The breast debacle...

On Sunday this article about breastfeeding was published in the Sunday Telegraph and on Monday it was published online, here at the Mamamia website.

On Facebook and on chat forums it has been both applauded and ridiculed. Some view it as an uninformed and misguided opinion while others praise the author for targeting perceived bullying and judgement by "lactavists".

One particular person who felt the need to correct some misconceptions that they felt Mia Freedman's article generated and perpetuated was author Tara Moss. She is an ambassador for the Australian Baby Friendly Health Initiative (BFHI).

After reading Mia's Article in the Sunday Telegraph Tara felt it necessary to forward this response to Mia via e-mail, as well as post it on her blog.

On Facebook and on chat forums Tara's response was praised for coming from a place of information and education rather than from pure opinion. Many have also praised Tara's tact and eloquence in her response.


It got me thinking about the whole debacle debate, and I decided to post my two cents worth on here:

While I respect every mother's right to make an informed decision about what is best for her baby, I think people living in developed countries lose sight of the issues that Tara raises about formula and bottle use having the potential to increase infection and disease.

I live in a country where infants, children and adults contract illness, and can die, due to poor water quality. And where parents will spend hard earned money on formula only to mix it incorrectly and with substandard water to give to their babies because they honestly believe that a store bought "white man" product is best for their child.

I have seen sick, malnourished infants, and poor formula practices this with my own eyes, and it's enough to break your heart.

People in Australia and other developed countries mustn't lose sight of the fact that the BFHI is a GLOBAL education initiative, and not simply one facility or organisation being paternalistic. It is not about opinions. It is about evidenced based education.

The World Health Organisation has a global hand hygiene education initiative. It is an evidence based initiative which stems from research and proven theories that hand hygiene reduces the transmission of disease and rates of infection and illness. This initiative has been adopted by institutions and governments world wide, and is viewed to be the basis of good hygiene and disease prevention not just in medical settings but also in the home. Many of us wouldn't dream of not washing our hands after using the toilet, or before eating, because we have been educated as to the risks associated with poor hand hygiene. We don't view this as paternalistic, so why should a global initiative to educate about the benefits of breastfeeding and the risks that may be associated with the use of formula and / or bottles as being such?

Step 6 of the 10 Steps to Successful Breastfeeding, as promoted by the BFHI, states "Give newborn infants no food or drink other than breastmilk, unless medically indicated".

"unless medically indicated" - Voila! There is the key phrase that people are overlooking in this whole "breast politics" debacle. If a mother is unable to produce enough milk, if cracked and painful nipples are inhibiting ones ability to feed, if a baby is not gaining weight as they should be... All of these are medical indications that complemantary feeds with formula, or exclusive feeding with formula would be appropriate interventions! It is up to medical professionals to get behind the BFHI initiative and identify when there are medical indications that may necessitate something other than breastfeeding.

It is not about creating a one rule for all scenario. It is about giving people the right information to allow them to make an informed decision about what is right for them.

What people chose to do with that information is then up to the individual, and that informed choice should be respected, even if it is not the choice that you personally would make.

Well done Tara for bringing some evidence and information to the table to help balance Mia's (less informed) opinions.

Mia printed an apology following Tara's contact, somewhere in the comments section of the Mamamia post. I do think a more identifiable correction might be in order in a more acessible place on the site!

Bed rest day 5 - Photographic Phriday

I'm totes over this bed rest bizzo, but am doing what I have to in order to make sure Our Monster is ok!

My arse hurts from sitting on the couch!

Today's Photographic Phriday showcases my bed rest photographic project that I have set for myself this week.

As usual all the pics have been taken with the Instagram App on my iPhone.

5 days, 5 photos, all of the things I can see while on "bed arrest"!

Day 1
- Inkwell Filter

Day 2
- XProII filter

Day 3
- Earlybird filter

Day 4
- Toaster filter

Day 5
- 1977 filter

A panicked day...

So after flying back to Oz last week for a few days because my mum had been sick in hospital (all is ok now hopefully), I got back in one piece yesterday afternoon.

On our way home from the airport The Man and I stopped in at a public meeting about a chicken farm being built in a water catchment area (great for the health of the town... NOT!), and then we decided we were too lazy to cook so we got some take away and came home, had a feed, a dip in the pool and then went to bed.

Early this morning we were having some lovely "mummy daddy time" when all of a sudden we noticed that there was blood everywhere! Cue panicked wrangling of emotions!

