Normally, pain is a sign that something is wrong, or out of the norm. A woman experiences sudden chest pain and severe shortness of breath. Something is wrong. Another woman trips and falls. She catches herself with her hand on the ground in front of her. A intense pain in her wrist tells her something is wrong.
A woman goes into labor. As it progresses, she no longer feels a tightening in her abdomen -- she feels pain with the contraction. Something is NOT wrong. Pain is an indication that labor is progressing. However, in many cases, labor and birth does not have to hurt as much as can.
The amount of pain a woman feels during labor and at the time of birth is based on many factors: position and size of the baby; the woman's own position at the time; fear and anxiety; uncomfortable procedures; restriction in movement and comfort options; lack of loving companionship; lack of empathetic care; length of labor; hunger; the use of pain relief medications; and so on.
Again, for many women, birth does not have to hurt as much as it can. When women are free to move around, have knowledgeable labor support, experience loving support from the baby's father and other family and friends, uses comfort measures including massage, aroma therapy, warm water baths or showers, peaceful environment, and more, the pain is typically not as intense. Labor is usually shorter than it would have been otherwise, and outcomes are better. There is less need for Pitocin (which causes very painful contractions), amniotomy (artificially breaking the "bag of water"), and operative deliveries like forceps, vacuum extraction, and C-section -- all of which carries increased health risks -- some very serious -- to the mother and baby.
Dr. Robert Bradley was a physician who developed one of the three most popular approaches to childbirth in the last century. He believed relaxation was the key to dealing with the discomfort of labor. He also felt husbands (as was typically the case at that point of our history as a country) played an important role in providing physical and emotional support for laboring women. Dr. Bradley was on a good track, but not quite on the right one.
You see, is was women, and not husbands, who took the role of labor support for thousands of years. Fathers provided emotional support, if they were part of the birth at all. Fathers sometimes became midwives in "emergency" birth (which really was birth that was going very well in most cases).
While loving husbands bring some security and support to women during birth, they only begin to bring the nurturing care women can bring. Also, men typically are way out of their comfort zone, no matter how many classes they have attended -- especially with a first birth experience. The stress on them can be enormous, making the experience less enjoyable.
Yes, I hear you. "If I am not enjoying it, then he shouldn't enjoy it either!". But wouldn't you want to have a birth experience in which your support team increased your confidence in your ability to give birth? Wouldn't you want an labor which is not a painful as what many women experience in a fully medicalized approach? Wouldn't you want an experience that, when it was over, you rejoiced in it instead of being traumatized or left feeling unfulfilled?
A man who has no background with birth, other than a childbirth and a breastfeeding class, does not have, in most cases, the confidence required to serve as a advocate for the mother in all situations.
"What if I'm wrong?" "Do I remember this correctly?" "Is this a unique situation?" "Will I be putting her in danger if I stand up for her birth plan in this instance?" "The doctor is saying this; he is supposed to know. Who am I to question?" These and other questions can quickly come to the Dad's mind and affect his ability to support the mother's choices.
A doula, however, is very aware of the research, of the scare tactics, and of the options. When pressure is put on the mother to accept an intervention when it's necessity is truly in question, a doula can educate the parents about the situation and options. She can offer alternatives. She can suggest how to word answers or questions when communicating with a care provider. She imparts the confidence and knowledge and skills required to avoid unnecessary interventions which can lead to undesired outcomes.
As a result of the Fall of Man, recorded in Genesis 3, women across the globe and over millennia have suffered oppression, abuse, and pain in childbirth. Still, God has provided ways to minimize the pain and optimize the experience. (By the way, the oppression and abuse women have endured since that time was NOT the original plan. One day, a world will exist where women will enjoy the intended position of respect --see "The Big Picture" page if you want to know more).
As we understand the natural, God designed, process more and more, and as we support that process, the rate of complications, and even the amount of pain can be lessened significantly in most cases.
Enter the doula. A doula understands the principles which promote natural childbirth in ways more comfortable to the mother. This professional birth companion is a knowledgeable, supportive, and caring resource for both mom and dad. She does not take dad's place. She takes stress off of the dad so he can participate with more confidence and less worry.
