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.

24 May

Date Night

Ten years ago, heavily pregnant, I said goodbye to a regular monthly social group that I knew I wouldn’t be coming back to for a little while. ‘Make sure you get out as a couple as soon as you can,’ was their parting advice. Looking forward to meeting my baby, and anticipating the tired and intense times to come, the advice fell on stony ground.

A few weeks later, my partner’s sister arrived to ‘take me out and make me feel like a girl again.’ I still have no idea what this means, but I let her come with me to the Bumps & Babies group. My first real Date Night with my partner came about when our baby was nearly six months old, and a kind friend from our NCT group babysat while we went out for a meal. We were home by 9.30pm. So out of the habit of lingering over food, and with nothing much to talk about that we couldn’t discuss at home, the whole thing felt like a waste of planning.

We were a tired team of two, rewriting ourselves as a family, moving on from the responsibility-free zone that was our life as a couple. The focus of our relationship was no longer exclusively each other. There were many, many challenges; not least the pressure to go out and ‘be ourselves.’ Our selves were growing into something new, not constantly seeking something lost. When Date Nights were more of a chore to arrange than a treat to enjoy, they added to the challenges.

Having a child undoubtedly changes a relationship, and pressure to get back to ‘normal’ can make it harder to adjust. Time spent together does not have to exclude the baby, especially in those early weeks when newborns will sleep quietly in someone’s arms. Meals out can happen at lunchtime. Couple time may be snatched and precious, but it is the support and consideration that builds a relationship and maintains it through these dramatic changes.

Date Nights still aren’t a very frequent occurrence, and they can still take a reasonable amount of planning (grandparent visits, sleepovers with friends, and so on). But now we can enjoy them on our own terms, the experience is finally worth the effort.

Sprogcast 14 is all about sex and relationships, and we interview agony aunt Dr Petra Boynton about how to maintain and nurture a loving partnership after the birth of a child.

[Cross-posted on Huffington Post]

17 Mar

If only someone had told me…

In the first few weeks and months of parenthood, new mothers and fathers very often comment on the range of knowledge they were missing, and skills they didn’t have, to cope with this new experience. If they paid for antenatal classes, at least they have someone to blame for the gaping mismatch between expectation and reality; but the majority of new parents do very little formal preparation, and unsurprisingly say the same sort of things.

To misquote Tolstoy, “each new family is new in its own way.” This presents a challenge when it comes to helping a couple to prepare for parenthood. Living in the midst of extended family, as they might have done 100 years earlier, the whims and wiles of the newborn baby would have been somewhat less mysterious; or at least the family elders could have helped to unravel some of those mysteries. New mothers might have found themselves less isolated. New fathers might have had more clearly-defined roles. And there would have been none of this pesky research into attachment and brain development, less pressure to have it all, and not so much of an expectation to be the perfect parent.

“I wish someone had told me that cluster feeding is normal… that formula isn’t evil… what ‘broken sleep’ really means…” they say, or write, with the authority of the first fully enlightened human being to have studied this matter. Emerging from the newborn fug into the crystal clarity of a new mum or dad who is finally getting a bit of sleep, the simmering resentments about the truly unexpected turns in their road, and the vast range of surprises that society simply forgot to mention, become pronouncements upon The Things I Have Learned, From Which You Too Must Benefit.

As an antenatal educator, I am often advised of the many ways in which I failed to prepare people for what it’s really like to have a baby, and find yourself relentlessly on call to a tyrannical but adored bundle of cute, who speaks no language that you know, and for whose health and well-being you are entirely responsible.

And I know I would have mentioned cluster feeding, and can think of any number of reasons why they might not have really taken it on board: were they focused on the impending birth to the extent that this was too abstract to be meaningful? Did they think this would never happen to them? Was it one small forgotten detail, many weeks ago now, lost in the fog? Is it actually possible to convey the real intensity of early breastfeeding, with the language we have at our disposal?

