‘Free birthing’ and planned home births might sound similar but the risks are very different
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The death of premature twins in Byron Bay in an apparent “wild birth”, or free birth, last week has prompted fresh concerns about giving birth without a midwife or medical assistance.
This follows another case from Victoria this year, where a baby was born in a critical condition following a reported free birth.
It’s unclear how common free birthing is, as data is not collected, but there is some evidence free births increased during the COVID pandemic.
Planned home births also became more popular during the pandemic, as women preferred to stay away from hospitals and wanted their support people with them.
But while free births and home births might sound similar, they are a very different practice, with free births much riskier. So what’s the difference, and why might people opt for a free birth?
What are home births?
Planned home births involve care from midwives, who are registered experts in childbirth, in a woman’s home.
These registered midwives work privately, or are part of around 20 publicly funded home birth programs nationally that are attached to hospitals.
They provide care during the pregnancy, labour and birth, and in the first six weeks following the birth.
The research shows that for women with low risk pregnancies, planned home births attended by competent midwives (with links to a responsive mainstream maternity system) are safe.
Home births result in less intervention than hospital births and women perceive their experience more positively.
What are free births?
A free birth is when a woman chooses to have a baby, usually at home, without a registered health professional such as a midwife or doctor in attendance.
Different terms such as unassisted birth or wild pregnancy or birth are also used to refer to free birth.
The parents may hire an unregulated birth worker or doula to be a support at the birth but they do not have the training or medical equipment needed to manage emergencies.
Women may have limited or no health care antenatally, meaning risk factors such as twins and breech presentations (the baby coming bottom first) are not detected beforehand and given the right kind of specialist care.
Why do some people choose to free birth?
We have been studying the reasons women and their partners choose to free birth for more than a decade. We found a previous traumatic birth and/or feeling coerced into choices that are not what the woman wants were the main drivers for avoiding mainstream maternity care.
Australia’s childbirth intervention rates – for induction or augmentation of labour, episiotomy (cutting the tissue between the vaginal opening and the anus) and caesarean section – are comparatively high.
One in ten women report disrespectful or abusive care in childbirth and some decide to make different choices for future births.
Lack of options for a natural birth and birth choices such as home birth or birth centre birth also played a major role in women’s decision to free birth.
Publicly funded home birth programs have very strict criteria around who can be accepted into the program, excluding many women.
In other countries such as the United Kingdom, Netherlands and New Zealand, publicly funded home births are easier to access.
Ink Drop/Shutterstock
Only around 200 midwives provide private midwifery services for home births nationally. Private midwives are yet to obtain insurance for home births, which means they are risking their livelihoods if something goes wrong and they are sued.
The cost of a home birth with a private midwife is not covered by Medicare and only some health funds rebate some of the cost. This means women can be out of pocket A$6-8,000.
Access to home birth is an even greater issue in rural and remote Australia.
How to make mainstream care more inclusive
Many women feel constrained by their birth choices in Australia. After years of research and listening to thousands of women, it’s clear more can be done to reduce the desire to free birth.
As my co-authors and I outline in our book, Birthing Outside the System: The Canary in the Coal Mine, this can be achieved by:
- making respectful care a reality so women aren’t traumatised and alienated by maternity care and want to engage with it
- supporting midwifery care. Women are seeking more physiological and social ways of birthing, minimising birth interventions, and midwives are the experts in this space
- supporting women’s access to their chosen place of birth and model of care and not limiting choice with high out-of-pocket expenses
- providing more flexible, acceptable options for women experiencing risk factors during pregnancy and/or birth, such as having a previous caesarean birth, having twins or having a baby in breech position. Women experiencing these complications experience pressure to have a caesarean section
- getting the framework right with policies, guidelines, education, research, regulation and professional leadership.
Ensuring women’s rights and choices are informed and respected means they’re less likely to feel they’re left with no other option.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Broccoli vs Asparagus – Which is Healthier?
