17 Nov

Safe Sleep

Many new parents want more sleep, and one way to get that would be if their babies would sleep peacefully through the night. In fact, so often when asking a new parent how they’re getting on, well-meaning friends, relatives and complete strangers in the street focus on how much the baby is sleeping: “is she good?” usually means “does she sleep through the night?”

In fact it’s completely normal and, biologically speaking, healthy for newborns not to sleep through the night: a difficult truth for new parents to hear. The stomach capacity of a newborn is 5-7ml, and breastmilk is highly digestible, so it’s normal and necessary for a baby to wake to feed at least two or three times a night. All that feeding supports the rapid growth and brain development that goes on in this stage, as well as helping to boost the mother’s milk supply. Formula fed babies could also be fed little and often to mimic this frequent refuelling which is appropriate to the baby’s growth and capacity.

SIDS research also shows that babies’ light sleep helps them to arouse quickly in response to any changes or risks in their environment. This may reduce their risk. This is why it’s recommended that babies who sleep alone are put down to sleep on their backs, where they may not sleep as deeply or as long, but are at a lower risk of cot death. It’s also recommended that babies sleep in their parents’ bedroom until six months of age, when the risk levels drop.

The other safe sleeping guidelines are:

  • Place your baby on its back to sleep, in a cot in a room with you
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby
  • Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker
  • Never sleep with your baby on a sofa or armchair
  • Do not let your baby get too hot or too cold, keep your baby’s head uncovered, and place your baby in the “feet to foot” position
  • Breastfeed your baby

There are some great resources on sleep, including the Infant Sleep Information Source, which is fully-evidenced. We haven’t even got into some of the more controversial practices such as bed-sharing and swaddling here, but perhaps those are posts for another day.

13 Nov

Birth Plan Prompt Sheet

Birth planning is a vague science; some birth workers now refer to “birth preferences” instead, and some prefer to avoid this sort of planning altogether. I’ve found a few resources online including this comprehensive tool from the NHS, and cobbled together a list of prompts so that my clients and I can go through it together and make something that is completely tailored to their needs. I’ll be taking several copies with me to the birth!

Birth Plan

Early labour – where?

Where to give birth – MLU/delivery suite/pool etc

Who do I want to be with me?

Equipment I plan to take with me

Intermittent/continual monitoring of baby during labour

Keeping active during labour

Positions to adopt

Trainee midwives/doctors in the room

Immediate skin to skin

Pain relief preferences

Episiotomy

Third stage – active/managed

Breastfeeding

Vitamin K

Any special requirements

03 Nov

Getting started with solids: Purees

If you have chosen to offer pureed food for your baby’s first taste of solids, don’t forget it doesn’t have to be baby rice! For a healthy term baby showing signs of being ready for solid food, lots of other colours and flavours are available for those first steps on the journey towards a healthy enjoyment of food.

The main nutrients your baby needs in his or her diet between 6-12 months are still protein, fat and calcium, so there is no hurry to cut back on milk, which is such a great source of these things. When you start solids it’s all about the taste experience, so try not to let your baby fill up on food and have no room for milk. Just one or two teaspoons is plenty for the first few meals.

Vegetable Puree
You will need: approximately 100g of any suitable vegetable. This could be a small sweet potato, a carrot, a few florets of broccoli or cauliflower, half a butternut squash, a parsnip, a handful of peas, a fresh beetroot, some spinach leaves, or anything that can be cooked in the following way.

If you would normally peel the vegetable, then peel it. If not, just wash it. Cut larger vegetables into small dice.

Steam for 5-7 minutes, or boil in a small amount of water for 6-10 minutes.

Check it is soft enough to blend.

Using the chopping attachment of a hand blender, or in a food processor, puree the cooked vegetable until it is smooth. If necessary, add a small amount of cooking water to thin the puree.

If you want the puree to be smoother, pass it through a mouli or sieve. If you want it to have a little more texture, you could mash with a potato masher or fork.

Separate out a portion (two teaspoons) for the meal, and allow to cool before serving.
Cool the rest and store in clean containers in the fridge or freezer.

Fruit Puree
Hard fruits such as pears and apples can be prepared using the method for vegetable puree described above.

Soft fruits such as nectarines, peaches, plums, mangoes and apricots can be peeled and simmered for 3-5 minutes with a tablespoon of water, and then blended to a puree.

