Blind spot in the Australian Government's National Action Plan for the Health of Children and Young People

The Australian Government has, sensibly, recognised the health of children and young people as important to the health and wellbeing of Australian society in general.

A National Action Plan for the Health of Children and Young People is being developed to take a life course approach in providing a road map for a national approach to providing this cohort to the best start in life.

The Draft National Plan can be accessed here 

On page 8 of the draft plan, the key life stages for children and young people are noted as below:

As you would expect, 'preconception to birth and early childhood' are recognised as the foundation of the life cycle and one of the key life stages for children and young people.

The plan says they are taking a ‘life course’ approach and acknowledge preconception, antenatal and infancy time as the beginning of that and a ‘key life stage’ and say they are focusing on prevention and early intervention. There are thirteen priority actions for implementation

However, the plan has a gigantic blind spot in regard to the best way to focus on and succeed with ‘prevention and early intervention’, despite an avalanche of evidence about what works in this area of health care.  

Ensuring the health needs of First Nation Peoples, Rural and Remote Families and Vulnerable Families are met is entirely appropriate.  It makes sense that the plan would seek to ‘Expand support for families, especially families living with adversity’, however, the plan lists the following priority actions:

Priority Four is to 'Roll-out sustained nurse home visiting programs commencing antenatally and with a focus on women living in adversity'. 
Priority Five is to 'Expand evidence-based sustained nurse home visiting programs for Australian Indigenous families' - a US based program where midwifery is unknown in the main.

Where is the role of the midwife? 

Despite the overwhelming amount of evidence demonstrating that continuity of midwifery care improves an array of important outcomes for women and their infants, the midwife is missing from this document. 

You can read the plan here:  https://consultations.health.gov.au/population-health-and-sport-division-1/establishing-a-national-action-plan-for-the-health/

Please add your voice to the survey seeking feedback on the plan.

The invitation to comment on the plan opened on the 18 March 2019 and closes 28 March 2019

Information on the plan and the link to the survey can be found here

Children and Youth of Australia need your help to ensure continuity of midwifery care is embedded in the plan. 

The following important points to include in your response are:

• Getting it right from the start – the plethora of evidence supporting continuity of midwifery care to do just that
• The research based reasons to ensure women have access to continuity of midwifery care
• Implement Caseload models of midwifery care in rural and remote areas, as well as urban communities as that model is best practice Primary Health Care and Community Development
• Extending midwifery scope of practice from preconception to early years with appropriate educational opportunities for midwives
• The need for the involvement of the Australian College of Midwives (ACM) why they were not part of the consultation team is impossible to understand
• Midwives work to build capacity and wellbeing in childbearing women and families
• Why are we fragmenting care by introducing a home nursing service  
• Why are we following an American model of care where midwives are relatively unknown and when maternal and infant morbidity and mortality is increasing in the USA
• We have well educated and competent midwives in Australia - a professional group well placed to provide life saving and life enhancing care for childbearing women and their infants

Your voice is important. Let's make a real difference to the children and youth of Australia.

Let's ensure all childbearing women have access to continuity of midwifery care and the future reaps the benefits. 




More references, courtesy of a reader - thank you!

1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4: Cd004667.
2. Tracy SK, Hartz DL, Tracy MB, et al. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. The Lancet 2013; 382(9906): 1723-32.
3. McLachlan HL, Forster DA, Davey MA, et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(12): 1483-92.
4. Kildea S, Simcock G, Liu A, et al. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Archives of Women's Mental Health 2018; 21(2): 203-14.
5. Kildea S, Hickey S, Nelson C, et al. Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting. Aust Health Rev 2018; 42(2): 230-8.
6. Gao Y, Gold L, Josif C, et al. A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery 2014; 30(4): 447-55.
7. Toohill J, Turkstra E, Gamble J, Scuffham PA. A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital. Midwifery 2012; 28(6): e874-e9.
8. Department of Health and Aging. Improving maternity services in Australia: A discussion paper from the Australian Government: Commonwealth of Australia, 2009.
9. AHMAC. National Maternity Services Plan, 2011. Canberra: Australian Health Ministers Advisory Council, Commonwealth of Australia, 2011.
 

