02 Feb

Book review: Hard Pushed, by Leah Hazard

Hard Pushed is a memoir of midwifery, drawn from Leah Hazard’s years of experience in the NHS. Leah’s words bring the reader right into the maternity ward, sketching her colleagues and the women she cares for with mostly loving detail. This is a very different book from Ellie Durant’s New Walk, but similarly gives a real feel for the pressures and joys of modern midwifery.

Hard Pushed is structured into pairs of chapters, briefly describing a theme, and then illustrating the theme with a story. We have Eleanor the lesbian mother, Star the hypnobirther, the 15 year old mum, the woman being pressured to breastfeed, the trafficked woman: composites and archetypes of the swirling complex mass of human need encountered in a midwife’s world. These women serve to illustrate what it’s like to be a midwife, and the real insight here is very much from a midwife’s perspective. So we see how incredibly hard midwives work, getting through the day on biscuits and coffee, with barely time to go to the loo; and this gives context to the irritation that comes across at the many tiny anxieties expressed by pregnant women, and the dialogue with women in labour that skates over informed consent (“‘We might have to make a wee cut,’ I call brightly.”) For any reader unaware of the overload on our maternity services, this is a very clear picture.

But Leah does write with love, and what comes across is the midwife every woman wants to meet in labour: intuitive, kind, skilled, and willing to bend the rules just enough to personalise care when it matters most. She writes with gentle humour, but doesn’t steer clear of the bleaker stories. And as in real life, leaves many of the vignettes with an unresolved ending, just as these women leave her maternity ward to get on with their own lives, unlikely to be seen again.

This is a book that can be read for easy entertainment, but the subtext is not hidden far below the surface: midwifery is a challenging vocation. It does me good to be reminded of the efforts going on behind the scenes, and to be thankful that there are women prepared to do this work in such trying circumstances.

[Disclaimer: I received a free review copy of Hard Pushed]

27 Aug

Book review: New Walk, by Ellie Durant

New Walk is the first novel of midwife Ellie Durant, and a fitting companion-piece to Alice Allan’s Open My Eyes from the same publisher. It tells the story of Chloe, a Leicester teenager who has been the responsible member of her family in the years since her mother died, and has finally decided to do something for herself, and applies to study midwifery.

The main philosophical theme of the book is that dilemma between selfishness and responsibility: do women have the right to decline medical advice? Or to choose what happens to their own bodies? And who has the power?

Chloe is a likeable character going through some tough times, supported (or not) by a diverse cast. The plot may not twist much, but it is soundly structured, satisfyingly ended, and well decorated with the details of Chloe’s learning about pregnancy and birth. Ellie Durant writes confidently about what she knows, giving this novel a sincere and grounded feel. It’s light reading with some darker tones: great summer lit.

[Disclaimer: I was sent a free copy of New Walk by the publishers Pinter & Martin. Get yours here with a 10% discount at the checkout, using the code SPROGCAST]

31 Dec

A trilogy of book reviews

These are the last three books I have read in 2017, a very satisfying year when it comes to reading. I am not sure how I have managed to find the time, but hope that a less crazy 2018 might mean even more reading time!

A Midwife’s Story – Penny Armstrong & Sheryl Feldman

In this memoir of midwifery among the Amish community, Penny Armstrong reflects on her growth and development as a midwife. It’s fascinating to see her confidence in straightforward birth in a home environment increase through experience. She is well-placed to make the comparison with hospital birth in the 1970s, and it is horrifying to note how little has changed. The vignettes of Amish life are also charming, and this is a well-written memoir – certainly the best story of midwifery I’ve read, thanks to writer Sheryl Feldman’s well-judged turn of phrase. I found it utterly absorbing.

[Disclosure: Pinter & Martin sent me a free review copy of this book; you can get a 10% discount on your copy if you use the offer code SPROGCAST at checkout on their website.]

