Informed Choice for Women  
Moving Beyond the Limited Spectrum of Artificial Choice
& Into Realms of Personal Power













Part I:
Common Procedures & Interventions in the Clinical Environment
by Mary Ceallaigh



















Introduction

This is basic information from common obstetric & midwifery texts and typical hospital statistics as reported in major
periodicals.  Additional, excellent informed choice analysis on the medical management of healthy women's labor and its impact
on childbirth can be found in
Birth as an American Rite of Passage by Robbie Davis-Floyd, Ph.D, The Thinking Woman's Guide To
Childbirth
by medical writer Henci Goer, Our Bodies, Ourselves by the Boston Women's Health Collective, and Episiotomy and the
Second Stage of Labor
edited by Sheila Kitzinger.

Though "Informed Choice" is a popularized concept in women's health, and many women believe they are engaging with
education about the full-spectrum of that choice, the spectrum itself is often pre-packaged or edited according to prevailing
cultural & clinical values rather than the WHO's Mother-Friendly Initiative  centered or the non-clinical midwifery model of care,
is a public health and feminist health issue.

If Choice only happens within a limited spectrum, or a practitioner-centered spectrum that caters to outdated standards of
practice or values that are questionable in light of current inter-disciplinary and cross-cultural understanding of perinatal
psychology, instinctive birthing & bonding, sexual health, and full-capacity neonatal development - then that Choice is merely
"manufactured consent" and not really Choice.  This issue is being questioned more and more by critically thinking-women, for
the benefit of optimal human & social health.  

Background:  Birth in the U.S.A.

The #1 cause of hospitalization in the United States is childbirth:  though birth is not a disease, and in fact, for healthy women
birth is an optimal expression of health.  Drug-free, supported, instinctive birth with its amazing neurophysiology can be an
experience of optimal health with many long-term benefits for mother, child, family, and society - however, most clinical
environments are not designed with these values in mind.  (Unlike in Germany, where all hospital birth rooms have been reformed
to have natural light, light dimmers, low beds, deep jacuzzi tubs, and hidden & silent technical equipment).   

It is often surprising for American women when we learn that formal, well-documented studies have shown that for healthy
women attended by a skilled caregiver, home birth is not only just 'as safe' as hospital birth, it may be even safer, when the
sequelae/side-effects from various medical procedures are factored in.  Once fully informed about this, women are naturally
inclined to expect more from the clinical environments that they may use instead.

Most American obstetric practices are done in the name of compassionate care and ostensibly, to manage maternal-child health,
but the U.S. ranks only 29th on the list of nations in the
WHO's Report of Nations:  Infant Mortality Rates. Our NICUs are busy and
full with neonates who are separated from their mothers as both a medical philosophy and hospital administration fiscal objective
to reduce staffing costs, despite sound scientific evidence that maternal skin-to-skin newborn care for procedures as well as
kangaroo care by staff creates better outcomes for families.  

9 out of 10 otherwise healthy American women entrust ourselves to medical management of the intimate birth process, in
many cases because of lack of:  informed-choice information, prenatal empowerment, perceived financial options, and
personalized labor support.    
This is in stark contrast to, for example, an 80% non-medical homebirth/birth center rate in
modern, sophisticated Denmark.  

Instinctive birth is an organic function of the hind brain (the mammalian, primal brain processes) not the neo-cortex (the
thinking, analytical brain processes).  Institutional birth environments and medical practices typically  increase fear and
adrenaline in the laboring woman's neurological functioning, subsequently lowering pain-coping thresholds and simultaneously
increasing the likelihood of medication interventions.  Included in this is the early hospitalization of all women whose waters
naturally rupture before labor begins or in very early labor (about a third of healthy pregnant women).  Likewise, if a woman has
unresolved deep-seated fears and she feels unsupported or unsafe in the home or birth center environment, planned or
transported institutional birth may be her best option at the time.

