Karen Hall | Motherworldly

13 Nov

Birth Plan Prompt Sheet

Birth planning is a vague science; some birth workers now refer to “birth preferences” instead, and some prefer to avoid this sort of planning altogether. I’ve found a few resources online including this comprehensive tool from the NHS, and cobbled together a list of prompts so that my clients and I can go through it together and make something that is completely tailored to their needs. I’ll be taking several copies with me to the birth!

Birth Plan

Early labour – where?

Where to give birth – MLU/delivery suite/pool etc

Who do I want to be with me?

Equipment I plan to take with me

Intermittent/continual monitoring of baby during labour

Keeping active during labour

Positions to adopt

Trainee midwives/doctors in the room

Immediate skin to skin

Pain relief preferences

Episiotomy

Third stage – active/managed

Breastfeeding

Vitamin K

Any special requirements

03 Nov

Getting started with solids: Purees

If you have chosen to offer pureed food for your baby’s first taste of solids, don’t forget it doesn’t have to be baby rice! For a healthy term baby showing signs of being ready for solid food, lots of other colours and flavours are available for those first steps on the journey towards a healthy enjoyment of food.

The main nutrients your baby needs in his or her diet between 6-12 months are still protein, fat and calcium, so there is no hurry to cut back on milk, which is such a great source of these things. When you start solids it’s all about the taste experience, so try not to let your baby fill up on food and have no room for milk. Just one or two teaspoons is plenty for the first few meals.

Vegetable Puree
You will need: approximately 100g of any suitable vegetable. This could be a small sweet potato, a carrot, a few florets of broccoli or cauliflower, half a butternut squash, a parsnip, a handful of peas, a fresh beetroot, some spinach leaves, or anything that can be cooked in the following way.

If you would normally peel the vegetable, then peel it. If not, just wash it. Cut larger vegetables into small dice.

Steam for 5-7 minutes, or boil in a small amount of water for 6-10 minutes.

Check it is soft enough to blend.

Using the chopping attachment of a hand blender, or in a food processor, puree the cooked vegetable until it is smooth. If necessary, add a small amount of cooking water to thin the puree.

If you want the puree to be smoother, pass it through a mouli or sieve. If you want it to have a little more texture, you could mash with a potato masher or fork.

Separate out a portion (two teaspoons) for the meal, and allow to cool before serving.
Cool the rest and store in clean containers in the fridge or freezer.

Fruit Puree
Hard fruits such as pears and apples can be prepared using the method for vegetable puree described above.

Soft fruits such as nectarines, peaches, plums, mangoes and apricots can be peeled and simmered for 3-5 minutes with a tablespoon of water, and then blended to a puree.

Bananas make a very convenient no-cook puree: simply mash or mush with a fork, and use immediately.

Lots more introducing solids resources can be found here.

16 Oct

Book Review: The Birth Partner, by Penny Simkin

Penny Simkin is an author, doula, childbirth educator, and birth counsellor.

I was advised to read this book prior to my first job as a birth doula, and having now read it through, I will probably take it with me when I get the call. Aimed at dads, doulas and other birth companions, and packed with details of what happens before, during and after labour, it is not a small book, but its chapters are easily accessible and logically arranged.

The long section on normal labour is particularly useful. Each stage is broken down into a description, followed by what the mother feels, what a birth partner might feel, what a caregiver would be doing, and what a doula would be doing. There are suggestions for self-care and coping strategies appropriate to the challenges of each stage; it’s a real step-by-step manual.

There is a medical level of detail on pain relief, and this would need to be read and absorbed beforehand rather than at the time, but it remains a book to dip into during the process for an idea of what is happening and how to deal with it.

For when things don’t go to plan, the book covers instrumental and caesarean birth as well as other interventions. Helpfully value-free, Simkin sets out the things to take into consideration, and strategies for decision-making.

A comparatively short section at the end covers the baby’s first few days, and post-partum recovery; again with a what to expect/how to support the mother focus.

My one criticism of the book is its US-centric language, which makes me suspect that some of the procedures described may differ in the UK. But women’s bodies are the same all over the world, and ways of supporting a birthing mother are universal.

This book is a must-read for anyone working in birth, and for birth partners who prefer a lot of detailed information in a format they can refer to both before and during labour.

06 Oct

Dear Doctor

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

This weekend, Dr Ben Goldacre stood on a stage in front of hundreds of NCT Practitioners, volunteers and staff, and told us that we “push” breastfeeding. “Because you do,” he said, with a cheeky wink. “You’re the breastfeeding nazis.”

