It seems that everything in the parenting realm is up for debate, as differing opinions and standards may ultimately drive a wedge of fear between many mothers and mother’s intuition. “Recommendations” change with the season it seems, like the first introduction of solid food, and guidelines for car seat safety. The majority adapt to the changes and use them as a guide, even as a common ground among other mothers in social settings.
Photo copyright: Jennifer Canvasser
Why, then, when it comes to the health and well-being of the most fragile among us (babies born prematurely), does a lack of basic rights (especially for life-saving human milk) prevail? Statistically, it is clear that breastmilk is best. The American Academy of Pediatrics (AAP) advises that breast milk can help prevent or treat diseases such as necrotizing enterocolitis (almost 90% reduction, compared to formula1), gastrointestinal tract infections (64% reduction, and lasting two months post breastfeeding), and type 1 and 2 diabetes (30%; 40% reduction, respectively), to name a few, and that ”the potent benefits of human milk are such that all preterm infants should receive human milk”. Furthermore, per the AAP, “Lower rates of sepsis and NEC indicate that human milk contributes to the development of the preterm infant’s immature host defense.”2 Jane Morton, MD, FAAP states, “Unquestionably, breast milk is far superior to any formula designed for babies, and even more critical for the health of the premature baby.”3 Yet, the majority of hospitals (as much as 60%4) in the United States do not use donor milk, and many take it a step further by supplementing with conventional cow-based formula-fortifier, sometimes against the wishes of parents.
Barriers to human milk for those in NICU span beyond hospital regulation. Most insurance plans in the United States do not cover the costs associated with using donated breast milk (from a milk bank), which can be a hefty financial load to bare when already faced with medical expenses related to birth and the NICU. Few, if any, financial resources are available to parents in regards to donor milk. A lack of resources, support, and education can also be a deterrent for anyone when it comes to providing breast milk to NICU babies in particular. For example, not knowing how or where to donate milk; how or where to obtain pasteurized donor milk, or not being informed of the benefits of breast milk (especially breastfeeding) for premature babies.
A mother may experience a delay in lactation immediately following birth. Her supply may not easily increase (especially in an emergency situation, or a preterm birth) as it would if baby were directly breastfeeding on demand. New moms, especially in a critical situation, do not know how to breastfeed, nor how to pump. Providing resources, education, and assistance for mothers in a hospital setting will help both physically and emotionally for a mother to flourish in feeding her child. Hospital NICUs undeniably need to revamp lactation support policies, as well as provide a comfortable environment in which a mother can express milk or breastfeed.
Babies may be taken quickly from mother after birth (as in an emergency situation). It may be days before mom and baby are reunited, and possibly longer still before mom is able to touch or hold baby. During this time especially, support and education from the hospital itself is vital… for comforting mom, for preparing her and helping establish a milk supply, and for giving both mom and baby the freedom and ability to cuddle via skin-to-skin, bond, and thrive. Allowing as much skin-to-skin as possible leads to higher success of breastfeeding and/or pumping and provides numerous benefits to baby.5
Milk Banks typically provide monetary assistance for the shipment of milk from a donor to the bank. These organizations work with individuals to ensure that the process is stress and worry free. Donors are screened, and milk is pasteurized and cultured, to ensure the highest quality for fragile babies. The Human Milk Banking Association of North America provides a list of milk banks. Human Milk for Human Babies is an organization that provides informal breast milk donation, allowing mothers to connect personally. Milk donated exchanges hands directly between donor and recipient.
Jennifer Canvasser, founder of NEC Society, and mother of twins born prematurely, both of whom spent a length of time in the NICU at the University of Michigan Motts Hospital, knows firsthand the challenge of fighting for the right to human milk for babies. When faced with aversion, what can be done? With whatever energy a parent of a NICU infant has, Canvasser suggests, “Ask what are the policies around human milk for fragile babies? Do you have a program? Do you provide the infants with an exclusive human milk diet?”
Having an infant in a NICU is emotionally and physically demanding. Readily available resources for parents in regards to providing human milk for their baby (whether via mom or donor) could lessen some of the burden for parents. In addition, raising awareness of the need for human milk for fragile infants, sharing stories and experiences publicly, and working with healthcare professionals and administrations can be a start to ensuring the basic rights of those born prematurely: a safe environment, access to proper nutrition, and a fighting chance!
Organizations such as NEC Society and Best for Babes, along with recent documentary “The Milky Way” are actively doing just that. Says Canvasser of NEC Society’s current mission, “Our focus is on changing practices and reducing the incidence of necrotizing enterocolitis. We strive to empower NICU families and create real change in NICU practices that will better protect fragile babies. The first step is awareness and empowering families.”
How can an individual help to raise awareness? Simply put: talk. Discuss openly the benefits of breastmilk (especially for infants born prematurely) to friends and family, speak with the local hospital about policy, reach out to local media about possibly covering the story, meet with healthcare professionals to ensure accurate information is being spread and used, advocate on behalf of someone who’s experienced a loss as a result, or is currently in the midst of the battle. When emotionally ready, share with others. As the late Maya Angelou asserted, “There is no greater agony than bearing an untold story inside you.”
