Midwives and Breastfeeding
Is there anything more important than breastfeeding? It affects the health of the mother and the baby long-term, that is, forever in the life of each. Remember: birth is part of breastfeeding. They are one process. They have been separated by our semi-medical view of how things work. There is a tendency to separate many parts of “medicine” into specialties, but the midwife is specialist in all that pertains to motherbaby.
It is interesting that, at our conferences, most registrants don't sign up for breastfeeding classes. Most of our registrants are midwives, doulas and educators who are often involved in homebirth. We do not run into many breastfeeding problems in homebirth. In the 300 births I did as a midwife we only had one real problem. Are the homebirth moms self-selected? They may be, but something more is at work here and that is the relationship between the midwife and the mother. We have covered these important talks in the prenatal course. Mothers pick up our views on breastfeeding through this relationship. Most often, the midwife is a mother herself and, as such, imparts to the mother many subtle ideas and ideals. An amazingly intimate relationship evolves. Women have told me things they have never told anyone. These things are often very important to her birth. This is why continuity of care is necessary. Fragmented care is not care at all.
My first birth was a hospital birth. It was horrid and fragmented. It abused and wounded my soul. I did breastfeed my baby for three years though. I had the advantage of labor and birth. (According to Michel Odent women who have not gone into labor but are scheduled for a cesarean have a lot of trouble breastfeeding because the oxytocin is not present.) I was determined to nurse my baby. I had studied anthropology in college and never doubted that breastfeed is what I would do. There was no doubt in my mind that I could do it. In fact, it never crossed my mind.
If we want to stem breastfeeding problems we need to begin with our relationship to the mother during her prenatal care. We also should consider birth and breastfeeding to be one; have a loving, respectful midwife for every pregnant woman; and encourage more out-of-hospital births, while reworking hospitals to really serve motherbaby. Some day this will happen if we all keep working toward it.
Toward Better Birth and Breastfeeding!
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
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Pathways Magazine: Your resource for family wellness
Pathways Magazine provides vital resources for family wellness. Our articles give parents the necessary information to actively participate in their families' natural health choices. Geared towards new parenting, there are always articles on birth and pregnancy from the vitalistic, midwifery perspective. A must have for holistic education in your practice.
A substance found in human breast milk has the ability to kill cancer cells without harming healthy cells. Researchers from Swedish universities recently conducted human trials on the substance HAMLET (human alpha-lactalbumin made lethal to tumour cells) and found that HAMLET was effective in killing bladder cancer cells. Studies on other types of cancer cells, including skin cancer and brain tumors, are being planned. For more information on the HAMLET research, visit: http://www.sciencedaily.com/releases/2010/04/100419132403.htm
— Mossberg, et al. 2010. HAMLET Interacts with Lipid Membranes and Perturbs Their Structure and Integrity. PLoS ONE 5(2): e9384 DOI: 10.1371/journal.pone.0009384.
Breastfeeding during Pregnancy
Breastfeeding and Contractions
Nipple stimulation releases the hormone oxytocin into a woman's bloodstream (similar to what happens during female orgasm). Oxytocin is important for breastfeeding because it is the chemical messenger that tells breast tissue to contract and eject milk (the “milk ejection reflex”). Oxytocin also tells the uterine tissue to contract. All women experience uterine contractions during breastfeeding. Nipple stimulation can also augment labor after it is underway. Postpartum breastfeeding efficiently shrinks the uterus back to prepregnancy size.
Given these associations, it seems a short jump to guess that breastfeeding might trigger labor before its time. But this would be a false leap. Although a medical study is still lacking, preliminary data and related research on the pregnant uterus suggest that breastfeeding and healthy term births are quite compatible. Sherrill Moscona's 1993 survey of mothers who breastfed during some or all of pregnancy concluded that breastfeeding resulted in no apparent adverse consequences to the mothers' pregnancies.(3) There are also countless anecdotal reports of mothers who have breastfed throughout pregnancy and have given birth to healthy term babies.
Few mothers (7%) notice contractions during breastfeeding, even during pregnancy.(3) Interestingly, even those who experience intense “nursing contractions” often find that the contractions cease soon after ending the breastfeeding session. Like Braxton-Hicks contractions, nursing contractions commonly occur without disrupting the pregnancy. One mother in Massachusetts wrote to me:
“I felt contractions very strongly during my second pregnancy, some so strong that I was afraid of their intensity and ended the nursing session. Some of them were definitely more painful than Braxton-Hicks contractions. In every case where I was concerned about the number, duration or intensity, I was reassured to find that the contractions stopped within about 10–15 minutes of when the nursing session ended.
“I continued to nurse my son, Everest, through pregnancy and gave birth to his brother, Alden, at 39 weeks. I had similar nursing-induced contractions during my next pregnancy, but I was reassured by my previous experiences and did not worry. I continued to nurse both Everest and Alden through that pregnancy, and their baby sister, Ellery, was born at 39-1/2 weeks.”—Amanda(4)
The Well-protected Uterus
The specter of breastfeeding-induced preterm labor appears to spring from an incomplete understanding of the interactions between nipple stimulation, oxytocin and pregnancy.
