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.

16 Nov

Book Review: Trust Your Body Trust Your Baby, by Rosie Newman

Rosie Newman’s book aims to inspire confidence and trust in a mother’s own instincts, through pregnancy and birth, feeding and mothering. It is a book for women who need help with the paradigm shift of becoming a new parent. One of the things that really comes across is the value of surrounding oneself with like-minded, positive people. Newman is well-read and draws extensively on the literature of attachment parenting and straightforward birth.

Trust Your Body Trust Your Baby is sensibly structured with a logical progression, starting with a practical chapter on preparation for the baby’s arrival. The birth chapter gives an interesting history of obstetrics, an explanation of the role of hormones, and a valiant attempt to convey the reality of labour.

The following chapters cover life after birth: establishing breastfeeding, sleep, attachment, and the emotional and psychological adjustment. All of this is extremely good stuff that I would recommend to new parents; it is well-referenced and although it comes from a firm base in attachment parenting, and includes a great deal of Newman’s own experience, it is written with empathy and compassion for both the mother and the baby.

The last chapter is on elimination communication, and might make some new parents wonder if this really is the book for them, or whether it is too far from the mainstream. My clients tend to think The Baby Whisperer is a “a bit of a hippie,” so I’m conscious of wanting books like this to be accessible. Of course there is a huge part of me that really doesn’t want to pull any punches, too.

I was writing this review at a very quiet breastfeeding drop-in. Two mothers came in and we were talking about the conflict between trusting your instincts as a mother, and coping with the pressures of modern life, lack of sleep, lack of support, and the weight of expectations that babies should behave in a certain way by a certain age (both babies were 3 months old and not behaving in a certain way at all). So I gave one of them the book; may it help her find her way.

[Disclosure: I received a free review copy of this book from the publishers. You can get your own copy here, and a 10% discount using the code SPROGCAST at the checkout].

22 Feb

Book Review: The Gentle Discipline Book, by Sarah Ockwell-Smith

The Gentle Discipline Book is a book for parents, based firmly in attachment theory and gentle parenting practices, just as you would expect from an author who has very much made this her specialism.

Ockwell-Smith defines discipline as a supportive teaching process, and devotes a chapter to critique of discipline in its more widely-understood sense, i.e. punishment and reward. She supports this approach very thoroughly with a good chapter on neuroscience, and logical explanations of the developmental reasons for various behavioural issues in young children.

The book then goes on to look at a range of problems, from sulking to swearing, with helpful strategies for dealing with them. This is a widely applicable, useful read for all parents, and for anyone involved in educating parents and parents-to-be about raising children with empathy and kindness.

I also found that Ockwell-Smith gives a helpful perspective on parenting, recommending the 70/30 rule: “trying to be the best parent you can be 70% of the time and not worrying too much about the other 30%” (p238) As the mother of an occasionally difficult (but generally delightful) ten year old, I found this very affirming.

In this book, Ockwell-Smith offers an updated and less US-centric take on Sears’ Discipline Book, and I would recommend it unreservedly.

[Disclaimer: I was provided with a free review copy of this book]

17 Feb

Fed Is Best misses the big picture

There is a growing movement of vociferous breastfeeding skeptics, more organised and insidious than the usual lone voices of disappointed, angry, grieving women whose breastfeeding experience was not what they had hoped for. I have ignored it for long enough, but they now seem to be everywhere I look, and their words are dangerous and damaging.

As is so often the case, this “backlash” arises from one sad incident that happened to one articulate and privileged woman whose baby failed to thrive in circumstances where, if I understand it correctly, no baby could have thrived. I will refrain on commenting on a situation about which I know very little, as any well-trained and mother-centred breastfeeding supporter should. But this movement has easily, inevitably snowballed, gathering followers from that huge group of women who have been failed by society at a most vulnerable time.

This is a group of parents who are so upset that breastfeeding did not work for them, that they would prefer it not to work for anybody. Rather than campaign for better support and a more breastfeeding-friendly society, they present breastfeeding as an unnecessary choice, that mothers would be better off without. As with much of the anti-breastfeeding literature, we see the people who offer breastfeeding support portrayed as cruel, evangelical bullies and the well-evidenced disadvantages of formula milk downplayed.

