I am a midwife, hear me roar

I am so lucky that I can have both professional discussions on the state of healthcare in this country, as well as heart-to-heart talks about pregnancy, parenting, breastfeeding and sex with my fantastic, intelligent, articulate and well-respected midwife. She is an amazing woman with a big heart and a sharp mind, and here are her thoughts on the illusion of choice that is presented to a new mother. Unless she is savvy and well-informed, she is probably not getting the most well-rounded advice. (Although anyone who is paying a premium for a private obstetrician is probably thinking that she is getting the best care she’s paying for). Here’s what Joy said:

Informed Choice: a privilege but NOT a right

Notes: A short and technical explanation on evidence based medicine from the Cochrane Collaboration.

and another article on birth choices from Blue Milk:

Because reproductive rights include birth rights

Homebirth under threat

Cut from Hoyden About Town post:

Homebirth to become illegal in a year. … And no matter how low-risk the woman nor how much she desires a homebirth, women will not be allowed to do so legally with a midwife. Because the legislation introduced this week will ban midwives from practising without insurance; and there is no insurance provider for homebirth midwives. So long, too bad, so sad. Good bye.

For a good summary, see my midwife Joy’s post, who also wrote a great post about how the legislation affects private midwives attending home births:

It’s not true that *all* homebirth will be illegal after 1 July 2010, when the Health Practitioner Regulation National Law, which mandates professional indemnity insurance as a condition for registration, is set to come into effect.

Homebirth programs that are operated by hospitals and health authorities will be able to continue. The option that will become illegal is private arrangements between a woman and a midwife. That means midwives like me, and an estimated 150 others, will be out of work, and all the women who want to arrange homebirth privately will be denied that choice.

And please sign this petition to save private midwifery in Australia. Because I certainly don’t want to lose the right to the choice of being able to have a baby how I want to, and neither should any woman.

Home birth

Thankfully, all the friends I’ve told have been very supportive of my decision to have a home birth. (thank you, guys!) Even my mum and dad are saying that they will support whatever decision P and I have made, probably because they know me well enough to not interfere.

Obviously, I make all major (and most minor) decisions after full consultation with my husband (as one should), even though some people seem to think I just bulldoze and manipulate him. Those of you who know P and I well will know how unlikely that is!

I’ve only had a few instances of “oh, do you think it’s a good idea?” and “You’re brave” type comments. There is no obligation for me to justify my desisions to anyone but myself and my partner, I know. But this is my heartfelt response to any doubters out there.

To start, a short article from the Sydney Morning Herald on home birth, with a huge heap of interesting comments.

Is it safe?

According to the Cochrane Collaboration, a well-respected international research organisation:

The change to planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence. Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women.
{link}

As well as this article from the British Medical Journal from a study conducted from 1994 – 2003.

It’s rare for babies to die during birth in the UK, wherever they are born. Overall, in the 10 years of the study, less than 1 (0.79) in 1,000 babies died during or soon after childbirth. For women who chose a home birth and went on to have the baby at home without problems, the risk of the baby dying was even lower (0.48 in 1,000).

Pregnancy – clearing up 3 common misconceptions

1. Take your folic acid before you get pregnant (if you can).

Folic acid works, but it only works if taken before and during the first few weeks of pregnancy, when the neural tube is developing into the brain and spinal cord. {link}. The best way to get enough folic acid is to take a multivitamin with 400 micrograms of folic acid in it and eat a healthy diet. It doesn’t have to be a prenatal vitamin either. I have been taking a women’s multivitamin with adequate amounts of folic acid for about 8 years, and I spoke to a pharmacist who said that essentially there is no difference in women’s and prenatal vitamins and since I like mine so much (and had another months’ worth) I didn’t swap to a prenatal one.

2. Check your vaccination records (before you start trying).

Make sure you update your rubella and tetanus shots (most women will need a booster). And if you haven’t had chickenpox, might as well get that done too. Actually, if you’re a woman of childbearing age, may as well get those shots out of the way: current rubella and chickenpox vacinations will last your lifetime, and tetanus boosters (+whooping cough in the same shot in Australia) will last you about 10 years.

Many preventable infections can cause miscarriage, or birth defects. A quick blood test will reveal whether you’ve been inoculated for diseases such as rubella. If you need to be vaccinated with a live viral vaccine, as for rubella (German measles), you should wait one month after the vaccination before trying to conceive. This is a precaution, as it is thought that your body needs time to eliminate the injected virus, although there is no evidence to date of a link between rubella immunisation in pregnancy and birth defects.

You may also want to consider vaccination against chicken pox, which can cause problems for your unborn baby if you catch it for the first time in pregnancy. If you have already had this common childhood illness then you will already be immune. You may want to have a tetanus booster, and, if you’re at risk for hepatitis B, you may wish to consider being vaccinated against that disease as well.

More detailed articles available here and here.

3. Drinking during pregnancy (believe it or not, moderation is ok)

No matter how much I try to explain that there has been no concrete evidence that a small amount of alcohol periodically does any harm (just ask the French and Italian women who drink routinely with their meals), Hoyden about town has a recent post that explains it better than I do. Read it before you read the rest of this section.

