Monday, April 21, 2008

What will doctors say next??

In Today newspaper on Saturday, there was an article warning of a heightened risk for poor immunity in babies who were born via C-sec since they were not born via the birth canal. The birth canal being a place warm and rich with maternal bacteria, it stands to reason that a baby, born via the birth canal would be colonised with maternal bacteria. Also stands to logic that this is WHY the vagina is located right next to the anus - not traditionally the 'cleanest' place of human anatomy. With the colonisation of bacteria and subsequent breastfeeding, babies would be equipped with enough maternal antibodies as a first defence in a vulnerable and new immune system.

All this is not new and this theory has been put forward before. It sure makes sense to me.

Couple of things I just want to comment on here:

1) how doctors here responded to the claim put forward by the experts. Incidentally, who ARE these experts who made this claim? Let's see, one is an AP from the School of Biotechnology and Biomolecular Science at the University of New South Wales, another is an Emeritus Professor of Allergy Prevention and Paediatrics at the Institute of Environmental Medicine of the renowned Karolinksa Institute in Stockholm Sweden, and finally one was from Nestle. So all are highly trained, well-specialised researchers and experts in this field - not small potatoes.

So how do our doctors respond? Most were, as expected, cautious and slightly sceptical in their response. I am not surprised. But the response that took the cake was from a neonatologist who said: (and I quote) "General hygiene standards are increasing. Even if a woman goes through natural birth, the birth canal area is cleaned quite well. So the difference in bacteria gained through both delivery methods is less."

My jaw dropped when I read this.

How is the birth canal area "cleaned quite well"? In all my reading, all my research, all my birth observations, I have never once seen a doctor or nurse 'cleaning' the birth canal! How? Even the use of enemas have not prevented women from defecating involuntarily sometimes when the baby is about to be born - let alone having cleaned their 'birth canals'! By birth canal of couse, I understand to mean the vagina. Where and how, pray tell, is the vagina cleaned during labour and birth? Is this another unnecessary hospital intervention? What good reason could there be for doing this?

And even IF, lets give this gentleman the benefit of the doubt, the vagina is swabbed with antiseptic, how much bacteria does that remove? To claim that the "difference in bacteria gained through both delivery methods is less" is sweeping and incorrect - where is the evidence to say so? Have there been double-blind randomised trials done to check bacterial levels in a birth canal pre and post a cleaning swab? I very much doubt so. And what would be the benefit of doing so?

This doctor went on to say that babies are kept in 'clean' environments. So babies in general are 'less exposed' to bacteria after birth. I think he is missing the woods for the trees. The idea is not to expose babies to other bacteria in the air or in hospital wards, but to expose them to maternal bacteria - which serves a physiological purpose of building that first immunological blueprint for the baby. What is more, there are studies which show that the rate of infections in homebirths are no more than those in hospitals, in fact certainly less! And mind you, the home environment is far less 'sterile' than the hospital, by definition of those who are pro-hospital births. Certainly in homebirths, no one is busy swabbing or cleaning the birth canal!

And I'm also not sure that it is entirely beneficial for babies to be kept in 'clean' environments - by that of course I assume he means the plastic box in the hospital nursery, away from their mothers. Far more beneficial, in many more ways, it is to have babies constantly with their mothers from birth onwards. The UNICEF-led Baby-Friendly Hospital Initiative counts rooming-in, constant mother-baby time as one of its requirements for certification.

It is true that the C-section rate is alarmingly high - close to 30% at last count. This says that about 1 in 3 women here can't give birth vaginally. How is this physiologically possible? If this were so, the human race would have died out a long time ago. If you include the statistics for other operative births and inductions, it basically tells you that at least 40 to 50% of women need help to get their babies born in Singapore today. This is mindboggling!

2) This article in Today cited findings by Nestle. While I applaud the general intent of the article - to raise awareness of the risks associated with c-sections, I generally view statistics and studies offered by formula milk companies with some suspicion. Let's not kid ourselves. They aim to sell milk. Lots of artificial baby milk. Finally, in one paragraph of the article I found the hidden agenda (I quote): "If breastfeeding is not feasible, the next best option would be using a milk formula that has been enriched with good bacteria."

Huh? Were they not aware of WHO's recommendations for human milk? First, direct feeding from the mother, if that were not possible, then maternal ebm. If that option were not possible, then DONOR milk from another mother. Finally, if that could not happen, then and only then, should formula be offered.

In the same newspaper, on another page, it was reported that policemen in Bangkok have been trained with some basic baby delivery skills. Armed with a nasal bulb pump for mucus extraction, cord clamps, sterile gloves, and a baby blanket, the Bangkok policemen stand by on the ready for the calls that might come through requesting for assistance on a crowded gridlocked street in Bangkok. On their motorbikes, they move in a pair, to the specific vehicle to attend to the labouring mother. Todate, they have delivered 81 babies over 10 years! What kind of training do they get? Not some 5 to 6 year medical course, not even a year-long diploma or certificate course in midwifery. Just a "couple of days every three months" in state or private hospitals where they can "practise delivery using dolls."

So babies are born in the backseats of cars and taxis, backs of vans, beds of pick-ups in the Thai capital.

How sterile is this? Are birth canals 'cleaned' then? Is there a need to do so? How complicated is birth that policemen, given a quick course in how to deliver a baby, can now confidently do so amid the cacophony and pollution of Bangkok streets?

Everyday, since time immemorial, babies are born in fields, in streets, in shops, in alleyways, in toilets, in airplanes, in cars, buses, taxis, bullock carts, boats, in traffic jams, and in their own homes. And that's exactly the way it should be. Doctors and mothers ought to take a leaf or two from those Bangkok policemen and treat birth the way it should be - a simple, straightforward life event.

The truth is, birth is not all that complicated, frighteningly dangerous and risky business that the hospital and medical fraternity would have you believe it is.

But fear, on the other hand, is a money-churning emotion. And when there is money, there is big business and when there is big business, there is inevitably, politics.

So unless doctors grow less fearful of delivering breech or big babies vaginally (and being open to alternative birth positions to facilitate this), unless they learn to manage each pregnancy and baby individually and trust in vbacs, unless society learns that birth, like everything in life, holds no guarantees and is unpredictable and hence lets go of its litiginous streak, unless women learn to trust themselves and let go their fear of pain and learn to pierce the myths shrouding the beauty of birth, the c-section rate will never go down. It can only go up.

Birth today has become a business. And like any other business, as long as you have women willing to pay for c-secs out of fear or misinformation, you'll have doctors willing to cater to these fears and earn top dollar. Purely transactional.


The Chengs said...

Clean Birth Canal. *HAHAHAAAAAAAAAAAAAAAAAAAAAAAAAAAAH* Really cannot help it. LOL.

ManyBlessings said...

it really, really bugs me how the "experts" make birth so complicated!!! sure we hv much to thank medical science for but when every birth is treated as a medical condition.....serene