The Childbearing Society is approximately forty-five years old. We have been going strong since the early seventies, consistently featuring the same kind of high quality prenatal and postpartum classes that we continue to offer today.
As I read this issue that explores birth over the years—what has changed, and what has remained the same—I think about how The Childbearing Society has had to be flexible, ever shifting to accommodate changes in the birthing world, incorporating new information, adjusting to policy changes, and expanding or shrinking according to the needs of the day. This kind of endurance based on openness reminds me of the nature of labour: it is the capacity to surrender to the process, to yield to the unpredictable powers, that is often germane to coping, to finding the strength of endurance. It is this kind of steadfastness and flexibility that has enabled The Childbearing Society to remain true to the vision espoused by our founders.
What began as a grassroots initiative—a small group of parents and nurses who wanted to help pregnant families understand their choices, improve the birth experience for babies, and advocate for family-centred maternity care—remains essentially unchanged to this day. We are still a non-profit society, we still operate as a democratic collective, and we continue to represent the leading edge in perinatal education. We are the local group, the Vancouver group, the alternative to the mainstream classes. We are fact-based, information oriented, and eternally supportive of all of the parents, babies, and families who come our way. Our aim, as always, is to empower people to make their own best choices.
In this issue we look at birth through the ages through several lenses. Our Question of the Quarter ponders differences in immediate newborn care then and now; our past president reflects on changes she’s witnessed throughout her impressive career in maternity wards; an acupuncturist weighs in on how the role of alternative treatments has shifted over the years, and one of our instructors looks at ways the paradigm around how birth is perceived has shifted over time. All of these articles consider ways in which birth care has improved versus ways in which we may have taken wrong turns.
I think our founders would be quite proud if they could see the path that The Childbearing Society has faithfully maintained over the decades, a path I think we will continue to pave equally far into the future.
Q. My grandmother tells me that when she gave birth to my mother sixty years ago, she wasn’t allowed to feed the baby anything until after 24 hours. Whereas when my baby was born, my midwife wanted me to try breastfeeding him right away. Why is this? What has changed?
A. Good question! What has changed is our perception of newborns and their needs.
It did indeed used to be common practice in some places for babies to be “NPO” (non per os, or nothing by mouth) for the first 24 hours. These were the days when most babies were kept separate from their mother in a nursery, fed on a strict schedule that had nothing to do with their hunger, and most often fed formula (which was deemed to be more “scientific”).
Many babies were under the influence of strong medications and anaesthetics that the mothers had been given during labour. The babies were often disoriented from the medications, disorganized from the separation from their mothers, and stressed by the protocols that were common at that time, such as bathing, suctioning, and other procedures ranging from unpleasant to invasive. As a result, babies were often defended and distracted. Their primary drive for skin contact and their instinct to bond were dulled by the medications, and derailed by the delays and discomforts of standard care.
At that time (indeed until fairly recently), it was common practice to clamp and cut the umbilical cord as soon as baby was born, thereby depriving baby of a large percentage of their blood volume. This also contributed to the general impression that newborns were drowsy and minimally responsive, with weak muscle tone and poorly coordinated reflexes.
In the past, we also had less appreciation for the value of colostrum. For a long time colostrum was believed to be just drips or crumbs that preceded the arrival of real milk. It was not recognized for the salubrious ambrosia that we now know it is. Colostrum comes in very small quantities, so babies are born with an extra layer of fat that is specially intended to carry them through until the mother’s more plentiful, more filling milk comes in. But at the time, people saw little benefit to feeding baby on such meagre drops, and since the quantity of colostrum is so sparse, reasoned that it meant babies did not require nutrition or calories right away.
Also consider that within the first day of life, all babies go through a significant physiological transformation as their digestive and excretory systems are finally put to use. As they transition from an umbilical to an esophageal intake of nourishment, their intestines encounter foreign substances for the first time. If newborns receive mother’s colustrum, it coats the baby’s gut with beneficial bacteria that facilitates digestion and fosters the development of their immature immune system. Some babies don’t digest alternatives to mother’s milk very well during these first couple days, as their systems are still highly immature and vulnerable. They might fuss, vomit, or react poorly if given a milk substitute too soon.
With all these influences contributing towards neonatal indigestion, drowsiness, and uncoordinated reflexes, it comes as little surprise that babies may have exhibited fewer feeding cues within their first day of life, and when fed formula, did not always tolerate their measured feedings well. Thus, it became quite common in some hospitals to wait until later, after the babies had been given a day to mature. Now we understand that un-medicated babies that have not suffered any separation from their mothers or unnecessary interventions, are usually alert, ready and eager to try nursing within the first hour of being born. All they need is unfettered access to mother’s chest, and they usually know just how to do the rest.