Bananas make a very convenient no-cook puree: simply mash or mush with a fork, and use immediately.

Lots more introducing solids resources can be found here.

18 Oct

Maggie’s Birth Story

Maggie’s daughter turns 13 next week; here’s the story of her birth:

I had quite a traumatic birth experience with my son, so when I found out that I was expecting my second baby I was pleased, but partly worried that we would have to go through a similar experience again. My son’s birth had been a planned home water birth, but my blood pressure had become high in the last month of pregnancy and at the onset of labour he had become distressed, leading to an augmented labour, followed by a failed ventouse and then forceps delivery. I had the same community midwife with this second pregnancy, and at my booking-in appointment, she told me that I would have to be checked by the consultant, and strongly advised against having a home birth, given what had happened previously.

This second pregnancy went very well, until six weeks before my due date when my blood pressure went up to 130/90. At this point I started to worry about history repeating itself. Over the next six weeks, however, it stayed more or less constant at 130/90, which although high, was what it had been at my booking-in appointment, so the midwife and consultant weren’t unduly worried.

On the day after my due date I went to bed at 10pm and fell asleep very quickly. Two hours later I woke up as I realised that my waters had broken. My first labour had started the same way, but this time the fluid was clear – so far so good. An hour later we arrived at the Royal Berks Hospital. In the car, the contractions had been pretty mild, but coming about every 5 minutes. The midwife on duty gave me all the routine checks, told me I was about 1cm dilated and that everything seemed to be going normally. She just had to check on my contractions and the baby’s heartbeat and then I could go home and wait for the contractions to start in earnest.

On went the monitoring belts for the obligatory 20 minutes. At the end of this time the midwife looked worried, and told me that she wanted to leave the belts on for a bit longer and get the registrar to look at the trace. The baby’s heartbeat was apparently too steady – not enough variability, which meant that the baby was either asleep or distressed. At the end of 50 minutes the trace hadn’t changed much and the registrar was also worried. She told me that it was very likely that I would have to have a caesarean if the baby was distressed this early in labour, and even if not, they would have to speed things up with a drip. When we were asked what our feelings were about this my husband said angrily “I’m just afraid of the whole bloody thing going balls-up like it did last time”

In the meantime we were moved to a delivery room in order that they could attach a scalp electrode to the baby’s head to give a better indication of the heart rate. By now it was about 2.30am and my contractions were slowly gaining in strength and still coming regularly. Once the readings started coming through the scalp electrode the output from the monitor was faxed through to the on-duty consultant to determine whether the caesarean was required or not. The trace had improved somewhat, but was still considered suspicious. In the meantime my midwife took some blood samples from me as there was some concern regarding my blood pressure and the anaesthetic for the caesarean.

The reply from the consultant came back – no need to do a caesarean yet, but certainly augment the labour with a drip. When I was told this, I asked for an epidural to coincide with the drip going up, as I knew from my first labour that I didn’t want to have to deal with the more painful contractions that would result. However, it wasn’t possible to have either the drip or the epidural until the blood test results came back. By this time the contractions were beginning to get stronger and I was using the breathing technique to get through them, standing next to the bed and leaning on the monitoring machine. They were lasting about 45 seconds and coming every three minutes. I was beginning to think that I should have put my TENS machine on, but under the circumstances I hadn’t bothered as I’d thought I’d probably be on the operating table by now! I debated whether to use gas and air, but somehow I didn’t think I wanted it just yet as the breathing on its own was making a difference.

Eventually the blood test results came back just after 6am, they were fine, and by that time everything was set up ready for the drip to go in and the anaesthetist to do his work. Just before though, I asked for an internal examination to see how things were progressing on their own. I was 3cm dilated by this time, and having been up all night was glad to lie down on the bed for a while.

I had the epidural and up went the drip. Down went my blood pressure to about 70/40 as I reacted to the anaesthetic, felt extremely light headed and debated whether or not to be sick. This reaction passed fairly quickly, and I was pleased to discover that the anaesthetist had got the dose on the epidural spot on. It dulled the pain of the contractions, but I was able to stand up next to the bed and move around to a limited extent. My real fear was that I would end up having to lie still on the bed and give birth in that position. The midwife who had been with me all night went off duty shortly afterwards at 7.30 and another midwife took over.

