‘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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Navigating the health-care system is not easy, but you’re not alone.
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Hello, dear reader!
This is my first column for Healthy Debate as a Patient Navigator. This column will be devoted to providing patients with information to help them through their journey with the health-care system and answering your questions.
Here’s a bit about me: I have been a patient partner at The Ottawa Hospital and Ottawa Hospital Research Institute since 2017, and have joined a variety of governance boards that work on patient and caregiver engagement such as the Patient Advisors Network, the Ontario Health East Region Patient and Family Advisory Council and the Equity in Health Systems Lab.
My journey as a patient partner started much before 2017 though. When I was a teenager, I was diagnosed with a cholesteatoma, a rare and chronic disease that causes the development of fatty tumors in the middle ear. I have had multiple surgeries to try to fix it but will need regular follow-ups to monitor whether the tumor returns. Because of this, I also live with an invisible disability since I have essentially become functionally deaf in one ear and often rely on a hearing aid when I navigate the world.
Having undergone three surgeries in my adolescent years, it was my experience undergoing surgery for an acute hand and wrist injury following a jet ski accident as an adult that was the catalyst for my decision to become a patient partner. There was an intriguing contrast between how I was cared for at two different health-care institutions, my age being the deciding factor at which hospital I went to (a children’s hospital or an adult one).
The most memorable example was how, as a teenager or child, you were never left alone before surgery, and nurses and staff took all the time necessary to comfort me and answer my (and my family’s) questions. I also remember how right before putting me to sleep, the whole staff initiated a surgical pause and introduced themselves and explained to me what their role was during my surgery.
None of that happened as an adult. I was left in a hallway while the operating theater was prepared, anxious and alone with staff walking by not even batting an eye. My questions felt like an annoyance to the care team; as soon as I was wheeled onto the operating room table, the anesthetist quickly put me to sleep. I didn’t even have the time to see who else was there.
Now don’t get me wrong: I am incredibly appreciative with the quality of care I received, but it was the everyday interactions with the care teams that I felt could be improved. And so, while I was recovering from that surgery, I looked for a way to help other patients and the hospital improve its care. I discovered the hospital’s patient engagement program, applied, and the rest is history!
Since then, I have worked on a host of patient-centered policy and research projects and fervently advocate that surgical teams adopt a more compassionate approach with patients before and after surgery.
I’d be happy to talk a bit more about my journey if you ask, but with that out of the way … Welcome to our first patient navigator column about patient engagement.
Conceptualizing the continuum of Patient Engagement
In the context of Canadian health care, patient engagement is a multifaceted concept that involves active collaboration between patients, caregivers, health-care providers and researchers. It involves patients and caregivers as active contributors in decision-making processes, health-care services and medical research. Though the concept is not new, the paradigm shift toward patient engagement in Canada started around 2010.
I like to conceptualize the different levels of patient engagement as a measure of the strength of the relationship between patients and their interlocutors – whether it’s a healthcare provider, administrator or researcher – charted against the duration of the engagement or the scope of input required from the patient.
Defining different levels of Patient Engagement
Following the continuum, let’s begin by defining different levels of patient engagement. Bear in mind that these definitions can vary from one organization to another but are useful in generally labelling the level of patient engagement a project has achieved (or wishes to achieve).
Patient involvement: If the strength of the relationship between patients and their interlocutors is minimal and not time consuming or too onerous, then perhaps it can be categorized as patient involvement. This applies to many instances of transactional engagement.
Patient advisory/consulting: Right in the middle of our continuum, patients can find themselves engaging in patient advisory or consulting work, where projects are limited in scope and duration or complexity, and the relationship is not as profound as a partnership.
Patient partnership: The stronger the relationship is between the patient and their interlocutor, and the longer the engagement activity lasts or how much input the patient is providing, the more this situation can be categorized as patient partnership. It is the inverse of patient involvement.
Examples of the different levels of Patient Engagement
Let’s pretend you are accompanying a loved one to an appointment to manage a kidney disease, requiring them to undergo dialysis treatment. We’ll use this scenario to exemplify what label could be used to describe the level of engagement.
