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.

lest ye be judged

Monday, I wrote about the current crisis in midwifery in the National Capital Region.  While I did - and will continue to - obfuscate over many of the details, there was quite a bit of discussion about judgment.  As those who had gathered shared birth experiences, particularly those which were negative, unpleasant or which deviated from our desired approach to our births, there were many expressions of dissatisfaction, of anger, of judgment toward the midwives who had been involved and had committed these "wrongs".

The issue of judging the actions of others comes up a lot when talking about...well, anything even remotely controversial.  Childbirth, parenting, codes of practice, medical practices: it is nigh impossible to engage in a discussion of these topics without the dialogue leading to some level of judgment in the course of things.

My darling husband likes to make the point that we should judge, that we must judge, that judgment and discernment are important elements of being an intelligent and considerate human being.  It is what we choose to do with that judgment that determines whether we are just and fair...or not.  To judge for one's self does not necessitate being judgmental.

There are practices which we midwifery/natural birth/informed choice advocates generally oppose.  There are practices and trends and attitudes which I personally abhor. How do we reconcile supporting and caring for our midwives - as well as each other - while also advocating against the practices we oppose, even while these same midwives engage in these practices?

I do not want, and refuse, to be an apologist.  Unacceptable practices are just that: unacceptable.  It is unacceptable that there are fear-mongering midwives threatening mothers with the spectres of dead babies and hemorrhaging mothers.  It is unacceptable that women in the throes of labour are being let down by their midwives, too afraid of litigation to act in the best interest of the mother.  It is unacceptable that antiquated procedures - which evidence shows to be ineffective or harmful - continue to be used because they make some midwives comfortable.  Moreover, it is unacceptable that there are midwives who play the "uncomfortable" card with mothers and families with regard to informed choices which midwives had previously supported.  If the playing field remains the same (that is, if there is no change to the mother's or unborn child's condition) why are the rules being changed?

The answer is fear.  More on that later.

something is rotten in the state of birth

Several weeks ago, 18 people - women, men, mothers, fathers, and children as well - met at the home of a local supporter of midwifery and birth choice.  We met because we are concerned about the current state of the birth climate in this region.  We met because we want our rights, our choices, our bodies and our births honoured and respected.

I can't get into all of the specifics of what motivated us to meet with little warning, what events precipitated this meeting, nor all of the details that were discussed, because there are some...issues of legality.  Suffice it to say that we, a group of consumers and birth workers and advocates are not only concerned about some of the trends in midwifery in this province and this region, but are also prepared to stand up and take action.

Over the several hours of discussion that ran late into the night (it was pushing midnight by the time my ride - and new friend - left) there were several recurring themes.  What constitutes informed choice?  How do we define it?  Are we consumers, and if so, what are we consuming?  Do we consume a product or a service?  And if it is a product, what is it?

Many medically-minded advocates have penned articles or scripted news segments arguing that birthing women and men have unreasonable and unrealistic expectations of birth, that we have delusions of entitlement and have hedonistic visions of candle-lit, "perfect" birth experiences, and that these expectations have led to a culture of litigation among dissatisfied consumers post-birth, and a culture of fear and defensive medicine amongst obstetricians.  One of our concerns discussed at our meeting was that such a climate is no longer exclusive to obstetrics, but is disturbingly present within the current practice of midwifery as well.

The point was also made that the modern face of midwifery in Ontario is obstetrically-born.  We have virtually no (I know of only one) direct-entry midwife in this region, which is to say that only one of our local midwives learned and trained purely through apprenticeship.  All newly-licensed and registered midwives in Ontario must be university-educated, through three-year programmes at only a few schools in the province, schools with limited spaces for students.  The academic curriculae are based on a medical-model, and while a thorough understanding of human physiology and biology are - obviously - helpful in attending and assisting births, the resident fear in the medical model appears to be seeping into the culture of our midwives.  How can this be?  What can we do?

