10 birth decisions that are portrayed as momentous but are actually meaningless

Ten word on a corkboard

The natural childbirth industry likes to portray itself as existing in opposition to the unsafe, soul-deadening practices of conventional parenting. The reality is quite different. In large part the natural childbirth industry is based on unreflective defiance of authority, particularly medical authority.

Part of the portrayal of natural childbirth advocates as “educated,” enlightened and progressive is the elevation of trivial parenting decisions to momentous import. Those decisions can be used to set parents in opposition to conventional medical recommendations, and, conveniently to create the need for the books, services and products being peddled by the natural parenting industry itself.

Here are 10 birth decisions that women are encouraged to see as momentous that are actually meaningless:

1. Epidurals in labor: Here’s a secret about obstetricians and labor nurses: we don’t care whether or not you opt for pain relief in labor. It literally makes no difference to us because we are not feeling the pain. Sure we’ll offer it to you, the same way we offer pain relief to anyone else who is in pain, but we don’t care if you get it. Have an epidural; don’t have an epidural; it’s all the same to us.

We do feel sorry for you if you are under the mistaken impression that pain relief is harmful to you or your baby, or if you been drinking the natural childbirth kool-aid and actually imagine that refusing an epidural says something about your character. But don’t mistake that for imagining that we are scandalized, impressed or distressed by your decision. We don’t care.

2. Moving around in labor: Moving around in labor has a trivial impact (minutes) on the length of labor. If you want to move around, knock yourself out! But don’t expect us to fall for the idea that it is more important to move around than to monitor how your baby is tolerating labor, even if you fell for it.

3. Eating in labor: This has been studied quite a bit, and there is NO BENEFIT to eating in labor. Contrary to the fabricated claims of the natural childbirth industry, it doesn’t “increase your strength,” reduce interventions, reduce the C-section rate or do anything beyond increasing the risk that you might aspirate the food into your lungs if you happen to need general anesthesia for an emergency C-section. That’s because the intestines shut down during labor, hence the nausea that most women experience to one degree or another.

There is one “advantage”to eating during labor: you get to taste the food twice, once when you eat it and then again when you vomit it back up during transition.

4. Delayed cord clamping: There is no benefit to delayed cord clamping in term infants. Sure, they get extra red blood cells, but since every study has shown that they actually destroy those extra red blood cells since they apparently don’t need them, delayed cord clamping may be adding stress to the baby, not removing it.

Immediately after birth, the oxygen content of the cord blood begins dropping precipitously as the placenta begins to peel away from the wall of the uterus. No one has ever demonstrated any benefit in oxygenation from delayed cord clamping. That’s just another one of those things that natural childbirth industry made up in their ludicrous attempt to convince the gullible that a bunch of women with no education in science, statistics, obstetrics or medicine understand neonatal physiology better than physicians. It is amazing to me that anyone falls for that nonsense, but many women do.

If you want your provider to delay cord clamping, you should certainly ask for it. It makes no difference but if it is going to make you feel superior, go for it!

5. Immediate skin-to-skin contact: There is no scientific evidence of any benefit for immediate skin-to-skin contact. That’s just something made up by lactivists who have trouble distinguishing correlation from causation. If you want to hold your baby skin-to-skin, knock yourself out! But don’t imagine that it confers any benefit.

6. Vitamin K
and
7. Ophthamic eye ointment: These aren’t meaningless decisions, they are non-decisions. There’s a right choice and a wrong choice and refusing either or both is the wrong choice that exposes your baby to the risk of blindness, hemorrhage and death. But, hey, that’s a small price to pay for dissing neonatologists and pediatricians and showing solidarity with your equally ignorant friends who have been bamboozled by the natural childbirth industry, right?

8. Hep B vaccination: Wait, let me get this straight. You’re refusing a vaccine recommended by the CDC, immunologists, virologists, epidemiologists and public health officials because you read somewhere on the internet that you should? Surely you jest.

9. Circumcision: All things being equal, circumcision confers health benefits, though those benefits tend to be trivial in first world countries. If you want to circumcise your son, do so. If you don’t want to circumcise your son, don’t. It makes no difference to the rest of the world.

10. Breastfeeding: All things being equal, breastfeeding provides some health benefits, though those benefits tend to be trivial in first world countries. Of course, all things may not be equal for you, so there are plenty of reasons why you might choose formula feeding instead. Lactivists and the lactivism industry will be appalled and try to shame you, but just ignore them. They are looking to increase their self-esteem (and profits) by having you mirror their choices back to them; they couldn’t care less what is best for you and for your baby.

Why have these meaningless decisions been elevated to momentousness by the natural childbirth and lactivism industries? Three reasons:

First, the lay people of the natural childbirth industry (most “birth workers” are just lay people) don’t know much about the truly meaningful issues in obstetrics, the ones that can affect whether your baby or you lives or dies. As self proclaimed “experts” in “normal birth,” they don’t have a clue about serious complications so they can’t formulate recommendations for serious obstetric issues. Therefore, they have elevated trivial issues to momentousness to make the natural childbirth industry appear to be something other than irrelevant to the health and safety of babies and women.

Don’t get me wrong, the natural childbirth industry is definitely irrelevant to the health and safety of your baby and you. It’s just that by elevating the important of trivial decisions, they’ve made it seem to the lay public that they actually provide some value.

Second, the fundamental product sold by the natural childbirth and lactivism industries is distrust of the medical profession. You’re supposed to be gullible enough believe that obstetricians, neonatologists and pediatricians don’t care about your health and safety, while a bunch of privileged, Western, white women (birth workers!) who know nothing about obstetrics, neonatology, human physiology, science or statistics (and who take ZERO responsibility for the outcome of their “advice”), who get their information from random strangers of the internet are both more knowledgeable about your health and more concerned with preserving it.

Natural childbirth advocacy views conflict between patients and their providers as critical to selling their good and services, and they do everything they can to encourage women to be confrontational with their physicians. Elevating meaningless decisions to momentousness is just another way to create conflict and destroy trust. Think about it: women come to their providers with lists of demands and requests that are meaningless and then are shocked and angry that their providers view those decisions (appropriately) as irrelevant. Mission accomplished.

Third, elevating these decisions to momentousness is a form of marketing. It apes the practices of most purveyors of baby products. Baby furniture manufacturers imply that the choice of a crib is momentous. Baby swing manufacturers offer multiple variations at multiple price points. Baby bottle manufacturers imply that some bottles lead to better digestion than others. Baby toy manufacturers tout the benefits of certain types of toys. As consumers, we expect this and are able to recognize fact that manufacturers are attempting to move more of their own product in order to increase profits, and we take claims of superiority with a large grain of salt. We know that a baby toy manufacturer advertising the superiority of its products is not necessarily telling the truth. They are telling you what they think will get you to buy their products.

Mothers and mothers-to-be should apply the same level of skepticism to claims about birth decisions. Are they really momentous decisions or does encouraging you to view them as momentous decisions move more books, services and products? Does your obstetrician (who may be subject to large administrative, legal and financial penalties if he or she does not preserve your health and the health of your baby) really care less about ensuring a good outcome for you both than a bunch of random strangers on the internet whose chief motivation is selling their goods and services? Would obstetricians, pediatricians, and neonatologists really recommend medications and procedures that are harmful to you and your baby and the only ones who figured it out are a bunch of random lay people on the internet? Does that make any sense at all?

There are many momentous decisions you will make as a parent. These 10 birth decisions are not among them, no matter how much the natural childbirth industry pretends that they are.

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  • guest

    Are the benefits of circumcision in first world countries really trivial? The more we find out about the destructive role of HPV in so many different kinds of cancer, the more that circumcision’s protective effect makes sense to me.

    • Cobalt

      We might find that the benefits are greater with more HPV research, but probably still not as effective as condoms and vaccines. Time will tell.

      • guest

        I was just looking at this amazing NYT chart about the effectiveness of different contraceptive methods. In the real world, condoms have a terrible track record. And the vaccines are really effective … but so far they only defend against two of the carcinogenic strains. And in my neck of the woods, I suspect HPV vaccine uptake is even more pitiful than the U.S. performance as a whole. So I have to see circumcision as one of the partly effective tools in the toolbox.

        • Cobalt

          It does have at least some protective effect, definitely. But even if every male was circumcised, we would still need more effective protection, or at least I would want more for me and my kids. I would rather push for better vaccines and vaccination rates and getting young adults to actually use condoms (not easy!), because these methods can be improved to much better protection rates than circumcision can offer.

          I don’t remember the exact numbers but I think circumcision offers in the neighborhood of a 60% reduction in risk of sexually transmitted viruses, while condoms are closer to 80% with typical failure rates and much higher if actually used as advertised. Condoms are even better with bacterial infections. Vaccines, when available and used, do even better than that.

          • guest

            Perfecting things someday in the future is great, but I’m not holding my breath. I’d rather go with the entire range of what is effective – to me, it’s not a case of “I’d rather support this or that.” Because vaccination only protects against a couple of strains of high risk HPV, and more than a dozen of them can cause cancer. Because lots of people hate using condoms and because 86 out of 100 couples using condoms for contraception will have an actual pregnancy within ten years … and what that means for STDs is written across our entire country. Because the only age group of American women that doesn’t have a substantial fraction of high risk HPV infection (two of more than a dozen strains that can cause cancer) is the age group that isn’t sexually active yet. http://www.cdc.gov/std/stats12/figures/45.htm As one of the tools in the STD prevention toolbox, right now, today, circumcision cuts infection rates of HPV, HIV, herpes and bacterial vaginosis. (Possibly also syphilis and gonorrhea, although it bears looking into.) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907642/ It does it for people who aren’t vaccinated for HPV, like the majority of teens in the U.S. today. (Our rates are stubbornly stuck at under 40 percent). And it does it whether or not your partner hates condoms, as so many do. http://www.theatlantic.com/health/archive/2013/04/why-still-so-few-use-condoms/275301/

          • Box of Salt

            I just thought I’d point out that guest’s complaint that “vaccination only protects against a couple of strains of high risk HPV” fails to note that the two highest risk strains cause 70% of cervical cancers.
            For references, read here:
            http://www.skepticalraptor.com/skepticalraptorblog.php/one-stop-shop-science-myth-debunking-gardasil/

          • guest

            I’m not complaining about an effective vaccine. I’m complaining about an attitude that says the current vaccine and condoms are enough. Cervical cancer is a major killer of women and thief of women’s fertility worldwide. I’m not content to cede the remaining 30 percent of its victims. Neither are you, I hope. Plenty of people think circumcision is as meeeen. I think the way cancer kills people is mean. The meanest.

          • Box of Salt

            guest, I think we’re basically on the same page.

            Your comment needed clarification.

            To me, your turn of phrase suggested dismissing the value of the vaccine.

            Antivaccine advocacy specifically targeting the HPV vaccines has kept vaccine uptake in the US relatively low.

            You state you are not willing to cede the 30% whose cancers came from strains not covered by the vaccine. I’m not willing to risk the 70% whose cancers could be prevented because they’re fooled into believing the vaccine isn’t worth it.

          • guest

            I think if you read my comments more closely, you won’t find any need for clarification. I support the vaccine – but the vaccine cannot do it alone. Telling people that isn’t fooling them. It’s being honest.

          • Cobalt

            And parents should be told of the potential protective effects as a benefit of circumcision. But I would still tell my circumcised kid to use condoms, and get them vaccinated, even if HPV infection was the only risk of sexual activity.

          • guest

            As would I – I believe this is the third time I’ve said we should use every tool in the toolbox. But as I’ve said, the majority American parents don’t get their children vaccinated against HPV. (Although the majority still circumcise their sons, according to the latest statistics I’ve seen.) Even the vaccinated are not protected against every oncogenic strain. And even if you are the parent who is willing to real world nag your adult child about condom use, plenty of people who know better are very bad about using condoms. Since none of this bears repeating again, I’ll just re-iterate that I disagree with Dr. Tuteur. I don’t think circumcision is a trivial choice, even in first world countries where heterosexual HIV is not epidemic, because circumcision fights many STDs.

          • Box of Salt

            guest “But as I’ve said, the majority American parents don’t get their children vaccinated against HPV.”

            This is why I feel your earlier comment (which I did read carefully) needed clarification.

            It is why “being honest” includes pointing out that the strains covered by the vaccines cause 70% of the cervical cancers, instead of using terminology that will lead the fearful into avoiding the vaccine due to the Nirvana fallacy.

