Health Care Hashtags Resource on Twitter

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?

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

Human Physiology YouTube video 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

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?

"Waking up is hard to do"

Following my blog post about the importance of sleep, a friend of mine, Maxine, posted a link to a blog post on Not Totally Rad, a blog that gives insight into medical imaging. Maxine said that

"Probably only the medical types with as equally sick sense of humour as I will find this funny, but what the heck... "


Well, of course I had to look at the link and I'm so glad I did. I'm still chuckling and thought you may find it delightful as I did and do! 


Born at a Christmas party in 1990, they are a group of practicing Certified Registered Nurse Anesthetists who call themselves the Laryngospasms. The larynx is the voice box and a laryngospasm is a spasm of the larynx that is a complication of anaesthesia. The group create and perform medical parodies for audiences throughout the United States.



More music by the Laryngospasms found here

I needed this laugh!  What about you, do you think this is funny or sick?  Is it only those of us who are socialised into hospital culture who find this humour funny?  I'm really interested in what you think.  I know that we can always talk comfortably about the most amazing, body oriented subjects at mealtimes, which other members of the family and non-health related friends think is really 'off'.

Sleep, glorious sleep!

Sleeping is something I've tended to put on hold. As I seek to cram more into my day, I find the hours in the middle of the night are those that are most able to be contracted.

I used to wonder about sleep and whether we could learn to do without it. Sleeping seemed like such a  waste of time to me. All those hours just lying around, doing nothing. Especially wasteful when there is so much to do!  I've discovered that reducing the amount of time I sleep is not a good idea.

According to current understanding about sleep and its functions, sleep is essential to psychological and physical wellbeing and is neuro-protective. According to John Axelsson from the Karolinska Institute in Sweden, a good night's sleep is a very important component of looking attractive and healthy. Those ideas that my grandmother had about the hours spent sleeping before midnight being important are very likely to be true, much as I'd love to ignore that fact. She was right about a lot of things, my grandmother.

 I've found to my horror that sleep poverty is associated with obesity.  Apparently those of us who struggle with middle age (or any age) 'spread' or 'spare tyres' - polite terms for enlarged girth would be well advised to ensure that we regularly get a good night's sleep as good sleep patterns help to keep obesity related genes switched off!

Stress is another culprit! Even if people get enough sleep, unless the causes of too much stress are managed or diminished, the problems compound.

 I read Katy's blog this morning and she was talking about sleep - Katy is a biomedical scientist and her blog is always informative. Amongst other things Katy said:

"Sleeping the correct amount (or at least longer than you typically do) is a good place to start when trying to get to the root of any health issue.  As for body postures, it’s best (does the least to shorten muscles and stiffen joints) to sleep flat on your back, no pillow, on a firm mattress.  Sleeping in his way (or just getting into this position on the floor when you’re awake) reveals a lot about your chronic joint position.  If you need something under your knees to be comfortable, your psoas is too short for your height.  If you need a pillow under your head to keep your chin from elevating, the cervical (neck) extensors are too short for the length of your spine.  If you take yoga, executing the supine savasana posture takes a good chunk of time to work up to.  You’ve been practicing chair-asana (the art of sitting long hours with your hips and knees at 90 degrees, head forward to the spine, and chin elevated) 10 hours a day, it’s no wonder you feel stiff getting into bed.  Do five minutes of light stretching followed by a “floor assessment” of your tension patterns.  Set the timer for 10 minutes and relax your parts to the floor, breathing quietly and thoroughly, before hopping into bed.  This should make getting into REM state that much easier".

 As someone who practices 'chair-asana' on a daily, hourly basis, I've taken her words to heart!

Making the change to ensure good quality sleep means changing habits and establishing new routines. Some random tips for healthy sound sleep I've picked up over time are:

1. Avoid stimulating drinks, conversations, television and other similar activities immediately before bed. 
2. Spend time winding down; that can include a relaxing bath (with or without candles and aromatherapy)
3. Get regular physical movement - a good walk each day stimulates/coordinates our brain cells and the muscles leading to better functioning
4. Sweet talk - with yourself and if you have one, your beloved - quality mutually rewarding intimacy and sexual expression
5. Review your day and congratulate yourself for things well done
6. Avoid focusing on the things you could have done better - write those down and tell your self that you will review them in the morning
7. A warm drink before bed can be helpful
8. Think of five things you are grateful for and feel the feelings associated with that gratitude
9. Review the things you want to do the next day and imagine them done well
10. Ensure you are warm enough/cool enough and comfortable in bed
11. Clean, fresh linen and smooth sheets always feels good
12. Keep electrical appliances away from your bedside
13. Don't read newspapers or action books or watch television in bed
14. Make your room as dark as possible (optimal hormone release at night requires darkness)

Sleep well!