She provides a wealth of knowledge and expertise to facilitate the normal progress of labor and to decrease the amount of pain the mother would have otherwise. She helps women cope with labor. She supports the mother's right to objective, complete information. She will fight to the death for the mother's right to make informed decisions. She does not direct how the labor will be handled, she provides the information and tools and support so the mother can make these decision and benefit from natural pain control/coping methods.
I love my husband and I know he loves me. He endured three childbirth classes and three labors. Doulas were not available at the time in my area. Now that I understand and appreciate what doulas offer, I wish we could have had one. He would have enjoyed these three special experiences much more. His memories of them would be more precious. As for me, I have no doubt I would not be dealing with health issues from interventions I could likely have avoided if there had been today's doula supporting me.
Even though I was not blessed to have a doula, I have been blessed to serve as one for some of my class members and for one of my daughters in law over the years. After my first grandchild was born, my son said, "Mom, you are really good at this! You should think about doing this for a living." I had to laugh at this because I had been making part of my living over the years as a childbirth educator, lactation consultant, and on occasion, as a doula. He was ready "to do it again". He was just enjoying the "high" of witnessing the birth of his first child and forgot the years he lived with childbirth charts in his closet, or his mom counseling with pregnant and new mothers over the phone and at the stores.
With this birth, he participated as much as he was able, with loving caresses and slow dancing. He had hurt his back and was not able to do many of the counter pressure techniques, etc. This is another benefit to having a doula. If dad has an injury or health issue, the doula can assume more of the "heavy" support. My son's exuberance was just a confirmation of how the services of a doula enhances the experience for the mother AND the father.
Some women think that the L & D nurse can serve as a doula. Unfortunately, this does not work like many women anticipate. L & D nurses have many obligation beyond providing comfort measures for their patients. They often have to step away to attend to a myriad of responsibilities. A doula is WITH the mother at all times, stepping away only for brief, necessary breaks. All certified doulas have the necessary skils and knowledge to promote normal birth. Not all L&D nurses are trained this way. Many only know medical management with a few comfort technques. The nurse can assist only as time allows, even if she does have doula training.
So, if you are pregnant, or planning on having a baby, one of the most important things on your list is not all the designer baby gear which will get little use, but a doula. Below are some ideas on how to afford one.
If you still are not certain, think about the financial costs related to having a C-section, both in the hospital and while you are recovering. Your co-pay will be higher with most insurance companies, and will offset most, if not all of the services of a doula. Decreasing the risk of a C-section by having a doula makes financial sense.
There are other costs to mom's and baby's health which can occur with side effects of many unnecessary medical interventions. Having a doula to help protect health outcomes for mom and baby makes health sense. Enhancing the birth experience for mom and dad makes total sense.
Consider locating "birth circles" in you area. Visit them while you are pregnant. Listen to the birth stories. You will learn so much about how to avoid common problems. You will also learn how to increase the likelihood of a safe and positive experience. Doulas are good resources for locating birth circles.
With a doula, you will have someone there to advocate for your birth plan, and to help you during that first, extremely important breastfeeding.
To read about the research evidence related to doulas, click here: http://evidencebasedbirth.com/the-evidence-for-doulas/
Please listen to this old, and hopefully "birth wise", woman who has been there, done that, seen that, studied that, experienced that, and who has "that" as part of her life's work: find a doula. You will not regret it. To locate a doula in your area, click http://dona.org/
Note: In a recent Comfort Measures class, a mom who had taken the childbirth class told me she now had a doula. Dad's big smile and nod of his head told me he was relieved. They had practiced a wide variety of positions, massages, and counter pressure techniques in the class. They will be going through labor "together", but with the knowledgeable support of a doula.
One of the most frequent questions I am asked in my childbirth classes is about delayed cord clamping.
If we go back to the "normal" and "natural", perhaps the question should be about early cord clamping. Before physicians started clamping the cord almost immediately after delivery as part of their routine procedures, the cord would simply stop pulsating a couple of minutes after delivery.
Dr. Nicholas Fogelson presented a grand rounds on this topic and did a great job, in my opinion.
