28 Jan

Nature is Clever

Towards the end of my pregnancy, I remember being advised by friends that it was very important to get out as a couple as soon as possible after having the baby. I know this was coming from a well-intentioned place, but I’m glad I’m grounded enough to know that that wasn’t for me. Talking to new parents, I encounter a wide spectrum of parenting styles, and if you will allow me a sweeping generalisation, the ones who are having the easier time tend to be the ones who don’t put themselves under pressure to ‘get back to normal’ or ‘show the baby who’s in charge’ right from the start.

It may sound deeply obvious, but having a baby is a massive life event. It impacts on the couple as a couple and as individuals. Anthropologists have observed some interesting stuff about how the behaviour of men and women towards each other changes following the birth of a child; new mothers have a deep evolutionary need to remind our partners that they are responsible for us (for example, compulsively addressing him as ‘daddy’). Sorry, Old-Fashioned Feminists, but evolution takes thousands of years, and human behaviour (and biology) still works as though we live in clans with defined roles. My point is that pressure on a new couple to behave as if nothing has changed jars with our instincts and with the reality of life with a new baby.

Consumer-driven Twenty-first Century Western society, of course, has all the solutions for this. New parents can buy whatever they need to help create distance between themselves and this utterly dependent small creature: mechanical rocking chairs, under-mattress breathing detectors, artificial milk; there’s really no need to be at the beck and call of a baby, and it doesn’t do it any harm, does it?

I hate to talk about benefits and disadvantages. I prefer to talk about normal behaviour, biological expectations, and so on. Nature is very clever. Here’s an example: skin contact stimulates the release of oxytocin. What is oxytocin? It’s a hormone that makes you feel good. Remember orgasms? That’s oxytocin. Touching releases oxytocin; holding hands, kissing, nibbling someone’s ear, that all releases oxytocin. When your child grazes his knee and you kiss it better, that releases oxytocin. Oxytocin helps a woman to labour, and releases milk to feed her baby. Cuddling a newborn baby releases oxytocin. For both parties. Wrapping him up in a blanket and leaving him to cry himself to sleep in another room releases adrenaline, which suppresses oxytocin. For both parties.

Last week a couple came round for some help with feeding. It took a while to get mum and baby comfortable, but eventually we found a way [no surprises to anyone with any breastfeeding knowledge: mum reclined, baby self-attached]. The baby fed. Mum said: why does it make me feel so…. good? That’d be oxytocin, along with relief from anxiety and a sense of satisfaction.

Originally posted elsewhere on 2nd February 2011

08 Jan

Prepare for the worst

This week I’m hearing a lot from the 3rd Annual Birth Trauma Conference, particularly about mental health after birth, and how well prepared – or not – women feel. Milli Hill pointed out in a tweet what a straw man it is to blame antenatal preparation alone:

“Blame goes to antenatal teacher, or the woman herself…but oddly never to the system that doesn’t give women optimal chance of straightforward birth but instead often traumatises her. #birthtrauma18”

There are two things to look at here. One is how possible it really is to cover birth trauma and an issue as serious as postnatal psychosis, in a group of 8 couples (for your average NCT class), in a limited period of time and alongside other huge important topics, and in a context that is intended to empower women in the birthplace? The other is, how much impact does antenatal education have in the face of the barriers to straightforward birth including but not limited to lack of continuity of care, time pressures put on women by staff with time and protocol pressures on them, lack of real informed consent, and a society-wide assumption that birth is difficult and dangerous, and a healthy baby is all that matters? It’s a lot easier to say “NCT set me up to fail” than to acknowledge that the entire system sets women up to fail.

