pregnancy | Motherworldly

02 Jul

Book Review: Expecting Better, by Emily Oster

This book has come across my radar a few times, so I finally got round to picking up a copy. I think my lateness to the Emily Oster party may be because I didn’t much enjoy Linda Geddes’ similar book Bumpology, so let’s put that one to bed straight away; this is much, much better than Bumpology.

Expecting Better is well written, with a personal but not annoyingly chatty tone, while also explaining very clearly how to understand some quite complex research, and incorporate that into one’s decision making. It is aimed at parents-to-be and its chronology starts with trying to conceive, and to my disappointment ends at the birth, although I now see that there is a follow up, cleverly named Crib Sheets, which I shall be purchasing as soon as I finish typing this.

The consequence of the book ending with the birth of Oster’s daughter is that I cannot apply my usual test, of checking the tone and accuracy of the breastfeeding section. I have had, instead, to apply my more shallow knowledge of pregnancy and birth, to decide how good I think Expecting Better is.

Oster uses her introduction to explain that, as she is an economist by trade, she likes to make decisions using data. Her model of decision making is to take the data, and combine it with your own personal set of pros and cons. This, then, is how she has set out her book; and while it would be impossible for her to have researched every possible issue that a pregnant woman might face, it’s clear that she has written mainly about those decisions that she personally had to make. So we get almost an entire chapter on caffeine, and two paragraphs on restricted growth and related decisions. However, that is not to say that she doesn’t cover enough; the book is comprehensive, obviously well-researched, and thoroughly referenced., and key points are summarised at the end of each section for when you don’t feel like reading every nuance of the different antenatal screening options.

Language and some content has been edited for UK publication, however Oster is in the USA and this does skew some of what she feels she needs to know about, and her general attitude to birth. She touches on the role of midwives, but knows that a doctor (and a doula – hooray!) will be present at her birth, and she will certainly not be allowed to eat during her labour. The research she looks at are mostly USA, UK, Australian and European, with some cultural comparison as well. The induction methods discussed are definitely american, and there is limited discussion of any pain management options other than epidural.

The implicit message of this book is that informed consent is not possible for the majority of parents-to-be, as the necessary information is not easily accessible. Oster clearly makes up her own mind on a number of issues, after being given scant or even incorrect information by her own healthcare professionals; interestingly she doesn’t seem to question routine vaginal examination, and she is certainly working from an all-that-matters-is-a-healthy-baby point of view.

I sound critical but I did enjoy this book, learned some interesting things about caffeine, and was reminded that I haven’t read so much detailed information on food poisoning since I took my Intermediate Food Hygiene certificate, a quarter of a century ago. Emily Oster is a one-woman systematic review, driven by her own need for evidence to support her decision making; and the book she has produced will undoubtedly be useful for other parents, albeit with the caveat about some of the information being less applicable in the UK.

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]

03 Jun

Book Review: Inducing Labour: Making Informed Decisions, by Dr Sara Wickham

Sara Wickham’s new book Inducing Labour: Making Informed Decisions aims to explain the process of induction to parents and to professionals. It very clearly covers the how and why, and comprehensively goes into the risks and benefits of the most commonly encountered scenarios. Wickham argues strongly for women’s bodily autonomy and individualised care, and the whole book is set firmly within the evidence base. Her discussion of the evidence was for me (and unsurprisingly!) the strongest point of an all-round excellent book, and I was prompted to reflect on her point that we all interpret the evidence according to our existing biases.

This is a book written for women, addressing “you” the pregnant mother, but without holding back any technical points or difficult statistics. It is also an important read for antenatal teachers, midwives, and anyone supporting women to make decisions about their care. There are, for example, some useful points that a woman can use for agreeing a “due date” with her midwife or consultant, and some questions that are helpful to ask in order to ensure care is personalised rather than simply following a protocol. Above all, there is really clear information about the impact of induction in a number of different situations, and a good breakdown of statistics for example on the risk of stillbirth in older mothers, and how likely it is that earlier induction would make much difference to these stats (answer: not very likely).

In fact the message that comes across most clearly is to trust women and to trust women’s bodies. The evidence that induction routinely improves outcomes is simply not there, and anyone needing to argue that point with a clinician would find this book a really useful resource. In a culture where the baby’s safety is prioritised over everything, it is good to read a practical, straightforward discussion of why intervention is often not the best way to do no harm.

I was sent a free review copy of Inducing Labour. You can get more information here, and your own copy from here.

