Bereavement care. More than just part of the job.

I spoke at a seminar this week organised by La Trobe University’s centre for Health, Law and Society. Examining  reproductive loss from legal, social and political perspectives it was attended by about 20 people from varying backgrounds – law, psychology, activism, anthropology, peer support and midwifery. I was invited to share a midwife’s perspective on bereavement care.

Only one of the hardest presentations I’ve ever written …

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August Sander’s People of the 20th Century

 

  • The role of the midwife in bereavement care.

  • Tensions in care.

  • Future ideas…

This list is supposed to be a template for my ramblings – hopefully it will fool you into thinking that this thing has a structure. As in my research currently, my ideas are undisciplined and messy at the moment and that is how you will hear them today.

Hopefully they will be helpful in at least starting discussion or stimulating questions.

Thanks so much for asking me to be involved today. There is much about midwifery that I feel strongly about and bereavement care is no exception.

Thanks for naming the taboo and breaking the taboo with today’s seminar.

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Midwifery 101.

Midwives care for women through the continuum of pregnancy, labour, birth and the post partum period. In the maternity system in Australia midwives are present at every birth of a baby, regardless of the type of birth.

Normal births are of course what we are trained for, but we also stay “with woman” regardless of the birth outcome.

We practice “watchful waiting” and we work as much as possible with physiological events as they unfold.

Although most of us have trained in pretty heavily medicalised systems we are believers in pregnancy and birth as part of normal life – these are for us “normal physiological events”. Sometimes we have to work hard to “keep things normal” too – when events are threatening to spill over the boundaries into what is considered “abnormal” or “non-reassuring” or beyond the parameters of the particular institution we are working for – when there is a risk of intervention and what we refer to as the “cascade of intervention” as more and more interventions follow. These actions can be justified by the need to minimise risk, increase surveillance, expedite labour or birth or relieve the suffering of the birthing mother.

This is definitely a contested space in modern maternity care.

We seem unscientific in our mistrust of medical intervention, even unrealistic or unnecessarily reckless in our belief in the power of women’s bodies. Midwives live with the tension to varying extents.

Sometimes, too, we have to work in highly technical and medicalised situations with women who have serious medical conditions or who developed pregnancy or birth related complications.

And of course, sometimes we have to help women labour and give birth to their dead babies or to babies with serious or life-threatening abnormalities or who simply come too soon.

“With woman” is the meaning of “midwife” and we do this in all these situations.

We define ourselves as a constant support for women in what can be a vulnerable time and when they may be seen by many different caregivers.

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Providing bereavement care is a privilege for midwives.

Of course, being with women and families when their healthy, live baby is born is one of the biggest highs ever.

It is a glimpse into the universe. A glimpse that you might have three or four times in one shift on a busy night… or see three times in 45 minutes. Nonetheless a sacred moment.

In the balance of the universe, then, midwives understand the need for sensitive and supportive care for families deprived of that experience. So that these parents might too have a sacred moment.

Midwives recognise that this baby was born into love and a family and that this baby needs to be remembered and mourned, and the baby’s parents supported and cared for.

How things have changed in a generation or two – student midwives weren’t permitted to care for bereaved families when I trained and there was an unspoken rule that only “experienced” midwives could really do the work.

Unfortunately that meant that the work fell to a small number of midwives who did mostly bereavement care. There were no formal support systems for them – it also was traditional for them to be in charge of delivery suite at the same time that they were providing the care. Other midwives took on the rest of the workload and their care of bereaved families was intermittent rather than intensive.

It did also ensure some continuity of caregiver. It also in some way reflected the importance of this work by having the midwives with the most expertise and experience providing the care.

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What is the nature of bereavement care?

There is little definition of what is required of midwives in their role. It is an extension of their care role for women with live babies I guess. With some pretty fundamental differences. But it is not articulated. In the policy and procedure I read from the hospital the information was heavily procedural.

I would say that this is a significant tension in bereavement care: between providing relational, sensitive and personalised care and meeting procedural obligations.

