birth skin to skin

The Mother’s Role in a Not-So-Perfect Birth


This is a follow up on my post about Rixa Freeze’s birth story, and my OB friend Megan’s comment on the post.  In that post, I quoted a midwife blogger who found Inga’s resuscitation to be less “jarring” and more gentle than a hospital resuscitation would have been.

I first have to stipulate a few things:

  1. As far as resuscitation goes, I don’t know anything about it.  A long, long time ago I was certified in infant CPR, but that’s where my knowledge stops.  I have no idea if Rixa did it “right” or just “well enough” to get her baby breathing.  (And to be honest, I’ve wondered if Inga would have started breathing on her own if she had been rubbed/dried with a towel after being pulled out of the water, which she was not, but that’s neither here nor there.)
  2. I would never try to argue that all resuscitation’s (or reasons for needing resuscitation) are the same and should be treated the same.
  3. I will agree that there are cases in which the resuscitation experience doesn’t matter; if the outcome is the loss of the baby otherwise, then obviously 5-10 minutes (or hours/days) of a less than ideal experience ( a “jarring” experience, even) is a welcome trade-off for a healthy baby.
  4. I will also never say that I think hospitals are awful, evil places; I don’t think that in the least — I think they can provide excellent and needed care in some pretty harrowing circumstances.
Source: John Giammatteo

That said, I find Tatiana’s point about the naturalness of it all (Rixa’s response, Inga being resuscitated in her mother’s arms by her mother, cord still attached) an interesting one, as far as how we view the first minutes after birth and the role of the mother.  I think we need to ask ourselves, is the mother a passive patient being delivered of the baby by the doctor/midwife, or is she actively birthing her baby with a doctor/midwife available if needed? This question is one of the great dividing lines in obstetric/midwifery care.

I fall in the latter group, which believes that women can happily and healthily birth babies with minimal intervention.  I think support is very important – I couldn’t imagine birthing alone or even with just my husband.  Doulas are incredibly wonderful birth support, and it would be great to have a care provider who is able/willing to play a support role as well (as opposed to just coming in and catching).  I would never intentionally have an unassisted birth, nor would I advocate for unassisted birth; I do believe it’s important to have an adequately trained person present in case of emergent situations.  I recognize that things do happen (rarely) and someone needs to be prepared for that possibility.  BUT I don’t think that always means resuscitation away from the mother.

One of the biggest concerns I have with OB-Gyn and hospital care is that mothers are often left to feel that they aren’t the expert on their own body and baby, that a third party (the doctor) knows better than them what is going on.  Of course women struggle to find the strength within to work with their body and birth naturally, when they are taught birth is a medical process about which they and their bodies know little to nothing.   It’s no wonder we often feel overwhelmed by pregnancy and parenthood and about 13 percent of pregnant women and new mothers have depression, when we have little control over medical decisions for our own body or baby.  Come to think of it, it sort of reminds me of The Yellow Wallpaper, and we all know how that turned out…

As maternity care currently stands in America (so little skin-to-skin, for example) we need to make more room for the mother’s role in her baby’s first minutes, whether they are perfect, normal ones or whether they are minutes during which intervention is needed.  In considering the mother’s role, we can’t discount the primal protective nature of mothers.  Mothers have done extraordinary things to protect and save their offspring.  Just look at Rixa’s calm as she realizes what needs to be done for her newborn daughter and takes control of the  situation. And can you imagine how empowering it would be for a mother to be the one to save her own baby?  How much more positively that would impact her view of self as mother and her confidence level as a parent, than would the helplessness of not being able to do anything while “experts” saved your baby for you.  There are studies that show sense of control predicts depressive and anxious symptoms across the transition to parenthood. It would be great if the expert care provider could guide the mother through resuscitation in cases like Inga’s where a few breaths are all that’s needed (and then take over if further intervention becomes warranted).

Or, perhaps it’s too far out there to expect a doctor to talk a mother through something like resuscitation.  Not knowing anything about it and the reasons it may or may not be necessary, I don’t really know.  But if that is the case, or if the mother isn’t up for it, why can’t a more simple resuscitation (bagging, suctioning, rubbing) be done on a mother’s stomach?  There’s a lot of great evidence for the miracles of kangaroo care, like this Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns,which found that

Newborn care provided by skin-to-skin contact on the mother’s chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian “protest-despair” biology, and with “hyper-arousal and dissociation” response patterns described in human infants: newborns should not be separated from their mothers.

Even if the mother isn’t doing the “work,” she would still be in contact with her baby providing warmth and familiarity, and she wouldn’t be laying on the other side of the room wondering helplessly what’s going on.

What do you think?  Allowing that there are many different types of and reasons for resuscitation, are there cases in which the mother should/could be involved?  Would it be helpful to a mother’s confidence in her ability to parent to know that she play this additional role in giving her baby life?

Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns.Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns.

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