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!

**Update**
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.

how high do we set the bar?

A woman gave birth in Minnesota last night.  I'm sure she wasn't the only one, in fact, but I imagine she was the only one to do so live-streaming a video feed to the internet.  A massive number of viewers tuned in to watch her birth.  What began as a natural birth ended with an epidural, pitocin, and purple pushing in the lithotomy position.  There has been much discussion on facebook, and on a number of blogs, much of it analyzing, and some have said criticizing, the progress of the birth. I've weighed in on The Unnecessarean Facebook fan page and on Navelgazing Midwife's blog, but the discussion has compelled me to consider how we balance the expectations of birth with the reality of birth when that reality falls short of the bar we have set.

Very often we hear people say "As long as mother and baby are alive and healthy, that's all that matters" but such a phrase seems disingenuous and not terribly optimistic.  Shouldn't we expect more than mere survival and the avoidance of catastrophic events or wounds?  Why have we set the bar so low for birth in an era of relatively good health, good hygiene, access to nutritious food, and frequent medical miracles?  Isn't it reasonable to expect a great deal more than women are typically getting?  How can survival be enough?  And yet, how do we show the necessary care and compassion to those mothers whose births fall short of their own pre-birth expectations?  What do we say to our friends, our peers, our clients, when they are swept along in the tide of intervention despite a previous desire to avoid it?

How do we find the necessary balance?  What do we do?  What can we say?  I'd really welcome your thoughts, so please do comment.

the power of a four-legged creature

Hello, my blog, how I've missed you!

I wish I could give you a detailed rundown on the sessions at the 2nd International Breech Birth Conference as Rixa did on her blog.  Unfortunately, I wasn't able to attend any of the daytime sessions (one of the drawbacks to a toddler who exclusively breastfeeds is that leaving her for more than a couple of hours ata a time is pretty impossible) so I'll instead direct you here and here to read about the events at the conference.  From what I've read and in speaking to those who attended, it was just awesome and the arguments and evidence in favour of vaginal breech really gave the obstetricians and care providers pause.  One obstetrician, quoted by Rixa, expressed delight and excitement to begin attending hands-and-knees breech births.

While I didn't attend the conference itself, I did have the opportunity to attend the two evening events: Birth, Karen Brody's play, on Thursday evening, and a storytelling session with Ina May Gaskin on Friday evening.  I enjoyed the play, though I think the cast was tighter and more polished when I saw the play at its debut performance back during the original run in August.  It was particularly encouraging to see a greater male presence in the audience.  In August, there had been only a very few men present, whereas the audience at the remount in October was at least a quarter to a third men.

On Friday evening, Ina May spent the majority of her time somewhat focused on breastfeeding as her latest book, Ina May's Guide to Breastfeeding has just been released.  Her thoughts on breastfeeding and breastfeeding culture were very interesting.  There was a lot of laughter, particularly as she related the story of an Amish woman with extremely inverted nipples, and some of the suggestions Ina May made to her for dealing with the issue.  She related that she wasn't sure what limitations Amish principles had on the practices of the bedroom, so she wasn't sure how her suggestion that the expectant mother's husband suck on her nipples would be received.  She mentioned two ideas suggested in an old French textbook on breastfeeding: that an "intelligent" maid be found to suck on the woman's nipples to draw them out, or to find a large puppy (I kid you not) and put the puppy to the breast.  Ina May supposed that, by comparison, having one's husband suck on one's nipples would likely seem pretty tame and acceptable.  She noted in her talk about breastfeeding that four-legged mammals very rarely have difficulty nursing.  Baby creatures, more often than not, are able to nurse immediately after birth and without trouble, and mothers generally fare best when allowed to follow their natural inclinations to nurse.

During the second half of the storytelling session, questions were submitted by the audience. Some were very specific and related to particular issues in birth, such as CPD and VBAC.  One though, was quite thought-provoking.  Ina May was asked, "Of all your accomplishments, which one makes you most proud?"  She considered for a moment, then responded that learning from Guatemalan midwives the practice of rolling a mother onto hands-and-knees to resolve a shoulder dystocia and publicizing this maneuver (it's refered to, officially, as the Gaskin maneuver) makes her extremely proud.  I can only wonder how many infants have been safely birthed because of the judicious use of this maneuver, how many lives saved and how many mothers saved from unnecessary and risky surgery.

