‘I’m dreading birthing in such a system’: what Indigenous women globally think of birth care and what they’d like to see instead
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Pregnancy and having a baby can be a special time. And families want to feel safe and trust their maternity care.
But when we reviewed the evidence, we found many Indigenous families globally face unfair treatment during pregnancy and birth. This can include racism, neglecting cultural aspects of their care, or using health care poorly designed to accommodate their needs.
We found similar themes in research involving more than 1,400 Indigenous women, Elders, fathers, family members and health workers from locations including Australia, New Zealand, Canada, the United States, Greenland and Sápmi (parts of Norway, Sweden, Finland and Russia).
Many Indigenous families felt disrespected. They said hospital staff often didn’t understand their cultures or give them basic rights during their maternity care, such as being listened to, included in decision-making, or giving informed consent.
As a result, some families felt hesitant to seek care in mainstream hospitals. As one Indigenous woman told us during recent Australian research submitted for publication:
I’m dreading birthing in such a system.
But there are alternatives.
What can hospitals do?
There is a clear need to improve birthing services and cultural safety in mainstream hospitals with a focus on respecting the beliefs, practices and traditions of all families, including Indigenous ones.
For example, many Indigenous families view childbirth as a communal event with extended family support. But hospital policies that limit the number of support people often disregard these important cultural practices.
Indigenous families also need to get the type of health care they trust and feel comfortable with. Ideally this might involve staff with sound cultural knowledge and who can support families clinically in a culturally safe way.
Aboriginal patient liaison officers are sometimes available in hospitals or health services. But there are not often enough, they have to service entire facilities, and they provide cultural support not clinical patient care.
Indigenous families may also want to access a specific type of care. One example is “continuity of care”, where the same midwife or a small team of midwives, supports the family through the whole pregnancy. Ideally, these midwives should be Indigenous or, if not, be trained in supporting Indigenous families with respect and understanding.
What is ‘birthing on Country’?
For Indigenous women living in rural and remote areas, being sent away from home to give birth in a city hospital can be really hard.
Sometimes women and families are evacuated from their home communities and have to stay for weeks or months in temporary accommodation in the city, both before and after birth, or if their baby is born pre-term and needs extra care. This temporary accommodation can be far from the hospital.
All this takes place in unknown cities and towns, without family support, and sometimes away from their other children cared for by the community back home.
This makes it harder for mums who need extra support, and can get in the way of starting breastfeeding and bonding with their baby.
Again, there is an alternative. For many Indigenous families, giving birth is not just about having a baby. It’s also a spiritual and cultural event that strengthens their identity and connection to Country. A “birthing on Country” model of care, which respects Indigenous traditions and knowledge, reinforces that.
This is midwife-led care designed for and with Indigenous communities. It doesn’t mean you have to birth in rural and remote spaces, but it is a model of care that focuses on culture, and can also be implemented in the city.
Ideally, families would see the same midwife or team of midwives and use the “birthing on Country” model.
What else can we do?
Maternity services can be led by Indigenous people, which many women prefer. But Indigenous staff make up about 3.1% of the Australian health workforce.
So it is crucial to engage non-Indigenous staff in building relationships and to support Indigenous families in their right to receive culturally safe care.
This can start with better training for staff, not only to understand and respond to an Indigenous person’s individual needs, but to know when and how to speak up, call out or report racist or disrespectful behaviour.
This is everyone’s problem
A health system you can trust should be safe for everyone. If some people feel unsafe or face discrimination when getting care, this not only affects them, it affects everyone.
For instance, when Indigenous women avoid or delay going to the hospital because of past bad experiences or discrimination, it can lead to health problems that could have been prevented.
This not only harms the women, it puts more pressure on the public health system, which affects us all.
By talking about these issues, we hope all Australians begin to care about the safety of all women during pregnancy and birth.
Nina Sivertsen, Associate Professor, College of Nursing and Health Sciences, Flinders University; Susan Elizabeth Smith, Researcher in Aboriginal and Torres Strait Islander maternal health and wellbeing, Flinders University, and Tahlia Johnson, Lecturer and researcher, College of Nursing and Health Sciences, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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AI therapy: What to know about its risks
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What you need to know
- AI therapy uses algorithms to track moods, share coping tools, and chat with users in ways that mimic talk therapy.
