So you left Dubai. Who's looking after you and your baby?

So you left Dubai. Who's looking after you and your baby?

In my last blog I talked about how you're feeling. This one is about what actually happens — or doesn't happen — when you arrive somewhere new with a baby, a bump, or a toddler, and you need clinical support.

Because I want to be honest with you about something, and I say this as someone who has worked within and alongside the NHS, who trained within it, and who has enormous respect for the people holding it together right now.

'Just register with a GP' is not a plan. And if you've found yourself searching 'how do I find a lactation consultant in the UK' or 'why isn't breastfeeding working' at midnight, or 'how do i find a doctor for my baby in England' this post is for you.

It's a starting point. But it is not — not remotely — the equivalent of the clinical infrastructure you had access to in Dubai. And the gap between what families expect and what they actually find when they land is something I've watched cause real harm. Not always dramatic harm. Sometimes just the quiet, grinding kind. The kind that wears you down over weeks when you're already running on empty.

Let me tell you what I mean.

The health visitor question

The most common thing I hear from Dubai families heading back to the UK is some version of: 'It's fine, we'll have a health visitor.'

And you will. Technically.

What people don't realise — what nobody really tells you — is that health visiting in the UK in 2025 is a service under extraordinary strain. There is a health visitor shortfall of approximately FIVE THOUSAND in England alone. Caseloads are, in many areas, genuinely unmanageable, and health visitors may have up to 100 families on their caseload.. The contact you receive postnatally may be one visit, possibly two. It may be brief. It may not reach the actual question you needed answering that week. Most health visitors would love to have the families that provide tea and cake when they visit, rather than a full caseload of child protection and safeguarding cases on their books. And yes- I know 'middle class, tea and cake families' can also require safeguarding and social work input. My point is that if you don't actually NEED health visitor input, you're unlikely to receive regular visits.

Again — I am not saying this to criticise health visitors. The ones I know are dedicated, hardworking clinicians doing remarkable things within a system that is chronically underfunded. This is a structural, organisational problem, not a personal one.

But I do think families deserve to understand what that structure currently looks like before they arrive expecting something it cannot consistently deliver.

There is also something else I want to say, and it's something that doesn't get talked about enough in professional circles, so I'll say it here: Health visiting is a community nursing role that can be entered from an ADULT nursing background — without paediatric or neonatal clinical experience. You can qualify as a health visitor without ever having worked on a children's ward, without having worked in a NICU, without necessarily having seen what a sick baby looks like up close. You can also qualify as a health visitor right after becoming qualified as a nurse. I’ll let that sit with you for a minute, because it absolutely terrifies me. That is not the case for every health visitor — many come with deep, brilliant experience. But it is the case for many.

And this matters. It matters because knowing what a well baby looks like is what allows you to identify when something is wrong.

The baby I will never forget

I want to tell you about a baby I looked after in the NICU. I've thought about this baby many times since, and I think about them again now, every time someone tells me the system is fine.

It was a holiday period. Skeleton staff. The kind of reduced cover that happens over bank holidays and Christmas (and nights and weekends), when community teams are stretched even thinner than usual and supervision of newer colleagues is minimal (because babies don’t get sick in holiday periods, obviously).

A baby came in to us hypothermic, severely dehydrated, and very jaundiced. The kind of jaundice that had clearly been building for days. That baby required several resuscitation attempts, their heart rate on admission was lower than we would expect a healthy adults' heart rate to be.

The mother had been discharged on a 6 hour maternity discharge as both she and the hospital wanted her home for Christmas. The mother had been breastfeeding. Or trying to. The baby had been receiving virtually no milk — not because the mother wasn't trying, not because she didn't care, but because nobody with the clinical knowledge to identify what was happening had seen them at the right moment. The latch wasn’t optimal. The milk supply hadn’t come in. The health visitor who had visited was junior. Newly qualified. Without the experience to recognise the signs that this baby was in trouble.

Thankfully, that baby survived.