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Our Verdict
When comparing broccoli to asparagus, we picked the broccoli.
Why?
Both are great! But broccoli does distinguish itself:
In terms of macros, broccoli has slightly more protein, carbs, and fiber. The two vegetables have the same glycemic index. We’ll call this a slight win for broccoli based mainly on the higher fiber, but it’s not by a huge amount.
When it comes to vitamins, broccoli has more of vitamins B5, B6, B9, C, K, and choline, whereas asparagus has more of vitamins A, B1, B2, B3, and E. This would already be a 6:5 marginal win for broccoli, but it’s worth bearing in mind that broccoli’s margins are greater, especially with broccoli having around 15x the amount of vitamin C. So, a clear win for broccoli, respectable as asparagus may be.
In the category of minerals, broccoli has more calcium, magnesium, manganese, phosphorus, potassium, and selenium, while asparagus boasts more copper, iron, and zinc. A 6:3 win for broccoli here.
Both vegetables also contain generous amounts of antioxidant polyphenols and other beneficial phytochemicals, often a little different from each other, so that’s a case for enjoying both.
Still, if you’re going to pick just one, we recommend the broccoli!
Want to learn more?
You might like to read:
Take care!
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The Sprout Book – by Doug Evans
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Sprouting seeds are more nutritious than most people think, and “seeds” is also a much broader category than people think. Beyond even chia and sunflower and such, this book bids us remember that onions do not just appear on supermarket shelves fully formed (to give just one example of many); most plants come from seeds and of those, most can be usefully sprouted.
The author, most well-known for his tech companies, here is selling us a very low-tech health kick with very little profit to be found except for our health. By sprouting seeds of many kinds at home, we can enjoy powerful superfoods that are not only better than, but also cheaper than, most supplements.
Nor are the benefits of sprouting things marginal; we’re not talking about a 1–10% increase in bioavailable so much as what’s often a 100–1000% increase.
After explaining the science and giving a primer on sprouting things for oneself, there is a wide selection of recipes, but the biggest benefit of the book is in just getting the reader up-and-running with at-home sprouting.
Bottom line: if you like the idea of letting food be your medicine and even like the idea of essentially growing your own food with zero gardening skills, then this is an excellent book for you.
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Intermittent Fasting In Women
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Does intermittent fasting differ for women, and if so, how?❞
For the sake of layout, we’ve put a shortened version of this question here, but the actual wording was as below, and merits sharing in full for context
Went down a rabbit hole on your site and now can’t remember how I got to the “Fasting Without Crashing” article on intermittent fasting so responding to this email lol, but was curious what you find/know about fasting for women specifically? It’s tough for me to sift through and find legitimate studies done on the results of fasting in women, knowing that our bodies are significantly different from men. This came up when discussing with my sister about how I’ve been enjoying fasting 1-2 days/week. She said she wanted more reliable sources of info that that’s good, since she’s read more about how temporary starvation can lead to long-term weight gain due to our bodies feeling the need to store fat. I’ve also read about that, but also that fasting enables more focused autophagy in our bodies, which helps with long-term staving off of diseases/ailments. Curious to know what you all think!
~ 10almonds subscriber
So, first of all, great question! Thanks for asking it
Next up, isn’t it strange? Books come in the format:
- [title]
- [title, for women]
You would not think women are a little over half of the world’s population!
Anyway, there has been some research done on the difference of intermittent fasting in women, but not much.
For example, here’s a study that looked at 1–2 days/week IF, in other words, exactly what you’ve been doing. And, they did have an equal number of men and women in the study… And then didn’t write down whether this made a difference or not! They recorded a lot of data, but neglected to note down who got what per sex:
Here’s a more helpful study, that looked at just women, and concluded:
❝In conclusion, intermittent fasting could be a nutritional strategy to decrease fat mass and increase jumping performance.
However, longer duration programs would be necessary to determine whether other parameters of muscle performance could be positively affected by IF. ❞
~ Dr. Martínez-Rodríguez et al.
