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Subject:
From:
Judith Hayman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 30 Nov 2004 09:15:50 -0500
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Jennifer said:

>But, if we believe that all that matters is a "healthy"  
>mother and baby by--defined by medical standards, then 
>we never even have to ask ourselves what truly defines 
>a "healthy" mother and baby and whether this state is 
>one to be honoured and supported and nurtured or whether 
>it can be safely pushed aside. 

Ah.  In all these discussions I wondered when this would crop up.

The whole issue of interventions in birth is a thorny one.  I truly do
believe that physicians, midwives, nurses, LC's want the best health for
mother and baby.  If I believed otherwise I'd just have to quit!  But I
also believe that they define these in very specific ways, perhaps
according to their own areas of expertise or practice.

There is a basic plan for birthing.  It's not a very good one, frankly.
It's based on birthing babies that just barely fit through mom's pelvis
and don't come out easily. So there are interventions to help with
difficulty or catastrophe and their USE fits onto a spectrum between
essential and unnecessary.   But surely they are used because someone
believes they are necessary and needed at this moment, to ensure a
healthy outcome, again, at this moment. 

But health itself is hard to define.  It has so many variables and, for
any specific person or dyad or family, it is constantly evolving and
being influences by both internal and external variables. And what is
most healthy for one member of a family or dyad, may be detrimental or
impossible to achieve for another, rocking the stability of the group.  

My own perspective is a public health one (Your health, womb to tomb as
it were).  So I take the long view on health and look at outcomes ten,
twenty, thirty years down the road, not just the next hour or day or
week.  As someone already pointed out, we don't know what all the
interplays of pregnancy, labour, birth, postpartum are.  We especially
don't know them _in the long run_. 
 
Consider that in the forties and fifties, smoking was seen as pretty
harmless.
Consider that formula is generally considered safe.
Consider that the data on breastfeeding did not exist in the quantity
and quality it does now.  
Consider that the research really does support C/S as being safer for
babies.  

Now go back and think how long and hard it was to amass a comprehensive
body of data to actually cause the warnings against tobacco and then
support them in court.  

If we want change, we have to provide evidence, and it can't be
empirical but solidly based on research.  We are beginning to do so with
quality breastfeeding research, that demonstrates life-long advantages
to the breastfed and detriments to the artificially fed.  We are
beginning to do so with birthing practice research and it's impact on
BF.  If we are convinced, and wish to convince others, that intervention
in birth causes short-term difficulties with BF plus long-term health
concerns that we haven't defined clearly yet, than we have to find the
evidence and report it.  There is a very long way to go and we will have
to be prepared to potentially be disappointed by findings that are not
to our liking.  It is far too late too simply say that interventions
should just stop because we _think_ they may be over-used.   

Judith

Judith Hayman, RN, IBCLC, BSc, BScN
Public Health Nurse & Lactation Consultant



 




 

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