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.