Perhaps the most egregious and unnecessary interference with the normal birth sequence is the separation of mother and baby immediately after birth. Even a ten-minute separation is too long during this critical first hour after birth—it prevents the natural nipple stimulation that increases the mother’s oxytocin, which will contract the uterus and prevent a postpartum hemorrhage. Instead of baby-provided nipple stimulation, hospitals are now routinely using synthetic oxytocin by IV or injection after the birth to control bleeding.
Similarly, early cuddling of mother and baby stimulates oxytocin production in the newborn, thus raising the baby’s body temperature to help with the adaptation to the extrauterine environment. A mother’s body is a newborn’s best warmer.
Because different personnel are involved in providing piecemeal care for mothers and babies, providers do not always see how their actions in one area may cause problems in another. For example, because obstetricians are not involved in breastfeeding issues, they may not realize that cutting an episiotomy hampers a woman’s ability to sit comfortably in order to nurse her baby. Likewise, pediatricians may not realize that separating the mother and baby right after the birth in order to do a routine newborn exam also interferes with breastfeeding. Nursery nurses often do not seem to appreciate the importance of minimizing the separation of mother and baby, and thus also unwittingly interfere with breastfeeding. They tend to ignore the World Health Organization’s recommendations to delay initial bathing of the baby until at least six hours after the birth, even though bathing can cause a baby’s temperature to drop so dangerously low that they do not return him to his mother for an hour or more.
I emphasize the hazards to the breastfeeding relationship because breastfeeding is so vital to a newborn’s well-being, reducing infant mortality by 20 percent. This is a huge health benefit, and hospitals should be taking the lead in tailoring their routines to support breastfeeding. But because the functions of caring for mother and baby are separated into the roles of maternity nurses (who care for the mothers) and nursery nurses (who care for the babies), sometimes the mother and baby are also physically separated. Most of the time, there are no lactation consultants in the hospital—they are often only available during weekday business hours. But babies need to be fed around the clock, and if a lactation consultant isn’t available to help a struggling mother/baby pair, it might become necessary to feed the baby artificial breastmilk with a bottle, which further interferes with successful breastfeeding.
Because the entire model of hospital birth is based on birth as a medical procedure, hospital staff seem to miss the fact that they are interfering in a delicate time in a new baby’s life. Perinatal psychologists describe the first hour after birth as the “critical period,” during which the baby will learn how to learn and whether or not it is safe to relax and to trust the outer world. This has tremendous implications for mental health and stressrelated disorders.
A Natural Process
There was a time when cesareans were acknowledged to be a risky surgery reserved to save the life of the mother or baby. Now even cesarean surgery has become almost routine. Some obstetricians and hospital administrators are advocating for a 100 percent cesarean rate as a solution to liability and scheduling problems that are inherent in providing maternity care. Unfortunately, cesarean surgeries increase risks for the mother and child. They also increase the risk for subsequent pregnancies, with higher rates of placenta previa and placenta accreta, and introduce a small but non-zero risk that a pre-labor uterine rupture could result in the baby’s or even the mother’s death.
When someone needs to be in the hospital receiving medical treatment for a lifethreatening condition, the risk-benefit trade-off comes in heavily on the side of benefit. But for women who are hoping to have a drug-free birth, it makes no sense to expose themselves and their baby to the various infection risks associated with simply being in the hospital.
Most people know that it is unwise to take a newborn baby out and about in public because of the risk of exposing the baby even to ordinary germs. It is an even worse idea to expose the baby to the antibiotic-resistant strains of germs commonly found in hospitals.
When a woman planning a homebirth needs medical care and care is transferred to a hospital-based provider, the phrase “failed homebirth” is often written in her chart, even if she goes on to have an outcome that is better than if she had started out in the hospital. I would like to propose the concept of a “failed hospital birth” as any birth where hospital procedures specifically cause more problems than they solve. When you consider hospital infection rates, surgical complications and the damage to the breastfeeding relationship caused by routine separation of mother and baby, we might find that close to 95 percent of planned hospital births are failed hospital births. They failed to support the mother in an empowering birth experience to better prepare her for motherhood, and they failed to satisfy the baby’s overwhelming need and desire to enter and adapt to the outside world as nature intended.
Our society has an obligation to improve maternity care services as much as possible. Consider that the countries with the safest maternity care rely on midwives as the guardians of normal birth, reserving risky medical procedures for cases of true need. “In the five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births,” reported Caroline Hall Otis for the Utne Reader. “More than half of all Dutch babies are born at home with midwives in attendance, and Holland’s maternal and infant mortality rates are far lower than in the United States…”
A Return To Midwives
The United States needs to return to a model of midwives as the default maternity care providers, reserving the surgical specialists for the highest-risk patients. We need to educate pregnant women so that they understand that the choices they make about drugs during labor affect their baby, just like the choices they make about drugs during pregnancy. We need to offer women realistic pain relief alternatives to dangerous pharmaceuticals; warm water immersion during labor provides risk-free pain relief that many women find as satisfactory as an epidural. (Mothers who are uncomfortable with the idea of water birth can easily leave the tub to give birth “on land,” while still deriving the tremendous comfort and safety benefits of laboring in water.) Hospitals need to develop new routines that protect mother-baby bonding and the breastfeeding relationship as if they are a matter of life and death, because they are.
Obstetricians would do well to practice according to the wisdom contained in the phrase, “If it ain’t broke, don’t fix it.” This means supporting healthy women with normal pregnancies in birthing at home if they choose, and encouraging women planning hospital births to work with them to minimize interventions that turn normal births into risky medical procedures.
About the Author:
Ronnie Falcão, LM, MS, is a homebirth midwife practicing for twelve years in and around Mountain View, California. A direct-entry midwife trained through a homebirth apprenticeship and a residential internship at Casa de Nacimiento birth center in El Paso, Texas, she was licensed in 1997 under the California Challenge Process through the Seattle School of Midwifery. Ronnie is editor of the Midwife Archives at gentlebirth.org/archives.
Her personal web page is gentlebirth.org.