There are inevitable times where work and life in general can get you down. There are times when your hand is in your head in disbelief at the world and peoples reactions within it.
Today was a day that I was feeling down with no specific reason, a fatigue from a busy workload, pressures on family time and a chronic health condition flaring up , no doubt all contributing. Whatever the reason I was down. Then I received this gift of the mug pictured here. The smile at not only the humour of the gift but the appreciation of someones effort to show appreciation. I do receive notes of thanks and gifts of appreciation and often their timings are impeccable and definitely can change my day.
As I reflected on this, whilst consuming the rather weak tea from the vessel I was exposed to another gift, this time not a gift of a physical sense but words from a survivor from the dark day, expressing love for ALL, representing us as a garden that is more than its parts but together a wonderful tapestry existing as one garden.
March 15th was a horrid, black day but it was a day that also positively shone the light and showed a response of love and togetherness. A gift that if we take onboard and learn from can enhance our day.
My gift to you is a snippet from the memorial from the inimitable Steven Demetre Georgiou aka Cat Stevens, Aka Yusuf Islam. The words spoken by survivors and leaders really deserve to be viewed by everyone but my indulgent gift is this piece of music performed this morning.
"Kia Kaha We Stand Together"
There are many pressures on people involved in the pregnancy and childbirth. There is the pressure of ensuring optimum outcomes, of being objective and informed, of being appropriate and true to philosophy and ethics.
It often seems like a confrontation between disciplines, a them and us depending on your perspective. For the individual a view can be a confirmation or challenge to their value structure depending on the answer to the original enquiry.
On the whole, Obstetricians, doctors, midwives and women ALL want an outcome which optimally includes a physiologically, mentally and emotionally well infant, mother and family. It appears if you start off on that premise, that that it is a good working foundation on which to build. Unfortunately the avenues and navigations made on the journey to these optimal outcomes are thwart with subjective, political and emotionally charged biases and in this age of a wealth of information being provided without any substantiation it is an impossible task.
Obstetricians are often touted on one side as being the controlling self interested misogynistic discipline that focuses on control rather than the natural marvels of reproduction, whilst on the other side Obstetricians are the saviours of rational against absurdity, the purveyors of truth in a suspicious and superstitious world. On the opposite side of the coin midwives and doulas are perceived as being the stalwart bastions of all that is natural and empowering, the feminine struggling against the misogynistic control of patriarchal medicine whilst on the other hand being seen as being the unscientific, flowered up, rose tinted nature at all cost ignorant practitioners who rely on faith and trust. Women on the other hand are the flotsam and jetsam to be gathered collected and collated, whilst all the time celebrated as being the singular force in the decision making process. Unfortunately we ALL as health professionals encounter this in our working careers, witness it through our peers and experience it through ourselves and families.
Going back to the singular, on the whole truth, that we ALL want optimal holistic outcomes at the end of our care we should embrace all perspectives and empathies whilst being courageous to speak truth within the framework of respect. We should NEVER be scared of the word death as a reason to recommend an intervention, an extra observation etc. Whilst we embrace the overwhelming potential for uncomplicated "natural birth" and bathe in the miracles of childbirth we should always do so from an empowered position of being informed and trusted. We have to earn that right, which we do so by maintaining respect, inclusiveness and clarity of reasoning.
Drs. will collectively be more involved in complicated pregnancies and births, this is because their skill set is rightfully focused on when the natural journey through pregnancy takes a detour. With obstetric involvement does not come the surrender of the individuals views or rights, through trusted communication and consideration ALL parties will come to the decision and plan for care that embraces truth, understanding and acceptance of evaluated risks.
The provision of truthful, unbiased and accepted information is hard, it is organic and as such changes sometimes acutely, those promoting their own personal agendas on all sides can, subjectively use objective information to further their perspective. This is the crux of the dilemma, a dilemma that has both an easy and yet difficult solution, without surrender, trust and respect your client, doctor, midwife or woman. If it is not possible to do that, challenge yourself to why such a distrust exists and rectify it by asking questions, securing answers, restating opinions, challenging your own position and its origins, seeking objective information.