Wired for empathy?

Emotions are increasingly recognised as the language our bodies use to communicate. Between cells, between genes, between body processes, the chemicals of emotion trigger, calm, irritate, inflame and soothe.

John Heron, one of my heroes, was the first person I read who talked about our emotional needs. John identified that we have three core emotional needs and if these emotional needs are not met, we develop defense mechanisms.
The core emotional needs that John Heron identified are:

1. To love and be loved
2. To understand and be understood
3. To choose and be chosen.

When our emotional needs are not met, to avoid feelings of distress, we develop defense mechanisms

•      Rationalisation – judging, blaming

•      Projection – attributing one’s own faults to other people eg gossip, criticising behind backs

•      Reaction formation – overdoing the opposite of the emotion

•      Dissociation – distancing from feelings by excessive theorising, analysing, measuring

•      Substitution – carrying out activities guaranteed to succeed – focusing on minutae instead of addressing big issues (which may fail!)

•      Repression and denial of own emotions – intrinsic part of each of the previous defense mechanisms – ‘water off a duck’s back’ – ‘doesn’t bother me at all!’

The defence mechanisms can be seen as the foundations for bullying and violence generally. 

There are, according to John Heron, steps in  managing our emotions, now known as emotional and social intelligence and competence.

Emotion has the central role in determining what we perceive, experience and do (Goleman, 2006). According to the perspective taken by both Goleman and Heron, our power and ability in human affairs is a direct result of our feeling nature. Our deepest feelings are meant to guide us in how to live our lives.  Goleman suggests that the emotional life of an individual underpins their ethical and moral stance and therefore social behaviour. Obviously, if the individual's life has started in the right way, in a loving family with their emotional needs met, then they will be emotionally and socially intelligent and therefore empathetic to the needs of others.


An easy way to understand how we are wired for empathy came into my life this morning in the form of the You Tube video below.





Are we doomed if we didn't have the best start?  No, we can change. However change needs to be sought and new behaviours practiced so that our neurology and the emotional 'codes' are more in alignment with our desired way of being.  Norman Doidge has written a great book explaining how change can happen.

For John Heron, the process requires understanding the four basic skills and practising them continually to become competent.

These skills are: 

1.      Awareness – of one’s own emotions and their effect on behaviour

2.      Choice – between control and spontaneity

3.      Sharing emotions with other people as appropriate

4.      Releasing emotions cathartically (4 aspects)

    4.1 controlled letting go – aware of process and choosing time and place to do it

    4.2 letting go- allowing oneself to let go both emotionally and physically

    4.3 insights – catching intuitive and creative insights

    4.4 decision-making – after moving through emotion and intuition, use our intellect to consider the                learning and make decisions

What do you think of the video? Do you agree we are wired for empathy?  Do you think we can develop the self management skills as suggested by Heron and Goleman? The really big aspect in all of this for me is how to be self managing and stay embodied - to allow ourselves to feel the feelings and cherish the full gamut of what it means to be human.  Of course, like everything, the applications of all this for me is with our work as midwives with birthing women and their families.  Our role in facilitating the best environment so that a woman and her baby can grow well, birth well and enter the early parenting phase well and the woman feeling in control is vital to 'setting' foundational feelings of safety and love for the mother and her baby's relationship.

Focus, attention and brain connections: What's the implication for birthing women?

In this powerful and informative video, Dr. Fred Travis, Director, Center for Brain, Consciousness, and Cognition in Fairfield, Iowa, explains how repeated mental and physical activity builds and develops brain connections. 





What are the implications for birthing women? 


Every time you watch, imagine or identify with a particular way of giving birth, you are reinforcing and building brain connections about that experience.  This video demonstrates clearly how to build the brain patterns that are most beneficial and in line with what you really want. Patterns of neuronal firing have physical, emotional and mental consequences.


Our brain builds new connections when we are in a learning, curious, open state and reinforces commonly used connections constantly.  The other fascinating aspect of human reality is that we screen out anything that doesn't match our 'patterns' of perception. The following video demonstrates the way our brain is very selective about what it lets into our conscious awareness. 


Take note of how many times the people in white shirts pass the ball to each other.




