One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

Vision, perception and birth

Being able to see is a gift and yet, often taken for granted. How we see and what we see is regulated by the way the neurons fire together primarily in the visual cortex. Our vision also is influenced by our perceptions and our intentional/attentional networks. What we pay attention to influences what we see.

Graphics of the brain, like that above, while useful for showing the general region of activity of various parts of the brain, miss out on the myriad links and neuronal connections that influence and modulate the brain's activities.  Neurons are amazing. 35,000  neurons fit under a pinhead and each has anything from 60-60,000 connections. The neurons don't actually touch - they communicate and connect through chemicals and electrical signals.

The longest axons goes to our big toes! So everything is connected. The more connected, the richer and deeper our experiences. So too with vision.

Many years ago, a friend was at our place and waxing lyrical about his experiences with LSD - a popular drug at the time. He was trying to explain to me how the drug affected his ability to see things much more deeply and clearly. In an effort to get his message across, he told me with some exasperation that 'red was really red!"  I remained unimpressed and thought that his words were the ravings of an idiot - my impression of anyone who took drugs.  My friend's words came back to me about two decades later when I was driving across the Nullabor after a seven day residential meditation course. To my amazement, everything seemed brighter and more colourful. I finally understood what my friend had been trying to tell me all those years ago. Mind altering substances and mind altering experiences of meditation can have the same effect; that of opening up more connections in the brain enabling deeper, richer experiences.  The meditative strand is controllable, the drug induced experience much less so. Neuroscience tells us that it is our brain that sees, not our eyes and that our brain cannot tell the difference between what we imagine and what is actually in our visual field. Neuropsychologists have found that we don't see the world as it is, but how we 'are'.

Buble et al (2010) have found that when people are depressed, their colour differentiation is contracted, less vibrant. That finding makes sense to me when you think about attentional networks, neural linkages and moods, all of which are interconnected and all of which profoundly affect the way our physiology works. The greatest teacher the world has known said 'without vision the people perish'.  When we can't see beyond our current situation, our view contracts.  The ability to visualise or engage in 'imagineering' - seeing in our mind's eye what we desire to have happen or experience affects both mood and body physiology.

A midwifery student wrote a note about her experience of helping a birthing woman to use visualisation to change her labour trajectory.  The student has given me permission to repeat  her story and I do so here as I think her words demonstrate even more clearly what I'm talking about in this blog:

"Just HAD to tell you all of my experience in birthing suite last week!  Arrived at 7am to a primip (sic nullip) who had been having irregular pains all night following spontaneous rupture of membranes the day before.  Not coping well with these pains as the baby was in a posterior position, epidural was being inserted as we arrived, followed by Syntocinon infusion.  Unfortunately, we did not believe that established labour had begun, and the CTG showed little evidence of uterine activity.  Four hours post VE (showing barely 3cm at 7am), another was attended, and showed 4cm, posterior lie and thick cervix.  The midwife with me explained her concerns that this labour would probably end in a caesarean. Syntocinon was as high as it could go.  There were some typical decelerations noted on CTG.  She decided to let this woman know that labour did not appear to be progressing 'as it should', and that she should prepare herself for the possibility of the caesarean if no further progress occured.  While left alone with this lady (who had a big cry at this point with her supportive hubby), I suggested that she close her eyes and imagined her baby moving down and changing position, reassurring her that this was a powerful strategy to use.  We dimmed the lights and I left the room to allow the couple some space together.  At 1pm the obs registrar attended another VE and we were all elated when he announced it was time to start pushing!!  The look on the woman's face said it all.  Wow! I don't know who was more surprised - me, the midwife or the woman - who managed to birth her baby beautifully some 20 minutes later, cord tightly around neck, but Apgars 9,9 regardless.  Never underestimate the power of the mind OR the ability to birth well!"

For anyone who is concerned about a nuchal cord, which is the baby's cord around the baby's neck, let me refer you to the wonderful post of midwifery lecturer and independent midwife, Rachel Reed.

What do you think about all that? 

Bubl, E., et al. (2010). Seeing Gray When Feeling Blue? Depression Can Be Measured in the Eye of the Diseased. Biol. Psychiatry 68: 205-208. DOI: 10.1016/j.biopsych.2010.02.009.