Of course this had to happen when my usual doctor is overseas for 6 weeks and so we had to quickly come up with a Plan B that would mean the best possible care for our baby!

Plan B was implemented and another local clinic where I used to work was called. I haven't used this clinic during my pregnancy as the owners are good friends with The Man's ex-wife and I have concerns about confidentiality, and they were pretty nasty to me in the time after The Man and I got together, before I quit working for them.

The doctor at the clinic wasn't a doctor who was there when I worked there, but she was very kind, thorough and gentle and she did an ultrasound which showed that bubs wasn't in any distress and everything seemed ok. Our Monster's heart rate was thumping away at 148 beats per minute and s/he was wriggling around and having a grand old time.

I was sent home on bedrest and called to check in with the doc about the bleeding at lunchtime. Thankfully it had almost stopped.

Another, more detailed ultrasound this afternoon has shown a little placental abruption, where the placenta has come away from the uterine wall, hence the bleeding. Scary shizzle, I tell ya!!

Anyway, after checking in with the doc again this afternoon we now have a firm plan in place for medical evacuation to Australia with Careflight should the bleeding resume, and I've been prescribed a hefty dose of bedrest, which I have also interpreted as couch rest (as there's no way in hell I'm sitting in my bedroom all day with no telly to watch)! No getting up for anything other than going to the loo are my instructions!

This is my view from my perch on our two futons pushed together...

On the plus side according to today's ultrasounds bubs is weighing in at 937 grams and , despite the fact that based on LMP i'm 24 w 2 d, is measuring in on the ultrasound at 25 w 6 d! My EDD based on ultrasound is the 29th of May, although the last time we were in Oz the scan said that we were right on target for a June 9 delivery... this could get interesting!

Thankful Thursday

So I made it to Sydney unscathed, despite my realisation that airplane toilets are not made with fatty fatty boombahs, or growing pregnant bellies in mind.

Note to self: When flying as my girth continues to expand, go wees before getting on the plane. If using the dunny mid flight is absolutely unavoidable, then reversing into the cubicle may be a better option than trying to turn around in such a tight space!

Mum is all good, out of hospital, cheerful, and recovering well! Hopefully we now have a nice clear run to recovery!

My three things that I am thankful for this Thursday are:
1. My mum is ok.
2. I can still fit in an airplane loo with some room to spare.
3. I have e-mail on my mobile phone so I can incessantly e-mail The Man to tell him how much I love and miss him.

What are you thankful for today?

Warning, warning, warning!

So tomorrow I'm off for a few days to Sydney to visit my mum.

Unfortunately, what was supposed to be a relaxing birthday fly by has now become a bit of a mercy dash after mum has suffered a complication following some surgery last week.

Hopefully they get everything under control and sorted and mum can have a few days of relaxation and TLC with me.

Cross your fingers for us!

As a result, Thankful Thursday and Photographic Phriday will be dependent upon health circumstances and internet access, so we'll play it by ear!

Hope you all had a fabulous Valentine's Day!!

Home birth vs Hospital birth...

Last week I cam across this interesting and thought provoking opinion piece by Tara Moss in the Sydney Morning Herald. This piece was about the demonisation of home birth and the medicalisation of normal pregnancy and labour (which I have blogged about before).

The points that Tara raises in her piece have merit, and have stimulated a lot of thought for me regarding homebirth.

Given my geographical location, my journey to deliver my baby will be more complicated than some. Due to limited medical facilities and therefore a lack of what I personally view to be safe birthing options here in Vanuatu, I have chosen to have our baby in Australia (my home country). This means that I will be flying to Australia prior to 36 weeks, when the airlines will no longer accept a pregnant passenger, and then hanging out for a month or so until our little monster decides to drop. After which, we'll head bck to Vanuatu once Monster and I are fit to fly and Monster's passport is sorted out.

Due to these circumstances, and the fact that I don't really have  home to call my own in Australia, I have never considered home birth as an option for me. I have instead chosen to book into a family birthing clinic where I will be able to have as intervention-free a birth as I choose under the care of experienced midwives. The added benefit of this is that the clinic I have chosen is part of one of the foremost maternal and neonatal care facilities in Australia and therefore, should complications arise (touch wood they don't), there is every opportunity for my care to be escalated as necessary all without leaving the building!

The more I think about it though, if I lived in an urban area, close to emergency services and care, and I was comfortable in my own home, I think I would really quite like to have a midwife attended home birth! It think it would be incredibly comforting to be going through the birth process in my own "nest". However, as a nurse with maternal and infant care experience, I also have a healthy respect for needing to be close to emergency assistance "just in case".

