books | Motherworldly

15 Mar

Book Review: Birth Matters, by Ina May Gaskin

Ina May’s new book is a manifesta setting out the philosophy of natural birth, and therefore nothing that has not been said by wise women (and men) countless times before. The value of this work is its comprehensive, detailed, and clear presentation of the information, such that surely no rational human could disagree. It is The Politics of Breastfeeding for birth, and it is a scientific celebration of what nature has achieved and what women are capable of.

The first chapters set the subject in its global context, and birth stories are scattered through the text to remind the reader that while these are global, political issues, they have personal, individual impacts.

I have learned about the cultural loss of breastfeeding knowledge, and it makes a sad kind of sense to me to be reading the same description of society’s attitude to birth: the loss of skills among health professionals and the consequent loss of positive birth stories. This cycle will be perpetuated and added to, and will spread beyond the US increasingly rapidly, as we lose touch with and confidence in our own bodies.

Ina May Gaskin discusses the role of feminism in driving an ‘escape’ from pregnancy and motherhood, a push towards equality between men and women instead of a celebration of the important differences between us. Why should power be measured only in masculine terms and defined by the choice NOT to do something? Ina May’s positive, empowering feminism offers a far wider range of choices.

It seemed crazy to me to take on the belief that the human female is the only mammal on earth that is a mistake of nature… it’s our minds that sometimes complicate matters for us. (p.23)

She quotes Simone de Beauvoir describing the pregnant women as inciting fear in children and contempt in young people, ensnared: “life’s passive instrument.” De Beauvoir, the great feminist intellectual, writes as though she believes what men have said for centuries about women’s bodies: that we are disgusting, inefficient, and inferior to men (who cannot, normally, grow or feed babies); and seems unaware that historically speaking, medical men who profit from managing birth have had personal and financial interests in telling women that it is a dangerous and painful process, that requires the presence of a qualified doctor. Again the parallels with the unethical practices of formula manufacturers undermining women’s knowledge of and confidence in breastfeeding are clear.

Some of the practices resulting from this basic assumption of women’s inferiority and ignorance are barbaric, and many persist in 21st Century western healthcare. The book describes a bleak outlook for maternity care and motherhood in a world where politics and economics are everything. Yet the short-termism of the idea that labouring women must be cured or rescued from themselves costs far more in terms of money, life, and quality of life. How can this be an acceptable situation?

I was struck by the anecdote in which a couple kissed to raise oxytocin levels and aid relaxation and the progress of labour. It helped me to think about the way I talk to antenatal groups about the role of oxytocin in breastfeeding. And also of the way the idea of sex to bring on labour has been reduced to the role of prostaglandin, when everything about it promotes skin contact, eye contact, and a feeling of well-being. In this, I find yet another example of the big picture being reduced to one male-orientated detail.

I was aware that birth in the US was highly medicalised, but the details and the implications of that, as clearly laid out by Ina May Gaskin, are horrifying and depressing. At the same time, the positive birth stories are affirming, empowering tales, a contrasting picture of the good that is possible when women are informed and respected.

***

To order Birth Matters with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

08 Feb

Book Review: The Oxytocin Factor, by Kerstin Uvnas Moberg

On the whole, this is an interesting book exploring the magic of the hormone oxytocin, its widely varied effects, and the gaps in our knowledge about it.

The author describes the ‘calm and connection’ system, and contrasts this with the ‘fight or flight’ system, which has already been widely researched. She posits that modern life gives little opportunity for human beings to enjoy the various conditions of rest, relaxation, and pleasant interactions, which cause a natural increase in levels of oxytocin.

The book is divided into parts, and begins with an explanation of the physiological processes involved in the calm and connection system. All this makes a lot of sense, although much of it is based on research with rats.

The section on the effects of oxytocin is the most interesting part of the book. It shows that oxytocin increases sociability, curiosity and nurturing behaviour, and decreases anxiety and fear. It enhances recognition and calm, and alleviates pain. It improves the ability to learn; and, in different circumstances, either raises or lowers blood pressure. It moderates body temperature and enables a mother to moderate her baby’s body temperature. It regulates appetite and makes digestion more effective. It aids growth and healing, and the flow of breastmilk, and the contractions to birth our babies. All of these different effects have the result of enabling animals to grow and to reproduce.

The chapter on breastfeeding is fascinating. However I noticed here and elsewhere some remarks that I know are not supported by evidence, including that mothers who have had a c/section have more difficulties in breastfeeding, the assumption that colic is a stomach disorder, and the assertion that breastfeeding women must avoid alcohol. This leads me to wonder how much of the rest of the content of the book is actually based on real evidence of human experience and behaviour.

