Tuesday 23 December 2008

Garling Report

That fact that the NSW Health System is in crisis led to the appointment of Mr Peter Garling SC to conduct a review of the acute health care services in NSW in January 2008.

On 27th November, 2008, Mr Garling released his report. Terms of Reference and the report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index

The report makes sobering and fascinating reading as Mr Garling outlines the problems which are troubling our health care system, for example, problems such as increased numbers of people accessing health care facilities. Mr Garling praised the skill, competence and dedication of the health care staff, but outlines many changes which need to occur for the health care system to improve. A particularly important point that Garling makes is that "Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

These comments by Garling demonstrate his deep recognition of the power dynamics which are keeping the health care system stuck in its medieval origins and which mitigate against true efficiency and effectiveness for patients well being. Even though Garling only mentions nurse-doctor working relations, his comments are very applicable to the power dynamics which trouble maternity services. His words echo the conclusions of my study into midwife-doctor interactions in the care of birthing women.

thesis available on line here: http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509

The NSW Government is wanting feedback on the Garling Report. You can give feedback here:

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please take a moment to give feedback on this important report. In my feedback I've talked about how birth is normal and that we are seeing iatrogenic outcomes because birth has been treated as an illness. I've argued for an expansion of 1-2-1 midwifery services and talked about how mothers and babies are safer when women feel valued, listen to, respected and given information and then able to make choices which are actioned.

Imagine if we all gave this feedback?

Saturday 6 December 2008

50 Qualities of Successful People

If you stroll along the bookshelves of any book store, you will find hundreds of books telling you how to be successful in many, diverse fields. When you analyse what the books are saying, they all point to the ability to maintain an optimistic attitude in the face of difficult and/or challenging circumstances, as well as the ability to self manage/regulate as foundational requirements for success.

For parents and midwives, success means happy healthy mothers and babies. Happy, healthy mothers and babies are more likely when stressors are managed well. The enormous changes that pregnancy can bring can be challenging and lead to feelings of stress and even distress for some people. The reality is that for all of us, stressful reactions involves chemical messengers which can play havoc with our physiology. Anything we can do to learn to manage stressors in our lives well is a vitally important thing to do for our health and wellbeing.

I found this list of qualities of successful people on Lifehack. When I looked at the list, I realised that the qualities I read there were those of midwives I really admired. I also recognised that the women and men who moved into parenting in the most optimal way displayed these qualities. It seemed to me that all of us could use the benefits these qualities bring and that steady, consistent adoption of these qualities in our lives can make our lives really wonderful.

1. They look for and find opportunities where others see nothing.

2. They find lessons while others only see problems.

3. They are solution focused.

4. They consciously and methodically create their own success.

5. They may be fearful, but they are not controlled or limited by fear.

6. They ask the right questions -- the ones which put them in a positive mindset and emotional state.

7. They rarely complain.

8. They don’t blame, and take complete responsibility for their actions and outcomes.

9. They always find a way to maximize their potential, and use what they have effectively.

10. They are busy, productive and proactive.

11. They align themselves with like-minded people.

12. They are ambitious.

13. They have clarity and certainty about what they want.

14. They innovate instead of imitate.

15. They don’t procrastinate.

16. They are life-long learners.

17. They are glass half full people, while still being practical and down-to-earth.

18. They consistently do what they need to do, regardless of how they are feeling on a given day.

19. They take calculated risks.

20. They deal with problems quickly and effectively.

21. They don’t believe in, or wait for, fate, destiny, chance or luck.

22. They take action before they have to.

23. They are more effective than most at managing their emotions.

24. They are good communicators.

25. They have a plan for their life and they work methodically to turn that plan into a reality.

26. They become exceptional by choice.

27. They work through the tough stuff that most would avoid.

28. They have identified what is important to them and they do their best to live a life which is reflective of those values.

