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What in the world is a Lotus Birth?

What in the world is a Lotus Birth?

A Lotus Birth is the practice of keeping the placenta intact and attached to the baby for the first few days of the baby’s life, until the cord dries out and naturally falls off on its own, just like a cut umbilical cord would, usually within 3-10 days of the birth.  When I first heard of this practice, back in 2002 as a nursing student, I was completely aghast. Why in the world would anyone want to do something like that?? What do you do with the rotting and mouldering placenta that’s still attached to the baby? How do you dress the baby and care for the baby with the cord still attached?? I had a million questions, and the entire concept seemed completely alien.

(Photo courtesy of Danella Jade, 2018)

Further research into the subject, though, has changed my mind. It turns out many indigenous and aboriginal cultures honour the placenta, which makes a lot of sense when you think of the placenta as a guardian that has nourished and supported the baby in utero. Moari tradition buries the placenta on tribal land to help foster a connection in the child to that land. In the Hmong tribe in South East Asia, it’s believed that the placenta must be retrieved by the spirit after death, in order to ensure physical integrity in the next life, and therefore the placenta is always buried under the house where the baby was born so that the spirit will know where to find it (Buckley, 2003). In Zimbabwe, the placenta is buried by the family home to ensure that the child will always want to return home, and in Cambodia people believe that the child will stay safe so long as they are always near to their placenta (Buckley, 2010).  In Bali, the placenta (as well as the cord, amniotic fluid and blood) are called ‘Ari-Ari’, which means “younger siblings”, and these tissues–and in particular the placenta–are treated with the utmost respect, often bound in a coconut shell or placenta bag with herbs and flowers and buried outside the home (where it’s marked with a stone and then later a prickly bush is planted on top to help protect it).  A Balinese child will greet their placenta in the morning, and pray to it for protection at night, and the spirit of the placenta is thought to live on as the child’s guardian throughout their lifetime (Buckley, 2010).

(Photo credit: Nick and Vanessa Fisher)

In Western culture, the placenta is mostly seen as medical waste, and is often collected into biohazard bags and disposed of or incinerated by the hospital. The newer trend of placenta encapsulation, as well as some couples wishing to follow more traditional practices such as burying their child’s placenta under a tree in their garden, has led to more placentas being requested and brought home from the hospital than ever before.  Lotus Birth was first documented among chimpanzees, but was never practiced by humans until Claire Lotus Day (inspired by some of Jane Goodall’s research) sought an alternative to the routine cutting and clamping of the cord in 1974 and found an obstetrician who was willing to honour her wishes and leave the cord and placenta intact until they fell off naturally (Buckley, 2003; Lim, 2001). Since that time, Jeannine Pavarti Baker, Shivam Rachana and Dr. Sarah Buckley have all been proponents of Lotus Birth, and more recently Michel Odent has also spoken about the advantages of it.  While I can completely understand that this practice might not be for everyone, there are many good reasons to at least consider it.

First and foremost, a Lotus Birth would ensure that optimal placental transfusion occurred. At birth, one third of the baby’s blood supply is located in the placenta, and this vital supply of blood, oxygen, nutrients and stem cells rightly belongs to the baby (and is not waste!).  Left undisturbed, Mother Nature will gradually perfuse the baby with the remaining blood over the next several minutes while the placenta is still attached to the uterine wall; eventually, the cord will stop pulsing and the perfusion will end, often heralding signs of placental separation, followed by the delivery of the placenta. (I’ve written a lot more on physiological management of the third stage of labour in a different post). In hospitals right now, there is a big push to better support optimal cord clamping as we learn more about exactly how important this blood is to the baby. Recently, both NICE and WHO changed their guidelines to reflect the new research on this topic, urging practitioners to wait at least a minute before cutting the cord to allow placental transfusion to occur (a practice known as ‘delayed cord clamping’). However, other clinicians like Amanda Burleigh, founder of the “Wait for White” campaign, argue that a 1 minute delay isn’t nearly long enough to allow full placental transfusion, and believe that we need ‘optimal cord clamping’, which involves waiting until the cord has turned white before cutting it (more information on this can be found at Blood to Baby and in this fabulous podcast with Amanda). Unfortunately, there’s still a lot of room for improvement in this area, and lots of cords are STILL getting cut way too soon. But opting for a Lotus Birth would ensure that this would never even be a question, as the baby would receive their full portion of blood and the cord would never be cut (too soon, or otherwise).

