Thinkbirth

Bystanding Behaviour in Midwifery

noreply@blogger.com (Carolyn Hastie) — Mon, 02 Jan 2012 02:48:00 +0000

I was alerted by a friend on facebook, to this article Bystanding Behaviour in Midwifery, about the way midwives don't stand up for women and how midwifery students are acculturated and desensitised to unkind behaviour. The article, written in 2008, is by Margaret Jowitt, who did her masters in Keele in 1998 on Mothers' Experience of Birth at Home and in Hospital. The book "Childbirth Unmasked" was written as a result of her reseach. Margaret is a lay member of the Association of Radical Midwives UK and a columnist for the Huffington Post.

Margaret wrote:

"I HAVE LONG WANTED to write an article on ‘Woman's inhumanity to woman' but have shied away until now for fear of being seen as attacking midwives and failing to acknowledge all they have achieved over the years in the care they give to women, often under very difficult and alien circumstances when they are based in hospitals".

I'm very glad she found a way to move through her fear and publish this article on Bystanding Behaviour in Midwifery and good to see it online as the issues are still alive and well today and not just in the UK. Distressing as it is to think such articles are necessary, we need to examine and digest the ideas presented in this piece and discover what we can do to change or do better. I shared the article on facebook and twitter, thinking it would be useful for midwifery students. However, I was prompted to put this post up to explore the ideas further following a reply 'tweet' to the article on Twitter.

@Thinkbirth I was a bystander recently and it traumatized me , worse was my colleagues saying it was normal and I was being dramatic.#scary

How many of us have had our feelings about and discomfort with the way women have been treated minimised or dismissed?

What happens to us when abuse is normalised?

When there is a disconnect between what we know is right and what is happening, between what is taught and what is practice, there is cognitive and emotional dissonance and a sense of not knowing what to do next...

Photo from Prefrontal Org Blog

How do you deal with that?

Is this your experience?

Creating Optimal Birth Space

noreply@blogger.com (Carolyn Hastie) — Wed, 21 Dec 2011 11:10:00 +0000

The environment in which we live and move and have our being is critical to our physical, mental, spiritual and social functioning. More and more understanding is emerging about how the environment plays a pivotal role in all aspects of our lives. From mice to (wo) men, science is demonstrating that the body's neural network is "plastic", that genes are not destiny and that the "environment" is an integral part of how living creatures function and develop. Every physiological interaction and behaviour, from the way genes are expressed in the sperm and the ovum to our health and experience across the lifecycle depends upon the environment. The environnment gives feedback which will be either nourishing and provide the stimulus to function well and grow or hostile, which disrupts our functioning, leading to disease, distress and decay.

Recognition of the way the environment is integral to optimal functioning is expanding our understanding of the role of maternity care in providing optimal environments for childbearing women. The science is also demonstrating why woman centred care, facilitating the fulfilment of woman's choices and incorporating women's rights into maternity care are so much a part of optimising outcomes for women, their babies, their intimate relationships and society in general.

Bella Rose Birthing Centre

My friend and colleague, the wonderful Maralyn Foureur, Professor of Midwifery at the University of Technology of Sydney (UTS) presented on this topic at the recent homebirth conference in New Zealand. Maralyn is heading up a research team exploring birth space and has attracted a highly prized NHMRC grant for this work.

Click the link below and it will take you to the slide share of her presentation

Creating Optimal Birth Space

I think you will enjoy and get a lot out of her research.

Quotes for Midwives

noreply@blogger.com (Carolyn Hastie) — Sun, 11 Dec 2011 19:30:00 +0000

My last meeting with the lovely midwifery students I've been working with in Papua New Guinea is this morning. I've been surfing the net, looking for quotes that relate to midwifery, women and birth that I thought would inspire them. I've come across the following and thought I'd share them with you.

"You are a midwife, assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves!” - From The Tao Te Ching

Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of our greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well. ~ Mother Teresa

Ask me for strength and I will lend not only my hand, but also my heart. ~ Unknown

If you lay down, the baby will never come out! ~ Native American saying

Offer hugs, not drugs ~ Adina Lebowitz

Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth. ~Virginia Di Orio

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. ~Eleanor Roosevelt

For God hath not give us the spirit of fear, but of power, and of love, and of a sound mind.
~2Timothy 1:7

If I had my life to live over, instead of wishing away nine months of pregnancy, I'd have cherished ever moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle. ~Irma Bombeck

Making the decision to have a baby – it’s momentous. It is to decide forever to have your heart go walking around outside your body. ~Elizabeth Stone

What's done to children, they will do to society. ~Karl Menninger

A woman
in harmony
with her spirit
is like
a river flowing.
She goes
where she will
without pretense
and arrives
at her destination,
prepared
to be herself
and only herself.
~Maya Angelou

Right Livelihood Award: Ina May Gaskin

noreply@blogger.com (Carolyn Hastie) — Sat, 10 Dec 2011 23:54:00 +0000

The world's premier award for personal courage and social transformation, The Right Livelihood Award honours and supports those "offering practical and exemplary answers to the most urgent challenges facing us today".

The wonderful Ina May Gaskin, affectionately referred to as 'the mother of midwifery', was awarded the Right Livelihood Award this year for:

“… for her whole-life’s work teaching and advocating safe, woman-centred childbirth methods that best promote the physical and mental health of mother and child.“

Ina May's acceptance speech is sobering as she carefully catalogues the abuses that have been and continue to be perpetrated against women and their babies in the name of industrialised birth; inspirational as she talks about the brave and loving doctors who have acted in the face of repression and vilification from their less than women centred peers and seek to scare women into submission to the medical juggernaut...

"We must wake up to the fact that it is easy to scare women about their bodies, especially in countries in which midwives have little or no power in policy-making, relative to physicians and the influence of large corporate entities. This takes no real talent. Given such imbalance, fear, ignorance, and greed begin to reinforce each other, and rates of unnecessary intervention soar, with women and the babies suffering the consequences"

Ina May's speech is heart warming as she asks the Hungarian Goverment to release Agnes Gereb, a Hungarian doctor who supported women to birth at home and encouraging as she offers a vision of a better world through optimising midwifery care and supporting women's choices ...

Another site came across my computer screen this morning, and given the content is highly relevant to the content of Ina May's speech, I thought it was entirely appropriate to link it here.

I'm not sure why the midwife broke the sac on this breech baby as she was born, I would have thought it was better left alone to provide that lovely buffer that intact membranes offer. Even so, I'm grateful to the woman and her family and to the midwives for sharing this delightful photo journey. The explanatory notes are very useful.

Ina May's book Spiritual Midwifery, together with Frederick Leboyer's Birth Without Violence, changed my world when they were released in 1976. I first heard Ina May speak at a preconfernce workshop at the 1992 Homebirth Conference in Sydney. I was so emotional on being in the presence of Ina May, that I spent most of the workshop in tears - her passion and 'right thinking' about women and birth still has that effect on me as I watch and listen to her speech accepting her Right Livelihood award. Thank you Ina May for all you have done and are doing for Women and Birth and Midwifery. Congratulations on receiving this prestigious award. You certainly deserve it.

The Beautiful Cervix Project

noreply@blogger.com (Carolyn Hastie) — Wed, 16 Nov 2011 15:34:00 +0000

As part of my evening reading and reviewing, I happened upon a guest post on the Feminist Breeder blog of Gina Crosley-Corcoran. The post was about taking control of fertility and knowing about one's own body. The blogger, Kim Buettner-Garrett said:

"... the idea of taking hormones to prevent pregnancy really made me uneasy. And the mere thought of inserting a hunk of metal into my uterus to create a “hostile” environment for a fertilized egg (leading to possibly heavier and more painful periods) also made my stomach turn — I don’t want to make any part of my body “hostile”, thank you very much"

Kim recommended a book Taking Charge of Your Fertility by Toni Weschler and you can read what she said on the site here. I haven't read the book, but by the sounds of it, I need to get it and read it soon.

Kim's concerns reminded me of the way that Gail J Dahl referred to hormonal contraception as 'chemical castration' - a term I hadn't associated with the 'pill' (and other forms of hormonal contraception) until I read those words of Gail's. Kim's comments and others who responded reminded me how few of us women know much about the inner workings of our marvellous bodies. I remembered a wonderful site I came across some time ago "The Beautiful Cervix Project"

A student midwife decided to photograph her cervix through the menstrual cycle as a project for her course. Out of that project grew this amazing webiste and the project has expanded to include photos of the cervix across the reproductive cycle. Her site has had over two million hits. All different people with different reasons for exploring the wonder of the cervix visit her site. Take time to explore and get to know the cervix. You'll be glad you did!

Oh, please explore at your discretion. If you are likely to be offended, please don't go there, avoid it. The curator of the art has had trouble with people reporting her site for inappropriate content. As it is a blog about the cervix, photos of the cervix in all its phases and roles is highly appropriate.

So be warned.

Come back and share what you've learned and your reaction to the project. I'd love to read what you think about it.

What birth activists can learn from Steve Jobs

noreply@blogger.com (Carolyn Hastie) — Thu, 06 Oct 2011 21:11:00 +0000

Steve Jobs, the person, will be sadly and achingly missed by his family and friends and Steve Jobs the genius, will be missed by those of us who enjoy the amazing fruits of his formidable creativity and attention to detail.

So why, on a midwifery and birth related blog am I talking about Steve Jobs?

Hugh @gapingvoid an amazing cartoonist, had an obituary for Steve Jobs on his site yesterday. He quoted Steve Jobs in this way:

Hugh rightly said that Steve's legacy is more than the hardware, wonderful as that all is, it's what he "helped us believe about ourselves".

So important to believe we are capable, strong and courageous and that we can go beyond the boundaries and limitations imposed by upbringing, culture and the myriad other influences that seek to contain our genius and creative self expression.

Nowhere is this more important than with birth and the bringing forth of life.

Those of us who are birth activists, who care about how women are treated in the birthing world; who care about the way that babies are born and how the whole childbearing experience is constructed for women, partners/fathers and babies all over the world need to read these words of Steve Jobs and take them to heart.

We want to change the birthing world for the better and we can!

Thanks for reminding us what we are capable and who we are Steve. RIP.

Midwives and Social Media

noreply@blogger.com (Carolyn Hastie) — Thu, 29 Sep 2011 12:49:00 +0000

Midwives are becoming more engaged with social media and electronic communications in both their professional and personal lives. Because there has been controversy with the use of social media by a few health professionals lately, I explore some of the pitfalls, precautions and powerful possibilities that social media offers to midwives in this post.

Social media and midwifery

Midwives love networking - whether sitting in the tea room, hanging out at the ‘desk’, having dinner out with colleagues or catching up at midwifery conferences, workshops and meetings. The buzz of midwives conversations and laughter is inevitable. The move to using social media as a way to stay in touch and keep connected has become easy for midwives.

What is social media?

The term ‘social media’ is an umbrella term which covers the multiple ways that technology is used for social interaction. Social media differs from traditional media, such as newspapers, television and radio; in that anyone using mobile and web based technologies can publish and receive information at any time. Real time interactive dialogue enables the co-creation of meaning and value of all aspects of social life - perfect for a socially-based profession such as midwifery.

Forms of social media

Mobile and web based technologies take many forms. The main forms used by midwives are: Email, Texting, Forums, Facebook, Twitter, LinkedIn, Blogs, Ning, Wikis, OneTrueMedia and YouTube. Wikipedia has an extensive categorized list of social media. There are links on the Wikipedia page to an explanatory note about each modality. Google ‘social media’ and you will be amazed with what comes up for you to explore.

Uses of Social Media

Social media offers a means through which people can post their experiences as they go about their activities and enables their ‘followers’ and/or ‘friends’ to be updated instantaneously. You will be familiar with email and texting, so I won’t go into those tools in this article. Most of you will be familiar with Facebook too. Midwives who engage with social media tend to use Facebook as their social network platform, sharing their lives and their photos. Some midwives also use LinkedIn, a platform used by business owners and other professionals. The microblogging site, Twitter, is popular with midwives too but most of them are from the USA.

Apart from social networking and updating friends on daily/hourly activities, social media is an excellent tool for raising awareness about issues, sharing information and organising events. As recent world events have demonstrated one of social media’s most powerful roles is in mobilising community support for political and/or public interest issues. When the Gold Coast birth centre was threatened with closure in 2010, a massive campaign was launched on Facebook and Twitter to inform people that closure was imminent. The social media campaign culminated in a well publicised rally, traditional media became involved and the birth centre remains open. Facebook and Twitter were used effectively as both official and unofficial sources of news and information during the Queensland floods at the beginning of 2011. The immediacy and success of that social media intervention dramatically increased the profile of social media for both government and the general public.

Ning is a useful social networking site for groups as it is password protected and requires moderation to enable access. You will find midwifery, birth and parent related communities on Ning. Another popular social media tool is blogging. Many midwives blog. The word ‘blog’ is the contraction of “Web log” and is a website which functions as an open online journal maintained by an individual. The blog owner, or an invited guest, writes regular commentaries about events, ideas and/or experiences. An example of a midwifery blog is Queensland’s Rachel Reed’s MidwifeThinking.

