This essay explains, reflects and analyses a critical incident which occurred on a postnatal ward during my first clinical placement as a student midwife. The incident relates to breastfeeding practices on the ward and is classed as critical because it triggered an instinctual response in me which made me feel it was not right or helpful. My response and feelings at the time were not grounded in theoretical knowledge but rather an instinctual feeling. As a result of this instinctual feeling, the incident was explored. This exploration opened up a flood gate of information regarding what could be learned from this incident and ways to improve practice. What was learnt from this incident will be discussed with the use of relevant literature. Discussion of the following topics will facilitate reflection and evaluation of the critical incident, maternal (breastfeeding) instinct, the use of skin-to-skin contact, using baby slings, co-sleeping, baby-led attachment and use of the hands-off technique (HOT), ways to empower mothers, positive reinforcement, the Baby Friendly Hospital Initiative (BFHI) and ethical, legal and competency aspects of this critical incident.
The incident unfolded as follows. Ellen was a twenty-seven year old primipara who had been on the postnatal ward for five days. It was handed over that she was having difficulty breastfeeding due to large breasts and flat nipples and as a result the baby (Harry) wouldn’t attach and was very unsettled. My first contact with Ellen was when she requested assistance to breastfeed. The hands-off technique was used but Harry would not open his mouth to attach to Ellen’s nipple and was crying throughout. I enlisted the help of a senior midwife who had assisted Ellen previously. She settled Harry by placing her finger in his mouth and rubbing his soft pallet. She placed a rolled hand towel under Ellen’s breast and pushed Harry onto her breast. This ‘hands-on’ approach was successful in attaching Harry and he fed for thirty minutes.
Approximately three hours later Ellen requested I watch her attach Harry. I watched as she anxiously hurried to attach him and Harry soon became frustrated and began to cry. I could not see fault in her technique and had reached the limits of my breastfeeding understanding so enlisted the help of a second midwife. She attempted a hands-on approach, which was unsuccessful. She changed her approach and hand expressed milk from Ellen and feed it to Harry using a syringe with her finger in his mouth. The rationale for this, she