From the World of Water into the World of Air

What is the baby's experience right after birth? What do they need to initiate pulmonary breathing?


As you read this article, I invite you to take a deep breath and imagine yourself in your mother's womb, your surroundings, what you can hear, what you can see, what you can smell? Inside a mother's womb the baby experiences buoyancy while floating in the world of salt water like the sea. The baby swimming inside Mother Nature's ocean's life-giving water: the amniotic fluid.


A baby inside a mother's womb hears her heart beat, the whooshing sounds of the placenta, her digestion. The baby knows her smell, her voice and is being imprinted with the emotions and the emotional states their mother is experiencing. The temperature is always the same. The baby's body is growing miraculously while effortlessly and at ease. It's a calm atmosphere most of the time especially if this mother is not subject to prolonged or chronic stress.


Inside the growing uterus, the most amazing and strongest muscle in the human body, able to expand to contain and hold life as it gestates, the baby is always protected and never exposed. Physically, the fibers of the womb, the double sac of membranes (chorion and amnion), the placenta and the amniotic fluid form a cushion of support for the baby. There is a veil during gestation and there's a reason we cannot see them from the outside, but we can feel them from the inside. On an emotional level, the baby is being bathed with the hormones of pregnancy and being imprinted with their mother's love or lack thereof and all that surrounds her environment. The baby feels what the mother feels.


In a normal human gestation period (around 10 moon cycles within the womb), at the end of the third trimester, when the baby is preparing to come out and be born, there are some physiological shifts that take place in order to prime this baby for the huge journey that birth represents and for the immediate postpartum time, when a baby must transition into the world of air. First their lungs mature. Then when all is aligned and it's time to start their descent, stress hormones play a very important role in priming this water-baby into being alert and ready for life outside the womb.


During the birth process, dancing with the mother's uterine contractions, the baby will find ways to press into the cervix with every intense squeeze in their body and to make the necessary rotations so that they can descend and fit into the pelvic bones. It's a mammalian blueprint for birth that they have and that given the opportunity, they will find the exit themselves. The baby has inside information that we lack being outside! Healthy babies know how to birth themselves! I am reminded of Kirikou, the legendary baby hero from various ancient archetypical African stories featured in the glorious movie "Kirikou and the Sorceress", by Michel Ocelot: he speaks from within his mother's belly during labor "mother, birth me", then births himself; then he says "mother, bathe me", to which she responds: "a child who speaks from within a mother's womb can bathe himself". If you've never watched this movie, I urge you to! But I digress!


When the optimal hormonal cocktail for undisturbed physiological birth is protected in the birthing space, and the mother feels safe, unobserved and protected, she releases the perfect quantity of every ecstatic hormone for birth, mainly oxytocin, melatonin and endorphins, which will ensure a beautiful labor pattern while she moves intuitively and allows the baby to find the best route down and out. Just before the baby is born there is a shift within this dance of hormones.


When the baby's large presenting part (usually the flexed head, but could be the occasional buttox if the baby is presenting breech) touches the perineum from within the vaginal canal, catecholamines rise up to 900% which prime the mother for the birth of her baby, being present and laert right before her baby comes out. The fetal ejection reflex (FER) takes over and she feels "the urge to push" - the body is actually pushing for her. Meanwhile, the baby is also receiving this absurd amount of stress hormones with the purpose of ensuring their survival right after the birth! Having had their lungs massaged by the uterus and now again tightly squeezed inside the canal, they're able to expel liquid from their lungs.


Let's remember that the baby was living inside water up to this point, being oxygenated by the placenta, and that their lungs were filled with fluid! In order for them to be able to breathe in the world of air, they must expel some of that fluid. Usually, babies are able to clear their lungs by themselves. This is the beginning of their transition from the world of water into the world of air. By keeping the cord intact, we assure that a minimum quantity of oxygen (not only that, but also actual blood filled with hormones, nutrients and stem cells) is being transfused by the placenta into the baby's bloodstream. No mammalian animal severs the cord from the placenta like humans (only recently) have started to do. The placenta still has a very important job to do while the baby is transitioning and should be left untouched at least until the birth of the placenta to ensure optimal blood flow and oxygenation for the baby. Better left alone for a couple of hours or even for as long as one wants to (lotus birth) to ensure the full transfusion.


