Separated at Birth: How We Undermined Breastfeeding for Decades
Nursery separation, formula supplementation, immediate cord clamping, and 100% oxygen. Every one harmed the babies we were trying to protect.
The healthy newborn was taken from its mother.
Within minutes of birth, the cord was clamped and cut. The baby was carried to a warmer across the room. Its airway was suctioned with a bulb syringe. Silver nitrate was dropped into its eyes. It was weighed, measured, banded, and wrapped. Then it was taken to the nursery.
The mother, exhausted from delivery, was told the baby needed observation. She would see her child in a few hours, during scheduled feeding times. In the nursery, if the baby cried between feedings, it received glucose water from a bottle.
If the baby was born through meconium-stained fluid and appeared healthy, it was intubated anyway and its trachea suctioned. If the baby needed resuscitation, it received 100% oxygen. If it required volume resuscitation, sodium bicarbonate was pushed.
At bedtime, the baby was placed face down in its crib. Prone position. Everyone knew this prevented aspiration.
Every element of this scenario was routine care. Every element has been abandoned. The cord clamping deprived the baby of iron-rich blood. The nursery separation disrupted bonding and breastfeeding. The glucose water undermined lactation. The bulb suctioning and gastric suctioning offered no benefit. The meconium intubation of vigorous infants was unnecessary and delayed needed care for non-vigorous infants. The 100% oxygen caused oxidative injury. The sodium bicarbonate was ineffective. The prone sleeping position caused SIDS deaths.
Twenty practices. Every one well-intentioned. Every one wrong.
🎯 Free Subscriber Bottom Line: Neonatal care in the 1980s included 20 routine practices that have since been abandoned: immediate cord clamping, nursery separation, formula supplementation, routine suctioning, meconium intubation of vigorous infants, 100% oxygen resuscitation, sodium bicarbonate, glucose water feeds, silver nitrate prophylaxis, prone sleeping, and more. Each was supported by tradition rather than evidence. Cochrane reviews and randomized trials have reversed every one.
Below, paid subscribers get: - The delayed cord clamping evidence timeline and why it took a decade after the Cochrane review - Moore’s skin-to-skin Cochrane review and the Baby-Friendly Hospital Initiative - The Back to Sleep campaign: the fastest neonatal practice change in history - The meconium intubation reversal and the Vain trial - Resuscitation with room air: Saugstad’s paradigm shift - A complete table of all 20 neonatal practice reversals - What neonatal care still gets wrong.