The National Health and Medical Research Council (NHMRC) recommendations for women who are pregnant or might soon become pregnant are that they:

• Consider not drinking at all.
• Should never become intoxicated (drunk).
• Should note that the risk is highest in the earlier stages of pregnancy, including the time from conception to the first missed period. (which is when most women end up accidently drinking anyway)
• If they choose to drink, should have less than 7 standard drinks over a week, and no more than 2 standard drinks on any one day (at least two hours apart). A standard drink contains 10g of alcohol.

This link has more information.

Favourite Maternity Books

Here are some books I’ve found very useful. Keep in mind that I already know more than most about the medical side of childbirth, so there are no basic “What to Expect..” type books on this list. You might want to check them out at the library before you buy.

Better Birth: the definitive guide to childbirth – by Lareen Newman and Heather Hancock

This book has been an absolute godsend. The whole time I was reading it I kept thinking about the people I could give this book to. It is written by Australians, and contains inspiring women’s birth stories and a great list of Australian resources. It also happens to be very easy to read!

I found it on sale at Dymocks Melbourne store for $15 (RRP $29.95) and may even grab a few more copies for any of my friends who are becoming new parents.

Highly recommended. You can read an article by the author here.

Faulkner Fox: Dispatches from a Not-So-Perfect Life

A sassy, brilliant account of the realities of motherhood. I found so many light-hearted, fluffy or pessimistic motherhood books that this one really stood out. I enjoyed it so much I wanted to start the book again straight after I finished reading.

This review stood out:

“I devoured this book. Passionate, angry, honest and intelligent, the antidote to What to Expect When You’re Expecting, it’s one every pregnant or planning-to-be-pregnant woman with a modicum of ambition would do well to read.”

–Cathi Hanauer, editor of The Bitch in the House: 26 Women Tell the Truth about Sex, Solitude, Work, Motherhood and Marriage.

Excerpts and more from the author’s website.

The Nappy Bag Book (9th edition, 2008 – 2009)

I never realised how useful this book could be, but I have been looking through it every time I think: “I need this, but where in Oz will I get it?” or “Wonder who I can contact about …” It has up-to-date phone unmbers for care providers, and a fantastic list of resources and information. LOVE it.

I found this one at the op shop for $6. (yayy!) There are discount vouchers in the back. They last until March 2009 but I’m not inspired to use them. Previous editions are probably just as useful, so grab one at the second hand shop if you can get your hands on it.

La Leche League: The Womanly Art of Breastfeeding

I got this as a “work” book, when I was dealing with alot of new mothers. It’s been a very helpful, useful book to have around, and I’ve lent it to 2 new mums who have loved the supportive and calm tone in the book. Don’t be put off by the fact that it’s a La Leche League book – they are not militant about breastfeeding at all, just very supportive. It’s all about doing what feels right to you, which is why I like this book so much.

Green living, Worm Farming #3

Or, how anal and tight-arsed I can be.

Everyone knows about my Divacup. If you use tampons and have a strong stomach, make tampon tea and pour it on the garden. At least it’s some form of recycling! BTW, when I tried to find a link to tampon tea (I found the tip in one of my gardening books), the Google results were downright odd: from drinking the tea, to how to improve your plant’s aura, to odd sex-sounding topics (I wasn’t curious enough to check).

We also have a worm farm. No more guilt trip from throwing away fruit & veg that we forget to eat! If you have a smaller home, try a Bokashi bucket.

More about worm farming, Part 3:

1. A useful collection of articles.
2. Appropedia summary of typical designs and common problems.
3. (read part one & two)

Guerilla recycling – I reuse my envelopes by:

1. Using them as notepaper. Their thickness makes them the ideal shopping list. Write on them and throw them in your bag, it won’t get lost.
2. After they are all scribbled on, I cut the corners and use them as bookmarks. Especially handy in cookbooks or reference books when you can scribble little notes in the corner. Doesn’t hurt the book and makes recipes very easy to find. Especially if you colour code them with a highlighter.
3. THEN (and only then) they are dumped in our recycling bin. By this point, they’ve been used 3 times.

Other great ideas:

1. Turning off the lights and assorted power points (obsessively). If you think it’s a waste of time, read this mental_floss article on power vampires.
2. Using grey water on our garden. I try to time my laundry and showers for the hot days so that I can water the same evening. We rarely end up using mains water for our plants.
3. Op shop shopping. Buying used rescues products from becoming landfill and spreads the environmental cost of manufacture and freight. Almost all of my clothing is from op shops. Once I’m done with my clothes I pass them on to a friend or sell it on eBay, recycling them once again.

Links and thinks:

1. Being Skeptical of Green – New York Times
2. With big biz jumping on the green bandwagon, should activists cheer or jeer?
3. Living beyond our means | Guardian Unlimited
4. Going green means forever | Herald Sun- interesting, read comments.
5. Lifehacker green links

Gastro outbreak

There is a gastro bug outbreak going at the moment that is causing vomiting and diarrhoea, so I thought a reminder might be necessary, especially if you have kids.

