Posts by B Jones
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I thought the story in the Listener a couple of years ago was more interesting and nuanced: Another unfortunate experiment? despite the title. It seems to identify what the real problem is, and outline one possible solution.
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Hard News: Complaint and culture, in reply to Russell Brown,
So you could also say that complaints against midwives are more than twice as likely to be upheld as complaints against doctors.
Not without committing major selection bias. OBs are far more likely to be involved at the risky end of the business, when things go wrong.
I don't think the story backs its conclusions either. The anecdotes illustrate what can go wrong, but the uterine rupture thing sounds like it's as much the registrar's fault for giving the mother too much syntocinon as the midwives' for letting her push too long. That's something that could happen under the old system - it's not like OBs showed up at every actual delivery.
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Hard News: Complaint and culture, in reply to Danyl Mclauchlan,
difficult for formula feeding mothers to get jobs, because employers prefer to hire women who breastfeed
*Gulps with hysterical laughter* Anyone who can keep up breastfeeding while working in an office, let alone a shop or factory floor, has my congratulations and admiration.
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Until the Public Address webmonkeys work out how not to make the site crash on my Android mobile, I'm afraid breastfeeding will continue to be very difficult to combine with arguing about it online.
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Yes, but is that the result of product placement? An actual PR campaign, or just cultural associations? Babies have bottles all the time, but that doesn't mean formula is in them - mine got more of what I ended up calling Expresso.
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Hard News: Complaint and culture, in reply to James Butler,
A few flashy advertisements from formula companies has nothing on that as a "PR machine".
Notice how they only advertise "toddler milk", and the one I'm most familiar with starts with "Nothing compares to breastmilk, but how time flies. When you're ready to move on..." They know their audience is primed to hate them if they go there.
I wonder what things are like in China at the moment on that front. How awful, not to be able to trust that commercial products aren't stuffed with poison thanks to a pack of greedy middlemen.
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As far as I understand it, the benefits of milk over formula shrink over time - a little one who's not on solids has different needs to a bouncing year-old kid who's been on solids for months and can handle cow's milk straight. At first, it can affect the balance of gut microflora.
I'd like to see some examples of this PR machine in action, in NZ in 2011. Pretty hard to run a PR campaign when you're banned from promoting something in just about any way. The closest thing I've seen to formula promotion was a free sample in a shipment of nappies I got once. Whereas my midwife handed me a DVD on breastfeeding yesterday - I know which would cost more to produce.
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I'd just like to add to the largely-feminine death-stare being directed at Ross. As if one's attitude can change the shape of your baby's mouth and heal fissured nipples. As if one can do anything about one's attitude on four hours' non-consecutive sleep a night. I was keen as at first, but after a day or so of reality, dreaded every feed for the first three weeks - ironically, persisting doggedly rather than trying other tactics made it worse. Then my baby got the hang of it, and hung on in, so to speak, for the next 11 months.
The thing I found comforting was at the Plunket breastfeeding bootcamp I went to, someone said sometimes babies just take a while to get the hang of it. The idea that it was the baby's fault, rather than the mother's, was both frustrating and liberating - I couldn't do much about it, but it wasn't my fault, it was my adorable little lamprey's.
With control comes responsibility - the idea that mothers are responsible for their medical condition during pregnancy and childbirth can be oppressive as well as liberating. I've heard plenty of stories of mothers being blamed for their perinatal problems, for not having the right attitude, by people firmly wedded to the naturalistic fallacy that birth is natural and safe providing you don't mess with it.
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Hard News: Complaint and culture, in reply to Russell Brown,
my takeaway from the story was that there is no monitoring of perinatal harms apart from death of mother or baby. So birth injury that results in severe and lifelong disability isn't counted. This is not good enough.
Past tense. From the story:
outcomes like Charley’s, caused by oxygen deprivation at birth, will be included from next year in the Perinatal and Maternal Mortality Committee’s annual report.
Having read the article, it's actually quite good. I'm not sure about the conclusion that a whole natural birth attitude amongst midwives is responsible for problems - the anecdotes and reports I've read suggest that poor communication and co-ordination between specialists and generalists is more of an issue. None of the midwives I've dealt with (eight over two pregnancies, including students) have struck me as being anything other than professional, risk-averse and evidence-based, and I have a very low tolerance for woo.
That being said, I think Karen Guilliland comes across as v defensive in the article. Ironically she goes on about doctors doing unnecessary internal exams just for training - I had double the usual exams at my last delivery thanks to kindly agreeing to give the student midwife a learning opportunity. Was not fun. The only upside was that they explained exactly what they were looking for.
Danyl. the breastfeeding thing, I think I can understand up to a point. It's hard at first, but worth persisting with until it comes right, and a bit of pressure can get people past the first few awful days. The trick is knowing when to cave and provide support for the alternatives.
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Hard News: Complaint and culture, in reply to BlairMacca,
What distresses me is that midwives can vary so wildly, and don’t have to get a general nursing degree first, which is standard in a lot of other countries.
The latter doesn't bother me, but the former really bugged me last time round when I called at least half a dozen before I could get one to take me on. There's a shortage, which impacts horribly on choice. If I hadn't been happy with the midwife I eventually got, I would have had to take whoever was on shift at the hospital, or pay $$$ to go private for obstetric care I didn't need for a very uneventful pregnancy.
My wife and I don’t really care whether the birth is natural experience or not, we just want a birth where my wife and our baby are given proper care and treatment.
I was happy, last time around, to get a midwife in a medium/low-decile practice in the end. I figured they'd be vigilant about all the real problems, and wouldn't have a pile of wealthy clients wanting all the extra woo.