In talking about the Gaskin maneuver, Ina May said something which really struck me.  She paused for a moment, looked a little wistful, and said "we just need to make the mother a four-legged creature."  She had mentioned earlier that it took decades of working with mothers and infants before she noticed that newborns can crawl.  They can - even at only 5.5lb, Glynis was able to crawl up my chest for weeks after her birth - but, Ina May noted, only when they are placed face-down.  When we lay a newborn on her back, as is so commonly done immediately after birth, the infant is incapable of crawling or moving.  In laying the baby on her back, we steal her power and her autonomy, however limited it may be in the first moments out of the womb.

It is the same with birthing mothers.  When we lay a mother on her back, we take away her power, her means of autonomy, her control.  The Gaskin maneuver has been studied and found to be extremely effective in relieving shoulder dystocia and allowing the birth to proceed normally.  I read recently a supposition that it may be the act of rolling the mother over her side which helps dislodge the infant's shoulder, and that the final birthing position on hands-and-knees may be immaterial to the ultimate success in the birth.  If there is one thing that birth practitioners simply must appreciate, though, it is that we cannot separate the physiological events in a birth from the psychological ones.

A successful birth requires not only adequate positioning of the infant in utero (adequate, rather than ideal, because babies can and frequently are born in a posterior presentation, though it is far from ideal, just as babies can and are also born breech) but also the confidence and courage of the mother to effect the birth.  We cannot expect women to birth if we tell them they are incapable of doing so.  When we lay a mother on her back and immobilise her legs, even as we tell her "this is the way to birth" we are telling her body and her mind that she is powerless, she is impotent.  But roll her on her hands and knees so that she can sway, she can tilt, she can move, even if only a little, and we give her back her power, her autonomy, her self.  We put HER back in control of her birth.  We allow her the same dignity afforded an elephant, a dog, a horse, a gorilla, and the opportunity for her to find within herself the same strength, the same wisdom each animal mothers possesses.  How, then, can it be any wonder that such a maneuver is so frequently successful?

meta-post: responses to The Today Show's "Perils of Midwifery"

As I wrote last night, Friday's Today Show segment is bad , bad journalism, not only because it shamelessly attacks people, but because it lacks the journalistic integrity of unbiased and balanced reporting and fails to bolster its argument with substantive research (clue: the plural of  "anecdote" is not "data").  NBC will receive hundreds, if not thousands of angry letters, including one from me.  But (to quote Levar Burton) don't just take my word on it:
 

Iridescent tile makes all the difference -  A very impassioned post relating the claptrap so many hospital administrators think we birthing mothers "need" to the name-calling in The Today Show segment.  (Also, having just discovered this woman's blog, I am already a huge fan. She's made of awesome.)

Grassroots Network: Today Show in bed with ACOG - Susan's post is quick and to the point (*cough* unlike my own *cough*) and includes helpful links like this one so that we can email our thoughts on the segment to the people at The Today Show.  I'm sure they'd love to hear from all of us.  Multiple times. :)

Reality Rounds Calls a "Code Bullshit" on The Today Show - a great post from another one of my new favourite blogs (I've got to hand it to The Today Show: thanks to their shoddy, smarmy segment, I have discovered some fabulous blogs!  So, thank you, I guess.)  The comments to this post are particularly awesome, including one from a woman who has spoken with Catherine, the mother featured in the segment.

Physicians Take Anti-Midwife Smear Campaign to the Airwaves: Home Birth Mothers, Celebrities, Insulted on National TV - a pdf of The Big Push for Midwives press release in response to The Today Show's segment.
And last but most definitely not least:
Code Mec! Code Mec! - Rixa of Stand and Deliver calls a Code Mec (because it's icky and leaves a stain) on The Today Show, and delivers an extensive and superb meta-post of her own wherein you will find commentary on the segment and links to other responses.

Found another response to the segment that you think I'd like to read: post a link in the comments!  Written one yourself (perhaps you, too, have a blog?): post a link in the comments!  I am perpetually expanding my blogroll.  There's always room for more, so get in on the fun.