I spend much of my working hours and my voluntary time chipping away at the system, and write and broadcast constantly about those big issues. So let’s just look at that one smaller issue, how we tell a group of already-fearful pregnant women that birth might leave them with PTSD, without undoing all the work of empowering them to trust their bodies and birth their babies with as little unwanted intervention as possible. I can’t speak for all antenatal education (and let’s not forget that NCT isn’t the only provider of antenatal courses), but I can tell you about my own. I do this in small groups, providing a set of handouts and a case study for each group. The case studies cover baby blues, postnatal depression (men and women) and relationships and expectations after the birth. The handouts also mention postpartum psychosis. The ensuing discussion covers risk factors, symptoms, self-care, support, and so on. Some groups really engage with this, and often when someone has experience of depression, they make very valuable contributions. I’m always aware that there may be people who have experienced it and will stay very quiet. Once I observed an antenatal session where the practitioner covered feelings after birth immediately after doing a relaxation, and left the lights down low; in that atmosphere of safety and calm, a woman shared the story of her antenatal depression and it was powerful.

I just want to say that if even NCT, who have the best trained and most rigorously assessed antenatal practitioners out there, can’t always get this right for women, perhaps we need to go back and take on the difficult task of addressing the big issues, and work together instead of blaming – which potentially puts people off accessing valuable support and education. It’s also worth noting that antenatal educators of any brand don’t operate in a cheerful idealistic vacuum: we sit on Maternity Voices Partnerships, we campaign, we listen to women, we make and listen to podcasts, we are mothers; and we are involved in the system and we are active in trying to make it better. “Setting women up to fail” is an unfair accusation.

31 Dec

A trilogy of book reviews

These are the last three books I have read in 2017, a very satisfying year when it comes to reading. I am not sure how I have managed to find the time, but hope that a less crazy 2018 might mean even more reading time!

A Midwife’s Story – Penny Armstrong & Sheryl Feldman

In this memoir of midwifery among the Amish community, Penny Armstrong reflects on her growth and development as a midwife. It’s fascinating to see her confidence in straightforward birth in a home environment increase through experience. She is well-placed to make the comparison with hospital birth in the 1970s, and it is horrifying to note how little has changed. The vignettes of Amish life are also charming, and this is a well-written memoir – certainly the best story of midwifery I’ve read, thanks to writer Sheryl Feldman’s well-judged turn of phrase. I found it utterly absorbing.

[Disclosure: Pinter & Martin sent me a free review copy of this book; you can get a 10% discount on your copy if you use the offer code SPROGCAST at checkout on their website.]

How To Have A Baby – Natalie Meddings

How To Have A Baby is a doula in a book. It’s nearly a big enough book to fit in an actual doula, and crammed with wisdom (just the “big necessaries,” writes Natalie Meddings) sourced from her own experience and the stories of many mothers. Meddings’ tone, like the ideal doula, is firm but gentle, calm and encouraging.

The book takes the expectant mother through the usual route of pregnancy and planning, into labour, birth and the unexpected, and out the other side to feeding and newborn days. Descriptions are clear and “tips and tricks” are shared helpfully at every stage. Meddings is pragmatic and honest. Birth is discussed in terms of an involuntary bodily function, and how to create the optimal conditions for this to happen. Induction is presented as “a ticket on the intervention rollercoaster” (p116) which is an interesting choice of words, however the pages explaining induction are practical and compassionate, giving a clear idea of what happens and what can help.

This book is an excellent resource for birth planning. Meddings is very concerned with consent and human rights, both of which she covers very clearly; and this is her real strength. I much prefer these well-referenced and forthright pages, to the liberal sprinkling of homeopathy etc alongside the useful coping suggestions.

You are waiting to hear what I think of the breastfeeding information, so I won’t keep you in any more suspense. With contributions from Maddie McMahon, the importance of early feeding and skin to skin is discussed, and Meddings describes the newborn feeding reflexes and how to support the baby to self-attach. It is a little surprising when she goes on to describe a rather prescriptive way to hold the baby, which does not support those reflexes so well, given her let-nature-take-its-course-and-things-will-work approach to other aspects of birth and parenting. And sound the klaxon for “breastfeeding granola,” which looks delicious but should correctly be termed “granola,” given that breastfeeding experience is not generally influenced by the consumption of roasted oats and nuts and so on.

Matters are redeemed by the rest of the new-baby/new-mother section, referencing such respected authors as Naomi Stadlen and Deborah Jackson, and with plenty of exhortations to eat cake.

