Growing Up Pregnant

This week I have been reading something a bit different: Growing Up Pregnant, by Deirdre Curley.

This book is an account of Ms Curley's experience of unplanned pregnancy at eighteen, and her journey into motherhood and adulthood simultaneously. At a time when birth culture is endeavoring to be more representative, it's good to hear the voice of young mothers.

The book alternates between Deirdre's own account and some factual information about pregnancy. I found the information to be very selective and sometimes dubious, and I think it could be entirely cut out of the book, because it is in the autobiographical sections that the book's value lies. If I were gifting this book, I would also give something more informative, such as The Positive Birth Book, alongside it. Ms Curley is not afraid to tell her own embarrassing experiences and to be honest about her own feelings. She benefited from very supportive family on both sides, and a secure financial situation, which I know is not the case for many teenage parents, but it is always beneficial to hear the experience of someone who has come out the other side of your situation, and I think many people going through unplanned pregnancy could benefit from this book. In particular, Deirdre's frank discussion of relationships, and adjusting mentally to your changing body, are open and reassuring.

I am keen to regift this book somewhere young mothers can read it, so if you can make this happen please do get in touch and I will send it to you.

Your No Guilt Pregnancy Plan

If you've been around long enough to remember my review of Why Human Rights in Childbirth Matter, you'll know I absolutely adore the work of Rebecca Schiller. As a former postgraduate student of human rights, and considering myself a birth activist in a small way, I am in awe of her work with Birthrights, as well as her excellent writing. Her ability to take a charged and emotive subject and explain it clearly and coolly is second to none. If you think that's hyperbole, I suggest you follow her Instagram stories (follow me too! I like making friends!). I was absolutely delighted to receive a copy of her latest book Your No Guilt Pregnancy Plan to review.

I have spend a long time reading this book. My copy is full of margin notes and post its marking important and interesting points. There are so many, I just can't share them all with you, but here are some of the features that I feel make this book stand out.

The tone of this book is rather unique. It's like having a supportive, caring, knowledgeable Doula walk you through your journey. Rebecca has the softest, calmest way of speaking, and I can hear it coming through in her writing. All the facts you  might need to know about birth, pregnancy, and early parenting, are presented clearly, but in addition to the discussion of your physical health and the choices you might have to make about your care, there are sections on subjects that you might never have considered in this context. When addressing each stage of your journey as a parent, this book prompts you to think about your mental health, your career, your relationships with those around you, and your personal identity. In an age when mothers are struggling to maintain their careers and increasingly suffering from mental health challenges, these additions to your preparation are crucial, but so often neglected. Rebecca is unafraid to tackle these difficult issues, and provides plenty of additional resources for those who need them through her website and links to other helpful organisations. These are helpfully placed within the book where discussion of the relevant topic takes place, rather than collected in an appendix, where they might not be read. There is a lot of outside input in the book, both in terms of the real life experiences of parents, and specific input from professionals such as psychologists.

The subtitle of this book describes it as a "revolutionary guide," and I really agree with that. It has all of the basic biological facts, but so much more. This book truly sees women as whole persons, in the way that we might wish society would. If you are prepared to be open to this approach this is a fabulous preparation for parenthood. It is definitely the book for the modern liberal, and the beautiful product of feminist progress.

I'd love to hear what you think of this book, do drop me a line!

Elizabeth

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.

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!

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.

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!

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.