The Golden Hour After Birth
Another amazing post by HuffPost!
In the moments after I gave birth to my second child — a healthy, 9-pound chunk of a baby — I felt the most physically exhausted I’ve ever been in my life. My labor was fast and chaotic, punctuated by me chasing my toddler around while I tried to time contractions on my iPhone. I threw up a lot and delivered within minutes of arriving at the hospital.
After holding my newborn for a few minutes, I asked someone — maybe the nurse, maybe the midwife, it’s all a blur — if they wanted to take my son and weigh him. I was still shaking. I remember feeling certain that I did not want to be responsible for him in that moment. I wanted to catch my breath. But my doula, whom I’d hired to support me physically and emotionally, was clearly dismayed. “Oh, but it’s the golden hour!” she insisted, before someone else in the room recognized how utterly wiped I was and took the baby to check on him and clean him up, then brought him back to me a few minutes later.
The “golden hour” my doula was talking about is not a clinical term, but it’s become a popular one in recent years. For decades, hospital policies have separated mothers from their newborns for standard medical procedures (exams, cleaning, etc.) as a matter of course. Nowadays, as hospitals and health care providers have shifted their focus toward promoting breastfeeding — and women and birth workers have fought for less medicalized births even within clinical settings — those policies have also shifted. To the extent it is possible, the general recommendation is that moms and new babies should be kept together for what’s sometimes called that “golden hour” after birth.
Of course, in so many cases that’s not feasible, either because women are tired like me and need a break or because either mothers or their babies need immediate medical attention that gets in the way of them relaxing for an hour together. Either way, when the golden hour is interrupted, it can set new moms up for feelings of disappointment or guilt. After all, who wants to miss out on that first “magical” hour of motherhood?
But the truth is, it’s a lot more nuanced than that.
The scientific case for immediate skin-to-skin contact
The power of that first hour after birth is rooted largely in the practice of making sure moms and babies get skin-to-skin contact, in which the newborn is placed directly on the mom’s body (usually the chest) with no clothing or bedding in the way. It’s one of the practices the Centers for Disease Control and Prevention recommends for creating a breastfeeding-friendly environment, and has been endorsed by major medical groups from the American Academy of Pediatrics to the World Health Organization.
There’s plenty of evidence for it. Skin-to-skin can help regulate blood glucose levels, decrease crying and reduce pain for moms and babies, according to the American Academy of Pediatrics. It may also help reduce a woman’s risk of postpartum hemorrhage, which continues to be a leading cause of birth complications and deaths in the United States. Skin-to-skin can be particularly powerful for the most vulnerable babies. While the aforementioned benefits extend to all infants, much of the initial research into skin-to-skin contact came out of neonatal intensive care units, where experts learned that “kangaroo care” (in which preterm babies are held against their parents’ chests) can help with babies’ heart rates, their breathing and their ability to gain weight, among other benefits.
So for those reasons and more, many hospitals around the country — including those that seek the Baby-Friendly designation, signifying that the institutions do just about everything they can to promote breastfeeding — have changed their policies to prioritize keeping moms and babies together immediately after birth.
But there’s also evidence that there is not as much “magic” to that first hour as some birthing world circles would have parents-to-be believe.
A 2016 Cochrane review found no evidence that skin-to-skin contact immediately after birth was any different from skin-to-skin contact after the baby had been washed and examined. Nor did that review of the existing scientific literature find that holding the baby skin to skin for under 60 minutes affected outcomes.
Unrealistic expectations can set parents up for failure
The problem with the popularization of the “golden hour” is that while it’s rooted in evidence, it has also been overblown and oversold to expectant parents. The golden hour is “your reward,” moms have been told. It’s not just magical; it “lays the foundation” for caregiving.
That narrative can be difficult for moms to grapple with if they’re not able to have the golden hour after birth for medical reasons. (Or if, like me, they’re tired and just want a break.) One in 3 women who give birth in the United States do so via cesarean section, and once the baby is delivered, they often need immediate medical care. There has been a move toward “family centered” C-sections that allow for immediate skin-to-skin contact and other changes such as delayed umbilical cord clamping, but that still tends to be the exception, not the norm.
The idea of the golden hour becomes an issue when mothers who miss out on that “magical time” — and who go on to struggle with breastfeeding, or who don’t feel immediately bonded with their newborns, or who have any number of other very real postpartum concerns — wonder whether those missed moments are the root cause.
“I didn’t hold him until the next day. We definitely did not (first) breastfeed for more than 24 hours,” one mom told Today in a 2019 article about the golden hour. She told the publication that she worried her subsequent breastfeeding challenges (she nursed her child for four weeks) were related to missing that hour.
Not so ‘golden’ after all
While changing hospital policies that take into account birthing patients’ needs and wants are a good thing, mental health experts say it is critical for everyone — from doctors to birth workers such as doulas — to keep in mind that best practices such as immediate skin-to-skin are fluid.
The postpartum period is also an emotionally turbulent time, when seemingly small issues — like whether or not a mother and her baby get to spend their first hour cuddled up together — can take on an outsize role.
“We tend to portray these parts of parenting as necessary in a way that sets us up for a lot of despair if those things don’t happen,” Kate Kripke, founder of Colorado’s Postpartum Wellness Center of Boulder, told HuffPost.
“What is undebatable is that those first moments, hours, what have you, with a newborn are really useful for things. The skin-to-skin contact is super useful for early bonding and attachment, certainly useful for starting breastfeeding. Oxytocin is released ... there’s all of these physiological things that can happen,” said Kripke, who emphasized that she is in favor of hospital policies aimed at giving parents the birth experiences they hope for. “But the moment we say they have to happen in order for these other things to occur is when we get off track.”
In her work as a perinatal mental health expert, Kripke often urges her patients to think about the distinctions between a fear, a hope and an expectation. If a hope is not met, that can lead to disappointment, but women can work through disappointment, Kripke said. On the other hand, when an expectation isn’t met, it can lead to deeper feelings of shame or resentment, exacerbating mental health concerns that are already prevalent during the postpartum period. Up to 20% of women grapple with postpartum anxiety according to some estimates, while the CDC says 12% experience postpartum depression (and that estimate might even be low).
All of this offers a note of caution for anyone getting ready to have a baby or working in the birth world: embrace nuance, and be careful of how concepts like the golden hour can set birthing parents up for unnecessary pain. Yes, it’s wonderful when it happens. But moms and babies have plenty more time to bond. I wasn’t particularly concerned when my doula doubted my decision to hand my baby off, but I wonder if it would’ve stung more had I been a first-time parent — and if, as I fumbled through my first clueless months of motherhood, I would have questioned whether I was struggling because of it.
“Anytime we have this binary thinking of ‘good, bad, right, wrong,’ it can set moms up for a lot of psychological despair in new motherhood,” Kripke said. “Yeah, sure, there are benefits to having that time. But no, it’s not necessary.”
Thank you so much to Huff Post for another great article!
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- The Baby Whisperers