If you would like to find out more about the way that health professionals use social media, Sarah Stewart, the social media guru midwife has a blog article A discussion with health professionals about their use of social media with a video discussion on the use of social media. Sarah has initiated and coordinated the immensely successful and popular Virtual International Day of the Midwife, a virtual conference held over a 24 hour period on May 5^th. This year, 2011, marks the third year of that conference. Details can be found on Sarah’s blog. Social media is making inroads into health care as health care facilities and doctors seek to improve patient doctor communication. Dr Kevin Pho, has a popular Medscape blog, KevinMD, He also discusses on YouTube Social Media to Traditional Media the way that social media helps to prepare doctors to talk with patients and the general public.

Traps for the unwary in using social media

Some of my greatest learning has been from sharing stories about birth with other midwives. Sitting in the tea room or going out to lunch and talking ‘shop’ is usually safe for discussing clinical issues and we are all aware of the need to ensure confidentiality in those forums. Those words we shared disappeared into thin air and only our memories recorded what we talked about. However, the online environment and communicating through social media permanently records our conversations. The fact that what we say and how we say it can be read by anyone forever in the online world means we as health professionals must be careful to project a professional persona in all our online communications. A rule of thumb for engaging in any social media is to ensure that you don’t write or say anything that you wouldn’t want to read on the front page of the national newspaper.

A recent study found that there were inappropriate physician comments on Twitter. The researchers in this study identified 3% of the posts that were unprofessional because the posts contained:

Discriminatory statements;
Potential violations of patient privacy;
Profanity
Sexually explicit material (Rettner, MyHealthNewsDaily/MSNBC, 2/17).

About 1% of posts included unsupported claims about a product or repeated promotions for certain health products. Ten of these tweets contradicted medical guidelines or knowledge (HealthDay, 2/17).

The results of that study are demonstrated further in a situation concerning the indiscriminate use of slang on twitter by several doctors. Anne Marie Cunningham, a GP lecturer from Cardiff, Wales wrote a professional and reflective blog post Social Media, Black Humour and Professionals about her experience when she sought to discuss privately what she thought was unprofessional language on social media with the doctors concerned. Her post led to a very heated response from some, including an item on the Facebook page of The Medical Registrar in which Anne Marie was called a 'humourless old trout' amongst other things. I've blogged about this situation which some wag labelled #hcsmgateuk (health care social media 'gate', referring to the watergate affair in the US).

The Australian Medical Association, concerned that its members could find themselves in trouble through inappropriate behaviour on social networking sites, developed A guide to online professionalism for medical practitioners and medical students (available on their website). Even Liberal Party MPs now have a Liberal Party guide to social media, after several MPs were forced to resign for posting controversial tweets.

People do strange things, like calling in sick and then updating their status on Facebook talking about what they are doing for the day - neither wise nor honest. Even parents complaining about childrens' messy rooms can sometimes find their words have fallout they couldn't imagine. Employers don’t take kindly to employees who bad mouth their workplace on social media sites either. Remember that the information and images you post on social networking sites are there forever.

An increasing trend is for employers to check prospective employee’s online information and take that information into their consideration of the applicant’s suitability for the position. Employers are looking at what their current employees are writing. I was told recently that someone employed at a university was advised to ‘defriend’ another person who posted a negative news item about the university on their Facebook page. Women in our care, and our colleagues, may also check us out on social networking sites.

As a summary of the perils that befall the unthinking, here is a list of “dont's” that have led to people being fired because of their behaviour on social media.

Don’t post off-color remarks

Don’t post confidential details

Don’t badmouth your clients

Don’t disrespect your employer

Don’t post inappropriate photos

Don’t create animated videos of your co-workers

Don’t talk trash about your boss

Don’t play hooky - and then post about it

Netiquette and Social Media

So how do we engage in social media and stay safe? While I’m sure the mistakes made in the examples above will not be made by any midwife, there are other pitfalls that need to be considered. We need an appreciation and understanding of the set of social conventions regarding online communication to ensure our communication will not offend others or land us in ‘hot water’. An important consideration is that there are no body language cues available for people to ‘read’ what we mean in online communication. The lack of body language cues means that humour can be misread or misinterpreted, especially what we may consider as merely ‘sarcasm’ and ‘wit’. We therefore have to ensure our message is clear and personable. Other important aspects of Netiquette are:

Capital letters for whole words indicate shouting and is considered rude
Keep emails short and put the important part of the message in the top sentence
Make sure the email subject line is appropriate to the email topic
Don’t expect or demand immediate responses when emails or texts are sent and don’t send another one immediately if there isn’t a quick reply
If something private or urgent needs to be discussed, ring the person or direct message (DM) them. Don’t put it where everyone can see it
Don’t conduct personal, private conversations on social media unless the site is locked and even then realise that the information, even DMs and emails can be subpoenaed by a court
Be courteous and polite
Ensure the message is the message you send: reread before posting and ask yourself, how will this message be interpreted by the person who receives it?
Avoid the use of profanities
Avoid any words or images that victimise, blaspheme or vilify
Avoid any words or images that are racist, sexist and anti religious
Treat everyone and talk about everyone in positive terms, remember, what is written lasts forever
Don’t post and/or tag unflattering or compromising photos of friends. Be aware of your own photos and ensure the photos you are posting are professionally appropriate
Be wary of who you ‘friend’ and your privacy settings; often you are required to take some action to ensure privacy
Be aware that privacy settings are still vulnerable
Ensure spelling and grammar are correct
Remember that you are projecting your professional image whether you realise it or not
If someone else makes a mistake, be kind. If you choose to correct them, do it privately and kindly Be respectful of intellectual property

The USA’s Centre for Disease Control and Prevention produced an excellent Social Media Toolkit for health professionals you will find interesting and useful.

The rule of thumb bears repeating here. Don’t post anything you would not want to see on the front page of the national newspaper.

Remember, even with all those social networking rules, engaging in social media is fun and informative. The various forms of social media provide great tools for keeping in touch with family and friends. Social networking is a wonderful way to promote midwifery and you can make friends across the world in your areas of interest and expertise. Here's a link to a post Medical Students and Social Media: How to get involved that has some good tips for using social media to your advantage. If you keep the ‘rule of thumb’ in mind, you will enjoy the sense of connection social networking brings and even feel free to develop a blog and tweet, secure in the knowledge that you are safe professionally and personally because you know the rules of engagement.

I look forward to seeing you online!

This article was first published in the Australian Midwifery News, a publication of the Australian College of Midwives newsletter in the Autumn edition, 2011. I'm reproducing it here with permission and with some extra information added.

Hastie, C. 2011, 'Midwives and social media', Australian Midwifery News, Vol. 11, No. 1, Autumn 2011, pp.

Strong College, Strong Midwives, Strong Mothers

noreply@blogger.com (Carolyn Hastie) — Sun, 25 Sep 2011 14:52:00 +0000

I've talked previously on this blog about the fact that:

"Birth is not only about making babies. Birth is about making mothers - strong, competent, capable mothers who trust themselves and know their inner strength". Barbara Katz Rothman

The environment a woman finds herself in is a great mediator for how well she is able to develop that strength. A supportive environment is enabling. A supportive environment is capacity building.

Picture: http://www.crystalinks.com/midwifery.html

Midwives have traditionally been a vital part of the woman's birth territory where ever the woman gave birth. Midwives have protected the space and provided the support, encouragement and trust in the birth process that is so integral to women feeling free to birth and mother well. Midwives stand strong with women as they bring their babies forth into the world. Many's the time I've been with a birthing woman who would glance at me as she laboured and I'd smile and nod and she would go back to her process satisfied that she was 'on track'. Those women would invariably say later, "I was feeling frightened and when I looked at you and you smiled at me, I knew I was ok".

The word 'midwife' comes from the Anglo-Saxon "mid-wyfe" which means 'with woman'. There is a long history (at least the last four thousand years has been recorded) of the way that being with women has brought midwives into conflict with 'authorities'. The Bible gives evidence that midwives have always stood with women and protected them and their infants in the most difficult circumstances and despite powerful edicts to the contrary. Exodus (1:15-22) contains "several verses recounting the experiences of two Hebrew midwives who refused to kill male infants in defiance of the King of Egypt".

And now, in Australia, women and midwives have a new challenge.

In response to political posturing by various authorities, the Australian College of Midwives has released an Interim Statement on Homebirth in an attempt to restrict where women can birth and what midwives can do. The statement, hastily drafted as it was, nonetheless was rapidly endorsed by the newly formed Australian Nurses and Midwives Board, even before the statement was reviewed by the College's members. You will note that the statement endorsed by the board does not mention the word 'interim'. What is also concerning is that the College statement references two papers whose data collection methods have been poorly regarded (Kennare et al (2010) paper on planned homebirth in South Australia, and Bastian et al (1998).

Interesting.

Submissions on the statement were requested by Friday 23rd September 2011 (after publication on the web). The College states it intends to finalise the statement in October this year. Many of us are not impressed by the statement as it stands because it does not position the woman as the decision maker. Midwifery ethics are all about the woman as decison maker.

You will find considered responses to the interim statement on homebirth by midwives who work in private practice on the following links.

Rachel Reed of MidwifeThinking's response

Australian Private Midwives' Association's position statement on homebirths

I was thrilled to see the clarity of thinking and recognition of women's rights in the response from the National Alliance for Students of Midwifery.

This statement from the International Confederation of Midwives on women's choices and birth territory is clear and unfortunately, not reflected in the interim statement by the Australian College of Midwives.

So here's my submission to the College for consideration in the Board's deliberations over the wording and intent of the Final Statement on Homebirth.

Carolyn Hastie
Midwifery Facilitator
23rd September 2011
Dear Colleagues,
Re: Australian College of Midwives Statement on Homebirth: Women's Rights to a Homebirth and Their Right to a Skilled Attendant
Firstly, I want to know that my College supports women to have sovereignty over their own bodies and agency, including the right to choose where they give birth.

I also want to know that my College supports midwives to support women with their choices.

Guidelines and standards are important, however, risk status is an indicator, not a predictor and each woman has the right as an adult to be self determining. As an adult, a woman has the right to informed consent and informed refusal.

What enables women to be safest when giving birth is a known competent midwife, agency to choose to give birth where she feels most relaxed, a seamless means of transfer and acceptance at a local health service and collaboration with that service and prompt medical attention as required; the woman's chosen midwife able to continue to provide midwifery care with the support of the hospital's midwifery team.

Science is clear that when women have a perception of control over what happens to them, they have reduced levels of glucocorticoids in their peripheral circulation. Stress hormones are implicated in much of what goes wrong in labour and birth. Our role as midwives and as a midwifery organisation is to be 'with woman' and reduce stress, not create it.

As Barbara Katz Rothman said, "when there is a strong and autonomous midwifery profession, women and their babies do well".

We need to be a strong and autonomous midwifery profession. I want to feel proud of my College and our final Statement on Homebirth. The Interim statement both horrifies and embarrasses me, especially as it has been already endorsed and published by the Australian Nurses and Midwives Board - how on earth did that happen?

Yours Sincerely,
Carolyn Hastie
ACM Member and Fellow
MO5257

Women's rights to sovereignty and bodily autonomy are under threat and we need to stand beside them, to ensure they have the information they need to make their choices and support those choices.

That is what 'midwife' means.

We need our College to support women’s right to choose what suits them and their families and to support us to support women. We need a strong College, so midwives can be strong to support women in their choices so they can become the strong mothers they need to be.

The Environment is everything!

King hit on the funny bone: Labia room

noreply@blogger.com (Carolyn Hastie) — Fri, 16 Sep 2011 18:26:00 +0000

I love humour.
I love those people who have a great sense of humour. I'm always amazed when someone can come out with just the right response to a situation. I love it when something someone says is so funny, I laugh til tears roll down my face. Quirky, off beat, clever humour like that of the Monty Python team really appeals to me. I can watch their skits and movies over and over again.

However, unkind and derogatory put downs or sling offs aimed at those who are vulnerable I find rude, offensive and inappropriate, not funny.

I also love social media. I love the way the various forms of social media provide an easy and quick way to keep in touch and gain and share information. Twitter, for example, was invaluable to many as a tool of communication during the recent natural disasters. The ability to communicate over huge distances with a minumum of fuss has meant that social media is increasingly used as a tool for health promotion. With that ease of communication enabled by the various social media platforms has come concerns about privacy, online behaviour and confidentiality. A code of conduct for online behaviour, coined 'netiquette' has emerged.

Unfortunately for many, they think their conversations on social media are the same as in the tea room, pub or corridor.

They are not.

They are permanently recorded and therefore able to be read by anyone for all time. A good way to think about it is to consider that what you say on a social media platform is like writing it on the front page of a national newspaper. If you wouldn't want what you are going to say recorded in that way, then don't use social media for that conversation.

Many of us have written about the use of social media for health professionals. I wrote an article earlier this year for midwives in our college newsletter. Still I see indiscretion amongst my colleagues posts at times that I feel concerned about. I do wonder how those who use health care think about some of the comments that are made; how would prospective employers perceive such comments if they were to look. My understanding is that human resource departments are using social media platforms to find out more about applicants.

