Lotus Birth Associated With Idiopathic Neonatal Hepatitis

Alternate Birth Strategies

Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.

Beyond cord clamping: Complexities of umbilical cord management after birth

The benefits of delayed cord clamping have been investigated in multiple studies and supported by various professional associations. Other aspects of umbilical cord management strategies occurring after cord clamping have not been fully thoroughly analyzed. This article will explore and deliberate elements of umbilical cord nonseverance, vascular access management, and blood banking.

Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices

The purpose of this report is to educate providers about the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This report will provide information pediatricians may use to counsel families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.

Alternative Birth Plans and Unintended Maternal and Neonatal Consequences: A Review of the Literature

Importance

Birth plans are an important part of childbirth preparation for many women.

Objective

The aim of this review was to discuss some common requests, specifically home birth, water birth, placentophagy, lotus birth, vaccination refusal, and vaginal seeding, including evidence-based recommendations, perceived benefits, and potential maternal and neonatal consequences.

Evidence Acquisition

A literature search for each topic was undertaken using PubMed and Web of Science. For the home birth section, the MeSH terms home AND birth OR childbirth AND outcomes OR complications OR recommendations OR guidelines were used. For the vaccination section, birth OR childbirth OR maternal AND vaccination refusal were searched. For the remainder of the sections, umbilical cord AND nonseverance OR placentophagy OR vaginal seeding OR lotus birth were searched. A total of 523 articles were identified. The abstracts were reviewed by 2 authors (J.R.W. and J.A.R.); 60 of these articles were selected and used for this review.

Results

Home birth is currently not recommended in the United States. Immersion in water for labor is acceptable, but delivery should not occur in water. Placentophagy and lotus birth should be discouraged because of risk of neonatal infection. Vaccines should be administered in accordance with national guidelines. Vaginal seeding should be discouraged until more is known about the practice.

Conclusions and Relevance

These evidence-based recommendations provide clear guidance for physicians so that the birthing experience can be enhanced for both mother and neonate without compromising safety.

Relevance Statement

This is an evidence-based literature review of alternative birth plans and recommendations for directive counseling.

Cutting Ties With an Old Friend: Omphalitis and Bacteremia With Umbilical Cord Nonseverance

Umbilical cord nonseverance (UCNS) is the practice of leaving the umbilical cord attached to the placenta after delivery. Limited case reports exist revealing adverse outcomes of UCNS. We report a case of neonatal omphalitis associated with Escherichia coli bacteremia and urinary tract infection after UCNS.

A Case of Severe Infant-to-Placenta Hemorrhage in Association with Prolonged Delayed Cord Clamping

Patient: Male, newborn

Final Diagnosis: Hemorrhage

Symptoms: Hemorrhagic shock • respiratory distress

Medication: —

Clinical Procedure: Blood transfusion • CPAP treatment • head scan • saline bolus

Specialty: Pediatrics and Neonatology

Neonatal Omphalitis After Lotus Birth

Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.

Qualitative Study on the Experience of Lotus Birth

OBJECTIVE

To describe the experiences of women who had lotus births, that is, leaving the umbilical cord uncut so that the placenta remains attached to the newborn until the umbilical cord naturally detaches.

DESIGN

Descriptive phenomenological.

SETTING

Seven cities in four geographic regions of Turkey.

PARTICIPANTS

Nine women who experienced lotus birth.

METHODS

Data were collected through semistructured, face-to-face interviews.

RESULTS

Our analysis revealed six themes: Meaning of the Lotus Birth Experience, Decision Making Regarding Lotus Birth, Lotus Birth Process, Perceived Benefits and Disadvantages of Lotus Birth, Reactions to Lotus Birth, and The Future of Lotus Birth. In addition, we created 15 subthemes related to these overarching themes.

CONCLUSIONS

The themes we extracted are reflective of the desire for a natural and healthy birth that is experienced as positive and beneficial. Our results contribute to a deeper and more nuanced understanding of lotus birth. Moreover, our findings provide women and all health care providers, especially maternity nurses, with valuable information and increased awareness of lotus birth.

Medico-legal considerations on "Lotus Birth" in the Italian legislative framework

The term “Lotus Birth” identifies the practice of not cutting the umbilical cord and of leaving the placenta attached to the newborn after its expulsion until it detaches spontaneously, which generally occurs 3–10 days after birth. The first reported cases of Lotus Birth date back to 2004 in Australia.

Supporters of such a procedure claim that the newborn is better perfused, endowed with a more robust immune system and “less stressed”.

However, it should be pointed out that histopathological study of the placenta is increasingly being requested in order to investigate problems of an infective nature or dysmaturity affecting the foetus, and situations of risk affecting the mother. Moreover, from the legal standpoint, there is no uniform position on the question of whether the placenta belongs to the mother or to the newborn. Lastly, a proper conservation of the embryonic adnexa is very difficult and includes problems of a hygiene/health, infectivological and medico-legal nature.

The authors analyzed all these aspect in the Italian legislative framework, reaching the conclusion that Lotus Birth is inadvisable from both the scientific and logical/rational points of view.

Lotus Birth: A Case Series Report on Umbilical Nonseverance

Lotus birth is the practice of leaving the umbilical cord uncut until separation occurs naturally. Our case series report describes delivery characteristics, neonatal clinical course, cord and placenta management, maternal reasons for a lotus birth, and desire for future lotus births. Between April 2014 and January 2017, six lotus births occurred. Mothers (four of the six) were contacted by phone after giving birth. A chart review was completed on each patient to evaluate if erythromycin ointment, hepatitis B vaccine, and vitamin K (intramuscular or oral) were administered, treatment of the placenta, maternal group B streptococcus status, postnatal infant fevers, infant hemoglobin or hematocrit levels, jaundice requiring phototherapy, and infant readmissions. Three of the six families decided to cut the cord before hospital discharge. No infections were noted. All contacted mothers would elect for a lotus birth again (4/6). One hepatitis B vaccine was given; all others declined perinatal immunization.

Staphylococcus lugdunensis sepsis and endocarditis in a newborn following lotus birth

A term newborn, who underwent lotus birth, developed Staphylococcus lugdunensis sepsis and endocarditis on the 1st day of life. This case reports an uncommon pathogen known to cause destructive endocarditis in the adult and paediatric populations, causing endocarditis in a neonate. We speculate that lotus birth, an atypical birthing practice, may have contributed to the development of this infection.