There is no need to add anymore than what is said from this incredible person. On notice indeed!
A review of more than 60 studies and 20 million births has found that caesarean birth is linked to a higher risk of autism spectrum disorder and attention-deficit hyperactivity disorder in kids. The international review, which includes Australian studies, shows kids have 33 per cent higher odds of developing autism spectrum disorder and 17 per cent higher odds of developing ADHD if they are born by c-section. Whether the c-section delivery was elective or emergency made almost no difference to the odds of developing these disorders. The researchers say understanding why this link might occur will be important given the increase in C-section rates.
Research link HERE:
Reaction and consideration.
The findings of this large study are significant, interesting and require consideration. However as with all research it requires scrutiny and with much research further study and investigation to clarify the findings implications.
Autism has had an association with Pre-term birth, and LSCS (Lower Segment Caesarean Section) is associated more commonly with pre-term birth to avoid physical complication or stresses upon the baby.
This is one factor that can compounded by uncorrected over view studies.
The 63 papers that contribute the body of evidence of which this association has been drawn has little reference to whether adjusted corrections have been made or considered in reference to the conclusion results. That is not to underplay the findings, they are significant and of interest but dictate clarification and further assessment.
Assoc. Prof. Jason Howitt of Swinburne University identifies concerns that some of the studies had high rates of autism not consistent with the general population and suggests heavy bias as it is " not consistent with worldwide rates of autism of between 1-3% of all birth." In some studies included in this research the rates were between 10-70%.
Professor Jeffrey Keelan acknowledges the significance of the study but that the researchers have been unable to adequately adjust for many factors that may link outcome with birthing method. He reiterates that further evaluation and research is need to clarify the findings.
Dr Alex Polyakov is a Senior Lecturer in the Department of Obstetrics and Gynaecology at The University of Melbourne and a Consultant Obstetrician, Gynaecologist and Fertility Specialist
"It is a meta-analysis which combined data from 61 studies that included more than 20 million deliveries. The authors reported a statistically significant association between caesarean delivery and autism spectrum disorders as well as ADHD. Other psychiatric disorders did not demonstrate a statistically significant association with the mode of delivery. The methods employed in meta-analysis have been criticised recently. This criticism is usually centred on the fact that a number of unrelated studies, which employed a variety of methodologies, populations and statistical analysis techniques are combined to produce a point estimate of risk. The legitimacy of such data manipulation must be questioned and its results are usually of doubtful exactitude. This can easily be demonstrated if one was to examine two largest individual studies included in the autism spectrum disorders (ADH) and ADHC meta-analysis.
A study by Curran et al was conducted in Sweden between 1982 and 2011 and used ICD-9 and ICD-10 to define ADH and examined 2,697314 deliveries, 28,290 children were diagnosed with ADH. This translates to a prevalence of ADH of 1.05% in this population. This is the largest study in this meta-analysis. The second-largest study was by Yip et al and was conducted in Norway and Finland between 1984 and 2004. It used ICD-8, 9 and 10 to define ADH and included 1,052,397 deliveries with 1,303 children being diagnosed with ADH. In this study, which is the second-largest included in this meta-analysis, the prevalence of ADH was 0.12%, approximately 10 times less than reported by Curran et al. This demonstrates the pitfalls of combining radically different studies to try to arrive at a meaningful conclusion.
The above exercise can be repeated with the ADHD portion of the article. If the two largest studies included are examined, the prevalence of ADHD in one was 2.77%, while in the second-largest sample it was 0.2%, again a tenfold difference.
What can be concluded from these discrepancies in the prevalence of the two diagnoses? Firstly, even if the final results are accepted, it is almost impossible to assess their clinical significance. A 20% increase in risk has radically different meanings, depending on the prevalence of a particular outcome. For example, a 20% jump from a baseline of 3%, will translate into 3.6%, probably a clinically significant increase, that would warrant an intervention to prevent it. On the other hand, the same 20% increase, if applied to the baseline rate of 0.2%, will result in 0.24% prevalence, which may not be as clinically troublesome and may not warrant an intervention.
Secondly, one must question the wisdom of combining such divergent studies and expecting an accurate and unbiased estimation of risk. The old saying from computer science: 'garbage in, garbage out' seems to apply, as poor quality input will invariably produce sub-optimal output.
Overall, it must be stated that both caesarean section and vaginal delivery have risks for mothers and babies. These risks are not the same and there is no consensus as to which mode of delivery is better overall. The study adds another possible risk to indiscriminate utilisation of caesarean section as the preferred mode of delivery, but it must be balanced against recognised risks of alternative delivery strategies."