In the past decade, I have written this again and again: we do not need to divide mothers and babies into the false categories of Breastfeeding and Formula Feeding. The first rule of infant feeding is to feed the baby, but “fed” is only best if “not fed” is the only alternative. And with better knowledge about breastfeeding and a more supportive environment, not fed should not happen. A woman with the confidence to trust her own instincts does not restrict feeds just because she has been told her baby’s stomach capacity is small; a well-informed woman who wishes to breastfeed understands that frequent feeding is what builds up a milk supply, and the delightful contents of every nappy can reassure her that this is happening; an educated health professional can support her with this knowledge.

Those key elements, maternal instinct and good information, slip through the cracks. And why do they slip through the cracks? Because in western society we believe, in the face of the evidence, that breastfeeding does not work. And why do we believe that it does not work? Because the voices of anger and disappointment are louder than the voices of women who just got on with it because it was no big deal.

There is no money in breastfeeding that works, unless you count the savings made in better overall health outcomes (and families who don’t have to shell out for formula): if anyone was really counting that, the governments of the western world would be investing in breastfeeding support and promoting a society that is truly supportive of breastfeeding mothers. Instead we have one where vitamins are marketed to them in case their milk isn’t good enough. One where lanolin cream is advertised for when their nipples hurt, as if this were inevitable. One where babies are expected not to inconvenience their mothers by requiring to be fed and to be held. One where qualified doctors can flatly deny science and continue to speak with the authority granted by their white coat.

It is a scientific fallacy to believe that cows milk, modified in a factory and dried into a powder, is better for human babies simply because it is sometimes more readily available. And it is a fallacy of privilege to believe that it is always readily available. It is not uncommon even in the UK for parents using formula not to follow the guidelines when making it up: too much powder (to make the baby grow), too little powder (to make the pack last longer), or water that is not hot enough to kill the bacteria (because it’s inconvenient, or they just don’t know, or they haven’t got a kettle). An 800 g tub of a popular formula costs £12.99 and would last roughly ten days for a newborn and five days at six months, if you feed according to the instructions on the side of the pack. Babies need breastmilk or a suitable formula until they are a year old. Breastfeeding support is free at the point of access. So tell me which of these is the choice of the privileged family?

Perhaps it is only the affluent and educated who can afford the privilege of lashing out at the passionate but inadequately funded network of people who could have helped them, and of missing the big picture of what is wrong in a world that let them down so badly.

08 Feb

Book review: Pride & Joy, A Guide for Lesbian, Gay, Bisexual and Trans Parents – by Sarah & Rachel Hagger-Holt

2017-02-07-18-30-37 This is the most perfectly-titled book I have ever come across, a fact which became increasingly evident as I read it – in one sitting – and found it to be so warm and upbeat, a book that is truly full of pride and joy.

Pride And Joy would be useful and interesting for LGBT parents; those considering becoming parents or even wondering if they ever can become parents; children of LGBT parents and other extended family members, and anyone working in a support role including health professionals, antenatal teachers and others. It is packed with anecdotes and quotes from that same wide-ranging group, so that it gives the reader a rich narrative, coherently exploring the broad experiences in the LGBT world. Each chapter ends with some points to consider, with signposting to useful resources, making it practical as well as very readable.

One thing that came across to me was that LGBT families have more common factors than differences with non-LGBT families. The authors treat extended and complex family situations as largely positive, acknowledging that blended families are now the norm for many people in western society, whatever the sexual orientation or gender identity of the parents. Many issues relating to pregnancy, birth, new parenthood, and growing up are not unique to LGBT families, however the fact that much of the support offered in these situations comes from the straight community reminds us of the importance of being open and inclusive when supporting parents. This book is well positioned to increase knowledge and understanding, and I hope it will be very widely read.

[Disclaimer: I was sent a free copy by the publisher. You can buy your own copy from their website, and use the code SPROGCAST at the checkout for a 10% discount]

04 Feb

Welcome to The Motherland

New guidance from the British Medical Association recommends a change of language, from “expectant mother” to “pregnant person,” in order to recognise trans parents who may not identify as women. I confess that this is very confusing for me, and my confusion arises from how, then, we should define motherhood. There is also a conflict between my inclination to accept whatever terms people want to use for themselves, but also to value motherhood in a way that does not easily allow me to erase the “womanness” of it.