I also know I didn’t say that that formula was evil. In fact I may well have given examples of making a positive decision to use it. I explained about milk supply and responsive parenting and feeding cues, but I don’t believe that formula is evil, so why would I have said it? Is it perhaps that they expected me to say that, and didn’t really listen to what I actually said? Or did someone else say it, and they misremember it as being me?

As for sleep: well, some babies sleep, and some babies don’t sleep, and your interpretation of broken might be different from mine. The challenge is to drill down through platitudes and unrealistic expectations, without frightening the living daylights out of people who can’t predict what’s coming their way. In a society where people with some medical or scientific authority still insist, in the face of the evidence, that babies “should” sleep in a certain way, it’s not surprising that the sporadic and uncontrollable nature of newborn sleep should be hard for parents to manage.

I call for people to carry on being this honest about their experiences as new parents, but not to assume their experience is universal, nor to blame the people offering information and support for the fact that parenthood is not, in every way, as you expected. Join your voice to ours in increasing the support available. Ask the government not to cut funding to essential services such as Children’s Centres and breastfeeding support groups. And don’t be part of the problem by telling other parents-to-be what to do: every new family is new in its own way.

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.

01 Apr

Dean & Claire’s first week of parenthood

This follows Dean’s birth story, here.

Day One.
I’m back in at 10am, Claire has got 1 hours sleep but looks great on it even if she doesn’t feel it. Alexander has had his first attempt at breastfeeding and it’s not going well. Claire is frustrated at not being able to get the right position and when she does he latches on, takes a few sucks and falls asleep. Blowing on his face, tickling his tummy or pinching his feet wake him for a few more gulps and then he’s back in the world of nod.

This is how it’s been all night and we are slightly concerned, but the midwives are ok with it. In fact, listening to other conversations around the ward this seems to be a common theme. Read More

10 Jun

Baby Boxes or Tickboxes?

This lovely article was all over twitter on Tuesday Why Finnish Babies Sleep In Boxes:

For 75 years, Finland’s expectant mothers have been given a box by the state. It’s like a starter kit of clothes, sheets and toys that can even be used as a bed. And some say it helped Finland achieve one of the world’s lowest infant mortality rates.

The box contains baby clothes, breastpads, nappies and other essentials for the first few weeks, and comes with a mattress that fits in the bottom so it can be used as a crib. A graphic in the article shows the dramatic drop in the infant mortality rate since the box was introduced in 1938, attributed to, amongst other things, the decreased rate of unsafe bedsharing* and increased rate of breastfeeding that the box has helped bring about. 99% of Finnish mothers initiate breastfeeding, compared with 81% in the UK. While these are quantifiable factors that are known to have positive health outcomes, the underlying message to parents that they and their offspring are valued and important must surely also have some impact on early parenting.

Compare this with the pitiful situation here in the UK. Our equivalent state-sponsored freebies come from an organisation called Bounty, which promises free samples in return for your personal details, and then inundates you with adverts and misinformation in the form of a chatty little booklet called Emma’s Diary. New parents receive a small sample of nappy cream, one nappy, and a sachet of detergent (or something similar). The government pays Bounty £90,000 per year to distribute the freely-available Child Benefit Form in amongst all the adverts. Bounty reps collect new parents’ personal data and sell it on to other advertisers.**

What message does this send, in contrast to the Finnish government’s warm welcome to new babies? That mothers and babies are only worth their economic value. That they should be encouraged to buy the nappies and creams and household products that appear to have government, and by reason of being brought to you at your hospital bedside, NHS-approval. That love for your newborn baby can be measured by your willingness to buy a photograph from a stranger. That parents must hurry back to work in order to keep the economy afloat, and can do so thanks to lowering the standards of nursery care but probably not the cost.

The social impact of the Finnish baby box undoubtedly goes beyond impressive breastfeeding rates to make parents feel cared for:

This felt to me like evidence that someone cared, someone wanted our baby to have a good start in life.

