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Infant Mortality and Nursing in Public

OK, I’m not making a claim that nursing in public protects against infant mortality (but hey, it’s certainly plausible, on the public health level at least.) No, I’m writing about these two topics today because I’m hoping you’ll go read my two guest posts, hosted on two of my favorite blogs.

Over on Giving Birth With Confidence, I wrote a post called, From the Bedroom to the Board Room: How I learned to nurse in public. It’s about the fact that early in my mothering, I actually breastfed at the board room table while presenting a report to Lamaze’s Board of Directors. And it totally shaped my perception on breastfeeding, my body, and family-friendly policies:

I look back on this time now and I realize how fortunate I was. My earliest experiences of opening my baby’s and my universe to others reinforced that nursing is normal, joyful, and important. In a way, it was totally unremarkable to nurse my baby while addressing my supervisor and her Board of Directors. But at the same time, it was something to be celebrated. The people at the table weren’t weirded out that I was breastfeeding. They loved it – reveled in it. We even talked about how it is important to have babies at our conferences. Our work affects them!

That post is part of the Nursing in Public Blog Carnival. The carnival coordinators got so many great posts, they started a new (amazing!) web site, Nursing Freedom. Go spread the word!

Art by Erika Hastings at http://mudspice.wordpress.com/

I also have a new post up at RH Reality Check about disparities in infant mortality. I challenge birth advocates to get behind prenatal care models that are effective and proven to reduce preterm birth and close the gap between blacks and whites. I discuss my own experiences with incredible prenatal care from my home birth midwives, and come to the chilling conclusion:

THIS is how prenatal care should be. Right? Well, not necessarily. Unless and until there is a major upheaval in healthcare financing and staffing patterns, having this kind of prenatal care is a privilege. And I don’t mean privilege like “I’m so lucky.” I mean privilege in the sense that I can’t have that kind of care unless others are deprived of it.

If everyone woke up tomorrow and realized that they deserved to have every question answered, every fear and concern explored, every test/procedure/diagnosis explained, we would quickly run out of midwives to provide that care. That is, if our solution was to provide one-to-one care on the traditional prenatal schedule. In short, that kind of prenatal care, however great it is, is not scalable to levels that could benefit all women and babies.

I also discuss CenteringPregnancy, an evidence-based, relationship-centered model of group prenatal care that has shown to reduce preterm birth rates, especially among African American mothers.

I wrote that post as part of Courtroom Mama’s blog carnival at The Unnecesarean. Check out the link to read through the other important posts.

And for those of you who are interested in learning more about infant mortality and disparities in perinatal care, here are a couple of great resources.

This widget from Kids Count, a project of the Annie E. Casey Foundation, let’s you see data for any U.S. state or territory on different indicators including the infant mortality rate, child poverty rate, and teen pregnancy rate.

And here’s a fantastic recent documentary on disparities in infant mortality in Tennessee, one of the states with the highest infant mortality rates, and where funding to address the problem was recently on the chopping block. (Mercifully, the programs seem to have been spared in budget cuts.)

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  1. | #1

    “OK, I’m not making a claim that nursing in public protects against infant mortality,”

    But doesn’t it, indirectly? When you consider the fact that many women cite anxiety about nursing in public as a major reason they didn’t breastfeed, or had to discontinue breastfeeding? And then factor in the risks of formula feeding, especially for babies with medical risks (as discussed in the Melissa Bartick study earlier this year)? I’d say it is at least a small but legitimate factor. My SOLE criticism of “Crisis in the Crib” is that there was no mention of breastfeeding, especially considering that prematurity is an enormous part of the problem.

    Great post(s), as per always!

  2. | #2

    @Dou-la-la
    Completely! I just wanted to make sure no one thought I was saying that nursing your own baby in public decreases the baby’s risk of dying (though I could certainly buy that possibility, too). But a culture that was 100% cool with public breastfeeding, in my mind, would definitely have better infant health outcomes, including lower mortality. Maternal health would probably benefit, too. I never actually thought of the two things together until I sat down to write this post.

  3. avatar
    Veronica
    | #3

    I’ve been thinking about this for the last couple of weeks after hearing some moms’ birth stories, but I really wish we had more information on outcomes of CenteringPregnancy programs. Anecdotal evidence makes me really question what the limits of this program are. While I can believe that it can reduce preterm birth rates in some populations, doesn’t any increased amount of prenatal care (for example, visiting nurse programs) improve preterm birth rates?
    I would like to see if there is a difference in intervention rates and cesarean rates, especially if the mothers in the CenteringPregnancy groups forgo traditional childbirth classes.
    I’m just not convinced they will prove to be solution they promise to be.

  4. avatar
    Kate
    | #4

    @Veronica
    Actually, there are multiple studies about the effectiveness of CenteringPregnancy, including this randomized controlled trial published in 2007: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276878/. There isn’t very good or reliable data for the impact that childbirth classes, have, on the other hand – at least not that I’ve found.

    I work at an outpatient clinic that utilizes CenteringPregnancy with teen and adult moms, and our data shows a significant impact on birth weight, preterm birth, Cesarean birth, and breastfeeding initiation, as well as patient and provider satisfaction. We’ve been using the model for over 10 years. One of the crucial components of Centering is the group and peer support that women receive. It’s not a very high-tech model of care, which is what makes it so amazing. It’s cost-effective AND it works!

    I agree that many programs (like nurse home visitation programs) make differences in addition to Centering, but wouldn’t it be great to see the positive synergistic effects that utilizing all of the tools in the toolbox could have? Wow – what fantastic outcomes we might achieve!

  5. | #5

    @Kate
    Thanks Kate for weighing in. I was going to make similar points to Veronica’s concerns. I also want to make the point that in many although certainly not all settings that have adopted Centering, the women don’t have the resources to attend good quality childbirth education classes, so Centering in that context is not siphoning off CBE attendance – it’s actually giving women far more education than they would have otherwise had. I am also aware of Centering sites that are co-facilitated by Lamaze-certified childbirth educators, and at least one site (Magee Women’s Hospital) where they added doula support for Centering participants.

    I think that the cesarean epidemic won’t be solved with models of prenatal care or birth education (although they can certainly contribute). The reasons for the cesarean rate have much more to do with hospital practices and protocols and bigger picture issues such as fear of liability and payment incentives. That Centering hasn’t reduced the c-section rate in the published studies shouldn’t be a deterrent from adopting it. And anecdotal evidence like Kate’s tells us that in some settings, Centering does impact intrapartum interventions.

    Thanks to both of you for your comments!

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