The right to challenge tradition and cultural conditioning, Michel Odent
ODENT M. Midwiferytoday 2016; 119: 19-22
The socialization of childbirth is an aspect of the domination of Nature that started about 10 thousand years ago. It cannot be dissociated from the advent of agriculture and animal husbandry, and other aspects of the ‘’Neolithic revolution’’. We have a sufficient amount of documents at our disposal to claim that, before such a turning point in the history of mankind, women used to isolate themselves to give birth; there were no perinatal rituals.
Since that time, with all sorts of variants, childbirth has been gradually more socialized and controlled by the cultural milieu. Extreme limits have been recently reached with the masculinization and the medicalization of the environment. Where childbirth is concerned, one can claim that we have reached the limits of the domination of Nature, since, at a planetary scale, the number of women who give birth to babies and placentas thanks to the release of a ‘’cocktail of love hormones’’ is becoming insignificant, and since, immediately after birth, the immune system of most human beings does not start its ‘’education’’ among a great diversity of familiar microbes.
These limits have been reached at the very time when there are more and more contradictions between tradition and cultural conditioning on the one hand and, on the other hand, what we learn from emerging and fast developing scientific disciplines. It appears today that only scientific perspectives have the power to challenge deep rooted cultural conditioning.
A culturally acceptable scientific discovery
There are already examples of the neutralization of the effects of tradition by scientific advances. The best example is offered by a spectacular discovery of the second half of the 20th century. Until that time nobody knew that a newborn baby needs its mother. When I was an “externe” (medical student with minor clinical responsibilities) in a Paris hospital, in 1953, I never heard of a mother who would have said, just after giving birth: “Can I keep my baby with me?”. The cultural conditioning was too strong. Everybody was convinced that the newborn baby urgently needed “care” given by a person other than the mother. The midwife was quick to separate mother and baby by cutting the umbilical cord and at putting the baby in the hands of a nurse. This is what she had learnt to do at the midwifery school. At that time it would have been the same in the case of a home birth. Then, while staying in the maternity unit, babies were in nurseries and mothers were elsewhere. Mothers were not asking to stay in the same room as their baby.
We must realize that, for thousands of years, in all human societies we know about, mothers and newborn babies have been separated and the initiation of breastfeeding has been delayed. In other words, it has been routine for a long time to neutralize the ‘maternal protective aggressive instinct’. The nature of this universal mammalian instinct is easily understood when one imagines, for example, what would happen if one tries to pick up the newborn baby of a mother gorilla who has just given birth.
It would take volumes to review all the invasive perinatal beliefs and rituals that have been reported in a great variety of cultures. As early as 1884, ‘Labor Among Primitive Peoples’ by George Engelmann provided an impressive catalogue of the one thousand and one ways of interfering with the first contact between mother and newborn baby. It described beliefs and rituals occurring in hundreds of ethnic groups on all five continents.1
The most universal and intriguing example of cultural interference is simply to promote the belief that colostrum is tainted or harmful to the baby, and that it is even a substance which needs to be expressed and discarded.2 The negative attitude towards colostrum implies that, immediately after the birth, a baby must be in the arms of another person, rather than with his or her own mother. This is related to the widespread deep-rooted ritual of rushing to cut the cord. Several beliefs and rituals can be seen as part of the same interference, all of them reinforcing each other.
Recalling these roots of our cultural conditioning is a necessary step in evaluating the importance of the scientific advances of the 1970s. A new generation of human studies was inspired by what we learned from ethologists about mammals in general. The time was ripe to evaluate, through sophisticated randomised controlled trials, the effects of immediate skin-to-skin contact between mother and newborn baby as an absolutely new intervention among humans. 3, 4, 5, 6 This is also the decade when a sudden interest in the content of human colostrum developed. After thousands of years of negative connotations, human colostrum was officially recognised as a precious substance. In parallel other researchers were interested in the behavioural effects of hormones that fluctuate in the perinatal period, particularly oestrogens.7 In the 1970s we also learned that when there is a free undisturbed and unguided interaction between mother and newborn baby during the hour following birth, there is a high probability that the baby will find the breast during the hour following birth8,9 For obvious reasons, nobody knew, before the 1970s, that the human baby has been programmed to find the breast during the hour following birth. The 1970s was also a period of rapid development in immunology and bacteriology: we were suddenly in a position to understand that from immunological and bacteriological perspectives a newborn baby needs ideally to be in urgent contact with the only person with whom he (she) is sharing the same antibodies (IgG). After referring to these extensive scientific activities of the 1970s, we can observe that it has been possible, during the second half of the 20th century, to discover the basic needs of the newborn baby. We summarize these basic needs by claiming that the newborn baby needs its mother.
This is the best example of scientific discoveries that had the power of challenging thousands of years of cultural conditioning. While, a century ago, at a time when most babies were still born at home, mother and baby were routinely separated at birth, today words such as ‘’bonding’’ and ‘’attachment’’ are familiar to the general public. We have reached a time when, from the very first seconds following birth, immediate skin to skin contact is usual, even occasionally on the operating table in the case of a caesarean section.
The limits of a major scientific discovery
In reality, this major discovery has limited practical implications as long as other pieces of recently acquired scientific knowledge are not assimilated. In the current scientific context, we should be more precise about the basic needs of a newborn baby: a newborn baby ideally needs to be in the arms of a mother who has reached a specific physiological state among a great diversity of familiar microorganisms. We’ll consider two typical examples of scientific knowledge that, until now, have not reached the power to challenge the dominant cultural conditioning: the concept of neocortical inhibition and the concept of bacteriologically familiar environment.
The concept of neocortical inhibition
From a physiological perspective, the birth process appears as an involuntary process under the control of archaic brain structures. As a general rule, one does not try to help an involuntary process. The point is to identify possible inhibitory factors. From a practical viewpoint, the key word is protection. Several physiological concepts clearly indicate the factors that can negatively interfere with the process of parturition. The concept of adrenaline-oxytocin antagonism is essential where mammals in general are concerned: mammals postpone the delivery when releasing emergency hormones of the adrenaline family. Although this concept is well established, in practice it is not always taken into account, as if it is not perfectly assimilated.
When considering the case of human birth, the focus should be on the concept of neocortical inhibition, a key to understanding human nature in general. We should keep in mind that some human abilities are usually obscured by neocortical activity. There has been, until now, a lack of interest in this essential particularity of our species. Human parturition is better understood if introduced in the framework of functions usually obscured by neocortical activity. A first example is offered by olfactory abilities. An ingenious experiment has explored the human sense of smell after neocortical desinhibition by alcohol consumption.10 Another example is offered by the human swimming abilities: the capacity to adapt to immersion and have coordinated swimming movements when submerged disappears around the age of three or four months, when the neocortex is reaching a certain degree of power.11
When the concept of neocortical inhibition is understood and taken into account, it is easy to challenge the assumption that mechanical factors are the main reasons for difficult births in our species. In fact, the mechanical factors are undoubtedly overestimated, since there are women with no morphological particularities who occasionally give birth quickly without any difficulty. There are anecdotes of women who give birth before realizing that they are in real labour. The best way to clarify the nature of the specifically human handicap during the period surrounding birth is to consider the case of civilized modern women who have given birth through an authentic ''fetus ejection reflex''.12 It is exceptionally rare in the context of socialized birth. The birth is suddenly preceded by a very short series of irresistible, powerful, and highly effective uterine contractions without any room for voluntary movement.
The important point is that when the “fetus ejection reflex” is imminent, women are obviously loosing neocortical control. They become indifferent to what happens around. They forget what they previously learned. They forget their plans. They behave in a way that, in other situations, would be considered unacceptable regarding a civilised woman. For example they dare to scream or to swear. Women in hard labour can find unexpected, complex, and usually bending forward asymmetrical postures. Such scenarios clearly indicate the solution Nature found to make birth possible in our species: it is a reduced neocortical control.
This essential aspect of birth physiology in our species offers an ideal perspective to reach the simple conclusion that a labouring woman needs to be protected against all possible stimulants of her neocortex. Since language is a major stimulant, silence appears as a basic need that is culturally ignored or underestimated after thousands of years of socialisation of childbirth. Light has not been scientifically studied as a powerful cortical stimulant until recent advances regarding the functions of melatonin, the ''darkness hormone''. Recent studies of the interactions inside the triad oxytocin-melatonin-GABA offer a promising avenue for research. It is already understood that the GABA(A) receptors mediate the effects of melatonin on neocortical activity.13,14 When considering the effects of melatonin, and therefore light, on human parturition, we have to deviate from the concept of neocortical inhibition and refer to recent advances regarding peripheral effects. It is now established that there are melatonin receptors in the human myometrium, and that melatonin is synergistic with oxytocin to enhance contractility of human uterine smooth muscle cells. 15,16,17,18,19 Today melatonin appears as an important hormonal agent in human parturition. This is confirmed by the significant amount of melatonin in the blood of neonates, except those born by pre-labor caesareans.20 The importance of these findings appear clearly when the protective anti-oxidative properties of melatonin are taken into account.