29. They have balance. They know that money is a tool and ultimately, it’s just another resource.

30. They understand the importance of discipline and self-control.

31. They are secure in their sense of self-worth.

32. They are generous and kind.

33. They are happy to admit mistakes and apologize.

34. They are adaptable and embrace change.

35. They keep themselves in shape physically.

36. They work hard and are not lazy.

37. They are resilient.

38. They are open to, and more likely to act upon, feedback.

39. They don’t hang out with toxic people.

40. They don’t invest time or emotional energy into uncontrollable things.

41. They are happy to swim against the tide.

42. They comfortable with their own company.

43. They set high standards for themselves.

44. They don’t rationalize failure.

45. They know how to relax, enjoy what they have in their life and to have fun.

46. Their career is not their identity, it’s their job.

47. They are more interested in what is effective than in what is easy.

48. They finish what they start.

49. They realize that not only are they physical and psychological beings, but emotional and spiritual creatures as well.

50. They practice what they preach.

Lifehack May 12, 2008

Friday 5 December 2008

Garling Report

Adverse publicity ensured the shortcomings of the NSW Health System were spotlighted and it was widely recognised that acute care services were in crisis. On the 29th January 2008, the NSW Governor appointed Mr Peter Garling SC to inquire into and report upon matters falling within the Terms of Reference (link available below).

On the 27th November, 2008, the Final Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals Overview was presented to the NSW Government and released to the public.

The report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/vwFiles/E_Overview.pdf/$file/E_Overview.pdf

The report makes sobering and fascinating reading as Mr Garling highlights the troubled aspects of our health care system. Garling is impressed by the skill, dedication and competence of health care service staff but notes that many things need to change so that staff can work more effectively. Of particular importance, Garling notes:

"Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

This is a very positive comment and fits with the thesis of my research into midwives and doctors interactions in the care of birthing women. I know Garling only mentions nursing staff in this statement, but it is equally applicable to maternity care issues, if not even more so, given that childbirth is, above all else, a healthy process suffering from iatrogenic outcomes.

You can access the terms of reference here:

Terms of reference

http://www.lawlink.nsw.gov.au/lawlink/special_projects/ll_splprojects.nsf/pages/acsi_terms

The Garling Report is available for comment and the link to the comment pages is here:


Feedback on Garling Report

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please have your say and make the point that maternity services need to be focussed on what keeps women and babies safe. Women and babies are safer when the services which are being provided are women centered, that is respectful of and listening to women's concerns, questions,ideas and choices and ensuring that women's choices are implemented. It is also about ensuring that the profession that is expert in working with women to keep birth normal, that is midwives, are primary care givers.

Sunday 30 November 2008

My thesis on line

Hi everyone, here is the link to my thesis "Putting women first: Interprofessional Integrative Power"

You can download it here:

http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509

I'm interested in your comments.

Carolyn

Saturday 29 November 2008

Breastfeeding

This post is for questions about breastfeeding. I'll answer to the best of my ability, if I don't know, I'll find out. love, Carolyn

Pregnancy

This thread is for anyone who wishes to ask questions about pregnancy. Please drop me a line and I'll answer to the best of my ability. If I don't know, I'll find out. love, Carolyn

Sunday 16 November 2008

Women rallying across Australia for 1-2-1 midwifery care and The Age misses the point!

Women rallied across Australia today in support of 1-2-1 midwifery care in the wake of the close of submissions to the National Maternity Services Review.

The Age newspaper runs a story with the headline "Huge rise in obese mums-to-be"
Jill Stark November 16, 2008

The article says

"A RISE in the number of obese women becoming pregnant has sparked calls for more vigilant monitoring and weighing of expectant mothers, amid fears babies' lives are being put at risk.

Specialists at leading Melbourne hospitals have told The Sunday Age that women with pre-pregnancy weights of 150 kilograms or more are increasingly common, with some then adding up to 30 kilograms before giving birth — around three times the recommended weight gain of 7 kilograms to 12 kilograms.

