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From Womb to World

Hello people,

Nature, nurture, a combination of the two, perhaps spiced with a pinch (or more) of lifestyle? The debate about what makes us the persons we are today, has generated numerous possible answers over time. Recently, a new ingredient has been proposed by some: the possibility that we have been shaped at least partly by our experiences before and during birth. Some of the external factors influencing fetal development – e.g. drug and alcohol consumption by the mother – are well known. Others are newer.

A recent TIME Magazine article adds for example the mother’s “state of mind” and describes the “provocative contention” that all these external factors provide the unborn child with information that may shape both its physical and mental traits. Processes like these, the article suggests, might be triggered by something called “epigenetic modification, in which environmental influences affect the behavior of genes without altering DNA” (please bear in mind however the exact definition of what constitutes epigenetics still seems to be subject of debate, even among scientists themselves). 

Something similar is put forward by Anna Verwaal. Last weekend, this eloquent international speaker and lecturer gave a series of workshops with the compelling title "From Womb to World", in the beautiful entourage of the sixteenth century castle of Alden Biesen (Bilzen, Belgium). In the workshop I attended, she discussed how conception, pregnancy and birth can impact not only our lives, but also how we pass on life to the next generation.

Let me first introduce you to Anna Verwaal. Her record is intriguing. It evolves from a career as a Maternal Child Health Nurse and Certified Lactation Educator to that of a Birth Photographer, Birth Consultant and Midwifery & Doula Instructor. Since 1990, she has been based in the United States and traveling the world to raise awareness among those involved in childbirth and education of her vision on how imprints from even before conception can impact lives and how each human being might have developed patterns that still affect them.

Verwaal's premise is that understanding the roots of one’s imprints, one’s birth story and that of one’s family, can be helpful in dealing with unresolved issues in life (on a physical, emotional, mental, relational and maybe even a spiritual level). In 2013, Anna Verwaal gave her first TEDx-talk, which might give you a better idea about what her work is all about. 

When entering the workshop we received a questionnaire. Just going through the questions was a mind-opener since it made each of us realise that there are quite a few blank spots in what we actually know about our conception, our life in the womb and our own birth. Just think for a moment. What do you know about your birth? Let me give you just some questions to go along with your ponderings...

• Was your conception a surprise, an accident, an act of violence, planned or unplanned, wished for and wanted, or were you maybe even adopted? 
• What emotions did your parents have about your coming into their life? 
• Where you hoped to be a girl or a boy? Did you already have siblings? 
• Were you part of a twin pregnancy in which one of the twins vanished, or was your conception preceded by a stillbirth, a loss, an abortion or another trauma? 
• Under what conditions were you conceived? 
• Did your parents drink or smoke, use drugs or medication, and what was their diet? 
• Were your parents exposed to stressful events, trauma's, conflcits or certain particular environmental conditions? 
• Where were you born? At home or in the hospital? Pre-, term- or postterm?
• Who was present and how did the delivery go? 
• Did you breath spontaneously and right away or did we need stimulation? 
• Where was your father during your birth and what was his role? 
• Were you separated from our mothers or kept skin-to-skin? 
• Did your mother breastfeed you and for how long? 
• How was your mother’s and your post-partum period? Were there any medical interventions performed?

It is often said that in order to be able to understand the present, it is necessary to know the past. If, in analogy, the claim that what we have experienced in our earliest stages of development affects who we are today holds true, it is remarkable that many of these questions are likely to remain unanswered. 

If birth imprints are indeed that influential as suggested, it might urge for a new awareness in both pregnant women and those accompanying them through pregnancy and birth (like the partner, family, midwife and the doula) on the importance of their actions and inactions. I would not be surprised to hear in the near future a call for change of our current birth culture and the place we give to our birth story.   

The growing attention for epigenetics and cellular memory also shows in "In Utero". This recent documentary movie by American director Kathleen Gyllenhaal is currently being broadcast in different theatres in The Netherlands. In an interview with Michael Parker the filmmakers explain epigenetics and discuss the impact of "unconscious" memories. Watch the interview and the trailer here:

Many questions in the fields of epigenetics, pre- and perinatal psychology and pre- and perinatal health are still unexplored and claims need further investigation. Nevertheless, the growing body of literature does provide food for thought for anyone involved in ensuring that children have a healthy and happy entrance into this world.

