Showing posts with label support. Show all posts
Showing posts with label support. Show all posts

Saturday 11 August 2012

Natural Births A Major Cause Of Post-Traumatic Stress? Wrong!

A Tel Aviv University researcher has linked natural birth with post traumatic stress disorder (PTSD).

Natural Births A Major Cause Of Post-Traumatic Stress

Interestingly, some people consider that PTSD is a very modern trauma

According to the Tel Aviv study, 1 in 3 postnatal women in their study sample showed signs of PTSD while a small percentage were severely affected.

What causes PTSD?  A posting on medical news today in 2009 states that PTSD is triggered by a traumatic event and that:

"The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness".

"a woman is four times more likely to develop PTSD than a man. Psychiatrists say this is probably because women run a higher risk of experiencing interpersonal violence, such as sexual violence"
Traumatic events that commonly trigger PTSD in women - these include rape, sexual molestation, physical attack, being threatened with a weapon, childhood physical abuse.

Given that labour and birth are innately highly emotional, vulnerable times for women - and that is to enable the liberation of the 'love hormone' oxytocin - the emotional 'fixative' for attachment, bonding and breastfeeding - the feeling is a natural 'high' - the reward for labour and birth;  care needs to be respectful, supportive, kind and competent for labour to go well.  Women need to feel in control, to have agency and feel safe during labour and birth.   Numerous studies have found that women labour and birth well when they have caregivers they know and trust.



Women who have their emotional needs met in labour and birth enter motherhood feeling awesome!

Feeling good after giving birth is not about whether it was natural or not, it is not about whether you coped with the pain or not, although labour is much harder to handle when you are not in a good environment or in control of what's happening to you - it's about how you are treated, how well supported you are, how protected and private your birth territory is and how well you feel in control of what's done to you.

I think the good doctors need to investigate what is going on in their hospitals! They are 'barking up the wrong tree'.



Monday 12 December 2011

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


Saturday 20 March 2010

Perception of effort, not muscle fatigue, limits endurance performance

"As recently as 2008, scientific research papers were citing the theory that endurance performance is limited by the capacity of the skeletal muscles, heart and lungs and that exhaustion occurs when the active muscles are unable to produce the force or power required by prolonged exercise.
Dr Sam Marcora, an exercise physiologist at Bangor University, has now disproved this for the first time and proposed an alternative - that it is your perception of effort that limits your endurance performance, not the actual capability of your muscles. He showed that the muscles were still able to achieve the power output required by endurance exercise even when the point of perceived exhaustion had been reached".
The idea that the perception of effort limits a person's endurance performance is relevant to any physical activity that requires endurance, not just the sporting arena.

For birthing women, their families and midwives, this information is very important. Perceptions around labour and birth are culturally constructed. Many women are apprehensive about giving birth because of the negativity they are subjected to on a daily basis from well meaning friends, associates and even total strangers. That apprehension that many women feel, coupled with also well meaning but negative, undermining comments when they are in labour, may lead many women to perceive that they are 'at the end of their tether' and unable to go on. Birthing physiology requires the woman to feel safe and loved to work optimally.

Many partners get frightened by the rawness and primal nature of labour and seek to make themselves feel better by sympathising/pitying and/or suggesting pain relief for the labouring woman. An example is regarding one of the couples, several years ago, who came back to an antenatal group to talk about their birth experience six weeks earlier. When they had told their story, the man said "I was so happy when she had the epidural, I couldn't stand it any longer".

Women do look to their partners and caregivers to check how they are 'doing' in labour. Women get feedback that way. Fear-filled or pitying faces trigger mirror neurons to create similar feelings in the women, disrupting their physiological functioning for birthing. Unless the woman's self talk is particularly strong and positively oriented, her mind will be filled with fearful reactive thoughts, further disrupting her birthing physiology.

On the other hand, in a similar way to what happens in sporting situations, when partners/family and midwives provide encouragement, words of praise, smiling faces and a firm belief in the woman's ability, women's self talk changes and they find the inner strength to continue, even getting a 'second wind' as the energy in the room picks up. That's where the analogy to sport ends because with birthing there is no competition. There is no one to beat. The wonder is that there is a beautiful baby and fabulous placenta to welcome into the world.


The recipe for enabling birth, as it is for any physically related endeavor requiring focus and endurance:

  • believe you can 'do it'
  • prepare yourself
  • surround yourself with people who believe in you
  • ask your partner/support people to say supportive messages and to smile at you in labour
  • tell yourself that you 'can'
  • do it

Perception of effort, not muscle fatigue, limits endurance performance

Friday 19 February 2010

Resilience therapy empowers family violence survivors

Resilience therapy empowers family violence survivors

"Thousands of men, women and children experience family violence each year, according to the U.S. Department of Justice. Traditionally, therapy for violence survivors has predominantly focused on evaluating their trauma and pain. In contrast, a University of Missouri researcher broadens the therapeutic focus to empower survivors through highlighting their resilience, resourcefulness, and ability to overcome adversity".

