantastic.

5. I was only contacted about any classes on the day of the class by that time I

was already at work. I had a c section no one told we what I needed to do or expect in regards of not showering that morning shaving etc. Was

embarrassing. I was told that I wouldn't need a birth plan because she was

still breech and I'd be likely having a c section. 6. Midwife was very helpful during labour. As it was my first I was not sure what

was best to do to be comfortable so she made suggestions and went from there.

7. The wise hippo hypnobirthing classes were amazing

8. I had a very fast labour this time so wasn't really an option for me to make

many decisions! 9. We had wanted a natural birth, but ended up induced and lead to assisted

delivery. As per birth plan I did this with minimal drugs but was in pain for

several hours. My partner didn't feel supported by midwife and felt I the way during labour. I think in hindsight I should have accepted more pain relief and

it may have been a better experience for all

10. Had unplanned induction so few options open

11. I did not want the injunction after birth to deliver the placenta as I was

worried about haemorrhaging and a few other reasons. I felt pushed and

rushed into having it. 12. Parent craft classes felt rushed, at birth initial midwife was respectful of birth

plan - which we had written without input or interest from community midwives, after shift change during birth felt like birth plan was less

importnant/used and partner not supported as much, felt like learning

28

experience for student, staff all friendly and nice but felt like some of the decisions we faced were not included in or were forced on us,

13. The midwives were very good at offering as much information as possible. I met the doctor during my labour and she was keen to suggest an epidural,

although I had stated in my birth plan that I would prefer to ask for any pain

management and not be directly offered (in keeping with the hypnobirthing class I had attended). The midwife in charge however, reassured my that she

had read my birth plan and didn't push me to discuss the epidural any further

and stuck more closely to the hypnobirthing "ethos" 14. No antenatal classes due to staffing issues. Birth plan was not looked at at all

by local midwives despite asking to go through it with them on several occasions.

15. Very supportive of us as hypnobirthing parents

16. At last check before planned section, things had changed and I had option to

go for vbac. Staff allowed plenty if info and time for myself and husband to make this decision.

17. Nobody can prepare you for childbirth really - need to experience it... Forceps birth.

18. The consultant I had when I arrived in hospital after the delivery of my baby

(in the ambulance) was not clear why I was having to be taken away from my baby to have surgery to remove the placenta. I was devastated.

19. I was well supported but due to induction I didn't get to follow my plan & wasn't really asked about music etc

20. I didn't feel well informed about was happening (I was transferred to another

hospital to be induced) no one examined me when I arrived at hospital and the induction process wasn't explained to me.

21. Things were done such as an epidural in my case which I did not feel informed

about and now suffer back pain 22. Health visitor and breastfeeding support worker were far too pushy and

insisting on visits pre and post-natal especially considering it was my third baby. I didn't feel that they told me anything new and thought their visits

were complete overkill. A waste of time and resources surely they can assess

who they need to see more often than others.

23. It was all a blur in the end, I didn't really realise what was going on

24. Staff were amazing and explained all that was happening they were reassuring

and lovely 25. I was (falsely) made to believe that things went moving on and i wasn't

dialating, because there was no room for me in the labour ward.

26. Felt some staff didn't stick to my birth plan in supporting my decisions.

27. Classes were in Wick baby was delivered in Raigmore so you are not prepared or familiar with the unit. Birthing plan was not even looked at and ended up

with a section. Staff in Raigmore were stretched to breaking point and hadn't

no time to offer adequate care

28. No advice provided by midwives.


1. In hospital I was encouraged to introduce bottle feeding within 24 hours and

regularly encouraged to do this thereafter despite making my wishes clear that I planned to exclusively breastfeed. Community midwife and health visitor very

supportive. 2. Poor support in relation to breastfeeding until referred to Karen Mackay - Infant

Feeding Specialist, then received excellent support and enabled to continue

breastfeeding

29

3. Very Poor breast feeding support in Raigmore

4. wouldve stopped bf in 1st week if not for the help from the infant feeding support workers, still feeding at nearly 10months

5. Sent home with tounge tied baby. I had cracked nipples and the pain was horrendous. I questioned why this wasnt picked up in the hospital. It wasnt

checked for at my first home visit but then a different midwife on the 2nd visit

identified it. I had to wait two weeks to get it snipped when it could have been done on labour ward before we left.

