In Your Voice

Submitted by: Emily C. Taylor, MPC, IHI-IA, LCCE, CD(DONA)

Founder and Director of WISE (Women-Inspired Systems’ Enrichment)

According to the Oxford English Dictionary, normal means “Serving to establish a standard.  Of natural occurrence.  The usual, typical or expected state or condition.”  Rarely does this definition apply as precisely as it does to breastfeeding.  Let’s break that definition down: 1) it is, indeed, the standard by which all other methods of feeding a human infant are judged.  (Can’t you hear the formula ads proudly proclaiming, “Our closest even to breastmilk!”?)  2) Much like other natural occurrences, even the 93 chemical elements, breastfeeding is at its finest without artificial aid.  And, 3) the flow of milk from mother to child can safely be expected to transpire.

When then, if breastfeeding is so normal, do we insist on asking women “Do you plan to breastfeed?”  And, why, do so many women respond, “I’d like to try?”  As a doula, a childbirth educator, a Baby-Friendly Hospital expert, and as a woman, I’m sad to say it’s because well-intended “supporters” among us treat breastfeeding as if it is the exception.  Therefore, it is up to us to protect the normal until this paradigm shifts.  Here are three suggestions for mothers, birth workers, or anyone who wishes to don their super-heroes cape and protect the normal:

1)     Be smarter than the advertising.  Better yet, avoid it altogether… Denounce it!  In a recent study I published with my esteemed colleagues, we found that women’s confidence in their ability to breastfeed decreased remarkably after viewing a few common advertisements.  Before reviewing the ads, women decreed that mothers’ milk was best; after the ads, they wondered whether their own milk would meet their babies’ ever-changing needs.  I don’t care how beneficent these advertisements appear: They serve their purpose of getting women to use the products.

So, what can you do?  Ask your local hospitals and providers if they are compliant with the International Code of Marketing of Breastmilk Substitutes.  If so, they refrain from distributing formula company advertising.  If not, ask them to do so.   (Hospitals can register with www.banthebags.org to show their solidarity with the thousands of other hospitals who have signed on.  (Massachusetts and Rhode Island are bag-free states!)  If they won’t do it, tell everyone you know to leave those bags (or “educational materials” or coupons) behind.

2)     Go “Baby-Friendly”!  The Baby-Friendly Hospital Initiative is designed to give mothers and babies the optimal environment in which to start breastfeeding.  Staff is trained to provide evidence-based support on infant feeding, mothers are encouraged to hold their babies skin-to-skin, and to room-in continuously.  Only 6% of hospitals in the US are designated as Baby-Friendly.   But, you can make your own “Baby-Friendly” by requesting the practices for yourself and those you are serving.  Set the expectation: “The baby will be going skin-to-skin immediately after birth, and will stay there through at least the first feed.”  “The baby and mother will be rooming-in so they have an opportunity to practice baby-led feeding, and get to know each other with the support of the hospital staff.”  And, of course, stay close if you’re at home or a birth center, too!

3)     Learn about how the Affordable Care Act protects working mothers’ rights to breastfeed.  The ACA amends the Fair Labor Standards Act to require break time and a private place for hourly workers to nurse or express milk.  Employers sometimes need a bit of guidance about their role in protecting the normal.  Mothers and birth workers can (educate themselves and) point employers to the Division of Labor and the Office on Women’s Health.  A house bill called “Supporting Working Moms Act” is currently before the House of Representatives.  It seeks to expand ACA’s requirements to all employers.  Track S.934 so that you are ready to support it when its day arrives.

Above all, remind yourself that breastfeeding IS normal, and that like most things in this day and age, normal needs protecting.

Happy National Breastfeeding Month!

[Birth workers: If you would like to read more about protecting breastfeeding, check out our new book, Achieving Exclusive Breastfeeding: Translating Research into Action (Clinics in Human Lactation), by Labbok, Taylor or Parry, 2013.]

Also, see what the Surgeon General has to say on the matter by reading her Call to Action to Support Breastfeeding.

