What is the future of the human capacity to give birth? What is the future of underused physiological functions? Should we expect an evolution of Homo sapiens in relation to the way babies are born? Can fast-developing scientific disciplines induce a new awareness?
In this wide-ranging, interdisciplinary look at the future of birth, renowned obstetrician Michel Odent takes the question ‘Do we need midwives?’ as a starting point. If a paradigm shift occurs, what kind of midwives shall we need? For how long can we go on neutralizing the laws of natural selection? Are human beings able to raise vital questions before it is too late? Unprecedented situations should first and foremost inspire appropriate questions.
CHAPTER 9
At the edge of the precipice
When considering the current phase of the history of childbirth and the history of mankind, some analogies may reflect a little dose of optimism while others are more pessimistic. I have occasionally used the phrase ‘at the bottom of the abyss’. Such an easily understood analogy is appropriate to transmit pure pessimism and hopelessness. Since emerging scientific disciplines keep providing reasons for hope and therefore optimism, we’ll adopt the phrase ‘at the edge of the precipice’. When at the edge of a precipice it may still be possible to stop and take another direction. The best way to justify our choice is to refer once more to one of the most important scientific discoveries of the second half of the twentieth century, because this discovery has the power to challenge thousands of years of cultural conditioning and provides reasons for hope.
A twentieth-century scientific discovery
Those of my generation are in a position to recall how we suddenly learnt – from a scientific perspective – that a human newborn baby needs its mother. This had been understood for thousands of years – by farmers in particular – in the case of non-human mammals. However, even after the advent of the concept of evolution of the species, our deep-rooted cultural conditioning made it difficult for us to accept our mammalian roots. When I was an externe (medical student with minor clinical responsibilities) in a Paris hospital, in 1953, I had never heard of a mother who would have said, just after giving birth: ‘Can I keep my baby with me?’ The cultural conditioning was too strong. Everybody was convinced that the newborn baby urgently needed ‘care’ given by a person other than the mother. The midwife was quick to separate mother and baby by cutting the umbilical cord and putting the baby in the hands of a nurse. This is what she had learnt to do in midwifery school. At that time, the same would happen at home births. Then, while staying in the maternity unit, babies were in nurseries and mothers elsewhere. Mothers did not ask to stay in the same room as their baby.
The turning point had its roots in the middle of the twentieth century, when Konrad Lorenz, Niko Tinbergen and Karl Von Frisch collaborated in developing ethology as a separate sub-discipline of biology. Ethologists study a particular behavioural process rather than a particular animal group. For example, they may study aggression in a number of unrelated animals, including humans. It is easy to understand their capacity to inspire human studies. This is how, when they introduced the concept of critical periods for mother-newborn attachment, explaining that among mammals in general there is a crucial short period of time immediately after birth that will never happen again, they inspired studies of humans.
The time was ripe to evaluate the effects of immediate skin-to-skin contact between mother and newborn baby as an absolutely new intervention among humans. The names of Marshall Klaus and John Kennell in the United States are associated with such studies,1 which were also conducted in Sweden.2,3,4 In parallel, other researchers were interested in the behavioural effects of hormones that fluctuate in the perinatal period, particularly oestrogens.5,6,7 This was also the decade when a sudden interest in the content of human colostrum developed. Until that time ‘colostrum’ was a fruitful keyword in veterinary medicine, but not in human medicine. In the 1970s, the focus was on local antibodies (IgA) and anti-infectious substances.8,9,10 After thousands of years of negative connotations human colostrum was officially recognised as a precious substance.
In the 1970s we also learned that, when there is a free, undisturbed and unguided interaction between mother and newborn baby during the hour following birth, it is highly probable that the baby will find the breast during that hour: human babies usually express the ‘rooting reflex’ (searching for the nipple) during the hour following birth, at a time when the mother is still in a special hormonal balance and has the capacity to behave in an instinctive ‘mammalian’ way. The result of the complementary behaviour between mother and newborn baby is an early initiation of breastfeeding.11, 12 For obvious reasons, nobody knew, before the 1970s, that the human baby was programmed to find the breast during the hour following birth.
The 1970s was also a period of rapid development in immunology and bacteriology. We mentioned the importance of studies about the easy and effective transfer of maternal antibodies (IgG) across the human placenta.13, 14 This implies that the microbes familiar to the mother are also familiar, and therefore friendly, to the germ-free newborn baby. This was the beginning of a new vision of human birth from a bacteriological perspective. We were in a position to understand that the main questions are about the first microbes that occupy the territory and become the rulers of the territory. In other words, we were in a position to understand that from immunological and bacteriological perspectives a newborn baby ideally needs to be in urgent contact with the only person with whom he or she shares antibodies, and in a place that is bacteriologically familiar.
