HOW TO FIND A MATERNITY NURSE OR NIGHT NANNY WHO IS SUPPORTIVE OF BREASTFEEDING
by Cordelia Uys, NCT Breastfeeding Counsellor April 2021
Katinka with baby Sage
In March 2021, I posted this request on the Facebook group NWL Breastfeeding, which has almost 2.5k members, all London-based:
Hi everyone, my colleagues and I often hear of night nannies and maternity nurses having a negative impact on a mother's breastfeeding journey. We therefore thought it would be helpful to ask about your experiences, either positive or negative, in order to create a document to put in the files of this group.
I was pleased to receive over 70 responses, which I’ve attached below.
Interestingly, not that many members of NWL Breastfeeding posted about negatives experiences with a maternity nurse or night nanny (from now on, I’m going to use the abbreviation MN/NN). This might be because those who had negative experiences are no longer breastfeeding and therefore not members of the group. Or maybe those who had negative experiences felt uncomfortable sharing, as was the case for a couple of women who contacted me directly and asked for their comments to be anonymous. Another possibility is that parents don’t always realise that the advice from their MN/NN had a negative impact on breastfeeding.
It is nevertheless clear from the numerous positive responses I received that many women find having the help of a MN/NN in those early weeks invaluable, and appreciate the practical assistance and emotional support.
If a new mother would like to breastfeed her baby, it is critically important that she and her partner understand what kind of support is needed for breastfeeding to be successfully established, and what actions are detrimental, so they can be sure the person they hire is willing and able to provide the right type of assistance for their family. I therefore thought it would be helpful to explore what new parents need to know if they are considering hiring a MN/NN.
Factors to bear in mind when hiring a maternity nurse or night nanny
Maternity nurses and night nannies are not usually medically trained nurses and will not necessarily have undergone in-depth training in infant care. Anyone can call themselves a maternity nurse or nanny. Just because someone has been working as a MN/NN for years, doesn’t mean that they have been following evidence-based practices.
Unless the MN/NN is a breastfeeding counsellor from one of the four main charities (NCT, BfN, ABM or LLL) or an IBCLC lactation consultant, her breastfeeding knowledge is unlikely to be comprehensive. Even midwives don’t always receive training in breastfeeding support.
When you read good references for a MN/NN, it’s possible that the people writing the references will not be aware of the impact that person had on their breastfeeding journey.
Before you have hired her, a MN/NN might tell you what she thinks you want to hear.
Informing yourself
I’ve written an article about how pregnant women and new mothers can maximise their chances of successfully establishing breastfeeding, which readers might find helpful:
How breastfeeding works
If you would like to breastfeed your baby, it is undoubtably helpful to understand how breastmilk production works.
Supply and demand: for the first 2 or 3 days after a baby is born, their mother will be producing colostrum (the first milk). Colostrum production is hormonally driven, meaning it is produced whether a baby is put to the breast or not. However, from around day 3, breastmilk production switches to being locally controlled, meaning it works on a supply and demand basis.
In order for a mother’s milk supply to be established and maintained in the early months, milk needs to be removed from both her breasts a minimum of 8-12 times in 24 hours. In fact, 8 times is the bare minimum and UNICEF talks about an average of 10 to 14 feeds in 24 hours, with many babies needing to feed more often than this.
Programming your breasts: when your baby is born, your breasts have no way of knowing if you have had one, two, or more, babies, or how big your baby is.
It takes 6 weeks for the prolactin receptors in your breasts to work out how much milk your baby, or babies, require. Regular and reliable milk removal from both breasts programmes them to make the right amount of milk for your baby or babies.
The Feedback Inhibitor of Lactation (FIL): whenever breasts get hard and full, a negative feedback mechanism kicks in, telling them to stop making milk. This means milk production slows down when breasts are full and speeds up when breasts are emptier. The more often a mother feeds her baby, the more milk she will make.
In the early weeks, if a mother goes longer than 3 or 4 hours without breastfeeding or pumping, the FIL will kick in, giving her breasts the message to reduce milk production, and she will also be at risk of developing blocked ducts and mastitis.
Some factors which can derail your ability to establish breastfeeding
The risks of routine feeding
Some MN/NNs have outdated views on how to feed and care for a baby, and are keen to establish a feeding routine, which makes their life easier. However, for the vast majority of women, breastfeeding to a routine, especially in the early weeks, will have a negative impact on their milk production, and on their baby’s weight gain.
UNICEF, the NHS and all other respected health bodies recommend responsive feeding (which used to be called feeding on demand), not only in order to establish a good milk supply, but also because it’s kinder for babies. Think back to what it felt like the last time you were very hungry or very thirsty and had to wait for quite a while, and then imagine what that feels like for a baby who has no concept of time.
It’s also worth remembering that babies have small tummies and that breastmilk is very bioavailable and digested very fast.
In this article for UNICEF, Emma Pickett (IBCLC lactation consultant and chair of the Association of Breastfeeding Mothers) explains why routine feeding is not recommended:
The risks of missing night feeds
The levels of prolactin (the hormone that makes milk) in a mother’s body are highest between 2am and 4am, meaning that night feeds are vitally important for establishing and maintaining a new mother’s milk supply.
As Emma Pickett mentions below, mothers and babies are physiologically programmed to stay close to each other, particularly at night. Young babies have evolved to wake and feed frequently at night. Both are protective against SIDS (Sudden Infant Death Syndrome). Even outside of the high prolactin-level hours, frequent feeds (both day and night) are pivotal for establishing a robust milk supply.
