Saturday, 28 April 2012

I forgot to talk about poop!

Ina May Gaskin and me!

That. was. a. maze. ing! 

I had the great good fortune to be able to attend the MAMAconference in Troon on the 26th and 27th April 2012. Speaking were such well respected people as Michel Odent, Ina May Gaskin, Denis Walsh, Kerstin Uvnäs-Moberg, Sheena Byrom, as well as many others and amongst the delegates were some very knowledgeable and passionate midwives, doulas and obstetricians as well as many keen student midwives and birth workers.

During my self directed learning I could say that I have discovered most of what was presented and discussed over these two days, but that does not detract from the wonderful experience of sitting listening to such inspirational speakers. It is heartening to know that recent research affirms all that I believe in when it comes to physiological birth and that nothing has changed to affect my passion for birth. New advances in research and maternal medicine only serve to further benefit the understanding of how birth works. I feel justified in my beliefs about physiological birth and in the emotional and spiritual side of birth. Something which scientists will find hard to quantify.

So, what were the greatest discoveries for me from the conference?

The shocking realisation that many 'professionals' in maternity services still don't get physiological birth. This is 2012 and yet our midwifery and medical schools still don't teach enough, anything like enough, about physiological birth, it would seem. 

I have read about avoiding early cord clamping, I understand the physiology of it, I understand that the blood circulating between the baby and the placenta belongs to the baby and is separate from the mothers blood. Yet, my jaw dopped to hear from an obstetician that he knows of some other obsteticians who think that by not clamping the cord the baby will get the mother's blood!

If this is true, then Michel Odent's thoughts that 'We are at the bottom of the abyss in childbirth' are correct. He is 82 and no longer wishes to be politically correct. He feels that we need to 'rediscover what is simple'.  I believe he is right, we can no longer afford to work quietly in the background, changing the face of birth one birth at a time, we have to act fast, and NOW!
Michel Odent with Chair of Conference Gillian Smith,
RCM Director of UK Board for Scotand

Michel was explaining more about epigenetics, which I have read a little about, and watched programmes on TV. It is my understanding that the genes that our parents give to us also have markers on them which can be primed (often during or by the process of physiological birth) to activate at different points. If I understand correctly, in relation to childbirth, this could mean that in even just one generation we can be affecting women's ability to birth. If babies are born by surgical means will their genes have markers on them which say that a vaginal birth is not necessary? It is incredibly scary to think that by interfering in birth where not necessary we could be speeding up an evolutionary process beyond our expectations. Perhaps it is not just global waming that Man has influenced! We can be affecting our future generations in many other ways we don't yet understand and it is possible that current birth practices of epidurals, synthetic oxytocin, immediate cord clamping, instrumental deliveries and Caesaeans without a valid medical reason could be having far reaching and serious health implications for future generations. Thinking about asthma, mental health issues and austism to name but a few....
As Michel says, "It is becoming serious!"

The common consensus from speakers such as Dr David Hutchon, Dr Sheena Kinmond and Denis Walsh is that there is VERY little evidence base to many current birth practices in modern facilities. We suffer from a very paternalistic approach to childbirth which has little understanding about physiological birth. But as Denis said "Some things that really count, can't be counted".  So how can obstetricians and paediatricians understand birth and newborns if they cannot do ethical research, and indeed if some of them can't seem to even grasp basic biology and physiology?

Most work to the principle that all that matters is a healthy baby. They forget to look at the emotional and spiritual side of birth, they neglect the mother. The presentations by Dr Roch Cantwell and Mia Scotland came from quite different perspectives but confirms my own beliefs that we are affecting mothers' mental health detrimentally and that a very much more holistic approach needs to be considered when caring for mothers during the antenatal, perinatal and postnatal periods.

It comes back to mothers then, listening to their instincts. Women need to stipulate in their Birth Preferences what they want for a physiological birth, and indeed for a necessary surgical birth. They need to demand that their wishes be respected, they must decline certain offers of intervention if they so wish. They must gather the strength to NOT defer to the experts. Change is ONLY going to happen from the ground up.

And there is evidence for this.

Ina May Gaskin's figures at the Farm Midwifey Centre in Tennessee actually speak for themselves. Women going to her and opting for physiological birth can expect to have one. Between 1970 and 2010 there were 2844 women planning a birth at the Farm.
  • 1.7% ended in a Caesarean (compared to US 32.3%)
  • 0.37% were forceps deliveries and 0.04% were vacuum extractions
  • 3.5% were breech and of those 8.6% required a Caesarean
  • 1.7% had a post partum haemorrhage
  • 5.4% were induced, but this was by castor oil or by stretch and sweep
  • 19 sets of twins were born, all vaginall7
  • 1.5% epidural (compared to US 80+%)
  • 99% Breastfeeding Initiation (compared to US 50%)
  • 0.39% Pre-eclampsia (compared to US 7%)
I know of women who have demanded their wishes be respected in some challenging cases. Although we cannot make birth 100% safe in all cases, whether home births or Caesareans, if women take responsibility for their own bodies, their own babies, their own births then they CAN be the instrument for change.  Then perhaps the medical people will have more of a chance to see for themselves what a physiological birth looks like. 

Just chatting to, or overhearing from, student midwives made me realise that in my short time as a not very busy Doula I have seen far more physiological births than most student midwives see in 3 years training, if any! And obstetricians certainly rarely see any and so their pactice is entirely clouded by fear from only seeing the abnormal. But fear is a tangible emotion, at least by hormones, and if a woman is fearful, or someone in the room is fearful, then her very clever body stops birthing to protect her baby. This is a fundamental part of labour which many medical professionals fail to grasp. If they cannot understand the very delicate balance of hormones which drive labour then it is no wonder we have such high intervention rates. 

I call for those who understand physiological births to be given the opportunity to teach this to the upcoming medical students. This is a very important aspect that needs to be added to current medical training as it clearly is lacking at the moment.

"Oh..., I forgot to talk about poop!" - Ina May Gaskin, 27th April, Troon in Scotland.

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