1 in 4 otherwise healthy American women are undergoing major surgery (cesarean) to have their child extracted.  Giving birth
physiologically and in a freestanding manner is indeed even rare in some social circles. Cesarean surgery, though very welcome
and humane in rare complications in healthy women, and modern breech birth protocol limitations, does bring with it a 12 times
greater risk of death, significantly  interrupted early bonding with the baby, and severe postpartum incapacitation.  Post-
cesarean female sexual dysfunction, particularly when a woman did not experience  emotional support in labor, is another
marked issue in  women's heath.

There has also been a recent revival in operative delivery techniques in the U.S., using metal forceps and/or vacuum pumps to
extract babies as a technique to avoid cesarean surgery due to dysfunctional second stage labor sequelae from epidural
immobilization of the mother.   However, extractive techniques have their own violent repercussions on the maternal tissues,
long-term pelvic floor health issues, and, adding to the already stressful impact on the baby, severe nervous system shock and
trauma  through sustained traction, and bruising or hematomas.  

Due to these many maternal-child health issues inherent in modern obstetrics, some well-known obstetrical spokesmen are now
promoting "scheduled, non-labor cesarean surgery" as the new, humane response to labor dysfunctions in the medical
environment.  The alternative of instead humanizing hospital labor wards to facilitate healthy women by encouraging home
laboring with doulas, installing en-suite birth pools in hospital rooms, providing more active labor support, and creating
freestanding birth centers at hospitals is not an option that interests conventional obstetrics and profit-focused hospital
administrator.s

The estimated "clinical" Postpartum Depression rate in the United States is 40% if not higher, as it is greatly under-reported.  
Prescription antidepressant usage by mothers of babies and young children is considered common in 2005.  It is not difficult to
correlate unsupported, negative birth experiences and physiological disruption with later neuroendocrine issues in mothers.   
However, being that our cultural tendency is to entrust the expertise of the medical professional we choose (or is chosen for
us), as a whole, women are commonly unwilling or too overwhelmed when it comes to connecting the dots between dissociative
birth practices and a dissociative postpartum.   Though anti-depressants may provide a very needed bridge back to sanity,
let us
not underestimate the power of woman
(even after having had one or two dissociative or negative birth experiences) to create
optimal preconception balance, an aware pregnancy, and supported spontaneous birth physiology.
  This is what sets the stage
for a joyful postpartum immersion of skin-to-skin bonding, pleasurable nursing, and supported domestic retreat.  In this context,
the normal hormonal shifts ('the baby blues')that occur around the day 4-7 postpartum do not linger and postpartum wellness is
the trajectory rather than depression.

The benefits and empowerment of nursing/breastfeeding, though strongly encouraged by the World Health Organization, are
often experienced as physiologically challenging and psychologically less fulfilling and much less pleasurable for women who have
had endocrine disruptions during medical birth (pitocin and anesthesia affect the pituitary-hypothalmic milk production
orchestrations that go on during labor).  Even so, Nature is a generous mother, and the support of a postpartum doula can help
a woman help herself integrate her particular birth experience and access more relaxation and flow with her little one, often
with increase in milk production and breastfeeding happiness.

For
men who are becoming fathers in the medical birth room, as committed partners, unspoken stresses/issues of their very
own can occur through witnessing the graphic and often unpleasant looking group interventions - upon that which they
privately helped conceive.   Once the  "domino effect" of medical interventions upon an otherwise healthy mother-baby begins,
men likewise may unconsciously feel inadequate long-term in their role with their lover - in a key time when a man's own re-
orientation of himself as a provider and a father is occurring.  All the ways a woman brings awareness to her fertility and birthing
likewise expand her partner's capacity to connect to his own role and to the woman and baby, from deep within himself.

Typically, first time birthing women (primaparas) who are not aware of variations in hospitals and medical birthing practices, are
also not aware that we have options, including the option to postpone and/or refuse certain protocols and procedures.  

Some Common Medical Birth Procedures:

Surgical cutting of the external female genitals/Vulva (episiotomy)

Purpose:  

In an immobilized, medicated vaginal delivery the chances of episiotomy are very high, for the ubiquitous reason of shortening
second stage labor by 3-6 minutes even when there is no fetal distress.  

