Mother and Child - Reshma Azmi
I'm crying as I write this. I hope it doesn't mean there are too many typos. I'll correct them as I edit over the next day or so.
In 2007, I asked for help for Baby E. Baby Elisha, as it happens. Elisha was 5 months old, when she was taken from her mother's arms, literally, in the street, by Essex Social Services. Her mother, Rachael, who was a teenager, had exclusively breastfed her from birth, and safely co-slept with her. Rachael was a stroppy teenager - and wasn't very good at being told what to do by anyone. Whilst she was a loving, caring and supportive mother, utterly dedicated to her daughter, she had a fraught relationship with her own mother. Rachael had gone to live in a supported mother and baby unit, and lived there, with Elisha. She didn't get on well with many of the other teenage Mums who were in the unit, many of whom thought she was weird when she breastfed, and didn't start solids early, and slept with the baby in the moses basket beside her. Maliciously, and without any evidence, one of the other teenage Mums told the Health Visitor that Rachael was taking drugs.
One Monday, Rachael attended a hearing that she'd been told she had to go to. No one had told the family why. She went on her own, and the family had no idea it was a 'serious' meeting. Without any warning whatsoever, and without legal representation, Rachael emerged from the hearing, with Elisha now on the 'at risk' register. The family rallied round, and in the middle of the shocked disbelief, it was arranged that Elisha and Rachael should stay with Rachael's mother - Elisha's grandmother.
On the Friday, Rachael and her Mum had an argument, and Rachael stormed off out, with Elisha. Rachael was going to go round to her grandmother, Elisha's great grandmother, and calm down. She first went to a friend's, to moan about how her Mum didn't understand her.
Unbeknowst to Rachael, and in an moment of worry that the grandmother will carry with her for the rest of her life, Rachael's Mum phoned Essex Social Serives, and asked for support. She wanted to chat to someone, and have someone advise her on how to manage the weekend, with Rachael being so unhappy at having to stay there.
Essex Social Services phoned the police and initiated a search for a mother who had stolen her own child.
Social workers spotted Elisha in the arms of one of Rachael's friends, in the street. Rachael, on the way to her own Gran's for tea and a chat, had nipped into the loo in the house of another friend, as they passed. The social worker tried to pull Elisha from the hands of the girl holding her. Rachael emerged to find her friend, hysterical and distraught, arguing with complete strangers trying to take the baby.
Elisha was screaming her head off.
Rachael, whilst trying to calm Elisha, breastfed her. In later reports, the social worker claimed this was evidence that she was not a fit mother, as it was inappropriate behaviour to breastfeed in the street.
In the middle of all the screaming and crying, the social worker told Rachael the baby was only going to be taken for the weekend, in order to let Rachael calm down. Finally, the social worker toook Elisha from her mother's arms, put her in a car, and drove off.
Such was Rachael's shock, she and the rest of the family attended the local police station a few hours later, to report that Elisha had been kidnapped. The police explained that social services could do what they wanted.
Elisha's grandmother, distraught and in shock, desperately tried to get through to social services - Elisha was exclusively breastfed. She'd never had a bottle, would they monitor this properly? The family were terrified Elisha would end up dehydrated and distressed, and in hospital. Meanwhile, Rachael was becoming engorged and in pain herself, so they also desperately arranged a pump and lactation support. I was put in touch with them on the Sunday, and they sent me all the court papers, there and then.
Elisha was not returned.
The months passed... and with Rachael being asked not to breastfeed in access meetings, with Rachael being criticised for not having a high chair, as this was evidence she was not in tune with her baby's developmental needs, with Rachael's insistence on breastfeeding Elisha during access meetings being cited as evidence she was not a responsible mother... Elisha moved further and further towards permanent adoption.
Rachael was forced to attend parenting classes, where she was instructed on how to strap her baby into a high chair and force feed it solids. Or rather, how to strap a doll into the high chair, as she wasn't allowed to attend with Elisha. Where she had to prove she knew how to parent according to the social services book and had to buy equipment they deemed crucial, even 'tho it went against her every instinct as an attached, baby wearing, co-sleeping and baby led weaning, mother. Before the removal, in the accommodation she and Elisha had had in the mother baby unit, Rachael had been told that it was not good enough that she had no bottle steriliser, no bottles, or baby formula, or a crib in the room. These 'lacks' were evidence that Rachael was not a good mother.