Then read this account of the experiment. 

The big question is how do we use this information to improve our lives and make birth and parenting more what we want it to be?

First, decide what you want - get a clear idea of that.  Then, keep focusing on that which you want. Hang out with those who support what you want. Avoid those who wish to bring them down, or at least, understand they are coming from a fear based perspective, and as you saw in Dr Fred's video, that violent and unhelpful emotional energy causes holes in people's brain function as well as their thinking. 


You can train your brain!  Pianists, Olympians, typists - anyone who has ever mastered anything demonstrates that clearly.  We are truly amazing - neuroscience is demonstrating how capable we really are!

OB Gyn perspective on "OB Patient"

YouTube - OB patient

There is a rash of these mini movies. Clever, 'funny' (?) and short. Humour is a great way of getting a message across.



Ask yourself, what is the message that is being sent with this movie?

Here's another mini movie doing the rounds.



What is the message being promoted in this mini movie about women? What message is being sent about pregnant women?

and then, there is the anaesthetist's perspective on midwifery



I asked someone 'in the know' is that really how 'they' see us? "I'm afraid it is" was the answer.

all in good fun the film maker said. Really?

Words are powerful creators and transmitters of cultural beliefs and habits. What we see and what we hear shape and create patterns of thinking that become our perspective and our reality. These patterns and ideas take a life of their own, becoming a cultural meme and influencing every aspect of our minds, our behaviour and our culture. Emotions make those patterns deeper and stronger. Humour is a great release and can often bring the truth of a situation into a clear light. However, humour can seem benign, but is in reality, a particularly powerful pattern 'fixer' and giving more life to a meme.

I feel deep concern that childbearing women are being profiled in the way that these videos do. Yes, there are women who take advantage of systems and other people. In the main, most women want the best for their babies. Ignorance, abuse, violence and poverty are common themes in the lives of those who take drugs, avoid maternity care and lack education. Objectifying women as these videos do is unkind and leads to the adoption of a negative stereotypical view of anyone who is different and then flows on to include all those who seek choice, control and autonomy.

Maternity care is generally constructed to suit the health care institution and the doctors. For some women, their experience of maternity care is horrendous and deeply traumatising. These women can feel raped, violated and brutalized by their experience.

As Amity Reed writes "we should be striving to make all birthing environments, whether at home or in hospital, both safer and more peaceful and empowering".

Safe, peaceful, empowering birth environments for all women is a meme that is essential for our culture to adopt and create. Pregnancy and birth set the foundations for the future health and wellbeing of the baby.

We all know that anyone can change, grow and develop. Respectful, kind, supportive care that engages the heart of the woman does more to promote growth than unkind objectification and superior attitudes.

Videos like those above create a perspective that is harmful and ultimately degrading what's possible.

One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

Vision, perception and birth

Being able to see is a gift and yet, often taken for granted. How we see and what we see is regulated by the way the neurons fire together primarily in the visual cortex. Our vision also is influenced by our perceptions and our intentional/attentional networks. What we pay attention to influences what we see.

Graphics of the brain, like that above, while useful for showing the general region of activity of various parts of the brain, miss out on the myriad links and neuronal connections that influence and modulate the brain's activities.  Neurons are amazing. 35,000  neurons fit under a pinhead and each has anything from 60-60,000 connections. The neurons don't actually touch - they communicate and connect through chemicals and electrical signals.

The longest axons goes to our big toes! So everything is connected. The more connected, the richer and deeper our experiences. So too with vision.

Many years ago, a friend was at our place and waxing lyrical about his experiences with LSD - a popular drug at the time. He was trying to explain to me how the drug affected his ability to see things much more deeply and clearly. In an effort to get his message across, he told me with some exasperation that 'red was really red!"  I remained unimpressed and thought that his words were the ravings of an idiot - my impression of anyone who took drugs.  My friend's words came back to me about two decades later when I was driving across the Nullabor after a seven day residential meditation course. To my amazement, everything seemed brighter and more colourful. I finally understood what my friend had been trying to tell me all those years ago. Mind altering substances and mind altering experiences of meditation can have the same effect; that of opening up more connections in the brain enabling deeper, richer experiences.  The meditative strand is controllable, the drug induced experience much less so. Neuroscience tells us that it is our brain that sees, not our eyes and that our brain cannot tell the difference between what we imagine and what is actually in our visual field. Neuropsychologists have found that we don't see the world as it is, but how we 'are'.

