Woman as Patient – Birth / Newborn Care

One of the more infuriating aspects of Woman as Patient are the events that tend to unfold  during and immediately following the birth.  Just as during labor, the power dynamic is established early on, so too, is the establishment of “possession” of and entitlement to the newborn immediately following the birth.

I’ve explored in some detail in a prior post the power struggle that takes place during the birth.  Here, I’ll focus on the events immediately following the birth, and how they serve to maintain woman as patient, thereby diminishing her confidence in her own intuition as a mother.

Announcing the Sex

Many parents choose to learn the sex of their baby midway through pregnancy, but for those who don’t this moment of discovery has been anticipated for many months.  For mothers who are respected and quietly given their baby immediately, often this discovery takes place many moments following the birth, as she simply revels in the euphoria of this new life.  I recall with my two youngest, this being the case.  While exploring this new being’s beautiful body, it occurred to me to check, and it was I who whispered, “it’s a boy” each time.  But for many, this experience is robbed.  The detail is exclaimed for the entire labor ward to hear just as the gendered parts emerge.

Immediate Cord Clamping / Cutting

In the technocratic model, the cord is clamped and cut immediately following the birth.  Some practitioners will wait a moment or so, but under this model, there is no room for waiting and variations – certainly not something as obscure and uncalculated as waiting for the cord to cease pulsating.  (See here for details on the importance – with scientific support – of delayed cord clamping.)  Not only does this pose risks to the baby, as noted in the article referenced above, but this practice has its roots in immediate and routine separation of the mother-baby dyad immediately following the birth.

The cutting of the cord is also very symbolic – representing the weaning of the physical connectivity of the pregnancy.  An abrupt severing of this connection signals the imposition of quick transition, rather than one that is intuitive, gradual and loving.  It reinforces the idea that baby is its own entity, separate and independent of its mother.

Immediately severing the mother-baby connection displays the institution’s sense of ownership over not only the process, but also the “product.”

Suctioning of the Newborn

Courtesy of Birth of a New Earth

Courtesy of Birth of a New Earth

 

Within seconds of the birth, baby will be suctioned – usually with a bulb syringe, and sometimes with deep suction via a tube down the throat.  Baby usually objects, obviously.  It is quite intrusive to have a rubber object forced into the mouth; even more so, the throat.

Most people don’t understand the concern over suctioning.  After all we need to ensure that baby breathes well, right?  Of course.  But the assumption that baby will not do this on her own without outside intervention again communicates our complete disconnect from and mistrust in the natural process.

Intervening with immediate suctioning without waiting to see if baby needs assistance is not only disrespectful and intrusive, it potentially sets up breastfeeding difficulties, as baby’s first experience with something in her mouth is a rubber syringe, which she actively tries to push out during the experience.  This first experience is now imprinted in her brain, and it can be a challenge to reprint when the nipple is introduced.

Separation of Mom and Baby

Courtesy of Birth of a New Earth

Courtesy of Birth of a New Earth

 

While most mothers today opt to remain with their babies (dubbed “rooming in”) rather than send their newborns to the nursery, there still does remain an initial separation for most mother-baby dyads following the birth.  In the managed care birthing system, where birth is likened to a factory process, there are numerous items on the newborn’s chart waiting to be systematically checked off.  While many practitioners have (finally) recognized the importance of placing baby immediately on mom’s chest following the birth, most still don’t get it.

Usually mom is allotted several moments with her precious babe before he is whisked over to the warmer, where he will be measured, weighed, injected, cleaned up, wrapped up and served back to mom in a neat little package.

Again, not only is this process disrespectful to a mother who has just completed the most difficult work of her life, but it disrupts a natural bonding process that has been facilitated by mom’s hormones, now surging with the purpose of ensuring attachment and love.  The interruption leaves both mom and baby feeling confused, lonely and distressed.  Additionally, it lends again to trouble breastfeeding.  Studies show that initial separation interferes with baby’s ability to self-latch as much as a baby groggy from medication (Lancet, Vol. 336,1105-07).

In this routine interruption, we are reminded that hospital procedure and staff convenience trumps mom’s and baby’s experience.

