It is said that Julius Caesar was not born in the conventional way, but that a cut was made through his mother’s abdomen into her womb and the child emerged that way.

The modern operation to deliver a child has been called caesarean section because of this.

Until recently, a caesarean childbirth was a rare last-ditch event.

In America the rate has increased three or four times over the past 10 years and now one baby in eight is born this way. At a large Australian hospital caring for mothers and babies, the rate is only half that.

Medical consumers — pregnant women and their husbands — are demanding a return to more “natural” methods of childbirth. Why then, are the suppliers of the service — the medical profession — making it more scientific and involved?

In obstetrics, there are two patients — the mother and the baby. In the past, the greater emphasis was placed on the mother’s welfare and the baby had to take second place. Now that modern medicine has reduced the risks to the mother, the concern is increasingly for the health and welfare of the child.

*94/71/1*

The social context. The significance of other people to both yourself and your client is an important source of information for your ethical decision making. Everyone is motivated by the attitudes and opinions of others, especially those who are important in one’s life.

How do the opinions and attitudes of others affect this client’s goals? Obese clients often declare that they wish to lose fat because someone else wants them to, usually a partner but sometimes also another helper such as a physician. A careful examination of the relationship between the client and the other person will tell you something about the ethics of working with the client. For example, the extent to which the client wishes to lose fat for personal reasons, or feels forced into it, is likely to be relevant.

How do the opinions of others affect your goals? Everyone’s job meets a variety of personal needs, including social ones. For example, a client may have been referred to you by someone you respect or value as a source of referrals and do not want to disappoint. You may feel the need to get a good result in order to secure your relationship with the referrer. This need to impress the referrer may make it difficult for you to turn the client down even if there are good reasons to do so. Conversely, you may feel the need to prove your effectiveness as a fat loss agent and may therefore avoid offering help to clients who appear unlikely to achieve impressive fat losses even though they could benefit greatly from your help in other ways.

*232\186\4*

The glycaemic index concept (the G.I. factor) was first developed in 1981 by Dr David Jenkins, a professor of nutrition at the University of Toronto, Canada, to help determine which foods were best for people with diabetes. At that time, the diet for people with diabetes was based on a system of carbohydrate exchanges or portions, which was complicated and not very logical. The carbohydrate exchange system assumed that all starchy foods produce the same effect on blood sugar levels even though some earlier studies had already proven this was not correct. Jenkins was one of the first researchers to question this assumption and investigate how real foods behave in the bodies of real people.

Jenkins approach attracted a great deal of attention because it was so logical and systematic. He and his colleagues had tested a large number of common foods. Some of their results were surprising. Ice cream, for example, despite its sugar content, had much less effect on blood sugar than ordinary bread. Over the next fifteen years medical researchers and scientists around the world, including the authors of this book, tested the effect of many foods on blood sugar levels and developed a new concept of classifying carbohydrates based on the glycaemic index (G.I. factor) of a food.

For some years the glycaemic index was a very controversial area. There were avid proponents and opponents of this new approach to classifying carbohydrate. The two sides almost came to blows at conferences aimed at reaching a consensus.

Initially, there was some criticism which was justified. In the early days, there was no evidence that G.I. factors for single foods could be applied to mixed meals or that the approach brought long-term benefits. There were no studies of its reproducibility or the consistency of G.L factors from one country to another. Many of the early studies used healthy volunteers and there was no evidence that the results could be applied to people with diabetes. But now the evidence is in and we know that it is a valid tool and a clinically proven tool in its applications to diabetes, appetite control and sport. To date, clinical studies in the United Kingdom, France, Italy, Sweden, Australia and Canada all have proven without doubt the value of the glycaemic index. Notably, the United States remains one of the last bastions of opposition. This may have more to do with academic politics than science!

The glycaemic index (or G.L factor) of foods is simply a ranking of foods based on their immediate effect on blood sugar levels. To make a fair comparison, all foods are compared with a reference food such as pure glucose and are tested in equivalent carbohydrate amounts.

Today we know the G.I. factors of hundreds of different food items that have been tested following the standardised method.

*22\33\4*

I do not intend to discuss each and every form of pain, but this system lends itself so well to the control of the pain of childbirth that we must have a few final words about it.

