Here, to celebrate the first anniversary of the launch of my book, is the second part of my gift of the first chapter (see March 2018 blog post for part 1):
YOUR BABY SKIN TO SKIN
Chapter 1 (continued)
Coming into the World: Your Highly Evolved Baby
The first moments
Hello, little one
Mothers with their still-damp babies inhale deeply, instinctively drinking in the musky aroma of their own and their baby’s body scents mingled together like some heady cocktail. The high adrenaline level in both mother and baby heightens their awareness and ensures that these aromas fix themselves deep in the memory for good. Even months (and, indeed, years) after birth, a lot of time is spent burying their noses into each other. As sweet and cosy as this is, it is simply evolution’s solution to ensuring that a mother and baby know each other in the dark of the night and that we protect our own genetic inheritors first. Remembering this with the birth of my first son, I now find myself sniffing my grandson in a way I have never felt moved to do with the thousands of babies I have held as a midwife. I already know his unique smell and can sometimes catch it on myself days after seeing him.
Much the same happens with our baby’s first cries: they move us so deeply to respond. Even if we have never held a baby before, we hear those first tiny gasps and mewls and immediately our hands begin to hold, stroke, soothe and reassure. We slide our baby up closer to our face so we can whisper in the tiny ear and kiss the top of the warm head. The higher female voice being particularly ‘keyed into’ the baby brain, and the mother being particularly triggered by her new baby’s cries, further two-way bonding and imprinting takes place. Our baby will take a little while to learn the unique look of our face but she already recognises the particular pattern and timbre of our voice from those months listening to the bath-like echoes inside the womb. During the early hours and days, the imprinting deepens and mothers find that they are completely unable to relax until they have responded to their baby’s cry and feel anxious when separated for even a very short time. Seeing someone else holding their crying newborn will make them twitchy and want to grab her back – this complete stranger already a permanent resident in their heart.
Skin to skin
In the modern birthing environment, irrespective of how the baby made her entrance, women are encouraged to enjoy prolonged ‘skin to skin’ time. While this automatically happened before the times of mass hospitalisation, during the 1970s and early 1980s increased medicalisation led to babies being bathed, dressed and wrapped before their exhausted mothers got to hold them after birth. By the mid-1980s ‘bonding’ was all the rage, and women today still ask me if the purpose of skin to skin is to help them ‘bond’. In fact, those early hours when we hold our peach-soft, damp, warm bundles of wiggliness on our chests do very much more than give us sniffing time. This is where our baby picks up more friendly bacteria – the ones that we have bred to protect us from the harmful bacteria we always carry on our bodies. So our babies gain protection from the bugs in our homes that we have as our companions.
More than that, skin to skin time calms the baby’s autonomic nervous system (ANS) right down. We will look at the ANS in great detail in Chapter 6 as it tells us so much about why our babies behave in the seemingly random way that they do, but, for now, you just need to know that skin to skin helps the newly birthed baby to stay soothed, warm and safe while you get to know each other.
Falling asleep during skin to skin
The first in-bed snuggles after birth are often wide-awake ones as the adrenaline that has permeated labour hasn’t quite left yet. Women describe staring at their newborn baby for hours; right through the first night together. However, you might fall asleep on a sea of endorphins and oxytocin and you need to keep yourself and baby safe. The safest way to share a bed in these early hours is skin to skin together under light covers (a hospital sheet and light blanket or, if you are at home, your summer duvet tucked under your elbow); don’t swaddle your baby in your bed and don’t try to limit her movement with pillows or tucked-in sheets; if she is tucked up with you like this, she really doesn’t need a hat!
If you are bottle-feeding formula milk or are still under the influence
of labour drugs, sleeping with your baby is not safe: set an alarm on
your phone to buzz after about 20–30 minutes so that, if you do nod off despite your best efforts to stay awake, you will wake pretty soon and can put your baby in a crib. If you are at home, make sure that, if your partner is in bed with you, he or she is not drunk or been smoking.
Your baby, after the first post-birth suckling, may sleep for many hours and, as long as she is kept skin to skin, she will wake when she is ready to suck again.
The first suckling
Even more soothing and calming for both the baby and her mother is suckling. As we saw with our primitive baby, soon after birth, the newborn, lying seemingly helpless on the mother’s chest, starts to instinctively search out the breast. She isn’t thinking ‘I must feed. I must get just the right amount of calories and nutrients inside me and I know just the restaurant!’ She is driven by primitive reflexes and instincts, just like every other mammal on the planet, to search out a nipple. Smells, sensations and sounds guide her and, to begin with, her journey can seem pretty random. But as she gets closer to the breast, that enticing contrast line of the paler flesh against the dark edge of the areola catches her eye, and off she heads to explore. Women often tell me when I ask about the first feed that ‘It just happened. I don’t really remember doing anything. She just knew what to do!’ Of course. It would be a bit of a disaster if our primitive mother, having just given birth in the dark shadows of a cave shelter and still needing to urge out the afterbirth, had to know how to get a baby onto her breast to suckle. This baby can’t wait around for her mother to practise and learn! In any case, in the low light, the mother wouldn’t be able to see much of what she is doing. The baby can do this solo.
We are really not very far away from this early setting, and evolutionary adaptation ensures that the newborn baby, driven by a rooting reflex, hunts and snuffles around until eventually she finds the nipple and, after prolonged head-bobbing and faffing, draws it in and sucks. Endorphins and oxytocin flood the bloodstream of baby and mother, taking away the pain of birth and replacing it with a deep relaxation and sense of calm, at the same time causing contractions in the womb to push out the placenta and stop bleeding. With the surge of the placenta contraction, the mother pulls her baby in even closer to her chest and the baby suckles more deeply. There is no need to help or direct the baby and, in fact, she will manage better without you doing very much except what comes instinctively. She has a reflex and, just like with a sneeze, if you try to help it might get a bit messy!
Love at first sight?
You may believe you should feel an immediate thunderbolt of love hit you when you first hold your baby or, at the very least, soon afterwards.
And if you don’t, you feel there’s something wrong with you. In my experience, although many women do indeed feel an almighty rush of instant love at first sight when they first hold their baby, for just as many it isn’t like that at all. So, whereas for some new mothers it feels like an instant recognition of a loved one – ‘Oh my word, it’s YOU! I know you and I love you so much!’ – it may feel more like ‘Oh! Hello. Not quite sure what you mean to me. I’m pretty puzzled right now because I really don’t know you at all. Who ARE you?’ or ‘Hmm, you’re a funny- looking thing! Not at all what I expected and I’m not sure quite how much I care about you at the moment. We will have to muddle this one through …’
Sometimes relationships simply take a while to grow, settle and cement. Don’t worry. Your baby doesn’t have any of these worries and doesn’t care about your musings (she doesn’t know that you feel somewhat ambivalent right now). She will show you how to mother her. As you feed her and change her over the days and weeks, her smells and her cries and her searching eyes will gradually, bit by bit, get inside you if you just relax into what it is rather than try to wrestle it into what you think it should be.
Although much of this book inevitably looks at mothering, there is plenty here for partners. Reading through the whole of the chapters will help you understand things from your child’s mother’s perspective. It may help you make sense of her hormonal swaying, explaining why it can seem at times as if the woman you love has left the building and been replaced by a stranger! At the end of each chapter is a bit just for you, to help you discover your unique and essential role, different as it is from that of the mother. Your baby needs you and your partner to be different; this helps build flexibility of thinking and, in time, your baby will grow into a child who understands how to respond differently to different people and how to understand emotional needs.
During the labour, birth and first minutes and hours, the birthing woman is completely awash with hormones, driven by instinct and reflexes to bring your child into the world safely. It can be tough to watch. Many partners feel a huge need to rescue their birthing woman, but there is no need. She needs your strong emotional and physical support right now. She is quite safe with the midwives and doctors, who are expertly trained to do the checking and rescuing (if necessary) so that you can be the support coach to the marathon runner. There is nothing to be scared of – this is simply what we look like and sound like when we are pushing another human being into the universe. It’s fine to ask the midwife if you can watch your baby’s head emerging if you like (and if your partner doesn’t need you to hold her while she pushes) and even to ask if you can help hold the baby as she is finally born. If all is going well, most midwives are only too happy to guide your hands. Or simply watch in awe …
The first moments after birth
The moments immediately after the birth can be very emotionally mixed. Exhaustion and adrenaline mix with shock and delight. Watch now as your partner and baby, driven by deep, deep instinct, discover each other. This is millions of years of evolution laid out in front of you. Your baby may take some time to splutter and cry. Don’t worry: the cord is still pulsing with oxygen and nutrients and she will breathe for herself in good time. Stay close to your partner and just be. It’s fine to join in the gentle touching and see if you can smell those musky tones too. Your partner’s senses are massively heightened to ensure that she knows her baby’s scent from the very beginning. It won’t be so strong for you – you have a different role to play – but you may still be surprised by how powerful and good your baby’s smell seems.
Refreshments all round
When your baby starts to nuzzle and move around, searching for a nipple, don’t feel moved to help: the baby needs to take her own journey in her own time and her mother will ease her up without even thinking. Instead, while your baby sets about foraging, you can ensure that your partner is warm and nourished. Pop a warm blanket or towel over the snuggling couple first and then sort out refreshments. If she needs stitches, you will need to wait until these are done before sorting out food. You and your partner will need plenty to eat and drink, but keep it light. Tea and toast is the usual order of the day. A very newly birthed woman will tell you that the first cup of tea after birth is the best cup of tea in her life, EVER. If you make it, rather than leaving the job to the care assistant, you will get the kudos!
Skin to skin
Eventually, after much nuzzling and eating and chatter, most women want a shower and you can finally enjoy some skin to skin time with your baby. Simply put a hat on her head, pop a nappy on her bottom and then carefully pass her down your T-shirt until just the top of her head is sticking out. That’s it! Talk to your baby, kiss her, smell her, or just grin and enjoy this moment in silence.
