Friday, April 24, 2009

Sustainability and Midwifery

In response to Sarah's comments on my 'Raising a nappy free baby' post I just want to write down a few ideas on sustainability and the midwifery profession from my point of view.

I think the most sustainable thing the midwifery profession can do is to encourage women to birth at home. This way there are far fewer resources being used than in the hospital system, there is a greater chance of a natural birth free from interventions such as induction, epidurals, pain relief drugs that get through to the baby and cesarean sections, more chance of immediate and prolonged skin to skin contact and less stress created by being in a familiar environment.

This is coming from someone who had a prolapsed umbilical cord during the homebirth of my son! With no warning it was about to occur, I was grateful that I had just reached second stage and my son was born alive after an episiotomy without anesthetic and 12 minutes of the hardest most painful work I have done! I will have another homebirth as I am quite aware that this was a very rare event and I am scared to think what might have been attempted had I been in the hospital. No intervention could have happened as quickly as I birthed my son.

A bit side tracked there, but I did want to show that it still possible to have rare and very unwanted things happen during a homebirth and still have the ability to deal with it successfully. I could have had anesthetic for the episiotomy, but wasn't willing to waste the time with it!

In order for more women to have natural births with no intervention a midwife can be proactive in informing a pregnant woman on the ways to help their baby present in the best position, be healthy and strong through diet and appropriate exercise, decrease stress in their lives, prepare physically and psychologically themselves and with family members. Preparing a pregnant woman for a positive, intervention free labour and birth is the most sustainable thing a midwife can do. The hospital is always there as a back up. There are risks in labour and birth, but they are no higher than the risks we take going out into the world every day.

Post birth there are many things that a midwife can advise and encourage. I biggest barrier for midwives is the minimal 6 weeks post birth they have with mother, baby and family. Consistency of care for a longer period would enable midwives to support women to breastfeed for longer, make decisions about caring for and raising their babies. I would push for ongoing care for up to a year! This is an issue at the national health system level. At least until this happens (we can advocate for it and hope for the best) a midwife would improve the social sustainability of their profession with greater handover to a well-child network provider, make links for the family with a La Leche League (LLL) Leader and other open and holistic parents support groups such as the Dunedin Conscious Parenting group.

Aspects of raising a baby that I consider to be more sustainable (most are social, though there are definitely elements of environmental and economic sustainability):

- Wearing your baby in a sling, or another ergonomic device that holds the baby safely against mum or any other family member. Frontpacks do not support the baby's hips and spine. The baby must be supported under the full length of his/her thigh when being carried. Countries where babies are carried in this way do not have congenital hip problems.

- Raise your baby without the use of nappies (see my previous post), or use cloth nappies as a back up. Natural Infant Hygiene (nappy free) even part time with the use of cloth nappies as a back up is far more sustainable environmentally and has huge benefits socially.

- Co-sleep safely. More parents in the world sleep with their babies than those who don't. It can be done safely and has been shown to be most effective in the initiation and continuation of breastfeeding.

- Breastfeed. Breast is definitely best. For 2 years and beyond - World Health Organisation recommendation. Unfortunately the NZ health system recommend only 1! It is my opinion that midwives need more training in helping a mother to breastfeed and picking up on problems early. In reality a midwife needs to be a lactation consultant if NZ is to improve our breastfeeding rates. So often women stop breastfeeding before or shortly after 6 weeks (when their midwife no longer supports them). I don't think that one paper on lactation in a midwifery course is enough. Either that or midwives need to have a stronger connections to LLL or a lactation consultant.

-Let your baby lead the weaning process. Baby-lead weaning is a great way to introduce solids. This does not mean you wean your baby from your breast milk! (it's not a great term in that respect!).

-Families need to make informed decisions about vaccinations! Forget your own opinion and offer families information from both sides of the debate. Vitamin K is not a simple vitamin, it's a vaccine! It is possible that the rate of childhood cancer caused by the Vitamin K injection is as high if not higher than the risk of hemophilia that the vaccine is made to prevent!  I was never told this and presumed it was a simple vitamin.