The stress hormones subside very fast, coming back into low levels as mother and baby meet each other outside the womb for the first time and while both receive the largest amount of oxytocin humans ever receive in their lives. The rush of the hormone of love oxytocin is powerful and will stay elevated for the first three days in the mother's blood stream, ensuring bonding and priming her body to transition from gestation to lactation.


The baby's first breaths are not regular breaths. The five first breaths are actually clearing the fluid in the lungs. Newborn babies take some time to transition into pulmonary breathing. Some will cry hard right away, forcefully clearing the fluids in the lungs, while others will transition quietly. Learning and being able to identify what's normal for neonatal transition into pulmonary breathing is a very important skill for birth workers of any capacity in any setting. Newborn babies usually look a little pale, but "pink up" fast once their body receives more oxygen from the air for the first time into their lungs. Babies who are doing fine will have good muscle tone, will be grimacing, will have good color, make a respiratory effort, will have a normal heart rate (if one decided to check that) and may start to cry or not. It's important to give babies who are doing fine the time they need to transition.


There are so many brusque changes from the world of water into the world of air! First, your wet skin is greeted by air for the first time. You had never experienced shifts in temperature before - it's a brutal drop, that's why it's so important to receive the baby into a warm room and have plenty of warm blankets around for baby and mother. Then air must come into the lungs eventually. If the cord is intact and the baby seems to be transitioning well (observing the signs given above), they will have the respiratory drive to inflate the lungs on their own, get rid of some fluid and absorb the rest. Then as more oxygen comes into the minuscule alveoli, oxygen will circulate fast into their bloodstream.


It's fascinating to delve into the transformations from fetal circulation inside the womb to all the necessary changes that take place mostly in minutes, but sometimes in a few hours and even days as a baby transitions Earthside. One of my most favorite things to know is that in a normal umbilical cord there are three vessels: two arteries and one large vein. Contrary to adult circulation, in utero, the vein brings oxygenated blood and nutrients from the placenta into the baby's bloodstream, while the arteries carry deoxygenated blood and waste products into the placenta and into the mother's bloodstream. Then after the baby is born and has initiated pulmonary breathing, the cord collapses within a few hours and inside the baby's body the heart will be receiving oxygenated blood from the lungs for the first time. Major changes for the circulatory system happen within minutes, hours and the first days postpartum in the newborn.


This is a blueprint! Just like for birth, most babies know how to initiate pulmonary breathing and their bodies will take over for all the adaptations and necessities in order to live in this world of air. Does that mean that every baby will always do that on their own? That depends on other things: how was the labor? Was this mother drugged during labor? Did mother and baby get the full cocktail of hormones for birth? And so on and so forth. Sometimes, a baby will be born and will either not initiate breathing or will have some form of respiratory distress even in an undisturbed labor and birth process. As birth attendants who know how physiology and psychophysiology work, as well as having a minimal understanding of the baby's experience of birth (physically as well as emotionally as in pre and perinatal psychology), we are able to identify if and when it's important to help a baby to breathe, and that's when being trained in integrative neonatal resuscitation comes into the picture. Studying and training with Karen Strange, midwife and NRP trainer, has been one of my biggest joys in this journey into becoming a midwife. With her years of experience, she has come to create a beautiful Integrative Neonatal Resuscitation program which I encourage everybody who attends birth to take!


Keeping mother and baby together is the next most important thing for babies to fully transition. Mothers have a chance to fall in love with their babies and babies will have the love imprint that they will carry for the rest of their lives. This is when repair is possible as well if there was any disturbance in the physiological blueprint of the birth process. Ibu Robin Lim says: "if no one cuts the cord, where is this baby going? Nowhere!". This was one of the most important things I learned as a beginner doula when I started birth work years ago. Now taking on the role of midwife and knowing so many of the things that happen, how babies transition and what they need even if they need help to breathe, I have a deeper understanding of the motherbaby dyad.


In order to continue to raise the vibration of our planet, it is crucial that we are able to protect the foundation for love imprinting in human life at birth, keeping mother and baby together. This is what "peace on earth begins with birth" means, the famous quote by the late visionary Jeannine Parvati Baker.


*Scene from the motion picture Kirikou and the Sorceress, by Michel Ocelot, Internet source



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