Certainly the final section of the book is almost entirely based on speculation about the gaps in our knowledge, and uncritically discusses the role of oxytocin in acupunture and other complementary medicine.

I found much that was useful in this book, particularly on the subject of bonding, and specifically in relation to fathers, which is very relevant for me in my work. However I found the speculation in the final chapters vague and disconnected. I was surprised, given the original assertion that modern life is not conducive to natural oxytocin release, to read that the author is looking forward to oxytocin being available as an drug that can be administered for various conditions. I had expected the book to conclude that human beings need to use our knowledge of natural oxytocin to engage in more behaviour, or create more circumstances, where oxytocin is naturally maximised; not just to pop a pill to achieve all those beneficial effects.

***

To order The Oxytocin Factor with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

25 Jan

Book review: Successful Infant Feeding, by Heather Welford

This comprehensive book takes a broad view of infant feeding, including how-to sections for both breast and bottlefeeding, along with an interesting examination of the history and politics, and the social and emotional aspects of the subject. It gives enough detail to be useful to breastfeeding supporters and other health professionals, without being too dense for parents and parents-to-be.

I warmed to the book immediately on reading the opening chapter, about babies’ development over the first year. This sets the subject of feeding nicely into the wider context of babies’ needs; and yet, without pulling any punches about the risks of formula feeding, manages to be inclusive and non-judgmental about the range of choices that parents make. Importantly, Welford acknowledges that, for many parents, formula feeding is not a choice willingly or happily made, and that it is very hard for health professionals to get the right tone when it comes to supporting parents in making decisions about feeding.

This book is useful because as well as accurate how-to information, it also touches on a range of special situations and common concerns, briefly explains the WHO code, and looks at how individual babies’ feeding patterns might change over time. It even includes enough information on the introduction of solid food to render the purchase of anything by Annabel Karmel completely unnecessary.

The language used is crystal-clear and helpfully free of value-laden terms. I have already heard myself reciting bits of it in antenatal classes (while hoping that Heather won’t want any royalties!), have sent a copy to my sister-in-law who is expecting her first baby, and recommended it widely. It is the book that our profession has been waiting for, and should be on the reading list for anyone working with new parents.

10 Jan

Book review: You, Me and the Breast

This is a colourfully illustrated book about breastfeeding. Its simple story follows a mum and baby from birth to weaning, and mentions lots of memorable moments, such as snuggling up in bed with daddy, mama milk to comfort and soothe, and those relaxing moments where one’s ever-active infant becomes still for a little while at the breast.

Although it is clearly presented as a children’s book, I was a little confused about who the target audience was. Some of the information: ‘my nipple darkened… and gave off a rich smell’ sounds unnecessarily technical in a book for a small child. The cursive script was too difficult for my competent five year-old to read himself, and he had a lot of questions about the illustrations (‘which one is her hand?’ ‘why has she got birds in her hair?’).

It was nice to see dad included in some of the pictures, although I have reservations about the depiction of him ‘aeroplaning’ puréed food into the baby’s mouth.

On balance, the more books for children that normalise breastfeeding, the better. It would be good to see this widely available in local libraries and schools.

***

To order You, Me and The Breast with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

04 Jan

Book Review: When Your Baby Cries, by Deborah Jackson

You are the still waters – p.57

You get the sense that, when giving the book its subtitle ’10 Rules for soothing fretful babies (and their parents)’ Deborah Jackson’s tongue was firmly in her cheek, as the basic tenet of the book is that there are very few rules, only a handful of general guidelines that each parent will apply in their own way.

The first, and probably most important of these, is to relax. Despite having been given a copy of When Your Baby Cries by a wise friend, towards the end of pregnancy, it took me a long time to master the art of calm. I’m constantly surprised when my feedback as a BFC describes me as calm, and I wish I could harness this within my own family! Motherhood maximises our potential for guilt, anxiety, self-doubt, and sleep-deprived irritability; inner calm can be hard to find.

The ‘rules’ in the book are based around learning about babies, and specifically, learning about your own baby, so that each parent finds their own way to respond. There is an emphasis on understanding and meeting the baby’s needs through love and attention, as opposed to trying to make the baby conform to modern notions of good behaviour. Scattered throughout the text, quotations, statistics and facts about baby care in other cultures illustrate the author’s gentle suggestions and explanations.

As the mother of a colicky baby, I found rule 4 particularly helpful, as this gave me permission not to have to stop him from crying, but simply to be there for him and hold him, and accept that I could not understand why he cried. It was a good lesson that we were both on the same side.