ACOG has sunk to a new low

As if scare-mongering and fact-twisting weren't enough, they have now sunk to exploiting a heart-broken couple's pain.  This Today Show segment is rapidly making the rounds on the internet (I've had about four or five friends post it to their Facebook pages so far, and it's popped up in at least four blog feeds, as well) and for good reason.  The segment is so obviously intended to further the position of the ACOG, so obviously meant to attack the midwifery and homebirth movements, and so obviously lacking in any effort to provide unbiased or well-balanced journalism that it is almost laughable.  Almost.

Exploiting a family tragedy in a veiled effort to shore up their own image by undercutting the alternative is utterly ludicrous.  Sadly, though, it's extremely common in this sensationalist-style "journalism" (though to call it that insults all of my journalist friends who do actual, you know, research before airing their stories).  No, what I find even worse is the blatant and slanderous insult.  Andrew Goldman of New York Magazine, and author of the article "Extreme Birth" is briefly on screen and delivers this soundbite:

 One of the doctors I spoke to said that he thought that homebirth had become almost the equivalent of a spa treatment, that it was this sort of hedonistic concept of birthing.

 As if insulting every woman who has ever considered or had a homebirth wasn't bad enough: they felt the need to slander, shame and blame the woman whose story they were exploiting for the very basis of the segment!  Obviously, if only she hadn't been so selfish, so self-involved and self-important, if only she had really considered her baby, she would have happily bought into the load of lies and half-truths and evidence-less practices so often sold by members of the ACOG.  If only...  

What's even more spurious about this segment is the date of its airing.  The very day the ACOG released the results of their 2009 Survey on Professional Liability, in which the ACOG admits that current practices are known to harm women and babies.

"This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns," said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. "Women's health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine."

 Forced to practice defensive medicine.   Let's all just ruminate on that phrase and consider it's meaning.  Continuous Electronic Fetal Monitoring.  Mandatory IV's.  Mandatory antibiotics for GBS mothers.  Mandatory induction after rupture of waters.  A national caesarean rate of 31.8% in the USA.

It has been stated to me recently that ob-gyns do not begin their practices in an effort to victimize women.  I would tend to agree with this statement.  I would like to think that, at their core, or at least in their genesis, doctors have a desire to help or to heal.  But that does not excuse engaging in practices and procedures which hurt women and children!  It does not excuse ignoring study after study after study which shows that common procedures routinely harm the very women and babies they are supposedly to help!  And it certainly does not excuse denying women bodily autonomy or informed consent.  For this there is simply. no. excuse.

It has been suggested that the current expectations for birth are unrealistic, that parents expect "perfection" from their doctor and that when their experience falls short they choose to litigate to make up for it.  Perhaps that is so.  Perhaps a 91% claim rate against respondents to the 2009 liability survey is indicative of parents having ludicrous expectations.  But should the doctors not shoulder some of that blame as well?  Should we, instead, address and acknowledge the fact that if the doctors are the "experts" they should be imparting a little of that wisdom to their "patients" (I'm utilizing sarcastic quotation marks again: a pregnant woman isn't sick) and having frank and earnest conversations about the realities and limitations of practitioners and birthing environments?  Perhaps if doctors were honest with women, were honest with parents, and actually divulged some of the information they so often try to keep hidden, there would be a greater understanding on the part of those parents after the birth for any perceived shortcomings.  Marsden Wagner writes in his recent paper "Fish Can't See Water":

One reason for the epidemic of epidural in many countries is that women are not told the scientific facts about all of the risks to them and their babies when epidural block is used for normal labour pain. Indeed, at one meeting of obstetric anesthesiologists in the US, discussions were held on how to prevent any information on risks of epidural from reaching the public. The excuse used was the typical patronizing approach of some doctors: "We don't want to scare the ladies." It is absolutely essential that any women offered epidural must be told all the scientific facts about the risks before she gives informed consent to the procedure. 

 Instead of respecting women - and also men; we must not exclude male partners from the equation - and dealing with them honestly, there is an overwhelming air of paternalism which often just smacks of chauvenism and downright misogyny.  And what's so totally ridiculous about it is that it only serves to shoot these same, paternalist, controlling doctors in the foot when claims are launched against them by dissatisfied and even injured women and parents (I say parents because if it is the child who is injured, the infant will obviously not be launching the claim).  Holly Barhamand, a doula and childbirth educator, contributed a comment to a recent post on Reality Rounds about whether patients can ever have any say in their own healthcare.  Her comment sums up my point better than I ever could.  With her permission:

I’m sure it’s a prevalent attitude, but I think it’s dangerous. When a patient has the decision making taken away from them, they are no longer responsible for the outcome. So when the outcome is adverse (and it will be sometimes, inevitably), then the doctor is at fault. Even if it was always out of the doctor’s hands. And this is a setup for distrust and fear for both sides and probably litigation. If a patient has a true voice in his healthcare, the responsibility for the outcome falls on his shoulders as well. I think this would solve a lot of problems, even if it means more time and investment for both sides.