The mothers' excess fat is posing serious challenges for medical staff, who are struggling to detect babies on ultrasound machines and monitor their heart rates. Many of the women suffer obesity-related diabetes and high blood pressure, with their size tripling their babies' risk of sudden death or birth defects.

Pregnancies for very large women are considered so risky that most hospitals are turning away expectant mothers with a body mass index higher than 35 or 40. A healthy BMI is 20 to 25."

That's all true of course and worthy of concern. However, two things are of interest here. One is that this story was run when, on the same day, there was a women led rally for better maternity care options. This article could be seen as an effort to keep women in their place and interestingly, the article was written by a woman!

The other interesting and not mentioned fact is that circulating and unremitting levels of stress hormones are part of the problem in the obesity epidemic. Stress hormones interfere with healthy physiology and disrupt growth and repair mechanisms. This means that women are more likely to become fatter as high stress hormone levels interfere with glucose and insulin pathways.

Pregnant women and their babies are vulnerable to the stress caused by ever increasing social pressures. When childbearing women feel loved and cared for, and are able to talk with their midwife about the things that are bothering them, their stress hormones are lower, they feel more in control with what happens to them and their clinical outcomes are improved.

One to one midwifery care, where the focus is on the woman and her needs and wants, has far ranging health and wellbeing benefits for mothers and babies.

Thank goodness Nicola Roxon appears to be listening to good science, rather than scare mongering, power plays and sensationalism.

Thursday 13 November 2008

It's not Failure to Progress, it's the Quantum Zeno Effect: time to apply quantum physics to reproduction

I was reading Jeffrey Schwartz's book "The Mind and the Brain: Neuroplasticity and the power of mental force" and came across the concept of the Quantum Zeno effect.

Quantum physics says that when something is observed, the observer affects what is observed. Quantum Zeno effect is when at the atomic level, physicists can measure whether an atom is in its original state or not. They have found by carrying out these measurements repeatedly and rapidly, they can hold the atom in its initial state.

That's the 'watched pot' effect.



Schwartz writes "taken to the extreme, observing continuously whether an atom is in a certain quantum state keeps it in that state forever... the mere act of rapidly asking questions of a quantum system, freezes it in a particular state, preventing it from evolving as it would if we weren't peeking. Simply observing a quantum system suppresses certain of its transitions to other states".

I immediately thought of labouring women and how, when they, their process and their progress are being watched with impatience, by either relatives, themselves or their care providers, how labour frequently stalls.

What we are observing here is the Quantum Zeno effect. Also known as the watched pot effect - you know how the pot takes forever to boil when we are watching it impatiently, ready to add the vegetables, or when we are standing around waiting for the kettle to boil for our lovely cup of tea! After a while of standing there and impatiently waiting, looking to see if it has boiled yet, we give up and go off and do something to fill in the time. We've taken our attention off the kettle and the kettle boils in a heartbeat.

 I notice that stretching of time when I'm at an intersection and waiting for a space to pull out into - whenever I'm impatient, a space is so long coming, but when I'm calm and 'know' a space in the traffic is coming, it is there in an instant.

Thinking about Quantum Zeno Effect and how impatience can be seen to slow things down is fascinating. We can apply it to so many of our day to day experiences.

And that's why, when the impatient relative goes out of the room, there is a staff change or something happens that takes the focus off 'watching' the woman, the woman suddenly progresses ...

If the woman can be encouraged to move and do something different ... the energy shifts and she progresses...and if the health care provider changes... she suddenly progresses...

The problem is when a woman who is progressing well has the Quantum Zeno effect triggered by an unhelpful change in her environment. If her relatives or support people start getting bored and watching the clock; if her health care provider changes and she gets one who is an efficiency expert and starts watching her and the clock, the watchfulness, impatience and focus on signs of progress of those in attendance and/or herself will increase. That impatient, measuring behaviour invokes what Schwarz described above as
 "the observer repeatedly in quick succession or constantly and closely observes something, it can freeze that something in place for a long time. The particles of the 'something' are held in position, and so interferes with the dynamic evolution of that system"
 In the case of the labouring woman, the woman is the something whose particles are being effected by the watching and measuring, all too frequently causing her labour to stall - leading to a longer than necessary labour and even worse, a diagnosis of 'failure to progress'.