20 Apr

Book Review: Your No-Guilt Pregnancy Plan, by Rebecca Schiller

I’ve been waiting for this book for years – since my own pregnancy, in fact.

Rebecca Schiller, director of Birthrights, has created a manual for pregnancy, birth and the early weeks of parenthood, that is mother-centred and evidence-based, and achieves that incredibly difficult feat of getting the right tone when balancing those two things.

Your No-Guilt Pregnancy Plan – A revolutionary guide to pregnancy, birth and the weeks that follow skips the “your baby is the size of a walnut/pear/skateboard” theme that most writers on this subject consider to be mandatory, and focuses on what is happening to the woman: how she might be feeling, how her body is changing, how the pregnancy/baby affects her world. It includes exercises and checklists to help women reflect on their goals and enjoy the experience; and is kept completely up to date with an accompanying set of links to further reading and support on Rebecca’s own website.

As with most such books, there is a chronological approach. However some things you will not find in most such books are a clear emphasis on the rights of women, on the basis that when women are well cared-for and respected, outcomes improve for them and for their babies. It’s a very realistic book, and a fine example of giving information without advice. With one or two small exceptions, this book is about the reader, not the writer.

And so we come to the breastfeeding section, which you know I looked at first. It’s good. It covers the basics of milk supply and positioning, some of the early challenges, and where to go for help. This sits alongside clear guidance about formula feeding, and not a lactation cookie in sight.

The final chapter of the book helps the reader to refer back to relevant sections of the book, in order to create a personalised plan for pregnancy, birth and afterwards, including a going into labour checklist, and a ‘little black book’ of support for the early days, so you don’t have to figure it out when you need it.

This is the most realistic, practical and informal guide I have seen, and goes straight to the top of my pile of recommendations.

[Disclosure: I received a free review copy of Rebecca’s book.]

29 Aug

Book Review: Growing Up Pregnant, by Deirdre Curley

I sat up in bed and admired all the women in the room. All of us had different birth stories, and we each realised how lucky we were to have healthy babies. Although we were all at different stages in our lives, we were all going to be going through the exact same transition into motherhood. (p184)

Deirdre Curley is pregnant and 19. She is surrounded by a supportive family and a loving partner. She really wants to be an actress, and she isn’t at all sure she wants to be a mum.

In Growing Up Pregnant, she tells the story, not just of pregnancy and birth, but all the things that bring her to this point. And then in detail she takes us through the months of her pregnancy, and the reader witnesses her maturing from good-time girl to “the most beautiful pregnant lady” one waitress has ever seen. When she and her partner make up their minds that they will be parents, they commit to the changes they need to make, even when it’s hard to adjust to the loss of old pleasures and still-partying friends. It’s so interesting to read about their mixed feelings as they adjust to this new lifestyle, and the strength and positivity they bring to it is admirable.

Deirdre pauses between each trimester to give a little rundown of what a pregnant woman might be experiencing, how her baby is developing, and any preparation she might consider doing. This includes the most down-to-earth “what to buy” lists of any pregnancy book I have read. She refrains from too much specific detail about pregnancy and birth, but gives a useful overview that would be relevant to a pregnant woman of any age.

This is a properly grounded book, both reflective and informative, and does as good a job as any (and better than most) of getting across what it’s really like to be pregnant and to have a baby. Although the focus is on pregnancy as a young mum, most of the feelings Deirdre expresses are pretty universal: what is happening to me? Will my body ever be the same again? Can I rely on the support of my partner? Am I going to be a good enough mum? Women twice her age think the same things.

I enjoyed taking this journey with Deirdre and her partner Gary, as they put down roots and prepare for the baby. The birth itself is well-written, and early motherhood is covered with both wistfulness and joy. It is a very realistic description and I would certainly recommend this book to pregnant women, whatever their age.

[Disclaimer: I was sent a free review copy of Growing Up Pregnant. You can order yours from Pinter & Martin, with a 10% discount at the checkout if you use the code SPROGCAST]

16 Mar

Book Review: Why Hypnobirthing Matters, by Katrina Berry

This interesting little book explores the development of hypnobirthing as an approach to childbirth, from its origins in the thinking of Grantley Dick-Read, to its modern usage in situations from freebirth to caesarean and beyond. Author Katrina Berry points out what a useful coping technique it can be for early parenthood and for life in general.

