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serious conversation program Number 2 22 Air Date. April 7th 1976 State. Recorded. February 28th 1976. Director Connor Hello, I'm Mike Cannon and this is conversation. Birth may be described as the most awesome, the most inspiring, the most significant and the most moving of all human experiences for the infant.

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It might also be the most traumatic of experiences, and so there has risen to the surface in recent years. A group of obstetricians and others who have proposed what might be called gentle birth. Why they have proposed it and what it is, is the subject of this conversation, and I'll be back in a moment with my guest conversation.

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A discussion of social, political, scientific and religious issues of the day. Your host is Dr Michael began in professor of religion in history at the University of Florida. My guest on conversation is Dr Charles Mahan, associate professor of obstetrics in the College of Medicine of the University of Florida.

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Welcome Charlie to conversation, and I opened our program with the remark that for the infant, the experience of birth could be described as traumatic White. Could you argue that case and why have many done so of light? Well, you might find many American obstetricians that would argue against that.

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I think that Dr Leboyer is point. The man whose book is bringing this to a great deal of popularity at the present time is that the baby is brought into a world that's quite different in the world it's been in for the last nine months. And that just a the cold temperature, the noise the, uh um lights in the delivery room can be such a dramatic change after the difficult travel through the birth canal that, um if things were sort of toned down or ameliorated a bit, why the baby might have a better start, Uh, in the world.

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Now, this is Dr Frederick Leboyer, a French physician who has popularized this view. Um, where did he originate this view in his own experience, Or has he discovered this as, ah practice elsewhere in the world that the infant ought to be given the best possible circumstances immediately following birth circumstances that duplicate the life in the womb?

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Where did he first come to this theory or idea? Well, Dr LaVoy was visiting us here last April and stayed for a few days. And so we got to talk with him in great detail about this. And there seemed to be a couple of sources for this one.

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Was, um, sometime that he spent in India observing the birth process there, in which he says, And I have no experience with India, that the most of the babies born in India are born under these subdued conditions and hey, feels that they're more responsive, apparently happier babies.

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The other source in his background, he says, is his own psycho analysis, in which he was taken back back to the time of his birth, and he remembers it as a severely terrifying experience. But again, I have no experience with psycho analysis, but his theory was that the birth experience might leave lasting scars, right?

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All right, all right. Now what happens in the typical American delivery room today? You have, as you pointed out before ah, loud noises and sounds of air conditioning, and the coolness of the air conditioning itself violates the world from which the infant has just come and and the lights because the infant has lived in a dark world or on uh, now, at least the proposition is that the infant would be more comfortable in an atmosphere of subdued light.

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Sure, the lights are like these and in the delivery room. I'm certainly not comfortable under these lights. And yes, uh, neither am I, but all right, now going building from that. What does Dr The boy a proposed be done? And what are you doing at the College of Medicine?

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In following his theories? Well, Dr LaVoy proposed that the moment of arrival in the delivery room be made as much like the environment that the baby just came out of. So that, um, the steps that he takes to do this air. Pretty simple. And some of the steps were steps that many American obstetricians have done routinely for many years.

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But probably nobody has put them all together like this. Um, when the baby's first delivered the before the head has delivered, the delivery room has been made fairly low light with just enough light to see, um, the delivery of the baby and the bright spotlights or not placed where the baby would get them right in the face.

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As the baby was delivered. The everybody has asked to speak in whispers, and the delivery room has kept quiet. Um, immediately after delivery, the baby is observed briefly by the obstetrician and then placed on the mother's abdomen. And usually the mother would have a drape, a sterile drape on our abdomen, and we don't put that on with this procedure.

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We just put some antiseptic solution up to her around her belly button and then lay the baby across the bottom of her abdomen. And then she massages the back of the baby, and that keeps the baby warm. And Dr Leboyer proposes that the baby be kept there until the cord stops pulsating and this takes anywhere from a few seconds to maybe five minutes until that stops, and then the court is cut.

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And then we have the nurse, um, pull up a tub full of warm water, which is about the same temperature of a za mother's body temperature 98.6. And Thio put the baby back in a wet, warm environment from whence it game, and the nurse shows the father how toe put the baby in the tub bath.

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And so it's the combination of the low lights the warmth of the mother's body. No noise. And we also don't slap the baby to make it cry. It's felt that this is not really necessary that we could tell immediately whether the baby is breathing or not.

