The downside of trying to "manage" birth...

What is the downside of trying to manage birth?

After I mentioned Alan Greene’s TED talk on delayed cord clamping in a blog post, I ended up playing it for a friend on my laptop, and hearing it again reminded me of something that I had intended to write about for a while. I have recently come to think about these issues again (in part because I have updated the book that I mention in this post) and so I am updating the post with my current thoughts.

Greene spends most of the first half of his talk building a fantastic foundation for the revelation that the lack of oxygen and iron that some babies experience can be prevented by the simple act of not cutting the cord immediately after birth. He focuses a lot on the importance of oxygen and iron for babies.

“Among the highest risk kids in the world for iron deficiency are the babies who are exclusively breastfed for at least six months.” Which, he explains, he found really counterintuitive, “because breast milk is the perfect food for human babies, so why would those be the ones at risk?”

“But here it is…”, he continues. “Breast milk is – quote unquote – “low” in vitamin D. Because presumably babies got vitamin D from the sun. Today they spend most of their life indoors. And breast milk is – quote unquote – “low” in iron, presumably because, historically, they got it a different way. And not from boxed cereal and infant formula.”

As Greene’s talk continues, he reveals to the audience that babies were meant to get their iron from the blood that was in the placenta, a mechanism that we inhibit when we practise early cord clamping. But my mind was elsewhere.

It was meandering through the talks and courses that I run on vitamin K, in which I say something a bit similar. I note that, yes, vitamin K is very effective when given to newborn babies. But is it also frustrating that, although only one in several thousand babies would have a problem without it, we don’t know enough about which babies would have had a problem without it and which would have been fine.

“Babies are born with what are perceived to be “low” levels of vitamin K, and there are “low” levels of vitamin K in breastmilk.” I say, using my fingers to illustrate the ‘quote unquote’ bits. “But who determines whether that “low” level is really low, or whether it is only “low” in relation to adult levels, or in relation to artificially-created infant formula, which is hardly a benchmark for quality human food? Do most babies need less vitamin K than adults, were they historically getting it from another source, are most better off without it, and/or is there a bigger picture here that we’re not seeing?”

I’m not going to suggest that delayed cord clamping would significantly increase babies’ vitamin K stores, however, because I don’t think that’s the case. Vitamin K is fat soluble and it is stored in the liver and in fat. My understanding is that, while delayed cord clamping would lead to a very slight increase in blood vitamin K, the additional amount of extra vitamin K that would be gained wouldn’t be enough to make a difference in relation to the risk of bleeding problems in those few babies that would encounter them. And it’s an ongoing issue, not a one-off. But the more important issue is that the vitamin K deficiency bleeding is rare and the vast majority of babies don’t have a problem.

Dr Sara Wickham’s comprehensive guide to the ins and outs of vitamin K for newborn babies; helping families to make the decisions that are right for them.

What I am going to do is go back to the general point that underlines Greene’s argument, because this is a theory that I believe is worth exploring. That is, some – perhaps several or even many – of the things that we currently identify as being problematic are caused by our own efforts to manage and control the journey of birth and of being born. These efforts may have been well-intended, but they can end up being counterproductive in that they can interfere with age-old processes that have evolved to help us be born successfully, healthily and with a healthy mother to continue to turn to for our needs.

The solution, I humbly suggest, is to slow or cease our acceptance of the notion that women’s and babies’ bodies fail so often and so spectacularly, and to be willing to think about how nature, evolution or whatever you believe in might have designed us to land on the earth with what we needed in the first place. Then, we can work out how to stop our unnecessary meddling and thus creating problems where none existed, while saving our skills, knowledge and expertise for those mums and babies who genuinely do have problems and actually need it.