Sixty years ago, we didn’t know that the constant suckling newborns do to extract the sparse yet thick colostrum also serves to activate the mother’s prolactin receptors, which helps bring forth her milk. The constant suckling likewise stimulates the production of oxytocin, which fosters milk flow and bonding behaviours. The colostrum helps clear the intestines of meconium, so the baby’s digestive system can complete its transition from foetal to neonatal. Who knew that the first twenty-four hours of suckling were so important?
Sixty years ago, no one would have believed that brand new babies were capable of the self-directed efforts they make to find the breast and, their amazing ability to start feeding, their mobility, awareness, and the sense of purpose they possess. Who knew that newborns were so ‘human’! It is interesting though, that while newborns were once deprived of all food for their first full day, we now weigh them several times with focused concern, during that same period. While we have learned to appreciate a newborn’s immediate capability and motivation to nurse, we now impose an opposite restriction when we routinely intervene with supplements if baby loses “too much” weight within those same first twenty-four hours. Funny how the times change.
(Originally printed in our Autumn 2009 Newsletter)
After forty years of preoccupation with all things around birth, it would be a daunting task for me to list all of the many positive and negative changes that have taken place over the years. Rather, I will compare some of the worst and best aspects of the standard practices of the sixties, seventies and the present decade.
I observed the practices around birth as a nursing student in the sixties and then again as I gave birth to our sons in 1969 and 1973. I feared many things that I thought might be done to me while birthing our first child in 1969. I was as comfortable as a person could be in a large hospital, Vancouver General Hospital, given that I knew every inch of it having trained there as a student nurse and worked there as a graduate nurse for eight years. Despite this familiarity, I was aware that it was not in the vanguard of change, and that the facility was old, stark and operated under a system of rigid rules uninfluenced by the community. Women laboured in tiny, bare rooms with a fan attached to the wall above the foot of the bed as the only amenity. Even though it was November, the hospital was stuffy, I was hot from the work of labour and the little fan proved to be a huge help. I have since wished that modern “birthing rooms” had such a simple comfort measure. But let me take you through the process of admission while in labour, to the actual birth itself, and to the early postpartum that was accepted practice so long ago.
Upon arrival at the hospital women were subjected to having their pubic hair shaved. This practice was in the process of being modified in 1969 to one half of the hair shaved. This was thought, erroneously, to decrease the incidence of infections in the episiotomy that was certain to be done just before the baby’s birth. Quite the opposite: any nick from the razor left the previously intact skin now open to infection. Women were also given a large enema whether they had stool present in their bowel or not. This was justified by saying that it prevented the indignity of passing stool during the pushing of second stage. Another claim was that it would speed up labour, but in some cases it sent a very active labour into a precipitous birth in the admitting area or en route to the delivery room. For my part, trying to expel the contents of my bowel while sitting on a bedpan, atop a stretcher, without its brakes on and within earshot of the waiting room was infinitely more undignified.
Once settled in the delivery room, the labouring mum was virtually alone. Husbands were told to stay in the waiting room, and the nurses checked the labouring mother and her baby once every thirty minutes to listen to the baby’s heart. They assessed cervical dilation about every four hours (or more often if progress demanded it) by an uncomfortable rectal exam. Only physicians were allowed to assess the cervix via the vagina directly. Husbands paced the floor of the waiting rooms unable to support their wives. No same sex partners, friends, mothers or other relatives were allowed near the labouring woman either. Because VGH had the most progressive doctors and a few nurses who would break the rules, a few of my contemporaries did have their husbands by their sides. Fortunately, my husband was with me, but he was an exception.
The “Case Room” was the OR-like room in which women gave birth to their babies. It had an operating room table with stirrups and the bottom half that rolled under the top to allow the physician to sit on a stool between the mother’s legs in order to perform an episiotomy, to direct her to push, to catch the baby and to suture the episiotomy following the birth. The modern birth bed is often used in a similar manner to enable the birth assistant/doctor to be comfortable, with little consideration foe the mother’s comfort. With my doctor I negotiated many modifications for our second birth. He wrote an order to allow my husband to be present at each step of the labour. I made sure that I arrived at the hospital in good labour to reduce the actual time that I would be under their control. During the birth in the Case Room, I did not use stirrups and the bottom of the was bed was in place but a little lower than the top half so that the doctor had a little room to manoeuver the baby’s body during the birth if it was necessary. The top half of the table was raised to a 45 degree angle so that I could push more effectively and watch the birth of our baby. I did not feel that I was pushing my baby out into an open, unsafe space. I asked if I could lean my legs on my doctors belly and to this day I can remember that feeling of being surrounded by breathing, warm, caring people. Those moments at the birth were precious to me.
