"All women have the right to dignified health care."

I'm posting this email in its entirety. There is nothing that I can add to the information in this heartfelt request. The title of the post says it all. I've donated and I hope you do too. Thank goodness for women who care like Adina and midwives like Hannah. What a blessing to the world they are!! 


Hello Carolyn,

I read your natural birth blog, and really appreciate what you stand for. I live in a developing country,  Guatemala, where women are not educated about birth choices and many times they only have one option. Due to lack of money they go to the public hospitals where there is more than 70% C-section rate. Then, confronted with birth trauma, they search for any other option possible. Many of them find my midwife with Manos Abiertas, a clinic dedicated to helping these women have a natural birth.

 In a developed country, people have the luxury of forming a self-educated opinion on their preferred manner of giving birth, thankfully, and we are working towards making that an option in Guatemala.

 The clinic that helps mostly indigenous and low income Guatemalan women works on a sliding pay scale. This often means patients visit free of charge or pay much less than their visit costs, because most can't afford the $5 for a checkup. However, as anyone involved in midwifery knows, there are always numerous costs involved.

I am asking you to help by spreading the word via an interview with one of the only licensed midwives in Guatemala who has her own birth clinic: Hannah Freiwald. She explains the situation here: http://www.all-about-guatemala.com/registered-midwife-guatemala-interview.html

You could also help by spreading the news via blog story told here: http://sagaunscripted.blogspot.com/2011/06/birthing-options-in-guatemala-city.html

If you are able to make donations, thank you. If you are not, but you can spread their story, thank you! Every little bit helps.

If you can link to us on your blog or forum, more people will see and hopefully help. I am not a midwife. I am only a citizen who supports my midwife and who sees a very great need with the women of Guatemala. If nothing else, they need the power to choose their birth. They need the right and education to know and choose what happens with their own bodies. Together, we can make this an option.

Thank you,

Adina Barnett

Manos Abiertas

"All women have the right to dignified health care."

Knowing about birth and interventions: Women's role

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

So who were these women that Klein et al studied?

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

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

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

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

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

Now here is something very interesting in this study:

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

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

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

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

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

This comment is interesting:

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

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

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

Now, this final finding that:

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

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

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

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

The conclusion of the Klein et al study that"

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

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

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

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

Healing from Birth Trauma

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

The headings provide links to Amber's blog.

Tale of Two Birth Stories, Part 1

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

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

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

Symbols, power and woman's place in the world

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

So it was with great interest that I followed this link

 

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

 

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

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

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

Why does that bother me?

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

Maria says that:

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

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

Maria explains that:

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

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

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

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

Symmetry from Everynone on Vimeo.


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

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

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

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

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

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

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

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

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

Raising birthing consciousness: moving beyond cruelty to women and babies

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

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

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


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



Birth Trauma from Centre Quiropràctic Molins on Vimeo.


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

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

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


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

Senate Inquiry re: complaints about midwives

The Australian Senate Finance and Public Administration Committees are holding an Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). On 23 March 2011 the Senate referred the following matter to the Senate Finance and Public Administration Committees for inquiry and report.
Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). Submissions should be received by 14 April 2011. The reporting date is 13 May 2011.

The Committee is seeking written submissions from interested individuals and organisations preferably in electronic form submitted online or sent by email to fpa.sen@aph.gov.au as an attached Adobe PDF or MS Word format document. The email must include full postal address and contact details.

I have just sent my submission to this inquiry.

The situation as it stands is like this report from Kelly at the Belly Belly site:

"There is currently a major problem occurring with the process of complaints about midwives.

Several midwives around the country have had conditions placed on their registration due to complaints. These complaints are mostly from hospital staff when a labouring woman and her partner are transferring from a homebirth. Most of these restrictions demand that the independent midwife can only practice midwifery within a hospital birthing unit. This brings their homebirth practice to a screaming holt, leaving their women without a care provider and the midwife without an income!

The process as it currently stands is this:

The hospital staff or anyone put in a complaint to the Nursing and Midwifery Board (NMB) about a midwife. The Board meet monthly and decide whether the complaint needs to go to investigation or not. In some cases they’ll decide it doesn’t need an investigation and the conditions will automatically go onto the midwives registration.

