LOTUS BIRTH: Birth with an intact umbilical cord.

Baby and placenta are kept together until the cord falls off naturally.

Lotus birth is another grass roots movement.  Woman to woman the word is passed. . . it makes sense and a heartstring is touched. . . .the father is enlisted for support and, one family after another, declines the use of scissors at birth.  This movement causes the knowledgeable professionals to stop and then flounder for answers.  As the things they hold to be sacred are questioned and thrown out, everything they know to be true is also called into question.  This is a good thing and enriches those who can admit that things are not always as they seem.

When your clients are planning a lotus birth, think ahead to what some of the pitfalls might be.

1.            The relatives might be upset.  Many couples who plan lotus birth see the days with the placenta (usually 4 to 6 days) as private family time and make a rule that they will not have guests until the placenta is separated.  This relieves the new mother of performance anxiety as she gets to know her new baby.  It gives the baby a quiet transition period to intensively bond with his/her parents. One couple I know did not let anyone know their baby had been born until the placenta had separated naturally.

2.            What if it smells terrible? Ground rosemary sprinkled all over the surfaces gives the placenta a pleasant smell like turkey stuffing.  Some women put lavender and rosemary essential oil on the placenta first to prevent smell.  Some put salt on both sides.  There will be a smell.  It is not terrible.  A cake rack  or a Chinese wooden steamer can be helpful to place the placenta on to allow air to circulate.  Blue Chux (incontinent) pads are helpful to prevent bedclothes from being stained with blood. The placenta is organ meat that is fresher than any meat you have ever purchased.  It will naturally begin to smell after a few days of being in the air.

3.            What if I decide not to do it once I’ve started? Not a problem.  The cord can be cut at any time and usually is atrophied (dried and shrunk) enough that it needs no clamp after 24 hours.  It is common for new parents to go through periods where they think Lotus birth is just too much trouble.  Often the mother wants to give up and cut the cord and the father will talk her into persisting a while longer; then, the father can be fed up and the mother will encourage him to keep going. It becomes a quiet meditation to wait vigilantly for the cord to fall and in our fast-moving society it is a real contest to slow down for the baby.   Parents report that the days spent with the placenta attached taught them a great deal about cooperative parenting and patience.

4.            What are the annoying aspects of Lotus birth?  It can seem like a nuisance to have to move the placenta every time you move the baby.  Having a piece of raw meat in your family bed is a little peculiar, too, and can be messy.  Once the cord dries after 24 hours, it has the consistency of rawhide which makes it seem like your baby has a wire coat hanger protruding from his/her belly.  None of these problems is insurmountable if the parents can be relaxed, stay close to bed and view Lotus Birth as a rites of passage.

5.            How do I do this with a 3 year old jumping around on the bed? This is actually one of the biggest challenges and is a reason that Lotus Birth most often happens with first births. Protecting the newborn from the exuberance of a 3 year old is not easy at the best of times.  Prior to the birth, the parents should put some thought into creating a “nest” for the new baby and mom for the Lotus time.  The father and older child can build a “play space” of some kind with new library books and music for nap times.  Enlisting friends and family to take the older child for some active outdoor fun each day will also help the new parents maintain the sanctity of the Lotus time for the baby.

The role of the Attendant in a Lotus birth

Educating your clients about the possibility of a Lotus birth is easily done with a handout.  For many families, Lotus birth is not a preference but knowing that there is no problem leaving the cord intact indefinitely reassures them that it’s all right to slow down the cutting of the cord after the birth. When physicians justify early clamping and cutting of the umbilical cord with erroneous statements like “the baby may become jaundiced”, the parents can point to Lotus birth as proof that patience with cord clamping is perfectly healthy.

If your clients decide to have a Lotus birth, your encouragement and support can mean a lot to them. Talking through the logistics prior to the birth and making a plan for what equipment will be needed is helpful.  Remind the mother to keep the house warm so that she can be naked (except for panties/pad) and the baby can just wear a diaper.  Lots of skin-to-skin contact in the first few days of life gets the breastfeeding relationship off to a good start.  A supportive attendant can remind parents that the Lotus process has its highs and lows and that many people find deep meaning in giving this patient beginning to their child.

Caroline and Paul’s Lotus Birth

Caroline is the daughter of a family physician and Paul works in the film industry.  They were planning a home water birth for their first baby and had heard about Lotus Birth and wanted to give it a try.  The birth process was long but Caroline coped well and gave birth around suppertime in the water.  Paul was so captivated with the birth that he did a poor job of filming it!  The midwives helped the family to take lots of photos of parents and baby and placenta all resting in bed together.  It was a glorious feeling for everyone —a birth that flowed easily and needed no scissors, clamps or cutting of any kind.

