tag:theconversation.com,2011:/global/topics/birth-703/articles
Birth – The Conversation
2023-12-18T23:18:02Z
tag:theconversation.com,2011:article/217803
2023-12-18T23:18:02Z
2023-12-18T23:18:02Z
Women want to see the same health provider during pregnancy, birth and beyond
<figure><img src="https://images.theconversation.com/files/566233/original/file-20231218-17-b7lsjp.jpg?ixlib=rb-1.1.0&rect=8%2C146%2C5742%2C3578&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mid-adult-female-nurse-comforting-tensed-228783766">Tyler Olson/Shutterstock</a></span></figcaption></figure><p>In theory, pregnant women in Australia <a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">can choose</a> the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs. </p>
<p>While standard public hospital care is the <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/about">most common</a> in Australia, accounting for 40.9% of births, the other main options are: </p>
<ul>
<li>GP shared care, where the woman sees her GP for some appointments (15% of births)</li>
<li>midwifery continuity of care in the public system, often called <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">midwifery group practice</a> or caseload care, where the woman sees the same midwife of team of midwives (14%)</li>
<li>private obstetrician care (10.6%)</li>
<li>private midwifery care (1.9%). </li>
</ul>
<p>Given the choice, which model would women prefer?</p>
<p>Our <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06130-2">new research</a>, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician. </p>
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<strong>
Read more:
<a href="https://theconversation.com/more-than-6-000-women-told-us-what-they-wanted-for-their-next-pregnancy-and-birth-heres-what-they-said-211435">More than 6,000 women told us what they wanted for their next pregnancy and birth. Here's what they said</a>
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<h2>Assessing strengths and limitations</h2>
<p>We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.</p>
<p>We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.</p>
<p>Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths. </p>
<h2>What women thought of standard maternity care in hospitals</h2>
<p>Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care. </p>
<p>Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system. </p>
<figure class="align-center ">
<img alt="Baby being cleaned after birth" src="https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sometimes midwives and doctors in the public system exceeded expectations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-being-cleaned-assessed-by-paediatrician-1118249573">Inez Carter/Shutterstock</a></span>
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<p>The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days. </p>
<p>Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:</p>
<blockquote>
<p>The experience was very impersonal, their focus was my cervix, not preparing me for birth.</p>
</blockquote>
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Read more:
<a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">1 in 10 women report disrespectful or abusive care in childbirth</a>
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<h2>Why women favoured continuity of care</h2>
<p>Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals. </p>
<p>Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.</p>
<p>The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:</p>
<blockquote>
<p>Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).</p>
</blockquote>
<p>However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the <a href="https://doi.org/10.1016/j.wombi.2020.06.001">cost</a> and the small numbers working in Australia, particularly in <a href="https://www.ruralhealth.org.au/sites/default/files/publications/fact-sheet-midwives.pdf">regional, rural and remote areas</a>, among other barriers.</p>
<p>Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments. </p>
<p>This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive. </p>
<p><iframe id="iRWBu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/iRWBu/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor. </p>
<h2>What about shared care with a GP?</h2>
<p>While shared care between the <a href="https://raisingchildren.net.au/pregnancy/health-wellbeing/tests-appointments/gps-shared-care-pregnancy">GP</a> and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care. </p>
<p>Considering there is strong evidence about the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004667.pub5/full">benefits of midwifery continuity of care</a>, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay. </p>
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Read more:
<a href="https://theconversation.com/birthing-on-country-services-centre-first-nations-cultures-and-empower-women-in-pregnancy-and-childbirth-170641">Birthing on Country services centre First Nations cultures and empower women in pregnancy and childbirth</a>
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<img src="https://counter.theconversation.com/content/217803/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Keedle is affiliated with the Australian College of Midwives. Funding for this study was from a School of Nursing and Midwifery Partnership Grant through Western Sydney University, The Qiara Vincent Thiang Memorial Award and Maridulu Budyari Gumal SPHERE Maternal, Newborn and Women’s Clinical Academic Group funding.</span></em></p><p class="fine-print"><em><span>Hannah Dahlen has received funding from the National Health and Medical Research Commission, the Australian Research Council, the Medical Research Future Fund (funding and for this study and funding from a School of Nursing and Midwifery Partnership Grant through Western Sydney University), The Qiara Vincent Thiang Memorial Award and Maridulu Budyari Gumal SPHERE Maternal, Newborn and Women’s Clinical Academic Group funding.</span></em></p>
Women favour seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.
Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/210301
2023-11-20T14:36:06Z
2023-11-20T14:36:06Z
Early births – between 34 and 37 weeks – for moms with pre-eclampsia can reduce baby and mother deaths
<p>About <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">half a million</a> babies die each year as a result of pre-eclampsia, an aggressive and potentially life-threatening problem in pregnancy. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">46,000 women also die each year due to the disorder</a>.</p>
<p>The condition – a high blood pressure (hypertension) disorder – can affect multiple organs in the woman’s body, including the liver, kidneys, heart, brain and blood clotting system, as well as the growth and development of the foetus. If severe, and untreated, it can lead to the placenta detaching from the womb (placental abruption), seizures, stroke, maternal death and stillbirth.</p>
<p>Pre-eclampsia can be difficult to predict, and it can progress rapidly. The only treatment is delivery. </p>
<p>In a <a href="https://cribs-i.org/wp-content/uploads/2023/07/Lancet-Planned-Delivery.pdf">recent paper</a> we found that planned early birth reduced the risk of stillbirth and improved most outcomes for mothers and babies. We concluded that clinicians can routinely deliver babies for mothers who have pre-eclampsia, from 34 weeks – even in a low resource setting. </p>
<p>We recommend that planned early delivery is implemented to reduce adverse pregnancy outcomes in late preterm pre-eclampsia, particularly stillbirth. We argue that the intervention should form part of a concerted global effort to end all maternal and perinatal deaths from preventable causes.</p>
<h2>When to deliver</h2>
<p>Deciding when to offer birth requires careful balancing of risks and benefits. Early preterm delivery (before 34 weeks’ gestation) is only recommended if severe complications of pre-eclampsia have developed, where the benefit of delivery outweighs the risk of potential complications of early preterm birth for the baby (for example, breathing or feeding difficulties). </p>
<p>For the period between 34 and 37 weeks, there has not been enough research to guide women and clinicians as to whether it is better to routinely offer late preterm birth to all women with pre-eclampsia, or to watch and wait until either 37 weeks’ gestation is reached, or complications develop. </p>
<p>We set out to answer this question in a trial which we carried out in India and Zambia.</p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 trial</a> was a randomised controlled trial which compared planned delivery (initiating delivery within 48 hours of trial entry) to usual care (watching and waiting until 37 weeks, or the development of complications needing delivery). Women who agreed to participate were randomly allocated to either planned delivery, or to usual care. A total of 565 women with pre-eclampsia, between 34 and 37 weeks of pregnancy, without an immediate indication for delivery, took part. The trial was conducted across nine sites in India and Zambia.</p>
<p>The study found that planned delivery significantly reduced the risk of stillbirth – by 75%. In addition, planned delivery did not increase the risk of the baby needing to go to the neonatal unit. Neither did it increase the risk of short-term complications after birth, such as breathing or feeding difficulties. This is an especially important finding for clinicians working with limited neonatal resources, who can be reassured that planned early birth is safe. </p>
<p>Encouragingly, planned delivery reduced the risk of severely high blood pressure in the woman, compared to usual care. Rates of other complications such as eclampsia and placental abruption (where the placenta detaches from the womb) were also lower in the planned delivery group. Mothers who delivered early were as likely as those in the usual care group to achieve a vaginal birth, and spent less time in hospital. </p>
<h2>Next steps</h2>
<p>The current maternal mortality rate in the world is 223 per 100,000. The aim under the Sustainable Development Goals is to reduce that to <a href="https://www.un.org/sustainabledevelopment/health/">70 per 100,000 live births by 2030</a>.</p>
<p>But this won’t happen unless there is a focus on interventions that address the major causes of maternal death in regions where they are most needed. These include sub-Saharan Africa and south Asia, <a href="https://www.who.int/publications/i/item/9789240068759">according to the World Health Organization</a>.
Our findings show that one such intervention should be to incorporate planned delivery from 34 weeks into routine care. </p>
<p>But this won’t be easy, particularly in low- and lower-middle income settings, due to over-stretched, under-staffed healthcare systems, where access to key resources may be variable. </p>
<p>To progress the idea, a number of steps need to be taken.</p>
<p>Firstly, early delivery should be incorporated into national and international guidelines across the globe. For this to happen there must an increased understanding around pre-eclampsia via community engagement. Women need to be better informed about what to look out for and what action to take, and need to be able to access healthcare facilities.</p>
<p>Community engagement is critical to translating research into impact and creating awareness about ways to alleviate this health issue. </p>
<p>This has already been initiated in some countries. For example, our research group has developed community engagement tools including docu-dramas designed alongside communities in Zimbabwe, Haiti and Sierra Leone. </p>
<p>A recent dynamic awareness campaign about pre-eclampsia was launched in Sierra Leone. It included creating competitions at universities to produce poems and videos about pre-eclampsia, putting stickers on taxis and motorbikes and putting up posters. </p>
<p>In Zambia, a national television broadcast encouraging women to attend antenatal care and recognise the danger signs of pre-eclampsia was shown on World Pre-eclampsia Day. </p>
<p>Secondly, planned delivery needs to be implemented alongside a range of interventions. Medical practitioners need to be enabled to provide early risk stratification, prediction of pre-eclampsia, safe labour and delivery care, and postnatal follow-up. </p>
<p>Thirdly, more research needs to be done in resource-stretched settings. Currently, only <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30539-8/fulltext">2% of clinical trials</a> take place in sub-Saharan African countries and even fewer address the most important causes of maternal mortality. </p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 Trial</a> acts as an important example of how this can be changed, and demonstrates the power of locally-driven evidence.</p><img src="https://counter.theconversation.com/content/210301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Beardmore-Gray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Planned early delivery is a key component of reducing child and maternal mortality.
Alice Beardmore-Gray, Cradle 4 Trial Coordinator, Department of Women's Health, King's College London
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/211435
2023-09-05T02:39:09Z
2023-09-05T02:39:09Z
More than 6,000 women told us what they wanted for their next pregnancy and birth. Here’s what they said
<figure><img src="https://images.theconversation.com/files/545717/original/file-20230831-29-n7bhi3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-newborn-child-birth-maternity-hospital-1938100312">Shutterstock</a></span></figcaption></figure><p>Many women want a different kind of pregnancy and birth the next time around. Many want to see the same one or two midwives throughout, and want to choose where they give birth. And when the time comes, they want a vaginal birth, with less intervention. </p>
<p>This is what thousands of Australian women told us when we asked if they would do anything differently if they had another baby.</p>
<p>We publish our findings today in <a href="http://dx.doi.org/10.1136/bmjopen-2023-071582">British Medical Journal Open</a>. </p>
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<em>
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Read more:
<a href="https://theconversation.com/curious-kids-why-do-babies-cry-when-they-come-out-of-their-mum-205477">Curious Kids: why do babies cry when they come out of their mum?</a>
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<h2>What we did</h2>
<p>In 2021, we undertook Australia’s largest national study of birth experiences. As part of that, we asked women, “Would you do anything different if you were to have another baby?”</p>
<p>A total of 6,101 women left comments. More than 85% of comments were from women who said they’d do things differently the next time around.</p>
<p>Several themes emerged.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-women-forget-the-pain-of-childbirth-12271">Monday’s medical myth: women forget the pain of childbirth</a>
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<h2>‘Next time I’ll be ready’</h2>
<p>The largest group of comments (39.2%) were from women who wanted to avoid a repeat of their previous pregnancy and birth experience. They wanted to better advocate for themselves, get more informed about their choices, and avoid certain birth interventions. </p>
<p>For example, there were more than 500 comments from women who would try to avoid having their next labour started manually, known as an <a href="https://theconversation.com/too-many-healthy-women-are-having-their-labour-induced-for-no-identified-medical-reason-our-study-shows-161281">induction of labour</a>. </p>
<p>A woman from Western Australia, who ended up having a caesarean, said:</p>
<blockquote>
<p>I would 100% opt for no induction. I believe it’s the reason that led me to a c-section.</p>
</blockquote>
<p>Australia has a high rate of induction, especially for women having their first babies <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/onset-of-labour">(41% induced labour rate for women having their first baby)</a>. Women feel they are <a href="https://pubmed.ncbi.nlm.nih.gov/32146087/">inadequately informed</a> about the process of induction and not given a choice or alternative options.</p>
<p>We have also shown an induction of labour in Australia can lead to <a href="https://bmjopen.bmj.com/content/11/6/e047040">further medical interventions</a>. High rates of medical intervention, such as induction, can lead to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31472-6/fulltext">poorer</a> maternal and neonatal outcomes when used excessively. </p>
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<em>
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Read more:
<a href="https://theconversation.com/too-many-healthy-women-are-having-their-labour-induced-for-no-identified-medical-reason-our-study-shows-161281">Too many healthy women are having their labour induced for no identified medical reason, our study shows</a>
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<h2>‘I want a specific birth experience’</h2>
<p>This was the second largest category (28.5% of comments). Here, most women said they wanted their next birth to be a vaginal birth (1,735 comments) and some would opt for a caesarean (438 comments). </p>
<p>Of the women wanting a vaginal birth, 1,021 comments related to wanting the next birth at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Newborn baby wrapped in towel, with mum holding wrinkly tiny fingers" src="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many women wanted their next birth at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-holds-onto-their-fathers-1519293962">Shutterstock</a></span>
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<p>
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Read more:
<a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">Explainer: what are women's options for giving birth?</a>
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<h2>‘I want a specific model of care’</h2>
<p>Women also said they wanted to be better prepared by getting better support. This ranged from a more supportive partner, hiring a <a href="https://theconversation.com/what-is-a-doula-and-how-do-they-help-women-giving-birth-113562">doula</a> and choosing their care provider.</p>
<p>Some 17.8% of all comments, the next-largest group, identified a specific <a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">model of maternity care</a>. Women wanted to access a more supportive model that would respect their choices and wishes.</p>
<p>Most women in this group wanted “<a href="https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-early">midwifery continuity of care</a>”. This is where women are cared for by one or two midwives throughout their pregnancy, labour and birth, and into the post-birth period.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Midwife or doctor measuring pregnant woman with tape measure" src="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many women prefer to see the same one or two midwives throughout.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kind-obstetrician-examining-pregnant-belly-clinic-538015297">Shutterstock</a></span>
</figcaption>
</figure>
<p>A woman from Victoria, who told us she wanted continuity of care next time around, said:</p>
<blockquote>
<p>It is very important to me that next time I have a care provider who I fully trust, who has a good understanding of my birth preferences and who I know will be a strong advocate for me and who will encourage, empower, support and believe in me and my ability to birth my baby.</p>
</blockquote>
<p>Midwifery continuity of care is <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">available</a> now in many public hospitals and is commonly called midwifery group practice or caseload midwifery. Some women access this type of care through private midwives. These charge a fee (there are some Medicare rebates) and can support women to have births at home.</p>
<p>But access to midwifery continuity of care <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/about">is still limited</a> and booked out early, meaning many women miss out, especially if they live in regional or remote regions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">Call the Midwife: playing catch up with Australia's maternity care </a>
</strong>
</em>
</p>
<hr>
<h2>‘I want better access’</h2>
<p>This group of comments (2.9%) included ones from women in regional and remote parts of Australia.</p>
<p>They said they wished they had access to more local maternity services and equitable access to models that offer continuity of care and homebirth, such as private midwives. </p>
<p>A woman from a remote town in New South Wales said:</p>
<blockquote>
<p>If I ever fell pregnant again. I would move to a bigger town. Obstetric care in the bush is very much lacking. Rural women like myself are lucky to even be alive after our experiences.</p>
</blockquote>
<p>With many maternity units in rural and remote areas <a href="https://www.abc.net.au/news/2023-02-27/rural-remote-maternity-services-in-crisis-experts-have-solutions/102020056">shutting down</a>, women are forced to travel big distances and have fewer maternity care options than women who give birth in cities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman driving, holding belly" src="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pregnant women can end up driving long distances to access care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-driving-car-buttoned-belt-633963140">Shutterstock</a></span>
</figcaption>
</figure>
<h2>‘I don’t want to change anything’</h2>
<p>Some 10.2% of comments were from women who didn’t want to change anything the next time around.</p>
<p>Of these, just under half (47%) were from women who received midwifery continuity of care.</p>
<p>This is significant as midwifery continuity of care only represent <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/what-do-maternity-models-of-care-look-like/major-model-category">15%</a> of maternity models in Australia.</p>
<h2>Why are birth experiences important?</h2>
<p>We’ve shown that many women who reflect on their experience of pregnancy and birth wish they had made <a href="https://www.sciencedirect.com/science/article/pii/S1877575622000854">different decisions</a> and wish they had a more positive experience to look back on. </p>
<p>A <a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">negative birth</a> experience can lead to <a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">birth trauma</a> and post-traumatic stress disorder. </p>
<p>Some of this may be unavoidable, such as when emergency situations arise during the labour. But trauma can also be related to the way women are <a href="https://journals.sagepub.com/doi/10.1177/10778012221140138">respected</a>, informed and cared for.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">So your birth didn't go according to plan? Don't blame yourself</a>
</strong>
</em>
</p>
<hr>
<h2>What happens next?</h2>
<p>What women are asking for is humanised, evidence-based maternity care. So it’s time to act if we are to avoid the type of experiences highlighted during the current <a href="https://www.parliament.nsw.gov.au/committees/listofcommittees/Pages/committee-details.aspx?pk=318">NSW Select Committee on Birth Trauma</a>.</p>
<p>With evidence from more than 4,000 submissions, this reminds us we often fail women during one of the most vulnerable, yet potentially transforming experiences in their life. We hope women’s voices are finally heard.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">1 in 10 women report disrespectful or abusive care in childbirth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Keedle is affiliated with the Australian College of Midwives. </span></em></p><p class="fine-print"><em><span>Daniella Susic is affiliated with UNSW Sydney, RANZCOG and MothersBabies. Funding for research has been received via RANZCOG.</span></em></p><p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC, ARC and MRFF. She is affiliated with the Australian College of Midwives </span></em></p>
Many women want to see the same one or two midwives throughout, and want to chose where they give birth. And when the time comes, they want a vaginal birth, with less intervention.
Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University
Daniella Susic, Clinical Academic Obstetrician, UNSW Sydney
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/207360
2023-08-29T15:34:41Z
2023-08-29T15:34:41Z
When being a new mum feels overwhelming, here’s some expert advice on what you need to know
<figure><img src="https://images.theconversation.com/files/542176/original/file-20230810-11401-f0k38u.jpg?ixlib=rb-1.1.0&rect=11%2C15%2C2544%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being a new mother can take a lot of adjustment. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/parents-looking-at-their-baby-3584088/">pexels?nappy</a></span></figcaption></figure><p>We are sold the idea that becoming a new mother is the <a href="https://psycnet.apa.org/record/2016-38769-001">happiest time of your life</a>. But for many women, the reality doesn’t fit that perfect picture. Yes, they may love their baby very much but the broader impact of having a baby and becoming a mother can feel far more complex. </p>
<p>Research shows that when we look at happiness over our lifetime, the year after having a baby can be one of our <a href="https://psycnet.apa.org/record/2013-15090-008">lowest points</a>. It’s not about our relationship with our baby but rather the other parts of our lives that have changed so much. Social media hasn’t helped any of this. We are all tempted to just share the best bits, thinking we need to hide our feelings because we think <a href="https://psycnet.apa.org/record/2018-45585-002">everyone else is so happy</a>. But speaking out helps everyone. </p>
<p><a href="https://www.independent.co.uk/news/health/negative-thoughts-new-parents-baby-pregnant-children-parenting-b694300.html">It’s normal</a> to experience some challenging emotions when you become a new parent. You might not immediately bond with your baby, wondering why that flash of love didn’t appear. You might grieve for your old life and identity. You might feel trapped, wanting to escape yet at the same time feeling you can’t leave your baby. </p>
<p>Worries about not being “good enough” for your baby are also common. But honestly, you don’t need to get it right all the time. You are more than enough for your baby. None of these very normal reactions to change mean that you don’t love your baby.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<hr>
<p>But knowing when these are normal feelings and when you might need support is important. At least <a href="https://maternalmentalhealthalliance.org/about/perinatal-mental-health/">one in five</a> new mothers will experience a mental health issue after birth. Though this is likely an underestimation because many hide these feelings. But hiding them just prevents you from getting the support you need. So here are some signs to look out for:</p>
<p><strong>Postnatal depression:</strong> <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/">Depression</a> isn’t simply feelings of sadness. In fact, anxiety, about something specific or a general feeling of dread is common. You might lose pleasure in doing things, feel hopeless about the future, or feel very low about yourself. </p>
<p><strong>Anxiety and intrusive thoughts:</strong> We all have moments where we imagine ourselves dropping our baby. Sometimes however these thoughts become <a href="https://www.verywellfamily.com/overcoming-postpartum-ocd-and-intrusive-thoughts-5187982">repetitive, frequent</a> and we can’t make them go away. You might find yourself <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/perinatal-anxiety/">unable to sleep</a> or waking too early. You might feel restless, overwhelmed in public or feel shaky. </p>
<figure class="align-center ">
<img alt="Woman lying in bed with baby." src="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s normal for life to seem radically altered and to feel a loss of identity.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-resting-on-the-bed-with-her-baby-on-top-6849528/">pexels rdne stock project</a></span>
</figcaption>
</figure>
<p><strong>Postnatal rage:</strong> We often don’t talk about rage when it comes to mothers but it’s <a href="https://www.irishtimes.com/life-and-style/health-family/i-was-a-charging-brutal-half-animal-the-ugly-truth-about-postnatal-rage-1.2950662">more common</a> that you think. You might find yourself feeling on edge or irritable and then snap when something small goes wrong. Hormonal fluctuations and a lack of sleep might exacerbate this but more often it’s a reaction to feeling overwhelmed, powerless and unsupported. </p>
<p><strong>Birth or breastfeeding trauma:</strong> Many women have some difficult memories of birth but sometimes, even if you are able to talk them over with friends afterwards, <a href="https://www.youtube.com/watch?v=A43qlYkSMyU">these don’t go away</a>. You might find yourself having flashbacks, feel unable to go near the hospital or anything that reminds you of the birth, or feel very angry about your experience, or blame yourself. </p>
<p>Your sleep or appetite might be affected, or you might feel very jumpy or on edge. Sometimes these feelings are linked to physical events during the birth, but often they’re more about how you felt or were treated.</p>
<p>Increasingly similar feelings of trauma or grief are being recognised around <a href="https://welldoing.org/article/why-breastfeeding-grief-trauma-matter">infant feeding experiences</a>. If you experienced breastfeeding difficulties or had to stop before you were ready, you might be feeling guilt, anger or loss about that, despite your baby thriving. </p>
<h2>Getting support</h2>
<p>If you’re feeling overwhelmed by the emotions you are experiencing or find your sleep, energy or appetite is affected, here are some things to try:</p>
<figure class="align-center ">
<img alt="Woman with baby and laptop." src="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t suffer in silence, get as much support and help as you can.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/young-working-mother-cuddling-baby-and-using-laptop-at-home-7282818/">Pexels/sarah chai</a></span>
</figcaption>
</figure>
<p><strong>Talk to friends:</strong> Sometimes just sharing how we feel and realising that others feel this way can help us realise we are not alone </p>
<p><strong>Discuss with your health visitor or GP:</strong> They can help you understand how you are feeling and discuss different treatments such as counselling and medication</p>
<p><strong>Contact one of the many organisations that can help:</strong> The <a href="https://maternalmentalhealthalliance.org/resources/mums-and-families/">Maternal Mental Health Alliance</a> has a list of contacts. You can talk through difficult infant feeding experiences with a <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/">breastfeeding charity</a>. Many doulas (a person who can support you through pregnancy, labour and birth) also offer help to explore <a href="https://doula.org.uk">how you are feeling</a> about your birth and caring for your baby. </p>
<p><strong>Focus on looking after yourself, too:</strong> Your diet, activity levels and time outdoors can all affect how you feel. Do not be afraid to ask others for help or to use sources such as childcare to get some time for you to be able to do this. Explain to them how you feel and what you need. </p>
<p><strong>Creativity is good:</strong> The <a href="https://www.maternaljournal.org/">Maternal Journal</a> project holds in-person and online group sessions supporting you to explore how art can help, while also caring for your baby. </p>
<p><strong>Try baby massage:</strong> It can help you to slow down and connect with your baby. And it can help increase <a href="https://pubmed.ncbi.nlm.nih.gov/11246096/">oxytocin levels</a> in you both, calming your system.</p>
<p><strong>Explore some grounding techniques:</strong> <a href="https://www.healthline.com/health/grounding-techniques#physical-techniques">These can help you</a> to manage your anxiety. When you feel symptoms of anxiety, look for things in the environment around you. Try and find five things that are blue. Or five things that are soft. Count them and say them out loud. </p>
<p>Most of all remember that none of these feelings are anything to do with how much you love your baby or how well you care for them. Often mothers experiencing mental health difficulties are highly attuned to their baby’s needs because they are so worried about not getting it right. Your baby will be fine, but it’s important that you are too.</p><img src="https://counter.theconversation.com/content/207360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, MRC, NIHR, HEFCW, UKRI, Infant feeding charities and Public Health Wales. She is a trustee for First Steps Nutrition Trust.</span></em></p>
New motherhood is often portrayed as a time of joy but it can also be filled with fears and complicated feelings. Here’s how you can get help and support.