I'm thinking too about when women are under the 'count down' when they are 'due' and the pressure that comes to bear on 'haven't you had that baby yet' from relatives and the threat of induction if women go past their 'due date'. The 'waiting for labour' to start with pressure from both inside and outside herself may cause a woman to look frequently for signs of labour - is there a 'show'? any fluid? any discomfort? which unwittingly triggers the Quantum Zeno Effect and the woman's physiology goes into a 'holding pattern' which stalls the woman's progression to labour.

Other applications of the Quantum Zeno Effect could include 'trying to get pregnant'. How many people do you know who gave up 'trying' and got pregnant?

And the list goes on ...

Birthing women do best in a supportive loving environment, not a judgemental one.  Judgement slows things down and even stops it altogether. True of life, true of birth.

Time to call it for what it is... it's not 'failure to progress' it's the Quantum Zeno effect!



3rd November 2014

Addendum:

The Guardian has published a wonderful piece today on the emerging application of quantum physics to biology.  This article is well worth reading as you will find it explains how scientists are starting to see the way that quantum physics/mechanics makes sense of biological phenomena that previously seemed mysterious.  These are exciting understandings for us a species.

The application of quantum physics/mechanics to biology is of immense interest to midwifery for what it means for the care of childbearing women. This new application should be of immense interest to all people who are engaged in the provision of maternity services in whatever way they are involved.  Understanding how childbearing women are affected on the quantum level and applying that understanding  to the way maternity services are managed and provided has huge social and financial implication, don't you think?



Sunday 26 October 2008

My submission for the Maternity Services Review

Submission to the National Maternity Services Review
October 2008
Submitted by: Carolyn Hastie RM, RN, Grad Dip Primary Health Care, IBCLC, Master of Philosophy

Introduction
The current system of maternity service provision in Australia disempowers women in both birth and motherhood (1). Modern maternity care is also plagued with communication failures and turf wars, none of which advantages women and their babies(2, 3). The history of maternity care in Australia is replete with stories of medical domination, midwifery subordination and women being left out or caught in the middle of the warring factions(4, 5). Adverse outcomes in health and maternity care are linked to poor communication (6, 7) and while efforts have been made to improve relationships through workshops and policies promoting teamwork between doctors and midwives, these strategies are insufficient on their own to change the culture (8). The way that the maternity care system is organised must be changed if there is to be any real benefit to childbearing women and their babies. That is because organisational factors are more important than the personalities of the individuals involved in providing maternity care. Organisational factors frame, direct and limit what discourses and therefore behaviours are possible(8). The problem is the underlying structure of health service delivery which gives preference and privilege to one group over another and the enormous power imbalance this system of preferential treatment creates. As the history of maternity services demonstrates, the enormous power imbalance inherent in modern maternity care creates tensions, underhanded practices, over inflated personalities and unsatisfied women. It also produces avoidable adverse outcomes for women and babies(8).