Benefits:  

In cases of fetal distress that does not resolve through the mother changing her position, the medical care provider
(obstetrician or medical midwife) will do the surgery in order to help speed delivery of the child, along with accepting the risks
of harm caused to the perineum and during recovery.  Traditional midwives do not cut the vulva, allowing the upright woman's
supported tissues to occasionally tear naturally.  Such natural tearing of the tissues heals much faster than a surgical cut, due
to the fibrous weave of the tissue.

Risks:

Of first-time birthing women (primaparas) who have vaginal births in most American hospitals, nearly 90% have their genital
perineum cut with substantial risk of further 4th degree lacerations that continue to the rectum.  Such tears are only known to
occur as sequelae to episiotomy, as natural lacerations are only minor in comparison.  This surgery obviously has severely
uncomfortable side effects for women the first 2-3 postpartum weeks as well as higher  risk of infection and, for some women,
emotional and sexual response issues having to do with feeling violated.  
 

Episiotomy, or female genital cutting, is the most commonly practiced surgery in the United States, so a pregnant woman needs
to choose her care provider carefully if she wishes to be supported to avoid such an intervention.  For multiparas with previous
episiotomies, medical care providers will assume a repeat surgery unless the woman requests otherwise or changes care
providers.  For men in the birthing room, seeing the copious betadine application to the genitals and the actual cutting
procedure done to their sexual partner can be unpleasant to say the least, triggering many conflicting feelings which take effort
to resolve postpartum.

Alternatives:

Maintaining the integrity of the female genitals is a primary skill of midwifery and women's self-care, and episiotomy prevention
techniques to facilitate tissue elasticity often rely on:

unmedicated, free-moving labor;
immersion in warm water;
deep relaxation and emotional wellbeing of the laboring woman;
breathing into the perineum & pelvic floor;
perineal massage;
private orgasm/vulva massage during unmedicated labor by self or baby's father;
hot compresses;
squatting position (or any other loose tailbone postion like hands & knees) during second stage labor, physical perineal support;  
and ancient visualization techniques.

Other interventions that may be required:

Any episiotomy requires postpartum repair, which is a whole other procedure entailing local anesthetic, common separation of
mother and baby, and distraction of mother's attention away from baby.  The typical deep continued lacerations that occur
after the initial episiotomy cut involve complicated and skilled surgical stitching technique.  If an error occurs during the
stitching, it must be undone and begun again, a laborious process delaying family rest & bonding during a crucial time.

Postpartum self-care of genital stitches often involves the additional intervention of pain medication (often ibuprofin) for the
continuous perineal pain and searingly painful sensations during every urination.  Postpartum episiotomy recovery has even been
described by women as more painful than labor.  Needless to say, a woman's sense of humor can suffer greatly, and various
emotional issues can take over a time which is meant to be one of receiving nurturing and experiencing deep recovery
.

Laboring while Immobilized in a Hospital Bed

Purpose:
To cater to the misconception that both staff (and women themselves may have) that women are safer in bed, as depicted in
western culture imagery found in movies and TV shows.  It provides a more convenient field of operation for care provider during
the second and third stage (expulsion of baby and placenta), but is most inconvenient for maternal tissues.  Many obstetricians
and nurse-midwives are not trained in supporting a variety of birthing positions, especially those that are low on the floor
(supported squat, birth stool).  This is merely a matter of practitioner convenience and common practice.

Benefits:
None.  Women feel more instinctive, more sensual/sexual, more empowered, and more creative when they can walk, sway, and
take various positions around the hospital room or home.  Moving intuitively on the feet also induces a relaxation response in the
brain.

Risks:
Encourages fetal malpresentation; decrease in normal intensity of contractions resulting in a lengthening of labor; limits the
mother’s ability to make herself comfortable; creates insecurity in the laboring woman; increases chances of instrumental
delivery and surgery due to fetal malpresentation; creates a drop in maternal blood pressure which results in poor oxygen supply
to the baby.  Laboring supine (flat-on-the-back) is the absolute WORST possible position for a laboring woman.

