New Study into Skin-to-Skin Contact

This post by Science and Sensibility really says it all, but I will highlight something that I have thought of a lot:

The second lesson is that we most likely don’t know the extent of the harm the current package of newborn care causes because we haven’t measured it. When researchers observe “normal” newborn transition and mother-infant bonding behavior in a typical hospital environment, they are in fact observing how babies and mothers adapt to and overcome disruptions that may include early clamping of the umbilical cord, suctioning, and routine separation. However brief and benign these practices seem, they disrupt the normal adaptation that has been honed throughout evolution to ensure that our species survives. When “active management” of newborn transition is all we ever see, its effects become invisible. And when problems occur, these reinforce the dominant view that birth is intrinsically risky, when in fact these problems may arise from practices imposed on healthy women and babies right after birth – or, for that matter, in labor.

I’ve thought on this topic before, with things like the three elements of “active management” of birth — a shot of Pitocin with the birth of the anterior shoulder, immediate cord clamping, and umbilical cord traction. From what I’ve read, it appears that the “package” reduces maternal hemorrhage… but I’m unsure about the accuracy of these studies, because I wonder if they’re comparing two flawed systems, as opposed to comparing the physiologic manner of birth to an actively-managed birth. First, the package may reduce the amount of blood a woman loses; but whether or not the blood loss is troublesome is a different consideration altogether. It may be in third-world countries; it might not be in industrialized countries. Second, if women give birth in a horizontal (“stranded beetle” or lithotomy) position, it might have some negative effects on birth, which the active management package then corrects. But it wouldn’t have been necessary quite so often in the first place had the woman given birth in a physiologically normal position. For instance, gravity may help the uterus to contract or for the placenta to detach more quickly; or giving birth vertically may push more blood from the placenta into the baby with the birth (whether or not the cord is immediately clamped), which reduces the blood volume of the placenta, making it quicker and/or easier to detach. Clamping the cord immediately may trap an abnormally large volume of blood in the placenta, making it bigger and therefore more difficult to remove, which then “necessitates” cord traction. But this difficulty is not physiologically inherent, considering that the biological norm is for the cord to stop pulsing of its own accord before the baby is detached from the placenta.

Recently, I heard the question, “Do fish know they’re wet?” That’s sort of the angle I’m using when thinking about this sort of question. Do doctors and many other health practitioners even know what “normal” is? It is not up to the advocates of “physiological normal” to prove that they’re right; it’s up to the proponents of change, of interference, intervention, “improvement” to show that their theoretical way of management is actually superior. Until it is shown to be so, the physiological way should be employed. That is practically impossible, I know, in a hospital setting. The legal environment and concerns would never allow it; or else the malpractice insurance company would pitch a hissy-fit. But allow me to dream, anyway. It should be first proven that routine IVs, and enforced laboring in bed, and continuous EFM are beneficial and have no risks or negatives, before they are used on every woman. Since these are not physiologically normal, but are practically universal in many US hospitals, although never proven to have any benefit for the typical low-risk woman, it makes everything that follows afterward suspect — including what a typical birth looks like when a woman is lying down with her feet in stirrups, “purple pushing,” episiotomy rates, use of vacuum or forceps, risk of C-section, etc.

Still, the fact that studies demonstrate benefits with physiological normal, even when much of the environment of the study is decidedly abnormal…

if we see such remarkable benefits of skin-to-skin contact in the studies we have (however flawed), just imagine what benefits we might see if the contact truly was immediate, prolonged, and undisturbed.

8 Responses

  1. Do fish know they’re wet?

    I don’t believe they have any idea they’re soaked.

  2. Thanks for cross-posting. I really appreciate your take on it and am happy to see that what I wrote resonated. Your instincts are right – the context affects every single thing we study in obstetrics, and the result is that we can’t rely on research to tell us what normal really looks like. This goes for postpartum bleeding, length of labor, pain, you name it. We also can’t be sure if what is being offered to women and infants is any better than the “placebo” – i.e., intervening not at all.

    Thanks again!

  3. Do fish know they’re wet?

    I don’t believe they have any idea they’re soaked.
    Sorry, forgot to add great post! Can’t wait to see your next post!

  4. I am very fond of skin to skin, especially since it had it’s origins in neonatal care. Countries that are too poor to afford isolettes, would put the premature babies skin to skin on mom, and the mom would help regulate the babies temperature. If the baby became too cold, mom would heat up, if the baby became too hot, mom would cool down. I remember the first time I put a 500 gram, 24 weeker, skin to skin on mom. Harrowing, but amazing all at the same time. All the baby’s vital signs improved during the “kangaroo” care. We only interrupted the skin to skin contact when mom had to get up to pee!

    • RR, your comment made me think of this story, titled, “Mum saves baby’s life with cuddle” — a woman gave birth to a baby weighing only 20 oz., and she couldn’t bear the thought of her dying cold and alone, so she picked the baby up and put her on her chest, assuming it would just be until the baby died. Incredibly, the baby started breathing. And crying. And she lived. Gives me chills!

  5. I read a rant by DA about how MANA is stockpiling information on homebirths, but won’t release the data. Well, I hope that the legislative powers that be realize that this type of data could be an offset to all of those in-hospital studies. I think that this could be troublesome for hospital practitioners. For instance, it could re-write the average length of labor, normalize periods of non-progression, and show that 2-3 hours is a perfectly reasonable amount of time to wait for the delivery of the placenta. There are other factors among many which could also be measured like average blood loss without induction or augmentation, % of births in the caul, length of placental transfusion, time to first breath, preferred birthing positions, % of fetal distress without oxytocics, and of course, skin to skin benefits, not to mention establishing a truer rate for necessary c/s. Just entering the hospital is an intervention in itself, so these things and many more have a place in research, as does birth at home. Stating that this type of research could be done in hospitals or birthing centers is just laughable. The world would have to change it’s axis first.

    • Evie, yes it would be fascinating to look at these data. Of course (tongue in cheek), “we couldn’t rely on such data, because they’re just second-class midwives who don’t know enough to intervene when they should, so put a lot of mothers and babies at risk unnecessarily. Besides, all of these things you mentioned have already been studied at length (of course, you’ll have to look up the studies yourself, or just take my word for it) in large, random, multi-center trials, and show without a doubt that these interventions are absolutely evidence-based. *Of course* doctors use *only* evidence-based medicine!” [Did that sound enough like DA? :-)]

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