Amy Brown, Professor of Child Public Health, Swansea University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/207753
2023-08-22T14:52:07Z
2023-08-22T14:52:07Z
Six pregnancy terms you probably won’t hear again, including ‘high risk’ and ‘failed’
<figure><img src="https://images.theconversation.com/files/542983/original/file-20230816-17-towf59.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5152%2C3435&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The language midwives use is an important part of the care they provide.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-pregnant-woman-visit-gynecologist-doctor-1404770729">Blue Planet Studio/Shutterstock</a></span></figcaption></figure><p>Medical terminology evolves alongside our understanding of medicine. As time goes by, new terms are adopted while others are abandoned. In midwifery, there should always be a strong emphasis on the language we use, particularly in pregnancy.</p>
<p>In 2020, the Royal College of Midwives launched an initiative to discover the impact language has on women. The aim of the <a href="https://www.rcm.org.uk/rebirth-hub/">Re:Birth</a> project was to find language around pregnancy that could be understood both by people delivering maternity care and those receiving it. </p>
<p>It was the first project of its kind to consult the maternity community (including new mothers and healthcare professionals) directly on their preferred language to describe labour and birth. The findings of the project supported the fact that many women were less concerned about the way their baby was born but with whether they had a positive experience and felt safe and listened to.</p>
<p>Last year, the Royal College of Midwives published a <a href="https://www.rcm.org.uk/media/6234/re_birth_summary_.pdf">report</a> outlining their findings and a new pocket guide is being issued to midwives this year. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<hr>
<p>Here are six maternity terms you are now unlikely to hear:</p>
<h2>1. Delivery</h2>
<p>The term “birth” has now been accepted, rather than the term “delivery”, which has commonly been used in the past. Women and health professionals also wanted accurate, specific descriptions as far as possible to describe what had happened in the labour and birth. For example, “birth with forceps” or “birth with ventouse”. This also includes “caesarean birth”.</p>
<h2>2. Low risk / high risk</h2>
<p>“Universal care needs” is being used rather than “low risk”. While “additional care needs” is now the preferred term for “high risk”. The word “risk” is associated with uncertainty and it is vital that women feel comfortable and confident during their pregnancy.</p>
<h2>3. Normal</h2>
<p>“Normal birth” is a term that has long been used by midwives and other healthcare professionals to describe a spontaneous, physiological vaginal delivery. But what counts as “normal”? Does this label someone as “abnormal” if they did not experience what we classify as “normal” birth?</p>
<p>The new preferred term, “spontaneous vaginal birth”, covers spontaneous labour without significant medical interventions such as induction and oxytocin. It also covers spontaneous vaginal birth without the need for instruments, such as forceps. </p>
<h2>4. Emergency caesarean</h2>
<p>The new overarching term for an operative caesarean section is “caesarean birth”. This replaces the word “emergency”, which is a term that may cause alarm. The term “unplanned caesarean birth” is now preferred over “emergency caesarean”. </p>
<h2>5. Incompetent cervix</h2>
<p>“Incompetent cervix” has connotations of personal failure. So, the preferred term is now “cervical insufficiency”. </p>
<h2>6. Failure / failed</h2>
<p>During the Re:Birth project, women were keen to share how terms such as “failure to progress” can contribute to feelings of failure and trauma. “Delayed progress in labour” or “slow labour” are now preferred terms.</p>
<p>We can apply the same logic to terms such as “failed induction” or “failed homebirth”. “Induction of labour, with delay and followed by operative birth” and “transfer in during planned homebirth” are favoured, respectively. </p>
<figure class="align-center ">
<img alt="A pregnant woman wearing a yellow top clutches her belly." src="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Language matters.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-african-american-woman-doing-morning-1842709132">Prostock-studio/Shutterstock</a></span>
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<p>Language which infantalises pregnant women, such as “good girl” or “you are allowed/not allowed to” should also be avoided, as should language which has connotations of blame. Examples of this include “poor maternal effort” and “refused”. </p>
<p>During pregnancy and birth, which is a vulnerable time for many, the role of the midwife is to empower women and to value their autonomy over their care decisions. </p>
<p>The Nursing and Midwifery Council’s <a href="https://www.nmc.org.uk/globalassets/sitedocuments/standards/standards-of-proficiency-for-midwives.pdf">standards of proficiency for midwives</a> document states that midwives provide universal care for all women and new-born infants. Midwives support physical, psychological, social, cultural and spiritual safety. The emphasis on psychological care is clear, therefore, with language having a profound impact on wellbeing.</p>
<p>Healthcare professionals must acknowledge that the language we use is an important part of the care we provide. Improved psychological safety and wellbeing is closely linked to improved safety, positive outcomes and future experiences. Language matters.</p><img src="https://counter.theconversation.com/content/207753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Aubrey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Several familiar maternity terms have been abandoned after a consultation with pregnant women and healthcare professionals.
Sarah Aubrey, Lead Midwife for Education, University of South Wales
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/205477
2023-08-18T02:08:23Z
2023-08-18T02:08:23Z
Curious Kids: why do babies cry when they come out of their mum?
<figure><img src="https://images.theconversation.com/files/543119/original/file-20230816-21-5r1861.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-78559918">Shutterstock</a></span></figcaption></figure><blockquote>
<p>Why do babies always cry when they come out of their mum? – Nam, 12, Hanoi, Vietnam</p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>When babies are born, they all seem to cry. We see this a lot <a href="https://www.goldderby.com/gallery/best-tv-births-ranked-worst-to-best/tvs-most-memorable-births-little-house-ont-the-prarie/">on TV</a>.</p>
<p>But not all newborn babies cry straight away. Here’s what’s going on.</p>
<h2>What happens at birth?</h2>
<p>When a baby is born, they move from their mum’s warm body, and out of their dark, watery world into a much cooler, drier and brighter one.</p>
<p>It’s a bit of a squeeze. As the baby comes out from their mum, the cooler air hits their wet skin. </p>
<p>The cooler air makes them gasp. They also gasp when the midwife or doctor touches their body to help them come into the world.</p>
<p>That gasp is their first breath, which usually comes with a cry. And when this happens the gasp or cry triggers an amazing <a href="https://www.youtube.com/watch?v=zTXmaVgobNw">change</a> in how the baby gets oxygen and moves it around their body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-cry-119814">Curious Kids: why do we cry?</a>
</strong>
</em>
</p>
<hr>
<h2>What changes?</h2>
<p>In the womb, babies depend on their mum for oxygen – via the <a href="https://theconversation.com/explainer-what-is-placenta-28851">placenta</a> and <a href="https://theconversation.com/ive-always-wondered-whats-behind-the-belly-button-84598">umbilical cord</a>.</p>
<p>The placenta looks a bit like a pancake and filters oxygen-rich blood from the mum. The umbilical cord then pumps that to the unborn baby.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Unborn baby with umbilical cord and placenta" src="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The placenta, on the left, and the umbilical cord work together to send oxygen from the mum’s blood to the unborn baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111807">Shutterstock</a></span>
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<p>But once babies are born, their first breath or cry triggers a whole range of changes to the way their heart moves blood around their body. So, rather than breathing fluid from the womb, they can now breathe air and get oxygen into their lungs just like we do. </p>
<p>The process of being born also squeezes water out of the baby’s lungs, allowing them to work properly.</p>
<p>A newborn baby crying is a sound parents and health workers are very <a href="https://www.romper.com/p/why-do-babies-cry-at-birth-the-answer-will-probably-surprise-you-18746386">happy</a> to hear. That’s because it usually means the baby is well and won’t need any extra help to breathe.</p>
<p>But not all newborn babies cry. And it’s not always something to be worried about.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-is-it-true-that-male-seahorses-give-birth-92843">Curious Kids: Is it true that male seahorses give birth?</a>
</strong>
</em>
</p>
<hr>
<h2>Why don’t all babies cry?</h2>
<p>Sometimes this switch to moving oxygen around the body just like us <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/persistent-pulmonary-hypertension#:%7E:text=In%20persistent%20pulmonary%20hypertension%2C%20also,difficult%20birth%2C%20or%20birth%20asphyxia.">does not happen smoothly</a>.</p>
<p>There might be problems with the baby’s heart, or there may have been a difficult birth. For instance, the baby might have been very short of oxygen in the womb and need some help to start breathing when they are born. </p>
<p>Sometimes there’s a delay in babies crying. </p>
<p>Babies born by caesarean section – when doctors operate on the mum to lift the baby out of her womb – might be <a href="https://link.springer.com/article/10.1007/s00404-019-05208-7">slower</a> to breathe and cry. That’s because they don’t have the fluid squeezed from the lungs like they do when born through the vagina. </p>
<p>Sometimes newborn babies don’t cry at all.</p>
<p>Babies born in water (known as a <a href="https://www.bellybelly.com.au/birth/doulas/preparing-for-a-water-birth/">waterbirth</a>) may have lots of warm water around them and not even realise they are born. That’s because they don’t feel cold air as they come into the world; they are often in their mother’s arms in the water. So they tend to just <a href="https://www.sarawickham.com/questions-and-answers/whats-an-aqua-apgar/">breathe quietly</a>, and turn pink (showing they are getting enough oxygen), without crying.</p>
<hr>
<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/205477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. She is affiliated with The Australian College of Midwives</span></em></p>
Crying triggers changes in how a newborn baby gets their oxygen. But not all new babies cry, and it’s not always a problem.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/208089
2023-07-03T12:05:53Z
2023-07-03T12:05:53Z
Vaccination in pregnancy greatly reduces risk of severe illness and death from COVID-19, and protects babies up to 6 months after birth
<figure><img src="https://images.theconversation.com/files/534923/original/file-20230629-17-ey9jrq.jpg?ixlib=rb-1.1.0&rect=100%2C191%2C6438%2C4275&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Extensive evidence shows COVID-19 vaccinations in pregnancy are safe, when given at any time during the pregnancy.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>From the early days of the pandemic, it has been evident that a COVID-19 infection in pregnancy can be serious. Hundreds of studies from around the world have consistently shown that a COVID-19 infection in pregnancy carries <a href="https://doi.org/10.1093/cid/ciac544">significantly higher risk</a> for <a href="https://doi.org/10.1136/bmj.m3320">admission to intensive care units (ICU), invasive ventilation, preeclampsia and death</a>, compared to other COVID-19 patients. </p>
<p>The data is stark: there is a <a href="https://doi.org/10.1001/jamapediatrics.2021.1050">five times higher risk of ICU admission and 22 times higher risk of maternal mortality</a> due to COVID-19 infections in pregnancy. There are also <a href="https://doi.org/10.1016/j.xagr.2021.100049">considerable risks to the fetus</a>, with a higher risk of preterm delivery, low birth weight as well as serious fetal outcomes such as stillbirth, and neonatal mortality. </p>
<p>Interestingly, and not entirely surprisingly, studies have found that stillbirths and neonatal deaths occurred predominantly in <a href="https://doi.org/10.1038/s41591-021-01666-2">those who were unvaccinated </a> against SARS-CoV-2 at the time of infection. The same study also showed that 90 per cent of all hospitalizations and 98 per cent of critical care hospitalizations in pregnancy due to COVID-19 infection were also in the unvaccinated.</p>
<h2>Safety of COVID-19 vaccines in pregnancy</h2>
<p>As a science communicator and a Doctor of Public Health student, a lot of my work has focused specifically on understanding vaccine hesitancy. Despite the overwhelming data on the risks of COVID-19 infection in pregnancy, many have still been reluctant to get vaccinated, <a href="https://doi.org/10.1186/s12889-022-14617-4">citing safety concerns</a>.</p>
<p>We now have extensive evidence that shows COVID-19 vaccinations in pregnancy are safe, when given at any time during the pregnancy. </p>
<p>Globally, multiple meta-analyses have confirmed that there is <a href="https://doi.org/10.1038/s41467-022-30052-w">no evidence of a higher risk of adverse outcomes</a> in either the pregnant person or the infant. No differences were found in miscarriage, earlier gestation at birth, placental abruption, postpartum hemorrhage, maternal death, lower birthweight or neonatal intensive care unit admission with a COVID-19 vaccine given in pregnancy. </p>
<p>In fact, most of these studies found that <a href="https://doi.org/10.1001/jamapediatrics.2022.3456">vaccination offered positive</a> health outcomes: those who were vaccinated had a lower risk for stillbirths, preterm births and neonatal intensive care unit admission and more favourable <a href="https://www.aboutkidshealth.ca/Article?contentid=427&language=English">Apgar scores</a>.</p>
<h2>Infants protected by transfer of antibodies across placenta</h2>
<p>Several <a href="https://doi.org/10.1016/j.ajogmf.2021.100481">studies</a> have documented the presence of SARS-CoV-2 antibodies in umbilical cord blood after <a href="https://doi.org/10.1172/jci150319">maternal vaccination</a>. This confirms that there is an added benefit of vaccination, with SARS-CoV-2 IgG antibodies - which are the most common type of antibody found in blood, and protect against infections - <a href="https://doi.org/10.1038/s41467-022-32188-1">transferring across the placenta from mother to fetus</a>, particularly when vaccination occurs <a href="https://doi.org/10.1093/cid/ciac135">in the third trimester of pregnancy</a>.</p>
<figure class="align-center ">
<img alt="An infant in arms" src="https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is an added benefit of COVID-19 vaccination in pregnancy: SARS-CoV-2 IgG antibodies transfer across the placenta from mother to fetus, particularly when vaccination occurs in the third trimester of pregnancy.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>What was unknown until very recently, however, is whether vaccination in pregnancy generates functional antibodies that are detectable in the infant post-birth and, if so, do they confer any benefit to the infant in terms of protection from COVID-19 infection or severity of infection. </p>
<p>Recent studies have shown that these IgG antibodies transferred to the fetus can remain in the baby for several months after birth. One study showed <a href="https://doi.org/10.1001/jama.2022.1206">57 per cent of infants</a> born to vaccinated mothers had detectable antibodies at six months. </p>
<p>A study conducted by the Centers for Disease Control and Prevention (CDC) published in the <em>Morbidity and Mortality Weekly Report</em> (MMWR) showed that COVID-19 mRNA vaccination during pregnancy was <a href="https://doi.org/10.15585/mmwr.mm7107e3">61 per cent effective</a> in preventing COVID-19-related hospitalization in infants aged less than six months. </p>
<p>A recently published study from Ontario assessed the effectiveness of maternal mRNA COVID-19 vaccination during pregnancy against Delta and Omicron variants in preventing hospital admission in infants younger than six months of age. </p>
<p>The study found that vaccine effectiveness against hospital admission in infants from two maternal doses was <a href="https://doi.org/10.1136/bmj-2022-074035">97 per cent for Delta variant and 53 per cent for Omicron</a>. Vaccine effectiveness against infant Omicron infection was found to be highest for the first eight weeks of life, but then declined in a stepwise manner. </p>
<p>While COVID-19-related infections in the pediatric population are generally mild, there is considerable variability and a small — but real — number of children get <a href="https://doi.org/10.1080/24694193.2021.1930288">moderate or severe disease</a>. </p>
<p>Children younger than six months have the highest risk for <a href="https://doi.org/10.3389/fped.2021.674899">severe outcomes</a> associated with COVID-19 infections, including <a href="https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Age-in-Years-/3apk-4u4f/data">hospitalizations and death</a>. </p>
<h2>Benefits of a COVID-19 booster in pregnancy</h2>
<p>Recently the <a href="https://cdn.who.int/media/docs/default-source/immunization/sage/2023/march-2023/sage_march_2023_meeting_highlights.pdf?sfvrsn=a8e5be9_3">World Health Organization</a> recommended a COVID-19 booster during pregnancy if the last dose was over six months ago. </p>
<p>It is abundantly clear that COVID-19 infection in pregnancy carries considerable risk to the pregnant person and the fetus. Given the high efficacy of COVID-19 vaccinations in preventing severe illness in the pregnant woman, as well as the substantive benefits for the infant, there is a robust and evidence-driven indication to recommend a COVID-19 booster routinely in all pregnancies, particularly if the last dose was more than six months ago. </p>
<p>Recommending additional boosters will allow families a superior opportunity to protect themselves and their babies in the fourth year of the pandemic. We have in our arsenal an intervention that has the potential to make a meaningful impact on maternal and infant health. So I ask, what are we waiting for?</p><img src="https://counter.theconversation.com/content/208089/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabina Vohra-Miller does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
COVID-19 vaccination has been shown to be safe in pregnancy, and protects both the mother and infant from severe disease. It’s now also clear that infants’ antibody protection continues after birth.
Sabina Vohra-Miller, Doctor of Public Health Student, University of Toronto
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/197516
2023-03-14T19:23:12Z
2023-03-14T19:23:12Z
Pregnant during the pandemic: Long-term effects and the importance of social support
<figure><img src="https://images.theconversation.com/files/515004/original/file-20230313-22-qhm8v.jpg?ixlib=rb-1.1.0&rect=368%2C116%2C3530%2C2478&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Results of a new study show the need for more, easily accessible mental health and social support services for pregnant and postpartum people and their families.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/pregnant-during-the-pandemic--long-term-effects-and-the-importance-of-social-support" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic brought changes to many people’s daily lives, and resulted in <a href="https://doi.org/10.1186/s12992-020-00589-w">high levels</a> of <a href="https://doi.org/10.1186/s12992-020-00589-w">mental health problems</a>. The pandemic was especially difficult for <a href="https://doi.org/10.3389/fpsyg.2020.617001">pregnant people</a>. <a href="https://doi.org/10.1016/j.earlhumdev.2022.105606">New research</a> investigates the long-term impact of the pandemic on pregnant and postpartum people and their infants.</p>
<p>There is concern that the difficulties experienced by pregnant people during the pandemic could be related to <a href="https://globalnews.ca/news/8890300/canada-covid-pandemic-babies/">issues down the road</a>.
Experiencing disaster-related stress during pregnancy, like that felt during the <a href="https://www.cbc.ca/news/canada/montreal/ice-storm-1998-1.4469977">January 1998 ice storm in Québec</a>, can have a lasting impact on <a href="https://www.mcgill.ca/projetverglas/icestorm">parents and their children</a>. How can we help people begin to recover from the pandemic and support pregnant and postpartum people during future large-scale disasters?</p>
<h2>Research over the last two years</h2>
<p>The <a href="https://dpresearchcentre.com/current-research-projects">COVID-19 Wellbeing and Stress Study</a> is an ongoing study conducted in partnership between researchers at Mount Saint Vincent University, McMaster University and Toronto Metropolitan University. The research team began following 304 pregnant women from Ontario in the spring and summer of 2020. </p>
<p>Participants completed surveys during pregnancy, and at six weeks, six months and 15 months postpartum. </p>
<p>We wanted to know how the COVID-19 pandemic affected access to prenatal care and how self-reported anxiety, depression and stress affected birth outcomes. We also wanted to know how participants’ mental health fared as the pandemic continued, and what could potentially protect them from the negative impact of the pandemic.</p>
<h2>Prenatal disruptions</h2>
<figure class="align-center ">
<img alt="A woman lying on a clinic bed getting an abdominal ultrasound while a technician in scrubs points to an image on a screen" src="https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Almost all study participants were not allowed to bring a support person to their prenatal appointments at some point during their pregnancy in 2020.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>According to <a href="https://doi.org/10.1016/j.earlhumdev.2022.105606">study participants</a>, access to social and health services during their pregnancies was disrupted. </p>
<p>Almost all participants (91.7 per cent) were not allowed to bring a support person to their prenatal appointments at some point during pregnancy (in 2020). Nearly one-quarter (23 per cent) had prenatal appointments cancelled, and almost half (47.9 per cent) had trouble accessing prenatal classes.</p>
<p>Our research looked at the effects of these disruptions to care on mental health. Disruptions were linked to elevated levels of self-reported anxiety and depressive symptoms. These results are similar to the findings of a <a href="https://doi.org/10.3389/fgwh.2021.648428">national study</a>.</p>
<h2>Birth experiences</h2>
<p>Disruptions also extended to birthing experiences. The majority (60.8 per cent) of participants experienced a change to their birth plan, affecting things like delivery location, support people or child-care arrangements for other children. </p>
<p>More than one-quarter (28 per cent) of parents reported that their infant experienced problems during delivery, and nearly one-half of infants (46.6 per cent) had at least one problem after birth, such as jaundice or difficulties breathing. Importantly, however, <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310040401">infant birth weight</a> and rates of <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310042501">preterm birth</a> were similar to Canadian rates prior to the pandemic.</p>
<p>We then looked at how psychological factors were associated with birth outcomes. Some participants self-reported pregnancy-specific anxiety — things like feeling anxious about the health of the baby, miscarriage and experiencing difficulties during birth. These feelings were associated with lower infant birth weight, preterm birth and more infant birth problems.</p>
<p>This was not surprising. Other <a href="https://doi.org/10.1016/j.jad.2021.03.083">research</a> has shown that mental health problems during pregnancy are <a href="https://doi.org/10.4088/JCP.17r12011">associated with these same adverse birth outcomes</a>.</p>
<h2>Long-term impact</h2>
<figure class="align-center ">
<img alt="A woman slightly out of focus in the background with an infant asleep on her shoulder in the foreground" src="https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">On average, from pregnancy to the postpartum, more than half of participants (50 to 58 per cent) self-reported high levels of depressive symptoms.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We followed the study group for more than a year after they gave birth. Participants had reported high rates of anxiety, depressive and stress symptoms during pregnancy, and these rates declined over the first 15 months of their infants’ life. However, participants did continue to experience these symptoms in the postpartum period. </p>
<p>On average, from pregnancy to the postpartum, more than half of participants (50 to 58 per cent) self-reported high levels of depressive symptoms. Up to one-third (24 to 36 per cent) reported moderate to severe anxiety symptoms. High levels of stress were also reported (13 to 18 per cent). </p>
<p>In comparison, prior to the COVID-19 pandemic, <a href="https://doi.org/10.1111/jocn.16121">global postpartum depression rates are estimated at 14 per cent</a>.</p>
<h2>Importance of social support</h2>
<p>Despite these high numbers, one thing was clear: participants who were able to seek support from their family, friends and significant other had <a href="https://doi.org/10.1016/j.jad.2021.01.027">lower levels of anxious, depressive and stress symptoms during pregnancy</a>. Those who were able to use other <a href="https://doi.org/10.1007/s00737-021-01135-2">effective coping strategies</a> (for example, reframing thoughts, problem solving and seeking support) showed lower mental health and distress symptoms. The importance of social support to protect against the negative impact of the pandemic has been <a href="https://doi.org/10.3389/ijph.2022.1604608">noted by others as well</a>.</p>
<p>These results tell us that we need more, easily accessible mental health and social support services for pregnant and postpartum people and their families. Social support and mental health programs are essential in anticipation of future — possibly long-lasting — public health crises.</p><img src="https://counter.theconversation.com/content/197516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer E. Khoury receives funding from the Canada Research Chair Program (Tier II) in Interdisciplinary Studies in Neurosciences, the Canada Foundation for Innovation (CFI), the Social Sciences and Humanities Research Council of Canada (SSHRC), the Canadian Institutes of Health Research (CIHR), the National Institute of Child Health and Human Development (NICHD), and Research Nova Scotia.
