The
Nature of Birth and Breastfeeding
By
Michel Odent Bergin and Garvey, Westport, Connecticut, London; 1992
|
A Book review by Lakshmi Landa, October 2008 As
said in the Introduction to the American edition, there are many
paradoxes in attitudes towards childbirth in the 1990’s when this book
was written. Fetal
monitoring has proven to increase the rate of cesarean sections, yet it
is continually used. The
most impressive childbirth statistics come from Holland where 1/3 of
births occur at home, yet home birth is continually said to be
dangerous. Where midwives
are numerous, birth statistics are best, yet where birth statistics are
poor, midwifery is devalued. Reducing
medical costs is a high priority, yet routine costly electronic fetal
monitoring continues. Serious
concern is shown about long-term ill effects of drugs used during labor
esp. with regard to cancer and drug addiction, yet there is no general
tendency to reduce drug use. Michel
Odent says the existence of so many paradoxes is typical of a period of
transition, and we are transitioning now to a post-electronic age of
childbirth. Obstetrics is
discovering its own limitations and is finally evaluating the power of
the environment in the period surrounding birth.
The same is true of breastfeeding.
“The
best way to make a birth longer, more difficult, more painful (and more
dangerous) is to stimulate the neocortex”.
(p 56) This
quote appears in a chapter about the 2 brains of humans, the primitive
brain, which we share with all mammals, and the new brain or neocortex,
which is a distinguishing feature of humans compared to other mammals.
He calls the first one, the “old” brain; old in that it is
the source of our existence and development as living beings and also
old in that it reaches maturity very early on in our lives.
This brain governs emotions and instincts and is associated with
the hormonal system and the immune system.
One of its functions is like a gland releasing the hormones
necessary for the birth process inducing efficient uterine contractions
and protecting against pain as well.
The new brain, neocortex, is the main distinguishing feature of
human beings. Its activity
during birthing hinders the activity of the old brain; in fact all
inhibitions come from it during birth as during any sexual activity.
Development
and function of the two brains: The
primitive brain matures at the age when we are still dependent on our
mothers. Since we now know
that our attitude towards life is deeply ingrained during this time
(prenatal up to the age of 2 or so), it follows that a positive attitude
towards life goes hand in hand with the undisturbed development of a
strong primitive brain (p 68). This
scientifically explains the findings of prenatal psychology and also
Freud’s work discovering the importance of the primal period and first
years of life. M.
Odent’s speaks often of the primal period (early life experiences of
prenatal, birth and the first hour after birth) as key in influencing an
individual’s life. He
makes a further correlation in this book to “suspect that any
serious preparation for birth should concentrate on this period!”
because the part of the brain that is active and most important during
birthing develops during this time. (p 56) This
chapter on the old and the new brains helps us rediscover the critical
role the old brain plays in physical, mental and emotional health and
how to nurture it for mature development.
In addition to its role in birthing and sexual life, its mature
development is key in achieving true health.
“Health is a matter of how well our oldest adaptive systems work – those that were the first to mature. The old brain is directly involved in what we call health” (p 64) Odent
also postulates the relationship between one’s religious sense and the
power of water that is developed during this period, and how singing, as
an activity unique to humans, and other artistic activities harmonizes
our two brains. Working
with the breath, voice, language, when we sing the two brains mange to
harmonize their powers of control.
This is why there were weekly singing nights at the hospital he
worked at for years in France where pregnant couples were invited along
with the whole hospital staff. With
regards to birthing, the part of the brain that is active during birth
is the primitive part. If
the neocortex is stimulated, a birthing woman is pulled out of
nature’s course of birthing and labor may stop.
Birth is easier when the new brain, the neocortex, takes a back
seat. “A
reduction of neocortical control is a prerequisite for a normal
physiologically directed delivery.” p 100 Other
Themes of the book: Privacy How
to use water successfully for birthing The
adrenaline rush for second stage of labor The
post-electronic age of childbirth Interference
in the first moments after birth around the world The
love hormone – oxytocin Family
and Social Structure Privacy
“Medical
students should be asked on their examinations:
What kinds of environmental factors inhibit human parturition?”
(p 9) Even though
this is a good question, in the current climate they would not find this
information anywhere in the textbooks, at least not in books about human
birth. Scientists who have
studied the birth of other mammals have found some interesting answers.
Birthing mothers are disturbed by unfamiliar places, by moving
and by being watched. Mammals
in general hide and isolate themselves not only from predators but from
their own social group. Perhaps
the strongest theme in this book, M. Odent brings up the issue of
privacy for the birthing woman in every chapter.