The one intervention that was standard practice was the episiotomy. I requested that my doctor let me tear rather than do an episiotomy but at the last moment he lost his nerve and asked my permission to do one. It wouldn’t be until the early 90’s that the first research studies proved that a cut in intact tissue increases the probability of an extensive tear rather than a tear, if it happens, along natural cleavage lines. I had a painful perineum for months following both births and I often wondered if a tear’s healing would have left me more comfortable. This same obstetrician worked with me as a colleague for many years and after irrefutable evidence from research he and most other physicians changed their practice during the nineties. In later years, this doctor claimed that I taught him about warm compresses and slowing the birth to allow the tissue to stretch and prevent a large tear. Although that may not be true, I was one of the first people he knew to question the conventional practice of episiotomies leading to fast births and large tears. The weight of evidence from modern studies has proved what midwives have always known.
Not all women had a goal to have none or very little medication in labour in those days. Many drugs were often used in labour starting with sedatives in early labour, and narcotics and gas at the second stage. Epidurals were heavy and frequently left women incapable of moving in the bed or pushing their baby out. Forceps were used often because caesareans were considered to put women and babies at greater risk. Doctors used forceps to reposition babies and then pull them down from a high position relative to the mother’s pelvis. Only after research showed that it was safer to do a caesarean rather than use high forceps when the baby was not well descended into the pelvis, did the frequency of the use of forceps go down. This type of intervention has not really diminished over the intervening years because low forceps and vacuum extraction of babies is widely done when women are unable to push their babies out following an epidural. Today, the majority of women having their first babies have an intravenous line in place, an epidural and many have an oxytocin augmentation of labor and are assisted with a vacuum extractor at the time of the birth. Second babies deliver much faster on average so women who have prepared for a birth without interventions sometimes get to experience this with second and subsequent babies.
In the sixties and seventies, directly after the birth, and while still in the Case Room, the baby was bathed in tepid water and phisohex, a lotion-type antiseptic soap that was later proven to be harmful to babies, but was done because we had the misguided notion that babies were somehow contaminated during their journey through their mother’s birth passage. Little did we know that even full term babies are stressed by exposing them to the cooling effects of the water directly after birth. Bathing a newborn is still a contentious practice. Some believe that babies are better left alone and allowed to derive the benefits of their own flora and protective barrier that the amniotic fluid provides. Others think that, when the baby’s temperature has been stable for six successive hours, and if the bath is warm and of a short duration and they are placed skin to skin immediately following, parents benefit from learning to handle and care for their newborn. Most parents still want to be shown how to bathe their babies and find doing it with the nurse helpful.
Postpartum in the hospital was dictated by old hospital routines based on years of stultifying practices never put to the test of studies. With our first baby I went along with the practice of four-hourly feeds with the baby being kept in the nursery for the first day. I did get our baby at my bedside on the second to fourth day because I was in a four bed ward, for which I paid extra. Had I been in the open ward with twenty or more mothers, I would not have had him near by and would have had to endure the smoking and disruption caused by the other patients and their visitors. Prior to my second postpartum I had read about “rooming-in” and requested that I have our baby with me at all times. The hospital staff was caught a little off guard but decided that after their one hour of observation of our son that I could have him only if I paid for a private room and accepted their requirement to be put on isolation. We now know our baby was much safer from infections when isolated with me than taking his chances with the handling from staff members in the central nursery.
In the seventies, breastfeeding education was inconsistent and mostly based on old tradition. Most caregivers were not aware of the process of how the mother’s milk supply matches the demand from the baby, or how to help a mother latch her baby or how to solve the many little issues that can crop up in the first days and weeks. I was fortunate to have read a lot and was in close touch with the La Leche League, a group of breastfeeding mums who had lots of experience solving common problems and who had a willingness to listen and to even make home visits. My colleagues in Childbearing were also a big help and my partner also believed that it was the best way to feed our babies and supported me in many ways. Women who did not have this support usually introduced formula (that the hospital or doctor gave to them) early on which began the process of weaning their babies. Today, lactation consultants are available in most cities to help women who are experiencing difficulties.