 

 Emily C. Taylor, MPC, IHI-IA, LCCE, CD(DONA), Achieving Exclusive Breastfeeding: Translating Research into Action (Clinics in Human Lactation), by Labbok, Taylor or Parry, 2013 is also Founder and Director of WISE (Women-Inspired Systems’ Enrichment).

 

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Submitted by Guest Writer: Denny Hartung, MD

Unless  you have a philosophy background, degree or interest, or are a fan of Plato, you may not have heard of the concept  of “The Noble Lie”.  I first heard about it in Washington, DC, at The International  Breech Conference in November, 2012. A wonderful midwife from Canada named Betty-Anne Daviss shared it while waxing philosophical at one of the lectures, and I share the concept humbly with you. I believe it has merit as we think about the childbirth experience over the spectrum of care today.

Betty-Anne told us The Noble Lie comes from Plato’s Republic.  It is a myth or “untruth”, if you will, told by an elite, to maintain or advance an agenda. I did a little more digging after the conference and found out, in the “Republic”, the myth went something like this:  Into whatever societal class you were born, there you will always remain and exist.  Slaves and serfs are always in the lowest class, landowners will always lord it over the serfs, and the politic or ruling class will always have most of the wealth and always rule.  If the ruling elite got the masses to believe that, then they maintained control and there was less chance that the masses would revolt and disrupt the status quo.  We know this idea today to be antithetical to the general good of society.  All have opportunity to improve their status in life, contribute to society to the fullest, and can grow, given the right circumstances.

The “Noble Lie” of childbirth, as Betty-Anne tells it, is this, “Women in childbirth need to be saved most of the time.” Her idea is that “the elite” are telling women they cannot give birth on their own. “You need that epidural.  Your baby needs continuous monitoring.  You need an IV.  You need pitocin to help you deliver your placenta.  You need that cesarean to save your baby from the difficulties of natural childbirth. You cannot deliver a breech baby vaginally.” I could go on and on.  One wonders if the childbirth industry is telling us that to maintain control too.  Something to think about…

Birth is a sentinel event in the human experience. The world is never the same after each and every birth.  A new life is here to change everything. Maybe another Mozart or Gandhi or Goethe has come.  Even more amazingly, a woman has been transformed into a mother.  The process and outcome should be given the respect it deserves.

I believe that women need “saving” from childbirth only rarely. Cesarean birth can be good – sometimes. Epidurals can be helpful – sometimes, as can pitocin, etc.  But, I believe we trivialize the experience of childbirth for each woman, her partner, her growing family, society and the global community when we disempower  her from the most powerful and difficult thing she will ever do.  Too much unnecessary intervention not only affects her, it affects our community adversely.  Once a woman has given birth, she knows what she is made of. Let’s not let the “Lie” lead us away from the real truth of childbirth.  Most of time she CAN DO IT.  As a mother, she can then help others through it.  She can lead our community and her family better.  She can withstand practically anything.  She is empowered.  She can change the world.

 

Denny Hartung, MD learned that art of gentle birthing while he served as an Army OB/GYN with military Nurse-Midwives for 11 years in Alaska.  Since his Army retirement in 2005,  he has practiced community Obstetrics and Gynecology in Hudson, WI, and in the eastern suburbs of the Twin Cities area of Minnesota.  He has an interest in VBAC/TOLAC and vaginal breech birth and promoting the midwifery model of care in obstetrics.

 

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A Call for Birth Workers to have Breakfast in Bed with “Listening to Mothers III”

Submitted by Jill Wodnick, M.A., LCCE, ‘Giving Birth & Being Born’, Montclair State Univ. Center for Autism & Early Childhood Mental Health

It’s time for me to restock my Corn Flakes! Thanks to the support from the Kellogg Foundation, the Listening to Mothers III research was released May 9, 2013.  In no surprise to birth professionals, a national survey of new mothers reveal that risky procedures in healthy populations are overused and many beneficial practices are underused.  My hope is that the leverage of this report found in today’s Wall Street Journal and Consumers Reports is that the conversation will expand and permeate into the paradigm of optimal maternity care.

