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Unnecessary inductions raise risk of complications

Pregnant women who are induced for “non-recognised” medical reasons have a higher chance of birth complications than other mums, a study has found.

A team from the University of Adelaide studied 28,000 births over a year, comparing spontaneous labours with inductions of women who were induced for medical reasons, and those who were induced for non-recognised medical reasons, such as living a long way from a hospital or wanting a birth to occur on a particular day or time.(canvas prints australia canvas photo prints)

    In the absence of serious maternal or fetal problems or a medical recommendation, induction is best avoided

The study found that inductions performed for non-recognised medical reasons ­led to a 67 per cent higher chance of having a caesarean section.

Babies who were induced for non-recognised medical reasons had a 64 percent higher risk of being admitted to the Neonatal Intensive Care Unit, and a 44 percent higher chance of needing medical treatment.

Rosalie Grivell, from the university’s Robinson Institute, said spontaneous labour had the best outcomes for mother and baby.

“In the absence of serious maternal or foetal problems or a medical recommendation, induction is best avoided,” she said.

Women had the lowest risk of having an epidural if they went into labour at or after 41 weeks’ gestation. Other results showed that mums were at the lowest risk of suffering a severe perineal tear if they laboured after 38 weeks’ gestation.

“We hope our findings will increase awareness of potential complications related to the common use of induction of labour in situations where there is no serious maternal or fetal problem,” Grivell said.

Women labouring longer than they did 50 years ago

A US study has found that women are spending longer in labour than they did 50 years ago.(canvas prints online canvas art prints)

Scientists at the National Institute of Child Health and Human Development compared 39,491 births from 1959 to 1966 with 98,359 births from 2002 to 2008. All the women had gone into labour without complications.

    The first stage of labour has increased by 2.6 hours for first-time mums, and by 2 hours for women who have already had children

The researchers found that the first stage of labour has increased by 2.6 hours for first-time mums, and by 2 hours for women who have already had children.

Babies of modern parents were born five days earlier, on average, than those in the 1960s, but also tended to weigh more.

So what caused the difference? The authors noted that on average, women in the modern group were 2.5 years older than those in the first. And women giving birth in the 2002-08 group had an average body mass index of 29.9, putting them close to the obese range, compared with 26.3 in the earlier group.

"Older mothers tend to take longer to give birth than do younger mothers," said the study's lead author, Dr S. Katherine Laughon. "But when we take maternal age into account, it doesn't completely explain the difference in labour times."

The researchers pointed to delivery room practices as a likely reason for the longer labours. Only 4 per cent of women in the earlier group received epidural analgesia, compared with 55 per cent in the recent group.

About 12 per cent of women in the '60s received oxytocin to induce labour, compared with 31 per cent in the modern group.

A team from the University of Sydney found that in Australia, epidural analgesia use increased from 17.2 per cent in 1992 to 26.5 per cent in 2003. In 1979, 75 per cent of births were to women under the age of 30; by 1999, births to women younger than 30 had dropped to 52 per cent. By 2009 this figure had dropped to 46 per cent, according to figures from the Australian Bureau of Statistics.

Labour the second time round - is it easier?

Pregnancy and labour go hand in hand with old wives tales. But while we may be able to dispel old ways to predict the sex of the baby, or labour inducing home therapies, is there any truth to labour being easier the second time round? A common perception is that a woman’s body will know what to do in a second labour and the whole experience will be easier than the first time.(canvas prints online acrylic prints)

Research has shown that compared to the first labour the duration of the second labour and even the oxytocin requirements in the second labour are significantly reduced. So does a shorter labour suggest it is an easier labour?

Approaching the birth of her first child, Kristy was concerned about labour and the birth process. Nineteen long hours later, with oxytocin and intervention she was cradling her beautiful daughter, with a sense of overwhelming exhaustion. Two years later she anticipated the birth of her second child very differently “I was more scared going into this labour than I was the first one because I knew what to expect in terms of pain, I knew how bad it was going to be.”

But it seemed the old wives tale was true for Kristy. Labour was only five hours and there was no oxytocin or intervention. “Your body does know what to do the second time round, it is like it has a memory, and I really listened to my body and did what my body wanted to do.” However, Kristy was quick to point out that a shorter, less complicated labour was not easier. “It is not easier in terms of the pain; the pain was more intense and I still had to get through it, both mentally and physically.”

Can women anticipate a second labour to be quicker and perhaps with less intervention? Midwife Liz Wilkes, from My Midwives and President of Midwives Australia, does agree that “second labours are generally shorter than first labours.” So it does seem that “for the majority of women this means that they typically experience it as a ‘better’ ‘easier’ experience, however it is not always the case.”

“For some women a very short labour means they have less time to adjust to what is happening.” Liz says that transition is usually much shorter “usually minutes, a few contractions” meaning the part of labour that was often very tough in the first birth is gone before the woman realises she is in it.  “Most women welcome this, but for a few, it may be an out of control experience.”

Jacqueline thought everything was going perfectly in her second pregnancy; she finished work five weeks before her due date, ready to settle in for some rest and nesting. Finishing work on the Wednesday, she fell ill with a stomach virus on the Thursday and went into her second labour on the Friday. “The first time I was more prepared, I was focused and could get through it, whereas this time I was caught by surprise and the whole thing felt like it was out of my control.”

Seventeen hours of labour the first time left Jacqueline apprehensive about what was about to happen; only to be surprised with a five hour second labour. But this mum does not think it was easier. “Labour was stronger and the pain was more intense because it was in a shorter period of time.” Jacqueline encourages that “quicker was better because it is not drawn out and it is reassuring knowing that your body does know what it is doing.”

Yet her words of advice to anyone facing a second or subsequent labour are perhaps more truthful than any wives tale could ever be. “Like every child is different, I think every labour is different and whether it is your first or second, you can only prepare so much and you should never expect it to be easy.”

While the perception may be that labour is easier the second time round, perhaps it is more so that mothers are more confident, more in-tune to the demands of and the capability of their body. Second time mothers may have also shed the inhibition and initial fears that cloaks labour the first time round. And while it seems labour can be quicker for subsequent births, quicker is not a scapegoat for easier.

Meconium stained liquor and meconium aspiration syndrome: the facts

What are meconium stained liquor and meconium aspiration syndrome?

Most infants have their first bowel movement, called meconium, in the first 24 hours after delivery. Mecomium is a sticky dark-green consistency, and when the amniotic fluid is tinted green or yellow, instead of being clear, it is called meconium stained liquor. This happens when an infant passes meconium before they are born.(canvas prints australia canvas printing sydney)

Meconium aspiration syndrome is when an infant inhales the meconium before, during or after labour. It can cause respiratory problems as serious as pneumonia, and although it rarely happens, it can be fatal.

Not all babies who are born with meconium staining will develop meconium aspiration syndrome, and those that do usually have their airways cleared quickly to prevent further health problems.

What are the risk factors?