The young woman approaching childbirth is in fact subjected to an extraordinary number of

anxiety-producing influences. Other women seem bent on telling her stories of terrible pain and complications. The stories often end with a kind of negative suggestion, “But you will be all right, dear,” which of course conveys the idea that she just might not be all right. Many women tend to talk of their experience of childbirth in the way that others describe their adventures in sports or war. “Of course, I had to have six stitches.” All this has its effect on the young woman. The very fact of going to the hospital makes her feel that there is something wrong. She thus goes with a high level of anxiety to have her baby, and with the clear expectation of suffering considerable pain. Her anxiety not only lowers her threshold of pain, but may tend to make the contractions of the womb less smooth and co-ordinated. And worst of all, anxiety makes tense those parts which should relax, so that they are painfully forced by pressure instead of relaxing easily and naturally.

However, the young woman can guard against these unpleasant eventualities by being secure in her knowledge that childbirth is a natural process, and that older women often gain some strange satisfaction in telling exaggerated stories of their own experiences.

An unfortunate aspect of the problem is that the situation tends to become self-perpetuating. The woman in her first pregnancy is made anxious and expects pain. As a result, she experiences pain. Then with this experience behind her, she is increasingly nervous at her second pregnancy, and the painful experience is repeated, and so on. One of the reasons why this unhappy state of affairs is allowed to persist is that obstetricians are usually very busy people and often short of sleep. They simply do not spend the necessary time with the expectant mother to put these things right.

With these thoughts in mind, do a little preparation for the coming event. Practise the relaxing mental exercises, naturally and easily, so that you can let yourself go into the relaxed mental state when you wish it. This will also help you with the discomfort of the increased weight of the last few weeks. If you like, you can practise the exercises with pain, but this is not essential, because if you really learn the mental relaxation, pain will not be a problem.

When you feel the first contractions—this is what the older women call “the pains”

—remember what is happening. The muscles of your womb are contracting to push your baby down into the birth canal. As the contraction comes on, you let yourself go.—You let yourself go completely.—You let yourself go in body and mind as you feel the contraction.—You feel it good and strong.—It is good, pushing the baby down to be born.—It is strong.—You feel the strength, natural strength.—Natural, so that there is no hurt. —Between the contractions you lie back, easy and relaxed. —And all the time you have with you the calm and the relaxation of the mental exercises.

The baby is pushed down the birth canal slowly and easily and naturally. His head comes to the muscles at the end of the canal. You feel this because there are more nerves in these muscles. Now you relax deeper, deeper than ever, knowing that it is good that he has reached the end of the canal, and in a few moments he will be born.

There is just one other point that I would mention. Some people feel that they do not get themselves deep enough, as it were, in their relaxing mental exercises. They feel,

“This would not be sufficient if I were in real pain.” The fact is that when we are actually faced with potentially painful stimuli, as in childbirth, we can let ourselves go very much more completely. This may seem strange to you, but it is true. The reason is that in practising our exercises we lack real psychological motivation; we only have an intellectual logical motivation, which is not the same thing. So in the actual situation we surprise ourselves by doing much better than we expected.

Just one last comment. Take your obstetrician into your confidence about what you are doing. Remember that obstetricians have different views about this kind of approach, and that some still adhere to a rather mechanistic, drug-oriented way of doing things. Do not let any conflict

develop between you and your doctor on account of this, as such would only cause tension. It is best to find out the obstetrician’s views early in pregnancy, so that if necessary you can find another who will go along with you in these matters. If it is too late for this, go along with him. If he wants you to have drugs or injections, do not fight about it. In any case, you will need very much less than if you had not had the experience of the mental exercises.

*148\57\2*

The pupil as such is entirely dependent upon the function of the iris. Therefore, all reactions and conditions of the pupil are to be considered basically as no more than changes affecting the inner margin of the iris. For the irisdiagnostician, however, only those abnormal conditions are significant which by paralysis or irritation of the nerves controlling the muscles of the iris, produce changes in the function or state of the pupil. (M. sphincter pupillae = pupil contraction and M. dilatator pupillae = pupil dilation.) Consequently, all those disturbances which are caused by local injuries or other conditions of the eyeball are to be ignored.

The normal shape of the pupil is circular. It should lie in the centre of the iris (perhaps somewhat disposed towards the nasal side), and appear neither too large nor too small under ordinary conditions of lighting. The normal diameter is 3-4 mm. On the whole, relatively larger pupils are found in small children, while in adults the size of the pupil progressively diminishes as old age advances.

The pupil should not show any undue variation in width, and the movements of contraction and dilation should affect both pupils symmetrically.

