Victoria WF Honar, a name very familiar to breastfeeding mothers in the Kingdom of Bahrain. And I am thrilled to be able to feature her on my blog – after all Bahrain is where I was born and raised. To celebrate World Breastfeeding Week 2017, here is my interview with Vicky Honar, an IBCLC – that means she’s an international board certified lactation consultant. The only kind of medical person one should visit to address breastfeeding concerns.

Vicky originally trained as a nurse, then carried on to become a midwife and worked as a midwife for more than 20 years in Scotland and the United Arab Emirates.

Tell us a little about your training and background as an LC

I originally trained as a nurse, then carried on to become a midwife and worked as a midwife for more than 20 years in Scotland and the United Arab Emirates. I very much enjoyed being a midwife and learned so much about pregnancy, birth and breastfeeding from all the women of many different cultures and nationalities that I came into contact with during my working life in hospitals and the community. I was always very interested in breastfeeding: my mother was brought up on a dairy farm and worked with cows from a very young age so she understood how lactation works and the importance of the mother’s milk as the first food for babies. She had seven children and breastfed all of us for at least one year and often remarked how this made us stronger children who had very few illnesses and infections as compared to other children who were bottle fed which was almost the norm in Scotland in the 1950s and 60s when were all born. As a midwife I read everything I could find about breastfeeding and became particularly interested in the political and commercials aspects of the marketing of breast milk substitutes and the frequent contraventions of the WHO Code regulating the marketing of breastmilk substitutes http://www.who.int/nutrition/publications/code_english.pdf

I joined the Nestle Boycott more than 30 years ago http://www.babymilkaction.org/nestlefree

While I was working at Al Corniche Hospital in Abu Dhabi, I was part of a team who started the hospital on the journey to achieve Baby Friendly Hospital accreditation http://www.who.int/nutrition/topics/bfhi/en/ . As part of this initiative the hospital encouraged midwives and nurses to take the IBLCE exam: as I was part way through an online degree I did not do the exam then but waited until I had graduated when I had time to prepare for the exam. I passed the IBLCE exam in 2005.

What motivated you to become an LC?

My mother was a very important influence. My own experience of breastfeeding my two children: as a midwife and with all my reading I understood the reasons why breastfeeding is so important, and to a certain extent, the physiology of milk production. But I had very little idea of the practicalities and the realities of life with a newborn. The first weeks with my baby son, on my own most of the time in an apartment in Abu Dhabi in the middle of summer were – to put it mildly – very challenging. I had not arranged for any support and my husband was working long hours. As soon as my son’s passport was ready I flew back to Scotland for about 6 weeks and was able to relax and enjoy my baby with the support of my parents in a lovely cool climate. This time was a very steep learning curve and I came to understand how important support is to women during the period after birth.

I often look back on that experience and wish I had known then what I have learned as a lactation consultant, it would have made my life so much easier. Despite the early problems I breastfed my son, for two years and my daughter for 18 months, returning to work full time when she was 11 weeks old so I had the experience of maintaining my supply while at work, dashing out of a busy labour ward to pump milk for my baby whenever I had the chance.

I really wanted to have an in depth understanding of human lactation and studying for the IBLCE exam seemed to me the best way to do this. I wanted to be able to use that knowledge and understanding to help women achieve their breastfeeding goals, to support them especially in the face of all the obstacles to breastfeeding in this modern world. I believe that breastfeeding is part of women’s and babies’ human and reproductive rights and as such should be supported not only by individuals like myself, but also governments and national and international institutions. Furthermore that breastfeeding should be protected against interference and being undermined by disinformation from commercial and other interests such as formula companies and inadequately trained ‘health’ professionals.

Tell us about your career in Bahrain

I moved to Bahrain with my family in 2001 when my children were still young. Al Corniche Hospital in Abu Dhabi was a very busy, forward thinking establishment where the care for women in pregnancy and labour is primarily midwife led i.e. the doctors are only involved if there is a complication, which made it an ideal place for me to work. Unfortunately there is nowhere like that in Bahrain so I have never worked in any of the hospitals here. I finished my degree in 2003, and then started to study for the IBLCE exam.

