The Heart of Touch Web Series: Episode 1

Beyond a Fast-Food Model of Maternity Care with

Melissa Cheyney, PhD

Full Transcript of The Heart of Touch Interview with

Dr. Melissa Cheyney:

My name is Melissa Cheyney. And I'm a medical anthropologist at Oregon State University. I'm associate professor here. I'm also a midwife. 

So my research focuses on a field of medical anthropology called evolutionary medicine. And in evolutionary medicine, we try to understand how humans evolved and then how we live today and ask if there's any differences between how we evolved and how we live today and how that might produce problems for us, especially health issues. 

So the premise of my work is something called the discordance hypothesis. And this is the idea that because humans have these really long generations, it takes a long time for us to evolve and change over time. So we essentially live in these upper Paleolithic bodies that are about 50,000 years old in terms of the model of our body. And then we live in this information age society. 

So probably some of the best known theories around evolutionary medicine really have to do with what we eat and how much we exercise. So human ancestors would have moved around a lot to collect their food and eaten lots of vegetable material and a small amount of meat and been relatively lean and lots of high muscle mass. And today is sort of the opposite of that. 

We have lots of high fat foods available to us. And we end up doing a lot of what I'm doing right now, and that's sitting still. So we have some health issues that emerge from that discordance, or that separation, between how we evolved and how we live today. And in my work, I ask how that applies to birth and early parenting. 

And as you know, the subject of our film is skin to skin. So can you tell us a little about why you think this practice is valuable and how you define it? 

Yes. So in evolutionary medicine, we're often looking not only at what other human groups do that have more traditional practices, but also what other primates do. And if you look across the primate order, what we see is that when babies are born, the mom brings the baby up the chance, often to the left side. And they look at each other. They stare into one another's eyes. 

And they have a way of vocalizing that's kind of quiet but also high pitched. And babies and mothers across the primate order will sort of stare into each other's eyes and imprint and begin to bond with one another. And as they do that, the baby's heartbeat regulates to that of the mother, the breathing regulates, and so does the body temperature. 

So in evolutionary medicine, we call that coevolution. So we understand that the mother and the baby have sort of in this dance evolved together over time to meet each other's needs. And so as an evolutionary biologist and as a midwife, it has always made sense in my practice to sort of ask, what is the normal human condition, or what is the normal primate condition, and then work to support our evolved biology rather than working against it. 

So from the perspective of evolutionary medicine, we would never think about taking a baby away from his or her mother. Everything in that woman's body and in that baby want to be together. And they have coevolved over many thousands of years to need that. 

One of probably the best known examples would be the way the third stage is managed among primates, who, of course, have placentas. So once the baby is born, mom puts the baby up to the chest, and right away the baby begins to nuzzle at the breast. The mother secretes oxytocin that causes the uterus to clamp down, and it controls bleeding. And that has allowed for the particular kind of live birth that mammals have. 

So in evolutionary medicine, we say, don't mess with that, unless you have to. There are certain, of course, pathological conditions where we want to intervene. But in a normal healthy delivery, we want to work with the evolved biology of the mother and baby and not against it. 

And I think there are real benefits that science is showing us today. It's like they're rediscovering what evolution has taught us all along. And that is that mom and baby need to be together. 

So given that our world has changed a lot, what would you say are some of the reasons that mom and babies seem to get separated or some of the barriers to this practice of skin to skin. 

So I see a couple of things. One is very practical, and the other I think is larger and sort of ideological. And the first one is that there are a lot of practices in place that can function to keep mother and baby separated. 

So if you have restrictions about how frequently the baby's vital signs have to be taken or whether they need a bath, those things can cause the baby to be taken away from the mother, not out of absolute necessity, because of course, it's possible to do those things on the mother. But just because of ease or the culture of the particular place where you're working, it's become normative to separate mom and baby. And we think of that as acceptable. 

And so that's what we do. And sometimes, we find ourselves then having to work back to put programs and protocols in place to facilitate that after sometimes many generations of having that separation be there. So we're sort of working back against that cultural flow. 

But I think ultimately part of it is sort of a mistrust of nature and putting more emphasis in technology and as a society believing that somehow technology provides us with an improvement over nature. And that just simply doesn't work for evolutionary biologists. We know that natural selection, selective pressures, are wicked when it comes to reproduction. And humans wouldn't be here if there hadn't been selective pressures over time that sort of shaped mothers and babies. 

And so, again, we want to work with that rather than against that. So a fundamental respect for the maternal body and for the baby and having a sense that, in the absence of a pathological condition and the absence of disease, this should work relatively smoothly, because it's the result of 5 to 7 million years of evolution. So we put a lot of faith in that and I think wouldn't want to go against that unless absolutely necessary. So a reverence for that over the idea that we can somehow improve upon Mother Nature. There's a little bit of arrogance there I think as well. 

So you've done a lot of work both in this country and internationally with midwifery research and birth-related research. What would you like to see happen? And specifically when it comes to this issue but as a big picture, what motivates you, I guess, to do this research? 

That's a great question. I think in my work I really see sort of that the pregnancy, the birth, and the postpartum as this continuum. And I think that one of the things that has so impressed me from talking to women around the world is how important their birth experience really is to them. Oftentimes, I think we can get kind of clinical about it. 

One of my research participants called our model of birth a fast food model of birth, which I think in anthropology we often will study a particular topic. And it really provides us with a lens into what the cultural value system is. So if we think about the reliance on technology, a fast food model of birth, that is pretty reflective of US society. 