Both giveaways are aimed at improving outcomes by bringing families into contact with health services. It would be interesting to compare the social return on investment in Bounty Packs, taking account of their negative messages about birth and breastfeeding, with the investment in a few articles of baby clothing and a nice blanket.

*That is, sharing a bed in unsafe conditions; not bedsharing per se.
**The petition against Bounty reps on maternity wards is here.

Further Reading
Come for the box, stay for the life saving services
Alice Roberts: Why are Bounty reps allowed on maternity wards?
Profits from pregnancy: how trusted organisations sell out women to commercial interests
http://margaretmccartney.com

25 Feb

What I’m Really Thinking

I’ve always assumed The Guardian’s What I’m Really Thinking column is meant to be a caricature, not something to be offended by. I know that last week’s anonymous piece by ‘The Child-Free Friend’ is not meant to represent the views of all childless people, and I admit that ten years ago I could have written it myself. I can quite smugly tell you that now I’m no longer childless, I finally have some empathy with parents, but that’s not to say that I speak fluently the language of child, that I find all babies beautiful, or that I ever want to change a nappy [unpaid!] again. I’m sure I’m not the only parent in the world who doesn’t really notice other people’s children until they make an annoying noise. That’s why I’m a doula, not a childminder; doulas care for mothers.

The writer is of the opinion that since parenthood is self-inflicted, parents deserve exactly zero amount of sympathy, even from a friend who claims to “care about you and your life,” when they express sadness at missing pre-parenthood freedoms. How can she possibly complain about the relentless demands of parenting, when this is what she signed up for? I’m sure you don’t have to offer to babysit for a night, to try to imagine that however much you love your child, there are always going to be times when you long guiltily for a night out that doesn’t take months of planning, an uninterrupted lie-in, or even just five minutes when nobody is asking anything of you. These are the things parents aren’t allowed to say, and because we aren’t allowed to say it, it comes as a shock to many new parents, to find that the child has no off-switch, our leisure time can no longer be filled by going to the gym or watching a Lord of the Rings triple bill, and the money drain never stops. So she didn’t sign up for it, exactly. A huge amount of doula work and breastfeeding support is about helping when reality doesn’t meet expectations.

As for your friend thinking that your life choices are less sincere, enduring or fulfilling, I had to laugh at how a paragraph about feeling judged could be so judgemental. This is why I knew that the writer didn’t stand for all childless people, because choosing to be childless is just one of many lifestyle choices, and most of us tend to think that the things we choose are better than the things other people choose. And most lifestyles are not simple binary choices.

It’s just as hard for parents to hold on to their non-parent friends as the other way around. It’s hard to have a conversation when part of your brain is permanently allocated to childcare, especially when you’re aware that the person you’re chatting with doesn’t like your snot-encrusted marmalade-fingered darling, is bored by their latest achievements, and just doesn’t get how your priorities are different now. And we’re tired. All the time. Like when you’re jetlagged or you’ve been working hard to meet a deadline or you’ve run a marathon, and those are lifestyle choices too, and you would expect some understanding.

Motherhood is pretty complex, and many non-parents seem to perceive it only at a very superficial level. We’re all childless before we have kids, we’ve all stood in your shoes. Now why don’t you try and stand in mine?

18 Apr

What do we *really* need?

A friend recently sent me a long shopping list of things she might need when her first baby comes along in May. I set to with a red pen; the items in capitals are the ones I added. Of course, this is just my opinion, so what would you add or delete from the list?

Sleep

  • moses basket + 2 sheets
    Don’t be surprised if baby doesn’t like it much. Try and get one second hand, and probably more sheets.
  • cot water proof mattress, 3 x sheets, 2-3 x blankets
    buy second hand and just get a new mattress. Current recommendation is for baby to sleep in your room for first 6 months to reduce risk of cot death, so check a cot will fit in your room. Possibly worth looking at co-sleeper cot like the bednest – look on ebay.
  • sleeping sack
    These are SO useful. You can definitely get in a nearly new sale.
  • baby monitor
    not needed until you’re likely to leave baby sleeping in another room – won’t happen in first few weeks
  • room thermometer not really needed
  • night light not needed until much later, but a low light in the bedroom is useful for night time feeding.
  • chest of drawers for clothes or, you know, a box!