If you feel for sharing and exploring your own birthstory or processing your own labour and childbirth experience, feel free to contact me. I am a registered Midwife and hold trust and confidentiality principles high.

* * * 

Dad's Postpartum

Hello readers,

Today something on the fathers... It is commonly known that the first weeks after birth are quite precarious for mother and child, who both go through a huge process of transformation. The presence of daddy during these days contributes in a positive way to the birth of a family. Moreover, it gives new dads the perfect opportunity to add a crash course in fatherhood to their cv. Later on in life, fathers not seldom complain that due to professional obligations they missed out on the precious first days of bonding. It won't come as a surprise that the debate on the number of (paid) days off during the immediate postpartum has been on political agendas across the globe for many years.

Photography Cheriejoyful, Creative Commons Flickr

In The Netherlands for instance, some have been arguing for years that the country is lagging behind with its low number of paternity leave days.  

The Dutch government is now working on legislation that is planned to enter into force in 2019 and that will extend the number of paid paternity leave days from the current 2 days to 5 days, reports Het Financieele Dagblad. Would this bridge the gap?

Photography Owen Lin, Creative Commons Flickr

A 2014 report by the International Labour Organization allows for a quick global comparison. According to the ILO, at least 79 countries of the 167 monitored, have enshrined paternity leave in their national legislation. Of these, 44 countries – among which for instance Benin, Kenya, Latvia, Slovenia, Portugal and Iceland – offered a paternity leave of seven days or more.

Numbers do not say everything though. The number of paid days, conditions upon which payment is granted and the height of the benefit may vary. Furthermore, much depends on the exact definition of ‘paternity leave’. Some countries for instance, might not make the distinction between paternity and maternity leave on the one hand, and parental leave on the other hand.

Photography Colin Bowern, Creative Commons Flickr

For practical reasons, I’ll stick to the description offered by the ILO in the above mentioned report. It notices that paternity leave is usually seen as “a short period of leave to care for the child and the mother around the time of childbirth”. Parental leave on the other hand “tends to be a longer period of leave to care for the child beyond maternity or paternity leave and is typically available to one or both of the parents”. With this in mind, let us take a closer look at some countries of interest.


Belgium

In Belgium, fathers have a right to ten days of paternity leave which they can claim within four months of the delivery (starting on the day of birth itself). They do not necessarily have to claim them all in an uninterrupted row. During the first three days of leave, fathers have a right to their full wage, to be paid by the employer. In the final seven days, they have a right to a benefit of 82% of their lost bruto wage. More information can be found here.

Denmark

Fathers in Denmark have a right to two weeks of paternity leave, which they should use within fourteen weeks of the delivery. The leave is paid, but the exact amount of the benefit varies from sector to sector. Employees in the public sector are paid their full wage, while in other sectors it depends on the arrangement negotiated between employers and employees. More information can be found here.

Photography Talli, Creative Commons Flickr

Germany

In Germany there seems to be no paternity leave in the Dutch and Belgian sense of the word. More information on the general system of parental leave and allowance – ‘Elterngeld’ and ‘Elterngeldplus’ can be found here and here.

Norway

Norway makes no distinction between different forms of leave concerning birth and upbringing of children. Instead, all couples who are eligible (depending on, among other things, the last place of employment, duration of employment prior to the leave, and income) get 49 or 59 weeks of parental leave, depending on whether they choose a 100% or an 80% financial coverage. Of these weeks, thirteen are allocated to the mother – three prior to, ten after delivery – and ten to the father. The parents can divide the remaining weeks among themselves as they see fit. More information can be found here. 

Photography Szoki Adams, Creative Commons Flickr

Slovenia

In Slovenia, fathers have a right to fifteen days of paid leave within the first six months after their child is born. According to their own preference, they may use them all in a row, or plan individual days. More information can be found here, here, and here.  

Sweden

Swedish fathers have a right to ten days of paid leave after their child is born. On a larger scale, the Swedish system of parental leave is quite elaborate. More information on the Swedish model can be found here, and here.