Eye Drops

Mothers experiencing managed care in pregnancy are tested prenatally for STI’s.  Even if mom is found clean of any STI, baby is still expected to take the antibiotic eyedrops as a precautionary routine.

Even though it is essentially unnecessary antibiotic exposure in the first hours of life.

Even though mom is breastfeeding and providing heaps of her own perfectly concocted antibodies and immunities.

Even though it is completely unnecessary if there is no infection present in mom.  

The message here is that a woman’s body is unclean, a potential harbor of germs and bacteria waiting to infect her newborn.

Vitamin K InjectionVitamin K shot

Babies are born with low levels of Vitamin K, which is why newborns receive routine Vitamin K injection at birth.  The purpose is to prevent a very rare bleeding disorder, Hemorrhagic Disease of the Newborn.

The fact that newborns are born with extremely low levels of vitamin K should not automatically lead to the conclusion that all newborns are thereby “deficient” in Vitamin K.  Our bodies work in very specific ways for very specific purposes.  It is interesting to note that Vitamin K does not pass easily through the placenta, even when mom ingests large quantities, prenatally, suggesting that the fetus is actually being protected from high levels.  On the other hand, Vitamin K does pass easily through breastmilk, which suggests that a gradual increase in levels following the birth is what nature intended.

Routine administration demonstrates the belief in the futility of the innate structure of the human body, and the superiority of human-made supplements.

Bathing

The amniotic fluid residue and vernix hold very specific purposes following the birth, which is why it is important to delay washing the newborn.  Vernix is a wonderful cold cream-like substance, holding wonderful benefits for the infant’s sensitive skin.  The amniotic fluid contains the same smell as the secretions from the breast, which is why the fluid is referred to as the “path to the breast.”  Cleaning it off can lead to …. can you guess?….. Ding! Ding!  Breastfeeding difficulties.  (I’m beginning to note a pattern, here.)

In the hospital, the baby is washed of the birth residue as soon as possible.  It is equivalent to a bio-hazard.  And really, why wouldn’t it be?  Where hundreds of patients lie in one building, some with lingering bodily fluids all over them, of course it would behoove anyone to remove it in order to keep the place sterile and free from the spread of germs.

So, herein lies the deepest issue of them all.  Birthing women should never have been brought into an institution whose mission is to tend to the diseased and injured.  Laboring women are neither.  Confining them in the same institution as the diseased and broken lays the groundwork for the way that they are treated.

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Comments

  1. Yuman says

    It is a good thing you are not liable when things go wrong, unlike doctors…….I can assure you, there is not viable amount of vitamin k in breastmilk for the baby, even with a perfect diet……furthermore, std infection of eyes can cause permanent blindness. Finally, if respiratory problems do,occur in baby, it truly is best to be in a hospital…..thus,with the auctioning, it truly is better safe than sorry.
    There are many advantages to a home birth, but you are doing a patients a great disservice by not providing this information-unfortunately,as a pediatrician, I know more about the negative incomes than you folks…please correctly inform everyone about the dangers of it all.. We do not go to school for 10+ years in the name of harming others.

    • Kathi says

      Yuman,

      Unfortunately, you’ve missed the point entirely of this article. This article is part 3 in a series on the managed care model of treating women as patients during pregnancy and in labor. The point in all of these articles is not to steer women from medically necessary treatment when it is needed, but to point out the complete disconnect from the natural process and the subsequent stripping of respect and rights from women that happened in the abandonment of women-centered care.

      Your comment simply serves to cement my point that in the technocratic model “liability” reigns supreme, and that a doctor’s authority should not be questioned. Thus, woman as submissive patient is of utmost importance in this model.

      Certainly, I would not argue that doctors go to school for “10+ years in the name of harming others.” I would, however, assert that doctors “treating” low-risk women as patients – like they would in any other ward of the hospital – does do more harm than good.