There was a sort of silent stunned gasp, followed by a burst of laughter; it was the funniest thing, a great ironic deconstruction of the name-calling rubbish (with acknowledgement to my colleague Kerry from whom I pinched that description). It was funny the second time he said it, too. After a while I was much reminded of my eight year old son and how he repeats the joke until you have to sit him down and explain that we’re really over it now.

We were treated to Goldacre’s standard comedic romp through the Daily Mail’s war on cancer, his low opinion of Gillian McKeith, and a selection of amusing headlines that can be achieved by cherry-picking statistics. Lucky us, we got a little extra bit on research statistics, and then a worked example using Brion et al’s 2011 article entitled What are the causal effects of breastfeeding on IQ, obesity and blood pressure? This study does contain flaws, and I wondered if Goldacre had also read this commentary, though on reflection if he had read it, its conclusion might have helped him to write a conclusion of his own:

Although the collective evidence suggests that breastfeeding—initiation, longer duration or exclusivity— may very well exert a modest protective effect on childhood and adolescent obesity, it no longer appears to be a major determinant. Nevertheless, because breastfeeding also reduces infection and allergy-related outcomes and probably increases IQ, World Health Organization recommendations for 6 months of exclusive breastfeeding remain a just and justifiable policy around the world.

By the umpteenth repetition of the breastfeeding nazi joke, I had the impression that Goldacre did not quite understand what NCT does, and while I have no evidence for this assertion, I’m pretty sure he hasn’t read our excellent Infant Feeding Message Framework [pdf]. Reading through the reasons women give for stopping breastfeeding, it would appear that for mothers, the evidence itself is not the highest priority when it comes to evaluating the experience, and that is where NCT comes in, to support parents in the situation they are in: non-judgemental, respectful support where support is asked for.

Ben Goldacre told us he doesn’t care about breastfeeding, he cares about misuse of evidence, and nobody in the room would have disagreed with that. But I would have liked him to have been a bit more thorough in his own research and understanding of how NCT supports parents.

03 Sep

Breasts against the patriarchy!

…to take a stance that you control what a woman does with her body is an assumption that you have power over her. You are dictating what is appropriate behavior. You are trying to “get her” to do what you want. If she doesn’t comply, then you obtain assistance to “get her” to do so. Here’s the deal: every time you prevent a woman from choosing what she does with her body, you are acting in a violent manner.

One man’s response to a request that his wife not breastfeed their baby in a public place, from Empowered Papa.

02 Sep

Every child wanted

“Abortion is very, very ordinary and a mark of civilisation – liberty for women and every child wanted.”

I had written and scheduled yesterday’s post about my abortion before I saw Polly Toynbee’s article in The Guardian. In fact I wrote it quite a while ago, in response to a request from the BPAS for case studies to debunk the myths that people who have abortions are reckless teenagers, or that they are somehow scarred and regretful for the rest of their lives.

As Toynbee points out, the media still treats abortion as a back street business, a dirty scandal, a secret we must never share. The storylines that end in miscarriage before the fateful decision is made tell us that as a society we are very confused about unwanted babies. We know it’s better for them not to exist, but we don’t want to admit that. Certain saintly (often childless) people may take the view that their god’s creations are all sacred and we mere humans don’t have the right to deny them life, but it is questionable just how relevant this is to the majority of women who find themselves in the position of having to make the decision.

I want abortion to be talked about in terms of a woman’s right to have control over her own body, not a shameful thing that we mustn’t mention in polite company.

01 Sep

On having an abortion

[10 years ago]

It’s 4.30am. I’m sitting on the side of the bath, watching as the moisture seeps up the stick. A line appears, dark pink, just as it should. The instructions said five minutes, so I continue to watch, and slowly, beside it, a second pink line appears, such a pale ghost of the first that I could almost kid myself that I am dreaming it. But definitely a line.

I’m stunned. This is an experience I never expected to have. Of course there is no question of me having a baby right now, I know that straight away; but I still feel strangely pleased and positive. It’s shattered my fundamental assumption that I can’t conceive, and that’s a huge deal. I feel sad that this is very much the wrong time, but completely astounded that I do have the option, after all.

My marriage ended a year ago, and I’ve been with my boyfriend for a few months. We’ve just made the big decision to reduce the 100 miles between our homes and live together. We have so much fun, so much in common, so many possibilities. We’re not ready to bring a baby into this relationship, there just isn’t room, yet.

I see my GP who points out that I’m 33 and it’s taken me months to conceive; what if I have an abortion and then never conceive again, won’t I regret it? But my priority is my relationship, and what if I go ahead with the pregnancy and the relationship doesn’t survive? I currently have no maternity rights and no savings, and I’m happier than I’ve ever been in my adult life.

