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Lotus birth (or umbilical nonseverance) is the practice of leaving the umbilical cord uncut after childbirth so that the baby is left attached to the placenta until the cord naturally separates at the umbilicus, usually a few days after birth.
The birth process is a significant transition for fetal circulation, as it changes from obtaining oxygen from the maternal circulation via the placenta through the umbilical cord, to obtaining oxygen via the baby's lungs. Clamping the umbilical cord is thought to be an important means of increasing the arterial blood pressure in the neonatal circulation, thereby increasing the flow of blood to critical structures (like the heart and brain), diverting blood away from structures that are not useful after birth (the placenta), and finally assisting the circulation to mature. Although a neonate can survive with the placenta intact and the umbilical cord will eventually fall off on its own, this will reduce the baby's cardiac reserve, and therefore decrease its ability to fight infectious and environmental stresses.
As the placenta is a vital organ of the baby, composed of the same cells as the baby, and as it was formed by the sixth week of conception from these cells, lotus birth takes an integral approach to postpartum bonding. Given that the baby and placenta share cellular material and gestational molecular resonance, lotus birth practitioners view the placenta with respect and care, and allow for the natural process of undisturbed bonding and the slow drying cord to provide a unique transitional period of mindfulness between birth and neonatal existence. This is of great importance from the perspective of prenatal and perinatal psychology and maternal-child health through bonding during the very early neonatal period.
The undisturbed human umbilical cord and placenta undergo structural changes in their physiological drying process - the cord becoming like sinew, and the placenta preserving itself (if birth fluids are properly rinsed off, sufficient air exposure allowed, and drying agents such as salt or herbs are plentifully applied). The placental drying process can be halted at any point for usage of the placenta as medicine or for burying it. If left to dry with the use of natural preservatives such as sea salt or honey, it will eventually result in a small rock-like artifact, which is often kept in tribal cultures as a birth-story reminder for children and used in healing ceremonies.
In the full lotus birth clinical protocol, the umbilical cord which is attached to the baby's navel and placenta, is not clamped nor cut, and the baby is immediately placed on the mother's belly/chest (depending on the length of the cord) or kept in close proximity to the mother in cases when medically necessary procedures such as resuscitation may be needed. In lotus birth, after the placenta is born vaginally (often with the maternal informed choice for passive management of third stage allowing for natural detachment of the placenta within appropriate time allowed for it, with no hormonal injections such as oxytocin) or via cesarean section (the most common operating room procedure in the U.S.), it is simply put in a bowl or quickly wrapped in absorbent towelling and placed near the mother-baby caregivers step back to allow for undisturbed maternal-child bonding to occur as the primary event for an hour or more. It is only after this initial intense bonding period that the placenta is managed by rinsing, drying, applying powdered herbs/salt or essential oils, and positioning it in a way that allows for plentiful air circulation and proximity to the baby. This is followed by several days of extended slow transition until the cord dries into sinew and detaches from the baby's belly, generally 2–3 days postpartum. During this time the new family is allowed a more relaxed and mindful or meditative psychological postpartum transition. As the initial postpartum period is medically prescribed for rest & recovery, the lotus birth transition period encourages maternal relaxation and emotional integration and poses no conflict for mobility. In the lotus birth navel integrity practice, the baby-cord-placenta is viewed as a unit, an integral theory perspective on human development.
In the abbreviated lotus birth clinical protocol, undisturbed bonding is facilitated with the cord neither clamped nor cut for the first 4 hours postpartum. Following this, the shrunken, blood depleted cord is hygenically severed, without any clamp or clip needed at the navel site. The placenta is prepared as in full lotus birth, and kept in close proximity to the mother-baby for the early postpartum day or two, before it is given to a care provider for preparation as Traditional Chinese medicine, or cryogenically preserved for future use.