Stress, Telomeres and Health

Our chromosomes have protective sheaths and caps at their ends. These caps are known as telomeres and protect the ends of the chromosomes. An analogy is the little plastic ends on shoelaces. The length of these little caps has been found to indicate the health of our cells. Shortened caps are associated with advanced cellular aging.

Telomeres and the enzyme telomerase are responsible for protecting the chromosomes which take care of  the replication of our cells. Chromosomes which are unprotected are associated with cancer and other mutations of cells. Shortened or damaged telomeres have been found in women who are chronically stressed in caring roles (Epel, Blackburn & Lin 2004).

Researchers at University of California San Francisco (UCSF) were calling for volunteers to take part in a trial to look at the role of stress on telomere length and health. 

I volunteered, because I figured it would be a good thing to be part of this research looking at whether knowing the length of these cell replication protection units would be useful as a health  marker.  I got an email back today telling me they were fully subscribed for the study. Many women had responded to the newspaper article. I'm delighted that so many people saw the value in this research.  What really impressed me was the note the researcher included in her email.  She said and I quote:

"Just a side note --we can try to keep our telomeres healthy, without having to have them tested. To keep healthy  telomeres, it seems the same factors that protect the heart also protect the telomeres- regular vigorous activity, healthy diet with lots of fruit and vegetables (antioxidants from foods) and less processed meats, and to reduce stress, feeling socially connected and being mindful and relaxed when we can.  My own favorite stress buster is yoga.

With best regards,

Wanda Truong, Clinical Study Coordinator
Elissa Epel, PhD, Principal Investigator (head of the study)"

I was invited to reply if I was interested in being part of further studies and of course I am, so I replied and told them so.  I figure that if these researchers are suggesting ways to keep our telomeres healthy, then that's worth listening to!

By the way, Dr Elizabeth Blackburn has been seeking to find ways to enhance life as we age and her efforts led to her winning, along with two of her colleagues the 2009 Nobel prize in physiology or medicine for the discovery of “how chromosomes are protected by telomeres and the enzyme telomerase.”


Accelerated telomere shortening in response to life stress. by E. S. Epel, E. H. Blackburn & J. Lin, et al. Proceedings of the National Academy of Science (PNAS), 2004, 101(49)

Fathering

A few days ago, I was on the train on the way to Sydney. A well dressed couple with two little boys got on and sat down at the seat ahead of me. The boys were about 2 and 3 1/2 years old. The father sat down on the seat and immediately opened his newspaper. The children sat by the window and asked endless questions all the way. The mother was fully engaged, answering questions, explaining fascinating things like why the water was blue, where did the boats go, what did frogs do when the train came and so on. The conversation indicated that they were on their way to a day at the zoo and the boys were obviously very excited.

The boys were interested, full of life and questions. The mother was calm, attentive and engaged. At one stage, one little fella said he was hungry. The mother said kindly, that he had a chance to eat his breakfast and that he had chosen not to do that. She explained that he would have to wait until he got to the zoo when they would have morning tea to have something to eat. The way the mother handled the situation was very impressive and the young boy did not 'carry on' so clearly knew his boundaries.

I enjoyed watching the mother with the boys and when I got off the train a stop before they were getting off, I commented on the way she interacted with her children and congratulated her. She was very engaging with me and we had a good interaction in those few moments. The father put his paper down slightly and smiled warmly at me as I said goodbye, then looked back at his paper. As I saw the train pull away from the platform, I waved at the little family; he was head down reading and she was pointing, waving and talking with the two excited boys who smiled and waved at me. 

A couple of days later I was talking with a very proud new grand father.  He was telling me how his son helped with the 'crap work'!  This 'crap work' is with the one week old baby.  I asked what the 'crap work' was with great interest. The grand father told me with great pride that his son bottle fed the baby while his partner caught up with sleep. I knew the woman was breastfeeding and must admit that I was shocked and the look on my face must have made my reaction obvious.  I said I was surprised that feeding was considered 'crap work' and was told, in a defensive tone, that "it is when you are sleep deprived". I found that a very difficult conversation because there was no entry point to have a discussion about newborn needs and the importance of finding ways to protect, support and promote optimal breastfeeding.

