Why the way maternity care is provided has to change!

You have to read this post!  It clearly demonstrates all that's wrong in contemporary maternity care.

Nathan is leaving the building and he is exactly the kind of obstetrician we need to help stop the madness of modern maternity 'care'.  

He writes: 

The life of a hospital-based OB/GYN is misery. Phone calls throughout the night to fix problems that we created through attempts to induce or intensify birth surges are a prime example of how our priorities have become totally ass-backwards.

Read on ... 

Click the link below to read Nathan's heartbreaking and yet inspiring reflection - he shows clearly what needs to  happen

On my departure from hospital-based birth - a reflection

Modern maternity care has become a self-fulfilling hampster wheel of fear and intervention, becoming more and more disabling for everyone involved.  Nathan nails it.  Let's change it.

We need to move entirely to woman-centred care; let's provide continuity of midwifery care; let's leave things alone until there are signs some help is needed - let's not break women's birth processes and then have to fix them.   Let's not use war metaphors for our practice - women don't need pre-emptive strikes, but they do need loving support, kindness and safe places to explore what becoming a mother means - as does her partner need the same care.

Let's do it and bring back Nathan and all the other Nathans and midwives who leave in disgust at home the system traumatises everyone.

The image below is from Nathan's Blog Post and I thought it apt, very apt ...
 

Handmaidens of the hospital birth machine - No More

The emotional work of being with women is immense and what we see and come to embody is that birth is now a battle ground, leaving bruised, battered and traumatised women in its wake, with many midwives the witness or the handmaids of the hospital birth machine

Quote from student's guest post 'No Woman's Land' on Midwife Thinking's blog

Click on the link to read the full post

I walk into the Panopticon, affectionally known as the fishbowl, the central area in the birthing unit where a bank of monitors line the walls, each one displaying a fetal heart rate and her/his mother's contractions as part of the fetal surveillance tactics of modern obstetric care. Despite the evidence that these tracings called CTG's - cardiotocographs - don't change fetal/newborn outcomes; lead to more and more interventions and harpoon women to beds, restricting their movements and compromising their ability to find comfort, every woman in the place is hooked up to one of these 'machines that go ping'.

I could be in any birthing unit in a tertiary referral hospital in the country and what I've described above is what I'd see.

Birthing is not a relaxed, happy event in a medically dominated, fragmented care system.

I was wondering 'was it ever?'

The correct answer is probably not. Certainly not in major teaching hospitals. Perhaps yes in small country hospitals, where everyone knew everyone. Many of these small hospitals have been closed over the last ten to twenty years.

Birthing women have been ignored, dismissed, controlled and managed ever since hospitals became the norm.  There is something very weird about healthy women bringing babies into the world in places where sick people go to be cared for and healed or die. Intervention in the birthing process has been accelerating in the last few decades.  More and more women are emerging from their childbearing experiences shocked and traumatised.

That's one hell of a start to mothering a defenceless, needy brand new human!

The identification of unexpected and preventable events that influence mortality is a key indicator of the safety of health care for those who access the services. When interventions to reduce these events are not utilised, or health providers don't have the skills to use them, it's called 'failure to rescue'.  'Failure to rescue' as an outcome indicator identifies hospital characteristics as a potent contributor to adverse outcomes. What does 'failure to rescue' mean for midwifery care and maternity services?   Marie Hastings-Tolsma and Anna Nolte have written an excellent paper, reconceptualising 'failure to rescue' in midwifery. In considering the importance of protecting labouring women from encountering an adverse event, the authors ask "What processes are in place to prevent unnecessary interventions for low-risk women and thus, promote normal birth processes?"  

The authors continue: 

The ability to provide ‘watchful waiting’ is typically eroded by the culture of the hospital setting. Such restriction contributes to failing to rescue where women seek care which promotes normal childbirth.

None of us are prepared to put up with this situation any longer. Things have to change.

