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Thursday, September 09, 2010

Birth. Choices.

This post was written quite some time ago, several days after returning from a doula client labor which ended in Cesarean birth. I hastily wrote the passage below, then decided to wait a long time before posting it. Primarily because I didn't want there to be any connection to a hospital staff member or situation surrounding a specific birth, as this town is very small. I want to put some thought into what procedures are done to newborns the first hour after birth--what is required? what is optional? Also, in reflection, I will discuss my personal dilemna about whether I could've done something differently...

The mom was down in recovery from ceserean and the dad was up in the nursery with the baby. A friend of the couple and I watched through the window as the nurse did the babies vitals, weight etc which she did as quickly as possible then swaddled the baby up and handed him to dad. It took dad a solid 15 minutes to bounce the baby around to get him calmed down and not crying.

Then the nurse comes over and says, "Ok, hand him over. Its time for his bath." I was thinking to myself, "Bath? Hes not dirty?!" but I didn't say anything. It wasn't my place to say anything. By this time the dad, his friend and myself were in the nursery. The dad looked at me a little confused and handed the baby over. I think we were all a bit speechless.

The nurse took the baby from the dad, got the baby naked on the counter, and put him a small plastic tub filled with hot water which sat in a large cold stainless steel sink. The bright nursery flourscent lights were on and as soon as he was naked, he screamed so hard he stopped breathing (seemingly--you know how when babies are really mad and nothing comes out of their mouth they are crying so hard). The bath was quick, but watching it seemed like it took forever. I understand that babies need to be bathed at some point (in the days or weeks following their birth), but they are born from moms sterile womb and to induce such shock on them during their 1st hour of life seems unfair. That first hour of life is so precious, and such a transition from the womb to the world. Why not save some of the weight, foot prints, etc for later and just let the baby be near his dad in a dark, quiet place?

Some Afterthoughts...
--I later asked a Kodiak OB Nurse if it is to bathe a baby after a cesarean and I learned the answer is "No". In fact, if parents request, most or many post-partum procedures can be delayed 1 or 2 hours to give mom and baby bonding time. Of course, if something is wrong with the baby's function, then things change. In this case, the dad had the option of waiting on a bath he could've taken the baby right to the hospital room to help sooth and quiet the baby.

--The second topic of conern with this scenerio was the interruption into the first hour of birth. The first hour is a time which can never be given back. Mom and Baby have the highest levels of Oxytocin (Love hormone and the hormone that causes uterine contractions) then they'll have at any other time in their life. This first hour of bonding is such a critical one--as the stage is set for mom and baby to connect and initiate breastfeeding. When this is interrupted with optional medical procedures that could be done at a later hour (or day) then this precious bonding time is lost and will never be recovered.
Research shows that if the time is delayed for mom and baby to spend together after birth, then breastfeeding is more difficult for them in the first few weeks of life. Here in Kodiak, mom is able to request that the baby stay with her after Cesarean birth, and depending on the situation (staff and circumstances surrounding the birth)-this request may be granted. This means the baby can stay down in the Recovery Room with the mom. If this isn't able to happen, the next best thing is for baby to be on the dad or birth partner, where baby can feel the persons warmth and hear their heart beat and voice.

--As a doula, I ask myself, "What could I have done differently? Should I have done anything differently?". A doula works with parents during labor to help support them emotionally and physically during the hours prior to and following birth. In that moment, perhaps I should've tapped dad on the shoulder and gently let him know that he has the option to hold on the bath. Or not. At the time, I wasn't 100% sure that the bath was optional, so I didn't say anything. Even if I did know it was optional, maybe I still wouldn't have pointed it out. In general, I don't give information unless it is requested from me by parents. Some parents like to have their little ones bathed right after birth, and others prefer to wait. The important part is that the parents had the ultimate say in what happened to their little one AND they were presented with options. Choices.

This post gathered dust sitting in my drafts folder. In all honesty, I've been nervous about publishing it. Birth topics are so close to my heart--and yet I don't want to upset staff or offend anyone, so this post is one I've needed to sit on and decide how much it really meant to me. In the end, if writing this means that 1 person in Blog World is able to look at the first hour after birth with a new perspective, and perhaps share in discussion with 1 other person then it will have been worth it. Its important to keep the healthy birth conversation going!



