First, a note: I received a great comment from my friend Megan on the last post and I started to write back to her, but as I typed, and typed, and typed, I realized my response would be better served as a blog post. As it turns out, this is going to be a two-parter, because I have so much to say. I’d love to know what your thoughts on this are as well, so please leave me a comment!
I think, in general, there is a vast contrast between hospital and home birth as far as the first minutes and hours of the baby’s life. There is also a contrast between in-hospital midwife deliveries and OB deliveries, but regardless of practitioner, in most, but certainly not all cases, babies born in hospitals spend more time away from their mothers at birth than do babies born at home.
Despite the importance of early contact for attachment and breastfeeding, most babies were not in their mothers’ arms during the first hour after birth, with a troubling proportion with staff for routine, nonurgent care (39%). Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences
A good example of this can be seen in almost every birth shown on the Lifetime TV show I referenced last week. Several minutes pass and several procedures are done before baby is put skin to skin with mom, if baby even goes skin-to-skin at all — in many cases the babies are completely swaddled before being handed to mom for the first time.
This may look cute and cozy, but it does nothing for baby and mama.
That sort of birth practice is all too common in US hospitals. According to the 2007 CDC National Survey of Maternity Practices in Infant Nutrition and Care, only 40.4% of the facilities surveyed reported that “most” patients experience mother-infant skin-to-skin contact for at least 30 minutes within 1 hour of uncomplicated vaginal birth and only 29.3% reported skin-to-skin for at least 30 minutes within 2 hours of uncomplicated cesarean birth. That same survey reported that while 91% of birth centers “almost always” perform routine infant procedures while mother and infant are skin-to-skin, the rates are drastically lower for government, non-profit, private, and military hospitals (11.6%, 14.2%, 8.1%, 18.5% respectively). Additionally, only 49.9% of all facilities surveyed could report no separation of mothers and infants following vaginal birth in transition to recovery room, a number which is skewed upward by birth centers and military hospitals (the rate of separation is much higher for private and government hospitals).
Obviously, this is not always the case; there are differences of practice between hospitals and between individual care providers — some are more attentive of experience and keeping baby with mom than others. Nora was born in a hospital birth center, yet still had immediate skin to skin — she wasn’t even suctioned away from me, I helped to catch her and pull her up, then they did the suctioning/rubbing/etc on my stomach. This video, which provides a great look at baby-friendly cesareans that have immediate and on-going skin to skin, is also evidence of difference in practice.
[youtube=http://www.youtube.com/watch?v=m5RIcaK98Yg]
Unfortunately, this sort of attention to detail and care among OBs is rare.
I think it’s fair to describe the “gentlest” birth as one which most approximates a biologically and physiologically natural birth and which provides the least distress for the baby, while providing the best health outcome for mother and baby. There is a large body of evidence which shows that skin-to-skin contact is a major contributor to meeting that definition of gentle birth. According to a Cochran Review of 30 studies, study after study has found statistically significant and positive effects of early skin-to-skin contact (SSC) on breastfeeding at one to four months post birth and on breastfeeding duration; trends were found for improved summary scores for maternal affectionate love/touch during observed breastfeeding and for maternal attachment behavior; SSC infants cried for a shorter length of time; late preterm infants had better cardio-respiratory stability with early SSC; and no adverse effects were found. Based on that data, skin-to-skin and direct contact with the mother is clearly the best and “gentlest” birth practice.
So if CDC data shows that less than half of U.S. hospitals have babies and mothers skin-to-skin, and we have more than 30 studies telling us how important skin-to-skin is, what does that mean? And if nearly all birth centers and (presumably) all home births meet the skin-to-skin criteria, then of course it’s completely reasonable to conclude that hospital care providers treat mothers and children less gently (and with less care for mother-baby contact during initial moments of life) than do birth center and home birth attendants. There may be individual variations and exceptions to the rule, but the fact is that most hospitals in the U.S. are not meeting the biological need of babies and mothers to be and to stay together.
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