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Qualitative Study on the Experience of
Lotus Birth
_
Ilknur Münevver Gönenç, Meneks¸e NazlıAker, and Emel Ay
ABSTRACT
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.
JOGNN, 48, 645–653; 2019. https://doi.org/10.1016/j.jogn.2019.08.005
Accepted August 2019
Lotus birth is the practice of leaving the um-
bilical cord uncut and keeping the newborn
attached to the placenta after birth; the placenta
and the umbilical cord are expected to separate
naturally from the newborn (Katheria, Troung,
Cousins, Oshiro, & Finner, 2015). This practice is
named for Clair Lotus Day, who in 1974 observed
that a chimpanzee did not separate the placenta
from her newborn (Zinsser, 2018). Lotus births
were first used in home births and are currently
used in hospital births, including cesarean births
(Rachana, 2011). The incidence of lotus birth is not
known; however, lotus birth is practiced in many
countries, including the United States, Australia,
Italy,and Turkey (Burns, 2014; Karakoc¸, Demirgo
¨z,
Bingo
¨l, & Cerit, 2018; Rachana, 2011).
During a lotus birth, the third stage of labor is
passively managed. The placenta is expected to
deliver spontaneously, oxytocic drugs are not used,
the umbilical cord is not clamped, and traction is not
applied to the cord (Karakoc¸ et al., 2018). When the
umbilical cord is not cut, umbilical veins constrict
and placental blood circulation generally stops in 5
minutes (Hutchon, 2012). After birth, the placenta is
washed, salted, wrapped in an absorbent material,
and, after 2 to 3 hours, wrapped in herbs such as
lavender and/or rosemary. The salting process
continues at least once a day until the umbilical cord
separates on its own. The moisture of the umbilical
cord and placenta are examined daily. If the mois-
ture does not diminish, salting is increased to twice a
day (Zinsser, 2018).
According to advocates of lotus birth, because
the fetus and the placenta are formed from the
same cell, they represent a single unit. Thus, if the
newborn is not artificially separated from this part
of itself, a considerable amount of blood will be
transported to the newborn through the umbilical
cord (Vidhya & Kalaimathy, 2011). In addition,
advocates believe that energy flow from the
placenta continues after birth to the newborn and
that the interruption of this flow adversely affects
the newborn (Zinsser, 2018).
Lotus birth also promotes more bonding between
a woman and her newborn because it is unlikely
The authors report no con-
flict of interest or relevant
financial relationships.
Correspondence
Meneks¸e NazlıAker, MSc,
Ankara University, Aktas¸
mah. Plevne cad., Aktas
Kavsagı. No. 5, 06340
Altındag, Ankara, Turkey.
menekseaker@gmail.com
Keywords
birth
lotus
placenta
women
_
Ilknur Münevver Gönenç,
PhD, is an assistant
professor, Faculty of
Nursing, University of
Ankara, Ankara, Turkey.
Meneks¸e NazlıAker, MSc,
is a lecturer, Faculty of
Nursing, University of
Ankara, Ankara, Turkey.
Emel Ay, BSc, is a
retired midwife, Konya,
Turkey.
ª2019 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Published by Elsevier Inc. All rights reserved.
http://jognn.org 645
RESEARCH
that the newborn will be easily separated from her
for unnecessary medical procedures (Rachana,
2011). Lotus birth ensures that the woman and
her newborn are isolated from the negative
effects of the external environment in the first few
days after birth. This practice is focused on the
initiation of physical, emotional, psychological,
social, and spiritual relations among the newborn,
the mother, and the nuclear family; initiation of
breastfeeding; and facilitation of attachment
(Karakoc¸ et al., 2018).
However, it is not known whether lotus birth poses
any risks or leads to infant complications after
birth. There is no placental circulation during the
postnatal period, and the newborn becomes
particularly vulnerable to infection (Tricarico et al.,
2017; Zinsser, 2018). The placenta is nonviable,
and the blood in the placenta does not circulate
after birth. Hence, the placenta may be a source
of infection, and the infection could theoretically
spread to the newborn, although there is no
strong evidence of the incidence or severity of
this occurrence (Monroe, Rubin, Mychaliska,
Skoczylas, & Burrows, 2019). Furthermore, the
lotus birth may expose the newborn to potential
trauma if the umbilical cord is pulled uninten-
tionally (Zinsser, 2018). Delayed umbilical cord
clamping, including lotus birth, should not be
implemented in maternal or neonatal emergen-
cies, such as the need for immediate resuscita-
tion of the newborn, maternal hemorrhage,
placental abnormalities such as placenta previa
or placental abruption, and placental attachment
abnormalities (American College of Obstetricians
and Gynecologists, 2017).
