28 Sep

Where’s the evidence?

Louise Timlin is a Health Economist and mother of two.

When I was pregnant with my first child I was often asked about baby-brain. A colleague or friend would smile indulgently and share a story about how they left their laptop on the train, or their wife put their socks in the fridge while pregnant. I smiled politely whilst I thought to myself, of course no non-pregnant person has ever made such a mistake. One day at work, when I was about 6 months pregnant I inadvertently sent out two invites for the same meeting to the same colleagues but for different days. Oops, I thought and shared my error with my boss who was one of the invitees. He laughed heartily and jokingly referred to my “baby-brain”. On my return to my desk I noticed that everyone invited had accepted both meetings without question, yet none of them were pregnant.

I am sure that baby-brain is simply another example of finding evidence for something if you look hard enough. For example I believe that some people are labelled “forgetful” who are probably no more forgetful than anyone else but every time they make a small mistake it is pounced on as evidence of their intractable forgetfulness.

And apparently I am right, according to a study conducted by Dr Helena Christensen from the Centre for Mental Health Research at the Australian National University. The study, published in the British Journal of Psychiatry, followed a representative cohort of women and measured cognition before, during and after pregnancy. No significant differences in cognition were found, leading to the conclusion that previous studies were flawed or biased.

Dr Helena Christensen said, “Part of the problem is that pregnancy manuals tell women they are likely to experience memory and concentration problems, so women and their partners are primed to attribute any memory lapse to the ‘hard to miss’ physical sign of pregnancy. Not so long ago, pregnancy was ‘confinement’ and motherhood meant the end of career aspirations.”

It may be that pregnancy shifts a woman’s focus away from work, and who wouldn’t forget where they’d left the remote control whilst chronically sleep deprived from looking after a new-born baby. But come on girls, give yourselves a break, you are not cognitively deficient and don’t let anyone tell you otherwise.

Having spent 12 years working in the highly regulated field of clinical research I am not a big fan of “alternative therapies”. Don’t get me wrong, I am a big fan of the placebo effect, just don’t kid yourself it is anything else. If it’s not backed up by evidence from a series of well designed, placebo controlled, regulatory and ethically approved clinical trials then you would do well to be sceptical.

The 1023 group concur. They staged a demonstration at 10.23am on 30th January in which more than 400 homeopathy sceptics took a “homeopathic overdose” in protest at Boots continued endorsement and sale of homeopathic remedies. Homeopathic remedies are hugely diluted substances. They are commonly sold at strengths labelled 6C. This means there is 0.0000000001% of the active substance in them.

There are people who are certain that homeopathy works for them. This is why the most rigorous clinical trials are placebo controlled. In clinical trials for antidepressants, up to 40% of patients taking placebo report a beneficial effect. A paper published in the Lancet in 2005 and the Cochrane Collaboration concluded that homeopathy is nothing more than a placebo effect. Proponents will claim that at worst it does no harm. However even this claim should be treated with scepticism. If patients delay seeking proper expert medical advice whilst using homeopathy to treat their condition, they could risk their condition degenerating. By all means go ahead and try it, but don’t forget, we have medicines that have actually been proven to work; why not give them a go at the same time?

Originally written for the Wokingham NCT Newsletter

Views expressed here are my own, and do not represent the views of NCT.

21 Sep

No Big Deal

The thing about breastfeeding is that the milk production system is dynamically stable, provided you don’t mess with it, and you ensure it’s operating effectively. The system has all these different elements that facilitate its stability and effectiveness, and when these elements are undermined or misunderstood, that’s when it goes wrong. Sadly the culture we live in is big on the undermining and misunderstanding of breastfeeding, and that’s why the majority of women stop doing it before they feel ready.

Here are some of the indredients in the recipe for no-big-deal breastfeeding.