- While chatbots can be quick and free, they can’t diagnose problems, read emotions, or step in during a crisis the way a trained therapist can.
- Experts also warn that AI platforms lack safeguards to protect users’ privacy.
As artificial intelligence technology advances, more people—especially teens—are turning to AI apps and chatbots for mental health support. A July survey from Common Sense Media found that about one in three teens has used AI for social interaction, including emotional support. Many teens say these tools feel easier to access and less intimidating than traditional therapy.
In February, the American Psychological Association raised concerns about unregulated AI therapy chatbots, which in some cases have allegedly encouraged unsafe behavior among users. And in August, Illinois became the first state to restrict AI therapy, aiming to “protect vulnerable children amid the rising concerns over AI chatbot use in youth mental health services.”
Here’s what to know about how AI therapy works and what experts say about its risks.
How does AI therapy work?
AI therapy uses algorithms to track moods, share coping tools, and chat with users in ways that mimic talk therapy. These might include daily mood check-ins, journaling prompts, or stress-relief exercises.
What are the risks of using chatbots for mental health support?
Some chatbots present themselves as licensed therapists, using names, photos, or misleading credentials, a practice that worries many mental health experts. “You’re putting the public at risk when you imply there’s a level of expertise that isn’t really there,” said Vaile Wright, the APA’s senior director of health care innovation.
General-purpose AI platforms like ChatGPT, Replika, and http://character.ai/ are designed to mirror what users say and feel, a feature that can make them sound supportive but does not necessarily make them safe.
“They are purposely programmed to be both user affirming and agreeable because the creators want these kids to form strong attachments to them,” said Don Grant, a media psychologist and national adviser of healthy device management for Newport Healthcare. Chatbots are “taught to learn and subscribe [users] to a sometimes risky and codependent type of relationship and offer guidance and advice that is not healthy—or [could be] even dangerous.”
Common Sense Media found that some chatbots didn’t consistently intervene when users posing as teens described risky behavior, and a few even encouraged choices like dropping out of school, ignoring caregivers’ guidance, and accessing drugs and weapons. In some tragic cases, parents have sued chatbot companies after their teens turned to AI for mental health support and later died by suicide.
Some therapy chatbots use prewritten scripts developed by mental health professionals, which can make them safer than general-purpose AIs. But even those can’t replace a therapist’s ability to read nonverbal cues, make diagnoses, or step in during a crisis.
A chatbot “can’t call for help, alert emergency services, or ensure your safety in a critical moment. That human layer of protection just isn’t there,” said Cranston Warren, clinical therapist at Loma Linda University Behavioral Health, in a July article.
Plus, unlike licensed human therapists, who must follow strict federal privacy laws, most AI platforms lack safeguards to protect users’ data. “Your interaction with AI is not guaranteed to be private,” Warren said. “Everything you feed into the model is being analyzed for data.”
Why do people seek AI therapy?
Despite these concerns, many people still turn to AI for help. In the U.S., getting mental health care can be hard because of cost, staffing shortages, and long wait times. It’s estimated there is only one mental health care provider for every 340 people nationwide. AI tools, on the other hand, are often free or low cost, and they respond right away without needing to fill out long forms.
Stigma and fear of judgment may also make AI chatbots feel safer than talking to a person. In an August study published in the Journal of Participatory Medicine, young adults said that they sometimes felt judged or anxious meeting face to face with a therapist and were more comfortable opening up to a chatbot.
Need free or low-cost mental health resources?
If you’re seeking human-led free and low-cost mental health support, there are helplines and treatment options available. Public Good News has compiled this list.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, or upset or needs to talk, call or text the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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Why do I poo in the morning? A gut expert explains
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No, you’re not imagining it. People really are more likely to poo in the morning, shortly after breakfast. Researchers have actually studied this.
But why mornings? What if you tend to poo later in the day? And is it worth training yourself to be a morning pooper?
To understand what makes us poo when we do, we need to consider a range of factors including our body clock, gut muscles and what we have for breakfast.
Here’s what the science says.
H_Ko/Shutterstock So morning poos are real?
In a UK study from the early 1990s, researchers asked nearly 2,000 men and women in Bristol about their bowel habits.