How does this all come back to the Today Show segment?  The ACOG - through the guise of Peter Alexander - is trying to tell us that self-determination and personal responsibility are bad things.  They are trying to convince us that we want no part of the decision making process.  And they are, unequivocably and entirely, WRONG.

BirthLove - a truly phenomenal online resource

I was linked to a website, BirthLove, through a Facebook friend. It is an absolutely amazing resource. I haven't yet read everything on there because there is, quite simply, WAY too much on this site to be read in one day while also playing with a toddler, feeding a toddler, dealing with meals... It is a very prolific site.  Amongst their contributors are Gloria Lemay - one of Canada's best known and respected birth attendants - and Marsden Wagner - former director of Women's and Children's Health with the WHO - as well as Gretchen Humphries - I've linked to her site in the 'Resources' sidebar - and Sarah Buckley - a mother and writer from New Zealand.

One article recently really jumped out at me from the site.  It's entitled  Rape of the Twentieth Century.   It is a shockingly honest and brutal portrayal of the sadly-common tragedy of unpleasant hospital births.  The author begins with a description of her five hospital births, each one a broken birth, a birth in which her choices and her body were treated with disregard and disrespect.  She describes how her body and her births were used as teaching tools, rather than treated with honour and sanctity, how unnecessary and unwarranted procedures were performed on her and her unborn children "in the name of science".  It is a harrowing tale.

She goes on to discuss the interventions used in medicalized births and many of their untold risks: the use of episiotomy motivates heavy suctioning to clear the infant's lungs, and poses the possibility of cutting the baby, forceps can disfigure women's genitals, caesarean section increases the likelihood of maternal death by a factor of sixteen.  And as the author writes:

In a cesarean section, a private, secret, and sensual event becomes a sterile crucifixion in a room full of slicing, staring strangers. And the ultimate rape is that we are told we need to be cut. The sanctity and power of birth becomes a meek "yes, doctor" and we become spectators to our own violation; we even thank the doctors as they scurry on their way out of the operating room.

Her description of medicalized birth is unforgiving and cuts deeply, but she writes as one who has had more experience with hospital births than is average.  Five hospital births.  Five births which left her alone and weeping.  Five births in which she felt her body a failure, defective and incapable.

She argues strongly in favour of homebirth and midwifery, not purely because it is so pleasant, it is so simple, but because hospital births truly do pose such a grave risk.  It is a risk not only of undesired intervention or surgery, not only of dissatisfaction, but one of deep and abiding sadness at what has been lost, and of avoidable death.

We are living in strange and savage times. This century will be remembered as one of war and genocide; and violent, coercive childbirth. Birth is weeping, and bleeding. We are made to believe we must give birth in sometimes hostile and mostly indifferent hospitals, where interference with a woman's natural birthing rhythms is the norm. Our vaginas can be stared at and cut by strangers, and abnormal emotional and physical behaviors- such as excessive fear, crying, and stress-induced stoppage of labor- have become normal and expected. Babies are routinely harmed; and the perpetrators are exalted as life savers, instead of reviled as child abusers. A birth without unnecessary intervention is now unusual, even though we all have the potential to birth beautifully- if only left alone.

Research supports delayed cord clamping

A study done in 2006 found that premature infants fared better when the clamping and cutting of their umbilical cord was delayed. This seems entirely logical to me: weak and compromised infants would certainly benefit from the nutrient-rich, oxygenated blood found in the cord and the placenta. Moreover, by leaving the cord attached and not clamped, the mother can continue to oxygenate blood for the placenta, essentially continuing to breathe for her baby. What a lovely, gentle way to ease a tiny child's entry into the outside world. The study I linked above was conducted by a woman who is both a researcher and a midwife. So can someone tell me why, precisely, our own midwife immediately clamped and cut our 35 week and 5 day gestation daughter and handed her off to a pediatrician? The standard of care may support immediate clamping but the research does not. At what point will all health care providers - ob's, gp's and midwives alike - begin performing evidence-based care? If the research fails to uphold the standard of care, the standard must change.

