The Birth Project - Our ABC

 Our ABC is investigating giving birth in Australia!

Despite Australia having one of the lowest maternal and infant mortality rates in the world, too many women are emerging from the birth system feeling hurt and damaged. Induction and caesarean section rates are soaring but there is no change in key indicators such as stillbirth. Meanwhile, physiological birth and breastfeeding rates plummet. 

Please share this request for birth stories with all your friends and neighbours!

 

 

Here is more information and the links:

https://www.abc.net.au/news/health/2022-11-03/birth-project-australia-abc-investigation/101574750 

Use this form to send the ABC your story about birth.

They want to hear about your experiences of pregnancy and birth – and from those of you who provide maternity care.

What's working? What's not? And what can we do better?

The Birth Project is running from late 2022 into 2023. Here are some of the stories they've told so far:

• Birthing a better way: Statistically, Australia is a very safe place to give birth, but the care families receive is a lottery. Three women who live less than 90 minutes apart had very different experiences, by choice, chance and necessity. Their stories reveal a complicated system crying out for change.
• Revealing the impacts of birth trauma: While she was pregnant, Amy dreamed about the time she'd spend with her first son Bobby. She didn't imagine incontinence, therapy and surgery — and Amy's experience is all too common, according to the results of a new survey.

Looking forward to ABC being provided with many stories explaining what happened, what worked for you and what didn't work for you.  

Would love to read your thoughts.

 

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 ....

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

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.

Birth Genius

Birth is amazing.

Women's embodied wisdom about birth is brilliant and babies ability to be born is stunning. Both geniuses come together when they are supported wisely in an optimal environment to express their innate ability and intelligence. 

Trust, both of self and the others in the birth environment by the woman is a powerful mediator for birth to go well.

The others have to be trustworthy though.

This video gives an excellent example of genius in action.



I would have loved to see the woman hold the baby, the cord to have been left intact and the film to have shown the placenta being born.  I do love seeing this video of the birth of this footling breech baby with the cord around it's neck three times. I've watched it quite a few times!

There is something exquisitely satisfying about an example of everything being right with something that others say is wrong or dangerous. An example of natural intelligence in action.

The gentle way the practitioner held and touched that baby was delightful and reverent, as it is meant to be.

I couldn't help but compare that behaviour of the doctor in the video to the behaviour I saw recently at a birth.

The doctor kept poking and pushing at the baby's head as it was being born.  The doctor then pulled the head around, twisting the neck the wrong way ( I said where the back was on palpation; that information was ignored).  Then, obviously worried about the possibility of shoulder dystocia, the doctor proceeded to tug the baby out.

The woman tore and needed sutures (not as bad as last time apparently!).

I felt strongly that the meddling caused the tearing. She had been labouring in a quiet, self managed way and if she had been supported to push that baby out with her urges, with patience and direction to push gently between contractions, she could have avoided the tear.

I guess surgeons don't have a problem with suturing, after all, it's their bread and butter.

For the woman, however, it's her body and good to keep intact.

I also recognise that the recumbent position leaves women open to being 'manhandled' during birth. An upright position makes touching so much more difficult. I suspect that the vulnerabilty inherent in the recumbent position makes touching and manipulation 'ok' whereas when a woman is upright, she is more in her power. I wonder if her size in an upright position appears bigger and therefore less vulnerable?  Lying down was her choice and of course, should not be an invitation to unnecessary interference.  I wonder if lying down on our back triggers the primitive brain region to assume dominance in those that are upright?

When Tracy Donegan read this post, she sent me an article about positions of power posing and neuroendocrine effects.  Thanks for this information Tracy!

Another beautiful example of breech birth is given by Lisa Barrett on her blog. One of my favourite photos of birth is in the photo essay.

Lots to think about here.

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.

'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).

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

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".

Optimal Environmental Conditions for Childbearing

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

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

Optimal Environmental Conditions For Childbearing

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

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

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

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

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

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

Writing Speeches For The Government

Writing Speeches For The Government

MYLES PETERSON

February 21, 2010

Midway through last year I was head-hunted by the federal Department of Health and Ageing to write speeches for their ministers - a surprise as I had no experience or qualifications. As far as the department was aware, my limited skills were derived from reviewing video games for The Canberra Times.
Perplexed and amused, I dusted off the suit and attended my one and only interview. ''I'll be writing speeches for who?''
''Minister Roxon,'' answered my interviewer.
''And you're going to pay me how much?''
''Eighty thousand a year. Will that be enough?''
So began my journey down the public service rabbit-hole. I would soon learn that swine flu and a raid on staff by another department were to thank for my recruitment.

