Healthy Birth Blog Carnival #6: MotherBaby Edition

We've hosted Blog Carnivals for each of the Lamaze Healthy Birth Practices at our sister blog, Science & Sensibility.

This time, we're bringing our 6th Blog Carnival to Giving Birth with Confidence.  As usual, the bloggers offered up such insightful, thoughtful contributions and I believe yet again that we have one of the best collections on the topic out there on the internet!

Why does keeping moms and babies together after birth matter? Because separating moms and babies is harmful.

 Kimmelin Hull at Writing My Way Through Motherhood and Beyond writes:

The research on this issue is crystal clear: babies do better in the first minutes, hours and days, the more time they spend in skin-to-skin contact with their mothers. Their breathing and heart rates remain more stable. Their body temperatures fluctuate less. Ditto for their blood sugar levels. They cry less and they nurse and sleep better, too."

All of this just from putting our newborn's baby against our own? Kristen at Birthing Beautiful Ideas says it simply (and beautifully): Women have superpowers!

Perhaps babies have superpowers, too. The power, that is, to protect their mothers from postpartum depression. Lauren at My Postpartum Voice discusses the amazing health benefits for preterm or low birthweight newborns who experience "Kangaroo Care" -- skin-to-skin contact with their mothers in the neonatal intensive care unit. Research also suggests that Kangaroo Care offers protection or relief from postpartum depression. Lauren reports on a study in which no mother developed depression during their Kangaroo Care stay.

Research aside, what about common sense? From the baby's perspective, the "maternal environment" represents a familiar landscape in which to feel safe and avoid distress (which has well-documented physiological effects.)

Danielle at Informed Parenting describes the moments after birth from the perspective of the baby held skin-to-skin:

Then suddenly he is enveloped in warmth, laying wet and slippery on his mothers chest. He hears it- the beating of his mothers heart. He hears her voice, so clearly for the first time. He knows what he needs and he seeks out that attachment, the physical bond to tie them back together. Little toes flex and dig into his mother soft belly as he wiggles and squirms forward, his little mouth open and questing. The sound of her voice draws him forward. Her arms support him in his journey. In a feat of strength and coordination that is truly amazing he reaches his goal and re-establishes their physical bond. As he suckles her nipple, drops of liquid gold land on his tongue.

Mamapoekie at Authentic Parenting describes a similar scenario, and then contrasts it with the far more common scenario:

You are being pulled away from the one smell and feel you knew to again another entirely different setting. They prick you and it hurts and they rub you down and put stuff in your eyes, it stings even more than the light! You are starting to feel very desperate, very helpless.

From the mother's perspective, we yearn for closeness with our babies, to take in every detail of their newborn bodies. After all, we've worked so hard to grow and give birth to them.

Molly at first the egg writes that while the yearning instinct is deeply primal, yearning is not part of birth when mother and baby are kept together. With gorgeous pictures from her own birth in 1981 and her son's birth in 2006, Molly shares,

My mother had to yearn for closeness while she fell in love with me. I am so grateful that, twenty-five years later, my newborn and I got to have it.

And from the family's perspective, keeping mother and baby together in the hours and days after birth helps them develop a rhythm together and begin to bond and grow as a family. Lauren at Hobo Mama wrote:

Sam, Mikko, and I stayed together from the time we entered our room, three hours prior to the birth, until we all exited as a new family two days later, and it was absolutely the best way I can think of handling it.

boheime at Living Peacefully with Children believes that both birth and bonding are easiest when the mother feels well cared for, and can simply be with her baby to find the right rhythm. She relies on her very willing husband as her primary support for both.

With the birth of each child, he has taken off 2-3 weeks from work in order to cook, clean, and help out however I need him. It's because of his support that I have been able to focus on getting to know each of our children, establish breastfeeding with them, and not feel as though the entire house has fallen apart.

With so many documented harms from mother-infant separation, not to mention the primal urge for mothers to hold their babies, routine separation of mothers and babies is a mainstay of modern obstetrics, and may give rise to the epidemic of breastfeeding problems.

Sheridan at the Enjoy Birth Blog remarked that her students who have given birth before are among the most surprised that mothers are "allowed" to have their babies with them right after birth. She writes:

It is shocking to me how many moms who are taking my Hypnobabies class for the 3rd or 4th baby and they are amazed that they have the option of keeping the baby on them for an hour or two.

Lamaze educator Nicole VanWoudenberg who blogs at A Little Bit of This and a Little Bit of That was in fact one of those women who didn't know about the importance of immediate and close contact after birth until after she had had several babies. She describes her first and last births. After her first birth:

They cleaned her up, weighed and measured her, gave her the vitamin K shot, the eye ointment and whatever else, I was stitched up and approximately 45 minutes later, I got my burrito-baby. Seriously, she was diapered and all wrapped up in towels!! I did not know better, and left her like that while "bonding" with her. Did I have breastfeeding issues? Absolutely. Are the two connected? Absolutely.

For her fourth baby, born at home, she recalls:

I didn't wait 45 minutes to receive my son. I birthed him and brought him up to my chest, for skin to skin snuggling myself. And there he stayed while we marveled at the wonder of birth, and his appearance! I only let him go while I got out of the pool to birth my placenta. As soon as I was settled on the couch, he was back in my arms, skin to skin - starting to nurse. He breastfed the best, and the longest of all four of my children. Are these two things connected? Absolutely.

Molly at Talk Birth discusses the Birth-Breastfeeding Continuum in her post. She writes:

New mothers, and those who help them, are often left wondering, "Where did breastfeeding go wrong?" All too often the answer is, "during labor and birth." Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed.