The conclusions?
Early cord clamping robs the baby of about 40% of the blood s/he would have received if it were delayed until the cord stops pulsing.
Clamping at about a minute gives the baby about one-half of the 40%.
Delayed cord clamping improved the amount of iron stores in the baby's body. This decreases the chance of iron deficiency anemia in breast fed babies and babies on formula not fortified by iron. Remember that iron in breast milk is better absorbed than similar amounts in formula. This is why formula has larger amounts of iron - - and this can lead to an increase in G.I. related illnesses.
Iron is important in the development of the myelin sheath (the insulation material around neurons). Good iron stores in infancy help with proper central nervous system development for the lifetime.
Delayed cord clamping in preterm babies born less than 32 weeks gestation decreased their risk of intraventricular hemorrhage -- especially Grade 2 -- and late onset sepsis (brain bleeds and blood infections).
There was no increase in clinically significant jaundice, or polycythemia (overabundance of red blood cells) -- in other words, no more babies became sick from these issues than did early cord clamped babies.
As long as the baby's position was 20 centimeters or less in relation to the placenta, the blood transfer was about the same. Babies placed on mom's abdomen or at her side (if some stimulation or resuscitation procedures which could be done while the baby is connected to the cord needs to be done) are well within this 20 cms above or below the placenta.
Small babies seem to benefit more from delayed cord clamping.
Babies continue to receive oxygen via the cord as they begin to breathe. There is no rush for baby to breathe quickly. The transition is easier. Slow to get started babies are supported by the oxygen coming through the umbilical cord. This may decrease the effects of an insult to the brain, etc.
Babies receive their full supply of umbilical cord stem cells. It is thought that some of these can grow into cells to replace damaged cells of various types in the babies body. This benefit could be life long.
Dr. Fogelson made some good points. "Why rob the baby of 40% of it's blood supply unnecessarily?" "The burden of proof is on the intervention versus the natural" (paraphrased). "Why phlebotimize the baby of 40% of it's blood supply? (i.e. a MAJOR blood draw or "blood letting" as it was known hundreds and thousands of years ago).
He also shows videos of animal births and the type of attention paid to the cord immediately post birth. He does discuss the "evolution" to delayed cord clamping. Going from better to less beneficial is arguably not "evolution". Again, God's design is perfect.
Click on the following to hear the entire grand round presentation. Also, Penny Simkin has a nice visual demonstration.
Grand Rounds Part 1
Grand Rounds Part 2
Grand Rounds Part 3
Grand Rounds Part 4
More and more physicians and midwives are allowing the cord to stop pulsating before clamping. Talk with your physician or midwife about this topic. This is something you would probably want noted on your birth plan.
I read this story online a couple of weeks ago. I have been a little surprised as to its effect on me. I found myself wishing I could have one more birth experience and handle it like this one. I have even dreamed about it one night.
Bear with me. There are some important points I feel I should make before providing the link to Sarah's story. Of course, you can scroll down and watch it right away, but I hope you will read and consider what I have written before you read her story.
So many women in our culture question their ability to give birth even with the help of a team of care providers, medical equipment, and all manner of procedures meant to control negative outcomes.
This birth story will, I hope, encourage women to trust the God-designed birth process. Yes, there is a place for OB intervention if a complication should arise. However, there is a large body of evidence that many routine "preventative" procedures actually interfere with normal birth and increase the rate of operative deliveries, health issues with mothers and babies, and breastfeeding failure.
The body of research supports the following with regard to optimal health for mother and baby during and after normal, natural childbirth:
- mother goes into labor naturally
- mother labors and births in the place where she feels the most safe (this can be home, at a birth center, or at a hospital -- or combination of these)
- there is no medication of any kind and for any purpose put into the mother's system
- she eats and drinks as she desires to be able to accomplish the intense demand on her body
- she utilizes a variety of positions for comfort; she is supported by someone who is knowledgeable about labor and birth (doula), and who has a "heart" for mothers and babies
- no medical procedure is done unless it is based on the research evidence and the benefits outweigh the risks in each unique labor or birth situation
- nothing is done because of the care provider's time constraints or preferences -- the mother and baby's needs come first ALWAYS
- the mother is cared for by a competent midwife (studies indicate certified nurse midwives as the primary choice here) or a physician who is knowledgeable about and comfortable with the natural birth process
- there is an obstetrician willing to take care of the mother when any indication that the birth is not progressing normally; mother and baby have quick access to stepped-up care.