National Day of Birth

Dear Readers!

 Just a short note to mark a special day.

Daily, an average of 500 babies are born in The Netherlands. For the majority of couples, giving birth and welcoming their baby is one of the happiest moments of their life. Unfortunately, for about 48 couples a day, this happiness is overshadowed by sorrow. Their babies are born with complications, ranging from premature birth, low birth weight/growth restriction, and congenital abnormalities to a combination of different problems.

Today, it is the National Day of Birth in The Netherlands. A day on which we celebrate the joy of welcoming new life without turning a blind eye to the challenges we are still facing in ensuring a healthy start for every single baby. 

This day is an initiative of the dutch Born Healthy Foundation, which advocates a healthy birth and tries to generate funding for establishing scientific research that can contribute to finding causes, ways of prevention and cures for common birth complications like pre-eclampsia, congenital abnormalities, and growth restriction. The research also focusses on the pregnant woman herself and how she can optimize the outcome of her pregnancy.

As a midwife, I wholeheartedly support this cause, and wish everyone – pregnant or not – a happy and healthy Day of Birth!

Those of you who feel like supporting the drive towards making pregnancy and birth even healthier, can have a look here.

Birth of a midwife

Hi Folks!

Sorry for keeping you all in the dark about my weal and woe for so long. I had such a hectic time. I rounded up my internship in Slovenia, finished the last assignments of my midwifery training, graduated, and took a long, well deserved, and necessary summer-break. I tried to spend as much time as possible offline to recharge my batteries. And here I am, back with new, fresh energy to embark upon the job-hunting journey and to start my working life as a midwife!

Assignments, graduation and holidays!

As most of you know, I did a traineeship at the Labour Ward of the University Medical Centre Ljubljana from February until May 2016. In that context, I was interviewed by Utrip, the newsletter of the professional association of nurses and midwives in Slovenia. One of the main things they wanted to know was what kind of experiences and competences I acquired while at the UMCL.

Interview in Utrip

Coming from Belgium, arriving in the hectic clinical setting of a big labour ward with an impressive number of births a year was quite exciting. The UMCL birth centre is located in its own building and encompasses a labour assessment unit (triage), 11 labour rooms and two operating rooms, several maternity floors, a Maternity Intensive Care (MIC), a neonatology department (N*), and a Neonatal Intensive Care Unit (NICU).

Most of the time, I worked at the labour ward, where a team of multidisciplinary professionals warmly welcomed me in their midst and took an active part in my learning process. The team of eight midwives that took me under their guidance, made me feel at home and at ease right from the start.  

It was very inspiring for me to train in a clinical setting in which the midwives are the primary birth experts. They turned out to have a lot of experience in applying labour and delivery techniques that spare the perineum and avoid episiotomies as much as possible. I am very grateful they were willing to pass on this know-how to me.

Thank you to the team!

In Slovenia I got to experience the added value of working in a large and multidisciplinary team, with all disciplines involved in childbirth at little more than shouting distance. Having so many different competences and fields of expertise at hand, creates an environment that is both challenging and stimulating – I really enjoyed working in this team setting and learning from the varying individual skills of the other team members.

In Belgium we have CTG monitors in the office and in the rooms of the patients. It holds the risk of relying on the screen too much and paying less attention to clinical observations. In Slovenia, I further learned to focus on the patient. Because of the higher number of natural births, I also gained more experience in recognizing, guiding and coaching the different stages of labour. I conducted more than the required number of deliveries for my logbook and I got the chance to see different kinds of high-risk labours and pathologies and learned about their management.

Through this internship, my horizon of knowledge, my clinical competency, and my flexibility have been broadened and deepened. Working in a foreign clinical setting has made me familiar with the use of other materials, approaches and procedures in health care. I acquired knowledge and skills that will help me pursue my ambition of a career as a global midwife and to provide high-level midwifery care regardless of the health care setting I am in.

Thank you to the mothers! (picture with permission)

Thanks to the positive teaching and learning climate, I also gained confidence in my competency as a midwife. This traineeship helped me to further strengthen my interpersonal skills and it further stimulated my open-mindedness and helped me to rethink and sometimes revise my ideas and approaches where useful/necessary. It also further increased my capability to fit in any type of working environment.