Patient involvement: In our case, if your loved one – or you – fills out a satisfaction or feedback survey about your experience in the waiting room and all that needed to be done was to hand it back to the clerk or care team, then, at a basic level, you could likely label this interaction as a form of patient involvement. It can also involve open consultations around a design of a new look and feel for a hospital, or the understandability of a survey or communications product. Interactions with the care team, administrators or researchers are minimal and often transactional.
Patient advisory/consulting: If your loved one was asked for more detailed information about survey results over the course of a few meetings, this could represent patient advisory/consulting. This could mean that patients meet with program administrators and care providers and share their insights on how things can be improved. It essentially involves patients providing advice to health-care institutions from the perspective of patients, their family members and caregivers.
Patient advisors or consultants are often appointed by hospitals or academic institutions to offer insights at multiple stages of health-care delivery and research. They can help pilot an initiative based on that feedback or evaluate whether the new solutions are working. Often patient advisors are engaged in smaller-term individual projects and meet with the project team as regularly as required.
Patient partnership: Going above and beyond patient advisory, if patients have built a trusting relationship with their care team or administrators, they could feel comfortable enough to partner with them and initiate a project of their own. This could be for a project in which they study a different form of treatment to improve patient-centered outcomes (like the time it takes to feel “normal” following a session); it could be working together to identify and remove barriers for other patients that need to access that type of care. These projects are not fulfilled overnight, but require a collaborative, longstanding and trusting relationship between patients and health-care providers, administrators or researchers. It ensures that patients, regardless of severity or chronicity of their illness, can meaningfully contribute their experiences to aid in improving patient care, or develop or implement policies, pilots or research projects from start to finish.
It is leveraging that lived and living experience to its full extent and having the patient partner involved as an equal voice in the decision-making process for a project – over many months, usually – that the engagement could be labeled a partnership.
Last words
The point of this column will be to answer or explore issues or questions related to patient engagement, health communications or even provide some thoughts on how to handle a particular situation.
I would be happy to collect your questions and feedback at any time, which will help inform future columns. Just email me at max@le-co.ca or connect with me on social media (Linked In, X / Twitter).
It’s not easy to navigate our health-care systems, but you are not alone.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Sweet Potato & Black Bean Tacos
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Fiber, protein, and polyphenols! What more could one ask for? Well, great taste and warm healthy goodness, which these deliver:
You will need
For the sweet potatoes:
- 2 medium sweet potatoes, cubed (we recommend leaving the skin on, but you can peel them if you really want to)
- 1 tbsp extra virgin olive oil
- 2 tsp garlic powder
- 2 tsp smoked paprika
- 1 tsp chili powder
- 1 tsp black pepper
- 1 tsp ground cumin
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
For the black beans:
- 2 cans black beans, drained and rinsed (or 2 cups black beans that you cooked yourself)
- ¼ bulb garlic, minced
- 1 fresh jalapeño finely chopped (or ¼ cup jalapeños from a jar, finely chopped) ← adjust quantities per your preference and per the quality of the pepper(s) you’re using; we can’t judge that from here without tasting them, so we give a good basic starting suggestion.
- 2 tsp black pepper
- 1 tsp red chili flakes
- ½ tsp MSG or 1 tsp low-sodium salt
For serving:
- 8 small corn tortillas, or your preference if substituting
- 1 avocado, pitted, peeled, cubed, and tossed in lime juice ← we’re mentioning this here because you want to do this as soon as you cut it, to avoid oxidation
- Any other salad you’d like to include; fresh parsley is also a good option when it comes to greenery, or cilantro if you don’t have the soap gene
- Tomato salsa (quantity and spice level per your preference)
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400°F / 200°C.
2) Toss the sweet potato cubes in a large bowl with the rest of the ingredients from the sweet potato section above, ensuring they are evenly coated.
3) Bake them in the oven, on a baking tray lined with baking paper, for about 30 minutes or until tender inside and crispy at the edges. Turn them over halfway through.