Recent events (Natural Childbirth Group Shuts down after stillbirth, Undiagnosed twins at home controversy, The alarming rise of Free-birth ) have shown how subjective views with political or philosophical agendas can promote inappropriate courses of actions/inactions and outcomes. As usually there are shocked and reactionary statements, criticisms and calls for actions. I lament the pressures on people to exist in a suspicious and paranoid care environment but ignoring its existence is to bury ones head.
Self analysis and reflection, openness, and the cultivation of productive, respectful relationships is the key to informed decision making. It's all communication really!
On a personal note, I love the challenges of my vocation. The people I meet have their hopes and dreams, their problems and challenges and we face them together as a team. Agendas are dropped as we work through options and solutions. There is no exclusionary aspect, the woman advises me of her preferences based on all considerations and recommendations. How privileged I am to be trusted by these women with their care, may I long deserve and receive such respect.
My husband shared with me the above video it had stayed with him since he saw it many years ago. It was for the Guardian newspaper and won awards. When reflecting on the the simple premise that perspective has the power to change one's views I began to extrapolate to my practice and relationship to clients.
One of the most, if not the most important aspects of quality care provision is effective communication. Clarity in expressive and receptive dialogue, transparency of influence and agenda. Without this fundamental aspect of care all other facets become suboptimal, ineffective and at times disruptive.
To see the other persons view requires one to listen and engage, it is not sufficient to be simply skilled and knowledgable, it is essential that ones practices truely engages and encompasses the clients perspective in relation to your own.
He still reads the Guardian to this day, in a time of questionable muddled infomercials posing as truth, he has found his.
Back from a wonderful and much needed and anticipated holiday, I was expecting to feel a little blue as I returned back to work. Of course, I was anxious to meet up with all the families that have trusted me to care for them, catching up on their pregnancy journeys and experiences but nevertheless still lamenting the back to the 24hr 'phone on' and accessibility required to provide the care which I am passionate to provide.
In the midst of this I was exposed once more to the potential of the hidden face of depression. Depression that can lay as undercurrent in an individual's with far reaching consequences.
I am lucky to foster and benefit from mutually open and nurturing relationships with all my clients and welcome the opportunities to celebrate their abilities and achievements as well as aiding in recognising and supporting them through the inevitable challenges that they encounter.
Not everyone feels depression in their pregnancy or puerperium but there is a significant percentage to cause concerns. A Conservative estimate identifies that one in seven women experience depression during pregnancy and after birth. Depression negatively impacts on mothers, children and families. It can affect birth outcomes, bonding and long term mental health. When untreated, depression can also lead to tragic outcomes, including but not limited to suicide and infanticide.
Of course depression isn't just encountered as an aspect of pregnancy, I endeavour to support, nurture and encourage openness and awareness of all women who have trusted me with their with Gynaecological, and sexual health needs or concerns.
I love working with the women and their families that seek my care and enjoy the personal and trusting relationship that is fostered and afforded.
For anyone reading this that has any issues, I would encourage them to foster a relationship with your own health care providers, be they doctors,midwives or other health practitioners. Ensure a trusting, open and comfortable relationship that fosters an environment where you can explain your feelings and concerns and plan for more personalised support.
If this raises any concerns for you and you feel helpless or in need of support please consider the following:-
Moderate alcohol consumption is safe for mothers breast-feeding their infants. Moderate alcohol consumption is defined as about one drink per day. At this level, research shows there are no known harmful effects to the infant. However, more than one drink per day is not recommended.
Of course, not drinking alcohol while breast-feeding is the safest option. Avoiding alcohol while nursing will prevent any exposure to alcohol in your infant. It's also the best way to prevent possible drinking-related nursing issues, including reduced milk production.
While it is safe to nurse and drink in moderation, it's important to understand how long alcohol is present in your breast milk after you drink and what you can do if you want to avoid sharing any alcohol with your infant.
Alcohol and breastmilkAlcohol can be detected in breast milk for two to three hours after drinking. Research shows that only about 5 to 6 percent of the amount of alcohol in the mother's bloodstream enters the baby's bloodstream via breast milk.