I am very grateful to the patients who entrusted it to me to bring their hope and dreams into this world, and to all team members for offering me this training opportunity and for contributing so positively to the birth of this midwife.

International Day of the Midwife 2016

Hello world!

Today was International Day of the Midwife (IDM), this year themed 'Women and Newborns: The Heart of Midwifery! In Ljublana, it didn't went unnoticed, as we, midwifery students, occupied the central square near the famous Triple Bridge. Apart from stands with information, there was a 2 kilometer Midwifery Run to bring our beautiful profession into the limelight.

'I am a midwife, this is what I do'

The above is the slogan used for this year's IDM social media campaign (#IDM2016), inviting midwives from across the globe to share a photo and some words about what they do to give women and newborns the best possible care. Talking to some of my fellow students, I noticed how differently the role of a midwife is worked out from country to country. For me, used to the Belgian context, Slovenian midwifes have a  rather independent role. Although home births are not an established here, midwives are the ones who guide the low risk labours in a clinical setting and conduct the deliveries. Some fellow students from Estonia, on the other hand, told me that they considered Slovenian midwives to be less independent than their Estionian counterparts and their role to be rather limited. It illustrates that the position of the midwife is still subject of debate and too often under pressure. Personally, I think that the encounter with a midwife differs in character from one with a gynecologist or a doula. That is why I would advocate for an own, independent role of midwives. In Slovenian, they aren't called babica, also the word for (wise) grandmother, for nothing. All women should be enabled to draw from that well.

"May the wise midwives of today
leave their special mark
in the hearts of women
with their knowledge, respect,
loving kindness and warmth
so very much needed
by the birthing women,
as well as their children
longing to find themselves
earthside,
breathing with lungs fully
for the very first time.

May they be there
with their loving support
when couples become families
and when families expand -
changing the world
one mother, one baby, one family
at the time.
Wishing all the very best
to all the midwives of this world
on this International Day of the Midwife!"

Ksenija Malia Leban

Slovenian surprises...

A quick guide to Slovenia in some surprises...

1. The toilets

No, seriously. In Ljubljana, even the toilets are a source of amazement. They don't just do 'male' and 'female' at the Pritlice; a third, 'genderneutral' option is also provided. My good old curiousity led me to have look inside... only to be amazed again, this time by a lovely handwritten proverb.

2. The climate

No, I don't dislike snow. In fact, I like the view of an old city covered in a spotless white veil. But ten centimetres of snow falling in the midst of spring...? I couldn't help but feeling somewhat sad about the branches and blossom giving way under a weight that shouldn't be there.

3. Lolita

Talk about sweet surprises! I had already put patisserie Lolita on my to do-list early on in my internship. After passing by numerous times, I recently decided to take action, and that proved to be a great idea. On the friendly waiter's advice, I decided to have this 'Mangolita' monocake to go with my coffee... and boy, a good choice it was. It was exquisite!

4. Koper

During my previous trip to Slovenia, I visited the lovely coastal towns of Isola and Piran. Some weeks ago, I decided to complete this trinity, so on my day off, I headed for Koper by bus. Windy as it was, it was good to stroll around the city and see the Adriatic again. Though the palm trees and the old city center weren't lacking, I must admit that Koper has a less romantic feel to it than Isola and Piran. Still, sipping coffee to the sound of a whispering sea makes for a fine day out!

5. Skuhna

Who would have thought that I would get a taste of my beloved Nigeria right here in Ljubljana? You can take that quite literally, as I am referring to the Nigerian dish I had at Skuhna, a restaurant where migrants from Africa, South America and Asia prepare food according to their various culinary traditions. A lovely social initiative that allows the cooks to integrate while you travel by using your tastebuds. 

6. Wise words for the good life

There is at least one restaurant in Ljubljana that serves it meals with a side dish that nourishes the mind rather than the body. Its menu is also partly a scribbling pad, in which customers may leave a message. Between the soup and the salad I found one that seems to apply to the way many students approach their Erasmus exchange period.