4) While that’s happening, mix the black beans in a bowl with the other ingredients from the black bean section above, and heat them gently. You could do this in a saucepan, but honestly, while it’s not glamorous, the microwave is actually better for this. Note: many people find the microwave cooks food unevenly, but there are two reasons for this and they’re both easily fixable:
- instead of using high power for x minutes, use medium power for 2x minutes; this will produce better results
- instead of putting the food just in a bowl, jug, or similar, use a wide bowl or similar container, and then inside that, place a small empty microwave-safe glass jar or similar upturned in the middle, and then add the food around it, so that the food is arranged in a donut shape rather than a wide cylinder shape. This means there is no “middle bit” to go underheated while the edges are heated excessively; instead, it will heat through evenly.
If you really don’t want to do that though, use a saucepan on a very low heat, add a small amount of liquid (or tomato salsa), and stir constantly.
5) Heat the tortillas in a dry skillet for about 30 seconds each on each side, when ready to serve.
6) Assemble the tacos; you can do this how you like but a good order of operations is: tortilla, leafy salad (if using), potato, beans, non-leafy salad including avocado, salsa or other topping per your preference.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- White Potato vs Sweet Potato – Which is Healthier?
- Kidney Beans or Black Beans – Which is Healthier?
- Coconut vs Avocado – Which is Healthier?
- Glutathione: More Than An Antioxidant
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we hit 4/5 today!
Take care!
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How To Keep Warm (Without Sweat Patches!)
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝I saw an advert on the subway for a pillow spray that guarantees a perfect night’s sleep. What does the science say about smells/sleep?❞
That is certainly a bold claim! Unless it’s contingent, e.g. “…or your money back”. Because otherwise, it absolutely cannot guarantee that.
There is some merit:
❝Odors can modulate the latency to sleep onset, as well as the quality and duration of sleep. Olfactory modulation of sleep may be mediated by direct synaptic interaction between the olfactory system and sleep control nuclei, and/or indirectly through odor modulation of arousal and respiration.
Such modulation appears most heavily influenced by past associations and expectations about the odor, beyond any potential direct physicochemical effect❞
Source: Reciprocal relationships between sleep and smell
Translating that from sciencese:
Sometimes we find pleasant smells relaxing, and placebo effect also helps.
That “any potential direct physiochemical effect”, though, when it does occur, is things like this…
Read: Odor blocking of stress hormone responses
…but that’s a mouse study, and those odors may only work to block three specific mouse stress responses to three specific stressors: physical restraint, predator odor, and male–male confrontation.
In other words: if, perchance, those three things are not what’s stressing you in bed at night (we won’t make assumptions), and/or you are not a mouse, it may not help.
(and this, dear readers, is why we must read articles, and not just headlines!)
But! If you are going to go for a pillow fragrance, something well-associated with being relaxing and soporific, such as lavender, is the way to go:
- Effects of aromatherapy on sleep quality and anxiety of patients
- Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units
- Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study
tl;dr = patients found lavender fragrances relaxing, experienced less anxiety, got better sleep (significantly or insignificantly, depending on the study) and enjoyed lower blood pressure (significantly or insignificantly, depending on the study).
PS: this writer uses a pillow spray like this one
Enjoy!
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How To Make Drinking Less Harmful
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Making Drinking Less Harmful
We often talk of the many ways alcohol harms our health, and we advocate for reducing (or eliminating) its consumption. However, it’s not necessarily as easy as all that, and it might not even be a goal that everyone has. So, if you’re going to imbibe, what can you do to mitigate the harmful effects of alcohol?
There is no magical solution
Sadly. If you drink alcohol, there will be some harmful effects, and nothing will completely undo that. But there are some things that can at least help—read on to learn more!
Coffee
It’s not the magical sober-upperer that some would like it to be, but it is good against the symptoms of alcohol intoxication, and slightly reduces the harm to your body, because it is:
- Hydrating (whereas alcohol is dehydrating)
- A source of antioxidants (whereas alcohol causes oxidative stress, which has nothing to do with psychological stress, and is a kind of cellular damage)
- A stimulant, assuming it is not decaffeinated (it’s worth noting that its stimulant effects work partly by triggering vasoconstriction, which is the opposite of the vasodilation caused by alcohol)
To this end, the best coffee for anti-alcohol effects should be:
- Caffeinated, and strong
- Long (we love espresso, but we need hydration here and that comes from volume!)
