It was precisely this potential to divert us into discussing *other* issues
we feel passionately about, that prompted the reminder I sent yesterday
about staying on topic.  

Personally I must confess to reading, eagerly, all the posts on the topic so
far, even as I am pleading with you to continue the discussion about the
appropriate approach to breech birth off the list.  

I posted as a listmother who is herself a midwife, and for the record I hold
a Bachelor of Science in Nursing from a top-ranking US school.  Being a
nurse was a minimum entry requirement to become a midwife where I live now,
a country that has had government regulation of midwives and their education
for a couple hundred years.  Only those holding a current authorization as
such, may call themselves midwives at all.  My professional association
marks its 100th anniversary this year.  I work in a hospital with all the
trimmings of modern obstetrics and neonatal intensive care.  I also attend
home births.  Both are in keeping with how I am authorized to practice based
on my education in the Norwegian health care system.  My license gives me a
high degree of professional autonomy, which I regard as a privilege carrying
with it a significant responsibility to do no harm.  Sadly, for me it is far
easier to refrain from doing harm when I am not within the confines of the
institution where I earn most of my income, and that is why I continue to
jump at the chance to attend women who give birth at home.  I also learn
more about oxytocin every time.

Elisabet Helsing has just published a new version of her classic Norwegian
text on breastfeeding, this time augmented by the expertise of IBCLC and
NICU nurse Anna-Pia Haggkvist.  I was astonished to learn from the book that
WHO carried out a review of the breastfeeding situation in nine countries
over the years 1975-78*, and discovered that in every country they looked
at, there was a direct negative correlation between contact with the health
services and breastfeeding duration.  The oftener mothers were in contact
with the health services, the less they breastfed.  Another survey carried
out in Latin America ten years later**, showed that the higher the rate of
births attended by professionals, the shorter the duration of breastfeeding.
In Norway breastfeeding continuation rates really started to plummet when
all births were centralized in hospitals, about 1960.  Breastfeeding
continuation had suffered earlier when the health visitor system was
established a few decades previously, removing breastfeeding from the
purview of normal life and placing it in the hands of well-meaning but
ignorant professionals, but the real coup de grace came with total
institutionalization of birth.  

This is not to say that birth in institutions need be inherently bad, for
birth or for breastfeeding.  But if normalcy in birth/breastfeeding is to
protected in institutions, the institutions must be highly vigilant if they
are to refrain from fixing things that ain't broke.  If you look at what the
Ten Steps to Successful Breastfeeding say, you realize that most of them are
just telling us to stop doing needless and harmful things, not so much start
doing something else.  Stop separating mothers and babies, stop giving the
babies inappropriate nutrition, and stop meddling in the intimate
relationship between mother and child which in the vast majority of cases
will result in breastfeeding that works brilliantly.  If we were really
doing that, we would have plenty of time to help the mothers and babies who
don't figure it out on their own soon enough.

For anyone who feels as Elisabet Helsing does, that the birth isn't over
until the child is weaned, it is unnatural to view breastfeeding as an
isolated phenomenon, unrelated to pregnancy and birth.  Of course it matters
what happens during pregnancy and birth, and in particular the first hours
and days of the child's life, for which birth really sets the stage.  But
apart from mentioning the salient features of the birth which have bearing
on the particulars of a specific case, or a discussion of some specific
aspect of care which may be especially harmful or advantageous for
breastfeeding, there just is not room on Lactnet to discuss the entire broad
issue of where to give birth and with whom.

Your posts on this topic reflect the different ways mothers define and seek
safety for themselves in childbearing, and the different ways we who strive
to provide safety for them do the same.  It is indeed the case that maternal
mortality in the US is on the rise at present, and anyone working in
maternity care should be concerned about why, and how to turn that trend
around.  Dead mothers are notoriously bad at breastfeeding.  I'm concerned,
because I live in the same world, and we are seeing far more large
postpartum blood losses and more serious maternal infections than we used to
do.  It is more often mothers who have had cesareans who need blood and who
have infections, in their surgical wounds.  

* WHO, Contemporary Patterns of Breast-feeding. Report on the WHO
Collaborative Study on Breast-feeding. (p 149) WHO, Geneva, 1981
**Pérez-Escamilla R. Breastfeeding patterns in nine Latin American and
Caribbean countries. Bulletin of PAHO 1993;27(1):23-42 

Rachel Myr
Kristiansand, Norway

 "I think that taking life seriously means something such as this: that
whatever man does on this planet has to be done in the lived truth of the
terror of creation, of the grotesque, of the rumble of panic underneath
everything. Otherwise it is false."  --Ernest Becker

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