While acknowledging the complex role of environment during
birthing, he offers this aphoristic statement:
“The length of labor is proportionate to the number of people
around.” Whether an
electronic fetal monitor or obstetrician, midwife, hospital staff, doula
or father, any observer is likely to prolong the process.
At
that moment when the laboring woman is ready to shift into another level
of consciousness, go off to another planet as M. Odent says, any
stimulation to the neocortex will hold her back and prolong the labor.
Fetal monitors are the biggest offenders of this problem of
observation, but it also could be a father looking the mother in the
eye, the presence of a horde of birth attendants, or a camera.
Bright lights and listening to people talking logically and
rationally are also offenders. Security
is important to protect this privacy so a father or birth attendant can
play this role giving the mother her space to go off to that other
planet. In
olden times and in various cultures, women often gave birth alone,
sometimes in a small hut, with an experienced person watching from a
distance. To
make birth as easy as possible, we need a radically new attitude that
relinquishes attempts to control birth with chemicals, machine
monitoring, or even instructions such as how to breathe, when to push or
what position to use. The
need for privacy continues after birth to stimulate the placenta
ejection reflex and to avoid hemorrhage.
Skin-to-skin, eye-to-eye contact between mother and baby along
with a warm, dark, silent place helps mother secrete the hormone
necessary for success of this stage.
An uninterrupted, unobserved mother would also naturally assume a
position that minimizes blood loss so she need not be told what to do.
(p 40) Most
Western languages do not have a word for privacy that refers to the
state of not feeling observed, with a positive connotation.
“Why are so many languages deprived of a concept that
corresponds to this deeply rooted need in all mammals to isolate
themselves to give birth and to die?”
Probably because most known human cultures have denied the
mammalian need for this privacy for so long that the concept has been
lost. This concept is of
key importance as we move to the post-electronic age when it would be
beneficial to move more births from hospitals into homes and to
significantly increase the ratio of midwives to obstetricians. We must
also redefine authentic midwifery (p 101-5) and go back to its roots to
understand better the physiological processes of birth. 1 How
to use water successfully for birthing
M.
Odent suggests a laboring woman not enter a warm bath until the onset of
hard labor. Then one can
expect she will dilate quickly, say 1-1 ½ hours for a first baby. The
contractions are less intense, less painful and more efficient in warm
water. Water is an obvious
easy way to dramatically reduce adrenaline and it is a well established
fact that low adrenalin makes the first stage of labor easier and
faster. 2 He
goes on to say that there comes a time when mothers in water feel the
contractions are not working efficiently any longer; then when she gets
out of the pool and experiences the cooler atmosphere the baby is born
after a few huge contractions. Odent
tells us that the adrenalin rush caused by the change of temperature
creates a fetus ejection reflex. The
adrenaline rush for the second stage of labor
“There
are documents suggesting that various human groups throughout history
have know that a sudden sense of fear can trigger a fetus ejections
reflex at a very precise stage of the delivery in precise
circumstances.” p 34 In
some cultures, during a difficult labor someone might shout from a
distance triggering the needed fear reaction,.
However, in a normal birth without any evidence of interference,
this fear reaction can be observed. (This is the well known self-doubt
phase of course when near complete dilation.)
M. Odent calls this “physiological fear.”
There is a sudden change in the mother’s hormonal balance, a
rush of adrenalin, which can be expressed as anger for some women or
euphoria for others, and the fetus ejection reflex begins working. “Any
emotion can be seen as a change in the hormonal balance, and it has a
specific role to play.”
p 34 Just
by listening, an experienced birth attendant will know more about how
labor is progressing than any vaginal or other exam.
The first and second stage of labor are not distinguished by
measurement of dilation but according to the way she behaves and her
state of consciousness, i.e. her hormonal balance.
(It is interesting to note that different ethnic groups may
perform differently in this area of dilation and the onset of the
ejection reflex. Some may
fully dilate well before the reflex begins while others may begin the
reflex before full dilation. p 36) The
post-electronic age of childbirth
When
vaginal exams for dilation measurement give way to emotional checks, the
post-electronic age will be established.