Emeritus Professor Alastair MacLennan AO (head of Australian Collaborative Cerebral Palsy Research group and University of Adelaide) also identifies a cautionary overview.
"Although an interesting and controversial topic the many methodological weaknesses of this study make any conclusion very unreliable.
Firstly no realistic physiological mechanism for the weak association of autism and ADHD with mode of delivery is offered.
The studies analysed were very different (heterogeneous) and all were observational studies that do not allow for a wide variety of potential biases.
As a general rule for outcomes in observational studies to be plausibly significant the Odds Ratio (times difference) should be more than 2 and the confidence intervals should not cross one. In this study, the ASD odds ratio was only 1.33 and ADHD was only 1.17.
For all the other outcomes examined the confidence intervals crossed one meaning that there was no statistical significance."
In summary, it is a large study with an interesting and well-performed metaanalysis of neurodevelopment outcomes on an impressively large number of deliveries (over 20 million) from over 60 studies performed across 19 different countries. The central findings are that caesarean section deliveries are associated with a 33% increase in risk of autism spectrum disorder (ASD) and a 17% increase in attention-deficit/hyperactivity disorder (ADHD).
The issue is: can a casual connection and link be drawn based on the evidence? Further research is required.
Is it ok to masturbate during pregnancy?
It is generally perceived that masturbating during pregnancy is safe, in some instances it can provide health benefits, such as lowering stress and promoting blood flow.Women experience different effects on their libido whilst pregnant, their hormones have a large effect on this.
Women often wonder whether masturbating while pregnant is safe or if there are any risks. The good news is that, in most cases, it is totally safe. Dr Petrina Duncan welcomes consultation in regard to your own personal contextual consideration in this regard.
Masturbation is safe during low-risk pregnancies.In most low-risk pregnancies, masturbation is a perfectly safe way to relieve stress and manage an elevated libido. Consultation with Dr Petrina or your chosen health professional is advised. Sex toys can be utilised as long as hygeine is maintained and all toys are clean.
Wash all toys with soap and water to prevent bacteria from entering the vagina. Hands should also be clean and nails trimmed to prevent any risk of cuts or lacerations.
Are there benefits?
Masturbation, including during pregnancy, can be good for the body. Some women even report stronger or more intense orgasms while pregnant.
Some benefits of masturbation during pregnancy include:
Are there side effects?Later on in pregnancy, a woman may notice increased Braxton-Hicks contractions following an orgasm. These contractions, though sometimes uncomfortable, are nothing to worry about. There are other cramping sensations that can be associated with the post orgasmic state but these should remain mild. If they raise any concern, you should always consider contacting Dr. Petrina or your chosen health provider
Are there any risks?
There are no risks associated with masturbation for a woman having a low-risk pregnancy who has no complications or other medical issues.
When preterm labor is a risk, however, vaginal penetration — or even having an orgasm — can trigger labor. In these cases, the doctor may recommend avoiding intercourse or orgasms to lower the chances of premature delivery.
As identified above without appropriate consideration there are potential risks of infection from grazes and cuts caused by long nails.
When to avoid masturbating during pregnancy
This advise may be that a woman avoids having orgasms altogether or only refrain from vaginal penetration, for example.
The Uterine muscle contracts during orgasm. In some situations, this can trigger early labor, premature delivery, or other serious complications.
If vaginal penetration is to be avoided, masturbation or mutual masturbation with a partner can be a good alternative. However if an orgasm is contra-indicated and has been advised against then one should avoid masturbation and all other sexual activity.
If the water has broken or if there is any vaginal bleeding, refrain from masturbation and other sexual activity. Always consult your chosen health professional.
Some sexual activity is not safe during pregnancy and as with most things, whilst pregnant consultation with your chosen health professional is advised.
All content is strictly informational and should not be considered medical advice.
Two Years of Kindred. Time has flown and it has been a magnificent 2years of welcoming many people into our family as New mothers, mothers to be and mothers of mothers. Thank you to everyone within Kindred and all those that I have seen as their doctor or supported with their own personal needs. It truly is a pleasure and I look forward to many years of committed resolve to provide the best Obstetric and Gynaecological care there is. So Proud.
Before anyone says anything I know the anniversary is in February but I am just using this time to reflect, and I have been sooooooooo busy, so many babies.
For those of you that have not been watching or even been aware, there is a revolution in womens football happening. The womens world cup 2019 has been an amazing spectacle of athletic prowess and artistry. It is now at the semi final stage.
