The Better Baby Book (29 page)

17

The Best Way to Welcome Baby: A Gentle Birth

Whether you choose to have your baby at the hospital or at home, there are many things you can do to improve the experience for both mother and baby. Our recommendations in this chapter are designed to encourage your baby to stay in growth mode as much as possible through the birth process, transforming birth from a traumatic event to a comfortable time for the family with minimal stress. These things will make your baby's birth a gentle birth.

A Mother's Eyes

Right after giving birth, a mother is in a state of consciousness that's unlike any other. This state of consciousness usually follows immediately after the baby is born (that is, leaves the birth canal). There may be a brief period of involuntary uterine contractions during which a new mother can't engage in much physical voluntary movement. It is a way for the body to catch its “breath” after giving birth. Moments later, the new mother will look at her child and touch him and take him in her arms to initiate the first eye-to-eye contact. The baby's eyes are usually large and wide, due to the heightened level of norepinephrine released during birth.

This initial eye contact is an important part of early mother-baby interaction, and some research suggests it plays a significant role in a baby's development. Niko Tinbergen, who shared the 1973 Nobel Prize in physiology, studied autistic children by living with families who had an autistic child. He was convinced that a number of factors surrounding birth—like labor induction, anesthesia during labor, and delivery with forceps—may contribute to autism. He also believed that initial eye contact was a key factor for the baby's later social development.

Much of human interaction occurs with eye contact. Given that autistic children avoid eye contact with people, Tinbergen suspected that the disruption or prevention of eye contact between a mother and her baby right after birth might be a factor in autism. If a practice this simple might prevent autism, it is well worth the effort, although we are in no way convinced that autism is caused by, or even related to, eye contact. Regardless of its effect on health, the period of first eye contact is an extremely rewarding and special time for a new mother, and it certainly
feels
like something powerful and important is happening.

Self-Attachment

Self-attachment is the process by which a baby finds the mother's nipple on his or her own to breast-feed. It was first observed by a team of Swedish researchers in the 1990s who wanted to see whether newborn babies, when left alone on their mothers' abdomens, would find the breast and feed on their own. They observed that babies naturally know to crawl
up the mother's abdomen to the breast, which, after a brief investigation, they latch on to and begin to suck. The baby innately knows how to find the breast. The process usually took about fifty minutes.

Later research showed that letting your baby figure out how to breast-feed on his or her own can prevent feeding problems later. Babies who self-attached had few problems latching on to the mother later, and the mothers of these babies rarely had sore nipples or breast-feeding complications. Self-attachment is now common in Norway, Sweden, and parts of Canada. Self-attachment is most successful if mother and baby are relaxed and warm, and it should be learned right after birth, if possible. If circumstances cause you to miss the chance for self-attachment at birth, you can keep trying within a few days of the birth.

The Umbilical Cord

It's common for hospitals to clamp the umbilical cord almost immediately after your baby is born. This was not a common practice until the last hundred years, and even now it's only typical in “developed” countries. Early clamping can result in shock and has been associated with brain damage and autism. In addition, it's been associated with complications fatal to infants, like hyperviscosity syndrome (blood that's too thick), infant respiratory distress, anemia, hypovolemia (not enough blood plasma), and hypoxia (oxygen deficiency).

Early clamping is dangerous, because the umbilical cord is the baby's only lifeline until he or she starts breathing. If the cord is cut before it stops pulsing, the baby's supply of oxygenated blood will be cut off. It's much safer to wait until the cord stops pulsing and the baby's lung function has been established, which will happen within about fifteen minutes after birth.

Ideally, you should wait nearly an hour, until the placenta transfusion is complete. The placenta and the umbilical cord have been part of your baby up to this point, and the blood in the placenta and the umbilical cord is your baby's blood. Think of the placenta as one of your baby's organs. It doesn't make sense to amputate a live organ! We opted to let the placenta die naturally an hour or so after birth, then severed the cord.

If the cord is not clamped too soon, the placenta gives the remaining blood it contains to the baby. Another one-third of a cup per pound is transferred within just the first three minutes after birth. This means that blood loss resulting from early clamping isn't just an effect of birth, it's your baby losing blood. In
Care in Normal Birth: A Practical Guide
, the World Health Organization acknowledges that “late clamping (or not clamping at all) is the physiological way of treating the cord, and early clamping is an intervention that needs justification.”

Delaying the clamping of the umbilical cord may even boost intelligence—even a two-minute delay can boost a baby's iron level and prevent anemia for months. Infants deficient in iron display a lower cognitive ability than their iron-sufficient peers through age nineteen. We didn't clamp the umbilical cord early for either of our children. You can discuss the issue with your doctor ahead of time to make sure it doesn't happen.

If there are so many good reasons to delay clamping, why don't
doctors do it? The blood passing between the baby and the placenta through the umbilical cord carries oxygen to the newborn, preventing oxygen deficiency until the baby starts breathing. Many doctors believe that inducing a shortage of oxygen will cause the baby to start breathing. This is not necessarily so.

Another common belief is that delayed clamping causes jaundice. Many midwives who practice delayed clamping haven't observed this at all. They've observed the opposite: a lower rate of jaundice when clamping is delayed. Clamping the cord is convenient for hospital procedures and speeds up the process. It's also easier for a doctor to work on a baby who's having problems if the baby isn't attached to the mother. In these situations, however, cutting the baby's life supply is probably the very worst thing the doctor could do.

Water Birth

In a water birth, the mother sits in a tub full of warm water during labor. This can reduce the pain and make the mother more comfortable. Water birth seems to help the baby into the best position for birth. Mothers like the safety of having their own place in the tub, and the warmth of the water increases the blood flow to the uterus, which increases the blood flow to the placenta and provides more oxygen for the baby.