Finally, when the paperwork emerged with active criticism of the breastfeeding in writing, and at the request of the family, I asked for
your support. Mor Dioum of the
Victoria Climbie Foundation, also took on Essex on behalf of the family, attending the meetings being held.
Elisha was returned to her family, but not her mother. Breastfeeding had been severed. Elisha had carried on for months, in the access meetings, but, finally, the trauma was too great, and she refused to breastfeed. Rachael was devastated, feeling she had lost so much with her precious, gorgeous, and beautiful first born.
Now, over two years later... Elisha is back with her Mum. Her and her new baby sister, who had automatically been put on the at risk register the moment she was born, are free from social services and live happy lives. The family could not be more grateful, to all of you who phoned, faxed and emailed Essex, and demanded to know why breastfeeding was being used as evidence of lack of mothering.
There never was a single scrap of evidence that Elisha had either been harmed, or that Rachael was in any way involved in drugs. Throughout it all, Rachael refused point blank into being bullied into drug testing. Even this, was used as evidence she was unfit to mother her own child. Elisha has always been a happy and completely healthy child: there was never any evidence of anything, other than the malicious gossip of one teenager, to a third party. And that a teenager left her own mother's house, to walk to her grandmother's, to have a cup of tea with her, after having an argument with her Mum. Elisha was removed in less than an hour of Rachael going out for a walk. She had signed a written agreement that she would sleep overnight with her mother... well, there had been no overnight for her not to sleep in her Mum's house. The baby was gone before night fell.
The family have knitted back their lives. Rachael has found her life partner and had another child, Elisha's sister. Elisha's sister breastfed until she self-weaned, never had a bottle, never had a dummy. Only recently, have they managed to finally free Elisha of the dummy habit forced upon her by the foster carer.
They've also been pursuing formal complaints against Essex Social Services. As part of this, we at Nursing Matters prepared a complaint advocacy statement, on Elisha' s behalf, to further the complaint against Essex.
But, as this complaint has still to be even heard properly, we'd not publicised the case. It was more important, to keep a low profile, and pursue Essex for their actions.
This changed this weekend. Rachael and her mother, Juliet, are in such agonies... for Kerry, Mark and Ben. This weekend, hearing the reports of how Ben was taken from his mother's arms, as he'd been breastfeeding... the pain they are feeling is just immense. The memories are sharp and tearing.
But they want to help. Above all, they want to help. Therefore, in Elisha's name... they are releasing the advocacy complaint. It's below. It's a gift from Elisha, to Ben. From Rachael, to Kerry. She knows it will hurt to read, but also knows that it needs to be read.
Be warned. It is not good reading. We took the careful notes made by the foster carer in charge of Elisha, and wove them into the complaint on her behalf. It contains details of Elisha's stress, when being force fed by bottle. It describes her distress. It also mentions perhaps the most damning element of all, in how Essex failed to care for Elisha: it reveals that Essex interpreted Elisha's distress as withdrawal from drugs, given via her mother's milk. They noted the distress. They noted the baby's refusal to feed from the bottle. They hadn't a clue how to interpret that distress. No preparation had been made at all, for Elisha being breastfed. In fact, they simply told the foster mother, if she won't feed, take her to Accident & Emergency. That was their 'care plan' - get her to hospital and have her put on an IV drip if she starts to dehydrate.
This is a huge thing for this famly to do. Damnit, I'm crying again. Their pain, over the past two years, and Elisha's pain on being removed from her mother's breast... such pain is not for public consumption.
