Once your baby is born, the birth seems to be over. Parents hold their new baby, exhausted and relieved, engrossed and amazed, utterly entranced and focused, and are often perplexed when their caregiver asks for one more small push. What on earth for? This is the third stage of labour: the afterbirth. And there are still some choices to be made.
The term ‘afterbirth’ is often used as a synonym for the placenta, which is indeed central to the third stage of labour, but it can also refer to the precious time immediately following baby’s arrival. A lot happens in the short time after baby emerges: the birth of the placenta, the cutting of the umbilical cord, maybe the initiation of breastfeeding, and ideally the golden hour of parents and baby meeting for the first time and beginning the long process of imprinting and bonding.
Although the third stage is hardly ever what expectant parents spend time picturing or planning, it is nonetheless an important and potentially memorable stage of birth for parents and baby alike. Even in the event of a surgical birth, many of these same options might be possible depending on the circumstances. As always, we encourage you to ask questions, talk to your caregivers, and include the ‘after birth’ in your vision.
When preparing for the birth of a new baby, many mothers-to-be focus very intensely on what it will be like to labour and give birth. It is important to learn pain management techniques, what happens when an epidural is administered, specific breathing techniques, labour and pushing positions, but there’s often a big hazy unknown when it comes to the moments immediately after the baby is born. Those first moments then extend into the postpartum period and beyond.
It can feel difficult to plan for the moments immediately following the birth since they will be different depending on whether or not any interventions or medical assistance is required. However, thinking through what you’d like to see happen in several different situations and planning for mom and baby staying together as much as possible is a good way to prepare for the uncertainty of birth and increase your chances of a positive bonding experience.
Why should you keep your baby with you after birth?
There are several important reasons to keep your baby close immediately after birth, all of which work together to keep baby and mom safe, healthy and bonded with one another. Placing baby on mom’s belly or chest for skin-to-skin contact helps regulate baby’s temperature and breathing. If mom is unable to hold baby skin-to-skin immediately after birth, this can be an opportunity for dad or partner to take off his or her shirt and get involved in the bonding process.
Hormones from delivery also prime mom and baby to bond with each other, beginning the foundation of emotional attachment. These hormones are at their peak immediately following the birth and for an hour or so afterwards, which usually coincides with the newborn’s window of quiet alertness. During this time a newborn will look around with wide eyes, searching for faces. This is when the magic of bonding happens, and it’s important for mom or dad to be holding the baby during this time.
Unless there is a life and death emergency, there is no need for medical staff to take a baby away from mom after the birth. A newborn does not need to be immediately weighed, measured, bathed, dressed, immunized or have eye drops administered, at least not within the first hour or so. All these things can wait while mom and baby recover from the birth and get to know each other.
Bonding is powerful
When I was pregnant with my first child I learned about natural birth and decided to have my baby at home in order to have the best chance at having a natural birth. I read about the importance of early bonding during the window of quiet alertness after birth and the natural rush of oxytocin, and I knew I wanted to start breastfeeding straight away. Even with all that knowledge under my belt, I was still surprised when I looked up from where I was lying on the bed, resting after giving birth to my new baby to discover that my husband, midwife and her assistant were all in the kitchen having tea together. I had been lying there, busy gazing at and falling in love with my new baby and I hadn’t even noticed them leave. I don’t even know how long they were gone for. I remember a brief moment of, “I wonder what they’re talking about?” and “I wonder if they’ve forgotten about me?” but I was very thankful for the quiet, peaceful space they gave me to enjoy simply being with my new baby.
Reforming birth practices in countries where birth has become a highly medicalized event means recognizing birth as a multi-dimensional, life-changing event for all members of the family. When birth is recognized and honoured as an emotional, spiritual, transformational AND biological process, then the importance of keeping a new baby and mother together will become more apparent. It may be easier, faster or more efficient for medical staff to perform their routine examinations immediately after birth, but a new baby’s bonding window won’t wait for the nursing staff’s schedule. Having a birth plan can help make it clear to your doctor and nurses that it is important that baby stays with mom after birth, and hiring a doula can help too. For women with low-risk pregnancies, consider hiring a midwife and giving birth at home.