So a blogpost about an interaction on twitter between male doctors by Ann Marie Cunningham, a GP and lecturer in Wales UK with an interest in social media caught my attention when she said:

"I came across a discussion between several male doctors on twitter which caused me to reflect on this very topic. The doctors were using slang, which I have not come across before, to refer to the wards in which they might have been working. The terms used were 'labia ward' and 'birthing sheds' to refer to the delivery suite where women give birth, and "cabbage patch" to refer to the intensive care ward where many patients are unconscious.

I was shocked at this and angry and did query the doctors about some of the other things they said, but I felt I couldn't challenge them directly at that time about this language. One of the doctors referred to midwifes as 'madwives'"

The blogpost "Social media, black humour and professionals" and the responses are well worth reading to get a sense of what the doctors themselves and the readers of Ann Marie's blog thinks about these remarks. There are some very interesting comments on Ann Marie's blog itself, but by far the most fascinating reaction has come on Facebook on the The Medical Registrar's fanpage.

Alongside the link to Ann Marie's blog are the words:

The medical registrar " makes no comment, other than anyone who uses terms like "space" to describe a blog is a humourless old trout until proven otherwise"

The medical registrar didn't need to say anymore, because the readers have made up for it with 72 comments at the time of writing this post. These comments are also worth reading.

The attitudes and values of the people responding are clearly discernable. A former CEO of a large Boston hospital, Paul Levy, has discussed the response to Ann Marie's post on his blog.

Paul Levy wrote that he is 'left aghast' at the some of the comments and found the mindset of a few medical colleagues 'extremely upsetting'.

According to the good doctors however, using those terms "labia wards" and "birthing sheds" for rooms where women give birth and "cabbage patch" for ICU where people are unconscious is just good old fashioned humour, a way to let off steam in a stressful environment. Others, like me, find them offensive and degrading.

Is it purely a case of 'humorless old trouts'? or something else?

What do you think?

Compassion hurts

noreply@blogger.com (Carolyn Hastie) — Sun, 24 Jul 2011 04:14:00 +0000

The massacre of young people in Norway has shocked and distressed me. I know I am not alone in feeling these emotions. My heart goes out to all those youngsters who survived as they now process the loss of their friends and the feelings of guilt that comes with surviving such unfathomable horror when others didn't. I have been reading all the reports and stories, quite compulsively I realised. I was surprised by my compulsion and became aware that I'm trying to get some sense of where that cold, calculating killer was coming from; what enabled him to mercilessly and methodically shoot scores of young people.

I read that this killer lived with his mother. As a midwife, my life has been dedicated to helping women, their partners and babies connect, knowing that our primary relationship(s) set the stage for our future health and well-being in every aspect of life. I wondered how his mother was feeling. There was no mention of his father or any other family member in the news items.

My information about the horrible events in Norway have come from individuals and links posted on Twitter. I have read the various newspaper reports that were linked on twitter. As the information trickled through the net, painting the picture of the events unfolding in Norway, I couldn't get my head around the way that the killer set off the bomb in Oslo, then travelled to a small island where teenagers were on a summer camp and slaughtered so many of them. Why????

A link on twitter provided a clue "Who kills 80 Teenagers, one by one?" .

We now know there have been at least 94 teenagers murdered, but there are still some young people unaccounted for and still to find. I can only hope they are alive, but the prospects are grim.

The car bomb was placed near the offices of the socialist government and the teenagers were worker's party members. Rick Falkvinge, the blogger, suggested that the bomb in Oslo itself was a diversionary tactic to keep the police busy while the killer "executed (the teenage party members) in cold blood, as a political strategy to cripple a political party decades in the future."

The killer's murderous rampage drew the following comment on Falkvinge's blogpost.

Let Norway show him mercy, not because he deserves it, but because their vision of civilization is more complete than his.

A steady stream of information was tweeted by Ketil B Stensrud, who described himself as a 'football-fantatic journalist, who worked for The Independent, Daily Mirror, AP, TV2 and VG, turned general manager at Radio NRJ Kristiansand. One of his tweets contained the following:

BREAKING: Here you can download the Oslo/Utøya gunman's manifesto, in which he gives detailed account of planned attack.

The manifesto is enlightening, if depressing.

There are pages and pages of anti-Muslim, anti-multiculturalism rhetoric. There is anti feminist rhetoric. The manifesto is worth looking at as it shows how a mind seeks the evidence it needs to support its biases and bigotry. We are all capable of that self affirming and self referencing behaviour. As you read it, you can see how delusions can become very powerful and how the brain can become closed to any other way of thinking.

In the document, the killer's reasoning is carefully laid out. His plan to decimate the pro-multicultural element in his country has been brewing for 9 years according to the information in this document. The level of lies and deceit he employed are breathtaking.

The New York Times article this morning "Scouring the Web for Clues to a Suspected Attacker's Motives" contains sources and links to information about the murderer and his motives by both the journalist and the readers. A psychologist has, in response to the massacre, written that mass murderers see themselves as victims. That somewhat fits this killer's positioning, however, he seems himself more like an avenging angel or knight.

He saw himself as a Justiciar Knight fighting multiculturalism. You can read in his manifesto what that means. He surrendered easily to the police when they arrived on the island and under interrogation, confessed to the crimes. This newspaper heading indicates what is to come. Norway massacre suspect calls his deeds atrocious, but necessary

There have been examples of extraordinary heroism throughout this horrific event by individuals and immense courage and resiliency of the young people. The leader of the party Jens Stoltenberg has been an inspirational and compassionate leader, saying:

Today,we have been hit by two savage and cowardly attacks. Tonight, we all stand together, taking care of each other"affirming that "The answer to violence, is even more democracy. Even more humanity"

The massacre in Norway illustrates the profound problems inherent in fundamentalism of all stripes. The killer espouses a vile fundamentalism that strips away people's dignity and worth. His fundamentalism seeks to validate violence for the 'right' reasons of his own making. Norway and her people and their response to this ghastly event remind us that respect for different viewpoints and valuing diversity is the only way humanity can evolve and even survive.

I feel sad. I feel a bit despairing that a native of a country with such great values and social justice practices as Norway could commit such a crime, but people are people.

I take comfort in the knowledge that for every person like this dangerously misguided and deluded individual there are thousands who are trying to live life in the best, most socially responsible, inclusive, generous hearted way.

Elizabeth of @mymilkspilt fame posted this earlier today. The comment summed it all up for me:

"Compassion hurts. When you feel connected to everything, you also feel responsible for everything. And you cannot turn away. Your destiny is bound with the destinies of others. You must either learn to carry the Universe or be crushed by it. You must grow strong enough to love the world, yet empty enough to sit down at the same table with its worst horrors."

Andrew Boy (Source: myspiltmilk via changingmyperspective, via guerrillamamamedicine)

I don't know who Andrew Boy is, but I sure admire his sentiment.

The following are the last two tweets from the man who provided much of the information I've shared in this blog post.

ketilbstensrud Ketil B. Stensrud

The brutal, calculated home-grown terrorist has confessed. Rest is now left to our judicial system. I'm exhausted. Time for bed.

ketilbstensrud Ketil B. Stensrud

One last thought: It's a beautiful world we live in, with warm, inspiring, loving, courageous people all over. Let's keep it that way. Out.

I love his parting comment. It truly exemplifies the spirit of the Norwegian people. I hope he managed to get some sleep. Thinking of all the people in Norway as they recover and heal from this terrible ordeal and come to terms with the loss of so many beautiful young people. I know that Norway will continue to provide the inspiration, ideals and values that we all love and admire so much; the leadership and people have demonstrated that commitment in the worst of times.

"All women have the right to dignified health care."

noreply@blogger.com (Carolyn Hastie) — Sat, 18 Jun 2011 08:27:00 +0000

I'm posting this email in its entirety. There is nothing that I can add to the information in this heartfelt request. The title of the post says it all. I've donated and I hope you do too. Thank goodness for women who care like Adina and midwives like Hannah. What a blessing to the world they are!!

Hello Carolyn,

I read your natural birth blog, and really appreciate what you stand for. I live in a developing country, Guatemala, where women are not educated about birth choices and many times they only have one option. Due to lack of money they go to the public hospitals where there is more than 70% C-section rate. Then, confronted with birth trauma, they search for any other option possible. Many of them find my midwife with Manos Abiertas, a clinic dedicated to helping these women have a natural birth.

In a developed country, people have the luxury of forming a self-educated opinion on their preferred manner of giving birth, thankfully, and we are working towards making that an option in Guatemala.

The clinic that helps mostly indigenous and low income Guatemalan women works on a sliding pay scale. This often means patients visit free of charge or pay much less than their visit costs, because most can't afford the $5 for a checkup. However, as anyone involved in midwifery knows, there are always numerous costs involved.

I am asking you to help by spreading the word via an interview with one of the only licensed midwives in Guatemala who has her own birth clinic: Hannah Freiwald. She explains the situation here: http://www.all-about-guatemala.com/registered-midwife-guatemala-interview.html

You could also help by spreading the news via blog story told here: http://sagaunscripted.blogspot.com/2011/06/birthing-options-in-guatemala-city.html

If you are able to make donations, thank you. If you are not, but you can spread their story, thank you! Every little bit helps.

If you can link to us on your blog or forum, more people will see and hopefully help. I am not a midwife. I am only a citizen who supports my midwife and who sees a very great need with the women of Guatemala. If nothing else, they need the power to choose their birth. They need the right and education to know and choose what happens with their own bodies. Together, we can make this an option.

Thank you,

Adina Barnett

Manos Abiertas

"All women have the right to dignified health care."

Knowing about birth and interventions: Women's role

noreply@blogger.com (Carolyn Hastie) — Fri, 17 Jun 2011 02:52:00 +0000

A recent study by Klein et al, sought to discover the knowledge and attitudes of women pregnant for the first time to their own roles in their pregnancy and towards the use of technology in birth. The report was written up in the Los Angeles times as Pregnant women show an amazing lack of knowledge about childbirth options, study shows - latimes.com . You could be forgiven for thinking that modern childbearing women were obviously failing in their duty to be informed and either submissive or unintelligent.

So who were these women that Klein et al studied?

The sample of 1318 women was a convenience broad based sample of "mainly well-educated, middle-class women" whose planned place of birth

"ranged from home to hospital, and from rural centres to large city hospitals ... 13.2% of respondents were in the first trimester, 39.8% were in the second trimester, and 47.0% in the third"

A good range of sites for birth, so who was their primary care giver?

"Overall, 42.6% were under the care of an obstetrician, 29.3% a family physician, and 28.1% a registered midwife; 18% planned to engage a doula."

OK, nearly half had a private obstetrician, plus nearly 30% who had family physicians makes nearly 3/4 of the total number of women 'under' the care of a medical practitioner.

Now here is something very interesting in this study:

"Women attending obstetricians reported attitudes more favourable to the use of birth technology and less supportive of women’s roles in their own delivery, regardless of the trimester in which the survey was completed"

What do you suppose could be going on there? There is no doubt that some women access medical care because they want the assurance of the ready availability of intervention if they 'need it'. Some choose to have intervention from the start, but that number is considerably less than is touted by mainstream media or medical rhetoric. Part of that orientation however, comes from the steady undermining that goes on at every antenatal visit with many of our medical colleagues. Comments such as 'small pelvis', 'large baby', 'getting stuck', 'bleeding to death', plus the steady supply of 'horror stories' and hype about birth danger that women are regaled with by the doctors as they seek to validate their interventionist perspective are ubiquitous. The orientation that 'doctor knows best' is also very much alive in our community and the way that antenatal care is organised so that the women wait for hours and get seen for minutes feeds the belief system that doctors are 'so busy' and 'don't have time for women's petty concerns' - so women don't raise them in visits - that silence from the women aided and abetted by the 'not wanting to be a bother' stereotypical stance of many women.

Another lens on this phenomenon is provided by this study from 1995 which reported that privately insured pregnant women were more likely to experience interventions and surgical birth than comparable women in the public hospital system, but that the rate of intervention was greater for those women:

"who in late pregnancy were thinking clearly, had high self esteem, mature means of dealing with anxiety, were confident in their knowledge of childbirth procedures and in secure relationships with highly educated men"

A paper in 2000 by Roberts, Tracy and Tracy explored the differences in intervention between public and private hospitals maternity services offers some insights for the higher level of intervention for women in private medical care. Litigation fears, physician convenience factors and theatre staff availability are suggested as reasons for the increased rate of interventions and surgical birth in private hospitals. But what if there is something more 'underbelly' about the way intelligent, articulate women with supportive, educated husbands are subjected to increased rates of intervention? What if it is a situation of putting uppity self assured women in their place? Women will always preference their baby's well-being over their own, so it is easy to undermine them and when they are told that the 'fluid around the baby' is 'suspect' therefore induction is a good idea "I'll book you in for tomorrow" or "you have a placenta praevia (actually low lying) and I'll take the baby at 37 weeks because we don't want the placenta ripping and the baby being short of oxygen" how many women are going to challenge that? So many of the women who are induced for spurious reasons are told after 8 hours of desultory but painful contractions that they aren't going anywhere and may as well have the baby now rather than later when they are even more tired and the baby gets stuck " I can just take you upstairs/downstairs/across the hall and it will be all over and you'll have your baby in your arms" - who is going to argue then? Anyone who has worked or is working at a private maternity unit can relate similar stories.