Mothers who choose lotus birth cite are assured of undisturbed bonding with their child and no unnecessary medical procedures to distract them, particularly during the first hour after birth, which is the most critical time for the establishment of exclusive bonding focus for breastfeeding and is neurologically affected by any interruptions. Full lotus birth is not a medical necessity in the west, and its benefits have not been yet been proven out in the U.S. and Canada, though lotus birth is a routine practice found in the culture of present-day Bali, a growing practice in Australian hospitals (including for cases of prematurity and cesarean) and is occasionally practiced in clinical birth centers and home births worldwide. Lotus birth is one practice of several in the neonatal integrity and birth psychology movement among perinatal professionals in western medicine & midwifery, inter-disciplinary scholars in anthropology, primal and peak-state psychology, and is a growing informed choice option for parents.
In scenarios of prematurity, lotus births can be practiced, with great benefit to the newborn, in-situ with the mother in kangaroo care, as is routinely practied in Bali and since 2010 increasingly practiced in Australian clinical settings.
Though most of the western medical academy has never seen a natural clamping & cord detachment process and this is not taught in medical schools, some physicians have published on the topic, most notably Sarah Buckley MD, and Australian physician and Michel Odent MD, a French obstetrician. One often-cited benefit of lotus birth is that the risk of neonatal tetanus is eliminated. Neonatal tetanus is a complication of early cord cutting (rather than cord cutting after the cord has internally clamped and then shruken in diameter a few hours after birth). Neonatal tetanus is a major cause of death in many developing countries and a risk for infants everywhere during the first 2-3 neonatal weeks when parents are waiting for the cut cord's stump to fall off and religiously applying antibacterial agents to the wounded navel on a daily basis.
Birth Center director, internationally acclaimed midwife Robin LimCPM, CNN 2011 Hero of the Year, has reported lotus birth practice as providing superb for at-risk infants, of which many of her cases are comprised. Midwife Lim is founder of the Bumi Sehat International Foundation birth centers in Bali and Aceh, Indonesia, which provide full-range birth care for over 1000 cases a year utilizing umbilical nonseverance as a routine informed choice option and clinical practice. These non-profit birth centers also train perinatal professionals from both obstetrics & midwifery through an innovative volunteer internship program where these professionals learn how to manage 3rd and 4th stage labor with minimal intervention and maximum support of maternal-child wellness & bonding.
Immediately postpartum, the umbilical cord pulsates as it transfers blood to the placenta from the baby, and vice versa. Changes in the cord's Wharton's jelly then produce a natural internal clamping within 10–20 minutes postpartum. Care providers immediately assign an Apgar score and proceed with any needed suctioning or stimulation, but usually postpone further procedures to allow the infant to start breastfeeding, and to have skin-to-skin contact with the mother. The infant, along with the umbilical cord and the placenta, is swaddled by the mother's arms, or held by the father or a nurse if maternal surgical suture is needed.
Excess fluids are wiped off the placenta, which is then placed in an open bowl or wrapped in permeable cloth and kept in close proximity to the newborn. Air is allowed to circulate around the placenta to dry it, so that it cures/preserves rather than rots. A thick coating of finely powdered herbs such as rosemary, tulsi, neem, or goldenseal, powdered clay, or sea salt is often applied to the placenta to help dry it out. Often antibacterial and aromatic essential oils, such as lavender, clove, rose or frankincense are also applied, 1-2 drops on each side, to neutralize any smell during the preservation process, and for their antibacterial properties.
Some practitioners choose not to apply any drying aids, instead allowing the naturally aired placenta to dry of its own accord. The untreated airing placenta, if initially well rinsed with all excess blood/clots removed from its surface, does not have any scent, but it can become malodorous after detachment depending on the extent to which external blood products remain. This can be halted by directly planting the placenta or by refrigerated storage. If the placenta is not given sufficient air circulation, such as if it is sealed in a plastic bag, it will immediately begin the bacterial process of decay, which is not proper procedure.
The umbilical cord dries to thin, golden brown sinew and after a few days naturally detaches from the umbilicus. As it dries it becomes stiff; parents thus take great care to move the baby and the cord as little as possible to avoid causing it to detach prematurely. Once the cord is detached, the placenta is either cared for throughout the rest of its drying process until it becomes similar to petrified wood, the size of a handheld stone, or is planted in the earth. The use of sea salt in placental drying, as it affects the mineral content of the soil it is placed in, is therefore avoided by some practitioners.
