Knitted Noggins, aka the Newborn Cap

That first moment that a baby is brought to the mother's chest - blissful, slippery, wet, gooey, smelling of amniotic fluid, vernix, and mama's womb; the mama tips her head down to her fresh new babe and nuzzles, cuddles, sniffs, cooes, rubs, and kisses babe all over the top of their head and face. Babe blinks wide, bright eyes, focusing on their mother's face, soaking up the affection of their first few moments on earth.

They are mesmerized and memorizing, falling in love, bonding.

Now imagine an outsider interrupts this space, leaning in across mother's abdomen and stretches a knitted or nylon hat over the fresh, sweet head of the newborn. Momentarily, the babe looses eye contact with his mother, the mother smells the scent of the well-meaning care provider, feels her scrubs rub against her bare arms. The care giver struggles slightly to get the tight cap over the newborn's head, pulling and tugging, albeit gently, until it is snuggle on baby's crown.

The mother attempts to reconnect with her newborn. Yes, she is successful, yes babe eagerly searches out his mama's eyes once again, but there is now a barrier between mother's fondling and caressing, the immediate magic is gone, and a knitted veil stands between her baby and her.
We have to ask ourselves about the way this hat thing got going.  Babies not doing well after being born to medicated women and immediate cord clamping.  That baby who has started off at such a deficit will lose body heat and be in very rough shape.  Helping keep in heat by a hat might be a matter of life and death in this instance where the body is so weakened.

Contrast that to a baby born spontaneously and placed on his mother’s body. . . both of them wrapped in a warmed blanket skin to skin.  Then, the baby and the mother lock in a gaze; the mother recognizing that this is her own; she buries her nose in the wet head and drinks in the smell of her young; she locks the imprint of that child’s whole being into her vision and she would not ever confuse her baby with someone else’s.  Later, she chooses the clothing SHE wants her child to wear; she dresses and grooms her own baby. . . she is in charge and has been born as the mother.  No one and no article of clothing has come between her and her total impressions of that baby.  Through skin, mouth, nose, eyes and heart she has claimed the baby as her own and the bond is strong. 

Bringing medicalized birth practices to a natural birth is a sign that we lost so much knowledge in the dark years when home birth/midwifery was wiped out.  Now, we can look again at these things and lay them aside as foolish for well women and their infants.- Gloria Lemay
This post came about when talking to a group of mothers about the immediate moments after birth and how they felt. Every woman talked about the immediate bliss of hearing their baby's voice, the baby's smell, the feel of their skin and the magica moment when they locked eyes for the first time.

One woman stopped us all, though, with her next sentence.

"But that #$%^ cap. There was no one else in the world for a blissful 2 minutes. And then, my midwife swooped in and crammed this ugly thing on her head." She continued, "that was bad; but what added insult to injury is that the blasted thing wouldn't stay on! Every time it would slip off, someone would swoop in again to cram it back on her head. I even told them not to worry about it, I had us both covered in blankets, but they insisted."

I was shocked at her anger and frustration at something that seems so mundane. But, as I thought about it and thought back on my own experiences with newborn caps, another woman chimed in.

"I know what you mean", she said, "I felt guilty for sneaking it off for a few moments just to see how his long dark locks curled against his ears. I just wanted a few moments to run my hands over his head, bury my nose in his furry little neck rolls, and breath in his scent! It was so strong under that hat. But I felt like I had to sneak it off. I was being bad, it felt illicit."

The third woman spoke up when the other two noticed she wasn't sharing, "My doctor didn't put one on. We had the warm blankets over the two of us. In fact, I literally put the blanket over my head, putting us three [her husband included] in a tent. We couldn't get enough of her. She laid naked on my naked chest, we explored each other - she, my face and breast, me, her tiny ears, downy hair, deep earthy scent, and wide eyes. Tiny fingers, tiny toes... the only time he bothered us is when he slipped a hand under and asked me to put the stethoscope on her back for a few moments."