But it is for public notice, if it will prevent another baby going through this. If it helps get Ben back to his mother's breast, in the next few days. If it helps get proper guidelines in place, so that all babies taken from the breast, have the support they need to continue breastfeeding until the case against their mothers is clear: no baby should wither from the lack of their mother's breast until is is _proven_ that they will come to harm. Mother and baby units exist - they should be used first and foremost. Other family members can always be in attendance - they should be empowered. Social services have to stop being afraid of breastfeeding. Afraid there is something they cannot control. Mothers will submit to 24 hours observation, to keep their babies safe: the option has to be made available until harm is proven.
Innocent, until proven guilty.
Dear Ben... have this, in case it helps... much love, from Elisha. XXX
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Nursing Matters advocates on behalf of breastfeeding babies, by presenting evidence based medical information and informed medical opinion based on the biological needs of babies and infants. As an organization, we seek to support the baby’s own biological imperatives and to speak for the baby alone, in any disagreement or involvement of the mother, with statutory services. We speak for the baby.
Nursing Matters was contacted by the family, within 48 hours of Elisha’s removal on Friday 22 June, 2007, and have therefore been documenting on her care throughout her entire time away from her mother. We advised the family of lactation care for Elisha’s mother, as well as instigated a global alert on the need to protect breastfeeding when Essex Social Services sought to criticise a mother for breastfeeding her baby in access meetings. And to cite breastfeeding as evidence she did not understand her own baby’s needs. We will continue to work with statutory agencies, the international medical and lactation community and all relevant political structures, to ensure the human rights and biological needs of normally fed babies are not ignored by statutory agencies.
Based on the care records and actions of Essex Social Services in their care of Elisha during her removal, we would therefore add our voice in complaint, in Elisha’s name, for the care she received by Essex Social Services on her removal.
Please note, every quote made in this document by a health care professional with lactation qualification, is made directly about Elisha, and is made as a result of reading the notes in her case, written by the foster carer and social workers. They are not generic. They are in response to Essex Social Services own records.
Therefore, in Elisha’s name, we support the formal complaint made by the family, that Elisha’s needs and rights as a breastfeeding baby were not accounted for, or supported appropriately, by Essex Social Services. Further, that her care actively destroyed her breastfeeding relationship with her mother.
“What is striking in the document you have provided for comment is not that Baby Essex’s breastfeeding relationship was neither considered nor supported but that it was actively undermined and, eventually, extinguished in the face of decades of evidence and public health statements about the importance of breastfeeding to the health and well being of infants.” Nina Berry, University of Wollongong, former Breastfeeding support field worker for Save The Children
In the first instance, Elisha had a right to her mother’s breast, a right which was denied her. The European Court of Human Rights has recognized this dynamic– the right of the child to the breast as long as the mother wishes it, as a basic Human Right, and this is recognised in the English courts:
"Local authorities also had to be sensitive to the wishes of a mother who wants to breastfeed, and should make suitable arrangements to enable her to do so, and not merely to bottle-feed expressed breast milk. Nothing less would meet the imperative demands of the European Convention on Human Rights."...In the matter of unborn baby M; R (on the application of X and another) v Gloucestershire County Council. Citation: BLD 160403280; [2003] EWHC 850 (Admin). Hearing Date: 15 April 2003 Court: Administrative Court. Judge: Munby J. Abstract. Published Date 16/04/2003
At no point were Essex Social Services sensitive to this need. We are aware that the family requested expressed milk form her mother, was sent to Elisha, and Essex Social Services did nothing to arrange, support or facilitate this. Elisha’s access to her mother’s breast appeared not to have been part of the paperwork we have seen, or part of their planning at all, as a facet of Elisha’s care. This is completely unacceptable and Elisha suffered for the lack of this planning:
“Any milk expressed by the mother should be given to the baby as soon as possible. There is no justification for discarding it or withholding it from the baby, unless the baby has some medical condition requiring some other type feeding. Babies are put at health risks from formula feeding, and any breastmilk feeding reduces those risks.” Alison Blenkinsop, IBCLC
We wish to highlight that at the time of the international appeal to Essex Social Services, about their procedures and criteria for care of a breastfed infant, the service repeatedly stated it was following National Guidelines for the care of a breastfed infant. And yet, there is no evidence of this in the paperwork to and from the foster carer, and practically no mention made of it. Breastfeeding is not a category included in the standard form for transferring breastfeeding babies to the foster carer, and no checks are evident on how the breastfeeding is supported. There is no advice or support plan at all, on how to support the breastfeeding.