That's very low. Even if a mother were binge drinking, one study found that the levels of alcohol in her breast milk would not reach clinically significant amounts. Of course, binge drinking is not advised.
Alcohol levels typically peak 30 to 60 minutes after drinking an alcoholic beverage. The alcohol can be detected in breast milk for two to three hours.
If you're concerned about transferring alcohol to your infant, you can wait two hours after a single drink before you nurse. This will give your liver time to filter the alcohol.
The more alcohol you drink, the higher your blood alcohol level will climb. The level of alcohol in your breast milk is equivalent to the alcohol level in your blood. Extra drinks prolong the duration that alcohol will be detectable in blood and breast milk.
Does pumping remove alcohol from milk?
Alcohol is in breast milk as long as alcohol is in your bloodstream. Once the blood alcohol level peaks, it will slowly dissipate as your liver is able to process it.
You may have heard of women pumping breast milk immediately after drinking alcohol and discarding it. This "pump and dump" practice is not necessary, and it doesn't reduce the amount of alcohol present in your milk more quickly. It can help reduce engorgement, though, if you've been drinking alcohol and are unable or unwilling to breast-feed to avoid potentially passing alcohol to your baby.
If you plan to drink alcohol and know your baby will be hungry within the two-hour window after you drink, you can always pump ahead of time. However, unless you are experiencing discomfort, there is no need to pump breast milk until your infant is ready to nurse again, even if you've been drinking.
As your blood alcohol level falls, the level of alcohol in your breast milk will fall, too.
If the baby is hungry within two hours after you drink a moderate amount of alcohol and you did not pump ahead, it is likely safe to breast-feed. Again, the amount of alcohol transferred to your baby through breast milk is so low there are no known problems, complications, or issues.
Effects of alcohol on babiesAt moderate levels (one drink per day), alcohol has no known complications or side effects for babies, especially if the mother waits two hours after drinking to breast-feed or pump. Exposure to alcohol above this moderate level, however, may lead to delayed development, growth problems, and interrupted sleep patterns for the infant.
Despite the all-clear from leading health organizations, some studies have raised concerns that low-level drinking may cause issues for babies, even if they are not long-term and chronic. For example, one very small, older study from 1998 found that infants who had alcohol via breast milk slept for 25 percent less time than infants who did not have breast milk with alcohol.
Another study from 1989, which is often cited among groups who do not think mothers should drink while breast-feeding, concluded that 400 one-year-olds who had been exposed to alcohol via breast milk in their first year of life had lower scores in motor skill development than children who were not exposed to alcohol. However, the researchers were unable to replicate those findings in a follow-up study six months after their initial findings.
In short, research does not suggest that infants experience any negative side effects or complications if their mothers have a drink occasionally. Of course, it's important to keep in mind that higher levels of alcohol consumption may be problematic for both mother and baby.
How long do you need to wait after drinking?Alcohol will be in breast milk as long as alcohol is in your blood. The length of time alcohol will be in your blood and breast milk will increase as you drink more alcohol.
In moderate drinking terms, one drink is defined as:
If you drink alcohol, this guide will help you know how long you should wait to breast-feed if you're concerned about passing alcohol to your infant.
Is it safe?It's likely safe to drink when you're nursing as long as you're drinking no more than one drink per day. Not drinking alcohol is the safest option, of course.
If a mother does drink while breast-feeding, their infant may experience some changes to sleep, but research hasn't linked moderate drinking to any long-term complications, risks, or adverse health outcomes.
Source and Link
Well striving to achieve better and safer maternity care there are risks. The Netherlands have just ceased an early study in relation to the use of Viagra in Pregnancy. Please click on the link to the Guardian report here.
#viagra #baby #netherlandsviagrastudy
Whether a pregnant woman is at risk of premature delivery could eventually be predicted by a blood test, according to new research.
Watching with interest and hope.
Causes of stomach tightening during each trimester
Stomach-tightening is one such symptom that many women experience during pregnancy.There are many reasons for the stomach or abdomen to tighten during pregnancy, and these may vary, depending on the trimester. Of course speaking to your chosen health care provider is always recommended if any concern is experienced.