Lotus births are rarely practiced in hospitals in the U.S. and Canada, but many hospital cases in Australia have been reported. Lotus births are the clinical routine protocol of the Yayasan Bumi Sehat birth center in Bali. In the U.S., lotus births are more common in freestanding birth centers and in home births.
Underlying beliefs and research
Once the umbilical cord has stopped pulsating after birth, transfer of physical substances is said to be complete by current medical standards within 30 seconds after birth. However, 'clamping the cord is rarely a physiological necessity', but rather most typically a medical augmentation of the natural process for the unquestioned convenience of clinical resource management. Several clinical studies have shown that delaying clamping the umbilical cord for a significant period not only allows more blood to be transferred but helps prevent anemia as well. Cord blood also contains many valuable stem cells, making this transfer of stem cells a process that might be considered ‘the original stem cell transplant’ and rendering the artificial "harvesting" of stem cells for profitable cord blood banks an ethical question. In midwifery and university settings, caregivers have observed that new mothers will give exclusive focus to their new babies and skin-to-skin bonding if given the chance, and that cord management beyond basic birth assistance guarding is not at the request of mothers but rather due to trained habits of practitioners.
Though the current clinical World Health Organization standard practice is now a 3 minute pause before cord clamping in order to allow for this transfer, this is not an enforceable practice and critics say that clinicians and medics are still practicing immediate clamping of the umbilical cord.
"When a baby is born, about a third of the baby's blood is still in his/her cord and placenta. With no good evidence to support it, it is accepted practice to accelerate the arrival of the placenta with an injection and clamp and cut the cord immediately, depriving the baby of this blood." ~ Belinda Phipps, chief executive of the National Childbirth Trust, U.K.
In addition, the benefits of extended (20–60 minutes) cord clamping delay, and super-extended (1–3 hours cord clamping delay) having not been considered by conventional medical science as significant thus have received very little research yet in the Northern Hemisphere. However, at the Bumi Sehal birth centers in Bali and Aceh, a minimum of 3 hours passes before any cord cutting, and most clients choose lotus birth instead. There have been many lotus births in Australian hospitals, with benefits proven for the special needs neonatal transitions of premature babies and cesarean babies. New Australian research is ongoing into the internal physiology of the postpartum placenta is reporting a low oscillation reflex impulse (cranial reflex impulse, or CRI) that occures during the process of placental drying some, as many circulatory channels transmute fluids. This low oscillation pulse would be felt by the highly sensitive nervous system of the unsevered newborn at the navel site, thus providing it with a further transitional rhythm as it leaves its primordial pulse of the gestational placental orientation.
Informed Choice and Institutional Reform
Proponents of Lotus Birth view the neonatal transition period before detachment as having value for optimal neuroemotional maternal-child bonding and also physical benefits for neonatal health through guarantee of full transfer of stem cell blood and reduced physical stress upon the neonate who is accustomed to the accompaniment of the cord & placenta. As cord cutting is a cosmetic surgery rather than medically necessary procedure, and something which clinical environments rely upon for convenience of conventional practices, proponents criticize this values dissonance in contrast with the mother-friendly and women-centered initiatives that are currently reforming & updating instiutions to meed the primal health needs of mother and babies for undisturbed bonding the first neonatal hour. Proponents also cite intactness as protective for babies rather than the creation of an open wound requiring further medicinal applications, as using scissors to sever the umbilical cord carries a risk of tetanus, and nonseverance is a valuable protection. Significantly delayed cord cutting as well as nonseverance being found in the annals of birth anthropology along with the universality of reverence for the cord & placenta (as found in the Tree of Life beliefs of tribal cultures around the world and reported to the world by scholar & professor Joseph Campbell.
Proponents of lotus births view the baby and the placenta as one on a cellular level, as they are from the same source egg & sperm conceptus. They also assert that the newborn and the placenta as existing within the same quantum field and thus influencing various expressions of quantum mechanics that influence health involving transfers of energy & cellular information continuing to take place gradually from the tissue of the placenta to the baby during the drying process. The energy field of the human being in the eastern medical science has been articulated and explored, for over 5000 years, as not just the physical body but also mind, emotion, and energy and the important connection between them.
