Tuesday, 8 May 2018

Why Home Birth Matters

I am a big fan of the Why It Matters series of detailed and concise guides to pregnancy, birth, and early parenting subjects, so I was quite excited to get my hands on the latest volume: Why Home Birth Matters, by Natalie Meddings.

I have given birth in hospital once and at home twice, and many of my friends and family have also given birth at home. Having been exposed first hand to a range of experiences, I was very interested to see what Natalie had chosen to include in her book. Birth is such an emotive subject, and home birth arguments often become polarised between those who only see the risks and those who refuse to see the risks. What I found was a delightful and realistic guide to home birth. As well as going through the practicalities and advantages of birthing at home (mostly focused on the set up in the UK), Natalie discusses why a home birth might not be appropriate for all mothers and babies, and why a home birth might become a hospital birth. Discussing how these transfers are not usually the life-and-death emergencies man suppose them to be gives a clearer idea of how home birth works: we are so lucky in this country to have access to very highly skilled midwives, who are able to observe that things may not be following the best course early on, long before an emergency occurs, and preventing it. Natalie reminds us that midwives have the same monitoring and resuscitation equipment at a home birth that they have in hospital. By going through the physiological processes of birth, Natalie highlights how "terrifying television portrayals...have about as much to do with real birth as porn does with real sex." I love this! But because most of us are only exposed to those media portrayals, many mothers may find that they are immediately criticised for considering a home birth. This book arms expectant parents with the facts that they will need to address any concerns from people they care about (top tip: if you don't care about a person, don't be bothered by their opinion on your birth. It's presumptuous of them to offer one). Natalie also shows beautifully how the processes of birth are supported in the home environment in a way they cannot be in a hospital, and how birthing at home stacks the odds of an intervention-free birth in the birthing parent's favour.

Bob and I on the sofa, seconds after his birth

There is only one thing in this book which caused me to hesitate. Natalie describes labour beautifully, abandoning the language of "stages" in favour of describing the process as a series of rooms the birthing person passes through. She describes the build up to labour as a time when you can still return to normal and speak between contractions, and labour as the time when you enter yourself and can no longer do this. This was not my experience, so I asked around, and found that it was not the case for many of my friends either. In fact, we hear time and time again of mothers being disbelieved when they tell their carers that they are in labour and close to birth, because they can still converse. I think this is something that i highly subjective, and should be applied with extreme caution.

Sausages and Bob coming down in the morning to find Baby 3 had arrived while they slept

I think this book will be very helpful for expectant parents considering their place of birth to make informed decisions, and to withstand pressure from others to capitulate and go to a hospital, where as Natalie points out, their chances of a physiologically normal birth are greatly reduced. Home birth is not the best option for every family, but it is a safe and enjoyable experience for many, and I hope this book will help them to see that!

Hospital was the best place to birth my premature baby

If you would like to learn more on this subject, I highly recommend Tell Me A Good Birth Story, your local Positive Birth Movement group, and Becky Reed's account of her work with the Albany group, Birth in Focus.

Saturday, 7 April 2018

A Midwife's Story

Last year I had a wee hunger to hear about different birth cultures around the world. I think it was fuelled by Sheila Kitzinger's accounts in her autobiography of the different birth cultures she encountered around the world. I read quite a few things that took me to various different parts of the world, including this little gem:

A Midwife's Story, by Penny Armstrong and Sheryl Feldman. I notice that it has recently been republished, so I thought I would share it with you. If you are interested in birth or the lives of women then this is a book for you. It is a beautiful, moving account of the lives not only of the midwife, but of the women of the Amish community which she served. Told with humour and without criticism, these stories give insight into the joys and challenges faced by Amish women giving birth. The writing style is easy to read, and I'd chose it over an airport paperback any day. If you enjoy Call the Midwife you'll love this one too.

I'm looking forward to reading A Wise Birth by the same authors. I hope some of you enjoy this book too! It really is a delight!