The most common time to poo was in the early morning. The peak time was 7-8am for men and about an hour later for women. The researchers speculated that the earlier time for men was because they woke up earlier for work.
About a decade later, a Chinese study found a similar pattern. Some 77% of the almost 2,500 participants said they did a poo in the morning.
But why the morning?
There are a few reasons. The first involves our circadian rhythm – our 24-hour internal clock that helps regulate bodily processes, such as digestion.
For healthy people, our internal clock means the muscular contractions in our colon follow a distinct rhythm.
There’s minimal activity in the night. The deeper and more restful our sleep, the fewer of these muscle contractions we have. It’s one reason why we don’t tend to poo in our sleep.
Your lower gut is a muscular tube that contracts more strongly at certain times of day. Vectomart/Shutterstock But there’s increasing activity during the day. Contractions in our colon are most active in the morning after waking up and after any meal.
One particular type of colon contraction partly controlled by our internal clock are known as “mass movements”. These are powerful contractions that push poo down to the rectum to prepare for the poo to be expelled from the body, but don’t always result in a bowel movement. In healthy people, these contractions occur a few times a day. They are more frequent in the morning than in the evening, and after meals.
Breakfast is also a trigger for us to poo. When we eat and drink our stomach stretches, which triggers the “gastrocolic reflex”. This reflex stimulates the colon to forcefully contract and can lead you to push existing poo in the colon out of the body. We know the gastrocolic reflex is strongest in the morning. So that explains why breakfast can be such a powerful trigger for a bowel motion.
Then there’s our morning coffee. This is a very powerful stimulant of contractions in the sigmoid colon (the last part of the colon before the rectum) and of the rectum itself. This leads to a bowel motion.
How important are morning poos?
Large international surveys show the vast majority of people will poo between three times a day and three times a week.
This still leaves a lot of people who don’t have regular bowel habits, are regular but poo at different frequencies, or who don’t always poo in the morning.
So if you’re healthy, it’s much more important that your bowel habits are comfortable and regular for you. Bowel motions do not have to occur once a day in the morning.
Morning poos are also not a good thing for everyone. Some people with irritable bowel syndrome feel the urgent need to poo in the morning – often several times after getting up, during and after breakfast. This can be quite distressing. It appears this early-morning rush to poo is due to overstimulation of colon contractions in the morning.
Can you train yourself to be regular?
Yes, for example, to help treat constipation using the gastrocolic reflex. Children and elderly people with constipation can use the toilet immediately after eating breakfast to relieve symptoms. And for adults with constipation, drinking coffee regularly can help stimulate the gut, particularly in the morning.
A disturbed circadian rhythm can also lead to irregular bowel motions and people more likely to poo in the evenings. So better sleep habits can not only help people get a better night’s sleep, it can help them get into a more regular bowel routine.
A regular morning coffee can help relieve constipation. Caterina Trimarchi/Shutterstock Regular physical activity and avoiding sitting down a lot are also important in stimulating bowel movements, particularly in people with constipation.
We know stress can contribute to irregular bowel habits. So minimising stress and focusing on relaxation can help bowel habits become more regular.
Fibre from fruits and vegetables also helps make bowel motions more regular.
Finally, ensuring adequate hydration helps minimise the chance of developing constipation, and helps make bowel motions more regular.
Monitoring your bowel habits
Most of us consider pooing in the morning to be regular. But there’s a wide variation in normal so don’t be concerned if your poos don’t follow this pattern. It’s more important your poos are comfortable and regular for you.
If there’s a major change in the regularity of your bowel habits that’s concerning you, see your GP. The reason might be as simple as a change in diet or starting a new medication.
But sometimes this can signify an important change in the health of your gut. So your GP may need to arrange further investigations, which could include blood tests or imaging.
Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What you need to know about tuberculosis
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Tuberculosis is the deadliest infectious disease globally. While it’s more common in developing countries, the U.S. has recently experienced outbreaks in Kansas and North Carolina.
TB is often called the “silent killer” because it can go unnoticed—and show no symptoms—in its inactive or latent state. The CDC estimates that up to 13 million people live with inactive TB in the U.S.
The bacteria that cause TB can hide “in a very small area in the lungs or a lymph node, stay there, and in a sleepy state, remain [there] for weeks to several years before emerging and causing disease,” says Dr. Patricio Escalante, a critical care medicine specialist and pulmonologist at Mayo Clinic. Once it reappears, it can cause symptoms and illness, and transmit to others by air, he adds.