It isn't enough for women and men to simply say "We want a change."  We need to find a way to not only effect that change but to support it as well.  Anyone with eyes open to the climate of birth in North America and the Western world in general knows that we are socially trained to fear birth, to see it as inherently dangerous and risky.  We can not simply demand that our midwives - women (and men) who have been largely been born and raised in this same climate of fear - ignore that fear, withstand the pull of that fear on their spirits and act entirely differently.  We must acknowledge the great task that stands before our midwives, the great challenge they face in not only assisting families to have safe, positive birth experiences but also be brave and courageous amidst the majority of the birth-working community (id est doctors and nurses) who have been taught so effectively to fear birth and all the natural outcomes thereof.

But what can we do?  How can we as consumers, as clients, as mothers and fathers, as men and women, as families and citizens, support our midwives?  How can we help them be brave and courageous?  How can we assist them in feeling the passion and zeal they had when first they decided to pursue the path to attending and assisting births?  How can we nurture their livelihoods and nurture their souls?

We didn't come to any specific conclusions during our meeting.  What we did acknowledge is that this will be an ongoing process: there is no quick fix, and supporting and upholding not only today's midwives but the entire art of midwifery is something which will continue to be of great value and importance.  What we begin today must continue for generations.

resources and reaching out

I don't think I mentioned the lovely message I got over Facebook from a friend of mine.  It was several weeks ago, now.  My friend is young, only 21, and one of my opera compatriots.  She has said on several occasions, and repeated in her message, that she doesn't intend to have children.  More power to her for knowing what she wants to do with her life and her body: parenthood isn't necessarily for everyone, and that's just fine.

Despite her plan not to have children, she thanked me for writing this blog and posting links to articles and blog posts on birth to my Facebook page.  In part, she wrote, "Thank you for putting it out there. Even if people are slow to see the truth, it needs to be out there - that way, when people ARE ready for the information, it's there. And thank you for making it accessible, and educating me in the process."

Isn't that lovely? Isn't it reassuring that there are young women who understand the magnitude of these issues, who appreciate that birth and bodily autonomy and chauvinism are a universal concern?  I wrote her a long and grateful response, including,

I can't tell you how much I admire you for informing yourself on issues that may not now, or may never, directly concern you (the really birth-specific issues, like cord-clamping for instance). Every person who informs him or herself becomes a resource, a source of knowledge for every other person. So even if you never have children, some woman or baby may benefit from you having taken the time to learn and then share that information. And that is an encouraging thought.

This young friend of mine enthusiastically replied that she wants to be a resource, to share knowledge and information.  How delightful!  For generations we have separated birth from regular life, making it of concern only to those who are actively having children or working in the birth 'industry'.  It should not be this way.  There are many wonderful, gifted midwives and doulas who have never had and may never have children.  That doesn't prevent them from listening to women or acting based on centuries of knowledge as well as modern research.  Information and education are for everyone.

It's one of the messages of Debby Takikawa's film (nota bene: didja see her comment on my post about her film?  How cool is that?!): birth is a further reaching concern than we currently think.  It affects us all.  How we approach birth and babies and women's bodies and personal choice is very, very indicative of the state of our society.  What does our current approach say about us?  That we are fearful?  That we are disrespectful?  That we are paternalistic and patriarchal?  That we are dismissive?

And what do we want to say?  That we are courageous.  That we are faithful.  That we are respectful.  That we are dignified.  That we are caring.  That we show concern.  That we are open to new possibilities.  That we welcome miracles.

what babies want

I had the great pleasure to attend a screening of Debby Takikawa's film What Babies Want on Friday evening.  The screening was in support of the International Breech Conference which will be held in Ottawa in just a few weeks, on October 15 and 16 (*hint hint* if you can make it, you should definitely go!).  The basic premise of the film is that how we are born, our experience during birth and in the perinatal period following birth, matters, is internalized by the infant and carries long-term implications both individually and interpersonally for the child. 

The film makers connect youth violence, including suicide, as well as behavioural issues with the injustices and wrongs so commonly visited upon our newest and tiniest people.  Author Joseph Chilton Pierce suggests that by removing violence from birth we could, perhaps, put an end to violence entirely.  Sadly, I think it is a far more complicated issue, however, I completely agree that the manner in which we are born and treated immediately following birth informs us, for good or for ill.

