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Climbing trees.

I was one of those kids who loved to climb trees.  I grew up in Ontario, Canada, where some of the best climbing trees grow. The short growing season and cold winters create ideal conditions for slow growing hardwoods to flourish.  What I didn’t know then was the impact climbing trees would have on my life.

Creative commons Gillette, Bill, 1932-, Photographer

Creative commons Gillette, Bill, 1932-, Photographer

When my parents had to drag me inside and along to the homes of their friends, where they had boring adult conversations, I would look in their gardens hopefully for suitable trees to climb.  The search began even as we would drive up the driveway.  That was nothing new; I looked at every tree I ever saw in the world with the sole purpose of categorizing its climbability.  I was a quiet child, and it would usually be a while before I was missed.  Eventually, my parent’s friends would look out their windows and seeing me high above the ground they would say, “Should she be doing that?” “Aren’t you afraid?”  “What if she falls?”  They would make calculations in their heads:  leg fracture height, neurological injury height, the height of probable death.  My mother would crane her neck upwards, and say, “She’ll be fine”.

I want to be clear: climbing trees was not, to me, about taking risks.  There was nothing about tree climbing that felt risky, in fact, it felt very safe, to be cradled in the canopy of a tree.  Besides feeling safe, I felt other things too. The solid branches underneath my hands and feet, warm from the sun.  The bark: smoothness interrupted with the scarified design of leaf wounds, insect burrows, woodpecker holes. No art installation I’ve ever seen since could match the beauty of leaves which turned and rustled in the wind as sunlight skipped along them.  In the canopy of a tree I could hear my own thoughts more clearly.  Aloft, I felt steady and attached to the earth and to nature.

That it felt safe was one thing.  That it was safe, you might say, is another thing altogether.

Some people think children should not climb trees.  They’ve banned it in school yards.  Today some might claim that my parents were irresponsible. Perhaps they would have reported my mother to CYFS.  I might be given a tree climbing substitute:  playground equipment, with safety nets and supervision.  Harnesses might be procured, a helmet to protect my head.

There are people who believe that risk shouldn’t be allowed in childbirth either.   Since it involves an unborn child, who cannot consent, parents should be made to do the right thing.   An innocent child, many quite rightfully believe, deserves protection from a parent’s bad decision making.   After all, there are seatbelt laws, bike helmet laws, antismoking laws, and similar pieces of legislation in place to protect the public good from bad decisions made by individuals.  In the same vein some argue that homebirth should be made illegal because of risk.

Home Birth Risk

Atlas of risk, figures shown for females in 20-44 age range. Calculator sourced from NHS http://www.nhs.uk/Tools/Pages/NHSAtlasofrisk.aspx

But if the risk model is applied to homebirth then it must be turned back on hospital birth also.  There is a label we give to the harms caused by doctors:  it is called iatrogenesis.  Iatrogenesis has many forms: the side effects of prescribed drugs, the complications of surgery, or when people pick up an infectious illness in the hospital.  Iatrogenesis in childbirth is huge problem. It stems from the fact that interventions are applied in the name of risk reduction to people who do not need them. We are not good enough in the prediction of complications to ensure that only those who need interventions get them.

Birth violence, birth trauma

Mum and baby after a traumatic hospital birth.

There are some risks of hospital birth that the iatrogenesis model doesn’t take into account.   These may be small risks, but if we counted each they could reach significance.  Does the risk of hospital birth, for example, include the risks entailed when driving to the hospital in a car?  How about the risk of driving home?

Taken to the extreme, one can soon run into absurdities with a risk model. Life entails some risk, if we want to avoid it entirely we should stay in bed and send an avatar of ourselves into the world.  (Though then, we’d risk developing blood clots in our legs from immobility).  For the purposes of a thought experiment, if somehow we could factor all of these risks on either side precisely into a giant equation and come up with the definitive answer to the risk associated with the place of birth, we’d still be no further ahead in predicting the risk to ourselves.   There are dangers of applying risks at the population level to individual people.  If the risk of a complication for a member of the population is 1 in 100, it is not the same as saying that your risk is 1 in 100.   Your risk is dependent on your unique set of factors, and some of those factors are things about you that you alone know.

Arguably more important are values that don’t show up on the balance sheet of risk.  These values are the benefits, often immeasurable, that one gets from having experiences. What is it worth to you to have the feeling of being tucked into your own bed with your freshly birthed baby, minutes old, beside you? What price could be assigned to that feeling that some of us secretly know?   The feeling, from the vantage point above fresh sheets and below a lovingly fluffed duvet, snuggled in with your baby:  where you know with certainty that the whole world is made of two.