After another hour and a half the registrar returned and at the same time I realised that the epidural was beginning to wear off, so I asked for a top-up. This was administered just before the registrar announced that they wanted to take blood samples from the baby’s scalp to gauge how distressed it might be. So, back on the bed I went and the registrar started to try and take the blood samples. In passing she told me that I was now 4cm dilated. In the end she had to take three samples as there wasn’t enough in the first two samples to do an accurate blood test. Once she had taken the third she told me I was now dilated to 7cm. At this point I was beginning to suspect that the top-up epidural wasn’t working as not only was I feeling uncomfortable from the internal examinations, but the contractions were getting more painful rather than less. Whilst waiting for the blood results to come back (normal again) the registrar performed a stretch and sweep and told me I was 9cm dilated – quarter of an hour after I’d been 4cm!

The registrar then left my husband and I alone with the midwife. By this time the initial epidural had completely worn off and the top-up hadn’t done anything so I could turn round on the bed so I was kneeling and leaning against the head of the bed, and very shortly I started getting the urge to push. My new midwife was great at this point, she stood back and told me to go with my body, and do whatever felt right.

As the urge to push got stronger I went with it and started pushing. Four minutes and four contractions later at 9.30am the baby’s head appeared, followed at the next contraction by the rest of her body – a little girl! After an eleven minute third stage and some oxygen for the baby she was put to the breast to feed and stayed there for half an hour! After everything that had gone before it was an extremely positive birth experience in the end.

Three and a half hours after the birth we left hospital and brought our daughter home to meet her brother. My mum, who had been babysitting, was amazed to see us – the last update she’d had from my husband had been when we were preparing to have a c-section!

16 Oct

Book Review: The Birth Partner, by Penny Simkin

Penny Simkin is an author, doula, childbirth educator, and birth counsellor.

I was advised to read this book prior to my first job as a birth doula, and having now read it through, I will probably take it with me when I get the call. Aimed at dads, doulas and other birth companions, and packed with details of what happens before, during and after labour, it is not a small book, but its chapters are easily accessible and logically arranged.

The long section on normal labour is particularly useful. Each stage is broken down into a description, followed by what the mother feels, what a birth partner might feel, what a caregiver would be doing, and what a doula would be doing. There are suggestions for self-care and coping strategies appropriate to the challenges of each stage; it’s a real step-by-step manual.

There is a medical level of detail on pain relief, and this would need to be read and absorbed beforehand rather than at the time, but it remains a book to dip into during the process for an idea of what is happening and how to deal with it.

For when things don’t go to plan, the book covers instrumental and caesarean birth as well as other interventions. Helpfully value-free, Simkin sets out the things to take into consideration, and strategies for decision-making.

A comparatively short section at the end covers the baby’s first few days, and post-partum recovery; again with a what to expect/how to support the mother focus.

My one criticism of the book is its US-centric language, which makes me suspect that some of the procedures described may differ in the UK. But women’s bodies are the same all over the world, and ways of supporting a birthing mother are universal.

This book is a must-read for anyone working in birth, and for birth partners who prefer a lot of detailed information in a format they can refer to both before and during labour.

06 Oct

Dear Doctor

Views expressed here are my own, and do not represent the views of NCT.

This weekend, Dr Ben Goldacre stood on a stage in front of hundreds of NCT Practitioners, volunteers and staff, and told us that we “push” breastfeeding. “Because you do,” he said, with a cheeky wink. “You’re the breastfeeding nazis.”

There was a sort of silent stunned gasp, followed by a burst of laughter; it was the funniest thing, a great ironic deconstruction of the name-calling rubbish (with acknowledgement to my colleague Kerry from whom I pinched that description). It was funny the second time he said it, too. After a while I was much reminded of my eight year old son and how he repeats the joke until you have to sit him down and explain that we’re really over it now.

We were treated to Goldacre’s standard comedic romp through the Daily Mail’s war on cancer, his low opinion of Gillian McKeith, and a selection of amusing headlines that can be achieved by cherry-picking statistics. Lucky us, we got a little extra bit on research statistics, and then a worked example using Brion et al’s 2011 article entitled What are the causal effects of breastfeeding on IQ, obesity and blood pressure? This study does contain flaws, and I wondered if Goldacre had also read this commentary, though on reflection if he had read it, its conclusion might have helped him to write a conclusion of his own:

Although the collective evidence suggests that breastfeeding—initiation, longer duration or exclusivity— may very well exert a modest protective effect on childhood and adolescent obesity, it no longer appears to be a major determinant. Nevertheless, because breastfeeding also reduces infection and allergy-related outcomes and probably increases IQ, World Health Organization recommendations for 6 months of exclusive breastfeeding remain a just and justifiable policy around the world.