          • Young CC Prof

            And note that even with low vaccination rates, the incidence of HPV has dropped dramatically since the introduction of the vaccine, and dropped somewhat even in unvaccinated youths. Since it is an STD and therefore spreads fairly slowly, the vaccine appears to be creating some herd immunity even at like 40% vaccination rates!

          • guest

            If I wanted to increase vaccination rates among the vaccine resistant, the argument that the current rotten rate is providing some herd immunity for them to hide in … would not be the argument that I would lead with. My leading argument is that the more things we do to knock down the HPV infection rate (vaccine plus condoms plus circumcision), the less likely it is that their child will have to wear a dental dam to prevent oropharyngeal cancer from *any* oncogenic HPV serotype. That’s what I would lead with. Because the fallacy that you really have to overcome is the it-won’t-happen-to-me-or-mine fallacy. The same one that convinces them that they won’t be the ones that need a homebirth hospital transfer or a C-section or a NICU or a coffin because that serious stuff, like cancer and its treatment, happens to *other* people.

  • DaisyGrrl

    OT: if anyone is bored today, this week’s Dear Prudence features a letter writer who is shocked, shocked! to find out that his wife’s homebirth midwives are anti-vax. The comments at this point are refreshingly pro-hospital birth along with a helping of education about CPMs. I suspect some of the regulars here are hard at work.

    http://www.slate.com/articles/life/dear_prudence/2014/11/dear_prudence_our_midwives_are_anti_vaccination_activists_should_we_fire.html

    • Bugsy

      Love this comment:

      The Almighty Speaks1 hour ago
      Your midwives are as dedicated to medical science as creationists are to earth science. Both believe what they believe and can’t be bothered with actual facts. Good luck.

  • yentavegan

    But delayed cord clamping is VITAL! because 1/3 of the baby’s total blood volume is squeezed back into the placenta as the baby passes through the birth canal and you have to allow time for it to return to the baby because that blood belongs to the baby and this is true because I read it on page 47 of the 8th edition of the Womanly Art of Breastfeeding. AMIRIGHT?

    • Bugsy

      Well, if you read it in the Womanly Art of Breastfeeding, then you know it’s accurate, fair and completely non-judgmental.

      Seriously, that book makes me want to scream. I unfortunately read the copy that my AP friend gave me (complete with the sections she highlighted that were most important for me to follow). It was such a painful/amusing read that even though I can’t stand keeping it, I refuse to donate it out of fear that it could legitimately traumatize another new mom. Perhaps I’ll save it for fireplace season?

      • yentavegan

        I was shocked and heartsickened when I read this “newer” revision of the WAB. My older copy of WAB did not have such a militant negative slant towards standard hospital procedures and was more touchy feely.

        • Bugsy

          Wow, that’s really good (and unfortunate) to know. I had a hard time processing how the book could be so popular and have been around for the so long in its current form.

      • KeeperOfTheBooks

        Sounds like an excellent idea to me. Pre-baby, I had a whole stack of natural childbirth/nursing/etc–the greatest hits of Ina May (what the hell was I thinking?), WAB, etc, etc. It felt very, very freeing to get rid of them, especially when I remembered those first couple of weeks of trying to nurse, pouring over WAB, and saying, “But that isn’t safe,” (cosleeping), “According to 2 LCs, 3 docs, and countless nurses, I AM doing everything right, and it still hurts worse than any post-C-section pain!” (in reference to “nursing doesn’t hurt, and if it does, you’re doing something wrong) and “how the hell am I ever supposed to get any me time at all if I never let anyone give her a bottle?”

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      • Smoochagator

        I threw out my “Ina May’s Guide to Childbirth.” For a second I considered donating it, but then I flipped to the section about GBS screening and got so angry about how she trivialized the risk, I walked right out to the trash can and tossed it.

  • Same ol’ same ol’

    It really confuses and boggles my mind that someone would listen to an untrained lay person, who has no training(except how to find fake candles and make ~you feel better~) over a MEDICAL professsional when it comes to the birth of a child.

    You’re not looking for advice on how to say, advance to the next level of a video game; you are about to bring a child into the world! A life. A human being.

    I’ve never had a negative experience with nurses/doctors/etc. but, that could be because I’m having a child and everything is dedicated to that….not that my fake candles aren’t lit and some ~soothing~ nature sounds CD isn’t playing.

    Also? All birth is natural. No matter HOW you deliver the child. Unless they press some button on the wall like in New/old Star Trek Movies and the baby slides out on a tray all ready for you(like whatever those food makers were in the series/movies).

    • SporkParade

      But I think that’s exactly the issue, that it makes the woman feel better. (Perhaps not as much better as adequate pain relief during labor, but nonetheless.) My theory is that the entire NCB advocacy nonsense is actually a reflection of the fact that they are terrified of labor, and the only way they can deal with it is to pretend that they have mastery over it. So they say that the pain isn’t actually traumatizing, you don’t actually need doctors because nothing’s going to happen to you, there’s no point in learning about potential complications because they’re rare, there’s no need for monitoring, trust birth, etc. And doctors are the bad guys because they won’t let you pretend it will all be okay.

      • Bugsy

        Wow, that’s a really good theory.

  • S

    Mostly OT but Dr. Amy, i’ve meant to thank you ever since my second kid was born. I can’t tell you how badly i wanted to yank that monitor off while in labor — the sensation was unbearable to me! But i remembered, vaguely, that it was really important for some reason. That’s how much of an impression your posts made on my brain! The late decelerations post is one of my all-time favorites. So, thank you! Or maybe my nurse and OB should thank you. =)

    (I did ask for an epidural right away but was fully dilated by the time it was placed.)

  • Trixie

    It could be the place I live, and the fact that most people circumcise here, but hospital staff sure seemed to care a lot about whether we were circumcising because I got asked about it by various people at least twice a day. In my drugged state I started to get really scared that it was so routine that they’d do it anytime they took him away, so by the third day I started telling every nurse that came for him not to do it. I probably seemed crazy but I’d been asked to schedule his circumcision at least 6 times by then and it was really starting to freak me out. (I’ve got no issue with others’ decision to circ, but for cultural reasons it was important for us not to do it).

    • Jessica

      Interesting. Our pediatrician said that the nurses at our local hospital hate circumcising because they think it interferes with breastfeeding (and she sort of rolled her eyes), so she said it was probably easier to have it done at the two week checkup. At no point during our hospital stay (at least that I can recall) were we asked whether we wanted to circumcise our son. We live in Oregon – our pediatrician said it’s about 50/50 among the patients she sees.

      • Trixie

        I suspect this varies regionally quite a bit.

        • KarenJJ

          It’s not commonly done in Australia anymore. I had one of the few obgyns that will do it in Sydney. When I gave birth to my son he asked once and that was it.

          • Michelle

            Same in NZ, very few will do it outside of situations where it is medically necessary, and even then they’ll try other things first before considering it like a steroid cream for phimosis. Basically it’s never mentioned at all, as they know the small % that wish to do it non-therapeutically will ask anyway if they want it and they can talk to them about that then or they make their own arrangements.

          • Jen

            We were never asked with either of our boys. I know there is one Ob in Canberra who will do it soon after birth and at least one other who will do it at about 18 months under a GA.

        • Guestll

          In Ontario, where I live, you have to pay OOP for it, and ask for it if you want it done. My husband in particular has strong feelings about not doing it.

          • Lori

            I think most circumcisions are done out of the hospital here in ON. Incidentally, I will be at my clinical placement tomorrow where every Thurs is “circ day” so the waiting room is full of baby boys awaiting their turn.

          • Guestll

            Thanks, that makes sense.

      • Cobalt

        I was asked each day by the nurses with my sons, it seemed like they wanted to schedule all the “out of room” stuff all at once. It weirded me out a bit the second day, like maybe they weren’t reading the right chart or something.

        • Smoochagator

          I think it’s better that they ask repeatedly instead of just assume they have all the right information. Kinda like verifying name and birthdate and all that 😀

          • Cobalt

            I’d certainly rather they ask than get it wrong, especially with procedures that are irreversible.

    • Mishimoo

      I was expecting that sort of experience, and was really surprised when my CNMs kind of boggled at the idea of circumcision. It’s not standard here any more and hasn’t been for a while.

    • Elaine

      They asked me at every shift change, but I got the impression it was more in a handover kind of way, each new provider wanted to make sure that they were clear on my preferences.

  • Guest

    Can anyone point me to studies regarding delayed cord clamping? I recently read something that suggested that there were benefits, but that those benefits are all realized within a minute of birth and that the baby had to be held lower than the placenta (it seems to me that most NCB put the babies right to their chests and wait much longer than a minute to clamp the cord, so I wonder how many of the benefits they receive). I am currently pregnant with my 4th baby, and after reading that article was considering delayed cord clamping with this baby, but if it really makes no difference, what’s the point?

    • Maria

      I found this blog post interesting when I was pregnant with my second. http://scienceofmom.com/2012/10/11/why-consider-delayed-cord-clamping/

      She comes down on the side of unless there is a medical reason to not delay cord clamping (baby needs immediate attention), what’s the harm of waiting 2 minutes after the baby is born. But, essentially she acknowledges the benefits are not monumental. Read the comments to for further details.

    • Becca McMahan Parrish

      If It really makes no difference, why not wait to cut the cord? The cord is still pumping blood, and also filling with Wharton’s jelly (so the blood can’t flow back to the placenta) so there is no need to hold the baby lower than the placenta. I would wait ’till the cord stopped pulsing just to give my baby all the blood to work with possible. I cannot see this having a negative result. Then, the baby’s system can dispose of what it decides it doesn’t need, as Dr. Amy says. Breastmilk is low in iron, so I believe it is important to give your baby as much as possible to store in the body ’till they begin to eat solid food. This is a good article:

      http://scienceofmom.com/2012/10/11/why-consider-delayed-cord-clamping/

      and there are so many more if you google “waiting to cut the cord.” Good luck! 🙂

      • Maria

        I don’t have any sources, but I do remember reading that delaying for longer than 2-3 minutes showed no real benefits over delaying for just 2 minutes or so. So, waiting for the cord to stop pulsing is probably not necessary. Also, there is no harm in cutting the cord right away either, so it does point to the fact that this isn’t the most monumental decision you will make regarding your baby’s health.

      • Maria

        Oh, and jinx on posting the same article!

      • Sue

        Hi, Becca. The umbilical vein and arteries are buried within Wharton’s jelly – it’s not in the vessels. The umbilical VEIN carries oxygenated blood to the fetus, the arteries take it back from the fetus to the placenta. (The opposite to adult circulation).

        We’ve talked about the cord ”pulsing” before – it’s not the maternal pulse, but the fetal one, being transmitted through the fetal arteries BACK to the placenta.

        The placenta breaks down its oxygenation function quickly, so the maternal venous blood may or may not be oxygenated.

        Certainly there is some volume of blood sitting in the umbilical veins that can go into the newborn, but studies don’t show any clinical benefit from that additional blood, but some potential harm from additional red cell breakdown causing jaundice.

        • Becca McMahan Parrish

          I am aware that the Wharton’s jelly is not within the vein and arteries. “In absence of external interventions, the umbilical cord occludes physiologically shortly after birth, explained both by a swelling and collapse of Wharton’s jelly in response to a reduction in temperature and by vasoconstriction of the blood vessels by smooth muscle contraction. In effect, a natural clamp is created, halting the flow of blood. In air at 18°C, this physiological clamping will take three minutes or less.”
          Polycythemia (a rarity) can be caused by a number of things having nothing to do with (but surely exacerbated by delayed clamping) such as abnormal bone marrow, gene mutation, presence of cancer, etc…and since when is jaundice a serious complication? As for there being no studies showing a benefit to delayed cord clamping, this obviously depends on which studies you read. I certainly found no shortage of plentiful and recent studies showing benefits and don’t consider the possibility of jaundice reason enough not to do it.

          • Dr Kitty

            “Since when is jaundice a serious complication”…

            When it is pathological jaundice caused by sepsis, isoimmunisation, haemolysis, biliary atresia, various syndromes (Dubin-Johnson, Crigler-Najjar, Cystic Fibrosis), metabolic and endocrine problems (hypothyroidism, galactosaemia).
            Not all jaundice is physiological.

            All jaundice, no matter the cause, has the potential to cause brain damage if the bilirubin levels are high enough and phototherapy is delayed or ineffective. Exchange transfusion is the next treatment step if phototherapy fails, by the way.