Before having their babies, parents-to-be often think that if someone else can give a bottle of expressed milk at night, the nursing mother will be able to get more sleep. However, many women find pumping hard work, and often find that direct breastfeeding at night can be easier and more convenient, especially if they can master the side-lying position.
Please see my article: https://www.cordeliauys.co.uk/in-praise-of-the-sidelying-position
A video explanation of the side-lying position: https://www.youtube.com/watch?v=MZARPE9RUGE
For information about safe bed sharing, please see this Lullaby Trust leaflet: https://www.lullabytrust.org.uk/safer-sleep-advice/co-sleeping/
The risks of early pumping
It’s common for a MN/NN to encourage a new mother to pump so that the MN/NN can bottle feed the baby, while the mother gets some sleep.
Although there are some circumstances in which pumping in the early days can be really helpful, (such as when a baby is born premature, or unwell, or if they can’t latch), if breastfeeding is going well, it’s recommended to wait around 6 weeks before doing any pumping. Early pumping puts a new mother at risk of oversupply, which can create numerous breastfeeding challenges.
In addition, if a mother goes long stretches between feeds, the Feedback Inhibitor of Lactation will kick in, telling her breasts to make less milk, and she will be at risk of developing blocked ducts and mastitis.
The risks of bottle feeding for a breastfed baby
When breastfed babies are given bottles in the early days, they can start to reject the breast, particularly if paced bottle feeding is not being practised.
This video explains paced bottle feeding: https://www.youtube.com/watch?v=OGPm5SpLxXY
If your baby is going to be receiving bottle feeds, I would recommend finding out if the MN/NN is familiar with paced bottle feeding, and willing to practise it with your baby. Paced bottle feeding is vitally important for protecting breastfeeding. When a baby is held in the traditional, reclined bottle feeding position, a combination of gravity and the baby’s sucking reflex means it is easy to persuade them to drink more milk than their tummy can comfortably fit. This puts them at risk of overfeeding, and gets them used to a fast flow, which in turn means they are likely, sooner or later, to reject the breast, which usually has a much slower flow.
Managing pumping safely
As mentioned above, pumping before 6 weeks is not usually recommended when breastfeeding is going well. However, if you would like to pump so the MN/NN can give your baby a bottle of expressed milk during night, the logistics need to be managed carefully.
The bottle must always be given using the paced bottle feeding method.
The person feeding your baby must never try to get them to drink large volumes, or to finish the bottle. In the early weeks, babies tend not to take more than 60ml-90ml per feed.
You need to make sure that you don’t go more than a maximum of 3-4 hours without breastfeeding or pumping, otherwise you will be at risk of developing blocked ducts and mastitis.
Never let your breasts get uncomfortably full as this puts you at risk of blocked ducts and mastitis, and reduced milk supply.
Questions to ask when interviewing a maternity nurse or night nanny
Q: Did you breastfeed your own children? If so, for how long?
A: If a MN/NN has breastfed a child for at least 6 months, she will have a much better understanding of what is involved. Women who haven’t breastfed their own children can have unresolved feelings which might subconsciously undermine their ability to be supportive.
Q: What level of breastfeeding support do you offer as part of your service and what are your qualifications to provide this?
A: Here’s a link explaining the various levels of training in breastfeeding support: https://usercontent.one/wp/lcgb.org/wp-content/uploads/2018/02/Whos-Who-2017-Oct-17-1.pdf
Q: How do you feel about responsive feeding?
A: Responsive feeding is essential for establishing and maintaining breastfeeding, and to make sure babies get enough milk. Babies cannot be spoiled and do not need to be in a routine. Please read these two UNICEF leaflets:
Q: How often do babies need to breastfeed?
A: UNICEF talk about an average of 10 to 14 feeds in 24 hours and many babies will want to feed even more often. Ideally you want the MN/NN to respond that it varies from baby to baby, but at least 8-12 in 24 hours, whenever the baby shows feeding cues. Please see this chart: https://www.rch.org.au/uploadedFiles/Main/Content/Cocoon/feeding_cues.pdf
Q: How long should a breastfeed last?
A: This is a trick question: a breastfeed can last anywhere between 5 minutes and 45 minutes. The amount of time a baby spends on the breast is not a good indication of how much milk they’re drinking.
Q: How can you tell if my baby is getting enough milk?
A: 1) Their pees and poos: https://www.nct.org.uk/sites/default/files/related_documents/What%27s%20in%20a%20nappy%20%28ENGLISH%20VERSION%29%20FINAL%20WITHOUT%20BLEED.pdf
2) Their weight gain: https://kellymom.com/bf/normal/weight-gain/
Q: How will you support my breastfeeding journey?
A: By encouraging lots of skin to skin, frequent and responsive breastfeeding, looking out for your baby’s feeding cues, and helping you get support from a lactation consultant or breastfeeding counsellor, if necessary.
Q: How do you suggest we manage the night feeds as I want to exclusively breastfeed?
A: Many breastfeeding mothers find it helpful to have the baby in their room, and/or to bed share, and for the MN/NN to come in to change nappies and settle the baby after feeds.
Q: Are you willing to support my wishes for managing my baby overnight even if that means I’m waking up multiple times to feed?
A: Yes, absolutely!
Q: What are your thoughts on introducing a bottle for an exclusively breastfed baby and how to manage feeding /pumping overnight if using a bottle for one feed?
A: See the ‘Managing Pumping Safely’ section above.
Q: Are you familiar with paced bottle feeding? If we decide to give bottles, are you willing always to practise paced bottle feeding?
A: Beware if the MN/NN isn’t familiar with paced bottle feeding (see video above) or tries to persuade you that it will give your baby wind.