When there is a women centred approach to service delivery, then team work, collaboration, good interprofessional relationships and optimal outcomes for mother and baby are more likely to occur (8). A woman centred approach in maternity care means the care is individualised. The woman is regarded as an autonomous being who is the expert on herself and the best person suited to care for her baby. The woman has the right to be self determining and have control over what happens to her. She has the right to be fully involved in decision making about her care (9). When a woman feels in control, her stress hormones are reduced, enabling her physiology to work in optimal ways, keeping mothers and babies safer (10, 11). In this model, the midwife and doctor establish a partnership with the woman to meet her needs within the context of her childbearing experience. Australia needs a primary health care, woman and family-focused approach to maternity services, which addresses this empowerment issue while providing safe and effective maternity services. (1) A major challenge is that the concept of collaboration for doctors tends to mean midwifery cooperation and submission to medical authority (8). Midwives, however, view collaboration as meaning equal relationships based on professional recognition and respect with a common goal (8). For midwifery, that goal is women centred care. Any organisational effort designed to improve collaboration and outcomes of maternity care will fail unless or until we have a woman centred approach to care provision (8). For a true women centred approach to be made a reality, it must be coupled with successful interventions that move towards disbanding professional silos, instituting genuine dialogic relationships between midwives and doctors as well as addressing social and emotional intelligence and competence in both professional groups (8).

Barriers to equitable, effective and sustainable maternity care

Commonwealth policies and processes are contributing to the lack of women’s access to choice and quality in maternity care and reduced economic effectiveness in the following ways:
• The current organisation of maternity services is geared to the needs of the health professional, particularly medical, rather than the woman’s needs.
• Funding arrangements which perpetuate medical dominance in maternity services and subjugates other professional bodies, such as midwives
• Exclusion of midwives from access to Medicare provider numbers creates an inappropriate monopoly by GP and specialist Obstetricians in private maternity care and disadvantages health services which provide midwifery led options for care in public maternity care.
• The provision of Medicare rebates for medical intervention in birth creates financial incentives to intervene inappropriately in the private arena of maternity service provision.
• The health insurance rebate for private maternity care services provides large subsidies for a sector of maternity care providers who are unaccountable for their outcomes, and who are usually over-servicing clients (e.g. high rates of caesarean section in private hospitals) (12, 13).
• Allowing state expenditure of Commonwealth health funding on inadequate and expensive models of maternity care in public hospitals that deprive women of relationship based care which has been shown to be safer and more satisfying for women.
• State/Commonwealth cost shifting diverts resources and focus from the needs of women and their families.

Although these are only some of the elements obstructing women centered and therefore, equitable, effective and sustainable maternity services in Australia, it is clear that funding is the key element to solving the current crises in maternity care.

Recommendations


Promotion of a woman centered approach to maternity service provision

The Federal government should lead the way in promoting a woman centered approach to maternity service provision. Any and every policy document, guideline or announcement should articulate a women centered focus and approach to maternity service provision.


Access to continuity of midwifery care for all childbearing women in the public health system

Make available to all women the choice of having a community midwife provide continuous maternity care through their childbearing experience in the publicly funded health system. Access to continuity of midwifery care will ensure savings in health dollars and bring Australia into line with international best practice in addition to meeting community demands for a range of readily accessible and appropriate maternity services (10). Whatever the medical risk status of a childbearing woman, the provision of continuity of midwifery care is vital for her emotional and social wellbeing which translates into better physical wellbeing for the woman and her baby.

Remove Medicare item 16400.

Remove the payment for nurses to provide antenatal care. Antenatal care is outside the educational background and scope of practice of all nurses. They have neither the qualifications nor the experience of providing antenatal care to pregnant women. It is dangerous for women to receive antenatal care from a nurse who is being pressured to provide care outside the nurse’s scope of practice. Regulatory bodies for nurses and midwives have developed national competency standards and the provision of antenatal care is not one of the competencies of nursing. GP’s are often ill equipped to provide antenatal care as they do not have the necessary knowledge to do so and it is poor organisation to have them responsible for another health practitioner’s care when they themselves are not competent in that aspect of caring for a pregnant woman.

Medicare provider numbers for midwives

Medicare provider numbers for midwives will enable health services which provide midwifery led models of care to bulk bill Medicare for maternity services provided by midwives and pathology and ultrasonography services ordered by midwives in these models. It will also enable midwives to engage in private practice on a level playing field with medical doctors.

Medicare rebates for birth

Provide the highest rebate rate for normal birth and reduce the payment rate for every intervention performed, as the more women pay for maternity care, the more intervention they receive (12-14).

