Occasionally unborn babies can take everyone by surprise and arrive quite literally, out of the blue. This Mt. Maunganui couple pulled in to a local petrol station when it became apparent their baby was about to be born in rush hour traffic. While I waited for the couple to arrive at the hospital, I was able to coach them through the delivery until the ambulance staff, and a back-up midwife arrived. Read the full story here.
New Zealand midwives choose to provide care to women in very different ways. Here are some basic care requirements for LMCs (Lead Maternity Carers) set out by the Ministry of Health, and widely accepted as standard practice in NZ. While it is expected that an LMC would provide additional care where it is clinically indicated, many midwives offer care which is in generous addition to the minimum requirements, please be aware that this is done out of the kindness of your midwife’s heart, as (with the exception of additional post natal visits) your midwife is not compensated for providing care that is not clinically indicated.
Prior to booking:
Some midwives are happy to meet with women prior to a formal booking visit, some prefer to talk over the phone, others expect a woman to have decided on her LMC before they meet in person. This type of expectation varies regionally (in busy regions like South Auckland, midwives may not have time for a friendly chat outside of their usual workload) and is based on the availability of the midwife. Women who feel uncomfortable with a midwife at their first visit are not obligated to book with that midwife. If a woman decides to change her midwife, it is considerate to inform them so that the midwife is aware she is no longer responsible for the care of the woman and her baby.
This guideline varies based on the woman’s needs, which is usually determined by the midwife and sometimes an obstetrician as well. A woman having her third or fourth baby who feels relaxed about pregnancy may choose to decline regular visits, while a woman with complications or risk factors may require additional visits. Your midwife is able to clarify your care requirements with you. They generally include 4 weekly visits until 28 weeks of pregnancy, fortnightly visits until 36 weeks and weekly visits until the baby is born. Some midwives choose to provide additional assessments for a baby who is overdue. Most urban midwives offer antenatal care from a clinic which the woman is expected to attend. Midwives who provide antenatal home visits are doing this out of the kindness of their heart as this not a standard expectation; however, antenatal home visits can be normal for women who live in remote areas.
Because antenatal care is only one part of a midwife’s role, clinic appointments are not usually available any old weekday between 9am-5pm like you might expect with a GP or dentist. It is common for midwives to have set clinic days and do not generally work from one location all the time. Clinic appointments are often booked 4 weeks in advance and appointments outside business hours are offered out of the kindness of your midwife’s heart. It is normal for clinic appointments to be rescheduled if the midwife is attending a birth, or needs sleep after working through the night etc. If you are unable to attend a scheduled appointment with your midwife, it is considerate to inform her – it is not expected that she will offer you a follow up appointment outside her usual clinic hours. Your employer is legally required to give you leave for midwifery appointments and your midwife can offer you a medical certificate if required.
Standard pregnancy scans for well women depend on her informed consent and may include: a dating scan if the midwife considers this necessary, a scan at around 12 weeks as part of screening for chromosomal abnormalities (like Downs’ Syndrome) and an anatomy scan at around 20 weeks. Any scans outside of this are usually indicated by risk factors and are not considered standard ie: not every woman requires a growth scan. Scans are not offered to women purely to find out the sex, or to see a picture of their baby – they must be offered for a clinical indication.
Labour and birth:
It can be normal for women to be offered an early labour assessment by their midwife, and to remain at or return home if she is not in established labour. An LMC is not expected to provide continuous support to a well woman who is not in established labour.
LMC midwives are not obligated to provide secondary care (such as epidural care, inductions or augmentations of labour) to women in labour, although many choose to. Again, this care is being provided at the generosity of the midwife and in many regions this is not a standard expectation. If an epidural, or other types of secondary care are a possible part of your labour, you should feel comfortable discussing this with your midwife in advance.
If your midwife chooses not to provide your secondary care during labour you are still entitled to care from her, or a back-up midwife in a support capacity (ie: non clinical care).
Women should be offered the following visits, any of which they may choose to decline:
A daily visit in the post natal ward, provided they are no longer receiving secondary care (eg: after a caesarean section).
A minimum of five home visits including a visit within 24 hrs of your discharge from hospital. This includes visits where your midwife has arranged to see you, but you are not at home at the expected time. Your midwife is not expected to visit you at other people’s houses. If the midwife feels unsafe visiting a woman’s house, her post natal care may be offered from the midwife’s clinic, or other location. A woman can request post natal visits at the midwife’s clinic if she prefers.
A minimum of 7 visits in total (which may not be offered weekly) but should be based on you and your baby’s individual needs. A maximum of 10 visits, unless there are specific risks identified by the midwife.
