Sam, your analysis of the increasing C/sec rate in the US and defence
of VBAC is well taken, and the increasing rate of unnecessary C/secs
is to be abhorred. But I think it's easy to lose sight of the fact
that it is not the increasing C/sec rate which is the major
contributing factor to breastfeeding difficulties; it is the lack of
support for breastfeeding. When hospital practices are "permitted"
to interfere with normal initiation of breastfeeding, it is too easy
to blame the type of birth.
There is no earthly reason for mandatory nursery time for most
healthy babies born by C/sec - newborns can be positioned and
assisted by nursing staff to breastfeed in the recovery room, even
when the mother is still coming round from a general anesthetic, and
mothers and babies can and should room in, or bed in, in the normal
way. I've seen mothers after a second (elective or planned) C/sec
suffer less pain, become mobile and competent and able to care for
their babies without help faster than those who have had stitches
after a vaginal birth. To be sure, when babies are delivered "too
early", then many of them, particularly if they are also below normal
weight, breastfeed less effectively, but many of them breastfeed just
fine, and some of them much more efficiently than smaller babies born
vaginally. So it's all relative. The answer is make breastfeeding
after any birth the top priority; to facilitate early mother-baby
contact, early breastfeeding, or early breastmilk-feeding for every
baby, including those who are sick/small enough to need to be cared
for in the NICU, to teach all mothers (regardless of the method of
delivery) how to know that their babies are breastfeeding effectively
- or not - and how to express/pump and provide EBM top-ups for the
time that it takes the baby to become competent. While pain
medication during labour can, and does, interfere with newborn
sucking reflexes, we can reassure the mother that this is not her
fault, the effects will wear off, and meanwhile she can
breastmilk-feed her baby while she waits for him to recover.
It's too easy to blame a less-than-ideal birth for breastfeeding
failure. What we need to do is to beef up our breastfeeding
advocacy, and to initiate hospital protocols (eg borrow one or two
from the BFHI) which can work around the early difficulties that
C/secs and drug-filled labours seem to place in the way of "ideal"
breastfeeding. These difficulties are not insurmountable. The fact
is that in developing countries there are far fewer C/sections, far
less medicated deliveries (and far higher maternal and neonatal
mortality rates), but breastfeeding is seen to be so crucial that
what happens at the birth is not permitted to interfere with
breastfeeding afterwards.
That being said, now that I live in a country where breastfeeding is
clearly not seen to be very important, and almost anything is laid
down as a perfectly valid reason why it's OK for babies to be
bottle-fed, I share your frustrations.
Pamela Morrison IBCLC
Rustington, England (formerly Zimbabwe)
-----------------------------
Sam wrote, "With the increase in cesarean section, there is the
corresponding increase
in breastfeeding "difficulties" due to routine (and in our local hospital)
mandatory nursery time. With the "need" to deliver these babies before
their mother might enter into a natural labor, these mothers are delivering
earlier and earlier - thus compounding the very high infant mortality rate
the US has (currently the highest infant mortality rate of all developed
nations)."
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