What you don’t see

Why do we do skin-to-skin?

It seems to be pretty common practice these days to encourage skin-to-skin contact directly after birth. The benefits have been shown to calm and relax the mother and baby, regulate the baby’s heart rate, breathing, temperature, and blood sugar. It stimulates their digestion and interest in feeding, and stimulates the release of hormones to support breastfeeding and mothering. 

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What happens during skin-to-skin contact?

When skin-to-skin is initiated after birth, it starts a strong instinctive behavior between mother and baby. The mother will have a surge of maternal hormones that urges her to touch, stroke, smell, and engage in her baby. The baby instinctively follows a unique process that, when left alone and uninterrupted, will cause the baby to work itself to the breast to self-latch. The baby can even recall this behavior in future feeds! This helps avoid some common breastfeeding problems. 

This is an important bonding process, and it is best to limit separation of mother and baby that would disturb this extremely valuable time. 

So, Why Doesn't The Mother and Baby Get This Same Opportunity After Cesarean?

Good question, and one that I have been asking for over a decade. The standards have definitely changed since 2010. Back then, babies were whisked away to the warmer for weights, measurements, and medications. There wasn’t even the standard practice of delayed cord clamping. Everything was so rushed and aggressive. Now there is more patience, more calm, and moms get to hold their baby’s right away… except for our cesarean moms. 

This process does vary from facility to facility. Some hospitals have a standard, while some just do what they can with what they have. Well, I have a thought about this “standard.” That thought is… IT NEEDS TO CHANGE! We need to give the cesarean mother the same respect and the time she needs right after birth to bond with her baby. Most mothers are not even aware they can do such a thing. What thing is that, you ask? It is SKIN-TO-SKIN IN THE OR. Where the family is never separated, they remain together, and the mother is able to hold her baby as though she birthed vaginally. 

I believe this change has to come from the demand of the patients, the nurses, the providers – FROM EVERYWHERE! Hospitals need to provide adequate staffing to support this necessary process and to prioritize the bonding of mother and baby that sets them up for success down the road. Cesareans can be very upsetting, disappointing, or even traumatizing to a mother. I go into this a little more in my blog, All About VBAC. There are serious risks involved from this major abdominal surgery. Yet there is an expectation to behave afterwards as though it is all about you being a mother, not a post-operative patient.

Surgical patients receive extra care, extra rehabilitation, physical therapy, while most women who have a cesarean are simply discharged home with instructions to not lift anything heavy and to keep the area clean and dry to prevent infection. There isn’t a discussion about how she may be feeling confused or detached, or that maybe she can’t connect with the feeling that she just gave birth because the INVISIBLE PROCESS AT BIRTH has not taken place in her body. She did not feel the surge of hormones a mother gets with expulsion of the baby in a vaginal birth. 

The birth is not finished when the baby is born. There is a specific hormonal balance following the vaginal birth process. The mother still has needs immediately after she births. Immediately after giving birth, a mother has the capacity to reach a level of oxytocin that is higher than for the delivery itself  (Odent et al., 2013). This peak of oxytocin is vital, not only to encourage the delivery of the placenta and minimal blood loss, but also because oxytocin is the main component in the cocktail of love hormones a woman is supposed to release during that phase of labor. 

Oxytocin is a hormone whose release is highly dependent on environmental factors to the extent that the environment can influence or interfere with this special hormonal peak just after the birth of the baby. 

First Factor: The mother must not be cold for peak oxytocin release, but operating rooms are often very cold to limit infection opportunities. 

Second Factor: the mother must not be distracted when discovering her baby. She needs to feel the contact of baby’s skin, look in the baby’s eyes and smell the odor of the baby. Any distraction can inhibit the release of oxytocin. Can you imagine all the distractions happening in the operating room?

Yes, synthetic oxytocin is given after birth, but it only helps facilitate the detachment of the placenta. It won’t recreate the feelings of love we have when our own natural oxytocin is released, because in order to be effective, this release must be pulsatile. The higher frequency of pulses, the more effective the hormone is!  

Oxytocin is never released in isolation. In the hour following birth, the physiologic processes that create this high peak of oxytocin also emit a high level of prolactin, or the ‘motherhood hormone’. This is the most effective situation for inducing love of babies! Oxytocin and prolactin complement each other. Estrogens activate the oxytocin and prolactin receptors. These hormones are still circulating during the hour following birth and have not yet been eliminated. They all have a specific role to play in the mother-newborn bonding interaction. 

During labor, the mother will release an opiate-like hormone called endorphins, and the baby releases its own during the birth process as well. This also facilitates the beginning of attachment of the mother and her baby. 

All of these processes are happening in the first hour. All of these processes are interrupted and taken away from the mother and baby when she is not given the opportunity of skin-to-skin in the operating room. Skin-to-skin seems even MORE important in the operating room, since the cesarean mother does not get the same physiologic release of the hormone cocktail that the mother who births vaginally gets! The attachment, bonding, and postpartum recovery time may be delayed by cesareans births. 

Bottom Line: Cesarean births must be taken more seriously, as there is more to it than just the surgery. Because of these invisible processes that are taking place within the first hour of birth, skin-to-skin MUST be offered as soon as possible to each and every woman who has a cesarean birth. We have to help her so that she can achieve better bonding, better attachment, better feelings toward her cesarean experience, better breastfeeding, better healing… better EVERYTHING! For her, for her baby, for her family, for society, and for the human race.