Q: What would you do if I run into any complex breastfeeding issues?
A: Contact an IBCLC Lactation Consultant or Breastfeeding Counsellor.
Postnatal support - other options
There is no doubt that caring for a baby is extremely hard work and that it can be enormously helpful to have a kind and knowledgeable person who is able to offer practical and emotional support in those early days. In an ideal world, this would be a loving friend or family member, a sister, mother or aunt. But, of course, that isn’t always possible.
A postnatal doula
When help from a family member isn’t possible, there is the option of hiring a postnatal doula, whose role is to support the mother, doing things like cooking, the laundry and light cleaning, while providing information on general newborn care, as well as watching the baby while the mother rests. This is different from a maternity nurse whose role is to take care of the baby, which can disempower a new mother and undermine her confidence. Some postnatal doulas offer night-time support.
To find a postnatal doula:
https://developingdoulas.co.uk/doula-listings/
Or email Victoria Greenly at info@youniquepostnatal
Jean Goodliffe, NCT Antenatal Teacher and Breastfeeding Counsellor, is also a postnatal doula: https://doula.org.uk/?s=Jean+Goodliffe
What help can a maternity nurse or night nanny provide that is supportive of breastfeeding?
There are undoubtedly MN/NNs who are supportive and respectful of a new mother’s desire to breastfeed. You will see from the responses below that what women tend to find most useful is having someone who will do everything other than feed the baby. At night time in particular, it can be massively helpful if they change the baby’s nappy and settle them to sleep, so the mother can go straight back to sleep after breastfeeding.
Here are the responses I received from members of NWL Breastfeeding
IBCLC Lactation Consultants and a Breastfeeding Counsellor share their thoughts:
Emma Pickett IBCLC:
‘I’d like to share my thoughts too if that’s okay. Several times a year, I support a family struggling with breastfeeding when baby is around 6-8 weeks old. The ONLY problem has been sabotaged by a poorly trained maternity nurse/ night nanny. There are good ones too, but those families don’t need my help. I’m seeing babies with faltering growth, milk supply issues, pain, lack of parental confidence. They may have been instructed not to breastfeed overnight, or to not feed their baby is response to cues, or that all 2021 thinking about breastfeeding is incorrect and the 1990s [and scheduled feeds] are where it’s at. So much damage. It is heartbreaking. One of the hardest aspects to being a North London LC. If you want to breastfeed, you need to check really carefully that any professional has had proper training AND understands the limits of their training. Do they understand how milk supply works? Are they familiar with responsive feeding and WHY it’s recommended?’
Response from Cordelia Uys (NCT BFC):
‘Emma Pickett, this is exactly what my colleagues and I see all the time and I was hoping to build a record of this as a document to share with new parents. I guess one challenge is that many parents might not realise how much the issues they’re facing have been caused by poor advice from a night nanny or maternity nurse.’
Emma Pickett IBCLC:
‘I think that’s likely to be true. I sometimes meet families who only realise with a second baby, and more antenatal education that something was amiss the first-time round. The reason they moved to formula feeding at 10 weeks was in fact not primary milk supply issues, but the fact they’d been feeding 6x in 24hrs with an 8 hour gap overnight from birth.’
Zhenya, breastfeeding mother:
‘I also I have a feeling you will get many more good stories, than bad. Since the bad advice, particularly for a first-time parents can get internalised as the ‘right’ advice. And so they wouldn’t know to complain....Emma Pickett, what is 1990s thinking on breastfeeding? I’d only just moved to the UK, so quite curious. I do remember a well-respected family friend was convinced that you should get the babies onto petit filous at about 4 months...’
Emma Pickett IBCLC:
‘The 1990s were very schedule focused. Pre-ultrasound research on breast anatomy, people thought you should only allow babies to feed every 3 or 4 hours. Emphasis on not letting babies ‘snack’ (thinking long feeds were always best and every feed must be a full meal rather than understanding breastfeeding is multi-functional and babies sometimes get thirsty). A focus on babies being independent as soon as possible rather than an understanding of responsive parenting. It was the end of a 20th century movement that had a poor understanding of human biology. Some currently working professionals were trained in this era or trained by those still thinking along these lines.’
Ruth Tamir IBCLC:
‘My experience of the majority of maternity nurses in my over 30 years of providing breastfeeding support, is that they are really basing their modelling of baby care, (especially at night) on formula-fed babies. And now with an increasing number of mothers wishing to breastfeed, they apply the same methods, which do not work.
The main reason a mother will employ a maternity nurse (who most often isn’t actually a nurse) is to get some more sleep at night and to get the baby into a good night time routine, in line with many popular books on the market.
Most new mothers, and especially first-time mothers, will need skilled help in latching a new baby onto her breasts and finding comfortable positions to enable effective transfer of milk, weight gain and frequent stooling.
Mothers and their babies are all different and many will not have large milk supplies and many babies will not be very effective feeders in the early days.
New babies need to feed extremely frequently after birth, especially throughout the night to stimulate efficient milk supply. This means switching breasts, sometimes several times in a feed and using breast compressions. Most new babies will not settle alone on their backs in a cot especially at night.
The problem when a maternity nurse is employed at night is that rarely is there skilled breastfeeding support offered, rather mothers are encouraged to space out feeds at night and ‘express’ afterwards which is not realistic or indeed safe.
Swaddling a new baby and rocking it during the night, which nurses often do, will settle a baby but at the expense of very needed access to frequent suckling and skin to skin next to the mother. They are also very formulaic and quite strict about the need to burp, and putting babies down at night alone.