I think this book is jam-packed with stuff that would be useful during labour and birth, and it would set up a new mother nicely for those early days and beyond. Practically speaking, the book is probably a bit too chunky to carry around with you and make notes in, as Meddings suggests in the beginning; in fact I think it would work brilliantly as a loose-leaf binder (or perhaps an app), so the reader can pull out relevant sections as needed (which would facilitate reading whilst feeding). Some websites and numbers are given to access support but there could be a lot more of this. On the whole a very highly recommended book for practitioners and parents-to-be alike.

[Disclosure: Natalie sent me a free copy of her book to review – thank you!]

Eleven Hours – Pamela Erens

The last book I finished reading this year was perfect to follow these two, and I think I may even have bought it myself. In Eleven Hours, Lore is in labour, cared for by Franckline who is also in the early stages of pregnancy. As Lore’s contractions come and go, we learn both women’s sad stories: Franckline’s lost babies, and Lore’s lost love. Franckline’s midwifery is full of empathy and kindness, but this is starkly framed by the harsh restrictions and requirements of hospital policy, and the insensitive words and actions of her colleagues.

Lore arrives in the maternity ward alone, with a five page birth plan. Franckline is the only one to read and respect this, and does her best to steer things back towards Lore’s wishes, even as events keep on sliding off track. The labour progresses slowly, and then takes an unpredictable turn. Gripping fiction, and a great way to wrap up Meddings and Armstrong, and 2017.

18 Dec

Milk Machine

It makes me feel like a cow, she said.
Just to look at it now.
Its friendly pastel plastic
Fills me with dread
And I can’t get out of my head
The sound of a robot baby
Taking my milk.
It fills me with dread
When I think of the nights ahead,
The stirring and snuffling noises
That will pull me
From my warm bed;
When I think of the nights,
There’s no light
At the end
Just shattered sleep,
Shattered me,
Overwhelmed with dread,
And with longing
That somebody else
Could do this instead.
I’ll be a cow if it means
It’s not just me
Getting up in the night
To sit in the dark
And long for my bed.
I’ll be the cow,
But it fills me,
It fills me with dread.

12 Dec

Book Review: The Expectant Dad’s Handbook, by Dean Beaumont

This book came out a few years ago to accompany Dean Beaumont’s DaddyNatal antenatal course for men. It covers pregnancy, labour and birth, and life after birth, in a chatty but intelligent style, while keeping the focus firmly on the partner’s role in supporting the new mother or mother-to-be. I like Beaumont’s approach of describing the situation and the options available, and then exploring what the partner can do to give support.

As with all such books, the first chapter I looked at was the one on breastfeeding. Unlike the birth chapters, Beaumont gives no ‘how it works’ information, which is disappointing given that I often find the men in an antenatal session to be fascinated by the science. In a scant five pages, there is a little too much focus on how dads can get it wrong, and of course the inevitable suggestion that they can help out by giving a bottle, with little exploration of the complications that this can introduce. Formula feeding doesn’t get so much as a sidelong glance.

However, this is the weakest part of the book, and in fact the information on labour and on life with a new baby is thorough and evidence-based. I would recommend this book to an Expectant Dad, but I’d also suggest something a bit more comprehensive on feeding, alongside.

23 Nov

Book Review: Beautiful Birth, by Suzanne Yates

This is a nice book, a keeper for sure. Beautiful Birth is an attractive, slim volume with an immediate appeal to anyone looking for practical techniques for coping with childbirth.

It has two main sections. The first section covers breathing and visualisation, positions for labour, and massage. It gives an uncomplicated rationale for why these things are helpful, and a step by step approach to practicing them during pregnancy, and using them during labour. It does include a little more chinese medicine and shiatsu than I would normally be comfortable with, but actually the book is so useful that for once I’m not going to make snarky comments about that.

The second section is on preparing for birth, and is a straightforward explanation of what happens and how a woman can use the coping techniques from the first section, to help herself have a positive experience. Its approach to planning the birth is about connecting with yourself and reflecting on what kind of environment and support feels best. It touches on decision making when things don’t go to plan, and very briefly on the “fourth stage” of labour, meeting the baby.

