Midwifery voices needed on WHO draft of Every Newborn Action Plan

Calling all midwives: Please read this request from the International Confederation of Midwives and ensure the midwifery perspective is included in this important plan to save newborn lives.

Your voice is urgently needed: The WHO together with partners have drafted an action plan to end preventable newborn deaths (Every Newborn Action Plan). The draft is now online for a public consultation process with the deadline on the 28th of February. It is crucial that midwives have an input as the plan will affect midwives in their work and midwifery on a global level. Strong indications from midwives are needed that this Action Plan is about high quality midwifery, normal birth and normal care of healthy babies (as well as the complications and treatments highlighted in the document).

Feedback is coming in to WHO, but sadly not (yet!) from midwives. The voices of midwives are urgently needed!

Thank you to those who have responded. For those who have not yet, kindly take some time from your busy schedule and provide feedback to this important document. 

Don’t miss this opportunity to make your voice heard and make sure the midwife perspective is included in the plan! Click on the link to comment: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/ 

The deadline is FEBRUARY 28th and unfortunately cannot be extended.

Thank you for the time and effort.

Kind regards

Charlotte Renard
International Confederation of Midwives

The voice of reason: Researchers reject statement that co-sleeping in dangerous

So good to see this media release from researchers at The Queensland Centre for Mothers & Babies! At last, the voice of reason and evidence informed practice on this very important aspect of parenting.

Researchers reject statement that co-sleeping in dangerous

Researchers from UQ’s Queensland Centre for Mothers & Babies are concerned about recent messages that parents should never sleep in the same bed as their babies. 

QCMB Director Professor Sue Kruske said a recent comment by the Victorian Coroner, who labelled it “inherently dangerous” for a parent to sleep in the same bed as an infant younger than a year old, was not representing current evidence.

“It is not the act of bed sharing that is solely responsible for these deaths,” Professor Kruske said.

“Rather it is other environmental factors that occur in combination with bed sharing.”

She said the vast majority of these 'co-sleeping deaths' were in the context of other circumstances including smoking, alcohol and drug use and unsafe adult sleep environments.

“Prohibiting bed-sharing will actually lead to more harmful practices such as falling asleep with the baby on a couch, which is known to be dangerous, as well as increased cases of babies falling,” she said.

She said research showed many benefits for babies who bed-share safely with their parents, including improved breastfeeding duration rates, improved settling with reduced crying, more infant arousals which are protective for baby, and improved maternal sleep.

Dr Jeanine Young, Chair of SIDS and Kids National Scientific Advisory Group and safe infant sleep expert, said inconsistent messages were making it hard for parents to make informed decisions.

“To make sweeping statements about this practice would require reliable prevalence data,” Dr Young said.

“We know from the studies we have done that shared sleeping is understandably very common for families in Australia especially for breastfeeding parents. If deaths could be ascribed to co-sleeping without other risk factors present, we would expect a lot more.

“No environment for babies is risk free. Babies have died alone in cots and babies have died in adult beds. We give clear advice for reducing risks in cot environments but we have not yet addressed shared sleep environments in the same way.

“Many people die in car accidents but we don’t tell people not to drive. We tell them not to drink and drive, to wear seat belts and not speed.

“Similarly, the message for parents is that if you choose, or have no option but to co-sleep, the risks can be reduced by not overheating the baby, not wrapping the baby while bed-sharing, not having either parents as smokers, or under the influence of drugs or alcohol.

“We also know that premature or unwell babies are at higher risk of sudden infant death.”

Media: Professor Sue Kruske 0418 882 337, Dr Jeanine Young 0415 174 003, or Andrew Dunne, QCMB Communications Manager, 0433 364 181.

About the QCMB

The Queensland Centre for Mothers & Babies is an independent research centre based at The University of Queensland and funded by the Queensland Government. The role of the Centre is to work towards consumer-focused maternity care that is integrated, evidence-based and provides optimal choices for women in Queensland.

Midwifery Care: What's in it for Women?

What is midwifery care?


The debut video for I am a Midwife, a new online series about midwives and what they do, explores just that! Eight different "real life" midwives describe the safe, satisfying and supportive care midwives in all settings provide women and their families!

From the Midwives Alliance of North America: http://mana.org/IAAM/

Giving birth is not a competition

International Women's Day has been a powerful reminder of how far we've come as a species.

IWD has also shown how far we still have to go to create a social world where the vast majority of women and many men enjoy the human rights of sovereignty and social safety to live as they desire and deserve.

From delusions of being able to create the master race to the idea that you can reduce or even eliminate risk in life, medicine and science have sought to control and dominate nature.

