Childbirth, breastfeeding, power and hypocrisy

As I said earlier today (about 2.30am actually – insomnia is so much fun), I was particularly taken by three posts on the 46th Carnival of Feminists, which are all about childbirth and maternity. I have been musing about the ideas all today, in between cups of coffee.

When I was first pregnant, my older brother, an anaesthetist, said something fascinating. By then he had been studying and working in medicine for about 15 years. “In my time in medicine,” he said, “I have seen power in childbirth pass from doctors to midwives. But it is still not where it should be, which is with the mother giving birth.”

Having been through two labours and three deliveries (how does a twin birth get counted?), I know that when my body was involved in the intense and difficult work of seeing my babies into the world, all I could manage to do was survive from moment to moment, and push. (I had difficult deliveries – posterior presentations all of them.) I was completely dependent on my partner, and my obstetricians and midwives. So in some senses, it’s reasonable for power to remain with professionals – I was in no position to make sensible judgements.

However, I wonder if the midwifery inspired mythology around labour and childbirth can be a disservice to women. From being told that labour and childbirth was a problem to be managed medically, we seem to have swung the other way, into believing that labour and childbirth is a natural, and therefore good and easy process. Somehow, we have forgotten that women and babies used to die, routinely, in childbirth. And in many developing countries, they still do. When a midwife prattles on about natural processes, and control over bodies, what they are doing is setting an impossible standard for many Western women.

I found it very difficult to find a midwife who would listen to me when it came to my deliveries. For the most part, they had their heads filled with some sort of spiritual naturalistic claptrap, and they didn’t seem to want to believe that all I wanted was my babies. I didn’t need a life-changing experience.

So maybe my brother was right about power still not being where it belongs in childbirth.

Then there’s breastfeeding. Anyone who thinks a woman and baby should not breastfeed in public can just go away. That’s not what’s irking me today.

What I am more concerned about is the Baby Friendly Hospital initiative. The aim of the initiative is to encourage women to breastfeed their babies.

Here’s what it takes to be certified as a baby friendly hospital.

1 Have a written breastfeeding policy that is routinely communicated to all health care staff.
2 Train all health care staff in skills necessary to implement this policy.
3 Inform all pregnant women about the benefits and management of breastfeeding.
4 Help mothers initiate breastfeeding within one half-hour of birth.
5 Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6 Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7 Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.
8 Encourage breastfeeding on demand.
9 Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Nice, isn’t it. The trouble is, I think it’s a women and family unfriendly initiative. It prioritises the baby, as all costs, even when that baby is going to be living in the social context of a family.

7 – Rooming in looks very nice, but there’s a big problem with it. Although it is phrased as “allow”, in practice, it becomes, “mothers and babies must be kept together”. So a woman who has been through an exhausting delivery will nevertheless not be given any chance to sleep, because the nursing staff won’t help her to settle her baby, and won’t consider taking the baby into a nursery even just for a while, to allow the mother to sleep. The baby can always be brought back to the mother when it wakes, so there’s no lack of breastfeeding. However, it does take staff time to manage a nursery. So babies must stay with mothers, even at the cost of the mother’s exhaustion. This is a worse problem if the mother is heading home to other children. Unless she has a partner who has time off work, or family nearby, she will be required to look after those children too. So her brief time in hospital really is the last chance she will have to get a decent rest for weeks, if not months. And surely, that must have a bad effect on babies.

And I just don’t see how any hospital which encourages new mothers to leave after just two or three days could possibly be described as a “baby friendly” hospital. Breastfeeding is a learned skill. Some women and babies find it very, very easy, but others don’t, at all. They need help and support, especially in those early few days, when they are tired from the processes of giving birth and being born. By about day three, a new mother’s milk will be coming in, so she and her baby will be getting used to an entirely new process, but that’s almost exactly when hospitals kick mothers out the door. New mothers need to be able to stay in hospital, where they can rest, and where they can get help, for more than just a few days. To my mind, to deserve the title, “Baby Friendly”, a hospital needs to encourage women to stay for five or six or even more days after birth, if that’s what they need. And in order for that to happen, hospitals need to be properly funded. Otherwise the Baby Friendly Hospital initiative is just so much hot air.


6 responses to “Childbirth, breastfeeding, power and hypocrisy

  1. The reason we have less mortality in childbirth in the West than we used to is because of the rise in the standard of living. Yes obstetrics saves some women and babies but it’s not the overriding reason for the level of safety we have now. Things like adequate nutrition, clean water, adequate housing, good primary healthcare etc are the things that made the difference (and would make the difference in other parts of the world too).

  2. I agree. I’d imagine a lot of women end up with post natal depression in part because they have been led to believe that birth and breast feeding will be a wonderful transcendent natural experience and when they aren’t- that is their failure. To which I say as long as you and the baby are ok then everything is ok.

    I don’t like the sound of the so called Baby Friendly Policy. It is very difficult to speak against something with a name like that because if you do it implies you are “anti baby”and no one wants to be that.

    But I will bravely say as far as I’m concerned “my body, my choice” means a woman has a right not to breast feed if she doesn’t want to- for whatever reason. It should be a personal choice and a woman should not be subjected to bullying or emotional blackmail if she makes that choice.

  3. Thanks for this very interesting post Deborah. My midwife doesn’t seem to be pushing me much about “natural” birth, but we haven’t discussed the birth plan yet. My attitude is simply whatever is necessary, to deliver the baby healthy and keep me as healthy as possible too. I had been dreading the birth, but through asking a friend who is very open and had a child a little while ago I am learning a lot and feeling like maybe, just maybe, it is a process I can live through! 😉

    In regard to breastfeeding, I totally agree with the last commenter. The “breast is best” approach is just as judgemental towards women (and their bodies) as so many other parts of the pathway to motherhood which feminists criticise. I would prefer to breastfeed (I think!) but I hear that it can be painful, unpleasant, you get clogged milk ducts (ewww), and of course you have another life form sucking the sustenance from your body. So much of new motherhood seems to be wound up with breastfeeding that it must be very very difficult for mothers who are finding it hard. I fear that if I can’t breastfeed, or find it hard, or even resent doing it, then I’m going to feel awful about myself.

  4. My attitude is simply whatever is necessary, to deliver the baby healthy and keep me as healthy as possible too.

    Me too. But I got spitting mad when one midwife phaffed at me that I should be sitting still and watching the clouds go by. It showed a complete lack of understanding about who I was, and it was all tied up in the midwife’s idea of who I should be.

    As for breastfeeding – first time around it was a breeze for me, and second time, a nightmare, and we ended up bottle feeding. The girls weren’t poisoned by formula. But I felt so guilty and wretched about it, and as ‘though I was a failure. I blame the breast police for that. I only got over it when a friend of mine who was also unable to feed, despite trying her best, said “Yes, of course you feel guilty about it.” That normalised my ‘guilt’ for me, and I got over it, sort of.

    Best wishes. For most women, most of the time, all does go well, and there’s no reason that it shouldn’t for you and your baby.

  5. Why do English women have such a problem about normal birth and breastfeeding, when women have been doing this for over 1 million years. The other comments about women dying etc in the past are untrue as the other person commented. It has been improved nutrition, clean water, sanitation, better antenatal care that has improved outcomes.
    Read The Cry and the Covenant and you’ll understand more.
    Baby Friendly Initiative also includes teaching those who artificially feed mixing instructions.
    One has to only know some of the ingredients in formula to replicate DHA (long chain polyunsaturated fatty acids) and one might think twice about the commitment to breastfeeding. Only 1 in 100 can not produce enough milk, (ask Jordan!) but it is a learned new job and like any takes time and persistence.