It's something simple. It's just a knitted hat, right? From this conversation alone, we, as childbirth professionals, should use wisdom and take pause to reconsider this attitude.
Without the hat, a mother dips her head down to s-n-i-f-f and rub her cheek and breathe, and the very presence of her face and cheeks and breath warm and dry the top of the baby’s head and perhaps contribute to that early, life-long, crazy-glue love affair. Put a hat on, and Mama doesn’t sniff, or rub her cheeks, or perform any of those other innate little head-top rituals, or if she does, she doesn’t get the same feedback. Does it matter? Who knows? But we do know that there’s no research to support the hat. And we don’t know how important it is not to have it. Trust yourself to mother well, be alert to the many tiny intrusions on this self-sufficient system, keep your baby with you… and let the outsiders wear the hat if they like. - Diane Weissinger
So let's look at the practice as a whole. The medical profession states that it is necessary to prevent babies from loosing their body heat out of their heads. This myth was perpetuated by a study done by the military in the mid 1960's. Obviously, if you look at the study alone, we know that we don't loose most of our body heat through our heads.

Next, let's look at some basics regarding birth. There is a normal, physiological benefit to some cooling of the newborn immediately after birth. As long as babe is not chilled, but simply cooling as is physiologically normal, they have a better grasp on learning to regulate their own temperatures through simple skin to skin contact - instead of diapers, mittens, a onsie, a cap, and two blankets firmly wrapped around them before being nestled against their mother (can we say overkill?).

In addition, a baby who has had a traumatic birth can actually benefit from cooling. As we see from babies who were born not breathing, evidence now suggests that head cooling can actually be helpful. We also know that cooling of a part of the body actually increases the peripheral oxygen absorption of the rest of the body.

Next, let's take a look at when it would be appropriate. If a newborn is premature, has low body mass, or is otherwise abnormally chilled (bluish lips, quivering lips that are not from crying, etc..), a newborn cap can benefit them by helping them to regulate their temperatures until they are strong enough to do it themselves.

Even when a newborn might benefit from capping, it is also important to take a critical look at the type of capping that is done. Most hats in birthing kits and in the hospital are polyester; it has been proven through research literature that these types of caps do not keep baby heads warm. Not only is this a major drawback for when capping might be appropriate, but also the polyester caps are so snug that they may very well affect how the plates of the skull resolve after birth. We can't know for sure, though, because, to date, there is no research into the possible harm that these extremely tight fitting hats might cause.
We should also take a keen look at why it is beneficial, to the mother and neonate, to reconsider routine capping of the neonate. The most glaringly obvious reason is because it breaks up that very important bubble of newborn bonding that families do immediately after birth. As described above, the intrusion is very real and very disruptive. It's not only that we touch, prod, and otherwise break the 'spell' of the moment, but we also leave a lasting tangible object to continue being disruptive.

Since the conception for this post set root, I asked many women what they felt about different situations regarding their newborn's cap. Many women reported feeling guilty for taking it off, wanting it off, or sneaking it off. Some women felt 'naughty' for removing it the moment that their nurse/doctor/midwife/mother was not in the room. Some women were paranoid to find their baby without a hat on after naptime wiggled it from their brow.

I can see a host of harm being done to new mother's over the angst of keeping an unnecessary hat on. New mother's have enough of their own worries and hormonal upheaval to work through without the added guilt or upset of a knitted noggin. What a relief it would be for a mother to not ever be presented with the concept of that guilt, naughtiness, or paranoia! I don't know about you, but I would do anything in my power to alleviate that from a new mother's mind and heart!

Some of the most potent baby smells are on the babies scalp. When we cover that gloriously goopy, wet, sensual scalp with a cap, we are taking away one of the strongest bonding tools that there is between a mother and her newborn - smell.

All babies are born with a group of special qualities called attachment- promoting behaviors— features and behaviors designed to alert the caregiver to the baby's presence and draw the caregiver, magnet like, toward the baby. These features are the roundness of baby's eyes, cheeks, and body; the softness of the skin; the relative bigness of baby's eyes; the penetrating gaze; the incredible newborn scent; and, perhaps, most important of all, baby's early language—the cries and precrying noises. - Dr. Sears