I think most pregnant women could find something useful in Beautiful Birth, whatever kind of birth they are expecting; it’s never unhelpful to have some strategies for bringing calm. It’s a shame the pictures are not more ethnically diverse, but I would generally recommend this book.

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

22 Nov

Book Review: Truly Happy Baby, by Holly Willoughby

Truly Happy Baby – Holly Willoughby

First, a confession. My name’s Karen and I have no idea who Holly Willoughby is. Having browsed her book, I understand that she is a photogenic mother of three. I assume she’s also some sort of television personality, former pop star, or reality TV type. Why her views on how to parent your baby are important escapes me completely, but an antenatal session rarely goes by these days without someone mentioning her wonderful book.

So I have acquired the wonderful book, and set out to see just how wonderful it truly is.

Holly explains in her introduction that, on becoming a mother, she became the expert on motherhood, and immediately knew she would write a book telling other mothers all the things that nobody else tells them. This is a subject I may have touched on before. Holly’s approach is encouraging: trust your instinct, don’t expect too much too soon, be led by your baby. These are all very important points. She’s also going to be as honest as she can, and give you lots of top tips that worked for her, but you should still do your own thing because every baby is different, and everything will be alright because love.

The book begins with a chapter on feeding, in which she shares some useful information but in the most mealy-mouthed way in order to be inclusive of mums who give formula. In the first few pages Holly provides a useful shopping list, some nonsense about what to eat to “improve the quality and quantity of the milk you are producing” (p17) and a recipe for lactation cookies. There are some pictures to demonstrate positioning, none of which are laid back and there are some helpline numbers for support, none of which are the NCT. She also perpetuates the unhelpful idea of foremilk and hindmilk. Solutions offered for painful nipples are lanolin cream and nipple shields, and absolutely no mention of positioning and attachment, or skilled support.

Moving on to expressing, she points out that “you’ll feel like a cow” (p29), but does at least mention the role of oxytocin in expressing milk.

On formula, she lets us know that she paid a premium for one with a probiotic; other useful information she might have included is that all baby formula must be made to the same standard, and different manufacturers use different names for the same added, unnecessary probiotics. She does describe the recommended method of making up formula, but on the facing page another one of her great tips is not to bother doing it like that because it’s just too much faff to feed your baby safely.

I love the section on winding, in which she says “there’s never a good reason not to wind” (p43) and then goes on to give a good reason not to wind (i.e. your baby doesn’t have wind).

On weaning, again Holly plays fast and loose with the guidelines, because “ultimately it’s up to you.” (p46) Of course this is true, but how can she expect the poor harried mother to decide when the information she shares is so contradictory?

You’d think by this time I would have stopped reading in order to maintain my famous calm, but I couldn’t help dipping into the chapter on sleep. So far so good, we have lots of information about safe sleeping conditions; however within two paragraphs she tells us that co-sleeping is not a good idea, but she did it anyway… on a sofa bed! So about as unsafe as you can get. Remember, she says, do what works for you. Every baby is different. She can’t say that enough, she says. (She can).

Unsurprisingly, Holly recommends getting into a routine from three months. There are lots of nice clock-shaped charts, which she recommends not trying to follow too closely because they worked for her but every baby is different, etc. Apparently turkey is a good food for getting a baby to sleep, who knew. Let’s skip the bit about sleep training, and move on to the useful stuff on getting support for your own sleep deprivation.

The next chapter is on wellbeing, and is actually a very useful and comprehensive guide to caring for a newborn. I’d be inclined to pull this bit out of the book and offer it to people who feel they need some sort of baby manual; it’s far better than the rest of it.

Chapter four, named Lifestyle, seems to be an extension of the wellbeing chapter, with a few extra bits about how to register a birth and how to go on holiday with a baby. None of this is particularly ground-breaking or unavailable online.

And finally, Looking After You. Here we learn about piles and postnatal depression. Interestingly, we get fewer personal anecdotes in the pages about resuming your sex life, but Holly does advise that it’s scientific fact that new mothers don’t love their partners for the next 18 months. No reference is provided for this fascinating piece of research.

