Mavericks and why we need them

MAVERICKS AND WHY WE NEED THEM.

At the moment Covid-19 (SARS-CoV-2) has highlighted the importance of accurate and ethical science, evidence underpins patient care, public policy and law making. We have been thrust into a world where nightly news bulletins bring scientific evidence that impacts on our personal daily lives; queuing at the supermarket, loss of liberty, socialising, gainful employment for some and risk to financial ruin for others, all to stifle the threat of the potential deadly virus.

We put our trust into those that know best and obey the new rules. Our leaders have our best interests at heart …..Right?  Digital applications and social media platforms provide wider access to news and of course damaging fake news. Research and information outlets containing alternative beliefs and  conflicting scientific evidence  can polarise the readership and ultimately society, it appears  hegemony is peaceful until challenged.

The Covid-19 Pandemic has highlighted this phenomena, Simon Sineck (https://www.youtube.com/watch?v=ReRcHdeUG9Y) discusses positive leadership and the advantages for that leader, perhaps a comfortable home, a top of the range car, a bigger office, more money and power.  Compensation for the late nights and early mornings, coming in on days off, complex decision making, forward planning, calculating and taking risks to ensure progression and success for the majority.

Positive leaders are rewarded with cohesive respect, productivity and above all else loyalty. Supporters with good leaders feel heard and safe in the knowledge that their leaders will look out for their interests too. If leaders fail in this most ancient of ‘contracts’ as Simon says  a  ‘visceral’ unease spreads through the ranks leading to low morale and dissent, perhaps attrition.

As health professionals, birth-workers, doulas and all the other valuable groups who work on the ground with women and families we are well aware of the need for progress away from patriarchal ‘we know best’ policies and guidance. The claim for womens birth autonomy and credence in innate birth physiology is becoming increasingly evident and passionate.

Historically some examples of  scientific obstetric advancements in the care of women and babies have been abandoned .Marsden Wagner (2008) discusses this list in the eye opening documentary ‘The Business of Being Born’ see link in references  . The 1930s – 40s saw the liberal use of carcinogenic x-rays in pregnancy to assess the size of the pelvic outlet as women were struggling to birth their babies.

The female pelvis was suddenly malfunctioning despite millennia of human procreation, yet the narrow gurneys on which women were forced to lie in lithotomy position often  for hours, perhaps scared and  infantilised Hill (2019), within stark clinical settings and  alone with strangers in masks, apparently  escaped the blame for the womans’ incompetent physiology and  lack of progress in labour.

The notorious Thalidomide scandal in the 1950s and 60s a medication to reduce morning sickness, given to pregnant women without appropriate clinical testing, resulted in generations of severely handicapped babies.

The 1970s saw the Peel Report (1971), heralding all women to give birth in hospitals under the covetous gaze of medicalised care.

After almost a decade in 1999, the realisation and rapid discontinuation of giving ‘Cytotech’ ( utero – tonic similar to Misoprostol) to women in labour with a history of caesarean sections resulted in thousands of ruptured uteri. These interventions were not evidenced based and did not appear to represent ‘first, do no harm’ ethical principles.

Immediate cord clamping, a practice that followed the ubiquitous actively managed third stage of labour had no evidence at all to support lack of harm to infants, in fact infants weren’t considered, despite the knowledge that the procedure deprived them of approximately 30% of their blood volume (Myles, Bennett and Brown, 1999).

Current research has suggested that  optimal cord clamping has several benefits for babies such as increased haemoglobin and iron levels, reducing potential anaemia, bioavailable stem cells improved immune responses, improved fine motor neuro social skills in four year olds and  reduces the need for blood transfusions in premature babies (Burleigh, 2017)

One midwife observed that Immediate Cord Clamping (ICC) had no evidence base and set about changing practice; in 2010 75% of babies born in the unit had ICC.  This prompted audits which lead to 75% of babies born on the unit in 2012, receiving Optimal Cord Clamping (OCC) Personal Communication (May 2020)

In 2011, developed by a national team of clinicians, the Lifestart Resuscitation Trolley won a national innovation award and went into production. Then in 2012 Midwife of the Year Award, was granted and the midwife sensed that her work and passion for improvements to practice were being heard and more importantly accepted in the culture of Obstetrics and Midwifery. The accolade was ‘ridiculed’ by management ultimately leading to the withdrawal of OCC practice within days of the award with a return to immediate cord clamping within the unit. This policy was eventually rescinded in 2015 by new managerial clinicians (ibid).