When the midwife returned to the home the next afternoon, the bloom was off the rose.  The father looked rather anxious and wanted to know “How much longer are we going to have to have that THING on the baby?”  The mother and baby were sleeping peacefully together so the midwife had some time to spend talking to the father as they cleared up dishes in the kitchen.  She let the father know that his impatience to have things “tidied up” after the birth was normal.  She also pointed out that very few times in his life would be as profound as the first days of his son’s life.  She encouraged him to really listen to the messages that his son, his wife and the placenta might be telling him.  The father decided to relax again and let the placenta stay attached.

A few days later, he was lying beside his son on the bed and, as he watched him, he saw the cord slowly detach from the baby’s belly.  Right then, he felt a “release” from his own belly and something freed up in his core that had been blocked.  He began sobbing with joy.  When he planted the placenta under a tree in front of the house, he felt a deep sense that his transition into fatherhood had taken place, not in an instant, but in a slow leisurely process of learning and letting go.

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I’m a little afraid to even mention this in case it disappears. Shhhhhh. . . don’t tell anyone but there’s a doctor talking about leaving the baby’s precious backup oxygen supply (the umbilical cord) alone to do its physiological job.  He’s calling it “delayed cord clamping” which is a ridiculous description but, as long as babies get to enjoy some cord time, I’m not going to quibble about semantics.  Perhaps we’ll see an end to this kind of violation of a newborn baby who is trying desperately to protect herself from the bulb syringe and the clamps/scissors that are stopping her oxygen supply.

You can read all about his research and insights at Academic ObGyn

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

I’m going to paste in here the comment by Gail Hart, midwife from Portland, Oregon because she has an interesting view of the history and physiology involved in leaving the cord to pulse.

December 6, 2009 at 9:29 am

Gail Hart comment

“The large body of research over 5 decades shows benefits from delayed clamping of the umbilical cord, but there are conflicting reports of potential rise in rates of jaundice. I believe the conflict in these reports is a result of the variations in conduct of third stage. The practice of delayed cord-clamping does not mix well with oxytocics given as part of “active third stage management”.

Under normal physiologic conditions, the uterus remains in quiet tone for a few minutes while the baby receives the “correct” amount of blood remaining in the placental circulation.

If oxytocics are given with delivery, the early uterine contractions may result in an over-infusion of blood to the baby, polycythemia, and elevated risk of jaundice. In my region, the understanding of the association of increased risk of jaundice with the practice of “pitocin with the shoulders” was the major reason for the abandonment of this routine in the 1980s.I think a wise policy is to allow normal third-stage umbilical transfusion by clamping after the cord goes flat under most circumstances. But when pitocin is used then the cord should be clamped within 30 seconds.

Midwives and doctors who follow this policy report rare incidences of neonatal jaundice, and extremely rare need for phototherapy.

Regarding ‘what to do with the baby while waiting”… Let MOM deal with the baby!

In almost all cases, the cord is long enough to allow the baby to be held on mom’s abdomen (and in her arms). There is no need to keep the baby at the level of the introitus: in fact, this is not physiological. It is normal instinctive behavior for mothers to want to hold their babies at birth; in evolutionary terms, this means mothers hold babies while the cord is still intact!

The maternal abdomen may be considered to be close enough to the level of the placenta that gravity is not likely to impact either under-infusion or over-infusion, unless the woman has given birth while standing (and this is unusual in our culture)

(On a personal note: I’ve been a midwife for almost 40 years and can attest that babies do extremely well with a policy of delayed cord-clamping! I think they transition to extra-uterine life more easily, and breathe more quickly and deeply with a lower incidence of “gunky lungs” or TTN (transient tachypnea of the newborn). Also, their intact cord allows them an additional life-line in the rare instance when they require assistance.

Immediate cord-clamping is a very new development in human history. The routine evolved as a method to reduce the neonatal load of maternal medication when births were conducted under general anesthetic.

Those days are LONG past, but this old routine still remains!

We’re having a heck of a time getting rid of the silly thing!

see: JAMA. 2007 Mar 21;297(11):1241-52.

Late vs. early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.

Hutton EK, Hassan ES.

CONCLUSIONS: Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in who cord clamping was delayed, this condition appeared to be benign.

PMID: 17374818

(note nearly a 1000 babies in late-clamping study)

also check out PMID: 16567393

PMID: 15510946

PMID: 18624002 — describes additional benefit of increased alveoli perfusion and recommends a minimum of 3 minutes delay

PMID: 11783688

end of Gail’s comment.

