Birth and Breastfeeding: Looking Back as We Ring in the New Year

I’ve been thinking about the passage of time as we slip into a new decade. I was a doula at my first birth in 1992; that baby recently turned 27. The same year I started teaching prenatal classes for what was then Harvard Community Health Plan; I taught families there for 25 years until they eliminated their Health Promotion department. In all this time, pregnancy, birth, babies, and breastfeeding have lost none of their magic. Watching couples transform into parents and discover new strengths in themselves and each other, while being humbled by the awesomeness of birth and parenting, as they learn to care for a tiny human, will never grow old. Every baby is a miracle.
We have family-centered cesareans now, with babies breastfeeding during the surgery, something I once couldn’t have imagined. Milk banks are back and some NICUs are now exclusively feeding human milk. Informal milk sharing isn’t new, but Facebook groups have made it possible in new ways. More people initiate breastfeeding. Geez I remember when there was only one size pump flange available.
But the cesarean rate has gone up over 60% since I started this work. Midwives who gave me my early training lamented that the hospital cesarean rate was 20%. How we wish it was that low now. The rate of inductions is higher than ever. I’ve watched us spend more and more money on perinatal care as our maternal and infant mortality rates climb.
I have watched many wonderful doulas and midwives suffer trauma from seeing how some hospital staff treat laboring people and newborns and burnout from long hours, unpredictable schedules, and inadequate financial compensation. I’ve laughed and cried with colleagues as we discuss how to make it better for one family at a time. Must we work like the child on the beach throwing one starfish at a time back into the ocean?
I’ve been a birth professional for almost 3 decades now. Over that entire time I have heard delayed cord clamping, delayed first bath, declining the eye erythromycin, the healing properties of human milk, the physiology of cosleeping, and the harmful effects of epidurals and pitocin discussed as new ideas. They say it takes an average of 17 years for research evidence to reach clinical practice, but at 27 years and counting, I can tell you it can be much longer than that.
To all the dedicated doulas, childbirth educators, lactation consultants, nurses, and midwives thank you for all that you do for families. Here’s to a happy new year and a decade of improvement for perinatal families.