However around  this time the midwife had left her workplace citing the price was simply “too high to pay” in terms of her health and emotional well-being and with an uncomfortable feeling that her original purpose of helping improve outcomes for mother and babies become lost, embroiled  in politics and subjugation (Ibid).

According to the midwife who challenged the status quo, she experienced acute anxiety and stress on a daily basis  in bringing about a simple yet crucial change in practice, groupthink attitudes, power agendas and plain old fashioned bullying by health professionals affected her emotional, mental and physical health, family life, relationships and her career pathway (Ibid).

If such a devastating price is to be paid for those who are agents for positive change, it would be far easier to simply conform, never question and just accept our lot. Should we remain static? Never improve or challenge our knowledge base?  Our employers and professional codes of conduct require a responsibility and accountability to demonstrate quite the opposite.

To experience humiliation and divisive behaviour on a regular basis would chip away at the strongest of characters, yet this midwife continued with her research with a deep intuitive drive that has now achieved  global endorsement in policy guidelines National Institute for Health and Care Excellence (2017) ; World Health Organisation (2014).

Parents can access education about the benefits of OCC www.waitforwhite.com as stakeholders theirs is the right to become informed and make choices autonomously.

History is a valuable teacher, Ignaz Semmelwies a Physician (1818-1865) who discovered that thorough handwashing the lives of many women could be saved.  Puerperal Fever or Childbed fever was the cause of skyrocketing mortality in birthing women circa 1800-1900’s as Physicians carried out vaginal examinations or repairs without aseptic techniques.  Contemporaries and colleagues were appalled by the idea that physicians were responsible for the spread of Sepsis via unwashed hands.

Within a few short months Semmelwies reduced mortality rates from 18.27 % to 1.27% within his obstetric unit, then students and fellow clinicians supported his methods, unfortunately he was mocked by his superiors, posthumously he is revered with respect by both clinicians and scientists for his simple yet brilliant hypothesis (Zoltan, 2020).

During the current global pandemic basic hygiene principles including handwashing are the banner of public health policy yet Semmelwies was considered a maverick and troublesome by the establishment.

Baddeley (2015) comments that, bias in science underpinning the evidence base may hinder its own progress due to herding behaviours and a protective stance of the status quo. This would suggest that despite huge jumps forwards in knowledge and technology this problem is just as predominant now as it was 200 years ago.

We need our leaders, we need evidenced based practice with positive  collaboration between ideologies  but crucially we need our mavericks, the ones who tackle challenges with fortitude despite suffering rejection , the ones who are marginalised , at least until their ideas gather traction or enjoy some success before the cautious naysayers jump on board. Without them, it is possible our endeavours to continually improve care for mothers and babies will stagnate, a glimpse back in history has  valuable lessons for us all.

 

Author Tracy D Ripley

RM/HV Birth Educator based in Huddersfield

 

References

National Institute of HealthCareExcellence https://www.nice.org.uk/guidance/qs105/chapter/Quality-statement-6-Delayed-cord-clamping

Nursing and Midwifery Council (2015) The Code Online https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf Accessed 10.7.2020

BurleighA, (2017) Whose Blood is it anyway? online,https://www.sciencedirect.com/science/article/abs/pii/S1871519217303591?via%3Dihub Accessed 18.6.2020

Hill (2019) Give birth Like a Feminist ; your body ,your baby , your choices. Harper Collins: London

Baddeley, M(2015) Herding, social influences and behavioural bias in scientific research. Online https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552483/ Accessed 18.6.2020

Marsden Wagner (2009) online https://www.youtube.com/watch?v=12BG_bWVW4c&list=TLPQMTAwNzIwMjBKnZ15LxPUGg&index=1 Accessed 10.7.2020

Myles, M., Bennett, V. and Brown, L., 1999. Myles Textbook For Midwives. Edinburgh: Churchill Livingstone.

