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Effects of skin-to-skin contact and breastfeeding at birth on the incidence of Postpartum haemorrhage: A physiologically based theory

Significance Statement

Postpartum haemorrhage is a major contributor to maternal illness and death – particularly in the developing world which lacks life-saving blood transfusions and intensive care facilities.  The vast majority of cases of Postpartum haemorrhage are caused by inadequate uterine contraction during and after the birth of the placenta. The main approach to preventing Postpartum haemorrhage is to routinely use artificial oxytocin at birth. In this situation oxytocin acts by fitting onto the receptor sites on uterine muscle cells and stimulates them to contract strongly – thus preventing Postpartum haemorrhage. In spite of artificial oxytocin, or similar drugs, being routinely given to women in the West, the rate of Postpartum haemorrhage has been steadily rising from around 5% in the early 80s to around 20% in obstetric units now. There is some evidence that when women experience calm birth with midwives and have skin-to-skin contact and breastfeeding at births there are far fewer PPHs; lower than 5%. This paper provides the physiological explanation of why a warm, calm environment and immediate, uninterrupted and sustained skin-to-skin contact and spontaneous breastfeeding at birth optimises the women’s reproductive physiology to produce all  the natural oxytocin she needs for her uterus to contract properly and thereby prevent haemorrhage.  This type of midwifery care, which we call ‘pronurturance’, also minimises the woman’s fear and that is crucial because adrenaline blocks the uptake of oxytocin on the uterine muscle cells. Pronurturance is a free, ‘non-intervention’ that has the potential to improve women’s health and save lives; additionally pronurturance is associated with reduce rates of postnatal depression and increased the rates of successful breastfeeding. If pronurturance was a drug it would be aggressively marketed internationally.

Effects of skin-to-skin contact and breastfeeding at birth on the incidence of Postpartum haemorrhage: A physiologically based theory. Global Medical Discovery

 

 

 

 

Journal Reference

Saxton A1, Fahy K2, Hastie C1. Women Birth. 2014 Dec;27(4):250-3.

1Southern Cross University, Coolangatta, Queensland, Australia.and

2Southern Cross University, Coolangatta, Queensland, Australia. Electronic address: [email protected]

Abstract

BACKGROUND:

The importance of optimising maternal/baby psychophysiology has been integrated into contemporary midwifery theories but not in the detail required to really understand the underpinning biological basis.

METHOD:

The functioning of the autonomic nervous system, as it relates to the uterus is reviewed. The physiology of myometrial cell contraction and relaxation is outlined. The main focus is on the factors that affect the availability and uptake of oxytocin and adrenaline/noradrenaline in the myometrial cells. These are the two key neuro-hormones, active in the 3rd and 4th stages of labour, that affect uterine contraction and retraction and therefore determine whether the woman will have an atonic Postpartum haemorrhage or not.

DISCUSSION:

The discussion explains and predicts the physiological functioning of the uterus during the 3rd and 4th stages of labour when skin-to-skin contact and  breastfeeding  occurs and when it does not.

CONCLUSION:

This biologically based theory hypothesises that to achieve and maintain eutony and eulochia, midwives and birthing women should ensure early, prolonged and undisturbed skin-to-skin contact for mother and baby at birth including easy access for spontaneous breastfeeding.

Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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