If they decide it needs investigating they slap ‘interim conditions’ on the midwives registration. In the case of homebirth midwives the conditions are “Must work only in a hospital and under supervision”.

The investigation then goes to the HCCC and the conditions remain on the midwives registration until the investigation is complete.

Basically, it is a matter of midwives being found guilty until proven innocent.

Investigations can take a year or more. This is leaving many women without a midwife (some are 39 weeks pregnant) and leaving midwives without income – and for some it could be a matter of losing their home, as they cannot pay their mortgage etc".

Given that the Collaborative Arrangements Inquiry had thousands of submissions which the committee dutifully ignored, it will be interesting to see what they do with the submissions for this one.
 
We live in hope that sanity and a 'fair go' for women and midwives will prevail in Australia.

A coroner's perspective on the death of a baby

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

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

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

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

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

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

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

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

Maternal intelligence: Calling the baby in

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

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

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

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

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

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

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

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

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

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

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.

The Secret to Blogging?

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

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

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

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

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

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

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

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

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

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

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

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

Midwifery students?

Education? 

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

Carolyn

The Umbilical Cord: When do we clamp it?

Clamping the umbilical cord immediately at birth was something that I was taught to do as a routine part of 'delivery' management. The reason for clamping the cord so quickly, I was told, was to stop the baby getting unnecessary blood because the extra blood would be all the more for the baby to process and they would be at risk of becoming jaundiced, caused by the breakdown of all the fetal blood cells.  A nuchal cord (cord around the neck of the baby) was felt for and cut before the shoulders and rest of the baby was born.

Added to the problem of extra blood with an uncut cord, was the fact that the woman was routinely injected with a synthetic form of oxytocin to hasten third stage. The injection of the synthetic oxytocic in third stage made the uterus contract. Authorities believed that if the cord wasn't cut swiftly, the uterine contractions caused by the injection would cause an even greater surge of blood into the new baby, causing the baby to be overloaded with blood and at even more risk of jaundice. 

Once I started working with childbearing women in a one to one way in private practice, the need to clamp and cut the umbilical cord immediately at birth was challenged by the women I worked with. They wanted the cord to be left alone until it stopped pulsating. Some even wanted the placenta to be born before the cord was cut. A few wanted the placenta and cord to be left attached to the baby and allowed to drop off itself, a process called Lotus birth.

The literature was mixed in regards to the advisability of leaving the cord to pulsate or clamping immediately. The opposed camps had reasons such as jaundice, blood volume, postpartum haemorrhage rates to explain their particular views and reasons for their recommendations. The reasons for cutting the cord have been proven to be spurious.  There is however a lot of evidence for leaving the cord alone.  Women and midwives have been talking about and promoting leaving the cord alone as a best practice strategy for several decades now and the evidence for doing so is only getting stronger.  Have a look at the way the cord changes in the minutes after birth.  The evidence for leaving the cord intact is also clear in the case of nuchal cords. Leaving them alone, gently 'somersaulting' the baby to untangle the cord as the baby is born works perfectly and there is no risk of having the baby's oxygen supply prematurely interrupted.  As beautifully explained on the Midwife Thinking blog, the oxygen carrying capacity of an intact cord is the baby's first line of resuscitation after birth. Our medical colleagues have been slower to take up the idea of leaving the cord alone. However a 2011 report has confirmed that iron stores are improved when the cord is left to stop pulsating. A more recent review found that "newborns with later clamping [were heavier and] had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping".


A wonderful demonstration of why the umbilical cord should be left alone is provided by Penny Simkin in this video.

Hope for a more balanced approach to the topic of cord clamping or leaving it alone is on the horizon as an obstetric doctor in the US has written about what he calls 'delayed cord clamping' and has produced the following videos for The Grand Rounds on this topic.

Delayed cord clamping Grand Rounds 1

Delayed cord clamping Grand Rounds 2

Delayed cord clamping Grand Rounds 3

Delayed cord clamping Grand Rounds 4 

For more information on the umbilical cord and placenta, go to Rachel Reed's Midwife Thinking blog.  There is a post on the placenta in birth films on this blog here.