I passed the exam and certified as an IBCLC in 2005. At the time I was working as a teaching assistant in my children’s school and I subsequently decided to take a PGCE to become a qualified teacher. Consequently I did not see many clients at that time; to be honest I did not really know how to set up as a lactation consultant. I was always willing to share my knowledge with pregnant colleagues and several of them credit my advice for their success in breastfeeding.

My daughter developed a serious illness so I returned to Scotland with her for 18 months for her treatment, which was fortunately successful. Coming back to Bahrain in 2010, I was unable to commit to full time work as my daughter still needed regular checkups in Scotland, and my time away had allowed me to focus on what I really wanted to do – to work as a lactation consultant in private practice. I had already set up my Facebook page Breastfeeding in Bahrain, which helped women to contact me. My listing with the ILCA (International Lactation Consultant Association) also helped. I also started organizing regular breastfeeding cafes where pregnant and breastfeeding women could get together to share their experiences of pregnancy, birth and breastfeeding and support one another. I am very pleased to say that the cafes have now been going for over 6 years and are still well attended. Last year we started monthly Saturday morning cafes for mothers who work outside the home.

Last year, 2016, I carried out a total of 80 consultations: as I offer packages of prenatal and postnatal consultations many of these would have been repeat visits. There were also 13 breastfeeding cafes in 2016.

What are some of the biggest hurdles faced by breastfeeding mommies?

This is a huge subject! Where to begin?? Here in Bahrain the first problems new mothers face are in the hospital including the routine and in the majority of cases completely unnecessary separation of mother and baby within minutes of the birth so no opportunity for skin to skin contact that should be immediate and prolonged, not only to facilitate early breastfeeding but also to seed the baby’s skin with the mother’s healthy microbiome. (https://www.hyperbiotics.com/blogs/recent-articles/the-miracle-of-the-infant-microbiome).     In some hospitals newborns are given routine formula feeds without the mother’s knowledge or permission, and in other cases mothers are told by staff that they don’t have enough milk and that the baby needs formula. In general the support around breastfeeding is very variable in Bahraini hospitals and their knowledge base of the physiology of lactation seems to be very poor. Families can also be an issue: the new mothers, especially Bahrainis who make up most of my clients, are obliged to have many more visitors than they want and are constantly bombarded with ‘advice’ much of which is about giving formula, and leaves the poor women feeling confused and distressed.

I would add that probably the biggest hurdle is not knowing what to expect: newborn infants need to suckle frequently and often for long periods to stimulate the continuing growth and development of the breasts and to build up the mother’s milk supply. This is perfectly normal newborn behavior but is often interpreted as the baby being very ‘hungry’ and the mother ‘not having enough milk’ when in the majority of cases this is not true. There are also a lot of books which recommend putting very young babies onto strict routines of feeding and sleeping which are totally unrealistic and very damaging to establishing breastfeeding: newborn babies (in the first 6 – 8 weeks) are neurologically and physiologically too immature to be regulated in this way and when these ‘routines’ don’t work out, the mothers feel that they have failed or are inadequate in some way.

How important is support (be it from husband, immediate family, or work)?

Support for a new mother after birth is essential: she needs time to recover from the birth and to be able to be with her baby to establish breastfeeding which is very time consuming in the first weeks. Ideally she should be relieved of all other responsibilities during this period. When a woman chooses to breastfeed, it is very important that her husband should support her as she is likely to have times when she is very tired and doubts her ability to feed her baby, so reassurance and encouragement is essential.

In Bahrain and other parts of the region, many women stay with their parents for a month or 6 weeks after the birth. This can work well if her mother and other family members are supportive, but there can also be problems when the new mother is bombarded with unasked for and inaccurate advice, or the grandmother takes over care of the baby and excludes the mother.

I advise woman to discuss arrangements for expressing milk with their workplace before they have the baby so that a suitable room can be allocated for pumping, and so that their employers understand why regular expressing is necessary. With the assistance of some of my clients I have put together advice for employers ‘Supporting Your Breastfeeding Employee at Work’ to help them understand why this is so important, and how they can help.

The breastfeeding cafes also provide important woman-to-woman support for breastfeeding mothers at all stages of their breastfeeding journey.

Is there value to learning about breastfeeding before delivery – for both mom and dad? Is there any education mechanism in place in Bahrain? How do we tackle the issue of lack of awareness?

