Skin-to-Skin in the O.R. after a C-section

Being born vaginally is good for babies, in part because it colonizes them with the mother’s good bacteria, setting them on the road to health; a C-section bypasses this normal process and may be part of the reason why babies born by Cesarean have higher rates of things like asthma. But putting the baby skin-to-skin with the mom, especially after a Cesarean, can restore some of this good colonization; otherwise, the baby will be colonized only with hospital bacteria. Skin-to-skin contact is also beneficial in facilitating breastfeeding. Typically, when babies are born, they have an innate ability and desire to get to the breast and self-attach; wrapping babies up in a blanket like a burrito prevents this. All too often, whether the baby is born vaginally or by C-section, babies are only briefly shown to the mom right after birth, and then are taken across the room for the newborn assessment and procedures, before finally being returned to their mothers securely swaddled in a hospital blanket. Then, many times, babies are taken to the nursery soon after birth for a bath, then kept in the nursery under the warmer for a few hours to warm back up, and then finally taken back to their mothers… just in time for them to fall asleep for a few hours. But it doesn’t have to be that way. Healthy babies can — and should — be placed skin-to-skin with their mothers immediately after birth, even with a C-section.

Update: Here’s a video showing skin-to-skin after a C-section


If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility? If you are a nurse or midwife, do you ever put babies skin-to-skin on their moms, even if they have a C-section?

Weigh in on this topic on the Breastfeeding with Comfort and Joy fan page [currently, it’s the most recent post, dated May 28]. Laura Keegan, the author of Breastfeeding with Comfort and Joy, will be giving Grand Rounds in June/July, so will have the opportunity to talk about this important topic to attending physicians, L&D nurses, and residents in OB, pediatrics, and family practice. She would love to have input from women about their experiences with skin-to-skin contact (or the lack thereof) after both vaginal and Cesarean births, to pass along to the doctors, nurses, and doctors-in-training. What did it mean to you to be able to hold your baby with nothing between you, and just a blanket put over both of you? What did it mean to you to be denied this? Please comment on the fan page post, and also spread the word (blog, share on facebook, Tweet about it, etc.), so that doctors and nurses can find out from you and other women what they otherwise might not hear.

Advertisements

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.

Two Great Posts in One

Kangaroo Care (snuggling a premature infant skin-to-skin 24/7) has been a topic I’ve meant to research and write about. But this post has an article which sums it up nicely. Why reinvent the wheel? — just go and read it.

Also on that post (the first half of it), it talks about another topic related to premature infants that I’d never thought of before: additives, including alcohol, dyes and sweeteners, being given to premature infants at amounts much higher than they should receive for their weight. The article urges that medicines given to premies be manufactured in forms that are free from unnecessary additives. I guess I assumed that most medications would be given through an IV; but it makes sense that if a premature infant needs a medication that is available in oral form, that it would be given it. Unfortunately, a lot of these medicines contain too much of bad things, including alcohol, red dye and aspartame. Can anyone explain why a medication given to a child of, say, less than a year old need to include dye? The purpose of the dye is to make it look tasty and palatable, and I don’t think infants really care that much; even if older infants do, premies likely never even see the medicine coming, so certainly don’t need for it to look pretty. Sweetness is an acquired taste, to a certain degree. While the human tongue is attuned to sweetness, medicines don’t have to be sweet (a spoonful of sugar, à la Mary Poppins) to make it go down — especially babies too tiny to fight nasty-flavored medicines going into their mouths. May not be pleasant for the wee babes, but they really can’t struggle too much, the way a child of even six months can. Besides, things are overly sweetened these days — and I say that as someone with a very developed sweet tooth! (I’ve recently given up sugar, and am surprised at how sickeningly sweet my kids’ jam is on their PB&J; I never used to notice it.) Even if these babies can taste well, and should be given stuff that is palatable, it doesn’t have to be as sweet as it is made in order for them not to dislike it. And don’t even get me started on alcohol for infants! Here we have pregnant women who risk society’s wrath if they ever take so much as a sip of an alcoholic beverage while pregnant, yet these babies (who should still be gestating but were born too early) are getting alcohol straight from their medicine, not even diluted via the mother’s blood-alcohol content. Kinda makes ya think, hmm?

So, if you are pregnant now, or know someone who is, or are planning on having more children in the future, go read this article, because there is always the possibility that you will have a premature baby (even if you think you won’t because you’re so healthy or you’ve never had a problem before, you could be involved in a car wreck and have the placenta dislodged — rare possibility, but still there — so still read it). Many hospitals may be unfamiliar with kangaroo care, and tell you instead that the babies need to be left alone so that they reduce the risk of infection. That is a consideration, but one to counterbalance against all the benefits of kangaroo care laid out in the article. At least read the article and discuss it with your care-givers. And nurses may also not even think about all the additives they are giving your baby along with the medication. You can help educate them, and perhaps save your baby from some negative effects of, say, alcohol poisoning.