            If your baby would only have had mild breast milk jaundice, the extra stress on them caused by having to haemolyse extra red blood cells they don’t need may cause prolonged or more serious jaundice.

            A baby that might have got away without photo therapy might require it.

            A baby that might have needed phototherapy might need a transfusion.

            And a baby whose caregivers ignore prolonged, severe or delayed onset jaundice as “no big deal” might end up with brain damage.

            http://www.patient.co.uk/doctor/neonatal-jaundice-pro

            http://www.patient.co.uk/doctor/kernicterus

          • Guest

            “…and since when is jaundice a serious complication?”

            Spoken like some who has never known a baby with kernicterus or the mental retardation and seizures that it causes.

          • The Bofa on the Sofa

            But even if we grant that these outcomes are rare, wouldn’t the same apply to anemia? Anemia can be serious, for sure, but generally is not.

            So she’s got a dichotomy going here….jaundice is no big deal because it’s readily treatable and rarely results in anything serious. Anemia, however….oooooo……it’s not that common, and even when it occurs it’s generally treatable and rarely results in anything serious, but we have to prevent it!!!!!!

            I’m all for preventing both jaundice and anemia, and don’t see an argument to sacrifice one to help the other.

          • Sue

            Thanks for the cut-and-paste, Becca, but did you get the bit about arteries and veins, and that the pulsation reflects the baby’s heart beat?

            You’re welcome.

            On the basis that you had that bit back to front, maybe your personal opinion of the possibility of jaundice and its implications may not be based on a great deal of clinical knowledge.

            You can decide whatever you like for yourself, but its best not to make assertions outside your area of expertise on an OB’s blog.

          • Young CC Prof

            “since when is jaundice a serious complication?”

            Don’t even. My baby had to be readmitted to the hospital for jaundice and placed in NICU. He could have suffered brain damage or died.

            Also, polycythemia is considerably more common in newborns, and can be caused by things like low birth weight.

            Get some background information first.

          • fiftyfifty1

            “Polycythemia (a rarity) can be caused by a number of things having nothing to do with (but surely exacerbated by delayed clamping) such as abnormal bone marrow, gene mutation, presence of cancer,”

            Hint, you have cut and pasted the causes of ADULT polycythemia, a totally different ball of wax than neonate polycythemia with completely different causes and different risks.

          • Dr Kitty

            Umm hmmm.

            Neonates with polycythemia may have the following findings:

            Lethargy
            Irritability
            Jitteriness
            Tremors
            Seizures
            Cerebrovascular accidents
            Respiratory distress
            Cyanosis
            Apnea

            This is because they have literally too many red blood cells, which makes their blood hyper viscose and actually prevents delivery of glucose and oxygen to vital organs.

            Think of capillaries as roads, and neonatal polycythaemia as like gridlock due to heavy traffic, with red blood cells being cars.

            Partial Exchange Transfusion is the treatment of hyperviscosity, and will definitely interrupt BF, as you can’t feed a baby while they are having a blood transfusion or for several hours afterwards. The treatment is controversial, and there is some evidence that long term outcome are the same regardless of treatment.

            So, delayed cord clamping may cause your baby to have a stroke, require a blood transfusion, interfere with breastfeeding, and be left with long term neurological sequelae.

            OR don’t delay cord clamping and give them vitamin and iron drops…

          • Dr Kitty

            The Wiki article about polycythaemia in adults is actually pretty good, and explains the different types.
            But it has nothing to do with neonatal polycythaemia.
            http://en.m.wikipedia.org/wiki/Polycythemia

      • fiftyfifty1

        ” I cannot see this having a negative result. ”

        This is exactly why we have trained scientists and doctors. It’s their job to know how the biology actually works, including anticipating downsides (complications of polycythemia, jaundice etc) that untrained individuals could never have seen coming.

        • Becca McMahan Parrish

          Jaundice is an extremely common and very treatable condition! Especially when the mother breastfeeds. How is this a complication any more than anemia? Polycythemia is rare and not directly caused by (but is admittedly made worse) delayed clamping.

          • Sara Lucy

            Because jaundice can be dangerous? A minor skin infection is very common and easily treated, but sepsis and cellulitis are more troubling. We pay attention to minor infections so they don’t turn into major ones.

            Jaundice and infection are by no means the same process, but still, “common” and “treatable” doesn’t mean everything’s perfectly fine. At minimum, jaundice calls for extra monitoring and a bit of intervention.

            Isn’t anemia a complication?
            Is quick cord clamping causing anemia?

          • Becca McMahan Parrish

            If babies that have cord clamping delayed have less of an incidence of anemia than those whose cords were cut immediately, even months later….you tell me…A baby having jaundice isn’t perfectly fine, I didn’t say it was. Neither is an anemic one, one with a low birth rate, or one with abnormal breathing. As mothers I guess we must pick which risk we are willing to take with our babies’ lives. Because ultimately, it’s not up to the doctor. That is a dangerous misconception. We have to live with the decisions we make for our children. That is why we must be well-informed and not believe everything we are told from either the medical profession or the natural birthers.

          • Amy Tuteur, MD

            But they don’t have a lower incidence of anemia. That’s the point:

            http://www.skepticalob.com/2013/07/delayed-cord-clamping-much-ado-about-nothing.html

          • Becca McMahan Parrish

            I guess we’ll all refer to studies that support what we already believe. How’s that for objective?

          • Amy Tuteur, MD

            Wrong. That’s not how science works. Science looks at all the evidence, evaluates it and synthesizes it to reach conclusions. That’s how we know that delayed cord clamping does not prevent anemia in term babies.

          • Becca McMahan Parrish

            You are convinced that Science is the end-all, be-all yet how can science give us two different answers to the same question? I still say that we must make our own INFORMED decisions.

          • The Bofa on the Sofa

            But you aren’t informed. You don’t know enough to know what you do and don’t know.

          • Dr Kitty

            You don’t understand how science works.
            You don’t understand how research works.
            You don’t understand how human physiology works.

          • Amazed

            What, exactly, do you consider an INFORMED decision? So far, I’ve seen you discounting science for mother’s intuition and insist that what you “feel” is the right decision.

            Information has nothing to do with your choice. You rely on gut feelings that teach you sime dangerous untruths… like jaundice v. anemia and the magical ability of breastmilk to prevent jaundice.

            Make all the choices you like. That’s your right. But don’t pretend that they are INFORMED ones. Because you seem remarkably information resistant.

          • !!! I Sarah Post This Testimony Coz Am Pregnant Thanks To Dr.Ukaka

            My name is Sarah Valdez my partner and I have been trying for a baby for over two years now, We were going to a fertility clinic for about 5 months before somebody told us to contact this spell caster who is so powerful, We contacted him at this email; freedomlovespell@hotmail.com , for him to help us, then we told him our problem, he told us that we will either conceive in February 2014 or March 2014,but after two years of trying we were at a point where we were willing to try anything. And I’m glad we came to Dr Ukaka, Because his pregnancy spell cast put us at ease, and I honestly believe him, and his gods really helped us as well, I am thankful for all he has done. contact him via email: freedomlovespell@hotmail.com if you are trying to get a baby or want your lover back. he has powers to do it, he has done mine,

          • The Bofa on the Sofa

            You know, if you actually referred to studies that showed the opposite of the ones that Dr Amy describes in the link above, we might actually worry about whether it supports what we already believe. OTOH, just asserting there are studies that support you is certainly NOT objective.

          • Becca McMahan Parrish

            These studies, which are not hard to find, support the theory that delayed clamping reduces anemia, both early on and later in the baby’s first year. They also suggest that delayed clamping could contribute to
            http://www.sciencedirect.com/science/article/pii/S0140673606688892

            358 (75%) mother-infant pairs completed the trial. At 6 months of age, infants who had delayed clamping had significantly higher mean corpuscular volume…. A cord clamping delay of 2 minutes increased 6-month iron stores by about 27–47 mg.
            Interpretation:
            Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before 6 months of age, when iron-fortified complementary foods could be introduced.

            http://www.bmj.com/content/343/bmj.d7157

            Conclusions Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anemia.

          • The Bofa on the Sofa

            But Becca, those studies WERE INCLUDED in the Cochrane review that is discussed in the link above!!!!!! In other words, those results have been taken into account in drawing the conclusion that was drawn.

            That’s the beauty of a review – it takes a look at ALL the data available and draws the conclusion.

            Those papers don’t contradict what is in the review, they are part of it.

            Now, where’s the review that shows otherwise?

          • Samantha06

            “That is why we must be well-informed and not believe everything we are told from either the medical profession or the natural birthers.”

            I don’t know about you, but I’d rather get my information from medical professionals who are educated and trained, versus a bunch of lay people masquerading as “experts”.. but that’s just me…

          • Becca McMahan Parrish

            You are all assuming I hold a position I may not. I’m either with you or against you, I guess! I think you could find a doctor or two who would support delayed cord clamping. I’m not tramping about with a bunch of hippies on a bus caravan chewing my child’s umbilical cord in two here. @ TheBofaontheSofa: How does a review invalidate previous studies unless a new study demonstrates an opposite result? I am still looking for the review on the Cochrane website. Haven’t found it yet, can you re-post the link please? That’s all for today…wow this is a time sucker, but very good to discuss.

          • The Bofa on the Sofa

            How does a review invalidate previous studies unless a new study demonstrates an opposite result?

            Why does it have to be a new study that does that? Perhaps there are existing studies that show the opposite that are ALSO included in review?

            The authors of the Cochrane review considered the results of studies based on quality criteria, irrespective of result. Assuming that they found results that suggested an increase in anemia, the conclusion that there is no effect would mean there are also results in the opposite direction.

            Now, if you disagree with the authors selection criteria and their treatment of the data, provide a specific criticism to the work, which is not “science can be used to support either side.”

            For example, there have been criticisms of Cochrane reviews that end up being based on too few of studies to say anything meaningful. But in that case, the criticism is that the data sizes aren’t large enough to show a significant effect, so it’s hard to say you can’t draw the conclusion that there is no detectable effect if the sample size isn’t large enough to show an effect in the first place.

          • Sue

            A review considers the totality of the evidence. There is no area of medicine that is decided on the results of one study.

          • Amy Tuteur, MD

            No, I”m assuming you have absolutely no idea what you are talking about and you are simply regurgitating the natural childbirth propaganda that you gullibly believed, since you had no background with which to independently assess it.

          • !!! I Sarah Post This Testimony Coz Am Pregnant Thanks To Dr.Ukaka

            My name is Sarah Valdez my partner and I have been trying for a baby for over two years now, We were going to a fertility clinic for about 5 months before somebody told us to contact this spell caster who is so powerful, We contacted him at this email; freedomlovespell@hotmail.com , for him to help us, then we told him our problem, he told us that we will either conceive in February 2014 or March 2014,but after two years of trying we were at a point where we were willing to try anything. And I’m glad we came to Dr Ukaka, Because his pregnancy spell cast put us at ease, and I honestly believe him, and his gods really helped us as well, I am thankful for all he has done. contact him via email: freedomlovespell@hotmail.com if you are trying to get a baby or want your lover back. he has powers to do it, he has done mine,….

          • The Bofa on the Sofa

            That is why we must be well-informed and not believe everything we are told from either the medical profession or the natural birthers.

            OK, even granting that to be the case, how do you decide which things we are told from the “medical profession” you are going to discount?

            In fact, rationally, if it is a question of who to believe, choose the one that is the most reliable. It’s a very simple exercise to show that when you pick and choose which to believe without any actual basis, you are going to be wrong more often than if you just pick the most likely to be right. And that’s the objective approach…

          • Sue

            ”Because ultimately, it’s not up to the doctor.”
            ”we must be well-informed and not believe everything we are told from either the medical profession”

            If it wasn’t for medical knowledge, how would we even know about anaemia, or polycythaemia, or jaundice, and all their implications or treatments?

            Or have you done your own trials?

          • anon13

            Especially when the mother breastfeeds? I had a 5 day wait for my milk to come in, about 3 with #1 who was a lazy nurser and got quite yellow. If he had delayed cord clamping it may have been a worse condition. He didn’t since there was mec aspiration. I think it’s an okay thing to do, but I’m not sold at all about any true benefits. Studies of three month olds showed no difference in blood iron levels between delayed or quick clamping.

          • fiftyfifty1

            “Jaundice is an extremely common and very treatable condition!”

            And the treatment often consists of needing to keep infant separated from mom under bili lights in the hospital. Is this cool with you? In contrast, preventing anemia is as simple as some poly-vi-sol w iron vitamin drops, and you need to give the vitamin drop anyway because breastmilk is deficient in vitamin D.

