Thursday, September 2, 2010

Skin-to-skin mother-baby contact revives micro-premie

**Update: the news story linked to at the top of this post has been significantly edited from its original version.  My additional commentary on this story can be found at the bottom of this post.**

This news story from the UK has been making the rounds on the internet. It's a truly touching story: a baby was born extremely prematurely and his doctors struggled and failed to resuscitate him manually and handed him to his mother so that she could say goodbye to her newly born son as he died. But this story has a deliriously happy ending: skin-to-skin contact with his mother revived the tiny infant and he began breathing on his own. He's now over 5 months old, and the picture of health.

It's a remarkable story of survival against the odds, but  it is not, as Dr. Nils Bergman points out, without precedent.

Writes Dr. Bergman:
A news report of an infant declared dead, and surviving after being given to mother to hold in skin-to-skin contact, has made major media attention. Prompted by inquiries, I have made this commentary.
This is an emotive story, but hardly original! Unusual, but occurs ... actually right here in Cape Town just two weeks ago! Susan Ludington-Hoe opens one of her books on Kangaroo Care with a similar anecdote.
My own research and "hypothesis" on this is based on the fact that to almost all newborn mammals, separation from mother is life-threatening. This activates a very powerful defence response, which is to shut down and immobilise ( freeze and dissociation by vagal nerve activation). Reptiles use this exact same vagal defence mechanism to slow their hearts to levels that would kill mammals, who need more oxygen! As adults, we think that stress increases heart rate because of our sympathetic nervous system, but what is not properly understood is that even full term newborns have very immature sympathetic nervous systems, and premature infants extremely immature. Prems can only dissociate, and if they are stressed before they are born, they may just remain in dissociation ... with dangerously low oxygen levels. 
Our resuscitation technology can force some regulatory oxygen and breathing and blood pressure and temperature ... but it is working against the "autonomic nervous system tide". There is great variability in sensitivity and resilience in all human beings, and some are sensitive and succumb despite our technology.
What "kangaroo care" does is restore the basic biology for survival. It is "skin-to-skin contact" which is the key, because the deep sensory fibres from the skin go to the "emotional processing unit" of the brain (amygdala), and tells the brain "you are safe". This de-activates the dissociation (un-safe mode), and restores the regulation (safe mode) - which is the real function of the vagal nerve.
But there may be a paradox in this very case. Circumstances led to this infant being allowed to stay in skin-to-skin contact for a long time, which may in fact have been its saving grace !! Perhaps its tolerance of separation may have been non-existant. But the paradox may work even deeper ... perhaps it was so profoundly powerful in its vagal response to dissociate in order to survive, that it could last long enough in the shutdown state to be allowed to come back to mother! He may therefore be highly resilient, which is why he survived !!!! The World Health Organisation calls this Kangaroo Mother Care, and Mother was the key to this baby's survival. 
But it is good that this is receiving so much attention ... 
all babies should be in skin-to-skin contact with Mother from birth onwards, 
no babies should be separated from their mothers (or fathers!).
This applies particularly to premature babies.
Dr Nils Bergman
Cape Town, South Africa

I found Dr. Bergman's commentary extremely illuminating. My gut instinct has always told me that babies will always thrive best when in contact with their mother, but to have that supported by biological evidence is always reassuring and helpful (understanding why something is preferable can help us to do it better).

Congratulations, Ogg family! And thank you for sharing your beautiful story with the world!

The story I linked above has been significantly edited between when I initially read it several days ago and when I wrote this post.  I thought at first, as I was looking for sections of the story to quote, sections which  no longer exist, that I had mistaken this birth account for another story.  Reading this article, however, confirms my earlier suspicion that the original article was edited.

This second article linked immediately above adds some important elements to this story.  This is not only a story of a remarkable recovery by a baby, of a mother's instinct saving her child, but also a story of at best bad bedside manner, and at worst medical malpractice.  As the Ogg's held their tiny baby, and began to appreciate that he was reviving and strengthening, they encountered no encouragement from medical staff.
Kate finally began to believe her baby was actually alive. “We thought, ‘He’s getting stronger — he’s not dead,’ ” she said. But the family wasn’t getting any encouragement from their doctor. While the Oggs urged hospital personnel to summon him, they were repeatedly told what they were seeing was still just reflex from a baby already declared dead.
But the doctor refused to return to the family's hospital room.  According to the original account in the Daily Mail, he would instead send his input to the parents via verbal messages delivered by a hospital midwife.

Kate Ogg told Curry they had to “fib” to get the doctor to return to her bedside. “We kept saying, ‘He’s doing things dead babies don’t do, you might want to come and see this,’ ” she told Curry.

But the skeptical doctor still didn't return. “So David said, ‘Go and tell him we’ve come to terms with the baby’s death, can he just come and explain it.’ That made him come back.” 
Parents shouldn't have to lie in order to get necessary care and attention for their children.  More generally, patients should never feel compelled to lie in order to get fair, considerate, appropriate, attentive care from practitioners.  It happens all the time, though: I know that I have certainly lied to doctors and nurses in order to get proper care (as an example, saying that we were "behind" in getting our daughter vaccinated, rather than honestly saying that we were using an alternative and selective schedule, purely in order to avoid a lecture  on an occasion when we had our two-year old in the ER after falling down a flight of basement stairs).

Moreover, any health care practitioner - in any practice - will almost certainly have to assist someone, someday, in the act of dying.  It may be an unfortunate reality, but our mortality walks hand-in-hand with our birth and our living.  No practitioner should shirk his or her responsibility in attending a dying patient.  If Jamie Ogg had, in fact, died as the doctors expected, and Kate and David Ogg had, indeed, been merely imagining that he was reviving, it was the responsibility of their care providers to do precisely that: care for them.  It was only when they lied to the nurses and doctors, saying that they had accepted their son's death - and no longer needed the same sort of compassion and support - that they were given the care and attention they needed and deserved.

This dismissiveness, lack of feeling and inattentiveness is absolutely unacceptable.  This doctor should feel ashamed of himself.

1 comment:

  1. Thanks for sharing this! What a wonderful story. And isn't that right where every baby should be?