Let us take a critical look at the present. In some hospitals we now have beautiful birthing rooms that women can use without moving to another room for the labour, birth or postpartum. The system has come a long way to give families the facilities that they deserve and to educate families and staff about the unique possibilities for every woman. Women still have to seek out caregivers who have a non-interventionistic approach but many are willing to support their goals. If women are motivated, educated, and luck is on their side they can have a drug-free labour and birth with a midwife or physician, nurse, doula, partner or other support people chosen by the mother available to help. All are prepared to give ample labour support to help her have the best birth possible. Women need to probe the culture of the hospital that they plan to use so that there will be few surprises during their stay. They need to be even better educated if they are planning a home birth with a midwife so that they and their family can handle the additional responsibilities. In either case, as it was in the past, women need to surround themselves with supporters who will advocate for them, help them access their strength, remain open to unforeseen circumstances, help them make adjustments as needed, and help them trust and listen to their bodies.
Some of the changes that were needed forty and more years ago are still needed. The erythromycin ointment for baby (that is now not recommended), is still sometimes suggested, or the parents are asked and need to then sign a waiver if they refuse. The Vitamin K shot can be done safely within six hours after birth and should be done when the baby is suckling well at the breast, so as to reduce the pain of the injection for the newborn. Breastfeeding at the time of any injections or heel pricks has been proven in many studies to be an effective pain reliever. Some nurses are committed to latching the baby first, but many are not. The lab staff are particularly rigid about their methods and, unless reminded, do not initiate breastfeeding prior to their blood draws. Parents need to speak up on behalf of their babies and ask for the laboratory staff’s patience while they latch their babies.
As always, parents need to be their own advocates to ensure that they have a satisfying, well-informed and positive birth experience. It all begins with comprehensive childbirth classes, reading widely, watching informative videos or talking with health professionals, family or friends. Having a baby is one of life’s most significant experiences and leaves us with memories that will last a lifetime.
Diane Donaldson is one of the founding members of The Childbearing Society. A retired Childbirth Educator and Perinatal Nurse, mother of two, and an inspiration to all of us.
In Canada, as our knowledge has grown, opinions about the use of acupuncture have changed dramatically. Today, midwives are calling on acupuncturists to assist with difficult pregnancies, acupuncturists are working next to obstetricians in hospitals helping women through labour, and family physicians refer to acupuncturists to help with post partum care.
Today’s reality reminds me of one story shared by an instructor at a seminar on pregnancy and acupuncture. Years ago when he first started practicing, doctors and nurses were not sure how to integrate his work with theirs. One day, he was called into the delivery room to help with a difficult labour—both mother and baby were in distress. Their heart rates were up and the labour was not progressing. My instructor used a few well-known acupuncture points and instantly the monitors showed both the baby and mother’s heart rates return normal. The medical team was amazed. It has been instances like this that have helped legitimize acupuncture to the Western medical establishment. Today, Jean Levesque works with a team of over 20 acupuncturists who specialize in pregnancy in the province of Quebec. His team has helped hundreds of women through the birthing process.
For me, it has been a great opportunity to learn from sage healers like Jean Levesque, Bob Flaws, Debra Betts, and Raven Lang who have been treating labour and pregnancy with acupuncture and Chinese medicine for decades. It was not easy for them—pioneers of Traditional Chinese Medicine (TCM) and acupuncture in the West—to pave the way for practitioners such as me. It used to be that for someone to learn acupuncture and TCM, and to learn it well, they first had to learn how to speak and read Chinese. This is not the case today. These doctors have translated information and made it possible for the next generation to also become talented doctors of TCM.
I have been practising Chinese Medicine and Acupuncture for over eighteen years and have observed an incredible increase in interest in acupuncture. Working with women before, during, and after pregnancy is a large part of my practice. Fewer are the days when I am asked “Once I am pregnant, is it safe for me to continue with the acupuncture?” My answer remains, “Absolutely, and your body would prefer if you did.”
By no means has acupuncture and Chinese medicine become “mainstream”. However, with family physicians and reproductive specialists referring patients for acupuncture, I am confident that medicine is moving in that direction.
Dr. Jeda Boughton is a doctor of acupuncture and Chinese Medicine. She practices with a team of specialists at BodaHealth in Vancouver, B.C. You can learn more about her practice at bodahealth.com
There was a time, not so very long ago (early 1900’s), when the majority of pregnant women in North America gave birth at home, attended by a midwife. Roughly 95% did. Then in 1955 that figure became the number birthing in a hospital. What happened? What brought about this dramatic decline in home births?
During that time, a few prominent obstetricians, like Dr. Joseph DeLee, the inventor of forceps, pursued the adoption of massive universal changes in obstetric protocol for birthing women. These changes weren’t based in research studies or scientific evidence. The paradigm shift moved from the understanding of birth as a normal healthy process of biology to one of pathology. From the obstetrician’s perspective, birth was dangerous and in need of specialized care – their care.