Chances of meconium stained liquor and meconium aspiration syndrome are raised if any of the following are present:

- foetal distress during labour (such as having a difficult delivery or umbilical cord problems)
- being an older mother
- smoking cigarettes
- having medical conditions such as diabetes, high blood pressure or cardiovascular problems
- having an infection or placenta problems
- being overdue (meconium staining rarely occurs before 38 weeks of pregnancy).

What are the signs?

Besides stained amniotic fluid, other signs a baby may have meconium aspiration syndrome include breathing difficulties, a slow heartbeat, a distended chest or making “grunty” noises, and receiving a low APGAR score (which is based on a few different tests that evaluate a baby’s health straight after birth).

How are they diagnosed?

Meconium stained liquor is diagnosed through observation of the amniotic fluid.

Meconium aspiration syndrome can be diagnosed by listening to a baby’s lungs with a stethoscope for wet or crunchy sounds. If they can be heard, chest X-rays can be ordered to show patchy areas on the lungs. Blood can also be taken to show how much oxygen an infant has in their circulation, which can both be used to make a final diagnosis and start treatment.

What's the treatment?

Meconium stained liquor observed during labour is a signal for increased monitoring of the baby during labour.

Treatment depends on how much meconium is inhaled. If meconium staining can be seen during labour, an amniofusion can be performed to prevent aspiration syndrome. This is when the meconium is flushed out of the amniotic fluid with a saline solution before the baby can inhale it, although this practice isn’t usually performed in Australia.

If a baby has inhaled meconium but their heartbeat or breathing isn’t affected, they will be monitored but may not require any treatment.

Doctors can perform suction to remove the meconium from the trachea and lungs until it’s all gone. The baby may sometimes need antibiotics.

Some babies who have inhaled a lot of meconium will need to be placed on a ventilator and cared for in a neo-natal intensive unit. Many babies will be fine within a matter of days or weeks, although very rarely a baby may experience longer-term health issues such as asthma or developmental problems.

Practicing birth positions

There are many birthing positions that your partner can adopt to help facilitate an easier birth. You, my friend, will help her with these positions and will need to know them and to encourage her to try different positions as the labor progresses. (cheap canvas prints canvas print)

Some of these positions include squatting, kneeling and standing and all require good muscle strength to pull them off.  By practicing these positions during pregnancy you are not only doing a trial run for the big day you are also helping her strengthen the right muscles....don’t forget she’ll be a lot heavier then so the muscles will need time to adjust to her increasing weight over time.

    Don’t be a spectator in the Grand Prix of baby making. Be a co-driver, get behind the wheel and feel the exhilaration of building a baby and making a real difference.

All this sounds ridiculous and a waste of time right? Do you want your birth to be as enjoyable, painless (for mum, baby and YOU) and as memorable as possible? If the answer is Yes then start exercising today, or tomorrow if you are reading this in bed.

So there you have it lads. Assisting your partner to eat well and exercise are the two biggest ways that you can directly influence the health and development of your baby. Don’t be a spectator in the Grand Prix of baby making. Be a co-driver, get behind the wheel and feel the exhilaration of building a baby and making a real difference. It’s your first role as being a dad.

In defence of birth plans

"My personal view of birth plans is that they’re most useful when you set them on fire and use them to toast marshmallows. But there are some women who live for them: I call them Birthzillas because just like a Bridezilla focusses on the wedding not the marriage, The Birthzilla appears more interested in having a birth experience than a baby," writes Mia Freedman in the Sunday Telegraph in a piece on the decidedly ugly game of ‘My Birth Was Better Than Yours’.

Birthzillas, Bridezillas and perhaps all ‘Zillas’ are bad news. It’s amusing stuff, but the thing is, birth plans are helpful for many parents, and an increasing number of obstetricians and midwives request them. There are a number of reasons for this.(canvas prints canvas prints melbourne)

    Women have the right to control what is done to their bodies, always, including during the intense process of birth

The majority of Australian women choose to birth in hospital and all hospitals do not have the same protocols. It is easy to imagine they would, but they don’t, not from state to state and not even from hospital to hospital in the same city. Even individual health practitioners in the same facility sometimes do not follow the same protocols.

For instance, unless specifically requested, many hospitals do not automatically offer valuable skin-to-skin time, where baby is simply placed on mother’s chest straight after birth for about an hour, despite research showing substantial health benefits including increased success with breastfeeding and mother-baby bonding. (I recommend this very beautiful experience and thankfully most hospitals will offer it if requested, even in circumstances where mum has given birth by caesarean.)

Things like skin-to-skin are the sorts of thing you can put in your birth plan, along with other important requests, including who you would like present during birth, "I’d like my husband to be present to support me", "By no means let my in-laws into the birthing suite" etc. If you want those things but don’t express them, you may find bub whisked away for weighing and washing before you get the opportunity for skin-to-skin or your first breastfeed, and you might find your well-meaning mum-in-law wandering in when you aren’t ready for company.

Do you want pain medication offered, or would your rather ask for it yourself? Do you want to avoid certain optional medical procedures, like an episiotomy? Do you want cord blood saved for cord banking? The list goes on.

Women have the right to control what is done to their bodies, always, including during the intense process of birth when the body is arguably most out of our individual control. Informed consent is important in birth, as it is in our sexual experiences, in breastfeeding, and in the sadder times when illness and death take over. During these times it pays to be particularly clear about our wishes and requests, to ourselves, but most importantly to those who will be in that experience with us – our carers, our partners, our doctors, our families, our friends.

Clearly communicated requests about what we would or would not like to have done to our bodies is important, which is why birth plans are recommended by many obstetricians and midwives. These requests are not set in stone, of course, but it pays to write our requests down and chat clearly with our chosen health practitioner about those requests beforehand because: a) we then don’t have to worry about what unknown things will be done to us in various circumstances, as the different scenarios will have been discussed clearly beforehand, b) our carers will know what our wishes are and can communicate them to all of the staff who will be involved in our care, and c) we are actively involved in the decisions made about your bodies and the bodies of our newborn children.

There's no right or wrong way to give birth

A few weeks ago, I mentioned to a fellow health worker that I'd co-written a book on postnatal depression. ''Really? I have an interest in postnatal depression,'' she said.(cheap canvas prints canvas printing sydney)

Assuming she meant a professional interest, I asked her to elaborate. ''My sister committed suicide a few years ago,'' she said.

The story she went on to tell me was an eerily familiar one: a traumatic vaginal delivery, family interstate, no one checking on the mental health of a vulnerable young woman, a devastated husband and a motherless child left behind.

Unthinkable, but more common than you'd imagine. In last Saturday's News Review, Catherine Naylor reported on the rise in birth complications in Australia. In the story, Hannah Dahlen, a midwifery professor at the University of Western Sydney, is quoted as saying the following:

''Suicide is one of the leading causes of women dying after childbirth in the developed world.

''According to some studies, one in 10 women are coming out of childbirth traumatised, showing symptoms of post-traumatic stress disorder … If you are coming out of childbirth feeling devastated, like a failure, unable to get on with life, those interactions with your baby are fundamentally wiring that baby's brain and there are psychological implications for children.''