Father and newborn

After these two recent experiences, I find myself wondering about fathering and how and what we midwives can do to encourage optimal engagement of fathers. We know that men who are fully engaged during pregnancy and birth are more engaged as fathers. We also know that men who have skin to skin with their newborn children have oxytocin (the love hormone) surges and decreased testosterone (the war hormone) and are more attentive fathers who are less likely to spank or hurt their babies and children. Those of us who work one on one with childbearing women and their partners have seen that in action. These two experiences indicate to me that we still have a way to go. Finding creative ways to engage fathers and perhaps grand fathers too, more right from the start will help to unravel and rejig those unhelpful myths, negative attitudes and disabling practices that still abound in our society and disrupt men's ability to be the kind of fathers that is their potential.

Facilitating Online 2010 Course

I'm feeling very excited! The Facilitating Online Course 2010 being run again by the wonderful Sarah Stewart, of The International Day of the Midwife fame, is starting soon.

  Facilitated Networking by love2dreamfish Dreamfish Flickr

I'm really looking forward to learning all the elements of online facilitation that Sarah has thoughtfully put together. There are people from different parts of the world, in various occupations who have signed up with Sarah.

Sarah says:

"Facilitation is a rare and valuable skill to have. It is a service that is often used in conferences, debates, panels and tutorials, or simply where groups of people are meeting and need someone to help negotiate meaning and understanding, and to keep everyone engaged and on task.

This online course is designed to help people to access and interpret models, research, and develop professional expertise in online facilitation"

As part of the course, we are expected to keep a reflective blog, so stay tuned for evidence of my learning and development in the field of online facilitation.  Participation in the course is free, but if anyone wants personalised attention and a certificate for completion, fees apply. The program starts on July 19th 2010 and runs until November 26th. If you are interested in learning and exploring online facilitation, contact Sarah Stewart who will be delighted to help you get started.

Item 4 of what we have to do at the beginning of the course is: Make a plan for what you want to learn and explore, and write it up (or present in another way eg mindmap, video recording) on your blog. Answer these questions.

• What do you want to learn to facilitate?
• What are you doing now in terms of online facilitation?
• What would you like to achieve, change or do more of?
• What do you need to do or make happen to achieve your goal?

I'll have to spend some time thinking about these questions and work out a creative way to answer them!

The Look of Love: birth, mothers, babies and attachment

We humans are gifted with a prefrontal cortex, the site of our executive functioning. Our prefrontal cortex allows us to make choices, decide on different courses of action, rather than reflex, reactive behaviour.  Our prefrontal cortex enables us to evaluate different options and make a decision on what suits us best.

Sociologists contend that rather than being self determining agents with free will, we are culturally constructed, and our decision making is culturally driven and that we do not make decisions based on true free will, but based on what society has taught us is 'expected' and 'accepted' behaviour. Certainly, marketing psychology takes advantage of our tendency to buy on emotions and rationalise our purchases. We make our decisions based on emotionally based programming, we over ride our instincts and go with what is culturally predetermined as 'right'.  In the eyes of the law and culturally accepted social codes, such as avoiding fighting, stealing and self aggrandizement, that form of socially constructed behaviour is useful and makes for a safer and perhaps kinder society. However, there is a down side to over-riding innate instincts. 

Nowhere is the negative side of culturally driven behaviour more apparent than childbirth. Childbirth has been corrupted in our modern world.  In 1972, Doris Haire wrote a wonderful piece about the Cultural Warping of Childbirth, drawing attention to the way that the medicalisation of women's bodily processes at birth were causing harm. A more recent article by Estelle Cohen has drawn attention to "alarming continuing decline in the scores of high school students on the Scholastic Aptitude Tests or, "SAT's," a decline which had started with the 18-year-olds born in 1945 and thereafter. From 1963 to 1977, the score average on the verbal part of the SAT's fell 49 points. The mathematical scores declined 31 points. (1)" Estelle questions whether this decline in academic performance is linked to the way that obstetrics "manages" childbirth.

There are myriad intersecting and interconnecting influences on the personality, health, breastfeeding success, intelligence etc of any human being. However, the links between the way someone is born and their future health and wellbeing is becoming more understood. Epigenetics is one of the scientific arenas that are explaining the links. Many of the practices around the birth of a baby are pivotal and set the scene for the long term relationship of mother and baby. More and more attention is being paid to the mother baby interaction at birth, the role of being skin to skin for mother and baby on both the mother and the baby's future health.

Hospital practices have meant that entire generations of mothers and babies have been separated at birth. The consequences of that separation are only now starting to really be understood.

