Science! Science, I Say!

While making scones I was thinking about how breastfeeding and childbirth have been damaged by the attempt to make them more "scientific".  (yes, I have random thoughts when baking, or any time, really) My train of thought then went to my days of studying archaeology and learning about "New Archaeology" (or Processual Archaeology), wherein some declared that what archaeology needed was to be more scientific.  I find it interesting that these major interests of mine can be united by the fact that all, at one time or another, were under some kind of pressure to conform to a scientific method.  With breastfeeding and childbirth, this took the form of schedules and time limits and various procedures, instead of going with the natural flow of things; with archaeology this took the form of putting archaeology under anthropology and trying to be more scientific in analysing artefacts and an assumption that all aspects of a culture could be analysed through the material record.

Now, science certainly has its place within the study of breastfeeding, childbirth, and archaeology, and the scientific study of these things has led to greater understanding in some ways.  The problem, however, comes in trying to force these things to fit within a certain framework (obviously it's a bit different with archaeology, since we're not talking about a natural biological function but the study of past societies and that study must be thorough and rigorous, but the human element still remains).  Thankfully "new archaeology" was soon criticised for its shortcomings, and thankfully the "scientific" rules for breastfeeding are, in general, no longer in vogue.  We're getting there with childbirth, but there's still a ways to go.

The underlying assumption, really, is that the unpredictability and organised chaos of human systems is somehow deficient and inferior to a purely logical, scientific approach.  Seeing as we are not Vulcans, though, our bodies and societies do not, and will never, conform to a rigid system.  This is part of the beauty of breastfeeding, childbirth, and archaeology, in my opinion.  The way science can, and has, helped in these areas is by giving us greater understanding of them instead of trying to force them to conform to arbitrary standards in the name of "science".

Twilight Sleep: a Thing of the Past?

A friend and I were talking about our experiences with giving birth to our eldest children, and the discussion naturally turned to pain relief.  In discussing that, I had to ask whether the era of "twilight sleep" is truly a thing of the past.

For those who don't know about it, twilight sleep is when the mother is given an injection of morphine and scopolamine.  The morphine was to deaden the pain and the scopolamine produced an amnesiac effect so she wouldn't remember the pain.  This was the common practise from c1914-the 1940s or a little later.  Unfortunately, it also had the effect of hampering bonding by removing the mother from the experience of birth.  It also depressed the baby's central nervous system.  And so the practise fell out of fashion.

Or did it?  True, they no longer inject women with scopolamine to induce an amnesiac state, and morphine itself isn't usually used, but other opioid drugs such as pethidine or diamorphine are commonly used.  My friend and I both received these injections: I was given pethidine (combined with an antiemetic) and she was given diamorphine.  We agreed that the drugs didn't actually deaden the pain, but they made it so we couldn't truly respond to the pain.  In my case, the antiemetic also made me incredibly drowsy.  Both drugs cross the placenta and have a depressive effect on the baby's respiration, and may interfere with breastfeeding.  This isn't sounding too different from twilight sleep.

I have to say that I also don't see the point of giving an amnesiac drug during labour.  I won't say that I forgot the pain, but I didn't care about it once the child was born.  The endorphins we get during labour are also quite powerful.  A little support in a calm environment can go a long way, really.  I'm not saying women shouldn't have access to pain relief if they want it, but let's make it pain relief that actually relieves pain instead of depressing our ability to respond to it, and pain relief that doesn't have the potential to interfere with/hamper breastfeeding or depress our babies' breathing.

All That Matters

As you've probably noticed, I have a tendency to talk about labour and birth quite a bit, and I also tend to get in more animated discussions about it, especially when the subject of home birth arises.  Sometimes in these discussions there's someone who says something to the effect of "all that matters is a healthy baby".  This can be said either in discussing why one shouldn't have a home birth, or said after a mother mentions various interventions that she found to be more traumatic.

Let's think about this statement though - all that matters is a healthy baby.  So what about the mother's physical and emotional health?  Birth isn't just some medical procedure, but is a highly emotional, personal experience.  Now, I certainly agree that the baby's health is of the utmost importance, and I would sacrifice myself for my child if it came down to it (I suppose in a way labour and just being a mother are sacrificing myself for my child, but I digress).  However, I do not at all subscribe to either the false dichotomy of pitting mother against child instead of working to ensure both are well, in every sense of the word.  The mother's emotional welfare shouldn't be neglected, either, and telling her that the baby is all that matters gets translated to her as saying that she doesn't matter and she should just forget any emotional trauma.

