Tag Archives: Taunton birth forum

Taunton Birth Forum 4th September 2012

I was delighted to have made it to The Taunton Birth Forum this month as I have had such a busy Summer I have missed a few. It is always a pleasure to See Eleanor Copp and her husband Simon and learn from the speakers she invites along.

This month was a real treat with speaker Katherine Ukleja teaching about the embryonic face. katherine is a Cranio Sacral Therapist, teacher and lecturer. She has also undergone prenatal and birth training with Ray Castellino.

Katherine started off explaining how human babies are born immature compared to other species, and how this means we are dependent on our parents for our basic needs (warmth food etc). Babies are reliant on face to face contact which enables their brain to develop. The baby’s “social nervous system” allows babies to pick out a human face and mimic facial expressions (such as sticking their tongue out) within minutes of birth. This allows baby to engage with parents and communicate it’s needs, as it is helpless otherwise. Through this social engagement and play the baby’s nerves learn to “self regulate”. The baby’s face is a major form of communication, and the helpless baby relies on parents being able to read it’s facial expressions.

Now the technical part

The embryonic stage of development lasts until 8 weeks. during this time all body structures are present and just develop further beyond that point. At 3-5 weeks of development the baby’s face begins to develop. It develops between the brain and the heart in a series of folds that used to be called gills, as they resembled those of fish.

The face is where the internal and external world meet. the outer world covered by the skin of the face, and the inner world of the body, with entrances at the mouth and nose. Exteroception being the sensitivity to stimuli originating outside the body and  interoception being sensitivity to stimuli originating within the body.

The structures of the face and head develop in the mesoderm (the middle germ layer of an animal embryo, giving rise to muscle, blood, bone, connective tissue, etc).  when the mesoderm is compressed it forms cartillage and when it is stretched it becomes membrane. Bone then develops from the cartillage. The base of the skull is formed from cartillage and are less moveable than the upper cranium. The cranial nerves develop in the folds of the embryonic face and make up what is known as “the social nervous system”. The cranial nerves supply the facial muscles, help babies orientate their heads towards their parents, and alow them to identify the human voice over background noise. The nerves that control expression are very important to humans. As adults we read facial expressions to tell if another human is safe to approach.

One branch of the cranial nerves, the vagus nerve, supplies the heart and lungs. it modulates the heartrate, enabling enough blood to supply the brain. It also allows baby to coordinate sucking, breathing and communicating. The cranial nerves exit the head at the base of the skull.

Because of our large brains our babies need to be born relatively immature. To enable passage through their mother’s pelvis the upper bones of the skull develop seperately and can move over each other (moulding) during the birth process to navigate through the pelvis.

 

As baby travels through the pelvis it moves under it’s mother’s pubic arch, and at this point there is potential for the nerves to be compressed or overstretched. This is more likely in instrumental births like forceps, ventouse and caesareans where traction is applied to the head to pull the baby out. There is also a possibility of this if the baby is pulled out by the head during a so called normal birth. (Note from Joy: in the normal birth process there should be no pulling on the baby’s head!).

If these nerves are dammaged the baby can suffer feeding problems, pain from the injury, impaired hearing and facial expressions. Cranial nerve injury can also affect arousal of the vagus nerve with increased heartrate, inability to sleep and colic. All of these injuries affect the baby’s ability to communicate with it’s parents, and their empathy with their baby. A traumatised newborn baby feeling fear cannot use the “fight or flight” mechanism, so develops a self preservation behaviour of freezing or playing possum. This makes communication even more difficult.

Babies need to communicate face to face from birth as eye contact and empathy encourage brain development. Playing with babies and sharing joy increases dopamine and oxytocin production in the baby, which increase brain growth. In babies the right half of the brain develops first. This ensures emotional strength develops before intelligence. The stimulation of the right half of the brain is important in the first year after birth, as without stimulation these areas can atrophy. A well developed brain leads to empathetic behaviours in the child rather than antisocial ones.

It is a survival mechanism for babies to be able to communicate. Babies read the emotional tone of their carers. If parents are unhappy then the baby will be unhappy.