Clothes

  • 6-8 x sleep suits/long sleeved suits
    or more! But you’ll be given loads.
  • 6-8 x vests – short sleeved suits as above
  • 2 x cardigans knitters will knit these for you…
  • 2 x small trousers newborns don’t wear trousers. Sleep suits are where it’s at.
  • 2 x baby socks don’t be surprised if they never stay on tiny feet
  • 2 x hats see above re: knitters. Also, it will be summer.
  • 2-3 x mittens don’t need these unless you want some scratch mitts, which are not essential. Babies like to suck on their fingers for comfort.
  • bootees Not essential.
  • SUN HAT

Bathroom stuff

  • changing mat very useful. Not essential because you could use a towel but not expensive so you may as well.
  • nappies You’ll do at least 10 changes a day to start with. But dad can always go to the shops for more.
  • nappy cream you don’t usually get much nappy rash in the beginning. You may well be given samples in the hospital and that should be enough to start with.
  • nappy bag (I do not want bin for nappies in the room/bathroom) you might change your mind 😉
  • baby bath support optional. Easiest way to bath a baby is to get in the big bath with him. Dad could do this.
  • bath thermometer not essential
  • towels (2-3 enough?) you don’t need special towels if you have some nice soft ones already.
  • loads of cotton wool pads (or cotton balls – which one is better?) cotton wool pleat – the sort you tear off in big chunks, is best. I also recommend washable wipes, e.g. cheap cotton facecloths cut into quarters. Cotton wool tends to smear the poo around a bit.
  • baby wipes (for later, first use cotton wool) yes, later, especially useful when you’re out
  • baby bath oil definitely not
  • baby shampoo no
  • baby sponge yes
  • baby lotion no – don’t bother with any toiletries, babies’ skin is very absorbent so you should only use water to begin with. Also, they don’t get very dirty. Sweet almond oil is a useful moisturizer, you can get it in health shops.
  • hair brush or comb (which one is better?) you don’t need either until baby gets some hair!
  • nail clippers (and file?) I liked clippers, other people like a file. You don’t need both.

Travel system

  • car seat you’ll need this, obviously. I think the sort where the car seat converts into a pushchair is useful, and you can use these from newborn.
  • pram Just make sure you can fold it, lift it, and fit shopping into the basket underneath. A cupholder is nice to have.
  • push chair later – at least 6 months.
  • sling really really useful. You may be able to find a local slingmeet group and try a few out. I absolutely loved the sling I had but if I was doing it again I’d go for a stretchy cloth wrap sort or a ring sling rather than a baby carrier sort. Ask for these as presents. You may even find that if you have one of these then you don’t need a pushchair or a pram at all.

Feeding items

  • breast pumps (automatic, and manual as well?) wait until you know why you need it.
  • muslin square (how many 10?) more!
  • bibs (how many? 6-8 enough??) not essential unless baby is very dribbly and you’re fussy about his outfits!
  • sterilising equipment most practical and cheap sterilizer is Milton tablets and a bucket of water. I wish I had known this.
  • feeding bottles only if it makes you feel better if you’ve got an emergency back up. If you need them in hospital, they will give you them. Otherwise it’s very easy to buy them if you need them.
  • formula (just in case I can’t breast feed) see above. And remember you can get a lot of support.
  • nasal aspirator (nose sucker) I have one somewhere. It was very useful. But revolting.
  • BREASTPADS you may not need them (not everyone leaks milk) but it’s definitely worth getting some to start off with. You can get washable ones which are good if you’re going to need a lot.
  • NURSING BRAS Get fitted around 37 weeks by a trained bra fitter. Have at least two plus a stretchy sleep bra.
  • NURSING NIGHTIE Night-time feeding will be that little bit easier if you are wearing something easily accessible.
  • DVD BOX SETS, KINDLE ETC you spend a lot of time sitting around feeding. May as well have something to do.

