By Tom Smith
Web Exclusive

Sharon’s alarm buzzes, and I wait for her to turn it off. Finally I roll over, mumbling that it’s her alarm, and would she please turn it off-only to find myself talking to an empty bed. I groan, remembering the 2 a.m. phone call and thinking of the harried morning ahead.

When they call, she goes. It doesn’t matter what time it is, it doesn’t matter where in the movie you are or who’s over for dinner. Out the door she goes, and woe to the man who tries to stop her. I did, once. We were having a fight and she got the phone call. It wasn’t fair, I said. I stamped my foot. I cried. She just got madder and madder. She asked me if I wanted to call the woman and tell her to go ahead and have the baby herself. For a moment I hated the woman having the baby, but I also began to realize that for Sharon, a laboring mother always takes first priority.

I’ve heard midwives say, sometimes jokingly, sometimes with fierceness, that there is no profession quite like it. I agree, and would add that there is nothing quite like being married to a midwife. I hate what she does and I love what she does. I find it annoying and I find it exciting. Someone once told me that the divorce rate is high among homebirth midwives. I thought, “Are you kidding? What with the low pay and the bad hours and throw in the risk of prosecution in our state, what man wouldn’t want a midwife for a spouse?”

Am I angry? Sometimes. Do I want her to do something else? No way. How can I, when she comes home at 4 a.m. with tears in her eyes and tells me the story of a mother who was so afraid because her last baby had died in utero at 6 months, and how the grief and pain and joy combined as the 9 lb. baby burst into the world? She loves her work and she loves her women. She makes so many hard choices. I don’t want to make her choose between her work and me. Besides, I’d probably lose.

When our daughter, Hannah, whines and asks why her mother has to go out again tomorrow, Sharon says simply, “It’s my work, it’s what I do.” That’s true, but it is also her calling and her passion. It’s what she does to make a difference in the world. She is a lioness when she says, “Women need to have a choice about where they have their babies.” I admire her greatly at that moment–and then the phone rings. I listen as she explains about the importance of eating to feed the baby. She waves her hand as she talks, cutting to shreds the myth of minimal weight gain during pregnancy. She says, “For God’s sake, if you’re hungry, eat! Eat lots of protein. Sure, four eggs with hot sauce is fine. We want fat, happy babies.” She hangs up, and the phone rings again.

One day Hannah answered the phone, and then called Sharon, who retreated into the bedroom. I asked my daughter who it was. She said she didn’t know, but it sounded like a midwife. I thought, “Oh yes, I know what you mean. The friendly but businesslike tone, the willingness to talk to children and the sound of sisterhood coming over the lines, ‘I need to talk to your mother about something.’” As Sharon shuts the door to the bedroom I hear her say, “We use comfrey and rosemary in our sitz bath for postpartum moms and find…”

The homebirth midwives I know soak up knowledge like hungry sponges. I envy Sharon’s single-minded drive for information, whether found in a medical bulletin or in the herbal lore that is passed around orally. She eagerly collects birth stories and medical texts, experiential knowledge and book knowledge. These women have to know their stuff, because they walk a pretty narrow line–especially in Indiana. Homebirth midwifery is not exactly illegal here, but neither is it licensed.

Sometimes I feel like I’m living with an emotional roller coaster. Most of the births are uneventful, and Sharon returns home exhausted and satisfied. But sometimes when she gets home her face is filled with pain and she begins, “We had to transport…” A story of loss begins, and I go down with her into the anguish. Often the stories are not easy to listen to: the agonizing decision as it becomes increasingly clear that this birth is not going to happen in the home, the cold sterility of the ER room, the gruffness and sometimes outright hostility of the doctors who don’t have much contact with midwives. And through it all, the grief, because often, though not always, a transport means a cesarean. The midwife goes along, assisting the woman’s partner, suggesting options at the hospital. The cord of sisterhood remains intact even in this environment, so different from the quiet security and warmth of a home.

I confess that Sharon’s profession frightens me at times. She works so close to the window between life and death. She assists in the pouring forth of life into the world, and sometimes it’s a dangerous place to stand.

I talk about it as if I’m actually there, but I’m just a small part of the supporting cast. I’m a listener. I wonder at the beauty and the pain, at the toughness and vulnerability of women, and yet I stand outside. I learn the names of the birthing women and hear their birth stories, but never meet most of them.

I often think that I’m married to someone on the Wise Woman path. But Sharon is not an archetype; she’s a real woman who deals in blood and pain and bulging bellies and the epiphany of new life. She is a guardian of the birth time, and when that times comes, there nothing to do but let her go. The phone rings and she’s gone.