Please don’t imagine that my point of reference for motherhood is limited to floating around in a cloud of organic breastfeeding loveliness. In fact, I think that might be the core of the dilemma: this question of whether to use the word “mother” is just terribly reductionist, as though motherhood can be only one thing.

Motherhood emerges in so many different forms, perhaps uniquely for every single person who has – but there’s the problem – has what? Given birth? Some mothers adopt. Parented? Are women who miscarry or suffer stillbirth not mothers? The literature is at pains to emphasise that they are. Does that mean that women whose pregnancies end in abortion are also mothers? Some of them might feel that way; it was certainly the start of the journey into motherhood for me.

Clearly there is not one single event that turns a person into a mother. Motherhood is more like a place you go to, where you experience new things, which you may have expected or not, and which you may enjoy or not, and which change you, but do not turn you into a specific and new type of person. As with travelling, those experiences will affect you to some extent, but will be assimilated into your existing self.

A close friend tells me that she always knew she wanted to be a mother, by which she means give birth to and raise children, yet a decade in she still feels that this isn’t the real her, these boys aren’t really hers (this existential angst must necessarily co-exist with doing the laundry and preparing packed lunches). On the other hand, I never particularly yearned for motherhood (and I overheard my own mother, when I was six months pregnant, remarking “Karen was never very maternal.”) And yet I simply could not be the person I am now, and do the most fulfilling work I have ever done, without it.

It seems acceptable for other people to identify me as a mother, but I would prefer them to understand that I am not solely – or even mostly – that, while still being that to my very core. Yet having argued that neither being pregnant, nor being a parent, are intrinsic to motherhood, I think we could explore the possibility of having a term that isn’t gendered, to represent having travelled to this place, should it be necessary to reveal that element of one’s identity.

What of fathers, who now are expected to take on more of the nurturing role traditionally associated with motherhood? Up to 50 weeks of parental leave can now be shared in the UK, so dads can take on the majority of the parenting from very early in a child’s life (and technically a man can “father” a child without even knowing about it, so how can fatherhood then be part of his identity?). Perhaps the word “mother” is only differentiated by being the one who is expected to do the majority of the housework, whether he or she works outside the home or not.

[Cross-posted from Huffington Post]

02 Oct

Book Review: Baby-Led Parenting, by Gill Rapley & Tracey Murkett

From start to finish, this book is thoroughly useful. I loved its measured tone and empowering language, and its clear explanations of how babies’ behaviour has evolved to meet their basic survival needs.

It is clearly divided into chapters along the main themes of meeting baby, feeding, sleep etc: those crucial subjects for a new parent. Particular highlights include p65 on the father’s role during a babymoon period, the excellent baby-centred advice around bottle feeding, and the long list of suggestions to soothe a crying baby.

Throughout, and especially in the chapter on communication, Rapley & Murkett encourage new parents to develop empathy with the baby’s point of view, as well as reassuring them that responding promptly and positively to a newborn’s needs will foster independence, security, and a strong bond between parent and child.

If I had to come up with a criticism, it would be that a glossier, more colourful book, might have wider appeal with new parents. But this really is a positive book full of well-evidenced, practical information, from authors who are well-respected authorities in their field.

03 Mar

Book Review: Beyond the Sling, by Mayim Bialik

Mayim Bialik is a neuroscientist, an actress, and with this book a real spokesperson for Attachment Parenting. If you imagine a spectrum with absolutely routine-focused, parent-led families at one end, and completely baby-led, bed-sharing, nappy-free families at the other end, then Bialik is telling a story set right at the tip of the baby-led end of that spectrum. The title “Beyond the sling” tells us just how far along it is.

As she tells us at the start, this is not a quick-fix parenting manual. Although she clearly is writing about what, in her view, is the best way to parent, she delivers most of this through anecdotes about her own family. I spoke to a new mother recently who liked that because it gave her a new perspective to think about, rather than telling her what to do.

Attachment Parenting considers parenting to be “the most natural and instinctual event on the planet.” (p11), fostering respectful and loving relationships between parent and child, and ensuring a securely attached, happy individual. Bialik argues that this process is innate and this outcome biologically inevitable, and devotes one chapter to explaining some very basic science behind attachment theory. This section was disappointingly thin on actual science.