Because people can have TB without experiencing symptoms, controlling the disease’s spread requires investment in public health systems to detect and treat it, explains Dr. Peter Chin-Hong, a professor of medicine and infectious disease physician with University of California, San Francisco Health.
Read on to learn more about TB and why we’re seeing more outbreaks in the U.S.
What is tuberculosis?
TB is an infection caused by bacteria called Mycobacterium tuberculosis. It usually affects the lungs, but it can also affect other organs, including the brain, larynx (voice box), kidneys, spine, and lymph nodes.
TB is spread through the air when someone with active TB disease coughs, talks, or sings.
There are two types of TB:
- Inactive TB: Also known as latent TB, this form occurs when a person has TB germs in their body but no symptoms. They don’t feel sick and can’t spread it to other people. According to the Centers for Disease Control and Prevention, one in 10 people with inactive TB who don’t get treatment will get sick with active TB.
- Active TB: This form occurs when TB germs multiply in your body, creating symptoms. The bacteria can multiply and turn into active TB when the immune system is under stress, like during an illness. With active TB disease, you can spread the disease to others. Without treatment, active TB can be deadly.
Both inactive and active TB can be treated with antibiotics.
What are the symptoms of active TB disease?
Symptoms for active TB disease in the lungs include:
- Chest pain
- A cough that lasts three or more weeks
- Weakness or fatigue
- Fever
- Weight loss
- Night sweats
- Coughing up blood or phlegm
- Loss of appetite
Active TB disease outside of the lungs can cause other symptoms. For instance, TB disease in the lymph nodes can cause red or purple swelling under the skin.
Why are we seeing more cases of TB in the U.S.?
Chin-Hong explains that public health efforts to prevent TB have been underfunded for years and continue to be defunded. “Public health is really the backbone of how you control TB, because many people don’t know they have TB,” he adds.
“People have to go out and trace [it], see that the people who have TB take the medicines, and check the people who they’ve been in contact with to see if they [got] infected, even if they have no symptoms.”
When public health efforts are successful, there’s “a tendency to decrease investments on those public health organizations and programs because they are no longer seeing a lot of patients,” which can eventually cause outbreaks, adds Escalante.
Another possible reason for why we’re seeing outbreaks in the U.S. is the COVID-19 pandemic, says Chin-Hong. People may have delayed medical care for possible TB, so they could be spreading it to others in their communities.
Who’s most at risk for tuberculosis?
While anyone can get TB, certain people are at higher risk, including:
- People who are immunocompromised (because of conditions like HIV or cancer)
- People who live in group settings like prisons, jails, or homeless shelters.
- People who travel frequently or were born in places where TB is more common than in the U.S., including some countries in Asia, Africa, and Latin America.
- People who recently interacted with someone with active TB.
Is there a vaccine for TB?
Yes, there is a vaccine for TB called Bacille Calmette-Guérin. However, because there are usually not too many cases of TB in the U.S., the vaccine is not routinely administered here. The BCG vaccine is given to infants and young children in countries where TB is common.
How is TB treated?
Both inactive and active TB can be treated with antibiotics.
“It takes several antibiotics to treat active TB effectively” and to prevent the bacteria from mutating while on treatment, adds Escalante. Active TB requires a prolonged antibiotics treatment, which usually takes 6 months and can sometimes take up to nine months.
“We have to treat [TB patients] very carefully, with antibiotics delivered under close direct observation, because if the patient starts feeling well after a few weeks of treatment, they tend to stop the antibiotics, and that’s when the bacteria becomes resistant, if treatments are not appropriately completed,” he explains. “And, therefore, they need to be supervised to make sure they continue and complete treatment.”
How do I know if I have TB?
If you’ve been exposed to someone with TB or you think you may have it, you should contact your health care provider or state or local health department to get tested with a TB blood test or TB skin test.
How can I protect myself from TB?
Chin-Hong says it’s important to watch out for symptoms like fever, night sweats, and weight loss. In the U.S., he adds, “the only way you can really prevent TB as somebody who doesn’t have it or is not exposed is to continue to think of symptoms that you might have and [seek] medical attention.”
