PREGNANCY CARE OPTIONS AND CAMPAIGNING FOR CHANGE: RADICAL MIDWIVESAny serious attempt to improve the organisation, efficiency and experience of ante-natal care relies heavily on midwives. Whether it is better community facilities or better care in the hospital, mid-wives are one of the keys to success. Many midwives today feel abused, frustrated and bored. As the Short Committee found, a more interventionist, hospital-based ante-natal care has ‘resulted in obstetricians tending to undertake practices traditionally assigned to the midwife’. And as the Association of Radical Midwives says: ‘Midwives are at present being abused, being used solely as chaperones and clerks in hospital clinics.’According to the Short Report, one survey of a London health district revealed midwives being used to fill in for domestics, nursing and clerical staff:Many midwives feel that the increasing medicalisation of childbirth is fast removing them to the status of the North American maternity nurse – a mere machine minder and handmaiden to the obstetrician who relegates her to performing clerical and orderly duties. Even if they are allowed to operate as midwives, their skills and their autonomy are commonly undermined. In some hospitals they are not allowed to take case histories because this work is considered ‘too important’. Yet midwives can be at least as good as doctors at doing this, and often much better.Domiciliary, or community, midwifery is being drastically run down, with disastrous consequences:The running down of domiciliary midwifery – while depriving many midwives of the job satisfaction previously derived from their continuing responsibility for the mothers during the ante-natal period, delivery and puerperium – has also robbed the mother of a choice of giving birth at home, in familiar surroundings where the professionals are her guests, not her masters. In the home it is her decision, not theirs, whether her partner is there and her wishes are more likely to be respected. The most recent reorganisation of the National Health Service has led to another worrying development. Most of the new district health authorities have decided to organise their midwifery services around specific hospitals. No longer will midwives necessarily be in charge of midwifery. This means a further undermining of the midwifery profession and of community midwifery in particular. Unless stopped, it will lead to midwives losing their voice in policy making and cause a further decline in emphasis on community care.The Association of Radical Midwives (ARM) was set up to restore the role of the midwife for the benefit of the childbearing woman and her baby. Its aims are:To re-establish the confidence of the midwife in her own skills.To share ideas, skills and information.To encourage midwives in their support of a woman’s active participation in childbirth.To reaffirm the need for midwives to provide continuity of care.To explore alternative patterns of care.To encourage evaluation of developments in midwifery.Specific objectives include:Midwives should be given total responsibility for all normal expectant, labouring and newly delivered mothers up to twenty-eight days after the birth.Flexible working arrangements which ensure continuity of care.That women have a real, fully informed choice concerning all aspects of their maternity care.To ensure that attention is primarily directed towards universal availability of humane care in all aspects of childbirth, rather than scarce resources being directed towards funding the increased use of technological interventions of questionable value.Improvements in home help services.Improvements in midwives’ training to include:
seminars with consumers expressing their views;training in the art of supportive conversation and supportive silence, and better training in natural childbirth methods.
More opportunities for women to become midwives without first having to train as nurses.Decentralisation of ante-natal care into neighbourhood clinics in all areas.
ARM is a mutual support and study group. It has several branches in different parts of the country, and holds regular national meetings to discuss skills and strategies. It publishes a regular newsletter and several information sheets for women, such as Choices in Childbirth, and provides speakers when required. *44\343\2*

Various suggestions have been made to account for these differences in hysterectomy rates. It is possible that there are specific inherited tendencies for the development of certain gynaecological diseases in different countries and ethnic groups. Equally, the explanation may lie in environmental factors or lifestyle habits, for example nutrition, physical activity levels, or even methods of sanitary protection or contraception. Perhaps women in some countries are more assertive in taking control of their lives and bodies; or maybe cultural differences in perceptions of the uterus are important — some cultures viewing it as essential to womanhood, others regarding it as an optional extra once the desired family size is reached. Other plausible explanations for variations in rates of hysterectomy are that views about what constitutes a ‘normal’ bleeding pattern differ from country to country as does the acceptability of menstrual disturbances within intimate relationships and the paid workforce. Yet other reasons suggested for the large variations in rates of hysterectomy include different opinions about its acceptability as a sterilisation procedure, particularly among couples for whom religious beliefs preclude other forms of family planning.