Nowhere is this more apparent than in the area of reproduction and in particular, for western women. Western women have come under increasing surveillance, control and criticism from medical 'experts' and the population at large during childbearing and parenting.  Conflicting advice abounds creating confusion and distress for women, all of whom want the best for their babies and want to do 'the right thing'. Women are told on the one hand that the rate of stillbirth doubles after age 40 and so induction around 37 weeks is recommended. On the other hand, other experts say that babies born early around 37 - 38 weeks with induction of labour are at risk of health problems.

What's hard to reconcile with the constant negativity with what is a very normal, human activity is that evidence shows that medical error causes more death and disability to people in hospital than motor vehicle accidents, breast cancer or AIDS. You may note that childbirth doesn't get it a look in with the comparison because the real problems with childbirth, even those caused by intervention, are so low in the western world. The other disturbing fact about hospital culture is that people are afraid to report errors because they fear recrimination. So really, we don't know what actually goes on in hospitals. Our only clue in NSW for example, is the Mothers and Babies report and that is a broad brush view.

We do not know exactly what the rate of intervention in the birthing process is doing to developing brains and human relations, but there are some signals that there are detriments.

Various individuals and groups challenge medical domination of birth and the medical profession's dismissiveness of the social aspects. There are thankfully, some enlightened doctors championing "patient" centred care and calling on clinicians to "relinquish the role as the single, paternalistic authority."

Films such as the Face of Birth, which aim to defuse the hysteria and show the social view of humanity's most primal act, have a tough gig. The media's delight in traumatic tales, coupled with 'reality TV's' depiction of birth all flavour enhanced by the medical profession's staunch opposition to birth at home and midwifery care, especially in Australia, has led to public opinion becoming increasingly hostile and disapproving of those who choose other than the 'doctor in charge' status quo. As a result, western women are becoming increasingly fearful of birth.  They are increasingly feeling under 'siege', a state of perpetual fearfulness. What is not so well known is how 'fear' affects a person's physiology.  The biochemical correlate of fear is cortisol. There is a lot of work being done on the effect of cortisol on physiological functioning and brain development for the fetus. Prenatal programming is a burgeoning field of inquiry investigating how a person's lifetime risk of disease or health is actually 'set' in the womb and dependant upon the mother's social world. We need to really wake up to what that means.

Western women are also becoming increasingly insecure about their parenting, which for heaven's sake is hard enough without the avalanche of 'advice' and disapproval from all and sundry.  I have been reading the comments under the mass media's articles on birth at home and the different perspectives are fascinating and show how we all see life through our own lenses of beliefs and experiences.  What, however is alarming, is the punitive and nasty way that some people respond to people's choices.

The scorn and criticism heaped on women who choose to do things differently, no matter what 'norm' is being touted by whichever interest group, is horrendous and needs to stop.

Where a woman gives birth and who she gives birth with is her business. For anyone to think they care more about a woman's life and baby than she does is the height of ignorance and arrogance. Our job as a society is to support women's choices because the evidence is clear that when a women feels supported and has choices her cortisol level is lower and her physiology and therefore her baby's physiology is more likely to be 'normal'.

Birth is NOT a competition.

It is about feeling safe, supported and respected.  Interestingly, the outcomes, including those of maternal satisfaction, are very very good when that is the situation. On another note, so many people downplay the need for the woman to feel good after birth - the health and wellbeing of the family are enhanced when a woman feels loved, respected and cared for, so that should be the focus of society.  We need to ask ourselves where does she feel safe and how can we, as a society support her in that?

Meanwhile, in too many countries, women are dying in childbirth.  The current estimate is that around 1000 women die every day giving birth.  That statistic is shocking and, with the right conditions, preventable.  These statistics illustrate clearly the social determinants of health and disease. Women are dying because in their cultures, they are "nothing" - they are worthless in the eyes of their culture  - they are the possessions of their partners or parents; they have no access to contraception and often have (too) many children, their nutrition is very poor, they are dreadfully anaemic, in some areas have malaria, HIV/AIDS and live with domestic violence and the threat of more of it hanging over their heads. Their living conditions are harsh. If we use Maslow's Hierarchy of Needs to think about the social determinants of health, you can readily see that these women exist without even their basic human needs being met. No wonder the challenges of reproduction are sometimes too great for them.  These women do not have the best conditions at home to give birth there - even the hospitals are poorly equipped and lacking in staff, but at least there may be someone there, with some education and training, who can support them and help them give birth safely. We know that when there is a strong and capable midwifery profession,  childbearing women and their babies do well.  Capacity building midwifery education is one of AusAid's projects to improve maternal and neonatal wellbeing and decrease mortality and morbidity rates in PNG.

People in the western world who are so concerned with what childbearing women do and where they give birth need to turn their attention to the developing world and work on making it safer for all women and their children.  We are, after all, living in a global village. What affects one, affects us all.