Michelle Carchrae is a former homebirther, homeschooler and freelance writer. She is currently studying to become a counsellor at City University and lives with her family on Bowen Island.
The use of acupressure in labour has been gaining popularity in the west as a natural means to help women during labour with pain management as well as relaxation. It is easy to learn and in fact, a birth partner who knows even a few effective pressure points can really help during the three stages of labor and even post partum. I have included a link to a lovely free handbook for those interested in learning about Acupressure in birth that was generously provided by a colleague in New Zealand named Debra Betts which I encourage you to read.
Birth is a miracle! The hour immediately after the birth is considered the “golden hour” where parents and baby meet each other on the outside for the first time. This is a time of major physiological transition for mom and baby and includes a cascade of hormones vital to bonding and breastfeeding. This hour also encompasses the third stage of labour where the placenta is birthed. It’s easy to forget about this part even though it is really crucial.
Normally, the placenta is delivered relatively quickly after birth, from a few minutes to a half hour. It is important that this stage of birth be uncomplicated and timely. Did you know that applying a firm bilateral pressure to the tops of the shoulders can help? The specific point I would like to highlight today is GB 21, an empirical point used to help with the delivery of the placenta (among other things). It is so easy and accessible that everyone should know it.
GB21 is on the top of the shoulder halfway between the tip of the shoulder and the spine. The most precise point location is actually what feels best to the birthing mother. She may like it massaged, rubbed or firmly pressed, but acupressure is most effective with bilateral pressure. The point can be pressed for one minute (sometimes two or three) and released for a break. Repeat for as long as mom likes it and it seems useful. Let her guide the strength of the pressure.
GB21 is considered one of the forbidden points in pregnancy (before thirty-seven weeks) as it has a strong action to direct energy flow downward. It is this strong action that can help babies descend, helps the placental stage, helps facilitate the let down reflex of breast milk. If you must know just one point this one is extremely versatile and it feels really good.
In my experience, aside from the benefits I have outlined, I have found it to be very grounding. For example, the birth partner or doula can stand behind the birthing woman and press both shoulders at the same time during contractions. This will guide all the energy that comes with intense waves to move downward thus facilitating the birth and helping with relaxation. Moms have reported loving it. I have used it a lot in both my acupuncture practice and as a doula. It is amazing. After the birth, don’t forget to use it if there is a delay in the third placental stage, and try it during breastfeeding to help with promoting let down.
After becoming a mother in 2007, Renee’s passion for pregnancy and childbirth led her to shift the focus of her Acupuncture practice to begin serving the childbearing families of Vancouver as both an Acupuncturist for pregnancy and Doula/acupuncturist for birth. She has had the honor in attending over a hundred births and has treated thousands of pregnant women. It is a great joy for Renee to witness the incredible transformations her clients go through during their pregnancies and is deeply honored each and every time she shares in the miracle of childbirth.
Placentophagy is the act of mammals eating the placenta of their young after birth. The practice of eating placenta is not new. In fact, all mammals, with the exception of marine mammals and camels eat their placenta. Humans eating placenta started during the 1970s and has become more popular in the past 15 years or so. This is due to increased publicity about it, recent well known celebrities sharing about their experience taking placenta pills, and personal accounts found on social media such as Facebook. For many it’s considered a fad, but there are also many who claim that they benefited from eating their placenta. For more info on placentophagy go to: https://placentabenefits.info/placentophagys-biological-purpose/
There has been animal research done on ingestion of placenta, but human trials have been few and with small numbers. Yet they do show encouraging results, such as those related to iron levels in placenta. Research shows fatigue to be a contributing factor for postpartum depression. By taking one’s own placenta, the increased iron stores can lead to having more energy, therefore lowering risk for PPD (postpartum depression). Replenishing depleted iron is good news also for women who have experienced anemia during pregnancy, or had heavy blood loss during the birth.