This reframing of birth fostered two major beliefs that have become etched in our global consciousness. First that birth was risky, until doctors saved it, and second, pregnant women are sick and so naturally they should, like any sick person, rely on a physician’s help. Based on this premise came the medical ‘technocratic’ model of birth. Viewed through this lens it defines the body as a machine, birth as pathological and mechanistic. There is the use of aggressive intervention for short term results, and pain medications, which disturb birthing hormones, increasing risk of complications in a normal labour. This is an ‘illness’ model, with the patient as object.
Certainly it’s not so black and white as this. Among maternity care providers a blending of these two models can operate. The humanistic model isn’t solely attributed to midwives. Regardless of which model is practiced, the primary focus that must be at the forefront of care is respect for a woman’s autonomy.
Conversely, the ‘humanistic’ or midwifery model defines the body as an organism, and birth as a normal physiologic experience. This model takes an evidence based approach; promotes birthing hormones which optimize safety, benefitting both birthing mother and baby. This is a ‘wellness’ model and one that is relationship-centered.
With the change in birth setting, the hospital required women to labour in bed, on their backs, with legs strapped into stirrups. Obstetricians routinely did episiotomies and used forceps. Women were also often drugged to make them compliant. These conditions were a huge departure from how women had been birthing. Surrounded by the comforts of their own home, they had the freedom to move and adopt various positions that aided their natural labour process. It was a family centered, not a medical, event. The birth attendants were there to assist, if and when needed. It’s not surprising that with institutional restrictions came increasing difficulty to birth normally, which brought about complications. As expected, women needed more medical assistance and pain medication use rose.
Since those initial years when birth moved from home to hospital there has been an ever increasing use of intervention and surgery. This is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. As an example, in a large review published in 1987 covering tens of thousands of births in Australia, Europe and the US, it was found that the only statistically significant effect of continuous foetal heart monitoring during labour was an increase in the rate of Caesarean and forceps deliveries.
Currently, obstetric interventions are overused and misused in many maternity settings. When we examine birth practices today, particularly in institutions, we still see more than two-thirds of women give birth in the supine position, despite evidence that this position increases the likelihood of instrumental vaginal delivery and episiotomy.More than half of all birthers receive synthetic oxytocin to induce or augment labour, which increases the risk of caesarean. One third give birth via surgery – caesarean section.
The rate of caesarean birth in Canada has risen dramatically over the past few decades, a trend consistent across other developed countries. The Canadian caesarean rate has risen steadily since the mid 1990s, from 18.7% in 1997 to 26.7% in 2007 and then to 28.2% in 2016.The caesarean rate in British Columbia is the highest in Canada, at 35.3% in 2016-2017.
When medical intervention is necessary, and there are situations certainly where it is, caesarean birth, for example, is life-saving. It’s not the use of technology that is under scrutiny, but the over use, leading to complications in otherwise normal labours and births.
Even with recent efforts to implement changes there is an emerging population of new mothers sharing their stories of ‘birth trauma’ and what is termed ‘obstetrical violence’. These stories are becoming more prevalent. Unless the rampant over medicalization of birth ceases, this will be the reality of our birth culture. We are at a turning point. We can no longer afford to adhere to an outdated paradigm of birth as a pathology, where birthing women are managed and their labour controlled; where a cascade of routine interventions leads to unnecessary surgery; where a risk averse attitude instils fear leading to unnecessary harm. A new paradigm is needed.
Part of this ‘new’ paradigm (birth as a healthy physiologic process) is the resurgence of midwifery care. The return to midwives, care providers that are not only highly respected , but the predominant providers for birthing women, brings benefits for upcoming generations of healthy pregnant women. Research studies show that midwifery care has lower rates of intervention and caesareans, with low pain medication usage.
The current shift in awareness means inquiring minds are also questioning our culture’s belief that the safest place for birth is the hospital. At this point with the climbing rates of caesareans and interventions, birthing in a hospital can be risky for healthy pregnant women. A 2018 research study involving 500,000 labouring women showed only 38% had a spontaneous vaginal birth without any type of intervention.
There have been seventy years of institutionalized birth compared to thousands of years of home birth. Home birth is not a trend. Research into birthing at home shows it to be safe for low risk healthy pregnant women. The hospital is the optimal setting for those with pre-existing medical conditions, or conditions that occur during the labour process, which put them at risk. Yet for healthy pregnant women, their home or a birth centre are safe alternatives. This movement away from institutionalized birth is gaining momentum. Although a small percentage of total births, home birth rates are increasing.
