Tuesday's child: Scarlet's birth story

:: This birth story involves way more preamble than a birth story really ought to, however it felt necessary to include it. It explains why things happened the way they did. It also - I hope - will serve to inform since this birth was a little uncommon, but not unheard of. If you want to read a 100-word version of this birth story, both my girls' stories can be found here. ::

The story of our second birth begins with our first birth. Peanut was born in hospital and caught by midwives. The birthing experience was fine: great, in fact. After she was born, though, there was a lot that was done badly. Despite the fact that she was healthy and strong and vigorous, I didn't get to hold her for over an hour. That is an exceptionally long time to be separated from your first born for no good reason. The hospital staff were also just dreadful. So before we were pregnant again, before we were even seriously talking about when to try to conceive, The Recruiter and I knew we wanted to birth at home. We knew that the things that we had disliked about Peanut's birth would not occur in a home birth. I was also very adamant that I wanted Peanut to be able to be present and involved in the birth. As The Recruiter put it, "The next time you go into a hospital to give birth, you're getting wheeled in there."

blogging for choice...all choices

I missed the annual Blogging for Choice Day yet again this year (because that's what I do: I realize that a date is coming up after it has already passed.  It's a pattern of mine) but I'm posting some thoughts today anyway because, really, they need to be voiced.

I recently read the personal story of one family's painful experience with Trisomy 18.  Rates of Trisomy 21 - better known as Down Syndrome - amongst infants are far higher than T18, largely because it is suspected that the majority of T18 babies are naturally miscarried very early in pregnancy, and also because most T18 babies do not survive pregnancy. In truth, an extremely large number - not sure of the rate, actually - of T18 babies are therapeutically terminated during pregnancy shortly following diagnosis.

I can understand why a family might make such a choice.  Knowing that you are carrying a baby who is extremely unlikely to survive birth, and will assuredly not survive beyond one very challenging, entirely-in-hospital year of life would be unfathomably painful.  I cannot even begin to imagine carrying that burden while carrying that child.  I support a family's, a mother's, a woman's, choice.  But the essential thing to remember when we are talking about choices is that if there is, in fact, a choice, it means that there is an alternative action.  What is the alternative in this situation?

The alternative is to embrace the pregnancy, to embrace the possibility of meeting that child with a broken body, to embrace that tiny person as a part of the family and strive toward sharing some time, maybe a moment, maybe an hour, maybe - just maybe - a few days of life with that tiny person, that tiny spirit.  I support that choice, as well.  To do so would take a kind of strength - not more strength than the choice to end the pregnancy, but perhaps a rarer kind - that I suspect many of us do not have, and for that I applaud those families.

But what is the medical establishment's position on choice in this circumstance?  From the story that I read, from a fellow Canadian (and I'll link to it if I get the ok from the woman who writes the blog) our doctors are not supportive of the choice to continue the pregnancy.  This couple was repeatedly encouraged to terminate their son, as well as discouraged from pursuing every avenue to best enable their son to survive beyond birth and share some time earthside with his loving parents, aunts, uncles, grandparents, and brother.

This is not what supporting choice and honouring informed choice is supposed to be about.  If we support choice, it means we support it whether it is the choice we would make for ourselves or not.

some observations just need to be made

First off, an enormous congratulations to Miranda Kerr and husband Orlando Bloom on the recent birth of their son Flynn.  Miranda writes very enthusiastically and positively about her natural birthing experience with Orlando at her side as her support.

She also posted a beautiful picture husband Orlando took of Flynn and her nursing in bed.  Not exactly surprising that the supermodel photographs well even lounging about at home, but what's so lovely is seeing her embracing everything new motherhood offers, including the bonding of nursing.

But some commenters think the photograph is "obscene".  Anyone familiar with me or who has read much of this  blog knows how I feel about nursing images, breastfeeding in public and the ridiculous double standards regarding body imagery, so I won't bother to rehash it yet again, particularly when it's already been done so spectacularly well.

wholesome

I try to live a wholesome life.  We strive to eat a healthy, balanced diet, to feed our daughter real foods.  We bake our own bread, make our own pasta sauce, mix our own hummus. We cloth diaper.  I've stopped using commercial products in my hair and now wash my hair (now dreaded!) with baking soda and apple cider vinegar.  Our daughter has only ever been washed in natural, organic soaps: we are big, big fans of Dr. Bronner's.  We avoid unnecessary medication and try to use herbal remedies when we can.  At nearly two-and-a-half years old, Glynis is still nursing.  We live downtown and avoid using a car or motorized transportation the vast majority of the time.

Before we conceived Glynis, I was a devoted pescatarian.  I ate a primarily lacto-ovo vegetarian diet, but with occasional fish, mostly sushi.  In the last few weeks before we conceived, I took a week-long trip to Russia in which I knew I would have very few food options.  I opted to eat chicken while there, when it was offered (usually the protein available was very grey-looking pork: ick!) knowing that otherwise I would likely be underfed the whole time I was there.  But I had every intention of returning to my veg/pescatarian diet upon my return.  I planned for a vegetarian pregnancy, researching it before conception, even buying a book dedicated to the benefits of a vegetarian diet during gestation, Your Vegetarian Pregnancy.  I found it to be a helpful book - though with its flaws, certainly - and felt very confident that our baby and I could be perfectly healthy despite abstaining from meat for the duration of the pregnancy.

Then we conceived.  And the cravings and food aversions started.