The book goes on to explain how hypnobirthing works, and its relevance for birth partners and midwives. It does not claim it as the province of one particular type of birth, but does emphasise its role in increasing the likelihood of a straightforward birth, and offers information to empower women to make their own choices in any situation.

It finishes with a useful comparison of the different hypnobirthing tribes, in their own voices. This gives a real flavour of the slight changes in perspective from one programme to another.

Parents-to-be or practitioners with an interest in hypnobirthing can use this book to learn about what it is, and then decide which path will help them on their own journey.

[Disclaimer: I was given a free review copy of this book by the publisher Pinter & Martin. You can buy it here, with a 10% discount using the code SPROGCAST at checkout.]

24 Feb

Book Review: How to grow a baby and push it out, by Clemmie Hooper

Clemmie Hooper is the new Mark Harris: the midwife all the talk shows want, popular on social media, and with a new, slightly different book about pregnancy and birth. Sorry Mark.

‘How to grow a baby and push it out‘ is a colourful, cheery book, with lots of pictures (mainly of Clemmie herself looking pregnant and glamorous). With a heavy emphasis on what to buy and how best to treat yourself (“Find a really, really lux hotel to stay in.” p101) and an assumption that you will “buy friends” by doing NCT classes, this really is the yummy mummy’s handbook.

I would have quite liked this book during my pregnancy ten years ago. In between the slightly vapid chapters about shopping, it covers a lot of topics, including how to massage your perineum, what to consider when choosing a place to give birth, and different options for coping with pain. With its bite-sized chapters and clear explanations, it is more accessible and less gloomy than the book I did have, ‘What to expect when you’re expecting.’

Reading it now, I would like to see more on consent and informed choice; Clemmie is in a good position to talk about building that kind of trusting relationship with Health Professionals, but at the end of the day she is working within a medical model, and that’s what comes across. The information given about breastfeeding is scant and inadequate, starting with a list of its benefits, omitting any discussion of how it works, conveying the message that it is always difficult and usually painful, and then admonishing readers not to pay attention to pressure about how long to do it for. This could have been done so much better.

I liked the positive tone of the book, although in places the chumminess gets annoying; and I liked the focus on active birth, and the signposting (other than in the breastfeeding section) for readers who would like to explore the many topics in greater depth. It’s a nice starting point for mums-to-be who like a guidebook, but doesn’t really replace good quality antenatal education, where there will be more for partners, and lots of opportunities to discuss what might happen and how you might feel, rather than just be passively told about it all.

29 Feb

Maternity Review: Informed Choice and Personalised Care

Yesterday’s publication of the 2016 Maternity Review, glossily titled “Better Births,” gave rise to a mixed response in the press. The 126 page document is a fascinating compilation of statistics and feedback gathered from parents and health professionals, much of which tells an all-too-familiar tale about disconnected care, conflicting advice, families feeling unsupported, and midwives and other health professionals working within the confines of a complex high-pressure environment.

The main recommendations of the report were:

Personalised care, with genuine choice, informed by unbiased information;
Continuity of carer;
Safer care, with professionals working together across boundaries, and a culture of safety, with rapid and transparent investigation of mistakes;
Better perinatal mental healthcare;
Community hubs so that women can access a range of care from different professionals, including local midwifery practices;
Reform of the payment system for maternity services.

Mainstream media were quick to focus on the proposal that women should have a £3000 budget and a choice of birth places and carers. The Times describes this as women being “handed £3000 by the NHS,” a scenario which seems as unlikely as its tone seems dismissive of women’s abilities to think straight if presented with such quantities of money.

In what I will call the “birth press,” the response was more mixed, with much applause for the focus on personalised care, continuity of carer, and genuine informed choice. Doula and founder of Birthrights Rebecca Schiller wrote in The Guardian of her expectation of “the inevitable barrage of scepticism about whether we can handle the weight of responsibility for our own health.”

Jane Merrick in The Independent immediately obliged:

Do all expectant mothers really want personalised care plans, as proposed by the National Maternity Review? […] Although there is no cost to the individual, placing the burden on mothers, with a price tag attached, is yet more pressure and yet another thing for pregnant women to worry about.

There was a widespread response that, since homebirth is generally cheaper than birth in a hospital, the focus on cost efficiencies would see health professionals encouraging more homebirths, even, according to Kim Thomas, author of Birth Trauma, when this is not clinically appropriate. Many birth workers will be reading this with a raised eyebrow; experience suggests that the interests of the baby always trump the interests of the mother, and it would take a huge change of culture for homebirth to be routinely recommended even when it is clinically appropriate.