Alternatives:
Remaining active with a wide range of positions and movements throughout established labor... laboring in a more upright
position, allowing gravity to help increase the strength of contractions and dilate the cervix more efficiently.  This encourages
optimal fetal positioning (birthing is a partnership  between a mother's pelvic movements and the baby's movements.  

Other interventions that may be required:
Pharmacological augmentation; a desire for pain medication due to “back labor” often associated with an OP (occiput posterior)
baby; increased fear and anxiety due to being incapacitated to a bed, with subsequent increase in pain perception;  
instrumental delivery or cesarean due to fetal malpresentation.

Continuous Electrical Fetal Monitoring (EFM)

In the United States, EFM (electronic fetal monitor) use for healthy women who bring their childbearing to the hospital
environment is often, though unnecessarily, continuous in routine hospital admissions.   Therefore even laboring women who
would prefer to have an unmedicated birth are immobilized and subject to increased discomfort and lower pain tolerance which
creates more tension, fear, and pain.   This can be actively addressed, however, with the help of a doula or empathic nurse to
disconnect the EFM cords after the minimal reading time (10-15 minutes per hour in most states).   Wireless EFMs are now being
introduced into some hospitals, however, though beneficial for mobility continuous ultrasound exposure for large numbers of
babies during labor is another issue altogether.

Purpose:
Monitors fetal heart rate and maternal contraction pattern, indicates how the baby’s heart reacts to contractions, and how
long, strong and close together the contractions occur; they also provide a permanent record for hospital litigation concerns.  
Can be done both externally with sensors belted to the mothers belly and internally with an electrode attached to the baby’s
scalp.

Benefits:
Theoretically, allows one nurse to monitor several patients at one glance of the screen; useful if intermittent monitoring
indicates a possible problem.  Provides hospitals with potential litigation defense material.

Risks:
Very high “false positive” rate (indications of fetal distress when there isn’t any) thus resulting in unnecessary intervention,
including surgical delivery; variability of staff interpretation of EFMs, over-dependence upon at-a-distance monitoring; the signal
is often lost when the baby moves or the mother adjusts her position; ultrasound impacts the arterial red blood cells in the
baby's circulation, with unknown subtle influences, from an eastern perspective; internal monitoring is invasive and introduces
the risk of infection;

Alternatives:
Intermittent monitoring with a Doppler ultrasound device for several checks over a 15 minute period every hour; continuous
telemetry (wireless) monitoring; non-ultrasound fetoscope (available through some midwives for home births).

Other interventions that may be required: Artificial Rupture of Membranes, (AROM) is required with internal monitoring;
cesarean surgery due to “false positives.”

Routine IVs

Purpose:
To replace oral intake of fluids; also provides easy access for medication, which is expected to be administered.

Benefits:
Keeps the mother hydrated

Risks:
Inhibits mobility - makes the woman dependent both physically and psychologically; fluid overload, which can lead to fluid in
both the mother’s lungs (pulmonary edema) and the baby’s lungs (neonatal trachnea);  painful inflammation at the site (also a risk
with 'saline lock' device); leakage from the punctured blood vessel resulting in painful bruising (also a risk with saline lock);
increase of maternal and fetal blood sugar levels to diabetic levels (hyperglycemia) when fluids contain glucose (referred to as
“dextrose IVs”)

Alternatives:
Fluids (and foods, if possible) by mouth during labor; saline lock

Other interventions that may be required:
Treatment for problems caused by fluid overload, infection at IV site and hyperglycemic conditions in mother and baby

Artificial Rupture of Membranes (AROM) or Amniotomy

Purpose:
To induce or augment labor (removing the cushion of fluid and allowing the baby’s head to press directly against the cervix will
theoretically aid in opening it) and check for meconium staining of the fluid (an indication of fetal distress two thirds of the
time); it is also necessary to rupture membranes to place an internal monitor (an electrode attached to the baby’s scalp) when
indicated.