What's different now is that we are more aware, we are more educated and we have more knowledge abour our physiology and what conditions help physiology to work in an optimal way.  We expect to be treated with respect and care to be given with our best interests at heart.

We also have the evidence.

The evidence says that relationship based care is the best; that knowing your midwife reduces complications, increases the normal birth rate and supports successful breastfeeding.

At the ICM ICM Africa Regional Conference ICM President@FrankaCadee left us with a strong parting message in her welcome address that “the hand that rock the cradle should also rock the boat.” The time is now for midwives, we cannot keep silent and ‘behave’! 

No more tinkering with and disrupting women's physiology!

Women don't have their brains bathed with natural oxytocin 'the love hormone' during labour and birth when they're being induced with artificial hormones

Infants born by caesarean section  have disrupted and different microbiomes than babies born normally

Women birthing in hospitals don't get pronurturance - care at birth associated with lowered rates of postpartum haemorrhage and improved rates of succcessful breastfeeding and more settled, happier babies - hospital protocols get in the way!

Midwives are stressed, burnt out and depressed by their sense of powerlessness and what they see happening to women on a daily basis in the health care system.

Dr Liz Newnham says the Time for Midwifery is Now and provides the following suggestions:

• The truth is out there

• Call out obstetric discourse

• Speak truth to power

• Refuse to participate

• Support birth physiology

• Prioritise relationship

• Association #Strongertogether

    And our ICM President has the last word ....

Midwives, exhaustion and safety

A recent survey of midwives and maternity support workers in the UK, found that the majority were stressed because of their workload and fearful of making mistakes because of exhaustion. Over half of those surveyed had observed errors and incidents which could have caused harm to women and their infants. These stressors are not restricted to the UK. I hear similar concerns from Australian midwives.

This situation is untenable for the midwives and the women and families in their care. 

 

It's about time governments and funding decisions reflect and respect the vital importance of childbearing to the fabric of society and fund maternity care appropriately. 

Better staffing levels are required. 

Staffing of maternity services decisions need to be made in acknowledgement of: 

• The increasing complexity of maternity care
• The fundamental requirement for adequate time for antenatal visits
• One-to-one care from a known midwife in labour 
• The need for adequate postnatal care

Only when these aspects are factored into the staffing model can we ensure that women of all risk and their infants get the care they deserve and the care which keeps them safe. 

Midwifery Continuity models for women of all 'risk' are what's required. 

Whatever model of maternity care is provided however, there must enough staff to provide the service safely - safely for women, their infants and safely for the midwives.

Midwives are dedicated professionals and consistently go above and beyond to care for women and their infants. That dedication should not be exploited. The current practice of staffing to the bare minimum, putting midwives on call after they've already had a full day at work in case there's an increase in activity, coupled with the ever-expanding list of mandatory education and competency requirements means the demands on midwives are creating a pressure cooker environment.  

Running midwives 'ragged' is not good government or health service policy. 

Appropriate and adequate funding of maternity care is essential.

We have a duty of care as a society to care for midwives and other maternity health care providers so they can care for the women and families they work with in the best possible way. 

The future depends upon it. 

Midwives warn of making mistakes due to burnout

The secret life of a midwife: I feel I work in a factory

Staff levels the risk: midwives

Bystanding Behaviour in Midwifery

I was alerted by a friend on facebook, to this article Bystanding Behaviour in Midwifery, about the way midwives don't stand up for women and how midwifery students are acculturated and desensitised to unkind behaviour. The article, written in 2008, is by Margaret Jowitt, who did her masters in Keele in 1998 on Mothers' Experience of Birth at Home and in Hospital. The book "Childbirth Unmasked" was written as a result of her reseach. Margaret is a lay member of the Association of Radical Midwives UK and a columnist for the Huffington Post.