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If it's not, we don't go through most of this procedure. We take steps immediately. Thio. Get oxygen to the baby's brain with resuscitation. Charlie, You brought along some films that were taken of this process. They're still photographs and in black and white because of the Sidhu light atmosphere.

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Let's ah, take a look at these now in Siris. And if you describe this first one, please, the first one shows the obstetrician standing at the foot of the delivery table, Um, observing for the moment of delivery or waiting toe. Catch the baby. Really, that's most normal deliveries.

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That's all there is to it. All right, And then let's go on to the second, and that's the beginning of the delivery of the baby's head. I think in that one you can see the baby's hand beside its's, its head. Yes, and that's another shot of the delivery of the baby's head.

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It's all wet and moist from blood and fluid amniotic fluid. You do not clean the infant before placing the infant on the abdomen of the mother. Infant looks a little grubby, but it's not really infected or anything like that. All right, now, what is this one?

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Let's pause a little bit here. This is a bit hard for me to see, but I believe it's the baby being placed on the mother's abdomen, and then the mother will massage it with her hand. Yes, there. That's a better picture of the So does the infant make any sound?

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Uh, as I understand gentle birth. The infant does not a za rule cry as much as in the other type. Birth procedure. That's right. The, um, baby sometimes will whimper or cry a little bit. This bothers people that have been used to the traditional pat on the foot.

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When the baby clutch is out and screams, Um, sometimes they just make a little gurgling noises and ah, little grunting sounds. But that's about but the baby seems to be more at peace in this kind of situation than in the other. And I suppose that it's a very beautiful experience for the mother.

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We missed a shot there of the baby being placed in the warm bath. I don't know if we could go back to that or not, but I wanted to talk about that, too. Is that simply a water? So our is a saline solution or just plain water?

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Just plain water. And, um, the baby is placed with the so the father is shown how to hold it in. His relaxed to position is possible because the baby can pick up the fact that he's tense. If he's worried and afraid of putting it's head under the water, why, that would be a problem.

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And that's probably the most remarkable part of the whole procedure as faras the baby's reaction because, um, up to this point, it's not too unlike any other delivery. But at this point, the baby really seems to relax A instead of being tight, and, um, they just seem to relax in the water.

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They sometimes play with their hands and feet, and as doctor the boy has pointed out. Occasionally they smile or what appears to be a smile, but they open their eyes. They look around. Usually newborns don't do that. Usually, there, there, scrunched up in their eyes were closed.

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And what stage are we in here? That's after the babies out of the water bath, um, wrapped up in ah, blanket and again showing one of the interesting things that thes general birth babies seem to do. One of the things that we can key on and that is that the baby seemed to open their eyes the first few weeks of life and gaze at their parents and things around them a lot more than newborns usually do.

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That's interest. Whether that means anything or not is for people other than myself to decide. But now who is it? As a rule that takes the baby and puts the baby in the bath? Well, the they I usually hand it to the nurse, and then the nurse will put it in the bath.

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But at the same time, the father would be right there and showing the nurse would be showing him and then just turning it immediately over to him. All right, well, now you speak of the father as though the father has a strong role in this type of birth.

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Oh, yes. And the father is present throughout this whole procedure. But this is not necessarily the type birth that father is always participate in when they're present in the delivery room, is it? No, no, no. And we We like to combine this procedure with, um, prenatal classes.

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Such is the Childbirth Education Association in town would offer. We have our own people teaching those courses it's llamas or prepared childbirth classes in which the mother and father go to classes for the last two or three months. The pregnancy. They, um, learn all the details about labor and delivery.

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They learn exercises, breathing exercises they could do to decrease pain and labor and speed up labor. Um, exercises that the mother could do to keep in shape, to be in good shape for labor and deliver. It requires a tremendous amount of physical exertion. So it's sort of like getting in shape for the big game, and the father is included all the way along.

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And yet Shan's The father is in the labor room. He's the primary support for his wife. They're working together as a team. Um uh, if a woman, let's say if the husband's away or the, um, she's unmarried, sometimes a mother or a grandmother or sister or friend will substitute for the father, but it's really a tremendous support.

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Uh, and then in the delivery room, the father is present. He's able Thio, uh, see the delivery to help his wife with pushing part of the delivery and to experience all that. And then this is really just adding on a little bit extra to it and letting him participate, actually, in handling the baby, um, which he did to a small extent before.