The work discussed in this publication was funded by a Canadian Institutes of Health Research (CIHR) Project Grant - PA: Pandemic and Health Emergencies Research (465280). This work was also supported by a Tier II CRC awarded to Dr. Jennifer Khoury and a Tier II CRC awarded to Dr. Andrea Gonzalez.</span></em></p><p class="fine-print"><em><span>Kiera O'Neil does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Being pregnant and giving birth during the pandemic meant disruptions in pregnancy care and birth experiences, as well as detrimental effects on mental health and birth outcomes.
Kiera O'Neil, Manager, Developmental Psychobiology Research Centre, Mount Saint Vincent University
Jennifer E. Khoury, Assistant Professor, Tier II Canada Research Chair in Interdisciplinary Neuroscience, Mount Saint Vincent University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/191582
2022-11-07T01:55:30Z
2022-11-07T01:55:30Z
More and more women in Australia are having their labour induced. Does it matter?
<figure><img src="https://images.theconversation.com/files/489707/original/file-20221014-13-z1vhte.jpg?ixlib=rb-1.1.0&rect=0%2C12%2C4009%2C2657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">anastasiia chepinska/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Induction of labour for women having their first baby has risen in Australia from 26% in 2010 to 46% in 2020, according to the latest data from the Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/mothers-babies/ncmi-data-visualisations/contents/labour-and-birth-indicators/induction-of-labour">(AIHW)</a>. This compares to a rise from <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2020-21/deliveries---time-series">21% to 34%</a> over roughly the same period in the UK (for all births, not just first-time mothers). </p>
<p>South Australia was the <a href="https://www.aihw.gov.au/reports/mothers-babies/ncmi-data-visualisations/contents/labour-and-birth-indicators/induction-of-labour">highest state</a> with 48.8% induction rates for first time mothers, and Queensland the lowest with 40.5%.</p>
<p>Why are rates so high in Australia, and why are they increasing?</p>
<h2>First, why do we induce labours?</h2>
<p>Doctors or midwives might recommend induction when they believe allowing the pregnancy to continue could pose a risk to the mother or baby. </p>
<p>This can be for multiple reasons, including prolonged pregnancy (being overdue), diabetes, bleeding, medical complications, ruptured membranes, high blood pressure, twin pregnancy, infection, large babies or foetal death.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman at hospital wearing hospital gown, leaning on the side of the bed" src="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many reasons labour might be induced, including being overdue.</span>
<span class="attribution"><span class="source">jimmy conover/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>If the woman or birthing parent decides to proceed with induction, this can occur in several ways. A popular method for inducing labour involves the midwife or doctor inserting a small catheter through the woman’s cervix (the neck of the womb) and inflating a balloon on the other side, or sometimes on both sides. </p>
<p>This mechanical pressure can stimulate the production of prostaglandin (a natural hormone that helps prepare for labour) and encourage a slight opening of the woman’s cervix. This allows the doctor or midwife to break the membranes (releasing the amniotic fluid) around the baby with a special plastic hook. At this point, a hormone called oxytocin can be used to stimulate contractions and labour.</p>
<p>Other methods for inducing labour include applying hormones directly to the cervix, or rupturing the membranes of the amniotic sac.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weight-gain-during-pregnancy-how-much-is-too-much-89016">Weight gain during pregnancy: how much is too much?</a>
</strong>
</em>
</p>
<hr>
<h2>Why are induction rates increasing?</h2>
<p>Australian women are giving birth at the average age of 30.8 years, which has been slowly increasing over the <a href="https://www.aihw.gov.au/reports/mothers-babies/health-of-mothers-and-babies#Mothers">past decade</a>. Pregnancy risks and medical complications increase with advanced age or with very young women. Many of these complications can increase the likelihood of a recommendation of induction.</p>
<p>Obesity adds another layer of complexity when considering pregnancy and birth. The <a href="https://www.aihw.gov.au/getmedia/aa54e74a-bda7-4497-93ce-e0010cb66231/aihw-per-108.pdf.aspx?inline=true">AIHW 2018</a> report found 47% of women giving birth in Australia were either obese or overweight at their first antenatal visit. We know women who are overweight or obese have significant increased risks in pregnancy and birth and these risks extend to their babies. </p>
<p>The UK’s <a href="https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.15386">Care of Women with Obesity in Pregnancy Guideline</a> and <a href="https://wpstaging.ranzcog.edu.au/wp-content/uploads/2022/05/Management-of-Obesity-in-Pregnancy.pdf">Best Practice Statement</a> from the Royal College of Australian and New Zealand College of Obstetricians and Gynaecologists highlights the risks for overweight pregnant women and these include hypertension, pre-eclampsia, haemorrhage, depression, diabetes, venous thromboembolism, infection, failed induction and death.</p>
<p>They also highlight additional risks for the baby if the mother is overweight or obese in pregnancy and these can include stillbirth, large baby, shoulder dystocia (where the baby gets stuck during birth), prematurity, admission to the nursery and undiagnosed congenital abnormalities.</p>
<p>Some inductions occur at the request of the woman and in the absence of risks that might necessitate induction. It is these cases where a reduction in rates should be targeted. Women can mistakenly believe induction is a risk-free procedure when we know it is better for mother and child a woman establishes in labour without interventions where possible. This is because each intervention in the birthing process is <a href="https://pubmed.ncbi.nlm.nih.gov/28251626/">more likely to lead to further interventions</a>.</p>
<h2>Does it matter rates are increasing?</h2>
<p>A recent <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub5/full#CD004945-abs-0002">review of studies</a> found in places where labour is induced once a woman reaches 40 weeks or shortly thereafter, there are fewer stillbirths and perinatal deaths (deaths shortly after birth).</p>
<p>However when labour is induced the baby must be monitored, which involves strapping equipment to the woman’s abdomen or directly to the baby’s head. This can restrict movement for some women, and women frequently use movement to help them manage contractions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman lying in hospital bed with monitor around her abdomen." src="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Moving around helps women manage contractions, and foetal monitoring equipment makes that difficult.</span>
<span class="attribution"><span class="source">alexander grey/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sometimes despite using the methods described above the induction may not be successful. In these cases, a different method may be attempted, or the doctor or midwife may try again in a few days. Sometimes a caesarean may be recommended.</p>
<p>Another potential side effect is from the hormone used to stimulate contractions – occasionally these hormones cause over-stimulation of the uterus, and this can stress the baby. The hormone can be stopped but sometimes because of the impact on the baby’s wellbeing a caesarean might be recommended.</p>
<p>Induction rates are higher in Australia than like countries and without detailed data about all reasons for induction it is difficult to comment on the cause of these increases. The demographics as described above may be one factor.</p>
<p>Ultimately women should talk with their midwife or doctor about any concerns they may have, and make the best decision that is informed by their individual pregnancy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-blame-and-shame-women-for-unintended-pregnancies-50977">Don't blame and shame women for unintended pregnancies</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191582/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
What are the risks and benefits of having labour induced?
Angela Brown, Midwifery Program Director, University of South Australia
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/188361
2022-08-11T03:00:19Z
2022-08-11T03:00:19Z
Sepsis is serious during pregnancy, but thankfully it is still rare
<figure><img src="https://images.theconversation.com/files/478470/original/file-20220810-14-z1zgd6.jpg?ixlib=rb-1.1.0&rect=23%2C46%2C5152%2C3399&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/asian-pregnant-woman-patient-on-600w-454486129.jpg">Shutterstock</a></span></figcaption></figure><p>The tragic case of <a href="https://www.theage.com.au/national/victoria/a-cascade-of-failures-how-annie-moylan-lost-her-child-and-her-life-in-melbourne-s-private-hospitals-20220802-p5b6je.html">Annie Moylan</a>, who died in Melbourne in 2017 from sepsis, when 18 weeks pregnant, has put a spotlight on this life-threatening condition. </p>
<p>Delay in receiving blood results, admission to a private hospital that did not provide obstetric care, and communication breakdown when Annie transferred to another private hospital all seem to have played a role in what has been described as a “cascade of failures”. A <a href="https://www.theage.com.au/national/victoria/a-cascade-of-failures-how-annie-moylan-lost-her-child-and-her-life-in-melbourne-s-private-hospitals-20220802-p5b6je.html">coronial inquest</a> into her death begins on Monday. </p>
<p>Sepsis can also happen after birth, as was seen in the devastating loss of <a href="https://www.abc.net.au/news/2018-02-27/michaela-perrin-coroner-findings-say-inadequate-care-given/9489790">Michaela Perrin</a> who died in 2014, six days having a healthy baby girl via caesarean section.</p>
<p>Women who are currently pregnant may worry about how cases such as these can happen in a country like Australia with an excellent health system. </p>
<p>Sepsis is a serious health condition for anyone, and pregnant women are no exception to this. Thankfully it is still rare for young women to die from the condition. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sepsis-still-kills-1-in-5-people-worldwide-two-icu-physicians-offer-a-new-approach-to-stopping-it-175650">Sepsis still kills 1 in 5 people worldwide – two ICU physicians offer a new approach to stopping it</a>
</strong>
</em>
</p>
<hr>
<h2>When the body fights itself</h2>
<p><a href="https://www.cdc.gov/sepsis/what-is-sepsis.html">Sepsis</a> is syndrome (or group of symptoms) mostly caused by a bacterial infection. It results when the body is trying to fight an infection and begins to damage its own tissues. This can lead to a serious drop in blood pressure, and organ damage. </p>
<p>In Australia, <a href="https://www.safetyandquality.gov.au/sites/default/files/2020-05/epidemiology_of_sepsis_-_february_2020_002.pdf">around 12%</a> of people hospitalised with sepsis will die from it. Very young (less than 12 months) and older people (over 85 years) are most vulnerable. The death rate for pregnant women with sepsis worldwide is estimated to be <a href="https://www.ajog.org/article/S0002-9378(19)30246-7/fulltext">between 1% and 4.6%</a>. </p>
<p>Treatment relies on early identification, antibiotics, intravenous fluids (fluid through a drip) and skilful medical care. For those who survive, there can be lifelong damage, both <a href="https://www.sepsis.org/sepsisand/amputations/">physically</a> and <a href="https://www.sepsis.org/sepsisand/post-traumatic-stress-disorder-ptsd/">psychologically</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1556227148683296768"}"></div></p>
<h2>What causes sepsis during pregnancy, or after birth?</h2>
<p>When sepsis happens during pregnancy, it is sometimes called maternal sepsis. After birth it is called postpartum or puerperal sepsis. </p>
<p>The syndrome can result from an infection anywhere in the body (such as pneumonia or a urinary tract infection) or it can be introduced during medical procedures like a caesarean section. </p>
<p>For this reason, all women who have a caesarean section are given intravenous antibiotics in the operating theatre to prevent sepsis. </p>
<p>For around <a href="https://www.ajog.org/article/S0002-9378(19)30246-7/fulltext">30% of cases</a>, no source of infection is found. </p>
<p>When identified, the <a href="https://www.somanz.org/content/uploads/2020/07/2017SepsisGuidelines.pdf">most common causes</a> of sepsis during and after pregnancy are <em>Escherichia coli</em> (<em>E. coli</em>) and group B <em>Streptococcus</em>. As mixed infections are also possible with sepsis, broad-spectrum antibiotics are given as soon as possible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaginal-birth-after-caesarean-increases-the-risk-of-serious-perineal-tear-by-20-our-large-scale-review-shows-173249">Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows</a>
</strong>
</em>
</p>
<hr>
<h2>Sepsis was a major cause of women dying after birth</h2>
<p>Puerperal sepsis was once one of the main causes of women dying following childbirth. As knowledge about hygiene practices advanced and then antibiotics were introduced, this declined rapidly. However, sepsis has never been eliminated.</p>
<p>The work of Viennese physician <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.185363">Ignaz Philipp Semmelweis</a> in the mid-1800s led to the discovery that health provider hand-washing could reduce infection rates in women. </p>
<p>Semmelweis observed there was a much lower rate of women dying when cared for by midwives than doctors in two clinics and realised the midwives were not involved in autopsies and hence not carrying bacteria from the autopsy rooms into the maternity ward. </p>
<p>Semmelweis told anyone attending autopsies to scrub their hands with chloride and lime before entering the maternity ward. Soon after this, the rate of maternal deaths in the doctors’ clinics fell. </p>
<p>It took nearly another 30 years for Semmelweis’s ideas to be fully embraced. He <a href="https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives">suffered a tragic death</a> in an asylum and ironically succumbed to sepsis from a gangrenous wound to his hand.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctors washing hands" src="https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478471/original/file-20220810-4975-i1fx4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rates of maternal sepsis improved with the advent of better clinical hygiene.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/couple-surgeons-washing-hands-before-600w-633363035.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>It has been estimated nearly a half of all maternal deaths in the pre-antibiotic era (before the 1930s) were due to <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.185363">infection</a>. </p>
<p>“<a href="https://fivethirtyeight.com/features/what-the-history-of-back-alley-abortions-can-teach-us-about-a-future-without-roe/">Back-alley abortions</a>” were once another major cause of sepsis and death in women before better access to proper medical care for abortions was legislated in many countries. </p>
<p>Today, around <a href="https://msf.org.au/article/project-news/unsafe-abortion-forgotten-emergency">one in 12 maternal deaths</a> are from lack of access to safe abortion care and infection remains a big part of this. This is one reason why there is such grave concern over the recent overturning of <a href="https://www.ajog.org/article/S0002-9378(19)30246-7/fulltext">Roe vs Wade</a> in the United States.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-can-be-transmitted-to-babies-during-and-after-pregnancy-we-should-be-watchful-but-not-alarmed-188283">Monkeypox can be transmitted to babies during and after pregnancy. We should be watchful but not alarmed</a>
</strong>
</em>
</p>
<hr>
<h2>Rates of maternal sepsis today</h2>
<p>While sepsis is considered to be a <a href="https://www.ajog.org/article/S0002-9378(19)30246-7/fulltext">preventable cause</a> of maternal death, it continues to be a major cause of women dying during or after childbirth, even in high resource countries such as Australia. </p>
<p>Sepsis was the <a href="https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-australia#maternal-deaths">second most common cause</a> of maternal death between 2010 and 2019 in Australia (22 deaths). </p>
<p>According to the <a href="https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality-surveillance-system.htm">Centres for Disease Control and Prevention</a> sepsis is the second leading cause of pregnancy related deaths in the US, leading to around 14% of pregnancy-related deaths. </p>
<p>Investigations into sepsis cases during pregnancy and following birth in the United Kingdom <a href="https://www.ogmagazine.org.au/21/4-21/managing-the-septic-patient-in-labour/">found</a> 63% of deaths were associated with substandard care, such as delays in recognising or managing sepsis.</p>
<p>Delays in diagnosing sepsis or misdiagnosis of sepsis in childbearing women is made more complicated due to the physical changes in women’s bodies during pregnancy, labour and the postnatal period. Sepsis can also <a href="https://www.ogmagazine.org.au/21/4-21/managing-the-septic-patient-in-labour/">progress more rapidly</a> in pregnant women. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"968383732620189696"}"></div></p>
<h2>We should all be alert</h2>
<p>If you are unwell during pregnancy or following birth let your health care provider know and persist in seeking care if you are not satisfied. </p>
<p>Most of the time everything will be fine but there are signs of sepsis that can be detected by health providers, such as low blood pressure, temperature or via blood tests.</p>
<p>Health providers have processes for <a href="https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/292193/Maternal-Sepsis-Pathway-December-2016.pdf">suspected maternal sepsis</a>, <a href="https://www.somanz.org/content/uploads/2020/07/2017SepsisGuidelines.pdf">guidelines</a> to follow and regular training on this important health emergency. </p>
<p>Health providers need to listen to women and take them seriously when they are unwell, and have the possibility of sepsis in mind. </p>
<p>The brave and persistent actions of <a href="https://www.theage.com.au/national/victoria/a-cascade-of-failures-how-annie-moylan-lost-her-child-and-her-life-in-melbourne-s-private-hospitals-20220802-p5b6je.html">Annie Moylan</a>’s parents in seeking answers about their daughter’s death from sepsis will make care safer for other women.</p><img src="https://counter.theconversation.com/content/188361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
While sepsis is considered to be a preventable cause of maternal death, it continues to be a major cause of women dying during or after childbirth, even in Australia.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/181593
2022-04-20T19:56:21Z
2022-04-20T19:56:21Z
There’s more than one way to grow a baby
<figure><img src="https://images.theconversation.com/files/458754/original/file-20220420-25-6432x.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C4281%2C2848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-cat-cares-her-20-days-160645280">Shutterstock</a></span></figcaption></figure><p>In his 1989 book <a href="https://en.wikipedia.org/wiki/Wonderful_Life_(book)">Wonderful Life</a>, evolutionary biologist Stephen Jay Gould famously argued that, if we could “replay the tape”, life on Earth would evolve to be fundamentally different each time. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="X-ray style drawing showing the wings and skeletons of a pterosaur, a bat, and a bird." src="https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=934&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=934&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=934&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1173&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1173&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458730/original/file-20220419-15105-obec4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1173&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wings and flight evolved differently, and independently, in (1) pterosaurs, (2) bats, and (3) birds.</span>
<span class="attribution"><span class="source">George Romanes</span></span>
</figcaption>
</figure>
<p>Was he right? Convergent evolution, in which similar features evolve to perform similar functions in distantly related organisms, offers an excellent model in which to run Gould’s thought experiment. </p>
<p>One classic example of convergent evolution is the independent evolution of wings and flight in insects, birds, pterosaurs, and bats. Another is live birth (or “viviparity”), which has evolved independently from egg-laying <a href="https://doi.org/10.1002/jmor.20272">more than 150 times</a> in vertebrates (animals with backbones).</p>
<p>To understand how this happened, we studied the genes involved in pregnancy and live birth in six different live-bearing species. We <a href="https://doi.org/10.1093/molbev/msac077">discovered</a> that, despite broad similarities in the anatomy and physiology involved, each species used a completely different set of genetic tools to give birth to live young. </p>
<h2>Is live birth controlled by a universal set of genes?</h2>
<p>In nearly all live-bearing vertebrates examined so far, changes to the gestational tissues and biophysical processes during pregnancy appear remarkably similar. </p>
<p>Some common elements of the process are:</p>
<ul>
<li>tissues in the bodies of the mother and fetus which <a href="https://doi.org/10.1016/S1095-6433(00)00274-9">grow more blood vessels</a> to <a href="https://doi.org/10.1002/jez.1402660508">exchange gases and water</a> with each other</li>
<li><a href="https://doi.org/10.1111/mec.16333">protection of the fetus</a> from the mother’s immune system</li>
<li><a href="https://doi.org/10.1530/REP-13-0309">allocation of nutrients</a> to the fetus.</li>
</ul>
<figure class="align-center ">
<img alt="A triptych of photographs showing a cow giving birth to a calf." src="https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=140&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=140&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=140&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=176&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=176&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458731/original/file-20220419-13-geoepc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=176&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Live birth is driven by a complex suite of morphological, physiological, and genetic changes.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Cow_giving_birth,_in_Laos_(step_by_step).jpg">Modified from an image by Basile Morin</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The changes that occur during pregnancy and birthing must be mainly controlled by genetics, and we know that the expression of genes changes during pregnancy in different live-bearing animals. </p>
<p>However, the generality of these changes is less clear. For example, are the same genes used during pregnancy in mammals and fish? Or are similar outcomes driven by entirely different genes? </p>
<p>That’s what we set out to discover in our study, <a href="https://doi.org/10.1093/molbev/msac077">newly published</a> in Molecular Biology and Evolution, in collaboration with researchers from the University of Queensland and James Cook University.</p>
<h2>Measuring gene activity during pregnancy</h2>
<p>An animal’s development is controlled by its genes, its environment, and an interaction between the two. </p>
<p>Not every gene within an animal is always active. Genes are switched on (or “expressed”) when needed, and then switched off again when no longer needed. </p>
<p>Gene expression levels naturally vary over time as an animal interacts with the environment and undergoes physiological changes, such as those <a href="https://doi.org/10.1152/physrev.00040.2011">associated with pregnancy</a>. Using a technique called “transcriptomics”, we can take snapshots of these changes in gene expression as they occur.</p>
<p>To investigate the genetic changes occurring in the uterus during pregnancy in different species, we collected samples or used existing data from six live-bearing animals: the Australian sharpnose shark, three species of Australian lizards, the gray short-tailed opossum, and the brown lab rat.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A tiny lizard perched on a human finger." src="https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=320&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=320&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458732/original/file-20220419-15-uagqhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=320&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The spotted skink <em>Niveoscincus ocellatus</em>, sampled in our study, gives birth to live young.</span>
<span class="attribution"><span class="source">Charles Foster</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Sampling this wide range of animals allowed us to determine whether the same gene expression changes occur during pregnancy across species in which live birth evolved independently. </p>
<p>Our work is the first quantitative study into the genetic basis of live birth at such a broad evolutionary scale.</p>
<h2>There are many different ways to grow a baby</h2>
<p>We expected to find many of the same genes used during pregnancy to support the growth and survival of embryos in each of the live-bearing species we sampled. </p>
<p>This hypothesis seemed logical, given the <a href="https://doi.org/10.1002/jmor.20272">many similarities</a> in anatomical changes during pregnancy across live-bearing vertebrates, along with qualitative findings from <a href="https://doi.org/10.1038/s41559-021-01555-4">previous research</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/this-lizard-lays-eggs-and-gives-live-birth-we-think-its-undergoing-a-major-evolutionary-transition-133630">This lizard lays eggs and gives live birth. We think it's undergoing a major evolutionary transition</a>
</strong>
</em>
</p>
<hr>
<p>Instead, we found there was no one set of “live-bearing genes” utilised during pregnancy across our sampled range of animals. In other words, evolution has converged on similar functions for successful pregnancy but those functions have been achieved by recruiting different groups of genes. </p>
<p>Despite not being what we expected, this finding also makes sense. Different animal lineages may have <a href="https://doi.org/10.1093/molbev/msac077">different “toolboxes” of genes</a> to draw from, due to their unique evolutionary histories.</p>
<p>A genetic “toolbox” can be thought of as a broad class of genes that perform similar basic functions. Over the long timescales of evolution, different genes from this ancestral toolbox can be recruited to carry out the same physiological functions in different animals. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A photograph showing a greyish white shark with an umbilical cord and placenta." src="https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458733/original/file-20220420-28457-hzx4t2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Like humans, the Australian sharpnose shark transports nutrients to developing embryos via a placenta.</span>
<span class="attribution"><span class="source">Camilla Whittington</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For example, developing babies require access to a supply of amino acids for successful development. In many species these amino acids are transported from the mother to the fetus across the placenta via “solute carrier” genes. </p>
<p>We identified more than 75 different solute carrier genes in the combined genetic toolbox of our study species. However, each species recruited different genes from the toolbox to transport amino acids during pregnancy.</p>
<h2>Rethinking live birth</h2>
<p>Our findings force us to rethink the idea that the cross-species similarities in live birth are controlled by the same genetic changes.</p>
<p>We can also consider our results in the context of Gould’s thought experiment about “replaying the tape of life”. </p>
<p>Was the evolution of live birth predictable? It depends on how you look at it.</p>
<p>Large-scale similarities, such as the anatomy and functions of the uterus, seem predictable. They appear to have evolved repeatedly to solve the biophysical challenges of successful pregnancy. </p>
<p>However, our results show this predictability does not extend to the underlying genes.</p><img src="https://counter.theconversation.com/content/181593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Foster has previously received funding from the Australian Research Council, and is currently employed via funding from the Medical Research Future Fund (Australian Government Department of Health) and the University of New South Wales. </span></em></p><p class="fine-print"><em><span>Camilla Whittington receives funding from the Australian Research Council and the University of Sydney.</span></em></p><p class="fine-print"><em><span>James Van Dyke receives funding from the Australian Research Council and the Australian Government Department of Industry, Science, Energy and Resources.</span></em></p>
Live birth has evolved independently more than 150 times. The underlying biophysical processes all look quite similar, but new research shows they use completely different genetic tools.