            “Especially when the mother breastfeeds.”
            Dangerous levels of jaundice are much more common in breastfed infants both because of low volumes and the intrinsic bili-clearing-inhibition property of breastmilk. This makes jaundice more common and more difficult to treat.
            You really do not understand the biology at all, it seams.

          • AlisonCummins

            Formula clears jaundice more rapidly than breast milk. Is that what you’re referring to when you say “jaundice is extremely common … especially when the mother beastfeeds”?

    • psuedoscience sucks

      Supposedly there is a difference for babies that they expect will go to the NICU. Babies who have delayed cord clamping are less likely to need blood transfusions, so our NICU now recommends it. I think this is one of the studies they used when they were reevaluating the policy. http://www.bmj.com/content/343/bmj.d7157

  • Sara Lucy

    A friend of mine and his wife recently had a baby and the photo of the swaddled little burrito came with the announcement that he was born “100%
    natural!”
    Sorry, I’m gonna need that to be “vegan” and “no GMOs”, too.

    But seriously, what does that make my kid? 35% natural? Can longer breastfeeding improve the ranking?

    • OldTimeRN

      Why is he swaddled? That isn’t natural? Who cares if mom was sleeping or peeing. That baby needs to be skin to skin. At least according to the “evidence”

    • Bombshellrisa

      I always thought born 100% natural would exclude the use of all technology, including the camera. The only truly natural birth announcement would be if the parents walked from friend to friend to show off the baby. No cars, no car seats and no phones. No email. And no mail! It’s not “natural”.

    • The Computer Ate My Nym

      Actually, I’m kind of hoping to be able to GMO the critters soon. Lots of nasty conditions that could use a little GMOing out of existence.

      • Cobalt

        Gattacca?

        • KarenJJ

          Except mine’s spelled Gatcacca…

      • KarenJJ

        If I get to a certain age and they happen to want volunteers to try and modify DNA I plan to put my hand up.

    • Maria

      I would have rolled my eyes at that. I know that had I sent out an announcement detailing all the medical procedures that came with the births of either my kids people would have thought I was really weird. So why don’t people think this is weird too?

    • Sue

      Mine is 100% ORGANIC!

    • just me

      No need to disparage vegans…

      • Sara Lucy

        I’m disparaging the application of labels that I associate with food products to human children, not the labels themselves.

        There’s nothing wrong with “100% natural” but don’t see why it has to be advertised. Just like I don’t care if someone is vegan unless I’m planning to eat them, or feed them lunch.

        • LJ

          Vegan is a description of a belief system, not a plant based diet. When a product is described as “vegan” it’s a shortened way of saying suitable for vegans. It is ignorant to think of it as a food label.

          So you did disparage vegans, and your comment also seemed to lump them in with things that are generally sneered at and considered hippyish.

          • Sara Lucy

            Wow, so is vegan merely a belief system, or is it an oppressed people group, too?

            Sorry, but no. I’m not joining that cause.

    • Ardea

      Gluten-free, too.

    • Roadstergal

      If the kid is a Borg, I think that counts as 45-55% natural.

  • OldTimeRN

    I love this post so much I want to frame it and gift wrap it to every mother who come in to deliver in our hospital.
    I think one of the best points you made was pitting the mom to be against the doctors and nurses. Moms come in now knowing everything they want to do and get upset, mad and sometimes argumentative when we present a different reality based on their individual baby. I’ve seen mothers break down because their baby has a low glucose and formula is needed and they feel we are ruining their birth plan. I’ve seen parents of 36/37 weekers who don’t understand the extra care and attention the baby will need, even though the baby has been sent to regular nursery. There is a reason a pregnancy goes 40 weeks. So sorry if your baby didn’t comply with your birth plans. But please don’t kill the messenger. Those moms already have it engrained in them that we are out to destroy their plan when in reality we are trying to do what’s best for the baby.
    On a personal note, I birthed my own children via c/s and didn’t do skin to skin with any of them. And you know what? I bonded damn well with all of them. I’m sure we all know an adoptive family who also bonded with the babies. What are they saying to the older generation moms, or adoptive moms? Are they going to argue and say we didn’t bond with our babies? So where is all this evidence they keep shouting out?

  • Jocelyn

    Posted this on Facebook; friend wants to know what studies show that walking around doesn’t shorten labor. Anyone want to help me out with sources?

    • Jocelyn

      Also, lack of benefits on skin to skin.

      • OldTimeRN

        On skin to skin I’d turn the question around and ask what are the benefits of skin to skin. The skin to skin educators, imo are the ones they want the change they they should be the ones providing the proof. The rest of us have years of evidence that lack of skin to skin does nothing to stale or reduce bonding. Why change what isn’t broken? Unless you have some evidence? Real evidence?

        • Cobalt

          Skin to skin was beneficial to me, as the mom, for anxiety reduction in the first hour post delivery, especially in the first minutes. I wanted to hold my babies ASAP. I was willing to wait until the doctor had a chance to do the first look over in case of major issues, but I was a mental mess until I could hold them and look them over myself. I also struggled with any separation in the first few hours.

          • Amy M

            Sure, I doubt anyone would argue that skin-on-skin is harmful, as long as everyone involved is healthy and doesn’t need any acute medical care. It’s just not necessary.

            I had my babies right before this fad became popular, and didn’t even hold them until a few hours after they were born. Eventually, we did some skin-to-skin, because in order to wake them enough so they would eat, we had to get them naked and I was trying to nurse them, so by default–skin-to-skin. But, after we left the hospital, I didn’t nurse them anymore, and it was January in New England, so they stayed dressed most of the time.
            We have a very normal and loving bond, despite all the layers of clothing that came between us in the early days.

          • Cobalt

            I’m certain our skin to skin time meant nothing to my babies other than warmth, and they liked being in the warmer just as much as me holding them (maybe more, who knows?). I just needed to look them over and have them very close in an anxious, biologically driven, non-rational way. The urgency of it faded with the hormones. We weren’t even skin to skin very long, I wanted them in a diaper and a blanket pretty quickly.

          • Becca McMahan Parrish

            This is not a b&w issue! You will not necessarily have a wonderful bond with your child forever if you do skin-to-skin contact, nor are you guaranteed distance and strife if you don’t. I believe there are benefits to holding your baby close and on your skin for many reasons that include many factors, but the biggest issue is the mother’s parenting style and feeling that she has done what she believes is right and beneficial for her little one. There is a lot to be said for feeling like you did what you thought was right (in a healthy, uncomplicated birth) and I think it will only help your confidence as a mother to follow a path that fits you and your lifestyle and certainly, in normal cases does absolutely no harm. Mother/child connections go much deeper than the clinical studies can explore and there is much to be said for mother’s intuition. I would think a mother of 4 would know this (Dr. Amy). Studies can be disproven and doctors can be JUST as biased as “natural birthers” as I have just discovered.

          • The Bofa on the Sofa

            This is not a b&w issue! You will not necessarily have a wonderful
            bond with your child forever if you do skin-to-skin contact, nor are you
            guaranteed distance and strife if you don’t.

            But it’s not a question of black and white, it’s a question of whether there is ANY correlation?

            Are mothers who have immediate skin-to-skin even more likely, in any way, to be bonded with their child? Or better bonded? Or are parents who don’t have skin-to-skin less likely at all to be bonded?

            No one has ever provided the slightest hint of any sort that it makes one lick of a difference to bonding or anything else substantive, like breastfeeding.

          • Sue

            And if it isn’t anything special, why even call it ”skin-to-skin”, rather than ”do you want to hold the baby before we wrap her up?”

          • Roadstergal

            That’s a good point. It’s like the conversation about being a ‘babywearer’ instead of just finding a way to carry the baby that works in a given circumstance.

          • KarenJj

            So then we can give women the option if they want it and not worry about it if they don’t? Seems ideal to me. LIke I said upthread I thought it was important prior to the birth of my first, but decided it wasn’t and didn’t bother with my second. Somehow I happen to love both kids and I don’t believe it’s worth a lot of angst. Which seems to be exactly what Dr Amy is saying in this post.

          • Becca McMahan Parrish

            I agree. That is the most level-headed thing I’ve read on here. This discussion has gone a little beyond the scope of this article. However, saying epidurals and breastfeeding are just ho-hum decisions to me seems very misleading. I just disagree with most of this post.

          • The Bofa on the Sofa

            Deciding on the color of the curtains in your dining room can be a momentous issue, too. I know my wife and I struggled over it for hours, comparing samples and everything. Doesn’t mean that, in the end, it isn’t meaningless or ho-hum decisions.

          • Sue

            Becca, the discussion has escalated in response to your posts. We don’t know who you are – only what you write.

          • Becca McMahan Parrish

            Yes I see this. I feel like the brake line was cut. Yikes. I do feel like I was thrown to the wolves a little bit here. I am simply someone who’s been indoctrinated in a childbirth class (not really being sarcastic there) and expecting a baby in less than 2 months. I do have a vested interest in these decisions and the outcomes they have. Seeking out different perspectives and even challenging them and listening to the response is part of the process of becoming informed.

          • fiftyfifty1

            ” and expecting a baby in less than 2 months. I do have a vested interest in these decisions and the outcomes they have.”

            This is where Dr. Tuteur is trying to help. Here you are, apparently about to be a first time mother, being told that how you perform on a bunch of meaningless metrics is going to lead to outcomes that matter to the health of you and your baby. That if you fail on these things, your baby will pay. These quacks are preying on your very understandable desire to do what’s right for your baby.

            So if all goes well for you in the upcoming months, and you do jump through all the bullshit hoops successfully, that is great. I know I speak for all of us when I wish you a lovely, easy, speedy, uncomplicated labor and delivery overflowing with health and joy. …..and if that isn’t what the cards have in store for you, we are here to tell you that none, absolutely none, of that extraneous shit matters, that you have not let down your baby one iota, and that we wish you and your new family all the best and trust you are a great mom.

          • Who?

            I’m really horrified to learn, secondhand, what seems to be taught at childbirth classes. Seriously, one person arrives, 2 people leave, ideally both at the same time and both as well as possible, must be the goal of anyone at all involved in caring for pregnant women.

            Epidural or don’t, breastfeed or don’t, skin to skin or don’t: none of that makes any meaningful longterm difference to your child. Hope for an easy delivery, but keep your mind open to the possibility that the journey might not be as you hope-this is one of those times when the destination is the point.

            Be well and be kind to yourself. Tying yourself in knots is not what makes you a good mother, despite what some would have you believe.

          • fiftyfifty1

            So you feel that epidurals and breastfeeding are not just “ho-hum” decisions where whatever a woman chooses is fine. That’s your position. Okay, then give us some evidence that how a woman chooses regarding these topics is important. Because to call these decisions important implies that the decision matters, and that a woman should override her personal preferences for some important reason. I am waiting.

          • AlisonCummins

            In what way is it misleading?

          • Who?

            They are important decisions, and it is important that accurate information is available. But breastfeeking v bottle and epidural v not is irrelevant to the longterm health and wellbeing of mother, child or family.

          • fiftyfifty1

            Okay, so let me see if I have this right. You don’t actually think skin-to-skin really is important for bonding, but you think it is good to let women think that it is, so that then when they do it they can have a boost of confidence because they did something “right”. And you don’t see a downside to this “in normal cases”. Okay then, so let’s talk about what happens in NOT normal cases. Like when a baby is in distress and needs resuscitation or mom has a PPH? Now mom feels like she HASN’T done what is right. How do you think this mom’s confidence level is?

            It’s uncool to pretend that things have benefits that they don’t, because moms take that crap seriously and feel bad if they don’t do what they were told was beneficial. Seriously uncool. And sorry, no amount of backpedaling about “well you tried your best honey don’t feel too bad about it, it’s not the most important thing” is going to fix it for moms who believe they have started out motherhood by failing.