I have some concerns with the suggestions of homeopathy and chinese medicine, both of which are expensive treatments shown to work no better than a placebo. These could only be described as doing no harm (p.81) if there was definitely nothing wrong with the baby; and in that case, it would almost certainly be more effective to turn to one of Jackson’s other suggestions instead.

The section on feeding is clear and factual, but again emphasises the important of comfort over and above food, as illustrated by the study of tube-fed babies (p.21) showing that a full stomach does not always stop the crying.

Deborah Jackson has addressed co-sleeping in her book Three In A Bed. This is condensed into a single chapter in When Your Baby Cries, including safety information, along with many other gentle ways to help your baby sleep.

Other ‘rules’ include carrying baby in a sling, establishing a support network, and not bothering too much about the housework, all of which I fully agree with.

This book is firmly based at the attachment end of the parenting spectrum, but without any smug or judgmental tone. It allows space for parents to find their own style, and to cuddle their babies as much as they want to.

***

To Order When Your Baby Cries with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

01 Dec

Book Review: How Not To F*** Them Up, by Oliver James

I read They F*** You Up: How to Survive Family Life about five years ago, enjoyed it very much, and widely recommended it. The follow-up, How Not To F*** Them Up, was sitting on my shelf for nearly a year, and eventually I picked it up and started to read.

Half way through the introduction, I started to skip bits; and then I began to flick through using the ‘Practical Top Tips’ Index; and then I just leafed through the rest. I will not be widely recommending this book.

James claims that ‘solid scientific research’ (p5) divides mothers into three types, and goes on to write unpleasant caricatures of each type. I know which type he would consider me to be, but that does not make me find his descriptions of the other two types any less offensive. We have the selfish, stressed-out Organiser, the martyred earth-mother Hugger, and the dithering, overstretched Fleximum.

James exhorts the reader not to skip to ‘her’ section but to read the whole book exactly as presented, in order to gain a full understanding of herself through reading about the others. This overbearing paternalistic tone persists throughout the book, and may be one of the reasons why I did precisely the opposite.

When James writes about under-threes, I find that he is spot on. His section on the needs of (and myths about) toddlers is clearly evidence-based, and he is relatively open about the harm caused by controlled crying, as well as the pointlessness of the naughty step at that age. However almost every statement he makes about mothers is a patronising generalisation. The case studies are written in a deeply judgmental tone, giving the impression that, whichever camp we are in, we mothers haven’t got a hope of getting it right.

Of course the first section I skipped to was the three pages on breastfeeding, in which James repeats a lot of over-technical information about positioning, attributing it to respected midwife Chloe Fisher. He dismisses Health Visitors as breastfeeding supporters, and then falls into the well-established pitfall of the untrained breastfeeding supporter himself, by basing his advice entirely on his own experience. He repeatedly states that colic is caused by not draining the breast properly. There is no research that conclusively establishes the cause of colic, and advice to ‘drain’ the breast can be very confusing.

This book lacks empathy with the subjects of the case studies and with mothers in general. The useful and accurate information about the needs of babies and toddlers can be found in They F*** You Up. As far as mothers are concerned, though, I would recommend that we all stop reading at page 5, where he states that ‘mothers rarely find anything as helpful as talking with each other;’ and go out and find a Bumps & Babies group or an NCT Early Days course instead.

22 Nov

Book Review: Testing Treatments

Testing Treatments by Imogen Evans, Hazel Thornton, Iain Chalmers & Paul Glasziou asks the crucial question, how can we ensure that medical research effectively meets the needs of patients? It is a crucial question because all over the world, resources are wasted on poor quality research, research that only meets the needs of drug companies, and on unproven, disproven, or unnecessary treatment.

The authors state that medical research is ‘everybody’s business’ (p.114) and suggest that if patients, doctors and researchers worked as a team, the testing of treatments could be more effective, precise and useful. The BMJ famously bans the phrase ‘more research is needed,’ and Evans et al, who comment ‘do less… but focus the research on the needs of patients’ (p114) clearly agree.

A useful complement to Ben Goldacre’s Bad Science and Simon Singh’s Trick or Treatment, Testing Treatments clearly lays out the principles of robust research, defining what makes a fair test, and explaining the importance of setting a study within the context of existing research. In itself, these principles do not sound particularly challenging, but the authors go on to show how the waters are muddied by vested interests, patient pester power, paternalistic clinicians, and inexcusable poor practice.

Finally, they set out a strong blueprint for a better future, asking for patients to be treated as equal partners, both as individuals requiring treatment, and as groups participating in research.