The causes of postnatal depression are many and varied: genetics, hormones, an anxious disposition, no family support and stressful life events among them. But I can't help wondering if the language that surrounds childbirth is part of the problem. Why would a woman feel ''like a failure'' after a birth that hadn't gone to plan unless someone suggested she should?

Modern motherhood has taken on a disturbingly competitive edge. There seems to be a right way (vaginal delivery with extra points for no epidural/ breastfeeding for a year) and a wrong way (caesarean delivery/ bottle feeding) to become a mum. If you fall into the latter category, you risk being judged, or at very least perceiving yourself as being judged. During the emotionally charged months after childbirth, this is a potentially dangerous mix.

In another story, Amy Corderoy reported that the Royal Hospital for Women at Randwick is bucking the trend on rising caesarean rates, having reduced the rate in their public wing from 28 per cent to 25 per cent in the past three years. No one doubts this is a laudable public health initiative - a vaginal delivery is always preferable if there's no risk to mother and baby.

However, I did a double take at the interview with mother Audrey Tamburini, who had delivered vaginally after a previous caesarean. According to the story, Tamburini's caesarean had left her feeling ''disempowered, traumatised and incapacitated''. Tamburini says: ''I believe the whole experience helped me to heal emotionally from the [previous] C-section and gave me heaps of confidence and empowerment in the first months of Juliette's life.'' ''Heal'' and ''empowerment'' - such emotionally laden words. Audrey Tamburini had the outcome she desired, but what about other women reading the story who need to have a second caesarean? How would they feel? I suspect for some it would be a kick in guts, making them feel less worthy.

I'm willing to bet that empowerment in childbirth is a uniquely Western preoccupation. I wonder if the women on the plains of Africa feel empowered when they give birth naturally or whether they're just grateful that they and their babies have survived the experience. Or go back a few generations. I expect my maternal great-grandmother, who died in childbirth, would have gratefully accepted a caesarean if one had been on offer.

I could be accused of bias as I've had three caesareans. My first baby was breech. With my second, my obstetrician pushed for a trial of labour, but it didn't work out. The third was a no-brainer. I don't remember feeling unempowered or even particularly incapacitated after the births, just very much in love with my three beautiful babies.

I don't think it is bias because I was an exemplary breast feeder and get just as angry when the ''breast is best'' public health message is distorted by overzealous lactation advocates. One of my closest friends couldn't breastfeed and was made to feel a failure because of it. Breastfeeding difficulties are a recognised trigger for postnatal depression.

My first baby is now nearly 20. Motherhood is a long haul and if we are to judge mothers at all (although I'd prefer we didn't), it should be on how well they nurture their child's emotional development, not on how they deliver or feed their baby in first few months. When you have a 20-year-old, all that early stuff seems very unimportant.

So can we please mind our language when it comes to the birth experience? There may be a vulnerable young woman reading or listening.

Caesarean rate not just a result of ageing, overweight mums

For a man who has spent his whole life researching the pelvic floor, Dr Peter Dietz's comments that women are endangering their health in a quest for natural birth to avoid caesarean sections comes as no surprise.(canvas prints acrylic prints)

There is no doubt that pelvic floor injuries are a threat to the health of child-bearing women. It's imperative that we continue research in this area, and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.

I was part of the multi-disciplinary committee in 2010 that worked on the 'Towards Normal Birth' policy that Dr Dietz criticises. The policy was based on sound scientific evidence, and is in line with international recommendations from groups such as the World Health Organization.

More importantly, it was in response to intense consumer lobbying over the high rates of caesarean section in NSW and the resulting trauma (physical and emotional) for women.

Dr Dietz argues the rising caesarean section rate is linked to older and overweight women giving birth. This is, in part, true. It does not, however, account for the fact that we see significantly lower rates of caesarean sections in Scandinavia and the Netherlands, where women have the same demographic profile.

We published a paper last year repeating a study undertaken a decade earlier, which showed that with the same matched low-risk (no medical complications, under 35 years of age) population of women in NSW, there had been a 5 per cent rise in caesarean sections in the public sector, and 10 per cent rise in the private sector.

The ''oldest'' women giving birth in NSW do so in birth centres and at home, and have the highest rates of normal vaginal birth.

Studies show that women who give birth in private hospitals are much less likely to be overweight than those birthing in the public section, yet they have nearly twice the caesarean section rate.

So the question that must be asked is this: is the problem more about our attitude to women and the models of care and environments in which they give birth, rather than changing demographics and medical risks?

The rising caesarean section rate is therefore not as ''inevitable as the weather'', as Dr Dietz argues.

Dr Dietz states that reducing epidural pain relief is ''reprehensible and anti-Hippocratic''. There is no intent to deny a woman an epidural if she wants one; we need to ensure they're not used unnecessarily. Women who have epidurals during labour have higher rates of instrumental birth (forceps and vacuum), which Dr Dietz quite rightly points out is a major cause of pelvic floor problems.

But continuity of midwifery care, for example, leads to a reduced need for epidural and higher satisfaction with birth, along with many other advantages. Immersion in water reduces the need for epidural and increases women's sense of control, so access to this is supported under the 'Towards Normal Birth' policy.

Dr Dietz's statement that ''human childbirth is a fundamental biomechanical mismatch: the opening is way too small and the passenger is way too big'' provides a real insight into why the caesarean section rate may be so high in this country.

If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?

Birth, blokes and 'the business end'

Robbie Williams probably isn’t the first man to compare watching the birth of his daughter to the loss of a great love. “It was like my favourite pub burning down”, he said when he appeared on the Graham Norton Show in November. But is there any truth in this popular quip, or is it merely male bravado?

“Sometimes men just find it easier to make jokes about our favourite pub than actually talk about how special and beautiful something was, that’s what we do”, says parenting blogger Matt Ross.(cheap canvas prints canvas print)

“But I’m sure there are men who see the birth of their child and the biology of it all and do find it hard to shake that image or association”.

Mark Knight is one such man, confessing that witnessing the birth of his son did leave him with some uncomfortable mental images. “I never really had any reservations about being down there – I was fascinated. But it was not what I expected”.

“When our son started to crown I was overwhelmed. I fought like mad to hold back the tears. But at the same time I was trying really hard to ignore the fact that my wife’s bum hole was inverted and being pushed out too.

“Did it make me fancy my wife any less? You know what…I know that I should say ‘no’, but it kind of did a bit. The ‘poo shoot’ memory is one which haunts me and does make intimacy less appealing”, admits Mark.

Dr Rakime Elmir, a nursing and midwifery lecturer at the University of Western Sydney, says that a small proportion of men are negatively affected when witnessing their partner give birth.

“These men feel out of control, powerless and helpless. Relationships are affected as these men are unable to be intimate with their partners due to the images seen at the birth”, explains Dr Elmir.

For fathers that have witnessed a particularly traumatic birth in which things have not gone according to plan or medical intervention has been needed it may be necessary to seek professional counselling in order to move on.

“If fathers feel that they are constantly recounting the events of the birth in a negative way it is paramount for them to seek professional advice to prevent postnatal depression and other emotional and physical symptoms”, advices Dr Elmir.

