The President of the Australian Medical Association (WA), Dr Michael Gannon, has been reported as saying an obsession among mothers and midwives to have immediate skin to skin contact after birth is putting newborn babies at risk of injury or death.
This comment was reported in The West Australian online newspaper, following the tragic death of a newborn at Fiona Stanley Hospital in Perth in February.
While the incident is being investigated by the Coroner, it is believed to have happened after the new mother fell asleep while breastfeeding or holding the baby. Dr Gannon states there have been a number of newborn deaths in Perth hospitals in the last 18 months, occurring when mothers who have been left alone with their babies have accidentally rolled onto them after falling asleep.
Dr Gannon is critical of the skin to skin “obsession”, stating it has “stemmed from taking whatever possible measures that might lead to small increases in the number of women who breastfeed.”
He then goes on to state postnatal care as being a problem. “What we are seeing is a lot of women and babies are then not being supervised. They (the babies) are quite vulnerable in the first few hours of life, when they have not properly established their own circulation. New mothers are often exhausted by a long day in labour and there are the side effects of opioid drugs, epidurals or c-section.”
Is Skin To Skin Dangerous, or Important?
Skin to skin is far from a recent fad that women have selfishly insisted on. It is the biological norm for mammals to be close to their newborns in the hours following birth. There are some very well researched and documented benefits for babies who receive early skin to skin contact with their mothers. It is only in many western cultures that separation after birth is seen as normal.
Skin To Skin Following A Non Medicated Labour
During a natural, undisturbed labour, a woman’s body is producing exactly the right amount of hormones, and is being primed for the first contact with her baby when it is born. The love and bonding hormone, oxytocin, is present in large amounts in both mother and baby at the moment of birth, causing mother and baby to imprint on each other.
Babies who have skin to skin contact with their mothers for the first hours after birth are better able to regulate their temperature and respiration, making it less likely they will require extended stays in neonatal intensive units, or require breathing assistance.
Close skin contact stimulates particular neurobehaviours that ensure mother and baby can find and recognise each other in the days following birth, and that basic survival needs are met.
Early skin to skin contact is also vital in assisting transference of the mother’s bacteria to the baby, which helps prime the baby’s immune system for life. This is particularly important when babies are born via c-section, as early skin to skin and breastfeeding are excellent ways to help increase their exposure to good bacteria.
Babies who remain close to their mother’s skin are calm and less likely to experience high levels of stress hormones. Early breastfeeding is more likely to lead to a successful nursing relationship long term. Considering the low rates of breastfeeding after 4 and 6 months in many western countries, encouraging and supporting practices which promote breastfeeding would appear to be in the best interest of both mothers and babies.
Skin To Skin Following A Medicated Labour
It is estimated that 97% of women birthing in a hospital setting have some form of intervention during labour and birth. Whether it is a ‘routine’ vaginal examination or a c-section, a procedure has the potential to disturb the natural process of labour, so women are more likely to require pain medication, or be exhausted because of the effects of interventions. They are less likely to be able to experience skin to skin for long, or might not be aware of their inability to manage without assistance.
Epidurals are fairly common in many countries. More than 65% of women in the US, and over 25% in the UK, have epidural analgesia during labour. In Australia, epidural analgesia is used in approximately 33% of all labours. Women who have epidurals are unable to move alone for many hours following birth, and usually experience some side effects, such as low blood pressure, headaches, or dizziness. Women who have had a c-section are also limited in movement and possibly in pain.
Certain medications from the opioid family of drugs can make you drowsy or have slow reaction times. If you need pain medication during labour or following birth, make sure you talk to your care provider about avoiding any medications which could cause you to be less alert.
What Is The Answer?
Most women today expect to deal with the medicalisation of birth and, in most cases, accept it as part of the labour and birth package. At the same time, women also want to incorporate more natural practices, such as skin to skin, delayed cord clamping, and baby-led breastfeeding.
These practices are not outlandish on a normal scale, but in hospital settings they are not priorities. Midwives tend to encourage natural and normal birth practices because they are aware of the benefits for mothers and babies. They also care for women who are exposed to less than ideal surroundings and interventions that undermine the natural process of labour from the beginning.
As Dr Gannon rightly points out, staff shortages are a huge hindrance if women are being left alone to care for their newborn babies when they have just been through a medically assisted birth or are extremely exhausted. Instead of blaming mothers for wanting what is a biologically normal practice, and which holds huge benefits for their babies, it is imperative that those responsible for the birth setting ensure there is sufficient help available, so women are supported in the first hours after birth. Women who have just given birth are often treated as less valuable than the babies they have given birth to, which is a great failure of duty of care.
If you are birthing in a hospital setting, make sure your care provider knows your preferences for skin to skin and early breastfeeding. Ensure there is adequate staff available to help you, and don’t hesitate to ask for assistance at any stage if you are tired or have taken medication. Many hospitals have a nursery and might suggest you have a rest while postnatal midwives care for your baby. If you prefer that your baby stay with you, ask the midwives to check on you regularly, and make use of the in-room bassinet if you are worried you might fall asleep while holding your baby.
Recommended Reading: Hospital Birth – Is It The Safest Option For Healthy Women?