*39\78\2*

They are trying another kind of treatment at both these places too. When they first started to investigate the hormone level in patients suffering from premenstrual tension, they discovered that women who had a low level of progesterone in their blood often had a correspondingly high level of another hormone called prolactin. They felt that the correct balance might be restored if they gave these patients drugs which would cut back the amount of prolactin they were producing. Prolactin is another one of those powerful hormones that have a profound effect on the way our bodies function and the way we feel and behave, as you can see if you look at the particular times in our lives when we naturally produce greater quantities of it. They’re the great private moments. And the first of them is when we have made love and enjoyed it. Now as prolactin is one of the hormones that dampen down our response to stress and make us feel less anxious, this could be one of the reasons why we feel so good after really pleasurable love making. Although only one, of course! We also release large quantities of prolactin when we are giving birth. And when we suckle our new babies, their sucking makes us produce more prolactin and the prolactin in its turn makes us produce more milk. Which is a nice neat way of ensuring that the supply will meet the demand.

But it doesn’t stop there. As the baby sucks and our bodies respond by producing more prolactin two other very important things happen as a result. For a start, the prolactin cuts down the amount of adrenalin we’re producing, and this keeps us calm while we’re feeding our infants and gives us that lovely purring sense of well-being that so many happily breast-feeding mothers enjoy. And on top of that, it makes us produce another of those subtle but very influential body scents or pheromones. This one is specially for the baby who will smell it and respond to it at once. This is how even a very new baby can recognize its own mother and respond to her. It’s a powerful, natural way of ensuring that these two very important human beings bond to each other. And it works on the same principle and in the same sort of way as the sexy pheromones we produce half-way through the month — the ones that turn on our husbands and boyfriends.

I can’t help feeling that we shouldn’t tamper with such a powerful hormone, especially when we know what far-reaching effects it has on the way we function as wives and mothers. Even the doctors at St Thomas’ who are the most ardent advocates of using drugs to cut down the amount of prolactin their patients produce, are honest enough to admit that they don’t know yet exactly what the effects of suppressing it may be. One of them, Dr Brush, a biochemist who works at St Thomas’ says: ‘The exact mechanism of action of pyridoxine in premenstrual tension treatment is not yet fully understood but it is likely to be at more than one level’.

*84\177\2*

It’s no joke to lose your balance. It’s the quickest way to get hurt or to hurt someone else. And it’s terribly upsetting to know that you’re being clumsy with people as well as objects and there doesn’t seem to be anything you can do about it. Yet many women are completely off-balance for anything from three to fourteen days every month.

For some it’s simply a matter of being more clumsy than usual; they burn the toast or break the china or can’t park the car. For others, clumsiness leads to accidents; they cut themselves on carving knives or fall downstairs or burn themselvs on irons or ovens; they have road accidents; they get injured at work. Others find that their clumsiness takes the form of making them less alert than usual, and although they don’t have accidents themselves, their children do. During a survey carried out at the Middlesex Hospital, London, it was discovered that forty nine per cent of the mothers of one hundred children who had been admitted as emergencies were suffering from the approach of a period at the time their child was hurt. If you took a random sample of any hundred women, you would expect to find that there were about a quarter of them in the last week of their particular monthly cycle. Yet the survey revealed a figure twice as high as you would expect.

British industry suffers too because of ‘menstrual difficulties’. A recent estimate claimed that about three per cent of the total wage bill was paid to women unable to work because of their

periods.

And as if it weren’t bad enough to be accident prone, many of us also notice that our senses seem to be blunted by an approaching period. They desert us just at the moment we need them most. Our sense of smell isn’t nearly so acute. So we don’t notice that we’ve left the gas tap on and unlit until much later than we usually would. Some of us find it difficult to focus our eyes. We don’t seem to see straight. Is it any wonder that we miss our footing?

It’s nothing new, of course. In lots of early cultures menstruating women were set apart; they were not allowed to cook food in case they spoiled it, or to use sharp knives or unwieldy instruments. Very sensible when you think about it, although it was tough on the women who weren’t off-balance. In those days people thought that there was something magic and evil about menstrual blood. Now we know that it’s chemistry that’s doing the damage. We’re clumsy and accident-prone because the chemical balance of our bodies is upset. So I think when we are having a period if we know we’re vulnerable we should try to keep out of harm’s way as much as we can.

You’ve no doubt read that one of the most dangerous places in which to work is your own home — an odd fact but one that is supported by a great many statistics. Most houses are full of hazards and a very high proportion of all accidents, especially to children and old people, happen at home. I’ve tried to suggest ways of dealing with danger at home and at work. The third most hazardous place is on the road, whether you’re a pedestrian or a driver. Plainly, if you’re accident prone before a period, you must be particularly careful.

*42\177\2*

Symptom

Forceful ejection of the contents of the stomach

Home care

-     Solid foods, milk, or aspirin tablets aggravate vomiting and should not be given.

-     Have the child sip ice water, carbonated beverages, tea with sugar, flavored gelatin water, commercial mineral or electrolyte mixtures, or apple juice.

