CountryMidwife.com

a source of home birth history on the internet


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“Of the 5418 women, 655 (12.1%) were transferred to hospital intrapartum or postpartum…

Five out of every six women transferred were transferred before delivery, half (51.2%) for failure to progress, pain relief or exhaustion. 

After delivery, 1.3% of mothers and 0.7% of newborns were transferred to hospital, most commonly for maternal haemorrhage (0.6% of total births), retained placenta (0.5%), or respiratory problems in the newborn (0.6%).

The midwife considered the transfer urgent in 3.4% of intended home births. 

Transfers were four times as common among primiparous women (25.1%) as among multiparous women (6.3%) but urgent transfers were only twice as common among primiparous women (5.1%) as among multiparous women (2.6%).”

 

Johnson and Daviss 2005, p. 1417


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Routine Newborn Appointments May Undermine Breast Feeding

Upon discharge from birth facilities new parents are asked to bring their newborn into a pediatrician’s office several times in the first week postpartum. Bringing the newborn to a medical facility requires the postpartum mother to attend to social standards that are not helpful to the establishment of good breastfeeding technique.

  • Getting dressed in “out of the house” clothing, putting on makeup and fixing hair, managing infant car-seat, driving to and from the medical office–these things do not assist the process of healing from childbirth, nor help mom’s bodies produce milk or give babies opportunities to learn good latch, sucking and swallow coordination
  • Mothers often feel inhibited about breastfeeding in public places, especially when baby is very very new; while in a clinic we may be less likely to attempt breastfeeding when our babies exhibit hunger cues
  • Parents are more likely to use pacifiers in the car or at the clinic to keep babies quiet, potentially contributing to nipple confusion
  • Babies bundled up in travelling clothes do not have ready access to good breastfeeding positions and skin contact

Typical time investment for a pediatric appointment: One hour for mother to get ready for appointment, 30 minutes to one hour to get baby bathed, dressed and adjusted into car seat/strapped in, 15-30 minutes drive time to clinic, 15-30 minutes in waiting room; 15-30 minutes with physician; 10 minutes scheduling next appointment, 15-30 minutes drive time to home, 15-30 minutes undoing car seat, removing outerwear, changing diaper and settling in at home.

This adds up to a three to four HOUR time investment for each pediatric office visit (assuming you live within 15-30 minutes of the clinic).  That translates to the potential interruption of about two feeding cycles per visit. If a mother/infant pair misses two feeding cycles every day or every other day during the first week postpartum, they will have missed six to ten critical feeding opportunities in the first week!

Core Knowledge to Help Breastfeeding Happen for Mothers and Infants:

  • Skin-to-skin contact 24-hours a day (or as much as possible-think “honeymoon”)
  • Nurse baby on demand
  • Recognize and respond to early hunger cues: rooting, smacking lips & tongue, pushing hand into mouth; don’t wait for crying!
  • Postpartum rest for mother assists physical healing and mother’s energy is put into milk production
  • No artificial nipples of any kind: No pacifiers, No bottles
  • Optimal positioning of baby’s body to mother’s body is tummy to tummy, baby’s face and body directly toward mother’s torso and breast
  • Optimal positioning of baby’s mouth is wide open, tongue down
  • It is not unusual to offer the breast to a newborn every hour during the first few days…the more opportunities to latch that the baby has, the more quickly he/she learns how to effectively and efficiently nurse.

While medical check ups are a necessary part of postpartum and newborn care, I propose that our health system institute widespread use of HOME CARE for all postnatal mothers and newborns. If your pediatrician is unable to provide home care consider hiring a postpartum midwife to provide home maternal & pediatric check ups in place of the pediatric office visits during the first two weeks postpartum.