When my daughter was born, she was whizzed off to the resus trolley, cleaned up and wrapped, then shoved under my nose for about five seconds, then whisked off to the nursery.  I didn't see her until the next morning. About three hours after she was born, I found myself pacing the corridor of the hospital ward. I was surprised by my behaviour, but I recognise now that my body was looking for my baby, even though my conscious mind knew she was in the nursery. I did not think to question, to ask to see her; I fully accepted that she was in the nursery.


Lynne Reed, a Birth Keeper said in a recent interview that “We are the only animals on this planet where the mother will willingly give up her baby to someone else,” she says. “To me, that’s a huge indicator of how separated we are from our natural instincts, which would be so fierce to protect the baby.”

I certainly was separated from my natural instincts and days passed before I saw my daughter naked and we never had the skin to skin experience. I wonder if that is why I was so keen to go back to work and why putting her on the bottle was totally acceptable?  Research shows clearly that women who have skin to skin time at birth with their babies have all kinds of benefits and sequelae such as happier babies, self soothing babies, better breastfeeding experiences, less likely to leave their babies with others, babies smile earlier and more frequently. The list goes on and on.


A significant part of the experience seems to be the first eye to eye connection between mother and baby. Carla Hartley from Trust Birth has spoken about the smile a newborn gives her mother when she looks up at her as they connect skin to skin at birth. Carla describes that moment as 'precious' and 'sacred'. That eye to eye connection can be seen as a connection of spirits, a recognition of souls on this life journey.

For those who haven't had this connection, the gap can feel profound and deep. For example, in a Facebook conversation about this topic, Katherine Suszczewicz said " I was adopted. I hadn't realized until just now how my birth affected me today. It just occurred to me reading this that I have lived 45 years with a smothered urge to look my (birth) mother in the eye, something she didn't do when I was born. That feeling has been simmering and is quickly reaching a rolling boil. Just to look into each other's eyes, there's something there". When I asked Katharine if I could share her words she gave permission and said "whatever choices a momma makes, I think that first gaze is crucial....to begin life with the first air breath, a stare into your mother's eyes, and a feeling of love, security, to feel that someone is fiercely protecting you.....will carry you all your days on earth".

Leah Ann Sandretzky commented on Katharine's post and gave me permission to share her story. Leah said

"Katherine Suszczewicz: my heart goes out to you. ♥ my mother was and still is a recovering drug addict and alcoholic; she's looked me in the eyes many times and I have never seen that love. She says she loves me; and I know she does deep down . . . but her heart is gone from her selfishness. I was cared for by my grandparents most of my life; ...and to this day my soul longs for a Mother's love in my heart. I've taken that pain, that want, and turned it around to love my children 10x more than I think I can every day....in honor of the mother I never had. I don't know your story, your heart; but I hope that whether or not you have or will find that Mother's love in someone's eyes for you; you can go on loving like a Mother should. ♥ "

Another woman said "... the "look" I never received, I was adopted as well. My mother wasn't allowed to look, touch or hear me at birth due to the trauma of adoption on her. I was wisked away and the nurses kept me in the closet behind the nurses station so my mother or her family wasn't tempted to see me. The nurses spoiled me, I was told... and held me all the time but it just isn't the same. I hear the pain of the other women saying almost the same things. Way before reading this article I came to a conclusion during self reflection that I had a very hard time allowing anyone to get too close to me. I have attachment issues with everyone on this planet except for my children. Who I wouldn't let out of me sight when they were born. Thanks for posting this. I never put the two together about the "look" and bonding, I always assumed it was not being with my birth mom in general".

 

That look of love at birth is crucial for brain patterning and wiring a sense of self for the baby. Newborn babies are wired to look at faces and to prefer their mother's face to any other. That look of love triggers cascades of oxytocin in both mothers and babies, welding them together, spiritually, emotionally and physically. 

 

The implications for midwifery practice are clear. We are the guardians of the birth territory. We must facilitate the space so that mothers and babies can connect in this deep and profound way. The future of society and every individual's health and wellbeing depend upon us getting the beginning 'right' and providing an optimal environment, enabling a woman to respond to that innate voice and do what comes 'naturally' or rather, instinctively. 