Zoltan, I. 2020 online https://www.britannica.com/biography/Ignaz-Semmelweis. Accessed 10.7.2020

Peel, j., 1971. The Peel Report online https://discovery.nationalarchives.gov.uk/details/r/C289661 accessed 27.7.20

World Health Organisation online https://www.who.int/nutrition/publications/guidelines/cord_clamping/en/ Accessed 27.7.2020

 

 

 

THe Fourth Trimester

The Fourth Trimester

 

It comes as no surprise for those who have given birth that labour is called labour for a good reason! It signifies the hard work your body has done to carry and bring your baby earth-side, plus the unseen emotional, mental and yes even spiritual labour that produced not only a baby but a mother at the same time. Universally whether it is your first or last, each experience is totally unique and requires a period of readjustment.

A woman does not just become un-pregnant after giving birth she and her family will evolve, making changes, decisions and sacrifices, feeling the height of love and joy and the depths of self-doubt and exhaustion, eating, showering and brushing teeth  and time to do anything seem like a distant pleasant memory in this new landscape.

The Fourth Trimester, is crucial time for babies and parents. The UK, US and other modern western cultures appear to think that once women are deemed ‘medically fit’ then they have done it… become a mother in an instant  almost expected to be out shopping and having coffee, make-up and hair done,  with a peacefully sleeping ‘good’ baby within days of this huge transition  NO PRESSURE THEN!

Sadly women may be left feeling, isolated, overwhelmed, anxious, stressed, over protective, guilty, sore, angry or even traumatised by life changing events and real or imagined expectations. These feelings are reflected in the growing number of women who report low mood,  a sense of disconnectedness and Peri-natal depression, The Fourth Trimester is when a woman needs to find her circle, tribe or kin, a safety net of support and care not just for a few days but for the coming weeks, months even years.

In several countries such as India, Malaysia, Japan, China, South America, some areas of Europe, it is understood and accepted that the woman and baby will need to be nurtured, perhaps ‘mothered’ by her female circle, both have just been born! Chores and cooking are attended to, her baby safe with a trusted and knowledgeable other so she can take care of herself properly.

Many physiological neurological and emotional developments are triggered by closeness of skin, smell and sight therefore they need time together to rest, snuggle, to feed, to learn subtle cues. The mother needs recovery time from the birth to reflect, digest and make sense of her changed status. Some of the traditional post-natal practices seen in these countries are available here such as Closing the Bones, a celebration of the womans’ body in growing and birthing this miraculous human being. The focus is on the mother and her creative wisdom and knowing, a chance to talk about her birth experience. A lovely way to re align her uterus and re-close the pelvis with nurturing massage. There are many birth workers out there who recognise the importance of kind knowledgeable support and guidance from the first to the often neglected fourth trimester.

An industrialised, commercial system cannot ‘financially gain’ from a woman who is just ‘being’ with her baby it is not recognised by  Gross Domestic Product statistics and so places no value on it, yet she holds the key to the most important job of all… raising the next generation.

Interesting then, that this was written in testament to motherhood almost two hundred years ago..

‘Blessings on the hand of women!

Angels guard its strength and grace,

In the Palace, Cottage, Hovel

Oh no matter where the place…

Would that never storms assailed it

Rainbows ever gently curled,

For the hand that rocks the cradle

Is the hand that rules the world ’

William Wallace 1819

Tracy Ripley

Bsc (Hons) Midwifery

Msc Pg Dip SCPHN

Therapist and Doula

When your birth choice, does not have a tick box.

I have quite a varied role in my work – for which I am grateful. I generally have three small jobs. They include teaching and practicing holistic therapies,specializing in womens reproductive health and well-being  the other side of my role involves teaching antenatal education/postnatal education; trauma resolution and a hands on Doula and advocate for pregnant and birthing women.

I have had the privilege of working with a woman from early pregnancy, who was expecting twins (Dichorionic Diamniotic, DCDA) often viewed as the lower risk of twin pregnancies . Multiple births account for 15.8% of the total births in the UK according to the Office of National Statistics (2017),  she happily attended antenatal appointments and was clear from the outset to her health care professionals, that after a previous home birth with baby No2 her informed choice was to have another. I know, you may be thinking  ‘yes ! but this time it is TWINS !’ with toes curling at the  thought of it.

Home birth in England and Wales accounts for 2.1% of births, the majority of women choosing hospital or birth centre units, having a home birth is more popular with women who have had a previous live birth 3.1% compared with first time mothers at  0.8%. When i was born , 1968 around a 25% of women birthed at home (Ibid). Agreed, Cass had chosen a different pathway, just not the smooth, well trodden, usual one.