The manifesto is laudable, but for this to work, people need to read this book and get on board; and not just other academics. There is an obvious effort to make the style of the book accessible to the wider public, and indeed it is, as I read it in two days despite the company of a bored five year old. I found the slight dumbing-down of some of the terminology (words like ‘menstrual’ and ‘cardiac’ explained in parentheses) slightly patronising; and the over-simplified diagrams lacked much meaning. Boxed quotations are scattered over almost every pages, which breaks up the flow of the text without adding very much in terms of content. However the chapters are very clearly laid out and richly illustrated with anecdotes and examples. It was impressive that the entire chapter on statistics managed to avoid using the word ‘statistics.’

I would definitely recommend this book to my colleagues and to some of my more sciencey friends, but this is why I feel that it will mainly preach to the converted. Those paternalistic GPs who are certain of their infallibility, those focus groups desperate to prolong precious life, those politicians in the pockets of big pharma: they should be forced to read it!

I took away from Testing Treatments, a much enhanced understanding of the arguments against routine screening, and an appreciation of the need for greater regulation and better-informed consent for treatment outside the context of clinical trials. I enjoyed reading what could potentially have been a heavy-going book, but was in fact, as Ben Goldacre says in the foreword, ‘interesting and clever.’ (p.xii)

***

To order Testing Treatments with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

18 Nov

Book Review: Saggy Boobs & Other Breastfeeding Myths, by Val Finigan

Saggy Boobs & Other Breastfeeding Myths is a fabulous little book! It may be a light read, but it is certainly not light on evidence-based information.

Dispelling breastfeeding myths is one of my main aims in antenatal classes, and the myths appear to be limitless: babies get the runs when you eat curry, champagne gives them hiccups, you end up with boobs like spaniels’ ears, and of course you’re at the beck and call of a miniature tyrant who never learns to sleep, if you breastfeed.

I love the clear, factual answers, especially the response to ‘modern formula milks are as good as breastmilk,’ (p.20) which I might memorise:

Even though modern milks are considerably better than old-fashioned milks they do not replicate breastmilk. They contain no antibodies to fight infections, no living cells, no enzymes and no hormones. They contain higher levels of aluminium, manganese, cadmium, lead and iron than breastmilk. They have significantly higher levels of protein than breastmilk, and the proteins and fats are fundamentally different from those found in breastmilk.
The constituents of formula do not change feed-to-feed, day-to-day like breastmilk and are not species specific. All we can say about formula milk is that it is successful at making babies grow well.

Each page includes the most amazing embroidered illustrations by Lou Gardiner, and the whole book is so unique, accessible and appealing that I think it should be standard issue for expectant mothers. The author and publishers may be interested to know that there is one at every Baby Cafe Local in Hertfordshire.

***

To order Saggy Boobs & Other Breastfeeding Myths with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

10 Nov

Book Review AND Giveaway: How Mothers Love (and how relationships are born) – Naomi Stadlen

I am a huge fan of Naomi Stadlen’s first book, What Mothers Do: Especially When it Looks Like Nothing, which I first read when my son was around six months old, and then again five years later when I had just completed my doula training. So I have been looking forward to getting my hands on her second book, How Mothers Love; and as soon as I did, I set about creating some space (ignoring the rest of my family!) so that I could read it.

This is a wise and compassionate book, with a pondering gentle tone and a very Plain English style. In its quest to describe and explain how mothers and babies relate to each other, and to examine the implications of this for the development of relationships in later life, the book provides another wealth of anecdotal colour that would sit alongside a more sciencey tome such as Sue Gerhardt’s Why Love Matters: How Affection Shapes a Baby’s Brain.

I read this book holding a pencil with which to annotate moments of epiphany and insightful remarks I would like to quote later. I have underlined something on nearly every page, as I repeatedly recognise something from my own experience or from talking with other mothers, including the idea of mothers as fellow travellers, the dread of disapproval, the feeling that motherhood is undervalued and misunderstood in wider society.

This last point led me to wonder if non-parents could even begin to understand this book, or grasp why it is so important. Stadlen describes herself, beautifully, as being ‘steeped’ in the conversation of mothers, and her frame of reference is highly accessible to me, being similarly steeped. But when trying to convey some of these concepts to non-parents (or even to parents for whom motherhood is not an important subject), I feel like I am speaking a different language. This is why Stadlen has to make up wonderful words to describe something like making ‘heartroom’ for our babies; and why she frequently laments that our language simply has no words for so many of the deeply significant but less tangible things that mothers do.