Another undercurrent in the response among the birthy people is that the report, and particularly the recommendation of the birth budget, opens up the door to privatisation of maternity care, as well as the use of NHS funds for non-evidenced forms of care. The report itself tells us that parents want to be able to make informed decisions:

Many women expressed frustration over receiving conflicting advice from different healthcare professionals throughout their care. Women and their families told us they need to be able to access
appropriate information to enable them to make genuinely informed decisions about their care and where to give birth. They wanted information to be evidence-based and available to them in a range of
formats, including online.

What this report is calling for is a huge cultural upheaval, as well as a change to the infrastructure of birth in the UK. To be able to offer genuine choice of birth place, we would need more midwife-led birth units and more midwives able to support homebirths. Health professionals across the board would need training to bring about a shared knowledge of the evidence base as well as an understanding of the different perspectives they bring to maternity care. I think perhaps the body of the NHS may be willing, but the purse strings are held too tightly by people who do not have this knowledge or understanding.

Cross-posted from Huffington Post.

25 Feb

Why are twins double trouble?

From conception onwards, having twins seems to raise the bar. Through pregnancy and birth, mothers having twins are viewed as twice as delicate, with their precious double burden, placing a pressure on babies and parents that impacts on the birth as well as the early days and weeks of the babies’ lives.

Google “having twins is” and autofill offers the options of “hard” “so hard” “a blessing” and “a nightmare.” It must be difficult to focus on the blessing when society is so hell-bent on telling you you’re in for double trouble. “The way the majority of people turned my twin pregnancy into a negative really surprised me,” says mother of twins Jen. Another mum Mally adds “It makes you feel incredibly isolated. People are incredibly arrogant to think that they are much better off with ‘just the one’ (at a time).”

Having twins is increasingly common in the UK, partly because the overall birthrate is increasing, and medical advances means that more twins survive when born prematurely. In addition, women tend to wait a little longer to have babies, and over the age of 30 the likelihood of releasing multiple eggs, and therefore having twins, increases. Assisted conception through IVF and fertility drugs is another contributing factor. And more twin pregnancies means more opportunity for little old ladies to hover over your bump or your pushchair, giving advice and telling you what hard work it’s all going to be.

Kate, who has triplets, says: “Apparently it’s perfectly fine for the first question out of the gate to be ‘are they natural?’ Or ‘How were they conceived?’. What difference does it make? But it always feels like a loaded question to me.” It is loaded: with the assumption that you couldn’t have managed this all by yourself, and therefore that you cannot possibly birth, feed, or generally manage these babies all by yourself.

Most mothers who are having twins give birth to healthy babies. Some complications are more common in twin pregnancies, and modern medical practices mean monitoring for high blood pressure (a sign of pre-eclampsia), gestational diabetes and anaemia, all of which can usually be managed. For the babies, the complications that are likely to arise are a result of prematurity or low birth weight.

Giving birth to twins without medical professionals hovering around like cats on hot bricks seems unlikely. Even in the most uncomplicated twins pregnancy, it can be a challenge to avoid being channelled down the high-risk route and straight into theatre for a c-section. The effect of this is that skills and confidence in giving birth to twins without intervention are gradually eroded, and this is self-perpetuating.

I had the lady serving me in the post office say ‘twins? Poor you!’ the other week. I was so shocked I just stared at her. She then said ‘so you’re done now then’. I thought about her comments all day and got more and more upset. (Marie-Claire)

Once the babies arrive, the focus switches to all the things you surely cannot manage to do with two babies: breastfeed, sleep, get out of the house, retain your sanity. Most of the time I talk to singleton mums who tell me that all of those things are difficult; I’m not convinced that they are twice as difficult with twins, and one thing I know is that twins mums are a little better at recruiting the help they need. Life with any number of new babies can be hard work, and it’s hard to define “more” sleep-deprived when you’re as sleep-deprived as it seems possible to be.

Society needs to stop feeling sorry for mothers of twins; it’s a judgement they probably don’t need, and they get twice as much of it.

Thanks to members of Reading & District Twins Plus Club for their input. We’re talking about having twins in the next episode of Sprogcast.
Cross-posted from Huffington Post.

01 Sep

On having an abortion

[10 years ago]

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

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

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

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

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

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

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

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

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

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

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

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