Knowing about birth and interventions: Women's role

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

So who were these women that Klein et al studied?

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

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

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

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

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

Now here is something very interesting in this study:

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

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

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

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

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

This comment is interesting:

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

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

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

Now, this final finding that:

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

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

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

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

The conclusion of the Klein et al study that"

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

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

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

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

Healing from Birth Trauma

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

The headings provide links to Amber's blog.

Tale of Two Birth Stories, Part 1

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

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

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

Symbols, power and woman's place in the world

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

So it was with great interest that I followed this link

 

to YouTube to see Symmetry, a short vimeo film by Radiolab that Maria said "explores the dualities of human existence, best short film you'll see all week".

 

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

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

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

Why does that bother me?

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

Maria says that:

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

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

Maria explains that:

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

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

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

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

Symmetry from Everynone on Vimeo.


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

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

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

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

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

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

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

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

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

Raising birthing consciousness: moving beyond cruelty to women and babies

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

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

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


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



Birth Trauma from Centre Quiropràctic Molins on Vimeo.


Both those items and the accompanying comments have really troubled me. That women still emerge from their birthing experiences feeling like they have been abused is a dreadful and indefensible underbelly of maternity care. I left the public system thirty years ago to go into private midwifery practice because of the abuse I'd observed. I've written about that in my master's dissertation.
 
My friend told me she had been very roughly examined vaginally during the birth of her first baby and how devasted she had felt after that experience.  She told me that she felt it was the beginning of her slide into severe postnatal depression with that child and the source of the tremendous fear that she felt with her second pregnancy.  My friend said that she didn't stand up for herself at the time and as she was a midwife she 'should have'.  Then she said something that really illuminated the whole issue of birth trauma and abuse for me. She said "I should have stood up for myself, but I didn't have the words to do it..."
 
I thought about the way that women trust their health care practitioner to do the right thing by them and believe their practitioner has their best interests at heart.  Obviously, when the practitioner is rough, or behaves differently to what the woman expects, the woman goes into a shock-like biobehavioural state and has a cognitive dissonance experience. Cognitive dissonance experiences are usually difficult to put into words at the time.

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

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


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

A coroner's perspective on the death of a baby

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

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

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

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

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

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

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

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

Maternal intelligence: Calling the baby in

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

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

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

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

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

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

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

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

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

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

The Secret to Blogging?

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

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

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

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

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

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

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

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

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

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

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

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

Midwifery students?

Education? 

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

Carolyn

The Umbilical Cord: 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!

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?

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.

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.

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.

Power and Agency in Childbirth: Women’s relationships with obstetricians.

Trust, Power and Agency in Childbirth: Women’s relationships with obstetricians.

This great article by Monica Campo, a feminist sociologist and scholar, needs to be shared. Monica is doing her PhD at La Trobe University, in Victoria, and this article is part of her work for her PhD. The article is published online at Outskirts: Feminism along the Edge. Monica explains the content of this article this way:

"This paper has a twofold argument: that women participating in this study enter into a relationship of trust with their obstetrician based both on their class positioning and their belief and entrenchment within the hegemonic biomedical model of birth; and that their confidence and trust in their own ability to birth without medical expertise is subtly eroded in the medical encounter as well as through cultural fears surrounding birth. I use this evidence to make a wider claim regarding the limits of choice and agency within the obstetric encounter. Women in medical systems of maternity care are not ‘passive dupes’ of obstetric hegemony but their autonomy is nonetheless constrained by their relationship with their obstetrician and an increasing normalisation of medical birth".

Why midwives and women have to stay upbeat about birth: The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist

In the latest New Scientist (19th May 2010), an article by John Casti, Senior Research Scholar and a futurist (castiwien@cs.com) based at the International Institute for Applied Systems Analysis in Laxenburg, Austria who is developing early-warning indicators for extreme events in society, informs us that

"No collective human activities or actions, such as globalisation or, for that matter, trends in popular culture such as fashions in films, books or haute couture, can be understood without recognising that it is how a group or population sees the future that shapes events. Feelings, not rational calculations, are what matter. To see what our world might be like tomorrow, next year or next decade, we need to spend time and money investigating "social mood". Put simply, the mood of a group - an institution, state, continent or even the world - is how that group, as a group, feels about the future".

How would we, as a group of people who care about what happens to women and babies during the childbearing year, be described as feeling about the future?

Are we optimistic or pessimistic? "

According to John Casti, how we feel and how we see the future, does much to create it. In the Selfish Gene, British scientist, Richard Dawkins coined the word 'meme' as a concept to enable discussion about these collective social, cultural moods/orientations and behaviours as evolutionary principles in explaining the spread of ideas and cultural phenomena.

What's our meme? What do we want it to be?

Casti's essay is based on his new book Mood Matters: From rising skirt lengths to the collapse of world powers.

The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist