Dear Friends:
    Janet makes a point about the beauty of midwifery care and its positive
impact on birthing and breastfeeding. This model is true in the countries in
the world with better infant and maternal mortality and morbidity than the USA.
Marsden Wagner talked about how in some of those countries, midwives do 80% of
the births, and the 'doctor isn't even in the room' but is available as
needed.
    However, in my part of the country, certified nurse midwives are hobbled
in their practice by the policies of their back-up physicians. If the
physicians don'tsupport or understand the midwifery model, then the midwives become
'junior doctors' who augment 20% of their clients (as at a birth center across
the street from a teaching hospital where I used to work), and make comments
like "that woman just needs a little vitamin P" (heard from a CNM), and push
epidurals and inductions "because I have a waiting room full of patients that
have to be seen."
    A large teaching center down the street from me fired all its midwives a
few years ago, so that the residents would have enough clients. This firing
was sudden, and even included a midwife being removed from a room where she was
with a laboring woman! The midwives went quietly; they didn't contact every
reporter and news outlet they could to protest. They were outflanked,
outnumbered, and dismissed.
    In addition, the lower insurance reimbursement to CNMs has driven some
midwifery practices out of business.
    The medical model has a negative impact on breastfeeding. I worked with a
mother yesterday who had an unnecessary cesarean section. She was induced (no
medical reason given, healthy young woman, blood pressure fine), given an
epidural, couldn't feel enough to push effectively so had surgery to get the baby
out. Breastfeeding was lost the minute she got home because she was in too
much pain to focus on the baby (plus she delivered in a hospital quick to give
formula bottles), and now her incision is opening and looks infected.
    Imagine the impact on the future of a relationship if, when the two
parties first meet each other, one is hit by a car. How would the two parties learn
to communicate with each other? How could there be any mutual fulfilling of
needs, one from the other? This is what getting breastfeeding going in too many
cases in the US today is like.
    The midwifery model, including direct-entry or professional midwives, is
perfect for the majority of women, but only when it functions in an atmosphere
of respect and appreciation. That is not in the US.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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