02 Dec

Book review: Biological Nurturing, by Suzanne Colson

On reading the second edition of Biological Nurturing, I am reminded of what a powerful influence the first edition has been on my work as a breastfeeding counsellor, both in terms of how I talk about positioning, skin to skin, and the transition from womb to world in antenatal sessions; and how I support mothers with breastfeeding after the birth.

Suzanne Colson has vast clinical experience and research experience of what is now widely known as her method: biological nurturing. Biological nurturing is far more than just laid-back breastfeeding; it is a deep understanding of the needs and abilities of the breastfeeding dyad, almost a philosophy of positioning. It is a mother-centred process, using gravity and both parties’ instinctive behaviour, to achieve comfortable and effective breastfeeding.

It could be argued that this is simply a rediscovery of ancient behaviour: the way women breastfed long before male experts took over all the thinking and management of it, to spare our pretty little heads. Colson describes some of the social and cultural movement away from instinctive breastfeeding, using her own science to show how wrong those 18th and 19th Century men of science were about what we do. As she tells us, “you cannot teach mothers to do this,” (p158) because it is instinctive behaviour, highly dependent on the hormonal environment. So the role of a breastfeeding supporter is to enable that environment to be right for the mother and the baby, and to have confidence that this innate behaviour works.

Colson has a great deal of research to support her work, presenting it here in detail, and yet with accessible language and even QR codes so that the reader can access video clips. She is critical of the deeply entrenched, prescriptive ways that some midwives manage early breastfeeding, and this might be a difficult – but essential – read for those who work in that way. It is a fascinating and useful book for anyone supporting breastfeeding, and for mothers who are interested in a much deeper level of knowledge than they will get from your average book on breastfeeding.

[Disclosure: I was sent a review copy of Biological Nurturing. You can obtain yours, with a 10% discount when you use the SPROGCAST code, from Pinter & Martin].

29 Nov

Book review: Informed is Best, by Amy Brown

This afternoon I opened the latest copy of MIDIRS, and a couple of inserts dropped out of it. They are training modules, one on infant skincare, and one on breastfeeding challenges. I browsed the latter for a moment, noticing a paragraph mentioning a Cochrane review on the treatment of nipple pain:

However, the latest Cochrane review (2014) found insufficient evidence to recommend breast milk or any other intervention for treating nipple pain.”

So I looked up the Cochrane review, and here’s what it actually says:

Currently, there is not enough evidence to recommend any specific type of treatment for painful nipples among breastfeeding women. These results suggest that applying nothing or expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.

The picture above shows who produced this document: Lansinoh. A company with a vested interest in selling an ointment such as lanolin.

With this in mind, I picked up my copy of Amy Brown’s latest book, Informed is Best, a book which purports to help the reader fight their way through the tangle of misinformation, opinion, and hidden agendas that gets deeper and deeper as you wade into pregnancy, birth and parenting. This is a very useful and important book, and is more important than ever in an era of fake news, limited attention spans, and a distrust of experts – as the book itself explains in glorious detail.

What I find amazing about Amy’s writing is her ability to gather so much information, and distil it into meaningful and accessible writing; in fact she quotes a study where a mother describes wanting “mom-level detail from an expert” (p226) and this is exactly what we have in this book. Amy sets the context, looking at how the media, social media, and the patriarchy shape our access to good quality information. She explains different types of research, and even gives us a quick blast of how to understand statistics in a way that didn’t actually make me want to poke my own eyes out. The text is wonderfully seasoned with examples, including unpicking many twisted media reports of research; and presented in her marvellously offhand-but-serious-really style. For a book about research, it’s just such an enjoyable read.

One thing I especially love about this book is her exploration of her own bias, along with sections that really should make the reader reflect on their personal biases. The Dunning-Kruger effect really gave me pause for thought. How often do I dismiss someone’s work because of a connection with something I didn’t like reading or hearing? It definitely happens.

Each chapter ends with a practical list of ways to keep informed, summarising the detail within. My favourite is: “To any female expert reading this, I urge you to have the confidence of a mediocre White man.” (p124). Oh yes indeed.

If you want more, I interview Amy about the book in episode 56 of Sprogcast. To get your copy of the book, use our 10% discount code SPROGCAST at the Pinter & Martin checkout here.