There are a mountain of forms to fill out that are specific to bereavement care. They concern information for perinatal statistics, consent [or non-consent] for post-mortem, information for funeral directors, follow up appointments and so on. There are also the round of people who are usually involved in postnatal care that need to be informed about the nature of the birth… maternal and child health nurses will make a phone call if able… home visits from hospital midwives are offered. The woman’s GP will receive a delivery summary including the birth outcome.

These forms generate a significant amount of anxiety for midwives, for while they are part of a “team” of carers – the midwife co-ordinates the care. And this paperwork is distinctive for bereavement, so it is often unfamiliar. It also assumes a continuity for midwives – a “primary” midwife signs the care map and takes responsibility. And yet it’s rare that someone will take care of the woman throughout her hospital stay, much less beyond this.

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I want to talk more about the nature of bereavement care. What is it that makes it a privilege to be involved in.

I have been reading about embodied care and the work of French embodiment theorist, Maurice Merleau-Ponty.

How we humans are by nature social beings.

How there is an intertwining of knowledge and relationships. How the “I care” and the “cared for” share a reciprocity where both receive benefit. This reminds me of the intensity of the midwife-woman relationship. This is a relationship of embodied care – in contrast to much of the disembodiment we experience in our lives in the late post modern world. The midwife makes use of her connection to her own knowledge of her body – not always, statable, rational knowledge but rather pre-conscious or felt knowledge to care for the woman. By nature, this embodied knowledge is reciprocal – the midwife gains as much as she gives in her carer’s role. Unfortunately this kind of relationship is often discouraged in institutional settings where distance between cared for and the carer is encouraged by its systems and culture. Ostensibly this is to control the anxiety of the caregiver as per Isabel Menzies Lyth’s work on nurses. This is possibly amplified by feelings of guilt and blame in the case of a bereaved family.

Where in fact these care relationships are what make the job worthwhile.

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So back to talking about the nuts and bolts of bereavement care. In my workplace, as well as the midwives providing care, there is also a bereavement worker that is chosen by the woman – more religious or not, or maybe a genetic counsellor that a family has come to know over the pregnancy.

These carers work 9 to 5 but are also available on call to some extent.

Their responsibilities are to do with “intended arrangements” – they meet the family and discuss funeral or memorial service arrangements and follow up and refer to other services as needed.

The worker usually meets the woman and family once after the baby is birthed. There is scope for further contact via follow up phone calls in the coming weeks.

Interestingly, midwives are invisible in the hospital’s policy and procedure. They are barely mentioned. There is some expectation they will fulfil the tasks of the bereavement worker if the birth occurs after hours.

As a clinician I was often confused by what the role of the bereavement worker was. They sometimes had more time to spend with families than you could so that was welcomed… and they had expertise about arrangements for burial and memorial services and so on, but looking at things now I wonder about the wisdom of introducing yet another person to the experience. Now from a distance this looks like unnecessary fragmentation of care, but it would be great to hear how families respond to this. They may find it very helpful.

This is clearly an experience where relational care is clearly important… where midwives are practising their craft of being “with woman” for very vulnerable people.

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So what might be a better way to think about the midwife’s role in bereavement?

Maybe it’s about more honouring of the mother-midwife relationship. A commitment to continuity of caregiver is associated with better outcomes in midwifery care as proven by randomised controlled trials.

I often felt a sense of non-closure after caring for these families. I’m not sure whether that has to do with the nature of the care itself or perhaps of the enormity of the task. Possibly it is connected to being involved in an “unexpected outcome” –guilt perhaps?

We are conditioned to sharing happy events with families.

How can we feel satisfied with our care when the outcome is devastating?

Families too, can have difficulty leaving the hospital – often without their baby. In some ways they fall into a hole or a chasm after discharge – ideally into the arms of a supportive family but not always. Because of the taboo conversations with others are difficult – there is much to be negotiated.