Tom Smith divides his time between writing, homeschooling his two children, Ben and Hannah, and working at the local library. He lives in Lafayette, Indiana, where he is still married to the midwife after 14 years.

Introduction:
More and more North American boys are being allowed to keep their normal, natural penis the way nature designed it, and circumcision rates are dropping steadily. In the Western US the number of intact (not circumcised) boys is over 70% now and rising, with around 90% of boys kept intact in neighboring Western Canada. But because circumcision was once so widespread, both N. American physicians and parents have lost the ancient ‘folklore’ about how to care for a normal, natural, intact boy. This is especially true in the USA, the last country to impose routine infant circumcision on a majority of its children. One recent medical textbook on care of the newborn freely admits:

“Because circumcision is so common in the United States, the natural history of the preputial development has been lost, and one must depend on observations made in countries in which circumcision is usually not practiced.” (Avery’s Neonatology: Pathophysiology and Management of the Newborn, by Mhairi G. Macdonald, Mary M. Seshia, and Martha D. Mullett (Lippincott Williams & Wilkins–2005, at page 1088).

The myth that boys need special penile hygiene, including forced retraction of the foreskin to clean the glans, was started by 19th century physicians who suggested that the child’s penis produced itchy substances which encouraged masturbation. As they believed masturbation caused insanity, blindness, tuberculosis, and a litany of other diseases (for which they could offer no other cure), these early physicians urged parents to employ aggressive, even cruel, hygiene. Those pre-germ myths became imbedded in English language culture and linger even today. They can even be heard in locker room jokes. As a result, our DOC physicians get regular complaints from parents of sons about antique advice given by well-intentioned but ill-informed medical professionals or older relatives. One medical historian points out how odd it is that boys alone were affected by this mythology:

“To appreciate the scale of the error, consider its equivalent in women: it would be as if doctors had decided that the intact hymen in infant girls was a congenital defect known as ‘imperforate hymen’ arising from ‘arrested development’ and hence needed to be artificially broken in order to allow the interior of the vagina to be washed out regularly to ensure hygiene.” (Dr. Robert L. Darby, “A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain” Univ. of Chicago Press 2005:235)

Thus in English-language countries, both medical providers and parents need updating in the proper way to care for the intact boy the way Europeans have understood it for centuries. Luckily this is amazingly easy—mostly, there is nothing to do –but do nothing.

We provide below some answers to common questions curious or concerned parents ask our DOC physicians all the time. We hope these provide some comfort and reassurance. Of course each child is unique. For highly unusual cases and special circumstances, we are able to recommend ‘foreskin-friendly’ medical providers in many parts of North America. Please email us in confidence and privacy if the discussion below does not assist you with your son’s situation, or you need the face-to face help of a medical provider in your region. Feel free to print out this text or portions of it, to present to your medical providers if you feel that is appropriate. We encourage you to do so.

Check out the remainder of this article to find answers to the below questions:

Was I foolhardy to leave my son intact?
* Does my intact (not circumcised) son require any special hygiene?
* Is it necessary to pull a boy’s foreskin back to clean it?
* Is it true my son’s foreskin should have been retractable by age 5?
* Should I retract my son’s foreskin just a little bit more each day?
* Does my son really need a circumcision to treat a foreskin infection?
* What if my son gets a urinary tract infection?
* Why does my son’s foreskin puff-out when he pees?
* Do the white bumps under my son’s foreskin indicate infection?
* Does my son’s overhanging foreskin need a ‘trim’?
* How do I stop my toddler from ‘fiddling’ with his penis in front of our guests?
* What should I tell my son to say if he is teased for being intact?

http://www.doctorsopposingcircumcision.org/video/prepuce.html

This original article can be found right here: http://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone

By James J. McKenna Ph.D.
Edmund P. Joyce C.S.C. Chair in Anthropology

Where a baby sleeps is not as simple as current medical discourse and recommendations against cosleeping in some western societies want it to be. And there is good reason why. I write here to explain why the pediatric recommendations on forms of cosleeping such as bedsharing will and should remain mixed. I will also address why the majority of new parents practice intermittent bedsharing despite governmental and medical warnings against it.

Definitions are important here. The term cosleeping refers to any situation in which a committed adult caregiver, usually the mother, sleeps within close enough proximity to her infant so that each, the mother and infant, can respond to each other’s sensory signals and cues. Room sharing is a form of cosleeping, always considered safe and always considered protective. But it is not the room itself that it is protective. It is what goes on between the mother (or father) and the infant that is. Medical authorities seem to forget this fact. This form of cosleeping is not controversial and is recommended by all.