Sunday, 25 March 2018

Review: Trust Your Body Trust Your Baby

I was asked to review this book recently, and it's been a lovely read: Trust Your Body Trust Your Baby, by Rosie Newman. This book contains a broad span of parenting, including pregnancy, birth, breastfeeding, safe sleep, toileting, and attachment. Because it is a small book, and the range of topics is large, there is plenty of opportunity to follow up Rosie's copious references and look deeper into any particular topic. I would say that the subject is similar to Mayim Bialik's Beyond the Sling, but perhaps more accessible to those who find that work too "hippy." Trust your body is a holistic discussion, encouraging parents to listen to their instincts and to their baby, and to follow these two to find their own parenting style. In this respect it offers a healthy alternative to the artificially regimented baby books that have become so popular in the mainstream, written by people who have never had children of their own, and seem to have no knowledge at all of the beautiful dance that takes place between a parent and their baby.

This book is very well researched, and most of it is reinforced with reference to scientific evidence supporting a more instinctive parenting style. Because of this the reader is easily able to look up the author's references and cover a subject in more detail. For me, however, this was a bit off-putting: in many cases the author simply includes large passages of direct quotation from other books which I have already read, such as Ina May Gaskin's Guide to Childbirth, and Ruth Kamnitzer's account of raising her son in Mongolia. Because of this I would not recommend this book for people who have already read around this area, but as a good gentle introduction to those new to the subjects. The tone is kind and informative, and contains such beautiful insights into the author's own parenting journey. Definitely a good read for expectant parents looking for something to help them form their own ideas about how they would like to shape their journey in parenthood.

Saturday, 6 January 2018

The Birth of Homo, the Marine Chimpanzee

I recently read the latest work by the French obstetrician Michel Odent, famous for popularising the use of water in childbirth in the UK.

This is a very complicated work, and I am not ashamed to say that some of it is beyond my level of understanding, as a person without a background in biology.

In this book Odent puts forward his contribution to the hypothesis that homo sapiens in descended from an aquatic ape. Further to the established features such as our hairlessness, fat layer under the skin, the height of our larynx etc, Odent explores more unusual features such as the fact that we share menopause with certain species of cetacean; that we have a layer of vernix at birth in common with seals; and our crucial need for nutrients such as iodine and omega three, that come readily from seafood. He also points to the fact that newborn humans can swim automatically if placed in water, and the relaxing effect of water, both through sight and touch, on our minds and bodies.

As well as discussing this theory about how homo sapiens have evolved to be the way they are, Odent points to our own time as a turning point in human evolution. We know that there are many events surrounding birth that can result in changes in our epigenetics, that are then passed down to future generations. The study of the microbial nature of birth has become very fashionable, and has been shown to affect our health for the rest of our lives. While many who are concerned with the birth microbiota focus on the difference between vaginal and caesarean birth, Odent states that we should be more concerned about the difference between home and out of home (hospital, birth centre) birth. He illustrates this fundamental separation by pointing to the fact that the human placenta transfers vast quantites of maternal antibodies to the foetus as the pregnancy approaches term, such that at 38 weeks gestation the concentrations are the same between mother and foetus, and the foetal levels continue to rise, meaning that a baby born at term has higher concentrations of maternal antibodies than the mother herself. This means that the immune system of the baby is already prepared to deal with the microbiome with which the mother's immune system is familiar: crucially that of the home,a and not the hospital. Odent also wishes us to focus on the differences resulting from in-labour and pre-labour birth, again rather than between vaginal and caesarean birth. It is thought currently that labour is triggered by the production of surfectants in the baby's lungs. This is a feature of the baby's development, and so labour starts when the baby is developmentally ready to be born. We know that babies born by pre-labour caesareans are at greater risk of various health problems. babies born by pre-labour caesarean go through a very different hormonal experience, and there are repercussions of this for the development of their brain and hormonal system. There are also repercussions for the mother, who is more likely to experience placenta praevia in future pregnancies, and who has experienced an altered operation of her own hormonal system.

This is a richly detailed and referenced book, and I am keen to find out what more knowledgeable experts than I have to say about it! Odent's perspective on our time as a turning point in our own evolution is both fascinating and terrifying. I look forward to seeing what he produces next!

Saturday, 23 September 2017

Review: Why Mothers' Medication Matters

I was excited recently to get the chance to review Wendy Jones' new book Why Mothers' Medication Matters. I am such a fan of this series of concise guides, and also of Wendy! You can find out more about Wendy Jones and what she does (and get help) here and here. Wendy is a pharmacist who specialises in mothers'medication, and especially in the safety of drugs for breastfeeding mothers and their infants. She provides a service that supports mothers and health professionals in finding appropriate treatment. I have received help from Wendy myself, and she was very knowledgeable and supportive.