Unable to replace the blood, doctors resorted to all kinds of techniques to stop the bleeding. These included hysterectomy and radiological methods of inducing menopause such as bombarding the ovaries with X-rays or placing radium rods in the vagina. A contemporary example of changing medical definitions of illness is the recent claim that menopause constitutes a ‘disease’ and that the cure is to prescribe hormone therapy for all women. This may have implications for hysterectomy rates because, as noted by the US Congress Office of Technology Assessment, women receiving hormone therapy are more likely to undergo hysterectomy, possibly because bleeding is a common side-effect of its use. It has also been claimed that some health systems encourage high rates of hysterectomy through methods of health financing that encourage swift surgical ‘solutions’ rather than more prolonged treatments; the expectations of surgeons that hysterectomy should be part of their professional work and source of income; the availability of hospital beds; and the extent to which doctors get paid for the number of operations they perform.

Most studies that have examined the characteristics of women who have hysterectomies are in agreement on one point at least — the fewer the years of high school or college education, the more likely a woman is to have a hysterectomy. Complementing this rinding, a recent study in the US State of Maine has found that better-educated women are more likely to have non-surgical treatments for fibroids, abnormal bleeding or chronic pelvic pain, all common reasons for hysterectomies. In view of the consistent link between lower education levels and hysterectomy, it is difficult to explain the seemingly contradictory finding that the wives of medical practitioners have more hysterectomies proportionately than other well-educated groups in the US.

Another interesting finding to come out of the Maine study is that women who agree to hysterectomies have symptoms that are both more severe and more incapacitating than women who seek relief through non-surgical approaches. They often endure debilitating symptoms for several years before deciding on hysterectomy. Other studies have revealed that women having the surgery are more likely than average to be overweight, to have diabetes or to have high blood pressure. With some notable exceptions, such as US doctors’ wives, hysterectomy, poor health and low education levels seem to go hand in hand. Researchers studying the phenomenon of hysterectomy rate variations agree that no simple explanation can account for these differences.

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Doctors suspect that infections of the uterus could play a crucial role in very early deliveries (before 32 weeks). Uterine infections accelerate the disintegration of the protective membrane in which the baby is encased. Then, a few weeks after the onset of disintegration, the infections cause the uterus to begin contracting. However, as the membranes fall apart, a protein called fibronectin is released. This can be detected using a high vaginal swab (spotting it early would allow doctors to treat the infections using a drug called metronidazole). In a 1998 study, women who were at high risk of pre-term delivery, and were screened for asymptomatic bacteria (an infection causing no symptoms), were given metronidazole and this significantly reduced the incidence of premature birth and also low birth-weight.

Of course, in an ideal world, it would be better for women to be screened for these bacteria before conception so that they did not need treatment while pregnant.

Candida

Candida albicans (often called thrush) is a yeast which occurs naturally in the gut, in the skin and in the vagina and is usually controlled by other bacteria. It may not be stopping you conceiving but if you are aiming to optimize your health before conception then it is well worth eliminating it. When the immune system is compromised, say because of illness or bad diet, the proportions of the different bacteria can alter, allowing Candida to grow out of control. When antibiotics are given for infection they do not discriminate between the ‘good’ bacteria in the body and the ‘bad’ bacteria, they just wipe out everything. In this situation, there are not enough of the ‘good’ bacteria to keep the Candida under control and it can overgrow. Previous use of the Pill can also cause problems with Candida, and so can long-term steroid or antibiotic use.

The main symptoms of vaginal thrush are a thick, white, sticky discharge with soreness and irritation. Men can also experience a discharge from the penis with soreness or redness.

Candida is often carried in the digestive system and can give rise to symptoms such as food cravings (especially for sugar and bread), fatigue, bloated stomach with excessive flatulence, feeling spaced out and feeling drunk on a small amount of alcohol. For these symptoms it is best to consult a nutritional therapist.

If you are susceptible to vaginal thrush, prevention is best. Wear cotton underwear and looser-fitting clothes because the yeast grows in a warm, moist environment. Have a break from using tampons and use sanitary towels instead. Avoid perfumed soaps and bubble baths. Use a few drops of tea tree oil in the bath to act as an anti-fungal. Take a good probiotic (the opposite of an antibiotic) which will help to re-colonize the gut flora. For example, you could buy a good acidophilus supplement, made by a company such as BioCare or Solgar and keep it in the fridge.

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Generally speaking, many women I see do get many of the symptoms reported here. I use iris diagnosis. I find it extremely helpful in cases such as endometriosis. If I suspect there might be irritable bowel syndrome, iris diagnosis will show that and will also show me where the inflammation is.

Most endometriosis sufferers have inflammation around the fallopian tubes, ovaries, bowel and in the pelvic area generally. I believe it can also be transported to the breast and the lungs.