When I look back, I am sure that climbing trees gave me some immeasurably important gifts.  One was a belief in my own body.   I’m not a star athlete; I don’t consider myself particularly stoic, or brave, or over-confident.  That belief in my own body served me well later on during the birth of my children, and in attending the births of others.   Years later, I remember the feeling you get from the vantage point of a crow looking out from the top of the highest tree in the heart of a stand of ancient Carolinian forest.  It is the feeling that the whole world belongs to you.  Climbing trees gave me the experience of trusting my own body and my own decisions, and of finding great and secret delight in an activity that others might forbid because of risk.

Risk of BirthDr Alison Barrett BSc, MD, FRCS(C), FRANZCOG. has worked as a specialist obstetrician and gynaecologist for many years in both New Zealand and in Canada. She was the Chief of Obstetrics and Gynaecology in a rural hospital in Ontario, and an assistant professor in the Northern Ontario School of Medicine.  She is currently working as a consultant obstetrician and gynaecologist in Hamilton New Zealand, where she is a RANZCOG training supervisor for junior doctors. Prior to entering medical school Dr Barrett studied ecology and biological sciences, and these two fields continue to inform her clinical work. She has served on many committees addressing maternal and infant health issues including the National Breastfeeding Advisory Committee for the New Zealand Ministry of Health and the Infant Feeding Advisory Group for Health Canada. She is a member of the Professional Advisory Group of La Leche League New Zealand.

11 Comments

  • Reply July 5, 2014

    Jenna Richards

    Wonderful article! I’ll be sure to pass this around and look forward to reading more
    Jenna

  • Reply July 5, 2014

    Lyn Stark

    Absolutely love this article

  • Reply July 5, 2014

    Susan crowther

    Lovely to read your story and journey. Refreshing and insightful
    Susan crowther AUT university midwifery senior lecturer and locum rural midwife who LOVES out of hospital births with a passion

  • Reply July 5, 2014

    Michele Prince

    What a wonderful piece of writing Alison . Enjoyable read 🙂

  • Reply July 5, 2014

    Laura Carroll

    Inspirational article. Wonderfully written. I shall be sharing with my clients. Thank-you.

  • Reply July 5, 2014

    Liz

    So well said!

  • Reply July 9, 2014

    mamaellie

    I have experienced out of hospital birth with midwives as well as birth in hospital. I did not find the experience of snuggling with my precious newborn any less lovely in the hospital. There were sweet, wonderful nurses there who doted on my baby, brought me warm blankets and lovingly cared for us both. There were nurses in the postpartum ward who complimented my older girls’ pretty dresses and helped make their experience of meeting their new brother as special as it should have been. I don’t feel that I have experienced anything more wonderful having had my two out of hospital births. No woman reading this who gave birth in the hospital should feel that she missed out.

  • Reply July 22, 2014

    Evelyn

    That is all fine and well if everything goes well but it doesn’t always. Of course it is desirable to reduce unnecessary interventions but at least in Canada it is possible to deliver in the hospital with a midwife. That would allow for an intervention free birth; however it needed, it also allows for transfer of care. The risk of homebirth might be low but low is not enough when you are talking about risking the life or quality of life of a newborn. I had a perfect complication free pregnancy with no risk factors. I had a text book labour until the last 5 minutes, when already in the pushing stage, the baby shifted and got stuck cutting off his oxygen supply. I am beyond thankful that I was in the hospital where I had to be. In that situation every SECOND counts and a ambulance ride is too long. My baby was delivered by assistance in an emergency situation and had a paediatric team waiting as he emerged. He was resuscitated immediate but still suffered HIE and spent time in the NICU. He’s doing wonderfully now and I have no doubt it’s because he was able to get the help he needed immediately with NO delay. Is the risk of brain damage worth it??? Not in my opinion.

    • Reply July 23, 2014

      Bernadette

      Thank you, great read. I’m sorry that happened to you evelyn and I’m glad your baby is well. I just want to say that it’s about weighing up risks, and that the risk of something like that happening needs to be weighed against the risks of iatrogenesis. (thanks for the new word!) people often forget the risks of hospital birth (or are never aware of them until it’s too late) For most of us who choose to birth at home, and have done all the research and thinking we can manage, the balance definitely tips and leaves home birth a clear winner over hospital birth .

  • Reply July 25, 2014

    Kong Choon Yen

    Thanks for the comparison of risks in various aspects. Birth is a normal physiological event. Birth is about trusting yourself and receiving the right type of support from people who share the same belief. Though not all births are risk free and healthy. It is so important that the couple plan and prepare their birth together. When it comes to decision making, they will not be panic. I believe it all depends on how comfortable the woman/couple feels to birth at home or hospital with her choice of support team.

  • Reply July 29, 2014

    Juliet

    What a lovely article. I too was a tree climber as a child, and now my granddaughter climbs trees while I watch from a distance. She is learning about balance and dexterity. I know I can trust her because she can trust her own body.

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