Compared to current approaches that emphasize diagnosing symptoms and mental health issues, the strengths-based approach helps identify survivors' abilities, such as perseverance and overcoming, and how those skills can be used in their present-day lives.

"What are normally regarded as negative traits in survivors of family violence might actually be their survival strengths," Anderson said. "Traits that practitioners often try to change may be extremely important to maintain and can help survivors thrive in environments where there isn't violence."
Focusing on a strengths based approach to working with people is totally congruent with contemporary understanding about how the brain and nervous system works. Such an approach is capacity building and particularly useful for midwives working with childbearing women negotiating the changes that come with being pregnant, labour and learning how to be a mother with a new baby.

There are lessons to be heeded here:

"The strengths-based approach trains social workers, mental health practitioners, educators and students to uncover the positive in survivors' life stories—the skills gained by enduring and coping with immense adversity. This facilitates a more collaborative process, where the professional and the survivor each utilize their individual expertise to develop solutions.

"Victims of family violence find it difficult to see their own strengths and self-worth because it's often colored by shame and blame," Anderson said. "Similarly, practitioners find it difficult because they tend to focus only on victims' problems. Instead, they need to cast a light on survivors' abilities to cope and overcome the adversity brought on by family violence. This reveals hope that they won't always be victims of violence and they can achieve what they want in their lives, whatever their dreams are.

Most people find it difficult to see their own strengths and self worth, both necessary attributes for living a life of happiness and wellbeing. Midwives would do well to read this book and integrate the information into their practice so that the women they work with feel better about themselves when they leave their presence than when they came. That way women will also come to believe they can achieve what they want for themselves and their children.

Thursday 18 February 2010

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

from MedPage

"Babies with misshapen heads from lying on their backs too long may be at heightened risk for developmental delays, researchers said, although they stressed that infants should still sleep in the supine position"
The worry about SIDS (Sudden Infant Death) is understandable. Parents have been terrified about the possiblity of SIDs and it is heartbreaking when SIDS occurs. The Back to Sleep campaign has reduced the number of SIDs cases, but parents have become terrified to put their children in any other position than on their backs.
SIDS has been linked to low levels of a hormone called Serotonin and the enzyme that makes it in the baby's brainstem.  Brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children's Hospital Boston, and colleagues reported in the Feb. 3 issue of the Journal of the American Medical Association. A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.
 These researchers suggest that the back to sleep campaign has saved those babies who would not have been able to move their heads or bodies in response to changing physiology. 

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

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

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

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

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

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



CO-SLEEPING RESEARCH

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

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

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

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

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

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

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

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

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

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

Tuesday 5 January 2010

t r u t h o u t | Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy

Paulo Freire has been an inspiration to me and his theory has underpinned and informed my work in my roles as educator and midwife ever since I first read his book "Pedagogy of the Oppressed". This respectful, thought provoking, beautifully written article "Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy" by Henry A. Giroux, provides an inspiring lens on the most amazing educational theorist ever to grace this earth.

Giroux says, about Freire:

Occupying the often difficult space between existing politics and the as yet possible, Paulo Freire spent most of his life working in the belief that the radical elements of democracy are worth struggling for, that critical education is a basic element of social change and that how we think about politics is inseparable from how we come to understand the world, power and the moral life we aspire to lead. In many ways, Paulo embodied the important but often problematic relationship between the personal and the political. His own life was a testimonial not only to his belief in democracy, but also to the notion that one's life had to come as close as possible to modeling the social relations and experiences that spoke to a more humane and democratic future. At the same time, Paulo never moralized about politics, never employed the discourse of shame or collapsed the political into the personal when talking about social issues. For him, private problems had to be understood in relation to larger public issues. Everything about him suggested that the first order of politics was humility, compassion and a willingness to fight against human injustices.


For anyone who cares about education, liberation and personal mastery, this article is a must read.

t r u t h o u t | Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy

Tuesday 22 December 2009

Honoring Embodied Wisdom

I was exploring the peaceful birth project's wall (http://www.thepeacefulbirthproject.com/) on Facebook and came across the article about perineal integrity from Midwifery Today 2005.

Honoring Body Wisdom - by Pamela Hines-Powell



Pamela has some wonderful insights including:

"... there are very few things I personally can do to really prevent tearing in a client, but there are a whole host of situations and instances where I could actually create an environment for perineal tearing".