Comments(5)

I’m sharing below an e-mail conversation with a Midwife/Lactation Consultant from Israel. Gloria

From: Leslie Wolff, Israel

Subject: Lactation Consultants in the labor & delivery room

I was a midwife in the labor/delivery ward for 14 years - and am now a IBCLC for the past four years - working as the coordinator of breastfeeding at my hospital, which means getting to Labor and Delivery also…mostly when the midwives ask me if I can give some help…

I have a few of my own beliefs about breastfeeding immediately after delivery. I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the diad - mother and baby - to recover from the birth experience, is a Win Win situation that requires no effort , there is nothing to “succeed” in - it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast - great..and if not, or the breast is offered and the baby doesn’t GO FOR IT - that’s fine. .I also truly don’t like to give “instructions/ advice” during those first two special hours..I know that proper latching is important, but that mother JUST GAVE BIRTH - I could never see myself “instructing her” - maybe a little helping the baby get the nipple farther into the mouth , maybe a word here or there - there is plenty of time to help her when she is in Postpartum ward - those first two hours after birth seems like a special, quiet , almost holistic time ( having nothing to do with the fact that the baby had a natural or very intervened-with ( is there such a word?) birth, maybe even a C-Section…..I know that babies are “supposed to” “immediately” start breastfeeding beautifully - but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin ,I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth…)

I’m glad that you brought the subject up - because I too am interested in how others ” do it” during that first period after birth labor/delivery ward, and am interested in any comments about what I wrote..

Close to the Heart

Leslie Wolff, Israel

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Leslie, may I have permission to put your wise words on my blog. I attend only homebirths and have the same attitude. It’s the skin to skin contact and little (or big) noises of the baby that cause the uterus to contract powerfully post partum. It is a sacred time right after birth that can never be recaptured. When the mother and baby have warmth and privacy they will “discover” each other and fall madly in love. This is the best child protection method both in the short and long term. We are mammals. We must sniff, lick, coo, cuddle, look at and hear our young. In turn, the baby does many “pre-nursing behaviours”-climbing, licking, looking, hearing, sniffing. . . who knows what they are doing because it’s dark and private, remember? How do I know this? Because I had it with my own 2 homebirths. Just like sex, it has to be experienced to be believed. My mission in life is to learn how to take my interference away from the mammatoto. Gloria Lemay, Vancouver, BC
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Dear Gloria - it is my honor and pleasure to be quoted on your blog!
Tomorrow I am giving a power point presentation - two lectures - one on Skin to Skin for the Healthy Newborn and the second : Kangaroo Care for the Premature - for nurses and midwives and a few doctors at a breastfeeding course in Tel Aviv ( an acknowledged course for IBCLC). For the first time I am going to take a firm stand on my thoughts about those first two hours , with the support of the feedback I got from you and others.

Linda Smith wrote me, when I mentioned to her that the words of the 4th Step of Baby Friendly put more emphasis on breastfeeding than skin to skin, and I think it should be the opposite):

From Linda Smith: “Take a look at how Step 4 is currently interpreted:

This is WAY more than your beliefs - the science on this is very clear!
Linda J. Smith, BSE, FACCE, IBCLC, FILCA Bright Future Lactation Resource Centre, Ltd.”

So these past letters - yours and others - have come for me just at a perfect time - and I appreciate your feedback very much…
CLOSE TO THE HEART and MIDWIFERY IN PEACE
Leslie

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http://www.neonatology.org

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Only about 1 in 5,500 babies gets neonatal herpes, even though the virus is widespread in the adult population. Neonatal herpes is not a reportable disease in most countries, so there are no hard statistics about the exact number of newborns affected. However, most researchers estimate there are between 1000 and 3000 cases a year in the United States, out of a total of four million births. To put this number in greater perspective, an estimated 20-25% of pregnant women have genital herpes, while less than 0.1% of babies contract an infection. Although remarkably rare in newborns, herpes outbreaks can cause severe and lasting damage to those who are infected with the virus.

Transmission rates to the baby are lowest for women who acquire herpes before pregnancy. One study (Randolph, JAMA 1993) places the risk at about 0.04% for such women, who then have no signs or symptoms of an outbreak at delivery. The chances of transmission are highest when a woman acquires genital herpes late in pregnancy. With monogamous partners, this is a very rare occurrence.

Medical practitioners are concerned about release of the membranes for longer than four hours when a woman has a herpes outbreak. Great care must be taken not to release the membranes. No one shouldb e stripping the membranes of a pregnant woman who is a herpes carrier.  The speculum exam at the time of birth should be the only pelvic exam. Internal scalp monitors must not be inserted because insertion can infect the child through the scalp puncture.