It’s also a movement that has educated and well informed women desiring a physiologic birth,viewing birth as a healthy normal process and not being influenced by fear – a fear that is escalating to terror, perpetuated by our society. We are coming full circle. As it stands today, physiologic birth in many industrialized countries is in danger. Our reliance on technology and our belief that it is superior to nature is wreaking havoc for birthing women and their babies. That, combined with the belief that birth is a medical emergency waiting to happen keeps the old paradigm intact. The work to be done is to de-program. Fear runs deep in the collective unconscious.
But a consciousness is awakening that remembers birth as a rite of passage, with trust in women’s bodies. Thousands of years of evolution can’t be wrong! Hopefully the pendulum will swing to attain balance: that normal birth is wholly supported, not interfered with, and medical technology is accessible when it’s truly needed, not as routine. This vision isn’t only possible, it’s imperative.
Debra Woods is a seasoned birth & postpartum doula who’s cared for more than 800 childbearing families. She has been practicing professionally for 30 years. She is also a certified childbirth educator and placenta encapsulation specialist. Mother to one son, who was born at home, she is passionate about educating expectant parents on evidence based birth. She specializes in supporting couples who believe in birth as a healthy process and desire a physiologic birth, without the use of intervention and pain meds.
Welcome to the Childbearing Society’s winter newsletter, newborn edition!
Much has been discovered about the youngest members of our species over the past few decades. It may surprise some of you to realize how little we used to know about newborns, to imagine that not so long ago, we believed these small babies were just blank slates—empty vessels waiting to be filled with knowledge, incapable of experiencing emotions, sensations, suffering, or fulfilment.
Research on newborns, as fascinating and important as it is, is merely beginning to vindicate what parents have always observed, and what we have always known in our hearts. Babies are complex little people, with strong personalities, explicit needs, and a wide range of emotions. Although it is true that they don’t come with a manual, babies are quite good at telling us what they need. In this issue, we take a look at some of the more recent findings about newborns, what they’re all about (Babies Remember, by Bonnie Davies),what they need to thrive (The Pursuit of Proximity by Pat Currie), and how we parents cope with their sudden and overwhelming centrality in our lives (Why Can Motherhood Feel so Hard, by Stephanie Jhala). Our question of the quarter examines the popular question of swaddling for young babies: Yes? No? Sometimes?
We hope you gain some insights from this issue, but we hope you trust your instincts, and turn instead to your own baby for the real low down on his or her needs. A baby may not come with a manual, but they don’t need to. Your baby *is* the manual, full of cues and information. And learning to ‘read’ your baby makes you the most knowledgeable expert in the world.
Humans are classified as mammals ; species distinguished by the mammary glands and ability to breastfeed and yet you might ask why are there are so many challenges in this physiological function? Well to begin with, let me reassure you that not all women around the world have as many challenges as western women do. Why? Because in many cultures, women don’t question their body’s ability to feed their babies and they have confidence that their babies know how to do it, just like all other mammals do. Have you ever doubted that a puppy can breastfeed? Then why is the baby of the most intelligent species having so many issues? Maybe because we don’t trust them as much as we trust a puppy for this!!
In my 18 years of experience as a midwife back home in Iran, I didn’t have anywhere close to the number of clients I’ve had in five years here in Canada as a Lactation Consultant. For this reason, I’ve decided to make an educational video on breastfeeding that emphasizes on the baby’s capability to breastfeed and prove how the less mom does in this physiological function, the better. In all mammals, babies do the latching not the moms! our babies can’t run to us like a puppy does, but if they’re in their habitat and have the freedom to move and adjust their body, they will have the best latch and thrive.
To no surprise, my video is called “We’re Mammals”. It should be ready by early 2019.
If anyone is interested in taking part in this video, please contact me at firstname.lastname@example.org
Q:Should I swaddle my newborn? I have received several swaddling blankets as gifts, but I have heard conflicting things.
A:Swaddling babies used to be routine practice. It was a way of helping agitated babies calm down and settle when they were separated from their mothers. Since babies used to be kept in nurseries, removed from the loving arms and warm bodies that they needed, swaddling provided a way to mimic some of the sensations of being held and protected.
However, even though it appeared to calm babies down and reduce crying, we now realize that swaddling did not, in fact, provide any of the other benefits of snug body contact. When held by a parent, a newborn’s systems all settle into a state of calmness and homeostasis. The baby’s heart rate, blood pressure, breathing, and hormone production are all affected, and by extension their digestive system, their neural development, their senses, and their growth. Babies literally ‘organize’ themselves through proximity to a parent or attached caregiver. So swaddling confers none of the actual benefits of being held, but is there any harm?
