Friday, 28 March 2014

Breastmilk and the Pool, again.

Once more a swimming pool is infringing on a woman's right to mother as she thinks is appropriate. 
photo shared with permission
To whom it may concern:

I have with interest been following the incident which Mrs ******** ******** and her partner have raised with the sign in the attached photograph.  I was very pleased to hear that the Louisa Centre has removed the sign after reviewing the appropriate guidance from Maternity Action.

However, I am less than pleased with the lack of support the Centre's management has shown for the spirit and the letter of the guidance and the legislation (Equality Act of 2010) where breastfeeding is specifically protected.  It is quite worrying that you are misusing the element of health and safety under the Equality Act to bar women from breastfeeding poolside or in the water.  This argument is only valid if there is actually a risk present, which I will outline below is a very questionable position to hold.

Your response to Mrs ******** cited enforcement of your position based on health and safety grounds, that a.  a child may vomit in the pool and b. vomit on the poolside creates a risk to slipping.

Point a.  You will be aware that toddlers and babies will urinate quite frequently in the pool and that swim nappies only hold the solid content of excrement.  Using your logic, I fail to understand how a small amount of breastmilk which may be regurgitated is of any risk in comparison to what toddlers and babies already do in the pool.   

A lactating woman in the pool may leak and in addition to the urine and faecal matter already mentioned, there is also the possibility of phlegm from congested sinuses, sweat, dead skin cells, and menses, to name a few excretions which may also already be in the pool.  If your pool cleaning system is efficient then there is no problem with it removing breastmilk from the water.  You may be unaware so far that while all the other bodily secretions mentioned above have potential health and safety risks, breastmilk is the only one which kills bacteria and viruses including norovirus.

Point b.  While vomit on the poolside may be a risk for slippage, the average spit up of a breastfed baby is between a teaspoon and table spoon's worth or 5 - 15ml.  This is in no way comparable to the vomit which an adult or medium sized child may do on the side of a pool. Using your logic once more that a breastfed baby's vomit is a danger, all pools must be shut forthwith as there is typically wet foot prints from the end of the first swimming lesson till the pool closes in the evening.

In addition, babies sometimes suck on life vests, ducklings swimming lessons encourage putting babies' faces in the water so that they can blow bubbles and get water in their faces.  In addition, a calculation made by the Canadian Red Cross (1) suggests that babies in some baby swimming programmes where babies are dunked underwater show that babies may drink up to 50 ml or 2 oz of pool water in a session.  On the other hand, when a baby breastfeeds, the baby's mouth forms a vacuum seal over the breast preventing air or water, in this case, from entering the baby's mouth.  

Breastfeeding has significant benefits to a small baby or child. It is not just food to the child.  It is security in an environment which can be noisy and intimidating.  Breastfeeding allows a frightened, tired, or cold child to feel warm and secure without a mother potentially slipping while leaving the water to feed a child in a cubicle, a journey which will allow the child to grow colder and more distressed.  If there are any accompanying siblings, it may also mean dragging two or more children to a cubicle and removing the pleasure of the experience for all.  

Co. Durham including Stanley is an area of high social and economic deprivation and besides being economical, breastfeeding is one activity which improves the health outcomes for poorer children throughout their lives and also it is shown to increase their confidence and academic performance in childhood and beyond.  By supporting mothers with mothering, the council facilities help mothers to breastfeed for longer and she becomes a model for other women who see breastfeeding as a normal and feasible option for her children.

I ask the facility to reconsider its position once more and I await your response on this matter.

the Rabbit in the Moon

This comprehensive report by the Breastfeeding Action Committee of Edmonton deals with just about any question or eventuality in discussions with leisure facilities management when this issue arises.  It is evidence based and provides a multitude of references for further information.

1 In an unpublished study done for the Canadian Red Cross, in which babies were intentionally submerged during a water experience program, 31 of 80 test weights done afterwards showed an average gain of about 50 ml, or 1/4 of a cup of water, with no ill effects.  Not only do swimming pools not exclude young children from the water, they actively encourage them to participate. Thus a double standard seems to exist at some pools regarding breastfeeding babies who might ingest pool water and other babies enjoying the  water who might do the same. 
 Breastfeeding at Municipal Pools in Canada:
A Report from the Breastfeeding Action Committee of Edmonton
August 16, 2002

Wednesday, 26 March 2014

The Third Stage - Birth of a Placenta

As I recounted in my last post, the midwives arrived about 5 minutes after my daughter birthed in a planned unassisted birth.  She was cradled in my arms and I was still in the pool.  I wanted to stay there as I had only just gotten in!