The first trimester has many factors that can cause stomach tightening and pains including:
During the first trimester, the uterus is growing and stretching rapidly to accommodate the growing fetus. This can cause abdominal cramping or sharp, stabbing, or shooting pains along the side of the abdomen, as the ligaments and other tissues stretch.
Wind Pain or constipation
Gas pain is a very common problem throughout pregnancy. It can cause cramping or shooting pain in the abdomen, and it can be very painful. Constipation is also a common complaint in early pregnancy. The changing pregnancy hormones can slow down the gastrointestinal tract.
Also, the iron in some prenatal vitamins can harden stool and make it difficult to go to the bathroom. Both gas and constipation can sometimes make it feel as if the stomach is tightening. Should you have any concerns about being able to have your bowels open you should share your concerns with your chosen health professional.
This of course is the major concern for anyone experiencing abdominal discomfort. As you can see there are many reasons for abdomen pain, most are irritations that can be aided away or will naturally resolve however, tightening of the abdomen can signal a miscarriage, which is the loss of a pregnancy before 20 weeks.
A miscarriage is most common before the 12th week of pregnancy. Other signs of a miscarriage include:
Stretching, cramping, and stabbing pain along the sides of the uterus often continues into the second trimester, and is known as round ligament pain. The round ligaments are located on either side of the uterus and connect the uterus to the groin.
During pregnancy, the ligaments stretch as the uterus grows, which can cause the sharp pain. This pain commonly occurs with changes in position, such as sitting to standing or bending down.
Most women start to feel their uterus contract and periodically tighten some time during the second trimester, the point in their pregnancy between 14 to 28 weeks. These are known as Braxton-Hicks contractions, false labor, or practice contractions.
The purpose of Braxton-Hicks contractions is for the uterus to prepare for the hard work of labor and delivery. It is thought that they help to tone the muscle in the uterus and promote blood flow to the placenta.
Braxton-Hicks contractions are normal and very common. They typically last for around 30 to 60 seconds but can be as long as 2 minutes. They are not as painful as regular contractions, but can still cause considerable pain and discomfort.
Braxton-Hicks contractions can be exacerbated by sex (particularly orgasm), dehydration, retaining urine and poor urination habits as well as baby activity.
Braxton-Hicks contractions are common during pregnancy, mention them to your chosen health professional at your antenatal visits. This can help in reassuring that they are braxton hicks and not signs of pre-term labour. To assist in ensuring they are B-Hicks and not worrying signs of early labour it is essential that you inform your chosen health care provider of
Braxton-Hicks contractions may increase in strength.Stomach-tightening associated with Braxton-Hicks contractions increases in strength and frequency during the third trimester. These contractions are especially common during the last few weeks of pregnancy as the uterus prepares for birth.
However, it is still important to notice and keep track of them. If a woman has more than a few in an hour, she should inform her chosen health provider.
In the third trimester things that can assist with pains and contractions include:
Maintaining hydration, drinking water and resting. Ensuring full bladder emptying and not holding on to a full bladder. Positional changes and considerations. Using immersion in a warm bath or warm shower to relieve muscle stresses.
Again, you should have a relationship with your chosen health professional to be able to discuss any concerns or changes that are occuring in your pregnancy.
Labor vs. Braxton-Hicks contractions.Often Braxton Hicks contractions are not regular in strength or frequency but will eventually develop into contractions of labour that are. Labour contractions are not relieved so readily by positional change and rudimentary observations of hydration and position. It is of benefit to discuss any concerns with your chosen health professional.
Exposing the gut to chlamydia protects against subsequent infection in the genital tract and other tissues, researchers from UT Health San Antonio discovered. Chlamydia is the most common sexually transmitted disease and is associated with and can cause infertility, ectopic pregnancy and pelvic inflammatory disease if left untreated.
"This research emphasizes the pre-exposure of chlamydia to the gastrointestinal (GI) tract as a vaccine," said Guangming Zhong, M.D., Ph.D., professor in the Joe R. & Teresa Lozano Long School of Medicine at UT Health San Antonio.