We would all love to believe that anything that can help a baby sleep longer and deeper is a good thing. But babies are not actually meant to sleep so soundly. As inconvenient as it is for us tired parents, babies are supposed to sleep lightly so that they can rouse frequently and easily when they feel a need that requires action, such as hunger, fear, thirst, temperature, or a need for attachment. A swaddled baby may be at increased risk for SIDS because they can’t utilize the ‘startle’ reflex that helps them wake up at regular intervals (which, unfortunately for exhausted parents, newborns need to do for their own safety).
Recent studies have also shown that babies who are routinely swaddled are slower to gain weight, and have increased challenges establishing the mother’s milk-supply. Frequently swaddled babies are at increased risk for hip-dysplasia, and are more susceptible to hyperthermia (over-heating). As well, swaddling makes it harder for babies to move gas and air through their digestive systems (which they do by pumping their arms and legs), and restricts their movement at the expense of exercise and muscle development. Some researchers propose that what we have been mistaking for relaxation, may actually be babies just giving up, because they are helpless in their little straight jackets. Most important, babies should never be swaddled when they sleep, as it restricts their ability to move into a more comfortable or safer position, and increases the risk of SIDS.
So is swaddling a terrible thing to be avoided at all costs? The answer is no. Like most parenting practices, there is a time and a place for almost everything. A baby that has to be separated from adults for any reason will probably be at least somewhat soothed by swaddling. There are also those nights when baby is particularly twitchy when swaddling seems to be the best last resort (but please unwrap your baby once they fall asleep. If they get wedged facedown or in a corner, a swaddled baby can’t always push themselves up to breathe. This increases the danger of suffocation). And of course there are some babies who simply relax into snug swaddling more than any other kind of cuddling. As parents, everyone has to make their own decisions for what works for their own babies. But when making such a decision, it is useful to be aware of the downsides of swaddling, especially if used routinely.
Did you know that up until 1986, surgeries were routinely performed on babies without anaesthetic? The most common were intestinal and heart surgeries requiring the most invasive surgical techniques in existence. It was thought that babies were barely conscious and didn’t really feel anything, so it didn’t matter what happened to them early on. This may seem barbaric to us now, but that kind of thinking persists, even though science tells us that babies feel pain just as we do, are conscious of what is going on around them, and are exquisitely aware.
A newborn’s first experiences are imprinted in their minds in a profound way; memory of their early experiences gets recorded implicitly. This means that while we don’t ‘remember’ per say what happened to us before the age of two, these experiences influence our unfolding personality, how we react to things in our world, and our gut responses to things as we grow – our early experiences become a part of us. Experiences such as when and where we feel unsafe or threatened in some way are recorded in a part of the brain called the amygdala and are used to help us avoid similar experiences as we get older. Although we don’t ‘remember’ the initial incidents of feeling unsafe, our brains have recorded them and this imprint becomes a part of how we react to situations as children and, later, adults.
Why this is important when talking about a newborn baby is because his or her early experiences literally get built into their bodies and shape their brains and nervous systems for life. Science now tells us that a baby’s brain is highly impressionable and is being shaped by every experience that it has. Knowing this, there are ways to support our babies from the start that can really help them with this imprinting process. When we can slow down, babies can integrate what is happening to them; when we can attune to their inner experience, they feel seen and met by us.
One of the most important things to remember about babies is that we need to go slow with them,because their nervous system is operating at a speed that is 10-15 times slower than ours. What does going slow mean? It means that we slow down our movements, our language, and we talk to babies and prepare them for what is about to happen, much like we do with older children. So, for example, when we take the baby away from the mother for the first time after birth, we let the baby know there is a change coming, we tell them what is about to happen, and we go really slow. We keep in mind that this is the very first time the baby has left the mother’s body; it is a profound moment. When we slow down and talk to our babies about what is about to happen, we give their nervous system time to adapt to the change. This is really good practice to get into with babies because everything that happens to them in a day is beyond their control.
How else can we support our babies? Babies learn about themselves by how we treat them. They grow optimally when they are nurtured, responded to in a timely manner, and attuned to. Attunement is the parent’s ability to ‘tune in’ and have sensitivity to what the baby is feeling and expressing. For example, you can take note that your baby is over-stimulated because you’ve had a busy morning out, and they are showing signs of fussiness. “We’ve been so busy this morning and we need some down time; let’s go sit in the corner where it’s quiet and nurse.” You can also notice that your baby seems angry over a toy. “Oh, you’re angry that I took that away from you. I’m sorry, here’s something fun!” When we are able to have this kind of ongoing communication and attunement, our babies receive the message that we see them, hear them, and that they are being met by us. This helps them to grow a sense of self, that how they feel matters to us, and this helps them build a sense of worthiness and belonging.