Part Two of the book is entitled “What a baby needs,” and covers birth, breastfeeding, babywearing, bedsharing, and elimination communication, which she feels gave her a deep intuitive connection with her children. These chapters are mostly evidence-based, however they frame this style of parenting very much within the limitations of natural birth, exclusive breastfeeding, and easily cleanable floors, which I fear would make her exhortations inaccessible to many parents.

Part Three is about what babies don’t need, and while there is much to admire in keeping one’s home free of battery-operated toys, I absolutely cannot get behind her “informed decision” not to vaccinate her children, and feel that the resources offered to support this very brief section are rather one-sided.

The chapter on discipline gave me a lot to think about; I felt like I violently agreed or disagreed with every other paragraph. There is much clear and logical thinking about how to deal with behavioural matters, but many of the anecdotes about how she and her co-parent implement this thinking seem not to line up with the theory. I think that a child would understand “not for Miles” (p195) to mean exactly the same thing as “no,” but perhaps it depends on the parenting context. I feel like I must be missing some very subtle nuance here.

I would be unlikely to recommend this book to someone who hadn’t specifically asked for something on Attachment Parenting. I am uncomfortable with dogma at any end of the spectrum. Bialik states that “this is not a judgemental book,” nor is it one of those books that “make me feel that I am failing and inadequate,” (p13); and yet this is exactly how I felt reading it – and this is from the perspective of a straightforward birth, bedsharing, full term breastfeeding, and a pretty good grasp of brain development myself. When Bialik claims that she does not need to put her own needs on hold to parent in this extreme way, she also contradicts herself by repeatedly telling us how tired she is, but that it is the right thing to do. I think it would be okay to be honest about the amount of sacrifice needed to parent in this extreme way, and that there are parents who will choose it anyway, or moderate their approach to meet both their own needs, and those of their children.

Disclosure: I was sent a free review copy of Beyond The Sling by the publishers Pinter & Martin. You can currently buy it on their website for £6.99.

19 Oct

Book Review: The Food of Love, by Kate Evans

The Food of Love is a fun breastfeeding guide full of Kate Evan’s clever pictures and even fuller with words. I think it is aimed at mums-to-be and new mums, but I think it’s also widely enjoyed by people working with new parents.

There is a lot to like about this book. Most of the cartoons are funny (some of them are a bit judgey), and it is jammed with a huge amount of well-researched information. Evans positions herself firmly at the Attachment Parenting end of the spectrum, and is more than capable of backing up her position with evidence. Unfortunately she doesn’t, always, which relegates a lot of her bold statements to opinion. The book would be much stronger if it was better referenced.

In the early chapters, Evans covers the basics of how breastfeeding works, using cartoons to demonstrate very clearly the mechanics of breastfeeding as well as a lot of the interesting sciencey stuff about breastmilk. The section on hand expressing is excellent; the section on positioning is surprisingly prescriptive – I’m sure laid-back Kate didn’t always sit bolt upright to breastfeed.

Evans’ passion and enthusiasm for breastfeeding comes across on page after page of often rather stream-of-consciousness text, as though she has scribbled down everything she can think of about breastfeeding, and when she runs out of that she goes on to talk about parenting in general, sleep, postnatal depression, relationship stuff, and toddler discipline. It’s a really useful general parenting book in that respect and could probably reach a wider market if sold as such.

I enjoyed the lovely bit on the evolutionary context of attachment theory, again illustrated with amusing drawings. Occasionally she follows a fairly idealistic opinion section with a contrasting realistic cartoon, for example the starfish baby in the middle of the bed showing the reality of co-sleeping for many parents.

We have the obligatory dip into alternative medicine (which if it worked would be called medicine), which is a shame when she’s so clear and comprehensive on brain chemistry and other sciencey stuff. The recommendation of homeopathic belladonna as a treatment for mastitis is a highway to a breast abscess.

The chapter offering solutions to common breastfeeding problems includes some excellent flowcharts (pp131-132), however the solutions offered are a bit garbled in places and there is no signposting to reputable breastfeeding support organisations such as NCT or ABM, nor any discussion of breastfeeding support groups (which surely would lend themselves well as subjects for caricature).

In summary, I loved parts of this book but not all of it. I probably would give it to a new parent, but not universally; I think some people might be more receptive to it than others. I’d love to see it repackaged as a general parenting book as it’s so good on attachment parenting. And I can strongly recommend Kate’s blog!

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