Exonerated by my GP

There is something to be said for doctors. Doctors are trained and authorised to make decisions about things, in contrast to nurses, including health visitors, who are trained and authorised to trigger procedures.

Two weeks ago, I took Henry back to the HV for yet more jabs, and yet more weight monitoring, and he’d crossed another line. He’s now gone from the 91st centile to 50th, in about eight weeks. I was so sure that he’d grown enough, this time. I’d spent the whole of the previous day feeding him at 90 minute intervals, in a bid to make him as heavy as possible. Besides, he had to have grown – he was so obviously healthy, and alert, and etc, etc, how could he not be growing? I just wanted her to say, “That was a blip, he’s fine, off you go”. But of course, she didn’t – he’d crossed another line on the chart, and so she began.

“On the one hand, he looks and seems perfectly healthy. But on the other, it would be remiss of me not to respond to this lack of weight-gain in some way.”

I must have given her a look, because she said, “I know you’re angry…”

I hate being handled. Somebody at some point has trained her to say that when people give her the look I’d just given her; she was trying to make me feel Heard, and Empowered. I loathe that. You need more grace than that to mess with my head without irritating me intensely. My dad was a counsellor, and I learned pretty robust anti-counselling defences at a fairly young age. Besides, she was wrong. I was angry, but the look was about trying not to cry. I’d tied myself up in knots trying to make my feeding of him better, somehow, and I’d proved myself to be a dismal failure – a failure as a mother, not least. She denied that it meant my milk wasn’t good enough, but really, if that wasn’t what she was saying, what was she saying?

She flirted with referring him to Alder Hey for Failure to Thrive, but I think that even she saw that as ludicrous. He is thriving, he’s not losing weight, he’s just not as fat as she would appear to wish. So her second suggestion was that I take him to the breast feeding clinic at the Women’s Hospital. This did not delight me.

I’ve been to the breast feeding clinic before, when Daisy was tiny – not because of her growth, but because of the acute pain and bleeding in my nipples. The thing is, I think I’ve heard pretty much everything they are ever likely to say about breast feeding. I can recite their positioning mantras, and was reciting them all through Henry’s first week, when it was so unspeakably painful. But he’s four months old, now, and there’s nothing wrong with our positioning. I can’t imagine how breastfeeding could suddenly stop working, or what they would say in response to such a thing. I mean, if I’d been ill, or stopped eating, or taken up some kind of prescription or illegal medication… yes, these things could affect your milk. Just trotting along in more or less the same way as you had for the previous two months, however, is a bizarre way to make milk supply problems.

The extent of my desire to drag my baby and my three-year-old to the LWH on Thursday must have shown on my face, because her next suggestion was, “I could ask one of the GPs here to check him over. Would that be worth doing?”

I said, “It’s worth doing if it means I don’t have to trek all the way out to the Women’s later in the week.” So off she toddled, to find a GP. The one she found was in the next room, so I gathered up Henry and Daisy, and took them next door, and the minute the door closed, the doctor said, “Don’t tell her I said this: I’m sure he is fine, and I’m only doing this to get her off your case.”

Cheered almost immediately, I chatted to her a bit more, and learned that her own first baby plummeted down the charts, to the extent that she was referred to Alder Hey, and prodded and poked, and she was fine. She was a big baby, who was destined to be a smaller-end-of-average person, and there is no way to get from one of those points to the other without crossing lines on the growth chart. She talked about bell curves, and the fact that no-one wants to be at the the extreme ends of the chart; that if he’d stayed on the 98th centile, he’d almost certainly be obese, and/or suffering from some kind of enzyme/hormone deficiency; that the graphs are based on bottlefed babies anyway; that Health Visitors are trained to prioritise growth, because the profession was established to fight malnutrition in babies, but that isn’t the evil of modern culture – quite the opposite. She basically said that my baby was healthy, and everyone else’s are overweight!

She listened to his heart, because she’d said she would, and gave some cursory poking, but was perfectly happy with him. So then we talked about the Health Visitor. Now, I’m sure there are many worse HVs in circulation than mine. As I’ve said before, she’s a perfectly nice woman. But I really, really didn’t want to keep bringing him back to her, to be weighed, sighed over, criticised, and to walk away needing to eat chocolate, drink wine, and sob on Kevin’s shoulder at how inadequate I appeared to be. I felt like I was caught in a vicious cycle, and everything in me wanted to take Henry out of there, and just never take him back. As long as no-one weighs him, I believe he’s fine, so stop weighing him.

