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From:
Kathy Dettwyler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 3 Jan 1999 15:58:39 -0600
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> I do agree, however, that even though it's not nearly that many, the
number of babies and mothers that would not survive childbirth without the
availability (NOT routine use) of modern interventions would be unacceptable
to us.

The above was said about Dr. Green's un-referenced comment that in the "old
days" before modern medicine, half of all babies died before they reached
one year of age.  First of all, I have asked Dr. Green for a reference, and
he has not responded.  Second of all, in Third World countries today, the
very highest rates of infant mortality (birth to 12 months of age) are found
in rural Africa, and some of them approach 250/1,000 live births, which is
25%.  The very highest rates of childhood mortality (birth to 5 years of
age) are found in rural Africa, and some of them approach 500/1,000 live
birth, which is 50%.  I do not believe that anywhere, or anytime, in the
history of the human species have infant mortality rates been as high as Dr.
Green claims.

Third of all, where infant mortality rates are extremely high, the causes of
infant death are seldom linked to birth or to anything that suctioning would
have helped.  In Mali, West Africa, where I have done research on child
growth and health and infant/child feeding practices, the primary killers of
infants during the first year of life are: neonatal tetanus (due to an
unfortunate cultural practice of putting cow dung on the umbilical cord
stump), diphtheria, and malaria.  The primary killers of toddlers are
malaria and measles.  Modern medical care in the form of immunizations and
antibiotics are wonderful things, and are helping to lower the infant and
childhood mortality rates where they are becoming available in rural Africa.
I seriously doubt that very many children die from not being suctioned.

I encourage all LactNetters to watch The Learning Channel's Baby Show for a
week and take careful note of the *way* in which ALL infants are suctioned
immediately after birth.  It is barbaric -- no other word for it, and it is
done routinely, on every infant, without regard to whether the child
actually needs it or not.  In general, the babies are having extremely
roughly in most episodes, being flung about and rushed over to the warming
cart, and roughly towelled off, etc.  They are NOT treated gently or with
respect.

Final point -- I interviewed a rural traditional Malian midwife in 1989
about her career.  She had been a midwife for 30 years, and had lost ONE
MOTHER/BABY pair during her career, which we estimated included more than
4,000 births.  The one mother/baby pair she lost involved a case where the
baby's arm was coming out first, and the midwife put mother and baby on a
donkey cart and sent them on a many-hour journey over dirt roads to the main
paved road.  There they caught a ride on a truck to the hospital two hours
south -- but that hospital said they couldn't deal with the situation, and
sent them back towards the capitol city, which was 5 hours away.  The mother
(and baby) died on the bridge going into to capitol city.

Think about this.  This midwife had not had a single mother or infant death
during 30 years of delivering babies in a remote, rural African village.  I
would say this was a more than "acceptable" level of maternal and infant
mortality without access to any modern medical technology!  This midwife's
equipment consisted of her knowledge, wisdom, and experience.  Her birthing
center consisted of 3-rooms.  One room was the "birth room" -- it had a
sloping dirt floor and a hole at the base of the wall for washing down the
floor, a grass mat for the women to labor on, and the midwife.  No
equipment.  No scissors, no razor blades, no alcohol -- certainly no blue
syringes, no fetal monitors, no facilities for Casearian sections, no
warming lights, no bili lights, no formula, no glucose bottles, no tests for
bili or hematocrit levels. The middle room had two chairs and was for
visitors.  The third room had a metal cot and thin foam mattress, and this
is where mother and baby stayed for 3 days following the birth.  That's it
folks.  I didn't ask her specifically about what she did when babies
"wouldn't latch on" -- but I doubt it was a problem.  All babies were breastfed.

Kathy Dettwyler, Ph.D.
Associate Professor of Anthropology and Nutrition
Texas A&M University
College Station, TX 77843-4352

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