December is the month when the birth of Jesus preoccupies Christians. But birth issues should preoccupy all of us, always, until we fix our baby-harming system. If Jesus had been born under USA standards, he might not have been the wise, calm, peaceloving person he became. Why? Because birth has shifted from a welcoming to a punishing experience for mom and baby. These are concerning for moral development because first impressions of life and relationship can affect one’s social capacities neurobiologically and one's view of the social world.
My students and I cover a number of areas of birth in the next posts. The first one is below. All that we raise are ethical issues. When we have a bias it is first for babies and then for mothers.
Birth: Routine Institutionalized Trauma
Trauma at any point in life is detrimental. But in early life it can set the course for the rest of life. Childbirth is traumatic for most mothers and children now, for a host of reasons. Why?
One main reason is that there is common inattention to natural processes. Doctors (and some moms) want to have control over natural processes and make things happen according to a schedule they have chosen, to the detriment of the child.
Which due date? Unless there is in vitro fertilization, there is no way to know the exact due date for a child. Physicians can only guess, making several sets of assumptions that lump all conception possibilities into the same set (e.g., fertilization on the 14th day of ovulation, 28- day periods). Due dates are guesses but they are often treated by doctors as written in stone so that they induce labor when the due date passes, even though in natural circumstances the baby signals the mother when it is ready to be born, starting a cascade of hormonal events that lead to birth. Doctors who take the guessed due date as doctrine are likely to induce labor when the mother moves too far past the guessed date, even though it is likely that the baby is not ‘ripe’ and ready to be born. This will be traumatic for the baby.
Why allow inducement around guessed due dates? As the director of the National Institutes of Health, Thomas Insel, has pointed out, there has been insufficient research into the effects of exogenous oxytocin on maternal and infant outcomes. It is evident that exogenous oxytocin works differently from endogenous oxytocin. The latter comes in waves to propel contractions and collaborating with endogenous painkillers whereas the former overwhelms natural systems, making contractions too painful to bear, and leading to the use of epidurals (painkillers), which leads to the drugging of babies. It takes weeks if not months for the drugs to leave the baby’s body because it takes about that long to have full liver function. Drugged babies often have difficulties latching on to breastfeed, sleep too much and have difficulties with early bonding and communication processes.
What happened to full-term birth? The old perception of full term birth was 40-42 weeks. At that age, babies have around 25% of their brains developed. Now, 37 weeks is considered full-term. But a baby born before 40 weeks will not have 25% of the brain developed and may lack other things such as muscle development needed for breastfeeding. Why is medicine encouraging these underage baby births? An underdeveloped baby is difficult for the mother.
Why are laboring mothers treated as spectators? Instead of being in control of their birth experience, working in concert with the baby’s signals, mothers have been put in the place of spectators as medical personnel take charge of the birthing process. This leads to all sorts of harms to mother and child and their relationship.
Why aren’t mothers encouraged to (learn how to) attend to their body signals? Mothers have been taught to be alienated from their bodies (perhaps in part due to their traumatic early experiences) and so they often have difficulty giving birth (e.g., too much tension), leading to a cascade of interventions that harm the baby (inducement of labor, painkillers to mother that drug the baby)
Why allow doctors to drug babies? Women are condemned if they use drugs during pregnancy, yet doctors routinely drug the pregnant mother, drugging the baby too. Painkilling drugs for mother enter the baby who is unable to expel them for weeks if not months due to underdeveloped liver function. If we put babies first, every recourse should be taken to avoid any drug use. This means moms need to be prepared and empowered to take charge of their own birthing experiences with known ways to use the body’s painkillers instead of exogenous drugs.
Why allow babies to be hurt? Painful post-natal interventions are conducted on babies for no medical reason but as a matter of habit (e.g., eye treatment for side effects of gonorrhea or chlamydia even though these are treated in prenatal care). If there is no medical reason for pain inducement then it should not be done. Many procedures can wait for hours if not days to avoid a painful first impression of the world for the baby. Parents can prepare a refusal letter for procedures like vitamin K shots and hepatitis vaccination (see more here):
Where is maternal and familial informed consent? Long before labor, are mothers informed of the dangers of inducement, artificial oxytocin, epidurals, and c-sections? Do parents give informed consent to all the traumatic treatments of the neonate (e.g., suction, circumcision)? Are they made aware of how fetuses and neonates do feel pain and how early pain makes lasting impressions on the brain? If not, we have an ethical problem.
To be an ethical professional, one needs to be aware of one’s limitations. The temptation through the course of birth and after is to play god--to manipulate and control the mother, the baby and the outcome, without taking into account the longterm collateral damage. Although most hospitals are past strapping mothers down, they still restrict her movements, movements that would facilitate the birth and lessen pain. I have talked to nurses who laugh at mothers who come in with birth plans. Such medical personnel put themselves above the mother and baby. It’s easy to mistreat people when you feel superior. Instead we should be educating mothers how to take back the birthing experience.
One could argue that human rights of mothers and babies are being violated left and right. Mothers and babies should not be enslaved to medical procedures and institutions. Many a mother-child dyad has been traumatized by these practices. Britain reports a huge rise in traumatic birth. See here for an alternative view.
Posts in this series:
Lanius, R.A., Vermetten, E., & Pain, C. (Eds.) (2010). The impact of early life trauma on health and disease: The hidden epidemic. New York: Cambridge University Press.
Trevathan, W. (2011). Human birth. New York: Aldine de Gruyter.
Wagner, M. (2006). Born in the USA: How a broken maternity system must be fixed to put women and children first. Berkeley: University of California Press.
For more information on early experience, see new book:
Narvaez, D., Panksepp, J., Schore, A., & Gleason, T. (Eds.) (2013). Evolution, Early Experience and Human Development: From Research to Practice and Policy. New York: Oxford University Press. Blog post about the book here.