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Interventions, Neonatal transition, Physiological birth, Placental transfusion

Mother and baby–positioning after birth

Mother and babe on bed

“This is the first moment we met each other. I was so overwhelmed and stunned that our baby was here that I hadn’t even picked her up! She is still attached to the cord and the placenta isn’t birthed yet. Before the birth, I had visualised in my head that I would pick her up and cuddle her immediately – but the whole experience took my breath away that I stayed in this position until my lovely Midwife helped me lie down so that I could cuddle our little girl. And I cuddled her for hours.”
Image with ‘modesty edit’ provided by mother – used with permission. Go to Beautiful Birth Facebook page to check out more pregnancy and birth photography

*****

Just like the mother in this image, when I gave birth for the first time (on my hands and knees), I did not want to pick up my baby. Instead I stayed on all fours and looked down to see her sweet, wriggling purple body beneath me and watch her take her first breath. I remember feeling so relieved the birth was over and shocked by the appearance of a new person in the room! It instinctively felt right to pause and watch my baby from above. My instincts to remain upright and leave my baby for the time being would have resulted in a rapid placental transfusion of blood to my baby, as her lungs and other organs transitioned to independent functioning.

(Unfortunately for me and my baby, this moment was short-lived. We were denied a physiological transition and third stage, and any skin contact. The hospital midwives clamped and cut the cord seconds after she was born and separated us for over 30mins – for vigorous suctioning (despite my baby screaming) and ‘removing’ the placenta, before sending me off to shower. I was compliant and didn’t know any better at the time.)

But getting back to the topic of positioning after birth, I have since observed many birth videos where the birth attendant/s determine the position of the baby immediately after birth.

Has anyone else noticed these things happen in some births/ birth videos?

  • A mother lies on her back with her baby placed on her stomach or chest (as high as cord length will allow) – while she gazes elsewhere (shocked) and talks to those around her, not yet looking at her baby?
  • A mother braces herself to give birth in an upright position,  after which her baby is lifted up and placed on her chest before the mother has a chance to free her arms to hold her baby (resulting in some awkward moments)?
  • A mother gives birth on all fours, and remains in this position (breathing, moaning, crying, rejoicing, hiding her face) once her baby is born – followed by an instant chorus around her to “move”, “pick up your baby”? – (Sometimes others physically move the woman to lift her head up, move her knees and pick up the baby.)
  • A baby is born in water and lifted up to the mother’s chest – but the baby is pale, floppy or has a lot of liquid to clear from the airways. The mother rubs her baby’s back and looks concerned and worried, no longer comfortable in the water? (not a common occurrence)

Given the extensive practice of cord clamping, birth attendants determining the timing and placement of “skin to skin contact” and popularity of water births, most of us have only ever experienced or seen birth with interference (or lifted up quickly out of the water).

I do wonder if more women gave birth without interference (or out of water maybe), would we be more accustomed to seeing mother-directed third stage of labour - where women might have a short rest before attending to her baby - and have a greater appreciation and understanding of physiological fetal-to-neonatal transition?

It is instinct in some mammals to rest in the first 30s-1m or so after birth – leaving the baby undisturbed during placental transfusion. Do we have these same instincts, to be above our babies, to gaze at and touch our babies, to watch them breathe and check the cord…before lifting our babies up??

I know some women interpret their responses and feelings immediately after birth as somehow “not caring about the baby at first”. Some women feel surprised or even ashamed they were not instantly responsive to their newborn. But what if this ‘rest and be thankful’ stage is protective, provides babies with a faster, less complicated transition, and restored blood volume quicker after birth??

Edited Feb 20102 to add link: Waiting to Inhale: How to Unhurry the Moment of Birth, Mary Esther Malloy, MA, CD(DONA), CLC, AAHCC

Please note: the author is not critical of water birth and has given birth in water before. This discussion is about gravity and women responding to instinct – and if their instincts were to ‘lower’ the baby, then being in water will obviously have altered the woman’s behaviour to a degree. However, many women seek to hold their baby to their chest immediately after birth, whether in water or not. And where a baby does requires further support in a waterbirth, this is can be attended to on the mother’s chest or the mother and baby can exit the birth pool (to lower the baby below the placenta/ commence resuscitation).