 

Breastfeeding helps build healthy bones

Nutrition is a key ingredient in health and wellness for every individual. Even before conception, the mother's nutritional state influences her baby's genetic and physical makeup, plus long term health and wellbeing.

Osteoporosis is a crippling and painful disease that afflicts some people as they age.

A wide variety of high impact exercise during the teenage years plus good nutrition including calcium and Vitamin D is known to set in place stable bone mass and provide a healthy bone structure for life. Weight bearing and resistance exercise, including netball, basketball, tennis, swimming and sprinting in the teenage years, means reduced risk of osteoporosis in the later years. Peak bone mass for girls is laid down by 16 years of age for girls and 20 years of age for young men.

Telegraph.co.uk

A new study by Stahl and colleagues have found that calcium intake in the neonatal period may be critical for life long bone health.

Stahl et al took two groups of newborn piglets and fed one group calcium enriched diet and the other group were fed calcium deficient diet during their first 18 days of life. The piglets were subjected to frequent blood sampling and daily weighing. At the end of the study, samples were collected from the bone marrows, livers, kidneys and small intestines of the animals. The strength and bone density of their hind legs was also tested.

Calcium deficient piglets were compromised in their bone density and strength. Many of the mesenchymal stem cells that eventually become bone forming cells were found to have been programmed to become fat cells. Reduced numbers of bone forming osteoblasts in early life means a reduced ability to repair and grow bones throughout life. The researchers conclude that lack of calcium in the neonatal period leads to programmed mesenchymal stem cells, predisposing the individual to having bones that are less mineralised and contain more fat. In this way, Stahl suggests, osteoporosis can be seen as a paediatric disease with later onset, rather than a disease of old age.

Irrespective of what I think about this study on piglets, who are very intelligent and sensitively aware animals, I was intrigued that Stahl and his colleagues didn't also add a control group of breastfed piglets to the study. Breastmilk, also known as 'white blood' because of its alive, blood like nature and inability to be manufactured, is known to contain bio-available calcium amongst the nutrient mix. I would have thought to include breastfeeding and breastmilk to have been a foundational, sensible thing for a scientific endeavor aiming to find a reason and a cure for disease.

However, I found the following written in the article:

Stahl and his colleagues have a long-standing interest in understanding how much calcium babies need in order to optimize bone density and strength when they get older. Not only is this a worthy academic question, but it has special relevance to the infant food industry which currently fortifies most baby formulas with calcium at levels substantially above those found in breastmilk - considered the "gold standard" for infant nutrition. This differential level of fortification has been based largely on older studies suggesting that breastmilk's calcium is substantially more usable than that in baby formulas. However, more recent research has challenged this dogma, and Dr. Stahl and his group are committed to helping determine what is best in this regard.

I italicized and bolded the words in the quoted text above.

You will notice several things about this quoted piece.

1. The infant food industry would seem to be behind this study from what is written above. No wonder that a breastfeeding control group was not included!
2. the words 'gold standard' are in inverted commas leading the reader to subliminally appraise the term negatively
3. The word 'dogma' is used to degrade the idea that breastmilk is the gold standard for infant nutrition.
4. Dr Stahl and his group are committed to helping determine what is best in this regard! Yet Dr Stahl does not include breastmilk in his study!!!

I know this study was about pigs, but I smell a rat!

Who pays Dr Stahl and who funded this research???

No matter what Stahl's objective or who funded the research, the study is actually useful for promoting breastfeeding as it shows how important good calcium intake is in early life and breastmilk provides that along with all the baby needs for optimal nutrition. Now we know breastfeeding protects the individual from osteoporosis and builds bones that can last a lifetime with the right input of exercise and good nutrition in adolescence.  Thank you Dr Stahl and colleagues.



