THE FIRST IDEAL OF ATTACHMENT PARENTING:
BEING PREPARED FOR CHILDBIRTH
Note: This article was published, citation information below.
Ang, M. (2006). The First Ideal of Attachment Parenting: Being Prepared for Childbirth. In Infanity magazine, February 2006 issue.
AP parents will typically enter parenthood as well prepared as they can. This includes educating themselves on as many aspects of parenting as possible through extensive reading, attending childbirth and breastfeeding classes as well as carefully discussing and weighing up parenting philosophies and birthing choices. In the case of the latter they will, as far as possible, opt for the most natural or least interventionist delivery approach. AP parents often prepare birth plans, stating their preferences on matters such as labour, monitoring, pain control, delivery positions, post-delivery baby care, breastfeeding and caesarean sections.
PARENTING 101: GETTING AN EDUCATION
With the wealth of books and material available, it is no wonder many first time parents feel overwhelmed and just don’t know where to start reading. It is crucial to know that just because a book is available for sale in a respectable bookstore, it doesn’t mean that the information contained in it is good. Anyone can write and publish a book if you have enough money to do so. So how does a new parent know which books are good and useful and which are unhelpful or even downright dangerous in what they advise? The key is in the independent, authoritative book reviews. What do I mean by authoritative? For example, there is a certain series of easily available parenting books that has been condemned outright by the American Academy of Paediatrics (www.aap.org), the most influential professional medical body in children’s medicine in North America and possibly the world. Why? Because hundreds or even thousands of babies have been diagnosed with failure to thrive after their parents adopted those books’ approach to raising their children. So this is very serious stuff. Never simply buy a book and just follow what it says (the same goes for simply following the advice of other people as well) – make sure the practices you adopt with your baby are valid and based on solid medically supported advice – this is your baby! There is no room for mistakes!
Good reading material always includes plenty of reference to scientific research findings in recognized peer reviewed journals, usually medical. This doesn’t mean that to be an educated parent you have to have a medical degree, though many AP parents end up becoming extremely well versed with current relevant medical literature! Good reading material is available in the form of books, magazines and websites.
A Recommended Reading List
An excellent basic book to buy is “The Baby Book” by William and Martha Sears. It covers everything you need to know from birth to age two. The Sears library includes other good titles too. You can get these books in all the leading bookstores, including MPH, Kinokuniya and Borders.
The AskDrSears.com website is also an indispensable resource for parents and parents-to-be. One of the best websites on the Internet for everything to do with breastfeeding and attachment parenting is Kellymom.com. For us Internet buffs, this has to be the bread-and-butter (or rice bowl if you prefer!) resource for moms – it contains the answers to every question you are likely to come up with, not only in the early days but even as your baby grows into toddlerhood and beyond. Other very useful websites are Mothering.com and of course the Attachment Parenting International website at www.attachmentparenting.org.
I won’t give you an exhaustive list here, just a sampler. All the websites I’ve recommended provide lots of further reading lists for you, including other helpful books you may want to buy.
Childbirth and Parenting Classes
Attending a course can be very helpful as it gives you the chance to ask your instructor questions and get immediate answers, as well as to practice physical exercises. It should not exclude reading however, the two forms of parenting education should ideally go hand in hand for you to have as whole an education as possible.
A complete childbirth and parenting course typically runs for several weeks and requires both parents to attend together, along with a few other couples. It should cover pregnancy, delivery and newborn parenting, including breastfeeding. Be wary of courses that are sponsored by formula companies – these have a vested interest in wanting you to eventually become buyers of their products. Many hospitals run their own classes, ranging from a single day or even a single afternoon session to classes that run for several weeks. You should be aware that hospital classes may focus on that specific hospital norms and could sometimes not give you a complete picture of all available birthing options. If the cost is significant, check that the syllabus to be covered includes information on natural childbirth and a thorough explanation of the impact of drugs and procedures during childbirth (I will explain more in the paragraphs below).
Independently run classes are also available, run by qualified midwives. If you live in the Klang Valley, you should definitely check out the classes available from Mamalink.com.my.
What you need to know about C-Sections
Given the exceptionally high and ever increasing rate of Caesarean Section deliveries in recent years, especially in the Klang Valley, I would like to address this issue first.
The World Health Organization (WHO) states that no country is justified in having a Caesarean rate greater than 10 percent to 15 percent. This is because the C-section is a major surgery bringing serious well-documented risks to both mother and baby and should not be undertaken unless absolutely necessary. An elective C-section increases the risk to the baby of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and high financial costs. Even with full-term babies, the absence of labour increases the risk of breathing problems and other complications. C-section mothers run a whole gamut of serious risks, including
Natural Labour and Delivery
Four major hormone groups are active during labour and birth: oxytocin; endorphins; adrenaline and noradrenaline; and prolactin.
During pregnancy, oxytocin enhances nutrient absorption, reduces stress, and conserves energy by inducing sleepiness. During labour it causes the rhythmic contractions of the uterus. Its levels peak at the delivery of the baby and subside after the placenta is delivered. Baby also produces oxytocin during labour, possibly triggering its onset, and further production in mother is stimulated by baby’s suckling at the breast upon delivery, prompting the let-down reflex that ensures baby gets good milk supply. Good levels of oxytocin also protect against postpartum haemorrhage by ensuring good uterine contractions. Throughout the time when mother continues breastfeeding, oxytocin continues to reduce stress levels to keep her relaxed.
The endorphins help in pain control during labour, and also facilitate the release of prolactin that prepares the mother for breastfeeding, aiding also in maturing the baby’s lungs. Its presence in breastmilk enhances mutual dependency of mother and baby, thus promoting a longer nursing relationship beneficial to both.