There are some men who avoid the risk of having negative memories of their partner’s anatomy by staying a safe distance from the ‘action’. David Pruell says that while he wasn’t worried about “ruining” his “admiration for the 'area' concerned”, his partner, Sarah, had made it clear she wanted him to stay away from the ‘business end’. He also says that he wanted to meet his baby at the same time as Sarah.

“I had always considered childbirth to be something we experienced together and wanted us both to 'meet' our child at the same time rather than have a staggered introduction. I also wanted to be close to Sarah so that I could give her the support that she needed during the birth”.

Liz Wilkes, practicing midwife and spokesperson for Midwifes Australia estimates that around 50% of men want to be at the ‘business end’. “Some men are not worried about the visual around birth, whilst other are adamant that they want to see nothing at all”, she says.

Wilkes says that in the twenty years she has been delivering babies the most common reaction to birth from the father’s perspective is one of joy. “Most men who support their partner through labour feel the same surge of love for the baby as the woman, and with that an overwhelming feeling of love for their partner”, she explains.

There is no doubt Robbie Williams experienced this ‘surge of love’ too. After making jokes with fellow guests about “rebuilding” the “ruins” of his favourite pub he concluded the conversation about his daughter’s birth by looking directly into the camera and emphatically telling his wife Ayda, “I love your foo”.

Babies, not burgers: why we need better designed labour wards

I recently visited a new McDonald’s outlet on the northern fringes of Sydney. What I found inside left me gawping in astonishment: soft lighting, views of nature, a mixture of private and communal spaces, adaptable furnishings, excellent way-finding, warm colours, natural materials, positive distractions!

Everywhere I looked I saw evidence-based design features that, when translated to the hospital environment, have been shown to improve experiences and outcomes for users. But this was a McDonald’s ... so why did it feel better designed for low-risk maternity care than most hospitals?(canvas prints canvas prints melbourne)

The answer is simple. McDonald’s is using design to create spaces that support an optimal consumer experience.

The influence of design

In the maternity care setting, the childbearing woman is the primary consumer. And from a health perspective, the optimal experience and outcome for most women is a normal birth – without medical intervention.

But despite this, medical intervention is at an all-time high in this country, with caesarean sections now accounting for 33 per cent of all births.

About 97 per cent of Australian women give birth in conventional hospital labour ward rooms. These rooms are commonly designed with a narrow bed as the focal point, contain multiple pieces of medical equipment and display a clinical aesthetic.

According to a Cochrane Review, women who labour in conventional birth rooms are more likely to experience interventions, including caesarean section. Women who labour in alternately designed or ambient rooms use less epidural pain relief, have fewer medical interventions and a higher chance of having a normal birth.

Women have reported that the birth environment is a key factor in how easy or hard it is to give birth. Remarkably, one UK study found that simply obscuring medical equipment from view with a painted screen shortened the duration of labour by two hours and reduced requests for epidural pain relief by 7 per cent.

Although the reasons that underlie birth outcomes are complex, design is likely to play a role. This is partly because the designed environment has widely acknowledged effects on human neurobiology.

The complex hormonal system that controls labour is disrupted when part of the brain called the neocortex is stimulated. A range of environmental factors can stimulate the neocortex, including bright lights, loud noises, unknown people and places that are perceived as hostile or frightening.

By adapting the design of hospital birth rooms to minimise these factors, we give women a better chance of achieving a normal birth and optimal health outcomes.

Spaces for an optimal experience

Maternity care providers are now implementing strategies to increase the normal birth rate and decrease caesarean sections. The NSW Health policy directive 'Towards Normal Birth', for instance, states that all women giving birth in hospital should have access to an environment that "is conducive to facilitating/promoting normal birth".

This is reinforced in the Australasian Health Facility Guidelines for maternity units. They state that birth rooms should be designed so “women may use them much as they would use their own homes”. The guidelines clarify that the bed should not be the focal point of the room, and a calm, private, ambient space is the ideal.

The cost of refurbishing or rebuilding maternity units to reflect these guidelines is perceived as a barrier to the birth rooms that support optimal outcomes. However, many design features that facilitate normal birth, such as wall-mounted bars, benches of various heights, birth stools and inflatable birth pools can be added to existing birth rooms without major alterations to architecture or infrastructure.

Simple changes to enhance ambience can be made by simply altering colour, lighting and room layout. These changes may ultimately reduce health expenditure by lowering the number of costly interventions performed during labour and birth.

Even simple changes to enhance ambience can make a difference.

Designing for health

Innovative, evidence-based hospital birth room design has been incorporated into a handful of new maternity units around the country, such as the Centenary Hospital for Women and Children in the ACT and the (yet-to-open) Royal North Shore Hospital in Sydney. In these units, rooms incorporate the needs of healthy, active women while still providing safe emergency options.

These units show that normal birth and unexpected outcomes can be catered for in the same space by implementing thoughtful design. Hopefully these advances inspire further change around the country.

Let’s face it: if you can get good design when you’re having a burger, you should really be able to get it when you’re having a baby.

Push for more home births in the UK

Home births are in the news in the UK this week, after new guidelines have recommended that more women should be encouraged to labour at home.(cheap canvas prints canvas print)

The guidelines have come from the National Institute for Health and Care Excellence (NICE), and have been largely met with support. They suggest that all women with uncomplicated pregnancies should be encouraged to give birth in midwife-led units instead of hospital labour wards, and that women who are pregnant with their second or subsequent children should be encouraged to give birth at home, as long as they aren't considered medium or high risk.

It's easy, in my view, to see why the guidelines have had such a positive response. There's a continued argument about the over-medicalisation of pregnancy and birth, and intervention rates are consistently high. So if we're changing direction towards a framework that empowers women and returns confidence in their bodies, surely that is a good thing? Reducing medical intervention rates is surely beneficial, too.

Sadly, however, it feels like much of the debate around home births comes back to the central issue of funding. There simply isn't enough money. Many areas lack midwife-led units. Other areas have seen those units closed due to financial constraints. These are the issues that are resulting in more women being on labour wards.

There is also a desperate need for more independent midwives. Without them, there cannot be more home births.

In addition, it is an inescapable fact that birth is unpredictable. Women considered to be low risk and women who have had straightforward pregnancies can still experience complications during birth. There needs to be adequate funding to ensure these women can immediately access the medical help they need if that happens. That means the creation of more birthing units, because currently, many women can't have home births because they are too far from help if they need it.

Aside from funding, the guidelines have seen many mothers repeat a call for choice and information. On talkback radio, on internet forums, on comment sections, women have been discussing their own birth stories, and the common theme is that women must be able to make their own decisions.

It is brilliant that women will be encouraged to have home births - but only if they want them. Pregnant women should be given the information they need to make well-researched choices. Just as there should be no pressure for them to birth at hospitals if it isn't necessary, there should be no pressure on them to have home births if they don't feel that option is right for them.

I've heard many women say in response to the new guidelines that they wouldn't be "brave enough" to have a home birth. If encouraging women to have a home birth means some feel this way, then the movement has gone too far. No woman should feel that giving birth is about being "brave enough". Similarly, no woman should feel that giving birth is about surrendering their body to a medical system that is beyond her control or comprehension.

