Here in Ontario, I have watched the profession of midwifery change from
being unrecognized (but not illegal) to being a recognized profession
covered by government health insurance. While in the past midwives could do
home deliveries but were only allowed to provide labour support for hospital
births, now they do both home and hospital births and have admitting
privileges in hospitals.

This has resulted in many more people having access to midwife-attended
births, but there has also been a downside: the midwives have become
increasingly medical in their approach to birth. For example, a mother I
know who had planned a home birth went into labour when she was 36 weeks and
6 days, and was told she must go to the hospital because she was earlier
than the guideline of 37 weeks. This is just one of many, many situations I
have seen and heard about. Those who have resisted this more medical
approach find themselves criticized by colleagues and increasingly burned
out.

I think that those who are both RNs and LCs face similar challenges. Just as
birth is about more than just getting the baby out, so breastfeeding is
about more than just getting milk into the baby. I think the recent
discussion of breastfeeding logs and their value (or lack of value) is one
example of the challenge. Logs seem to me to be a rather medical concept -
part of the desire to quantify and record. I can see situations where they
might be helpful, but I can also see how they can mask other problems and
can interfere with the mother-baby relationship that is being established.

Teresa Pitman
Guelph, Ontario

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