Women want to see the same health provider during pregnancy, birth and beyond
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Hazel Keedle, Western Sydney University and Hannah Dahlen, Western Sydney University
In theory, pregnant women in Australia can choose 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.
While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:
- GP shared care, where the woman sees her GP for some appointments (15% of births)
- midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
- private obstetrician care (10.6%)
- private midwifery care (1.9%).
Given the choice, which model would women prefer?
Our new research, 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.
Assessing strengths and limitations
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.
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.
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.
What women thought of standard maternity care in hospitals
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.
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.
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.
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:
The experience was very impersonal, their focus was my cervix, not preparing me for birth.
Why women favoured continuity of care
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.
Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.
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:
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).
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 cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.
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.
This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.
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.
What about shared care with a GP?
While shared care between the GP 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.
Considering there is strong evidence about the benefits of midwifery continuity of care, 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.
Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University and 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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The Best Form Of Sugar During Exercise
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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 😎
❝What is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etc❞
Great question! Let’s be clear first that we’re going to answer this specifically for the context of during exercise.
Because, if you’re not actively exercising strenuously right at the time when you’re taking the various things we’re going to be talking about, the results will not be the same.
For scenarios that are anything less than “I am exercising right now and my muscles (not joints, or anything else) are feeling the burn”, then instead please see this:
Snacks & Hacks: Eating For Energy (In Ways That Actually Work)
Because, to answer your question, we’re going to be going 100% against the first piece of advice in that article, which was “Skip the quasi-injectables”, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, they’re not. See also:
Which Sugars Are Healthier, And Which Are Just The Same?
However…
When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere it’ll fit to put it away, which is very bad for us), because right now, in the exercise scenario we’re describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.
Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:
- glucose: the body can use immediately and easily convert whatever’s spare to glycogen (a polysaccharide of glucose) for storage
- fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), you’re not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesn’t trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, it’s going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
- sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides you’ll see mentioned sometimes are maltose and lactose, but again, they’re just an extra step removed from useful metabolism, so to save space, we’ll leave it at that for those today.
- dextrose: is just glucose, but when the labeller is feeling fancy. It’s technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someone’s going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.
We’d like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:
A Comprehensive Study on Sports and Energy Drinks
As for how to take it, again this is the complete opposite of our usual health advice of “don’t drink your calories”, because in this case, for once…
(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely don’t spike your blood sugars because that will worsen inflammation)
…just this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.
And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).
Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:
CHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. it’s clinically significant, it’s a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):
Oxidation of Solid versus Liquid CHO Sources during Exercise
We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they don’t load it with fiber to slow it down. Which differentiates this greatly from, say, getting one’s sugars from whole fruit.
If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldn’t find it.
Today has been all about what’s best during exercise, so let’s quickly finish with a note on what’s best before and after:
Before: What To Eat, Take, And Do Before A Workout
After: Overdone It? How To Speed Up Recovery After Exercise
Take care!
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Thai-Style Kale Chips
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…that are actually crispy, tasty, and packed with nutrients! Lots of magnesium and calcium, and array of health-giving spices too.
You will need
- 7 oz raw curly kale, stalks removed
- extra virgin olive oil, for drizzling
- 3 cloves garlic, crushed
- 2 tsp red chili flakes (or crushed dried red chilis)
- 2 tsp light soy sauce
- 2 tsp water
- 1 tbsp crunchy peanut butter (pick one with no added sugar, salt, etc)
- 1 tsp honey
- 1 tsp Thai seven-spice powder
- 1 tsp black pepper
- 1 tsp MSG or 1 tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Pre-heat the oven to 180℃ / 350℉ / Gas mark 4.
2) Put the kale in a bowl and drizzle a little olive oil over it. Work the oil in gently with your fingertips so that the kale is coated; the leaves will also soften while you do this; that’s expected, so don’t worry.
3) Mix the rest of the ingredients to make a sauce; coat the kale leaves with the sauce.
4) Place on a baking tray, as spread-out as there’s room for, and bake on a middle shelf for 15–20 minutes. If your oven has a fierce heat source at the top, it can be good to place an empty baking tray on a shelf above the kale chips, to baffle the heat and prevent them from cooking unevenly—especially if it’s not a fan oven.
5) Remove and let cool, and then serve! They can also be stored in an airtight container if desired.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Brain Food? The Eyes Have It!
- Our Top 5 Spices: How Much Is Enough For Benefits?
- What’s The Truth About MSG?
Take care!
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Caesar Salad, Anyone? (Ides of March Edition!)
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The Mediterranean Diet: What Is It Good For?
More to the point: what isn’t it good for?
- It’s been found to reduce all-cause mortality, which is about the best thing one can say of any diet.
- It’s especially good for heart health and against cancer.
- It’s particularly recommended for the prevention or management of diabetes.
- It’s also been found, societally, to reduce general healthcare costs—basically, people get sick less and so have fewer healthcare costs.
What brought it to the attention of the world’s scientific community?
Back in the 1950s, physiologist Ancel Keys wondered why poor people in Italian villages were healthier than wealthy New Yorkers. Upon undertaking studies, he narrowed it down to the Mediterranean diet—something he’d then take on as a public health cause for the rest of his career.
Keys himself lived to the ripe old age of 100, by the way.
When we say “Mediterranean Diet”, what image comes to mind?
We’re willing to bet that tomatoes feature (great source of lycopene, by the way), but what else?
- Salads, perhaps? Vegetables, olives? Olive oil, yea or nay?
- Bread? Pasta? Prosciutto, salami? Cheese?