Your midwife is responsible for your well baby’s care for 4-6 weeks after they are born, however your visits can be negotiated so they are more specific to your needs – experienced mums may require less input from their midwife, unwell mums or babies may require more. It can be difficult for a midwife to predict how long each visit may take (anything from 10 mins to 90 mins or more) and for this reason some midwives do not offer specific times for post natal home visits. Just like childbirth, a midwife’s schedule is highly unpredictable so it is common for home visits to be offered at the availability of the midwife, rather than the woman.
If your baby is well, they may only be weighed three times in total and this is normal – a well baby might not be weighed every week.
Your midwife is not expected to provide care to an acutely unwell baby, this is usually done by a GP, hospital, or an after hours service.
You can receive care from Plunket/Tamariki Ora any time after 4 weeks. If your midwife is no longer providing home visits after 4 weeks, she should generally be available to you for things like questions, concerns, prescriptions or referrals until your baby is 6 weeks old.
After 6 weeks, you are no longer registered to your midwife’s care and she is not expected to offer you any clinical support, referrals or prescriptions.
It is considerate for a woman to be informed in advance if her midwife is planning time off-call. An LMC’s time off is generally negotiated between her and the person who is covering for them in their absence. Many midwives support each other to have alternate weekends off-call. This could be 2 days out of every 14 which is not a lot of time off compared to other professions! Once again, availability during scheduled time off is offered at the generosity of the midwife – she is not obligated to attend a birth if she has scheduled time off and arranged for back up attendance.
It is reasonable for a woman to know who her back up midwife might be, and opportunities to meet with that midwife in advance are based on the back-up’s availability. If your midwife is unable to provide your basic care requirements for any reason, you are entitled to the support of a back up midwife during this time.
If you are not happy with your midwifery care:
The first thing to do is to clarify your expectations, or discuss your concerns with your midwife – there could be a simple misunderstanding. If this does not help, or your midwife is not open to this, every woman has the right to change midwives, but it is reasonable to explain this decision to your LMC. In addition, you can provide feedback about your midwife here. The NZ College of Midwives offers the services of a Resolutions Committee to women who want to make a formal complaint and if serious, they can be referred to the Health and Disability Commission.
How Much does a midwife get paid? Find out here.
For a more in-depth look at the MOH guidelines for LMC midwives, check out section 88, here.
It is anticipated that one in four pregnant women will receive a Caesarean section here in New Zealand. It is a rate that obstetricians, midwives and other health professionals are keen to reduce.
In Brazil where I have lived, it is estimated that as many as 86% of women in private hospitals will receive a Caesarean section, and as many as 50% in public hospitals. This article outlines some of the cultural, social and political barriers to women being supported in normal childbirth in Brazil:
It is difficult to argue:
This is an excellent article discussing the risks of induction for women who are overdue, written by Australian midwife Rachel Reed. I have included it for parents who are interested in making fully informed choices with balanced information, prior to agreeing to an induction of labour. Please note, if an induction has been suggested to you for reasons other than being overdue, your individual risks may vary from those outlined. Rachel is the author of the informative midwifery blog, midwifethinking.com.
Edited and updated: June 2013
In Australia 25% of labours are induced. The most common reason for induction is a ‘prolonged pregnancy’. That’s an awful lot of babies outstaying their welcome and requiring eviction. I am not going to get stuck into the concept of a ‘due date’ and how accurate or not they are, otherwise this will be a very long post. I also think the EDD (estimated date of delivery) is here to stay – it is deeply embedded in our culture and health care system. You can read about the history of timelines in birth here. This post will focus on induction for prolonged pregnancy and the complexities of risk.
A quick word about risk
I don’t particularly like the concept of ‘risk’ in birth. There are all kinds of problems associated with providing care based on risk rather than on individual women. However, risk along with ‘due dates’ is here to stay, and women often want to know about risks. Risk is a very personal concept and different women will consider different risks to be significant to them. Everything we do in life involves risk. So when considering whether to do X or Y there is no ‘risk free’ option. All women can do is choose the option with the risks they are most willing to take. However, in order to make a decision women need adequate information about the risks involved in each option. If a health care provider fails to provide adequate information they could be faced with legal action. Induction for prolonged pregnancy is not right or wrong if the choice is made by a woman who has an understanding of all the options and associated risks. As a midwife I am ‘with woman’ regardless of her choices. It is my job to share information and support decisions – not to judge.
What is a prolonged pregnancy?
Before we go any further lets get some definitions clear:
- Term (as in a ‘normal’ and healthy gestation period): is from 37 weeks to 42 weeks.
- Post dates: the pregnancy has continued beyond the decided due date ie. is over 40 weeks.