There are a few who have a good understanding of the breastfeeding relationship and have undergone some basic training, but they are the minority. Successful breastfeeding of a newborn is about managing realistic expectations and I feel that many set the new mother up to fail and feel like failures.’
Kathryn Stagg IBCLC:
‘This is also my experience as a northwest London IBCLC. Finding a maternity nurse or night nanny who has a good understanding of breastfeeding seems to be difficult. They are as rare as hen's teeth.
I am involved with BabyEm and they seem to have good training from IBCLCs, so that might be a good place to start if looking for somebody.’
Anonymous IBCLC Lactation Consultant:
‘I wanted to share privately a recent experience. A mum of twins contacted me, and we had a great session with a realistic plan of feeding the twins and building up her milk supply. She was really happy and enthusiastic at the end of our meeting. She then messaged me later that day to say that her live-in maternity nurse, who had 2 weeks left of her 5-week tenure, wasn't willing to engage in the plan.’
Dr Sharon Silberstein, GP and IBCLC:
‘So far, I have met 2 or 3 night nurses who do not bully mums into their idea of infant feeding. About 2 years ago I had a complaint from a patient (my only one in many years): the baby was fussy on the breast and the parents asked me to check for tongue tie. I could not find one and after asking for more details, it turned out that the baby, who was born at 37 weeks during a heatwave, was combination fed, swaddled and strictly fed every 3 hours during the day and 4 hours during the night. The mat nurse insisted that all her babies gain 500g a week (!!) and that her way of doing things was better than chaotic baby led breastfeeding. When I pointed out that fussiness on the breast might be a result of the feeding method and not necessary always related to tongue tie, they got really angry. I spent 2.5 hours with them on a Friday afternoon, ran late for my kids’ pick up and it caused so much aggravation. They chose to believe the maternity nurse over me and refused to pay me at the end for my time. I was in such shock over this whole episode.’
Comments from two maternity nurses who are also breastfeeding mothers
Katinka Goulet:
‘Hey! Night nanny/nanny in general here. I think it all really depends on nanny’s experience with breastfeeding and basically what mum wants. I definitely don’t think it always gives a negative impact. However, it’s very important to nurse baby on demand in the early days. So you really need to set out a plan which is crucial.
A night nanny is used in general so mum can get some sleep, however I’d always offer breast if baby wakes, then give baby to nanny to wind and settle again.
Also night nanny mostly takes over from maternity nurse, so it also really depends on maternity nurse and how she’s set a routine (or not) for mum and baby.
So many factors here..’
Cordelia Uys NCT BFC:
‘I totally agree that it makes a big difference what kind of experience of breastfeeding the nanny in question has had. It's the same for health care professionals. For example, if your GP has breastfed successfully, she is much more likely to be able to provide good and helpful information.’
What I would point out is that nursing on demand (what UNICEF now prefers to call responsive feeding) isn't just important at the beginning, it's important for maintaining milk supply, and for a baby's happiness, at least until 6 months, and even after that, although as babies get older, and start solids, there is more flexibility of course.’
Joane Powers:
‘I think it depends on Maternity Nurse, their philosophy, experience and training. I am a Maternity Nurse and trained breastfeeding peer supporter, I worked with different families for more than 2 decades. The majority of my clients are breastfeeding and did well with my support, single, twins and triplets, like my client now, doing amazing breastfeeding for 2 years. I would also add, it takes two to tango, there's also some mom, no matter what support you give is just not into it. So I would say it's all down to every individual.’
Cordelia Uys BFC:
‘Yes I’m sure it’s all to do with the individual. It’s just that in my experience, many maternity nurses don’t understand how breastfeeding works and encourage scheduled feeds, introducing bottles early and other practices that are likely to disrupt, if not destroy, a new mother’s chances of establishing breastfeeding. Of course, if a mother doesn’t want to breastfeed, it makes no sense for a maternity nurse to try to persuade her to do so. It’s good to hear that you are trained in breastfeeding support and have been able to provide the help your clients need to establish successful breastfeeding.’
Negative experiences of maternity nurses and night nannies
Cordelia Uys BFC:
‘Hi everyone, just to say I've had a couple of messages from Lactation Consultants saying they have had similar experiences to those described by Emma Pickett. Then today I received a heart-breaking email from a client of mine who has asked to be anonymous. This was her experience of using a night nurse, who she believes permanently harmed her ability to breastfeed her baby.’
Anonymous:
‘I saw your post on Facebook and I would like to let you know that after my experience. I would never get a night nurse again. She harmed both me and my baby, specifically from a breastfeeding perspective. Ultimately bottle feeding was easier for her to manage and so she almost did everything possible to push me that way:
From day one after he was born - she said he needed a 3hour routine.
She wouldn’t encourage me to feed him before because it would create “bad habits”.
She would pull him off me violently after 15 min on each boob even though he was sucking furiously - she said it was enough and I needed sleep.
She then said he was a big boy so needed a top up of milk with formula.
She went through my fridge and told me off for having chocolate as “dairy harms the baby”.
She also told me off for having a salad - as “tomatoes are too acidic”.
When he didn’t put on weight, she said I urgently needed a private doctor.
She said I should only breastfeed with nipple shields.
When I tried to cut ties with the night nurse, she told me that when a child doesn’t have the constant attention of a night nurse, they can get autism.
When my mum saw what was happening, she told me to lie down in bed and just feed him. It was game changing, although I have never got the supply I needed and still mix feed. Just to say this woman came highly recommended by multiple people and is sadly still being used.’