The film is divided into chapters.  In the second chapter, Sobonfu Some is featured, and engages several pregnant women and a small group of people in a welcoming ritual to bless and invite the not-yet-born infant to the world.  The scene is deeply, deeply moving.  From my seat in the auditorium I could see several other women wiping away tears, as I was, myself.  I find myself teary even thinking about it now: a small community of people, gathered in a circle, singing welcome and blessing to the infant in the womb, kneeling on the earth, embracing the mother's belly and speaking soft and encouraging and loving words to the child, standing and embracing the mother, speaking words of courage and joy to her in her final weeks of preparation before her birth.  The image struck me not only as a welcome to the baby, but almost similar to worship.  As each person knelt before the mother's belly, it was very like the supplicants of ancient Greece, or like the actions of those struck with a deep and reverent fear and awe.  Through the ritual of welcome, those participating not only invite the child into the world and make him or her welcome, they also remind themselves of the importance and specialness of that child, the very preciousness of this new person and that this tiny person is bringing important and necessary gifts not only to the parents but to the world.  Each baby is a gift for us all.

The film spends quite a bit of time on examining exercises in regression and rebirthing.  The stories and people featured are extremely interesting.  In particular, I was astounded by the story of a 6 year old girl who remembered with great clarity the hospital room in which she was born, including such small details as where her mother's shoes had been on the floor, and where her father had sat next to the bed.  She had been separated from her mother after her birth, and their relationship had always been troubled.  After this little girl used toys to recreate the scene of her birth - without prompting - she reimagined her birth, putting a baby figurine with a mother figure, in effect giving herself the birth experience she had been denied.  And amazingly, it worked: her relationship with her mother improved vastly, the divide between them somehow healed.

The filmmaker uses these stories and scenes of regressions to underscore the need for just and gentle birthing and aftercare.   It was fascinating, but sadly, I think it may weaken the film simply because it may prove fodder for sceptics who will decry hypnotherapy as 'bunk' and cite the many children who, in the 80's, were fed stories and convinced they had repressed memories of past abuses.  The stories featured in the film are, of course, very different.  As it is pointed out in the film, these are not intellectual memories about "that time in that place" but are instead impressions, sensations and feelings, both emotional and physical in addition to sense memories.  They may not be expressible, but they are present and inform our character.

The seventh chapter of the film examines the ancient and primal nature of birth.  Actor Noah Wyle, who was involved in the support and production of the film, in addition to being featured and narrating, describes his reaction to his son's smell after birth, how it suffused his [Noah's] being and seemed to imprint his son upon him.  Another father interviewed describes his desire to lick his newborn immediately after birth, and to lift him up in exultation.  What is most important to learn from the stories in this chapter of the film is that birth has ritual implications in our lives.  It is not merely the passing of the child out of the mother: it is an rite, a ritual, and when we touch birth we touch something deep, primal, and very, very old.  Birth is bigger and more powerful than we are.

So what, then, do babies want?  What is the ultimate message we take away from this film? I think that it can be reduced quite simply to one word: respect.  Such a conclusion is too simple, however, to be in any way helpful.  Babies want to be treated with respect, yes, just as any adult wishes to be treated with dignity and respect.  Babies are as deserving of dignity and respect as adults are, and should be afforded such treatment from the very moment of birth, and even before birth.  Babies want to be loved, yes, and held, certainly, but ultimately to have their needs and wants met as they express them, which they will in the expectation that we will respond in kind.

And we can extrapolate further.  In order to properly respect the baby, we must respect the mother and we must - we must - respect the process.  They cannot be separated; they are intrinsically linked.  We cannot properly meet the needs of the infant when the mother's body is needlessly put asunder, when the very act of birth is precipitous and truncated.  Likewise, we do not respect the mother when we tear her baby away from her, when we are more concerned with injections and sutures than with the transformation she has just experienced, and fail to allow her to encounter her infant child.

Respect the baby, respect the mother, respect the process: it's what babies want.

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.