Instead of making birth a "who's right or wrong' competition, let's make it about cooperation, compassion and support.

If we want a peaceful society and happy mothers and babies, we would do well to ensure women felt loved and cared for, respected and nurtured, fed good food, rested, kept away from bad news and surrounded by loving family and friends and able to give birth the way they want to, with people they know and trust around them.

The Umbilical Cord: When do we clamp it?

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

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

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

The literature was mixed in regards to the advisability of leaving the cord to pulsate or clamping immediately. The opposed camps had reasons such as jaundice, blood volume, postpartum haemorrhage rates to explain their particular views and reasons for their recommendations. The reasons for cutting the cord have been proven to be spurious.  There is however a lot of evidence for leaving the cord alone.  Women and midwives have been talking about and promoting leaving the cord alone as a best practice strategy for several decades now and the evidence for doing so is only getting stronger.  Have a look at the way the cord changes in the minutes after birth.  The evidence for leaving the cord intact is also clear in the case of nuchal cords. Leaving them alone, gently 'somersaulting' the baby to untangle the cord as the baby is born works perfectly and there is no risk of having the baby's oxygen supply prematurely interrupted.  As beautifully explained on the Midwife Thinking blog, the oxygen carrying capacity of an intact cord is the baby's first line of resuscitation after birth. Our medical colleagues have been slower to take up the idea of leaving the cord alone. However a 2011 report has confirmed that iron stores are improved when the cord is left to stop pulsating. A more recent review found that "newborns with later clamping [were heavier and] had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping".


A wonderful demonstration of why the umbilical cord should be left alone is provided by Penny Simkin in this video.

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

Delayed cord clamping Grand Rounds 1

Delayed cord clamping Grand Rounds 2

Delayed cord clamping Grand Rounds 3

Delayed cord clamping Grand Rounds 4 

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

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


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

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

Postscript: There is an article (8th October 2014) in the Journal of Midwifery and Women's Health on clamping the umbilical cord at birth. Called "Is it time to Rethink Cord Management when Resuscitation is needed" the article provides compelling evidence for leaving the cord intact and resuscitating a compromised infant by the mother's side.

Post Postscript: A landmark paper published 26th May 2015 has added evidence to my theory of brain & gut damage associated with early cord clamping:

The authors concluded:

Delayed cord clamping (CC) compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimising the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.

PPS A non peer reviewed article discusses the issues of hypovolaemia in newborns caused by premature cord clamping says this:

Modern human childbirth is “managed” obstetrics, designed to avoid complications and to preserve physiology – a normal, healthy outcome. However, management often intrudes on physiology, producing unintended consequences.

and raises concerns around the potential for multiple organ damage, including brain damage with premature cord clamping.

Now for anyone not yet convinced of the value in leaving the cord to do its magic, this post from AWHONN on a Placental Transfusion for Neonatal Resuscitation after a complete Abruption may help you to change your mind!

Time for practice change everyone!

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.

Medical News: Developmental Delay Linked to 'Flat Head' Syndrome - in Pediatrics, General Pediatrics from MedPage Today

from MedPage

"Babies with misshapen heads from lying on their backs too long may be at heightened risk for developmental delays, researchers said, although they stressed that infants should still sleep in the supine position"

The worry about SIDS (Sudden Infant Death) is understandable. Parents have been terrified about the possiblity of SIDs and it is heartbreaking when SIDS occurs. The Back to Sleep campaign has reduced the number of SIDs cases, but parents have become terrified to put their children in any other position than on their backs.

SIDS has been linked to low levels of a hormone called Serotonin and the enzyme that makes it in the baby's brainstem.  Brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children's Hospital Boston, and colleagues reported in the Feb. 3 issue of the Journal of the American Medical Association. A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.

 These researchers suggest that the back to sleep campaign has saved those babies who would not have been able to move their heads or bodies in response to changing physiology. 

Now researchers are saying that flat heads from back lying are associated with neurodevelopmental delay. A fascinating and troubling finding. The authors are at pains to say that these babies may have developed plagiocephaly because they already had a problem and caution that parents should still ensure babies lie on their backs to sleep.

I wonder if we are not having a problem that is self perpetuating here.  Neurophysiologists like James Prescott (a hero of mine) tell us that the brainstem gets 'set' at birth by the environment the baby meets. If the baby gets skin to skin with his/her mother, the brain stem gets set for love, happiness and contentment - states associated with serotonin.  If babies are whizzed off to the resuscitaire, their brain stems are set for fear and distress. That state is associated with a lack of serotonin.

These days, with the back to sleep campaign, many children are not having any tummy time, they are not being carried and they are certainly not sleeping with their mother, all of which adds up to mean they are not having the stimulation from movement and touch that they get from being held, carried and laid in different positions. I suspect the brainstem issue could relate to how they are treated at birth and the neurodevelopmental delay that is associated with plagiocephaly could be due to lack of stimulation.

