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.

keep on keeping on

I have to admit that maintaining a blog like this one is not for the faint of heart. There is something decidedly soul-sucking about posting link after link, post after post about the atrocious things that happen to women and babies during pregnancy, birth and infancy. Worse, though, is the overwhelming culture of fear which afflicts not only so many health care practitioners, but those same women. Repeatedly reading women defending their unnecessary and damaging caesareans, convinced that normal birth would have assuredly killed them and their babies, is, quite frankly, hard. I'm a total wimp for writing that, but it's true: it hurts me. It hurts me for the baby's sake and it hurts me for the mother's sake. It hurts me as a lover of people, as a lover of women, as a feminist, as a lover of liberty.

But for that same reason I can't not post, either. I recently saw an old camp friend of mine (yes, I worked at a camp, and yes, they were some of the best times of my young life). She is unmarried, unattached, not imminently having children, but she mentioned that she reads my posts about parenting and birth. One more young woman, set up to have a good birth experience, set up to make wise, informed choices. One more young woman empowered.

If that isn't reason enough to persevere, I don't know what is.

politics and birth

There is an increasing trend that really, really bothers me. I'm not sure if it indicates a problem within the birthing sphere or if it is evidence of a general misunderstanding of the political "spectrum" as we in the West conceive it (id est left wing = big government, right wing = small government), but it's there and it concerns me: repeated references to natural birthing, pro-midwifery, pro-informed choice advocates as obviously being "left-wing".

There are two main reasons why. First, good, informed, positive, empowered birth experiences do not belong to the left wing: they belong to everyone. They belong to every woman, every family, regardless of ideology, regardless of religion, regardless of the family structure. Everyone. And those of us who advocate for precisely these birth possibilities may belong to any ideology, any religion and any family structure. They are not inherently linked, nor are any of them necessarily mutually exclusive. Making blanket statements about how empowered women are automatically left-wing, or automatically not people of faith is not only patently untrue, but unfair.

The second reason is fairly simple. As an advocate for informed choice, I advocate for every woman, every family to make decisions for themselves. Give people the necessary information they need regarding prenatal care, birth choices, and infant and child care and then let them decide for themselves. What has shocked me - as someone who used to fairly happily proclaim herself to be stolidly left-wing - is that much of the left-wing as I have encountered it doesn't seem entirely in keeping with this personal ideology. There is a certain degree of "don't worry: we've done the research and we know what's best for you". And that doesn't fly with me, even if what is being prescribed is precisely what I would have chosen for myself and what I believe to be best. Because what I might choose may differ greatly from what others may choose, whether I like it or not.

With this post, I'm pretty obviously coming out of the closet as non-left-wing. I couldn't say what I am, precisely, or where I fall on the entirely inadequate left-right political spectrum, but I do know these two things with certainty: I am always in favour of choice, and I refuse to tie up birth advocacy with any political identity. To do so is exclusionary, and if we are advocating for all women we simply cannot start excluding people.

something new

I've been remiss in blogging for, well, quite a while now. Turns out moving house (yet again!) with a two year-old while also trying to fulfill a part-time job, particularly one which involves committee meetings like mine does, while still struggling to maintain one's sanity is a bit of a challenge, and one that leaves little time for composing posts. But I have something to tell you! Something new and exciting.

As I blogged about before, there is some concern amongst a number of people in this city - consumers and midwives alike - about how the informed choice of birthing women is being respected, or not, as the case may be. It isn't about attacking practitioners, or going on the offensive: it's simply a matter of wanting to uphold informed choice, and support those who strive to uphold birthing women. Out of this, the Informed Choice Coalition has been born. We're a group of people, women and men, lay people, doulas, midwives, and even other organizations who feel strongly about the importance of informed choice, and want to create a support system to better enable birthing women and men to execute their choice, as well as to assist practitioners in honouring those choices.

It's extremely exciting, and I am so privileged to be a part of this community of concerned citizens, and to have the opportunity to be a part of this from the beginning. Watching it grow is - and will be - very rewarding. Already the ICC has generated interest in other cities and other provinces across Canada. We are not the only ones concerned about the state of choice in birth and during the birthing years.

We are part of something bigger than just we are. I can't wait to see where this leads us!

2

I am so blessed. For two years I have had the privilege of nurturing, growing and loving a wondrous little person. She is a gift from God, and she has taught me more about being a mother than any other person could. She teaches me every day to delight in life, in little things, in all things. She teaches me the immeasurable value of small gestures, tiny smiles, tight hugs and wet kisses. She shows me how truly lovely life is.

I am so exceptionally happy.

beautiful

This has been making the rounds on Facebook, but it's worth reposting here as well. This is a slideshow of a beautiful, wonderful, colourful, personal, family homebirth 12 months ago. This is what birth can be. This is how birth and families can be honoured and upheld. This is what taking birth out of hospitals can be.

The Homebirth of Lucia Mae from Sara Janssen on Vimeo.