Buble et al (2010) have found that when people are depressed, their colour differentiation is contracted, less vibrant. That finding makes sense to me when you think about attentional networks, neural linkages and moods, all of which are interconnected and all of which profoundly affect the way our physiology works. The greatest teacher the world has known said 'without vision the people perish'.  When we can't see beyond our current situation, our view contracts.  The ability to visualise or engage in 'imagineering' - seeing in our mind's eye what we desire to have happen or experience affects both mood and body physiology.

A midwifery student wrote a note about her experience of helping a birthing woman to use visualisation to change her labour trajectory.  The student has given me permission to repeat  her story and I do so here as I think her words demonstrate even more clearly what I'm talking about in this blog:

"Just HAD to tell you all of my experience in birthing suite last week!  Arrived at 7am to a primip (sic nullip) who had been having irregular pains all night following spontaneous rupture of membranes the day before.  Not coping well with these pains as the baby was in a posterior position, epidural was being inserted as we arrived, followed by Syntocinon infusion.  Unfortunately, we did not believe that established labour had begun, and the CTG showed little evidence of uterine activity.  Four hours post VE (showing barely 3cm at 7am), another was attended, and showed 4cm, posterior lie and thick cervix.  The midwife with me explained her concerns that this labour would probably end in a caesarean. Syntocinon was as high as it could go.  There were some typical decelerations noted on CTG.  She decided to let this woman know that labour did not appear to be progressing 'as it should', and that she should prepare herself for the possibility of the caesarean if no further progress occured.  While left alone with this lady (who had a big cry at this point with her supportive hubby), I suggested that she close her eyes and imagined her baby moving down and changing position, reassurring her that this was a powerful strategy to use.  We dimmed the lights and I left the room to allow the couple some space together.  At 1pm the obs registrar attended another VE and we were all elated when he announced it was time to start pushing!!  The look on the woman's face said it all.  Wow! I don't know who was more surprised - me, the midwife or the woman - who managed to birth her baby beautifully some 20 minutes later, cord tightly around neck, but Apgars 9,9 regardless.  Never underestimate the power of the mind OR the ability to birth well!"

For anyone who is concerned about a nuchal cord, which is the baby's cord around the baby's neck, let me refer you to the wonderful post of midwifery lecturer and independent midwife, Rachel Reed.

What do you think about all that? 

Bubl, E., et al. (2010). Seeing Gray When Feeling Blue? Depression Can Be Measured in the Eye of the Diseased. Biol. Psychiatry 68: 205-208. DOI: 10.1016/j.biopsych.2010.02.009.

Stress, Telomeres and Health

Our chromosomes have protective sheaths and caps at their ends. These caps are known as telomeres and protect the ends of the chromosomes. An analogy is the little plastic ends on shoelaces. The length of these little caps has been found to indicate the health of our cells. Shortened caps are associated with advanced cellular aging.

Telomeres and the enzyme telomerase are responsible for protecting the chromosomes which take care of  the replication of our cells. Chromosomes which are unprotected are associated with cancer and other mutations of cells. Shortened or damaged telomeres have been found in women who are chronically stressed in caring roles (Epel, Blackburn & Lin 2004).

Researchers at University of California San Francisco (UCSF) were calling for volunteers to take part in a trial to look at the role of stress on telomere length and health. 

I volunteered, because I figured it would be a good thing to be part of this research looking at whether knowing the length of these cell replication protection units would be useful as a health  marker.  I got an email back today telling me they were fully subscribed for the study. Many women had responded to the newspaper article. I'm delighted that so many people saw the value in this research.  What really impressed me was the note the researcher included in her email.  She said and I quote:

"Just a side note --we can try to keep our telomeres healthy, without having to have them tested. To keep healthy  telomeres, it seems the same factors that protect the heart also protect the telomeres- regular vigorous activity, healthy diet with lots of fruit and vegetables (antioxidants from foods) and less processed meats, and to reduce stress, feeling socially connected and being mindful and relaxed when we can.  My own favorite stress buster is yoga.

With best regards,

Wanda Truong, Clinical Study Coordinator
Elissa Epel, PhD, Principal Investigator (head of the study)"

I was invited to reply if I was interested in being part of further studies and of course I am, so I replied and told them so.  I figure that if these researchers are suggesting ways to keep our telomeres healthy, then that's worth listening to!