Margaret wrote:

"I HAVE LONG WANTED to write an article on ‘Woman's inhumanity to woman' but have shied away until now for fear of being seen as attacking midwives and failing to acknowledge all they have achieved over the years in the care they give to women, often under very difficult and alien circumstances when they are based in hospitals".

I'm very glad she found a way to move through her fear and publish this article on Bystanding Behaviour in Midwifery and good to see it online as the issues are still alive and well today and not just in the UK.  Distressing as it is to think such articles are necessary, we need to examine and digest the ideas presented in this piece and discover what we can do to change or do better. I shared the article on facebook and twitter, thinking it would be useful for midwifery students.  However, I was prompted to put this post up to explore the ideas further following a reply 'tweet' to the article on Twitter.

@Thinkbirth I was a bystander recently and it traumatized me , worse was my colleagues saying it was normal and I was being dramatic.#scary 

How many of us have had our feelings about and discomfort with the way women have been treated minimised or dismissed?

What happens to us when abuse is normalised?

When there is a disconnect between what we know is right and what is happening, between what is taught and what is practice, there is cognitive and emotional dissonance and a sense of not knowing what to do next...

Photo from Prefrontal Org Blog

How do you deal with that?

Is this your experience?

Quotes for Midwives

My last meeting with the lovely midwifery students I've been working with in Papua New Guinea is this morning.

 Pacific Adventist University Midwifery Students PNG

I've been surfing the net, looking for quotes that relate to midwifery, women and birth that I thought would inspire them.   I've come across the following and thought I'd share them with you.

"You are a midwife, assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves!”  - From The Tao Te Ching

Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of our greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well. ~ Mother Teresa

Ask me for strength and I will lend not only my hand, but also my heart. ~ Unknown

If you lay down, the baby will never come out! ~ Native American saying

Offer hugs, not drugs ~ Adina Lebowitz

Someday, after mastering the winds, the waves, the tides and gravity, we shall harness for God the energies of love, and then, for a second time in the history of the world, man (sic) will have discovered fire. ~ Pierre Teilhard de Chardin

  Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth. ~Virginia Di Orio

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. ~ Eleanor Roosevelt

For God hath not give us the spirit of fear, but of power, and of love, and of a sound mind. ~2Timothy 1:7

If I had my life to live over, instead of wishing away nine months of pregnancy, I'd have cherished ever moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle. ~Irma Bombeck

Making the decision to have a baby – it’s momentous. It is to decide forever to have your heart go walking around outside your body. ~Elizabeth Stone

What's done to children, they will do to society. ~Karl Menninger

A woman
in harmony
with her spirit
is like
a river flowing.
She goes
where she will
without pretense
and arrives
at her destination,
prepared
to be herself
and only herself.
~Maya Angelou

Strong College, Strong Midwives, Strong Mothers

I've talked previously on this blog about the fact that:

"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

The environment a woman finds herself in is a great mediator for how well she is able to develop that strength. A supportive environment is enabling. A supportive environment is capacity building.

Picture: http://www.crystalinks.com/midwifery.html

Midwives have traditionally been a vital part of the woman's birth territory where ever the woman gave birth. Midwives have protected the space and provided the support, encouragement and trust in the birth process that is so integral to women feeling free to birth and mother well. Midwives stand strong with women as they bring their babies forth into the world. Many's the time I've been with a birthing woman who would glance at me as she laboured and I'd smile and nod and she would go back to her process satisfied that she was 'on track'. Those women would invariably say later, "I was feeling frightened and when I looked at you and you smiled at me, I knew I was ok".

The word 'midwife' comes from the Anglo-Saxon "mid-wyfe" which means 'with woman'. There is a long history (at least the last four thousand years has been recorded) of the way that being with women has brought midwives into conflict with 'authorities'. The Bible gives evidence that midwives have always stood with women and protected them and their infants in the most difficult circumstances and despite powerful edicts to the contrary. Exodus (1:15-22) contains "several verses recounting the experiences of two Hebrew midwives who refused to kill male infants in defiance of the King of Egypt".

