Jennifer writes:
<This point, however, on which I agree with Heather,
raises the issue that I always come back to--what is the premise
underlying
any particular practice, procedure or intervention? Here, it is the
premise
that we need to increase the safety of pregnancy and childbirth. Increase
over and above what baseline level? Does this assume that they (preg and
birth) are inherently unsafe?>
For many mothers, yes. Sure, there are a lot of women in the world who
could carry their babies to term without professional care and give birth
without complications for mother or baby. But there are huge numbers who
would have less fortunate outcomes.
Hence the March of Dimes campaign to get prenatal care early and
regularly. Not all mothers are well-educated and socio-economically well
off. Even those who are, are not immune from certain complications of
pregnancy, which can often be foreseen and managed to avoid emergencies
or poor outcomes.
I don't think this is necessarily "medicalization". If memory serves me
correctly, in the U.S., well into the early 20th century, the physician
was only called in case of an emergency during the labor or delivery or
postpartum period. I am told my own grandmother died in childbirth.
It was the Public Health nurses in Boston who noted as they made their
neighborhood visits how maternal and child health were intimately bound
up with sanitation, ignorance, poverty, malnutrition and social problems.
Out of their observations grew the effort to improve many of the
conditions for mothers they saw, through education and referral for
nutritional and social services. They have been credited with the
"invention" of prenatal care.
This line of reasoning extended right on into maternal and child health
following birth. Even now, I think there are many in public health who
are avid supporters of breastfeeding and anything else that can improve
health for children and their mothers.
Public health departments have not been keeping statistics for over a
century "just for the fun of it." They do it to research trends in order
to improve outcomes. And clinical "practice" is just that - practice. I
think we are all trying to do the best we know how, and trying to improve
when we see a way. We just come at it from different viewpoints. I agree
we should work on challenging the attitudes of some of the prenatal (and
peri- and postnatal) caregivers, but please don't knock the idea of
prenatal care!
Jean
***************************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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