The protection is very robust and is across tissues, which is called transmucosal immunity. Protected sites include the genital tract and the lungs, said Dr. Zhong, whose faculty appointment is in the Department of Microbiology, Immunology & Molecular Genetics.
The discovery, reported Nov. 13, 2017, in Infection and Immunity, indicates that exposing the gut first to chlamydia is a novel avenue to explore in preventing the genital infection. However, when the genital tract is the site of initial chlamydia exposure, a different outcome may result. In this scenario, genital chlamydia spreads to the gut and induces responses that promote further disease in the genital tract. Dr. Zhong hypothesized this disease pattern in a review article published Dec. 27, 2017, in Trends in Microbiology.
Human exposure to chlamydia is unpredictable, perhaps coming through genital or non-genital sexual contact with an infected partner and perhaps via contact with contaminated materials. The UT Health San Antonio scientists are utilizing a mouse model that is a controlled way to study chlamydia transmission.
The team found that if the gut is the first site to be colonized by chlamydia bacteria, then the mice are immunized against further disease. The gut infection is benign. But if the genital tract is the first to be infected, the resulting disease is harmful. This results in a worse disease prognosis, including the possibility of infertility because the disease is advanced before symptoms are evident.
"If you are exposed to chlamydia in the GI tract first, it's a vaccine, but if you are exposed in the genital tract first, you may have enhanced disease," Dr. Zhong said.
A probiotic for the gut
Dr. Zhong is exploring the possibility that Chlamydia trachomatis, the bacterium that causes chlamydia, could be delivered orally as a vaccine.
"We take probiotics for our GI health," Dr. Zhong said. "In the future, we may add chlamydia as a probiotic for the gut. Once the bacteria are established in the GI tract, they don't spread."
About 1.6 million cases of chlamydia were reported to the U.S. Centers for Disease Control and Prevention in 2016. Because many individuals have no symptoms and don't get tested, the number of annual cases is estimated to be as high as 2.8 million.
Chlamydia is especially common among young people, and the CDC estimates 1 in 20 sexually active young women age 14-24 have the STD.
Source https://www.sciencedaily.com : Luying Wang, Cuiming Zhu, Tianyuan Zhang, Qi Tian, Nu Zhang, Sandra Morrison, Richard Morrison, Min Xue, Guangming Zhong. Nonpathogenic Colonization with Chlamydia in the Gastrointestinal Tract as Oral Vaccination for Inducing Transmucosal Protection. Infection and Immunity, 2018; 86 (2): e00630-17 DOI: 10.1128/IAI.00630-17
Take any two cells from your body and there's a good chance their genetic sequences will be a match. That is, unless you happen to have what's referred to in the medical literature as a 'tetragametic chimerism' – a condition that causes separate fertilised embryos to merge into a single body.
Once thought to be rare among humans, there's good reason to suspect we might be seeing a lot more of it in the future.
The truth is, nobody is really certain how many humans have cells in their body that once belonged to a sibling.
Unlike the transplantation of a fully developed organ into a grown body, the presence of genetically distinct cells early in life won't trigger alarm bells in the immune system.
That makes it possible for two (or more) fertilised eggs – siblings, for all purposes – to bump into one another in the uterus, and mistake their new neighbour for another cell in their own growing body. Far from rejecting each other, the cells team up and continue to build a single human.
The tides of hormones and other chemical signals directing the embryo's evolution tend to affect the two cells in pretty much the same way, making it hard to spot where one developing tissue ends and another begins.
On occasion, however, the different sets of genes do make themselves known.
Increased reliance on assisted reproductive technologies means we can expect more multiple conceptions.
Just how many of these embryonic siblings merge into a single person is far from clear. Given how little we know about either its prevalence or how it might be responsible for anything from allergies to auto-immune disorders, this could be concerning.
But no doubt it's a topic we'll be learning more about in coming years.
Petrina Duncan, Obstetrician, Gynaecologist, and mother. Writes about events, news issues and health issues.