Preventing postpartum hemorrhage: a follow-up

August 26, 2010 at 8:54 pm

After publishing my last post, “Preventing postpartum hemorrhage naturally,” I was lying in bed thinking, and I realized I should have talked about the importance of skin-to-skin contact and breastfeeding to keep oxytocin levels high, reducing postpartum bleeding. Then this morning I got a lovely comment from Sherry reminding me about Michel Odent’s recommendations for preventing postpartum hemorrhage. So I whipped out my copy of Odent’s Birth and Breastfeeding to refresh my memory (it’s been about five years since I read it).

Darkness

I’ll admit that I was originally a little hesitant to suggest that low lighting might make a difference in preventing postpartum hemorrhage. Of all the tips I mentioned in my last post, that was the one I felt least confident about. I even asked my husband, after he finished reading the post, whether he thought I was “way out in left field” on that one. So I was relieved, as I skimmed through Odent’s book this afternoon, to find that his views support my “left field” suggestion. He says:

The need for privacy does not end when the baby is born. An environment that enhances the delivery is also needed immediately afterwards, so as not to disturb the first contact between mother and baby. . . . The best way to avoid haemorrhage is to enable mother and baby to stay in close contact in a warm, dark, and silent place—and get rid of any observers. The contact with the baby’s eyes and skin helps the mother to secrete the hormone necessary to stimulate the ‘placenta ejection reflex.’ When the baby suckles the nipple, the reflex is reinforced. (Birth and Breastfeeding, p. 46-47, emphasis mine)

Off your back

He also added another point I hadn’t thought of (or had forgotten about):

Interestingly, when a mother feels uninhibited and is not given any orders, or even any suggestions, she tends of her own accord to find a position that minimizes compression of the big vein returning blood from the uterus to the heart; and in so doing, she reduces her own blood loss. (For, as everybody has probably observed, if you want to make a vein bleed a little more . . . you just have to compress the flow downstream.) . . .

Just as during the delivery itself, in this post-delivery stage it is out of the question to recommend one good position in particular. In fact there is only one positively bad position: the mother lying on her back but semi-seated, with the baby on her tummy. In this position, the weight of the baby plus the weight of the uterus will tend to compress the vena cava. (Birth and Breastfeeding, p. 47-48)

We hear all the time how important it is not to lie down on our backs while largely pregnant because of the risk of compressing the vena cava. It’s unfortunate that medical professionals seem to forget about that recommendation during labor and delivery. I recently watched Diantha’s Crossing, a touching short historical fiction film dramatization of a Mormon pioneer midwife’s assistance at a breech birth. As I watched, I couldn’t help feeling ridiculous amounts of anxiety that the pregnant woman in the story spent her entire labor literally flat on her back, mostly unconscious. It wasn’t even real, but I spent that whole hour wanting to jump into the screen and turn her onto her side. Just thinking about it makes my heart pound anxiously. (Silly me.) Anyway… I had never really considered how avoiding compression of the vena cava might be important in the prevention of postpartum blood loss. Fascinating.

No photos, please?

Odent says he has felt comfortable assisting home births of women who have previously suffered postpartum hemorrhages in hospitals because he is “so convinced that most haemorrhages are due to an improper environment” (p. 48).  Later in the book, he urges the end of birth photography because of its potential negative impact on the delicate birth environment:

There was once a time when it was imperative to do away with many of the old mental images associated with words like delivery and birth.  The point—and we felt it to be urgent—was to put forward pictures that showed alternatives to childbirth with the mother on a table, under bright lights, surrounded by guides and coaches.

Now, the priority is to rediscover the need for privacy, and the importance of dim lights. We must learn to eliminate all the onlookers and all their different ways of observing. (p. 105)

Turn off the lights, ma!

I recently shared my hopes of spending most of my next birth in complete darkness and acknowledged that it wasn’t very conducive to photographs. But I must admit that I absolutely love birth photography. I could look at birth photos and slideshows all day long. And I’ve even fantasized about becoming a birth photographer someday. But maybe Odent is right? Might the necessary lights and inherent observation of birth photography be impeding the hormonal symphony required for a smooth, uncomplicated birth and postpartum period? I felt very “observed” during my last birth, but it was still my fastest (approximately four and a half hours from the first contraction to delivery). Maybe lack of privacy isn’t essential for all women, but perhaps for some of them? It’s definitely something to think about.  Maybe we should wait an hour or two after birth, after mother and baby have enjoyed some private time to bond and stabilize, before we whip out the cameras?

Do you have any thoughts or experiences to share about the importance of darkness or privacy or any of this?

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