- baby is born via the birth canal and is immediately placed on mom's abdomen (by care provider or the mother herself)
- no hat is placed on baby's head (this does NOTHING for a baby kept in contact with his mother and just gets in the way of the mother smelling and touching ALL of her baby)
- no suctioning of the mouth or nose occurs unless is become clear the infant can not handle its mucous. This takes at least one minute to determine.
- the cord is not cut until it stops pulsating -- or for least 3 three minutes
- baby is allowed to complete the steps which result in self attachment to mom's breast
- baby is allowed to breastfeed until he or she goes to sleep
- mother and baby are allowed to remain together -- under the watchful eye of an alert, attentive adult -- for the first nap and for as much of the first few days as mom desires
- baby's first bath is delayed for at least 8 hours, if not longer
- a vitamin K injection is not given immediately (wait until after the first breastfeeding), and is given while the baby is nursing (a comfort measure)
- all other normal newborn procedures are delayed until the infant has completed its first breastfeeding
- no newborn procedures are done until the parents have been informed of the pros and cons for their unique situation, and are based on best practices based on the body of research
- no artificial nipples, liquids, or baby milk is given to the newborn; baby receives nothing but his own mother's colostrum and colostrum/mature milk mix for two weeks
- baby is breastfed exclusively for six months; and finally, baby is breastfed for as long and mom and baby desire as solid foods are incorporated into the baby's diet.
Again, research supports each of these components of an "optimal" birth. However, we do not live in an "optimal" world. Problems can, and do arise, which require medical intervention. Sometimes the problem is brought on by common physician and hospital practices.
Still, some women in our culture are able to plan and experience this type of birth. These women have taken the time to learn about the pros and cons of various approaches to childbirth. They understand the "cascade" of interventions". They have become educated about different options they have as health care consumers. They have discovered a place of delivery and a support team which will allow this approach to birth. Most importantly, there were no complications occurring in labor which required meds or other interventions. The mother has tools and support she needs to manage pain without requiring medication, unless the she escalates from coping to suffering.
Many women are afraid of the pain of labor and do not have the knowledge and support necessary to cope with intense contractions. Some medical procedures and policies actually lead to increased discomfort and slower labor progress. The natural comfort techniques which have been shown to be very effective in coping with pain are not always suggested or available. Pain medication, including the use of epidurals, is the often the first, instead of last, resort to cope with pain.
In many hospitals today, there are government required surveys which are the basis for financial reimbursement. If patients do not give high ratings in all areas of the survey, the amount of payment to the hospital is reduced. One common question is something like "Was your pain always managed well"
This should be true in all areas of a hospital EXCEPT labor and delivery. Why? Because some mothers do not want their pain managed by epidurals or systemic medications. The mothers can't rate the hospital with a high score because the pain is part of the normal labor process. A better question would be "Was pain managed to the level you desired?".
Why does this matter? Because labor and delivery nurses, like nurses on all other units, have to try to eliminate pain for their patients. This is one reason so many ask the mother what her pain level is -- and ask it so often during labor. They usually suggest something for pain -- often an epidural. Laboring women are tempted to accept, even if this was not their original goal. When women are able to deal with their pain via natural methods and support, and are not tempted (or badgered in some cases) with pharmacological pain relief, they often will opt to avoid, or at least minimize the amount of medication they receive.
Because of direct and indirect education, and because of direct or indirect pressure during labor, many women doubt their bodies' ability to give birth without the need for medical intervention -- including medications as the tool for coping with pain.
In the "optimal" world, the health care system would provide enough trained nurses, midwives, physicians, and yes, doulas, to offer a "low-tech" birth to healthy, low-risk, mothers and babies in a variety of safe birth environments. There would be no governmental expectations which would influence pain control in labor an delivery. The health care team would be able to shift, as needed, to intervene when birth is not normal. They could also shift according to the mothers' desires for interventions -- once she has given informed consent.