The first little-known fact is that during pregnancy less oxytocin is released in response to nipple stimulation than when a woman is not pregnant.(5) But the key to understanding breastfeeding during pregnancy is the uterus itself. Contrary to popular belief, the uterus is not at the beck and call of oxytocin during the 38 weeks of the “preterm” period. Even a high dose of synthetic oxytocin (Pitocin) is unlikely to trigger labor until a woman is at term.(6)
As midwives, you are well aware that the uterus must actively prepare in order for labor to commence. We could say that there are two separate states of being for the uterus: the quiescent baby-holder (with a muffled response to oxytocin) and the active baby-birther (with a magnified response to oxytocin). How—and when—does this remarkable transformation take place? Many discussions of breastfeeding during pregnancy mention “oxytocin receptor sites,” the uterine cells that detect the presence of oxytocin and cause a contraction. These cells are sparse up until 38 weeks, increasing gradually after that time, and increasing 300-fold after labor has begun.(6)
Keeping down the number of oxytocin receptor sites is an important safeguard during pregnancy—but it is not the only one. When I delved deeper into the molecular biology of the pregnant uterus I found layer after layer of defenses. In order for oxytocin receptor sites to respond strongly to oxytocin they need the help of special agents called “gap junction proteins.” The absence of these proteins renders the uterus “down-regulated,” relatively insensitive to oxytocin even when the oxytocin receptor site density is high. And natural oxytocin-blockers, most notably progesterone, stand between oxytocin and its receptor site throughout pregnancy.(7–9)
With the oxytocin receptor sites sparse, down-regulated and blocked by progesterone and other anti-oxytocin agents, oxytocin alone cannot trigger labor. The uterus is in baby-holding mode, well-protected from untimely labor.
- Moscone [sic], S.R. and M.J. 1993. Breastfeeding During Pregnancy. J of Hum Lact 9 (2): 83–88.
- Flower, Hilary. 2003. Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond. Schaumburg, Illinois: La Leche League International, 225–26, 235–36, 250–52.
- Amico, J., and B. Finley. 1986. Breast Stimulation in Cycling Women, Pregnant Women and a Woman with Induced Lactation: Pattern of Release of Oxytocin, Prolactin and Luteinizing Hormone. Clinical Endocrinology 25: 97–106.
- Kimura, T., et al. 1996. Expression of Oxytocin Receptor in Human Pregnant Myometrium. Endocrinology 137: 780–85.
- Chwalisz, K., et al. 1991. The Progesterone Antagonist Onapristone Increases the Effectiveness of Oxytocin to Produce Delivery Without Changing the Myometrial Oxytocin Receptor Concentrations. Am J Obstet Gynecol 165: 1760–70.
- Grazzini, E., et al. 1998. Inhibition of Oxytocin Receptor Function by Direct Binding of Progesterone. Nature 392 (6675): 509–12.
- Zingg, H.H., et al. 1998. Genomic and Non-genomic Mechanisms of Oxytocin Receptor Regulation.
Adv Exp Med Biol 449: 287–95.
— Hilary Dervin Flower
Excerpted from “Breastfeeding during Pregnancy—Moving from Fear to Instinct,” Midwifery Today, Issue 68
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- Birth in 2050
“Birth really is a human rights issue. How do we get the idea of that across and work on making changes so that all mothers and babies have an optimal birth? Is a day coming when every motherbaby will receive these birth rights: access to good food, clean water and loving care? When motherbaby has access to an optimal and hopefully miraculous birth, we will see our world change, and I believe we will live on a more peaceful and loving planet.”
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Question of the Week
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Question of the Week Responses
Q: What do you look for in a potential apprentice?
— Midwifery Today staff
A: When taking on a potential apprentice, I am looking first and foremost to see that she is committed to birth work and willing to place a high priority on her responsibilities surrounding the opportunities she is offered in a midwife's practice. Initially, students often have no idea what being on-call and managing a practice is all about, and sometimes seek an apprenticeship with a very dreamy concept of midwifery in mind. Being on-call 24/7 (without complaint) and the unpredictability of births is probably the single hardest thing to balance for most. Throw in regular client visits, paperwork, studying, etc., and many students end up not being cut out for the long haul.
I am also looking for a passionate, yet open-minded and humble, student. I believe it's necessary for us all to observe and read as much as we can. Students who think they already know "everything" before they've completed much (or any) training appear un-teachable. Being too idealistic and opinionated about what the "right way" is to do anything can be problematic, to say the least. It takes maturity to realize that no woman's birth takes place in a vacuum and that the world is just not that black and white.
I am quite hesitant to take on a student who often complains about her financial status and/or her spouse's lack of support. Long births, babysitting issues, no income, etc., are difficult for some spouses to accept and students may feel pressure to "get done fast and make money" to keep the peace at home. I've known this to happen and I fear that the quality of their training is likely affected. It is very concerning, particularly in areas where the minimum standards midwives must meet are low or nonexistent.
Midwifery is not an instant-gratification calling, and apprenticeship should not be seen as an easy shortcut to a money making career!
— Candace Robinson, CPM
Q: What was the longest second stage you've experienced, and how well did mother and baby pull through?
— Midwifery Today staff
A: Longest second stage? 13 hours and 15 minutes.
I had a first-time mom, who started labor with a rupture at 3:30 in the morning the day before she gave birth. She received an epidural (6–7 cm) at 6:30 in the evening. She was complete at 2 am, but didn't start pushing until 6:30 am. Fortunately, this is also when mom's care provider changed from an obstetrician (recommending a cesarean) to the midwife on-call (willing to work with her). Active pushing lasted 8 hours and 45 minutes. Baby was manually rotated twice during the last four hours of pushing. Near the last two hours of pushing, there were four or five women (doula, nurses, a student and midwife) supporting this mother. The birth team was completely exhausted but, surprisingly, the mom pushed with a big smile on her face the entire time and the baby came out the same way! The baby weighed 6 lb 9 oz with Apgars of 8/9.
— Michelle McClafferty, CD, CPD, ICCE
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