Unfortunately, the terms cosleeping, bedsharing and a well-known dangerous form of cosleeping, couch or sofa cosleeping, are mostly used interchangeably by medical authorities, even though these terms need to be kept separate. It is absolutely wrong to say, for example, that “cosleeping is dangerous” when roomsharing is a form of cosleeping and this form of cosleeping (as at least three epidemiological studies show) reduce an infant’s chances of dying by one half.

Bedsharing is another form of cosleeping which can be made either safe or unsafe, but it is not intrinsically one nor the other. Couch or sofa cosleeping is, however, intrinsically dangerous as babies can and do all too easily get pushed against the back of the couch by the adult, or flipped face down in the pillows, to suffocate.

Often news stories talk about “another baby dying while cosleeping” but they fail to distinguish between what type of cosleeping was involved and, worse, what specific dangerous factor might have actually been responsible for the baby dying. A specific example is whether the infant was sleeping prone next to their parent, which is an independent risk factor for death regardless of where the infant was sleeping. Such reports inappropriately suggest that all types of cosleeping are the same, dangerous, and all the practices around cosleeping carry the same high risks, and that no cosleeping environment can be made safe.

Nothing can be further from the truth. This is akin to suggesting that because some parents drive drunk with their infants in their cars, unstrapped into car seats, and because some of these babies die in car accidents that nobody can drive with babies in their cars because obviously car transportation for infants is fatal. You see the point.

One of the most important reasons why bedsharing occurs, and the reason why simple declarations against it will not eradicate it, is because sleeping next to one’s baby is biologically appropriate, unlike placing infants prone to sleep or putting an infant in a room to sleep by itself. This is particularly so when bedsharing is associated with breast feeding.

When done safely, mother-infant cosleeping saves infants lives and contributes to infant and maternal health and well being. Merely having an infant sleeping in a room with a committed adult caregiver (cosleeping) reduces the chances of an infant dying from SIDS or from an accident by one half!

Research

In Japan where co-sleeping and breastfeeding (in the absence of maternal smoking) is the cultural norm, rates of the sudden infant death syndrome are the lowest in the world. For breastfeeding mothers, bedsharing makes breastfeeding much easier to manage and practically doubles the amount of breastfeeding sessions while permitting both mothers and infants to spend more time asleep. The increased exposure to mother’s antibodies which comes with more frequent nighttime breastfeeding can potentially, per any given infant, reduce infant illness. And because co-sleeping in the form of bedsharing makes breastfeeding easier for mothers, it encourages them to breastfeed for a greater number of months, according to Dr. Helen Ball’s studies at the University of Durham, therein potentially reducing the mothers chances of breast cancer. Indeed, the benefits of cosleeping helps explain why simply telling parents never to sleep with baby is like suggesting that nobody should eat fats and sugars since excessive fats and sugars lead to obesity and/or death from heart disease, diabetes or cancer. Obviously, there’s a whole lot more to the story.

As regards bedsharing, an expanded version of its function and effects on the infant’s biology helps us to understand not only why the bedsharing debate refuses to go away, but why the overwhelming majority of parents in the United States (over 50% according to the most recent national survey) now sleep in bed for part or all of the night with their babies.

That the highest rates of bedsharing worldwide occur alongside the lowest rates of infant mortality, including Sudden Infant Death Syndrome (SIDS) rates, is a point worth returning to. It is an important beginning point for understanding the complexities involved in explaining why outcomes related to bedsharing (recall, one of many types of cosleeping) vary between being protective for some populations and dangerous for others. It suggests that whether or not babies should bedshare and what the outcome will be may depend on who is involved, under what condition it occurs, how it is practiced, and the quality of the relationship brought to the bed to share. This is not the answer some medical authorities are looking for, but it certainly resonates with parents, and it is substantiated by scores of studies.

Understanding Recommendations

Recently, the American Academy of Pediatrics (AAP) SIDS Sub-Committee for whom I served (ad hoc) as an expert panel member recommended that babies should sleep close to their mothers in the same room but not in the same bed. While I celebrated this historic roomsharing recommendation, I disagreed with and worry about the ramifications of the unqualified recommendation against any and all bedsharing. Further, I worry about the message being given unfairly (if not immorally) to mothers; that is, no matter who you are, or what you do, your sleeping body is no more than an inert potential lethal weapon against which neither you nor your infant has any control. If this were true, none of us humans would be here today to have this discussion because the only reason why we survived is because our ancestral mothers slept alongside us and breastfed us through the night!

I am not alone in thinking this way. The Academy of Breast Feeding Medicine, the USA Breast Feeding Committee, the Breast Feeding section of the American Academy of Pediatrics, La Leche League International, UNICEF and WHO are all prestigious organizations who support bedsharing and which use the best and latest scientific information on what makes mothers and babies safe and healthy. Clearly, there is no scientific consensus.