Those were “active women”; another study looked at just women who were overweight or obese (we realize that “active women” and “obese or overweight women” is a Venn diagram with some overlap, but still, the different focus is interesting), and concluded:
❝IER is as effective as CER with regard to weight loss, insulin sensitivity and other health biomarkers, and may be offered as an alternative equivalent to CER for weight loss and reducing disease risk.❞
As for your sister’s specific concern about yo-yoing, we couldn’t find studies for this yet, but anecdotally and based on books on Intermittent Fasting, this is not usually an issue people find with IF. This is assumed to be for exactly the reason you mention, the increased cellular apoptosis and autophagy—increasing cellular turnover is very much the opposite of storing fat!
You might, by the way, like Dr. Mindy Pelz’s “Fast Like A Girl”, which we reviewed previously
Take care!
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How To Avoid Carer Burnout (Without Dropping Care)
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How To Avoid Carer Burnout
Sometimes in life we find ourselves in a caregiving role.
Maybe we chose it. For example, by becoming a professional carer, or even just by being a parent.
Oftentimes we didn’t. Sometimes because our own parents now need care from us, or because a partner becomes disabled.
Philosophical note: an argument could be made for that latter also having been a pre-emptive choice; we probably at some point said words to the effect of “in sickness and in health”, hopefully with free will, and hopefully meant it. And of course, sometimes we enter into a relationship with someone who is already disabled.
But, we are not a philosophy publication, and will henceforth keep to the practicalities.
First: are you the right person?
Sometimes, a caregiving role might fall upon you unasked-for, and it’s worth considering whether you are really up for it. Are you in a position to be that caregiver? Do you want to be that caregiver?
It may be that you do, and would actively fight off anyone or anything that tried to stop you. If so, great, now you only need to make sure that you are actually in a position to provide the care in question.
It may be that you do want to, but your circumstances don’t allow you to do as good a job of it as you’d like, or it means you have to drop other responsibilities, or you need extra help. We’ll cover these things later.
It may be that you don’t want to, but you feel obliged, or “have to”. If that’s the case, it will be better for everyone if you acknowledge that, and find someone else to do it. Nobody wants to feel a burden, and nobody wants someone providing care to be resentful of that. The result of such is two people being miserable; that’s not good for anyone. Better to give the job to someone who actually wants to (a professional, if necessary).
So, be honest (first with yourself, then with whoever may be necessary) about your own preferences and situation, and take steps to ensure you’re only in a caregiving role that you have the means and the will to provide.
Second: are you out of your depth?
Some people have had a life that’s prepared them for being a carer. Maybe they worked in the caring profession, maybe they have always been the family caregiver for one reason or another.
Yet, even if that describes you… Sometimes someone’s care needs may be beyond your abilities. After all, not all care needs are equal, and someone’s condition can (and more often than not, will) deteriorate.
So, learn. Learn about the person’s condition(s), medications, medical equipment, etc. If you can, take courses and such. The more you invest in your own development in this regard, the more easily you will handle the care, and the less it will take out of you.
And, don’t be afraid to ask for help. Maybe the person knows their condition better than you, and certainly there’s a good chance they know their care needs best. And certainly, there are always professionals that can be contacted to ask for advice.
Sometimes, a team effort may be required, and there’s no shame in that either. Whether it means enlisting help from family/friends or professionals, sometimes “many hands make light work”.
Check out: Caregiver Action Network: Organizations Near Me
A very good resource-hub for help, advice, & community
Third: put your own oxygen mask on first
Like the advice to put on one’s own oxygen mask first before helping others (in the event of a cabin depressurization in an airplane), the rationale is the same here. You can’t help others if you are running on empty yourself.
As a carer, sometimes you may have to put someone else’s needs above yours, both in general and in the moment. But, you do have needs too, and cannot neglect them (for long).
One sleepless night looking after someone else is… a small sacrifice for a loved one, perhaps. But several in a row starts to become unsustainable.