In a tale of two labors, inductions had drastic birth outcome implications.  53% of women had inductions; whereas  47% had no induction. Looking at birth outcomes, the  woman who went into labor without an induction and without an epidural had a cesarean birth rate of 5%; the woman who had an induction and epidural had a cesarean birth rate at 31%. The value of the Listening to Mothers is that Childbirth Connection did just that: listened with clarity over the past decade to mothers from all over America making a real imprint in the buzz word of ‘patient centered care.’

Today’s webinar by Childbirth Connection to present the Listening to Mothers III featured a cross section of change makers.  In hearing Leah Binder, president of the Leap Frog Group focus on the employers and purchasers of health care, she was quick to point out that labor and delivery make-up 25% of hospital charges.  New Jersey’s own Dr. Thomas Westover, M.D., Co-Chair, New Jersey Hospital Association Perinatal Safety Collaborative, Assistant Professor, Maternal & Fetal Medicine & OB&GYN, Robert Wood Johnson Medical and Cooper Medical School detailed the need to engage payers so hospitals have the capacity offer consistent VBAC access.

Aligning incentives for higher quality care will go a long way to foster the gap that is in maternity care between protocols and best practices.  Only 2 out of 5 women walked around during labor.  More than two-thirds (68%) of women who gave birth vaginally reported that they lay on their backs while pushing their baby out and giving birth. The anonymous quotation of this woman tells the journey of what so many women experience:  “I was not allowed to get up and walk around, even go to the restroom, after I had been strapped with the fetal monitor.”

The fact that freedom of movement is not consistently accessible nor available begins the cascade of many interventions which drive up cost and can derail the treatment of women.  Issues of  equity, access and disparities all make this report critical to review.

Callers on the webinar about Listening to Mothers III asked about sharing this information with medical providers and the challenge for employers to support education and information for pregnant women.

Third times a charm.  The last two LTM surveys have been a much needed voice in patient centered care and narrative medicine.  Now, we have a decade worth of Listening to Mothers.  We can list out the need to improve care and the list of underused comfort measure and list over used procedures.  We can find that in the past decade, our lists may have gone on deaf ears when it comes to consistent implementation of best practices.

The root word of both list and listen is the Indo European word root of kleu.  They are together because listening involves tilting or leaning over to a side to hear something. So hear the direct words of LTM III:

‘Over the three Listening to Mothers surveys, respondents have increasingly supported the idea that birth processes should not be interfered with unless medically necessary. However, there was little indication that the maternity care system protects, promotes, and supports the intrinsic physiologic capacities of this largely healthy population of women and their fetuses/newborns.

Technology-intensive maternity care continues to predominate.

Our maternity care system is failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies. Moreover, this unnecessarily costly style of care places a considerable burden on governments, employers, and families who pay the bills for this major sector of the health care system.

The Institute of Medicine’s landmark Crossing the Quality Chasm report exposed the gulf between where our health care system is and where it should be with respect to safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.’

As you take the time to read Listening to Mothers III, take a moment over your own breakfast cereal to read the research.  You will digest the research and resources of what maternity care can be in the United States and our role in the many dimensions of care.

 

Jill Wodnick teaches didactic sessions to medical residents as well as Lamaze Childbirth Education through Montclair State University’s Center for Autism & Early Childhood Mental Health.  Speaking frequently about birth, she recently delivered a webinar for the NJ Hospital Association on sustaining NJ’s BabyFriendly Hospital Initiative through the use of doulas. She can be found singing and playing board games with the 3 boys and husband in Montclair, NJ. www.JillWodnick.com

Submitted by: Suzanne Swanson, PhD, LP

Introduction from Debra: We have reached a time in the developed world that it is not enough to survive childbirth, women must survive and thrive physically and emotionally.  To ignore the importance of  a women’s emotional well-being during childbirth is to leave a mark that can create a lifetime of pain.  As Dr. Sarah Buckley says” When women are safe, supported and undisturbed” they can find comfort and pleasure in birth and I would add thrive emotionally. ~  Debra Pascali-Bonaro