27 Nov

Book Review: Inspired Parenting, by Dorka Herner

Dorka Herner is a Hungarian psychologist and mother of five, and this is her book of reflections on motherhood. Divided into six chapters, such as “Reshaping the patterns that shape us,” it seems to be intended as a tool for learning or developing the reader’s own parenting; however it really is just a series of daily writings, from funny little aphorisms about saying a nursery rhyme and realising it is intended as a tool of mind control; to longer vignettes about her twins getting into a good school. Nothing in the book asks the reader to consider how it relates to them, or to reflect on its meaning. It doesn’t advocate a particular style of parenting, or offer advice on any of the many challenges described – just tells you about them.

Inspired Parenting may offer some insight into someone else’s parenting, and it’s always useful to try to understand how other people live. It’s a pleasant book to dip into now and then.

[Disclosure: I was sent a review copy of Inspired Parenting by the publisher. You can get a copy here, with a 10% discount using the code SPROGCAST at the checkout.]

11 Oct

Book Review: Give Birth Like A Feminist, by Milli Hill

I tried to narrow down who I thought should read this book. Expectant mothers? Their partners? Midwives? Doctors? All humans? Pretty much the only people who don’t really need it, are those of us already actively calling for recognition that birth is a feminist issue, within our working community. I fervently hope that the latter are not the only people who read it.

Milli Hill has a strong history of writing well about childbirth, rooted in her own experiences and capitalising on her work as an established journalist. She is able to talk to more mainstream audiences than many of us, and her writing style is passionate, informed and accessible. A strong tenet of this book is that the truly feminist perspective is to support and respect all birth choices, even if they would not be our own.

In case that isn’t a persuasive enough argument, Give Birth Like A Feminist provides a feminist historical and cultural context of birth, looking at why certain things are done just as they have been done for centuries, with no real evidence base. From induction to lithotomy, she examines the assumption behind birthing protocols, which is essentially that women’s bodies are badly designed and ineffective when it comes to reproducing the species. It’s astonishing that we have survived so long. And can I just say, the Husband Stitch? WTF.

From this context, Milli develops the argument that societal attitudes to women’s bodies and behaviour pressure us to conform to a stereotype of being weak, helpless and incapable. In fact, images and stories that represent women as capable and powerful are often repressed; take for example Facebook’s banning of certain images of birth and breastfeeding, that are no more revealing than apparently acceptable images of underdressed celebrities. Women are both infantilised, and expected to be available for sex/pleasing to men in particular and society in general. A good woman, like a good baby, is quiet, undemanding, and has no leg or armpit hair.

Give Birth Like A Feminist furthers a new narrative of childbirth and women’s bodies, elevating women above the mere vessel for and caretaker of the next generation. Milli Hill is constantly kickstarting this conversation, and challenging the way birth is presented in the media and in the world. Just carrying this book into a room last week gave me an insight into attitudes to both birth and feminism, when people around me raised eyebrows and chuckled at the very idea.

This is a well-referenced book, and Hill supports her points with case law and evidence. She has a tendency to write about her own experience, and I find this a distraction from her important argument that this happens to most women, in one way or another. She also fills the book with other women’s voices, and points out that she does not have to ask around for long to find stories where women felt their choices were shut down, belittled, or never discussed at all; where women are abused and coerced, where midwives are unable to work, where we’re all either baby brain or birthzilla, not human beings at all.

There are also some small practical sections describing actions to take or ways to look at evidence, and the BRAIN decision-making tool used widely by NCT is shared again, which can be no bad thing. This is not a practical manual like the Positive Birth Book, but very much a book I would give to a pregnant friend.

Thanks to Milli for the review copy of Give Birth Like A Feminist, and also for sparing time in the summer holidays to chat with me for Episode 54 of Sprogcast.

18 Jul

Book review: Why Breastfeeding Matters, by Charlotte Young

You may be familiar with Charlotte Young, the sometimes-ranty but always well-informed blogger known as The Analytical Armadillo, one of the few reliably evidence-based information sources to be found online. Her wealth of knowledge is collected here into 16 neat chapters on the how and why of breastfeeding.

Like other books in the Why It Matters series, this is small but dense, covering how breastfeeding works; the wide range of normal baby behaviour and parental strategies for coping with it; expressing, formula and mixed feeding; and a couple of good chapters on the socio-cultural context of breastfeeding, and the impact of the formula milk industry.

Young is very aware of being a passionate supporter of breastfeeding mothers, in a bottle-feeding society, so much of her work is around myth-busting, whether she’s addressing the nonsense idea that breastfeeding mothers must eat a bland diet, or the notion that Mommy Wars is a feminist advert. She is careful to reference everything; perhaps a little less careful not to sometimes come across as sarcastic.