How To Have A Baby – Natalie Meddings

How To Have A Baby is a doula in a book. It’s nearly a big enough book to fit in an actual doula, and crammed with wisdom (just the “big necessaries,” writes Natalie Meddings) sourced from her own experience and the stories of many mothers. Meddings’ tone, like the ideal doula, is firm but gentle, calm and encouraging.

The book takes the expectant mother through the usual route of pregnancy and planning, into labour, birth and the unexpected, and out the other side to feeding and newborn days. Descriptions are clear and “tips and tricks” are shared helpfully at every stage. Meddings is pragmatic and honest. Birth is discussed in terms of an involuntary bodily function, and how to create the optimal conditions for this to happen. Induction is presented as “a ticket on the intervention rollercoaster” (p116) which is an interesting choice of words, however the pages explaining induction are practical and compassionate, giving a clear idea of what happens and what can help.

This book is an excellent resource for birth planning. Meddings is very concerned with consent and human rights, both of which she covers very clearly; and this is her real strength. I much prefer these well-referenced and forthright pages, to the liberal sprinkling of homeopathy etc alongside the useful coping suggestions.

You are waiting to hear what I think of the breastfeeding information, so I won’t keep you in any more suspense. With contributions from Maddie McMahon, the importance of early feeding and skin to skin is discussed, and Meddings describes the newborn feeding reflexes and how to support the baby to self-attach. It is a little surprising when she goes on to describe a rather prescriptive way to hold the baby, which does not support those reflexes so well, given her let-nature-take-its-course-and-things-will-work approach to other aspects of birth and parenting. And sound the klaxon for “breastfeeding granola,” which looks delicious but should correctly be termed “granola,” given that breastfeeding experience is not generally influenced by the consumption of roasted oats and nuts and so on.

Matters are redeemed by the rest of the new-baby/new-mother section, referencing such respected authors as Naomi Stadlen and Deborah Jackson, and with plenty of exhortations to eat cake.

I think this book is jam-packed with stuff that would be useful during labour and birth, and it would set up a new mother nicely for those early days and beyond. Practically speaking, the book is probably a bit too chunky to carry around with you and make notes in, as Meddings suggests in the beginning; in fact I think it would work brilliantly as a loose-leaf binder (or perhaps an app), so the reader can pull out relevant sections as needed (which would facilitate reading whilst feeding). Some websites and numbers are given to access support but there could be a lot more of this. On the whole a very highly recommended book for practitioners and parents-to-be alike.

[Disclosure: Natalie sent me a free copy of her book to review – thank you!]

Eleven Hours – Pamela Erens

The last book I finished reading this year was perfect to follow these two, and I think I may even have bought it myself. In Eleven Hours, Lore is in labour, cared for by Franckline who is also in the early stages of pregnancy. As Lore’s contractions come and go, we learn both women’s sad stories: Franckline’s lost babies, and Lore’s lost love. Franckline’s midwifery is full of empathy and kindness, but this is starkly framed by the harsh restrictions and requirements of hospital policy, and the insensitive words and actions of her colleagues.

Lore arrives in the maternity ward alone, with a five page birth plan. Franckline is the only one to read and respect this, and does her best to steer things back towards Lore’s wishes, even as events keep on sliding off track. The labour progresses slowly, and then takes an unpredictable turn. Gripping fiction, and a great way to wrap up Meddings and Armstrong, and 2017.

30 May

Book Review: Birth Work as Care Work, by Alana Apfel

Birth Work as Care Work is an important introduction to the subject of intersectionality in the birth movement, drawing out themes of oppression and inequality through the stories of women.

Alana Apfel and her contributors identify the challenges of a profit-driven healthcare system dominating birth, and a society where “white volunteerism” overlooks the real lived diverse experience of birthing women in communities that are not their own. Apfel creates a space for birth workers to be heard on both a personal and a political level, including four beautiful birth stories.

I found this book challenging to read as a white middle class straight cis woman, because although I am steeped in a culture of empowerment, of being “with woman,” and of respect and awe of the birthing body, the contributors are quite deliberately not talking to me. Reading it has been a good lesson in making myself aware of the water I swim in, and not trying to “fix” others’ experience from within my own frame of reference.