7. Street view, classic style

What they can do, I can do, so eat your heart out, Google! ;-) Ljubljana offers all one needs for a nice classic style street view, and adds a modern twist to round it off.

8. Build to last?

You can't be in Ljubljana without stumbling upon the name 'Emona', or, as below, one of its variants. It refers to the Roman settlement of Emona, that was constructed in what is now Ljubljana in 14 AD, succeeding an earlier settlement. They did a good job, as the city of Emona outlasted the Roman empire itself by about two centuries... Present day Emonika is quite a different story. In fact, this huge project for a shopping, working, entertainment and-what-more center never really took off, and to date, construction still hasn't started. To be honest, this isn't all that bad, since Ljubljana can do without another symbol of modern trade. In the meanwhile, I'll happily stick to the kind of local, small scale trade that has proven its worth over the centuries.

9. @Home

Ah, the sweet scent of home, where, in my rare free time, I rest and plan new wanderings. Unless, that is, the rather whimsy April weather thwarts the plan. Yes, I know that (meteorological) beauty is often in the eye of the beholder, but let's be honest: beautiful spring sunrises AND dreary, wintery afternoons within one week in April...? As we say in Dutch: April doet wat hij wil ('April does as it pleases').

Giving birth to laughter?

Dear readers, 

During my internship, I’m often asked about the differences between Belgian and Slovenian midwifery practice. In this blog, I will shed some light on one of the major differences. It is no secret that giving birth is generally not something to be laughed with. Most women who enter the labour ward are somehow frightened by the expected labour pain, not in the least because of horror stories told by their mother or friends. The cry for pain relief is probably one of their loudest. The Belgian and the Slovenian answer to it, vary considerably. In Slovenia, there is space for some laughter in the labour room! But is that laughter the best medicine for labour pain?

Pain relief

In Belgium, pain relief in the labour ward generally boils down to either epidural anesthesia or nothing. 70% of the Flemish women who gave birth in 2014 received epidural anesthesia. Recently, the Flemish Professional Association of Midwives (VBOV) announced that it will start exploring the admission of laughing gas. So far, only one Flemish hospital has introduced laughing gas in the labour room (A.Z. St. Blasius Dendermonde).

Contrary to Belgium, in Slovenia four options for pain relief are available: laughing gas, two sorts of opioids (remifentanil and pethidine) and epidural (spinal) anesthesia. Where epidural is the golden standard for labour pain relief in Belgium, in Slovenia its use has only begun to rise in recent times and is still far from established practice. All options have their pros and cons, which I will not discuss here. I will however discuss the most commonly used method of pain relief in Slovenia: laughing gas. 

Laughing gas

Laughing gas is a simple anaesthetic agent that has been in use in medical settings for two centuries now. It made its entrance in obstetric care in the 1930s because of its anxiolytic and analgesic effect. It is a mixture of nitrous oxide (N20) and oxygen, and in the obstetric context usually contains 50 percent of each.

Advantages

Laughing gas is seen as a analgesic that does not intrude in the course of the birth since it doesn’t intervene with the release of oxytocine, the hormone that is the key to progress in labour. Laughing gas works rapidly and its effects expire quickly once administration is stopped. Furthermore, its availability expands the number of options for pain relief during labor and it might add to women's feeling of being in control since they can administer it themselves (though solid research data seem to be lacking on the latter). When used for a limited period of time during labour, laughing gas is considered to be safe for both mother and child.

Disadvantages 

Laughing gas is seen as a generally less effective painkiller than neuraxial anesthetics. Also, when compared to women who received no analgesics or a placebo, women who received laughing gas more often suffered from nausea, vomiting, dizziness and drowsiness. Furthermore, laughing gas cannot be administered when contra-indications such as hemodynamic instability or impaired oxygenation exist. Caution is necessary if a woman simultaneously receives other sedative medication.

www.labourpains.com

Effect on health care workers

There are also questions about the effect of laughing gas on health care workers. In animal experiments, under a number of conditions a teratogen effect was found, but in humans, the picture is less clear. Furthermore, laughing gas might be a cause of disruption of the vitamin B12-metabolism. Based on the outcomes of the animal tests one author urges reservation when using laughing gas, and advises to only use it under strict indications (that, he claims, do exist).

