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Analysis

One-to-one: The dawn of a new world

8 September, 2014

One-to-one: The dawn of a new world

What will the acclaimed Michel Odent be talking about at this year’s RCM student conference? Read on to find out.

The business of childbirth is undergoing a revolution and student midwives will be pivotal in driving it. So says French obstetrician and childbirth specialist Michel Odent.

He would like to see the new world emerging from the revolution as one in which midwives shield women from anyone, including health professionals, who try to manage the birth. Instead, the woman is given the space and peace to birth as nature intended.

‘A midwife would be the protector of the evolutionary process rather than an agent of cultural milieu controlling the process, which has been the case for a long time,’ he says.

He has famously described the ideal as being a woman birthing alone – no birth partner to distract her – with only a knitting midwife in the corner of the room. Michel is quick to acknowledge that this seems unmodern. His point is that the midwife is not interacting with the labouring woman and, therefore, there is no transmission of adrenalin that might affect the birthing process.

It is quite far removed from the practice of most midwives working in the NHS and the experiences of students.

But there is one enormous incentive for student midwives to take up the cause, says Michel. And that is that they are fighting for their survival in the new world. If the revolution in how modern childbirth is managed goes in another direction, then midwives will become extinct, he says.

‘It is already happening in some countries. In some Latin American cities, the midwife has disappeared.’

The role of science

To understand his argument, Michel says that it is important for the next generation of ‘middies’ to appreciate how science and culture have shaped practice. He will talk about this in his session ‘Childbirth in the scientific context of 2014’ at the RCM student conference in November. In the past, science has been in contradiction to the natural process of birthing. Now, the pendulum is swinging the other way, as science makes progress in understanding why the traditional ways were important.

For example, it became the norm to give women enemas and shave the pubic area before birth to avoid the newborn coming into contact with bacteria. Newly born infants were whipped away from their mothers to be cleaned up and breastfeeding was not initiated for some time after birth. Newborns even slept in a nursery, separate from their mothers.

Nowadays, this would never happen because science, particularly microbiology, has proven that microbes are important and healthy. Likewise, it is understood that babies will find a breast and feed immediately after birth. In fact, Michel says he was the first person to speak and write on this subject (Odent, 1977), which is one of his proudest achievements.

However, childbirth for most women in thedeveloped world is still far removed from the traditional ways.

‘The paradox today is that it is unacceptable to recreate the conditions of an easy birth. In fact, protocols make it very difficult to have an easy birth,’ says Michel.

The power of oxytocin

In spite of medical science accepting that natural oxytocin is needed to initiate and maintain labour, the systems in the developed world do not help it to flow. Oxytocin requires a dark, quiet, non-threatening environment to flow, but birth units tend to be brightly lit, noisy with unknown people coming in and out of a room, often trying to intervene.

Many years of cultural conditioning have led to a point where intervention of one sort or another is very common. It is not always an intervention by medical device, such as ventouse, forceps or scalpel, either. Most labouring women are given synthetic oxytocin in modern day births, perhaps because they are in environments that are the antithesis of that much-needed natural oxytocin.

This is of great concern to Michel. It is astounding, he says, that a drug so widely used has so little research into its long-term effects. Last year, he published a paper on the possible link between synthetic oxytocin and breastfeeding difficulties in new mothers (Odent, 2013). One of the problems with studies, he says, is that synthetic oxytocin is often used in conjunction with other pharmacological assistance during labour, particularly epidural fentanyl. Michel is planning to run research into the use of synthetic oxytocin without the accompanying anaesthesia.

There is also the possibility that synthetic oxytocin can affect how mothers and newborns bond. Natural oxytocin – the ‘love hormone’ – facilitates the bond, but the synthetic variety does not have the same effect. It blocks and prevents the production of natural oxytocin.

Then, there is his hypothesis that there are links between synthetic oxytocin and autism and anorexia nervosa (Odent, 2010). In both, there is a disturbance in the levels of oxytocin, which may be because synthetic oxytocin was used during birth.

‘Synthetic oxytocin does not reach the brain of the mother because of the blood brain barrier. But it can go straight to the brain of the baby, which is of huge concern because it might affect the brain development,’ says Michel.

A revolution

Many of these theories are explored in his book, Childbirth and the evolution of homo sapiens – a new title for the second edition of a publication that came out last year as Childbirth and the future of homo sapiens.

Whereas the measures used to identify successful births have been short term – such as rates of perinatal and maternal deaths – this is changing. Now, there is a shift towards longer term and this could change practice completely. It is now known, for example, that babies born by CS are more likely to be obese as adults (Darmasseelane et al, 2014).

As science advances, there is the opportunity to move back to the traditional ways of birth. But there is also the chance that the changes will be the antithesis of nature.

‘We need new criteria to evaluate the way that babies are born. Caesareans now can be so fast with minimal blood loss, so it might be that a decision is made that everyone should have one. If that happens then we don’t need midwives anymore,’ says Michel.

‘On the other hand, if there is a new awareness of the power of modern science, then midwives will be the person protecting the space when women are giving birth.’

He hopes that midwives will help steer the revolution in the right direction. After all, a truly natural birth is better for women, babies and, of course, midwives.

All about Michel

  • Michel was in charge of the surgical unit and the maternity unit at the Pithiviers state hospital (1962 to 1985)
  • He is founder of the Primal Health Research Centre in London. He now spends most of his time in the capital
  • In the 1970s, he introduced the concepts of home-like birthing rooms and birthing pools in maternity hospitals
  • He is the author of the first article in the medical literature about the use of birthing pools published in The Lancet in 1983
  • But he is more proud of the fact that he was the first to write about the initiation of breastfeeding following birth
  • He is the author of 12 books published in 22 languages and author (or co-author) of 92 articles.
  • Michel Odent will be speaking at the RCM’s student midwives’ conference in Telford on 11 November at 12.15pm.

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References

K. Darmasseelane, Hyde MJ, Santhakumaran S, Gale C, Modi N. (2014) Mode of delivery and offspring body mass index, overweight and obesity in adult life: a systematic review and meta-analysis. PLOS ONE. See: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0087896 (accessed 28 August 2014).

Odent M. (2013) Synthetic oxytocin and breastfeeding: reasons for testing an hypothesis. Medical Hypotheses 81(5): 889-91.

Odent M. (2010) Autism and anorexia nervosa: Two facets of the same disease? Medical Hypotheses 75(1): 79-81.

Odent M. (1977) The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynaecology, Rome 1977. Academic Press: London.