And now, in Australia, women and midwives have a new challenge.

In response to political posturing by various authorities, the Australian  College of Midwives has released an Interim Statement on Homebirth in an attempt to restrict where women can birth and what midwives can do. The statement, hastily drafted as it was, nonetheless was rapidly endorsed by the newly formed Australian Nurses and Midwives Board, even before the statement was reviewed by the College's members.  You will note that the statement endorsed by the board does not mention the word 'interim'.  What is also concerning is that the College statement references two papers whose data collection methods have been poorly regarded (Kennare et al (2010) paper on planned homebirth in South Australia, and Bastian et al (1998).

Interesting.

Submissions on the statement were requested by Friday 23rd September 2011 (after publication on the web). The College states it intends to finalise the statement in October this year. Many of us are not impressed by the statement as it stands because it does not position the woman as the decision maker. Midwifery ethics are all about the woman as decison maker.

You will find considered responses to the interim statement on homebirth by midwives who work in private practice on the following links.

Rachel Reed of MidwifeThinking's response

Australian Private Midwives' Association's position statement on homebirths

I was thrilled to see the clarity of thinking and recognition of women's rights in the response from the National Alliance for Students of Midwifery.

This statement from the International Confederation of Midwives on women's choices and birth territory is clear and unfortunately, not reflected in the interim statement by the Australian College of Midwives.

So here's my  submission to the College for consideration in the Board's deliberations over the wording and intent of the Final Statement on Homebirth.

Carolyn Hastie
Midwifery Facilitator
23rd September 2011
Dear Colleagues,
Re: Australian College of Midwives Statement on Homebirth: Women's Rights to a Homebirth and Their Right to a Skilled Attendant
Firstly, I want to know that my College supports women to have sovereignty over their own bodies and agency, including the right to choose where they give birth.

I also want to know that my College supports midwives to support women with their choices.

Guidelines and standards are important, however, risk status is an indicator, not a predictor and each woman has the right as an adult to be self determining. As an adult, a woman has the right to informed consent and informed refusal.

What enables women to be safest when giving birth is a known competent midwife, agency to choose to give birth where she feels most relaxed, a seamless means of transfer and acceptance at a local health service and collaboration with that service and prompt medical attention as required; the woman's chosen midwife able to continue to provide midwifery care with the support of the hospital's midwifery team.

Science is clear that when women have a perception of control over what happens to them, they have reduced levels of glucocorticoids in their peripheral circulation. Stress hormones are implicated in much of what goes wrong in labour and birth. Our role as midwives and as a midwifery organisation is to be 'with woman' and reduce stress, not create it.

As Barbara Katz Rothman said, "when there is a strong and autonomous midwifery profession, women and their babies do well".

We need to be a strong and autonomous midwifery profession. I want to feel proud of my College and our final Statement on Homebirth. The Interim statement both horrifies and embarrasses me, especially as it has been already endorsed and published by the Australian Nurses and Midwives Board - how on earth did that happen?

Yours Sincerely,
Carolyn Hastie
ACM Member and Fellow
MO5257

Women's rights to sovereignty and bodily autonomy are under threat and we need to stand beside them, to ensure they have the information they need to make their choices and support those choices.

That is what 'midwife' means.

We need our College to support women’s right to choose what suits them and their families and to support us to support women. We need a strong College, so midwives can be strong to support women in their choices so they can become the strong mothers they need to be.

The Environment is everything!

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.

'Science speak and minifisms': hiding the horrible truth

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

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

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

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

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

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

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

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

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

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

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

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

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

The webpage states:

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

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

Alice Dreger continues

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

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

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

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

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

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

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

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

Life, birth and death: The horror of poverty

This video from Time, on Maternal Mortality in Sierra Leone, the story of Mamma - one woman's journey from pregnancy to death is a heart wrenching portrayal of what is happening to too many women in
impoverished circumstances.