If you’re looking for an accurate breastfeeding text that pulls no punches, gives both the practical side of things and the context, and explains all of this logically and clearly, then this book is highly recommended.

[Disclosure: I obtained a free review copy of Why Breastfeeding Matters from the publishers. You can order a copy and get 10% discount using the code SPROGCAST, from their website here]

02 Jul

Book Review: Expecting Better, by Emily Oster

This book has come across my radar a few times, so I finally got round to picking up a copy. I think my lateness to the Emily Oster party may be because I didn’t much enjoy Linda Geddes’ similar book Bumpology, so let’s put that one to bed straight away; this is much, much better than Bumpology.

Expecting Better is well written, with a personal but not annoyingly chatty tone, while also explaining very clearly how to understand some quite complex research, and incorporate that into one’s decision making. It is aimed at parents-to-be and its chronology starts with trying to conceive, and to my disappointment ends at the birth, although I now see that there is a follow up, cleverly named Crib Sheets, which I shall be purchasing as soon as I finish typing this.

The consequence of the book ending with the birth of Oster’s daughter is that I cannot apply my usual test, of checking the tone and accuracy of the breastfeeding section. I have had, instead, to apply my more shallow knowledge of pregnancy and birth, to decide how good I think Expecting Better is.

Oster uses her introduction to explain that, as she is an economist by trade, she likes to make decisions using data. Her model of decision making is to take the data, and combine it with your own personal set of pros and cons. This, then, is how she has set out her book; and while it would be impossible for her to have researched every possible issue that a pregnant woman might face, it’s clear that she has written mainly about those decisions that she personally had to make. So we get almost an entire chapter on caffeine, and two paragraphs on restricted growth and related decisions. However, that is not to say that she doesn’t cover enough; the book is comprehensive, obviously well-researched, and thoroughly referenced., and key points are summarised at the end of each section for when you don’t feel like reading every nuance of the different antenatal screening options.

Language and some content has been edited for UK publication, however Oster is in the USA and this does skew some of what she feels she needs to know about, and her general attitude to birth. She touches on the role of midwives, but knows that a doctor (and a doula – hooray!) will be present at her birth, and she will certainly not be allowed to eat during her labour. The research she looks at are mostly USA, UK, Australian and European, with some cultural comparison as well. The induction methods discussed are definitely american, and there is limited discussion of any pain management options other than epidural.

The implicit message of this book is that informed consent is not possible for the majority of parents-to-be, as the necessary information is not easily accessible. Oster clearly makes up her own mind on a number of issues, after being given scant or even incorrect information by her own healthcare professionals; interestingly she doesn’t seem to question routine vaginal examination, and she is certainly working from an all-that-matters-is-a-healthy-baby point of view.

I sound critical but I did enjoy this book, learned some interesting things about caffeine, and was reminded that I haven’t read so much detailed information on food poisoning since I took my Intermediate Food Hygiene certificate, a quarter of a century ago. Emily Oster is a one-woman systematic review, driven by her own need for evidence to support her decision making; and the book she has produced will undoubtedly be useful for other parents, albeit with the caveat about some of the information being less applicable in the UK.

30 Mar

NCT courses: a clarification

This Guardian article today tells you that NCT courses “can set you back by £400.”

NCT is, by the way, a charity. Not a profit-making enterprise. Surplus from courses goes into charitable work such as campaigning for better services and support for new parents, and providing that support, usually completely free of charge to parents, whether they are NCT members or not.

This page shows very transparently the hourly rates for NCT courses.

This page shows that NCT discounts courses by up to 90%.

None of these pages explain the level of training (minimum two years, currently a foundation degree), assessment and CPD that NCT Practitioners undertake, nor the fact that NCT Practitioners are specifically trained in facilitating adult learning (unlike most midwives). NCT courses don’t just transfer information into passive vessels, and most people come out with tools and strategies as well as knowledge. Oh, and the “bought friends,” of course.

If you’re spending that much money (or not), you might want to look into the qualifications and ethos of the organisation you are spending it with.

27 Feb

Book Review: Why Homebirth Matters, by Natalie Meddings

Natalie Meddings is a doula and the founder of Tell Me A Good Birth Story, so sharing positive tales of birth is her way of life. She knows this subject extremely well, and has already covered it extensively in her previous book, How To Have A Baby. Her latest book fits nicely into the Why It Matters series, adding a good helping of How It Works so that this handy little text is both political and practical.