Babies need to be carried, they need to sleep with their mothers to get the stimulation necessary for optimal brain growth . One of my many heroes, Dr James McKenna at Notra Dame University has done many mother-infant sleep studies.

Go to  Dr McKenna's home page to find the latest research and information about the sleep studies.

Dr McKenna's sensible and baby/mother friendly suggestions for babies sleeping safely can be found at this link:    Babies Sleeping Safe



CO-SLEEPING RESEARCH

The psychophysiological effects of sleep-sharing are studied in sleep laboratories that mimic, as much as possible, the home bedroom. Over the past few years, over a million dollars of research money has been devoted to sleep-sharing research. These studies have all been done on mothers and infants ranging from two to five months in age. Here are findings based on mother-infant pairs studied in the sleep-sharing arrangement versus the solitary-sleeping arrangement (Elias 1986, McKenna 1993, Fleming 1994; Mosko 1994):

1. Mothers and babies who sleep together are more 'in sync' than those who do not: when either the mother or the baby moved, stirred, coughed or changed stages of sleep, the other would change in synchrony, without waking.

2. Both mother and baby generally spent more time in the same stage of sleep and for longer periods when they slept together.

3. Mothers sleep better even though their babies sleep deeply for shorter periods when they sleep together: thought to be a protective mechanism. Mothers tend to stir and babies follow if baby sleep is deep for any length of time.

4. Sleep-sharing infants arouse more and breastfeed more than babies who sleep separately; mothers to not report waking more frequently than those who slept separately.

5. Sleep-sharing infants tended to sleep more often on their backs or sides and less often on their tummies, a factor that could itself lower the SIDS risk.

6. Mothers and babies who sleep together, touch and interact a lot, even when sleeping: each affects the night time behaviour of the other.

Insightful mothers have always felt better sleeping with their babies. Babies suffer separation distress when they are apart from their mothers.

In my view, plagiocephally (flat back of head) is an iatrogenic problem. The neurodevelopmental delay associated with plagiocephaly results from the lack of stimulation caused by the 'lie your baby on its back dictum' is, also, in my view, iatrogenic.

Our culture is really weird. Anything that is good and wholesome, like birth at home with those you love, sleeping with your baby and attachment parenting is branded medically suspect. I guess the beneficiaries of the regular doctor visits, helmet makers and surgeons who correct misshapen heads have to make a living.

Ethics, AMA and that South Australian Homebirth 'study'

Barbara Katz Rothman, Ph.D,  Professor Department of Sociology,  City University of New York, is the author of fabulous books such as The Tentative Pregnancy and In Labour: Women and Power in the Birthplace. W.W. Norton and Company, 1982, now updated as Laboring On: Birth in Transition in the United States, With Wendy Simonds and Bari Meltzer Norman. Routledge, 2007.

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

Barbara Katz Rothman made another great comment about how whenever there is a move to return power to women, patriarchal interests rise up in protest to reclaim their position. I haven't got the exact quote, but something along that line.

What is particularly interesting right now is that the negative voice of reproductive medicine headed by their president, is growing louder and louder, warning everyone that birth is dangerous!  The voice is getting louder, telling women and the community that birth at  home is dangerous, just as the Federal Government begins to move to increase women's birth choices and position midwifery as the health care profession most suitable and appropriate to provide primary health care for childbearing women.

Coincidentally, a report on homebirth in South Australia was published recently in the AMA medical journal.

Medical Journal of Australia article on SA homebirth

The president of the AMA Dr Andrew Pesce, wrote the editorial of the issue of the AMJ which published the 'study'. He listed his competing interests this way

"I am President of the Australian Medical Association, which is opposed to home birth in Australia".

The title of Dr Pesce's editorial is "Planned home birth in Australia: politics or science?"

Dr Andrew Pesce (Dr 3am)'s Editorial in the MJA

Good question, Dr Pesche, all looks good and transparent on the surface so far!

Dr Pesche discussed the controversy surrounding homebirth and midwifery practice and quoted the following 'facts' from the 'study' of SA homebirth statistics:

"planned home birth was associated with a sevenfold increase in risk of intrapartum perinatal mortality compared with planned hospital birth, and a 27-fold higher risk of death due to intrapartum asphyxia.6 These differences were significant despite a sample size of only 1141 home births. Overall perinatal mortality standardised for gestation and birthweight was more than double that of planned hospital births, but because of low numbers these differences were not statistically significant. Of course, not all severe adverse perinatal outcomes in labour can be avoided, but they are better avoided, statistically speaking, when birth is planned to take place in a hospital birth unit".