6. My baby had a tongue tie and difficulty latching and caused a lot of pain. The

first community midwife I saw was the most helpful in dealing with the issue, got us referred and nipples shields to get us through.

7. Baby was delivered early and had little sucking reflex but could latch, therefore breastfeeding was difficult. I didn't feel there was much support in SCBU for

mums who were struggling to breast feed naturally and staff on ward were not

really involved with mums who's babies were in SCBU. So mum is stuck in the middle with little support. Would have been helpful to have someone in SCBU

to discuss feeding options, how to pump milk properly, positions, ways of encouraging baby etc. I really struggled with the decision to move to bottle

feeding due to feeling of guilt, would have been good to have someone to

discuss this with and help us make an informed choice as parents. 8. emphasis all on breasts feeding...little to no information given on bottle

feeding. I am unable to breastfeed due to previous surgery therefore knew I would be bottle feeding

9. In Caithness there seems to be an anti breast feeding mentality with several

health professionals telling me they would not breast feed if they had kids. Where I lived previously breast feeding was the norm and bottles were for

those who struggled with breast feeding. The support workers here have a

difficult job when their colleagues undermine them. 10. I have had a horrendous experience with support and help with breast feeding.

The only reason i have managed to continue and hopefully finally after 11 weeks achieve it is due to sheer determination and self study and research. I

have been completely let down my the NHS on this front.

11. After birth baby was jaundiced so had to be fed a lot. The support was great but I felt that the advices varied from midwife to midwife. It was a very difficult

3 days in hospital. After discharge community my were so helpful and supportive.

12. This being my second baby I didn't need any breastfeeding support as I was

confident in my own abilities and baby lached on and fed well. With my first I needed a lot of help and support to establish feeding and received it from the

staff in hospital, my community midwives, online support and local mothers at

baby group. 13. We're still breastfeeding at 1. Had tongue tie fixed at 7 weeks, we had wanted

to introduce 1 bottle feed of expressed milk , but were advised to wait until 13 weeks following tongue tie until feeding established. Baby never took to bottle

and parter has felt left out of feeding and that aspect of night time routine

14. Highland bf support and peer suppporters are great

15. Asked for initial support in hospital with feeding, felt unsupported that partner not able to stay on ward in night after birth. Experienced problems with feeding

initially due to undiagnosed tongue tie - hospital and community midwives missed - helped with latch only a couple of times. When baby admitted to

hospital with TT it was a matter of luck in finding correct support from those

with BF expertise/knowledge, felt pressured to give formula and felt struggle to insist keeping bf and expressing, little help provided with bottle feeding advice/

practical support for top up feeds, no long or short term plan in place with

feeding and top ups.

16. One of the midwives in the hospital was very bossy over the feeding of my

30

baby in the first hours. He was a sleepy baby and as such wasn't keen to feed, so the midwife essentially insisted he would need a formula feed. We had to

resort to a cup feed (as I was particularly reluctant to skip straight to bottle feeding) and he still wasn't keen to feed, so I felt she was pushy and had taken

over. She did later apologise if I felt she had been pushy. The midwives in

Caithness General, the community midwives, the health visitor and the infant feeding support worker all made me feel that they had time for me and were

available to answer any feeding related questions and offered a good deal of

encouragement. 17. I have breastfed all my children I think the assumption was made that I didn't

need advice or information. Leaflets and a DVD were given but no discussion held.

18. Poor support in maternity ward, which delayed breastfeeding. Much better

community support (community midwife, infant feeding support workers) which ultimately helped me to start breastfeeding 2 weeks after birth.

19. Infant support peer was a major help with establishing breastfeeding

20. I have ebf so partner not really involved. But he felt health care staff always included him effectively.

21. Partner couldn't wait to bottle-feed. Never happen really... Was sorry for him...

22. Some midwives in the hospital were extremely helpful, others really unhelpful.

The breastfeeding support workers were very helpful and my community midwife Fiona was brilliant.

23. I would have benefited from more support & advice about the reality of breast feeding, how hard it can be & the difficulties faced if you have a section as my

milk was late & we ended up back in hospital & I then had to use shields.

24. Excellent support with breast feeding in local hospital where I returned to after giving birth in raigmore, where I didn't feel I was supported enough to breast

feed.

25. I did not feel that staff had time to support breastfeeding even when at home

26. In the hospital the advice was rushed and they moved the baby into position and i struggled to copy as I had a section and found it hard to move.