This comment is interesting:

"Women attending midwives reported attitudes less favourable to the use of technology at delivery and more supportive of women’s roles"

The fact that these women have a better understanding of women's roles in childbirth is heartening and affirming, as midwifery care is all about capacity building and information sharing. The fact that women who access midwives as primary care givers are less interested in technology comes as no surprise as that is usually one of the reasons women seek out midwifery care. Another important point is that midwives use stories too. Midwives use stories to inspire and instill confidence in a woman's sense of self and ability to birth and parent well.

The finding that women attending family practices had opinions that "fell between the other two groups" is encouraging, but could clearly be better:

Now, this final finding that:

"For eight of the questions, “I don’t know” (IDK) responses exceeded 15%. These IDK responses were most frequent for questions regarding risks and benefits of epidural analgesia, Caesarean section, and episiotomy".

is very concerning. There is some comfort in the fact that:

"Women in the care of midwives consistently used IDK options less frequently than those cared for by physicians".

as that demonstrates that midwives role in information sharing and discussion about labour and birth is clearly occurring, even though there is scope for improvement. One of the benefits of midwifery care is the longer time for antenatal visits, where thoughts, feelings, stories and information can be shared and discussed. Perhaps the room for improvement here is with models of midwifery care that have short antenatal visit times scheduled and discussions are limited.

The conclusion of the Klein et al study that"

"women held different views across a range of childbirth issues, suggesting that the three groups of providers were caring for different populations with different attitudes and expectations"

is true in many regards, but not in all cases and not for all women. I've met many women who were privately insured and cared for by obstetricians, who were genuinely bemused and upset that they had unplanned intervention, I've seen others who argued that the doctor saved their lives (or the baby's) having (in my view based on observation and experience) created the problem in the first place.

Most people aren't that interested in finding out about pregnancy and birth until it becomes an immediate reality. School, parents and friends provide a particular perspective and background to people's information and knowledge about birth and babies, the media certainly provides another. Many women and their partners have never held a newborn baby until they hold their own. The primary care provider, be it midwife, family physician or obstetrician has a duty of care to provide opportunities to explore information, knowledge, understandings and experiences with pregnant women/couples who access their services.

To say that women are ignorant of options and interventions says volumes about their health care provider. What do you think?

Healing from Birth Trauma

noreply@blogger.com (Carolyn Hastie) — Sun, 29 May 2011 08:36:00 +0000

A very important post on birth trauma was posted by a guest blogger on the wonderful Rachel Reed's Midwife Thinking blog the other day. As I read the post and then the comments, I was taken by a young woman's story of her two births; one traumatic and one healing. I emailed Amber and asked her if she would allow me to publish her stories on my blog because there are many powerful lessons to be learned from her experiences. Amber kindly agreed and here are her stories. The posts are long, but well worth reading in depth to gather and savour the illuminations she gives us. For those of us who are pregnant parents and those of us who are midwives or other health care practitioners working with birthing women, her words are precious invitations into the world of birth and what women need.

The headings provide links to Amber's blog.

Tale of Two Birth Stories, Part 1

I wish to share my birth stories because becoming a mother is where this journey began. I cannot tell the one without the other—it would only be telling half the story of how I came to be the woman I am today. The birth of my son, now almost three years ago, is still very fresh and vivid in my mind…and deeply painful. I have been repeatedly reminded that I am so fortunate, a hemorrhage is such a little thing; and indeed, as I commented recently, “on paper” it looks like a wonderfully successful natural birth, but to me, it was a nightmare, and one I’ve lived repeatedly over the years. It was only recently that I realized I have truly been grieving over this birth and, allowing myself to go through that process, I believe I have finally arrived at a peace and even a gratitude for that day: for without it I would never had had the courage to take my first step into this wonderful adventure God is unfolding before me now.

I made the choice to birth in hospital as a compromise. I had wanted a homebirth from the time that I knew they were still an option—I’m an introvert and deeply sensitive when it comes to privacy—but due to fear of confrontation and concern for my mother (who is not well and unable to handle stress), I convinced myself that a CNM in hospital wouldn’t be horrible: I still had a midwife and my mom wouldn’t have to worry unduly. I had also convinced myself that Mom had to be a part of the birth of her first grandchild (how could I deny her that?) even though I knew she’s never been able to handle any situation in which I’ve been ill or in pain.

My heart screamed it was a mistake throughout all my prenatal care, but I stuck to my choice even though I was becoming increasingly unwell. Because I was perfectly healthy in all the numbers, my concerns were repeatedly ignored and downplayed as mere complaining. I was frustrated, determined, hopeful, and excited all at once. Thus sets the stage for that eventful day…

I went for my 39-week checkup around 2pm on a hot August day. I told G, my CNM, my last week’s adventure: I had lost my mucus plug six days before and had had some regular contractions for about 3 hours every evening since then. Though they didn’t hurt at all, I could feel the pressure of contractions on and off and decided to use these times to “practice” different labor positions. She replied that I was getting really close and asked me to lie back so she could check out the baby’s position. I pulled up my shirt and she stopped short and said, “You’re having contractions now.” I responded, “Really?” G looked at me very oddly and asked, “Don’t you feel them?” And I said, “Nope, not a clue!” She smiled and said, “Must be more Braxton-Hicks.” Everything looked great! She asked if I wanted to check dilation and I told her that I’d rather wait and was soon on my way home.

I spent the afternoon snacking on carbs and posting to facebook “I’ve just served the eviction notice on this baby!” around 7:30pm. I had had 3 contractions in that span of time that I had actually felt, eh, no big deal. I stood up to stretch and hit the bathroom…again…and felt a slight gush. I sat back down and texted my husband “Okay, no reason to freak out or anything, but I think my water just broke. ” I laughed at what I had just entered as my status as I decided to take a walk around outside to see if I could get some contractions going. Without warning they started, almost knocking me to my knees from the intensity. I struggled to make it back inside and could barely climb up the porch stairs…and yeah, they were about 1 minute long and every 3 minutes. I texted Hubby again, “I’m having contractions. Don’t worry. Still no need to rush.”

A few minutes later I was leaning over the kitchen table forcing myself to text “Okay, forget that. Get here now!” He was in a neighboring town so it took an hour before we actually got to the hospital. I walked into the main doors as a lady asked me if I were okay. I mumbled, “I think I’m in labor.” so she got a wheelchair. I only remember the sense of being whisked past things as I already had the outside world mostly shut out. We stopped momentarily and I heard G saying something about being surprised to see me again so soon and another voice sigh that it was a busy night.

I was then in my room at the end of an extremely long hall way. I just wanted back on my feet, but I had to be checked first. The nurses swarmed with activity while I protested, “Can I please stand up? No, I do not want an IV. I hate IV’s. They’re so uncomfortable and I don’t need one. I don’t want this belt on me. I want to get up now. How much longer are you going to take?” I was 5cm dilated—half way there! They promised to leave me alone as soon as they got all their base readings. Yes!

Somewhere Hubby was around. The hospital gown was unbearable. Maybe the tub would be nice.
Hubby filled up the tub and looked a mixture of worried, scared, and out of his element. I would have smiled if it were possible. I remained confident for his sake. I knew I could do this. He asked a million questions about what I needed. “Nothing. I’m fine.” All I needed to know was that I wasn’t alone. He texted our friends and read me their responses. It was good to know that they were praying for me.

The warm water felt great for about 5 minutes. Though it eased the tension considerably, giving me time to recharge, I felt way too constricted. I needed to move my hips and there was no place in this tub for that to happen. Hubby helped me out and I paced the bathroom for a while. It was nice and secluded. The nurses came back to check my progress again (7 cm) and they let me stay standing this time. I got back into the tub. Everything melted away again—it was so nice to rest—if only there were more room. My mom arrived and wanted to know if it were okay to come in for a moment. I said something like, “I don’t care. I’m naked so if she doesn’t mind seeing me then I don’t care.”

The nurses asked me to come out for another progress check so I made my way out of the bathroom again. I think I was 8cm dilated—not long now! At this point, all I remember was complaining that I needed to pee so badly and couldn’t. G asked if I wanted to try a catheter which I accepted. Nothing. She said I had “a bubble” from my amniotic sac pushing on my bladder. She broke it and I felt so much better! Now it was back to breathing very deeply. “In. Out. Oxygen for the baby. Push the pain away” was the mantra in my head. The hospital gown was now suffocating; and though I didn’t want to be exposed for the world to see, I couldn’t communicate to Hubby that I wanted my tank top from my bag. All I could do was breathe. I bent over the bed swaying back and forth. It wasn’t long before the contractions were on top of each other and my stomach decided to empty itself of all contents, but I didn’t care anymore who saw what—though I did wonder what my mom was thinking because she was still hanging around.

Hubby was rubbing my back too hard and driving me crazy, but I couldn’t bring myself to say anything because he was trying so hard to be helpful. The nurse eventually took over and the tension melted away. Mom got a cool rag for my forehead. “Breathe deep. In. Out. Oxygen for the baby. Push the pain away.” I started praying that it wouldn’t be much longer. I was nearing the end and I didn’t know how much longer I could go. Mom began urging me to breathe “hee-hee-hee” and I ignored the irritation, continuing to breathe deeply. She then tried to push me into taking some pain medicine and was becoming quite unsettled. Finally G (God bless her!) politely explained I was doing beautifully. That quieted her. With the outside annoyances gone, I again felt completely able to forget everything around me and ride the rollercoaster of my contractions. My body was working extremely hard, but it wasn’t unbearable!

G suggested that I try a different position, but that wasn’t happening. I moaned here and there. G asked if I felt like pushing yet. “No… I don’t know… Okay! Yes! Now I do!” I had an overwhelming feeling to squat, so G offered to help me with the squatting bar. I acquiesced, but could not figure out how to use the thing. I wanted to return to the side of the bed and this is where things began to break down: I had no more strength to assert what I wanted and Hubby had dropped out of the picture, having succumbed to his long day. We tried getting on hands and knees, but this didn’t feel right either. I could find no voice to explain I wanted to stand again. I was sorely irritated. I didn’t know what I was doing and I was starting to panic, but continuing to breathe deeply helped for the time.
Finally, somehow, I was on my back. In my head I was screaming, “No! No! No! No! This is the worst! Ahhh! I want up!” But all I could do was breathe.

The intensity of the contractions and pressure on my back skyrocketed! I knew I wasn’t pushing effectively, but I couldn’t figure it out while struggling with the pain. I began panicking again, panting out, “I can’t. Please just let me rest a minute.” I couldn’t explain that I meant I couldn’t be on my back any longer. Everyone was hovered over me, counting, and Hubby’s voice was barely there at all. Mom stepped up and began encouraging me, but still insisted that I breathe weird. G told me I couldn’t stop.

I was in a mental agony and fighting hyperventilating. Everything within my being was screaming that I needed everyone to back off, but I felt trapped—completely powerless to do anything but comply. I asked Mom how long I’d been pushing and she told me about half an hour. Then G grabbed my hand, saying, “Here. Feel the baby’s head.” I felt his wet, silky hair and gave in to the sinking feeling that my time had come. I took a deep breath to rally all my remaining strength and finally started pushing better, but I had risen to such a state of perfect terror that I pushed with all my might. I had no idea how long I could continue on, exhausted, my thoughts only flashing “danger!” Eventually I grabbed my own legs and started pushing whether I was having a contraction or not. I didn’t care anymore. I had to have him out. I knew it wouldn’t be pretty. Everyone seemed to back off, but I was wild with panic and no one noticed that this was my driving force.

After another half hour of pushing, my son was laid on my belly. All I said was, “Thank you, Jesus!” He was safe. He wailed and I stroked his head wondering, “This is giving birth? This is what I’ve been waiting for all my life? What’s the big deal? …What’s wrong with me?” I was bewildered that I felt eerily emotionless at the meeting of my first-born, but I was abruptly shaken from this reverie.

A nurse pulled him away as warmth began pouring around me: I was hemorrhaging. They shot Pitocin in my legs as I felt fainter and fainter. I heard a nurse say that the baby was 8lbs 5oz and born at 1:16am. I smiled. “That was what…6 hours?” My head started swimming. In that moment I thought, “I could die right now and I’d leave my baby alone without me.” But peace rushed over me like I’ve never felt before and I knew that everything would be okay. It was all quite surreal. I was still bleeding badly so G resorted to bi-manual compression. Thus jolted into alertness, I jumped from the bottom of the bed to the very top and shrieked.

Finally, the bleeding was under control. G stitched a tear, but the local anesthetics hadn’t worked. I cried out again, gritted my teeth, and waited for it to be over. Needless to say, I was severely swollen. Awaiting family was finally allowed into the room. I wanted my baby but could only watch as everyone passed him around. Then I was very chilled and began shivering uncontrollably. The nurses piled on heated blankets until I couldn’t move from their weight and still I was freezing. G told me to stay calm: it was because of all the blood I’d lost. I felt numb all over, like everyone was celebrating without me. I hadn’t even really gotten to hold him yet. I lie there half-dead.