Although lotus birth is becoming a preferred
approach for some women (Katheria et al., 2015),
it occurs rarely, and minimal research has been
conducted to explore the practice, conse-
quences, and benefits of lotus birth (Monroe
et al., 2019). Given the rarity of the request for
lotus birth, maternity care providers may not have
information available to guide care and clinical
decisions. Investigation of this practice will pro-
vide guidance for women and maternity care
providers. Therefore, the aim of our study was to
describe the experiences of women who experi-
enced lotus birth. We were particularly interested
in how women described the significance of lotus
birth, their reasons for choosing it, their sources of
information about lotus birth, and their pre- and
postnatal experiences related to their lotus births.
Methods
Design
We used a descriptive phenomenological design
to investigate women’s experiences of lotus birth.
In phenomenology, the experiences of a few in-
dividuals related to a phenomenon or concept are
defined and extrapolated to a universal descrip-
tion (Creswell, 2013). We defined lotus birth as
the phenomenon to be described through the
experiences of women who had lotus births. The
study was approved by the ethical board of
Ankara University.
Setting and Participants
Women who experienced lotus births in Turkey
participated in the study. The first lotus birth in
Turkey was recorded in 2013, and the second
occurred in 2014 (Dursun, 2019). For this reason,
we attempted to reach all women in Turkey who
had lotus births since 2013. The inclusion criteria
for participation was having a lotus birth,
speaking Turkish, and being 18 years of age or
older. Rubin and Babbie (2011) recommended
the use of snowball sampling when it is difficult to
obtain the required number of participants.
Because lotus birth is quite rare, we used snow-
ball sampling to recruit participants. Through key
informants, we contacted women who had
experienced lotus birth and recruited new par-
ticipants from referrals. Turkey is divided into 81
provinces and seven geographic regions. We
conducted the interviews in seven provinces of
four geographic regions of Turkey with nine
women. We finalized the data collection process
when no new referrals were received.
In Turkey, 97% of births occur in hospitals
(Hacettepe University Institute of Population
Studies, 2014). The postpartum hospital stay is
24 hours if the mother and newborn are healthy
after a vaginal birth and breastfeeding has been
initiated (Republic of Turkey Ministry of Health,
2018).
Procedures
We collected data between December 2017 and
May 2018 using a personal information form and
a semistructured, in-depth interview guide (see
Table 1). The personal information form included
questions related to age, educational level,
marital status, mode of birth, location of birth,
Limited information exists with which to guide women and
health care professionals regarding lotus birth.
Qualitative Study on the Experience of Lotus BirthRESEARCH
646 JOGNN, 48, 645–653; 2019.https://doi.org/10.1016/j.jogn.2019.08.005 http://jognn.org
time of umbilical cord natural separation, and
complications of the newborn, including hyper-
bilirubinemia and infection.
We conducted the interviews in Turkish using the
interview guide (see Table 1). One of the authors
(M.N.A.) obtained participants’ permission to
audiotape the interviews and conducted the in-
terviews. The recorded interviews lasted for 45 to
65 minutes and were transcribed verbatim. A
graduate student in midwifery who holds a
bachelor of science degree in English translation
and interpretation translated the transcribed in-
terviews into English. Native English speakers
verified the accuracy of the quotations.
Data Analysis
Analysis of the interview transcripts was based on
the Moustakas (1994) phenomenological pro-
cedure for data analysis. The general compo-
nents of this procedure consist of epoche
´,
phenomenological reduction, imaginative varia-
tion, and essence (synthesis of composite
textural and structural descriptions). During the
process of epoche
´, we consciously blocked our
assumptions and experiences from the study so
that each participant’s experience was presented
thoroughly with no prejudgment. In our study, to
treat each statement of the participants anony-
mously, we assigned a number to each sentence.
