Tuesday, June 8, 2010

Mothers Yearn for Their Babies at Birth

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I have been caring for newborns for over 20 years. I make a point of asking moms about their babies’ births and listening to their stories when we meet. The long term relationships I have developed with many of these families has led me to conclude that birth has a profound impact on the ease with which a mom adjusts to mothering her new baby.

Mothers are usually eager to share and process their birth experiences. Moms speak of their emotional responses as well as the basic descriptions of interventions and types of births. The emotions around birth range from blissful pride and awe to profound sadness and disappointment, even when the moms’ feelings have been dismissed because their babies are healthy. 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. I have noticed the hugely positive impact of keeping moms and babies together at birth on breastfeeding, bonding, and mom’s self-confidence and emotional state.

How many breastfeeding problems could be prevented if we facilitated this close contact at birth?

Dr. Michel Odent, a French obstetrician and author of such books as Birth Reborn observes, “It has been my experience, in thirty years of obstetrics, that when a mother and her baby are allowed to be alone together in the first two hours after birth the mother will learn how to put the baby to her breast correctly, without anyone’s help.”

Most of the time moms and babies have been separated at birth for routine procedures. Progress has been made in many settings where routine procedures are delayed but often only when the mom knows and remembers to request it. Far more progress has been made in this area for vaginal births than for Cesarean births over the years in my community. With approximately one-third of all births being by Cesarean, mom-baby contact needs to be optimized in our operating rooms as well as our birthing rooms.

I would like to emphasize the role of the doula in keeping mom and baby together at birth and after. A doula is there for mom, believes in mom and supports mom in all her efforts and supports those present at her birth. Doulas have been found to positively impact labor, birth and breastfeeding. I believe this is because of the combination of their steadfast belief in mom, expertise, and focus on mom’s needs, and the ability to follow her lead and not to interfere with her unique process.
I have found myself incredibly frustrated and saddened by the unnecessary separation of mothers and babies at birth. Skin to skin contact at birth is what mothers desperately want and I have wondered why they have been denied this immediate skin to skin contact that is so beneficial to both mom and baby.

In terms of hospital staff I want to respect the huge demands on their time and the need to complete the overwhelming number of tasks at hand. In terms of surgeons and anesthesiologists, I want to respect their comfort zone as they have a huge responsibility and must dictate policy. So how do we convince these incredibly overworked professionals to make difficult adjustments in the way they have been practicing for years?

I have thought: Seeing is believing. Listening to moms will speak to their hearts. They can adjust and will be motivated to make it work.

So I began my search for images of moms and babies skin to skin and/or breastfeeding in the operating room. Recently, with the help of Preparing For Birth, Mother’s Utopia, and Amy Romano of Science and Sensibility, I was alerted to a blog post with a photograph and a mother’s story of meeting her baby in his "birthday suit" in the operating room, and the video below that shows a baby skin to skin with his mom and feeding at birth in the operating room. I posted these and asked for moms’ comments. I am hoping that the images and comments help moms get that yearned-for closeness at birth when possible and that health care personnel become comfortable with the adjustment in procedures necessary to make this happen.

For more information:

A medical journal article presenting modifications of Cesarean birth procedures with a description of how to do skin to skin in the OR: “The natural caesarean: a woman-centred technique

For more beautiful images of babies and moms skin to skin at birth, its benefits and to hear from moms about what it meant to them, check out this video:

Keep Your Baby With You After Birth – Lamaze Healthy Birth Practice 6

Here is a sampling of some of the comments from moms about skin to skin contact at birth.

This one from a dear friend and colleague Anne Samojedny, PT cranial sacral therapist. Our professional relationship began after finding ourselves together in our first course in cranial sacral therapy together over 10 years ago. We co-treat patients and find that the birth experience has a huge impact on breastfeeding and much of our cranial work is devoted to healing birth trauma.

I sent her the video and her response was:
“This is really beautiful. I can relate. When my C-Section experience came up during a cranial session, my therapist asked me what the experience was like. I said I felt like I had been crucified. It was frightening and humiliating to be "tied up" on the arm boards. My experiences certainly have influenced my practice.”
These comments from Breastfeeding with Comfort and Joy facebook page:

Katherine Sims Roberts -
… needing an emergency C-section, something that I had not prepared for at all. To this day, the thing that still pains me the most is that so many other people held/touched him before I did. ... I absolutely believe that had I been allowed to have skin to skin contact right away instead of delayed by 45min to an hour or more, our nursing relationship would have been much easier from the very start, and that the memory of those early minutes/hours would not cause me so much regret and pain.
Anne DeAtley
… right after the surgery they held Alex over the curtain and b/c they hadn't restrained my arms I reached up to touch my baby and was quickly yelled at "Don't touch him!" and he was whisked away. …
Carrie Lyn Woods-Bryant
I had 3 c-sections and had trouble getting breastfeeding started with all three. Especially my third. I did go onto breastfeeding successfully and for extended time with all 3. But I feel that had I been allowed to have skin to skin and be allowed to breastfeeding on the table, I would not have had such a difficult time getting started in addition to having a difficult time with bonding. My c-sections were extremely emotionally painful for me and if only doctors would get on board with just how important it is for the woman and the baby to have this first very important contact.
Tracye Kingsley Mason
Skin to skin is divine perfection.
Babies Fouroneone:
What a great video! Thanks so much for sharing this! Will show to our director and hope to implement this!
Sarah Stoddard-Gunn:
What a beautiful video. The most painful part of my daughter's delivery was being unable to see, touch, or breastfeed her. She was perfectly healthy, yet I was told that skin-to-skin contact was "impossible" until I was in the recovery room. I may send this video to my old providers.
Stork Stories post: Skin to Skin Minutes after C/S in OR … Speaking Up and Making it Happen (A must read: An ob nurse with 35 years experience shares her efforts in keeping moms and babies together at birth in the OR with an amazing story of a mom, vocal and adamant about what she wanted, ensuring her baby was ON her at the moment of birth.)

Comments from the Stork Stories post:

from Mamalade: I had a c-section 8 months ago and had this been me I would have avoided many many months of painful flashbacks, therapy, and nightmares. You probably single-handedly turned this scary and deeply traumatic event into a wonderful, if disappointing, birth story. I wish more medical “professionals” were as wise and caring as you. Please continue to speak your truth and help women bring their babies into the world as they were meant to.

from VK: I wish you had been at my section. I argued for skin to skin until they let my baby get cold and then they had an excuse to put him in an incubator and call him ‘ill’. I didn’t see him again for 6 whole hours. It was agony and it still gives me nightmares where he dies and they give me a different baby because I am screaming and screaming for him…Even poorly babies do better on their mums, so why is our birth culture so barbaric?
As a final note, I want to emphasize that we must make every effort to keep moms and babies together not just in the immediate postpartum time, but also in the days and weeks after the birth as well, so that mom can recover and she and her baby can establish breastfeeding with the greatest ease possible. Ideally, moms’ responsibilities should be limited so that they can be with their babies and not distracted by household duties, child care, and dressing for visitors.
In support of this practice, Camila Alves speaks at Celebrity Baby Blog about the tradition in Brazil of allowing for downtime after giving birth: “We call [it the] 40-day break after the baby.”
And also from CBSNews.com producer, the story of his baby with the inability to move his facial muscles, being able to establish breastfeeding after weeks of mom and baby working together on their own. It speaks to the expertise of parents and the importance of keeping mom and baby together after birth.

Update: This blog post is part of the Healthy Birth Blog Carnival #6 MotherBaby Edition. For more insight and information on keeping mothers and babies together at birth hear from other bloggers at the carnival here.