Another aspect that hasn't really been explored in great detail as yet, is the perfusion of the newborn's brain at birth. My thinking is that leaving the cord alone allows the newborn's brain to be optimally perfused and ensures that the neuronal connections that proliferate in response to birth to wire in the best possible way, especially when the baby is skin to skin with her/his mother and exposed to the multisensory stimulation that occurs in a physiologically mediated birthing experience. The question to be asked is "do babies suffer subtle brain damage through premature clamping of the cord and less than optimal sensory experiences at birth?" I suspect they do.


Some women want the cord clamped and pulled to get the placenta out as quickly as possible, others see the placenta as the spiritual twin of the baby and want to keep the baby and placenta together.  There are many reasons for leaving the transition to extrauterine life and resuscitation system alone, what's your view?

I can see the day dawning when we look back and say "remember when we used to think that cutting the umbilical cord prematurely was a good thing to do" with incredulous amazement.

Postscript: There is an article (8th October 2014) in the Journal of Midwifery and Women's Health on clamping the umbilical cord at birth. Called "Is it time to Rethink Cord Management when Resuscitation is needed" the article provides compelling evidence for leaving the cord intact and resuscitating a compromised infant by the mother's side.

Post Postscript: A landmark paper published 26th May 2015 has added evidence to my theory of brain & gut damage associated with early cord clamping:

The authors concluded:

Delayed cord clamping (CC) compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimising the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.

PPS A non peer reviewed article discusses the issues of hypovolaemia in newborns caused by premature cord clamping says this:

Modern human childbirth is “managed” obstetrics, designed to avoid complications and to preserve physiology – a normal, healthy outcome. However, management often intrudes on physiology, producing unintended consequences.

and raises concerns around the potential for multiple organ damage, including brain damage with premature cord clamping.

Now for anyone not yet convinced of the value in leaving the cord to do its magic, this post from AWHONN on a Placental Transfusion for Neonatal Resuscitation after a complete Abruption may help you to change your mind!

Time for practice change everyone!

Explaining Tongue Tie

Tongue tie, officially known as Ankyloglossia, is one of those developmental 'glitches' that can cause big and life long problems for the person with it and disrupt their ability to breastfeed. The inability to properly latch onto a mother's breast that comes with the condition of Ankyloglossia can make makes breastfeeding, which should be a source of joy and satisfaction, into a nightmare of pain and suffering for the woman. 

All babies should be checked for tongue tie at birth. Midwives and doctors should ensure the baby's tongue can move freely and fully extend in a thrusting movement. If there is any twisting or 'pull back' into a heartshape of the tongue tip, the baby is most likely tongue tied. This brochure shows you how to check and identify if a baby is tongue tied.

Treatment of 'tongue tie' has gone through different 'fashions'. The last few decades have seen a lack of recognition of this problem and when identified, a real reluctance to treat it. This widespread ignorance has caused many oral and developmental problems for the children and breastfeeding 'failure' for women who rightfully, couldn't bear the pain and trauma to their nipples caused by their babies inability to attach themselves to the breast. Treatment has been the source of a much controversy. Some experts advise taking a 'wait and see' approach and delaying any surgical intervention until the child is older. This 'wait and see' approach is associated with speech and normal mouth development disruptions and lactation failure.

Thankfully, due to the work and care of a few dedicated lactation consultants and paediatric doctors, the condition and ensuing problems are increasingly recognised. In the last few years, appropriate correction of the defect is being instituted with excellent results.

This brochure has been produced by a paediatric dentist and demonstrates the various forms of Ankyglossia (tongue tie) - the photos are excellent. The problems this condition can produce long term are given and treatment options are explained.

If any woman has problems with sore and damaged nipples, ensure your midwife or doctor checks your baby's mouth for tongue tie. The brochure also shows you how to check yourself. Sometimes the tongue tie can be 'occult' that is, not obvious when looking, you have to feel under the tongue against the base of it to identify the tethering.

If the link for the brochure doesn't work, look on Dr Kotlow's website for it

Another resource is the excellent milk matters site and this post on tongue tie as the hidden cause of feeding problems.