In the phenomenological reduction step, we
synthesized participants’ descriptions of their
experiences, excluded repetitive or irrelevant text
in the data, and then identified significant state-
ments within each set of data. In the imaginative
variation process, we constructed a global sense
of the transcripts by rereading them several times
and dividing the data into meaning units that were
gathered under themes. With this approach, we
obtained participants’ structural descriptions of
the lotus birth experiences that formed the
imaginative variation part of the study. Subse-
quently, we developed possible descriptions for
the overlapping statements of all participants to
construct new meanings. In the process of
essence, we combined these textural and struc-
tural descriptions for an accurate representation
of the lotus birth experience. This process also
included the final step of the data analysis, which
yielded the phenomenological perspectives of
the participants. Consequently, we identified the
meaning of themes that constitute the essential
structure of the phenomenon of lotus birth.
Lincoln and Guba explained that confirmability,
dependability, credibility, and transferability
ensure rigor in qualitative research (Lincoln &
Guba, 1985). To increase the confirmability of
the study, the process of the study and the pro-
cedures carried out in this process were
explained in detail (audit trail). To increase the
transferability of the study, future research find-
ings could be compared and/or replicated
through use of thick detailed descriptions of the
phenomena under study. To increase the
dependability of the study, the study data were
coded separately by two researchers. Eventually,
the transcripts were double-checked by an in-
dependent researcher with experience in quali-
tative research (external audits). To increase the
credibility, we had participants read the findings
and asked them by e-mail whether the statements
were accurately reflected in the themes (member
checking).
Results
The ages of the nine participants ranged from 25
to 38 years, six had bachelor’s degrees, three
were high school graduates, and all were mar-
ried. All participants gave birth vaginally, one at
home and the others in hospitals (see Table 2). All
participants initiated breastfeeding within the first
30 minutes after birth. An independent midwife,
who was not part of the hospital birth teams,
provided support to all participants for the care of
the placenta after lotus birth. This midwife
continued to provide care until the umbilical cord
separated from the newborn at an average of
5 days after birth.
Table 1: Interview Guide
What is the significance of lotus birth?
What was the experience of lotus birth like for you?
Could you tell us about your decision-making process
related to lotus birth?
What did you experience with lotus birth (problems,
benefits, harm)?
Would you like to talk about the reactions of the people in
your circle about lotus birth?
How would you assess the health care staff related to lotus
birth?
The study participants stated that cutting the umbilical
cord was a disruption of a natural process and showed
disrespect for the placenta.
Gönenç,
_
I. M., Aker, M. N., and Ay, E. RESEARCH
JOGNN 2019; Vol. 48, Issue 6 647
The essence of participants’ experiences was
their desire to choose the healthiest and most
natural mode of birth. Participants preferred lotus
birth because they perceived it as a natural pro-
cess. They also believed that there is a spiritual
relationship between the newborn and the
placenta and that cutting the umbilical cord is
disrespectful to the placenta. Participants gave
positive feedback about the benefits of lotus birth
and wanted to have lotus birth for their subse-
quent births. They described the crucial need for
information about the process of lotus birth and
that their sources of information were limited.
The following six major themes emerged from the
findings: Meaning of the Lotus Birth Experience,
Decision Making Regarding Lotus Birth, Lotus
Birth Process, Perceived Benefits and Disadvan-
tages of Lotus Birth, Reactions to Lotus Birth, and
The Future of Lotus Birth. Fifteen subthemes were
organized under the six primary themes.
Meaning of the Lotus Birth Experience
The primary expressions used to describe the
meaning of lotus birth experiences were respect
for birth and the placenta (five participants),
naturalness and preservation of the naturalness
of birth (six participants), saying goodbye to the
placenta (three participants), and completion and
integrity (three participants). One participant
described respect for birth as follows:
If they are moving out together, I think they
should decide for the separation them-
selves and they should convince them-
selves and say goodbye. So lotus birth is
the continuation of that respect. As a
continuation of respect for birth, a state of
showing respect for leaving its placenta.
Decision Making Regarding Lotus Birth
Participants shared their experiences regarding
the decision-making processes they used when
considering lotus birth, including motivation for
and sources of information about lotus birth.
Participants were motivated by their desire for
noninterventional, natural birth; the spiritual
meaning they attributed to the placenta; and the
desire to choose the most beneficial option for the
newborn. One participant described the placenta
as follows:
The child lives with the placenta for
9 months, in the womb, establishing a
bond in one way or another. It’s actually
part of you and the baby. And you are
separating it suddenly.... We have a mate-
rialist approach to everything.