Kmom at The Well Rounded Mama reviewed the research surrounding "Baby-Friendly" practices, points to a study that reported only 8% of babies actually experience the six Baby-Friendly practices, and then examines breastfeeding issues in women of size. She writes:

The role of aggressive birth interventions in the lower rate of breastfeeding among obese women typically goes conveniently unexamined in the research. Breastfeeding failure is blamed solely on fatness, when in fact, the high level of interventions in obese pregnancies and births may also play a significant role.

Laura Keegan, author of Breastfeeding with Comfort and Joy writes about the birth stories of women she works with in her practice. "A common theme in all of these stories has been the shock from the denial of contact with their babies or the importance of having that yearned-for close contact at birth," and asks, "How many breastfeeding problems could be prevented if we facilitated this close contact at birth?"


Hobo Mama and her babe.











So, why are women and babies separated? Usually for routine care. But it doesn't have to be that way.

Sheridan at the Enjoy Birth Blog is one of several bloggers who remind us that nurses can do everything they need to do for a healthy baby with the baby in the mother's arms. She writes, "I understand that nurses have jobs they need to get done, checklists to mark off, but this time is so precious and these routines can wait!"

Fortunately, a new video has just become available to train hospital staff to incorporate skin-to-skin contact after both vaginal and cesarean births. Jeannette Crenshaw reviewed it on Science & Sensibility.

Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital:which "sets the stage" for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom's abdomen. After the cesarean birth, the nurse immediately places the baby on mom's chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby's father is at mom's side in both segments...Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

Also on Science & Sensibility, I discuss a new vital sign for nurses to document after birth, the duration of skin-to-skin contact. I argue that this data may help hospitals comply with new Joint Commission perinatal quality standards.

If hospitals are serious about improving their exclusive breastfeeding rates, they should get serious about measuring the duration of skin-to-skin care. A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge.

The Nurse Blogger at At Your Cervix looks at how weighing babies can be done more humanely, when the time comes (after skin-to-skin contact and breastfeeding). She vows to start weighing newborns in the prone position on soft layers of blankets and states the expected outcome of her new approach:

newborns in the prone position while being weighed, lying on soft blankets, will be more content, with decreased startle reflex, as evidenced by reduced or absent crying.

Let us know how it goes, At Your Cervix!  Or better yet, publish your results!

Dionna at Code Name Mama points out that circumcision is another common reason mother and babies can be separated, and is not medically necessary.

The reason that American medical associations (and the vast majority of medical associations worldwide) do not recommend routine infant circumcision is because it is not medically necessary. And as the Lamaze Healthy Birth Practice Paper #6 details, "experts agree that unless a medical reason exists, healthy mothers and babies shouldn't be separated after birth or during the early days following birth." Consequently, unless there is a medical reason to circumcise your newborn son, it is inadvisable to agree to this unnecessary medical procedure.

Cesarean surgery is another major contributor to mother-infant separation after birth. But if this Blog Carnival has achieved anything, it has been to get the blogosphere talking about the fact that skin-to-skin contact is possible immediately after cesarean surgery. A powerful video emerged and was passed around in several of the bloggers' contributions and on Facebook and Twitter:

Kathy at Woman to Woman Childbirth Education asks, "If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility?"

CPN at Cesarean Parent's Blog got skin-to-skin contact with her baby after her cesarean without even asking for it, and didn't know what a gift it was until after learning that this is not standard practice. She compares her experience to the typical experience in "reality" TV shows about birth, noting that OR staff do not just separate babies from their mothers for assessments, but for "silly things&, such as having foot prints taken, diapering, and tight swaddling, all before baby gets to meet their mom."

Birthing Goddess also wrote about the care of mothers and babies after cesarean birth, including the importance of a "Baby Moon" and plenty of support during the longer recovery.

As much as I wish every woman to experience a truly undisturbed and gentle birth, I also know that as of today, close to one out of three women in North America gives birth in the OR. It is up to us to demand things to change for the sake of our children, up to us to bring back a more humane and healthy perspective on birth. Hospital policies can be changed, but the consequences of risky practices for our children can't. As a community, we can also support our fellow moms who have gone through a difficult birth, help them adjust to motherhood and their new babies, without judging, with compassion and care.

A system that pits babies' needs against those of mothers give poor care to both.

 Molly at the Citizens for Midwifery Blog muses about the phrase Maternal-Fetal Conflict and discusses the need for terminology that accepts mothers and babies as interdependent:

I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto--or, motherbaby--the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what's good for one is good for the other).

The blogger at Thoughtful Birth discusses bonding as an act that involves both the primitive brain and the rational brain, and happens easiest when the birth and postpartum settings facilitate the woman's integration of the two.

Certainly the ability to override the physical is an amazing skill that allows a woman to overcome a traumatic birth to bond with her baby, or even to bond with an adopted baby. But when we take it for granted that a mother will use her powers of reason to bond with her baby no matter how much we abuse their relationship, we ignore the way the emotional, physical, and spiritual sides of ourselves participate in the birth and bonding process. Pregnancy and labor involve neurochemical and physical changes that make it easier for us to be mothers, and that emotional and hormonal dance does not end with labor.

Michelle at The Parenting Vortex suggests that what happens in the moments right after birth remains a mystery to many pregnant women, but these moments represent a major life transformation for both the woman and the baby, who now become separate but interdependent beings. She writes:

Reforming birth practices in countries where birth has become a highly medicalized event means recognizing birth as a multi-dimensional, life changing event for all members of the family. When birth is recognized and honoured as an emotional, spiritual, transformational AND biological process, then the importance of keeping a new baby and mother together will become more apparent.

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