But I want to be very clear: this is not an isolated incident. Dehydration in breastfed newborns is a known clinical risk. Jaundice that goes unrecognised and untreated can cause brain damage. These are not rare, theoretical risks. They are things that happen, more often than they should, in the gap between hospital discharge and adequate community follow-up. If you're ever unsure whether your breastfed newborn is getting enough milk, the signs to watch for include fewer than 6 wet nappies in 24 hours after day 5, persistent weight loss beyond day 4, extreme sleepiness or difficulty waking for feeds, and jaundice that is deepening rather than fading. If you see any of these, please seek clinical help the same day — not tomorrow, not after the weekend.

Doctors, obstetricians, and midwives are not lactation consultants. I say this with complete respect — they are brilliant at what they do. But infant feeding is a specialist clinical skill, and it is not part of their core training.

The breastfeeding support gap — and why it's worse than you think

Here is something that genuinely shocks people when I tell them: There are very few IBCLCs — International Board Certified Lactation Consultants — in the south and east of England. Finding one who does home visits is harder still. The IBCLC is the gold standard qualification in lactation — it requires thousands of hours of clinical experience and a rigorous international exam. It is NOT the same as a breastfeeding peer supporter, or a midwife who has done a module on feeding, or a health visitor who attended a study day. And yes- Dubai has a similiar issue of people calling themselves lactation consultants (when they're not) or any one of a number of titles such as 'breastfeeding specialist' or 'lactation supporter' amongst many other phrases I've heard over the years. If you're searching for 'breastfeeding support near me' and finding peer supporters, NCT counsellors, or midwives offering feeding advice — all of whom do valuable work — it's worth knowing that none of these are the same qualification as an IBCLC. When feeding is genuinely struggling, that distinction is incredibly important.

I qualified as an IBCLC after over 15 years of clinical experience, including years of supporting breastfeeding in the NICU. And I will tell you honestly: the things I learned on my IBCLC course blew my mind. Not because I didn't know how to support feeding — I did, and had been doing it for years. But because I finally understood the physiology behind why the things I was doing worked. And equally, why some of the things I had confidently been doing were actually wrong.

If that was my experience after two decades at the bedside, imagine how it feels to be a new mother trying to find her way through infant feeding with advice from five different people who all contradict each other — none of whom hold that qualification.

I have personally supported several mothers who delivered in London, privately, in excellent hospitals, and were encouraged from the start to give formula top-ups so they could 'sleep.' Not as an informed choice. Not with a proper conversation about the impact on supply. Not with any guidance on how to protect or establish breastfeeding alongside a bottle. Just — here's the formula, it'll be easier.

Formula feeding is a completely valid choice when it's a choice. When it's something that happens to you because nobody around you had the knowledge to support the alternative, that is a failure of care. Those are different things, and they shouldn't be confused. Formula top-ups given without proper guidance can significantly impact milk supply within days. This is not a scare story — it's physiology, and it's entirely preventable with the right support at the right time.

What about those of you who stayed in Dubai?

Dubai has its own version of this problem, and it is worth naming.

Access to lactation support in Dubai exists — but it is expensive, patchy, and largely dependent on knowing who to ask. The hospital you deliver in may have a lactation consultant on staff. They may be excellent. They may also have fifty other mothers to see and limited time with each of you. Private IBCLCs in Dubai charge rates that not every family can sustain for ongoing support.

And then there is the specific cultural pressure around feeding in the UAE — the mixed messages from hospital staff, the formula pushed at discharge, the inconsistency between what one midwife tells you and what the next one says. I've written about this before. It doesn't disappear just because you're still in the country.

For those of you elsewhere — South Africa, Australia, Canada

The version of this problem varies by country but the core of it doesn't. You are in a new healthcare system you don't fully understand yet, without your existing community, potentially without your partner full-time, and with a baby or a pregnancy and a set of clinical questions that deserve proper answers.

Geography should not determine the quality of feeding support you receive. In practice, for far too many families, it does.

That bothers me. It has bothered me for a long time. And it is, honestly, a large part of why I built what I built.

In my next blog, I'm going to tell you about the Lullabies Nest — what it is, what it covers, and why I think of it as the health visitor service you don't have to wait in for. I needed to say all of this first, so you understand what it was built to solve.

Lisa Adair is a UK & DHA-licensed paediatric and NICU nurse, IBCLC lactation consultant, and infant sleep specialist with over 20 years of clinical experience. She is the founder of Lullabies (lullabies.ae), a baby and child wellness practice supporting families in the UAE and internationally.