I wish more women could become more confident in the way their bodies have been designed to give birth. If they understand this amazing process, if they had quiet, capable support, and if they knew medical help was available IF it was needed, I think the C-section rates would drop and the exclusive breastfeeding rates at three and six months would rise significantly.
The medical system can do so much more to improve birth and breastfeeding experiences for mothers and babies. The knowledge and technology for the critical cases is there. What is missing is understanding of and the ability to truly support the normal birth process.
The only exposure many women have to birth are stories and/or videos of "complicated" births, or births which were handled like a medical event which requires a lot of intervention. I hope that Sarah Nannan's birth story will help calm fears and dissipate uncertainty.
Even thought we live in an uncertain world, we have a God Who designed an amazingly detailed, yet very functional way to deliver and protect our babies.
I am NOT saying that all women should give birth like Sarah did. I just want women to see that God made us strong and capable to give birth without any help at all -- other than confidence in His love and sovereignty. When help is needed, we can be grateful it is available.
Knowing God made us capable can encourage women who, like Sarah, give birth WITH a supportive health care team in attendance.
Confidence is one's ability to give birth goes a long way in achieving that outcome. Christian women have reassurance that a sovereign, wise, and loving God is in control.
Sarah's story is enhanced by a photo slide show of her remarkable birth, so decide if you want to scroll past or not. I personally found it beautiful, but I am used to seeing birth and birth images.
Learn from Sarah how a woman can accept and rejoice over the birth process. Even though she does not reference Him, you can still marvel at how wise and loving is our God. Grab a tissue because your emotions may surge -- especially when you learn, as Paul Harvey would say, "the rest of the story". Once you have seen it, I would not be surprised that prayers for Sarah and her precious children ascend on their behalf.
Sarah, thank you for sharing your story with all of us.
http://www.improvingbirth.org/2014/03/sarah/
As a childbirth educator and lactation consultant, I often learn about the newer issues in maternal child health care long before the changes are made in the local hospitals. I also have seen that sometimes the changes are made because the parents/patient has become informed and begin to request or decline certain procedures. While I can talk about these things with class members, it is each parent in the class who must do more research, make the decision, and make that decision clear with the physician or midwife, and with the nurse caring for the mother and baby. Just because something is "hospital policy", it does not trump a mother's right as both a parent and health care consumer. Dad's, too, have a voice and an important role in the type of care his child receives.
Technology is allowing us to understand more and more that natural, God-designed, birth and breastfeeding processes. We are learning that little things, like the length of time it takes for Wharton's jelly on the umbilical cord to swell and stop the flow of blood through it has a reason. Vernix, the "cold cream" material on the baby's skin is there for a reason. Newborn vitamin K levels are low FOR A REASON. Colostrum has the nutrients and components it has FOR A REASON.
Expectant parents should do their own investigation into may common restrictions and procedures which are placed on the mother and newborn. The health of each, including lifelong health issues, can be affected.
A recent research literature review SUPPORTS the use if Vitamin K injections in order to prevent rare cases of internal hemorrhaging, including the brain. Vit. K has shown to virtually eliminate the risk of a clotting disorder. However, the shot can be delayed until after the baby had finished its first breastfeeding. It can be given when baby is nursing during another breastfeeding to lessen the pain.
Here is a link to an article which briefly addresses some of the questionable newborn procedures. From here, you may want to do more investigation.
http://blindedbythelightt.blogspot.se/2012/10/newborn-procedures-to-reconsider.html?m=1
I have been doing some research on the effects of physicians offices and hospitals marketing infant formula. One thing which keeps popping up is the claim that DHA and AA added to formula improves the infant's brain function and eye development.
The studies are deemed, in many cases, to be "inconclusive" when reviewed as a body of research. It appears that the studies which support the premise tend to be funded by the formula companies.
In my reading, I have come across statements which researcher or women themselves point out that it is easy for consumers to think that the formula with DHA and AA will be as good as breast milk in the area of mental and eye development. Always remember: the ultimate goal of the formula business is to make profit. Their literature and labels support this goal.