Sometimes it will be necessary to do the best you can, and accept that you cannot do everything all the time.
There’s a saying amongst engineers that applies here too: “if you don’t schedule time for maintenance, your equipment will schedule it for you”.
In other words: if you don’t give your body rest, your body will break down and oblige you to rest. Please be aware this goes for mental effort too; your brain is just another organ.
So, plan ahead, schedule breaks, find someone to take over, set up your cared-for-person with the resources to care for themself as well as possible (do this anyway, of course—independence is generally good so far as it’s possible), and make the time/effort to get you what you need for you. Sleep, distraction, a change of scenery, whatever it may be.
Lastly: what if it’s you?
If you’re reading this and you’re the person who has the higher care needs, then firstly:all strength to you. You have the hardest job here; let’s not forget that.
About that independence: well-intentioned people may forget that, so don’t be afraid to remind them when “I would prefer to do that myself”. Maintaining independence is generally good for the health, even if sometimes it is more work for all concerned than someone else doing it for you. The goal, after all, is your wellbeing, so this shouldn’t be cast aside lightly.
On the flipside: you don’t have to be strong all the time; nobody should.
Being disabled can also be quite isolating (this is probably not a revelation to you), so if you can find community with other people with the same or similar condition(s), even if it’s just online, that can go a very, very long way to making things easier. Both practically, in terms of sharing tips, and psychologically, in terms of just not feeling alone.
See also: How To Beat Loneliness & Isolation
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The End of Food Allergy – by Dr. Kari Nadeau & Sloan Barnett
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We don’t usually mention author credentials beyond their occupation/title. However, in this case it bears acknowledging at least the first line of the author bio:
❝Kari Nadeau, MD, PhD, is the director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University and is one of the world’s leading experts on food allergy❞
We mention this, because there’s a lot of quack medicine out there [in general, but especially] when it comes to things such as food allergies. So let’s be clear up front that Dr. Nadeau is actually a world-class professional at the top of her field.
This book is, by the way, about true allergies—not intolerances or sensitivities. It does touch on those latter two, but it’s not the main meat of the book.
In particular, most of the research cited is around peanut allergies, though the usual other common allergens are all discussed too.
The authors’ writing style is that of a science educator (Dr. Nadeau’s co-author, Sloan Barnett, is lawyer and health journalist). We get a clear explanation of the science from real-world to clinic and back again, and are left with a strong understanding, not just a conclusion.
The titular “End of Food Allergy” is a bold implicit claim; does the book deliver? Yes, actually.
The book lays out guidelines for safely avoiding food allergies developing in infants, and yes, really, how to reverse them in adults. But…
Big caveat:
The solution for reversing severe food allergies (e.g. “someone nearby touched a peanut three hours ago and now I’m in anaphylactic shock”), drug-assisted oral immunotherapy, takes 6–24 months of weekly several-hour-long clinic visits, relies on having a nearby clinic offering the service, and absolutely 100% cannot be done at home (on pain of probable death).
Bottom line: it’s by no means a magic bullet, but yes, it does deliver.
Click here to check out The End of Food Allergy to learn more!
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What are house dust mites and how do I know if I’m allergic to them?
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People often believe they are allergic to house dust. But of the 20% of Australians suffereing with allergies, a number are are actually allergic to microscopic house dust mites.
House dust mites belong to the same family as spiders and ticks. They measure just 0.2-0.3 mm, with 50 fitting on a single pinhead. They live for 65–100 days, and females lay 60–100 eggs in their life.
Some 50 house dust mites can fit on one pinhead. Choksawatdikorn/Shutterstock House dust mites love temperate climates and humidity. They feed off the skin cells we and animals shed, as well as mould, which they digest using special enzymes. These enzymes are excreted in their poo about 20 times a day. They also shed fragments of their exoskeletons.
