Mother and Child - Reshma Azmi
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
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
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;  EWHC 850 (Admin). Hearing Date:
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 , 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
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
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
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.