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!

Monday, 15 May 2017

My Birth Planning Journal

I'd like to share today a book that was quite useful to me when I was waiting for baby 3's arrival.

This is a relatively new venture from the Happy Birthing Company: a guide to planning and engaging with your birth.

I agree so strongly with this statement on the back cover. You can't predict what kind of birth you will experience, you can't really choose to have no complications, but you can stack the odds of getting your desired outcomes in your favour. I prefer the language of birth preferences rather than plans, because I feel this better reflects the reality of birth. We might prefer not to have a medicalised delivery, but if we have informed ourselves about the circumstances under which one might be necessary, and explore how we might like it to go in such eventuality, we will surely be in a better position for a positive birth than if we only plan for the outcomes we want but face the situation we don't.                                                                              

This lovely little book functions as a set of prompts for exploring your own birth preferences. Whether you are starting with a clear idea of what sort of birth might be the right one for you, or if you are starting right at the beginning of the journey with no ideas at all, these prompts can really help you to make your own informed decisions about birth. Small, light, and spiral bound so that it stays open and flat, the book is ideal for tucking in with maternity notes or into your birth bag (you can also download a PDF). It has plenty of space for you to write your thoughts and preferences, as well as prompts to encourage you to do your own research about important decisions.

This little book was a great tool for Husband and me in preparing for the birth of Baby 3. It provided the starting point for important conversations and decisions that we had to have, and I highly recommend expectant families use it in this way: as a guide and starting point for communication with each other and with care givers, or perhaps a doula. I think that the range of subjects mentioned will give every expectant parent something to think about, something they need to research further and inform themselves about. I hope this really takes off, because it has the potential to make a big difference to outcomes for mothers.

Thursday, 16 March 2017

Yarn Along

There's not much reading going on here this week, but I am really enjoying listening to Untold: The Daniel Morgan Murder. This is a podcast telling the true story of the murder of a private detective in the UK from the 1980s. It will definitely appeal to anyone who enjoys Serial. Speaking of which, I see the Serial production team have a new podcast coming out soon, which I'm looking forward to.

I am still working on the blue tit soaker, but in reality I have barely touched it. I'm so busy, and the little ones wake at night, so I'm either taking care of them or sleeping! As substitute I'd like to share with you these longies that I finished a couple of weeks ago. The photos are poor because there is no light and the baby is sleeping (yes on his front. He will only sleep that way), but I love the texture of these trousers. The yarn is Wendy traditional aran. It's cheap, and feels scratchy in the ball, but it's incredibly springy, and soft after washing.

Don't forget to check out the Yarn Along link up, and let me know what you're crafting this week!


Tuesday, 14 March 2017

Breastfeeding Uncovered Giveaway!

This review has been a long time coming, since I received the book just before baby three put in his appearance, but I especially want to share it with all my friends who support mothers. Breastfeeding Uncovered explores the factors that influence whether mothers want to breastfeed, whether they do breastfeed, and how long they breastfeed for. In the first chapter Dr Brown explores why these questions are worth exploring. She identifies the key issues as: that there is a health benefit from increasing breastfeeding rates; and that mothers who want to breastfeed but don't feel upset, guilty and criticised, and this can be avoided. The strength of her discussion of these issues is a detailed explanation of the statistics involved in understanding the health outcomes of breastfeeding versus not breastfeeding, for both mother and baby. We all know someone who was raised on artificial milk and is hale and hearty, but in the same way that we all know someone who smoked since childhood and lived to be a hundred, this does not mean that breastfeeding isn't the better option when trying to skew the odds of good health outcomes in our favour.

We live in a society that assumes bottle and artificial milk feeding, and this creeps in to our lives invisibly all the time. Baby dolls come with bottles, and pictures of toddlers breastfeeding their dolls are deemed controversial. Many women never see a baby breastfed until they have their own. Much of this book is concerned with how this affects our breastfeeding decisions and outcomes. Our societal expectations of mothers and babies in general are written by this assumption of bottle feeding as the norm, and this makes it hard for mothers to decide to breastfeed. For example, we can't measure how much our breastfed baby is getting, only the outcome that they are healthy. A mother who finds herself spending a lot of time, day and night, breastfeeding a baby may become overwhelmed, if she was expecting her baby to just have a ten minute bottle every four hours like her friend's bottle fed baby, or her mother says she did. Mothers may also be embarrassed to breastfeed their babies out and about, and either find themselves stuck at home (miserable), or bottle feeding outside the home, which rapidly becomes bottle feeding altogether. They have grown up thinking of their breasts as sexual, and have heard of women being asked to leave places for breastfeeding. I have heard husbands undermine breastfeeding because they feel they need to feed the baby to bond with it (not true. Why not try wearing it in a sling while mum has a nap or out for a stroll, or taking a bath with the baby, or finding a special song that only dad sings to settle the baby?), because they feel that their partner's breasts are sexual, and somehow their property (hello? A woman's breasts belong to her alone, and they are evolved for feeding babies), or because they are embarrassed that other men will see their wives breastfeeding (they should be proud! Look what a great start you are giving your children!). The attitudes of partners and other family members are so influential in whether and how long a mother breastfeeds her baby.