“Breastfeeding with Comfort and Joy” — a review

Wonderful!

Beautiful photography!

Excellent advice!

It’s hard to top the words of praise Dr. Christiane Northrup and others — both doctors Laura Keegan has worked with and mothers she has helped — have given:

like having a wise and loving grandmother show you exactly how to nurse your baby… Laura has created a manual of wisdom and celebration… what you need to know to get started in establishing a comfortable breastfeeding relationship and to solve problems should they occur… Before this experience, I never would have believed that learning the correct latch in this book meant that I would spend less time nursing my twins than I did nursing my firstborn and without the pain of sore nipples…

Plus there are many, many more in the opening pages of the book — a variety of mothers who had difficulties nursing for many different stated reasons (one mother was told that her baby had an “abnormal suck”, one baby was slow to gain weight, several mothers had cracked nipples), who resolved all those difficulties with the techniques brought forth and beautifully illustrated in this book.

Once you go past the introductory words of praise and the table of contents (which you can see by going to BreastfeedingwithComfortandJoy.com and clicking on “click here for excerpts”), there are beautiful photographs on every two-page spread — usually one large picture on the left-hand page with explanatory text on the right-hand page, but frequently a series of smaller pictures (for instance, several photos taken just seconds apart showing a baby properly latching onto the breast). These pictures show a variety of babies, from the tiny, still-wrinkly newborns to those oh-so-chubby babies of several months old, with several “milk-drunk” babies who have fallen asleep while nursing, and smile that sweet, satisfied smile. The pictures primarily show good latches and good positioning, with only one “what not to do” picture — this is important, because it is much better to show what to do rather than what not to do. In this way, women get strong and repeated correct images of how to properly breastfeed.

One thing that struck me the strongest while reading this book is the statement she made about how that women in this country often “automatically hold their babies and their breasts in ways that work for bottle-feeding since that is what most of us have imprinted in our minds” — as opposed to women growing up in cultures where breastfeeding is the norm. And it is this “incorrect imprinting” that is the root of so many problems with breastfeeding.

I remember my Daddy kind of poking fun at organizations like La Leche League, or wondering out loud why it was that women should have such problems with nursing their babies when animals don’t have that problem. To be honest, I never had any problems with nursing either. The only times it hurt were when my children got to that stage (about 6 months old?) where they are easily distractable and frequently turn to see what made that noise without letting go of the breast first; and also a couple of times when I was pregnant and nursing, my 10-month-old son would occasionally latch on incorrectly (I don’t know why — we’d obviously been nursing for quite some time), and it would hurt, so I would take him off and start him again (and I couldn’t tell you what was the difference), and it wouldn’t hurt the second time. And sometimes when I hear stories of women who have had just dreadful pain while nursing — like my sister-in-law whose nipples cracked and bled the whole time she nursed her oldest child, and she had terrible pain with every feeding (I give her full kudos for sticking with it for 11 months — I think I’d’ve given up much sooner!) — when I’d hear stories like that, I’d sometimes wonder why it is so hard for some women, when it was so easy for me. Now, I think I know most if not all of the answer.

The next several pages go into detail (in words and in pictures) about the differences between both maternal and baby positioning with breastfeeding vs. bottle-feeding. And it is this that makes all the difference in the world. When the breast and baby are not in proper alignment, the nipple is subjected to abuse which causes pain initially, and if not changed, can lead to cracked and bleeding nipples. I’ve not had that, but I can imagine it to be not fun in the slightest. Yet, often women are told that even when they are in pain that there is nothing wrong — that happened to my sister-in-law I just mentioned. (Just for background, she didn’t tell me about her problem with breastfeeding until well after she had weaned her daughter — she first mentioned it a couple of weeks after I had my first son, when she asked if I was having any problems with pain, cracking, or bleeding. I think she was a little jealous and quite astounded when I said ‘no.’ She may have been a little perturbed at her “bad luck,” but I don’t think “luck” was the problem.) Anyway, when she was in the hospital after having had her baby, the nurse told her that she was doing everything right — despite the pain she was feeling. Because this “authority figure” (I believe she called her a “lactation consultant,” but I’ve heard that sometimes nurses are given that appellation or a similar one when they’ve had little or no training in breastfeeding, but they may be the only L&D nurse with breastfeeding experience, so they are the “go-to person” whenever a mom has a problem) told her that there wasn’t a problem, she persisted with an incorrect latch through months of pain and bleeding. It shouldn’t happen.

There are other sections (see the table of contents in the excerpts of the book) that deal with several other common problems or areas of concern — including many, many pictures of mothers breastfeeding twins, showing different positions for the babies to be in — as well as skin-to-skin contact, kangaroo care, colic, engorgement, etc.

Again, the pictures are just beautiful and both pictures and text are quite informative. It’s a must-have for any woman who has problems with nursing, or anyone who has contact with such women (midwives, doulas, nurses, childbirth educators…). I’m going to loan my copy to a woman at my church who is expecting her first baby any day now. I hope I get it back!