Notwithstanding the fact that facing up to the many adaptation dilemmas for babies (and their mothers) in the aftermath of C-section and prematurity is important – hence this blog – prevention of both remains the most important strategy for minimising or eradicating the harm left in the wake of these two sub-optimal beginnings to extra-uterine life.
Key dilemmas after C-section and prematurity
The two key dilemmas have to do with the infant not reaching term development, and/ or not going through physiological labour processes. The lower the gestational age of the infant, the greater the range and intensity of the dilemmas faced will be. Even premature infants born vaginally will suffer many of the same harms precisely due to immature anatomy and physiology. Infants not exposed to physiological labour (especially when C-section takes place before spontaneous labour commenced) face a complicated fetal-newborn transition and adaptation to extra-uterine life because the essential cortisol and catecholamine surges associated with labour, which prime organs and enzymes just before, during and immediately after birth, are absent. As a result:
- There’s sub-optimal oxygenation of the newborn lungs and they remain fluid-filled
- There’s under-perfusion of the lungs and other vital organs, as well as blood volume, stem cell and haemoglobin deficit, especially if the cord was clamped immediately after birth
- Temperature regulation is negatively affected, with possible hypothermia (likely followed by hypoxaemia, hypoglycaemia or even death), because there is not the physiologically activated metabolism of brown adipose tissue (or there’s insufficient in prematurity) which facilitates heat production via non-shivering thermogenesis
- Recovery after the expected short-lived postnatal infant blood glucose level drop (triggered by a glycogen surge resulting from sympathetic stimulation and cortisol-induced catecholamine release) doesn’t occur or is sub-optimal
- The suckling reflex is poor, threatening Baby’s glucose stores and breastfeeding success
- Endogenous oxytocin (a neuroendocrine hormone) is not released as it would be under normalised circumstances of birth and mothering confidence and uterine contraction, mother-baby dyad bonding/attachment, and infant homeostasis suffer
In addition, NICU admission, dyad-separation, complementary artificial feeding, digestive symptoms like colic and reflux, neuro-behavioural and neuro-developmental conditions, and suppressed immunity all pose some or other degree of harm or challenge – and that’s naming but a few!
Seven Simple Steps for Repair
While not all harm can be eradicated, midwives can help to encourage these steps for significantly improved outcomes:
- Delay cord clamping post C-section and premature birth
Far greater postpartum homeostasis is achieved; there’s less dyad separation, neonatal jaundice and infant anaemia; Baby gets his rightful stem cells and exposure to key hormones.
- Ensure skin-to-skin care asap and continued KMC
There are benefits for temperature regulation, recovery of hormonal release, faster growth for prems, improved breastfeeding outcomes and mothering confidence, and attachment benefits.
- Protect the NICU/postnatal space
Use silence, music, homely touches, compassion… Provide cluster care, involve the mother and show respect for physiology.
- Support breastfeeding
Create a conducive aura; value colostrum’s special benefits, also for prems; give informed latching support; no scheduling of or top-up feeds; and be wary of test weighing.
- Advocate safe co-sleeping
It provides further skin-to-skin benefits, a form of KMC and ‘touch therapy’ benefits; it allows for optimal sleep effects for brain development; and the mother is more relaxed, which means Baby is too.
- Encourage hands-on play
There are benefits for vestibular stimulation, it can involve Dads, there are touch benefits and the fun and happiness release feel-good hormones; it promotes self-awareness, improves non-verbal skills and reduces tactile defensiveness.
- Learn and teach infant massage
Research demonstrates faster growth in prems; it provides emotional comfort, increases maternal confidence and bonding, decreases PND in Mom, improves Baby’s circulation and coordination, and strengthens Baby’s (and Mom’s) immune response.
Let’s also own our repair role!
Acknowledge the all-too-frequent iatrogenic nature of the problem; let’s educate, talk and inspire those in our care to minimise the chances of falling prey to iatrogenesis; and let’s tackle the collegial team with evidence, so that there’s no more hiding behind ignorance!
Make pregnancy consultations count, protect first stage at all costs and always champion best care.