Wednesday, August 22, 2012

We know better now . . . right?

The early twentieth century was an interesting time in birth and childcare.

Twilight Sleep
In 1899, German doctors began treating wealthy women with scopolamine and morphine to create labor in a state of delirium. The drugs created an amnesia that made women unable to remember the birth process. The practice was common in the US for decades afterwards. After my grandmother delivered her son in the 1940s, the nurse asked her if she wanted to see her baby. She asked, "What baby?"

"Twilight sleep" was discontinued after people realized that drugging mom (and thus baby) with morphine meant the baby came out weaker and with more breathing problems. In 1958, Ladies' Home Journal published nurses' stories of what the mothers themselves couldn't remember: women giving birth in a drug-induced psychosis, women clawing to get out of the wrist straps that were used to restrain them, women's cries stifled with masks. Husbands didn't know, because they weren't present for any part of the birth.

While mothers spent days in a drugged state waiting for birth, someone had to care for their other children. It wasn't normal for fathers to take time off work to care for the kids while the mother was in the hospital, so if no grandmother was available, rich kids were farmed out to residential nurseries. It was assumed that children would be fine as long as someone was taking care of them, even if that person was a stranger. Because staff rotated shifts, no one person consistently cared for the same child. (Of course, we now put our children in daycares with strangers, but not 24/7.)

Psychologist John Bowlby documented the reaction of young children to a stay in such nurseries: first a distressed searching for a familiar adult, then despair, then an emotional withdrawal. Social worker James Robertson documented similar effects of long hospital stays on young children in a time when parents were discouraged from visiting. As a result, hospitals and nurseries changed the policies that kept children away from their parents for weeks or months.

But not all institutions recognized the importance of any human contact at all. The invention of incubators resulted in babies who got food and heat but virtually no affection. They created a new diagnosis for the resulting failure to thrive: "hospitalism." Infants in poorer hospitals weren't susceptible to this new ailment because they were still held by staff rather than in incubators.

In the 1940s René Spitz and Catherine Wolf studied 91 babies in orphanages where they basically lay in cribs all day. Despite getting good food, 1/3 of the children died in their first year of life. They compared this group to babies who were with their mothers in prison - all the imprisoned children survived to age 5, despite worse food and sanitation. The orphanages were acting on scientific principles of the day - it was reasoned that isolating children would keep them safe from communicable diseases. Turns out that isolation is much worse than disease: babies can literally die from a lack of affection.

Starting in the 20th century, baby formula began to be marketed as the most "scientific" way to feed your baby. (To be fair, it was better than the cow's milk and sugar concoctions people had been using for formula before!) Hospitals used to proudly report their high rates of bottle-feeding.

Now every health authority is backpedaling and trying to get moms to return to breastfeeding. Now we know about the immune-system benefits of the first milk, even for moms who don't plan to breastfeed more than a day or two. And the evidence is clear that breastfed babies have less risk of ear infections, diarrhea, and pneumonia. For mom, the benefits include less cancer and less heart disease.

Birth interventions
Today, we've learned from much of the evidence. We don't handcuff birthing women. We place children in foster homes rather than orphanages (though, sadly, not everywhere). Currently, "kangaroo care" or skin-to-skin contact for premature infants is gaining popularity. Skin time with an adult gives the baby the heat it needs while also helping parent and child bond.

And yet our birth practices could stand to return to some of the methods of past centuries, before birth was medicalized. Medical interventions like c-sections and fetal heart monitoring can save lives when they are really needed, but in most cases a low-intervention birth is safest. The US has a rate of Cesarean section of over 30%, double what the World Health Organization used to recommend when it still gave recommendations. Maternal mortality is on the rise in the US, and some of that is probably due to an increase in unnecessary c-sections.

Evidence-based practices for birth include moving around (rather than lying on your back, which means gravity works against you) and having a doula or birth coach for support. One medical professor describes the evidence that a low-intervention birth is safest: "Our midwife could be trusted to be scientific, whereas our obstetrician could not."

As I approach parenthood, I don't want to be enslaved to the current attachment-parenting style that implies, as my housemate put it, "if you break eye contact with your baby, it will explode." But I do want to know what the evidence is when I make my choices. Hopefully we won't look back in 50 years and wonder why we made such terrible choices in the name of modernity.


Boris Yakubchik said...

Quote: "And the evidence is clear that breastfed babies have less risk of ear infections"

I heard an explanation that sounded very plausible: when a child is breast-fed, s/he is held sideways - which allows whatever fluid built up in the ear to flow out; this may be the primary mechanism through which ear infections are prevented.

I'm all ears about evidence on this ;)

Julia Wise said...