- Without sugar (you don’t want to create an adverse osmotic gradient to leech water from your body)
As for milk/cream/whatever, have it or don’t, per your usual preference. It won’t make any difference to the alcohol in your system.
Antioxidants, polyphenols, flavonoids, and things with similar mechanisms
We mentioned that coffee contains antioxidants, but if you want to really bring out the heavy guns, taking more powerful antioxidants can help a lot. If you don’t have the luxury of enjoying berries and cacao nibs by the handful, supplements that have some similar benefits are a perfectly respectable choice.
For example, you might want to consider green tea extract:
L-theanine 200mg (available on Amazon)
Specialist anti-alcohol drugs
These are somewhat new and the research is still ongoing, but for example:
Dihydromyricetin (DHM) as a novel anti-alcohol intoxication medication
In short, DHM is a flavonoid (protects against the oxidative stress caused by alcohol, and has been found to reduce liver damage—see the above link) and also works on GABA-receptors (reduces alcohol withdrawal symptoms after cessation of drinking, and thus also reduces hangovers).
Once again: the marketing claims of such drugs may be bold, but there’s a lot that’s not known and they’re not a magic pill. They do NOT mean you can take them alongside drinking and drink what you like with impunity. However, they may help mitigate some of the harmful effects of alcohol. If you wish to try them, these can be purchased at pharmacies or online, for example:
Alcohol Defense Capsules (available on Amazon)
Bottom line
Alcohol is bad for your health and none of the above will eliminate the health risks. But, if you’re going to have alcohol, then having the above things as well may at least somewhat reduce the harm done.
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Statin and Antidepressant Side Effects
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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
Side effects of statins, are they worth it? Depression, are antidepressants worth it?
About statins, that depends a lot on you, your circumstances, and—as it happens—your gender. We covered this in a main feature recently, but a short answer is: for most people, they may not be the best first choice, and could even make things worse. For some people, however, they really are just what’s needed.
- Factors that make them more likely better for you: being a man, or having atherosclerosis
- Factors that make them more likely worse for you: being a woman in general
Check out the main feature we did: Statins: His & Hers?
As for antidepressants? That depends a lot on you, your physiology, your depression, your circumstances, and more. We’ll definitely do a main feature on that sometime soon, as there’s a lot that most people don’t know!
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The Autoimmune Cure – by Dr. Sara Gottfried
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We’ve featured Dr. Gottfried before, as well as another of her books (“Younger”), and this one’s a little different, and on the one hand very specific, while on the other hand affecting a lot of people.
You may be thinking, upon reading the subtitle, “this sounds like Dr. Gabor Maté’s ideas” (per: “When The Body Says No”), and 1) you’d be right, and 2) Dr. Gottfried does credit him in the introduction and refers back to his work periodically later.
What she adds to this, and what makes this book a worthwhile read in addition to Dr. Maté’s, is looking clinically at the interactions of the immune system and nervous system, but also the endocrine system (Dr. Gottfried’s specialty) and the gut.
Another thing she adds is more of a focus on what she writes about as “little-t trauma”, which is the kind of smaller, yet often cumulative, traumas that often eventually add up over time to present as C-PTSD.
While “stress increases inflammation” is not a novel idea, Dr. Gottfried takes it further, and looks at a wealth of clinical evidence to demonstrate the series of events that, if oversimplified, seem unbelievable, such as “you had a bad relationship and now you have lupus”—showing evidence for each step in the snowballing process.
The style is a bit more clinical than most pop-science, but still written to be accessible to laypersons. This means that for most of us, it might not be the quickest read, but it will be an informative and enlightening one.
In terms of practical use (and living up to its subtitle promise of “cure”), this book does also cover all sorts of potential remedial approaches, from the obvious (diet, sleep, supplements, meditation, etc) to the less obvious (ketamine, psilocybin, MDMA, etc), covering the evidence so far as well as the pros and cons.
Bottom line: if you have or suspect you may have an autoimmune problem, and/or would just like to nip the risk of such in the bud (especially bearing in mind that the same things cause neuroinflammation and thus, putatively, depression and dementia too), then this is one for you.
Click here to check out the Autoimmune Cure, and take care of your body and mind!
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