Charles Foster, Postdoctoral Research Associate, UNSW Sydney
Camilla Whittington, Senior lecturer, University of Sydney
James Van Dyke, Senior Lecturer in Biomedical Sciences, La Trobe University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/176464
2022-03-08T03:38:42Z
2022-03-08T03:38:42Z
Feminist stories and dangerous bodies: Siri Hustvedt in conversation with Julienne van Loon
<figure><img src="https://images.theconversation.com/files/444989/original/file-20220208-21-6erpo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>I first discovered Siri Hustvedt through her best known novel, What I Loved (2003), which caught my attention through <a href="https://www.nytimes.com/2003/03/09/books/let-s-have-a-fivesome.html">Janet Burroway’s review in the New York Times</a>: “that rare thing: a page turner at full intellectual stretch”. </p>
<p>Narrated via Leo, an ageing art historian who reflects on family and relationships across several decades, the novel begins as a contemplative look at art, gender and representation, and finishes in the genre of the thriller.</p>
<figure class="align-left ">
<img alt="woman" src="https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=933&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=933&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=933&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1172&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1172&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1172&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Siri Hustvedt’s 2003 breakout hit, What I Loved.</span>
</figcaption>
</figure>
<p>Hustvedt’s body of work spans novels, including <a href="https://www.hachette.com.au/siri-hustvedt/what-i-loved">What I Loved</a> and the Man Booker longlisted <a href="https://www.hachette.com.au/siri-hustvedt/the-blazing-world">The Blazing World</a> (2014), memoir, essays and poetry. Her work ranges across feminism, psychoanalysis, art criticism, psychology, philosophy and neuroscience. </p>
<p>We first met seven years ago, when she agreed to be interviewed for <a href="https://www.newsouthbooks.com.au/books/thinking-woman/">my essay collection, The Thinking Woman</a> (2019). I spent two mornings in Hustvedt’s home in Brooklyn that northern winter of 2014, as we talked at length about the nature of play. </p>
<p>In early 2022, when Hustvedt and I zoomed into one another’s living spaces to talk about her new essay collection, <a href="https://www.hachette.com.au/siri-hustvedt/mothers-fathers-and-others-new-essays">Mothers, Fathers and Others</a>, positive cases of the Omicron strain of COVID-19 were rising sharply in both New York and Melbourne. </p>
<figure class="align-right ">
<img alt="Child inside two-faced head that is both man and woman, inside a light bulb." src="https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=925&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=925&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=925&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1162&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1162&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1162&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Book cover, Mothers, Fathers and Others: New Essays, cover artwork by Louise Bourgeois (subject of one of the essays).</span>
</figcaption>
</figure>
<p>The 20 new essays were written between 2019 and 2020, against the backdrop of the latter part of Trump’s presidential rule and the arrival of the COVID pandemic in New York. </p>
<p>We talked about art, gender, misogyny, racism and cultural authority, and her long fascination with the work of US visual artist <a href="https://www.moma.org/artists/710">Louise Bourgeois</a>.</p>
<p>Our conversation began and ended by recognising that, as thinkers, writers, and mothers, our lives don’t fit into strict categories – nor are they contained by borders.</p>
<h2>Disordered cultures, policing borders and post-Trump America</h2>
<p>The essay “Open Borders: Tales from the Life of an Intellectual Vagabond” began as a lecture Hustvedt delivered in Guadalajara, Mexico during 2019, while work was underway on Donald Trump’s infamous wall.</p>
<p>She foregrounds a serious discussion of policing borders with a playful childhood memory of visiting the <a href="https://navajonationparks.org/tribal-parks/four-corners-monument/">Four Corners Monument</a> at the border of four US states, placing a hand in each of two states and a leg in each of the others: “promiscuous habitation”.</p>
<figure class="align-center ">
<img alt="Man in suit walks along tall wall." src="https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Former US President Donald Trump walks along the completed 200th mile of border wall, Tuesday, June 23, 2020.</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Hustvedt writes: “We take for granted that our own human boundaries end with the organ that is our skin, but every person was once a cluster of dividing cells inside the body of another person.” Yet why are borders of all kinds so passionately policed? And why are porous borders so often represented as a site of horror in our culture?</p>
<p>Hustvedt turns to Mary Douglas’s <a href="https://www.routledge.com/Purity-and-Danger-An-Analysis-of-Concepts-of-Pollution-and-Taboo/Douglas/p/book/9780415289955">Purity and Danger: an analysis of the concepts of pollution and taboo</a>, first published in 1966, to help answer those questions. I ask why this particular book keeps drawing her back.</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> I first read Douglas’s Purity and Danger not long after I arrived in New York City, in graduate school. It’s one of those books that has sustained me over the years. The central idea is that all cultures have a need for order, all cultures fear disorder, and that our cleaning habits are culturally determined. </p>
<p>In some cultures, faeces are just a joke and in other cultures they’re considered really dangerous. So, Douglas is not saying that we all share the same kinds of pollution concerns, but she’s saying that pollution concerns exist in all cultures. And the blur, the mush – especially the bodily mush we all experience, the fluids or substances that cross over the thresholds of the body – are particularly liable to being considered dangerous.</p>
<p>This was really for me a profound opening into how one thinks about borders of all kinds. Douglas makes it very clear that you cannot separate bodily borders from societal borders.</p>
<p>We mentioned, of course, Trump and the border. The border became more of a metaphor than a reality… I mean, there are people at the border, yes. But in the right-wing drama that was being acted out, what was important was the idea of sealing border from dark intruders. And this relates to purity concerns, but also to intense anxieties about sexual encounters, about fear of an encroaching Other, and the threat to borders created by gender rights that erode the male/female binary by bleeding and leaking across that border – and then, as I’m sure we’ll discuss later, a terror of human origin inside another person.</p>
<p>And it’s funny because Mary Douglas does not focus on birth in Purity and Danger. Birth is the most profound and dramatic border crossing imaginable, right?</p>
<p><strong>JULIENNE VAN LOON:</strong> Yes.</p>
<p><strong>SIRI HUSTVEDT:</strong> We all do it! [Laughter] We don’t remember [being born], but we all do it! And yet Douglas doesn’t treat birth separately as maybe the most fundamental cultural event to be codified. The beginning of life outside. Scholarship and Western philosophy and Western science have suppressed the realities of gestation and birth in ways that just flabbergast me.</p>
<p><strong>JULIENNE VAN LOON:</strong> Your concern with that suppression comes through as a key theme in Mothers, Fathers and Others. It’s a profound absence from the serious scientific and philosophical literature, isn’t it?</p>
<p><strong>SIRI HUSTVEDT:</strong> Yes, it’s what’s forgotten. And what’s forgotten turns out, for me anyway, to play a huge role in how to think about Western culture. </p>
<p>I’m really obsessed with omission as a key to understanding what has gone wrong. I’m working on a novel, but I’m hoping to write a book about the placenta after it’s finished, a non-fiction book.</p>
<hr>
<figure class="align-center ">
<img alt="An embryo with umbilical cord" src="https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">I’m hoping to write a book about the placenta, says Siri Hustvedt.</span>
</figcaption>
</figure>
<h2>‘Umbilical phantoms’: why Freud and other thinkers missed obvious birth metaphors</h2>
<p>Hustvedt goes on to describe the way the suppression of gestation and birth has prevented key players in psychoanalysis – Freud, Winnicott, Bion – from seeing (and therefore naming) images and metaphors that are placental or gestational in nature.</p>
<p>She begins by talking about <a href="https://www.oxfordreference.com/view/10.1093/oi/authority.20110803095829728">Freud’s famous observation of the “fort/da”</a> or “here/gone” game played by his 18-month-old grandson. He observed the child playing with a piece of string attached to a cotton reel, throwing it from his cot and calling “oh” when he could no longer see it, and then “ah” when it re-appeared. In in his essay <a href="https://www.freud.org.uk/2020/05/12/beyond-the-pleasure-principle-a-virtual-reading-experience/">“Beyond the Pleasure Principle”</a> (1920), Freud interpreted the game as a fantasy about control.</p>
<p>If you visualise the game for even a moment, Hustvedt points out, the placental connection becomes obvious. The string!</p>
<hr>
<p><strong>JULIENNE VAN LOON:</strong> … the umbilical cord!</p>
<p><strong>SIRI HUSTVEDT:</strong> Exactly.</p>
<p><strong>JULIENNE VAN LOON:</strong> That’s beautiful.</p>
<figure class="align-center ">
<img alt="Images of the placenta and umbilical cord." src="https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Louise Bourgeois: an unfolding portrait (MOMA exhibition)</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<h2>Interdependence, natural cycles and human connection</h2>
<p>Hustvedt’s growing interest in gestation and the placenta got me thinking about the notion of nourishment – and the work of political philosopher Corine Pelluchon, whose book <a href="https://www.bloomsbury.com/uk/nourishment-9781350073876/">Nourishment</a> I have <a href="https://www.griffithreview.com/articles/asking-the-relevant-questions/">written about</a>.</p>
<p>For Pelluchon, hunger is central, because the decisions we make about how to maintain our own life and support the lives of others come back to it. Pelluchon sees hunger as “the originary site of ethics”. If we follow this line of thinking, we can see that the ecology we depend on – from basic material needs like water and shelter to people - depends on us in turn to maintain it. </p>
<p>Pelluchon argues that our political order needs to be reorganised to better recognise both vulnerability and interdependence.</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> Many people who are looking at ecological models now are theorising the fact that we’re all porous and interdependent beings. [That is, we are not self-contained individuals with firm boundaries between ourselves and other forms of life.] Finding food is vital, so is our reproductive drive, our sexual drive, but we also need to breathe, a passive need dependent on the outside.</p>
<p>Another thing I’m deeply interested in is the rhythmic reality of human existence in relation to the rhythmical “out there”. We have circadian rhythms; we have a heartbeat. There’s the menstrual cycle during fertility for women. There’s breathing, but there’s also the rhythm of night and day and the pull of the tides. All of these must be recognised as part of the processes of our temporal existence, which gets covered over, too. We have an essentialist, static way of looking at the world as a bunch of fixed things. I prefer cyclical time to biographic time. We die, but others are born from us and the world moves on.</p>
<p>Speaking of nourishment again, what does the placental cord deliver? It delivers maternal nourishment, and essential hormones to the foetus, removes waste, keeps the maternal and foetal blood systems separate and orchestrates cell exchange during pregnancy. The more scientists find out about this organ, the weirder it gets. The cellular exchange creates chimeras of both mother and foetus during pregnancy. </p>
<hr>
<p>A <a href="https://www.britannica.com/science/chimera-genetics">chimera</a> is a single organism or tissue made up from cells containing more than one set of DNA.</p>
<p>“<a href="https://www.britannica.com/topic/Chimera-Greek-mythology">In Greek mythology</a>, a chimera is a fire-breathing she-monster … a mix, a blend … a terrifying animal,” Hustvedt writes, “because it involves mixing.” </p>
<hr>
<figure class="align-center ">
<img alt="Older woman dressed in black, smiling mischievously." src="https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Louise Bourgeois, Robert Mapplethorpe, 1982. (Tate London)</span>
</figcaption>
</figure>
<p><strong>SIRI HUSTVEDT:</strong> This is every pregnancy, and it’s typical of scientists that the old way of thinking about [cell traffic] was that they were leaks and accidents because the ideal is a sealed border.</p>
<p>After a normal birth, the placenta is delivered after the infant, and the placenta dies. The role that the placenta played as mediator inside the body of the mother is over. Its job is done. And what takes its place? Social space.</p>
<figure class="align-center ">
<img alt="Newborn baby on its mother's body." src="https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Western philosophy and Western science have really supressed the realities of gestation and birth in ways that just flabbergast me, says Siri Hustvedt.</span>
</figcaption>
</figure>
<p>And that social space is one of feeding, holding, rocking, comforting, but also, crucially, of playing. Infants who can’t play are infants who will not thrive. They can die.</p>
<p><strong>JULIENNE VAN LOON:</strong> Absolutely. And adults too, right? Because play in that social space – the space between – is a lifelong essential. These ideas really come through in your essay “Both-And”. </p>
<hr>
<h2>Louise Bourgeois: wit, neuroses and ‘the yuck factor’</h2>
<p>“Both-And” explores the work of French-American visual artist, <a href="https://www.theguardian.com/books/2007/oct/06/art">Louise Bourgeois</a>, whose etching, titled Self-portrait, is reproduced on the cover of Mothers, Fathers and Others.</p>
<hr>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-i-could-go-anywhere-id-revisit-maman-louise-bourgeois-9-metre-spider-at-londons-tate-modern-157859">If I could go anywhere: I'd revisit Maman, Louise Bourgeois' 9-metre spider at London's Tate Modern</a>
</strong>
</em>
</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> What has annoyed me with the way Bourgeois has been written about by critics is that many of them turn her into someone who is less playful, less satirical, someone who has less fun and is less smart than she is.</p>
<p>A woman artist is never considered as ironic or as intelligent as a male artist. Bourgeois’s work [is so often understood as] autobiographical – and it is, of course, but if it were only that, it would be very different. She directly takes on what I call the yuck factor – bodily mess and blur. (This goes back to Mary Douglas.) But Bourgeois is so witty that she uses this theme as a form of armour. And she’s funny. She’s dead serious too, but everyone [in the critical commentary] emphasises the depths of her neuroses, depression and agony. That’s not all there is.</p>
<p><strong>JULIENNE VAN LOON:</strong> It’s fascinating to see the way her ideas circulate and are received. And this is what I found interesting when I was writing The Thinking Woman, in terms of the women whose work I was looking at. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1186&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1186&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1186&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">goodreads</span></span>
</figcaption>
</figure>
<p>I was reading their work [including yours] and at the same time reading its critical reception over time. And you get this really clear sense of the gendered nature of the way [women’s] work is received. I think so often we vaguely notice aspects of gendered critique in passing. We sort of see little bits and pieces, but we don’t often have the opportunity to put the whole narrative together.</p>
<p><strong>SIRI HUSTVEDT:</strong> A lot of the gendered response is unconscious, implicit forms of prejudice that appear in the criticism. There are overtly hostile responses too, but I’m not sure even those critics know why they’re so angry. </p>
<p><strong>JULIENNE VAN LOON:</strong> This reminds me of another line from “Both-And”. You write: “Perception is conservative.” What do you mean? </p>
<h2>Perception, prejudice and the story of feminism</h2>
<p><strong>SIRI HUSTVEDT:</strong> It’s an idea currently popular in the neuroscience community. </p>
<p>The brain is a predictive organ. The idea is that through past experience, experiences codified in us through repetition become “priors” that shape our present perception. Most of this is below our awareness. Only when we discover errors in those expectations because they are not borne out are we forced to change our predictions.</p>
<p>We live in a townhouse. We’ve lived here for 25 or 26 years. One of the light switches is on the wrong side in our living room. It’s an old house. It used to be lit by gas. I cannot tell you how many thousands of times I have reached with the wrong hand to turn on that damn light switch. Because the architectural convention is coded in my body. I reach for what isn’t there. In order to do it right, we have to become conscious of it. This simple example suggests scientists are on the right track to think about prediction as important to perceptual habits.</p>
<p>This relates to prejudice too. If all perception is biased by what’s happened in the past then it helps to explain why it’s so damned hard for people to undo their prejudices. Whether it’s about gender, so-called race, religion or disability. Take your pick. </p>
<p>You have to become conscious of the light switch – or your own tendencies to typecast, say, in racist or sexist ways to combat automatic gestures or feelings. And that’s why bias is not dependent on the social identity of a person. People who identify as women harbour biases against a woman who runs for political office, for example. The social code that ambition is repugnant in women has become an embodied reality.</p>
<p><strong>JULIENNE VAN LOON:</strong> Contemplating this notion that perception is inherently conservative, how do we make change possible on a grand scale? The story of feminism in the West over the last 50 years is in some ways hard to feel positive about. I sometimes think I’m so disappointed that we’ve made so little progress or we’ve gone backwards at times. I think we have to be so patient and so constant in this project of consciousness raising, with a relentless putting back on the table of the topic of prejudice – including race, including sexuality.</p>
<p><strong>SIRI HUSTVEDT:</strong> Yes, the biases are omnipresent. We also need to combat the idea that we’re always making progress. It’s complete nonsense.</p>
<p><strong>JULIENNE VAN LOON:</strong> Absolutely.</p>
<p><strong>SIRI HUSTVEDT:</strong> The notion is a legacy of 19th-century positivism. The world has never worked like that.</p>
<figure class="align-center ">
<img alt="body organs like a bunch of flowers" src="https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=994&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=994&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=994&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1249&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1249&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1249&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">From Louise Bourgeois: An Unfolding Portrait (MOMA exhibition)</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dwhartwig/38687842894">Daniel Hartwig/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<h2>Political turmoil, writing as activism and the sinister science of eugenics</h2>
<p>I asked Siri if she was conscious of a more overtly political turn in her recent writing.</p>
<hr>
<figure class="align-center ">
<img alt="Bettmann/CORBIS" src="https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">07 May 1970, Kent, Ohio, USA — Anti-war demonstrators at Kent State University run as National Guardsmen fire tear gas and bullets into the crowd. — Image by © Bettmann/CORBIS.</span>
<span class="attribution"><span class="source">https://www.flickr.com/photos/97930879@N02/10501033583</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><strong>SIRI HUSTVEDT:</strong> My writing has become more urgently political. I was politically active as a teenager, during another period of political crisis. I was born in 1955, and I was 15 when Kent State happened. </p>
<hr>
<p>In 1970 a group of Kent State University students peacefully protesting the expansion of the Vietnam War into Cambodia were fired upon by the Ohio National Guard. Four students were killed.</p>
<hr>
<p>I already opposed the Vietnam War. I marched against it. I became a feminist young. That’s when I first read Kate Millett’s <a href="http://cup.columbia.edu/book/sexual-politics/9780231174251">Sexual Politics</a>and Simone de Beauvoir’s <a href="https://www.penguin.com.au/books/the-second-sex-9780099595731">The Second Sex</a>.</p>
<p>Yes, looking authoritarianism in the face, listening to racist, misogynistic, anti-immigrant rhetoric was like hearing Goebbels again, and it has lit a fire under my butt. When Trump was still president and running for re-election, my husband and I and several others started an organisation, Writers Against Trump, now called <a href="https://www.writersfordemocraticaction.org/">Writers for Democratic Action</a>. And in whatever way we can, we’re trying to mobilise writers to write political pieces and get out the vote.</p>
<p><strong>JULIENNE VAN LOON:</strong> Has living through this period changed your thinking about what fiction can do?</p>
<p><strong>SIRI HUSTVEDT:</strong> I’m trying to write a novel now. It’s a political novel. It’s a weird political novel. But yes, I think I’ve been galvanised. </p>
<p>For several years, I’ve been researching the history of race science, eugenics, and behavioural genetics that constitute what I regard as a single history. I think that history is ongoing. It is linked to statistics, big data, and the popular notion of the gene as the determinant factor in our lives. This is bad biology but potent ideology.</p>
<p>The new version of scientific racism and sexism looks a little different, but it is something we should be really worried about.</p>
<p><em>This is the first in an occasional series of conversations between writers and thinkers.</em></p><img src="https://counter.theconversation.com/content/176464/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julienne van Loon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
On International Women’s Day, two women writers discuss feminism, writing in the age of Trump and Covid – and being ‘flabbergasted’ by the absence of birth from Western art and philosophy.