  2. says

    My sister just had her first baby (in a hospital) and she recently showed me the video of my nephew just moments after birth. He was lying on what looked like a fairly hard, flat surface and was crying, while various hands of nurses and/or doctors were performing various procedures on him, cleaning, measuring, getting the footprint, etc. I immediately thought after watching the video, “I wouldn’t want my newborn baby’s first experience in the world to be like that — so clinical and unwelcoming” — and, most of all, I thought, “Where is my sister?!”

    Kathi’s articles on “Women as Patient” put to words that gut feeling I had when watching the video. Not to mention, my sister discovered a bruise and two cuts on my nephew’s ankle from an anklet that was placed on his ankle for the duration of his hospital visit. That’s getting close to abuse there — although I can’t speak to that being a recurring problem, as my nephew is the only newborn I’ve been close to, but it is definitely cause for concern that my sister’s own OBGYN, whom she really adores, didn’t even notice the bruise/cuts when she came to check on the baby.

    I actually have another experience to share that has left me disillusioned with the “traditional” medical community in regards to the birth experience in a hospital. When my mother was in labor with my brother, the umbilical cord became wrapped around his chest and his heart rate fell to zero and the doctor used the “salad tongs” to pull him out right away, and he was blue. We think that this experience has caused long-term effects on my brother, one being a crippling learning disability that is still a constant struggle. This might be completely off topic and a unique experience that doesn’t relate — but I’m wondering how my mother’s (and brother’s) experience might have been different in a non-hospital environment. If a case like this should arise in a home birth, how would a midwife respond to it? (Again, might be off topic, but this has been on my mind a lot recently and maybe you might have an answer).

    Ah, I just thought of yet another story of a hospital birth. My husband’s mother had to have an emergency C-section and afterwards, for hours, the hospital refused her to see her son. She was coming off of the pain medication and was begging them to allow her to see her son and they kept saying, “Not yet, soon.” How can someone refuse your own child to you?

    I am enjoying this thread of articles, especially because (as has been proven in this lengthy — sorry! — comment) I’ve heard so many horror stories of hospital births! And I would never think that a mother of three who has experienced three natural births, not to mention provides bradley method childbirth classes and doula services, would be doing anyone — especially new mothers — a disservice by sharing her experiences and knowledge on bringing a happy, healthy baby into the world. In response to Yuman, this is exactly — it seems — what Kathi is referring to. I would think that girls and young women should be learning about birth from their mothers and other women who have had children, but we are expected to learn, instead, from “professionals” and peope who have gone to school for 10+ years, but these seem to to be the people who weren’t able to prevent the negative experiences I described above from happening.

  3. says

    Yuman, you are describing the medical model that has been in place for many decades now. Women are patients, birth is a procedure. You are correct that all the fears you list as possible may occur…but at what rate? By treating every woman and baby as a potential problem this model has caused much of what it portends to prevent. If you doubt we should make a change just look realistically at our infant mortality and maternal mortality rates…dismal! The medical model has had ample opportunity and has failed for all but the providers convenience and profit. Open your eyes Yuman and get with the change!You may dare to leave your fears behind and enjoy birth for the miracle it is.

  4. says

    I’d like to gently encourage a minor change in the language that describes the timing for clamping and cutting a newborn’s umbilical cord.

    “Early” actually describes the premature clamping and disruption of the necessary placental (or 3rd stage) transfusion of the baby’s own normal blood volume back into its own body. This is in contrast to “physiological” clamping, which allows the physiologically necessary blood volume to be provide to the neonate.

    Distressed (and premature) babies desperately need the 40% of their normal blood volume (50% in the case of premature babies) that is in the placental-umbilical cord end of their circulatory loop. If uninterrupted at the time of birth, a normal process of placental transfusion returns the major proportion of the externalized blood volume to the baby body. Without this normal physiological blood volume, the baby is the biological equivalent of the crankshaft of an internal combustion engine that is three quarts low in oil – that is, an inadequate quantity to do a critical job.

    In the case of a newborn, the critical new function is perfusing the baby’s lungs for the very first time. During its nine months in utero, the normal route of fetal blood skips the lungs in a unique type of short-circuit that occurs only during fetal life. Before birth the baby’s blood is being oxygenated by the placenta, so the reduced volume of endogenous blood in its body is not a problem. However, at birth the baby’s body must switch from exogenous placental oxygenation to an endogenous air-breathing process. This increases the necessary level of “normal” blood volume, which means that part of the baby’s blood that is in the cord and placenta must be returned to the baby’s circulatory system so the lungs can be perfused.