Participants accessed information about lotus
birth through prenatal education, Web sites, so-
cial media, other women who previously had lotus
births, and health care professionals:
Table 2: Characteristics of Participants
Participant
Number
Age
in
Years
Education
Level
Birth
Place
Mode of
Birth
Age of the
Infant at
Time
of the
Interview
Natural
Separation
of
Umbilical
Cord
Neonatal
Hyperbilirubinemia
Neonatal
Infection
1 29 University Hospital Vaginal 3 years 4th day
3rd day
No
Yes
No
No
2 38 University Hospital Vaginal 22 days 3rd day No No
3 33 University Hospital Vaginal 5 years 4th day No No
4 30 University Hospital Vaginal 1.5 years 7th day No No
5 27 High school Home Vaginal 24 days 5th day No No
6 35 University Hospital Vaginal 1 year 7th day No No
7 28 University Hospital Vaginal 3.5 years 7th day No No
8 37 High school Hospital Vaginal 6 months 5th day No No
9 25 University Hospital Vaginal 1.5 years 5th day No No
Note. Participant 1 had two lotus births.
Qualitative Study on the Experience of Lotus BirthRESEARCH
648 JOGNN, 48, 645–653; 2019.https://doi.org/10.1016/j.jogn.2019.08.005 http://jognn.org
I started searching for it on the Internet
after I talked to my midwife.... I called and
talked to the friend who had the second
lotus birth in my country. My midwife
advised me to talk to her about the nega-
tive aspects, positive aspects. I wanted to
talk to someone who had a real experience,
and I was convinced.
All participants said that their information sources
were limited and that they wanted to access more
information. Although two participants described
the roles of physicians and midwives in their
processes for decision making and obtaining in-
formation, all participants thought their maternity
care providers generally had inadequate knowl-
edge about lotus birth:
The health care [sic] staff has no idea
[about it].... They gave extra care. For it
was a different birth.... They looked at it
with curiosity. They are curious, but they do
not know it.
Lotus Birth Process
The theme Lotus Birth Process included three
subthemes: Lotus Birth Preparation, Lotus Birth
Rituals, and First Encounter With the Placenta.
During the preparatory phase, all participants
stated that they had cotton fabric bags prepared
and that they had obtained sea salt and some
herbs for the placenta:
I made bags to put, to put the placenta [in].
The bloody fluid of the placenta would leak
for a while, so it would get wet, thus I pre-
pared two of them. My midwife said that
lavender would be useful to avoid infection
and bad smell. Lavender, I went [to the
shops] and tried to get the best and the
most natural. I found rosemary, and I made
some sea salt available in the same way.
The process of lotus birth is given in Table 3. All
participants reported that there were rituals
related to lotus birth. They stated that they
washed the placenta after birth or that they kept it
in a container until all the blood was drained. They
also stated that they placed some material in the
container to absorb the blood and that they
changed this material at certain intervals. They
later salted the placenta to prevent infection,
repeated the salting process at certain intervals,
and sprinkled rosemary and lavender to eliminate
foul odor.
Two participants hid and four buried the placenta
after the umbilical cord had fallen off. Some said
that they expressed thanks to the placenta and
said goodbye (three participants):
It stayed at home for a year. I looked at the
way how [sic] it petrified. I remember
thanking it so sincerely. It is the thing that
fed my baby. I think we have established a
bond. Saying goodbye was not easy. We
buried it under an olive tree that looks
young, and we visit it every year.
Participants stated that they had positive or
neutral feelings when they first saw the placenta.
Some participants cried and were excited when
they first saw the placenta; others said that they
did not feel that much:
Table 3: Steps in the Process of Lotus
Birth
1 The newborn is placed on the mother’s chest after
birth while the placenta is delivered gently and
spontaneously.
2 The blood flow in the umbilical cord spontaneously
ends a few minutes after birth. The umbilical
cord is not clamped.
3 After the placenta is delivered, a general
examination is performed.
4 The placenta is washed or kept in a container until
all the blood is drained.
5 A sterile gauze compress is placed in the
container to absorb the blood, and this material
is changed at certain intervals.
6 A mixture of 1 kg sea salt, 0.5 kg rosemary, and
0.5 kg lavender is made. Half of this mixture is
sprinkled on the placenta on the first day and
the other half on the second day. This is done to
dry the placenta, prevent infection, and
eliminate foul odor.