Julienne van Loon, Associate Professor, Writing and Publishing, School of Media & Communication, RMIT University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/173249
2022-01-27T19:08:45Z
2022-01-27T19:08:45Z
Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows
<figure><img src="https://images.theconversation.com/files/442175/original/file-20220124-23-enfx0j.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5458%2C3655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/mother-newborn-child-birth-maternity-600w-1936891393.jpg">Shutterstock</a></span></figcaption></figure><p>Pregnant women who previously birthed by caesarean section are presented with a choice: whether to try for a vaginal birth, or book in for a repeat caesar. </p>
<p>Those mulling over a vaginal birth are counselled at length about the risk of a rare but nasty outcome – the uterus rupturing while labour is in full flight. </p>
<p>But new research looking at 130,000 births over five years has uncovered an increased risk of another outcome women deserve information about: extensive tearing around the vaginal region during birth.</p>
<p>Our new study, <a href="https://pubmed.ncbi.nlm.nih.gov/34913246/">published</a> in the British Journal of Obstetrics and Gynaecology, hones in on the risk of vaginal trauma for those who birth vaginally after a prior caesarean. This kind of birth trauma relates to significant injury to a woman’s perineum, the important region between the vagina and anus. The perineum anchors many pelvic floor muscles that help control the bladder and bowels.</p>
<p>We defined serious birth injury as a tear in the perineum that <a href="https://www.thewomens.org.au/images/uploads/fact-sheets/Perineal-tears-third-and-fourth-degree.pdf">extends</a> into the anal sphincter – the delicate ring of muscle that helps us control our bowels. Damage to this muscle is called a third-degree perineal tear. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-vaginal-birth-after-caesarean-48328">Explainer: vaginal birth after caesarean</a>
</strong>
</em>
</p>
<hr>
<h2>What we studied</h2>
<p>The study looked at 130,000 births in Victoria and compared the risk of a third-degree perinatal tear among first-time mums with those who birth vaginally after a prior caesarean (sometimes referred to as a <a href="https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery">VBAC</a>). In our study, vaginal birth included women birthed without any medical assistance, and births by forceps or the ventouse (vacuum birth). Anything but birth by caesarean.</p>
<p>The results were clear: a vaginal birth after a previous caesarean increases the chance of significant vaginal trauma (third-degree tear) by 21% (albeit from a low baseline rate).</p>
<p>A potential reason for this increased risk might include a mismatch between a uterus that has birthed before and a perineum that has not. If this is the case, the labour progresses quickly, which does not allow enough time for the perineum to stretch naturally. However, the real reason for this risk is unknown and further research is needed.</p>
<h2>Lifelong impacts</h2>
<p>Once a vaginal birth injury occurs, the tears are immediately repaired by obstetricians. Many women heal fully – but some who sustain a third-degree tear during birth develop distressing issues that never disappear, despite expert care, including from specialist physiotherapists. </p>
<p>Symptoms can include an ongoing dragging sensation in the pelvic floor, or true prolapse of the vaginal walls. Sometimes, coughing or sneezing can cause urine leakage. And for some, jogging becomes too hard due to leaking of urine and pelvic discomfort. Others might suffer from reduced faecal control and even the odd episode of faecal soiling. Sex can be painful.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman with caesar scar holds baby" src="https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women who had a caesarean birth the first time around are at greater risk of serious birth injury from a subsequent vaginal birth.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/closeup-woman-belly-scar-cesarean-600w-1883782888.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>This doesn’t mean women shouldn’t consider VBAC</h2>
<p>This increased risk of injury does not make it unsafe for women who have had a caesarean before to try for a vaginal birth. But our results should be incorporated into counselling of these women about their choices.</p>
<p>Since the risk of vaginal birth injury including the anal sphincter sits at <a href="https://www.safetyandquality.gov.au/sites/default/files/2021-04/perineal_tears_ccs_v3.pdf">around 5-7%</a> in Victoria for first-time mothers, the increase of 21% raises the overall likelihood to around 6–8.5%. It’s a modest rise that will bother some, but not others. </p>
<p>Still, women deserve to be given this information so they can judge for themselves whether it worries them enough to ask for a repeat caesarean, or try for a vaginal birth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pregnant woman in waiting room" src="https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Birth counselling should fully explain the risks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-courses-expectant-mothers-1185645562">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mothers-need-better-care-to-reduce-post-traumatic-stress-after-childbirth-12272">Mothers need better care to reduce post-traumatic stress after childbirth</a>
</strong>
</em>
</p>
<hr>
<p>Counselling is not just about cautioning women of the risks. As midwives and obstetricians, we talk with these women about what will happen when they go into labour, when to come into hospital, and what their chance (and definition) of “successful” vaginal birth might be. </p>
<p>We also mention the most enticing advantage for those whose destiny is an uncomplicated vaginal birth – they sidestep another caesar. Often, this means a <a href="https://pubmed.ncbi.nlm.nih.gov/17181678/">shorter recovery time</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/23186385/">improved likelihood of breastfeeding</a>.</p>
<p>After these discussions, some women will feel the very small risk of serious vaginal trauma (or <a href="https://doi.org/10.1371/journal.pmed.1001184">uterine rupture</a>) is one well worth taking and opt to try for a vaginal birth. Others will opt for the certainty of a repeat caesarean.</p>
<p>Women deserve full support in their birth choices. And they deserve to be fully informed about possible risks. It’s time we broaden our discussions with women planning a vaginal birth after caesarean section to include the increased risk of vaginal birth trauma.</p><img src="https://counter.theconversation.com/content/173249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthea Lindquist receives salary and project funding from the National Health and Medical Research Council. Her current funding (Ideas grant funding) is not related to this project.</span></em></p><p class="fine-print"><em><span>Stephen Tong receives salary and grant funding from the National Health and Medical Research Council of Australia (NHMRC). His NHMRC funding is not related to this project (aside from salary support). Stephen authored The Birth Book and he receives royalties from sales.</span></em></p>
Women deserve to know all the risks and be supported in their birth choices.
Anthea Lindquist, Obstetrician and Perinatal Epidemiologist, The University of Melbourne
Stephen Tong, Professor of Obstetrics and Gynaecology, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/162330
2021-06-15T13:42:27Z
2021-06-15T13:42:27Z
What Greek epics taught me about the special relationship between fathers and sons
<figure><img src="https://images.theconversation.com/files/405985/original/file-20210611-27-1140y10.jpg?ixlib=rb-1.1.0&rect=0%2C81%2C3615%2C2489&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Odysseus reuniting with his father, Laertes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/odysseus-and-his-father-laertes-king-of-the-cephallenians-news-photo/167069604?adppopup=true">Leemage/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Father’s Day inspires mixed emotions for many of us. Looking at advertisements of happy families could recall difficult memories and broken relationships for some. But for others, the day could invite unbidden nostalgic thoughts of parents who have long since died.</p>
<p>As a <a href="https://www.brandeis.edu/facultyguide/person.html?emplid=1be7ee967d45605afddf7da9ad4ca2c049a26c0b">scholar of ancient Greek poetry</a>, I find myself reflecting on two of the most powerful paternal moments in Greek literature. <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0134%3Abook%3D24%3Acard%3D507">At the end of Homer’s classic poem, “The Iliad</a>,” Priam, the king of Troy, begs his son’s killer, Achilles, to return the body of Hektor, the city’s greatest warrior, for burial. Once Achilles puts aside his famous rage and agrees, the two weep together before sharing a meal, Priam lamenting the loss of his son while Achilles contemplates that he will never see his own father again.</p>
<p>The final book of another Greek classic, “The Odyssey,” brings together a father and son as well. After 10 years of war and as many traveling at sea, Odysseus returns home and goes through a series of reunions, ending with his father, Laertes. <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0136%3Abook%3D24%3Acard%3D232">When Odysseus meets his father</a>, however, he doesn’t greet him right away. Instead, he pretends to be someone who met Odysseus and lies about his location. </p>
<p>When Laertes weeps over his son’s continued absence, Odysseus loses control of his emotions too, shouting his name to his father only to be disbelieved. He reveals a scar he received as a child and Laertes still doubts him. But then Odysseus points to the trees in their orchards and begins to recount their numbers and names, the stories Laertes told him when he was young.</p>
<p>Since the time of Aristotle, interpreters have questioned “The Odyssey"’s final book. Some have wondered why Odysseus is cruel to his father, while others have asked why reuniting with him even matters. Why spend precious narrative time talking about trees when the audience is waiting to hear if Odysseus will suffer at the hands of the families whose sons he has killed?</p>
<p>I lingered in such confusion myself until I lost my own father, John, too young at 61. Reading and teaching "The Odyssey” in the same two-year period that I lost him and welcomed two children to the world changed the way I understood the father-son relationship in these poems. I realized then in the final scene, what Odysseus needed from his father was something more important: the comfort of being a son. </p>
<h2>Fathers and sons</h2>
<p>Fathers occupy an outsized place in Greek myth. They are kings and models, and too often challenges to be overcome. In Greek epic, fathers are markers of absence and dislocation. When Achilles learns his lover and friend, Patroklos, has died in “The Iliad,” he weeps and says that he always imagined his best friend returning home and <a href="https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0134%3Abook%3D19%3Acard%3D309">introducing Achilles’ son, Neoptolemus, to Achilles’s father, Peleus</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Son of the warrior Achilles and the princess Deidamia in a scene from the Greek mythology." src="https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406240/original/file-20210614-125373-kj2k0m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Greek myths highlight many moments in father-son relationships.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-repentance-of-neoptolemus-1880-son-of-the-warrior-news-photo/654314530?adppopup=true">The Print Collector/Hulton Archive/Getty Images</a></span>
</figcaption>
</figure>
<p>The Trojan Prince Hektor’s most humanizing moment is when he laughs at his son’s <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0134%3Abook%3D6%3Acard%3D414">startled cry at seeing his father’s</a> bloodied armor. Priam’s grief for Hektor’s loss stands in for the grief of all parents bereft of children taken too soon. When he hears of the death of his son, he lies prostrate on the earth, covering his head with ash and weeping. The sweetness of Hektor’s laugh foreshadows the bitter agony of his father’s pain.</p>
<p>I don’t think I had a grasp of either before I became a father and lost one.</p>
<h2>How stories bring us home</h2>
<p>Odysseus’ reunion with his father is crucial to the completion of his story, of his return home. In Greek the word “nostos,” or homecoming, is more than about a mere return to a place: It is a restoration of the self, a kind of reentry to the world of the living. For Odysseus, as I explore in my recent book “<a href="https://www.cornellpress.cornell.edu/book/9781501752346/the-many-minded-man/">The Many-Minded Man: The Odyssey, Modern Psychology, and the Therapy of Epic</a>,” this means returning to who he was before the war, trying to reconcile his identities as a king, a suffering veteran, a man with a wife and a father, as well as a son himself.</p>
<p>Odysseus achieves his “nostos” by telling and listening to stories. As psychologists who specialize in <a href="https://www.cornellpress.cornell.edu/book/9781501752346/the-many-minded-man/">narrative therapy</a> explain, our identity <a href="https://www.apa.org/pubs/books/4317515">comprises the stories we tell and believe about ourselves</a>. </p>
<p>The stories we tell about ourselves condition how we act in the world. Psychological studies have shown how losing a sense of agency, the belief that we can shape what happens to us, can keep us trapped in cycles of inaction and make us more prone to depression and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905522/">addiction</a>. </p>
<p>And the pain of losing a loved one can make anyone feel helpless. In recent years, researchers have investigated how <a href="https://dx.doi.org/10.31887/DCNS.2012.14.2/mshear">unresolved or complicated</a> grief – an ongoing, heightened state of mourning – upends lives and changes the way someone sees oneself in the world. And more pain comes from other people not knowing our stories, from not truly knowing who we are. Psychologists have shown that when people do not acknowledge their mental or emotional states, they experience “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212305/">emotional invalidation</a>” that can have negative mental and physical consequences from depression to chronic pain.</p>
<p>Odysseus does not recognize the landscape of his home island of Ithaca when he first arrives; he needs to go through a process of reunions and observation first. But when Odysseus tells his father the stories of the trees they tended together, he reminds them both of their shared story, of the relationship and the place that brings them together. </p>
<p>[<em>3 media outlets, 1 religion newsletter.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-3-in-1">Get stories from The Conversation, AP and RNS.</a>]</p>
<h2>Family trees</h2>
<p>“The Odyssey” teaches us that home is not just a physical place, it is where memories live – it is a reminder of the stories that have shaped us.</p>
<p>When I was in third grade, my father bought several acres in the middle of the woods in southern Maine. He spent the rest of his life clearing those acres, shaping gardens, planting trees. By the time I was in high school, it took several hours to mow the lawn. He and I repaired old stone walls, dug beds for phlox, and planted rhododendron bushes and a maple tree.</p>
<p>My father was not an uncomplicated man. I probably remember the work we did on that property so well because our relationship was otherwise distant. He was almost completely deaf from birth, and this shaped the way he engaged with the world and the kinds of experiences he shared with his family. My mother tells me he was worried about having children because he wouldn’t be able to hear them cry. </p>
<p>He died in the winter of 2011, and I returned home in the summer to honor his wishes and spread his ashes on a mountain in central Maine with my brother. I had not lived in Maine for over a decade before his passing. The pine trees I used to climb were unrecognizable; the trees and bushes I had planted with my father were in the same place, but they had changed: they were larger, grown wilder, identifiable only because of where they were planted in relation to one another.</p>
<p>That was when I was no longer confused about the walk Odysseus took through the trees with his father, Laertes. I cannot help but imagine what it would be like to walk that land with my father again, to joke about the absurdity of turning pine forests into lawn.</p>
<p>“The Odyssey” ends with Laertes and Odysseus standing together with the third generation, the young Telemachus. In a way, Odysseus gets the fantasy ending Achilles couldn’t even imagine for himself: He stands together in his home with his father and his son.</p>
<p>In my father’s last year, I introduced him to his first grandchild, my daughter. Ten years later, as I try to ignore another painful reminder of his absence, I can only imagine how the birth of my third, another daughter, would have lit up his face. </p>
<p>“The Odyssey,” I believe, teaches us that we are shaped by the people who recognize us and the stories we share together. When we lose our loved ones, we can fear that there are no new stories to be told. But then we find the stories that we can tell our children. </p>
<p>This year, as I celebrate a 10th Father’s Day as a father and without one, I keep this close to heart: Telling these stories to my children creates a new home and makes that impossible return less painful.</p><img src="https://counter.theconversation.com/content/162330/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Christensen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
On Father’s Day, a scholar of ancient Greek poetry explains how he came to understand the father-son relationship and his journey of loss and yearning through reading the epics.
Joel Christensen, Professor of Classical Studies, Brandeis University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/161281
2021-06-01T06:52:47Z
2021-06-01T06:52:47Z
Too many healthy women are having their labour induced for no identified medical reason, our study shows
<figure><img src="https://images.theconversation.com/files/403677/original/file-20210601-13-nau4lg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-being-induced-hospital-iv-1977552374">Shutterstock</a></span></figcaption></figure><p>Pregnant women in Australia are increasingly having their labours induced rather than giving birth spontaneously – and some without good reason. </p>
<p>A large proportion of first time mothers (41.6%) were induced in <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-data-visualisations/contents/summary">2018</a>, when the latest national data were published, compared with 30.6% in 2010.</p>
<p>Our study, <a href="http://dx.doi.org/10.1136/bmjopen-2020-047040">published today in BMJ Open</a>, found the induction rates tripled for women who were 37 and 39 weeks pregnant in New South Wales in the 16 years to 2016. And 15% of new mothers were induced without a medical reason listed. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1399463165675507716"}"></div></p>
<p>Induction of labour can be life-saving in some situations. But when it’s not medically indicated, it could put women and babies at unnecessary increased risk of complications.</p>
<h2>Remind me, what is induction?</h2>
<p><a href="https://ranzcog.edu.au/womens-health/patient-information-resources/induction-of-labour">Induction of labour</a> is where labour is started medically. This can be with hormones, by using a balloon-shaped catheter placed in the woman’s cervix to open it up, or by breaking the bag of water around the baby. </p>
<p>Induction is often <a href="https://ranzcog.edu.au/womens-health/patient-information-resources/induction-of-labour">recommended</a> when:</p>
<ul>
<li>pregnancy has gone over 41 weeks to reduce the risk of stillbirth</li>
<li>the mother has high blood pressure or diabetes</li>
<li>there is another significant issue threatening the health of the mother or baby. </li>
</ul>
<p>Our research found sometimes inductions are done where there is no identified medical reason. As previous research has shown, this is especially the case in <a href="https://theconversation.com/birth-intervention-and-harm-more-likely-in-private-hospitals-26801">private hospitals</a>. </p>
<p>Sometimes women are told their baby is bigger or smaller than normal. Bigger babies may lead to more complications with the birth, and smaller babies may not be growing well. However, ultrasound can be <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003190">very inaccurate</a>, and babies thought to be small or large are often a very average size at birth.</p>
<p>Sometimes women are sick of being pregnant and are (understandably) uncomfortable and request an induction or are offered it by doctors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/birth-intervention-and-harm-more-likely-in-private-hospitals-26801">Birth intervention – and harm – more likely in private hospitals</a>
</strong>
</em>
</p>
<hr>
<h2>Greater intervention</h2>
<p>Our <a href="http://dx.doi.org/10.1136/bmjopen-2020-047040">BMJ Open study</a> tracked almost 475,000 births in NSW between 2001 and 2016. </p>
<p>Of these, 69,397 (15%) had an induction of labour with no medical reason given. These women were aged 20 to 35 years, had a healthy pregnancy, and didn’t smoke or have high blood pressure or diabetes.</p>
<p>Compared to first-time mothers who went into labour themselves, those who were induced were more likely to have:</p>
<ul>
<li>an <a href="https://theconversation.com/from-barber-surgeons-to-car-mechanics-the-technologies-of-vaginal-birth-20474">instrumental birth</a> with forceps or vacuum (28% for women who were induced vs 24% for women who gave birth spontanesously)</li>
<li>a caesarean section (29% vs 14%)</li>
<li>an epidural (71% vs 41%)</li>
<li>an <a href="https://theconversation.com/episiotomy-during-childbirth-not-just-a-little-snip-36062">episiotomy</a>, which is a surgical cut to the perineum, the area between the vaginal opening and the skin leading towards the anus (41% vs 30%). </li>
</ul>
<p>In one area there were benefits for mothers who were induced: severe perineal tears were slightly lower for first time mothers (4.2% vs 4.9%) and those who had given birth previously (0.7% vs 1.2%). </p>
<p>Mothers having subsequent babies did not have the same high intervention rates that first time mothers did.</p>
<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/34022593/">recently published study</a> had similar findings of increased caesarean section rates for first time mothers.</p>
<h2>Earlier inductions</h2>
<p>We found a big rise in NSW babies being induced at what we call “<a href="https://www.sciencedirect.com/science/article/pii/S1744165X18301252">early term</a>” (37 and 38 weeks) over the 16 year period. </p>
<p>The number of babies born at 37 weeks’ gestation tripled, while the number born at 38 weeks doubled. </p>
<figure class="align-center ">
<img alt="New mother in hospital holds her baby on her chest and closes her eyes." src="https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403698/original/file-20210601-27-1jyrwpv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inductions are occurring too often and too early.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-holding-her-premature-newborn-713505415">Shutterstock</a></span>
</figcaption>
</figure>
<p>Yet those last couple of weeks of being in their mother’s uterus are important for the development of the child’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721566/">brain</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28729012/">other body systems</a> such as the lungs, and the ability to control blood sugar and body temperature. </p>
<h2>Long-term outcomes</h2>
<p>Previous research has suggested inducing healthy pregnant mothers after 41 weeks of pregnancy <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1800566">reduces stillbirth</a> and this is what the World Health Organization recommends (we previously recommended induction after 42 weeks).</p>
<p>While our research did not look at stillbirth, as all our mothers and babies were healthy when labour started, we found no difference in the rates of neonatal, infant and child death between the two groups.</p>
<p>Our study is one of the first to look at long-term outcomes associated with induction of labour.</p>
<p>Following induction of labour, babies had more trauma during birth, and were more likely to need resuscitation. This is probably partly due to being born early and/or having more surgical intervention. </p>
<p>Babies born after induction were more likely to be admitted to hospital with breathing difficulties and infections (ear, nose, throat, respiratory, sepsis) at a range of ages, up to 16 years. </p>
<p>We could only look at hospital admissions which occur when there are more serious health issues, so this does not represent visits to a GP or other community services. </p>
<h2>Loss of control</h2>
<p>Most women prefer to start labour spontaneously, finding induction more painful (hence more epidurals), and feeling they have less control during labour. </p>
<p>Women who are induced can’t move around as easily due to the baby needing to be continuously monitored to pick up any signs of distress. The drugs used for induction can make the contractions very strong, reducing oxygen to the baby. Most women have intravenous fluids running, further restricting movement. </p>
<p>This lack of control <a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">can lead to</a> women feeling disappointed with their birth and some may even be traumatised. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1397843153357582337"}"></div></p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/31208865/">recent review of the evidence</a> found decisions about induction were largely made by clinicians rather than women, whose expectations and preferences were often unmet. </p>
<h2>Time for change</h2>
<p>There is widespread variation in <a href="https://pubmed.ncbi.nlm.nih.gov/31285166/">clinical practice guidelines</a> about when women should be induced. </p>
<p>The <a href="https://apps.who.int/iris/bitstream/handle/10665/277233/9789241550413-eng.pdf">World Health Organization</a> has advised against induction of labour without medical indication before 41 weeks gestation. </p>
<p>And this month the National Institute for Health and Care Excellence in the United Kingdom released its <a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10082/consultation/html-content">draft guidance</a> for consultation, also recommending women be offered induction at 41 weeks but opening the discussion on induction up for debate. </p>
<p>There is no doubt induction of labour can save lives if used judiciously. But it’s a major medical intervention and so should not be offered routinely before 41 weeks without discussing the risks and the potential increase in other interventions women may not anticipate. </p>
<p>This discussion should also include not yet knowing all the potential longer-term effects of inductions. </p>
<p>Most important of all, women need to be aware they can <a href="https://humanrightsinchildbirth.org/index.php/rights/">decline or accept</a> any intervention or treatment offered or recommended by health providers and the information provided to them must be balanced, evidence based and without coercion.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">So your birth didn't go according to plan? Don't blame yourself</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/161281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen has received funding from NHMRC and ARC in the past. </span></em></p><p class="fine-print"><em><span>Soo Downe is currently funded for research projects by the UK NIHR (ESRC), Bill and Melinda Gates Foundation, and WHO</span></em></p><p class="fine-print"><em><span>Ank de Jonge and Lilian Peters do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Induction of labour can be life-saving in some situations. But women are increasingly induced for non-medical reasons, and earlier in their pregnancies.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Ank de Jonge, Associate professor of midwifery science, Vrije Universiteit Amsterdam
Lilian Peters, Epidemiologist/Assistant Professor at the Department of Midwifery Science (Amsterdam UMC, Groningen UMC), Vrije Universiteit Amsterdam
Soo Downe, Professor of Midwifery Studies, University of Central Lancashire
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/149264
2020-12-03T22:06:53Z
2020-12-03T22:06:53Z
Tokophobia is an extreme fear of childbirth. Here’s how to recognise and treat it
<figure><img src="https://images.theconversation.com/files/372676/original/file-20201202-15-1rfluvi.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5144%2C3448&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Many pregnant women worry about birth. Some, however, suffer from a much more serious condition called tokophobia: a severe and unreasoning dread of childbirth, which is sometimes accompanied by a disgust of pregnancy.</p>
<p>At its most extreme, tokophobia can lead to:</p>
<ul>
<li>an obsessive use of contraception to prevent pregnancy</li>
<li>termination of pregnancy</li>
<li>not attending maternity care appointments</li>
<li>post-traumatic stress disorder and/or other mental health disorders and mother-baby bonding difficulties.</li>
</ul>
<p>Tokophobia comes in two forms: primary (in women who have not had a baby before) and secondary (women who have previously had a baby). Women with tokophobia in a previous pregnancy are more likely to have it in a subsequent pregnancy, resulting in a potential cycle of anxiety and depression.</p>
<p>Our new <a href="https://www.tandfonline.com/doi/full/10.1080/02646838.2020.1843908">paper</a>, published in the Journal of Reproductive and Infant Psychology, reflects on a recent meeting of researchers and clinicians about what’s missing from the way we identify and treat tokophobia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tokophobia-what-its-like-to-have-a-phobia-of-pregnancy-and-childbirth-91271">Tokophobia: what it’s like to have a phobia of pregnancy and childbirth</a>
</strong>
</em>
</p>
<hr>
<h2>Hard to define, hard to screen for</h2>
<p>It’s hard to say how many women are affected by tokophobia; it’s been defined and measured using different questionnaires. One <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13138">research paper</a> estimated the prevalence of tokophobia at 14% of pregnant women worldwide.</p>
<p>Screening for tokophobia is not common practice around the world. Screening questionnaires sometimes ask the woman questions about her mood, whether she has fears for herself or her baby, about feeling so afraid of childbirth she’s considered terminating the pregnancy, or feeling fear so overwhelming it interferes with eating, work or sleep.</p>
<p>In other words, tokophobia goes beyond normal childbirth concerns and worries, and becomes an intense and irrational fear of pregnancy and/or labour.</p>
<p>It’s important women with this condition are identified as soon as possible but that often only happens when they seek specialised professional help. This can sometimes (but not always) take the form of a request for a termination of pregnancy or caesarean section.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman holds a packet of contraceptive pills." src="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An obsessive use of contraception to prevent pregnancy is one possible symptom of tokophobia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Treatment options</h2>
<p>Treatment for tokophobia remains patchy but should be determined based on factors such as the woman’s level of fear, stage of pregnancy and her individual wishes.</p>
<p>Early conversations about fear of childbirth — and understanding exactly what those fears are — may reduce negative impact and prevent anxiety.</p>
<p>For women with birth trauma (and potential secondary tokophobia), helping them prepare for uncertainty and building trust in themselves and their caregivers can result in a future positive experience.</p>
<p>Approaches that may help include:</p>
<ul>
<li>additional <a href="https://pubmed.ncbi.nlm.nih.gov/29773474/">midwifery support</a> to discuss the birth, with continuity of care, which is where the same midwife and/or midwifery care team sees the woman throughout pregnancy and labour</li>
<li>involvement of the obstetrician in decision-making around birth</li>
<li>extra education about childbirth</li>
<li>the involvement of the birth partner,</li>
<li>supported visits to the delivery suite, and</li>
<li>the development of a <a href="https://www.communitypractitioner.co.uk/features/2020/02/pregnant-fear">supportive birth plan</a>.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks worriedly into the distance." src="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many pregnant women worry about birth. Some, however, suffer from a much more serious condition called tokophobia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Pathways of care</h2>
<p>The way childbirth is often depicted in the media may play a role in setting birth up in women’s minds as a negative experience. But it’s important women share birth stories - the good and the bad. <a href="https://www.bmj.com/content/362/bmj.k3933/rr-0">Like-minded peer support mechanisms</a>, including parenting forums, which can be really helpful for some women.</p>
<p>During pregnancy, women should be encouraged to share their fears with their maternity care provider and ask questions.</p>
<p>Our understanding of fear of childbirth has undoubtedly increased, and some pioneering “<a href="https://search.proquest.com/openview/8785069f9dd679cef1540fc8881f6c0f/1?pq-origsite=gscholar&cbl=47216">pathways of care</a>” for women with tokophobia already exist. </p>
<p>But there is much work left to do if we are to understand and identify when standard worries deviate from expected levels to problematic levels.</p>
<p>We owe it to women and babies everywhere to find better ways to support women with tokophobia and maximise their chances of a positive birth experience.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tokophobia-the-women-with-an-extreme-fear-of-pregnancy-and-childbirth-103886">Tokophobia: the women with an extreme fear of pregnancy and childbirth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/149264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Jomeen received funding for this work from the Society for Reproductive and Infant Psychology development grant scheme </span></em></p><p class="fine-print"><em><span>The consensus statement referred to in the paper co-authored by Catriona Jones was facilitated by a small Society for Reproductive and Infant Psychology (SRIP) development grant, which funded the workshop.</span></em></p><p class="fine-print"><em><span>Claire Marshall is funded by the National Institute for Health Research. Claire Marshall is employed by Humber Teaching NHS Foundation Trust. </span></em></p><p class="fine-print"><em><span>The consensus statement referred to in the paper co-authored by Colin Martin was facilitated by a small Society for Reproductive and Infant Psychology (SRIP) development grant, which funded the workshop.