I have found that when couples have a prenatal consultation there are fewer problems with breastfeeding. During a prenatal visit, I describe normal newborn feeding behavior and encourage early and continued skin-to-skin care as the optimum way to get breastfeeding off to a good start. Another IBCLC also provides regular workshops about breastfeeding which many women find helpful. Some hospitals provide birth preparation classes but I have not had much positive feedback from these,

Additionally there is a lot of good information on the internet if you know where to look. I recommend Kellymom – http://kellymom.com/ ; La Leche League http://www.llli.org/; Dr Jack Newman’s Breastfeeding Inc https://www.breastfeedinginc.ca/ and the Australian Breastfeeding Association https://www.breastfeeding.asn.au/ as good sources of information.

Lack of awareness: of breastfeeding I assume? Providing information and support for pregnant and breastfeeding women in forums like the breastfeeding cafes; social media is an increasingly important way to diffuse information. Encouraging breastfeeding women to talk to family and friend about their experiences and telling them where they can access help when required.

What are some experiences you consider victories in your time in Bahrain?

I consider the breastfeeding cafes to have been a real success and have had a huge amount of positive feedback from women who have found support in the cafes.

Also two of my clients with my encouragement and using ‘Supporting Your Breastfeeding Client at Work’ have persuaded their employers to provide a dedicated room for breastfeeding women to use for expressing milk at work. I am hoping that this number can be increased with growing awareness in workplaces.

I am also delighted that we now have a Bahraini IBCLC who passed the exam last year, and another Bahrain is currently preparing for the exam.

Whenever a woman achieves her breastfeeding goals with my support, I regard that as the most important ‘victory’.

What are some of the challenges you face as an LC in Bahrain

My main concerns are the outdated practices and inadequate support in most hospitals in Bahrain. As I said previously, a prenatal consultation makes a huge difference as the mother can be very clear about what she wants when the baby is born i.e. immediate skin-to-skin, delayed bathing, keeping the baby with her at all times, no formula supplements and her husband can support her especially if she has a caesarian section and is not able to be with the baby initially.

Unfortunately, many women do not contact me until the baby is several weeks old and the baby is taking a lot of formula, and may even be refusing the breast. It can be very challenging to deal with these issues but with time, patience and persistence, it is possible to help the mothers and babies get back on track.

Currently I have a major issue with finding a doctor to assess and correct tongue tie which can cause major issues with breastfeeding. Previously I referred them to an experienced ENT surgeon but he has now retired and I have yet to find someone else.

Any advice for new and expecting mommies?

  • Educate yourself and your husband about breastfeeding BEFORE the birth so that you know what to expect, and how best to get breastfeeding off to a good start.
  • Arrange suitable support for a month/ 6 weeks after the birth so that you are relived of all responsibilities and can be with your baby.
  • Go to bed with your baby and care for her skin to skin when you come home from hospital; keep the room warm and the lights dimmed; put away your mobile phone and other electronic devices; keep visitors to a minimum.
  • Don’t argue with people when they bombard you with inaccurate but well-meaning advice: smile and thank them, but do what YOU think is right.
  • Don’t watch the clock – baby led feeding is the best way to establish a good milk supply.
  • Talk to your workplace before you go on maternity leave about what you will need after you return to work: adjusting your working day to include your ‘breastfeeding hours’; a suitable room for expressing milk.
  • TRUST YOURSELF: as the baby’s mother YOU know what is best for you and your baby. When you feel unsure or anxious, go into a quiet room and hold your baby skin to skin and gaze into her eyes and you will know what you need to do.

In case you want to read more on breastfeeding:

Breastfeeding 101: http://mommydil.com/2016/05/26/breastfeeding-101/

Supply : http://mommydil.com/2016/06/09/breastfeeding-supply-supply-supply/

Breastfeeding – Half Month Mark – http://mommydil.com/2016/03/23/the-half-month-mark-breastfeeding/

The Importance of Breastfeeding Education – http://mommydil.com/2017/03/02/the-importance-of-breastfeeding-awareness-education/

Pumping 101 – http://mommydil.com/2016/06/12/breastfeeding-pumping-101/

Supplemental Nursing System – http://mommydil.com/2016/11/06/sns/

Relactation – http://mommydil.com/2017/05/15/relactation/

The saga of a pumping mom – http://mommydil.com/2016/11/03/the-saga-of-a-pumping-mom/