By the way, Dr Elizabeth Blackburn has been seeking to find ways to enhance life as we age and her efforts led to her winning, along with two of her colleagues the 2009 Nobel prize in physiology or medicine for the discovery of “how chromosomes are protected by telomeres and the enzyme telomerase.”


Accelerated telomere shortening in response to life stress. by E. S. Epel, E. H. Blackburn & J. Lin, et al. Proceedings of the National Academy of Science (PNAS), 2004, 101(49)

Fathering

A few days ago, I was on the train on the way to Sydney. A well dressed couple with two little boys got on and sat down at the seat ahead of me. The boys were about 2 and 3 1/2 years old. The father sat down on the seat and immediately opened his newspaper. The children sat by the window and asked endless questions all the way. The mother was fully engaged, answering questions, explaining fascinating things like why the water was blue, where did the boats go, what did frogs do when the train came and so on. The conversation indicated that they were on their way to a day at the zoo and the boys were obviously very excited.

The boys were interested, full of life and questions. The mother was calm, attentive and engaged. At one stage, one little fella said he was hungry. The mother said kindly, that he had a chance to eat his breakfast and that he had chosen not to do that. She explained that he would have to wait until he got to the zoo when they would have morning tea to have something to eat. The way the mother handled the situation was very impressive and the young boy did not 'carry on' so clearly knew his boundaries.

I enjoyed watching the mother with the boys and when I got off the train a stop before they were getting off, I commented on the way she interacted with her children and congratulated her. She was very engaging with me and we had a good interaction in those few moments. The father put his paper down slightly and smiled warmly at me as I said goodbye, then looked back at his paper. As I saw the train pull away from the platform, I waved at the little family; he was head down reading and she was pointing, waving and talking with the two excited boys who smiled and waved at me. 

A couple of days later I was talking with a very proud new grand father.  He was telling me how his son helped with the 'crap work'!  This 'crap work' is with the one week old baby.  I asked what the 'crap work' was with great interest. The grand father told me with great pride that his son bottle fed the baby while his partner caught up with sleep. I knew the woman was breastfeeding and must admit that I was shocked and the look on my face must have made my reaction obvious.  I said I was surprised that feeding was considered 'crap work' and was told, in a defensive tone, that "it is when you are sleep deprived". I found that a very difficult conversation because there was no entry point to have a discussion about newborn needs and the importance of finding ways to protect, support and promote optimal breastfeeding.

Father and newborn

After these two recent experiences, I find myself wondering about fathering and how and what we midwives can do to encourage optimal engagement of fathers. We know that men who are fully engaged during pregnancy and birth are more engaged as fathers. We also know that men who have skin to skin with their newborn children have oxytocin (the love hormone) surges and decreased testosterone (the war hormone) and are more attentive fathers who are less likely to spank or hurt their babies and children. Those of us who work one on one with childbearing women and their partners have seen that in action. These two experiences indicate to me that we still have a way to go. Finding creative ways to engage fathers and perhaps grand fathers too, more right from the start will help to unravel and rejig those unhelpful myths, negative attitudes and disabling practices that still abound in our society and disrupt men's ability to be the kind of fathers that is their potential.

Facilitating Online 2010 Course

I'm feeling very excited! The Facilitating Online Course 2010 being run again by the wonderful Sarah Stewart, of The International Day of the Midwife fame, is starting soon.

  Facilitated Networking by love2dreamfish Dreamfish Flickr

I'm really looking forward to learning all the elements of online facilitation that Sarah has thoughtfully put together. There are people from different parts of the world, in various occupations who have signed up with Sarah.

Sarah says:

"Facilitation is a rare and valuable skill to have. It is a service that is often used in conferences, debates, panels and tutorials, or simply where groups of people are meeting and need someone to help negotiate meaning and understanding, and to keep everyone engaged and on task.

This online course is designed to help people to access and interpret models, research, and develop professional expertise in online facilitation"

As part of the course, we are expected to keep a reflective blog, so stay tuned for evidence of my learning and development in the field of online facilitation.  Participation in the course is free, but if anyone wants personalised attention and a certificate for completion, fees apply. The program starts on July 19th 2010 and runs until November 26th. If you are interested in learning and exploring online facilitation, contact Sarah Stewart who will be delighted to help you get started.

Item 4 of what we have to do at the beginning of the course is: Make a plan for what you want to learn and explore, and write it up (or present in another way eg mindmap, video recording) on your blog. Answer these questions.

• What do you want to learn to facilitate?
• What are you doing now in terms of online facilitation?
• What would you like to achieve, change or do more of?
• What do you need to do or make happen to achieve your goal?