The arrival of the midwives changed the atmosphere to one of  a busy bus stop.  Two arrived with a student midwife as I had said was ok in my birth notes.  The more experienced midwife, going by her age and demeanor, began to be busy herself with asking me questions and make notes regarding the birth.  I remember being asked what time labour started, when did my water break and in retrospect, my living room now took on the atmosphere of a busy room.  Not helped by having the main lights blazing, lighting it up like a supermarket.

Then we were waiting for the placenta.  I did not want to get out of the pool.  At first partly because I only in for 10 minutes now but also because I did not want to be touched by the midwives.  I didn't want anyone prodding and poking me and I was wary that seeing I was not the most compliant of antenatal mothers that they may be suspecting that I deliberately waited to call them.

I had a two or three strong contractions but then they died down.  I realised that really warm water could cause this to happen but I still did not want to get out.  The main midwife was sitting next to the pool, hovering, with the longest rubber gloves on, waiting for something it seemed.  I found the gloves a little ludicrous as I recalled the gloves vets used on farm animalsl, and she didn't touch the water and asked me to fish out the blood clot that was in the water which disappointingly for me was not a placenta!

My baby stayed in my arms quiet, peaceful sleeping or feeding.  It seems farcical now but this is what my husband calls a 'Mexican Standoff'.  They wary of me.  Me wary of them.  At some point someone had the good sense to turn down the lights.  The student midwife took advantage of the situation and fell asleep in a chair.  My friend, Fay, stayed quiet in the background.  She recalls sweating like crazy because the pool turned the living room into a sauna but for me the water was perfect.

Finally, I could feel the water temperature dropping and I had to make up my mind to come out of the pool.  I asked by husband to come from upstairs where he had gone to put my older child to sleep to come and cut the cord and then I asked Fay to hold my new baby so that I could climb out the pool.  This was my decision as being in the place I was, I was insistent that this 'bossy' midwife was not going to be the first person outside my family to touch my baby.

After 2 hours with no placenta.  The midwife announced stated quite firmly that if they don't use syntometrin and traction to remove the placenta then I would 'have to' go to hospital.  For me that was it.  The old hospital trigger made me acquiesce to what I think was a bullying way of getting me to concede to their policy.  I hated being touched by her to do this.  It is the one event that I would change.  I would at that point told them to leave and I would have waited at home, alone in the quiet of my time.   But also getting it over and done with won out and I endured traction and prodding by blocking my emotions.

Velamentous Cord Insertion
She looked my placenta over and then stated that it was very interesting and called the student over to look at it.  Of course this my curiousity piqued and I wanted to know why.  It turns out that it was a velamentous cord insertion placenta and she said that she had not seen one in years and that it was the best example she'd seen of one, even better than text books.  So naturally I asked to keep it.  Which I duly smelled, touched, and photographed as this wondrous thing with such power.

But it was good to get her out of my house.  They left at 8 am, handing me over to the community midwife, the team leader who told me that 'if they were busy I would have to come in'. She now praised me for having a 'fantastic' birth.

In retrospect, I feel like the arrival of the midwives brought the hospital to my home.  They wanted things done their way once they got there and it is hard to say 'no'.  A year later, chatting to Fay who by then had a newborn of her own, asked my opinion of the midwives.  I said one was very bossy.  It was now that Fay told me that, sotto voce, she had said to her, "I can see who is in charge here."  I do not know what or how I would have reacted at the time if I had heard that.

For me ultimately I had a hands off second stage which was important to me.  For days I felt like I was walking on a cushion of air.  It was like winning Olympic Gold.

Someone asked recently how do I feel about having an attended birth now, considering that I have had a healing birth and therapy for post traumatic stress disorder.  Despite everything I have said, I am a powerful advocate of births attended by midwives as that is how most women relax for childbirth and how they feel safe for birth.  For me, I have crossed the Rubicon.  I don't know if I can ever go back to the other side.