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From:
Johnston <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 15 Oct 1997 08:43:59 +1000
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I want to comment on the place of birth (hospital/ birth centre / home) from the perspective of an independent midwife attending homebirths, and a mother/midwife who has given birth in a US hospital and an Australian hospital Birth Centre.
Patricia Gima in Milwaukee wrote:
<But the usual hospital birth (in the US) is anything but normal, of course.  The baby experiences many painful procedures, including rough skin scrubbing and needle sticks, perhaps deep suctioning, and on and on.  You in hospital settings know more about this than I do.  All of this could interfere with the normal functioning of the newborn's little body and certainly with her centering for coordinated feeding.
Perhaps experiences in birthing centers like the one Michelle mentioned will move hospital births to be a more "baby friendly" environment. Many little ones would like more than 1 hour, of course, but that's a start.>
We have good evidence that suctioning, narcotics, timed feeding,  use of fluids other than breastmilk, separation of babe from mother, conflicting advice &c (all the BFHI 10 steps) interfere with the successful establishment of breastfeeding. 
Many of these issues are less applicable in the home birth situation, although the new mother may get well-meaning advice from friends, mother ..., which follows the patterns learned from hospital management.  As midwife I try to establish a good level of communication with the mother, so that if she has any conflicting advice, or doubts about what is happening, she will call me.  I believe it is crucial that the woman accept authority for her own body, in this case for breastfeeding.  The reality of homebirth is that the midwife is there only briefly (a couple of hours each day) compared with the hospital situation of 24-hour care.  HOWEVER the midwife coming to the home is consistent from day to day in the advice she gives - which I think makes a big difference.  
As the saying goes, "There's many a slip 'twixt cup and lip", and it's not all easy out there in homebirth land.
A couple of recent situations to illustrate.  
1 A young mother with her first child, uncomplicated birth, who breastfed frequently from birth.  At 48 hours mother assured me that everything was wonderful, had just finished a feed when I arrived (ie did not need any help).  By about 72 hours the baby was looking dry, passing very little urine (with heavy ureates), and acting very hungry.  Fell asleep at the breast.  Mother's nipples were sore, breasts full, and she and her husband were exhausted.  Now asking for help.  When I observed the feeding process I showed the mother the difference between effective attachment and suckling, and nipple sucking.  I explained the principles, and the mother chose a 'management plan' (sounds too formal)  which included attempting all feeds at the breast, expressing milk and giving it to baby in a medicine cup after going to the breast, co-bathing, and plenty of rest.  When I visited her the next day she had turned the corner.  Her baby settled after feeds, and she was well rested.  In the bath he had taken more breast into his mouth than ever before, and the mother had regained confidence in her own ability.  She used the cup for the next day or so, but baby quickly became so good that he was soon doing it all himself.
2 A mother aged 41, had her 7th baby at home.  This mother had breastfed well for her first 2, but for many reasons had had difficulties with the subsequent children, who were all very close together in ages.  Breastfeeding seemed to be successful, but by 3 weeks ( I was not consulted) the baby was hungry and losing weight.  The mother had previously been through the routines of expressing, supplemental line feeding, and many other systems, and she had no faith in such things.  By the time she came to me for a 6 week check she had weaned him completely, and had been through 3 formulas because he was very constipated ("passing bricks").  BUT he was gaining weight!
Joy Johnston, Midwife IBCLC
Melbourne Australia

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