Do I have a moral obligation to have the baby? No. I have a moral obligation, when I make a positive decision to have a baby, to be prepared. To have a body free of alcohol and antibiotics, a secure roof over my head, and a few more years to solidify this relationship, to give a baby a stable family. This is not a difficult decision, but nor is it one I make lightly.

I have to endure Christmas through morning sickness and hormones and a strange stab of conscience with every glass of wine I drink. In early January I am sent for family planning counselling, expecting to be judged or dissuaded, but none of that happens. It’s all very practical and I feel a bit scared, mainly of how I might feel after The Procedure. I notice that none of the professionals seem to use the word “abortion.” They tell me that there will be a lot of blood.

My boyfriend and I book a Friday off work and I spend a miserable night and morning feeling nervous and not allowed to eat in advance of the anaesthetic. The clinic looks like a large house on a residential street, inside and out. I’m taken to a bedroom with two other women, and the nursing sister talks to us all together about what will happen. We put on surgical gowns, then we wait for a bored, tense hour, to be taken through. We don’t chat.

I am the last of the three to be taken away. The staff are pleasant and efficient; it’s so clearly all in a day’s work. They check my temperature and my blood pressure, and give me a hairnet. The anaesthetist and the surgeon introduce themselves to me. I am not particularly bothered that they are men, but younger girls might mind, I suppose. As I lie on the bed being wheeled through to another room, a voice asks “is this our last one this morning?” It makes me feel like I’m being processed on a conveyor belt, and frankly the impersonal touch is exactly what I need.

I lie looking up at the lights, just waiting for the anaesthetic; at this stage, I really don’t want to know any more about it. I want to be out, I want that moment before unconsciousness, where I’m certain that the next thing I know, it will be over. They take an age to get the needle into my hand and I panic that for some reason it might not work. The last thing I remember before the feeling of numbness starts to creep through my veins, is them fixing stirrups to the side of the bed, a moment of knowledge that my pregnancy is about to be sucked out of me, and then nothing.

I wake in post-op, where a nurse is watching for me. I try to speak and my words sound slurred. I say I can feel terrible cramps, and the nurse tells me that’s my womb clamping down, and it will stop soon. I’ve been given painkillers and antibiotics but they haven’t kicked in yet. I gather myself up, and someone walks me back to my bed in the waiting room.

I lie down feeling tearful and lonely, wanting to be able to let my boyfriend know I’m alright, wanting to go to sleep, wanting a cup of tea. That wish is granted about twenty minutes later: tea and biscuits, and I sit up and feel a bit better. The cramps fade. I listen to the other women chatting quietly. One already has three children, she didn’t want to go through it all again. The other woman is Irish.

Finally I am allowed home, and I can spend the weekend feeling a bit delicate but on my way back to normal. It takes a little while for the hormones to seep out of my body. I still have this strange feeling of sad-happy acceptance of the situation, that I’ve had from the moment I took the pregnancy test. This is something I needed to do for me, for us, at this time. It was weird to be pregnant, without being a mum-to-be, and over the weeks I was pregnant, I did let myself form an odd detached attachment to my little clump of extraneous cells, knowing that I would have to say goodbye soon. I thought of it as a little bundle of potential which I was putting on hold until the time is right.

11 Jul

Book Review: Nurturing new families, by Naomi Kemeny

Naomi Kemeny is an experienced postnatal doula and has written Nurturing New Families for anyone supporting parents of newborn babies. It has useful chapters for grandparents and friends as well as for postnatal doulas, particularly those starting out. It gives a good background on why postnatal support is so important in 21st Century Britain, and a useful overview of the needs of mothers and babies in those challenging early weeks. There are also sections for special situations such as single mothers, twins and multiples, postnatal depression, families with pets, and other circumstances.

All of this is relevant in whatever capacity the reader is supporting new parents, but it is difficult to tell who would buy this book; new grandparents might find that there is too much advice for doulas, and vice versa. It might, however, be very useful for a grandparent to understand the value of a doula.

I was quite surprised that Murkoff et al’s What To Expect The First Year (described by Naomi Wolf with scathing accuracy as “the intellectual equivalent of an epidural” in her book Misconceptions) is Kemeny’s idea of “an excellent reference manual.” (p.33). I can think of about twenty books I would rather have to hand, and actually Nurturing New Families could be one of them.

There are some excellent guidelines on empathic listening, which is hard to do when you’re close to the person you’re supporting, so this of course is useful for grandmothers and friends, but essential for doulas. I strongly agree with Kemeny’s advice to take the opportunity to debrief one’s own breastfeeding experience before trying to support someone else with its particular challenges.

Some of the book is a little repetitive, for example the advice on page 68 for grandparents is repeated on page 136 for doulas, and some of the quotations are pulled from the stories at the back. The book is so full of useful stuff that it does not need this kind of padding, but I feel I am being picky. It’s a useful book, and I would have found it really handy in my early work as a postnatal doula. I would recommend it to someone at the beginning of their doula career, as it covers a good range of different situations and is full of sensible advice.

