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Breastfeeding training – why health professionals aren’t getting enough

“Going to have a baby? You might reasonably expect breastfeeding support from health professionals who have received adequate pre-service education, but is that the case?

The Greens have made a $10 million election promise for better maternity care and breastfeeding support, but how qualified are the health professionals who provide these important services?

In the post below, Janelle Maree, Naomi Hull, Jen Hocking and Julie Smith report new research helping explain why Australian women are disappointed about help with newborn care and breastfeeding.


Janelle Maree, Naomi Hull, Jen Hocking and Julie Smith write:

A recent report by WBTi Australia assesses the state of health professional education on breastfeeding in Australia. WBTi Australia is a coalition of health professionals, academics and others formed to evaluate national breastfeeding policies.

After reviewing curricula, it reported that few medical, nursing or midwifery schools teach health workers about how to help breastfeeding mothers with problems.

Only one profession, midwifery required any competency in breastfeeding support as part of their professional standards.

So most health professionals emerged from their pre service training with minimal or even no education how to support women to breastfeed.

Breastfeeding Advocacy Australia research

This reflected the findings of another survey, conducted in early 2019, by online breastfeeding advocacy group, Breastfeeding Advocacy Australia(BAA).

BAA asked the health professionals among its 2,843 members about the pre service training they received, and if it helped their professional practice. Forty-two responded with details of their professional education and training experience.

The results were shocking. General themes were – no training, poor training, personal experience only, on the job experience only… and an abiding sense of failing the mothers they  were caring for.

Insufficient training

One respondant, who had studied Nutrition and Dietetics recalled that it was a single 2 hour lecture and a mention in a few other lectures, like a general public health message and basic anatomy/physiology:

 …certainly not anything that would allow you to provide individualised care. Dietitians are supposed to refer to the NHMRC Infant feeding guidelines (which include breastfeeding guidelines).

We are taught enough to believe that we are knowledgeable about breastfeeding, but not enough to ‘know what we don’t know’.”

This dietician saw wider issues:

We are not taught about the important role that lactation consultants play and what our true scope of practice is with regard to breastfeeding.

It really concerns me when I hear stories of Dietitians giving individualised breastfeeding advice – we really do not have the training to do this at all.”

Personal experience

As parents, health professionals may themselves struggle with lack of skilled and knowledgeable support, and also rely on family experience or advice from friends.

A midwife, who previously had studied nursing, reported no breastfeeding education in nursing, and only one afternoon lecture and maybe one assignment on breastfeeding:

I know more about breastfeeding from breastfeeding my own seven children.”

This confirms prior Australian research that GPs’ advice to new mothers rests largely on their personal experience of breastfeeding.

The problem with this is that community knowledge, influenced by industry messaging, may be outdated and inconsistent with modern science, or the everyday reality of having a new baby in Australia.

Frustrations and inconsistencies

Not surprisingly, some new mothers are unhappy about their experiences of breastfeeding support.

Consultations held for the latest Australian National Breastfeeding Strategy (ANBS) are revealing. Some were frustrated at inconsistent and inaccurate advice. Others experienced even worse:

I was told in the first 24 hours of my son’s birth that I had low milk supply so was forced to give my son formula top-ups. When I say forced I mean the hospital refused to let me take my son home unless I gave him formula. I learned that this was false information as milk supply doesn’t come until a few days after birth.” 

After leaving the hospital, new pressures created new difficulties.

Then for the months that followed the MCHN still kept pushing formula as I stopped formula after learning it was affecting my milk supply and the health risks of formula. 

She told me my son wasn’t putting on enough weight as my breast milk wasn’t nutritional enough for him.  I then did my own research, saw an ICBLC and found out my son had tongue and lip ties which we then had corrected.” 

The ‘quick fix’ of formula

Donor human milk banks are now more common, but access remains limited. By contrast, milk formula is freely available in most maternity facilities.

Commercial milk formula is the ubiquitous ‘quick fix’ for time pressed health workers. Widely available in maternity care facilities, its reputation is enhanced by clever marketing throughout Australian health services.

Few health workers can attend adequate professional development on breastfeeding and lactation support after graduating.  As a result, gaps in professional education or training are filled by the formula milk industry.

Conflicted interests – such as tobacco, food or drug companies – running courses or sponsoring education for lung cancer, obesity or cardiac specialists would be unacceptable.

By contrast, it is apparently acceptable that health services or professional associations caring for women with newborns accept funding or sponsorship from companies promoting breastmilk substitutes.

For example, milk formula is heavily promoted to paediatricians, including through industry sponsorship of their professional medical associations.

Loss of confidence

This is leading to a loss of trust by consumers in health professionals, as the following response to the consultations on the ANBS demonstrates:

I found out from a midwife at the hospital that they have a special arrangement with S26Gold to promote their products to all mums and babies.  So they don’t care about what’s right for the babies, only about their special deal with a formula company for rewards!” 

