To Hat or Not to Hat, That is the Strange Conundrum

Have you heard the phrase, “Stop hatting, chatting and patting?”  I first heard the phrase from California midwife, Carla Hartley, who has studied during her thirty year midwifery career, the affects that interventive third stage practices have on both mother and newborn.  There are multi-faceted layers behind why hatting, chatting and patting are disruptive to the mother-baby dyad, but they all encompass the importance of giving mom and baby uninterrupted time to participate in the physiological process of bonding immediately following the birth.

I posted the above meme on my facebook page a few weeks back, and was shocked by the negative response that this little suggestion brought forth.  There was this weird clinging to this practice of hatting, and commenters were demanding that we have “substantial evidence” before suggesting that it is harmful, or suggesting that babies not be routinely hatted.


Because, interestingly, when babies began being hatted in this country, there was NO EVIDENCE that placing hats on newborns was better than the physiological process of mother-baby heat transfer.

Granted, skin-to-skin wasn’t happening during this state of maternity care, as mothers were so drugged – many unconscious at the time of birth – that they couldn’t even hold their equally drugged newborn.  But I digress…

Or do I?  Because considering the many detrimental practices that were routinely implemented as birth was ushered into the institutional setting, actually serves to illustrate how blindly we’ve accepted NON-EVIDENCE based care, simply based on who suggests it, carries it out, and where this care takes place.

Surely if it’s performed by a doctor in hospital, there must be science to support it, right?  (If you buy that, then there’s way more work to be done than this article can even begin to tackle….)

So, I asked Carla to weigh in on the subject.  Here’s what she has to say:

…..I have been researching this topic more than thirty years. Any person with a thorough understanding of the physiology of third stage could explain why.

Study the olfactory system, oxytocin, the limbic system to start with. The limbic system is waiting for the signal via the olfactory system that the baby has been identified, the placenta has been released and the uterus can stop bleeding…. Then the largest production of oxytocin is released. It is a brilliant system that is impeded by anything between baby’s head and mother’s nose.

And no recent studies support the use of stockinet hats in terms of regulation of core temp. Brain cooling is efficacious, thus the large head.  Optimal safety and experience are achieved when we do not interfere with the chemistry and physiology of birth and third stage. Mothers and babies have a biological imperative to see, smell, touch, hear each other.

The bare head (as intended) elicits bonding and nurturing behavior in everyone who gets a whiff of those pheromones but they are meant for the mamma and daddy……..


Many decades after the practice of hatting newborns began, there did surface a study  (D.M. CHAPUTDE SAINTONGE, K.W. CROSS, M.K. SHATHORN, SHEILA R. LEWIS, J.K. STOTHERS) on hatting newborns in 1979, which found that hats worked to minimize heat loss.  However, this study involved newborns exposed to radiant heaters only.  No comparison was made against the normal, physiological process of skin-to-skin, which is entirely different.

More recently, in 2010, a study (McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S) was carried out on preterm and low birth weight babies.  The purpose of the study was to analyze hypothermia prevention on these higher risk newborns.  The study found, among other things, that:

“Stockinet caps were not effective in reducing heat losses.”


Unhatted newborn. Photo courtesy of the amazing Earthside Birth Photography.

Kangaroo Care has been well researched in recent decades, and many practitioners are now realizing the importance of skin-to-skin.  Check out this site, which lists the myriad benefits of the practice.

One of the most profound findings with Kangaroo Care (in terms of the hatting issue) is this study (Ludington-Hoe, Lewis, Cong, Anderson, Morgan, Reese), which found an amazing phenomenon referred to as “thermal synchrony” that appears to happen between a mother and her newborn when practicing Kangaroo Care.  The study found that the mother’s breast temperature increased and decreased in response to her newborn’s temperature fluctuations, thus helping baby regulate her own body temperature.  This even works when twins are worn skin-to-skin.


The most interesting study I found on the olfactory system is this review, “Olfaction in the Human Infant” (Regina M. Sullivan, Ph.D)

“There is considerable evidence documenting the importance of odors in initiating and maintaining the mother-infant relationship. This relationship is more complex than it seems and involves a series of behaviors which must be coordinated between the mother and new baby. Although the mother clearly holds most of the responsibility of this communication, the infant must do its part. The failure of mothers to bond to an infant that is not responsive to her illustrates the important role the infant plays in this dyad (Porter & Moore, 1981; Porter et al., 1988; Russell et al., 1983; Schaal & Porter, 1991).”


I found this quote by Lisa Belkin, columnist at The Huffington Post, in an unrelated article, but found the sentiment contained within to resonate precisely with my confusion on the resistance to change a practice – especially one that does not provide sufficient scientific evidence of support to begin with:

“I am continually amazed at what it takes to redirect parenting opinion. It is dizzying how quickly one study or article can — sometimes — change our ways.

We started placing infants on their backs rather than their stomachs when there were hints of correlation, but not proof of causation, with crib death.