Every woman is different, and every woman will have a different experience of pregnancy and birth. Hopefully the new guidelines will go some way to helping women give birth in the way that is right for them.

Mum sues over forced c-section delivery

After two caesarean sections, Rinat Dray wanted to give birth naturally.

The mum of three said that during her first pregnant, her doctor began urging her to have a caesarean after her water had broken and she had laboured for a few hours. Hoping for a different outcome for her second pregnancy, she went to a different hospital, with the same result.(canvas prints canvas prints melbourne)

Still hoping for a vaginal birth, she changed doctors again for the third pregnancy. She also hired a doula to help her with the childbirth.

But when she arrived at Staten Island University Hospital in labour, the doctor immediately began pressuring her, she said, to have a C-section.

The doctor told her the baby would be in peril and her uterus would rupture if she didn’t have the surgery, and that she would be committing the equivalent of child abuse and that her baby would be taken away from her, she said.

“I was begging, give me another hour, give me another two hours,” Dray said. In return, she claims, the doctor said “I’m not bargaining here … don’t speak.”

After several hours of trying to deliver vaginally and arguing with the doctors, Dray was wheeled to an operating room, where her baby was delivered surgically.

The hospital record leaves little question that the operation was conducted against her will: “I have decided to override her refusal to have a C-section,” a handwritten note signed by James Ducey, the director of maternal and foetal medicine, says, adding that her doctor and the hospital’s lawyer had agreed.

But Dray is suing the doctors and the hospital for malpractice, charging them with “improperly substituting their judgment for that of the mother” and of trying to persuade her by “pressuring and threatening” her during the birth of her third son, Yosef, in July 2011.

More broadly, her case is part of a debate over the use of caesarean sections. It also raises issues about the rights of pregnant women to control their own bodies, even if that might compromise the life of a foetus.

High caesarean rates

Across the country, nearly 33 percent of births, or almost 1.3 million, were by caesarean section in 2012, according to the Centers for Disease Control and Prevention. The World Health Organization recommends that the rate should not be higher than 10 to 15 percent.

The rate has been climbing since 1996, despite warnings from health officials that C-sections are more likely than normal births to cause problems for the health of the mother and the baby. It has recently leveled off.

Indeed, in Dray’s case, her bladder was cut during the procedure, according to court papers.

The increase in the number of caesareans has been attributed to a rise in high-risk pregnancies; a desire by doctors and mothers to schedule their deliveries; and fears of malpractice lawsuits should the baby be injured during a normal delivery. Obstetricians pay some of the highest malpractice insurance premiums of any medical specialty because of the frequency of birth-related lawsuits.

A spokesman for the hospital, Christian Preston, said he couldn’t comment on the case because of the litigation and privacy concerns. But he defended the hospital’s record, saying it had a 22 percent caesarean section rate, compared with a state average of 34 percent. Its 2012 rate of VBAC (vaginal birth after C-section) was almost 29 percent, much higher than the state average of 11 percent, he said.

The lawsuit, filed last month in Brooklyn’s Supreme Court, also names Leonid Gorelik, who delivered the baby, and Ducey as defendants.

Gorelik, in court papers, denied that he had taken Dray for the surgery against her will. He said her own “conduct and want of care” contributed to any injuries she may have suffered.

“We won’t tie you down”

Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, who has published on the subject of patient autonomy, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child.

“In my worldview, the right to refuse is uncircumscribed,” Minkoff said, cautioning that he was not commenting on the particular facts of Dray’s case. “I don’t have a right to put a knife in your belly ever.”

Such a person might be accused of being immoral or a terrible mother, he said, “but we won’t tie you down.”

How to use birth pools safely

The recall of hired home-birthing pools after a baby contracted Legionnaires' disease will inevitably lead some women to worry about having a water birth at home. While the incidence is rare, it is worth keeping in mind some clear guidelines about how to best use a water pool.(photo on canvas Acrylic canvas printing)

Home birth is an option for women who are at low risk of complications, but it is certainly not widespread. In the UK, the percentage of women who have their baby at home is very low – only 2.3 per cent in 2012 (included in this figure are many home births that are unplanned). Others who plan home births initially labour at home using water, but then transfer to hospital for additional pain relief.

But about half of women who planned home births use water birth pools, as immersion in water helps relieve pain.

In the case of the baby with Legionnaires', it was born in a pool that was pre-filled and kept heated for several days before. The recommended water temperature for water birth pools is 36-37°C so that during labour the baby isn't overheated or shocked by cold water. But this is also an ideal temperature for many bacteria to flourish in, including the Legionnelle bacteria, which can cause a severe lung infection, so the recommendation is that home birth pools should never be pre-filled and kept warm. This is the reason hot tubs that aren’t looked after have also been implicated in cases of Legionnaires' disease.

Some women may be tempted to pre-fill the pool when they know they could go into labour so they don’t have to wait while it fills up when labour starts, or to try it out beforehand. But a good idea is to fill it with cold water to see how long it takes to fill – most only take 10-20 minutes – before emptying, cleaning and drying the pool until it’s actually needed, which will also give you an idea of when to start the process. This would prevent the unusual Legionnaire bacteria and also more common bacteria.

Hiring a pool

Not all women buy pools as they're usually for a one-off use, or they may be too expensive to buy. As a result, many women prefer to hire them. These hired pools come in a variety of types, usually free standing, and can have inflatable or rigid frames with disposable liners. Most come with pumps and pipes to aid filling and draining, and most companies provide advice about safety and hygiene which should be read and adhered to. Even so, it’s ideal to discuss the pool, how and when to fill it and ensure it’s clean and safe with a midwife.

While an investigation into how the baby contracted Legionnaires' is carried out, certain types of birthing pools have been bannedin the UK until further notice. Heated pools from the particular supplier in this case have been recalled, and a further six companies that hire out pools are being questioned over whether they carry out the right risk assessments.

Concerns about infection are not new. But a Cochrane review I lead that looked at the evidence to date showed no difference in the incidence of infection in mothers or babies using a variety of pools, both plumbed in and free-standing. Importantly, however, all were filled at the time of use, were carefully maintained with strict cleaning regimes, or used with one time use only liners.

All midwives are also very aware of the risk of infection and any woman considering birth at home or using water during birth should speak to her midwife about her plans. Advice in local waterbirth workshops for expectant parents also now often includes not using pre-filled/heated pools because of the rare but possible infection risk.

There are important advantages for women giving birth at home, such as a sense of well-being from being in their own environment. The use of water during labour and birth is likely to be a contributing factor to this, so it's vital that women have all the information they need to safely birth at home and use water immersion during labour if they wish.

So the key message must be that any infection is unusual – and Legionnaires' is extremely rare – but good practice when it comes to birthing pools, and under the guidance of a midwife, will contribute to a positive birth experience for all.

Labour pain relief may reduce risk of postnatal depression: study

Controlling women's pain levels during childbirth and the post-delivery period may reduce the risk of new mums suffering from postnatal depression (PND), according to a new study.