Anastasia:
‘Is there like a body that they can be reported to?’
Cordelia Uys BFC:
‘I don’t think so. I don’t think night nurses are regulated. Sleep trainers certainly aren’t, which is a massive concern as so many practices they recommended are extremely harmful both to breastfeeding and to a child’s psychological well-being.
Sadly, this is much more the kind of experience I hear about when I’m contacted by parents. My own brother sacked their extremely expensive and fashionable maternity nurse after she told my Japanese sister-in-law she couldn’t eat sushi while breastfeeding.
I suspect many of our members who had bad experiences don’t feel like posting because it’s too upsetting, and also some might feel embarrassed about being bullied.’
Judith:
‘That sounds like a lady we interviewed when we were clueless and terrified. Luckily we realised we couldn't afford her anyway. She said private hospitals get twins in routines even when breastfeeding so we could use a routine with one. She said she saved various women’s sanity, had been on Channel 4, and if we didn't use her now that "we would suffer" and that we'd come back to her after 4 months when we had gone out of our minds with sleep deprivation. We never contacted her again but it's strange because we strongly felt we didn't fit but I guess there was always part of me that wondered if she was right and I hated that.’
Laura:
‘This is just heart breaking. Could your document contain a short succinct ‘how to explain politely to your family that you would prefer the support of a qualified lactation consultant rather than a night nurse’ section? It’s so hard to not seem to be criticising their parenting choices by not wanting to follow the same path.’
Mandira Bhimjiyani, BfN Mother Supporter:
‘So my experience, and I’m sorry if this triggers anything for anyone, but just to say this is based on me personally and my feelings.
Those around me, all my influences as a pregnant mum to be, had babies who were combi fed and on formula by 2-4 months. With night nannies and in routines from 2-4 weeks. I thought this was the thing to do and a sign of what made a good parent. I spent weeks of my pregnancy compiling names, recommendations and calling around discussing night nanny packages. There are an UNBELIEVABLE number of women who do this, who come highly recommended and all give what I now know to be terrible advice. I wasn’t fortunate enough to come across some of the more positive sounding experiences on this thread. And I thought that was normal/appropriate.
So I booked one. We had a catch up. She turned up for an intro/meet the baby and nanny session on baby’s first Bath around day 10 or so, with a 6-8 week package starting from day 14. And it was a horrendous experience. For someone who interviewed so well, came so highly recommended, and was so professional, she looked so incredibly uncomfortable holding a baby. She didn’t think to keep a towel close, or know anything about BF which I was struggling with (an undiagnosed tongue tie). She told me I may as well move onto formula and it would help with the routine setting anyway. She put my baby in the Moses basket whilst we prepped the bath, and baby started wailing and she told me it was good to show them who was in charge and that she was fine.
I was in pieces from this visit. I found it tough to deal with, she lacked empathy and warmth, and was so unnatural with my baby, and gave advice that countered everything I had googled in the first week of struggling with BF in all my late-night panicked browsing.
And thank god she was so terrible in person in session! Because if she’d been halfway decent in how she came across I might’ve believed her, I might have powered through and doubted myself.
Instead, we (myself and hubby) had a gut-wrenching conversation and heart to heart that evening. We called her and cancelled her services, she flipped on the phone and swore at us, despite us resignedly giving up a few hundred pounds deposit for no service at all. And I went on to struggle my way through fixing our BF journey and stumbling across the drop in a few weeks later when we got to the bottom of things and I found my crunchy tribe who showed me the error of my ways. It meant I went against the way of parenting that all those around me had gone for, and it took months (of not years or still ongoing) of having to justify or stand up for my every parenting decision to those I was closest to (but never my hubby who has been my biggest ally in my parenting journey as should be!)
I would never go for a night nanny (or choose more carefully of course). And I would openly explain this and my reasons and feelings why in an evidence-based way to anyone who cared to discuss.
I’m so thankful every day that we took a different path, and so sad for what might have been for me/what is the reality for other unsure first-time mums who trust what they believe to be the voice of reason/experience in a totally unregulated and hugely popular industry.
I’m so saddened when I think of all the babies subjected to routines and scheduled feeding from almost birth when all they want are mummy cuddles. Obviously, I know you can’t tar everyone with the same brush, and it sounds like there are some wonderfully supportive and knowledgeable ladies out there, but for every true support there are probably 10 others who go the other way...
I’m so thankful for this space you have created, the supportive and incredible team you have put together and for the evidence-based information you continue to offer.
I’d love to see this document contain a guided list of questions that would draw out a more appropriate form of support for those who want/need it, and help rule out those who go against what is biologically normal and so crucial for our little humans’ development.
Clare:
‘My experience was that the understanding of breastfeeding is not there. I had a lovely lady but with hindsight her advice to swaddle the baby stifled her breastfeeding cues. It didn’t help that my baby was also tongue tied. Once the pandemic hit and she stopped coming from a breastfeeding POV it was much better. Though sleep wise obviously a lot worse.’
Jocelyn:
‘I had a slightly frustrating experience. The night nanny was lovely, but just wouldn’t take my instructions to wake me when the baby needed feeding, so just fed him the available expressed milk and then I woke up incredibly engorged and had to pump because the baby was full and sleeping...! She was wonderful at burping him, changing him and settling him, which definitely gave me more sleep, but I still cancelled her after a couple of nights because I was worried about the impact on my supply. I also slept better when I did sleep because I wasn’t on tenterhooks listening out for the baby!! She was supportive about breastfeeding, but I think just really prioritised letting me sleep, even though that wasn’t necessarily my priority. I didn’t have any issues around the night nanny either trying to reduce the number of feeds or encouraging formula though, which I am sorry to hear others have experienced!’