          • Becca McMahan Parrish

            I do think it helps bonding, but never said you would never bond with your child if you didn’t do it. I bonded with my mom and she had C-sections with all of us. But if there’s a better way, why not try that? That’s why I said “it’s not a b&w issue.” It’s not a right and a wrong, it’s more like just picking the best option. The studies I’ve read (that of course support my beliefs, as do the ones you read and agree with support yours) also mention it raising the levels of oxytocin which not only facilitates bonding, but acts as a painkiller, which is nice, un-medicated birth or not. The baby being placed against the mother’s chest keeps the baby at an optimal temperature which is convenient when you don’t have an incubator around, which we didn’t. The baby getting a chance to breastfeed and have even a little bit of colostrum even if they are taken off to the nursery is only going to help their immune systems fight off any germs they’ll undoubtedly encounter along the way. The baby is surely going to benefit psychologically from being near it’s mother’s sounds, warmth and smells moments after being birthed/pulled from her body. I don’t really see how you could argue with that. I also am not militant about everyone doing this, which is why I said the mother has to make the choice that she’ll have peace about. I think babies can be totally healthy and have a good bond with parents even if this doesn’t occur, as I did with my mom after being pulled from her womb during a C-section. Saying this is not a momentous decision to me downplayed the importance of all the decisions we have to make as mothers. And yes, there is a lot of stress and pressure to do the “right thing.” Saying there are absolutely no benefits to avoid people feeling a bit of guilt is to me a reflection of a culture that avoids discomfort at all costs. I do not think I’m morally superior to my mother because she was not able to have skin-to-skin contact with me immediately…but sometimes I do wonder if all her “non-momentous” decisions (the C-section was elective) had been made a bit differently if it would have changed anything. No, she didn’t fail! ..but we both entered into our relationship drugged up and isolated from each other. Is that the ideal?

          • fiftyfifty1

            Your posts are long strings of unsupported assertions interrupted only by insinuations of danger (better get some drops of colostrum in you before what is bound to be a dangerous trip down the hall to the nursery!) And you use it to beat up other mothers in the most passive aggressive way possible.

          • Becca McMahan Parrish

            Wow, WOW! I am not beating anyone up here, simply saying I disagree with a post. The only aggression I sense is from you and it’s not passive. I thought it was a friendly debate. Is a hospital not where many sick people go? Is the word iatrogenic a “scare tactic?” Are germs of all kinds that are not in the mother’s everyday environment, including antibiotic-resistant ones not found in hospitals??

          • Amy Tuteur, MD

            What’s your basis for disagreement? It doesn’t comport with the natural childbirth lies and half truths that you prefer to believe?

          • Becca McMahan Parrish

            My basis for disagreement is my carefully constructed viewpoint based partially on half-truths (I’m discovering) being challenged and my impending due date to be honest. The things I’ve read on here have been good eye-openers and challenging to come to terms with, especially this far along in my pregnancy. I only wish they were delivered with a little less condescension. Maybe I brought it upon myself. Nonetheless, I will continue to read this blog for the sake of the process of informing myself. I don’t think one just suddenly reaches the end of learning and “arrives” at the destination of “knowing” one day… aaand I’ll breastfeed my baby because I think that’s why breasts fill with milk when you give birth and no formula is going to match what’s in them given a proper diet.

          • Who?

            Good luck with the breastfeeding.

            I’m not into natural remedies myself, and I have observed that where there are a lot of natural remedies, you will find a common problem. There are a lot of natural remedies for low milk supply, sore nipples, and all the other challenges of breastfeeding.

            Again, if the point is doing what’s best for baby, it may be that you end up supplementing or fully formula feeding, because the point is a fed baby.

            My experience of parenting is that the more I do it the less I ‘know’-it is a learning curve that never ends. I’ve developed a plethora of possible strategies though.

          • AmyH

            Hey there… I think I see where you’re coming from. I found this blog when I was pg with my first child, and certainly found the commenters quite agressive (woe to the woman who said she didn’t get an epidural because she had a high tolerance).

            I did the same… just kept reading to inform myself. I eventually decided that they were right and had their facts together about most stuff. Didn’t engage in the comments for a long time, though… Don’t stop reading!

            (And I actually like most of the commenters here now; don’t think I’m implying everyone is mean. But until you read for a while, I don’t think you really get the level of frustration against the leaders pushing some of the natural agenda.)

          • Becca McMahan Parrish

            oops, did not mean to downvote this; still learning all the buttons…

          • Life Tip

            Yes, the hospital is where people go when they are sick but it’s not like they typically let people with the flu go barf in the baby nursery. And if there is terrifying antibiotic resistant germs lurking in every corner, do you really think your colostrum is going to do a damn thing? I can’t even figure out what you are trying to argue here.

          • fiftyfifty1

            Far and away the #1 germ threat to a newborn are the germs from their mother’s own vagina e.g GBS, HSV, GC, anaerobes etc. The only place these infections can be prevented and/or treated is in a hospital setting. To make women believe that a hospital setting is an infection waiting to happen, when in reality it is the place that gives their babies far and away the best chance at an infection free start in life, yes is a scare tactic.

          • Who?

            I’m not sensing any aggression from either side. You seem to be painting yourself into a corner though.

            Skin-to-skin is good because if a mum believes it is and wants to do it, and does it, and everything else is otherwise normal, she feels she’s done the ‘right’ thing? We’re right back in AP world, parenting to suit parents’ needs in the guise of ‘doing what’s best for baby’.

            There are all sorts of germs everywhere. As others who know all about it point out, one of the idiocies of the anti-vax movement is complaining about the ‘assault’ on the immune system, which is nothing compared with what’s in the air and the world around us every day.

            Honestly, not every decision, not even most decisions we make as parents are momentous. In my experience, those that turn out to be the most life-changing are not the ones we expect-deciding to go here by car rather than there by train, and having an accident on the way for example.

            And pretending that the hour or two after birth is somehow more ‘special’ than the whole rest of a life, rather than just part of a long continuum, is just plain perverse.

          • AlisonCummins

            The word you’re looking for is ‘nosocomial.’

          • Becca McMahan Parrish

            I concede. I would like my money back from my childbirth class that didn’t even give me the right definition to the word “iatrogenic,” among other things. 🙁

          • Who?

            Did they ask for feedback? Would be interesting to know how they respond if you raised this with the provider. Getting basic medical terms right hardly seems a stretch.

          • fiftyfifty1

            Saying that skin-to-skin is not a momentous decision does not “downplay the importance of all the decisions we have to make as mothers.” Instead it helps us by allowing us to focus on the things that really ARE important, and lets us relax and enjoy surrounding all the choices that are nothing more (and nothing less) than personal preferences.

          • Amy Tuteur, MD

            The studies you’ve read?

            What peer reviewed scientific studies have you read in full (not merely the abstract)? I’m going to guess you’ve read ZERO studies in full.

            What qualifications do you have to evaluate the studies? Do you have a college degree? In what subject? Do you have advanced training in science and statistics? Do you have training in obstetrics or midwifery? Why do you consider yourself qualified to decide what the scientific evidence actually shows?

          • LJ

            But you’re not a urologist or sex scientist, yet you believe you’re qualified to give your opinion on circumcision. It’s funny how a few years ago, you were rabidly calling mothers who keep their babies intact (ie everyone except a third of Americans and most Israelis) “foreskin fetishists”, and now you see that people were unhappy with that you’ve changed your tune to “it doesn’t matter”.

          • Life Tip

            First of all, intelligent people don’t just read articles that support their pre-conceived belief. Babies can get a few drops of colostrum right away or after they’ve been cleaned up/weighed/etc. No real difference there. And it’s not like the other option besides skin to skin is putting the baby naked on the cold tile floor. Most modern hospitals have the means for drying the baby off and keeping their body temperature optimal. And no, the baby isn’t “surely” going to benefit from his mother’s smells. What reason do you have to think that? Does the baby smell his mother in utero?

            Do you really think the circumstances around your birth influence your relationship with your mom today? How so? Do you think you are better bonded with your child than I am to mine, because of your ideal birth experience? There are real implications to your assertions.

          • Cobalt

            Wait, oxytocin is a painkiller now? I always thought it was the stuff responsible for contractions and afterpains, which are the reasons women choose epidurals, narcotics, and NSAIDS during and after labor and delivery. If oxytocin is such a fantastic painkiller, why is pitocin induction anecdotally known as more painful?

          • araikwao

            Yeah, oxytocin is a uterotonic, which post-partum, is REALLY PAINFUL (sorry for shouting, I still remember the beastly after-pains nearly 2 yrs later)

          • Life Tip

            You say a lot about what you believe and feel, which is nice for you but has nothing to support it. You also claim that mother/child connections go much deeper than clinical studies. Ok, then how come such a deep connection is apparently so fragile it might be shattered by a tiny separation that only the mother has the capacity to realize/remember?

            If you (or anyone) wants skin-to-skin, and there is no medical concern, then fine. But pretending that it is anything more than a preference is damaging to mothers. Why? Well actually, for many of the reasons you state yourself. Most moms want to do what they feel is right and beneficial for their little one. Most moms feel more confident when they are able to do things they want to do. Imagine you’ve been lied to throughout your pregnancy, and you give birth believing that skin to skin immediately makes any difference whatsoever in your baby’s ability to bond with you. Now, imagine there are complications and you are unable to hold her new baby for 3-4 hours. How would you feel? Pretty shitty, no? Even with an understanding that the medical intervention was necessary, you would still have spent the first few hours of your child’s life feeling like you did not give them the best. Then you might spend some time afterward concerned about your baby’s ability to bond. How’s that for confidence?

            It is a serious problem to pretend something has benefits when it doesn’t. It’s not just simply a matter of something feeling or seeming nice, and it can’t hurt. Lying or misleading women about the benefits of something just so you can feel special or superior is damaging to women.

          • Becca McMahan Parrish

            I didn’t say the connection would be shattered if skin-to-skin didn’t occur!! I simply think it is better than not doing it. Better–not right vs. wrong. I state why I think it’s better in a comment below. If a complication had occurred where my baby needed medical intervention, I would have gladly handed her over to medical professionals and been thankful for technology, not been under the false impression I’d “failed.” Yes, I had my ideal birth pictured, but also had the sense to realize that not everything was in my hands and being adaptable would only serve to give my baby the best.

          • KarenJJ

            Better for your circumstances. Other women might differ in their opinion.

            ” Yes, I had my ideal birth pictured, but also had the sense to realize that not everything was in my hands and being adaptable would only serve to give my baby the best.”

            So you have no idea how it *actually* feels for other women. Other women that presumably have less ‘sense’ then you do.

          • fiftyfifty1

            “This is not a b&w issue!”

            Exactly! Skin-to-skin is more of a orange and purple issue. As in “I like the color orange” vs. “I prefer purple”. Luckily BOTH choices are great because neither choice matters and it is nothing more than a matter of personal taste!

          • Life Tip

            The problems with admitting that it simply is a personal preference are 1. No one else cares so you can’t brag about it 2. You aren’t superior to other mothers for having done it.

            And it looks like that makes certain people a little upset.

          • The Bofa on the Sofa

            The best pizza toppings are Canadian bacon and sauerkraut. Anyone who doesn’t like Canadian bacon and sauerkraut on their pizza*** just has no taste, but that’s probably because their uneducated, and haven’t tried it.

            Now, we know how important it is to choose the right toppings for a pizza. Just look at how hard it is to do it when you have a large group. It’s pretty insulting to suggest that a decision that takes so much effort and causes so much dispute among people involved can is ultimately meaningless.

            And if Canadian bacon/sauerkraut is available, there’s really not even a decision to make, just get it. If it’s not available, check to see if they serve something like Reubens or bratwurst, because if they do, they will have kraut around that they can add.

            I pity the poor saps who don’t get Canadian bacon and sauerkraut on their pizza. Those who think that ham and pineapple is “exotic,” Bless their heart.

            ***ham and sauerkraut is an acceptable alternative, and some people will go with corned beef and kraut, which is also good.

          • sdsures

            I was born at 28 weeks’ gestation, and was halfway out by the time Mom and Dad got to the hospital. I know they got to touch and hold me in the NICU (Polaroids!), but I would hazard a guess that the doctors and nurses were more concerned with making sure I was kept alive than immediate skin-to-skin.

          • toni

            I can’t even remember if I had skin to skin with my son, really no idea. They placed him on me within seconds of him being born so obviously he was naked but I was wearing a gown. Then they took him away to clean up, get shots etc and brought him back to breastfeed but I’m not sure if he was swaddled or still in the buff. The hospital was going for baby friendly status so maybe he was. his face and my boob got skin to skin at the very least. Wasn’t something I was concerned about at all. I was eager to hold him but didnt even think about clothing disrupting things. He spent the rest of his stay with a hat and onesie with mittens on and we’ve always been plenty bonded, he’s my little barnacle!

          • Ash

            It seems like the main thing here is not skin to skin, but rather assessments at the bedside when possible, correct? For example, if you wanted to hold a swaddled baby, isn’t that the same thing?