All these fragments trigger allergies in people with this type of allergic rhinitis (which is also known as hay fever)
shuttertock. PeopleImages.com – Yuri A/Shutterstock What are the symptoms?
When people with house dust mite allergy inhale the allergens, they penetrate the mucous membranes of the airways and eyes. Their body recognises the allergens as a threat, releasing chemicals including one called histamine.
This causes symptoms including a runny nose, an itchy nose, eyes and throat, sneezing, coughing and a feeling of mucus at the back of your throat (known as a post-nasal drip).
People with this type of allergy usually mouth breath, snore, rub their nose constantly (creating a nasal crease called the “dust mite salute”) and have dark shadows under their eyes.
House dust mite allergy can also cause poor sleep, constant tiredness, reduced concentration at work or school and lower quality of life.
For people with eczema, their damaged skin barrier can allow house dust mite proteins in. This prompts immune cells in the skin to release chemicals which make already flared skin become redder, sorer and itchier, especially in children.
Symptoms of house dust mite allergy occur year round, and are often worse after going to bed and when waking in the morning. But people with house dust mite allergy and pollen allergies find their year-round symptoms worsen in spring.
How is it diagnosed?
House dust mite allergy symptoms often build up over months, or even years before people seek help. But an accurate diagnosis means you can not only access the right treatment – it’s also vital for minimising exposure.
Your clinician can talk you through treatment options and how to minimise exposure. Monkey Business Images/Shutterstock Doctor and nurse practitioners can order a blood test to check for house dust mite allergy.
Alternatively, health care providers with specialised allergy training can perform skin prick tests. This involves placing drops of the allergens on the arm, along with a positive and negative “control”. After 15 minutes, those who test positive will have developed a mosquito bite-like mark.
How is it treated?
Medication options include one or a combination of:
- daily non-sedating antihistamines
- a steroid nasal spray
- allergy eye drops.
Your health care professional will work with you to develop a rhinitis (hay fever) medical management plan to reduce your symptoms. If you’re using a nasal spray, your health provider will show you how to use it, as people often use it incorrectly.
If you also have asthma or eczema which is worsened by dust mites, your health provider will adapt your asthma action plan or eczema care plan accordingly.
If you experience severe symptoms, a longer-term option is immunotherapy. This aims to gradually turn off your immune system’s ability to recognise house dust mites as a harmful allergen.
Immunotherapy involves taking either a daily sublingual tablet, under the tongue, or a series of injections. Injections require monthly attendances over three years, after the initial weekly build-up phase.
These are effective, but are costly (as well as time-consuming). So it’s important to weigh up the potential benefits and downsides with your health-care provider.
How can you minimise house dust mites?
There are also important allergy minimisation measures you can take to reduce allergens in your home.
Each week, wash your bedding and pyjamas in hot water (over 60°C). This removes house dust mite eggs and debris.
Opt for doonas, covers or quilts that can be washed in hot water above 60°C. Alternatively, low-cost waterproof or leak proof covers can keep house dust mites out.
If you can, favour blinds and wood floors over curtains and carpet. Dust blinds and surfaces with a damp cloth each week and vacuum while wearing a mask, or have someone else do it, as house dust mites can become airborne during cleaning.
But beware of costly products with big marketing budgets and little evidence to support their use. A new mattress, for example, will always be house dust mite-free. But once slept on, the house dust mite life cycle can start.
Mattress protectors and toppers commonly claim to be “hypoallergenic”, “anti-allergy” or “allergy free”. But their pore sizes are not small enough to keep house dust mites and their poo out, or shed skin going through.
Sprays claiming to kill mites require so much spray to penetrate the product that it’s likely to become wet, may smell like the spray and, unless dried properly, may grow mould.
Finally, claims that expensive vacuum cleaners can extract all the house dust mites are unsubstantiated.
For more information, visit healthdirect.gov.au or the Australian Society of Clinical Immunology and Allergy.
Deryn Lee Thompson, Eczema and Allergy Nurse; Lecturer, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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