Our role as midwives is to create the environment where a woman can find her own way, get in touch with her inner power, her inner intelligence and innate guidance system. A woman can find her own way when there is an atmosphere of loving, capacity building trust in the process of birth and the woman's ability that the midwife engenders by having a mindful approach to her role in creating that environment. A mindful approach for the midwife involves awareness of and congruency in her intention, focus, thinking patterns, body language, movement and words. A midwife's mindful approach also includes attention to those aspects of the woman she is working with. Such an environment optimises a woman's birthing psychophysiology. A woman's optimal birthing psychophysiology means her mind, body and spirit are in harmony, her brainwave patterns are in gamma, alpha, theta and delta wavebands (known as a 'flow' state) a relaxed, focussed mode; her brain's attentional networks are focused on her baby and her baby's impending birth; the woman is able to let go of her orienting and alerting brain networks with their beta brain waves. When a woman is able to be in that biobehavioural state, genetic switches are flipped to parasympathetic mode; oxytocin and endorphins flow and the woman is able to respond instinctively to her body cues; labour progresses and birth happens.

Pamela asks a really good question: "As midwives, are we finding ways to support women's instinctive behaviors or do we undermine their instincts by directing them?"

How we look, how we move, everything we do and say has an effect on the labouring woman.

Pamela writes:

"The birthing woman is highly susceptible to suggestion—even if very subtle. For instance, a midwife lays a chux pad on the bed. The message received is "sit here"—many women will follow the placement of the chux and reside wherever it is placed, even if there is no spoken direction by the provider. However, left to her own devices, a woman will rarely lie down to push her baby out".

There is so much wisdom in that information. The first job for a midwife on the learning curve of being 'with woman' is to understand and integrate that truth into their practice.

I'm reminded of the words of the wonderful Nicky Leap, a brilliant midwife. Nicky said "the less we do, the more we give". That 'doing less' has to come from a position of trust in birth, trust in women's innate capacity to give birth well as well as being mindful of what is happening with that woman, her baby and the labour process. 'Doing less' is not about being lazy or lassez faire about women and birth. Doing less, is actively mindful, fully present and conscious in the moment, actively aware of the ebb and flow of labour and birth; being a source of feedback for the woman when required; subtly monitoring the woman, her baby and her experience; ready to support adjustment if needed. 'Giving more' in this context means that a woman who is supported to be instinctive feels powerful, her capacity is strengthened, she emerges from labour and birth feeling amazing. Barbara Katz Rothman says that birth is about building strong, capable mothers as well as welcoming new life into the world.

As midwives, we can create a safe, nurturing, protective environment where a woman can express her individuality, her innate wisdom and feel free to make the changes needed in becoming a mother. We can provide a supportive environment within which a woman can empower herself, find her innate power and utilise it; we can't empower her. We can however, disempower. We can 'pull the rug' from underneath a woman, destabilising her so she doubts herself and loses her confidence.

Pamela's question is a good one. We can extend that question and ask ourselves "am I creating an environment where a woman feels safe to be herself and does she feel better about herself when she leaves my presence?" We need to ask ourselves that frequently. We need to ask the women we work with for feedback about that too.

Friday 18 December 2009

What is "Normal"? - Mamapedia™ Voices

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

Good to ponder

A friend of mine had a baby with Down's syndrome.
She told me one day that her child 'wears his imperfections on the outside'.
What is "Normal"? - Mamapedia™ Voices

Sunday 8 November 2009

Fathers Gain Respect From Experts (and Mothers) - NYTimes.com

"when couples scored high on positive relationship traits like willingness to compromise, expressing affection or love for their partner, encouraging or helping partners to do things that were important to them, and having an absence of insults and criticism, the father was significantly more likely to be engaged with his children"

Fathers Gain Respect From Experts (and Mothers) - NYTimes.com

Thursday 20 August 2009

Can words hurt? Patient–provider interactions during invasive procedures

In an article in the Journal PAIN (2005) 114 303-309 Lang et al had this to say:

Abstract
Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behavior. This study assesses how such descriptions affect patients’ pain and anxiety during medical procedures. The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self hypnotic
relaxation. One hundred and fifty-nine videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients’ ratings of pain and anxiety on 0–10 numerical scales (0 No Pain, No Anxiety at All and 10 Worst Pain Possible, Terrified) after the painful event and/or sympathizing statement were the basis for this study. Warning the patient in terms of pain or undesirable experiences resulted in greater pain (P!0.05) and greater anxiety (P!0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (P!0.05). Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different patient–practitioner interactions. q 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

This study provides a perfect example of the way that hypnotic suggestion works.