[Disclosure: I was given a free review copy of Nurturing New Families]

03 Jul

Book Review: Life After Birth, by Kate Figes

Kate Figes seems to make a living writing about how awful things are. According to her, birth is awful, and motherhood is awful, and if you haven’t done either of these things yet, this book is pretty certain to put you right off. Reading it during pregnancy would be an extremely bad idea.

In keeping with the genre, Figes presents her rationale, which is that motherhood is difficult and lonely and nobody tells you that beforehand. Here she is in good company; Rachel Cusk‘s slightly depressing motherhood memoir comes to mind. In fact so many authors have written about how nobody tells you how awful motherhood is, that I’m starting to suspect that it might not be true.

Despite the age (2000) of my edition, Life After Birth sets out the context with an explanation which remains topical today, explaining how birth has become so safe for women, that the focus is now almost exclusively on the wellbeing of the baby (see our review of Optimal Care in Childbirth for the bang-up-to-date, academic version of this). However, in a tone of thin sarcasm, most of the book delves into all the things it is possible for a mother to do wrong, and presents motherhood as unfeminist and slightly idiotic.

On the front cover, a quote from The Times describes Life After Birth as a manual; but it would be disingenuous to describe this as a manual, since nowhere does it contain suggestions, strategies or support for the wide range of unpleasant experiences she describes. What comes across is a series of rather peevish attempts to justify her own feelings and decisions; for example in her attempt to debunk the well-evidenced attachment theory on page 63, and her language when referring to authors with whom she clearly disagrees, namely Deborah Jackson (“Leaving a child to cry himself back to sleep apparently teaches him to be resigned to his impotence” – my emphasis – p.117) and Sheila Kitzinger, who “believes” that certain babies are more likely to have sleep problems (p.119). It’s a shame she doesn’t adopt this same circumspect tone when advocating homeopathy to aid recovery from a Caesarean birth, on page 32.

Each chapter contains enough references to give the impression of academic authority, and these hang together with a long string of generalisations and personal anecdotes, rendering the whole thing fairly meaningless. For example, pregnant women “are unlikely to have close friends who are also pregnant.” (p.143) and “Women on the other hand find themselves suddenly defenceless and dependent on a man they may not altogether trust.” (p.145).

Reading this makes me feel sad for whatever complex awfulness this woman went through in her relationships when she became a mother, but it is hard to identify with much in this book, even having been on my own rollercoaster of motherhood only a few years ago. Naomi Stadlen shows that it is possible to be honest and realistic about motherhood without painting an entirely bleak picture. As for Kate Figes, the positive aspects of motherhood finally get a whole paragraph on the last page, but I’m afraid these fears of “being labelled ‘selfish,’ ‘immature’ or ‘not fit to be a mother,'” (p.245) are far from universal, and if these are your fears, this is not the book to help resolve them.

23 Jun

Baby Shock

I meet a lot of new parents, and have come to recognise the glazed stare of someone at the height of sleep deprivation, and anxiety, coming to terms with the reality of life with a newborn baby.

Of course my sample is skewed by the fact that my job entails being there to help when there are difficulties. Many new parents have strong support networks, realistic expectations, and enough confidence in their own instincts, to enjoy these first weeks and sail off into the parenthood sunset.

Feedback from antenatal sessions tells me that parents-to-be sometimes feel they would like more preparation for parenthood. They request practical things: nappy changing always evaluates well but clients would like antenatal teachers to tell them how to get their babies to sleep. Everyone tells you about the sleepless nights to come, usually with a wry smile; but nobody tells you what it feels like. It isn’t like working shifts or travelling across timezones, because of the emotional and hormonal whirlwind going on around you, the physical recovery from birth, and the realisation of immense, relentless responsibility. You can’t sleep this off, and anyway, opportunities to do so are rare.

New parenthood is such an unpredictable and chaotic time, but gradually instincts emerge and you start building knowledge and confidence in yourself. You get to know your baby, and perhaps start to see why we can’t tell you, in advance, how to manage this little person. Your family and your baby are unique, and things are going to shape up in their own way. Only a tiny percentage of babies are “in a routine” by six months of age, but more than half are sleeping through the night. At a recent Introducing Solids session, mothers of four and five month old babies talked about how their babies had slipped into natural rhythms, whether they as parents had tried to manage this, or not.

Life with a new baby might be a big unknown, but you can prepare for it by gathering around you the people you trust to give you care and support, by not expecting too much in terms of “normal” life, and preparing mentally for meeting and getting to know your unique little one when he or she arrives.