I wish I could tell you that I'm one of those crunchy moms who eats nothing but whole, healthy, organic foods while pregnant.  I wish - truly, I do! - that I could honestly say that I eat no fried or sugary or processed foods while pregnant.  I wish that I could honestly tell you that I didn't crave McChicken sandwiches nearly constantly while expecting Glynis, and that I didn't daydream about pork breakfast sausages from time to time during that pregnancy as well.  I wish that I could regale you with tales of cravings for salad and unprocessed yogurt and raw vegetables.  But I can't.

Because I'm sitting here, in front of my computer, with a small glass of Coke on my left, and a styrofoam container of chip wagon poutine on my right.  Yep.  Coke and poutine.  The Coke settles my constantly-nauseated stomach - it's one of the only things that does - and the poutine is one of the few foods I could think of today that didn't make me feel sick to my stomach at merely thinking of eating it.

I'm not happy with my diet.  It is deeply, deeply flawed.  But I'm pregnant, I'm still nursing a toddler and I'm losing weight.  And I didn't exactly have a lot of extra to begin with.  So I'm eating what I can.  I'm trying to avoid dropping any further below 120lb.  And I'm hopeful that when nearly all foods no longer make me feel violently ill, I'll be able to start eating better.

It's not a perfect solution, definitely, and I am by no means bragging or revelling in the flaws of my diet.  But I felt the need to be honest that, try as I might, this is the best I can do right now.  I know better, but sadly, I cannot, at this moment, do better.  Maybe next week.  Maybe next month.  But for right now, this poutine is making my day.

distractions

It's been quite some time since I last posted.  I've been meaning to do so, but I've been distracted.

I wear a number of hats.  Birth junkie.  Midwifery advocate.  Lactivist.  Intactivist.  And also mommy.  But the hat that brings with it a small paycheque is that of Youth Minister.  I've been focusing on that, on encouraging and nurturing young faith.  It is, after all, my job.

But as passionate as I am about that - and as much as my faith is very informing for my position on the normalcy of birth and the beautiful creation that is the human body - I've been a little distracted from that, too.

I'm wearing another hat.  A hat I've worn before, a hat I adored wearing, one I've been very hopeful to wear again.  It's that hat that led to me putting on those first five hats that I mentioned.

I'm birthing in May again.

I hope you'll be patient while I struggle to get my blogging mojo back, and encourage me while I struggle through some pretty debilitating nausea.  I hope you'll join me on this new journey.  I'm interested to see how my thoughts through this pregnancy differ from those during my pregnancy with our daughter.  I know so much more, now.  I have so much more confidence: my body has been tested and tried and came through with flying colours.  But I'm also more aware of how precarious these things are, of how unexpectedly things can turn out.  So it should be interesting to see how I reflect on this.  And also on this new addition.  Glynis and I have such a good thing going, from day to day: adding someone new will change almost everything.

I hope you'll keep checking in not only for my commentary on what's happening in birthing, but also as a companion on this road.

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.

lactic acidosis associated with ftp and subsequent surgical birth

A few days ago, this link made the rounds of the birthy-minded folks on Facebook. Researchers have published a series of studies (here's a better description of it, including references to the researchers involved and their studies) which linked levels of lactic acid in amniotic fluid with long labour and caesarean sections resulting from failure to progress. The conclusion they reached was that pitocin augmentation was ineffective for women in whom their amniotic fluid contained heightened levels of lactic acid. Lactic acid is produced by fatigued muscles, and a researcher was quoted as saying that an already fatigued uterus being supplemented with pitocin was akin to asking a marathon runner to run an extra 10 000 metres after crossing the finish line.

I was a party to a number of discussions on it. Some commenters argued - as do the researchers - that this represents an improvement in maternity and partum care. Now women who are destined for long, painful labours without the likelihood of a successful vaginal birth at the end can avoid the hours of trial and have the inevitable caesarean section sooner, avoiding the exhaustion and trauma of a long labour.

But others saw this differently. Will this publication be used as yet another excuse by injudicious obstetricians to encourage mothers - particularly first time mothers, as noted in the article - into prophylactic caesarean surgery? And will practitioners suspecting lactic acidosis be willing to wait for the spontaneous rupture of membranes in order to check the amniotic fluid for lactic acid levels, or will they more readily turn to amniotomy? We know that amniotomy does not greatly shorten labour, and that it is linked to an increase in the rate of caesarean section, so to even unintentionally encourage the use of amniotomy would serve to only exacerbate matters.

We can go further with this, though. Shouldn't we look at why mothers may be experiencing lactic acidosis and find ways of avoiding it? Could it be that the way labour and birth are approached is leading to uterine fatigue? None of the studies referenced in the article appear to examine any external influence which could be contributing to acidosis. Could immobility and chemical pain management be associated with fatigue to the uterine muscles? Is there evidence that acidosis predates the beginning of labour, in which case, can we be caring for our bodies during late pregnancy in such a way that lactic acid build up may be avoided? And what about the iatrogenic norms in regards to defining labour as "long"? Hospitals are notoriously clock-oriented in their approach to labour, and far more liberal with the application of the diagnosis "failure to progress" than are home-based practitioners. How long did researchers "allow" (I hate using that word!) women to labour before declaring their labour unsuccessful and a caesarean necessary for failure to progress/failure to dilate/labour dystocia?

I'd love to believe that this study will be a good thing for mothers and babies, I really would, but frankly, I just don't see it that way. Too many important and fundamental questions are left unasked and unanswered. The outlook taken by researchers is predictably pathological, looking for what is wrong, rather than looking at what can be made right. I'm all for avoiding unnecessary suffering and trauma, but increasing prophylactic caesarean sections is not going to achieve that.