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Date: | Mon, 28 Jun 2004 22:18:22 +0100 |
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In answer to Pamela Morrison's posting, I can see I should be a little more
careful about my language!
I should perhaps have made it clear that I work in a midwifery-led unit. All
mothers booked to birth with us are 'low risk' and at term, We do
occasionally have women walk in off the street and deliver a breech or prem
but its not usual.
Blood sugars are not routinely done on term babies unless the baby is
displaying physical signs that are a cause for concern. The only babies to
receive eye drops are those who have an infection diagnosed by culture -
that is what I mean clinical indication.
All mothers (in my area of practice) are given information about Vitamin K,
verbal and written, and have the opportunity to discuss the pros and cons
with a midwife and if they wish a paediatrician. It is strongly recommended
by the paeds and the Dept of Health so I doubt if most parents make a truly
informed decision, but they do have to give their consent before the baby
receives it.
When I said that mothers can choose to have the baby weighed and measured
soon after birth... although we try to encourage them to leave it until the
baby has had a good breastfeed... I mean that for some parents it is more
important to know the weight than to have skin contact and breastfeed. Today
I booked a young woman who is expecting her second baby, a friend of my
daughter (who is breastfeeding a 2 year old), she positively shuddered when
I spoke about the value of having skin contact with the baby immediately
after birth and grimaced at the prospect of breastfeeding. Our following
conversation allowed her to open up about lots of personal issues. I don't
assume everyone gets that chance.
Hopefully most mothers are aware of the importance of uninterrupted skin
contact for the initiation of breastfeeding before they go into labour. It
doesn't always happen, its not a perfect world. We try not to ask leading
questions that would result in a cessation of skin contact, eg, Is it okay
to weigh her now? or Shall I give him to dad to cuddle so you can drink your
tea? or Are you ready for a shower? or You must want to get off that messy
bed now! Some women decide to end skin contact after a short time others
continue for hours. The main point is that it should always be their
decision, if it were not we would fail Step Four on reassessment as mothers
are interviewed.
I had imagined that it went without saying that if a baby appeared to be
compromised or needs resuscitation we would need to act and that would
probably necessitate removing the baby from skin contact. You could see that
as over-riding a mother's choice but I've never met a mother who would have
expected me to act any differently.
Yes it does sound provocative. That's great by me, anything to encourage us
to think about what we say, maybe too glibly at times. You wonder when
breastfeeding will be so important that it will require policy rather than
mere advocacy? Well in my world it already is. We have a breastfeeding
policy and if it is not adhered to then it is as much an issue of
professional conduct as any other part of midwifery practice. Also we have
to follow the Ten Steps to the letter if we are to maintain our global
award.
Hilary Myers
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