Also for thousands of years Traditional Chinese Medicine (TCM) doctors have used placenta as an ingredient in certain remedies to treat patients with lowered energy (chi), blood disorders, infertility and other conditions. TCM uses placenta to aid in good lactation. https://placentabenefits.info/placenta-for-healing/
Placenta Encapsulation is the process of preparing human placenta into capsules for ingestion. The placenta is dehydrated from either a raw state or after being warmed by steaming, then ground down and put into capsules.
Summary from research article: Placental tissue is a source of natural hormones, trace elements and essential amino acids – the ingestion of raw or dehydrated placenta could influence postpartum convalescence, lactation, mood and recovery.
The risk of intoxication from individual intake appears to be low in terms of microbiological contamination and the content of potentially toxic trace elements. However, the mother should be advised that the processing and use of the placenta is her responsibility and that the transmission of infections cannot be ruled out.
Further studies focusing on the bioavailability of the hormones after oral ingestion and their potential physiological effect are necessary to evaluate the use of placental preparations. Patients with an interest in placentophagy should be informed about the potential risks and effects.
Recently in a news report Canadian obstetricians warned mothers about the danger of ingesting their placenta, and stated that there are no proven benefits.
The warning stemmed from a case in the USA in 2017 when a baby became sick from GBS and it was thought to be caused by the mother taking her placenta pills. GBS was found in the pills. Yet the baby was ill from GBS prior to the mother ingesting her placenta. The baby became sick a second time after the mother began taking her pills.
Another question concerning placenta ingestion was posed by a Lactation Consultant concerned that the hormones in placenta, specifically progesterone and estrogen would cause low milk supply. A response was presented in this article.
Despite concerns new mothers continue to have their placenta encapsulated. There are numerous positive anecdotal stories that lead to other mothers following suit. Many claim that it’s helped them with having great energy, maintained a good mood, and others believe it’s helped with an abundant milk supply. Mothers who didn’t encapsulate after a first birth and then for a second, swear it made a huge difference with their postpartum recovery.
It is wise to research who prepares placenta, and if, for example, they have completed a certified training course and know how to handle and prepare it properly. Training includes learning about and following OSHA guidelines (handling blood borne pathogens), as well as Food Safe requirements. Here is a list of three organizations that offer trainings.
Vancouver hospitals such as BC Women’s require that a form be signed allowing patients to take home their placenta. If there were complications during a pregnancy or with labour, or baby, the placenta may be sent to the Pathology Lab for testing. Placentas are disposed of in the hospital’s incinerator. If you want your placenta to be encapsulated, it needs to be kept on ice, or in your own cooler until it can be picked up by an encapsulator. Hospitals do not store placenta in their fridges.
Google to find local placenta encapsulators. There are many located within the Greater Vancouver area.
Debra Woods is a seasoned birth & postpartum doula who’s cared for more than 750 childbearing families. She has been practicing since 1989. She is also a certified childbirth educator and placenta encapsulation specialist. Mother to one son, who was born at home, she is passionate about women becoming fully informed about birth in order to make the best decisions for themselves. She loves helping families with their newborns so they can experience a smooth adjustment into parenthood.
What are my options with regard to the timing of cutting the umbilical cord?
There are four main approaches to cord cutting.
Immediate cord clamping (now sometimes called ‘premature’ cord clamping): This entails clamping and cutting the cord immediately after the baby is born, before the cord has stopped pulsing. This practice became popular in the 1940’s and has remained standard amongst many physicians, sometimes out of concern that delaying cord clamping might increase the risk of newborn jaundice, and sometimes simply out of habit. This approach is now falling out of favour amongst many practitioners, since it has been discovered that it puts babies at increased risk for anaemia, and prevents the absorption of approximately one third of baby’s total blood volume, reducing baby’s alertness and muscle tone, and dulling baby’s newborn instincts and reflexes.