Video examples:

Homebirth – mother rejoices with baby between legs

Homebirth – undisturbed birth

Practitioner-led birth (warning: includes checking for nuchal cord and excessive force on unborn baby’s head, will distress some viewers)

To read more responses to this article where women discuss gravity, instinct and their experiences, click here

2013 article by Birthjoy.co.uk Birth keeper or Baby catcher discusses mothers catching their own babies

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About Kate Emerson

Kate Emerson, BA (sociology/politics) Kate is a clinical student pursuing her interest in neonatal transitional physiology and clinical cord clamping practices. She produces articles and popular media to increase the level of awareness about delayed cord clamping, for parents, students and interested practitioners. Please visit www.cord-clamping.com to read more.

Discussion

28 thoughts on “Mother and baby–positioning after birth

  1. Hi, Here in Finland you can birth at hospital or if you´re really lucky – at home. Hospitals have new protocol for babies. When moms give birth at the hospitalbed ja baby is born, keep midwife babies at metallic trolley for 3 minutes. After that they give baby to mother. I think that it´s awful intervention and those 3 minutes are SO LOOOOOOONG for the mother who is just waiting to see and nurture her baby! Hospitals do this for blood transfusion.

    Posted by Terhi | December 19, 2011, 11:38 pm
    • So the new policy is 3 minutes of the umbilical cord left intact, with the baby contained in a metal trolley so the baby’s transition and the placental transfusion can be controlled/ measured/ observed?

      I have to wonder if ‘maternal experience’ will be included in any evaluation of this practice? Can’t say I’m impressed.

      Posted by GiftedBirth | January 5, 2012, 11:23 pm
  2. This has rung so true to me, I have had 3 children 2 of which were Hospital birth of which the cord was instantly clamped and cut and baby taken away for a few seconds for suctioning.
    My 3rd baby was born Unassisted at home, (unplanned) he was born whilst i was on all Fours, afterwards i just sat and looked at him, shocked mainly as to what had happened but not worried in the slightest just looking down on his perfect face, his cord was clamped and cut 10mins later when a Midwife arrived and Placenta was delivered naturally another 10mins after that.
    It came as complete instinct for me to do nothing but look in awe at my baby, (where as the otherhalf was flapping lol!)

    Posted by Becca | December 20, 2011, 9:00 am
  3. Thank you sooo much for this post! I felt the same during the birth of my daughter: she was born in water and I was on all 4 in the pool and believed someone would pick her up and was just regaining conscience that she was out :) I felt soo guilty that I did not look for her imediatly until the midwife told me to grab her :) That pause makes perfect sense, especially in a first babe… Thank you :)

    Posted by moya | December 20, 2011, 10:58 pm
    • Many comments made on Facebook about this article reflect yours Moya…I hope you no longer feel guilty.
      For many women, giving birth naturally can be followed by the need for a quick breather – and obviously my thoughts are this is normal AND protective.

      Posted by GiftedBirth | January 5, 2012, 11:30 pm
  4. Those videos are beautiful… they made me cry ! The mothers are goddesses… beautiful.

    Posted by Carrie | December 20, 2011, 11:32 pm
  5. what a great article.of my 3 children 2 were born out of hospital with me on my knees.Both times the baby lay on the bed while I just gazed at them. I do think both times someone suggested I pick them up. This time around I plan on leaving her laying there on the bed until I am ready to pick her up.

    Posted by Courtney | December 21, 2011, 12:29 am
  6. left to your own devices, i think this may be how it naturally happens! or at least it was this exact way for me with mine….born at home unassisted.