Dangers to the baby who develops herpes include death (60% mortality rate), herpes encephalitis or aseptic meningitis (inflammation of the brain or spinal cord), which, in turn, leads to neurological damage. The first symptom of disease in the newborn may be a sore on the skin, which can be tested with a fluorescent stain to diagnose it as a herpes lesion.

If left to develop into full-blown herpes, it can cause the baby’s death, brain damage, or blindness. Early treatment is imperative if there is a suspicion that a baby might have a herpes skin eruption. Premature or otherwise compromised babies are at greater risk when a woman has a recurrent outbreak of HSV II.

Preventing outbreaks

•             Avoid coffee, sugar, chocolate, and junk food.

•             Get plenty of sleep each night.

•             Reduce work- and relationship-related stress.

•             Take elderberry, zinc, vitamin C, garlic or alfalfa to help support the immune system.

•             Take olive oil extract.

•             Take 500 mg of lysine (an amino acid) daily.

•             Take colloidal silver orally after consultation with a naturopath (research colloidal silver; it is an important antiviral, antibacterial, and antifungal.  Don’t overdo, it can turn the skin permanently blue).

During an outbreak of herpes in pregnancy, have the pregnant woman take 1000 mg lysine three times a day along with vitamin C (500 mg, 3 times a day). If the woman is having recurrent outbreaks in pregnancy despite all the preventive measures taken, at 36 weeks the midwife may suggest she take Acyclovir 400 mg BID daily until the birth. Pharmaceuticals are thought to prevent outbreaks at term but they don’t always work and are hard on the baby’s liver.  If the pregnant woman has an allergic reaction to the antiviral drug, she should stop taking it immediately and report it to her provider.

After the birth, the mother and breastfeeding baby should be kept warm and skin-to-skin. Breastfeeding is of ultimate importance for the baby’s well being.  Rest for the mother is extra important. Nourishing fluids and extra vitamin C after the birth is recommended. Visitors should be kept to a minimum, told to wash hands carefully before entering the mother’s room, and barred from visiting if the visitor has any type herpes outbreak or infection.

— Gloria Lemay, “Herpes Simplex II,”  first published in  The Birthkit Issue 37 (Midwifery Today)

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Here’s the new url for the College of Physicians & Surgeons of B.C. policy statement on male genital mutilation.

https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf

They’ve changed their website and I found it awkward to locate the document now. It’s a strongly worded statement against male genital mutilation. Gloria

Quote from the document:
“Circumcision removes the prepuce that covers and protects the head or the glans of the penis. The prepuce is composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings and erogenous tissue. Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death.”

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It seems like the baby from Indonesia who weighed 19.2 lbs at birth has become world famous.  The press needs some feel good items once in a while to lighten all the bad news.  For people who work in obstetrics, however, this is actually a rather tragic situation.  This is a baby who could very easily have died in utero from the effects of out of control blood sugars in a diabetic mother.  Then, the world would never have heard of him.  This happens every day around the world.  Even after being born alive, any pediatrician will tell you that these babies who look so big and strong are alarmingly vulnerable.  Most pediatricians would rather look after a tiny premature baby any day than a macrosomic (large) infant of a diabetic mother (IDM).

     This photo is from an Australian newsservice.

This was sent to me by a nurse friend.  It’s off an online email list for nurses.
Gloria Lemay, Vancouver BC
 

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Another set of sucrose questions:
 

1)     What is the strength of the sucrose you are using for pain tx
during circs?   25%
 

2)      Do you solely apply the sucrose to a pacifier or do you
administer a prescribed amount?  sucking and sweet are synergistic, so
we do use a pacifier
 

3)     For those using pacifiers, how do you deal with breastfeeding
moms who are adamantly against them?  we tell them it is only during the
procedure and then we throw it away
 

4)     Do any of you use breast milk in lieu of sucrose? Haven’t,  but could
 

5)   Where do you get your sucrose?  Toot Sweet 1 mL twist off single use
vials from Hawaii Medical www.hawaiimedical.com
 

Thanks in advance for your answers! I appreciate each one of you! Feel
free to contact me off-list.
 

Another nurse answers:
I would imagine you can use a gloved finger for the baby to suck instead
of a pacifier.>>

Is it any wonder that we have such low rates of successful breastfeeding in the United States?  Right at the beginning of life we are inflicting pain, comforting with white sugar, and putting latex/rubber into the mouths of these little baby boys.  Nurses who want to end the insanity can join Nurses for the Rights of the Child and get support for being a conscientious objector.