Sigh! An article well worth reading. So this is what we are dealing with folks!

YouTube - Our bodies rally.wmv

On the 18th February, 2010 in 14 locations across Australia, 1000's of people rallied to register their protest at the Rudd Government policies that threaten to restrict options for women.

Jane Palmer's wonderful video montage of the rallies for women's right to choose what happens to their bodies in childbirth

And some media on the 'issue'


The Sunrise piece that seems to have stirred up the Government

http://au.tv.yahoo.com/sunrise/video/play/-/6819641/

a TV piece from Chan 7 yesterday

http://www.youtube.com/watch?v=LvZFZ0gd-Zw

http://www.facebook.com/l/64996;www.mybirth.com.au/19-02-2010/women-rally-at

Nicola Roxon's response to collaboration agreements.

http://www.abc.net.au/news/stories/2010/02/19/2824133.htm

Roxon says: "I'm unapologetically on the record as saying let's encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them.." 

That's great in theory and obviously something that sounds very reasonable. 

The question then has to be asked: So why not restrict doctors work unless they collaborate - they are the ones who make things difficult! 

In reality, Roxon's 'encouragement' is only fueling the power imbalances and women are caught in the 'rip'.

 

 

 

Founders of British obstetrics 'were callous murderers' | UK news | The Observer

Founders of British obstetrics 'were callous murderers' | UK news | The Observer

"They are giants of medicine, pioneers of the care that women receive during childbirth and were the founding fathers of obstetrics. The names of William Hunter and William Smellie still inspire respect among today's doctors, more than 250 years since they made their contributions to healthcare. Such were the duo's reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.
But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses.
"Smellie and Hunter were responsible for a series of 18th-century 'burking' murders of pregnant women, with a death total greater than the combined murders committed by Burke and Hare and Jack the Ripper," writes Don Shelton, a historian. "Burking" involved murdering people to order, usually for medical research."
"Motivated by ego, personal rivalry and a shared desire to benefit from being acclaimed as the foremost childbirth doctors of their time, Hunter and Smellie sacrificed life after life in their quests to study pregnancy's physical effects and to develop new techniques, the author says. "Although it sounds absolutely incredible, the circumstantial literary evidence suggests they were most likely competing with each other in experimenting with secret caesarean sections on unconscious, or freshly murdered, victims, with a view to extracting and reviving the babies," Shelton told the Observer".
Another founder of obstetrics, Dr Marion Sims, who has the Sim's speculum named after him, was also callous about women and their bodies and performed hundreds of operations on black women slaves without anaesthetic.

          Sims contended that ‘Black women don’t feel pain'

Modern obstetrics evolved from this era.

When you consider the foundations of anything, the foundations do influence the structure of what comes after. Modern obstetrics imposes an impersonal, efficiency model onto women's organic, dynamic birthing processes. There are, of course, doctors who treat women individually and take into account what women want - they are however, not in the majority.

I'm not talking about those women-centred doctors here.

I'm talking about the 'cookie cutter' approach to labour and birth adopted by obstetrics generally. The process that women are subjected to has been linked to the industrial age Taylorist ideas of factory processing - speed, efficiency and cost containing - supposedly.

Many women emerge bruised and shattered from their birth experience having been 'done to' by the 'machine'.

Meanwhile, midwifery emerged from millions of years of women helping women during their life cycle events such as the birth of children. Midwifery remains woman focused and has sought and is seeking to keep birth normal, keep maternity care woman focused, accommodating women's individual needs, desires and dreams for her baby and her experience.

That is where the 'rip' is - the two tides of beliefs, attitudes, values, historical underpinnings, philosophy (etc) come together and create a field of dissension and distress for both women and midwives.

Many theorists are saying how invasion, genocide, penal colony origins, drunkenness, murder and mayhem were the foundations of contemporary Australia and underpin the rules, regulations and behaviours of 'mateship' - football culture, 'tall poppy' syndrome and other rather distasteful aspects of our culture.

In terms of modern maternity care and the 'turf wars' together with rising rates of surgical birth and maternal depression, as we look through the lenses of the foundations of medicine and midwifery - makes us think doesn't it.

          What do you make of all this?

          Update 25 August 2017 

          In the USA  Black Women are protesting Sims' statue