This view stands in opposition to common medical training and practice in hospitals and global medical centers, which favours an active management of third-stage labour (the delivery of the placenta): administration of the synthetic hormone oxytocin, immediate external clamping of the cord at birth, cutting it forthwith, then applying traction to the cord to speed the birth of the placenta. The cord blood may or may not be taken for cord blood banking. The baby's umbilical cord and placenta are then disposed of as medical waste, sold for-profit by hospitals to laboratories or cosmetic companies without the mother's knowledge or consent Evidence-based Maternity Care report or, with the mother’s consent, may be donated for research into pregnancy and pregnancy disorders.
Detractors cite institutional staffing inconvenience, impractical budgetary limitations for increasing per-case staff hours, maternal inconvenience, and concerns about familial hygiene practices (which are always of concern, regardless of mode of birth).
Detractors also cite concern regarding pathological jaundice in the newborn, however large studies and reviews have not found an excess of pathological jaundice among late-clamped babies, but there may be an increase in physiological jaundice, which is beneficial to the baby by providing the antioxidant properties of bilirubin at a critical time in free radical formation. Pub Med source
Being that the evidence has been accepted on delayed cord clamping, compared with early clamping, resulting in greatly improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia (as documented in a comprehensive Swedish study published in the British Medical Journal.), a growing weight of medical opinion in the West wants medical institutions to change to a routine policy of delaying clamping for up to five minutes for babies born at full-term and at least 30 to 60 seconds for the 10% of babies who are born premature, before 37 weeks.Guardian UK article The fact that any clamping or cutting is medically unnecessary in the vast majority of cases, and only a cosmetic/convenience choice, further study is needed in order to link the cost-effectiveness of full and abbreviated lotus births upon public heath, in terms of the sequalae of undisturbed bonding, successful breastfeeding, more complete psychological transition for both mother & child, and better outcomes for longer term postpartum (i.e., reduced postpartum depression, calmer/healthier babies, etc.) This also raises as yet undefined ethics issues for practitioners who may not be updating their practices or empowering the informed choice of their clients to choose navel integrity/lotus birth.
"Change in institutional practice could bring opposition. The leading-edge obstetrical & perinatal professional movement to advise delayed clamping could affect cord blood banking for transplants, research, and private industry. The reason: the earlier cords are clamped, the more stem cells they can offer, some report. And the field is growing. The World Marrow Donor Association lists half a million units of cord blood in 60 public banks in 40 nations. Each cord is worth $20,000 to $40,000. Cord blood transplants have swelled from one in 1998 to 50,000 a year. Global public banking is worth well more than $30 million. A large private banking sector has emerged. Still there is no agreement on how affected the cord blood industry would be. Many blood banks say they only do later ex utero (post placenta-expulsion) collection anyway." BioScience Technology, April 2013
"Clinical primary care providers, who consider themselves to be the ones running the show, have yet to learn that there are times when pockets are to put hands in, and door posts are to lean on. There are times to "interfere" and times to leave well alone, but they don't appear to know yet, when to leave well alone. Even worse, they don't know why." --Hilary Butler, elder New Zealand scholar of Delayed Cord Clamping (DCC) 2010
Primatologist Jane Goodall, who was the first person to conduct long-term studies of chimpanzees in the wild, reported that they did not chew or cut their offspring's cords, instead leaving the umbilicus intact, like many other monkeys. As chimpanzeees share 99% of their genetic makeup with humans, the process of natural nonseverance and detachment may be expression of evolution rather that devolution. Newborn mammalian stone-age needs for bonding, communicating, and successful establishment of nursing are met by chimpanzees without any diversion of maternal attention, which would indicate an enhanced neurochemistry is taking place, protective of the optimal health of the newborn. Though other mammals may sever their offspring's cords, they only do so after initial maternal sensory reception, unwinding of the cord, massage/cleaning (through touch), and initiation of nursing  phase which has been observed to involve at least one hour, if left undisturbed.
The physiology of the placenta is different for a mammal that births single offspring as opposed as to those that birth litters. Animals that birth litters general consume the placenta. Chimpanzees and other mammals that do not birth litters tend to nestle with offspring until natural detachment occurs the next day.
