Hi!  This letter addresses two different postings, but they seem to have a 
common theme...empowerment of women. First, this is in response to Dr. 
Lieberman's interesting contention that epidurals are responsible for posterior 
presentation deliveries or "sunny side up." As not only an IBCLC but an LCCE and 
labor background RNC I have seen far too many epidurals and the effects that may 
influence labor and deliveries and often postpartum. 
One thing that may not be truly addressed in Dr. Liebman's  study about 
epidurals is that when women labor with epidurals they are often unable to assume 
positions that enhance the baby's ability to rotate in the pelvis into an 
occiput anterior presentation.  
Women who can rotate their OP(occiput posterior) presentations are usually on 
hands and knees, doing positions that allow the baby to go more to mid pelvis 
and then do a long arc rotation.  In other words, they are ambulating or able 
more freely than someone whose legs cannot support them as is so often with 
an epidural.  Also if Mom has a questionable monitor strip and an epidural 
"lite" then many labor nurses will only turn Mom into a position supportive of a 
good tracing.  Babies who often rotate will have a strip that may show 
increased variables since they may be putting some pressure against the cord. This 
causes labor nurses to put Mom back into a position where the tracing is more 
reassuring.  At least this what I have observed in the land of 95% + epidurals.  
None reassuring epidurals will get you into the OR faster than a speeding 
bullet. How epidurals effect fetal position is a nice concept, but it won't make 
most docs defer from epidurals; because most docs who like epidurals think 
women can't labor without them and so their patient population concurs. it's a sad 
supposition.
I would much rather have Dr. Lieberman or someone investigate how epidurals, 
spinals and their medications of Astromorph, Duramorph and Fentanyl after the 
first few days of breastfeeding; thus causing Moms to have babies who latch 
more poorly and suck poorly and think their babies are unable to breastfeed and 
subsequently want to give formula. 
I remember when birth was the empowering event in a woman's life.  It still 
is in many areas, but only when some caregivers return to the concept of Normal 
Birth and letting women know all the evidence will we be able to say it truly 
is.  Women who attempt labor make choices even for epidurals will also feel 
empowered to face many challenges ... like working with a baby who is slow to 
latch, who has issues because she knows she has met a challenge and made 
choices and can continue on.
I see this on a day to day basis. Women are remarkable creatures that only 
need the confidence in themselves to see, meet and survive struggles no matter 
how small insignificant they may seem to others.  Women and men who care for 
women must allow them the permission to meet these challenges.  Marsha Glass's 
letter promotes this theory.  Mr. Bush and his advisors continue to diminish 
these concepts by their appointments to positions of influence where woman and 
babies are effected.  We who see and work with women daily should carry the 
torch to help women realize they can birth in the best way possible, they can 
find support to nourish their children by breastfeeding. This week of all weeks 
seems appropriate to empower caregivers, nurses, lactation specialists, 
consultants and the mothers we encounter to realize they may not change all things 
but they can keep trying. 
I gave this information of meeting one challenge at a time to one of my 
daughters a month ago when she thought her world had crumbled down when her ideal 
birth turned into an emergency cesarean delivery and she didn't recall the 
baby's first cry. I told her she did her best, she did have a healthy baby who 
despite all of what had occurred demanded to be breastfed by her Mommy and now 
she must move on to the next stage.  This has gotten her through several other 
little challenges. The choices are hers and the people she chooses to care for 
her and her child....made with research and faith in herself and them. We who 
care for women may not be able to change a position in utero of a baby, but we 
change a position of a latch or position of thought of a mother, a family or 
a politician.  Happy Mother's Day to all of us who are, will be or care for 
mothers throughout the world.
Leanne Jewell, RNC, IBCLC, LCCE, FACCE
SFl
   

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