My friend came to my side and held a straw for me so I could sip some warm chicken broth. Tea. Water. I had those as well. G said it was vital to get lots of fluids or else I would need a transfusion and she didn’t want that if she could help it (neither did I). I started feeling sick to my stomach, but forced myself to keep sipping everything offered. Everyone left. I don’t remember much about the rest of that morning until realizing it was dawn. I hadn’t slept and I couldn’t really hold my son because I was so weak. I have fuzzy recollections that I finally had an IV in my hand to push fluids and a catheter because I wasn’t allowed to get out of bed for 18 hours. Hubby laid the baby beside me and helped me roll over so I could nurse him.

More family came and went, but I only wanted to get to know my son for myself. I put on an act, smiling and pretending nothing was wrong, so that everyone else could continue in their blissful ignorance that reality was quite to the contrary. Later that day, J, another CNM, sat down with my mom, who was still quite shaken from the experience, and explained why I would be fine. I was very touched by her thoughtfulness.

At some point an OB came, insisting I needed a transfusion which I declined. He tried coercion: a few girls had hemorrhaged that night and “they” were getting “their” transfusions. This made me livid, but I again politely declined and he left. A nurse came after that proudly proclaiming that she knew I’d hemorrhage because I wouldn’t take the IV—everyone who refuses does.

I only stared in utter amazement at what I was hearing. Mr. OB came back and insulted my husband in an attempt to bully us into a transfusion. I again told him no and he left visibly infuriated. Another nurse came to check on me, telling me that my labor was absolutely beautiful to watch and I did a great job—she’d never heard a negative word or an angry tone.

That small kindness, after all I endured that day, did wonders for my broken heart. I felt defeated and blamed myself for what happened. I was livid at the rudeness I’d endured all day and overwhelmed with the sense that this was not how it was supposed to be. I was “supposed” to be with my baby—we needed each other—yet a seeming endless parade of people separated us and I couldn’t speak up. I was weak. How extremely glad I was to go home, rest in my own bed, and finally get to know my little son without interruption! As the days and weeks passed, I began to understand an important distinction: I had had a non-medicated birth, but it certainly wasn’t “natural”. A new resolution began stirring within my heart then, a longing that would be satisfied—a natural birth, at home.

Tale of Two Birth Stories, Part 2

My daughter’s story is very intense all the way around. Life was nothing short of a wild tempest and we were tossed upon the waves of the dark sea with no end in sight. It was a 9-month-long full recovery from my hemorrhage and my intense little son was extremely draining on what little energy I had. There was too seldom anything left to give to my husband. This little boy stormed into our lives like a whirlwind and threatened to tear our marriage apart.

My husband and I blamed each other. We had no family or friends nearby to reach out to for help. Instead of sympathy or encouragement, I would call my mom to hear “I told you not to get married and have kids.” and “He’s just like you—I could never stay so calm.” and “Well, you’d better not have anymore or you will die next time and how do you think he’ll be then, never knowing his mother?”

Life was spiraling out of control. I began crying out to God to show me wisdom, to lead me in the paths of righteousness for His name’s sake…and then I was quite startled to realize I’d missed my period. I said nothing for the longest time, not even to my husband.

I never could bring myself to take a pregnancy test and was about 3 months along when I finally accepted the fact that we were bringing another baby into this life of ours. I cried bitterly for 4 days straight and when I’d exhausted that fountain of tears, we called our families. We talked to my brother- and sister-in-law first. It seemed like the proper thing to do since they had recently suffered a miscarriage. I had struggled with the irony of this moment for several weeks: God had given me a most precious gift which I could only dread to see come…while she longed for the little one she had wanted so badly. I convinced myself that my child would die too: I was the one who deserved my heart to be shattered into a million bits, not her, for feeling the way I did. As it turned out, she was pregnant again too. I was happy for her, but still was haunted my entire pregnancy with the expectation that something would go horribly wrong and my baby would be stillborn.

Now, don’t get me wrong: I wanted another child—desperately—but not in this mess! How could I do this with two little ones? How could I possibly have room for another one in my life? My husband was just as unhappy. It was a very emotional pregnancy: I was struggling over the “whys” of my son’s birth and I could feel no bond to the little one within me—I worried if I ever would. Yet in the darkness, God began whispering to my heart words of peace, comfort, hope, and joy. Joy? Yes, joy…and slowly, step by step, I struggled to believe and walk forward in faith. I clung to my Savior’s hand for it was the only stay I had; and as I took the next step, I grew stronger. He was calling me to conquer, to overcome, and promised that in Him I would succeed. Our son was slowly growing as well and becoming a little more independent each day. Maybe life would be livable! …and this upcoming birth—this new little child—would be a blessing.

At the height of the fury, when all hope seemed to be lost, she broke in upon us, scattered the darkness, and brought the beauty and brilliance of the sunlight. “Peace, be still.” Thus was life unfolded to us and thus was her birth…

It was the end of May when started getting those first signs of my body preparing for birth. I hoped this would be a June baby after all, but kept an open mind to that little nagging doubt that this baby was coming late. The little one was lying posterior so I tried to focus on getting her to turn. I read birth stories about sunny-side-up babies to get myself mentally prepared. The thing I dreaded most was a hard, quick labor that would not allow time for my midwife to make it to the birth. Six weeks of cramps, horrible nausea, back ache, hip ache, pelvic ache, and regular contractions that would start off strong and then fade away after a couple of hours—with every new burst of activity I was having signs of losing my mucus plug. It couldn’t be long, right?

In hindsight, I see how I gradually progressed through days of cramps that turned into days of contractions 10 minutes apart, then days of stronger contractions 6 minutes apart, and so on. The first night I was tempted to call my midwife, I’d had cramps all afternoon that turned into light contractions that suddenly stopped. Everything picked up again around 11pm and I labored for 2-3 hours, even getting into the shower to help with the discomfort. These were perfect “textbook” early labor contractions, but why stop as quickly as they come? The week I was due (mid-June) my mood shifted: I was exhausted and discouraged that not the slightest thing happened. I wanted to have this baby, but it wasn’t the “I’m ready to pop.” kind of feeling. I was sick of being stuck at home, too hot, with nothing to do besides wait, wait, wait.

The next week things picked up in full force. Now I had to focus through my contractions. Getting an exercise ball had helped tremendously. By now, my midwife, Donna, and I had discussed all my “what ifs” and I felt prepared for anything. I was positive we could handle anything. We were prepared for a quick labor since my first had been only 6 hours. I kept myself busy still trying to get the little bean to turn. I had nightmares of her getting stuck in deep transverse arrest and worried about her head not being flexed. I worked so hard, but she wouldn’t budge. I also worried hitting post-term dates. This baby was just starting to feel like a full-term-sized baby and so I tried to comfort myself with the thought that if she were smaller, maybe giving birth to an OP baby wouldn’t be so bad. The scripture “When thou passest through the waters, I will be with thee; and through the rivers, they shall not overflow thee” from Isaiah 43 ran through my head constantly and I finally gave every single fear over to God. Ah, to have that peace reigning in your heart once more!

The week before I gave birth was horrendous. Though my energy came back, I was completely miserable. I couldn’t eat or sleep. I was approaching the 43 week mark and knew that I’d have to go into labor soon or my back up care would start getting antsy. The last three days leading up to the birth were the worst. Six weeks of soft bowel movements turned into something akin to the most excruciatingly miserable stomach flu of your worst nightmares. I’d have very strong cramps, back ache, and contractions all in a muddle for hours every afternoon until I felt like collapsing from exhaustion by evening.

All I could feel was pressure. Pressure on my bladder. Pressure on my bowels. Pressure on my pelvic floor. If things hadn’t kept stopping, I would have sworn I was in labor. I tried to laugh it off by cracking jokes and hoped that if my stomach were empty maybe I wouldn’t get sick during transition this time. I finally felt my time was here—I wasn’t going to be pregnant forever! I was going to have a baby by the weekend (I knew it!) and I clung to the promise “my heart trusted in Him, and I am helped; therefore my heart greatly rejoiceth” from Psalm 28:7. The Lord had ordered my every step with this birth and He was going to work every detail out to the very end for His glory. I was miserable, yes, but I had a strong joy running beneath the surface.

The night before baby arrived, I snapped. I was tired of “wasting” my days focusing on contractions and ending up frustrated and disappointed every night. I went to Walmart for groceries, put everything away when I got home, and cleaned up the entire kitchen. This house was going to get clean! The next morning, I had a bout of upset stomach pretty early and I thought, “That was off the norm, but whatever, I’m ignoring it all until I know that I’m in labor. I actually feel pretty good now though, so maybe I can finally eat!” I wanted to start out the day making homemade buttermilk pancakes—with blueberries for the little man and me. I felt so much better after breakfast, though I needed to sit and rest. Hubby cleaned the kitchen while we laughed at J-bug saying “bue-bee pancocks”. Sometime during all this I became vaguely aware of an odd pain and pressure in my pubic bones. It would come quite sharply, almost like a cramp, but felt like the baby’s forehead was hitting up against my bones and trying to press its way out my front. They would leave as quickly as they came and were infrequent enough to not be a hindrance. I mentally noted that the time was around 11am—just in case.

After resting, I started on laundry and general pick up around the house. The sharp pains continued and by about 1:30pm I realized they were coming more frequently and strong enough to force me to drop to my knees and moan. As soon as it was over I got up and continued cleaning. I wasn’t going to stop my plans because they weren’t contractions per se: my mind was set. I still clung to a labor very much like my first—obvious. I anticipated it being shorter and more intense, but I still had convinced myself that she’d turn and things would calm down. I’d have time to get J-bug to Mom’s, my midwife would come, and we’d have a very peaceful birth in every way.

At 1:58pm I asked Hubby to start timing contractions. I would have this pain, a series of contractions—four or five coupled together—and then a minute or two pause before it started again. I was on my knees hugging my exercise ball rocking back and forth. It was all I could do to keep from crying. Hubby started calling family, telling them I was in labor which extremely irritated me because I was still trying to get things done! Yeah, this hurt, but it would stop. It always did. All this pain was weird, but I wasn’t convinced it was labor yet. At some point, Hubby persuaded me to call Donna.

Then I had J-bug help me pack his overnight bag to keep him distracted. He bounced back and forth from excited to leave and being scared for me. I was desperately trying to play off all the pain as nothing for his sake and to be patient with his increasing fretfulness, but everything within me screamed for everyone and everything to leave me alone! I just wanted be able to think!

At 2:42pm, I struggled to update my facebook status while J-bug clung to me crying, trying to kiss my boo-boo’s. Hubby tried to keep him off of me, only agitating him even more. I finally caved in and called Mom to come get J-bug NOW and my midwife to tell her that I was in considerable pain, though I was still trying to laugh it off in my denial that I was so close. I was convinced that I still had a couple of hours. Hubby carried a screaming little boy out the door to meet Mom as I fled to the shower. He came back to ask if I were sure it was okay if he left me and I practically screamed “No! Just leave me alone!”

And alone I was. I regretted it all in about five minutes. Nothing helped. I couldn’t relax nor breathe through the pain. I needed someone. Oh! I didn’t want to be alone anymore! I was in a mental agony, but still trying to convince myself this baby would turn, labor would settle down, and then I could gain control. I called my sister-in-law; she was just the right person to help. We talked for 8 glorious minutes as she coached me to vocalize properly through the contractions and relax. In a passing thought I said “I feel like I’m in transition” though I was only now giving into the fact that today was the day. She suggested I call Donna again to make sure she was on her way. The time was 3:15pm—I had been having contractions for about an hour and 20 minutes. I struggled to talk now and panted out: “I’d really feel better…if you were here…right now.” She was just headed out the door and would be another hour!

I vocalized through some more contractions until the huge sinking hit: my contractions were starting to spread out and I was feeling more pressure in my back and that same “I just needed to squat” sensation. ”Oh, God!” I prayed, “Please let someone get here! I don’t want to have this baby alone!” I had been in transition and I wasn’t ready for what was coming. I felt trapped, pacing around and around in the shower like a wild animal, trying to get comfortable yet too afraid to leave the slight comfort of the warm shower. Images of our dog in labor played in my mind—she would do just the same thing. I laughed at the fact that I was comparing myself to my childhood pet. There was nothing to be done now but to face the horror that was in front of me alone, humor was all I had.

I’d been in the shower for half an hour and it suddenly ran cold. I tried to get out and dry off, but a contraction hit me so hard that I fell to my knees and clung to the side of the tub as for dear life. There was no turning back—my body was starting to push at the peaks of the contractions—but I wasn’t ready! They were so severe that, try as I might to keep from it, all I could do was scream and growl like I didn’t know was possible. This was the kind of labor that I dreaded. I called Hubby and waited for him to pick up. In my head: “Please, please, please! Another one’s coming. (Oh, God! Please help me!) Hurry. Pick up the phone. Too late—” With the hello on the other end of the line came a full series of screams. It was as uncontrollable as the pushing itself, though I was amused with the humor in the situation. This was completely different from anything that either of us expected. After the contraction was over, I panted out that I needed him NOW! He was 10 minutes away and was going to call our friend (an EMT) to come just in case Donna didn’t make it. I felt slightly better knowing I wouldn’t be alone much longer and turned around so that I could cling to the towel I was on, alternating between the hands-and-knees position and open-knee chest.

I was deeply impressed with how Hubby helped me once he got there. I screamed and cried that there was nothing he could do, but he calmly bathed my neck and forehead with a cool clothe and told me how well I was doing. God bless him! I relaxed a little, and while he left to see if anyone had arrived yet, my water broke. The baby descended a little further as I realized fully that my every nightmare was coming true. I was glad that I could scream with all my might in the privacy of my own bathroom and that the neighbors were too deaf to hear!

