I learned that all human beings are mammals. All mammals hide themselves, isolate themselves to give birth. They need privacy. It is the same for humans. We should always be aware of this need for privacy.
~ Michel Odent
Despite the invention and development of many new technologies over the years, our bodies function in exactly the same ways as our ancestor’s did (virtually none of whom had any access to any birth technologies). Babies are still made the same way and women still have the same anatomy.
Despite what we are led to believe, our bodies work pretty well. They work in the same way they have done for millions of years. Our bodies have the same innate level of wisdom and survival features that they always have. The same ones that have allowed our species to successfully exist on this planet for hundreds of generations. When you really think about it, Mother Nature came up with a pretty fantastic design (although it may not seem like it) for pregnancy, labor and birth. When it all unfolds naturally, the concoction of hormones, emotions, reflexes and innate behaviors that evolve from both the mother and the baby, paint the most perfect picture.
Picture taken from http://www.wildheartwisdom.com
Unfortunately in our modern times we tend to paint our own version of this picture, which sadly, isn’t quite so beautiful!
Many of the routine procedures we practice in maternity units every day (many of which seem unrelated to breastfeeding), interfere with a mother’s own ability to produce the appropriate level of hormones before, during and after birth to facilitate a great start in breastfeeding.
You are probably already aware that the epidural is the most common form of pain relief in the United States. What you may not be aware of, are its unwanted side effects that can have an impact on getting a good start on breastfeeding. Before a woman can have an epidural it is necessary for her to start IV fluids, as one of the most common side effects of the epidural is a sudden drop in maternal blood pressure. The IV fluids need to be in place so that if this does happen, your blood pressure can be quickly recovered, otherwise this can result in a lack of blood and (therefore oxygen) being transported to your baby.
IV fluids can result in swollen breasts, making it difficult for your baby to be able to latch on correctly when feeding. If your baby is not latched on correctly, not only will that that cause damage to the delicate tissues of the nipple causing painful breastfeeding, your baby will not be getting an adequate amount of milk needed for them to grow and thrive.
Another common side effect of the epidural is the ‘epidural fever’. Women opting for epidural anesthesia are 5 times more likely to develop a fever during labor, than women with unmedicated births. This type of fever cannot be distinguished from a fever caused by a dangerous interuterine infection, which means it is likely to result in your baby being subjected to an array of blood draws, tests, evaluations, possible antibiotics, and even a lumbar puncture immediately after birth, which can be frightening. Prolonged separation and likely admissions to NICU, can prove challenging when breastfeeding. When you are separated, it is difficult to pick up on cues from your baby to know when they need feeding. In the normal scenario, a mother’s natural instinct is to stare, touch, listen to and smell and kiss her newborn baby (in the animal kingdom, mothers will also lick their newborns). We do all of these things for a reason. We use all of our senses to maximize the bonding experience. This experience heightens the levels of breastfeeding hormones Oxytocin (known as the hormone of love) and Prolactin (known as the mothering hormone) in order for us to get ready for feeding.
Oxytocin is also the hormone which causes the uterus to contract during labor. Oxytocin levels gradually increase throughout labor, and are at an all time high at the time of birth, which contributes to the euphoria and receptiveness that a mother feels towards her baby, usually after an unmedicated birth. A woman’s Oxytocin levels in the first moments after birth will be the highest she will ever experience in her life. This peak, is triggered by sensations of stretching of the birth canal as the baby is born, which does not occur when an epidural is in place. There is evidence to suggest that epidurals (and other pain medications, and planned cesarean sections) interfere with the normal bonding process, which in turn plays its part on the initiation of breastfeeding. Dr Michel Odent is a retired French Obstetrician and has written extensively on the hormones of birth.
Interruptions during the ‘Golden Hour’
The first hour after birth is often referred to as the ‘Golden Hour’. You may not know that what you and others around you do in that very first hour of your baby’s life can have a significant—even lifelong—impact on the bond you have with your baby.
