I have to agree wth Jo-Anne in her post about respectng women's choices.
Along with being an LDRP nurse, I also do maternal/child home visits on
the side (a lot, really). It seems that private insurances (as well as
Medicaid, of course) around here offer many women (even thoose with no
documented problems)one or two home visits, which can of course be
extended if I find problems which need to be addressed. So because of
this, I have the good fortune to be able to follow lots of woman in those
first few days and weeks in their homes after the baby's birth.In other
words, I am going into their territory: a guest in their homes and at this
time, they are no longer under the influence of "the medical model" that
some of you have spoken out against so passionately.I go into the worst
little one room rattle-traps that are filthy and cluttered (where I
wouldn't want to even sit down), the subsidized low income housing
projects where drugs are rampant,all the way to the palacial homes with
the three or four car garages that leave me wondering how the couples pay
for this. So, I get to see it all. I consider myself very fortunate to
have this insight. None of my nursing or medical colleagues have this
advantage. This may be why I approach this breastfeeding issue (and others
like it) as I do.
What I have come away womdering sometimes, is how do these women even
survive? How do some of the children even survive in the surroundings I
see? Other times, I look at the young couples in the beautiful homes
remembering what it was like to start out.
My point is that because of these experiences, I have developed a respect
people for who they are and what they believe and how they manage their
lives.They have grown up under circumstances that I can only imagine and
who am I to assume that I know better for any of them? In other words, I
have a healthy respect for people as individuals.
All of these people come into their pregnancies and resulting parenthood
with their own ideas, experiences and backgrounds and because of that,many
of them make choices that you and I would probably not make (no matter
what end of the financial scale they are on). We can teach and teach and
each person is going to hear what she personally wants to hear and she is
going to do what she wants to do. It is NOT up to us to change them, but
to meet each woman where she is and guide her and support her personal
choices.
I once had a patient who told my manager I had said that "formula was
poison." Now of course, I had never said that (and would never say that).
What I had said was that "breastmilk is superior nutrition for human
babies." She had no desire to breastfeed and was obviously looking for
reasons that made it okay for her to choose NOT to do so. Turning my words
around was her way to get out from under any guilt feelings she had about
not wanting to breastfeed. This was just her choice.
We must meet women where they are, regardless of what they choose to do.
It is the same for the women in the one room apartments right up to those
in the big houses. They all have their own agendas and will take our
information as they each choose. It is up to us to support their choices.
So when some OB's tell you that women are forcing them and come into the
practice knowing what they want, they are telling you the truth. All
practitioners deal with people's choices all the time. OB's around us
don't even accept some women into the practice if they come in professing
desires that are incompatible with the philosophy of the practice ( a
rarity thank goodness). We had one practice that had to "fire" a patient
out of the practice after the birth and PP care because she had
jeopardized all of us (and herself and the baby as well). If the physician
feels the woman in jeopardizing their practice by making choices that
might threaten her health, they won't accept the patient. It is the same
with many of the pediatricians who will not accept non-vaccinators into
their practices.
So, the respect for choice goes both ways: from practitioner to patient
but also from patient to practitioner.
Betsy Riedel RNC, IBCLC
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