Joe called Donna at 4:06pm to tell her my water broke. She was about 10 minutes away! Hurray! Perhaps she would make it, but there was no sign of our friend. With stronger contractions I wrapped my whole stomach in my arms and held on while my body pushed with all it had without my input. I was so exhausted, but I couldn’t fight the pushing. I struggled against the pain instead. I would just start to catch my breath and calm down when another contraction would, literally, slam me into the floor. All I could do was scream as if someone were ripping me apart. I was as low on the floor as I could get with my pregnant belly, clinging to the towel I was on and trying to spread my hips out as wide as I could. This position helped, but as I felt the baby descend lower and lower the pain increased until there was no respite between contractions at all. There was so much constant pressure that my screaming turned into a growl with pushing and then into huge sobs after it was over. I kept praying and the scripture I’d clung to for days would answer back: “my heart trusted in Him, and I am helped; therefore my heart greatly rejoiceth.” Honestly, in the midst of the most horrific pain I had ever experienced in my life, I could say this was just so—I had trusted God completely and He was helping me. I was home and would soon have an incredible blessing in my arms—it would be more than worth it all. My heart did rejoice.

Donna came at 4:16pm and our friend arrived about that time too. They quickly set up all the supplies and Donna came to my side, applied a firm hand on my sacrum, and reassured me. Most of the tension I’d held onto instantly melted away. Nothing let up, but I didn’t have to fight the pain alone anymore. As the baby moved down, the pressure on my tailbone increased to the point I thought it would break. I poured out all my sorrows in broken sobs between contractions and Donna was so wonderful a motherly comforter! If I could have moved at that point, I would have climbed up into her arms. I thanked God for her being there. The pain was still intensifying, but I was gaining some control. She handed me a rolled up towel and I bit into it, screaming with all my might. It felt so good to let it all go; if I had to scream, at least I could finally scream out the pain.

Then the babies’ head was beginning to crown. Again, I was flooded with not feeling ready for the task, but this was the last fight and the sooner I gave in, the quicker it would be over. In the midst of the agony I was deeply in awe. I could feel her moving forward and then sliding some back; with each fresh wave the burning increased and I struggled to let go so my body could stretch freely. Yet this pain was only a drop of the new level of pain that was mounting. Yes, it is true, it happens, and the only way to describe it is this: you feel like you are being ripped in half from the bottom up. My hips and tailbone were being stretched to their breaking point—I could feel every ligament. I grabbed my bottom and screamed harder yet. I didn’t know I had all that bound up inside me. Greater and greater was the pain still until suddenly out came her head and instantly there was relief. Donna told me not to push so I waited for my body to finish the work it had done completely without my effort. A contraction mounted as Donna gave the okay; I grabbed my stomach once more and felt all of her slide out of my body—AMAZING! Donna announced “It’s a girl!” and passed her between my legs. It was 4:44pm.

It was over in slightly under 3 hours. I was never so relieved in my life. Instantly, I smiled and chattered to my little girl as I held her for the first time. One soft little cry and then she was so quiet and alert. I leaned against the sink and marveled at the miracle as I watched her pink up and thought about all that was going on in her little body. All too soon the placenta came and it was time to get up. I handed her away so Hubby could greet his little daughter. I was surprised to only shake very slightly for a minute or two and immediately felt like I was able to stand. I sat in the warm tub a few moments with DD again and eventually made it to the bed to nurse away. It was so nice to curl up with a new baby at my breast and my husband by my side—completely at liberty the fall in love all over again.

No strangers. No routines. Just time standing still—allowed to stand still—as it should in every important moment of your life. Donna walked in with a smile and told me that I did a great job, that how easily I delivered her showed how well I’d taken care of myself during pregnancy. She told me later that not only was she OP but presented the crown of her head first as well…yeah, I guess that does make a difference…and her head had barely molded at all.

I lie awake staring at her all night while she lay in my arms—something I couldn’t do with J-bug and I had mourned so badly. Finally, God had brought to pass His promise to me: “Surely goodness and mercy shall follow me all the days of my life.” For all the horror of her birth, the recovery was incredible. I didn’t tear and I wasn’t swollen. By the time I made my third trip to the bathroom that night, I wasn’t sore at all anymore. I bled very little. Other than my tailbone aching if I sat too long and after-birth pains to match the birth, I felt wonderful! This little one has been the cheery, bright-eyed blessing that only God knew how badly we needed in our lives. “He gives beauty for ashes, strength for fear, gladness for mourning, peace for despair.”

Thank you Amber, for letting us into your world and allowing us to learn from your experiences.

Symbols, power and woman's place in the world

noreply@blogger.com (Carolyn Hastie) — Thu, 21 Apr 2011 04:12:00 +0000

I always enjoy Maria Popover's links and articles. Her Brain Pickings blog has fascinating and often obscure articles which are relevant to my interests. I follow Maria on Twitter - her twitter name is @brainpicker

So it was with great interest that I followed this link http://j.mp/f3667F to Maria's BrainPicking site to see Symmetry, a short vimeo film by Radiolab that Maria said "explores the dualities of human existence, best short film you'll see all week".

The film is very clever - it juxaposes images concerning the dualities of existence to explore

"What the origin of the universe has to do with gender identity, binary parallels and anatomy"

I felt disturbed by the juxtaposition of hot chips and tomato sauce, pepsi and coke, popcorn and movies as typical of life on this beautiful planet of ours, but this following image really bothered me

Why does that bother me?

Positioning these images as the gender divide and to represent masculinity and feminity bothers me because of the inclusion of the disabled sign with the woman figure.

Maria says that:

"Symmetry is a mesmerizing split-screen short film exploring the poetic parallels and contrasts of our world — birth and death, heart and brain, masculinity and femininity, all many more of humanity’s fundamental dualities. It’s the best thing you’ll watch all week, we promise"

Given the producers and Maria are cluey in regards to the messages we receive from the visual stimuli around us, it is hard to believe that they didn’t recognise the way this image can subliminally erode women’s sense of self and personal power. Perhaps they didn’t ‘see’ the message the film is sending because that view of women is 'normal' and that makes it all the more fascinating and concerning.

Maria explains that:

"The film was inspired by Radiolab’s Desperately Seeking Symmetry episode, which examines how symmetry and its pursuit shape the core of our existence, from the origins of the universe to what we see when we look in the mirror"

Is that how you see yourself when you look in the mirror?

Here's the film so you can make up your own mind

Read more: http://www.brainpickings.org/index.php/2011/04/20/radiolab-symmetry/#ixzz1K7q855ff

Symmetry from Everynone on Vimeo.

Those of us who are birth workers are very aware of the way that in western culture at least, women are being progressively disabled to birth normally. Women are embodying the messages that birth is something to be medicated... avoided... that being delivered surgically is preferable and 'safer for the baby' even though it is certainly not.

Our connection to 'nature' is eroding and our birth DNA, our wild side, is getting switched off and put under the lock and key of medicalisation.

The grunting, groaning, sweating, swearing, movement and effort associated with giving birth is increasingly perceived as unbefitting modern women. Birth is now sanitised with pretty delivery room decorations and epidurals on demand. I've noticed many partners and other family members feel relieved when the woman is neatly in bed, unable to move and 'painfree' for labour. The fact that they can't push or move and end up with baby extractions either with abdominal or perineal cuts doesn't seem to be an issue. The disablity accompanying the pain and difficulty moving for some time after the baby extraction doesn't seem a problem for anyone either. '

We have to ask what it is about the birth process that causes all this angst about 'pain' in labour. That's probably a topic for another time.

Back to the images in this short film and what they represent. My perception is that the unconscious coupling of a woman with the disabled sign positioned as symmetrical with the male symbol is a striking indicator of how women are culturally constructed as disabled in our world.

The fact that the message is subliminal and that neither the producers, nor those who understand subliminal marketing and neuroscience recognised the message makes it even more powerful and dangerous to women's sense of self, power and place in the world.

And then there is the message about what it means to be female in western society fostered by the likes of the ubiquitous Child Beauty Pageants. As Heidi Davoren, in her column Dirty Laundry for Life & Style section of the Brisbane Times wrote:

"Shame on us as a society that our daughters are groomed into submission, objectification and sexualisation at such a tender age, in the name of entertainment. In fact, in the name of ‘building self-esteem’."

The rampant sexualisation of girls is another powerful and dangerous threat to women's sense of self, power and place in the world.

Raising birthing consciousness: moving beyond cruelty to women and babies

noreply@blogger.com (Carolyn Hastie) — Tue, 19 Apr 2011 11:33:00 +0000

I met a friend for breakfast this morning at a lovely little cafe on the shores of a local lake. My friend is a Calmbirth practitioner and I have had 30 years in private midwifery practice. We are both passionate about sharing information and exploring ideas about birth and parenting with couples. Our conversation involved a lot of animated discussion on the subjects dear to our hearts, including why women chose the care they do.

How women and their partners think about the birth of their babies and choose their care provider and their birth place is intriguing. Women who sought out my midwifery care wanted to know who was going to be with them during their labour and birth, so building trust and understanding during pregnancy was an integral part of their plan. They wanted to ensure privacy and be in control of what happened to them and their baby. They wanted continuity of care into the postnatal period for support. How their baby was born was something they considered deeply; they wanted their babies to be born gently, into a loving environment and for themselves to be as involved as possible. These parents desired to be the first to touch their babies; they sought minimal intervention and to discover the sex of their children themselves. They were fully aware that their baby was a conscious being who participated fully in the labour and birth experience.

According to my friend, women who access her services don't realise there is any other choice but private or public medical care. They didn't consider public maternity care and didn't generally know about midwifery models of care. As they are generally privately insured, they want to "get their monies worth" by employing an obstetrician and having a private room in the hospital. We discussed the way that employing a surgeon usually means you will end up with interventions and surgery.

I told my friend about a video on birth trauma that Gloria Lemay had shared on Facebook (see below) and a post Birth Abuse by Navel Gazing midwife. Routine obstetric management of birth is shown in the video. The video is a compilation of clips are from women's own birth videos collected by a chiropractor and made into this short film. For those not habituated to medical care at birth, these scenes may be distressing, so please take care of yourself when watching this information.

Warning: If you are pregnant, it may be best to give this video a miss as you are better off watching beautiful birth films that inspire and support your birth vision.

Birth Trauma from Centre Quiropràctic Molins on Vimeo.

Both those items and the accompanying comments have really troubled me. That women still emerge from their birthing experiences feeling like they have been abused is a dreadful and indefensible underbelly of maternity care. I left the public system thirty years ago to go into private midwifery practice because of the abuse I'd observed. I've written about that in my master's dissertation.

My friend told me she had been very roughly examined vaginally during the birth of her first baby and how devasted she had felt after that experience. She told me that she felt it was the beginning of her slide into severe postnatal depression with that child and the source of the tremendous fear that she felt with her second pregnancy. My friend said that she didn't stand up for herself at the time and as she was a midwife she 'should have'. Then she said something that really illuminated the whole issue of birth trauma and abuse for me. She said "I should have stood up for myself, but I didn't have the words to do it..."

I thought about the way that women trust their health care practitioner to do the right thing by them and believe their practitioner has their best interests at heart. Obviously, when the practitioner is rough, or behaves differently to what the woman expects, the woman goes into a shock-like biobehavioural state and has a cognitive dissonance experience. Cognitive dissonance experiences are usually difficult to put into words at the time.

A comment on Navel Gazing midwife's blog explored the Roots of birth abuse. The comment sheds some light on the reasons why birth abuse occurs. The big question is how do people (partners, family members, midwives, obstetric nurses, doulas, registrars, paediatricians etc) accept these atrocities committed in the name of obstetric 'care'? Mind you, there is conversation in the various tea rooms across the land that revolves around these issues and I know many doulas lament what they observe in labour wards.

Perhaps in the main, the focus of wanting the baby 'out' and 'alive' means the 'how' and the 'why' pales into insignificance until we 'wake up' to the actual brutality of what is accepted as routine obstetrical management. Until we wake up, we are blind to that reality. Blindness to anything other than that which the person is focused on is called 'inattentional blindness'. An explanation for inattentional blindness can be found in the latest research on how certain neurons actively suppress visual data streaming into the brain. This research informs us that we are only aware of approximately 1% of what's going on around us.

My friend and I discussed ways to provide information to women and men about birth options and ways to raise consciousness about birth choices and effects. How do we help this generation of parents to understand that abdominal birth and vaginal birth are not equal; that the choices they make for their care will have profound effects on the outcomes and their experiences? How do we create a culture where violence against women and babies, even that form of violence couched in terms of 'obstetric care' is unacceptable? How do we lay the foundation of kind, respectful woman centred care in maternity services? How women are treated in their most vulnerable state during childbearing provides a template for how society treats women generally. How do we help parents recognise and engage with the spirit and consciousness of the child that is embodying and being born?