So in summary, Holly Willoughby has three babies, but all babies are different and you should do what’s right for you. For £16.99 you too can benefit from this profound wisdom.

16 Nov

Book Review: Trust Your Body Trust Your Baby, by Rosie Newman

Rosie Newman’s book aims to inspire confidence and trust in a mother’s own instincts, through pregnancy and birth, feeding and mothering. It is a book for women who need help with the paradigm shift of becoming a new parent. One of the things that really comes across is the value of surrounding oneself with like-minded, positive people. Newman is well-read and draws extensively on the literature of attachment parenting and straightforward birth.

Trust Your Body Trust Your Baby is sensibly structured with a logical progression, starting with a practical chapter on preparation for the baby’s arrival. The birth chapter gives an interesting history of obstetrics, an explanation of the role of hormones, and a valiant attempt to convey the reality of labour.

The following chapters cover life after birth: establishing breastfeeding, sleep, attachment, and the emotional and psychological adjustment. All of this is extremely good stuff that I would recommend to new parents; it is well-referenced and although it comes from a firm base in attachment parenting, and includes a great deal of Newman’s own experience, it is written with empathy and compassion for both the mother and the baby.

The last chapter is on elimination communication, and might make some new parents wonder if this really is the book for them, or whether it is too far from the mainstream. My clients tend to think The Baby Whisperer is a “a bit of a hippie,” so I’m conscious of wanting books like this to be accessible. Of course there is a huge part of me that really doesn’t want to pull any punches, too.

I was writing this review at a very quiet breastfeeding drop-in. Two mothers came in and we were talking about the conflict between trusting your instincts as a mother, and coping with the pressures of modern life, lack of sleep, lack of support, and the weight of expectations that babies should behave in a certain way by a certain age (both babies were 3 months old and not behaving in a certain way at all). So I gave one of them the book; may it help her find her way.

[Disclosure: I received a free review copy of this book from the publishers. You can get your own copy here, and a 10% discount using the code SPROGCAST at the checkout].

12 Nov

Back to business as usual

Wearing many hats at the Mental Health Starts in the Womb conference

Monday It’s always an early start these days, now that my son is at secondary school and has a long walk in the mornings. I ought to appreciate the extra hour it gives me in my working day, but I’m not sure I really do. I dropped off some NCT leaflets to be added to delegate packs at the Mental Health Starts In The Womb conference I’m helping at later in the week. Then I spent two hours with my newly qualified Breastfeeding Peer Supporters, finding out what their first month of peer supporting has been like. And the evening was spent running the final session of my Essentials course with a really lovely group, who enjoyed meeting some real life new parents and their baby.

Tuesday I managed to get out for a run, which is impressive because I’m struggling to motivate myself to do that lately. A busy day at my desk with my laptop, working on various things including my presentation for the next Adult Learner study days. And another evening with an antenatal group, this time facilitating a breastfeeding session.

Wednesday In Windsor this morning for another antenatal breastfeeding session, this time with a student observer, making me highly conscious of my language! My dad called in on his way to Gatwick, and dropped off my birthday presents for later in the month, and the nicest point of the day was an hour in the pub with Pete while my son was at his karate lesson.

Thursday Slept really badly, but had to get on with things today as I’d promised to help out at the Mental Health Starts in the Womb conference. I managed the morning – checking people in, moving chairs, standing at the table giving out NCT brochures – but had to leave at lunchtime because I really couldn’t keep my eyes open. Fell asleep on the sofa.

Friday Thankfully a quiet day, empty of much ‘work’ stuff apart from cycling over to the other side of town to inspect a scout hut that we might use for NCT courses.

Saturday All day NHS antenatal course. These are once a month and seem to come round quickly. Usually an absolute blast, but I’ll be exhausted by the end of it.

Sunday Going to see Paddington II at the movies.

10 Nov

Running for President

Earlier this year, I made the decision to stand for election as president of NCT. I’m not going to pretend this decision wasn’t nudged along by colleagues; it’s not the sort of thing you could do without a lot of conversations with people you trust. The person I trust most in the world, my partner Pete, was completely on board when I put the idea to him, and that was the final deciding factor.
Read More