27. Was made to feel that breastfeeding was the only option and if I stopped then I was doing wrong I had a bad time breastfeeding and was told to persevere

instead of helping me

28. Ushered home from hospital without proper latch despite requesting help, no peer support assigned, had to request health visitor to aid feeding/provide

feeding support as no help offered

29. Breastfeeding support was excellent.

30. Was told I had caused mastitis by expressing (only done because of bleeding

nipples), made me feel like it was my fault.

31. Staff at Raigmore had no time to help what so ever. Infant support worker Kerri Ann and my health visitor Theresa were very helpful, practical and

supportive

32. The breast feeding advisor who came to my home was a god send. The advice she gave me in the first few weeks was invaluable and I think if it wasn't for

her I couldn't have breastfed for 13months.


1. One to one support with health visitor and breastfeeding advisor

2. The family nurse partnership has been fantastic! I love learning about my child's development and having the support of my family nurse. I feel extremely lucky to be able

to have such a lovely family nurse guiding me and giving me the best information on

what is best for my baby. The family nurse partnership is very useful and I recommend it

31

to every young mum.

3. i have found the family nurse partnership absolutely invaluable and feel that I am a better parent for it.

4. Peer support from other parents

5. Availability of health visitor

6. Community midwife support

7. I think midwives have the most support

8. Midwife support after the birth

9. Support with difficulty breastfeeding

10. Health visitor / online groups

11. infant feeding support worker - taking time to understand the problem and ensuring referrals are made

12. Health visitor.

13. We have an excellent health visitor who is very supportive and encouraging. Support

from family has also been invaluable 14. Baby books/online communities and HV in early days of parenting, but mainly

grandparents/siblings who are parents and other mums. The importance of being

surrounded by other people in the same position as you cannot be underestimated.

15. Peer support

16. health visitor

17. We've not seen a health visitor due to lack of staff, only a EYP.

18. For me reading books that support my way of parenting have helped. Family support and

my partner have been essential. The midwives and health visitors have been ok but often stuck in guidelines. People have been quick to point out problems but little support has

been there to back up and help. I have often felt quite bullied and disrespected despite

having my own childs best interests at heart. The staff always seem tiered and overworked and this causes mistakes, rudeness and taking shortcuts.

19. My family

20. Health care workers in the local area have been amazing. I also had friends who have also recently had babies which has been a life saver for the little questions and also

support. BF peers can offer this support but it is hard as you don't have the personal

relationship with them.

21. Local baby groups.

22. The mum and baby groups led by midwives held on weekly basis and breastfeeding

support group

23. Online suppport - Facebook group

24. The support of bf and the issues I had with latching, tongue tie, no milk etc.

25. Bf support

26. The support of my family and my husband's family and the local health professionals

(e.g. HV and midwives) all offered a good deal of support

27. My own experience from previous births and the Internet.

28. Infant feeding support

29. Support from family has been second to none. Also having a friend with a baby roughly the same age is great for comparing where they are meant to be in terms of milestones

they're reaching or not reaching, what to look out for etc

30. Breastfeeding support

31. Health professionals

32. Midwifes, health visitors, support groups...

32

33. Breast feeding support workers and Hypnobirthing

34. Visits from professionals, breastfeeding support group, family support

35. Local Breast feeding support group. Online 'the milk meg'.

36. Looking things up online and others experience

37. local midwives and health visitors were lovely and very supportive

38. Family

39. Midwife visits/ consultant visits prior to birth

40. The text breastfeeding support was amazing, I would have stopped without her

41. Midwife visits in first days at home an health visitor

42. Family and friends

43. Consultant clinic

44. Being able to access a health visitor

45. I have got a lot of support from friends and family. I feel that professionals involved in mine and baby's care are very stretched.

46. Breastfeeding support but not from health visitor

47. From HV

48. family support

49. Hypnobirthing classes and support from family and friends.

50. This is 2nd baby and felt well prepared

51. Reading provided and on call support for breastfeeding

52. Marie the Breastfeeding Advisor

53. Online groups


1. There needs to be more breastfeeding support from the midwives

2. Lack of info pre-birth especially around breastfeeding, lack of face-to-face support in local srea

3. Poor support in Raigmore

4. I felt that I didn't see a health visitor as often as I would have liked

5. Feeding information before birth & support between 3months & 1 year

6. Encouraging breastfeeding and midwives not having time to help in hospital.

7. no breastfeeding support given in hospital (for either of my babies), figured it out

myself with 1st baby but had to look for help with second baby, lot of support available IF you know where to look or who to ask.

