Sunday, March 6, 2016

Fads, birth and safety

A 'prominent' Perth obstetrician and president of the Australian Medical Association (WA) Dr Michael Gannon, was reported as saying that "an “obsession” with skin-to-skin contact between mothers and babies after birth is a fad that is putting newborns at risk of death and serious injury".  His comment appeared in the article 'Skin-to-skin' fad blamed for deaths of babies published in The West Australian online newspaper 5 March 2016.

The coroner is investigating the death of a newborn at the Fiona Stanley Hospital. The article suggested that the baby is thought to have died 'after the mother fell asleep while holding or breastfeeding the baby'.

The AMA president rightly raised concerns about drug affected, exhausted women:
"New mothers are often exhausted by a long day in labour and there are the side effects of opioid drugs, epidurals or c-section"

However, he also criticises what he calls a
" new obsession amongst mothers and midwives with immediate skin-to-skin contact after birth ... which "stemmed from taking whatever possible measures that might lead to small increases in the number of women who breastfeed"

Far from a fad, skin-to-skin contact for women and their newborns at birth and beyond is a well-researched instinctive behaviour. This instinctive behaviour has been shown to not only improve breastfeeding success, but also, combined with breastfeeding attempts, reduce the rate of primary PPH, along with enhancing the sense of safety and attachment for the newborn and her mother. There are implications for the newborn's microbiome and there is some evidence that skin-to-skin experience reduces mothers' stress levels.

The doctor is reported to have said, in response to the claims for skin-to-skin, that:
 “I think that gets over-interpreted. Babies, instead of being in a safe environment like a warming crib, are being left on their mother’s chest”

Now the attitude that a newborn is better off in a warming crib than with its mother is the nub of medicalisation of the childbearing process and the disconnect between the use of technology and our humanity.

The medicalisation of childbirth is a done deal. Whilst physiological birth is appealing from both an evolutionary and capacity building perspective, the reality is the majority of women in the western world, are already heavily socialised into accepting and wanting medicalisation. Whilst choosing and embracing medicalisation and interventions, women are drawn to the idea of having their newborns with them skin-to-skin from birth and in the main, to breastfeed them. There is even a push (excuse the pun) for 'natural' and 'self-assisted' surgical births. Midwives are drawn to 'keeping things normal' and whilst supporting women in their choices; they are also drawn to facilitating skin-to-skin for the woman and her newborn at birth.

There is no doubt that 'drug affected, exhausted women' are vulnerable, as are their newborns, to the creation of potentially asphyxiating situations. A review of Apparent Life-Threatening Events in Presumably Healthy Newborns During Early Skin-to-Skin Contact  highlighted the issues for six babies left prone, unsupervised by a midwife or other health professional, on their mothers' abdomens. 

The reality is that midwives are increasingly having to care for postnatal women who are 'drug affected and exhausted'. The current staffing levels are woefully inadequate to care properly for these 'drug affected and exhausted women' together with their newborns.  Some people suggest recruiting partners or other family members to observe the newborn who is skin-to-skin with its mother, but that's a cop-out. 


Often partners and others don't know what to look for and the bottom line is, the woman and infant's well-being is the responsibility of the institution that provides the 'care'. 

Whilst a decrease in medicalisation of birth would be ideal, that ideal will need a revolution in society's attitudes. In the meantime, what the good doctor and the AMA should be arguing and agitating for is not a separation of a mother and her infant, but for women and their infants to be treated with the profound respect they deserve and adequate midwifery staffing levels so that women and their infants can benefit from best practice and have the support and expertise of the midwife's presence to ensure that experience is a safe one.

Dr Gannon and the AMA need to understand that it is not skin-to-skin experience at birth that is putting newborn babies at risk.

What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal.



The mother whose baby died at the Fiona Stanley hospital deserves our heartfelt love and support, kindness and respect - not blame for her baby having skin-to-skin and breastfeeding at birth - she was doing the very best she could for her baby.

If the little one is found to have succumbed because of airway obstruction, then our society has failed her and her family.  Our society does not value childbearing women enough to provide adequate staffing levels and midwifery expertise to be their guardians through their most vulnerable time. 





7 comments:

Melissa L said...

What a ludicrous accusation! Skin to skin in the first hour of life supports newborn changes to extra uterine life, this is deeply known by every woman and in our primal core. The thing that I picked up on in this article is the mention of exhausted women who were under the effects of residual drugs administered in labour.... My thoughts go to: why were the drugs administered? What type of care did the woman receive in labour? Was she supported by a known midwife, and labouring in a calm, safe environment? Could the need for pain relief have been reduced if she was cared for in a way that supported her natural pain processes? Or was she also induced? ARM? Synto infusion? And maybe if those interventions occurred then the hospital policies should support staffing levels that provide time and enough midwives to ensure that the mother and baby are observed until the effects of the drugs wear off. Also, where was her family/partner at this time? Does hospital policy on visitors reduce the amount of time that she is surrounded by her own people? What changes can be made to ensure the woman's 'village' is with her? This goes so much deeper than 'skin to skin is a fad, and needs to be stopped'...

Carolyn Hastie said...

Great comment Melissa, you are so right in all that you have said

Jo Hendry said...

Here, here, Melissa !

Unknown said...

I believe this is the key message in this article:

What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal.

Maybe Dr Michael Gannon can pay a visit to maternity hospitals around the country and see for himself how "real people" work and what conditions they work under.

Get your facts straight Dr Gannon

100joblo said...

I believe this is the REAL issue at hand:

"What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal"

Maybe Dr Gannon should pay a visit to maternity hospitals around the country and see reality. Come and work in a maternity unity and see what goes on and how underpaid we are for the work we do.

Before making rash statements, get your facts straight Dr Gannon. Skin to skin has been around for centuries and there is well documented evidence to support the benefits of skin to skin.

Anthea Thomas said...

Fantastic response to a very damaging article & comments by Dr Gannon. Well done!

Pferdenuts said...

Thank you Carolyn, so perfectly said! It is a sad indictment on our maternity care system that there is still this "blame game" going on, particularly if the coroner has not handed down findings yet.
The research is there. We need everyone to look at it.