This is a recommended read for anyone interested in the broad political and social context of birth, and wiling to feel like our work is radical, valuable, and important.

[Disclaimer: The author sent me a free copy of her book]. We will be chatting with Alana in Sprogcast Episode 27.

09 Sep

Book Review: Birth In Focus by Becky Reed

IMG_20160909_133611 What I love the most about this book is all the different perspectives. We have a collection of personal stories and photographs, mainly – inevitably – of births that take place at home. There are births in water, breech births, twins and a caesarean; and the stories are told both by midwife Becky Reed and by the mother, and then in several cases also by the partner, a sibling, and even a grandmother. It gives such a fascinating, colourful, and relentlessly positive picture of birth, in all its amazing variety.

The stories are then used to illustrate and provide anecdotal evidence for the final chapter, which all too briefly explores the theory of normalizing birth, giving a good overview of relevant research, and a great introduction to the subject for parents-to-be and birth professionals alike.

This is a book that is both useful and beautiful, and therefore it has a place in every home!

[Disclosure: I received a free review copy of Birth In Focus from the publisher Pinter & Martin. Order yours here, currently with free delivery and 10% off if you use the code SPROGCAST at the checkout]

19 Jun

Book Review: Optimal Care in Childbirth, by Henci Goer and Amy Romano

This dense and fascinating book presents a huge amount of evidence and a highly articulate argument for a physiological model of birth, starting from the premise that pregnancy and birth are healthy, normal experiences for the majority of women, and only where risk exists, does medical management become appropriate.

This approach fits nicely with my own philosophy of pregnancy and birth, and is well-supported by short analyses of the research in each chapter. Other reviewers have pointed out that the evidence is somewhat cherry-picked, as is always the way in the context of books on birth. It seems to be categorically impossible to have a truly objective reading of the evidence on this subject, and few people with any real knowledge seem to occupy a middle ground on the spectrum from hardline birth skeptics who can only allow the medical model, and advocates of straightforward physiological birth. Both groups tend to be very blinkered about research that contradicts their point of view.

Optimal Care in Childbirth gives a good insight into the source of this deep opposition between the two philosophies. Within the medical model, pregnancy and birth are presented as intrinsically dangerous and difficult. The historical background to this assumption is well documented. In the 21st Century western world, overall levels of risk, particularly to the mother, are very low; and this results in a narrow focus where almost the sole positive outcome to be achieved is a live baby and mother. Strategies are therefore devised to minimise the maximum potential risks, and preventative procedures become routine. This leads to an assumption that the medical approach is the norm, which has a knock-on effect on the research available. The more women who give birth by caesarean section, for example, the greater the belief in the medical community that birth is difficult and dangerous, and the more deskilled midwifery becomes.

There is no doubt that childbirth is complex, variable, and human; and the outcomes of childbirth are soft, complex and variable too. Goer and Romano define the optimal outcome as:

“the highest probability of spontaneous birth of a healthy baby to a healthy mother who feels pleased with herself and her caregivers, ready for the challenges of motherhood, attached to her baby, and who goes on to breastfeed successfully.” [p21]

However since the language and thinking of research is based in the medical model, the basic assumption is that non-intervention in childbirth equals risk, rather than the other way around. Optimal Care in Childbirth recommends reserving medical intervention for those women who would genuinely face greater difficulty without it, rather than protocols that offer it routinely in order to reduce risks that are already small.

The chapters of the book cover all the main topics of relevance to anyone working in childbirth (it is probably not a book aimed at pregnant women, who might get similar but more accessible information from Ina May Gaskin’s books). The chapters cover caesarean birth, induction of labour, care during labour, birth, postnatal care, and midwifery practice. Each chapter includes a mini-review of research and strategies for optimal care. It is a very practical book and an important resource for midwives, obstetricians, doulas and antenatal educators.