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Book Review
Impact of Birthing Practices on Breastfeeding:
Protecting the Mother and Baby Continuum

by Mary Kroeger with Linda J. Smith
Reviewed by Beverly Morgan, IBCLC, CLE
Georgetown TX USA
From: LEAVEN, Vol. 41 No. 3, June-July 2005, pp. 58-59.

The subject of this book, the impact of birth choices on breastfeeding, fits so well into Series Meeting Three! Linda J. Smith, one of the co-authors, is a longtime LLL Leader. Her background as an LLL Leader, IBCLC, and as an athletic coach gave experiences that were valuable in writing this book. The late Mary Kroeger's experience as a nurse, midwife, and international maternal and child health consultant with experience in different cultures, gave her a global view on childbirth. The well-documented research to back up their opinions makes for a compelling book.

Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum is a wonderful addition to the Group Library. As LLL philosophy states, "Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start." In order to make an informed choice about their birth plan, mothers need to have access to information sources such as this book. Additionally, as LLLI philosophy also states, "Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby," and "Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply." Both of these statements are relevant immediately after birth and can be affected by the birth experience.

One mother who had difficulties with breastfeeding wrote:

I wanted the whole natural birth and breastfeeding thing. I prepared very well and failed miserably on both counts. Each feeding was a cycle of trying to get my baby to latch on, alternating between frantic crying from my baby and comforting her to try again. I couldn't get her to latch on without four to six hands holding her in position. I was so frustrated and discouraged that I was in tears daily. My husband hated seeing me break down every morning before he left for work and I was faced with another day of "failure" ahead of me.

Books such as this one give expectant mothers factual information to help plan a safe and empowered birth that leaves mother and baby both feel comfortable after birth.

In the text, Dr. Michel Odent's observations about research are described. Dr. Odent talks about circular research and cul-de-sac research. The term "circular research" refers to the studies that are repeated and built on beyond the point of reasonable doubt, to test the same question again and again. These are the studies that are often quoted. "Cul-de-sac research" results in a dead end. One study is done and published in an authoritative medical or scientific journal. No one, including the original author, follows up on the research. Cul-de-sac research is rarely quoted after its original publication. At this time, Dr. Odent feels that studies that tie birth interventions to breastfeeding results are cul-de-sac research. In the words of Dr. Odent, "An optimistic analysis would stress that it is possible to break through the dead end of a cul-de-sac and open an avenue."

This landmark book, in the hands of La Leche League Leaders, lactation consultants, birth educators, medical professionals, and empowered parents, has the potential to move birth interventions and breastfeeding into the path of circular research, thereby humanizing birth and avoiding many of the heartbreaking outcomes we now see when a baby's ability to effectively breastfeed are compromised by his birth.

The authors do a wonderful job throughout the book connecting the dots between birth and breastfeeding. I was, however, frustrated with Chapter 7, "Physics, Forces, and Mechanical Effects of Birth on Breastfeeding" because no alternatives were suggested that might remedy the problems caused by various birth interventions, and thus enable successful breastfeeding. For example, the following treatments to consider using to promote and protect breastfeeding, are not mentioned: Cranial Sacral Therapy™, massage therapy, chiropractic care, physical therapy, and occupational therapy. A mother who reads this book may well feel regret for the way that her labor went and still not know what strategies are available to help resolve the trauma. While a detailed discussion of various treatment plans for the various difficulties would be beyond the scope of this book, it is disappointing that not even one paragraph, nor a list of resources for parents and professionals, is provided to help mitigate the circumstances around the birth trauma. LLL Leaders may be a source of information and support.

The role LLL plays in joining breastfeeding to birth is recognized in the text on pages six to nine. However, some readers may take exception with the author's implication that LLL is not doing all it "should" do to inform mothers about the consequences of choosing certain (elective) medical interventions during the birth process. One passage states: "Not mentioned at all (in the fifth edition of THE WOMANLY ART OF BREASTFEEDING) are some of the iatrogenic [physician-caused] reasons for this rising c-section rate. Nor is there a section that describes clearly the disadvantages and side effects of invasive medical interventions and labor medications, including epidural anesthesia, on the baby and breastfeeding."

This book fills a gap between the academic and clinical division between obstetrics and pediatrics and has become an instant classic that should be read by everyone who works with pregnancy, birth, and breastfeeding. It would make fascinating reading for LLL Leaders and Applicants.

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