- Post term: the pregnancy has continued beyond term ie. 42+ weeks.
The World Health Organization’s definition of a ‘prolonged pregnancy’ is one that has continued beyond 42 weeks ie. is post term. I am pretty sure that this was not the definition used when collecting the above induction rate statistics because most hospitals have a policy of induction at 41 weeks which is before a prolonged pregnancy has occurred. Very few women experience a prolonged pregnancy.
The idea of a prolonged pregnancy also assumes that we all gestate our babies for the same length of time. It seems that genetic differences may influence what is a ‘normal’ gestation time for a particular woman. Morken, Melve and Skjaerven (2011) found “a familial factor related to recurrence of prolonged pregnancy across generations and both mother and father seem to contribute.” Therefore, if the women in your family gestate for 42 weeks so might you. The initiation of labour may be influenced by maternal metabolism (Dunsworth, et al. 2012).
The risks associated with waiting
In theory after term ie. 42 weeks the placenta starts to shut down. There is no evidence to support this notion and Sara Wickham gives a great critic of this theory if you ever get the chance to attend her workshops. There is also a good physiological explanation of the development and ageing of the placenta here, which concludes that: “There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not…” I have seen signs of placental shut down (ie. calcification) in placentas at 37 weeks and I have seen big juicy healthy placentas at 43 weeks. There is also the idea that the baby will grow huge and the skull will calcify making moulding (when the bones in the baby’s skull adjust), and therefore birth difficult. Again there is no evidence to support this theory and babies are pretty good at finding their way out of their mothers expandable pelvis.
The concerns around waiting beyond 41 weeks gestation focus on the potential death of the baby (perinatal death). A Cochrane review summarises the quantitative research examining induction vs waiting at 41 weeks or more: “There were fewer baby deaths when a labour induction policy was implemented after 41 completed weeks or later.” However, it goes on to say:“…such deaths were rare with either policy…the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks.” Hands up all the women who had a discussion with their care provider about the relative and absolute risks of waiting vs induction… hmmm thought so. The review also found lower rates of caesarean section andmeconium aspiration in the induction group but no difference in admission NICU.
So, essentially according to the available research, if you are induced at 41 weeks your baby is less likely to die during, or soon after birth. However, the chance of your baby dying is small either way – less than 1%… or 30 out of every 10,000 for those waiting vs 3:10,000 for those induced. In order to prevent one death 410 women need to be induced.
Reviews can only be as good as the research they review and there are some concerns about the quality of the research. The World Health Organization recommends induction after 41 weeks based on this review but acknowledges the evidence is “low-quality evidence. Weak recommendation”. Sara Wickham discusses the flaws in the research on a free MIDIRs podcast you can download here. And you can find further critical analysis of the data here.
One of the main problems with quantitative research is that it rarely answers the question ‘why’, and rather focuses on ‘what’ (happens). It also takes a general perspective rather than the risk for an individual woman in a particular situation.
Anyhow – to pretend their are no risks associated with prolonged pregnancy (in general) is not helpful for women trying to make decisions about their options. These general risks should be part of the information a woman uses to decide what is best for her.
The risks associated with induction
It can be difficult to untangle and isolate the risks involved with induction because usually more than one risk factor is occurring at once (eg. syntocinon, CTG, epidural). I did attempt to create a mind map but it ended up looking like a spider had spun a web while under the influence. So I have stuck to a written version:
Risks associated with the actual procedure of induction
The induction process is a fairly invasive procedure which usually involves some or all of the following (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg. nausea, discomfort etc.) There are also some major risks:
- Prostaglandins (prostin E2 or cervidil) to ripen the cervix: hyperstimulation resulting in fetal distress and c-section.
- Rupturing the membranes: fetal distress and c-section (see previous post)
- IV syntocinon / pitocin: Mother – rupture of uterus; post partum haemorrhage; water intoxication leading to convulsions, coma and/or death. Baby – hypoxic brain damage; neonatal jaundice; neonatal retinal haemorrhage; death. There is also research suggesting that there may be a link between the use of syntocinon/pitocin for induction and ADHD (Kurth & Haussmann 2011)
The most extreme of these risks are rare but fetal distress and c-section are fairly common. The potential effects of uterine hyperstimulation on the baby are well known (Simpson & James 2008)- which is why continuous fetal monitoring is recommended during induction.