Delayed cord cutting (now sometimes called ‘physiological’ cord cutting): Another option is to give the cord the chance to stop pulsating before it is cut. This allows all the nutrients, blood and oxygen time to complete their transfer from the placenta to the baby. Some researchers argue that this gives the baby the opportunity to gently transition from cord to lung breathing rather than being shocked by the sudden deprivation of oxygen caused by immediate cord cutting. Allowing babies to receive their full blood transfer lowers their risk of anaemia and increases their alertness and general competence. Once the cord has stopped pulsating, the transfer of blood and oxygen to the baby is complete. This can take from 2 to about 5 minutes, depending on the baby.
Waiting for the placenta to be delivered: Yet another choice is to delay cutting the cord until after the placenta is born. This is what most other mammals do and likely what humans did once upon a time. Some people believe that cutting the cord any time prior to the birth of the placenta interferes in a natural process, while others believe that there is no reason to wait longer than when the cord stops pulsating. Waiting for the placenta to be born can take between 15 minutes and 2 hours.
Lotus birth: The final option at the far end of the spectrum of choices is to leave the cord intact until it falls off by itself. This is called a ‘Lotus Birth’ and it is by no means a common choice. It involves carrying the placenta around alongside the baby until the cord has sufficiently dried up that it falls away from the baby’s navel with no interference. This takes a week or more, and involves salting and wrapping the placenta, as well as carrying it everywhere mother & baby go.
What about cord blood banking? The BC Women’s cord blood bank can extract whatever amount remains in the umbilical cord even after it stops pulsating. If you choose delayed cord cutting, you can still donate cord blood if you wish.
As you can see, there is reason to think carefully about your choices and discuss these issues with your caregiver before the birth of your baby. No matter what you choose, we encourage you to research your options and, in consultation with your caregiver, arrive at the decision that is best for you and your baby.
No matter what we were picturing, it is never exactly as we imagined. It might be faster or slower, it might be harder or easier, there might be more or fewer medical decisions, it might not be in the location we planned… But even aside from these obvious differences, birth always entails an element of the unexpected. It is one of those rare life experiences that takes us outside of our usual frame of reference, to the far edges of our consciousness, into the extremes, the in-between–beyond the framework of our imagination.
No one opens their birth story with ‘it was exactly as we expected…’. No one talks about their birth as if it were a usual, humdrum event. No matter how mundane from a medical perspective, no matter how ‘textbook’, the way we experience birth is transformational. It’s transcendent. From the most negative to the most positive, from the traumatic to the ecstatic, birth can always be described as unexpected.
In this Summer issue, we discuss several specific instances of the unexpected during birth: The unlikelihood of the due date, having a baby with Down syndrome, having an intersex baby, and what about an unplanned caesarean... But even if nothing so obvious takes your birth down an unanticipated path, even if your own path was entirely as predicted, we think you’ll be able to relate to the sense that giving birth–having a baby–always feels astonishing. It is never, ever, exactly what we expected.
A. Not very. In fact, only about 4% of babies arrive on their so-called ‘due date’.
So why do we call it a due date when it applies so rarely? The way we calculate the due date is a very old practice based on the assumptions of a German doctor called Naegele in 1812. He derived his theory from a biblical notion that women gestate for ten lunar months. He proposed calculating from the first day of the last menstrual period, adding one year, subtracting nine months, and then adding seven days to arrive at the ‘due date’.
This method has a few flaws. One, is that a lunar month actually has 29.5 days, not 28. This would move the due date to more than two weeks past his calculations, which, as any pregnant person will attest, is a significant oversight. Another flaw is that he assumes all women have twenty-eight day cycles, and ovulate on day fourteen. We know this is absurdly untrue, as cycles vary widely from person to person. Another flaw is that babies develop at their own individual timetable, which is very different for each baby. Some develop faster, and some slower. After all, we don’t all hit puberty on exactly the same birthday, either.