The only technology needed might be a small hand held device to
evaluate the baby’s heartbeat. Such
a piece of equipment already exists, an ultrasound stethoscope called a
Doptone or Sonicaid. Specialists
will always be needed for the times when physiology is inefficient such
as to do epidurals when endorphins aren’t present, drips when the
pituitary hormones are not sufficient, and cesareans to rescue babies in
distress. The
best time to decide whether to give birth at home or hospital is during
the first stage of labor. Odent
says the label “high risk” is a risk itself by triggering and
maintaining a state of anxiety. When
it comes to the birth, he says, based on his own experience: “As a
general rule, the risks are minimal when the first stage has been
straightforward.” He does
not refuse attending a home birth just because of breech position,
previous c-section or a first time mother over 40 yrs old.
“In
a big modern hospital, very few women can achieve the complex hormonal
balance that makes a normal birth possible.” (p 79) However,
M. Odent suggests we needn’t give up but rather look for substitutes
for privacy during this period of transitioning to the post-electronic
age of childbirth. “Self-Hypnosis
might be one of the techniques adapted to the present situation.” (p
106) Pregnant women trained to use this technique can switch
off completely at will and escape from reality.
This is similar to visualization, multisensory visualization and
guided imagery used in the USA and to the sophrologie used in the French
and Spanish speaking countries. He
stresses that self-hypnosis maintains one’s own autonomy which is
different from authoritarian hypnosis that has been used in obstetrics
for a long time and that implies a dependency on the hypnotist. Interference
in the first moments after birth around the world
A
majority of cultures the world over have found excuses to deny the need
for privacy in the period of time surrounding birth and specifically
have prohibited or reduced the consumption of colostrum. (see p 74-80)
This probably had an evolutionary advantage as it effectively
distorts the relationship between mother and the newborn and the
capacity to dominate any and all forms of life was important for
survival of many human groups. Now
priorities are different -- weakening respect for the planet and
interfering in the mother-baby relationship cannot be advantageous any
more. “Cross-cultural
comparisons suggest a link between the quality of the mother-baby
relationship and respect for Mother Earth.” (p xii)
Three
known cultures that did not disturb mother/baby early connections, the
Huichols in Mexico, Pygmies in the deep equatorial forests and the
Maoris of New Zealand, are also known for their respectful attitudes
towards people and Mother Earth.(p 67 and 81) “A
study of the connections between Man and the Earth can no longer be
dissociated from a study of the attachment between baby and mother.”
(p 67) M.
Odent invokes a “Colostral Revolution” to fuse the image of the
Mother and the image of Mother Earth.
A
whole chapter called Colostrum and Civilization tells us to keep mother
and baby together and give them privacy >
not only for the health benefits from antibodies, microbes necessary for
healthy intestinal flora and EFA’s (essential fatty acids necessary
for brain development) present in colostrum; >
not only to take advantage of the state of consciousness and hormonal
balance of the mother and baby to get a good start on breastfeeding and
bonding; and >
not only to encourage a safe delivery of the placenta and reduce risk of
hemorrhage, >
but to affect babies to respect and care for our earth home which could
very well save our world from the destructive path we have created for
ourselves. Birth
Hormones
The
chapter called The Hormone of Love, tells us that “the release of
oxytocin actually peaks in the hour after birth when the mother and baby
make first contact.” p109 It
is known as the hormone of love by scientists who have triggered
maternal behavior in virgin animals by injecting this hormone in certain
areas of the brain. Prolactin
is the hormone for secretion of milk, and is the basis for nest building
and triggering aggressively defensive behavior in lactating females. It also reduces libido and tends to engender subordinate and
submissive states of mind as well as certain anxiety. “All of these behavior effects are easily explained in
terms of the survival of the species.”
p 110 M
Odent reflects that a unique characteristic to our Western culture is
that high levels of Prolactin are present for only a very short period,
due to having few children and brief periods of breastfeeding, as
compared to other times and other cultures.
He says the scarcity of Prolactin is unique to our society and
speculates on the cultural characteristics of what such a society might
entail, such as: Ø
the satisfaction of the needs of the baby will not be much of a
priority Ø
the need for privacy on the part of the woman in labor or after
birth will not be recognized Ø
there will be an abundance of erotic stimuli Ø
lack of respect for the laws of nature Ø
cavalier attitude toward natural phenomena and a tendency to
“play with fire.” In
such a society there would be little counterbalance to the purely
masculine brain. And
what would characterize a society where Prolactin is abundant? Ø
needs of babies and children would be respected and even given
priority Ø
erotic stimuli would be less ubiquitous Ø
great respect for the laws of nature and for destiny. He
says such a society can actually be found among the Brahmin caste of
Hindus where children are normally breastfed 3-5 years and men spend
much time in deep meditation getting saturated with endorphins aiding
the release of Prolactin. He
notes that Brahmin priests often have unusually big breasts.