There is always medical follow-up after post mortem at an outpatient appointment – midwives might like the option of being involved in this. Maybe this wouldn’t provide closure… but a feeling of being cared for? Both for mother and midwife?

A familiar face? A bridge between the medical and the maternal?

Someone who was there and knows the intricate details of the “case” as well as how people were during the experience.

A chance to talk about life since then.

A baby death in whatever form is taboo. What are the impacts for caregivers? It is often an unspoken experience for midwives – not even to be shared with our significant others. What impact on our own pregnancies and birth experiences? We count the weeks of viability to ourselves, we hold a hidden knowledge that even a baby at 38 weeks might die mysteriously. It would be great to hear these experiences.

Given how much has changed in a few generations, might we allow for more stories to be told? – beyond the front page hysterics of “preventable baby deaths”?

And the public airing of women’s stories of lost babies in situations they couldn’t understand…

I have argued for more recognition of the midwife’s role in bereavement care. We are the ones standing next to the woman through it all. Systems can change to allow for relationships to flow between bodies.

People seek relationships in times of trauma.

Midwives would need support to do this work – formal and structural and dedicated.

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I had a formative experience with two friends.

Their first baby came “too soon” at 22 weeks. They brought her home with them soon after she was born and I was invited around to visit.

I learnt so much from them. I stayed for a few hours and we talked through the experience of the past few days. They had brought their baby home and I cuddled her and we took photos and talked to her and cried a lot together.

I attended a funeral ceremony with their friends and family a few days later. They are both health professionals and they were determined to acknowledge the birth of this first child of theirs.

They brought others into their circle of care.

They had more children after this one – but she is always part of their family.

There is no question that it was a privilege for me to be involved in the events surrounding her death – and birth, and then in seeing how the experience fitted into the rest of their life.

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Homebirth and other things that matter | Part one

This is the first of several blog posts I want to write reflecting on the inquest into the case of a woman who died in hospital after giving birth at home in Victoria, Australia.

In part 1 I discuss the context in which homebirth and homebirth midwives are regarded in Australia and allude to some of the challenges faced by them in carrying out their work including attitudes toward homebirth, concepts of risk and communicating with mainstream services.


 

I have worked as a midwife in Australia for the last 20 years and I was interested to know more about a recent case where a woman had died in hospital after giving birth at home. I attended one day of the initial coroner’s enquiry and then another day of the inquest.

I admit that I really wanted to know whether this would be a case of putting homebirth on trial and/or independent midwifery. Does that sound cynical? Let me explain the context.

Fewer than 2% of births in Australia are planned homebirths. Other countries are more accepting of the model – it is the default model of care for women with normal pregnancies in The Netherlands. In the UK there is official acknowledgement that homebirth is a safe and reasonable option for many women and that it also serves to (pragmatically) relieve some burden on an already overcrowded hospital system. Both of these countries have an enduring culture of midwifery care for pregnancy and childbirth. This is not a coincidence.

But if you think that homebirth in Australia is only a marginal dreadlocks- tie-dye- hippyfest please note that there are a dozen or so publicly funded homebirth programs currently operating in Australia, many connected with maternity hospitals.

Despite this, generally speaking, the mainstream maternity care system has little respect for alternatives.

A friend of mine, planning a homebirth, presented at a large tertiary maternity teaching hospital with some elevated blood pressure late in her pregnancy – as suggested by her independent midwife. The doctor who she saw in the emergency department asked her first up why she was trying to have a home birth – didn’t she care about the health of her baby?

So that’s just one lousy case, but it’s what I have found to be a pretty standard (and disappointing) reflection of the general attitude to homebirth amongst medical (and many midwifery) staff in the hospital system.

I say disappointing because the choice a woman makes about her care in pregnancy and birth should surely be respected.

Where there is no respect for this choice, women who have planned to birth at home and then unexpectedly need hospital care may indeed face a hostile audience (see above).


 

We live in a world arranged around risk management – in life as in maternity care.  In this coroner’s case there was considerable discussion of the risk status of the woman in question.