Some important facts:

1. Gastroenteritis is usually caused by a virus (about 80% of the time) – therefore there is no magic cure and antibiotics don’t work – your body has to fight it.
2. It is very contagious and spreads like wildfire.
3. Basically the germs have to get from someone’s body secretions (faeces /stools and vomit) to your mouth. Sounds unlikely? Well, it happens when you:
   • Change a nappy, mop up some vomit or wipe your bum
   • Touch the taps, flush the toilet, turn on the lights
   • Forget to wash your hands really well
   • Some poor sod comes along and touches all the surfaces you’ve touched
   • They forget to wash their hands well
   • They eat a cookie or a small snack – the germs transfer from their hands to the food to their stomach
   • Voila! You’ve got gastro
4. So the key here is to wash your hands well and wash them often!
5. Here are some more tips and don’t forget the gastro bug article too.

If you’re sick

After a very busy and quite awful night shift, I crash into bed only to wake up to P shivering uncontrollably beside me. I go from dead-to-the-world to fully alert in a heartbeat, feel his head (fine) and try and calm him down. Then I feed him some Ibuprofen and lots of water, and he stops shaking in about 5mins.

I have a feeling he’s getting a cold, but a bad one, so I get online (as you do) and find this great symptom checker on WebMD. I hope you never have to use it, but here it is anyway and it’s probably a good idea to bookmark it.

P is now out cold on the floor beside me, but hey, at least he’s not burning up.

Oh, and another thing – fevers are seldom dangerous – read this. Here’s a short excerpt:

How Do I Know if My Child’s Fever Is a Sign of Something Serious?

In the past, doctors advised treating a fever on the basis of temperature alone. But now, they recommend taking both the temperature and the child’s overall condition into account.

Children whose temperatures are lower than 38.9 degrees Celsius usually don’t require medication, unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, call your baby’s doctor or go to the emergency department. Even a slight fever can be a sign of a potentially serious infection in very young infants.

For older children, take behavior and activity level into account. By watching how your child behaves, you can get a pretty good idea as to whether he or she has a minor illness or needs to be seen by a doctor.

Healthy Travel

I’ve just made a very useful addition to my Health Resources page, the TravelDoctor.com.au Vaccine Advisor.

Everyone travels, and this is the best place to get detailed information if you are from Australia. There is a bit of marketing slipped into the clinical information, but you can just ask for the same vaccinations at your GP.

First aid kits for traveling are very easy to make up:

• Most essential is hand wipes or sterilizer, as keeping your hands clean will prevent you from getting anything nasty in the first place. I have found that it is generally cheaper in the country you visit, so I buy mine in Singapore/ Malaysia/ Mexico.
• Another thing I always have is Gastrolyte or some other oral rehydration solution, which I can never seem to find outside Australia in little packets.
• Take some strong (prescription) painkillers and a general antibiotic as well.
• Other useful things are scissors and tweezers, but you should be carrying those as part of your travel gear already.
• Everything else, like band aids and antiseptic cream, can be bought on an “as needed” basis as they should be freely available and cheap everywhere you go. I personally never cover minor wounds, and spit + soap work just as well as antiseptic.
• The most lightweight, useful thing you can carry is knowledge, so sign up for a first aid class near you before you go, especially if you are visiting a higher risk country or traveling for a long time. The other option is to find reliable information online, print it out and take it with you.
• Don’t forget to make an appointment for your return, to get booster shots and a general check to make sure you didn’t bring back any nasty bugs!

Divacups (and other menstrual devices)

I first blogged about them a while ago here, but let me tell you, these things are wonderful. Why?

1. They’re environmentally friendly – no adding blood soaked slops of pads and tampons to landfill (do you really want to think about that?) and you save money in the long run ($20 one-off or tampons for the next 20 years? You do the math).
2. They’re convenient - change it every 12 hours, wash it, stick it back in when you shower. Great if you are traveling when there are limited toilet facilities or no place to dispose of pads/tampons on a hike. They don’t pick up extra water so they’re fabulous if you swim, surf, scuba dive, kayak or do any type of water sport. You can even insert it the day your period is due (before you get it) and not have to deal with any anxiety or mess!
3. They’re embarassment-proof: they don’t leak, you don’t need to visit the toilet every 4-6 hours to change tampons or pads – even if you have very heavy periods, don’t need to tote any feminine bits n bobs around, no string to slip out of your swimsuit when you swim, did I say they don’t leak?
4. Do I really need to go on?

There are some things to know first:

1. They can be fiddly to insert. So you have to be quite comfortable poking around down there trying to get it right. It might take a few cycles before it’s all good.
2. You can’t faint at the sight of blood, or be easily grossed out.
3. You should like goofy gadgets, trying new things and be open to new experiences.

So girls, save the planet and your vagina and go get one! If you have questions, check out menstrualcups.org or send me an email. I love my Divacup and I’m thinking of importing a large batch of them or the Mooncup, if there is enough interest and selling them.