</span></em></p>
Tokophobia goes beyond normal childbirth concerns and worries and becomes an intense and irrational fear of pregnancy and/or labour.
Julie Jomeen, Professor of Midwifery and Dean in the Faculty of Health Sciences, Southern Cross University
Catriona Jones, Senior Research Fellow in Maternal and Reproductive Health, University of Hull
Claire Marshall, National Institute for Health Research Fellow, University of Hull
Colin Martin, Adjunct professor, Southern Cross University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/142261
2020-07-09T06:48:41Z
2020-07-09T06:48:41Z
During COVID-19, women are opting for ‘freebirthing’ if homebirths aren’t available. And that’s a worry
<figure><img src="https://images.theconversation.com/files/346500/original/file-20200709-38-ihn108.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C994%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-labor-leans-forward-onto-back-474513481">from www.shutterstock.com</a></span></figcaption></figure><p>The pandemic is prompting some Australian pregnant women to give birth at home without a midwife or <a href="https://www.ahpra.gov.au/About-AHPRA/What-We-Do/FAQ.aspx#protected">registered</a> health provider, according to a <a href="https://www.midwives.org.au/news/womens-experiences-maternity-care-height-covid-19">survey</a> out this week. Another <a href="https://www.sciencedirect.com/science/article/abs/pii/S1871519220302717">new survey</a> helps explain why.</p>
<p>The number of women who say they have either had or were thinking about “<a href="https://www.womenandbirth.org/article/S1871-5192(10)00082-X/fulltext">freebirthing</a>” is concerning, due to the increased risk to mothers and babies when unrecognised complications arise or emergencies occur.</p>
<p>So we need to support women to choose where they give birth, or they may be forced to choose this riskier option.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">Explainer: what are women's options for giving birth?</a>
</strong>
</em>
</p>
<hr>
<h2>How many women are changing their birth plans?</h2>
<p>The evidence to date indicates the risk of COVID-19 for pregnant women and babies <a href="https://theconversation.com/coronavirus-while-pregnant-or-giving-birth-heres-what-you-need-to-know-133619">is not as high</a> as other groups. But women have understandably <a href="https://www.abc.net.au/news/2020-05-12/precautions-during-covid-19-for-birth/12234906">been concerned</a>.</p>
<p>This has led to a spike in inquiries from women wanting to <a href="https://www.smh.com.au/lifestyle/health-and-wellness/keep-myself-my-baby-safe-home-birth-inquiries-surge-amid-covid-19-crisis-20200324-p54da3.html">change where they give birth</a>. We see this trend, from hospital to home, in Australia and <a href="https://www.vox.com/first-person/2020/4/28/21225201/coronavirus-covid-19-pregnancy-home-birth">overseas</a>.</p>
<p>For instance, in Victoria a publicly funded homebirth program <a href="https://www.facebook.com/watch/?v=1410587449142735">tripled</a> the number of homebirths provided from March to May compared to the previous year. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">So your birth didn't go according to plan? Don't blame yourself</a>
</strong>
</em>
</p>
<hr>
<p>Now, <a href="https://www.midwives.org.au/news/womens-experiences-maternity-care-height-covid-19">a national survey</a> the Australian College of Midwives conducted during the peak of the COVID-19 pandemic provides further evidence.</p>
<p>Out of 2,750 responses from women about their experience of maternity care,
26% reconsidered where they wanted to give birth and who provided their care.</p>
<p>Reasons ranged from fear of contracting COVID-19 in hospital to restrictions on support people allowed in hospital for pregnancy, birth and postnatal care. </p>
<p>Most of those who reconsidered their maternity care looked for a homebirth option. But of those who wanted a home birth, 60% couldn’t find a private midwife, and 39% found they were fully booked. Around 3% chose to freebirth. </p>
<h2>Why do women choose to homebirth or freebirth?</h2>
<p>We have just published the results of the <a href="https://www.sciencedirect.com/science/article/abs/pii/S1871519220302717">largest survey</a> in Australia examining why women choose to give birth at home. We conducted this survey before the COVID-19 pandemic, with 1,681 women responding.</p>
<p>Most women said they wanted to give birth at home with a midwife. But nearly half said they would consider a freebirth or finding an <a href="https://pubmed.ncbi.nlm.nih.gov/29803611/">unregulated birth worker</a> if they could not have a midwife. One in ten women had a freebirth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/episiotomy-during-childbirth-not-just-a-little-snip-36062">Episiotomy during childbirth: not just a 'little snip'</a>
</strong>
</em>
</p>
<hr>
<p>Reasons for wanting to give birth at home included wanting to avoid medical interventions, such as induction of labour or <a href="https://theconversation.com/episiotomy-during-childbirth-not-just-a-little-snip-36062">episiotomy</a>, or to avoid feeling pressured to have them, rather than being supported to have the birth they wanted.</p>
<p>Many of the women who responded to the survey described their previous hospital experience as traumatic (32%) or were diagnosed with <a href="https://pubmed.ncbi.nlm.nih.gov/29337007/">post-traumatic stress disorder</a> (6%).</p>
<h2>Are homebirths safe?</h2>
<p>In Australia only <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-and-babies-2018-in-brief/contents/table-of-contents">0.3%</a> of women are able to access a homebirth attended by a midwife.</p>
<p>This contrasts with other countries such as the <a href="https://www.perined.nl/producten/publicaties/jaarboeken">Netherlands</a> (12.7%) <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2017">UK</a> (2.1%), <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310042901">Canada</a> (2%) and <a href="https://www.health.govt.nz/publication/report-maternity-2017">New Zealand</a> (3.4%) where this birth option is funded and supported for low risk women by government and key obstetric colleges, such as those in the <a href="https://www.midwivescollective.ca/site/wp-content/uploads/UK_Homebirth_Statement.pdf">UK</a> and <a href="https://themidwivesclinic.ca/site/wp-content/uploads/Planned-home-birth-statement-.pdf">Canada</a>.</p>
<p>In Australia the obstetric college RANZCOG <a href="https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Home-Births-(C-Obs-2)-Review-July-17.pdf?ext=.pdf">advises against</a> homebirth.</p>
<p>Yet reviews published in <a href="https://pubmed.ncbi.nlm.nih.gov/29727829/">2018</a>, <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext">2019</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136633/">2020</a> find strong evidence for the safety of a homebirth for low risk women with a midwife attending.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/346501/original/file-20200709-38-1v75dqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having a homebirth with a midwife is more common overseas. So why not in Australia?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-prays-together-wife-labors-birthing-477573283">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Why aren’t there more homebirths in Australia?</h2>
<p>There are many reasons for the lack of support for homebirths in Australia. These include <a href="http://classic.austlii.edu.au/au/journals/PrecedentAULA/2010/46.pdf">medical opposition</a>, <a href="https://www.midwives.org.au/insurance-exemption-private-midwives">lack of insurance</a> for private midwives to attend a homebirth and <a href="https://www.smh.com.au/lifestyle/health-and-wellness/midwives-and-doctors-push-for-medicare-rebate-for-home-births-20190813-p52gls.html">lack of Medicare funding</a>. </p>
<p>Women who live within 20-30 minutes of one of the 17 <a href="https://www.uts.edu.au/research-and-teaching/our-research/centre-midwifery-child-and-family-health/research/past-projects/national-publicly-funded-homebirth">publicly funded</a> homebirth programs (run out of public hospitals) and remain low risk, can birth at home. But these programs are oversubscribed and inaccessible to many women, especially in non metropolitan areas.</p>
<p>Others will try to find one of around 200 private midwives nationwide, who are not already fully booked, to care for them. They will pay <a href="https://www.bellybelly.com.au/birth/how-much-does-it-cost-to-give-birth-in-australia/">up to A$6,000</a> for a private midwife to attend a homebirth, getting no Medicare rebate for the birth at home and little chance of private insurance rebates.</p>
<p>COVID-19 has escalated this demand for homebirth even further.</p>
<h2>Here’s what we can do</h2>
<p>We have <a href="https://www.booktopia.com.au/birthing-outside-the-system-hannah-dahlen/book/9781138592704.html">written</a> <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-02944-6">extensively</a> about the reasons why women choose freebirth, and engage non regulated providers such as <a href="https://www.sciencedirect.com/science/article/pii/S1871519218306607">birth workers</a>.</p>
<p>So we need to support women to choose where they give birth and not to be forced into less-safe options. Here’s what would make a difference:</p>
<ul>
<li><p>make respectful care a reality for all women, to reduce birth trauma in the first place</p></li>
<li><p>support women’s access to their chosen place of birth and model of care</p></li>
<li><p>support midwifery care at home through funding and insuring midwifery care</p></li>
<li><p>offer more flexible, acceptable options for women experiencing risk factors during pregnancy and/or birth</p></li>
<li><p>get the policy, regulatory and educational framework right to enable safe and sustainable homebirth services.</p></li>
</ul>
<hr>
<p><em>Heather Sassine was the lead author of the study and undertook the survey as an honours student in the School of Nursing and Midwifery at Western Sydney University.</em></p><img src="https://counter.theconversation.com/content/142261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from the NHMRC and ARC. </span></em></p>
Many women are turning away from hospital births during the pandemic, preferring to give birth at home. But midwives aren’t always available to support them. So some are birthing without one.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/138209
2020-05-11T19:58:39Z
2020-05-11T19:58:39Z
Not all twins are identical and that’s been an evolutionary puzzle, until now
<figure><img src="https://images.theconversation.com/files/333912/original/file-20200511-49565-1bwrkd6.jpg?ixlib=rb-1.1.0&rect=0%2C98%2C3000%2C1904&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Beth Shepherd Peters/Shutterstock</span></span></figcaption></figure><p>When a mother gives birth to twins, the offspring are not always identical or even the same gender. Known as fraternal twins, they represent a longstanding evolutionary puzzle. </p>
<p>Identical twins arise from a single fertilised egg that accidentally splits in two, but fraternal twins arise when two eggs are released and fertilised. Why this would happen was the puzzle.</p>
<p>In research <a href="https://www.nature.com/articles/s41559-020-1173-y" title="An age-dependent ovulatory strategy explains the evolution of dizygotic twinning in humans">published today in Nature Ecology & Evolution</a> we used computer simulations and modelling to try to explain why natural selection favours releasing two eggs, despite the low survival of twins and the risks of twin births for mothers.</p>
<h2>Why twins?</h2>
<p>Since Michael Bulmer’s landmark 1970 <a href="https://books.google.com.au/books/about/The_Biology_of_Twinning_in_Man.html?id=awo-AAAAYAAJ">book on the biology of twinning in humans</a>, biologists have questioned whether double ovulation was favoured by natural selection or, like identical twins, was the result of an accident.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-some-twins-identical-and-some-not-121435">Curious Kids: why are some twins identical and some not?</a>
</strong>
</em>
</p>
<hr>
<p>At first glance, this seems unlikely. The embryo splitting that produces identical twins is not heritable and the incidence of identical twinning does not vary with other aspects of human biology. It seems accidental in every sense of the word. </p>
<p>In contrast, the incidence of fraternal twinning changes with <a href="https://doi.org/10.1017/S0021932000007896" title="Ethnic differences in twinning rates in Nigeria">maternal age</a> and is <a href="https://doi.org/10.1016/S0140-6736(03)14237-7" title="Twinning">heritable</a>.</p>
<p>Those do not sound like the characteristics of something accidental.</p>
<h2>The twin disadvantage</h2>
<p>In human populations without access to medical care there seems little benefit to having twins. <a href="https://doi.org/10.1046/j.1420-9101.2001.00287.x" title="The fitness of twin mothers: evidence from rural Gambia">Twins</a> are more likely to die in childhood than single births. Mothers of twins also have an increased risk of dying in childbirth.</p>
<p>In common with other great apes, women seem to be built to give birth to <a href="https://doi.org/10.1111/j.1558-5646.1990.tb05211.x" title="ON THE EVOLUTION OF HUMAN BROOD SIZE">one child at a time</a>. So if twinning is costly, why has evolution not removed it?</p>
<p>Paradoxically, in high-fertility populations, the mothers of twins often have <a href="https://doi.org/10.1046/j.1420-9101.2001.00287.x" title="The fitness of twin mothers: evidence from rural Gambia">more offspring</a> by the end of their lives than other mothers. This suggests having twins might have an evolutionary benefit, at least for mothers. </p>
<p>But, if this is the case, why are twins so rare?</p>
<h2>Modelling mothers</h2>
<p>To resolve these questions, together with colleagues Bob Black and Rick Smock, we <a href="https://doi.org/10.1038/s41559-020-1173-y" title="An age-dependent ovulatory strategy explains the evolution of dizygotic twinning in humans">constructed simulations and mathematical models</a> fed with data on maternal, child and fetal survival from real populations. </p>
<p>This allowed us to do something otherwise impossible: control in the simulations and modelling whether women ovulated one or two eggs during their cycles. We also modelled different <a href="https://doi.org/10.1016/j.tree.2007.09.002" title="The status of the conditional evolutionarily stable strategy">strategies</a>, where we switched women from ovulating one egg to ovulating two at different ages.</p>
<p>We could then compare the number of surviving children for women with different patterns of ovulation.</p>
<p>Women who switched from single to double ovulation in their mid-20s had the most children survive in our models – more than those who always released a single egg, or always released two eggs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333966/original/file-20200511-49558-4l8o82.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This suggests natural selection favours an unconscious switch from single to double ovulation with increasing age.</p>
<h2>A strategy for prolonging fertility</h2>
<p>The reason a switch is beneficial is fetal survival – the chance that a fertilised egg will result in a liveborn child – <a href="https://doi.org/10.1126/science.aaa3337" title="Common variants spanning PLK4 are associated with mitotic-origin aneuploidy in human embryos">decreases rapidly as women age</a> </p>
<p>So switching to releasing two eggs increases the chance at least one will result in a successful birth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/same-same-but-different-when-identical-twins-are-non-identical-112684">Same same but different: when identical twins are non-identical</a>
</strong>
</em>
</p>
<hr>
<p>But what about twinning? Is it a side effect of selection favouring fertility in older women? To answer this question, we ran the simulations again, except now when women double ovulated the simulation removed one offspring before birth.</p>
<p>In these simulations, women who double ovulated throughout their lives, but never gave birth to twins, had more children survive than those who did have twins and switched from single to double ovulating.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333982/original/file-20200511-49558-d6tomg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This suggests the ideal strategy would be to always double ovulate but never produce twins, so fraternal twins are an accidental side effect of a beneficial strategy of double ovulating.</p><img src="https://counter.theconversation.com/content/138209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph L Tomkins receives funding from The Australian Research Council. </span></em></p><p class="fine-print"><em><span>Rebecca Sear and Wade Hazel do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
While identical twins are seen more as an accidental splitting of a single egg, there could be a good reason mothers produce non-identical twins from two separate eggs.
Joseph L Tomkins, Associate Professor in Evolutionary Biology, The University of Western Australia
Rebecca Sear, Head of the Department of Population Health, London School of Hygiene & Tropical Medicine
Wade Hazel, Professor of Biology, DePauw University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/133630
2020-04-02T23:45:32Z
2020-04-02T23:45:32Z
This lizard lays eggs and gives live birth. We think it’s undergoing a major evolutionary transition
<figure><img src="https://images.theconversation.com/files/320542/original/file-20200315-50538-1hweilq.jpg?ixlib=rb-1.1.0&rect=33%2C16%2C3657%2C2058&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Nicholas Wu</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Our earliest vertebrate (animals with backbones) ancestors laid eggs, but over millions of years of evolution, some species began to give birth to live young. </p>
<p>There is a traditional dichotomy in vertebrate reproduction: species either lay eggs or have live births. However, as is often the case in biology, things aren’t as simple as they first appear, and there are a handful of vertebrate animals that do both.</p>
<p>One of these is the three-toed skink (<em>Saiphos equalis</em>). <a href="https://onlinelibrary.wiley.com/doi/10.1111/mec.15409">Our recent research</a> suggests the egg-laying <em>S. equalis</em> may currently be in the process of transitioning from egg-laying to giving live birth.</p>
<p>Studying them gives us a unique opportunity to watch evolution in action.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320547/original/file-20200315-50543-2fa3gj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Saiphos equalis</em> has a distinctive yellow belly, and a long, slender body, ideal for its underground lifestyle.</span>
<span class="attribution"><span class="source">Charles Foster</span></span>
</figcaption>
</figure>
<h2>From eggs to babies, and back again?</h2>
<p>There are two main reproductive strategies in vertebrates. </p>
<p>Animals that lay eggs are called “oviparous”. For instance, many fish species spawn eggs that are fertilised externally. In other oviparous species, including birds and some lizards and snakes, eggs are fertilised inside the mother, an eggshell is added, and then eggs are laid. </p>
<p>Depending on the species, much or all of the nutrition needed to grow a healthy baby is supplied in the egg yolk.</p>
<p>In contrast, “viviparous” animals carry embryos internally until they are fully developed. The embryos can rely entirely on yolk for nutrition, or the parents can provide supplementary nutrition, sometimes via a placenta (as in humans).</p>
<p>There is strong evidence that <a href="https://www.ncbi.nlm.nih.gov/pubmed/24652663">egg-laying is ancestral to live birth</a>, meaning it came first. Many physiological changes were necessary for live birth to have evolved from egg-laying. With this transition, some structures were lost, including the hard outer eggshell. Other mechanisms were gained to ensure embryonic survival within the parent, including the supply of adequate oxygen and water during development.</p>
<p>The evolution of live birth has occurred frequently, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24652663">including at least 121 times in independent groups of reptiles</a>. </p>
<p>Evolutionary “reversals” to egg-laying are much rarer, probably because <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jez.b.22614">regaining the physiological machinery for producing eggshells</a> would be exceptionally difficult.</p>
<h2>¿Por que no los dos?</h2>
<p>Despite the vast differences between egg-laying and live birth, some species can do both. This phenomenon called “bimodal reproduction” is exceptionally rare. There are <a href="http://reptile-database.reptarium.cz/search?search=lizard&submit=Search">more than 6500 species of lizards worldwide</a>, but only three exhibit bimodal reproduction. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lizards-help-us-find-out-which-came-first-the-baby-or-the-egg-29954">Lizards help us find out which came first: the baby or the egg?</a>
</strong>
</em>
</p>
<hr>
<p>We’re lucky enough to have two of these in Australia. <a href="https://www.camillawhittington.com/">Our research group</a> at the University of Sydney studies the bimodally reproductive three-toed skink, in the hope of understanding how live birth evolved. </p>
<p>In northern NSW, the three-toed skink <a href="https://www.publish.csiro.au/zo/zo97023">gives birth to live young, but near Sydney, they lay eggs</a>. Even though they reproduce differently, <a href="https://academic.oup.com/biolinnean/article/74/2/131/2639614">previous research</a> has shown these lizards are a single species.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=637&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=637&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=637&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=801&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=801&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320548/original/file-20200315-50551-w9rfd1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=801&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The three-toed skink displays geographic variation in reproductive mode. It has four very tiny legs, and only three toes per foot.</span>
<span class="attribution"><span class="source">Yi-Kai Tea</span></span>
</figcaption>
</figure>
<p>Even the egg-laying members of the species are odd, as the eggs are retained within the mother for a relatively long time. After being laid, ordinary skink eggs are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1420-9101.1998.11010063.x">incubated for at least 35 days</a> before they hatch, but some three-toed skink eggs <a href="https://www.publish.csiro.au/zo/zo97023">hatch in as few as five days</a> after being laid.</p>
<p>One female even <a href="https://theconversation.com/the-first-known-case-of-eggs-plus-live-birth-from-one-pregnancy-in-a-tiny-lizard-113460">laid eggs and gave birth to a live baby in the same litter</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320543/original/file-20200315-50583-1psbn01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An egg-laying three-toed skink from near Sydney with its clutch of eggs.</span>
<span class="attribution"><span class="source">Stephanie Liang</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-first-known-case-of-eggs-plus-live-birth-from-one-pregnancy-in-a-tiny-lizard-113460">The first known case of eggs plus live birth from one pregnancy in a tiny lizard</a>
</strong>
</em>
</p>
<hr>
<h2>The genetics behind different reproductive modes</h2>
<p>Most aspects of an animal’s development are controlled by its genes, but not every gene is always active. Genes can be expressed (switched on) to different degrees, and gene expression can stop when not needed.</p>
<p>An egg-laying skink uterus undergoes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174741/">only a couple of genetic changes</a> between being empty and holding an egg. </p>
<p>A live-bearing skink uterus is different. It undergoes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318437/">thousands of genetic changes</a> to help support the developing baby, including genes that probably help provide oxygen and water, and regulate the mother’s immune system to keep the baby safe from <a href="https://www.sciencemag.org/news/2018/01/key-successful-pregnancy-tamed-immune-reaction">immunological attack</a>.</p>
<h2>Unexpected similarities between the egg-laying and the live-bearing</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/mec.15409">Our research</a> measured changes in gene expression between egg-laying and live-birth in the three-toed skink. We investigated how the expression of all genes in the uterus differed between when the uterus was empty and when it held an egg or embryo.</p>
<p>As expected, live-bearing <em>S. equalis</em>, undergo thousands of genetic changes during pregnancy to produce a healthy baby. </p>
<p>But surprisingly, when we looked at the uterus of the egg-laying <em>S. equalis</em>, we found these also undergo thousands of genetic changes, many of which are similar to those in their live-bearing counterparts. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320544/original/file-20200315-50583-15ws3px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Embryos of egg-laying Saiphos equalis are nearly completely developed at the time of laying.</span>
<span class="attribution"><span class="source">Stephanie Liang</span></span>
</figcaption>
</figure>
<p>Some of the most important genetic changes in gene expression in egg-laying <em>S. equalis</em> allow embryos to develop within the mother for a long time. These genes also seem to allow the uterus to remodel to accommodate a growing embryo, and drive the same kinds of functions required for the embryonic development in live-birthing three-toed skinks.</p>
<h2>Are ‘reversals’ to egg-laying easier than previously thought?</h2>
<p>Our findings are important because they demonstrate that egg-laying three-toed skinks are an evolutionary intermediate between “true” egg-laying and live birth.</p>
<p>We now know that uterine gene expression in egg-laying <em>S. equalis</em> mirrors live-bearing skinks much more closely than true egg-laying skinks. These results may explain why it’s possible for a female three-toed skink to <a href="https://royalsocietypublishing.org/doi/10.1098/rsbl.2018.0827">lay eggs and give birth to a live baby in a single pregnancy</a>.</p>
<p>The similarities in gene expression between egg-laying and live-bearing three-toed skink uteri might also mean “reversals” from live birth back to egg-laying could be be easier than previously thought. However, this may be restricted to species in which live-birth has evolved recently, such as the three-toed skink.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-were-not-giving-up-the-search-for-mainland-australias-first-extinct-lizard-117831">Why we're not giving up the search for mainland Australia's 'first extinct lizard'</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/133630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Foster receives funding from The University of Sydney. </span></em></p><p class="fine-print"><em><span>Camilla Whittington receives funding from The University of Sydney and the Australian Research Council. </span></em></p>
The three-toed skink can give birth to live young and lay eggs in the same pregnancy. What can this little critter teach us about the evolution of live birth?