In Australia some women are considered to be of sufficiently low risk to “qualify” for a homebirth in the public system or with an independent midwife. Others don’t make the cut and are assigned to  more medicalised care. Pre-existing medical issues or a chequered obstetric history place them at “high” or “higher” risk.

The social science discussion around our modern obsession with risk acknowledges the rationalist and neoliberal influence on our thinking – where things are quantifiable they are containable and manageable.

Right…?

I pity the person who claims to be able to contain and manage that behemoth we know as childbirth. Still, we try.

In an ideal world, independent midwives look after low risk women as per professional guidelines.

Independent midwives, however, are often sought as carers by women who have been traumatised by the mainstream maternity care system or healthcare system in general (or even other institutions).  These women quite understandably seek the woman-centred, continuity of caregiver, non-interventionist philosophy that defines homebirth midwifery – regardless, or indeed perhaps because of, their “risk status”.  Independent midwives may face the very difficult decision of whether to continue to care for a woman beyond her scope of care or risk the woman deciding to birth on her own without care.

Paradoxically, women who have the most challenges in their pregnancies or birth – which may or may not translate as their “risk level” are also known to benefit from a relational model of care involving continuity of caregiver… just as their low-risk peers do.

Which is just the kind of model that an independent midwife offers. And yet we know that independent midwives may have difficulty communicating and collaborating with more mainstream maternity services because of attitudinal barriers related to homebirth.

Independent midwives who care for those women least likely to engage with mainstream maternity models need to be valued by that system and offered every chance available to provide the care that this woman and her family need. This would involve mainstream services being open to supporting rather than condemning women and midwives working in this model of care.

Every pregnant and birthing woman needs care not only in relation to her risk status but her individual needs.

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Once upon a time there was a hospital…

This is a piece I wrote about a local hospital in the outer suburbs of Melbourne, Victoria, Australia. I know it’s a sensitive topic to many of my colleagues and friends, but I’m writing it because I’m tired of the way women have been used in the media coverage of this issue and the way staff at this hospital (and others) have been vilified.

 


 

The stories that have unfurled over the past four months regarding Bacchus Marsh Hospital’s maternity services have certainly been concerning. More than expected numbers of unexplained baby deaths were the trigger for the hospital’s board to be sacked and for the Health Minister to announce concerns about the hospital’s obstetric practices and standards of care. But the media’s handling of the issue has been focussed on blame and retribution and an almost voyeuristic preoccupation with personal stories of baby deaths and maternal wound infections. There also seems to have been little concern for the reputation of local health services in general.

There have been numerous television and print media stories about the alleged “horrors” of Bacchus Marsh hospital’s obstetric services. Even a newspaper piece written by one of the litigation lawyers.

Many of the stories in these reports have come from women whose babies have been stillborn or who have themselves personally suffered infections or complications post-birth at the hospital. Very upsetting stories. Of an often very personal nature. Life-changing events for these women and their families.

These stories have been used by the media to argue that particular doctors at the hospital are unfit to practice.

It is not the media’s responsibility to judge the competency of medical staff at this or any other health service and their use of women’s very personal experiences to this end does not honour these mothers or the memory of their babies.

Instead, the stories have been used to create emotional leverage bordering on hysteria, all the while touted as “giving mothers a voice”. Meanwhile these women have shared their heart-wrenching stories with the world – but to what end?

Many media segments have similarly implied that every baby death at every Victorian hospital is the direct result of medical mismanagement. Sadly, there are babies born every single day in Victoria who never take a breath. The perinatal mortality rate for Victoria in 2011 was 10 in 1,000 births. The reasons for these deaths are often a complex combination of macro structural issues and individual management – important factors that need ongoing close and careful examination by people with appropriate experience and training such as the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM).

One newspaper article last year listed the “likelihood” of baby deaths in specific Victorian hospitals. Interesting stats but what do they really mean and to what end?