The rise of womens football is a story of realisation, belief and commitment. It is a story of empowerment and breaking constricting perceptions.
Watch this Optus advert promoting the empowerment of our sisters and daughters and be inspired...
I am not a huge football fan but I enjoy watching the games both my husband and son watch. Die hard LEEDS United fans and I have shared some time watching previous world cups with them.
But it is this world cup, where the world is listening and open to the power of womens sport.
The worlds game has recorded record audiences, over 1billion tickets sold, tv audiences inc average viewers per match of France av.10.106 million, Brazil 22 Million, Italy 7million, USA up to 40 million and England V's Norway broke the record at 7.6million viewers watching at home in England! I include the last one as my husband is religiously cheering on the 3 Lionesses (England). Viewing figures in Australia have also been the highest they ever have been and sponsors have flooded in to take advantage of the epiphany, for some, that womens football has truely arrived!
There are the detractors, the nay sayers and general dismissive individuals with their blinkered perspectives, my son was told by a peer he must be "gay" when he glowing reported some of the excellent football he had witnessed. A befuddling slur being a pubescent boy watching women play extremely athletic sport is surely the opposite, but he rises above it and sees it for what it is, ignorance. My husband defends the game online faced with short sited followers of the male game that can't open to see another beautiful facet of the sport they profess to love. But, more and more it is embraced by the football masses as another facet of this enticing game. Watch if you will the passionate display of energy, fans and players of the recent France v's USA game to see magnificence.
Why am I writing about this, because it reflects broader perceptions of women in society. I have the pleasure and honour of supporting women at all stages of their womanliness, be it reproductive or restoratively, and I never ceased to be amazed at the courage, strength and commitment of the women I meet. Perhaps I am reflecting a hope that instead of rhetoric the world is open to equality, no more, no less, equality! Free from pre-conceptual prejudice based on gender, sexuality, age, ethnicity or belief.
I am basking in my husbands undiminished support of the game he watches, blind to the gender just basking in the delights of watching football as he shouts on England with our son and daughters by his side. England play the USA on Wednesday morning at 5am and then on to the final. Whatever the score, whichever team hoists the cup aloft. Football, choice, men and women have won! Equal pay, equal rights
Getting up to date information would appear so easy in the internet age, but this perception is sometimes flawed. The wealth of information can blind you to the quality, appropriateness and accuracy of accessed information.
In the information pages on this website it was the original intention of providing a quick go resource for those seeking general but trustworthy advice. Of course all the pages carry a warning about seeking specialised support, either from myself or another suitably qualified professional but nevertheless a resource pool to aid in the provision of general information. To counteract misleading resources of dubious objective advice that people are often inadvertently subjected to.
The moment I post a link or recreated a publicly accessible .pdf however I fear it may contribute to the misinformation, this is because whilst trying to pool a large single repository one may subject a person to a less than "latest" publication. It is my opinion that there is a benefit of shared, collected knowledge at least found from authoritative resources but even this still requires a caution on taking the information at face value.
Rest assured I am always working at expanding the resources available on this site and will endeavour to afford the latest links if not direct downloads of found resources online.
If you have any suggestions for links to either PDF's Videos or other sources of support or information I welcome you to get in touch either directly or indirectly.
We all struggle with time management, we all struggle with costings and quality but these famous quotes provide inspiration and guide me in several ways.
“It's unwise to pay too much, but it's worse to pay too little. When
you pay too much, you lose a little money - that's all. When you pay
too little, you sometimes lose everything, because the thing you
bought was incapable of doing the thing it was bought to do."
We have all bought the cheaper item only to find it breaks and costs us more in the long run, or paid for a service that is woeful in comparison to the providers promises, but we have also balanced obscene prices that do not reflect a quality commitment.
In private practice one charges for ones time, commitment and expertise. Many charge vast amounts and have their own conscience to answer to, whilst others undercut and undervalue or accurately represent the quality they provide. Getting the balance as in all things in life is for me the right choice.
“We think, mistakenly, that success is the result of the amount of time we put in at work, instead of the quality of time we put in.”
I often sacrifice the time with my family to provide exceptional quality care, to ensure the best start for women and their families. This commitment and determination is essential to provide care I am proud of. I am fortunate to have an understanding and accepting family that support me in my commitment, and I thank them everyday for letting me support women as they deserve to be supported.
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.
Petrina Duncan, Obstetrician, Gynaecologist, and mother. Writes about events, news issues and health issues.