Hi Valerie et al,
I can't resist pointing you and LActnet in the direction of a study published in 1999,I think in the BMJ Journal of Epidemiology and Public Health. Sorry for the lack of citation, I am at work, and cannot find it right now. chief author was Marion Mcdornan of CDC. the study population was the entire cohort of birthing women in the US for one year. The study purpose was to compare birth outcomes of nurse midwives and physicians. All c-sections, premature births, and certain other high-risk pregnancies were risked out of the study. Guess what they found? Babies delivered by physicians had a MUCH higher neonatal and perinatal mortality rate. That's MORTALITY not MORBIDITY. I am not knocking doctors at all, but I worked side by side with nurse-midwives as well as with physicians delivering babies, for 13 years of my career. The models of care are extremely different. the midwifery model doesn't just feel better, it is safer.
Martha Johnson Rn IBCLC
Eugene OR
-----Original Message-----
From: Valerie W. McClain [mailto:[log in to unmask]]
Sent: Sunday, September 14, 2003 3:55 AM
Subject: Birth/breastfeeding
Barbara you wrote,
"However, home birthed mothers today tend to be among the lowest risk
category due to good screening by midwives who wisely don't want to manage
high risk deliveries outside of hospitals. Therefore, perhaps we (and I
include myself since I had two home births) also constitute a group with
lower risk with regard to breastfeeding difficulties."
High risk is determined by our medical community. Midwives have been made to
limit their services by a medical community that has a history of harrassment
and destruction of midwifery services. One of the midwives who was at the
birth of my first daughter, was trained at the Frontier School of Midwifery in
Kentucky. The population they served was the rural, poor population who did
not have access to medical care. I believe they had an excellent track record.
I know of some midwives who work in hospital settings where the docs give the
midwives all the patients who have no prenatal care (high risk). These
midwives are working with high risk mothers and having excellent outcomes.
Midwives in order to practice are governed by protocols determined by a medical
community that believes that birth is a medical event. Thus, I believe we cannot
know the true impact midwifery would have on the general population.
I know of mothers (including myself) who had enormous breastfeeding
difficulties yet had straight forward homebirths. Does homebirth mean less
breastfeeding difficulties? I think a study might be meaningful. Does risk in birth
equal risk in breastfeeding? Will risk be determined by a medical community,
like it is done with birth?
The discussion about not seeing colostrum is truly worth remarking about.
Why should we be "seeing" colostrum? Normal breastfeeding in the early days
should mean that all colostrum goes from mother's breast/nipple into the baby's
mouth. We shouldn't be seeing, quantifying it. We know it's there, we have
other visual cues-swallows/infant behavior. Mother's who doubt its existence
should be taught to gently hand express. We don't need to see it, we know it
exists. Doubt in mothers and her caregivers (including and specifically LC's),
leads to unnecesary interventions--including the use of breastpumps.
I don't doubt that medicalized birth is impacting breastfeeding. What I
wonder and worry about is the perspective we seem to have adapted from the medical
community. If there are more and more women not having colostrum after
giving birth, then those of you who are working the frontlines needs to do a study
documenting this. Until then, I think we should continue to preserve the
belief that almost all women have colostrum after giving birth.
Valerie W. McClain, IBCLC
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