- Pizza but only if it’s Romana style, not Chicago?
- Pan-seared liver, with some fava beans and a nice Chianti?
In reality, the diet is based on what was historically eaten specifically by Italian peasants. If the word “peasants” conjures an image of medieval paupers in smocks and cowls, and that’s not necessarily wrong, further back historically… but the relevant part here is that they were people who lived and worked in the countryside.
They didn’t have money for meat, which was expensive, nor the industrial setting for refined grain products to be affordable. They didn’t have big monocrops either, which meant no canola oil, for example… Olives produce much more easily extractable oil per plant, so olive oil was easier to get. Nor, of course, did they have the money (or infrastructure) for much in the way of imports.
So what foods are part of “the” Mediterranean Diet?
- Fruits. These would be fruits grown locally, but no need to sweat that, dietwise. It’s hard to go wrong with fruit.
- Tomatoes yes. So many tomatoes. (Knowledge is knowing tomato is a fruit. Wisdom is not putting it in a fruit salad)
- Non-starchy vegetables (e.g. eggplant yes, potatoes no)
- Greens (spinach, kale, lettuce, all those sorts of things)
- Beans and other legumes (whatever was grown nearby)
- Whole grain products in moderation (wholegrain bread, wholewheat pasta)
- Olives and olive oil. Special category, single largest source of fat in the Mediterranean diet, but don’t overdo it.
- Dairy products in moderation (usually hard cheeses, as these keep well)
- Fish, in moderation. Typically grilled, baked, steamed even. Not fried.
- Other meats as a rarer luxury in considerable moderation. There’s more than one reason prosciutto is so thinly sliced!
Want to super-power this already super diet?
Try: A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week
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Young Mind Young Body – by Sue Ziang
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This is a very “healthy mind in a healthy body” book, consistent with the author’s status as a holistic health coach. Sometimes that produces a bit of a catch-22 regarding where to start, but for Ziang, the clear answer is to start with the mind, and specifically, one’s perception of one’s own age.
She advocates for building a young mind in a young body, and yes, that’s mind-building much like body-building. This does not mean any kind of wilful self-delusion, but rather, choosing the things that we do get to choose along the way.
The bridge between mind and body, for Ziang, is meditation—which is reasonable, as it’s very much mind-stuff and also very much neurological and has a very real-world impact on the body’s broader health, even simply by such mechanisms as changing breathing, heart rate, neurotransmitter levels, endocrine functions, and the like.
When it comes to the more physical aspects of health, her dietary advice is completely in line with what we write here at 10almonds. Hydrate well, eat more plants, especially beans and greens and whole grains, get good fats in, enjoy spices, practice mindful eating, skip the refined carbohydrates, be mindful of bio-individuality (e.g. one’s own personal dietary quirks that stem from physiology; some of us react differently to this kind of food or that for genetic reasons, and that’s not something to be overlooked).
In the category of exercise, she’s simply about moving more, which while not comprehensive, is not bad advice either.
Bottom line: if you’re looking for an “in” to holistic health and wondering where to start, this book is a fine and very readable option.
Click here to check out “Young Mind Young Body”, and transform yours!
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Happy Mind, Happy Life – by Dr. Rangan Chatterjee
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Let’s start with a “why”. If happiness doesn’t strike you as a worthwhile goal in and of itself, Dr. Chatterjee discusses the health implications of happiness/unhappiness.
And, yes, including in studies where other factors were controlled for, so he shows how happiness/unhappiness does really have a causal role in health—it’s not just a matter of “breaking news: sick people are less happy”.
The author, a British GP (General Practitioner, the equivalent of what the US calls a “family doctor”) with decades of experience, has found a lot of value in the practice of holistic medicine. For this reason, it’s what he recommends to his patients at work, in his books, his blog, and his regular spot on a popular BBC breakfast show.
The writing style is relaxed and personable, without skimping on information density. Indeed, Dr. Chatterjee offers many pieces of holistic health advice, and dozens of practical exercises to boost your happiness and proof you against adversity.
Because, whatever motivational speakers may say, we can’t purely “think ourselves happy”; sometimes we have real external threats and bad things in life. But, we can still improve our experience of even these things, not to mention suffer less, and get through it in better shape with a smile at the end of it.
Bottom line: if you’d like to be happier and healthier (who wouldn’t?), then this book is a sure-fire way to set you on that path.
Click here to check out Happy Mind, Happy Life and upgrade yours!
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Herring vs Sardines – Which is Healthier?
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Our Verdict
When comparing herring to sardine, we picked the sardines.
Why?
In terms of macros, they are about equal in protein and fat, but herring has about 2x the saturated fat and about 2x the cholesterol. So, sardines win this category easily.
When it comes to vitamins, herring has more of vitamins B1, B2, B6, B9, and B12, while sardines have more of vitamins B3, E, and K. That’s a 5:3 win for herring, although it’s worth mentioning that the margins of difference are mostly not huge, except for that sardines have 26x the vitamin K content. Still, by the overall numbers, this one’s a win for herring.
In the category of minerals, herring is not richer in any minerals*, while sardines are richer in calcium, copper, iron, manganese, phosphorus, and selenium, meaning a clear win for sardines.
*unless we want to consider mercury to be a mineral, in which case, let’s mention that on average, herring is 6x higher in mercury. However, we consider that also a win for sardines.
All in all, sardines are better for the heart (much lower in cholesterol), bones (much higher in calcium), and brain (much lower in mercury).
Want to learn more?
You might like to read:
Farmed Fish vs Wild Caught: Antibiotics, Mercury, & More
Take care!
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