Adrenaline and noradrenaline trigger the fetal ejection reflex that occurs at the moment of delivery. Its presence ensures that baby is born alert. These hormones also promote instinctive mothering behaviour.
The final hormone, prolactin, stimulates milk production and the feeling of anxiety in mother about the well-being of her baby. This ensures mother will be alert and attentive to her helpless newborn’s needs.
Impact of Drugs and Procedures
Modern medicine has introduced many medical interventions in the labour and delivery process. Practising Attachment Parenting does not mean that you need to necessarily reject all these in favour of a completely natural, intervention-free delivery (though some AP parents do choose this route), but it does mean that you take the trouble to understand exactly what each of these interventions do and the effect they have on your baby. I have already explained about the C-section delivery, we will now consider other typical medical interventions.
Induction and Augmentation
Both these interventions involve the use of synthetic oxytocin, typically Pitocin or Syntocinon – in induction for the initiation of labour (typically when the baby goes more than 10 days past the estimated due date), and in augmentation for the speeding up of it (typically when labour is perceived to be progressing “too slowly”). It is important to understand that synthetic oxytocin does not work exactly the same as natural oxytocin. The induced contractions are different, and sometimes cause reduced blood supply to baby. It does not produce the stress releasing effects of natural oxytocin, and instead of reducing postpartum haemorrhaging it actually increases its risk.
Induction is usually recommended when baby goes past the estimated due date, usually by 10-14 days. It is not necessary earlier than that (unless perhaps there are other medical complications) – the reason I mention this is because some are quick to ask for an induction when baby doesn’t appear on the due date itself, or is late by a day or two. Please remember that the due date is merely an estimate – that’s why it’s called the “estimated due date”, and mothers are always told that baby could appear as much as two weeks earlier or two weeks later. It is always better to let baby make his or her appearance when ready, rather than hurrying the process through artificial induction.
Augmentation is also frequently the result of overanxious parents rushing to the hospital too early in labour. Typically, mothers are asked to call the doctor and go to the hospital when regular contractions are five minutes apart. Many however rush to hospital at the first sign of contractions. When this happens, some hospitals have a policy of speeding up the labour through augmentation, perhaps because they need the bed space or for whatever other reasons. It is therefore advisable for parents to wait until the contractions really are 5 minutes apart before rushing to the hospital.
Pain during labour is primarily caused by uterine contractions. Outside the labour and delivery room, pain is typically a warning signal associated with injury or illness. It is helpful for mothers to focus on the fact that within childbirth, pain instead signals progress, not warning. Positive mental association is the first step towards natural pain management involving positioning and breathing techniques. It is useful to know that lying down flat on your back for delivery is in fact the most painful position you can adopt, among the reasons because baby’s weight presses on your spine. It was however the commonly adopted position for a number of years as it was convenient for doctors!
At the onset of early labour, it is highly recommended that mother keep mobile – slow walking is a good way to relax and help baby make the descent to the outside world. In fact, in some government hospitals, the midwives will coax you to walk around or even up and down the corridors – this is an excellent practice. Closer to actual delivery, you will want to take up a more “stationary” position, though you should always be free to move into whatever position you feel most comfortable. An upright position makes it easy for baby to eventually slide out, while not putting unneeded pressure on your backbone. Variations on this include standing, squatting, sitting and kneeling. Some mothers feel more comfortable in a side lying position. Special breathing techniques that you can learn in the childbirth classes I’ve described earlier in this article are essential in natural pain management. In fact, such classes are indispensable with regards to natural pain management.
Medical pain management includes analgesics (pain medications) and anaesthesia (including epidurals). Analgesics may be administered through an injection or intravenously. The most commonly used analgesic is pethidine. The effect on baby depends on how much and how close to delivery the drug is given to the mother. Some babies are therefore born drowsy, while some mothers experience drowsiness and nausea that makes them less able to handle contractions. Epidural anaesthesia is administered continuously over several hours through a tube into the space around the spinal cord, providing continual pain relief to the entire body below the naval. They may make it more difficult for mother to push her baby out due to lack of sensation, and they can cause her blood pressure to drop. More detailed information is available at http://www.mothering.com/articles/pregnancy_birth/birth_preparation/ecstatic.html
Some hospitals have a policy of whisking baby away from mother immediately after delivery and depositing baby in the hospital nursery. This policy can interfere with early bonding between mother and baby; besides being detrimental to getting the right start with breastfeeding (the topic of breastfeeding will be covered in depth in a future article, stay tuned!) You can and should request for your baby to be given to you directly after delivery, during which time you should put your baby to breast for at least several minutes. AP mothers will typically also request that baby room in with them rather than in the hospital nursery so that mother can respond to baby’s cries instantly rather than depending on hospital staff to respond and bring baby to her when necessary (or worse, for baby to be brought in according to an externally imposed schedule).
PREPARING YOUR BIRTH PLAN
AP parents often prepare a Birth Plan, stating their preferences on matters such as labour, monitoring, pain control, delivery positions, post-delivery baby care, breastfeeding and caesarean sections. A Birth Plan ensures that everyone involved in the delivery of your baby knows exactly what your preferences are at every stage.
The steps involved in preparing and using your Birth Plan are as follows:
This article has covered the typical approach of AP parents to Childbirth. A useful way to remember the 8 Ideals of Attachment Parenting is to refer to them as the 8B’s – Birthing, Bonding, Breastfeeding, Baby wearing, Bed sharing, Being there, Behaviour and Balance. Next month we’ll look at Bonding, i.e. responsiveness to your child’s emotional needs.