-Encourage families to question the way they treat their babies and children. What messages are we sending our children through our language and actions? Exactly why are we praising them? How do we discipline them with love? Is discipline really necessary? There are some fantastic websites on alternative ways of parenting.

-Controlled crying is not a compassionate way to treat our babies. Babies wake often, they're meant to. It stimulates their growing brains, gives them the chance to breastfeed, be comforted and feel secure. Parents force their babies to sleep through the night for their own sake, not the babies. It would have been great to be blessed with a 'sleeper'. Alas I haven't been. We have tried many things to help our son to sleep through the night, but never have we left him alone to cry. Not even for a minute. That would just be teaching him that we are not going to respond to him when he needs it most. He will learn that we can't be trusted to meet his needs. No thanks! I'll continue my gentle attempts to help him to sleep through the night and endure the sleep deprivation! Some mothers claim that they will be better mothers if they could sleep through the night. I think they mean they'd be better housewives. What does your little baby care if you lie around with them all day and sleep when they do! This has been a great book for me: Gethin, Anni & Macgregor, Beth. (2007?) Helping your baby to sleep: Why gentle techniques work best. Finch Publishing.

I'm sure there are many more ways that midwives can operate and practice sustainably. Please feel free to add your suggestions in a comment. Now speaking of sleep! See ya.


Leigh Blackall said...

Great post Anna, quite inspiring. Thanks for all the links.

Charndra at Part Time EC said...

A lovely post, Anna. There can never be too many resources about gentle parenting options.


P.S We sleep chare with our sons too. I have a page of all our 'sleep sharing minutiae' at this page:

(OMG! Yes, I feed them to sleep! LOL....)

hadashi said...

Hi Anna

My wife forwarded the link to your blog to me. I was surprised to see that you are also at Poly. We staff really need to be aware of what the rest of us are doing.
I look forward to trying the baby toilet training - it makes good sense to me (better than a stadium :-) I attended the mid-term scan with my wife today. Looks like we're going to have a baby girl.

Leigh Blackall said...

wow william! Congrats to Mami and you.. a baby girl is so fitting somehow.

Good to see the blogging helping to bring us together a little more

Sarah Stewart said...

a great post along with your 'nappy-free' post. If you're interested, it would be lovely to hear you replicate this in a real-time forum using Elluminate (Leigh would help you). But if you cannot do that, I will link to your posts & hopefully we'll get some conversation going:

Sarah Stewart said...

Thank you, Anna, for agreeing to doing a session for International Day of the Midwife - that is fantastic! I'll leave Leigh to help you with Elluminate. I have booked your space in the wiki-can you give me a couple of sentances to expalin what your talk is all about so people know to join us. cheers Sarah

Anna Hughes said...

Thanks for you comments everyone. Charnda I really appreciate the link to your site. It is fantastic and I will pass it onto the Dunedin Conscious Parenting group. Look forward to reading more myself.
Sarah I will email you from work tomorrow. I'll base my presentation on this latest post, but send you a blurb about it. Cheers. Anna :)

hadashi said...

Hi Anna

This is a little off topic, but the essay I was talking about at lunchtime is on Ran Prieurs blog. The address is

SusanB said...

Great post! I'm in the states (Alabama). Home births with a midwife are illegal here. Some moms use lay midwives on the sly though and pay out of pocket since insurance does not cover homebirths. Hopefully change will be in the wind.

Anna Hughes said...

Hi Susan. Wow illegal! That's outrageous! A lot of research shows that homebirth is actually a safer option for babies and mothers. Often free of drugs, stress of a foreign place and people, quiet, dark and intimate just as birthing has always been, until the last few hundred years. I do hope that changes for your population. I do feel very lucky living here sometimes and I'm always on the look out to guard what we have. All the best. Anna :)

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