I do agree that women need choices with birthing options.  It sounds like 
the Netherlands have an ideal situation with a home like atmosphere with 
close access to emergency help.  I think that an structured education is 
very important for providing any kind of care.  One of the reasons that so 
many nurses provide poor lactation support, is because they have not been 
educated in normal breastfeeding.

I have see the results of birth accidents and incompetence or inexperience 
which has resulted in damaged babies.  These things happen with both doctors 
and midwives in attendance.  It is painful to watch the perfect looking baby 
with no blink or gag reflex and the parents that are experencing emotional 
pain and grief.  The parents want everything done for their baby and 
unfortunately there is not much to do but to stabilize and try treatments 
like head cooling.  I have not heard of babies dying at home (during the 
birthing process) in my community, so it seems that most parents choose to 
provide medical care when a home birth fails.

Over the course of many years, I have seen less morbidity (infants have less 
severe brain damage) because of rapidly performed c-sections in hospital 
births.  Home births may have more severe outcomes because of the distance 
from the hospital.

As lactation consultants, you probably never see the severely affected 
infants.  They are unable to swallow their secretions and require tube 
feedings for their nutrition.  They are at high risk for aspiration.

Some of the less severely affected infants may bottle, but they usually 
don't have a normal suck and may make more of a chewing motion.  I did just 
work with a baby that recovered nicely from the birth asphyxia and was able 
to latch and breastfeed.  He may or may not have long term neurological 
problems.  The financial and emotional burden on these families are huge and 
the more severe the damage the higher the financial (and probably emotional) 
cost.

I hope that your New Year has been peaceful.  Sincerely, Rachel Wahl RN 
IBCLC

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