Cordelia Uys BFC:
‘Jocelyn, I think your experience is typical and highlights my concerns. Not waking you for feeds would have put you at risk of developing blocked ducts and mastitis, and reduced milk supply. Lots of women sleep better when their baby is nearby because they don't have the anxiety of wondering if the baby is crying.’
Emma Pickett IBCLC
‘Thank you for sharing Jocelyn. I think it’s also important to note that when a third party wakes a parent in response to a baby’s cues, their responsiveness to that baby will be different. A baby close to a mum is likely to be fed sooner. Even the MOST switched on nanny/ nurse may miss some cues or baby may be unsettled because they are not close to us. We also know that when babies and mums sleep close, sleep cycles start to become in sync. We gently start to rouse as their respiratory rate changes, and it means waking is likely to be less jarring. Being shaken awake from a phase of deep sleep without that cycle matching may actually mean parents are less rested.’
Cordelia Uys BFC:
‘This is so beautifully put Emma. I know that for some women, the ability to catch up on sleep can make all the difference to their physical and mental wellbeing, but we need to be honest about the fact that, as a result of hundreds of thousands of years of evolution, babies and mothers are not designed to be separated, especially at night, and that doing so carries risks. In an ideal world, there to be someone to do take care of all other duties and work, so a mother can rest during the day, and for someone else to be available to settle the baby at night if necessary, but for the baby to remain close to their mother both day and night.’
Zhenya:
‘We need to remember that we live in a time when mothers and more and more isolated from their family and communities when a baby is born, and I think this is part of the reason night nannies and nannies in general will be ever more popular. Particularly given that so many births are traumatic or very medicalised, meaning a mother’s recovery takes longer. We all have so much more on our plates and are doing it increasingly alone.
I’m 100% for baby lead weaning and sleeping nearby/co-sleeping. If only I could sleep when baby slept and not worry about there being no clean dishes, empty fridge, and no clean clothes, etc as well as take care of my recently battered lady bits/other post pregnancy health issues - that would be grand. In the first days/weeks I just couldn’t switch off. A second pair of hands was what I needed, and that’s what the night nanny provided. So, it’s not just about the breastfeeding, it’s about taking care of mum - full stop.’
Emma Pickett:
‘Zhenya, absolutely. We’ve seen isolation particularly in the last year. Mothers need care. And ideally, care from folks who will help them in the long term and help them with their feeding goals. They are out there!’
Tuti:
‘It is so nice that so many people had positive experiences. When I had my first baby, I was totally clueless. I badly wanted to breastfeed. The night nurse kept giving him top-ups after my night feeds to make him sleep. She got bored because I was holding him all the time when awake and generally put unhelpful ideas in my husband’s head that became sources of disagreement. She was lovely and everything but in hindsight, is 80% of the reason why I didn’t manage to breastfeed my first ...’
Mandira Bhimjiyani:
‘Tuti, sorry you went through that. It’s hard navigating as a first-time mum and the unhelpful advise is the opposite of what a new mum needs. Glad you figured it out with your next.’
Positive experiences of maternity nurses and night nannies
Zhenya:
‘I had an amazing night nurse/nanny when I had my first. She was invaluable - I felt so helpless and she showed me so many things that a first-time mum can just be lost about - how to bathe, change a nappy, soothe a baby to sleep. She also really helped me with building up my milk supply - gave me pro tips and worked with my plan from the GP (I was on domperidone). So a big thumbs up from me.
Downside – expensive.’
Emma:
‘We had an amazing night nanny who my friend (also breastfeeding) used. For us we brought her in at 6 months to help us set a routine as we just couldn't sort anything. She didn't believe in timed crying or crying it out but literally changed out routine and by night one had our lives sorted. With my husband's work I was solo parenting a LOT so she was also there as a shoulder to cry on and support as my parents are also abroad. So it was amazing. She fully supported me exclusively breastfeeding.’
Fatema-Zahra:
‘Pros: especially in COVID times where family and friends couldn’t help out, I found it such a relief to know I had someone who could teach us all the first “how to”. She asked from the start what type of feeding I was going with and supported me in BF including helping me try different positions, tips on preventing mastitis, checking baby for tongue tie. We did a few night shifts after the first month, and it was such a relief to get a few hours of continuous sleep, I did a mix of waking up to feed baby (and she handled the rest which was a godsend as I had to keep baby upright for 30min post feed) as well as expressed BF (I still woke up to pump at least once due to breast discomfort). All in all, extremely helpful and supportive of my BF journey.
Cons - as above, indeed an investment.
I was reminded actually when reading the above, that I was told by my maternity nurse that I should eventually be prolonging time between feeds in an attempt to set a routine, but luckily my baby was very vocal about what he wanted and when he wanted it, so I quickly went back to responsive feeding.’
Stacey Zimmels IBCLC:
‘I had one with my second baby. Caveat - I am an IBCLC but I suffered significant post-natal anxiety due to sleep deprivation following my first and I decided I wanted some help. I told her exactly what I did and didn’t rant which was helpful. I didn’t start until I felt that the supply demand rhythm of breastfeeding was established which for me was around 3 weeks. It was fine. She did exactly what I asked her to do and I felt confident enough to sleep whilst she was looking after him. We only had her around 6 times over about 3 weeks after which I ended the contract as he was sleeping really well and was easy at night so didn’t feel I needed to spend the money.’