Why is the lymphatic system so important

The lymphatic system manufactures white blood cells to create antibodies to fight infection. Every day the lymphatic system takes nutrients and oxygen to every cell in the body and removes wastes. When the lymphatic system is congested, you start to feel unwell and tend to get tired quickly. It is important at that stage in the treatment to clean up the lymphatic system. A clogged lymphatic system creates an ideal situation for the development of tumours and cancers.

Do most women with endometriosis also have candida albicans

Some symptoms of endometriosis could also come under the heading of candida albicans. The reason that I list Candida albicans amongst my questions is because I do believe it and endometriosis often go together. If I suspect Candida is present – once again the iris is great for showing that – I treat it first. Once the Candida goes, so does the intolerance to many foods. Candida can really give a distorted picture.

Herbs or tinctures/extracts usually prescribed

Herbs are beneficial in helping with pain. Normally your herbalist will prescribe ‘tinctures’ which are solutions of herbs – usually not very pleasant tasting but effective.

Depending on your symptoms – severity of pain, digestive problems, infertility, heavy bleeding, inflammation, headaches -the herbalist will blend together a bottle of herbal solution that often looks like murky dishwater – and quite often smells like it! You will be advised as to how often and when this tincture should be taken. All are administered orally, either as a few drops on to the tongue or mixed with a little warm water.

Many endometriosis sufferers report good results using herbal remedies for the treatment of pain, tiredness, depression, irritability, lethargy, headaches and many digestive problems.

Probably one of the most difficult things after an inspiring visit to a naturopath or herbalist is to arrive home with an armful of vitamins and a combination of herbs. Apart from being expensive, you have to train yourself to remember to take them daily. But many women certainly find the effort worthwhile. Many endometriosis sufferers have reported the benefits of vitamins in helping to reduce tiredness, pain, lethargy and depression.

But don’t expect immediate miracles. You will not be cured overnight – be prepared to wait for three months before noticing any change in your condition.

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The uterus may have developed extra swellings in its muscle wall, changing the shape of the uterus and making it more difficult for the fertilised egg to implant. These are called fibroids, which are benign tumours. They are more commonly associated with heavier periods. Even small fibroids can sometimes interfere with fertility. Polyps within the cavity of the uterus may do the same thing.

Occasionally a condition similar to endometriosis can affect the wall of the uterus, The condition is called adenomyosis and is generally found in older women (closer to 40 years), and can give rise to painful heavy periods.

The cervix. When the sperm begin their trek onward and upward in the hope of finding an egg to fertilise, the first barrier they have to pass is the cervix. The cervix may cause a couple of different problems.

The cervix produces mucus which changes in quality at different times of the menstrual cycle. Around the time of ovulation it is positively trying to let those sperm through. If there is infection on the cervix, or the cervix has been damaged in some way, it may be more difficult for the sperm to make it through the mucus, or there may not be much mucus around.

Some women produce mucus which is hostile, or at least not helpful, to sperm. There can be antisperm antibodies in the cervical mucus, and this can interfere with the passage of sperm through the cervical canal.

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Nausea, and occasionally vomiting, tends to happen from about six weeks gestation to about twelve weeks. It is probably a result of a reaction to all the increased hormones floating around as a result of the pregnancy. Some women notice it increases with different things, like various smells, hunger, or certain foods. Unfortunately it is difficult to predict what might aggravate it in a particular person (but from what many women tell me, walking through the meat section of the market is not a good idea).

Women can try a few things to decrease the nausea. Having a small amount of fruit mice, or a drink and a biscuit before actually getting out of bed in the morning often helps. After that, it seems that having small, relatively frequent intakes of food (about every three to four hours, even if you are not particularly hungry) can help to settle the feeling down. You may not feel like certain foods, particularly fatty foods, so avoid them. Try to remember to eat good quality food. It is often difficult to eat the recommended balanced diet during the first trimester, but it is possible to catch up on nutrients later on if you have missed out on them earlier.

Vitamin B6 (pyridoxine) has sometimes been found to help hormonally induced symptoms. Taking 25 to 50 milligrams of vitamin B6 up to three times a day may be worth trying.

If symptoms are preventing a woman getting adequate fluid and nutrition, it may be wise to use anti-nausea medication. Certainly, most people would recommend avoiding unnecessary medications in pregnancy (see further this chapter), but if the symptoms warrant treatment, there are drugs which have been used over many years and have been found to be safe in pregnancy. The two most commonly used types are antihistamines (like meclozine, trade name Ancolan) and a specific anti-nausea drug (metoclopromide, trade name Maxalon). These can be prescribed by doctors in tablet form, and may aid in relieving nausea and vomiting.