Accountability

All services receiving direct or indirect taxpayer funding be required to provide timely and publicly accessible data on outcomes. Currently in many states no outcome information is available to the public from facilities providing maternity services. This secrecy is inconsistent with goals of safety, accountability or the control of costs.

References

1. Maternity Coalition, Australian Society of Independent Midwives, Community Midwifery WA Inc. National Maternity Action Plan: Maternity Coalition; 2002 September.
2. Reiger K, Lane K, Possami-Inesedy A. Childbirth and the culture of risk. Health Sociology Review 2006(Special Issue).
3. Reime B, Klein M, C, Kelly A, Duxbury N, Saxell L, Liston R, et al. Do maternity care provider groups have different attitudes towards birth? British Journal of Obstetrics and Gynaecology 2004;111:1388-1393.
4. Fahy K. An Australian history of the subordination of midwifery. Women and Birth 2007;20(1):25-29.
5. Reiger K. Domination or mutual recognition?:Professional subjectivity in midwifery and obstetrics. Social Theory and Health 2007;in press.
6. Hart E, Hazelgrove J. Understanding the organisational context for adverse events in the health services: the role of cultural censorship. Quality and Safety in Health Care 2001;10:257-262.
7. Douglas N, Fahy K, Robinson J. Final Report of the Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital 1990-2000”, (Five volumes), Western Australian Government.Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital Western Australia State Law Publishing. ; 2001.
8. Hastie C. Putting women first: Interprofessional Integrative Power. Newcastle: The University of Newcastle; 2008.
9. Powell Kennedy H. A model of exemplary midwifery practice: results of a Delphi study. Journal of Midwifery and Women's Health 2000;45(1):4-19.
10. Hatern M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4.; 2008.
11. Power ML, Schulkin J, editors. Birth, Distress and Disease. First ed. Cambridge: Cambridge University Press; 2005.
12. Fisher J, Smith A, Astbury J. Private health insurance and a healthy personality: new risk factors for obstetric intervention. Journal of Psychosomatic Obstetrics and Gynecology 1995;16(1).
13. Roberts C, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. British Medical Journal 2000;321:137-141.
14. Tracy S, Tracy M. Costing the cascade: estimating the costs of increased intervention in childbirth using population data. British Journal of Obstetrics andGynaecology 2003;110:717-224.

Thursday 16 October 2008

Stop using talcum powder!

The use of talcum powder in the genital area and ovarian cancer have been linked for decades. Talcum powder is still being used and it seems many women do not know the association with ovarian cancer. Here is yet another study which warns women against using talcum powder!

CME Talc Use in Genital Area Linked to Increased Risk for Ovarian Cancer
Women should avoid using talc in the genital area, say researchers reporting further evidence supporting an association between such use and an increase in the risk for ovarian cancer.
(Cancer Epidemiol Biomarkers Prev. 2008;17:2436-2444.) Medscape Medical News
http://mp.medscape.com/cgi-bin1/DM/y/eBxTx0NkcAk0F6A0Jk7L0Gy

Sunday 12 October 2008

Australian Maternity Services Review

It's exciting times. The Federal government is conducting a review of maternity services. I know we have had 41 reviews around Australia all saying the same thing. This is different. Nicola Roxon is fully committed to primary health care and committed to ensuring Australians have health services that really are about health, not just illness, sickness or for the aggrandisement of one professional body.

There is a huge groundswell of change, with midwifery models of care being shown to be safer than other models for healthy pregnant women.

See this latest Cochrane Review of Midwife-led versus other models of care for childbearing women.

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004667/frame.html

Conclusion: All women should be offered midwife-led models of care and women should be encouraged to ask for this option.


It would be fantastic if people got together and wrote joint submissions, or wrote their opinions of what is needed for optimal care for women and their babies.

