I was one of those kids who loved to climb buy cialis super active online trees.  I grew up in Ontario, Canada, where some of the best climbing trees grow. The buy dosages levitra 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

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 levitra vardenafil their gardens hopefully for suitable trees to climb.  The search began even as we would best viagra and popular in uk 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.

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.

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.

Dr 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.