In a message dated 11/12/0 1:45:33 PM, [log in to unmask] writes:

Kate wrote:
<< I'm sorry but I do have to interrupt your discussion of certified
professional midwives vs. certified nurse midwives. The CNM in our area are
VERY invested in breast feeding and do an excellent job of creating a
"normal" birth (if there is an "normal") even within a medical setting. >>

Kate,
In my post I explicity referred to my own area and stated that requirements
and scope of practice vary from area to area.
I said:
<< There is a similar situation (in the US) regarding midwives. Certified
professional midwives are not university trained, but rather are trained in
the apprentice model. Certified nurse midwives are trained at the university
level. Depending on the state in which they practice, scope of practice and
even legality of practice varies for both. >>

Katye wrote:
<<I prefer the term "a gentle birth". >>

I actually prefer Jeannine Pavarti's term "free birth", but didn't want to go
that far here. There are, after all, lunatic doctors out there who think that
a gentle birth for every baby means an elective cesarean for every mother.
and "natural", which used to mean w/o interventions now means vaginal to most
women, no matter what other interventions occurred.

Kate wrote:
<<They actually also serve and even MORE important role which is to give as
gentle and non-interventional a birth as possible to women with high risk
pregancies. These conditions include pre-eclampsia, gestational diabetes,
VBAC, premature labor. >>

I said:
<<In my very personal experience, it is the CPM who primarily practice in the
midwifery model and protect normal birth. Many CNM's practice in the medical
model, which as we all know is more invasive and leads to less bf success.>>

My point is that it is the medical model which is at fault, not CNM's. Their
ability to support normal birth depends on the model in which they practice,
which largely depends upon their training.

Kate wrote:
<<Please don't forget that preganacy and labor can be dangerous. I agree that
it has been over-interventionalized, but there are still very real risks and
not all women have the choice of delivering at home. Similarly, not all women
are willing or able to take the risk of delivering at home. Please don't
discard these women as having  no "hope for a normal birth". At the same
time, please don't discard all the women for the past millenia who have died
in childbirth. >>

I would never "discard" women at all. I also know absolutely that birth is
inherently safe and that hospital births carry far greater risks than
homebirths for most women in the USA. I intentionally did not refer to safety
issues concerning hb in my post b/c I did not want to get into that debate,
but feel compelled to correct your statement. I do not imagine there is
anyone who has "no hope for a normal birth", as I have done labor support for
women in very medicalized settings who have come away with completely
non-interventive births. What I referred to was the hope for normal birth as
a cultural model, not any individual birth.

I said:
<<The point I am making is that breastfeeding, like birth, is not an illness.
I am very concerned with the idea that we can normalize bf while medicalizing
the education of those who support and promote bf. I think we are buying a
false premise which ultimately does not serve bf or women and their babies.
In my state, there are very few medically trained midwives who practice in a
midwifery model. The hope for normal birth rests w/ those who practice in the
midwifery model. So, where would the hope for normalizing bf lie? Right now,
I think that many LC's, both RN (or other HCP) and non-RN, retain the
normalcy of bf b/c of their own bf experiences. What would happen, I wonder,
if being an LC became just one more medical profession?

And on a personal note, my father's first wife died in childbirth (leaving
him with 2 babies to raise), so believe me I would never "discard" those
women either. OTOH, I have not let the fear I grew up with make my choices
for me. I became educated and birthed w/o fear. I highly encourage those who
want to understand the importance of normalcy in birth to read books such as:
 Robbie Davis-Floyd: "Birth As An American Rite of Passage", Suzanne Arms:
"Immaculate Deception II", Michel Odent, MD: "Birth Reborn", Marsden Wagner,
MD: "Pursuing The Birth Machine", Henci Goer: "The Thinking Woman's Guide to
a Better Birth", Marjorie Tew: "Safer Childbirth?" and David Stewart: "The
Five Standards of Safe Childbirth".


Kate wrote:
<<The "system" is not going away but CNMs in our area are doing their best
every day to tweak it and to alter it for the good of the women that they
serve. They take patients whom the CPM's cannot or will not see and they give
some wonderful experiences to these women. Their percentage of successful
breastfeeding moms is very high in my practice. >>

No disrespect meant to any hardworking and committed midwife, but tweaking is
not what the system needs. This is the very system that has disempowered
women in birth and breastfeeding. I believe strongly that if we really care
about bf, we must care about birth. And just as we understand that AF has
become the norm b/c of the media, the promotion of AF by manufacturers and
undermining by the medical profession, the same is true of medicalized birth.
It is no more true that we need medicalized birth than it is that we need
medicalized infant feeding. And the two are inextricably intertwined.

Jennifer Tow, IBCLC, CT, USA

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