Researchers found that 14 per cent of women who had an epidural for pain relief during labour reported suffering depression six weeks after the birth of their baby, compared with 34.6 per cent for women who had no pain relief during childbirth.(glass prints Cheap Canvas Online Wholesale Photo Prints)

The Chinese study, which analysed data from 214 women, also found that breastfeeding was more common in the group who had an epidural for their pain (70 per cent) compared to those who did not (50 per cent).

Writing about the findings in the current issue of Anesthesia and Analgesia journal, perinatal psychiatrist Katherine Wisner described the findings as "exciting" and said the information could be particularly helpful for women who are already at risk of postnatal depression.

"It's a huge omission that there has been almost nothing in postpartum depression research about pain during labour and delivery and postpartum depression. There is a well-known relationship between acute and chronic pain and depression," said Wisner, who is a professor of psychiatry and behavioural sciences and gynecology at Chicago's Northwestern University Feinberg School of Medicine.

"Maximising pain control in labour and delivery with your obstetrician and anesthesia team might help reduce the risk of postpartum depression."

While biological and emotional factors are known to contribute to postnatal depression, Wisner said chronic pain might also play a part by hindering a mother's ability to emotionally attach to her new baby.

The incidence of severe acute postpartum pain is approximately 11 per cent, Wisner says. While the rate of chronic pain varies between studies, it ranges from 1 to 10 per cent for vaginal delivery and 6 to 18 per cent following a caesarean.

Wisner says a woman who has chronic pain one to two months after delivery should be screened for depression.

"Pain control gets the mother off to a good beginning, rather than starting off defeated and exhausted," Wisner said. "Whether it's vaginal or caesarean section delivery, pain control postpartum is an issue for all new mothers. There is no way to have a delivery without pain; the objective here is to avoid severe pain.

"Controlling that delivery pain so a woman can comfortably develop as a mother is something that makes a lot of sense."

According to the Black Dog Institute, depression during pregnancy or the postnatal period affects between 15 and 20 per cent of women in Australia. About three per cent suffer severe depression in the early months after their baby's birth.

Common symptoms of PND include loss of enjoyment in usual activities, loss of self-esteem and confidence, loss of appetite and weight (or weight gain), difficulty with sleep, a sense of hopelessness and being a failure, suicidal thoughts, panic attacks and loss of libido.

Anyone needing more information about postnatal depression can go to Beyond Blue's Just Speak Up website or I've Been There.

Child's play – How to play with your baby from 7-9 months

7-9 months

Your baby is integrating everything she has learned so far by seven to nine months of age. Motor and visual skills are more in tune with one another, as seen in your baby's capacity to manipulate things using her hands and better hand to eye coordination.(canvas prints acrylic prints glass prints)

- Give your baby a few sealed containers filled with different items (rice, coins, rocks) and let her shake them and bang them together. Also show her how to make noises with other things that provide a wide range of variations in pitch, such as a bell, a whistle, keys on a ring or a music box.

- As babies become more aware of cause and effect, any items that light up, move, make noise or turn on and off, will be of interest, including mobile phones, TV remotes and light switches so try and find toys with lots of buttons (such a baby entertainment board) to help satisfy these urges.

- Your baby will extend this knowledge of cause and effect to the use of her own body parts and how to use her arms and legs to her advantage as she begins to crawl and pull herself into a standing position. Point and tell your baby the names of her body parts and engage her in games that are full of motion and predictability such as pat-a-cake.

- Once your baby can sit unsupported and have a bath in the family bathtub, bath games are a great way to get your baby to love bath time and playing with water boosts a seven to nine month old baby's sensory range with regards to texture and temperature. Additionally, blowing bubbles with your baby in the bath or in the garden (especially on a breezy day) is bound to create fascination and giggles.

- Your baby's comprehension of object permanence and the ability to seek out hidden objects is a good reason to play games centred around placing toys under covers or in different rooms where your baby needs to move around to locate them.

How to play with your baby from 4-6 months

4-6 months

Your baby will start to exert some control over her individual digits and consequently, objects that she can hold and touch as well. A baby of this age is also beginning to differentiate colours, shapes and sizes, as well as developing association with various smells. Most importantly any activities that combine auditory, tactile and visual experiences such as holding, looking and listening to a book being read, or listening, moving and singing sounds in music, are ideal as they cultivate several of your baby's senses, all at one time.(canvas prints canvas prints melbourne)

- Lightly spray your baby's toys with safe, natural scents such as lemon, vanilla and peppermint (nothing that could cause irritation) and let her sniff them one by one. State the name of the smell and repeat it for your baby to hear. Do the same when coming in contact with bad odours such as when you change your baby's nappy or burn some toast – it aids your baby with the distinction of pleasant and unpleasant smells.

- Because babies can recognise a wider range of bright colours at this stage of development, ensure there is plenty of exposure to a broad colour pallet through toys and interior and external surroundings such as green grass, staring up at a blue sky or a bright red rose placed in a vase within their eyeline. In doing this, baby's become familiar with primary colours so that recognition of pastel colours follows shortly after.

- Line up materials of different textures (such as wool, velvet, towelling, lace) along a board and place it in front of your baby to pat and stare at.

- Roll your baby from side to side during tummy time to introduce the movements that are needed for your baby to flip from front to back and vice versa. Hold objects out of reach and watch your baby reach for them. Board books or cloth books are very good for babies of this age as they try to grab and turn the pages.

- Peek-a-boo can become more sophisticated at this age, with parents hiding behind furniture, doors and curtains, instead of just their hands. Making funny noises and laughing during peek-a-boo helps babies realise it's a game and that they're not being abandoned.

Why movement is so important for your baby's growth

As parents we often can’t wait until our babies can crawl and then walk – and then we spend the rest of our time wishing we could find them or catch them.

    Your baby's developmental roadmap
    Your toddler's development

Seeing our child able to move, whether it’s a commando crawl, a bum skid or a tummy roll, is a fabulous moment in our parenting journey.(canvas prints photo on canvas canvas prints australia)

But it’s much more than that, of course, as without plenty of natural movement, babies and toddlers run the risk of experiencing developmental delays in all areas of life.

Movement is not just about the physical body; it is a very sophisticated necessity for developing healthy brains, healthy minds and nurturing the socio-cultural development of every human being. As parents, we need to be wary of passivity and a lack of natural movement for our kids.

So why are we ‘containerising’ many of today’s children in ways that prevent them from moving?

Human beings were born to be movers, and living a sedentary life is really a disruption to our authentic nature.

Research shows that exercise and physical activity increase the levels of serotonin, norepinephrine and dopamine, which are crucial neurotransmitters that traffic thoughts and emotions throughout the body.

Essentially, exercise has a profound impact on cognitive abilities and mental health. Not only that, it makes the blood pump through the body and stimulates the brain to work more efficiently and soundly.

It is an interesting irony that the modern world is hell-bent on creating gadgets and equipment to improve our lives, yet they often end up making it hard for our children to do what they are biologically wired to do: to move in deeply encoded ways to ensure they gradually grow in all their competencies.