Other

  • maternity pads get a few packets, this is the one thing you may not want to send Dad to the shops to buy. You might also want to get some very cheap pants or some disposable knickers, that you can just throw away. Post-birth blood loss can go on for a few weeks.
  • nursing bra get fitted at about 37 weeks by a trained fitter, and it’s useful to have two bras plus a stretchy sleep bra.
  • nipple cream Not essential – only useful if you have cracked, damaged nipples; and if this happens you could call your local breastfeeding counsellor for some help. You’ll probably get samples in hospital. The Medela pure-lan cream (yellow packaging) is cheaper than Lansinoh (purple packaging)
  • baby bag (I really do not like the style of them!! Could a small, comfy back-pack do, I have one.) your back pack will be perfect, just get a cheap folding changing mat to go in it, or get the Boots Bounty free bag and take the mat out of that.
  • dummy not recommended before breastfeeding is established (usually a few weeks)

Day time & play items

  • baby bouncer / rock chair useful. Buy secondhand.
  • baby gym mat not very useful before about 3 months, you could use a blanket on the floor.
  • nursery rhymes books not essential! You could read the BBC News website, baby will be most entertained by the sound of your voice and looking at your face.
  • baby toys as above
  • thermometer (ear one) Not essential. We don’t have one but I know some people like them.


What else would we need?????

  • Non-biological laundry detergent if you don’t already have it
  • Antibacterial handgel, especially useful for nappy changes when you’re out
  • Loose/stretchy t-shirts for easy breastfeeding (don’t buy special breastfeeding tops unless you really want to)
  • A freezer full of food that’s easy to heat up
  • I still find our nappy bucket useful, it’s one of the best things we bought. Not for dirty disposables but for any dirty laundry, washable wipes, muslins etc.
  • Chocolate.
  • The Analytical Armadillo has her own take on the subject:
    20 “Essential” Baby Items That Aren’t Essential…

21 Feb

Support, Advice, and Parental Instinct

As a breastfeeding counsellor, I am sometimes asked why my antenatal classes do not go into great detail about problem solving when things go wrong. The pat answer to this, of course, is that every new family is unique, and I can’t possibly account for all the possible scenarios. I’m also wary of introducing a lot of potential pitfalls, and therefore undermining my own work to show that breastfeeding can be a straightforward experience, and that being well-prepared with an understanding of how it works is more useful than being armed with copious detail about problems that may not occur.

This is a dilemma for me, because to be realistic about breastfeeding as experienced by the majority of new mothers in the UK, I have to acknowledge that there are challenges. So one of my main objectives is to raise awareness of the huge amount of support available to new parents. If time permits, we compile a list, and the group is always impressed by how many people they can think of who might be able to help them over the first few weeks of their babies’ lives. Here are some of the ideas I usually see:

The real trick, though, is in figuring out which of these are sources of trustworthy information (or practical help); and which are, probably with the best intentions in the world, recycling myths and misinformation, or unhelpfully comparing your baby with theirs. But each of these different sources of support has its function, whether it’s sympathy and a cup of tea, the loan of a dvd box set to while away a marathon feeding session, or reassuring confirmation that what you and your baby are going through at any particular stage, is completely normal.

It can also take courage not to follow advice that does not feel right, especially when it comes from a figure of authority. So another of my objectives, both antenatally and postnatally, is to empower new parents to have confidence in their own parenting. We are among the first generations of parents to raise our children in isolation form the extended family, and there are huge commercial interests in undermining parental instincts.

It’s tough being a new parent in the 21st century, but remember that there are reliable sources of help, many of which are under-utilised. So don’t feel you have to struggle on alone, but do pick your support carefully.

Originally written as a guest post for the liberating blog, Free Your Parenting.