Additionally, a Lotus Birth helps preserve the mother-infant bond, and helps enforce a “lying-in” period, or a “breaking-forth”, as Dr. Sarah Buckley calls the time between when the baby is born and when the cord naturally falls off (Buckley, 2010).  It’s hard to get out and about with a baby who’s still attached to a cord (although not impossible, as placenta bags are portable and easy to use), and the practice ensures that the first few days unfurl at a slower, more gentle pace, with the mother taking it easy and spending the majority of her time resting and bonding with the baby. A baby who’s still attached to the cord is a visual reminder to visitors that the baby is still new and needs to be protected, and also helps prevent the baby being passed from one excited relative to the next (potentially to the mum and baby’s detriment). It’s also a bit harder to fully dress a baby who’s cord is still attached, which gently encourages skin-to-skin bonding to keep the baby warm, rather than dressing, and we know how important uninterrupted skin-to-skin is when it comes to establishing breastfeeding.  Anecdotal reports have emphasised the calm and peaceful transition Lotus Birth allows for, as well as the calmer and more relaxed temperaments of babies who are still attached to their cords (although this might be influenced more by the uninterrupted bonding and attachment fostered by a Lotus Birth, rather than the actual physical presence of an intact placenta). Author Shivam Rachana has written about how babies seem to automatically flinch or cry out or grab their cord as it’s being cut, and Robin Lim, international midwife and founder of the Bumi Sehat birthing center in Bali, reports on a Lotus Birth where the placenta was seen to pulse at the same time that the baby was breastfeeding (Lim, 2001). The father of that baby, himself a PhD biochemist, was amazed by this discovery, stating: “I am certain that something here is being communicated. I am not fooled by the dry appearance of the cord, deep in the center there is life. Something essential is being provided to my baby by his placenta,” (Lim, 2001). In the same article, Robin Lim beautifully sums it up:

Midwives are the guardians of normal birth. Yet in these times we may have forgotten what normal is. We are certain that a close bond between mother and child is normal. My experience is that Lotus birth facilitates that bond. Yes, it is inconvenient to move around with the baby attached to her placenta. So mother lies in, close to the baby and placenta; breastfeeding is established in this sacred circle of quiet, restful seclusion. Yes, few visitors feel welcome while the placenta is still attached. It is during this space out-of-time that family may be invented, and that the new mother reinvents herself.

 

(Photo credit: Veronika Richardson, Fox Valley Birth & Baby, “Tranquility”, 2018)

So what about the practicalities? How does one actually have a Lotus Birth?  This article is great for answering many frequently asked questions (with lovely images of Lotus Birth to boot).  According to Lotusbirth.net,  first you wash the placenta in warm water after it’s been delivered (and after it’s finished pulsing/ transfusing all its blood to the baby) and then pat it dry. Then place the placenta in a sieve over a bowl for about 24 hours to allow it to drain. After this, the placenta can be placed in a nappy or cloth and covered with salt and herbs like dried goldenseal, lavender, turmeric or sage, with more salt and herbs added daily and the nappy changed daily (if you have a placenta bag, the nappy can be placed inside the bag). There are no reported cases of infections being transferred from a degenerating placenta to a baby, although RCOG states that there is the potential for infection and advises that practitioners should act quickly if any signs of infection in the baby are noted. Many anecdotal reports state that the placentas dried out and remained surprisingly odourless for days when salt was used to preserve them.

Naturally, Lotus Birth won’t feel right to many women, but if this appeals to you, don’t hesitate to ask for it. As midwives, we need to be able to support all women’s birth choices, including Lotus Birth.  As quoted from a Guardian article on Lotus Birth: “Unsurprisingly, lotus birth is a minority home birth activity, says Mervi Jokinen of the Royal College of Midwives, although there is no reason you couldn’t ask for it at a hospital birth. “The people who do this are happy to see the experience as a life event and a natural thing. It’s difficult to make a clinical comment on this because there are no studies.” Which is all just to say that even if it’s an unusual practice, it’s absolutely something that midwives can (and should) support. We didn’t have a Lotus Birth with either of our home births, but looking at all of this information now, part of me wishes that we had!