In conclusion, Amy Brown sets out an eighteen point manifesto for a breastfeeding friendly society, which I reproduce here with her permission:

Step 1: Teach mums, and those around them, how normal it is for breastfed babies to feed frequently and why this is important.

Step 2: Tell all new parents and those around them about normal baby sleep, why feeding doesn't affect is, and support them in other ways to get more rest.

Step 3: Tell parents and those around them about normal patterns of weight loss and weight gain in breastfed babies, and why this doesn't mean that they are underweight.

Step 4: Be more aware of how experiences during childbirth may affect breastfeeding. Invest in maternity units to give staff more time with mothers, to help reduce interventions during birth, and ultimately increase breastfeeding rates.

Step 5: Early hospital practices can make a significant difference to breastfeeding. The more Baby Friendly practices a hospital adopts, the better their breastfeeding rates. So it's obvious. Make all hospitals (and neonatal units) Baby Friendly!

Step 6: invest in expert support services for all breastfeeding mums right from the start of breastfeeding.

Step 7: Support new mothers to feed and mother, don't abandon them to juggle everything. Mother the mother.

Step 8: Bin all the rubbish baby care books.

Step 9: Support employers to be breastfeeding friendly.

Step 10: Stop this ridiculous body image pressure on new mothers and come to terms with our own illogical sensitivities and prejudices about human milk and the female body.

Step 11: Give new mothers the emotional and practical support they need, every step of the way.

Step 12: Breastfeeding support needs to be tailored to individual needs.

Step 13: Educate dads to be the breastfeeding supporters they can be.

Step 14: Invest in health services so more health professionals have more time and more knowledge to support breastfeeding mothers.

Step 15: Educate the public to stop being idiots, or at least do no harm.

Step 16: Regulate products that are designed to create anxiety in new mums.

Step 17: Crack down on brand advertising and prevent industry access to professionals and parents.

Step 18: Step up and fund healthcare and breastfeeding support.

I would love for everyone supporting mothers to read this book. For those of us living in the pro-breastfeeding community, we can gain understanding of why women make the choice not to breastfeed. For those in the wider community, knowledge of how our actions and environment can affect these important decisions must surely guide our behaviour.

Here's the exciting bit: Amy has very kindly sent me an extra copy of the book to give away to a reader! To enter, just pop a comment below, and I'll draw the winner on Sunday night! I can only really pay UK postage, but if you're further afield and happy to pay most of your own postage, then go ahead and put yourself forward.

P.s. what targeted advertising did I receive when I looked at the book's Amazon page? Artificial milk (formula). Go figure.

Wednesday, 8 March 2017

Yarn along

Today I am attempting to post on my tablet while feeding baby three, so it's a bit of an experiment! I thought I'd submit to Ginny's yarn along. Knitting this week is a soaker in the rather gorgeous blue tit yarn by West Yorkshire Spinners. I've been fighting the urge to cast on a cardi for myself this week. I fancy something simple and open fronted, perhaps the Harvest by Tin Can knits. I love all the patterns in their Simple collection, and they're free, so if you haven't discovered them yet do have a look. I currently have very little knitting time because three NEVER wants to be put down. This always gives me castonitis!

Reading this week is just some quick fiction between factual books. Jodie Picoult is very readable. If you like her style but prefer an English voice I highly recommend this little gem. Enjoy!

If you're missing my parenting related book reviews do pop back soon because I have two in the works, and one comes with a giveaway, which I'm hoping to run over the weekend. In the mean time stay creative, keep reading, and see you soon!

Friday, 24 February 2017

Robots and Gadgets

Recently Sausages was sent his very own book to review, so here is his very own book review!

"I liked this book very much. I liked all the different activities and the stickers. I liked designing my own robots the best."

The book contains a wide range of activities including sticker pages, puzzles, colouring and drawing, and creative challenges. It was really well suited to Sausages, who is a methodical, cognitive sort of chap. The age range is 5-8. Sausages is 6 and a good reader. All of the reading and activities were nicely within his capabilities and he needed no input from me, although we did have lots of good chats about the interesting problems set within the book.

Because of the variation of activities in this book I think it would be great for travel entertainment. So often I pick up a magazine or colouring book to entertain the boys on a plane or ferry, only to find there isn't really enough there to hold their attention. I see online that there are quite a few books in this Factivity series, so I'll probably order a couple for the trips we have lined up for this year. This one on coding particularly appeals to me.

The explanations and factual writing are good for developing comprehension skills. They prompted a lot of discussions and clearly gave Sausages plenty to think about.

The stickers and drawing problems offer opportunities to support fine motor control.

What Sausages does Bob must also do, of course! But this book was a long way above his level! I'd love to hear your suggestions for similar quality activity books for this age group, our clever boy needs us to step up a level!