The woman who we can call Cass, presented with no prior or current health concerns,  her antenatal appointments suggested all was well. Her team were happy. With her  due date fast approaching the miscommunication between providers surfaced leading to confusion between health care teams going rapidly from ‘a home birth, no problem!’  to a unknown midwife withholding the home birth boxes & double checking her mental capacity in insisting on a home birth; withdrawing the word ‘support’ to ‘enabling’; the balance of power symbolically tipped  firmly in the hands of the healthcare team.

 Cass now felt disempowered and doubtful of the professionals’ faith in her body and her birthing ability and an uncomfortable conviction that she would bow to pressure and change her mind . Cass discussed her situation calmly despite her increasing stress levels in pursuing what she felt was right for her and her family, the midwives who knew Cass were consistently supportive, The organisation and its’ protocols appeared to falter in the face of the impending birth.

I reached out to Birthrights -after attending a conference last year, I felt sure they could offer guidance, I was not disappointed. I swiftly received a very thorough reply and passed on the helpful and bolstering information to Cass.

I was honoured to witness the home birth of Cass’s twins, a woman sure in her innate ability to birth her babies, surrounded by family and experienced, kind midwives. We all took courage from Cass, she shone, and we all benefited from her light .

Cass demonstrated that birthing outside the tick box is entirely possible and can be a  positive experience for all… her legacy ? A daughter and son who saw a calm mummy labouring in the home, normalising birth, without fear; a husband who was not traumatised but left in awe of his wifes power, health professionals who witnessed a woman with a high risk pregnancy give birth physiologically and  change the statistical bell curve and finally a friend and supporter who went home inwardly cheering  ‘she did it and I knew she would !!

 

 

Tracy Ripley

 

 

 

Gotta love Oxytocin !

It has been a very long time since I blogged ! I guess I have rediscovered the pleasure I find in writing and the head space to do it.

I recently penned an article on a topic that lights me up about the hormones of birth in particular, Oxytocin, what a marvelous molecule often misunderstood, obscure yet powerful. So powerful in fact, that it can change our perceptions and realities into adulthood. It is the blueprint for our future selves and how we interact with other human beings.

For persons who are pregnant or a partner/significant other to someone that is going to give birth Oxytocin plays multiple roles and is essential follow the link below to read about our super chemical messengers and how they can help YOU through pregnancy labour birth and bonding as a family unit.

 

Oxytocin our hormonal helper

We need more Oxytocin  in this fast paced and digital world – and it is relatively easy to generate.

Meditation

Face to Face contact

Touch – Massage

Prayer

Shared  ‘Hygge’  moments with friends

Intimacy

 

Happy reading x

 

 

 

 

Christmas!

Christmas is upon us. I am sat writing this paragraph by candlelight  (by choice not because my electricity is off ! ). I have just remembered the odd bits that I have forgotten to buy in but unlike years gone by I will not be trudging around the shops to get them.

Of course everyone’s thoughts turn to another new year and I am no different I have several goals but my main aim is to plan my adventure in my camper ! Certain things have to be put in place before I can load the dogs and myself up and set off down the road with no strict time frame, destination,itinary or plans .I want to go on an adventure learning along the way !

The anniversary of my dad’ s death looms on New Years Day I think he would be pleased with my plan – he lived ‘off grid’ on a boat in the Sea of Cortez and my mum has recently sold her house to live and travel in her camper at the age of 71- it must be in the genes !

Merry Christmas and a happy new year 😁😁

Time

It seems like a good while that I sat down to write about things – is is just me or do the days pass by so quickly that they almost disappear into a foggy blur ?

As I have got older TIME has become a much considered aspect of my life – i didn’t think of the implications of time in my twenties and thirties, when my sons were toddlers  I seemed to wish time away, always onto the next stage of development or waiting for something else to fall into place. Time came and went and i didn’t acknowledge or respect it. Time then made its presence felt  as i got into my forties, the realization that here I am and my babies have grown up , people have gone, moved on, died, changed.

Then I  had a respect for time !! I found it to be a thing of value, a commodity not to be wasted on trivia, bad relationships or pointless ventures. I know i have only so much of Time, it can be wonderful, fulfilling, life affirming period or a waste of energy and resources, I guess its about finding a balance of what is dear to you and your priorities.