What I’d like to share from what I learnt is that:

  • Babies are born very immature and depend on us for their survival.
  • Babies are ready to communicate with their parents from the moment of birth.
  • The birth needs to be gentle to avoid dammage to the cranial nerves.
  • No pulling babies out by their heads!
  • If a baby’s nerves have been dammaged he may be less able to feed or communicate his needs.
  • These injuries can heal with time but craniosacral therapy can help.

Thank you for sharing your wisdom Katherine. xx

“Am I allowed?”

A woman this week asked me one of the things that make me want to get on my soapbox about assertiveness and women’s rights.  What she said was “are you allowed to give birth to a breech baby?” My response, as ever, to this type of question is “it you who allows or disallows your care providers to do anything to you or your baby. Nothing can be done to you or your baby at home or in a hospital setting, without your consent. You are a mentally competent adult making rational decisions about your care, and you, more than anyone, has the best interests of your baby at the foremost in your mind”.

The Nursing and Midwifery Council (NMC), that govern all practicing midwives, provide information to midwives and nurses on the issue of consent:

“Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Nurses and midwives must respect their refusal just as much as they would their consent”.

The problem may lie with the allocation of power and responsibility in maternity care. Midwives and doctors are in a uniquely privileged position to be able to serve women at such a vulnerable time in their lives. We train long and hard to amass knowledge to help those we care for, but we should not use this to control or coerce women into what we think they should do. We are after all “Professional Servants” (Mary Cronk). We are there to serve the families we care for, but it is also our professional duty to inform them of any risks associated with their choices. The Nursing and Midwifery council (which regulates all midwives and nurses) has rules and codes of conduct advising us how to support our clients such as:

1. You must treat people as individuals and respect their dignity

2. You must not discriminate in any way against those in your care

3. You must treat people kindly and considerately

4. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support

5. You must respect people’s right to confidentiality.

6. You must ensure people are informed about how and why information is shared by those who will be providing their care.

7. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

8. You must listen to the people in your care and respond to their concerns and preferences.

9. You must support people in caring for themselves to improve and maintain their health

10. You must recognise and respect the contribution that people make to their own care and wellbeing.

11. You must make arrangements to meet people’s language and communication needs.

12. You must share with people, in a way they can understand, the information they want or need to know about their health.

Point number 2 was obviously not read or understood by midwives who attended a woman’s home birth. The woman was from a particular religious group and her partner was from a different ethnic group. The woman phoned me as a result of midwife harassment in her current pregnancy, and in telling me her previous birth experiences said the midwives at one of her previous births had made racist remarks! I was livid and asked if she had complained – no she hadn’t! this is so wrong on so many levels I don’t know where to start! Harassing heavily pregnant women, and going against their wishes in labour is not acceptable but racism from a so called professional is a disciplinary offence. I gave the woman information and advice to make written complaints about current and previous problems, and gave her AIMS contact details.

Another part of our rules concerns consent:

13. You must ensure that you gain consent before you begin any treatment or care.

14. You must respect and support people’s rights to accept or decline treatment and care.

15. You must uphold people’s rights to be fully involved in decisions about their care. 

16. You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.

17. You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.

Whether your care provider will like or dislike your choices should be no concern of yours. I personally don’t like junk food, but understand that some people know the risks of consuming it, and still chose to do so. I may offer education about the risks, but wouldn’t dream of telling people not to do it just because I don’t like it myself. This applies to many areas of midwifery care, for example if you are told you are not allowed to give birth at home it would be good to ask if there are specific risks you need to be aware of, before thanking your health professional for their opinion, informing them that you will consider what they’ve said very carefully and let them know you will let them know your decision in due course (Taken from Mary Cronk’s assertiveness phrases). Consider how your care provider would actually be able to force you to do anything against your will (sadly, women have informed me of social services being used as a threat in some circumstances!).

REMEMBER: You do not have to ask permission to do anything which concerns your own body or your baby. Politely question your caregivers, do your own research then take responsibility for your choices! Your body, your baby, your choice!

See also:

Mary Cronk’s assertiveness comments on Angela Horn’s great homebirth website

AIMS the Association for the Improvement in Marternity Services has a great website and provides telephone support for anyone having trouble finding good maternity care. Please consider becoming a member or making a donation to their good work. x

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