The doctor cut a deal with me. Incidentally, she admitted that she never took her second baby to be weighed, and was much better off as a result, but we decided that I would bring Henry back in a fortnight, just to check, but I would bring him to her, in surgery. I’ve no idea what she told the Health Visitor – she went off, either explained, blamed me, blamed her, or fudged the thing somehow, then came back and told me it was fine. And that’s why, today, I took him to the surgery, to see the doctor for weighing, instead of taking him to clinic tomorrow.

She was torn. He’s gained some weight, but not as much as we were all hoping – enough to allow us to say, “A blip. Ah, well.” However, she still believed everything she said two weeks ago. She added that he’s not malnourished, or underweight in any sense – he has creases in the fat of his legs, his ribs don’t stick out, he’s clearly getting as much milk as he needs. She said, “There is no question of him being insufficiently fed,” which throws the breast feeding clinic out the window, really. She said, if he was referred, the hospital would test him for things like cystic fibrosis, and other diseases that would impair his growth. But she also said, when I asked her, that if he came back in two weeks or a month having crossed the 25 centile line, but still looking as healthy as he does now, she still wouldn’t be inclined to refer him. If he was ill, he’d be, well, ill somehow.

That led to the question, why are we monitoring his weight at all? She toyed with telling me to bring him back in a month, but in the end, we left it up to me. I mean, obviously, it’s up to me anyway, but it was “Bring him if you want to, or if you’re worried, but I’m not saying, ‘I definitely want to see him’. And if you do bring him, I won’t assume that you suddenly are worried – don’t let that put you off. If you like, bring him, we’ll have a chat, and not weigh him at all.” (I’m busy today, I have to take Henry to the doctors to not be weighed…).

So, I’ve done it. I’ve shaken off the over-attentiveness of the NHS. If he seems ill, I’ll take him to doctors, and if he doesn’t I won’t. That sounds so basic and obvious, I’m wondering why it took so long to get here.

Kevin pointed out that the lines on the graph imply that babies start in one place and grow steadily from that point. There’s no evidence, on the chart, that the top 3% of babies at 2 weeks and the top 3% at four weeks are the same babies. The line is arbitrary – why are we trying to make him follow it?

The other thing that occurred to me, this evening, is that the GP wasn’t saying, “There was a problem, it’s gone now.” She was saying, “There was never a problem.” She was categorical that my feeding him wasn’t at issue, which cuts across the things that the Health Visitor seemed to be implying, with all her “How do you feed him” questions. There’s nothing wrong with my feeding – with my milk, with how often, with how long, it’s all fine. Just like I always knew it was, until they knocked the stuffing out of me. In the interim, I’ve been trying to feed him more often, in the hopes that he’d put more weight on, and get us both off the hook. And I seem to have succeeded in taking a baby who happily fed once every three hours, and turned him into one who needs to feed every 90 minutes. It’s not affected his weight gain, so presumably he’s taking half as much milk, twice as often, with only one effect – to make feeding him more inconvenient. Some babies need to feed that often, because of how much milk is available at one time, or because of how much milk they can fit into their tummies. Mine I’ve just trained that way, which is unspeakably stupid.

Still, if I can edge him one way, hopefully I can edge him back again!

4 thoughts on “Exonerated by my GP

  1. Cor, a sensible GP! Lucky you!

    I have only once met a HV who was actually useful and supportive, and who – just as importantly – knew her own skills and limits. We didn’t agree on everything but she supported our choices anyway. She acknowledged that I knew more about breastfeeding than she did and used to actually ring me and ask permission to pass my phone number on to other mums. And thus, when I did have concerns, I felt able to speak to her.

    The majority of them, it appears, aren’t like that. Rather than supporting families, they seem to often do the opposite – what your HV did – undermine their confidence. Such a huge amount of time, money, resources wasted, when there are so many families who could actually benefit from all of that if it was only in the right place.

    I’m glad you’ve got someone you can talk to about your worries, that you’re not getting caught up on the FTT treadmill (as we were last year). They need to stop calling it that and start looking with their eyes and seeing that some babies are visibly thriving, just failing to comply with their bloody charts!

  2. Deb – now there’s a thought. Stop calling it Failure to Thrive, and start calling it Failure to Conform, and suddenly the rebel in me WANTS him to bloody-mindedly cross the percentile lines whilst remaining doggedly healthy…

    Dad – she does, and I believe she breastfed them. I can only imagine that her babies didn’t do this, or at least, did it to a lesser extent. Mind you, if it turned out that she’d given up on breast feeding after a fortnight, and her entire reaction to breastfed babies was a channelling of her repressed guilt, I shouldn’t be a bit surprised.

  3. you’d think someone would tell them that new mum’s are vulnerable – even when they’ve done it before. we are desperate to do it right and need encouraging not undermining!
    just keep doing what you’re doing – it’s fine.

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