7 The placenta is stored in a special bag that allows
air circulation until the umbilical cord separates
from the newborn.
8 The umbilical cord becomes dry and hard after
1 day.
9 The newborn, cord, and placenta are carried
together until the umbilical cord separates from
the newborn spontaneously.
10 After the separation, the placenta can be dried
and stored or buried.
Gönenç,
_
I. M., Aker, M. N., and Ay, E. RESEARCH
JOGNN 2019; Vol. 48, Issue 6 649
I cried. You actually think of it as a piece of
flesh but it’s weird to know that it hosts so
much code. I mean, it is something with no
eyes, hands, or arms but, that’s, it’s my
son’s partner. It arose positive things in me.
Another participant stated, “I did not feel that
much, a piece of flesh. I did not look at it that
pleasantly in the way I looked at my baby.”
Perceived Benefits and Disadvantages of
Lotus Birth
The theme of Perceived Benefits and Disadvan-
tages of Lotus Birth included three subthemes:
Perceptions of Harm, Perceptions of Benefits,
and Worries About Lotus Birth. No participants
perceived negative effects of lotus birth to their
newborns or themselves: “No, I do not think there
is any harm. There was no written evidence of its
harm in any sources we have read.”
Participants experienced several benefits of lotus
birth. All participants reported that their newborns
were peaceful and calm after lotus birth. Four
participants reported that it prevented anemia, as
evidenced by their newborns’ blood test results;
two participants reported better breastfeeding,
and one participant reported better mother–infant
bonding.
Participants stated that they experienced some
worries during this process. The greatest concern
was about how to carry the placenta and
newborn together, which participants described
as difficult. They were worried that the placentas
would pull on the umbilicus and hurt their new-
borns. Another concern was the fear of infection,
jaundice, and damage to the umbilical cord. One
participant reported jaundice that required treat-
ment, but none reported infection of their new-
borns (see Table 4):
I was very worried due to hearing the word
jaundice, jaundice, jaundice repeatedly.
Breastfeed the baby a lot, if not it develops
jaundice. What if the baby develops jaun-
dice? And does anyone relate it to this
[lotus]. I’ve had a lot of worries about this,
too. Thank goodness, nothing happened.
Reactions to Lotus Birth
Participants experienced some positive and
negative reactions to lotus birth, and these were
captured under two subthemes: Reaction of the
Social Environment and Reaction of Health Care
Personnel (obstetricians, pediatricians, family
physicians, midwives, and nurses). Participants
stated that they received positive and negative
reactions from their social environment (family
members, friends, neighbors, etc.). One partici-
pant described a positive reaction: “Mom has
shown a positive reaction, and my husband is
happy about my decision.”
However, most participants reported negative
reactions: “A total disappointment after the birth.
Everybody is treating you as if you have leprosy.
This has worn me out much.”
They believed that many people had outdated
information and were not open to newly acquired
information. Therefore, participants believed that
people reacted negatively when they saw some-
thing different from their own experiences. Par-
ticipants reported that many people told them to
cut the umbilical cord off, which irritated them.
Participants generally were disturbed by the re-
actions of health care personnel and the inade-
quate support they received from those
personnel. They said that they needed the sup-
port of health care personnel in this process:
I definitely wanted to get support from the
physician professionally. I was in a state
hospital after the birth, and I encountered a
doctor there referring me to a university
hospital on the grounds that he had never
conducted lotus birth before. This made
me so unhappy. For this reason, because it
Table 4: Participants’ Experiences of the Positive and Negative Aspects of Lotus Birth
Positive Aspects Negative Aspects
Prevention of anemia
Strengthens the mother–newborn bond
Promotes breastfeeding
Peaceful and calm newborn
Potential for hyperbilirubinemia (requiring treatment)
Difficulty when carrying the newborn around
Qualitative Study on the Experience of Lotus BirthRESEARCH
650 JOGNN, 48, 645–653; 2019.https://doi.org/10.1016/j.jogn.2019.08.005 http://jognn.org
was a lotus birth, they did not examine my
baby. Literally, we felt alienated.
The Future of Lotus Birth
All participants stated that they wanted to have
lotus birth again at their next births: “I can run
counter to everyone and have lotus birth again. I
want something beneficial for my baby.” They
also recommended lotus birth to other women.