Because of the lack of conclusive scientific evidence about possible congenital disorders caused by laughing gas, the Dutch Association for Anesthesia and the Dutch Association for Obstetrics and Gynecology urge to not expose pregnant staff to (high doses) of nitrous oxide (especially not in the first term).

Debate about laughing gas in the labour ward

In 2004, the Dutch Health Care Inspection (IGZ) advised hospitals to restrict the use of laughing gas in labor wards “as much as possible” and to “preferably” end its use. The debate that followed led to strict rules for the use of inhalable analgesics in Dutch labour wards: thorough ventilation of rooms, an exhaustion system in the room and a ‘scavenging system’ fitted to every mask (measures, by the way, that are not imposed on the labour ward here in Slovenia). The Royal Dutch Association of Midwives (KNOV) adds annual checkups of staff exposed to laughing gas, a risk assessment and evaluation, training and a protocol to this list. Nevertheless, the KNOV considers the IGZ’s discouragement of the use of laughing gas to be based upon methodologically doubtful research.

My impressions

As a Belgian student, working with laughing gas was a quite new experience to me. The impression might exist that nitrous oxide gets all women to laugh their way through labour, like in this YouTube video:

However, this is not really my experience so far. Rather, women in serious labour are holding on to their mask as to their lifeline, gulping gas during contractions. Some start to say funny things or laugh a bit, but most of the time the women concentrate on making it through the contraction. From their reports, the gas only seems to take away the top of the pain. Even with the gas, labour is hardly a laughing matter.

I wonder whether some sort of placebo effect can be ascribed to the use of the mask. Since the women are administering the gas to themselves, they seem focused on their own breathing, which is in general very important during labour. This focus on a steady, deep breathing might add to the relief by drawing the women’s attention away from the actual pain. Thorough research into this matter and the actual effect of laughing gas seems to be lacking. 

My experience is also that the use of laughing gas doesn’t enhance the mobility of the women (which I consider to be very important for the progress of labour), since the effect often seems to lead to their staying in bed. I also have some questions about how consciously they experience their labour when using the gas, and the psychological effect this has. 

Personally, I don't feel too comfortable working without ventilation measures, like we do in Slovenia. Out of precautiousness, I would endorse the ventilation measures described above, in the interest of the newborn, the partner attending the labour and the medical staff present. I don't have a clear cut answer to the question whether we should advocate the introduction of laughing gas to Belgian labour rooms. Somehow, I have the impression that intensive one-on-one coaching by a midwife, back massage, guidance in using the correct breathing techniques (maybe the administration of some extra oxygen), the use of different positions, et cetera might be as effective. This makes me wonder what the added value of laughing gas really is. I am looking forward to more evidence-based insights on this.  

Literature used:

Brief Hoofdinspecteur Inspectie voor de Gezondheidszorg (IGZ) (2004). Kenmerk IGZ/FMT/GB-04-31749. Den Haag: IGZ.

Collins, M., Starr, S., Bishop, J. & Baysinger, C. (2012) Nitrous Oxide for Labor Analgesia: Expanding Analgesic Options for Women in the United States. Rev Obstet Gynecol 5(3/4): e126-e131 doi: 10.3909/riog0190

Devlieger, R., Martens, E., Martens, G., Van Mol, C. & Cammu, H. (2015) Perinatale Activiteiten in Vlaanderen 2014. Brussel, SPE. Found on the internet:

http://www.zorg-en-gezondheid.be/sites/default/files/atoms/files/SPE_jaarrapport%202014.pdf

Klomp, T., Van Poppel, M., Jones, L., Di Nisio, M., Lagro-Janssen, A. (2012) Inhaled analgesia for relieving pain during labour. Cochrane Database of Systematic Reviews. Found on the internet:

http://www.cochrane.org/CD009351/PREG_inhaled-analgesia-for-relieving-pain-during-labour

Knape, J. (2006) Lachgas niet onveilig, maar wel steeds minder nodig. Ned Tijdschr Geneeskd 150(19): 1053-1054