The Cornucopia Institute has compiled quite a bit of information about this topic. I highly recommended women who are considering how to feed their babies, who are feeding formula, and who are buying other products containing DHA and AA (ARA) read their materials.
Here is a video clip by Cornucopia: DHA and AA in Formula
Click here to visit Cornucopia's web site.
If breastfeeding is not possible, or if mom chooses formula feeding, know that the FDA has established strict guidelines concerning minimal standards for nutritional content, processing, packaging, etc. Prominently marketed formulas with DHA and AA (ARA) additives cost about 15% more than standard formulas. With these additives in question, parents can save a significant amount of money using the less expensive, but FDA acceptable brands.
The best thing to do if you are unsure which formula to use, or if you should buy yogurt and other foods claiming they will support you or your child's "brain health", is to use the brain you have to do some research, and then decide if you feel the claimed benefits outweigh the suspected risks.
Oh, by the way. The DHA and AA in "God's formula" -- breastmilk -- has been shown to optimize baby's brain development. The longer the baby is breastfeed, the greater the effect. Mom's body, and not algae or fungus, is the source of natural DHA and AA. Best of all, it's free.
Until the age of formula, when a woman could nor or chose not to breastfeed, she would employ a wet nurse, or a family member who was lactating would feed the baby. In some cases, the wet nurses were slaves.
Below is a photo of a slave feeding a white baby. Slavery breaks my heart. Even more so, many slaves were not allowed to nurse their own children when they were nursing their owner's babies. and had to find wet nurses for their own babies.
Today, we have pasteurized milk banks where hospitals caring for preterm babies can procure milk for them. I attended a seminar on the topic a few years ago and learned that in one case, where the mother died around the time of childbirth, the insurance company paid for pasteurized breast milk for the first year of her baby's life.
Just a few weeks ago -- although I have not confirmed it -- I heard first of all that Prince William and Princess Kate were giving Prince George pasteurized milk. I wondered why. Then I heard later that Kate is pregnant again. Again, I have not tried to confirm this. However, if what I've heard is true, this could explain why they are purchasing PHM (pasteurized human milk). I do know that Prince William is a strong believer in organic foods, so continuing to give his baby HM via a milk bank would be his "natural" choice.
This source of milk is costly. It also tends to be reserved for use by sick and preterm babies still in the hospital. However, the future King of England probably deserves special consideration. They know that they would prefer a healthier and more intelligent King than you might have if Prince George were to be formula fed. The royal family does have enough funds to purchase PHM, which in America, currently costs about $5 an ounce, including shipping.
But what about women who strongly believe that babies deserve HM, even when mothers can't breastfeed? Well, there is an online resource for "milk sharing" It can be found at https://www.facebook.com/hm4hb
Their web page is www.HM4HB.net
Clearly, this a controversial topic. One study was done which seemed to discourage it, but then a rebuttal was written by a physician who has expertise in breastfeeding. She pointed out flaws in the study. You an read her response on this blog. Just click here.
At this point, I am not going to advocate for milk sharing. I WILL advocate for a mother to research her options and then decide what she thinks is best for her baby.
Human Milk for Human Babies is a global organization, started in 2010. It is set up so women can find donor milk in their communities, which sometimes means state. Mothers post a need, and someone who lives in their community or state, or as close by as possible can contact the mother and arrange transfer of the milk. The only cost is for shipping. The milk is donated.
Trust is a big factor. The receiving mother must trust that the donating mother is in good health. She must trust that the milk has been stored properly and shipped properly. A certain level of risk is involved. However, women who desire to donate unused breast milk tend to do so out of a belief that what they are doing is going to help another baby. Rare would be the case where a mother would knowingly send milk if she is aware of any reason her milk might cause harm. There could be a situation where she has an undiagnosed rare condition where her milk should not be given. (See "When Breast is Not Best" on this blog).
Still, some women weigh the risks of formula feeding and the risks of the "modern wet nurse" of milk sharing and decide human milk from a source they consider to be safe is preferable to formula.
I have no doubt, however, that at some point the government will get involved, possibly from pressure from formula companies, and this option will become regulated or illegal.