The Time photo montage shows a photo of young woman with a glazed, far away look on her face, intravenous therapy in her hand, lying on a trolley bed, a baby on a chair beside her.  The photo's caption says:

"Birthing Room
Forced to marry at age 14, Mamma Sessay first gave birth when she was 15. Three years later, at the age of 18, she gave birth to the first of a pair of twins near her village, but when the contractions ceased for the second child, she traveled by canoe and ambulance to the Magburaka Government Hospital, where she waits, in the photo above, to deliver".

Read more at Time Photos: Maternal Mortality in Sierra Leone

The video of Mamma Sessay's life and death experience is recorded and reproduced here:

Video: Maternal Mortality in Sierra Leone

Poverty and the associated lack of clean water, sanitation, good food, contraception, respect for women, education, family planning, antenatal care, being married too young, having babies too early - the list goes on and on, is the real problem. The other real problem is social apathy and feelings of helplessness about women's lot in disadvantaged situations. Labour and birth are peak and demanding activities. Women do best when they are well nourished, well hydrated, informed, have good midwifery care during pregnancy, labour and postnatal period, are having babies when they want to, have been well prepared for labour and birth, are able to labour and birth with loved ones around and able to access good medical care if and when required.

The article in Time, called The perils of pregnancy is horrific, but the emphasis is wrong. The emphasis should be on the perils of poverty.


Why are our governments spending our hard earned tax dollars on war for oil, when we could spend our money on making life better for our brothers and sisters across the world. With a different way of looking at world affairs we could save the lives of women like Mamma.

There are some good signs. According to Dr Margaret Chan, Director-General of the World Health Organisation, in her opening address on behalf of eight organizations at the Women Deliver 2010 Ministers Forum Washington, DC, USA  on the 7th June 2010

"Domestic resources and donor funds are making a real difference to the lives of millions. The number of children dying before reaching their fifth birthday has been falling for several years. We are now seeing early signs of progress in reducing the number of women dying in pregnancy and child birth, in addition to the achievements in HIV, TB and malaria".

and added

"This progress is most welcome, but is fragile, uneven, inequitable and inadequate. Far too many women and children continue to die needlessly"

calling for a world wide, coordinated effort and finances, including:

"government leadership of inclusive partnerships at country and global levels to design, implement and monitor the commitments and promises of all stakeholders".

Letter writing and political activism required. 

What do you think?

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

The Cardiotocograph test: Absurd at best?

When I did my midwifery training in the 70's, the Cardiff Infusion pump was used to induce labour. The women were placed flat on their backs and monitored with a cardiotocograph machine. The cardiotocograph machine recorded an approximation of the fetal heart rate with an ultrasound transducer. There was also a capacity to record the uterine activity, but the uterine activity was actually monitored by the Cardiff pump machine. Women had their amniotic sac membrane broken with an instrument called a amnihook. A thin plastic tube with a pressure monitoring device was inserted into the woman's uterus through the cervix and into the sac next to the baby. The pressure monitoring device was hooked up to a machine called a Cardiff pump. The pump also provided a syntocinon (a synthetic hormone designed to induce labour) infusion into the woman's blood stream via a cannula in a vein in her arm. The rate of the infusion was set according to the pressure of the uterine contractions. The theory was that the rate of infusion of syntocinon would be governed to deliver the right amount of uterine stimulating drug and no more.

Of course there were problems with that process!

The Cardiff infusion pump has been phased out because of all the problems, but the cardiotocograph lives on, despite evidence that it is not reliable, overly useful, accurate nor does it enable women freedom of movement, known to provide the best opportunity to birth well and have optimal oxygenation of the woman and her baby.

The cardiotocograph machine has become the constant in the standard birth room and has taken the place of the midwife in the role of being 'with woman'.

An insightful honest account of the uselessness of cardiotocograph monitoring of labouring women is provided in the link below.

