May 5th is International Day of the Midwife. There are a growing number of midwives in Canada. Canadian midwifery is exercised in some provinces with independent practitioners and in other provinces and territories with midwives as employees of the local health region. However, all jurisdictions share some key values – CHOICE is a big one – choice of birthplace, choice of caregiver and client informed choice. CARE by familiar caregivers rather than fragmentation of care is the key value, as well as COLLABORATION with other members of the woman’s team. In addition, midwifery re-emerged in Canada in the environment of EVIDENCE-BASED PRACTICE and the need to participate in research. So midwives embrace breastfeeding as evidenced-based practice, they embrace it in their personal lives and provide informed choice and support for their clients.
Midwives make an important contribution to their clients’ success with breastfeeding. The Health Canada Maternity Experiences study published in the journal Pediatrics in 2010 uncovered that women giving birth at home are five times more likely to meet the World Health Organization recommendation for babies to receive only breastmilk from birth and onwards for the first six months of life.
Why is this important? – Because there are health benefits and relationship benefits for children and for their mothers when infants breastfeed exclusively for the first six months. These benefits have impacts on short term and long-term health of both the mother and the child. The evidence shows that these health benefits translate into economic benefits for society as a whole.
So why would there be this big difference of women birthing at home as compared to birthing and in hospital? The authors of the paper suggest that birthing in hospital carries a much greater exposure to artificial baby milks. About 47% of babies born in hospital have been given infant formula before discharge. There are babies for whom there are medical indications for the use of supplements such as low blood sugar that is unresponsive to the amount of colostrum the mother can give. However, the number of babies given supplements before hospital discharge is greater than the number of babies for whom there is a medical indication.
So what else is it about midwifery care at home that makes a difference? We know that these are healthy mothers, or they would have been counseled to birth in hospital. They also have not given birth by cesarean section, which is another scenario that increases the probability the baby will be exposed to other milks by six months. Because birthing at home as the norm was lost for a period of time in Canada, it is more likely that women who have the resources and education to get informed about options of place of birth are more likely to birth at home – and these are also characteristics that describe women who are more aware of the World Health recommendation to wait until babies are six months of age before introducing other foods. While there is no reason for healthy low risk first- time mothers to avoid planning a homebirth, often there is a greater percentage of mothers who have older children who give birth at home. These women have more experience with babies and likely with breastfeeding with their first children. They have developed their support systems, and can relax – as Kate Middleton is with her new baby!
There are other aspects of midwifery care that are available to all their clients. According to a recent article in the Journal of Human Lactation, the attitude toward breastfeeding of partner and mother in a woman’s life affect her ability to reach her breastfeeding goals. Canadian midwives are known to their clients, and develop a relationship with her working in small teams. They see women for longer visits, 30-60 minutes prenatally, making it worth the while of partners to take time off to attend prenatal visits. The midwives see the family in the home for some visits in the post partum period – which is another opportunity to interact with the partner – extended family and friends who are visiting and also to counsel a mother about ways to cope with unsupportive family and friends. The ongoing support and easy availability of the known team of midwives during the first six weeks is another aspect of the Canadian model of midwifery care that counteracts a known risk factor affecting breastfeeding when mothers go home with breastfeeding challenges that have not been resolved yet.
So please join us at Breastfeeding Matters in wishing our midwives Happy International Day of the Midwife and our encouragement to keep up the good work!