Fads, birth and safety

A 'prominent' Perth obstetrician and president of the Australian Medical Association (WA) Dr Michael Gannon, was reported as saying that "an “obsession” with skin-to-skin contact between mothers and babies after birth is a fad that is putting newborns at risk of death and serious injury".  His comment appeared in the article 'Skin-to-skin' fad blamed for deaths of babies published in The West Australian online newspaper 5 March 2016.

The coroner is investigating the death of a newborn at the Fiona Stanley Hospital. The article suggested that the baby is thought to have died 'after the mother fell asleep while holding or breastfeeding the baby'.

The AMA president rightly raised concerns about drug affected, exhausted women:

"New mothers are often exhausted by a long day in labour and there are the side effects of opioid drugs, epidurals or c-section"

 Photo from Midwifery Today site

However, he also criticises what he calls a

" new obsession amongst mothers and midwives with immediate skin-to-skin contact after birth ... which "stemmed from taking whatever possible measures that might lead to small increases in the number of women who breastfeed"

Far from a fad, skin-to-skin contact for women and their newborns at birth and beyond is a well-researched instinctive behaviour. This instinctive behaviour has been shown to not only improve breastfeeding success, but also, combined with breastfeeding attempts, reduce the rate of primary PPH, along with enhancing the sense of safety and attachment for the newborn and her mother. There are implications for the newborn's microbiome and there is some evidence that skin-to-skin experience reduces mothers' stress levels.

The doctor is reported to have said, in response to the claims for skin-to-skin, that:

 “I think that gets over-interpreted. Babies, instead of being in a safe environment like a warming crib, are being left on their mother’s chest”

Now the attitude that a newborn is better off in a warming crib than with its mother is the nub of medicalisation of the childbearing process and the disconnect between the use of technology and our humanity.

The medicalisation of childbirth is a done deal. Whilst physiological birth is appealing from both an evolutionary and capacity building perspective, the reality is the majority of women in the western world, are already heavily socialised into accepting and wanting medicalisation. Whilst choosing and embracing medicalisation and interventions, women are drawn to the idea of having their newborns with them skin-to-skin from birth and in the main, to breastfeed them. There is even a push (excuse the pun) for 'natural' and 'self-assisted' surgical births. Midwives are drawn to 'keeping things normal' and whilst supporting women in their choices; they are also drawn to facilitating skin-to-skin for the woman and her newborn at birth.

There is no doubt that 'drug affected, exhausted women' are vulnerable, as are their newborns, to the creation of potentially asphyxiating situations. A review of Apparent Life-Threatening Events in Presumably Healthy Newborns During Early Skin-to-Skin Contact  highlighted the issues for six babies left prone, unsupervised by a midwife or other health professional, on their mothers' abdomens. 

The reality is that midwives are increasingly having to care for postnatal women who are 'drug affected and exhausted'. The current staffing levels are woefully inadequate to care properly for these 'drug affected and exhausted women' together with their newborns.  Some people suggest recruiting partners or other family members to observe the newborn who is skin-to-skin with its mother, but that's a cop-out. 

Daily Mail

Often partners and others don't know what to look for and the bottom line is, the woman and infant's well-being is the responsibility of the institution that provides the 'care'. 

Whilst a decrease in medicalisation of birth would be ideal, that ideal will need a revolution in society's attitudes. In the meantime, what the good doctor and the AMA should be arguing and agitating for is not a separation of a mother and her infant, but for women and their infants to be treated with the profound respect they deserve and adequate midwifery staffing levels so that women and their infants can benefit from best practice and have the support and expertise of the midwife's presence to ensure that experience is a safe one.

Dr Gannon and the AMA need to understand that it is not skin-to-skin experience at birth that is putting newborn babies at risk.

What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal.

The mother whose baby died at the Fiona Stanley hospital deserves our heartfelt love and support, kindness and respect - not blame for her baby having skin-to-skin and breastfeeding at birth - she was doing the very best she could for her baby.

If the little one is found to have succumbed because of airway obstruction, then our society has failed her and her family.  Our society does not value childbearing women enough to provide adequate staffing levels and midwifery expertise to be their guardians through their most vulnerable time. 

Midwifery voices needed on WHO draft of Every Newborn Action Plan

Calling all midwives: Please read this request from the International Confederation of Midwives and ensure the midwifery perspective is included in this important plan to save newborn lives.

Your voice is urgently needed: The WHO together with partners have drafted an action plan to end preventable newborn deaths (Every Newborn Action Plan). The draft is now online for a public consultation process with the deadline on the 28th of February. It is crucial that midwives have an input as the plan will affect midwives in their work and midwifery on a global level. Strong indications from midwives are needed that this Action Plan is about high quality midwifery, normal birth and normal care of healthy babies (as well as the complications and treatments highlighted in the document).

Feedback is coming in to WHO, but sadly not (yet!) from midwives. The voices of midwives are urgently needed!

Thank you to those who have responded. For those who have not yet, kindly take some time from your busy schedule and provide feedback to this important document. 

Don’t miss this opportunity to make your voice heard and make sure the midwife perspective is included in the plan! Click on the link to comment: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/ 

The deadline is FEBRUARY 28th and unfortunately cannot be extended.