And, finally, here’s what one baby thinks about the idea of amputating his foreskin: 

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For some reason, Washington, D.C. has one of the highest rates of circumcision of newborn males in North America.   Danelle Frisbie, a birth worker in Washington, D.C. started this conversation on her Facebook page:

Danelle Frisbie loves hearing from moms who say, “My 2nd/3rd/4th sons are intact - I became wiser as I got older” but hopes to someday hear the same for son #1.

K. S. my first son is intact!

C.C. All 3 of my boys are!

K.K. Both of my boys are intact!

S.G.  I only have girls, but they’re intact too.

E.P.D.  If we are ever blessed with a son, he will remain intact!

S. E. My only son is intact. I couldn’t imagine anyone doing that to my baby. People would ask me when I found out I was having a boy “Are you going to have him circumcised?”  My answer…”Over my dead body!”

V. L.  My first son is intact! In fact, ALL of my husband’s boys are intact.

J. T.  All of my sons are intact, and my grandsons will be intact, too! My 21-year-old has already assured me that none of his sons will be cut, and my 10-year-old son has marched with me at the intactivist demonstrations in D.C. I’m hoping that by the time the 10-year-old is old enough to be a dad, circumcision will be unthinkable.

D. F.   J., LET’S HOPE this will be true when the time comes for your 10-yr-old to become a father.

And thanks everyone for sharing!!

C. W. A.  My first (and only) son is intact. =)

Michelle Richardson:  I’m so happy for you all. Reading this makes me feel so incredibly sad and downright ANGRY that my first son was circ’d. At least I questioned it and told the nurses I didn’t think it was a good idea. Instead if properly informing me or my severely sleep deprived husband (been up for three days) they drugged me and did it anyways. I’d about chewed her a new ass when she opened his diaper to show me his new raw and bloody penis and his entire body was completely swollen and purple. That moment will haunt me to my grave. I gave birth to the rest of my babies at home and now have two intact sons and 5 children who will go on to have intact sons (hopefully, with me as an intactivist they will).

D. F.  Oh, Michelle, I cannot even imagine the horror of that sight. Your poor, poor little man. Thank you so very much for all you do today - so no other mother and her son have to endure the same.

Michelle Richardson:  And, that’s why I do this. I do not want another mother to go through unrelenting guilt, knowing that her son had been sexually tortured and raped and skinned alive or another child to endure the agony of the knife against his most sensitive sexual organs when no one is saving him from the pain. My son has expressed a sincere desire to sue, “because he doesn’t want her to do this to another baby”. There isn’t a “consent form” in any of the records. He is 9 right now. When he is able, I will help him win!

Michelle Richardson:  I’d like to add: After my other boys were born I’d have sweaty nightmares that he had been taken to have his penis reduced only to wake up in relief that he was still intact. Those dreams lasted for four months (something about postpartum hormones). I’d snuggle them tight thanking God that my baby boy didn’t go through this insane cultural practice.  If I could, I’d have 5 more boys just to populate America with more intact boys! But I have a strong feeling my children will carry on the legacy of not only keeping their children intact but to teach them to teach their children the value of being intact….

J. S.  All my children are intact !

J. J.  My first 17 years old and second 2 are both intact

J. M. My first and only boy intact and perfect!!

J. C.   Michelle, I hope your circ’ed son makes his case and wins. Bless his heart.

M. M. makes me want to adopt 20 baby boys and start to restore ASAP.

L. W. T.  My first is intact as well as my 2nd!! I’m so thankful for obsessively reading while pregnant.

D. F.  Michelle, - I hope he wins his case as well. He CERTAINLY deserves it (and much more).

L.   - I, too, am so thankful for obsessively researching before pregnancy. It is true - the MORE you know about circumcision, the WORSE it is.

S. M. K.  My first son is intact. We had made that decision when I first got pregnant with our first baby 10 years ago.

V. D.   number 1 is intact!

J. M.  Michelle, - and any other mother who had a similar experience : my heart goes out to you - we all have to keep bringing this issue to light so other baby boys aren’t brutalized like this anymore!!!! So barbaric and tragic, I strongly believe it’s why so many young men act out violently in their early puberty, as a result of coming to terms with their own first interpersonal contact between their sexual organs and another human being. Sad sad sad!!!!

W. N.  I am one of those moms. My oldest is 14, and when he was born, I didn’t even know to question the practice. The good news is, he’s so miffed that it happened to him that he is now an outspoken advocate against it!

Gloria Lemay:  what amazing brave voices. Everyone brings something to this movement to end male genital mutilation. Thanks for sharing everyone. www.nocirc.org