Wendy Jones explains that one of the biggest problems with medications for expectant and breastfeeding mothers, whose offspring may be affected by what they take, is that there is so little research done. It is almost impossible to set up an ethical trial that might affect the health and development of unborn babies and infants. As a result, manufacturers refuse to take responsibility for this research. We have all seen the disclaimer: "if pregnant or breastfeeding, consult your doctor or pharmacist." In this way the manufacturer passes the responsibility to the prescriber or retailer. This is confusing for a mother, when her doctor, pharmacist, and the patient information leaflet with her medicine all tell her something different. Dr Jones quotes studies that have shown that mothers are reluctant to believe reassurances about the safety of drugs in breastmilk. This leads to a blanket over-caution, which can harm the breastfeeding relationship, or mean the mother not receiving treatment, sometimes unnecessarily. This can have a negative impact on her health, or mean she stops breastfeeding when she wants to continue. Pregnant women are also often expected to go without help for various conditions, which treats them as reproductive vessels, rather than persons.

One problem is that sometimes health care professionals do not understand or appreciate the nature of breastfeeding. Over caution may lead them to tell a mother that she must stop breastfeeding altogether, or express and discard her milk for a period of time. While this may be the case, Dr Jones finds that this often happens when it is not necessary. We must not fail to understand that breastfeeding is not like formula feeding. Stopping breastfeeding can have a big impact on a mother and her child. buying artificial milk costs money. There will be an emotional impact for both parties. Treatment for post natal depression must take this into account: treatments such as CBT that require separation of mother and child are not suitable and might put the mother off getting help; breastfeeding itself has an impact on depression which should be taken into account. Artificial milk is not the same product as breastmilk, and the baby may not react well to it, as well as missing out on all of the advantages of breastmilk, such as immunological factors. A mother told to express and discard her milk may give her baby a bottle, which can lead to latch issues and nipple confusion, threatening the breastfeeding relationship. She may not have a store of expressed breastmilk, and may delay treatment until she has created one, which may affect her health. She would also be at risk of blocked ducts and mastitis because expressing is not he same as breastfeeding for her breasts, and she may not express frequently enough, as it is inconvenient. This could also create a supply problem. Where mothers hear poor information on breastfeeding from their care givers they come to doubt their medical opinion and look elsewhere for help, which could be dangerous. Appropriate breastfeeding knowledge from the HCP can prevent this.

There are several different situations in which mothers might need to know about the safety of their medication. Some are straightforward and predictable, such as in pregnancy and breastfeeding, but some are not. Mothers with preexisting conditions might arrive at their due date with no idea whether their medication is suitable for breastfeeding. As breastfeeding continues for longer, the issue of breastfeeding mothers receiving fertility treatment might arise. Tandem feeding mothers have babies who might be affected by medications in different ways. Some mothers have chronic conditions, and sometimes treatment is urgent. All of these are situations in which specialist information is required. Dr Jones quotes NICE Maternal and Child Nutrition Guideline PH11 (2008) recommending that prescribers/dispensers consult supplementary sources; support continuation of breastfeeding where possible; recognise the consequences of ending breastfeeding for mother and child. I.e. the BNF is not sufficient reference. Dr Jones points to the LactMed database and the UKMI specialist centre for addressing the safety of drugs in breastmilk, among others, as appropriate resources for HCPs. She finds that too many health professionals will not go beyond the BNF, partly because they do not value breastfeeding over artificial milk feeding. In practice most health care professionals receive very little training in this area, and their thoroughness tends to depend on their own experiences of breastfeeding. Additional training in this subject for GPs has had very low take up, and those who did take it up were mostly women and parents of breastfed children. Adult hospital wards are not set up to accommodate expression and milk storage, and may be hostile to it. I was particularly struck by Dr Jones example of hospital policies on MRIs and breastfeeding, which stipulate a 24 hour cessation of breastfeeding, directly opposing professional guidelines and the facts about the half lives of the medications.