Babies can actually be full term anywhere from 37 – 42 weeks gestation, which is a five-week long window. Approximately 85% of babies are ready to be born within this time frame, which means that an additional 15% of babies are born even earlier or later.
But for some reason we still insist on using this archaic due date system, even though we know that only a tiny minority of babies will be born on their exact due date (4%). In fact, so seriously do we take these due dates, that we use misleading language about when the vast majority of babies are born. Forty-one weeks is not ‘overdue’—it falls exactly within normal range. But we use terms like ‘early’ and ‘late’ as if we believed the due date to be accurate.
Even ultrasound dating only gives a two-week range of accuracy, slightly better if done before twelve weeks, and worse if done later. The margin for error increases the more the baby grows, so that ultimately, the window isn’t much clearer than Naegele’s method.
So please don’t expect your baby to arrive on your so-called due date. Statistically, the majority of first-time mothers give birth a full eight days after their due date, while a smaller number give birth prior to the due date. The only truly unusual outcome is to give birth on the actual due date itself. So when it comes to expectations, I propose stepping back and viewing your estimated due date as more of a due month. Or even a due-season. There is no compelling reason to narrow our focus down to such a misleading single date. So how likely are you to give on your due date? Not very likely at all.
They say life is what happens when you’re busy making other plans. I don’t know what exactly I had planned, but receiving a prenatal diagnosis of Down syndrome (also known as Trisomy 21) certainly wasn’t part of any plan I had.
Fear of the unknown immediately consumed me, and my pregnancy went from being a joy and celebration I could share with those around me, to being a very dark and lonely time. We were grieving a dream we thought we lost. We were scared of what lay ahead. It seemed like something bigger than we could handle and that we were alone. But we took a leap of faith and believed that our son is exactly who he is meant to be and that being his mother is exactly who I am meant to be.
Our unexpected outcome has taught me to be an advocate for my son and all those differently abled. Our son has opened our eyes to the beauty in difference and that more often than not, we have more similarities with those around us than differences. Our experience also shed light on a medical system not well equipped to emotionally support new parents with receiving a Down syndrome diagnosis. To this day, you’re handed a brochure or a piece of paper that’s been photocopied a hundred times. Through this experience, our non-profit organization Baskets of Love Down Syndrome Support Societycame to be.
We believe new parents of a child with Down syndrome deserve more. New parents deserve to be loved and supported. They are welcoming or have just welcomed a child. A child worth celebrating. It wasn’t until we met other families of children with Down syndrome that we started to heal. A community rose around us and supported us in a way we desperately needed. It’s scary, yes, but everything is going to be okay and that little extra chromosome turns out to be a gift you never knew you wanted.
In the middle of the night on the day our son was born, when all was quiet and it was just the two of us, I vividly remember holding him whilst sitting in a wooden rocking chair too hard for my sore body. Tears flowing and falling on his just washed hair, I whispered promises to him. A promise that I will always be there for him. I will always be his momma bear, protector and advocate. I promised that he would always be mine and I would always be his. In that moment I saw his perfection. Every fibre of his being. Every chromosome. All of him. He lifts us in a way I could never properly describe and I’m so grateful that our outcome wasn’t what we were hoping for. It’s so much more.
There are times I struggle to believe that I am enough for him but with the heartaches there is so much more joy. So much love. There is no better combo. He has shown us that we never lost our dream. No one can ever tell you what your journey will look like. I wish I could put into words the moment when somewhere in the middle of all the therapies and appointments and frustrations that I knew I would never trade him for the world. That without his 47 chromosomes he wouldn’t be who he is and I couldn’t imagine our world without him.