8. Not being told the truth about how tough breastfeeding was going to be.

9. Infrequent support from health visitor

33

10. Not enough groups about for mums with newborns. The first 3-6 months can be

extremely lonely and there is not enough about to encourage mums who may be needing support. Also no help for couples, becoming a dad is as big a change as

becoming a mum. This can cause issues within a relationship and it would be good if

there was help available for couples do discuss these problems.

11. too much emphasis on birth and not the practicalities of after

12. Lack of useful antenatal classes, lack of support for breast feeding, lack of support through having 1 named midwife contact, lack of info on practicalities of getting to

and home from raigmore in/just after labour

13. There is a lots of emphasis on breast feeding but not enough experienced and

knowledgeable staff to back it up. I felt there was not enough education before the

birth. After the birth i was given detrimental advice and when there were problems later i was referred to the wrong professionals for help.

14. i have been attending classes through CALA which has been great but have only just

started. It would be good to see midwife led baby groups. Often there are silly

questions but you don't want to take up doctor/hv/mw time a class/group would be easier for asking these questions.

15. Lack of family close by to provide support, can't fault health service. They've been fab

16. Hv always very busy and hard to get hold of

17. A diagnosis of reflux, milk protein/lactose intolerance and months of dithering over meds and dairy free. If I'd been told to go have completely no dairy I wouldn't have

had half the problems.

18. Mental health, long term plan for feeding baby,

19. None

20. I have unfortunately found all services seriously lacking in one respect or another. Local midwifery services were poor and I dread to think how I would have coped if I

was a less experienced mother.

21. Support in ward was poor, staff were inconsistent and overstretched.

22. Don't think there is any. HV is available every week at the clinic if I have any concerns.

23. All focused on first few months then not so much support/information for later stages

24. It should be made clearer that breast feeding is really hard at first even if you are doing it right.

25. Quite long gap between health visitor checks (I know you can call them anytime). I

think should be one visit at 6 months - just when you start to introduce solids...

34

26. A weaning class would be great for both food & breast.

27. A class on how to bathe a baby, how to hold, swaddle and change a babies nappy

would've been helpful!

28. I didn't realise I was a bit depressed. Until afterwards when I was over it. Very sleep

deprived

29. After care of my physical health such as excercises for emac and breastfeeding

explaining the actual process of an induction before starting step by step

30. not sure if there is enough support to help with breast feeding problems

31. None

32. Health visitor admitted forgetting about me and my baby and we missed a couple of checks. More classes needed about positions for feeding. Possible practice with

dummy

33. Making new mums feel awful about bottle feeding

34. Breastfeeding support in the community

35. Slow referral to peadiatrics, lack of support in baby's developmental problems

36. very rarely heatd from health visitor.

37. Was supposed to be referred at 12 week check for continued mental health support but midwife/doctors forgot until third trimester. Got the majority of support on

breastfeeding from family and friends.

38. Nil

39. No information given about Caesarean sections; I had an emergency section after failed induction and felt lost and overwhelmed the whole time as I had no information

or preparation.

40. Nhs support lacking as in rural and apparently affluent area


1. health visitors should be giving out the same information as the family nurse parternship. Also there needs to be more emphasis on car seat safety as a lot of

parents are clueless when it comes to this.

2. I think everyone should have a family nurse they are so helpful.

3. Additional antenatal classes - parents in my area (Badenoch and Strathspey) only have access to 3 classes pre birth; consistency of care (I saw 4 different midwives during

my pregnancy so wasn't able to build a good relationship; peer support invaluable e.g.