Deeper analysis of the 'data' reveals the statistics are somewhat skewed. I have written else where about the results of this 'study'.  As the old truism goes there are 'lies, damned lies and statistics' - it requires enormous rigor and willingness to look at one's blind spots when interpreting statisics.  One of the ways to assist with blind spot removal is to have independant reviewers go over the results of data interpretation. Everyone would presume the AMJ would do that to maintain credibility and transparency. A reasonable assumption given that the Journal’s website links to the World Association of Medical Editors Position Statement on “Conflict of Interest in Peer-Reviewed Medical Journals”: http://www.wame.org/conflict-of-interest-in-peer-reviewed-medical-journals

However, following various online articles debunking the analysis of the statistics, including an article by Melissa Sweet at Crikey.com  Don't believe the homebirth horror headlines galvanised Dr Pesche and the AMA to seek a right of reply.

In his reply to the criticism of both the article and his editorial, Dr Pesce said

"My editorial was primarily about the politics of home birth.  Most neutral commentators have commended me on the balance of the editorial".

As Croakey comments "Dr Andrew Pesce, for those who haven’t been following the story thus far, is the president of the AMA (which opposes homebirth), an obestetrician and gynaecologist, one of the reviewers of the new study, and also the author of the MJA editorial on the study".

Now wait a minute! Dr Pesce was one of the reviewers of the new study? Hmmmm  and wasn't Dr Mark Keirse, an obstetrician,  one of the authors of the discredited Bastion study also cited by Pesce as evidence of the dangerous nature of birth at home?

Uh oh.  Excuse me,  the bias is showing.

I'd love to know who the 'neutral commentators' were!

Using 'science' to back up biased opinions is hardly new or unique to this particular study and the rhetoric which surrounds it.  However, frightening childbearing women and the community about the safety of birth in any context is unethical, given what we know about the way that the hormones of fear impact upon both the fetus and the woman.

Dr Pesce also asks the reader

"...to be fair, my editorial did mention the lower intervention rates, the similar rate of post partum haemorrhage and other favourable outcomes of home births found in the study".

Dr Pesce needs to listen to the despairing voices of midwives and student midwives who struggle daily with the way that medicine interferes, disrupts and pushes the birthing process into places that women are not ready to go with disabling consequences.

for example

"So, after watching BOBB (The Business of Being Born) and doing my current reading about the history of midwifery/hospitals/medicine, my eyes have been opened, yet again (still!) as to how harmful the hospital environment can be towards childbirth and women.

Yes, hospitals, medicine and nursing care can save lives. However, ever notice the trickle down effect of us *causing* some of the problems in the first place?"

Some self loathing, some guilt, and a whole lot of venting

It's time Dr Pesce to stand back and look at who's interests are being served in this 'debate' and controversy?  This 'shroud waving' and 'spin doctoring' of facts is an 'emperor has no clothes' kind of situation. What do we make of it in light of the fact that over $2.11 million dollars of tax payer's 'safety net' money has been siphoned off into the pockets of some doctors?

Changes to obstetric safety net are fair, despite foul cries – Croakey

The big question is how do we get to work together so that the woman is in control of her body and reproductive process and we as health care professionals are there to support and encourage every woman to feel safe in her own body and respected for her evidence informed choices?  There are some great doctors who really respect women and believe that the natural brilliance of the birth process works well when women are informed and supported to labour and birth undisturbed in the place of her choosing. These doctors are there, respectfully supportive for the rare occasion when some kind of intervention is warranted.


Birth is as safe as life gets Dr Pesce.  The therapeutic use of self as a health care practitioner is what makes both life and birth safer. As Barbara Katz Rothman says "birth is about making strong and capable mothers". Time to stop pulling the rug from under women's sense of self with all this 'turf war' rhetoric!

peaceful parenting: Breastfeeding Baby Jesus

This video shows religious art - images of Mary breastfeeding baby Jesus. What the images reveal is the societal attitude towards breastfeeding at the time the art work was created.

Note the hand positions of Mary and the age of the various representations of baby Jesus. 

A wonderful compilation from Danelle Frisbie at Peaceful Parenting. Danelle has a wonderful blog. http://www.drmomma.org/




peaceful parenting: Breastfeeding Baby Jesus

YouTube - (Baby's perspective) barnets perspektiv!

Ever wondered what it is like to be baby looking out at the world from inside a pram? Wondered what it is like to be a baby being carried? This short video demonstrates the difference. The language is not English, but for those English speakers, the visual portrays the message brilliantly.



YouTube - Barnets perspektiv!

Tesco Ultra Softcarry Pack Mini 44 product information - Tesco.com

The effects of advertising on human behaviour is well known. Marketing psychologists are paid huge money for coming up with ideas, images, ways of presenting information that influences people subliminally so that they 'naturally' change their behaviour and buy the product.