The natural design inherent in the human umbilical cord changes and detachment process is relevant information for parents & practitioners if faced with an unexpected birth scenarios - such as in conditions of catestrophic weather, war, or delayed transportation. In such scenarios, there is no need to worry about cutting the cord - in fact, cutting the cord introduces a new spectrum of hygiene concerns. Though full lotus birth may not be preferable or amenable, a significant time period of non-disruption of the cord has a natural process that requires no additional supplies or support.
In Tibetan and Zen Buddhism, the term "lotus birth" is used to describe spiritual teachers such as Gautama Buddha and Padmasambhava (Lien-hua Sen), emphasizing their entrance into the world as intact, holy children. References to lotus births are also found in Hinduism, for example in the story of the birth of Vishnu.
Although recently arisen as an alternative birth phenomenon in the clinical West, super-delayed (1+ hours post-birth) umbilical severance is common in home births, and umbilical nonseverance have been recorded in a number of cultures including that of the Balinese  and of some aboriginal peoples such as the !Kung.
Early American pioneers, in written diaries and letters, reported practicing nonseverance of the umbilicus as a preventative measure to protect the infant from an open wound infection.
The practice gained notice in the yoga practitioner community when Jeannine Parvati Baker, author of the first book on prenatal yoga in the West, Prenatal Yoga & Natural Childbirth, practiced neonatal navel integrity for two of her own births, seeing it as a practical application of the yogic value of ahimsa as well as the core insight inherent in the primal bonding process and the meditation process that "all attachments will fall away of their own accord."
In the 1990s, Sarah Buckley MD, an Australian family physician and noted parenting advisor for the magazine Mothering, published her personal birth stories in the text Lotus Birth; she has produced numerous scholarly publications of her research on the physiological benefits of passive management of third-stage labor.
Umbilical nonseverance is an informed choice option currently practiced by a minority of homebirth scenarios in the West, and is increasingly a clinical practice utilized in Australian hospital births (see the research of Sarah Buckley, M.D.) and Indonesian clinical birth centers such as Bumi Sehat, under the guidance of Robin Lim) CPM. Navel integrity practice is increasingly popular continuing education topic for licensed midwives and certified nurse midwives in publications such as the magazines Midwifery Today and Mothering.
Current Ethinicity & Class Demographics for Lotus Birth
Though there are no formal demographics currently recorded for lotus birth in most of the West, documentation is underway in Australia, as reported by Sarah Buckley, MD and Rachana Shivam in numerous 2013 interviews that estimate the number of lotus birth children in Australia to be in the thousands. In Australis, as in other part of the West, Lotus Birth is attractive to people to those who place a high value on ecological sustainibility and integrative/holistic medicine, representing a variety of cultural backgrounds and professions. Being that the values of yoga philosophy are coherent with the holism of navel integrity and neonatal transition, and that it was promoted by the first author of prenatal yoga in the West, it is of particular interest to yoga teachers in their family choices and teaching. Though Lotus Birth is attractive to those who value the low-interventionist approach to birth & postpartum, it can also appeal to those facing unexpected maternal health issues or scenarios as an attempt to optimize outcomes.
As mentioned above, Lotus Birth is the general protocol at birth centers in Bali and Aceh Indonesia, and common in the traditional midwifery to this day in the region.
Controversy and Safety Issues
The Royal College of Obstetricians and Gynaecologists (RCOG) has stated, "If left for a period of time after the birth, there is a risk of infection in the placenta which can consequently spread to the baby. The placenta is particularly prone to infection as it contains blood. At the post-delivery stage, it has no circulation and is essentially dead tissue," and the RCOG strongly recommends that any baby that undergoes lotus birthing be monitored closely for infection.
Current and Future Research
The women's health care movement has worked to reform hospital settings towards implementing a low-intervention, continuous emotional support mother-friendly and health-centered approach to normal childbirth in healthy women as well as leading-edge care that emphasizes maternal bonding for premature babies (known as kangaroo care). Current medical practice and clinical environments vary country by country, and within large countries such as the U.S. can vary widely per city. Woman-centered and maternal bonding-centered clinical research, being a relatively new perspective for conventional obstetrics and perinatalogy, is an area which is seeing increased and much-needed research by integrative medicine yet transfer to the obstetrical clinical environment may be slow or hindered by institutional policies that require complex changes or communication of data to pertinent decision makers.