But cross-culturally, women really remember their birth experience. And often how they get started out on that journey really matters for them and for their relationship with their child. So I'd like to see us come back to remembering how valuable that experience really is and to trust the body and trust the mother and trust the baby to do what they've evolved to do, intervening only when absolutely necessary. 

So my work is really motivated around trying to define what the range of normal really is for human birth. And when you have so many years of intervening and providing medications, for example, that augment or speed up labor, it's pretty hard to understand what is normal labor. What's an average length? What's an appropriate length? What's too long? 

And so most of my work has really focused on normal physiologic birth. And I see that as extending into the early parenting period. So what are the things that we can do to support the relationship between the mother and infant so that breastfeeding is smoother, so that the mother is getting the benefits of those positive hormones right after the birth to help with her psychosocial state, as she's transitioning into being a parent, which is a very difficult job? What can we do to work with rather than against that and provide women with all the social supports that we know they need to be successful, and not just for US women or for white Euro-American women who can afford it, but for all women in our culture and cross-culturally. 

So the other question that I think is what kind of motivated me to get started with this film-- and I'm just always curious how other people see it-- but I feel like the reason I took up this particular issue is that it's really reflective of what's wrong for me with American deliveries, in that, number one, we know just by looking at nature that this is the right thing to do. We also have 40 years of research and over 2,000 studies that say this is the right thing to do. And yet, only 50% of the births in America integrate any kind of skin to skin. And whatever they're doing is not really enough. 

But I feel like personally that if we were able to make a shift-- and I think this is a very doable objective-- if we convince, at least this country and can convince the world-- that this is an essential part of birth, that we could really change the world-- 

Absolutely. 

--for obvious reasons. And number one, I think it can bring the power back to the families, because-- 

Absolutely. 

--if you have a birth that's complicated in some way, it's easy to get intimidated and to feel like, what can I really do, and you feel pretty powerless after that experience. But even in a normal delivery, if there's a lot of commotion going on right after the birth when you're trying to connect with your baby, you can feel unsure about your role. So I feel if we're doing this every time and families really feel like I'm the one who can do this the best, then I think it brings birth really, literally back into the family, which is where it should be. 

Absolutely. 

So that's part of my objective in working on this film. But I wonder if this were to move forward, how do you see the world being different or birth being different? 

I actually think the world would be a more peaceful place. We have a saying in anthropology. We say that we can't all be created equal, if we don't get an equal start in life. So part of it is removing some of the layers of institutional racism and structural violence that give some people access to the kinds of birth that they want and others don't have that. And what we really need to do is try to remove all of those structural barriers, so that everyone gets the best possible start that they can have in life. 

And when mothers get to a position where they're struggling-- and we all have faced those times, because we know how challenging parenting can be-- you can either have a birth experience that you recall back that feels sacred and special and blessed to you and draw on that really positive energy and experience to go forward and parent your child. Or you can draw back on that experience and feel re-victimized and traumatized and alienated from your child. And it's a much different picture to be parenting from that second place. 

So while opponents, or people who aren't so sure they want to make these changes in their spaces, can sometimes act like this is not that important, I would totally disagree. I think it's absolutely essential. And many cultural groups actually refer to that first hour after birth as sacred. And they do that because it means it's special-- it's not mundane, it's not like the everyday. There is something unique about this moment that will never happen again for that mother and baby. 

And if we can all call to mind that before we attend a delivery and try to keep that space sacred for mothers and babies, that can only bring good. That doesn't bring hatred or negativity or frustration or fear or pain or suffering. It's brings goodness and kindness and compassion and power. And I think that's really where we want all of our mothers and babies to start from. So I think it's of critical importance. 

And I have one more question. I think as a midwife yourself, and myself as well, that there's usually like a story or two, at least, where you were at a birth, and whether it be a home delivery or in hospital, but where you actually saw something in that moment that made you think, yes, this was-- I'm glad this happened. 

In terms of skin of the skin? 

Right. 

What if all my births are skin to skin? 

Were any of them-- did any of them stand out? 

I think the birth that actually comes to mind, as I think about skin the skin and how valuable it is, is my own birth experience, because I was a midwife for years before I ever had my own baby. And I had a really challenging labor. My baby was posterior. I pushed for a long time. And when she was born, she wasn't-- didn't immediately breathe. I had to stim her and just give her a little bit of oxygen to get her going. 

But the moment of her actually emerging and me reaching down for her and bringing her up to my chest, I mean, it was the most magical moment of my entire life. And I remember thinking in that moment she needs a little extra love right now, but she came around really quickly. And then there is no way anybody would have been able to take her out of my arms, no way. I mean, I felt I had earned that time with her for all the hard work that had led up to it. 

And I remember thinking in that moment, beyond just thinking of how much I loved her instantaneously, is that I will keep being a midwife. No matter how challenging it gets to be a home birth midwife in this country, I will keep doing it, so that every woman has the opportunity to feel these moments that I just felt. I think it's critical. 

And you know what, I thought about it probably 100 times a day for the first six weeks of her life and could relive for a few moments what that actual moment felt like and what that first hour was like with her. Now, I still think about it, not a hundreds times a day. But I think about it every week, every month. It's still something that propels me in my parenting. And, yeah, I'm committed. I think every woman should have that moment, that time.