Benefits:
Shortens labor by 1-2 hours and may reduce the use of Pitocin (synthetic oxytocin, derived from cows)

Risks:
Cord prolapse, fetal heart rate abnormalities due to lack of fluid (when done early in labor), maternal infection,

Alternatives:
Conserve membranes and allow labor to progress with maximum cushioning of the baby's head;  less invasive methods of
stimulating labor, such as the woman going back home, prostaglandins via sexual intercourse (semen's potent prostaglandins are
ten times more efficient when absorbed through the gut via oral sex, for the zealous committed couple) walking, active nipple
stimulation in privacy by the laboring woman and/or her lover (though breast pumps effectively stimulate nipples, they are
stressful, noisy, unpleasant, psychologically undermining, and unnatural), acupressure, relaxation and visualization if
augmentation is indeed necessary; waiting for labor to occur spontaneously.

Other interventions that may be required:
Amnioinfusion (replacing fluid via catheter); pharmacological induction or augmentation in cases of prolonged rupture of
membranes; cesarean for cord prolapse.

Labor Induction and Augmentation with Pitocin

Western obstetric management, in contrast to the midwifery model of care, often includes labor induction to suit practitioner
schedules or to initiate labor after the 40th week.  This involves continuous electronic monitoring.

Purpose:
To “jump start” a stalled labor or initiate labor before it has begun

Benefits:
Usually effective in inducing or augmenting labor; can be stopped if adverse reactions occur

Risks:
Restriction of movement due to IV & EFM; dramatically more painful labor because of overriding the body's endorphin production
mechanism; uterine hyperstimulation (contractions that do not stop) which can result in fetal distress; increases risk of uterine
rupture in VBACs due to tectanic (extreme contractions that come on all at once, unlike the body's natural initiation of
gradually increasing contractions); may increase postpartum blood loss and incidence of newborn jaundice; increases risk of
cesarean due to dysfunctional labor and fetal distress.

Alternatives:
Less invasive methods of stimulating labor, such as going back home, walking, loving nipple stimulation, prostaglandins via the gift
of partner's semen  (
10x quicker physiological absorption for labor onset occurs when received through the gut, i.e., orally
rather than cervically), acupressure, relaxation and visualization if augmentation is indeed necessary; and, last but not least,
being willing to wait for labor to occur spontaneously according to the biodynamic alignment of the woman/couple/family.

Other interventions that may be required:
An IV will be necessary; an internal monitor due may be necessary, thus requiring AROM; due to a higher intensity of
contractions, the mother may be more inclined to request pain medication; cesarean for fetal distress.

IV Medication (Narcotics or Analgesics into IV fluids)

Purpose:
To dull or “take the edge off” the pain of labor

Benefits:
Do not require a needle in your back - no risk of spinal perfusion, does not require continuous EFM or a catheter; quick relief
(there will be little delay in receiving it after you request it), do not slow labor or interfere with the second stage.

Risks:
Nausea; a drop in maternal blood pressure; maternal glandular system stress; Interference with maternal endocrine pre-lactation
orchestrations; respiratory depression in mother which may result in fetal distress due to inadequate oxygenation;  alteration of
the maternal-child syncopation, unity, and depth of bonding upon birth; significant stress upon the newborn's endocrine
system;  interference with newborn behaviors, including suckling reflex; neonatal respiratory distress.

Alternatives:
An environment that is more comforting, familiar and conducive to relaxation; a care provider with midwifery approach to
childbirth; a doula (statistically proven to reduce the use of pharmacological pain relief);hydrotherapy; massage; acupressure;
guided relaxation; visualization; patterned breathing techniques; movement and changing position often; vocalization; TENS
(transelectronic nerve stimulation).

Other interventions that may be required :
Anti-nausea medication; rescue measures and possible resuscitation in cases of neonatal respiratory distress

Epidural Anesthesia
(get informed:  to see a very detailed photo essay of the actual epidural procedure by award-winning photographer Patti Ramos,
click here
.

