Here, mothers who have had a normal vaginal delivery with no significant blood loss & a good weight beby will go home in 4 to 6 hours. They stay in longer if the babe hasn’t fed or if there was meconium or pyrexia, maybe they’ll stay in 6 to 8 hours, & one the pyrexia is under control, off they go!

A c-section means a 3 day stay, sometimes more, sometimes less.

We don’t teach bathing as we recommend no baths for a week, just topping & tailing… things like that are all taught in antenatal classes anyway. We do spend a lot of time, both in the hospital & at home, on breast feeding support. Sometimes we’ll be in a house for a few hours, getting it right.

I guess my point with all this, is that there is very little support to mothers PP… and I really think that that has a lot to do with the high post partum depression rate. After the birth of my first child two years ago, I didn’t even know what the baby blues were.(and I took the class you referenced as well) I was completely surprised when all the sudden I was crying for no reason. I think that something needs to be done to change this. Not only for the health of mothers but for the health of babies as well.

Breastfeeding does not come naturally, and many women don’t know other women who have done it successfully. Grandmas who breastfed don’t live in the next room anymore to help out the new mom. Most of our grandmas (or mothers) probably exclusively formula fed. I had never seen another mom breastfeed until I joined a local AP group in my area.

Once the baby is born, the care of the couplet is transfered to a different nurse - still working for the L&D unit, but is assigned to mother-baby care that day. She works to provide comfort to mom if she’s had any lacerations/episiotomy/cesarean, instructs mom on how to wash baby, and helps out with getting breastfeeding going soon after birth and troubleshoots any issues that come up. She watches for illness in mom and baby. For a first-time mom she might give more hands-on teaching/assistance with baby care. She should talk about the differences between baby blues and PPD. Our local hospital has a PPD support group however that is not well known. (It’s listed as a resource on our birth network site, however.)

At the hospital I usually go to, we have lactation consultants on staff M-F during normal “office” hours. A mom usually will stay in the hospital for one to two nights after a birth - if it was a cesarean birth she’ll stay an extra night or two. Chances are unless she gave birth late Friday, the lactation consultant will stop in to mom’s hospital room. They talk not only about breastfeeding and how things are going but will often discuss baby care basics such as Dr. Harvey Karp’s “Happiest Baby on the Block”’s five S’s (swaddling, side/stomach position for cradling, shushing, swinging, sucking) and how not to operate on any timeline, how to tell if your baby is getting enough to eat, etc.

It really depends on the nurse you get - some are very pro-breastfeeding but some really push the formula to be on the safe side, even if iron levels, etc. all come back within the normal range. I’ve heard of nurses telling patients that formula is the same thing as breastmilk.

When Mom is discharged, she is offered a free gift bag from either Similac or Enfamil that contains various goodies and also a big can of formula. (Whether or not mom has chosen to breastfeed exclusively this is offered.) Often this leads to Mom beginning supplementation with formula at home for convenience factors or fear something isn’t going quite right with supply or whatever - when in actuality everything is perfectly normal. Often that leads to mom’s supply not having a chance to build properly in those early weeks and then supplementation becomes more and more necessary. (This is not even mentioning the formula ads in magazines, mailers, baby fairs and television.)

Free phone support and clinic visits to the lactation consultant are available after mom is home. (Too bad more women who wish to breastfeed don’t take advantage of this before they pop off the lid of the free can of formula.) They’ll weigh baby before and after a feeding, check her latch, troubleshoot and/or answer any questions mom might have about supply issues, how often to feed, etc.

As of this moment we do not have an active local La Leche League chapter but I’m hoping to change that soon. Our hospital offers breastfeeding education as part of their three-day prepared childbirth series (so much to cover in three days!) but does not have a separate class just about breastfeeding.

After hospital discharge, the next time mom sees her provider (usually an OB), it is in week six. Breastfeeding is discussed as is mom’s and baby’s health and mom’s mood is discussed and PPD/baby blues is screened for, usually informally unless there are obvious signs.

Once the six week visit is up, that’s usually the end of the assistance in a normal birth scenario.

Here in the UK we visit the mother at home for ten days postnatally. That is… if she gives birth in the hospital & leaves at say, 8am, then we’ll probably pop by that afternoon to see how she is. If she is discharged at night or late afternoon, we’ll be by in the morning to see how things are going. Same for a home birth.

We visit on days one through ten, sometimes daily, sometimes just 3 times - it all depends on the woman. We usually discharge on day 10, but can discharge up to 4 weeks postnatally if a woman needs more support. We then hand over to a health visitor, who visits a few times a year for up to 5 years.

We run baby weighing clinics for, well, baby weigh-ins. We also run breast feeding peer support & baby cafe’s.

How does that differ to the US?

The situations I brought up in questions in my first response was to point out that the fact that statistics can be made to support a particular side, it depends on the test subjects and the conditions of the study. More information about how the study is conducted and who was tested helps me understand the statistics better. For instance, testing all healthy women may yield different results from testing all women who may have circumstances arise that affect the outcome no matter what birthing method is used. So it wasn’t that I was trying to put down the statistics but gain more information about it.