Therefore, there is need for more research on a variety of topics related to prolonged post-birth placental physiology techniques, the impact of full neonatal stem cell infusion on long term health projections, the present rate of cord stump complications and risks, and mindfulness practices applied by practitioners and parents to third stage labor and the fourth stage of early bonding. Lotus birth is an increasing area of continuing education workshops at universities in Australia and may be on the rise in other countries as well.
- 1955-, Walsh, Denis, (2007-01-01). Evidence-based care for normal labour and birth : a guide for midwives. Routledge. ISBN 0415418909. OCLC 156908214.
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- The Anthropology of Health and Healing. Womack PhD., Mari. AltaMira Press, 2010. ISBN 0759110433
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- Rachana, Shivam (2000). Lotus Birth: Leaving the Umbilical Cord Intact. Greenwood.
- Michel Odent, MD as quoted in the text Lotus Birth by Shivam Rachana, Greenwood Press, 2000 ISBN 0646406523
- British Journal of Midwifery, April 2010, Vol. 18, No. 4. pp 269. David Hutchon, Narendra Aladangady and Amanda Burleigh.
- "USF Health News Archives » USF researchers: Do we clamp the umbilical cord too soon?". hscweb3.hsc.usf.edu. Retrieved 2017-02-09.
- "Cutting cord too early puts babies at risk, NHS warned" by Denis Campbell. The Guardian Newspaper, London. 4/25/13
- Interview of Lotus Birth scholar Rachana Shivam, Australian Radio's Matt and Jo Show, April 18th 2013.
- The New Physics of Healing lecture, Harvard Medical School, Deepak Chopra MD, Cambridge, Mass. ISBN 156455919X , Audio recording.
- "Management of the Third Stage of Labor". Retrieved 2007-12-29.
- See In the Shadow of Man by Jane Goodall.
- Human Birth: An Evolutionary Perspective. Wenda Trevathan PhD, Univ of New Mexco Press, 2011. ISBN 1412815029
- see Eat, Pray, Love by Elizabeth Gilbert, pp. 252-252
- Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750 to 1950. New York: Oxford University Press, 1986 pp.21-37
- Buckley, Sarah. "Leaving well alone: A natural approach to the third stage of labour". Retrieved 2007-12-29.
- "RCOG statement on umbilical non-severance or "lotus birth"". Royal College of Obstetricians & Gynaecologists. Retrieved 2017-02-09.
- "Bibliography for Leading Change | Transforming Maternity Care". transform.childbirthconnection.org. Retrieved 2017-02-09.
- Buckley MD., Sarah. Gentle Birth, Gentle Mothering, Australia, 2006
- Davies RN, Leap RN, McDonald. Examination of the Newborn & Neonatal Health: A Multidimensional Approach, Elsevier Health Sciences, 2008. ISBN 0-443-10339-9
- Lim CPM, Robin. After the Baby's Birth: A Complete Guide for Postpartum Women, Ten Speed Press, U.S. 2001
- Parvati Baker, Jeannine. Prenatal Yoga & Natural Childbirth, North Atlantic Books, U.S., 2001
- Trevathan, Wenda. Human Birth: An Evolutionary Perspective, Univ. of New Mexico Press, 2011
- World Health Organization (WHO). Care in normal birth: A practical guide, report of a technical working group, Geneva, Switzerland, 1997
- Lotus Birth, A Ritual For Our Times by Sarah Buckley, MD
- Lotus Birth Education Video by Mother Culture One Art & Culture
- Common questions about lotus birth
- Mothercultureone's Lotus Birth Info Page
- Institute for the Study of Peak States, and Developmental Events Model
- The International College of Spiritual Midwifery: Lotus Birth
- Lobus Birth For Midwives
- Ezekiel 16 (New American Bible)
- Jane Goodall Research Center website
- Association for Pre & Perinatal Psychology & Health's official website
- World Health Organization's standards of care for the Third Stage of Labor