These are local community hospitals that people rely on for their healthcare.

There is rarely an alternative service for these people to choose. What do locals do when they lose trust in their neighbourhood health service? And what exactly does it mean that babies are 80% more likely to die at your local hospital? There was no attempt to contextualise these statistics.

At what point does the media take responsibility for the impact this kind of reporting has on undermining local trust in health services?

Bacchus Marsh is a local hospital. It has been a great option for women in the area with normal pregnancies to receive maternity care and to birth close to home. The number of women booking  to have their babies there increased exponentially over the last ten years.  Despite departmental concerns, the hospital is still open for business and presumably it’s staff are trying to somehow rebuild some of that local trust they gained as the hospital’s birth rate grew and grew over the last ten years.

From all this it seems that there are really two key issues that need addressing in this situation:

1. the professional regulation of medical and allied health practitioners is currently the responsibility of AHPRA, and its actions are being called into question, especially regarding delays into investigations of practice. No doubt this is a complex issue related to process and structure.

2.The other issue involves systems of management and leadership for hospitals in Victoria to ensure safe practice and good health outcomes in these services. Not exactly a racy media hook, but good structures can improve accountability and importantly,  help to ensure that people trust their health services to provide safe care for them.

So why not focus on investigating these issues rather than fishing around for allegedly shonky operators who are unlikely to be solely responsible for large numbers of baby deaths, or bringing down the names of local health services who may or may not have practice issues related to their statistics?

If a health service is truly dangerous it should be shut down – no question.

But my heart is with those dedicated health professionals still working at Bacchus Marsh – battling every day the fallout from media stories denigrating their work.

It’s also with the women and families who have shared their stories of heartbreak publicly. Maybe their experiences will help us see the human side of the statistics.

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Breastfeeding support – what makes it good.

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I’m reading  a lot of research that considers  the best ways to prepare and support women to breastfeed.

Truth is, we really don’t know for certain what’s the most effective way to do it.

One theme that seems to be coming through is that the what isn’t so much of an issue as the how.

When women are asked about what care was helpful to them, they talk about having their feelings acknowledged and being listened to.

Graffy and Taylor (2005) undertook a randomised controlled trial in the UK to measure the outcomes from a particular model of breastfeeding support. As well as this, they asked the women in the trial about what they thought constituted “Good Breastfeeding Support”.

The authors summarised it in 5 points:

1. women wanted good information about the benefits of breastfeeding. This was so they could defend their decision to breastfeed when they were questioned (as they expected to be) by their family and friends (!).*

2. women, as I mentioned above, wanted their feelings acknowledged and wanted to feel listened to.

3.  women wanted practical tips for breastfeeding such as different positions for feeding.

4. they also wanted reassurance and encouragement to breastfeed.

5.  Provision of resources for what to do if they were having trouble – someone to call or make contact with.

Not a bad list.

I would defy any midwife to not know how to provide the elements these women were after.

One of the big points here is that women aren’t expecting a huge amount from their caregivers. Mainly time, patience, a listening ear and some encouragement. You don’t need to solve all their problems….but hey, preventing some would be excellent.

As midwives, we can do this by helping them get to know their new baby – to read the baby’s cues, to offer the breast when the baby is quietly alert, to hold the baby close any time.

To believe them when they say they have tried to feed.

To stay with them when they are going to try.

You don’t need all the answers – you will have seen enough babies to know the range of what is normal – and be amazed by the immense variation in this!

Something I tried to mention to women in clinic when we were talking about breastfeeding at the 26 week visit (probably should have had a chat about it at every single visit…) was: “as midwives we know a lot about lots of different babies …but not so much specifically about yours – you will very quickly become the expert on your baby – you can use us midwives to help along the way with figuring it all out”.

My experience as a volunteer breastfeeding counsellor and then training to be a lactation consultant helped me realise there are more important things than “knowing all the answers” to breastfeeding problems when we are supporting women to breastfeed.

So much more is about walking beside them on the journey.


