It was a disheartening response from a facility seeking international accreditation as a Baby Friendly Hospital. Sitting in a waiting room in Queen Elizabeth Hospital earlier this month, Amanda O’Halloran decided to breastfeed her baby son before their turn came for a consultation. But she soon found herself the target of nurses’ censure. “I have been absolutely blasted by three nurses for breastfeeding and told I am upsetting other patients and that there have been complaints,” she swiftly wrote in a post to Hong Kong Moms, a Facebook community, on May 5. “They have asked me to walk to another floor/building to use the breastfeeding room. I have refused to move. Explained I am almost at the front of the line to be seen and my baby is asleep and I’m not waking him to move.” Breastfeeding mum pumped milk in ‘filthy toilet cubicle’ before Hong Kong company converted an interview room A teacher and mother of two, she added: “I’m very experienced at being discreet and there is hardly even a slither of boob showing. First time in ages I’ve experienced such hostility – now got a group of eight nurses staring at me and shaking their heads wondering what their next move should be. “I’m angry, embarrassed and upset.” Unfortunately, O’Halloran’s experience is by no means uncommon. Within hours of her post, more than 300 outraged women responded with messages of support – and stories of similar run-ins at hospitals across Hong Kong. The incident coincided with the release of a survey by the local chapter of Unicef, the UN children’s agency, which found that 40 per cent of mothers in Hong Kong have had an unpleasant experience while breastfeeding in a public place. Two days later, about 100 Hong Kong women gathered to breastfeed at Tai Wai MTR station in a flash mob event organised by MamaMilk Baby Alliance. It was the fourth year the group had staged an annual event to protest at discrimination against nursing in public. Breastfeeding flash mob descends on Tai Wai MTR station O’Halloran had an anxious time during pregnancy as her unborn son was diagnosed with a life-threatening condition. She’s full of praise for the care that she and her family received at Queen Elizabeth Hospital, but says it is being let down by some nurses’ misplaced and old-fashioned views towards breastfeeding. When her baby was recovering after diaphragm surgery last year, she was continually told to move to a breastfeeding room for nursing even though he was hooked up to monitors and machines, she says. Yet the hospital is committed to becoming the first in Hong Kong to achieve Baby Friendly Hospital status – part of a global initiative launched in 1991 by Unicef and the WHO to remove barriers to breastfeeding in health facilities. A spokesman for the Hospital Authority, which oversees Hong Kong’s 41 public facilities, says that hospitals working towards accreditation have put in place measures to achieve that goal. These include regular training for staff on encouraging breastfeeding, introducing a 45-hour teaching module in the midwifery training course, and establishing a lactation clinic. As a result, the breastfeeding rate at discharge from government hospitals rose from 57.6 per cent in 2005 to 81.6 per cent in 2014. Hong Kong lags behind in support for breastfeeding mothers But despite having supportive doctors and better policies to promote breastfeeding, O’Halloran says there is still a lack of training, empathy and understanding among nurses. Following her original post, O’Halloran shared her experience with Christine Lam Chi-oi, nursing consultant at Queen Elizabeth Hospital, who readily agreed to make changes across the facility. If a patient is concerned about a mother breastfeeding her child in public, then we should stand up for the mother and explain that breastfeeding is a normal, natural way to feed and comfort a child Christine Lam “We need to conduct more briefings and sharing with all our staff to [convey the message] that if a mother needs help, then we give help; and if she says she’s OK, then let her breastfeed freely and comfortably,” Lam says. “If a patient is concerned about a mother breastfeeding her child in public, then we should stand up for the mother and explain that breastfeeding is a normal, natural way to feed and comfort a child.” Referring to O’Halloran’s encounter in the waiting room, Lam says: “I think that our nurses were taking a ‘safe’ approach. Their intention is, with a good heart, to help mothers feel comfortable while breastfeeding.” The feedback they received from O’Halloran has presented them with an opportunity to further improve services, she adds. “Our staff have been briefed and hospital managers are talking to unit managers to ensure that, from the top to frontline staff, everyone knows the hospital’s pro-breastfeeding policy.” The Hospital Authority has its work cut out trying to instil a more positive attitude among staff in other hospitals. The day before O’Halloran’s revelation, Zoe Blaauw, another mother of two, shared similar experiences while breastfeeding in a waiting room at United Christian Hospital. Posting on the page of Facebook community Hong Kong Breastfeeding – Women Only, Blaauw recounts how she was told to move to a private room although the only other people present when she was feeding were her mother-in-law, a nurse and a health care assistant. Blaauw stood her ground and when she fed her three-month old daughter again, the nurse closed the doors so that no one could enter the waiting room. Her post also prompted a barrage of responses from mums sharing similar negative experiences at hospitals. Blaauw has experienced significant breastfeeding challenges at United Christian. Her daughter Kara was premature by two months and had to be fed breast milk through a tube for the first three weeks. After the feeding tube was removed, staff told her that it would be difficult to exclusively breastfeed her daughter, Blaauw says. She was not offered any help with breastfeeding, nor did anyone check that Kara was latching on properly. Nurses would insist on cup feeding her baby after she tried to breastfeed for 10 minutes or so. And each time, she had to nurse Kara behind screens. “The nurses were very busy, so if I needed to feed Kara or wanted to have skin-to-skin contact, I would have to ask them and wait for them to bring out the screens. It made something that I could have done quickly and discreetly feel like this huge production,” Blaauw says. If there were no screens available, all fathers were asked to leave the room while a mother nursed her child. That was unfair as dads, who came to visit their babies during lunch break, would have to sit outside for 30-45 minutes each time a mother was breastfeeding. Fed up with the fuss, Blaauw resorted to cup feeding Kara with her breast milk until they could go home. Caroline Carson, a leader of the local La Leche League, finds that despite improvements in policy, there are some deep-seated notions that remain unchanged in hospitals – “a major one being the view that breastfeeding is something that needs to be hidden away”, she says. It’s the only place that I have ever been asked to move or cover myself Zoe Blauuw Education about breastfeeding in hospitals is still poor, Carson says. A 2012 survey by the Health Department found that only 12 per cent of paediatricians had received any training in breastfeeding. Another 2012 survey by Dr Marie Tarrant, an associate professor in Hong Kong University’s School of Nursing, found that 80 per cent of mothers wanted to breastfeed exclusively but only around 41 per cent were able to do so. “There is an obsession with numbers – volume of milk, weight – that works against direct breastfeeding, where it can’t be measured,” Carson says. “It’s not enough for hospitals to say, ‘We support breastfeeding’; changes need to be made to practices to demonstrate this support.” Blauuw says the hospital is the only place where she has been made to feel uncomfortable suckling her child in public. “It’s the only place that I have ever been asked to move or cover myself: the one place where it should be completely normal to see. I do try to be as discreet as I can, but I refuse to be told how and where I should feed my child,” she says. “I understand some people want privacy but not every baby wants to feed under a cover and not every mother wants to sit in a room on her own like some sort of social outcast. It is nothing to do with anyone else and there is nothing sexual about it, dirty or disrespectful. If you don’t like it, don’t look.” A spokeswoman for the MamaMilk Baby Alliance still encounters prying gazes from passers-by when she nurses her child in a public place. “My nursing cover provides full coverage, so you basically cannot tell what I am doing. But people continue to stare and give me weird looks.” Although breastfeeding is more common and society is more accepting of mothers nursing in public, there is clearly a long way to go, and the only way to change this is through education and raising awareness, she says. Additional reporting by Rachel Cheung