Think of it, nature has hard-wired us, as mothers, to want to take in that vernixy, fluid soaked baby head. We are attracted to nuzzle, stroke, and snuggle into babies head. Perhaps we don't stop at simply bonding? Perhaps there is aromatherapeutic properties to the potent smell of a newborn's head; perhaps the massaging that many mother's give their babies heads, when not capped, promotes the cranial plates to return to their proper places (as does cranialsacral therapy). We don't know because we have not asked.
One of the most critical steps in circumventing the extinction of our species is to rekindle the bond a mother has with her baby that enables her to protect them from harm. In a world where danger abounds, it is essential that mothers stay rooted to this most instinctual, intuitive survival skill to ensure the survival of future generations. - Imani
As a birth professional, watch these mothers at birth, watch them without touching or prodding, without intruding or talking. Watch as the mom and baby interact, unobtrusively and from a distance.

Without a hat, mother will nuzzle and snuggle, pulling baby protectively into the crook of her arm or the crook of her neck, soaking in the smell, covering herself in babies scent even. If baby is already capped, watch their interactions. Mom will immediately want to take the hat off to see how much hair, what color, if there are curls, where the soft spots are... and they will most likely dip their chins down to breath in the baby's scent. There is such intimacy in this gesture, such obvious need for it.

And finally, let's not forget the act of nursing. Nursing raises both mom and babies core body temperatures, making them veritable space heaters, I cannot see justification for routine capping in these instances either.

If mom is not in a very cold OR or hospital room, if their room, whether in the home, birth center, or hospital, is warmed appropriately for mom and baby, if baby is full-term and not showing signs of chilling, if mom and baby are skin to skin, what is truly the justification for a knit cap?

I challenge you, the childbirth professional, the pregnant woman, the friend or sister - to take a closer look at our reasons for such a routine and seemingly harmless act as neonatal caps immediately after birth.


G said...

Another timely and well put together post, Nicole.

I remember meeting a woman who had given birth to a still born baby at 36 weeks. She opened her precious box of baby memories to show me a photo of her little one. There was the baby with a hat on. What could the staff at the hospital have been thinking? Even a baby who has died has to have a hat on. . . it's so ridiculous and I felt for that mother that she had no photos of just HER baby.

shannon said...

I remember Karen Strange, the woman who teaches out of hospital NPR classes, commenting on how the hat just gets wet, and thereby chilling baby even more. Useless! And polyester, ugh!! Great post!!

Kimberly O. said...

Great post.

I was one of those that never felt guilty for taking the hat off. My daughter would even try to paw at the hat and fuss a little...she didn't like it! Why should I make her wear one when even she, hours old, obviously did not want it on?!

I still kept it as a memory...my oldest daughter has one as well. I think they are silly and mostly unnecessary. I always beamed when the nurses or doctors came to put my little ones hat back on because as soon as they were out of the room, that hat was on its way off. (Same with swaddling. Neither of my girls have tolerated swaddling, and having my newborn cuddled up against me in warm blankets, in my eyes, was just as good, if not better, than being swaddled.)

Allison Mitchell said...

What a beautiful article. One thing bugged me though...human babies do not imprint, you may want to reword.

Nicole D said...

Hi Allison - thanks for the note, I don't want anyone to be confused, so I did change it... BUT, when I chose the word "imprinting", I wasn't meaning in terms of a psychological imprinting as occurs in, say, fowl, but more to:

"To fix firmly, as in the mind"

which is another one of the definitions. :)

Thank you, though, and I did change it.. just picturing a few little babies crawling after a goose was enough for me to reword...

Unknown said...

Enjoyed reading this. When my son was born, I was obsessed with smelling his head, I knew most people would think it was weird, so I never told anyone at the time. But I couldn't stop myself from smelling him, he smelled so good to me. I remember the nurse giving me a funny look when she said, well, are you SURE you don't want to give him a bath. He didn't need one I told her and she walked away, shaking her head.
There is something very raw and primitive about a mother bonding in the first few hours, and if mom wants to smell the baby's head, well she probably smells something that no one else does, so leave her be! Just like you said, I was falling in love, intoxicated by my baby and all I wanted was time to enjoy the moment.

Unknown said...

I've never even considered this! Polyester, for real? I hope hope hope that the homebirth in my head happens and we won't have a single had in sight... :]

Curls said...

Interesting, I especially liked the Gloria LeMay quote.


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