Pregnant women stopped having sushi, soft cheese, caffeine and even a sip of alcohol on the remote but striking possibility that a small amount could have consequences.

BPA bottles disappeared in certain circles overnight when there was an unofficial link to cancer.

But other times, we just don’t want to know.”

Exactly.  And that’s what this is really about for me.  You probably think I’m a staunch proponent of not hatting.  Meh.  Do I think hatting is necessary?  No.  Certainly not in a normal, physiological process, where mom and baby are respected, skin-to-skin is the norm, and birth is trusted.  Do I think it’s devastating if you do hat your baby?  Probably not.  The hatting issue, itself, is not necessarily the issue for me.

The issue for me is what the fuss around it represents.

This resistance to trusting normal physiology over non-evidence based intervention fuels a need to prove all that is basic and biological.  And this, in turn, fuels  a woman’s ongoing fear and doubt about her body’s ability to carry, birth and nurture her young.

When we lose sight of even the most basic trust in the normal, physiological processes, we continue to undermine a woman’s confidence and trust.  This, my friends, is at the root of the birthing system dysfunction.  It is up to us to embrace normal birth – even if it feels scary – and resolve to trust it.

While nothing in life is certain or predictable, almost none of us calculate the risk of getting into our cars each day.  And yet, that daily risk is far, far greater than birthing a baby will ever be.  It is time to start believing that in reality, “Birth is as safe as life gets.” – Harriette Hartigan

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  1. says

    great response. Dr. S. Luddington from USKC still advocates the use of hats right after birth due to the head being wet but once thermo regulation occurs than it really should not be used at all as that is the area that cools off the warmth of the baby.

    • Kathi says

      Attie, thank you for sharing that. Do you have a source for that information on Dr. Ludington’s recommendations? She is the author of some Kangaroo Care studies, yes? I’d like to take a look at her findings of why the hat seems so imperative immediately following birth. I understand the wet head, but it seems like mom’s body would do better with a warm blanket over top. It seems like there is conflicting experiential data, as well, with practitioners communicating to me that they find the hat to impede and be unnecessary in the moments following birth, but then later to be necessary.

  2. says

    Thanks for sharing this. I have also been reading Carla Hartley’s discoveries about not hatting, chatting and patting and putting into practice. I used to “hat” because I was taught to. Now I am teaching everyone I know not to!!
    May I use the photo the owner?
    Lina (Midwife)

    • Profile photo of Kathi Valeii says

      Hi Lina,

      The photos in the article are not my original property, so I am unable to grant permission for their use. I have cited the original owners for both images, so you could contact them directly.


  3. says

    I watched the hatting practice become fashionable. It certainly is an example of herd mentality. It also demonstrates how a much more harmful practice gained ground and became the dictum of ‘experts’ and that is premature cutting of the umbilical cord before the it has stopped pulsating or having delivered the essential cord blood to the baby”s vital organs. This horrendous procedure is carried out despite the obvious pain and distress displayed by the infant and what was previously taught that it is injurious to the child.

  4. Sharon Schlicher, Midwife says

    Thank you, your argument about us not trusting the Normal process of birth finally made sense.The not hatting argument has always been silly to me. However, the not trusting the process of birth fad has been ongoing for the entire thirty years I have been in practice. I will reconsider the hatting fad because it feeds into not trusting Birth, which is something all of us very much want to avoid.

  5. says

    Hi, having spent almost 60 years in the birthing world, I am constantly appalled at many of the accepted practices. Do we really believe that nature is unable to provide a safe birth process? “Hatting” babies is something very few cultures do. It ranks with washing a baby before allowing the mother to touch it. Left alone mothers recognize their own baby by it’s smell.
    My thought is that the smell of birth fluids, or an unwashed baby make many care-givers uncomfortable– a “good birth” smells of sex, or as a fellow midwife once said. “It smells like a brothel”.
    Very few of today’s birth care practices have been properly researched before becoming common.
    I could go on for hours about them, but will stop before I get carried away
    Jean Sutton

    • says

      You are absolutely right Jean! We should not be washing the scents off of mom or baby. They are essential for bonding and when we “clean” the baby we are robbing that mother and her child of an enriching experience as they bond and reconnect with each other. They have spend 9 months communicating internally and when they finally have a change to connect with each other and explore one another we ruin the whole event with our soaps and washcloths and perfumes. If midwives would begin to study these topics and start to make changes in how they practice we would start to see an amazing shift in birth that is a long time coming! Thanks for sharing your thoughts and comments. I enjoyed reading them. :0)

  6. Sarah Martin says

    I’m just curious – I agree with everything in this article, and about the comments on the importance of bonding BEFORE washing baby… but how does this work with water births? I’m not a mommy yet, but am so excited for the day that I become one, and want to know how to have the best experience possible. I’ve heard friends say that water births are amazing experiences, but does the water wash off some of that baby smell?

    • Profile photo of Kathi Valeii says

      Nope. It would take more than swimming in the water (which would typically be infused with birth fluids during the process) to wash off that luscious smell. :)