Some women stay in the tub for the entire birthing process. If the baby is born in the tub, he or she will, of course, be brought directly to the surface before the first breath. Since your baby is still breathing through the umbilical cord, being under water for a second or two after birth isn't dangerous at all. For babies, the transition from the womb to the air is actually far more comfortable when they get to spend a few seconds in warm water.

Caesarean Section

Unless there's an emergency, we don't recommend birth by caesarean section because it is one of the most traumatic birth processes possible, for both mother and baby. A 2007 study compared the risks and benefits of caesarean birth to vaginal birth. It found that nonemergency caesarean birth results in greater risk for mother and baby regardless of a mother's medical or pregnancy history. Women having C-sections had twice the rates of illness, pregnancy-related death, hysterectomy, blood transfusion, and admission to intensive care as women having vaginal deliveries. C-sections also resulted in five times the frequency of postnatal antibiotic treatment for mothers, which is likely to result in breast milk that is less healthy and perhaps even harmful for the baby.

For the babies, caesarean delivery was associated with double the rate of staying in intensive care after birth, and neonatal death increased by 70 percent. Only in the case of breech-birth babies did caesarean section result in a lower overall risk level for both mother and baby. We know that C-sections are sometimes necessary. What we don't agree with is the widespread use of preplanned C-sections when they're not necessary. As usual, nature's way is healthier and safer most of the time. Consult your doctor and plan a vaginal delivery if you can.

Home Birth: At Least as Safe as Hospital Birth

The latest research has found home birth to be extremely safe—often safer than hospital birth. We were a little surprised to see this, and we wanted to be sure, so we looked for research that found hospital birth to be safer than home birth. But the research we found wasn't statistically sound. In one study performed in Washington, the researchers' count of home births included unplanned home births, unassisted home births, and home births in which the attendants were poorly qualified. An Australian study included high-risk home births that were far from hospitals. This study is touted by those in favor of hospital birth even though the study itself did not conclude that hospital safety statistics were higher because the births were in the hospital.

Any study tracking the safety of home versus hospital birth should consider situational circumstances that apply to most home births: they are planned and attended by a professional midwife in an area where a medical team is available within seventy-five minutes. Research has shown that mother and baby have a safety margin of about seventy-five minutes for a surgical team to arrive if there's a true emergency. In 1999 a comprehensive review was done of all studies comparing home birth to hospital birth. The authors concluded, “No evidence exists to support the claim that a hospital is the safest place for women to have normal births.”

Since then, further research has only supported this finding. A 2005 study published in the
British Medical Journal
found home births and hospital births to have similar safety rates; in fact, the home births had fewer interventions and complications. A 2009 study conducted in
Canada observed the outcomes of thousands of planned, midwife-assisted home births and thousands of midwife- and physician-assisted hospital births. It found that the rate of perinatal death was actually higher for hospital births than for home births. Home-born babies were less likely to need resuscitation at birth or need oxygen therapy beyond twenty-four hours of age. While home birth presented no increased risk for the babies, the mothers actually benefited greatly from it. The women who had planned home births were far less likely to have obstetric interventions or adverse maternal outcomes like third- or fourth-degree perineal tears.

The Issue of Hospital Birth

When we thought about birth from the perspective of epigenetics, it became clear why hospital birth is riskier than home birth these days. Hospital births are rife with unnecessary interventions that create stress for both mother and baby, often traumatic stress. In short, hospital births are often far from gentle.

Unnecessary C-sections, epidurals, Pitocin (a drug used to induce contractions), and intravenous drugs are used in hospital births every day. Many of these procedures are toxic or otherwise harmful for a baby, especially during birth, which even under ideal conditions is a situation of extreme stress and even clinical shock for a baby. Epidurals can lower the mother's blood pressure so much that the baby is getting far less oxygen through the placenta, which can cause fetal distress and require an emergency C-section.

Pitocin can cause uterine contractions so strong they induce fetal distress, which can derail the baby's growth mode during his or her emergence into the world, one of the most critical developmental stages. The intravenous narcotic drugs given to mothers to relieve their pain affect the baby so much that he or she may not even begin breathing after birth. For this condition, there's yet another drug that hospitals use to get the baby to start breathing.

At home, women are free to give birth in positions that minimize stress on the baby: squatting, on hands and knees, or in a tub of warm water. Compare this with the stressful and painful position commonly used in hospitals, in which the woman lies on her back in the hospital bed (making birth occur against the force of gravity rather than with it). Birthing at home also gives the family members the chance to exercise their own desires or customs, such as the father catching the baby or the siblings being involved.

Beyond having to endure interference and drugs, babies born in
hospitals get infections four times as often as home-born babies, and those infections are more likely to be resistant to antibiotic treatment. This is serious, considering that more people (ninety thousand a year) die from hospital-acquired infections than from all accidental deaths combined (seventy thousand a year), including automobile crashes, fires, burns, falls, drownings, and poisonings. Another ninety-eight thousand people die every year from medical errors.

Mothers giving birth in hospitals are cared for by so many different people that the potential for miscommunication among them is great. One hospital even released a report detailing how a baby died as a result of miscommunication among hospital personnel. Many people are convinced that a hospital must be the safest place to give birth to a baby because of all of the equipment that's available. Yet if you are having a normal delivery, you do not need that equipment. And unless the right people are there to use the equipment, it's not helpful.

Most women go into labor at night. This is the time of day when there are fewer registered nurses and trained physicians available to use this equipment and more medical technicians are on duty, and they often know
how
to use the equipment but not necessarily
when
. A 2005 study found that a higher rate of neonatal death for babies born at night, and staff availability is a reasonable cause.