Test leads to needless C-sections | Philadelphia Inquirer | 04/26/2010

What's known is that the rampant use of cardiotocographs has increased the caesarean section rate with no benefit.

Dr Alex Friedman, a Fellow of Maternal-Fetal Medicine at the Hospital of the University of Pennsylvania said: 

"A 2006 analysis by the British Cochrane Collaboration, evaluating all available research, found that fetal heart monitoring failed to reduce perinatal mortality - the risk of a baby's dying late in pregnancy, during birth, or shortly after birth - and increased cesarean section rates and forceps deliveries, compared with listening to a baby's heart rate intermittently".

Steven Clark and Gary Hankins, two prominent obstetricians said

"A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best," they wrote in the American Journal of Obstetrics and Gynecology. "Electronic fetal heart rate monitoring has probably done more harm than good."

and The Doctors' Channel has an excellent video explaining that C-Sections, necessary or not increase maternal morbidity and mortality.

So why are they still done so mindlessly?

The answer is best summed up by this comment:

"Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don't work and can cause harm".

Breastfeeding helps build healthy bones

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

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

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

Telegraph.co.uk

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

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

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

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

However, I found the following written in the article:

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

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

You will notice several things about this quoted piece.

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

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

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

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



Study suggests a much earlier onset for bone problems

Flu vaccination ban goes national after fever, convulsions in children

More than 60 children around WA have had adverse reactions to the flu vaccine, Fluvax. This vaccine contains three different flu components, including swine flu. If a child has already been exposed to swine flu, experts suggest that some children may be reacting badly to receiving a second exposure. Reactions have included febrile convulsions leaving one child in a critical condition. Doctors have been advised by the department of health to stop giving the vaccine to children under five years of age.

Photo from WA News 23rd April 2010

The official response to the adverse reactions has been remarkably slow.

Chris Thompson reported in WA News that

"WA's chief public health officer Tarun Weeramanthri has defended the response time in closing down the state's juvenile flu vaccine program amid revelations that children were presenting with convulsions more than two weeks ago".

The ABC said on Friday, 23rd April, 2010, that authorities in SA and Queensland have also acknowledged a number of adverse reactions to the vaccine in young children. The AMA have agreed with the ban on Fluvax to young children, however they caution parents not to lose confidence in immunisation.

In the ABC news story on Friday, Professor Peter Collignon, from the Australian National University, whose expertise is in infectious diseases, voiced concern about wide scale vaccination with Fluvax. Professory Collignon doesn't think that we have enough data to roll out a population wide vaccination program because it might cause more harm that good.

I'm wondering if the delayed reaction to the widespread reaction to the Fluvax is the result of an inability to truly perceive what was happening because the phenomenon is so outside the belief system that has been created about vaccination.

While the authorities claim they were monitoring the situation, the reality appears otherwise. They appear to have been rationalising.

The pro- vaccination lobby has been virulent in the way that open debate and discussion about the value of vaccination has been squashed until now. Dissent has been forbidden, thought patterns about vaccination have been dictated. I was told at an immunisation nurses' update session to leave the room if I didn't agree with newborn babies being given Hep B immunisation. I was seeking honest, open discussion and information. I was told "you have to believe!!" in very strong tones. Well, I don't agree to 'just believe' I want to keep my thinking open, curious and able to critique events if and when they occur.

The cult like behaviour that accompanies the pro-vaccination stance reminds me of fundamentalism.

Fundamentalism in any context is dangerous. Slavish following of 'science' is no different to slavish following of 'religion'. Slavishness removes the ability to discern, debate and think clearly.

The delayed response to the childrens' vaccine reactions can be seen as a symptom of a fundamentalist, non thinking bio-behavioural state.

The Term Breech Trial and Catholic Priests paedophilia are both examples of slavishness; also recognised as cult like behaviour - (no independent thinking encouraged or allowed) with dreadful sequelae that continues to reverberate.