 

Buckley, S. (2003) ‘Lotus Birth: A Ritual for Our Times’, Midwifery Today, 68 (Autumn 2003), pp. 36-38.

Buckley, S. (2010) The Amazing Placenta. Available at: http://www.mothering.com/articles/the-amazing-placenta/. (Accessed 8 March 2018)

Lim, R. (2001) ‘Lotus Birth–Asking the Next Question’, Midwifery Today, 58 (Summer, 2001), pp. 14-16.

Ovulating While Breastfeeding

Ovulating While Breastfeeding

A friend of a friend recently asked me a question that I couldn’t answer. She’s in her late 30s, has a two year old daughter, and has been breastfeeding on demand for the past two years. She and her husband have been trying to have another child, but she just recently learned that she miscarried after their first attempt. She has only recently started getting her period again, and was wondering if the breastfeeding could negatively impact her body’s ability to get pregnant again. I speculated that the high levels of prolactin which occur during breastfeeding might inhibit ovulation, just as high levels of oestrogen inhibit breastmilk supply by competing with prolactin for binding sites in breast tissue, but I told her I wasn’t really sure and that I would investigate. I thought that somehow oestrogen and prolactin were counter opposites: one could not exist in high levels while the other was around. Turns out I was waaaaay off base. Here’s what I found:

During pregnancy, the corpus luteum, acting on instructions from the placenta, secretes the oestrogen and progesterone necessary to maintain the pregnancy. These high levels of steroid hormones simultaneously suppress Follicle Stimulating Hormone (FSH) and Leutenizing Hormone (LH), the two hormones most responsible for ripening an egg and then triggering ovulation—after all, if you’re already pregnant, there’s no need to ovulate. After delivery, once the placenta is removed, the high levels of oestrogen and progesterone no longer exist, and the levels of FSH and LH gradually begin to rise again, preparing the body for ovulation. Eventually, as the levels creep up, the pituitary takes notice again, and begins to release more FSH and LH through a negative feedback loop, which eventually will trigger ovulation.

“Most nonlactating women resume menses within 4 to 6 weeks of delivery, but about one-third of the first cycles are anovulatory, and a high proportion of first ovulatory cycles have a deficient corpus luteum that secretes sub-normal amounts of steroids. In the second and third menstural cycles, 15% are anovulatory and 25% of ovulatory cycles have luteal-phase defects…Lactation, or breastfeeding, further extends the period of infertility and depresses ovarian function. Plasma levels of FSH return to normal follicular phase values by 4 to 8 weeks postpartum in breastfeeding women. In contrast, pulsatile LH stimulation is depressed…in the majority of lactating women throughout most of the period of lactational amenorrhea.” [1]

In other words, after not menstruating for so many months, it takes the body a few tries to get the delicate hormone balance back up to speed again. The first few cycles either don’t release an egg, or if an egg is released, the corpus luteum, which is responsible for secreting enough progesterone to maintain the pregnancy until the placenta can take over, isn’t quite up to the task. This is called a luteal phase defect, and it’s a very common cause of early miscarriages. In women who are breastfeeding, the process of returning to normal ovarian cycles takes even longer.

In breastfeeding women, FSH, the hormone responsible for ripening an egg, returns to normal pre-pregnancy values fairly early, but LH, the hormone responsible for triggering egg release, continues to be suppressed due to the breastfeeding. (However, contrary to popular belief, prolactin is not at all responsible for this suppression. It’s the constant suckling and stimulation of the nipple itself which actually suppresses ovarian function, which is why on demand breastfeeding is so essential to maintaining lactational amenorrhea.)

So, there you have it. To answer the question: it will probably just take a few more cycles for your body to get back into full swing in terms of ovulating, but continued breastfeeding did not contribute or cause the miscarriage in any way, and will not prevent conception. Most likely, the miscarriage was caused by a short luteal phase or corpus luteum that just wasn’t quite ready to maintain a pregnancy, and this will no longer be a problem once your body goes through a few more cycles and gets used to ovulating again.

[1] Hatcher, R.A. et. al. (2011) Contraceptive Technology, 20th Revised Edition. Ardent Media, Inc.: New York.