Unfortunately in some maternity settings it is still common practice to see policies and procedures focus mainly on the medical side of a newborn’s health, putting the nature-nurture side second. Obviously some babies will need some medical attention after birth, but in the majority of cases this is not so. In times gone by, the following scenario was very common-the doctor hands the baby to a nurse who takes the baby to a warming table, examines him, administers immunization shots, injections or medications, takes him over to the sink for a good scrub down, puts on a diaper, swaddles the baby in a blanket and then takes the baby over to the proud parents so they can finally hold their new bundle of joy.We now know better, but this out of date approach still exists in some settings.
This initial hour is essential for optimal bonding and imprinting. Once the baby is born, they should be put directly on to the mother’s chest. This initial skin to skin contact helps to calm the baby and regulates their own heartbeat, breathing and temperature. For the mother, the work of labor generates changes in her brain chemistry that increase her desire for nurturing. Skin-to-skin contact with baby and suckling at the breast releases mothering hormones that are the basis for a mother’s intuition. The baby should be able to find the breast for themselves within the first hour. Research has shown that breastfeeding within the first hour improves infant survival and prolongs the duration of exclusive breastfeeding. This is also one of the Baby Friendly ’10 Steps to Successful Breastfeeding’. It is advisable to put off any routine procedures such as weighing the baby, examinations, the bath and immunizations for as long as possible, or at least after the ‘Golden Hour’. In some hospitals this may not be possible due to time pressures. Remember that you are entitled to decline anything you do not wish your baby to have.
Painting by Katie M. Berggren
Imagine stepping out of the bath naked in a big open room without a towel-You would feel cold very quickly. This is effectively what happens to babies when they are born, so it is important that they are dried off to prevent them loosing too much heat and dropping their temperature. Some babies (especially small or premature babies) have a hard time maintaining their temperature in the first 24 hours of life. Exposing your baby the the bath too early can be too much for some babies, and can cause them to drop their temperature too low. Babies have an immature thermo-regulation (temperature control) system, which can become easily off balanced. If a baby becomes too cold, they will have no interest in feeding. If a baby’s temperature becomes very low they can develop hypothermia, which is cause for concern.
Giving a baby a bath before they have had chance to get a really good breastfeed, can also interrupt Mother Nature’s design. Using soaps or fragranced baby wash products, washes away that yummy newborn smell. Mother Nature made newborns smell so perfect so that mother’s could use their senses to enhance the bonding and breastfeeding experience by increasing her levels of Oxytocin. The smell of the amniotic fluid on the baby helps with imprinting and bonding for both Mom and Dad.
On the flip side of the coin, a mother getting up to shower before the baby has has a good feed, can also interfere with breastfeeding initiation. Using body wash or soap on her breasts washes away some of that primal smell and attraction for the newborn. It makes finding the breast and the nipple harder for the baby because the smell of the milk is no longer as strong. If you do want to get up to shower before you have had chance to breastfeed your baby, I would encourage you not to use any soaps or lotion on your breasts.
Circumcision & Immunizations
The practice of circumcising newborn boys is still widespread in the United States. However, there is no compelling evidence to support routine circumcision. The American Academy of Pediatrics (AAP) now states that circumcision cannot be justified on medical grounds. The British Medical Association (BMA), ‘considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it’.
It is important to note that this surgical procedure is not always done with a local anesthetic, and even if it is, the experience is usually both painful and extremely frightening for your baby. This experience causes high levels of stress hormones in the baby, which increases their heart rate, and initiates their ‘fight or flight’ response. This suppresses the high levels of Oxytocin that normally trigger their innate impulses to seek the breast.
If you are planning for your baby to be circumcised, I would encourage you to postpone this procedure until breastfeeding is well established. Sometimes painful and frightening experiences too soon after birth, can cause sensitive newborns to become too tense and distrustful to be able to feed at the breast.
The same goes for immunizations. With Moms being discharged earlier and earlier from hospital, it is common place for these procedures to happen very early after birth. Immunizations and injections are nearly always painful for the newborn, even if they are only momentarily, and they can still be frightening, depending on the nature in which they are performed.