Meddings examines current attitudes to birth generally, and homebirth in particular, both from the medical perspective and that of the general public. However her own perspective, that “birth has never been safer” (p17) guides the reader as she explains the how and why of homebirth in a way that makes both logical and intuitive sense.

For expectant women and their partners, this book has a useful level of detail, making homebirth a realistic possibility, and without neglecting potential “forks in the road” (p109). This is a good resource for getting informed, and for navigating the various faces of the health service in a positive and productive way. This is the kind of little manual that you really could carry around with your pregnancy notes, dipping in as needed or wanted, to really immerse yourself in the way of birth.

[Disclosure: I was sent a free review copy of How To Have A Baby. I’d recommend it, and you can get a copy from the publisher, with a 10% discount if you use the code SPROGCAST at the checkout]

26 Feb

Book review: Why Mothering Matters, by Maddie McMahon

Why Mothering Matters is a book full of myth and metaphor, exploring the metamorphosis of woman into mother in a world of judgement and inequality. Maddie McMahon is well qualified to write this book, with her years as a doula, doula trainer, and breastfeeding counsellor granting her a profound understanding of the many different forms this transformation can take, and the almost endless pressures and influences that bear down on the work of mothering.

A contemporary companion to Naomi Stadlen’s What Mothers Do, this book starts its journey here in the 21st Century, listening to the voices of mothers who share their feelings and experiences. What this uncovers is a world of contradiction, where we can feel isolated and yet never disconnected from the world, and where advice comes so thick and fast that it is impossible to grasp hold of the threads that might be useful. We see the many different relationships that can smooth out a difficult day, or blow your confidence out of the water, just in a choice of words.

But this book is not all crowdsourced anecdata; and particularly in the chapter on ‘The Chemical Soup of Motherhood’ Maddie gives us the science behind attachment and baby brain development, relating this to the mother’s wellbeing as the foundation stone of healthy growth in both those areas.

We then swim deeper into the global and historical context of mothering, and page by page the book gets more deeply and gloriously feminist, capturing the essence of motherhood: it is hard, we even make it hard for ourselves, and then the world makes it harder; but it is amazing and under-appreciated. What would the world be like, Maddie asks; what would politics be like, if the country was run by a circle of mothers?

It’s a manifesto and a celebration, but also a very personal piece of writing. Maddie writes about how vulnerable mothers can be, and makes herself vulnerable with this subject which is clearly so precious to her. It’s a really beautiful piece of writing, in so many ways.

[Disclosure: I was sent a free copy of Why Mothering Matters by the publishers. You can get your copy here, with a 10% discount if you use the code SPROGCAST at the checkout]

Maddie talks about the process of writing the book in Episode 46 of Sprogcast.

02 Feb

Book review: Hard Pushed, by Leah Hazard

Hard Pushed is a memoir of midwifery, drawn from Leah Hazard’s years of experience in the NHS. Leah’s words bring the reader right into the maternity ward, sketching her colleagues and the women she cares for with mostly loving detail. This is a very different book from Ellie Durant’s New Walk, but similarly gives a real feel for the pressures and joys of modern midwifery.

Hard Pushed is structured into pairs of chapters, briefly describing a theme, and then illustrating the theme with a story. We have Eleanor the lesbian mother, Star the hypnobirther, the 15 year old mum, the woman being pressured to breastfeed, the trafficked woman: composites and archetypes of the swirling complex mass of human need encountered in a midwife’s world. These women serve to illustrate what it’s like to be a midwife, and the real insight here is very much from a midwife’s perspective. So we see how incredibly hard midwives work, getting through the day on biscuits and coffee, with barely time to go to the loo; and this gives context to the irritation that comes across at the many tiny anxieties expressed by pregnant women, and the dialogue with women in labour that skates over informed consent (“‘We might have to make a wee cut,’ I call brightly.”) For any reader unaware of the overload on our maternity services, this is a very clear picture.

But Leah does write with love, and what comes across is the midwife every woman wants to meet in labour: intuitive, kind, skilled, and willing to bend the rules just enough to personalise care when it matters most. She writes with gentle humour, but doesn’t steer clear of the bleaker stories. And as in real life, leaves many of the vignettes with an unresolved ending, just as these women leave her maternity ward to get on with their own lives, unlikely to be seen again.

This is a book that can be read for easy entertainment, but the subtext is not hidden far below the surface: midwifery is a challenging vocation. It does me good to be reminded of the efforts going on behind the scenes, and to be thankful that there are women prepared to do this work in such trying circumstances.

[Disclaimer: I received a free review copy of Hard Pushed]