Skin-to-Skin

As a doula, there is nothing more beautiful to witness than a mother welcoming her new baby into her arms. Ahh, what a luxury for a mother to get to hold her newborn immediately after it's born. But you know what? A mother embracing her newborn on her bare chest is not simply an emotional need for mothers. It turns out that it's actually good for the baby! (Faking surprise here.)

Maria posted recently about "the breast crawl," where a newborn baby less than an hour old crawls up his mother's chest and latches on to her breast without any outside assistance. It's not an accident that a baby can do this - it's the perfect art of evolution. A baby is born with reflexes providing the ability to crawl. This reflex goes away shortly after birth. In the immediate postpartum, however, a baby is able to crawl to his food. You can almost picture the evolutionary path here - years and years ago a woman gives birth alone. She is too exhausted to lift her baby to the breast. In order to survive (time lapse years and year) babies develop: 1) the ability to crawl at birth, 2) the ability to recognize his mother in the scent her colostrum (colostrum smells like amniotic fluid), providing an incentive to move closer to the breast and eventually latch on, where the colostrum is excreting, and 3) an instinctual visual attraction to round things (like nipples). At the same time, women evolved to develop large, darkened areolas at birth, providing an easy-to-see target for hungry babies.

As if this process weren't perfect enough, the baby's crawling to the breast and his nursing actually benefits his mother. Here is more evolution allowing mothers to survive childbirth. The baby's moving feet as he crawls press on his mother's uterus, helping it to clamp down to stop any postpartum bleeding that may occur. Did you know that if the baby doesn't do this, often a nurse, midwife, or doctor will have to? Also, when a baby breastfeeds, oxytocin is produced in the mother. The oxytocin causes uterine contractions, which also cause the uterus to clamp down, also stopping or slowing maternal bleeding. If the baby doesn't do this, a mother may need synthetic oxytocin (Pitocin) injected to accomplish this.

And you know what?! The perfection continues! A recent perusal of the Cochrane Review database brought my attention to a review on skin-to-skin contact at birth. As background, Cochrane Reviews are the gold standard of medical reviews. They combine several quality studies on a specific medical issue to create a statistically significant mega-study. They provide conclusions on quality medical care based on their conclusions, which can include a conclusion that evidence supports a certain medical practice. Or they may conclude that evidence doesn't support a certain practice. It's fascinating reading.

Anyway, a review I read recently had this conclusion:

Early skin-to-skin contact for mothers and their healthy newborn infants

Skin-to-skin contact between mother and baby at birth reduces crying, improves mother-baby interaction, keeps the baby warmer, and helps women breastfeed successfully.

In many cultures, babies are generally cradled naked on their mother's bare chest at birth. Historically, this was necessary for the baby's survival. In recent times, in some societies as more babies are born in hospital, babies are separated or dressed before being given to their mothers. It has been suggested that in industrialized societies, hospital routines may significantly disrupt early mother-infant interactions and have harmful effects. The review was done to see if there was any impact of early skin-to-skin contact between the mother and her newborn baby on infant health, behavior and breastfeeding. The review included 30 studies involving 1925 mothers and their babies. It showed that babies interacted more with their mothers, stayed warmer, and cried less. Babies were more likely to be breastfed, and to breastfeed for longer, if they had early skin-to-skin contact. Babies were also, possibly, more likely to have a good early relationship with their mothers, but this was difficult to measure.

Eureka! (Faking surprise again.) I had seen studies showing this, but a Cochrane Review of the evidence takes it to a whole different level.

So, in short, babies who are immediately placed on their mother's chest at birth:

• cry less
• interact with their mothers
• stay warmer than babies in baby warmers (what? technology is trumped by nature?!)
• breastfeed better
• breastfeed longer
  
• breathe better ("have better cardio-respiratory stability" according to the author's conclusions as reported at the end of the review)

When I first started attending births, many providers would "let" the mother hold her baby for a few minutes only. Often it was presented as an indulgence to the mother's emotional whims. More recently, however, the trend has been turning in some hospitals. The providers who follow medical research are not separating mothers and babies, conducting any needed postpartum care on the baby while the baby is on his mother's chest, knowing that a baby is going to do better there than he would in a warmer. Plus, keeping the baby on his mother's chest also allows for the cord to stay intact until it stops pulsating, which is also shown under Cochrane Reviews to produce long-term benefits to the baby.

Is it any wonder that I am continually amazed by birth and the perfection of the human body?

Lesson From a Cloth-Diapering Mama

I learned a lesson recently that you cloth-diapering mamas need to know, if you don't already, about disposable diapers. If you are like us, you keep some disposables on hand and use them in a pinch. Here's the lesson I learned. The velcro tabs on cloth diaper covers are toddler-proof. The velcro tabs on disposable diapers are not. I learned the hard way.

Frank's Day

Today is Frank's birthday. He turns two. How is it possible that two years have passed already? He is such a young man. He likes to take the stairs by himself, saying "no no no!" if someone wants to help him. He enjoys burying himself in a pile of blankets, even in the heat and humidity we've had lately. His favorite toy is anything with wheels, but especially trains. ("Choo choo! All aboard!")

I love that Frank licks the butter off his bread, and I love that he says, "Ta da!" when someone turns on a light. I also love that he wants me to sing to him at night. He prefers "Twinkle Twinkle Little Star" and occasionally our version of "Hush Little Frankie." I know that there will be a day when he won't want his mom, so I'm enjoying these years while he does.

Happy 2nd birthday, Frankie. I love you, my dear.


Video footnotes: Can you tell that Frank was presented with his birthday cake an hour into nap time? He has that zombie stare of a kid who is ready to pass out with exhaustion. Also, it appears that Frank blows out the second candle all by himself, but if you watch closely, you will see it was Andrew. What a good dad - making it seem to Frank and everyone else that it was actually Frank who did it!

Big & Black

The other day Belén and I were out for a walk. We passed an apartment complex in our neighborhood. A large, buff (and good looking, I might add) black man was loading a bunch of stuff into a car in the parking lot, which was a rather large parking lot for our neighborhood. Belén is a friendly child, and she calls out to him. "Hi!" she says. He looks up from his work, smiles, and returns her greeting. We keep walking.

We are no more than five seconds down the road when she says to me, "Wow. That was a big, black..."

(She pauses here as if to emphasize her point. My mind, meanwhile, begins to spin. I'm thinking in these three seconds that Belén shouldn't be noticing anyone's color. She's grown up with people and friends of all different ethnicities and colors. She's never commented on them before. We've worked hard to raise her this way. I actually begin to wonder if some of her new friends have maybe warped her.)

My mind races as Bel continues, "Wow. That was a big, black...

... sidewalk."

What? A big, black sidewalk?! I turn and look back at the apartment parking lot. Sure enough, it's paved in black tar. And it is very large.

The World According to Andrew - June 9th, 2009

I love you. I probably wouldn't marry you if I met you today. But I'm glad I did.

Stupid Sign Made Smart

Last fall I posted about this stupid sign:


Well, guess what? They fixed it! Here is what I spotted over the weekend:

The World According to Bel - May 30, 2009

"Maybe" means "yes."