Human milk nourishes, protects, and heals. Every baby, regardless of circumstance, deserves the right to thrive.
1 “Necrotizing Entercolitis Risk”. US National Library of Medicine National Institutes of Health. NCBI. April 2012. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357630/>
2 “Breastfeeding and the Use of Human Milk”. Pediatrics. Vol. 129. pp. e827-e841. Official Journal of the American Academy of Pediatrics. 27 Feb 2012/1 March 2012. Web. <http://pediatrics.aappublications.org/content/129/3/e827.full#content-block>
3 “AAP Policy on Breastfeeding and the Use of Human Milk”. Breastfeeding Initiatives. 28 May 2014. American Academy of Pediatrics. Web. <http://www2.aap.org/breastfeeding/policyonbreastfeedinganduseofhumanmilk.html>
4 “Fast Facts: Miracle Milk”. NEC Society. 06 May 2014. Web. <http://necsociety.org/>
5 “Holding your baby close: Kangaroo Care”. March of Dimes. Web. 2014. <http://www.marchofdimes.com/baby/holding-your-baby-close-kangaroo-care.aspx>
On September 20, 2012, the groundbreaking documentary, Freedom For Birth, by film makers Toni Harman and Alex Wakeford, was shown in over 1000 screenings and over 50 countries around the world. I hosted a screening in Raleigh, NC, and while we only had six people attend, I cannot adequately express my excitement at being part of this larger movement to benefit birthing mothers and their attendants. But under the excitement is a call to action based on the tragic state of birth in our world. Given all we know about physiological birth and the overall desire in our society to uphold the rights of the oppressed, it is unfathomable that mothers, infants, and birthing professionals are literally battling for what is arguably the most basic human rights to be free to give birth where, when, and with whom they choose. This is not a simple issue or a case of some minority complaining over a preference. It is a matter of a grave violation of human rights, human mothers and human infants, in perhaps the most vulnerable time of any human's life. I've seen a lot of blogs and articles speaking out for mothers' rights following the Freedom For Birth screening, but I feel like we've yet to really go far enough. I get the sense that women are afraid to be angry, as if we will be criticized (as we often are) for overreacting to the issue of how mothers and babies are disrespected and abused in birth. If there is one message coming through loud and clear through the work of the One World Birth team and their supporters, it's this: You are right to be angry! Procedures done to your body without your informed consent are abuse, no less real than someone punching you in the face! It's a violation of your rights as a human being! Just in case this seems too extreme, let's take a step back and examine the issue, based on facts, and you can draw your own conclusions. And that, my friends, is what we call an informed decision.
First, let's consider the phrase “human rights violations”. This might bring to mind Nazi Germany, Democratic Republic of Congo, and our own history of human slavery followed by the Jim Crow era. Now consider the phrase “I'm a doctor”. You might envision a plane crash or other emergency setting, a heroic individual rushing forward to lend assistance in the midst of panic and chaos. Our culture teaches us to categorize these two concepts very differently. Those who violate human rights are monsters, untrustworthy, cruel, serving a personal agenda at the expense of others. Those who serve as doctors are life-saving, quick-thinking under pressure, making difficult decisions while keeping their patient's health, well being, and best interests in mind. If you were to suggest combining these concepts, imply that a doctor might be capable of violating human rights, people start to shift in their seats, grumble, look away, or even become aggressively defensive. A doctor would never violate human rights. A doctor has sworn an oath to “first do no harm”. A doctor can be trusted. To imagine otherwise is frightening because there are times in life when we must hand ourselves, our lives, or the lives of loved ones over to doctors. There are times when the law requires us to involve a doctor, our families pressure us to seek assistance from a doctor, or we fear the outcome of not having a doctor present. What happens in these circumstances if the doctor can't be trusted?
This scenario is playing out all over the world for women in childbirth. I don't mean to demonize all doctors; there are some truly revolutionary, brave, amazing doctors in our world on the front lines for women's rights in childbirth. But... there are many more, some working out of ignorance, some out of malice, who have taken part in a global effort to control birth for their own convenience or out of fear. While it is human nature to fear things we don't understand, it is human failure to not try to understand the things we fear. And in this, our doctors have failed us.
To be fair, it isn't just doctors who are fault. Our culture supports an ideology of fear, ignorance, and lack of faith in female physiology, all tied into a history of misogyny. If we're honest, women's rights have been violated for time immemorial. We have struggled for equality, for representation, for education, for security, for safety. We have sought to balance our feminine nature and instincts with a need to be free of social/cultural pigeonholing. We've come to expect a fight by virtue of being female, and society delivers. When you put this in the context of birth and becoming a mother, it becomes clear why the freedom of informed choice in birth is really about human rights and in particular women's rights. We've been numb to the rights of birthing mothers for far too long. It's time we call it like it is, acknowledge the human rights violations that have become normalized in our society and around the world, and then... do something to change the status quo and take back birth!