Nursing Matters therefore has to request that the guidelines Essex Social Services have stated they were adhering to in Elisha’s care, be made public by Essex Social Services, in order for appropriate assessment to be made on their being fit for purpose. Nursing Matters has requested a copy of statutory guidance for supporting breastfeeding babies during removal by social services, from the Department of Children, Schools and Families, and have been informed that there is no current guidance available from them, as they are still being developed. In light of this, we request , again, that Essex Social Services reveal the guidelines they have stated they worked with at the time.
In addition to the complaint that Essex Social Services did not facilitate Elisha’s right to her mother’s breast during the removal, we would also like to highlight the problems that arose as a result in the deficiency of her care at the foster home in the first few days. We would suggest that Elisha’s right to continue her breastfeeding relationship with her mother, was actively undermined by the standard of care she received.
This complaint refers only to the description of care that is detailed by the records of Essex Social Services, and quotes the notes made by the foster carer. For the purposes of clarity, we will distill out the main areas of complaint, on Elisha’s behalf.
1) Primarily, as outline above, the lack of support for Elisha’s right to the breast, as detailed above.
2) The complete lack of preparation of either the removing social worker, or the foster carer, on the most appropriate methods of feeding and comforting an exclusively breastfed baby. Attempts were made by a social worker to bottle feed Elisha within hours of her removal, and no understanding of the harm this could do, is evident in any of the interactions. There is no mention of the removing social worker or the foster carer being aware that cup feeding was the most appropriate method of feeding for Elisha. In fact, there are several distressing descriptions of how Elisha refused the bottle teat completely, and displayed physical and emotional distress on being forced to engage with the bottle. As she had so completely refused the bottle teat at first attempt, and was already under threat of dehydration when she arrived at the foster carer, the foster carer was alerted that syringe feeding should be used and if all else fails, have Elisha admitted to A&E. We find this lack of basic understanding of the feeding needs of a normally fed infant bordering on professional negligence and something that needs to be addressed within Essex Social Services, as a service provider, with the utmost urgency.
Negligence is a powerful term, and should only be used when completely appropriate. We would suggest that the forcing of a bottle teat and syringes into Elisha’s mouth, in conjunction with the introduction of a dummy, is strong evidence of negligence in the matter of the supporting of Elisha’s breastfeeding:
“There is no medical reason for a breastfed baby to ever receive a dummy. A five month old infant who had never had a dummy before would not be able to use a dummy for comfort-sucking, and no doubt would have been extremely distressed by not being able to receive either nutritive or non-nutritive sucking at the breast.” Pamela Morrison, IBCLC, in response to Elisha’s notes from her foster carer.
It is also of note that no permission from the mother had been given, for the use of either a bottle and teat, or a dummy, in Elisha’s care. We would ask… why was a dummy forced into Elisha’s mouth, and repeatedly returned to her mouth, in order to teach her to use it?
3) Lack of understanding of her emotional and physical distress, in particular, repeat attempts being made to force bottle feeding on her without due attention being paid to her breastfeeding status.
“Feeding from a teat or sucking on a dummy is not a physiological norm. A fully breastfed baby may not be able to feed in any other way. Abrupt cessation of breastfeeding puts a baby at risk, both physically from difficulty in taking milk another way, and psychologically from the loss of comfort, sucking, and familiar sensations.” Alison Blenkinsop, IBCLC
Breastfed babies are in control of their own feeding, and have never experienced having anything forced into their mouths, such as a syringe, bottle teat or dummy, and of being forced to swallow. Despite her obvious signs of distress:
“I did not know when Mum had last fed her and the family care worker said they had tried to feed her by bottle and she took half an ounce. Tried SMA Gold via a bottle, but (baby) unable to take this also unable to suck a dummy.”
““Fed her via syringe, a slow job but she managed 3oz. Very restless and fidgety, thrashing about a lot. Cries and fights when nursed in arms, more relaxed when put on shoulder.”