          • Cobalt

            Pretty much. It was the proximity that really was comforting to me, not them being naked ON me. I wanted to see them naked briefly, just for visual reassurance, but a blanket and a diaper felt right for very practical reasons immediately after that.

        • Trixie

          I liked skin to skin a lot.

        • Julia

          I loved immediate skin to skin – I was so excited to finally see my baby! So, yes, it was great, but I guess the benefits were mostly for myself (and for our families abroad who wanted pictures *immediately*)

        • Sue

          The ”skin to skin immediately” brigade seem to neglect the physical intimacy that takes place for the subsequent YEARS, every day. The idea that the first few moments in a newly hatched life can make any difference is totally implausible.

        • CrownedMedwife

          Obstetric practices are ever changing. Just a few decades ago, many babies went to the NBN for observation, measurements and physical exam. That practice subsided and babies began to routinely stay in the room with an immediate exam under a radiant warmer, then wrapped and handed to parents. Most recently, it has become routine for babies to be placed skin to skin with parents during the recovery period and a full physical exam done after the first hour or two. If it’s a practice many parents request, why not honor it? The overwhelming majority of new mothers are anxious to meet and cuddle their long awaited baby. If it provides adequate thermoregulation, an opportunity to initiate feeding and new mothers desire it, why shouldn’t skin to skin be incorporated as routine NB care? It doesn’t need to be, nor should it be, presented as a critical component of bonding or breastfeeding.

          Just 40 years ago, it became a big deal to have fathers present during Labor and Delivery. There isn’t any evidence that fathers can fix a Cat II tracing or rotate a persistent OP position, but the majority of mothers want their partners present and that’s enough reason.

          We do a disservice to expectant mothers by presenting skin to skin as critical to bonding or breastfeeding, but it doesn’t mean we need evidence to support its practice as an opportunity for new mothers to meet and hold their babies.

          • moto_librarian

            This is exactly the right attitude about it. I did not have skin-to-skin with either of my children, although they did place our eldest son directly on my chest immediately (I remember the sensation of his cord pulsing). They took him when he decided to poop all over me, and then we didn’t see each other again until the next morning due to my complications and his admission to the NICU. Our second passed mec during labor, and he went into severe distress during the actual delivery. His cord was cut immediately and he was handed to the NICU team. The minutes we waited to hear him cry were the longest of my life, and I was grateful to have him in my arms within 20 minutes, swaddled and hatted.

            Do I sometimes wish we could have had skin-to-skin? Yes, but you don’t always get what you want, and our collective health was most important.

        • Jenk

          Skin to skin helps babies regulate their temperature and it’s good for moms to have their babies immediately. Having a hospital policy in place that all babies go skin to skin at birth and remain there for the first hour does a lot to cut down on providers bringing the baby to to warmer to perform tasks. Some nurses like to get their work done efficiently: weight, measurements, gestational assessment, meds, and vitals, and do so at the expense of the parents meeting their babies right away. None of these tasks are necessary immediately after birth.

          • Bombshellrisa

            Someone Here was a victim of that policy-her meconium covered baby was placed skin to skin for the minimum amount of hours and the whole time she was asking if someone could please clean the baby up. It was the policy and they would not break policy.
            Home birth midwives don’t do assessments right away, they value the parents meeting the babies right away as opposed to giving correct and timely APGARs.

          • AlisonCummins

            What do you mean exactly by ‘good for mothers’?

          • Jenk

            I mean it’s good for mothers to have the experience of meeting and holding their babies immediately. Most mothers desire this and it should be respected. If the baby needs medical attention, they should obviously go to the rescusitation cart, but if not, there’s no reason to delay the first meeting by routine procedures.

          • AlisonCummins

            So ‘it’s good for mothers’ is better phrased as ‘most mothers like it.’

            The problem with your phrasing is that it implies that it should be imposed on all mothers whether they want it or not because ‘it’s good for them.’ If the issue is just that they like it, then the mothers who want it should probably get it and the ones who don’t, shouldn’t. It would be *bad* for the mothers who don’t want it.

          • Jenk

            If mom doesn’t want to hold the baby, the family can. Making it a hospital policy changes the way nurses provide care during newborn transition to be more family focused. The scene changes from a baby under the warmer to a baby held by mom or family. It’s a positive change, not something imposed on people. I did not mean to imply moms who didn’t do it were bad. Our hospital recently made this change and mothers and their families are very happy with it.

            So, fine, most mothers like it.

          • F.N.

            You’re conflating the universal desire to see/meet/hold, if possible, the baby, as soon as possible, with your philosophical belief that mother and baby ought to be naked when this happens. I’m not comfortable putting the top of my gown down just to satisfy the personal cultural beliefs of hospital staff, which I do not share, and others have shared that they were not comfortable being left to soak in bodily fluids and excrement in order to perform this ritual. (I also wonder exactly how well thermoregulation is supposed to work when you’re both exposed to the air and wet.) There’s a lot of daylight between holding the baby as soon as possible and dogmatically refusing to so much as clean it up. That obviously has nothing whatever to do with what mothers actually want. Something unscientific and culturally weird is definitely going on if nurses are being convinced that for moms and babies, unique among all patients, wet and dirty is actually the optimal state. In any other setting, refusing to remove excrement from a patient’s skin, provided you have the time and access to do it, would be instantly recognized as abuse. As would requiring a specific state of undress, not for access or safety, but for cultural/philosophical reasons.

          • Cobalt

            It was very very good for me do so. A friend of mine who I sat with for the delivery of one of her babies was completely baffled and almost dropped him when the doctor, in one fluid motion, caught him and swung him up onto her chest. She was of the “let’s get everyone washed and dressed first” mindset. Different moms have different preferences.

          • F.N.

            I’m boggling at the assertion that vital signs aren’t necessary immediately after birth.

          • Jenk

            Vital signs are routinely done at 30 minutes of life and can be done while mom holds the baby. Prior to this, the nurse is watching the breathing and color, but not necessarily counting and charting it.

          • NICU-RN

            Really? Than how are APGARs being assigned without a heart rate and assessment of respirations?

          • Jenk

            The APGAR score is done on mom’s chest if baby is stable. Taking a set of vital signs (resp rate, heart rate and temp) is not done at 1 and 5 minutes of life.

          • Dr Kitty

            Are you saying APGARS are based on guesstimates of heart rate?

          • Jenk

            Are you saying I need to listen for a full minute to know it’s above 100?

          • birthbuddy

            Jenk, you just don’t get it, do you?

          • Jenk

            What’s that supposed to mean? I’m sure I get it. We are having a group discussion and I’m sharing my point of view as someone who works in the field and does this every day.

          • AlisonCummins

            So you’re saying that skin-to-skin isn’t actually necessary, it’s just that touting it is a good way to keep babies out of the warmer and to prevent efficient care.

            What’s wrong with the warmer? What’s wrong with efficient care? It seems to me that if a newborn can be looked after quickly, then nurses and staff don’t have to hover over it and the mother as much and can leave them in peace.

        • KarenJj

          I did skin to skin in the operating theatre after my first was born, but it was a bit awkward and messy and I didn’t feel like I got enormous benefits from it. I didn’t bother requesting it with my second.

          Instead we got some lovely cuddles together afterwards during our hospital stay that I treasured even more due to knowing I’d be dealing with both bub and toddler when I got home.

        • F.N.

          The phrase “skin-to-skin” bothers me. I am far from prude but the way advocates talk it up makes me feel like I am expected to use my disrobed body to act out a “natural woman” role based on somebody else’s faux-primitivist ideals. Tales of women sitting naked in pools of their own blood, or made to handle a meconium-covered baby and refused help cleaning him, do nothing to reassure me. I am so glad this was not pressed on me when I had my child. I would have reacted quite badly, especially since I had complications and a c-section and was really out of it at the moment of birth. To apply a naked baby to the chest of a person in the distressed state I was in (with my arms still strapped down like Jesus on the cross? seriously?) would seem quite impersonal and objectifying. Perhaps I’m to sensitive on this point but given that warmers and blankets work perfectly well for healthy babies in equipped modern hospitals, insisting that the mother use her own skin seems to come from cultural motivations, and I’ll be damned if I bare my skin to satisfy somebody else’s cultural beliefs about motherhood and womanhood.

          • The Bofa on the Sofa

            Yeah, why does it have to be skin-to-skin? Can’t it be “cuddle baby while dressed with a properly adjusted heating pad over them?”

            When I held my younger guy for 45 minutes after he was born, did it not count because it wasn’t skin-to-skin? It’s not like he was cold.

            (my older guy was cold, and, in fact, spent a lot of time under the heat lamp to increase his body temp, because cuddling wasn’t doing it)

      • araikwao

        It feels lovely, I think, and to me that was enough. But, as per CanDoc below, I believe it does have benefits for the smaller/more fragile infants born in resource-poor settings.

    • Karen in SC

      where is the evidence that shows it does?

  • Julia

    And what about “hatting”?

    • araikwao

      Obviously it is the devil’s work.

      • Bombshellrisa

        My son would agree-the video of him seconds after he was born shows him clearly putting his hand on the cap and pulling it off multiple times. The nurses thought it was adorable.

        • DiomedesV

          My kid couldn’t stand the hat. She kept pulling it off! Then the nurses would come in and put it right back on and imply that it was essential. I couldn’t believe that she actually needed it so I left it off whenever I could.

          • Mishimoo

            I was worried about them losing warmth too easily, especially my first because she was all of 6lb, 3oz. Her hat kept disappearing because she insisted on taking it off.

          • Amy M

            My twins are identical, so we were worried we wouldn’t be able to tell them apart when they were first born—the hats acted as labels. In the hospital, they actually labeled the hats A and B with a sharpie, and at home, we put solids on one baby and patterns on the other. It turned out we always knew who was who, but the labeling helped other people, and in pictures, we can tell.

          • Sue

            If the newborn is strong enough to pull off their hat, their body temperature is probably just fine.

          • Mishimoo

            That was what I thought, but the nurses were slightly concerned about their temp, so I was worried and followed their directions.

          • Young CC Prof

            My tiny newborn kept shrugging out of his hat and his shirt, because they were enormous. And then the nurse is like, “You need to keep a shirt on him, he’s going to get cold,” and I’m like, “It would help if I had a shirt that wasn’t designed for a baby three times his size.”

          • Mishimoo

            Awwww little escape artist!

          • DiomedesV

            Interesting, my kid was in that ballpark, too. Maybe next time I’ll stand my ground and we can have our first power struggle!

    • Cobalt

      I think newborns are cuter with the little hats than without, so I’d say hatting improves bonding.

      • Julia

        Definitely in the case of my little conehead 😉

        • Jocelyn

          I had a conehead. My mom tells me she cried and told little baby me she would protect me from all the people that would make fun of me, lol.

          • The Bofa on the Sofa

            Just tell people you are from France. #pcmcredit

      • MLE

        Agree, it’s way to easy to focus on the conehead without a hat.

        • moto_librarian

          My husband still believes that the purpose of hatting newborns is to prevent the fathers from freaking out about coneheads. He thought something was wrong with our eldest, lol.

        • me

          None of mine had the conehead (aparently you could drive a semi thru my hips)…. but they still looked cuter with the little hats on.

    • Mishimoo

      Two of mine hated it, whereas the third would not sleep without his hat. He even took a dummy (pacifier)!

      • Sue

        Hat haters!

        • Mishimoo

          They loved chatting and patting! My babies are definitely unnatural 😉

    • Sue

      Hatting also has the auxilliary purpose of keeping knitters busy. There are already too many booties.

  • Allie P

    One issue that I keep running into with my friends who have chosen “natural” childbirth is that their choices are, they believe, morally superior to mine. I honestly don’t care if they get pain relief in labor or not, the same way I don’t care whether they order chicken or salad at a restaurant. But it’s impossible to even discuss it because the sole reason they made the choice is because they think it’s morally superior. They can’t “not care” in the same way I don’t. Whether spoken or unspoken, there’s a “I could never do that to my kids” element.

    • Guesteleh

      I think you need new friends.

  • Gretta

    They are important because they are easy to understand. Anyone can read about any of those, understand them, form an opinion on them, and feel somehow good about themselves…. feel researched…. feel special. They are simple…. easy…. marketable.

    • Gretta

      Let me clarify…. “important”.