I'll have to spend some time thinking about these questions and work out a creative way to answer them!

The Look of Love: birth, mothers, babies and attachment

We humans are gifted with a prefrontal cortex, the site of our executive functioning. Our prefrontal cortex allows us to make choices, decide on different courses of action, rather than reflex, reactive behaviour.  Our prefrontal cortex enables us to evaluate different options and make a decision on what suits us best.

Sociologists contend that rather than being self determining agents with free will, we are culturally constructed, and our decision making is culturally driven and that we do not make decisions based on true free will, but based on what society has taught us is 'expected' and 'accepted' behaviour. Certainly, marketing psychology takes advantage of our tendency to buy on emotions and rationalise our purchases. We make our decisions based on emotionally based programming, we over ride our instincts and go with what is culturally predetermined as 'right'.  In the eyes of the law and culturally accepted social codes, such as avoiding fighting, stealing and self aggrandizement, that form of socially constructed behaviour is useful and makes for a safer and perhaps kinder society. However, there is a down side to over-riding innate instincts. 

Nowhere is the negative side of culturally driven behaviour more apparent than childbirth. Childbirth has been corrupted in our modern world.  In 1972, Doris Haire wrote a wonderful piece about the Cultural Warping of Childbirth, drawing attention to the way that the medicalisation of women's bodily processes at birth were causing harm. A more recent article by Estelle Cohen has drawn attention to "alarming continuing decline in the scores of high school students on the Scholastic Aptitude Tests or, "SAT's," a decline which had started with the 18-year-olds born in 1945 and thereafter. From 1963 to 1977, the score average on the verbal part of the SAT's fell 49 points. The mathematical scores declined 31 points. (1)" Estelle questions whether this decline in academic performance is linked to the way that obstetrics "manages" childbirth.

There are myriad intersecting and interconnecting influences on the personality, health, breastfeeding success, intelligence etc of any human being. However, the links between the way someone is born and their future health and wellbeing is becoming more understood. Epigenetics is one of the scientific arenas that are explaining the links. Many of the practices around the birth of a baby are pivotal and set the scene for the long term relationship of mother and baby. More and more attention is being paid to the mother baby interaction at birth, the role of being skin to skin for mother and baby on both the mother and the baby's future health.

Hospital practices have meant that entire generations of mothers and babies have been separated at birth. The consequences of that separation are only now starting to really be understood.

When my daughter was born, she was whizzed off to the resus trolley, cleaned up and wrapped, then shoved under my nose for about five seconds, then whisked off to the nursery.  I didn't see her until the next morning. About three hours after she was born, I found myself pacing the corridor of the hospital ward. I was surprised by my behaviour, but I recognise now that my body was looking for my baby, even though my conscious mind knew she was in the nursery. I did not think to question, to ask to see her; I fully accepted that she was in the nursery.


Lynne Reed, a Birth Keeper said in a recent interview that “We are the only animals on this planet where the mother will willingly give up her baby to someone else,” she says. “To me, that’s a huge indicator of how separated we are from our natural instincts, which would be so fierce to protect the baby.”

I certainly was separated from my natural instincts and days passed before I saw my daughter naked and we never had the skin to skin experience. I wonder if that is why I was so keen to go back to work and why putting her on the bottle was totally acceptable?  Research shows clearly that women who have skin to skin time at birth with their babies have all kinds of benefits and sequelae such as happier babies, self soothing babies, better breastfeeding experiences, less likely to leave their babies with others, babies smile earlier and more frequently. The list goes on and on.


A significant part of the experience seems to be the first eye to eye connection between mother and baby. Carla Hartley from Trust Birth has spoken about the smile a newborn gives her mother when she looks up at her as they connect skin to skin at birth. Carla describes that moment as 'precious' and 'sacred'. That eye to eye connection can be seen as a connection of spirits, a recognition of souls on this life journey.

For those who haven't had this connection, the gap can feel profound and deep. For example, in a Facebook conversation about this topic, Katherine Suszczewicz said " I was adopted. I hadn't realized until just now how my birth affected me today. It just occurred to me reading this that I have lived 45 years with a smothered urge to look my (birth) mother in the eye, something she didn't do when I was born. That feeling has been simmering and is quickly reaching a rolling boil. Just to look into each other's eyes, there's something there". When I asked Katharine if I could share her words she gave permission and said "whatever choices a momma makes, I think that first gaze is crucial....to begin life with the first air breath, a stare into your mother's eyes, and a feeling of love, security, to feel that someone is fiercely protecting you.....will carry you all your days on earth".