Another point I would like to make is that medicine is a ‘practice’ and not an exact science. We learn from a particular disease or situation and do what works the majority of the time. Unfortunately, there is always one person who reacts differently to a particular illness or situation. It is a constant learning process. We are constantly reviewing our treatment methods to see how we can improve upon them.

As medicine moved from the dark ages and medical break throughs occurred, the medical community felt the need to save everyone. But that lead to new problems such as end of life issues. Now we have learned that it is ok to allow a patient to die with dignity instead of keeping them a live forever and ever. The medical community used to be very strict on visiting hours and who could visit and everything looking so sterile. Now, we look for non-medical ways to help promote healing. For example, I work at a ‘Planetree’ hospital. That means that there are no set visiting hours (except when report is given to protect patient privacy), any family member can come visit you (including your pets), music, and massages are available, religious leaders are encouraged to visit as well as having clergy on staff who respond to all emergent situations to help families, we have a healing garden as well as a non denominational chapel (we have even taken our patients on a ventilator down to the garden) and many other things all to help promote healing. We no longer kick families out during resuscitative efforts but allow them to be in the room if they so desire. Even our birthing rooms have changed from the past to try to make the room closer to a home environment. Is the system perfect? NO. But that is why we encourage input and are constantly reviewing and looking for ways to improve. It is essential to healing. And does the change happen quickly, not always, it takes time. (some times too long)

Even out medical treatments are constantly changing. We test methods or treatment and then review and review and review. If the results aren’t what we want, we go back to the drawing board and try a new method. And the public probably doesn’t see all the changes that occur but also realize there are strict rules governing how we treat our patients. You can see that process when a new drug comes out. It takes years before we see a new drug available because it has to go through so many testing processes. Our sue happy society has prompted that process. If it is a good drug the process takes too long. If it is a bad drug, they didn’t test it long enough.

I’m glad that you keep up on the latest medical news so that you can provide the best advice and care for your patients. But I wanted to share with your readers the fact that medicine is ever evolving and not just in the areas of medicinal treatment but non-medical treatment as well.

And as I have said before, choose your care provider carefully. I have been on many deliveries where the physician is very good about helping the mother have a positive delivery and does what he can to avoid episiotomies and c-sections. I have also been to deliveries where I wondered if the physician knew what he was doing. I’m sure there are also doula’s and midwives out there that are fantastic and some that you wouldn’t recommend to anyone. It becomes an interview process to choose someone who has your best interest in mind.

I also want to briefly mention that not all women, though they enjoy their baby once it is here, do not enjoy pregnancy or actually giving birth. And that’s OK. Just because it is a wonderful and miraculous process, it’s ok if someone doesn’t like it and voices her options that she doesn’t like it. And if she does have an opportunity to express her dislikes, it provides an opportunity for those who do enjoy it to suggest what might make it a better experience for her next time.

I do have another thought. We put a lot of education into the pregnancy and the birthing process but sometimes I think we forget to educate our women about what happens after birth. How long it takes for your milk to come in, the help available for nursing mothers (not all babies get the hang of it right away), how you will feel afterwards, etc. I think that was a bigger eye opener for me when I had my first baby and wish I had a little better education in that area. Postpartum depression is a prime example of some of the education needed before the baby is born. We should be more proactive about making sure our mothers have a positive experience beyond the birthing room.

As far as you questions regarding multiple births and cerebral palsy, I found a website that might better answer your questions. Here’s the link http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm
I hope that helps.

In regard to Karen’s comments. I personally am not a doula but I work in the Neonatal Intensive Care Unit and throughout most areas of the hospital (ER, Adult Critical Care, Intermediate Unit, Medical floor, Surgical Floor, Pediatrics). I attend all high risk deliveries. I find it interesting that so many of us have similar opinions but express those opinions very differently. I think that is where forums like this help to clarify what one is thinking so that as a community, we can work together for what is best for our patients and their families instead of against each other.

In regard to Single Mom~Left of the Middle. You are right that you must choose carefully who your care provider is. Especially when you are going to work so closely with this individual for at least 9 months. Use your intuition. If you don’t feel comfortable with who you have chosen, find someone new. Your care provider should be willing to work with you, answer your questions, address your concerns and make you feel confident enough to trust him or her. If a provider won’t take that time with you, find someone new. Remember that every patient has a bill of rights. Look for it the next time you are in a hospital. Here is a website link to an example of that those Bill of Rights are.
http://www.cancer.org/docroot/MIT/content/MIT_3_2_Patients_Bill_Of_Rights.asp

And as I have said before, ASK QUESTIONS! A lot of information or comforts are available, you just have to ask. Unfortunately, not everyone informs their patients of the kind of options they can have but the have to ask for. So keep asking questions until you are comfortable.

I sometimes where my activism hat - at BirthNetwork here in CT, when I was in the birth play, sometimes even as a teacher of Childbirth Education. I will play the role of advocate in the labor room - but never activist. Like you, I know the time and place for all these things. My most important role in that room is support and I cherish it, as you do too.

I believe multiple births increases the number low weight babies.

I believe low weight in a baby is a risk factor for cerebral palsy.

Have fertility drugs increased the number of cases of babies born with CP?