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.

Who's driving this thing, anyway?

It occurs to me that I haven't introduced myself.  There is some personal history that motivates me to write this blog and advocate to anyone who'll listen - and speak loudly enough that those who choose to disregard me cannot help but overhear - about birth choice.

In May of 2008, I gave birth, vaginally and without pain management or medical intervention, to our daughter, Glynis, after 35 weeks 5 days gestation (or exactly 36 weeks, depending on how you choose to do the math).  We were attended by a midwife and a midwifery student who acted as our doula.  Ours was a hospital birth, and a pediatrician was present because of the pre-term nature of our daughter's birth.  Despite the research, and her APGAR of 9 at birth, Glynis was clamped and cut immediately, and handed to the pediatrician to be taken across the room to where I could barely see her to be poked and examined.  My midwife administered a shot of pitocin to chemically manage the third stage of labour.  I didn't get to hold my baby, my first child, for about an hour after her birth.

My labour was fantastic.  It really was.  I can't say enough good things about how it felt to be swept along on the power of physiological labour.  It was awesome to see how my body could be so strong, so amazing, so powerful.  But the circumstances surrounding the immediately ante-natal period are just not good.  Our choices were ignored, our birth plan disregarded, our consent not obtained, and evidence-based care not administered.

It was months, truly, before I became angry about the circumstances of our daughter's birth.  For 8 weeks following her birth, we fought like hell to establish a successful breastfeeding relationship - and we did succeed, thanks to Dr. Jack Newman's help and support via email and one 7-hour long drive to see him - so I was just happy that my baby was healthy.  But as time and distance allowed me a more objective perspective, I began to realise that what had transpired was not acceptable.  It was not necessary for things to have occurred as they did, and events as they played out may have even exacerbated our trouble with nursing.*

By many perspectives, I had a good birth.  I am "lucky".  I "should be happy".  And, comparatively, I am.  I could have had an ob who tried to pressure me into an unnecessary epidural.  I could have had my child whisked off to the NICU and fed formula and sugar water just because of her dates and birth weight (5.5 lb: pretty good for a 36 weeker, actually) regardless of her actual health.  I didn't, and for that I am, most definitely, glad.  But her birth could have been handled better.  It should have been handled better.

So now I advocate.  I try to educate.  I speak loudly and passionately about birth choice and informed consent and refusal and evidence-based care.  I encourage women to ask questions, to listen to their gut, and to really think about what they want and think is best.

*half-way down the page: “It seemed to me that the babies in which we had delayed cord-clamping were just stronger. They nursed better, they were calmer babies.”

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.