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But then, after this, the baby goes to breast, usually with mother for breastfeeding. And, uh, um, the father can't do that. So, uh, about how long does the father hold three infant in the water salute in the warm water. But as Dr Boy would say, there's no I keep calling this a procedure, but he says, this is not a procedure.

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You know, this is something that you do according to how the parents and the baby are reacting to it. And if they really are just having a great time with the baby in the bath, and the baby really seems to like it and the parents are enjoying it while then they constrain a in there Onda.

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Often it has to be taken out when the water gets cold. Sure, and about How long does the infant remain on the mother's abdomen immediately after? The same thing is really all right. They're not really matter that there's no sign. Another might just get a little tired.

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Some others might really like the massage and and say, Gee, I'd like to keep this up. Others might say, I'd like to see what the baby does in the water bath transferred pretty quickly. Alright, his anesthesia used as a rule in the delivery. There's a very from patient to patient.

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I hate to use the word patient. It's probably wrong because the mother is not a patient. Technically, really, unless something goes wrong, she really isn't. But we still do. Call them that. Clients. Sounds like such a harsh word, but I guess that's just mother. That's that's better.

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Sure. Well, what about births at home? Could this process not take place at home? I understand that there is, ah, a rising chorus of please that birth be taken out of the hospitals and placed once again in the bedroom of the home. What about that Charlie.

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Well, I think that that Z we're quite aware that there are many people desire ng home births. And fortunately, I can speak from having done a great number of them when I was a medical student, a senior medical student at the Chicago Maternity Center, so that I'm not reacting in a hostile way from no experience but the I think one of the reasons that were really interested in providing these experiences in hospital is, um, because we really are concerned about home delivering.

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Um, I'm just reviewing a book or was asked to review a book on called Childbirth at Home by a Woman in California. Um, and certainly there are a lot of good cases for this, but I think that, um, she does underplay the dangers of what she says that 95% of deliveries or normal and could go well at home without any problem.

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Um, that's not really true in the If she's talking about a wealthy suburban population and not including adolescence, maybe she's right. Um, you have more difficulty with births In the case of adolescent mothers. Oh, yes, and and poor mothers, mothers who are not well fed and have other problems.

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Economic psychological problems at home. Um, our complication rate and those mothers is more than half of them have serious problems. What about the argument that if anything should happen to the mother in delivery there, the whole all of the facilities of the hospital are right there at her disposal?

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Certainly, beyond this makes advantageous hospital delivery instead of a home delivery. Sure that, Z exactly right. And there are there are steps that could be taken between. We've made great strides in the last few years and obstetrics, and we can we have in our grasp the ability to prevent almost all mental retardation and cerebral palsy.

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But ah, we can only identify about two thirds of the mothers that are going to have trouble in labor before they actually get into labor. S o the other show up while they're actually on the spot. And it takes somebody with quite a bit of training and perhaps, um, equipment to really find out that something is happening that's bad for the baby.

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So their steps that we're trying to take two meet people halfway. I think that we feel strongly that because of the unpredictability. And to be honest, the other thing is the malpractice situation. No physician in the United States is going to go into a home under the present conditions and deliver a baby because it's just too risky.

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So we're trying to work toward things such as family, senator, maternity care, where in the best of all possible worlds, we would have a room set up in the hospital. It's sort of like a motel room. Um, I helped design the unit Minneapolis that's being built.

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Now that is doing this. They're using nurse midwives to run the unit. It's right down the hall from the high risk unit with all the equipment if it's needed. And the mid nurse midwives are excellent at determining whether anything is going wrong in labor. This could be done, of course, um, by interested physicians rather than nurse midwives.

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We the mother labor's in a setting with her family around her. The next problem is getting the hospital to agree to let you know Children in. If if the family wants the Children presents some do and some don't, um, she labors with her friends she delivers in the bed, Um, and stays there with the baby beside her in the same next day.

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Bad eyes in her room. Sure, but the delivery does not take place in the room itself, does it? Yes. The motel, right? I e mean, like room? Yes, it's a pretty room. It's not a sterile hospital room. It's got pictures on the wall on wallpaper and curtains.