“Woke at 12.30am, offered her a bottle, held her in my arms and made eye contact, and sang – she seemed to relax a little and she took 4oz from a bottle. Woke at 4.45 am, crying and thrashed about. Not interested in feeding and I nursed her on my shoulder, and she slept.”
… Elisha is repeatedly subjected to being held in the cradle position, a bottle feeding position, and forced to accept either a syringe, a bottle teat, or a dummy into her mouth. The carer notes Elisha’s distressed behavior, but is seemingly unaware that it is the feeding methods, and the dummy use, that is causing much of it.
“Thrashing about and crying are normal behaviours of an infant in distress - particularly exhibited by a baby who cannot feed, eg a hungry newborn baby who cannot attach to the breast, or an older baby who is being "fed" for the first time by a stranger with an unusual and unknown hard silicone teat, instead of the expected feeding and warmth of the soft and familiar mother's breast.” Pamela Morrison, IBCLC.
“This behaviour is normal in a healthy, fully breastfed baby. Difficulty in taking feeds any other way is normal. This baby is demonstrating that difficulty. Bottle/syringe feeding requires different actions from breastfeeding. A fully breastfed baby’s co-ordination would be affected by enforcing another feeding method, which could put her at risk of choking and aspiration, and is likely to be very distressing.” Alison Blenkinsop, IBCLC
“The description provided of Baby Essex’s behaviour when first faced with a bottle offered by a stranger is completely congruent with the behaviour of other exclusively breastfed babies I have worked with. Forcing a teat into a baby’s mouth is often associated with significant distress evidenced by the kind of thrashing behaviour described by Baby Essex’s carer. It is not uncommon for an exclusively breastfed baby to refuse bottles and many mothers seek my help with this as they consider returning to work. These babies commonly arch their backs, turn their heads from side to side to avoid the bottle and do so with considered determination. They do not recognise bottles as either a source of food or comfort and it often takes many weeks of quiet persistence to familiarise a baby with a bottle.
This phenomenon has been observed, documented and described by Elsie Mobbs (Mobbs 2007 ). Her work notes that ‘infants exhibit great emotional distress when their fixated sucking comfort object is not available … replacement fixated sucking objects are at first rejected and there is great emotional distress before a switch is achieved’. In the case of an infant who has only ever been fed and comforted at her mother’s breast, her mother is her ‘fixated comfort sucking object’. Therefore Baby Essex’s behaviour could well be explained, in the absence of evidence to the contrary, simply by the fact that she had been deprived of her mother.” Nina Berry, University of Wollongong
Our understanding from the family, is that Elisha’s distress, as so carefully recorded by the foster carer, has been linked to her mother’s care of her prior to the removal. If this is indeed the case, and records emerge to prove this, we should advise Essex Social Services that several international professionals, such as Elsie Mobbs, whose academic work is referred to above, are happy to provide expert witness on Elisha’s behalf, based on the records of the foster carer. The lactation community as a whole, are anxious that clear, evidence based scientific and medical research, is applied thoroughly to understanding the distress caused to Elisha by forcing hard objects into her mouth, at a time when she had been removed from her mother’s breast. And suggestion that this is a minor matter, that did not impact on Elisha’s wellbeing dramatically, will be met with a sustained, professional, response.
4) The matter of asking Elisha’s mother to restrict her breastfeeding during what little access Elisha had to her breast. We will not elaborate on this here, as it is an area that has already generated a huge response to Essex Social Services, and the clear evidence of the requests to her mother for her to refuse Elisha’s request to be fed, and subsequent statements that a mother’s desire to meet her daughter’s clearly expressed need for the breast is evidence of her inability to mother her baby… are already a matter of public record. We can revisit it in detail if required. Just to note, that this complaint on Elisha’s behalf, also includes this vital area, and Nursing Matters would be expecting this area to be fully covered in the complaint process finally underway.
We are, of course, available for further comment and evidence based response, at any point. Nursing Matters will seek to uphold Elisha’s breastfeeding rights in the process of this complaint, in its entirety.
