Health

Gentle questions of birth

Pat Ohlendorf April 21 1980
Health

Gentle questions of birth

Pat Ohlendorf April 21 1980

Gentle questions of birth

Health

Pat Ohlendorf

The natural childbirth movement was well under way by 1975, when French obstetrician Frederick Leboyer popularized his novel method of delivering babies in Birth Without Violence. What he contributed was a fresh portrait of the infant’s often terrifying and lonely experience in the delivery room, and the startling suggestion that the birth trauma—one of those “givens” in psychiatric theory— might be transformed into an easy, even joyful transition for the baby. Leboyer worked in a quiet, darkened delivery room, clamped the umbilical cord late (to allow the baby to adjust to breathing without being deprived of its

oxygen supply), placed the newborn on the mother’s abdomen immediately after birth (to help establish a secure bond between them), and gave the baby a warm bath, reminiscent of the womb it had just left. Leboyer and his followers believed that babies born by this gentle method were calmer and more responsive than others, and would become more secure and creative adults. To many obstetricians, however, questions of safety were more important. How well could problems be spotted in a

dark working area? Wouldn’t the infant be more susceptible to jaundice because of the infusion of blood due to late cordclamping? Wouldn’t the baby become chilled when taken out of the bath? Wasn’t the whole procedure, in fact, a lot of fuss and bother for very questionable benefits?

Until now, doctors and prospective parents have relied only on personal in-

clination in deciding whether to use Leboyer’s methods or steer clear of them. But the results of a two-year study at Hamilton’s McMaster University, published last month in the New England Journal of Medicine, provided proponents as well as critics with scientific information for the first time. In addition—and perhaps of greater ultimate significance—the study implicitly

raised the question, “What should a hospital birth be like?”

To test the effectiveness and safety of the Leboyer procedures, medical scientist Nancy Nelson, obstetrician Murray Enkin, pediatrician Saroj Saigal and their colleagues studied two groups of 28 women who were treated alike except for one thing: the test group had Leboyer-type births in the labor room while the control group had “conventional” births in the delivery room. “In all respects,” the study reports, “attention was paid in both groups to gentle handling of the newborn and to facilitation of parent-infant interaction.” The behavior of the 56 babies was recorded minute-by-minute during the first hour of life and checked during the first three days; follow-up assessments of temperament and development were made at six weeks and eight months.

At the end of the two years, after all the observations had been translated into numbers and all the numbers had rolled through the computer, what did the researchers find? Leboyer babies appear to be no different from babies born by a “gentle conventional delivery.” “To me, the study was very sound,” comments Dr. Robert Usher of the Royal Victoria Hospital in Montreal, an authority on newborn care. “It really tested the hypothesis that some of the members of that study group firmly believed in: that a child delivered by the Leboyer method would have a much better psychological reaction to birth and that there would be a better bonding between the mother and baby after birth.”

Dr. Alvin Pettle, an Etobicoke obstetrician who has performed more than 200 Leboyer-type deliveries, says the study hasn’t changed his mind at all.

“In fact, it helps me because it shows that you can carry out a gentle childbirth with no adverse effects to the newborn.” And one of his patients, Toronto teacher Bev Merkley, says nothing can dampen her enthusiasm over her youngest child’s birth. “I couldn’t believe how peaceful she was—our other babies had screamed and screamed from the moment of their birth. But LoraLee is different. She’s extremely outgoing and secure with people.” Merkley is looking forward to her fifth child—and her second Leboyer delivery—in August.

To many women with bitter memories of hospital deliveries, the McMaster study must seem mere hairsplitting between one enlightened method of childbirth and another. “What would be really interesting,” comments llene Bell, Toronto prenatal counsellor and home-birth attendant, “would be to compare the McMaster control group with the conventional hospital birth.” Although there have been improvements in hospital childbirth practices in the past several years, the battle is far from over. The dramatic rise in home births in Canadian cities attests to continuing dissatisfaction with hospital deliveries. And couples enrolled in prenatal classes today often spend as much time learning how to handle hospital staff as anything else. Says Pettle: “Seventy-five per cent of my patients ask questions that really mean, I fear you’re going to take over my body, do things to me—give me enemas and give me intravenous—and ƒ don’t want it!”

“Many people feel that our comparison group is not an appropriate one in that McMaster is one of the most advanced maternity units in the country,” says Nelson, head of the project. But, as the study explains, “The control deliveries, while more conventional, were intended to be equally gentle, to avoid confounding the controversial specifics of Leboyer’s method with the principles of gentleness.” Adds Saigal: “It’s not good medicine to compare a Leboyertype method with something that we consider archaic.”

This is the heart of the McMaster Leboyer study: not what it says about a certain set of rituals, but what it shows is possible in hospital delivery rooms today. The main concerns at McMaster are gentleness, patience, the bonding period between parents and baby, and the recognition that within the limits of safety the birth of a child is the couple’s experience, not the obstetrician’s. “It’s time we started having faith in ourselves,” emphasizes Nelson, “not in this method or that method.” Adds Enkin: “My response to a womàn who asks for a Leboyer delivery will continue to be, ‘The only woman who has a Leboyer delivery is Mrs. Leboyer. What do you want for your birth?’ ”