Cesarean Birth: What about the Baby?
by Robin Lim, CPM
© 2001 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today Issue 57, Spring 2001.]
Two weeks ago I received two babies—a beautiful girl, and a few days later, a boy. Here in our small town there were a total of five babies born that week, the two I was honored to receive in their family homes, and three born in the hospital.
The three hospital-born babies are still in neonatal intensive care. All three were given antibiotics. All three have suffered separation from mother. All three were delivered by cesarean. It was a rough week.
One of my home-born babies had a wrinkle-free gentle entrance into our world. The other was an almost seven-minute shoulder dystocia. After three and a half minutes of CPR, he took hold of his life and is thriving. He has never been separated from mother. Breastfeeding has been wonderful, uninterrupted and blissful for this boy.
I wish I could say that our three hospital-born babies were doing as well. Having lived and worked in Asia for most of my life as a midwife, I have had the opportunity to assist in many cesarean births, some of them unnecessary. Others were life saving procedures. Placenta previa and previous cesarean scar rupture are two classic examples that had me thanking God for science and skilled surgeons.
In the best cesarean birth I’ve seen, the mother and baby were reunited about one hour after the birth. During that hour of separation the baby’s cord was cut. He was suctioned aggressively, measured, weighed; eye prophylaxis was administered against the mother’s written birth plan.
The baby’s temperature was determined rectally, his footprints were taken, his heel was jabbed to obtain blood for PKU testing, and vitamin K was injected. He was bathed, swaddled and banded for identification. When he cried and rooted for his mother’s breast, a rubber pacifier was put in his mouth. He was lucky. Other cesarean-born babies I’ve known did not fare so well.
My experience as a midwife has given me ample opportunity to wonder: What about the baby? What are the risks to body and soul of our cesarean-born infants? Dr. Seuss lets the Lorax speak for the trees, who speaks for our babies?
Nyoman was a 38-year-old primip and a talented Balinese artist. Many interventions led to her baby being born by cesarean. The 3.5-kilogram, full-term and robust baby girl was taken immediately to the nursery. There I tenderly held her as a patch of her thick black hair was shaven so IV antibiotics could be administered. Nyoman was taken to another wing of the hospital. For the rest of the night I ran up and down stairs and traveled long hallways to keep an eye on mother and child. At dawn, when both were apparently stable and well, I went home. That night I attended a homebirth. In the morning I returned to my home and prepared to go to the hospital to check on Nyoman and her baby. The phone rang; it was Nyoman’s husband telling me the baby had died (probably from sepsis, but no cause of death was determined). The small perfect body was immediately sent home for burial. Nyoman remained in the hospital, febrile; she never did see her beautiful daughter.
In my overseas work spanning seven years in Indonesia and the Philippines, I’ve observed that Western obstetrical surgical procedures have been aggressively exported to Asia. However, they are practiced without benefit of safe standards of hygiene.
The 1985 edition of Williams Obstetrics (p. 868) states: “Certainly, maternal and perinatal mortality and morbidity are typically higher with cesarean delivery, in part because of the complication that led to the cesarean section and in part because of the increased risks inherent in the abdominal route of delivery.”
In A Good Birth, A Safe Birth the editors report that the four most frequent complications of cesarean to the infant are jaundice, respiratory distress syndrome, drug effects and fewer quiet alert periods after birth.(1) All four interfere with early contact bonding between mother and baby. The first three often cause the baby to undergo treatment that is uncomfortable, perhaps terrifying for the newborn.
Research into the hormone oxytocin brings up another aspect of the effects of cesarean on the baby. Oxytocin, which has been called the hormone of love, is present when human beings share a meal, present in lactation, and is released by both the male and female partner during lovemaking. The most profound display of the power of oxytocin, however, is during labor and childbirth.
What might happen, then, to a baby whose body is denied the influx of oxytocin experienced in a vaginal birth? Research has found that oxytocin levels are comparatively low in autistic children.(2) Nobel prize-winning ethologist Niko Tinbergen found correlations between medical interventions at birth and predisposition to autism.(3) In 1991, Ryoko Hattori evaluated the risks of autism with birth location and found that children born in hospitals that routinely tamper with the normal process of labor and birth and that promote the use of sedatives, anesthesia and analgesics are significantly more at risk for becoming autistic.(4) What does this research teach us about the practice of scheduled cesarean births? We must suspect that a baby who misses out on the astonishing process of normal labor and birth, as God intended it, loses something vital to life itself.
In his book, The Scientification of Love, Dr. Michel Odent explores the effects of birth and the first few hours of extra-uterine life. He skillfully documents and references a growing body of research that proves what mothers and midwives have always known—conditions surrounding one’s birth and the first hours of life determine a human being’s psychological and spiritual health. Research has shown that the attachment between mother and baby is the prototypical form of love, that immediately after birth there is a short, critical period of time that has long-term consequences. Sadly, this translates: separation from mother immediately after birth can impair one’s ability to love.
Most hospital-born babies experience some separation from the mother immediately after birth. Certainly cesarean-born babies must endure longer separations. In order to protect hospitals and their staffs from potential lawsuits, administrators set policies that routinely keep babies in neonatal intensive care for observation after cesarean birth. Because surgery increases the risk of infection, cesarean-born infants are more likely to be given antibiotics than those born vaginally.
Imagine intrauterine life: the warmth, the softness, the taste of mother, the sound of her heartbeat and gentle voice. Mother is all baby knows. Even father the baby knows in relation to mother—how he makes her feel. Mother is nourishment. She is the universe. When we take the baby away, even a few feet away, trust is broken. The baby’s world is shattered.
Midwives must accept that now and again a mother and baby in our care will experience cesarean birth. I stress the word “birth,” as a birth by cesarean is as much a miracle as a vaginal birth. Postpartum care for parents who have had an unplanned cesarean birth must include reassurance.
I tell parents who are understandably concerned that no significant differences between vaginal and cesarean parents have been found in parental attachment to the baby at one month postpartum.(5) This is good news.
I once heard Elisabeth Kubler-Ross say, “People are 100 percent repairable!” She said it joyously, with conviction. I cling to her words. Parents of cesarean-born children—have faith, and heal your baby with touch, with love.
Robin Lim, CPM, is a poet/midwife who splits her time between a small town in Iowa, a tiny village in Bali, Indonesia and Baguio City in the Philippine mountains. Her first book, After the Baby’s Birth…A Woman’s Way to Wellness, was published by Celestial Arts, Berkeley.
- Korte, D. and Scaer, R. 1992. A Good Birth, A Safe Birth, 3rd ed. Harvard Common Press (reported from Madeline Shearer writing for Birth Journal).
- Odent, M. 1999. The Scientification of Love. London and New York: Free Association Books.
- Tinbergen, N. & Tinbergen, A. 1983. Autistic Children. London: Allen and Unwin.
- Hattori, R. et al. 1991, June. Autistic and developmental disorders after general anaesthesic delivery. Lancet 337 (8753): 1357–58.
- Fortier. 1988. In: Mosby. 1997. Maternity and Women’s Health Care, 6th Ed.
Rx: visit the Primal Health Web site: www.birthworks.org/primalhealth
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