Monday, 30 April 2012

Are some birth quotes damaging to women?.

This is a blog post I started two years ago and got stuck with. This is why I have not really posted since June 2010.

"We have a secret in our culture, and it's not that birth is painful; it's that women are strong" - Laura Stavoe Harm

I have this quote on my Facebook profile. Let me tell you why.

I believe the fact that women are strong IS a secret and sadly it is kept secret from many of us. I did not know I was strong, I knew very little about my body, my hormones and myself. I had to reach my 40s before I began to realise. I had to have an emergency caesarean, post-natal depression, query Post Traumatic Stress?), a VBAC with spinal and forceps (so I still feel that my baby was extracted) and it was only after I began to become more holistic in my life that I began to realise. Seeing  (wish I'd seen this as a teen), for example, actually listening to my instincts rather than ignoring them, etc. has helped me to realise that I am strong, and that I always was, but that my strength and feminine instinct had been subverted for so long by science and over-medicalisation.

Medical science has given us the ability to save lives but sadly the tendancy of those in the medical profession with misquided intentions to help or fear of litigation based practice, has meant that routine intervention is actually more of a risk than a help. Iatrognic birth injury may possibly be the greatest cause of mortality or morbidity but I have no statistics, just the anecdotal stories I hear time and again.

I accept that many women do feel that some quotes hurt them, but I urge them to consider that it's not that they weren't strong. They were and they are, it's just that they didn't realise and were 'not allowed'.

We do the best we can, with the information we have at our disposal, in the circumstances we find ourselves. But for too long we have been conditioned to believe that birth is dangerous, and for too long women have been subjected to this very paternalistic system. It's no wonder we don't appreciate our strengths! So yes, it does hurt to think that we must have done something wrong and that we were not strong enough. But really, it's not our fault. 

Where did it all go wrong?

Women have lost the 'knowledge', ever since midwives were persecuted as witches back in the 1600s and then when they were superceded by obstetricians in the paternalistic model of medicine.

I hope that one day we will get back to the times when women were revered as the givers of life, when women had their faith in their abilities and no fear about birth, when women were respected for their strengths balancing against the strengths that men possess.

"But saying to me after a birth like that, that the secret is not that birth is painful, but that women are strong would have been like a knife twisting in my chest. It says immediately to me that ‘you should have been stronger’.  And maybe also “If you were strong, your birth wouldn’t be bothering you now”.
Of course, it saddens me greatly that women are feeling such pain. I am passionate about physiological birth, and of more women getting back to this type of birthing, but preserving their mental health is even more important to me and I would defend to the death a woman's right to a caesarean birth if this is her infomed decision. Unfortunately, women are being let down by maternity practices that do not serve the interests of individuals, and this leads to women feeling a failure because they were not able to make informed choices about their body, their baby and their birth.  

I believe women ARE strong, in many different ways, but that does not meant that we can always overcome the current medicalisation of birth when it happens to us in that fragile, hormonal birth dance of labour. However, I believe that strength will carry us forward as we strive to regain balance, as we strive to return to the instinctual, mammalian model of birth that our physiology affords us. When our birthing is returned to us, when the voices of Ina May Gaskin, Michel Odent, Denis Walsh, Sarah Buckley, Gloria Lemay and many others are finally heard by the world, then... THEN we will see just how truly strong Woman is.

Sunday, 29 April 2012

Wisdom Birth

During a heart bypass operation do you think it would be wise to stop the heart BEFORE switching on the bypass machine?


So why is it common pactice to immediately cut the cord of a compromised baby before taking it away to be resuscitated? How many valuable minutes are lost to the baby? This practice has become commonplace over the 20th century for reasons I shall not go into here.

Dr Sheena Kinmond co-presented the lecture on 'Avoiding immediate or early cord clamping' with Dr David Hutchon and explained to us the importance of the baby receiving its full blood volume from the placenta. Cutting the cord too soon can cause up to 40% of the baby's blood to be retained back in the placenta. This can cause a dramatic reduction in blood pessure which impacts on the ability of the lungs to inflate and transition into beathing air. Thus, you have a baby who is already compromised in a situation where her ability to revive is shockingly reduced. It makes absolutely NO sense!!!

Dr Hutchon told us, with passion, that babies should NOT have their umbilical cords cut EVEN when the baby needs resuscitation. He was very tearful at the thought of his own early practice and the damage he had been unwittingly doing before he learned about the physiological benefits of waiting. But I say to him, and all parents who accepted procedures they may have doubts about now, you can ONLY do the best you can, in the situation, with the information you have at the time.  

Robin Lim talks about when the cord should be cut on this You Tube video:

I am intrigued by the BASICS trolley that has been devised and feel that it may be a useful tool. Sadly for many of the delegates, Dr Hutchon did not have a trolley to show us, or any further information about its dimensions. However, the best place to resuscitate a baby, in my opinion, is the mother. 

Dr Nils Bergman, a doctor in South Africa who specialises in Kangaroo Mother Care, says "The mother's skin is the baby's natural environment, and both physically and emotionally the healthiest place for the baby to be".

So, we need to keep ALL babies connected to their mother until long after the umbilical cord has stopped pulsating and been cut.

What is surprising, pehaps, is that this knowedge about timing of cord cutting has been known long before we had the modern scientific research to back it up.

“Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases.  As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.
                                                                        Erasmus Darwin, Zoonomia, 1801.

It really doesn't matter if it is a healthy term baby or a compromised premature baby.... no, scap that. It matters EVEN more to the compromised premature baby. We need medical professionals to be taught how to resuscitate a baby on the mother's abdomen. We can fundraise to get BASICS trolleys in every unit and/or we can get wall mounted resus units installed with oxygen hoses that can be taken to the baby wherever the mother is resting immediately after birth. But most of all we need to ensure that resuscitation is done to baby without separation from the mother.

Again, as in my previous post, it may be that it will be a ground swell from parents that drives the change from immediate clamping to waiting until the cord stops pulsating. Many mothers are now even waiting until the cord separates from the baby naturally. This has been termed Lotus Birth.

But also, the time is long overdue for medical professionals to stop looking at procedures for short term gain. They need to look at the bigger picture and ensure that research also focuses heavily on long term outcomes.

"Everybody doing it together" - Sheena Byrom, 26/04/12 Troon in Scotland

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.