Purpose:
To eliminate the maternal bodily sensations of labor contractions and pain by creating a temporary mind-body split (dissociation
or induced psychosis)through the administration of cocaine derivatives (bupivicaiane/marcaine) and sometimes additional
opiods.   Being that the baby still continues to be fully present to all labor sensations, the maternal absence/anesthesia greatly
reduces if not severs the mother-baby unified field of consciousness - it takes great determination on the part of the numbed
mother to stay mentally, spiritually, and emotionally connected to the  baby's experience, however, such an intention of
connection can be maintained via keeping loving hands on belly, and allowing no distractions to interfere with your awareness
that the baby is feeling each and every contraction, in a very profound, life-changing way.

Benefits:
Usually eliminates the sensation of pain, allowing the mother to relax and sleep in active labor; MAY encourage progress of a
“stalled” labor in a distressed mother by promoting relaxation; allows a mother to remain awake and alert during a cesarean

Risks:
Tends to slow labor; risk of infection at injection site; increases the risk of instrumental delivery and cesarean; episiotomy due
to tissue swelling; risks postpartum include maternal fever, temporary urinary incontinence, nerve injury, hematoma, spinal
headache and a considerable drop in blood pressure - thus decreasing awareness and pleasure in bonding; increases the risk of
much more serious complication including maternal convulsions, respiratory paralysis and cardiac arrest, and permanent spinal
injury.  Sometimes women suffer partial epidural effects (one side of body) or medical negligence may occur that also involves
injecting the wrong substance, as in the case of
Grace Wang, whose story has sparked a global community outrage.

Also, unknown effects on newborn, both short and long term, from exposure to the drug which was definitively proven by Mt.
Sinai Medical Center to enter the fetal bloodstream.   Unknown longterm effects on the species, as sustained maternal
dissociation during labor was unprecedented in human history until this past century.   

Alternatives:
An environment that is more comforting, familiar and conducive to relaxation; immersion in warm water/ a birth pool; a care
provider with a less interventive approach to childbirth; a doula;  massage; acupressure; guided relaxation; visualization; deep
abdominal breathing techniques; movement and changing position often; vocalization; TENS (transelectronic nerve stimulation).  
Other interventions that may be required:
Pharmacological augmentation if labors slows; WILL require electronic fetal monitoring, precautionary IV and possibly a bladder
catheter (consider the risks associated with these procedures and the intervention “domino effect”); instrumental extraction of
the baby with a vacuum or forceps, or cesarean.

"Purple Pushing" or Forceful Pushing

Purpose:
To expedite the second stage of labor/the expulsive stage; to provide women who are medicated and unable to feel “the urge”
instruction on when to push.  To continue management of a physically numbed woman on anesthesia.  Also a variation of this is
used by some medical midwives who were not trained in full 2nd stage facilitation.

Benefits:
To provide those who are medicated and unable to feel “the urge” instruction on when to push.  To actively manage those who
are not medicated in accordance to what is convenience or protocol of the care provider- rather than facilitate a woman
"breathing her baby out."

Risks:
Contributes to maternal exhaustion;  greatly increased likelihood of tearing; greatly increased risk of "diastasis recti"  abdominal
muscle damage which is difficult to restore; compromises fetal oxygen supply.

Alternatives:
Upright tailbone-free birthing position, or, laying on left side with right leg completely supported by a doula; pant, breathe, or
grunt or moan your baby out; "Breathing the baby out" passive 2nd stage rather than forceful pushing and/or valsalva breath
holding;  Birthing the baby's head in the squatting or support squat position (speeds delivery via gravity, increases the pelvic
outlet by 1.5 cm and increases intra-abdominal space, with tremendous oxygenation & glandular benefits, by 30%).

Other interventions that may be required :
Instrumental delivery or cesarean due to maternal exhaustion.

Immediate/Early Clamping (30 seconds - 3 minutes) of the Baby's Cord rather Extended-Delayed 10-20 minutes
or Non-Clamping/Natural Clamping

Purpose:
Though the umbilical cord's inherent physiology involves an organic internal clamping that occurs within 10-20 minutes after bird,
artificial cord clamping was created as a routine clinical practice for practitioner speed and hospital staffing convenience, based
in outdated notions that there is no benefit in physiological self-clamping.  Artificial cord clamping involves applying force via a
dual clamping procedure, due to the fact that the cord artery and two veins are full of highly pressurized blood and plasma.  