Leah Ann Sandretzky commented on Katharine's post and gave me permission to share her story. Leah said

"Katherine Suszczewicz: my heart goes out to you. ♥ my mother was and still is a recovering drug addict and alcoholic; she's looked me in the eyes many times and I have never seen that love. She says she loves me; and I know she does deep down . . . but her heart is gone from her selfishness. I was cared for by my grandparents most of my life; ...and to this day my soul longs for a Mother's love in my heart. I've taken that pain, that want, and turned it around to love my children 10x more than I think I can every day....in honor of the mother I never had. I don't know your story, your heart; but I hope that whether or not you have or will find that Mother's love in someone's eyes for you; you can go on loving like a Mother should. ♥ "

Another woman said "... the "look" I never received, I was adopted as well. My mother wasn't allowed to look, touch or hear me at birth due to the trauma of adoption on her. I was wisked away and the nurses kept me in the closet behind the nurses station so my mother or her family wasn't tempted to see me. The nurses spoiled me, I was told... and held me all the time but it just isn't the same. I hear the pain of the other women saying almost the same things. Way before reading this article I came to a conclusion during self reflection that I had a very hard time allowing anyone to get too close to me. I have attachment issues with everyone on this planet except for my children. Who I wouldn't let out of me sight when they were born. Thanks for posting this. I never put the two together about the "look" and bonding, I always assumed it was not being with my birth mom in general".

 

That look of love at birth is crucial for brain patterning and wiring a sense of self for the baby. Newborn babies are wired to look at faces and to prefer their mother's face to any other. That look of love triggers cascades of oxytocin in both mothers and babies, welding them together, spiritually, emotionally and physically. 

 

The implications for midwifery practice are clear. We are the guardians of the birth territory. We must facilitate the space so that mothers and babies can connect in this deep and profound way. The future of society and every individual's health and wellbeing depend upon us getting the beginning 'right' and providing an optimal environment, enabling a woman to respond to that innate voice and do what comes 'naturally' or rather, instinctively. 

 

 

 

Birth and Bugs

Note: for some reason the links aren't showing up in this post. Just run your cursor over the words and they will show as a purple colour. I can't fix this glitch, not sure why! Sorry.

Mumma and babe

Some interesting posts about the importance of the way babies are born and the bacteria they are exposed to through the birth process are emerging in cyberspace. The information is not only interesting, it helps to inform our practice as midwives and enables parents to understand one of the many reasons why there is a concerted move in both midwifery circles and government agencies to turn the tide more towards normal birth. Concerns are being raised that environmentally triggered changes to immune cells of babies born by caesarean section are predisposing those babies to be susceptible to immunological diseases such as diabetes and asthma in later life.

A blogger has explained the importance of our exposure to bugs at birth this way.

and a teacher of molecular biology at Princeton University, Bonnie Bassler, explains how bacteria talk to each other chemically. Bonnie informs us that we are composed of 10x more bacteria cells than human cells!

This information is a powerful addition to the accumulating evidence about normal, natural, unhindered, supported birth being best for mother and baby.

'Science speak and minifisms': hiding the horrible truth

An article on the Bioethics Forum highlighted the way that medical jargon and a 'scientific' approach can be used to obscure ethical, moral and philosophical breaches in medical interventions.

Recent attention has been paid to the issues around genital mutilation, currently focused on the suggestion taken up and rapidly dropped by the American Pediatric Association that a 'ritual nick' in a young girl's clitoris would reduce the risk of parents taking girls overseas for more debilitating tradition based cutting. 

However, under the guise of medicine, a paediatrician, Dr Poppas, at Cornell University, is performing nerve sparing ventral clitoroplasty on baby girls. What that means is that his surgical team is cutting the sides out of a girl's clitoris. Why are they doing this surgery? The girl's clitoris is deemed too big.

Another blogger suggests that the reason for the clitoral reduction surgery  may be more to do with homophobia than cosmetics because apparently, a woman with a large clitoris is more likely to identify as lesbian. An interesting suggestion.

Whatever the reason, the medical explanation is not in any way acceptable to any thinking person. Far from being benign and helpful, the surgical reduction of a girl's clitoris has been associated with physical, emotional, psychological and relational harm. A most disturbing and chilling aspect of this surgery is the follow up process.