Anyway, while it is still around in its current form, it is a relatively simple option for some mothers.
CVS Caremark announced today that it will stop selling cigarettes at its pharmacies.
"Ending the sale of cigarettes and tobacco products at CVS/pharmacy is
the right thing for us to do for our customers and our company to help
people on their path to better health," said Larry J. Merlo, President and CEO, CVS Caremark. "Put simply, the sale of tobacco products is inconsistent with our purpose."
What if the offices of physicians (obstetricians, perinatologists, and family practitioners) who serve pregnant women would announce something similar? Obviously, physician offices don't promote tobacco products. But, many do promote a product with known risks to the health of the baby and the mother.
What if they said "Ending the distribution of formula company marketing material, including free formula at our office is the right thing for us to do for our patients to help them on their path to better health, and on the path for better health for their babies. Simply put, the distribution of formula company marketing materials is inconsistent with our purpose."?
Merlo, with CVS Caremark, continues: "As the delivery of health care evolves with an
emphasis on better health outcomes, reducing chronic disease and
controlling costs, CVS Caremark is playing an expanded role in providing
care through our pharmacists and nurse practitioners. The significant
action we're taking today by removing tobacco products from our retail
shelves further distinguishes us in how we are serving our patients,
clients and health care providers and better positions us for continued
growth in the evolving health care marketplace."
Could perinatal physicians say "As the delivery of health care evolves with an emphasis on better health outcome, reducing chronic disease and controlling costs, our office is playing an expanded role in providing care through our staff and associate professionals. The significant action we're taking today by removing formula company marketing materials from our closets, waiting rooms, patient rooms, and office decor further distinguishes how we are serving out patients."?
The CVS Caremark press release goes on to state " Smoking is the leading cause of premature disease and death in the United States
with more than 480,000 deaths annually. While the prevalence of
cigarette smoking has decreased from approximately 42 percent of adults
in 1965 to 18 percent today, the rate of reduction in smoking prevalence
has stalled in the past decade. More interventions, such as reducing
the availability of cigarettes, are needed."
Formula feeding causes approximately (only) 900 infant deaths per year in the US. However, its effect on the health of US citizens over the lifespan is much greater. It has been shown that weaker immune systems, propensity to diabetes, asthma, G.I illness, certain cancers, and so on are caused by formula feeding. Women who do not choose to breastfeed are more likely to suffer from breast, ovarian, and uterine cancer . . . all potentially lethal. All illnesses resulting from not feeding babies breast milk cause an enormous financial strain on the health care system to the tune of billions of dollars per year. The pressure that a sick baby or child puts on families is felt more readily than that which comes from cigarette smoking. Tobacco related illness typically take years to develop.
Perhaps, most significant of all, is the effect of formula on the developing brain of the child. While formula fed babies are not at risk of becoming the village idiot, studies show an lower IQ by an average of 8 points. This means the child will not reach its full potential. Of course people will say, "I was formula fed and I'm just fine". But, wouldn't we all like our IQ to be 8 or so points higher? The potential for solving issues or improving life for society is lessened with the loss of brain power multiplied over and over. Effects on the lives of each child and on society in general can be significant, both socially and financially.
CVS Caremark has made a statement by their action. In essence, they are saying "We are here to promote optimal health care. One thing we can do is to stop 'endorsing' a product, which is known to be detrimental on the health of our customers, by promoting it or making it available."
CVS Caremark customers already know the serious health risks associated with tobacco use. There has been campaign after campaign over the years by governmental and organization sources to educate against those dangers. Yes, smoking does have benefits. It calms the addicted smoker. It gives kids a sense of maturity and self confidence when they do something "adult", like smoking. It provides for taxes for the government. It provides profits so tobacco companies can contribute to campaigns of politicians who will protect and support their industry. These reasons, however, do not excuse a health care business in promoting the product by simply having it available.