(Lack of) Rooming-In
Baby Friendly step 7, involves practicing 24 hour ‘Rooming-in’. This means that you and your baby share the same room, instead of the baby being separated and put in a hospital nursery and brought to you for feeds. Around 50 years ago central nurseries used to be common practice, allowing mothers to rest after the birth, while nurses and doctors kept an eye on the baby. Although this sounds like a great idea, Dr Marsden-Wagner called this practice, ‘the biggest pediatric mistake of the last 100 years’. There are a number of problems associated with this practice-mix up of babies, interference with the development of a mother’s self confidence in caring for her baby, increased anxiety from the mother (leading to less sleep in fact), possible delay in a mother’s milk ‘coming in’, as well as interference with successful breastfeeding and depriving a mother the chance to bond with her baby. Having your baby placed in a nursery, inevitably means less skin to skin contact between mother and baby, which results in less Prolactin (hormone needed to produce milk) which in turn results in less milk production. It also increases the likelihood of well-intentioned (but ignorant) care providers giving your baby supplementary formula milk to keep the baby quiet while you rest, which again results in less Prolactin and less milk. Your milk supply works on a supply and demand basis. If you look at the extreme, at a mother who has no desire or intention to breastfeed, she will not put her baby to her breast to feed. Over time her body realizes that there is no demand for the milk, her Prolactin levels will decrease and her body will not supply any milk. The more times your baby is put to the breast and the more they suckle (even if they are not feeding at the time), the more this tells your body that the baby needs more milk (the demand is increased), which results in a greater milk supply.
Rooming-in allows you to have as much skin to skin contact with your baby as possible, and it means you can breastfeed as many times as you like-the way nature intended. Your baby will be more content and will cry less knowing you are close by, and actually you will get more rest and sleep, because having your baby beside you will stimulate higher levels of stress-reducing hormones, which will help you sleep better.
Note Baby Friendly states 24hour Rooming-in. Despite recommendations from the American Academy of Pediatrics (AAD) some hospitals still do not offer Rooming-in, or will offer ‘modified Rooming-in’, where your baby will spend most of the time during the day with you, and will be taken to the nursery during the night.
The optimal breastfeeding environment will offer you uninterrupted time, privacy and respect for both you and your baby after birth, and will provide support to help you solve and overcome any problems which may occur.
Wherever you choose to give birth, I would encourage you to ask your care providers what their normal birth practices are.
Painting by Katie M. Berggren
- The Baby Friendly Way (smiffybaby.com)
- Birth Practices Which Interfere With Breastfeeding (smiffybaby.com)
- Breastfeeding Resource for all Mothers (smiffybaby.com)
I’m really excited as a Midwife and a Doula, and someone who loves all things birth, about the launch of this new project. I’m equally excited that the 2 front runners of this project are Brits!! 2 wonderfully passionate film makers Toni Harman and her partner Alex Wakeford, inspired by their own childbirth journey, decided to launch a new global film project about birth-a video website aimed at birth professionals (and anyone else interested in birth) to empower women to believe that they CAN give birth fully informed of their choices.
What’s great about these videos is that they offer credible evidence-based information and opinions from leading birth experts around the world. Toni and Alex have not just filmed anyone, they have filmed many of the BIGGEST, most influential names in the business, including…Ina May Gaskin, Sheila Kitzinger, Michel Odent, Elizabeth Davis, Debra Pascali-Bonaro, Cathy Warwick (RCM), Mary Newburn (NCT), Marilyn Curl (Lamaze International), Dr Sarah Buckley, Professor Soo Downe, Professor Lesley Page, Professor Cecily Begley, Professor Kerstin Uvnas-Moberg, Professor Ngai Fen Cheung, Associate Professor Denis Walsh and lots more leading midwives, academics, obstetricians, authors, doulas, birth educators and birth warriors around the world.
The One World Birth website launched today, is a fantastic video resource aimed at birth professionals, campaigners and parents who want to place their finger right on the pulse of what is happening in birth today. It’s an on-going, online TV channel about birth. The idea is that people like you and me use the site as a ‘grab bag’, taking clips that interest us and spreading the word via as many different social media mediums as possible. They want us to post their clips on Facebook, Twitter, Google +, blogs…wherever, to get as much exposure to this information as possible. They want us to power the revolution in birth! Stand up and shout, wave our hands and make our voices heard! The only way the wheels of this revolution will really get moving, is by uniting all of the voices around the world. We need to build a strong, powerful community of passionate followers in order to create a global movement to make change.
They’ve done their bit, let’s do ours!
Save Birth, Change the World.
Join them today at www.oneworldbirth.net