Pregnant? Consider a Midwife

Our Bodies Ourselves has posted a video on their blog asking the question "Why Choose a Midwife?" The video is mainly being used to address legislation in Massachusetts governing midwives, but it has the added benefit of detailing the benefits of the midwifery model of care.

Parts of the video are drawn from Natural Born Babies which is told by 10 mothers describing their journey to have a natural childbirth. The video is amazing! I promise I'm not just saying that because I'm biased having worked with Executive Producer, Lorri Walker at South Coast Midwifery & Women’s Health Care or having had the blessed opportunity to serve as doula to the family who helped direct the film. If you are pregnant and are looking for a healthcare provider these films will give you pause and a reason to consider hiring a midwife.

Are You Familiar With The Mother-Friendly Childbirth Initiative?

If you are pregnant or trying to conceive take the time to familiarize yourself with The Mother-Friendly Childbirth Initiative (MFCI). It is the first and only consensus document on maternity care in the United States. MFCI is evidence based and focuses on prevention and wellness while promoting a mother, baby and family friendly model. MFCI takes the approach the childbirth is a normal, natural and healthy process and should be respected as such.

Mother-Friendly Childbirth Initiative

Consensus Document by the Coalition for Improving Maternity Services

A mother-friendly hospital, birth center, or home birth service:

1. Offers all birthing mothers:

• Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
• Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
• Access to professional midwifery care.

1. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
2. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
3. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
4. Has clearly defined policies and procedures for:

• collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
• linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.

1. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:

• shaving;
• enemas;
• IVs (intravenous drip);
• withholding nourishment or water;
• early rupture of membranes*;
• electronic fetal monitoring;

1. other interventions are limited as follows:

• Has an induction* rate of 10% or less;†
• Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
• Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
• Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

1. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
2. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
3. Discourages non-religious circumcision of the newborn.
4. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

• Have a written breastfeeding policy that is routinely communicated to all health care staff;
• Train all health care staff in skills necessary to implement this policy;
• Inform all pregnant women about the benefits and management of breastfeeding;
• Help mothers initiate breastfeeding within a half-hour of birth;
• Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
• Give newborn infants no food or drink other than breast milk unless medically indicated;
• Practice rooming in: allow mothers and infants to remain together 24 hours a day;
• Encourage breastfeeding on demand;
• Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

As you look for healthcare providers talk with them about their approach to the Mother-Friendly Childbirth Initiative. Here are 10 questions to ask and help as you explore your options.

The Realities of Working and Breastfeeding

"When providing breastfeeding support we must listen to the mother and meet her where she is."

Last month I attended the Breastfeeding and Feminism 2010 Symposium: Informing Public Health Approaches. It was an inspiring and educational conference. This is the quote that came from my workgroup at the conference that really spoke to me. It is where I believe all individuals need to come from when working with a breastfeeding mother.

As I look at breastfeeding and work there are certain realities that we cannot escape. One of the most recent breastfeeding accomplishments in public health was the health care reform law that allows women employed in businesses with over 50 employees to be permitted to pump and have a place to do so. This is an amazing accomplishment that we need to applaud, but at the same time we must also recognize the limitations of this legislation and work with breastfeeding mothers to help them overcome whatever obstacles prevent them from continuing a breastfeeding relationship.

I returned to work when my oldest son was 3 months. I had an office job that allowed me the flexibility to pump when I needed. Even when I was on the traveling, I built in time to pump. I also worked from home a few days a week, so I had the added benefit of being able to breastfeed my son and not pump at least one day a week. Like many, I struggled with supply issues here and there, but I was able to recover and continued pumping until he turned 1. Our breastfeeding relationship continued until he was 22 months. I was lucky. I had an ideal pumping and breastfeeding scenario. Sure I pumped in the car before a meeting, while typing an email to a coworker and while on a conference call (muted of course-have you heard how loud the pumps can be?). However, I fully recognize how lucky I was.

If my scenario was perfect, what happens in real life? What happens if the breastfeeding mother is:

• The teacher who needs to be in her classroom for the majority of the day?
• The doctor or nurse who works a 12 hour shift?
• A waitress who has customers to attend to during her entire shift?
• A woman who works in the chicken processing plant who never freely walks off the production line?

These scenarios assume that mother is fully able to breastfeed? What happens if:

• Baby never learned to latch so mom needs to exclusively pump?
• Mom's supply starts to wain?
• Mom wants support in combining breastfeeding and formula?

How can we help these women? This goes back to my initial quote. We must listen to the mother. What does she need? As a doula I know the logistics. I know the positions. I know the how and why of breastfeeding, but I don't have all the answers. I know we must listen to her and help support her whatever she needs.

I do know that there are somethings we can do in our day to day lives to help. We can help normalize nursing and continue to make it easier for mothers who want to continue to support policies that encourage breastfeeding when mom returns to work.