What we do agree on, however, is what specific “factors” increase the chances of SIDS in a bedsharing environment, and what kinds of circumstances increase the chances of suffocation either from someone in the bed or from the bed furniture itself. For example, adults should not bedshare if inebriated or if desensitized by drugs, or overly exhausted, and other toddlers or children should never be in a bed with an infant. Moreover, since having smoked during a pregnancy diminishes the capacities of infants to arouse to protect their breathing, smoking mothers should have their infants sleep alongside them on a different surface but not in the same bed.

My own physiological studies suggest that breastfeeding mother-infant pairs exhibit increased sensitivities and responses to each other while sleeping, and those sensitivities offers the infant protection from overlay. However, if bottle feeding, infants should lie alongside the mother in a crib or bassinet, but not in the same bed. Prone or stomach sleeping especially on soft mattresses is always dangerous for infants and so is covering their heads with blankets, or laying them near or on top of pillows. Light blanketing is always best as is attention to any spaces or gaps in bed furniture which needs to be fixed as babies can slip into these spaces and quickly to become wedged and asphyxiate. My recommendation is, if routinely bedsharing, to strip the bed apart from its frame, pulling the mattress and box springs to the center of the room, therein avoiding dangerous spaces or gaps into which babies can slip to be injured or die.

But, again, disagreement remains over how best to use this information. Certain medical groups, including some members of the American Academy of Pediatrics (though not necessarily the majority), argue that bedsharing should be eliminated altogether. Others, myself included, prefer to support the practice when it can be done safely amongst breastfeeding mothers. Some professionals believe that it can never be made safe but there is no evidence that this is true.

More importantly, parents just don’t believe it! Making sure that parents are in a position to make informed choices therein reflecting their own infant’s needs, family goals, and nurturing and infant care preferences seems to me to be fundamental.

Our Biological Imperatives

My support of bedsharing when practiced safely stems from my research knowledge of how and why it occurs, what it means to mothers, and how it functions biologically. Like human taste buds which reward us for eating what’s overwhelmingly critical for survival i.e. fats and sugars, a consideration of human infant and parental biology and psychology reveal the existence of powerful physiological and social factors that promote maternal motivations to cosleep and explain parental needs to touch and sleep close to baby.

The low calorie composition of human breast milk (exquisitely adjusted for the human infants’ undeveloped gut) requires frequent nighttime feeds, and, hence, helps explain how and why a cultural shift toward increased cosleeping behavior is underway. Approximately 73% of US mothers leave the hospital breast feeding and even amongst mothers who never intended to bedshare soon discover how much easier breast feeding is and how much more satisfied they feel with baby sleeping alongside often in their bed.

But it’s not just breastfeeding that promotes bedsharing. Infants usually have something to say about it too! And for some reason they remain unimpressed with declarations as to how dangerous sleeping next to mother can be. Instead, irrepressible (ancient) neurologically-based infant responses to maternal smells, movements and touch altogether reduce infant crying while positively regulating infant breathing, body temperature, absorption of calories, stress hormone levels, immune status, and oxygenation. In short, and as mentioned above, cosleeping (whether on the same surface or not) facilitates positive clinical changes including more infant sleep and seems to make, well, babies happy. In other words, unless practiced dangerously, sleeping next to mother is good for infants. The reason why it occurs is because… it is supposed to.

Recall that despite dramatic cultural and technological changes in the industrialized west, human infants are still born the most neurologically immature primate of all, with only 25% of their brain volume. This represents a uniquely human characteristic that could only develop biologically (indeed, is only possible) alongside mother’s continuous contact and proximity—as mothers body proves still to be the only environment to which the infant is truly adapted, for which even modern western technology has yet to produce a substitute.

Even here in whatever-city-USA, nothing a baby can or cannot do makes sense except in light of the mother’s body, a biological reality apparently dismissed by those that argue against any and all bedsharing and what they call cosleeping, but which likely explains why most crib-using parents at some point feel the need to bring their babies to bed with them —findings that our mother-baby sleep laboratory here at Notre Dame has helped document scientifically. Given a choice, it seems human babies strongly prefer their mother’s body to solitary contact with inert cotton-lined mattresses. In turn, mothers seem to notice and succumb to their infant’s preferences.

There is no doubt that bedsharing should be avoided in particular circumstances and can be practiced dangerously. While each single bedsharing death is tragic, such deaths are no more indictments about any and all bedsharing than are the three hundred thousand plus deaths or more of babies in cribs an indictment that crib sleeping is deadly and should be eliminated. Just as unsafe cribs and unsafe ways to use cribs can be eliminated so, too, can parents be educated to minimize bedsharing risks.