 

 

 

Birth and Bugs

Note: for some reason the links aren't showing up in this post. Just run your cursor over the words and they will show as a purple colour. I can't fix this glitch, not sure why! Sorry.

Mumma and babe

Some interesting posts about the importance of the way babies are born and the bacteria they are exposed to through the birth process are emerging in cyberspace. The information is not only interesting, it helps to inform our practice as midwives and enables parents to understand one of the many reasons why there is a concerted move in both midwifery circles and government agencies to turn the tide more towards normal birth. Concerns are being raised that environmentally triggered changes to immune cells of babies born by caesarean section are predisposing those babies to be susceptible to immunological diseases such as diabetes and asthma in later life.

A blogger has explained the importance of our exposure to bugs at birth this way.

and a teacher of molecular biology at Princeton University, Bonnie Bassler, explains how bacteria talk to each other chemically. Bonnie informs us that we are composed of 10x more bacteria cells than human cells!

This information is a powerful addition to the accumulating evidence about normal, natural, unhindered, supported birth being best for mother and baby.

'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).

Judging Right and Wrong?

Great changes are happening to midwifery and women's birth choices in Australia. The government has passed legislation that on the one hand gives more autonomy and a wider scope of practice to midwives working in the public health system and on the other hand, restricts the services able to be offered by midwives in private practice. More women will be able to have their babies at home as more public hospital homebirth services are being offered. However women will have less ability to choose their own midwife. In accessing publicly funded services, women will have to, in the main, take 'pot luck' with their midwives. Women who have 'criteria' also known as risk factors will be denied a choice of birth venue, even though many of the risk factors are poor predictors of outcomes. With good midwifery care, these women birth  well.

I have had an email from someone recently who is absolutely distraught because her local hospital staff are bullying her into having another caesarean. The maddening thing is that the woman has given birth normally both before and after the caesarean birth. The hospital where the woman lives has a 'once a caesarean always a caesarean' policy and does not take into account the individual and her circumstances . The woman is unable to pay a private midwife and any other options are non existent.

Just yesterday, a woman who was booked to have a homebirth with a publicly funded service, was explaining to some midwifery students how she found out that her allocated midwife was off when she went into labour. She rang the phone number and got a midwife on the other end who she felt was not the least bit interested in her. The woman told the students how uncomfortable she felt and how she had to ring someone in charge and get another midwife allocated to care for her. She was finally allocated two midwives she felt good with. Once that arrangement was settled, she was able to focus on her baby and her labour. She went on to have a her baby at home.

I've found the various perspectives on the current changes polarised and distressing for many people. I can understand the distress. Change is always challenging. Many people feel we are losing too much. I believe that we have to stay focused on what we want and how we want maternity services to be. Focusing on the problem only adds energy to the problem. Looking clearly at what is going on and then choosing our path and taking action is a much better way.

I truly want everything - I want women led maternity services.  I want women and their babies to be safe and given the care they want so that their physiology works well and their safety is optimised. I want publicly funded birthing services, including venue of choice to be freely available.  I want midwives in private practice able to work to the full scope of their practice. I want 'no fault' compensation for women and their families when babies have problems as they occasionally do regardless of birth venue.  I want women, midwives and doctors to work together and with other health care providers as needed for any particular woman's circumstances.  I believe we can achieve these changes.

Imagine my delight when I found this email newsletter in my inbox from a wonderful man, Charlie Badenhop, this evening talking about right and wrong. Charlie is a fourth degree black belt and certified instructor of Aikido in Japan, and a certified trainer in NLP and Ericksonian Hypnosis. He is also a long term practitioner of various forms of bodywork, Self-relations therapy, the Japanese healing arts of sei tai and seiki jutsu, and Yoga.

I have found Charlie well worth listening to as he always has something interesting and appropriate to say. As I read the newsletter, I thought how pertinent Charlie's writing is to our circumstances. I wrote to Charlie and asked if I could share the newsletter. He readily agreed and to my surprise, told me that at one stage he had thought about becoming a midwife but ended up in Japan instead.

Enjoy!  If you like what Charlie has to say, you can subscribe to his newsletters down the bottom of the blog post.

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c).

Punishment, and the concept of "right or wrong"

"A lot of the best learning I received as an Aikido student came when we were outside of the dojo with sensei. We could be having a cup of coffee, or occasionally having a drink, and at some point it would become clear sensei had a message to deliver.