Take, for example, the capsules that keep our babies safe in cars. Of course they are a fabulous invention for protecting babies in case there is an accident. But while leaving your baby in the capsule for long periods of time once out of the car might seem convenient and harmless, it is not optimal for spinal development, as movement is severely restricted.

The primary early requirements of baby movement are ones that involve stretching the spine, as this ensures the baby will be able to practice primitive reflexes to enable proper and healthy growth.

One of the most disturbing trends in modern life is that babies, toddlers and children have less freedom to move naturally, and it can impact on their behaviour and capacity to learn. So many products stop babies and toddlers from moving naturally and without restraint.

Think of walkers, prams, high chairs, bouncing gyms and plastic seats that can hold babies who are developmentally unable to sit by themselves. When we combine these contraptions with very little free movement, especially time on the floor, we may be creating unnecessary inhibitors to optimal baby and toddler development.

These containers are convenient for parents, but they also need to be seen through the lens of early child development, and maybe used less rather than more.

It can cause stress for babies, toddlers and infants to be restricted rather than being free to move, so it’s important to remember to relax, sit on the couch and simply watch your baby or toddler interact with the real world through the magic of movement in their own time and in their own way.

Children learn best by moving and doing, and this means they will often be noisy, untidy, messy and unpredictable.

Yes, sometimes life with little ones can feel boring and repetitive, but that’s okay. Without enough spinning, tumbling, balancing and rolling, toddlers and infants can run the risk of an under-developed cerebellum, which can feature in many children with attention issues and learning difficulties, particularly reading difficulties.

Many paediatric physiotherapists and OTs I’ve met also express concern at the increasing numbers of young preschool children with serious posture problems and chronic back pain.

They believe a combination of hours engaged with hand-held devices, plus an absence of climbing or hanging by their body weight on trees and monkey bars, are mainly to blame.

Movement skills have also been shown to contribute to improving literacy skills, concentration spans and the ability of children to shift their attention at will. Poor self-regulation is contributing to much of the restless, inappropriate behaviour we see in early years and primary school classes.

One other thing that has changed in childhood has been the freedom of children to move and play in bare feet.

Yes, there are so many cute little shoes and footwear, but bare feet matter. The soles of our feet are very sensitive and intrinsically wired to our brain. Podiatrist Tracy Byrne, who specialises in podopaediatrics in London, believes that wearing shoes at too young an age can hamper a child’s walking and cerebral development.

“Toddlers keep their heads up more when they are walking barefoot. The feedback they get from the ground means there is less need to look down, which is what puts them off balance and causes them to fall down,” Byrne writes in The Guardian.

The benefit of letting our little ones move as much as possible in the early years – using all their senses, engaging in the real world, preferably outside – is that it will help them to grow up healthier, happier, stronger, smarter, calmer and more capable.

So move baby, move, and don’t stop.

Running for these precious lives

"In that instant our brains went into shut-down. It's like we went into a wind tunnel and were cut off from anything happening around us, unable to take anything in. I would say it was like my worst nightmare, but I don't think I have ever had a nightmare as bad as what we were being told."(canvas prints photo on canvas canvas prints online)

They are the words of father Simon Rowe describing the moment he and partner Hanna Torsh learnt that their baby girl had been diagnosed with cancer 11 days before her first birthday.

Simon and Hanna took daughter Lena to the doctor in early March this year after noticing her left eyelid was not opening fully. They were referred to an ophthalmologist and were told their little girl most likely had a viral infection.
Lena's family and friends are taking part in the Run2Cure even to help raise money for research into neuroblastoma.

Lena's family and friends are taking part in the Run2Cure even to help raise money for research into neuroblastoma.

But two days later the left side of Lena's face became paralysed, and her parents took her to the emergency department at Sydney Children's Hospital in Randwick.

"We were told it was probably Bell's palsy, which can be triggered by a viral infection,'' Simon remembers. "They decided to do a scan of her head to rule out other possibilities. We were told it could be a tumour but also that it was very unlikely that was the case."

But two-and-a-half hours later, as they continued to wait for their daughter to be brought out from the procedure they were told would take only 45 minutes, Simon and Hanna were worried.

"The paediatric neurologist came and spoke to us and said 'Sorry, it's really bad news, it's cancer. It's not what we were expecting'. He told us the tumour was in the bones of Lena's face and skull and encasing both her eyes."

Lena's form of cancer is neuroblastoma, the third most common type of childhood cancer after leukemia and brain tumours. It is the leading cause of cancer deaths of children under five.

It's been just over three months since her diagnosis and in that time the family, including four-and-a-half-year-old big sister Lottie, have had their world turned upside down.

Initially Lena's cancer was assessed as being of "intermediate risk", meaning there was 90 per cent chance of survival. But sadly, tests last week showed the tumour had grown despite two rounds of chemotherapy. Her condition is now considered "high-risk".

"We've been told the chances of survival are now very much the wrong side of 50/50,'' Simon says. "Because her tumour has gotten worse we are now facing more cycles of increased intensity chemotherapy with more negative side effects and a greater risk of infection."

Despite the ordeal she's going through at such a tender age, Simon says little Lena is "probably the happiest person in our family right now".

"Because of her age, she is shielded from the knowledge and understanding of what is happening. The rest of us are filled with pain every time we look at our beautiful baby girl,'' Simon says.

"Lottie doesn't have a full understanding of what's happening, but she knows that Lena is sick and Mum and Dad are very worried. She has learnt the word 'cancer', but we try not to say too much around her as she's been having nightmares about death."

Despite the difficult time the family is facing, Simon says he and Hanna remain thankful for two things.

Firstly, that they live in a city where getting their daughter the best possible medical care does not mean having to uproot their family for the duration of her treatment. Secondly, the family has been blown away by the support they have received from extended family and friends - some who they had not been in contact with for years.

"We are very fortunate that we have an amazing network of friends and family helping us through,'' Simon says. "Whether it's dropping off food for us, or toys for the girls, or taking Lottie for playdates while Hanna and I need to be at hospital with Lena, so many people have shown us they care."

In addition to helping Simon, Hanna, Lena and Lottie in practical ways, some of those friends and family members will also be doing their bit to help raise funds for research into Neuroblastoma. The group will be taking part in the Run2Cure Neuroblastoma fun run in Sydney's Domain and Botanical Gardens this Sunday.

"Fundraising for neurobalstoma is very important," Simon, who is himself an intern doctor, explains. "Even though it's the cancer which kills the most children it's still a very rare condition, so from a public health perspective it's not something the government can justify spending money on.

"The only way we are going to get a cure, or better treatments, is through fundraising and the collaboration of researchers across the world in America, Europe and here in Australia."

The life-saving vaccine our children are being denied

New parents are urged to keep their children's immunisations up to date from the day their bundle of joy arrives in an attempt to keep dangerous diseases at bay. But there's one vaccine which could protect children from a deadly disease which isn't on the nation's child immunisation schedule.(canvas prints photo on canvas canvas prints australia)

Meningococcal B vaccine Bexsero (4CMenB) has been available for purchase privately in Australia since March 5 this year, but unlike the vaccine for Meningococcal C, is not funded through the Pharmaceutical Benefits Scheme. And at about $125 per injection -with babies requiring four injections before they are 12 months old - it is simply financially out of reach for many families.