It’s a remarkable phenomenon how far we’ve come since receiving our prenatal diagnosis when I was curled up in bed sobbing so hard I thought my head would explode. Today, I’m curled up in bed with him, soaking in his laugh and loving him so hard I think my heart might explode.
A positive pregnancy test result. All the emotions arise. Excitement, shock, fear, doubt, and the most intense bliss flood you. There is a light inside of you. Every thought you have has a new emotion attached to it, your mind is spinning with what’s to come. Your body starts to change, adapting to this new life that is within you. The dreams begin. You picture yourself with a growing belly, and with that you start to dream of birthing this light that is within in it. How will I be in my birth time? You ask yourself. Will I be loud? Will I be primal? Will I be in water? Who will be with me? Will I be at home or hospital? Drugs or no drugs? So many questions, and the visualizations are strong.
When I ask my clients what they fear most or what they really want to avoid the most common answer is,
A caesarean section.
Yes. I hear you. Let’s sit with that. Let’s dig a bit deeper. When we think about a caesarean we attach it to the words emergency, fear, sterile, forced, loss of control, surgery, blood, stillness and recovery. I could go on.
During our pregnancy we do all the things to prepare for the expansion of our family. This new little human that will rock our world and flip it inside out and bring so much joy and new experiences. What we don’t do is visit the place inside of us that has our fears tucked away deep. We do that because this is supposed to be the most positive time of our lives. You are growing a life, what could be more beautiful? Why touch on the dark negatives?
I want you to go to that dark place. Crack it open and shed light to it. Let’s make it less scary. When we don’t visit our fears, and work on them, they are only magnified if they do happen. This is when we see trauma, pain and negative birth experiences that can cause damage that lasts possibly a lifetime.
For some the pregnancy becomes high risk and those dreams are plucked away one by one. For others something during labour occurs and we see it cascade towards a section. For a smaller number, there is a true emergency. Many of these are out of our control. Loss of that control is what is terrifying. Let’s acknowledge that we can only do so much to avoid a caesarean. What we can do, is be prepared for the possibility of one, and how we can make it a more positive, empowering experience. It is the birth of your child after all.
Choose a care provider that is going to support you in your wishes. That has your best interests in heart. Someone who takes the time to actually get to know you and will do their best to help facilitate your dreams. Keep your birth yours, hear your voice and give you the ultimate say in what happens. If your pregnancy takes a turn and more support is needed, trust that your primary care provider will assist you in the addition to your team, and be by your side as you navigate these new waters. with that, choose the birth place that will support you and make you feel safe! Do the research into your chosen hospitals stats. Home is your territory and you can feel the most powerful and comfortable there, and for some the hospital is their safe place.
Hire a doula! More support is always a good thing. Doulas are the best drug, and will help keep you on course and remind you of your goals. Doulas reduce your chances of a caesarean by up to 50%. They are there for you, only you! No judgement, no agenda, no bias. This is your birth, and they want you to reflect back on your birth day feeling proud and bad ass.
Be healthy. Eat good food, move your body, laugh, love, and honour yourself in this time. Go for massages, acupuncture and chiro to help support your body in labour. Take charge!
Take a prenatal class. Educate yourself! Ask questions, read and pull in the positive stories, block out the negative. Build a community of other pregnant families, and create your support team.
Most importantly, visit that scary place. Talk about cesareans. Whether it’s your health, your babies, or your birth took a u turn and a belly birth is your only option, how can we make it better?
Make sure it is needed. Not forced. Ask questions. Ask more questions. This is your birth and you still have a say! Have your doula present, ask for all the names of those present and see the faces behind the masks. Ask for delayed cord clamping, immediate skin to skin, take pictures and make your wishes be heard! It may be an operating room, but it’s still your special day and you have rights.