Risks associated with factors that commonly occur during an induction
The Cochrane review (above) found reduced rates of c-section for women who were induced. This is an interesting finding and does not fit with my observations. However, the review does not separate first time mothers with women who have birthed before. And they are a different kettle of fish. A research study by Ehrenthal et al. (2010) found an increased c-section rate of 20% for women being induced with their first baby. They concluded that: “Labor induction is significantly associated with a cesarean delivery among nulliparous women at term… reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.” Another study by Selo-Ojeme et al (2011) found induction increased the chance of a c-section x3 for first time mothers. The researchers recommend that“Nulliparous [first baby] women should be made aware of this, as well as potential risks of expectant management during counselling.” It is now well established that there are significant risks associated with c-section for both mother and baby. Childbirth Connection provide an extensive and evidence based list.
Induced labour is usually more painful than a physiological labour. Syntocinon (aka pitocin) produces strong contractions often without the gentle build up and endorphin release of natural contractions. In addition unlike natural oxytocin, syntocinon does not cross the blood-brain barrier to create the spaced-out, relaxed feelings that help women to cope with pain (seeprevious post). Not surprisingly, first time mothers are more than 3x more likely to opt for an epidural (Selo-Ojeme et al. 2011) during an induction. A Cochrane review found that: “Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever and association between epidural analgesia and instrumental birth.” The review also found an increased risk of instrumental delivery, and c-section for fetal distress with an epidural.
There are significant risks associated with ventouse and forceps birth, both for the mother and baby – RANZCOG lists them here. And the risks of c-section available via the link ‘Childbirth Connection’ above. The study by Selo-Ojeme et al. (2011) also found induction = increased risk of uterine hyperstimulation; ‘suspicious’ fetal heart rate tracings; and haemorrhage following birth. Not surprisingly ‘babies born to mothers who had an induction were significantly more likely to have an Apgar score of <5 at 5mins and an arterial cord pH of <7.0′ (basically not in a good way on arrival). Another recent study by Elkamil et al (2011) ‘found that labour induction at term was associated with excess risk of bilateral spastic CP [cerebral palsy]..’ Remember we are inducing labour to prevent harm to the baby…
The experience of labor
Once again the Cochrane review states:“Women’s experiences and opinions about these choices have not been adequately evaluated.”This is becoming a theme across Cochrane reviews. However, one thing is certain – choosing induction will totally alter your birth experience and the options open to you. Women need to know that agreeing to induction means agreeing to continuous monitoring and an IV drip, which will limit movement. Induced contractions are usually more painful than natural contractions and the inability to move and/or use warm water (shower or bath) reduces the ability to cope. The result is that an epidural may be needed. An induced birth is not a physiological birth and requires monitoring (vaginal exams) and time frames. Basically you have bought a ticket on the intervention rollercoaster. For many women this is fine and worth the risk, but I encounter too many women who are unprepared for the level of intervention required during an induction.
There have been some attempts to find out about womens’ experience of induction. Heimstad et al. (2007) conducted a survey of women randomised to immediate induction at 41 weeks or waiting with regular ‘fetal surveillance’. They found that women preferred induction. However, these were women who were allocated an option rather than chose one. Another survey byChildbirth Connection asked mothers about their experience of induction (not necessarily for prolonged pregnancy) – 17% of those induced felt they were under pressure to do so by health care professionals. The quotes from women make interesting reading too. A study by Hildingsson et al. (2011) found that labour induction was associated with a less positive birth experience, and women who were induced were more likely to be frightened that their baby would be damaged during birth. However, again this research was not limited to induction for prolonged pregnancy therefore the women may have had genuine pregnancy complications requiring induction.
Alternatives to waiting or medical induction
Before labour begins the uterus and cervix need to make physiological changes ready to respond to contractions. It is now thought that the baby is the controller of the labour ‘on’ switch. So, the baby signals to the mother that he/she is ready, oxytocin is released and the uterus responds. In comparison to other mammals, humans have the most variable gestation lengths. This suggests that other factors such as environment and emotions (eg. anxiety) also influence the start of labour. This would make sense considering what we know about the function of oxytocin (seeprevious post). It is also something most midwives are aware of – a stressed out mother is more likely to go post term than a relaxed and chilled out mother. Having said that, post term is probably the normal gestation length for many women regardless of what is going on. Creating anxiety and stress around due dates and impending induction is probably counter productive to labour.
There are a number of ‘alternative’ or ‘natural’ induction methods available (BellyBelly covers most of them here). However, an induction is an induction. Trying to force the body/baby to do something it is not ready to do is an intervention whether it is with medicine, herbs, therapies, techniques… or anything else. Interventions of any kind can have unwanted effects and consequences. However, ‘interventions’ (massage, acupuncture, etc.) that are aimed at relaxing the mother and fostering trust, patience and acceptance may assist the body/baby to initiate labour if the physiological changes have already taken place.