But there are times when oral medication will be insufficient. (It is sometimes difficult to keep tablets down when you are vomiting.) Some women will need admission to hospital to have medication, and occasionally intravenous fluids, until they are able to tolerate oral fluids again. The name given to this relatively uncommon and fairly severe form of morning sickness is hyperemesis gravidarum (which is Latin for Mots of vomiting while pregnant’).

It is difficult to give definite reasons why some people should have such dramatic morning sickness, and others sail through without so much as a burp. Certainly doctors have been able to identify some conditions which may be associated with severe morning sickness, but not everyone who gets it has one of these. Increased emotional stress often aggravates morning sickness. Women with underlying or pre-existing stomach problems may find the going rougher. Having twins, or a ‘molar pregnancy’ (see further this chapter) means there are more pregnancy-type hormones around, so symptoms like morning sickness may be exaggerated.

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Infection with wart virus is common; it is thought that most sexually active adults will be in contact with a genital sub-type of wart virus at some time. Many of these people will never have a visible wart in their genital area, but will have antibodies in their blood-stream if tested (but this is usually only done in the course of research). Sexual transmission of the genital sub-types is common, although it is not the only mode of transmission. It is possible for the virus to be passed by other contact, like touching, or from mother to child. Non-sexual spread is confirmed by the presence of the virus in virgins and children. Scientists are still trying to find out more about how this bug is spread.

The wart virus has been responsible for more than simply nuisance value. Not only are they yucky things to have growing on your bottom, but a link has been found between wart virus infection of the cervix and the development of abnormal pap smears.

Before everyone who has ever had a wart jumps up and down in a panic crying ‘I’m going to get cancer!’, take a deep breath and read on.

Women who have been in contact with the genital sub-types of the wart virus may develop warts which are visible, or they may not. They may develop changes on their cervix (not usually anything that looks like a wart) which, when looked at under magnification can be identified as wart virus change in the cervical cells. These changes may come and go, just as warts on the skin may spontaneously disappear, and maybe come back later. A couple of the subtypes of the virus have been found to be associated with other cervical cell changes, namely pre-cancerous changes. It is not certain how the two are related, or whether the virus actually causes the precancerous change. It may be that wart virus effects plus some other factor makes cancer more likely to develop. It is not yet clear what the relationship is, but it is a significant finding, and in many ways we are lucky to know about it.

Women who have regular pap smears can have the cells of their cervix examined for any evidence of these changes. If any pre-cancerous changes are found, action can be taken to identify and treat the problem, before it develops into cancer. That is the basis of routine pap smear screening.

If you have actually had any genital warts, or your sexual partner has, it is wise to make sure you have a pap smear at least once every twelve months, until there have been at least two negative smears a year apart, then routine two-yearly smears may be recommenced. If wart virus change has actually been identified on any of your pap smears, you should time your smears according to the recommendations of the pathologist who reported it and your doctor. Women should be guided individually by the recommendations of their own doctors, but it is important that regular smears are done.

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The actual incidence of serious side-effects of the pill is very small. These can be divided into groups: common and pleasant, less common and a nuisance, very rare and nasty, very rare and potentially disastrous.

Common and pleasant—A welcome side-effect of the pill is lighter and less painful periods. They are also generally on time, every twenty-eight days. It is possible to manipulate the cycle to prevent your period falling on a particular day, or to miss the occasional period all together.

There is scientific evidence that the pill may have other benefits. There is a decrease in the incidence of benign (non-cancerous) breast lumps. (The relationship between the pill and breast cancer is still being debated. Studies showing contradictory results have been released). The pill is actually associated with a significantly decreased incidence of some other cancers, in particular cancer of the ovary and cancer of the endometrium (the lining of the uterus).

The pill can be used to treat some types of hormone disorders, like a condition called polycystic ovarian syndrome. It can be helpful, in combination with other medication, in the treatment of excess body hair, and acne.

The pill is sometimes used in women who have prolonged times without periods. This is because these women would otherwise be lacking oestrogen, which is needed to maintain healthy, strong bones. Osreoporosis is more common when there have been prolonged times of oestrogen deficiency, for whatever reason.

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Occasionally a tumour in the pituitary gland may form, and produce excess prolactin (called a prolactinoma). This has the effect of stopping ovulation, and can therefore present as a disturbance in the menstrual cycle, and sometimes causes milk production in the breasts of a non-pregnant woman.

Menopause occurs when the ovaries don’t take notice of the FSH and LH from the brain, which are giving them the message to produce eggs. The ovaries slow down production of oestrogen and progesterone, and ovulation doesn’t occur. The relative lack of oestrogen can give rise to changes in other parts of the body, like the skin, bones and arteries.

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