Additionally, if you work or live in a high-risk environment where you might be exposed to TB—such as a nursing home, hospital, homeless shelter, or prison—you should get screened for TB. Chin-Hong adds that most employers in those settings already offer screening to employees.
Other things you can do include:
- Cover your mouth when coughing or sneezing.
- If you have an inactive or latent TB infection, follow your treatment plan and doctor’s recommendations.
- Avoid close contact with people with active TB.
- Wash your hands often.
- If you’re traveling to an area where TB is more common, talk to your doctor about how you can protect yourself.
Find out more about TB here.
This article first appeared on Public Good News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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Improving Women’s Health Across the Lifespan – by Dr. Michelle Tollefson et al.
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We say “et al.”, because this hefty book (504 pages) is a compilation of contributions by about 60 authors, of whom, 100% are doctors and about 90% are women.
As one might expect from a book with many small self-contained chapters by such a lot of doctors, the content is very diverse, though the style is consistent throughout, likely due to the authors working from a style sheet, plus the work of the editorial team.
About that content: the focus here is lifestyle medicine, and while much of the advice will go for men too (most people are unlikely to go wrong with “eat more fruits and vegetables and get better sleep” etc), anything more detailed than that (of which there’s a lot) is focussed on women. Hence, we get chapters on optimal nutrition for women, physical activity for women, sleep and women’s health, etc, as well as topics that can affect everyone but disproportionately affect women—ranging from autoimmune diseases to social burdens that affect health in measurable ways. There’s also, as you might expect, plenty about sexual health, pregnancy-related health, menopausal health, and so forth.
The strength of this book is really in its diversity; it’s very much a case of “60 heads are better than one”, and as such, we’re pretty much getting 60 books for the price of one here, as each author brings what they are most specialized in.
Bottom line: if you are a woman and/or love a woman, this book is packed with information that will be of interest and applicable use.
Click here to check out Improving Women’s Health Across The Lifespan, and do just that!
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The Exercises That Help Keep Breast Cancer At Bay
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For women, our lifetime risk of being diagnosed with breast cancer is about 1 in 7, before we take into account any added risk or protective factors.
For men, it’s more like 1 in 556, which again, is before taking into account any added risk or protective factors.
Here’s a good place to start on improving those odds: How To Triple Your Breast Cancer Survival Chances
And for that matter, check out: 8 Signs On Your Breast You Shouldn’t Ignore
And for those concerned (or even just curious) about the pros and cons of menopausal HRT when it comes to breast cancer:
The Hormone Therapy That Reduces Breast Cancer Risk & More ← this is actually very important to understand, as otherwise it’s easy to accidentally self-sabotage and increase one’s overall mortality risk
So, what’s this about exercise and breast cancer?
There are two things to focus on
No, not those.
Well, yes, those, but also: aerobic exercise and resistance training.
A research team (Dr. Alice Avancini et al.) analysed data from 22 randomized controlled trials (total n=968 participants) that investigated the effects of exercise on various pro-inflammatory biomarkers (mostly interleukin variants, but also c-reactive proteins) that are known to increase breast cancer reoccurrence risk.
What they found was:
❝Exercise induced small to large significant reductions in IL-6 (SMD = -0.85; 95% CI = -1.68 to -0.02; p = .05) and TNF-α (SMD = -0.40; 95% CI = -0.81 to 0.01; p = .05) and a trend for a decrease in CRP.
When stratifying by exercise mode, trends toward reduction in IL-6 and TNF-α were observed for combined exercise, whilst changes were not generally affected by exercise program duration❞
The “combined exercise” mentioned?
Aerobic exercise and resistance training.
This is important, because as regular 10almonds readers may remember…
What Your Metabolism Says About How Aggressive Breast Cancer Is Likely To Be For You ← this makes a huge difference to survival chances
So, this study’s findings are very consistent with that, because:
- Aerobic training increases cardiovascular fitness, improving metabolism
- Resistance training increases muscle mass, improving metabolism*
*because muscle “costs” calories to maintain, prompting an increase in metabolism, whereas fat prompts our metabolism to slow, to conserve energy to face the obvious food shortage that must be coming
See also: Stop Cancer 20 Years Ago
Want to learn more?
Here’s the best book we’ve read on breast cancer survival:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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