Pay attention to your reaction when someone tells you they had a caesarean. Congratulations is in order because they worked hard! They did everything they could to avoid it, they pushed themselves to a place they never imagined. They discovered their true strength. A belly birth is not an easy birth but it is still special! They still deserved to be honoured and celebrated. They said yes, with so much hesitation and fear behind it. They handed themselves over to science, they let go of their dreams. They lay there with no feeling and all they can see is white and green and bright lights, covered faces hovering over them. Their bodies shake, and their breath taken away as their light is pulled from their body. They only exhale when they hear the cries of their baby, that is behind a sheet. Turning their heads following those cries, yearning to touch and smell their babies. Those few minutes feel like eternity. This is not how they dreamed of welcoming their baby into this world. It’s not even over yet. Recovery. It’s slow, and hard and yet we see parents pushing through and still smiling. They too were just born.
So know this, if the unexpected happens and you find yourself on that table with bright lights. You are strong. You are brave. You are worth celebrating and we honour you. You did the harder birth. You did what you had to because your love for that baby is so great. This is love.
Visit those dark places and discuss how they can be empowering for you if they happen. When you reflect back on your birth it should be a memory that makes you smile and reminds you of how strong you really are. Your child also deserves to hear how they came into this world, and that it may not have been the most ideal, but it was still the best day!
Michelle Maclean is a birth and postpartum doula in Vancouver. Serving over 1200 families since 2005. She is the mother of two girls and recently gave birth as a surrogate. Michelle is the doula trainer at Pacific Rim College, and oversees the Holistic Doula training. You can find her at www.thedivinechild.ca
This is likely one of the first questions you received, after you received congratulations on your pregnancy. In the first trimester, maybe someone dangled a ring on a string over your belly. In the second trimester, maybe you had a revealing ultrasound. Maybe you’ve decided to wait until you meet your baby. But how does a baby come to be assigned male or female, and are those our only outcomes?
Sex is a configuration of several parts. Our chromosomes, internal reproductive systems, genitals, and hormones all contribute to what is currently defined as sex. This does not include the secondary sex characteristics that develop in puberty, nor one’s gender identity or presentation. Yet babies are often assigned male at birth (AMAB) or assigned female at birth (AFAB), just based on the appearance of their genitals. Other times, a newborn’s genitals do not align with medicalized expectations for male or female classifications, welcoming new parents into the fold of an unexpected, ongoing, and contentious conversation.
Intersex is defined by the World Health Organization as, “a congenital anomaly of the reproductive and sexual system”. Meaning that people are born intersex, and while the origins are related to one’s sexual configuration, it is an umbrella term without fully defined parameters. Note that intersex bodies are medically defined as an “anomaly”, though we don’t have an accurate picture of the prevalence of intersex people.
Some groups cite an old statistic that roughly 1 per 2,000 (0.05%) babies are born visibly intersex, meaning they have ambiguous genitalia. Of course, this does not include the intersex variations which cannot be visually assessed, often chromosomal or hormonal, and may or may not be discovered later in life. Other studies, which account for all intersex conditions place the estimate closer to 1.7% of births. As common as having red hair. Still, this estimate can be misleading by collapsing all intersex variations into one category, though some are known to be more common than others. We still have a lot to learn, which means we need to ask important questions.
With no concrete parameters, and a lack of knowledge of prevalence, how can intersex bodies be called an anomaly? Why are some bodies considered less natural than others? How do our bodies come to be? And how do we then come to be assigned as intersex, female, or male?
Your baby’s sexual development began at conception. The ovum and the sperm that made your baby likely donated one sex chromosome each to form the zygote. There are less common developments as well, a few births per thousand, where babies will have a single sex chromosome (monosomies). As well as births with three or more sex chromosomes (polysomies). Ova can only provide X chromosomes, while sperm can either provide X or Y chromosomes. If your baby has two X chromosomes, one from the ovum and one from the sperm, they are considered ‘genetically female’. If your baby has one X chromosome from the ovum, and one Y chromosome from the sperm, then they are considered ‘genetically male’.