A significant minority of babies will not be born by 41 weeks gestation. Whilst the definition of a prolonged pregnancy is 42 weeks+, induction is usually suggested during the 41st week. Women need to be given adequate information about the risks and benefits involved with either waiting or inducing in order to make the choice that is right for them. There is no risk free option. The risk of perinatal death is extremely small for both options. I know women who have lost a baby in the 41st week of pregnancy, and women who have lost a baby as a result of the induction process. For first time mothers the induction process poses particular risks for themselves and their babies. Each individual woman must decide which set of risks she is most willing to take – and be supported in her choice.
Maternity Coalition information sheet for parents.
You may have noticed that sugar-being-the-bad-guy has become a bit of trend recently in magazines and health headlines. While not usually one to jump on a band wagon, I do feel strongly about this one, mainly because I have been trying to eliminate sugar from my own diet for three years now. This is something I have been casually researching from a wide range of sources since 2010 and gradually adjusting my lifestyle around so what advice I offer in this post, I also live by myself! You will notice the info offered in this post is fairly basic, so for more comprehensive research, check out the sources at the bottom of this page.
As a midwife and a sugar-free advocate, I can safely recommend processed sugar be eliminated from anyone’s diet, especially pregnant women, for the simple fact that:
PROCESSED SUGAR OFFERS NO NUTRITIONAL VALUE TO THE BODY.
Processed sugar (sucrose) is half glucose (fuel that our body runs on) and half fructose (a toxic sugar). Eventually, everything we eat is broken down into glucose so this fuel can come from any other food in ample doses. Fructose on the other hand, induces a series of toxic effects on the body while stripping it of vital nutrients and minerals and at the same time, creating an addictive association in the brain equivalent to OPIATES (like morphine). The more we eat, the more we want and the less healthy we become.
For a brief report, check out this 60 Minutes article: Sweet Poison
In my antenatal clinic I meet women every week who have worked hard to cut out alcohol, cut down on caffeine, stop smoking, drink more water and eat better than they usually would while pregnant. Some women start this process before they have even conceived, and go to great lengths to avoid toxins in their physical environment if they think it will help them reduce general risks to their baby. The suggestion of also eliminating sugar from your diet “because you are pregnant” is usually seen as being an over cautious step for the health-freaks. Most people don’t consider the amount of sugar they eat to be excessive, and if they are already watching their diets (a commitment which doesn’t often last an entire pregnancy) they figure they will have enough self-control to regulate their own health and well being, thank you very much! But here is what our sugar-addicted generation is unaware of:
The World Health Organisation currently recommends sugar intake be limited to one and a half tablespoons per day, to prevent chronic disease. That’s about the same as two pieces of whole fruit.
In 2005, the average Kiwi consumed over half a cup of sugar per day.
That statement might not scare you if you are used to eating what you think is a small amount of sugar each day and don’t think it is affecting you much, if at all. These statistics should (I apologise, they are American; NZ/Australian statistics do not date back this far):
Average processed sugar consumption over a 300 year period:
- 1700: the average person consumed around 1.8 kgs of sugar per year.
- 1800: the average person consumed around 8.2 kgs of sugar per year.
- 1900: average sugar consumption had increased to a whopping 41 kgs per year.
- In 2005, Kiwis were consuming a jaw dropping average of 50 kgs of processed sugar each!
- In 2009, more than 50 percent of Americans consumed a heart stopping 82 kgs of sugar.
THE PROBLEM WITH MODERATION IS: EVERYONE CALLS WHAT THEY ARE DOING MODERATION!
If you are still not convinced, stop right now, and go check out your pantry. But don’t just look at the ‘naughty’ foods, look for hidden sugars: specifically check the nutritional tables of your favourite cereal, spreads, snack bars, most used sauces & dressings, yoghurt, favourite drinks, lets not forget anything with the words “low fat”, and don’t be afraid to also check out the amount of sugar in savoury foods like crackers, potato chips, even frozen pizzas. A healthy guideline is 3 gms of sugar or less per 100gms. I will confidently state that most people eat WAY more sugar than they think they do, because most of us are not even aware we are eating it.
So, if you are coming to the realisation that our generation is eating more sugar than anyone else in history, well done! But if you’re like me, you’re probably not yet convinced that this is affecting you, or your family personally. Here’s some info to make you think again:
Fructose reduces serum folate (folic acid) levels in women. Folic Acid is important for the development of your baby’s spinal cord – that’s why midwives recommend taking it as a supplement in pregnancy. Depleted serum folate can lead to conditions such as spina bifida. For more info, click here.
Every time you eat fructose, your immune system is suppressed for approximately 6 hours. Processed sugar reduces the ability of white blood cells to kill germs by 40%. During pregnancy, your body’s immune system is already suppressed, so eating sugar will make you even more vulnerable to infection, illness, bacteria and viruses. Multiple times a day. Read about it here.