Jowers Inc. said...

I agree with you, and numerous others, that the first hour is crucial. My second child was delivered in a hospital with a staff not ready for her. Because of the panic about the room, excessive lighting, and no attending midwife during her actual entrance into the world, I was not inclined to snuggle my bundle. Instead, they rushed her off to the nursery immediately after birth. I, feeling rather helpless and with-out rights found myself hours later, alone in a recovery room. When they finally brought her to me, 4 hours old, they had already given her a pacifier and she was too upset to want to nurse. This made feeding her much more difficult in the coming months, and I dare say for the first year, we did not have the same bond I did with my first born. Whom I spent the first hour swooning over, breastfeeding in an ill lit room.
Thank you for making us aware of this and giving us courage to be a parent from the first second of life, not at check out time.

Zoya, Patrick, Nora and Stuart said...

Thank you for your reply. The last sentence of your comment really spoke to me--it is these moments immediately after birth which begin the parenting journey.
I appreciate your thoughtful response and support. Your story is an example of how truly important those first hours are.
Best wishes, Zoya

Becca and Jason said...

Zoya... my jaw dropped to learn that I could've had M with me in recovery! I wish I had known that at the time, but no one ever told me! At least Jason was able to cuddle her up in the nursery, so she wasn't alone, and thankfully, it never hindered our breastfeeding relationship (still going at a week short of 14 months!!!).
This is a great reminder for parents to educate themselves on what the hospital policies are where they deliver, to know what choices they have, and to not be afraid to speak up if their wishes aren't being honored at any stage during the birth and hospital stay!
Maybe this is one of those things you can talk about with your doula clients in advance so you don't end up in the awkward position of trying to decide if you should say something or not? That way the parents will know their "rights" and you'll know their wishes in advance, which may make it easier for you to say something if the parents get overwhelmed!!
I'm glad you posted this... I think the more these kinds of issues are in the forefront of peoples' minds, the better the chance that the medical "establishment" will finally start to back off from unnecessary interventions at all phases of births!

Zoya, Patrick, Nora and Stuart said...

Becca, thanks for your thoughts on this! Having your baby with you in recovery is done on a case-by-case basis and it has only started happeneing quite recently (within the past 18 months or 2 years I believe). It depends on the anesthetist/surgical team wishes.

Sometimes during doula meetings, I hate to be the "doom and gloom" voice regarding post-cesarean care decisions, as the couple is trying to avoid cesarean. However, I would rather spend a couple of minutes on discussing their plan, adn have them be pleased with the course of action following an unplanned cesarean. Also, if these things are in a birth plan, the chances of everyone involved knowing the couples desires increases.
I also want to to point out that these procedures is very typical of any hospital care of infants today in the US. The scene which I described is no different from what is done after 99.9% of Cesarean births in the US.
Kodiak hospital is unique in that moms can actually request to have baby in the OR after surgery and even begin breastfeeding in recovery. THis has been a very recent development, as I mentioned above.
Thanks again for your thoughts on this, Becca! :) Zoya

Zoya, Patrick, Nora and Stuart said...

One other thought--It is SO FABULOUS that Jason was able to cuddle up with your girl in the nursery. This gave her a sense of calm I imagine-hearing his voice and being right with him. As I mentioned in my post, if baby can't be with mom, the next best thing is next to dad!
:) Zoya

Coastieturtle said...

Yes, I agree that the first few hours are very important. Thankfully one of the lactation consultants told us that we could request for the baby not to get a bath and to take her down to me in recovery as soon as possible. It worked out well. D. followed her to the nursery and then brought her straight to me. However, we may have not known that info if someone hadn't told us....

Zoya, Patrick, Nora and Stuart said...

S, Thank you for your post about your story after having D. I am SO GLAD to hear that the lactation consultant at your hospital helped advocate to get baby to you ASAP and to refrain on bathing. Yeah! That must have made the first post-partum hours a bit easier --having her there with you. Hopefully this will someday soon be the norm in all hospitals.
Thanks for your comment! :) Zoya