Immediate practical implications
This is how, in a nutshell, scientists revealed in the 1970s that a newborn baby needs its mother, challenging thousands of years of tradition. The discovery had immediate practical implications. It is not by chance that the concept of ‘rooming-in’ suddenly developed: it implies that mother and baby are in the same room while staying in the maternity unit. In fact, this concept originally appeared in some American hospitals during World War Two. But at that time the main reasons for this new organisational arrangement were practical; it was a way to adapt to the nursing shortage. In some hospitals, it has been a way to reduce the effects of epidemics of neonatal infections in nurseries. This concept spread out all over the world. In 1981, I was invited to speak at a conference about ‘rooming-in’ in Olomouc, Czechoslovakia. At that time, in the context of the communist regime, being critical of the concentrations of neonates in nurseries was considered revolutionary. Also in 1981 I went to Bogotà, Colombia, where they had been practising ‘kangaroo care’ for premature babies for two years (although the term ‘kangaroo care’ was not yet used). They had understood that when a premature baby does not need help to breathe the mother can be the best possible incubator.
Also at that time, there were unexpected effects from the sudden popularisation of the concept of ‘bonding’ immediately after birth. While scientific disciplines were studying the interaction between mother and newborn baby, some birth activists and theoreticians understood that the newborn baby needs its parents. It was exactly at that time that the idea of the baby’s father participating in the birth began to spread all over the world. Today, immediate contact between mother and newborn baby, even on the operating table after a caesarean birth, is another practical consequence of the discoveries of the 1970s.
A transitory phase in our history?
In spite of these concrete practical changes, these scientific advances had limited effects. We can easily understand why: it is simplistic to claim that, according to modern scientific knowledge, a newborn baby needs its mother. In fact we should emphasise that the newborn baby ideally needs a mother who is in a specific physiological state just after giving birth, before hormones such as oxytocin, prolactin, endorphins, vasopressin and so on are eliminated. Ideally the birth would have occurred in such a context that the mother could start transmitting her microbiome to the baby. Finally, in our societies, these conditions are almost never met. Let us hope that we are in a transitory historical phase, between the time when the basic needs of newborn babies have been seriously identified and the time when we’ll eventually dare to reconsider our understanding of the basic needs of labouring women.
Read more here
Klaus, M.H., Kennell, J.H. Maternal-infant bonding, CV Mosby, St Louis, 1976
De Chateau, P., Wiberg, B. ‘Long-term effect on mother-infant behavior of extra contact during the first hour postpartum. I. First observations at 36 hours.’ Acta Paediatrica Scand 1977;66:137
De Chateau, P., Wiberg, B. ‘Long-term effect on mother-infant behavior of extra contact during the first hour postpartum. II. Follow-up at three months.’ Acta Paediatrica Scand 1977;66:145.
Schaller, J., Carlsson, S.G., Larsson, K. ‘Effects of extended postpartum mother-child contact on the mother’s behavior during nursing’. Infant Behavior and Development 1979 (2):319-324
Terkel, J., Rosenblatt, J.S. ‘Humoral factors underlying maternal behaviour at parturition: cross transfusion between freely moving rats.’ J Comp Physiol Psychol 1972;80: 365-371
Siegel, H.I., Greenwald, M.S. ‘Effects of mother-litter separation on later maternal responsiveness in the hamster.’ Physiol Behav 1978;21:147-149.
Siegel, H.I., Rosenblatt, J.S. ‘Estrogen-induced maternal behaviour in hysterectomized-ovariectomized virgin rats’. Physiol Behav 1975;465-471.
Jelliffe, D.B., Jelliffe, E.F.P. (eds). ‘The uniqueness of human milk.’ Am J Clin Nutr 1971;24:968-1009.
Jelliffe, D.B., Jeliffe, E.F.P. Human milk in the modern world, Oxford University Press, 1978
McClelland, D.B., McGrath, J., Samson, R.R. ‘Antimicrobial factors in human milk. Studies of concentration and transfer to the infant during the early stages of lactation.’ Acta Paediatr Scand Suppl. 1978;(271):1-20.
Odent, M. ‘The early expression of the rooting reflex.’ Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynaecology, Rome 1977. London, Academic Press, 1977: 1117- 19.
Odent, M. ‘L’expression précoce du réflexe de fouissement.’ Les cahiers du nouveau-né 1978; 1-2: 169-185
Virella, G., Silveira Nunes, M.A., Tamagnini, G. ‘Placental transfer of human IgG subclasses.’ Clin Exp Immunol. 1972 Mar;10(3):475-8.
Pitcher-Wilmott, R.W., Hindocha, P., Wood, C.B. ‘The placental transfer of IgG subclasses in human pregnancy.’ Clin Exp Immunol. 1980 Aug;41(2):303-8.