Tuesday, May 27, 2014

Breastfeeding inequities in their village and in mine

In my village but never theirs....

I had come home from Haiti, wanting to do a few things.  One of them was to look at the many ways that all people share common problems and concerns.  I had wanted to look at the birth practices of my own community. I had wanted to find that common thread and to understand the meaning of "best practices' world wide.  I had wanted to simplify my thinking and in that find some universal truth.

I also undertook the work of taking the 90 hours of lactation education related to Baby Friendly Certification which I have found to be a unifying way of caring for babies endorsed by WHO and UNICEF.  As I watched still another mother and baby struggle to live, I considered that this could be a unifying good for Haiti' mothers and babies as well as the mothers and babies in my own community.

I was only home a few days when the classes began.  They were 9 to 6 and required large amounts of time on the computer.  I jumped from a world with very little electricity to a classroom totally dependent on electricity and the internet.  I went from a world where people sat at sunset and talked to a world where we were suppose to chat on line.   I was still having nightmares about a box of dead babies spilling onto the floor while I was delivering a baby.  I was shaken by that and then by the death of a dear friend.   I was experiencing cultural shock that was exasperated by on-line learning, yes, but something more.

I had helped thousands of mothers bring their baby to breast with no difficulty.  I had considered it part of the birth. I would have no sooner left a birth without the abby nursing than I would have left a placenta in. It was part of the birth.  It was my job as the birth attendant.  Here I was in a world where helping the mother to breastfeed was a whole other vocation.  I was trying to get LaGonave caught up on prenatal care and they are fast moving into a world of breastfeeding so foreign to me; even in my own community.

Through the course, I could see that many babies in my villages do not latch easily or early because of drugs and procedures used in childbirth.  Women in my villages, thousands of them, have surgeries to improve the look of their breasts.  In my country, women ahve the time and money to worry about how their breasts look.

As I move through the course, I can see that there is not much I can bring back to Haiti or any low resource setting.  A great deal was based on electricity, plumbing and computers.   Mother is Haiti rarely have access to lab work, NICU's, and high tech birth.

In some ways, the mothers of Haiti are far more successful.  I am sure their breastfeeding rates are far higher.  Not breastfeeding means almost certain death to a baby there.  In my village they have milk banks where milk is psateurized, tested and cooled.  I think they cannot even do that for cow milk for older children, let alone babies.

We review the metabolic diseases, jaundice, prematurity, low milk supply and I think well, I guess in Haiti all of those babies simply die.  Sometimes I consider still the box of dead babies. I see them all with their arms around each other and the tiny hands.  I find myself trying to determine their gestational age as we are shown slides of premature babies in my villages NICU.  The babies were not that young - perhaps as they say they were late prematures or they were term but no one knew how to care for them at birth.

Some will die of infections passed from mother to baby that are never tested let alone treated.  Some will surely have blood types that cause them to die in the first hours of life.  The inequities of care go on and on and on.  I sit through a 90 hour journey of extreme inequity of global resources.  In my village women have breast surgery, have fertility treatments and keep their babies alive for months in the NICU.

In Haiti. we are happy if they get prenatal care and can get to help if there is an emergency.  Some of us dedicate hard won fund raising dollars to getting care to women through mobile clinics or birth centers. it is not , I tell myself, the women's fault.  My country has created this culture of disparity.

I sit and watch. I do my assignments and try to take part but I am a world away.   I wonder if some children are worth more than others.

I will go back in a few days and help the matrones and agent santes and midwives with breastfeeding complications. I plan a workshop on this topic but I know I will not bring any of the gadgets, pumps, feeders, banked human milk, lab equipment and vast technology of the NICU in the village where I live.  I will bring some pictures.  i'll work with a translator and do the best I can.  There are no lactation consultants.

Many of the reasons women struggle with breastfeeding, in my village, are reasons related to birth, the media and the need for mothers of young babies to return to work.  I try to find the simple truths beneath all I have learned.   I try to think about what it mans to care for the young in any culture, in any place on earth.

It is a beautiful morning. I consider what it means to be born fully awake and alive with no drugs pulsing through our bodies to a mother who reaches down and brings us to her breast.   This is almost always true in haiti and almost never true in my villages.   Our babies are often induced, born through surgery, effected by maternal drugs.  The women in Haiti have much to offer the women in my villages about birth and breastfeeding.  I am angry and confused about all the things they don't have that US women have but then I can see that in many ways they have the most important things to help a baby latch and establish a good milk supply;  a culture that supports and appreciates a breast feeding mama.

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