 

*just by the by…I think this issue needs unpacking (and highlighting) a bit more.  Never mind criticism of the health message “breast is best” – when women are being judged on their decision to breastfeed by their own families!

The issue of skin-to-skin.

photo (3)Atul Gawande  is a general surgeon and researcher from North America. And he writes. And thinks.

I “discovered” him a couple of years ago when I read an article of his in The New Yorker on how medicine takes up new ideas into practice (see links below).

In part of the article he described the efforts of public health workers in India trying to instil the practice of immediate skin-to-skin contact for mothers and babies after birth. The proven power of skin-to-skin contact in reducing infant mortality means it should be a natural activity for birth workers to encourage. And it’s an easy thing to facilitate and encourage in the clinical setting. But still it took time for widespread taking-up of the practice.

Gawande’s conclusion was that people are key in creating change in clinical practice.

Health workers with some clinical skills were employed to visit health care facilities to educate on the importance of the practice and also to make connections with practitioners. Practice is a complicated thing. Clinicians go through many processes in order to change their practice. It is one thing to know what the “evidence” is. It’s another thing to incorporate that into what you do. There may be particular factors which prevent the practice from being carried out, and perhaps most importantly, there may be colleagues who don’t share your priorities.

In the case of skin-to-skin contact, I thought of a few obstructions that might occur in a typical Australian maternity setting:

– the need or expectation that other activities will occur following the birth, such as checking the woman’s perineum, delivering the placenta or checking the baby, which skin-to-skin contact may delay or prevent being carried out.

– the desire of family, friends or health workers to give the mother “a rest” from her baby after what may have been a long and difficult labour.

– the belief that the operating theatre environment is too cold for a newborn baby to be unwrapped.

– the belief that a mother having skin-to-skin contact with her baby on an operating table will interfere with the rest of the caesarean procedure.

– the pressure on labour rooms necessitating the transfer of women who have given birth to postnatal wards as soon as possible.  This might mean that administrative tasks take precedence in the activities following birth.

In fact, many of these obstructions were issues in Indian healthcare facilities too!

Gawande’s conclusion in the Indian situation was that this ongoing person- to- person contact was the most effective means of creating change in practice.  Why?

-It meant that the activity was perceived as a priority (why else have someone dedicated to the task of changing practice?)

-It allowed for the clinician to understand all the reasons for the new activity by discussing it with the health worker.

-It gave local clinicians the opportunity to “own” the activity because they could discuss the particularities of their place of workplace with someone else and adapt their practice in a way that suited their context.

-When the practice was increasingly adopted the results could also be observed by the clinician which then had a positive feedback effect…and so skin-to-skin would become a “standard” feature of post-birth care.

And we haven’t even started to talk about breastfeeding…

 

The New Yorker article: http://www.newyorker.com/magazine/2013/07/29/slow-ideas

Atul Gawande’s website: http://atulgawande.com

speech made on leaving the best job ever…

WitchesIt’s almost a year since I left work to start full-time study as a PhD student. So ended ten years of part-time and casual work as a midwife in a major metropolitan maternity teaching hospital.

I hosted an afternoon tea in the postnatal ward – and I made a little speech, because I grew up in a family where making a speech was a way of marking an occasion… and because it all felt like a big thing to be doing.

This month I have started doing a few shifts back there … just to remind myself of the realities of clinical work and to catch up with friends and colleagues. It feels ok.

Jen’s end of work speech. 2/1/2014  

I have loved working here – although some days are better than others! I have great colleagues who care about the women they provide care for. I have met so many inspiring, interesting women and families and had the privilege of sharing what is a life-changing event with them. They personify what I think this place is all about – the highs and lows of human existence. And they let us experience this with them!
Our work as midwives is so important.