Health professionals advising one mother insisted she remain in hospital unless the baby was fed formula.

My bub was born 4 weeks early and had lost weight when we were supposed to be leaving and they insisted he stay another night and be given formula top-ups.  I had to promise to give him the top-ups and they gave me pre-mixed formula so I could start immediately. 

This was all only 2 days after he was born, so my milk hadn’t even come in.  I just fed him without top-ups at home and milk came in the next day. It was appalling they would only let me leave if I promised to use formula.” 

Positive experiences

On the bright side, a small number reported excellent grounding for their future careers providing quality maternity care. This highlighted that training as an Australian Breastfeeding Association (ABA) breastfeeding counsellor was important for knowledgeable and skilled health professional practice.

The ABA is a recognized training authority delivering a Diploma of Breastfeeding Management and a Certificate IV in Breastfeeding Education.

The qualified volunteers operate ABA’s popular, and highly endorsed National Breastfeeding Helpline (funded by the Department of Health and Ageing) and online LiveChat, along with face to face local group meetings.

Respondents noted that these qualifications involved many hours of study and experience working with breastfeeding women, along with having breastfed their own children.

The study provided essential breastfeeding knowledge but also helped me gain counselling skills that are transferable to my paid employment and are a life skill.”

Others recorded details of training as ABA (or La League):

12 months for a Cert 4 in Breastfeeding Education, approx 3-4 hours a week private study. Along with a training day once a month and “hands on” learning by volunteering fortnightly at meets.

 Just over 16 months of study at about 6-8 hours per week including volunteering time, probably 18 months all up including the practicum.”

Many lactation consultants (IBCLCs), who are certified by the International Board of Lactation Consultant Examiners, and ABA counsellors are also nurses, midwives or doctors with particular interest and experience in breastfeeding support. They offer specialty health qualifications in supporting difficult lactation issues.

World Health Organization standards

The World Health Organization (WHO) has recently updated and revised its evidence-based standards for breastfeeding support in maternity care.

It finds that health workers have struggled to support breastfeeding, and calls for better research and resourcing to build the necessary capacity for working effectively with breastfeeding parents.

WHO implementation guidance focuses particularly on challenges that have arisen due to inadequate resourcing of pre-service education, and responsibilities of education authorities in this area.

WHO implementation guidance focuses particularly on challenges that have arisen due to inadequate resourcing of pre-service education, and responsibilities of education authorities in this area.

Future actions

Australian health ministers issued a press release in 2012 encouraging hospitals to adopt Baby Friendly Health Initiative standards, which involves standards of competency for staff in breastfeeding management.

However, no additional resourcing was allocated. Unrealistically, ministers expected maternity services to carry the cost, notably for the substantial staff training involved.

The new Australian National Breastfeeding Strategy was recently approved by Australian Health Ministers Advisory Council but the plan is not yet public. Previous policies have failed to deliver for women and babies, as governments’ budget dollars didn’t follow on from Ministers’ policy statements.

The release of the new strategy may shine the spotlight on the minimal resources committed to health system and health professional curricula investments in breastfeeding support.

But what should be done, and by whom?

Universities, government and professional associations have an important role to play in improving pre-service and professional development for health workers, but will they act?

Health authorities and professional bodies in Australia typically have policies ‘encouraging’ breastfeeding. However, without backing such statements with action, these have little practical impact.

A copy of the WBTi report has been delivered to every health minister in Australia and all have had the opportunity to discuss the dismal results. There is no excuse for Ministers saying they “didn’t know.”

Virtue signalling on breastfeeding policies by health ministers and health professions is not enough.

Australian women and babies deserve better than just words, and taxpayers will benefit from the investment in better maternity care, through reduced future health costs.

Comments 1

  1. Heather Gale says:

    All major parties have made promises to support breastfeeding this election through supporting the ongoing work of the Human Milk Banks. Nice, and much appreciated! The milk has to come from somewhere though…oh that’s right…human mummies who are breastfeeding! What is going to happen to Milk Banks and the babies whose lives will be saved by the milk donated, if less and less mummies are breastfeeding? World wide, the WHO has reported that less than 45% of the world’s babies are being given breastmilk, in Australia we are doing a bit better then that, but this deteriorates after leaving hospital due to inconsistent health professional support, and the power of the formula companies. Step up major political parties…make the change, fund a national breastfeeding strategy, including a national health promotion program that will influence education curriculums across Australia. We have done it before…#slipslopslap; #lifebeinit;#quit(smoking), future little Australians have a right to their human potential! Breastfeeding can make that happen, oh and it will help save the planet…WHAT WILL IT TAKE TO BE HEARD?

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Summer Reading 2019-2020
The Conversation
The Health Wrap
TOO MUCH of a Good Thing
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
CroakeyNews
Cultural determinants of health
Digital platforms
Elections and budgets
Federal Budget 2019-20
Federal Budget 2020-21
Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Health workers
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
housing
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH