Birthing Choices - Is the Lotus Birth right for you?
(first published in LagosMums 25th April 2017)
Hello Mums and Mums to be!
In many cultures around the world and indeed Nigeria, the birth of a baby is such an important event, and profound experience to mothers and families. It is arguably the end of one phase heralding the beginning of another – defining the continuation of the human race. It is existential!
Yet while childbirth is such a gift from nature and a source of great joy to most, it can sometimes be challenging and unpredictable in outcome.
Well, that is to say – we know what should happen but sometimes it doesn’t.
Whether by natural or assisted delivery, the outcome we want is a safe mum and baby.
This is why the birth process has been the subject of many and extensive studies and practices through the ages and around the world to improve our understanding of what approaches would produce the best outcomes.
Yes, childbirth is a process that starts from the onset of labour into the delivery of the baby and then the delivery of the placenta.
It can be physically, psychologically and emotionally stressful requiring total care and support to transition from childbirth to maternal child-care and puerperium (the period of 6 weeks just after the baby is born).
This introduces us to the controversial subject of Lotus Births and whether they are the right option for you and your family.
First let us summarise the relationship between the mum, baby and placenta, because these connected entities are important and involved in the delivery process.
The placenta is a fleshy spongy tissue with a lot of blood vessels that is formed and starts to grow in the womb as soon as a baby is conceived. Its main function is to support the growing baby and it also grows as baby does.
The placenta is connected to the baby by the umbilical cord. It rests inside the womb like a little cushion full of blood vessels and the placenta’s blood vessels interact with the blood vessels of the womb.
The placenta’s vessels will take oxygen and other nutrients from the mum through the cord and into the baby for the nourishment, development and growth of the baby.
As the baby’s body builds up waste, this is taken away from the baby’s body by a different group of blood vessels through the cord again and into the placenta which passes the waste to the mum’s body for disposal. A fantastic network that works till it’s time for the baby’s birth.
So hopefully this simple explanation can provide the foundation for understanding Lotus Birth as an option for women to make informed decisions and choices bearing in mind that in the end, what is most important is the health outcomes we want for mum and baby.
‘A Lotus Birth is the process of leaving the cord and placenta to detach naturally in the days after birth.'
Basically, the whole essence of a Lotus Birth is to allow this process to continue until nature itself ends it (can take about one week), rather than when interrupted by a birth attendant (midwives or doctors).
What has become usual practice in many settings, whether by natural or assisted delivery, is that soon after the baby is delivered and has taken the first breaths, the umbilical cord is clamped and cut.
Then while the baby is bonding with mum, the birth attendants concentrate on the birth of the placenta.
At the end of the process, the connected parts – mum, baby and placenta – are separated.
In the Lotus Birth protocol, there is no umbilical cord clamping and cutting. The baby is delivered and provided with immediate care by attendants (by the side of the mum) while awaiting the delivery of the placenta.
On delivery of the placenta (taken for-granted that it is inspected fully delivered), it is placed in a clean bowl or wrapped in an absorbable cloth and kept beside baby and mum for at least 1 hour – before any effort is made to clean/preserve the placenta.
Lotus birthing has been practised in some cultures including early American pioneers, some Aborigines, and the Balinese.
More recently, the practice seems to have returned to the United States and Australia in the 1980s, and has gained recognition in the United Kingdom in recent years.
To understand the finer details of the process and possible hiccoughs that may occur when trying to implement a Lotus birth among traditional birth practice, there is a helpful resource here.
What are the benefits of a Lotus Birth?
It is believed by some practitioners that it reduces stress to the baby. That the act of cutting the umbilical cord immediately after birth (ICC- Immediate Cord Clamping) results in crying and distress. They feel that not intervening by cutting in a normal delivery process allows baby to continue in the calm relaxed environment that it was in the womb for as long as possible.
Some practitioners support an aspect of the Lotus birth referred to as Delayed Cord Clamping (DCC). This means that rather than clamping the cord immediately the baby is delivered, the cord is left free for 2-3 minutes.
It is important to point out that it has been the thinking among practitioners that as soon as a baby is born and the baby takes its first breaths, the baby’s circulation takes over the function of the placenta.
On the other hand, proponents of Lotus birth believe that by holding off cutting the umbilical cord even for 2-3 minutes, the baby gains blood (carrying oxygen and vital nutrients) from the placenta.
Evidence from some research suggests that 10% of babies born in the US develop anaemia (due to ICC) which can cause complications and impact mental development such as attention and memory deficits, among others.
Given the above potential benefits of Lotus birth, what are the potential downsides and risks to inform decision?
The Royal College of Obstetricians and Gynaecologists in the UK, has expressed concern about Lotus births, stating that there is insufficient evidence about the process and its benefits; and warning about potential risks, uppermost being the risk of infection being transferred from the placenta to the baby that can be life-threatening.
While women have the option to make informed choices on their birth process, Lotus Birth is certainly not a common practice or the norm in UK hospitals – in normal or assisted deliveries.
In 2016, a study was reported that showed a Lotus birth baby who may have developed liver damage following an infection that was most likely associated with the birth method.
The child, born at home, needed an admission on the third day of life at which point the umbilical cord was cut.
He seemed to improve after light treatment but had to be readmitted as an emergency when his condition worsened.
Tests conducted in hospital suggested that the liver damage likely came from an infection and the possible source was the mode of birth.
Fortunately, he recovered and at the time of the report in 2016, was doing well.
How does the environment and culture in Nigeria and other West African countries affect Lotus Births?
Lotus births should not be confused with some belief systems locally that give special significance to the placenta and in which some mums / families may wish to go home with their placenta and dispose of it according to their tradition.
In this scenario the usual practice of cutting the umbilical cord is performed and on the birth of the placenta, it is bagged and handed over to the mum and family member.
The practice of Lotus birth however is not popular in Nigeria and many other West African countries, and not supported by the National and West African Colleges of Obstetrics and Gynaecology.
Given general environmental challenges impacting health care delivery in most West African countries, one understands the position of training and regulatory bodies on Lotus birth:
Firstly, the placenta is a fleshy spongy tissue with a mesh work/bed rich of blood vessels and blood, and therefore excellent medium for infection as soon as it is delivered and exposed to environment.
With high rate of health care-associated infection in Nigeria for example; growing resistance to antimicrobial agents and relatively weak healthcare system, the potential risks that Lotus birth exposes the baby, mum and families would outweigh its potential benefits.
Methods of preservation by Lotus birth practitioners include rock salt and flowers (the latter to help ward of nasty smell, but ...really?).
Some people store the placenta in a cool bag kept beside the baby.
How would this work in the average Nigerian setting?
What about availability in Nigeria of the cold bag used in storing the placenta and the additional costs?
What about the care needed in keeping the placenta clean?
Irrespective of socioeconomic class relative to affordability, what about the effects of relative humidity in local weather conditions ?
What about the many visitors and well-wishers, naming ceremony events and other activities just after birth that are embedded in local Nigerian and other West African cultures?
Conclusion
So apart from the potential infections and related complications, Lotus Birth seems to me impractical as a birth choice in the Nigerian setting.
While DCC has benefits and should be encouraged, full Lotus birth protocol would bring additional challenges especially in the Nigeria setting.
Even for upwardly mobile Nigerians that can afford to have their birth attended in cleaner, more advanced settings locally, the risks of infection and the practicality must be weighed carefully against the benefits to make consequential decisions of birth.
And what do you think?
As usual, your thoughts make a great part of the story!
Till then,
Stay Well
Editing by AskAwayHealth Team Disclaimer All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence based guidance and to help promote quality health care. The advice in our material is not meant to replace management of your specific condition by a qualified health care practitioner. To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org