KNOV (2009) Adviesrapport – Het gebruik van Relivopan in de eerstelijns verloskunde. Utrecht: KNOV werkgroep ‘Etonox’. Found on the internet:

http://www.knov.nl/fms/file/knov.nl/knov_downloads/911/file/KNOV.adviesrapport_Relivopan_eerstelijns_verloskunde_november_2009.pdf?download_category=overig

Nederlandse Vereniging voor Anesthesiologie [NVA] en Nederlandse Vereniging voor Obstetrie en Gynaecologie [NVOG] (2008) Richtlijn medicamenteuze pijnbehandeling tijdens de bevalling. Found on the internet:

http://www.nvog.nl/upload/files/definitief-richtlijn-pijnbehandeling-bij-de-partus_def-091208.pdf

Rooks, J. (2011) Safety and Risks of Nitrous Oxide Labour Analgesics: A Review J Midwifery Womens Health 56(6): 557-565. Found on the internet:

http://www.porterinstrument.com/~porterin/dentalcontent/app/webroot/files/datasheets/Safety-and-Risks-of-Nitrous-Oxide-Labor-Analgesia-JMWH-[2011].pdf

Schyns-van den Berg, A., Engel, N., Marcus, M. & Beenakkers, I. (2010) Partus en pijn hoeven nergens hand in hand. Medisch Contact 65(50): 2716-2721

VBOV (2015). Lachgas tijdens de bevalling, een optie in België? Press release by the Flemish Professional Association of Midwifes. Found on the internet:

http://www.vroedvrouwen.be/nl/vroedvrouwen_in_de_media

Wellness

Hello everyone!

As you may have noticed, from the beginning, there has been somewhat of a delay in my blogging. Besides the normal process of adapting to a new situation, my first weeks in Ljubljana were sometimes a bit hard. The main reason was that I have not been feeling well, in particular because of a persisting hypertension. Luckily, my colleagues proved to be very helpful and concerned. When they noticed I wasn’t feeling well, they immediately referred me to the emergency department.

So, entirely unplanned, I got to see the Slovenian health care system from the patient’s perspective. It proved to be an interesting experience. The first thing I noticed, was the very efficient way I was treated. No waiting lists for appointments, I was quickly attended to and the approach was very constructive in working towards finding causes and solutions. The specialists spoke good English and were very helpful.

Next week, I hope to round up the last examinations and discuss the results with the internist, who gave me apart from medication some usefull advices to make my situation as comfortable as possible in the meanwhile. Those advices basically boiled down on trying to keep my stress level as low as possible by not doing extra work for school outside of working hours, to enjoy the good Slovenian life by going for hikes and outings, enjoying the amazing Slovenian foodculture, going for a good massage and even… getting a local boyfriend. Being a good patient, I have already started to work through this unexpected bucket list. So let me update you on the progress sofar...

1    Outings

Although I have little or no time to leave Ljubljana for outings, I have been out and about with friends, dining, having coffee, chatting, laughting and generally having a great time. Particularly colourful (and sunny!) was our visit to the Botanic Garden of Ljubljana University.

A peak experience in the most literal sense of the word was having a coffee on the top floor of Nebotičnik, or in English, 'the Skyscraper'. When they finished building in 1933, it was the tallest structure in the then Kingdom of Yugoslavia.

A city within the city, that’s how one might consider the BTC area in Ljubljana. While the little streets in the city center host many small, creative shops, people do their general shopping at the BTC, where things are big, bigger, biggest. My search for a new charger for my laptop brought me there, and it is quite an experience (though not necessarily a pleasant one).

The BTC has  one large shopping mall, and over a dozen smaller ones. Besides, there’s a hotel, as well as bars, restaurants (including Slovenia’s only Burger King), a cinema and sporting clubs. One of the office buildings, the so called Crystal Palace, is the highest building in the country. On a whole, BTC City claims to be among the largest shopping and entertainment area’s in Europe – in a country as small as Slovenia…

On sunny days, one of Ljubljana’s attractions is the river Ljubljanica. Especially during the first days of spring, with the trees blossoming forth, its banks provide lovely opportunities to relax and enjoy the good city life. In earlier ages, the river was equally important to the people living in this region, but not necessarily for recreational purposes.

