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From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 31 Dec 2007 18:47:41 +0100
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I've just read 'Improving Maternity Services: Small is Beautiful - lessons
from a birth centre' by Denis Walsh, a reader in midwifery in England.
There isn't much about breastfeeding per se in the book but it raises points
about how the scale of a maternity unit affects the ability of the people
using it and those working in it to care for each other.  The book is about
Walsh's own ethnographic research in one specific British free-standing
birth centre and his fascination with how the staff worked.  In particular,
he was impressed with how they created a nest for 'matrescence', or
'becoming mother'.  The staff cared for one another the way they cared for
the women they served and the women turned out in force, on the streets,
when the centre was faced with closure as a cost-cutting measure in the
health services.   The centre survived.  

While approximately one in six women might best be served by giving birth in
hospital, the other five would do fine elsewhere.  We have the knowledge to
figure out which group a woman belongs to beforehand.  It's eminently
defensible to offer such a service to far more women than get it today,
particularly in settings where transportation is really a minor practical
challenge and not a potentially life threatening obstacle.  

I found this book inspiring and thought-provoking.  I attend home births
because I want to do things in my own institutional workplace so that women
will have an experience more like what women get at this birth centre, where
they feel supported, accepted and nurtured, instead of feeling they are
making unreasonable demands if they need help at night, or have to have
something explained more than once.  I need to be at home births to remind
myself what such care looks like.  Mothers who feel nurtured have an easier
time nurturing their young.

If we could develop a service in which only those women in need of
interventions got them, we would also have the time to give those women the
attention they need afterwards, to recover and to get a good start with
their children.  As it is, we are flooding a specialist service with women
who really need someone to support them as they do for themselves through
the normal process of childbirth, and this misuse of resources results in a
lack of staff time to give *any* of the mothers adequate care post partum.  

Hospitals may be argued to be the best place for births in which doing for
oneself would be ill advised.  Which births fall into which category is a
matter for a different discussion.  I'd also advise women to look closely at
the hospitals available to them and choose one with low rates of
intervention in labor and high rates of exclusive breastfeeding.  It's
likely they would find both these things in the same hospital.  Far more
women could give birth in birth centres or at home, than do so, and we need
to be willing to consider the possibility that their choices are not at
present being made on the basis of solid evidence.  Also, choosing a
hospital with the capability to intervene swiftly when necessary should
actually reduce the numbers of needless interventions done *just in case*
because when you are confident you can intervene if you have to, you can
adopt a stance of vigilant restraint  and keep it much longer.  Please note
that this does not apply to the same degree when there are other incentives
to intervene, especially financial.  I learned that in Australia, the single
most important determinant of whether a birth would go normally, was if the
woman had no private insurance.  Women with private insurance had much
higher risk for cesareans.  Australia may not be the only place where this
is true.

Rachel Myr
Feeling relieved that I can't see into the future, and wishing everyone on
this list all the best in 2008, which arrives in about five hours time here
in Kristiansand, Norway

  

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