    Posted by Normal Streetj | December 21, 2011, 2:28 am
  7. My favorite birthing video of all time is “birth in the squatting position” where squatting women push their babies out letting them tumble gently onto a towel then just watch their babies.

    This is what happened in my unplanned homebirth. I was on all fours and my sister caught my son placing him on the bed between my legs. I just laughed and said hello! It’s a lot harder to see your baby when you are holding them. One concern about not having skin to skin right away is the baby’s body temp dropping, but I’ve read arguments that a certain amount of temperature loss is probably physiologically normal.

    Posted by Rebecca | December 21, 2011, 2:06 pm
    • I agree with Rebecca, the Brazilian film “Birth in the Squatting Position” is my favourite film of all time too. That film, released in the late 70′s, opened my eyes about birth, not only in regards to the upright position, but also the fact that women looked at their babies for a few minutes before they tentatively touched them, then reached down and picked them up themselves. So much of what we do as health professionals ‘interferes’ in the process and our actions, kind and well meaning as they are, unleashes many tiny biochemical and epigenetic interactions of which we have not the slightest clue what they do – one thing I know we do is by our actions imply that women are incapable… sigh … reminds me of the old saying ‘the road to hell is paved with good intentions…”. It is women like you Kate, doing what you are doing so beautifully – drawing atttention to and challenging what passes for standard ‘treatment’ that will change things for the better.

      Posted by Carolyn Hastie | December 21, 2011, 6:44 pm
      • I love your comment Rebecca, “it’s a lot harder to see your baby when you are holding them”. So true and I’m sure this is another impetus for some mothers to gaze at their babies before collecting them to their chest. A change in temperature and the ‘cold pressor’ reflexes are part of the physiological transition at birth. Environment plays a big part in temperature loss obviously and this is an important consideration in cool, controlled environments (eg hospitals). – I haven’t addressed all of these considerations in this article since I was trying to keep this post conversational, however I will expand upon these themes and responses in another article and provide references to literature etc.

        Carolyn, thank you for reading and your support. Your research and contributions to midwifery are inspiring (to say the least) and I look forward to sharing your work with the readers of this website.

        I shall endeavour to watch this film, thank you both for mentioning it.

        Posted by GiftedBirth | January 5, 2012, 11:50 pm
  8. In order to birth our son (he was 11lb 30oz) I was on one knee in the birth pool but had my other leg out the side, I think my body naturally just tried to create the greatest space to birth him. I was leaning forward onto a chair because the angle of being more vertical than on all fours was helping too. I had to birth his head in 4-5 contractions and his body in 3 or maybe more, he did not fall out like his predecessors! He was born into his daddy’s arms and after a short breather I flicked my leg over the cord and looked at my huge boy and a ‘suddenly sitting in the birth pool’ daddy who was just blown away, I don’t think he really wanted to hand him over!

    Posted by birthaftercsmum | December 22, 2011, 12:11 am
    • I know the position you describe very well – except my body was more upright on one knee with the other leg completely stretched out to the side. I was experiencing the foetal ejection reflex for the first time (3rd birth) and I think the midwife worried I was trying to stand up in the hospital bath! This position/reflex made for a rather quick and efficient second stage though, and it was fantastic to have my hands free to touch and catch my own baby. It sounds like you and your partner shared a wonderful experience, well done and thanks for sharing!

      Posted by GiftedBirth | January 6, 2012, 12:00 am
  9. I have three sons, three births and of those three two have been unmedicated and at home. My last birth was pretty much textbook birth, straightforward, no complications or anything. When the baby was born, I stood on my knees and midwife caught the baby from behind me. Then he handed the baby to me and I took him. But I did not pick him up to my chest. I held him with my arms straight and asked for the lights to be turned on so that I could watch him. I cooed with him and talked to him lovingly meeting the person who had just moments before been inside me. Before I realised it the cord had stopped pulsating and the midwife wanted to cut it and milk a blood sample from it. I felt the cord and it had stopped. I did not think for a moment about the cord before it had done its job.