Sophie:
‘I also had a positive experience and like others am aware that it’s to do with trust, and developing a good relationship and open communication with the individual. I’d had a caesarean so having an extra pair of hands around to pick up and bring me the baby for night feeds helped greatly. She would resettle or change nappy as needed too. In the morning she’d also get her ready for the day, give her a little wash and dress her. She’d also help with folding and putting away her laundry. I did exclusively Bf for the first few weeks and then we introduced one bottle at night to help me get more sleep which I don’t regret and would do again. Obviously at the time I deliberated a lot and making the decision stressed me out but, in the end, felt that one bottle in 24 hours (on the nights she was there) was ok! She actually told us about paced feeding so that was great. The only thing she/I didn’t know about was the timing of the bottle was important - she had been doing the feed between 2 and 6 am which I later found out from Cordelia Uys, at the drop-in at her house, could have been damaging to my milk supply as that’s an important time for milk production. So once I found that out, I shifted the bottle feed to earlier in the night and I did the early morning feed.
Of course, everyone’s situation is different, and I can see how/why it wouldn’t work out. But for us the main benefit was it meant more sleep. Plus, her general calming and trusting manner made us feel so reassured. In the first few days my whole body would physically relax when she arrived. I didn’t have much of an appetite due to being so overexcited/anxious/overwhelmed, and when she walked in the door I’d suddenly relax and be ravenous and able to eat again knowing the baby was in safe hands. We reduced the number of nights she did over time. And then we went on holiday for 2 weeks when she was 5 months and I EBF the whole time, after that my baby refused bottles! So that was the end of that! My little girl is 2 years 3 months now and we’re still breastfeeding.’
Rose:
‘I had a night nurse with both my kids for the first few weeks. I told her explicitly to bring the baby to me as soon as he started to stir so I could feed him. If he didn’t go back to sleep she would then wind the baby or change his nappy etc and get him settled again. It worked really well for me and meant I could get some sleep between feeds and had absolutely no negative impact on breastfeeding at all. I fed both of them 100% exclusively from the breast (no pumping) for 14m for my first and still going now at 14m with my second!’
Zhenya:
‘Yep, same here. By the time we got the night nurse in I was so desperate for respite. She would do all the other duties apart from feeding the baby at night - changing nappies, burping him. She would make me tea and a bite to eat, made sure I drank enough water. She even did the washing up and hang the endless baby laundry. I was on my own for the first two months (visa issues with husband, thanks Teresa May....), so she was a godsend. It was made very clear that one of my challenges was building up milk supply, and she talked me through the whole business of using and cleaning a pump, giving baby both breasts, keeping a diary of when he fed (to see what the patterns were, not to enforce them..), checking the latch, and just generally being there and listening to all my worries and woes. She was the most compassionate and gentle lady. She also had that gentle way with my son - when a person just exhumes warmth and calm. I needed that after a pretty traumatic birth. I guess the point is, that there are takeaways as to what makes a good night nurse and what makes a bad one. We were very lucky... We found her through an agency and she came to see me straight in hospital (I was readmitted after a few days at home - due to preeclampsia).’
Anastasia:
‘I always wondered how it would work at night? Do they bring baby to you? Rock baby after?’
Cordelia Uys BFC:
‘Anastasia, as you probably realise, one of the big problems is that night feeds are crucial for establishing and maintaining milk supply. Mums and babies have evolved over hundreds of thousands of years not to be separated at night. This is why learning how to breastfeed in the side-lying position is such a godsend to breastfeeding mothers, and they can feed their babies and sleep!’
Stacey Zimmels IBCLC:
‘If you have a baby who is feeding for 30 mins every two hours night after night - but also needs a nappy change and settling it can be really helpful for you do just doing the feed and not getting out of bed and someone else doing the nappy change first and any cuddling that may be needed if baby doesn’t settle after a feed and doesn’t want more milk. It’s the difference between 4 -6 hours or broken sleep vs 1-3 some nights. If you’re struggling, I think the right support is a good option as for many the alternatives may lead the parent to move away from breastfeeding.’
Anastasia:
‘Stacey Zimmels, fair enough. I used my husband for that so baby can bond with parents but appreciate not everyone has that support and sleep deprivation is a killer.’
Stacey Zimmels IBCLC:
‘Absolutely. I’m certainly not saying we should all do it and many aren’t in a position to afford it but Cordelia Uys was asking about the benefit / role for exclusively breastfed babies. I had a small toddler and my husband was working full time so we chose to try and protect his sleep so he could support my eldest in the night and day and then work. So I did the nights all on my own when we didn’t have the help. Each family has their own way. I think this thread is super helpful so we can learn from each other’s experiences good and bad and so Cordelia can put a really useful resource together for other moms who may consider it in the future.’
Cordelia Uys BFC:
‘Stacey Zimmels, I totally agree, someone else to change nappies and settle the baby would be perfection itself.’
Noni:
‘Hi, I had a really good experience, but I had to find the "right" person who understood my needs which were: I would breastfeed on demand, this meant I would breastfeed and hand baby over for burping and changing and go back to sleep. If baby needed feeding 10mins or 2 hrs later, she'd wake me up/tell me and I would feed. In the first 5 weeks after birth (the period I used her) it was such a huge help as I was completely sleep deprived. In the long run I exclusively breastfed for 14 months so safe to say it didn't have a negative impact on breastfeeding.’
Steph:
‘We had a wonderful experience with our night nanny who would wake me to breastfeed our little boy. I don’t know how I would have done it without her help (nor my husband’s!)’