Once we were sitting in a coffee shop waiting for a train in the countryside.
Seemingly out of nowhere, sensei said, "I think there are many people in the world who act in a confrontational manner, and thus I wish more people understood the Aikido principle of non-dissension."

"Instead of spending so much time and so many human lives quarreling over who is right and who is wrong, I think the world would be a better place if we spent more time exploring how both sides are both right and wrong."


Myself, and the other two students sat there and said very little, knowing sensei was just beginning to get warmed up.

"You see," sensei said, "In Aikido we learn to refrain from engaging in confrontation, but that does not mean we shy away from protecting ourselves. It always intrigues me when new students attend a class and ask, ‘How can Aikido really be a martial art if you don't attack or retaliate against your opponents.' By this time the three of you have heard my reply many times over. In Aikido we have no attack form because we have no desire or intention to harm our adversaries. Instead we strive to bring hostilities to a conclusion that is respectful of all involved."

"If my opponent has never harmed me, never struck me, never hurt me, then why would I want to hurt or punish him? Do I want to punish him simply because he has thought about hurting me, or because he has made a weak effort that was easily rebuffed? You see, even in a court of law, you can't charge someone with murder simply because they thought about murdering someone. Attempted murder and actual murder are two very different crimes. When I am relaxed, aware, and fully present in the moment, then my adversary will have little opportunity to successfully attack me. Since he hasn't hurt me, since he hasn't truly threatened me, I have little desire to punish him in any way. His own thoughts, and the negative results he achieves in the world will be punishment enough."

"Related to punishing someone, is the idea of someone or something being either right or wrong. In Aikido, we learn to refrain from believing one path, or one way of thinking, is inherently superior to another. We also learn to refrain from engaging in thinking that any one point of view is the opposite of others."

"When we think in terms of opposites and disagree with someone else's opinion, we begin to oppose the other person's point of view. And this is exactly the kind of thinking that leads to resisting, combat, antagonism, and an overall disrespect for our perceived adversary."

"In Aikido, we do not attack, but we also do not concede or give up. In every day life the same can be true. Without attacking the viewpoint of others, without conceding or giving up our own viewpoint, we can still maintain ourselves, and continue to act in a way that is consistent with our beliefs."

"Keep that in mind," sensei said as he looked across the table. "More than once I've heard you arguing with other students, trying to prove your viewpoint was more correct than theirs. When you act like that, not only will you fail to convince them that you are right, and they are wrong, you'll also wind up losing them as friends and allies."

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c). All rights reserved. Click if you would like to subscribe.

Distracted parenting: Hang up and see your baby - The Boston Globe

Claudia Gold, a paediatrician in Great Barrington, wrote in the Boston Globe today:

"RECENTLY I was on vacation sitting by a pool. I noticed a father with his infant daughter who looked to be about 3 months old. Perched on a table in her car seat, she sat kicking and smiling. Her father faced her, but was talking on his cellphone. He distractedly shook the rattle hanging in front of her as he spoke in an animated way with the person on the other end of the line"

Her article continues to talk about how the baby develops her/his sense of self by the way the mother looks at her/him and interacts on a moment to moment basis. Dr Gold cautions that parents are perhaps not aware of the critical importance of the first few months and the vital importance of attending to and engaging with the baby to optimise the way the brain develops and the infant forms her/his sense of self. Fathers are taking more and more of the primary caretaking role of newborns and infants. A recent article in the New York Times outlined the way that social norms are changing as fathers become more engaged in parenting. Gold discusses the role of oxytocin in the way that mothers are preoccupied with their babies. Perhaps males are disadvantaged in this biological aspect? As feminists in the 70's, one of our catch cries was that 'biology is not destiny' but perhaps we were and are wrong not to pay attention to biological factors and instead of seeing these physiological realities as 'biological determinism' we could reframe the way that hormones and other communication molecules behave as 'biological intelligence'.

