Lotus Birth in the Modern Era: An Integrative Review of Cultural Integrity, Ethical Dilemmas, and Clinical Realities in Obstetric Practice

Abstract

Lotus birth, or umbilical non-severance, involves leaving the umbilical cord and placenta attached to the newborn until spontaneous separation occurs several days after birth. Although uncommon in mainstream obstetric care, interest has increased alongside greater emphasis on parental autonomy, culturally sensitive maternity care, and alternative birth philosophies. Uncertainty remains regarding its clinical implications, particularly compared with evidence-supported delayed cord clamping. This integrative review, informed by PRISMA-based search and selection procedures, evaluated 29 eligible sources identified through PubMed, Scopus, the Cochrane Library, Google Scholar, and institutional sources. Evidence included case reports, observational and qualitative studies, reviews, medico-legal analyses, and policy documents and was synthesized across clinical, cultural, ethical, legal, and psychosocial domains, with consideration of methodological limitations and risk of bias. The literature was predominantly characterized by low-certainty evidence derived from case reports, case series, qualitative studies, and narrative reviews. Reported parental motivations included cultural identity, spiritual beliefs, perceived enhancement of maternal–infant bonding, and preferences for noninterventionist birth practices. Reported adverse outcomes included omphalitis, sepsis, hepatitis, and endocarditis; however, these findings were primarily derived from isolated case reports and small observational studies and may be influenced by publication and reporting biases. Current evidence does not demonstrate physiological benefits beyond those achieved through delayed cord clamping. Given the limited and heterogeneous evidence base, healthcare professionals should provide balanced, evidence-informed counseling and individualized assessment. Further prospective research is needed to clarify maternal and neonatal outcomes and inform culturally respectful clinical practice and policy.