Just how bad are the violations I'm talking about? Let's look at some basic facts. Currently, the national average for c-section delivery is 32.9%.1 When you look at the rates by individual state, you get an idea of just how influential one's location alone can be on the chances of having a c-section. Did you catch that? Location! Not health, not emergency need, not because it's the best thing for the mother or baby. Just by virtue of where you live and what the trends are in your area. Who decides these rates? What criteria are used to determine these rates? Are women in one state that much less capable or less healthy in giving birth vaginally than in another state? If you can't answer these questions for where you live, call your local hospitals and OB-Gyn offices and see if they can.
C-sections are so normalized in our society that a lot of people don't find the current rates that problematic. Maybe they see these numbers as an indication of a real need. So let's look at some other troubling facts, such as vaginal exams being performed without consent while a patient is under anesthesia, rates of interventions in labor, maternal and infant mortality rates, and of course there are barbaric practices like the husband's knot2 (still in use!), which as its name implies is definitely NOT for the benefit of the woman. When you consider the prevalence of these procedures and statistics in a society so proud of its medical advances, you might begin to question the necessity and safety of a lot of our common medical practices, particularly in obstetrics.
So if a mother does question certain common procedures, if she decides that birth is not a disease in need of curing, if she chooses to follow her instincts and engage birth as a process her body inherently knows and her baby actively participates in with her, how is she received? What are her options? What are her rights? Sadly, a woman's right to give birth as she chooses, where she chooses, and with whom she chooses is extremely limited, especially in the US. This has not always been the case, and in fact the history of modern gynecology/obstetrics and how birth was stolen from women warrants its own article (in the mean time, check out pretty much anything by Sheila Kitzinger).
One of the options women have exercised for millennia is home birth, an option that is currently under attack around the world. Part of the focus of Freedom For Birth was the case of Agnes Gereb, a midwife who is currently under house arrest in Hungary for attending women giving birth at home. This hits especially close to home for me. In my state of North Carolina, while it is technically not illegal to give birth at home, women have a hard time finding adequate support to do so. Our CNMs (certified nurse midwives) are required to work with an OB and deliver at the hospital. Our CPMs (certified professional midwives) have gone underground or stopped practicing following recent events. Providing licensure for CPMs in NC would offer them a legal way to practice their calling and offer mothers the assurance that their birth professionals really know what they are doing and have some level of legal accountability. Instead, our state has chosen to attack home birth as dangerous in general and apply the threat of legal action for those assisting women at home. This does make home birth dangerous. Desperate mothers will either try to birth at home without professional support, or they will seek the help of someone with questionable credentials.
Luckily, the argument against the safety of home birth is being negated by study after study in recent years (here's a very recent one). More importantly, women are waking up and demanding the option to birth at home, not just because they prefer it or are crunchy granola hippies (nothing against crunchy granola hippies; I'm fairly crunchy myself), but because they've done their homework, understand what their bodies are capable of and don't fear birth, and because they are tired of having this decision taken away from them. This is obvious by recent events such as Where's My Midwife rallies, The National Rally for Change put on by ImprovingBirth.org, and the Freedom for Birth screenings. These are all positive steps in the right direction that generate media attention and start conversations to bring about real change and education. But there are still too many women in the world suffering trauma, abuse, and even death (themselves, their babies, or both) to drop our guard and proclaim victory.
I'm so proud and grateful to have had the opportunity to participate in the Freedom For Birth screening event. I'm honored to know Toni and Alex personally (see my article about their visit to Raleigh in November 2011). I'm humbled by the passion and energy I'm witnessing in the birthing community, among moms, and growing within the medical profession as more OBs partner with midwives, push for the rights of their patients, and just listen to the cry for support and freedom that is growing louder as we connect human to human. Again, this is a fantastic beginning, but we have a long way to go. You can be a part of this movement for change and help reclaim birth for women all over the world. You can help create a world where women can birth safely where they feel safest, whether that is at home or in the hospital, where interventions occur to save lives and not to get a doctor home in time for dinner, where c-sections are performed in times of real need, hand in hand with a genuine respect for the female body, and trust in the process that affects every single human on this planet. You can help educate women and doctors alike to stop fearing birth. You can help create freedom for birth!
2In her book, Essential Exercises for the Childbearing Year, Elizabeth Noble has this to say about this procedure: “This 'knot,' which is actually an extra stitch or two, does not restore any PF [pelvic floor] function for the woman; it merely makes the vaginal entrance a little tighter. The name is significant since it reveals not only a sexist bias but implies that the female vagina is quite passive and therefore improvements need to be structural instead of functional. The women's needs, as the name indicates, are totally secondary! Sometimes an actual tuck is taken as the birth canal outlet is sewn up 'as tight as a virgin' after an episiotomy...This can cause pain to the woman during sexual penetration.”
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