  • anonymous

    Cue the intactivists in 3…2..1…

    • just me

      I had 2 girls so didn’t have to deal with this. But I would have circumcised due to risk of infection, Looking like dad, etc. To each their own, but I have read some people saying things like “I won’t make that decision for him. He cN decide later” But, um, isn’t it really too late if not done at birth? And I could imagine some of these kids thinking, gee thanks for leaving me intact.

      • KarenJJ

        My understanding is that recovery is a bit tougher but you can perform it on adults. My FIL’s cousin was an anaethetist in the Vietnam War and it was one of their surprisingly common procedures – it’s hard to keep clean in the jungle.

        • baileylamb

          Yep happened to my uncle… Who then went AWOL because he was upset about it… Long horrible story. I heard they have to do it in the ME as well.

  • lauren

    I’m just a stupid mom who has had six kids, but with every one of my labors I had to be standing or moving or else my contractions stall completely. I have found I can take a nap at 7cm and then stand up and get right back to the task at hand. Might not fit the textbooks, but if I’m not moving, labor will not progress.

    • fiftyfifty1

      Sounds terrific. So you never have to labor at night or any other inconvenient time. You just lie down and it stops until it fits better in your schedule. That must be useful when you have a big family. I wish I could give your superpower to all women! Instead, large studies show that for typical women, labor is prolonged only by mintues by lying down.

      • lauren

        I sincerely did not realize this was such a rare phenomena as you so aptly jest. I only shared because my assumption in life is that if I experience something, I am probably not the only one. It is no convenience or superpower to have labor stop and go dependent on my movement.

        • fiftyfifty1

          ” It is no convenience or superpower to have labor stop and go dependent on my movement.”
          Why not? You literally never have to labor at night. Or when nobody is around to drive you to the hospital. Don’t you find that convenient?

          • megamechameg

            Ooh. And if you find labor overwhelming you can give yourself a break. I have heard one too many birth stories where the women involved describe the pain as managable but relentless. Not gonna lie, super jealous.

      • Therese

        So what about bedrest for preterm labor? If movement has nothing to do with contractions, why is bedrest prescribed for preterm labor?

        • Amy M

          I think because they figure it can’t hurt, might help. That’s how it was presented to me anyway, when I was put on bedrest for preterm labor. Also, being upright allowed more pressure on the cervix, maybe?

          • DiomedesV

            The problem is that bedrest can have negative consequences. If mom has a job, or has other children to care for, bedrest is more than just inconvenient. Also, people lose bone mass and strength if they lie in bed too much. I think you start to lose bone mass after about 3 days. If it doesn’t actually prevent preterm labor, and mom makes it as far as she can anyway but is then in worse shape to care for a baby, then it may really not be a good thing.

            I’m assuming that if I were prescribed bed rest I would do it, too. But I’d be pretty angry about it for all of the above reasons.

          • Amy M

            I spent 3 weeks on “modified” bed rest at home (I was allowed to be up and walk around, but not allowed to go to work, or travel anywhere unnecessary.) Then, four more weeks of bed rest in the hospital–I was allowed to get out of bed, but not allowed to leave my room unless in a wheelchair.

            Luckily, my job gave me short and long term disability pay and I was pregnant with my only children. It was boring, and scary at times (when the babies made breaks for freedom) and ultimately, they sent me home, still (34wk) pregnant because things were stable. Babies held out for another 2wks. Anyway, why they didn’t come at 30 or 32 weeks like they tried? No idea. Could the tocolytics have helped? Maybe. The bedrest? Maybe. Just plain luck? Maybe that too. I’m pretty sure my doctor wanted me in the hospital so if labor didn’t stop, the babies could go to NICU asap and have the best chance at full brain function.

        • RNMomma

          It’s my understanding that data doesn’t really show it helps, but it would be unethical not to suggest something, I suppose.

        • fiftyfifty1

          Great question, it’s an area of controversy because none of the studies we have show it helps. It is my understanding that ACOG has even issued guidelines stating as much, but that this is an area where individual practices have not changed quickly because as of now there isn’t much else to offer. If there were a good and reliable way of preventing preterm births, it would be abandoned in an instant.

        • Sue

          Bed rest is still recommended for various things in which is has no benefit. First trimester miscarriage is one of them. The fetus will only ”fall out” if the pregnancy has already failed. If it remains viable, walking around wont make it fail.

    • Bombshellrisa

      So the contractions stop or you can’t feel them?

    • Cobalt

      I’ve slept (unmedicated) through transition with one of mine. I didn’t feel any contractions, and they were smaller and way spaced out on the monitor while I slept. It happens, it’s just rare.

      • RNMomma

        A hot shower during active labor (not transition) made me so sleepy I went and took a nap with my husband. It was one of the best parts of my labor next to the dose of Nubain I got a few hours later.

    • S

      I believe it. Probably something that’s peculiar to you though.

      With my first kid, early labor, i only had good strong contractions when lying down. Standing and walking gave me this constant vague, crampy pain that didn’t feel like contractions. Fine with me! I watched television and lay in the tub.

  • Amy M

    The one that really bugs me is the “immediate skin-to-skin/breastfeed” thing. These jerks have a whole lot of new mothers convinced that if this doesn’t happen, baby will never bond with mother, like a duckling that was hatched in a litter of puppies. That’s just mean! As far as the mothers go, really if they just stopped to think for a minute, they could see that that is ridiculous and that of course bonds are formed over time, with anyone who makes the effort. But, I can understand how new mothers, afraid and in emotional turmoil, no thanks to the constant messages of what failures they will be unless they can live up to some impossible standard, can’t stop to think. The biggest weapon of the NCB crowd is fear-mongering, which they attribute to anyone who attempts to mention facts.

    • The Bofa on the Sofa

      Our LC, who is in general been pretty good, has been off on the “importance of immediate skin-to-skin” and has my wife now lamenting it. I told her, yeah, I can understand why you would have liked it, but where is the importance in terms of bonding? It’s not like she and the kids don’t have a great bond, so it didn’t seem to cause a problem there. In fact, our younger guy is even more of a mommy’s boy than the older guy (who is more of a daddy’s boy), despite the fact that, when he was born, his first hour was actually spent with me, by ourselves, in the post-partum room, because there was no room in the nursery for his baby checkup.

      Yet, he’s mommy’s boy and is the one who took to breastfeeding better.

      This skin-to-skin is, in terms of a term baby, is so insignificant. I have no problem saying yeah, it would be nice to do it, but important? Not at all.

      • Roadstergal

        It’s like one of the comments yesterday – if you can worry about these things, it’s a sign everything went very well indeed.

      • Sue

        I love those stories about Dads who get to hold the newborn and spend time with them first – it’s a magical time. Mothers generally don’t have a shortage of ”bonding”activities over a child’s life – why not let fathers have as many as they can for themselves?

    • Mel

      If I had had immediate skin-to-skin contact and breast-feeding, I’d be dead. Suspect that would have lead to less bonding, but hey, I could be wrong…..

    • Mel

      Plus, they have the bonding shit backward. The bonding is that the MOM attaches to the BABY in most mammalian systems – cattle, sheep, some monkeys etc.

      Yes, sheep and goats have a short window triggered by the scent of an amniotic fluid covered baby. After a few hours, they have no interest in babies that don’t smell like theirs.

      On the flip side, we have cats that “borrow” kittens. One barn cat gave birth to 4 kittens. Two weeks later, she had 6. Somewhere, she had found 2 younger kittens and brought them back to her nest and raised them. We have dairy cows that “collect” calves. They tend to be older cows who are near term. When a calf is born to another cow or heifer, that cow takes the baby, cleans it and tries to get it to nurse on her.

      Which of these sounds closer to human behavior? Put an adult who is comfortable around babies by a crying infant and see which happens. I know where I’d put my money…..

    • Sara Lucy

      My hospital does this now and I was thinking “Oh cool, yeah, sounds good.” And I did it. So for the prescribed 2 hours I was lying in a pool of blood and awkwardly trying to position myself to breastfeed.

      At the time I thought “I HAVE TO do this for the good of the baby.” I’m an idiot. I should have just told my nurse I was miserable and wanted to get cleaned up first.

      • Cobalt

        They should have offered to at least do a wipe down and change the pads while you held the baby or reassure you that someone else holding baby for 5 minutes was completely fine. They can do a basic clean up very quickly, and sitting in the leftovers is unpleasant at best.

        • Sarah

          Absolutely. I was able to give my daughter a cuddle and feed as soon as they’d finished stitching, which is what I wanted to do, and didn’t stand up for about 4 hours after delivering her. I was cleaned up and had my pad changed a couple of times during this period. There’s no reason why it has to be either/or.

        • Sara Lucy

          I think my nurse was kind of inexperienced and just forgot. I didn’t think to ask, because it didn’t bother me at first and the time seemed to fly by. I just remember her finally asking me “are you comfortable like that?” and I realized no, I was very uncomfortable.

  • kodiaksable

    Thank you for this. I love it.

  • CanDoc

    Thanks for the well-considered post, as always. Although I agree in principle with the spirit and most of the data, I would suggest subtle professional disagreement on the following issues:
    1) For infants at risk of iron-deficiency anemia (anemic mom, low SES, anticipate extended breastfeeding), there is most certainly a (slight) improvement in iron stores and (slight) decrease in risk of iron-deficiency anemia and 6 and 9 months of age with delayed cord clamping. This may important on a population level given iron deficiency as a contributor to mild developmental. (And of course, NOT appropriate for infants already polycythemic secondary to IUGR, maternal diabetes, etc… or if they’re flat.)
    2) Skin to skin has the small benefit that it improves thermal regulation (most prominently in low-resource settings) and slightly decreases NICU admissions for TTNB.
    3) Circumcision is an elective surgical procedure and I would agree with some of my international counterparts (although not especially fervently) that from an ethical standpoint it should generally be performed once a child is of an age to provide consent.
    Thanks for all your hard work!

    • CanDoc

      I meant “mild developmental delay”, that is, in point 1.
      Clearly my cord was clamped immediately.

    • The Computer Ate My Nym

      I agree.

      Delayed cord clamping has risks and benefits. OTOH, the only one that is likely to be particularly monumental in the long run is whether or not you banked the baby’s cord blood for possible transplant (to the baby or someone else) later on. So on the whole I’d advocate not delaying clamping but rather harvesting the cord blood, all else being equal (i.e. not a preemie, not an anemic mom, etc).

      I see no reason that the decision to take or leave circumcision can’t be left to the person whose body it is. (There’s a joke in here somewhere about it being no foreskin off anyone else whether he decides to accept or not, but I’m not quite getting it.)

      • Young CC Prof

        Ugh, private cord banking. I really think they’re the reason public banking is so inconvenient, rather than an easy checkbox choice. I wanted to donate my son’s cord blood, but was baffled by the logistics.

        • Dinolindor

          I wanted to donate the cord blood from both of my babies, especially because they are the product of 2 mixed race parents and it is very difficult to find matches of virtually anything for mixed race people. I filled out something like 20 pages of family history, and then because my daughter was born on a Saturday they said they couldn’t collect the cord blood. They had no way to store it properly until pick up on Monday. I was pretty annoyed by that.

        • The Computer Ate My Nym

          Private cord banking is a mess: not just ethically dubious but they don’t do it right. A study of quality of cord blood a few years ago basically showed that very little of the privately banked CB was usable whereas most of the publically banked blood was. Though I would like to see people be able to reserve the CB in cases where there is a genuinely high risk of the baby needing it later (i.e. known mutation with high risk of leukemia.)

          • Young CC Prof

            Actually, in that case, the child’s own cord blood is unlikely to be useful, since it’s got the same bad genes.

            A sibling without that gene, on the other hand, THAT cord blood would be worth having. As I understand it, a substantial number of children have been saved by a sibling’s cord blood, but last I heard no child has ever been treated with his or her own cord blood.

            It could be useful for adult cancer and other diseases, but for adults, one dose of cord blood isn’t enough.

        • Bugsy

          My husband was working for a blood bank when our little guy was born, and we were able to donate it. It turns out that our sample didn’t have enough blood in it to be stored, unfortunately. I can’t help but wonder how many private blood banks wouldn’t have been honest with it while gladly taking our money…

        • CanDoc

          We’ll have a national cord blood bank here in canada, if all goes well, in about 10 years. 🙂

        • Are you nuts

          Agreed. I gave up on public. Everything I read about private made it seem like a scam.

      • baileylamb

        Well the problem with circumcision is that in general it is a lot cheaper for an infant compared to a toddler or an adult. Unless you get it free from Uncle Sam like my uncle did… Also infants aren’t good at risk evaluation.