    This experience left me thinking about the same thing. Does the mother instinctively know to keep the baby low if she has birthed all by herself and naturally feels free to do whatever she feels is right with the baby after (s)he is born.

    Posted by Elisa | December 22, 2011, 2:05 am
  10. Nicholas Fogelson’s presentation of the research found that there was no difference in placental transfusion whether the baby was placed below the placenta, at the same level or 10 cm above the placenta. I am 16 or so weeks away from my first birth so can only imagine but it does make sense about a short pause for the mum to catch her own breath after the delivery as well as the baby – you had some interesting points. Watching a lot of birth videos I feel that there is too much talking at the mum period – but that may just be me “oh there’s the head”, “good job” “keep going” “you’re almost there” “oh there’s lots of hair” “reach down for your baby” … I have to mute them often and will be telling my attendants to keep quiet and let me concentrate. I do however believe that our we have become so far removed from being able to listen to our instincts sometimes people do need the prompts.

    Posted by Shayla | January 5, 2012, 5:45 am
    • Thank you for your comment and feedback :)

      Studies of ‘delayed clamping’ with the baby placed 10cms above or below the level of the placenta have shown no significance difference after a 2 to 3 minute delay before clamping. These studies were of low risk, full term babies.

      But studies of placental transfusion have shown that gravity can effect placental transfusion, where the infant being 40cms below placenta hastened the transfusion to be near-complete within 30secs but being above the placenta slowed or reduced the transfusion (by gravity negating the hydrostatic pressure of by uterine contractions).

      (Experiments in keeping a baby warm and unexposed at birth showed similar results in disturbing the baby’s transition, whereby an infant maintained placental circulation when the ‘cold pressor’ reflex was inhibited.)

      (A referenced article on these subjects is under development)

      For me, this poses many questions regarding interventions:

      - where babies are immediately lifted above the placenta at birth and the cord clamped off quickly,

      - where babies are kept very warm or without any exposure prior to early cord clamping,

      - where babies are born hypoxic and hypovolemic (due to compression) and lifted above the placenta before having their umbilical cords immediately clamped (rather than lowered, with cord intact and compression relieved).

      The existing science is limited and standard practice means the vast majority of premature or compromised infants are immediately cut off from the placenta, do not receive placental transfusion and denied the time required to clamp the cord physiologically. (The design of most clinical birth spaces ‘separate’ the mother-baby dyad at birth and produce an ‘either-or’ scenario when it comes to facilitating placental transfusion or providing resuscitation. Our society has invested a lot in these designs and institutions.)

      A question posed in this article is- would an increase in the number of births with a mother-directed third stage – with the baby maybe left undisturbed by the mother for 10, 20 or 30secs longer below the level of the placenta – increase our understanding of normal transition and possibly reduce our need/impulse to intervene in the birth by amputating the baby from the placenta and terminating placental transfusion/chance for baby to ‘clamp’ the cord naturally?

      Posted by GiftedBirth | January 5, 2012, 11:20 pm
  11. Interesting article and perspective. I did, however, love my water birth and “scooped” my baby up and brought her to my arms, and loved doing that, and it felt very instinctual. Maybe some women don’t scoop their babies because they’ve only ever seen others do it for women, maybe it is not knowing what to do, maybe it is fear, maybe it is to take a moment and recover from the exertion, maybe it is some innate reason to help with the transfer of blood, or… maybe, for whatever the reason it is just perfect because it is… in any case, any birth in which a mother and baby are undisturbed and a mother acts instinctively is a beautiful birth indeed. Thank you!

    Posted by Zeresh Altork | December 15, 2012, 2:45 pm
  12. I loved holding my babies immediately after birth! I can’t imagine not! My first was a c-section and I held her as soon as they got my sewed up until hours later! Then my 3 homebirths, I was thrilled to scoop them up and put them on my chest!

    Posted by Amanda | December 15, 2012, 3:08 pm

Trackbacks/Pingbacks

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