Most participants believed that lotus birth would
be widespread and that women would demand it
in the future. To make lotus birth widespread, they
expressed that media should emphasize it, sci-
entific studies should be conducted on its effects,
the knowledge and support of doctors and mid-
wives should be increased, women’s instincts
should be taken into consideration, the birth
method should be questioned, and the best birth
method should be investigated. At the same time,
there were participants who thought that lotus
birth would not become widespread and believed
the most important obstacles to this type of birth
were the perspectives of health care personnel
and the fears of women.
Discussion
In our first theme, we defined Meaning of the
Lotus Birth Experience for the women. Our par-
ticipants experienced lotus birth as a natural and
necessary process. They reported that lotus birth
should be used as a way to respect the placenta
and the birth itself. Similarly, Burns (2014) noted
that the purpose of rituals related to the placenta
is primarily to show respect and honor for the
placenta.
Our second defined theme was Decision Making
Regarding Lotus Birth. Our findings indicated that
the desire for a noninterventional natural birth, the
spiritual meaning attributed to the placenta, and
the desire to choose the most beneficial method
for the newborn motivated the participants to
choose lotus births. Similarly, Zinsser (2018)
found that women decided to have lotus births
because of spiritual motivations and the desire to
have natural births and natural postnatal care.
The reason for choosing lotus birth stemmed from
the perceived spiritual connection between the
newborn and the placenta (Williams, 2017).
Participants in our study emphasized that their
sources of information were limited, they wanted
access to more resources, and the lack of re-
sources was frustrating. This underlined the sig-
nificance of closing the gap in the literature related
to lotus birth. Our participants also reported that
research about lotus birth was inadequate and that
most women could not access the research
because most studies were published in English.
Grimes, Forster, and Newton (2014) found that
women with non–English-speaking backgrounds
used fewer written and online sources and that the
current sources of information for pregnant women
did not meet their needs. The literature about lotus
birth, which is a rare practice, is very limited
(Monroe et al., 2019). Thus, studies on lotus birth,
expansion of resources, translation of those re-
sources into different languages, and develop-
ment of educational materials for women and their
families would help women collect reliable
information.
Lotus Birth Process was the third theme in our
study. All of our participants reported that they
performed rituals during the lotus birth process.
Zinsser (2018) found that women washed and
salted the placenta, used dried lavender, and
kept the placenta in a bag, a small pillow cover, or
a case. Similarly, in lotus births in Michigan, the
placenta was checked, washed, and salted, and
women placed it in a package of their choice
(Monroe et al., 2019). These findings indicated
that lotus birth rituals were applied similarly in
different cultures (Rachana, 2011).
Our participants also reported that they per-
formed rituals related to the disposal of the
placenta. They thanked the placenta and said
goodbye to it. They hid or buried it and attributed
spiritual significance to the place of burial. Simi-
larly, Burns (2014) reported that the placenta of
each infant in the family was buried under a fruit
tree in the garden as an indication of respect.
Young and Benyshek (2010) found that the most
common method for the disposal of the placenta
was burying, and that in many cultures, in-
dividuals buried the placenta in their backyards
or at the place of the birth.
The fourth theme that we defined was Perceived
Benefits and Disadvantages of Lotus Birth. Our
participants emphasized that the placenta
affected the child’s life. They believed that lotus-
born newborns were peaceful and calm and that
lotus birth helped promote the mother–newborn
Health care professionals should increase their knowledge
about lotus birth, help women make informed choices, and
respect women’s preferences for lotus birth.
Gönenç,
_
I. M., Aker, M. N., and Ay, E. RESEARCH
JOGNN 2019; Vol. 48, Issue 6 651
bond and breastfeeding. Young and Benyshek
(2010) reported that a child’s life, or at least
some aspects of it, could be influenced by a
number of cultural ideas regarding the placenta.
Vidhya and Kalaimathy (2011) reported that after
lotus birth, newborns seemed more peaceful,
more relaxed, calmer, and healthier than their
counterparts whose cords were cut immediately
after birth. These authors highlighted lotus birth as
an enjoyable bonding experience. However, there
was minimal research evidence to support these
effects, and no data were available about the
safety of lotus birth (Tricarico et al., 2017).
According to the experiences of our participants,
lotus birth prevented anemia, but we did not find an
effect of lotus birth on reported anemia in our study.