The recent death of a two-year-old boy in NSW who was infected with meningococcal B has thrown the spotlight on the new vaccine, with support groups calling for it to be included in the National Immunisation Program (NIP) immediately.

The Pharmaceutical Benefits Advisory Committee is meeting next month to discuss if the B-strain vaccine should be included on the NIP. An application by Bexsero manufacturer Novartis Vaccines for PBS listing last year was rejected by the committee, which argued the vaccine was not cost effective.

Meningococcal Australia director Kirsten Baker said although the disease is rare, the speed at which is spreads and its potentially deadly outcome justify the inclusion of the Bexsero vaccine as a routine immunisation.

"The problem is so many of the symptoms are similar to when a child has a bit of a cold. Parents often don't realise something is really wrong until they see the rash, but the rash is the usually the final symptom appear,'' Baker said.

"Also young children may not be able to explain what they are feeling, so they might just appear to be tired and generally unhappy in the early stages. But the clear message is that whoever thinks their child, or a child in their care, is showing symptoms of meningococcal disease, should seek urgent medical attention.

"This disease can become deadly within hours, and the sooner treatment is started the better the chance of a positive outcome."

Baker spent two weeks in hospital after contracting meningococcal septicaemia in 2005. She said the symptoms came on suddenly and believes if she had not sought immediate medical attention she may not have survived.

She is hopeful the government committee will approve an application to add Bexsero to the routine childhood immunisation schedule. She also encourages adults to make sure their own vaccinations are up to date.

"The rates of meningoccal C have plummeted since the vaccination was added to the childhood immunisation program in 2003, and we would love to see that happen with the B strain,'' she said.

One family who knows how quickly meningococcal disease can take hold is the Manulat family from Anna Bay, north of Newcastle in NSW.

Last Tuesday night their two-year-old son Ryder went to bed showing no signs of sickness, before waking up on Wednesday morning with a rash of pinprick spots on his body. He was rushed to hospital, where doctors quickly diagnosed the deadly meningococcal disease and administered antibiotics.

By 10am the little boy, who had Down syndrome, was placed on life support, and by 2pm he had passed away.

After the little boy's death his parents spoke about the fact they were not aware of the availability of a vaccine for the meningococcal B-strain which killed their son.

Around 200 Australians contract meningococcal disease each year, with children under five years of age and teenagers and adults between 15 and 25 most at risk. Up to 10 per cent of people who contract the disease die as a result.

According to Meningococcal Australia, symptoms of the disease vary and include headache, fever, drowsiness, a stiff or painful neck, sensitivity to light, vomiting, shivering, cold hands or feet, muscle or joint pain, and changes in skin colour. A late-stage rash may also develop, which can start off as spots, blisters and pinpricks and later appear as purple, bruise-like blotches.

One fifth of survivors are left with lifelong disabilities, including brain damage and limb loss.

Meningococcal B is the most common strain of the disease in Australia, being responsible for 83 per cent of cases.

Besxero has been approved by the TGA for use in Australia following a review of the vaccine’s safety and effectiveness. The vaccine has already been recommended for inclusion on the childhood National Immunisation Program in the UK, based on the results of trials involving more than 8000 people.

Running for these precious lives

"In that instant our brains went into shut-down. It's like we went into a wind tunnel and were cut off from anything happening around us, unable to take anything in. I would say it was like my worst nightmare, but I don't think I have ever had a nightmare as bad as what we were being told."(canvas prints photo on canvas canvas prints online)

They are the words of father Simon Rowe describing the moment he and partner Hanna Torsh learnt that their baby girl had been diagnosed with cancer 11 days before her first birthday.

Simon and Hanna took daughter Lena to the doctor in early March this year after noticing her left eyelid was not opening fully. They were referred to an ophthalmologist and were told their little girl most likely had a viral infection.
Lena's family and friends are taking part in the Run2Cure even to help raise money for research into neuroblastoma.

Lena's family and friends are taking part in the Run2Cure even to help raise money for research into neuroblastoma.

But two days later the left side of Lena's face became paralysed, and her parents took her to the emergency department at Sydney Children's Hospital in Randwick.

"We were told it was probably Bell's palsy, which can be triggered by a viral infection,'' Simon remembers. "They decided to do a scan of her head to rule out other possibilities. We were told it could be a tumour but also that it was very unlikely that was the case."

But two-and-a-half hours later, as they continued to wait for their daughter to be brought out from the procedure they were told would take only 45 minutes, Simon and Hanna were worried.

"The paediatric neurologist came and spoke to us and said 'Sorry, it's really bad news, it's cancer. It's not what we were expecting'. He told us the tumour was in the bones of Lena's face and skull and encasing both her eyes."

Lena's form of cancer is neuroblastoma, the third most common type of childhood cancer after leukemia and brain tumours. It is the leading cause of cancer deaths of children under five.

It's been just over three months since her diagnosis and in that time the family, including four-and-a-half-year-old big sister Lottie, have had their world turned upside down.

Initially Lena's cancer was assessed as being of "intermediate risk", meaning there was 90 per cent chance of survival. But sadly, tests last week showed the tumour had grown despite two rounds of chemotherapy. Her condition is now considered "high-risk".

"We've been told the chances of survival are now very much the wrong side of 50/50,'' Simon says. "Because her tumour has gotten worse we are now facing more cycles of increased intensity chemotherapy with more negative side effects and a greater risk of infection."

Despite the ordeal she's going through at such a tender age, Simon says little Lena is "probably the happiest person in our family right now".

"Because of her age, she is shielded from the knowledge and understanding of what is happening. The rest of us are filled with pain every time we look at our beautiful baby girl,'' Simon says.

"Lottie doesn't have a full understanding of what's happening, but she knows that Lena is sick and Mum and Dad are very worried. She has learnt the word 'cancer', but we try not to say too much around her as she's been having nightmares about death."

Despite the difficult time the family is facing, Simon says he and Hanna remain thankful for two things.

Firstly, that they live in a city where getting their daughter the best possible medical care does not mean having to uproot their family for the duration of her treatment. Secondly, the family has been blown away by the support they have received from extended family and friends - some who they had not been in contact with for years.

"We are very fortunate that we have an amazing network of friends and family helping us through,'' Simon says. "Whether it's dropping off food for us, or toys for the girls, or taking Lottie for playdates while Hanna and I need to be at hospital with Lena, so many people have shown us they care."

In addition to helping Simon, Hanna, Lena and Lottie in practical ways, some of those friends and family members will also be doing their bit to help raise funds for research into Neuroblastoma. The group will be taking part in the Run2Cure Neuroblastoma fun run in Sydney's Domain and Botanical Gardens this Sunday.

"Fundraising for neurobalstoma is very important," Simon, who is himself an intern doctor, explains. "Even though it's the cancer which kills the most children it's still a very rare condition, so from a public health perspective it's not something the government can justify spending money on.

"The only way we are going to get a cure, or better treatments, is through fundraising and the collaboration of researchers across the world in America, Europe and here in Australia."