This suggestion to slow down and attune to our babies is not some folk remedy – it is supported by the most current scientific research and clinical practice. Paediatric neuroscientist Dr. Bruce Perry’s research demonstrates that the earliest most fundamental experiences that shape the brain are these sensitive interactions between mother and baby and that this forms a kind of template that moulds future responses to human contact.
To find out more about newborns and their brain development, check the birthcontinuum website events page. We offer education and coaching to parents on infant development, sleep issues, and toddler behavioural concerns. This fall, birthcontinuum will be offering several 8-week series of classes for parent/baby, and parent/tot focused on enhancing emotional/social development through singing, dancing and playing.
Bonnie Davis, RCST & attachment specialist,has been working with Vancouver families since 2002. She is a registered craniosacral therapist, experienced birth and postpartum doula and perinatal educator in Vancouver. She offers workshops, counselling services and education for new parents. She brings her experience with babies and a passion for supporting families to create strong attachments in the primal period.
When asked to write about attachment and infants I decided to prime my thoughts about this time of my life by watching home videos of the birth and early months of my children’s lives. Surprisingly, it wasn’t in the videos where my thoughts on attachment and infants started but it was in the fact that my fourteen and twelve-year-old children wanted to sit next to me and watch my son’s birth and the moment they met. I realized, while we were smiling and laughing together, that all the time and effort I spent caring for and responding to my children when they where infants led to the kind of relationship in which they wanted to be with me now.
Often when I tell people that I support attachment parenting they will respond with, “you’re one of those parents”, and I will see their eyes roll. People often misunderstand the word “attachment” and confuse it with baby bonding or spoiling a child by not establishing rules or boundaries.
The definition of attachment that resonates with my intuition is that of Dr. Gordon Neufeld.
“attachment is the pursuit and preservation of proximity, of closeness and connection: biologically, physically, behaviourally, emotionally and psychologically”
(Gordon Neufeld, Hold On To Your Kids, page 17).
Put another way, every human has the instinct, need and drive to connect with other humans. When our new babies are first placed in our arms they exhibit a drive to connect in their motions. Their lips suck and their heads move in search of someone, they will turn towards the sounds of human voices (especially those of their parents), and if you put them down they will cry to be picked up and held.
In our infants this need to connect is purely about survival. Their dependence on adults for everything, drives their relentless pursuit for connection, seeking for their needs to be met. I remember the struggle to have a shower, or even just go to the bathroom, while having my babies stay connected to me: leaving them sleeping on the shirt with the most breast milk stains so they would smell my scent; constantly singing so they could hear my presence (I still do this with my children.); and, pumping what seemed liked endless amounts of breast milk for others to feed them. The moment the connection is broken, we are made immediately aware–there is no mistaking the cry of panic that alerts us that we are desperately needed.
Fulfilling this drive to connect in our infants not only provides safety and security, but elicits the crucial brain growth that needs to occur in this early stage of development. Research tells us that the loving relationship with a primary caregiver is the key to brain development. At birth a child’s brain contains 100 billion neurons, but very few are connected. During the first three years of life, a warm, loving, responsive relationship with a primary caregiver, produces the chemical reactions necessary for these neurons to begin making their important connections (synapses). While brain growth is spontaneous, it is the role of primary caregivers—parents–to support this growth, so it can reach it’s optimal development.
The sleepless nights and the diaper changes are not just mundane tasks. The small acts of caring for an infant help it know it is being cared for, help it feel a sense of safety in the world, and provides opportunities for the brain to grow. As I watched the midwife in the video place my daughter in my arms for the very first time, I looked over at my daughter, now fourteen years old and sitting next to me, with all the same love and warmth that I did that first time. The moment our children are present in our lives, we are responsible for creating and holding them in this loving, caring relationship. When we do so, and become the parents our children need, we create an attachment to us. It is this attachment that gives us the ability to lead them, the ability to parent them, and gives them the ability to grow and thrive within our care.
Pat Currie is a Parent Educator in East Vancouver. Pat’s desire to help others understand their children from the inside out has led her to become a certified Neufeld Course facilitator. Pat brings warmth and insight to her courses by sharing her experiences as the mother of a fourteen and a twelve year old. Pat can be reached at www.oakandtheacorns.com.