In the age of electric lights, the reasons to improve our understanding of melatonin release and melatonin properties are obvious. It is already well established that short-wavelength light (in practice ''blue'' light) is the most melatonin suppressive. This is an important fact, since it is the kind of light typically emitted by lamps in conventional delivery rooms. It is probable that, when birth physiology is better understood, there will be spectacular practical implications of these recent scientific advances. Can we imagine a time when it will be considered rational to give birth in the light of a candle?
After mentioning language and light, we might summarize the most important points by emphasizing that all attention enhancing situations are stimulants of neocortical activity. This is the case of feeling observed: it implies that one of the basic needs of a labouring woman is privacy. The perception of a possible danger is another example of attention enhancing situations: it implies that a labouring woman need to feel secure. We'll notice that similar conclusions can be reached when using as a starting point the concept of adrenaline-oxytocin antagonism.
Until now, the concept of neocortical inhibition has not reached the power to challenge the dominant paradigm we may call the helping-guiding-coaching-managing-supporting paradigm.
The concept of bacteriologically familiar environment
Among mammals in general, the early colostrum is, strictly speaking, vital. Among humans, even if the early colostrum is precious, it is not vital: the main questions are about the bacteriological environment in the birthing place and, in particular, how familiar it is to the mother. The reason for such differences are related to placental structures and functions. Among most non-human mammals, the placenta is not effective at transferring antibodies to the fetus: the transfer of antibodies starts immediately after birth via the colostrum. Among humans the trans-placental transfer of antibodies (namely IgG) is highly effective.21,22,23,24 In humans, fetal concentrations of IgG approximate to maternal concentrations at 38 weeks and continue to increase thereafter. These facts explain inter-species differences regarding the basic needs of neonates. Among humans, the microbes that are familiar to the mother are also familiar to the newborn baby.
The time has come to realize that, from bacteriological and therefore immunological perspectives, there has been recently a spectacular turning point in the history of human births. A century ago, nearly all women were giving birth among a huge diversity of familiar micro-organisms. Today, most human beings are born in unfamiliar bacteriological environments characterized by a low microbial diversity. The effects of unfamiliar environments may be amplified by the use of antibiotics and birth by caesarean, i.e. by-passing the bacteriologically rich perineal zone. The early programmation of the human immune systems has therefore been dramatically modified: a turning point in the history of our species. From bacteriological and immunological perspectives, one cannot imagine substitutes for home birth.
There is already an accumulation of data confirming that the maturation of a balanced immune response (‘Th1/Th2’) is affected by the mode of delivery.25 There is also an accumulation of epidemiological studies detecting risk factors in the perinatal period for health conditions such as type 1 diabetes (and other autoimmune diseases), atopy, autism and obesity (www.primalhealthresearch.com).
The emerging generation of epidemiological studies of the long term consequences of radical changes in birth environment must overcome many difficulties. As a point of departure, we will need studies contrasting births at home and births elsewhere. In practice, for multiple reasons, such studies are not feasible in emerging and developed countries, apart from the Netherlands. A Dutch birth cohort study involving more than 1000 children (born at a time when the rates of home births were above 25% in that country) included data on birth characteristics, lifestyle factors, and atopic manifestations collected through repeated questionnaires from birth until age 7 years.26 Fecal samples were collected at age 1 month to determine microbiota composition, and blood samples were collected at ages 1, 2, and 6 to 7 years to determine specific IgE levels. Vaginal home delivery, compared with vaginal hospital delivery, was associated with a decreased risk of atopic diseases. The differences were highly significant for children with atopic parents.
On the day when childbirth is looked at from these unavoidable perspectives, there will be a radically new basis for discussions between those who promote planned home birth and those who consider hospital birth as the only rational option.27, 28
Meanwhile
Although it may still be difficult to assimilate pieces of knowledge provided by emerging scientific disciplines, some women are ready to understand the concept of neocortical inhibition, whatever the vocabulary they personally use. There are also women who are convinced that there is no real substitute for birth in a familiar environment. All these women should be given the right to challenge tradition and cultural conditioning.
References
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