Charles Foster, Postdoctoral Research Associate, University of Sydney
Camilla Whittington, Senior lecturer, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/133280
2020-03-30T09:06:20Z
2020-03-30T09:06:20Z
Bonding with baby: what it should feel like and how long it may take
<figure><img src="https://images.theconversation.com/files/320144/original/file-20200312-111268-18os20i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">By six months, the vast majority of parents have bonded with their baby.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/parents-sitting-on-sofa-cuddling-baby-562380934">Monkey Business Images</a></span></figcaption></figure><p>We often assume that giving birth triggers immediate feelings of joy and unconditional love that last a lifetime. But after a long and painful delivery, not every parent feels immediately attracted to the wrinkled and crying newborn who desperately wants to get back into the womb. If this sounds shocking, it may be because a social stigma around “slow bonding” makes people reluctant to share such experiences.</p>
<p>While many parents really do experience the birth of their baby as a major and happy life event, some have an immediate reaction of wishing it had never have happened. And a large proportion of parents will fall somewhere in between, perhaps having simultaneous feelings of wonder and anxiety or even frustration. But what is normal and what constitutes a problem? And what can you do to increase your chances of successful bonding?</p>
<p>Parent-infant bonding is often confused with <a href="https://theconversation.com/parenting-practices-around-the-world-are-diverse-and-not-all-about-attachment-111281">infant-parent attachment</a>. Bonding is the parental feeling of being connected with the infant, experiencing a sense of unconditional love and closeness. Attachment, on the other hand, describes the infant’s need to be close to a protective caregiver. Both develop gradually during the first year of life, based on a biological preparedness and the experience of frequent interactions.</p>
<p>False beliefs about bonding proliferate on social media and the internet, often under the umbrella of “<a href="https://www.theatlantic.com/health/archive/2012/05/what-everyones-missing-in-the-attachment-parenting-debate/257918/">attachment parenting</a>” – suggesting that, for example, early skin-to-skin contact is indispensable for bonding, or that <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2264-0">breastfeeding</a> and <a href="https://www.researchgate.net/publication/298427230_Parent-child_bed-sharing_The_good_the_bad_and_the_burden_of_evidence">co-sleeping</a> would be needed – or even the female gender. </p>
<p>But research on infants adopted at around six months after birth demonstrates that bonding within the first few weeks or even months is <a href="https://psycnet.apa.org/record/2009-02007-019">not necessary for a secure attachment</a> between the infant and a mother or father to emerge. Nevertheless, pregnancy, delivery and breastfeeding might help the human mind to prepare for the new parental responsibilities.</p>
<h2>How common is slow bonding?</h2>
<p>The fact that bonding is an ongoing process rather than a bolt of lightening that hits you once and for all can perhaps explain the fact that people have such different experiences. The number of parents who report not falling in love immediately with their newborn varies, but it <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1523-536X.2001.00274.x">can be between 25% and 35%</a> depending on definition and type of measure. </p>
<p>But even if bonding can take time, it normally happens for all parents eventually. According to a recent Scandinavian survey, at six months after birth, only about 4% of the mothers and 5.5% of the fathers <a href="https://www.tandfonline.com/doi/full/10.3109/03009734.2016.1143540">showed “impaired bonding”</a> (“slow” is a better word).</p>
<p>So what helps parents bond? When women get pregnant, they experience huge hormonal changes. Their oxytocin levels <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902863/">increase during pregnancy</a>, and peak around childbirth and when breastfeeding. A first effect of oxytocin is that it is relaxing and makes us forget painful experiences – which is rather welcome after giving birth.</p>
<p>But oxytocin also affects the salience of social signals, making parents more attentive to signs that the baby is happy or distressed. In our brain scanning studies, we gave women a nose spray with oxytocin to investigate its effect further. We found that women with higher oxytocin levels had more <a href="https://www.ncbi.nlm.nih.gov/pubmed/21470595">connectivity between the brain’s reward centres</a> when they listened to infant laughter – suggesting they enjoyed it more than others.</p>
<p>At the same time, when listening to infant crying, oxytocin led these same women to have less activity in the amygdala, a brain region involved in anxiety, and more activity in empathy-related brain regions. Given that it takes only seconds after birth before babies cry, and around six weeks before they smile, the hormonal system helps young parents to overcome the first tiring weeks.</p>
<p>Oxytocin may also help distinguish between baby cries that need an immediate response and crying that is not urgent, but instead marks the transition from being awake to being asleep in some babies. The brains of women who sniffed oxytocin as part of our study showed less activity when we told them the cry came from a “bored baby” than when it came from a “sick baby”. Such context information, colouring the meaning of the very same cry sound, was <a href="https://www.ncbi.nlm.nih.gov/pubmed/24734297">better taken into account</a> when oxytocin levels were high.</p>
<p>Oxytocin also help fathers. When we asked fathers to take a sniff of it <a href="https://www.ncbi.nlm.nih.gov/pubmed/22544470">they played</a> in a more stimulating and sensitive way with their child. And we know that fathers’ oxytocin levels <a href="https://www.researchgate.net/publication/323385506_Interoception_sensitivity_in_the_parental_brain_during_the_first_months_of_parenting_modulates_children's_somatic_symptoms_six_years_later_The_role_of_oxytocin">increase in the first six months</a> after the baby’s born, and go up during active play with their infants. </p>
<p>So experience helps, too. A new study has shown that the brains of parents <a href="https://www.researchgate.net/publication/330749972_Towards_a_neural_model_of_infant_cry_perception">respond differently to infant crying</a> than the brains of non-parents – they process the sound in a more immediate and emotional way. This is in contrast with non-parents, who use more cognitive processing. Moreover, <a href="https://www.pnas.org/content/111/27/9792">one study in fathers</a> showed that connections in the brain that support caregiving increase with the number of hours they are directly responsible for infant care.</p>
<h2>Bonding support</h2>
<p>A lack of bonding <a href="https://www.tandfonline.com/doi/full/10.3109/03009734.2016.1143540">is strongly associated with</a> experiencing exhaustion, burn-out, sleepless nights and postnatal depression. These are things that can mess with our brain chemistry.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320150/original/file-20200312-111289-6c81ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babies can bond with many people.</span>
<span class="attribution"><span class="source">mimagephotography/shutterstock</span></span>
</figcaption>
</figure>
<p>Raising and successfully bonding with newborns therefore requires all parents to share the workload. Mothers are in fact evolved to <a href="http://www.naturalhistorymag.com/features/09270/meet-the-alloparents?page=2">rely on the support of others</a> to raise their offspring, and children have evolved to become attached to more than one caregiver for survival in a dangerous world.</p>
<p>That means <a href="https://theconversation.com/do-mothers-really-have-stronger-bonds-with-their-children-than-fathers-do-57590">there’s no reason to assume</a> that babies can’t become attached to fathers just as easily as they can be attached to mothers. It is also an argument for societies to facilitate (slow) bonding of both mothers and fathers through paid parental leave. The majority of countries, however, <a href="https://srcd.onlinelibrary.wiley.com/doi/full/10.1111/cdep.12347">fail to provide paid paternity leave</a>.</p>
<p>There are also tricks to speed the process up. For example, many parents <a href="https://www.sciencedirect.com/science/article/pii/S2352250X17300428?via%3Dihub">benefit from watching videos</a> of pleasurable experiences derived from moments of smooth interplay with their baby. Baby carriers might also be helpful to sooth a crying baby, and to strengthen parental bonding. </p>
<p>Ultimately, the birth of a baby is a major life event and bonding helps parents cope. But it is a process and can take time. A lack of initial bonding doens’t mean you have failed – the vast majority of parents successfully bond with their baby after the first few months, after they get to know her. And for anyone struggling at this point, talk to a health professional about getting support.</p>
<p>With time, practice and support to learn the new language of the baby, bonding is likely to develop – slowly but definitely.</p><img src="https://counter.theconversation.com/content/133280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marinus van IJzendoorn receives funding from the Netherlands Organization for Scientific Research (Spinoza prize). He is additionally supported by the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant number 024.001.003).</span></em></p><p class="fine-print"><em><span>Marian Bakermans-Kranenburg receives funding from the European Research Council (ERC AdG), and is supported by the Gravitation program of the Dutch Ministery of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant number 024.001.003).. </span></em></p>
Up to 35% of mothers and fathers don’t fall in love with their baby immediately.
Marinus van IJzendoorn, Honorary Senior Visiting Fellow of Primary Care, University of Cambridge
Marian Bakermans-Kranenburg, Professor of Clinical Child and Family Studies, Vrije Universiteit Amsterdam
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/133619
2020-03-16T03:52:02Z
2020-03-16T03:52:02Z
Coronavirus while pregnant or giving birth: here’s what you need to know
<figure><img src="https://images.theconversation.com/files/320628/original/file-20200315-50519-wgotvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Having a baby is stressful enough without a coronavirus (COVID-19) <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen">pandemic</a> and all the associated misinformation. </p>
<p>If you’re pregnant and/or due to give birth soon, it’s best to get information from trusted sources such as the <a href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">World Health Organisation</a>, the <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/">Royal College of Obstetricians</a> and the <a href="https://www.health.gov.au/news/launch-of-the-coronavirus-covid-19-campaign">Australian Government Department of Health</a>.</p>
<p>Here are the key take-home messages.</p>
<p><a href="https://theconversation.com/newsletter"><img src="https://images.theconversation.com/files/320030/original/file-20200312-116261-a6ugi0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" alt="Sign up to The Conversation" width="100%"></a></p>
<h2>It’s a new virus</h2>
<p>As COVID-19 is a new virus, we are learning more about it every day. As most pregnant women are young and generally healthy, they’re less likely to be severely affected (which is good news). But as there is also a baby to consider, the picture can be more complex. </p>
<p>A baby born recently to a mother in the UK with COVID-19 recently tested <a href="https://www.theguardian.com/world/2020/mar/14/newborn-baby-tests-positive-for-coronavirus-in-london">positive</a> soon after birth but we are not sure whether it was infected in the womb (unlikely) or after birth (more likely). </p>
<p>As far as we know, the baby is fine and the mother is being treated. Other reports on babies with COVID-19 have also shown they had mild symptoms and a good recovery.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-with-a-baby-what-you-need-to-know-to-prepare-and-respond-133078">Coronavirus with a baby: what you need to know to prepare and respond</a>
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</em>
</p>
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<h2>From China’s experience to WHO advice</h2>
<p>To date, much of our information on COVID-19 has come from China. This is where one of the first <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext">studies</a>, involving just nine pregnant women with COVID-19, came from. </p>
<p>All these women had caesarean sections, none were seriously unwell and all mothers and babies recovered. The study found none of the babies appeared to get COVID-19 and there was no evidence of the virus in the baby, breastmilk or fluid surrounding the baby. It’s not clear why these babies were born by caesarean section. China has a very high caesarean section rate, which is <a href="https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf?sequence=1">not optimal</a>, and this may have influenced how they responded.</p>
<p>The World Health Organisation’s new <a href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">guidelines</a> state: </p>
<blockquote>
<p>there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester … WHO recommends that caesarean section should ideally be undertaken only when medically justified</p>
</blockquote>
<h2>Why pregnant women are not more susceptible to COVID-19</h2>
<p>Pregnant women are generally more susceptible to viruses that cause breathing problems (like the flu). Their immunity is lowered, their lungs are more compressed and they need more oxygen. </p>
<p>However, this doesn’t seem to be the case with COVID-19. In an <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">analysis</a> of 147 women with COVID-19, only 8% had severe disease and 1% were in critical condition. That’s lower than the general population.</p>
<p>The <a href="https://immunology.sciencemag.org/content/2/15/eaan2946">lowered immune response</a> of pregnancy, which is needed to stop a woman’s body responding to her baby as a health threat, may actually provide extra <a href="https://www.statnews.com/2020/03/03/who-is-getting-sick-and-how-sick-a-breakdown-of-coronavirus-risk-by-demographic-factors/">protection</a> with COVID-19. COVID-19 seems to be<a href="https://www.medrxiv.org/content/10.1101/2020.02.26.20026989v1.full.pdf"> more severe</a> in people with an immune system working hard dealing with other health disorders. </p>
<p>With COVID-19, <a href="https://www.statnews.com/2020/03/03/who-is-getting-sick-and-how-sick-a-breakdown-of-coronavirus-risk-by-demographic-factors/">more men than women</a> are affected and women are less likely to get severely ill and die. To date, the death rate is 1.7% for women and 2.8% for men. </p>
<p>However, as the pandemic spreads this may change. Women comprise the majority of the <a href="https://www.weforum.org/agenda/2020/03/the-coronavirus-fallout-may-be-worse-for-women-than-men-heres-why/">health workforce</a> and caregivers will be in contact with more sick people. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1118&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1118&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320672/original/file-20200316-53543-m3sq1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1118&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sneeze or cough into your elbow to reduce the spread of germs.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>How can pregnant women protect themselves and others?</h2>
<p>Pregnant women should do the same things as the general public to protect themselves, including:</p>
<ul>
<li>covering the mouth when coughing (by coughing into the crook of your elbow)</li>
<li>avoiding people who are sick</li>
<li>asking people who are unwell to avoid visiting</li>
<li>washing hands often with soap and water or an alcohol-based sanitizer and</li>
<li>avoiding large gatherings. </li>
</ul>
<p>It would be sensible not to travel overseas at the moment; you may have to self-isolate when you return. </p>
<p>Women who think they may have contracted COVID-19 can now consult their GP or other health professional with a <a href="https://www.health.gov.au/sites/default/files/documents/2020/03/covid-19-national-health-plan-primary-care-bulk-billed-mbs-telehealth-services_0.pdf">bulk billed telehealth call</a> (video call) rather than having to go in person. </p>
<p>Women who are pregnant or have new babies are given priority for telehealth services. </p>
<p>If you have been asked to self-isolate due to contact with someone with COVID-19, or have the illness, make sure you contact your midwife or obstetrician by phone and follow the advice of your health care provider. </p>
<h2>What about going to hospital for antenatal visits and birth?</h2>
<p>Keep going to appointments but don’t stress if you miss a couple, and early discharge might be a good idea if you’re able.</p>
<p>If you are booked into a birth centre or hospital, lots of precautions are in place to minimise the risk of infection. Birth will proceed as planned in the vast majority of cases and going home early would be ideal and may be encouraged if you and your baby are well. </p>
<p>Be aware some hospitals are restricting visitors and even support people, other than the partner, to try and reduce risk to the community.</p>
<h2>Can the baby be infected with COVID-19 in the uterus?</h2>
<p>The placenta is a very efficient filtering system and does an amazing job protecting babies from harm. The Zika virus was an <a href="https://www.ncbi.nlm.nih.gov/pubmed/29291210">exception</a> to this.</p>
<p>There is no evidence of increased complications, though if a woman was very unwell (with high temperature or pneumonia, for instance) then the baby may be born prematurely. </p>
<p>This may be due to deliberate intervention by health professionals if the woman is very sick. </p>
<p>In general, though, a COVID-19 diagnosis should not lead to a decision for an early birth, unless ending the pregnancy is thought to be beneficial to the mother due to her overall condition.</p>
<p>There is not enough evidence that COVID-19 increases miscarriage and it is too early to know other longer-term impacts on the baby. </p>
<h2>What should I do after the birth?</h2>
<p>The benefits of breastfeeding are so significant the WHO <a href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">recommends</a> this should begin within an hour of birth. <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/">Skin-to-skin contact</a> should be supported immediately following birth if the baby is well. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320669/original/file-20200316-53574-16p9o3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Skin-to-skin contact should be supported immediately following birth if the baby is well.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>If the mother is too ill, she should be assisted to express her milk. Breastfeeding is particularly effective against infectious diseases because it transfers antibodies and other important immune factors to the baby. If the woman or the baby have an infection, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22258136">the composition of breastmilk</a> even changes to increase important components that help the baby fight infection. So, if you were thinking of giving up breastfeeding, perhaps continue until this pandemic ends. </p>
<p>WHO recommends women who have COVID-19 should wash their hands before and after contact with the baby, use a medical mask when near the baby if they have symptoms (such as coughing), and routinely clean and disinfect surfaces they may have touched. </p>
<h2>What else can you do?</h2>
<p>When the seasonal flu vaccine becomes available, <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/influenza_and_pregnancy.aspx">get vaccinated</a>. We know this can be protective during pregnancy. It is free for pregnant women and there are no risks to your baby from flu vaccine. You will not be protected from COVID-19 but you will get some protection from the flu (which can be very problematic for pregnant women). The last thing you want is to have the flu and COVID-19 at the same time. </p>
<p>Free flu vaccinations will be available from GPs mid-April but if women want them earlier, they can get them for a fee at the pharmacy from end of March.</p>
<p>Most of all, try and stay calm and talk to your midwife or doctor if you are getting very worried.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-5-ways-to-manage-your-news-consumption-in-times-of-crisis-133614">Coronavirus: 5 ways to manage your news consumption in times of crisis</a>
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<img src="https://counter.theconversation.com/content/133619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. Hannah is a member of the Australian College of Midwives </span></em></p><p class="fine-print"><em><span>David Ellwood receives funding from NHMRC and MRFF.</span></em></p>
Having a baby is stressful enough without also having to process misinformation. Here are the facts from the WHO, experts and the research evidence.
Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney University
David Ellwood, Professor of Obstetrics & Gynaecology, Griffith University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/132650
2020-03-11T12:22:58Z
2020-03-11T12:22:58Z
Newborn babies weigh less today – possibly due to the increased popularity of cesarean sections and induced labor
<figure><img src="https://images.theconversation.com/files/319455/original/file-20200309-118913-1b33ag4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cesarean sections have become more common in the U.S. </span> <span class="attribution"><span class="source">Tomsickova Tatyana/Shutterstock.com</span></span></figcaption></figure><p><em>The Research Brief is a short take on interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The decline in U.S. birth weight has been somewhat of a puzzle for public health researchers. Between 1990 and 2017, average <a href="https://www.cdc.gov/nchs/nvss/births.htm">birth weight declined</a> from 7.36 pounds to 7.19 pounds.</p>
<p>There was some speculation about what might explain the decline in birth weight. Some thought it might be the <a href="https://doi.org/10.1097/AOG.0b013e3181cbd5f5">fact that the average U.S. mother is now older</a>. Other research suggested that the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977951/">decline in average length of pregnancies</a> might play a role. </p>
<p>Sociologist and demographer <a href="https://www.colorado.edu/sociology/ryan-masters">Ryan K. Masters</a> <a href="https://www.andreatilstra.com">and I</a> wanted to contribute to the conversation by examining how cesarean deliveries and induction of labor might be involved. </p>
<p>We used the Centers for Disease Control and Prevention’s <a href="https://www.cdc.gov/nchs/nvss/births.htm">National Vital Statistics Systems data</a> to examine single U.S. births between 1990 and 2013. We discovered, <a href="https://doi.org/10.1007/s13524-019-00843-w">in a study published Jan. 29</a>, that the rate of cesarean deliveries increased from 25% to 31% and that labor induction increased from 12% to 29%. </p>
<p>The data show that physicians are intervening more in births than they did in years past, most frequently between weeks 37 and 39 of pregnancy. Weeks 37 to 38 are <a href="https://www.acog.org/About-ACOG/ACOG-Departments/Deliveries-Before-39-Weeks?IsMobileSet=false">typically considered “early full term,”</a> while weeks 39 and 40 are considered full term. </p>
<p>Research shows that there are <a href="https://doi.org/10.1542/peds.2009-0913">substantive differences in the weight of infants</a> born between 37 and 41 weeks. So interventions are increasingly occurring at a key time in gestation, when a substantial amount of fetal growth occurs. </p>
<p>We then simulated what might have happened to average U.S. birth weights if rates of cesarean deliveries and labor induction had not increased. We found that if rates of obstetric interventions had not increased, then U.S. birth weight would have increased. </p>
<p><iframe id="4NyjG" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4NyjG/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>These technologies are certainly beneficial in many circumstances, <a href="https://doi.org/10.1016/j.ajog.2011.01.062">including high-risk pregnancies</a>, which are often delivered early. But the vast majority of the interventions are not occurring among preterm births. </p>
<p>Obstetric interventions are more expensive for patients and hospitals than births that proceed without intervention.</p>
<p>Inductions and c-sections are also associated with <a href="https://doi.org/10.1016/S0140-6736(18)31930-5">potential maternal and infant health risks</a>. For example, cesarean deliveries are associated with increased risk of uterine rupture for mothers and altered immune development for infants. </p>
<p>Despite recommendations from the American College of Obstetricians and Gynecologists <a href="https://journals.lww.com/greenjournal/Fulltext/2019/02000/ACOG_Committee_Opinion_No__765__Avoidance_of.43.aspx">to not intervene before week 39</a>, the most dramatic increases in interventions are occurring just before that time. </p>
<h2>What still isn’t known</h2>
<p>Medical professionals and public health scholars alike are interested in decreasing the rates of these interventions, especially those that are not medically necessary.</p>
<p>But researchers don’t know much about why rates of cesarean deliveries and labor induction increased. </p>
<p>Some research suggests that the rise is happening because <a href="https://nyupress.org/9780814764114/cut-it-out/">health care organizations are under pressure</a> to make money and to avoid potential legal consequences. This can result in encouraging physicians to turn to profit-generators like cesarean deliveries.</p>
<p>This question is the topic of my dissertation research. I hope to shed more light on changes in how society talks about the risk of obstetric interventions. Studies show that <a href="https://doi.org/10.1053/j.semperi.2012.04.025">physicians</a> are more afraid of situations that they perceive as risky and as such might act in ways to protect themselves. The medical field is encouraging physicians to engage in more defensive medicine, as indicated by <a href="http://doi.org/10.1097/MLR.0b013e31818475de">higher medical malpractice premiums</a>. </p>
<p>Our team also doesn’t know much about how the patterns we observed vary by demographic characteristics. We’re now investigating this further, by examining patterns across mothers’ race and ethnicity and the state where the birth occurred. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Tilstra receives funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). </span></em></p>
The decline in US birth weight is somewhat of a puzzle for public health researchers.