    An excellent example of this physiology applies to the use of a heart-lung machine for open-heart surgery patients. It is the patient’s (or in this case the fetus’s) own blood being pumped out of its physical body into a mechanical device or body organ (the placenta) that is the sole source of oxygenation and exchange of other critical gases.

    To precipitously clamp and cut a neonate’s cord at the instant of birth has the same biological effect as clamping the tubing to a heart-lung machine at the end of surgery. Without accounting for the 20, 30 or 40% of the patient’s blood volume circulating through heart-lung machine’s filtration system to be returned to the patient, a significant portion of vitally important blood will be left in the tubing and the machine and then discarded as a waste product. Of course, no cardiac team would ever allow that to happen.

    Premature cord claming has the same biological effect as pinching off tubing that connects the heart-lung machine to the surgical patient. For babies denied of their normal blood volume and its other benefits — warm, oxygenated, pH-balanced blood – the neonate’s body automatically shunts blood away from all the biological functions not at that moment critical to survival. This routes arterial blood away from the baby’s skin, muscles, liver and intestines so it can be circulated thru the lungs, to open pulmonary blood vessels for the first time and permit the process of perfusion to the capillary beds where oxygen is taken into the blood stream and carbon dioxide is expelled.

    For a healthy term neonate after a normal labor and spontaneous birth, this is usually not a problem. Research has shown that within 6 hrs, differences between two groups of babies — the prematurely-clamped vs. physiologically-clamped cords – are nil.

    However, in the case of premature babies and those who suffer an adverse event such shoulder dystocia or a cord accident, physiological clamping can be the difference between a baby with no special medical needs and one that will need to spend days, weeks or months in the NICU and on rate occasions, die as a direct or indirect result of an otherwise non-fatal complication.

    Physiological cord clamping is an evidence-based practice. Making it the standard of care would save hundreds of millions of dollars in NICU care AND for babies that suffer from preventable life-long handicaps and learning disabilities. This may be the least expensive (costs nothing!), most available (no special equipment, no lengthy, costly research) and most cost-effective practice in the history of maternity care for a healthy population. Viva the pulsating cord that gets to stop of its own accord after its work is done!

    • Kathi says

      Faith,

      Thank you so much for stopping by and for providing such a wealth of information on the fetus’ and newborn’s circulatory system, specifically as it relates to the timing of cutting the cord.

      Just to clarify, your edit then, would be to transition from using the words “early” or “immediate” and replace them with “premature”; and also the word “delayed” with “physiologic”. This really makes so much sense in that the former words fit within the vocabulary of an allopathic model, whereas the latter has the tone of an holistic approach to the normal physiology of birth.

      Thank you again, Faith. I feel honored that you take time to provide such valuable feedback and addendum’s to my writing.

  5. says

    It’s vital that the language we use is itself ‘normative’. To use the word “delayed” to describe appropriately-timed physiological cord clamping means we are accepting the medical model as normative.

    This perspective sees midwives as ignoring science and wantonly diverging from the standard of care. It also describes parents who ask to ‘delay’ cord clamping as misinformed or hedonistic and needlessly risking the health of their new baby.

    However it’s early/premature cord clamping that is the unexamined medical intervention. Unfortunately this protocol, originally based on historical circumstances that no longer apply, was allowed to become and remain a customary practice w/o scientific validation.

    Instantaneous cord clamping was first introduced in the United States in the early 1900s, when American obstetrics organized itself into a new surgical speciality. The obstetrical profession used its political influence to eliminate the physiologic care of midwives and instead promoted the notion that normal childbirth in healthy women should be conducted as a surgical procedure and performed under anesthesia by MDs.

    Unfortunately when anesthetic gases are given to mothers during delivery, they also cause respiratory depression in their newborns. Immediate clamping of the baby’s cord was a well-intentioned attempt to prevent additional amounts of ether or chloroform from being circulated to the baby through its umbilical cord. As a result, immediate cord clamping became the customary medical practice (or standard of care)in the United States.