Fructose promotes inflammation in the body. What pregnant woman wants to be more uncomfortable than they already are? Really?! Read about it here.
Fructose feeds cancer cells. It loves them like a pregnant woman loves cake. Check this out
Fructose suppresses your appetite regulation hormones, so you can no longer tell when you are full. In fact, research shows that fructose consumption leads to one of my favourite things in life – food seeking behaviour! This means you overeat more easily when you are eating sugar on a regular basis. Without processed sugar, our brains are much more efficient at signalling our bodies to stop eating. Read this!
Processed sugar is concentrated amounts of empty calories. This means, sugar makes you fat but unlike other food groups, it offers the body NO nutrients at all! Weight gain is a difficult subject for many body conscious pregnant women to discuss, but it is important because excess weight gain in pregnancy is associated with increased risks for pretty much everything: gestational diabetes, pre-eclampsia, prolonged labour, emergency intervention in labour, anaesthetic complications, fetal shoulder dystocia, varying health complications in newborn babies…the list is endless. Unless you are drastically underweight, the recommended weight gain for Kiwi mums varies between 6 and 16 kgs, depending on your BMI (Body Mass Index). To physically grow a healthy baby, your dietary requirements increase in almost every category, so healthy women can expect to gain this weight while eating a balanced diet during pregnancy. Avoiding processed sugar while pregnant will decrease unnecessary weight gain, and help steer you towards healthier foods with a high nutritional value.
Research around the effects of giving up sugar is very limited – lets face it, most of our generation is offended by the suggestion! – the most noticeable, and therefore most commonly reported benefits so far include weight loss, increased immunity, sustained energy levels, fewer headaches, less period pain, balanced moods and more stable sleep patterns.
For people keen to eliminate sugar from their lifestyles, there are some basic recommendations to keep in mind. Firstly, most people are aware that fructose is found in fruit and fruit is good for us. What is also found in fruit in directly proportional amounts, is exactly the right amount of fiber and water our bodies need to metabolise the fructose back out of our systems – nature is a genius! Current dietary guidelines recommend two pieces of whole fruit per day as part of a balanced diet. That’s your WHO recommended sugar limit gone folks, sorry!
Secondly there is evidence to suggest that sugar alternatives like artificial sweeteners could also be very bad for our bodies. Do not swap sugar for artificial sweeteners without informing yourself first.
Thirdly, ‘natural sugars’ like honey, agave syrup, palm sugar, fruit juice, apple sauce or dried fruits are higher in fructose than processed sugar – don’t be fooled by these alternatives they are likely to increase the toxic effects of fructose on your body, not reduce them.
For more comprehensive info…
For in-depth information, research, and fully informed quitting advice (trust me, it’s flippin’ hard!), I highly recommend:
Professor of Paediatrics Dr. Robert Lustig offers an informative lecture entitled “Sugar: The Bitter Truth” which is available on youtube and has had more than 3,000,000 views. The lecture is quite scientific at times, and 90 minutes long, so an equally informative short version is also available on youtube, here.
“This is your brain on sugar” Research conducted at UCLA shows high fructose diets contribute to memory loss and learning impairment.
Yale study shows fructose is linked to over eating.
Breakthrough research from the Liggins Institute at the University of Auckland has looked at the effects of fructose on unborn rats. They found it was linked with smaller placentae and less healthy female baby rats. Of course, we are not rats, but the evidence was compelling enough to warrant further, more investigative research into it’s effects on other mammals.
There are numerous “I Quit Sugar” websites to be found online at the moment, one of the better ones is written by Australian tv host, Sarah Wilson, who also has a great range of “I Quit Sugar” books available.
I recently giggled my way through this book by Kiwi comedian and presenter in the “Keep Calm & Carry On” parenting series, Jaquie Brown. Jaquie has done a remarkable job of chronicling her own (rather harrowing) pregnancy experience as well as those from a wide selection of other Kiwi mums and – I was delighted to see – dads! I usually pick up Americanised pregnancy books with fear and trepidation at the scare tactics pregnant women are exposed to at the hands of some out-of-touch publishers. This book however, was refreshingly honest and down-to-earth and included balanced insights from a range of respected health professionals including obstetricians, midwives, nutritionists, baby sleep specialists and even a pregnancy exercise specialist!
This book is a bit of a one-stop-shop for Kiwi parents who want to know exactly what it is they want to know about “getting pregnant, being pregnant and surviving life with a crazy but wonderful newborn”. I also recomend checking out this review, or just give it a look-see for yourself!