The link for the review terms of reference is:

http://www.health.gov.au/maternityservicesreview

Exciting times indeed.

Carolyn

Saturday 11 October 2008

Mind Movie for Pregnant Women

A mind movie is a visualisation tool that enables a person to provide multisensory input and provide positive suggestions to the subconscious mind about a particular and desired outcome. Quantum physics informs us that we are forever in a field of possibilities. Neuroscience has discovered that the human brain is a quantum processor, making our tomorrows out of our todays.

If we want to create something wonderful in our life, we have to imagine it, in full technicolour, with surround sound and 'be' completely at one with whatever we wish to create.

The experts tell us that imagining/visualising our ideals first thing in the morning and last thing at night is what powerfully impacts our subconscious minds, providing a template for our inner intelligence to express itself through.

Many women do not have experience with birth, other than what they see on that master of suggestion, the television. Unfortunately, what is presented on television is invariably sensationalist, negative, alarming and often, inaccurate or only partially accurate and ultimately distressing. That is particularly true of the birthing process. The birth of our precious babies has been corrupted by false advertising through mainstream media and the ensuing horror stories. That corruption of birth has lead to unbelievable levels of fear and trauma in our society for both mothers and babies. Unmitigated fear is toxic to body and mental function and the reason that is so is explained by our physiology.

Mediated by the nervous system and our 'perceptions', our physiology has two primary modes of 'being'. One, the parasympathetic mode is 'on' when we are calm, relaxed and happy, in love and optimistic. In this mode, the whole body is well perfused with oxygen rich blood, the immune system functions well as do all the other growth and repair functions of the body. In this state, the brain functions optimally, thinking is clear, we are creative and our emotions consist of the positive hormones, such as oxytocin, endorphins and relaxins.

The other mode is switched on when we perceive a threat in our environment, this is the fight, flight or freeze response, the sympathetic branch of our nervous system. When this system is activated, blood is diverted from those parts of us that are not considered essential for immediate survival when attack appears imminent and our life threatened. The parts of us that are deprived of the normal blood flow at these times include our gut and digestion, our reproductive systems and its components, including, for pregnant women, the uterus and baby, plus other maintenance and repair systems. The blood is sent to our arms and legs for fighting and fleeing. The hormones associated with this biobehavioural state are adrenalins, noradrenalins and cortisol. Cortisol is great for helping a person lift a car off someone trapped underneath, we've all heard those kind of heroic stories of unbelievable strength in dire circumstances. However, in day to day life, activation of the sympathetic aspect of our nervous system disrupts cellular and immune system function and shuts down our rational thinking, leading to road rage, neuronal death and illness. It also leads to a self defeating, self reinforcing cycle of negative experiences.

Pregnant women are well advised to avoid horror stories, television dramas and any negative representation of birth, parenting and babies. Pregnant women benefit by being immersed in positive stories, images and surrounding themselves with loving, supportive and encouraging people. Pregnant women also benefit by having someone, preferably a midwife, with whom they can talk though their fears and apprehensions, so that they approach the birth of their precious babies in a loving, confident and calm manner. In this way, women's physiology works optimally and prenates grow well.

A mind movie is designed to provide and develop a positive view and orientation to pregnancy, labour, birth and breastfeeding for pregnant women, their partners and their families.

A woman can make her own mind movie. She can make it in her imagination, or by making a real life video. Either way, collect in your mind or physically, lovely photos of birth, babies and other images that remind you of your body and mind in harmony, working well. Add your favourite music to the mix and every morning and night, soak your mind in the ideas of birth to come, remembering to think about the birth occurring at the perfect time in the perfect way with the perfect people in the perfect place when the baby is fully grown, ready for birth. Imagine the whole process, including the birth of the placenta, your feelings on seeing your baby for the first time, being skin to skin with and breastfeeding your baby. Imagine yourself joyful after the event.

You will be amazed at how effective this process is for helping create a wonderful birth experience for you and your baby.