    During the 1940s, 50s, and 60s, obstetricians believed that neonatal jaundice and polycythemia (higher level of red blood cells) were both caused by over-filling a neonate circulatory system with the exogenous blood in the umbilical cord at the time of delivery. Under this theory, the baby’s lower endogenous blood volume (only 60% of its total) was 100% perfect at delivery for its physiological needs as an air-breathing neonate. According to this thinking, the blood circulating in the placental-umbilical loop is bad for the baby and should be discard with the placenta. As a result, the protocol of immediate cord clamping was expanded to include all babies, not just those whose mothers were delivered under the influence of general anesthetics.

    In more modern times, the obstetrician’s normal role no longer includes providing immediate care to the newborn at birth. This is particularly true for a distressed or premature neonate, in which there is a ‘hand-off’ to a different hospital staff — nursery nurses and perinatologists — at the moment of delivery. After the OB doctor hands the baby to the neonatal team, they must carry their new ‘patient’ across the room to a special area equipped for the practice of neonatology. Obviously this convention also requires that the cord connecting the baby to its mother (and to its own placenta) be quickly clamped and severed.

    Last but not least, there are contemporary medico-legal aspects of immediate cord clamping. Harvesting a six-inch segment of double-clamped umbilical cord at the moment of birth provides a sample of fetal blood that provides information on the baby’s oxygen levels before it breathed air. This segment of clamped cord is quickly sent to the hospital lab for blood gas analysis. Occasionally this information is important in treating a sick newborn. However, it main purpose is to provide exculpatory evidence in case of a malpractice lawsuit. Blood gas values can sometimes exonerate the obstetrician and hospital of any culpability for a neurologically damaged baby. Therefore double-clamping the cord to determine blood gases is an important aspect of ‘risk reduction’ protocols for an institution.

    One of the most crucial consumer issues is to first educate the public and then require hospital staff to obtain written informed consent of the parents prior to allowing the hospital to harvest the umbilical cord before the baby breathes and before third stage placental transfusion is complete and the cord stops pulsing on its own.

    This is especially important in circumstances of fetal distress or preterm birth. It’s illogical to discard the baby’s cord blood as a waste product or send it off to the hospital laboratory at the very time when that newborn baby is most vulnerable and most needs its full blood volume.

    *NOTE: Some doctors tell parents they are ‘just going to clamp the cord’ but won’t cut it until the parents are give their permission. This is disingenuous and/or dishonest. Parents need to understand that *clamping* the cord instantly ends all blood flow btw their baby and its placenta.

    • Kathi says

      Faith, I wish I could dialogue with you every day. Thank you for adding that information, as well. There is so much valuable information – new information – that I don’t think many women have access to. I’m worried not enough people will see it here in the comments section. How would you feel about turning it into a guest post on my blog?

  6. Tatiana Escobar says

    I am beyond the moon having found your blog! You put into words all of the things that run through my mind as a feminist & birth assistant.

    And after reading the discourse between the lovely Faith Gibson and yourself (after having watched Parts 1 & 2 of her interview), my mind is flooded with so much valuable information I could jump with glee!

    Thank you so much for devoting your time to spreading this birth knowledge!

  7. Lenore Gaudin says

    I am so grateful for this information since I will be teaching my expectant parents “medical interventions” next week. One of the tools I use is to give my students resources that I respect so that they can do their own research. The names I suggest are Michele Odent, Marsden Wagner, Henci Goer and my former teacher and friend Tom Brewer. My primary goals are to prepare my moms and babies with nutritional information so that they both are as well nourished as possible and to educate them so that they take responsibility for their births and understand the meaning of “standard of care”. I want to preserve for them, as much as possible, respect and gratitude for the system we call, “medical care”. I am well aware that change only comes through a comprehension of the existing flaws, an educated populace, and insistence on evidence based obstetrical practices.

    Thank you for doing your part in my understanding so that I can be more effective in what I enjoy most–educating any who are willing to listen.

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