Last year I had the privilege of working with Angela and Sean Marsh as they welcomed their twin boys, Te Manu and Te Auripo into the world. Angela and Sean faced many challenges as they prepared to keep the birth of their boys as low-fuss as possible, and I was inspired by their continual patience and understanding, in a system which was not readily offering them the same considerations! As Angela and Sean interacted with many health professionals over the course of their pregnancy, their resolute calmness and positivity lead me to rethink my own responses towards the frustrating treatment some women receive in our health system. I have often remembered Sean’s quiet strength and Ange’s trust and acceptance when situations have not turned out the way some of the mums I have worked with had hoped.
Ange has generously offered her photos to be used on this website. Kia ora Ange!
People always say that you never know what it feels like until you have your own children; and at the time you can’t understand how it could get much better than being involved in something as amazing as a niece, nephew or godchild’s life. Then you have your own children and that saying makes sense because suddenly you have this little being that is dependent solely on you. This little being that you love more than you thought possible. Time no longer seems to exist in the same way because a week will feel like a day, and they are growing out of newborn clothes, 000’s and on their way to 1’s and 2’s before you can believe.
When you have children you automatically become part of a secret club without even realising it or meaning to. You can’t stop yourself from talking about new clothes you brought them, what they learned today, how beautiful they are. It’s like they are the only point of conversation that you know how to talk about anymore and you become one of those babbling parents that you used to find tedious.
I had my son younger than I had hoped and not many of my friends had or were having children at the same time, except a small few who were a couple of years older than myself. I quickly learned who my real friends were and who hadn’t finished growing up yet. It didn’t mean they were bad people just that we were suddenly on very different paths. My son’s father, and I had split up before we had found out I was pregnant and by the time the news came to light, he had a new girlfriend who also fell pregnant a few weeks after it came out that I was carrying. It meant that I was doing it on my own as a “teen mum” with my family for moral support. Pregnancy can be the most exciting time of your life as you know it, or it can be an experience that you find yourself resenting. For me it was an exciting time. I had a little wriggler in my stomach that I already loved but at the same time it was very lonely. For any other mums going through something similar trust me when I say it will pass and it is all very much worth it. Gillian was a big help in keeping me strong, especially when I found out that the natural birth I had set my heart on wasn’t even an option. My little man had become stubbornly breech and I ended up having to have a c-section, something that I found very hard to deal with the concept of.
Those friends that had been there to support me couldn’t understand why I found it so upsetting but it comes back to my original point, that you don’t know until you have your own children. While some people who do have children won’t understand either, I know others out there will. I felt like I had failed, I can’t explain why because to this day I don’t know the reason. All I know is that I felt like it was my fault, like I was missing out on this massive rite to becoming a mother. I wanted to be able to say, “I was in labour for 8 hours and I did that” and be able to be proud of myself for going through one of the hardest things a woman can do. It took me a while but I understand now when I see my son’s smiling face every day, that it doesn’t matter how he got here because he is here and he is healthy and so incredibly happy all the time!
Then there was breastfeeding, something I was even more determined to do since I hadn’t been able to have the birth I had wanted. That ended up being more of a hassle than the birthing issue! After two major cracks, one minor graze, a nipple shield, thrush, infections, what I can only describe as two friction burns, two weeks of hand expressing and a lot of tears, I felt like even more of a failure than I had before. While I was enjoying baby Angelo’s company and I loved him so incredibly, I couldn’t stop the voice in my head doubting myself. I remember thinking “I can’t give birth normally and I can’t even feed him in the most natural way there is, what kind of mother am I?”
I stuck through it all and now that Angelo is nearly 8 weeks old, we finally have breastfeeding down as of just under a week ago.
I have had a few people tell me that I’m ruining my life by having Angelo when I’m “so young” (even though I’m now twenty years old), and that I will become just another teen mum who doesn’t look after their children properly. This annoys me because the majority of teen mothers younger than myself are actually very good parents and it’s a small percentage that give all others a bad reputation. I don’t think age should determine how good a mother you are, it’s the sacrifices that you make that makes you a great mother.
I wouldn’t have my life any other way now that I have him, I can’t imagine my life without him and I don’t want to. He is getting so big so quickly, he is already in 00’s, rolling from his stomach to his back and trying to roll the other way around now as well. He is laughing and smiling all the time and only waking once in the night. I can honestly say looking after him is the easiest thing I have ever done! I know that I have had troubles during feeding but I can’t remember them, I can’t remember the nights he’s had growth spurts and been up all night, I can’t remember him being grizzly the day of his immunisations. Even if I could it would still all be more than worth it.
All I can say now is just hang in there to other mum’s who are still pregnant or in the first few weeks after the birth of your little ones, it really does get better and it is the most amazing thing you will ever do and it is so rewarding watching them grow.
