Ient this reply to Cathy Bargar and forgot to post it to LN:

<So the "natural childbirth" wave comes in & goes out.We
think we've found The Answer, then we find out that The Answer is flawed,
so
we go back to the "natural" way, and then some new Answer comes along
with
*different* negative consequences, and on & on it goes...>

Cathy,

I think you may be a little naive in forgetting to factor in some health
care economics in your analogy.

At the height of the Natural Childbirth movement, there were many
independent childbirth education organizations, "manned" by dedicated
volunteers who paid their likewise dedicated part-time instructors, and
delighted in talking about medications and anesthetics much the way we
talk about ABM.

Same kind of fervor. Same kind of dedication. In our neck of the woods,
there were some caudals back then, but with fewer IV's involved. There
were more spinals and saddle blocks right in the delivery room, with
perhaps one IV.

Most of these were administered by the OB, and monitored, if at all, by a
nurse anesthetist. Many mothers were still getting generals, without
IV's, while quite a number were doing without medication, and maybe got a
little novocaine for a pudendal block or a local, and no IV's.

There was enough controversy over the term "Natural Childbirth" and what
it meant (like our recent discussion on the meaning of "exclusive
breastfeeding") that our local group at least began to refer simply to
"prepared childbirth".

Somewhere along the line, in about the 1970's, the birth rate seemed to
be going down and the OB's and maternity departments felt the
consequences.

They beefed up their strategies with some not-so-subtle marketing.
Hospitals began to sponsor childbirth classes and references to "painless
childbirth" began to multiply.

More and more women were returning to work sooner, and the kind of
volunteer power for local independent organizations slowly began to dry
up.

In our town, one by one, many instructors split off from independent
groups and signed on to teach hospital classes, as a more steady source
on income without all the prerequisite organizational work attached. The
independent organization folded.

As could be predicted, those instructors found themselves quickly
muzzled. What they could say in a hospital sponsored class required them
to "soft-pedal" or frankly, leave out, some of the things they had been
saying in independent classes.

As anesthesiologists began to proliferate (it seems) and "muscle in" on
the OB area, or expand into it as the C. Section rate went up and all or
most C. Sections began to be done in the OB suite itself, lo and behold,
they were sometimes "guest speakers" in the CB classes! Surprise! Pie in
the sky! Painless childbirth!

Somewhere along the line, word of mouth spread among the less idealistic
(or more naive) pregnant women "Why bother to take classes? We can
request the epidural early on anyway, and it's a breeze from there on!"

Of course, concurrently, the amount of IV fluids being given began to
increase, because of the need to avoid blood pressure problems with the
administration of epidurals.

Postpartum edema came to be viewed as normal, since so many of the
mothers in training institutions had it! Many physicians and nurses had
never seen it any other way!

With fewer people taking classes, fewer mothers got any advance
instruction on getting breastfeeding off to a good start.

Breast pump manufacturers were making inroads, and this fit right in
along with the other technology (monitors, etc.) In the 50's, we had a
half dozen bicycle horn pumps. During the same time period, the hospital
maternity unit was mixing and sterilizing its own formula.

In the 60's, and on into the mid 70's, we had one electric pump on the
whole unit for occasional use, with multiple sets of glass flanges that
were resterilized. The availability escalated from there. And the formula
companies were beginning to market their wares more agressively,
including "inservice education".

IMHO, with more overhydration, less advance instruction, freer use of
pumping on already edematous breasts, the mothers' breasts suffered some
added effects.

There had always been engorgement, because of delays in initiation. But
the kind of engorgement and it's stubbornness seemed to be different,
somehow, especially in those mothers with long pitocin inductions.

All this is quite separate from any medications left over in the babies.
(That was really not so new, as twilight sleep and generals did quite a
number on babies too.)

And then, whammo, along came HMO's and 2 day stays. The mothers, having
served their economic purpose to the OB's, anesthesiologists, and
hospital, were out the door, perhaps lucky enough to have the services of
a home visit nurse or savvy pediatrician's office staff who could guess
how to deal with increased early breastfeeding problems.

I think any "Waves" involved have had a lot of economic "churning" to
help them along! And I don''t see that tide going out!

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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