Monday, June 25, 2007






The homeborn newborn: how do mothers manage breastfeeding when there's noone to show them what to do?

Based on a presentation given to midwifery staff at Royal Women's Hospital, Carlton in June 2006.

Introduction:

Today I have been asked to talk about why babies born at home generally do better with breastfeeding than hospital born babies and how midwives in birth suites can better support their clients.

The first point I would like to make is the safety of homebirth. We all know that babies and mothers are best able to get breastfeeding started if they are both well, and without dangerous drugs influencing their behaviours.

“The safety of planned homebirth has been well established. Mothers who give birth at home have less interventions and babies born at home consistently have less distress, respiratory problems and birth trauma.

“With homebirth there is less disruption for the entire family and more control over the birth environment. Mothers and fathers report birth at home to be more enjoyable, satisfying, intimate and beautiful.” (Maternity Coalition 2006)

We can add to that statement that babies born at home are unlikely to be separated from their mothers for any reason. Babies born at home are unlikely to be fed foods other than mother’s milk. Babies born at home are unlikely to have narcotics in their systems, dangerous drugs which inhibit basic neuro responsive activities which are important in the initiation of breastfeeding.

2 claims

In addressing this broad topic I want to make two claims about mothers who give birth at home:

  1. They are ordinary mothers – no more or less ‘ideal’ for natural birth or breastfeeding than the general population.
  2. Breastfeeding is the norm

I would also like to make a parallel claim about the midwives attending homebirth – we are ordinary midwives; our qualification and education is the same as that of hospital midwives. Some but not many have qualified as lactation consultants or bring other skills. Many are mothers who have learnt from experience rather than from text books how to breastfeed their own babies. Midwives who attend homebirth have chosen to work within the boundaries of the natural birthing process, within a one-to-one relationship with each woman, and over time there is a strong trusting partnership that develops between the woman and her known midwife.

Breastfeeding is like birth – it’s part of the natural birthing continuum. For many women, there is no need for expert skill – it just works. But as with birth there are some, a minority, for whom there are difficulties, and there are sometimes difficult decisions that need to be made. At any decision point the midwife’s skill as well as the woman’s trust in her midwife or other professional advisor are challenged. These decision points come at home as well as in the hospital, and they come at all hours of the day and night. As with birth there are many interferences that can in themselves lead to a downward spiral in which the woman quickly loses confidence in her own ability to achieve this basic life challenge, interferences with the breastfeeding process can lead to a loss of confidence.

Breastfeeding is like birth – it’s not something that can be taught in a lecture situation, or bought off the counter. There are no gadgets that make breastfeeding (or birth) work. It is a process that is learnt by each mother, with her own baby, and their own unique situations. The best teacher is intuition – a deep knowledge that’s already within each mother. The midwife supports this natural learning process and enables the mother to take responsibility for her own wellbeing. At the end of the day the mother is often amazed and proud and can rightly say “I did it myself.”

Discussion

  • Health Promotion – enabling

“Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.” (from Ottawa Charter for Health Promotion. WHO 1986)

When applied to the birthing event and establishing breastfeeding, the midwife stands out as the leading health professional who is positioned to enable each woman to increase control over her health and the health of her family.

  • Baby-friendly is mother-friendly

The protection, promotion and support of breastfeeding is, first of all, the responsibility of the midwife. This is the case whether the mother gives birth or received postnatal care in the home or the hospital.

More reading: Baby Friendly Mother Friendly Ed Susan F Murray 1996.

When assessing hospitals for the Baby Friendly Hospital Initiative I have been surprised at the number of breastfed babies who receive formula supplements, even in hospitals that have passed the BFHI accreditation several times. It seems that there is a culture of reliance on artificial supplements. When I look at the situations in which these babies are supplemented, there are often alternatives, such as teaching the mother to express colostrum, that have not been done. I encourage hospitals to look critically at every situation in which babies are given artificial supplements.

  • Impact of hospital practices on breastfeeding

More reading: Impact of Birthing Practices on Breastfeeding: Protecting the mother and baby Continuum. Mary Kroeger with Linda J Smith. 2004

Conclusion

It would be easy for me to paint a picture of good/bad, black/white – but that would be a false portrayal of the world in which we live.

The reality is that the Australian government’s funding for maternity services does not support a woman-centred philosophy of care, or women who choose homebirth, or midwives who practise in the home. Hospital birth is the norm, and is likely to stay that way for the foreseeable future.

The reality is that Australian breastfeeding rates are as good as or better than many other similar countries around the world. The Netherlands, for example, has 30% of its babies born at home, in the care of midwives, yet Dutch babies are much less likely to be breastfed than our babies are. We can do better, but we should also be proud of what we have.

The reality is that commercial pressures will continue to undermine a mother’s reliance on her own milk as the unique and ideal food for her child.

The reality is that the fathers, grandmothers and other family members will continue to have a significant impact on a mother’s confidence to work through any challenges that arise.

The place of birth, though significant in many ways, is not the key issue. I believe that the midwife as the primary carer, working in a partnership with individual women, and collaborating with other care providers when specialist skills are needed, whether it’s for a complicated birth or a sick baby or a difficult breastfeeding breastfeeding situation, will begin to turn the tide towards health promotion through enabling women in their birthing, nurture, and nourishing of their newborn children.

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