Moving Beyond Judgments to Understanding

We still do not know what causes SIDS. But fortunately the primary factors that increase risk are now widely known i.e. placing an infant prone (face down) for sleep, using soft mattresses, maternal smoking, overwrapping babies or blocking air movement around their faces. In combination with bedsharing, where more vital normal defensive infant responses and may be more important to an infant (like the ability to arouse to bat a blanket which momentarily falls to cover the infants face when its parent moves or turns) these risks become exaggerated especially amongst unhealthy infants. When infants die in these obviously unsafe conditions, it is here where social biases and the sheer levels of ignorance associated with actually explaining the death become apparent. A death itself in a bedsharing environment does not automatically suggest, as many legal and medical authorities assert, that it was the bedsharing, or worse, suffocation that killed the infant. Infants in bedsharirng environments, like babies in cribs, can still die of SIDS.

It is a shame and certainly inappropriate that, for example, the head pathologists of the state of Indiana recommends that other pathologists assume SIDS as a likely cause of death when babies die in cribs but to assume asphyxiation if a baby dies in an adult bed or has a history of “cosleeping”. By assuming before any facts are known from the pathologist’s death scene and toxicological report that any bedsharing baby was a victim of an accidental suffocation rather than from some congenital or natural cause, including SIDS unrelated to bedsharing, medical authorities not only commit a form of scientific fraud but they victimize the doomed infant’s parents for a third time. The first occurs when their baby dies, the second occurs when health professionals interviewed for news stories (which commonly occurs) imply that when a baby dies in a bed with an adult it must be due to suffocation (or a SIDS induced by bedsharing). The third time the parents are victimized is when still without any evidence medical or police authorities suggest that their baby’s death was “preventable,” that their baby would still be alive if only the parents had not bedshared. This conclusion is based not on the facts of the tragedy but on unfair and fallacious stereotypes about bedsharing.

Indeed, no legitimate SIDS researcher nor forensic pathologist should render a judgment that a baby was suffocated without an extensive toxiological report and death scene investigation including information from the mother concerning what her thoughts are on what might or could have happened.

Whether involving cribs or adult beds, risky sleep practices leading to infant deaths are more likely to occur when parents lack access to safety information, or if they are judged to be irresponsible should they choose to follow their own and their infants’ biological predilections to bedshare, or if public health messages are held back on brochures and replaced by simplistic and inappropriate warnings saying “just never do it.” Such recommendations misrepresent the true function and biological significance of the behaviors, and the critical extent to which dangerous practices can be modified, and they dismiss the valid reasons why people engage in the behavior in the first place.

For More Information:
A Popular Parenting Book
Sleeping With Your Baby: A Parent’s Guide To Cosleeping by James J.McKenna (2007). Platypus Press.

The Scientific Perspective
McKenna, J., Ball H., Gettler L., Mother-infant Cosleeping, Breastfeeding and SIDS: What Biological Anthropologists Have Learned About Normal Infant Sleep and Pediatric Sleep Medicine. Yearbook of Physical Anthropology 50:133-161 (2007)

McKenna, J., McDade, T., Why Babies Should Never Sleep Alone: A Review of the Co-Sleeping Controversy in Relation to SIDS, Bedsharing and Breastfeeding (pdf). Paediatric Respiratory Reviews 6:134-152 (2005) ]]> http://fullmoonsdaughter.com/blog/2010/07/cosleeping/feed/ 0 http://fullmoonsdaughter.com/blog/2010/07/care-after-a-miscarriage/ http://fullmoonsdaughter.com/blog/2010/07/care-after-a-miscarriage/#comments Sat, 24 Jul 2010 17:10:19 +0000 Courtney http://fullmoonsdaughter.com/?p=1013 Take care of your immune system. If there is something you normally do, like eating a clove of garlic everyday or taking Echinacea, do it. You can drink Miso soup daily or make chicken and veggie stock. Besides the eating nutritious foods and drinking lots of water, get sleep. Rest and nap daily and be sure to honor your healing time by sleeping. You’ve just been through a lot.

Try making Vitality Stock. Along with the below herbs, throw in some marrow bones and veggies and let simmer:
Dong Gui – 2-3 slices
Astragalus – 3 slices
Codonopsis – 1 root
Da Zao – 2-3 dates
Ginger – 2-3 slices

Make a medicinal strentgh quart of Nettle tea every night to drink the next day. Do this for a month. The Nettle will help rebuild chi, liver and blood. There is also lots of assimilated iron in Nettle.

And of course, be kind to yourself. You’ve just been through a death, lost a dream and now must heal. Grief isn’t something that is straight-forward and it doesn’t end in a set amount of time.