By the umpteenth repetition of the breastfeeding nazi joke, I had the impression that Goldacre did not quite understand what NCT does, and while I have no evidence for this assertion, I’m pretty sure he hasn’t read our excellent Infant Feeding Message Framework [pdf]. Reading through the reasons women give for stopping breastfeeding, it would appear that for mothers, the evidence itself is not the highest priority when it comes to evaluating the experience, and that is where NCT comes in, to support parents in the situation they are in: non-judgemental, respectful support where support is asked for.

Ben Goldacre told us he doesn’t care about breastfeeding, he cares about misuse of evidence, and nobody in the room would have disagreed with that. But I would have liked him to have been a bit more thorough in his own research and understanding of how NCT supports parents.

03 Sep

Breasts against the patriarchy!

…to take a stance that you control what a woman does with her body is an assumption that you have power over her. You are dictating what is appropriate behavior. You are trying to “get her” to do what you want. If she doesn’t comply, then you obtain assistance to “get her” to do so. Here’s the deal: every time you prevent a woman from choosing what she does with her body, you are acting in a violent manner.

One man’s response to a request that his wife not breastfeed their baby in a public place, from Empowered Papa.

02 Sep

Every child wanted

“Abortion is very, very ordinary and a mark of civilisation – liberty for women and every child wanted.”

I had written and scheduled yesterday’s post about my abortion before I saw Polly Toynbee’s article in The Guardian. In fact I wrote it quite a while ago, in response to a request from the BPAS for case studies to debunk the myths that people who have abortions are reckless teenagers, or that they are somehow scarred and regretful for the rest of their lives.

As Toynbee points out, the media still treats abortion as a back street business, a dirty scandal, a secret we must never share. The storylines that end in miscarriage before the fateful decision is made tell us that as a society we are very confused about unwanted babies. We know it’s better for them not to exist, but we don’t want to admit that. Certain saintly (often childless) people may take the view that their god’s creations are all sacred and we mere humans don’t have the right to deny them life, but it is questionable just how relevant this is to the majority of women who find themselves in the position of having to make the decision.

I want abortion to be talked about in terms of a woman’s right to have control over her own body, not a shameful thing that we mustn’t mention in polite company.

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.

11 Jul

Book Review: Nurturing new families, by Naomi Kemeny

Naomi Kemeny is an experienced postnatal doula and has written Nurturing New Families for anyone supporting parents of newborn babies. It has useful chapters for grandparents and friends as well as for postnatal doulas, particularly those starting out. It gives a good background on why postnatal support is so important in 21st Century Britain, and a useful overview of the needs of mothers and babies in those challenging early weeks. There are also sections for special situations such as single mothers, twins and multiples, postnatal depression, families with pets, and other circumstances.

All of this is relevant in whatever capacity the reader is supporting new parents, but it is difficult to tell who would buy this book; new grandparents might find that there is too much advice for doulas, and vice versa. It might, however, be very useful for a grandparent to understand the value of a doula.

I was quite surprised that Murkoff et al’s What To Expect The First Year (described by Naomi Wolf with scathing accuracy as “the intellectual equivalent of an epidural” in her book Misconceptions) is Kemeny’s idea of “an excellent reference manual.” (p.33). I can think of about twenty books I would rather have to hand, and actually Nurturing New Families could be one of them.

There are some excellent guidelines on empathic listening, which is hard to do when you’re close to the person you’re supporting, so this of course is useful for grandmothers and friends, but essential for doulas. I strongly agree with Kemeny’s advice to take the opportunity to debrief one’s own breastfeeding experience before trying to support someone else with its particular challenges.

Some of the book is a little repetitive, for example the advice on page 68 for grandparents is repeated on page 136 for doulas, and some of the quotations are pulled from the stories at the back. The book is so full of useful stuff that it does not need this kind of padding, but I feel I am being picky. It’s a useful book, and I would have found it really handy in my early work as a postnatal doula. I would recommend it to someone at the beginning of their doula career, as it covers a good range of different situations and is full of sensible advice.

[Disclosure: I was given a free review copy of Nurturing New Families]