        • The Computer Ate My Nym

          So why not wait until adulthood? In western countries with good access to HIV prevention, it’s essentially a body modification (except in rare cases). Why not wait until the person is old enough to decide whether they want or don’t want the procedure for themselves. It might cost more per patient but since not every man will decide to get it, it won’t cost that much more on a societal basis.

          • baileylamb

            100 percent of the men on my mom’s side of the family (including my grandpa) had to be circumcised before they were 6 years old. Oh except for the my uncle who had it done at 18 thanks to Uncle Sam. No drama with that (snark). That’s why I did not wait till my son was older. Looking back we made the right decision, there is little doubt that my son would have made it to 3 without issue. Again different strokes for different folks. Edit to add: My point is sometimes it is about health.

          • Cobalt

            If you know ahead of time that your child is highly likely to have a certain condition, and that preventative treatment is safe, available, reliable, easier by far than reactive treatment, and the consequences of the preventative treatment are generally negligible, you probably have a really easy choice to make. Anyone who would argue against it is just ridiculous.

          • Guestll

            I tread lightly into these waters because while I am not militantly opposed, I am not at all in favour of RIC in developed countries. It just isn’t done in my family or my husband’s, and it’s no longer routine in my region, plus bodily autonomy yadda. With that said, I really appreciate the measured, reasoned approached in these comments. Too often, these discussions degenerate into veritable shitstorms, with heavy feces precip from both sides of the equation.

        • Cobalt

          I think the recovery is easier the younger it’s done, as the foreskin develops it becomes fussier to remove.

          • mnf123

            How would you know that recovery is easier in an infant? You can’t ask them.

          • Cobalt

            The procedure itself is easier and less involved and healing time is shorter. Infants may not be very articulate, but they certainly can communicate discomfort. Infants display less discomfort, and for less time, than adults after circumcision.

      • Guesteleh

        What are the origins of intactivism? I wonder because while my sexual partners have included circumcised and uncircumcised men, I’ve never met a man who wasn’t 100% in love with his own penis and didn’t derive tremendous satisfaction in using it regardless of whether or not he still had a foreskin. It seems like the whole civil rights/bodily autonomy movement sprang up out of thin air.

        • Cobalt

          True that!

        • Bugsy

          I think that it was activists looking for the next cause with a catchy ring to it; lactivism alone wasn’t enough. I refuse to debate anything hiding within my son’s diaper, but I have to admit that “intactivism” has a very amusing ring to it.

      • CanDoc

        Interestingly, it’s no an either/or for DCC and banking. A baby only gets 10-15 cc of blood from delayed clamping (which is, actually, a lot of a baby but still a VERY small volume overall), whereas the banked sample usually has approx 75-200 cc.

    • Roadstergal

      Meh. I don’t think it’s unethical in a general sense. I’m not religious and have no feeling that
      we were at all intelligently designed, so I have no respect for a
      superfluous flap of skin, any more than I do for the appendix. (Or for my long-gone tonsils.)

      All of the good studies
      that I’ve seen show none of the long-term penile and sexual harm that
      I’ve heard claimed by intactivists (provided it’s done by professionals
      in a hospital), so it’s pretty low-risk as far as mildly helpful
      interventions go. I just don’t think there’s any reason to load up parents with guilt about being unethical/abusive if they make a rational risk/benefit decision to allow a minor procedure with no real long-term ills and moderate but real long-term positives. If this particular flap of skin weren’t attached to the penis – if we were, hypothetically, discussing a minor procedure to remove a flap of skin that partially covered the anus and removal at birth conferred minor health benefits – I don’t think the discussion would be so loaded. That’s the bit that annoys me the most, I think.

      A most excellent list, overall. Although now I keep feeling like “clamping my cord” should be a euphemism.

    • araikwao

      I would add to your list that the universal application of eye ointment is not that useful, but I have no stats. I’m awake and reading this because of pre -exam anxiety, but I’m not going to risk any information falling out of my head by looking up the NNT. which is not relevant to my exams here because we don’t use routine eye ointment in Australia. think was in the realm of 70. Maybe. Eek, sorry for the blather, I’m rather stressed!

  • Bugsy

    6. Vitamin K

    7. Ophthamic eye ointment:

    Two comments: We sure were glad our son had his Vit K shot when his umbilical cord peeled off 6 days after he was born – we saw more of his blood than we wanted to even with the shot. So thankful he had it.

    We interviewed a doula who informed us that there was zero purpose to the eye ointment, that it was simply Vaseline.

    Safe to say that we didn’t hire her services.

    • The Bofa on the Sofa

      For pete’s sake, I’ve used that ophthalmic eye treatment myself!

      I had an eye infection a couple of years ago and had to put a strip of that gunk on my eye every day. It was freaky, but it’s NOT Vaseline. Don’t put Vaseline in your eye.

      • Cobalt

        Erythromycin is good stuff!

        • Dr Kitty

          Not for me.
          I got Stevens-Johnson Syndrome which meant painful sores in my mouth and being unable to eat or speak for 10 days (and being really very unwell) the one time I took it.
          But that is a one in a million reaction, and I happily prescribe it to other people.

          My body, as well as deciding that normal spines are for suckers, apparently thinks antibiotics are poison- I’ve had life threatening reactions to three major classes now.

          • Cobalt

            Yikes! Antibiotics are an especially scary allergy.

        • FormerPhysicist

          I’m pretty sure I’m allergic to it. Last time my kid gave me pink-eye, the dr gave me ointment. It burned way worse than the pink-eye, my eye swelled up and life was unhappy for a while. It stopped when I stopped the eye ointment.

          From now on, I’m going to insist on a culture before I take anything. I assume that can be done – tell if it’s viral or bacterial.

      • Amy M

        Yeah, and breast milk in the eyes is pointless too—I asked Dr. Beneroch of Pediatric Insider, and he obligingly did the research. Cause you know the same loonies who have a problem with newborn “eye goop” in the hospital, go around squirting breast milk into their babies’ eyes when the babies get clogged tear ducts or conjunctivitis.

        • Ash

          @Amy M, you nailed it. There’s tons of advice on the internet for squirting breastmilk into a child’s eyes instead of ointment. It goes even further than that–blocked tear ducts, acne, cradle cap, eye infections, eczema. Is your kid having their first birthday party and you want to make a cake? Use breastmilk to make the frosting!

          I am NOT making this up. People have actually done this.

          • Amy M

            People are dumb. Seriously. Breastmilk has a purpose for sure—to feed an infant. Why would it need any further use? Most of the above afflictions don’t even need treatment and clear up fine when left alone, and if there is an actual disease that needs medication, then get actual medication! This isn’t hard. I mean, I wouldn’t just start putting snot on bruises, if I had a cold and had a lot of extra snot around.

          • Cobalt

            The fact that the infection clears up in spite of the fact that they’ve squirted a nutrient rich, warm liquid all over it is held up as “proof” that it worked.

          • Becca McMahan Parrish

            Breast milk is a powerful substance full of antibodies. It’s not simply a food source. I don’t see why it wouldn’t clear up a minor irritation. Primitive cultures’ practices are not always right, and they are also not always backwards and wrong. They also are backed up by many years of trial and error. Not everything needs a prescription to be solved.

          • Cobalt

            Is there any evidence that the antibodies in breastmilk are effective topically? That they can directly destroy bacteria on the skin or in the eye?

            The minor irritations and infections common in newborns’ eyes almost always resolve independent of treatment method, including benign negligence. This is backed up by decades of scientific “trial and error”.

            Which primitive culture has years of trial and error backing up your claim?

          • just me

            Wtf? Both my kids had blocked ducts at a few weeks old. We gladly used antibiotic ointment which cleared it up.

          • Sue

            Pro Tip #1: antibodies don’t kill bacteria
            Pro Tip #2: milk feeds bacteria

          • The Bofa on the Sofa

            All I can think of is, if breast milk is such a great antibiotic, we should figure out why and isolate it and use it as the next generation antibiotic.

            Now, the problem with this idea is that it’s so obvious that if the premise were correct, it would have been done long ago. You know how hard scientists work to find a new type of antibiotic? I do, because I know folks who do stuff like this.

            And you know what? They don’t try breastmilk.

            RE: pro-tip #2, all I can think is, oh yeah, you know what’s great for killing bacteria? Throwing sugar on it…

          • Amy M

            So is blood.

          • PrimaryCareDoc

            Can you please provide me with information about exactly which “primative cultures” advocate squirting breast milk into eyes? Other than the forum members at mothering.com, I mean.

          • DiomedesV

            ” I don’t see why it wouldn’t clear up a minor irritation.”

            This is the problem with virtually all your posts. “I don’t see why it wouldn’t” is not the kind of reasoning required to answer the question or make an informed decision.

            The correct question is: “Do we have any specific reason to believe that will work” and by “specific” I mean far more biologically specific and plausible than “it’s a powerful substance full of antibodies.”

            Also, if someone is pursuing a treatment for a bacterial infection on the grounds “I don’t see why it wouldn’t work” instead of pursuing a treatment that we *know* works, that’s a problem, because that is effectively an infection that is not being properly treated. Many infections will clear up on their own, but some will not and can have really bad consequences for the children involved.

          • DiomedesV

            ” Primitive cultures’ practices are not always right”

            Also, “primitive cultures”? Please share which cultures you are talking about and why, in your view, they are “primitive.”

          • Bugsy

            Ewwww. Remind me to avoid eating one of those cakes!

      • Pappy

        If I ever needed further proof of the idiocy of NCB advocates, the fact that you actually had to say “Don’t put Vaseline in your eye.” is it.

        • The Bofa on the Sofa

          Ok, but it doesn’t come anywhere close to my favorite idiocy, where they had to clarify to use

          Castor

          for inducing labor, and not Castrol oil, which is a brand of car oil (made famous in American Graffiti, where Steve (Little Opie Cunningham) tells Terry the Toad that his car uses only “30-weight Castrol-R”)

          “Don’t drink motor oil” is, to me, the ultimate proof of the idiocy of NCB

      • theadequatemother

        well…ophthalmic ointment is usually in a base of mineral oil and white petroleum jelly (aka vaseline)…so you are actually putting vaseline in your eye. The difference is that the ointment is sterile in the tube while the tub of vaseline is likely pretty nasty…at least in our house where sometimes we used it as a barrier for diaper rash.

      • fiftyfifty1

        Well it’s petroleum jelly with antibiotic added. So Vaseline with antibiotic.

    • Julia

      Actually…. what are the reasons for possibly refusing the eye ointment? Is it just reflexive opposition or are there more, well, “detailed” reasons?

      • Sara Lucy

        Just another bonding thing. Supposedly babies can’t see you through the eye goop (not that they can see very well at that age anyway.) Also “it bothers them.”

        In the past there was more concern about burning, stinging, but not with erythromycin.

      • Poogles

        I have heard women say the only reason it is needed is if the mom has an STD, so if they don’t have an STD, why should they put that nasty goop on their precious baby? Nevermind that these same moms frequently don’t get tested for the STDs involved. Very frustrating.

      • Cobalt

        With the last two, I asked them to wait on everything that wasn’t medically urgent until after I had gotten to do my “mommy time”, because I was super anxious until I had a chance to hold them and waiting half an hour on the standard protocol stuff doesn’t hurt. It was a relief to get the baby so quickly, but I wouldn’t pass up the ointment, shots, tests, etc.

    • pettelly

      In two of the countries I’ve given birth in, they don’t do the eye ointment unless you have an STI (testing is routine). I didn’t want it in my baby’s eyes when I had her in the US but apparently it is legally mandated. Not a big deal, I just wiped it off as soon as they put it on. Same with hep B. Most other countries DON’T give it to newborns routinely – only if mom has it or hgih risk. I refused it here as I know I don’t have hep B. I agree it’s not a momentous decision, risks are tiny either way. Similarly, I lived in a country where the Varicella vaccine isn’t recommended but I wanted it for my kids so sought it out privately. Sometimes the decisions of medical authorities are driven by public health concerns rather than purely clinical. This is totally legitimate but doesn’t mean that I have to blindly follow this advice when it differs from place to place.

      • Poogles

        It differs from place to place because the risks differ from place to place, due to the particular demographics and disease prevalence in a particular country.

        I seriously hope you realize there are a myriad of ways for a child to be infected with Hep B even if you yourself are not a carrier. I also hope that your child received the vaccine early on, even if not at birth, to protect against a chronic infection and the liver cancer it can cause.