Anonymous:
‘I had a really positive experience with a night nurse. I do hear what others have said here about the potential of night nurses who don't listen to mums’ wishes potentially hindering the BF process. To those ladies I send love and am sorry you experienced that. I had a lovely night nurse that totally respected the plan I was following from my wonderful IBCLC. We only had her 4 nights in total so not so much but for a new mummy recovering from 10 days in hospital I took anything! I was feeding on the breast responsively whenever needed and then pumping straight after to increase supply and topping up with expressed milk and formula if still needed after that. She was so respectful, she would wake me if it had been just a few minutes or a couple of hours to feed. Then she took baby to wind and settle after we fed so that I was able to pump. She also taught me a lot of new mum tips like how often I needed to sterilise the breast pump equipment and how to stack it all in the best way. My little one has never had the best latch and winding has always been part of the process so she taught me lots of lovely positions for both. I don't think she was an IBCLC but she had training of other sorts, I can't remember exactly. The only caveat I would say is that one time my hubby felt she might have over fed with one of the top ups when I had already gone to sleep. Overall, I was really lucky to have such a positive experience.’
Andrea:
‘I also had a very positive experience with a night nanny who I used 1-2 times a week when my daughter was 2 - 4 months old. I would usually pump enough for one feed so that she could give my daughter one bottle at night and I could have a slightly longer stretch of sleep. Otherwise, she would bring her to me to breastfeed whenever she showed hunger cues and take care of everything else (nappy, burping, rocking, etc). She also helped us set a routine and reassured us about the various anxieties that many new parents feel - particularly at a time of uncertainty and isolation like we were experiencing during lockdown. At a time when my mental health was deteriorating, her calming and encouraging presence, together with the extra sleep, helped me pull through a difficult time - and in doing so, continue with my BF journey, which is still going strong. I'm very sorry to hear about the negative experiences mentioned by others, but in my opinion and from my own experience, there is nothing inherently conflicting about using a night nanny and breastfeeding responsively.’
Sheetal:
‘The night nurse I had, helped me with breastfeeding, encouraged me to pump, keep doing skin to skin and see a lactation consultant which is why I contacted Cordelia. She told me I needed to rest when I wasn’t with the baby so I would recover faster and not need her anymore. While my baby was sleeping, she would sort out the laundry and even brought me a home cooked meal that she prepared so I could eat as soon as she arrived in the evening and then rest. She taught me how to bathe my daughter confidently by myself. My daughter was born 5 weeks early, had jaundice and needed phototherapy and a heated mattress before we left the hospital. I had an episiotomy, and the pain was terrible. We had a lot on as first-time parents and I can’t imagine what those first few weeks would have been like without the help and support. She is a midwife and works with the NHS as day job but does night nurse roles from time to time. She has a network of midwives that do the same and on the nights she couldn’t make it, she organised for one of her colleagues to help us out and they were always briefed about what was going on and knew exactly what needed to be done. I think it’s about finding the right night nurse. My daughter just turned one and we are still breastfeeding.’
Suzanne:
‘I used a night nanny for my twins and wouldn’t have survived without the help! My son (the reason I went to Cordelia’s drop in years ago) was 18months when the twins were born, and I had only just weaned him off the breast halfway through that pregnancy as it was absolutely exhausting for me. My husband was traveling for work a lot and any support around me was pushing bottles for the twins. I lucked out with the 2 night nurses who split up the time that I needed them. I started using them the week after the girls were born but I didn’t use a night nurse every night as I wanted to do as much as I could on my own. But the nights I did use them were amazing. One was a maternity nurse from the ward I delivered in (I hired her through an agency) and the other was a GP in her previous country - and both supported breastfeeding and worked with me with exactly what I wanted. They would bring the babies to me for a feed and then wind them and change them when I was done. Again they weren’t there every single night so the nights they were there I very much welcomed the help!! I also pumped to have some milk stored up in the freezer/fridge if need be but mostly I was feeding them myself and catching some extra sleep bc settling the 2 of them plus my toddler who wasn’t a great sleeper at the time was overwhelming. They were invaluable!’
In conclusion
If you understand what’s required to establish breastfeeding, are aware of the pitfalls and can dedicate some time and effort to searching for the right person, it is possible to find a MN/NN who will be supportive of breastfeeding, respectful of all your wishes, and make those early days less exhausting and less stressful. Trust your gut feelings: if the person doesn’t feel like a good fit, don’t compromise, keep looking, no matter how impressive their references.
Maternity nurses
Joane Monsanto Llacuna (Joane Powers on Facebook), mobile: 07850760947 email: joanematernitynurse@gmail.com
Stacey Zimmels has a friend called Steph who trained with her as an IBCLC lactation consultant. Steph runs a maternity nursing company and offers breastfeeding support with maternity nursing: https://www.holisticbabiesouthlondon.com/?fbclid=IwAR2rgs_PY0Nn9HcJ2sR07Nnw0RbYCwYikO4kV-PMmccNRow7EmVu8LFqvDg
Vanessa telephone: 07939 370400. is a night nanny recommended by Dr Farah Alobeidi: ‘I think maternity nurses and night nannies are normally a hinderence to breastfeeding. I had a few bad experiences as they are just keen to bottle feed the baby. However, Vanessa is a wonderful exception. I used her with N and A and she is completely au fait with paced feeding, handling and storing breastmilk and pump parts and is very gentle and loving. She is a mother herself and understands what babies need. She doesn't let babies cry and will instead cuddle them and give them lots of love so you can rest knowing your baby is in safe hands. She also understands the importance of overnight feeds to maintain supply so she will not allow you to skip feeds (which other maternity nurses have done in my experience).’