This article can be found at Midwifery Today: http://www.midwiferytoday.com/articles/firsthour.asp
by Michel Odent

© 2002 Midwifery Today, Inc. All rights reserved.

The hour following birth is undoubtedly one of the most critical phases in the life of human beings. It is not by chance that all human groups have routinely disturbed the physiological processes in this short period of time, via beliefs and rituals. Our cultural milieus are to a great extent shaped at the very beginning of the mother-newborn interaction.

The first hour following birth may be looked at from a multitude of complementary perspectives. My objective is to catalogue 12 such perspectives to demonstrate the real dimension of this enormous subject.

Perspective 1: The sudden need to breathe

We do not need to develop this widely documented perspective. It is well understood that during the first hour following birth the baby must suddenly use its lungs. This implies, in particular, that the heart must urgently pump blood to the pulmonary circulation. The prerequisite is that the pulmonary and systemic circulations separate by closure of the connections between them (ductus arteriosus and foramen ovale).

Perspective 2: The behavioral effects of hormones

This perspective needs to be developed, so recent are the available data.

Today we are in a position to explain that all the different hormones released by mother and fetus during the first and second stages of labor are not yet eliminated during the hour following birth. All of them have a specific role to play in the mother-newborn interaction. Until recently the behavioral effects of these hormones had not even been suspected.

The key hormone involved in birth physiology is undoubtedly oxytocin. Its mechanical effects have been well known for a long time (effects on uterine contractions for the birth of the baby and the delivery of the placenta; effects on the contractions of the myo-epithelial cells of the breast for the milk ejection reflex). Prange and Pedersen demonstrated the behavioral effects of oxytocin for the first time in 1979 via experimentation with rats: An injection of oxytocin directly into the brain of virgin rats induced a maternal behavior. This experiment laid the foundation for a new generation of studies. The results of hundreds of such studies can be summarized in one or two sentences: Oxytocin is the typical altruistic hormone; it is involved whatever the facet of love one considers.

These data appear important when one knows that, according to Swedish studies, it is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances (for example sexual intercourse or lactation) the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm (so that the level of hormones of the adrenaline family is as low as possible). It is also easier if the mother has nothing else to do but look at the baby’s eyes and feel contact with the baby’s skin, without any distraction. The way oxytocin is released is a new avenue for research. To be effective, this release must be pulsatile: The higher the frequency of pulses, the more effective this hormone is.

Oxytocin is never released in isolation. It is always part of a complex hormonal balance. That is why love has so many facets. In the particular case of the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the “motherhood hormone.” This is the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other. Furthermore, estrogens activate the oxytocin and prolactin receptors. We must always think in terms of hormonal balance.

It was also in 1979 that the maternal release of morphine-like hormones during labor and delivery was demonstrated. The release of these endorphins is now well documented. In the early 1980s we learned that the baby also releases its own endorphins in the birth process, and today there is no doubt that, for a certain time following birth, both mother and baby are impregnated with opiates. The property of opiates to induce states of dependency is well known, so it is easy to anticipate how the beginning of a “dependency”—or attachment—will likely develop.

Even hormones of the adrenaline family (often seen as hormones of aggression) have an obvious role to play in the interaction between mother and baby immediately after birth. During the very last contractions before birth the level of these hormones in the mother peaks. That is why, in physiological conditions, as soon as the “fetus ejection reflex” starts, women tend to be upright, full of energy, with a sudden need to grasp something or someone. They often need to drink a glass of water, just as a speaker may do in front of a large audience. One of the effects of such adrenaline release is that the mother is alert when the baby is born. Think of mammals in the wild, and we can more clearly understand how advantageous it is for the mother to have enough energy—and aggressiveness—to protect her newborn baby if need be. Aggressiveness is an aspect of maternal love. It is also well known that the baby has its own survival mechanisms during the last strong expulsive contractions and releases its own hormones of the adrenaline family. A rush of noradrenaline enables the fetus to adapt to the physiological oxygen deprivation specific to this stage of delivery. The visible effect of this hormonal release is that the baby is alert at birth, with eyes wide open and dilated pupils. Human mothers are fascinated and delighted by the gaze of their newborn babies. It is as if the baby was giving a signal, and it certainly seems that this human eye-to-eye contact is an important feature of the beginning of the mother and baby relationship among humans.

The highly complex role of hormones of the adrenaline-noradrenaline family in the interaction between mother and baby has not been studied for a long time. A small number of animal experiments open the way to further research. Mice that lack a gene responsible for the production of noradrenaline leave their pups scattered, unclean and unfed, unless they are injected with a noradrenaline-producing drug when giving birth.