  1. A newborn baby has a stomach capacity of around 5ml. A teaspoon of colostrum (the kind of milk you have when your baby is first born) is therefore big enough to fill it. It is likely that the tiny tummy will both fill and empty quickly, and therefore need to refill frequently. (Undermined by the idea that colostrum is insufficient therefore artificial milk needs to be given, therefore breastmilk production system insufficiently stimulated).
  2. Short frequent feeds stimulate the milk to change from colostrum to mature milk, which happens over the next days. (Undermined by the idea that baby’s frequent demand for the breast indicates a problem with breastfeeding, when in fact it may be normal, or it may indeed indicate some problem that could be dealt with. Offering artificial milk does not deal with this problem).
  3. Newborn humans are highly dependent and inherently appealing. In cultures where ‘lying in’ is practiced, the newborn’s needs to be close with his or her parents are naturally fulfilled. (In cultures where governments spend 14 pence per baby on promoting breastfeeding, and baby milk manufacturers spend £20 per baby on promoting formula, such as the UK, we have tended to forget about the baby as a person with needs, and started to cast it as a demanding creature that makes its mother’s life difficult). A baby who is kept close to his or her mother is likely to feed little and often, stimulating the milk supply and growing well.
  4. When the change in the milk occurs, around day 4, there will be a lot of milk in the breasts. This is called engorgement. It is what it sounds like. It is important to get this milk moving out of the breasts, using baby or pump as necessary. That’s because milk contains something called Lactation Inhibitor, and if the milk remains in the breast then the LI informs the body that milk is no longer needed. Milk production then decreases or ceases. It’s also because the baby needs to feed on the milk.
  5. Breastfeeding should not be painful. Pain indicates a problem. The majority of the time, the problem is something to do with the way the baby is held, or the way the baby attaches at the breast. The majority of the time, such a problem can be dealt with by giving careful attention to these things, finding a way to make mother and baby more comfortable. If the baby is well-attached, the mother should feel no pain. If the baby is well-attached, then he or she can feed effectively, giving the correct level of stimulation to the milk supply, keeping mum from getting engorged, and consuming enough milk to sustain his or her own growth and development. (Undermined by the phrase of course it hurts, what did you expect? leading mothers to persevere through pain and misery to the point at which it becomes unbearable, and they stop.
  6. Newborn humans may be highly dependent and helpless, but they do have the ability to signal when they are hungry (see above), and stop feeding when they are full. Therefore it should be possible to feed the baby on cue, for as long as he or she needs to feed, without pain, and for breastfeeding to work. (Undermined by pressure from ourselves or others to be in control of the chaos, to get back to normal, to have a life, etc etc etc).

I see a big circular diagram with lots of arrows connecting all these things together. The challenge for me is to convey to pregnant couples that for breastfeeding to work well and fit easily into one’s life (an oft-stated aim), it is necessary to optimise all of these elements. I fear that what this comes across as is an edict that you have to Give In To Your Baby, otherwise you are a Bad Mother Who Never Really Wanted to Breastfeed Anyway. Our modern culture clashes horribly with the needs of a breastfeeding mother&baby. I can understand how hard it is for so many of the women I meet, coming from Important Jobs and busy lifestyles where they are used to having control and predictability. Many work until very shortly before the baby is born, and it seems to me when I meet them in classes that the baby is still very abstract, and their idea of what life is going to be like is unrealistic. Perhaps we should be encouraged to stop working a good month or more before the due date, and spend that time hanging out with new mums (Hm, isn’t that what NCT Bumps and Babies groups are for?). Initially this would be disastrous because all they would hear is the horror stories, but perhaps slowly an understanding of the necessarily fuzzy boundaries of new motherhood might develop.

14 Sep

Massage for pregnancy and postnatal care

Linda Cook is a massage therapist, NCT Antenatal Teacher, and NCT Birth Companion.

Would you like to feel pampered and nurtured?  A massage during your pregnancy will provide you with time to relax, unwind and connect with your baby.

You may also be aware of your body’s changing shape and you may be experiencing one or more of the discomforts associated with pregnancy:-  headaches, sinus congestion, stretch marks, oedema (puffiness) in your hands and/or feet, sciatica, back, neck or shoulder discomfort, cramp, insomnia, anxiety….

Massage can help alleviate these discomforts by releasing tightness in the muscles around your neck, shoulders, upper and lower back which can cause headaches, sinus problems and possibly sciatica too. Oedema in your feet and hands can be uncomfortable and massage can help to reduce the fluid retention. Carpal tunnel syndrome can be caused by the oedema in your hands and I can show you exercises to minimise the discomforts you may be experiencing with this condition.