When will health professionals realise that when they talk, their words are powerful. Pregnant women get this negativity all the time with the talk of 'risk' in relation to their normal, natural process of giving birth. The negative talk creates a self fulfilling prophecy for many women. Then the 'care' givers can use the outcome to reinforce what they think and say, not realising that they created what they believed to be true.

As the above article demonstrates, words are powerful. The sort of words that should be used around birthing women are words that foster a sense of normalcy, increase self efficacy, build self worth and self trust. Every health professional who has anything to do with birthing women should be working to build capacity for wellness and optimal psychophysiological functioning with every woman they interact with.

Friday 16 January 2009

When you think you can't, watch this

In life, we often get challenges which test us to the depths of our courage and self belief. This is true whether the context is personal, professional or global. These challenges can include everything from becoming a parent, going through the birthing process, finishing a degree, some global emergency, dealing with personal loss or issues with difficult people. I'm going through one of those times right now. Someone sent me this video and watching this man has transformed my thinking about my situation and capabilities.

Copy and paste this in your browser to view it

http://www.maniacworld.com/are-you-going-to-finish-strong.html

Isn't he amazing and what a blessing for all of us who get to experience his strength, courage, determination and generosity.

Saturday 6 December 2008

50 Qualities of Successful People

If you stroll along the bookshelves of any book store, you will find hundreds of books telling you how to be successful in many, diverse fields. When you analyse what the books are saying, they all point to the ability to maintain an optimistic attitude in the face of difficult and/or challenging circumstances, as well as the ability to self manage/regulate as foundational requirements for success.

For parents and midwives, success means happy healthy mothers and babies. Happy, healthy mothers and babies are more likely when stressors are managed well. The enormous changes that pregnancy can bring can be challenging and lead to feelings of stress and even distress for some people. The reality is that for all of us, stressful reactions involves chemical messengers which can play havoc with our physiology. Anything we can do to learn to manage stressors in our lives well is a vitally important thing to do for our health and wellbeing.

I found this list of qualities of successful people on Lifehack. When I looked at the list, I realised that the qualities I read there were those of midwives I really admired. I also recognised that the women and men who moved into parenting in the most optimal way displayed these qualities. It seemed to me that all of us could use the benefits these qualities bring and that steady, consistent adoption of these qualities in our lives can make our lives really wonderful.

1. They look for and find opportunities where others see nothing.

2. They find lessons while others only see problems.

3. They are solution focused.

4. They consciously and methodically create their own success.

5. They may be fearful, but they are not controlled or limited by fear.

6. They ask the right questions -- the ones which put them in a positive mindset and emotional state.

7. They rarely complain.

8. They don’t blame, and take complete responsibility for their actions and outcomes.

9. They always find a way to maximize their potential, and use what they have effectively.

10. They are busy, productive and proactive.

11. They align themselves with like-minded people.

12. They are ambitious.

13. They have clarity and certainty about what they want.

14. They innovate instead of imitate.

15. They don’t procrastinate.

16. They are life-long learners.

17. They are glass half full people, while still being practical and down-to-earth.

18. They consistently do what they need to do, regardless of how they are feeling on a given day.

19. They take calculated risks.

20. They deal with problems quickly and effectively.

21. They don’t believe in, or wait for, fate, destiny, chance or luck.

22. They take action before they have to.

23. They are more effective than most at managing their emotions.

24. They are good communicators.

25. They have a plan for their life and they work methodically to turn that plan into a reality.

26. They become exceptional by choice.

27. They work through the tough stuff that most would avoid.

28. They have identified what is important to them and they do their best to live a life which is reflective of those values.

29. They have balance. They know that money is a tool and ultimately, it’s just another resource.

30. They understand the importance of discipline and self-control.

31. They are secure in their sense of self-worth.

32. They are generous and kind.

33. They are happy to admit mistakes and apologize.

34. They are adaptable and embrace change.

35. They keep themselves in shape physically.

36. They work hard and are not lazy.

37. They are resilient.

38. They are open to, and more likely to act upon, feedback.

39. They don’t hang out with toxic people.

40. They don’t invest time or emotional energy into uncontrollable things.

41. They are happy to swim against the tide.

42. They comfortable with their own company.

43. They set high standards for themselves.

44. They don’t rationalize failure.

45. They know how to relax, enjoy what they have in their life and to have fun.

46. Their career is not their identity, it’s their job.

47. They are more interested in what is effective than in what is easy.

48. They finish what they start.

49. They realize that not only are they physical and psychological beings, but emotional and spiritual creatures as well.

50. They practice what they preach.

Lifehack May 12, 2008