Thank you for the time and effort.

Kind regards

Charlotte Renard
International Confederation of Midwives

Explaining Tongue Tie

Tongue tie, officially known as Ankyloglossia, is one of those developmental 'glitches' that can cause big and life long problems for the person with it and disrupt their ability to breastfeed. The inability to properly latch onto a mother's breast that comes with the condition of Ankyloglossia can make makes breastfeeding, which should be a source of joy and satisfaction, into a nightmare of pain and suffering for the woman. 

All babies should be checked for tongue tie at birth. Midwives and doctors should ensure the baby's tongue can move freely and fully extend in a thrusting movement. If there is any twisting or 'pull back' into a heartshape of the tongue tip, the baby is most likely tongue tied. This brochure shows you how to check and identify if a baby is tongue tied.

Treatment of 'tongue tie' has gone through different 'fashions'. The last few decades have seen a lack of recognition of this problem and when identified, a real reluctance to treat it. This widespread ignorance has caused many oral and developmental problems for the children and breastfeeding 'failure' for women who rightfully, couldn't bear the pain and trauma to their nipples caused by their babies inability to attach themselves to the breast. Treatment has been the source of a much controversy. Some experts advise taking a 'wait and see' approach and delaying any surgical intervention until the child is older. This 'wait and see' approach is associated with speech and normal mouth development disruptions and lactation failure.

Thankfully, due to the work and care of a few dedicated lactation consultants and paediatric doctors, the condition and ensuing problems are increasingly recognised. In the last few years, appropriate correction of the defect is being instituted with excellent results.

This brochure has been produced by a paediatric dentist and demonstrates the various forms of Ankyglossia (tongue tie) - the photos are excellent. The problems this condition can produce long term are given and treatment options are explained.

If any woman has problems with sore and damaged nipples, ensure your midwife or doctor checks your baby's mouth for tongue tie. The brochure also shows you how to check yourself. Sometimes the tongue tie can be 'occult' that is, not obvious when looking, you have to feel under the tongue against the base of it to identify the tethering.

If the link for the brochure doesn't work, look on Dr Kotlow's website for it

Another resource is the excellent milk matters site and this post on tongue tie as the hidden cause of feeding problems.

One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

Distracted parenting: Hang up and see your baby - The Boston Globe

Claudia Gold, a paediatrician in Great Barrington, wrote in the Boston Globe today:

"RECENTLY I was on vacation sitting by a pool. I noticed a father with his infant daughter who looked to be about 3 months old. Perched on a table in her car seat, she sat kicking and smiling. Her father faced her, but was talking on his cellphone. He distractedly shook the rattle hanging in front of her as he spoke in an animated way with the person on the other end of the line"

Her article continues to talk about how the baby develops her/his sense of self by the way the mother looks at her/him and interacts on a moment to moment basis. Dr Gold cautions that parents are perhaps not aware of the critical importance of the first few months and the vital importance of attending to and engaging with the baby to optimise the way the brain develops and the infant forms her/his sense of self. Fathers are taking more and more of the primary caretaking role of newborns and infants. A recent article in the New York Times outlined the way that social norms are changing as fathers become more engaged in parenting. Gold discusses the role of oxytocin in the way that mothers are preoccupied with their babies. Perhaps males are disadvantaged in this biological aspect? As feminists in the 70's, one of our catch cries was that 'biology is not destiny' but perhaps we were and are wrong not to pay attention to biological factors and instead of seeing these physiological realities as 'biological determinism' we could reframe the way that hormones and other communication molecules behave as 'biological intelligence'.

Mothers behaviour and orientation to their babies displays what D.W. Winnicott called 'primary maternal preoccupation'. Mothers are meant to be fixated on their babies, attending to their facial expressions; responding and reacting to them. In the past, women were told that babies are such 'time wasters'; that sitting staring at a baby was of no value, however, neuroscience has proven the value of primary maternal preoccupation and those hours of staring, awestruck at the wonder of one's own baby. From the beginning, a baby's brain wires itself, connecting and associating neurons to other neurons in response to environmental cues and emotional experiences. These neuronal associations form patterns of connection that from the earliest days form a mental map for security, enabling an infant to feel safe (or not) in the presence of her/his primary care giver. This primary relationship sets the stage for the child's future relationships and how the child perceives the world. As an infant feels more and more secure in her/his attachment to her/his primary care giver, she/he is able to then turn outward to the world and start engaging with the people and events in his/her wider environment. In those early days, the mother's face provides a mirror which allows the infant to see him/herself and form a sense of self that reflects that image. When mothers are fully engaged, smiling, encouraging, reflecting joy in being, the infant emerges emotionally resilient. Research has shown that mothers with flat affect produce withdrawn, less communicative infants.

Walking through any postnatal unit or going to any home where a new mother and baby reside, you see the ubiquitous cell phone in residence, either next to the woman's ear or being pounded by her flashing finger tips as she dashes off messages to cyberspace. Is it possible that primary maternal preoccupation has, in many instances, been diverted to the cell phone. What message and brain patterning do you think the little ones are getting? What do you think Mary Ainsworth and John Bowlby would make of this phenomenon?