Saturday, September 13, 2008

Bonding after Cesarean Birth in the News

I read Tara Parker-Pope's most recent blog entry in the Health section of the New York Times, "Delivery Method Affects Brain Response to Baby's Cry" last week and I've been thinking about it ever since.

Pope opens with some personal experience, explaining that her feelings of "being numb" and "uninvolved" with her daughter's Cesarean birth surprised her, and that "When I finally heard a baby cry, it took a minute for me to realize that the sound belonged to my own baby."

She goes on to summarize the study:
"That’s why I was particularly interested to read of new research showing that the method of delivery seems to influence how a mother’s brain responds to the cries of her own baby. The brains of women who have natural childbirth appear to be more responsive to the cries of their own babies, compared to the brains of women who have C-section births . . . The study, published in The Journal of Child Psychology and Psychiatry, found that the cry of a woman’s own baby triggered significant responses in several parts of the brain related to sensory processing, empathy, arousal, motivation, reward and habit-regulation"
(I'm going to interrupt myself here to say that I hate it when people euphemize "vaginal birth" with "natural birth" - is the word vagina that threatening? because to me, and to lots of other people, natural birth is not the same as, or interchangeable with, vaginal birth. A vaginal birth could have been induced with cytotec (to soften the cervix) and pitocin (to stimulate contractions); the amniotic membranes could have been artificially ruptured; the mother could have been hooked up to an IV (with the Pitocin drip) and an epidural and a catheter; baby could be removed with a vacuum extractor. Does all this result in a vaginal birth? Yes, certainly! But is that a "natural" birth?? I'm not sure how all those medications and procedures equal "natural", even in the loosest sense of the word. And when doctors and/or scientists, and those who report their findings, start choosing not to distinguish between the two, that's when we're in real trouble - see VBAC link below...).

Anyway! Here are two links to a summary of the study: "Maternal brain response to own baby-cry is affected by cesarean section delivery". I like this summary because it reports that this study was done on a sample size of (only!!) TWELVE women - six who "delivered vaginally" and six who elected for a Cesarean birth; and "Natural childbirth makes mothers more responsive to own baby-cry", which I think summarizes the study in easier to understand language, though they do make that pesky trick of making "vaginal" into "natural" in their title (!!).

Another blogger, who writes about oxytocin (the "hormone of luuuuuvv" is what I call it in class), has this blog entry about the study.

Reading that study made me think back to something that I read (or heard?) about monkeys who reject their babies born by Cesarean. After a little searching, I found out that the reknowned French obstetrician has a very interesting website called WombEcology. In one terrific article, "In-labor Physiolocial Reference", he reminds us that humans are mammals, and that we give birth as mammals. He describes the handicaps that are special to human mothers giving birth, and how we can help minimize them. It's really a terrific article - much better than the title makes it sound - go read it!

One thing he highlights in the article is that:
"Physiologists constantly refer to what they learn from non-human mammals. This leads to keep in mind the main differences between human beings and other species. One of the main differences is that the effects of a disturbed birth process on maternal behaviour are much more evident at an individual level among non-human mammals . . .

Today caesareans are common in veterinary medicine, particularly among dogs. This is possible as long as human beings compensate for a frequently inadequate maternal behaviour, assist the process of nursing and provide, if necessary, commercial canine milk replacers. The effects of a caesarean on the maternal behaviour of primates are well documented, because several species of monkeys are used as laboratory animals. This is the case of the ‘crab-eating macaques’ and the rhesus monkeys.(3) In these species the mothers do not take care of their baby after a caesarean; laboratory personnel must spread vaginal secretions on the baby’s body in order to try to induce the mother’s interest for her newborn.

We don’t need to multiply the examples of animal experiments and observations by veterinarians and primate-using scientists to convince anyone that a caesarean – or just the anaesthesia that is necessary for the operation – can dramatically alter the maternal behaviour of mammals in general. In this regard humans are special. Millions of women all over the world have taken care of their baby after a caesarean birth or simply an epidural birth or a ‘twilight sleep birth’.

We know why the behaviour of humans is more complex and more difficult to interpret than the behaviour of other mammals, including primates.(4) Human beings have developed sophisticated ways to communicate. They speak. They create cultures. Their behaviour is less directly influenced by their hormonal balance and more directly by the cultural milieu. When a woman knows that she is expecting a baby, she can anticipate displaying some maternal behaviour. This does not mean that we cannot learn from non-human mammals. The spectacular and immediate behavioural responses of animals indicate the questions we should raise about ourselves."
The reason I include this excerpt is because I think that for some women, feelings of distance, or not feeling immediately "bonded" to her baby, become one more thing that she feels guilt or shame about. I think it's critical to realize that bonding happens over time, and that we as humans can overcome a less-than-optimal beginning. I think the truth - that feelings of distance can be a part of some women's postpartum experience - gets covered up, which can make women feel alone and also make it very hard to find resources for help.

If we realized, accepted, and publicized as part of informed consent that epidural anesthesia and/or Cesarean birth can have a physiological impact on bonding and post-partum blues/depression, women could make more informed decisions about their care and could prepare in one of the many ways (extra support, more skin-to-skin contact with baby, and massage come immediately to mind) that are shown to promote bonding and lessen post-partum blues.

If any of this gets you wondering about choices for VBAC (vaginal birth after cesarean), or the safety of VBAC, I came across a great article on the Midwifery Today website, Homebirth after Cesarean: The Myth and the Reality (see also if you're interested in how equating vaginal birth with natural birth as affected hospital policies on VBACs).

You can also visit the Online Resources section of my site for links to and ICAN (International Cesarean Awareness Network), as well as lots of links to postpartum depression and support sites.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Blogger Baby Keeper said...

Great article. So important to know.

I totally agree with you about the use of natural birth to mean merely vaginal with all the interventions.
This is a link to my trailer for the film, "The Other Side of the Glass."

I hope you can check it out and pass it on to your colleagues, friends, family, and list groups.



September 14, 2008 at 8:27 PM  
Blogger Pocha huntas said...

Natural birthing can be a very painful for you if you not know the Birthing Hypnosis which helps to made your natural birthing easy and less painful for you. Natural birthing is very good process for giving birth of baby at the place where you want, but without knowing the right way of performing the natural birthing can be dangerous for you. So you should get the proper training before doing this.

March 12, 2017 at 9:57 AM  

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