Look what women and families are being 'sold' in the UK

What's the message here?

Tesco newborn nappies with a beautiful woman and newborn baby. That in itself is fully understandable. However, the packet shows the woman is bottle feeding her newborn. 

Hmmm.  

This photo is clearly a deal made with formula makers (do we smell money kickbacks here) and is the sort of socially corrupt marketing activities that are undermining breastfeeding as normal. This photo is an example of the way that marketing activities by big formula companies are working to make bottle feeding the 'norm' in a subliminal and unfortunately, powerful way.

This behaviour of undermining optimal nutrition for babies for corporate advantage is disgraceful. Many women struggle to breastfeed their babies already with the countless adverse social factors that mitigate against women feeling comfortable in their own bodies.

The future health of babies and society are influenced by this underhanded ' for profit' marketing

While the Code for marketing breastmilk substitutes has some clout, for other advertising there is no such protection. What a pity the genius minds of marketing psychologists aren't gainfully employed in producing campaigns for encourage people to work with their natural, physiological intelligence.  

Oh, wait, there's no money in that! 

UK Marketing Director of Tesco Carolyn Bradley can be contacted on: carolyn.bradley@uk.tesco.com 

Tesco Ultra Softcarry Pack Mini 44 product information - Tesco.com

Reducing infant mortality and improving the health of babies

A powerful video on  Reducing infant mortality and improving the health of babies from film maker and writer Debbie Takikawa


Reducing Infant Mortality from Debby Takikawa on Vimeo.


The risk of premature birth is discussed in  Report: 13 million babies worldwide born premature
and 1 million premature babies die each year

"The preterm birth rate in the USA is especially high: 12.7% of all babies are born early, according to the March of Dimes. That rate has increased 36% in the past 25 years, partly because of an increase in elective cesarean section, an increase in older mothers and the growing use of assisted reproduction, which increases the risk of twins, triples and higher-order multiple births, the report says. Most of the increase in the USA is in "late preterm" babies, born at 34 to 36 weeks of pregnancy, the report says."

The Role of Environmental Hazards in Premature Birth is being more closely examined, because, as Jennifer Howse states in her position statement preceding the conference report

" Not long ago, discourse on preterm birth was nearly always centered on the role of the mother. Increasingly, however, environmental hazards are being recognized as contributors to the devastating and costly problem of preterm birth"

The words reportedly attributed to Nicholas Fisk, director of the University of Queensland Centre for Clinical Research in Australia bear close investigation and consideration.

"Instead of focusing on acute preterm labor, researchers might help more women by identifying underlying problems, such as inflammation, that develop early in the pregnancy"

These emerging insights into the role of environmental toxins in premature birth and other disruptions to the whole process are providing a clarion call for the wholehearted support of all childbearing women by community and government structures to reduce stressors so that inflammatory processes are not switched on.

Norweigan Scientist says breastmilk is no better for babies than formula - mirror.co.uk

Interesting report on research from Norway, where breastfeeding support is high and most women breastfeed? What's going on?

Scientist says breastmilk is no better for babies than formula - mirror.co.uk

Statue in front of hospital on Margarita Island Venezuela

UNICEF has refuted the study

http://www.babyfriendly.org.uk/items/item_detail.asp?item=620

Ben Goldacre from Bad Science fame posts the press release that lead to the BIG STORY which has been subsequently plastered all over the media

http://bengoldacre.posterous.com/

These articles and responses to them are well worth reading to get the full story behind the 'story'.

Essentially, what the researchers are saying is that women who have high testosterone levels in pregnancy, have trouble breastfeeding.

There is a very thoughtful informed response by Australia's Karleen Gribble PhD School of Nursing and Midwifery, UWS, reproduced below.
Karleen's post was in response to a query about the study on en-net, " a free and open resource to help field practitioners have access to prompt technical advice for operational challenges for which answers are not readily accessible" The Emergency Nutrition Network is a UK registered international charity, set up by humanitarian agencies to improve effectiveness of emergency food and nutrition interventions through rapid identification and dissemination of lessons learnt in the course of operational practice, and through research and evaluation.