This post was written in July 2011, while volunteering in Mozambique with Iris Ministries:
This week was our final day of practical mission, and so my last afternoon at the Mieze Milk Clinic. Unfortunately we are yet to hear from Falume’s family (the severely malnourished baby we encountered on outreach) since we heard he was admitted to hospital three weeks ago, for what we don’t know. Brigit tells us no news is bad news. I will have to live with never knowing Falume’s outcome, but I have peace that at least God knows, and one way or another, is holding Falume in his hand. When we last saw him, Falume had gained a grand total of 300gms in a two week period, bringing his emaciated 12 month old frame to 4.4kg. After working for four years in Mozambique, Brigit was excited about this and announced it was good progress. I, on the other hand (used to first world recoveries in state-of-the-art hospitals with every medication at our fingertips), was not celebrating.
Being involved with the clinics here has been a challenging experience. The knowledge and experience that comes with being a midwife is something that quite literally, thousands of childbearing and breastfeeding women in Mieze are in a position to benefit from. Not because I know any better than the generations of women who throughout history, have been raising their babies using methods that the west has only recently concluded are ideal (natural birth, exclusive breastfeeding, kangaroo care etc), but because the hardship that Mozambican life brings leaves the women so vulnerable that even the most casual gesture can make a significant difference.
You would think that being in a position to support so many women and babies would be a positive thing. Unfortunately I am learning that knowledge can be both a blessing and a curse. Assisting a young mum with raging mastitis and an open abscess to continue breastfeeding is a plus; knowing that she will never benefit from IV antibiotics, re-hydration, 24 hour breastfeeding support, adequate nutrition and other basics is heartbreaking. More than once while working in western hospitals, I have heard colleagues complain that the care their patients received was no better than that of the third world. That is a sheltered perspective if ever I’ve heard one!
Three weeks ago we were joined at the milk clinic by three very premature additions. Two were twins, carried in on the backs of mum and grandma with no special treatment, as if the fact that they were alive at all was reason enough to throw them head first into life’s great hall of hardship. The third was carried in by an defensive aunt, demanding milk because the baby’s mother had supposedly gone crazy, run away and abandoned her child (mum then arrived at a subsequent clinic in seemingly perfect mental health with a sheepish looking aunt). The volunteers gathered around and cooed at the lethargic babies, lucky to weigh 2kg if that. While they admired them for being ‘so brand new’, their prematurity to me was painfully obvious. Hospital cards reported the babies to have been born at 30 weeks gestation. Their dates of birth made them each a week old. I laughed to myself at the thought of 30 week old infants surviving the African bush, and African parenting, for a whole week without any support. Mozambican newborns are not considered fragile like babies at home. They are expected to survive the same hardships as everybody else, and so are treated with alarming indifference.
A quick examination revealed that – praise God – all three babies had a well developed suck reflex, making them roughly 35 weeks and much more likely to survive. Weighing them confirmed they were losing far too much of what little weight they were born with, so my first priority was nutrition. With the help of a translator I gave my “Breastfeed!! As often as is physically possible!!” speech. I could see from the glazed faces and occasional giggle that my advice was being taken with a grain of salt. They would treat these babies the same way they treated all their babies – by feeding them if they cried. Going by the babies’ lethargy and dramatic weight loss, this was just not working. Time for the formula.
I worked my way through a formula demonstration resisting the same glazed stares and puzzling amusement. Would any of this advice make ANY difference?! I addressed the families and began to explain how much to give each baby. I was hit with the realisation that the concept of three hourly feeds was beyond them. Did I actually expect these Mozambican families to string up a clock on the walls of their bamboo huts, learn how to tell time and follow it counter-intuitively to everything they know? I had to change tack. “These babies need to be fed at least four times during daylight and four times after dark. You must be very patient, and not let them fall asleep during a feed. You must keep them as close as possible to your skin, you must protect them from the smoke of your cooking fire, you must not let young children, or sick children carry them around…” I could only pray my advice was getting through. Following our formula demonstration with the first bottle, I asked a mum to demonstrate what she had learned with the second. Sure enough, her tiny baby took three sucks before it fell asleep and the formula was stored away for the next feed. This was an uphill battle.
Everything in me wanted to scoop all three babies into my arms, carry them back to Pemba and begin around-the-clock care to ensure they were at least given a fighting chance at survival. Instead I waved as each family threw a baby into their sling and wandered back into unforgiving village life. Sometimes I sense the mothers need as much protection as their babies do. No wonder my concern is amusing to the Mozambicans, for whom death is just a part of life.
Images courtesy of Jodie