Breastfeeding support group on Facebook; knowledge of midwives and health visitors around issues such as breastfeeding, allergies, reflux etc needs to be improved to

ensure referrals into the right services and support at the right time

35

4. Needs to be easy to access services. Lots of people post on social media now rather than getting professional advice. Think it'd be useful to combine both to make

professional pages available

5. Provide practical information on feeding options & problems during pregnancy

6. need a more consistant approach - advice even from same team differs, health visitors should keep up to date with latest research especially if they are providing advice on

that matter

7. Nhs highland should offer the wise hippo to everyone.

8. I really think it would help if people knew to expect the first few weeks of breast

feeding to be difficult, that it's normal but it will get easier. Knowing lots of friends who breast fed and hearing they had difficulties at the start but got through them gave me

to confidence to believe that we too would get through it and we did

9. My only complaint would be the night midwives at raigmore hospital were not helpful or kind. With me being a first time parent their attitude really upset me and I could not

wait to leave the hospital because of this. They need to be kinder and more helpful.

10. Its very hard in the early days and will change your life in ways you never expected. There is lots said about how wonderful it is to become a parent (which it is) but as a

society we still don't address how difficult this transition can be.

11. need for more practical classes antenatally.....how to bathe a child...how to recognise colic and what to do...how to change nappies and encourage developmental stages..

12. Much more respect for the mother is required and birthing options better explained

including laws and rights.

13. As I said above groups for babies. Playgroups can be daunting as a new parent and

often there are no other young babies there.

14. Do an intolerance test to rule out anything straight away! Too quick to diagnose as reflux. Being told s baby will grow out of being in horrendous pain is not good enough.

You wouldn't leave a fog in pain for a week never mind a year!!

15. More wholistic approach, felt fell between gaps of responsibility of midwives, HV and Gp - seemed to be misunderstanding/ lack of communication of who responsible for

what at each stage

16. A little more information about other types of normal emotional changes during pregnancy could be useful. I was very irritable and didn't realise that "pregnancy rage"

was common, so I felt like I was going a little crazy.

17. Better information for rural mothers postnatally to avoid isolation. More online forums

or parent and child groups. Ensure everyone has access to antenatal classes to encourage supportive friendships and avoid post natal isolation. Don't make

assumptions that people are ok because they've done it before ensure they have

adequate support.

18. More focus on basic baby care/the first few weeks in parentcraft classes - birth was easy in comparison!

36

19. Find out about Group B Strep! It's not covered in any literature given by the midwives

(a national directive not highland). Our baby girl nearly died as we never knew she was

ill or could become ill with meningitis the way she did. We were very lucky we saw that something wasn't right and sought help. Awareness of GBS will save babies lives.

20. Trust in yourself to know your baby

21. Like I've said - nothing can prepare you for that. No groups, no conversations... You need to experience it yourself. But support and information that was provided was

enough... :-)

22. I find the percentile lines on the charts in the red book unhelpful. They make you

worried if the baby isn't tracking a line. It's hard to focus on 'reading the child' when the line says he's not putting on weight as he should. Could Health Visitors have a

record of where they are in relation to the lines but parents not be made aware of it unless it becomes a problem?

23. weaning

24. Encouraging mums to trust their instincts, through pregnancy, birth and beyond. To

increase the support for breast feeding mothers in hospital and beyond. Less focus on weight and more on how baby thriving. Increased eduction about the benefits of breast

feeding- it's not just about nutrition; it's a way of mothering. Responding to baby was the best advice I received. No schedules or clock watching.

25. If I won the lottery I would supply every new mum with a copy of The Aware Baby by Aletha Solter it saved my sanity. My child is fab too very grounded and understanding

of her emotions

26. I found a lot of whispering between staff in labour suite just before emcs just being

honest with parents that there is worries or complications and for mothers/parents to be given all information consequences of decision to be able to make fully informed

choices

27. when i ended up back in hospital i had to leave my EBF 3 weeek old with my parents as there was no help for me to keep her with me in the hospital and that few days

apart were very hard

28. I feel that support should be offered instead of you feeling obliged to have to have

these people come and visit! The level of support offered now is far more than when I had my eldest 2 children but I feel as a third time mum it was too much, had it been

offered when I had my first I would of found it helpful but not now!

29. Perseverance is the key

30. Honest information about the pressures and struggles of breastfeeding

31. More regular developmental check up(s) between 3 and 6 months, better offered support with breastfeeding without mother having to seek it herself.

32. Health professionals should warn mothers about the initial problems that can come with breastfeeding (mastitis, cracked nipples etc) so they are better prepared and

don't get discouraged.

33. Better advice for people who have to travel to urban areas from rural areas a state at

present there is nothing in place

37

References Brown A. (2016) Breastfeeding Uncovered Who really decides how we feed our babies?