The en-net forum is made possible by the support of the American People through the United States Agency for International Development/Office of Foreign Disaster Assistance (USAID/OFDA) and the support of the Irish People through Irish Aid.

http://www.en-net.org.uk/

Karleen wrote on the above list:

"There's a few things that you need to understand about this study (which I have read) and the context in which it was carried out. This research is from Norway, the country with the best breastfeeding rates in the Western world- 99% initiation of breastfeeding and 80% of women still breastfeeding at 6 months. Societial support for breastfeeding women in Norway is very good. The very small number of women who cease breastfeeding in the early weeks of their infant's life would include those whose have a genuine physiological problem with making sufficient milk for their babies. It was found that these women were more likely to have higher levels of androgens during pregnancy. This is not a huge surprise, it's been something that others have been suggesting for some time (see the book for mothers "Making more Milk" by West and Maracso). The researchers seem to think that androgen levels can account for pretty much every factor associated with early weaning....they are endocrinologists....it's a case of if your only tool is a hammer, everything looks like a nail. It's a bit simplistic but there's no doubt that they have found a useful priece of the puzzle.
As to the idea that formula is as good as breastmilk. Well, the references cited in the study as providing evidence for this idea are 4 from the PROBIT study (the huge RCT of the implementation of BFHI in Belarus). The 4 studies cited looked at the impact of BFHI implementation (and lower of higher artificial feeding rates) on child behaviour, growth, dental caries, allergies/asthma- that's it. You'll get few people getting all het up saying you must breastfeed otherwise you're child will have behaviour problems or holes in their teeth. And to be perfectly frank any results from the PROBIT study on allergy and asthma is going to be questionable because the issue with allergic disease is exposure to allergens- and the only way to do this properly is a longitudinal study which records the time of the infant's first exposure to anything other than breastmilk- the only study I am aware of that has done this is one by Wendy Oddy in W Australia (and indeed, the critical factor was the timing of the first exposure to cows milk protein). There was nothing in the study that addressed the most common morbidities and mortalities due to artifical feeding, that is: diarrhoeal disease and respiratory infection.
Shall I be cynical and say that the researchers wanted to get media interest in their study?? (This was just a single small paragraph in the paper) Perhaps. Or maybe they just don't see the adverse effects of formula feeding since they are in Norway, where as I mentioned, just about every woman breastfeeds for a substantial period of time and where they have one of the best public health systems in the world.
And just a note about language when we talk about infant feeding. Breastfeeding is the normal way of feeding babies. It is extremely important and in fact it is vital, essential, indispensible to the wellbeing of infants and young children. It has NO BENEFITS. It is NOT best. Rather, artificial feeding is risky and dangerous. It actively and passively harms the immune system and the health of infants. Breastfeeding does not decrease disease, artificial feeding increases it. Breastfeeding is not best, infant formula is deficient.
This may seem pedantic but we actually have a growing body of evidence that if we talk about breastfeeding as best and the benefits of breastfeeding that we fail to effectively communicate the importance of breastfeeding and the risks of formula feeding- we actually assist in the promotion of formula feeding.
I can provide more evidence on this if there is interest".

Medical News: Childhood Abuse Linked to Migraine - in Pediatrics, Domestic Violence from MedPage Today

This important study shows why getting it right during pregnancy and birth are so important. Babies and children must be protected. We have clear evidence of what helps to provide an environment where babies and children are cherished and protected. Childbearing women need to have their needs met, feel respected and valued. Women and their partners who are supported to bond with their babies during pregnancy and experience skin to skin with their babies at birth are less likely to abuse them. Babies who are breastfed are less likely to be abused. If we get it right at the beginning, imagine all the suffering we can eliminate.

Child Abuse Linked to Migraine

by Kristina Fiore, Staff writer, MedPage Today
Published: January 07, 2010
Reviewed by Dori F. Zaleznik, MD, Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Some

" Research suggests that there's an interaction between early maltreatment and chronic stress that leads to hypothalmic-pituitary-adrenal axis dysregulation


"Studies suggest that emotional abuse may have more lasting consequences, including psychiatric sequelae, than physical or sexual abuse," the researchers wrote. "Our finding that persons reporting emotional abuse had a significantly earlier age of migraine onset may have implications for its role in migraine pathophysiology."
For the third part of their study, the researchers looked at the relationship between childhood maltreatment and comorbid pain conditions in headache patients.
They found that 61% of patients reported at least one comorbid condition, while 18% reported two, and 13% reported three or more.
Prevalence of pain conditions was as follows:

• Irritable bowel syndrome: 31%
• Chronic fatigue syndrome: 16%
• Fibromyalgia: 10%
• Interstitial cystitis: 6.5%
• Arthritis: 25%
• Endometriosis (in women): 15%
• Uterine fibroids (in women): 14%

They found that emotional abuse was associated with increased prevalence of irritable bowel syndrome, chronic fatigue syndrome, and arthritis, while physical neglect was associated with arthritis.
In women, physical abuse was associated with endometriosis and physical neglect with uterine fibroids.

Medical News: Childhood Abuse Linked to Migraine - in Pediatrics, Domestic Violence from MedPage Today

Preterm babies grow better with Mozart's music

Gone are the days when babies were thought to be 'blank slates' requiring only sleep, clean nappies, warmth and food.