Senate Inquiry re: complaints about midwives

noreply@blogger.com (Carolyn Hastie) — Wed, 13 Apr 2011 14:06:00 +0000

The Australian Senate Finance and Public Administration Committees are holding an Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). On 23 March 2011 the Senate referred the following matter to the Senate Finance and Public Administration Committees for inquiry and report.
Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). Submissions should be received by 14 April 2011. The reporting date is 13 May 2011.

The Committee is seeking written submissions from interested individuals and organisations preferably in electronic form submitted online or sent by email to fpa.sen@aph.gov.au as an attached Adobe PDF or MS Word format document. The email must include full postal address and contact details.

I have just sent my submission to this inquiry.

The situation as it stands is like this report from Kelly at the Belly Belly site:

"There is currently a major problem occurring with the process of complaints about midwives.

Several midwives around the country have had conditions placed on their registration due to complaints. These complaints are mostly from hospital staff when a labouring woman and her partner are transferring from a homebirth. Most of these restrictions demand that the independent midwife can only practice midwifery within a hospital birthing unit. This brings their homebirth practice to a screaming holt, leaving their women without a care provider and the midwife without an income!

The process as it currently stands is this:

The hospital staff or anyone put in a complaint to the Nursing and Midwifery Board (NMB) about a midwife. The Board meet monthly and decide whether the complaint needs to go to investigation or not. In some cases they’ll decide it doesn’t need an investigation and the conditions will automatically go onto the midwives registration.

If they decide it needs investigating they slap ‘interim conditions’ on the midwives registration. In the case of homebirth midwives the conditions are “Must work only in a hospital and under supervision”.

The investigation then goes to the HCCC and the conditions remain on the midwives registration until the investigation is complete.

Basically, it is a matter of midwives being found guilty until proven innocent.

Investigations can take a year or more. This is leaving many women without a midwife (some are 39 weeks pregnant) and leaving midwives without income – and for some it could be a matter of losing their home, as they cannot pay their mortgage etc".

Given that the Collaborative Arrangements Inquiry had thousands of submissions which the committee dutifully ignored, it will be interesting to see what they do with the submissions for this one.

We live in hope that sanity and a 'fair go' for women and midwives will prevail in Australia.

A coroner's perspective on the death of a baby

noreply@blogger.com (Carolyn Hastie) — Thu, 07 Apr 2011 08:52:00 +0000

The coroner, in his report released today on the intrapartum death of a baby girl at a private hospital in Queensland, was critical of both the midwife and the obstetrician involved in the labour and birth care of the mother.

The care was found to be substandard by the coroner on many levels. The midwife was found to have altered the woman's medical records after the event; did not follow hospital protocols regarding monitoring and documentation and did not refer to an obstetrician in a timely manner. The coroner will be reporting the midwife to the Director for Public Prosecutions.

The coroner found the doctor's response to the clinical situation to be ''inadequate" and recommended that he be reported to the hospital board. I wonder why the coroner is not reporting the doctor to the Director of Public Prosecutions too?

The coroner made 21 recommendations from the content of antenatal education and the way they are formatted to the essential nature of good collaborative care for safe care of mothers and their babies.

The president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Dr Rupert Sherwood commented that this case highlighted the reasons why the college "has always insisted on collaborative arrangements between doctors and midwives". He further claimed that there were two aspects of good collaborative care: adherence to protocols and timely referral. Those aspects, while very important, are not the key to what constitutes either collaboration or safe maternity care.

There is no doubt that collaborative maternity care is the safest for both mothers and babies. I have had the supreme good fortune of working collaboratively with a number of skilled, compassionate and insightful obstetricians. I have sadly, had the misfortune of working with the others too. The key to collaborative maternity care provision is the way the organisation is structured. There are two aspects to that positioning. One, that the organisation overtly recognises that birth is a normal natural event which sometimes needs expert and timely intervention. The other, fundamentally crucial aspect is the acceptance and promotion of the woman's right to self determination, evidenced by the woman being treated as an equal partner in the care planning and giving. A woman centred maternity service, where both obstetrics and midwifery AND the organisation has the woman, her wellbeing, her desires, needs & requirements at the centre of their practice leads to the leveling of hierarchies and the destruction of professional 'silos' which engenders an atmosphere of trust with optimal communication. I found in my research that without that organisational structure creating the culture of collaboration, with warm, trusting relationships of mutual respect and woman centred practice, both doctors and midwives lose their emotional and social competence, they act stereotypically, the turf war is in full swing and mothers and their babies suffer.

The loss of this little baby Samara is a tragedy for all concerned. The fact that with good collaborative care, this baby's death could most likely have been avoided is heart wrenchingly tragic.

This coroner's report is a must read for everyone associated with maternity services, from caregivers to managers as it contains important directions and information regarding staffing, culture and practice.

Maternal intelligence: Calling the baby in

noreply@blogger.com (Carolyn Hastie) — Sun, 06 Mar 2011 12:12:00 +0000

I've just read the most intense and illuminating blog post of a woman's birth story.

Rixa, of Stand and Deliver fame, posted the story of her baby Inga's unintended unassisted birth at home. One of my favourite comments, showing Rixa's wonderful presence of mind is when she was seeking to understand how close to birth she was...

"I knelt and reached inside. Sure enough, there was a hard round head about two knuckles deep. I felt around for a while, trying to figure out what was what. With all of the folded tissues and wrinkly baby’s head, it’s sometimes hard to tell where you end and baby begins!"

Baby Inga needed resuscitation, which Rixa did brilliantly. You can see how Rixa managed the resuscitation of her baby with great mindfulness and focussed attention in the second video on her blog about Inga's birth.

Rixa explained that she had been certified in neonatal resuscitation a few years before. I'm not sure what other midwives do, but for anyone I considered could labour and birth quickly, I made a point of taking them through resuscitation of the newborn in case the baby arrived before I did. These days I recognise everyone needs that information, both for birth and beyond. We never know when those skills may come in handy; a woman told me that she was so glad I'd taught her as she had resuscitated a friend's child who fell in a swimming pool.

In terms of a newborn's transition to extrauterine life, certainly having the cord intact helps. Anyone who has seen a newborn with the cord clamped and cut immediately at birth would recognise the extra effort it takes for those babies to ground themselves and recover from the birth process.

Watching Rixa resuscitate her baby with five quick breaths and words of encouragement is a useful and informative experience for anyone to view. The way she talks to her baby is so important and I encourage mothers and fathers to do the same when they are in labour and when the baby is born. "Calling the baby in" to its body is an essential part of the birth and transition to extrauterine life process and the importance is an understanding shared by indigenous cultures and homebirth midwives. "Calling the baby in" is a recognition of the spiritual essence or consciousness of the baby and indicates an understanding of the way that the spirit can separate from the body (also known as 'out of body' experiences) during intensely emotional and/or challenging times. My personal view is that a mindfully aware, welcoming and lovingly focussed on the baby mother (and father) is the most important safety feature of labour and birth.

Rixa's birth and action to help her baby reminded me of the maternal intelligence in this video (following) of an elephant mother. Some people may be offended by the association of an animal's behaviour with that of a human. However it is important to recognise that scientists use animals in all sorts of ways to see how they respond to get insights into human experience and behaviour. Therefore it is highly appropriate to think about the commonalities in these two mothers and their attention to the needs of their newborn babies. We are wiser with the way we treat animals as we realise we have to leave them alone to birth normally. We recognise that surveillance and well meaning intervention does more harm that good with animals. We have yet to fully appreciate that with human labour and birth.

The elephant mother is Nikki, her baby is Riski. Note the mindful attending presence of the elephant mother and the way she calls her baby in. Watch the baby's eye as the spirit enters and stays.

Whatever your perspective about spirit, consciousness, birth, danger, surveillance, mother's innate intelligence, newborn babies resilience etc, these videos and the maternal intelligence that is evident in these videos invites us to think deeply about these matters.

Birth Genius

noreply@blogger.com (Carolyn Hastie) — Sun, 06 Feb 2011 11:35:00 +0000

Birth is amazing.

Women's embodied wisdom about birth is brilliant and babies ability to be born is stunning. Both geniuses come together when they are supported wisely in an optimal environment to express their innate ability and intelligence.

Trust, both of self and the others in the birth environment by the woman is a powerful mediator for birth to go well.

The others have to be trustworthy though.

This video gives an excellent example of genius in action.

I would have loved to see the woman hold the baby, the cord to have been left intact and the film to have shown the placenta being born. I do love seeing this video of the birth of this footling breech baby with the cord around it's neck three times. I've watched it quite a few times!

There is something exquisitely satisfying about an example of everything being right with something that others say is wrong or dangerous. An example of natural intelligence in action.

The gentle way the practitioner held and touched that baby was delightful and reverent, as it is meant to be.

I couldn't help but compare that behaviour of the doctor in the video to the behaviour I saw recently at a birth.

The doctor kept poking and pushing at the baby's head as it was being born. The doctor then pulled the head around, twisting the neck the wrong way ( I said where the back was on palpation; that information was ignored). Then, obviously worried about the possibility of shoulder dystocia, the doctor proceeded to tug the baby out.

The woman tore and needed sutures (not as bad as last time apparently!).

I felt strongly that the meddling caused the tearing. She had been labouring in a quiet, self managed way and if she had been supported to push that baby out with her urges, with patience and direction to push gently between contractions, she could have avoided the tear.

I guess surgeons don't have a problem with suturing, after all, it's their bread and butter.

For the woman, however, it's her body and good to keep intact.

I also recognise that the recumbent position leaves women open to being 'manhandled' during birth. An upright position makes touching so much more difficult. I suspect that the vulnerabilty inherent in the recumbent position makes touching and manipulation 'ok' whereas when a woman is upright, she is more in her power. I wonder if her size in an upright position appears bigger and therefore less vulnerable? Lying down was her choice and of course, should not be an invitation to unnecessary interference. I wonder if lying down on our back triggers the primitive brain region to assume dominance in those that are upright?

When Tracy Donegan read this post, she sent me an article about positions of power posing and neuroendocrine effects. Thanks for this information Tracy!

Another beautiful example of breech birth is given by Lisa Barrett on her blog. One of my favourite photos of birth is in the photo essay.

Lots to think about here.

The Secret to Blogging?

noreply@blogger.com (Carolyn Hastie) — Thu, 03 Feb 2011 14:06:00 +0000

I called this blog 'ThinkBirth' because as a midwife, I've thought a lot about birth, women's experiences, babies experiences, men's experiences, midwife and doctor relationships, pregnancy, breastfeeding ... you get the idea

and of course, I can make anything relate to childbearing - nutrition, exercise, brain development, epigenetics etc and of course all these topics do, in one way or another.

That reality is probably one of the challenges that comes with having a deeply developed holistic viewpoint :-) everything seems relevant.

There are some fabulous midwifery and birth related blogs out there. Midwife Thinking for example is a well written, incredibly practical, well researched blog. Some are very scientific and challenge the status quo like Science and Sensibility and some, like Midwife Mutiny have lots of lovely birth stories and share controversial ideas about midwifery.

There are a zillion others. What makes people want to read a blog? What inspires people to comment, to engage in conversation about the subject of the posting?

To find out, I've been paying attention as I read different sites and explore various subject areas. I've been observing what attracts me

(and lots of things do, surprise, surprise!)

There are lots of experts giving advice on what makes a great blog. The most consistent suggestion seems to be to focus on your niche when you write.

Find the area that fascinates you, the area you know most about and blog about that.

That advice gave me a bit of a jolt. I tend to be wide ranging in what I put on this blog. Because I'm a curious person, I find lots of things that interest me. I also love sharing information and ideas, so anything that 'grabs' me, I think you may be interested in too.

But perhaps my approach is wrong. Maybe you would really enjoy or prefer a niche blog.

What would you like? Stories? ideas? guest bloggers? a focus on a particular area to do with childbearing (the skies the limit there!) for example, preconceptual matters, prenatal matters?

Midwifery students?

Education?

Take a minute and drop me a note. Let me know what you think/want. I'd love your feedback. I look forward to your comments.

Carolyn

The Umbilical Cord: Why do we clamp it?

noreply@blogger.com (Carolyn Hastie) — Mon, 31 Jan 2011 03:25:00 +0000

Clamping the umbilical cord immediately at birth was something that I was taught to do as a routine part of 'delivery' management. The reason for clamping the cord so quickly, I was told, was to stop the baby getting unnecessary blood because the extra blood would be all the more for the baby to process and they would be at risk of becoming jaundiced, caused by the breakdown of all the fetal blood cells. A nuchal cord (cord around the neck of the baby) was felt for and cut before the shoulders and rest of the baby was born.

Added to the problem of extra blood with an uncut cord, was the fact that the woman was routinely injected with a synthetic form of oxytocin to hasten third stage. The injection of the synthetic oxytocic in third stage made the uterus contract. Authorities believed that if the cord wasn't cut swiftly, the uterine contractions caused by the injection would cause an even greater surge of blood into the new baby, causing the baby to be overloaded with blood and at even more risk of jaundice.

Once I started working with childbearing women in a one to one way in private practice, the need to clamp and cut the umbilical cord immediately at birth was challenged by the women I worked with. They wanted the cord to be left alone until it stopped pulsating. Some even wanted the placenta to be born before the cord was cut. A few wanted the placenta and cord to be left attached to the baby and allowed to drop off itself, a process called Lotus birth.