Physicians and hospitals also have a responsibility for health promotion. Yes, formula has it benefits. If a mother truly can not breastfeed (rare) and if breast milk is not available to give to that baby, formula will keep it alive. (Note: most cases of "can't breastfeed" are due to mismanagement of labor, birth, and/or early days of breastfeeding). Of course, some women will choose to formula feed for a variety of reasons. Their informed choice should be respected. But many women choose to formula feed just because their mother formula feed all of her children. They don't really know the pros and cons of their choices.
Formula can NEVER allow the mother or baby to enjoy OPTIMAL health. The components needed by the body for establishing incredibly complex systems necessary for life long optimal health are just not in formula. They are found only in human milk. Dr. Ruth Lawrence, an expert in human lactation states that formula provides basic nutrients and helps to stave off starvation, but predisposes to obesity.
The act of breastfeeding also affects the mother's systems and provide some protection against cancer, heart disease, osteoporosis, and other illnesses.
So, what can physician offices and hospitals do?
First, adhere to the guidelines from governmental and professional organizations on ways to promote, support, and protect breastfeeding. These in include the Centers for Disease control, the World Health Organization, the Office of the Surgeon General, the American Academy of Pediatricians (who, sadly have violated their 2012 policy statement), the Academy of Breastfeeding Medicine, and others.
1. Do not dispense formula company education materials as a resource for the mother to learn about breastfeeding. By doing so you are sending a message: " Formula is the standard. Formula is an equal choice for infant feeding. Breastfeeding may be a little better, but formula provides everything your baby needs. We are recommending it by having promotional material all around the office, and by giving you these materials, including free formula gift bags."
2. Remove any marketing materials from view. Evaluate office decor. Does it suggest support of bottle feeding or breastfeeding as the standard?
3. Ask each patient what she has heard about breast feeding and about formula. Do NOT just ask "Are you planning to breastfeed or bottle feed?" Talk with her about the risks of formula for her baby and of not breastfeeding for herself. Encourage her to breastfeed! There are studies that show the patients respond to physician's advice, including the advice to breastfeed. Encourage her to read a good book on breastfeeding. Refer her to a class. However, assure her that she is the one who knows her situation and that you will respect and support her informed feeding decision.
4. Tell the mother that colostrum is a special medicine that a mother makes specifically for HER baby. It sets up the immune and other systems in the baby's gut. Let her know that her baby will be able to handle formula better if she breastfeeds for two weeks, until the colostrum is no longer in her milk. Let her know she can talk with the lactation consultant at the hospital to learn how to wean comfortably when the mother is ready to start formula.
5. If her decision is not to breastfeed, tell her how she can save money by not using the most expensive formulas. Let her know that the 'new and improved, brain developing" (and more expensive) formulas have not been able to establish that their product does what it says it will do. Let her know the ingredients for brain growth in these formulas are not the same as what a mother makes for her baby.
6. Tell her that if pasteurized breast milk is available, it is preferable to formula, but if not, formula is better than plain milk from a cow, goat, or a plant.
7. Work with a lactation consultant. Have one on staff to assist with questions, education, or consults.
8. Because of the significance of breastfeeding, become more educated in this important area of health care. A great website to start with belongs to the Academy of Breastfeeding Medicine -- www.bfmed.org
9. . Adjust medical practice, if necessary, so that it is based on evidence. In addition to www.bfmed,org, a great website to check out is www.EvidenceBasedBirth.com .
Support more natural approaches to labor. Avoid interventions, when
possible, which might affect breastfeeding.
It is only in the human
medical system that birth is considered complete once the baby has been
delivered. In the animal world, birth is not complete until the newborn
has nursed. Encourage birth practices like skin to skin contact
immediately after both vaginal and c-section deliveries. Postpone
routine procedures until baby has latched and breastfed. C-section moms
and babies can often begin breastfeeding before the surgery is
completed. This is now becoming a "best practice".
10. Encourage the hospitals where you deliver babies to stop giving out formula company gift bags. Studies, overall, confirm that this results is more women giving up breastfeeding sooner than planned.
Removing formula company marketing materials from OB offices won't make the news like removing tobacco products from CVS Caremark. But it will serve to improve health outcomes for more patients. If all physicians did this, and all hospitals were more "Baby Friendly" and "Mother Friendly", the positive impact on the health of the nation could be even more significant.