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Did we answer the question before about anesthesia? We got the rodeo on whether or not the mother was a patient. We feel over the research of the last five or 10 years that any drug used in prenatal care or labor and delivery is potentially dangerous so that this has made the, um, anesthesia the anesthetics that we've chosen for mothers, um, less and less toward the concept of knocking people out or putting them to sleep.

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That just really isn't done anymore unless mothers having a cesarean section and then it's done for a very brief period of time. The most of the anesthetic such is in this type of delivery that would be given would be a local anesthetics. If the mother needs any at all.

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Many of them are so well prepared on there, so well trained and so with it that they don't need any help that way at all, and they don't want any. And that's fun. Um ah, general anesthesia. Would it have an influence on the infant? In other words, would the infant, still drawing its sustenance from the mother's bloodstream, be affected by anesthetics introduced into the bloodstream, gets it right straight across by the same pipeline, gets the oxygen and the drug and be adversely affected, perhaps by three?

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And that's why we don't use it anymore. And I think the the idea of put being put to sleep for a vaginal delivery is really a horse and buggy type of idea is just not done in modern obstetrics unless there's a serious complication of rapid emergency occurs, and they're just a very few indications for that happening.

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But for the most part we're using, if somebody is having a lot of pain and they aren't well prepared, there are things like epidurals, which are a type of spinal block that air given they're quite safe for the baby, Um, but we'd really rather have the parents go to classes and be prepared.

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It's the fear that causes the pain or a lot of it certainly accentuates it and knowledge gets rid of the fear. And, uh, it makes a tremendous difference. But well, if we're trying to return to natural practice in childbirth, would that not also apply to breastfeeding?

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Oh, yes, sure. And you urge in this system if I can call it a system breastfeeding on the part of the mothers? Some mothers cannot breastfeed their babies, uh, for one reason or another. So I'm told there's no not very many. Just a tiny, tiny fraction can't.

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And the Laci League, the group that's highly interested in breastfeeding, feels that essentially 100% of mothers can breastfeed that lead, by the way, took its name from Ah, a little Spanish shrine in ST Augustine, about 70 miles away from here. It was ah, shrine built by the Spaniards in the first quarter of the 17th century.

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Um, there was among the Spanish Christians in ST Augustine, a devotion to Mary, the mother of Jesus under the title Nuestra Senora de la Ley que, uh, Gwen part Oh our Lady of the Milk and of happy delivery. And ah, a little statue was brought over from Spain and placed on the altar.

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And the little chapel on the grounds of Mission Nombre de Dios in ST Augustine in the chapel depicted Mary breastfeeding the infant Jesus. And this devotion, um, lasted in ST Augustine all during Spanish Times, which was about 2.5 centuries and then disappeared for a while and was brought back again by American citizens of the city in the last quarter of the 19th century.

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And that, uh, there's a new shrine building that stands on that site today in a replica of that statue. So, uh, that is where the Little League takes its name. If I can add that little trivia Charlie, is this going to catch on? Is this going to be the new procedure for childbirth?

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Well, the problem is, and when we sit here and talk about this, it sounds like every delivery we do is a general birth. And that's not really true since Dr Leboyer was here, which has been about 10 months ago, and we started doing them, we've probably done about 40 and that's out of about 2000 deliveries.

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So that, um, many of our mothers have come to Shands or poor, And, uh, they don't either have the means or sometimes the the we haven't found the way to interest them in, um, childbirth education. But we think it's highly important because certainly people with that air poor and have nutrition problems and are going to have problems in labor are the ones that are, especially the ones that shouldn't get any drugs in labor for pain.

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And yet they're the ones that often need them because they're afraid so. Unfortunately, we sat down at the, uh, the Childbirth Education Association meeting a few months ago, and we we really felt that we were only reaching 5 to 10% of the people that delivered in a natural county with any kind of prepared childbirth.

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So it's going to be a while before this catches on, even locally, not to speak of special interest, upper middle class phenomenon now, but hopefully it'll you know, it's all we can say as far as its benefits at the present time. Are that it? It's It really creates a tremendous sense of bond with the parents.

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It's something that makes the father feel more involved, and the parents that have other babies to compare it with, really feel that the babies react in a in a much more sensitive way for the first few weeks, And it will be interesting to follow the lifetimes of these babies to see if they show greater mental and physical health over the course of years, uh, than those delivered by another an earlier system.

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Thank you very much. Dr Charles Mahan, associate professor of obstetrics and the College of Medicine of the University of Florida. This has been conversation waking up.