An example of monosomy is Turner syndrome. Turner syndrome is also called monosomy X, as people with Turner syndrome have only one sex chromosome: the X. People with Turner syndrome experience abnormal growth patterns, are generally shorter than people with two X chromosomes, do not develop feminine secondary sex characteristics, and are infertile. Compare this with a polysomy (called Triple X syndrome) where people have not one X chromosome, but three. With three X chromosomes, people develop feminine secondary sex characteristics, and are generally taller than people with XX chromosomes. Triple X syndrome is more common than Turner syndrome.
The most common intersex variation related to chromosomes is Klinefelter syndrome, which is diagnosed in 1 in 600 people AMAB. People with Klinefelter syndrome have two or more X chromosomes, in addition to their Y chromosome. People with Klinefelter syndrome are often tall, infertile, and produce low testosterone – as a result, their secondary masculine sex characteristics are often not fully developed. Chromosomes are just the first piece in the larger mosaic of how sex is assigned, as they prompt further development of internal reproductive systems.
All fetuses, regardless of their chromosomes, have the capacity to develop either ‘male’ and ‘female’ internal reproductive systems. These systems rely on cues from the fetal body to develop further. You may have heard we are all ‘female’ in utero, unless a ‘male’ system develops. This is somewhat misleading. In truth, we all had universal potential, by possessing two internal reproductive systems. These systems are called the Wolffian (‘male’) and Müllerian (‘female’) systems. The Wolffian system must be prompted in order to develop, while the Müllerian system will develop without additional cues. Gonads, which develop as ovaries or testicles, are neither Wolffian nor Müllerian. Internal reproductive system development is prompted by chromosomes, but it is fetal hormones which sustain and influence their course.
Congenital Adrenal Hyperplasia, sometimes called Androgenital Syndrome, results from low cortisol during development. It can affect anyone regardless of their chromosomal arrangement, however people with XX chromosomes will develop a masculinized appearance as a result. Androgen Insensitivity Syndrome is the name for people who develop external feminine genitals and secondary sex characteristics despite having XY (‘genetically male’) chromosomes. A study which interviewed people with Androgen Insensitivity Syndrome, found that each participant was satisfied with having being raised feminine. All identified as women, and none desired surgical or hormonal alterations to their body. Most were satisfied with their psychosexual development and their sexual function.
The medical community and intersex advocates have historically had conflicting views on intersex bodies. The broader medical community diagnoses them as having disorders of sex development (DSD), defines being intersex as an abnormality, and urges parents to consent to “corrective” or “normalizing” surgery. Intersex advocates have chosen the term intersex for themselves, consider being intersex a variation rather than an abnormality, and urge parents not to consent to elective surgeries, but rather to consider the risks of surgeries to their child’s physical, psychological, and emotional health.
If you learn your child is intersex at birth, our recommendation is to take your time. Find relief in the knowledge that you have all the time you need to learn about your baby before any choices will present themselves. Surely, this is just one of many ways your child will surprise, challenge, and delight you throughout their life! Find out what specific intersex variation they have, as each is unique, and educate yourself what that specific variation means for their development throughout their life. Find a community to connect with intersex people and their family members, you are a member of this community and you are welcome here.
Some people go their entire lives without knowing they are intersex, as many intersex variations cannot be visually assessed and do not inherently pose any identifiable symptoms or conditions. Some people find out when trying to conceive, others during puberty. You may be the first to know your child is intersex, when you first meet.
Certainly someone has asked you. Consider it yourself, do you know if you’re having a boy or a girl yet?
Emma Mas is an apprentice with The Childbearing Society, and a doula working towards DONA certification. She’s originally from Seattle, but made a home in Vancouver after graduating from UBC with a degree in Psychology and Family Studies. She came to birth work while working as BC Women’s Hospital, meeting thousands of families shortly after birth, though her position as the Coordinator of the UBC Early Development Research Group.