The girls, aged six and over, fully conscious, have their clitorises stimulated with a vibrator by Poppas. Their parents, other researchers and probably students look on.

Alice Dreger, Professor of Clinical Medical Humanities and Bioethics at Northwestern University's Feinberg School of Medicine and Ellen Feder, Associate Professor and Acting Chair in the Department of Philosophy and Religion at American University have been arguing that the surgery performed by Poppas and his team has no benefit for the last decade. Dreger and Feder have only just become aware of the follow up process, which is described in this way:

"Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue"

The article states that  "Study received medical institution review board approval".  I can only wonder how. Board approval could reflect the fact that people tend to over ride their ethical and moral compass in favour of the expert's view. Stanley Milgram provided a graphic example of that phenomenon in his research in the 1974. Researchers at Wellcome Trust Centre for Neuroimaging at UCL (University College London) in collaboration with Aarhus University in Denmark  have found activity in the reward centre in the brain shows that the opinion of other people matters and demonstrates why people change their mind to agree with someone they believe is an expert.

Milgram's experiment was repeated on a French reality TV show in March 2010. The show aimed to show how ordinary, decent people could become torturers. The outcome created an uproar.
  

Added to our tendency towards obedience, an illusory sense of superiority has been found to over inflate both self confidence and a sense of competence.  The Wiki page on illusory sense of superiority does a good job of bringing together a lot of the research about our ability to self evaluate and recognise our inherent biases.  There are some very good references on that page that are fascinating to follow up and explore further.

Back to our man Dr Poppas and his team. Does he/they suffer from an illusory sense of superiority and competence and because of that, posed as experts and managed to fool the board?

The webpage of the Pediatric Department at the Cornell University gives no indication that 'clitorplasty' is still contentious and criticised by both clinicians and patient advocates for the last 15 years.

The webpage states:

"The type of surgical repair performed must be tailored according to each individual patient's anatomy. The first important issue is the timing of the reconstruction. This has been a controversial area in the past, but presently the standard of care is to perform reconstructive surgery at an early age rather than delaying until adolescence. Reconstruction is generally initiated between the ages of 3 and 6 months old. An early one stage repair is recommended because female patients are able to undergo a more natural psychological and sexual development when they have a normal appearing vagina. The major features of reconstructive genitoplasty are clitorplasty, labioscrotal reduction, and vaginal exteriorization (vaginoplasty)".

The words on this web page sound so clinical, so medical, so scientific, so right. All those big words that mean nothing to most people. How would parents know anything different? Most parents believe what experts (paediatricians) say and are too intimidated to even ask questions, let alone ask for a second opinion.

Alice Dreger continues

"Yang, Felsen, and Poppas describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”

Each girl child from the time testing starts (about 5 -6 years of age) has her "thigh, her vagina, her labia minora, and her clitoris stroked with a Q-tip while she's asked if she can feel the doctor touching her. ("Can you feel me now?")"

There is doubt as to whether Poppa had/has ethics approval for the sensory testing he and his team conducted. That little detail seems to have slipped through unnoticed. 

We don't know what parents are told or not told. Talking through procedures such as Poppa promotes should take many hours of compassionate counselling and information sharing, shifting through the various ideas and schools of thought about these interventions on what appears to be variations on normal healthy genital structures. Many parents feel concerned about challenging the experts, even if the parents feel uncomfortable with a treatment that is being suggested. Parents can feel anxious about their child being victimised if they as parents 'rock the boat' and ask too many questions of health professionals.  Can you imagine what that 'sensory testing' would be like for those babies and young children and Poppa says testing is ongoing!  Poppa would prefer that the vibrators he uses to test the sensory ability of the surgically altered clitoris are referred to as a 'medical vibratory device'.  This abysmal story is full of 'minifisms' - words used to scale down the significance of the intervention. 

I'm reminded of the Butcher of Bega with this story.

Thank goodness for people like Alice Dreger and Ellen Feder who bring these abominable acts to light. Our job is to write to the authorities asking for an explanation.

Yang, Felson & Poppas (2007) Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability, The Journal of Urology, Vol 178, Issue 4, pp 1598-1601 Supplement (October)

Correspondence: Institute for Pediatric Urology, Rodgers Family Professor of Pediatric Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th St., Box 94, New York, NY 10021 (telephone: 212-746-5337 begin_of_the_skype_highlighting            212-746-5337      end_of_the_skype_highlighting; FAX: 212-746-8065).