From the hormonal perspective it appears clearly that sexuality comes full circle. In all the different episodes of our sexual life the same hormones are released and similar scenarios are reproduced. For example, during sexual intercourse, both partners—male and female—release oxytocin and endorphins. It is the beginning of an attachment that is following the same model as the mother-baby attachment during the hour following birth.

Our current knowledge of the behavioral effects of different hormones involved in the birth process helps us to interpret the concept of a sensitive period introduced by ethologists. It is clear that all the different hormones released by the mother and by the baby during labor and delivery are not eliminated immediately. It is also clear that all of them have a specific role to play in the later interactions between mother and baby.

Perspective 3: The perspective of ethologists

Ethologists observe the behaviors of animals and human beings. They often study one particular behavior in a number of unrelated species. They were the first scientists who claimed that, in terms of mother-newborn attachment among birds and mammals, there is a short yet crucial period immediately after birth that will never be repeated. Harlow studied in particular the process of attachment among primates.

The importance of the ethological approach is gradually emerging after the recent discovery of the behavioral effects of hormones involved in the birth process.

An ethological study of the first hour following birth among humans is difficult because the physiological processes are routinely disturbed. However, it is possible in unusual circumstances. Imagine a woman who gave birth in her own bathroom while her husband was shopping. She is in a very warm and quite dark place. She does not feel observed at all. However, from the crack of the door you can catch a glimpse of the scene now and then. By combining what you learned from different stories like that, you’ll be in a position to describe a stereotyped behavior. First, the mother looks at her newborn baby between her legs. After a while she dares to touch her with her fingertips. Then she becomes more and more audacious and wants to hold her baby in her arms. At that time most women are as if fascinated by the baby’s eyes.

Perspective 4: The first hour as the beginning of lactation

There was a time, not so long ago, when we wouldn’t have considered the first hour following birth as the time when lactation is supposed to start. Imagine a baby born at home a century ago. The cord was cut right away. Then the baby was washed, dressed and shown to the mother before being put in a crib. An anecdote can help us realize how recent this perspective is. In 1977, in Rome, at the Congress of Psychosomatic, Gynaecology and Obstetrics, I presented a paper about the early expression of the rooting reflex. I was simply describing the ideal conditions that allow the baby to find the breast during the first hour following birth. None of the obstetricians and pediatricians present at that session could believe that a human baby would be able to find the breast during the hour following birth.

Today most midwives know that the human baby is naturally programmed to find the breast during the hour following birth. Moreover, one can understand that, in physiological conditions, when the newborn baby is ready to find the breast, the mother is still in a particular hormonal balance. She is still “on another planet.” She is still very instinctive. She knows how to hold her baby. Among humans, breastfeeding is potentially instinctive—during the hour following birth. After that there is room for education, imitation and even technique.

Perspective 5: First hour and metabolic adaptation

As long as the baby is in the womb the nutrients, particularly the vital fuel glucose, are provided in a continuous mode via the cord. Immediately after birth the baby must adapt to a discontinuous supply. The remarkable ability of the neonate to respond to significantly low glucose value has been studied in depth by M. Cornblath in the United States, and by Jane Hawdon, Laura Derooy and Suzanne Colson (see Suzanne’s article “Womb to World,” Midwifery Today Issue 61, page 12) in the United Kingdom.

Perspective 6: The bacteriological point of view

At birth, a baby is germ-free. An hour later there are millions of germs covering her mucous membranes. To be born is to enter the world of microbes. The question is, which germs will be the first to colonize the baby’s body? Bacteriologists know that the winners of the race will be the rulers of the territory. The germ environment of the mother is already familiar and friendly from the perspective of the newborn because mother and baby share the same antibodies (IgG). In other words, from a bacteriological point of view, the newborn human baby urgently needs to be in contact with only one person—her mother. If we add that early consumption of colostrum will help establish an ideal gut flora, there is no doubt that, from a bacteriological point of view, the hour following birth is a critical period with lifelong consequences. Our gut flora can be presented as an aspect of our personality that cannot be easily modified later on in life.

Perspective 7: Starting up the process of thermoregulation

While in the womb the baby never had any opportunity to experience differences in temperature (apart from possible episodes of maternal fever). Once more, the first minutes following birth appear as an interruption of continuity. As the mechanisms of thermoregulation are not yet mature at birth there are theoretical reasons to be worried about the cases of maternal hyperthermia during labor that are induced by an epidural anesthesia or a too hot bath. Such situations might challenge in a dangerous way the thermoregulation of the baby by exaggerating the differences of temperature between the intra- and the extra-uterine environments.