Massage improves skin tone and elasticity whilst helping to minimise stretch marks. Gentle massage will improve your circulation, helping oxygen, nutrients and waste products more efficiently to and from your own body tissues and your baby’s placenta.

On your first appointment we will spend some time getting to know each other and discuss your general health and also how you’ve been feeling during your pregnancy. Whether you are in the 1st, 2nd or 3rd trimester the massage treatments will be gentle and adapted specifically for your needs on the day. For your comfort and to allow for your growing baby, various positions may be used whilst supporting your changing body with pillows.

Postnatally, massage can be very helpful whilst you adjust to your new life as a mum as it is still important that you find time to rest and relax. Massage is very beneficial at this time to minimise and prevent any discomforts that you may be feeling. On an emotional level, massage may help to alleviate any feelings associated with postnatal depression.  Babies are very welcome to join you for any postnatal session as they also find it a comforting time relaxing and bonding with their mum.

As a massage therapist I enjoy working with mums and babies as I feel it’s a very important time in a woman’s life. My experiences as an NCT antenatal teacher and birth companion have enhanced my skills, providing me with additional knowledge and tools to share with you within your session.

If you would like any more information or would like to have a chat about how I may be able to help you, please call Linda on 0118 9697461

Celtic Touch

07 Sep

Guest post: Why I Love Oxytocin

You’re in labour. Your baby will probably be born in a matter of hours, while your body will do the most incredible thing it’s ever done. But what is actually going on?

Well, it’s all orchestrated by this amazing chemical called oxytocin, which is often nicknamed ‘the love hormone’ – I’ll explain why later on.

This fascinating hormone is coursing around your blood stream, telling your uterus to contract, which pulls your cervix up and open during the first stage of labour, and pushes your baby out during the second stage.

Every contraction sends a message to your brain to send more oxytocin, which causes another surge of power in what is now the largest muscle in your body. But even when your baby’s been born, oxytocin doesn’t just stop working! In fact, oxytocin is an important hormone in many other areas of our lives, not just labour.

Long before you even got pregnant, it’s likely you’ve had many a time made far more pleasant by its presence: it’s released in huge quantities in the weeks we’re falling in love; we get a boost of it whenever we have skin-to-skin contact with someone we care about; and we get a massive shot of it when we have an orgasm.

Oxytocin’s job in these situations is to help you form relationships and build trust between two people, hence the nickname ‘the love hormone’. Without it, you wouldn’t be able to fall in love.

So what causes it to be released? Well, apart from when you’re in labour, when it’s part of the amazing positive feedback loop I’ve already explained, it’s mostly that skin-to-skin contact with someone we care about that does the trick.

Even larger quantities are released if that skin-to-skin contact involves particular areas of your body which are super-sensitive to touch – ear-lobes, genitals, and nipples.

Which brings me back to your labour and birth. Your baby may well be born straight onto your tummy, skin-to-skin, which means more oxytocin. But – get this – your baby’s hands and face are likely to be near one of your nipples, so that gets a whole lot of touch too, stimulating even more oxytocin.

And as you haven’t quite finished the process of birth yet – your placenta still needs to be born – that oxytocin is really important because it keeps your uterus contracting so that the placenta can detach from the uterine wall and be pushed out of your body.

Of course, all that oxytocin is also helping you to fall in love with your baby and helping your baby, who is also getting an oxcytocic rush, fall in love with you. This is what we all call ‘bonding’.

As if the poor hormone didn’t have enough to do – making labour happen, helping you bond – it also has a vital role to play in breastfeeding. When you hold your baby close, and particularly when your baby is suckling at the breast, the resulting oxytocin causes the milk ducts within your breasts to open, and let the milk flow towards your nipple so that your baby can get to it. We call this a let-down, and breastfeeding doesn’t work without it.

So now you know why oxytocin is such an important, exciting hormone, and you know how to get more of it, so get cuddling!

Clare Kirkpatrick is a writer and a home educating mother of four girls. She is an NCT trained breastfeeding counsellor and is the editor of the liberating blog, Free Your Parenting. You can also follow her on Twitter: @clarekirkp and her Facebook page is at: facebook.com/freeyourparenting

Views expressed here do not represent the views of NCT.