Wednesday 28 July 2010

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?

Saturday 24 July 2010

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.

Monday 19 July 2010

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)

Sunday 18 July 2010

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.





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.

Saturday 10 July 2010

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.


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!

Sunday 4 July 2010

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.




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.