It was precisely this potential to divert us into discussing *other* issues we feel passionately about, that prompted the reminder I sent yesterday about staying on topic. Personally I must confess to reading, eagerly, all the posts on the topic so far, even as I am pleading with you to continue the discussion about the appropriate approach to breech birth off the list. I posted as a listmother who is herself a midwife, and for the record I hold a Bachelor of Science in Nursing from a top-ranking US school. Being a nurse was a minimum entry requirement to become a midwife where I live now, a country that has had government regulation of midwives and their education for a couple hundred years. Only those holding a current authorization as such, may call themselves midwives at all. My professional association marks its 100th anniversary this year. I work in a hospital with all the trimmings of modern obstetrics and neonatal intensive care. I also attend home births. Both are in keeping with how I am authorized to practice based on my education in the Norwegian health care system. My license gives me a high degree of professional autonomy, which I regard as a privilege carrying with it a significant responsibility to do no harm. Sadly, for me it is far easier to refrain from doing harm when I am not within the confines of the institution where I earn most of my income, and that is why I continue to jump at the chance to attend women who give birth at home. I also learn more about oxytocin every time. Elisabet Helsing has just published a new version of her classic Norwegian text on breastfeeding, this time augmented by the expertise of IBCLC and NICU nurse Anna-Pia Haggkvist. I was astonished to learn from the book that WHO carried out a review of the breastfeeding situation in nine countries over the years 1975-78*, and discovered that in every country they looked at, there was a direct negative correlation between contact with the health services and breastfeeding duration. The oftener mothers were in contact with the health services, the less they breastfed. Another survey carried out in Latin America ten years later**, showed that the higher the rate of births attended by professionals, the shorter the duration of breastfeeding. In Norway breastfeeding continuation rates really started to plummet when all births were centralized in hospitals, about 1960. Breastfeeding continuation had suffered earlier when the health visitor system was established a few decades previously, removing breastfeeding from the purview of normal life and placing it in the hands of well-meaning but ignorant professionals, but the real coup de grace came with total institutionalization of birth. This is not to say that birth in institutions need be inherently bad, for birth or for breastfeeding. But if normalcy in birth/breastfeeding is to protected in institutions, the institutions must be highly vigilant if they are to refrain from fixing things that ain't broke. If you look at what the Ten Steps to Successful Breastfeeding say, you realize that most of them are just telling us to stop doing needless and harmful things, not so much start doing something else. Stop separating mothers and babies, stop giving the babies inappropriate nutrition, and stop meddling in the intimate relationship between mother and child which in the vast majority of cases will result in breastfeeding that works brilliantly. If we were really doing that, we would have plenty of time to help the mothers and babies who don't figure it out on their own soon enough. For anyone who feels as Elisabet Helsing does, that the birth isn't over until the child is weaned, it is unnatural to view breastfeeding as an isolated phenomenon, unrelated to pregnancy and birth. Of course it matters what happens during pregnancy and birth, and in particular the first hours and days of the child's life, for which birth really sets the stage. But apart from mentioning the salient features of the birth which have bearing on the particulars of a specific case, or a discussion of some specific aspect of care which may be especially harmful or advantageous for breastfeeding, there just is not room on Lactnet to discuss the entire broad issue of where to give birth and with whom. Your posts on this topic reflect the different ways mothers define and seek safety for themselves in childbearing, and the different ways we who strive to provide safety for them do the same. It is indeed the case that maternal mortality in the US is on the rise at present, and anyone working in maternity care should be concerned about why, and how to turn that trend around. Dead mothers are notoriously bad at breastfeeding. I'm concerned, because I live in the same world, and we are seeing far more large postpartum blood losses and more serious maternal infections than we used to do. It is more often mothers who have had cesareans who need blood and who have infections, in their surgical wounds. * WHO, Contemporary Patterns of Breast-feeding. Report on the WHO Collaborative Study on Breast-feeding. (p 149) WHO, Geneva, 1981 **Pérez-Escamilla R. Breastfeeding patterns in nine Latin American and Caribbean countries. Bulletin of PAHO 1993;27(1):23-42 Rachel Myr Kristiansand, Norway "I think that taking life seriously means something such as this: that whatever man does on this planet has to be done in the lived truth of the terror of creation, of the grotesque, of the rumble of panic underneath everything. Otherwise it is false." --Ernest Becker *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. 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