Mothers behaviour and orientation to their babies displays what D.W. Winnicott called 'primary maternal preoccupation'. Mothers are meant to be fixated on their babies, attending to their facial expressions; responding and reacting to them. In the past, women were told that babies are such 'time wasters'; that sitting staring at a baby was of no value, however, neuroscience has proven the value of primary maternal preoccupation and those hours of staring, awestruck at the wonder of one's own baby. From the beginning, a baby's brain wires itself, connecting and associating neurons to other neurons in response to environmental cues and emotional experiences. These neuronal associations form patterns of connection that from the earliest days form a mental map for security, enabling an infant to feel safe (or not) in the presence of her/his primary care giver. This primary relationship sets the stage for the child's future relationships and how the child perceives the world. As an infant feels more and more secure in her/his attachment to her/his primary care giver, she/he is able to then turn outward to the world and start engaging with the people and events in his/her wider environment. In those early days, the mother's face provides a mirror which allows the infant to see him/herself and form a sense of self that reflects that image. When mothers are fully engaged, smiling, encouraging, reflecting joy in being, the infant emerges emotionally resilient. Research has shown that mothers with flat affect produce withdrawn, less communicative infants.

Walking through any postnatal unit or going to any home where a new mother and baby reside, you see the ubiquitous cell phone in residence, either next to the woman's ear or being pounded by her flashing finger tips as she dashes off messages to cyberspace. Is it possible that primary maternal preoccupation has, in many instances, been diverted to the cell phone. What message and brain patterning do you think the little ones are getting? What do you think Mary Ainsworth and John Bowlby would make of this phenomenon?

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?

Safe Bed Sharing

This montage is beautifully done by Kathleen Kendall Tackett, also known as Uppity Science Chick
Kathleen has written books on breastfeeding, Postnatal depression, and inviting serenity into your home.

The photos in the montage are delightful, soft, heartwarming. Wouldn't you love to have been one of these babies?  Good to see the Dads in the photos as well as the Mothers.   The messsage is clear and powerful. Well done Kathleen.  Please give Kathleen feedback, she would like to know what you think about this mini video.

Make an on-line slideshow at www.OneTrueMedia.com

Further to the 'ritual nick' - Effective Intactivism

I've been reading more about the circumcision debate and happened upon a couple of very good blog posts on a site called Peaceful Parenting in my net travels.

The following quote was from a post was about the purpose of the prepuce . The article is well worth reading as it contains a thorough and thought provoking run down on the astonishing functions of that little bit of 'useless' and 'unnecessary' skin on a penis. The prepuce is rightly defined as an organ by two human sexuality experts. A full description of the myriad purposes of the prepuce are on the Peaceful Parenting blog post, but the following information really stood out for me

"A circumcised male, or his partner, for that matter, can never know the intimacy of the normal penis and the ability of the foreskin to open and glide up and down the shaft. An entire dimension of sexuality has been lost to both the male and his sexual partner"... Intact males can be more tender, gentle, relaxed, and loving during sex because the slightest and subtlest gesture or motion evokes deeply satisfying sensations. Circumcised males have to work harder just to feel sensations. This is an unhealthy situation for both the male and his partner".

I know that female circumcision is popular amongst some groups because cutting out her clitoris diminishes a woman's enjoyment of the sexual act, not to mention any sexual feelings and therefore functions to keep women 'faithful' - and under control! I don't think that as a culture, we truly understand the way that male circumcision interferes with male sexuality to the degree that it does. Circumcised men often laugh when that suggestion is made, because sex is just fine for them. The reality is of course, that they don't know what they haven't got. If circumcised males have to work harder, thrust harder and for longer just to feel sensations and get that level of stimulation required to orgasm because the sensory nerves on the head of their penis have been traumatised AND they lack the sensory nerves of the prepuce, that level of activity would be normal for them. The leap to thinking about what that level of activity actually means for their partners is then an easy one to make. Our cultural practice of male circumcision is actually blunting the sexual pleasure of couples, not just the head of the penis's feelings.

Coupled with that reality, the fact that circumcision leads to trauma and even death for some boys is explored in another post by Peaceful Parenting's Danelle Frisbe.

Intactivism is gaining ground as social media takes up the case for keeping both girls and boys intact. The latest post on Peaceful Parenting is excellent, explaining why we need to focus on solutions and in this case it is keeping children safe by keeping them intact. Aubrey Taylor a social activist, explains that negative emotions are understandable when we really think about what circumcision means and how human rights are being violated by the practice. However, people don't respond to negativity and anger - such reaction tends to invoke resistence and opposition.  Aubrey talks about Effective Intactivism which involves getting our language and feelings 'right' and coming with clear vision of how we want the situation to be.

Effective Intactivism involves education, compassion, love, persistence and patience.

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".