Birth and separation
In the previous pages we considered how industrialisation led to social and cultural changes regarding when sleep should happen. In this section we think about how separation of mothers and babies became commonplace over the past 100 years, when, for the vast majority of human history, mothers and newborn babies have slept together, the mother’s body providing protection, warmth, food and support for the baby’s physical and psychological well-being.
Separation at birth — the role of anaesthesia
The evolution of our large brains set humans apart from other primates in many ways. One notable difference was that – compared to all other primates and all other animals – childbirth became a hazardous activity, often requiring assistance (Trevathan 2010) and leading to high death rates for both mothers and babies. By the Victorian era ways of easing the fear and pain of childbirth had been developed (Loudon 1992). The anaesthetic of the day – chloroform – could only be accessed in a hospital setting, so women who would previously birthed at home assisted by a local midwife or family, increasingly chose to have their babies in hospitals. A major side-effect of chloroform was that it made mothers incapable of looking after their babies following birth. Some early anaesthetics also affected the babies making them very sleepy after birth. In some cases their breathing was affected and they had to be closely monitored. For this reason babies were removed from their mothers after birth to be cared for in a nursery by hospital staff (Ball 2008). Because the drugs also affected sucking ability many babies were force fed formula in the nursery. From this point on, and through the development of new anaesthetics such as Twilight Sleep and barbiturates, separation of baby from mother immediately following birth became the norm due to the mother’s incapacitation.
… and infection control
Even when the heavy use of anaesthetics fell from fashion during the psychoprophylaxis era in the seventies, babies were still routinely removed to the hospital nursery at night despite their mother no longer being incapacitated. Now separation was justified by infection control — babies were removed from their mothers to a ‘safe place’ and only returned for scheduled feeds (Ball 2008). It was only recently that the importance of early and prolonged mother-infant contact began to be realised, and ‘rooming-in’ (baby sleeping in a cot in the same room as the mother, rather than being removed to a nursery) became the norm in UK hospitals.
The separation of mother from baby after birth – for the reasons of mother’s incapacity, need for rest, effect of anaesthesia on the baby or infection control, all of which were consequences of a hospital birth and the birthing environment – meant that for much of the last 100 years in Britain separation of mother and baby after birth was routine. From the 1940s the development of aseptic practices and antibiotics meant that the death rate for mothers giving birth in hospital dropped dramatically, and ever more mothers chose to give birth in hospital. In America by 1973, 99% of all births took place in hospital.
The routine separation of mother and baby, had serious unintended consequences for infant care and mother-baby relationships. Research comparing nursery care with rooming-in showed that removing babies to nurseries resulted in less frequent breastfeeding, greater likelihood of breastfeeding failure, no more sleep for the mother, less sleep and more crying for the baby (Keefe 1987, 1988).
As a consequence of mother-baby separation and the medicalisation of childbirth, the use of infant formula as a human milk replacement became widespread. The use of formula played an important role in keeping babies alive when their mothers were incapacitated as a result of traumatic birth and the effects of narcotic drugs. However when such drugs were phased out in favour of medication that did not have such a damaging effect on maternal and infant abilities, clinicians continued to advocate the use of formula so that infant feeding could be ‘scientifically managed’ (Hardyment 1983).
In recent years the importance of keeping mothers and babies in close contact, and of inititating breastfeeding soon after birth, have been recognised and advocated both in and out of hospital. However the culture of separation and artificial-feeding had become deeply ingrained, and continues to affect popular ideas about what is ‘normal’ for human babies and mothers.