Didn’t catch that? I’ll say it again – our work is so important.
From the booking visit in clinic to the last home visit …. Sure we have expertise: we know plenty of stuff about normal pregnancy and birth. But we’re more than that – we’re another woman, we like having a chat, we care about the whole woman and we meet women where they are.
So then we write the dicky little sentences in the antenatal record about holidays planned, sickness in the family, concerns about another child, how last time’s experience is effecting this pregnancy…
And sometimes we are one of the very few people who have taken the time to listen, to care about what’s happening to this woman in her life. We may well be the only positive educational experience she has had. We can be part of a life-changing time for her – diet, exercise, relationships, doing something amazing for herself and her family by bringing a baby into the world.
So I’m leaving being a midwife because I love being a midwife so much! And people have asked me: “why are you leaving and doing this?”
The project I will do about Lactation Consultants is a means of learning how to do research. The masters sparked it for me – I realised there was so much research out there that can help our clinical practice, answer our questions, help us ask more and help us to live with the doubt.
Anyway, so that’s what I’m going to do. And maybe I’ll come back to help you guys do some research too.
Just one thing to finish with … I don’t think we’re very good at letting each other know how fabulous we are. Do me a favour – tell your colleagues – don’t just thank them for their help, but tell them how you admire their practice, their attitude to women, their commitment to caring, their ability to help a woman birth her baby.

And enjoy your work. Thanks

bash the breastfeeding supporter

Is it me?

Probs it is me.

It’s like when you notice women with prams everywhere when you’re pregnant.

Seems to me there’s a bit of beating up of breastfeeding supporters and advocates going on.

Allegedly they (we) are making women feel guilty about not breastfeeding.

Even when a woman has had a bilateral mastectomy for breast cancer (if you must know) … see Emily Wax http://www.theguardian.com/lifeandstyle/2014/oct/18/breastfeeding-mothers-formula-breast-cancer%5D

A couple of my thoughts on this:

1.96% of women in Australia initiate breastfeeding. In my professional experience, first-time mothers who plan to bottle-feed their babies from the go-get are as rare as inverted nipples*. I’m guess I’m saying this is a very small group of women to be getting an awful lot of words written about them. They in no way should be judged for their decision, but I would hope that their decision is an informed one.

2.Women who are feeding their babies at least some formula are more and more numerous as time goes by…85% of Australian mothers, in fact, just before their babies turn six months old. So formula feeding to some extent in our culture is not a rare occurrence, although as to why this is….it’s complicated. But women who are formula feeding shoudn’t really feel like a marginalised group. By six months they are firmly in the majority.

What happens?

Lactation Consultants and midwives and peer counsellors who provide care for women and their newborn babies really  want to help the 96% of mothers  fulfil their goal of breast-feeding their babies.  Women need some/none/mega amounts of support to do this.

Some breast-feeding supporters are over-enthusiastic in the way they explain breastfeeding, or in the way they explain the benefits of breastfeeding. It’s all a pretty embarrassing scenario really, with breasts and nipples and crying babies and stuff.

And it’s also in the context of recovering from childbirth (with maybe one third of women recovering from major abdominal surgery), no sleep, managing visitors and a lack of privacy in hospital, perhaps a lack of general support from home too…

All in all it’s a very challenging environment to be teaching people about a new life skill. No wonder misundertandings arise.

Breastfeeding supporters know that this postnatal environment is a tough gig. It’s neither “technologic nor dramatic”.

They (we) do it because they feel privileged to be a part of this time with a family and their new baby – and all the promise it holds. Many do it because they themselves had difficulties with their own first or subsequent babies. Some do it because they feel that this time is one of the most important in a new family’s life, even though it’s the cinderella of maternity care (few doctors are interested or present, many midwives are more interested in labour and childbirth, it’s all happening in a pretty tricky environment,as I mentioned earlier, of sleep deprivation, post-operative pain, sore bums, bloody pads and renogotiated family relationships).

I’m saying that we’re not in it for the recognition or the laughs.

But we believe that if women set out to do something like breastfeed their baby, we’ll help them to, even when it gets tough.

Because they, and their babies are worth the effort.mother_BFing

 

*very uncommon indeed.