I had never previously considered the impact of Freud’s work on parenting (perhaps I should give my psychology degree back!) but it was interesting to add him to the pile of ‘experts’ undermining mothers’ instincts across the years. Equally, while I am well aware of the dichotomy in fashionable parenting styles, I had never thought of it in terms of Spartan versus Athenian, a description which really elucidates the fundamental differences between the two philosophies, and the resulting conflict in how mothers think and the ways in which they relate to each other.

For me the book throws up the stark contrast with one group of mothers (and fathers) who do not feature quite so strongly; that is, the expectant ones (and I quite understand why this is). In antenatal sessions, parents-to-be refer to ‘the baby’ as ‘it,’ and their expectations are often that a Spartan approach to parenting will work very well for them. The dawning of realisation that their baby is a person deserving of respect and warmth must be a huge epiphany for many first time parents, and I find it frustrating to have confidence that this almost always happens, but not to be able to convince them of that in the antenatal period.

How Mothers Love enlarges on the themes of What Mothers Do, and introduces new ones, going on to look at how the supply of love expands (like breastmilk, as one of the women in my own antenatal group once said), to meet the needs of the next child, and the next; and how being a mother changes one’s relationships with the other members of the family.

Towards the end there are suggestions about how mothers could co-operate to have their work recognised and valued more widely; but I feel that short-term financial interests will always work against this optimistic manifesto. As a Breastfeeding Counsellor, the work I do is a drop in the ocean. A book like this can make waves where I cannot. Reading this helped to reaffirm my approach to my paid work; but more importantly, to my unpaid work as a mother.

***

Naomi Stadlen’s publisher, Piatkus, has very kindly offered two copies of How Mothers Love as a giveaway to two readers of the Double Helping Doulas blog. I have never had a giveaway before, and I’m torn between holding an actual competition, or offering the books to the first two commenters. I have no idea if anyone even reads this thing, so to increase the number of comments, just let me know you’re there and you’re interested, and I’ll pick names out of a hat on Tuesday 15th November.

03 Nov

Book Review: Complementary Feeding: Nutrition, Culture and Politics, by Gabrielle Palmer

Palmer’s ‘The Politics of Breastfeeding’ was a hugely influential book for me as a breastfeeding counsellor, opening up a far wider picture of the subject than I had ever seen before. ‘Complementary Feeding’ has done the same thing with the subject of introducing solid food and feeding infants and young children on food other than milk.

The title itself raises the huge issue of what we call this process, which many people refer to as ‘weaning.’ As Palmer explains, this is in fact the term for cutting down on milk, which may well be a consequence of introducing solid food, but is not, in fact, the same thing. This confusion of the terms leads to parents and healthcare professionals having a drive to reduce a baby’s milk intake long before he or she is developmentally ready to do so.

I particularly enjoyed the book because it reinforced my own approach to talking about the introduction of solids, with the focus being on education and exploration rather than on filling the child up with non-nutritious cereal-based or pureed foods to the exclusion of milk. She even pinched my throwaway remark that food is a great, cheap educational toy that comes in lots of lovely colours and textures, and can be played with at the table while the rest of the family gets on with their meal!

The book starts with an overview of the inequalities in global food entitlement, a subject I had not considered before, but which became highly topical this morning when research comparing the average English diet with diets in Scotland, Wales and Northern Ireland, suggested that if they all stopped eating deep fried Mars Bars, they would, amazingly, live longer. Of course, the research does not say this at all, but identifies food entitlement inequalities in less affluent populations in the UK, but that does not make such a good headline.

It goes on to look in greater detail at the evolution of the human diet, and cultural variations, as well as innate factors such as the drive for nutrient-dense food (hence the preference for salty, sweet and fatty foods), and the inbuilt appetite control mechanism that allows baby-led complementary feeding to become the natural progression from baby-led breastfeeding. I learned some interesting facts about human consumption of animal milk (most humans do not produce the necessary enzyme to digest milk, beyond infancy, but northern Europeans have evolved to do so), and was interested, but (I admit) slightly revolted by the discussion of feeding insects and molluscs to small children. My cultural prejudices are pretty well embedded!

Finally, Palmer suggests some processes for change, including an examination of the language used around feeding children; and compares the effects of wartime rationing with a frankly disempowering US initiative to provide poorer families with food but not with information about nutrition or food preparation.

For me, one of the most important conclusions of the book is that malnutrition exists in affluent cultures as well as in the developing world, because parents are driven to cut back on milk and give commercial or home-made processed foods to their children, often before the children are ready to move on to a solid diet. Also, that spinach is not particularly good for children; as Palmer writes, how wise they are to refuse it!

This book was a free copy kindly sent by Pinter & Martin publishers, and can be obtained from them here.