Jennifer writes: <This point, however, on which I agree with Heather, raises the issue that I always come back to--what is the premise underlying any particular practice, procedure or intervention? Here, it is the premise that we need to increase the safety of pregnancy and childbirth. Increase over and above what baseline level? Does this assume that they (preg and birth) are inherently unsafe?> For many mothers, yes. Sure, there are a lot of women in the world who could carry their babies to term without professional care and give birth without complications for mother or baby. But there are huge numbers who would have less fortunate outcomes. Hence the March of Dimes campaign to get prenatal care early and regularly. Not all mothers are well-educated and socio-economically well off. Even those who are, are not immune from certain complications of pregnancy, which can often be foreseen and managed to avoid emergencies or poor outcomes. I don't think this is necessarily "medicalization". If memory serves me correctly, in the U.S., well into the early 20th century, the physician was only called in case of an emergency during the labor or delivery or postpartum period. I am told my own grandmother died in childbirth. It was the Public Health nurses in Boston who noted as they made their neighborhood visits how maternal and child health were intimately bound up with sanitation, ignorance, poverty, malnutrition and social problems. Out of their observations grew the effort to improve many of the conditions for mothers they saw, through education and referral for nutritional and social services. They have been credited with the "invention" of prenatal care. This line of reasoning extended right on into maternal and child health following birth. Even now, I think there are many in public health who are avid supporters of breastfeeding and anything else that can improve health for children and their mothers. Public health departments have not been keeping statistics for over a century "just for the fun of it." They do it to research trends in order to improve outcomes. And clinical "practice" is just that - practice. I think we are all trying to do the best we know how, and trying to improve when we see a way. We just come at it from different viewpoints. I agree we should work on challenging the attitudes of some of the prenatal (and peri- and postnatal) caregivers, but please don't knock the idea of prenatal care! Jean *************************************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html