So what are Dr Jones' conclusions? "When I think about what I want doctors to know about breastfeeding and the safety of drugs in breastmilk, it boils down to this:

  • how to signpost to a local breastfeeding specialist
  • how to access databases and expert books on the safety of drugs in breastmilk."
I can only wholeheartedly agree with Dr Jones when she says that "pregnancy and lactation are normal human states and mothers deserve to have their medical conditions treated and managed appropriately, just like everyone else." For me this makes it clear that the subject of mothers medication is a feminist issue. This book is fantastically thorough and informative, with clear signposting to further resources for both mothers and care professionals. I would hope that mothers would read this book to make themselves aware that as a specialist subject, they may need to do their own research into their treatment (and how to do so), and that health care professionals would also read it to understand why they should engage in finding the appropriate treatment for their patients who are pregnant or breastfeeding.

Sunday, 30 July 2017

Why Starting Solids Matters

Baby Three has just passed six months, and we decided he was ready to start eating solid food, so I was delighted to receive a copy of Why Starting Solids Matters to review. Blog regulars will know that I love this Why it Matters series, and I also appreciated Dr Brown's previous book, Breastfeeding Uncovered, so I had high hopes of this one! It arrived just at the right time to inform our decisions about introducing Three to his first foods.

Dr Brown starts with a fascinating discussion of the history of infant feeding and the introduction of solids, in both far and near history. This is incredibly relevant because it informs our ideas about how and when we introduce solids today. I had no idea that our ancestors were introducing solids much, much later than we do today. Dr Brown's discussion of why we currently introduce solids at six months is highly pertinent. Despite the fact that the UK guidelines changed from four months to six months in 1994, twenty three years ago, I still know mothers who have given their children food early. When I asked why, I was told "because it says from four months on the packet." Interestingly, as Dr Brown explains, this is a violation of the WHO code, but not UK law. Dr Brown points out that there is a significant change in development between four and six months of age, such as the ability to sit unaided and the loss of the tongue thrust reflex, which are relevant to both puree and baby led weaning. Amy puts it beautifully: "babies develop externally to self-feed at about the same time they develop internally to cope with that food. It's as if Mother Nature intended it." These babies weaned early are at increased risk of infection, amongst other things, both because of the intake of food, and a reduction in the amount of breast milk consumed. Dr Brown also dismisses the idea that there is any "golden window of opportunity" that can be missed when introducing solid foods.

Dr Brown's discussion of the baby food industry is sadly reminiscent of that of the artificial milk industry: it is a tale of exploitation for profit, without concern for welfare. Like formula manufacturers inventing "follow on milk" to get around legislation prohibiting the advertising of infant milks, baby food manufacturers have created "stages" to encourage parents to move gradually through their range of products. Looking at the contents of prepared foods, it seems that many are unexpectedly high in sugar, and can contain surprisingly little of the main ingredient. While their occasional use may not be harmful, a diet of exclusively prepared baby foods would be too high in sugar and protein, and the manufacturers' suggested portion sizes exceed the recommendations. Furthermore, Dr Brown cites studies which have shown a negative correlation between the amount of prepared foods consumed, and the amount of fresh fruit and vegetables the child will consume at preschool and primary age.

Parents today might choose to eschew puree or spoon feeding their babies and instead follow the Baby Led Weaning (BLW) approach popularised by Dr Gill Rapley. This is an approach under which babies are fed family foods from six months, and feed themselves rather than being fed by the caregiver.  Dr Brown points out that there is yet little scientific data on BLW, either in support or criticism of it, but she herself is engaged in research into the impact of different throroughnesses of the approach. She highlights that there is no evidence on the benefits of puree of spoon feeding either: it is simply what has been done. The emergence of BLW has coincided with the change in recommended age for starting solids from four to six months, which makes the approach feasible. It is certain that later introduction of solids leads to reduced fussiness, a lower risk of overweight, and a lower risk of infection. Allowing babies to feed themselves means there is little risk of choking, since they develop the ability to move food around their mouths simultaneously with the development of their manual dexterity, and ability to pick up smaller and smaller items.

