Community Midwife Situation This Is a Personal

¶ … Community Midwife Situation

This is a personal account based on my experience during a postnatal visit to a home where a new mother had given birth, in the town where I live. My own visit was because I was accompanying a midwife and observing the steps that the midwife takes. But while I was in the house I witnessed a situation with a young mother and a midwife that caused me considerable concern. This is a reflective account of that situation, and what should have been done, what could have been done, what are the correct steps a midwife should take to care for a primagravidae mother who is having problems getting her newborn girl to breastfeed -- all of those issues will be discussed and critiqued in this paper.

Home Births, Breastfeeding, Paperwork, and Priorities

Home Births: It is not a unique idea to give birth at home. I have always applauded women who preferred to have their babies in the comfort and shelter of their own homes. In fact I have done the research for this paper and according to the Centers for Disease Control and Prevention (CDC) website, the number of home births increased by 29% from the year 2004 to 2009 (MacDorman, et al., 2012). In 2009, there were 29,650 home births in the United States, and although that only represented 0.72% of all births in the U.S., and the great majority of home births are attended by midwives (just 5% of home births were attended by doctors (MacDorman, p. 3).

Why do many women prefer home births? I asked this question of the midwife I was with that day and she didn't have an answer other than to say that some women want to stay home and others want to be in a hospital in case there are complications with the birth. The CDC article points out that the percentage of home births that were "preterm" (early) was 6% and the percentage of births that were preterm in hospitals was 12% (MacDorman, p. 5). And the percentage of home births that had low birthweight was 4% compared with 8% for hospital births. My point here is there is a lower risk profile for home births, and so it is a wise decision for the pregnant woman to create a comfort zone for the delivery of her baby in her own home. I studied the statistics and the literature on home births and on breastfeeding prior to my visit.

Breastfeeding Problems: No sooner had we entered the home of the primagravidae mother than it was very obvious that this young, 22-year-old mother was struggling, trying to get her baby to breastfeed. She was in anguish. She was worn out because she said she had been up all night trying to get the infant to latch on to her breast. It wasn't working for her. I was empathetic to the point that I actually experienced her torment. This was all new to her and clearly she did not have the tutoring / mentoring that she needed up to that point. She was knowledgeable enough to realize her baby might be dehydrated.

Rather than immediately attend to the breastfeeding crisis for this young, first-time mother, the midwife offered a few words of advice and then changed the subject. The mother should have been attended at the very moment the midwife realized the struggle she was going through. It is no secret that a mother's stress and tension is automatically passed on to her baby. I knew that, and I was nervous and anxious myself, as a witness to this scenario in a private home. On top of the stress that the mother was experiencing, her breasts were engorged (swollen) to the point of being painful. She was in serious discomfort.

In the Medline Plus publication (produced by the U.S. National Library of Medicine and the National Institutes of Health) it explains that a mother has several steps she can take to reduce the discomfort of engorged breasts. "Learning to relax and finding a comfortable position," is the first step, and a "gentle massage" along with applying heat to the breast, is another step (Medline Plus). But clearly this mother needed to get that infant to start drawing the milk from her breast and reduce the build-up of milk while at the same time satisfying the baby.

Did the midwife respond as healthcare professionals recommended? No. Instead she told the mother that her baby was due for the heel prick (taking a bit of blood, which will be sent to a lab for screening in case the baby suffers from a health problem at birth). After telling the mother about the heel prick, the midwife did quickly examine that infant and determined that the baby had urate crystals in her nappy. That condition reflects the fact that the infant is dehydrated, and any alert person could see that in this case the dehydration is a result of a lack of breastfeeding.

Paperwork Requirements: The midwife explained to the mother that she needed to make sure the baby was drinking (which obviously the baby was not doing), and with that brief bit of advice, the midwife returned to the duty she seemed most interested in completing -- a big stack of papers that needed to be filled out. What is most important in this situation, I asked myself as I witnessed this little drama; getting the paperwork all filled out, or assisting a struggling brand new and inexperienced mother? That is a rhetorical question because the answer is so obvious the question need not be asked, but I asked it to emphasize the drama I witnessed.

My thoughts and feelings were so strong I was tempted to advise the midwife that she needed to attend to the breastfeeding issue. She was buried in a stack of papers that no doubt she was obligated to fill out; community midwife programs have strict protocol standards, and there is no doubt that the midwife wanted to get this part of the visit out of the way. It might have been that she was negatively critiqued in the recent past for not filling out paperwork promptly, so she was determined to get it done promptly. Or perhaps she was having a terrible day and something in her personal life was standing in the way of her duties and responsibilities as a midwife. But what I witnessed was a midwife hearing but not really listening to a struggling new mother.