I last discussed the dangerous practice of Lotus Birth back in 2018. In the roughly 18 months since then, no evidence has emerged to change my final conclusion that there is zero benefit and plenty of risk. Unfortunately, more evidence for the potential serious harm inherent in the practice did come to my attention earlier this month. The tragic case of Harlow Eden is one of the more heart wrenching and infuriating that I’ve encountered in my nearly two decades of interest in pseudoscience in medicine.
A quick primer on Lotus Birth
Lotus Birth occurs when both the baby and the placenta are delivered without severance of the umbilical cord, which is typically delayed 30 to 60 seconds but must be done right away when a newborn needs urgent evaluation and possible resuscitation. In most Lotus Births, the placenta is left attached to the baby for at several days and is kept in a special salt and herb-filled sack or bucket until the dried umbilical cord separates naturally from the baby.
In her still prominent (top ten when searching “Lotus Birth” on Google) and recently updated post on Lotus Birth, Genevieve “Mama Natural” Howland attempts to present a balanced discussion of the practice, likely pulling in people on the fence, but fails miserably:
Lotus birth is about keeping the umbilical cord and placenta with the baby while he or she gently transitions to life outside the womb. It is a quiet and respectful transfer of attachment, without the trauma of being cut from the mother.
This implies that cutting the umbilical cord after 30-60 seconds, which has solid evidence of benefit compared to immediate severance when a newborn is stable, is somehow…disrespectful and traumatic. This is absurd. I put the full weight of my 2 decades of medical experience behind the fact that babies don’t care when the cord is cut. And it is a painless procedure, as there are no nerves in the cord.
Howland further reveals her bias by implying that Lotus Birth is based in some kind of ancient wisdom:
The name comes from the lotus flower, a flower important to Eastern cultures for its symbolism of unity, detachment, and rebirth. Lotus births speckle the history of childbirth in cultures around the globe, in places like Bali and Southern Africa. Historical traces of lotus births appear in Europe as early as the Middle Ages. And records of not cutting the umbilical cord appear on the American continent as early as the pioneer days. In Western nations, lotus birth seems to be a new birth trend steeped in early tradition.
She links to a 2012 article that discusses the timing of cord severance from a historical perspective but which doesn’t at all touch on Lotus Birth. Since 2012, we have learned a lot about the potential benefits of delaying clamping of the umbilical cord and it has become a science-based practice. But again, Lotus Birth is not remotely the same thing as delayed cord clamping.
So what are the proposed benefits? Besides claiming that for many it is a “spiritual practice that honors the birthing process and the sacred relationship baby has with the umbilical cord and placenta”, Howland lists five potential positive outcomes associated with Lotus Birth:
- “More blood”: This is delayed cord clamping. Yes, there is benefit to the baby getting a little more blood from the placenta in a safe and controlled manner. Again, that’s not what makes a Lotus Birth a Lotus Birth. Delayed cord clamping for 30-60 seconds is very safe, although there is a small increase in the risk of jaundice. If done improperly, babies can get too much blood from the placenta, which puts them at risk of hyperviscosity syndrome and subsequent stroke, seizures, organ damage, and death. Thankfully that is pretty rare though.
- “No open wound means less infection risk”: No. And I mean a hard no. In fact, Infection risk is increased by Lotus Birth and the practices that tend to be clustered with it, such as refusing vaccines and vaginal seeding.
- “Faster healing of the umbilicus”: Nope. Not a thing.
- “Emotional wellbeing”: No studies exist looking into whether or not newborns who experience Lotus Birth have improved psychological outcomes. Frankly, there is zero plausibility that they would experience a specific benefit after teasing out all the confounding variables. In my opinion, this is just another way for natural birth advocates and new age believers to pressure mothers and make them feel like they are doing it wrong.
- “Postpartum healing”: She claims that Lotus Birth forces a mother to take it easy, thus improving healing, which is quite a stretch.
Now on to Howland’s discussion of the risks in her “balanced” post. To her credit, she mentions that most medical organizations do not support Lotus Birth. This is misleading, however, because exactly zero legitimate medical organizations support it. She does point out that the Royal College of Obstetrics and Gynecology says Lotus Birth is an infection risk because, and I’m paraphrasing a bit, attaching a baby to a rotting sack of blood for several days might not be a good idea.
Howland mentions infection as a risk, but not that this infection can kill the baby. She also implies that it can be prevented if the placenta is properly cared for but she can’t possibly know this. Nobody knows this because it isn’t standardized and has never been studied. And infections have occurred despite “proper care”. As I’ll soon discuss, death has even occurred. The only other “drawbacks” she mentions are that mothers choosing Lotus Birth can’t eat the placenta or travel easily with the baby.
Check out this excellent discussion of Lotus Birth by Joshua Krisch as a counter to Howland’s egregious post. This paragraph in particular stood out:
Of course, not all parents have even a passing understanding of microbiology and those that swear by the practice speak of it in less medical terms, claiming to feel a spiritual attachment to what is essentially decaying, diseased tissue. But emotional urge to retain this piece of pregnancy shouldn’t be conflated with an evolutionary instinct. Nor should it be argued that cutting the umbilical cord too soon is bad for your baby.
The tragic case of Harlow Eden
We now come to the hear-wrenching story of Harlow Eden.
Don’t say I didn’t warn you.
In 2017, Harlow was born via an emergency C-Section in a Melbourne hospital. She was a “miracle baby” born after 13 years and more than a dozen IVF attempts. This, and exposure to all manner of pseudoscientific medical misinformation, likely led Harlow’s parents to choose a Lotus Birth. Their stated goal was to ease Harlow’s transitioning and to boost her immune system.
As is often the case, because parents unfortunately tend to cluster these types of poor medical decisions, Harlow’s parents also chose to refuse science-based recommendations for intramuscular vitamin K and the Hepatitis B vaccine. They also practiced vaginal seeding, another risk factor for serious infection. And, sadly, they also refused initial attempts by hospital staff to move Harlow to a special care nursery for closer observation.
By 16 hours of age, Harlow had developed hypoglycemia, which can occur in any baby but is more likely to occur when they are sick. At that point, the umbilical cord was cut and she was transferred to the special care nursery. She soon developed signs of sepsis, with respiratory distress and poor perfusion, so antibiotics were initiated. Despite this, she died the following day after having been transferred to a tertiary care center. The coroner determined that Harlow died from sepsis in the setting of a Lotus Birth.
Medico-legal considerations on Lotus Birth
In refreshing my fund of knowledge on Lotus Birth, I came across an interesting discussion of the medico-legal considerations on Lotus Birth in the Italian Journal of Pediatrics which was free and in English. It isn’t too long but goes into significantly greater detail than I do, particularly on the pathophysiology of the placenta, so it’s worth a read if you are curious about that kind of thing. But it is the ethical considerations that I was most interested in.
In the paper, the authors point out the connection between Lotus Birth and natural birth that I made earlier in this post. They describe how in this community, the act of cutting the cord can be viewed as a violent act. More importantly, a woman choosing Lotus Birth may be attempting to “exercise her right to individual choice and self-governance”. But, they point out, autonomy requires adequate information and awareness of the implications of a choice, which we know can be lacking in the world of medical pseudoscience.
In the case of Lotus Birth, the ethical principle of autonomy faces off with the ethical principles of non-maleficence and beneficence. The baby has to be considered to be a vulnerable person that must be protected. Taking into account what is known of the risks and benefits of Lotus Birth, the authors conclude that it is “ethically inadmissible”. This conclusion naturally seems like common sense, but it was still nice to see a thorough discussion by experts in the field of bioethics.