Andrea Tilstra, Ph.D. Candidate in Sociology, University of Colorado Boulder
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/132015
2020-02-21T01:31:02Z
2020-02-21T01:31:02Z
What is hypnobirthing, the technique the Duchess of Cambridge used?
<p>In a new <a href="https://www.abc.net.au/news/2020-02-16/duchess-of-cambridge-kate-middleton-hypnobirthing-podcast/11969832">parenting podcast</a>, Catherine, the Duchess of Cambridge, said she used hypnobirthing techniques to help her get through severe morning sickness – a condition called <a href="https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-ehandbook/hyperemesis-gravidarum-hg-assessment-and-management">hyperemesis gravidarum</a>.</p>
<p>She also used the techniques during labour. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B8kG9RlltWq","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>She <a href="https://www.abc.net.au/news/2020-02-16/duchess-of-cambridge-kate-middleton-hypnobirthing-podcast/11969832">told the Happy Mum, Happy Baby podcast</a>:</p>
<blockquote>
<p>I saw the power of it, the meditation and the deep breathing and things like that, that they teach you in hypnobirthing, when I was really sick, and actually I realised that this was something I could take control of during labour.</p>
<p>It was hugely powerful.</p>
</blockquote>
<p>So what is hypnobirthing and what does the evidence say about its use?</p>
<h2>Calmness and relaxation</h2>
<p>Hypnobirthing aims to reduce fear, pain and anxiety during childbirth. It involves learning calm breathing techniques, some deep relaxation, guided mediation, visualisation, positive suggestions and affirmations. </p>
<p>These affirmations might include phrases such as, “I have the ability to give birth to my baby,” or “I trust in my body and my baby to help me.” </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">Explainer: what are women's options for giving birth?</a>
</strong>
</em>
</p>
<hr>
<p>Hypnobirthing teaches women to induce a “self-hypnotic” state of mind where a woman focuses her attention inwards, concentrates deeply and this helps her to decrease peripheral awareness. But she can still respond to suggestions and affirmations.</p>
<p>When a woman is afraid she will physically become tense, rigid and produce the stress hormones adrenaline and cortisol. Her perception of pain will increase and this can affect labour. </p>
<p>Hypnobirthing aims to counteract the effects of fear and help women secrete the hormones oxytocin and endorphins which enable her to remain calm and relaxed, so labour can progress. </p>
<p>Some women who have used hypnobirthing techniques <a href="https://www.babycenter.com/0_hypnosis-for-labor-does-hypnobirthing-work_10351603.bc">say they feel</a> like they are day dreaming, in a trance and drifting into a calm, deeply relaxed state but are not actually sleeping. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316389/original/file-20200220-92530-8o5y70.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women who use hypnobirthing techniques aim to decrease their peripheral awareness.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-having-contraction-during-natural-200199683">Shutterstock</a></span>
</figcaption>
</figure>
<p>Hypnobirthing techniques are founded on British obstetrician Grantly Dick-Read’s observations. In his 1942 book, <a href="https://www.booktopia.com.au/childbirth-without-fear-grantly-dick-read/book/9781780660554.html">Childbirth without Fear</a>, he proposed women in a calm state of mind, and who had faith in their ability to give birth, did so with less pain.</p>
<p>These days, women and their partners or support people can learn self-hypnotic techniques for hypnobirthing by attending one-to-one sessions, group classes or <a href="https://apps.apple.com/au/app/birth-made-easy-hypnobirthing/id1021177624">online courses</a>. </p>
<p>Usually, women attend <a href="https://hypnobirthingaustralia.com.au/">sessions</a> from about 25-30 weeks of pregnancy but self-hypnosis and guided mediation techniques are sometimes taught earlier in pregnancy.</p>
<p>There is also emerging evidence it could be used postnatally if women have had a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26162981">traumatic birth</a> or are experiencing increased levels of anxiety, stress or <a href="https://www.asch.net/portals/0/journallibrary/articles/ajch-49/49-3/yexley49-3.pdf">depression</a> after birth.</p>
<h2>Fear and anxiety in childbirth</h2>
<p>Historically, women have been supported and comforted by other women during labour and birth, including in <a href="https://www.researchgate.net/publication/215781043_Traditional_Aboriginal_birthing_practices_in_Australia_Past_and_present">traditional Aboriginal birthing practices</a>. Women would support other women by performing special songs, chants and rituals to ease the birthing process and make the woman feel safe and calm.</p>
<p>But while great advances in care have resulted in better outcomes for mothers and babies in childbirth, many women today <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1659-7">are extremely anxious and afraid</a> of this process. </p>
<p>So it’s important find ways to reduce anxiety and fear associated with childbirth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/parent-education-and-complementary-therapies-reduce-birthing-risks-62417">Parent education and complementary therapies reduce birthing risks</a>
</strong>
</em>
</p>
<hr>
<p>Other strategies women can also use alongside hypnobirthing include having a <a href="https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth">continuous support person for labour</a> and undergoing <a href="https://bmjopen.bmj.com/content/6/7/e010691">combined complementary therapies</a>, such as yoga, acupressure and learning breathing techniques, in preparation for birth. </p>
<h2>What does the evidence say about hypnobirthing?</h2>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009356.pub3/full?highlightAbstract=hypnosis%7Cchildbirth%7Cwithdrawn%7Chypnosi">2016 Cochrane review</a> examined the effectiveness and safety of hypnosis for pain management in labour and birth. The review examined nine studies of varying quality which included just under 3,000 women. </p>
<p>It found women who used hypnobirthing techniques used less of some kinds of pain relief such as opioid pain medication or inhaling nitrous oxide and oxygen, than women who didn’t. However epidural rates were similar in both groups.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316391/original/file-20200220-92502-15msefw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The evidence suggests hypnobirthing is linked to a decreased use of opioids and gas, but not epidurals.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-pain-hospital-waiting-give-231817183">Shutterstock</a></span>
</figcaption>
</figure>
<p>There were no clear differences between women who used hypnobirthing techniques and those who didn’t for most of the other measures. These included their satisfaction with pain relief, their sense of coping with labour and their likelihood of having a spontaneous vaginal birth.</p>
<p>Importantly, the review found hypnobirthing didn’t cause any harm.</p>
<p>Overall, little research has been conducted on hypnobirthing. We need more well-designed studies to accurately assess the effectiveness of these techniques.</p>
<h2>It might help some women and not others</h2>
<p>Some women who participated in a clinical trial of self-hypnosis were <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0659-0">followed up and interviewed</a> and reported feelings of calmness, confidence and empowerment.</p>
<p>But the techniques don’t work for everyone. </p>
<p><a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0659-0">Some women reported</a> feeling frustrated or disappointed when their labour and birth experiences didn’t match their expectations, or when their midwives misinterpreted their relaxed state.</p>
<p>Other women find it extremely difficult to switch off and relax. They may find they’re not able to put themselves into a deeply relaxed state and then respond to positive suggestions and affirmations. </p>
<p>Some women may be sceptical of the process and don’t see any potential benefits.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-everything-you-see-on-tv-hypnosis-is-less-far-fetched-and-far-more-important-57212">Don’t believe everything you see on TV: hypnosis is less far fetched and far more important</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/132015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Steen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Hypnobirthing aims to reduce fear and pain during childbirth. But while the evidence suggests it’s associated with decreased use of some pain medications, it doesn’t affect epidural rates.
Mary Steen, Professor of Midwifery, University of South Australia
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/128962
2020-02-20T12:18:27Z
2020-02-20T12:18:27Z
The US birth rate keeps declining: 4 questions answered
<figure><img src="https://images.theconversation.com/files/314555/original/file-20200210-109930-vlde1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many American women are having children later in life.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-first-many-small-hospital-1103569475">Sopotnicki/Shutterstock.com</a></span></figcaption></figure><p>Over the last few decades, <a href="https://www.un.org/press/en/2003/pop850.doc.htm">birth rates</a> have decreased across the globe.</p>
<p>The United States is no exception. Aside from a few years in the mid-2000s, the number of births in the United States have been falling for the last three decades and have now reached their lowest number in 32 years.</p>
<p>The country is now below <a href="https://www.cdc.gov/nchs/nvss/births.htm">population replacement rates</a> as a nation. This means that the population will start to shrink in numbers, generation by generation.</p>
<p>As <a href="https://www.obgyn.pitt.edu/people/marie-n-menke-md-mph">a specialist in infertility</a>, I see women who live this trend on a daily basis as they struggle with their decisions regarding childbearing and fertility.</p>
<p><iframe id="ekYWJ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ekYWJ/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>1. Why are birth rates declining?</h2>
<p>There can be many reasons, and not all of them are bad. Certainly the reduction in <a href="https://www.cdc.gov/nchs/fastats/teen-births.htm">teenage birth rates</a> – from 41.5 per 1,000 women in 2007 to 17.4 per 1,000 women in 2018 – should be welcome news. </p>
<p>Age plays a role as well. While birth rates declined for nearly all age groups under 35, they rose for women in their late 30s and early 40s. This data shows that women are delaying childbearing. </p>
<p>Indeed, over the last decade, the Centers for Disease Control and Prevention reported an <a href="https://www.cdc.gov/nchs/products/databriefs/db21.htm">increase in average age at first birth</a> and an eight-fold increase in proportion of first births to women aged 35 years or older. </p>
<p>The <a href="https://www.cdc.gov/nchs/fastats/births.htm">mean age at first birth</a> in the U.S. is now at a record high – 26.9 years in 2018.</p>
<p><iframe id="Cqj7w" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Cqj7w/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>2. Is delayed childbearing a problem?</h2>
<p>Like all choices, having children later in life comes with pros and cons.</p>
<p>At the population level, delayed childbearing results in <a href="https://www.un.org/en/development/desa/population/publications/factsheets/index.asp">a slowed pace of population growth</a>. It changes the distribution of the population by age and reduces the number of children relative to the size of the working-age population. </p>
<p>On the individual level, delayed childbearing offers the opportunity to seek financial stability before starting a family.</p>
<p>However, delayed childbearing has been implicated in <a href="https://doi.org/10.1097/AOG.0000000000002853">increased rates of multiple births</a>, both with and without assisted reproductive technology, as well as <a href="https://doi.org/10.1542/peds.109.3.399">pregnancy-associated complications</a>, such as gestational diabetes and preeclampsia.</p>
<p>Similarly, as women get older, they are less likely to become pregnant without medical assistance or to avoid a C-section.</p>
<p>While a woman attempting to conceive in her early 30s has a <a href="https://www.reproductivefacts.org/resources/infographic-gallery/images/your-chance-of-pregnancy-each-month-declines-with-age/">20% chance of getting pregnant per month</a>, a 40-year-old woman has a 5% chance.</p>
<p>The likelihood is high that many of these women in the older brackets of childbearing will have turned to infertility treatment as a method to build their families. In the U.S. in 2007, approximately <a href="https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2017">6,000 IVF cycles</a> were started in women over 42 using their own eggs. By 2017, this number was over 10,000.</p>
<h2>3. Why are women waiting?</h2>
<p>The CDC reports population-level statistics based on <a href="https://www.cdc.gov/nchs/products/databriefs/db346.htm">births per 1,000 women</a>.</p>
<p>However, these rates do not show the number of women who delayed childbearing and subsequently could not conceive, or the reasons why women might have waited.</p>
<p>Female fertility declines with age, but almost one-third of women who visit a fertility clinic <a href="https://doi.org/10.1093/humrep/des409">report they expected to get pregnant without difficulty at age 40</a>. This is simply <a href="https://doi.org/10.1080/02646838.2017.1320363">not the case</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19135565">Some studies</a> suggest that relationships and enjoyment of current lifestyle are a major reason for delay. In my clinic, women frequently cite work and education. Many of my patients wanted to wait until they were in a better place in their life before starting their family.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315062/original/file-20200212-61958-rn49vi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Female fertility declines with age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-looking-ultrasound-scan-baby-303963932">Phil Jones/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>4. I’m not ready – what should I do?</h2>
<p>Treatment options for women who have difficulty conceiving with fertility treatment are limited. </p>
<p>Although some women do still conceive with their own eggs, the national <a href="https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2017">average live birth rate in women over the age of 42</a> is approximately 3% among women who undergo IVF using their own eggs. Individual medical history may raise or lower this percentage, but not to a large degree. </p>
<p>For women who are not ready to conceive, but wish to preserve the option for use of their own eggs, elective oocyte cryopreservation, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/30396539">egg freezing</a>, has become increasingly available. Women should understand this is an option to preserve the chance, but not a guarantee, for future childbearing.</p>
<p>The American Society of Reproductive Medicine and the American College of Obstetricians and Gynecologists have <a href="https://www.ncbi.nlm.nih.gov/pubmed/18669745">stressed the need for education and immediate evaluation</a> of age-associated fertility decline.</p>
<p>Whatever the underlying reason, the increased birth rates at later ages are enough to suggest that education on the risks and benefits of delayed childbearing should start early. Although I’d hope this discussion could occur in a general practitioner’s setting, the reality with health care today is that a physician office visit has to cover a lot of ground. By the time a woman is ready to discuss fertility, it may already be more difficult to conceive than she realizes. </p>
<p>As more and more families face declining fertility, the chance to learn and discuss at early stages of family planning have never been more important.</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/128962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie Menke does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The number of births in the United States have been falling for the last three decades, reaching their lowest number in 32 years.
Marie Menke, Assistant Professor of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/126424
2019-11-13T13:08:38Z
2019-11-13T13:08:38Z
Could the Federal government start paying for abortions after the 2020 elections?
<figure><img src="https://images.theconversation.com/files/300177/original/file-20191104-88399-1gz9dqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Abortion rights advocates wear pink shirts while opponents wear red at a public hearing in Boston.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Abortion-Bills/80e8c51db875472e97b5f476d3d8500e/120/0">AP Photo/Steven Senne</a></span></figcaption></figure><p>In 1976, conservative Congressman <a href="https://www.govtrack.us/congress/members/henry_hyde/400192">Henry Hyde</a> of Illinois introduced a bill that would <a href="https://www.kff.org/womens-health-policy/issue-brief/the-hyde-amendment-and-coverage-for-abortion-services/">ban the use of federal funding for abortion expenses</a> except in instances of rape, incest or danger to the life of the mother.</p>
<p>Today, the Hyde Amendment, which has been added as a rider to federal budget appropriation bills since 1977, <a href="https://www.theatlantic.com/politics/archive/2019/06/democrats-hyde-amendment-history/591646/">prohibits abortion coverage</a> for approximately <a href="https://www.statista.com/topics/1091/medicaid/">74 million</a> Medicaid recipients.</p>
<p>It also prohibits the federal government from covering abortion in health programs for federal employees, federal prisoners, those who rely on Indian Health Services, active military members and veterans, <a href="https://www.guttmacher.org/gpr/2017/01/real-life-federal-restrictions-abortion-coverage-and-women-they-impact">among others</a>. </p>
<p>I’m a <a href="https://www.researchgate.net/profile/Gretchen_Ely">social work health scholar</a> who studies vulnerable people’s access to reproductive health care. <a href="https://www.wmur.com/article/joe-biden-was-denied-communion-at-a-catholic-church-in-south-carolina/29629415">Now that the Hyde amendment</a> <a href="https://www.washingtontimes.com/news/2019/oct/24/pete-buttigieg-power-women-plan-guarantee-abortion/">has become a focus</a> for some candidates in the <a href="https://www.politico.com/story/2019/06/09/bernie-sanders-hyde-amendment-1358518">2020 presidential election</a>, I believe it’s important to understand who it affects and how it can be repealed.</p>
<h2>Hyde hurts young people of color</h2>
<p>At the amendment’s inception, Henry Hyde noted his inability to restrict abortion for everyone and said he would have to settle for impeding access for <a href="https://www.guttmacher.org/gpr/2007/03/heart-matter-public-funding-abortion-poor-women-united-states">poor women</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=678&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=678&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=678&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=852&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=852&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300173/original/file-20191104-88419-sulm16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=852&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hyde sponsored a bill in Congress limiting spending of tax money to pay for abortions.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Campaign-2016-Abortion-Funding/0d96851c527141069ec1d7651f3f4c53/1/0">AP Photo/Charles Harrity</a></span>
</figcaption>
</figure>
<p>In its current form, the amendment primarily affects poor people, people of color and those who are young. </p>
<p>As the Kaiser Foundation indicates, women of color have <a href="https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/">higher rates of unintended</a> pregnancy <a href="https://bixbycenter.ucsf.edu/news/women-color-need-improved-information-and-access-effective-contraception">compared with white women</a>. This likely results from difficulty accessing <a href="https://bixbycenter.ucsf.edu/news/women-color-need-improved-information-and-access-effective-contraception">preventive health care</a>.</p>
<p>In fact, the majority of those who have abortions in the U.S. <a href="https://www.kff.org/womens-health-policy/issue-brief/the-hyde-amendment-and-coverage-for-abortion-services/">are adolescents and young adults with limited financial resources</a>. </p>
<p>My own research shows that adolescents in a sample of people who could not afford abortions were <a href="https://doi.org/10.1111/hsc.12582">more likely to identify as black or African American</a>, compared with adults in the same sample. </p>
<p>So, does the amendment prevent abortions, as Sen. Hyde intended it to do? <a href="https://www.nytimes.com/2019/06/07/us/politics/what-is-the-hyde-amendment.html">It’s hard to say</a>, because we have no data showing how many people who are served by federal health programs get abortions without using their insurance.</p>
<p>However, the Guttmacher Institute estimates that between 18% and 37% of Medicaid recipients who carried unwanted pregnancies to term did so due to an <a href="https://www.guttmacher.org/sites/default/files/report_pdf/medicaidlitreview.pdf">inability to pay</a> for desired abortions.</p>
<p>Abortion opponents <a href="https://lozierinstitute.org/hydeat40/">view this as evidence of Hyde’s success</a>, but research indicates that there are varied and serious public health impacts for those who are denied abortion and for their children. These include poverty, greater <a href="https://doi.org/10.2105/AJPH.2017.304247">reliance on public assistance programs</a> and <a href="https://doi.org/10.1016/j.jpeds.2018.09.026">child development delays</a>.</p>
<h2>The Hyde Amendment’s impact</h2>
<p><a href="https://doi.org/10.1080/00981389.2016.1263270">My research</a> highlights the ways Hyde disproportionately affects marginalized populations that have the most difficulty affording abortion. </p>
<p>Abortion funds are organizations that <a href="https://abortionfunds.org/about/">provide financial assistance to help pay for abortions</a>. My research indicates that the majority of people assisted by these organizations are <a href="https://doi.org/10.1080/00981389.2016.1263270">young people of color who are already parenting</a> at least one child. </p>
<p>Some states, such as <a href="https://www.health.ny.gov/health_care/managed_care/famplan10ques.htm">New York</a> and <a href="https://accesswhj.org/sites/default/files/docs/NHeLP-CAAbortionCoverageFactSheet-Web.pdf">California</a>, use their own funds to <a href="https://www.kff.org/medicaid/state-indicator/abortion-under-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">go around the Hyde requirements</a> and include abortion services for Medicaid recipients. Unsurprisingly, I found that people who received private financial assistance to help with abortion costs were more likely to live in states <a href="https://doi.org/10.1080/19317611.2017.1316809">that had not expanded their Medicaid programs</a> to cover abortions.</p>
<h2>Bipartisan appeal</h2>
<p>Hyde has survived for more than 40 years because historically there has been <a href="https://www.theatlantic.com/politics/archive/2019/06/democrats-hyde-amendment-history/591646/">bipartisan support</a> for the amendment in Congress, and there is certainly not a road to repeal when Republicans hold a majority in the Senate.</p>
<p>That said, eliminating Hyde is straightforward. Because the amendment is added as a rider to the budget appropriation each year, all that’s required is to vote for lawmakers who will end this practice. <a href="https://www.vice.com/en_us/article/neak4m/2020-democrats-hate-the-hyde-amendment-but-they-vote-for-it-anyway">Moving forward</a>, that would permit abortion coverage in federal health programs.</p>
<p>Some officials are taking an active approach to repeal. For example, <a href="https://thehill.com/homenews/house/448728-ocasio-cortez-starts-petition-to-repeal-hyde-amendment">Alexandria Ocasio-Cortez</a> introduced a petition to repeal the amendment. In March, several Democrats reintroduced the <a href="https://www.guttmacher.org/article/2019/03/each-woman-act-offers-bold-path-toward-equitable-abortion-coverage">Equal Access to Abortion Coverage in Health Insurance Act</a>, which would allow federal insurance programs to cover abortion. </p>
<p>While a slight majority of Americans polled <a href="https://www.pollingreport.com/abortion.htm">support</a> requirements for insurance to cover abortion, the majority also <a href="https://slate.com/news-and-politics/2019/06/joe-biden-hyde-amendment-democratic-support.html">oppose</a> public funding for abortion. This suggests that the voters may not understand that public funding of abortion is necessary for abortion to be covered by all insurance plans. </p>
<p>[ <em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/126424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gretchen E. Ely has previously received funding from the Society of Family Planning and inroads: the International Network for the Reduction of Abortion Discrimination and Stigma.</span></em></p>
The Hyde Amendment bans federal abortion funding for most people.
Gretchen E. Ely, Professor of Social Work and Associate Dean for Academic Affairs, University at Buffalo
Licensed as Creative Commons – attribution, no derivatives.