However, in other studies, late cord clamping was
associated with a reduction of anemia in infants at
8 and 12 months after birth (Kc et al., 2017;
McDonald, Middleton, Dowswell, & Morris, 2013).
Carrying the placenta and the newborn together
was the biggest problem for participants in our
study. They also expressed concern about the
development of infection, jaundice, and fear of
harming the umbilical cord. One participant re-
ported that her newborn needed treatment for
hyperbilirubinemia, which is also a concern with
late clamping of the umbilical cord. Tricarico et al.
(2017) reported that a case of acute jaundice and
hepatitis was associated with a lotus birth. Their
findings suggested that infants whose mothers
chose a lotus birth should be monitored closely
for serum bilirubin levels (Tricarico et al., 2017).
Another point of concern our participants expe-
rienced was the potential for the development of
infection, although none of the participants’
newborns developed infection. Similarly, Monroe
et al. (2019) reported that no infants developed
infections among six women who had lotus births.
According to some literature, the lack of circula-
tion in the placenta after birth in lotus birth is
thought to pose an infection risk that can spread
to the infant (Ittleman & Szabo, 2018; Monroe
et al., 2019). Ittleman and Szabo (2018) re-
ported that as an atypical birthing practice, lotus
birth might contribute to the development of such
infections. Before choosing lotus birth, all women
should be fully informed of the potential risks,
which may include infection and associated risks
to the newborn’s health.
Our last themes were Reactions to Lotus Birth and
The Future of Lotus Birth. Our participants found
that the knowledge and practices of the health
care staff about lotus birth were inadequate and
resulted in inadequate professional support. In
addition, they were disturbed by the reactions of
the health care personnel and thought these re-
actions stemmed from lack of information. Some of
our participants reported that they were alienated
by the health care staff because they had lotus
births. However, as Sua
´rez-Corte
´s, Armero-
Barranco, Canteras-Jordana, and Martı
´nez-
Roche (2015) pointed out, it is the natural right of
women to decide how they wanted to give birth,
and this right is grounded in the bioethical princi-
ple of autonomy. The Royal College of Midwives
maintained that all women should have the right to
make informed choices about the birth process
and postpartum options (Royal College of
Midwives, 2014). Women should be given
enough information about the potential risks,
including risk of infection and associated risks to
the health of the newborn, when they consider
lotus birth. In this regard, it is unethical for nurses,
midwives, or physicians to ignore or react nega-
tively to lotus birth. It is necessary for health care
personnel, especially midwives and nurses, to
know the positive and negative effects of lotus birth
for women and newborns, to inform women about
these effects, and to show respect for women’s
preferences.
Limitations
One limitation of our study is the issue of accurate
recall: it becomes more difficult to remember past
experiences as time passes. Our data, past ex-
periences that participants recalled and put into
words, depended on their memories. Another
limitation is the small sample size, which limits
generalizability of the findings. Finally, potential
adverse effects cannot be studied qualitatively
because of the relative infrequency of these ef-
fects (e.g., infection and hyperbilirubinemia).
Larger sample sizes are needed to determine if
they are more frequent with lotus births.
Conclusion
The experience of lotus birth was shown by six
themes: Meaning of the Lotus Birth Experience,
Decision Making Regarding Lotus Birth, Lotus
Birth Process, Perceived Benefits and Disadvan-
tages of Lotus Birth, Reactions to Lotus Birth, and
The Future of Lotus Birth. On the basis of these
themes, the essence of the phenomenon of lotus
birth in this study is the woman’s desire to have a
natural and healthy birth. Lotus birth generates a
positive experience, which inspires women to
continue using it. Women and health care pro-
fessionals require information about the lotus birth
Qualitative Study on the Experience of Lotus BirthRESEARCH
652 JOGNN, 48, 645–653; 2019.https://doi.org/10.1016/j.jogn.2019.08.005 http://jognn.org
process. Health care personnel, especially ma-
ternity nurses and midwives, should be informed
about lotus birth. It is crucial for maternity nurses to
discuss the potential risks of lotus birth with women
and provide them with information about these
risks. The themes we identified about women’s
experiences of lotus birth provide a deeper and
more nuanced understanding of a topic about
which only limited knowledge exists. These find-
ings may help guide women and health care staff
and increase their awareness about lotus birth.
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Gönenç,
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I. M., Aker, M. N., and Ay, E. RESEARCH
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