Perspective 8: Adaptation to gravity

During the first hour a new relationship to gravity is established. Suddenly the vestibular nerve, which serves equilibrium, is carrying to the brain an unprecedented flood of impulses from the semicircular canals, utricles and saccules.

Perspective 9: The ethnological approach

Ethnology has established itself as a science by publishing databases. Today its material on pregnancy, childbirth and the first days following birth is easily accessed.

Most cultures disturb the first contact between mother and baby during the hour following birth. The most universal and intriguing way is simply to promote a belief, such as the belief that colostrum is tainted or harmful to the baby, even a substance to be expressed and discarded. Such a belief necessitates that, immediately after birth, the baby must not be in her mother’s arms. This implies rituals such as the ritual of cutting the cord immediately. The first contact between mother and baby can be disturbed through many other rituals: bathing, rubbing, tight swaddling, foot binding, “smoking” the baby, piercing the ears of the little girls, opening the doors in cold countries, etc.

It would take volumes to present a comprehensive study of the characteristics of a great number of cultures in relation to how they challenge the maternal protective instinct during the sensitive period following birth. However a simple conclusion can be drawn from a rapid overview of the data we have at our disposal: The greater the social need for aggression and an ability to destroy life, the more intrusive the rituals and beliefs are in the period surrounding birth.

If disturbing the first contact between mother and baby and promulgating such excuses as the belief that colostrum is bad are so universal, it means that these behaviors have carried evolutionary advantages.

After taking into account and combining all the perspectives that indicate the importance of the hour following birth, and after referring to perinatal rituals and beliefs, we are in a position to claim that the cultural milieus are to a great extent shaped during the hour following birth. Now we can consider the hour following birth in the context of our modern societies.

Perspective 10: The obstetrical approach

All these considerations were necessary before looking at the hour following birth in the context of our modern societies. In our societies the cultural control of childbirth is mostly a medical control.

From medical literature and textbooks it appears that, in obstetrical circles, the question is: “How do you manage the so-called third stage?” Medical journals periodically publish prospective randomized, controlled studies comparing different ways to “manage” the third stage. The only objective is to evaluate the risks of postpartum hemorrhage. These studies are conducted in the context of large obstetrical units. All research protocols use a negative definition of “expectant management” (e.g., no use of uterotonic drugs and no clamping of the cord). The factors that can positively facilitate the release of oxytocin are not included in the protocols. The results of such trials have led to the practice of routinely injecting oxytocic substances into all mothers at the very time of the birth of the baby. Such substances block the release of the natural hormone; furthermore they have no behavioral effects. The effects of these obstetrical routines must be considered in terms of civilization.

Perspective 11: The midwifery approach

Certain midwives can still practice authentic midwifery. This means they are not prisoners of strict guidelines and protocols. They can play their role of protectors of the physiological processes. Immediately after the birth of the baby the main preoccupation of such midwives is the release by the mother of a high peak of oxytocin because it is necessary for safe delivery of the placenta and is the hormone of love.

They first make sure the room is warm enough. During the third stage women never complain that it is too hot. If they are shivering, it means the place is not warm enough. In the case of a homebirth, the only important tool to prepare is a transportable heater that can be plugged in any place and at any time and can be used to warm blankets or towels. Their other goal is to make sure the mother is not distracted at all while looking at the baby’s eyes and feeling contact with the baby’s skin. There are countless avoidable ways of distracting mother and baby at that stage. The mother can be distracted because she feels observed or guided, because somebody is talking, because the birth attendant wants to cut the cord before the delivery of the placenta, because the telephone rings, or because a light is suddenly switched on, etc. At that stage, after a birth in physiological conditions, the mother is still in a particular state of consciousness, as if “on another planet.” Her neocortex is still more or less at rest. The watchword should be, “Don’t wake up the mother!”

Perspective 12: A Political Note

It makes sense that studying the third stage of labor from a non-medical perspective makes many people—particularly doctors—feel uncomfortable. Any approval that might lead us to reconsider our attitudes during this short period of time is shaking the very foundations of our cultures. Research can be politically incorrect. Politically incorrect research includes certain aspects of “primal health research,” particularly studies exploring the long-term consequences of how we are born. The medical community and the media shun the findings of these important studies—on such topical issues as juvenile criminality, teenager suicide, drug addiction, anorexia nervosa, autism, etc.—despite their publication in authoritative medical or scientific journals.

Michel Odent, MD founded the Primal Health Research Centre in London and developed the maternity unit in Pithiviers, France, where birthing pools are used. He is the author of ten books published in twenty languages. Two of them—Birth Reborn and The Nature of Birth and Breastfeeding—were published originally in the United States. His most recent book is The Farmer and the Obstetrician.