Study suggests a much earlier onset for bone problems

Optimal Environmental Conditions for Childbearing

The shocking deaths within the last six months of two child brides from the Yemmen ,one from sexual intercourse related haemorrhage five days after her forced marriage and one from childbirth, provide a graphic and tragic illustration of the disastrous circumstances that can accompany female reproductive lives. Their stories are testimony to the difficulties that girls and women face in living their lives in ways that are empowered and valued.

Thinking about these young girls and their lack of choices, driven by culture,  religion, standard of education, political will and misogyny, led me to consider what is the optimal environment for childbearing?

Optimal Environmental Conditions For Childbearing

In an optimal social environment, childbearing women, babies and children are highly valued in ways that are quite tangible. The vital contribution that mothers and babies make to society is recognised as fundamental to the health and wellbeing and indeed the future of society. The needs of mothers and babies needs are at the heart of government policies and social considerations. The society as a whole expects every workplace to be family friendly and therefore it is the norm. To be considered family friendly, a workplace has on-site childcare, flexible working hours and breastfeeding facilities as a matter of course. Breastfeeding is a normal, accepted part of childbearing. Breastfeeding in public is normal and there are easily accessible facilities in every large department store, recreational and public utility for breastfeeding women and their babies. All children are educated at school about child development, contraception, maternity care, pregnancy, birth and breastfeeding. In our optimal social environment, women have true choice about pregnancy. If a woman chooses to stay childless, that is accepted as a valid choice. Women are not pressured in any way by the media or their social network. Women have access to the contraceptive that suits their needs. There is general agreement that no women should have to bear a child that is unwanted. There is an appreciation that an unwanted pregnancy creates unacceptably high levels of suffering for the woman and for the individual who is born unwanted. Women’s self determination is valued and encouraged. Every pregnant woman is in a stable and loving relationship and has at least five people that she knows, love and support her in emotional and in practical ways. 

Every woman who wants to become pregnant is financially secure. She is at her best nutritionally, physically and emotionally with the help of free and easily accessible holistic pre-conceptual health care. A visit to the pre-conceptual health centre is a normal thing to do for a couple planning a pregnancy. At these centres, couples build on their knowledge gained from their school education and learn more about prenatal and infant development. The role of nutrition, stress management and exercise in optimising the prenatal environment for their future pregnancy is explored. A conscious approach to conception, pregnancy, birth and childrearing is treasured. Couples go to courses about relationships and parenting to ensure they are well equipped to provide a loving environment for their own growth and development as partners and parents. Families are encouraged to be supportive of one another as family friendly practices are part of the educational process in schools and work places.

There are women centred health services in neighbourhood centres where pregnant women can access relationship based midwifery care and an integrated perinatal service. The integrated perinatal service includes midwives, doctors, social workers, psychologists, mental health nurses, psychiatrists, dieticians, early childhood nurses and paediatricians. According to the individual woman’s needs, members of the health care service work with the women as an integral part of the team. Women can choose to give birth at these centres or at home. If there is some condition requiring close medical attention and care in labour, the woman can birth at the tertiary referral centre with her midwife and other team members support. 

The woman and her partner are supported by their midwife and a home help person for up to six weeks after their baby is born.

Of course the optimal environment for childbearing that I have described can be seen as a 'pipe dream' a fanciful idea that is unattainable. I suggest that for our species to become all it can be, humanity needs to look seriously at how women and children are treated in this world.  We will only fulfill our potential if we start taking  proper care of women and children and ensuring there is an optimal environment for childbearing.  The plight of young girls in the Yemmen is a blight upon humanity.  However, the Yemmen is not the only place where being female is a liability.

Everyone needs to take responsibility for the position of females in society.  Everyone has to do their bit to improve the social structure. Nothing changes until we change.