Until half way into the nineteenth century, the Ljubljanica was the way to transport goods into, and from the city. Some centuries before, during the Middle Ages, the river also was a means of punishing people. Bakers who had been caught cheating with the weight of their bread, were publicly humiliated by being thrown into cold waters of the Ljubljanica from one of the bridges…

Nowadays, it is less easy to enter the river. In fact, since 2003, you need a permit to dive into it. This measure was to stop people from searching the river and its beds that are known for the archeological artefacts that can be found there. These often disappeared with their finders, much to the dismay of the official historians. 

Estimates are that up to 13.000 historical artefacts have been found over the years, from a Stone Age arrow head (35.000 – 45.000 years ago) up to stuff from the Renaissance. It is believed that the locals have long considered the river a sacred place, and perhaps offered artefacts to it a sign of mourning or thanksgiving.

The magic of Ljubljana lies in its capacity to transform the way we perceive life. Strolling along the city, you’ll suddenly find yourself feeding spring flowers to muskrats. Everything seems to look cuter here. Or is Ljubljana just triggering the birth of spring in you, the season that makes you more perceptive of life’s beauty?

The Ljubljana Castle stands proudly on Castle Hill, a site that has been occupied since 1200 BC. The present castle is not that old, however, most of it was built (or rebuilt) in the sixteenth and seventeenth century. Over the millennia, ‘Ljubljana Grad’ was, amongst other things, a fortification, a prison and a home for the poor. Currently, it is it used for all kinds of cultural events and as a wedding venue.

Above all, it is lovely place to linger for both tourists and locals. I went there with some friends, and we were rewarded for the climb up Castle Hill with a great view of Ljubljana. Too bad there are no separate tickets for the castle’s Viewing Tower. You have to buy  a ticket for all the castle’s features, which, student discount included, still costs around 5 Euros. It struck us as a bit too much just for an extra bit of view! For a moment, we were tempted to fish for the coins people throw into the castle’s wishing well and use them to buy the tickets. However, our good manners quickly overcame the temptation… or was it our lack of ingenuity? ;-)

2     Food

Peace of mind does not only come from visiting relaxing places and enjoying good company. In fact, as Igor Gaber tries to teach his fellow inhabitants of Ljubljana: peace begins on your plate. I discovered the one and only Ljubljana Loving Hut, part of an international chain of vegan fast food restaurants. Based on the idea that all creatures, whether human or animal, can live in peace with each other and the earth, they serve a range of fine vegan dishes. As I can now say from my own experience, contributing to world peace has never been so enjoyable!

Just around the corner from my place is the Centralna Postaja, or Central Station in English. As the photograph on the upper right, they serve good lunches (with salads in jars!), but that's not the only thing they do. They have their very own radio station broadcasting from the building (which you can listen to here). A great place to hang out with a good ambiance, especially on warm spring evenings.

3     Massage

I even found the time to go for a proper massage at a wellness club the doctor had advised. Since I had no intention of ending up in some dubious place, I decided to stick to her advice, which turned out to be very good. It was in fact my first ever ‘official’ massage, but probably not my last. This 80 minute Thai massage really helped to reduce my stress level. Funny enough, I felt the effect even more the day after, when I noticed an increased energy level.

Leaving the place, I decided to prolong this little moment for myself, by having a Irish coffee at the dreamy riverside on a gentle night at the Solist Bar. Perhaps for the first time in my life, I am thoroughly enjoying flying solo.

4       Local boyfriend

As a student in the medical field I know that treatment fidelity is an import component in curing a patient. However, treatment fidelity of the medical staff (when it concerns their own health) is generally known to be low. I am not an exception in this respect. Sometimes, I’m too absorbed in my work, I easily forget to take my medication or I don’t allow myself a break. Lucky enough, I always have my colleagues around to remind me to take good care of myself. I have been a good patient where working on the doctor’s bucket list mentioned above is concerned. However, in the battle between treatment fidelity and boyfriend fidelity, the latter won, and the ‘local boyfriend’ item was crossed out of the list. 'Baby, there aint nobody out there like you'.

From a colourful Ljubljana, I wish you all a beautiful springtime! In my next blog, I will return to writing about my internship.