Odent
poses the question: How can
we break the vicious circle of humanity dominating the biosphere to the
point of its destruction, in a society where Prolactin is scarce? Family
and Social Structure
In
an effort to discover the physiological ideal for the duration of
breastfeeding, Odent says we can (a) compare humans with other mammals
and take into account the duration of pregnancy, degree of maturity at
birth, lifespan, special nutritional needs of our big brain, etc.
This approach will not be precise, but it suggests breastfeeding
among humans was originally maintained for years not months; (b) study
individuals who have been breastfed different lengths of time or not at
all; and (c) compare societies and establish correlations.
He
goes on to discuss observations of cultures with polygamy and prolonged
breastfeeding, the comparison of divorce rates esp. in the first year
after the birth of a child, and
revelations by couples about reduced libido during breastfeeding and
concludes that the duration of breastfeeding and the family structure
are two topics we should never disassociate.
This is an interesting chapter about polygamy noting that in all
such societies breastfeeding is prolonged for several years.
Polygamy is by far the most common marital arrangement the world
over – with 76% found in a study of 558 societies considered as
representative. He talks
about prolonged breastfeeding as a cause and effect of marital
structure. He says in most
mammalian societies females have great sexual freedom and describes the
social reasons for marriage among humans giving examples of norms in
polygamous societies and giving a little history of polygamy and
monogamy in the western Judeo-Christian world. Odent
says we should look harder at the breastfeeding situation when talking
about advantages and disadvantages of polygamy vs. monogamy, and vice
versa, we should look at family structure when considering duration of
breastfeeding for the sake of the baby and survival of the (human)
species. Another
interesting observation: we are at a phase of history in which family
structures are evolving rapidly. Although
we are officially a monogamous society, we are in fact a society with 2
kinds of polygamy. (1)
serial monogamy where people have successive spouses and also where
cohabitation is common and (2) where marriage partners have other sexual
partners - a study of American and British middle classes found 4 of 5
married men and women had at least one second partner averaging 5 years
after marriage (with women taking the plunge first!) Odent
acknowledges that these kinds of discussions might be considered
scandalous but it is simply factual and they are issues we cannot evade
any longer. What kind of
family is the most appropriate to meet the basic needs of human babies?
And to what extent is the nuclear family as a model maintained by
childbirth in hospitals? He
says simply we need to raise these issues.
Another
good point on breastfeeding: Mothers
need to avoid the dangerous trans-fatty acids that are now common in the
national diet for the sake of their babies who need real fatty acids for
brain development and in the composition of cell membranes.
He also says when breastfeeding mothers lose weight, more
trans-fatty acids are released into the milk carrying with it poisons
from herbicides and pesticides stored in mother’s body.
In such a case, the mother can take EFA supplements. It
is interesting that pregnant and breastfeeding women are often isolated
in their social group, having to fend for themselves while laboring
women are surrounded with “help” and “support”.
Our mammalian needs are in fact the opposite – pregnant and
breastfeeding women need support and the laboring woman needs privacy. Superscripts:
PERSONAL
COMMENTS: If
we are to continue offering birth care in hospitals, creating emotional
connections to the people and place can offer the familiarity and
comfort level that will enable birthing women to relax and go to the
level of consciousness where natural birth takes place.
M.
Odent describes natural birth as when mothers are left to themselves to
follow their instincts, often comparing humans with other mammals.
This necessitates privacy and non-interference and often involves
a rush of adrenalin for the second stage to promote a fetus ejection
reflex. He describes the
automatic actions of laboring mothers in terms of choosing the birth
position and expressing their emotions.
In other words, they don’t need to be told what to do. Hypnobirthing
appears at first glance to be different in that it promotes the close
companionship of the father/birth partner and doesn’t emphasize this
rush of adrenalin for the second stage.
However, it is not contrary because of (a) the quote just above
about familiarity of the environment and that (b) in the absence of fear
and adrenalin, a mother will lie quietly and the hormones may work
efficiently to direct the body through labor and delivery.
My
experience in hearing from HypnoBirthing mothers is that some of both
occur. Some do indeed lie
quietly throughout most of the labor as in the videos shown in class
while some say they “just had to push” and get actively involved in
the second stage. I have
also observed that those who had interference usually do not fare as
well, while those who are confident and left on their own seem to do
well on their own. I
am surprised to see this book was written in 1992. How popular has it
been? How much influence
has it had on birthing practices world-wide?
What has Michel Odent been doing since then? |