Printer and Martin, UK Facvulty of Public Health and Mental Health Foundation (2016) Better Mental Health for

All. [internet] available from:

http://www.fph.org.uk/uploads/Better%20Mental%20Health%20For%20All%20FINAL%20low%20res.pdf

Gask, L., Lester, H., Kendrick T. and Peveler, R (2009) Primary Mental Health Care.

Royal College of Psychiatrists [internet] available from: https://books.google.co.uk/books?hl=en&lr=&id=Jxfm86wOR8UC&oi=fnd&pg=PA198&d

q=perinatal+mental+health&ots=fgN10tDW_T&sig=s4VkLtTFG45nec9hhCWuk2HBm6A#v=onepage&q=perinatal%20mental%20health&f=false

Highland Council (2014) For Highland’s Children Service Plan 2014-2019 [internet]

Available from: http://www.forhighlandschildren.org/pdf/forhighlandschildren.pdf Highland Council (2017) Local Housing Strategy 2017-2022 [internet] available from:

file:///Users/PolicyLead/Downloads/Highland_Local_Housing_Strategy___Committtee_Version__31_January_2017.pdf

Highland Council (2017) Performance Report – Children’s Services June 2017. [internet]

available from:

http://www.highland.gov.uk/meetings/meeting/3822/education_children_and_adult_se

rvices_committee ISD Scotland(2016) Data Tables Maternity and Birth, ISD Scotland and NHS National

Services Scotland. [internet] available from: http://www.isdscotland.org/Health-

Topics/Maternity-and-Births/Publications/data-tables.asp Lancet (2016) Breastfeeding Series [internet] available from:


Lancet (2016) Breastfeeding 2 Why invest and what will it take to improve breastfeeding practices? Vol 387 January 30, 2016 [internet] available from

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf

Lancet 2016 Breastfeeding: a smart investment in people and in economies [internet] available from http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-

6736(16)00012-X.pdf Lancet (2014) No health without perinatal health [internet] available from:


Royal College of Midwives (2012) Emotional Wellbeing and Infant Development A good practice guide for midwives [internet] available from:

https://www.rcm.org.uk/sites/default/files/Emotional%20Wellbeing_Guide_WEB.pdf

UNICEF (nd) Breastfeeding in the UK [internet] available from: https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/breastfeeding-in-the-uk/

World Health Organisation (2015) 10 facts on breastfeeding [internet] available from: http://www.who.int/features/factfiles/breastfeeding/en/

Scottish Government Scottish Government Urban Rural Classification 20113-2014

[internet] available from: http://www.gov.scot/Publications/2014/11/2763/5 Solte, A.J. (2001) The Aware Baby, Shining Star Express, USA.

Stein, A., et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet Volume 384, No. 9956, p1800–1819, 15 November 2014 [internet] Available

from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61277-

0/fulltext Useful Link: Hypnobirthing http://www.highlandhypnobirthing.co.uk/

Human Milk, Tailor-made for Tiny Humans

https://m.youtube.com/watch?v=2adrIKweZTE

https://books.google.co.uk/books?hl=en&lr=&id=Jxfm86wOR8UC&oi=fnd&pg=PA198&dq=perinatal+mental+health&ots=fgN10tDW_T&sig=s4VkLtTFG45nec9hhCWuk2HBm6A



http://www.forhighlandschildren.org/pdf/forhighlandschildren.pdf

/Users/PolicyLead/Downloads/Highland_Local_Housing_Strategy___Committtee_Version__31_January_2017.pdf

/Users/PolicyLead/Downloads/Highland_Local_Housing_Strategy___Committtee_Version__31_January_2017.pdf

http://www.highland.gov.uk/meetings/meeting/3822/education_children_and_adult_services_committee

http://www.highland.gov.uk/meetings/meeting/3822/education_children_and_adult_services_committee



http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00012-X.pdf

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00012-X.pdf


https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/breastfeeding-in-the-uk/

http://www.who.int/features/factfiles/breastfeeding/en/

http://www.gov.scot/Publications/2014/11/2763/5

http://www.thelancet.com/journals/lancet/issue/vol384no9956/PIIS0140-6736(14)X6113-1

http://www.highlandhypnobirthing.co.uk/

https://m.youtube.com/watch?v=2adrIKweZTE

mums and babies survey - hcypf...7 “i was told by family and friends that breast feeding can be...

Documents