29 Oct

Book Review: What Mothers Do, by Naomi Stadlen

Naomi Stadlen has collated the views of new mothers from hundreds of interviews and conversations. From the women’s words she has defined numerous of the almost-intangible things that mothers do on a daily (and nightly) basis, even though it looks and feels like they are ‘only’ looking after their babies.

She points out that mothering is a unique experience, in allowing us to focus on how badly we are doing, simply because there seems to be no language to describe succinctly all the things we do well.

Some of the things that mothers do are defined as being ‘instantly interruptible;’ comforting; being responsible; coping with tiredness; figuring out what babies want; loving their baby; redefining their own identity; redefining their other relationships, particularly with their partner and with their own mother; and supporting other mothers.

The collection of insights opens one’s eyes both to the huge accomplishments of everyday mothering, and to the subtle pressures and unexpected challenges we encounter. It is so easy for a new mother to feel that she achieves nothing, until we take account of the thousand interruptions and her instant, unconditional availability for her child.

This book along with something on human babies’ normal emotional and psychological development, such as What Every Parent Needs To Know by Margot Sunderland or Why Love Matters by Sue Gerhardt, should be required reading (though perhaps in digested form!) for any new mothers, to give perspective and positive encouragement.

The value of this book for a postnatal doula is in helping her to step outside her own frame of reference and consider the huge variety of maternal experience. Every mother carries the emotional payload of her own birth and postnatal experience, and of course this informs our work with other women; but this book broadens one’s focus and understanding.

I originally read the book when my son was around six months old, and of course my perspective has been changed both by my own experience and by the stories told by the mothers I work with. I feel more removed from the subject matter now, and find it moving to be reminded of the importance of celebrating what seems like little achievements, and of the context in which we become mothers in our culture.

I particularly appreciated the description of how mothers learn about their babies: not from books or gurus, but from their own baby. Stadlen states that ‘Uncertainty is a good starting point for a mother’ (p45) because that is precisely what enables her to learn.

This reassures me that uncertainty is also a good starting point for a doula, and that our role is very much about listening to the stories, pointing out the achievements, and celebrating motherhood.

08 Oct

Trick or Treatment

Trick or Treatment: Alternative Medicine on Trial
By Simon Singh and Edzard Ernst

Cheekily dedicated to HRH The Prince of Wales, Trick or Treatment is an investigation of alternative therapies, using scientific methods to determine whether any of them work.

Between them the authors have medical and scientific backgrounds, and Prof. Ernst has also practised homeopathy and other alternative treatments. They argue that this places them in a strong, objective position from which to investigate these therapies.

The book specifically examines over 40 complementary therapies, from aromatherapy to yoga. The authors have critically reviewed the available research, and drawn conclusions about whether the therapies are effective, and for what sort of conditions they might be beneficial.

Whole chapters are devoted to four of the therapies: acupuncture, homeopathy, chiropractic and herbal medicine. Within these chapters, the authors give detailed descriptions of the history and development of the therapies, and discuss the theories behind them. In valuable addition to the discussion of the therapies themselves, these chapters include colourful explanations of research methodology, and concepts such as bias. For this reason I strongly recommend the book to anyone who wishes to understand how clinical trials are conducted, and what factors can affect the results.

The chapter devoted to the placebo effect considers the ethics of promoting ineffective treatments for conditions that might respond to conventional medicine.

Singh and Ernst conclude that homeopathy and acupuncture are at best benign placebos, but can in fact be dangerous quackery. Chiropractic treatment is shown to work for a limited number of conditions, but the financial and physical risks to patients are high, and it is no more effective than conventional treatment. Some herbal medicine is shown to be effective, but the paucity of the research leaves a muddied picture.

The conclusions reached about most of the other therapies are that they are largely ineffective, although some, such as yoga, may have a short-term calming or de-stressing effect. Most are shown to be expensive, not founded in actual scientific knowledge, and may be dangerous, particularly when used instead of an effective conventional treatment.

The book is extremely readable, with hundreds of memorable examples, such as the death of George Washington being caused by his doctors’ practice of bloodletting. The tone is amusingly scathing, occasionally strident, and the authors pull no punches. The book would not be enjoyed by believers in or practitioners of alternative medicine but ought to be required reading for anyone considering using it, for their own good.

03 Oct

Closest to breastmilk

While it’s no longer legal in this country for the milk manufacturers to claim that their infant formula is “closest to” or “inspired by” or (yes, this has happened) “better than” breastmilk, the idea that these companies are beavering away trying so hard to come up with the perfect infant food has a fairly strong hold. As long as they are seen to be competing to be the best infant formula, they can hope that we will overlook the fact that they are all nutritionally inadequate in different ways. This makes their claim to be the best yet more irresponsible, as bottlefeeding mothers tend to stick to one brand.

It is simply impossible to support a claim to be “close to breastmilk,” because the components of breastmilk change constantly. They change from day to day, from feed to feed, according to the age of the child, the needs of the child, and even the weather. Seriously. On a hot day, babies drink thinner, more thirst-quenching milk. If formula manufacturers cannot identify all the ingredients, and cannot establish the function of many of those ingredients that they have identified, and cannot synthesise many of those whose function they do understand, and cannot balance the synthetic ingredients to achieve the same nutritional end result, then how can they possibly be selling something that is supposed, in some way, to be equivalent to human milk?

On top of that, there is the slightest teeny tiny suspicion that sometimes, some of the changes made to the formula might not be entirely attributable to amazing new discoveries about the contents of human milk, but in fact can be attributed to amazing new discoveries about what parents will buy if it is suggested to them that a particular product contains “essential” ingredients for brain growth, prebiotics, or the wonderful immunofortis. And no-one ever calls them to account for the fact that these essential ingredients were missing in the previous formula. Infant formulae are revised over 100 times a year, and each one is more perfect than the last, just as each Mars Bar is the biggest ever.

The bioavailability of nutrients in human breastmilk is high for its human consumers, because of the interaction between the ingredients of the milk, and the body’s mechanism for processing them. If one element is needed to process another, but is not available, then something else will be used, and the balance is upset. For example, too much iron causes a zinc deficiency; yet artificial milk contains twenty times the concentration of iron found in human milk, because cow’s milk lacks human lactoferrin, and therefore the iron in cow’s milk cannot be as easily absorbed by the human infant. Human iron is all absorbed, but the iron added to artificial milk is not, resulting in more waste for the newborn’s body to process, and encouraging the growth of harmful bacteria such as salmonella and candida in the gut. The guts of artificially fed children are already at more risk from such pathogenic bacteria, because they have a higher pH, because the lactose in human milk encourages the growth of friendly bacteria which keeps the pH naturally low. You see? As soon as one domino clicks down, the others start to tumble.

Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine. – Frank Oski, M.D., retired editor, Journal of Pediatrics

Today’s post once again owes a lot to Maureen Minchin – Breastfeeding Matters: What we need to know about infant feeding and the ever-factual Royal College of Midwives’ Successful Breastfeeding. Other sources were Kellymom, and Gabrielle Palmer – The Politics of Breastfeeding.

Originally posted elsewhere on 14th May 2008