Sometimes when i feel down or ‘hormonal’ I become angry and guilty for allowing myself to be robbed of time that could be spent being happy and untroubled by life’s turbulence I suppose I am just a human and I believe an empathic one so my question is – is it part of the human condition to experience happiness all the time ? the world of media and advertising would have us believe that we ‘should be happy’ vital and fit with limitless energy, The world of medicine makes billions out it, I am certain there are others out there, who feel the deficit of reality versus what society dictates we ought to be !

I think we should feel OK that we don’t always feel OK- ups and downs are healthy, feelings of disappointment, a period of low mood, even anger are a natural and transient state of being but we are urged to spend money on buying things to make us feel ‘better’ the high of a new purchase does not last long so we repeat the cycle   A few duvet days of recovery and thinking and self care  shouldn’t be a source of self scorn or be judged by other people as lazy or good for nothin’ !  of course this type of behavior does not sit well in a productive and consumerist culture, everybody wants  a piece of our time, but remember your time is not infinite, spend it wisely.

Sick and tired, of being sick and tired !

Part of the reason for this blog is to inspire others for change. For the last year I have been through some huge life changes – a relationship break up, a massive change in career direction and creating a new business from scratch plus grieving for my dad who died almost one year ago on New Years Day.

All this has left me overweight, constant aches and pains, disturbed sleep, digestion problems, extreme heartburn, dry patchy skin, anxiety, poor motivation and hot flushes.

I was a birth doula for a woman and her husband and stayed with them postnatally for a few days and they introduced me to the research and evidence behind promoting your microbiome and gut health. I had read some things around it and knew that Serotonin (the happy chemical) thought to be produced by your brain is actually produced in the gut (90%) and a small amount in the brain( the remaining 10%), this research, questions traditional methods of dealing with depression and anxiety.

The gut bacteria effects all bodily systems and if it should be over colonized by Candida, that thrives off sugar wheat and alcohol this can lead to gas, bloating, cravings and malaise. I was tired of feeling sick and tired all the time ! I wanted myself back my muscles were stiff and i felt uncomfortable with my hefty body. So i decided to invest in ME .

After some research online for a few weeks taking Pro Argy 9 to boost up my circulation and vitamins and minerals with amino acids then  I bought a Microbiome  Purify Kit , it wasn’t cheap, but as they offer your money back within 90 days if you are not satisfied i thought i would go for it. In a way purchasing the kit made me even more determined to see through the 21 day program. I hadn’t gone 24 hours let alone 21 days without sugar, wheat, caffeine or booze so i knew it was going to be a challenge.

I am not finished yet, 5 days to go,  I had to write about this because of the results i have experienced. The first thing to go was indigestion and heartburn it has not returned. My dry red skin patches went after the first 4-5 days. Head fog gone, energy, this to me is the best bit ! has returned along with mental clarity. I have boosted my confidence and my resolve because I have said NO for a while to let my body reboot and it has responded.

Now that I am beginning to get myself back i can tackle other things, like my weight this 21 days has taught me that i may have those things that actually don’t agree with me in large quantities but i can enjoy with balance.

If you would like to know more comment or follow the link for info about the research etc  https://1952130.synergyworldwide.com/shop/product/Purify%20Kit

 

 

 

 

 

 

Hello to you !

I felt inspired to begin blogging firstly as my own experiences have inspired me to share my trials and tribulations plans and aspirations -then meeting and talking to other women I quickly realised; that at a certain time of life after it has taught us heartbreak ,tough times ,overcoming challenges and gratitude (this may be at any age) these events are universal, experienced and dealt with differently by us all .Personally I got the impression that culture and society was giving a sly wink and hinting that life was on the wind down from here on in ! Stale relationships, jobs, careers,attitudes almost enslaving you mentally. Our society may not appreciative mature female wisdom or physical appearances BUT actually possess a wealth of goodies not just for others but for OURSELVES !

‘To strong women,may we know them,may we raise  them,may we BE them  💕”

I like that quote – my blog may not be professionally done or even crude at times but I want it to open honest and real . I plan to write perhaps weekly or fortnightly and in the New Year making plans for travel  (Alone yikes !! ) and setting up an online (Skype perhaps) support service for those experiencing CHANGES be it physical emotional mental spiritual . Be good to yourselves x