Immediate-Early cord clamping is also used due to the manufactured consent procedure of a heavily marketed cord-blood
banking business whose procedures halt the plancental transfusion of rich stem cell blood (90mL on average, but sometimes up
to 180mL - well over a third of the infant's total blood supply) from entering the baby at the time when the baby needs it the
most, instead harvesting it into vials for future storage for some future illness - an illness which may in fact be furthered by the
diminishment of early neonatal placental transfusion.

Benefits:
The benefits of routine cord clamping intervention are practitioner-centered and cord-blood bank centered - with few to zero
benefits for mother and baby and, in fact, increased neonatal stress and vital blood depletion. The only maternal-child reason to
clamp the cord would be in extremely rare scenarios where immediate separation is necessary due to actual life threatening
conditions - as in cases of placenta accreta with short cord.  Many if not most infant resuscitation and maternal resuscitations
can be done with practitioners facilitating in-situ maternal-child proximity, however this requires teams to change the way they
are accustomed to practicing.

Risks:

Cord clamping severely reduces the amount of whole blood available to the neonate during a time when an entire new internal
circulation system is launching.  This whole blood that is pulsing into the baby from the placenta via the cord upon birth
contains serum, plasma, the interferon protein (an amazing immunity enhancer) and alpha, beta, and gamma globulins. Each of
these types of globulin provide antibodies to help the newborn fight any infections that may have been medically caused during
the birthing processes or that it may have been exposed to in the birthing environment (particularly if that environment is at a
center of infectious disease, i.e., a hospital).  In addition, the red blood cells carry oxygen to all cells, and to carry away wastes
- and a reduction of neonatal blood is a huge impact on all of its physiology.  

Immediate-Early cord clamping (30 seconds) reduces the placental blood transfused to the baby to about only 30%.

"Delayed" cord clamping (3 minutes, as named by obstetricians, not midwives, who consider it hardly a delay) reduces the
placental blood return to about 80%.  

"
Extended-Delayed" cord care, or "Natural Clamping"  involves no artificial clamping.  The Wharton's Jelly internal process in the
normal neonatal post-birth creates a structural clamping by 20 minutes post-birth in warm-water immersion births, and as soon as
10 minutes in non-water births where the cord is exposed to cold air.  Extended-delayed cord care is the routine practice of
non-clinical midwives, and can be client-imposed in hospital via medical directives/informed consent by mothers.  The umbilical
cord undergoes many structural changes during the first one-hour after birth, after which time it is also much easier to sever via
hygienic practice with scissors or a traditional burn-box method.  However, as severing the cord is not a medical necessity,
undisturbed bonding is given top priority by midwives and empathic obstetricians - and both mother and baby do better if
unnecessary distractions are minimized for at least one hour (WHO standard) and, in midwifery protocols in the Balinese
Bumi
Sehat birth centers, a minimum of 4 hours (called "short lotus birth" for those clients who are choosing to sever the shrunken
cord for some reason, such as needing to travel or due to maternal illness).  

Non-Cutting/Nonseverance, or "Lotus Birth" allows for the natural process of physiological clamping to occur, along with  
nonseverance cord drying, and natural cord detachment.

(
Lotus Birth) protects the inherent natural integrity & function of the baby-cord-placenta unit, and has been shown, in clinical
studies in Australia and Bali, to have enormous benefits for pre-term babies.  Anecdotally, lotus birth indicates a difference
between what is typically considered the "normal" newborn and what is the undisturbed, fully-bonded and transitioned  "full-
capacity" newborn.
Read the INSPIRING story about
one of the rare, appropriate cesarean deliveries:  
midwifery homebirth transport of a well-prepared,
healthy woman with definite unexpecteds:  
here
Stone Carving at entrance, Bumi Sehat Yayasan
Ubud, Bali, Indonesia