Something interesting is happening in birth: Part I

Yesterday evening, I attended a performance of the play “Birth” by Karen Brody. The play was staged by Three Sisters, a company of professional actresses in Ottawa, and was staged in order to raise funds and awareness for the Coalition for Breech Birth. The Coalition was founded by consumers, women who had had their births stolen from them by a system which refuses to admit the reality of breech birth, a system which fails to instruct its physicians in catching breech babies, and allows those physicians to coerce mothers into unwanted, unconsented and unnecessary caesarian sections.

The play is beautiful. It tells the story of 10 women's births with their first (and in one case, second, third and fourth) children. There are stories of joy: a woman chanting a mantra as she births squating, supported by her husband and her doula, believing and trusting her body; a woman kneeling in a pool in her home, her three children beside her, cheering her through her labour. But there are many, many stories of sorrow. Women coerced into deviating from their birth plan, into denying the needs of their own body. Women treated with disregard and disrespect while pregnant and while labouring. Women assaulted while birthing: cut, without need or consent, while bringing her child into the world.

It's extremely difficult to watch, even when staged in a minimalist, Vagina Monologues-style format. An actress, mimicking birth, telling the true story of a true woman's birth, screaming, not only in pain but in terror, in sorrow, in rage, at the realization that, just as she reached between her legs to feel her daughter's head being born, her doctor, her practitioner, was slicing through her perineum. Watching it, it was not just unethical, and not just assault: it was rape.
 
This is happening. This happens far more often than we'd like – and than any physician would ever dare – to admit. This is one of the realities of birth in North America. Women experiencing the trauma of rape during their births.

What do we do? Me: I'm getting mad. I'm getting really, really mad. I'm getting vocal. I'm pissing people off. I'm happily making an obnoxious ass out of myself. But here's one of the problems: too often, when we start talking about birth choices, and making options truly available to women, those who've chosen non-traditional births (I'm using the word traditional in the, well, traditional sense, to mean the sort of births that women have been having since the dawn of Creation) and gone a more medical route, become defensive. Arguments start being made about the importance of medical intervention, the value of pain-managing medications, the reassuring availability of caesarian sections.

I struggle to express to people that my issue is not with their personal choices – after all, those choices should be theirs and theirs alone – but with the fact that for many, many women, their choices are not their own: they belong to a nurse, a doctor, a midwife. But not to the labouring parents.

I'm not fighting other mothers to make decisions the way I would make them: I am fighting a system that is telling mothers, all mothers, what decisions to make about their bodies, their babies, their births. I am not in the practice of fighting mothers. I am fighting the medical establishment. I am fighting social norms. But I am not fighting the mother in front of me.

For far, far too many people, birth continues to be viewed as a black and white issue. You're either all-natural, crunchy-granola, kum-ba-ya and western medicine is the work of Satan, or you're not. And so many of the people – men and women – seem to assume that we who are natural-birthers, who are birth activists or working with birthing women, see things that way, too.

I don't. Western medicine has saved countless women and children from certain death. This is a fact. Surgery has literally saved the lives of mothers and babies I've known. And thank God for it. Thank God that J, our prenatal instructor, and her son were saved when she suffered a placental abruption with her first birth. But thank God, as well, that she was able to go on to have two midwife-attended homebirths after that. I

t isn't so simple as saying “old is bad: new is good”. It's equally not so simple as saying the reverse. There is a place for life-saving medicine in birth. But let it be life-saving. Let's not let it be time-saving or pride-saving. Let's not let it be about the doctors. Let's let the reasons for intervening in a birth be good ones, important ones, lives-hanging-in-the-balance ones. Let's not let it be about dates or estimated weights or breech presentation. Let's let it be about need.

So I will continue to tell people about birth. I will continue to cull statistics and research results and store them away in my mind for those conversations with sceptics and the uninformed where there is the possibility of educating one. More. Person.

And maybe, someday we won't have to. Maybe, just maybe, someday...everyone will already know. Originally posted on knit me a new one