The literature was mixed in regards to the advisability of leaving the cord to pulsate or clamping immediately. The opposed camps had reasons such as jaundice, blood volume, postpartum haemorrhage rates to explain their particular views and reasons for their recommendations. The reasons for cutting the cord have been proven to be spurious. There is however a lot of evidence for leaving the cord alone. Women and midwives have been talking about and promoting leaving the cord alone as a best practice strategy for several decades now and the evidence for doing so is only getting stronger. Have a look at the way the cord changes in the minutes after birth. The evidence for leaving the cord intact is also clear in the case of nuchal cords. Leaving them alone, gently 'somersaulting' the baby to untangle the cord as the baby is born works perfectly and there is no risk of having the baby's oxygen supply prematurely interrupted. As beautifully explained on the Midwife thinking blog, the oxygen carring capacity of an intact cord is the baby's first line of resuscitation after birth. Our medical colleagues have been slower to take up the idea of leaving the cord alone. However a recent report, has confirmed that iron stores are improved when the cord is left to stop pulsating.

Hope for a more balanced approach to the topic of cord clamping or leaving it alone is on the horizon as an obstetric doctor in the US has written about what he calls 'delayed cord clamping' and has produced the following videos for The Grand Rounds on this topic.

For more information on the umbilical cord and placenta, go to Rachel Reed's Midwife Thinking blog. There is a post on the placenta in birth films on this blog here.

Another aspect that hasn't really been explored in great detail as yet, is the perfusion of the newborn's brain at birth. My thinking is that leaving the cord alone allows the newborn's brain to be optimally perfused and ensures that the neuronal connections that proliferate in response to birth to wire in the best possible way, especially when the baby is skin to skin with her/his mother and exposed to the multisensory stimulation that occurs in a physiologically mediated birthing experience. The question to be asked is "do babies suffer subtle brain damage through premature clamping of the cord and less than optimal sensory experiences at birth?" I suspect they do.

Some women want the cord clamped and pulled to get the placenta out as quickly as possible, others see the placenta as the spiritual twin of the baby and want to keep the baby and placenta together. There are many reasons for leaving the transition to extrauterine life and resuscitation system alone, what's your view?

I can see the day dawning when we look back and say "remember when we used to think that cutting the umbilical cord prematurely was a good thing to do" with incredulous amazement.

Explaining Tongue Tie

noreply@blogger.com (Carolyn Hastie) — Sun, 09 Jan 2011 21:21:00 +0000

Tongue tie, officially known as Ankyloglossia, is one of those developmental 'glitches' that can cause big and life long problems for the person with it and disrupt their ability to breastfeed. The inability to properly latch onto a mother's breast that comes with the condition of Ankyloglossia can make makes breastfeeding, which should be a source of joy and satisfaction, into a nightmare of pain and suffering for the woman.

All babies should be checked for tongue tie at birth. Midwives and doctors should ensure the baby's tongue can move freely and fully extend in a thrusting movement. If there is any twisting or 'pull back' into a heartshape of the tongue tip, the baby is most likely tongue tied. This brochure shows you how to check and identify if a baby is tongue tied.

Treatment of 'tongue tie' has gone through different 'fashions'. The last few decades have seen a lack of recognition of this problem and when identified, a real reluctance to treat it. This widespread ignorance has caused many oral and developmental problems for the children and breastfeeding 'failure' for women who rightfully, couldn't bear the pain and trauma to their nipples caused by their babies inability to attach themselves to the breast. Treatment has been the source of a much controversy. Some experts advise taking a 'wait and see' approach and delaying any surgical intervention until the child is older. This 'wait and see' approach is associated with speech and normal mouth development disruptions and lactation failure.

Thankfully, due to the work and care of a few dedicated lactation consultants and paediatric doctors, the condition and ensuing problems are increasingly recognised. In the last few years, appropriate correction of the defect is being instituted with excellent results.

This brochure has been produced by a paediatric dentist and demonstrates the various forms of Ankyglossia (tongue tie) - the photos are excellent. The problems this condition can produce long term are given and treatment options are explained.

If any woman has problems with sore and damaged nipples, ensure your midwife or doctor checks your baby's mouth for tongue tie. The brochure also shows you how to check yourself. Sometimes the tongue tie can be 'occult' that is, not obvious when looking, you have to feel under the tongue against the base of it to identify the tethering.

If the link for the brochure doesn't work, look on Dr Kotlow's website for it

Another resource is the excellent milk matters site and this post on tongue tie as the hidden cause of feeding problems.

Health Care Hashtags Resource on Twitter

noreply@blogger.com (Carolyn Hastie) — Sat, 11 Dec 2010 23:06:00 +0000

I've been learning more and more about Twitter.

Twitter is a great resource for information about anything you may find interesting. The river of tweets provides ongoing and rapidly changing news headlines. Tweets are text-based posts of up to 140 characters displayed on the user's profile page. At any moment, you can see what people are experiencing, what is important to them and what they are thinking. If the topic of the 'tweet' is your subject area, then you can choose to interact or not. The stream of information lets you know something of interest about what is important to you. Of course, it's sensible to only 'follow' people who's work/life and/or philosophy is of interest to you.

Last week, in response to something I tweeted, I was invited to join a scheduled twitter chat about the use of social media and healthcare on Sunday night. Here's the link to the conversation. As the benefits of social media in health care, in particular, maternity services and information sharing, is of great interest to me, I joined in. I found the process confusing at first. The conversation is like being at a big party where everyone is talking at once. If you read the transcript of the session you will see what I mean.

How amazing that a transcript of the event can be produced and stored in a virtual file to be accessed at any time! That resource is so useful to me. I was able to return to the information and read it at my leisure. What's the purpose you may ask? That conversation has much to offer. I was looking for links to any useful information; I wanted to check out how others are thinking about the use of social media, the benefits and pitfalls of doing so. I was also interested in how practitioners are talking about ways to keep professionally safe using the medium; all of which and there was much more in that conversation to explore, provides food for thought.

For those of you who are interested in health care, Twitter offers a real opportunity to engage in real time with people from anywhere in the world about your topic of interest, from the comfort of your own home/computer. No need to travel and lose time in getting to different parts of the world to learn from people who know what you want to know; the only expense is your computer and internet server/connection. A really important and liberating aspect of Twitter is that there is no 'status' to get in the way of discussion or communication on Twitter. People who are technology nerds, CEO's, journalists, mothers, fathers, PhD's, scientists of all kinds, anyone who is interested, communicate and collaborate in an open, respectful way about their chosen topic. If anyone is not respectful, they are 'unfollowed' - no one is interested in 'fighting' or engaging with those who 'troll' and disrupt.

This morning, when I was checking the twitterstream # tags for twitterchats on health care and the use of social media (#hcsm and #hcsmanz), I found a tweet about a site that compiled all the twitter conversations about different aspects of health care. That site is found here. I noted that midwifery didn't have a hashtag, so have filled out the form to create a midwifery presence on that site. I've just been exploring the site that hosts the hashtag directory and that web page is interesting too, well worth having a look at and considering what an online presence is all about.

If you are interested in exploring the conversation about health care and social media tonight (Sunday) on twitter, join us using the hashtag #hcsmanz in your twitter posts. If you are not yet on Twitter, go here to learn about Twitter and to open up an account (it's free) and start tweeting! You can 'follow' me - which means you follow my conversation. You can tweet back anytime you like in response to any tweet. If you do follow me, then put the hashtag #hcsmanz in the tweet. After you post, you can click on the hashtag and that will take you to the list of tweets about that subject. Then you can save that search as a list which can be accessed, with updates, at any time.

I look forward to our conversations on Twitter.

What do you think, will I see you there? Comments and questions welcome.

What effect does ultrasound have on growth restricted babies?

noreply@blogger.com (Carolyn Hastie) — Mon, 06 Dec 2010 13:12:00 +0000

Some years ago, a research project from WA suggested that babies who were repeatedly subjected to ultrasound to check their growth, were in fact even smaller because of that ultrasound intervention. That idea was dismissed later because the babies did not seem to have any long term effect.

A midwifery colleague asked on an email midwifery list if anyone knew of any follow up studies to that work done in Perth, WA.

This question piqued my interest, so I had a look at the effect of ultrasound on cells. Ultrasound is used therapeutically for various physical problems e.g. rehab and to detect fetal anomalies.

I've fallen in love with cells lately and am finding them eminently fascinating.

This human physiology site has some wonderful graphics about cells, such as the one below, including simulated videos of cell structure, function and behaviour. Well worth exploring!

I found some links with information worth investigating:

This article explains how ultrasound can blow holes in cell membranes

http://gtresearchnews.gatech.edu/newsrelease/ultrasound.htm

a great drawing of a cell membrane from WikiBooks

and the following abstract has a bit more on holes and bubbles

http://www.ncbi.nlm.nih.gov/pubmed/16785012

This article is aimed at horticultural interests. How amazing it is what ultrasound can do at different intensities

http://www.hielscher.com/ultrasonics/extraction_01.htm

and I quote from the above article:

"It showed that ultrasound is capable to peptize soy protein at almost any commercial throughput and that the sonication energy required was the lowest, when thicker slurries were used. (Moulton et al. 1982)"

Not that we can call the substance in human cells 'slurry' but I wonder if the density of that substance affects the way that ultrasound works in pregnancy?

and just what is ultrasound doing to bones?

http://www.ncbi.nlm.nih.gov/pubmed/17706764?holding=utmemlib_fft_ndi&myncbishare=utmem

Cancer cells get blasted with high intensity ultrasound, however, I wonder what ultrasound does to fetal mitochondria?

http://www.highbeam.com/doc/1G1-219200153.html

You need to sign up to get the whole article

A 3D reconstruction of microtubules - the skeleton of the cell

low pressure and high pressure effects on cells noted in this abstract from Japanese investigators

http://sciencelinks.jp/j-east/article/200317/000020031703A0538751.php

and from Czech Republic, microtubules and microfilaments (essential cell components) are the subject of examination when ultrasound is coupled with cytostatic drugs in this study reported below:

http://www.muni.cz/research/publications/377561

microfilaments provide shape, movement and support for cells, particularly muscle cells

and then E Coli were not that fussed on ultrasound:

http://www.scribd.com/doc/8567360/The-effect-of-ultrasound-on-Escherichia-coli-viability

That article is particularly good and easy to read. I was a bit uncomfortable when I read that the researchers noted: "cell viability decreased exponentially with time at different intensities of ultrasound"

However, there are some amazing therapeutic applications for ultrasound as explained in this video by Yoav Medan, who with his team is "developing a tool for incision-less surgery via focused ultrasound". In this video, the techniques are explained and in the comments, you will see that someone has asked about the safety of ultrasound in pregnancy. The reply is that ultrasound is safe in pregnancy as the frequncy used scan a fetus is lower than that used elsewhere.

These following studies are particularly interesting when we consider fetal growth restriction from ultrasound, as this one focuses on what happens to fat cells with rats

http://academic.research.microsoft.com/Paper/10626545.aspx

and this one with men

http://prodactaessentials.com/weight-loss/effect-of-ultrasound-application-on-fat-mobilization/

That last couple are fascinating aren't they? Do you think that gives us a bit of a window into what may be going on with the observations around ultrasound adding to growth restricted babies' physical development?

The question is, what can we do differently? I have some ideas on that. Look for another blog post on this subject.

Just to add another lens on this fat shrinking/blasting idea, here's how the ultrasound machine makers are reaping the benefits of this versatile technology in another realm of people's fears - the 'perfect body syndrome' also disguised as the 'obesity epidemic' with 'fat' as the enemy.

21 strategies to help keep birth normal

noreply@blogger.com (Carolyn Hastie) — Sun, 14 Nov 2010 01:06:00 +0000

NSW Health has released a policy aimed to help with increasing the rates of normal birth and decreasing surgical births. Called Towards Normal Birth, the policy "provides direction to NSW maternity services regarding actions" to achieve those aims.

At a recent conference with about 100 midwives looking at why and how to "keep birth normal' and what we as midwives need to do, a brainstorming session produced the following list. These strategies run from the big ticket culture change items to the seemingly small, but profoundly effective 'watch our language' individual action.

The list:
1. Avert the medical 'gaze'
2. Be powerful and able to negotiate as equals to doctors
3. Establish a "round table culture'
4. Dispel 'urban myths' about birth
5. Support women to choose upright positions in labour
6. Educate teenagers
7. Promote the use of positive images of birth
8. Look at system issues: promote and change to woman centred midwifery models
9. Discuss what normal birth means to us and ensure we are talking about the same things
10. Listen to women with respect - what does the woman want?
11. Encourage women in labour to stay home as long as possible
12. Establish and provide support structures to help women stay at home in early labour
13.Establish and provide support structures so women can choose to stay home to give birth if desired
14. Examine our own attitudes to 'being with woman' in pain and uncertainty
15. Seek to establish a relationship with each woman
16. Allay fear: let woman know what birth is really about
17. Address anxiety of support people and other health professionals
18. Pay attention to the language we use
19. Have confidence in women's ability to give birth
20. Pay attention to our body language as body language conveys meaning: what are we saying?
21. Set up birth space intentionally - find out what makes each woman feel safe and do that.

Each of these strategies could be a blog post on its own! What do you think? What else can we do? How do we put these strategies into practice?