Even since I was a nursing student, I have been strongly against the unnecessary medicalisation of normal pregnancy and labour. I believe in making an informed decision, and in there being a safe option for as many ways of thinking as possible. Information is they key to each individual chosing which option is right for them.

While I hope very much for an intervention free birth, I am not naive enough to think "that's it, there's my birth plan and I'm sticking to it!". I know that challenges and complications my arise, however I have faith in my chosen facility to give me as much information as possible to allow The Man and myself the ability to make the best decisions for us and our baby.

I know some of the ladies whose blogs I read are preparing for home births. What do you guys think of this piece? I'd love to hear about it!

More controversial than delivering a pizza!

At the end of November I noticed this article in the Sydney Morning Herald. The article is about the alarm within health circles, specifically in New South Wales (NSW), Australia, regarding the jump in induced births throughout the state, both in public and private patients.

According to statistics sourced by the writer from the Ministry of Health website, in NSW in 2009 34% of women aged between 20 - 34, having their first baby, had an induced labour! 34% of women who, based upon their ages, are generally a lower risk group when it comes to pregnancy and labour!

Many women and their partners may not realise, and according to the article they may not have been told explicitly by medical professionals, that induction of labour greatly increases the risk of a caesarean, vacuum, or forceps delivery. In light of this it is not surprising to note that while caesarean and forceps delivery rates have increased in the state, the rate of normal vaginal deliveries has reduced.

Even as a nursing student I had pretty strong beliefs against the medicalisation of normal pregnancy and delivery. During my student clinical placements and employment in some of Sydney's leading private maternity units, I became increasingly wary of the way interventions were advocated during what were otherwise normal, low risk labours and deliveries. To my eyes it wasn't so much the midwives who were encouraging intervention, but the obstetricians. Inductions were common place in the units in which I worked, as were elective caesareans.

Just to be clear, I am NOT against medical intervention in pregnancy and labour if it is medically necessary. However, I feel that the increasing trend of medical intervention during NORMAL, low risk, pregnancies and labours is concerning.

I feel concerned about it for several reasons, including:

• that the medicalisation of pregnancy and labour discourages women to have faith in their bodies and what they have evolved to do naturally over the millennia. I want to be able to trust my body to do what it does naturally. I don't want to be told that my body is inadequate for the task simply because medicine has a "better" way of doing things. It is my firm belief that, when it comes to pregnancy and delivery, unless my body is medically incapable of performing its duties, medicine will only ever be able to compliment, rather than out do evolution.
• that people may be agreeing to treatment without fully understanding the procedure and the benefits and risks involved. I am a huge believer in informed consent, and I don't believe that people can truly and honestly consent to a procedure or treatment without entirely understanding the ins and outs of things. I also believe that in a hospital setting it is up to the medical professionals to provide enough comprehensive and unbiased information for a person to give informed consent, regardless of the procedure.
• that people may be opting for "convenience" to fit in to their own, or other people's schedules, and risking their own health, their child's health, and their chance to fully experience and enjoy the process of pregnancy and giving birth.

The day this article came out I posted it to my wall on Facebook. A 29 year old nursing friend of mine, who has recently had her own first baby, read the article and posted a very interesting comment about her own experiences with an induced labour. She was very regretful about her decision to agree to an induction, but felt that because her whole pregnancy had been medicalised (she had undergone IVF to conceive), she had to accept an induction. She said her experience with the Syntocin was "AWFUL!!", and wished she'd had more information before she agreed to an induction, especially after realising that the risk to the baby at the time was minimal. After an epidural and a forceps delivery she is now the proud mother of a beautiful baby girl. However, she is adamant that next time around she will make sure she is more informed before being forced to make crucial decisions about her labour and delivery.

The week following the release of this article, NSW Health released a set of guidelines for use in the states public hospital system regarding the induction of labour and the administration of Oxytocin during induction. These new guidelines clearly outline an Oxytocin dosage protocol to be adhered to by medical professionals, guidelines as to when induction is and isn't appropriate, as well as clearly stipulating that women being offered an induction must be explicitly informed that induction can increase the risk of caesarean, vacuum or forceps delivery.

It is an admirable step toward reducing the amount of intervention in normal pregnancies and reversing the alarming trend of normalising interventions in pregnancy and labour.

I am really interested to hear other people's opinions about this. What do you think?