Dr Brown's main point is that more important than which method you chose, is that you feed your baby responsively. Like breastfeeding, we should follow our babies cues, and look to them to determine when and how much they should eat. I certainly agree with her statement that "responsiveness is a general parenting ethos rather than just about eating." This is an approach that hinges on trust: trust that you will provide what they need; trust that they will consume what they need. The idea is based on the fact that most children are born with the ability to be "satiety responsive:" i.e. to stop eating when they are full. However, social factors can override this over time. Preschool children are still able to self regulate, but primary aged children have been shown to be significantly less so. The idea of eating at set times can be a factor in this, as can encouraging children to finish what's on their plate, and celebrating with food. Restricting foods has been shown to be counterproductive, and pressuring children to eat can be harmful. The more you pressure a child to eat a food,t eh less they like it. Using food to shape behaviour as a bribe for eating other foods, as a reward or comfort, or withholding it as a punishment, is harmful for eating habits and puts children at increased risk of overweight. Bottle feeding faces more challenges to responsive feeding than breastfeeding, such as encouraging a baby to finish a bottle, or a baby gulping down more milk than they need because it is flowing into their mouth, whereas the breastfed baby must work to extract the milk. Breastfeeding parents must trust that baby is taking enough milk at the breast. Responsive milk feeding leads to satiety responsive toddlers.

Dr Brown's book ends with a ten point summary that can support most parents, and should be stuck in every red book. Her focus on responsive feeding shows us how we can take the practicalities of different family lives into account and look at the bigger picture of how we feed our babies and young children to their best advantage, and also how we can sidestep exploitation by commercial interests. I also love her voice; her tone of writing. This is yet another fantastic book from this series. I hope it finds its way into the hands of health visitors and parents across the country.

Sunday, 4 June 2017

The Positive Birth Book

I don't know whether I have mentioned this before, but in the "real world" (although on as well as off the internet) I facilitate a local group for the Positive Birth Movement. The founder and leader of the Positive Birth Movement, Milli Hill, has poured her extensive knowledge and experience into The Positive Birth Book, and I was delighted to receive a copy to review.

This book is a really fresh approach to thinking about pregnancy and birth. Milli starts the book by looking at how our society sees and portrays birth, and how this affects the ideas pregnant women have about their own approaching births.Then she settles into an honest description of what birth is actually like, taking the medical division of the three stages of labour (active labour; birth; birth of the placenta) and turning it into a fourteen stage journey, plus an exploration of the experience of cesarean birth. Like any conventional book on birth there is a certain amount of myth expelling to be done, and there is a balanced discussion of the various coping strategies and methods of pain relief that most women can choose from during labour. What you won't find in a conventional birth book are Milli's two steel beams of choice: you have a choice; you have human rights in childbirth. These two are fundamental to improving women's experiences of childbirth. Time and time again I hear women describing how they are "not allowed" to do a particular thing in relation to their birth, be it give birth vaginally, carry past a certain gestation, or give birth in a place of their choosing. Doctors and midwives do not have the authority to tell women what to do with their bodies. Milli follows this statement of choice with a detailed discussion on how to make a birth plan that works for you, and what you might like to consider. She discusses equally different birth place options, and her "What if..." section can be a real help in working through any unexpected experiences along the way. Finally she ends with a section on "The Birth of a Mother," seeing the experience of birth through beyond the arrival of the baby.

I love the tone of this book. It's informal, but at the same time manages to convey a vast amount of detailed information. The real life birth stories that illustrate each section really help to do this, turning the theory and facts on paper into relatable human experience. Milli isn't afraid to deal with subjects that are often neglected but are life changing for women, such as having a child with an illness or disability; loss; birth trauma; postnatal depression; puerperal psychosis; or premature birth. This frankness can only benefit women who find themselves facing these situations. There are some really useful tools in this book too. Milli is skilled at pointing women at where they can find the highest level research and guidance on important subjects. Her "steel beams" teach women that the decision making for their births is their own, that the power lies with them. The amazing visual birth plan icons designed by Kate Evans help women to make their own choices and convey them to their care givers. You can download these icons for personal use (and for free) here. The BRAIN and HEART acronyms are great for helping women to feel in control when facing the unexpected.

Usually I recommend that every woman read Ina May Gaskin's Guide to Childbirth. That is a wonderfully inspiring ode to what the female body is capable of, and should give every woman confidence in herself. However, I have had some friends tell me it is too "hippie" for them. Well, this book isn't hippie, but it isn't conventional either. I think The Positive Birth Book is my new go-to for expectant mothers, and it's certainly suitable for their partners and supporters. If you are giving birth in the near future I would definitely recommend this book. Thank you Milli!