Even without my first birth being truly traumatic, I can understand this, for I do have some emotional baggage, as it were, with Kieran's birth.  I'm thrilled beyond words that Kieran is fine, but I'm also angry and hurt at being subjected to interventions that shouldn't have been necessary, had I had continuous support been more educated on various positions and the like and been more confident.  No, I'm not blameless.  (and no, I'm not saying interventions are never necessary, nor that women aren't traumatised if an intervention is necessary).

Whatever the circumstances, though, telling the mother that it only matters that the baby is well, or even telling her that it's okay because both she & the baby are alive, serves only to belittle her emotional well-being.  I don't think people intentionally do this, for I don't think others realise just how emotional birth is and that the experience itself, as well as the outcome, is important.  In fact, I'm sure I was guilty of this way of thinking prior to having Kieran.  It's helped to be able to talk about it, and has spurred me on to educate myself more, thus leading to my ongoing reading and research.  Now I see the bigger picture, that a healthy baby and mother are important, and that this goes beyond physical health.

Cord Blood

I was just reading a post on Midwife Thinking's Blog that does a great job of explaining why I don't go in for cord blood banking.  I know the usual reasons I've heard are that those stem cells could someday be used to treat that child's illness later on, or that they are an ethical source of stem cells to develop treatment for others.

The problem with the first reason is that the child may never have an illness where those stem cells could be helpful in treating him.  Even if he does, there's no guarantee those stem cells will create a viable treatment for him.  But it has been shown that allowing the baby to receive the full amount of his blood is beneficial.  It's possible that blood, with those stem cells, could even help prevent any potential illness for which the stem cells would later be used to treat.

That leads me to the problem with the second reason.  Is it truly ethical to deprive a newborn of his own blood in order to bank it either for his or another's future use, without his consent?  Blood that makes Vitamin K deficiency bleeding less likely, raises his iron stores, and make his transition to breathing easier.  I'm not so sure it's really ethical to do that, to be honest.

I will say that I thought about cord blood banking when I was pregnant with K.  However, the more I looked into it, the more convinced I was that delayed cord clamping was the way to go, and that means cord blood banking isn't an option.  Unfortunately they did not follow my wishes about the delayed cord clamping with K, but C received the full amount of her blood, since the cord was not cut until it stopped pulsating.

Evidence?

I'm a big believer in evidence-based medicine.  I don't want a treatment just for the sake of doing something, nor do I want something that hasn't been proven to be beneficial and effective, with those benefits outweighing any potential risks/side effects.  I'm thankful that there are doctors who look at the evidence and change practises if need be.  This is what Dr Nicholas Fogelson is doing in now advocating for delayed cord clamping, since he hasn't seen evidence justifying routine immediate cord clamping.  This is also why routine episiotomies are becoming less common, thankfully.  And why kangaroo care is, thankfully, becoming more commonplace with preemies.

These things lead me to wonder, though, why these practises were adopted at all, given that the evidence doesn't seem to be there.  The commonality I see is that these were all things that said that our bodies were wrong and not to be trusted, or perhaps not "scientific" enough.  Maybe that's cynical, but it's how I see it.  In the process, women have been told (by implication) that they always need help birthing and caring for their babies.  Note: I'm not speaking of those times when medical intervention truly is needed, I am speaking about routinely treating birth as a medical procedure that will always need medical intervention.

Of course, one could also argue that all the things I mentioned above came about due to the medicalisation of birth and women being supine when giving birth in a medical setting, and sometimes too drugged or badly positioned to push effectively.  This could, of course, lead to an episiotomy instead of repositioning the woman, and immediately cutting the cord to check the baby instead of placing the baby on the mother's chest.  I'd like to say that these things no longer happen, or at least not with midwives, but both happened to me when I had K.  There was an OB there, too, so I'm not sure who made the decision for the episiotomy and immediate cord clamping; I only know that it was done, and that I had no say in it.  It's one thing if it's a true emergency (though one should always get informed consent if at all possible), but these things likely could have been averted had they just helped me change position first.

Going back to the cord clamping, though, I would again ask: where's the evidence for immediate cord clamping, even when the baby was thought to be in distress?  We know about the importance of immediate skin-to-skin contact to regulate the baby's temperature, calm the baby, and facilitate breastfeeding and bonding.  We also know that delayed cord clamping can be done even with active management of the third stage of labour.  While it might not be routine, the initial checks can be done with the baby on the mother's chest, allowing for both skin-to-skin contact and delayed cord clamping.  This could also mean that the baby will avoid being put in a warmer due to his temperature dropping (thankfully that didn't happen with K, as they did hand him over once he'd been checked over).

So before something is done my child or me, show me the evidence.