Questions and answers
At the end of each chapter you will find some answers to common questions. Tempting though it is to turn straight to this bit, do read the full chapter as it will help you make sense of the answers.
I am expecting to give birth/have given birth by Caesarean. How can I ensure that my baby gets the friendly bugs?
Evolution has done a brilliant job of getting us here, but there are still inevitable glitches (that kind of defines how evolution works), and medical interventions give us a means to survive these glitches. Caesarean-section (C-section) births, forceps births, ventouse births, epidurals: these things have dramatically improved the lives of thousands of mothers and babies. For our part, we need to look at the bits that science can’t yet replicate and add those in as best we can. Compared with vaginally born babies, those born by C-section are more likely to develop asthma, allergies, eczema, type 1 diabetes and coeliac disease. They are more likely to be hospitalised with tummy bugs. While some of this may be attributable to the greater likelihood of these babies having formula milk in the early days, there is growing interest in the notion that babies born by C-section just don’t get the good bacteria from the mum’s vagina and perineum. Some maternity units now encourage mothers expecting to birth by C-section to collect friendly bugs from their vagina before the operation. If your unit does not suggest this to you, just put it in your birth plan and do this:
Take a piece of gauze soaked in normal steriles aline.
Fold it up like a tampon with lots of surface area and insert it into your vagina.
Leave for one hour, remove just prior to surgery, and keep it in a sterile container (the sort of pot you collected your pee in during pregnancy is ideal).
Immediately after birth, simply wipe the swab around the baby’s mouth, face, then the rest of the body.
Note: It is really important that you only do this if you are free from HIV, thrush, group B strep and any STDs or other infections. If you are in any doubt, talk to your midwife.
Also, as soon as possible, get skin to skin and stay that way with your baby for as long as possible (hours rather than minutes and days rather than hours). There is no reason not to have skin to skin while the post-op stitching is completed unless you are too poorly to hold your baby. If this is the case, your partner could, if possible, hold your baby skin to skin on you or on themselves. Let your baby suckle freely and don’t feel the need to bathe her for at least 24 hours. If possible, take your own linen into hospital and don’t be obsessive about you or your partner forever cleaning yourselves! Just normal daily hygiene is enough.
My baby is in special care! What now?
It is incredibly stressful for everyone when a baby is too poorly or too little to be with her parents and needs the care of a neonatal unit. The newly birthed mother can feel split between gratitude that her baby is in safe hands and misery that her arms ache to cuddle her newborn. This upset can be made even worse when a baby has to stay in hospital after the mother has been discharged. There is clear evidence of the benefits of ‘comfort holding’ and ‘kangaroo care’ for premature and sick infants. ‘Comfort holding’ can simply mean touching your baby with your warm hands on her skin while she rests in an incubator and it can also extend to sitting quietly in a chair with her lying on your chest. This can bring rest and comfort to mother (or partner) and baby and is also a simple, effective way of reducing stress for both when a baby has to have unpleasant procedures like blood tests.
‘Kangaroo care’ is an extension of ‘comfort holding’ and involves putting the baby, skin to skin, with mum or her partner, either sitting in a chair or while they are getting on with something else. Skin to skin has a profound positive impact on babies and their parents, settling breathing and heart rate, reducing stress and managing temperature as well as helping to protect against infection by increasing the baby’s exposure to those essential friendly bugs. As well as getting close to your baby as often as possible, express your milk for her. Even tiny amounts of your milk will protect her from infection and soothe her emotionally. Read Chapter 4 on feeding for tips on expressing.
Skin to skin during stitching
I want to keep my baby skin to skin for a long time after birth, but what if I need stitches?
If we hold and suckle our babies while we are stitched, have blood taken, have ‘after pains’ or are upset for any reason, we get a rush of endorphins and oxytocin and feel better! Most women simply don’t ask or, if a midwife says ‘I need to give you a few stitches – maybe your partner would like to hold baby?’, they don’t say ‘Thank you very much for your kind offer, but I’d like to keep her with me and feed her.’ If needs be, get your partner to hold your baby against your bare skin. Of course, your partner could hold the baby skin to skin with themselves, but the ideal is for baby to get your friendly bugs first and foremost. There will be ample time ahead for cuddles with others.
No skin to skin
I had a vaginal birth but didn’t get any skin to skin time. Is it too late?
No! Things just don’t always go according to plan. We have tougher labours and births than anticipated, we have drugs that make us and our babies sleepy, we are too sore or poorly just after birth to hold our babies … so don’t panic! Just let the dust settle and then catch up. Strip your baby down to her nappy, strip yourself off down to your pants and get snuggling. Don’t worry about your baby getting cold: as long as her tummy is skin to skin with yours and her back is snuggled under your blanket, you will share your body heat and smells with her. Explore her with your hands and face or simply relax and read a good book – you will quickly discover that those ‘lost’ moments just after birth will fade.
I hope that you have enjoyed reading chapter 1 “Your Baby Skin to Skin”. To enjoy the rest of this unique look at the first year of your baby’s life, follow this link to buy a copy …