"I get a lot of positive feedback and am happy to give it back"

Original interview in the Scheizerische Ärztezeitung

Bernd Gerresheim, you are Head of Obstetrics and Prenatal Medicine at Bethesda Hospital in Basel - and you are a certified breastfeeding counsellor. Why did you complete this additional training?

Before I came to Basel about five years ago, I was head physician at a clinic in Germany for twelve years. Many women there wanted to breastfeed. But quite a large percentage of them stopped breastfeeding during their hospitalisation or shortly afterwards because it didn't work. It became important to me to change this.

Why?

In conversations with affected mothers, I realised that many of them were struggling with the negative feeling of not being able to feed their child themselves. And we couldn't always help them fulfil their wish. Originally, I thought I would only have to tweak one or two things to make it work better.

But?

I realised that the paediatric nurses there were hardly willing to change their approach. They also had a knowledge advantage over me. As a gynaecologist with further training in special obstetrics, I hardly knew anything about breastfeeding.

What reasons for the low breastfeeding rate were given to you by the paediatric nurses who looked after the women and children after the birth?

Basically, it was always the others' fault. They said, for example, that women can no longer breastfeed because they only look at their mobile phones. But I thought to myself that it couldn't be that alone. I knew that if I wanted to change something, I had to become more competent in this area myself.

so you started training to become a breastfeeding counsellor.

I turned to the European Institute for Breastfeeding and Lactation, where there were also courses for doctors. However, the first of two courses had already been completed. That's why I was allowed to attend the second part. In order to get my hours, I was then supposed to attend courses that were also attended by midwives and nurses. I found these interprofessional courses particularly enriching because the midwives and nurses looked at the subject from a completely different perspective to us doctors.

How has this training changed your professional life?

Before, the most important thing for me was that mother and child went home healthy after the birth. Of course, that is still the most important thing. But before, I didn't find anything beyond that incredibly exciting. Now I realise that bonding between mother and child is very important. Of course, the few days that the women spend with us are not the only chance to build a good bond. But we can set the course here. This is extremely important, because securely attached people have a much easier time in life than insecurely attached people.

Were you able to change the circumstances at your place of work after the additional training?

I tried to implement my newly learnt skills at my former workplace. But that proved to be difficult. In the end, Bethesda Hospital came to my attention. Here I was able to put into practice what had inspired me during my training as a breastfeeding counsellor. Even before I started my job, a lot of emphasis was placed on the topic of bonding between mother and child.

The Bethesda Hospital now employs certified breastfeeding counsellors who help with breastfeeding problems and thus contribute to promoting the bond between mother and child. Is this one of the aspects you wanted to implement?

It's important for me to say that we started the professionalisation of breastfeeding counselling together as a team. For around two years now, we have had trained breastfeeding counsellors who are really only responsible for breastfeeding counselling. They also run an outpatient breastfeeding clinic where women can call for advice from home.

Next to the maternity clinic at Bethesda Hospital is the midwife-led birth centre. If things go well, women give birth there without the presence of a doctor. What was it like for you to get involved in this collaboration?

It was a new experience for me too and difficult to imagine at first. But I embraced it, perhaps also because of the experience I gained during my training.

What do you mean by that?

Since my training as a breastfeeding counsellor, it has been clear to me that there can only be cooperation in obstetrics on an equal footing. In concrete terms, this means that the midwives at the Haus der Geburt look after the pregnant women almost exclusively, and the women only come to me occasionally. This exchange works very well. This is because every professional involved wants to contribute their best to the success of the pregnancy and the most natural birth possible from their own perspective.

How does this interprofessional approach affect the working atmosphere?

It is an incredibly satisfying working environment when you support and appreciate each other. I get a lot of positive feedback and am happy to give it back. Our midwives are very competent, reliably realise when something is not going well and then get in touch with me. The collaboration with the Haus der Geburt also has an impact on our work at the hospital. As a project for the future, we can imagine introducing a midwife-led birthing centre. If it is not necessary, there should be no doctor present during the entire birth.

Does interprofessional collaboration require a lot of human resources?

Of course, you need enough midwives, but in the end, interprofessional collaboration is not more expensive, according to research. There shouldn't be fewer midwives in our team, but we still have enough resources.

Why is such an interprofessional effort more than just "nice to have" for a maternity clinic?

This collaboration on an equal footing is essential for us to provide good obstetric care. Our in-house team has a very low caesarean section rate of around 22 per cent. For me, this is also a quality indicator. The caesarean section rate is even lower at the Haus der Geburt.

How visible is your interprofessional profile during your work? Do the women notice that you are a gynaecologist with additional training in breastfeeding counselling?

We gynaecologists do a lot of ultrasound examinations, send women 3D images of their unborn children on their mobile phones and so on. You'd think that would go down particularly well. But I realise that I can build a really close bond with women by giving them successful advice on breastfeeding. I've often had mums write to me later saying how much I've helped them in a difficult situation with breastfeeding. These women are particularly happy to come back to us in their next pregnancy