Advances in neuroscience demonstrate that babies need much more than cursory attention to their basic physical needs. Babies from birth, whatever their gestation, require love, sensory stimulation including movement, skin to skin experience with their mothers and the opportunity to engage eye to eye with their mothers. Babies are sensitive, social and interactive; constantly seeking to engage; adjusting, learning and developing according to environmental cues, feedback and experiences.

The environmental needs of babies who are born prematurely require thoughtful consideration as they are often in nurseries, handled by strangers even though they are generally kind and well meaning and subject to painful and unpleasant stimuli.

Exciting work, exploring the needs of premature babies is leading to brilliant discoveries by pioneers such as Dr Nils Bergman, who was the first to highlight the tactile needs of premature babies and developed kangaroo mothercare, or skin to skin baby wearing for premature infants and their mothers.

Dr Bergman demonstrated that premature babies who had 'kangaroo care' stabilise better and faster, cry less, fuss less, grow better and have enhanced brain development. Mother/baby bonding is improved too.

http://www.kangaroomothercare.com/


The recognition that babies are people too and thrive in an enriched environment has had another boost.

A new study carried out by Dr. Dror Mandel and Dr. Ronit Lubetzky of the Tel Aviv Medical Center affiliated with Tel Aviv University's Sackler School of Medicine has found that pre-term infants exposed to thirty minutes of Mozart's music in one session, once per day expend less energy -- and therefore need fewer calories to grow rapidly -- than when they are not "listening" to the music.
"It's not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated," says Dr. Mendel, a lecturer at Tel Aviv University.
In the study, Dr. Mandel and Dr. Lubetzky and their team measured the physiological effects of music by Mozart played to pre-term newborns for 30 minutes. After the music was played, the researchers measured infants' energy expenditure again, and compared it to the amount of energy expended when the baby was at rest. After "hearing" the music, the infant expended less energy, a process that can lead to faster weight gain.
A "musical environment" for preemies
When it comes to preemies, one of the main priorities for doctors is to get the baby up to an acceptable body weight so he or she can be sent home. At the hospital, preterm babies may be exposed to infections and other illnesses, and a healthy body weight keeps them immune to other problems in the future.
While the scientists are not sure what occasioned the response, Dr. Mandel offers one hypothesis. "The repetitive melodies in Mozart's music may be affecting the organizational centers of the brain's cortex," he says. "Unlike Beethoven, Bach or Bartok, Mozart's music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed."
The study came about through an international project led by the U.S.-based consortium NIDCAP, whose goal is to create a set of standard practices to optimize the health and well-being of neonates. A number of environmental effects, such as tactile stimulation and room lighting, are already known to affect the survival and health of these very susceptible babies.

A sonata a day keeps the doctor away

Wonderful to see this work steadily improving the lot of premature babies and their mothers. However, we need to also focus on preventing prematurity as premature babies have extra risks and potential burdens to deal with as they grow outside the womb. One to one midwifery care with a midwife who respects, listens and cares for the individual woman provides a space place for the woman to explore becoming a mother; process her stressful feelings and develop self confidence. In such a capacity building environment, stress hormones are diminished because women feel valued and in control; inflammatory processes are not triggered and babies grow better and to term.

Breastfeeding is Normal

The women who made this video said:

"The purpose of our video is to encourage mothers to feed their child, no matter where they are! And to give encouragement to new and expecting mothers that breast is best, and nursing IS normal".

YouTube - NIN CHARLOTTE

What is "Normal"? - Mamapedia™ Voices

This is a lovely exploration of the concept of 'normal' by Lisa Morguess of "Finnian's Journey" on Mamapedia.

Good to ponder

A friend of mine had a baby with Down's syndrome.
She told me one day that her child 'wears his imperfections on the outside'.

What is "Normal"? - Mamapedia™ Voices

Newborn care key to baby’s survival—DoH - INQUIRER.net, Philippine News for Filipinos

"MANILA, Philippines—The current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country.
“This is a paradigm shift,” was how Director Honorata Catibog, head of the Department of Health (DoH) task force on the rapid reduction of maternal and neonatal mortality, described the new program introduced by the DoH and the World Health Organization.

Proponents of the Essential Newborn Care (ENC) are changing the protocol currently observed by childbirth

practitioners.

The ENC protocol prioritizes drying the newborn and initiating skin contact with the mother before clamping and cutting the umbilical cord. It prescribes a proper sequence of interventions that even a single health worker could perform and calls for initiating breastfeeding within the first hour of life".


Newborn care key to baby’s survival—DoH - INQUIRER.net, Philippine News for Filipinos

Early life stress has effects at the molecular level

More evidence of the need to keep mothers and newborn babies together and ensure skin to skin uninterrupted time at birth. Maternity service providers, midwives and doctors take note

Early life stress has effects at the molecular level