-    If you do not know why the child is vomiting, consult the doctor. Note if abdominal pain, fever, or headache accompany the vomiting.

Precautions

-         Prolonged or severe vomiting can cause dehydration, which can be very serious in infants.

-     If vomiting and diarrhea occur at the same time, control the vomiting first.

-        Abdominal pain, whether it is accompanied by vomiting or not, may indicate appendicitis.

-    Some phenothiazine drugs that are given to control vomiting in adults can have serious side effects in children and should not be given.

-    If the child is on medication, vomiting may hinder the action of the medication.

Vomiting is a common occurrence during childhood. In most instances it is merely a nuisance, but at times it can hinder the work of medications, cause the child to lose so much fluid that dehydration (loss of body fluids) occurs, or indicate a problem that requires medical attention.

Most infants spit up and occasionally vomit. If this vomiting does not hinder weight gain, it is neither harmful nor abnormal. Excessive vomiting, however, may indicate an intolerance of formula, milk, or some foods. Frequent forceful vomiting during an infant’s first two months suggests an obstruction at the end of the stomach (pylorospasm or pyloric stenosis).

In children, a viral infection of the digestive tract (gastroenteritis or intestinal flu) or an infectious disease elsewhere in the body can cause vomiting. Less common causes are abnormalities of the brain (concussion, migraine, meningitis, encephalitis, tumours); poisoning; appendicitis; severe emotional distress; jaundice; foreign bodies in the digestive tract; abdominal injuries; and motion sickness.

*244/84/5*

Many people feel that if only there were some way to have insulin that didn’t involve a needle, life with diabetes would be very much better. We know that insulin cannot be swallowed as a medicine or capsule, because insulin is destroyed in the intestines before it could be absorbed. Are there any other possibilities?

1. Jet injection

It has been known for a long time that it is possible to give some drugs beneath the skin forming a high speed jet stream of fine particles (much like jet injection in the diesel engine) and aiming it close to the skin. The particles go right through and lodge beneath the skin and there may be little sensation or pain in this process.

This method is used for local anesthetics and immunizations. It is also used to give insulin and there are several types of jet injections that are now available. The problem up to date had been that it is difficult to administer an accurate dose and one that could be altered when needed by small amounts. Some people have felt that rather expensive and complex paraphernalia needed for jet injection isn’t worth it just to avoid a fine needle.

2. Nasal insulin

Insulin can be absorbed into the body through the membranes of the nose. There is some research evidence to show that diabetes could be controlled by insulin given this way. The disadvantages – so far – are very large doses are needed which is expensive and wasteful. It is also possible that a reaction could be set up in the nose that would cause an irritation and perhaps interfere with the way the insulin was absorbed.

3. Inhalation of insulin

Insulin can also be absorbed through the lining of the lung. It is possible to make a very fine spray of insulin – like a mist of very fine liquid particles – and this could be inhaled into the lungs where the insulin can be absorbed. This system would work rather like the inhalation of medication of asthma and some lung conditions.

This method would probably take longer to give insulin than to give a simple injection, and has the similar potential difficulties to nasal insulin. Nevertheless there is research going on that might develop this and other techniques for having insulin without a needle.

*78/54/5*

There is evidence showing that meditation in the absence of visualization is more effective in the treatment of cancer. The main problem that leads people into visualizing is that the inexperienced see it as something practical as opposed to the rather mystical idea of stillness. Visualization is an easy technique as it gives the meditator something to do. This overcomes the initial difficulty of the meditator learning to let his mind run in stillness, but it leads to an inferior type of meditation.

It does not require long periods of meditation to obtain relief from stress. Ten minutes twice a day has produced dramatic relief in some hundreds of people who have consulted me professionally.

To get the full effect of meditation, it is important not to do it when too tired. The effect is greatest when we are alert and frisky.

As we learn to meditate in this way, it soon becomes a pleasant experience. It is something to which we look forward. This comes with the ease that there is about it. There is no making ourselves relax, no making ourselves meditate. It is all very simple and natural. That is why we soon come to like doing it. Then we come to feel less stressed, and our motivation for our meditation is further increased.

Besides, there are many fringe benefits! The effects of successful meditation flow on into our everyday life. Although we may initially have been meditating to control stress or some psychosomatic illness, there are many side-effects, and they are all positive, and all good. They include inner peace, better interpersonal relationships, clearer thinking, increased work capacity – even tycoons agree on this, better sexual relationships due to less tension, absence of disturbing dreams, and smoother physical reactions often shown in better performance in sport.

*88/98/5*